Investigating mental health risk assessment in primary care and the potential role of a structured decision support tool, GRiST

Aim: To explore current risk assessment processes in general practice and Improving Access to Psychological Therapies (IAPT) services, and to consider whether the Galatean Risk and Safety Tool (GRiST) can help support improved patient care. Background: Much has been written about risk assessment practice in secondary mental health care, but little is known about how it is undertaken at the beginning of patients' care pathways, within general practice and IAPT services. Methods: Interviews with eight general practice and eight IAPT clinicians from two primary care trusts in the West Midlands, UK, and eight service users from the same region. Interviews explored current practice and participants' views and experiences of mental health risk assessment. Two focus groups were also carried out, one with general practice and one with IAPT clinicians, to review interview findings and to elicit views about GRiST from a demonstration of its functionality. Data were analysed using thematic analysis. Findings Variable approaches to mental health risk assessment were observed. Clinicians were anxious that important risk information was being missed, and risk communication was undermined. Patients felt uninvolved in the process, and both clinicians and patients expressed anxiety about risk assessment skills. Clinicians were positive about the potential for GRiST to provide solutions to these problems. Conclusions: A more structured and systematic approach to risk assessment in general practice and IAPT services is needed, to ensure important risk information is captured and communicated across the care pathway. GRiST has the functionality to support this aspect of practice.

Pichia pastoris regulates its gene-specific response to different carbon sources at the transcriptional, rather than the translational, level

Background: The methylotrophic, Crabtree-negative yeast Pichia pastoris is widely used as a heterologous protein production host. Strong inducible promoters derived from methanol utilization genes or constitutive glycolytic promoters are typically used to drive gene expression. Notably, genes involved in methanol utilization are not only repressed by the presence of glucose, but also by glycerol. This unusual regulatory behavior prompted us to study the regulation of carbon substrate utilization in different bioprocess conditions on a genome wide scale. Results: We performed microarray analysis on the total mRNA population as well as mRNA that had been fractionated according to ribosome occupancy. Translationally quiescent mRNAs were defined as being associated with single ribosomes (monosomes) and highly-translated mRNAs with multiple ribosomes (polysomes). We found that despite their lower growth rates, global translation was most active in methanol-grown P. pastoris cells, followed by excess glycerol- or glucose-grown cells. Transcript-specific translational responses were found to be minimal, while extensive transcriptional regulation was observed for cells grown on different carbon sources. Due to their respiratory metabolism, cells grown in excess glucose or glycerol had very similar expression profiles. Genes subject to glucose repression were mainly involved in the metabolism of alternative carbon sources including the control of glycerol uptake and metabolism. Peroxisomal and methanol utilization genes were confirmed to be subject to carbon substrate repression in excess glucose or glycerol, but were found to be strongly de-repressed in limiting glucose-conditions (as are often applied in fed batch cultivations) in addition to induction by methanol. Conclusions: P. pastoris cells grown in excess glycerol or glucose have similar transcript profiles in contrast to S. cerevisiae cells, in which the transcriptional response to these carbon sources is very different. The main response to different growth conditions in P. pastoris is transcriptional; translational regulation was not transcript-specific. The high proportion of mRNAs associated with polysomes in methanol-grown cells is a major finding of this study; it reveals that high productivity during methanol induction is directly linked to the growth condition and not only to promoter strength.

Deconstructing phonological tasks:the contribution of stimulus and response type to the prediction of early decoding skills

Abstract Phonological tasks are highly predictive of reading development but their complexity obscures the underlying mechanisms driving this association. There are three key components hypothesised to drive the relationship between phonological tasks and reading; (a) the linguistic nature of the stimuli, (b) the phonological complexity of the stimuli, and (c) the production of a verbal response. We isolated the contribution of the stimulus and response components separately through the creation of latent variables to represent specially designed tasks that were matched for procedure. These tasks were administered to 570 6 to 7-year-old children along with standardised tests of regular word and non-word reading. A structural equation model, where tasks were grouped according to stimulus, revealed that the linguistic nature and the phonological complexity of the stimulus predicted unique variance in decoding, over and above matched comparison tasks without these components. An alternative model, grouped according to response mode, showed that the production of a verbal response was a unique predictor of decoding beyond matched tasks without a verbal response. In summary, we found that multiple factors contributed to reading development, supporting multivariate models over those that prioritize single factors. More broadly, we demonstrate the value of combining matched task designs with latent variable modelling to deconstruct the components of complex tasks.

Exploring novel auditory displays for supporting accelerated skills acquisition and enhanced performance in motorsport

This paper explores the design, development and evaluation of a novel real-time auditory display system for accelerated racing driver skills acquisition. The auditory feedback provides concurrent sensory augmentation and performance feedback using a novel target matching design. Real-time, dynamic, tonal audio feedback representing lateral G-force (a proxy for tire slip) is delivered to one ear whilst a target lateral G-force value representing the ‘limit’ of the car, to which the driver aims to drive, is panned to the driver’s other ear; tonal match across both ears signifies that the ‘limit’ has been reached. An evaluation approach was established to measure the efficacy of the audio feedback in terms of performance, workload and drivers’ assessment of self-efficacy. A preliminary human subject study was conducted in a driving simulator environment. Initial results are encouraging, indicating that there is potential for performance gain and driver confidence enhancement based on the audio feedback.

Motivating students to learn through good and helpful coursework feedback

The 2008 National Student Survey revealed that: 44% of full-time students in England did not think that the feedback on their work had been prompt nor did they agree that the feedback on their work helped them clarify things that they did not understand (HEFCE, 2008). Computer Science and Engineering & Technology have been amongst the poorest performers in this aspect as they ranked in the lower quartile (Surridge, 2007, p.32). Five years since the first NSS survey, assessment and feedback remains the biggest concern. Dissatisfaction in any aspect of studies demotivates students and can lead to disengagement and attrition. As the student number grows, the situation can only get worse if nothing is done about it. We have conducted a survey to investigate views on assessment and feedback from Engineering, Mathematics and Computing students. The survey aims at investigating the core issues of dissatisfaction in assessment and feedback and ways in which UK Engineering students can learn better through helpful feedback. The study focuses on collecting students' experiences with feedback received in their coursework, assignments and quizzes in Computing Science modules. The survey reveals the role of feedback in their learning. The results of the survey help to identify the forms of feedback that are considered to be helpful in learning and the time frame for timely feedback. We report on the findings of the survey. We also explore ways to improve assessment and feedback in a bid to better engage engineering students in their studies.