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Fifty-three tests designed to measure aspects of creative thinking were administered to 410 air cadets and student officers. The scores were intercorrelated and 16 factors were extracted. Orthogonal rotations resulted in 14 identifiable factors, a doublet, and a residual. Nine previously identified factors were: verbal comprehension, numerical facility, perceptual speed, visualization, general reasoning, word fluency, associational fluency, ideational fluency, and a factor combining Thurstone's closure I and II. Five new factors were identified as originality, redefinition, adaptive flexibility, spontaneous flexibility, and sensitivity to problems.
In many applications, it is desirable to estimate binomial proportions in m groups where it is anticipated that these proportions are similar but not identical. Following a general approach due to Lindley, a Bayesian Model II aposteriori modal estimate is derived that estimates the inverse sine transform of each proportion by a weighted average of the inverse sine transform of the observed proportion in the individual group and the average of the estimated values. Comparison with a classical method due to Jackson spotlights some desirable features of Model II analyses. The simplicity of the present formulation makes it possible to study the behavior of the Bayesian Model II approach more closely than in more complex formulations. Also, it is possible to estimate the amount of gain afforded by the Model II analyses.
The association between cannabis and psychosis is established, but the role of underlying genetics is unclear. We used data from the EU-GEI case-control study and UK Biobank to examine the independent and combined effect of heavy cannabis use and schizophrenia polygenic risk score (PRS) on risk for psychosis.
Methods
Genome-wide association study summary statistics from the Psychiatric Genomics Consortium and the Genomic Psychiatry Cohort were used to calculate schizophrenia and cannabis use disorder (CUD) PRS for 1098 participants from the EU-GEI study and 143600 from the UK Biobank. Both datasets had information on cannabis use.
Results
In both samples, schizophrenia PRS and cannabis use independently increased risk of psychosis. Schizophrenia PRS was not associated with patterns of cannabis use in the EU-GEI cases or controls or UK Biobank cases. It was associated with lifetime and daily cannabis use among UK Biobank participants without psychosis, but the effect was substantially reduced when CUD PRS was included in the model. In the EU-GEI sample, regular users of high-potency cannabis had the highest odds of being a case independently of schizophrenia PRS (OR daily use high-potency cannabis adjusted for PRS = 5.09, 95% CI 3.08–8.43, p = 3.21 × 10−10). We found no evidence of interaction between schizophrenia PRS and patterns of cannabis use.
Conclusions
Regular use of high-potency cannabis remains a strong predictor of psychotic disorder independently of schizophrenia PRS, which does not seem to be associated with heavy cannabis use. These are important findings at a time of increasing use and potency of cannabis worldwide.
Although Lippmann's The Good Society was written to address the crisis in liberal democracies in the 1930s, we argue that it offers a novel and plausible institutionalist account of the productivity slowdown and the increase in the experience of insecurity that has characterised most liberal democracies over the last 20–40 years. Central to Lippmann's account is a Smithian-institutionalist model of growth where property rights have to evolve both to encourage continued levels of risk taking in the face of new uncertainties and also to offset new sources of unequal bargaining power that the very process of growth itself creates. When property rights fossilise and fail to evolve, as in the 1930s and plausibly also now, productivity growth slows down, insecurity rises, and illiberal political creeds prosper. To avoid this, Lippmann's analysis suggests that property rights have to change to re-energise risk taking and to offset the new sources of unequal bargaining power. For example, in current circumstances, new ‘positive’ property rights arising from the development of social insurance might encourage risk taking and new ‘negative’ property rights in personal data might help offset the new sources of unequal bargaining power that have emerged.
The COVID-19 pandemic initiated a mass switch to psychological therapy being delivered remotely, including at Anxiety UK, a national mental health charity. Understanding the impact of this forced switch could raise implications for the provision of psychological therapies going forwards.
Aims
To understand whether the forced switch to remote therapy had any impact on outcomes, and if certain groups should continue to be routinely offered certain delivery modalities in future.
Method
Data were available for 2323 individuals who accessed Anxiety UK services between January 2019 and October 2021. Demographic data, baseline and discharge anxiety and depression symptoms, and mode of therapy delivery were available.
Regression models were built to model (a) the mode of therapy delivery received pre-pandemic using logistic regression, and (b) outcomes pre- and post-pandemic onset within demographic groups.
Results
No statistically significant changes in baseline anxiety symptoms, demographics or outcomes were observed before and after the onset of the COVID-19 pandemic.
Pre-pandemic, males were more likely to receive online video therapy than telephone therapy (Relative Risk Ratio (RRR) 1.42, [1.01, 1.99]), while older clients were less likely to receive online video therapy (RRR 0.98, [0.97, 0.99]). However, no differences in outcomes were observed post-pandemic onset within these groups, with only the number of sessions of therapy being a significant predictor of outcomes.
Conclusions
Anxiety UK services remained effective throughout the pandemic. We observed no evidence that any demographic group had worse outcomes following the forced switch to remote therapy.
NHS Scotland, one of the keystone healthcare providers in the UK, have recently set a wide variety of sustainability targets in an effort to mitigate waste and the intensive energy demands of healthcare. Medical garment production, management and design is an area in which design researchers can explore and offer solutions. This paper presents a series of co-design explorations to examine design alternatives to single-use theatre caps, the majority of which are currently disposed of routinely. Using a series of probes, major insights into how theatre cap design may be improved is presented.
This paper reveals a novel and perhaps surprising ingredient in the mix of influences that inspired and informed the work of Elinor and Vincent Ostrom on self-governance: cybernetics, understood as a theory of control via feedback mechanisms. Based on this crucial insight, the paper portrays self-governance as involving an architecture of multiple levels of so-called ‘second order’ feedback mechanisms. Such compounded systems of organization are the key to understanding any self-governance process and the paper argues that their intrinsic logic provides a critical link between the work of the Ostroms and the public choice and constitutional political economy perspectives on institutional order. The paper thereby offers both a fresh perspective on the Ostromian view of self-governance and also of also of governance theory in general.
Selection into core psychiatry training in the UK uses a computer-delivered Multi-Specialty Recruitment Assessment (MSRA; a situational judgement and clinical problem-solving test) and, previously, a face-to-face Selection Centre. The Selection Centre assessments were suspended during the COVID-19 pandemic. We aimed to evaluate the validity of this selection process using data on 3510 psychiatry applicants. We modelled the ability of the selection scores to predict subsequent performance in the Clinical Assessment of Skills and Competencies (CASC). Sensitivity to demographic characteristics was also estimated.
Results
All selection assessment scores demonstrated positive, statistically significant, independent relationships with CASC performance and were sensitive to demographic factors.
Implications
All selection components showed independent predictive validity. Re-instituting the Selection Centre assessments could be considered, although the costs, potential advantages and disadvantages should be weighed carefully.
Empowering the Participant Voice (EPV) is an NCATS-funded six-CTSA collaboration to develop, demonstrate, and disseminate a low-cost infrastructure for collecting timely feedback from research participants, fostering trust, and providing data for improving clinical translational research. EPV leverages the validated Research Participant Perception Survey (RPPS) and the popular REDCap electronic data-capture platform. This report describes the development of infrastructure designed to overcome identified institutional barriers to routinely collecting participant feedback using RPPS and demonstration use cases. Sites engaged local stakeholders iteratively, incorporating feedback about anticipated value and potential concerns into project design. The team defined common standards and operations, developed software, and produced a detailed planning and implementation Guide. By May 2023, 2,575 participants diverse in age, race, ethnicity, and sex had responded to approximately 13,850 survey invitations (18.6%); 29% of responses included free-text comments. EPV infrastructure enabled sites to routinely access local and multi-site research participant experience data on an interactive analytics dashboard. The EPV learning collaborative continues to test initiatives to improve survey reach and optimize infrastructure and process. Broad uptake of EPV will expand the evidence base, enable hypothesis generation, and drive research-on-research locally and nationally to enhance the clinical research enterprise.
This paper explores Elinor Ostrom's account of practical reason through the conceptual lens provided by a typology of dimensions of rational conduct advanced by Amartya Sen. On Sen's view, self-interested behaviour has three independent, and separable, features: self-centred welfare, self-welfare goal and self-goal choice. We suggest that Ostrom is committed to a version of rational choice theory that retains the assumptions of self-welfare goal and self-goal choice but, by acknowledging that people's welfare is affected by factors beyond their material consumption, departs from the assumption of self-welfare goal. We argue that this departure is not necessarily driven by an acknowledgement, along Senian lines, that people may have reasons for action other than the single-minded pursuit of their own goals, but rather by Ostrom's belief that the decision problem people face is so complex that maximising behaviour is rendered impossible. We illustrate this argument by analysing how Elinor Ostrom's position differs not only from Sen's but also from that of her husband and long-time collaborator Vincent Ostrom, who in his analysis of the covenantal aspects of rule-making seems to depart from the assumptions of instrumental rationality and preference-satisfaction.
Treatment of seriously ill patients is often complicated by prolonged or complex transfers between hospitals in sub-Saharan Africa. Difficulties or inefficiency in these transfers can lead to poor outcomes for patients. “On-call” triage systems have been utilized to facilitate communication between facilities and to avoid poor outcomes associated with patient transfer. This study attempts to examine the effects of a pilot study to implement such a system in Rwanda.
Methods:
Data collection occurred prospectively in two stages, pre-intervention and intervention, in the emergency department (ED) at Kigali University Teaching Hospital (CHUK). All patients transferred during the pre-determined timeframe were enrolled. Data were collected by ED research staff via a standardized form. Statistical analysis was performed using STATA version 15.0. Differences in characteristics were assessed using χ2 or Fisher’s exact tests for categorical variables and independent sample t-tests for normally distributed continuous variables.
Results:
During the “on call” physician intervention, the indication for transfer was significantly more likely to be for critical care (P <.001), transfer times were faster (P <.001), patients were more likely to be displaying emergency signs (P <.001), and vital signs were more likely to be collected prior to transport (P <.001) when compared to the pre-interventional phase.
Conclusion:
The “[Emergency Medicine] EM Doc On Call” intervention was associated with improved timely interhospital transfer and clinical documentation in Rwanda. While these data are not definitive due to multiple limitations, it is extremely promising and worthy of further study.
Academic research on Christian nationalism has revealed a considerable amount about the scope of its relationships to public policy views in the US. However, work thus far has not addressed an essential question: why now? Research by the authors of this Element advances answers, showcasing how deeper engagement with 'the 3Ms' – measurement, mechanisms and mobilization – can help unpack how and why Christian nationalism has entered our politics as a partisan project. Indeed, it is difficult to understand the dynamics of Christian nationalism without reference to the parties, as it has been a worldview used to mobilize Republicans while simultaneously recruiting and demobilizing Democrats. The mechanisms of these efforts hinge on a deep desire for social dominance that is ordained by God – an order elites suggest is threatened by Democrats and 'the left.' These elite appeals can have sweeping consequences for opinion and action, including the public's support for democratic processes.
Robert Sugden has advanced various critiques of behavioural welfare economics, offering the notion of opportunity as an alternative. We agree with much of Sugden's critique but argue that his approach would benefit from a broadening of the informational base beyond opportunities to include people's concern for decision processes. We follow Amartya Sen in arguing that the process through which choices are made (process freedom) is something individuals care about beyond the availability of choice options (opportunity freedom) as they value a sense of agency. We argue that individuals’ agentic capabilities are crucial for people's process freedom and hence for their sense of agency. In the final section of the paper, we sketch the institutional implications of our argument, i.e. what a joint consideration of opportunities and agentic capabilities means for behavioural public policy.
Utsana Phloengtham's The Story of Jan Dara is one of the most widely known stories in Thailand. It is remembered as ‘erotic fiction’ as well as an ‘immortal classic’. It has also been praised as a Buddhist treatise. Yet, despite being replete with Buddhist terminology and references, it has never been analysed in English as a work of Buddhist fiction. This article argues that Jan Dara is one of the very few examples of Thai Buddhist modernist literature, and a highly original and highly layered one at that. The novel employs a diverse number of techniques and concerns derived from modernist authors such as D.H. Lawrence to explore sexual life in an aristocratic mansion of the 1930s. Understood with reference to the literary modernist tropes it employs and the debates in Buddhist cosmology and morality at the time of writing, it can be shown to be a scathing indictment of old-fashioned moralistic ‘hypocrites’ who practice decadent lives ‘while mouthing the Buddhist precepts’.
Many clinical trials leverage real-world data. Typically, these data are manually abstracted from electronic health records (EHRs) and entered into electronic case report forms (CRFs), a time and labor-intensive process that is also error-prone and may miss information. Automated transfer of data from EHRs to eCRFs has the potential to reduce data abstraction and entry burden as well as improve data quality and safety.
Methods:
We conducted a test of automated EHR-to-CRF data transfer for 40 participants in a clinical trial of hospitalized COVID-19 patients. We determined which coordinator-entered data could be automated from the EHR (coverage), and the frequency with which the values from the automated EHR feed and values entered by study personnel for the actual study matched exactly (concordance).
Results:
The automated EHR feed populated 10,081/11,952 (84%) coordinator-completed values. For fields where both the automation and study personnel provided data, the values matched exactly 89% of the time. Highest concordance was for daily lab results (94%), which also required the most personnel resources (30 minutes per participant). In a detailed analysis of 196 instances where personnel and automation entered values differed, both a study coordinator and a data analyst agreed that 152 (78%) instances were a result of data entry error.
Conclusions:
An automated EHR feed has the potential to significantly decrease study personnel effort while improving the accuracy of CRF data.