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Research assistants' experiences recruiting patients with psychosis into clinical trials: a qualitative study.
OBJECTIVES: Treatments for patients diagnosed with psychosis need to be improved. Clinical trials are an important way of assessing the efficacy of new treatments. However, recruiting patients into trials is challenging. This study sought to better understand the reasons for this from the perspective of research assistants. DESIGN: A qualitative study underpinned by a critical realist ontology and contextualist epistemology. METHODS: Research assistants who had recruited patients with psychosis into trials, primarily of psychological interventions, were interviewed. Reflexive thematic analysis was used to identify themes. RESULTS: Overarching themes representing four types of factors influencing recruitment of patients with psychosis into clinical trials were generated: patient, clinical team, research team, and NHS infrastructure. Patients largely wished to take part in trials but needed time to build trust with research assistants. Clinical teams held the power in suggesting patients for trials; therefore, it was essential for research teams to build strong relationships with clinical staff. Research teams recruiting into trials benefited from lived experience expertise, support systems, and institutional knowledge. A key NHS infrastructure factor was that mental health staff had limited time to consider trials for their patients. CONCLUSIONS: Trial participation needs to be made more accessible to patients with psychosis, who often want to take part but lack opportunities. Methods of increasing accessibility could include identifying and addressing barriers to referral from clinical teams, employing multiple recruitment strategies, and flexible appointment formats. Qualitative research with clinical teams and patients will also help in developing the understanding of barriers to recruitment.
Exploring auditory morphodynamics: Audiovisual associations in sound-based music
This article explores audiovisual associations within the context of contemporary and experimental music practices, particularly focusing on sound-based music. While extensive studies exist on crossmodality in relation to traditional music genres (such as classical instrumental music), the perceptual potential of sound-based music remains an underexplored field of psychological research. In an online procedure, 152 participants were exposed to six musical excerpts from spectralism and electronic-glitch music and were asked to rate the extent to which each audio matched with six ad hoc generated black and white abstract images. Statistical analysis revealed that ratings were highly consistent across participants, indicating that they may rely on a shared set of implicit perceptual criteria rooted in Gestalt and morphodynamic features common to both auditory and visual stimuli. In particular, smoothness, continuity, numericity, symmetry, and spectrotemporal dimensions emerged as the primary factors influencing the association ratings. We discuss the implication of these findings both for crossmodal research and musicology, and suggest some directions for future research in audiovisual associations using sound-based music.
What will society think about AI consciousness? Lessons from the animal case.
How will society respond to the idea that artificial intelligence (AI) could be conscious? Drawing on lessons from perceptions of animal consciousness, we highlight psychological, social, and economic factors that shape perceptions of AI consciousness. These insights can inform emerging debates about AI moral status, ethical treatment, and future policy.
Malignancy Risk in Turner Syndrome+Y, Early Gonadectomy, and the Ethics of Parental Choices.
This case relates to an infant with Turner syndrome harboring the Y chromosome (TS+Y) and explores the boundaries of parental decision-making. Traditionally, gonads have been surgically removed in early childhood in this condition because of the risk of gonadoblastoma and potential malignant transformation. However, in the case discussed here, the infant's parents do not wish for surgery. In other differences of sex development resulting in intersex traits (increasingly termed congenital variations of sex characteristics [VSC]), some institutions report a shift in the last decade away from early surgical management, in favor of allowing children to be involved in decision-making when they are old enough to participate meaningfully. But should that approach change when there is a risk of malignancy? Two commentaries are presented. One outlines ethical considerations around early surgery in the case of VSC, highlighting implications for the child's bodily integrity and future sexual and reproductive autonomy. A second commentary analyzes the case in terms of pediatric ethics, medical uncertainty, and the zone of parental discretion. Both commentaries conclude that given a lack of adequate data to demonstrate net harms in delaying intervention, and some prospective benefit, it could be reasonable to defer surgery in accordance with the parental request.
Generative AI in healthcare education: How AI literacy gaps could compromise learning and patient safety.
AIM: To examine the challenges and opportunities presented by generative artificial intelligence in healthcare education and explore how it can be used ethically to enhance rather than compromise future healthcare workforce competence. BACKGROUND: Generative artificial intelligence is fundamentally changing healthcare education, yet many universities and healthcare educators have failed to keep pace with its rapid development. DESIGN: A discussion paper. METHODS: Discussion and analysis of the challenges and opportunities presented by students' increasing use of generative artificial intelligence in healthcare education, with particular focus on assessment approaches, critical thinking development and artificial intelligence literacy. RESULTS: Students' widespread use of generative artificial intelligence threatens assessment integrity and may inhibit critical thinking, problem-solving skills and knowledge acquisition. Without adequate artificial intelligence literacy there is a risk of eroding future healthcare workforce competence and compromising patient safety and professional integrity. CONCLUSION: While generative artificial intelligence presents significant challenges to healthcare education, it offers great promise if used carefully with awareness of its limitations. The development of artificial intelligence literacy is crucial for maintaining professional standards and ensuring patient safety and mitigating its potentially negative impact on the formation of critical thinking skills.
Adversarial testing of global neuronal workspace and integrated information theories of consciousness.
Different theories explain how subjective experience arises from brain activity1,2. These theories have independently accrued evidence, but have not been directly compared3. Here we present an open science adversarial collaboration directly juxtaposing integrated information theory (IIT)4,5 and global neuronal workspace theory (GNWT)6-10 via a theory-neutral consortium11-13. The theory proponents and the consortium developed and preregistered the experimental design, divergent predictions, expected outcomes and interpretation thereof12. Human participants (n = 256) viewed suprathreshold stimuli for variable durations while neural activity was measured with functional magnetic resonance imaging, magnetoencephalography and intracranial electroencephalography. We found information about conscious content in visual, ventrotemporal and inferior frontal cortex, with sustained responses in occipital and lateral temporal cortex reflecting stimulus duration, and content-specific synchronization between frontal and early visual areas. These results align with some predictions of IIT and GNWT, while substantially challenging key tenets of both theories. For IIT, a lack of sustained synchronization within the posterior cortex contradicts the claim that network connectivity specifies consciousness. GNWT is challenged by the general lack of ignition at stimulus offset and limited representation of certain conscious dimensions in the prefrontal cortex. These challenges extend to other theories of consciousness that share some of the predictions tested here14-17. Beyond challenging the theories, we present an alternative approach to advance cognitive neuroscience through principled, theory-driven, collaborative research and highlight the need for a quantitative framework for systematic theory testing and building.
Modulation of alpha oscillations by attention is predicted by hemispheric asymmetry of subcortical regions
Evidence suggests that subcortical structures play a role in high-level cognitive functions such as the allocation of spatial attention. While there is abundant evidence in humans for posterior alpha band oscillations being modulated by spatial attention, little is known about how subcortical regions contribute to these oscillatory modulations, particularly under varying conditions of cognitive challenge. In this study, we combined MEG and structural MRI data to investigate the role of subcortical structures in controlling the allocation of attentional resources by employing a cued spatial attention paradigm with varying levels of perceptual load. We asked whether hemispheric lateralization of volumetric measures of the thalamus and basal ganglia predicted the hemispheric modulation of alpha-band power. Lateral asymmetry of the globus pallidus, caudate nucleus, and thalamus predicted attention-related modulations of posterior alpha oscillations. When the perceptual load was applied to the target and the distractor was salient caudate nucleus asymmetry predicted alpha-band modulations. Globus pallidus was predictive of alpha-band modulations when either the target had a high load, or the distractor was salient, but not both. Finally, the asymmetry of the thalamus predicted alpha band modulation when neither component of the task was perceptually demanding. In addition to delivering new insight into the subcortical circuity controlling alpha oscillations with spatial attention, our finding might also have clinical applications. We provide a framework that could be followed for detecting how structural changes in subcortical regions that are associated with neurological disorders can be reflected in the modulation of oscillatory brain activity.
Efficacy of a 6-month supported online programme (Feeling Safer) for the treatment of persecutory delusions: protocol for a randomised controlled trial.
INTRODUCTION: Persecutory delusions are very common in severe mental health disorders such as schizophrenia. Existing treatments often do not work well enough. We developed a face-to-face theory-driven psychological intervention, called Feeling Safe, that produces very large reductions in persistent persecutory delusions. The challenge now is to make Feeling Safe widely available. So, we developed a 6-month supported online version, called Feeling Safer. The aim is an intervention that patients can easily access and use, reduces persecutory delusions and can be supported by a range of mental health professionals in less contact time than face-to-face therapy. Initial proof of concept testing of Feeling Safer was very encouraging. In a randomised controlled trial, we now plan to test whether Feeling Safer is efficacious for patients and can be successfully delivered by any of three different mental health staff groups (peer-support workers, graduate psychologists and cognitive behavioural therapy (CBT) therapists). We will also test whether Feeling Safer works equally across gender, age, ethnicity and cognitive functioning (moderation) and whether Feeling Safer works via the targeted psychological processes (mediation). METHODS AND ANALYSIS: The study design is a multicentre, single-blind (outcome assessor), parallel, four-arm randomised controlled trial; 484 patients with persistent persecutory delusions will be randomised to one of the four conditions (1:1:1:1): Feeling Safer (added to treatment as usual (TAU)) supported by peer-support workers, or Feeling Safer (added to TAU) supported by graduate mental health workers including assistant psychologists, or Feeling Safer (added to TAU) supported by CBT therapists or TAU. Feeling Safer will be provided for 6 months with a staff member. Assessments will be conducted at 0, 3, 6 and 9 months by research assistants blind to group allocation. The primary outcome is severity of persecutory delusions at 6 months rated with the Psychotic Symptoms Rating Scale-Delusions. The secondary outcomes are other psychiatric symptoms (depression, anxiety, insomnia, agoraphobia and paranoia), psychological well-being, recovery, activity and health-related quality of life. Analysis will be conducted under a treatment policy strategy following the intention-to-treat principle, incorporating data from all participants including those who do not complete treatment. Moderation and mediation will be tested. A within-trial cost-effectiveness analysis will be conducted of Feeling Safer compared with TAU. ETHICS AND DISSEMINATION: The trial has received ethical approval from the NHS Health Research Authority (23/LO/0951). Informed consent will be obtained from all participants. A key output will be an open-access publication in a peer-reviewed journal reporting on the clinical effectiveness of a high-quality supported online programme for the treatment of persecutory delusions that has the potential to be used at scale in mental health services. TRIAL REGISTRATION NUMBER: ISRCTN93974770.
How do people recover from persecutory delusions? An interpretative phenomenological analysis
Background: Patient perspectives on recovery from psychosis have been studied. However, there are few studies on recovery from particular psychotic experiences. Persecutory delusions are common, often distressing, and can disrupt day-to-day life and relationships. We explored how patients report recovering from persecutory delusions. Methods: Semi-structured interviews were completed with 15 patients who had recovered from persecutory delusions. Interpretative Phenomenological Analysis was used. Results: Three superordinate themes were identified. The first was “Foundational background features set the context for recovery”. A range of features, including support and respect from others, routine, calm environments, and medication, provided the basis for recovery. The second superordinate theme was “Activity as a route for positivity and re-engagement with the world”. Engagement in activity was important to re-orient attention away from paranoid fears, and to improve mood. The third superordinate theme was “The effortful discovery of safety”. Generating, considering, and testing alternative explanations was a key route to learning safety. Discussion: Recovery from persecutory delusions can take many routes, which vary between individuals. Supporting individuals to reengage with activity and generate acceptable and sufficiently-evidenced alternatives to paranoid fears are potentially valuable treatment targets in the processes of recovery from paranoia.