The effect of questions used by psychiatrists on therapeutic alliance and adherence

This is an author-produced electronic version of an article accepted for publication in the British Journal of Psychiatry. The definitive publisher-authenticated version is available online at http://bjp.rcpsych.org© The Royal College of Psychiatrists 2015Background Psychiatrist questions are the mechanism for achieving clinical objectives and managing the formation of a therapeutic alliance - consistently associated with patient adherence. No research has examined the nature of this relationship and the different practices used in psychiatry. Questions are typically defined in binary terms e.g. ‘open’ vs ‘closed’ that may have limited application in practice. Aims To undertake a detailed examination of the types of questions psychiatrists ask patients and explore their association with the therapeutic alliance and patient adherence. Method A coding protocol was developed to classify questions from 134 outpatient consultations, predominantly by syntactic form. Bivariate correlations with measures of patient adherence and the therapeutic alliance (psychiatrist-rated) were examined and assessed using Generalised Estimating Equations, adjusting for patient symptoms, psychiatrist ID and amount of speech. Results Psychiatrists used a small subset (4/10) of question types regularly 1) yes/no auxiliary questions 2) wh questions 3) declarative questions and 4) tag questions. Only declarative questions predicted better adherence and perceptions of the therapeutic relationship. Conversely, wh questions - associated with positive symptoms – predicted poorer perceptions of the therapeutic relationship. Declarative questions were frequently used to propose an understanding of patients’ experiences, in particular their emotional salience for the patient. Conclusions A more granular definition of questioning practices is necessary to improve communication in psychiatry. The use of declarative questions may enhance the alliance and adherence - or index their manifestation in talk e.g. better mutual understanding. The function of ‘soprefaced’ declaratives, also found in psychotherapy, are more nuanced than negatively connotated ‘leading’ questions. Hearable as displays of empathy, they attend closely to patient experience, while balancing the tasks of assessment and treatment.Medical Research Council (MRC

Helping, I Mean Assessing Psychiatric Communication: An Applicaton of Incremental Self-Repair Detection

18th SemDial Workshop on the Semantics and Pragmatics of Dialogue (DialWatt), 1-3 September 2014, Edinburgh, ScotlandSelf-repair is pervasive in dialogue, and models thereof have long been a focus of research, particularly for disfluency detection in speech recognition and spoken dialogue systems. However, the generality of such models across domains has received little attention. In this paper we investigate the application of an automatic incremental self-repair detection system, STIR, developed on the Switchboard corpus of telephone speech, to a new domain – psychiatric consultations. We find that word-level accuracy is reduced markedly by the differences in annotation schemes and transcription conventions between corpora, which has implications for the generalisability of all repair detection systems. However, overall rates of repair are detected accurately, promising a useful resource for clinical dialogue studies

Myosin IIA-mediated forces regulate multicellular integrity during vascular sprouting

Angiogenic sprouting is a critical process involved in vascular network formation within tissues. During sprouting, tip cells and ensuing stalk cells migrate collectively into the extracellular matrix while preserving cell-cell junctions, forming patent structures that support blood flow. Although several signaling pathways have been identified as controlling sprouting, it remains unclear to what extent this process is mechanoregulated. To address this question, we investigated the role of cellular contractility in sprout morphogenesis, using a biomimetic model of angiogenesis. Three-dimensional maps of mechanical deformations generated by sprouts revealed that mainly leader cells, not stalk cells, exert contractile forces on the surrounding matrix. Surprisingly, inhibiting cellular contractility with blebbistatin did not affect the extent of cellular invasion but resulted in cell-cell dissociation primarily between tip and stalk cells. Closer examination of cell-cell junctions revealed that blebbistatin impaired adherens-junction organization, particularly between tip and stalk cells. Using CRISPR/Cas9-mediated gene editing, we further identified NMIIA as the major isoform responsible for regulating multicellularity and cell contractility during sprouting. Together, these studies reveal a critical role for NMIIA-mediated contractile forces in maintaining multicellularity during sprouting and highlight the central role of forces in regulating cell-cell adhesions during collective motility.R01 EB000262 - NIBIB NIH HHS; R01 HL115553 - NHLBI NIH HHSPublished versio

Coordinating in dialogue: Using compound contributions to join a party

PhDCompound contributions (CCs) – dialogue contributions that continue or complete an earlier contribution – are an important and common device conversational participants use to extend their own and each other’s turns. The organisation of these cross-turn structures is one of the defining characteristics of natural dialogue, and cross-person CCs provide the paradigm case of coordination in dialogue. This thesis combines corpus analysis, experiments and theoretical modelling to explore how CCs are used, their effects on coordination and implications for dialogue models. The syntactic and pragmatic distribution of CCs is mapped using corpora of ordinary and task-oriented dialogues. This indicates that the principal factors conditioning the distribution of CCs are pragmatic and that same- and cross-person CCs tend to occur in different contexts. In order to test the impact of CCs on other conversational participants, two experiments are presented. These systematically manipulate, for the first time, the occurrence of CCs in live dialogue using text-based communication. The results suggest that syntax does not directly constrain the interpretation of CCs, and the primary effect of a cross-person CC on third parties is to suggest to them a strong form of coordination or coalition has formed between the people producing the two parts of the CC. A third experiment explores the conditions under which people will produce a completion for a truncated turn. Manipulations of the structural and contextual predictability of the truncated turn show that while syntax provides a resource for the construction of a CC it does not place significant constraints on where the split point may occur. It also shows that people are more likely to produce continuations when they share common ground. An analysis using the Dynamic Syntax framework is proposed, which extends previous work to account for these findings, and limitations and further research possibilities are outlined

Differential production of type I IFN determines the reciprocal levels of IL-10 and proinflammatory cytokines produced by C57BL/6 and BALB/c macrophages

Pattern recognition receptors detect microbial products and induce cytokines, which shape the immunological response. IL-12, TNF-alpha, and IL-1 beta are proinflammatory cytokines, which are essential for resistance against infection, but when produced at high levels they may contribute to immunopathology. In contrast, IL-10 is an immunosuppressive cytokine, which dampens proinflammatory responses, but it can also lead to defective pathogen clearance. The regulation of these cytokines is therefore central to the generation of an effective but balanced immune response. In this study, we show that macrophages derived from C57BL/6 mice produce low levels of IL-12, TNF-alpha, and IL-1 beta, but high levels of IL-10, in response to TLR4 and TLR2 ligands LPS and Pam3CSK4, as well as Burkholderia pseudomallei, a Gram-negative bacterium that activates TLR2/4. In contrast, macrophages derived from BALB/c mice show a reciprocal pattern of cytokine production. Differential production of IL-10 in B. pseudomallei and LPS-stimulated C57BL/6 and BALB/c macrophages was due to a type I IFN and ERK1/2-dependent, but IL-27-independent, mechanism. Enhanced type I IFN expression in LPS-stimulated C57BL/6 macrophages was accompanied by increased STAT1 and IFN regulatory factor 3 activation. Furthermore, type I IFN contributed to differential IL-1 beta and IL-12 production in B. pseudomallei and LPS-stimulated C57BL/6 and BALB/c macrophages via both IL-10-dependent and -independent mechanisms. These findings highlight key pathways responsible for the regulation of pro- and anti-inflammatory cytokines in macrophages and reveal how they may differ according to the genetic background of the host.his work was supported by The Francis Crick Institute, which receives its core funding from Cancer Research UK (FC001126), the U.K. Medical Research Council (FC001126), and the Wellcome Trust (FC001126) since April 1, 2015 and before that by U.K. Medical Research Council Grant MRC U117565642 and also by European Research Council Grant 294682-TB-PATH (Crick 10127). A.H. was additionally funded by a U.K. Medical Research Council Centenary Award. M.S. was funded by Fundação para a Ciência e Tecnologia, Portugal Grant FCT-ANR/BIM-MEC/ 0007/2013. M.S. is an associate Fundação para a Ciência e Tecnologia, Portugal investigator.info:eu-repo/semantics/publishedVersio

Divergence in Dialogue

Copyright: 2014 Healey et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.This work was supported by the Economic and Social Research Council (ESRC; http://www.esrc.ac.uk/) through the DynDial project (Dynamics of Conversational Dialogue, RES-062-23-0962) and the Engineering and Physical Sciences Research Council (EPSRC; http://www.epsrc.ac.uk/) through the RISER project (Robust Incremental Semantic Resources for Dialogue, EP/J010383/1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Local Alignment of Frame of Reference Assignment in English and Swedish Dialogue

In this paper we examine how people assign, interpret, negotiate and repair the frame of reference (FoR) in online text-based dialogues discussing spatial scenes in English and Swedish. We describe our corpus and data collection which involves a coordination experiment in which dyadic dialogue participants have to identify differences in their picture of a visual scene. As their perspectives of the scene are different, they must coordinate their FoRs in order to complete the task. Results show that participants do not align on a global FoR, but tend to align locally, for sub-portions (or particular conversational games) in the dialogue. This has implications for how dialogue systems should approach problems of FoR assignment – and what strategies for clarification they should implement

“LOL what?”: Empirical study of laughter in chat based dialogues

We propose a method for investigation of laughter in incremental text-based dialogues. We report a proof-of concept pilot study which inserts spoof contributions into ongoing text based dialogues. These take the form of additional laughs and laughter clarification requests which appear to come from one’s dialogue partner. This pilot shows that this is a useful way to investigate laughter in dialogue

“LOL what?”: Empirical study of laughter in chat based dialogues

We propose a method for investigation of laughter in incremental text-based dialogues. We report a proof-of concept pilot study which inserts spoof contributions into ongoing text based dialogues. These take the form of additional laughs and laughter clarification requests which appear to come from one’s dialogue partner. This pilot shows that this is a useful way to investigate laughter in dialogue