Inequalities in the management of diabetic kidney disease in UK primary care: A cross-sectional analysis of a large primary care database.

AIMS: To determine differences in the management of diabetic kidney disease (DKD) relevant to patient sex, ethnicity and socio-economic group in UK primary care. METHODS: A cross-sectional analysis as of January 1, 2019 was undertaken using the IQVIA Medical Research Data dataset, to determine the proportion of people with DKD managed in accordance with national guidelines, stratified by demographics. Robust Poisson regression models were used to calculate adjusted risk ratios (aRR) adjusting for age, sex, ethnicity and social deprivation. RESULTS: Of the 2.3 million participants, 161,278 had type 1 or 2 diabetes, of which 32,905 had DKD. Of people with DKD, 60% had albumin creatinine ratio (ACR) measured, 64% achieved blood pressure (BP, <140/90 mmHg) target, 58% achieved glycosylated haemoglobin (HbA1c, <58 mmol/mol) target, 68% prescribed renin-angiotensin-aldosterone system (RAAS) inhibitor in the previous year. Compared to men, women were less likely to have creatinine: aRR 0.99 (95% CI 0.98-0.99), ACR: aRR 0.94 (0.92-0.96), BP: aRR 0.98 (0.97-0.99), HbA1c : aRR 0.99 (0.98-0.99) and serum cholesterol: aRR 0.97 (0.96-0.98) measured; achieve BP: aRR 0.95 (0.94-0.98) or total cholesterol (<5 mmol/L) targets: aRR 0.86 (0.84-0.87); or be prescribed RAAS inhibitors: aRR 0.92 (0.90-0.94) or statins: aRR 0.94 (0.92-0.95). Compared to the least deprived areas, people from the most deprived areas were less likely to have BP measurements: aRR 0.98 (0.96-0.99); achieve BP: aRR 0.91 (0.8-0.95) or HbA1c : aRR 0.88 (0.85-0.92) targets, or be prescribed RAAS inhibitors: aRR 0.91 (0.87-0.95). Compared to people of white ethnicity; those of black ethnicity were less likely to be prescribed statins aRR 0.91 (0.85-0.97). CONCLUSIONS: There are unmet needs and inequalities in the management of DKD in the UK. Addressing these could reduce the increasing human and societal cost of managing DKD.

The relationship between attitudes to human rights and to animal rights is partially mediated by empathy.

Veganism has become increasingly popular in recent years in many countries including the UK and the USA. Studies have found that vegans tend to be female, lower in Right-Wing Authoritarianism (RWA) and Social Dominance Orientation (SDO), and higher in feminist perspectives (FPS). Study 1 (n = 311) investigated the relationships among meat consumption, ethical veganism (using a custom-written scale), RWA, SDO, and FPS, in a series of questionnaires completed online. RWA, SDO, and meat consumption correlated together in one group of variables; FPS and ethical veganism correlated together in a distinct group. In Study 2 participants also completed the Toronto Empathy Questionnaire (TEQ) as a potential mediator variable. The relationship between RWA, SDO, and FPS as predictors, and ethical veganism as target, was partially mediated by empathy. This pattern of results suggests that individuals who hold egalitarian and inclusive views as regards human-human relationships also tend to have similar views as regards human-animal relationships, with empathy as an underlying common factor.

Student Perceptions of Academic Integrity: A Qualitative Study of Understanding, Consequences, and Impact.

Background: Academic integrity (AI) is of increasing importance in higher education. At the same time, students are becoming more consumer-oriented and more inclined to appeal against, or complain about, a penalty imposed for a breach of AI. This combination of factors places pressure on institutions of higher education to handle alleged breaches of AI in a way acceptable to students that motivates them to continue to engage with their studies. Method: Students (n = 8) were interviewed to discover their perceptions of the process for dealing with breaches of AI. All students were based in one university in a very diverse area of London which has many first-generation students from non-traditional academic backgrounds. Results: Students reported strong emotional reactions featuring high levels of anxiety and stress. Some found the process to be threatening and demotivating and questioned continuation on their course of study, while others used more adaptive coping strategies. Students also went to great pains to make it clear that their own, and their friends', breaches of AI were unintentional, while expressing the view that other people were deliberately cheating and should be penalised.Key recommendations include: support for students to re-engage after the intervention; support for students to develop effective self-regulatory learning strategies and time management; provision of specific examples to clarify what is, and is not, acceptable academic practice; recognition of the strong emotions likely to be invoked, especially if accompanied by declarations of unintentionality.

Emotional responses to disfigured faces and Disgust Sensitivity: An eye-tracking study.

Facial disfigurement attracts attention and evokes negative emotion, but evidence is lacking for a link between these two reactions. The present experiment (n = 29) investigated emotional and attentional reactions to photographs of people with disfigured faces. An eye-tracker was used to measure fixation on internal expressive features and on the forehead. Disfigurement to the internal expressive features invoked a stronger emotional reaction than disfigurement to the forehead. Attention in the area of disfigurement was associated with negative emotion (embarrassment, sympathy, disgust, repulsion) as well as surprise. Attention to the disfigurement, and negative emotion, was related to the trait of Disgust Sensitivity.

Rational Thinking and Belief in Psychic Abilities: It Depends on Level of Involvement.

Previous research has shown that lay believers in psychic abilities are more prone to intuitive thinking, less inclined to rational thinking, and have an external locus of control, compared to non-believers. Psychic practitioners, however, may have different characteristics. Psychic practitioners ( n = 31; M age = 42.7 yr., SD = 13.1), lay believers ( n = 33; M age = 33.0 yr., SD = 10.3), and non-believers ( n = 31; M age = 34.4 yr., SD = 15.4) completed questionnaires measuring thinking styles, locus of control, and psychic belief. Comparisons of lay believers with non-believers confirmed previous observations: believers had a higher propensity for intuitive thinking, lower propensity for rational thinking, and more external locus of control. In contrast, practitioners were equivalent to non-believers in rational thinking and had the highest internal locus of control. This highlights the importance of considering level of involvement with psychic practice in understanding the thinking styles of believers. Results suggested that practitioners may have rationalized their beliefs and constructed a coherent model of psychic phenomena that satisfies a propensity for rational thinking within a community of belief.

Centre-surround inhibition is a general aspect of famous-person recognition: evidence from negative semantic priming from clearly visible primes.

A centre-surround attentional mechanism was proposed by Carr and Dagenbach (Journal of Experimental Psychology: Learning, Memory, and Cognition 16: 341-350, 1990) to account for their observations of negative semantic priming from hard-to-perceive primes. Their mechanism cannot account for the observation of negative semantic priming when primes are clearly visible. Three experiments (Ns = 30, 46, and 30) used a familiarity decision with names of famous people, preceded by a prime name with the same occupation as the target or with a different occupation. Negative semantic priming was observed at a 150- or 200-ms SOA, with positive priming at shorter (50-ms) and longer (1,000-ms) SOAs. In Experiment 3, we verified that the primes were easily recognisable in the priming task at an SOA that yielded negative semantic priming, which cannot be predicted by the original centre-surround mechanism. A modified version is proposed that explains transiently negative semantic priming by proposing that centre-surround inhibition is a normal, automatically invoked aspect of the semantic processing of visually presented famous names.

Attentional effects of masked famous faces (but not names) and subjective evaluations of a target person.

Two experiments are reported using a 1986 version of the dot-probe paradigm of MacLeod, Mathews, and Tata, in which the masked subliminal faces of famous persons were differentially associated with attention depending on participants' attitudes toward the famous person. There was attentional avoidance of the faces of persons invoking high disgust (Exp. 1, n=20) or dislike (Exp. 2) but attentional orientation toward the faces of persons invoking low disgust or liking. In Exp. 2 (n=28), this effect was apparent for the faces but not the names of famous persons, despite evidence that the famous names were recognised without awareness. The aversion of attention from faces, but not the names of famous persons who are regarded in a negative light but who are not particularly threatening, may suggest an automatic tendency to avoid making eye contact with an undesirable person thereby avoiding unwanted social interaction.

Developing a curriculum statement based on clinical practice: genetics in primary care.

BACKGROUND: Advances in medical genetics are increasingly being incorporated into clinical management outside specialist genetic services. This study was therefore undertaken to develop learning outcomes in genetics for general practice specialty training, using methods to ensure the knowledge, skills, and attitudes relevant to genetics in primary care were identified. AIM: To identify key knowledge, skills, and attitudes in genetics and to synthesise these into learning outcomes to assist training in genetics for primary care. DESIGN OF STUDY: Delphi survey and review by expert group. SETTING: Primary care practices and Regional Genetics Centre in the West Midlands region of the UK. METHOD: A modified Delphi survey involved GP trainers, programme directors, and geneticists (n = 60). The results, along with results from a survey of GP registrars, were reviewed by an expert group, which included GPs, geneticists, and educationalists. RESULTS: Core genetics topics for GPs were identified, prioritised, and developed into competency statements in the style of the curriculum structure of the Royal College of General Practitioners. CONCLUSION: The development of the GP curriculum statement Genetics in Primary Care was based on a study of educational needs, incorporating the views of practitioners (GP trainers, programme directors, and registrars) and specialists (clinical geneticists). This inclusive approach has enabled the identification of learning outcomes which directly reflect clinical practice.

Categorical priming of famous person recognition: a hitherto overlooked methodological factor can resolve a long-standing debate.

The Burton, Bruce and Johnston [Burton, A. M., Bruce, V., & Johnston, R. A. (1990). Understanding face recognition with an interactive activation model. British Journal of Psychology, 81, 361-380] model of person recognition proposes that representations of known persons are connected by shared semantic attributes. This predicts that priming should be observed between persons from the same category, e.g. famous persons with the same occupation. Empirical investigations to date have produced mixed results, and comparison of methods suggests that priming based on shared occupation may have been suppressed by the presence of prime-target pairs representing a stronger relationship of close association. In the present experiment, 72 participants performed a familiarity decision to famous names preceded by close associates or members of the same occupational category. As predicted, categorical priming was observed in the group of participants for whom the same occupation prime-target pairs were presented before the close-associate pairs, but not in the group for whom the two types of relationship were intermixed. Associate priming was significant in both groups. These results are attributed to differing levels of processing of the primes, invoked by participants' observation of the most salient prime-target relationship.

The categorical structure of knowledge for famous people (and a novel application of Centre-Surround theory).

Knowledge of familiar people is essential to guide social interaction, yet there is uncertainty about whether semantic knowledge for people is stored in a categorical structure as for objects. Four priming experiments using hard-to-perceive primes investigated whether occupation forms a category connecting famous persons in semantic memory. Primes were famous faces exposed for 17ms with masking, resulting in severely restricted awareness and thus precluding expectancy-based priming effects. Targets were consciously perceptible famous faces (Experiments 1-3), famous names (Experiment 3), or occupations (Experiment 4) representing either the same or different occupation to the prime. Significant priming demonstrated the operation of automatic processes, including spreading activation, among persons sharing a common occupation; this supports the categorical view. The direction of priming (faster/slower responses to same-occupation than different-occupation targets) was dependent on prime-target stimulus onset asynchrony (Experiments 1-3) and type of target (Experiment 4). This pattern of results is attributed to the Centre-Surround mechanism proposed by Carr and Dagenbach [Carr, T. H., & Dagenbach, D. (1990). Semantic priming and repetition priming from masked words: evidence for a centre-surround attentional mechanism in perceptual recognition. Journal of Experimental Psychology: Learning, Memory and Cognition, 16, 341-350]. These results support (a) the categorical structure of semantic knowledge for famous people and (b) the application of the Centre-Surround mechanism to the domain of person recognition.

A "neglected part of the curriculum" or "of limited use"? Views on genetics training by nongenetics medical trainees and implications for delivery.

PURPOSE: Although the importance of genetics education for health care professionals is increasingly recognized worldwide, little is known about the needs and views of nongenetics postgraduate medical trainees. METHODS: Data on the views of 143 learners from four specialties (family practice, neurology, cardiology, and dermatology) in two regions in England (West Midlands and South Western) were collected using focus groups, questionnaires, and interviews. RESULTS: Low levels of genetics training were reported by both trainee family practitioners and trainee hospital consultant specialists. Responses to attitude statements indicate that the majority of trainee family practitioners believed genetics was important but thought that they were underprepared in this area. Focus groups with specialty trainees revealed general consensus that there was not enough formal postgraduate genetics training, although some cardiologists disagreed and trainees in all three specialties thought that the existing curriculum was overcrowded. Trainees stressed the importance of tailoring genetics education to be directly relevant to their daily practice. Trainee family practitioners prioritized topics related to the identification and referral of patients, and the subsequent implication of results. In contrast, specialty trainees prioritized topics related to the genetics and management of particular diseases. CONCLUSION: There is still work to be done before trainees in nongenetics specialties recognize how genetics can be relevant to their practice. Involvement of specialty trainers in the development and delivery of genetics education may help to address this issue.

Strength of visual percept generated by famous faces perceived without awareness: effects of affective valence, response latency, and visual field.

Participants who were unable to detect familiarity from masked 17 ms faces (Stone and Valentine, 2004 and Stone and Valentine, in press-b) did report a vague, partial visual percept. Two experiments investigated the relative strength of the visual percept generated by famous and unfamiliar faces, using masked 17 ms exposure. Each trial presented simultaneously a famous and an unfamiliar face, one face in LVF and the other in RVF. In one task, participants responded according to which of the faces generated the stronger visual percept, and in the other task, they attempted an explicit familiarity decision. The relative strength of the visual percept of the famous face compared to the unfamiliar face was moderated by response latency and participants' attitude towards the famous person. There was also an interaction of visual field with response latency, suggesting that the right hemisphere can generate a visual percept differentiating famous from unfamiliar faces more rapidly than the left hemisphere. Participants were at chance in the explicit familiarity decision, confirming the absence of awareness of facial familiarity.

Accuracy of familiarity decisions to famous faces perceived without awareness depends on attitude to the target person and on response latency.

Stone and Valentine (2004) presented masked 17 ms faces in simultaneous pairs of one famous and one unfamiliar face. Accuracy in selecting the famous face was higher when the famous person was regarded as "good" or liked than when regarded as "evil" or disliked. Experiment 1 attempted to replicate this phenomenon, but produced a different pattern of results. Experiment 2 investigated alternative explanations and found evidence supporting only the effect of response latency: responses made soon after stimulus onset were more accurate to liked than to disliked faces, whereas responses made after a longer delay were equally accurate to disliked faces. It appears that the effect of negative valence was corrected within the space of a few hundred milliseconds. Experiment 3, using an affective priming paradigm, supported the concept that an early-arising effect of valence is corrected if it is misleading to the directed task.

Better the devil you know? Nonconscious processing of identity and affect of famous faces.

The nonconscious recognition of facial identity was investigated in two experiments featuring brief (17-msec) masked stimulus presentation to prevent conscious recognition. Faces were presented in simultaneous pairs of one famous face and one unfamiliar face, and participants attempted to select the famous face. Subsequently, participants rated the famous persons as "good" or "evil" (Experiment 1) or liked or disliked (Experiment 2). In Experiments 1 and 2, responses were less accurate to faces of persons rated evil/disliked than to faces of persons rated good/liked, and faces of persons rated evil/disliked were selected significantly below chance. Experiment 2 showed the effect in a within-items analysis: A famous face was selected less often by participants who disliked the person than by participants who liked the person, and the former were selected below chance accuracy. The within-items analysis rules out possible confounding factors based on variations in physical characteristics of the stimulus faces and confirms that the effects are due to participants' attitudes toward the famous persons. The results suggest that facial identity is recognized preconsciously, and that responses may be based on affect rather than familiarity.

Perspectives on prosopagnosia and models of face recognition.

The two papers by Bobes et al. (2003, this issue) and by Sperber and Spinnler (2003, this issue) add to the large body of literature demonstrating covert face recognition in prosopagnosia. This viewpoint will offer some perspectives on this interesting phenomenon. First, a re-analysis of the empirical literature will indicate an important misconception concerning the preserved abilities of prosopagnosics. The second section will briefly assess the contribution of Bobes et al. (2003, this issue) and Sperber and Spinnler (2003, this issue) to the debate about the locus, in cognitive terms, of the underlying causal deficit in prosopagnosia with covert face recognition. Both papers make reference to the two main models seeking to explain this phenomenon: the model proposed by Burton and colleagues (Burton et al., 1991; Burton and Young, 1999; Young and Burton, 1999) and that proposed by Farah and colleagues (Farah et al., 1993; O'Reilly and Farah, 1999). Finally, an observation will be offered concerning representations of faces in the Burton et al. (1991) model.