10-Year Trends in Healthcare Spending among Patients with Schizophrenia in Alberta, Canada.

OBJECTIVES: Schizophrenia is characterized by high levels of disability often resulting in increased healthcare utilization and spending. With expanding healthcare costs across all healthcare sectors, there is a need to understand how healthcare spending has changed over time. We conducted a population-based study using administrative health data from Alberta, Canada, to describe changes in medical complexity and direct healthcare spending among patients with schizophrenia over a 10-year period. METHODS: A serial cross-sectional study from January 1, 2008, to December 31, 2017, was conducted to determine changes in demographic characteristics, medical complexity, and costs among all adults (18 years or older) with schizophrenia. Total healthcare spending and sector-specific costs attributable to hospitalizations, emergency department visits, practitioner billings, and prescriptions were calculated and compared over time. RESULTS: Over the 10-year period the contact prevalence of patients with schizophrenia increased from 0.6% (n = 16,183) to 1.0% (n = 33,176) within the province. There was a marked change in medical complexity with the number of patients living with 3 or more comorbidities increasing from 33.0% to 47.3%. Direct annual healthcare costs increased 2-fold from 321 to 639 million CAD (493 million USD) with a 7-fold increase in medication expenditures over the 10-year time frame. As of 2017, spending on pharmaceutical treatment surpassed hospitalizations as the leading spending category in this population. CONCLUSIONS: Healthcare spending among patients with schizophrenia continues to increase and may be partially attributable to growing rates of multimorbidity within this population. Although promising second-generation antipsychotic medications have entered the market, this has resulted in considerable changes in the distribution of healthcare spending over time. These findings will inform policy discussions around resource allocation and efforts to curb health spending while also improving care for patients with schizophrenia.

Story choice matters for caregiver extra-textual talk during shared reading with preschoolers.

This study aimed to examine the influence of the complexity of the story-book on caregiver extra-textual talk (i.e., interactions beyond text reading) during shared reading with preschool-age children. Fifty-three mother-child dyads (3;00-4;11) were video-recorded sharing two ostensibly similar picture-books: a simple story (containing no false belief) and a complex story (containing a false belief central to the plot, which provided content that was more challenging for preschoolers to understand). Book-reading interactions were transcribed and coded. Results showed that the complex stories facilitated more extra-textual talk from mothers, and a higher quality of extra-textual talk (as indexed by linguistic richness and level of abstraction). Although the type of story did not affect the number of questions mothers posed, more elaborative follow-ups on children's responses were provided by mothers when sharing complex stories. Complex stories may facilitate more and linguistically richer caregiver extra-textual talk, having implications for preschoolers' developing language abilities.

Affective theory of mind inferences contextually influence the recognition of emotional facial expressions.

The recognition of emotional facial expressions is often subject to contextual influence, particularly when the face and the context convey similar emotions. We investigated whether spontaneous, incidental affective theory of mind inferences made while reading vignettes describing social situations would produce context effects on the identification of same-valenced emotions (Experiment 1) as well as differently-valenced emotions (Experiment 2) conveyed by subsequently presented faces. Crucially, we found an effect of context on reaction times in both experiments while, in line with previous work, we found evidence for a context effect on accuracy only in Experiment 1. This demonstrates that affective theory of mind inferences made at the pragmatic level of a text can automatically, contextually influence the perceptual processing of emotional facial expressions in a separate task even when those emotions are of a distinctive valence. Thus, our novel findings suggest that language acts as a contextual influence to the recognition of emotional facial expressions for both same and different valences.

Measuring listening-related effort and fatigue in school-aged children using pupillometry.

Stress and fatigue from effortful listening may compromise well-being, learning, and academic achievement in school-aged children. The aim of this study was to investigate the effect of a signal-to-noise ratio (SNR) typical of those in school classrooms on listening effort (behavioral and pupillometric) and listening-related fatigue (self-report and pupillometric) in a group of school-aged children. A sample of 41 normal-hearing children aged 8-11years performed a narrative speech-picture verification task in a condition with recommended levels of background noise ("ideal": +15dB SNR) and a condition with typical classroom background noise levels ("typical": -2dB SNR). Participants showed increased task-evoked pupil dilation in the typical listening condition compared with the ideal listening condition, consistent with an increase in listening effort. No differences were found between listening conditions in terms of performance accuracy and response time on the behavioral task. Similarly, no differences were found between listening conditions in self-report and pupillometric markers of listening-related fatigue. This is the first study to (a) examine listening-related fatigue in children using pupillometry and (b) demonstrate physiological evidence consistent with increased listening effort while listening to spoken narratives despite ceiling-level task performance accuracy. Understanding the physiological mechanisms that underpin listening-related effort and fatigue could inform intervention strategies and ultimately mitigate listening difficulties in children.

Slippery slope arguments imply opposition to change.

Slippery slope arguments (SSAs) of the form if A, then C describe an initial proposal (A) and a predicted, undesirable consequence of this proposal (C) (e.g., "If cannabis is ever legalized, then eventually cocaine will be legalized, too"). Despite SSAs being a common rhetorical device, there has been surprisingly little empirical research into their subjective evaluation and perception. Here, we present evidence that SSAs are interpreted as a form of consequentialist argument, inviting inferences about the speaker's (or writer's) attitudes. Study 1 confirmed the common intuition that a SSA is perceived to be an argument against the initial proposal (A), whereas Study 2 showed that the subjective strength of this inference relates to the subjective undesirability of the predicted consequences (C). Because arguments are rarely made out of context, in Studies 3 and 4 we examined how one important contextual factor, the speaker's known beliefs, influences the perceived coherence, strength, and persuasiveness of a SSA. Using an unobtrusive dependent variable (eye movements during reading), in Study 3 we showed that readers are sensitive to the internal coherence between a speaker's beliefs and the implied meaning of the argument. Finally, Study 4 revealed that this degree of internal coherence influences the perceived strength and persuasiveness of the argument. Together, these data indicate that SSAs are treated as a form of negative consequentialist argument. People infer that the speaker of a SSA opposes the initial proposal; therefore, SSAs are only perceived to be persuasive and conversationally relevant when the speaker's attitudes match this inference.

Listening effort and fatigue: what exactly are we measuring? A British Society of Audiology Cognition in Hearing Special Interest Group 'white paper'.

OBJECTIVE: There is growing interest in the concepts of listening effort and fatigue associated with hearing loss. However, the theoretical underpinnings and clinical meaning of these concepts are unclear. This lack of clarity reflects both the relative immaturity of the field and the fact that research studies investigating listening effort and fatigue have used a variety of methodologies including self-report, behavioural, and physiological measures. DESIGN: This discussion paper provides working definitions for listening effort and listening-related fatigue. Using these definitions as a framework, methodologies to assess these constructs are reviewed. RESULTS: Although each technique attempts to characterize the same construct (i.e. the clinical presentation of listening effort and fatigue), different assumptions are often made about the nature of these phenomena and their behavioural and physiological manifestations. CONCLUSION: We suggest that researchers consider these assumptions when interpreting their data and, where possible, make predictions based on current theoretical knowledge to add to our understanding of the underlying mechanisms of listening effort and listening-related fatigue. FOREWORD: Following recent interest in the cognitive involvement in hearing, the British Society of Audiology (BSA) established a Special Interest Group on Cognition in Hearing in May 2013. In an exploratory group meeting, the ambiguity surrounding listening effort and fatigue was discussed. To address this problem, the group decided to develop a 'white paper' on listening effort and fatigue. This is a discussion document followed by an international set of commentaries from leading researchers in the field. An approach was made to the editor of the International Journal of Audiology who agreed to this suggestion. This paper, and the associated commentaries that follow, are the result.

Magnitude Judgements Are Influenced by the Relative Positions of Data Points Within Axis Limits.

When visualising data, chart designers have the freedom to choose the upper and lower limits of numerical axes. Axis limits can determine the physical characteristics of plotted values, such as the physical position of data points in dot plots. In two experiments (total N=300), we demonstrate that axis limits affect viewers' interpretations of the magnitudes of plotted values. Participants did not simply associate values presented at higher vertical positions with greater magnitudes. Instead, participants considered the relative positions of data points within the axis limits. Data points were considered to represent larger values when they were closer to the end of the axis associated with greater values, even when they were presented at the bottom of a chart. This provides further evidence of framing effects in the display of data, and offers insight into the cognitive mechanisms involved in assessing magnitude in data visualisations.

UK Reproducibility Network open and transparent research practices survey dataset.

Openness and transparency in the research process are a prerequisite to the production of high quality research outputs. Efforts to maximise these features have substantially accelerated in recent years, placing open and transparent research practices at the forefront of funding and related priorities, and encouraging investment in resources and infrastructure to enable such practices. Despite these efforts, there has been no systematic documentation of current practices, infrastructure, or training and resources that support open and transparent research in the UK. To address this gap, we developed and conducted the Open and Transparent Research Practices survey, a large-scale audit study completed by research-active staff in UK research institutions to better understand existing practices, needs, support, and barriers faced when implementing open and transparent research. The data presented here capture responses from over 2,500 research-active staff based at 15 institutions affiliated with the UK Reproducibility Network. The data provide a snapshot of open research practices that can be used to identify barriers, training needs, and areas that require greater investments.

Reasoning as we read: establishing the probability of causal conditionals.

Indicative conditionals of the form if p then q (e.g., if student tuition fees rise, then applications for university places will fall) invite consideration of a hypothetical event (e.g., tuition fees rising) and of one of its possible consequences (e.g., applications falling). Since a rise in tuition fees is an uncertain event with equally uncertain consequences, a reader may believe the statement to a greater or lesser extent. As a conditional is read, the earliest point at which this probabilistic evaluation can take place is as the consequent clause is wrapped up (e.g., as the critical word fall is read in the example above). Wrap-up processing occurs at the end of the clause, as it is evaluated and integrated into the evolving discourse representation. Five sources of probability may plausibly influence the evaluation of a conditional as it is wrapped up; these are P(p), P(q), P(pq), P(q|p), and P(not-p or q). A total of 128 conditionals were constructed, with these probabilities calculated for each item in a pretest. The conditionals were then embedded in vignettes and read by 36 participants on a word-by-word basis. Using linear mixed-effects modeling, we found that wrap-up reading times were predicted by pretest ratings of P(p) and P(q|p). There was no influence of P(q), P(pq), or P(not-p or q) on wrap-up reading times. Our findings are consistent with the suppositional theory of conditionals proposed by Evans and Over (2004) but do not support the mental-models theory advanced by Johnson-Laird and Byrne (2002).

Identifying Unique Subgroups of High-Cost Patients With Schizophrenia: A Population-Based Study Using Latent Class Analysis.

Schizophrenia does not present uniformly among patients and as a result this patient population is characterized by a diversity in the type and amount of healthcare supports needed for daily functioning. Despite this, little work has been completed to understand the heterogeneity that exists among these patients. In this work we used a data-driven approach to identify subgroups of high-cost patients with schizophrenia to identify potentially actionable interventions for the improvement of outcomes and to inform conversations on how to most efficiently allocate resources in an already strained system. Administrative health data was used to conduct a retrospective analysis of "high-cost" adult patients with schizophrenia residing in Alberta, Canada in 2017. Costs were derived from inpatient encounters, outpatient primary care and specialist encounters, emergency department encounters, and drug costs. Latent class analysis was used to group patients based on their unique clinical profiles. Latent class analysis of 1659 patients revealed the following patient groups: (1) young, high-needs males early in their disease course; (2) actively managed middle-aged patients; (3) elderly patients with multiple chronic conditions and polypharmacy; (4) unstably housed males with low treatment rates; (5) unstably housed females with high acute care use and low treatment rates. This taxonomy may be used to inform policy, including the identification of interventions most likely to improve care and reduce health spending for each subgroup.

Factors associated with high health care spending among patients with schizophrenia. / Facteurs associés aux dépenses élevées en soins de santé chez les patients atteints de schizophrénie.

INTRODUCTION: Understanding the reasons for the wide variation in health care spending among patients with schizophrenia may benefit the development of interventions aimed at improving patient outcomes and health care spending efficiency. The aim of our study was to determine factors associated with high health care spending in the patient population. METHODS: A serial cross-sectional study used the administrative health records of residents of Alberta, Canada between 1 January 2008 and 31 December 2017 and provincial costing methodologies to calculate total health care spending and sector-specific costs. Factors that modified the odds of being a high cost (i.e. 95th percentile or higher) patient with schizophrenia were estimated using generalized estimating equations. RESULTS: This study captured 242 818 person-years of observations among 38 177 unique patients with schizophrenia. Increased odds of being a high-cost patient were associated with younger age (18-29 years), male sex, unstable housing status and requiring care from multiple medical specialties. The strongest estimated associations between high cost status and comorbidity were for metastatic cancer (OR = 2.26) and cirrhosis (OR = 2.07). In contrast, polypharmacy was associated with a decreased odds of being high cost compared with untreated patients. CONCLUSION: Factors associated with being a high-cost patient are the result of complex interactions between individual, structural and treatment-related factors. Efforts to improve patient outcomes and address rising health care costs must consider the value of allocating resources towards early detection and support of patients with schizophrenia along with the prevention/management of comorbidity.

Children do not overcome lexical biases where adults do: the role of the referential scene in garden-path recovery.

In this paper we report on a visual world eye-tracking experiment that investigated the differing abilities of adults and children to use referential scene information during reanalysis to overcome lexical biases during sentence processing. The results showed that adults incorporated aspects of the referential scene into their parse as soon as it became apparent that a test sentence was syntactically ambiguous, suggesting they considered the two alternative analyses in parallel. In contrast, the children appeared not to re-analyze their initial analysis, even over shorter distances than have been investigated in prior research. We argue that this reflects the children's over-reliance on bottom-up, lexical cues to interpretation. The implications for the development of parsing routines are discussed.

Improving research quality: the view from the UK Reproducibility Network institutional leads for research improvement.

The adoption and incentivisation of open and transparent research practices is critical in addressing issues around research reproducibility and research integrity. These practices will require training and funding. Individuals need to be incentivised to adopt open and transparent research practices (e.g., added as desirable criteria in hiring, probation, and promotion decisions, recognition that funded research should be conducted openly and transparently, the importance of publishers mandating the publication of research workflows and appropriately curated data associated with each research output). Similarly, institutions need to be incentivised to encourage the adoption of open and transparent practices by researchers. Research quality should be prioritised over research quantity. As research transparency will look different for different disciplines, there can be no one-size-fits-all approach. An outward looking and joined up UK research strategy is needed that places openness and transparency at the heart of research activity. This should involve key stakeholders (institutions, research organisations, funders, publishers, and Government) and crucially should be focused on action. Failure to do this will have negative consequences not just for UK research, but also for our ability to innovate and subsequently commercialise UK-led discovery.

What Determines the Perception of Segmentation in Contemporary Music?

BACKGROUND: This study concerns the perception of musical segmentation during listening to live contemporary classical music. Little is known about how listeners form judgments of musical segments, particularly when typical section markers, such as cadences and fermatas, are absent [e.g., Sears et al. (2014)] or when the music is non-tonal (e.g., in much contemporary classical music). AIMS: The current study aimed to examine the listeners' segmentation decisions in a piece of contemporary music, Ligeti's "Fanfares"? METHODS: Data were gathered using a smartphone application [Practice & Research in Science & Music (PRiSM) Perception App] designed for this study by the Royal Northern College of Music (RNCM) Centre for PRiSM and the Oxford e-Research Centre. A total of 259 audience participants were asked to "tap" when they felt that a section had ended. Subjective responses were captured, as well as contextual data about the participants. RESULTS: The audience members demonstrated high levels of agreement regarding segmentation, mostly at places in the music involving breaks in the musical texture (one piano hand resting), changes in dynamic (volume), and changes in register/pitch. A sense of familiarity with contemporary repertoire did seem to influence the responses-the participants who self-reported being familiar with contemporary music used a wider range of cues to make their segmentation decisions. The self-report data analysis suggested that the listeners were not always aware of how they made decisions regarding segmentation. The factors which may influence their judgment of musical segmentation are, to some extent, similar to those identified by music analysis (Steinitz, 2011) but different in other ways. The effect of musical training was found to be quite small. CONCLUSION: Whether musically trained and/or familiar with contemporary classical music or not, the listeners demonstrate commonalities in segmentation, which they are not always aware of. This study has implications for contemporary composers, performers, and audiences and how they engage with new music in particular.

Typical object velocity influences motion extrapolation.

Previous work indicates that extrapolation of object motion during occlusion is affected by the velocity of the immediately preceding trial. Here we ask whether longer-term velocity representations can also influence motion extrapolation. Red, blue or green targets disappeared behind an occluder. Participants pressed a button when they thought the target had reached the other side. Red targets were slower (10-20 deg/s), blue targets moved at medium velocities (14-26 deg/s) and green targets were faster (20-30 deg/s). We compared responses on a subset of red and green trials which always travelled at 20 deg/s. Although trial velocities were identical, participants responded as if the green targets moved faster (M = 22.64 deg/s) then the red targets (M = 19.72 deg/s). This indicates that motion extrapolation is affected by longer-term information about the typical velocity of different categories of stimuli.

Communicating stereotype-relevant information: is factual information subject to the same communication biases as fictional information?

Factual information is more frequently read and discussed than fictional information. However, research on the role of communication in shaping stereotypes has focused almost exclusively on fictional narratives. In Experiments 1 and 2 a newspaper article containing information about heroin users was communicated along chains of 4 people. No stereotype-consistency bias was observed. Instead, a greater proportion of stereotype-inconsistent information was communicated than was stereotype-consistent or -neutral information. Three further experiments investigated explanations for the difference between the communication of fictional and factual information. Experiment 3 ruled out the possibility that participants' beliefs about the validity of the information could influence the way that it is communicated. Experiments 4 and 5 divided information into concrete (a specific event or fact) or abstract (opinion). A stereotype-consistency bias emerged only for abstract information. In summary, linguistic abstraction moderates whether stereotype-consistency biases emerge in the communication of stereotype-relevant factual information.

Modality differences in timing and the filled-duration illusion: Testing the pacemaker rate explanation.

Performance in temporal difference threshold and estimation tasks is markedly less accurate for visual than for auditory intervals. In addition, thresholds and estimates are likewise less accurate for empty than for filled intervals. In scalar timing theory, these differences have been explained as alterations in pacemaker rate, which is faster for auditory and filled intervals than for visual and empty intervals. We tested this explanation according to three research aims. First, we replicated the threshold and estimation tasks of Jones, Poliakoff, and Wells (Quarterly Journal of Experimental Psychology, 62, 2171-2186, 2009) and found the well-documented greater precision for auditory than visual intervals, and for filled than for empty intervals. Second, we considered inter-individual differences in these classic effects and found that up to 27% of participants exhibited opposite patterns. Finally, we examined intra-individual differences to investigate (i) whether thresholds and estimates correlate within each stimulus condition and (ii) whether the stimulus condition in which a participants' pacemaker rate was highest was the same in both tasks. Here we found that if pacemaker rate is indeed a driving factor for thresholds and estimates, its effect may be greater for empty intervals, where the two tasks correlate, than for filled intervals, where they do not. In addition, it was more common for participants to perform best in different modalities in each task, though this was not true for ordinal intra-individual differences in the filled-duration illusion. Overall, this research presents several findings inconsistent with the pacemaker rate explanation.

The effect of previously viewed velocities on motion extrapolation.

There is preliminary evidence for interference between subsequently encoded velocities. We explored this effect using a motion extrapolation paradigm. In Experiments 1 and 2, moving targets disappeared behind an occluder. Participants responded at the time when they thought the target should reappear. Participants responded as if the current velocity was faster after a previous trial with a fast velocity and vice versa. In Experiment 3 the targets reappeared either on-time, early or late. A greater proportion of early trials were reported 'correct' following a fast previous trial. These experiments indicate that blending occurs between successively encoded velocity representations.

An eye-tracking examination of readers' sensitivity to pragmatic scope information during the processing of conditional inducements.

Previous research into conditional inducements has shown that readers are sensitive after reading such conditionals to pragmatic scope differences between promises and threats; specifically, threats can be referred to as promises, but promises cannot be referred to as threats. Crucially, previous work has not revealed whether such scope effects emerge while processing the conditional itself. In the experiment reported here, participants' eye movements were recorded while they read vignettes containing conditional promises and threats. We observed a reading time penalty on the conditional itself when participants read a conditional promise that was described as a "threat" (e.g., Liam threatened Perry "if you tell dad, then I'll take equal responsibility"). There was no such penalty when the word "promise" was presented before a conditional threat. These results suggest that readers are sensitive during reading of the conditional itself to pragmatic scope differences between "threats" and "promises." (PsycINFO Database Record

'It's hard to write a good article': The online comprehension of excuses as indirect replies.

In an eye-tracking experiment, we examined how readers comprehend indirect replies when they are uttered in reply to a direct question. Participants read vignettes that described two characters engaged in dialogue. Each dialogue contained a direct question (e.g., How are you doing in Chemistry?) answered with an excuse (e.g., The exams are not fair). In response to direct questions, such indirect replies are typically used to avoid a face-threatening disclosure (e.g., doing badly on the Chemistry course). Our goal was to determine whether readers are sensitive during reading to the indirect meaning communicated by such replies. Of the three contexts we examined, the first described a negative, face-threatening situation and the second a positive, non-face threatening situation, while the third was neutral. Analysis of reading times to the replies provides strong evidence that readers are sensitive online to the face-saving function of indirect replies.