Violence outcomes in later adolescence with the Good School Toolkit-Primary: a nonrandomized controlled trial in Uganda.

BACKGROUND: We sought to determine whether the Good School Toolkit-Primary violence prevention intervention was associated with reduced victimisation and perpetration of peer and intimate partner violence four years later, and if any associations were moderated by sex and early adolescent: family connectedness, socio-economic status, and experience of violence outside of school. METHODS: Drawing on schools involved in a randomised controlled trial of the intervention, we used a quasi-experimental design to compare violence outcomes between those who received the intervention during our trial (n = 1388), and those who did not receive the intervention during or after the trial (n = 522). Data were collected in 2014 (mean age 13.4, SD 1.5 years) from participants in 42 schools in Luwero District, Uganda, and 2018/19 from the same participants both in and out of school (mean age 18, SD: 1.77 years). We compared children who received the Good School Toolkit-Primary, a whole school violence prevention intervention, during a randomised controlled trial, to those who did not receive the intervention during or after the trial. Outcomes were measured using items adapted from the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool-Child Institutional. We used mixed-effect multivariable logistic regression, with school fitted as a random-effect to account for clustering. RESULTS: 1910 adolescents aged about 16-19 years old were included in our analysis. We found no evidence of an average long-term intervention effect on our primary outcome, peer violence victimization at follow-up (aOR = 0.81, 95%CI = 0.59-1.11); or for any secondary outcome. However, exposure to the intervention was associated with: later reductions in peer violence, for adolescents with high family connectedness (aOR = 0.70, 95% CI 0.49 to 0.99), but not for those with low family connectedness (aOR = 1.07, 95% CI 0.69 to 1.6; p-interaction = 0.06); and reduced later intimate partner violence perpetration among males with high socio-economic status (aOR = 0.32, 95%CI 0.11 to 0.90), but not low socio-economic status (aOR = 1.01 95%CI 0.37 to 2.76, p-interaction = 0.05). CONCLUSIONS: Young adolescents in connected families and with higher socio-economic status may be better equipped to transfer violence prevention skills from primary school to new relationships as they get older. TRIAL REGISTRATION: Clinicaltrials.gov, NCT01678846, registration date 24 August 2012. Protocol for this paper:  https://www.researchprotocols.org/2020/12/e20940 .

Attentional enhancement of spatial resolution: linking behavioural and neurophysiological evidence.

Attention allows us to select relevant sensory information for preferential processing. Behaviourally, it improves performance in various visual tasks. One prominent effect of attention is the modulation of performance in tasks that involve the visual system's spatial resolution. Physiologically, attention modulates neuronal responses and alters the profile and position of receptive fields near the attended location. Here, we develop a hypothesis linking the behavioural and electrophysiological evidence. The proposed framework seeks to explain how these receptive field changes enhance the visual system's effective spatial resolution and how the same mechanisms may also underlie attentional effects on the representation of spatial information.

Independent effects of adaptation and attention on perceived speed.

Adaptation and attention are two mechanisms by which sensory systems manage limited bioenergetic resources: Whereas adaptation decreases sensitivity to stimuli just encountered, attention increases sensitivity to behaviorally relevant stimuli. In the visual system, these changes in sensitivity are accompanied by a change in the appearance of different stimulus dimensions, such as speed. Adaptation causes an underestimation of speed, whereas attention leads to an overestimation of speed. In the two experiments reported here, we investigated whether the effects of these mechanisms interact and how they affect the appearance of stimulus features. We tested the effects of adaptation and the subsequent allocation of attention on perceived speed. A quickly moving adaptor decreased the perceived speed of subsequent stimuli, whereas a slow adaptor did not alter perceived speed. Attention increased perceived speed regardless of the adaptation effect, which indicates that adaptation and attention affect perceived speed independently. Moreover, the finding that attention can alter perceived speed after adaptation indicates that adaptation is not merely a by-product of neuronal fatigue.

Equality judgments cannot distinguish between attention effects on appearance and criterion: a reply to Schneider (2011).

Whether attention modulates the appearance of stimulus features is debated. Whereas many previous studies using a comparative judgment have found evidence for such an effect, two recent studies using an equality judgment have not. Critically, these studies have relied on the assumption that the equality paradigm yields bias-free PSE estimates and is as sensitive as the comparative judgment, without testing these assumptions. Anton-Erxleben, Abrams, and Carrasco (2010) compared comparative judgments and equality judgments with and without the manipulation of attention. They demonstrated that the equality paradigm is less sensitive than the comparative judgment and also bias-prone. Furthermore, they reported an effect of attention on the PSE using both paradigms. Schneider (2011) questions the validity of the latter finding, stating that the data in the equality experiment are corrupted because of skew in the response distributions. Notably, this argument supports the original conclusion by Anton-Erxleben et al.: that the equality paradigm is bias-prone. Additionally, the necessary analyses to show that the attention effect observed in Anton-Erxleben et al. was due to skew in the data were not conducted. Here, we provide these analyses and show that although the equality judgment is bias-prone, the effects we observe are consistent with an increase of apparent contrast by attention.

Student, teacher, and caregiver perceptions on implementing mental health interventions in Ugandan schools.

Background: The vast majority of children and adolescents in low and middle-income countries (LMICs) lack access to interventions for mental health problems. Schools provide a critical platform for evidence-based intervention delivery for young people. However, a significant need exists to understand the implementation context and strategies for delivering school mental health interventions in LMICs. Methods: We conducted a focused ethnography to explore students', teachers', and caregivers' perspectives on implementing evidence-based mental health interventions (EBIs) within a widespread violence prevention program in Uganda. Data collection occurred in Kampala, Uganda, using two schools that have previously implemented an evidence-based violence prevention program widely used in Ugandan schools schools, the Good School Toolkit (GST). Trained, local researchers facilitated four focus group discussions (FGDs) with caregivers (n = 22), four FGDs with teachers (n = 25), and in-depth interviews with primary school students (n = 12). Verbatim transcripts were analyzed using a framework analysis approach. Results: Participants revealed a school culture that promotes schools' responsibility to students beyond academics, including positive teacher-student relationships. Participants recommended an implementation process that trains teachers and students in screening and referral, peer group delivery, and is accompanied by a school-wide approach to stigma reduction and mental health literacy. Participants fundamentally agreed that teachers could be trained as intervention facilitators. Conclusions: This study highlights the potential advantage of leveraging an existing intervention that already addresses implementation factors, such as school culture, as a fertile platform for implementing interventions for child and adolescent mental health in LMICs. Plain language abstract: Despite the growth of implementation research for child and adolescent mental health, the study of implementation science for child and adolescent mental health in low and middle-income countries (LMICs) remains scarce. Schools provide a critical platform for evidence-based intervention delivery for young people. However, a significant need exists to understand the implementation context and strategies for delivering school mental health interventions in LMICs. This study provides rich qualitative data describing the context and influences for the successful implementation of mental health interventions in LMIC schools. We conducted interviews and focus groups with teachers, students, and caregivers to determine their perspectives on implementing evidence-based mental health interventions (EBIs) within a widespread violence prevention program in Uganda. Participants revealed a school culture promoted by the existing program that promotes schools' responsibility to students beyond academics, including positive teacher-student relationships. Findings suggest the existing program provides fertile ground for the successful implementation of evidence-based mental health interventions in schools.

Attention reshapes center-surround receptive field structure in macaque cortical area MT.

Directing spatial attention to a location inside the classical receptive field (cRF) of a neuron in macaque medial temporal area (MT) shifts the center of the cRF toward the attended location. Here we investigate the influence of spatial attention on the profile of the inhibitory surround present in many MT neurons. Two monkeys attended to the fixation point or to 1 of 2 random dot patterns (RDPs) placed inside or next to the cRF, whereas a third RDP (the probe) was briefly presented in quick succession across the cRF and surround. The probe presentation responses were used to compute a map of the excitatory receptive field and its inhibitory surround. Attention systematically reshapes the receptive field profile, independently shifting both center and surround toward the attended location. Furthermore, cRF size is changed as a function of relative distance to the attentional focus: attention inside the cRF shrinks it, whereas directing attention next to the cRF expands it. In addition, we find systematic changes in surround inhibition and cRF amplitude. This nonmultiplicative push-pull modulation of the receptive field's center-surround structure optimizes processing at and near the attentional focus to strengthen the representation of the attended stimulus while reducing influences from distractors.

Evaluating comparative and equality judgments in contrast perception: attention alters appearance.

Covert attention not only improves performance in many visual tasks but also modulates the appearance of several visual features. Studies on attention and appearance have assessed subjective appearance using a task contingent upon a comparative judgment (e.g., M. Carrasco, S. Ling, & S. Read, 2004). Recently, K. A. Schneider and M. Komlos (2008) questioned the validity of those results because they did not find a significant effect of attention on contrast appearance using an equality task. They claim that such equality judgments are bias-free whereas comparative judgments are bias-prone and propose an alternative interpretation of the previous findings based on a decision bias. However, to date there is no empirical support for the superiority of the equality procedure. Here, we compare biases and sensitivity to shifts in perceived contrast of both paradigms. We measured contrast appearance using both a comparative and an equality judgment. Observers judged the contrasts of two simultaneously presented stimuli, while either the contrast of one stimulus was physically incremented (Experiments 1 and 2) or exogenous attention was drawn to it (Experiments 3 and 4). We demonstrate several methodological limitations of the equality paradigm. Nevertheless, both paradigms capture shifts in PSE due to physical and perceived changes in contrast and show that attention enhances apparent contrast.

Dynamic shifts of visual receptive fields in cortical area MT by spatial attention.

Voluntary attention is the top-down selection process that focuses cortical processing resources on the most relevant sensory information. Spatial attention--that is, selection based on stimulus position--alters neuronal responsiveness throughout primate visual cortex. It has been hypothesized that it also changes receptive field profiles by shifting their centers toward attended locations and by shrinking them around attended stimuli. Here we examined, at high resolution, receptive fields in cortical area MT of rhesus macaque monkeys when their attention was directed to different locations within and outside these receptive fields. We found a shift of receptive fields, even far from the current location of attention, accompanied by a small amount of shrinkage. Thus, already in early extrastriate cortex, receptive fields are not static entities but are highly modifiable, enabling the dynamic allocation of processing resources to attended locations and supporting enhanced perception within the focus of attention by effectively increasing the local cortical magnification.

Long-Term Outcomes of the Good School Toolkit Primary School Violence Prevention Intervention Among Adolescents: Protocol for a Nonrandomized Quasi-Experimental Study.

BACKGROUND: Violence against children in schools is a global public health problem. There is growing evidence that school-based interventions can be effective in reducing violence against children in schools. However, there is little evidence on the long-term impact of such interventions. The Good School Toolkit, developed by Raising Voices, a Uganda-based nonprofit organization, is a whole-school violence prevention intervention that aims to change the operational culture of primary schools. In 2014, the Good School Toolkit was evaluated through a cluster randomized controlled trial (Good Schools Study) and found to reduce teacher-to-student and student-to-student violence. OBJECTIVE: This protocol describes quantitative analyses to explore long-term outcomes of the Good School Toolkit intervention among adolescents in Uganda, including the extent to which it is associated with peer-violence victimization (primary outcome) and peer-violence perpetration, intimate-partner violence, acceptance of teacher-violence, equitable gender attitudes, agency, self-regulation, peer connectedness, social assets, psychological assets, and retention in school (secondary outcomes). METHODS: This is a nonrandomized quasi-experimental 4-year follow-up study of adolescents who attended the 42 Good Schools Study primary schools in 2014; 21 schools initiated the Good School Toolkit intervention during the trial from 2012, and 19 schools initiated the intervention after the trial (during the later delivery phase) from 2015; 2 schools did not implement the intervention. Students in the final school grade (Primary 7) during 2014 of the 19 primary schools in the later delivery phase are expected to have left school prior to toolkit delivery in 2015. Wave 1 data were collected in 2014 from 3431 grade Primary 5 to Primary 7 school students aged 11-14 years; these students were followed up in 2018-2019 when aged 16-19 years and invited to participate in the Wave 2 survey. Data were collected in face-to-face interviews by trained Ugandan field researchers. Toolkit exposure groups are defined as exposed during the Good Schools Study trial (from 2012), as exposed during later delivery (from 2015), or not exposed including those expected to have completed Primary 7 prior to later delivery or from the 2 schools that did not implement the toolkit. Associations between outcomes at Wave 2 and toolkit exposure groups will be analyzed using mixed-effect multivariable logistic and linear regression models for binary and continuous outcomes, respectively. This analysis is exploratory and aims to generate hypotheses on if, and under what circumstances, the toolkit influences later adolescent outcomes. RESULTS: Data collection was completed in August 2019. CONCLUSIONS: To our knowledge, this is the first long-term follow-up study of adolescents exposed to a school-based violence-prevention intervention in sub-Saharan Africa. If the intervention reduces violence and improves other outcomes in later adolescence, then this study supports primary school interventions as key to achieving long-term population impacts. The pattern of effects will inform where reinforced or additional interventions are needed. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/20940.

Receptive field shift and shrinkage in macaque middle temporal area through attentional gain modulation.

Selective attention is the top-down mechanism to allocate neuronal processing resources to the most relevant subset of the information provided by an organism's sensors. Attentional selection of a spatial location modulates the spatial-tuning characteristics (i.e., the receptive fields of neurons in macaque visual cortex). These tuning changes include a shift of receptive field centers toward the focus of attention and a narrowing of the receptive field when the attentional focus is directed into the receptive field. Here, we report that when attention is directed into versus of receptive fields of neurons in the middle temporal visual area (area MT), the magnitude of the shift of the spatial-tuning functions is positively correlated with a narrowing of spatial tuning around the attentional focus. By developing and applying a general attentional gain model, we show that these nonmultiplicative attentional modulations of basic neuronal-tuning characteristics could be a direct consequence of a spatially distributed multiplicative interaction of a bell-shaped attentional spotlight with the spatially fined-grained sensory inputs of MT neurons. Additionally, the model lets us estimate the spatial spread of the attentional top-down signal impinging on visual cortex. Consistent with psychophysical reports, the estimated size of the "spotlight of attention" indicates a coarse spatial resolution of attention. These results illustrate how spatially specific nonmultiplicative attentional changes of neuronal-tuning functions can be the result of multiplicative gain modulation affecting sensory neurons in a widely distributed region in cortical space.

Attention changes perceived size of moving visual patterns.

Spatial attention shifts receptive fields in monkey extrastriate visual cortex toward the focus of attention (S. Ben Hamed, J. R. Duhamel, F. Bremmer, & W. Graf, 2002; C. E. Connor, J. L. Gallant, D. C. Preddie, & D. C. Van Essen, 1996; C. E. Connor, D. C. Preddie, J. L. Gallant, & D. C. Van Essen, 1997; T. Womelsdorf, K. Anton-Erxleben, F. Pieper, & S. Treue, 2006). This distortion in the retinotopic distribution of receptive fields might cause distortions in spatial perception such as an increase of the perceived size of attended stimuli. Here we test for such an effect in human subjects by measuring the point of subjective equality (PSE) for the perceived size of a neutral and an attended stimulus when drawing automatic attention to one of two spatial locations. We found a significant increase in perceived size of attended stimuli. Depending on the absolute stimulus size, this effect ranged from 4% to 12% and was more pronounced for smaller than for larger stimuli. In our experimental design, an attentional effect on task difficulty or a cue bias might influence the PSE measure. We performed control experiments and indeed found such effects, but they could only account for part of the observed results. Our findings demonstrate that the allocation of transient spatial attention onto a visual stimulus increases its perceived size and additionally biases subjects to select this stimulus for a perceptual judgment.