Gamified antimicrobial decision support app (GADSA) changes antibiotics prescription behaviour in surgeons in Nigeria: a hospital-based pilot study.

AIMS: Surgical Antibiotic Prophylaxis (SAP) in Nigeria is often not evidence based. The aim of this study is to test if the GADSA application can change prescription behaviour of surgeons in Nigeria. In addition, the study aims to identify AMS strategies and policies for the future. METHODS: The GADSA gamified decision support app uses WHO and Sanford prescribing guidelines to deliver real-time persuasive technology feedback to surgeons through an interactive mentor. The app can advise on whether clinician's decisions align with SAP recommendations and provides the opportunity for clinicians to make adjustments. Twenty surgeons actively participated in a 6-month pilot study in three hospitals in Nigeria. The surgeons determined the risk of infection of a surgical procedure, and the need, type and duration of SAP. The study used a longitudinal approach to test whether the GADSA app significantly changed prescribing behaviour of participating surgeons by analysing the reported prescription decisions within the app. RESULTS: 321 SAP prescriptions were recorded. Concerning the surgical risk decision, 12% of surgeons changed their decision to be in line with guidelines after app feedback (p < 0.001) and 10% of surgeons changed their decision about the need for SAP (p = 0.0035) to align with guidelines. The change in decision making for SAP use in terms of "type" and "duration" to align with guidelines was similar with 6% and 5% respectively (both p-values < 0.001). CONCLUSION: This study suggests that the GADSA app, with its game based and feedback feature, could significantly change prescribing behaviour at the point of care in an African setting, which could help tackle the global challenge of antibiotic resistance.

Exploring barriers to guideline implementation for prescription of surgical antibiotic prophylaxis in Nigeria.

Background: In Nigeria, the prescription of surgical antibiotic prophylaxis for prevention of surgical site infection tends to be driven by local policy rather than by published guidelines (e.g. WHO and Sanford). Objectives: To triangulate three datasets and understand key barriers to implementation using a behavioural science framework. Methods: Surgeons (N = 94) from three teaching hospitals in Nigeria participated in an online survey and in focus group discussions about barriers to implementation. The theoretical domains framework (TDF) was used to structure question items and interview schedules. A subgroup (N = 20) piloted a gamified decision support app over the course of 6 months and reported barriers at the point of care. Results: Knowledge of guidelines and intention to implement them in practice was high. Key barriers to implementation were related to environmental context and resources and concern over potential consequences of implementing recommendations within the Nigerian context applicable for similar settings in low-to-middle-income countries. Conclusions: The environmental context and limited resource setting of Nigerian hospitals currently presents a significant barrier to implementation of WHO and Sanford guidelines. Research and data collected from the local context must directly inform the writing of future international guidelines to increase rates of implementation.

A pilot sequential multiple assignment randomized trial (SMART) protocol for developing an adaptive coaching intervention around a mobile application for athletes to improve carbohydrate periodization behavior.

BACKGROUND: It has recently been identified that manipulating carbohydrate availability around exercise activity can enhance training-induced metabolic adaptations. Despite this approach being accepted in the athletic populations, athletes do not systematically follow the guidelines. Digital environments appear to allow nutritionists to deliver this intervention at scale, reducing expensive human coaching time. Yet, digitally delivered dietary behavior change interventions for athletes and the coaching strategy to support them are still novel concepts within sports nutrition. METHODS/DESIGN: We aim to recruit 900 athletes across the UK. 500 athletes will be recruited to test the feasibility of a novel menu planner mobile application with coaching for 6 weeks. 250 athletes with pre-existing nutritionist support will also be recruited as control. We will then conduct a 4-week pilot sequential multiple assignment randomized trial (SMART) with an additional 150 athletes. In the SMART, athletes will be given the application and additional coaching according to their engagement responses. The primary outcomes are the mobile application and coach uptake, retention, engagement, and success in attaining carbohydrate periodization behavior. Secondary outcomes are changes in goal, weight, carbohydrate periodization self-efficacy, and beliefs about consequences. Due to the high attrition nature of digital interventions, all quantitative analyses will be carried out based on both the intention-to-treat and per-protocol principles. DISCUSSION: This study will be the first to investigate improving carbohydrate periodization using a digital approach and tailored coaching strategies under this context. Foundational evidence from this study will provide insights into the feasibility of the digital approach.

An ontology-based modelling system (OBMS) for representing behaviour change theories applied to 76 theories.

Background: To efficiently search, compare, test and integrate behaviour change theories, they need to be specified in a way that is clear, consistent and computable. An ontology-based modelling system (OBMS) has previously been shown to be able to represent five commonly used theories in this way. We aimed to assess whether the OBMS could be applied more widely and to create a database of behaviour change theories, their constructs and propositions. Methods: We labelled the constructs within 71 theories and used the OBMS to represent the relationships between the constructs. Diagrams of each theory were sent to authors or experts for feedback and amendment. The 71 finalised diagrams plus the five previously generated diagrams were used to create a searchable database of 76 theories in the form of construct-relationship-construct triples. We conducted a set of illustrative analyses to characterise theories in the database. Results: All 71 theories could be satisfactorily represented using this system. In total, 35 (49%) were finalised with no or very minor amendment. The remaining 36 (51%) were finalised after changes to the constructs (seven theories), relationships between constructs (15 theories) or both (14 theories) following author/expert feedback. The mean number of constructs per theory was 20 (min. = 6, max. = 72), with the mean number of triples per theory 31 (min. = 7, max. = 89). Fourteen distinct relationship types were used, of which the most commonly used was 'influences', followed by 'part of'. Conclusions: The OBMS can represent a wide array of behavioural theories in a precise, computable format. This system should provide a basis for better integration and synthesis of theories than has hitherto been possible.

Emotion recognition ability: Evidence for a supramodal factor and its links to social cognition.

Accurate recognition of others' emotions is an important skill for successful social interaction. Unsurprisingly, it has been an enduring topic of interest, and notable individual differences have been observed. Despite this focus, the underlying functional architecture of this ability has not been thoroughly investigated, particularly concerning emotion recognition across different sensory domains and stimulus modalities. Using a structural equation modelling approach, Study 1 (N = 284) established the structure of emotion recognition ability across three expressive domains - face, body and voice - and observed strong evidence for a superordinate 'supramodal' emotion recognition factor, over and above domain-specific factors. Additionally, we observed a significant moderate negative association between this superordinate factor and alexithymia. In Study 2 (N = 218), findings indicated that supramodal emotion recognition ability and face identity recognition are two related but independent constructs. In Study 3 (N = 249), we examined links from both supramodal emotion recognition and face identity recognition to broader cognitive ability, and observed that general intelligence was a significant predictor of supramodal emotion recognition ability. In contrast, there was no association between intelligence and face identity recognition ability. Across three independent samples, then, our findings offer strong support for an emotion recognition ability factor existing across visual and auditory domains encompassing social signals conveyed by face, body and voice, and outline its associations to broader cognitive and affective traits.

Performance Nutrition in the digital era - An exploratory study into the use of social media by sports nutritionists.

This study aimed to explore how social media is being used by sports nutritionists as part of service provision, as well as practitioners' experiences and opinions of its use in practice. An exploratory sequential mixed methods approach was used during this research. Forty-four sports nutritionists completed an online survey detailing their personal and professional social media use. Semi-structured follow-up interviews were conducted with 16 participants who volunteered to do so. Survey responses were collated and reported as descriptive statistics. Interviews were thematically analysed. Social media was used by 89% of sports nutritionists to support practice, of which 97% perceived its use to be beneficial. Platforms were used to deliver information and resources, and support athletes online via pages, groups and 1-2-1 messaging. Social media facilitated improved communication between the practitioner and the athlete, as well as facilitating mobile and visual learning. Lack of digital intervention training and time were reported as challenges to social media use in practice. Sports nutritionists have embraced social media as an extension of service provision. Professional education should now consider supporting nutritionists' in developing digital professionalism.

Carotenoid skin colouration enhances face and body attractiveness: A cross-cultural study.

Previous research has indicated that faces with higher levels of skin carotenoid colouration are perceived as healthier and more attractive. However, it is not known whether this preference is specific to faces or reflects a more generalised preference in biological stimuli: for example, non-face body parts. Moreover, it is not yet well established whether the preference for carotenoid colouration extends beyond Caucasian populations. Three studies were conducted to address these issues. In Studies 1 and 2, Caucasian and Hong Kong Chinese participants, respectively, selected the more attractive image in pairs of high and low carotenoid colouration versions of images of Caucasian faces and body parts, and also for non-face/body-part control stimuli (scrambled faces). In Study 3, a similar study protocol was used with an independent sample of Hong Kong Chinese participants using stimuli generated from Chinese individuals. The results showed that high carotenoid colouration was preferred across all the three studies in faces and body parts, but not in the control stimuli. In addition, there was a stronger preference for high carotenoid colouration in faces compared with body parts in Studies 1 and 2-although this preference was not observed in Study 3. Overall, these findings demonstrate that higher levels of skin carotenoid colouration are preferred both in face and body parts, but not in non-face stimuli, and that these preferences are evident in Caucasian and Hong Kong Chinese individuals.

Development of a formal system for representing behaviour-change theories.

Use of natural language to represent behaviour-change theories has resulted in lack of clarity and consistency, hindering comparison, integration, development and use. This paper describes development of a formal system for representing behaviour-change theories that aims to improve clarity and consistency. A given theory is represented in terms of (1) its component constructs (for example, 'self-efficacy', 'perceived threat' or 'subjective norm'), which are labelled and defined, and (2) relationships between pairs of constructs, which may be causal, structural or semantic. This formalism appears adequate to represent five commonly used theories (health belief model, information-motivation-behavioural skill model, social cognitive theory, theory of planned behaviour and the trans-theoretical model). Theory authors and experts judged that the system was able to capture the main propositions of the theories. Following this proof of concept, the next step is to assess how far the system can be applied to other theories of behaviour change.

Sex differences in emotion recognition: Evidence for a small overall female superiority on facial disgust.

Although it is widely believed that females outperform males in the ability to recognize other people's emotions, this conclusion is not well supported by the extant literature. The current study sought to provide a strong test of the female superiority hypothesis by investigating sex differences in emotion recognition for five basic emotions using stimuli well-calibrated for individual differences assessment, across two expressive domains (face and body), and in a large sample (N = 1,022: Study 1). We also assessed the stability and generalizability of our findings with two independent replication samples (N = 303: Study 2, N = 634: Study 3). In Study 1, we observed that females were superior to males in recognizing facial disgust and sadness. In contrast, males were superior to females in recognizing bodily happiness. The female superiority for recognition of facial disgust was replicated in Studies 2 and 3, and this observation also extended to an independent stimulus set in Study 2. No other sex differences were stable across studies. These findings provide evidence for the presence of sex differences in emotion recognition ability, but show that these differences are modest in magnitude and appear to be limited to facial disgust. We discuss whether this sex difference may reflect human evolutionary imperatives concerning reproductive fitness and child care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Instagram use is linked to increased symptoms of orthorexia nervosa.

PURPOSE: Social media use is ever increasing amongst young adults and has previously been shown to have negative effects on body image, depression, social comparison, and disordered eating. One eating disorder of interest in this context is orthorexia nervosa, an obsession with eating healthily. High orthorexia nervosa prevalence has been found in populations who take an active interest in their health and body and is frequently comorbid with anorexia nervosa. Here, we investigate links between social media use, in particularly Instagram and orthorexia nervosa symptoms. METHODS: We conducted an online survey of social media users (N = 680) following health food accounts. We assessed their social media use, eating behaviours, and orthorexia nervosa symptoms using the ORTO-15 inventory. RESULTS: Higher Instagram use was associated with a greater tendency towards orthorexia nervosa, with no other social media channel having this effect. In exploratory analyses Twitter showed a small positive association with orthorexia symptoms. BMI and age had no association with orthorexia nervosa. The prevalence of orthorexia nervosa among the study population was 49%, which is significantly higher than the general population (<1%). CONCLUSIONS: Our results suggest that the healthy eating community on Instagram has a high prevalence of orthorexia symptoms, with higher Instagram use being linked to increased symptoms. These findings highlight the implications social media can have on psychological wellbeing, and the influence social media 'celebrities' may have over hundreds of thousands of individuals. These results may also have clinical implications for eating disorder development and recovery.

Do capuchin monkeys (Sapajus apella) prefer symmetrical face shapes?

In humans, facial symmetry has been linked to an individual's genetic quality, and facial symmetry has a small yet significant effect on ratings of facial attractiveness. The same evolutionary processes underlying these phenomena may also convey a selective advantage to symmetrical individuals of other primate species, yet to date, few studies have examined sensitivity to facial symmetry in nonhuman primates. Here we presented images of symmetrical and asymmetrical human and monkey faces to tufted capuchin monkeys (Sapajus apella) and hypothesized that capuchins would visually prefer symmetrical faces of opposite-sex conspecifics. Instead, we found that male capuchins preferentially attended to symmetrical male conspecific faces, whereas female capuchins did not appear to discriminate between symmetrical and asymmetrical faces. These results suggest that male capuchin monkeys may use facial symmetry to judge male quality in intramale competition. (PsycINFO Database Record

Promoting protection against a threat that evokes positive affect: The case of heat waves in the United Kingdom.

Heat waves can cause death, illness, and discomfort, and are expected to become more frequent as a result of climate change. Yet, United Kingdom residents have positive feelings about hot summers that may undermine their willingness to protect themselves against heat. We randomly assigned United Kingdom participants to 1 of 3 intervention strategies intended to promote heat protection, or to a control group. The first strategy aimed to build on the availability heuristic by asking participants to remember high summer temperatures, but it elicited thoughts of pleasantly hot summer weather. The second strategy aimed to build on the affect heuristic by evoking negative affect about summer temperatures, but it evoked thoughts of unpleasantly cold summer weather. The third strategy combined these 2 approaches and succeeded in evoking thoughts of unpleasantly hot summer weather. Across 2 experiments, the third (combined) strategy increased participants' expressed intentions to protect against heat compared with the control group, while performing at least as well as the 2 component strategies. We discuss implications for developing interventions about other "pleasant hazards." (PsycINFO Database Record

Functional architecture of visual emotion recognition ability: A latent variable approach.

Emotion recognition has been a focus of considerable attention for several decades. However, despite this interest, the underlying structure of individual differences in emotion recognition ability has been largely overlooked and thus is poorly understood. For example, limited knowledge exists concerning whether recognition ability for one emotion (e.g., disgust) generalizes to other emotions (e.g., anger, fear). Furthermore, it is unclear whether emotion recognition ability generalizes across modalities, such that those who are good at recognizing emotions from the face, for example, are also good at identifying emotions from nonfacial cues (such as cues conveyed via the body). The primary goal of the current set of studies was to address these questions through establishing the structure of individual differences in visual emotion recognition ability. In three independent samples (Study 1: n = 640; Study 2: n = 389; Study 3: n = 303), we observed that the ability to recognize visually presented emotions is based on different sources of variation: a supramodal emotion-general factor, supramodal emotion-specific factors, and face- and within-modality emotion-specific factors. In addition, we found evidence that general intelligence and alexithymia were associated with supramodal emotion recognition ability. Autism-like traits, empathic concern, and alexithymia were independently associated with face-specific emotion recognition ability. These results (a) provide a platform for further individual differences research on emotion recognition ability, (b) indicate that differentiating levels within the architecture of emotion recognition ability is of high importance, and (c) show that the capacity to understand expressions of emotion in others is linked to broader affective and cognitive processes.

Heat protection behaviour in the UK: results of an online survey after the 2013 heatwave.

BACKGROUND: The Heatwave Plan for England provides guidance for personal and home protection measures during heatwaves. Although studies in the USA, Australia and Europe have surveyed heat-related behaviours during heatwaves, few have been conducted in the UK. This study assesses personal and housing (at-home) behaviour and housing characteristics of the UK population during the 2013 heatwave. METHODS: This paper analyses data from 1497 respondents of an online survey on heat protection measures and behaviour. Participants were asked questions about their behaviour during the 2013 heatwave, the characteristics of their current housing as well as about any negative health outcomes experienced due to the hot weather. We used multinomial logit regression to analyse personal and home heat protection behaviour and logistic regression to analyse characteristics of participants' current home (installed air conditioner, curtains etc.). We stratified the outcomes by age, sex, ethnicity, income, education and regional location. RESULTS: In 2013, for all heat-related illness (except tiredness), a higher proportion of those in the younger age groups reported symptoms compared with those in the older age groups. Women, higher income groups and those with higher education levels were found to be more likely to report always/often taking personal heat protective measures. The elderly were less likely to take some personal and home protective measures but were more likely to live in insulated homes and open windows at night to keep their home cool. CONCLUSION: Our study has found a high level of awareness of the actions to take during heatwaves in the UK, and has identified important demographic indicators of sections of the UK population that might benefit from additional or more targeted information. The health agencies should attempt to provide better information about heatwaves to those vulnerable (elderly, those at risk living in London, low income earners) or identify any barriers that might be preventing them from undertaking protective behaviour.

Heat protection behaviors and positive affect about heat during the 2013 heat wave in the United Kingdom.

Heat waves pose serious health risks, and are expected to become more frequent, longer lasting, and more intense in the future under a changing climate. Yet, people in the UK seem to feel positive when thinking about hot weather. According to research on the affect heuristic, any positive or negative emotions evoked by potentially risky experiences may be used as cues to inform concerns about risk protection. If so, then their positive feelings toward hot weather might lead UK residents to lower intentions to adopt heat protection behaviors. Here, we examine the relationships between heat protection behaviors during the July 2013 UK heat wave and self-reports of having heard heat protection recommendations, feeling positive affect about heat, seeing heat protection measures as effective, and trusting the organizations making those recommendations. Responses to a national survey revealed that 55.1% of participants had heard heat protection recommendations during the 2013 UK heat wave. Those who reported having heard recommendations also indicated having implemented more heat protection behaviors, perceiving heat protection behaviors as more effective, feeling more positive about heat, and intending to implement more protection behaviors in future hot summers. Mediation analyses suggested that heat protection recommendations may motivate heat protection behaviors by increasing their perceived effectiveness, but undermine their implementation by evoking positive affect about hot weather. We discuss our findings in the context of the affect heuristic and its implications for heat protection communications.

Fruit over sunbed: carotenoid skin colouration is found more attractive than melanin colouration.

Skin colouration appears to play a pivotal part in facial attractiveness. Skin yellowness contributes to an attractive appearance and is influenced both by dietary carotenoids and by melanin. While both increased carotenoid colouration and increased melanin colouration enhance apparent health in Caucasian faces by increasing skin yellowness, it remains unclear, firstly, whether both pigments contribute to attractiveness judgements, secondly, whether one pigment is clearly preferred over the other, and thirdly, whether these effects depend on the sex of the face. Here, in three studies, we examine these questions using controlled facial stimuli transformed to be either high or low in (a) carotenoid colouration, or (b) melanin colouration. We show, firstly, that both increased carotenoid colouration and increased melanin colouration are found attractive compared to lower levels of these pigments. Secondly, we show that carotenoid colouration is consistently preferred over melanin colouration when levels of colouration are matched. In addition, we find an effect of the sex of stimuli with stronger preferences for carotenoids over melanin in female compared to male faces, irrespective of the sex of the observer. These results are interpreted as reflecting preferences for sex-typical skin colouration: men have darker skin than women and high melanization in male faces may further enhance this masculine trait, thus carotenoid colouration is not less desirable, but melanin colouration is relatively more desirable in males compared to females. Taken together, our findings provide further support for a carotenoid-linked health-signalling system that is highly important in mate choice.

A face for all seasons: Searching for context-specific leadership traits and discovering a general preference for perceived health.

Previous research indicates that followers tend to contingently match particular leader qualities to evolutionarily consistent situations requiring collective action (i.e., context-specific cognitive leadership prototypes) and information processing undergoes categorization which ranks certain qualities as first-order context-general and others as second-order context-specific. To further investigate this contingent categorization phenomenon we examined the "attractiveness halo"-a first-order facial cue which significantly biases leadership preferences. While controlling for facial attractiveness, we independently manipulated the underlying facial cues of health and intelligence and then primed participants with four distinct organizational dynamics requiring leadership (i.e., competition vs. cooperation between groups and exploratory change vs. stable exploitation). It was expected that the differing requirements of the four dynamics would contingently select for relatively healthier- or intelligent-looking leaders. We found perceived facial intelligence to be a second-order context-specific trait-for instance, in times requiring a leader to address between-group cooperation-whereas perceived health is significantly preferred across all contexts (i.e., a first-order trait). The results also indicate that facial health positively affects perceived masculinity while facial intelligence negatively affects perceived masculinity, which may partially explain leader choice in some of the environmental contexts. The limitations and a number of implications regarding leadership biases are discussed.

Impressions of dominance are made relative to others in the visual environment.

Face judgments of dominance play an important role in human social interaction. Perceived facial dominance is thought to indicate physical formidability, as well as resource acquisition and holding potential. Dominance cues in the face affect perceptions of attractiveness, emotional state, and physical strength. Most experimental paradigms test perceptions of facial dominance in individual faces, or they use manipulated versions of the same face in a forced-choice task but in the absence of other faces. Here, we extend this work by assessing whether dominance ratings are absolute or are judged relative to other faces. We presented participants with faces to be rated for dominance (target faces), while also presenting a second face (non-target faces) that was not to be rated. We found that both the masculinity and sex of the non-target face affected dominance ratings of the target face. Masculinized non-target faces decreased the perceived dominance of a target face relative to a feminized non-target face, and displaying a male non-target face decreased perceived dominance of a target face more so than a female non-target face. Perceived dominance of male target faces was affected more by masculinization of male non-target faces than female non-target faces. These results indicate that dominance perceptions can be altered by surrounding faces, demonstrating that facial dominance is judged at least partly relative to other faces.

Facial width-to-height ratio predicts self-reported dominance and aggression in males and females, but a measure of masculinity does not.

Recently, associations between facial structure and aggressive behaviour have been reported. Specifically, the facial width-to-height ratio (fWHR) is thought to link to aggression, although it is unclear whether this association is related to a specific dimension of aggression, or to a more generalized concept of dominance behaviour. Similarly, an association has been proposed between facial masculinity and dominant and aggressive behaviour, but, to date, this has not been formally tested. Because masculinity and fWHR are negatively correlated, it is unlikely that both signal similar behaviours. Here, we thus tested these associations and show that: (i) fWHR is related to both self-reported dominance and aggression; (ii) physical aggression, verbal aggression and anger, but not hostility are associated with fWHR; (iii) there is no evidence for a sex difference in associations between fWHR and aggression; and (iv) the facial masculinity index does not predict dominance or aggression. Taken together, these results indicate that fWHR, but not a measure of facial masculinity, cues dominance and specific types of aggression in both sexes.

Facial width-to-height ratio relates to alpha status and assertive personality in capuchin monkeys.

Social dominance hierarchies play a pivotal role in shaping the behaviour of many species, and sex differences within these hierarchies often exist. To date, however, few physical markers of dominance have been identified. Such markers would be valuable in terms of understanding the etiology of dominant behaviour and changes in social hierarchies over time. Animals may also use such traits to evaluate the potential dominance of others relative to themselves (i.e. a physical "cue"). Facial width-to-height ratio (fWHR), for example, has been suggested as a cue to dominance in humans, with links to both dominant behaviour and the perception of dominance in other individuals. Whether this association is present in non-human animals is currently not known. Therefore, here we examine within-species links between fWHR and dominant behaviour in 64 brown capuchin monkeys (Sapajus spp.) aged between 2 and 40 years. fWHR was positively associated with alpha status and with a dimensional rating of assertive personality in both males and females. Moreover, fWHR showed significant sexual dimorphism in adults but not juveniles, suggesting a developmental change may occur during puberty. In a sub-sample, sex differences were mediated by weight, suggesting fWHR dimorphism does not exceed what would be expected by differences in body weight. This is the first report of an association between face shape and behaviour in a non-human species. Results are discussed in terms of the role that face-behaviour associations might play within capuchin societies, and the possible selective forces that might have led to the evolution of fWHR-dominance associations in humans.