The reflections of health service providers on implementing contingency management for methamphetamine use disorder in Australia.

INTRODUCTION: Contingency management (CM) is the most effective treatment for reducing methamphetamine use. We sought to understand why CM has not been taken up to manage methamphetamine use disorder in Australia. METHODS: Six focus groups (4-8 participants per group) were conducted with health workers from agencies in Australia that provided drug-related health care to people who use methamphetamine. These agencies had no previous experience delivering CM for substance use. The potential acceptability and feasibility of implementing CM in their services were discussed. RESULTS: Participants felt that it would be beneficial to have an evidence-based treatment for methamphetamine use disorder. This sentiment was offset by concerns that CM conflicted with a client-centred harm-reduction approach and that it dictated the goal of treatment as abstinence. It was also perceived as potentially coercive and seen to reify the power imbalance in the therapeutic relationship and therefore potentially reinforce stigma. There was also concern about the public's perception and the political acceptability of CM, who would fund CM, and the inequity of providing incentives only to clients with a methamphetamine use disorder. Some concerns could be ameliorated if the goals and structure of CM could be tailored to a client's needs. DISCUSSION AND CONCLUSIONS: Many healthcare workers were keen to offer CM as an effective treatment option for people with methamphetamine use disorder, but CM would need to be sufficiently flexible to allow it to be tailored to client needs and implemented in a way that did not adversely impact the therapeutic relationship.

Behavioral therapies targeting reward mechanisms in substance use disorders.

Behavioral therapies are considered best practices in the treatment of substance use disorders (SUD) and used as first-line approaches for SUDs without FDA-approved pharmacotherapies. Decades of research on the neuroscience of drug reward and addiction have informed the development of current leading behavioral therapies that, while differing in focus and technique, have in common the overarching goal of shifting reward responding away from drug and toward natural non-drug rewards. This review begins by describing key neurobiological processes of reward in addiction, followed by a description of how various behavioral therapies address specific reward processes. Based on this review, a conceptual 'map' is crafted to pinpoint gaps and areas of overlap, serving as a guide for selecting and integrating behavioral therapies.

Contingency inferences from base rates: A parsimonious strategy?

The pseudocontingency framework provides a parsimonious strategy for inferring the contingency between two variables by assessing the base rates. Frequently occurring levels are associated, as are rarely occurring levels. However, this strategy can lead to different contingency inferences in different contexts, depending on how the base rates vary across contexts. Here, we examine how base-rate consistency influences base-rate learning and reliance by contrasting consistent with inconsistent base rates. We hypothesized that base-rate learning is facilitated, and that people rely more on base rates if base rates are consistent. In Experiment 1, the base rates across four contexts implied the same (consistent) or different (inconsistent) contingencies. Base rates were learned equally accurately, and participants inferred contingencies that followed the base rates but deviated from the genuine contingencies within contexts, regardless of consistency. In Experiment 2, we additionally manipulated whether the context was a plausible moderator of the contingency. While we replicated the first experiment's results when the context was a plausible moderator, base-rate inferences were stronger for consistent base rates when the context was an implausible moderator. Possibly, when a moderation-by-context was implausible, participants also relied on the base-rate correlation across contexts, which implied the same contingency when base rates were consistent but was zero when the base rates were inconsistent. Thus, our findings suggest that contingency inferences from base rates involve top-down processes in which people decide how to use base-rate information.

How does social contingency facilitate vocabulary development?

Previous research shows that infants of parents who are more likely to engage in socially contingent interactions with them tend to have larger vocabularies. An open question is how social contingency facilitates vocabulary growth. One possibility is that parents who speak in response to their infants more often produce larger amount of language input, which accelerates vocabulary growth. Another possibility is that the simplicity of contingent language input is especially suitable to support early word learning. A third possibility is that more evidence of the communicative nature of language, achieved through frequent contingent responses, helps infants build a link between their own words or vocalizations and others' behaviors. This link may lead to a better understanding of the communicative nature of language and further language advances, including vocabulary growth. To distinguish between these hypotheses, we analyzed the relations between parent-infant interactions when infants were 9 months and their vocabulary size at 12 months, using a naturalistic corpus. Our findings show that the frequency of parents' verbal contingent responses predicts receptive vocabulary size at 12 months and this predictive relation is unlikely to be due to the amount of language input or the simplicity of language within socially contingent interactions. RESEARCH HIGHLIGHTS: Infants of parents who respond to their vocalizations more often during the first year of life tend to have larger vocabularies in the second year. It is an open question what drives the predictive relation between parents' responsiveness and infants' vocabulary; we tested three hypotheses that offer competing explanations. More responsive parents might provide (1) more language input, (2) simpler language input, (3) more evidence of the communicative nature of language (via frequent responses). We find support for the third hypothesis; the frequency of parents' responses predicts infants' vocabularies above and beyond the amount and simplicity of language input.

Novel risk index integrating practical operation limits enhances probabilistic contingency ranking for large-scale photovoltaic plant planning.

This research addresses the pressing need for heightened grid security amid increasing uncertainties in photovoltaic PV generation. The research problem lies in the limitations of conventional contingency analysis metrics, failing to adequately consider both contingency occurrences and uncertainties inherent in PV generation. In response, a comprehensive algorithm is proposed that introduces a novel severity function framework, enhancing traditional contingency ranking metrics. This approach incorporates grid remedial actions and refines line and bus voltage classification by considering available correction time, aiming to offer a more robust security assessment. Motivated by the imperative to address uncertainty in PV generation, the proposed work builds on established analysis tools. A probabilistic load flow algorithm manages PV generation uncertainties, utilizing historical data for contingency incidence uncertainty. Additionally, a probabilistic model for PV plants integrates historical solar data, deriving hourly probability density functions to meet grid code requirements, including reactive power considerations. The justification for this work lies in the algorithm's demonstrated efficacy, validated on the IEEE 14-bus network. Results highlight its ability to identify risks associated with line overloading and bus voltage breaches. Comparative evaluations underscore proper coupling buses for security, favoring distributed capacity to mitigate line overloading risks. The study's key results emphasize voltage risk amplification with reactive power omission, stressing the significance of compensation strategies. This research addresses a critical problem, presenting a comprehensive algorithmic solution to enhance grid security amidst uncertainties in PV integration. Findings offer valuable insights for strategically interaction between large scale PV plants and electrical grid, contributing to an improved grid security paradigm in a dynamic and uncertain energy model.

Are minimally verbal autistic children's modality and form of communication associated with parent responsivity?

Prior work examined how minimally verbal (MV) children with autism used their gestural communication during social interactions. However, interactions are exchanges between social partners. Examining parent-child social interactions is critically important given the influence of parent responsivity on children's communicative development. Specifically, parent responses that are semantically contingent to the child's communication plays an important role in further shaping children's language learning. This study examines whether MV autistic children's (N = 47; 48-95 months; 10 females) modality and form of communication are associated with parent responsivity during an in-home parent-child interaction (PCI). The PCI was collected using natural language sampling methods and coded for child modality and form of communication and parent responses. Findings from Kruskal-Wallis H tests revealed that there was no significant difference in parent semantically contingent responses based on child communication modality (spoken language, gesture, gesture-speech combinations, and AAC) and form of communication (precise vs. imprecise). Findings highlight the importance of examining multiple modalities and forms of communication in MV children with autism to obtain a more comprehensive understanding of their communication abilities; and underscore the inclusion of interactionist models of communication to examine children's input on parent responses in further shaping language learning experiences.

Experimentally Induced Reductions in Alcohol Consumption and Brain, Cognitive, and Clinical Outcomes in Older Persons With and Those Without HIV Infection (30-Day Challenge Study): Protocol for a Nonrandomized Clinical Trial.

BACKGROUND: Both alcohol consumption and HIV infection are associated with worse brain, cognitive, and clinical outcomes in older adults. However, the extent to which brain and cognitive dysfunction is reversible with reduction or cessation of drinking is unknown. OBJECTIVE: The 30-Day Challenge study was designed to determine whether reduction or cessation of drinking would be associated with improvements in cognition, reduction of systemic and brain inflammation, and improvement in HIV-related outcomes in adults with heavy drinking. METHODS: The study design was a mechanistic experimental trial, in which all participants received an alcohol reduction intervention followed by repeated assessments of behavioral and clinical outcomes. Persons were eligible if they were 45 years of age or older, had weekly alcohol consumption of 21 or more drinks (men) or 14 or more drinks (women), and were not at high risk of alcohol withdrawal. After a baseline assessment, participants received an intervention consisting of contingency management (money for nondrinking days) for at least 30 days followed by a brief motivational interview. After this, participants could either resume drinking or not. Study questionnaires, neurocognitive assessments, neuroimaging, and blood, urine, and stool samples were collected at baseline, 30 days, 90 days, and 1 year after enrollment. RESULTS: We enrolled 57 persons with heavy drinking who initiated the contingency management protocol (mean age 56 years, SD 4.6 years; 63%, n=36 male, 77%, n=44 Black, and 58%, n=33 people with HIV) of whom 50 completed 30-day follow-up and 43 the 90-day follow-up. The planned study procedures were interrupted and modified due to the COVID-19 pandemic of 2020-2021. CONCLUSIONS: This was the first study seeking to assess changes in brain (neuroimaging) and cognition after alcohol intervention in nontreatment-seeking people with HIV together with people without HIV as controls. Study design strengths, limitations, and lessons for future study design considerations are discussed. Planned analyses are in progress, after which deidentified study data will be available for sharing. TRIAL REGISTRATION: ClinicalTrials.gov NCT03353701; https://clinicaltrials.gov/study/NCT03353701. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53684.

Optimizing Contingency Management with Reinforcement Learning.

Contingency Management (CM) is a psychological treatment that aims to change behavior with financial incentives. In substance use disorders (SUDs), deployment of CM has been enriched by longstanding discussions around the cost-effectiveness of prized-based and voucher-based approaches. In prize-based CM, participants earn draws to win prizes, including small incentives to reduce costs, and the number of draws escalates depending on the duration of maintenance of abstinence. In voucher-based CM, participants receive a predetermined voucher amount based on specific substance test results. While both types have enhanced treatment outcomes, there is room for improvement in their cost-effectiveness: the voucher-based system requires enduring financial investment; the prize-based system might sacrifice efficacy. Previous work in computational psychiatry of SUDs typically employs frameworks wherein participants make decisions to maximize their expected compensation. In contrast, we developed new frameworks that clinical decision-makers choose actions, CM structures, to reinforce the substance abstinence behavior of participants. We consider the choice of the voucher or prize to be a sequential decision, where there are two pivotal parameters: the prize probability for each draw and the escalation rule determining the number of draws. Recent advancements in Reinforcement Learning, more specifically, in off-policy evaluation, afforded techniques to estimate outcomes for different CM decision scenarios from observed clinical trial data. We searched CM schemas that maximized treatment outcomes with budget constraints. Using this framework, we analyzed data from the Clinical Trials Network to construct unbiased estimators on the effects of new CM schemas. Our results indicated that the optimal CM schema would be to strengthen reinforcement rapidly in the middle of the treatment course. Our estimated optimal CM policy improved treatment outcomes by 32% while maintaining costs. Our methods and results have broad applications in future clinical trial planning and translational investigations on the neurobiological basis of SUDs.

Assessing REALTER simulator: analysis of ocular movements in simulated low-vision conditions with extended reality technology.

Immersive technology, such as extended reality, holds promise as a tool for educating ophthalmologists about the effects of low vision and for enhancing visual rehabilitation protocols. However, immersive simulators have not been evaluated for their ability to induce changes in the oculomotor system, which is crucial for understanding the visual experiences of visually impaired individuals. This study aimed to assess the REALTER (Wearable Egocentric Altered Reality Simulator) system's capacity to induce specific alterations in healthy individuals' oculomotor systems under simulated low-vision conditions. We examined task performance, eye movements, and head movements in healthy participants across various simulated scenarios. Our findings suggest that REALTER can effectively elicit behaviors in healthy individuals resembling those observed in individuals with low vision. Participants with simulated binocular maculopathy demonstrated unstable fixations and a high frequency of wide saccades. Individuals with simulated homonymous hemianopsia showed a tendency to maintain a fixed head position while executing wide saccades to survey their surroundings. Simulation of tubular vision resulted in a significant reduction in saccade amplitudes. REALTER holds promise as both a training tool for ophthalmologists and a research instrument for studying low vision conditions. The simulator has the potential to enhance ophthalmologists' comprehension of the limitations imposed by visual disabilities, thereby facilitating the development of new rehabilitation protocols.

How does the external context affect an implementation processes? A qualitative study investigating the impact of macro-level variables on the implementation of goal-oriented primary care.

BACKGROUND: Although the importance of context in implementation science is not disputed, knowledge about the actual impact of external context variables on implementation processes remains rather fragmented. Current frameworks, models, and studies merely describe macro-level barriers and facilitators, without acknowledging their dynamic character and how they impact and steer implementation. Including organizational theories in implementation frameworks could be a way of tackling this problem. In this study, we therefore investigate how organizational theories can contribute to our understanding of the ways in which external context variables shape implementation processes. We use the implementation process of goal-oriented primary care in Belgium as a case. METHODS: A qualitative study using in-depth semi-structured interviews was conducted with actors from a variety of primary care organizations. Data was collected and analyzed with an iterative approach. We assessed the potential of four organizational theories to enrich our understanding of the impact of external context variables on implementation processes. The organizational theories assessed are as follows: institutional theory, resource dependency theory, network theory, and contingency theory. Data analysis was based on a combination of inductive and deductive thematic analysis techniques using NVivo 12. RESULTS: Institutional theory helps to understand mechanisms that steer and facilitate the implementation of goal-oriented care through regulatory and policy measures. For example, the Flemish government issued policy for facilitating more integrated, person-centered care by means of newly created institutions, incentives, expectations, and other regulatory factors. The three other organizational theories describe both counteracting or reinforcing mechanisms. The financial system hampers interprofessional collaboration, which is key for GOC. Networks between primary care providers and health and/or social care organizations on the one hand facilitate GOC, while on the other hand, technology to support interprofessional collaboration is lacking. Contingent variables such as the aging population and increasing workload and complexity within primary care create circumstances in which GOC is presented as a possible answer. CONCLUSIONS: Insights and propositions that derive from organizational theories can be utilized to expand our knowledge on how external context variables affect implementation processes. These insights can be combined with or integrated into existing implementation frameworks and models to increase their explanatory power.

OASIS: An interpretable, finite-sample valid alternative to Pearson's X2 for scientific discovery.

Contingency tables, data represented as counts matrices, are ubiquitous across quantitative research and data-science applications. Existing statistical tests are insufficient however, as none are simultaneously computationally efficient and statistically valid for a finite number of observations. In this work, motivated by a recent application in reference-free genomic inference [K. Chaung et al., Cell 186, 5440-5456 (2023)], we develop Optimized Adaptive Statistic for Inferring Structure (OASIS), a family of statistical tests for contingency tables. OASIS constructs a test statistic which is linear in the normalized data matrix, providing closed-form P-value bounds through classical concentration inequalities. In the process, OASIS provides a decomposition of the table, lending interpretability to its rejection of the null. We derive the asymptotic distribution of the OASIS test statistic, showing that these finite-sample bounds correctly characterize the test statistic's P-value up to a variance term. Experiments on genomic sequencing data highlight the power and interpretability of OASIS. Using OASIS, we develop a method that can detect SARS-CoV-2 and Mycobacterium tuberculosis strains de novo, which existing approaches cannot achieve. We demonstrate in simulations that OASIS is robust to overdispersion, a common feature in genomic data like single-cell RNA sequencing, where under accepted noise models OASIS provides good control of the false discovery rate, while Pearson's [Formula: see text] consistently rejects the null. Additionally, we show in simulations that OASIS is more powerful than Pearson's [Formula: see text] in certain regimes, including for some important two group alternatives, which we corroborate with approximate power calculations.

Should contingency management protocols and dissemination practices be modified to accommodate rising stimulant use and harm reduction frameworks?

BACKGROUND: Stimulant-related overdoses have increased dramatically, with almost 50% of overdoses in the United States now involving stimulants. Additionally, harm-reduction approaches are increasingly seen as key to reducing the negative impact of substance use. Contingency management (CM), the provision of financial incentives for abstinence, is the most effective treatment for stimulant use disorder, but historically has not been widely implemented. Many recent, large-scale implementation efforts have relied upon foundational CM protocols that may not sufficiently account for recent increases in the prevalence and lethality of stimulant use nor the growing preference for harm reduction versus abstinence-only frameworks. ARGUMENT: We argue the need to (1) consider whether and how CM protocols might be modified to address rising stimulant use and harm reduction frameworks and (2) make CM widely accessible so that it can reduce population-level stimulant use while ensuring that it is delivered with fidelity to its basic principles. Proposed changes include changing CM reinforcement schedules to emphasize treatment engagement and reductions in use in addition to abstinence, changing guidelines on the duration of and re-engagement in CM, investing in research on virtual CM, incentivizing providers and health systems to deliver CM, making it easier to purchase and use point-of-care drug screens, using direct-to-consumer marketing to increase demand for CM and adapting CM to the community in which it is being implemented. CONCLUSIONS: Our proposed modifications to contingency management (CM) protocols and accessibility may more effectively address rising stimulant use and align CM more closely with harm-reduction frameworks. Given the urgent need to reduce overdose deaths, developing and testing modified CM protocols may need to rely upon methods other than randomized controlled trials. Efforts to disseminate CM widely to reduce population-level stimulant use must be balanced with the need to maintain fidelity to CM's basic principles.

Biosecurity practices in the dairy farms of southern Brazil.

Biosecurity refers to a set of practices that prevents and/or controls the introduction, spread, and elimination of harmful biological agents in a production system. In this study, we aimed to survey the biosecurity practices and determine their correlation with the size of production systems. A biosecurity assessment form was provided to 69 farms in the Campos Gerais region of Paraná, Brazil. The questionnaire was divided into two sections: general and bovine viral diarrhea virus- and bovine herpesvirus type-1-specific sections. The general section covered topics on traffic control, quarantine and animal isolation, hygiene practices, carcass disposal, and disease monitoring/control. The specific section consisted of questions on the reproductive and respiratory factors, use of antimicrobials, and vaccination schedule. The 69 farms were also classified into small (≤ 61), medium (62-201), and large (≥ 202) size farms based on the number of lactating cows. Moreover, multiple correspondence analysis (MCA) was performed between the biosecurity measures and farm size. The main risk factors and variability were related to the traffic control of people, animals, and vehicles/equipment, animal quarantine/isolation, and hygiene practices. MCA revealed that the small farms exhibited a lack of biosecurity measures, including those related to traffic control, animal quarantine, and hygiene. In medium-size farms, contact between bovine animals of different ages and difficulty in animal isolation in the quarantine system were among the main risk factors. In contrast, isolation of sick animals was easy, but the need to frequently purchase cattle was an important risk factor in large farms. These results highlight the relationship between biosecurity measures and farm size, providing valuable insights for the development of better biosecurity plans for production systems.

Theories of the origin of the genetic code: Strong corroboration for the coevolution theory.

I analyzed all the theories and models of the origin of the genetic code, and over the years, I have considered the main suggestions that could explain this origin. The conclusion of this analysis is that the coevolution theory of the origin of the genetic code is the theory that best captures the majority of observations concerning the organization of the genetic code. In other words, the biosynthetic relationships between amino acids would have heavily influenced the origin of the organization of the genetic code, as supported by the coevolution theory. Instead, the presence in the genetic code of physicochemical properties of amino acids, which have also been linked to the physicochemical properties of anticodons or codons or bases by stereochemical and physicochemical theories, would simply be the result of natural selection. More explicitly, I maintain that these correlations between codons, anticodons or bases and amino acids are in fact the result not of a real correlation between amino acids and codons, for example, but are only the effect of the intervention of natural selection. Specifically, in the genetic code table we expect, for example, that the most similar codons - that is, those that differ by only one base - will have more similar physicochemical properties. Therefore, the 64 codons of the genetic code table ordered in a certain way would also represent an ordering of some of their physicochemical properties. Now, a study aimed at clarifying which physicochemical property of amino acids has influenced the allocation of amino acids in the genetic code has established that the partition energy of amino acids has played a role decisive in this. Indeed, under some conditions, the genetic code was found to be approximately 98% optimized on its columns. In this same work, it was shown that this was most likely the result of the action of natural selection. If natural selection had truly allocated the amino acids in the genetic code in such a way that similar amino acids also have similar codons - this, not through a mechanism of physicochemical interaction between, for example, codons and amino acids - then it might turn out that even different physicochemical properties of codons (or anticodons or bases) show some correlation with the physicochemical properties of amino acids, simply because the partition energy of amino acids is correlated with other physicochemical properties of amino acids. It is very likely that this would inevitably lead to a correlation between codons (or anticodons or bases) and amino acids. In other words, since the codons (anticodons or bases) are ordered in the genetic code, that is to say, some of their physicochemical properties should also be ordered by a similar order, and given that the amino acids would also appear to have been ordered in the genetic code by selection natural, then it should inevitably turn out that there is a correlation between, for example, the hydrophobicity of anticodons and that of amino acids. Instead, the intervention of natural selection in organizing the genetic code would appear to be highly compatible with the main mechanism of structuring the genetic code as supported by the coevolution theory. This would make the coevolution theory the only plausible explanation for the origin of the genetic code.

Contingency management for smoking cessation for individuals with overweight or obesity: A randomized controlled trial.

BACKGROUND: Interventions for quitting smoking and weight control among individuals with excess weight are scarce. Our study evaluated the effectiveness of cognitive behavioral therapy (CBT) plus contingency management (CM) in this population, and examined whether CM for smoking cessation improved CBT treatment outcomes at end of treatment (EOT) and at 1-, 3-, 6-, and 12-month follow-ups (FU). METHODS: In an 8-week randomized clinical trial, 120 adults who smoke with overweight or obesity (54.16% females; MBMI = 31.75 ± 4.31) were randomly assigned to CBT for both quitting smoking and weight control (n = 60) or the same treatment plus CM for smoking cessation (n = 60). Outcome variables were compared (i.e., treatment completion, smoking abstinence, weight change and secondary outcomes). RESULTS: At EOT, the CBT + CM group achieved 78.33% 7-day point-prevalence abstinence rates compared to 61.67% in the CBT group (p = .073), and rates declined over time (12-month FU: 18% vs 12%). Participants who attained abstinence weighed more compared to baseline at EOT (Mkg = 1.07; SD = 1.88) and over time (12-month FU: Mkg = 4.19; SD = 4.31). No differences were found between the two groups in outcome variables. CONCLUSIONS: Both interventions were effective in promoting abstinence and reducing tobacco use over time. Combining CBT with CM for smoking cessation did not improve treatment outcomes in individuals with overweight or obesity compared to CBT only. Future studies should evaluate whether implementing CM for weight maintenance helps control post-cessation weight gain in this population.

[The neural basis of face-to-face communication: exploring transmission and sharing through neuroimaging].

Effective human communication is a complex process that involves transmitting and sharing information, ideas, and attitudes between two or more individuals. Researchers need to explore both transmission and sharing concepts to understand the neural basis of communication. Face-to-face communication refers to changing someone's mental state by sharing information, ideas, or attitudes. This type of communication is characterized by "mutual predictability." Scientists are working to clarify the neural basis of communication by studying how inter-individual synchronization of behavior and neural activity occurs during face-to-face communication.

Building language learning: Relations between infant attention and social contingency in the first year of life.

In Western societies, social contingency, or prompt and meaningful back-and-forth exchanges between infant and caregiver, is a powerful feature of the early language environment. Research suggests that infants with better attentional skills engage in more social contingency during interactions with adults and, in turn, social contingency supports infant attention. This reciprocity is theorized to build infant language skills as the adult capitalizes on and extends the infant's attention during socially contingent interactions. Using data from 104 infants and caregivers, this paper tests reciprocal relations between infant attention and social contingency at 6- and 12-months and the implications for infant vocabulary at 18-months. Infant attentional skills to social (women speaking) and nonsocial (objects dropping) events were assessed, and social contingency was examined during an 8-minute toy play interaction with a caregiver. Child receptive and expressive vocabulary was measured by caregiver-report. Both social and nonsocial attentional skills related to engagement in social contingency during caregiver-infant interaction, though only models that included social attention and social contingency predicted vocabulary. These findings provide empirical evidence for the proposed reciprocal relations between infant attention and social contingency as well as how they relate to later language.

Priority effects transcend scales and disciplines in biology.

Although primarily studied through the lens of community ecology, phenomena consistent with priority effects appear to be widespread across many different scenarios spanning a broad range of spatial, temporal, and biological scales. However, communication between these research fields is inconsistent and has resulted in a fragmented co-citation landscape, likely due to the diversity of terms used to refer to priority effects across these fields. We review these related terms, and the biological contexts in which they are used, to facilitate greater cross-disciplinary cohesion in research on priority effects. In breaking down these semantic barriers, we aim to provide a framework to better understand the conditions and mechanisms of priority effects, and their consequences across spatial and temporal scales.

Exploring resonance theory and uncontrollability during co-creative art making: A qualitative study among cancer patients.

PURPOSE: Co-creation, characterised by artists and patients creating a joint work of art, may support patients with the integration of life events, such as living with cancer, into their life story. In the process of co-creation, resonance relationships between patients, artists and material may evolve that support such integration. Using the framework of resonance theory, we aim to investigate if and how patients move through the three phases of resonance during a process of co-creation and explore the role of uncontrollability in this process. METHODS: Ten patients who received cancer treatment with palliative intent completed co-creation processes, which were audio recorded. These recordings were imported in Atlas-Ti and analysed by applying content analysis. We searched for the three phases of resonance, Being affected, touched and moved; Self-efficacy and responding; Adaptive transformation. We additionally searched for signs of uncontrollability. RESULTS: Patients used 4-8 sessions (median 5 sessions) with a duration 90-240 min per session (median duration 120 min). We found that patients move through the three phases of resonance during co-creation processes. Uncontrollability both presents a challenge and an invitation to integrate experiences of contingency into one's life narrative. Patients express self-recognition and the experience of contingency in their work of art. CONCLUSIONS: Integration of experiences of contingency into a life narrative can be supported by the process of co-creation of art, which invites patients to relate to their illness, their environment and themselves. The phases of resonance in combination with uncontrollability as a continuously present factor, provide a means to both study and support the integration of experiences of contingency into the life narrative.