Quality Improvement of Sample Collection Increases the Diagnostic Accuracy of Quantitative Fecal Immunochemical Test in Colorectal Cancer Screening: A Pilot Study

Objective: The diagnostic efficiency of the quantitative fecal immunochemical test (qFIT) has large variations in colorectal cancer (CRC) screening. We aimed to explore whether the practical sample collection operant training could improve the diagnostic accuracy of the qFIT in CRC screening.Methods: Moderate-/high-risk individuals aged 50–75 years old were invited to participate in a prospective observational study between July 2020 and March 2021. Participants took a qFIT sample without fecal sample collection operant training in advance and then completed another qFIT sample after the operant training. The primary outcome was the sensitivity and specificity of the qFITs for CRC and advanced colorectal neoplasia (ACRN). The secondary outcome was the difference in the area under the curves (AUCs) and the concentrations of the fecal hemoglobin (Hb) between the qFIT without and after the operant training.Results: Out of 913 patients, 81 (8.9%) patients had ACRN, including 25 (2.7%) patients with CRC. For CRC, the sensitivities of the qFIT without and after the operant training at 10 μg/g were 80.4 and 100.0%, respectively, and the specificities were 90.1 and 88.4%, respectively. For ACRN, the sensitivities were 49.4 and 69.1% and the specificities were 91.7 and 91.3%, respectively. The AUC of the qFIT after the operant training was significantly higher than that without the operant training for CRC (p = 0.027) and ACRN (p = 0.001). After the operant training, the concentration of the fecal Hb was significantly higher than that without the operant training (p = 0.009) for ACRN, but there was no significant difference for CRC (p = 0.367).Conclusion: Practical sample collection operant training improves the diagnostic accuracy of the qFIT, which increases the detection of the low concentrations of fecal Hb. Improving the quality of the sample collection could contribute to the diagnostic efficiency of the qFIT in CRC screening.

Investigating Gaze Behaviour of Children Diagnosed with Autism Spectrum Disorders in a Classroom Setting

A defining feature of ASD is atypical gaze behaviour, however, eye-tracking studies in ‘real-world’ settings are limited, and the possibility of improving gaze behaviour for ASD children is largely unexplored. This study investigated gaze behaviour of ASD and typically developing (TD) children in their classroom setting. Eye-tracking technology was used to develop and pilot an operant training tool to positively reinforce typical gaze behaviour towards faces. Visual and statistical analyses of eye-tracking data revealed different gaze behaviour patterns during live interactions for ASD and TD children depending on the interaction type. All children responded to operant training with longer looking times observed on face stimuli post training. The promising application of operant gaze training in ecologically valid settings is discussed.

Evidence for a dissociation between causal beliefs and instrumental actions

Human experiments have demonstrated that instrumental performance of an action and the causal beliefs of the effectiveness of an action in producing a reward are correlated and controlled by the probability of an action leading to a reward. The animal literature, however, shows that instrumental performance under free-operant training differs even when the reward probabilities are matched while subjects undergo training under ratio or interval schedules of reward. In two experiments, we investigated whether causal beliefs would correlate with instrumental performance under ratio and interval schedules for matched reward probabilities. In both experiments, we found that performance was higher under ratio than under interval training. However, causal beliefs were similar between these two conditions despite these differences in instrumental performance. When reward probabilities were increased by experimental manipulations in Experiment 2, the causal beliefs increased but performance decreased with respect to Experiment 1. This is evidence that instrumental performance and causal action-reward attribution may not follow from the same psychological process under free-operant training.

Evidence for a dissociation between causal beliefs and instrumental actions

Human experiments have demonstrated that instrumental performance of an action and the causal beliefs of the effectiveness of an action in producing a reward are correlated and controlled by the probability of an action leading to a reward. The animal literature, however, shows that instrumental performance under free-operant training differs even when these reward probabilities are matched while subjects undergo training under ratio or interval schedules of reward. In two experiments, we investigated whether causal beliefs would correlate with instrumental performance under interval and ratio schedules for matched reward probabilities. In both experiments we found that performance was higher under ratio than under interval training. However, causal beliefs were similar between these two conditions despite these differences in instrumental performance. When reward probabilities were increased by experimental manipulations in Experiment 2, the causal beliefs increased but performance decreased with respect to Experiment 1. This is evidence that instrumental performance and causal action-reward attribution may not follow from the same psychological process under free-operant training.