Search

Background Cardiac rehabilitation improves health and quality of life and reduces risk of further cardiac events. Twenty-eight per cent of cardiac rehabilitation patients experience clinically significant anxiety and 19% suffer depression. Such patients are at greater risk of death, further cardiac events and poorer quality of life and use more health care, leading to higher NHS costs. The available psychological treatments for cardiac patients have small effects on anxiety and depression and quality of life; therefore, more effective treatments are needed. Research shows that a thinking style dominated by rumination and worry maintains anxiety and depression. A psychological intervention (metacognitive therapy) effectively reduces this style of thinking and alleviates depression and anxiety in mental health settings. The PATHWAY study evaluated two versions of metacognitive therapy applied in cardiac rehabilitation services. Objectives The primary aim was to improve psychological outcomes for cardiac rehabilitation patients. We evaluated two formats of metacognitive therapy: (1) a group-based face-to-face intervention delivered by cardiac rehabilitation staff (group-based metacognitive therapy) and (2) a paper-based, self-directed intervention (home-based metacognitive therapy). Each was compared with usual cardiac rehabilitation alone in separate randomised controlled trials. Design A randomised feasibility trial (work stream 1) and a full-scale randomised controlled trial (work stream 2) evaluated group-metacognitive therapy, while separate feasibility and full-scale trials (work stream 3 and work stream 3+, respectively) evaluated home-based metacognitive therapy. A cost-effectiveness analysis of group-metacognitive therapy was conducted, along with stated preference surveys and qualitative studies examining patient psychological needs and therapists’ perspectives on metacognitive therapy. Setting Seven NHS cardiac rehabilitation services across the north-west of England. Participants Adults aged ≥ 18 years who met cardiac rehabilitation eligibility criteria, scored ≥ 8 on depression or anxiety subscales of the Hospital Anxiety and Depression Scale, and were able to read, understand and complete questionnaires in English. Interventions Work stream 1 and work stream 2 – a 6-week group-metacognitive therapy intervention delivered by cardiac rehabilitation staff plus usual cardiac rehabilitation compared with usual cardiac rehabilitation alone. Group-metacognitive therapy was delivered once per week for 6 weeks, with each session lasting 90 minutes. Work stream 3 and work stream 3+ – home-based metacognitive therapy plus usual cardiac rehabilitation compared with usual cardiac rehabilitation alone. Home-metacognitive therapy was a paper-based manual that included six modules and two supportive telephone calls delivered by cardiac rehabilitation staff. Main outcome measures The Hospital Anxiety and Depression Scale total score at 4-month follow-up was the primary outcome in all trials. A range of secondary outcomes were also evaluated. Results Our qualitative study with 46 patients across three cardiac rehabilitation services suggested that cardiac rehabilitation patients’ psychological needs were not met by current approaches and that metacognitive therapy might offer an improved fit with their psychological symptoms. The internal pilot feasibility study (work stream 1; n = 54) demonstrated that a full-scale randomised controlled trial was feasible and acceptable and confirmed our sample size estimation. A subsequent full-scale, single-blind randomised controlled trial (work stream 2; n = 332) showed that adding group-based metacognitive therapy to cardiac rehabilitation was associated with statistically significant improvements on the Hospital Anxiety and Depression Scale (primary outcome) in anxiety and depression compared with cardiac rehabilitation alone at 4-month (adjusted mean difference −3.24, 95% confidence interval −4.67 to −1.81, p < 0.001; standardised mean difference 0.52) and 12-month follow-up (adjusted mean difference −2.19, 95% confidence interval −3.72 to −0.66, p = 0.005; standardised mean difference 0.33). The cost-effectiveness analysis suggested that group-metacognitive therapy was dominant, that it could be cost saving (net cost −£219, 95% confidence interval −£1446 to £1007) and health increasing (net quality-adjusted life-year 0.015, 95% confidence interval −0.015 to 0.045). However, confidence intervals were wide and overlapped zero, indicating high variability in the data and uncertainty in the estimates. A pilot feasibility trial (work stream 3; n = 108) supported a full-scale trial of home-metacognitive therapy and was extended (work stream 3+; n = 240). In the full trial, the adjusted mean difference on the Hospital and Anxiety and Depression Scale favoured the metacognitive therapy + cardiac rehabilitation arm (adjusted mean difference −2.64, 95% confidence interval −4.49 to −0.78, p = 0.005; standardised mean difference 0.38), with statistically significant greater improvements in anxiety and depression in home-metacognitive therapy plus cardiac rehabilitation than in cardiac rehabilitation alone at 4-month follow-up. A stated preference survey on clinic-delivered psychological therapy (not specific to metacognitive therapy) indicated a preference for including psychological therapy as part of cardiac rehabilitation. Participants favoured individual therapy, delivered by cardiac rehabilitation staff, with information provided prior to therapy and at a lower cost to the NHS. A pilot stated preference study focused on preferences for home- or clinic-based psychological therapy. Preferences were stronger for home-based therapy than for centre-based, but this was not statistically significant and participants highly valued receiving therapy and having reduced waiting times. Limitations Limitations include no control for additional contact as part of metacognitive therapy to estimate non-specific effects. Work stream 3+ did not include 12-month follow-up and therefore the long-term effects of home-based metacognitive therapy are unknown. The health economics analysis was limited by sample size and large amount of missing data in the final follow up. Findings from the qualitative study cannot necessarily be generalised. Conclusions Both group-based and home-based metacognitive therapy were associated with significantly greater reductions in anxiety and depression symptoms at 4 months, compared with cardiac rehabilitation alone. The results in group-based metacognitive therapy appeared to be stable over 12 months. Introducing metacognitive therapy into cardiac rehabilitation has the potential to improve mental health outcomes. Future work Future studies should evaluate the long-term effects of home-metacognitive therapy and the effect of metacognitive therapy against other treatments offered in cardiac rehabilitation. Given the uncertainty in the economic evaluation, further work is needed to determine the cost-effectiveness of metacognitive therapy. Trial registration Work stream 1/work stream 2: NCT02420431 and ISRCTN74643496; work stream 3: NCT03129282; work stream 3+: NCT03999359. The trial is registered with clinicaltrials.gov NCT03999359. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research Programme (NIHR award ref: RP-PG-1211-20011) and is published in full in Programme Grants for Applied Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information. Plain language summary Depression and anxiety are common among cardiac rehabilitation patients. Cardiac patients with anxiety and depression are at greater risk of death, further cardiac events and poorer quality of life and use more health care, leading to higher NHS costs. Current talking-based therapies have small effects on anxiety and depression in patients with cardiovascular disease. It is important that more effective treatments for mental health are added to cardiac rehabilitation. We applied two versions of a recent treatment called metacognitive therapy in cardiac rehabilitation: a group version and a home-based (self-help) paper-based manual. The programme had three work streams conducted across seven NHS trusts. In work stream 1, we ran a pilot trial showing that adding group-metacognitive therapy to cardiac rehabilitation was feasible and acceptable A full-scale trial (work stream 2) followed, and this showed that adding group-metacognitive therapy to cardiac rehabilitation was associated with greater improvement in anxiety and depression than cardiac rehabilitation alone. In work stream 3, we created a home-based version of metacognitive therapy and ran a feasibility trial, which was extended to a full-scale trial and showed that home-metacognitive therapy plus cardiac rehabilitation was associated with improved anxiety and depression outcomes compared with cardiac rehabilitation alone. Interview studies of patients’ needs, treatment preferences and reactions to treatment were included, and our patient and public involvement group advised the research team throughout the trial. The originator of metacognitive therapy, Adrian Wells, was the chief investigator of the study and is the director of the Metacognitive Therapy Institute. He has funding for the study ‘Implementing Group Metacognitive Therapy in Cardiac Rehabilitation Services (PATHWAY-Beacons; NIHR29567)’ as chief investigator. To maintain objectivity along with the trial statistician and research assistants he did not know patient treatment allocation, data were managed by a separate clinical trials unit and a plan for analysis was devised before analysis took place. Project oversight and monitoring were undertaken by an independent Trial Steering Committee. Scientific summary Background Cardiac rehabilitation (CR) aims to improve heart disease patients’ health and quality of life and reduce the risk of further cardiac events: 28% of cardiac patients have clinically significant anxiety and 19% have depression. Such patients are at greater risk of death, further cardiac events and poorer quality of life and use more health care, leading to higher NHS costs. Available psychological treatments for patients with heart disease have small effects on improving anxiety, depression and quality of life. Therefore, more effective treatments for depression and anxiety need to be explored and made available in CR services. Research in mental health contexts shows that a style of thinking dominated by rumination and worry maintains distress. A psychological intervention [metacognitive therapy (MCT)] reduces this style of thinking and alleviates depression and anxiety. The PATHWAY study evaluated two versions of MCT applied in heart disease patients attending CR: (1) a 6-week intervention delivered face to face in a group setting by CR staff (group-based MCT) and (2) a paper-based, six-module, self-directed intervention (home-based MCT). Objectives The primary aim is to improve access to more effective psychological interventions for the range of heart disease patients attending CR services. The specific objectives were to: conduct a pilot randomised controlled trial (RCT) of group-based MCT (Group-MCT) to evaluate the acceptability and feasibility of delivering the intervention to CR patients who have symptoms of anxiety and depression establish evidence of the effectiveness and cost-effectiveness of Group-MCT in CR in a full-scale RCT produce a rigorous, well-specified Group-MCT package develop a home-based metacognitive intervention (Home-MCT) for CR patients with depression and/or anxiety establish the feasibility and acceptability of integrating Home-MCT into the CR pathway in a pilot RCT establish provisional evidence of the effectiveness and cost-effectiveness of Home-MCT develop a protocol and manual for Home-MCT to inform a full-scale RCT conduct a full-scale RCT evaluating the effectiveness of Home-MCT. Methods We conducted a randomised controlled pilot trial and a full-scale RCT comparing usual CR alone against CR plus group-based MCT [work stream (WS) 1 and WS2; n = 332)]. We also conducted a randomised controlled pilot trial and a full-scale RCT of home-based metacognitive therapy (WS3 and WS3+; n = 240). All trials included integrated qualitative (n = 52) and economic evaluations (n = 339; stated preference survey). Participants A total of seven NHS trusts that provided a routine CR service participated in the research, with the number of participants and specific sites varying by trial. Work streams 1 and 2 explored the acceptability and effectiveness of Group-MCT integrated into usual CR in hospital settings, whereas WS3 and WS3+ explored the acceptability and effectiveness of Home-MCT integrated into usual CR in hospital and community settings. Work stream 1 recruited participants from three NHS trusts in north-west England. Participant recruitment for WS2 took place in five NHS trusts across north-west England. WS3 and WS3+ patients were recruited from CR services at five NHS hospital trusts across north-west England. Participating CR patients in all trials had to score ≥ 8 on the anxiety and/or depression subscale of the Hospital Anxiety and Depression Scale (HADS), be aged ≥ 18 years and meet the British Association for Cardiovascular Prevention and Rehabilitation criteria for attending CR. Participants were randomly allocated in a one-to-one ratio to receive either MCT plus usual CR or usual CR only using a randomisation procedure that balanced the trial arms with respect to gender, HADS scores and trial sites. Interventions Group-MCT: a 6-week manualised MCT intervention delivered face to face in a group setting. Therapists were CR staff who were not mental health specialists (e.g. clinical psychologists) but were trained to deliver the intervention. The intervention was developed by Adrian Wells based on the metacognitive model of psychological disorder and uses effective metacognitive therapy methods tested in mental health settings. Home-MCT: a paper-based, self-directed MCT intervention consisting of six modules in a treatment manual following a structure and content like that of the group-based MCT intervention. Adrian Wells provided pre-trial training for staff but was not involved in the ongoing supervision of staff delivering the intervention to maintain blinding and objectivity. Outcome measures The primary outcome was HADS total score at 4 months, with HADS total scores at 12 months as a secondary outcome (WS1 and WS2, i.e. Group-MCT only). Other secondary outcomes were the separate HADS anxiety and depression subscales, traumatic stress symptoms, and psychological mechanisms including metacognitive beliefs and repetitive negative thinking. For both interventions, qualitative interviews were conducted to assess patients’ emotional experiences and needs following cardiac events, and their understanding and experience of MCT. In Group-MCT, practitioners were interviewed to understand their experience of delivering the intervention and their understanding of patients’ responses to it and patients’ emotional needs. Statistical analysis For the pilot studies, statistical analysis was principally descriptive. We assessed the acceptability of adding Group-MCT and Home-MCT to usual CR regarding rates of recruitment into the study, attrition by the primary end point, and numbers of MCT and CR modules/sessions completed. The feasibility of conducting a full RCT was assessed against the completion of follow-up questionnaires, adequate variability in the outcome measures, and re-estimation of the required sample size based on pilot study findings. Therapist adherence to the Group-MCT treatment protocol was also assessed. The full-scale RCTs of Group-MCT and Home-MCT were designed to detect a standardised mean difference (SMD) between trial arms of 0.4 in HADS total score at 4-month follow-up with 90% power, based on effect sizes reported for other psychological interventions for depression. Analysis was conducted following a prespecified plan detailing the analytic models, primary and secondary outcomes, choice of covariates, sensitivity analyses, and all other key aspects of the analysis. The primary analyses used intention-to-treat principles. To reduce bias, data from the trial were managed by a separate clinical trials unit and locked prior to analysis. The chief investigator (AW), trial statisticians and research assistants were kept unaware of patient treatment allocation throughout the programme and the analyses followed a prespecified plan. Cost-effectiveness analysis For Group-MCT only, a within-trial cost-effectiveness analysis with a 12-month time horizon compared the cost-effectiveness of MCT plus usual CR with that of CR alone, from a UK health and social care perspective. Key measures included health status (measured using the EuroQol-5 Dimensions, five-level) and self-reported health and social care use. Total costs and quality-adjusted life-years (QALYs) were calculated for the trial follow-up. Missing values were addressed using multiple imputation. The primary outcome was the incremental cost-effectiveness ratio. Regression analysis was used to estimate net costs and net QALYs, and 10,000 bootstrapped pairs of net costs and QALYs were generated to inform the probability of cost-effectiveness. For the home-based MCT pilot study, a simple between-group comparison of the available economic data (health status and NHS and social care costs), using summary statistics, was performed. Two stated preference studies (using discrete choice experiment designs), one focused on Group-MCT and the other on Home-MCT, were conducted to explore patient preferences for the delivery of psychological therapy in CR. Participants were asked to choose between two hypothetical interventions, described using five attributes. The cost to the NHS was used to estimate willingness to pay for aspects of intervention delivery. Results Group-MCT Fifty-two CR patients were consented to the pilot trial of Group-MCT + CR versus CR alone, of whom 23 were randomly allocated to Group-MCT + CR and 29 to CR. The trial recruited to target, and > 70% of participants completed the 4-month follow-up questionnaire. More than half of the patients in both arms attended at least six CR sessions, and 57% of Group-MCT participants completed an a priori defined minimal dose of the intervention likely to produce the benefit of at least four of the six MCT sessions. The addition of MCT to rehabilitation did not negatively impact on CR attendance, and we observed high therapist adherence to the protocol. The trial concluded that Group-MCT is an acceptable and feasible intervention to deliver in CR services. The Trial Steering Committee and NIHR as funder agreed to support the progression to a full-scale RCT of the Group-MCT intervention. No substantive changes were required to the trial procedures; therefore, the pilot and full RCT samples were pooled for final analysis. A total of 332 patients (including 52 from the pilot trial) consented to the full-scale RCT of Group-MCT + CR versus CR alone, with 163 randomly allocated to Group-MCT + CR and 169 randomly allocated to CR alone; 81% returned data at 4-month follow-up. The adjusted group difference on the primary outcome of HADS total score at 4 months significantly favoured Group-MCT + CR [–3.24, 95% confidence interval (CI) –4.67 to –1.81, p < 0.001; SMD 0.52], as did the difference at the 12-month secondary outcome point (–2.19, 95% CI –3.72 to –0.66, p < 0.01; SMD 0.33). Patients in the Group-MCT + CR arm also had lower mean HADS anxiety and depression subscale scores at 4 months (p < 0.001). Differences in anxiety remained statistically significant at 12 months (p < 0.01), but those in depression did not (p = 0.065). Most of the other secondary outcomes also favoured the MCT intervention. Attendance at CR sessions did not differ between trial arms. Over 60% of Group-MCT + CR participants attended four or more of the six MCT intervention sessions. However, Group-MCT did not appeal to some patients, with 40 (25%) of the 163 patients randomised to receive MCT attending no MCT intervention sessions. Home-MCT One hundred and eight CR patients consented to the pilot trial of Home-MCT, with 54 randomised to Home-MCT + CR and 54 randomised to CR alone. The trial recruited to target, with 96% of CR only and 83% of Home-MCT + CR participants completing 4-month follow-up measures. Forty-four per cent of patients in the MCT arm completed a minimally effective dose of more than four out of six modules. Exit questionnaire ratings were good. However, views about telephone support were mixed and the quality of calls was rated low. Home-MCT appeared to be acceptable and feasible to deliver in CR services. The Trial Steering Committee and NIHR as funder agreed to support the progression to a full-scale RCT of the Home-MCT intervention. We submitted a no-additional-cost variation to contract (VTC) on 29 January 2019 to progress WS3 to a full-scale RCT (WS3+). The VTC was awarded on 12 March 2019. No substantive changes were required to the trial procedures; therefore, the pilot sample was pooled with the sample from the full RCT in final analysis. A total of 240 patients (including 108 from the pilot trial) were consented to the full-scale RCT of Home-MCT, with 118 randomly allocated to Home-MCT + CR and 122 randomly allocated to CR alone; 89% returned 4-month follow-up data. The adjusted group difference on the primary outcome of HADS total score at 4 months significantly favoured the MCT + CR arm (−2.64, 95% CI −4.49 to −0.78, p = 0.005; SMD 0.38). Patients in the MCT + CR arm also reported significantly lower mean HADS anxiety and depression scores (p < 0.05). Most other secondary outcomes also favoured the MCT intervention. Attendance at CR sessions did not differ between the trial arms. Over 70% of participants in the Home-MCT arm completed more than four MCT modules, but the intervention did not appeal to some patients; 21 participants (18%) withdrew or were not contactable at 4 months, compared with only one in the CR-alone arm. An investigation of the impact of differential attrition on the findings using last-observation-carried-forward resulted in no changes in statistical significance for the primary outcome and most of the secondary outcomes. In the primary cost-effectiveness analysis, the Group-MCT intervention was dominant, that is cost saving (net cost −219, 95% CI −£1446 to £1007) and health increasing (net QALY 0.015, 95% CI −0.015 to 0.045). However, the CIs are wide and overlap zero, indicating a high level of variability in the data and uncertainty in the estimates. Stated preference research indicated a preference for the inclusion of psychological therapy as part of a programme of CR. Conclusions There is not currently a standardised approach for psychological interventions in CR, and interventions can vary. There is a preference for the inclusion of psychological therapy in rehabilitation. Group-based MCT and Home-MCT were associated with significantly better anxiety and depression outcomes when added to CR compared with CR alone. The implications for health care are (1) MCT could be provided as part of the menu of approaches used in CR and (2) patients could be given the option to choose between group-based or home-based treatment to increase access. The recommendations for future research are (1) implementation studies that assess barriers to and enablers of roll-out in the NHS, (2) studies of longer-term outcomes of home-based MCT and (3) an evaluation of MCT against alternative therapies. Trial registration Work stream 1/work stream 2: NCT02420431 and ISRCTN74643496; work stream 3: NCT03129282; work stream 3+: NCT03999359. The trial is registered with clinicaltrials.gov NCT03999359. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: RP-PG-1211-20011) and is published in full in Programme Grants for Applied Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information.

Background To encourage participation in trials, people need to have a positive experience. However, researchers do not routinely measure participant experience. Our aim is to facilitate routine measurement by developing a measure that captures the participant perspective, in a way that is meaningful, acceptable and useful to trial teams and participants. Methods We conducted a focus group and 25 interviews with trial professionals and trial participants to explore how participant experiences of trials should be measured, and to identify domains and items to include in the measure. Interviewees were also asked to comment on a list of candidate domains and items informed by a previous review of the literature on participant experience measures. Interviews were analysed thematically. Candidate domains and items were incorporated into a draft measure. Cognitive testing was undertaken in two rounds to ensure the items were comprehensible and grounded in participant experience. Results Interviewees and patient and public contributors reported that standardising the measurement of participant experience of trials had the potential to improve trial experience but described issues around the timing of measurement. Cognitive testing highlighted issues with comprehension, recall and response and numerous items were removed or refined. We developed a standard and a short version of the measure for feasibility testing. Conclusions We developed a measure covering important domains of participant experience of trials, which could assist trial teams and participants to improve trial design and enhance delivery of a meaningful participant experience.

Abstract Background Patient and Public Involvement (PPI) in research has become a key component recommended by research commissioners, grant award bodies and specified in government policies. Despite the increased call for PPI, few studies have demonstrated how to implement PPI within large‐scale research studies. Objective The aim of the current study was to provide a case example of the implementation of a patient advisory group in a large‐scale mental health research programme (PATHWAY) and to benchmark this against UK standards. Method A PPI group was incorporated throughout the PATHWAY research programme, from grant development to dissemination. The group attended regular meetings and supported participant recruitment, evaluated patient‐facing documents, supported the piloting of the research intervention and co‐developed the dissemination and impact strategy. The implementation of PPI throughout the project was benchmarked against the UK standards for PPI. Results The inclusion of PPI in the PATHWAY project provided tangible changes to the research project (i.e., improving study documents, co‐developing dissemination materials) but also proved to be a beneficial experience to PPI members through the development of new skills and the opportunity to provide a patient voice in research. We show how PPI was involved across seven study phases and provide examples of implementation of the six UK standards. The study did not include PPI in data analysis but met all the UK standards for PPI. Challenges regarding practical components (i.e., meeting frequency, language use), increasing diversity and PPI members' knowledge of research were highlighted as areas for further improvement. Conclusions We provide a case example of how PPI can be implemented throughout a research lifecycle and we note the barriers faced and make suggestions for PPI in future implementation and research. Patient and Public Contribution PPI members were involved throughout the lifecycle of the research programme. The PPI lead was a co‐author on the manuscript and contributed to report writing.

Objectives Primary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need.Design Focus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach.Setting Focus groups and interviews were conducted in community settings in the UK.Participants Fifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else.Results Participants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated.Conclusions Discussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service.

Previous research has shown that acute competition training stress negatively affects neuromuscular function which can perpetuate a predisposition to injury. This study's aim was to investigate the effect of accumulated competition training stress effect on neuromuscular function and incidence of increased injury risk in uninjured female D1 soccer players. Neuromuscular function was evaluated in fifteen female division I soccer athletes who played >85% of competitive season competitions who were tested for mobility/stability, leg length symmetry, and vertical power at three different points across the competitive season (pre, mid, and post time blocks). Leg length symmetry was measured from the anterior superior iliac spine to the lateral malleolus prior to Y-balance testing. The Y-balance testing measures unilateral anterior, posteromedial, and posterolateral reach achieved in single leg stance using metrics that include L/R normalized composite reach (NCOMP), L/R normalized antiorior reach (NANT), and L/R NCOMP/NANT segmental differences across time. Injury risk was evaluated using validated objective criteria that included: (NCOMP total reach 4.0. Maximal vertical power (MVP) was measured via vertical jump. Multiple repeated measures ANOVAs evaluated NCOMP, NANT, MVP, and leg length symmetry across time with LSD post hoc testing when relevant (X ± SD). A significant main effect was found [F(1, 14) = 62.92, p < 0.001; η2 =0.82] with training stress and neuromuscular function without affecting maximal vertical power. Eighty percent of subject's bilateral NCOMP scores fell below the YBT reach standard at midseason (ES = 0.95, p = 0.02) while all subjects NANT reach distance remained below the reach threshold (ES = 0.74, p = 0.003) indicating a 6.5× and 2.5× greater injury risk, respectively. Competition stress affected neuromuscular function without affecting maximal power, which negatively impacted stability and increased injury risk.

Abstract Background Electronic administrative data exist in several domains which, if linked, are potentially useful for research. However, benefits from data linkage should be considered alongside risks such as the threat to privacy. Avon Longitudinal Study of Parents and Children (ALSPAC) is a birth cohort study. The Project to Enhance ALSPAC through Record Linkage (PEARL) was established to enrich the ALSPAC resource through linkage between ALSPAC participants and routine sources of health and social data. Qualitative research was incorporated in the PEARL study to examine participants’ views about data linkage and inform approaches to information sharing. This paper focusses on issues of consent. Methods Digitally recorded interviews were conducted with 55 participants aged 17–19 years. Terms and processes relating to consent, anonymization and data linkage were explained to interviewees. Scenarios were used to prompt consideration of linking different sources of data, and whether consent should be requested. Interview recordings were fully transcribed. Thematic analysis was undertaken using the Framework approach. Results Participant views on data linkage appeared to be most influenced by: considerations around the social sensitivity of the research question, and; the possibility of tangible health benefits in the public interest. Some participants appeared unsure about the effectiveness of anonymization, or did not always view effective anonymization as making consent unnecessary. This was related to notions of ownership of personal information and etiquette around asking permission for secondary use. Despite different consent procedures being explained, participants tended to equate consent with ‘opt-in’ consent through which participants are ‘asked’ if their data can be used for a specific study. Participants raising similar concerns came to differing conclusions about whether consent was needed. Views changed when presented with different scenarios, and were sometimes inconsistent. Conclusions Findings from this study question the validity of ‘informed consent’ as a cornerstone of good governance, and the extent to which potential research participants understand different types of consent and what they are consenting, or not consenting, to. Pragmatic, imaginative and flexible approaches are needed if research using data linkage is to successfully realise its potential for public good without undermining public trust in the research process.

This study assessed how seasonal transitions and coaching influence affect aerobic capacity (AC) and body composition across the annual training cycle (ATC). Eleven division 1 female soccer players were tested after five predesignated time blocks (B1–B5): post-season 2016 (B1), nine-week transition (B2), spring season (B3), pre-season (B4), and post-season 2017 (B5). Height, weight, and body composition (fat-free mass (FFM)) were measured prior to a standardized 5 min treadmill running and dynamic movement warm up before a maximal AC test. Statistical analysis included a 4 × 5 repeated-measures analysis of variance (ANOVA) (dependent variable × time) with the Fishers Least Significant Difference (LSD) post-hoc test when relevant; data are presented as mean ± standard deviation, effect size (ES), and percent change (%). The statistical analysis revealed that the ATC had a significant main effect on AC and FFM (F3,4 2.81, p = 0.001; η2 = 0.22). There were significant increases in AC across the transition period (B1–B2) with reduced training volume (∆ + 12.9%, p = 0.001; ES = 0.50) while AC and FFM peaked after the spring season with directed concurrent training paired with adequate rest B1–B3 (∆ + 16.4%, p < 0.01; ES = 0.81). AC decreased across the pre-season with indirect training (B3–B4) (∆ − 7.0%, p = 0.02; ES = 0.50) and remained suppressed without change (p > 0.05) across the competitive season (B4–B5). Rest, concurrent training, and directed training positively affected AC, while indirect training and high training loads with little rest negatively affected AC.

ABSTRACT Background Electronic administrative data exist in several domains which, if linked, are potentially useful for research. However, benefits from data linkage should be considered alongside risks such as the threat to privacy. Avon Longitudinal Study of Parents and Children (ALSPAC) is a birth cohort study. The Project to Enhance ALSPAC through Record Linkage (PEARL) was established to enrich the ALSPAC resource through linkage between ALSPAC participants and routine sources of health and social data. Qualitative research was incorporated in the PEARL study to examine participants’ views about data linkage and inform approaches to information. This paper focusses on issues of consent. Methods Digitally recorded interviews were conducted with 55 participants aged 17-19 years. Terms and processes relating to consent, anonymization and data linkage were explained to interviewees. Scenarios were used to prompt consideration of linking different sources of data, and whether consent should be requested. Interview recordings were fully transcribed. Thematic analysis was undertaken using the Framework approach. Results Participant views on data linkage appeared to be most influenced by: considerations around the social sensitivity of the research question, and; the possibility of tangible health benefits in the public interest. Some participants appeared unsure about the effectiveness of anonymization, or did not always view effective anonymization as making consent unnecessary. This was related to notions of ownership of personal information and etiquette around asking permission for secondary use. Despite different consent procedures being explained, participants tended to equate consent with ‘opt-in’ consent through which participants are ‘asked’ if their data can be used for a specific study. Participants raising similar concerns came to differing conclusions about whether consent was needed. Views changed when presented with different scenarios, and were sometimes inconsistent. Conclusions Findings from this study question the validity of ‘informed consent’ as a cornerstone of good governance, and the extent to which potential research participants understand different types of consent and what they are consenting, or not consenting, to. Pragmatic, imaginative and flexible approaches are needed if research using data linkage is to successfully realise its potential for public good without undermining public trust in the research process.

Determining the extent to which the perceptual world can be recovered from language is a longstanding problem in philosophy and cognitive science. We show that state-of-the-art large language models can unlock new insights into this problem by providing a lower bound on the amount of perceptual information that can be extracted from language. Specifically, we elicit pairwise similarity judgments from GPT models across six psychophysical datasets. We show that the judgments are significantly correlated with human data across all domains, recovering well-known representations like the color wheel and pitch spiral. Surprisingly, we find that a model (GPT-4) co-trained on vision and language does not necessarily lead to improvements specific to the visual modality, and provides highly correlated predictions with human data irrespective of whether direct visual input is provided or purely textual descriptors. To study the impact of specific languages, we also apply the models to a multilingual color-naming task. We find that GPT-4 replicates cross-linguistic variation in English and Russian illuminating the interaction of language and perception. [ABSTRACT FROM AUTHOR]

This document provides summaries of several research studies related to multiple sclerosis (MS). The first study suggests that targeting genetic factors could potentially lead to improved treatments for MS. The second study highlights the potential genetic basis of pediatric-onset MS. The third study investigates the association of immunoglobulin A synthesis with disease activity and neuroaxonal injury in MS patients. The final study explores the use of machine learning models to predict clinical outcomes in MS patients. These studies contribute to our understanding of MS and may inform future research and clinical practice. [Extracted from the article]

Aim To explore how to help make online consultation notes easier for patient audiences to understand. Background Most patients in England will soon be able to access all new prospective entries (including free-text) within their online primary care health record via the NHS App or other online services. Method We conducted interviews and focus group discussions with 26 patients from underserved communities. Participants responded to vignettes about fictional patient consultation scenarios and assessed the clarity of corresponding simulated records. Participants were then asked to identify potential comprehension issues, offensive content, or anxiety triggers. Results Most participants struggled to understand a large proportion of simulated notes, particularly medical acronyms, clinician shorthand, and non-clinical abbreviations. Participants also identified issues that may cause unintended offence or additional anxiety. Participants considered that most patients will struggle to fully understand the content of their consultation notes in their current format. They made a number of suggestions about how this service may be improved to meet the needs of patient audiences and maintain positive patient-clinician relationships. Conclusion Opening up online record access to include patient audiences necessitates a significant cultural shift in the way that consultation notes are written and used. To maximise NHS investment in this policy and avoid worsening health inequalities, it is essential to ensure that all patients can understand and access the benefits of online access to their notes. To do this, clinicians need to be supported to manage the challenges of writing for patient audiences, while continuing to maintain effective clinical care. [ABSTRACT FROM AUTHOR]

Computational methods have started playing a significant role in semantic analysis. One particularly accessible area for developing good computational methods for linguistic semantics is in color naming, where perceptual dissimilarity measures provide a geometric setting for the analyses. This setting has been studied first by Berlin & Kay in 1969, and then later on by a large data collection effort: the World Color Survey (WCS). From the WCS, a dataset on color naming by 2 616 speakers of 110 different languages is made available for further research. In the analysis of color naming from WCS, however, the choice of analysis method is an important factor of the analysis. We demonstrate concrete problems with the choice of metrics made in recent analyses of WCS data, and offer approaches for dealing with the problems we can identify. Picking a metric for the space of color naming distributions that ignores perceptual distances between colors assumes a decorrelated system, where strong spatial correlations in fact exist. We can demonstrate that the corresponding issues are significantly improved when using Earth Mover's Distance, or Quadratic -square Distance, and we can approximate these solutions with a kernel-based analysis method. [ABSTRACT FROM AUTHOR]

Copyright of Psychology / Psichologija is the property of Vilnius University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Environmental enrichment standards are set in many animal welfare laws, but such protections are generally withheld from farmed animals. Instead, farmed animals are subject to substandard enclosures that are under-stimulating and inappropriate for their species-specific behavioral needs. Scientific studies have shown that the inclusion of environmental enrichment in an animal's enclosure balances their production of stress hormones, which has beneficial implications for the overall health and well-being of the animal. Establishing enclosure standards for farmed animals that include provisions relating to environmental enrichment would improve farmed animal well-being and, subsequently, the health of the humans who consume products deriving from farmed animals. [ABSTRACT FROM AUTHOR]

The purpose of this study was to observe changes in anaerobic power and capacity (resistance to fatigue) over an annual training cycle (ATC) in 14 Division I female soccer athletes (19.4 ± 1.0 years, 60.8 ± 5.4 kg, 164.9 ± 6.2 cm, 19.5±3.2% body fat, and 48.9±3.9 kg fat free mass). All subjects were evaluated across the ATC at 5 testing blocks (B1-B5) representing seasonal transitions: postcompetition I (B1), prespring (B2), postspring training (B3), precompetition (B4), and postcompetition II (B5) using 3 tests: countermovement vertical jump to measure peak vertical power (PVP), 40-yard sprint to measure peak horizontal power (PHP), and 35-m running anaerobic sprint test to measure anaerobic capacity via fatigue index (FI). Repeated measures analysis of variance was used with the Bonferroni post hoc test when relevant along with Cohen's d to evaluate effect size. Data are represented as mean ± SD; significance set to p < 0.05. Significant performance increases were observed from postseason I to spring season training (B1-B3) in PVP (6.61 ± 3.18 and 7.71 ± 3.20; p < 0.01, d = 1.12) while changes occurred from prespring season to postspring season (B2-B3) in PVP (6.84=3.15 and 7.71=3.20; p=0.03, d = 0.93) and PHP (6.65 ± 0.97 and 7.55 ± 1.26; p < 0.01, d = 1.06) with no change in body composition. No other significant changes were observed across the ATC (p > 0.05). Increases in PHP and PVP occurred with directed training after B3 and then declined remaining so across the competitive season. Peak horizontal power and PVP may be more sensitive to coaching style and seasonal transition compared with FI and body composition changes. [ABSTRACT FROM AUTHOR]

There is clear diversity among speakers of a typical language in how colors are named. What is the impact of this diversity on the people's ability to communicate about color? Is there a gap between a person's general understanding of the color terms in their native language and how they understand a particular term that denotes a particular color sample? Seventy English-speaking dyads and 63 Somali-speaking dyads played the Color Communication Game, where the "sender" in each dyad named 30 color samples as they would in any color-naming study, then the "receiver" chose the sample they thought the sender intended to communicate. English speakers played again, under instructions to intentionally communicate color sample identity. Direct comparison of senders' samples and receivers' choices revealed categorical understanding of colors without considering color naming data. Although Somali-speaking senders provided fewer color terms, interpersonal Mutual Information (MI) calculated from color naming data was similarly below optimal for both groups, and English-speaking dyads' MI did not improve with experience. Both groups revealed superior understanding of color terms because receivers showed better exactly-correct selection performance than was predicted by simulation from their senders' color-naming data. This study highlights limitations on information-theoretic analyses of color naming data. [ABSTRACT FROM AUTHOR]

Recent work has investigated the origin of infant colour categories, showing pre‐linguistic infants categorise colour even in the absence of colour words. These infant categories are similar but not identical to adult categories, giving rise to an important question about how infant colour perception changes with the learning of colour words. Here we present two novel paradigms in which 12‐ and 19‐month‐old participants learning English as their first language were assessed on their perception of colour, while data on their colour word comprehension were also collected. Results indicate that participants' perception of colours close to the colour category boundaries dramatically change after colour word learning. The results highlight the shift made from infant colour categories to adult‐like linguistically mediated colour categories that accompanies colour word learning. Research Highlights: We aimed to test whether colour perception is linguistically mediated in infants.We used novel eye‐tracking and pupillometry paradigms to test infant colour perception either side of learning colour words.Infants' discrimination of colour changes after learning colour words, suggesting a shift due to colour word learning.A shift from pre‐linguistic colour representation to linguistically mediated colour representation is discussed. [ABSTRACT FROM AUTHOR]

Twin Earth thought experiments are a standard philosophical tool for those offering, or criticizing, metasemantic theories: theories that attempt explain why referring words have the particular referents they have. The general recipe for Twin Earth thought experiments centrally features the description of a planet and population just like Earth and Earthlings, but with some single crucial differeence. In Hilary Putnam’s original version of the experiment, the difference is that the chemical composition of the stuff that looks and behaves like (our) water is XYZ rather than H2O. Such cases show how variation in the physical environment can induce a corresponding variation in reference. In other versions, variations in the linguistic dispositions of speakers are shown to induce corresponding variations in reference. The extension of the word ‘red’ depends on how the linguistic community is disposed to apply that word, as against ‘purple’ or ‘orange’. Perhaps most interestingly, basic normative terms like ‘ought’ or ‘immoral’ seem to vary in neither of these ways. Even if Earthlings and Normative Twin Earthlings consistently made moral judgments in line with two quite distinct moral theories, they might still be talking about the very same property: moral wrongness. The present paper describes and applies a general metasemantic view that yields plausible claims about all three sorts of cases. The view I will defend—neopragmatism—is a fully generalized version of the sort of local expressivism defended in the past by people like Simon Blackburn and Allan Gibbard. Throughout the paper, a contrast is made with a rival approach to the same phenomena: an appeal to reference magnetism. [ABSTRACT FROM AUTHOR]

Natural languages vary in their quantity expressions, but the variation seems to be constrained by general properties, so-called universals. Their explanations have been sought among constraints of human cognition, communication, complexity, and pragmatics. In this article, we apply a state-of-the-art language coordination model to the semantic domain of quantities to examine whether two quantity universals—monotonicity and convexity—arise as a result of coordination. Assuming precise number perception by the agents, we evolve communicatively usable quantity terminologies in two separate conditions: a numeric-based condition in which agents communicate about a number of objects and a quotient-based condition in which agents communicate about the proportions. We find out that both universals take off in all conditions but only convexity almost entirely dominates the emergent languages. Additionally, we examine whether the perceptual constraints of the agents can contribute to the further development of universals. We compare the degrees of convexity and monotonicity of languages evolving in populations of agents with precise and approximate number sense. The results suggest that approximate number sense significantly reinforces monotonicity and leads to further enhancement of convexity. Last but not least, we show that the properties of the evolved quantifiers match certain invariance properties from generalized quantifier theory. [ABSTRACT FROM AUTHOR]

Colour-emotion association data show a universal consistency in colour-emotion associations, apart from emotion associations with PURPLE. Possibly, its heterogeneity was due to different cognates used as basic colour terms between languages. We analysed emotion associations with PURPLE across 30 populations, 28 countries, and 16 languages (4,008 participants in total). Crucially, these languages used the cognates of purple, lilac, or violet to denote the basic PURPLE category. We found small but systematic affective differences between these cognates. They were ordered as purple > lilac > violet on valence, arousal, and power biases. Statistically, the cognate purple was the most strongly biased towards associations with positive emotions, and lilac was biased more strongly than violet. Purple was more biased towards high power emotions than violet, but cognates did not differ on arousal biases. Additionally, affective biases differed by population, suggesting high variability within each cognate. Thus, cognates partly account for inconsistencies in the meaning of PURPLE, without explaining their origins. [ABSTRACT FROM AUTHOR]

Background: NHS England have announced plans to enable all adult patients to have full prospective access to their primary care record by default. Despite this, little is known about the views and experiences of primary care staff regarding patients' online records access (ORA). Aim: To examine the views and experiences of primary care staff regarding patients having online access to their primary care health record, and how this service could be supported and improved. Design and setting: A qualitative study of a purposive sample of 30 primary care staff in England. Method: Online semi-structured interviews with primary care staff were conducted between December 2021 and March 2022. Verbatim transcripts were analysed inductively using thematic analysis. Results: Most staff agreed with the principle of patient access to online health records but had mixed feelings regarding the potential benefits and drawbacks of applying this in practice. Staff identified opportunities for improving patient engagement, health literacy, and efficiencies in some administrative workloads, as well as concerns about maintaining the clinical integrity of patient records and ensuring that staff and patient safety and wellbeing are protected. Conclusion: Participants acknowledged that ORA may transform the purpose and function of the record and that ORA has potential to instigate a significant cultural shift in primary care, changing how staff work and relate to patients. This underlines the need for additional staff training and support to expand capability and capacity to adapt practice and enhance patient engagement with, and understanding of, their health records. [ABSTRACT FROM AUTHOR]

Background: Patient and Public Involvement (PPI) in research has become a key component recommended by research commissioners, grant award bodies and specified in government policies. Despite the increased call for PPI, few studies have demonstrated how to implement PPI within large‐scale research studies. Objective: The aim of the current study was to provide a case example of the implementation of a patient advisory group in a large‐scale mental health research programme (PATHWAY) and to benchmark this against UK standards. Method: A PPI group was incorporated throughout the PATHWAY research programme, from grant development to dissemination. The group attended regular meetings and supported participant recruitment, evaluated patient‐facing documents, supported the piloting of the research intervention and co‐developed the dissemination and impact strategy. The implementation of PPI throughout the project was benchmarked against the UK standards for PPI. Results: The inclusion of PPI in the PATHWAY project provided tangible changes to the research project (i.e., improving study documents, co‐developing dissemination materials) but also proved to be a beneficial experience to PPI members through the development of new skills and the opportunity to provide a patient voice in research. We show how PPI was involved across seven study phases and provide examples of implementation of the six UK standards. The study did not include PPI in data analysis but met all the UK standards for PPI. Challenges regarding practical components (i.e., meeting frequency, language use), increasing diversity and PPI members' knowledge of research were highlighted as areas for further improvement. Conclusions: We provide a case example of how PPI can be implemented throughout a research lifecycle and we note the barriers faced and make suggestions for PPI in future implementation and research. Patient and Public Contribution: PPI members were involved throughout the lifecycle of the research programme. The PPI lead was a co‐author on the manuscript and contributed to report writing. [ABSTRACT FROM AUTHOR]

The presented study examines the question of colour categorization in relation to the hypothesis of linguistic relativity. The study is based on research conducted by Gilbert et al. (2006) and their claim that linguistic colour categorization in a particular language helps colour recognition and speeds the process of colour discrimination for colours from different linguistic categories but only for the right visual field. Our study approached the research question differently. We used the same methodology as Gilbert's team et al. (2006), but we used different colour categories in the Czech language and significantly enlarged the number of participants to 106 undergraduate psychology students. Our results show that the fastest reaction times were in trials when the target was located in the left visual field, quite opposite from the Gilbert's et al. (2006) study. We argue that this finding is based on different processes than simple colour linguistic categorisation and attentional processes actually play an important role in the task. [ABSTRACT FROM AUTHOR]

Color is a pervasive feature of our psychological experience, having a role in many aspects of human mind and behavior such as basic vision, scene perception, object recognition, aesthetics, and communication. Understanding how humans encode, perceive, talk about, and use color has been a major interdisciplinary effort. Here, we present the current state of knowledge on how color perception and cognition develop. We cover the development of various aspects of the psychological experience of color, ranging from low-level color vision to perceptual mechanisms such as color constancy to phenomena such as color naming and color preference. We also identify neurodiversity in the development of color perception and cognition and implications for clinical and educational contexts. We discuss the theoretical implications of the research for understanding mature color perception and cognition, for identifying the principles of perceptual and cognitive development, and for fostering a broader debate in the psychological sciences. [ABSTRACT FROM AUTHOR]

Philosophers rarely write in an extended way about particular colors. So, why write about brown? We shall see that an investigation of brown unsettles some established ideas about color in significant ways. In particular, I will (i) explore reasons for thinking that brown is an elementary color, (ii) reassess attitudes in color science that are taken to rule that possibility out, and (iii) present a new reason for rejecting most forms of color realism. [ABSTRACT FROM AUTHOR]

Objective: To synthesize available evidence that has examined the relationship between physical therapy (PT) and opioid use. Type: Scoping Review Literature Survey: Data sources including Google Scholar, Embase, PubMed, Cochrane Library, and CINAHL were searched for English articles up to October 24, 2019 using terms ("physical therapy"[Title/Abstract] OR physiotherapy[ Title/Abstract] OR rehabilitation[Title/Abstract]) AND (opiate*[Title/ Abstract] OR opioid*[Title/Abstract]). Methodology: Included studies evaluated a PT intervention and reported an opioid-use outcome. Data were extracted to describe the PT intervention, patient sample, opioid-use measurement, and results of any time or group comparisons. Study quality was evaluated with Joanna Briggs checklists based on study design. Synthesis: Thirty studies were included that evaluated PT in at least one of these seven categories: interdisciplinary program (n = 8), modalities (n = 3), treatment (n = 3), utilization (n = 2), content (n = 3), timing (n = 13), and location (n = 2). Mixed results were reported for reduced opioid-use after interdisciplinary care and after PT modalities. Utilizing PT was associated with lower odds (ranging from 0.2-0.8) of using opioid medication for persons with low back pain (LBP) and injured workers; however, guideline-adherent care did not further reduce opioid use for persons with LBP. Early PT utilization after index visit for spine or joint pain and after orthopedic surgery was also associated with lower odds of using opioid medications (ranging from 0.27-0.93). Emergency department PT care was not associated with fewer opioid prescriptions than standard emergency department care. PT in a rehabilitation center after total knee replacement was not associated with lower opioid use than inpatient PT. Conclusions: The relationship between timing of PT and opioid use was evaluated in 13 of 30 studies for a variety of patient populations. Eight of these 13 studies reported a relationship between early PT and reduced subsequent opioid use, making the largest sample of studies in this scoping review with supporting evidence. There is limited and inconclusive evidence to establish whether the content and/or location of PT interventions improves outcomes because of heterogeneity between studies. [ABSTRACT FROM AUTHOR]

Background: Anxiety and depression contribute to poorer physical and mental health outcomes in cardiac patients. Psychological treatments are not routinely offered in cardiac care and have mixed and small effects. We conducted a series of studies under the PATHWAY research programme aimed at understanding and improving mental health outcomes for patients undergoing cardiac rehabilitation (CR) through provision of metacognitive therapy (MCT). Methods: PATHWAY was a series of feasibility trials, single-blind, multicenter, randomized controlled trials (RCTs), qualitative, stated preferences for therapy and health economics studies. Findings: Patients felt their psychological needs were not met in CR and their narratives of distress could be parsimoniously explained by the metacognitive model. Patients reported they would prefer therapy over no therapy as part of CR, which included delivery by a cardiac professional. Two feasibility studies demonstrated that RCTs of group-based and self-help MCT were acceptable, could be embedded in CR services, and that RCTs of these interventions were feasible. A definitive RCT of group-MCT within CR (n = 332) demonstrated significantly greater reductions in the severity of anxiety and depression, exceeding CR alone, with gains maintained at 12 month follow-up (SMD HADS total score = 0.52 at 4 months and 0.33 at 12 months). A definitive trial of self-help MCT is ongoing. Conclusion: There is a need to better meet the psychological needs of CR patients. Embedding MCT into CR demonstrated high acceptability and improved efficacy on psychological outcomes. Results support roll-out of MCT in CR with evaluation of national implementation. Registration: URL: NCT02420431; ISRCTN74643496; NCT03129282. [ABSTRACT FROM AUTHOR]

Confederate memoirist Sam Watkins wrote from the perspective of the "high private," and has been the voice of the common soldier in the Army of Tennessee for scholars, public historians, and viewers of Ken Burns's documentary series. Yet this essay delves into the immense wealth and wartime slave-owning of Watkins himself and his famous Co. H, First Tennessee Infantry. Watkins's own camp slave, Sanker, makes no appearance in his memoir. Once seen, however, Sanker provides a lens through which to see the intentional manipulation of Civil War memory by an important author in the Lost Cause canon. [ABSTRACT FROM AUTHOR]

Background: Physical therapy and hip arthroscopy are two viable treatment options for patients with nonarthritic hip pain (NAHP); however, patients may experience considerable decisional conflict when making a treatment decision. Interdisciplinary evaluation with a physical therapist and surgeon may better inform the decision-making process and reduce decisional conflict. Objective: To identify the extent to which an interdisciplinary evaluation between a surgeon, physical therapist, and patient influences treatment plans and decisional conflict of persons with NAHP. Design: Randomized controlled trial. Setting: Hip preservation clinic. Participants: Adults with primary NAHP. Interventions: Participants were randomized to receive a standard (surgeon) or interdisciplinary (surgeon+physical therapist) evaluation. Surgeon evaluations included patient interview, strength and range-of-motion examination, palpation, gross motor observation, and special testing. Interdisciplinary evaluations started with the surgeon evaluation, then a physical therapist evaluated movement impairments during sitting, sit-to-stand, standing, single-leg stance, single-leg squat, and walking. All evaluations concluded with treatment planning with the respective provider(s). Outcome Measures: Treatment plan and decisional conflict were collected pre- and postevaluation. Inclusion of physical therapy in participants' postevaluation treatment plans and postevaluation decisional conflict were compared between groups using chi-square tests and Mann-Whitney U tests, respectively. Results: Seventy-eight participants (39 in each group) met all eligibility criteria and were included in all analyses. Sixty-six percent of participants who received an interdisciplinary evaluation included physical therapy in their postevaluation treatment plan, compared to 48% of participants who received a standard evaluation (p = .10). Participants who received an interdisciplinary evaluation reported 6.3 points lower decisional conflict regarding their postevaluation plan (100-point scale; p = .04). The interdisciplinary and standard groups reduced decisional conflict on average 24.8 ± 18.9 and 23.6 ± 14.6 points, respectively. Conclusions: Adding a physical therapist to a surgical clinic increased interest in physical therapy treatment, but this increase was not statistically significant. The interdisciplinary group displayed lower postevaluation decisional conflict; however, both groups displayed similar reductions in decisional conflict from pre- to postevaluation. This study also demonstrated the feasibility of an interdisciplinary evaluation in a hip preservation clinic. [ABSTRACT FROM AUTHOR]

Stormwater control measures, such as raingardens, tanks, or wetlands, are often employed to mitigate the deleterious effects of urban stormwater drainage on stream ecosystems. However, performance metrics for control measures, most commonly pollutant-load reduction, have not permitted prediction of how they will change stream ecosystems downstream. Stream ecosystem responses have more commonly been predicted by catchment-scale measures such as effective imperviousness (percentage of catchment with impervious cover draining to sealed drains). We adapt effective imperviousness, weighting it by a performance metric for stormwater control measures aimed at stream protection, the stream stormwater impact metric. Weighted effective imperviousness can serve as a predictor of stream response to stormwater control. We demonstrate its application in a before-after-control-reference-impact experiment aiming to test if stream health is improved by dispersed stormwater control measures. Trends in weighted effective imperviousness showed wide variation in degree of stormwater control achieved in the six experimental sub-catchments, despite similar effort in implementing control measures across the sub-catchments. Greater reductions in weighted effective imperviousness (on a log-scale, on which stream response is predicted) per unit effort were observed in smaller catchments with lower starting effective imperviousness. While implementation of control measures was sufficient to expect a stream response in at least two of the experimental sub-catchments, we did not achieve the reduction in effective imperviousness that we were aiming for. Primary limitations to success were the lack of available space in these established suburbs, particularly for final control measures near pipe outlets into streams, and a lack of demand for harvested stormwater. The use of the continuous variable, weighted effective imperviousness, to measure impact on streams, and the protracted period of SCM implementation that varied among catchments, required a new approach to modelling "before-after-control-impact" experiments, which has potentially broader application. [ABSTRACT FROM AUTHOR]

Background: Low back pain (LBP) has been associated with worse hip function for persons with femoroacetabular impingement syndrome (FAIS). Reports are limited to surgical populations and based on the presence or absence of LBP, regardless of pain severity. Objectives: To report the prevalence of clinically significant LBP for persons with FAIS; compare demographics, pain, and function between those with and without clinically significant LBP; and evaluate relationships between hip function and both LBP‐related disability and LBP severity. We hypothesized that participants with LBP would be older, have higher body mass index (BMI), and report worse groin pain, longer symptom duration, and worse hip function. We hypothesized that worse LBP‐related disability and LBP severity would be related to worse hip function. Design Observational cross‐sectional study. Setting: Hip preservation clinic. Participants: 158 persons with FAIS. Interventions: n/a Main Outcome Measure(s): Visual analog pain scales (VAS 0‐100) were used to categorize participants with (≥30) and without (<30) clinically significant LBP. Age, sex, BMI, pain severity and duration, and hip function (33‐item Hip Outcome Tool [iHOT33]) were compared between those with and without clinically significant LBP. Correlations were evaluated between the modified Oswestry Disability Index (ODI) and iHOT33, ODI and groin pain severity, LBP severity and iHOT33, and LBP and groin pain severity. Results: Sixty percent of participants reported clinically significant LBP (n = 95). These participants reported worse iHOT33 scores (mean difference: 10.1 points) than those without clinically significant LBP (p =.001). Worse ODI scores were associated with worse iHOT33 scores (P <.001; ρ = −0.74). Significant relationships were also observed between (1) ODI and groin pain, (2) LBP and iHOT33, and (3) LBP and groin pain, but the magnitudes of these correlations were weak (ρ ≤ 0.36). Conclusions: Clinically significant LBP is highly prevalent in persons with FAIS and is associated with worse hip function. Worse LBP‐related disability, but not LBP severity, was strongly associated with worse hip function. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the study was to synthesize studies of movement patterns and their association with hip pain, function/activity, and morphology in individuals with femoroacetabular impingement syndrome (FAIS). Methods: PubMed, SPORTDiscus, CINAHL, Embase, and Scopus databases were searched using predefined terms. Two authors independently reviewed abstracts and full texts. Studies were included if they enrolled individuals with FAIS, reported kinematic or kinetic data during movement tasks, and tested the data's associations with hip pain, function/activity, or morphology. Exclusion criteria were studies that did not evaluate associations between movement patters and pain, function/activity, or hip morphology. Additionally, studies with hip conditions other than FAIS, case reports, conference proceedings, review articles, and non-English studies were excluded. Descriptive consolidation and qualitative synthesis were performed for the included studies. Results: Of the 1155 potential studies, 5 studies met all eligibility criteria. Movement patterns were evaluated during walking (n = 4) and squatting (n = 1). Studies reported multiple associations between variables of interest. Statistically significant associations were identified between movement patterns and hip pain (n = 2), function/activity (n = 2), or morphology (n = 3). Significant associations included increased hip flexion moment impulse during walking was associated with worse pain, increased hip flexion moment during walking was associated with worse hip function, decreased hip external rotation during gait and hip internal rotation during squat were associated with larger cam deformity, and increased hip flexion moment impulse during walking was also associated with more severe acetabular cartilage abnormalities. Conclusions: Very little current evidence has evaluated the associations between altered movement patterns and hip pain, function/activity, or morphology in individuals with FAIS, and only low-intensity tasks have been tested. These studies found some preliminary associations between altered hip biomechanics and higher hip pain, worse hip function, and specific measures of hip morphology in individuals with FAIS. Impact: This review is a first step in gaining a better understanding of movement patterns and their associations with hip pain, function/activity, and morphology, which could ultimately assist with the development of movement retraining interventions and potentially improve rehabilitation outcomes for those with FAIS. [ABSTRACT FROM AUTHOR]

Colorful displays have evolved in multiple plant and animal species as signals to mutualists, antagonists, competitors, mates, and other potential receivers. Studies of color have long relied on subjective classifications of color by human observers. However, humans have a limited ability to perceive color compared to other animals, and human biological, cultural, and environmental variables can influence color perception. Here, we test the consistency of human color classification using fruit color as a model system. We used reflectance data of 67 tropical fruits and surveyed 786 participants to assess the degree to which (a) participants of different cultural and linguistic backgrounds agree on color classification of fruits; and (b) human classification to a discrete set of commonly used colors (e.g., red, blue, green) corresponds to natural clusters based on light reflectance measures processed through visual systems of other animals. We find that individual humans tend to agree on the colors they attribute to fruits across language groups. However, these colors do not correspond to clearly discernible clusters in di‐ or tetrachromatic visual systems. These results indicate that subjective color categorizations tend to be consistent among observers and can be used for large synthetic studies, but also that they do not fully reflect natural categories that are relevant to animal observers. [ABSTRACT FROM AUTHOR]

Polytrauma clinical triad (PCT) is the comorbid occurrence of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and pain after trauma. No clinical practice guidelines for postacute care of patients with PCT currently exist; instead, clinical practice guidelines have been published for the three conditions (TBI, PTSD, and pain) as distinct clinical entities. Using multiple, individual practice guidelines for a patient with PCT may lead to unintended prescription of multiple and potentially adversely interacting medications (ie, polypharmacy). Polypharmacy, especially that which includes central nervous system‐acting medications, may lead to overdose, suicidality, and chronic symptomatology. Current individual guidelines for each condition of PCT do not address how to coordinate care for the polytraumatic diagnosis. The purpose of this Practice Management piece is to describe the unintended consequences of polypharmacy in patients with PCT and to discuss mitigation approaches including rational prescribing, nonpharmacologic alternatives, and interdisciplinary coordination. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to describe movement impairments for persons with femoroacetabular impingement syndrome and their association with function, treatment recommendations, and treatment plans. Methods This report is a secondary, observational analysis of a clinical trial dataset in which participants received an interdisciplinary evaluation from a surgeon and physical therapist. The therapist documented frontal and sagittal plane movement impairments across 6 functional tasks. Associations between number of impairments in each plane and function (33-item International Hip Outcome Tool [iHOT33]) were evaluated using Pearson or Spearman correlations. Joint provider recommendations (physical therapist and surgeon) and participant-reported treatment plans were dichotomized based on the inclusion of physical therapy or not. Logistic regressions were used to examine the effects of (1) iHOT33, total movement impairments, and previous physical therapist treatment on joint provider recommendation and (2) these same variables along with joint provider recommendation on participant treatment plan; prevalence ratios and 95% CIs were reported for significant contributors. Results Thirty-nine participants demonstrated an average iHOT33 of 35.0 (SD = 19.5) and presented with a median 5 frontal and 3 sagittal plane impairments. More frontal plane impairments were associated with worse iHOT33 scores. Twenty-seven participants received a joint provider recommendation that included physical therapy; no significant contributors to these recommendations were identified. Twenty-four of the 27 participants with a physical therapist recommendation included physical therapy in their treatment plan. Two additional participants did not receive a physical therapist recommendation but included physical therapy in their plan. Joint provider recommendation was the only significant contributor to the participant-reported plan (prevalence ratio = 7.06; 95% CI = 3.25–7.97). Conclusion Persons with femoroacetabular impingement syndrome displayed clinically observable movement impairments that were associated with worse function. Joint provider recommendations strongly influenced participants' treatment plans to pursue physical therapy. Impact Physical therapists contribute new information to surgical examinations regarding movement. Joint recommendations from the physical therapist and the surgeon can influence patients' decisions to pursue physical therapy. [ABSTRACT FROM AUTHOR]

Colexification refers to the phenomenon of multiple meanings sharing one word in a language. Cross‐linguistic lexification patterns have been shown to be largely predictable, as similar concepts are often colexified. We test a recent claim that, beyond this general tendency, communicative needs play an important role in shaping colexification patterns. We approach this question by means of a series of human experiments, using an artificial language communication game paradigm. Our results across four experiments match the previous cross‐linguistic findings: all other things being equal, speakers do prefer to colexify similar concepts. However, we also find evidence supporting the communicative need hypothesis: when faced with a frequent need to distinguish similar pairs of meanings, speakadjust their colexification preferences to maintain communicative efficiency and avoid colexifying those similar meanings which need to be distinguished in communication. This research provides further evidence to support the argument that languages are shaped by the needs and preferences of their speakers. [ABSTRACT FROM AUTHOR]

Media portrayal of persons with mental health disorders (MHDs) can affect treatment seeking and overall recovery, but few studies focus specifically on the media coverage of MHDs among men and boys. This study examined the extent to which men and boy's mental health issues are discussed in the media, demographics of males covered most, and the tone/nature of coverage. Articles for three distinct six-month periods covering 2015–2018 were gathered using the "all news" search function in LexisNexis, a media monitoring platform. Although male mental health issues received frequent coverage, males of color, males from the LGBTQ community, and boys (under age 18) are covered to a lesser extent. Coverage of the first group is often associated with negative elements. This research improves our understanding of the frequency, dialogue, and message frames surrounding the media coverage of male mental health issues. The media have the potential to be a strong ally in public health initiatives to promote greater understanding of men's mental health issues. Our findings help inform media strengths and improvement opportunities in mental health coverage. [ABSTRACT FROM AUTHOR]

Two viral photographs, #The Dress and #The Jacket, have received recent attention in research on perception as the colors in these photos are ambiguous. In the current study, we examined perception of these photographs across three different cultural samples: Sweden (Western culture), China (Eastern culture), and India (between Western and Eastern cultures). Participants also answered questions about gender, age, morningness, and previous experience of the photographs. Analyses revealed that only age was a significant predictor for the perception of The Dress, as older people were more likely to perceive the colors as blue and black than white and gold. In contrast, multiple factors predicted perception of The Jacket, including age, previous experience, and country. Consistent with some previous research, this suggests that the perception of The Jacket is a different phenomenon from perception of The Dress and is influenced by additional factors, most notably culture. [ABSTRACT FROM AUTHOR]

Background: Outcomes for operative and nonoperative management of femoroacetabular impingement syndrome (FAIS) are variable. Understanding factors that inform patients' treatment decisions may optimize their outcomes.Objective: To identify factors that predict which patients with FAIS proceed to surgery within 90 days of their initial evaluation by an orthopedic surgeon. The study explored potential predictors of surgical intervention, including demographic factors, activity level, symptom duration, previous treatment, hip function, pain, presence of labral tear, and patient interest in surgical and physical therapy (PT) treatment.Design: Prospective cohort.Setting: Single-site academic medical center.Patients: Seventy-seven individuals with FAIS.Intervention: After evaluation in a hip preservation clinic, participants reported activity level, symptom duration, treatment history, hip function [Hip Outcome Score Activities of Daily Living(HOS-ADL)], pain severity and location, and treatment interests. These variables were evaluated based on univariate analysis for entry into a multiple binomial logistic regression to identify predictors of surgery within 90 days. Adjusted marginal prevalence ratios and 95% confidence interval estimates (PR [95% CI]) were reported (P ≤ .05).Main Outcome Measure(s): Ninety-day treatment (surgery or not).Results: Participants indicated initial interest in surgery (n = 27), PT (n = 22), both (n = 18), or neither (n = 10). Those only interested in PT had lower prevalence of diagnosed labral tear (P < .001) and previous PT for the hip (P < .001). Prevalence of previous injection was higher for those only interested in surgery than for those with any interest in PT (P < .001). Thirty-six of 77 participants (46%) underwent surgery within 90 days. Surgical interest (3.56 [1.57, 5.46]), previous hip injection (3.06 [1.73, 3.89]), younger age (0.95 [0.92, 0.98]), and worse hip function (0.97 [0.95, 0.99]) were significant (P ≤ .02) predictors of surgery.Conclusions: Treatment interest and history, patient function, and age were significantly related to participants' decision to pursue surgical intervention within 90 days. Patient engagement in the decision-making process should include considerations of patient knowledge of, and experience with, the various treatment options. [ABSTRACT FROM AUTHOR]

This study examines the cross‐cultural generality of Hering's (1878/1964) color‐opponent theory of color appearance. English‐speaking and Somali‐speaking observers performed variants of two paradigms classically used to study color‐opponency. First, both groups identified similar red, green, blue, and yellow unique hues. Second, 25 English‐speaking and 34 Somali‐speaking observers decomposed the colors present in 135 Munsell color samples into their component Hering elemental sensations—red,green,blue, yellow, white, and black—or else responded "no term." Both groups responded no term for many samples, notably purples. Somali terms for yellow were often used to name colors all around the color circle, including colors that are bluish according to Hering's theory. Four Somali Grue speakers named both green and blue elicitation samples by their term for green. However, that term did not name the union of all samples called blue or green by English speakers. A similar pattern was found among three Somali Achromatic speakers, who called the blue elicitation sample black or white. Thus, color decomposition by these Somali‐speaking observers suggests a lexically influenced re‐dimensionalization of color appearance space, rather than a simple reduction of the one proposed by Hering. Even some Somali Green‐Blue speakers, whose data were otherwise similar to English, showed similar trends in yellow and blue usage. World Color Survey data mirror these results. These within‐ and cross‐cultural violations of Hering's theory do not challenge the long‐standing view that universal sensory processes mediate color appearance. However, they do demonstrate an important contribution of language in the human understanding of color. [ABSTRACT FROM AUTHOR]