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BackgroundAlthough increasingly used, the benefit of surgical treatment of displaced 2-part proximal humerus fractures has not been proven. This trial evaluates the clinical effectiveness of surgery with locking plate compared with non-operative treatment for these fractures.Methods and findingsThe NITEP group conducted a superiority, assessor-blinded, multicenter randomized trial in 6 hospitals in Finland, Estonia, Sweden, and Denmark. Eighty-eight patients aged 60 years or older with displaced (more than 1 cm or 45 degrees) 2-part surgical or anatomical neck proximal humerus fracture were randomly assigned in a 1:1 ratio to undergo either operative treatment with a locking plate or non-operative treatment. The mean age of patients was 72 years in the non-operative group and 73 years in the operative group, with a female sex distribution of 95% and 87%, respectively. Patients were recruited between February 2011 and April 2016. The primary outcome measure was Disabilities of Arm, Shoulder, and Hand (DASH) score at 2-year follow-up. Secondary outcomes included Constant-Murley score, the visual analogue scale for pain, the quality of life questionnaire 15D, EuroQol Group's 5-dimension self-reported questionnaire EQ-5D, the Oxford Shoulder Score, and complications. The mean DASH score (0 best, 100 worst) at 2 years was 18.5 points for the operative treatment group and 17.4 points for the non-operative group (mean difference 1.1 [95% CI -7.8 to 9.4], p = 0.81). At 2 years, there were no statistically or clinically significant between-group differences in any of the outcome measures. All 3 complications resulting in secondary surgery occurred in the operative group. The lack of blinding in patient-reported outcome assessment is a limitation of the study. Our assessor physiotherapists were, however, blinded.ConclusionsThis trial found no significant difference in clinical outcomes at 2 years between surgery and non-operative treatment in patients 60 years of age or older with displaced 2-part fractures of the proximal humerus. These results suggest that the current practice of performing surgery on the majority of displaced proximal 2-part fractures of the humerus in older adults may not be beneficial.Trial registrationClinicalTrials.gov NCT01246167.

Abstract Objective Physiotherapists (PTs) play a crucial role in managing individuals with Frozen Shoulder (FS), frequently being the first healthcare professionals involved in the treatment of this condition. Aim This study aimed to compare the beliefs, expectations, and perspectives of individuals with FS with the knowledge, skills, and strategies of PTs, highlighting similarities and differences. Method This study adhered to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). From May 1st to August 1st, 2023, a two-part survey was conducted involving PTs and individuals diagnosed with FS. The survey focused on comparing key areas such as clinical assessment, patient education, treatment expectations, and the psychological aspects of the patient-clinician relationship. Results A total of 501 PTs and 110 subjects with FS participated in the survey. Most PTs showed proficiency in FS pathoanatomical conditions and were also attentive to psychological aspects (88.4%), describing the pathology evolution in three or two stages (68.2%). They also highlighted the importance of patient education (89.6%) and recognized the potential benefits of a multiprofessional collaboration in managing FS (82.2%). Reassurance was reported as a priority by 32.3% of PTs. Subjects with FS expressed a preference for PTs who are both expert and empathetic (73.6%). Regarding their understanding of FS, 29.09% of subjects reported receiving a three-phase explanation, while 26.36% felt inadequately informed. Nearly half of the subjects (49.09%) anticipated being managed independently by a PT, with 93.64% prioritizing the improvement of their range of motion. Conclusion This study revealed a general agreement between subjects with FS and PTs regarding aspects of the therapeutic relationship, patient education, pathology management, compliance and motivation strategies, and pain management preferences. However, significant differences emerged concerning the perception of physiotherapy effectiveness, primary treatment goals, subjects’ priorities, and the importance of psychological assessment.

Abstract Mnemonic strategies can facilitate working memory performance, but our knowledge on strategy use as a function of task characteristics remains limited. We examined self-reported strategy use in several working memory tasks with pretest data from two large-scale online training experiments. A three-level measure of strategy sophistication (no strategy, maintenance, manipulation) was coded based on participants’ open-ended strategy reports. A considerable portion of participants reported some memory strategy, and strategy sophistication was associated with objective task performance. We found a consistent effect of stimulus type: verbal stimuli (letters or digits) elicited higher strategy sophistication than nonverbal ones (colours or spatial positions). In contrast, the association between task paradigm and strategy sophistication was less consistent in the two experiments. The present results highlight the importance of self-generated strategies in understanding individual differences in working memory performance and the role of stimulus characteristics as one of the task-related determinants of strategy use.

Spontaneous strategy employment is important for memory performance, but systematic research on strategy use and within-task evolvement is limited. This online study aimed to replicate three main findings by Waris and colleagues in Quarterly Journal of Experimental Psychology (2021): in word-list learning, spontaneous strategy use (1) predicts better task performance, (2) stabilizes along the task, and (3) increases during the first two task blocks. We administered a shortened version of their original real-word list-learning task to 209 neurotypical adults. Their first finding was partly replicated: manipulation strategies (grouping, visualization, association, narrative, other strategy) but not maintenance strategies (rehearsal/repetition, selective focus) were associated with superior word recall. The second finding on the decrease in strategy changers over task blocks was replicated. The third finding turned out to be misguided: neither our nor the original study showed task-initial increase in strategy use in the real-word learning condition. Our results confirm the important role of spontaneous strategies in understanding memory performance and the existence of task-initial dynamics in strategy employment. They support the general conclusions by Waris and colleagues: task demands can trigger strategy use even in a familiar task like learning a list of common words, and evolution of strategy use during a memory task reflects cognitive skill learning.

Abstract Are we affected by growing up in either female or male environment? This study examined whether girls’ and boys’ academic strengths at age 16 in verbal/language school subjects, relative to technical/numerical subjects, and cognitive demands of a chosen occupation at age 35 are influenced by having same- or opposite-sex siblings. Using representative population data from Swedish registers, we extracted (Study 1) 3-sibling families (N = 17,233), focusing on the mid-born, and (Study 2) 2-sibling families (N = 118,688), focusing on the last-born child. Both studies demonstrated that individuals’ academic strengths were unaffected by sibship composition. Study 2 showed that boys with a sister tended to choose more numerically demanding occupations as compared to boys with a brother. Taken together, growing up in a more or less female or male environment, that is, having same- or opposite-sex siblings does not impact one’s tendency to be academically more or less verbally or numerically aligned.

Many causes potentially underline pain in the lower extremities, presenting a real challenge for primary care clinicians in the recognition of the source of the patient’s complaints. Peripheral arterial disease (PAD) is defined as a total or partial blockage of the vessels that supply blood from the heart to the periphery. PAD of the lower extremities may masquerade as lumbosacral radiculopathy (LSR)—a common source of leg pain. Physiotherapists should be able to screen for PAD in people presenting with pain in the lower extremities. Failure to correctly screen for PAD could put the patient at risk of severe disability and possible permanent sequelae. This case report outlines the relevant concepts relating to the pathophysiology, screening, and differential diagnosis of PAD, and then further describes the relevant findings from the history and physical examination from the physiotherapist’s perspective in a patient with an unusual symptom presentation. Although the patient was referred by a physician with a diagnosis of LSR, our case highlights the pivotal role of skilled physiotherapists in triaging a severe lower-limb PAD in need of referral. Therefore, this case report aims to increase clinicians’ awareness of the clinical features of a complex case of PAD.

Cognitive skill learning postulates strategy generation and implementation when people learn to perform new tasks. Here we followed self-reported strategy use and objective performance in a working memory (WM) updating task to reveal strategy development that should take place when faced with this novel task. In two pre-registered online experiments with healthy adults, we examined short-term strategy acquisition in a ca 20–30-minute adaptive n-back WM task with 15 task blocks by collecting participants' strategy reports after each block. Experiment 1 showed that (a) about half of the participants reported using a strategy already during the very first task block, (b) changes in selected strategy were most common during the initial task blocks, and (c) more elaborated strategy descriptions predicted better task performance. Experiment 2 mostly replicated these findings, and it additionally showed that compared to open-ended questions, the use of repeated list-based strategy queries influenced subsequent strategy use and task performance, and also indicated higher rates of strategy implementation and strategy change during the task. Strategy use was also a significant predictor of n-back performance, albeit some of the variance it explained was shared with verbal productivity that was measured with a picture description task. The present results concur with the cognitive skill learning perspective and highlight the dynamics of carrying out a demanding cognitive task.

Increasing evidence indicates that the coronavirus disease 2019 (COVID-19) pandemic is associated with adverse psychological effects, including heightened levels of anxiety. This study examined whether COVID-19-related anxiety levels during the early stage of the pandemic predicted demanding working memory (WM) updating performance. Altogether, 201 healthy adults (age range, 18–50) mostly from North America and the British Isles were recruited to this study via the crowdsourcing site www.prolific.co. The results showed that higher levels of COVID-19-related anxiety during the first weeks of the pandemic outbreak were associated with poorer WM performance as measured by the n-back paradigm. Critically, the unique role of COVID-19-related anxiety on WM could not be explained by demographic factors, or other psychological factors such as state and trait anxiety or fluid intelligence. Moreover, across three assessment points spanning 5–6 weeks, COVID-19-related anxiety levels tended to decrease over time. This pattern of results may reflect an initial psychological “shock wave” of the pandemic, the cognitive effects of which may linger for some time, albeit the initial anxiety associated with the pandemic would change with habituation and increasing information. Our results contribute to the understanding of cognitive–affective reactions to a major disaster.

Working memory (WM) represents a core cognitive function with a major striatal contribution, and thus WM deficits, commonly observed in Parkinson’s disease (PD), could also relate to many other problems in PD patients. Our online study aimed to determine the subdomains of WM that are particularly affected in PD and to clarify the links between WM and everyday cognitive deficits, other executive functions, psychiatric and PD symptoms, as well as early cognitive impairment. Fifty-two mild-to-moderate PD patients and 54 healthy controls performed seven WM tasks tapping selective updating, continuous monitoring, or maintenance of currently active information. Self-ratings of everyday cognition, depression, and apathy symptoms, as well as screenings of global cognitive impairment, were also collected. The data were analyzed using structural equation modeling. Of the three WM domains, only selective updating was directly predictive of PD group membership. More widespread WM deficits were observed only in relation to global cognitive impairment in PD patients. Self-rated everyday cognition or psychiatric symptoms were not linked to WM performance but correlated with each other. Our findings suggest that WM has a rather limited role in the clinical manifestation of PD. Nevertheless, due to its elementary link to striatal function, the updating component of WM could be a candidate for a cognitive marker of PD also in patients who are otherwise cognitively well-preserved.

Online quizzes building upon the principles of retrieval practice can have beneficial effects on learning, especially long-term retention. However, it is unexplored how interindividual differences in relevant background characteristics relate to retrieval practice activities in e-learning. Thus, this study sought to probe for this research question on a massive open online course (MOOC) platform where students have the optional possibility to quiz themselves on the to-be-learned materials. Altogether 105 students were assessed with a cognitive task tapping on reasoning, and two self-assessed personality measures capturing need for cognition (NFC), and grittiness (GRIT-S). Between-group analyses revealed that cognitively high performing individuals were more likely to use the optional quizzes on the platform. Moreover, within-group analyses (n = 56) including those students using the optional quizzes on the platform showed that reasoning significantly predicted quiz performance, and quiz processing speed. NFC and GRIT-S were unrelated to each of the aforementioned retrieval practice activities.

E-learning is being considered as a widely recognized option to traditional learning environments, allowing for highly tailor-made adaptive learning paths with the goal to maximize learning outcomes. However, for being able to create personalized e-learning systems, it is important to identify relevant student prerequisites that are related learning success. One aspect crucial for all kind of learning that is relatively unstudied in relation to e-learning is working memory (WM), conceptualized as the ability to maintain and manipulate incoming information before it decays. The aim of the present study was to examine how individual differences in online activities is related to visuospatial- and verbal WM performance. Our sample consisted of 98 participants studying on an e-learning platform. We extracted 18 relevant features of online activities tapping on Quiz accuracy, Study activity, Within-session activity, and Repetitive behavior. Using best subset multiple regression analyses, the results showed that individual differences in online activities significantly predicted verbal WM performance (p < 0.001, RAdjusted2 = 0.166), but not visuospatial WM performance (p = 0.058, RAdjusted2 = 0.065). The obtained results contribute to the existing research of WM in e-learning environments, and further suggest that individual differences in verbal WM performance can be predicted by how students interact on e-learning platforms.

During the past decades, working memory (WM) training has attracted considerable research attention, but its transfer to untrained tasks is still controversial. In a randomized controlled trial, we investigated the possible transfer effects of a novel sentence-level WM training regime. Sixty-eight healthy Finnish adults were randomized into either a WM training group or an active control group. The WM training group practiced for 4 weeks with two adaptive sentence-level WM training tasks, namely, a novel sentence-level updating task and a Reading span task. The active control group practiced on a quiz task that called for long-term memory but did not load on WM. There were no statistically significant training effects on the pre–post measures of near and far transfer. We suggest that the lack of training effects may reflect the specificity and automaticity of the sentence-processing system.