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The main clinical intervention for older adults with hearing loss is the provision of hearing aids. However, uptake and usage in this population have historically been reported as low. The aim of this study was to understand the hearing loss characteristics, from measured audiometric hearing loss and self-perceived hearing handicap, that contribute to the decision of hearing aid ownership. A total of 2833 adults aged 50+ years, of which 329 reported hearing aid ownership, were involved with a population-based survey with audiometric hearing assessments. Classification and regression tree (CART) analysis was used to classify hearing aid ownership from audiometric measurements and hearing disability outcomes. An overall accuracy of 92.5% was found for the performance of the CART analysis in predicting hearing aid ownership from hearing loss characteristics. By including hearing disability, sensitivity for predicting hearing aid ownership increased by up to 40% compared with just audiometric hearing loss measurements alone. A decision tree approach that considers both objectively measured hearing loss and self-perceived hearing disability, could facilitate a more tailored and personalised approach for determining hearing aid needs in the older population. Without intervention, older adults with hearing loss are at higher risk of cognitive decline and higher rates of depression, anxiety, social isolation. The provision of hearing aids can compensate hearing function, however, uptake and usage have been reported as low. Using a more precise cut-off from audiometric measures and self-perceived hearing disability scores could facilitate a tailored and personalised approach to screen and identify older adults for hearing aid needs. [ABSTRACT FROM AUTHOR]

Background: Often considered an "invisible disability", hearing loss is one of the most prevalent chronic diseases and the third leading cause for years lived with disability worldwide. Hearing loss has substantial impacts on communication, psychological wellbeing, social connectedness, cognition, quality of life, and economic independence. The Hearing impairment in Adults: a Longitudinal Outcomes Study (HALOS) aims to evaluate the: (1) impacts of hearing devices (hearing aids and/or cochlear implants), (2) differences in timing of these interventions and in long-term outcomes between hearing aid and cochlear implant users, and (3) cost-effectiveness of early intervention for adult-onset hearing loss among hearing device users. Materials and methods: HALOS is a mixed-methods study collecting cross-sectional and longitudinal data on health and social outcomes from 908 hearing aid and/or cochlear implant users aged ≥40 years, recruited from hearing service providers across Australia. The quantitative component will involve an online survey at baseline (time of recruitment), 24-months, and 48-months and will collect audiological, health, psychosocial, functional and employment outcomes using validated instruments. The qualitative component will be conducted in a subset of participants at baseline and involve semi-structured interviews to understand the patient journey and perspectives on the Australian hearing service model. Ethics: This study has been approved by the Macquarie University Human Research Ethics Committee (ID: 11262) and Southern Adelaide Local Health Network (ID: LNR/22/SAC/88). Dissemination of results: Study findings will be disseminated to participants via a one-page summary, and to the public through publications in peer-reviewed journals and presentations at conferences. Trial registration: Australia New Zealand Clinical Trial Registry (ANZCTR) registration number: ACTRN12622000752763. [ABSTRACT FROM AUTHOR]

Adults with spinal cord injury (SCI) are reported to have heightened risk of cognitive impairment, notably mild cognitive impairment (MCI). Reports of increased risk of MCI are almost exclusively based on cross-sectional assessments of cognitive function using norm-referenced scores. Norm-referenced single-point assessments do not reflect cognitive decline at the individual level but rather represent between group differences in cognitive function. The practice of relying solely on norm-referenced assessment to study MCI after SCI is therefore problematic as it lends to potential misclassification of MCI. Premorbid intelligence estimates permit comparison of people's actual versus expected cognitive function and thereby can be used to validate the presence of genuine cognitive decline. These are not utilized in the assessment of MCI after SCI. This study simulated data for 500,000 adults with SCI to compare norm-referenced and premorbid-intelligence methods of screening for MCI to examine the potential extent of MCI misclassification after SCI resulting from the overreliance on norm-referenced methods and exclusion of premorbid intelligence methods. One in five to one in 13 simulated adults with SCI were potentially misclassified as having MCI showing that measures of premorbid cognitive function must be included in assessment of cognitive function after SCI. [ABSTRACT FROM AUTHOR]

Background and Aim: Capsule endoscopy (CE) is a non‐invasive diagnostic modality enabling real time video imaging of the gastrointestinal (GI) mucosa. Pan‐enteric capsule endoscopy (PCE) is now able to thoroughly assess the entire GI tract, including for inflammatory bowel disease (IBD). Our aim was to evaluate the diagnostic accuracy of PCEs in IBD. Methods: We comprehensively searched electronic databases (MEDLINE, SCOPUS, EMBASE, and Cochrane Central Register of Controlled Trials) for studies comparing the diagnostic accuracy of PCE with endoscopic evaluation, intestinal ultrasound or magnetic resonance enterography (MRE). Data were analyzed by calculating forest plots and the use of the I2 statistic for heterogeneity. Results: Fourteen studies were identified, with seven studies evaluating PCE diagnostic yield in Crohn's disease (CD) and seven studies in ulcerative colitis (UC). In CD, there was a trend to superiority of PCE over MRE and colonoscopy with a pooled odds ratio (OR) of 1.25 (95% CI, 0.85–1.86%) for the detection of CD. This translates to an increased diagnostic yield of 5% and 7% for PCE compared with MRE and colonoscopy, respectively. PCEs had a diagnostic sensitivity for the detection of UC of 93.8% (95% CI, 87.6–97.0%) and a specificity of 69.8% (95% CI, 38.2–89.6%). Conclusion: PCEs have a comparable diagnostic yield to colonoscopy and MRE in Crohn's disease. The major difficulty remains standardization of PCE scoring systems and the lack of transmural assessment. In UC, PCE has an excellent diagnostic sensitivity and positive predictive value, but there are limitations to its use including the lack of histologic assessment and poor specificity. [ABSTRACT FROM AUTHOR]

Background: Relatively little is understood about real-world provision of oncology care in ambulatory outpatient clinics (OPCs). This study aimed to: 1) develop an understanding of behaviours and practices inherent in the delivery of cancer services in OPC common areas by characterising the organisation and implementation of this care; and 2) identify barriers to, and facilitators of, the delivery of this care in OPC common areas.Methods: A purpose-designed ethnographic study was employed in four public hospital OPCs. Informal field scoping activities were followed by in-situ observations, key informant interviews and document review. A view of OPCs as complex adaptive systems was used as a scaffold for the data collection and interpretation, with the intent of understanding 'work as done'. Data were analysed using an adapted "Qualitative Rapid Appraisal, Rigorous Analysis" approach.Results: Field observations were conducted over 135 h, interviews over 6.5 h and documents were reviewed. Analysis found six themes. Staff working in OPCs see themselves as part of small local teams and as part of a broader multidisciplinary care team. Professional role boundaries could be unclear in practice, as duties expanded to meet demand or to stop patients "falling through the cracks." Formal care processes in OPCs were supported by relationships, social capital and informal, but invaluable, institutional expertise. Features of the clinic layout, such as the proximity of departments, affected professional interactions. Staff were aware of inter- and intra-service communication difficulties and employed strategies to minimise negative impacts on patients. We found that complexity, coordination, culture and capacity underpin the themes that characterise this care provision.Conclusions: The study advances understanding of how multidisciplinary care is delivered in ambulatory settings and the factors which promote or inhibit effective care practice. Time pressures, communication challenges and competing priorities can pose barriers to care delivery. OPC care is facilitated by: self-organisation of participants; professional acumen; institutional knowledge; social ties and relationships between and within professional groups; and commitment to patient-centred care. An understanding of the realities of 'work-as-done' may help OPCs to sustain high-quality care in the face of escalating service demand. [ABSTRACT FROM AUTHOR]

Background: Relatively little is understood about real-world provision of oncology care in ambulatory outpatient clinics (OPCs). This study aimed to: 1) develop an understanding of behaviours and practices inherent in the delivery of cancer services in OPC common areas by characterising the organisation and implementation of this care; and 2) identify barriers to, and facilitators of, the delivery of this care in OPC common areas. Methods: A purpose-designed ethnographic study was employed in four public hospital OPCs. Informal field scoping activities were followed by in-situ observations, key informant interviews and document review. A view of OPCs as complex adaptive systems was used as a scaffold for the data collection and interpretation, with the intent of understanding 'work as done'. Data were analysed using an adapted "Qualitative Rapid Appraisal, Rigorous Analysis" approach. Results: Field observations were conducted over 135 h, interviews over 6.5 h and documents were reviewed. Analysis found six themes. Staff working in OPCs see themselves as part of small local teams and as part of a broader multidisciplinary care team. Professional role boundaries could be unclear in practice, as duties expanded to meet demand or to stop patients "falling through the cracks." Formal care processes in OPCs were supported by relationships, social capital and informal, but invaluable, institutional expertise. Features of the clinic layout, such as the proximity of departments, affected professional interactions. Staff were aware of inter- and intra-service communication difficulties and employed strategies to minimise negative impacts on patients. We found that complexity, coordination, culture and capacity underpin the themes that characterise this care provision. Conclusions: The study advances understanding of how multidisciplinary care is delivered in ambulatory settings and the factors which promote or inhibit effective care practice. Time pressures, communication challenges and competing priorities can pose barriers to care delivery. OPC care is facilitated by: self-organisation of participants; professional acumen; institutional knowledge; social ties and relationships between and within professional groups; and commitment to patient-centred care. An understanding of the realities of 'work-as-done' may help OPCs to sustain high-quality care in the face of escalating service demand. [ABSTRACT FROM AUTHOR]

Computed Tomography (CT) is commonly used for cancer screening as it utilizes low radiation for the scan. One problem with low-dose scans is the noise artifacts associated with low photon count that can lead to a reduced success rate of cancer detection during radiologist assessment. The noise had to be removed to restore detail clarity. We propose a noise removal method using a new model Convolutional Neural Network (CNN). Even though the network training time is long, the result is better than other CNN models in quality score and visual observation. The proposed CNN model uses a stacked modified U-Net with a specific number of feature maps per layer to improve the image quality, observable on an average PSNR quality score improvement out of 174 images. The next best model has 0.54 points lower in the average score. The score difference is less than 1 point, but the image result is closer to the full-dose scan image. We used separate testing data to clarify that the model can handle different noise densities. Besides comparing the CNN configuration, we discuss the denoising quality of CNN compared to classical denoising in which the noise characteristics affect quality. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) is a severe neurological injury that results in damage to multiple bodily systems. SCI rehabilitation requires a significant focus on improving adjustment to the injury. This paper presents a detailed description of the Spinal Cord Injury Adjustment Model (SCIAM), which clarifies how individuals adjust to SCI and contends that adjustment to SCI is a multifactorial process involving non-linear dynamic adaptation over time. Evidence supporting SCIAM is also discussed. Mediation analyses were conducted to test the mediator dynamics proposed by the model. The analyses tested the relationship between two moderators (self-care and secondary health conditions), mediators (two self-efficacy items and appraisal of quality of life or QoL), and positive versus negative vitality/mental health as outcomes. Results showed that higher self-efficacy and perceived QoL was related to greater independence in self-care and reduced negative impacts of secondary health conditions. This study supported the mediation role of self-efficacy and other appraisals such as perceived QoL in enhancing self-care and buffering the negative impact of health challenges. In conclusion, it is important to employ a holistic model such as SCIAM to conceptualise and increase understanding of the process of adjustment following a severe neurological injury such as SCI. [ABSTRACT FROM AUTHOR]

The assessment of mild cognitive impairment (MCI) following spinal cord injury (SCI) is vital. However, there are no neurocognitive screens which have been developed specifically to meet the unique requirements for SCI, nor are there consistent MCI criteria applied to determine the rates of MCI. The aim of this study was to determine the suitability of a neurocognitive screen for assessing MCI in adults with SCI. A total of 127 participants were recruited. Socio-demographic and injury related variables were assessed. All participants completed the screen. Descriptive statistics are provided for total/domain screen scores and all items, and the screen's ability to distinguish MCI was examined. Congeneric confirmatory factor analyses (CFA) were employed to investigate structural validity. The screen total score was sensitive to differences in neurocognitive capacity, as well as for time since the injury occurred (p < 0.01). The MCI rate ranged between 17–36%. CFA revealed attention and visuoconstruction domains had an adequate model fit and executive function had poor fit, while CFA models for memory and language did not fit the data (did not converge), hence could not be determined. While the screen differentiated between those with MCI and those without, and MCI as a function of time since injury, limitations of its suitability for assessing MCI after SCI exist, demonstrating the need for a specialized neurocognitive screen for adults with SCI. [ABSTRACT FROM AUTHOR]

Purpose: Dietary flavonoids are bioactive compounds that have been widely investigated for their associations with vascular health outcomes. As the development of tinnitus has been linked to vascular pathways, dietary flavonoids may have role in the prevention of tinnitus symptoms. This study reports the associations between the intakes of major classes of dietary flavonoids and 10-year incidence of tinnitus. Methods: Of the 1753 participants (aged ≥ 50 years) from the Blue Mountains Hearing Study with complete baseline data on tinnitus symptoms and dietary intakes, 536 (31%) cases of tinnitus were identified and excluded from further analysis. Dietary data was collected using a semi-quantitative food frequency questionnaire and intakes of the five major classes of flavonoids were determined using U.S. Department of Agriculture flavonoid databases. Presence of prolonged tinnitus was assessed by a positive response to a single question administered by an audiologist. Results: Of the remaining 1217 participants without tinnitus at baseline, 222 (18%) incident cases of tinnitus were identified over 10 years. After age–sex adjustment, participants in the third versus first quartile of proanthocyanidin intake were significantly less likely to develop incident tinnitus by 36% (HR = 0.64; 95% CI 0.43–0.96, Ptrend = 0.04). Following multivariable adjustment, this protective trend was non-significant (HR = 0.60; 95% CI 0.39–0.92; Ptrend = 0.06). Similarly, a non-significant protective trend was observed when comparing the fourth versus first quartile of intake of all flavonoids (OR = 0.61; 95% CI 0.39–0.96). No other associations were observed. Conclusion: Our findings do not support the hypothesis that dietary flavonoids are protective against the development of tinnitus over 10 years. The weak significant association observed between proanthocyanidin and incident tinnitus may be a chance finding as there was no significant trend following multivariate adjustments and, therefore, requires further studies to investigate these associations. [ABSTRACT FROM AUTHOR]

Neuropathic pain in people with spinal cord injury is thought to be due to altered central neuronal activity. A novel therapeutic intervention using virtual reality (VR) head-mounted devices was investigated in this study for pain relief. Given the potential links to neuronal activity, the aim of the current study was to determine whether use of VR was associated with corresponding changes in electroencephalography (EEG) patterns linked to the presence of neuropathic pain. Using a within-subject, randomised cross-over pilot trial, we compared EEG activity for three conditions: no task eyes open state, 2D screen task and 3D VR task. We found an increase in delta activity in frontal regions for 3D VR with a decrease in theta activity. There was also a consistent decrease in relative alpha band (8–12 Hz) and an increase in low gamma (30–45 Hz) power during 2D screen and 3D VR corresponding, with reduced self-reported pain. Using the nonlinear and non-oscillatory method of extracting fractal dimensions, we found increases in brain complexity during 2D screen and 3D VR. We successfully classified the 3D VR condition from 2D screen and eyes opened no task conditions with an overall accuracy of 80.3%. The findings in this study have implications for using VR applications as a therapeutic intervention for neuropathic pain in people with spinal cord injury. [ABSTRACT FROM AUTHOR]

Objectives: We examined the association between birthweight and objectively measured hearing loss in older men and women.Study Design: 893 community-dwelling participants aged 50+ years with pure-tone audiometry data and self-reported birthweight were included for cross-sectional analysis. Participants were asked how much they weighed at birth either in pounds and ounces or in kilograms and grams.Main Outcome Measures: The pure-tone average of frequencies 0.5, 1.0, 2.0 and 4.0 kHz (PTA0.5-4kHz) >25 dB HL in the better ear established the presence of hearing loss.Results: Around 31.9% and 50.0% of participants who self-reported low (<2.5 kg) and high birthweight (>4.5 kg), respectively, had hearing loss. The odds of experiencing any level of hearing loss (>25 dB HL) after multivariate adjustment was: OR 2.00 (95% CI 1.13-3.56) for low birthweight and OR 2.43 (95% CI 1.23-4.82) for high birthweight, compared with participants in the reference group who self-reported normal birthweight (3.1-4.0 kg). Additionally, participants with high birthweight had 2.4-fold greater odds of having mild hearing loss (25-40 dB HL), while participants with low birthweight had 2.6-fold greater odds of moderate to severe hearing loss.Conclusions: We observed an independent U-shaped association between birthweight and age-related hearing loss, that is, persons born with low or high birthweight had a greater likelihood of experiencing any level of hearing loss in older age. These findings provide further evidence to address an important gap in the literature regarding the influence of foetal growth on the auditory system in later life. [ABSTRACT FROM AUTHOR]

Background: Relatively little is understood about real-world provision of oncology care in ambulatory outpatient clinics (OPCs). This study aimed to: 1) develop an understanding of behaviours and practices inherent in the delivery of cancer services in OPC common areas by characterising the organisation and implementation of this care; and 2) identify barriers to, and facilitators of, the delivery of this care in OPC common areas. Methods: A purpose-designed ethnographic study was employed in four public hospital OPCs. Informal field scoping activities were followed by in-situ observations, key informant interviews and document review. A view of OPCs as complex adaptive systems was used as a scaffold for the data collection and interpretation, with the intent of understanding 'work as done'. Data were analysed using an adapted "Qualitative Rapid Appraisal, Rigorous Analysis" approach. Results: Field observations were conducted over 135 h, interviews over 6.5 h and documents were reviewed. Analysis found six themes. Staff working in OPCs see themselves as part of small local teams and as part of a broader multidisciplinary care team. Professional role boundaries could be unclear in practice, as duties expanded to meet demand or to stop patients "falling through the cracks." Formal care processes in OPCs were supported by relationships, social capital and informal, but invaluable, institutional expertise. Features of the clinic layout, such as the proximity of departments, affected professional interactions. Staff were aware of inter- and intra-service communication difficulties and employed strategies to minimise negative impacts on patients. We found that complexity, coordination, culture and capacity underpin the themes that characterise this care provision. Conclusions: The study advances understanding of how multidisciplinary care is delivered in ambulatory settings and the factors which promote or inhibit effective care practice. Time pressures, communication challenges and competing priorities can pose barriers to care delivery. OPC care is facilitated by: self-organisation of participants; professional acumen; institutional knowledge; social ties and relationships between and within professional groups; and commitment to patient-centred care. An understanding of the realities of 'work-as-done' may help OPCs to sustain high-quality care in the face of escalating service demand. [ABSTRACT FROM AUTHOR]

Through their results, the authors of these papers have provided a better understanding of cognitive states and brain activity based on different EEG signal processing methodologies and machine learning strategies. In this Special Issue, many novel EEG signal-processing strategies and analysis techniques are explored. Electroencephalography (EEG) signals are used widely in clinical and research settings. As EEG signals are acquired from the scalp, this paper presented an anatomically realistic textile-based head phantom for the assessment of EEG sensors. [Extracted from the article]

This systematic review explores the multifaceted nature of risk factors contributing to adult-onset HL. The objective was to synthesise the most recent epidemiological evidence to generate pooled proportional incidences for the identified risk factors. We conducted an extensive search of electronic databases (MEDLINE, EMBASE, and psychINFO) for studies providing epidemiological evidence of risk factors associated with hearing loss. Topic modelling using Latent Dirichlet Allocation (LDA) was first conducted to determine how many risk factor themes were available from the papers. Data were analysed by calculating the pooled proportional incidence using a meta-analysis of proportions. From the 72 studies reviewed, six key risk factor themes emerged through LDA topic modelling. The review identified ototoxicity, primarily caused by cancer treatments and antibiotics, infectious diseases like COVID-19, occupational noise exposure, lifestyle factors, health conditions, biological responses, and age progression as significant risk factors for HL. The highest proportional incidence was found with cancer-related ototoxicity at 55.4% (95%CI: 39.0–70.7), followed closely by ototoxicity from infectious diseases at 50.0% (95%CI: 28.5–71.5). This high proportional incidence suggests the need to explore less destructive therapies and proactively monitor hearing function during treatments. The findings of this review, combined with the synthesis of epidemiological evidence, enhance our understanding of hearing loss (HL) pathogenesis and highlight potential areas for intervention, thereby paving the way for more effective prevention and management of adult-onset hearing loss in our ageing global population. • Risk factors associated with hearing loss (HL) can influence the development of this condition. • Ototoxicity had the highest incidence emphasising the need to explore less destructive therapies. • Noise-induced HL is largely preventable, highlighting the need for occupational noise management. [ABSTRACT FROM AUTHOR]

Traffic injuries significantly impact people's psychological, physical and social wellbeing, and involve complex self-regulation responses. Psychological impacts are seldom recognized and addressed holistically. This study employs network analysis to investigate the interconnectedness between different dimensions that influence mental health vulnerability and recovery after traffic injuries. 120 adults with mild-to-moderate traffic injuries and 112 non-injured controls were recruited. The network investigation employed two main approaches. Four cross-sectional networks examined the interrelationships between self-regulation responses (cognitive and autonomic) and various health dimensions (psychological, physical, social) over time (1, 3, 6, 12 months). Three predictive networks explored influences of acute self-regulation responses (1 month) on long-term outcomes. Network analyses focused on between-group differences in overall connectivity and centrality measures (nodal strength). An overall measure of psychological wellbeing consistently emerged as the most central (strongest) node in both groups' networks. Injured individuals showed higher overall connectivity and differences in the centrality of self-regulation nodes compared to controls, at 1-month and 12-months post-injury. These patterns were similarly observed in the predictive networks, including differences in cognitive and autonomic self-regulation influences. Network analyses highlighted the crucial role of psychological health and self-regulation, in promoting optimal wellbeing and effective recovery. Post-traffic injury, increased connectivity indicated prolonged vulnerability for at least a year, underscoring the need of ongoing support beyond the initial improvements. A comprehensive approach that prioritizes psychological health and self-regulation through psychologically informed services, early psychological screening, and interventions promoting cognitive and autonomic self-regulation is crucial for mitigating morbidity and facilitating recovery. Trial registration: IMPRINT study, ACTRN 12616001445460. • Psychological health plays a central role in a person's optimal overall wellbeing. • Cognitive and autonomic self-regulation plays a central role in injury recovery. • Prolonged vulnerability remains for at least a year after a traffic injury. • Prioritizing psychological health as comprehensive approach to holistic recovery. • Cognitive and autonomic self-regulation may be a target to improve recovery. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Infertility may occur in women with Crohn's disease (CD) and ulcerative colitis (UC), especially after surgery such as ileal pouch-anal anastomosis (IPAA). Assisted reproductive technology (ART) may be an option, but the safety and efficacy in this setting has been based on small cohorts to date. We performed a systematic review and meta-analysis to address this data gap. METHODS: A systematic review and random-effects meta-analysis was performed until May 2020. The primary outcomes were pregnancy and live birth rates per cycle of ART. RESULTS: Eleven studiesmet inclusion criteria for the systematic review and 4 for themeta-analysis. Compared with the general population, women with CD(with andwithout previous surgery) had no difference in pregnancy rates (odds ratio [OR]50.69,95%confidence interval [CI]:0.45-1.05) but hadreduced live births (OR5 0.67, 95%CI: 0.53-0.85) per cycle of ART. ART live birth rates are not reduced in women withmedically managed CD; however, they are 49%-71% lower after CD-related surgery. Women with UC had no difference in both pregnancy rates (OR50.99, 95%CI: 0.63-1.55) and live birth rates (OR50.88, 95% CI: 0.67-1.17); however, live birth rates were reduced after IPAA failure (hazard ratio 5 0.36, 95% CI: 0.14-0.92). Two studies did not identify any significant safety signals. DISCUSSION: ART is safe and effective in patients with UC and medically managed CD, with pregnancy and live birth rates similar to that of the general population. However, within the limitations of the available literature, current data suggest that efficacy is reduced inwomen with CD-related surgery and IPAA failure. Greater gastroenterologist awareness of ART is needed to facilitate timely fertility therapy referral when indicated, particularly in CD. [ABSTRACT FROM AUTHOR]

Background: Hospitals are perceived as fast-paced and complex environments in which a missed or incorrect diagnosis or misread chart has the potential to lead to patient harm. However, to date, limited attention has been paid to studying how hospital sociotemporal norms may be associated with staff wellbeing or patient safety. The aim of this study was to use novel network analysis, in conjunction with well-established statistical methods, to investigate and untangle the complex interplay of relationships between hospital staff perceived sociotemporal structures, staff safety attitudes and work-related well-being.Method: Cross-sectional survey data of hospital staff (n = 314) was collected from four major hospitals in Australia. The survey included subscales from the Organizational Temporality Scale (OTS), two previously established scales of safety attitudes (teamwork climate and safety climate) and measures of staff-related wellbeing (job satisfaction, emotional exhaustion, depersonalisation).Results: Using confirmatory factor analysis, we first tested a 19-item version of the OTS for use in future studies of hospital temporality (the OTS-H). Novel psychological network analysis techniques were then employed, which identified that "pace" (the tempo or rate of hospital activity) occupies the central position in understanding the complex relationship between temporality, safety attitudes and staff wellbeing. Using a path analysis approach, serial mediation further identified that pace has an indirect relationship with safety attitudes through wellbeing factors, that is, pace impacts on staff wellbeing, which in turn affects hospital safety attitudes.Conclusions: The findings of this study are important in revealing that staff wellbeing and safety attitudes can be significantly improved by placing more focus on temporal norms, and in particular hospital pace. There are implications for increasing levels of trust and providing staff with opportunities to exercise greater levels of control over their work. [ABSTRACT FROM AUTHOR]

Purpose: Adults who stutter (AWS) have increased risk of comorbid social anxiety about speaking in social contexts. AWS also report experiencing embarrassment in different social situations; however, research has rarely been conducted on embarrassment and its relationship to social anxiety in AWS. Method: AWS (N = 200) reported their level of embarrassment on four 10-point Likert items when speaking in four situational contexts: at home, to an individual important to them, in social groups, and at work. Participants were also assessed for sociodemographic, stuttering, and anxiety variables. Construct validity for the four embarrassment items was examined, the extent of embarrassment established in the four contexts as a function of age and sex, and the relationship of embarrassment to social anxiety evaluated. Results: Evidence of acceptable construct validity and reliability is presented for the four embarrassment Likert items. Sixty-five percent of the sample experienced high levels of embarrassment when speaking in groups or at work, while 35.5% experienced high levels when speaking at home or to an individual important to them. Participants were significantly more embarrassed (p < .01) when speaking at work or when socializing in groups. Embarrassment was lowest when speaking in the home. Younger females were significantly more embarrassed when speaking at work or when socializing in groups. Those with high embarrassment scores on all four items were more likely to have elevated social anxiety scores (p < .001). Conclusion: These preliminary results suggest that the assessment of situational embarrassment could be an important clinical measure that may help improve stuttering treatment outcomes that also target social anxiety. [ABSTRACT FROM AUTHOR]

Objective: There have been few descriptions of how outpatient cancer care is provided to patients from culturally and linguistically diverse (CALD) communities. As populations who experience disparities in cancer care access and outcomes, deeper understanding is needed to help identify those factors which can shape the receipt of multidisciplinary care in ambulatory settings. This paper reports on data collected and analysed as part of a multicentre characterisation of care in Australian public hospital cancer outpatient clinics (OPCs). Results: Analysis of data from our ethnographic study of four OPCs identified three themes: "Identifying CALD patient language-related needs"; "Capacity and resources to meet CALD patient needs", and "Making it work for CALD communities." The care team comprises not only clinicians but also families and non-clinical staff; OPCs serve as "touchpoints" facilitating access to a range of therapeutic services. The findings highlight the potential challenges oncology professionals negotiate in providing care to CALD communities and the ways in which clinicians adapt their practices, formulate strategies and use available resources to support care delivery. [ABSTRACT FROM AUTHOR]

People who sustain injury in a road traffic crash (RTC) have significant risk of psychiatric morbidity, but effective screening for identifying at-risk individuals soon after the RTC is lacking. We investigated whether pre-injury vulnerability can assist as an early screen to manage this risk. We recruited 120 adults who sustained physical injury in a RTC and admitted to an emergency department (ED). They were comprehensively assessed for acute and long-term presence of psychiatric disorder/morbidity and disability over 12-months after the injury, with comparisons to a non-injury control. Propensity matching based on six pre-injury vulnerability factors (age, sex, education, socioeconomic status, prior mental health, prior physical health) with the control group was used to determine membership of high vulnerability (HV) and low vulnerability (LV) injury sub-groups. Compared to the LV sub-group and controls that had similar pre-injury vulnerability, the HV sub-group had a worrying post-RTC recovery profile, with significantly higher rates of long-term psychiatric morbidity (42.2% vs. 23.1% and 15.9% respectively, p =.002) including post-traumatic stress disorder and/or depression, and poorer psychological adjustment over the 12-months. In contrast, the HV and LV sub-groups were similar in injury-related characteristics and post-injury physical (pain, fatigue, physical functioning) and participation outcomes. Findings provide preliminary evidence that pre-injury vulnerability, primarily prior mental health status, is a promising screen for early identification of people at risk of psychiatric morbidity post-RTC. It is suggested this screen could be implemented in ED to prevent chronicity and improve recovery following a traumatic injury. Further research is warranted to enhance the screen's effectiveness. • Pre-injury vulnerability contributes to increased risk of psychiatric morbidity after a road traffic injury. • Physical recovery is less impacted by pre-injury vulnerability. • Risk of psychiatric morbidity could be screened as soon as in Emergency Department. • Screening could be improved for instance by assessment of peri-traumatic distress. [ABSTRACT FROM AUTHOR]

Background: While the quality of medical care delivered by physicians can be very good, it can also be inconsistent and feature behaviours that are entrenched despite updated information and evidence. The "nudge" paradigm for behaviour change is being used to bring clinical practice in line with desired standards. The premise is that behaviour can be voluntarily shifted by making particular choices instinctively appealing. We reviewed studies that are explicit about their use of nudge theory in influencing clinician behaviour. Methods: Databases were searched from April 2008 (the publication date of the book that introduced nudge theory to a wider audience) to November 2018, inclusive. The search strategy and narrative review of results addressed the Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews. Results: 22 studies were identified. Randomized trials or pre‐post comparisons were generally used in community‐based settings; single‐site pre‐post studies were favoured in hospitals. The studies employed eight intervention types: active choice; patient chart redesign; default and default alerts; partitioning of prescription menus; audit and feedback; commitment messages; peer comparisons; and redirection of workflow. Three core cognitive factors underpinned the eight interventions: bias towards prominent choices (salience); predisposition to social norms; and bias towards time or cost savings. Conclusions: Published studies that are explicit about their use of nudge theory are few in number and diverse in their settings, targets, and results. Default and chart re‐design interventions reported the most substantial improvements in adherence to evidence and guideline‐based practice. Studies that are explicit in their use of nudge theory address the widespread failure of clinical practice studies to identify theoretical frameworks for interventions. However, few studies identified in our review engaged in research to understand the contextual and site‐specific barriers to a desired behaviour before designing a nudge intervention. [ABSTRACT FROM AUTHOR]

Background The health, social and economic consequences of the severe acute respiratory syndrome coronavirus (SARS-CoV-2, henceforth COVID-19) pandemic have loomed large as every national government made decisions about how to respond. The 40 Health Systems, COVID-19 (40HS, C-19) study aimed to investigate relationships between governments' capacity to respond (CTR), their response stringency, scope of COVID-19 testing and COVID-19 outcomes. Methods Data over March and April 2020 were extracted for 40 national health systems on prepandemic government CTR (Global Competitiveness Index), stringency measures (Oxford COVID-19 Government Response Tracker Stringency Index), approach to COVID-19 testing and COVID-19 cases and deaths (Our-World-in-Data). Multidimensional scaling (MDS) and cluster analysis were applied to examine latent dimensions and visualize country similarities and dissimilarities. Outcomes were tested using multivariate and one-way analyses of variances and Kruskal–Wallis H tests. Results The MDS model found three dimensions explaining 91% of the variance and cluster analysis identified five national groupings. There was no association between national governments' prepandemic CTR and the adoption of early stringent public health measures or approach to COVID-19 testing. Two national clusters applied early stringency measures and reported significantly lower cumulative deaths. The best performing national cluster (comprising Australia, South Korea, Iceland and Taiwan) adopted relatively early stringency measures but broader testing earlier than others, which was associated with a change in disease trajectory and the lowest COVID-19 death rates. Two clusters (one with high CTR and one low) both adopted late stringency measures and narrow testing and performed least well in COVID-19 outcomes. Conclusion Early stringency measures and intrinsic national capacities to deal with a pandemic are insufficient. Extended stringency measures, important in the short term, are not economically sustainable. Broad-based testing is key to managing COVID-19. [ABSTRACT FROM AUTHOR]

Background: Is national healthcare performance associated with country-level characteristics, and if so what are the implications for international health policy? Methods and findings: We compared Hofstede's six cultural dimensions against relative health systems performance of 35 countries. Hierarchical cluster analysis identified best-matched groupings of countries. Performance was measured by the Organisation for Economic Co-operation and Development's (OECD's) Health at a Glance indicators data framework (five dimensions with 57 indicators) and the United Nations' (UNs') Sustainability Development Goals (SDG) data set (15 indicators). Three country clusters emerged: Collective-Pyramidal (n = 9: comprising Slovak Republic, Mexico, Poland, Greece, Spain, Turkey, Portugal, Chile, and Slovenia); Collaborative-Networked (n = 12: UK, Canada, Australia, USA, Ireland, New Zealand, Netherlands, Finland, Iceland, Norway, Denmark, and Sweden); and Orderly-Future Orientated (n = 14: Korea, Estonia, Latvia, Austria, Israel, Japan, Czech Republic, Hungary, Italy, Belgium, France, Germany, Luxembourg and Switzerland). The Collaborative-Networked cluster had significantly better performing health systems measured by both the Health at a Glance and SDG performance data, followed by the Orderly-Future Orientated cluster, followed by the Collective-Pyramidal cluster. The Collaborative-Networked Cluster was characterized by low power distance (e.g., greater levels of equity), low uncertainty avoidance (e.g., toleration of others' opinions), individualism (e.g., self-reliance) and indulgence (e.g., drives and norms to enjoy life and have fun). Conclusions: National cultures are associated with healthcare performance on two key international measures. In national and international efforts to improve health system performance, cultural characteristics play an important role. This information may be of value to regulators, policymakers, researchers and clinicians examining the practical impact of culture on healthcare performance. [ABSTRACT FROM AUTHOR]

The occurrence of mental fatigue during tasks like driving a vehicle increases risk of injury or death. Changes in electroencephalographic (EEG) activity associated with mental fatigue has been frequently studied and considered a promising biomarker of mental fatigue. This is despite differences in methodologies and outcomes in prior research. A systematic review with meta‐analyses was conducted to establish the influence of mental fatigue on EEG activity spectral bands, and to determine in which regions fatigue‐related EEG spectral changes are likely to occur. A high‐yield search strategy identified 21 studies meeting inclusion criteria for investigating the change in EEG spectral activity in non‐diseased adults engaged in mentally fatiguing tasks. A medium effect size (using Cohen's g) of 0.68 (95%CI: 0.24–1.13) was found for increase in overall EEG activity following mental fatigue. Further examination of individual EEG spectral bands and regions using network meta‐analyses indicated large increases in theta (g = 1.03; 95%CI: 0.79–1.60) and alpha bands (g = 0.85; 95%CI: 0.47–1.43), with small to moderate changes found in delta and beta bands. Central regions of the scalp showed largest change (g = 0.80; 95%CI: 0.46–1.21). Sub‐group analyses indicated large increases in theta activity in frontal, central and posterior sites (all g > 1), with moderate changes in alpha activity in central and posterior sites. Findings have implications for fatigue monitoring and countermeasures with support for change in theta activity in frontal, central and posterior sites as a robust biomarker of mental fatigue and change in alpha wave activity considered a second line biomarker to account for individual variability. There is significant risk of injury during tasks such as driving or operating machinery when mentally fatigued. Reliable biomarkers are needed that warn a fatigued person so they can take preventive action. This review uses meta‐analytic methods to synthesise the results from 21 studies. Results highlight the spectral bands and regions most promising for an EEG biomarker. [ABSTRACT FROM AUTHOR]

To the disbenefit of qualitative health services research, the generation of study design is too often implied as a logical consequence of aims or questions. Limited space is afforded to describing the critical processes we go through to devise our research for the ever-complex services we seek to understand. This article offers an in-depth examination of qualitative health services research design and the considerations inherent in the process. To illustrate, we present a worked example of our experience developing an investigation to characterize and explore multidisciplinary cancer service provision in hospital outpatient clinics. We map the development of our investigation from the a priori conceptualization of the phenomena of inquiry through to the detailed research plan, explicating the design choices made along the way. We engage with key issues for qualitative health researchers, which include how we make sense of and account for context; address multisite research considerations; design with and for stakeholder engagement; ensure epistemological, ontological, and methodological coherence; and select analytical and interpretative strategies. We arrive at a complex staged investigation that employs mixed and multi-methods to be conducted across a range of settings. Our purpose is to stimulate thinking about many of the contemporary design challenges researchers negotiate. [ABSTRACT FROM AUTHOR]

Background: The adoption of Patient Reported Outcome Measures (PROMs) in cancer care has been widely advocated, but little is known about the evidence for the implementation of PROMs in practice. Qualitative research captures the perspectives of health professionals as end-users of PROMs and can be used to inform adoption efforts. This paper presents a systematic review and synthesis of qualitative research conducted to address the question: What are the attitudes of health professionals towards PROMs in oncology, including any barriers and facilitators to the adoption of PROMS, reported in qualitative evidence?Methods: Systematic searches of qualitative evidence were undertaken in four databases and reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published in English between 1998 and 2018, which reported qualitative findings about the attitudes of health professionals working in oncology towards PROMs were eligible. Studies were assessed using the Critical Appraisal Skills Programme's Qualitative Research Checklist. A sentiment analysis was conducted on primary text to examine the polarity (neutral, positive or negative) of health professionals' views of PROMs. Qualitative meta-synthesis was conducted using a constant comparative analysis.Results: From 1227 articles after duplicates were removed, with 1014 excluded against the screening criteria, 213 full text articles remained and were assessed; 34 studies met the inclusion criteria and were included. The majority of studies were of good quality. Sentiment analysis on primary text demonstrated an overall positive polarity from the expressed opinions of health professionals. The meta-synthesis showed health professionals' attitudes in four domains: identifying patient issues and needs using PROMs; managing and addressing patient issues; the care experience; and the integration of PROMs into clinical practice.Conclusions: From the accounts of health professionals, the fit of PROMs with existing practice, how PROMs are valued, capacity to respond to PROMs and the supports in place, formed the key factors which may impede or promote adoption of PROMs in routine practice. To assist policy-makers and services involved in implementing these initiatives, further evidence is required about the relationship between PROMs data collection and corresponding clinical actions.Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42019119447, 6th March, 2019. [ABSTRACT FROM AUTHOR]

Background: Patients want information across their cancer journeys. We investigated what sort of information they want and at what stage in the cancer journey by examining English patients' satisfaction derived from ratings of their care. Methods: Using patient experience data from 209 Clinical Commission Groups (CCGs) involving 72 788 respondents in 2016, overall patient satisfaction ratings and information needs questions were extracted. Novel network analysis techniques were used to construct an undirected weighted concentration network to assess the relationship between information needs and patient satisfaction. Results: From the network analysis, we found that patients value information early in the pathway; there were higher associations between patient satisfaction and when information needs are met in earlier phases of the cancer journey. Across the stages of the cancer journey, strong associations between information needs and patient satisfaction emerged during diagnostic testing and also at those points when patients received information provided by the clinical nurse specialists. A mixture of strong and weak associations between patient satisfaction and information needs was found during later phases of the cancer journey, specifically when patients move from treatment to home care. Our study identified that meeting needs for information related to supportive care may be a weaker factor in patient satisfaction than meeting needs for information related to the patient's disease, its treatment and the side effects of treatment. Conclusion: If patients have their information needs met, especially during stages within the cancer journey when information needs are highest, they are more likely to be satisfied with their care. Our study has implications for information giving and improving patient satisfaction in cancer care. Most cancer patients wish to be well informed at all stages of their cancer journeys. Patients want information about their care, and receiving valued information is very strongly related to satisfaction with that care. If patients have their information needs met, especially during stages within the cancer journey when information needs are highest, they are more likely to be satisfied with their care. [ABSTRACT FROM AUTHOR]

Purpose Many adults who stutter have elevated negative mood states like anxiety and depressive mood. Little is known about how mood states change over time. The purpose of this study was to determine the trajectories or sub-types of mood states in adults who stutter over a 6 month period, and establish factors that contribute to these sub-types. Method Participants included 129 adults who stutter who completed an assessment regimen at baseline, including a measure of mood states (Symptom Checklist-90-Revised). Three mood states were assessed (interpersonal sensitivity or IS, depressive mood and anxiety) once a month over 6 months. Latent class growth mixture modeling was used to establish trajectories of change in these mood states over time. Logistic regression was then used to determine factors assessed at baseline that contribute to the IS trajectories. Results Three-class trajectory models were accepted as the best fit for IS, depressive mood and anxiety mood sub-types. Stable and normal mood state sub-types were found, incorporating around 60% of participants. Up to 40% belonged to sub-types comprising elevated levels of negative mood states. The logistic regression was conducted only with the IS domain, and revealed four factors that significantly contributed to IS mood sub-types. Those with low perceived control, low vitality, elevated social fears and being female were more likely to belong to elevated IS classes. Conclusions This research revealed mood sub-types in adults who stutter, providing direction for the treatment of stuttering. Clarification of how much stuttering influences mood sub-types versus pre-existing mood is required. [ABSTRACT FROM AUTHOR]

Introduction: Psychological distress following a motor vehicle crash (MVC) is prevalent, especially when the person sustains an associated physical injury. Psychological distress can exhibit as elevated anxiety and depressive mood, as well as presenting as mental disorders such as Post Traumatic Stress Disorder (PTSD) or Major Depressive Disorder (MDD). If unmanaged, psychological distress can contribute to, or exacerbate negative outcomes such as social disengagement (e.g., loss of employment) and poor health-related quality of life, as well as contribute to higher costs to insurers. This systematic review summarises current research concerning early psychological intervention strategies aimed at preventing elevated psychological distress occurring following a MVC.Method: A systematic review of psychological preventative intervention studies was performed. Searches of Medline, Embase, PsychINFO, Web of Science and Cochrane Library were used to locate relevant studies published between 1985 and September 2015. Included studies were those investigating MVC survivors who had received an early psychological intervention aimed at preventing psychological distress, and which had employed pre- and post- measures of constructs such as depression, anxiety and disorders such as PTSD.Results: Searches resulted in 2608 records. Only six studies investigated a psychological preventative intervention post-MVC. Interventions such as injury health education, physical activity and health promotion, and therapist-assisted problem solving did not result in significant treatment effects. Another six studies investigated psychological interventions given to MVC survivors who were assessed as sub-clinically psychologically distressed prior to their randomisation. Efficacy was varied, however three studies employing cognitive behaviour therapy (CBT) found significant reductions in psychological distress compared to wait-list controls.Conclusion: Psychological interventions aimed at preventing psychological distress post-MVC are limited, often involving small samples, with subsequent poor statistical power and subsequent high risk of bias. These factors make it difficult to draw conclusions, however CBT appears encouraging and therefore worthy of consideration as a preventative intervention. [ABSTRACT FROM AUTHOR]

Major goals of rehabilitation and health interventions in people with spinal cord injury (SCI) are to improve functional independence, increase social participation, and enhance quality of life (QOL). Determining functional areas perceived by consumers as most important can assist in research prioritization, planning for delivery of health services, and policy development. Five high priority areas of functioning for the SCI population (arm/hand use, walking, bladder/bowel control, sexual function, and relief of pain) were chosen to determine the preferences for these five attributes. A discrete choice experiment was conducted involving 151 persons with SCI sampled from Australia and the United States of America. Consistent with prior research, arm/hand function had the highest preference, with odds ratios of subjects being 44-76% more likely to choose arm/hand function over the other four functions. Preference for normal arm/hand function was found to be significantly more preferred by the group with paraplegia compared with those with tetraplegia; that is, retaining and not trading off existing arm/hand function for other improved functions. There were no significant differences found in preferences between bladder/bowel function and walking or elimination of pain, although walking was preferred in earlier (≤10) post-injury years and pain amelioration became more important with a longer duration (>10 years) post-injury. Sexual function had the lowest preference when traded against the other four functions. Understanding the functional preferences of persons with SCI will help to inform future research design, as well as enabling successful translation of research into practice and health policy, meeting the needs of people with SCI. [ABSTRACT FROM AUTHOR]

Background: It is estimated that up to 50 % of motor vehicle crash survivors develop significant psychological distress, such as depressive mood and anxiety, within 6 months of the crash. Associated impacts include loss of employment, delayed return to work, financial and familial stress, and increased medical and compensation costs. The major aim of this research is to investigate the efficacy of interventions for preventing the development of psychological distress following a motor vehicle crash. The efficacy of two brief interventions will be examined: a cognitive behaviour therapy (CBT) programme, targeting mood and anxiety, and a lifestyle programme, targeting sleep, diet and physical activity.Methods/design: This is a randomized, controlled multisite study. Participants include at least 180 adults injured in a motor vehicle crash who have entered a compensation process. Research will compare outcomes in three groups randomly assigned to: one group of 60 adults, who receive a brief email-delivered CBT programme, with one session every 2 weeks for 10 weeks and telephone contact every 2 weeks; a second group of 60 adults, who receive a brief email-delivered lifestyle intervention involving one session every 2 weeks for 10 weeks with telephone contact; and an active waiting-list control group of 60 adults who are provided claims processing-related reading material along with telephone contact every 2 weeks for 10 weeks. Participants will be recruited within 12 weeks of the motor vehicle crash, and will be comprehensively assessed before and after treatment, and 6 and 12 months post-injury. Assuming an α probability level of 0.05 and a power of 80 %, at least 180 participants will be recruited. The primary outcome measure is the presence and severity of psychological distress or disorder. Secondary outcome measures include assessment of self-efficacy, resilience employment status, social activity and support, lifestyle and physical health factors, along with process outcome measures of treatment acceptability, feasibility and generalizability.Discussion: This study will determine whether brief email-delivered interventions distributed soon after the injury and entry into the claims process can be effective in preventing the development of psychological distress.Trial Registration: ANZCTR, ACTRN12615000326594 . Registered on 9 April 2015. [ABSTRACT FROM AUTHOR]

This study examined the brain source space functional connectivity from the electroencephalogram (EEG) activity of 48 participants during a driving simulation experiment where they drove until fatigue developed. Source-space functional connectivity (FC) analysis is a state-of-the-art method for understanding connections between brain regions that may indicate psychological differences. Multi-band FC in the brain source space was constructed using the phased lag index (PLI) method and used as features to train an SVM classification model to classify driver fatigue and alert conditions. With a subset of critical connections in the beta band, a classification accuracy of 93% was achieved. Additionally, the source-space FC feature extractor demonstrated superiority over other methods, such as PSD and sensor-space FC, in classifying fatigue. The results suggested that source-space FC is a discriminative biomarker for detecting driving fatigue. [ABSTRACT FROM AUTHOR]

Highlights: [•] The relationship between social support and negative affect in 200 Adults who stutter and 200 adults, who do stutter, is presented. [•] Poor social support was found to have a harmful influence on mood. [•] The suggestion that social support and social integration should be addressed during treatment for adults who stutter. [Copyright &y& Elsevier]

Highlights: [•] Two meta-analyses were performed that examined levels of trait and social anxiety in almost 1300 people who stutter. [•] Adults who stutter were found to have moderately elevated trait anxiety. [•] Adults who stutter were found to have substantially elevated social anxiety. [•] These findings reinforce the need for stuttering treatments to include social anxiety management strategies. [Copyright &y& Elsevier]

Abstract: Objective: Fatigue is a common symptom in people with neurological injury such as spinal cord injury (SCI), though its nature and occurrence in people with SCI are not well understood. The objective of this research was to investigate fatigue and its relationship to factors such as mood states and self efficacy in adult people with SCI compared to able-bodied controls. Methods: Participants included 41 adults with SCI living in the community and 41 able-bodied controls matched for age and sex ratios and education. All participants first completed a comprehensive psychological assessment and were then asked to take part in a 2–3hour session composed of a regimen of cognitive tasks that required constant concentration and attention. Participants were assessed after completing this task. Results: The SCI group was found to have significantly elevated levels of fatigue, as well as elevated depressive mood, anxiety and poor self-efficacy. The SCI group was also found to suffer excessive levels of tiredness as a consequence of the 2–3hour task. Factors such as depressive mood and poor self-efficacy were shown to increase the risk of excessive tiredness. Conclusion: People with a neurological injury such as SCI have a high risk of having fatigue and are susceptible to experiencing excessive tiredness when performing extended tasks, and the presence of elevated depressive mood or poor expectations towards self management will increase this susceptibility. Implications for managing fatigue and improving social access in SCI populations are discussed. [Copyright &y& Elsevier]

Abstract: People who stutter often report negative impacts on their wellbeing as a result of their chronic fluency disorder. The need for a comprehensive assessment of the wellbeing and experience of stuttering should be a prime consideration when measuring treatment outcomes. One such measure designed to evaluate wellbeing and aspects of the individual''s experience of his or her stuttering is the Overall Assessment of the Speaker''s Experience of Stuttering (OASES). Normative data for the OASES Adult version (OASES-A; and hereafter referred to simply as the OASES) has begun to be collected over the past 10 years, though none are available for an Australian population. This paper presents Australian normative data for the OASES for 200 adult males and females who stutter, aged between 18 and 85 years. Additionally, the influence of age, sex, and frequency of stuttering on the Australian OASES scores are also presented. No significant relationships between OASES scores were found for sex and age, which is in keeping with the USA original dataset. However, those participants who had more severe stuttering were more likely to have higher negative impacts for ‘General Information’, Communication in Daily Situations,’ and for the overall OASES score. Implications for further research are discussed. Educational objectives : The reader will be able to: (i) describe the purpose of the Overall Experience of the Speaker''s Experience of Stuttering for Adults (OASES), (ii) evaluate the relevance of the OASES to treatment planning and the evaluation of stuttering treatment outcomes in the adult population, and (iii) compare Australian normative dataset with the USA and Dutch normative datasets for the OASES. [Copyright &y& Elsevier]

Assessing brain wave activity is a viable strategy for monitoring fatigue when performing tasks such as driving, and numerous studies have been conducted in this area. However, results of a systematic review on changes in brain wave activity associated with fatigue have revealed equivocal findings. This study investigated brain wave activity associated with fatigue in 48 nonprofessional healthy drivers as they participated in a simulated driving task until they fatigued. The results showed that as a person fatigues, slow wave activity increased over the entire cortex, in theta and in alpha 1 and 2 bands, while no significant changes were found in delta wave activity. Substantial increases also occurred in fast wave activity, though mostly in frontal sites. The results suggest that as a person fatigues, the brain loses capacity and slows its activity, and that attempts to maintain vigilance levels lead to increased beta activity. [ABSTRACT FROM AUTHOR]

Abstract: Stuttering is a chronic condition involving involuntary disruption to speech fluency. While elevated social anxiety has been found to be a risk factor for adults who have stuttered all their lives, it is unclear how stuttering influences other negative mood states such as interpersonal sensitivity and depressive mood. Consequently, controlled research was conducted that investigated negative affectivity across a number of domains in adults who stutter. Participants included 200 adults who have stuttered since childhood, with comparisons made to 200 non-stuttering controls of similar age and sex. The adults who stuttered were found to have significantly elevated levels of distress and negative mood states compared to the controls. As expected, significant differences were found for anxiety, however, significant and substantial differences were also found across a broad range of negative affect, including dimensions such as somatization, interpersonal sensitivity, depressive mood, hostility and paranoia. The implications of these findings for the better management of stuttering are discussed. Educational objectives: The reader will be able to describe: (a) the negative impact of a chronic disorder like stuttering on people who have stuttered all their life; (b) the factor structure of the SCL-90-R; (c) the negative affectivity construct, and (d) the difference between psychogenic theories of stuttering and neurological theories of stuttering. [Copyright &y& Elsevier]

Abstract: Stuttering has been found to deteriorate quality of life in psychological, emotional and social functioning domains. It is reasonable to assume then that stuttering would also be associated with economic consequences that may also challenge quality of life. Remarkably, the personal financial costs associated with stuttering in adults has rarely if ever been explored or investigated in the fluency disorders field. This study involved an assessment of the personal costs of stuttering and an investigation into determinants that may influence spending. Two hundred adults who stutter participated in this study. Findings indicated that the average total cost was around $5,500 (median cost $4,165) in 2007/08 Australian dollars over a 5-year period. Major financial items included costs of direct and indirect treatments for stuttering, self-help, stuttering related conferences, and technology. Financial costs were not significantly influenced by the sex of the person, annual income, or by how severe the person stuttered. However, those individuals younger than 60 years old spent significantly more on treatment related costs, while those with elevated levels of social anxiety spent significantly less than those with lower levels of social anxiety. Quality of life implications associated with stuttering are discussed. Educational objectives : The reader will be able to: (a) describe the method for assessing the direct financial costs of stuttering over a 5-year period; (b) describe the financial personal cost of stuttering for adults who stutter; (c) describe the relationship between factors like sex, age, severity of stuttering and financial costs; and (d) describe the relationship between social anxiety and the financial cost of stuttering. [Copyright &y& Elsevier]

Background: The nature and prevalence of social anxiety disorder (social phobia (SP)) in people who stutter is uncertain, and DSM-IV differential diagnosis guidelines make it difficult to classify an adult who stutters (AWS) with SP as it is assumed any social anxiety symptoms will be a consequence of their stuttering. The aim of this study was to determine the spot prevalence of SP in AWS and to investigate differences in social anxiety between AWS and controls who do not stutter. Methods: The study involved a comprehensive assessment of 200 AWS and 200 adults who do not stutter similar in age and sex ratio. Measures included stuttering severity, health status, self-report measures of social anxiety as well as a structured diagnostic interview for SP for randomly selected sub-group of 50 from each group. Results: The AWS were found to have significantly raised trait and social anxiety, as well as significantly increased risk of SP in comparison to the controls. Findings indicated a SP spot prevalence of at least 40% in AWS, and for them to be at high risk of having Generalized SP. Conclusions: It is concluded that the DSM-IV diagnostic guidelines for diagnosing SP in AWS could result in professional confusion and have possible negative mental health ramifications. Implications for the psychological and medical treatment of AWS are discussed. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Research and development has been conducted on a "hands-free" brain wave activity (electroencephalography-based) assistive technology device called the Mind Switch. It has been designed to provide a severely disabled person (such as someone with tetraplegia) with the ability to switch using their brain activity and thus activate devices in the environment. An area of concern has been the time it takes to complete set-up of the system before individual use, as well as the occurrence of errors in switching rates. In order to improve the user friendliness of the system, this study compared the efficacy of detecting electroencephalography (EEG) changes in brain signals that occur with eye closure and used as a "switch", with two different methods of processing the EEG. Using data from spinal cord injured participants, fractal analysis, that is, the change in fractal dimension of the EEG wave during eye closure was compared to the original method of using spectral analysis change. In comparison to the spectral technique, the fractal dimension technique improved set up time, and was substantially improved in reducing the number of false positive and false negative errors when activating the device. Furthermore, the time to switch was also marginally reduced when using fractal dimension processing. Implications for improving the viability of an EEG based environmental control system for the severely neurologically injured are discussed. [ABSTRACT FROM AUTHOR]

An assistive technology developed for "hands free" control of electrical devices to be used by severely impaired people within their environment, relies upon using signal processing techniques for analyzing eyes closed (EC) and eyes open (EO) states in the electroencephalography (EEG) signal. Here, we apply a signal processing technique used in continuous chaotic modeling to investigate differences in the EEG time series between EC and EO states. This method is used to detect the degree of variability from a second-order difference plot, and quantifying this using a central tendency measures. The study used EEG time series of EO and EC states from 33 able-bodied and 17 spinal cord injured participants. The results found an increased EEG variability in brain activity during EC compared to EO. This increased EEG variability occurred in the O2 electrode, which overlays the primary visual cortex V1, and could be a result of the replacement of the coherent information obtained during EO by noise. A continuous measure of the variability was then used to demonstrate that this technique has the potential to be used as a switching mechanism for assistive technologies. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) is believed to place the individual at a high risk of psychological disorder. The objective of this paper was to examine the relationship between SCI and negative psychological states by comparing levels of negative psychological states in SCI and able-bodied controls. Participants included 33 people with SCI who had completed their inpatient rehabilitation (that is, when living in the community) and 33 able-bodied controls matched for age and sex. In order to determine levels of negative psychological states, the Profile of Mood States and the Spielberger Trait Anxiety Inventory were completed by all participants. The SCI group was found to have raised levels of psychopathology, with 20% having elevated negative psychological states typical of people with a psychiatric disorder. People with SCI have an increased risk of suffering debilitating levels of psychopathology. Future research needs to investigate psychosocial rehabilitation strategies for lowering negative psychological states such as depressive mood in people with SCI after they have completed their rehabilitation program. [ABSTRACT FROM AUTHOR]

Abstract: Driver fatigue is a major risk for road accidents that can often result in injury and death. However, considerable debate still exists concerning factors associated with driver fatigue. Because of the complex nature of fatigue, this paper reports a study that investigated both physiological and psychological determinants of fatigue. Three fatigue outcome measures were used, including a physiological, psychological and a combined physiological and psychological measure. Fifty participants performed a driving simulator task till they showed symptoms of fatigue and were assessed before and after the task. Significant factors associated with physiological fatigue included higher levels of baseline delta activity and an extraverted personality. Factors related to the psychological fatigue outcome measure included sleepiness, low healthy lifestyle status, an extraverted personality and tension-prone personality, and negative mood states. The combined fatigue outcome measure was associated with factors such as a tension-prone and extraverted personality, low systolic blood pressure, and negative mood states. The findings emphasize the importance of assessing fatigue using a range of outcome measures in order to achieve a thorough understanding of what factors contribute to fatigue and highlight the need to develop fatigue countermeasures that employ a broad range of measures. [Copyright &y& Elsevier]

Abstract: The association between personality and resting brain activity was investigated. Personality was assessed using the NEO-Five-factor Inventory (NEO-FFI) and resting brain activity was indexed by eyes closed EEG spectral magnitude from four frequency bands over the entire cortex. Results suggest that there are differences between males and females in the NEO-FFI personality traits. The NEO FFI traits were associated with lower frequency brain activity in both males and females. Mild significant and consistent associations were found between delta and theta activity across all cortical regions with Extraversion and Conscientiousness. There were few associations between personality traits and alpha and beta activity, this was shown in males only. Fewer associations between personality and faster frequency bands such as alpha may be due to the methodological problem of using fixed alpha bands. Multiple regression analyses showed that individual alpha frequencies had a greater contribution to personality traits than fixed band alpha waves. [Copyright &y& Elsevier]

Abstract: Driver fatigue is associated with risks of road accidents that result in injury and death. Research has been limited by several issues such as confusion over definitions, how best to measure fatigue, and the contribution of psychological factors to fatigue. This study addressed these limitations by investigating the relationship between psychological factors and fatigue. Participants were assessed and were required to perform a monotonous task till they tired. Results found few psychological factors to be related to physiological and performance decrement fatigue outcome measures. However, psychological factors were found to correlate consistently with self-reported fatigue. The results suggest that fatigue is associated with a predisposition to be anxious, depressive, less self-assured, more conscientious (rule bound), less socially bold, less adaptable and low vigour. The results indicate that future research should employ a range of fatigue outcome measures in order to best understand what factors contribute to fatigue. [Copyright &y& Elsevier]

Behavioral effects of alcohol are known to be greater when the blood alcohol is rising, known as the Mellanby effect; however, research investigating the cortical changes during this period is scarce. The objective of this study was to investigate the effects of consumption of alcohol on cortical activity measured by the electroencephalogram (EEG) during the absorption or rising phase of alcohol. EEG signals were recorded using the entire 10/20 montage system. The experimental design consisted of a repeated measures randomized crossover design in which subjects acted as their own control. This involved recording two EEG baseline measures, each of which was followed by a placebo or alcohol condition, delivered over two days for ten subjects. All subjects had a 50% chance of receiving the alcohol first. All subjects were shown to have mean peak blood alcohol concentration (BAC) levels of around .03%. No significant differences were found between the two baselines. Significant increases in EEG magnitude occurred in the theta (4-7.75 Hz), alpha 1 (8-9.75 Hz), and beta 1 (13.25-19.75 Hz) spectrum in the frontal EEG regions, and alpha 1 (8-9.75 Hz,) in the central and posterior regions. No significant changes were found in the theta (4-7.75 Hz) or beta (13.5-30 Hz) spectrums in the central and posterior regions. There were also no significant results for alpha 2 (10-13 Hz,) in any of the regions. These results suggest that rapid cortical changes occur within the first 35 min after alcohol consumption. [ABSTRACT FROM AUTHOR]

Research suggests that many people hold pervasive negative stereotypes towards persons who stutter and that to date, success in changing these attitudes has been limited. However, few studies have selected people who had not had direct contact with a person who stutters or employed a true randomized and stratified selection of people from the community to assess attitudes towards stuttering. To assess stereotypes, a randomized and stratified investigation was conducted by telephone interview to assess the type of stereotypes 502 people from households in the state of New South Wales, Australia have about stuttering. Consenting persons were given a brief introduction to the research and a description of stuttering. Then they were asked if they or any person living in their household stuttered or whether they knew or had ever met any one who stuttered. If answers were no, they were asked to participate. If they answered yes to either question they were thanked and not asked to participate. Analysis showed that a large number believe persons who stutter are shy, self-conscious, anxious people who lack confidence. In contrast, many also believe they would not be embarrassed talking to someone who stutters, that they have average or above average intelligence, and are capable of holding responsible work-related positions. While this research yields a mixture of negative and positive community stereotypes, a significant portion of society continue to show little knowledge of the causes of the disorder. [ABSTRACT FROM AUTHOR]

Traumatic injuries can have long-term negative impacts on health, especially psychological health. A biopsychosocial approach is recommended to identify those likely to experience psychosocial stress, however large individual differences exist in stress reactivity and post-injury health that remain unexplored. Therefore, we investigated autonomic nervous system (ANS) stress responses and pre-existing psychosocial vulnerability as contributors to health in individuals who sustained a traffic-related injury. 120 adults with traffic-related injury and 112 non-injury controls underwent an integrative ANS (cardiac and skin conductance) assessment and a health-related assessment at 3–6 weeks post-injury. Propensity score matching based on six pre-injury psychosocial vulnerability factors (age, sex, education, prior mental/physical health, socioeconomic status) guided the definition of high vulnerability (HV) and low vulnerability (LV) injury subgroups, with the LV subgroup having similar propensity scores to non-injury controls. A three-group comparative analysis of ANS responsivity (baseline, reactivity, recovery/rebound) and post-injury health was performed. The HV subgroup exhibited the most negative immediate post-injury mental health profile and less adaptive ANS response patterns, indicating greater stress vulnerability/reactivity. Significant differences were found for psychological health (elevated psychological distress and catastrophizing), but not physical health (injury factors, pain, fatigue, physical wellbeing). HV participants showed sympathetic predominance at resting baseline (lower parasympathetic activity and/or elevated heart rate) compared to the LV and control groups, as well as smaller parasympathetic decrease during a cognitive task compared to controls. Despite preserved capacity for restoring initial homeostasis in both injury subgroups during recovery, there was some indication of blunted post-task sympathetic deactivation (larger sympathetic decrease) and reduced overall ANS adaptability (reduction in total power of heart rate variability spectrum), suggesting relative reduced capacity to face stressors compared to controls. Findings suggest that baseline resting ANS regulation, particularly parasympathetic activity, and pre-injury psychosocial factors are key contributors to individual psycho-biological responses following traumatic injury, and are therefore potential stress vulnerability markers. Post-stress recovery patterns may represent a novel physiological signature for a "biological intrinsic" vulnerability early after the injury. These findings provide direction for improved early identification and management of injured individuals, including innovative preventive interventions that target ANS regulation. • Resting autonomic regulation and pre-injury vulnerability were associated with psychological adjustment to traumatic injury. • Individuals with higher pre-injury vulnerability exhibited less adaptive psycho-biological responses to the injury. • Autonomic recovery patterns suggested a reduced capacity to deal with stressors immediately post-injury. [ABSTRACT FROM AUTHOR]