A brief report on the development of a theoretically-grounded intervention to promote patient autonomy and self-management of physiotherapy patients: Face validity and feasibility of implementation

Background Clinical practice guidelines for the treatment of low back pain suggest the inclusion of a biopsychosocial approach in which patient self-management is prioritized. While many physiotherapists recognise the importance of evidence-based practice, there is an evidence practice gap that may in part be due to the fact that promoting self-management necessitates change in clinical behaviours. Evidence suggests that a patient’s motivation and maintenance of self-management behaviours can be positively influenced by the clinician’s use of an autonomy supportive communication style. Therefore, the aim of this study was to develop and pilot-test the feasibility of a theoretically derived implementation intervention to support physiotherapists in using an evidence-based autonomy supportive communication style in practice for promoting patient self-management in clinical practice. Methods A systematic process was used to develop the intervention and pilot-test its feasibility in primary care physiotherapy. The development steps included focus groups to identify barriers and enablers for implementation, the theoretical domains framework to classify determinants of change, a behaviour change technique taxonomy to select appropriate intervention components, and forming a testable theoretical model. Face validity and acceptability of the intervention was pilot-tested with two physiotherapists and monitoring their communication with patients over a three-month timeframe. Results Using the process described above, eight barriers and enablers for implementation were identified. To address these barriers and enablers, a number of intervention components were selected ranging from behaviour change techniques such as, goal-setting, self-monitoring and feedback to appropriate modes of intervention delivery (i.e. continued education meetings and audit and feedback focused coaching). Initial pilot-testing revealed the acceptability of the intervention to recipients and highlighted key areas for refinement prior to scaling up for a definitive trial. Conclusion The development process utilised in this study ensured the intervention was theory-informed and evidence-based, with recipients signalling its relevance and benefit to their clinical practice. Future research should consider additional intervention strategies to address barriers of social support and those beyond the clinician level

False Discovery Rate and Localizing Power

False discovery rate (FDR) is commonly used for correction for multiple testing in neuroimaging studies. However, when using two-tailed tests, making directional inferences about the results can lead to vastly inflated error rate, even approaching 100% in some cases. This happens because FDR only provides weak control over the error rate, meaning that the proportion of error is guaranteed only globally over all tests, not within subsets, such as among those in only one or another direction. Here we consider and evaluate different strategies for FDR control with two-tailed tests, using both synthetic and real imaging data. Approaches that separate the tests by direction of the hypothesis test, or by the direction of the resulting test statistic, more properly control the directional error rate and preserve FDR benefits, albeit with a doubled risk of errors under complete absence of signal. Strategies that combine tests in both directions, or that use simple two-tailed p-values, can lead to invalid directional conclusions, even if these tests remain globally valid. To enable valid thresholding for directional inference, we suggest that imaging software should allow the possibility that the user sets asymmetrical thresholds for the two sides of the statistical map. While FDR continues to be a valid, powerful procedure for multiple testing correction, care is needed when making directional inferences for two-tailed tests, or more broadly, when making any localized inference

Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioral therapy for the treatment and management of chronic pain disorders: protocol for a systematic review and meta-analysis with indirect comparisons

Abstract Background Chronic pain disorders impact the physical, psychological, social, and financial well-being of between 10%–30% of Canadians. The primary aims of psychological interventions targeting chronic pain disorders are to reduce patients’ pain-related disability and to improve their quality of life. Cognitive behavioral therapy (CBT) is the prevailing treatment for chronic pain, however mindfulness-based stress reduction (MBSR) has displayed promise as an alternative treatment option. The objective of this systematic review and meta-analysis is to compare MBSR to CBT in their relative ability to reduce pain-related disability and intensity, to alleviate emotional distress, and to improve global functioning in chronic pain patients. Methods/design We will conduct a systematic review with meta-analyses to compare MBSR to CBT in the treatment of chronic pain disorders in adults. We will report our review according to the recommendations provided by the PRISMA statement. Randomized studies will be included and the literature search will comprise Ovid MEDLINE®, Ovid MEDLINE® In-Process & Other Non-Indexed Citations, Embase Classic + Embase, PsycINFO, the Cochrane Library on Wiley, including CENTRAL, Cochrane Database of Systematic Reviews, DARE, and HTA. Study selection and data extraction will be conducted by independent investigators and in duplicate. Outcomes of interest will include pain interference, pain intensity, emotional functioning, and patient global impression of change. The Cochrane risk of bias tool will be used to assess risk of bias of included studies. As we anticipate that scales used to measure participant responses will be related but varied from study to study, standardized mean differences will be used to compare effect sizes between treatment modalities. Given the possibility of little or no head-to-head evidence comparing MBSR with CBT, we will use indirect treatment comparison methodology to assess the relative effectiveness of these interventions. Discussion The findings from this study will assist patients and treatment providers to make informed decisions regarding evidence-based treatment selection for chronic pain disorders. Systematic review registration PROSPERO CRD4201400935

ALTERED MERISTEM PROGRAM 1 Is involved in Development of Seed Dormancy in Arabidopsis

Mutants in the rice PLASTOCHRON 3 and maize VIVIPAROUS 8 genes have been shown to have reduced dormancy and ABA levels. In this study we used several mutants in the orthologous gene ALTERED MERISTEM PROGRAM 1 (AMP1) to determine its role in seed dormancy in Arabidopsis. Here we report that there are accession-specific effects of mutations in AMP1. In one accession, amp1 mutants produce seeds with higher dormancy, while those in two other accessions produce seeds of lower dormancy. These accession-specific effects of mutating AMP1 were shown to extend to ABA levels. We assayed global gene transcription differences in seeds of wild-type and mutant from two accessions demonstrating opposing phenotypes. The transcript changes observed indicate that the amp1 mutation shifts the seed transcriptome from a dormant into an after-ripened state. Specific changes in gene expression in the mutants give insight into the direct and indirect effects that may be contributing to the opposing dormancy phenotypes observed, and reveal a role for AMP1 in the acquisition and/or maintenance of seed dormancy in Arabidopsis

Delocalization of brane gravity by a bulk black hole

We investigate the analogue of the Randall-Sundrum brane-world in the case when the bulk contains a black hole. Instead of the static vacuum Minkowski brane of the RS model, we have an Einstein static vacuum brane. We find that the presence of the bulk black hole has a dramatic effect on the gravity that is felt by brane observers. In the RS model, the 5D graviton has a stable localized zero-mode that reproduces 4D gravity on the brane at low energies. With a bulk black hole, there is no such solution -- gravity is delocalized by the 5D horizon. However, the brane does support a discrete spectrum of metastable massive bound states, or quasinormal modes, as was recently shown to be the case in the RS scenario. These states should dominate the high frequency component of the bulk gravity wave spectrum on a cosmological brane. We expect our results to generalize to any bulk spacetime containing a Killing horizon.Comment: 7 pages, 6 figure

Evaporation of a Kerr black hole by emission of scalar and higher spin particles

We study the evolution of an evaporating rotating black hole, described by the Kerr metric, which is emitting either solely massless scalar particles or a mixture of massless scalar and nonzero spin particles. Allowing the hole to radiate scalar particles increases the mass loss rate and decreases the angular momentum loss rate relative to a black hole which is radiating nonzero spin particles. The presence of scalar radiation can cause the evaporating hole to asymptotically approach a state which is described by a nonzero value of $a_* \equiv a / M$. This is contrary to the conventional view of black hole evaporation, wherein all black holes spin down more rapidly than they lose mass. A hole emitting solely scalar radiation will approach a final asymptotic state described by $a_* \simeq 0.555$. A black hole that is emitting scalar particles and a canonical set of nonzero spin particles (3 species of neutrinos, a single photon species, and a single graviton species) will asymptotically approach a nonzero value of $a_*$ only if there are at least 32 massless scalar fields. We also calculate the lifetime of a primordial black hole that formed with a value of the rotation parameter $a_{*}$, the minimum initial mass of a primordial black hole that is seen today with a rotation parameter $a_{*}$, and the entropy of a black hole that is emitting scalar or higher spin particles.Comment: 22 pages, 13 figures, RevTeX format; added clearer descriptions for variables, added journal referenc

Why do they do that?: Looking beyond typical reasons for non-urgent ED use among Medicaid patients

Barriers to accessing primary care, including lack of transportation and inadequate appointment times, are common reasons for non-urgent emergency department (ED) use yet even when these barriers are addressed, the problem persists. This study explored non-urgent ED use by Medicaid enrollees through interviews with patients and providers and sought to identify themes beyond the commonly mentioned logistical and access issues. Qualitative interviews with 23 Medicaid enrollees and 31 PCP and ED providers utilizing a semi-structured interview guide focused on reasons for seeking care in the ED and issues associated with PCP appointments. We identified overlap as well as surprising differences in themes identified by providers and by patients. Providers identified cultural and educational issues including that many Medicaid patients had grown up using the ED as their main source of care and lacked awareness of other sources healthcare. Patients did not mention educational and cultural factors directly, but discussed a concern that their condition was too serious for the PCP, or that the ED provided more comprehensive services. Both patients and providers raised neglected concepts, particularly those related to understanding primary care compared to emergency care. These results highlight the importance of addressing multiple paths toward more appropriate ED use, including barriers beyond logistical and access-related concerns. Considering the patient’s perception of the situation, as well as identifying opportunities to improve patients’ understanding of where to seek care may help to create interventions with broader impact than those that address access and logistical barriers alone

Interference of the T cell and antigen-presenting cell costimulatory pathway using CTLA4-Ig (abatacept) prevents Staphylococcal enterotoxin B pathology

Abstract Staphylococcal enterotoxin B (SEB) is a bacterial superantigen that binds the receptors in the APC/T cell synapse and causes increased proliferation of T cells and a cytokine storm syndrome in vivo. Exposure to the toxin can be lethal and cause significant pathology in humans. The lack of effective therapies for SEB exposure remains an area of concern, particularly in scenarios of acute mass casualties. We hypothesized that blockade of the T cell costimulatory signal by the CTLA4-Ig synthetic protein (abatacept) could prevent SEB-dependent pathology. In this article, we demonstrate mice treated with a single dose of abatacept 8 h post SEB exposure had reduced pathology compared with control SEB-exposed mice. SEB-exposed mice showed significant reductions in body weight between days 4 and 9, whereas mice exposed to SEB and also treated with abatacept showed no weight loss for the duration of the study, suggesting therapeutic mitigation of SEB-induced morbidity. Histopathology and magnetic resonance imaging demonstrated that SEB mediated lung damage and edema, which were absent after treatment with abatacept. Analysis of plasma and lung tissues from SEB-exposed mice treated with abatacept demonstrated significantly lower levels of IL-6 and IFN-γ (p &amp;lt; 0.0001), which is likely to have resulted in less pathology. In addition, exposure of human and mouse PBMCs to SEB in vitro showed a significant reduction in levels of IL-2 (p &amp;lt; 0.0001) after treatment with abatacept, indicating that T cell proliferation is the main target for intervention. Our findings demonstrate that abatacept is a robust and potentially credible drug to prevent toxic effects from SEB exposure.</jats:p