Interviewing in virtual environments: Towards understanding the impact of rapport-building behaviours and retrieval context on eyewitness memory.

Given the complexities of episodic memory and necessarily social nature of in-person face-to-face interviews, theoretical and evidence-based techniques for collecting episodic information from witnesses, victims, and survivors champion rapport-building. Rapport is believed to reduce some of the social demands of recalling an experienced event in an interview context, potentially increasing cognitive capacity for remembering. Cognitive and social benefits have also emerged in remote interview contexts with reduced anxiety and social pressure contributing to improved performance. Here, we investigated episodic memory in mock-eyewitness interviews conducted in virtual environments (VE) and in-person face-to-face (FtF), where rapport-building behaviours were either present or absent. Main effects revealed when rapport was present and where interviews were conducted in a VE participants recalled more correct event information, made fewer errors and were more accurate. Moreover, participants in the VE plus rapport-building present condition outperformed participants in all other conditions. Feedback indicated both rapport and environment were important for reducing the social demands of a recall interview, towards supporting effortful remembering. Our results add to the emerging literature on the utility of virtual environments as interview spaces and lend further support to the importance of prosocial behaviours in applied contexts. [Abstract copyright: © 2022. The Author(s).

Medial longitudinal arch development of school children : The College of Podiatry Annual Conference 2015: meeting abstracts

Background Foot structure is often classified into flat foot, neutral and high arch type based on the variability of the Medial Longitudinal Arch (MLA). To date, the literature provided contrasting evidence on the age when MLA development stabilises in children. The influence of footwear on MLA development is also unknown. Aim This study aims to (i) clarify whether the MLA is still changing in children from age 7 to 9 years old and (ii) explore the relationship between footwear usage and MLA development, using a longitudinal approach. Methods We evaluated the MLA of 111 healthy school children [age = 6.9 (0.3) years] using three parameters [arch index (AI), midfoot peak pressure (PP) and maximum force (MF: % of body weight)] extracted from dynamic foot loading measurements at baseline, 10-month and 22-month follow-up. Information on the type of footwear worn was collected using survey question. Linear mixed modelling was used to test for differences in the MLA over time. Results Insignificant changes in all MLA parameters were observed over time [AI: P = .15; PP: P = .84; MF: P = .91]. When gender was considered, the AI of boys decreased with age [P = .02]. Boys also displayed a flatter MLA than girls at age 6.9 years [AI: mean difference = 0.02 (0.01, 0.04); P = .02]. At baseline, subjects who wore close-toe shoes displayed the lowest MLA overall [AI/PP/MF: P < .05]. Subjects who used slippers when commencing footwear use experienced higher PP than those who wore sandals [mean difference = 31.60 (1.44, 61.75) kPa; post-hoc P = .04]. Discussion and conclusion Our findings suggested that the MLA of children remained stable from 7 to 9 years old, while gender and the type of footwear worn during childhood may influence MLA development. Clinicians may choose to commence therapy when a child presents with painful flexible flat foot at age 7 years, and may discourage younger children from wearing slippers when they commence using footwear

Characterisation of CDKL5 Transcript Isoforms in Human and Mouse

Mutations in the X-linked Cyclin-Dependent Kinase-Like 5 gene (CDKL5) cause early onset infantile spasms and subsequent severe developmental delay in affected children. Deleterious mutations have been reported to occur throughout the CDKL5 coding region. Several studies point to a complex CDKL5 gene structure in terms of exon usage and transcript expression. Improvements in molecular diagnosis and more extensive research into the neurobiology of CDKL5 and pathophysiology of CDKL5 disorders necessitate an updated analysis of the gene. In this study, we have analysed human and mouse CDKL5 transcript patterns both bioinformatically and experimentally. We have characterised the predominant brain isoform of CDKL5, a 9.7 kb transcript comprised of 18 exons with a large 6.6 kb 3’-untranslated region (UTR), which we name hCDKL5_1. In addition we describe new exonic regions and a range of novel splice and UTR isoforms. This has enabled the description of an updated gene model in both species and a standardised nomenclature system for CDKL5 transcripts. Profiling revealed tissue- and brain development stage-specific differences in expression between transcript isoforms. These findings provide an essential backdrop for the diagnosis of CDKL5-related disorders, for investigations into the basic biology of this gene and its protein products, and for the rational design of gene-based and molecular therapies for these disorders

The diagnosis of symptomatic forefoot neuroma from a clinical diagnostic protocol for podiatric assessment

There is limited evidence reporting the epidemiology of forefoot neuroma (FFN) in the general population of the United Kingdom (UK). Consequently, estimated incidence or prevalence are not known although the condition is considered common in the National Health Service (NHS) and private health care sectors. Therefore, there is a need to determine the extent of this condition to inform appropriate healthcare provision. Furthermore, it is thought that an accurate and timely diagnosis would improve the patient experience and use of pathways through the NHS. A specific set of symptoms, associated with FFN, has been consistently documented in the literature. Despite this, the optimal method for FFN diagnosis is challenging and anecdotally highly variable between clinicians; currently no reliable or valid clinical diagnostic protocol exists for the diagnosis of symptomatic FFN in podiatric practice. Therefore, there is a need to develop a clinical diagnostic protocol and to determine its reliability and validity. It was anticipated that accurate diagnosis will inform more targeted service planning and promote effective clinical decision making on the management options available to address participant reported symptoms.Three sequential studies were designed and delivered within a local NHS podiatry service line. In study one, the clinical pathways were reviewed and the numerical values of individuals accessing the local podiatry service for a forefoot assessment were defined. Study two developed a clinical assessment protocol (FNCAP) with agreed expert consensus for the diagnosis of FFN. Through study three, the content validity and reliability of FNCAP for the diagnosis of FFN was established.The findings of this thesis validate the estimated regional incidence and prevalence rates of symptomatic persons registered to the podiatry service line. However, records provided little insight into the diagnostic methods used to identify FFN from other forefoot pathology. This led to the development of a clinical diagnostic protocol from expert consensus for FFN. Through the Delphi study, six themes related to the clinical diagnosis of FFN: location of pain, non weight-bearing sensation, weight-bearing sensation, observations, clinical tests and imaging were identified. The themes were integrated such that 21 recommendations were identified and refined to form a clinical diagnostic protocol for FFN. The diagnostic test study indicated that there is content validity for the items that form FNCAP. The intra-rater reliability tests for the FNCAP revealed a ‘moderate’ threshold of agreement value. The sensitivity (100%) and specificity (95.6%) scores for FNCAP were high and indicated the FNCAP could be useful for diagnosing FFN in most cases. Feasibility testing of the FNCAP has indicated some usefulness in diagnosing FFN but further investigations are required to determine the FNCAP applicability in clinical practice

The evaluation of podiatrists, with knowledge and training in diagnostic musculoskeletal ultrasound, to describe sonographic images of diabetic foot wounds in the United Kingdom and Australia

Aims: currently, wound management decisions are based largely on visual observations such as photographs, descriptors or measurements which can lack detail and do not always capture the sub-wound area. A previous case series suggests that there is benefit in using ultrasound imaging (USI) to evaluate diabetic foot ulcers (DFU) at point-of-care, however no guidance exists to inform its use. This scoping exercise explores the capacity of podiatrists with experience in interpreting musculoskeletal structures using USI to interpret sonographic images of DFU. Methods: following a short briefing session, podiatrists with previous musculoskeletal (MSK) USI training were asked to review and report on previously recorded static sonographic images (n = 8) of active DFU. Content analysis was utilised to identify recurring keywords within the podiatrists’ reports which were coded and assigned to categories to gain context to the data. Results: seven podiatrists participated in the study. Four categories were constructed for the purposes of analysis:1)Frequency of reporting, 2) Language used in reporting, 3) Observations, 4) Clinical impression Frequently, the reported findings between podiatrists were found to be similar, especially those related to bone morphology. However greater variability was seen in the reporting of wound specific soft-tissue observations. Conclusion: this scoping exercise has shown that podiatrists can translate their existing USI skills to make rudimentary reports on clinical findings in DFU. All participants were consistently able to identify and describe characteristics associated with DFU from a single b mode static wound ultrasound image. Findings from this investigation can be used as a foundation for further work to establish accuracy and reliability to validate DFU sonography. In conjunction the development of protocols and training materials will enable the adoption of USI to assess DFU in clinical practice. This will in turn, contribute to improved patient care and establish a new paradigm for wound surveillance which is translatable to other wound types.</p

The clinical diagnosis of symptomatic forefoot neuroma in the general population:: a Delphi consensus study

Background:There is limited evidence for defining what specific method or methods should be used to clinically influence clinical decision making for forefoot neuroma. The aim of this study was to develop a clinical assessment protocol that has agreed expert consensus for the clinical diagnosis of forefoot neuroma.Methods:A four-round Delphi consensus study was completed with 16 expert health professionals from either a clinical or clinical academic background, following completion of a structured literature review. Clinical experience ranged from 5 to 34 years (mean: 19.5 years). Consensus was sought on the optimal methods to achieve the clinical diagnosis of forefoot neuroma. Round 1 sought individual input with an open ended question. This developed a list of recommendations. Round 2 and 3 asked the participants to accept or reject each of the recommendations in the list in relation to the question: “What is the best way to clinically diagnose neuroma in the forefoot?” Votes that were equal to or greater than 60% were accepted into the next round; participant’s votes equal to or less then 20% were excluded. The remaining participant’s votes between 20 to 60% were accepted and placed into the following round for voting. Round 4 asked the participants to rank the list of recommendations according to the strength of recommendation they would give in relation to the question: “What is the best way to clinically diagnose neuroma in the forefoot?” The recruitment and Delphi rounds were conducted through email.Results:In round 1, the 16 participants identified 68 recommendations for the clinical diagnosis of forefoot neuroma. In round 2, 27 recommendations were accepted, 11 recommendations were rejected and 30 recommendations were assigned to be re-voted on. In round 3, 36 recommendations were accepted, 22 recommendations were rejected and 11 recommendations were assigned to be re-voted on. In round 4, 21 recommendations were selected by the participants to form the expert derived clinical assessment protocol for the clinical diagnosis of forefoot neuroma. From these 21 recommendations, a set of themes were established: location of pain, non weight bearing sensation, weight bearing sensation, observations, tests and imaging.Conclusion:Following the identification of 21 method recommendations, a core set of clinical diagnostic methods have been prepared as a clinical assessment protocol for the diagnosis of forefoot neuroma. Based on expert opinion, the core set will assist clinicians in forming a clearer diagnosis of forefoot neuroma.<br/

Stakeholder views of podiatry services in the UK for people living with arthritis: a qualitative study

Background: the aim of this study was to explore the views of stakeholders in podiatry services, patients, commissioners and general practitioners (GP), to further understand experiences of referral, access and provision of treatment in the National Health Service (NHS) for foot problems for patients living with arthritis.Method: to explore in-depth individual views and experiences of stakeholders in podiatry services, 19 patients who had arthritis (osteoarthritis and/or rheumatoid arthritis) participated in one of four focus groups. In addition, seven commissioners and/or GPs took part in semi structured interviews. A purposive sampling strategy was adopted for all focus groups and semi structured interviews. To account for geographical variations, the focus groups and semi structured interviews were conducted across two predetermined regions of the United Kingdom (UK), Yorkshire and Hampshire. Data was rendered anonymous and transcribed verbatim. Thematic analysis was employed to identify key meanings and report patterns within the data.Results: five key themes derived from the focus groups and interviews suggest a variety of factors influencing referral, access and provision of treatment for foot problems within the UK. 1. Systems working together (navigation of different care pathways, access and referral opportunities for people with OA or RA, education around foot health services for people with OA or RA); 2.Finance (financial variations, different care systems, wasting resources); 3. Understanding what podiatry services have to offer (podiatrists are leaders in foot health services, service requirements in relation to training standards and health needs); 4. Person factors of foot pain (arthritis is invisible, affects quality of life, physical and mental wellbeing); 5. Facilitators of foot care (NICE guidelines, stakeholder events, supporting self-management strategies).Conclusion: the findings indicate that patients, commissioners and GPs have very similar experiences of referral, access and provision of treatment for foot problems, for patients living with arthritis. Essentially, commissioners and GPs interviewed called for a transformational approach in current systems to include newer models of care that meet the footcare needs of individual patient circumstances. Patients interviewed called for better signposting and information about the different services available to help them manage their foot health needs. To address this, we have formulated a signposting pack for all stakeholders to help them facilitate access to appropriate clinicians ‘at the right time, in the right place’ to manage foot health problems

Raising teenagers awareness of musculoskeletal health through LIFELAB: a collaboration between school students, teachers and clinical academic researchers

Background: Musculoskeletal (MSK) disease is the major cause of years lived with disability in the UK. The UK is behind other comparable countries in confronting consequences of long-term diseases. One potentially effective approach is by educating people to become more health literate. Early life interventions relating to exercise and good MSK health practices may be an effective addition to traditional approaches.LifeLab is a science-based approach to improving teenagers’ health-related attitudes and behaviour. The LifeLab approach was developed at the University of Southampton and combines educationalists, scientists, clinical researchers and school children and has been effective in improving young peoples’ understanding of the nature of diseases and reasoning about health issues. However, no specific MSK health education components have previously been included in LifeLab.Methods: In 2014 the first MSK LifeLab workshop was designed with educationalists and researchers in biomechanics, occupational therapy, podiatry, and physiotherapy from the MSK Research Cluster at Southampton for year 8 (age 12-13) school students. The workshops aimed to promote young peoples’ health literacy in musculoskeletal health and integrated experiential learning using 3D motion analysis, real-time ultrasound scanning of muscles contracting; radiographs of normal and osteoarthritis foot joints; anatomy models and hand and hip joint implants. The workshops covered a) the impact of osteoarthritis joint disease on daily life b) capturing and illustrating joint movement using state of the art 3D motion analysis technology and c) an in-depth look at muscles using ultrasound imaging. Learning objectives included students being able to:1. Identify key components of active healthy living for bones, muscles and joints 2. Observe patterns in how healthy joints can move and contrast patterns with injured joint movement3. Discover what role muscles play in healthy joints 4. Compare healthy joint structures with arthritic joint structures Results: 58 students from 3 state secondary schools, attended a university widening participation outreach day within which the MSK LifeLab workshop was run. On the same day the students also attended workshops in Humanities and Oceanography. When asked which workshop of the outreach day was their favourite 43 % of the students identified the MSK workshops. Feedback on why the workshops were enjoyable included; “I enjoyed biomechanics because I like looking at how things work and move”; “Ostioarphritus. I'm into sports &amp; find the body interesting”; “The bones because you got to find out about the body”. The interactive nature of the workshop with teenagers having hands on learning was also well received “My favourite was bones because they made it fun”; “The bones experiments because the technology involved was awesome.”Conclusions: Using interactive MSK workshops as part of LifeLab presents an exciting health literacy approach to encourage young people to start to engage in understanding their MSK health. Acknowledgements: These are not included in the abstract but will appear if we get a paper accepted. LifeLab, has been developed as a joint initiative, involving, in addition to the University of Southampton and the University Hospital Southampton NHS Foundation Trust; the MRC Lifecourse Epidemiology Unit, the University of Southampton (UoS) Faculty of Medicine and Southampton Education School, the Mathematics and Science Learning Centre (MSLC), the NIHR Southampton Biomedical Research Centre and the Garfield Weston Foundation. KWT is supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre Some facilities and personnel in the MSK Research Cluster are funded by Arthritis Research UK.<br/

Interviewing in virtual environments: Towards understanding the impact of rapport-building behaviours and retrieval context on eyewitness memory

Given the complexities of episodic memory and necessarily social nature of in-person face-to-face interviews, theoretical and evidence-based techniques for collecting episodic information from witnesses, victims, and survivors champion rapport-building. Rapport is believed to reduce some of the social demands of recalling an experienced event in an interview context, potentially increasing cognitive capacity for remembering. Cognitive and social benefits have also emerged in remote interview contexts with reduced anxiety and social pressure contributing to improved performance. Here, we investigated episodic memory in mock-eyewitness interviews conducted in virtual environments (VE) and in-person face-to-face (FtF), where rapport-building behaviours were either present or absent. Main effects revealed when rapport was present and where interviews were conducted in a VE participants recalled more correct event information, made fewer errors and were more accurate. Moreover, participants in the VE plus rapport-building present condition outperformed participants in all other conditions. Feedback indicated both rapport and environment were important for reducing the social demands of a recall interview, towards supporting effortful remembering. Our results add to the emerging literature on the utility of virtual environments as interview spaces and lend further support to the importance of prosocial behaviours in applied contexts