Testing an integrated behavioural and biomedical model of disability in N-of-1 studies with chronic pain.

Background. Previous research has supported an integrated biomedical and behavioural model explaining activity limitations. However, further tests of this model are required at the within-person level, because while it proposes that the constructs are related within individuals, it has primarily been tested between individuals in large group studies. We aimed to test the integrated model at the within-person level. Method. Six correlational N-of-1 studies in participants with arthritis, chronic pain and walking limitations. Daily measures of theoretical constructs were collected using a handheld computer (PDA), activity was assessed by self-report and accelerometer, and data analysed using time-series analysis. Results. The biomedical model was not supported as pain-impairment did not predict activity, so the integrated model was supported partially. Impairment predicted intention to move around while perceived behavioural control (PBC) and intention predicted activity. PBC did not predict activity limitation in the expected direction. Conclusions. The integrated model of disability was partially supported within individuals, especially the behavioural elements. However, results suggest that different elements of the model may drive activity (limitations) for different individuals. The integrated model provides a useful framework for understanding disability and suggests interventions, and the utility of N-of-1 methodology for testing theory is illustrated

Describing, predicting and explaining adherence to total skin self-examination (TSSE) in people with melanoma : a 12-month longitudinal study

Funding This work was supported by a grant from a Cancer Research UK Population Research Committee project award (C10673/A21685).Peer reviewedPublisher PD

Analysing N-of-1 observational data in health psychology and behavioural medicine : A 10-step SPSS tutorial for beginners

The SPSS dataset and syntax are available within the supplementary materials.Peer reviewedPublisher PD

Are processes in acceptance & commitment therapy (Act) related to chronic pain outcomes within individuals over time? : an exploratory study using n-of-1 designs

Acknowledgements The authors would like to thank the European Health Psychology Society for providing a grant that enabled the collaboration of the co-authors for this article. Author contributions HT designed the study, organized the data collection, carried out the statistical analyses and drafted the first version of the manuscript. DJ and MJ supervised the statistical analyses and were actively involved in writing and revising the manuscript. MVH and KS designed the study and were actively involved in writing and revising the manuscript. All authors read and approved the final manuscript.Peer reviewedPublisher PD

Intention, beliefs and mood assessed using electronic diaries predicts attendance at cardiac rehabilitation:An observational study

Background: Cardiac rehabilitation is effective in promoting physical/psychological recovery following acute coronary syndrome. Yet, rates of attendance at outpatient cardiac rehabilitation by eligible patients are low. Objectives: This study examined the determinants of attendance at outpatient cardiac rehabilitation in acute coronary syndrome patients following discharge until cardiac rehabilitation commencement. Design: A weekly electronic diary measured cardiac-related cognitions and mood and examined their relation to attendance at outpatient cardiac rehabilitation. Settings: Three United Kingdom National Health Service secondary care settings in two Health Board areas in Scotland. Participants: Acute coronary syndrome patients were recruited from March 2012 to June 2013 prior to hospital discharge. Of 488 eligible patients referred for cardiac rehabilitation, 214 consented. Results: 166 participants provided, on average, 5 weeks of diary entries before cardiac rehabilitation commenced. High intention (i.e. low “do not intend”) to attend CR and its rate of increase over time predicted attendance. Low negative emotional representation, high perceived necessity, high confidence in maintaining function, low negative affect, and high positive affect following discharge predicted attendance at cardiac rehabilitation. The rate of change in cardiac-related mood and these cognitions was not predictive. Baseline and rate of change in “do not intend” entirely mediated relationships between a) perceived necessity, b) negative affect and attendance at cardiac rehabilitation. Conclusions: Negative affect in the first weeks following discharge represents the key challenge to a patient maintaining their intention to attend cardiac rehabilitation. Intervention to improve attendance should focus on improving intention to attend following discharge and during recovery by improving patient understanding of cardiac rehabilitation and reducing negative affect

How can we better prepare new doctors for the tasks and challenges of ward rounds?:An observational study of junior doctors' experiences

Founding: Economic and Social Research Council Open access via T&F agreement Acknowledgements The authors would like to thank participating FY1 doctors and the senior staff who made this study possible. Funding The study was funded by the ESRC via a Doctoral Studentship awarded to CB.Peer reviewedPublisher PD

A Comparison of Delivery Methods of Cognitive-Behavioral Therapy for Panic Disorder: An International Multicenter Trial

Cognitive-behavioral therapy (CBT) is the psychological treatment of choice for panic disorder (PD). However, given limited access to CBT, it must be delivered with maximal cost-effectiveness. Previous researchers have found that a brief computer-augmented CBT was as effective as extended therapist-delivered CBT. To test this finding, this study randomly allocated 186 patients with PD across 2 sites in Scotland and Australia to 12 sessions of therapist-delivered CBT (CBT12), 6 sessions of therapist-delivered (CBT6) or computer-augmented CBT (CBT6-CA), or a waitlist control. On a composite measure, at post-treatment, the outcome for CBT12 was statistically better than the outcome for CBT6. The outcome for CBT6-CA fell between CBT12 and CBT6, but could not be statistically distinguished from either treatment. The active treatments did not differ statistically at 6-month follow-up. The study provided some support for the use of computers as an innovative adjunctive-therapy tool and merits further investigation

Development of an online tool for linking behavior change techniques and mechanisms of action based on triangulation of findings from literature synthesis and expert consensus.

Researchers, practitioners, and policymakers develop interventions to change behavior based on their understanding of how behavior change techniques (BCTs) impact the determinants of behavior. A transparent, systematic, and accessible method of linking BCTs with the processes through which they change behavior (i.e., their mechanisms of action [MoAs]) would advance the understanding of intervention effects and improve theory and intervention development. The purpose of this study is to triangulate evidence for hypothesized BCT-MoA links obtained in two previous studies and present the results in an interactive, online tool. Two previous studies generated evidence on links between 56 BCTs and 26 MoAs based on their frequency in literature synthesis and on expert consensus. Concordance between the findings of the two studies was examined using multilevel modeling. Uncertainties and differences between the two studies were reconciled by 16 behavior change experts using consensus development methods. The resulting evidence was used to generate an online tool. The two studies showed concordance for 25 of the 26 MoAs and agreement for 37 links and for 460 "nonlinks." A further 55 links were resolved by consensus (total of 92 [37 + 55] hypothesized BCT-MoA links). Full data on 1,456 possible links was incorporated into the online interactive Theory and Technique Tool (https://theoryandtechniquetool.humanbehaviourchange.org/). This triangulation of two distinct sources of evidence provides guidance on how BCTs may affect the mechanisms that change behavior and is available as a resource for behavior change intervention designers, researchers and theorists, supporting intervention design, research synthesis, and collaborative research.MR

Chandra Observation of the Globular Cluster NGC 6440 and the Nature of Cluster X-ray Luminosity Functions

As part of our campaign to determine the nature of the various source populations of the low-luminosity globular cluster X-ray sources, we have obtained a Chandra X-ray Observatory ACIS-S3 image of the globular cluster NGC 6440. We detect 24 sources to a limiting luminosity of ~2 times 10^31 erg/s (0.5-2.5keV) inside the cluster's half-mass radius, all of which lie within ~2 core radii of the cluster center. We also find excess emission in and around the core which could be due to unresolved point sources. Based upon X-ray luminosities and colors, we conclude that there are 4-5 likely quiescent low-mass X-ray binaries and that most of the other sources are cataclysmic variables. We compare these results to Chandra results from other globular clusters and find the X-ray luminosity functions differ among the clusters.Comment: 9 pages, 4 figures, accepted by ApJ, minor changes, added table of clusters' physical parameter

Why does work cause fatigue? A real-time investigation of fatigue, and determinants of fatigue in nurses working 12-hour shifts

Background One of the striking regularities of human behavior is that a prolonged physical, cognitive, or emotional activity leads to feelings of fatigue. Fatigue could be due to (1) depletion of a finite resource of physical and/or psychological energy or (2) changes in motivation,attention, and goal-directed effort (e.g. motivational control theory).Purpose To contrast predictions from these two views in a real-time study of subjective fatigue in nurses while working.Methods One hundred nurses provided 1,453 assessments over two 12-hr shifts. Nurses rated fatigue, demand, control, and reward every 90 min. Physical energy expenditure was measured objectively using Actiheart. Hypotheses were tested using multilevel models to predictfatigue from (a) the accumulated values of physical energy expended, demand, control, and reward over the shift and (b) from distributed lag models of the same variables over the previous 90 min.Results Virtually all participants showed increasing fatigue over the work period. This increase was slightly greater when working overnight. Fatigue was not dependent on physical energy expended nor perceived work demands. However, it was related to perceivedcontrol over work and perceived reward associated with work.Conclusions Findings provide little support for a resource depletion model; however, the finding that control and reward both predicted fatigue