The Role of Sleep in Learning New Meanings for Familiar Words through Stories

Adults often learn new meanings for familiar words, and in doing so they must integrate information about the newly-acquired meanings with existing knowledge about the prior meanings of the words in their mental lexicon. Numerous studies have confirmed the importance of sleep for learning novel word forms (e.g., “cathedruke”) either with or without associated meanings. By teaching participants new meanings for familiar word forms, this is the first study to focus exclusively on the specific role of sleep on learning word meanings. In two experiments participants were trained on new meanings for familiar words through a naturalistic story reading paradigm to minimize explicit learning strategies. Experiment 1 confirmed the benefit of sleep for recall and recognition of word meanings, with better retention after 12 hours including overnight sleep than 12 hours awake. Experiment 2, which was preregistered, further explored this sleep benefit. Recall performance was best in the condition in which participants slept immediately after exposure and were tested soon after they woke up, compared with three conditions which all included an extended period of wake during which they would encounter their normal language environment. The results are consistent with the view that, at least under these learning conditions, a benefit of sleep arises due to passive protection from linguistic interference while asleep, rather than being due to active consolidation

Diversity of narrative context disrupts the early stage of learning the meanings of novel words

High quality lexical representations develop through repeated exposures to words in different contexts. This preregistered experiment investigated how diversity of narrative context affects the earliest stages of word learning via reading. Adults (N = 100) learned invented meanings for eight pseudowords, which each occurred in five written paragraphs either within a single coherent narrative context or five different narrative contexts. The words’ semantic features were controlled across conditions to avoid influences from polysemy (lexical ambiguity). Posttests included graded measures of word-form recall (spelling accuracy) and recognition (multiple choice), and word-meaning recall (number of semantic features). Diversity of narrative context did not affect word-form learning, but more semantic features were correctly recalled for words trained in a single context. These findings indicate that learning the meanings of novel words is initially boosted by anchoring them to a single coherent narrative discourse

Learning new word meanings from story reading:The benefit of immediate testing

This study investigated how word meanings can be learned from natural story reading. Three experiments with adult participants compared naturalistic incidental learning with intentional learning of new meanings for familiar words, and examined the role of immediate tests in maintaining memory of new word meanings. In Experiment 1, participants learned new meanings for familiar words through incidental (story reading) and intentional (definition training task) conditions. Memory was tested with cued recall of meanings and multiple-choice meaning-to-word matching immediately and 24 h later. Results for both measures showed higher accuracy for intentional learning, which was also more time efficient than incidental learning. However, there was reasonably good learning from both methods, and items learned incidentally through stories appeared less susceptible to forgetting over 24 h. It was possible that retrieval practice at the immediate test may have aided learning and improved memory of new word meanings 24 h later, especially for the incidental story reading condition. Two preregistered experiments then examined the role of immediate testing in long-term retention of new meanings for familiar words. There was a strong testing effect for word meanings learned through intentional and incidental conditions (Experiment 2), which was non-significantly larger for items learned incidentally through stories. Both cued recall and multiple-choice tests were each individually sufficient to enhance retention compared to having no immediate test (Experiment 3), with a larger learning boost from multiple-choice. This research emphasises (i) the resilience of word meanings learned incidentally through stories and (ii) the key role that testing can play in boosting vocabulary learning from story reading

The Role of Sleep in Learning New Meanings for Familiar Words through Stories

Adults often learn new meanings for familiar words, and in doing so they must integrate information about the newly-acquired meanings with existing knowledge about the prior meanings of the words in their mental lexicon. Numerous studies have confirmed the importance of sleep for learning novel word forms (e.g., “cathedruke”) either with or without associated meanings. By teaching participants new meanings for familiar word forms, this is the first study to focus exclusively on the specific role of sleep on learning word meanings. In two experiments participants were trained on new meanings for familiar words through a naturalistic story reading paradigm to minimize explicit learning strategies. Experiment 1 confirmed the benefit of sleep for recall and recognition of word meanings, with better retention after 12 hours including overnight sleep than 12 hours awake. Experiment 2, which was preregistered, further explored this sleep benefit. Recall performance was best in the condition in which participants slept immediately after exposure and were tested soon after they woke up, compared with three conditions which all included an extended period of wake during which they would encounter their normal language environment. The results are consistent with the view that, at least under these learning conditions, a benefit of sleep arises due to passive protection from linguistic interference while asleep, rather than being due to active consolidation

Comparing alternating pressure mattresses and high-specification foam mattresses to prevent pressure ulcers in high-risk patients: the PRESSURE 2 RCT

Background: Pressure ulcers (PUs) are a burden to patients, carers and health-care providers. Specialist mattresses minimise the intensity and duration of pressure on vulnerable skin sites in at-risk patients. Primary objective: Time to developing a new PU of category ≥ 2 in patients using an alternating pressure mattress (APM) compared with a high-specification foam mattress (HSFM). Design: A multicentre, Phase III, open, prospective, planned as an adaptive double-triangular group sequential, parallel-group, randomised controlled trial with an a priori sample size of 2954 participants. Randomisation used minimisation (incorporating a random element). Setting: The trial was set in 42 secondary and community inpatient facilities in the UK. Participants: Adult inpatients with evidence of acute illness and at a high risk of PU development. Interventions and follow-up: APM or HSFM – the treatment phase lasted a maximum of 60 days; the final 30 days were post-treatment follow-up. Main outcome measures: Time to event. Results: From August 2013 to November 2016, 2029 participants were randomised to receive either APM (n = 1016) or HSFM (n = 1013). Primary end point – 30-day final follow-up: of the 2029 participants in the intention-to-treat population, 160 (7.9%) developed a new PU of category ≥ 2. There was insufficient evidence of a difference between groups for time to new PU of category ≥ 2 [Fine and Gray model HR 0.76, 95% confidence interval (CI) 0.56 to 1.04; exact p-value of 0.0890 and 2% absolute difference]. Treatment phase sensitivity analysis: 132 (6.5%) participants developed a new PU of category ≥ 2 between randomisation and end of treatment phase. There was a statistically significant difference in the treatment phase time-to-event sensitivity analysis (Fine and Gray model HR 0.66, 95% CI 0.46 to 0.93; p = 0.0176 and 2.6% absolute difference). Secondary end points – 30-day final follow-up: new PUs of category ≥ 1 developed in 350 (17.2%) participants, with no evidence of a difference between mattress groups in time to PU development, (Fine and Gray model HR 0.83, 95% CI 0.67 to 1.02; p-value = 0.0733 and absolute difference 3.1%). New PUs of category ≥ 3 developed in 32 (1.6%) participants with insufficient evidence of a difference between mattress groups in time to PU development (Fine and Gray model HR 0.81, 95% CI 0.40 to 1.62; p = 0.5530 and absolute difference 0.4%). Of the 145 pre-existing PUs of category 2, 89 (61.4%) healed – there was insufficient evidence of a difference in time to healing (Fine and Gray model HR 1.12, 95% CI 0.74 to 1.68; p = 0.6122 and absolute difference 2.9%). Health economics – the within-trial and long-term analysis showed APM to be cost-effective compared with HSFM; however, the difference in costs models are small and the quality-adjusted life-year gains are very small. There were no safety concerns. Blinded photography substudy – the reliability of central blinded review compared with clinical assessment for PUs of category ≥ 2 was ‘very good’ (kappa statistic 0.82, prevalence- and bias-adjusted kappa 0.82). Quality-of-life substudy – the Pressure Ulcer Quality of Life – Prevention (PU-QoL-P) instrument meets the established criteria for reliability, construct validity and responsiveness. Limitations: A lower than anticipated event rate. Conclusions: In acutely ill inpatients who are bedfast/chairfast and/or have a category 1 PU and/or localised skin pain, APMs confer a small treatment phase benefit that is diminished over time. Overall, the APM patient compliance, very low PU incidence rate observed and small differences between mattresses indicate the need for improved indicators for targeting of APMs and individualised decision-making. Decisions should take into account skin status, patient preferences (movement ability and rehabilitation needs) and the presence of factors that may be potentially modifiable through APM allocation, including being completely immobile, having nutritional deficits, lacking capacity and/or having altered skin/category 1 PU. Future work: Explore the relationship between mental capacity, levels of independent movement, repositioning and PU development. Explore ‘what works for whom and in what circumstances’. Trial registration: Current Controlled Trials ISRCTN01151335. Funding: This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 52. See the NIHR Journals Library website for further project information

Contextual diversity during word learning through reading benefits generalisation of learned meanings to new contexts.

From mid-childhood onwards, most new words are learned through reading. The precise meaning of many words depends upon the linguistic context in which they are encountered, which readers use to infer the appropriate interpretation. However, it is unclear what features of these linguistic contexts best support learning of new word meanings. We investigated whether learning words in contextually diverse sentences benefits word form and meaning learning in adults (n=239). Participants learned meanings for 8 pseudowords through reading 10 sentences about each. Four pseudowords were learned in a diverse condition (10 sentences on different topics) and four were learned in a non-diverse condition (10 sentences on the same topic). An old-new decision post-test indicated that diversity did not influence word form learning. In a second post-test, participants chose which trained pseudoword completed a sentence from either an unfamiliar, untrained context, or a familiar, trained context. For familiar contexts, accuracy was higher for pseudowords learned in the non-diverse condition, but for unfamiliar contexts, accuracy was higher for pseudowords learned in the diverse condition. These results suggest that diverse contexts may promote development of flexible, decontextualised meaning representations that are easier to generalise to new contexts. Conversely, non-diverse contexts may favour extraction of context-bound representations that are more easily used in the same context

Maintaining independence in individuals with dementia at home after a fall:a protocol for the UK pilot cluster randomised controlled trial MAINTAIN

Introduction: Individuals with dementia face an increased risk of falls. Falls can cause a decline in the individual’s overall functionality. All types of falls, including those that do not result in injury, can lead to psychosocial consequences, such as diminished confidence and a fear of falling. Projections indicate a rising trend in dementia diagnoses, implying an increase in fall incidents. Yet, there is a lack of evidence to support interventions for people living with dementia who have fallen. Our objective is to test the feasibility of a falls intervention trial for people with dementia. Method and analysis: This is a UK-based two-arm pilot cluster randomised controlled trial. In this study, six collaborating sites, which form the clusters, will be randomly allocated to either the intervention arm or the control arm (receiving treatment as usual) at a 1:1 ratio. During the 6 month recruitment phase, each cluster will enrol 10 dyads, comprising 10 individuals with dementia and their respective carers, leading to a total sample size of 60 dyads. The primary outcomes are the feasibility parameters for a full trial (ie, percentage consented, follow-up rate and cost framework). Secondary outcomes include activities of daily living, quality of life, fall efficacy, mobility, goal attainment, cognitive status, occurrence of falls, carer burden and healthcare service utilisation. Outcome measures will be collected at baseline and 28 weeks, with an additional assessment scheduled at 12 weeks for the healthcare service utilisation questionnaire. An embedded process evaluation, consisting of interviews and observations with participants and healthcare professionals, will explore how the intervention operates and the fidelity of study processes. Ethics and dissemination: The study was approved by the NHS and local authority research governance and research ethics committees (NHS REC reference: 23/WA/0126). The results will be shared at meetings and conferences and will be published in peer-reviewed journals. Trial registration number: ISRCTN16413728

A systematic review of the effectiveness and cost-effectiveness of peer education and peer support in prisons.

BACKGROUND: Prisoners experience significantly worse health than the general population. This review examines the effectiveness and cost-effectiveness of peer interventions in prison settings. METHODS: A mixed methods systematic review of effectiveness and cost-effectiveness studies, including qualitative and quantitative synthesis was conducted. In addition to grey literature identified and searches of websites, nineteen electronic databases were searched from 1985 to 2012. Study selection criteria were: Population: Prisoners resident in adult prisons and children resident in Young Offender Institutions (YOIs). INTERVENTION: Peer-based interventions Comparators: Review questions 3 and 4 compared peer and professionally led approaches. OUTCOMES: Prisoner health or determinants of health; organisational/ process outcomes; views of prison populations. STUDY DESIGNS: Quantitative, qualitative and mixed method evaluations. RESULTS: Fifty-seven studies were included in the effectiveness review and one study in the cost-effectiveness review; most were of poor methodological quality. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and that peer support services are acceptable within the prison environment and have a positive effect on recipients, practically or emotionally. Consistent evidence from many, predominantly qualitative, studies, suggested that being a peer deliverer was associated with positive effects. There was little evidence on cost-effectiveness of peer-based interventions. CONCLUSIONS: There is consistent evidence from a large number of studies that being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients. Research into cost-effectiveness is sparse. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ref: CRD42012002349

The importance of different frailty domains in a population based sample in England

Background: The aim was to estimate the prevalence of frailty and relative contribution of physical/balance, nutritive, cognitive and sensory frailty to important adverse health states (falls, physical activity levels, outdoor mobility, problems in self-care or usual activities, and lack of energy or accomplishment) in an English cohort by age and sex. Methods: Analysis of baseline data from a cohort of 9803 community-dwelling participants in a clinical trial. The sample was drawn from a random selection of all people aged 70 or more registered with 63 general practices across England. Data were collected by postal questionnaire. Frailty was measured with the Strawbridge questionnaire. We used cross sectional, multivariate logistic regression to estimate the association between frailty domains and known correlates and adjusted for age. Some models were stratified by sex. Results: Mean age of participants was 78 years (sd 5.7), range 70 to 101 and 47.5% (4653/9803) were men. The prevalence of overall frailty was 20.7% (2005/9671) and there was no difference in prevalence by sex (Odds Ratio 0.98; 95% Confidence Interval 0.89 to 1.08). Sensory frailty was the most common and this was reported by more men (1823/4586) than women (1469/5056; Odds Ratio for sensory frailty 0.62, 95% Confidence Interval 0.57 to 0.68). Men were less likely than women to have physical or nutritive frailty. Physical frailty had the strongest independent associations with adverse health states. However, sensory frailty was independently associated with falls, less frequent walking, problems in self-care and usual activities, lack of energy and accomplishment. Conclusions: Physical frailty was more strongly associated with adverse health states, but sensory frailty was much more common. The health gain from intervention for sensory frailty in England is likely to be substantial, particularly for older men. Sensory frailty should be explored further as an important target of intervention to improve health outcomes for older people both at clinical and population level.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.08/14/41/DH_/Department of Health/United Kingdom Project number 08/14/41/Health Technology Assessment Programmepre-print, post-print, publisher's version/PD

Pressure RElieving Support SUrfaces: a Randomised Evaluation 2 (PRESSURE 2): study protocol for a randomised controlled trial

Background Pressure ulcers represent a major burden to patients, carers and the healthcare system, affecting approximately 1 in 17 hospital and 1 in 20 community patients. They impact greatly on an individual’s functional status and health-related quality of life. The mainstay of pressure ulcer prevention practice is the provision of pressure redistribution support surfaces and patient repositioning. The aim of the PRESSURE 2 study is to compare the two main mattress types utilised within the NHS: high-specification foam and alternating pressure mattresses, in the prevention of pressure ulcers. Methods/Design PRESSURE 2 is a multicentre, open-label, randomised, double triangular, group sequential, parallel group trial. A maximum of 2954 ‘high-risk’ patients with evidence of acute illness will be randomised on a 1:1 basis to receive either a high-specification foam mattress or alternating-pressure mattress in conjunction with an electric profiling bed frame. The primary objective of the trial is to compare mattresses in terms of the time to developing a new Category 2 or above pressure ulcer by 30 days post end of treatment phase. Secondary endpoints include time to developing new Category 1 and 3 or above pressure ulcers, time to healing of pre-existing Category 2 pressure ulcers, health-related quality of life, cost-effectiveness, incidence of mattress change and safety. Validation objectives are to determine the responsiveness of the Pressure Ulcer Quality of Life-Prevention instrument and the feasibility of having a blinded endpoint assessment using photography. The trial will have a maximum of three planned analyses with unequally spaced reviews at event-driven coherent cut-points. The futility boundaries are constructed as non-binding to allow a decision for stopping early to be overruled by the Data Monitoring and Ethics Committee. Discussion The double triangular, group sequential design of the PRESSURE 2 trial will provide an efficient design through the possibility of early stopping for demonstrating either superiority, inferiority of mattresses or futility of the trial. The trial optimises the potential for producing robust clinical evidence on the effectiveness of two commonly used mattresses in clinical practice earlier than in a conventional design