Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial

BackgroundAnterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability.MethodsWe did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score—4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367.FindingsBetween Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5–13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications.InterpretationSurgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management

Managing dissociation in imagery rescripting for voice hearers with trauma: lessons from a case series

Trauma, voice hearing and dissociation tend to be closely linked. Cognitive models of voice hearing largely agree that traumatic events may predispose people to voice hearing via dissociative processes. While treating trauma in voice hearers may help to reduce voice distress and frequency, dissociation may be a barrier to this therapeutic work. This case series reports on the dissociative experiences of a sub-sample of voice hearing clients who reported dissociation during Imagery Rescripting (ImRs) for trauma (N=6, 50% of original sample) in the case series study reported on previously (Paulik, Steel & Arntz, 2019). The aims in the current paper were to explore the impact of dissociation on outcomes, the type of dissociative experiences encountered, where in the ImRs protocol they occurred, and the use of therapeutic techniques to address them. We found that clients who dissociated during therapy showed reductions in their trauma intrusions and voice-related distress and frequency. However, when compared to non-dissociators, these benefits took more sessions to achieve. The most common types of dissociation were flashbacks, losing control over the image, emotional detachment and trance/absorbed state. These were most likely to occur at points during the therapy where negative affect was heightened. Grounding and soothing techniques, as well as strategies to reduce the level of negative affect were reported effective by participants in preventing or interrupting dissociation. We recommend that dissociation should not be a barrier to implementing imagery rescripting with this group

Early maternal feeding practices: Associations with overweight later in childhood

Background Current understanding of the impact of maternal feeding practices on weight outcomes in young children remains unclear given equivocal longitudinal study outcomes. Objectives To determine whether feeding practices used by mothers when their child was less than 2 years of age were related to overweight status at ages 3.5 and 5 years in a large cross-country sample; and investigate whether these associations were moderated by weight status in early life. Design Data from mother-child dyads participating in four childhood obesity prevention trials across Australia and New Zealand were pooled (n = 723). Each trial administered items from the Comprehensive Feeding Practices Questionnaire (CFPQ) to mothers when infants were approximately 20 months of age, measuring food as a reward, modelling, restriction for health, pressure to eat, and emotion regulation. Poisson regression was used to determine risk ratios (RR) for overweight (BMI z-score ≥85th percentile) at 3.5 and 5 years by CFPQ scores. Results Greater use of emotion regulation at 20 months of age predicted higher risk for overweight at 3.5 and 5 years (RR = 1.19 and 1.28, respectively), while restriction for health predicted lower risk for overweight at 5 years (RR = 0.88). Child's weight status at 20 months moderated the association between pressure to eat and overweight risk at 5 years, such that those who were not overweight at 20 months of age had reduced risk of overweight associated with the use of pressure to eat (RR = 0.68) but those who were overweight had an increased risk (RR = 1.09). Conclusion Early maternal feeding practices are related to a child's later risk of overweight

Emotional and non-emotional mental imagery and auditory verbal hallucinations (hearing voices): A systematic review of imagery assessment tools

It is unknown to what extent mental imagery and auditory verbal hallucinations (AVHs) are related. Trials evaluating this issue used both emotional and non-emotional mental imagery tools, thereby complicating outcomes comparisons. Therefore, the present study aimed to systematically review the literature on mental imagery in individuals with AVHs to (1) inventory imagery assessment tools used in this population, (2) to collect information on the relation between emotional and non-emotional mental imagery in all sensory domains and AVHs and (3) to integrate the outcomes of this systematic review in a model of different mental imagery domains and related assessment tools. We conducted a systematic literature search in the PubMed Database. After full-text screening, 17 papers were included. Findings showed that a variety of assessment methods have been used to assess various aspects of mental imagery in people with AVHs, suggesting that there is a lack of agreed theoretical conceptualization of mental imagery and AVHs. In addition, the studies confirmed as was expected that non-emotional mental imagery seemed unrelated to AVHs whereas emotional mental imagery was related to AVHs. Lastly, we proposed a model of mental imagery domains and corresponding assessment methods distinguishing between emotional and non-emotional mental imagery

Rickettsia Detected in the Reptile Tick Bothriocroton hydrosauri from the Lizard Tiliqua rugosa in South Australia

Rickettsiosis is a potentially fatal tick borne disease. It is caused by the obligate intracellular bacteria Rickettsia, which is transferred to humans through salivary excretions of ticks during the biting process. Globally, the incidence of tick-borne diseases is increasing; as such, there is a need for a greater understanding of tick–host interactions to create more informed risk management strategies. Flinders Island spotted fever rickettsioses has been identified throughout Australia (Tasmania, South Australia, Queensland and Torres Strait Islands) with possible identifications in Thailand, Sri Lanka and Italy. Flinders Island spotted fever is thought to be spread through tick bites and the reptile tick Bothriocroton hydrosauri has been implicated as a vector in this transmission. This study used qPCR to assay Bothriocroton hydrosauri ticks collected from Tiliqua rugosa (sleepy lizard) hosts on mainland South Australia near where spotted fever cases have been identified. We report that, although we discovered Rickettsia in all tick samples, it was not Rickettsia honei. This study is the first to use PCR to positively identify Rickettsia from South Australian Bothriocroton hydrosauri ticks collected from Tiliqua rugosa (sleepy lizard) hosts. These findings suggest that B. hydrosauri may be a vector of multiple Rickettsia spp. Also as all 41 tested B. hydrosauri ticks were positive for Rickettsia this indicates an extremely high prevalence within the studied area in South Australia

Emotional and non-emotional mental imagery and auditory verbal hallucinations (hearing voices): a systematic review of imagery assessment tools

It is unknown to what extent mental imagery and auditory verbal hallucinations (AVHs) are related. Trials evaluating this issue used both emotional and non-emotional mental imagery tools, thereby complicating outcomes comparisons. Therefore, the present study aimed to systematically review the literature on mental imagery in individuals with AVHs to (1) inventory imagery assessment tools used in this population, (2) to collect information on the relation between emotional and non-emotional mental imagery in all sensory domains and AVHs and (3) to integrate the outcomes of this systematic review in a model of different mental imagery domains and related assessment tools. We conducted a systematic literature search in the PubMed Database. After full-text screening, 17 papers were included. Findings showed that a variety of assessment methods have been used to assess various aspects of mental imagery in people with AVHs, suggesting that there is a lack of agreed theoretical conceptualization of mental imagery and AVHs. In addition, the studies confirmed as was expected that non-emotional mental imagery seemed unrelated to AVHs whereas emotional mental imagery was related to AVHs. Lastly, we proposed a model of mental imagery domains and corresponding assessment methods distinguishing between emotional and non-emotional mental imagery

The Pantheon+ analysis : supercal-fragilistic cross calibration, retrained SALT2 light-curve model, and calibration systematic uncertainty

We present a recalibration of the photometric systems in the Pantheon+ sample of Type Ia supernovae (SNe Ia) including those in the SH0ES distance-ladder measurement of H0. We utilize the large and uniform sky coverage of the public Pan-STARRS stellar photometry catalog to cross calibrate against tertiary standards released by individual SN Ia surveys. The most significant updates over the “SuperCal” cross calibration used for the previous Pantheon and SH0ES analyses are: (1) expansion of the number of photometric systems (now 25) and filters (now 105), (2) solving for all filter offsets in all systems simultaneously to produce a calibration uncertainty covariance matrix for cosmological-model constraints, and (3) accounting for the change in the fundamental flux calibration of the Hubble Space Telescope CALSPEC standards from previous versions on the order of 1.5% over a Δλ of 4000 Å. We retrain the SALT2 model and find that our new model coupled with the new calibration of the light curves themselves causes a net distance modulus change (dμ/dz) of 0.04 mag over the redshift range 0 < z < 1. We introduce a new formalism to determine the systematic impact on cosmological inference by propagating the covariance in the fitted calibration offsets through retraining simultaneously with light-curve fitting and find a total calibration uncertainty impact of σw = 0.013; roughly half the size of the sample statistical uncertainty. Similarly, we find the systematic SN calibration contribution to the SH0ES H0 uncertainty is less than 0.2 km s−1 Mpc−1, suggesting that SN Ia calibration cannot resolve the current level of the “Hubble Tension.