Intensive aphasia speech-language therapy provision during clinical placements : clients’ experiences and students’ competency development.

The aim of the current study was to investigate the development of speech-language therapy (SLT) students’ clinical competency within clinical field placements involving the provision of intensive therapy, and to explore the experiences of clients who received intensive therapy delivered by students. Participants consisted of 2 groups: SLT students in the fourth year of the undergraduate Bachelor of Speech and Language Pathology programme (n=7) and clients (adults with communication impairments following stroke) who had received intensive treatment provided by students (n=10). A pre-test post-test design was utilized to evaluate the development of students’ clinical competency, confidence and anxiety. Student participants took part in a pre- and post-placement questionnaire in which they self-rated their confidence and anxiety in clinical tasks. Student participants’ clinical competency was assessed using the COMPASS® assessment tool. Client participants completed semi-structured interviews discussing their experiences and perceptions of intensive treatment and student involvement. Student participants’ questionnaire responses and COMPASS® scores were analysed with descriptive statistics. Client participants’ interviews were analysed through reflexive thematic analysis. Student participants made comparable change in competency ratings when compared with the class average, perceived reductions in self-ratings of anxiety and increases in self-ratings of clinical confidence. Client participants had positive perspectives of intensive therapy provided by SLT students. 6 themes were developed from the semi-structured interviews: the hard work is worth the effort, more treatment is better than less, there’s a “right time” for intensive treatment, it didn’t feel like they were students, we just got on so well, and they listened to what I wanted. The findings add to evidence that clients value access to intensive treatment and have positive experiences with SLT students and extends the evidence to suggest that student-implemented intensive therapy benefits both students and clients. Implications for clinical practice and future research directions are discussed

A novel integrative procedure for identifying and integrating three-dimensions of objectively measured free-living sedentary behaviour

The widely accepted definition of sedentary behaviour [SB] refers to any waking behaviour characterized by an energy expenditure ≤1.5 metabolic equivalents [METs] while in a sitting or reclining posture. At present, there is no single field-based device which objectively measures sleep, posture and activity intensity simultaneously. The aim of this study was to develop a novel integrative procedure [INT] to combine information from two validated activity monitors on sleep, activity intensity and posture, the three key dimensions of SB

Disentangling the relationship between sedentariness and obesity: Activity intensity, but not sitting posture, is associated with adiposity in women

Background The relationship between free-living sedentary behaviour (SB) and obesity is unclear. Studies may arrive at disparate conclusions because of inconsistencies and limitations when defining and measuring free-living SB. The aim of this cross-sectional study was to examine whether the relationship between SB and adiposity differed depending on the way SB was operationally defined and objectively measured. Methods Sixty-three female participants aged 37.1 years (SD = 13.6) with a body mass index (BMI) of 29.6 kg/m2 (SD = 4.7) had their body composition measured (BodPod, Concord, CA) then were continuously monitored for 5–7 days with the SenseWear Armband (SWA; sleep and activity intensity) and the activPAL (AP; posture). Data from both activity monitors were analysed separately and integrated resulting in a third measure of SB (activity intensity and posture; SEDINT). SB outputs were compared according to week or weekend day averages then correlated against body composition parameters after adjusting for moderate-to-vigorous physical activity (MVPA). Results SEDSWA resulted in the most sedentary time 11.74 h/day (SD = 1.60), followed by SEDAP 10.16 h/day (SD = 1.75) and SEDINT 9.10 h/day (SD = 1.67). There was a significant positive association between SEDSWA and body mass [r(61) = 0.29, p = .02], BMI [r (61) = 0.33, p = .009] and fat mass [r(61) = 0.32, p = .01]. SEDAP and SEDINT were not associated with any of the indices of adiposity. Correlations between SB and adiposity were non-significant when controlling for MVPA. Conclusions The relationship between SB and adiposity differed depending on how SB was operationally defined and measured, and was dependent on MVPA. The definition of SB based on a sitting posture (SEDAP) was not strongly related to body fat, whereas the accumulation of any behaviour (sitting or standing) with an intensity of <1.5 METs (SEDSWA) (offset by the presence of MVPA) was positively associated with indices of adiposity. These data suggest that the postural element of SB (sitting) is not sufficient for the accumulation of adiposity, rather activities requiring low EE (<1.5 METs) and the absence of MVPA, regardless of posture, are associated with higher fat mass

Priorities in policy and management when existing biodiversity stressors interact with climate-change

There are three key drivers of the biodiversity crisis: (1) the well known existing threats to biodiversity such as habitat loss, invasive pest species and resource exploitation; (2) direct effects of climate-change, such as on coastal and high elevatio

Aspects of hidden and manifest SL(2,R) symmetry in 2D near-horizon black-hole background

The invariance under unitary representations of the conformal group SL(2,R) of a quantum particle is rigorously investigated in two-dimensional spacetimes containing Killing horizons using DFF model. The limit of the near-horizon approximation is considered. If the Killing horizon is bifurcate the conformal symmetry is hidden, i.e. it does not arise from geometrical spacetime isometries, but the whole Hilbert space turns out to be an irreducible unitary representation of SL(2,R) and the time evolution is embodied in the unitary representation. In this case the symmetry does not depend on the mass of the particle and, if the representation is faithful, the conformal observable K shows thermal properties. If the Killing horizon is nonbifurcate the conformal symmetry is manifest, i.e. it arises from geometrical spacetime isometries. The SL(2,R) representation which arises from the geometry selects a hidden conformal representation. Also in that case the Hilbert space is an irreducible representation of SL(2,R) and the group conformal symmetries embodies the time evolution with respect to the local Killing time. However no thermal properties are involved. The conformal observable K gives rise to Killing time evolution of the quantum state with respect to another global Killing time present in the manifold. Mathematical proofs about the developed machinery are supplied and features of the operator H_g = -({d^2}/{dx^2})+ ({g}/{x^2}), with g=-1/4 are discussed. It is proven that a statement, used in the recent literature, about the spectrum of self-adjoint extensions of H_g is incorrect.Comment: 22 pages, 1 figure, latex 2e, some misprint corrected, a reference and a footnote adde

The Hypermultiplet with Heisenberg Isometry in N=2 Global and Local Supersymmetry

The string coupling of N=2 supersymmetric compactifications of type II string theory on a Calabi-Yau manifold belongs to the so-called universal dilaton hypermultiplet, that has four real scalars living on a quaternion-Kaehler manifold. Requiring Heisenberg symmetry, which is a maximal subgroup of perturbative isometries, reduces the possible manifolds to a one-parameter family that describes the tree-level effective action deformed by the only possible perturbative correction arising at one-loop level. A similar argument can be made at the level of global supersymmetry where the scalar manifold is hyper-Kaehler. In this work, the connection between global and local supersymmetry is explicitly constructed, providing a non-trivial gravity decoupled limit of type II strings already in perturbation theory.Comment: 24 page

Assessing mental health service user and carer involvement in physical health care planning: The development and validation of a new patient-reported experience measure

BackgroundPeople living with serious mental health conditions experience increased morbidity due to physical health issues driven by medication side-effects and lifestyle factors. Coordinated mental and physical healthcare delivered in accordance with a care plan could help to reduce morbidity and mortality in this population. Efforts to develop new models of care are hampered by a lack of validated instruments to accurately assess the extent to which mental health services users and carers are involved in care planning for physical health.ObjectiveTo develop a brief and accurate patient-reported experience measure (PREM) capable of assessing involvement in physical health care planning for mental health service users and their carers.MethodsWe employed psychometric and statistical techniques to refine a bank of candidate questionnaire items, derived from qualitative interviews, into a valid and reliable measure involvement in physical health care planning. We assessed the psychometric performance of the item bank using modern psychometric analyses. We assessed unidimensionality, scalability, fit to the partial credit Rasch model, category threshold ordering, local dependency, differential item functioning, and test-retest reliability. Once purified of poorly performing and erroneous items, we simulated computerized adaptive testing (CAT) with 15, 10 and 5 items using the calibrated item bank.ResultsIssues with category threshold ordering, local dependency and differential item functioning were evident for a number of items in the nascent item bank and were resolved by removing problematic items. The final 19 item PREM had excellent fit to the Rasch model fit (x2 = 192.94, df = 1515, P = .02, RMSEA = .03 (95% CI = .01-.04). The 19-item bank had excellent reliability (marginal r = 0.87). The correlation between questionnaire scores at baseline and 2-week follow-up was high (r = .70, P DiscussionWe developed a flexible patient reported outcome measure to quantify service user and carer involvement in physical health care planning. We demonstrate the potential to substantially reduce assessment length whilst maintaining reliability by utilizing CAT

Symptom burden and health-related quality of life in chronic kidney disease:A global systematic review and meta-analysis

BACKGROUND: The importance of patient-reported outcome measurement in chronic kidney disease (CKD) populations has been established. However, there remains a lack of research that has synthesised data around CKD-specific symptom and health-related quality of life (HRQOL) burden globally, to inform focused measurement of the most relevant patient-important information in a way that minimises patient burden. The aim of this review was to synthesise symptom prevalence/severity and HRQOL data across the following CKD clinical groups globally: (1) stage 1-5 and not on renal replacement therapy (RRT), (2) receiving dialysis, or (3) in receipt of a kidney transplant.METHODS AND FINDINGS: MEDLINE, PsycINFO, and CINAHL were searched for English-language cross-sectional/longitudinal studies reporting prevalence and/or severity of symptoms and/or HRQOL in CKD, published between January 2000 and September 2021, including adult patients with CKD, and measuring symptom prevalence/severity and/or HRQOL using a patient-reported outcome measure (PROM). Random effects meta-analyses were used to pool data, stratified by CKD group: not on RRT, receiving dialysis, or in receipt of a kidney transplant. Methodological quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data, and an exploration of publication bias performed. The search identified 1,529 studies, of which 449, with 199,147 participants from 62 countries, were included in the analysis. Studies used 67 different symptom and HRQOL outcome measures, which provided data on 68 reported symptoms. Random effects meta-analyses highlighted the considerable symptom and HRQOL burden associated with CKD, with fatigue particularly prevalent, both in patients not on RRT (14 studies, 4,139 participants: 70%, 95% CI 60%-79%) and those receiving dialysis (21 studies, 2,943 participants: 70%, 95% CI 64%-76%). A number of symptoms were significantly (p &lt; 0.05 after adjustment for multiple testing) less prevalent and/or less severe within the post-transplantation population, which may suggest attribution to CKD (fatigue, depression, itching, poor mobility, poor sleep, and dry mouth). Quality of life was commonly lower in patients on dialysis (36-Item Short Form Health Survey [SF-36] Mental Component Summary [MCS] 45.7 [95% CI 45.5-45.8]; SF-36 Physical Component Summary [PCS] 35.5 [95% CI 35.3-35.6]; 91 studies, 32,105 participants for MCS and PCS) than in other CKD populations (patients not on RRT: SF-36 MCS 66.6 [95% CI 66.5-66.6], p = 0.002; PCS 66.3 [95% CI 66.2-66.4], p = 0.002; 39 studies, 24,600 participants; transplant: MCS 50.0 [95% CI 49.9-50.1], p = 0.002; PCS 48.0 [95% CI 47.9-48.1], p = 0.002; 39 studies, 9,664 participants). Limitations of the analysis are the relatively few studies contributing to symptom severity estimates and inconsistent use of PROMs (different measures and time points) across the included literature, which hindered interpretation.CONCLUSIONS: The main findings highlight the considerable symptom and HRQOL burden associated with CKD. The synthesis provides a detailed overview of the symptom/HRQOL profile across clinical groups, which may support healthcare professionals when discussing, measuring, and managing the potential treatment burden associated with CKD.PROTOCOL REGISTRATION: PROSPERO CRD42020164737.</p

Free-living energy balance behaviours are associated with greater weight loss during a weight loss programme

Introduction: Free-living movement (physical activity [PA] and sedentary behavior [SB]) and eating behaviors (energy intake [EI] and food choice) affect energy balance and therefore have the potential to influence weight loss (WL). This study explored whether free-living movement and/or eating behaviors measured early (week 3) in a 14-week WL programme or their change during the intervention are associated with WL in women. Methods: In the study, 80 women (M ± SD age: 42.0 ± 12.4 years) with overweight or obesity [body mass index (BMI): 34.08 ± 3.62 kg/m2] completed a 14 week WL program focused primarily on diet (commercial or self-led). Body mass (BM) was measured at baseline, and again during week 2 and 14 along with body composition. Free-living movement (SenseWear Armband) and eating behavior (weighed food diaries) were measured for 1 week during week 3 and 12. Hierarchical multiple regression analyses examined whether early and early-late change in free-living movement and eating behavior were associated with WL. The differences in behavior between clinically significant weight losers (CWL; ≥5% WL) and non-clinically significant weight losers (NWL; ≤ 3% WL) were compared. Results: The energy density of food consumed [β = 0.45, p < 0.001] and vigorous PA [β = −0.30, p < 0.001] early in the intervention (regression model 1) and early-late change in light PA [β = −0.81 p < 0.001], moderate PA [β = −1.17 p < 0.001], vigorous PA [β = −0.49, p < 0.001], total energy expenditure (EE) [β = 1.84, p < 0.001], and energy density of food consumed [β = 0.27, p = 0.01] (regression model 2) significantly predicted percentage change in BM. Early in the intervention, CWL consumed less energy dense foods than NWL [p = 0.03]. CWL showed a small but significant increase in vigorous PA, whereas NWL showed a slight decrease in PA [p = 0.04]. Conclusion: Both early and early-late change in free-living movement and eating behaviors during a 14 week WL program are predictors of WL. These findings demonstrate that specific behaviors that contribute to greater EE (e.g., vigorous PA) and lower EI (e.g., less energy-dense foods) are related to greater WL outcomes. Interventions targeting these behaviors can be expected to increase the effectiveness of WL programs