Publications by authors named "Jo Smith"

85 Publications

The Importance of Positive Social Support During Reentry From Prison: Examining the Role of Volunteer Mentoring.

Int J Offender Ther Comp Criminol 2021 Nov 21:306624X211059316. Epub 2021 Nov 21.

University of Texas at Austin, USA.

Social support appears to be important in improving outcomes for incarcerated individuals during the reentry process not only in terms of general wellbeing but also in gaining employment and avoiding recidivism. Mentoring programs have become increasingly popular interventions that are intended to provide such support during reentry. However, research on mentoring programs is limited and tends to focus solely on the programs' impact on recidivism, a distal outcome. Through the use of semi-structured, in-depth interviews, this qualitative study focuses on more proximal outcomes, exploring how reentering individuals who are receiving volunteer mentoring through a transitional housing program define successful reentry and perceive the value of different types of support they received from their mentors. Participants identified several indicators of successful reentry and discussed the types of support that were helpful, harmful, or absent. Implications for practice and areas for future research are discussed.
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http://dx.doi.org/10.1177/0306624X211059316DOI Listing
November 2021

Assessing soil carbon dioxide and methane fluxes from a Scots pine raised bog-edge-woodland.

J Environ Manage 2021 Nov 18;302(Pt B):114061. Epub 2021 Nov 18.

Forest Research, Northern Research Station, Bush Estate, Roslin, EH25 9SY, UK.

Scots pine bog edge woodland is a type of habitat typical on raised bogs where trees cohabitate with bog vegetation to form a low-density stand. Even though nowadays this habitat does not cover large areas, in a future scenario it is possible that this environment will expand, either naturally (drier climate) or anthropogenically, as the result of the application of new restoration strategies that could increase net landscape carbon benefits from both peatland and woodland environments. This study is the first reported investigation in Scotland exploring carbon flux dynamics from sparse woodlands on raised bogs. We examined how Scots pine trees directly or indirectly affected soil temperature and moisture, ground vegetation, and consequently carbon dioxide (CO) and methane (CH) soil fluxes. Soil CO and CH were measured at different distance from the tree and thereafter assessed for both spatial and temporal variability. Our results showed that these low-density trees were able to modify the ground vegetation composition, had no effect on soil temperature, but did affect the soil moisture, with soils close to tree roots significantly drier (0.25 ± 0.01 m m) than those on open bog (0.39 ± 0.02 m m). Soil CO fluxes were significantly higher in the vicinity of trees (34.13 ± 3.97 μg CO m s) compared to the open bog (24.34 ± 2.86 μg CO m s). On the opposite, CH effluxes were significantly larger in the open bog (0.07 ± 0.01 μg CH m s) than close to the tree (0.01 ± 0.00 μg CH m s). This suggests that Scots pine trees on bog edge woodland may affect soil C fluxes in their proximity primarily due to the contribution of root respiration, but also as a result of their effects on soil moisture, enhancing soil CO emissions, while reducing the CH fluxes. There is, however, still uncertainty about the complete greenhouse gas assessment, and further research would be needed in order to include the quantification of soil nitrous oxide (NO) dynamics together with the analysis of complete gas exchanges at the tree-atmosphere level.
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http://dx.doi.org/10.1016/j.jenvman.2021.114061DOI Listing
November 2021

Self-paced treadmills do not allow for valid observation of linear and nonlinear gait variability outcomes in patients with Parkinson's disease.

Gait Posture 2021 Oct 7;91:35-41. Epub 2021 Oct 7.

Department of Electrical and Computer Science Engineering, Fowler School of Engineering, Chapman University, Orange, CA, 92866, USA.

Background: Due to the imposed constant belt speed, motorized treadmills are known to affect linear and nonlinear gait variability outcomes. This is particularly true of patients with Parkinson's Disease where the treadmill can act as an external pacemaker. Self-paced treadmills update the belt speed in response to the subject's walking speed and might, therefore, be a useful tool for measurement of gait variability in this patient population. This study aimed to compare gait variability during walking at self-paced and constant treadmill speeds with overground walking in individuals with PD and individuals with unimpaired gait.

Methods: Thirteen patients with Parkinson's Disease and thirteen healthy controls walked under three conditions: overground, on a treadmill at a constant speed, and using three self-paced treadmill modes. Gait variability was assessed with coefficient of variation (CV), sample entropy (SampEn), and detrended fluctuation analysis (DFA) of stride time and length. Systematic and random error between the conditions was quantified.

Results: For individuals with PD, error in variability measurement was less during self-paced modes compared with constant treadmill speed for stride time but not for stride length. However, there was substantial error for stride time and length variability for all treadmill conditions. For healthy controls the error in measurement associated with treadmill walking was substantially less.

Significance: The large systematic and random errors between overground and treadmill walking prohibit meaningful gait variability observations in patients with Parkinson's Disease using self-paced or constant-speed treadmills.
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http://dx.doi.org/10.1016/j.gaitpost.2021.10.008DOI Listing
October 2021

Agricultural methane emissions and the potential formitigation.

Philos Trans A Math Phys Eng Sci 2021 Nov 27;379(2210):20200451. Epub 2021 Sep 27.

Institute of Biological and Environmental Sciences, University of Aberdeen, 23 St Machar Drive, Aberdeen AB24 3UU, UK.

Agriculture is the largest anthropogenic source of methane (CH), emitting 145 Tg CHy to the atmosphere in 2017. The main sources are enteric fermentation, manure management, rice cultivation and residue burning. There is significant potential to reduce CH from these sources, with bottom-up mitigation potentials of approximately 10.6, 10, 2 and 1 Tg CHy from rice management, enteric fermentation, manure management and residue burning. Other system-wide studies have assumed even higher potentials of 4.8-47.2 Tg CHy from reduced enteric fermentation, and 4-36 Tg CHy from improved rice management. Biogas (a methane-rich gas mixture generated from the anaerobic decomposition of organic matter and used for energy) also has the potential to reduce unabated CH emissions from animal manures and human waste. In addition to these supply side measures, interventions on the demand-side (shift to a plant-based diet and a reduction in total food loss and waste by 2050) would also significantly reduce methane emissions, perhaps in the order of greater than 50 Tg CHy. While there is a pressing need to reduce emissions of long-lived greenhouse gases (CO and NO) due to their persistence in the atmosphere, despite CH being a short-lived greenhouse gas, the urgency of reducing warming means we must reduce any GHG emissions we can as soon as possible. Because of this, mitigation actions should focus on reducing emissions of all the three main anthropogenic greenhouse gases, including CH. This article is part of a discussion meeting issue 'Rising methane: is warming feeding warming? (part1)'.
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http://dx.doi.org/10.1098/rsta.2020.0451DOI Listing
November 2021

Soil-derived Nature's Contributions to People and their contribution to the UN Sustainable Development Goals.

Philos Trans R Soc Lond B Biol Sci 2021 09 4;376(1834):20200185. Epub 2021 Aug 4.

Department of Human Ecology, Rutgers University, New Brunswick, NJ, USA.

This special issue provides an assessment of the contribution of soils to Nature's Contributions to People (NCP). Here, we combine this assessment and previously published relationships between NCP and delivery on the UN Sustainable Development Goals (SDGs) to infer contributions of soils to the SDGs. We show that in addition to contributing positively to the delivery of all NCP, soils also have a role in underpinning all SDGs. While highlighting the great potential of soils to contribute to sustainable development, it is recognized that poorly managed, degraded or polluted soils may contribute negatively to both NCP and SDGs. The positive contribution, however, cannot be taken for granted, and soils must be managed carefully to keep them healthy and capable of playing this vital role. A priority for soil management must include: (i) for healthy soils in natural ecosystems, them from conversion and degradation; (ii) for managed soils, in a way to protect and enhance soil biodiversity, health and sustainability and to prevent degradation; and (iii) for degraded soils, restore to full soil health. We have enough knowledge now to move forward with the implementation of best management practices to maintain and improve soil health. This analysis shows that this is not just desirable, it is essential if we are to meet the SDG targets by 2030 and achieve sustainable development more broadly in the decades to come. This article is part of the theme issue 'The role of soils in delivering Nature's Contributions to People'.
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http://dx.doi.org/10.1098/rstb.2020.0185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8349629PMC
September 2021

The role of soils in provision of energy.

Philos Trans R Soc Lond B Biol Sci 2021 09 4;376(1834):20200180. Epub 2021 Aug 4.

School of Biological Science, University of Aberdeen, 23 St Machar Drive, Aberdeen AB24 3UU, UK.

Soils have both direct and indirect impacts on available energy, but energy provision, in itself, has direct and indirect impacts on soils. Burning peats provides only approximately 0.02% of global energy supply yet emits approximately 0.7-0.8% of carbon losses from land-use change and forestry (LUCF). Bioenergy crops provide approximately 0.3% of energy supply and occupy approximately 0.2-0.6% of harvested area. Increased bioenergy demand is likely to encourage switching from forests and pastures to rotational energy cropping, resulting in soil carbon loss. However, with protective policies, incorporation of residues from energy provision could sequester approximately 0.4% of LUCF carbon losses. All organic wastes available in 2018 could provide approximately 10% of global energy supply, but at a cost to soils of approximately 5% of LUCF carbon losses; not using manures avoids soil degradation but reduces energy provision to approximately 9%. Wind farms, hydroelectric solar and geothermal schemes provide approximately 3.66% of energy supply and occupy less than approximately 0.3% of harvested area, but if sited on peatlands could result in carbon losses that exceed reductions in fossil fuel emissions. To ensure renewable energy provision does not damage our soils, comprehensive policies and management guidelines are needed that (i) avoid peats, (ii) avoid converting permanent land uses (such as perennial grassland or forestry) to energy cropping, and (iii) return residues remaining from energy conversion processes to the soil. This article is part of the theme issue 'The role of soils in delivering Nature's Contributions to People'.
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http://dx.doi.org/10.1098/rstb.2020.0180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8349638PMC
September 2021

Impacts of different treatment methods for cattle manure on the spread of faecal indicator organisms from soil to lettuce in Nigeria.

J Appl Microbiol 2021 Jun 23. Epub 2021 Jun 23.

Department of Microbiology, Nasarawa State University, Keffi, Nigeria.

Aim: This study investigated impacts of different organic waste treatment methods on reduction and spread of faecal indicator organisms to food crops in a developing country.

Methods And Results: Fresh cattle manure was subjected to three different treatments; anaerobic digestion, burning and composting. Escherichia coli, coliforms and nitrogen content of cattle manure were measured before and after treatment in the amended soil and harvested lettuce. All treatments significantly reduced E. coli and coliform counts but differed in the ratio of E. coli or coliforms to nitrogen. Application of the recommended nitrogen dose of 120 kg ha as bioslurry resulted in significantly lower E. coli and coliform contamination of soil than the same nitrogen rate applied as compost or ash. The E. coli content of lettuces grown on soil amended with treated wastes at recommended rates did not differ between treatments but was significantly lower than in lettuces grown on soil amended with untreated manure.

Conclusions: Treatment of manure before use as an organic fertilizer significantly reduces potential contamination of both soil and food crops with E. coli and coliforms. To best reduce the spread of E. coli from organic fertilizers, manures should be treated by anaerobic digestion.

Significance And Impact Of The Study: Information from this study quantifies potential risks associated with use of manures in growing food crops by determining the ratio between pathogen content and required nitrogen application rate.
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http://dx.doi.org/10.1111/jam.15189DOI Listing
June 2021

Fear Avoidance Predicts Persistent Pain in Young Adults With Low Back Pain: A Prospective Study.

J Orthop Sports Phys Ther 2021 08 15;51(8):383-391. Epub 2021 May 15.

Objectives: To (1) quantify relationships between low back pain (LBP) symptoms, physical activity, and psychosocial characteristics in young adults and (2) identify subclasses of young adults with distinct pain trajectories.

Design: Prospective cohort study with 12-month follow-up.

Methods: One hundred twenty adults (mean ± SD age, 20.8 ± 2.6 years; 99 women) participated. Participants completed a baseline survey that measured anxiety, depression, fear avoidance, quality of life, and history and impact of any LBP. Participants completed follow-up surveys every 3 months for 1 year. Subclasses based on pain trajectories over time were identified using latent class analysis, and predictors of class membership at baseline were assessed.

Results: Individuals with LBP at baseline had lower physical quality-of-life scores than back-healthy participants ( = .01). Subclass 1 (25% of individuals with LBP) had persistent moderate-to-high pain intensity over the 1-year study period. Subclass 2 (75% of individuals with LBP) had significantly improving pain over the 1-year study period. Higher fear avoidance (physical activity subscale) and pain interference at baseline were associated with greater odds of membership in subclass 1 (odds ratio = 1.2; 95% confidence interval: 1.0, 1.3 and odds ratio = 1.4; 95% confidence interval: 1.1, 1.6, respectively).

Conclusion: Most young adults with LBP had symptoms that improved over time. Levels of fear avoidance and pain interference may help to identify individuals at risk of persistent pain early in the lifespan. .
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http://dx.doi.org/10.2519/jospt.2021.9828DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328870PMC
August 2021

Fear Avoidance Predicts Persistent Pain in Young Adults With Low Back Pain: A Prospective Study.

J Orthop Sports Phys Ther 2021 08 15;51(8):383-391. Epub 2021 May 15.

Objectives: To (1) quantify relationships between low back pain (LBP) symptoms, physical activity, and psychosocial characteristics in young adults and (2) identify subclasses of young adults with distinct pain trajectories.

Design: Prospective cohort study with 12-month follow-up.

Methods: One hundred twenty adults (mean ± SD age, 20.8 ± 2.6 years; 99 women) participated. Participants completed a baseline survey that measured anxiety, depression, fear avoidance, quality of life, and history and impact of any LBP. Participants completed follow-up surveys every 3 months for 1 year. Subclasses based on pain trajectories over time were identified using latent class analysis, and predictors of class membership at baseline were assessed.

Results: Individuals with LBP at baseline had lower physical quality-of-life scores than back-healthy participants ( = .01). Subclass 1 (25% of individuals with LBP) had persistent moderate-to-high pain intensity over the 1-year study period. Subclass 2 (75% of individuals with LBP) had significantly improving pain over the 1-year study period. Higher fear avoidance (physical activity subscale) and pain interference at baseline were associated with greater odds of membership in subclass 1 (odds ratio = 1.2; 95% confidence interval: 1.0, 1.3 and odds ratio = 1.4; 95% confidence interval: 1.1, 1.6, respectively).

Conclusion: Most young adults with LBP had symptoms that improved over time. Levels of fear avoidance and pain interference may help to identify individuals at risk of persistent pain early in the lifespan. .
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http://dx.doi.org/10.2519/jospt.2021.9828DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328870PMC
August 2021

Examining the effects of national initiatives to improve the physical health of people with psychosis in England: secondary analysis of data from the National Clinical Audit of Psychosis.

BJPsych Bull 2021 May 5:1-8. Epub 2021 May 5.

Royal College of Psychiatrists, UK.

Aims And Methods: To examine whether national initiatives have led to improvements in the physical health of people with psychosis. Secondary analysis of a national audit of services for people with psychosis. Proportions of patients in 'good health' according to seven measures, and one composite measure derived from national standards, were compared between multiple rounds of data collection.

Results: The proportion of patients in overall 'good health' under the care of 'Early Intervention in Psychosis' teams increased from 2014-2019, particularly for measures of smoking, alcohol and substance use. There was no overall change in the proportion of patients in overall 'good health' under the care of 'Community Mental Health Teams' from 2011-2017. However, there were improvements in alcohol use, blood glucose and lipid levels.

Clinical Implications: There have been modest improvements in the health of people with psychosis over the last nine years. Continuing efforts are required to translate these improvements into reductions in premature mortality.
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http://dx.doi.org/10.1192/bjb.2021.38DOI Listing
May 2021

Reliability of a Barre-Mounted Dynamometer-Stabilizing Device in Measuring Dance-Specific Muscle Performance.

Med Probl Perform Art 2021 Mar;36(1):27-33

Lutheran Spine Center, 1687 Cole Blvd. Suite 103, Lakewood, CO 80401, USA. Tel 303-403-6688.

Background: Hand-held dynamometry is considered an efficient, effective, and portable means of objectively measuring lower extremity strength; however, it has yet to be studied specific to dance-relevant muscle performance. Also, dynamometry is often criticized for variability in results based on tester strength and sex. Use of an external stabilizing device has been suggested to minimize differences in outcomes between male and female testers by reducing variability associated with tester strength limitations. Therefore, this study used a barre-mounted, portable dynamometer stabilizing device to improve consistency of results among different testers for assessing hip and lower extremity muscle performance in dance-relevant positions.

Objective: To assess the intra and inter-rater reliability of a barre-mounted dynamometer stabilizing device in measuring muscle performance in common dance maneuvers.

Methods: Two testers assessed muscle performance of three common dance maneuvers--développé en avant, à la secondé, and arabesque--on 11 pre-professional and professional dancers on two separate occasions to establish intra- and inter-rater reliability of the barre-mounted dynamometer stabilizing device.

Results: Intra-rater reliability was moderate to high and inter-rater reliability of the device was excellent, with intraclass correlation coefficients ranging from 0.527-0.851 and 0.834-0.953, respectively, for all positions.

Conclusions: The barre-mounted stabilizing device shows promise in mitigating tester strength or fatigue in assessing muscle performance of dancers. Initial assessment of the device suggests further study may be indicated to improve generalizability to applications of larger-scale muscle performance screening and assessment in dancers or other athletic populations who engage in movements that require extensive hip range of motion and multi-joint stability.

Clinical Relevance: Using a portable, barre-mounted stabilizing device in assessing multi-joint lower extremity muscle performance in dancers improves consistency of testing results. Application of this testing device into wider scale screenings could assist in developing normative data for a population that is lacking.
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http://dx.doi.org/10.21091/mppa.2021.1004DOI Listing
March 2021

Rapid tannin profiling of tree fodders using untargeted mid-infrared spectroscopy and partial least squares regression.

Plant Methods 2021 Feb 6;17(1):14. Epub 2021 Feb 6.

Institute for Global Food Security, Queen's University Belfast, Belfast, BT9 5DL, Northern Ireland, UK.

Background: The presence of condensed tannins (CT) in tree fodders entails a series of productive, health and ecological benefits for ruminant nutrition. Current wet analytical methods employed for full CT characterisation are time and resource-consuming, thus limiting its applicability for silvopastoral systems. The development of quick, safe and robust analytical techniques to monitor CT's full profile is crucial to suitably understand CT variability and biological activity, which would help to develop efficient evidence-based decision-making to maximise CT-derived benefits. The present study investigates the suitability of Fourier-transformed mid-infrared spectroscopy (MIR: 4000-550 cm) combined with multivariate analysis to determine CT concentration and structure (mean degree of polymerization-mDP, procyanidins:prodelphidins ratio-PC:PD and cis:trans ratio) in oak, field maple and goat willow foliage, using HCl:Butanol:Acetone:Iron (HBAI) and thiolysis-HPLC as reference methods.

Results: The MIR spectra obtained were explored firstly using Principal Component Analysis, whereas multivariate calibration models were developed based on partial least-squares regression. MIR showed an excellent prediction capacity for the determination of PC:PD [coefficient of determination for prediction (RP) = 0.96; ratio of prediction to deviation (RPD) = 5.26, range error ratio (RER) = 14.1] and cis:trans ratio (RP = 0.95; RPD = 4.24; RER = 13.3); modest for CT quantification (HBAI: RP = 0.92; RPD = 3.71; RER = 13.1; Thiolysis: RP = 0.88; RPD = 2.80; RER = 11.5); and weak for mDP (RP = 0.66; RPD = 1.86; RER = 7.16).

Conclusions: MIR combined with chemometrics allowed to characterize the full CT profile of tree foliage rapidly, which would help to assess better plant ecology variability and to improve the nutritional management of ruminant livestock.
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http://dx.doi.org/10.1186/s13007-021-00715-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866629PMC
February 2021

Psychological intervention, antipsychotic medication or a combined treatment for adolescents with a first episode of psychosis: the MAPS feasibility three-arm RCT.

Health Technol Assess 2021 01;25(4):1-124

Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK.

Background: When psychosis emerges in young people there is a risk of poorer outcomes, and access to evidence-based treatments is paramount. The current evidence base is limited. Antipsychotic medications show only a small benefit over placebo, but young people experience more side effects than adults. There is sparse evidence for psychological intervention. Research is needed to determine the clinical effectiveness and cost-effectiveness of psychological intervention versus antipsychotic medication versus a combined treatment for adolescents with psychosis.

Objectives: The objective of Managing Adolescent first-episode Psychosis: a feasibility Study (MAPS) was to determine the feasibility of conducting a definitive trial to answer the question of clinical effectiveness and cost-effectiveness of these three treatment options.

Design: This was a prospective, randomised, open-blinded, evaluation feasibility trial with a single blind. Participants were allocated 1 : 1 : 1 to receive antipsychotic medication, psychological intervention or a combination of both. A thematic qualitative study explored the acceptability and feasibility of the trial.

Setting: Early intervention in psychosis services and child and adolescent mental health services in Manchester, Oxford, Lancashire, Sussex, Birmingham, Norfolk and Suffolk, and Northumberland, Tyne and Wear.

Participants: People aged 14-18 years experiencing a first episode of psychosis either with an , Tenth Revision, schizophrenia spectrum diagnosis or meeting the entry criteria for early intervention in psychosis who had not received antipsychotic medication or psychological intervention within the last 3 months.

Interventions: Psychological intervention involved up to 26 hours of cognitive-behavioural therapy and six family intervention sessions over 6 months, with up to four booster sessions. Antipsychotic medication was prescribed by the participant's psychiatrist in line with usual practice. Combined treatment was a combination of psychological intervention and antipsychotic medication.

Main Outcome Measures: The primary outcome was feasibility (recruitment, treatment adherence and retention). We used a three-stage progression criterion to determine feasibility. Secondary outcomes were psychosis symptoms, recovery, anxiety and depression, social and educational/occupational functioning, drug and alcohol use, health economics, adverse/metabolic side effects and adverse/serious adverse events.

Results: We recruited 61 out of 90 (67.8%; amber zone) potential participants (psychological intervention,  = 18; antipsychotic medication,  = 22; combined treatment,  = 21). Retention to follow-up was 51 out of 61 participants (83.6%; green zone). In the psychological intervention arm and the combined treatment arm, 32 out of 39 (82.1%) participants received six or more sessions of cognitive-behavioural therapy (green zone). In the combined treatment arm and the antipsychotic medication arm, 28 out of 43 (65.1%) participants received antipsychotic medication for 6 consecutive weeks (amber zone). There were no serious adverse events related to the trial and one related adverse event. Overall, the number of completed secondary outcome measures, including health economics, was small.

Limitations: Medication adherence was determined by clinician report, which can be biased. The response to secondary outcomes was low, including health economics. The small sample size obtained means that the study lacked statistical power and there will be considerable uncertainty regarding estimates of treatment effects.

Conclusions: It is feasible to conduct a trial comparing psychological intervention with antipsychotic medication and a combination treatment in young people with psychosis with some adaptations to the design, including adaptations to collection of health economic data to determine cost-effectiveness.

Future Work: An adequately powered definitive trial is required to provide robust evidence.

Trial Registration: Current Controlled Trials ISRCTN80567433.

Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 25, No. 4. See the NIHR Journals Library website for further project information.
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http://dx.doi.org/10.3310/hta25040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869006PMC
January 2021

Evaluating a trait-based approach to compare natural enemy and pest communities in agroforestry vs. arable systems.

Ecol Appl 2021 06 17;31(4):e02294. Epub 2021 Feb 17.

School of Agriculture, Policy and Development, University of Reading, PO Box 237, Reading, RG6 6EU, United Kingdom.

Diversified farming systems, for example those that incorporate agroforestry elements, have been proposed as a solution that could maintain and improve multiple ecosystem services. However, habitat diversification in and around arable fields has complex and inconsistent effects on invertebrate crop pests and their natural enemies. This hinders the development of policy recommendations to promote the adoption of such management strategies for the provision of natural pest control services. Here, for the first time, we conducted a trait-based approach to investigate the effect of farming system on plant, invertebrate herbivore, and invertebrate natural enemy communities. We then evaluated this approach by comparing the results to those generated using a traditional taxonomic approach. At each of three working farms, we sampled within an agroforestry field (a diverse farming system comprising alleys of arable crops separated by tree rows), and within a paired non-diversified area of the farm (arable control field). Each of 96 sample points was sampled between 8 and 10 times, yielding 393,318 invertebrate specimens from 344 taxonomic groups. Diet specialization or granivory, lack of a pupal stage, and wing traits in invertebrates, along with late flowering, short flowering duration, creeping habit, and perenniality in plants, were traits more strongly associated with agroforestry crop alleys than the arable control fields. We hypothesize that this is a result of reduced habitat disturbance and increased habitat complexity in the agroforestry system. Taxonomic richness and diversity were higher in the agroforestry crop alleys compared to the arable control fields, but these effects were stronger at lower trophic levels. However, functional trait diversity of natural enemies was significantly higher in the agroforestry crop alleys than the arable control fields, suggesting an improved level of biocontrol, which was not detected by traditional diversity metrics. Of eight key pest taxa, three were significantly suppressed in the agroforestry system, while two were more abundant, compared to the arable control fields. Trait-based approaches can provide a better mechanistic understanding of farming system effects on pests and their natural enemies, therefore we recommend their application and testing in future studies of diversified farming systems.
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http://dx.doi.org/10.1002/eap.2294DOI Listing
June 2021

Cardiometabolic Risk in First Episode Psychosis Patients.

Front Endocrinol (Lausanne) 2020 24;11:564240. Epub 2020 Nov 24.

School of Allied Health and Community, University of Worcester, Worcester, United Kingdom.

Previous research in patients with schizophrenia in European and USA population groups has demonstrated a high prevalence of metabolic syndrome and disease progression (~35%-40%) and increased risk for cardiovascular disease and long-term mortality. Limited research has determined the prevalence of existing cardiometabolic risk factors at onset of a first episode psychosis. This cross-sectional study presents a clinical overview of the cardiometabolic risk profile in young people with first episode psychosis in the UK. Forty-six participants (72% male) clinically diagnosed with first episode psychosis (n = 25), schizophrenia (n = 13), bipolar disorder (n = 4), unspecified non-organic psychosis (n = 2) or acute psychotic episode (n = 2) with < 6 months Duration of Untreated Psychosis (DUP; mean 33.4 ± 37.2 days) were assessed for anthropometric, health risk behaviors and clinical measurements including resting heart rate, blood pressure, blood lipids, glycated hemoglobin, and prolactin. Overall, participants (aged 18-37 years) had a high prevalence of cardiometabolic risk factors due to: elevated values for BMI (73%) and abdominal adiposity (50%), blood pressure (47% prehypertensive; 23% hypertensive), resting heart rate (43%); hypercholesterolemia (32%); suboptimal HDL-C levels (36%); and hypertriglyceridemia (40%). Participants also self-reported poor health risk habits including smoking (55%), alcohol use (39%), substance use (18%), poor diet (52%), and sedentary behavior (29%). Young people with psychosis are at increased risk for cardiometabolic disorders due to elevated clinical markers and health risk behaviors. Physical health interventions (including health behavior advice) are needed early in the treatment process to address this increased risk for cardiometabolic disorders in individuals recently diagnosed with psychosis.
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http://dx.doi.org/10.3389/fendo.2020.564240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732528PMC
May 2021

Adaptations in trunk-pelvis coordination variability in response to fatiguing exercise.

Gait Posture 2021 02 18;84:1-7. Epub 2020 Nov 18.

Department of Physical Therapy, Chapman University, 9401 Jeronimo Road, Irvine, CA, 92618, United States.

Background: During walking, variability in how movement is coordinated between body segments from stride to stride facilitates adaptation to changing environmental or task constraints. Magnitude of this inter-segmental coordination variability is reduced in patient populations and may also decrease in response to muscle fatigue. Previously, stride-to-stride variability has been quantified with the Vector Coding (VC) method, however recent research introduced a new Ellipse Area Method (EAM) to avoid statistical artifacts associated with VC.

Research Question: Determine changes in trunk-pelvis coordination variability during walking turns in response to fatiguing exercise and to compare coordination variability quantified with VC to the EAM method.

Methods: 15 young adults (mean age: 23.7 (±3.2) years) performed 15 trials of a 90-degree walking turn before and after fatiguing paraspinal muscle exercise. Angular kinematics of the trunk and pelvis segments in the axial plane were quantified using three-dimensional motion capture. Stride to stride variability of axial coordination between the trunk and pelvis pre- and post-fatigue was calculated using both VC and EAM methods. Magnitudes of pre- and post-fatigue variability for VC and EAM were compared with paired t-tests and relationship between the magnitude of variability for the two methods was calculated using Pearson correlation coefficients.

Results: Using both analytical approaches, trunk-pelvis coordination variability decreased significantly post-fatiguing exercise across the stride cycle and within the stance phase of the turn (p < 0.034 for all comparisons). Average magnitudes of variability calculated with VC and EAM were highly correlated. Time series cross correlations pre-post fatigue ranged from 0.81 to 0.98.

Significance: In healthy individuals, magnitude of trunk-pelvis stride-to-stride coordination variability is reduced following fatiguing exercise but the temporal distribution of variability across the stride cycle is maintained. This finding is robust to the method used to quantify coordination variability.
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http://dx.doi.org/10.1016/j.gaitpost.2020.11.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902355PMC
February 2021

Early Intervention in Psychosis: Effectiveness and Implementation of a Combined Exercise and Health Behavior Intervention Within Routine Care.

Front Endocrinol (Lausanne) 2020 26;11:577691. Epub 2020 Oct 26.

School of Allied Health and Community, University of Worcester, Worcester, United Kingdom.

Aim: Young people with psychosis have higher rates of obesity, premature cardiovascular disease, and death compared to non-psychotic peers in the general population due to changes in metabolic regulation linked to antipsychotic medication and adverse health risk behaviors. The aim of this paper is to outline the development, implementation, and evaluation of a combined 12-week exercise and health behavior intervention delivered as part of an Early Intervention in Psychosis (EIP) routine service, within the UK.

Methods: Participants (n = 27) completed a 12-week combined intervention program, engaging in weekly, 90-min sessions comprising a healthy behavior education session (45 min), followed by a facilitated exercise session (45 min). Anthropometric data from participants (n = 26) were collected at baseline, 12 weeks, and 12 months post-intervention. Health behaviors and clinical measurements were assessed at baseline and 12 months.

Results: Mean baseline data suggests participants were at an increased health risk on entry to the program, with elevated values in mean body mass index (BMI; 70% overweight/obese), waist circumference, resting heart rate, and triglycerides. Fifty percent reported smoking daily, 64% ate < 5 fruits/vegetables per day, and 52% of participants were prescribed highly obesogenic antipsychotic medications (i.e., Olanzapine). At 12 weeks and 12 months, no changes were observed in mean BMI, waist circumference or any other clinical variable (p > 0.05). At 12 months, participants reported a positive impact on health behaviors including improved diet, increased physical activity levels, and cessation of substance use (n = 2), alcohol use (n = 2), and smoking (n = 4). Focus groups captured participant experiences, engagement with and satisfaction with the program, including challenges/barriers to program adherence.

Conclusions: The 12-week exercise and health behaviors program supported participants to attenuate their physical health risk which was sustained at 12-month follow-up. Self-reported positive health behavior changes are likely to have contributed to the prevention of excessive weight gain in this high-risk period. The evaluation was designed to have validity for a "real world EIP setting" and reflect the complexity of delivery to this participant group. Evaluation findings influenced subsequent commissioning of the physical health intervention as an ongoing element of routine EIP care within the participant site.
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http://dx.doi.org/10.3389/fendo.2020.577691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649318PMC
June 2021

Accuracy of urine dipstick tests and urine glucose-to-creatinine ratios for assessment of glucosuria in dogs and cats.

J Am Vet Med Assoc 2020 Aug;257(4):391-396

Objective: To assess the accuracy of automated readings of urine dipstick results for assessment of glucosuria in dogs and cats, compare visual versus automated readings of urine glucose concentration, and determine the utility of the urine glucose-to-creatinine ratio (UGCR) for quantification of glucosuria.

Sample: 310 canine and 279 feline urine samples.

Procedures: Glucose concentration was estimated in 271 canine and 254 feline urine samples by visual assessment of urine dipstick results and with an automated dipstick reader. Absolute urine glucose and creatinine concentrations were measured in 39 canine and 25 feline urine samples by colorimetric assay with a clinical chemistry analyzer (reference standard for detection of glucosuria), and UGCRs were determined.

Results: Automated assessment of the urine dipsticks yielded accurate results for 163 (60.1%) canine urine samples and 234 (92.1%) feline urine samples. Sensitivity of the automated dipstick reader for detection of glucosuria was 23% for canine samples and 68% for feline samples; specificity was 99% and 98%, respectively. Visual readings were more accurate than automated readings for both canine and feline urine. The UGCR was significantly correlated with absolute urine glucose concentration for both dogs and cats, yet there was incomplete distinction between dipstick categories for glucose concentration and UGCR.

Conclusions And Clinical Relevance: Urine dipstick readings for dogs and cats were useful for ruling glucosuria in when the result was positive but not for ruling it out when the result was negative. The evaluated dipsticks were more accurate for detection of glucosuria in cats than in dogs. Visual dipstick readings were more accurate than automated readings. The UGCR did not appear to provide additional useful information.
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http://dx.doi.org/10.2460/javma.257.4.391DOI Listing
August 2020

International application of standards for health care quality, access and evaluation of services for early intervention in psychotic disorders.

Early Interv Psychiatry 2021 06 25;15(3):723-730. Epub 2020 May 25.

School of Allied Health and Community, University of Worcester, Worcester, UK.

Aim: Standards for health care quality, access and evaluation of early intervention in psychosis services are required to assess implementation, provide accountability to service users and funders and support quality assurance. The aim of this article is to review the application of standards in Europe and North America.

Methods: Descriptive methods will be used to illustrate the organizational context in which standards are being applied and used, specific measures being applied and results so far.

Results: Both fidelity scales and quality indicators of health care are being used. Fidelity scales are being applied in Australia, Canada, Denmark, Italy and United States. In England, quality indicators derived from the National Institute for Health and Care Excellence guidance are being used.

Conclusion: In the last 4 years, significant progress has been made in the development and application of measures that assess quality and access to evidence-based practices for early intervention in psychosis services. This represents an important step towards providing accountability, improving outcomes and service user experience. The methods used allow for comparison between the services that are assessed with the same methods, but there is a need to compare the different methods. Further research is also required to explore links between quality of care and outcomes for community mental health services that deliver early intervention in psychotic disorders.
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http://dx.doi.org/10.1111/eip.12990DOI Listing
June 2021

Biomechanical characteristics of lumbar manipulation performed by expert, resident, and student physical therapists.

Musculoskelet Sci Pract 2020 08 11;48:102150. Epub 2020 Mar 11.

University of Southern California, Division of Biokinesiology and Physical Therapy. Los Angeles, CA, USA.

Background: Lumbar manipulation is a commonly used treatment for low back pain, but little research evidence exists regarding practitioner biomechanics during manipulation. Most existing evidence describes rate of force production through the hands into instrumented manikins and it is unclear how the practitioner moves their body and legs to generate this force.

Objectives: To identify and characterize important kinetic and kinematic factors in practitioners of varying experience performing lumbar manipulation in order to identify which factors distinguish experts from less experienced practitioners.

Study Design: This was a cohort observational laboratory study.

Methods: 43 male physical therapists (PT) and PT students (4 experts, 11 residents, 13 third year, and 15 first year students) performed 4 manipulations each on asymptomatic patient models. Angular and linear kinematics of the pelvis were measured using motion capture, and ground reaction forces were measured with force plates under the practitioner's feet.

Results: Peak pelvic angular velocity was greater and in the opposite direction in experts compared to other groups in the frontal plane (p = 0.020) and transverse plane (p = 0.000). Experts had greater downward pelvic linear velocity than third year students and first year students (p = 0.000). Experts also demonstrated faster rate of vertical ground reaction force unloading during the manipulation (p = 0.002).

Conclusions: Expert performance of manipulation was characterized by increased speed of linear and angular pelvic motion, and increased modulation of vertical ground reaction force. These results help to inform educators and practitioners that teach and use this complex manual skill.
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http://dx.doi.org/10.1016/j.msksp.2020.102150DOI Listing
August 2020

IMPlementation of An online Relatives' Toolkit for psychosis or bipolar (IMPART study): iterative multiple case study to identify key factors impacting on staff uptake and use.

BMC Health Serv Res 2020 Mar 17;20(1):219. Epub 2020 Mar 17.

Division of Health Research, Lancaster University, Bailrigg Campus, Lancaster, LA1 4YW, UK.

Background: Despite the potential of digital health interventions to improve the delivery of psychoeducation to people with mental health problems and their relatives, and substantial investment in their development, there is little evidence of successful implementation into clinical practice. We report the first implementation study of a digital health intervention: Relatives Education And Coping Toolkit (REACT), into routine mental healthcare. Our main aim was to identify critical factors affecting staff uptake and use of this online self-management tool for relatives of people with psychosis or bipolar.

Methods: A mixed-methods, theory-driven (Normalisation Process Theory), iterative multiple case study approach using qualitative analysis of interviews with staff and quantitative reporting of uptake. Carer researchers were part of the research team.

Results: In all, 281 staff and 159 relatives from Early Intervention teams across six catchment areas (cases) in England registered on REACT; 129 staff took part in qualitative interviews. Staff were positive about REACT helping services improve support and meet clinical targets. Implementation was hindered by: high staff caseloads and difficulties prioritising carers; perception of REACT implementation as research; technical difficulties using REACT; poor interoperability with trust computer systems and care pathways; lack of access to mobile technology and training; restricted forum populations; staff fears of risk, online trolling, and replacement by technology; and uncertainty around REACT's long-term availability.

Conclusions: Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, in partnership with the services they aim to support, and as part of a long term national strategy to co-develop integrated technology-enabled mental healthcare. Implementation strategies must instil a sense of ownership for staff and ensure they have adequate IT training, appropriate governance protocols for online working, and adequate mobile technologies. Wider contextual factors including adequate funding for mental health services and prioritisation of carer support, also need to be addressed for successful implementation of carer focussed digital interventions.

Trial Registration: Study registration: ISCTRN 16267685.
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http://dx.doi.org/10.1186/s12913-020-5002-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7077000PMC
March 2020

Corticomotor Excitability of Gluteus Maximus Is Associated with Hip Biomechanics During a Single-Leg Drop-Jump.

J Mot Behav 2021 24;53(1):40-46. Epub 2020 Feb 24.

Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.

The purpose of this study was to determine the association between corticomotor excitability (CME) of gluteus maximus (GM) and hip biomechanics during a single-leg drop-jump task. Thirty-two healthy individuals participated. The slope of the input-output curve (IOC) obtained from transcranial magnetic stimulation was used to assess CME of GM. The average hip extensor moment and peak hip flexion angle during the stance phase of the drop jump task was calculated. The slope of the IOC of GM was found to be a predictor of the average hip extensor moment (r = 0.18,  = 0.016) and peak hip flexion angle (r = 0.20,  = 0.01). Our results demonstrate that greater functional use of the hip was associated with enhanced descending neural drive of GM.
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http://dx.doi.org/10.1080/00222895.2020.1723480DOI Listing
June 2021

Task-invariance and reliability of anticipatory postural adjustments in healthy young adults.

Gait Posture 2020 02 9;76:396-402. Epub 2020 Jan 9.

Department of Rehabilitation and Movement Science, University of Vermont, 306 Rowell Building, 106 Carrigan Drive, Burlington, VT, 05405, United States.

Background: Anticipatory postural adjustments (APAs) occur in the trunk during tasks such as rapid limb movement and are impaired in individuals with musculoskeletal and neurological dysfunction. To understand APA impairment, it is important to first determine if APAs can be measured reliably and which characteristics of APAs are task-invariant.

Research Question: What is the test-retest reliability of latency, amplitude and muscle activation patterns (synergies) of trunk APAs during arm-raise and leg-raise tasks, and to what extent are these APA characteristics invariant across tasks at the individual and group levels?

Methods: 15 young adults (mean age: 23.7 (±3.2) years) performed six trials of a rapid arm raise task in standing and a leg raise task in supine on two occasions. Latency, amplitude and coactivation of APAs in the erector spinae and external/internal oblique musculature were measured, and APA synergies were identified with principle components analysis. Test-retest reliability across the two sessions was calculated with intraclass correlation coefficients. Task-invariance was assessed at the individual level with correlation and at the group level with tests of equivalence.

Results: Most variables demonstrated acceptable test-retest reliability. Synergies and many features of APA activation varied across tasks, although at the individual level, motor performance time and amplitude of lumbar erector spinae activation were significantly correlated across tasks. Average pre-motor reaction time, external oblique latency, contralateral oblique amplitude and internal oblique coactivation were equivalent across tasks.

Significance: Characteristics of trunk muscle APAs quantified during a single task may not be representative of an anticipatory postural control strategy that generalizes across tasks. Therefore, APAs must be assessed during multiple tasks with varying biomechanical demands to adequately investigate mechanisms contributing to movement dysfunction. The reliability analysis in this study facilitates interpretation of group differences or changes in APA behavior in response to intervention for the selected tasks.
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http://dx.doi.org/10.1016/j.gaitpost.2020.01.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028245PMC
February 2020

Individuals With Recurrent Low Back Pain Exhibit Significant Changes in Paraspinal Muscle Strength After Intramuscular Fine Wire Electrode Insertion.

PM R 2020 08 28;12(8):775-782. Epub 2019 Dec 28.

Department of Physical Therapy, Chapman University, Orange, CA.

Objective: To examine how insertion and presence of intramuscular fine-wire electromyography electrodes (IFWEs) in lumbar multifidus affect paraspinal muscle strength, endurance, and activation in persons with and without recurrent lower back pain (RLBP) during activities that require high levels of muscle contraction.

Design: Case-control with randomization of conditions.

Setting: Clinical research laboratory.

Participants: Forty participants age 18 to 40 years were recruited (18 female; mean age = 25.5 years); 20 with a history of RLBP were compared to a matching control group of 20 without RLBP.

Interventions: Each participant was tested under three conditions over three sessions. On Session 1, the baseline condition, we assessed muscle performance without IFWE insertion. On Sessions 2 and 3, participants were randomly alternated between two experimental conditions: (1) wire-in, in which the IFWE was inserted and remained within the muscle during testing; and (2) wire-out, in which the IFWE was inserted and immediately removed.

Main Outcome Measurements: Lumbar spinal extensor peak strength, endurance, and normalized electromyography (EMG) amplitude during the endurance test.

Results: Individuals with RLBP showed a significant decrease in peak strength during conditions that involved IFWE insertion and tend to experience more pain during muscle testing. Both groups exhibited similar levels of performance and muscle activation during the endurance test.

Conclusion: Our findings indicate that individuals with RLBP exhibited reduced lumbar extensor strength in response to IFWE insertion to the deep paraspinal muscles. This behavior is different from those without RLBP. Researchers should carefully consider the use of IFWE in individuals with RLBP during high exertion activities.
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http://dx.doi.org/10.1002/pmrj.12284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8214397PMC
August 2020

Individuals With Recurrent Low Back Pain Exhibit Significant Changes in Paraspinal Muscle Strength After Intramuscular Fine Wire Electrode Insertion.

PM R 2020 08 28;12(8):775-782. Epub 2019 Dec 28.

Department of Physical Therapy, Chapman University, Orange, CA.

Objective: To examine how insertion and presence of intramuscular fine-wire electromyography electrodes (IFWEs) in lumbar multifidus affect paraspinal muscle strength, endurance, and activation in persons with and without recurrent lower back pain (RLBP) during activities that require high levels of muscle contraction.

Design: Case-control with randomization of conditions.

Setting: Clinical research laboratory.

Participants: Forty participants age 18 to 40 years were recruited (18 female; mean age = 25.5 years); 20 with a history of RLBP were compared to a matching control group of 20 without RLBP.

Interventions: Each participant was tested under three conditions over three sessions. On Session 1, the baseline condition, we assessed muscle performance without IFWE insertion. On Sessions 2 and 3, participants were randomly alternated between two experimental conditions: (1) wire-in, in which the IFWE was inserted and remained within the muscle during testing; and (2) wire-out, in which the IFWE was inserted and immediately removed.

Main Outcome Measurements: Lumbar spinal extensor peak strength, endurance, and normalized electromyography (EMG) amplitude during the endurance test.

Results: Individuals with RLBP showed a significant decrease in peak strength during conditions that involved IFWE insertion and tend to experience more pain during muscle testing. Both groups exhibited similar levels of performance and muscle activation during the endurance test.

Conclusion: Our findings indicate that individuals with RLBP exhibited reduced lumbar extensor strength in response to IFWE insertion to the deep paraspinal muscles. This behavior is different from those without RLBP. Researchers should carefully consider the use of IFWE in individuals with RLBP during high exertion activities.
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http://dx.doi.org/10.1002/pmrj.12284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8214397PMC
August 2020

Bridging barriers to advance multisector approaches to improve food security, nutrition and population health in Nepal: transdisciplinary perspectives.

BMC Public Health 2019 Jul 18;19(1):961. Epub 2019 Jul 18.

Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.

Background: Understanding stakeholders' perceptions is crucial to the development and implementation of any intervention. However, a structured approach to eliciting stakeholder insights into complex, multisector issues of food security, household environment and health is lacking in many low and middle-income countries. This qualitative, workshop-based participatory study explores stakeholders' experiences of developing and implementing multisector interventions to provide transdisciplinary lessons for future developments in low and middle-income countries.

Methods: Participants were purposely selected based on their involvement in, or exposure to, the multisector intervention. Participants with interests in agriculture, nutrition, household air-quality, drinking water-quality and health from academic institutes, government and developmental organisations were brought together at a one-day workshop to participate in a series of discussions on issues relating to food security, nutrition, household environment and health in Nepal. All group discussions were audio-recorded and transcribed, and a thematic qualitative analysis performed to identify relevant themes.

Results: The government's ongoing Multisector Nutrition Plan, stakeholders' willingness to work together, availability of local infrastructure for cross-institutional inputs and increasing global movement towards transdisciplinary approaches were identified by the 33 workshop participants, representing 23 organisations as key factors determining success of transdisciplinary work. Fragmentation, lack of research-based and practice-based evidence, limited transdisciplinary knowledge amongst sectoral stakeholders, short-term funding and lack of knowledge-sharing mechanisms were identified as barriers, often creating systematic problems for successful implementation. Stakeholders suggested methods to bring about success included: improved knowledge, both amongst policy-makers and implementers, of food security and its linkage with nutrition, household environments, health and hygiene; investment in collaborative practice-based research and evidence-based practice; and strengthened transdisciplinary collaboration between multi-stakeholders, such as researchers, implementers and beneficiaries, throughout the intervention development and implementation process.

Conclusions: This study suggests that multisector approach needs to adapt to take into account the experiences and views of the stakeholders concerned. The paper offers recommendations for successful development and implementation of future multisector interventions in Nepal that can be extrapolated to other low and middle-income countries, and lays foundations for future transdisciplinary working to support realisation of the recommendations.
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http://dx.doi.org/10.1186/s12889-019-7204-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637542PMC
July 2019

Study protocol for a randomised controlled trial of CBT vs antipsychotics vs both in 14-18-year-olds: Managing Adolescent first episode Psychosis: a feasibility study (MAPS).

Trials 2019 Jul 4;20(1):395. Epub 2019 Jul 4.

The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.

Background: Adolescent-onset psychosis is associated with more severe symptoms and poorer outcomes than adult-onset psychosis. The National Institute for Clinical Excellence (NICE) recommend that adolescents with first episode psychosis (FEP) should be offered a combination of antipsychotic medication (APs), cognitive behavioural therapy (CBT) and family intervention (FI). The evidence for APs in treating psychosis is limited in adolescents compared to adults. Nevertheless, it indicates that APs can reduce overall symptoms in adolescents but may cause more severe side effects, including cardiovascular and metabolic effects, than in adults. CBT and FI can improve outcomes in adults, but there are no studies of psychological interventions (PI) in patients under 18 years old. Given this limited evidence base, NICE made a specific research recommendation for determining the clinical and cost effectiveness of APs versus PI versus both treatments for adolescent FEP.

Methods/design: The current study aimed to establish the feasibility and acceptability of conducting such a trial by recruiting 14-18-year-olds with a first episode of psychosis into a feasibility prospective randomised open blinded evaluation (PROBE) design, three-arm, randomised controlled trial of APs alone versus PI alone versus a combination of both treatments. We aimed to recruit 90 participants from Early Intervention and Child and Adolescent Mental Health Teams in seven UK sites. APs were prescribed by participants' usual psychiatrists. PI comprised standardised cognitive behavioural therapy and family intervention sessions.

Discussion: This is the first study to compare APs to PI in an adolescent population with FEP. Recruitment finished on 31 October 2018. The study faced difficulties with recruitment across most sites due to factors including clinician and service-user treatment preferences.

Trial Registration: Current controlled trial with ISRCTN, ISRCTN80567433 . Registered on 27 February 2017.
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http://dx.doi.org/10.1186/s13063-019-3506-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611021PMC
July 2019

Reduced Trunk Coupling in Persons With Recurrent Low Back Pain Is Associated With Greater Deep-to-Superficial Trunk Muscle Activation Ratios During the Balance-Dexterity Task.

J Orthop Sports Phys Ther 2019 12 15;49(12):887-898. Epub 2019 May 15.

Background: Motor control dysfunction persisting during symptom remission in persons with recurrent low back pain (LBP) may contribute to the recurrence of pain.

Objectives: To investigate trunk control in persons in remission from recurrent LBP and in back-healthy controls using a dynamic, internally driven balance task. No differences in task performance were expected between groups, but it was hypothesized that persons with recurrent LBP would exhibit greater trunk coupling, consistent with a trunk-stiffening strategy.

Methods: In this cross-sectional controlled laboratory study, persons with and without recurrent LBP (n = 19 per group) completed the balance-dexterity task, which involved balancing on one limb in standing while compressing an unstable spring with the other. Task performance measures included center-of-pressure velocity under the stance limb and vertical force variability under the spring. Trunk coupling was quantified with the coefficient of determination () of an angle-angle plot of thorax-pelvis frontal plane motion. Fine-wire and surface electromyography captured activations of paraspinals and abdominals.

Results: There were no differences between groups for any task performance measure. The group in remission from recurrent LBP exhibited reduced trunk coupling, or more dissociated thorax and pelvis motion, compared to the healthy control group ( = .024). Trunk coupling in this group was associated moderately with the lumbar multifidus-to-erector spinae activation ratio ( = 0.618, = .006) and weakly with the internal oblique-to-external oblique ratio ( = 0.476, = .046).

Conclusion: The balance-dexterity task is a submaximal, internally driven unstable balance task during which more dissociated trunk motion was observed in persons in remission from recurrent LBP. Findings underscore the task-dependent nature of trunk control research and assessment in persons with recurrent LBP. .
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http://dx.doi.org/10.2519/jospt.2019.8756DOI Listing
December 2019

Web-based indicated prevention of common mental disorders in university students in four European countries - Study protocol for a randomised controlled trial.

Internet Interv 2019 Apr 15;16:35-42. Epub 2018 Mar 15.

King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO59, 16 De Crespigny Park, London SE5 8AF, United Kingdom.

Background: Mental disorders and their symptoms are highly prevalent in the university student population, and the transition from secondary to tertiary education is associated with a rise in mental health problems. Existing web-based interventions for the prevention of common mental disorders in student populations often focus on just one disorder and have not been designed specifically for students. There is thus a need for transdiagnostic, student-specific preventative interventions that can be widely disseminated. This two-arm, parallel group randomised controlled trial aims to evaluate the effectiveness and cost-effectiveness of a web-based transdiagnostic mental health problem prevention programme (PLUS) across several universities in four countries.

Method: Students ( = 5550) will be recruited through a variety of channels and asked to complete a personality assessment to determine whether they are at high risk for developing common mental disorders. Students at high risk will be randomly allocated to either PLUS or a control intervention, which provides practical support around issues commonly experienced at university. Students at low risk will be allocated to the control intervention. Both intervention groups will be assessed at baseline, 4 weeks, 3 months, 6 months and 12 months after randomisation. Depression and generalised anxiety, assessed using the Patient Health Questionnaire and the Generalised Anxiety Disorder scales, will form the primary outcomes in this study. Secondary outcome measures include alcohol and drug use, eating behaviour, self-esteem, and quality of life. The cost-effectiveness of the intervention will also be evaluated.

Conclusions: This study will contribute to understanding the role of transdiagnostic indicated web-based interventions for the prevention of common mental disorders in university students. It will also be one of the first studies to investigate the cost-effectiveness of such interventions.

Trial Registration: This trial was registered in the ISRCTN register (ISRCTN15570935) on 12th February 2016.
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http://dx.doi.org/10.1016/j.invent.2018.02.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6364328PMC
April 2019
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