Mixed-methods evaluation of an enhanced asthma biologics clinical pathway in the West Midlands UK.

Biologic treatments can alleviate severe asthma symptoms and reduce health service use. However, service capacity limits and low referral rates from primary care indicate unmet patient need. We report a mixed-methods evaluation of an enhanced severe asthma pathway implemented in Staffordshire and Stoke-on-Trent, UK which aimed to optimise primary care referrals through training/education, and increased capacity in specialist clinics. Quantitative analysis assessed patient wait times between pathway stages, prescribing changes, exacerbations, hospital admissions and asthma control. Interviews with 12 stakeholders evaluated perceptions of the enhanced pathway across settings. In 12 months, 564 patients from 28 general practices were reviewed for biologics eligibility, of whom 125 (22.2%) were referred for specialist assessment. Wait times were significantly lower under the enhanced pathway when compared against historic patients following the standard pathway, and reduced overall from a mean of 76.4 to 26.7 weeks between referral and biologics initiation (p < 0.001). Patients commencing biologics (n = 46) showed significantly reduced reliever inhaler prescribing rates (p = 0.037), 60% lower oral steroid use (p < 0.001), significantly reduced exacerbation rates (p < 0.001) and fewer hospital admissions (p < 0.001) compared with the 12 months pre-treatment. Mean asthma control scores reduced from 3.13 pre-initiation to 1.89 post-initiation (p < 0.001) - a clinically significant improvement. Interviewees viewed the enhanced pathway positively, although ongoing issues related to difficulties engaging primary care amid concerns around increased workloads and pathway capacity. The large number of referrals generated from a comparatively small number of general practices confirms substantial unmet need that an enhanced severe asthma pathway could help address if implemented routinely.

Impact of a Wellness Leadership Intervention on the Empathy, Burnout, and Resting Heart Rate of Medical Faculty.

Objective: To evaluate the efficacy of a wellness leadership intervention for improving the empathy, burnout, and physiological stress of medical faculty leaders. Participants and Methods: Participants were 49 medical faculty leaders (80% physicians, 20% basic scientists; 67% female). The 6-week course was evaluated with a 15-week longitudinal waitlist-control quasi-experiment from September 1, 2021, through December 20, 2021 (during the COVID-19 pandemic). We analyzed 3 pretest-posttest-posttest and 6 weekly survey measurements of affective empathy and burnout, and mean=85 (SD=31) aggregated daily resting heart rates per participant, using 2-level hierarchical linear modeling. Results: The course found a preventive effect for leaders' burnout escalation. As the control group awaited the course, their empathy decreased (coefficientTime=-1.27; P=.02) and their resting heart rates increased an average of 1.4 beats/min (coefficientTime=0.18; P<.001), reflecting the toll of the pandemic. Intervention group leaders reported no empathy decrements (coefficientTime=.33; P=.59) or escalated resting heart rate (coefficientTime=-0.05; P=.27) during the same period. Dose-response analysis revealed that both groups reduced their self-rated burnout over the 6 weeks of the course (coefficientTime=-0.28; P=.007), and those who attended more of the course showed less heart rate increase (coefficientTime∗Dosage=-0.05; P<.001). In addition, 12.73% of the within-person fluctuation in empathy was associated with burnout and resting heart rate. Conclusion: A wellness leadership intervention helped prevent burnout escalation and empathy decrement in medical faculty leaders during the COVID-19 pandemic, showing potential to improve the supportiveness and psychological safety of the medical training environment.

A Visionary Think Tank to Address the Nursing Workforce Crisis.

The COVID-19 pandemic exacerbated an existing problem plaguing hospital systems across the United States: a nursing workforce shortage. This article describes how one institution applied the American Organization for Nursing Leadership Nurse Executive Competencies to convene an immersive think tank to reimagine the nursing workforce.

Who speaks "kid?" How experience with children does (and does not) shape the intelligibility of child speech.

Child speech deviates from adult speech in predictable ways. Are listeners who routinely interact with children implicitly aware of these systematic deviations, and thereby better at understanding children? Or do idiosyncratic differences in how children pronounce words overwhelm these systematic deviations? In Experiment 1, we use a speech-in-noise transcription task to test who "speaks kid" among four listener groups: undergraduates (n = 48), mothers of young children (n = 48), early childhood educators (n = 48), and speech-language pathologists (SLPs; n = 48). All listeners transcribed speech by typically developing children and adults. In Experiment 2, we use a similar task to test an additional group of mothers (n = 50) on how intelligible they found their own child versus another child. Contrary to previous claims, we find no evidence for an experience-based general child speech intelligibility advantage. However, we do find that mothers understand their own child best. We also observe a general task advantage by SLPs. Our findings demonstrate that routine (and even extensive) exposure to children may not make all children more intelligible, but that it may instead make particular children one has experience with more intelligible. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Zinc transporter 8 autoantibody testing requires age-related cut-offs.

INTRODUCTION: Zinc transporter 8 autoantibodies (ZnT8A) are biomarkers of beta cell autoimmunity in type 1 diabetes that have become more widely available to clinicians in recent years. Robust control population-defined thresholds are essential to ensure high clinical specificity in islet autoantibody testing. We aimed to determine the optimal cut-offs for ZnT8A testing. RESEARCH DESIGN AND METHODS: 97.5th and 99th centile cut-offs were determined using residual clinical sera from 1559 controls aged between 0 and 83 years with no history of diabetes and a hemoglobin A1c level of less than 6.0% (<42 mmol/mol). ZnT8A were measured by ELISA (RSR, Cardiff, UK) on a Dynex DS2 ELISA robot (Dynex, Preston, UK). We assessed the impact of age-related cut-offs in comparison with the manufacturer's recommended threshold in a mixed cohort of young-onset (

Short-term psychodynamic psychotherapy for functional somatic disorders: A systematic review and meta-analysis of within-treatment effects.

OBJECTIVE: A recent meta-analysis of 17 randomized, controlled trials (RCTs) showed that Short-term Psychodynamic Psychotherapy (STPP) for functional somatic disorders (FSD) reduced somatic symptoms compared to wait list, minimal treatment, and treatment-as-usual controls. A clinically important yet unanswered question is how much improvement patients experience within STPP treatment. METHODS: Following a systematic search, we identified STPP trials presenting data at baseline and post-treatment/follow-up. Meta-analyses determined the magnitude of changes in somatic symptoms and other outcomes from before to after STPP, and analyses examined effect sizes as a function of study, therapy, and patient variables. RESULTS: We identified 37 trials (22 pre-post studies and 15 RCTs) totaling 2094 patients treated an average of 13.34 sessions for a range of FSD. Across all studies, somatic symptoms improved significantly from pre-treatment to short-term follow-up with a large effect size (SMD = -1.07), which was maintained at long-term follow-up (SMD = -0.90). After excluding two outlier studies, effects at short- and medium-term follow-up remained significant but were somewhat reduced in magnitude (e.g., short-term SMD = -0.73). Secondary outcomes including anxiety, depression, disability, and interpersonal problems had medium to large effects. Effects were larger for studies of STPP that were longer than 12 sessions or used an emotion-focused type of STPP, and for chronic pain or gastrointestinal conditions than for functional neurological disorders. CONCLUSIONS: STPP results in moderate to large improvements in multiple outcome domains that are sustained in long-term follow-up. STPP is an effective treatment option for FSD and should be included in treatment guidelines.

The impact of the first COVID-19 surge on severe asthma patients in the UK. Which is worse: the virus or the lockdown?

Asthma therapy, including monoclonal antibodies, was not associated with #COVID19 infection or hospitalisation in a UK severe asthma population. Shielding led to a reported worsening of mental health in nearly half of patients contacted (47%). https://bit.ly/3jImUsG.

Targeted adaptation in infants following live exposure to an accented talker.

Infants struggle to understand familiar words spoken in unfamiliar accents. Here, we examine whether accent exposure facilitates accent-specific adaptation. Two types of pre-exposure were examined: video-based (i.e., listening to pre-recorded stories; Experiment 1) and live interaction (reading books with an experimenter; Experiments 2 and 3). After video-based exposure, Canadian English-learning 15- to 18-month-olds failed to recognize familiar words spoken in an unfamiliar accent. However, after face-to-face interaction with a Mandarin-accented talker, infants showed enhanced recognition for words produced in Mandarin English compared to Australian English. Infants with live exposure to an Australian talker were not similarly facilitated, perhaps due to the lower vocabulary scores of the infants assigned to the Australian exposure condition. Thus, live exposure can facilitate accent adaptation, but this ability is fragile in young infants and is likely influenced by vocabulary size and the specific mapping between the speaker and the listener's phonological system.

Identifying children's voices.

Human adults rely on both acoustic and linguistic information to identify adult talkers. Assuming favorable conditions, adult listeners recognize other adults fairly accurately and quickly. But how well can adult listeners recognize child talkers, whose speech productions often differ dramatically from adult speech productions? Although adult talker recognition has been heavily studied, only one study to date has directly compared the recognition of unfamiliar adult and child talkers [Creel and Jimenez (2012). J. Exp. Child Psychol. 113(4), 487-509]. Therefore, the current study revisits this question with a much larger and younger sample of child talkers (N = 20); performance with adult talkers (N = 20) was also tested to provide a baseline. In Experiment 1, adults successfully distinguished between adult talkers in an AX discrimination task but performed much worse with child talkers. In Experiment 2, adults were slower and less accurate at learning to identify child talkers than adult talkers in a training-identification task. Finally, in Experiment 3, adults failed to improve at identifying child talkers after three days of training with numerous child voices. Taken together, these findings reveal a sizable difference in adults' ability to recognize child versus adult talkers. Possible explanations and implications for understanding human talker recognition are discussed.

Short-Term Psychodynamic Psychotherapy for Functional Somatic Disorders: A Meta-Analysis of Randomized Controlled Trials.

INTRODUCTION: Functionalsomatic disorders (FSD) are common and costly, thereby driving the need for the development of effective brief treatment options. Short-term psychodynamic psychotherapy (STPP) is one candidate treatment method. OBJECTIVE: To review and meta-analyze, where possible, randomized controlled trials (RCTs) of STPP for FSD. METHODS: Following a systematic search of the literature, we performed a meta-analysis of available RCT groups to determine the effects of STPP on a range of outcomes after treatment, and medium- and long-term follow-ups. RESULTS: In meta-analyses of 17 RCTs, STPP significantly outperformed minimal treatment, treatment as usual, or waiting list controls on somatic symptom measures at all time frames, with small to large magnitude effect sizes. Descriptive reviews of 5 RCTs suggest that STPP performed at least as well as other bona fide psychological therapies. Limitations of this meta-analysis include small samples of studies and possible publication bias. CONCLUSIONS: STPP is a valid treatment option for diverse FSD conditions resulting in somatic symptom reductions that persist over time. STPP should be included in FSD treatment guidelines.

Clinical- and cost-effectiveness of intensive short-term dynamic psychotherapy for chronic pain in a tertiary psychotherapy service.

OBJECTIVE: The objective of this study is to assess the clinical- and cost-effectiveness of intensive short-term dynamic psychotherapy (ISTDP) for patients with chronic pain. METHOD: A sample of 228 pain patients was drawn from a larger naturalistic study of ISTDP. They received an average of 6.1 sessions delivered by 31 therapists. Psychiatric symptoms and interpersonal problems were assessed at three time points. Healthcare data from baseline year and three years following treatment came from independent governmental databases. RESULTS: Multilevel models indicated significant reductions in symptoms and interpersonal problems during treatment, including a moderate to large pre-post effect size (d = 0.76) for somatization. Further, the sample had successive reductions in yearly healthcare costs, reaching the normal population mean two years post-treatment. CONCLUSION: Within the limitations of the uncontrolled design, our study suggests that ISTDP may be both clinically effective and cost-effective for patients with chronic pain.

Training-induced pattern-specific phonetic adjustments by first and second language listeners.

The current study investigated the phonetic adjustment mechanisms that underlie perceptual adaptation in first and second language (Dutch-English) listeners by exposing them to a novel English accent containing controlled deviations from the standard accent (e.g. /i/-to-/ɪ/ yielding /krɪm/ instead of /krim/ for 'cream'). These deviations involved contrasts that either were contrastive or were not contrastive in Dutch. Following accent exposure with disambiguating feedback, listeners completed lexical decision and word identification tasks. Both native and second language listeners demonstrated adaptation, evidenced by higher lexical endorsement rates and word identification accuracy than untrained control listeners for items containing trained accent patterns. However, for L2 listeners, adaptation was modulated by the phonemic contrast, that is, whether or not it was contrastive in the listeners' native language. Specifically, the training-induced criterion loosening for the L2 listeners was limited to contrasts that exist in both their L1, Dutch, and L2, English. For contrasts that are either absent or neutralized in Dutch, the L2 listeners demonstrated relatively loose pre-training criteria compared to L1 listeners. The results indicate that accent exposure induces both a general increase in tolerance for atypical speech input as well as targeted adjustments to specific categories for both L1 and L2 listeners.

Correction: Cooper, A.; Abbass, A.; Town, J. Implementing a Psychotherapy Service for Medically Unexplained Symptoms in a Primary Care Setting. Journal of Clinical Medicine 2017, 6, 109-141.

The authors wish to make the following corrections to this paper [1].[...].

Toddlers' comprehension of adult and child talkers: Adult targets versus vocal tract similarity.

How do children represent words? If lexical representations are based on encoding the indexical characteristics of frequently-heard speakers, this predicts that speakers like a child's own mother should be best understood. Alternatively, if they are based on the child's own motor productions, this predicts an own-voice advantage in word recognition. Here, we address this question by presenting 2.5-year-olds with recordings of their own voice, another child's voice, their own mother's voice, and another mother's voice in a child-friendly eye-tracking procedure. No own-voice or own-mother advantage was observed. Rather, children uniformly performed better on adult voices than child voices, even performing better for unfamiliar adult voices than own voices. We conclude that children represent words not in the form of own-voice motor codes or frequently heard speakers, but on the basis of adult speech targets.

Implementing a Psychotherapy Service for Medically Unexplained Symptoms in a Primary Care Setting.

Medically unexplained symptoms (MUS) are known to be costly, complex to manage and inadequately addressed in primary care settings. In many cases, there are unresolved psychological and emotional processes underlying these symptoms, leaving traditional medical approaches insufficient. This paper details the implementation of an evidence-based, emotion-focused psychotherapy service for MUS across two family medicine clinics. The theory and evidence-base for using Intensive Short-Term Dynamic Psychotherapy (ISTDP) with MUS is presented along with the key service components of assessment, treatment, education and research. Preliminary outcome indicators showed diverse benefits. Patients reported significantly decreased somatic symptoms in the Patient Health Questionnaire-15 (d = 0.4). A statistically significant (23%) decrease in family physicians' visits was found in the 6 months after attending the MUS service compared to the 6 months prior. Both patients and primary care clinicians reported a high degree of satisfaction with the service. Whilst further research is needed, these findings suggest that a direct psychology service maintained within the family practice clinic may assist patient and clinician function while reducing healthcare utilization. Challenges and further service developments are discussed, including the potential benefits of re-branding the service to become a 'Primary Care Psychological Consultation and Treatment Service'.

Thai Rate-Varied Vowel Length Perception and the Impact of Musical Experience.

Musical experience has been demonstrated to play a significant role in the perception of non-native speech contrasts. The present study examined whether or not musical experience facilitated the normalization of speaking rate in the perception of non-native phonemic vowel length contrasts. Native English musicians and non-musicians (as well as native Thai control listeners) completed identification and AX (same-different) discrimination tasks with Thai vowels contrasting in phonemic length at three speaking rates. Results revealed facilitative effects of musical experience in the perception of Thai vowel length categories. Specifically, the English musicians patterned similarly to the native Thai listeners, demonstrating higher accuracy at identifying and discriminating between-category vowel length distinctions than at discriminating within-category durational differences due to speaking rate variations. The English musicians also outperformed non-musicians at between-category vowel length discriminations across speaking rates, indicating musicians' superiority in perceiving categorical phonemic length differences. These results suggest that musicians' attunement to rhythmic and temporal information in music transferred to facilitating their ability to normalize contextual quantitative variations (due to speaking rate) and perceive non-native temporal phonemic contrasts.

Patients' affective processes within initial experiential dynamic therapy sessions.

Research has indicated that patients' in-session experience of previously avoided affects may be important for effective psychotherapy. The aim of this study was to investigate patients' in-session levels of affect experiencing in relation to their corresponding levels of insight, motivation, and inhibitory affects in initial Experiential Dynamic Therapy (EDT) sessions. Four hundred sixty-six 10-min video segments from 31 initial sessions were rated using the Achievement of Therapeutic Objectives Scale. A series of multilevel growth models, controlling for between-therapist variability, were estimated to predict patients' adaptive affect experiencing (Activating Affects) across session segments. In line with our expectations, higher within-person levels of Insight and Motivation related to higher levels of Activating Affects per segment. Contrary to expectations, however, lower levels of Inhibition were not associated with higher levels of Activating Affects. Further, using a time-lagged model, we did not find that the levels of Insight, Motivation, or Inhibition during one session segment predicted Activating Affects in the next, possibly indicating that 10-min segments may be suboptimal for testing temporal relationships in affective processes. Our results suggest that, to intensify patients' immediate affect experiencing in initial EDT sessions, therapists should focus on increasing insight into defensive patterns and, in particular, motivation to give them up. Future research should examine the impact of specific inhibitory affects more closely, as well as between-therapist variability in patients' in-session adaptive affect experiencing. (PsycINFO Database Record

Linguistically guided adaptation to foreign-accented speech.

Adaptation to foreign-accented sentences can be guided by knowledge of the lexical content of those sentences, which, being an exact match for the target, provides feedback on all linguistic levels. The extent to which this feedback needs to match the accented sentence was examined by manipulating the degree of match on different linguistic dimensions, including sub-lexical, lexical, and syntactic levels. Conditions where target-feedback sentence pairs matched and mismatched generated greater transcription improvement over non-English speech feedback, indicating listeners can draw upon sources of linguistic information beyond matching lexical items, such as sub- and supra-lexical information, during adaptation.

Interdependent processing and encoding of speech and concurrent background noise.

Speech processing can often take place in adverse listening conditions that involve the mixing of speech and background noise. In this study, we investigated processing dependencies between background noise and indexical speech features, using a speeded classification paradigm (Garner, 1974; Exp. 1), and whether background noise is encoded and represented in memory for spoken words in a continuous recognition memory paradigm (Exp. 2). Whether or not the noise spectrally overlapped with the speech signal was also manipulated. The results of Experiment 1 indicated that background noise and indexical features of speech (gender, talker identity) cannot be completely segregated during processing, even when the two auditory streams are spectrally nonoverlapping. Perceptual interference was asymmetric, whereby irrelevant indexical feature variation in the speech signal slowed noise classification to a greater extent than irrelevant noise variation slowed speech classification. This asymmetry may stem from the fact that speech features have greater functional relevance to listeners, and are thus more difficult to selectively ignore than background noise. Experiment 2 revealed that a recognition cost for words embedded in different types of background noise on the first and second occurrences only emerged when the noise and the speech signal were spectrally overlapping. Together, these data suggest integral processing of speech and background noise, modulated by the level of processing and the spectral separation of the speech and noise.

Effects of tone training on Cantonese tone-word learning.

The present study examined the effect of improving lexical tone identification abilities on Cantonese tone-word learning. Native English non-musicians received training on Cantonese tones before learning the meanings of words distinguished by these tones. Their results were compared to English non-musicians and musicians who received no tone training. The tone-trainees obtained a similar level of word identification proficiency as musicians by the end of training and were significantly better than non-tone trained non-musicians. These results lend support for phonetic-phonological-lexical continuity in learning because enhancing listeners' perception of lower-level tonal information significantly contributed to success in a higher-level linguistic task.