Assessing the impact of a comprehensive mental health program on frontline health service workers.

Mental health issues are a growing concern in the workplace, linked to negative outcomes including reduced productivity, increased absenteeism, and increased turnover. Employer-sponsored mental health benefits that are accessible and proactive may help address these concerns. The aim of this retrospective cohort study was to evaluate the impact of a digital mental health benefit (Spring Health) on frontline healthcare service workers' clinical and workplace outcomes. The benefit was sponsored by a national health services company from 2021-2022 and included mental health screening, care navigation, psychotherapy and/or medication management. We hypothesized program use would be associated with improvements in depression and anxiety symptoms, and increased productivity and retention. Participants were employees enrolled in the benefit program, had at least moderate anxiety or depression, at least 1 treatment appointment, and at least 2 outcome assessments. Clinical improvement measures were PHQ-9 scale (range, 0-27) for depression and GAD-7 scale (range, 0-21) for anxiety; workplace measures were employee retention and the Sheehan Disability Scale (SDS) for functional impairment. A total of 686 participants were included. Participants using the mental health benefit had a 5.60 point (95% CI, 4.40-6.79, d = 1.28) reduction in depression and a 5.48 point (95% CI, 3.88-7.08, d = 1.64) reduction in anxiety across 6 months. 69.9% (95% CI, 61.8%-78.1%) of participants reliably improved (≥5 point change) and 84.1% (95% CI, 78.2%-90.1%) achieved reliable improvement or recovery (<10 points). Participants reported 0.70 (95% CI, 0.26-1.14) fewer workdays per week impacted by mental health issues, corresponding to $3,491 (95% CI, $1305-$5677) salary savings at approximately federal median wage ($50,000). Furthermore, employees using the benefit were retained at 1.58 (95% CI, 1.4-1.76) times the rate of those who did not. Overall, this evaluation suggests that accessible, proactive, and comprehensive mental health benefits for frontline health services workers can lead to positive clinical and workplace outcomes.

Enteroviruses and risk of islet autoimmunity or type 1 diabetes: systematic review and meta-analysis of controlled observational studies detecting viral nucleic acids and proteins.

BACKGROUND: Enteroviruses are routinely detected with molecular methods within large cohorts that are at risk of type 1 diabetes. We aimed to examine the association between enteroviruses and either islet autoimmunity or type 1 diabetes. METHODS: For this systematic review and meta-analysis, we searched PubMed and Embase for controlled observational studies from inception until Jan 1, 2023. Cohort or case-control studies were eligible if enterovirus RNA or protein were detected in individuals with outcomes of islet autoimmunity or type 1 diabetes. Studies in pregnancy or other types of diabetes were excluded. Data extraction and appraisal involved author contact and deduplication, which was done independently by three reviewers. Study quality was assessed with the Newcastle-Ottawa Scale and National Health and Medical Research Council levels of evidence. Pooled and subgroup meta-analyses were done in RevMan version 5.4, with random effects models and Mantel-Haenszel odds ratios (ORs; 95% CIs). The study is registered with PROSPERO, CRD42021278863. FINDINGS: The search returned 3266 publications, with 897 full texts screened. Following deduplication, 113 eligible records corresponded to 60 studies (40 type 1 diabetes; nine islet autoimmunity; 11 both), comprising 12077 participants (5981 cases; 6096 controls). Study design and quality varied, generating substantial statistical heterogeneity. Meta-analysis of 56 studies showed associations between enteroviruses and islet autoimmunity (OR 2·1, 95% CI 1·3-3·3; p=0·002; n=18; heterogeneity χ2/df 2·69; p=0·0004; I2=63%), type 1 diabetes (OR 8·0, 95% CI 4·9-13·0; p<0·0001; n=48; χ2/df 6·75; p<0·0001; I2=85%), or within 1 month of type 1 diabetes (OR 16·2, 95% CI 8·6-30·5; p<0·0001; n=28; χ2/df 3·25; p<0·0001; I2=69%). Detection of either multiple or consecutive enteroviruses was associated with islet autoimmunity (OR 2·0, 95% CI 1·0-4·0; p=0·050; n=8). Detection of Enterovirus B was associated with type 1 diabetes (OR 12·7, 95% CI 4·1-39·1; p<0·0001; n=15). INTERPRETATION: These findings highlight the association between enteroviruses and islet autoimmunity or type 1 diabetes. Our data strengthen the rationale for vaccine development targeting diabetogenic enterovirus types, particularly those within Enterovirus B. Prospective studies of early life are needed to elucidate the role of enterovirus timing, type, and infection duration on the initiation of islet autoimmunity and the progression to type 1 diabetes. FUNDING: Environmental Determinants of Islet Autoimmunity, European Association for the Study of Diabetes, JDRF, Australian National Health and Medical Research Council, and University of New South Wales.

Realistic and complex visual chasing behaviors trigger the perception of intentionality.

We not only perceive the physical state of the environment, but also the causal structures underlying the physical state. Determining whether an object has intentionality is a key component of this process. Among all possible intentions, the intention that has arguably been studied the most is chasing-often via a reasonably simple and stereotyped computer algorithm ("heat-seeking"). The current study investigated the perception of multiple types of chasing approaches and thus whether it is the intention of chasing that triggers the perception of chasing, whether the chasing agent and the agent being chased play equally important roles, and whether the perception of chasing requires the presence of both agents. We implemented a well-studied wolf chasing a sheep paradigm where participants viewed recordings of a disc (the wolf) chasing another disc (the sheep) among other distracting discs. We manipulated the types of chasing algorithms, the density of the distractors, the target agent in the task, and the presence of the agent being chased. We found that the participants could successfully identify the chasing agent in all conditions where both agents were present, albeit with different levels of performance (e.g., participants were best at detecting the chasing agent when the chasing agent engaged in a direct chasing strategy and were worst at detecting a human-controlled chasing agent). This work therefore extends our understanding of the types of cues that are and are not utilized by the visual system to detect the chasing intention.

Early mobilisation in critically ill children: Does routine patient screening reduce time to commencing mobilisation?

OBJECTIVE: The objective of this study was to investigate the impact of daily screening for medical readiness to participate in early mobilisation in the paediatric intensive care unit (PICU), on reducing time to mobilisation and to explore the safety-, feasibility-, and patient-level barriers to the practice. METHODS: An interventional study with a historical control group was conducted in a PICU in a tertiary teaching hospital in Australia. The Early Mobilisation Screening Checklist was applied at 24-48 h of PICU stay with the aim to reduce time to commencing mobilisation. All patients aged term to 18 years admitted to the PICU for >48 h were included in this study. Data on time to mobilisation and patient characteristics were collected by an unblinded case note audit of children admitted to the PICU over 5 months in 2018 for the baseline group and over a corresponding period in 2019 for the intervention group. MEASUREMENTS AND MAIN RESULTS: A total of 71 children were enrolled. Survival analysis was used to compare time to mobilisation between groups, and a cox regression model found that children in the intervention group were 1.26 times more likely to participate in mobility, but this was not statistically significant (P = 0.391, log rank test for equality of survival functions). Early mobilisation was safe, with no adverse events reported in 177 participant mobilisation days. Feasibility was demonstrated by 62% of participants mobilising within 72 h of admission. Mechanical ventilation during stay (P = 0.043) and days receiving sedation infusion (% of days) (P = 0.042) were associated with a decreased likelihood of participating in mobility. CONCLUSIONS: Implementation of routine screening alone does not significantly reduce time to commencing mobility in the PICU. Early mobilisation in the PICU is safe and feasible and resulted in no adverse events during mobilisation. Patient characteristics influencing participation in mobility warrant further exploration.

Metacognitive judgements of change detection predict change blindness.

People tend to think they are not susceptible to change blindness and overestimate their ability to detect salient changes in scenes. Yet, despite their overconfidence, are individuals aware of and able to assess the relative difficulty of such changes? Here, we investigated whether participants' judgements of their ability to detect changes predicted their own change blindness. In Experiment 1, participants completed a standard change blindness task in which they viewed alternating versions of scenes until they detected what changed between the versions. Then, 6 to 7 months later, the same participants viewed the two versions and rated how likely they would be to spot the change. We found that changes rated as more likely to be spotted were detected faster than changes rated as more unlikely to be spotted. These metacognitive judgements continued to predict change blindness when accounting for low-level image properties (i.e., change size and eccentricity). In Experiment 2, we used likelihood ratings from a new group of participants to predict change blindness durations from Experiment 1. We found that there was no advantage to using participants' own metacognitive judgements compared to those from the new group to predict change blindness duration, suggesting that differences among images (rather among individuals) contribute the most to change blindness. Finally, in Experiment 3, we investigated whether metacognitive judgements are based on the semantic similarity between the versions of the scene. One group of participants described the two versions of the scenes, and an independent group rated the similarity between the descriptions. We found that changes rated as more similar were judged as being more difficult to detect than changes rated as less similar; however, semantic similarity (based on linguistic descriptions) did not predict change blindness. These findings reveal that (1) people can rate the relative difficulty of different changes and predict change blindness for different images and (2) metacognitive judgements of change detection likelihood are not fully explained by low-level and semantic image properties.

Viruses and Type 1 Diabetes: From Enteroviruses to the Virome.

For over a century, viruses have left a long trail of evidence implicating them as frequent suspects in the development of type 1 diabetes. Through vigorous interrogation of viral infections in individuals with islet autoimmunity and type 1 diabetes using serological and molecular virus detection methods, as well as mechanistic studies of virus-infected human pancreatic ß-cells, the prime suspects have been narrowed down to predominantly human enteroviruses. Here, we provide a comprehensive overview of evidence supporting the hypothesised role of enteroviruses in the development of islet autoimmunity and type 1 diabetes. We also discuss concerns over the historical focus and investigation bias toward enteroviruses and summarise current unbiased efforts aimed at characterising the complete population of viruses (the "virome") contributing early in life to the development of islet autoimmunity and type 1 diabetes. Finally, we review the range of vaccine and antiviral drug candidates currently being evaluated in clinical trials for the prevention and potential treatment of type 1 diabetes.

The Physiotherapy in Preschools Program: Describing a Student-Led Assessment Service for Children With Possible Motor Skill Difficulties.

The aim of this study was to describe and undertake an initial evaluation of a student-led assessment service for children with possible motor-skill difficulties. A secondary analysis of cross-sectional descriptive clinical data collected from 2015 to 2016 was undertaken. Children (N = 102) were assessed in preschools by physiotherapy students (supervised by qualified physiotherapists). Key outcomes included the following: Children's Activities Scale, Movement Assessment Battery for Children-2, and demographic/service-usage/onward referral statistics. The results highlighted that for every five children referred/assessed, two were at risk of motor-skill difficulties (∼43%). About 66% of children were subsequently referred on or monitored (40% requiring multidisciplinary follow-up). Conversely 34% of children did not require further services. In conclusion, a student-led assessment service may be a sustainable and feasible option to assist children at risk of motor-skill difficulties, enabling onward referral. Additional evaluation is required to garner stakeholder feedback.

Not-so-working Memory: Drift in Functional Magnetic Resonance Imaging Pattern Representations during Maintenance Predicts Errors in a Visual Working Memory Task.

Working memory (WM) is critical to many aspects of cognition, but it frequently fails. Much WM research has focused on capacity limits, but even for single, simple features, the fidelity of individual representations is limited. Why is this? One possibility is that, because of neural noise and interference, neural representations do not remain stable across a WM delay, nor do they simply decay, but instead, they may "drift" over time to a new, less accurate state. We tested this hypothesis in a functional magnetic resonance imaging study of a match/nonmatch WM recognition task for a single item with a single critical feature: orientation. We developed a novel pattern-based index of "representational drift" to characterize ongoing changes in brain activity patterns throughout the WM maintenance period, and we were successfully able to predict performance on the match/nonmatch recognition task using this representational drift index. Specifically, in trials where the target and probe stimuli matched, participants incorrectly reported more nonmatches when their activity patterns drifted away from the target. In trials where the target and probe did not match, participants incorrectly reported more matches when their activity patterns drifted toward the probe. On the basis of these results, we contend that neural noise does not cause WM errors merely by degrading representations and increasing random guessing; instead, one means by which noise introduces errors is by pushing WM representations away from the target and toward other meaningful (yet incorrect) configurations. Thus, we demonstrate that behaviorally meaningful drift within representation space can be indexed by neuroimaging.

Downgraded phenomenology: how conscious overflow lost its richness.

Our in-the-moment experience of the world can feel vivid and rich, even when we cannot describe our experience due to limitations of attention, memory or other cognitive processes. But the nature of visual awareness is quite sparse, as suggested by the phenomena of failures of awareness, such as change blindness and inattentional blindness. I will argue that once failures of memory or failures of comparison are ruled out as explanations for these phenomena, they present strong evidence against rich awareness. To accommodate and explain these massive failures of awareness, any theory of phenomenal consciousness must downgrade phenomenology to a degree where it is functionless or, ironically, does not reflect what we experience.This article is part of the theme issue 'Perceptual consciousness and cognitive access'.

General Transformations of Object Representations in Human Visual Cortex.

The brain actively represents incoming information, but these representations are only useful to the extent that they flexibly reflect changes in the environment. How does the brain transform representations across changes, such as in size or viewing angle? We conducted a fMRI experiment and a magnetoencephalography experiment in humans (both sexes) in which participants viewed objects before and after affine viewpoint changes (rotation, translation, enlargement). We used a novel approach, representational transformation analysis, to derive transformation functions that linked the distributed patterns of brain activity evoked by an object before and after an affine change. Crucially, transformations derived from one object could predict a postchange representation for novel objects. These results provide evidence of general operations in the brain that are distinct from neural representations evoked by particular objects and scenes.SIGNIFICANCE STATEMENT The dominant focus in cognitive neuroscience has been on how the brain represents information, but these representations are only useful to the extent that they flexibly reflect changes in the environment. How does the brain transform representations, such as linking two states of an object, for example, before and after an object undergoes a physical change? We used a novel method to derive transformations between the brain activity evoked by an object before and after an affine viewpoint change. We show that transformations derived from one object undergoing a change generalized to a novel object undergoing the same change. This result shows that there are general perceptual operations that transform object representations from one state to another.

A Range of Service Delivery Modes for Children With Developmental Coordination Disorder Are Effective: A Randomized Controlled Trial.

PURPOSE: To investigate whether the environment and personnel providing intervention to children with developmental coordination disorder make a difference in motor outcomes and perceived competency. METHODS: Ninety-three children (66 males), aged 5 years 1 month to 8 years 11 months, with developmental coordination disorder were randomized to receive a 13-week group-based task-oriented intervention, either at school by a school assistant or physical therapist, or in a health clinic by a physical therapist. The Movement Assessment Battery for Children (MABC) assessed motor skills pre- and postintervention. Self-perception and cost-effectiveness were also assessed. RESULTS: Participants demonstrated a significant improvement in motor skills following intervention for all modes of delivery up to 6 months postintervention, MABC mean difference 7.20 (95% confidence interval, 5.89-8.81), effect size = 0.98. CONCLUSION: Group intervention programs for developmental coordination disorder can be run by either a health professional or a school assistant (supported by physical therapist) in either the school or clinic environment and provide successful outcomes.

Can you perceive ensembles without perceiving individuals?: The role of statistical perception in determining whether awareness overflows access.

Do we see more than we can report? Psychologists and philosophers have been hotly debating this question, in part because both possibilities are supported by suggestive evidence. On one hand, phenomena such as inattentional blindness and change blindness suggest that visual awareness is especially sparse. On the other hand, experiments relating to iconic memory suggest that our in-the-moment awareness of the world is much richer than can be reported. Recent research has attempted to resolve this debate by showing that observers can accurately report the color diversity of a quickly flashed group of letters, even for letters that are unattended. If this ability requires awareness of the individual letters' colors, then this may count as a clear case of conscious awareness overflowing cognitive access. Here we explored this requirement directly: can we perceive ensemble properties of scenes even without being aware of the relevant individual features? Across several experiments that combined aspects of iconic memory with measures of change blindness, we show that observers can accurately report the color diversity of unattended stimuli, even while their self-reported awareness of the individual elements is coarse or nonexistent-and even while they are completely blind to situations in which each individual element changes color mid-trial throughout the entire experiment. We conclude that awareness of statistical properties may occur in the absence of awareness of individual features, and that such results are fully consistent with sparse visual awareness.

Neural Discriminability of Object Features Predicts Perceptual Organization.

How does the neural representation of simple visual features affect perceptual operations, such as perceptual grouping? If the strength of feature representations in the brain is indicative of how the perceptual system partitions information into visual elements, then identifying the underlying neural representation may determine why things look the way they do. During functional MRI, participants viewed objects that varied along three feature dimensions: shape, color, and orientation. Afterward, participants performed an independent perceptual-grouping task outside the scanner to measure the strength of feature grouping. In lateral occipital cortex, neural feature discriminability, characterized using functional MRI multivariate pattern classification, positively predicted feature grouping strength: The more distinct the neural representations of a particular feature, the stronger the grouping was for that feature outside the scanner. Thus, variation in neural feature representation can be quantified to predict perceptual organization.

Stochastic or systematic? Seemingly random perceptual switching in bistable events triggered by transient unconscious cues.

What we see is a function not only of incoming stimulation, but of unconscious inferences in visual processing. Among the most powerful demonstrations of this are bistable events, but what causes the percepts of such events to switch? Beyond voluntary effort and stochastic processing, we explore the ways in which ongoing dynamic percepts may switch as a function of the content of brief, unconscious, independent cues. We introduced transient disambiguating occlusion cues into the Spinning Dancer silhouette animation. The dancer is bistable in terms of depth and rotation direction, but many observers see extended rotation in the same direction, interrupted only rarely by involuntary switches. Observers failed to notice these occasional disambiguating cues, but their impact was strong and systematic: Cues typically led to seemingly stochastic perceptual switches shortly thereafter, especially when conflicting with the current percept. These results show how the content of incoming information determines and constrains online conscious perception-even when neither the content nor the brute existence of that information ever reaches awareness. Thus, just as phenomenological ease does not imply a corresponding lack of underlying effortful computation, phenomenological randomness should not be taken to imply a corresponding lack of underlying systematicity.

Inattentional blindness reflects limitations on perception, not memory: Evidence from repeated failures of awareness.

Perhaps the most striking phenomenon of visual awareness is inattentional blindness (IB), in which a surprisingly salient event right in front of you may go completely unseen when unattended. Does IB reflect a failure of perception, or only of subsequent memory? Previous work has been unable to answer this question, due to a seemingly intractable dilemma: ruling out memory requires immediate perceptual reports, but soliciting such reports fuels an expectation that eliminates IB. Here we introduce a way of evoking repeated IB in the same subjects and the same session: we show that observers fail to report seeing salient events' not only when they have no expectation, but also when they have the wrong expectations about the events nature. This occurs when observers must immediately report seeing anything unexpected, even mid-event. Repeated IB thus demonstrates that IB is aptly named: it reflects a genuine deficit in moment-by-moment conscious perception, rather than a form of inattentional amnesia.

Repetition suppression and multi-voxel pattern similarity differentially track implicit and explicit visual memory.

Repeated exposure to a visual stimulus is associated with corresponding reductions in neural activity, particularly within visual cortical areas. It has been argued that this phenomenon of repetition suppression is related to increases in processing fluency or implicit memory. However, repetition of a visual stimulus can also be considered in terms of the similarity of the pattern of neural activity elicited at each exposure--a measure that has recently been linked to explicit memory. Despite the popularity of each of these measures, direct comparisons between the two have been limited, and the extent to which they differentially (or similarly) relate to behavioral measures of memory has not been clearly established. In the present study, we compared repetition suppression and pattern similarity as predictors of both implicit and explicit memory. Using functional magnetic resonance imaging, we scanned 20 participants while they viewed and categorized repeated presentations of scenes. Repetition priming (facilitated categorization across repetitions) was used as a measure of implicit memory, and subsequent scene recognition was used as a measure of explicit memory. We found that repetition priming was predicted by repetition suppression in prefrontal, parietal, and occipitotemporal regions; however, repetition priming was not predicted by pattern similarity. In contrast, subsequent explicit memory was predicted by pattern similarity (across repetitions) in some of the same occipitotemporal regions that exhibited a relationship between priming and repetition suppression; however, explicit memory was not related to repetition suppression. This striking double dissociation indicates that repetition suppression and pattern similarity differentially track implicit and explicit learning.

Language can boost otherwise unseen objects into visual awareness.

Linguistic labels (e.g., "chair") seem to activate visual properties of the objects to which they refer. Here we investigated whether language-based activation of visual representations can affect the ability to simply detect the presence of an object. We used continuous flash suppression to suppress visual awareness of familiar objects while they were continuously presented to one eye. Participants made simple detection decisions, indicating whether they saw any image. Hearing a verbal label before the simple detection task changed performance relative to an uninformative cue baseline. Valid labels improved performance relative to no-label baseline trials. Invalid labels decreased performance. Labels affected both sensitivity (d') and response times. In addition, we found that the effectiveness of labels varied predictably as a function of the match between the shape of the stimulus and the shape denoted by the label. Together, the findings suggest that facilitated detection of invisible objects due to language occurs at a perceptual rather than semantic locus. We hypothesize that when information associated with verbal labels matches stimulus-driven activity, language can provide a boost to perception, propelling an otherwise invisible image into awareness.

Eye-centered encoding of visual space in scene-selective regions.

We used functional magnetic resonance imaging (fMRI) to investigate the reference frames used to encode visual information in scene-responsive cortical regions. At early levels of the cortical visual hierarchy, neurons possess spatially selective receptive fields (RFs) that are yoked to specific locations on the retina. In lieu of this eye-centered organization, we speculated that visual areas implicated in scene processing, such as the parahippocampal place area (PPA), the retrosplenial complex (RSC), and transverse occipital sulcus (TOS) might instead possess RFs defined in head-, body-, or world-centered reference frames. To test this, we scanned subjects while they viewed objects and scenes presented at four screen locations while they maintained fixation at one of three possible gaze positions. We then examined response profiles as a function of either fixation-referenced or screen-referenced position. Contrary to our prediction, the PPA and TOS exhibited position-response curves that moved with the fixation point rather than being anchored to the screen, a pattern indicative of eye-centered encoding. RSC, on the other hand, did not exhibit a position-response curve in either reference frame. By showing an important commonality between the PPA/TOS and other visually responsive regions, the results emphasize the critical involvement of these regions in the visual analysis of scenes.

How reliable are visual context effects in the parahippocampal place area?

The parahippocampal place area (PPA) is a region of human cortex that responds more strongly to visual scenes (e.g., landscapes or cityscapes) than to other visual stimuli. It has been proposed that the primary function of the PPA is encoding of contextual information about object co-occurrence. Supporting this context hypothesis are reports that the PPA responds more strongly to strong-context than to weak-context objects and more strongly to famous faces (for which contextual associations are available) than to nonfamous faces. We reexamined the reliability of these 2 effects by scanning subjects with functional magnetic resonance imaging while they viewed strong- and weak-context objects, scrambled versions of these objects, and famous and nonfamous faces. "Contextual" effects for objects were observed to be reliable in the PPA at slow presentation rates but not at faster presentation rates intended to discourage scene imagery. We were unable to replicate the earlier finding of preferential PPA response to famous versus nonfamous faces. These results are difficult to reconcile with the hypothesis that the PPA encodes contextual associations but are consistent with a competing hypothesis that the PPA encodes scenic layout.