Effects of Self-Affirmation Feedback on Exercise Intention of Women in Their Twenties Depending on Construal Level.

This study examines how type of instructor feedback influences cognitive processes conducive to participants' health behavior, using a new theoretical approach based on self-affirmation and construal level theory. In Study 1, feasibility self-affirmed feedback (FSF) and desirability self-affirmed feedback (DSF) were qualitatively explored with Vinyasa Yoga instructors, and four FSF and DSF feedback scenarios were developed. In Study 2, 55 (FSF group: 28 and DSF group: 27) women in their twenties participating in a Vinyasa Yoga program were randomly assigned to two experimental self-affirmation feedback groups (FSF and DSF) and exposed to FSF and DSF, respectively, for four weeks based on the scenarios developed in Study 1. The analysis of changes in exercise intention triggered by the participants' exposure to self-affirmation feedback showed that participants exposed to DSF experienced a more positive influence than those exposed to FSF in their continuation intentions of success.

Reducing interrogative suggestibility: The role of self-affirmation and positive feedback.

Interrogative suggestibility, as measured with Gudjonsson Suggestibility Scales, consists of an individual's tendency to yield to misleading questions (Yield) and to change answers after negative feedback (Shift). This study aimed to determine whether reinforced self-affirmation (RSA), a technique that aims to boost self-confidence in order to increase the tendency to rely on one's own memory instead of external cues, can reduce interrogative suggestibility. RSA consists of self-affirmation induced by means of writing down one's greatest achievements in life and of manipulated positive feedback. The efficacy of two kinds of positive feedback was explored. Shift was reduced by positive feedback relating both to memory and to the feeling that a person is very independent in their judgements, while only feedback related to memory reduced Yield. The results are discussed in terms of the different mechanisms underlying Yield and Shift. Inducing independence of judgements might not have been effective in the case of Yield because to some extent it taps opinions but not the quality of a cognitive process such as memory. An individual may believe in their own opinions and views but still be unsure about the quality of their own memory.

The reward positivity: Comparing visual and auditory feedback.

Past work has demonstrated that the reward positivity (RewP) indexes a feedback-monitoring system sensitive to positive outcomes. Research on the RewP has frequently used simple guessing tasks. In the doors task, participants receive either feedback denoting monetary gain or loss on each trial after choosing one of two doors to "open." Typically, these tasks present visual stimuli on a computer monitor. The current study developed and validated a version of the doors task utilizing auditory stimuli to indicate gains and losses. Thirty-eight young adults completed both a standard visual doors task and a novel auditory doors task. Results indicated that the audio RewP was more positive and peaked earlier than the visual RewP. Additionally, the audio RewP both moderately correlated with and demonstrated similar internal consistency as the visual RewP. These results suggest that the auditory doors task elicits the same feedback-monitoring processes as the visual doors task.

Generative Feedback Explains Distinct Brain Activity Codes for Seen and Mental Images.

The relationship between mental imagery and vision is a long-standing problem in neuroscience. Currently, it is not known whether differences between the activity evoked during vision and reinstated during imagery reflect different codes for seen and mental images. To address this problem, we modeled mental imagery in the human brain as feedback in a hierarchical generative network. Such networks synthesize images by feeding abstract representations from higher to lower levels of the network hierarchy. When higher processing levels are less sensitive to stimulus variation than lower processing levels, as in the human brain, activity in low-level visual areas should encode variation in mental images with less precision than seen images. To test this prediction, we conducted an fMRI experiment in which subjects imagined and then viewed hundreds of spatially varying naturalistic stimuli. To analyze these data, we developed imagery-encoding models. These models accurately predicted brain responses to imagined stimuli and enabled accurate decoding of their position and content. They also allowed us to compare, for every voxel, tuning to seen and imagined spatial frequencies, as well as the location and size of receptive fields in visual and imagined space. We confirmed our prediction, showing that, in low-level visual areas, imagined spatial frequencies in individual voxels are reduced relative to seen spatial frequencies and that receptive fields in imagined space are larger than in visual space. These findings reveal distinct codes for seen and mental images and link mental imagery to the computational abilities of generative networks.

Biofeedback for treatment of irritable bowel syndrome.

BACKGROUND: Irritable bowel syndrome (IBS) is a prevalent condition that currently lacks highly effective therapies for its management. Biofeedback has been proposed as a therapy that may help individuals learn to exert conscious control over sympatho-vagal balance as an indirect method of symptom management. OBJECTIVES: Our primary objective was to assess the efficacy and safety of biofeedback-based interventions for IBS in adults and children. SEARCH METHODS: We searched the Cochrane Inflammatory Bowel Disease (IBD) Group Specialized Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Allied and Complementary Medicine Database (AMED) from inception to 24 July 2019. We also searched reference lists from published trials, trial registries, device manufacturers, conference proceedings, theses, and dissertations. SELECTION CRITERIA: We judged randomized controlled trials to be eligible for inclusion if they met the Association for Applied Psychophysiology and Biofeedback definition of biofeedback, and if they compared a biofeedback intervention to an active, sham, or no-treatment control for the management of IBS. DATA COLLECTION AND ANALYSIS: Two authors independently screened trials for inclusion, extracted data, and assessed risk of bias. Primary outcomes were IBS global or clinical improvement scores and overall quality of life measures. Secondary outcome measures were adverse events, assessments of stool frequency and consistency, changes in abdominal pain, depression, and anxiety. For dichotomous outcomes, we calculated the risk ratio (RR) and 95% confidence interval (CI). For continuous outcomes, we calculated the mean difference (MD) and 95% CI. We used GRADE criteria to assess the overall certainty of the evidence. MAIN RESULTS: We identified eight randomized trials with a total of 300 adult participants for our analysis. We did not identify any trials in children. Four trials assessed thermal biofeedback. One trial assessed rectosigmoidal biofeedback. Two trials assessed heart rate variability biofeedback. Two trials assessed electrocutaneous biofeedback. Comparators were: no treatment (symptom monitoring group; three studies), attention control (pseudomeditation; two studies), relaxation control (one study), counseling (two studies), hypnotherapy (one study), standard therapy (one study), and sham biofeedback (one study). We judged all trials to have a high or unclear risk of bias. Global/Clinical improvement The clinical benefit of biofeedback plus standard therapy compared to standard therapy alone was uncertain (RR 4.20, 95% CI 1.40 to 12.58; 1 study, 20 participants; very low-certainty evidence). The same study also compared biofeedback plus standard therapy to sham biofeedback plus standard therapy. The clinical benefit in the biofeedback group was uncertain (RR 2.33, 95% CI 1.13 to 4.80; 1 study, 20 participants; very low-certainty evidence). The clinical benefit of heart rate biofeedback compared to hypnotherapy was uncertain when measured with the IBS severity scoring system (IBS-SSS) (MD -58.80, 95% CI -109.11 to -8.49; 1 study, 61 participants; low-certainty evidence). Compared to counseling, the effect of heart rate biofeedback was unclear when measured with a composite symptom reduction score (MD 7.03, 95% CI -51.07 to 65.13; 1 study, 29 participants; low-certainty evidence) and when evaluated for clinical response (50% improvement) (RR 1.09, 95% CI 0.48 to 2.45; 1 study, 29 participants; low-certainty evidence). The clinical benefit of thermal biofeedback used in a multi-component psychological intervention (MCPI) compared to no treatment was uncertain when measured with a composite clinical symptom reduction score (MD 30.34, 95% CI 8.47 to 52.21; 3 studies, 101 participants; very low-certainty evidence), and when evaluated as clinical response (50% improvement) (RR 2.12, 95% CI 1.24 to 3.62; 3 studies, 101 participants; very low-certainty evidence). Compared to attention control, the effects of thermal biofeedback within an MCPI were unclear when measured with a composite clinical symptom reduction score (MD 4.02, 95% CI -21.41 to 29.45; 2 studies, 80 participants; very low-certainty evidence) and when evaluated as clinical response (50% improvement) (RR 1.10, 95% CI 0.72 to 1.69, 2 studies, 80 participants; very low-certainty evidence). Quality of life A single trial used overall quality of life as an outcome measure, and reported that both the biofeedback and cognitive therapy groups improved after treatment. The trial did not note any between-group differences, and did not report any outcome data. Adverse events Only one of the eight trials explicitly reported adverse events. This study reported no adverse events in either the biofeedback or cognitive therapy groups (RD 0.00, 95% CI -0.12 to 0.12; 29 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: There is currently not enough evidence to assess whether biofeedback interventions are effective for controlling symptoms of IBS. Given the positive results reported in small trials to date, biofeedback deserves further study in people with IBS. Future research should include active control groups that use high provider-participant interaction, in an attempt to balance non-specific effects of interventions between groups, and report both commonly used outcome measures (e.g. IBS-SSS) and historical outcome measures (e.g. the composite primary symptom reduction (CPSR) score) to allow for meta-analysis with previous studies. Future studies should be explicit in their reporting of adverse events.

Effects of Self-Controlled Knowledge of Results on Learning a Taekwondo Serial Skill.

Allowing learners to control feedback has been an effective strategy in motor skills learning. However, most studies of self-controlled (SC) feedback have used simple tasks that may be dissimilar to sports skills that generally demand more degrees of freedom and cognition. Thus, this study investigated the effects of SC knowledge of results (KR) on learning a complex Taekwondo skill. Twenty-four undergraduate volunteers of both sexes, aged 18-35 years, practiced a specific serial Taekwondo skill that was novel to them. We divided participants randomly into SC and yoked groups and compared their performance after they learned a specific displacement sequence, finishing with a lateral kick (bandal-tchagui) at a punching bag within a target time span. During acquisition, all participants performed 48 trials divided into six blocks and, on a retention test 24 hours later, they performed 10 more trials. We found that both groups reduced their errors from the first to the last block of the acquisition phase and that the SC group showed a better performance on the retention test, relative to the yoked control group. SC KR participants requested KR mainly after good trials, though they showed no statistically significant differences between trials with and without KR. Their inefficiency in estimating their own errors may have been due to task complexity, since many aspects of the task beyond its temporal requirement demanded the learners' attention. Our results, using a novel Taekwondo serial skill, confirm and extend the benefits of SC KR from just simple motor learning in past studies to learning complex motor skills.

Multipurpose Virtual Reality Environment for Biomedical and Health Applications.

Virtual reality is a trending, widely accessible, and contemporary technology of increasing utility to biomedical and health applications. However, most implementations of virtual reality environments are tailored to specific applications. We describe the complete development of a novel, open-source virtual reality environment that is suitable for multipurpose biomedical and healthcare applications. This environment can be interfaced with different hardware and data sources, ranging from gyroscopes to fMRI scanners. The developed environment simulates an immersive (first-person perspective) run in the countryside, in a virtual landscape with various salient features. The utility of the developed VR environment has been validated via two test applications: an application in the context of motor rehabilitation following injury of the lower limbs and an application in the context of real-time functional magnetic resonance imaging neurofeedback, to regulate brain function in specific brain regions of interest. Both applications were tested by pilot subjects that unanimously provided very positive feedback, suggesting that appropriately designed VR environments can indeed be robustly and efficiently used for multiple biomedical purposes. We attribute the versatility of our approach on three principles implicit in the design: selectivity, immersiveness, and adaptability. The software, including both applications, is publicly available free of charge, via a GitHub repository, in support of the Open Science Initiative. Although using this software requires specialized hardware and engineering know-how, we anticipate our contribution to catalyze further progress, interdisciplinary collaborations and replicability, with regards to the usage of virtual reality in biomedical and health applications.

Inflammatory Bowel Disease: A Stressed "Gut/Feeling".

Inflammatory bowel disease (IBD) is a chronic and relapsing intestinal inflammatory condition, hallmarked by a disturbance in the bidirectional interaction between gut and brain. In general, the gut/brain axis involves direct and/or indirect communication via the central and enteric nervous system, host innate immune system, and particularly the gut microbiota. This complex interaction implies that IBD is a complex multifactorial disease. There is increasing evidence that stress adversely affects the gut/microbiota/brain axis by altering intestinal mucosa permeability and cytokine secretion, thereby influencing the relapse risk and disease severity of IBD. Given the recurrent nature, therapeutic strategies particularly aim at achieving and maintaining remission of the disease. Alternatively, these strategies focus on preventing permanent bowel damage and concomitant long-term complications. In this review, we discuss the gut/microbiota/brain interplay with respect to chronic inflammation of the gastrointestinal tract and particularly shed light on the role of stress. Hence, we evaluated the therapeutic impact of stress management in IBD.

Neurophysiological Correlates of Gait Retraining With Real-Time Visual and Auditory Feedback.

Most people acquire motor skills through feedback-based training. How the human brain processes sensory feedbacks during training, especially in a gait training, remain largely unclear. The purpose of this paper is to explore how humans adopt a new gait pattern to reduce impacts during walking-with the aid of visual and audio feedbacks. This paper demonstrates the features of underlying brain activity in incorporating the visual or auditory cues to acquire a new gait pattern. Electroencephalography (EEG) and peak positive acceleration (PPA) of the heel were collected from 23 participants during walking on a treadmill with no feedback, with visual feedback, or with audio feedback. The feedbacks were presented after each foot strike, where a sub-threshold PPA triggered a positive feedback (green/low-pitched), and a suprathreshold PPA triggered a negative feedback (red/high-pitched). The participants were instructed to voluntarily control their gait, so that low PPA could be achieved. This control was perturbed in some sessions by an additional cognitive task, and the influence of such distraction was also explored. The PPA was significantly lower in the sessions with visual or audio feedback than in sessions without feedback, showing an immediate improvement in gait pattern, when the feedback was provided. Different feedbacks modulated neural activities at different locations and/or levels during training. Alpha event-related synchronization (ERS) was particularly increased during the encoding of auditory feedback or the introduction of a distracting task. In the meantime, prominent frontal and posterior theta ERS were coupled with negative feedback, and strong beta event-related desynchronization (ERD) was observed only in sessions with feedbacks. Our results indicate that feedback effectively enhances motor planning when acquiring a new gait.

Long-term Average Speech Spectra of Postlingual Cochlear Implant Users.

Long term average speech spectra (LTASS) is a commonly used voice analysis method for different purposes. This method offers an acoustic representation of the language in daily conservations. Results of that method can be altered by the deteriorations in the auditory feedback loop. Hearing losses occurred in the post lingual stage of life have some serious negative effects on the auditory feedback loop. Cochlear implantation may help these patients with regards to auditory feedback loop. Therefore, we aimed to evaluate the LTASS of cochlear implant users whose have a post lingual hearing loss. We assessed the LTASS of 24 cochlear implant users and compared our findings with normal hearing subjects. Our findings revealed that cochlear implant users have similar LTASS findings with normal hearing subjects. We conclude that cochlear implantation helps to the recovery of auditory feedback loop in patients with post lingual hearing losses.

Collaborative remembering reduces suggestibility: A study with the Gudjonsson Suggestibility Scale.

Collaboration during the retrieval phase can have both negative and positive effects (referred to as collaborative inhibition and error pruning, respectively) on emotional and eyewitness memory. To further elucidate these issues, the present experiment used the Gudjonsson Suggestibility Scale to investigate the question of whether collaborative remembering reduced post-event suggestibility. Collaborative and nominal pairs listened to the GSS2, provided immediate and delayed (after 30 min) free recalls, and answered a series of leading questions before or after receiving a negative feedback about their performance. We found no evidence of collaborative inhibition in the immediate and delayed free recall tasks. Importantly, however, collaborative pairs produced less confabulated elements in the free recall tasks, were considerably less prone to give in to leading questions (both before and after receiving the negative feedback), and exhibited lower levels of Total Suggestibility, compared to both nominal and individual dyads. Taken together, these results support the conclusion that collaboration can have a beneficial influence on eyewitnesses' accuracy, by strengthening their resistance to post-event suggestibility.

The Challenges of Multisource Feedback: Feasibility and Acceptability of Gathering Patient Feedback for Pediatric Residents.

OBJECTIVE: The Accreditation Council for Graduate Medical Education calls for residency programs to incorporate multisource feedback, which may include patient feedback, into resident competency assessments. Program directors face numerous challenges in gathering this feedback. This study assesses the feasibility and acceptability of patient feedback collection in the inpatient and outpatient setting at 3 institutions. METHODS: Patient feedback was collected using a modified version of the Communication Assessment Tool (CAT). Trained research assistants administered the CAT to eligible patients and families in pediatric ward, intensive care, and outpatient settings from July to October 2015. Completion rates and reasons for non-completion were recorded. Patient satisfaction with the CAT was assessed on a 5-point Likert scale. RESULTS: The CAT was completed by 860/1413 (61%) patients. Completion rates in the pediatric ward and intensive care settings were 45% and 38%, respectively, compared to 91% in the outpatient setting. In inpatient settings, survey non-completion was typically due to participant unavailability; this was rarely a reason in the outpatient setting. A total of 93.4% of patients were satisfied or very satisfied with using the CAT. It was found that 6.36 hours of research assistant time would be required to gather a valid quantity of patient feedback for a single resident in the outpatient setting, compared to 10.14 hours in the inpatient setting. CONCLUSIONS: Although collecting feedback using our standardized protocol is acceptable to patients, obtaining sufficient feedback requires overcoming several barriers and a sizable time commitment. Feedback collection in the outpatient setting may be higher yield than in the inpatient setting due to greater patient/family availability. Future work should focus on innovative methods to gather patient feedback in the inpatient setting to provide program directors with a holistic view of their residents' communication skills.

Combining role-play with interactive simulation to motivate informed climate action: Evidence from the World Climate simulation.

Climate change communication efforts grounded in the information deficit model have largely failed to close the gap between scientific and public understanding of the risks posed by climate change. In response, simulations have been proposed to enable people to learn for themselves about this complex and politically charged topic. Here we assess the impact of a widely-used simulation, World Climate, which combines a socially and emotionally engaging role-play with interactive exploration of climate change science through the C-ROADS climate simulation model. Participants take on the roles of delegates to the UN climate negotiations and are challenged to create an agreement that meets international climate goals. Their decisions are entered into C-ROADS, which provides immediate feedback about expected global climate impacts, enabling them to learn about climate change while experiencing the social dynamics of negotiations. We assess the impact of World Climate by analyzing pre- and post-survey results from >2,000 participants in 39 sessions in eight nations. We find statistically significant gains in three areas: (i) knowledge of climate change causes, dynamics and impacts; (ii) affective engagement including greater feelings of urgency and hope; and (iii) a desire to learn and do more about climate change. Contrary to the deficit model, gains in urgency were associated with gains in participants' desire to learn more and intent to act, while gains in climate knowledge were not. Gains were just as strong among American participants who oppose government regulation of free markets-a political ideology that has been linked to climate change denial in the US-suggesting the simulation's potential to reach across political divides. The results indicate that World Climate offers a climate change communication tool that enables people to learn and feel for themselves, which together have the potential to motivate action informed by science.

Alternating Modulation of Subthalamic Nucleus Beta Oscillations during Stepping.

Gait disturbances in Parkinson's disease are commonly refractory to current treatment options and majorly impair patient's quality of life. Auditory cues facilitate gait and prevent motor blocks. We investigated how neural dynamics in the human subthalamic nucleus of Parkinsons's disease patients (14 male, 2 female) vary during stepping and whether rhythmic auditory cues enhance the observed modulation. Oscillations in the beta band were suppressed after ipsilateral heel strikes, when the contralateral foot had to be raised, and reappeared after contralateral heel strikes, when the contralateral foot rested on the floor. The timing of this 20-30 Hz beta modulation was clearly distinct between the left and right subthalamic nucleus, and was alternating within each stepping cycle. This modulation was similar, whether stepping movements were made while sitting, standing, or during gait, confirming the utility of the stepping in place paradigm. During stepping in place, beta modulation increased with auditory cues that assisted patients in timing their steps more regularly. Our results suggest a link between the degree of power modulation within high beta frequency bands and stepping performance. These findings raise the possibility that alternating deep brain stimulation patterns may be superior to constant stimulation for improving parkinsonian gait.SIGNIFICANCE STATEMENT Gait disturbances in Parkinson's disease majorly reduce patients' quality of life and are often refractory to current treatment options. We investigated how neural activity in the subthalamic nucleus of patients who received deep brain stimulation surgery covaries with the stepping cycle. 20-30 Hz beta activity was modulated relative to each step, alternating between the left and right STN. The stepping performance of patients improved when auditory cues were provided, which went along with enhanced beta modulation. This raises the possibility that alternating stimulation patterns may also enhance beta modulation and may be more beneficial for gait control than continuous stimulation, which needs to be tested in future studies.

A Noninvasive Brain-Computer Interface for Real-Time Speech Synthesis: The Importance of Multimodal Feedback.

We conducted a study of a motor imagery brain-computer interface (BCI) using electroencephalography to continuously control a formant frequency speech synthesizer with instantaneous auditory and visual feedback. Over a three-session training period, sixteen participants learned to control the BCI for production of three vowel sounds (/ textipa i/ [heed], / textipa A/ [hot], and / textipa u/ [who'd]) and were split into three groups: those receiving unimodal auditory feedback of synthesized speech, those receiving unimodal visual feedback of formant frequencies, and those receiving multimodal, audio-visual (AV) feedback. Audio feedback was provided by a formant frequency artificial speech synthesizer, and visual feedback was given as a 2-D cursor on a graphical representation of the plane defined by the first two formant frequencies. We found that combined AV feedback led to the greatest performance in terms of percent accuracy, distance to target, and movement time to target compared with either unimodal feedback of auditory or visual information. These results indicate that performance is enhanced when multimodal feedback is meaningful for the BCI task goals, rather than as a generic biofeedback signal of BCI progress.

Auditory sensitivity to spectral modulation phase reversal as a function of modulation depth.

The present study evaluated auditory sensitivity to spectral modulation by determining the modulation depth required to detect modulation phase reversal. This approach may be preferable to spectral modulation detection with a spectrally flat standard, since listeners appear unable to perform the task based on the detection of temporal modulation. While phase reversal thresholds are often evaluated by holding modulation depth constant and adjusting modulation rate, holding rate constant and adjusting modulation depth supports rate-specific assessment of modulation processing. Stimuli were pink noise samples, filtered into seven octave-wide bands (0.125-8 kHz) and spectrally modulated in dB. Experiment 1 measured performance as a function of modulation depth to determine appropriate units for adaptive threshold estimation. Experiment 2 compared thresholds in dB for modulation detection with a flat standard and modulation phase reversal; results supported the idea that temporal cues were available at high rates for the former but not the latter. Experiment 3 evaluated spectral modulation phase reversal thresholds for modulation that was restricted to either one or two neighboring bands. Flanking bands of unmodulated noise had a larger detrimental effect on one-band than two-band targets. Thresholds for high-rate modulation improved with increasing carrier frequency up to 2 kHz, whereas low-rate modulation appeared more consistent across frequency, particularly in the two-band condition. Experiment 4 measured spectral weights for spectral modulation phase reversal detection and found higher weights for bands in the spectral center of the stimulus than for the lowest (0.125 kHz) or highest (8 kHz) band. Experiment 5 compared performance for highly practiced and relatively naïve listeners, and found weak evidence of a larger practice effect at high than low spectral modulation rates. These results provide preliminary data for a task that may provide a better estimate of sensitivity to spectral modulation than spectral modulation detection with a flat standard.

Does feedback on daily activity level from a Smart watch during inpatient stroke rehabilitation increase physical activity levels? Study protocol for a randomized controlled trial.

BACKGROUND: Practicing activities improves recovery after stroke, but many people in hospital do little activity. Feedback on activity using an accelerometer is a potential method to increase activity in hospital inpatients. This study's goal is to investigate the effect of feedback, enabled by a Smart watch, on daily physical activity levels during inpatient stroke rehabilitation and the short-term effects on simple functional activities, primarily mobility. METHODS/DESIGN: A randomized controlled trial will be undertaken within the stroke rehabilitation wards of the Second Affiliated hospital of Anhui University of Traditional Chinese Medicine, Hefei, China. The study participants will be stroke survivors who meet inclusion criteria for the study, primarily: able to participate, no more than 4 months after stroke and walking independently before stroke. Participants will all receive standard local rehabilitation and will be randomly assigned either to receive regular feedback about activity levels, relative to a daily goal tailored by the smart watch over five time periods throughout a working day, or to no feedback, but still wearing the Smart watch. The intervention will last up to 3 weeks, ending sooner if discharged. The data to be collected in all participants include measures of daily activity (Smart watch measure); mobility (Rivermead Mobility Index and 10-metre walking time); independence in personal care (Barthel Activities of Daily Living (ADL) Index); overall activities (the World Health Organization (WHO) Disability Assessment Scale, 12-item version); and quality of life (the Euro-Qol 5L5D). Data will be collected by assessors blinded to allocation of the intervention at baseline, 3 weeks or at discharge (whichever is the sooner); and a reduced data set will be collected at 12 weeks by telephone interview. The primary outcome will be change in daily accelerometer activity scores. Secondary outcomes are compliance and adherence to wearing the watch, and changes in mobility, independence in personal care activities, and health-related quality of life. DISCUSSION: This project is being implemented in a large city hospital with limited resources and limited research experience. There has been a pilot feasibility study using the Smart watch, which highlighted some areas needing change and these are incorporated in this protocol. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02587585 . Registered on 30 September 2015. Chinese Clinical Trial Registry, ChiCTR-IOR-15007179 . Registered on 8 August 2015.

Changing social norms: The impact of normative feedback included in motivational enhancement therapy on cannabis outcomes among heavy-using adolescents.

INTRODUCTION: Heavy cannabis use is a problematic behavior, particularly among some adolescents. Adolescents are particularly prone to social influence. As such, injunctive norms (perceptions of others' approval of cannabis use) and descriptive norms (perception of frequency of others' cannabis use) influence cannabis behavior. Given that norms are not always accurate, motivational enhancement therapy aims to reduce cannabis use through normative feedback and correction of normative misconceptions. The purpose of this study was to evaluate the relationships between perceived norms (descriptive and injunctive) and cannabis-related outcomes (use, cannabis-related problems, and cannabis use disorder symptoms) in a heavy cannabis-using adolescent population receiving motivational enhancement therapy. METHODS: Heavy cannabis-using individuals (n=252, 68% male, mean age 13.38, 59% Caucasian) were recruited from six Seattle high schools for a motivational enhancement therapy-based intervention involving normative feedback. RESULTS: Participants perceived higher rates of cannabis use among close friends than other same age teens and reported a higher perception of approval for cannabis use from close friends as compared to perceived approval of other same aged peers. Personal approval and the perceived approval of other same age teens were reduced following the intervention but there was no evidence of change in normative perceptions for close friends following the normative feedback interventions. Changes in normative perceptions were related to decreases in cannabis use and -related outcomes. CONCLUSIONS: Results suggest the importance of normative feedback in changing behavior in adolescent cannabis users, but also highlight the ongoing influence of close friends.

Individualized Fracture Risk Feedback and Long-term Benefits After 10 Years.

INTRODUCTION: This study aimed to determine if beneficial effects of individualized feedback of fracture risk on osteoporosis preventive behaviors and bone mineral density observed in a 2-year trial were sustained long-term. METHODS: This was a 10-year follow-up of a 2-year RCT in 470 premenopausal women aged 25-44 years, who were randomized to one of two educational interventions (the Osteoporosis Prevention and Self-Management Course [OPSMC] or an osteoporosis information leaflet) and received tailored feedback of their relative risk of fracture in later life (high versus normal risk groups). Bone mineral density of lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry. Physical activity, dietary calcium intake, calcium and vitamin D supplements, and smoking status were measured by questionnaires. RESULTS: From 2 to 12 years, the high-risk group had a smaller decrease in femoral neck bone mineral density (ß=0.023, 95% CI=0.005, 0.041 g/cm2) but similar lumbar spine bone mineral density change as the normal-risk group. They were more likely to use calcium (relative risk=1.66, 95% CI=1.22, 2.24) and vitamin D supplements (1.99, 95% CI=1.27, 3.11). The OPSMC had no effects on bone mineral density change. Both high-risk (versus normal-risk) and the OPSMC groups (versus leaflet) had a more favorable pattern of smoking behavior change (relative risk=1.85, 95% CI=0.70, 4.89 and relative risk=2.27, 95% CI=0.86, 6.01 for smoking cessation; relative risk=0.33, 95% CI=0.13, 0.80 and relative risk=0.28, 95% CI=0.10, 0.79 for commenced or persistent smoking). CONCLUSIONS: Feedback of high fracture risk to younger women was associated with long-term improvements in osteoporosis preventive behaviors and attenuated femoral neck bone mineral density loss. Therefore, this could be considered as a strategy to prevent osteoporosis. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) NCT00273260.