Refreshing the emergency medicine research priorities.

BACKGROUND: The priorities for UK emergency medicine research were defined in 2017 by a priority setting partnership coordinated by the Royal College of Emergency Medicine in collaboration with the James Lind Alliance (JLA). Much has changed in the last 5 years, not least a global infectious disease pandemic and a significant worsening of the crisis in the urgent and emergency care system. Our aim was to review and refresh the emergency medicine research priorities. METHODS: A steering group including patients, carers and healthcare professionals was established to agree to the methodology of the refresh. An independent adviser from the JLA chaired the steering group. The scope was adult patients in the ED. New questions were invited via an open call using multiple communications methods ensuring that patients, carers and healthcare professionals had the opportunity to contribute. Questions underwent minisystematic (BestBETs) review to determine if the question had been answered, and the original 2017 priorities were reviewed. Any questions that remained unanswered were included in an interim prioritisation survey, which was distributed to patients, carers and healthcare professionals. Rankings from this survey were reviewed by the steering group and a shortlist of questions put forward to the final workshop, which was held to discuss and rank the research questions in order of priority. RESULTS: 77 new questions were submitted, of which 58 underwent mini-systematic review. After this process, 49 questions (of which 32 were new, 11 were related to original priorities and 6 unanswered original priorities were carried forward) were reviewed by the steering group and included in an interim prioritisation survey. The interim prioritisation survey attracted 276 individual responses. 26 questions were shortlisted for discussion at the final prioritisation workshop, where the top 10 research priorities were agreed. CONCLUSION: We have redefined the priorities for emergency medicine research in the UK using robust and established methodology, which will inform the agenda for the coming years.

Priority III: top 10 rapid review methodology research priorities identified using a James Lind Alliance Priority Setting Partnership.

OBJECTIVES: A rapid review is a form of evidence synthesis considered a resource-efficient alternative to the conventional systematic review. Despite a dramatic rise in the number of rapid reviews commissioned and conducted in response to the coronavirus disease 2019 pandemic, published evidence on the optimal methods of planning, doing, and sharing the results of these reviews is lacking. The Priority III study aimed to identify the top 10 unanswered questions on rapid review methodology to be addressed by future research. STUDY DESIGN AND SETTING: A modified James Lind Alliance Priority Setting Partnership approach was adopted. This approach used two online surveys and a virtual prioritization workshop with patients and the public, reviewers, researchers, clinicians, policymakers, and funders to identify and prioritize unanswered questions. RESULTS: Patients and the public, researchers, reviewers, clinicians, policymakers, and funders identified and prioritized the top 10 unanswered research questions about rapid review methodology. Priorities were identified throughout the entire review process, from stakeholder involvement and formulating the question, to the methods of a systematic review that are appropriate to use, through to the dissemination of results. CONCLUSION: The results of the Priority III study will inform the future research agenda on rapid review methodology. We hope this will enhance the quality of evidence produced by rapid reviews, which will ultimately inform decision-making in the context of healthcare.

What are the most important unanswered research questions on rapid review methodology? A James Lind Alliance research methodology Priority Setting Partnership: the Priority III study protocol.

Background: The value of rapid reviews in informing health care decisions is more evident since the onset of the coronavirus disease 2019 (COVID-19) pandemic. While systematic reviews can be completed rapidly, rapid reviews are usually a type of evidence synthesis in which components of the systematic review process may be simplified or omitted to produce information more efficiently within constraints of time, expertise, funding or any combination thereof. There is an absence of high-quality evidence underpinning some decisions about how we plan, do and share rapid reviews. We will conduct a modified James Lind Alliance Priority Setting Partnership to determine the top 10 unanswered research questions about how we plan, do and share rapid reviews in collaboration with patients, public, reviewers, researchers, clinicians, policymakers and funders. Methods: An international steering group consisting of key stakeholder perspectives (patients, the public, reviewers, researchers, clinicians, policymakers and funders) will facilitate broad reach, recruitment and participation across stakeholder groups. An initial online survey will identify stakeholders' perceptions of research uncertainties about how we plan, do and share rapid reviews. Responses will be categorised to generate a long list of questions. The list will be checked against systematic reviews published within the past three years to identify if the question is unanswered. A second online stakeholder survey will rank the long list in order of priority. Finally, a virtual consensus workshop of key stakeholders will agree on the top 10 unanswered questions. Discussion: Research prioritisation is an important means for minimising research waste and ensuring that research resources are targeted towards answering the most important questions. Identifying the top 10 rapid review methodology research priorities will help target research to improve how we plan, do and share rapid reviews and ultimately enhance the use of high-quality synthesised evidence to inform health care policy and practice.

The representational dynamics of perceived voice emotions evolve from categories to dimensions.

Long-standing affective science theories conceive the perception of emotional stimuli either as discrete categories (for example, an angry voice) or continuous dimensional attributes (for example, an intense and negative vocal emotion). Which position provides a better account is still widely debated. Here we contrast the positions to account for acoustics-independent perceptual and cerebral representational geometry of perceived voice emotions. We combined multimodal imaging of the cerebral response to heard vocal stimuli (using functional magnetic resonance imaging and magneto-encephalography) with post-scanning behavioural assessment of voice emotion perception. By using representational similarity analysis, we find that categories prevail in perceptual and early (less than 200 ms) frontotemporal cerebral representational geometries and that dimensions impinge predominantly on a later limbic-temporal network (at 240 ms and after 500 ms). These results reconcile the two opposing views by reframing the perception of emotions as the interplay of cerebral networks with different representational dynamics that emphasize either categories or dimensions.

The perception of caricatured emotion in voice.

Affective vocalisations such as screams and laughs can convey strong emotional content without verbal information. Previous research using morphed vocalisations (e.g. 25% fear/75% anger) has revealed categorical perception of emotion in voices, showing sudden shifts at emotion category boundaries. However, it is currently unknown how further modulation of vocalisations beyond the veridical emotion (e.g. 125% fear) affects perception. Caricatured facial expressions produce emotions that are perceived as more intense and distinctive, with faster recognition relative to the original and anti-caricatured (e.g. 75% fear) emotions, but a similar effect using vocal caricatures has not been previously examined. Furthermore, caricatures can play a key role in assessing how distinctiveness is identified, in particular by evaluating accounts of emotion perception with reference to prototypes (distance from the central stimulus) and exemplars (density of the stimulus space). Stimuli consisted of four emotions (anger, disgust, fear, and pleasure) morphed at 25% intervals between a neutral expression and each emotion from 25% to 125%, and between each pair of emotions. Emotion perception was assessed using emotion intensity ratings, valence and arousal ratings, speeded categorisation and paired similarity ratings. We report two key findings: 1) across tasks, there was a strongly linear effect of caricaturing, with caricatured emotions (125%) perceived as higher in emotion intensity and arousal, and recognised faster compared to the original emotion (100%) and anti-caricatures (25%-75%); 2) our results reveal evidence for a unique contribution of a prototype-based account in emotion recognition. We show for the first time that vocal caricature effects are comparable to those found previously with facial caricatures. The set of caricatured vocalisations provided open a promising line of research for investigating vocal affect perception and emotion processing deficits in clinical populations.

What are the most important unanswered research questions in trial retention? A James Lind Alliance Priority Setting Partnership: the PRioRiTy II (Prioritising Retention in Randomised Trials) study.

BACKGROUND: One of the top three research priorities for the UK clinical trial community is to address the gap in evidence-based approaches to improving participant retention in randomised trials. Despite this, there is little evidence supporting methods to improve retention. This paper reports the PRioRiTy II project, a Priority Setting Partnership (PSP) that identified and prioritised unanswered questions and uncertainties around trial retention in collaboration with key stakeholders. METHODS: This PSP was conducted in collaboration with the James Lind Alliance, a non-profit making initiative, to support key stakeholders (researchers, patients, and the public) in jointly identifying and agreeing on priority research questions. There were three stages. (1) First an initial online survey was conducted consisting of six open-ended questions about retention in randomised trials. Responses were coded into thematic groups to create a longlist of questions. The longlist of questions was checked against existing evidence to ensure that they had not been answered by existing research. (2) An interim stage involved a further online survey where stakeholders were asked to select questions of key importance from the longlist. (3) A face-to-face consensus meeting was held, where key stakeholder representatives agreed on an ordered list of 21 unanswered research questions for methods of improving retention in randomised trials. RESULTS: A total of 456 respondents yielded 2431 answers to six open-ended questions, from which 372 questions specifically about retention were identified. Further analysis included thematically grouping all data items within answers and merging questions in consultation with the Steering Group. This produced 27 questions for further rating during the interim survey. The top 21 questions from the interim online survey were brought to a face-to-face consensus meeting in which key stakeholder representatives prioritised the order. The 'Top 10' of these are reported in this paper. The number one ranked question was 'What motivates a participant's decision to complete a clinical trial?' The entire list will be available at www.priorityresearch.ie . CONCLUSION: The Top 10 list can inform the direction of future research on trial methods and be used by funders to guide projects aiming to address and improve retention in randomised trials.

Dutch juvenile idiopathic arthritis patients, carers and clinicians create a research agenda together following the James Lind Alliance method: a study protocol.

BACKGROUND: Research on Juvenile Idiopathic Arthritis (JIA) should support patients, caregivers/parents (carers) and clinicians to make important decisions in the consulting room and eventually to improve the lives of patients with JIA. Thus far these end-users of JIA-research have rarely been involved in the prioritisation of future research. MAIN BODY: Dutch organisations of patients, carers and clinicians will collaboratively develop a research agenda for JIA, following the James Lind Alliance (JLA) methodology. In a 'Priority Setting Partnership' (PSP), they will gradually establish a top 10 list of the most important unanswered research questions for JIA. In this process the input from clinicians, patients and their carers will be equally valued. Additionally, focus groups will be organised to involve young people with JIA. The involvement of all contributors will be monitored and evaluated. In this manner, the project will contribute to the growing body of literature on how to involve young people in agenda setting in a meaningful way. CONCLUSION: A JIA research agenda established through the JLA method and thus co-created by patients, carers and clinicians will inform researchers and research funders about the most important research questions for JIA. This will lead to research that really matters.

Identifying trial recruitment uncertainties using a James Lind Alliance Priority Setting Partnership - the PRioRiTy (Prioritising Recruitment in Randomised Trials) study.

BACKGROUND: Despite the problem of inadequate recruitment to randomised trials, there is little evidence to guide researchers on decisions about how people are effectively recruited to take part in trials. The PRioRiTy study aimed to identify and prioritise important unanswered trial recruitment questions for research. The PRioRiTy study - Priority Setting Partnership (PSP) included members of the public approached to take part in a randomised trial or who have represented participants on randomised trial steering committees, health professionals and research staff with experience of recruiting to randomised trials, people who have designed, conducted, analysed or reported on randomised trials and people with experience of randomised trials methodology. METHODS: This partnership was aided by the James Lind Alliance and involved eight stages: (i) identifying a unique, relevant prioritisation area within trial methodology; (ii) establishing a steering group (iii) identifying and engaging with partners and stakeholders; (iv) formulating an initial list of uncertainties; (v) collating the uncertainties into research questions; (vi) confirming that the questions for research are a current recruitment challenge; (vii) shortlisting questions and (viii) final prioritisation through a face-to-face workshop. RESULTS: A total of 790 survey respondents yielded 1693 open-text answers to 6 questions, from which 1880 potential questions for research were identified. After merging duplicates, the number of questions was reduced to 496. Questions were combined further, and those that were submitted by fewer than 15 people and/or fewer than 6 of the 7 stakeholder groups were excluded from the next round of prioritisation resulting in 31 unique questions for research. All 31 questions were confirmed as being unanswered after checking relevant, up-to-date research evidence. The 10 highest priority questions were ranked at a face-to-face workshop. The number 1 ranked question was "How can randomised trials become part of routine care and best utilise current clinical care pathways?" The top 10 research questions can be viewed at www.priorityresearch.ie . CONCLUSION: The prioritised questions call for a collective focus on normalising trials as part of clinical care, enhancing communication, addressing barriers, enablers and motivators around participation and exploring greater public involvement in the research process.

The Role of Semantic Context in Early Morphological Processing.

There is extensive evidence pointing to an early, automatic segmentation of written words into their constituent units (farm-er, wit-ness); however, less is known about the potential role of contextual information in modulating this analysis. We adapted the standard masked priming paradigm to include an overt semantic prime in order to examine whether semantic context influences morpho-orthographic segmentation of complex words. In particular, we asked how the context will affect processing of semantically opaque forms (witness), where the embedded stem (wit) is incompatible with the meaning of the whole form. Results showed no masked priming facilitation for opaque forms in the presence of a semantic prime, indicating that context can influence early morphological analysis. Priming was found for both semantically transparent and opaque forms (farmer-farm, witness-wit) when there was no semantically-related context, consistent with the literature and an account positing early blind segmentation. These findings provide an important update to the long-standing debate on early morphological processing in written word recognition.

Real-time functional architecture of visual word recognition.

Despite a century of research into visual word recognition, basic questions remain unresolved about the functional architecture of the process that maps visual inputs from orthographic analysis onto lexical form and meaning and about the units of analysis in terms of which these processes are conducted. Here we use magnetoencephalography, supported by a masked priming behavioral study, to address these questions using contrasting sets of simple (walk), complex (swimmer), and pseudo-complex (corner) forms. Early analyses of orthographic structure, detectable in bilateral posterior temporal regions within a 150-230 msec time frame, are shown to segment the visual input into linguistic substrings (words and morphemes) that trigger lexical access in left middle temporal locations from 300 msec. These are primarily feedforward processes and are not initially constrained by lexical-level variables. Lexical constraints become significant from 390 msec, in both simple and complex words, with increased processing of pseudowords and pseudo-complex forms. These results, consistent with morpho-orthographic models based on masked priming data, map out the real-time functional architecture of visual word recognition, establishing basic feedforward processing relationships between orthographic form, morphological structure, and lexical meaning.

Neural dynamics of inflectional and derivational processing in spoken word comprehension: laterality and automaticity.

Rapid and automatic processing of grammatical complexity is argued to take place during speech comprehension, engaging a left-lateralized fronto-temporal language network. Here we address how neural activity in these regions is modulated by the grammatical properties of spoken words. We used combined magneto- and electroencephalography to delineate the spatiotemporal patterns of activity that support the recognition of morphologically complex words in English with inflectional (-s) and derivational (-er) affixes (e.g., bakes, baker). The mismatch negativity, an index of linguistic memory traces elicited in a passive listening paradigm, was used to examine the neural dynamics elicited by morphologically complex words. Results revealed an initial peak 130-180 ms after the deviation point with a major source in left superior temporal cortex. The localization of this early activation showed a sensitivity to two grammatical properties of the stimuli: (1) the presence of morphological complexity, with affixed words showing increased left-laterality compared to non-affixed words; and (2) the grammatical category, with affixed verbs showing greater left-lateralization in inferior frontal gyrus compared to affixed nouns (bakes vs. beaks). This automatic brain response was additionally sensitive to semantic coherence (the meaning of the stem vs. the meaning of the whole form) in left middle temporal cortex. These results demonstrate that the spatiotemporal pattern of neural activity in spoken word processing is modulated by the presence of morphological structure, predominantly engaging the left-hemisphere's fronto-temporal language network, and does not require focused attention on the linguistic input.