Context matters: How do task demands modulate the recruitment of sensorimotor information during language processing?

Many theories of semantic representation propose that simulations of sensorimotor experience contribute to language processing. This can be seen in the body-object interaction effect (BOI; how easily the human body can interact with a word's referent). Words with high BOI ratings (e.g., ball) are processed more quickly than words with low BOI ratings (e.g., cloud) in various language tasks. This effect can be modulated by task demands. Previous research established that when asked to decide if a word is an object (entity condition), a BOI effect is observed, but when asked to decide if a word is an action (action condition), there is no BOI effect. It is unclear whether the null behavioral effect in the action condition reflects top-down modulation of task-relevant sensorimotor information or the absence of bottom-up activation of sensorimotor simulations. We investigated this question using EEG. In Experiment 1 we replicated the previous behavioral findings. In Experiment 2, 50 participants were assigned to either the entity or action conditions and responded to the same word stimuli. In both conditions we observed differences in ERP components related to the BOI effect. In the entity condition the P2 mean amplitude was significantly more positive for high compared to low BOI words. In the action condition the N400 peak latency was significantly later for high compared to low BOI words. Our findings suggest that BOI information is generated bottom-up regardless of task demands and modulated by top-down processes that recruit sensorimotor information relevant to the task decision.

Acceptability of bisphosphonates among patients, clinicians and managers: a systematic review and framework synthesis.

OBJECTIVE: To explore the acceptability of different bisphosphonate regimens for the treatment of osteoporosis among patients, clinicians and managers, payers and academics. DESIGN: A systematic review of primary qualitative studies. Seven databases were searched from inception to July 2019. Screening, data extraction and quality assessment of full-articles selected for inclusion were performed independently by two authors. A framework synthesis was applied to extracted data based on the theoretical framework of acceptability (TFA). The TFA includes seven domains relating to sense-making, emotions, opportunity costs, burden, perceived effectiveness, ethicality and self-efficacy. Confidence in synthesis findings was assessed. SETTING: Any developed country healthcare setting. PARTICIPANTS: Patients, healthcare professionals, managers, payers and academics. INTERVENTION: Experiences and views of oral and intravenous bisphosphonates. RESULTS: Twenty-five studies were included, mostly describing perceptions of oral bisphosphonates. We identified, with high confidence, how patients and healthcare professionals make sense (coherence) of bisphosphonates by balancing perceptions of need against concerns, how uncertainty prevails about bisphosphonate perceived effectiveness and a number of individual and service factors that have potential to increase self-efficacy in recommending and adhering to bisphosphonates. We identified, with moderate confidence, that bisphosphonate taking induces concern, but has the potential to engender reassurance, and that both side effects and special instructions for taking oral bisphosphonates can result in treatment burden. Finally, we identified with low confidence that multimorbidity plays a role in people's perception of bisphosphonate acceptability. CONCLUSION: By using the lens of acceptability, our findings demonstrate with high confidence that a theoretically informed, whole-system approach is necessary to both understand and improve adherence. Clinicians and patients need supporting to understand the need for bisphosphonates, and clinicians need to clarify to patients what constitutes bisphosphonate treatment success. Further research is needed to explore perspectives of male patients and those with multimorbidity receiving bisphosphonates, and patients receiving intravenous treatment. PROSPERO REGISTRATION NUMBER: CRD42019143526.

Influence of combined vitamin D3 supplementation and resistance exercise training on musculoskeletal health in older men and women (EXVITD): protocol for a randomised controlled trial.

INTRODUCTION: Sarcopenia is a progressive loss in muscle mass, strength and function, the adverse consequences of which are severe, affecting quality of life and placing an increasing burden on social and healthcare systems. Vitamin D status is known to be associated with markers of sarcopenia, namely muscle mass, strength and function. Also, resistance exercise training (RET) is currently the only proven intervention to treat sarcopenia. However, very little data exist on the influence of combining the two interventions of vitamin D supplementation and resistance exercise training, although a recent systematic review provides tentative support for the current study's hypothesis that the combined intervention may further improve musculoskeletal function above exercise training alone. The aim of the present study is to determine whether vitamin D3 supplementation is any more effective in improving musculoskeletal function when combined with RET compared with exercise training alone in older adults. METHODS AND ANALYSIS: This double-blinded randomised placebo-controlled trial will recruit a target of 127 eligible men and women aged ≥65 years living independently or in sheltered housing within the Birmingham area to two groups: (1) 6 months RET and placebo or (2) 6 months RET and 800 IU/d vitamin D3. Measures of muscle power (Nottingham Power Rig), body composition (dual energy X-ray absorptiometry), muscle function (short physical performance battery, timed up and go), falls and fractures as events will be assessed. Assessments will take place at baseline and postintervention, with intermittent monitoring of bone turnover, calcium and vitamin D. The primary outcome will be lower limb extensor power output. Analyses of within-group changes and between-group differences in outcome measures are planned. ETHICS AND DISSEMINATION: The EXVITD study has ethical approval granted by the Black Country National Health Service Research Ethics Committee (14/WM/1220). Results of this trial will be submitted for publication in peer-reviewed journals and presented at conferences. The study is being conducted according to the principles of the Declaration of Helsinki.Trial registration numberNCT02467153; Post-results.

Grasping the Alternative: Reaching and Eyegaze Reveal Children's Processing of Negation.

There is evidence that children begin to understand negation early in the preschool years, but children's processing of negation is not well understood. We examined children's processing of denial negation using a variant of the visual world paradigm called the Shopping Task. In this task, participants help a puppet to find the items on a shopping list, selecting from two potential items on each trial in response to the puppet's affirmative ("the next item is an apple") or negation ("the next item is not an orange") sentence. In this binary decision context, participants' eye gaze and reaching behavior were tracked as they selected the item the puppet wants. Participants were 78 children aged 4-5 years and a comparison group of 30 adults. Results showed that children took longer to process negation than affirmative sentences, and that this difference arose early in processing. Further, children's eye gaze behavior suggested that on negation trials they regularly looked first to the negated object and were considering the negated meaning early in processing. Adults did not take longer to process negation than affirmative sentences, but their eye gaze behavior also indicated early consideration of negated meanings for negation sentences. We also examined relationships between children's language and executive function skills and their processing of negation and found no significant relationships. We conclude that both adults and children activate to-be-negated information in the processing of negation. Children, however, are less efficient at processing negation in this context.

Focused educational intervention improves but may not sustain knowledge regarding falls management.

BACKGROUND: The number of falls in hospital ranges from 3.8 to 8.6 falls per 1000 bed days.1 Around 30% of falls as inpatients are injurious, and 4%-6% can result in serious and life-threatening injury.2 3 This results in significant health burdens and economic burdens due to increased hospital stays following a fall. Junior doctors are usually the first point of contact for managing patients who fall in hospital. It is therefore important they understand the preventative measures and postfalls management. AIM: To assess the retention of knowledge regarding falls management in foundation year 1 (FY1) doctors before and after a short educational intervention. METHODS: A 3-stage quality improvement project was conducted at a West Midlands teaching hospital to highlight issues regarding falls management. A questionnaire assessing areas of knowledge regarding assessment and management of falls was delivered to 31 F1s. This was followed by a short presentation regarding falls management. The change in knowledge was assessed at 6 and 16 weeks postintervention. The questionnaire results were analysed using unpaired t-tests on STATA (V.14.2). RESULTS: The mean score for knowledge regarding falls management in the preintervention, early postintervention and late postintervention were 73.7%, 85.2% and 76.4%, respectively. Although there was an improvement in the knowledge at 6 weeks' postintervention, this returned to almost baseline at 16 weeks. The improvement in knowledge did not translate to clinical practice of falls management during this period. CONCLUSION: Although educational interventions improve knowledge, the intervention failed to sustain over period of time or translate in clinical practice. Further work is needed to identify alternative methods to improve sustainability of the knowledge of falls and bring in the change in clinical practice.

Development of fracture liaison services: What have we learned?

Due to dramatic improvements in life expectancy we are seeing a rapidly growing population of older people. Increasing frailty and susceptibility to fragility fractures are becoming pressing issues for both the individuals that suffer them as well as society, through pressures on health and social care budgets. The success of fracture liaison services, co-ordinated programmes enhancing the management of the fracture, osteoporosis, frailty and falls risk, is undisputed. To achieve optimal outcomes, however, it is important to have a standardisation of design, scope and structure of the service. Experience has taught us that by delegating responsibility for the holistic care of the patient to a trained and adequately resourced professional/team (fracture prevention practitioner) with clear standards against which benchmarking occurs, is the optimal model of delivery. Future challenges include how best to measure the success of services in imparting a reduction in fractures at a local population level as well as how to detect those patients with unmet need who do not uniformly present to health care services, such as those with vertebral fractures. The implementation of fracture liaison services however, is a clear demonstration of how collaboration between health care, social care and charity organisations, among others, has materially improved the health and well-being of the population.

Compliance with established guidelines for the radiological reporting of atypical femoral fractures.

OBJECTIVE: Atypical femoral fractures (AFFs) are important to diagnose early to avoid progression to complete fracture. We set out to determine the reporting accuracy of AFFs. METHODS: We conducted a retrospective analysis of imaging performed between November 2010 and June 2013 to analyse the X-ray reporting of AFFs and to describe the key clinical considerations. Radiological reports were reviewed from the 3805 separate femoral images for search terms thought likely to identify AFFs. This identified 1558 patients. The identified radiographs were reviewed by radiologists with reference to the 2010 American Society of Bone and Mineral Research (ASBMR) criteria. RESULTS: Within these 1558 patients, 16 patients met the radiological criteria for AFF according to the 2010 ASBMR task force statement of which, although all were identified as fractures, 15 were not reported as "atypical" by the original reporting author and none was formally classified as AFF by the original reporting author. Within the 1558 patients, there were an additional 17 patients labelled as having "atypical" fracture features originally, although only 1 patient met the 2010 ASBMR task force criteria for AFF. Only 13 of 16 patients had imaging of the contralateral femur, and there was a significant delay for those who were imaged (111 ± 44 days). Furthermore, two of the patients with an AFF had previous radiographs demonstrating cortical changes indicative of AFFs prior to formal diagnosis. CONCLUSION: Whilst AFFs are rare diagnoses, the compliance with published guidelines for their radiological classification is low. ADVANCES IN KNOWLEDGE: We have raised awareness of the importance of recognizing AFFs to guide management.