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We investigated the feasibility of recruiting patients unemployed for more than 3 months with chronic pain using a range of methods in primary care in order to conduct a pilot trial of Individual Placement and Support (IPS) to improve quality of life outcomes for people with chronic pain.
This research was informed by people with chronic pain. We assessed the feasibility of identification and recruitment of unemployed patients; the training and support needs of employment support workers to integrate with pain services; acceptability of randomisation, retention through follow-up and appropriate outcome measures for a definitive trial. Participants randomised to IPS received integrated support from an employment support worker and a pain occupational therapist to prepare for, and take up, a work placement. Those randomised to Treatment as Usual (TAU) received a bespoke workbook, delivered at an appointment with a research nurse not trained in vocational rehabilitation.
Using a range of approaches, recruitment through primary care was difficult and resource-intensive (1028 approached to recruit 37 eligible participants). Supplementing recruitment through pain services, another 13 people were recruited (total n = 50). Randomisation to both arms was acceptable: 22 were allocated to IPS and 28 to TAU. Recruited participants were generally not ‘work ready’, particularly if recruited through pain services.
A definitive randomised controlled trial is not currently feasible for recruiting through primary care in the UK. Although a trial recruiting through pain services might be possible, participants could be unrepresentative in levels of disability and associated health complexities. Retention of participants over 12 months proved challenging, and methods for reducing attrition are required. The intervention has been manualised.
Rigorous scientific review of research protocols is critical to making funding decisions, and to the protection of both human and non-human research participants. Given the increasing complexity of research designs and data analysis methods, quantitative experts, such as biostatisticians, play an essential role in evaluating the rigor and reproducibility of proposed methods. However, there is a common misconception that a statistician’s input is relevant only to sample size/power and statistical analysis sections of a protocol. The comprehensive nature of a biostatistical review coupled with limited guidance on key components of protocol review motived this work. Members of the Biostatistics, Epidemiology, and Research Design Special Interest Group of the Association for Clinical and Translational Science used a consensus approach to identify the elements of research protocols that a biostatistician should consider in a review, and provide specific guidance on how each element should be reviewed. We present the resulting review framework as an educational tool and guideline for biostatisticians navigating review boards and panels. We briefly describe the approach to developing the framework, and we provide a comprehensive checklist and guidance on review of each protocol element. We posit that the biostatistical reviewer, through their breadth of engagement across multiple disciplines and experience with a range of research designs, can and should contribute significantly beyond review of the statistical analysis plan and sample size justification. Through careful scientific review, we hope to prevent excess resource expenditure and risk to humans and animals on poorly planned studies.
The Protoplanetary Discussions conference—held in Edinburgh, UK, from 2016 March 7th–11th—included several open sessions led by participants. This paper reports on the discussions collectively concerned with the multi-physics modelling of protoplanetary discs, including the self-consistent calculation of gas and dust dynamics, radiative transfer, and chemistry. After a short introduction to each of these disciplines in isolation, we identify a series of burning questions and grand challenges associated with their continuing development and integration. We then discuss potential pathways towards solving these challenges, grouped by strategical, technical, and collaborative developments. This paper is not intended to be a review, but rather to motivate and direct future research and collaboration across typically distinct fields based on community-driven input, to encourage further progress in our understanding of circumstellar and protoplanetary discs.
Given that there are neural markers for the acquisition of a non-verbal skill, we review evidence of neural markers for the acquisition of vocabulary. Acquiring vocabulary is critical to learning one's native language and to learning other languages. Acquisition requires the ability to link an object concept (meaning) to sound. Is there a region sensitive to vocabulary knowledge? For monolingual English speakers, increased vocabulary knowledge correlates with increased grey matter density in a region of the parietal cortex that is well-located to mediate an association between meaning and sound (the posterior supramarginal gyrus). Further this region also shows sensitivity to acquiring a second language. Relative to monolingual English speakers, Italian–English bilinguals show increased grey matter density in the same region. Differences as well as commonalities might exist in the neural markers for vocabulary where lexical distinctions are also signalled by tone. Relative to monolingual English, Chinese multilingual speakers, like European multilinguals, show increased grey matter density in the parietal region observed previously. However, irrespective of ethnicity, Chinese speakers (both Asian and European) also show highly significant increased grey matter density in two right hemisphere regions (the superior temporal gyrus and the inferior frontal gyrus). They also show increased grey matter density in two left hemisphere regions (middle temporal and superior temporal gyrus). Such increases may reflect additional resources required to process tonal distinctions for lexical purposes or to store tonal differences in order to distinguish lexical items. We conclude with a discussion of future lines of enquiry.
There is no causal account of recovery patterns in bilingual aphasia. We propose that the causal mechanisms can be partially revealed by combining neuropsychological and neuroimaging methods. We briefly review the potentials and limitations associated with functional neuroimaging experiments on normal and neurologically impaired patients and then focus on the different levels of description required to reveal the causal basis of recovery patterns in bilingual aphasics. Finally, we suggest how functional imaging investigations might be meaningfully undertaken with bilingual aphasic patients. We illustrate our argument with respect to five different patterns of recovery and consider the theoretical and practical implications of such research.
This article illustrates how functional neuroimaging can be used to test the validity of neurological and
cognitive models of language. Three models of language are described: the 19th Century neurological model
which describes both the anatomy and cognitive components of auditory and visual word processing, and 2
20th Century cognitive models that are not constrained by anatomy but emphasise 2 different routes to
reading that are not present in the neurological model. A series of functional imaging studies are then
presented which show that, as predicted by the 19th Century neurologists, auditory and visual word
repetition engage the left posterior superior temporal and posterior inferior frontal cortices. More
specifically, the roles Wernicke and Broca assigned to these regions lie respectively in the posterior superior
temporal sulcus and the anterior insula. In addition, a region in the left posterior inferior temporal cortex is
activated for word retrieval, thereby providing a second route to reading, as predicted by the 20th Century
cognitive models. This region and its function may have been missed by the 19th Century neurologists
because selective damage is rare. The angular gyrus, previously linked to the visual word form system, is
shown to be part of a distributed semantic system that can be accessed by objects and faces as well as
speech. Other components of the semantic system include several regions in the inferior and middle temporal
lobes. From these functional imaging results, a new anatomically constrained model of word processing is
proposed which reconciles the anatomical ambitions of the 19th Century neurologists and the cognitive
finesse of the 20th Century cognitive models. The review focuses on single word processing and does not
attempt to discuss how words are combined to generate sentences or how several languages are learned and
interchanged. Progress in unravelling these and other related issues will depend on the integration of
behavioural, computational and neurophysiological approaches, including neuroimaging.
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