A pilot randomised controlled trial of acceptance and commitment therapy for medication decision-making and quality of life in women with breast cancer: The ACTION trial.

OBJECTIVE: Non-adherence to adjuvant endocrine therapy (AET) in women with breast cancer is common and associated with medication side-effects and distress. We co-designed an Acceptance and Commitment Therapy intervention (ACTION) to enhance medication decision-making and quality of life (QoL). We undertook a pilot trial of ACTION to inform the feasibility of a phase III trial, and to examine intervention acceptability. METHODS: This was a multi-site, exploratory, two-arm, individually randomised external pilot trial. Women with early breast cancer prescribed AET were randomised (1:1) to receive usual care (UC) or UC + ACTION. The ACTION intervention comprised a remotely delivered one-to-one ACT session followed by three group sessions delivered by clinical psychologists, alongside a website containing ideas for the self-management of side effects. RESULTS: Of the 480 women screened for eligibility, 260 (54.2%) were approached and 79 (30.4%) randomised. 71 (89.9%) women provided data at 3-month and 70 (88.6%) at 6-month 40 women were randomised to receive UC + ACTION and 32 (80.0%) completed the intervention. Most (75.0%) accessed the website at least once. ACTION was acceptable to participants (Borkovec & Nau Scale: mean = 7.8 [SD = 2.7] out of 10). Signals of effectiveness in favour of the UC + ACTION arm were observed for medication adherence (Adherence Starts with Knowledge questionnaire-12), QoL (work and social adjustment scale), health-related QoL (functional assessment of cancer therapy[FACT] general and FACT-ES-19/23), distress (generalised anxiety disorder -7, patient health questionnaire-9) and psychological flexibility (valuing questionnaire). CONCLUSIONS: The ACTION intervention was acceptable to patients. There were promising signals for effectiveness on primary and secondary outcomes. A phase III randomised controlled trial is feasible. TRIAL REGISTRATION: ISRCTN12027752.

School-based multidisciplinary student-led clinics in health and Australian accreditation standards: A scoping review.

INTRODUCTION: Student-led clinics can provide health services to marginalised groups where service offerings are sparse or difficult to access, such as rural areas. Offering these services to children and young people can promote health and well-being by addressing the individual challenges and the social determinants of health. There is uncertainty, however, as to whether student-led clinics can meet Australian accreditation standards for health professionals completing degree programs. OBJECTIVE: This study aims to determine the capacity for health student placements in school-based student-led clinics to meet accreditation standards. DESIGN: A systematic scoping review was conducted based on Arksey and O'Malley's framework and the PRISMA-ScR statement. SETTING: Several databases were examined, including Ebsco (Academic Source and CINAHL), ProQuest (PsycINFO, ERIC) and grey literature sources along with a desktop review of accreditation standards across seven health disciplines. Two independent reviewers screened eligible studies. FINDINGS: The search retrieved 1037 records with 65 full-text papers assessed for eligibility. Eleven papers met the inclusion criteria. Based on the evidence, both nursing and exercise and sports science accreditation standards were best suited to student-led clinics. DISCUSSION: Although broad categories of work-integrated learning activities were applied, it appears feasible to expect accreditation standards for health disciplines at an Australian university to be a good fit for health student-led school-based clinics. CONCLUSION: Increasing health student placement opportunities within student-led clinics can improve the health and well-being of children and young people in regional, rural and remote (RRR) areas of Australia who may otherwise have limited access to allied health services.

Acceptability, fidelity and trial experience of four intervention components to support medication adherence in women with breast cancer: A process evaluation protocol for a pilot fractional factorial trial.

Background: The Refining and Optimising a behavioural intervention to Support Endocrine Therapy Adherence (ROSETA) programme has developed four intervention components aiming to improve medication adherence in women with early-stage breast cancer. These are (a) text messages, (b) information leaflet, (c) Acceptance and Commitment Therapy-based guided self-help (ACT), (d) side-effect management website. Guided by the Multiphase Optimisation Strategy, our pilot trial will use a fractional factorial design to evaluate the feasibility of undertaking a larger optimisation trial. The pilot will include a process evaluation to maximise learning regarding the fidelity and acceptability of the intervention components before proceeding with a larger trial. The trial process evaluation has three aims: to assess the (1) fidelity and (2) acceptability of the intervention components; and (3) to understand participant's trial experience, and barriers and facilitators to recruitment and retention. Methods: The process evaluation will use multiple methods. Fidelity of the intervention components will be assessed using self-reported questionnaire data, trial data on intervention component adherence, and observations of the ACT sessions. Acceptability of the intervention components and trial experience will be explored using an acceptability questionnaire and interviews with patients and trial therapists. Trial experience will be assessed using a questionnaire and interviews with participants, while barriers and facilitators to recruitment and retention will be assessed using a questionnaire completed by research nurses and participant interviews. The pilot trial opened for recruitment on 20th May 2022 and was open at the time of submission. Conclusions: This process evaluation will provide information regarding whether the intervention components can be delivered with fidelity within a national healthcare setting and are acceptable to participants. We will also better understand participant experience in a pilot trial with a fractional factorial design, and any barriers and facilitators to recruitment and retention. Registration: ISRCTN registry ( ISRCTN10487576, 16/12/2021).

BACKGROUND: The majority of women with early-stage breast cancer are recommended adjuvant endocrine therapy (AET) to reduce the chances of their cancer coming back. Many women given this medication don't take it every day or stop taking it earlier than they should. We have developed four different interventions to help women take AET. These are; text messages reminding women to take AET; an information leaflet explaining how AET works and its benefits and side-effects; a therapy programme to reduce distress, consisting of five support sessions and four module booklets; and a website with strategies to manage AET side-effects. We are now testing whether these interventions can be delivered within the NHS in different combinations, in a small trial. STUDY METHODS: We have three aims: 1. To find out if the interventions can be given and are received in the way they were supposed to (fidelity).2. To find out if the support received as part of the trial was acceptable to women with breast cancer (acceptability).3. To find out what women's experience was of taking part in the trial overall (trial experience). To do this we will: 1. Interview participants to ask them how acceptable they found the interventions, what they understood, whether they used the interventions, and how they found participating in the trial.2. Interview therapists who delivered the therapy programme to see if they delivered it as they were supposed to, and how they found delivering the intervention.3. Ask participants to complete questionnaires about how acceptable the interventions were, and whether they read and used them.4. Ask the staff involved in finding participants for the trial about challenges and improvements. We will use what we find to make improvements in a future trial where we will test whether the interventions help women to take AET.

Reducing the burden of knee osteoarthritis through community pharmacy: Protocol for a randomised controlled trial of the Knee Care for Arthritis through Pharmacy Service.

INTRODUCTION: Knee osteoarthritis (OA) negatively impacts the health outcomes and equity, social and employment participation, and socio-economic wellbeing of those affected. Little community-based support is offered to people with knee OA in Aotearoa New Zealand. Identifying Maori and non-Maori with knee OA in community pharmacy and providing co-ordinated, evidence- and community-based care may be a scalable, sustainable, equitable, effective and cost-effective approach to improve health and wellbeing. AIM: Assess whether the Knee Care for Arthritis through Pharmacy Service (KneeCAPS) intervention improves knee-related physical function and pain (co-primary outcomes). Secondary aims assess impacts on health-related quality of life, employment participation, medication use, secondary health care utilisation, and relative effectiveness for Maori. METHODS AND ANALYSIS: A pragmatic randomised controlled trial will compare the KneeCAPS intervention to the Pharmaceutical Society of New Zealand Arthritis Fact Sheet and usual care (active control) at 12 months for Maori and non-Maori who have knee OA. Participants will be recruited in community pharmacies. Knee-related physical function will be measured using the function subscale of the Short Form of the Western Ontario and McMaster Universities Osteoarthritis Index. Knee-related pain will be measured using an 11-point numeric pain rating scale. Primary outcome analyses will be conducted on an intention-to-treat basis using linear mixed models. Parallel within-trial health economic analysis and process evaluation will also be conducted. ETHICS AND TRIAL DISSEMINATION: Ethical approval was obtained from the Central Health and Ethics Committee (2022-EXP-11725). The trial is registered with ANZCTR (ACTRN12622000469718). Findings will be submitted for publication and shared with participants.

Refining and optimising a behavioural intervention to support endocrine therapy adherence (ROSETA) in UK women with breast cancer: protocol for a pilot fractional factorial trial.

INTRODUCTION: Women with breast cancer who do not adhere to adjuvant endocrine therapy (AET) have increased risks of mortality and recurrence. There are multiple barriers to AET adherence, including medication side-effects, beliefs about medication, memory and psychological distress. We developed four intervention components, each targeting a different barrier. This pilot trial is part of the preparation phase of the Multiphase Optimisation Strategy, and aims to establish key trial parameters, establish intervention component adherence, establish availability and feasibility of outcome and process data, estimate variability in planned outcome measures and estimate cost of developing and delivering each intervention component. METHODS AND ANALYSIS: The four intervention components are as follows: short message service text reminders (target: memory); a written information leaflet (target: medication beliefs); a guided self-help Acceptance and Commitment Therapy programme (target: psychological flexibility to reduce distress) and a self-management website (target: side-effect management). To evaluate the feasibility of recruitment, acceptability of the intervention components and the availability of outcome data, we will conduct a multisite, exploratory pilot trial using a 24-1 fractional factorial design, with a nested process evaluation. We will randomise 80 women with early-stage breast cancer who have been prescribed AET to one of eight experimental conditions. This will determine the combination of intervention components they receive, ranging from zero to four, with all conditions receiving usual care. Key outcomes of interest include medication adherence and quality of life. Progression to the optimisation phase will be based on predefined criteria for consent rates, patient adherence to intervention components and availability of medication adherence data. ETHICS AND DISSEMINATION: The study was reviewed by the Wales Research Authority Research Ethics Committee 3 (21/WA/0322). Written informed consent will be obtained from all patients before randomisation. The results of this trial will be disseminated in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: ISRTCN10487576.

Knee osteoarthritis and the knowledgeable, trustworthy pharmacist: Patient and pharmacist perceptions of community pharmacy-based education and support.

BACKGROUND: Osteoarthritis (OA) clinical guidelines recommend self-management education, but education is often not included in primary care consultations. OBJECTIVE: To explore pharmacists' and patients' perceptions of a pharmacist-led model of service delivery for knee OA that was integrated within pharmacies' day-to-day workflow. METHODS: Cross-sectional qualitative design using Thematic Analysis. Community pharmacies were recruited in New Zealand and Australia. Pharmacy patients were screened for knee OA and offered tailored explanations, self-management information and referral for further support. Pharmacist focus groups and patient 1:1 interviews explored perceptions of the service delivery model. RESULTS: Nineteen pharmacists and 12 patients with knee OA participated. Pharmacist and patient data were analysed separately, with themes compared and contrasted to derive three meta-themes. Meta-theme 1: 'Welcome Engagement' included two pharmacist themes ('putting my broad skill set to use' and 'we're here and happy to help') and two patient themes ('information delivered well' and 'a welcome offer of help'). Meta-theme 2: 'The Knowledgeable and Trustworthy Pharmacist' included two pharmacist themes ('professional knowledge to help all sorts of patients' and 'managing time to help my patients') and one patient theme ('the accessible professional who I know and trust'). Meta-theme 3: 'The Opportunity for More Support' included one pharmacist theme ('this is not the end of the story') and one patient theme ('more help is available'). CONCLUSION: Community pharmacists are well-positioned to provide information and support to people with knee OA. Pharmacists appreciate the opportunity to better use their skills and accessibility for OA care, and patients welcome this engagement.

The osteoarthritis knowledge scale.

OBJECTIVE: Accurate knowledge is central to effective self-care of osteoarthritis (OA). This study aimed to assess the measurement properties of the Osteoarthritis Knowledge Scale (OAKS) with versions for the hip and knee. METHODS: Participants with hip OA (n = 144), knee OA (n = 327), and no OA (n = 735) were recruited. Rasch analysis was conducted to assess psychometric properties using data from all participants with hip OA and 144 randomly selected participants with either knee OA or no OA. Test-retest reliability and measurement error were estimated among those with hip (n = 51) and knee (n = 142) OA. RESULTS: Four items from the draft scales were deleted following Rasch analysis. The final 11-item OAKS was unidimensional. Item functioning was not affected by gender, age, educational level, or scale version (hip or knee). Person separation index was 0.75. Test-retest intraclass correlation coefficient was 0.81 (95% CI 0.74, 0.86; hip version 0.66 [0.47, 0.79]; knee version 0.85 (0.79, 0.90)). Smallest detectable change was 9 points (scale range 11-55; hip OA version 11 points; knee OA version 8 points). CONCLUSION: The OAKS is a psychometrically adequate, unidimensional measure of important OA knowledge that can be used in populations with and without hip and knee OA. Caution is needed when using with populations with only hip OA as test-retest reliability of the hip version did not surpass the acceptable range.

Feasibility of a randomised controlled trial of two types of written information for people with knee osteoarthritis.

Objective: Test the feasibility of conducting an individually randomised controlled trial recruiting people with knee osteoarthritis (OA) in community pharmacies and evaluate the impacts of a novel information booklet. Design: People with knee OA were identified by pharmacy staff using clinical criteria and randomised to receive a novel information booklet (intervention) or the currently available written OA resource (active control). Mixed-methods process evaluation assessed participant recruitment, retention, and experience. Participant-reported outcome measures, assessing OA illness perceptions, OA knowledge, fear of movement, and pain when walking at baseline and 4-weeks, were analysed using linear regression models (adjusted for baseline). Results: Of 72 eligible people, 64 were randomised to intervention (n â€‹= â€‹33) or control (n â€‹= â€‹31). The randomisation sequence was followed correctly and no protocol deviations identified. Mean recruitment rate was 2.7 participants per pharmacy per week. One-in-five participants had no educational qualifications and one-in-four had not received a knee OA diagnosis prior to the trial. Three meta-themes emerged from pharmacist and participant qualitative analysis: 'pleased to be asked'; 'easy process'; and 'successful process'. Three participants were lost to follow-up. At 4 weeks, intervention arm Knee Osteoarthritis Knowledge Scale scores improved (mean difference â€‹= â€‹3.6, 95%CI 0.7 to 6.5). Brief Illness Perceptions Questionnaire scores were similar between groups (mean difference 0.4, 95%CI -3.7 to 4.5). Conclusion: It is feasible to conduct an individually randomised trial in community pharmacy, a potentially effective setting to initiate accessible OA care. A novel information booklet improved OA knowledge, but is unlikely to affect illness perceptions on its own.

Supporting adjuvant endocrine therapy adherence in women with breast cancer: the development of a complex behavioural intervention using Intervention Mapping guided by the Multiphase Optimisation Strategy.

BACKGROUND: Adjuvant endocrine therapy (AET) reduces the risk of breast cancer recurrence and mortality. However, up to three-quarters of women with breast cancer do not take AET as prescribed. Existing interventions to support adherence to AET have largely been unsuccessful, and have not focused on the most salient barriers to adherence. This paper describes the process of developing four theory-based intervention components to support adherence to AET. Our aim is to provide an exemplar of intervention development using Intervention Mapping (IM) with guidance from the Multiphase Optimisation Strategy (MOST). METHODS: Iterative development followed the six-stage IM framework with stakeholder involvement. Stage 1 involved a literature review of barriers to adherence and existing interventions, which informed the intervention objectives outlined in Stage 2. Stage 3 identified relevant theoretical considerations and practical strategies for supporting adherence. Stage 4 used information from Stages 1-3 to develop the intervention components. Stages 1-4 informed a conceptual model for the intervention package. Stages 5 and 6 detailed implementation considerations and evaluation plans for the intervention package, respectively. RESULTS: The final intervention package comprised four individual intervention components: Short Message Service to encourage habitual behaviours surrounding medication taking; an information leaflet to target unhelpful beliefs about AET; remotely delivered Acceptance and Commitment Therapy-based guided self-help to reduce psychological distress; and a website to support self-management of AET side-effects. Considerations for implementation within the NHS, including cost, timing and mode of delivery were outlined, with explanation as to how using MOST can aid this. We detail our plans for the final stage of IM which involve feasibility testing. This involved planning an external exploratory pilot trial using a 24-1 fractional factorial design, and a process evaluation to assess acceptability and fidelity of intervention components. CONCLUSIONS: We have described a systematic and logical approach for developing a theoretically informed intervention package to support medication adherence in women with breast cancer using AET. Further research to optimise the intervention package, guided by MOST, has the potential to lead to more effective, efficient and scalable interventions.

Involving People With Lived Experience as Partners in Musculoskeletal Research: Lessons From a Survey of Aotearoa/New Zealand Musculoskeletal Researchers.

SYNOPSIS: Involving patients as partners in research enables their concerns, perspectives, lived experiences, and priorities to be integrated into research. Involving patient partners improves research processes, outcomes, and translating findings into practice. Although musculoskeletal researchers consider that it is important to involve patient partners, few projects involve them. Researchers who involve patient partners report that the contributions of patient partners are very valuable, and researchers perceive the process to be less challenging than expected. Musculoskeletal research is staring at a significant unrealized opportunity to enhance the quality and impact of research and reduce research waste-think what the field could achieve if researchers and patients worked better together. A culture change is needed so that involving patient partners in musculoskeletal research becomes standard practice, expected and supported by funders, journals, research institutions, and researchers alike. J Orthop Sports Phys Ther 2022;52(6):307-311. doi:10.2519/jospt.2022.10986.

Acceptance and Commitment Therapy to support medication decision-making and quality of life in women with breast cancer: protocol for a pilot randomised controlled trial.

BACKGROUND: Adherence to adjuvant endocrine therapy is affected by medication side-effects and associated distress. Previous interventions focused on educating women to enhance adherence have proved minimally effective. We co-designed an Acceptance and Commitment Therapy (ACT) intervention to enhance medication decision-making and quality of life by targeting a broader range of factors, including side-effect management and psychological flexibility. This study aims to establish key trial parameters, assess the acceptability of the intervention and the extent to which it can be delivered with fidelity, and to demonstrate "proof of principle" regarding its efficacy on primary and process outcomes. METHODS: The ACTION intervention includes an individual 1:1 ACT session followed by three group sessions involving 8-10 women and two practitioner psychologists. Participants are also provided with access to a website containing evidence-based methods for self-managing side-effects. The ACT sessions were adapted during the COVID-19 pandemic to be remotely delivered via video conferencing software. To evaluate the feasibility and acceptability of this intervention, a multi-site, exploratory, two-arm, individually randomised external pilot trial with a nested qualitative study will be undertaken. Eighty women with early stage breast cancer prescribed adjuvant endocrine therapy will be randomised (1:1) to receive treatment as usual or treatment as usual plus the ACTION intervention. The planned future primary outcome is medication adherence assessed by the ASK-12 measure. Progression to a phase III RCT will be based on criteria related to recruitment and follow-up rates, acceptability to patients, competency and fidelity of delivery, and proof of principle for change in medication adherence. DISCUSSION: This external pilot trial will be used to ascertain the feasibility of undertaking a future phase III RCT to definitively evaluate an ACT-based intervention to support medication taking behaviour and quality of life in women with early stage breast cancer on adjuvant endocrine therapy. TRIAL REGISTRATION: ISRCTN: 12027752. Registered 24 December 2020, https://doi.org/10.1186/ISRCTN12027752.

Strategies to self-manage side-effects of adjuvant endocrine therapy among breast cancer survivors: an umbrella review of empirical evidence and clinical guidelines.

PURPOSE: Side-effects of adjuvant endocrine therapy (AET) are common in breast cancer survivors, and can affect adherence to treatment. We synthesised the evidence for strategies to self-manage these side-effects. METHODS: We searched for systematic reviews and clinical guidelines on self-management strategies for AET side-effects (arthralgia, fatigue, hot flashes, gastrointestinal discomfort, nausea, vulvovaginal symptoms, and sleep disturbance). We searched oncology organisation's websites and eight databases (Inception-November 2020). Screening, data extraction and quality assessment were completed independently in duplicate. PROSPERO: 2019CRD4201914001. RESULTS: We identified 33 systematic reviews and 18 clinical guidelines. 21% of reviews were high quality, and the average quality score for guidelines was 44%. Evidence for most strategies was absent or weak. There was consensus from a low-quality review and multiple guidelines to recommend moisturisers, gels and lubricants for vulvovaginal symptoms. Evidence was weak for physical activity for self-managing most symptoms, although two high-quality reviews indicated yoga and aerobic exercise could reduce fatigue. Primary research was often biased by weak and underpowered study designs. Eleven reviews did not report information on adverse events. CONCLUSIONS: Most self-management strategies for breast cancer survivors experiencing side-effects from AET lack evidence. Primary research is needed using high-quality well-powered designs focusing on implementable strategies. IMPLICATIONS FOR CANCER SURVIVORS: Patients and clinicians should be aware that although the risk of harm is low for these self-management strategies, the likelihood of benefit is often unclear. Women should consider moisturisers, gels or lubricants for self-managing vulvovaginal symptoms, and yoga or aerobic exercise for alleviating fatigue.

Patient and health care professional co-development of an Acceptance and Commitment Therapy intervention to support hormone therapy decision-making and well-being in women with breast cancer.

OBJECTIVES: The aim of this work was to co-develop an Acceptance and Commitment Therapy (ACT) intervention to support medication adherence and quality of life in breast cancer survivors (BCSs). The research approach was intervention co-development. METHODS: The sample consisted of BCS focus groups (n = 24), health care provider (HCP) interviews (n = 10), and a co-development workshop (BCSs, n = 12; HCPs, n = 9).We conducted 6 BCS focus groups and 10 HCP interviews to understand the acceptability of ACT. We co-designed the intervention in a workshop. RESULTS: Participants reported high acceptability of an ACT intervention. BCSs preferred ACT exercises focused on values and self-compassion. Both groups recommended face-to-face intervention delivery, by a clinical psychologist, with a mixture of individual and group sessions. BCSs requested advice on side-effect management. CONCLUSIONS: We effectively used patient and HCP co-design to configure an ACT intervention to support medication adherence and quality of life for BCSs. If feasible and efficacious, this ACT-based intervention could support breast cancer survivorship.

NCS Assessments of the Motor, Sensory, and Physical Health Domains.

As part of the National Children's Study (NCS) comprehensive and longitudinal assessment of the health status of the whole child, scientific teams were convened to recommend assessment measures for the NCS. This manuscript documents the work of three scientific teams who focused on the motor, sensory, or the physical health aspects of this assessment. Each domain team offered a value proposition for the importance of their domain to the health outcomes of the developing infant and child. Constructs within each domain were identified and measures of these constructs proposed. Where available extant assessments were identified. Those constructs that were in need of revised or new assessment instruments were identified and described. Recommendations also were made for the age when the assessments should take place.

Knowledge about osteoarthritis: Development of the Hip and Knee Osteoarthritis Knowledge Scales and protocol for testing their measurement properties.

Objectives: 1) Develop unidimensional instruments to measure osteoarthritis (OA) knowledge among people with hip or knee OA, and 2) assess the structural validity, internal consistency, cross-cultural validity/measurement invariance, test-retest reliability, and measurement error of the Hip Osteoarthritis Knowledge Scale (HOAKS) and the Knee Osteoarthritis Knowledge Scale (KOAKS). Methods: Draft HOAKS and KOAKS were developed and refined following best-practice (COSMIN) guidelines with involvement of consumer research partners. Measurement properties of the HOAKS and KOAKS will be assessed through an online survey. The survey will include the novel HOAKS or KOAKS, the current short form of the Hip or Knee injury and Osteoarthritis Outcome Score (HOOS-12/KOOS-12), and items that gather demographic and OA characteristics and explore self-rated OA knowledge. People will be eligible to participate if aged 18 years and older, can communicate in English, and have either hip or knee OA as diagnosed by a health professional or by meeting diagnostic criteria. We aim to obtain 400 complete HOAKS or KOAKS responses and 100 complete HOAKS or KOAKS retest responses one week after initial completion. Rasch analysis will estimate structural validity, internal consistency and cross-cultural validity/measurement invariance. Assessment will include test-retest reliability (intraclass correlation coefficient) and absolute measurement error (standard error of measurement; smallest detectable change). Conclusion: This study will produce robust unidimensional instruments to measure hip and knee OA knowledge. We anticipate that the HOAKS and KOAKS scales will be useful in clinical and research settings to identify knowledge gaps or evaluate interventions designed to improve knowledge.

Beyond the mean reaction time: Trial-by-trial reaction time reveals the distraction effect on perceptual-motor sequence learning.

Perceptual-motor sequences can be learned quickly under distraction, often demonstrated by the mean reaction time (RT) change in a serial reaction time (SRT) task. However, any arbitrary mean RT can arise from one of many distinct trial-by-trial RT patterns. It is surprising that previous sequence learning studies have hinged only on the mean RT metrics while little is known about the distraction effect on its trial-by-trial processes. In an SRT task with or without distraction, we found that initially learning a fixed repeating sequence without distraction was expressed by a micro-online learning process where reaction time (RT) progressively improved within learning blocks as adults continuously performed the SRT task. Such online RT improvements, however, vanished when the SRT task was performed under distraction. Despite the detrimental effect of distraction on micro-online RT improvements, we observed offline enhancements in RT following rest intervals of 3 min that emerged to secure sequence learning under distraction. We reasoned that distraction may exert influence on the micro-online and offline learning by mediating the engagement of explicit and implicit memory. Given the offline RT change under distraction, a short rest between learning blocks may be a key player in early perceptual-motor sequence learning under distraction. We thus suggest that future studies investigating the distraction effect on sequence learning need to control the length of rest between learning blocks, while previous research with equivocal interpretations of the distraction effect failed to do so.

Two Single Incursions of H7N7 and H5N1 Low Pathogenicity Avian Influenza in U.K. Broiler Breeders During 2015 and 2016.

Low pathogenicity (LP) avian influenza viruses (AIVs) have a natural reservoir in wild birds. These cause few (if any) overt clinical signs, but include H5 and H7 LPAIVs, which are notifiable in poultry. In the European Union, notifiable avian disease (NAD) demands laboratory confirmation with prompt statutory interventions to prevent dissemination of infection to multiple farms. Crucially, for H5 and H7 LPAIVs, movement restrictions and culling limit the further risk of mutation to the corresponding highly pathogenic (HP) H5 and H7 AIVs in gallinaceous poultry. An H7N7 LPAIV outbreak occurred during February 2015 at a broiler breeder chicken premise in England. Full genome sequencing suggested an avian origin closely related to contemporary European H7 LPAIV wild bird strains with no correlates for human adaptation. However, a high similarity of PB2, PB1, and NA genes with H10N7 viruses from European seals during 2014 was observed. An H5N1 LPAIV outbreak during January 2016 affecting broiler breeder chickens in Scotland resulted in rapid within-farm spread. An interesting feature from this case was that although viral tropism occurred in heart and kidney endothelial cells, suggesting HPAIV infection, the H5N1 virus had the molecular cleavage site signature of an LPAIV belonging to an indigenous European H5 lineage. There was no genetic evidence for human adaptation or antiviral drug resistance. The source of the infection was also likely to be via indirect contact with wild birds mediated via fomite spread from the nearby environment. Both LPAIV outbreaks were preceded by local flooding events that attracted wild waterfowl to the premises. Prompt detection of both outbreaks highlighted the value of the "testing to exclude" scheme launched in the United Kingdom for commercial gallinaceous poultry in 2014 as an early warning surveillance mechanism for NAD.

Dos incursiones únicas de influenza aviar de baja patogenicidad H7N7 y H5N1 en criadores de pollos de engorde en el Reino Unido durante 2015 y 2016. Los virus de influenza aviar de baja patogenicidad tienen un reservorio natural en aves silvestres. Estos causan pocos (si es que se presentan) signos clínicos evidentes, pero se incluyen los virus de influenza de baja patogenicidad H5 y H7, que son notificables en avicultura. En la Unión Europea, las enfermedades aviares notificables (NAD, por sus siglas en inglés) requieren de confirmación de laboratorio con intervenciones reglamentarias rápidas para prevenir la diseminación de la infección a múltiples granjas. De manera crucial, para las los virus de baja patogenicidad H5 y H7, las restricciones de movimiento y el sacrificio limitan el riesgo adicional de mutación hacia los correspondientes virus H5 y H7 altamente patógenos en aves comerciales. Un brote de influenza aviar de baja patogenicidad H7N7 ocurrió en febrero del 2015 en una granja de pollos reproductores de pollos de engorde en Inglaterra. La secuenciación completa del genoma sugirió un origen aviar estrechamente relacionado con las cepas de aves silvestres contemporáneas europeas de baja patogenicidad H7 sin indicios para la adaptación humana. Sin embargo, se observó una alta similitud de los genes PB2, PB1 y NA con los virus H10N7 de focas europeas durante el 2014. Un brote de influenza aviar de baja patogenicidad por H5N1 en enero del 2016 que afectó a los pollos reproductores de pollos de engorde en Escocia resultó en una rápida propagación dentro de la granja. Una característica interesante de este caso fue que, aunque el tropismo viral ocurrió en las células endoteliales del corazón y el riñón, lo que sugería una infección por un virus de alta patogenicidad, el virus H5N1 tenía el sitio de disociación molecular característico de un virus de baja patogenicidad perteneciente a un linaje indígena H5 europeo. No se observó evidencia genética para la adaptación humana o la resistencia a los medicamentos antivirales. También es probable que la fuente de la infección fue a través del contacto indirecto con las aves silvestres mediadas a través de la propagación de fómites desde el entorno cercano. Ambos brotes de influenza aviar de baja patogenicidad fueron precedidos por inundaciones locales que atrajeron aves acuáticas silvestres a las instalaciones. La rápida detección de ambos brotes resaltó el valor del esquema de "Diagnóstico para Excluir" establecido en el Reino Unido para la avicultura comercial en el 2014 como un mecanismo de vigilancia de alerta temprana para las enfermedades aviares notificables.