Generic, disease-specific and individualised approaches to measuring health-related quality of life among people with heart disease - a comparative analysis.

Increasing emphasis is being placed on the evaluation of health-related quality of life. However, there is no consensus on the definition of this concept and as a result there are a plethora of existing measurement instruments. Head-to-head comparisons of the psychometric properties of existing instruments are necessary to facilitate evidence-based decisions about which instrument should be chosen for routine use. Therefore, an individualised instrument (the modified Patient Generated Index), a generic instrument (the Short Form 36) and a disease-specific instrument (the Quality of Life after Myocardial Infarction questionnaire) were administered to patients with ischaemic heart disease (n=117) and the evidence for the validity, reliability and sensitivity of each instrument was examined and compared. The modified Patient Generated Index compared favourably with the other instruments but none of the instruments examined provided sound evidence for sensitivity to change. Therefore, any recommendation for the use of the individualised approach in the routine collection of health-related quality of life data in clinical practice must be conditional upon the submission of further evidence to support the sensitivity of such instruments.

Judging where a ball will go: the case of curved free kicks in football

This study examined whether adding spin to a ball in the free kick situation in football affects a professional footballer's perception of the ball's future arrival position. Using a virtual reality set-up, participants observed the flight paths of aerodynamically realistic free kicks with (+/- 600 rpm) and without sidespin. With the viewpoint being fixed in the centre of the goal, participants had to judge whether the ball would have ended up in the goal or not. Results show that trajectories influenced by the Magnus force caused by sidespin gave rise to a significant shift in the percentage of goal responses. The resulting acceleration that causes the ball to continually change its heading direction as the trajectory unfolds does not seem to be taken into account by the participants when making goal judgments. We conclude that the visual system is not attuned to such accelerated motion, which may explain why goalkeepers appear to misjudge the future arrival point of such curved free kicks.

Judging Time Intevals using a model of perceptuo-motor control

Estimating a time interval and temporally coordinating movements in space are fundamental skills, but the relationships between these different forms of timing, and the neural processes that they incur, are not well understood. While different theories have been proposed to account for time perception, time estimation, and the temporal patterns of coordination, there are no general mechanisms which unify these various timing skills. This study considers whether a model of perceptuo-motor timing, the tau(GUIDE), can also describe how certain judgements of elapsed time are made. To evaluate this, an equation for determining interval estimates was derived from the tau(GUIDE) model and tested in a task where participants had to throw a ball and estimate when it would hit the floor. The results showed that in accordance with the model, very accurate judgements could be made without vision (mean timing error -19.24 msec), and the model was a good predictor of skilled participants' estimate timing. It was concluded that since the tau(GUIDE) principle provides temporal information in a generic form, it could be a unitary process that links different forms of timing.

Global and local contributions to the optical specification of time to contact: Observer sensitivity to composite tau

First-order time remaining until a moving observer will pass an environmental element is optically specified in two different ways. The specification provided by global tau (based on the pattern of change of angular bearing) requires that the element is stationary and that the direction of motion is accurately detected, whereas the specification provided by composite tau (based on the patterns of change of optical size and optical distance) does not require either of these. We obtained converging evidence,for our hypothesis. that observers are sensitive to composite tau in four experiments involving, relative judgments of, time to, passage with forced-choice methodology. Discrimination performance was enhanced in the presence of a local expansion component, while being unaffected when the detection of the direction of heading was impaired. Observers relied on the information carried in composite tau rather than on the information carried in its constituent components. Finally, performance was similar under conditions of observer motion and conditions of object motion. Because composite tau specifies first-order time remaining for a large number of situations, the different ways in which it may be detected are discussed.

Revisited: the inertia tensor as a proprioceptive invariant in humans

A multitude of tasks that we perform on a daily basis require precise information about the orientation of our limbs with respect to the environment and the objects located within it. Recent studies have suggested that the inertia tensor, a physical property whose values are time- and co-ordinate-indepenclent, may be an important informational invariant used by the proprioceptive system to control the movements of our limbs (Pagano et al., Ecol. Psychol. 8 (1996) 43; Pagano and Turvey, Percept. Psychophys. 52 (1992) 617; Pagano and Turvey, J. Exp. Psychol. Hum. Percept. Perform. 21 (1995) 1070). We tested this hypothesis by recording the angular errors made by subjects when pointing to virtual targets in the dark. Close examination of the pointing errors made did not show any significant effects of the inertia tensor modifications on pointing accuracy. The kinematics of the pointing movements did not indicate that any on-line adjustments were being made to compensate for the inertia tensor changes. The implications of these findings with respect to the functioning of the proprioceptive system are discussed.

Guiding contact by coupling the taus of gaps

Animals control contact with surfaces when locomoting, catching prey, etc. This requires sensorily guiding the rate of closure of gaps between effecters such as the hands, feet or jaws and destinations such as a ball, the ground and a prey. Control is generally rapid, reliable and robust, even with small nervous systems: the sensorimotor processes are therefore probably rather simple. We tested a hypothesis, based on general tau theory, that closing two gaps simultaneously, as required in many actions, might be achieved simply by keeping the taus of the gaps coupled in constant ratio. tau of a changing gap is defined as the time-to-closure of the gap at the current closure-rate. General tau theory shows that tau of a gap could, in principle, be directly sensed without needing to sense either the gap size or its rate of closure. In our experiment, subjects moved an effector (computer cursor) to a destination zone indicated on the computer monitor, to stop in the zone just as a moving target cursor reached it. The results indicated the subjects achieved the task by keeping tau of the gap between effector and target coupled to tau of the gap between the effector and the destination zone. Evidence of tau -coupling has also been found, for example, in bats guiding landing using echolocation. Thus, it appears that a sensorimotor process used by different species for coordinating the closure of two or more gaps between effecters and destinations entails constantly sensing the taus of the gaps and moving so as to keep the taus coupled in constant ratio.

Intercepting beats in predesignated target zones

Moving to a rhythm necessitates precise timing between the movement of the chosen limb and the timing imposed by the beats. However, the temporal information specifying the moment when a beat will sound (the moment onto which one must synchronise one's movement) is not continuously provided by the acoustic array. Because of this informational void, the actors need some form of prospective information that will allow them to act sufficiently ahead of time in order to get their hand in the right place at the right time. In this acoustic interception study, where participants were asked to move between two targets in such a way that they arrived and stopped in the target zone at the same time as a beat sounded, we tested a model derived from tau-coupling theory (Lee DN (1998) Ecol Psychol 10:221-250). This model attempts to explain the form of a potential timing guide that specifies the duration of the inter-beat intervals and also describes how this informational guide can be used in the timing and guidance of movements. The results of our first experiment show that, for inter-beat intervals of less than 3 s, a large proportion of the movement (over 70%) can be explained by the proposed model. However, a second experiment, which augments the time between beats so that it surpasses 3 s, shows a marked decline in the percentage of information/movement coupling. A close analysis of the movement kinematics indicates a lack of control and anticipation in the participants' movements. The implications of these findings, in light of other research studies, are discussed.

Is perception of upper body orientation based on the inertia tensor? Normogravity versus microgravity conditions

During lateral leg raising, a synergistic inclination of the supporting leg and trunk in the opposite direction to the leg movement is performed in order to preserve equilibrium. As first hypothesized by Pagano and Turvey (J Exp Psychol Hum Percept Perform, 1995, 21:1070-1087), the perception of limb orientation could be based on the orientation of the limb's inertia tensor. The purpose of this study was thus to explore whether the final upper body orientation (trunk inclination relative to vertical) depends on changes in the trunk inertia tensor. We imposed a loading condition, with total mass of 4 kg added to the subject's trunk in either a symmetrical or asymmetrical configuration. This changed the orientation of the trunk inertia tensor while keeping the total trunk mass constant. In order to separate any effects of the inertia tensor from the effects of gravitational torque, the experiment was carried out in normo- and microgravity. The results indicated that in normogravity the same final upper body orientation was maintained irrespective of the loading condition. In microgravity, regardless of loading conditions the same (but different from the normogravity) orientation of the upper body was achieved through different joint organizations: two joints (the hip and ankle joints of the supporting leg) in the asymmetrical loading condition, and one (hip) in the symmetrical loading condition. In order to determine whether the different orientations of the inertia tensor were perceived during the movement, the interjoint coordination was quantified by performing a principal components analysis (PCA) on the supporting and moving hips and on the supporting ankle joints. It was expected that different loading conditions would modify the principal component of the PCA. In normogravity, asymmetrical loading decreased the coupling between joints, while in microgravity a strong coupling was preserved whatever the loading condition. It was concluded that the trunk inertia tensor did not play a role during the lateral leg raising task because in spite of the absence of gravitational torque the final upper body orientation and the interjoint coupling were not influenced.

Do people with diabetes who need to talk want to talk?

Aim. To examine whether the people with diabetes who ask for psychological support are those who are experiencing clinically significant levels of psychological distress.
Method. In total 300 people with diabetes were asked to complete psychometrically validated questionnaires that assessed subjective need and objective psychological distress.
Results. High levels of psychological distress were reported: 25% of the sample reported depressive symptomatology, 41% reported clinically significant levels if anxiety and 51% reported a degree of binge eating behaviour. Participants also indicated a desire to talk to diabetes professionals about various problem areas in diabetes. Chi-square analysis demonstrated that those reporting psychological distress, especially depression, were most likely to indicate a desire to talk to somebody about living with diabetes.
Conclusions. Those who want to talk are those who need to talk. Future service development issues should acknowledge the needs and expressed wishes of service users.

Providing psychological services for people with diabetes

Previous research and service development guidelines have highlighted the importance of psychological issues in diabetes care, and both people with diabetes and diabetes professionals recognise the need for specialist psychological input. This article outlines the development of a service delivery model for psychological services in diabetes care, based on a patient needs assessment and the advice of diabetes professionals. This involved an assessment of the psychological needs of people with diabetes within an urban Health Trust in Northern Ireland, and the collation of the views of local diabetes professionals. Questionnaires to assess for depression, anxiety, binge eating behaviour and diabetes-specific worries were completed by 300 people with diabetes. The participants were accessed through both primary and secondary care diabetes teams. As expected, a high level of psychological distress relative to population norms was illustrated by the patient needs assessment. Particularly high levels of binge eating behaviour were reported, and levels of distress were higher for community-managed patients than for hospital-managed patients. The diabetes professionals unanimously agreed that there is a need for specialist psychological input and contributed to the service delivery model which is outlined in this article.

Why people experiencing acute myocardial infarction delay seeking medical assistance

Background: Delay time from onset of symptoms of myocardial infarction to seeking medical assistance can have life- 31 threatening consequences. A number of factors have been associated with delay, but there is little evidence regarding the predictive 32 value of these indices. Aim: To explore potential predictors of patient delay from onset of symptoms to time medical assistance 33 was sought in a consecutive sample of patients admitted to CCU with acute myocardial infarction. Methods: The Cardiac Denial 34 of Impact Scale, Health Locus of Control Scale, Health Value Scale and Pennebaker Inventory of Limbic Languidness were 35 administered to 62 patients between 3 and 6 days after admission. Results: Attribution of symptoms to heart disease and health 36 locus of control had a significant predictive effect on patients seeking help within 60 min, while previous experience of heart 37 disease did not. Conclusion: Assisting individuals to recognise the potential for symptoms to have a cardiac origin is an important 38 objective. Interventions should take into account the variety of cognitive and behavioural factors involved in decision making.