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Psychological interventions may make a valuable contribution to recovery following a mild traumatic brain injury (mTBI) and have been advocated for in treatment consensus guidelines. Acceptance and Commitment Therapy (ACT) is a more recently developed therapeutic option that may offer an effective approach. Consequently, we developed ACTion mTBI, a 5-session ACT-informed intervention protocol. To establish the feasibility of this intervention, we wanted to understand participants’ experiences of ACTion mTBI, determine acceptability and identify any refinements needed to inform a full-scale effectiveness trial. We recruited adults (≥16 years of age) diagnosed with mTBI who were engaged in community-based multidisciplinary rehabilitation. After completing the ACTion mTBI sessions, 23/27 (85.2%) participants (mean time post-injury: 28.0 weeks) completed a semi-structured interview about their experience of the intervention. Interviews were audio-recorded, transcribed verbatim and analysed using a qualitative description approach. There were two overarching themes 1) attacking the concussion from a different direction and 2) positive impact on recovery which depicted participants’ overall experiences of the intervention. Within these overarching themes, our analysis also identified two subthemes: 1) helpful aspects of the intervention which included education and ACT processes (i.e., being present and being able to step back) and 2) “ contextual factors that enabled intervention effectiveness ” which included being equipped with tools, cultural and spiritual responsiveness, the therapeutic connection, and the intervention having a structured yet flexible approach to order of delivery to meet individual needs. Participants’ experiences support acceptability, cultural and spiritual responsibility of ACTion mTBI. Suggested refinements included enabling access to intervention over time, not just at one point during recovery and the addition of a brief check-in follow-up.

Psychological interventions may make a valuable contribution to recovery following a mild traumatic brain injury (mTBI) and have been advocated for in treatment consensus guidelines. Acceptance and Commitment Therapy (ACT) is a more recently developed therapeutic option that may offer an effective approach. Consequently, we developed ACTion mTBI, a 5-session ACT-informed intervention protocol. To establish the feasibility of this intervention, we wanted to understand participants' experiences of ACTion mTBI, determine acceptability and identify any refinements needed to inform a full-scale effectiveness trial. We recruited adults ([greater than or equal to]16 years of age) diagnosed with mTBI who were engaged in community-based multidisciplinary rehabilitation. After completing the ACTion mTBI sessions, 23/27 (85.2%) participants (mean time post-injury: 28.0 weeks) completed a semi-structured interview about their experience of the intervention. Interviews were audio-recorded, transcribed verbatim and analysed using a qualitative description approach. There were two overarching themes 1) attacking the concussion from a different direction and 2) positive impact on recovery which depicted participants' overall experiences of the intervention. Within these overarching themes, our analysis also identified two subthemes: 1) helpful aspects of the intervention which included education and ACT processes (i.e., being present and being able to step back) and 2) \"contextual factors that enabled intervention effectiveness\" which included being equipped with tools, cultural and spiritual responsiveness, the therapeutic connection, and the intervention having a structured yet flexible approach to order of delivery to meet individual needs. Participants' experiences support acceptability, cultural and spiritual responsibility of ACTion mTBI. Suggested refinements included enabling access to intervention over time, not just at one point during recovery and the addition of a brief check-in follow-up.

ObjectiveTo investigate the prognostic value of the Subgroups for Targeted Treatment (STarT) Screening Tool adapted for concussion (STarT-C) on persistent symptoms and disability at 6–9 months following mild traumatic brain injury (mTBI).DesignSecondary analysis of two prospective studies: an observational cohort study in New Zealand and usual care control arm of a clinical trial in Canada (ClinicalTrials.gov Registry (NCT04704037)).SettingParticipants in the New Zealand cohort were recruited from concussion clinics (five sites) and those in the Canadian cohort were recruited from emergency departments/urgent care centres (eight sites).ParticipantsNew Zealand participants (n=93, median age 37 years, 60% women) were assessed at median=6 weeks post-injury (T1) and 6 months later (T2). Canadian participants (n=223, median age 38 years, 56% women) were assessed at median=2 weeks (T1) and 6 months later (T2).Main outcome measuresSymptoms at T2 were assessed using the validated Rivermead Postconcussion Symptoms Questionnaire (RPQ) and disability using the WHO Disability Assessment Schedule 2.0 12-item Interview.ResultsIn linear regression analyses, the STarT-C predicted symptom burden (R2=18–36%) and disability (R2=15–18%) at T2 in both cohorts. While the additional prognostic value over and above baseline variables was substantial (delta R2 8–40%), the additional prognostic value over the RPQ at T1 was variable and generally lower (delta R2=1–9%).ConclusionThe STarT-C—a brief screening tool—predicted persistent symptoms and disability in adults following mTBI. The incremental prognostic value of the STarT-C over the RPQ may be variable, but regardless, the tool may be useful for identifying those at risk of prolonged recovery who may benefit from early psychological intervention.

Neuropsychological memory testing is vital in the assessment of neurological conditions but evidence suggests that cultural factors can significantly impact upon the validity of the scores obtained. The lack of normative data for different populations may lead to misleading scores/inappropriate diagnoses. The present study aimed to assess clinicians’ perspectives around the validity of memory tests for use in NZ. Clinicians (n = 76) across NZ answered an online survey assessing the perceived validity of memory tests within the domains of working memory, visual learning and retrieval, auditory learning and retrieval, and prospective and autobiographical memory. Several of the most commonly used tests with a large language component were judged as lacking validity amongst clinicians. Current findings provide further evidence that common neuropsychological tests may lack validity and that the development of NZ-normative data and/or NZ specific tests are now long overdue.

The objective of this study is to test the dysregulation of goal/activity identification hypothesis and the role of psychological flexibility within it. A nonclinical sample of 247 adults completed the Personalized Psychological Flexibility Index (PPFI) and DASS-21. Participants' goal on the PPFI were categorized into abstract or concrete. The moderating effect of psychological flexibility on the relationship between goal abstraction and stress, depression and anxiety were examined. These relationships were explored using specific dimensions of psychological flexibility: harnessing, avoidance and acceptance. A significant interaction was found between psychological flexibility and goal abstraction on stress. Individuals who stipulated an abstract goal and had lower levels of psychological flexibility had significantly higher levels of stress. This relationship was not evident for concrete goals. These findings did not emerge when examining specific dimensions of psychological flexibility suggesting that multiple facets of psychological flexibility contribute to these findings. Harnessing was, however, unique. Individuals with a concrete goal and higher levels of harnessing had significantly higher stress. This study provides preliminary findings regarding the influence of psychological flexibility within the dysregulation of goal/action identification hypothesis. Future research, particularly in clinical samples is needed to confirm these associations and their combined role as a transdiagnostic process.

ObjectivesThis study aimed to determine the feasibility of recruiting, implementing and delivering an acceptance and commitment therapy (ACT) intervention for mild traumatic brain injury (mTBI) (ACTion-mTBI) within a multidisciplinary outpatient mTBI rehabilitation services. The study also aimed to conduct a preliminary investigation of group differences between ACTion-mTBI and an equivalent cognitive behavioural therapy (CBT) intervention on various outcome measures and psychological treatment targets.DesignA two-arm quasiexperimental feasibility study.SettingFive mTBI rehabilitation clinics throughout New Zealand.InterventionPsychologists working in mTBI rehabilitation clinics throughout New Zealand were trained to deliver ACTion-mTBI or CBT. Eligible participants were assigned to either of these interventions based on the psychologist available at the clinic they were referred to. ACTion-mTBI is a five sessions intervention that incorporates all six components of the ACT model. The CBT intervention is an equivalent intervention and incorporating all four components of the CBT model. Both interventions are adapted for an mTBI context.Primary outcome measuresThe primary outcomes were related to the feasibility of ACTion-mTBI. This included recruitment, retention and treatment adherence of participants, study procedure and fidelity of treatment delivery.Secondary outcome measuresTo explore group differences between ACTion-mTBI and CBT on functional disability, postconcussion symptoms, mental health, valued living and psychological flexibility.ResultsThe intervention proved feasible to implement with community-based mTBI rehabilitation services. Attrition rates were comparable between the two psychological interventions and fidelity to the treatments was high. At post-treatment, when covarying pretreatment scores, ACTion-mTBI had a significantly greater improvement in functional disability than CBT (moderate effect). ACTion-mTBI also had a significantly greater reduction in postconcussion symptoms, anxiety and stress. Promisingly, significant improvements in psychological flexibility was also found post-treatment. There were no group differences on depressive symptoms and valued living.ConclusionWe conclude that a full clinical trial of ACTion-mTBI for individuals with mTBI is feasible and warranted.Trial registration numberACTRN1262100059482.

The non-specificity of persisting concussion symptoms (PCS) following concussion can make treatment and rehabilitation a complex and challenging endeavour for clinicians. International studies have demonstrated that in neurologically healthy individuals similar symptoms also exist. This study aimed to examine the presence and frequency of symptoms similar to PCS in neurologically healthy adults in Aotearoa New Zealand and compare these to PCS following concussion. 252 neurologically healthy adults (34.22 years); completed the Rivermead Post-Concussion Questionnaire (RPQ). Scores on this measure were evaluated and compared with 146 individuals who were at least three months post-injury (34.62 years). 25.79% (n = 65) of the neurologically healthy individuals had scores on the RPQ of ≥16. Fatigue was the most commonly endorsed symptom (67.9%), followed by sleep disturbances (59.9%). Certain demographic factors (age, education history and gender) were associated with higher endorsement but only on specific symptoms. The concussion group had significantly higher scores on the RPQ and significantly more individuals with PCS. However, at the individual item level, just over half of PCS symptoms were significantly higher in the concussion group. These symptoms were predominately neurological, with only forgetfulness and irritability significantly different between the concussion and neurologically healthy groups. Symptoms similar to PCS are prevalent in neurologically healthy individuals in Aotearoa New Zealand. The implications of these findings on the rehabilitation and management of PCS are discussed.

Removing invasive rats from islands is a powerful conservation tool, and practitioners are now targeting larger islands for rat eradication. As they do so, they face the challenge of mitigating for potential non-target impacts on native biodiversity that may be susceptible to rodenticides. We report on the eradication of black rats Rattus rattus from Anacapa Island, California, in 2001–2002, which was the first-ever invasive rodent eradication from an entire island where an endemic rodent was present and the first aerial application of a rodenticide in North America. As a mitigation strategy we staggered the rodenticide application over 2 years and held a representative sample of the Anacapa deer mouse Peromyscus maniculatus anacapae in captivity. We also mitigated for bird species potentially susceptible to brodifacoum poisoning and monitored aspects of the terrestrial and marine environments. The free-ranging native rodent population severely declined following rodenticide applications but reintroduction and translocation efforts were successful, and the population quickly recovered to pre-eradication levels. Non-target impacts also included mortality of raptors, gulls and passerines, including high mortality of rufous-crowned sparrows Aimophila ruficeps obscura despite planned mitigation. All observed non-target impacts are expected to be ephemeral; however, further monitoring should reveal details on the dynamics of those impacts. Brodifacoum was not detected in the marine environment or in significant amounts in terrestrial soil, plants and arthropods. Seabird benefits from the rat eradication were quickly realized.

Male Red-winged Blackbirds (Agelaius phoeniceus) have red epaulets that are used as badges for intrasexual competition for territory acquisition and defense. Red epaulets reflect very little across ultraviolet (UV) wavelengths (300–400 nm) yet most birds, including Red-winged Blackbirds, are visually sensitive to UV light. Here, we conducted a field experiment to test if adding UV reflectance (UV+) to epaulets changed the effectiveness of signals to receivers relative to control epaulets. We constructed blackbird models with an epaulet made from red felt that reflected both long-wavelength (i.e., red) and UV wavelengths (UV+). To half of the models we applied sunscreen over the epaulets to block UV reflectance (UV–) and therefore mimic reflectance spectra of natural epaulets. UV+ and UV– models, along with small playback recorders playing oak-a-lee calls, were presented in established territories of male Red-winged Blackbirds. UV+ models received significantly more song flight displays (2017) and song spread displays (2019) from territorial males. Two territorial males physically attacked UV+ models but none attacked UV– models. To our knowledge, this is the first field experiment to add UV color to a plumage signal, resulting in a behavioral response from wild birds, raising questions for future research to explore a potential pre-existing visual bias for UV coloration in Red-winged Blackbirds and potential phylogenetic constraints on expression of UV reflectance of epaulets.

Male Red-winged Blackbirds (Agelaius phoeniceus) have red epaulets that are used as badges for intrasexual competition for territory acquisition and defense. Red epaulets reflect very little across ultraviolet (UV) wavelengths (300-400 nm) yet most birds, including Red-winged Blackbirds, are visually sensitive to UV light. Here, we conducted a field experiment to test if adding UV reflectance (UV+) to epaulets changed the effectiveness of signals to receivers relative to control epaulets. We constructed blackbird models with an epaulet made from red felt that reflected both long-wavelength (i.e., red) and UV wavelengths (UV+). To half of the models we applied sunscreen over the epaulets to block UV reflectance (UV-) and therefore mimic reflectance spectra of natural epaulets. UV+ and UV- models, along with small playback recorders playing oak-a-lee calls, were presented in established territories of male Red-winged Blackbirds. UV+ models received significantly more song flight displays (2017) and song spread displays (2019) from territorial males. Two territorial males physically attacked UV+ models but none attacked UV- models. To our knowledge, this is the first field experiment to add UV color to a plumage signal, resulting in a behavioral response from wild birds, raising questions for future research to explore a potential pre-existing visual bias for UV coloration in Red-winged Blackbirds and potential phylogenetic constraints on expression of UV reflectance of epaulets. Received IS October 2018. Accepted 12 March 2020.