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Correspondence to Dr James H Hull, Respiratory Medicine, Royal Brompton Hospital, London, UK; j.hull@rbht.nhs.uk Introduction This British Thoracic Society (BTS) Clinical Statement addresses the diagnosis, evaluation and management of respiratory problems in athletic individuals. [...]it is estimated that at least one in four individuals report troublesome exercise-related respiratory issues, such as breathlessness, cough and/or wheeze.1 Moreover, in competitive athletes, asthma is the most prevalent medical condition and encountered in approximately a quarter of those partaking in endurance sport.2 3 Although athletic individuals can develop any cardiorespiratory illness and thus general clinical guideline documents are broadly applicable, studies over the past three decades have highlighted issues that are particularly relevant when assessing respiratory problems in athletic individuals or in certain sporting scenarios. Scope The purpose of this document was to provide concise and pragmatic guidance to help clinicians from all aspects of the multidisciplinary team (ie, including doctors, physiotherapists, speech and language therapists, pharmacists, physiologists, psychologists and specialist nurses), in both primary and secondary care settings, in assessing and managing respiratory problems in athletic individuals. A thorough history should characterise the precise nature of exercise-related clinical features (eg, breathlessness and wheeze) and their relationship with exercise intensity and recovery.

Asthma is the most common chronic condition of childhood. In this review, we discuss an overview of strategies to empower children and young people with asthma. The key aspects of empowerment are to enable shared decision making and self-management, and help children minimise the impact of asthma on their life. The evidence behind these strategies is either sparse or heterogenous, and it is difficult to identify which interventions are most likely to improve clinical outcomes. Wider determinants of health, in high-resource and low-resource settings, can be disempowering for children with asthma. New approaches to technology could help empower young people with asthma and other chronic health conditions.

Abstract Although theoretical and clinical literature emphasize the role of both an unwillingness to experience emotional distress and physical pain tolerance in deliberate self-harm (DSH), research on their associations with DSH remains limited. This study sought to examine the relationships between DSH and the willingness to experience emotional distress and tolerate physical pain, including the moderating role of interpersonal distress in these relationships. To this end, young adults with recent DSH (n = 43) and controls without any DSH (n = 52) were randomly assigned to 1 of 2 emotion-induction conditions (distressing or neutral), after which behavioral measures of both the willingness to experience distress and physical pain tolerance were obtained. Consistent with hypotheses, findings indicated heightened physical pain tolerance among self-harming individuals only under conditions of interpersonal distress. Furthermore, findings provided some support for the hypothesized association between DSH and the unwillingness to experience emotional distress, suggesting that self-harming women evidence less willingness to experience emotional distress only under conditions of depleted regulatory capacity (eg, following an interpersonal stressor).

There is increasing awareness of the prevalence of deliberate self-harm (DSH) although the phenomenon is still poorly understood. Those who self-harm often have a poor long-term prognosis, yet systematic focused treatment interventions are scarce. DSH appears to share fundamental characteristics with addictive behaviour, including; impulsive or compulsive urges to act in the presence of triggers, positive and negative reinforcing consequences and endorsement of the diagnostic criteria for clinical dependence. Given this fact, a behavioural mode of DSH may be appropriate. A range of events are anecdotally reported to trigger DSH. This thesis was designed to identify these cues, to develop an understanding of how those who self-harm respond to these cues and the processes by which these cues may operate to maintain DSH. An intervention based on the management of urges to self-harm in the presence of these cues was developed. Study I identified that triggers for DSH (interpersonal, intrapersonal and environmental) were similar to those that reliably predict addictive behaviour. Respondents endorsed the diagnostic criteria for dependency and reported that the act of DSH reduced negative emotions. The second two studies identified self-reported cue reactivity, and generalised hyperarousal to both DSH and neutral stimuli in those who self-harm but no evidence of psychophysiological cue reactivity. Study IV used ERP methodology to evaluate cue reactivity at the CNS level and to evaluate two mechanisms by which cues might operate to maintain DSH. There was some preliminary support for enhanced preconscious attentional bias towards emotional, but not environmental DSH cues, and no support for emotional interference. Study V identified that those who self-harm exhibited enhanced tolerance to physical and psychological stressors, and that priming with interpersonal distress did not impact on this tolerance. Finally, a single case intervention study identified a reduction in DSH, reduced psychophysiological arousal and urges to self-harm and improved clinical symptomatology. However, clinical improvements were not time-locked to targeted exposure intervention phases. The clinical and theoretical implications for these findings are discussed.

Ensuring the validity of individual responses to psychometric tests is important in a wide range of psychology practice and research. This study compares a number of methods for detecting test faking on a measure not designed with explicit validity checks. A total of 270 students took part in two related studies, one using a standard 'pencil and paper' test presentation and the other a computer-based presentation. Techniques such as responses to specific test items and speed of responding may be useful for assessing the validity of responses. The implications are that such procedures may offer methods for identifying faked responding in a range of psychometric instruments where previously this has not been possible.

One potential target for intervention for individuals with persecutory delusions is direct enhancement of emotional processing. The clinical intervention literature describes a range of techniques that have been used to enhance emotional processing. Examination of the focus of these interventions, and study of the theoretical literature, identified three key mechanisms that might impede emotional processing: (1) emotional inhibition; (2) a lack of metacognitive awareness; and (3) nonacceptance (avoidance) of internal experiences. This chapter describes the authors’ recent work examining this. A brief intervention, emotional processing and metacognitive awareness (EPMA), was developed and piloted with patients who had persistent persecutory delusions. It was found that an intervention that directly targeted worry reduced levels of persecutory delusions and associated distress. The results indicate that encouraging patients to talk about their delusional experiences in a structured intervention such as EPMA may have therapeutic benefits.

Visual problems are an under-reported sequela following stroke. The aim of this study is to report annual incidence and point prevalence of visual problems in an acute adult stroke population and to explore feasibility of early timing of visual assessment. Multi-centre acute stroke unit, prospective, epidemiology study (1st July 2014 to 30th June 2015). Orthoptists reviewed all patients with assessment of visual acuity, visual fields, ocular alignment, ocular motility, visual inattention and visual perception. 1033 patients underwent visual screening at a median of 3 days (IQR 2) and full visual assessment at a median of 4 days (IQR 7) after the incident stroke: 52% men, 48% women, mean age 73 years and 87% ischaemic strokes. Excluding pre-existent eye problems, the incidence of new onset visual sequelae was 48% for all stroke admissions and 60% in stroke survivors. Three quarters 752/1033 (73%) had visual problems (point prevalence): 56% with impaired central vision, 40% eye movement abnormalities, 28% visual field loss, 27% visual inattention, 5% visual perceptual disorders. 281/1033 (27%) had normal eye exams. Incidence and point prevalence of visual problems in acute stroke is alarmingly high, affecting over half the survivors. For most, visual screening and full visual assessment was achieved within about 5 days of stroke onset. Crucial information can thus be provided on visual status and its functional significance to the stroke team, patients and carers, enabling early intervention.

Immune cell dysfunction within the tumor microenvironment (TME) undermines the control of cancer progression. Established tumors contain phenotypically distinct, tumor-specific natural killer (NK) cells; however, the temporal dynamics, mechanistic underpinning and functional significance of the NK cell compartment remains incompletely understood. Here, we use photo-labeling, combined with longitudinal transcriptomic and cellular analyses, to interrogate the fate of intratumoral NK cells. We reveal that NK cells rapidly lose effector functions and adopt a distinct phenotypic state with features associated with tissue residency. NK cell depletion from established tumors did not alter tumor growth, indicating that intratumoral NK cells cease to actively contribute to anti-tumor responses. IL-15 administration prevented loss of function and improved tumor control, generating intratumoral NK cells with both tissue-residency characteristics and enhanced effector function. Collectively, our data reveals the fate of NK cells after recruitment into tumors and provides insight into how their function may be revived.