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Rationale: The rat cognitive effort task (rCET), a rodent model of cognitive rather than physical effort, requires animals to choose between an easy or hard visuospatial discrimination, with a correct hard choice more highly rewarded. Like in humans, there is stable individual variation in choice behavior. In previous reports, animals were divided into two groups—workers and slackers—based on their mean preference for the harder option. Although these groups differed in their response to pharmacological challenges, the rationale for using this criterion for grouping was not robust. Methods: We collated experimental data from multiple cohorts of male and female rats performing the rCET and used a model-based framework combining drift diffusion modeling with cluster analysis to identify the decision-making processes underlying variation in choice behavior. Results: We verified that workers and slackers are statistically different groups but also found distinct intra-group profiles. These subgroups exhibited dissociable performance during the attentional phase, linked to distinct decision-making profiles during choice. Reanalysis of previous pharmacology data using this model-based framework showed that serotonergic drug effects were explained by changes in decision boundaries and non-decision times, while scopolamine's effects were driven by changes in decision starting points and rates of evidence accumulation. Conclusions: Modeling revealed the decision-making processes that are associated with cognitive effort costs, and how these differ across individuals. Reanalysis of drug data provided insight into the mechanisms through which different neurotransmitter systems impact cognitively effortful attention and decision-making processes, with relevance to multiple psychiatric disorders. [ABSTRACT FROM AUTHOR]

Deficits in cost/benefit decision making is a critical risk factor for gambling disorder. Reward‐paired cues may play an important role, as these stimuli can enhance risk preference in rats. Despite extensive research implicating the dorsal striatum in the compulsive aspects of addiction, the role of nigrostriatal dopaminergic activity in cue‐induced risk preference remains unclear, particularly in females. Accordingly, we examined the effects of manipulating the dopaminergic nigrostriatal pathway on cue‐induced risky choice in female rats. TH:Cre rats were trained on the cued version of the rat Gambling Task. This task was designed such that maximal reward is attained by avoiding the high‐risk, high‐reward options and instead favouring the options associated with lower per‐trial gains, as they feature less frequent and shorter time‐out penalties. Adding reward‐paired audiovisual cues to the task leads to greater risky choice on average. To assess the role of the nigrostriatal pathway, a viral vector carrying either Cre‐dependent inhibitory or excitatory DREADD was infused into the substantia nigra. Rats then received clozapine‐N‐oxide either during task acquisition or after a stable performance baseline was reached. Inhibition of this pathway accelerated the development of risk preference in early sessions and increased risky choice during performance, but long‐term inhibition actually improved decision making. Activation of this pathway had minimal effects. These results provide evidence for the involvement of the dopaminergic nigrostriatal pathway in cue‐induced risk preference in females, therefore shedding light on its role in cost/benefit decision‐making deficits and expanding our knowledge of the female dopaminergic system. [ABSTRACT FROM AUTHOR]

High-intensity resistance training (HIRT) is commonly performed by structural firefighters on duty to enhance occupational readiness. However, exercise-induced fatigue may negatively impact subsequent occupational performance. Therefore, the purpose of this study was to assess the acute effect of HIRT on subsequent occupational physical ability in structural firefighters and to determine the time course of recovery. Seven resistance-trained male firefighters performed a timed maximal effort simulated fireground test (SFGT) in 3 randomized conditions: baseline (SFGTbaseline), 10 minutes post HIRT (SFGT10min), and 60 minutes post HIRT (SFGT60min). Work efficiency and air depletion were assessed during the SFGT. The timed HIRT session consisted of a standardized set of exercises using absolute training loads. Repeated measures analysis of variance and minimal difference (MD) analysis assessed group and individual effects between the conditions, respectively. The level of significance was set at p < 0.05. SFGT10min completion time was greater than SFGTbaseline (430 ± 137 vs. 297 ± 69 seconds, p < 0.01), with no difference between SFGTbaseline and SFGT60min (297 ± 69 vs. 326 ± 89 seconds, p = 0.08). The MD analysis indicated that all firefighters' SFGT10min times exceeded the MD (±26.4 seconds) compared with SFGTbaseline. However, 43% of firefighters still exceeded the MD at SFGT60min. Air depletion during SFGT10min was greater than that during SFGTbaseline (2,786 ± 488 vs. 2,186 ± 276 lb·in-2, p = 0.02), with no difference between SFGTbaseline and SFGT60min (p = 0.25). Work efficiency during SFGT10min was 40% lower than that during SFGTbaseline (p < 0.01), with no difference between SFGTbaseline and SFGT60min (p = 0.25). These findings indicate that an acute bout of HIRT decreases multiple descriptors of firefighters' occupational performance 10 minutes post exercise with varied responses at 60 minutes post exercise. [ABSTRACT FROM AUTHOR]

The early attainment of high COVID-19 vaccination rates can minimize avoidable hospitalizations/deaths. The fifth wave COVID-19 outbreak in Hong Kong caused >9000 deaths, and most of them were unvaccinated older people. This study hence investigated determinants of taking the first dose vaccination at a later phase (Phase 3: during the fifth wave outbreak, i.e., February–July 2022) versus two earlier phases (Phase 1: first six months since vaccine rollout, i.e., February–July 2021; Phase 2: six months prior to the outbreak, i.e., August 2021–January 2022) via a random telephone survey among 386 ever-vaccinated Hong Kong older people aged ≥60 (June/July 2022). A total of 27.7%, 51.1%, and 21.3% took the first dose at Phase 1, Phase 2, and Phase 3, respectively. Unfavorable perceptions related to COVID-19/vaccination, exposure to conflicting/counter-information about the suitability of older people's vaccination from various sources, unsupportive family influences prior to the outbreak, and depressive symptoms were significantly associated with taking the first dose at Phase 3 instead of Phase 1 and Phase 2. To speed up COVID-19 vaccination and avoid unnecessary deaths, the government and health professionals should rectify misinformation, provide clear/consistent information for older people and their family members, and focus on those having depressive symptoms at an earlier stage of the pandemic. [ABSTRACT FROM AUTHOR]

Background: The levels of resource losses due to coronavirus disease 2019 (COVID-19) and mental distress may change during the pandemic period. Based on the Conservation of Resource (COR) Theory, this study investigated such changes and the mediation between survey time (Round 2 versus Round 1) and depression via resource losses. Methods: Two serial random population-based telephone surveys interviewed 209 and 458 Hong Kong Chinese adults in April 2020 and May 2021, respectively. Probable depression was defined as 9-item Patient Health Questionnaire (PHQ-9) score ≥ 10. The validated Conservation of Resources Scale for COVID-19 (CORS-COVID-19) scale was used to assess resource losses due to COVID-19. Multivariable logistic regression analysis, hierarchical logistic regression analysis, and structural equation modeling (SEM) was conducted to test the association, interaction, and mediation hypotheses, respectively. Results: The prevalence of probable depression declined from 8.6% to 1.0% over time, together with reductions in losses of financial resource (Cohen's d = 0.88), future control (Cohen's d = 0.39), social resource (Cohen's d = 0.60), and family resource (Cohen's d = 0.36) due to COVID-19. All the overall scale/subscales of the CORS-COVID-19 were positively and associated with probable depression [adjusted odds ratio (aOR) ranged from 2.72 to 42.30]. In SEM, the survey time was negatively associated with the latent variable of resource loss (β = − 0.46), which in turn was positively associated with probable depression (β = 0.73). In addition, the direct effect of survey time on probable depression was statistically non-significant (β = − 0.08), indicating a full mediation effect of resource losses. Conclusions: The lessening of the resource losses might have fully accounted for the significant decline in probable depression from Month 3 to 15 since the first COVID-19 outbreak in Hong Kong, China. The level of depression might have increased during the first phase of the pandemic, but might decline in the later phases if resources losses could be lessened. All stakeholders should hence work together to minimize individuals' COVID-19-related resource losses to prevent depression in the general population, as COVID-19 might be lasting. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of under-diagnosis among individuals with obstructive sleep apnea (OSA) is alarming, and may be associated with perceptions regarding OSA. To facilitate future studies on OSA, this study validated the revised version of the Illness Perception Questionnaire (IPQ-R) for OSA in a general population. Methods: A random anonymous population-based telephone survey interviewed 580 adults aged ≥ 50 years in Hong Kong, who self-reported not having been told by doctors as having OSA, from February 5 to March 19, 2021. Results: The confirmatory factor analysis identified a modified 7-factor model (i.e., timeline chronic, consequence, personal control, treatment control, illness coherence, timeline cyclical, and emotional representation) that showed satisfactory model fit index and internal consistency. Nine items were removed from the original version because of low factor loadings. No floor and ceiling effects were observed. Convergent validity was supported by the positive associations between the consequence subscale with perceived negative outcomes of OSA and between the illness coherence subscale and perceived understanding of OSA symptoms. The participants tended to endorse the items of timeline chronic, treatment control, and illness coherence but not with those of emotional representations. The mean scores of the IPQ-R subscales differed by age and education level. Conclusion: The modified IPQ-R of OSA showed acceptable psychometric properties. It is applicable to assessing illness perceptions of OSA in the Chinese general population aged ≥ 50 years not having received OSA diagnosis. The validated tool would support future studies and health practices related to OSA. [ABSTRACT FROM AUTHOR]

Importance: Although perceived as relatively harmless and nonaddictive, adolescent cannabis use significantly increases the likelihood of developing cannabis use disorder in adulthood, especially for high-potency cannabis. Risky decision-making is associated with chronic cannabis use, but given confounds of human studies, it remains unclear whether adolescent cannabis exposure and Δ9-tetrahydrocannabinol (THC) potency specifically predicts risky decision-making or influences cognitive response to the drug later in life.Objective: To leverage a human data set of cannabis users and a rat model to evaluate the long-term outcomes of adolescent THC exposure on adult decision-making and impulse control.Design, Setting, and Participants: This translational rat study tested the link between adolescent THC exposure and adulthood decision-making. A reanalysis of a previously published dataset of human chronic cannabis users was conducted to evaluate decision-making phenotypes. Computational modeling assessed the human and animal results in a single framework. Data were collected from 2017 to 2020 and analyzed from 2020 to 2022.Main Outcomes and Measures: Decision-making was measured by the Iowa Gambling Task (IGT) and Rat Gambling Task (rGT). Impulse control was assessed in the rat model. Computational modeling was used to determine reward and punishment learning rates and learning strategy used by cannabis users and THC-exposed rats. Cell-specific molecular measures were conducted in the prefrontal cortex and amygdala.Results: Of 37 participants, 24 (65%) were male, and the mean (SD) age was 33.0 (8.3) years. Chronic cannabis users (n = 22; mean [SE] IGT score, -5.182 [1.262]) showed disadvantageous decision-making compared with controls (n = 15; mean [SE] IGT score, 7.133 [2.687]; Cohen d = 1.436). Risky choice was associated with increased reward learning (mean [SE] IGT score: cannabis user, 0.170 [0.018]; control, 0.046 [0.008]; Cohen d = 1.895) and a strategy favoring exploration vs long-term gains (mean [SE] IGT score: cannabis user, 0.088 [0.012]; control, 0.020 [0.002]; Cohen d = 2.218). Rats exposed to high-dose THC but not low-dose THC during adolescence also showed increased risky decision-making (mean [SE] rGT score: vehicle, 46.17 [7.02]; low-dose THC, 69.45 [6.01]; high-dose THC, 21.97 [11.98]; Cohen d = 0.433) and elevated reward learning rates (mean [SE] rGT score: vehicle, 0.17 [0.01]; low-dose THC, 0.10 [0.01]; high-dose THC, 0.24 [0.06]; Cohen d = 1.541) during task acquisition. These animals were also uniquely susceptible to increased cognitive impairments after reexposure to THC in adulthood, which was correlated with even greater reward learning (r = -0.525; P < .001) and a shift in strategy (r = 0.502; P < .001), similar to results seen in human cannabis users. Molecular studies revealed that adolescent THC dose differentially affected cannabinoid-1 receptor messenger RNA expression in the prelimbic cortex and basolateral amygdala in a layer- and cell-specific manner. Further, astrocyte glial fibrillary acidic protein messenger RNA expression associated with cognitive deficits apparent with adult THC reexposure.Conclusions and Relevance: In this translational study, high-dose adolescent THC exposure was associated with cognitive vulnerability in adulthood, especially with THC re-exposure. These data also suggest a link between astrocytes and cognition that altogether provides important insights regarding the neurobiological genesis of risky cannabis use that may help promote prevention and treatment efforts. [ABSTRACT FROM AUTHOR]

Promotion of COVID-19 vaccination requires understanding its determinants, an important one of which is outcome expectancy. However, reliable and valid measurement tools are absent. This study thus developed and validated an Outcome Expectancy Scale for COVID-19 Vaccination (OES-COVID-19). An inductive approach was used for scale development; content validity of the items was then assessed by an independent evaluation expert panel. Iteratively, 17 scale items were created and validated in a population-based telephone survey conducted among 500 adults of the general population in Hong Kong, China, from August to September 2021. Using half of the sample (n = 249), exploratory factor analyses identified four factors of the OES-COVID-19, including (a) positive contribution to society, (b) functional benefits, (c) protective effect, and (d) negative impacts. Confirmatory factor analysis of these factors conducted on the second subsample (n = 251) was satisfactory. The OES-COVID-19 showed good psychometric properties in terms of internal consistency, absence of floor/ceiling effects, and concurrent validity. The newly created and validated OES-COVID-19 is deemed suitable for application. It may advance future studies related to COVID-19 vaccination behavior and intention, and potentially allows for comparisons across studies. Further validation with modifications across countries, populations, and phase of the pandemic are warranted. [ABSTRACT FROM AUTHOR]

We report on the preparation of synthetically versatile N-carboxyanhydrides (NCAs) directly from amino acids and CO2 using n-propylphosphonic anhydride. Most of the NCAs were isolated with >95% purity after simple workup, avoiding the need for tedious purification procedures typically required using conventional methods. Because the reagents and conditions employed are mild, tandem reactions with moisture-sensitive NCAs were carried out to transform them into the medicinally active alkaloids tryptanthrin and phaitanthrin A in one pot. A qualitative analysis revealed that our NCA synthesis approach is more green than conventional methods, which all directly or indirectly use the highly poisonous gas phosgene. [ABSTRACT FROM AUTHOR]

Outcome expectancies involving self-directed and others-directed domains are potential determinants of completed or scheduled first-dose COVID-19 vaccination (CSFCV). This study investigated factors of CSFCV, including (a) self-directed motives [personal positive outcome expectancies (POE) and personal negative outcome expectancy (NOE)], and (b) others-directed motives (societal POE and the personality trait of prosociality). It also investigated the mediations of personal POE between societal POE and CSFCV, and moderations of prosociality between personal POE/personal NOE/societal POE and CSFCV. A cross-sectional population-based telephone survey interviewed 500 people aged 18-75 in Hong Kong in May 2021. The prevalence of CSFCV was 21.0%. Significant factors of CSFCV included personal POE (i.e., physical/practical/emotional/interpersonal benefit), personal NOE, and societal POE. The association between societal POE and CSFCV was fully mediated by the overall scale and some domains of personal POE. Furthermore, the association between physical benefit and CSFCV was stronger at lower levels of prosociality; prosociality showed a stronger effect on CSFCV at lower levels of physical benefit. The results suggest that self-directed motives might be more important than others-directed motives in affecting CSFCV. The findings require confirmations from longitudinal studies and cross-country comparisons. [ABSTRACT FROM AUTHOR]

Expert judgment can be seen throughout climate science and even more prominently when discussing climate tipping points. To provide an accurate characterization of expert judgment we begin by evaluating the existing literature on expertise as it relates to climate science as a whole, before then focusing the literature review on the role of expert judgment in the unique context of climate tipping points. From this we turn our attention to the structured expert elicitation protocols specifically developed for producing expert judgments about tipping points. We highlight that expert elicitation is not only used for the quantification of uncertainty in this context, but also for the very identification and characterization of tipping points and their interactions, making expert judgment in itself a genuine scientific output. The central role of expert judgment in this domain raises several epistemic issues that require careful attention. Among other topics, we discuss the relationship between expert judgment and modeling, as well as the nonepistemic values that are involved in the production of expert judgments, highlighting how the elicitation protocols can be used to manage these values. In the perspective of climate change, clarifying the epistemic foundations of expert judgment in this context can help to navigate the epistemic situation between self‐defeating alarmism and blind dismissal, thus contributing to a better understanding of the challenges related to climate (and Earth system) tipping points. This article is categorized under:Climate, History, Society, Culture > Ideas and KnowledgeThe Social Status of Climate Change Knowledge > Climate Science and Decision Making [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has caused significant negative socio-political, economic, and psychological consequences. To investigate the impact of individual-level (illness representations of COVID-19) and structurally derived (anticipated social-political development in the economy, security, and social harmony in the next year) factors, and their potential moderation effects on depressive symptoms. An anonymous population-based telephone survey was conducted among the general public of Hong Kong, China during 3–10 April 2020 (n = 300, response rate 56%). Depressive symptoms were assessed by the validated Chinese version of the Patient Health Questionnaire-9. Of the participants, 8.7% showed probable moderate-to-severe depression. Hierarchical linear regression models showed that illness representations of personal/treatment control and emotional responses and anticipated deterioration in social harmony were independently and significantly associated with depressive symptoms. Anticipated deterioration in security significantly moderated the associations between perceived consequence/treatment control of COVID-19 and depressive symptoms, such that the associations were stronger among people who anticipated a strong deterioration in security. The findings suggested that perceptions of COVID-19 and future social-political development jointly and interactively contributed to depressive symptoms during the COVID-19 pandemic. Mental health professionals and promotions should take the multiple-level mental health determinants into account. [ABSTRACT FROM AUTHOR]

Background: The prevalence of coronavirus disease 2019 (COVID-19) vaccination is very critical in controlling COVID-19. This study mainly aimed to (1) investigate behavioral intentions of COVID-19 vaccination under various specific scenarios, and (2) associated factors of the afore-mentioned vaccination intentions. Methods: A random anonymous telephone survey interviewed 450 Chinese adults from September 16-30, 2020 in Hong Kong, China. Nine scenarios of behavioral intentions of COVID-19 vaccinations were measured combining effectiveness (80% versus 50%), safety (rare versus common mild side effect), and cost (free versus HK$ 500). Results: The prevalence of behavioral intentions of COVID-19 vaccination under the 9 specific scenarios was very low and varied greatly (4.2% to 38.0%). The prospective countries of manufacture also influenced vaccination intention (eg, Japan: 55.8% vs China: 31.1%). Only 13.1% intended to take up COVID-19 vaccination at the soonest upon its availability. The attributes of effectiveness and side effect influenced vaccination intention most. Positively associated factors of behavioral intentions of COVID-19 vaccination included trust/satisfaction toward the government, exposure to positive social media information about COVID-19 vaccines, descriptive norms, perceived impact on the pandemic, perceived duration of protectiveness, and life satisfaction. Conclusion: Intention of COVID-19 vaccination was low in the Hong Kong general population, especially among younger people, females, and single people. Health promotion is warranted to enhance the intention. The significant factors identified in this study may be considered when designing such health promotion. Future research is required to confirm the findings in other countries. Such studies should pay attention to the specific context of cost, safety, and effectiveness, which would lead to different responses in the level of behavioral intention of COVID-19 vaccination (BICV). [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the associations between some factors related to working from home status (WFHS) and positive/negative experiences due to social distancing and their interactions effects on depressive symptoms during the COVID-19 pandemic. Methods: A random population-based telephone survey interviewed income-earning adults in the Hong Kong general population during April 21–28, 2020 (n = 200). Results: Mild to severe depression (according to PHQ-9) was reported by 12% of the participants. The prevalence of WFHS categories was 14% for 3–7 days and 13% for ≥ 8 days (past 2 weeks). The multivariable regression analysis showed that, social isolation (β = 0.36; p < 0.001), relaxation feeling in daily life (β = − 0.22; p = 0.002), and WFHS ≥ 8 days (β = 0.15; p = 0.027), but not perceived huge inconvenience and improved family relationship, were associated with depressive symptoms. Statistically significant interaction effects were found. Some positive experiences buffered the potential harms of some negative experiences of social distancing on depressive symptoms; WFHS ≥ 8 days significantly moderated the risk/protective effects of social isolation, improved family relationship, and relaxation feeling on depressive symptoms. Conclusions: Social distancing is double-edged. Positive experiences should be maximized while negative experiences be minimized, as both were directly and interactively associated with depression. Intensive but not mild to moderate (< 80%) WFHS may impact depressive symptoms negatively via its direct association with depression; it also moderated the associations between positive/negative experiences due to social distancing and depression. Further research is required to discern the inter-relationships among WFHS, positive/negative experiences of social distancing, and depression to better cope with the stressful pandemic. [ABSTRACT FROM AUTHOR]

Background: Restriction of gathering size in all public areas is a newly and commonly exercised governmental social distancing policy during the COVID-19 pandemic. Its effectiveness depends on the general public's compliance. This study applied the Protection Motivation Theory (PMT) to investigate determinants (i.e., perceived severity, perceived susceptibility, perceived response efficacy, and perceived self-efficacy) of compliance with the social distancing policy of banning gathering of >4 people in all public areas (BG4PA) in the Hong Kong general adult population. Methods: 300 participants were interviewed through a population-based telephone survey during April 21–28, 2020. Results: The compliance rate of BG4PA was high (78%). Adjusted for the background factors, multiple linear regression analysis found that perceived response efficacy and perceived self-efficacy were significantly and positively associated with compliance with BG4PA (p<0.05), while the associations between perceived severity/perceived susceptibility and compliance were of marginal significance (0.05

The COVID-19 pandemic response limited access to many traditional forms of physical activity (PA). Purpose:To assess changes in objectively measured PAofUniversity staff during the initial stageofthe COVID-19 pandemic. We implemented a repeated measures natural experiment design. PA data (walking distance, steps∙d#x2D;1, and Moderate#x2D;to#x2D;Vigorous PA (MVPA) time) from commercial grade triaxial accelerometers were collected from employees (N#x3D;625) of a large, public university in the southeast United States during the months of Jan#x2D;May in calendar years 2019 and 2020. Walking distance (6#x2D;9#x25;, p#x3C;0.001) and steps∙d#x2D;1(7#x2D;11#x25;, p#x3C;0.001) were lower during April and May 2020 compared to 2019. However, MVPA time was not significantly different among calendar years for the months of March#x2D;May. Steps∙d#x2D;1significantly decreased after WHO's worldwide pandemic declaration (10,348#xB1;171 v. 9551#xB1;156 steps∙d#x2D;1, p#x3C;0.001) and campus closure (10,100#xB1;160 v. 9,186#xB1;167 steps∙d#x2D;1, p#x3C;0.001). Conversely, steps∙d#x2D;1significantly increased after implementation of the state's "Healthy at Home" order (9,693#xB1;177 vs. 10,156#xB1;185 steps∙d#x2D;1, p#x3C;0.001). A decrease in daily steps, but not MVPA, suggests increased sedentary behavior, not reduced participation in exercise, during the early stages of the COVID#x2D;19 pandemic. Specific pandemic response policies may positively or negatively affect PA and sedentary behavior. [ABSTRACT FROM AUTHOR]

Objective: High-dose methotrexate (HDMTX) is a mainstay therapeutic agent for the treatment of diverse hematological malignancies, and it plays a significant role in interindividual variability regarding the pharmacokinetics and toxicity. The genetic association of HDMTX has been widely investigated, but the conflicting results have complicated the clinical utility. Therefore, this systematic review aims to determine the role of gene variants within the HDMTX pathway and to fill the gap between knowledge and clinical practice. Methods: Databases including EMBASE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and the Clinical Trials.gov were searched from inception to November 2020. We included twelve single-nucleotide polymorphisms (SNPs) within the HDMTX pathway, involving RFC1 , SLCO1B1 , ABCB1 , FPGS , GGH , MTHFR , DHFR , TYMS , and ATIC. Meta-analysis was conducted by using Cochrane Collaboration Review Manager software 5.3. The odds ratios (ORs) or hazard ratios (HRs) with 95% confidence interval (95% CI) were analyzed to evaluate the associations between SNPs and clinical outcomes. This study was performed according to the PRISMA guideline. Results: In total, 34 studies with 4102 subjects were identified for the association analysis. Nine SNPs involving MTHFR , RFC1 , ABCB1 , SLCO1B1 , TYMS , FPGS , and ATIC genes were investigated, while none of studies reported the polymorphisms of GGH and DHFR yet. Two SNPs were statistically associated with the increased risk of HDMTX toxicity: MTHFR 677C>T and hepatotoxicity (dominant, OR=1.52, 95% CI=1.03-2.23; recessive, OR=1.68, 95% CI=1.10–2.55; allelic, OR=1.41, 95% CI=1.01–1.97), mucositis (dominant, OR=2.11, 95% CI=1.31–3.41; allelic, OR=1.91, 95% CI=1.28–2.85), and renal toxicity (recessive, OR=3.54, 95% CI=1.81–6.90; allelic, OR=1.89, 95% CI=1.18–3.02); ABCB1 3435C>T and hepatotoxicity (dominant, OR=3.80, 95% CI=1.68-8.61), whereas a tendency toward the decreased risk of HDMTX toxicity was present in three SNPs: TYMS 2R>3R and mucositis (dominant, OR=0.66, 95% CI=0.47–0.94); RFC1 80A>G and hepatotoxicity (recessive, OR=0.35, 95% CI=0.16–0.76); and MTHFR 1298A>C and renal toxicity (allelic, OR=0.41, 95% CI=0.18–0.97). Since the data of prognosis outcomes was substantially lacking, current studies were underpowered to investigate the genetic association. Conclusions: We conclude that genotyping of MTHFR and/or ABCB1 polymorphisms prior to treatment, MTHFR 677C>T particularly, is likely to be potentially useful with the aim of tailoring HDMTX therapy and thus reducing toxicity in patients with hematological malignancies. [ABSTRACT FROM AUTHOR]

Counterinsurgency does not increase the legitimacy of, or support for, central governments engaged in internal conflicts. Recent research shows quantifiable degrees of government legitimacy, national identity, and population security are necessary precursors and accurate predictors of a government's ability to outlast a civil uprising. Because the first two predictors--government legitimacy and national identity--can be measured and do not increase during a conflict, the probability of government failure in most cases can be accurately predicted when the conflict starts. [ABSTRACT FROM AUTHOR]

Social and physical distancing is important in controlling the COVID-19 pandemic and it impacts people's financial/social well-being tremendously. This study tested the application of the Theory of Planned Behaviors (TPB) to three types of social/physical distancing indicators (i.e. the number of close physical contacts on a single day in public venues, the frequencies of avoiding social gathering, and the levels of physical distancing in public venues). A population-based random telephone survey interviewed 300 Hong Kong Chinese adults in April 2020 when gatherings involving >4 people were banned. The participants on average made 15.3 close physical contacts (<1.5 m and for >3 min) in a day (5.0 in public transportation). About 80% practiced social distancing (avoided/reduced social gatherings) and physical distancing in public spaces (e.g. avoidance of going out, visiting crowded places, and gatherings of >4 people) but only 35.4% avoided using public transportations. Positive but not negative attitudes (inconvenience and lack of necessity), perceived behavioral control, and subjective norm were significantly associated with the three social/physical distancing outcomes. The data suggest that the levels of social/physical distancing were relatively high in the Hong Kong general population, and it, in general, supports the application of TPB to understand factors of social distancing for preventing COVID-19. Health promotion should take the findings into account. Furthermore, cross-cultural and time-series studies are warranted to compare the levels of social/physical distancing across countries and further explore their effectiveness in controlling the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Purpose: To investigate men's experiences of receiving external-beam radiotherapy (EBRT) with neoadjuvant Androgen Deprivation Therapy (ADT) for localized prostate cancer (LPCa) in the ProtecT trial.Methods: A longitudinal qualitative interview study was embedded in the ProtecT RCT. Sixteen men with clinically LPCa who underwent EBRT in ProtecT were purposively sampled to include a range of socio-demographic and clinical characteristics. They participated in serial in-depth qualitative interviews for up to 8 years post-treatment, exploring experiences of treatment and its side effects over time.Results: Men experienced bowel, sexual, and urinary side effects, mostly in the short term but some persisted and were bothersome. Most men downplayed the impacts, voicing expectations of age-related decline, and normalizing these changes. There was some reticence to seek help, with men prioritizing their relationships and overall health and well-being over returning to pretreatment levels of function. Some unmet needs with regard to information about treatment schedules and side effects were reported, particularly among men with continuing functional symptoms.Conclusions: These findings reinforce the importance of providing universal clear, concise, and timely information and supportive resources in the short term, and more targeted and detailed information and care in the longer term to maintain and improve treatment experiences for men undergoing EBRT. [ABSTRACT FROM AUTHOR]

The World Health Organization recommends young children receive influenza vaccination (IV) annually. Stratified by children's previous IV status, this study investigated the associated factors of parental intention to let their children aged 24 to 59 months receive IV in the next 12 months in Hong Kong, China. We conducted a cross-sectional population-based telephone survey among 540 Chinese parents of children aged 24 to 59 months. The prevalence of parental intention regarding their child's IV was 68.9% and 19.8%, respectively, in the ever-vaccinated and never-vaccinated groups. Adjusted for background factors, perceived susceptibility (adjusted odds ratio [ORa] = 3.20, 95% confidence interval [CI] = 1.07-9.54), perceived benefit (ORa = 4.77, 95% CI = 2.52-9.05), perceived barrier (ORa = 0.38, 95% CI = 0.17-0.84), cue to action (ORa = 3.57, 95% CI = 1.88-6.78), subjective norm (ORa = 11.23, 95% CI = 6.17-20.46), and having family members vaccinated (ORa = 1.79, 95% CI = 1.09-2.96) were associated with parental intention for ever-vaccinated children's IV, while only perceived benefit (ORa = 8.85, 95% CI = 3.36-23.34) and subjective norm (ORa = 21.66, 95% CI = 9.25-50.71) were significant for never-vaccinated children. Our findings showed that the identified factors and applicability of the health belief model varied according to child's vaccination status. Health promotion should consider segmentation principles. Besides modifying related cognitions like perceived benefit and barrier (only for the ever-vaccinated group), such programs should improve cue to action involving health professionals and family members and create supportive subjective norms. [ABSTRACT FROM AUTHOR]

Organisms must frequently evaluate the amount of effort to invest in pursuing future rewards. Despite explicit awareness of the potential benefits of cognitive work, individuals vary in their willingness to attempt cognitively demanding tasks, regardless of intellectual ability. Such differences may suggest that the degree to which cognitive effort degrades perceived outcome value is a subjective, rather than objective, process, similar to risk and delay discounting. Although numerous studies suggest the orbitofrontal cortex (OFC) is important for allowing subjective value estimates to be updated and/or used in cost/benefit decision‐making, the causal role of the OFC in valuations of mental effort has received scant investigation. We therefore trained 24 female Long‐Evans rats on the rodent cognitive effort task (rCET) and assessed performance following temporary bilateral inactivation of the ventrolateral OFC (vlOFC). In the rCET, rats decide at trial outset whether to perform an easy or hard attentional challenge, namely to localize a brief visual stimulus to one of five possible locations. The difficulty of the challenge is determined by the stimulus duration (1.0 vs. 0.2s for easy vs. hard trials respectively), and success on hard trials results in double the sugar pellet rewards. Somewhat surprisingly, inactivations of the vlOFC did not affect rats' willingness or ability to exert cognitive effort for larger rewards, despite increasing omissions and motor impulsivity on‐task. When considered with previous work, it appears the vlOFC plays a minimal role in cognitive effort allocation specifically, and in valuations of effort more generally. [ABSTRACT FROM AUTHOR]

Rationale: Staphylococcus aureus and Pseudomonas aeruginosa often infect the airways in cystic fibrosis (CF). Because registry studies show higher prevalence of P. aeruginosa versus S. aureus in older patients with CF, a common assumption is that P. aeruginosa replaces S. aureus over time. In vitro, P. aeruginosa can outgrow and kill S. aureus. However, it is unknown how rapidly P. aeruginosa replaces S. aureus in patients with CF.Methods: We studied a longitudinal cohort of children and adults with CF who had quantitative sputum cultures. We determined the abundance of P. aeruginosa and S. aureus in cfu/ml. We determined the duration and persistence of infections and measured longitudinal changes in culture positivity and abundance for each organism.Measurements and Main Results: Between 2004 and 2017, 134 patients had ≥10 quantitative cultures, with median observation time of 10.15 years. One hundred twenty-four patients had at least one positive culture for P. aeruginosa, and 123 had at least one positive culture for S. aureus. Both species had median abundance of >106 cfu/ml. Culture abundance was stable over time for both organisms. There was an increase in the prevalence of S. aureus/P. aeruginosa coinfection but no decrease in S. aureus prevalence within individuals over time.Conclusions: S. aureus and P. aeruginosa are abundant in CF sputum cultures. Contrary to common assumption, we found no pattern of replacement of S. aureus by P. aeruginosa. Many patients with CF have durable long-term coinfection with these organisms. New strategies are needed to prevent and treat these infections. [ABSTRACT FROM AUTHOR]

The article presents the discussion on sustained coinfections with Staphylococcus aureus and Pseudomonas aeruginosa in Cystic Fibrosis. Topics include animals maintaining under total intravenous general anesthesia for obtaining deep sedation as judged by the absence of corneal reflex; carbon dioxide produced from the metabolism being completely removed by the soda‐lime absorber; and adapting the flow of oxygen delivered to the circuit until no volume loss being sensed by the spirometer.

This study aimed to assess the psychometric properties of the 10-item Connor–Davidson Resilience Scale (CD-RISC10) and generate normative data for Chinese adolescents. A total of 24,499 participants (male 52.1%, mean age 13.3 years) were enrolled in the school-based survey among 132 secondary schools in Hong Kong during 2017. The CD-RISC10 showed high reliability and confirmatory factor analysis supported a unidimensional structure. Metric invariance across the gender, age, and grade subgroups was demonstrated. CD-RISC10 scores were positively correlated with psychological well-being and negatively correlated with mental distress. Male and younger students had higher resilience scores. There were significant interaction effects of gender and age/grade, with CD-RISC10 scores decreasing with age/grade in females while similar trends were not observed in males. Overall, the findings suggest that CD-RISC10 is appropriate for use in Chinese adolescents. The availability of normative data will facilitate the interpretation and comparison of research results in future studies. [ABSTRACT FROM AUTHOR]

Mobility is an important element of landslide hazard and risk assessments yet has been seldom studied for shallow landslides and debris flows in tropical environments. In September 2017, Hurricane Maria triggered > 70,000 landslides across Puerto Rico. Using aerial imagery and a lidar digital elevation model (DEM), we mapped and characterized the mobility of debris slides and flows in four different geologic materials: (1) mudstone, siltstone, and sandstone; (2) submarine basalt and chert; (3) marine volcaniclastics; and (4) granodiorite. We used the ratio of landslide-fall height (H) to travel length (L), H/L, to assess the mobility of landslides in each material. Additionally, we differentiated between landslides with single and multiple source areas and landslides that either did or did not enter drainages. Overall, extreme rainfall contributed to the mobility of landslides during Hurricane Maria, and our results showed that the mobility of debris slides and flows in Puerto Rico increased linearly as a function of the number of source areas that coalesced. Additionally, landslides that entered drainages were more mobile than those that did not. We found that landslides in soils developed on marine volcaniclastics were the most mobile and landslides in soils on submarine basalt and chert were the least mobile. While landslides were generally small (< 100 m2) and displayed a wide range of H/L values (0.1–2), coalescence increased the mobility of landslides that transitioned to debris flows. The high but variable mobility of landslides that occurred during Hurricane Maria and the associated hazards highlight the importance of characterizing and understanding the factors influencing landslide mobility in Puerto Rico and other tropical environments. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is producing widespread loss of life, unemployment, and social isolation that is triggering a mental health crisis. Experts warn there could be record levels of depression, suicide, and substance use disorders. The U.S. healthcare system is not prepared. It lacks the resources to provide prolonged psychotherapy at scale, and existing drug treatments are ineffective in about half the people who try them. Amid worsening mental health-related morbidity and mortality, the experimental drugs psilocybin and 3,4-Methylenedioxymethamphetamine (MDMA) are an untapped resource. These drugs belong to a class of compounds called the psychedelics, which has been criminalized and stigmatized by the U.S. war on drugs for over fifty years. The U.S. Drug Enforcement Administration (DEA) classifies them as Schedule I controlled substances with a high potential for abuse and no currently accepted medical uses. However, recent clinical trials conducted in the United States and abroad undermine the DEA's position and suggest that psilocybin and MDMA can safely treat a variety of mental health conditions. Moreover, unlike existing therapies, they act quickly, and their benefits are often sustained. This Article explores the legal obstacles to administering psilocybin and MDMA to mitigate the COVID-19 mental health crisis. It surveys the scientific evidence for their use and outlines a path toward rapid deployment. Due to the urgent need for effective mental health treatments, the DEA should deschedule psilocybin, reschedule MDMA, and lift annual aggregate production quotas on these drugs. The Food and Drug Administration (FDA) should issue emergency use authorizations (EUAs) for their therapeutic use. To enhance safety, the FDA Commissioner can attach conditions of use to the EUAs, comparable to Risk Evaluation and Mitigation Strategies (REMS), such as requiring psilocybin and MDMA to be administered in controlled settings under professional supervision. Prior to the onset of COVID-19, several cities decriminalized psychedelics while acknowledging their therapeutic benefits. The U.S. Department of Justice (DOJ), which enforces violations of the federal Controlled Substances Act (CSA), should pledge not to prosecute individuals who use psychedelics in accordance with state and local laws. Meanwhile, amid growing national scrutiny of law enforcement policies and procedures following high-profile police killings, Congress should reevaluate the DOJ's prominent role in U.S. drug policy. It has come to light that the war on drugs rests on a foundation of misinformation and racial animus, which has devasted communities of color. Moreover, due to restrictions on research and development, the drug war adversely impacts people with mental health conditions by depriving them of effective drug therapies. Accordingly, Congress should amend the CSA to shift drug control from law enforcement agencies to science and public-health oriented agencies, such as the FDA and the National Institutes of Health. This restructuring of responsibilities would align federal controlled substance regulation with state drug control, which is overseen by public health agencies instead of law enforcement. [ABSTRACT FROM AUTHOR]

Introduction: The National Psoriasis Foundation (NPF) published treat‐to‐target guidelines for psoriasis, yet their applicability in clinical practice remains unknown. Objectives: To estimate the proportion of psoriasis patients meeting the NPF's body surface area (BSA) 'target' (≤1%) and 'acceptable' (≤3%) response criteria and the cross‐sectional associations of these criteria with patient‐reported outcomes (PROs) in the Corrona Psoriasis Registry. Methods: Separately for three independent cross‐sectional cohorts of patients at the (i) enrolment, (ii) 6‐month and (iii) 12‐month visits, we calculated the proportion of patients with BSA ≤1% and ≤3%. Furthermore, we calculated odds ratios estimating the risk of PROs associated with not meeting criteria in the 6‐month cohort. Results: The enrolment, 6‐ and 12‐month cohorts included 2794, 1310 and 629 patients, respectively. At enrolment, 24% of patients had a BSA ≤ 1% and 41% a BSA ≤ 3%. In the 6‐month cohort, 43%/64% had a BSA ≤ 1%/BSA ≤ 3%. In the 12‐month cohort, 46%/69% of patients had a BSA ≤ 1%/BSA ≤ 3%. Patients not at target/acceptable criteria had higher odds for worse quality of life compared with those who were. Conclusion: While most patients at 6‐ and 12‐month visits were at the 'acceptable' response, less than half were at the 'target' response despite systemic therapy. There remain unmet needs to optimize psoriasis therapy and further validate current treat‐to‐target guidelines. [ABSTRACT FROM AUTHOR]

Background: Individuals must frequently evaluate whether it is worth allocating cognitive effort for desired outcomes. Motivational deficits are a common feature of psychiatric illness such as major depression. Selective serotonin reuptake inhibitors are commonly used to treat this disorder, yet some data suggest these compounds are ineffective at treating amotivation, and may even exacerbate it.Aims: Here we used the rodent Cognitive Effort Task (rCET) to assess serotonergic (5-hydroxytryptamine, 5-HT) contributions to decision-making with cognitive effort costs.Methods: The rCET is a modified version of the 5-choice serial reaction time task, a well-validated test of visuospatial attention and impulse control. At the start of each rCET trial, rats chose one of two levers, which set the difficulty of an attentional challenge, namely the localization of a visual stimulus illuminated for 0.2 or 1 s on hard versus easy trials. Successful completion of hard trials was rewarded with double the sugar pellets. Twenty-four female Long-Evans rats were trained on the rCET and systemically administered the 5-HT1A agonist 8-OH-DPAT, the 5-HT2A antagonist M100907, the 5-HT2C agonist Ro-60-0175, as well as the 5-HT2C antagonist SB 242, 084.Results: 5-HT2A antagonism dose-dependently reduced premature responding, while 5-HT2C antagonism had the opposite effect. 8-OH-DPAT impaired accuracy of target detection at higher doses, while Ro-60-0175 dose-dependently improved accuracy on difficult trials. However, none of the drugs affected the rats' choice of the harder option.Conclusion: When considered with existing work evaluating decision-making with physical effort costs, it appears that serotonergic signalling plays a minor role in guiding effort allocation. [ABSTRACT FROM AUTHOR]

Introduction: The use of eRD offers a simplified process compared to paper based repeat dispensing and electronic repeat prescribing, and has several benefits for GP practices, community pharmacies and patients. It is estimated that up to 80% of all repeat prescriptions could be replaced with repeat dispensing potentially saving 2.7 million hours of GP and practice time. eRD also has the benefit of reduced medicines and can contribute towards reducing overprescribing and supporting the NHS sustainability agenda. Aim: To determine if there are specific thresholds of eRD implementation by GP practices at which barriers to uptake occur. Subsequently to understand if these thresholds are associated with specific therapeutics and if the difficulty in increasing uptake is related to drug specific requirements or differing prescription management processes needed. Methods: Dispensed medicines data (Oct-Dec 22, ePACT2) was analysed at practice level nationally to test the hypothesis that there are multiple thresholds of eRD implementation uptake. The percentage of practices achieving less than or equal to each incremental %eRD value was plotted against % eRD implementation. Thresholds were identified by a change in the rate of implementation uptake. Prescribing data was then analysed by BNF chapter at the identified thresholds to determine how this variation was represented clinically. Dispensed medicines data (Jul-Sept 21, North of England (NoE)) was also reviewed by pharmacists at presentation level for appropriateness as an eRD item (excludes patient level considerations). The items considered prescribable by eRD were tagged and the data re-run to estimate the maximum %eRD that might have been achieved. Ethical approval was not required for this study as it utilised non-patient identifiable population level primary care prescribing data. Results: There were 8 thresholds (changes in rate of implementation) identified from the national data; occurring at 3, 9, 35, 42, 50, 57, 64 and 72% eRD. There is consistency in three of the most prescribed drug groups for eRD across all the NoE Integrated Care Systems (ICSs), which includes: lipid regulating drugs, proton pump inhibitors and renin-angiotensin system; readily implemented as eRD from the 3% threshold. The other most commonly prescribed drugs by eRD were: Beta-blockers, calcium channel blockers, antiplatelets and antidiabetics. Retrospective data analysis by pharmacists determined that a maximum of 66.6% of items Jul-Sept 21 in the NoE could have been prescribed by eRD if patient factors at individual review had also considered it appropriate. Discussion/Conclusion: Further clinical review and guidance on the appropriateness and requirements of specific therapeutics to be prescribed by eRD is required. For instance, rheumatic disease suppressant drugs, which require GP practices to establish monitoring arrangements in conjunction with eRD, increase from the 9% threshold. Whereas adrenoceptor agonists, requiring respiratory/inhaler reviews, increase from the 35% threshold. Further qualitative analysis is ongoing to understand the barriers occurring at different thresholds of eRD uptake. The maximum percentage of eRD achievable in the snapshot data was significantly lower than expected. This work is limited by the volume of items at presentation level that could potentially be prescribed. [ABSTRACT FROM AUTHOR]

The electronic structure and chemistry of interfaces between tris-(8-hydroxyquinoline) aluminum (Alq[sub 3]) and representative group IA and IIA metals, Al, and Al/LiF have been studied by x-ray and ultraviolet photoelectron spectroscopies. Quantum-chemical calculations at the density functional theory level predict that the Alq[sub 3] radical anion is formed upon reaction with the alkali metals. In this case, up to three metal atoms can react with a given Alq[sub 3] molecule to form the trivalent anion. The anion formation results in a splitting of the N 1s core level and formation of a new feature in the previously forbidden energy gap. Virtually identical spectra are observed in the Al/LiF/Alq[sub 3] system, leading to the conclusion that the radical anion is also formed when all three of these constituents are present. This is support by a simple thermodynamic model based on bulk heats of formation. In the absence of LiF or similar material, the reaction of Al with Alq[sub 3] appears to be destructive, with the deposited Al reacting directly with the quinolate oxygen. We proposed that in those circumstances where the radical anion is formed, it and not the cathode metal are responsible for the electron injection properties. This is borne out by producing excellent injecting contacts when Ag and Au are used as the metallic component of the cathode structure. © 2001 American Institute of Physics. [ABSTRACT FROM AUTHOR]

Presents a study which examined the processes of formation and epitaxial alignment of SrTiO[sub3] thin films prepared by metallo-organic decomposition. Experimental procedures; Results of the study; Conclusions.

This study aimed to investigate prevalence and associated factors of influenza vaccination (IV) among children aged 12–23 months. Our cross-sectional survey interviewed 489 parents of children aged 12–23 months anonymously at twelve maternal and child health centers in Hong Kong. Results showed that only 11.5% of the children had ever received IV (64.3% being subsidized). Adjusted for the child’s age, significant factors of the children’s IV included parental knowledge about governmental policy/recommendation (Adjusted odds ratio [AOR] = 2.64, 95%CI = 1.09,6.40), knowledge about annual IV requirement (AOR = 2.30, 95%CI = 1.21,4.38), perceived safety-related barrier (AOR≥0.14, 95%CI = 0.06,0.33), cue to action (AOR = 7.79, 95%CI = 3.45,17.58), and subjective norm (AOR = 4.59, 95%CI = 2.34,9.00). IV prevalence of children aged 12–23 months remained low despite a subsidization scheme. The higher IV prevalence of older children reported by other studies suggested that parents postponed action. Promotion campaigns should shift emphases from cost reduction and mass media approaches to dissemination of knowledge about IV policy and safety, enhancement of health professionals’ advice, and creation of supportive subjective norm. [ABSTRACT FROM AUTHOR]

Background: Adolescent Internet addiction (IA) is prevalent. No study, however, has applied the health belief model (HBM) to investigate issues on IA nor investigated factors associated with intention to correct one's perceived IA problem (self‐corrective intention). Such information facilitates design of related interventions, which are warranted. Methods: This cross‐sectional study surveyed 9,618 Chinese secondary school students in Hong Kong; 4,111 (42.7%) self‐assessed that they had IA (self‐assessed IA cases); 1,145 of these self‐assessed IA cases (27.9%) were also classified as IA cases (concordant IA cases), as their Chen Internet Addiction Scale score exceeded 63. Results: The prevalence of self‐corrective intention among these two subsamples was only 28.2% and 34.1%, respectively. In the self‐assessed IA subsample, the HBM constructs including perceived susceptibility to IA [adjusted odds ratio (ORa) = 1.24, 95% CI = 1.16, 1.34], perceived severity of IA (ORa = 2.28, 95% CI = 2.09, 2.48), perceived benefits for reducing Internet use (ORa = 1.21, 95% CI = 1.18, 1.24), self‐efficacy to reduce Internet use (ORa = 1.07, 95% CI = 1.03, 1.11), and cues to action to reduce Internet use (ORa = 1.15, 95% CI = 1.11, 1.20) were positively, while perceived barriers for reducing Internet use (ORa = 0.95, 95% CI = 0.94, 0.97) were negatively, associated with self‐corrective intention. Similar factors were identified in the concordant IA subsample. Conclusions: A large proportion of the students perceived that they had IA but only about one‐third intended to correct the problem. Future interventions may consider altering students’ HBM constructs, and focus on the segment of concordant IA with self‐corrective intention, as they show readiness for changes. [ABSTRACT FROM AUTHOR]

This study investigated the trend and associated factors of condom use among male clients of female sex workers (CFSW) in Hong Kong. A total of 25,443 males of the general population were screened to identify 2,330 CFSW via 13 rounds of population-based serial cross-sectional telephone surveys during 1998 through 2015. Over time, there were no significant changes in condom use with various types of female sex partners (p ranged 0. 219-0.837) and prevalence of self-reported STI (p = 0.975) in the past 6 months. Decrease in the prevalence of non-regular sex partners (p < 0.001) and increase in perceived efficacy of condom use for HIV prevention (p = 0.028) were observed. Perceived efficacy of condom use for HIV prevention and self-reported STI experience were significantly associated with condom use with various types of female sex partners in the past 6 months. No evident improvement for condom use was found. Tailored intervention programs are warranted. [ABSTRACT FROM AUTHOR]

Abstract: Professor Nagtegaal has already highlighted that lymph nodes are probably not responsible for the development of liver metastases. If they are not, then is there another mechanism? Professor Haboubi addresses the question of extranodal deposits – their frequency and their importance in the development of metastatic disease. The experts review the evidence and discuss whether this information will alter treatment decisions and staging systems in the future. [ABSTRACT FROM AUTHOR]

Internet addiction (IA) is prevalent among adolescents and imposes a serious public health threat. Familial risk and protective factors may co-exist and interact with each other to determine IA. We conducted a cross-sectional survey among 9,618 Secondary 1 to 4 students in Hong Kong, China. About 16% of the surveyed students were classified as Internet addicted; nearly one third of them perceived that at least one of their family members had IA (FMIA). We found that FMIA was a risk factor (multivariate odds ratio [OR] = 2.04), and perceived family support was a protective factor (multivariate OR = 0.97) of IA. We also found a significant risk-enhancement moderation effect between these risk and protective factors, that is, the risk effect of FMIA increased with perceived family support. The finding highlights that family-based interventions, which modify familial risk and protective factors, should be effective for adolescent IA, but caution is required about potential risk-enhancement moderations between such factors. [ABSTRACT FROM AUTHOR]

Abstract: Nonengaged youth (NEY) are those who have neither been working nor studying for a prolonged period of time. They are at risk of psychoactive substance use, but relevant studies are scarce. Based on a population‐based telephone survey and referrals, we anonymously interviewed 479 Hong Kong Chinese NEY aged 15–24 years. Of them, 14.8–23.7% reported moderate to severe depression, anxiety, and stress. Moreover, one fourth of the participants (24.8%; n = 119) had used psychoactive substances. Adjusted analyses showed that these three psychological distress variables were positively associated with, while resilience was negatively associated with, both ever‐use of psychoactive substances and intention to use such substances in the next 12 months. Loneliness was associated only with intention to use psychoactive substances. The mediating role of psychological distress was shown: Anxiety significantly mediated the association between resilience and ever‐use of psychoactive substances, whereas depression mediated that between resilience and behavioural intention. Resilience was not a significant moderator on the relationship between psychological distress and ever‐use of psychoactive substance use or behavioural intention to use those substances. The findings suggest that anti‐drug interventions should outreach NEY and should include mental health support as well as building up resilience, as NEY are prone to psychological distress that increases risk of substance use. [ABSTRACT FROM AUTHOR]

Background Governing organisations for health services currently recommend a patient-centred ( PC) approach to practice for all health professions, including dietetics. For the vulnerable older malnourished patient, this approach needs to be prioritised to improve outcomes. The paucity of patient experience data likely limits evidence-based, patient-centred care ( PCC) from being implemented effectively. The present study aimed to identify quality indicators of dietetic services from the perspectives of older malnourished patients to inform evidence-based PC dietetic care. Methods Surveys were completed by a sample of 28 females and 28 males (mean age 81 years) who had been seen by a dietitian for malnutrition assessment. In-depth, face-to-face, semi-structured interviews were undertaken with a sub-sample of four females and six males (mean age 81 years). Interviews were transcribed verbatim. Thematic analysis of transcripts and open-ended survey responses was conducted to determine patient-identified quality indicators. Results Three structure indicators (continuity of care through regular contact and post-discharge dietetic follow-up; interdisciplinary coordination and collaboration; and high-quality hospital food services), five process indicators (addressing a patient's primary medical concern; involving the patient's family; providing clear and simple dietetic information; providing expert dietary knowledge; utilising interpersonal communication skills) and three outcome indicators (improvement in health status; improvement or maintenance of independence; weight gain) were identified. The experiences of older malnourished patients with dietetic services, as described in the present study, reinforce the importance of ensuring high-quality and tailored dietetic care as a key element of PC dietetic services. Conclusions The quality indicators of dietetic services identified in the present study may facilitate dietitians to provide evidence-based PCC for older malnourished patients. [ABSTRACT FROM AUTHOR]

Purpose: Internet use has global influences on all aspects of life and has become a growing concern. Cross-sectional studies on Internet addiction (IA) have been reported but causality is often unclear. More longitudinal studies are warranted.Methods: We investigated incidence and predictors of IA conversion among secondary school students. A 12-month longitudinal study was conducted among Hong Kong Chinese Secondary 1-4 students (N = 8286). Using the 26-item Chen Internet Addiction Scale (CIAS; cut-off >63), non-IA cases were identified at baseline. Conversion to IA during the follow-up period was detected, with incidence and predictors derived using multi-level models.Results: Prevalence of IA was 16.0% at baseline and incidence of IA was 11.81 per 100 person-years (13.74 for males and 9.78 for females). Risk background factors were male sex, higher school forms, and living with only one parent, while protective background factors were having a mother/father with university education. Adjusted for all background factors, higher baseline CIAS score (ORa = 1.07), longer hours spent online for entertainment and social communication (ORa = 1.92 and 1.63 respectively), and Health Belief Model (HBM) constructs (except perceived severity of IA and perceived self-efficacy to reduce use) were significant predictors of conversion to IA (ORa = 1.07-1.45).Conclusions: Prevalence and incidence of IA conversion were high and need attention. Interventions should take into account risk predictors identified, such as those of the HBM, and time management skills should be enhanced. Screening is warranted to identify those at high risk (e.g. high CIAS score) and provide them with primary and secondary interventions. [ABSTRACT FROM AUTHOR]