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Additional file 1. Additional Tables S1–S4.

Additional file 2. Additional Figures S1–S8.

Gallstone ileus is an infrequent cause of mechanical small bowel obstruction. The mortality rate of gallstone ileus remains relatively high, since gallstone ileus usually presents on elderly patients with multiple underlying diseases. Typically, the way of gallstone migration to small bowel is through biliary-enteric flstula, which is a rare complication of chronic cholecystitis. Patients present with diffuse abdominal pain and vomiting when the gallstone lodges in distal small bowel. The goals of surgical intervention include release of the bowel obstruction and closure of biliary-enteric flstula.

Background: Depression is a common mental health condition that can have significant impacts on the physical and psychological well-being among older adults. The prevalence of depression increases substantially in older adults living in long-term care (LTC) facilities and may diminish their ability to pursue and experience pleasure. Pharmacotherapy for depression has adverse side effects and does not always benefit older people. Therefore, psychosocial interventions for older adults with depression are needed to improve mental well-being. A social robot called PARO, developed to engender a beneficial psychological effect or enrichment, is a potential psychosocial intervention for improving mental well-being in older adults with dementia. However, very little is currently known about PARO as an intervention for older adults with depression. Therefore, this study could fill current knowledge gaps and help with our understanding of the effect of using PARO with older people with depression. Objectives: There were two phases in this PhD study. Phase one was an online survey and phase two was a mixed methods experimental study. The aims of the online survey study were to: (1) modify, translate and validate the Chinese version of Attitudes Towards the Use of Social Robot (ATTUSR-C) questionnaire for use with Taiwanese health personnel; and (2) investigate the attitudes of Taiwanese health personnel working in LTC facilities towards the use of social robots for older adults. The aims of the mixed methods experimental study were to explore: (1) the effect of an eight-week 24-hour PARO intervention on depression and well-being in older adults in LTC facilities in Taiwan; and (2) participants’ experiences and perceptions following participation in the intervention. Methods: Phase one involved a cross-sectional design. Settings were LTC facilities across Taiwan. Purposive sampling was used and health personnel working in LTC facilities provided information for the cross-sectional survey. Content validity, internal consistency reliability, and factor analysis of the ATTUSR-C questionnaire were evaluated. All recruited participants received an email containing study information and a URL link to the survey. Data collection took place from November 2017 to May 2018. Phase two involved a mixed methods experimental design with a quasi-experimental approach. Embedded qualitative interviews were used to gain insights into statistical associations and individual perspectives in this present study. Settings were four nursing homes in southern Taiwan and the sample was 20 older adults with depression living in LTC facilities. Phase two consisted of two stages. Stage 1 was an eight-week observation stage in LTC facilities where the purpose was to observe usual mood, behaviour and activities of older adults with depression. Stage 2 was an eight-week 24-hour PARO intervention during which a PARO was introduced to participants and subsequently left with them. The Chinese version of the Geriatric Depression Scale – Short Form, the Chinese version of UCLA Loneliness Scale Version 3, and the Chinese version of the World Health Organization Quality of Life Questionnaire for older adults were administered at four time points: a week before the start of the eight-week observation, immediately after the eight-week observation, mid-point of the PARO intervention, and straight after the eight-week PARO intervention. A semi-structured interview was conducted with the older adults following the completion of their participation in the intervention. Results: Content validity of the modified Chinese version of the ATTSUR questionnaire was first assessed by a panel of five academic nursing professors (I-CVI = 0.83 / S-CVI/Ave = 0.93) followed by face validity examination by 10 clinical instructors (Fleiss’s kappa = 0.82). Finally, psychometric testing (i.e. exploratory factor analysis and internal consistency a = 0.84) was conducted using a convenient sample of 95 nurses. The final modified Chinese version of the ATTSUR questionnaire is a one-factor model consisting of 15 items with good validity and reliability. A total of 416 health professionals responded to the online survey. The mean age of respondents was 39.16 years (SD = 11.37). Of these, the mean length of work experience was 6.12 years (SD = 5.74). About 85.8 % of the respondents were female, and 14.2% were male. The majority of respondents (75.9 %) had obtained college or above education. Registered nurses (43.5%) and nursing aides (31.7%) were the majority of respondents. Over half of the respondents (56.5%) were working in nursing homes, and 25.7% were working in residential aged care. A point-biserial correlation was conducted to explore the relationship between attitudes and awareness of using social robots. Attitudes of respondents towards the use of social robots for older adults in LTC were found to be positively and significantly correlated with their awareness of the use of social robots in nursing homes (rpb = .18, p < .000). Most health personnel had positive attitudes towards the use of social robots in LTC facilities, as they considered social robots to be beneficial and practical in psychosocial care for older adults. The ATTUSR-C questionnaire had good validity and reliability. Twenty participants completed phase two. Scores on depression, loneliness, and quality of life demonstrated significant positive changes over time (p < .000). The qualitative findings showed that participants expressed positive experiences and perceptions about the PARO intervention, such as improved mood, alleviated loneliness, and increased interpersonal interactions with other people. Three themes emerged from the interviews: humanising PARO by relating it to personal experiences and engagement, increased social interaction with other people through participants' use of PARO and companionship, which all resulted in improved mental well-being. The outcomes demonstrate that a 24-hour PARO intervention has the potential to improve mental well-being among older adults with depression who live in LTC facilities. Conclusion: The ATTUSR-C questionnaire is a reliable and valid instrument for assessing the acceptability of social robots for health professionals working in LTC facilities. Positive attitudes towards the use of social robots can increase the acceptance and utilisation of social robots. Health personnel and nursing researchers can use the findings of this study to encourage and inspire further interventions that use robots to improve the quality of life in care settings. The findings of this mixed methods experimental study indicated that PARO has the potential to alleviate depression and loneliness and improve the quality of life for older adults living in LTC facilities. Using PARO for companionship can be a key factor in decreasing depression and loneliness, as it provided comfort and calming effects for older adults with depression. This study was the first study known to undertake a 24-hour PARO intervention in older adults with depression and confirmed the feasibility of the implementation of PARO in aged-care settings. As a consequence, the research findings provided theoretical foundations for further studies about the use of PARO in older adults with depression. The study filled gaps in knowledge and identified the need for further development in the area of PARO interventions with older people with depression.

Claims from observational studies often fail to replicate. A study was undertaken to assess the reliability of cohort studies used in a highly cited meta-analysis of the association between ambient nitrogen dioxide, NO2, and fine particulate matter, PM2.5, concentrations early in life and development of asthma later in life. The numbers of statistical tests possible were estimated for 19 base papers considered for the meta-analysis. A p-value plot for NO2 and PM2.5 was constructed to evaluate effect heterogeneity of p-values used from the base papers. The numbers of statistical tests possible in the base papers were large - median 13,824, interquartile range 1,536-221,184; range 96-42M, in comparison to statistical test results presented. Statistical test results drawn from the base papers are unlikely to provide unbiased measures for meta-analysis. The p-value plot indicated that heterogeneity of the NO2 results across the base papers is consistent with a two-component mixture. First, it makes no sense to average across a mixture in meta-analysis. Second, the shape of the p-value plot for NO2 appears consistent with the possibility of analysis manipulation to obtain small p-values in several of the cohort studies. As for PM2.5, all corresponding p-values fall on a 45-degree line indicating complete randomness rather than a true association. Our interpretation of the meta-analysis is that the random p-values indicating no cause-effect associations are more plausible and that their meta-analysis will not likely replicate in the absence of bias. We conclude that claims made in the base papers used for meta-analysis are unreliable due to bias induced by multiple testing and multiple modelling, MTMM. We also show there is evidence that the heterogeneity across the base papers used for meta-analysis is more complex than simple sampling from a normal process., Comment: 68 pages including supplemental material. arXiv admin note: text overlap with arXiv:2010.08628

To understand potential encoding mechanism of motor cortical neurons for control commands during reach-to-grasp movements, experiments to record neuronal activities from primary motor cortical regions have been conducted in many research laboratories (for example, (7), (17)). The most popular approach in neuroscience community is to fit the Analysis of Variance (ANOVA) model using the firing rates of individual neurons. In addition to consider neural firing counts but also temporal intervals, (5) proposed to apply Analysis of Covariance (ANCOVA) model. Due to the nature of the data, in this paper we propose to apply an integrated method, called heterogeneous Poisson regression model, to categorize different neural activities. Three scenarios are discussed to show that the proposed heterogeneous Poisson regression model can overcome some disadvantages of the traditional Poisson regression model.

The aim of this qualitative study of the New Age Movement (NAM) in Taiwan was to test the ideas about 'self-religion', 'reflexive modernisation' and 'globalisation' that underlie many sociological accounts of the New Age phenomena. It also explored the neglected issues of emotions and embodiment in New Age practices. By means of in-depth, semi-structured interviews with 40 participants in New Age activities, participant observation in two New Age courses about healing and documentary analysis, my project produced the following four conclusions.\ud \ud First, the characteristics of New Age spiritualities in Taiwan, such as 'spiritual but not religious' and 'transformational but not salvational', differ from those of the country's main religions and new religious groups. But many people in the NAM seek a new balance between 'tradition and modernity' or 'new age spiritualities and "old age" religions'. Second, changes in emotional states are critical for participants in New Age activities in terms of 'being healed' through a process of self-transformation. Participants experience emotional identification, display and experience, whilst also internalising a set of feeling rules based on the 'emotion ideology' of New Age spiritualities.\ud \ud Third, analysis of interviewees' biographical reconstructions of their experiences shows that the New Age can be regarded as an integral part of late modern society in Taiwan. Not only is the NAM mainly about self-reflexivity but it also influences the life politics of its followers. It can therefore serve as a source of 'alternative' expert knowledge in late-modern society.\ud \ud Fourth, the structure of the NAM in Taiwan can be described as a loose, web-like network. Furthermore, the globalised aspects of the movement cannot be regarded simply as an expression of 'Westernisation' or 'Americanisation', but should be properly understood as a process of 'parallel glocalization'.\ud \ud This thesis is an original combination of conceptual analysis, theoretical ideas and empirical investigation. Its main contributions are, on the one hand, to have integrated the New Age in Taiwan into theorising about late-modernity and globalisation and, on the other, to have placed emotions and healing at the center of the study of New Age activities.