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The use of Monte‐Carlo (MC) p$$ p $$‐values when testing the significance of a large number of hypotheses is now commonplace. In large‐scale hypothesis testing, we will typically encounter at least somep$$ p $$‐values near the threshold of significance, which require a larger number of MC replicates than p$$ p $$‐values that are far from the threshold. As a result, some incorrect conclusions can be reached due to MC error alone; for hypotheses near the threshold, even a very large number (eg, 106$$ 1{0}^6 $$) of MC replicates may not be enough to guarantee conclusions reached using MC p$$ p $$‐values. Gandy and Hahn (GH)6‐8 have developed the only method that directly addresses this problem. They defined a Monte‐Carlo error rate (MCER) to be the probability that any decisions on accepting or rejecting a hypothesis based on MC p$$ p $$‐values are different from decisions based on idealp$$ p $$‐values; their method then makes decisions by controlling the MCER. Unfortunately, the GH method is frequently very conservative, often making no rejections at all and leaving a large number of hypotheses "undecided". In this article, we propose MERIT, a method for large‐scale MC hypothesis testing that also controls the MCER but is more statistically efficient than the GH method. Through extensive simulation studies, we demonstrate that MERIT controls the MCER while making more decisions that agree with the ideal p$$ p $$‐values than GH does. We also illustrate our method by an analysis of gene expression data from a prostate cancer study. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether professionally applied topical fluoride‐hesitant caregivers are also hesitant about other forms of fluoride for their child. Methods: This was a mixed methods study of 56 caregivers hesitant about professionally applied topical fluoride for their child recruited from the University of Washington Center for Paediatric Dentistry and Seattle Children's Hospital's Odessa Brown Children's Dental Clinic. A 32‐item semi‐structured interview script was piloted and finalized. One‐time interviews with caregivers were conducted by phone in 2019. Associations between hesitancy of topical fluoride, fluoridated water and toothpaste were assessed quantitatively via two‐tailed chi‐squared tests. Qualitative data were coded using an inductive approach and content analytic methods to investigate reasons for hesitancy. Results: There were significant associations between hesitancy in all three pairwise comparisons of fluoride form (p <.01). Similar proportions of caregivers strongly or somewhat opposed fluoridated water compared with toothpaste (75% and 65%, respectively), but four times as many caregivers strongly or somewhat favoured fluoridated toothpaste compared to water for their child (25% and 7%, respectively). Concerns about harm were the most common reason caregivers opposed both fluoridated water and toothpaste. However, fluoride‐hesitant caregivers reported being more comfortable with fluoridated toothpaste because amount and frequency can be controlled, and ingestion can be prevented. Conclusions: Professionally applied topical fluoride hesitancy is significantly associated with fluoridated water and toothpaste hesitancy, but caregivers who were hesitant about topical fluoride was more comfortable with fluoridated toothpaste than fluoridated water for their child. [ABSTRACT FROM AUTHOR]

Background: Concussion public policies have been developed to address the burden of concussions. The aim of the present study was to examine implementation compliance, barriers, and facilitators of Canada's first concussion public policy, Ontario's Policy/Program Memorandum 158: School Board Policies on Concussion (PPM158). Methods: An electronic survey was sent to 515 randomly selected elementary and high school principals across specific geographic, language, and publicly funded school types in Ontario. Data were analyzed using both qualitative and quantitative methods. Results: One hundred and thirty‐five principals responded to the survey (26%). Concussion education was provided to teachers in 81% of schools, to students in 83%, and coaches in 79%. Additionally, 89% reported having a return‐to‐learn protocol in place and 90% reported having a return‐to‐play protocol. Implementation barriers included difficulties in providing concussion education to parents (42%), obtaining notes from physicians, and maintaining the volume of documentation. Eighty‐seven percent of respondents believed that PPM158 improves student well‐being. Conclusions: Identified implementation barriers and facilitators can inform concussion policy practices to improve student well‐being. We recommend: (1) an appointed concussion policy lead at each school, (2) electronic documentation, (3) determining the optimal education format to improve parent/guardian education, (4) fostering relationships between schools and health care professionals, and (5) student concussion education in every grade in Ontario schools. [ABSTRACT FROM AUTHOR]

Aim: To describe the impact of the COVID‐19 pandemic on stress, resilience and depression in health professionals from a public hospital in Barcelona, Spain after the first peak of pandemic. Background: The COVID‐19 pandemic in Spain has pushed boundaries in health systems and, especially, for health professionals. Analysis of resilience as an individual resource and it is essential to understand the mechanisms that make staff react unfavourably to stressors caused by the pandemic. Design: A descriptive cross‐sectional study was designed. Participants: Health professionals supervised by the nursing department, including registered nurses, health care assistants, health technicians, final year nurse student nurses, foreign nurses, and other nurse‐related health workers. Methods: The study complies with the STROBE checklist for cross‐sectional studies. An online survey was administered to all health professionals supervised by the nursing department between 6 and 27 May 2020. The survey included the ER‐14 Resilience Scale, the widely‐used PHQ‐9 depression scale, the Spanish version of the Nursing Stress Scale, and an ad‐hoc questionnaire to obtain sociodemographic and occupational variables. Results: A total of 686 participants answered the survey. Resilience was high or very high in health professionals, with an inverse correlation with stress and depression scores. Personal on fixed shifts showed better resilience. The most stressed health professionals were full‐time registered nurses, followed by health care assistants. Up to 25% of nursing professionals had depression. Conclusion: Our study showed a high degree of resilience among nurse professionals despite the overwhelming nature of the COVID‐19 pandemic. Relevant signs of depression and stress were detected among participants. Occupational factors heavily influenced nurses' resilience, stress and depression. Implications for Nursing & Health Policy: Government policy shifts are needed in Spain to improve nurses' workforce conditions, enhance the ratio of nurses to patient numbers, and avoid workforce losses. Maintaining the resilience of health professionals would assist in improving their health and their capacity to possible future emergency situations. [ABSTRACT FROM AUTHOR]

Aims: To clarify the hypothesis tests associated with the full covariate modelling (FCM) approach in population pharmacokinetic analysis, investigate the potential impact of multiplicity in population pharmacokinetic analysis, and evaluate simultaneous confidence intervals (SCI) as an approach to control multiplicity. Methods: Clinical trial simulations were performed using a simple one‐compartment pharmacokinetic model. Different numbers of covariates, sample sizes, effect sizes of covariates, and correlations among covariates were explored. The false positive rate (FPR) and power were evaluated. Results: The FPR for the FCM approach dramatically increases with number of covariates. The chance of incorrectly selecting ≥1 seemingly clinically relevant covariates can be increased from 5% to a 40–70% range for 10–20 covariates. The SCI approach may provide appropriate control of the family‐wise FPR, allowing more appropriate decision making. As a result, the power detecting real effects without incorrectly identifying non‐existing effects can be greatly improved by the SCI approach compared to the approach in current practice. The performance of the SCI approach is driven by the ratio of sample size to number of covariates. The FPR can be controlled at 5% and 10% using the SCI approach when the ratio was ≥20 and 10, respectively. Conclusion: The FCM approach still lies within the framework of statistical testing, and therefore multiplicity is an issue for this approach. It is imperative to consider multiplicity reporting and adjustments in FCM modelling practice to ensure more appropriate decision making. [ABSTRACT FROM AUTHOR]

Maternal capabilities-qualities of mothers that enable them to leverage skills and resources into child health-hold potential influence over mother's adoption of child caring practices, including infant and young child feeding. We developed a survey ( n = 195) that assessed the associations of 4 dimensions of maternal capabilities (social support, psychological health, decision making, and empowerment) with mothers' infant and young child feeding practices and children's nutritional status in Uganda. Maternal responses were converted to categorical subscales and an overall index. Scale reliability coefficients were moderate to strong (α range = 0.49 to 0.80). Mothers with higher social support scores were more likely to feed children according to the minimum meal frequency (odds ratio [OR] [95% confidence interval (CI)] = 1.38 [1.10, 1.73]), dietary diversity (OR [95% CI] = 1.56 [1.15, 2.11]), iron rich foods, (OR [95% CI] = 1.47 [1.14, 1.89]), and minimally acceptable diet (OR [95% CI] = 1.55 [1.10, 2.21]) indicators. Empowerment was associated with a greater likelihood of feeding a minimally diverse and acceptable diet. The maternal capabilities index was significantly associated with feeding the minimum number of times per day (OR [95% CI] = 1.29 [1.03, 1.63]), dietary diversity (OR [95% CI] = 1.44 [1.06, 1.94]), and minimally acceptable diet (OR [95% CI] = 1.43 [1.01, 2.01]). Mothers with higher psychological satisfaction were more likely to have a stunted child (OR [95% CI] = 1.31 [1.06, 1.63]). No other associations between the capabilities scales and child growth were significant. Strengthening social support for mothers and expanding overall maternal capabilities hold potential for addressing important underlying determinants of child feeding in the Ugandan context. [ABSTRACT FROM AUTHOR]

Aims To understand processes placing individuals at risk for stimulant (amphetamine and cocaine) use disorder. Design Longitudinal study. Setting University of California, San Diego Department of Psychiatry, CA, USA. Participants Occasional stimulant users (OSU; n = 184) underwent a baseline clinical interview and a functional magnetic resonance imaging (fMRI) session. On the basis of a follow-up clinical interview completed 3 years later, OSU ( n = 147) were then categorized as problem stimulant users (PSU: n = 36; those who developed stimulant use disorders in the interim) or desisted stimulant users (DSU: n = 74; those who stopped using). OSU who did not meet criteria for PSU or DSU ( n = 37) were included in dimensional analyses. Measurements fMRI blood oxygen level-dependent (BOLD) contrast percentage signal change from baseline collected during a Paper-Scissors-Rock task was examined during three decision-making conditions, those resulting in: (1) wins, (2) ties and (3) losses. These data were used as dependent variables in categorical analyses comparing PSU and DSU, as well as dimensional analyses including interim drug use as predictors, controlling for baseline drug use. Findings PSU exhibited lower anterior cingulate, middle insula, superior temporal, inferior parietal, precuneus and cerebellum activation than DSU across all three conditions (significant brain clusters required > 19 neighboring voxels to exceed F(1,108) = 5.58, P < 0.01 two-tailed; all Cohen's d > 0.83). Higher interim marijuana use was linked to lower pre-central and superior temporal activation during choices resulting in wins (> 19 neighboring voxels to exceed t = 2.61, P < 0.01 two-tailed; R2 change > 0.11). Conclusions Individuals who transition from stimulant use to stimulant use disorder appear to show alterations in neural processing of stimulus valuation and outcome monitoring, patterns also evident in chronic stimulant use disorder. Attenuated anterior cingulate and insular processing may constitute a high-risk neural processing profile, which could be used to calculate risk scores for individuals experimenting with stimulants. [ABSTRACT FROM AUTHOR]

This paper compares how frontline staff in four national child welfare systems and policy contexts - Finland, Norway, England and the USA (specifically, California) - respond to questions about a scenario of possible harm to children. The countries have different child welfare systems that we anticipated would be reflected in the workers' responses ( n = 1027). The analysis shows differences and similarities between the systems, although often not in line with system expectations. There is also variation within the country samples. The study shows the complex interactions of individual and agency characteristics in addition to the role of proceduralised decision-making systems and professional discretion. Key Practitioner Messages Professional discretion differs., Proceduralised and high threshold systems result in less variation between workers' responses., System categories do not seem to capture the nuances of frontline decision-making. [ABSTRACT FROM AUTHOR]

The article presents the study that explores on the use of haematopoietic stem cell transplantation (SCT) in the treatment of Fanconi anemia (FA) patients in Canada and the U.S. The topics discussed include the attributes of FA, the factors that influenced the decision making of FA patients and family members on SCT, and the benefits and probable risks of SCT.

Background/aim Feedback on clinical reasoning skills during fieldwork education is regarded as vital in occupational therapy students' professional development. The nature of supervisors' feedback however, could be confirmative and/or corrective and corrective feedback could be with or without suggestions on how to improve. The aim of the study was to evaluate the impact of supervisors' feedback on final-year occupational therapy students' clinical reasoning skills through comparing the nature of feedback with the students' subsequent clinical reasoning ability. Method A mixed-method approach with a convergent parallel design was used combining the collection and analysis of qualitative and quantitative data. From focus groups and interviews with students, data were collected and analysed qualitatively to determine how the students experienced the feedback they received from their supervisors. By quantitatively comparing the final practical exam grades with the nature of the feedback, their fieldwork End-of-Term grades and average academic performance it became possible to merge the results for comparison and interpretation. Results Students' clinical reasoning skills seem to be improved through corrective feedback if accompanied by suggestions on how to improve, irrespective of their average academic performance. Supervisors were inclined to underrate high performing students and overrate lower performing students. Conclusions Students who obtained higher grades in the final practical examinations received more corrective feedback with suggestions on how to improve from their supervisors. Confirmative feedback alone may not be sufficient for improving the clinical reasoning skills of students. [ABSTRACT FROM AUTHOR]

Background Childbirth fear is associated with increased obstetric interventions and poor emotional and psychological health for women. The purpose of this study is to test an antenatal psycho-education intervention by midwives in reducing women's childbirth fear. Methods Women ( n = 1,410) attending three hospitals in South East Queensland, Australia, were recruited into the BELIEF trial. Participants reporting high fear were randomly allocated to intervention ( n = 170) or control ( n = 169) groups. All women received a decision-aid booklet on childbirth choices. The telephone counseling intervention was offered at 24 and 34 weeks of pregnancy. The control group received usual care offered by public maternity services. Primary outcome was reduction in childbirth fear ( WDEQ-A) from second trimester to 36 weeks' gestation. Secondary outcomes were improved childbirth self-efficacy, and reduced decisional conflict and depressive symptoms. Demographic, obstetric & psychometric measures were administered at recruitment, and 36 weeks of pregnancy. Results There were significant differences between groups on postintervention scores for fear of birth ( p < 0.001) and childbirth self-efficacy ( p = 0.002). Decisional conflict and depressive symptoms reduced but were not significant. Conclusion Psycho-education by trained midwives was effective in reducing high childbirth fear levels and increasing childbirth confidence in pregnant women. Improving antenatal emotional well-being may have wider positive social and maternity care implications for optimal childbirth experiences. [ABSTRACT FROM AUTHOR]

'Jumping to conclusions' (JTC) is an established reasoning bias in people with psychosis and delusion proneness. Research investigating the JTC bias in other clinical populations remains in its infancy. This study investigated whether individuals with anorexia (AN) displayed the JTC bias compared with healthy controls and, if so, whether the bias was greater in relation to emotionally salient information. The study also investigated whether delusionality was correlated with the JTC bias. JTC was measured using the 'beads task'. Three versions were employed: the standard version and two emotionally salient tasks. Results indicated that a majority (55.6%) of people with AN ( n = 26) displayed poor insight into their eating disorder beliefs but did not display an elevated JTC compared with healthy controls ( n = 33) on any task. The level of delusionality in the AN group was not correlated with JTC bias. Findings suggest that although a majority of people with AN demonstrated limited insight, they did not display the JTC bias. This may suggest that poor insight in eating disorders has different characteristics to that found in psychotic disorders, which may suggest that differences are needed in relation to how they are treated using psychological means. However, this was a small study, and study replication is required. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2013; 27; 3-12 Discharge-planning for long-term care needs: the values and priorities of older people, their younger relatives and health professionals Discharge-planning decisions about long-term care (LTC) can be difficult and distressing for older people, families and discharge-planning health professionals. Retrospective research suggests that despite good intentions and a shared focus on the best interests of the older person, stakeholders may hold very different values about good outcomes and how to decide them. We aimed to compare the opinions and values of frail elders living at home, younger relatives and health professionals experienced in discharge-planning, prospectively: before, not after, a LTC decision. We interviewed three types of stakeholders (10 older people, 8 relatives and 18 health professionals) using a hypothetical vignette about a frail elder leaving hospital. In a mixed methods design, we quantitatively compared the discharge plans and decision-makers that stakeholders suggested, and qualitatively analysed the 36 interview transcripts for participants' articulation of underlying values during these discussions. Older participants often suggested safe restrictive options (residential care, proxy decision-making) for the hypothetical frail elder, while advocating autonomy for themselves. Younger people generally endorsed autonomous decision-making and less restrictive discharge options especially if the elder was mentally competent, but reported difficult ethical tensions between safety and autonomy. Individual personality and preferences, mental capacity, and the importance of personal care in supporting autonomy were central themes consistent with the Ecological Theory of Aging. Accordingly, discharge planners can usefully articulate the balance of safety and autonomy, conceptualizing home care as maintaining independence rather than accepting dependence. Ethical training should incorporate sophisticated models of practice specifying both psychological and physical safety as components of beneficence. Few elders adopt a consumer approach to LTC: health professionals can encourage mid-life adults to consider later care needs when planning for retirement. [ABSTRACT FROM AUTHOR]

Background Rapid development in health care has resulted in an increasing number of screening and treatment options. Consequently, there is an urgency to provide people with relevant information about benefits and risks of healthcare options in an unbiased way. Decision aids help people to make decisions by providing unbiased non-directive research evidence about all treatment options. Objective To determine the effectiveness of decision aids to improve informed decision making in pregnancy care. Search strategy We searched MEDLINE (1953-2011), EMBASE (1980-2011), CENTRAL ( CENTRAL, the Cochrane Library; 2011, Issue 4), Psycinfo (1806-2011) and Research Registers of ongoing trials (www.clinicaltrials.gov, www.controlled-trials.com). Selection criteria We included randomised controlled trials comparing decision aids in addition to standard care. The study population needed to be pregnant women making actual decisions concerning their pregnancy. Data collection and analysis Two independent researchers extracted data on quality of the randomised controlled trial ( GRADE criteria), quality of the decision aid ( IPDAS criteria), and outcome measures. Data analysis was undertaken by assessing group differences at first follow up after the interventions. Main results Ten randomised controlled trials could be included. Pooled analyses showed that decision aids significantly increased knowledge, (weighted mean difference 11.06, 95% confidence interval 4.85-17.27), decreased decisional conflict scores (weighted mean difference −3.66, 95% confidence interval −6.65 to −0.68) and decreased anxiety (weighted mean difference −1.56, 95% confidence interval −2.75 to −0.43). Conclusions Our systematic review showed the positive effect of decision aids on informed decision making in pregnancy care. Future studies should focus on increasing the uptake of decision aids in clinical practice by identifying barriers and facilitators to implementation. [ABSTRACT FROM AUTHOR]

Differential growth rate between males and females, owing to a sexual size dimorphism, has been proposed as a mechanism driving sex-biased survival. How parents respond to this selection pressure through sex ratio manipulation and sex-biased parental investment can have a dramatic influence on fitness. We determined how differential growth rates during early life resulting from sexual size dimorphism affected survival of young and how parents may respond in a precocial bird, the black brant Branta bernicla nigricans. We hypothesized that more rapidly growing male goslings would suffer greater mortality than females during brood rearing and that parents would respond to this by manipulating their primary sex ratio and parental investment. Male brant goslings suffered a 19.5% reduction in survival relative to female goslings and, based on simulation, we determined that a female biased population sex ratio at fledging was never overcome even though previous work demonstrated a slight male-biased post-fledging survival rate. Contrary to the Fisherian sex ratio adjustment hypothesis we found that individual adult female brant did not manipulate their primary sex ratio (50.39% male, n = 645), in response to the sex-biased population level sex ratio. However, female condition at the start of the parental care period was a good predictor of their primary sex ratio. Finally, we examined how females changed their behavior in response to primary sex ratio of their broods. We hypothesized that parents would take male biased broods to areas with increased growth rates. Parents with male biased primary sex ratios took broods to areas with higher growth rates. These factors together suggest that sex-biased growth rates during early life can dramatically affect population dynamics through sex-biased survival and recruitment which in turn affects decisions parents make about sex allocation and sex-biased parental investment in offspring to maximize fitness. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims The aim of this experiment was to determine the influence of acute bupropion pre-treatment on subject-rated effects and choice of intranasal cocaine versus money. Design A randomized, within-subject, placebo-controlled, double-blind experiment. Setting An out-patient research unit. Participants Eight cocaine-using adults. Measurements Subjects completed nine experimental sessions in which they were pre-treated with 0, 100 or 200 mg oral immediate release bupropion. Ninety minutes later they sampled an intranasal cocaine dose [4 (placebo), 15 or 45 mg] and made six choices between that dose and an alternative reinforcer (US$0.25), available on independent, concurrent progressive ratio schedules. Subjects also completed a battery of subject-rated, performance and physiological measures following the sample doses of cocaine. Findings After 0 mg bupropion, the high dose of cocaine (45 mg) was chosen five of six times on average compared to 2.25 of six choices for placebo cocaine (4 mg) ( P < 0.05). Active bupropion reduced choice of 45 mg cocaine to 3.13 (100 mg) or 4.00 (200 mg) out of six drug choices on average. Bupropion also consistently enhanced positive subject-rated effects of cocaine (e.g. good effects; willing to take again) while having no effects of its own. Conclusions The atypical antidepressant, bupropion, acutely appears to reduce preference for intranasal cocaine versus a small amount of money but to increase reported positive experiences of the drug. [ABSTRACT FROM AUTHOR]

Background Socioeconomically deprived women are at greater risk of adverse pregnancy outcomes. Research tends to focus on access of services. Yet access may not equate with the equity of services for women from different socioeconomic backgrounds. Objectives To determine whether pregnant women's perceptions of antenatal provision differed in relation to their socioeconomic deprivation ranking (determined by the Scottish Index of Multiple Deprivation 2006). Design A longitudinal, qualitative study with comparative antenatal case studies between January 2007 and April 2009. Setting/Participants Cases were primigravida women from 'least deprived' ( n = 9) and 'most deprived' ( n = 12) geographical areas within one local authority in Scotland. Analysis Data were analysed using case study replication analysis. Results There was little difference in access to antenatal services between the 'least' and 'most' deprived groups. Perception of care differed in relation to the level of 'engagement' (defined using constructs of: language and personalization of care; power and relationships; and health literacy). Engagement was evidenced in most of the 'least deprived' cases and almost none of the 'most deprived' cases. Specifically, socioeconomically deprived women described less evidence of personal connection to their own care, effective communication and the opportunity for shared decision making. Conclusion In women from socioeconomically deprived areas, access may be a less useful indicator than engagement when assessing antenatal service quality. As engagement levels may be one method by which to predict and improve health outcomes, a more equitable antenatal service may need to be developed through the early identification of those women at risk of non-engagement. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 464-472 Objectives Developing diagnostic competence in students is a major goal of medical education, but there is little empirical evidence on instructional strategies that foster the acquisition of this competence. The aim of this study was to investigate the effects of structured reflection compared with the generation of immediate or differential diagnosis while practising with clinical cases on learning clinical diagnosis. Methods This was a three-phase experimental study. During a learning phase, 46 Year 4 students diagnosed six clinical cases under different experimental conditions: structured reflection, immediate diagnosis, or differential diagnosis. This was followed by an immediate test and a delayed test administered 1 week later. Each test consisted of diagnosing four different cases of diseases presented in the learning phase. Performance in diagnosing these new cases was used as a measure of learning. Results Repeated-measures analysis of variance on the mean diagnostic accuracy scores (range: 0-1) showed a significant interaction between performance moment (i.e. performance in the learning phase and on each test) and instructions followed during the learning phase (p = 0.003). Follow-up analyses of this interaction showed that diagnostic performance did not differ between conditions in the learning phase. On the immediate test, scores in the reflection condition (mean = 0.48, 95% confidence interval [CI] 0.38-0.58) were significantly lower than scores in the differential diagnosis condition (mean = 0.62, 95% CI 0.54-0.70; p = 0.012) and marginally lower than those in the immediate diagnosis condition (mean = 0.61, 95% CI 0.52-0.70; p = 0.04). One week later, however, scores in the reflection condition (mean = 0.66, 95% CI 0.56-0.76) significantly outperformed those in the other conditions (differential diagnosis: mean = 0.48, 95% CI 0.37-0.58 [p < 0.01]; immediate diagnosis: mean = 0.52, 95% CI 0.43-0.60 [p = 0.01]). Comparisons within experimental conditions showed that performance from the immediate to the delayed test decreased in the immediate and differential diagnosis conditions (immediate diagnosis: p = 0.042; differential diagnosis: p = 0.012), but increased in the reflection condition (p = 0.003). Conclusions Structured reflection while practising with cases appears to foster the learning of clinical knowledge more effectively than the generation of immediate or differential diagnoses and therefore seems to be an effective instructional approach to developing diagnostic competence in students. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Decisions on whether and how to 'schedule' drugs (i.e. to determine their legal status and penalties to be applied for sale or possession) are often heavily criticized. We sought to assess more comprehensively the results of such decisions for newly emerging drugs. Methods Through analysis of legislation and secondary sources, we identified 63 substances that have emerged since 1971, including all that have been added to the most restrictive schedule by the United Nations, United States, United Kingdom, Canada, Australia and/or New Zealand. Measurements For each jurisdiction we recorded whether, when, and how the substance was scheduled and note what decisions engendered substantial criticism or controversy within the international treaties' framework of balancing medical benefits with risk of abuse. Findings (i) The rate of emergence of new drugs has been fairly steady. (ii) There is broad cross-national agreement on what should be scheduled. (iii) The United States often acts first. (iv) Temporary bans that delay final decisions by 12-18 months can sometimes allow final decisions to be grounded on a substantially expanded research base. (v) It appears that no more than seven of the decisions reached by the United States with respect to the 63 substances are candidates for being considered errors, and arguably the United States has committed at most one serious Type I and one serious Type II error. Results for other countries are broadly similar. Conclusions The process for determining the legal status of new psychoactive substances appears to function reasonably well, within the framework of international treaty obligations. Most criticisms relate to one or a few substances (e.g. 3,4-methylenedioxymethamphetamine) and/or complaints that the decisions discount benefits that are not recognized by the treaties (e.g. recreational or religious use). [ABSTRACT FROM AUTHOR]

Neural computational accounts of reward-learning have been dominated by the hypothesis that dopamine neurons behave like a reward-prediction error and thus facilitate reinforcement learning in striatal target neurons. While this framework is consistent with a lot of behavioral and neural evidence, this theory fails to account for a number of behavioral and neurobiological observations. In this special issue of EJN we feature a combination of theoretical and experimental papers highlighting some of the explanatory challenges faced by simple reinforcement-learning models and describing some of the ways in which the framework is being extended in order to address these challenges. [ABSTRACT FROM AUTHOR]

Background: Falling consent rates for postmortems, regardless of age of death, have been widely reported in recent years. The aim of this study was to explore parental attitudes to, and decision-making about, a perinatal postmortem after termination for fetal abnormality, late miscarriage, or stillbirth. Methods: A prospective self-completion questionnaire was given to 35 women and their partners. The participants had experienced second or third trimester pregnancy loss in a single fetal medicine and delivery unit in the United Kingdom and were making decisions about having a postmortem. They were asked to complete a questionnaire about their attitudes to, and expectations of, a perinatal postmortem. Results: Thirty-one questionnaires were received from parents of 17 babies (49% of those asked; 16 from mothers, 15 from fathers). Parents of nine babies (53%) said they would agree to a full postmortem, of three babies to a limited postmortem, and of four babies to an external examination only; one couple were undecided. The most important issues for the parents in this study that related to their decisions about a postmortem centered on the need for information, both for future planning and about what had happened. Moderately important issues related to altruism, which is, improving medical knowledge and helping other parents experiencing similar bereavement. Among the lowest scoring issues were potential barriers, such as concerns about cultural or religious acceptability of a postmortem, funeral delays, and what would happen to the baby's body. Conclusions: Bereaved parents who participated in this study, where postmortem consent rates were relatively high, thought that their need for knowledge eclipsed assumed barriers when deciding whether or not to have a postmortem for their baby. (BIRTH 39:1 March 2012) [ABSTRACT FROM AUTHOR]

Context and objective Shared decision making is especially advocated for preference-sensitive decisions. We investigated whether physicians' recommendations pull patients away from their preferred treatment option when making a preference-sensitive decision. Design, participants and methods Inpatients ( N = 102 with schizophrenia, N = 101 with multiple sclerosis) were presented with a hypothetical scenario (the choice between two drugs). They were first asked about their preferences concerning the two drugs and then they received a (fictitious) clinician's recommendation that was contrary to their preferences. Subsequently they made a final choice between the two drugs. Main outcome measures The main outcome measure was whether the patient followed the physician's advice in the hypothetical scenario. Thereby patient's (pre-recommendation) preferences served as a baseline. Results In the decision scenario, about 48% of the patients with schizophrenia and 26% of the patients with multiple sclerosis followed the advice of their physician and thus chose the treatment option that went against their initial preferences. Patients who followed their physician's advice were less satisfied with their decision than patients not following their physician's advice (schizophrenia: t = 2.61, P = 0.01; multiple sclerosis: t = 2.67, P = 0.009). Discussion and conclusions When sharing decisions with patients, physicians should be aware that their advice might influence patients' decisions away from their preferred treatment option. They should encourage their patients to identify their own preferences and help to find the treatment option most consistent with them. [ABSTRACT FROM AUTHOR]

The overwhelming majority of research in the neurosciences employs P-values stemming from tests of statistical significance to decide on the presence or absence of an effect of some treatment variable. Although a continuous variable, the P-value is commonly used to reach a dichotomous decision about the presence of an effect around an arbitrary criterion of 0.05. This analysis strategy is widely used, but has been heavily criticized in the past decades. To counter frequent misinterpretations of P-values, it has been advocated to complement or replace P-values with measures of effect size (MES). Many psychological, biological and medical journals now recommend reporting appropriate MES. One hindrance to the more frequent use of MES may be their scarcity in standard statistical software packages. Also, the arguably most widespread data analysis software in neuroscience, matlab, does not provide MES beyond correlation and receiver-operating characteristic analysis. Here we review the most common criticisms of significance testing and provide several examples from neuroscience where use of MES conveys insights not amenable through the use of P-values alone. We introduce an open-access matlab toolbox providing a wide range of MES to complement the frequently used types of hypothesis tests, such as t-tests and analysis of variance. The accompanying documentation provides calculation formulae, intuitive explanations and example calculations for each measure. The toolbox described is usable without sophisticated statistical knowledge and should be useful to neuroscientists wishing to enhance their repertoire of statistical reporting. [ABSTRACT FROM AUTHOR]

Background: Patients receiving implantable cardioverter-defibrillators (ICDs) often have severely impaired left ventricular function and a poor prognosis. Having an ICD in situ effectively denies them the possibility of a quick, arrhythmic death. It is still unclear if and when the end of life and device deactivation should be discussed with patients and how much patients want to know prior to ICD implantation. Methods: Patients with an active ICD for chronic heart failure were interviewed regarding their attitude toward the ICD, their recollection of the consent procedure, and how they felt the end of life should be discussed with ICD patients (n = 54). Patients who had received ICD therapies (n = 25) were reviewed as a subgroup with extended questions regarding attitudes toward device deactivation. Results: Fifty-four patients were recruited. Most patients were not aware that the ICD could be deactivated. The vast majority of patients (84%) wanted to be involved in the deactivation decision; 40% felt this discussion should be prior to ICD implantation but others felt the discussion should only occur if the patient was terminally ill (16%) or in the last few days of life (5%). Conclusion: Patients with ICDs are routinely counseled about the benefits of ICDs, but options for device deactivation are not well understood by patients. Most patients would like to be involved in deactivation decisions and we feel this should be discussed well in advance. (PACE 2011; 34:1628-1633) [ABSTRACT FROM AUTHOR]

Aims Several chronic care models for diabetes have been implemented in Italy, although conclusive data on their effectiveness are lacking. In the Cusano-Milanino diabetes clinic, patients with Type 2 diabetes with a stable disease/therapy (i.e. a steady level of HbA1c without need for therapy changes) are included in the SINERGIA programme: diabetologists, nurses and dietitians empower patients and telemedicine resources are utilized efficiently. Methods Clinical outcomes measured in the year before and after the initiation of SINERGIA were compared. A generalized hierarchical linear regression model for repeated measures was used. Results Altogether, 1004 patients were included; baseline characteristics were (mean ± SD): age 66.6 ± 6.2 years, 54.1% male, diabetes duration 10.8 ± 7.7 years, BMI 29.5 ± 4.8 kg /m², HbA1c 6.9 ± 0.9% (52 ± 14 mmol/ mol); 72.9% of patients were treated with anti-hypertensive drugs; 32.7%were treated with lipid-lowering drugs. After a median follow-up of 12 months (range 6-24 months), the proportion of patients with HbA1c ≤ 7.0% (≤ 53 mmol/mol) increased from 32.7 to 45.8%(P < 0.0001), while those with HbA1c ≥ 9%(≥ 75 mmol/mol) decreased from 10.5 to 4.3%(P < 0.0001). Patients with LDL cholesterol < 100 mg/dl (< 2.59 mmol/l) increased from 40 to 47% (P < 0.0001), while those with LDL cholesterol ≥ 130 mg/dl (≥ 3.36 mmol/l) decreased from 26.6 to 19.7%; blood pressure levels were slightly improved. The mean number of face-to-face encounters decreased from (median and range) 2.8 (2.3-3.4) to 2.3 (1.9-2.7) (P < 0.0001) visits per patient/year. Conclusions The SINERGIA model is effective in improving metabolic control and major cardiovascular risk factors, while allowing diabetologists to dedicate more time to patients with more acute disease. [ABSTRACT FROM AUTHOR]

To determine the relationship between exercise stage and decisional balance in overweight and obese individuals seeking advanced practice nurse (APN) care. A convenience sample of 175 persons aged 40 or above with the values of body mass index (BMI) exceeding 25. One fourth of the respondents were considering beginning exercise within the next month; 23% had exercised regularly for more than 6 months and 39% indicated that they exercised regularly. Most respondents believed the pros of exercise outweighed the cons, and as the pros increased, so did the likelihood of exercising. In approaching the subject of exercise among obese and overweight individuals it is important for the APN to understand behavioral change. Thus, it would be more fruitful to ask, 'What would it take to move those who intend to begin exercising to the next stage?' For health behavior change to occur, the pros must be twice as numerous as the cons. In clinical practice, reviewing and adding to the pros of exercise as outlined by the patient might tip the decisional balance in favor of exercise. [ABSTRACT FROM AUTHOR]

Background: Youth with family history of alcohol abuse have a greater risk of developing an alcohol use disorder (AUD). Brain and behavior differences may underlie this increased vulnerability. The current study examined delay discounting behavior and white matter microstructure in youth at high risk for alcohol abuse, as determined by a family history of alcoholism (FH+), and youth without such family history (FH−). Methods: Thirty-three healthy youth (FH+ = 15, FH− = 18), ages 11 to 15 years, completed a delay discounting task and underwent diffusion tensor imaging. Tract-based spatial statistics ( Smith et al., 2006 ), as well as follow-up region-of-interest analyses, were performed to compare fractional anisotropy (FA) between FH+ and FH− youth. Results: FH+ youth showed a trend toward increased discounting behavior and had significantly slower reaction times (RTs) on the delay discounting paradigm compared to FH− youth. Group differences in FA were seen in several white matter tracts. Furthermore, lower FA in the left inferior longitudinal fasciculus and the right optic radiation statistically mediated the relationship between FH status and slower RTs on the delay discounting task. Conclusions: Youth with a family history of substance abuse have disrupted white matter microstructure, which likely contributes to less efficient cortical processing and may act as an intrinsic risk factor contributing to an increased susceptibility of developing AUD. In addition, FHP youth showed a trend toward greater impulsive decision making, possibly representing an inherent personal characteristic that may facilitate substance use onset and abuse in high-risk youth. [ABSTRACT FROM AUTHOR]

Clinical trials are usually performed on a sample of people drawn from the population of interest. The results of a trial are, therefore, estimates of what might happen if the treatment were to be given to the entire population of interest. Confidence intervals (CIs) provide a range of plausible values for a population parameter and give an idea about how precise the measured treatment effect is. CIs may also provide some useful information on the clinical importance of results and, like p-values, may also be used to assess ‘statistical significance’. Although other CIs can be calculated, the 95% CI is usually reported in the medical literature. In the long run, the 95% CI of an estimate is the range within which we are 95% certain that the true population parameter will lie. Despite the usefulness of the CI approach, hypothesis testing and the generation of p-values are common in the medical literature. The p-value is often used to express the probability that the observed differences between study groups are due to chance. p-values provide no information on the clinical importance of results. Conclusion: It is good practice for authors of research articles to report CIs with their estimates instead of just p-values as p-values are less informative and convey no information on clinical importance. [ABSTRACT FROM AUTHOR]

Background: Few studies in developing countries have examined posthospital mortality and little is known about the magnitude of posthospital mortality and risk factors for long-term survival. A better understanding of the determinants of posthospital mortality could help improve discharge policies and interventions with implications for overall childhood mortality. Study population: In the period from 1991 to 1996 all paediatric admissions coming from the Bandim Health Project's area were registered at the National Hospital in Bissau, Guinea-Bissau. Posthospitalization information from a population-based surveillance system was available for 4153 admissions contributed by 3373 individuals having between 1 and 8 admissions during the period. Three thousand six hundred forty seven (3647) admissions by 2950 children resulted in live discharges. Postdischarge mortality included all deaths during 1 year following live discharge. Results: Among the 221 children who died during the first year after discharge, 170 died in the community and 51 children died during a subsequent hospitalization; thirty-eight died on the day of discharge and almost one third had died within the first 2 weeks. The overall in-hospital and 12-month posthospital mortality was 20%. Compared to the mortality level in the community and controlled for other determinants of childhood mortality, children discharged from hospital had 12 times higher risk of dying during the first 2 weeks after discharge. The mortality rate ratio (MR) was 6.2 (95% confidence interval 3.8–10.2) times higher when we excluded those who died at the day of discharge. For the period 30–91 days after discharge the MR ratio was 3.7 (2.5–5.5), and in the period 3–6 months after discharge, the risk estimate was still 2.5 (1.6–3.9) times higher than community mortality. In a multivariate analysis, the all-dominating risk factor was discharge status as ‘fled’ in the sense of nonmedical discharge, the MRs being 18.6 (9.5–36.6) in the first 2 weeks after discharge and 4.0 (2.0–8.3) in the remaining part of the first year. Other significant risk factors for postdischarge mortality included ethnic group, housing quality and maternal education, and were similar to risk factors for community mortality. The same diagnoses that had high acute mortality, including anaemia, diarrhoea and ‘other’, were also associated with high postdischarge mortality. Conclusion: There was a marked increase in mortality after hospitalization, the effect being particularly strong for children who fled the hospital. Improved discharge and follow-up policies might have an important impact on survival after paediatric hospitalization. Studies on the effect of focused intervention at discharge are needed. [ABSTRACT FROM AUTHOR]

Despite being under challenge for the past 50 years, null hypothesis significance testing (NHST) remains dominant in the scientific field for want of viable alternatives. NHST, along with its significance level p, is inadequate for most of the uses to which it is put, a flaw that is of particular interest to educational practitioners who too often must use it to sanctify their research. In this article, we review the failure of NHST and propose prep, the probability of replicating an effect, as a more useful statistic for evaluating research and aiding practical decision making. © 2007 Wiley Periodicals, Inc. Psychol Schs 44: 471–481, 2007. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the effect of the provision of a clinical practice guideline (CPG) on dental students' decisions to remove asymptomatic, impacted lower third molars. All dental students, who in 2001 were in the 3rd, 4th or 5th (final) year of their study at the Nijmegen College of Dental Sciences, were invited to participate. A pre-test–post-test control group design was used. Given 36 patient cases, all dental students were asked to assess the need for removal of asymptomatic, impacted lower third molars. All pre-test respondents were randomly allocated to the control or intervention group. After the provision of a CPG to the intervention group, both groups were asked to assess the same cases again. Frequencies of decisions to remove the third molars were calculated. Chi-square tests and anova were used to test the influence of study year and gender on the drop-out rate and on the effect of the provision of a CPG on students' treatment decisions. The decrease in indications to remove third molars by the intervention group was statistically significant ( P < 0.05). In the control group, no significant decrease was observed. It was concluded that the provision of a CPG significantly influences dental students' decision making about treatment in a third-molar decision task. Students who used the CPG showed more guideline-conformed decision making. [ABSTRACT FROM AUTHOR]

This paper deals with obtaining an upper tolerance limit for a largest observation X [ABSTRACT FROM AUTHOR]

The article offers the author's insights on the significance of employing good statistical approaches in making decisions on policies in plant science. The author mentions the drawbacks of using null hypothesis significance testing (NHST), which are based on using arbitrary threshold for evaluating statistical significance. He argues that NHST's significance threshold must be established to attain the objectives of the statistical test.