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COMBO (OrbusNeich Medical, Hong Kong) is a dual-therapy coronary stent featuring sirolimus as antiproliferative drug and an anti-CD34+ antibody coating to attract endothelial progenitor cells favoring rapid stent re-endothelization. The Mega COMBO collaboration aimed to evaluate the performance of the COMBO stent in a large contemporary cohort of patients undergoing percutaneous coronary intervention (PCI). Patient-level data of subjects undergoing PCI with the COMBO stent from the REMEDEE-Trial, REMEDEE-OCT, HARMONEE, REDUCE, SORT OUT X, REMEDEE-Registry and MASCOT studies were pooled together. The primary endpoint was 1-year target lesion failure (TLF), a composite of cardiovascular death, target vessel myocardial infarction (TV-MI) or clinically driven target lesion revascularization (CD-TLR). Secondary outcomes were the individual components of the primary endpoint and stent thrombosis (ST). Endpoints were evaluated against performance goals based on the EAPCI (the European Association of Percutaneous Coronary Intervention) recommendations for new drug-eluting stents. A total of 6753 patients (mean age 63.7 ± 11.4 years, 23% women) were included. At 1-year follow-up, TLF occurred in 303 (4.6%) patients. The rates of cardiovascular death, TV-MI, and CD-TLR were 1.3%, 1.8%, and 2.5%, respectively. The rate of definite/probable ST was 0.73%, early ST (<1 month) was 0.48%, while late ST (1–12 months) was 0.26%. The performance goals were met for all of the evaluated endpoints. This large patient-level pooled analysis provides a comprehensive outline of the performance of the dual-therapy COMBO stent. The low rates of primary and secondary endpoints suggest that this stent technology may be a good alternative to other contemporary drug eluting coronary stent platforms. • Despite promising early studies on the dual-therapy COMBO stent, recent randomized-controlled clinical trials have yielded mixed findings. • This individual patient data analysis of 5 randomized trials and 2 prospective registries represents the largest study on patients undergoing PCI with the COMBO stent. • The observed 1-year event rates favorably compared against the EAPCI performance goals for second generation DES. • Characteristics of the study cohort reflect a real-world PCI population; the low rates of adverse events provide reassurance on the safety and efficacy of the COMBO stent. • The COMBO stent represents a reasonable alternative to other drug-eluting stent platforms. [ABSTRACT FROM AUTHOR]

What is the effect of therapeutic exercise or tailored physical activity programs supported by a mobile app (compared with exercise or physical activity programs delivered using other modes) for people with musculoskeletal pain conditions? Systematic review of published randomised controlled trials with meta-analysis. People of all ages with musculoskeletal pain conditions. Therapeutic exercise or tailored physical activity programs supported by a mobile app. Pain intensity, pain interference, self-reported physical function, physical performance, adherence, psychosocial outcomes, health-related quality of life, work participation, physical activity, goal attainment and satisfaction. Eleven studies were eligible for inclusion, with a total of 845 participants. There was low certainty evidence that using mobile apps to deliver exercise programs helps to reduce pain intensity to a worthwhile extent (SMD –0.60, 95% CI –0.93 to –0.27). There was low certainty evidence that using mobile apps to deliver exercise programs helps to improve self-reported physical function to a worthwhile extent (SMD –0.92, 95% CI –1.57 to –0.27). Although the effect of using mobile apps to deliver exercise programs on pain interference was also estimated to be a worthwhile benefit (SMD –0.66), this estimate came with marked uncertainty (95% CI –1.52 to 0.19) so the effect remains unclear. The remainder of the outcomes were unclear due to sparse evidence. The most common behaviour change intervention functions in the mobile app interventions were: training, enablement and environmental restructuring. Mobile apps supporting therapeutic exercise or tailored physical activity programs for musculoskeletal pain conditions may help in reducing pain intensity and improving physical function. The mobile apps utilised a limited range of behaviour change intervention functions. CRD42021248046 [ABSTRACT FROM AUTHOR]

Climate change poses serious risks to rural communities which rely heavily on climate-sensitive resources. Rural communities are also significant contributors to GHG emissions given the prevalence of agriculture and related activities and are therefore expected to develop courses of action that tackle climate change. This includes either formulating a standalone plan that outlines mitigation and adaptation strategies or integrating these priorities into existing plans. The extent to which municipalities fulfill these planning functions, and how well, has been found to vary considerably from one community to another. In this study, we sought to contribute to knowledge about how well rural municipalities are planning for climate change risks. To this end, we systematically evaluated the contents and quality of rural climate change plans in Ontario (Canada). Using a well-established plan quality evaluation framework, we found that rural plans generally contained strong mechanisms for coordination between departments, and most had outlined specific goals concerning climate change action. By contrast, few plans provided a meaningful fact base to support their goals, many lacked specific policies to guide decision-makers in achieving climate goals, and most contained weak provisions for monitoring and evaluation. After drawing out some key themes from the plan quality analysis, the article concludes by pointing to areas of rural climate change planning that require further attention, and by outlining some areas for further study. • Rural municipal climate change planning is in its infancy in Ontario, Canada. • There is an emphasis on climate mitigation over adaptation. • There is a lack of meaningful fact base to support climate change goals. • Plans lacked specific policies to guide decision-makers in achieving climate goals. [ABSTRACT FROM AUTHOR]

BACKGROUND: Establishing and achieving learning goals (LGs) are important lifelong learning skills for residents. Faculty are critical in facilitation and achievement of residents' LGs, yet many have difficulty with this role in the busy inpatient setting. OBJECTIVES: Our primary aim was to improve faculty engagement in resident LGs, targeting ≥80% of faculty achieving a mean score ≥goal, over a period of 1 year by setting prerotation expectations and stressing team-based faculty accountability during the rotation in the current inpatient learning environment. METHODS: We identified key barriers to addressing LGs on an inpatient subspecialty service. Key interventions included 1) introducing LGs to faculty, 2) establishing a communication/handover process among faculty, 3) LGs development, and 4) tracking accountability. Baseline mean faculty milestone scores were determined from the prior year. Over 1 year, we developed and refined a system for residents to create and document LGs with faculty oversight and review. We reviewed faculty evaluations quarterly to measure progress and reviewed rotation evaluations. RESULTS: Faculty engagement with LGs improved through the course of the academic year. All but one faculty member had improved LGs scores during the intervention year. Most residents were very satisfied with the intervention and gave unprompted favorable feedback on rotation evaluations. The majority of submitted LGs were either partially or completely addressed. CONCLUSIONS: We demonstrated that a quality improvement approach to a faculty educational skill is feasible and effective. Our intervention related to LGs may be modified for any medical learner in any inpatient or outpatient setting. [ABSTRACT FROM AUTHOR]

Context: There is a paucity of data describing patients' expectations of goals of palliative radiotherapy (RT) and overall prognosis.Objectives: To explore patients' perceptions of and preferences for communication surrounding goals of palliative RT and cancer prognosis.Methods: We conducted a qualitative study utilizing semi-structured interviews with seventeen patients with either bone or lung metastases receiving their first course of palliative RT at a comprehensive cancer center. All patient interviews were recorded, transcribed verbatim, and thematically analyzed.Results: Themes of goals of palliative RT centered on either restoration, such as through improving quality of life or minimizing pain, or on a desire to combat cancer by eliminating tumor. While most patients perceived that palliative RT would palliate symptoms but not cure their cancer, some patients believed that the goal of palliative RT was to cure. Themes that emerged surrounding patients' understanding of prognosis and what lies ahead included uncertainty and apprehension about the future, a focus on additional treatment, and confronting mortality. Most patients preferred to receive information about goals of treatment and prognosis from their doctors, including radiation oncologists, rather than other members of the medical team. Patients also expressed a desire for written patient education materials on palliative RT.Conclusion: Unclear perceptions of goals of treatment and prognosis may motivate some patients to pursue unnecessarily aggressive cancer treatments. Patients desire prognostic information from their doctors, including radiation oncologists, who are important contributors to goals of care discussions and may improve patient understanding and well-being by using restorative rather than combat-oriented language. [ABSTRACT FROM AUTHOR]

How can artificial neural networks capture the advanced cognitive abilities of pioneering scientists? I suggest they must learn to exploit human-invented tools of thought and human-like ways of using them, and must engage in explicit goal-directed problem solving as exemplified in the activities of scientists and mathematicians and taught in advanced educational settings. [ABSTRACT FROM AUTHOR]

• China's central government balances local autonomy and central regulation. • Decentralization and centralization are used to explore flexible governance under the authoritarian system. • Goal-oriented governance employs hierarchical planning and experimentation. • Feedback about decentralization from local government influences state decisions. • Local policy-making and urban governance as a wavering multi-level interaction process. This study views decentralization and centralization as complementary strategies for balancing state control and local autonomy, with the goal of exploring effective governance under authoritarian regimes. We examine the governance framework the central government employs to balance "encouraging local autonomy" and "protecting the centrality of regulation," analyzing urban development and the central-local interaction under this governance framework. We believe that goal-oriented governance with information transmission at its core is the key to reaching such equilibrium, accompanied by two critical governance techniques: hierarchical planning systems and decentralized experimentation. The hierarchical planning system, with the auxiliary evaluation mechanism, passes down national goals and provides administrative guidance to local governors. Meanwhile, the procedural and experimental nature of plan formation has encouraged local policy innovation and bottom-up information feedback. Under goal-oriented governance and manageable experimentation, urban development decisions are formulated, and urban transformation takes place. The study deepens our understanding of the tentative nature of China's state rescaling, i.e., the search for a balance between state control and local autonomy to defuse governance problems at a given time. It also broadens our understanding of China's policy-making and urban governance as a wavering multi-level interaction rather than a dichotomous process of centralization and decentralization. [ABSTRACT FROM AUTHOR]

Context: Personal values are individual conceptions of the desirable appraisals and actions that guide our attitudes and behaviour. Advance care planning (ACP) now emphasises the consideration of personal life goals and values expressed as a Values Directive (VD) to guide discussions concerning medical treatment.Objective: To investigate the diversity of values, experiences and adaptations expressed in cancer patients VDs.Methods: Contents of the VDs of ACPs of cancer patients who participated in a randomised control trial comparing a video intervention showing values communication between cancer patient-caregivers with usual care were analysed. Qualitative phenomenological content analysis was used to understand how participants made meaning of their lived experiences.Results: Forty-two participants completed an ACP (37.2% response rate), with 97.6% of these completing a VD (57.1% female, mean age 72 years, 30.1% gastrointestinal cancer). Participants described diverse adjustments to frailty and adaptive coping with deteriorating functionality. Emotional and financial concerns were eased through experiencing benevolence and trust established through family and friendship bonds and reciprocation of care. Death anxiety and ambivalence were expressed concurrently with the experiential acceptance of dying. Secular and sacred rituals featured as an affirmation of their faith or beliefs.Conclusion: Cancer patients seek to make meaning of their experiences, concurrently posturing vulnerability and resilience, despite conflicting emotions and experiences. Given that the choices people make as they approach dying relate to their most deeply held values, ACP conversations should explore how patients draw from their values and life goals to optimise their adaptations to illness. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess perceptions about the inclusion of biopsychosocial and active care recommendations during chiropractic clinical encounters between doctors of chiropractic (DCs) and their midlife and older adult patients and to identify whether there were any discrepancies between their recollections. This descriptive cross-sectional survey was part of a mixed-methods research project designed to gather information about the role of electronic health interventions for midlife and older adults who use chiropractic care. For this study, a convenience sample of 29 DCs and 48 chiropractic patients aged 50 years and older from 2 metropolitan areas in the United States completed online surveys between December 2020 and May 2021. The survey matched questions about components of chiropractic care discussed by patients and providers over 12 months. We used descriptive statistics to explore congruence in perceptions between groups and qualitative content analysis to describe DC perceptions of working with this population. Doctors of chiropractic and patients agreed (>90%) that pain management was the top reason midlife and older adults seek chiropractic care, yet differed in their prioritization of maintenance/wellness care, physical function/rehabilitation, and injury treatment as care drivers. While DCs reported frequent discussions about psychosocial recommendations, fewer patients reported talking about treatment goals (51%), self-care (43%), stress reduction (33%), or the impact of psychosocial factors (23%) and beliefs/attitudes (33%) on spinal health. Patients reported varied recollections about discussing activity limitations (2%) and exercise promotion (68%), being taught exercises (48%), or reassessing exercise progress (29%), which differed from higher levels reported by DCs. Qualitative themes from DCs included psychosocial considerations in patient education, importance of exercise/movement, role of chiropractic in lifestyle changes, and reimbursement limitations for older patients. Doctors of chiropractic and their patients reported discrepant perceptions about biopsychosocial and active care recommendations during clinical encounters. Patients reported modest emphasis on exercise promotion and limited discussion on self-care, stress reduction, and psychosocial factors related to spine health compared to the recollections of DCs who reported frequent discussions of these topics. [ABSTRACT FROM AUTHOR]

Context: Seriously ill patients whose prioritized healthcare goals are understood by their clinicians are likely better positioned to receive goal-concordant care.Objectives: To examine the proportion of seriously ill patients whose prioritized healthcare goal is accurately perceived by their clinician and identify factors associated with accurate perception.Methods: Secondary analysis of a multicenter cluster-randomized trial of outpatients with serious illness and their clinicians. Approximately two weeks after a clinic visit, patients reported their current prioritized healthcare goal- extending life over relief of pain and discomfort, or relief of pain and discomfort over extending life - and clinicians reported their perception of their patients' current prioritized healthcare goal; matching these items defined accurate perception.Results: Of 252 patients with a prioritized healthcare goal, 60% had their goal accurately perceived by their clinician, 27% were cared for by clinicians who perceived prioritization of the alternative goal, and 13% had their clinician answer unsure. Patients who were older (OR 1.03 per year; 95%CI 1.01, 1.05), had stable goals (OR 2.52; 95%CI 1.26, 5.05), and had a recent goals-of-care discussion (OR 1.78, 95%CI 1.00, 3.16) were more likely to have their goals accurately perceived.Conclusion: A majority of seriously ill outpatients are cared for by clinicians who accurately perceive their patients' prioritized healthcare goals. However, a substantial portion are not and may be at higher risk for goal-discordant care. Interventions that facilitate goals-of-care discussions may help align care with goals, as recent discussions were associated with accurate perceptions of patients' prioritized goals. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effect of the Ryan Program for family planning training on patient counseling surrounding previable pregnancy loss.Methods: We conducted a retrospective cohort study of patients with first- and second-trimester miscarriages, therapeutic abortions, ectopic and molar pregnancies, from years before and after establishing a Ryan Program. We compared documentation of coping and future reproductive goals by patient factors, using chi square testing and logistic regression.Results: We included 285 pregnancies: 138 pre-Ryan, 147 post-Ryan. Documentation of coping and future goals was greater post-Ryan than pre-Ryan (57.8% vs. 26.8% for coping, 72.8% vs. 50.7% for goals; both p < 0.001). Coping was less likely to be documented for adolescents (aOR 0.02), patients of Asian race (aOR 0.08), those diagnosed in the emergency department (aOR 0.22), and those with ectopic or molar pregnancy (aOR 0.14) (all p < 0.005). Coping documentation increased with second-trimester loss (aOR 6.19) and outpatient follow-up (aOR 3.41) (all p < 0.005).Conclusions: Establishment of a Ryan Program was associated with greater attention to patient coping and goals after previable pregnancy loss. Patients experiencing medically-dangerous pregnancy losses receive less attention to their coping.Practice Implications: Comprehensive family planning training and outpatient access may improve patient-centeredness of care for previable pregnancy loss. [ABSTRACT FROM AUTHOR]

Objective: This scoping review aimed to identify patient goal elicitation and evaluation methods for older adults, and to investigate which methods can be used in medication optimization interventions for nursing home residents (NHRs).Methods: The Arksey and O'Malley framework guided the review. A search was launched in PubMed, Embase, CINAHL, and Web of Science. Reference selection and data extraction were performed by three independent reviewers, followed by team discussions to solve discrepancies. Inductive thematic analysis was applied to synthesize the data. Included papers were reconsidered to identify methods for medication optimization interventions for NHRs.Results: Ninety-six references, encompassing 38 elicitation and 12 evaluation methods, were included. Elicitation methods differed in structure, content, and patient involvement levels. Qualitative and quantitative methods were found to assess goal attainment. Five elicitation and three evaluation methods were developed for NHRs, but none of these contained a medication-related assessment.Conclusion: A variety of goal elicitation and evaluation methods for older adults was found, but none for medication optimization interventions in NHRs.Practice Implications: A holistic approach seems important to integrate patient goals into medication optimization interventions, not limiting goal elicitation to a medication-related assessment. Also, the choice of assessor seems important to obtain patient goals. [ABSTRACT FROM AUTHOR]

Substance use stigma has been positioned as a major driver of drug toxicity mortality. In response, governmental and public health organizations across Canada have invested significant resources into mass media campaigns that target stigma. Many of these campaigns feature images or stories about people who use drugs (PWUD). Although stigma and drug toxicity death disproportionately impact racially and economically marginalized PWUD, these campaigns often over-represent White, middle-class individuals. This effectively ignores intersecting roles of racism and classism in the experience of stigma and drug toxicity mortality. To investigate how this pattern of representation might occur, we examined the development process of the British Columbia (BC) Government's "Stop Overdose" anti-stigma campaign launched in 2018. We aimed to identify strategic goals, decisions, and underlying ideas that could help explain the campaign's eventual focus on White, middle-class PWUD. Through a Freedom of Information request we obtained 320 pages of documents from the BC Government outlining the real-time development, testing, and evaluation of the first wave of the campaign. We analyzed these documents using reflexive thematic analysis. We identified that campaign developers had a marked focus on challenging stereotypes about PWUD and humanizing PWUD, while ensuring the campaign was relevant to BC residents. To achieve these goals, campaign developers ultimately avoided images of what they deemed the inaccurately "stereotypical" marginalized drug user. Instead, they featured PWUD in more privileged social positions. By attaching labels like "co-worker" to this imagery, developers felt mainstream BC residents could relate to and have more empathy for these PWUD compared to marginalized PWUD. In effect, these strategies perpetuated the exclusion and dehumanization of marginalized PWUD facing disproportionate harms of the drug toxicity crisis. Since anti-stigma campaigns remain a common intervention, we highlight a need for strategic approaches informed by more critical perspectives on substance use stigma. [ABSTRACT FROM AUTHOR]

• Without COVID-19, San Francisco was likely to achieve HCV elimination among PWID. • Although the COVID-19 pandemic hindered progress to achieving HCV elimination progress in San Francisco, a partial rebound in testing rates and treatment numbers from April 2021 improved the likelihood of achieving elimination by 2030. • Scaled-up interventions among young adult PWID and unstably housed PWID could dramatically improve the likelihood of achieving elimination. Young adult (18–30 years) people who inject drugs (PWID) face high hepatitis C virus (HCV) prevalence. In San Francisco, where >60% of PWID lack stable housing, barriers hinder HCV treatment access. We assessed progress towards the World Health Organization's (WHO) HCV elimination goal of an 80% reduction in incidence over 2015–2030, focusing on young (YPWID) and unstably housed PWID in San Francisco. We developed a dynamic HCV transmission model among PWID, parameterized and calibrated using bio-behavioural survey datasets from San Francisco. This included 2018 estimates for the antibody-prevalence among PWID (77%) and care cascade estimates for HCV for YPWID (72% aware of their status and 33% ever initiating treatment). Based on programmatic data, we assumed a 53.8% reduction in testing and 40.7% decrease in treatment from 2020 due to the COVID-19 pandemic, which partially rebounded from April 2021 with testing rates then being 31.1% lower than pre-pandemic rates and treatment numbers being 19.5% lower. We simulated different scenarios of how services changed after the pandemic to project whether elimination goals would be met. Continuing post-pandemic rates of testing and treatment, the model projects an 83.3% (95% credibility interval [95% CrI]:60.6–96.9%) decrease in incidence among PWID over 2015–2030 to 1.5/100pyrs (95% CrI:0.3–4.4) in 2030. The probability of achieving the elimination goal by 2030 is 62.0%. Among YPWID and unstably housed PWID, the probability of achieving the elimination goal by 2030 is 54.8 and 67.6%, respectively. Importantly, further increasing testing and treatment rates to pre-pandemic levels by 2025 only results in a small increase in the probability (67.5%) of the elimination goal being achieved among all PWID by 2030, while increased coverage of medication for opioid use disorder among YPWID and/or housing interventions results in the probability of achieving elimination increasing to over 75%. The COVID-19 pandemic impeded progress toward achieving HCV elimination. Our findings indicate that existing partial rebounds in HCV testing and treatment may achieve the elimination goal by 2030, with an additional scale-up of interventions aimed at YPWID or unstably housed PWID ensuring San Francisco is likely to achieve elimination by 2030. [ABSTRACT FROM AUTHOR]

In 2015, the Sustainable Development Goals (SDGs) were announced with the agreement of 190 world leaders aiming for ending extreme poverty, fighting inequality and injustice by 2030. Among different approaches, investments in future generations' capacities to thrive are key to attaining these goals. Promoting children's thriving, however, is not a simple matter because child development is not a single state and is not determined by a single force. Promoting children's development and capacities necessitates a multifaceted approach, and place-based interventions stand out as a promising strategy. This paper reviewed current evidence on the outcomes of place-based interventions aimed at improving children's capacities to thrive. We found that 22 published texts that met our inclusion criteria, exhibiting a range of program effects. The review also highlighted several challenges related to implementation and evaluation. Additionally, we discussed how place-based interventions adapt in the digital age. [ABSTRACT FROM AUTHOR]

In the last years, the System 1/System 2 cognitive architecture, proposed by psychologist Daniel Kahneman, raised the interest of many researchers in the field. System 1 is an intuitive, automatic, and fast-thinking system working effortlessly, without conscious effort. System 2 is a deliberate, analytical, and slower-thinking system employing conscious effort and attention. This work proposes an innovative approach that exploits techniques typical of information retrieval (the trie data structure) to efficiently encode the solutions' repository at the border between System 2 and System 1. This repository stores the solutions (successful plans) the agent has already used and can re-enact to achieve the goals. System 2 conceives new plans and delegates System 1 to execute them. If the plan is successful (and so it becomes a solution), System 1 stores that in the repository to quickly retrieve any solution that may help fulfil the goals deliberated by System 2 in the future. • A step towards the definition of an interface between System 1 and System 2. • Efficient encoding of a repository of solutions and their quick access by System 1. • The repository is designed to support a goal-oriented perspective. [ABSTRACT FROM AUTHOR]

Although attending substance use-focused mutual-help meetings online may reduce attendance barriers, associations of attendance mode with group participation and outcomes are unknown. Using longitudinal data from mutual-help group attendees, this study, after identifying differences in baseline characteristics by attendance mode, examined associations of attendance mode with mutual-help participation (number of meetings attended, involvement) and outcomes (alcohol abstinence, heavy drinking, alcohol problems). The Peer Alternatives for Addiction Study 2021 Cohort sampled attendees of 12-step groups (e.g., Alcoholics Anonymous), Women for Sobriety, LifeRing Secular Recovery, and/or SMART Recovery in-person and/or online within 30 days before baseline. The baseline sample, recruited in fall 2021, was 531 adults with lifetime alcohol use disorder, followed at 6 (88 %) and 12 months (85 %). Differences in baseline characteristics by attendance mode were tested using Chi-squares and ANOVAs. GEE models examined associations of attendance mode, time, and their interactions with mutual-help group participation and alcohol outcomes. The in-person only mode was compared to the online-only, and to the in-person plus online, modes. At baseline, 53.7 % of participants had attended only online meetings in the past 30 days, 33.7 % had attended both in-person and online meetings, and 12.6 % had attended only in-person meetings. Online meeting attendees were less likely to endorse lifetime abstinence as an alcohol recovery goal than in-person-only meeting attendees. In adjusted models (including for recovery goal), those attending online meetings only, or both online and in-person meetings, attended a greater number of meetings compared to those attending only in-person meetings. However, online-only attendance was associated with less involvement than in-person-only attendance. In adjusted models, compared to baseline, involvement increased and outcomes improved at follow-ups. Adjusted models examining alcohol outcomes found that no attendance at mutual-help groups at follow-ups was associated with more heavy drinking compared to in-person-only attendance. Findings inform efforts to ascertain benefits of mutual-help group participation by suggesting that online attendance is associated with attending more meetings, less involvement, and lower endorsement of abstinence as a recovery goal, and is comparable to in-person attendance on alcohol outcomes. In-person attendance may be more beneficial for less heavy drinking than terminating attendance. • In-person-only attendees more often had the goal of lifetime alcohol abstinence. • Online-only attendance was associated with more meetings but less involvement. • Involvement and alcohol outcomes, but not attendance, improved at follow-ups. • Attendance mode did not relate to alcohol outcomes. [ABSTRACT FROM AUTHOR]

Self-efficacy, a patient-level factor, has been shown to facilitate patient engagement in treatment and optimize treatment-related outcomes in various health contexts. Research on interventions supporting hepatitis C virus (HCV) direct-acting antiviral (DAA) treatment uptake and adherence among persons who inject drugs (PWID) is needed, but whether self-efficacy factors influence DAA treatment cascade outcomes in this population has been less studied. Using the HERO study data, we analyzed a subset of participants with any general health self-efficacy data (n=708) measured at baseline and end-of-treatment time points using a 5-items instrument (facets: 'goal setting', 'goal attainment', 'having a positive effect', 'being in control', and 'working to improve'). The cascade outcomes included DAA treatment initiation, duration, adherence, completion, and sustained virologic response (SVR). The effect of baseline and change (Δ) scores for composite and item-level self-efficacy on the cascade outcomes was assessed using logistic regression and generalized linear models. Higher baseline composite self-efficacy [adjusted odds ratio (95 % confidence interval) =1.57 (1.07, 2.29)], 'goal attainment' [1.31 (1.03, 1.67)] and 'having a positive effect' [1.33 (1.03, 1.74)] were associated with greater likelihood of treatment initiation. 'Δ Goal attainment' was significantly associated with SVR [1.63 (1.04, 2.53)]. 'Δ Being in control' and 'Δ working to improve' were associated with treatment adherence and duration, respectively. General health self-efficacy positively influences DAA treatment initiation among PWID. 'Goal attainment' facilitates the achievement of DAA treatment-related outcomes. Further studies should assess the effect of self-efficacy related to performing healthcare tasks specific to DAAs on the treatment-related outcomes. • Health self-efficacy raises hepatitis C treatment rates among injection drug users. • Goal attainment self-efficacy especially increases hepatitis C cure rates. • Higher treatment adherence relates to increased 'being in control' self-efficacy. • Longer treatment duration relates to increased 'working to improve' self-efficacy. [ABSTRACT FROM AUTHOR]

Plant-based food refers to a diet focused on consuming primarily plant-derived ingredients for health, environmental, and ethical reasons. Since there is a growing recognition regarding the significant correlation between sustainable consumption and consumers' political inclinations, this study aimed to identify effective ways to promote plant-based food in a restaurant setting by analyzing the relative persuasiveness of advertisements in terms of three variables: consumer political orientation (liberal vs. conservative), regulatory focus (promotion vs. prevention), and message type (health vs. taste). This study confirms that there is a significant two-way effect between political orientation and regulatory focus on consumers' attitude and purchase intentions toward plant-based food. Additionally, this two-way effect between political orientation and regulatory focus varies depending on the type of message. The mediating role of goal relevance was confirmed as well. The study provides implications for effective marketing communication in the context of plant-based food promotion in the foodservice industry. • Liberals show higher responses for plant-based food than conservatives. • Liberals respond positively to plant-based food, regardless of message focus. • Liberals prefer taste-focused messages; responses to health-focused ones vary. • Liberals prefer health messages in promotion; conservatives favor prevention content. • Goal relevance guides plant-based food assessment based on personal goals and values. [ABSTRACT FROM AUTHOR]

Bluetooth Low Energy (BLE) has emerged as one of the reference technologies for the development of indoor localization systems, due to its increasing ubiquity, low-cost hardware, and to the introduction of direction-finding enhancements improving its ranging performance. However, the intrinsic narrowband nature of BLE makes this technology susceptible to multipath and channel interference. As a result, it is still challenging to achieve decimetre-level localization accuracy, which is necessary when developing location-based services for smart factories and workspaces. To address this challenge, we present BmmW, an indoor localization system that augments the ranging estimates obtained with BLE 5.1's constant tone extension feature with mmWave radar measurements to provide 3D localization of a mobile tag with decimetre-level accuracy. Specifically, BmmW embeds a deep neural network (DNN) that is jointly trained with both BLE and mmWave measurements, practically leveraging the strengths of both technologies. In fact, mmWave radars can locate objects and people with decimetre-level accuracy, but their effectiveness in monitoring stationary targets and multiple objects is limited, and they also suffer from a fast signal attenuation limiting the usable range to a few meters. We evaluate BmmW's performance experimentally, and show that its joint DNN training scheme allows to track mobile tags with a mean 3D localization accuracy of 10 cm when combining angle-of-arrival BLE measurements with mmWave radar data. We further assess two variations of BmmW: BmmW- Lite and BmmW- Lite+ , both tailored for single-antenna BLE devices, which eliminates the necessity for bulky and expensive multi-antenna arrays and represents a cost-effective solution that is easy to integrate into compact IoT devices. In contrast to classic BmmW (which utilizes angle-of-arrival info), BmmW- Lite uses raw in-phase/quadrature (I/Q) measurements, and achieves a mean localization accuracy of 36 cm, thus facilitating precise object tracking in indoor environments even when using budget-friendly single-antenna BLE devices. BmmW- Lite+ extends BmmW- Lite by allowing the localization task to be transferred from the edge to the cloud due to device memory and power constraints. To this end, BmmW- Lite+ employs a goal-oriented communication paradigm that compresses initial BLE features into a more compact semantic format at the edge device, which allows to minimize the amount of data that needs to be sent to the cloud. Our experimental results show that BmmW- Lite+ can compress raw BLE features by up to 12% of their initial size (hence allowing to save network bandwidth and minimize energy consumption), with negligible impact on the localization accuracy. [ABSTRACT FROM AUTHOR]

The increasing demand for social care, resulting from population ageing and the growing prevalence of chronic diseases and disabilities puts pressure on public resources. This trend necessitates decisions on the allocation of those resources to social care services. Several states have established explicit decision-making frameworks to inform resource-allocation decisions on healthcare to safeguard efficient and equitable access to healthcare services despite the scarcity of resources. While the theoretical and empirical underpinnings of such decisions on healthcare have been scrutinised, the underpinnings of resource-allocation decisions on social care remain unexplored. This study aims to contribute to filling this literature gap. We conducted a systematic literature search on seven databases following PRISMA guidelines. Based on the 42 articles included, we identified five different decision-makers (national, and local (health) authorities, case managers, service providers, and formal caregivers) responsible for resource-allocation decisions on social care on the macro, meso, and micro levels. We further developed a thematic framework consisting of 25 categories of underpinnings grouped under six themes that successively describe (cultural) norms and values, objectives, considerations, trade-offs, strategies, and factors that underlie and influence resource-allocation decisions. Our findings highlight the importance decision-makers attach to the provision of social care and the importance of informal caregivers for the sustainability of the social-care system on all decision levels. Furthermore, our findings highlight the strong competition with the healthcare system over resources and responsibilities, resulting in pressure on social care resource-allocation decision-makers to meet (post-)acute health needs in the short-term at the expense of longer-term social care needs. The multiplicity of decision-makers and variety of underpinnings signal the complexity of resource-allocation decisions on social care. To counterbalance the potential consequences of this complexity such as the potentially inequitable access to social care, decision-makers are advised to increase the consistency and transparency of decisions. • Resource-allocation decisions on social care are inherently complex. • Underpinnings of decisions are varied and inconsistent across decision levels. • Lack of consistency in decisions may increase inequity in access to social care. • Social care resources are often allocated to accommodate (post-)acute health needs. • Explicit decision-making frameworks may safeguard equal access to social care. [ABSTRACT FROM AUTHOR]

To explore the feasibility of guided goal setting (GGS) delivered via a tele-nutrition intervention in a Rural Native American community. Based on the social cognitive and goal setting theories, GGS, was designed as an alternative to self-set and prescribed goals and gives choices from a collection of tailored goals suitable for group education. Native American caregivers of young children living in remote rural communities. The Healthy Kids tele-nutrition intervention consisted of 6-weekly sessions delivered remotely by an EFENP educator. Eating Smart Being Active curriculum was augmented with GGS, food-related parenting, storytelling, and My Healthy Plate to target child malnutrition prevention. Acceptability of the goal setting strategy and tele-nutrition delivery were explored via participant survey after each session. Process evaluation data was collected on participant shared goal content. Focus groups were conducted at the last session. Two intervention series were conducted. Thirty-three participants registered for the intervention with 23 attending 4 or more sessions. Participants actively engaged in the GGS procedure by choosing goals, tracking progress, and engaging in session activities. Parents shared weekly goals during class discussions which included those from the tailored list, intervention topics, or personally relevant (ie, turn off TV at dinner, add fruit to water, take nature hikes). Post-session surveys revealed that 95% reported GGS was useful. Additionally, during focus group interviews, participants described liking goal setting, particularly the goal options, weekly tracking, and that it was motivating. A majority of participants (93%) indicated that they agree that the tele-nutrition modality was effective. In the focus group interviews, it was shared that the virtual classes were a valued opportunity but prefer face-to-face. Participants in this study actively engaged in GGS delivered via tele-nutrition and routinely challenged themselves by selecting or creating new weekly goals. Further research should include exploration of optimizing the GGS strategy specifically for this community and modality. NIFA [ABSTRACT FROM AUTHOR]

Goal-directed manipulation of internal representations is a key element of human flexible behaviour, while consciousness is commonly associated with higher-order cognition and human flexibility. Current perspectives have only partially linked these processes, thus preventing a clear understanding of how they jointly generate flexible cognition and behaviour. Moreover, these limitations prevent an effective exploitation of this knowledge for technological scopes. We propose a new theoretical perspective that extends our 'three-component theory of flexible cognition' toward higher-order cognition and consciousness, based on the systematic integration of key concepts from Cognitive Neuroscience and AI/Robotics. The theory proposes that the function of conscious processes is to support the alignment of representations with multi-level goals. This higher alignment leads to more flexible and effective behaviours. We analyse here our previous model of goal-directed flexible cognition (validated with more than 20 human populations) as a starting GARIM-inspired model. By bridging the main theories of consciousness and goal-directed behaviour, the theory has relevant implications for scientific and technological fields. In particular, it contributes to developing new experimental tasks and interpreting clinical evidence. Finally, it indicates directions for improving machine learning and robotics systems and for informing real-world applications (e.g., in digital-twin healthcare and roboethics). • Current frameworks do not integrate goal-directed cognition and consciousness • We introduce a theory that bridges conscious and flexible goal-directed cognition • Consciousness supports representation alignment with goals, thus boosting flexibility • The theory provides data interpretations, neuropsychological tasks, computational models • The theory fosters machine learning, robotics, and real-world applications [ABSTRACT FROM AUTHOR]

While parents' and professionals' perceptions regarding children with autism spectrum disorder (ASD) have been studied extensively, limited data regarding the perspectives of children with ASD on their needs and the challenges they face are available. The study aimed to examine how children with ASD understand their condition and the aims of the interventions they undergo. Nineteen children and adolescents (ages 5.7–14.2 years) formally diagnosed with ASD, with borderline to high intelligence (range 70–140), and able to converse verbally were interviewed in person at a child development clinic. A qualitative approach was used to capture children's perceptions of their strengths and challenges and their understanding of a novel ASD treatment. The interview included direct and projective open-ended questions on each topic. Interpretive content analysis was used to evaluate the children's answers. Medical data were extracted from medical records. The children's parents completed questionnaires on their children's disability levels, awareness of ASD diagnosis, and sociodemographic details. Children spoke of their embodied sensations and feelings and discussed "normality" vs. "disability." They varied in their awareness of their diagnosis/symptoms, and only one boy named his diagnosis and described its consequences in detail. Most children lacked an understanding of the educational and therapeutic aspects of the goals set for them. Children with ASD are aware of their unique emotional and behavioral challenges. Nevertheless, they are frequently excluded from the process of patient information provision and lack an understanding of the goals of interventions. Findings suggest the need to explore developmentally and emotionally adaptive ways to involve children with ASD in discussions of their condition and possible interventions. • Children with ASD were aware of their unique emotional and behavioral challenges. • Gaps exist between children's self-awareness and understanding of their diagnosis. • Children are frequently excluded from the patient information provision process. • Children had a limited grasp of the intervention's goals and practical elements. [ABSTRACT FROM AUTHOR]

Effort is both rewarded by attainment and powerfully aversive – the " effort paradox ". Here, we test the idea that Conscientiousness (C) decouples effort from aversive affect, permitting effort to proceed to goal attainment rather than being derailed by frustration. Study 1 (N = 1202) induced a workload using cognitive ability items. A strong association of effort with frustration was found (β = 0.40). Moreover, more difficulty predicted significantly higher felt effort (β = 0.12) and, more strongly, frustration (β = 0.32). Study 2 (N = 501) tested effects of C. Importantly, C significantly reduced frustration, and a significant C × effort interaction on frustration emerged in the easier task (β = −0.15). Study 3 (N = 700) replicated the main effect of C in the difficult task. Study 4 (N = 400) replicated both the main effect and significant C × effort interaction for the easier task. Results support the idea that C decouples frustration from effort and is adaptive, permitting high-C subjects to engage in higher goal-directed effort with less negative affect, especially for reliably completed tasks. This mechanism may reduce procrastination and increase persistence, potentially accounting for higher attainment and avoidance of "easy" lures leading to pitfall-strewn life paths. • Effort is highly frustrating. • Conscientiousness (C) reduces the frustration accompanying effort. • For attainable tasks, C interacts with effort, reducing frustration more. • Reduced frustration may be an adaptation enabling achievement goals. [ABSTRACT FROM AUTHOR]

We aimed to develop a context-specific intervention toward benzodiazepine deprescribing in nursing homes (NHs), with insights from behavior-change theories and involvement of stakeholders. Selection of behavior change techniques (BCTs), through online survey and group discussion, followed by operationalization of these BCTs into intervention components. The intervention was developed for Belgian NHs, involving various stakeholders: health care professionals (HCPs), NH administrators, and policy makers. Using the Theory and Techniques Tool, we preselected the BCTs linked to one of the 9 Theoretical Domain Framework domains identified as being the main barriers for benzodiazepine deprescribing in Belgian NHs. These were then presented to stakeholders. Based on the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Ethics) criteria, participants ranked BCTs through an online survey, and then performed final selection during a group discussion. Selected BCTs were operationalized into intervention components, with specific contents and methods of delivery validated by stakeholders. Thirty-seven potential BCTs were identified. Eighteen stakeholders participated in the survey, and 7 in the group discussion. This led to the final inclusion of 9 BCTs: instruction on how to perform the behavior, information about health consequences, pros and cons, problem solving, goal setting (behavior), social comparison, restructuring physical environment, restructuring social environment, and graded tasks. These BCTs were operationalized into a 6-component intervention: process and goal setting, HCP education, physical environment adaptations, audit and feedback, NH residents' and relatives' increased awareness, and multidisciplinary work. Use of a theory-based approach toward intervention development has the potential to improve the probability of its feasibility and effectiveness in tackling barriers to benzodiazepine deprescribing. By doing so, we have developed a multifaceted approach with actions taken at the patient, HCP, and NH levels. Our novel 6-component intervention will be evaluated in a pilot cluster-randomized controlled trial to assess its feasibility. [ABSTRACT FROM AUTHOR]

Hospital admissions can be hazardous for older adults, particularly those living in long-term care facilities. Preventing nonessential admissions can be beneficial for this population, as well as reducing demand on health services. This review summarizes the economic evidence surrounding effective interventions to reduce hospital attendances and admissions for people living in long-term care facilities. Rapid review of economic evidence. People living in long-term facilities. We searched MEDLINE, CINAHL, Cochrane CENTRAL, PubMed, and Web of Science on September 20, 2022, and again on January 10, 2023. Full economic evaluations and cost analyses reporting on advanced care planning, goals of care setting, nurse practitioner input, palliative care, influenza vaccinations, and enhancing access to intravenous therapies were eligible. Data were extracted using a prepiloted data extraction form and critically appraised using either the Drummond-Jefferson checklist or an amended NIH Critical Appraisal Tool appended with questions from a critical appraisal checklist for cost analyses. Data were synthesized narratively. We included 7 studies: 3 full economic evaluations and 4 cost analyses. Because of lack of clarity on the underlying study design, we did not include one of the cost analyses in our synthesis. Advanced care planning, a palliative care program, and a high-dose influenza vaccination reported potential cost savings. Economic evidence for a multicomponent intervention and a nurse practitioner model was inconclusive. The overall quality of the evidence varied between studies. A number of potentially cost-effective approaches to reduce demand on hospital services from long-term care facilities were identified. However, further economic evaluations are needed to overcome limitations of the current evidence base and offer more confident conclusions. [ABSTRACT FROM AUTHOR]

• Qualitative study, examining networking skills, and social ties that are built and bind care-leavers to others. • The importance of these social connections and how care-leavers elicit the necessary help to achieve their goals in society. • Importance of fostering community and building social skills to support young people's reintegration into society. • Social workers and care providers should work together to broaden care-leavers networks and build social skills. This article aims to deepen and theorize our understanding of the psychosocial processes young people who are transitioning out of residential care engage in, specifically networking people for goal attainment. A qualitative approach was used to collect data from 31 South African residential care-leavers who were one to seven years out of care, aged 17–26 years. Using a grounded theory method of data analysis this study aims to fill the gap in theoretically informed studies by constructing indigenous theories to explain the care-leaving journey. This paper presents findings on (1) the need to elicit social connections; (2) honing networking skills in eliciting social connections; and (3) the strength in weak ties. The implications for practice point to the necessity of fostering a sense of community among care-leavers prior to their transition since this would eventually promote the development of youth resilience. Thus, to support young people's reintegration, social workers and child and youth care providers should cooperatively assist them to cultivate and broaden their networks of social connections and work proactively on building social skills for those purposes. [ABSTRACT FROM AUTHOR]

• The study evaluated implementation of an innovation to support family goal planning. • Coaching reinforced knowledge and skills home visitors learned in training. • Findings offer evidence of coaching feasibility, acceptability, and usefulness. • Audio recordings of coaching sessions improve understanding of coaching practices. Early childhood home visiting services aim to support child and family health and development, yet challenges engaging and retaining families persist. One promising strategy to improve family engagement involves enhancing the capacity of the home visiting workforce to partner with families to set and implement service goals that align with families' needs and preferences. This study examined implementation of 'Goal Plan Strategies' (GPS), a training and coaching innovation designed to improve family-centered goal planning. Aims were to evaluate (1) the extent to which training and eight sessions of audio-based coaching were implemented with fidelity, (2) whether coaching fidelity was associated with home visitors' perceptions of coaching and confidence using goal planning strategies, and (3) whether GPS was perceived as feasible, acceptable, and useful by coaches and home visitors. Home visitors (N = 22) and coaches (N = 10) took part in GPS and completed surveys, session logs, and interviews. Training and coaching sessions were observed and coded for fidelity (e.g., dose, adherence, quality). GPS was implemented with high levels of fidelity. Findings support feasibility, acceptability, and usefulness of GPS, overall, and suggest the need to examine coaching dosage and overlap with other implementation supports more closely. Findings highlight the benefits of audio-based coaching, mentoring of coaches, and observational measures of implementation fidelity. [ABSTRACT FROM AUTHOR]

• African American and Latine youth living in low-income communities contribute meaningful, culturally relevant insights about intervention outcomes and mechanisms of action. • Intervention outcomes prioritized by African American and Latine youth living in low-income communities are self-regulation, empathic communication, persistence, positive racial identity, and positive social supports. • African American and Latine youth living in low-income communities experience participatory opportunities to be co-program designers, evaluators, and researchers as contributing to positive intervention impacts. • African American and Latine youth living in low-income communities experience considerable fulfillment in caregiving for community children. • Cross-age peer mentoring interventions can strengthen community cultural wealth of youth of color and promote their collectivist strengths. This project draws from youth voices to develop theory about outcomes and change mechanisms in a cross-age mentoring out of school program with urban African American and Latine youth living in low-income communities. With instructors' supports, African American and Latine mentors (N = 148, ages 14–20) in four U.S. urban, high-poverty communities of color mentored children weekly for an average of 16 sessions, followed by a debriefing session. Researchers used qualitative, participatory methods to elicit mentor perspectives about what made their program impactful. Diverse qualitative data were collected by staff and youth and analyzed thematically. Outcomes adolescent mentors deemed meaningful were 1) developing good character, specifically persistence, leadership and listening skills, patience, respectful collaborations, goal-oriented hopefulness, and more positive racial identities, and 2) building trustworthy, supportive relationships with mentees, peers, and instructors. Mechanisms mentors regarded as generating outcomes were 1) being active agents in program implementation and evaluation, and also contributing knowledge about themselves, and 2) the fulfillment of caring for community children, which youth regarded as a partial remedy for deprivations and injustices their communities experience. Differences in emphasis based on gender are described. Outcomes and generative mechanisms are discussed in relation to youths' community cultural wealth. Comprehensively empowering youth to co-lead program development, implementation, evaluation and theorizing can improve the fidelity of scientific knowledge to youths' strengths and priorities, and yield theories of intervention consonant with youths' cultural wealth. [ABSTRACT FROM AUTHOR]

Many applications require mechanical systems to meet several performance specifications, achieved through the suitable design of their mechanisms and controllers. The mechanical design establishes the parts and components that make up a mechanism to obtain valuable mechanical properties in its motion. Control design, however, aims to ensure that the mechanical system performs its task with the highest possible performance. By their very nature, these design problems can be conceived in a bilevel hierarchical way, where any change in the components of a mechanism to achieve mechanical design goals is affected by the control parameters that govern its behavior, which aim to achieve its own control performance goals. This work develops the simultaneous mechanical and control design of systems under a Semi-Vectorial Bilevel Optimization (SVBO) approach for the first time to study its advantages and drawbacks compared to other design approaches used to date. In this approach, a single-objective mechanical design problem is considered at the upper level, and a multi-objective controller design problem is addressed at the lower level. A proposed Evolutionary Semi-Vectorial Optimizer (ESVO) handles the resulting design model. The approach is tested using two case studies: the mechanical and control design of two four-bar mechanisms, one Grashof and one non-Grashof. The results obtained with the proposed approach are compared with three representative design approaches (manual, multiobjective and sequential). The proposed SVBO approach obtained adequate mechanical design with valuable trade-off between control requirements. The complete approach developed can be extended to tackle concurrent designs of other relevant engineering domains. • A novel approach to integrate mechanical and control design in a hierarchical system. • Introducing an Evolutionary Semi-vectorial Optimizer to mechanical and control design. • Proposed approach used to the design of Grashof and non-Grashof four-bar mechanisms. • Demonstrating the effectiveness of this approach by comparing it with other methods. • The proposal enhances mechanical system performance and attains multiple design goals. [ABSTRACT FROM AUTHOR]

Path planning remains crucial for efficient robot operation. A Halton Biased Rapidly-exploring Random Tree (HB-RRT) path planning algorithm is introduced in this study. The Halton sequence, known for its uniform distribution and low discrepancy, is employed for sampling. Issues arising from the pseudo-random sequence in the standard RRT algorithm, leading to uneven distribution of sampling points, are addressed. A mouse-inspired goal-oriented strategy and a candidate sampling pool strategy are incorporated to enhance the sampling point quality, thereby addressing the challenge of insufficient memory during node expansion. Path optimization is further achieved through a multi-level planning approach, which aims to minimize redundancy. A subsequent smoothing of the path is conducted using a cubic B-spline method. Comparisons with the RRT, Bionic Target Bias-RRT, and Informed-RRT* algorithms, through both numerical simulations and real-world testing, confirm the superiority of the HB-RRT algorithm in terms of planning time, path length, and overall path quality. [ABSTRACT FROM AUTHOR]

Goal-directed acting requires the integration of sensory information but can also be performed without direct sensory input. Examples of this can be found in sports and can be conceptualized by feedforward processes. There is, however, still a lack of understanding of the temporal neural dynamics and neuroanatomical structures involved in such processes. In the current study, we used EEG beamforming methods and examined 37 healthy participants in two well-controlled experiments varying the necessity of anticipatory processes during goal-directed action. We found that alpha and beta activity in the medial and posterior cingulate cortex enabled feedforward predictions about the position of an object based on the latest sensorimotor state. On this basis, theta band activity seems more related to sensorimotor representations, while beta band activity would be more involved in setting up the structure of the neural representations themselves. Alpha band activity in sensory cortices reflects an intensified gating of the anticipated perceptual consequences of the to-be-executed action. Together, the findings indicate that goal-directed acting through the anticipation of the predicted state of an effector is based on accompanying processes in multiple frequency bands in midcingulate and sensory brain regions. [ABSTRACT FROM AUTHOR]

Left and right-hand exhibit differences in the execution of movements. Particularly, it has been shown that manual goal-directed aiming is more accurate with the right hand than with the left, which has been explained through the shorter time spent by the right hand in the feedback phase (FB). This explanation makes sense for the temporal aspects of the task; however, there is a lack of explanations for the spatial aspects. The present study hypothesizes that the right hand is more associated with the FB, while the left hand is more strongly associated with the pre-programming phase (PP). In addition, the present study aims to investigate differences between hands in functional brain connectivity (FBC). We hypothesize an increase in FBC of the right hand compared to the left hand. Twenty-two participants performed 20 trials of the goal-directed aiming task with both hands. Overall, the results confirm the study's hypotheses. Although the right hand stopped far from the target at the PP, it exhibited a lower final position error than the left hand. These findings imply that during the FB, the right hand compensates for the higher error observed in the PP, using the visual feedback to approach the target more closely than the left hand. Conversely, the left hand displayed a lower error at the PP than the right. Also, the right hand displayed greater FBC within and between brain hemispheres. This heightened connectivity in the right hand might be associated with inhibitory mechanisms between hemispheres. • The right hand demonstrates greater proficiency in processing visual feedback. • The left hand is more strongly associated with the pre-programmed phase. • The spatial aspect appears to be more crucial in distinguishing hands. • The right hand demonstrates greater functional brain connectivity. [ABSTRACT FROM AUTHOR]

This study investigated whether contexts of failure improve preschool children's mechanistic reasoning. We showed 3- to 6-year-old children (N = 55, M = 5;2) how to make an unfamiliar toy work to play a goal-directed game. Between conditions we manipulated children's success in making the toy work by surreptitiously turning a hidden causal switch ON (Success) or OFF (Failure) before they interacted with the toy. We then measured children's exploration of the toy, explanations for how the toy worked, and generalizations about how a new functioning toy would work. Children in the Failure condition were more likely to discover the hidden causal mechanism and talk about it in their explanations about the toy. Younger children spent more time exploring the toy than older children but were not more likely to discover the hidden causal mechanism. The findings are discussed as they relate to the emergence of spontaneous mechanistic exploration over development, how this then supports mechanistic reasoning, and the role of failure in children's early causal reasoning. • Preschool children search more about causal mechanisms in the context of failure. • Preschool children talk more about causal mechanisms in the context of failure • 3- to 4-year-olds explore causal systems longer than 5- to 6-year-olds [ABSTRACT FROM AUTHOR]

Machine learning and learning analytics are powerful tools that not only support researchers in the detailed measurement and enhancement of learning processes in various learning environments, but also enable the aggregation and synthesis of evidence regarding effective educational practices. This paper describes the development and application of machine learning algorithms aimed at semi-automatic selection of abstracts for a meta-analysis on the effects of simulation-based learning in higher education. The goal was to reduce the workload while also maintaining the transparency and objectivity of the selection process. The algorithms were trained, validated, and tested on a set of 3187 studies on simulation-based learning found in medical and educational databases collected before April 2018. Subsequently, they were utilized to classify abstracts for a follow-up meta-analysis consisting of 2373 studies (published between 2018 and 2020). The aim of training the algorithms was to predict studies' abstract eligibility based on words and combinations of words used in these abstracts. The application of the algorithms reduced the number of studies that had to be manually screened from 2373 to 711. A total of 458 studies from automatically selected abstracts were included in the full-text screening, indicating the high precision of the algorithms (also compared to the performance of human raters). We conclude that machine learning algorithms can be trained and used to classify abstracts for their eligibility, significantly reducing the workload for the researchers without diminishing objectivity and quality when updating systematic literature reviews with or without a meta-analysis. • Machine learning algorithms can be used to classify abstracts for their eligibility. • Machine learning can significantly reduce the workload without compromising quality, when updating meta-analysis. • Some machine learning algorithms can outperform human raters in precision. [ABSTRACT FROM AUTHOR]

It is well established that people scoring high in narcissism fantasize about a grandiose future. However, little research has examined whether narcissism is associated with actually setting unrealistic, grandiose future goals for oneself. In the present study, we pool three independent adult samples (total N = 482) to evaluate the relationship between three dimensions of narcissism (agentic extraversion, antagonism, and narcissistic neuroticism) and self-reported likelihood of setting statistically unlikely goals (e.g., creating world peace). Through a series of bootstrapped correlation and regression analyses, we find that participants scoring higher in agentic extraversion and antagonism are more likely to set unrealistic goals, whereas participants scoring higher in narcissistic neuroticism are less likely to set unrealistic goals. When controlling for covariance between these narcissism dimensions as well as self-esteem and history of manic/hypomanic symptoms, agentic extraversion emerges as the strongest correlate of setting unrealistic goals. Overall, this study demonstrates that narcissism, and particularly agentic extraversion, is associated with intending to set grandiose future goals. [ABSTRACT FROM AUTHOR]

Pursuing personal goals above communally shared interests is incompatible with socially sanctioned norms yet represents the hallmark of high levels of dark traits (DT; narcissism, Machiavellianism, and psychopathy). One yet unaddressed question is how this conflict affects subjective authenticity, traditionally defined as a natural tendency to perceive and present oneself as genuine rather than contrived. In this theoretical paper, we propose a novel perspective on the nature of the true self, recasting Kernis and Goldman's process-oriented framework of authenticity (2006) to accommodate high DT individuals' particular authenticity paths. We review how self-concept perceptions may affect high DT individuals' interaction with their environment, leading to a more agentic or communal external orientation, affecting their behaviours and social relations. Acknowledging antisocial tendencies can aid in recognising situational factors that trigger the expression or the concealment of this "dark true self". Machiavellianism is related to internal self-orientation challenges (e.g. low awareness), whereas narcissism supports a more functional internal self-orientation. By bringing together previously disjointed lines of research on authenticity and self-presentation, along with situational contingencies, we aim to elucidate the cause of disfluencies in one's self-system and potentially initiate pioneering research in characterising the dark correlates of the true self. [ABSTRACT FROM AUTHOR]

Global population ageing underscores the imperative of ageism and dementia-ism in the heath care setting as there is both anecdotal and published evidence that older persons are liable to receive less than optimum evidence-based treatments on account of their age and apparent frailty. This article explores the reasons for this phenomenon and limitations of current approaches of clinical decision making. We propose a framework to guide decision making to optimize care, with a paradigm shift in redefining a default toward clinical practice guideline–recommended treatments, guided by evidence-based medicine within an ethical means-end proportionality framework, and regularly reviewed advance care plans and goals of care conversations to secure the best interests of older persons. [ABSTRACT FROM AUTHOR]

This study aimed to explore nursing and midwifery clinical educators' preparation practices related to in situ simulation-based education, at a tertiary health service in Australia. Simulation-based education is routinely used in healthcare education and training. A key mechanism to optimise simulation-based education is learner preparation. While diverse pre-simulation preparation approaches are described in the literature, these are predominantly focused on activities that are undertaken in either university and/or skills centre contexts. In contrast, the learner preparation practices for simulation-based education that is delivered insitu in healthcare facilities by clinical nurse and midwifery educators are underexplored. This study used an exploratory qualitative design. Participants were recruited using purposive sampling from a potential study group of thirty. Twelve individuals from the nursing and midwifery education group met selection criteria and agreed to participate in the study. Each individual participated in a semi-structured interview. Interview data were then transcribed and analysed using qualitative descriptive methods. Data analysis resulted in the development of four themes related to the preparation of participants for insitu simulation-based education sessions. Each theme informs the choices of clinical nurse/midwifery educators' preparation practices: 1) responsivity to workplace and clinical priorities; 2) clinical educator objectives; 3) preparedness for learning and clinical practice; and 4) evolving educational expertise. This study explored the preparation practices of nurse and midwifery clinical educators engaged in the delivery of insitu simulation-based education. Findings indicate a depth of experiences and a willingness to share practice insights, suggesting that insitu simulation-based education is an integral part of the in service repertoire and a key component of departmental education strategies, designed to support practice and hone skills required to deliver quality patient care. [ABSTRACT FROM AUTHOR]

Although outreach is a common activity in academic libraries, little has been written about strategies for assessing library outreach efforts. Assessing outreach efforts is important in order to measure the success of the outreach activity, identify areas for iterative improvement, and demonstrate the value of the outreach activity to stakeholders. This article is a case study describing the multifaceted strategies employed to assess a major outreach event, Texas A&M University Libraries annual Open House event. It details demonstrating value and programmatic improvement as the articulated goals for outreach assessment as well as the specific strategies used and the insights gleaned from each assessment strategy. [ABSTRACT FROM AUTHOR]

Purpose: Although mentorship has been associated with promotion, job satisfaction, and retention, data are limited on the mentorship experience of clinical- versus research-track physicians as well as feasibility and relative priority of formal program components.Methods and Materials: Within a single-institution, multi-site, academic network, we implemented a Radiation Oncology AcaDemic Mentorship Program (ROADMAP) for junior faculty. Validated surveys assessing mentee satisfaction were distributed at baseline and 1 year. The statistical analysis included Wilcoxon rank sum and signed tests. Mentees assessed the likelihood to recommend each program component (10-point Likert-type scale), and means with standard error (SE) are reported.Results: Among 42 eligible junior faculty, 36 (86%) opted into the program. The median time since residency was 2.5 years (interquartile range, 1.75-5.25) on the clinical track (n = 12) and 3 years (interquartile range, 2.75-5.00) on the research track (n = 24). At baseline, research-track physicians reported higher satisfaction with mentoring than physicians on the clinical track (2.92 vs 2.16; P = .02). Among 32 physicians completing 1 year, overall satisfaction with mentoring increased compared with baseline (2.72 vs 3.87; P < .001), which persisted on subset analysis for both clinical- (2.16 vs 4.03; P < .001) and research-track physicians (2.99 vs 3.77; P = .005). At 1 year, 28 mentees (88%) opted to continue the program. Program components were rated 8.25 (SE, 0.37) for mentor-mentee pairings, 7.22 (SE, 0.39) for goal setting, 6.84 (SE, 0.47) for administrative support, 6.69 (SE, 0.44) for peer mentoring, and 6.53 (SE, 0.45) for steering committee oversight. Ratings of peer mentoring were not associated with track (P = .59) or years in practice (P = .29).Conclusions: Clinical-track physicians may be less satisfied with mentorship than research-track faculty. However, all junior faculty, regardless of track, appeared to benefit from formalizing dyadic mentor-mentee relationships, goal setting, and peer mentoring. Further work is needed to determine the role of mentorship in addressing physician burnout. [ABSTRACT FROM AUTHOR]

• Evaluated a program to reduce aggressive driving (RAD program). • Most (87%) participants in program generated successful strategies to reduce aggressive driving. • Four months after the RAD, 86% were still using these strategies. • Self-reported anger and aggression were lower after the participation in the RAD. • These reductions were sustained four months after participation. Introduction: Aggressive driving contributes to crashes, which often result in serious or fatal injuries. Efforts to reduce road trauma need to include strategies to reduce emotional and aggressive driving. Thus far, solutions have not comprehensively addressed the reasons why drivers become aggressive. This study provides preliminary evidence of the effectiveness of the Reduce Aggressive driving (RAD) program in improving driver behavior. The RAD is based on group discussion, feedback, and goal setting to encourage more positive responses to triggers for aggressive driving. The aim of this study was to evaluate the delivery of the RAD and its impact on driver anger and aggression. Method: A total of 94 drivers, ranging in age from 18 to 74 years (Mean = 38; SD = 15; 56% males) attended one two-hour online RAD session during which they identified triggers for their aggression and developed individual strategies to avoid aggressive driving. Most (87%) participants agreed that the RAD helped them generate realistic strategies to avoid aggressive driving. A subset of 67 participants provided self-reported anger and aggressive driving tendencies one month, and four months after the RAD. Results: When these were compared to baseline measures taken before participation in the RAD, decreases across all measures were observed. Thus, anger and aggressive driving significantly decreased one month after the RAD, and these decreases were maintained at the four month follow up; providing evidence of the effectiveness of the RAD in reducing these dangerous behaviors. Further research is needed to objectively measure changes in behavior to and support broader roll-out of the RAD program. [ABSTRACT FROM AUTHOR]

• The study proposes an analytical framework which draws on, and merges, two perspectives: multi-level governance and capacities for transformative climate governance. • Capacity development in the regional energy transition requires a governance mode that is geared towards a goal-oriented multi-actor yet flexible collaboration. • The Dutch regional energy strategy (RES) is a new type of governance arrangement that is suitable for facilitating orchestration in the regional energy transition. • RES allows for engagement of a variety of actors but suffers from undefined roles and ambiguous responsibilities of actors who are used to work in a hierarchical set up. • The current RES arrangement is characterised by a high dependence on traditional hierarchical structures and high transaction costs. In this paper we analyse how interactions between governing bodies influence Dutch energy regions' capacity to govern the energy transition. We develop an analytical framework which draws on, and merges, two different theoretical perspectives: multi-level governance and capacities for transformative climate governance. We apply this framework in an exploratory case study of the Dutch energy regions Holland Rijnland and Noordoost Brabant. Results are primarily derived using a set of interviews and desk study. Aided by the framework, we find that, while the Regional Energy Strategy (RES) arrangement is clearly geared towards facilitating orchestration through coordination and exchange of ideas and standpoints, the current governance approach, is hindered by unclear and ambiguous roles and responsibilities, a referral back to and dependence on traditional hierarchical structures, and high transaction costs. These interactions negatively influence capacity development in the regional energy transition by complicating strategic alignment and the creation of opportunity contexts. [ABSTRACT FROM AUTHOR]

To evaluate the feasibility of a Social Cognitive Theory-based intervention on cognitive, affective, and behavioral outcomes in a college nutrition course. A pre-post quasi-experimental design. Large metropolitan university. College students (n = 138) aged 18–40 years. Students participated in weekly food challenges during a 15-week nutrition course to apply nutrition knowledge, develop self-efficacy and promote positive behavior change. Food challenges were implemented by a guided goal-setting strategy. Cooking videos, which modeled important nutrition-related skills, accompanied each challenge. Students independently selected 2-goal options to implement weekly and wrote a reflection about their experiences. Cognitive outcomes (nutrition and cooking self-efficacy), affective outcome (cooking attitudes), and behavioral outcomes (fruit and vegetable consumption). Descriptive statistics and paired sample t tests. Analyses showed significant increases in cognitive outcomes (produce consumption self-efficacy [ P = 0.004], cooking self-efficacy [ P = 0.002], using fruit/vegetables and seasoning self-efficacy [ P = 0.001]) and behavioral outcomes (fruit consumption [ P < 0.001], and vegetable consumption [ P < 0.001]). This pilot study suggested a framework for behavioral change, grounded in constructs central to Social Cognitive Theory, that simplified the goal-setting process (by using guided goal setting) and used video technology to decrease the cost of implementation. [ABSTRACT FROM AUTHOR]

To explore parents' accounts of the goals they seek when choosing foods for their young children through the lens of goal-systems theory. In-depth interviews with parents of children aged from 6 months to 5 years. Montevideo, Uruguay. Forty-two parents (aged 19–44 years, 90% female). Parents' personal experiences, feelings, and opinions related to how they choose foods for their children. Content analysis based on deductive-inductive coding. Parents' accounts confirmed they intended to pursue different goals when choosing foods for their children. Health-related goals mainly motivated the selection of healthy foods, but they also drove the selection of some ultra-processed products because of misconceptions about their healthiness. Pleasure and enjoyment motivated the selection of ultra-processed products, whereas stress avoidance was associated with selecting convenient foods. The selection of unhealthy foods raised conflicts between goals, which were solved using goal shielding, changes in risk perception and/or compensatory health beliefs. Results point to the need for communication campaigns and community-based interventions to introduce changes in how ultra-processed products are conceptualized and increase the associations between healthy foods and children's pleasure and enjoyment to promote healthier eating patterns during infancy and early childhood. [ABSTRACT FROM AUTHOR]

We formulate and analyze a goal-oriented adaptive finite element method for a semilinear elliptic PDE and a linear goal functional. The discretization is based on finite elements of arbitrary (but fixed) polynomial degree and involves a linearized dual problem. The linearization is part of the proposed algorithm, which employs a marking strategy different to that of standard adaptive finite element methods. Moreover, unlike the well-known dual-weighted residual strategy, the analyzed error estimators are completely computable. We prove linear convergence and, for the first time in the context of goal-oriented adaptivity for nonlinear PDEs, optimal algebraic convergence rates. In particular, the analysis does not require a sufficiently fine initial mesh. [ABSTRACT FROM AUTHOR]

Politeness embalms interactions, putting the parties in conversation at ease. Even the most well-intended communication can fall through if there is a manifestation of rudeness. Complementarily, even the most angst-prone situation can be communicated with much less hurt if lathered with politeness. In this paper, we propose a novel task named as Politeness Adaptive Dialogue System (PADS) to incorporate politeness feedback of agents' actions according to user's mood and demands. As there is no politeness labeled conversational data available, we annotate the recently released MultiDoGO dataset having six domains with appropriate politeness labels. The proposed end-to-end dialogue system comprises of a transformer-based politeness classifier that interacts with a reinforced learning framework with four different politeness-oriented reward algorithms, forcing the agent to adapt to polite actions upon encountering the user's dissatisfaction in the dialogue. We train and evaluate PADS by building six different user simulators, each corresponding to a domain. Quantitative and qualitative analysis show that our proposed politeness based reward algorithms improve the task success rate and reduce the dialogue length with state-of-the-art results. [ABSTRACT FROM AUTHOR]

Background: Sense of purpose, the feeling that one's life is goal-oriented and driven, tends to be protective for psychological health. Less is known about its relation with social health, particularly loneliness. We test whether the cross-sectional association between purpose and loneliness is replicable and whether purpose protects against the development of incident loneliness over time.Methods: Participants from 36 cohorts (total N = 135,227; age range 18-109) reported on their sense of purpose, loneliness, and psychological distress. Follow-up measures of loneliness were available in 28 cohorts that ranged from six weeks to 15 years. Prospective, random-effect meta-analysis was used to summarize the cross-sectional and longitudinal associations from each cohort.Results: Sense of purpose was associated significantly with less loneliness in all 36 cohorts, controlling for sociodemographic factors (meta-analytic mean effect estimate = -0.31, 95% CI = -0.34, -0.29, p < .001). This association was stronger among participants experiencing concurrent severe psychological distress. Sense of purpose was protective against the development of new incident loneliness (meta-analytic mean hazard ratio estimate = 0.85, 95% CI = 0.82, 0.87, p < .001). Age did not moderate any of the associations.Limitations: Limitations include the lack of lower-income countries. The mechanisms that explain this association also need to be identified in future research.Conclusions: Sense of purpose is associated with less loneliness and with protection against developing loneliness over time, associations that replicated across cohorts from North America, South America, Europe, and the Middle East. Sense of purpose may be a useful target of intervention to prevent or reduce loneliness, especially among individuals suffering from psychological distress. [ABSTRACT FROM AUTHOR]

How the brain generates response readiness and preparation for hand movements is not yet understood. We hypothesised that coupled interactions in alpha and beta frequencies become modulated in central-motor brain areas during response readiness. Phase synchronization in alpha (~9–11 Hz) and beta (~18–22 Hz) frequencies was analysed prior to a finger response in people with normal lateralised readiness potentials (LRP). Specifically, Phase Locking Values (PLV) and source topographies were assessed in EEG data with Go-NoGo tasks in 18 healthy participants. Analyses involving alpha and beta phase-coupled activity in electrodes overlying central-motor brain regions and from adjacent frontal sites were compared to address the hypothesised specificity of motor area modulations as underlying response readiness. Control analyses using alpha-beta phase-coupling with the alpha at electrodes overlying occipital areas were included. Results revealed smaller PLVs in the alpha-beta phase interactions using alpha from C3, Cz, C4 electrodes compared with alpha from F3, Fz, F4, thereby isolating motor regions specifically. Analyses of the source topography of synchronous beta signals (coupled with central-motor alpha) revealed parietal, occipital and right frontal areas, possibly implicating a role of motor and visual attention, movement intention in the time window of the LRP. In sum, we isolated central-motor interactions involving centrally located alpha, coupled with parietal, occipital, and frontal beta activity in association with processes of movement readiness. • Phase-coupling in the alpha and beta frequencies during motor readiness and preparation was investigated • Smaller PLVs were found with alpha from C3, Cz, C4 compared with alpha from F3, Fz, F4 and with control alpha from O1, O2. • Source topography of beta signal (coupled with central alpha) revealed parietal, occipital and right frontal areas. • Motor and visual attention, movement intention in the same time window as Lateralized readiness potentials are implicated. [ABSTRACT FROM AUTHOR]