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This article aims to analyse the evolution of 40 Sustainable Development Goals' (SDGs) health-related indicators in Brazil and Ecuador from 1990 to 2019. Epidemiological study of long-term trends in 40 SDGs' health-related indicators for Brazil and Ecuador from 1990 to 2019, using estimates from the Global Burden of Disease Study. Forty SDGs' health-related indicators and an index from 1990 to 2017 for Brazil and Ecuador, and their projections up to 2030 were extracted from the Institute for Health Metrics and Evaluation's Global Burden of Disease website and analysed. The percent annual change (PC) between 1990 and 2019 was calculated for both countries. Both countries have made progress on child stunting (Brazil: PC = −38%; Ecuador: PC = −43%) and child wasting prevalences (Brazil: PC = −42%; Ecuador: PC = −41%), percent of vaccine coverage (Brazil: PC = +215%; Ecuador: PC = +175%), under-5 (Brazil: PC = −75%; Ecuador: PC = −60%) and neonatal mortality rates (Brazil: PC = −69%; Ecuador: PC = −51%), health worker density per 1000 population (Brazil: PC = +153%; Ecuador: PC = +175%), reduction of neglected diseases prevalences (Brazil: PC = −40%; Ecuador: PC = −58%), tuberculosis (Brazil: PC = −27%; Ecuador: PC = −55%) and malaria incidences (Brazil: PC = −97%; Ecuador: PC = −100%), water, sanitation and hygiene mortality rates (Brazil and Ecuador: PC = −89%). However, both countries did not show sufficient improvement in maternal mortality ratio to meet SDGs targets (Brazil: PC = −37%; Ecuador: PC = −40%). Worsening of indicators were found for violence, such as non-intimate partner violence for both countries (Brazil: PC = +26%; Ecuador: PC = +18%) and suicide mortality rate for Ecuador (PC = +66%), child overweight indicator for Brazil (PC = −67%), disaster mortality rates (Brazil: PC = +100%; Ecuador: PC = +325%) and alcohol consumption (Brazil: PC = +46%; Ecuador: PC = +35%). Significant improvements are necessary in both countries requiring the strengthening of health and other policies, particularly concerning the prevention and management of violence and alcohol consumption, and preparedness for dealing with environmental disasters. [ABSTRACT FROM AUTHOR]

Differential attainment (DA) in post graduate medical training is a recognised challenge and refers to unexplained variation across groups when split by several protected characteristics. The Royal College of Radiology is committed to fostering diversity, inclusivity, and equality with the goal of narrowing existing gaps and improving training outcomes. This was a mixed methods study aiming to understand the causes of DA with view to helping the RCR develop strategies to address this. A cross-sectional survey was completed by 140 clinical oncology trainees in September 2022. Trainees and trainers (17 and 6 respectively) from across England, Scotland, Wales and Northern Ireland, took part in focus group and interviews from August to December 2022. Quantitative and qualitative data merged and interpreted. Results showed international medical graduates and trainees from ethnic minority backgrounds were more likely to encounter challenges. The qualitative findings were used to identify three themes through which these problems could be framed. The trainee as a "space invader," the hidden curriculum of clinical oncology training and the process of navigating and tacking the training journey. Differential attainment is the product of a complex interplay between the trainee, trainer, and the training environment. Therefore, interventions must be tailored to different people and contexts. At a national level, the RCR can adopt general policies to promote this such as mentorship programmes, protected time for supervision and cultural competency training. Efficacy of proposed interventions for trial and their impact on DA should be evaluated to drive evidence-based changes. • The GMC and Royal Colleges are committed to bridging existing gaps and addressing differential attainment. • A mixed-method research approach to provide a holistic understanding of differential attainment in Clinical Oncology. • Analysis of exclusionary mechanisms identified three main themes: space invaders, hidden curriculum and navigating. [ABSTRACT FROM AUTHOR]

Characterize experiences with cancer and perceptions of the preventable cancer burden attributable to diet among firefighters. A cross-sectional survey was distributed to assess cancer history and perceptions of cancer. US. US-based firefighters. History of cancer, perceptions of cancer, and perceptions of diet as a means to prevent cancer. Descriptive statistics and use of the Behaviour Change Technique Taxonomy v1 (BCTTv1) to evaluate qualitative responses. A total of 471 firefighters participated. Nearly half (48.4%) voiced they strongly agreed that they were at risk for cancer, whereas 44.6% agreed that changing diet could decrease cancer risk. The most common BCTTv1 codes focused on types of education, including "Instruction on how to perform the behavior" (45.1%, n = 189), followed by those centered on behavior execution (eg, "Action planning" [24.8%, n = 104]). Qualitatively, many were concerned about misinformation. Firefighters acknowledge the role of diet in cancer risk and have a desire for knowledge and behavioral support (eg, goal setting) that includes an emphasis on evidence and tackling misinformation. This information should serve as the basis of future interventions that target diet. [ABSTRACT FROM AUTHOR]

Bipolar disorder remains a disabling mental health condition despite the availability of effective treatments. Collaborative chronic care models (CCMs) represent an evidence-based way to structure care for conditions like bipolar disorder. Life Goals Collaborative Care (LGCC) was designed specifically for bipolar disorder, featuring psychoeducation alongside collaborative components (e.g. nurse care management or expert psychiatric consultation). Despite the use of Life Goals across health systems, a systematic review summarizing its effectiveness has never been conducted. We conducted a systematic review of randomized controlled trials (RCTs) of LGCC through December 2023 to help guide the field in treating bipolar disorder (PROSPERO: #404581). We evaluated study quality and outcomes in several symptom and quality of life domains. Ten articles describing eight studies met inclusion criteria. All studies featured group-based LGCC; most were compared to treatment as usual (TAU). Three of eight studies found LGCC to be associated with statistically significant effects for the prevention of manic episodes. Most studies finding positive effects featured additional collaborative care components beyond psychoeducation and were conducted in capitated healthcare systems. Limitations include: several types of potential bias in included studies; exclusion of observational studies of LGCC; lack of generalizability to pediatric populations; insufficient studies to conduct subgroup analyses; and low confidence in the quality of the evidence. In this systematic review, group-based LGCC demonstrated some positive effects for reducing mania recurrence; results for other outcome domains were equivocal. Future studies should investigate one-on-one LGCC, both in person and virtually, to enhance well-being for people with bipolar disorder. • Bipolar disorder frequently requires attention to psychoeducation and care coordination. • Life Goals Collaborative Care (LGCC) is a treatment approach featuring psychoeducation and collaborative care components. • Findings from this systematic review of LGCC suggest that it may reduce mania recurrence among people with bipolar disorder. • LGCC findings in other outcome domains, including depression and health-related quality of life, were less consistent. • Based on the included studies, confidence in the quality of the evidence was low, pointing to the need for further research. [ABSTRACT FROM AUTHOR]

We consider goal-oriented adaptive space-time finite-element discretizations of the regularized parabolic p-Laplace problem on completely unstructured simplicial space-time meshes. The adaptivity is driven by the dual-weighted residual (DWR) method since we are interested in an accurate computation of some possibly nonlinear functionals at the solution. Such functionals represent goals in which engineers are often more interested than the solution itself. The DWR method requires the numerical solution of a linear adjoint problem that provides the sensitivities for the mesh refinement. This can be done by means of the same full space-time finite element discretization as used for the primal non-linear problems. The numerical experiments presented demonstrate that this goal-oriented, full space-time finite element solver efficiently provides accurate numerical results for different functionals. [ABSTRACT FROM AUTHOR]

Social comparison is an inevitable aspect of human life, often leading to personal relative deprivation, wherein individuals experience a sense of unfair treatment when they perceive themselves as being at a disadvantage in comparison to others. Earlier research has observed a phenomenon called "lying flat" associated with personal relative deprivation, characterized by a lack of motivation for self-improvement. The purpose of this study is to investigate whether this pattern is suitable for the domains of health-promoting lifestyles given that health-promoting is driven by self-improvement motivation. In three studies conducted in China, an understudied non-Western society, we investigated the association between personal relative deprivation and health-promoting lifestyles by utilizing diverse measures and samples. Findings from Study 1 (N = 12,465) indicated a negative relationship between personal relative deprivation and health-promoting behavior. This effect was particularly prominent among older individuals (Study 2, N = 11,378). Study 3 (N = 234) indirectly explored the possibility that a decreased priority given to health goals explains the reduced adoption of health-promoting behaviors when experiencing personal relative deprivation. First, all health-promoting lifestyles are self-reported. Second, the mechanism between PRD and health-promoting lifestyles was not directly examined. Overall, this research confirms the physical "lying flat" phenomenon, highlighting that personal relative deprivation contributes to unhealthy diets and physical inactivity. Moreover, our findings also suggest that the lower significance placed on health goals relative to other life goals may serve as an underlying reason for this phenomenon. • Personal relative deprivation negatively affects health-promoting lifestyles. • Both physical activity and daily diet were affected by personal relative deprivation. • Personal relative deprivation also affects older individuals' lifestyles. • Reduced relative value placed on health may serve as a potential mechanism. [ABSTRACT FROM AUTHOR]

Recent advances in small, connected and intelligent satellite systems have created a wide range of opportunities for the adoption of intelligent Distributed Satellite Systems (iDSS) in communication, navigation and Earth Observation (EO) missions. iDSS are goal-oriented systems comprising of multiple satellites or modules that interact, communicate and/or cooperate with each other to accomplish the desired mission goals. The ability to mass-produce low-cost small satellites and contemporary developments in avionics/astrionics technology have spurred interest in iDSS, especially for Low Earth Orbit (LEO) satellite constellations and regional clusters. The SmartSat Cooperative Research Centre (CRC) and Australian space roadmap, as well as the landmark National Space Programme strategy and priorities, encompass EO. To date, insufficient progress and no conclusive outcome was made in terms of how contemporary Multidisciplinary Design Optimization (MDO) models and tools can be best tailored to the new capabilities and specificities of iDSS. The MDO of iDSS is challenging because it introduces new variables and highly non-linear interactions. In this context, we propose an MDO methodology to optimize an iDSS for persistent coverage over the entire Australian landmass. Several aspects of the iDSS are considered in this work, including the constellation model, subsystem models and the coupling interactions between different satellite subsystems and constellation design parameters. The constellation configuration, as well as the subsystems, are modelled using OpenMDAO, which is used to analyze and visualize the planned iDSS EO mission. The iDSS is then optimized using the Multidisciplinary Feasible (MDF) architecture approach and the iDSS interdependencies are numerically treated using the Nonlinear Block Gauss-Seidel (NLBGS) iterative solver. The resulting N 2 diagrams are presented and the proposed solution is both spatially and temporally optimized, demonstrating that the proposed iDSS will enable near real-time persistent coverage over the entire Australian continent. The following are the main contributions of the work presented in the manuscript: • Review of iDSS specificities and definition of a Multidisciplinary Design Optimization (MDO) framework suitable to flexibly address these factors and their evolutions; • Design optimization of an iDSS constellation for an Earth Observation (EO) mission to provide persistent regional coverage; • Consideration of prospective requirements for developing trusted autonomy in iDSS. [ABSTRACT FROM AUTHOR]

The United States Department of Agriculture expanded the Supplemental Nutrition Assistance Program (SNAP)-Ed program to all 50 states in 2004. In 2010, the Healthy, Hunger-Free Kids Act required that agencies implementing SNAP-Ed support policy, systems, and environmental (PSE) strategies, in addition to providing direct education (DE). Research has evaluated the impact of PSEs on health, but few studies have investigated the process of PSE implementation. The objective of this study was to identify facilitators and barriers to PSE implementation at SNAP-Ed partner sites from the perspectives of site contacts and SNAP-Ed implementers. This study employed a qualitative longitudinal design. The PSE planning and implementation process was observed over 1 year at SNAP-Ed partner sites. Semistructured interviews were conducted with site contacts and SNAP-Ed implementers throughout the year. Participants were SNAP-Ed implementers (n = 8) and site contacts (n = 18) from 18 partner sites where both PSE and direct education were occurring. SNAP-Ed implementers were debriefed once, and site contacts were interviewed three times over the course of the study. This study was conducted in a Southern US state with SNAP-Ed partner sites that intended to implement PSEs. The duration of data collection was October 2017 through September 2018. A thematic analysis of barriers and facilitators to PSE implementation across sites was conducted. The PSE implementation barriers were lack of site or implementer readiness or capacity; breakdowns in communication; and DE prioritized over PSE. Facilitators were effective communication; site capacity or readiness; and alignment between site and SNAP-Ed goals. Communication, capacity, and coordination between SNAP-Ed and partner sites were key components over the timeline of PSE planning and potential implementation. [ABSTRACT FROM AUTHOR]

The revised Suicide Crisis Inventory (SCI)-2 is a self-report measure to assess the suicide crisis syndrome (SCS). We aimed to assess the factor structure, reliability, and validity of SCI-2 among adults with major depression. Using a cross-sectional design, between November 2021 and August 2022, the Hindi SCI-2, along with other self-report measures, was administered to Indian adult respondents clinically diagnosed with major depression across 24 centers in India. Confirmatory factor analysis was carried out to test the factor structure of SCI-2. Additionally, convergent, discriminant, and criterion validity were tested using bivariate or biserial correlations, as appropriate. We obtained responses from 654 participants (Mean age = 36.9 ± 11.9 years, 50.2 % female). The SCI-2 fit both a one-factor (χ2[1769] = 14,150.74, p <.001, CFI = 0.98, RMSEA = 0.10), and five-factor solution (χ2[1759] = 13,130.83, p <.001,CFI = 0.98, RMSEA = 0.10) with the five-factor solution providing a significantly better fit. Internal consistencies of the SCI-2 total and subscale scores ranged from good to excellent. Most subscales significantly converged with each other and with other relevant measures although these associations were weak for thwarted belongingness and goal reengagement subscales. Small to moderate associations were noted in support of discriminant and criterion validity. We could not assess the predictive validity of SCI-2 for suicidal behaviors. Consistent with prior data, the Hindi SCI-2 fit a five-factor solution and showed good psychometric properties. These findings support the use of SCI-2 to assess SCS among Indian adults with major depression. • In the general population, the SCI-2 has demonstrated a five-factor solution. • We performed confirmatory factor analysis of Hindi SCI-2 in major depression. • The five-factor model of SCI-2 showed a superior fit versus the one-factor model. • Excellent internal consistency and good convergent validity were noted. • These findings support the use of SCI-2 in major depression in Asian settings. [ABSTRACT FROM AUTHOR]

This study aimed to examine changes in the proportion of smokers who were advised to quit smoking by health professionals as part of routine consultations or interactions with their patients between 2008 and 2019. Serial cross-sectional study. Data from two nationally representative cross-sectional surveys were used to examine changes over time in the proportions of smokers who were seen by a doctor or other healthcare provider for any health concern and were advised to quit smoking ('Advice_HP'). An additional dichotomous variable ('AdviceAccess_HP') was created and included smokers who were not seen by a doctor or other healthcare provider in the past 12 months in the 'no advice' received category. Crude and adjusted absolute differences in prevalence rates of smokers who were advised to quit smoking by health professionals as part of routine consultations or interactions with their patients between 2008 and 2019 were evaluated using a generalised linear model. The proportion of smokers who were seen by a health professional for any health concern increased from 58.8% in 2008 to 88.7% in 2019. The proportion of 'AdviceAccess_HP' increased from 33.6% in 2008 to 45.2% in 2019; however, the proportion of 'Advice_HP' decreased from 57.1% in 2008 to 51.0% in 2019. After adjustment for sociodemographic and smoking behaviour characteristics, differences remained virtually unchanged. In 2019, health professionals missed the opportunity to provide around 10 million smokers with brief advice to stop smoking. Monitoring the actions needed to encourage smoking cessation is critical for achieving the United Nations sustainable development goals. Primary healthcare workers should serve as role models for patients and provide brief advice that increases the likelihood of successfully quitting tobacco use, particularly in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Discussions between health professionals and nursing home (NH) residents or their families about the current or future goals of health care may be associated with better outcomes at the end of life (EOL), such as avoidance of unwanted interventions or death in hospital. The timing of these discussions varies, and it is possible that their influence on EOL outcomes depends on their timing. This study synthesized current evidence concerning the timing of goals of care (GOC) discussions in NHs and its impact on EOL outcomes. Systematic review. Adult populations in NH settings. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. We searched PubMed, Embase, and Cumulative Index of Nursing and Allied Health from January 2000 to September 2022. We included studies that examined timing of GOC discussions in NHs, were peer-reviewed, and published in English. Quality of the studies was assessed using the Newcastle-Ottawa Scale. Screening of 1930 abstracts yielded 149 papers that were evaluated for eligibility. Of the 18 articles, representing 16 distinct studies that met review criteria, 12 evaluated the timing of advance directives. There was variation in the timing of GOC discussions and compared with discussions that occurred within a month of death, earlier discussions (eg, at the time of facility admission) were associated with lower rates of hospitalization at the EOL and lower health care costs. The timing of GOC discussions in NHs varies and evidence suggests that late discussions are associated with poorer EOL outcomes. The benefits of goal-concordant care may be enhanced by earlier and more frequent discussions. Future studies should examine the optimal timing for GOC discussions in the NH population. [ABSTRACT FROM AUTHOR]

Diversity is a critical component in the advancement of human endeavor in science. Students who complete their education and training at diverse schools can serve patients from a wide range of ethnic backgrounds and promote cross-cultural competence. However, developing a diverse environment of professionals is a long-term effort which often takes generations to complete. Increasing awareness of underrepresented genders and/or minorities helps to establish goals for building a future of improved diversity. Specific to radiation oncology, professions such as medical physicists and radiation oncology physicians have reported underrepresented females and minorities. The problem is that there is a paucity of literature regarding diversity of medical dosimetry professionals. The professional organization does not track diversity data for those members currently working in the profession. Therefore, the purpose of this research was to present aggregate data demonstrating the diversity of medical dosimetry applicants and graduates. The methodology involved quantitative data collection from medical dosimetry program directors which answered the research question, what is the diversity of medical dosimetry applicants and graduates? In comparison to the U.S. population, there were less applicant and accepted students of Hispanic/Latino and African American ethnicities whereas the Asian population was higher. While the U.S. population data reveals 3% more females, there were 35% more female than male applicant and accepted students in this study. However, the results differ significantly from medical physics and radiation oncology physicians with only 30% female clinicians. [ABSTRACT FROM AUTHOR]

Although goal-directed fluid therapy (GDFT) has been proven to be effective in reducing the incidence of postoperative complications, the underlying mechanisms remain unknown. The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications. We further tested the role of this mediation effect using mean arterial pressure, a hemodynamic indicator. This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis. We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications. We conducted mediation analysis using the mediation package in R (version 3.1.2), based on 5,000 bootstrapped samples, adjusting for covariates. Among the 300 patients in the study, 40% (120/300) developed postoperative complications within 30 days. GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders (odds ratio: 0.460, 95% CI: 0.278, 0.761; P = 0.003). The total effect of GDFT on postoperative complications was –0.18 (95% CI : –0.28, –0.07; P < 0.01). The average causal mediation effect was –0.08 (95% CI : –0.15, –0.04; P < 0.01). The average direct effect was –0.09 (95% CI : –0.20, 0.03; P = 0.17). The proportion mediated was 49.9% (95% CI : 18.3%, 140.0%). The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications. Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications. [ABSTRACT FROM AUTHOR]

The primary objective of this research was to assess the impact of a novel, peer-directed intervention (iNSPiRED) on diabetes distress (DD) among veterans with type 2 diabetes and DD. Secondary objectives were to assess iNSPiRED's impact on anxiety, depression, and diabetes self-management behaviors. A single-blinded, randomized, parallel-group trial was conducted. Participants (n = 218) were recruited through a Veterans Affairs medical center and community agencies in a major metropolitan area from September 2019 through January 2022. Certified mental health peer specialists delivered iNSPiRED, a three-month goal-setting and resource navigation intervention. Outcomes were assessed at baseline, postintervention, and month six. Multilevel random-intercept linear regression models with treatment x time interaction terms were used to assess treatment effects. Frequency of following a healthy eating plan was higher for iNSPiRED vs usual care at month three relative to baseline (B = 0.58; p = 0.03) after adjusting for race and socioeconomic status. No other treatment effects differed significantly from zero (ps ≥ 0.05). Peer-directed interventions have the potential to deliver low-cost, highly scalable care. However, based on the largely negative findings of the current study, it is likely that more intense, multimodal interventions are needed to address DD. • Diabetes distress (DD) is linked to poor diabetes outcomes and quality of life. • A peer-led intervention (iNSPiRED) targeting DD and related outcomes was tested. • iNSPiRED participants improved more in frequency of healthy eating vs usual care. • No other treatment effects differed significantly from zero (ps ≥ 0.05). • More intense, multimodal interventions may be needed to address DD. [ABSTRACT FROM AUTHOR]

We discuss goal-oriented adaptivity in the frame of conforming finite element methods and plain convergence of the related a posteriori error estimator for different general marking strategies. We present an abstract analysis for two different settings. First, we consider problems where a local discrete efficiency estimate holds. Second, we show plain convergence in a setting that relies only on structural properties of the error estimators, namely stability on non-refined elements as well as reduction on refined elements. In particular, the second setting does not require reliability and efficiency estimates. Numerical experiments underline our theoretical findings. [ABSTRACT FROM AUTHOR]

Palliative radiotherapy is commonly used to achieve haemostasis for malignancy-induced haemorrhages. Our study aimed to examine the efficacy of palliative radiotherapy in the control of haemorrhages caused by various types of malignancy. A systematic review of the literature was conducted to determine the level of evidence for the use of palliative radiotherapy in achieving haemostasis. Searches of the Medline, Embase and Cochrane databases were completed for studies published between January 1947 and May 2017. Studies that reported either a qualitative or a quantitative effect of radiotherapy were selected for inclusion during the review process. In total, 836 abstracts were screened; 13 prospective and 45 retrospective studies met the criteria for inclusion in the review. Selected studies were sorted based on the underlying tumour type to provide readers the opportunity to compare dose and fractionation schedules. Significant variations in reporting of outcomes and low total patient numbers did not allow for a quantitative analysis to be carried out. A higher median dose and a hypofractionated schedule seem to provide numerically higher rates of control based on the available data. Palliative radiotherapy is useful in the management of bleeding related to advanced and incurable malignancies. Brachytherapy seems to be effective in haemostasis of certain malignancies, especially that of gynaecological origin. Treatment should be tailored to individual patient situations given the palliative goals of any such therapy. Further prospective studies could help to delineate optimal dose and fractionation schedules. • Radiation therapy is commonly used to achieve haemostasis in malignancy-induced haemorrhages. • Significant variations exist in radiation treatments with variable clinical outcomes. • Higher doses with a low number of fractions seem to achieve higher rates of haemostasis. [ABSTRACT FROM AUTHOR]

To explore how outpatient dietitians select and use applications (apps) to support nutrition education. Qualitative analysis of 20 dietitians who participated in semistructured interviews investigating their app use and recommendation processes. Transcripts were analyzed using thematic analysis. Four themes described how dietitians perceive apps for nutrition education: (1) nutrition education goals focus on long-term lifestyle behavior change while protecting patients' relationship with food, (2) attitudes toward tracking apps influence app selection, (3) dietitians differentiate among patients who will benefit from tracking vs information apps, and (4) barriers to optimal app use result in adaptations by dietitians. Barriers exist to optimal app use for nutrition education. However, accessible app design, app selection guides, and research expounding the effects of apps and their use by dietitians may improve how practitioners incorporate apps into nutrition education. [ABSTRACT FROM AUTHOR]

High-contact structured diabetes prevention programs are effective in lowering weight and HbA1cs, yet their intensity level can create barriers to participation. Peer support programs improve clinical outcomes among adults with Type 2 diabetes, but their effectiveness in diabetes prevention is unknown. This study examined whether a low-intensity peer support program improved outcomes more than enhanced usual care in a diverse population with prediabetes. The intervention was tested in a pragmatic 2-arm RCT. Participants were adults with prediabetes at three healthcare centers. Participants randomized to the enhanced usual care arm received educational materials. Participants in the Using Peer Support to Aid in Prevention and Treatment in Prediabetes arm were matched with a peer supporter: another patient who had made healthy lifestyle changes and was trained in autonomy-supportive action planning. Peer supporters were instructed to provide weekly telephone support to their peers on specific action steps toward behavioral goals for 6 months, then monthly support for 6 months. Changes in primary outcomes of weight and HbA1c and secondary outcomes of enrollment in formal diabetes prevention programs, self-reported diet, physical activity, health-specific social support, self-efficacy, motivation, and activation at 6 and 12 months were examined. Data collection occurred from October 2018 to March 2022, with analyses completed in September 2022. Among 355 randomized patients, in intention-to-treat analyses, there were no between-group differences in HbA1c or weight changes at 6 and 12 months. Using Peer Support to Aid in Prevention and Treatment in Prediabetes participants were more likely to enroll in structured programs at 6 (AOR=2.45, p =0.009) and 12 (AOR=2.21, p =0.016) months and to report eating whole grains at 6 (4.49, p =0.026) and 12 (4.22, p =0.034) months. They reported greater improvements in perceived social support for diabetes prevention behaviors at 6 (6.39, p <0.001) and 12 (5.48, p <0.001) months, with no differences in other measures. A stand-alone, low-intensity peer support program improved social support and participation in formal diabetes prevention programs but not weight or HbA1c. It will be important to examine whether peer support could effectively complement higher-intensity, structured diabetes prevention programs. This trial is registered at ClinicalTrials.gov, NCT03689530. Full protocol available at https://clinicaltrials.gov/ct2/show/NCT03689530. [ABSTRACT FROM AUTHOR]

Creativity involves associative thinking: linking concepts from memory. Computational models of semantic memory allow researchers to quantify associative thinking as movement through a semantic space of concepts. Associative thinking reflects a search process operating on a semantic memory network structure. Highly creative people travel further in semantic space, switch between more semantic subcategories, and make larger leaps between associations. Creativity involves both free associations, in which concepts are spontaneously connected, and goal-directed associations, in which concepts are strategically combined. Free association is relevant for artistic creativity, implicating domain-general cognitive abilities in domain-specific creative expertise. Neuroscience evidence indicates associative thinking engages brain regions involved in both semantic and episodic memory. Creativity has long been thought to involve associative processes in memory: connecting concepts to form ideas, inventions, and artworks. However, associative thinking has been difficult to study due to limitations in modeling memory structure and retrieval processes. Recent advances in computational models of semantic memory allow researchers to examine how people navigate a semantic space of concepts when forming associations, revealing key search strategies associated with creativity. Here, we synthesize cognitive, computational, and neuroscience research on creativity and associative thinking. This Review highlights distinctions between free- and goal-directed association, illustrates the role of associative thinking in the arts, and links associative thinking to brain systems supporting both semantic and episodic memory – offering a new perspective on a longstanding creativity theory. [ABSTRACT FROM AUTHOR]

Exposure to stress during the prenatal period is often associated with adverse maternal and neonatal health outcomes and is increasing in prevalence in the United States. Health care providers play a crucial role in addressing and mitigating this stress, but there is a lack of consensus regarding effective interventions. This review evaluates the effectiveness of prenatal provider-based interventions that reduce stress for pregnant people, especially those who are disproportionately affected by stress. A search of relevant English-language literature was conducted using PubMed, CINAHL, Web of Science, Embase, and PyscInfo. Inclusion criteria were 1) the target population was pregnant people, 2) the intervention was delivered within the U.S. health care system, and 3) the study intervention had the goal of reducing stress (stress-reducing intervention). A total of 3,562 records were identified in the search and 23 were included in analysis. The four identified categories for provider-led stress-reducing prenatal interventions included in the review are 1) skills-building, 2) mindfulness, 3) behavioral therapy, and 4) group support. Findings suggest an increased overall likelihood of mood and maternal stress improvement among pregnant people who complete provider-based stress-reducing interventions, especially group-based therapies that integrate resource allocation, skills-building, mindfulness, and/or behavioral therapy into an intersectional program. However, the efficacy of each type of intervention varies by category and type of maternal stress targeted. Although few studies demonstrated a significant reduction in stress for pregnant people, this review highlights the critical need for increased research and attention to stress-reducing interventions in the prenatal period, especially as it pertains to minoritized populations. [ABSTRACT FROM AUTHOR]

• A randomised pilot trial amongst adults with Cystic Fibrosis • Intervention consisted of wearable technology, goal setting and text message feedback • Active comparator group wore wearable technology only • Physical activity increased for both groups • Text messages based on collaborative goal setting showed significantly greater improvements Regular participation in physical activity (PA) is encouraged for people with Cystic Fibrosis (CF). This study aimed to assess the effectiveness of an intervention using wearable technology, goal setting and text message feedback on PA and health outcomes in people with CF. This was a pilot randomised trial conducted at University Hospital Limerick. Participants were randomly assigned to the intervention (INT) or active comparator (AC). The 12-week intervention consisted of wearable technology (Fitbit Charge 2) which was remotely monitored, and participants set step count goals. Participants were sent a one-way text message once a week over 12 weeks to positively reinforce and encourage PA participation. The AC group received the wearable technology alone. Follow up was assessed at 24 weeks. Outcomes assessed were PA, aerobic capacity, lung function, sleep, quality of life and wellbeing. Step count increased significantly for the INT group over 12 weeks when compared to the AC group (p=0.019). The INT group had a 28% week-to-week percentage change (Weeks 1-12), while the AC group reduced by 1%, p=0.023. Within group changes demonstrated that VO2 peak (ml/kg/min) significantly increased for the INT group at 12 weeks (24.4 ±7.65 to 26.13 ±7.79, p=0.003) but not at 24 weeks (24.45 ±7.05, p=0.776). There were no significant differences observed for VO2 peak (ml/kg/min) for the AC group. There was no significant effect on lung function, sleep, well-being, or quality of life for either group. A personalised PA intervention using wearable technology, goal setting and text message feedback increased PA and aerobic capacity in people with CF. Integration of this intervention into usual care may encourage regular PA participation for people with CF. [ABSTRACT FROM AUTHOR]

'Goal-directed haemodynamic therapy' describes various haemodynamic treatment strategies that have in common that interventions are titrated to achieve predefined haemodynamic targets. However, the treatment strategies differ substantially regarding the underlying haemodynamic target variables and target values, and thus presumably have different effects on outcome. It is an over-simplifying approach to lump complex and substantially differing haemodynamic treatment strategies together under the term 'goal-directed haemodynamic therapy', an imprecise umbrella term that we should thus stop using. [ABSTRACT FROM AUTHOR]

Previous research has explored the effectiveness of wearable activity trackers (wearables) for increasing child physical activity (PA) levels, but there have been mixed results. The use of theoretical frameworks and co-design techniques are recognised ways of increasing an intervention's acceptability and effectiveness. This study aims to use co-design workshops and an evidence-based theoretical framework (the Behaviour Change Wheel) to develop a family-based PA intervention using wearables. Three stages of intervention development outlined by the Behaviour Change Wheel were used. Co-design workshops with seven families (11 parents and 12 children) and seven PA experts were conducted where stakeholders discussed how to overcome previously identified barriers to families being active and using wearables. This resulted in the intervention's components being developed, with each component's mechanisms of action (e.g. intervention functions and behaviour change techniques) being retrospectively identified. The 'Move & Connect' intervention was developed, which targets family PA and wearable use. The intervention takes a flexible approach and includes eight components, including wearable devices (Fitbit Alta HR), support resources, an introductory workshop, collective challenges, goal setting and reviewing, engagement prompts, social support and health-related resources (e.g. educational videos). The intervention incorporates six intervention functions targeting PA and wearable use: education, training, modelling, persuasion, incentivisation and environmental restructuring and 24 behaviour change techniques, including goal setting, social comparison, feedback on behaviour and graded task. This is the first known study to use an evidence-based framework and co-design to develop a family-based wearable intervention. The identification of the intervention's mechanisms of action will prove useful when implementing and evaluating the 'Move & Connect' intervention and allow researchers to replicate its components. [ABSTRACT FROM AUTHOR]

The discovery of place cells and other spatially modulated neurons in the hippocampal complex of rodents has been crucial to elucidating the neural basis of spatial cognition. More recently, the replay of neural sequences encoding previously experienced trajectories has been observed during consummatory behavior—potentially with implications for rapid learning, quick memory consolidation, and behavioral planning. Several promising models for robotic navigation and reinforcement learning have been proposed based on these and previous findings. Most of these models, however, use carefully engineered neural networks, and sometimes require long learning periods. In this paper, we present a self-organizing model incorporating place cells and replay, and demonstrate its utility for rapid one-shot learning in non-trivial environments with obstacles. [ABSTRACT FROM AUTHOR]

In the seminal paper of Bank and Weiser (1985) [17] a new a posteriori estimator was introduced. This estimator requires the solution of a local Neumann problem on every cell of the finite element mesh. Despite the promise of Bank–Weiser type estimators, namely locality, computational efficiency, and asymptotic sharpness, they have seen little use in practical computational problems. The focus of this contribution is to describe a novel algorithmic approach to constructing hierarchical estimators of the Bank–Weiser type that is designed for implementation in a modern high-level finite element software with automatic code generation capabilities. We show how to use the estimator to drive (goal-oriented) adaptive mesh refinement for diverse Poisson problems and for mixed approximations of the nearly-incompressible elasticity problems. We provide comparisons with various other used estimators. Two open source implementations in the DOLFIN and DOLFINx solvers of the FEniCS Project are provided as supplementary material. [ABSTRACT FROM AUTHOR]

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]

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]

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]

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]

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]

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]

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]

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]

Objective: Setting goals collaboratively with patients is a key aspect in shared decision-making (SDM) in malnutrition interventions. The aim, therefore, was to gain an understanding of clinical dietitians' reflections regarding the process of goal-setting with patients at risk of malnutrition.Methods: Six semi-structured audio-recorded focus group discussions were held with registered dietitians (n = 29) from primary healthcare and hospitals in Sweden. Focus group transcripts were analysed thematically to find patterns in the data and identify themes.Results: Dietitians expressed striving to explore patients' narratives, capabilities, and resources before deciding on goals. They described different strategies in counseling patients and a lack of patient participation in the goal-setting. They emphasized the difficulties of setting feasible goals due to discrepancies between their clinically-oriented goals and patients' personal goals.Conclusion: Findings highlight a gap in the process of setting goals for patients at risk of malnutrition, where patients' participation was lacking. Education in SDM, and strategies and tools to support dietitians in involving patients in goal-setting, are required to bridge the gap and promote person-centeredness.Practice Implications: Findings may be further used to develop tools and strategies, and design studies on the implementation of and education in SDM and goal-setting for malnutrition interventions. [ABSTRACT FROM AUTHOR]

Nursing homes (NHs) provide care to residents with serious illness and related complex health care needs. As such, discussions about end-of-life care between NH staff and residents and families are necessary to ensure residents receive care consistent with their goals. Interventions such as video decision aids have been developed to promote discussions and improve advance care planning, but few studies have examined how NH characteristics may relate to the implementation of these interventions; such information might lead toward more use of successful interventions. The purpose of this study is to understand NH characteristics that are associated with the implementation of the Goals of Care (GOC) intervention, which combined a video decision aid with a structured discussion to guide decision-making in advanced dementia. A multiple case study. Staff surveys were conducted to examine factors related to implementation effectiveness in 11 NHs in North Carolina that participated in the GOC trial. Questions measured the dependent variable of implementation effectiveness: the consistency and quality of use of the GOC intervention. NH organizational characteristics were measured using publicly available data and an administrator survey. The analysis consisted of pattern matching logic. High management support aligned with implementation effectiveness within NHs. In addition, the within case pattern analysis indicated additional characteristics related to implementation effectiveness. Facility size, Medicare beds, residents' racial composition, and star rating were related to implementation effectiveness across 6 of the 11 NHs. NH financial resources, such as size and number of Medicare beds, may be important factors for successful implementation. NHs seeking to implement advance care planning interventions should focus on within and across NH differences, such as adequate management and financial support prior to implementation to increase the likelihood of implementation effectiveness. [ABSTRACT FROM AUTHOR]

In this article, we discuss goal-oriented a posteriori error estimation for the biharmonic plate bending problem. The error for a numerical approximation of a goal functional is represented by several computable estimators. One of these estimators is obtained using the dual-weighted residual method, which takes advantage of an equilibrated moment tensor. Then, an abstract unified framework for the goal-oriented a posteriori error estimation is derived based on the equilibrated moment tensor and the potential reconstruction that provides a guaranteed upper bound for the error of a numerical approximation for the goal functional. In particular, C 0 interior penalty and discontinuous Galerkin finite element methods are employed for the practical realisation of the estimators. Numerical experiments are performed to illustrate the effectivity of the estimators. [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]

A novel behavioral model for auction-based shared parking market is proposed in this study, in which anticipated regrets are incorporated to investigate the interdependency between parking behaviors and psychological factors. Two types of participants' anticipated regrets about winning and losing, which affect the bid prices for parking, are first considered in the proposed model. Four goals of normative, hedonic, gain, and economical are developed from the conceptional goal-framing theory to address the motivational explanation for participants' behaviors of changing bids. Welfare losses induced by these goal frames are further investigated and simulated. Results show that the normative goal and the combination of the gain goal and the economical goal are recognized as preferred goals for the shared parking auction market. Managerial implications of setting a market entry threshold to exclude certain participants and guiding participants to change from diverse goals to preferred goals are proposed to help reduce welfare loss for sustainable development. [ABSTRACT FROM AUTHOR]

Objectives: Early assessments of health technologies help to better align and integrate their development and assessment. Such assessments can take many forms and serve different purposes, hampering users in their selection of the most appropriate method for a specific goal. The aim of this scoping review was to structure the large set of methods according to their specific goal.Methods: A scoping review was conducted using PubMed and reference lists of retrieved articles, to identify review studies with a methodological focus. From the included reviews, all individual methods were listed. Based on additional literature and examples, we extracted the specific goal of each method. All goals were clustered to derive a set of subclasses and methods were grouped into these subclasses.Results: Of the 404 screened, 5 reviews were included, and 1 was added when searching reference lists. The reviews described 56 methods, of which 43 (77%) were included and classified as methods to (1) explore the nature and magnitude of the problem, (2) estimate the nature and magnitude of the expected (societal) value, (3) identify conditions for the potential value to materialize, and (4) help develop and design the type of research that is needed.Conclusions: The wide range of methods for exploring the societal value of health technologies at an early stage of development can be subdivided into a limited number of classes, distinguishing methods according to their specific objective. This facilitates selection of appropriate methods, depending on the specific needs and aims. [ABSTRACT FROM AUTHOR]

Women's empowerment is a UN Sustainable Development Goal and a focus of global health and development but survey measures and data on gender empowerment remain weak. Existing indicators are often disconnected from theory; stronger operationalization is needed. We present the EMERGE Framework to Measure Empowerment, a framework to strengthen empowerment measures for global health and development. We initiated development of this framework in 2016 as part of EMERGE – an initiative designed to build the science of survey research and availability of high-quality survey measures and data on gender empowerment. The framework is guided by existing theories of empowerment, evidence, and expert input. We apply this framework to understand women's empowerment in family planning (FP) via review of state of the field measures. Our framework offers concrete measurable constructs to assess critical consciousness and choice, agency and backlash, and goal achievement as the empowerment process, recognizing its operation at multiple levels-from the individual to the collective. Internal attributes, social norms, and external contexts and resources create facilitators or barriers to the empowerment process. Review of best evidence FP measures assessing empowerment constructs, social norms, and key influencers (e.g., partners and providers) show a strong landscape of measures, including those with women, partners, and providers, but they are limited in assessing translation of choice to agency to achievement of women's self-determined fertility or contraceptive goals, instead relying on assumption of contraceptive use as the goal. We see no measures on collective empowerment toward women's reproductive choice and rights. The EMERGE Framework can guide development and analysis of survey measures on empowerment and is needed as the current state of the field shows limited coverage of empowerment constructs even in areas which have received more study, such as family planning. • Definitions and indicators of empowerment constructs for measurement are lacking • The EMERGE framework conceptualizes and operationalizes gender empowerment measures • Measuring agency and social norms is critical to gender empowerment • The framework also points to key gender data gaps [ABSTRACT FROM AUTHOR]

Persons high in the manipulative, misanthropic trait Machiavellianism make use of various forms of deception to attain their goals. A recent study demonstrated that different facets of Machiavellianism account for different kinds of deception (Blötner & Bergold, 2023; doi:10.1111/bjso.12559). Intelligence could be another predictor of deception production. This research examined the interactions between different facets of Machiavellianism and verbal reasoning to predict the production of empty, vague pseudo-information that is supposed to help achieve desired states or prevent undesired ones (co-called " bullshit "). In a sample of 525 participants, and consistent with the hypotheses, individuals with high scores in the goal-oriented facet of Machiavellianism produced " bullshit " more frequently to achieve certain goals if they also scored high in verbal reasoning. Thus, and opposing common assumptions, Machiavellianism is not sufficient to explain engagement in deceptive behavior as it only reflects the motivation to do so. Especially in the case of verbally expressed deception, verbal skills are also required to be successful. [ABSTRACT FROM AUTHOR]

Autonomous motivation arising from a sense of truly valuing or enjoying one's pursuits ("wanting to do it") is associated with goal progress and well-being. Likewise, setting an implementation intention in the form of an if-then plan can lead to improved goal outcomes. We introduce the concept of autonomous motivation for if-then plans and study its association with plan enactment, goal progress, and action crisis severity (goal conflict) in the context of a goal study (N = 379). Results suggest that autonomous goal motivation is positively related to autonomous if-then plan motivation. Moreover, analyses reveal a positive synergistic effect of autonomous if-then plan motivation and frequency of plan enactment on goal progress and action crises: Goal progress was boosted, and action crises were minimized with higher autonomous if-then plan motivation and greater frequency of plan enactment. Implications of these results for promoting goal striving are discussed. [ABSTRACT FROM AUTHOR]