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This article investigates burnout among lawyers and proposes systemic changes to reduce pressure and stress in the legal profession while enhancing resilience among lawyers. The article focuses on factors influencing career continuity among Palestinian lawyers within a socio-politically complex environment. It discusses elements contributing to resilience, including a positive mindset, a strong support system, training, and social support. The study reveals exceptional resilience among Palestinian lawyers. A quantitative cross-sectional study was used; the goals of the study involved 323 participants from different places in Palestine. Data analysis employed Smart PLS4 to build a regression model. Challenging conventional notions, the study provides valuable insights for state strategies, legal firms, educational institutions, and policymakers to address challenges and improve lawyer retention and job satisfaction in an environment marked by unstable economic and political conditions. Additionally, it examines gender-specific career intentions, notably women lawyers displaying a stronger inclination to stay, potentially linked to socio-economic responsibilities. This study contributes significantly to existing literature by providing a unique case study on career continuance determinants within economic and political instability. It sets a precedent for further study and strategic improvements in lawyer retention and job satisfaction within high-stress professions in an economically and politically complex environment., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Hattab et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Alternative education provision such as Pupil Referral Units support young people who have been excluded from mainstream school settings and often from disadvantaged backgrounds. However, there is limited research to date exploring educators' perceptions of the complex needs of young people in PRUs, and the extent to which PRUs as currently configured can meet such needs., Methods: Between March 2019 and October 2020 twenty-two participants holding various educational roles from five different Pupil Referral Units across London and Southeast England were interviewed. The interviews aimed to explore the participants' experiences of working with students in PRU's and examine some of the challenges that they might encounter. Semi-structured interviews were analysed using Reflexive thematic analysis., Results: The three identified themes and their sub-themes highlighted the complex needs of these young people and identified significant barriers to effective service provision. The first theme 'Complexities of PRU population' highlighted the challenges that young people in PRUs face and perceived systemic short falls in addressing such complexity. The second theme 'Challenges of the PRU environment' highlights the frustrations that educators experience when it comes to providing adequate support to young people in PRU's, the absence of agency support, and the uncertainty that these educational settings can bring. The third theme 'Peer Group Influences' highlights the impact of peer groups from beyond the classroom on engagement within the classroom., Conclusions: Despite the clear complex needs of young people in PRUs, staff reported feeling ill-equipped to support these individuals and lacked access to effective inter-agency support. Participants reported that pupils' mental health difficulties were exacerbated by exclusion and reintegration practices, an over-zealous focus on educational outcomes and the impact of gang influences on their school lives. Implications include more specific mental health training for staff working in PRU's, improved inter-agency working and the incorporation of trauma-informed approaches in educational practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kaip et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Previous studies have emphasized the association between the intake of artificial sweeteners (AS) and type 2 diabetes mellitus (T2DM), but the causative relationship remains ambiguous., Methods: This study employed univariate Mendelian randomization (MR) analysis to assess the causal link between AS intake from various sources and T2DM. Linkage disequilibrium score (LDSC) regression was used to evaluate the correlation between phenotypes. Multivariate and mediation MR were applied to investigate confounding factors and mediating effects. Data on AS intake from different sources (N = 64,949) were sourced from the UK Biobank, while T2DM data were derived from the DIAbetes Genetics Replication And Meta-analysis.The primary method adopted was inverse variance weighted (IVW), complemented by three validation techniques. Additionally, a series of sensitivity analyses were performed to evaluate pleiotropy and heterogeneity., Results: LDSC analysis unveiled a significant genetic correlation between AS intake from different sources and T2DM (rg range: -0.006 to 0.15, all P < 0.05). After correction by the false discovery rate (FDR), the primary IVW method indicated that AS intake in coffee was a risk factor for T2DM (OR = 1.265, 95% CI: 1.035-1.545, P = 0.021, PFDR = 0.042). Further multivariable and mediation MR analyses pinpointed high density lipoprotein-cholesterol (HDL-C) as mediating a portion of this causal relationship. In reverse MR analysis, significant evidence suggested a positive correlation between T2DM and AS intake in coffee (β = 0.013, 95% CI: 0.004-0.022, P = 0.004, PFDR = 0.012), cereal (β = 0.007, 95% CI: 0.002-0.012, P = 0.004, PFDR = 0.012), and tea (β = 0.009, 95% CI: 0.001-0.017, P = 0.036, PFDR = 0.049). No other causal associations were identified (P > 0.05, PFDR > 0.05)., Conclusion: The MR analysis has established a causal relationship between AS intake in coffee and T2DM. The mediation by HDL-C emphasizes potential metabolic pathways underpinning these relationships., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Zhang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study establishes a risk index system to evaluate the financial risks of foreign agricultural investment in Belt and Road countries. Agricultural foreign investment risk prevention has emerged as a crucial concern across various sectors globally. We assess the four key dimensions such as political and military risk, economic market risk, social and cultural risk, and resource and environmental risk. We employ the Vertical and Horizontal Leveling Method and Entropy Weighting Method (VHSD-EM) for measuring and analyzing foreign agricultural investment risk levels in Belt and Road countries from 2014 to 2021. Moreover, we used spatial correlation analysis, the Getis-Ord Gi* statistic, to identify hot and cold spots of agricultural foreign investment risks. First political & military, and environmental risks are the main influencing factors of agricultural foreign investment risk. The average AFDI level exceeded in Southeast and South Asia, and certain spillover effects were found in Southeast Asia. Second, the Belt and Road" initiative effectively reduces the risk of AFDI and helps to weaken the spillover effect among fellow countries. A significant spillover effect in AFDI from neighboring countries can lead to high-risk areas for sustained AFDI formation. Third to address such challenges, the Chinese government has prerequisites to enhance foreign agricultural investments in Belt and Road countries and establish a measurement index for agricultural investment risks. Government needs to establish a public service system to enhance the development of large-scale multinational agricultural enterprises. Foreign cooperation is essential for multi and bilateral investment negotiation and optimizing the financial tools to mitigate agricultural foreign direct investment risk in Belt and Road countries., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Tian, Tunio. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

What are the effects of parenting styles on academic performance and how unequal are these effects on secondary school students from different gender and socioeconomic status families constitute the theme of this paper. A cross-sectional and purposive sampling technique was adopted to gather information from a sample of 448 students on a Likert scale. Chi-square, Kendall's Tau-c tests and hierarchical multiple regression analyses were used to determine the extent of the relationship among the variables. Chi-square and Kendall's Tau-c (Tc) test results established that the socioeconomic status of the respondent's family explained variation in children's academic performance due to parenting style; however, no significant difference was observed in the academic performance of students based on gender. Furthermore, hierarchal multiple regression analysis established that the family's socioeconomic status, authoritative parenting, permissive parenting, the interaction of socioeconomic status and authoritative parenting, and the interaction of socioeconomic status and permissive parenting were significant predictors (P<0.05) of students' academic performance. These predictor variables explained 59.3 percent variation in the academic performance of children (R2 = 0.593). Results of hierarchal multiple regression analysis in this study ranked ordered the most significant predictors of the academic performance of children in the following order. Family socioeconomic status alone was the strongest predictor (β = 18.25), interaction of socioeconomic status and authoritative parenting was the second important predictor (β = 14.18), authoritative parenting alone was third in importance (β = 13.38), the interaction of socioeconomic status and permissive parenting stood at fourth place in importance (β = 11.46), and permissive parenting was fifth (β = 9.2) in influencing academic performance of children in the study area. Children who experienced authoritative parenting and were from higher socioeconomic status families perform better as compared to children who experienced authoritarian and permissive parenting and were from low socioeconomic status families., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ali et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The World Health Organization has called on nation-states to statutorily govern, and integrate into state-funded healthcare systems, practitioners of traditional and complementary medicine (T&CM) (whose therapeutic approaches that fall outside the boundaries of conventional biomedicine). To date, however, there exist few rigorous reports of the degree to which individual nations have responded to this call. This study, an environmental scan, comprehensively documents the statutory governance and government reimbursement of T&CM practitioners in the United States (US). Across the US, where health practitioner governance falls within state and territorial (rather than federal) jurisdiction, over 300 laws have been enacted to statutorily regulate a wide range of T&CM practitioners. Nurse-midwives and chiropractors are universally licensed across all 56 US regulatory jurisdictions (50 states, 5 territories and the District of Columbia); other major T&CM practitioner groups are regulated in fewer jurisdictions (acupuncturists, n = 52; massage therapists, n = 50; direct-entry [non-nurse] midwives, n = 36; naturopaths, n = 24). Additional statutory stipulations exist to govern chiropractic assistants (n = 30), auricular (ear) acupuncture practitioners (n = 24), homeopathic practitioners (n = 3), and psychedelic facilitators (n = 1), as well as biomedical professionals who practice acupuncture and related techniques, e.g., 'dry needling' (n = 44). While professional entry requirements for licensed T&CM practitioners are substantially harmonized across jurisdictions, restricted titles and statutory scopes of practice vary. Ten states have furthermore implemented 'safe harbor' ('negative licensing') exemption laws enabling otherwise-unregulated T&CM practitioners to legally practice. Limited government reimbursement for T&CM care is available across several federal and state programs, including Medicare, Tricare, Veterans Health Authority, and Medicaid. Nurse-midwifery and chiropractic care is most frequently reimbursed; acupuncturists, naturopaths and massage therapists are eligible for much more limited coverage. Medicaid programs for low-income people in ten states furthermore cover the services of (unlicensed but statutorily-recognized) birth doulas. Additional research is needed to assess the impact of these regulations on US health care., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ijaz, Carrie. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

We aimed to develop and validate a comprehensive ambient air pollution health literacy instrument. We developed items covering 12 constructs, four information competencies within three health domains. In this population-based telephone interview study, probability proportional to size sampling and random digit dialing were used to determine participants. We conducted confirmatory factor analysis to analyze model fits and used content validity indices and Cronbach's alpha to measure content validity and internal consistency reliability. Twenty-four items were generated, and a total of 1,297 participants were recruited. A theoretically conceived 12-factor model was supported (root mean square error of approximation [RMSEA] = 0.068, comparative fit index [CFI] = 0.039, standardized root mean square residual [SRMR] = 0.934, normed fit index [NFI] = 0.914, Tucker-Lewis index [TLI] = 0.902). Content validity indices for relevance, importance, and unambiguity were 0.97, 0.99, and 0.94, respectively. Internal consistency reliability assessed by Cronbach's alpha was 0.93. The ambient air pollution health literacy instrument is valid and reliable and can be used in community residents. The novel instrument can guide the stakeholders and the authority to tailor and implement effective and appropriate interventions and actions, empowering the public to manage hazardous exposure and improving AAPHL of the public., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Orbital and nasal parameters among modern humans show considerable variation, which affects facial shape, and these characteristics vary according to race, region, and period in evolution. The aim of the study was to ascertain whether there are sex differences in the orbital and/or nasal indexes and/or the single measurements used to calculate these in a Kosovar population. The following parameters were taken into consideration: orbital height (OH), orbital width (OW), nasal height (NH), and nasal width (NW). The ratios between orbital index/nasal index (RONI) were calculated. All measurements were obtained from a population sample comprising 408 individuals. The accuracy in sex prediction was 52.86% (CI95% = 45.05%-60.67%) for NW and 64.96% for NH (CI95% = 57.50%- 72.42%). The difference between male and female indexes was statistically significant (P < 0.05). The anthropometric study revealed that only NW and NH are configured as predictors of sexual dimorphism. It could be useful to increase the number of samples to test the discriminant function in other population groups., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Scendoni et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Legal scholars have been trying to predict the outcomes of trials for a long time. In recent years, researchers have been harnessing advancements in machine learning to predict the behavior of natural and social processes. At the same time, the Brazilian judiciary faces a challenging number of new cases every year, which generates the need to improve the throughput of the justice system. Based on those premises, we trained three deep learning architectures, ULMFiT, BERT, and Big Bird, on 612,961 Federal Small Claims Courts appeals within the Brazilian 5th Regional Federal Court to predict their outcomes. We compare the predictive performance of the models to the predictions of 22 highly skilled experts. All models outperform human experts, with the best one achieving a Matthews Correlation Coefficient of 0.3688 compared to 0.1253 from the human experts. Our results demonstrate that natural language processing and machine learning techniques provide a promising approach for predicting legal outcomes. We also release the Brazilian Courts Appeal Dataset for the 5th Regional Federal Court (BrCAD-5), containing data from 765,602 appeals to promote further developments in this area., Competing Interests: Elias Jacob de Menezes-Neto declares no competing interests. Marco Bruno Miranda Clementino is a federal judge in the 5th Regional Federal Court jurisdiction. Although his position is not affected in any way by this paper, we understand that this affiliation may be seen as a non-financial competing interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Purpose: Atrial fibrillation (AF) is a significant independent risk factor for 1-year mortality in patients with first acute ischemic stroke (AIS). The CHA2DS2-VASc score was initially developed to assess the risk of stroke in patients with AF. Recently, this scoring system has been demonstrated to have clinical value for predicting long-term clinical outcomes in AIS but the evidence is insufficient. This large-scale prospective cohort study investigated the independent predictive value of the score in such patients., Methods: We included patients with AIS from the Taiwan Stroke Registry (TSR) during 2006-2016 as the present study population. Patients were divided into those with high (≥2) and low (<2) CHA2DS2-VASc scores. We further analyzed and classified patients according to the presence of AF. The clinical endpoint was major adverse cardiac and cerebrovascular events (MACCEs) at 1 year after the index AIS., Results: A total of 62,227 patients with AIS were enrolled. The median age was 70.3 years, and 59% of the patients were women. After confounding factors were controlled, patients with high CHA2DS2-VASc scores had significantly higher incidence of 1-year MACCEs (adjusted hazard ratio [HR] = 1.63; 95% confidence interval [CI] = 1.52, 1.76), re-stroke (adjusted HR = 1.28; 95% CI = 1.16, 1.42), and all-cause mortality (adjusted HR = 2.03; 95% CI = 1.83, 2.24) than those with low CHA2DS2-VASc scores did. In the comparison between AF and non-AF groups, the AF group had increased MACCEs (adjusted HR = 1.74; 95% CI = 1.60, 1.89), myocardial infarction (adjusted HR = 4.86; 95% CI = 2.07, 11.4), re-stroke (adjusted HR = 1.47; 95% CI = 1.26, 1.71), and all-cause mortality (adjusted HR = 1.90; 95% CI = 1.72, 2.10). The Kaplan-Meier curve revealed that both CHA2DS2-VASc scores and AF were independent risk predictors for 1-year MACCEs and mortality., Conclusions: The CHA2DS2-VASc score and AF appeared to consistently predict 1-year MACCEs of AIS patients and provide more accurate risk stratification. Therefore, increased use of the CHA2DS2-VASc score may help improve the holistic clinical assessment of AIS patients with or without AF., Competing Interests: The authors have declared that no competing interests exist.

This study analyzes aggregate data on trade flows to examine the performance of bilateral free trade agreements (BFTAs) between the United States and 11 BFTA nations in a two-dimensional approach. In line with the literature, this study applies the gravity model and analyzes the effect of the treatment using Poisson pseudo-maximum likelihood (PPML) panel data from 1992 to 2017. We use the PPML as an alternative methodology to an ordinary least squares model, as it can treat zero trade values and lead to unbiased estimates and different consistencies. We consider the trade in goods but excluded services because of the different nature of trade for services. Moreover, this study highlights the quantitative performance of BFTAs without considering the industry level to compare the overall benefits for the trade flows from the U.S. as an exporter to BFTA countries and vice versa. It thus adds to the debate on the effect of FTAs on trade flows and conducts pre-FTA and post-FTA analyses to compare the volumes of exports and imports during both periods. Findings vary according to the direction of trade; notably, some trading partners increased their trading volume to 388%. In sum, this paper provides a collective current state assessment to demonstrate the most plausible reasons for the effects of the 11 BFTAs, in addition to informing policymakers on the lessons learned from each BFTA., Competing Interests: The authors have declared that no competing interests exist.

Background: Aging-related hypogonadism in men is related to the deterioration of overall health. Those with this disease rarely receive treatment. The hypertriglyceridemic waist (HTGW) phenotype is a tool for predicting abnormalities of cardiovascular metabolism. However, the relationship between the HTGW phenotype and hypogonadism remains undetermined. This study aimed to determine the association between HTGW phenotype and hypogonadism in different age groups., Methods: Data of this cross-sectional study were obtained from MJ Health Screening Center in Taiwan from 2007 to 2016. The HTGW phenotype was divided into four categories based on whether the waist circumference (WC) and triglyceride levels were normal. WC of <90 cm and triglyceride level of <150 mg/dL were defined as normal. Hypogonadism was defined as a testosterone level of <300 ng/dL., Results: Overall, 6442 male participants were divided into three age groups: <50, 50-64, and ≥65 years (n = 4135, 1958, and 349; age groups 1, 2, and 3, respectively). The overall prevalence of hypogonadism was 10.6%. In group 1, participants with HTGW (odds ratio, 1.98; 95% confidence interval (CI), 1.354-2.896) had a higher risk of hypogonadism than those with normal WC and normal triglyceride levels after adjustment for body mass index and fasting blood glucose level. In group 2, participants with HTGW (odds ratio, 1.873; 95% CI, 1.099-3.193) had an increased risk of hypogonadism after adjustment for body mass index, fasting blood glucose level, Cholesterol levels, high-density lipoprotein (HDL) levels, low-density lipoprptein (LDL) levels and smoking status. However, no relationship was observed between HTGW phenotype and hypogonadism in group 3., Conclusion: HTGW phenotype was highly associated with hypogonadism in Taiwanese adult men. More attention should be paid to men aged <50 years with HTGW., Competing Interests: The authors have declared that no competing interests exist.

Objectives: To quantify nonfatal injurious police shootings of people and examine the factors associated with victim mortality., Methods: We gathered victim-level data on fatal and nonfatal injurious police shootings from four states that have such information publicly available: Florida (2009-14), Colorado (2010-19), Texas (2015-19), and California (2016-19). For each state, we examined bivariate associations between mortality and race/ethnicity, gender, age, weapon, and access to trauma care. We also estimated logistic regression models predicting victim mortality in each state., Results: Forty-five percent of these police shooting victims (N = 1,322) did not die. Black-white disparities were more pronounced in nonfatal injurious police shootings than in fatal police shootings. Overall, Black victims were less likely than white victims to die from their wound(s). Younger victims were less likely to die from their wound(s), as well as those who were unarmed., Conclusions: Racial and age disparities in police shootings are likely more pronounced than previous estimates suggest., Policy Implications: Other states should strongly consider compiling data like that which is currently being gathered in California. Absent data on nonfatal injurious police shootings-which account for a large share of deadly force incidents-researchers and analysts must be cautious about comparing and/or ranking jurisdictions in terms of their police-involved fatality rates., Competing Interests: The authors have declared that no competing interests exist.

In this paper, the Duckworth-Lewis-Stern (DLS) and Duckworth-Lewis-McHale-Asif (DLMA) methods of revising targets for a team batting in second innings in an interrupted Limited Overs International Cricket (LOI), are examined for fairness. The work discusses four significant points: flexibility, intuition, simplicity, and goodness-of-fit of the two mentioned methods. The research findings have shown that the DLMA method is better in every aspect than the DLS method. Further, the data of 1764 ODI matches played during 2004-2021 to investigate the compatibility of the DLMA for high run-scoring One-Day International matches. The results show that DLMA is compatible to the situation of the well-above run-scoring situation., Competing Interests: The authors have declared that no competing interests exist.

This article aims to identify networks of constitutional text structured in an imperceptible way. Constitutions has the power to reveal how its devices "dialogue" with each other, forming their own communicative communities. With the help from the network analysis methodology, an interpretative model of textual mapping is proposed based on internal references between the provisions of one Constitution. We use the Brazilian Constitution, whose text is very detailed, analytical and deals with various issues. As a result, a network was identified that included 174 connections between 95 articles of the Constitution and the existence of normative communities that share codes or communicative standards. The study demonstrates the strong possibility to found structuring axis of this communities and relates to the other issues that have reached constitutional stature, showing that the complexity of some Constitutions can be observed beyond its logical sequential structure., Competing Interests: The authors have declared that no competing interests exist.

How do people balance concerns for general health and economic outcomes during a pandemic? And, how does the communication of this trade-off affect individual preferences? We address these questions using a field experiment involving around 2000 students enrolled in a large university in Italy. We design four treatments where the trade-off is communicated using different combinations of a positive framing that focuses on protective strategies and a negative framing which refers to potential costs. We find that positive framing on the health side induces students to give greater relevance to the health dimension. The effect is sizeable and highly effective among many different audiences, especially females. Importantly, this triggers a higher level of intention to adhere to social distancing and precautionary behaviors. Moreover, irrespective of the framing, we find a large heterogeneity in students' preferences over the trade-off. Economics students and students who have directly experienced the economic impact of the pandemic are found to give greater value to economic outcomes., Competing Interests: The authors have declared that no competing interests exist.

Much has been written about gene modifying technologies (GMTs), with a particularly strong focus on human germline genome editing (HGGE) sparked by its unprecedented clinical research application in 2018, shocking the scientific community. This paper applies political, ethical, and social lenses to aspects of HGGE to uncover previously underexplored considerations that are important to reflect on in global discussions. By exploring 4 areas-(1) just distribution of HGGE benefits through a realist lens; (2) HGGE through a national interest lens; (3) "broad societal consensus" through a structural injustice lens; and (4) HGGE through a scientific trustworthiness lens-a broader perspective is offered, which ultimately aims to enrich further debates and inform well-considered solutions for developments in this field. The application of these lenses also brings to light the fact that all discussions about scientific developments involve a conscious or unconscious application of a lens that shapes the direction of our thinking., Competing Interests: The authors have declared that no competing interests exist.

Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where onchocerciasis has been previously detected. This threshold value was then used to classify IUs (more suitable or less suitable) based on the location within the IU with the largest mean prediction. Mean estimates of environmental suitability suggest large areas across West and Central Africa, as well as focal areas of East Africa, are suitable for onchocerciasis transmission, consistent with the presence of current control and elimination of transmission efforts. The ROC analysis identified a mean environmental suitability index of 0·71 as a threshold to classify based on the location with the largest mean prediction within the IU. Of the IUs considered for mapping surveys, 50·2% exceed this threshold for suitability in at least one 5 × 5-km location. The formidable scale of data collection required to map onchocerciasis endemicity across the African continent presents an opportunity to use spatial data to identify areas likely to be suitable for onchocerciasis transmission. National onchocerciasis elimination programmes may wish to consider prioritising these IUs for mapping surveys as human resources, laboratory capacity, and programmatic schedules may constrain survey implementation, and possibly delaying MDA initiation in areas that would ultimately qualify., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: WM is Program Analyst in Population and Development at the United Nations Population Fund-UNFPA Country Office in Peru, institution which not necessarily endorses this study. JAS reports personal fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio health, Medscape, WebMD, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, Practice Point communications, the National Institutes of Health, the American College of Rheumatology, Simply Speaking. JAS reports other contributions from Amarin, Viking, Moderana and Vaxart pharmaceuticals. JAS reports non-financial support from the FDA Arthritis Advisory Committee, the Steering committee of OMERACT, an international organization that develops measures for clinical trials and receives arms length funding from 12 pharmaceutical companies, the Veterans Affairs Rheumatology Field Advisory Committee, and the Editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis.

Clinical expertise has since 1891 a Swedish counterpart in proven experience. This study aims to increase our understanding of clinicians' views of their professional expertise, both as a source or body of knowledge and as a skill or quality. We examine how Swedish healthcare personnel view their expertise as captured by the (legally and culturally relevant) Swedish concept of "proven experience," through a survey administered to a simple random sample of Swedish physicians and nurses (2018, n = 560). This study is the first empirical attempt to analyse the notion of proven experience as it is understood by Swedish physicians and nurses. Using statistical techniques for data dimensionality reduction (confirmatory factor analysis and multidimensional scaling), the study provides evidence that the proven experience concept is multidimensional and that a model consisting of three dimensions-for brevity referred to as "test/evidence", "practice", and "being an experienced/competent person"-describes the survey responses well. In addition, our results cannot corroborate the widely held assumption in evidence-based medicine that an important component of clinical expertise consists of experience of patients' preferences., Competing Interests: The authors have declared that no competing interests exist.

In response to the Hong Kong Principles for assessing researchers, this Formal Comment argues that it is time to take gender and diversity considerations seriously in the pursuit of fostering research integrity; this requires acknowledging and reshaping the influence of research assessment criteria on researcher representation., Competing Interests: The authors have declared that no competing interests exist.

The determination of node centrality is a fundamental topic in social network studies. As an addition to established metrics, which identify central nodes based on their brokerage power, the number and weight of their connections, and the ability to quickly reach all other nodes, we introduce five new measures of Distinctiveness Centrality. These new metrics attribute a higher score to nodes keeping a connection with the network periphery. They penalize links to highly-connected nodes and serve the identification of social actors with more distinctive network ties. We discuss some possible applications and properties of these newly introduced metrics, such as their upper and lower bounds. Distinctiveness centrality provides a viewpoint of centrality alternative to that of established metrics., Competing Interests: The authors have declared that no competing interests exist.

We conduct laboratory experiments to study peer effects on compliance with extortive requests. To this aim, we use an "extortion game" with multiple victims. In agreement with our hypothesis, our results show that when the information on peers' behavior is available, compliance with appropriative requests is triggered by conformism among victims rather than by punishment. Moreover, we find that extorted sums are rather small, requests are proportional to the victim's earnings, similar across victims, and are significantly lower when the extorter self-selects into this role. Punishment is rare, but effective. Finally, our results indicate that fairness concerns matter even in a context of extra-legal taxation, shaping both extorters' requests and victims' compliance., Competing Interests: The authors have declared that no competing interests exist.

TV series represent a growing sector of the entertainment industry. Being able to predict their performance allows a broadcasting network to better focus the high investment needed for their preparation. In this paper, we consider a well known TV series-The Big Bang Theory-to identify factors leading to its success. The factors considered are mostly related to the script, such as the characteristics of dialogues (e.g., length, language complexity, sentiment), while the performance is measured by the reviews submitted by viewers (namely the number of reviews as a measure of popularity and the viewers' ratings as a measure of appreciation). Through correlation and regression analysis, two sets of predictors are identified respectively for appreciation and popularity. In particular the episode number, the percentage of male viewers, the language complexity and text length emerge as the best predictors for popularity, while again the percentage of male viewers and the language complexity plus the number of we-words and the concentration of dialogues are the best choice for appreciation., Competing Interests: The authors have declared that no competing interests exist.

Chronic pain patients enter treatment with different problem profiles making careful assessment a necessity for more individualized treatment plans. In this cross-sectional study we assigned 320 patients entering tertiary multidisciplinary pain treatment into four categories based on whether they scored low or high on the activity and the affective pain interference dimensions of the Brief Pain Inventory (BPI). To determine whether this categorization system delineates issues that should be assessed further, the categories were compared with ANOVA and MANOVA analyses on three domains: variables affecting physical well-being (body mass index, exercise, substance use), psychological resources (mood), and pain-specific psychological factors (pain anxiety, pain acceptance). The results indicated that subjects who scored low on both interference dimensions compared similarly in weight: mean Body Mass Index (BMI) 27.0 (SD 6.0) kg/m2, and exercise: mean of 2.4 (SD 1.7) exercising sessions over 20 minutes per week, to the general population, had no depressive symptoms on average: mean Beck Depression Index II (BDI-II) score 11.7 (SD 7.5), and had the most favorable psychological reactions to pain relative to the other categories: mean total Pain Anxiety Symptoms Scale-20 (PASS-20) score 36.4 (SD 17.9). In contrast, when interference was high on activity, more physical well-being problems were evident e.g. weight: mean BMI 31.0 (SD 7.3) kg/m2, diminished exercise: mean of 1.5 (SD 1.6) exercising sessions per week, and avoidance behavior: mean PASS-20 Escape/Avoidance subscale 3.7 (95% CI: 1.7 to 5.8) scores higher in comparison to activity interference remaining low. With high affective interference, more depressive symptoms: mean BDI-II score 17.7 (SD 7.3), and more cognitive pain anxiety: mean PASS-20 Cognitive Anxiety subscale 2.8 (95% CI 0.7 to 4.8) scores higher in comparison to affective interference remaining low, emerged. Having high interference on both dimensions indicated accumulated risks for reduced physical well-being: mean BMI 29.9 (SD 6.1) kg/m2, mean of 1.2 (SD 1.7) exercising sessions per week, mood problems: mean BDI-II 20.3 (SD 10.6), and negative psychological reactions to pain: mean total PASS-20 score 53.2 (18.4). The results suggest that low interference on both dimensions may allow assessment with only physician consultations, while high interference on either dimension may call attention to distinct issues to be addressed with the help of a physiotherapist or a psychologist, whereas high interference on both dimensions highlights the need for a full multidisciplinary assessment., Competing Interests: Authors T. Miettinen, H. Kautiainen, P. Mäntyselkä and S.J. Linton have no conflicts of interest to declare. E. Kalso reports personal fees from advisory board membership for Pierre Fabre and Orion Pharma, outside of the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Rising hostility between members of opposing political factions has gained considerable attention in both academic and popular press. The adverse effects of this phenomenon are widely recognized, but its psychological antecedents remain the focus of ongoing debate in political psychology. Past research has honed in on two conflicting explanations: one highlights the extent to which people self-define as supporters of particular parties or candidates (the identity view), and another points toward the intensity with which they disagree on substantive matters of policy (the issues view). A nationally representative survey of 1051 eligible Spanish voters yielded support for both explanations. The perceived magnitude and nature of disagreement were associated with increased partisan prejudice, while controlling for partisan identification. Path analyses revealed that issue-based prejudice was more pronounced among ideologically extreme agents (β = 0.237, 95% CI [0.174, 0.300]) than toward extreme targets (β = 0.140, 95% CI [0.078, 0.201]), and replicated recent findings that identity-based prejudice is motivated primarily by non-instrumental factors (β = 0.286, 95% CI [0.230, 0.337]). Together, these results indicate that discrimination across party lines responds to two fundamentally distinct, though at times co-occurring, imperatives: to coalesce in ideologically homogeneous communities, and to protect one's sense of partisan identity., Competing Interests: The authors have declared that no competing interests exist.

Background: Maternal mortality rates are still unacceptably high in many countries, indicating violation of women´s human right to life and health. Access to adequate information about maternal health rights and available services are essential aspects of realizing women´s right to accessible health care. This study aimed at assessing awareness of the right to access maternal health services among women who had recently given birth, and the association between such awareness and the utilization of maternal health services in two districts in Tanzania., Methods: This study was cross sectional in design. Interviews were conducted with women who gave birth within one year prior to the survey in two different district councils (DC) namely Hai DC and Morogoro DC, selected purposively based on the earlier reported rates of maternal mortality. We used a two-stage cluster sampling to select the study sample. Analysis employed Chi-square test and Logistic regression., Results: A total of 547 respondents were interviewed. Only a third (34.4%) reported to be aware of their right to access maternal health services. Main sources of information on maternal health rights were the media and health care providers. Occupation and education level showed a statistically significant association with awareness of access rights. Hai DC had higher proportion of women aware of their access rights compared to Morogoro DC. Women who were aware of their right of access were almost 5 times more likely to use skilled birth attendants compared to those who were not (AOR 4.61 95% CI: 2.14-8.57)., Conclusion and Recommendations: Awareness of the right to access maternal health services was low in the studied population. To increase awareness and hence uptake of Pregnancy care and skilled birth attendants at delivery we recommend the government and partners to prioritize provision of information, communication and education on women´s human rights, including the right to access maternal health services, especially to women in rural areas., Competing Interests: The authors have declared that no competing interests exist.

There are few acknowledged multidisciplinary quality standards for research practice and evaluation. This study evaluates the face validity of a recently developed comprehensive quality model that includes 32 defined concepts based on four main areas (credible, contributory, communicable, and conforming) describing indicators of research practice quality. Responses from 42 senior researchers working within 18 different departments at three major universities showed that the research quality model was-overall-valid. The vast majority believed all concepts in the model to be important, and did not indicate the need for further development. However, some of the sub-concepts were indicated as being slightly less important. Further, there were significant differences concerning 'communicable' between disciplines and academic levels, and for 'conforming' between genders. Our study indicates that the research quality model proposes the opportunity to move to a more systematic and multidisciplinary approach to research quality improvement, which has implications for how scientific knowledge is obtained., Competing Interests: The authors have declared that no competing interests exist.

The ability of an individual to participate in courtroom proceedings is assessed by clinicians using legal 'fitness to plead' criteria. Findings of 'unfitness' are so rare that there is considerable professional unease concerning the utility of the current subjective assessment process. As a result, mentally disordered defendants may be subjected unfairly to criminal trials. The Law Commission in England and Wales has proposed legal reform, as well as the utilisation of a defined psychiatric instrument to assist in fitness to plead assessments. Similar legal reforms are occurring in other jurisdictions. Our objective was to produce and validate a standardised assessment instrument of fitness to plead employing a filmed vignette of criminal proceedings. The instrument was developed in consultation with legal and clinical professionals, and was refined using standard item reduction methods in two initial rounds of testing (n = 212). The factorial structure, test-retest reliability and convergent validity of the resultant instrument were assessed in a further round (n = 160). As a result of this iterative process a 25-item scale was produced, with an underlying two-factor structure representing the foundational and decision-making abilities underpinning fitness to plead. The sub-scales demonstrate good internal consistency (factor 1: 0·76; factor 2: 0·65) and test-retest stability (0·7) as well as excellent convergent validity with scores of intelligence, executive function and mentalising abilities (p≤0·01 in all domains). Overall the standardised Fitness to Plead Assessment instrument has good psychometric properties. It has the potential to ensure that the significant numbers of mentally ill and cognitively impaired individuals who face trial are objectively assessed, and the courtroom process critically informed.

This paper examines the bank lending channel, which considers how monetary authority actions affect the variation of loans. We focus on the BRICS (Brazil, Russia, India, China and South Africa) totalizing 1254 banks from five countries in the period 2000-2012 (totalizing 13 years). The empirical results show that the effect of money supply growth on the growth of loans is non-linear and inverted U-shaped. In this context, our results show empirical evidence expansionary monetary policies do not increase the propensity of economic agents to systematically take greater risks on the market. After a certain level of money stock, increases in the money supply do not lead to increased negotiated credit., Competing Interests: The authors have declared that no competing interests exist.

The abundance of the eastern Taiwan Strait (ETS) population of the Chinese white dolphin (Sousa chinensis) has been estimated to be less than 100 individuals. It is categorized as critically endangered in the IUCN Red List of Threatened Species. Thus, immediate measures of conservation should be taken to protect it from extinction. Currently, the Taiwanese government plans to designate its habitat as a Major Wildlife Habitat (MWH), a type of marine protected area (MPA) for conservation of wildlife species. Although the designation allows continuing the current exploitation, however, it may cause conflicts among multiple stakeholders with competing interests. The study is to explore the attitude and opinions among the stakeholders in order to better manage the MPA. This study employs a semi-structured interview and a questionnaire survey of local fishers. Results from interviews indicated that the subsistence of fishers remains a major problem. It was found that stakeholders have different perceptions of the fishers' attitude towards conservation and also thought that the fishery-related law enforcement could be difficult. Quantitative survey showed that fishers are generally positive towards the conservation of the Chinese white dolphin but are less willing to participate in the planning process. Most fishers considered temporary fishing closure as feasible for conservation. The results of this study provide recommendations for future efforts towards the goal of better conservation for this endangered species.

As shown by the recent crisis, tax evasion poses a significant problem for countries such as Greece, Spain and Italy. While these societies certainly possess weaker fiscal institutions as compared to other EU members, might broader cultural differences between northern and southern Europe also help to explain citizens' (un)willingness to pay their taxes? To address this question, we conduct laboratory experiments in the UK and Italy, two countries which straddle this North-South divide. Our design allows us to examine citizens' willingness to contribute to public goods via taxes while holding institutions constant. We report a surprising result: when faced with identical tax institutions, redistribution rules and audit probabilities, Italian participants are significantly more likely to comply than Britons. Overall, our findings cast doubt upon "culturalist" arguments that would attribute cross-country differences in tax compliance to the lack of morality amongst southern European taxpayers.

The research focuses on the cooperative relationship and the strategy tendency among three mutually interactive parties in financing: small enterprises, commercial banks and micro-credit companies. Complex network theory and time series analysis were applied to figure out the quantitative evidence. Moreover, this paper built up a fundamental model describing the particular interaction among them through evolutionary game. Combining the results of data analysis and current situation, it is justifiable to put forward reasonable legislative recommendations for regulations on lending activities among small enterprises, commercial banks and micro-credit companies. The approach in this research provides a framework for constructing mathematical models and applying econometrics and evolutionary game in the issue of corporation financing.

We report results from an incentivized laboratory experiment undertaken with the purpose of providing controlled evidence on the causal effects of alcohol consumption on risk-taking, time preferences and altruism. Our design disentangles the pharmacological effects of alcohol intoxication from those mediated by expectations, as we compare the behavior of three groups of subjects: those who participated in an experiment with no reference to alcohol, those who were exposed to the possibility of consuming alcohol but were given a placebo and those who effectively consumed alcohol. All subjects participated in a series of economic tasks administered in the same sequence across treatments. After controlling for both the willingness to pay for an object and the potential misperception of probabilities as elicited in the experiment, we detect no effect of alcohol in depleting subjects' risk tolerance. However, we find that alcohol intoxication increases impatience and makes subjects less altruistic.

Objectives: The aim of this study was to investigate possible predictors of irrational parenthood cognitions among infertile women seeking treatment., Methods: In a cross-sectional study, 300 women who visited an Infertility Center in Iran during 2010 were studied. A pre-validated inventory was used to assess irrational parenthood cognitions. Potential predictors of the total irrational parenthood cognitions score were assessed., Results: Mean irrational parenthood cognition score was 39.7(Range 0-56). Through bivariate analysis, the score on irrational parenthood cognition was inversely correlated with age and positively correlated with length of time seeking for infertility treatment and length of time expecting pregnancy. In a multivariate model, infertile women with higher education, especially academic education, or those with higher economic status were less likely to have irrational parenthood cognitions. However, higher motherhood motivation, no previous experience of pregnancy and being under social pressure, from others around, increased the likelihood of having irrational parenthood cognitions., Conclusions: Some variables such as female spouse's educational level and being under social pressure can independently predict irrational parenthood cognitions among infertile women that may be of use in designing health promotion plans in order to target the vulnerable women.

Background: Greater access to evidence-based psychological treatments is needed. This review aimed to evaluate whether internet-delivered psychological treatments for mood and anxiety disorders are efficacious, noninferior to established treatments, safe, and cost-effective for children, adolescents and adults., Methods: We searched the literature for studies published until March 2013. Randomized controlled trials (RCTs) were considered for the assessment of short-term efficacy and safety and were pooled in meta-analyses. Other designs were also considered for long-term effect and cost-effectiveness. Comparisons against established treatments were evaluated for noninferiority. Two reviewers independently assessed the relevant studies for risk of bias. The quality of the evidence was graded using an international grading system., Results: A total of 52 relevant RCTs were identified whereof 12 were excluded due to high risk of bias. Five cost-effectiveness studies were identified and three were excluded due to high risk of bias. The included trials mainly evaluated internet-delivered cognitive behavioral therapy (I-CBT) against a waiting list in adult volunteers and 88% were conducted in Sweden or Australia. One trial involved children. For adults, the quality of evidence was graded as moderate for the short-term efficacy of I-CBT vs. waiting list for mild/moderate depression (d = 0.83; 95% CI 0.59, 1.07) and social phobia (d = 0.85; 95% CI 0.66, 1.05), and moderate for no efficacy of internet-delivered attention bias modification vs. sham treatment for social phobia (d =  -0.04; 95% CI -0.24, 0.35). The quality of evidence was graded as low/very low for other disorders, interventions, children/adolescents, noninferiority, adverse events, and cost-effectiveness., Conclusions: I-CBT is a viable treatment option for adults with depression and some anxiety disorders who request this treatment modality. Important questions remain before broad implementation can be supported. Future research would benefit from prioritizing adapting treatments to children/adolescents and using noninferiority designs with established forms of treatment.

Science and engineering research has becoming an increasingly international phenomenon. Traditional bibliometric studies have not captured the evolution of collaborative partnerships between countries, particularly in emerging technologies such as stem cell science, in which an immense amount of investment has been made in the past decade. Analyzing over 2,800 articles from the top journals that include stem cell research in their publications, this study demonstrates the globalization of stem cell science. From 2000 to 2010, international collaborations increased from 20.9% to 36% of all stem cell publications analyzed. The United States remains the most prolific and the most dominant country in the field in terms of publications in high impact journals. But Asian countries, particularly China are steadily gaining ground. Exhibiting the largest relative growth, the percent of Chinese-authored stem cell papers grew more than ten-fold, while the percent of Chinese-authored international papers increased over seven times from 2000 to 2010. And while the percent of total stem cell publications exhibited modest growth for European countries, the percent of international publications increased more substantially, particularly in the United Kingdom. Overall, the data indicated that traditional networks of collaboration extant in 2000 still predominate in stem cell science. Although more nations are becoming involved in international collaborations and undertaking stem cell research, many of these efforts, with the exception of those in certain Asian countries, have yet to translate into publications in high impact journals.

Background to the Debate: The human rights responsibilities of drug companies have been considered for years by nongovernmental organizations, but were most sharply defined in a report by the UN Special Rapporteur on the right to health, submitted to the United Nations General Assembly in August 2008. The "Human Rights Guidelines for Pharmaceutical Companies in relation to Access to Medicines" include responsibilities for transparency, management, monitoring and accountability, pricing, and ethical marketing, and against lobbying for more protection in intellectual property laws, applying for patents for trivial modifications of existing medicines, inappropriate drug promotion, and excessive pricing. Two years after the release of the Guidelines, the PLoS Medicine Debate asks whether drug companies are living up to their human rights responsibilities. Sofia Gruskin and Zyde Raad from the Harvard School of Public Health say more assessment is needed of such responsibilities; Geralyn Ritter, Vice President of Global Public Policy and Corporate Responsibility at Merck & Co. argues that multiple stakeholders could do more to help States deliver the right to health; and Paul Hunt and Rajat Khosla introduce Mr. Hunt's work as the UN Special Rapporteur on the right to the highest attainable standard of health, regarding the human rights responsibilities of pharmaceutical companies and access to medicines.