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Objectives Advance Care Planning (ACP) is a process by which people communicate their healthcare preferences and values, planning for a time when they are unable to voice them. Within Residential Aged Care Facilities (RACF) both the completion and the clarity of ACP documents is variable and, internationally, medical treatment orders have been used to address these issues. In this study, Goals of Patient Care (GOPC) medical treatment orders were introduced alongside usual ACP in three RACF to improve healthcare decision-making for residents. This study explored the experiences of RACF healthcare-providers with ACP and GOPC medical treatment orders. Methods The study was of Explanatory Descriptive design. Within three RACF where the GOPC medical treatment orders had been introduced, focus groups and interviews with healthcare-providers were performed. The transcribed interviews were analysed thematically. Results Healthcare-providers reported support for ACP and GOPC but also discussed many problematic issues. Analysis of the data identified four main themes: Enablers, Barriers, Resident autonomy and Advance documentation (ACP and GOPC). Conclusion Healthcare-providers identified ACP and GOPC as positive tools for assisting with medical decision-making for residents. Although barriers exist in completion and activation of plans, healthcare-providers described them as progressing resident-centred care. Willingness to follow ACP instructions was reported to be reduced by lack of trust by clinicians. Families were also reported to change their views from those documented in family-completed ACP, attributed to poor understanding of their purpose. Participants reported that GOPC led to clearer documentation of residents' medical treatment-plans than relying on ACP documents alone. This article is protected by copyright. All rights reserved.

AIMS: We profile the lack of specific regulation for direct-to-patient postal supply (DTP) of clinical trial medications (investigational medicinal products, IMPs) calling for increased efficiency of patient-centred multi-country remote clinical trials. METHODS: Questionnaires emailed to 28 European Economic Area (EEA) Medical Product Licensing Authorities (MPLAs) and Swissmedic MPLA were analysed in 2019/2020. The questionnaire asked whether DTP of IMPs was legal, followed by comparative legal analysis profiling relevant national civil and criminal liability provisions in 30 European jurisdictions (including The Netherlands), finally summarising accessible COVID-19-related guidance in searches of 30 official MPLA websites in January 2021. RESULTS: Twenty MPLAs responded. Twelve consented to response publication in 2021. DTP was not widely authorised, though different phrases were used to explain this. Our legal review of national laws in 29 EEA jurisdictions and Switzerland did not identify any specific sanctions for DTP of IMPs; however, we identified potential national civil and criminal liability provisions. Switzerland provides legal clarity where DTP of IMPs is conditionally legal. MPLA webpage searches for COVID-19 guidance noted conditional acceptance by 19 MPLAs. CONCLUSIONS: Specific national legislation authorising DTP of IMPs, defining IMP categories, and conditions permitting the postage and delivery by courier in an EEA-wide clinical trial, would support innovative patient-centred research for multi-country remote clinical trials. Despite it appearing more acceptable to do this between EU Member States, provided each EU MPLA and ethics board authorises it, temporary Covid-19 restrictions in national Good Clinical Practice (GCP) guidance discourages innovative research into the safety and effectiveness of clinical trial medications.

Background:In the care of people with intellectual disability, support staff apply restrictions to people with moderate intellectual disabilities (ID) in several domains of daily life, such as restrictions on bedtimes or on the amount of food intake. Support staff may experience moral dilemmas applying these restrictions. In this respect, moral case deliberation (MCD) is used as an instrument for support staff to jointly reflect on dilemmas in care and is considered a form of ethical support. MCD also seems to broaden the perspective of their participants.Specific Aims:This study examined to what extent MCD led to changes in support staff's perspectives with regard to daily life restrictions placed upon people with moderate ID. Consequently, this study examined to what extent support staff's perspectives on these restrictions were broadened as a result of their participation in the study.Method:Prior to and following a series of three MCD sessions on moral dilemmas commonly encountered in daily life care, interviews were held with 12 support staff across two teams. Participants were asked what they considered to be good care in the given dilemmas. To systematically compare all of the answers given in the interviews prior to and following the MCDs, the same interview-guide was used in both instances. Interviews were analyzed inductively.Findings:Following the MCD sessions, the respondents tended to hold onto their perspective to restrict clients to provide them with structure, clarity and rest, as expressed prior to the MCD. However, some respondents adapted their perspective on restrictions and were willing to provide people with moderate ID more freedom after the MCD.Discussion:This study contributed to the evidence underlying MCD in healthcare and in providing insights into MCD with regard to daily life restrictions in the care of people with moderate ID. Partly, MCD leads to a broadening of perspective on restrictions applied in the daily life of people with moderate ID.

Background A theoretical foundation in caring science is invaluable for nursing care because it enriches practice by providing explanations, clarity and direction. However, after graduation, students experience the frustration of not being able to sufficiently intertwine caring science theories in practice. Consequently, the integration of caring science theories in nursing education and practice is considered an essential focus area to reduce this theory-practice gap. Aim This study aims to elucidate master alumni's experiences of appropriation and application of caring science after completing a master's education. Methods The data were collected by semi-structured interviews with 21 alumni from Finland, Sweden and Norway who had recently completed a master's degree with caring science as the major subject. A thematic analysis was used. Findings The analysis resulted in two main themes, both with three subthemes. Educator's bearing and a learning community are important for students' appropriation of caring science theories. Learning through reflection and the response of others evoke new paths of thought, and practice-related teaching promotes the intertwining and application of caring science theory in practice. The appropriated theory has significance to alumni by providing a guiding basis that strengthens alumni's professional bearing and way of being. The caring science theory guides alumni in providing nursing care with an increased ethical awareness and questioning approach that enables good patient care. Their professional identity and confidence in caring are also strengthened. Conclusion Educators' bearing is of outermost importance for appropriation and application of caring science theory. It has a key function in facilitating students' understanding and intertwining of caring science theory and practice. Appropriated caring science theory provides authority and courage to practice nursing care. The appropriated theory promotes alumni's ethical awareness, confidence and a sense of pride in the profession.

In this article, we provide definitional clarity for the construct of social withdrawal as it was originally construed, and review the original theoretical and conceptual bases that led to the first research program dedicated to the developmental study of social withdrawal (the Waterloo Longitudinal Project). We also describe correlates (e.g., social and social-cognitive incompetence), precursors (e.g., dispositional characteristics, parenting, insecure attachment), and consequences (e.g., peer rejection and victimization, negative self-regard, anxiety) of social withdrawal, and discuss how the study of this type of withdrawal led to a novel intervention that targets risk factors that predict social withdrawal and its negative consequences.

The problem of low attainment in mathematics has been an increasingly prominent feature of the policy discourse in England over the last 60 years; however, evidence from comparative studies indicates that little progress has been made in finding a solution. In this paper, we analyse the changing policy discourse of low attainment in mathematics through the main reports and speeches published in England, beginning with the Newsom Report, Half Our Future, in 1963, and continuing to the present day. We chart the evolving perspectives on the nature of ability, expectations, curriculum ideology and frame of reference through the changing language used in these documents, noting tensions and inconsistencies which arise through continuing lack of clarity about definitions and assumptions.

Background Chronic pruritus (CP), itch lasting more than 6 weeks, is common in community-dwelling older adults. Understanding their illness perception allows the attending physician to develop a personalised care plan to mitigate CP. Aim This study explores the illness perception of CP among older Asian adults in an urban community. Design Qualitative research was conducted, framed by the Common-Sense Model of self-regulation (CSM). Through in-depth interviews (IDIs), qualitative data were gathered from Asian patients with CP, and then a thematic analysis was carried out. The emergent themes were grouped according to the five domains of CSM: 'identity', 'cause', 'time', 'controllability' and 'consequence'. Setting and patients IDIs were conducted in a Singapore public primary care clinic before the data were saturated. Results The CSM domains illustrate the illness perception of CP. CP was identified as a 'problem' rather than a disease and was often described in metaphor. Patients' perception of the cause was diverse due to the lack of provision of a clear explanation by their physicians. They opined that CP continued indefinitely. Without definite time to resolution, patients adapted their help- and health-seeking behaviours to control it. The consequences included therapeutic experimentation, alternative therapy, self-isolation, avoidance behaviours, emotional disturbance and dermatological complications. Conclusion and patient contribution Patients provided information on their perception of CP, which aligned with the CSM. A multipronged approach is needed to deliver holistic and personalised care to patients with CP, providing clarity on its natural progression, to set their expectations on its timeline, treatment effectiveness and undertake appropriate behaviour modification to adapt to its chronicity.

The diverse nature of complex drug products poses challenges for the development of regulatory guidelines for generic versions. While complexity is not new in medicines, the technical capacity to measure and analyze data has increased. This requires a determination of which measurements and studies are relevant to demonstrate therapeutic equivalence. This paper describes the views of the NBCD Working Group and provides pragmatic solutions for approving complex generics by making best use of existing U.S. Food and Drug Administration's abbreviated approval pathways 505(j) and 505(b)(2). We argue that decisions on the appropriateness of submitting a 505(j) or 505(b)(2) application can build on the FDA's complex drug product classification as well as the FDA's much applauded guidance document for determining whether to submit an ANDA or a 505(b)(2) application. We hope that this paper contributes to the discussions to increase the clarity of regulatory approaches for complex generics, as well as the predictability for complex generic drug developers, to facilitate access to much‐needed complex generics and to promote the sustainability of the healthcare system., This paper describes the views of the NBCD Working Group and provides pragmatic solutions for approving complex generics by making best use of existing U.S. FDA's abbreviated approval pathways of 505(j) and 505(b)(2). We argue that decisions on the appropriateness of submitting a 505(j) or 505(b)(2) application can build on the FDA's complex drug product classification as well as the FDA's much applauded guidance document for determining whether to submit an ANDA or a 505(b)(2) application.

Aim Children living in families impacted by parental mental illness are at increased risk of adverse mental and physical health outcomes compared with children living in families unaffected by mental illness. Considered to be a hard-to reach group, it is likely that there are unique barriers for these young people in seeking help for their difficulties. This systematized review synthesizes what is currently known about help-seeking barriers, facilitators and interventions for young people affected by parental mental illness. Methods Three databases were searched, yielding 2556 results and three studies were identified through other sources. Studies were screened on title and abstract review and were excluded if they were published before 2005 or if they did not include the perspectives of young people. At a second stage, full-text articles were screened based on the inclusion criteria. Eleven studies were included for data extraction and quality appraisal. Results Qualitative and quantitative data synthesis revealed three significant barriers (i) stigma, (ii) family communication and (iii) lack of belonging and shared experience, three key facilitators (i) individual characteristics, (ii) group identification and (iii) anonymity and three primary components of therapeutic interventions (i) psychoeducation, (ii) connection with peers and (iii) accessibility. Conclusions It was found that stigma towards mental illness is highly salient amongst young people impacted by parental mental illness and has unique effects on their patterns of help-seeking. Help-seeking research amongst this group is still emerging, with a need for greater clarity in operationalisation of help-seeking constructs and more robust methodological designs.

Sonography researchers are often confronted with questions concerning the relationship between measurements acquired in clinical practice. This educational commentary provides clarity on the definition of the terms correlation and agreement. We discuss the statistical tests used to assess correlation and outline some common pitfalls authors fall into when reporting these. We provide examples of the inaccurate use of these tests in the sonography literature and recommend better alternatives for assessing agreement. This review will benefit authors embarking on studies comparing measurements and reviewers considering manuscripts to ensure the methodology used is sufficient to justify the claims. The authors also provide plots created in the R statistical software package, and the supplementary data file supplied can be used and adapted for those wishing to perform similar statistical tests.

Industrial Relations scholars have argued that labor‐management partnerships influence union leaders' communication patterns within organizations. To date, however, these arguments have lacked theoretical clarity, as well as strong empirical support. We address this gap by developing and testing hypotheses that concern how the emergence of labor‐management partnerships shape union leaders' communication patterns within and between worksites (Study 1), as well as how these communications patterns associate with frontline workers' attitudes about their jobs and their union leader (Study 2). We test our hypotheses using multi‐source, multi‐year data from the context of U.S. public schools.

Researchers have been interested in discussing negative workplace gossip and its consequences, but have paid little attention to positive workplace gossip and its positive aspects in the workplace. Based on the perspective of social network, this study explores the two-path mediating mechanisms between positive workplace gossip and the socialization outcomes of newcomers. The data were collected in a multitime and multisource manner. The results show that information ties and friendship ties mediated the relationship between positive workplace gossip and the socialization outcomes of newcomers. Specifically, positive workplace gossip helped newcomers form instrumental and expressive social relationships (viz., informational ties and friendship ties), which in turn contributed to socialization outcomes (viz., role clarity and social integration). Theoretical and management implications are discussed as well.

AIMS To systematically evaluate the content and quality of national and international clinical guidelines on pelvic organ prolapse (POP). METHODS We searched medical databases and organizations websites, to identify national and international guidelines on diagnosis and management of POP. Five authors independently assessed guidelines using the validated AGREE II tool. Its six domains include (1) scope and purpose, (2) stakeholder involvement, (3) rigor of development, (4) clarity of presentation, (5) applicability, and (6) editorial independence. RESULTS Eight guidelines met the inclusion criteria. Three hundred and thirteen different recommendations were identified. One hundred and ninety-nine recommendations were comparable across guidelines. Thirty-one recommendations were not supported by research evidence. Assessment by history and physical examination using the POP quantification system and consideration of imaging were recommendations featuring in all guidelines. Conservative treatment recommendations namely pelvic floor muscle training and vaginal pessaries were also found in all guidelines. Regarding surgical management, patient counseling, treating only symptomatic POP, consideration of apical fixation during surgical treatment, and use of biological or synthetic implants in recurrent cases were recommendations in all guidelines. Overall, the highest median scores were in the domains "scope and purpose" and "rigor of development". The lowest median score was for applicability (28.3%). Although the median score of "editorial independence" was high (85.4%), variability was also substantial (interquartile range: 12.5-100). CONCLUSION We identified variations in quality and deficiencies in certain areas, especially "applicability" and "editorial independence." Improvements in these key domains may enhance the quality and clinical impact of clinical practice guidelines.

The evolution of autism diagnosis, from its discovery to its current delineation using standardized instruments, has been paralleled by a steady increase in its prevalence and heterogeneity. In clinical settings, the diagnosis of autism is now too vague to specify the type of support required by the concerned individuals. In research, the inclusion of individuals categorically defined by over-inclusive, polythetic criteria in autism cohorts results in a population whose heterogeneity runs contrary to the advancement of scientific progress. Investigating individuals sharing only a trivial resemblance produces a large-scale type-2 error (not finding differences between autistic and dominant population) rather than detecting mechanistic differences to explain their phenotypic divergences. The dimensional approach of autism proposed to cure the disease of its categorical diagnosis is plagued by the arbitrariness of the dimensions under study. Here, we argue that an emphasis on the reliability rather than specificity of diagnostic criteria and the misuse of diagnostic instruments, which ignore the recognition of a prototype, leads to confound autism with the entire range of neurodevelopmental conditions and personality variants. We propose centering research on cohorts in which individuals are selected based on their expert judged prototypicality to advance the theoretical and practical pervasive issues pertaining to autism diagnostic thresholds. Reversing the current research strategy by giving more weight to specificity than reliability should increase our ability to discover the mechanisms of autism. LAY SUMMARY: Scientific research into the causes of autism and its mechanisms is carried out on large cohorts of people who are less and less different from the general population. This historical trend may explain the poor harvest of results obtained. Services and intervention are provided according to a diagnosis that now encompasses extremely different individuals. Last, we accept as a biological reality the constant increase over the years in the proportion of autistic people among the general population. These drifts are made possible by the attribution of a diagnosis of autism to people who meet vague criteria, rather than to people who experienced clinicians recognize as autistic. We propose to change our research strategy by focusing on the study of the latter, fewer in number, but more representative of the "prototype" of autism. To do this, it is necessary to clearly distinguish the population on which the research is carried out from that to which we provide support. People must receive services according to their needs, and not according to the clarity of their diagnosis.

Online educational videos have the potential to enhance undergraduate biology learning, for example by showcasing contemporary scientific research and providing content coverage. Here, we describe the integration of nine videos into a large‐enrollment (n = 356) introductory evolution and ecology course via weekly homework assignments. We predicted that videos that feature research stories from contemporary scientists could reinforce topics introduced in lecture and provide students with novel insights into the nature of scientific research. Using qualitative analysis of open‐ended written feedback from the students on each video assigned throughout the term (n = 133–229 responses per video) and on end‐of‐quarter evaluations (n = 243), we identified common categories of student perspectives. All videos received more positive than negative comments and all videos received comments indicating that students found them intellectually and emotionally stimulating, accessible, and relevant to course content. Additionally, all videos also received comments indicating some students found them intellectually unstimulating, though these comments were generally far less numerous than positive comments. Students responded positively to videos that incorporated at least one of the following: documentary‐style filming, very clear links to course content (especially hands‐on activities completed by the students), relevance to recent world events, clarity on difficult topics, and/or charismatic narrators or species. We discuss opportunities and challenges for the use of online educational videos in teaching ecology and evolution, and we provide guidelines instructors can use to integrate them into their courses., In this case study, we sought to evaluate student perceptions of freely available educational videos and how such videos may contribute to student learning goals. We report the use of nine online videos for teaching concepts and competencies in evolution and ecology in a large‐enrollment introductory biology course. We share the results of our case study and provide guidance for the use of online videos in teaching evolution and ecology in higher education.

This paper examines the intellectual contributions of Professor W. M. (‘Max’) Corden to Economics. We focus on three main fields: trade theory and practice, especially his pioneering work on the theory of effective protection; open economy macroeconomics, including exchange rate policy, the international monetary system, Dutch Disease and economic crises; and Australian economic policy. We emphasise Max's motivation for working on these topics, as he sought to understand real‐world economic issues and challenges and to employ economic theory and expositional clarity in search of policy reform. We also draw attention to his personal life history, and how it has shaped his thinking on major economic and political questions.

Geriatricians have long debated the parameters, positioning, and prospects of their specialty. The year 2020 started full of promise as many organizations anticipated assessing themselves using perfect, or 2020, vision. While challenging on several levels, the momentous combination of events in 2020-the COVID-19 pandemic, Racial Justice Movement, and the November elections-provided Geriatric Medicine several opportunities to firmly secure a position in the mainstream. As we reflect on the new perspectives, programs, and partnerships initiated in 2020, five broader lessons emerge that can help safeguard the future of Geriatrics: the field could employ more intentional "direct to consumer" marketing strategies, expand the scope of what it means to be a patient advocate, pursue new strategic partnerships, take the opportunity to address racial injustice, and leverage existing skillsets to expand scope of care for patients. Given the interdisciplinary nature of Geriatrics, it is fitting that many of these lessons build upon this collaborative philosophy and are derived from domains outside of health care. So in an unexpected way, the events of 2020 may actually help Geriatrics see, with 2020 vision, how to remain mainstream. With this new clarity, Geriatrics holds renewed promise to truly become specialists in whole-person care and it is our hope that, with insight from the lessons shared here, the specialty brings this vision to fruition in the current decade and beyond.

Public sector managers are increasingly subject to management controls. In this study, we determine how management controls in public sector organizations influence managers’ well-being at work. Based on central beliefs and concepts in the management control literature and self-determination theory, we develop, test, and confirm a theoretical model predicting that positive effects of management controls on public managers’ well-being are explained by increased role clarity and negative effects by increased control burden, which in turn affects managers’ self-determination. The model was tested through web survey responses from 1,029 managers from ten Swedish local government organizations. Our research contributes to the literature on well-being effects of management controls by specifying how positive and negative effects on managers’ well-being occur.

Decades of environmental DNA (eDNA) method application, spanning a wide variety of taxa and habitats, has advanced our understanding of eDNA and underlined its value as a tool for conservation practitioners. The general consensus is that eDNA methods are more accurate and cost‐effective than traditional survey methods. However, they are formally approved for just a few species globally (e.g., Bighead Carp, Silver Carp, Great Crested Newt). We conducted a meta‐analysis of studies that directly compare eDNA with traditional surveys to evaluate the assertion that eDNA methods are consistently “better.”Environmental DNA publications for multiple species or single macro‐organism detection were identified using the Web of Science, by searching “eDNA” and “environmental DNA” across papers published between 1970 and 2020. The methods used, focal taxa, habitats surveyed, and quantitative and categorical results were collated and analyzed to determine whether and under what circumstances eDNA outperforms traditional surveys.Results show that eDNA methods are cheaper, more sensitive, and detect more species than traditional methods. This is, however, taxa‐dependent, with amphibians having the highest potential for detection by eDNA survey. Perhaps most strikingly, of the 535 papers reviewed just 49 quantified the probability of detection for both eDNA and traditional survey methods and studies were three times more likely to give qualitative statements of performance. Synthesis and applications: The results of this meta‐analysis demonstrate that where there is a direct comparison, eDNA surveys of macro‐organisms are more accurate and efficient than traditional surveys. This conclusion, however, is based on just a fraction of available eDNA papers as most do not offer this granularity. We recommend that conclusions are substantiated with comparable and quantitative data. Where a direct comparison has not been made, we caution against the use of qualitative statements about relative performance. This consistency and rigor will simplify how the eDNA research community tracks methods‐based advances and will also provide greater clarity for conservation practitioners. To this end suggest reporting standards for eDNA studies., A meta‐analysis shows that environmental DNA outperforms traditional methods for biodiversity monitoring, both in terms of cost and efficiency.

Based on ethnographic research with cadastral land surveyors and revenue bureaucrats in Gurgaon, North India, this article examines how the desire to etch out and impose digitized private property titles on India's urban frontier is mediated by the shifting socio‐materiality of bureaucratic work. The article argues that bureaucratic uncertainty structures the commodification of rural land in Gurgaon, and explores how digital technologies, designed to produce clarity, are being wielded by powerful groups to flexibly settle property claims. The bureaucratic office and cadastral survey are sites where competing actors 'work' land's intrinsic pliability, mobilize conflicting documentation, manipulate bureaucratic materials and navigate unmapped property claims in pursuit of territorial claims. In this context, much heralded digital property governance systems, the article argues, are not about producing clarity but rather capturing the conditions of uncertainty. Exploring the practices of surveyors and bureaucrats as they encounter land's shifting materiality and work with its multiple, conflicting representations, reveals the ways in which digitized property systems remain materially bound and always socially mediated, contested and secured.

We present a review of methods for procedurally generating the morphology of virtual creatures. We include a range of methods, with the main groups being from ALife over art to video games. Even though at times these groups overlap, for clarity we have kept this distinction. By including the word virtual, we mean that we focus on methods for simulation in silico, and not physical robots. We also include a historical perspective, with information on methods such as cellular automata, L-systems and a focus on earlier pioneers in the field

There is a persistent misconception that risk analysis is only suited for considering the immediate consequences of an event. Such a limitation would make risk analysis unsuitable for many challenges, including resilience, sustainability, and adaptation. Fortunately, there is no such limitation. However, this notion has stemmed from a lack of clarity regarding how time is considered in risk analysis and risk characterization. In this article, we discuss this issue and show that risk science provides concepts and frameworks that can appropriately address time. Ultimately, we propose an adjusted nomenclature for explicitly reflecting time in risk conceptualization and characterizations.

BackgroundTissue clearing technologies have enabled remarkable advancements for in situ characterization of tissues and exploration of the three-dimensional (3D) relationships between cells, however, these studies have predominantly been performed in non-human tissues and correlative assessment with clinical imaging has yet to be explored. We sought to evaluate the feasibility of tissue clearing technologies for3Dimaging of intact human prostate and the mapping of structurally and molecularly preserved pathology data with multi-parametric volumetric MR imaging (mpMRI).MethodsWhole-mount prostates were processed with either hydrogel-based CLARITY or solvent-based iDISCO. The samples were stained with a nuclear dye or fluorescently labeled with antibodies against androgen receptor, alpha-methylacyl coenzyme-A racemase, or p63, and then imaged with 3D confocal microscopy. The apparent diffusion coefficientand Ktrans maps were computed from preoperative mpMRI.ResultsQuantitative analysis of cleared normal and tumor prostate tissue volumes displayed differences in 3D tissue architecture, marker-specific cell staining, and cell densities that were significantly correlated with mpMRI measurements in this initial, pilot cohort.Conclusions3D imaging of human prostate volumes following tissue clearing is a feasible technique for quantitative radiology-pathology correlation analysis with mpMRI and provides an opportunity to explore functional relationships between cellular structures and cross-sectional clinical imaging.

Purpose/objectives The purpose of this study was to define and develop a set of Entrustable Professional Activities (EPAs) for dental education using a modified Delphi consensus approach. EPAs define the core tasks that a graduating dentist needs to perform independently in practice. The EPA framework facilitates assessment of competencies as they manifest in the tasks and independence needed to be ready for practice. Methods Feedback was obtained from participants about a list of EPAs, with modifications made after each of the 3 rounds, using a modified Delphi approach. Phase 1 included attendees at the ADEA Fall 2017 meeting (n = 35) who participated in an EPA workshop primarily composed of academic deans. The Phase 2 "reactor panel" consisted of 10 dental schools' academic deans and other individuals with expertise and interest in dental curriculum and assessment (n = 31). Phase 3 participants were attendees at the ADEA CCI 2019 meeting (n = 91) who also participated in a 2-day EPA workshop. Results In phase 1, overall ratings for acceptability of the EPAs were satisfactory. In phase 2, the next iteration of EPAs was judged as satisfactory for inclusion in curriculum, match well with clinical practice and clarity. In phase 3, the EPAs were judged as satisfactory for being an "entrustable, essential, and important task of the profession." Qualitative feedback suggested wording, measurability, and specific focus of EPA statements is important. Conclusions A preliminary set of EPAs was designed for predoctoral dental education through a systematic, careful consensus building approach involving a diverse set of participants.

Sustainability has emerged as an important industrial strategic outlook expanding beyond organizational boundaries to include the supply chain. Simultaneously, the industry has also been faced with supply chain resilience concerns. Research on the intersection of supply chain sustainability and resilience is nascent and is a consequence of their observed mutual influences. However, confusion about concepts, implementation methods, and measurements of sustainable and resilient supply chains remains. This study completes a systematic literature review that critically examines several major observations and directions. We find the concept of sustainable supply chains is more established, and general agreement on its theoretical foundations exists. Supply chain resilience is relatively less mature. The nexus and relationships between the two topics are often incoherent: there is confusion on sustainable and resilient supply chains establishment; there is no clarity on what practices could jointly advance both areas. A major conflict exists since sustainability generally focuses on efficiency, while resilience seeks effectiveness. We recommend studies to analyze implementation relationships and impact. We also observe that performance measurement systems should be developed to assess supply chain sustainability and resilience performance taking with explicit consideration time horizons considered in these measures.

Clinical practice guidelines often provide 'consensus-based recommendations' for issues where there is a lack of evidence to support an evidence-based recommendation, and 'practice points' to assist clinicians in various aspects of everyday clinical care. However, Australian clinical practice guidelines often fail to define these terms clearly, and there is significant inconsistency in how they are used. This lack of clarity presents an impediment to the effective practice of evidence-based medicine and an opportunity for reform in Australian clinical guideline development.

Issue addressed Alcohol-influenced drowning among young Australians (aged 18-24 years) is a prominent health concern. However, effectiveness of targeted prevention campaigns for this age group is unknown, as this information is not typically published in peer-reviewed or easily accessed grey literature. Accordingly, future campaigns cannot build on prior efforts to address this health problem. Methods Semi-structured interviews ascertained young Australian adults' perspectives on preventing alcohol consumption in aquatic settings, and their awareness of appropriate safety strategies and Australian national and state drowning prevention campaigns. Discussions were transcribed verbatim and thematically analysed using an interpretative phenomenological approach. Results Twenty-three individuals (mean age 20.65 years) participated in an interview. Participants had poor understanding of alcohol-focused drowning prevention campaigns and used logos and names to decipher key campaign messages. Education was recommended as the preferred method for prevention, and participants suggested preferences for delivery (eg social media, in schools, humour and shock tactics). The safety strategies discussed appeared to be transferred from strategies used in other contexts, rather than related to the specific risks of aquatic scenarios. Conclusions Drowning prevention practitioners should ensure transparency and clarity of their campaign names and logos to enhance understanding of the messages. Practitioners should also consider using audience analysis during campaign design, delivery and evaluation, alongside best practice recommendations from literature, to enhance campaign suitability and effectiveness. SO WHAT?: Water safety practitioners and policy makers should acknowledge these findings when developing campaigns which address young adults' lack of awareness of safe aquatic behaviours to encourage a sustained behaviour change.

Carey and Shugart's important personal vote seeking model has long dominated literature on electoral rules and district representation. Empirical support for the model is somewhat mixed, however. We think one reason may be that its applicability depends on the type of district-focused representation. We present an alternative “clarity model,” drawing from Lancaster, that may work better for one specific type of district-targeted representation—pork provision. The clarity model posits district magnitude should be linked to less pork regardless of ballot type because it limits clarity of responsibility for pork outcomes. Legislators not directly responsible for goods and services allocated to the district can still claim credit for them in high magnitude districts. We test this theory with elite survey data on legislators' priorities toward pork provision in 14 Latin American and 10 Western Europe democracies and find empirical support for a clarity theory of pork priorities.

It has recently been argued that a unidimensional approach to mood disorders, focusing predominantly on emotions is too narrow to capture the full spectrum of symptoms of affective disorders, and that additional symptom domains of activity and cognition are at least equally important - possibly even more so1 . This 'ACE' (Activity, Cognition and Emotion) model provides more clarity in conceptualising mixed states, the existence of which challenges the predominantly dichotomous view promulgated by DSM and ICD, in which mania and depression are deemed to be mutually exclusive and form two poles of mood disorders with little in between. However, in reality, there are symptoms that occur in both depression and mania, and to better understand mixed mood states it has been proposed that these 'overlapping' symptoms form the essence of mixed states, and therefore they should be central to their definition. Furthermore, within these, overlapping symptoms of distractibility, irritability and psychomotor agitation2 are possibly the most important for better defining mixed states and advancing our understanding. Thus, in this brief article we endeavour to further refine our focus, specifically narrowing in on irritability, and argue that perhaps 'it' in particular holds the key to defining these complex presentations and unlocking their secrets.

Individualized funding schemes are designed to offer people with disability greater choice and control over the services they receive. In this research, we report on a survey of over 700 families to explore how Australia's National Disability Insurance Scheme (NDIS) supported children and young people and their families to learn remotely during COVID‐19. NDIS funding to support education during the first COVID‐19 lockdown period forms an important case study of the flexibility of individualized funding schemes. Our results suggest that participant experiences varied widely, with some people able to make the changes they required and others left with a significant service gap. This shows that individual funding schemes are not necessarily more flexible than traditional systems in an emergency situation—useful flexibility depends on many factors, such as clarity of information giving, all actors having a shared message, proactive support of flexibility initiatives, and participants' ability to quickly navigate a complicated system. This research also highlights problems with the interface between the NDIS and mainstream services such as education.

Scientific presentations, usually given with slide presentation software such as PowerPoint™, are the most common method for disseminating knowledge to students and peers. Unfortunately, many are boring, text-heavy, and bullet point-riddled data dumps, with animations or cartoons that obscure or distract rather than clarify the message. These presentations, which we have all sat through and/or delivered, are often so dull that they are referred to as "death by PowerPoint™." In this paper, the authors intend to impart basic techniques for organizing and communicating information in the most effective, engaging, and actionable ways possible. We focus on three processes: generating ideas and outlining a talk, creating visually appealing uncluttered slides, and delivering an inspiring, practice-changing presentation. We also discuss considerations for a virtual presentation. We believe that even experienced speakers could benefit from reflecting on these recommendations and editing their slide presentations for clarity and simplicity.

Aims To investigate how job demands and resources interact with each other to predict intention to leave among assistant nurses and Registered Nurses. Design Longitudinal study. Methods Questionnaire data were collected yearly during three years (October 2012–December 2014) from Registered Nurses (RN) and assistant nurses (N = 840) employed in Swedish hospitals. Associations and interaction effects of demands and resources were assessed with correlation analyses and regression models. Results Job demands predicted assistant nurses' intentions to leave, while resources predicted RNs' intention to leave. For RNs, several resources were functional in moderating the associations between demands and intention to leave: social support, vertical trust, and humanity moderated work pace and workflow moderated emotional demands. For assistant nurses, organizational clarity and interprofessional collaboration moderated emotional demands. None of the resources had a moderating effect on the associations between quantitative demands or illegitimate tasks and intention to leave.

Surgery for adult obstructive sleep apnoea (OSA) plays a key role in contemporary management paradigms, most frequently as either a second‐line treatment or in a facilitatory capacity. This committee, comprising two sleep surgeons and three sleep physicians, was established to give clarity to that role and expand upon its appropriate use in Australasia. This position statement has been reviewed and approved by the Australasian Sleep Association (ASA) Clinical Committee.

The contributions of Murray Sidman to the field of behavior analysis have helped to put the field on a progressive path. In this paper we describe three areas as examples, drawn from the larger set of his notable contributions: the analysis of stimulus equivalence in a way that has fostered a behavior-analytic approach to derived stimulus relations and symbolic meaning; the observation and measurement of individual behavior through time; and his stance against punitive applied methods. In each of these areas Sidman was a dedicated behaviorist, avoiding appeals to mentalistic or transcendental forces, opposing hypothetical mediational accounts, and taking a functional and contextual approach. Clarity of assumptions was at the heart of Sidman's effective scientific practices and there is no reason to think that those same assumptions will not carry us further, as evidence mounts in support of these views on psychological research and practice.

Candidaemia is associated with high mortality. In the last few years, several guidelines have been published on the management of Candida bloodstream infection. However, adherence to the practice guidelines has been suboptimal. In order to facilitate and objectively measure the adherence to good practice recommendations, a scoring criterion was published by the European Confederation of Medical Mycology (ECMM). The ECMM Quality (EQUAL) of Clinical Candidaemia Management is an audit tool that comprises of 10 quality indicators. Each quality indicator is allotted between 1 and 3 points. The maximum achievable score is 22 or 19 in patients with or without a central venous catheter, respectively. This paper reviews each of the 10 quality indicators and provides the context for improving quality within the individual domains. The review also suggests areas that are in need of further clarity or areas which merit attention in the future updates of the EQUAL scoring system so that clinicians are able to derive maximum benefit from the audit tool. The EQUAL scoring tool is an important milestone in the quality improvement aspect of the management of candidaemia and contributes to the various components of clinical governance in the management of Candida infection of the bloodstream.

Introduction In the development of terminology of the lower urinary tract (LUT), due to its increasing complexity, the terminology for male LUT surgery needs to be updated using a male-specific approach and via a clinically-based consensus report. Methods This report combines the input of members of the Standardization Committee of the International Continence Society in a Working Group with recognized experts in the field, assisted by many external referees. Appropriate core clinical categories and a subclassification were developed to give a numeric coding to each definition. An extensive process of 14 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Results A Terminology Report for male LUT and pelvic floor surgery, encompassing 149 separate definitions/descriptors, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in male LUT surgery. Figures have not been included to avoid any preference or bias towards a specific procedure. Conclusions A consensus-based Terminology Report for male LUT surgery has been produced aimed at being a significant aid to clinical practice and a stimulus for research.

Background: Although the importance of developing health care trainees and trainers’ cultural competence is widely acknowledged, limited information is available on what elements of cultural competence should be taught. A lack of theoretical clarity and consensus over what constitutes the competence attributes is a key hurdle in faculty development (FD). This results in patchy cultural education across health schools globally. Based on a literature review, we propose a new framework that may inform clinical cultural education and the development of clinical educators in this area. Methods: A critical interpretive synthesis was carried out on articles extracted from Medline, CINAHL and Web of Science. Sixty-nine articles were included for analysis, through which we engaged with the reconceptualisation of cultural competence in order to provide theoretical clarity and pedagogical guidance for FD in clinical cultural education. Results: The synthesis illustrates that an ecological system is required to achieve comprehensive cultural competence development. We therefore composed a discursive multi-level framework to highlight the needs of achieving cultural competence at the individual, team, organisational and systemic levels. Affective, cognitive and behavioural domains are to be achieved at the individual level. Leadership skills training is a key component in achieving higher level competences. Successful FD needs to cover these developmental areas. Discussion: This review offers a multi-level approach to developing cultural competence, which can be useful for clinical educators to improve their clinical practice and education in diverse cultural contexts. More research is needed to evaluate the effectiveness of the proposed framework and the methods.

Creative Leadership is a tripartite leadership model that has been developed and pioneered by Rama Gheerawo, Director of The Helen Hamlyn Centre for Design (HHCD) at London’s Royal College of Art (RCA). It evolved over the last decade through observation and experience of the limitations of hierarchical models of leadership across a diverse range of sectors. During this, the three Creative Leadership attributes of Empathy (EMP), Clarity (CLA), and Creativity (CRE), have been explored through a range of primary and secondary research methods. The next stage of research and development involves a multidisciplinary convergence of design thinking with neuroscience that relates to brain plasticity, neural connectivity, and emotional intelligence theory. The aim is to develop a comprehensive grid of key performance indicators of Creative Leadership. Dr Melanie Flory, neuroscience project partner, explains that the three attributes are learnable, and correlate positively with wellbeing-sustaining values and behaviours in individuals and groups. When the cognitive, emotional and behavioural aspects of these traits are identified and understood, a three-dimensional complementary feedback loop of Learn – Retain – Apply can ensue through experiential learning and development. This positioning paper presents the evolution, scope and applications of Creative Leadership alongside a discussion on the emerging opportunities for novel design-neuroscience intersection relating to personal, leadership and organisational development, growth and transformation. It also reflects on the pandemic context of 2020.

Pericytes are vascular mural cells that surround capillaries of the central nervous system (CNS). They are crucial for brain development and contribute to CNS homeostasis by regulating blood–brain barrier function and cerebral blood flow. It has been suggested that pericytes are lost in Alzheimer's disease (AD), implicating this cell type in disease pathology. Here, we have employed state‐of‐the‐art stereological morphometry techniques as well as tissue clearing and two‐photon imaging to assess the distribution of pericytes in two independent cohorts of AD (n = 16 and 13) and non‐demented controls (n = 16 and 4). Stereological quantification revealed increased capillary density with a normal pericyte population in the frontal cortex of AD brains, a region with early amyloid β deposition. Two‐photon analysis of cleared frontal cortex tissue confirmed the preservation of pericytes in AD cases. These results suggest that pericyte demise is not a general hallmark of AD pathology.

This chapter presents several ways to hone connections between ideas through the use of references. The proximity of the in‐text citation to a given phrase within a sentence indicates the closeness of the relationship between the citation and the topic. This chapter discusses a diverse set of ways to synthesize literature. String citations are groups of citations that demonstrate how widespread a field, application, method, or other topic is. These citations occur most commonly at the beginning of a literature review. Topic citations sometimes operate as string citations to also show the breadth of the research. End‐of‐sentence citations tell the reader that the reference is simply evidence of the content of the prior sentence. In the accordion stage of revision, each sentence will be revised for clarity and conciseness, with the goal of condensing fluffy sentences with neighboring sentences.

Legal and clinical complexities surrounding consent to medical treatment for trans and gender diverse (TGD) youth in Australia continue to develop. New Australian Standards of Care and Treatment Guidelines have also introduced substantial clinical developments. Significant changes to legal principles from court decisions require doctors and health authorities, youth and parents, and legal advisors, to make and administer treatment decisions in compliance with the new legal requirements. Recent developments in the law relating to consent for medical treatment of TGD youth are clarified, with focus on the 2017 case Re: Kelvin and its implications for clinical practice. This article presents a new medico-legal analysis of clinical practice for treating TGD youth, mapping Australian clinical guidelines and legal principles against three stages of clinical treatment. Clinical scenarios are used to demonstrate situations where the legal framework no longer presents a barrier to clinical practice, as well as those where ambiguity remains. The aim of this paper is to ensure that clinicians working with TGD youth understand what the law currently requires in term of consent, with reference to the stages of treatment, and where the law fails to provide clear guidance for patients, parents and health professionals. Residual uncertainty in the applicable legal principles requires legislative or judicial resolution and policy clarity.

Objective The annual systematic search of the peer-reviewed and gray literature relevant to global emergency medicine (EM) was conducted by the Global Emergency Medicine Literature Review (GEMLR) to screen, evaluate, and review the most rigorously conducted and relevant research in global EM published in 2019. Methods After a broad search of PubMed and websites of organizations publishing relevant gray literature, all articles that were deemed relevant to the fields of disaster and humanitarian response, emergency care in resource-limited settings, and EM development by at least one reviewer, an editor, and the managing editors were then scored by two different reviewers using a 20-point scoring template relevant to either original research (OR) or review (RE) articles. This scoring system rates articles on their clarity, research design, ethics, importance to global EM, and breadth of impact. Articles that then scored in the top 5% were then critiqued in depth. Results A total of 23,321 article titles and abstracts were screened by 22 reviewers with a wide swath of clinical and research experience in global EM. From these, a total of 356 articles underwent full-text review and scoring on the 20-point scale; 26% were categorized as disaster and humanitarian response, 58% as emergency care in resource-limited settings, and 15% as EM development. Of these 356 articles, 276 (77.5%) were OR articles and 80 (22.5%) were RE articles. The 16 articles that scored in the top 5% (>17.5 of 20 points) received full in-depth narrative summaries. Conclusions In 2019, the overall number of studies relevant to global EM that were identified by our search decreased from the prior year, but more high-scoring articles related to the development of EM clinical practice and as a specialty in resource-constrained settings were identified.