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Purpose To investigate the clinical utility of transperineal template-guided saturation prostate biopsy (TPB) for risk stratification after transrectal ultrasound (TRUS)-guided biopsy. Materials and methods We retrospectively reviewed 155 patients who underwent TPB after previously negative results on TRUS-guided biopsy (n=58) or who were candidates for active surveillance (n=97) fulfilling the PRIAS criteria between May 2017 and November 2018. The patients' clinicopathologic data were reviewed, and the detection of clinically significant cancer (CSC) and upgrading of Gleason grade were identified. Results The patients' median age and pre-TPB prostate-specific antigen (PSA) value were 65.0 years and 5.74 ng/mL, respectively. A median of 36 biopsy cores was obtained in each patient, with a median TPB core density of 0.88 cores/cm3. Of the 58 males with a previous negative result on TRUS-guided biopsy, prostate cancer (PCa) was detected in 17 males (29.3%), including 8 with CSC. Of the 97 patient candidates for active surveillance, upgrading of the Gleason grade was identified in 31 males (32.0%), 20 with a Gleason grade of 7 (3+4), 6 with a Gleason grade of 7 (4+3), and 5 with a Gleason grade of 8 (4+4). The overall complication rate was 14.8% (23/155), and there were no Clavien-Dindo grade 3 to 5 complications. Conclusions TPB helps to stratify the risk of PCa that was previously missed or underdiagnosed by TRUS-guided biopsy. TPB might be used as a diagnostic tool to determine risk classification and to help counsel patients with regard to treatment decisions.

Older people increasingly want to remain living independently in their own homes. The aim of the ENABLE project is to develop a wearable device that can be used to support older people in their daily lives and which can monitor their health status, detect potential problems, provide activity reminders and offer communication and alarm services. In order to determine the specifications and functionality required for the development of the device, user surveys and focus groups were undertaken, use case analysis and scenario modeling carried out. The project has resulted in the development of a wrist-worn device and mobile phone combination that can support and assist older and vulnerable wearers with a range of activities and services both inside their home and as they move around their local environment. The device is currently undergoing pilot trials in five European countries. The aim of this paper is to describe the ENABLE device, its features and services, and the infrastructure within which it operates. © 2011 by Walter de Gruyter · Berlin · Boston.

Two experiments examined Ward, Avons and Melling’s (2005) proposition that the serial position function is task, rather than modality, dependent. Specifically, they proposed that for backward testing the 2-alternative forced choice (2AFC) recognition paradigm is characterised by single-item recency irrespective of the modality of the stimulus presentation. In Experiment 1 the same nonwords sequences, presented both visually or auditorially, produced qualitatively equivalent serial position functions with 2AFC testing. Forward testing produced a flat serial position function, whilst backward testing produced two-item recency in the absence of primacy. In order to rule out the possibility that the serial position functions for visual stimuli were the product of sub-vocal rehearsal, Experiment 2 employed articulatory suppression during the presentation phase. Serial position function equivalence was again observed together with a modest impairment in overall recognition rates. Taken together, these data are consistent with the Ward et al. proposition and further support the existence of a visual memory that can facilitate storage of visual-verbal material e.g. Logie, Della Sella, Wynn, and Baddeley (2000). However, the observation of two-item recency contradicts the original Duplex account of single-item recency traditionally observed for backwards recognition testing of visual stimuli (Phillips and Christie, 1977).

Two experiments examined item recognition memory for sequentially presented odours. Following a sequence of six odours participants were immediately presented with a series of two-alternative forced-choice (2AFC) test odours. The test pairs were presented in either the same order as learning or the reverse order of learning. Method of testing was either blocked (Experiment 1) or mixed (Experiment 2). Both experiments demonstrated extended recency, with an absence of primacy, for the reverse testing procedure. In contrast, the forward testing procedure revealed a null effect of serial position. The finding of extended recency is inconsistent with the single-item recency predicted by the two-component duplex theory (Phillips & Christie, 1977). We offer an alternative account of the data in which recognition accuracy is better accommodated by the cumulative number of items presented between item learning and item test.

We introduce a method for automatically rating the difficulty of puzzle game levels. Our method takes multiple aspects of the levels of these games, such as level size, and combines these into a difficulty function. It can simply be adapted to most puzzle games, and we test it on three different ones: Flow, Lazors and Move. We conducted a user study to discover how difficult players find the levels of a set and use this data to train the difficulty function to match the user-provided ratings. Our experiments show that the difficulty function is capable of rating levels with an average error of approximately one point in Lazors and Move, and less than half a point in Flow, on a difficulty scale of 1-10.

Objective Doctors’ confidence in their actions is important for clinical performance. While static confidence has been widely studied, no study has examined how confidence changes dynamically during clinical tasks. Method The confidence of novice (n = 10) and experienced (n = 10) trainee anaesthetists was measured during two simulated anaesthetic crises, bradycardia (easy task) and failure to ventilate (difficult task). Results As expected, confidence was high in the novice and experienced groups in the easy task. What was surprising, however, was that confidence during the difficult task decreased for both groups, despite appropriate performance. Conclusions Given that confidence affects performance, it is alarming that doctors who may be acting unsupervised should lose dynamic confidence so quickly. Training is needed to ensure that confidence does not decrease inappropriately during a correctly performed procedure. Whether time on task interacts with incorrect performance to produce further deficits in confidence should now be investigated.

Research has shown that individuals' knowledge structures change as a result of learning and experience. This article investigates the possibility that the content of graphical user interfaces can play a role in determining the nature of the knowledge structures users develop. Users employed either concrete, abstract, or arbitrary icon sets in a computer-based problem-solving task. The effects of these icons were assessed using standard measures of performance. On the basis of the assumption that users' mental models should be better if appropriate icons were presented on the interface, Pathfinder analysis was used to elicit users' knowledge structures as they gained experience with the interface. The efficacy of this measure was then compared with performance measures. Our findings show that users' knowledge structures do depend on the nature of the graphical information presented at the interface but do not rely as much on the use of the visual metaphor as previously thought. Although most measures were sensitive to initial differences between icon sets, only some measures were sensitive to the long-term differences that remained after users had gained experience with the icon set. The implications of these findings for interface design are discussed.

Writing your first paper for a peer-reviewed journal can be scary. You are putting your research, its findings and interpretations out to a wider and knowledgeable audience who may criticise any aspect of it. However, once you have made the mental step that you really want your work to be\ud out in the open, and you are about to draft your paper, then you need to decide to which journal you like to submit.\ud \ud This short paper raises some of the issues novice authors would need to consider. We also outline the process of submitting a paper to an academic journal based on the collective experiences of the three authors. All of us have all published widely, acted as reviewers or referees for many different academic journals and are members of editorial boards.

Social and cultural changes in Nepal, including better communication facilities and transport, more urbanization and a rising age at which people marry, have created more opportunities for young people for “dating.” Our qualitative study explores whether the existence of dating cultures influences young people’s sexual behavior in Nepal. Focus group discussions with a total of 75 participants and 31 in-depth individual interviews were conducted among young people in Nepal. Most urban and rural young people liked the dating culture. Although it is a new kind of culture in Nepalese society, it is gaining popularity. The mass media were regarded as encouraging and creating an environment for dating. Most participants believed that dating culture encourages premarital and extramarital sexual behavior. The authors underpin their findings by linking it to the “emerging adulthood” framework. In terms of public health, they recommend that dating practice should be discussed in formal and informal education to promote safer sex.

The proposition that chewing gum can improve alertness was investigated via both physiological and self-rated measures. The Pupillographic Sleepiness Test (PST) provided a measure of pupillary unrest (PUI); a physiological index of daytime sleepiness. Chewing gum reduced the extent of sleepiness as measured by both PUI and self-rated sleepiness. Specifically, in comparison with sham chewing and no chewing controls, the chewing gum condition significantly limited the increase in pupillary unrest following the 11-minute PST within a darkened laboratory: a finding indicating moderation of the daytime sleepiness increase for the chewing gum condition. In addition, there was some evidence that chewing gum (relative to the no-chewing condition only) moderated the increase in a self-rated measure of sleepiness (Stanford Sleepiness Scale). However, there was no evidence that chewing gum moderated the decrease in self-rated alertness (Bond-Lader Visual Analogue Mood Scale). Although the precise mechanism underpinning the effect of chewing gum is unclear, the reduction in daytime sleepiness may be underpinned via heightened cerebral activity following the chewing of gum or the arousing effects of mint flavour.

Employing intrinsically motivated individuals has been proposed as a means of improving public sector performance. In this article, we investigate whether intrinsic motivation affects the sorting of employees between the private and the public sectors, paying particular attention to whether extrinsic rewards crowd out intrinsic motivation. Using British longitudinal data, we find that individuals are attracted to the public sector by the intrinsic rather than the extrinsic rewards that the sector offers. We also find evidence supporting the intrinsic motivation crowding out hypothesis, in that, higher extrinsic rewards reduce the propensity of intrinsically motivated individuals to accept public sector employment. This is, however, only true for two segments of the UK public sector: the higher education sector and the National Health Service (NHS). Whilst our findings inform the literature on Public Service Motivation (PSM), they also pose the question whether lower extrinsic rewards could increase the average quality of job matches in the public sector, thus improving performance without the need for high-powered incentives.

Background Fatigue is one of the most commonly reported and debilitating symptoms of multiple sclerosis (MS); approximately two-thirds of people with MS consider it to be one of their three most troubling symptoms. It may limit or prevent participation in everyday activities, work, leisure, and social pursuits, reduce psychological well-being and is one of the key precipitants of early retirement. Energy effectiveness approaches have been shown to be effective in reducing MS-fatigue, increasing self-efficacy and improving quality of life. Cognitive behavioural approaches have been found to be effective for managing fatigue in other conditions, such as chronic fatigue syndrome, and more recently, in MS. The aim of this pragmatic trial is to evaluate the clinical and cost-effectiveness of a recently developed group-based fatigue management intervention (that blends cognitive behavioural and energy effectiveness approaches) compared with current local practice. Methods/Design This is a multi-centre parallel arm block-randomised controlled trial (RCT) of a six session group-based fatigue management intervention, delivered by health professionals, compared with current local practice. 180 consenting adults with a confirmed diagnosis of MS and significant fatigue levels, recruited via secondary/primary care or newsletters/websites, will be randomised to receive the fatigue management intervention or current local practice. An economic evaluation will be undertaken alongside the trial. Primary outcomes are fatigue severity, self-efficacy and disease-specific quality of life. Secondary outcomes include fatigue impact, general quality of life, mood, activity patterns, and cost-effectiveness. Outcomes in those receiving the fatigue management intervention will be measured 1 week prior to, and 1, 4, and 12 months after the intervention (and at equivalent times in those receiving current local practice). A qualitative component will examine what aspects of the fatigue management intervention participants found helpful/unhelpful and barriers to change. Discussion This trial is the fourth stage of a research programme that has followed the Medical Research Council guidance for developing and evaluating complex interventions. What makes the intervention unique is that it blends cognitive behavioural and energy effectiveness approaches. A potential strength of the intervention is that it could be integrated into existing service delivery models as it has been designed to be delivered by staff already working with people with MS. Service users will be involved throughout this research. Trial registration Current Controlled Trials ISRCTN76517470

For adults of any age the diagnosis of a visual impairment can be traumatic, and timely referral to informal peer support and/or professional counselling may be both beneficial and appropriate. It is estimated that 45/113 (40%) of UK voluntary organisations for people with sight loss provide professional counselling (n=17) or ‘informal support’ (n=28), such as peer support groups, telephone helplines and befriending.1 However, what is the evidence that these services help people adjust emotionally to their acquired vision loss and the consequences that flow from this? \ud \ud During the spring/summer of 2008, we conducted a follow-up to the scoping survey reported earlier1 to assess the evidence for effectiveness of professional counselling services for people with acquired sight loss. We contacted the 17 counselling services previously identified by Rees1 and further services via Vision 2020 UK, … \ud

Aim: To review the evidence for the presence of lower levels of psychosocial well-being in working age adults with visual impairment, and for interventions to improve such levels of psychosocial well-being. \ud \ud Methods: Systematic review of quantitative studies\ud published in English from 2001 to July 2008 that\ud measured depression/mental health, anxiety, quality of\ud life, social functioning or social support.\ud \ud Results: Included were 29 studies that measured one or\ud more outcomes (N¼52). Working-age adults with visual\ud impairment were significantly more likely to report lower\ud levels of mental health (mean difference¼14.51/100),\ud social functioning (MD¼11.55/100) and quality of life.\ud Studies regarding the prevalence of depressive\ud symptoms produced inconsistent results but had\ud methodological limitations.\ud \ud Conclusions: Future research is required into the prevalence of loneliness, anxiety, and depression in adults with visual impairment, and to evaluate the effectiveness of interventions for improving psychosocial well-being such as counselling, peer support, and employment programmes. \ud

Selective serotonin reuptake inhibitors have proven efficacy in the treatment of panic disorder, obsessive–compulsive disorder, post-traumatic stress disorder and social anxiety disorder. Accumulating data shows that selective serotonin reuptake inhibitor treatment can also be efficacious in patients with generalized anxiety disorder. This review summarizes the findings of randomized controlled trials of selective serotonin reuptake inhibitor treatment for generalized anxiety disorder, examines the strengths and weaknesses of other therapeutic approaches and considers potential new treatments for patients with this chronic and disabling anxiety disorder.

This article presents the usability and acceptability of a website that provides older people with tailored advice to help motivate them to undertake physical activities that prevent falls. Views on the website from interviews with 16 older people and 26 sheltered housing wardens were analysed thematically. The website was well received with only one usability difficulty with the action plan calendar. The older people selected balance training activities out of interest or enjoyment, and appeared to carefully add them into their current routine. The wardens were motivated to promote the website to their residents, particularly those who owned a computer, had balance problems, or were physically active. However, the participants noted that currently a minority of older people use the Internet. Also, some older people underestimated how much activity was enough to improve balance, and others perceived themselves as too old for the activities.

Until recently the guiding tenet in human-computer interaction was that any interface must be easy to learn and use. However, it has been increasingly recognized that the appeal of the interface to the user and their enjoyment of it is also important. The aim of the current study was to examine the nature of the relationships between icon characteristics, user performance, and aesthetic appeal. When participants were asked to rate the appeal of a corpus of icons, it was found that the same icon characteristics predicted appeal as those predicting user performance. The theoretical and practical implications of the remarkable similarity in the factors determining appeal and usability are discussed.

In Latin American (LA) and the major developed countries’ (MDC) suicide and undetermined deaths are analyzed as methods of suicide and the number of undetermined deaths are similar, possibly containing hidden suicides. The goal was to test the likelihood that LA cultural attitudes lead to higher undetermined rates and more hidden suicides. We used 3-year WHO average mortality data to compare LA and MDC mortality by age and gender, and χ² tests to examine any differences. In 13 LA countries younger-aged (15–34) men and women’s suicides were higher than all-age rates, and undetermined deaths exceeded the suicide rates. Nine LA countries had significantly more undetermined younger-aged male deaths than females. Sixteen of 18 LA countries had significantly higher undetermined death rates than the MDC. LA younger-aged malefs24 146s differential suicide: Undetermined rates indicated they may contain substantial numbers of hidden suicides. Inadvertently, cultural attitudes to suicide may hinder prevention.

Background The care of drug-using pregnant women is a growing health and social care concern in many countries. A specialist clinic was established offering multidisciplinary care and advice to pregnant drug users in and around Aberdeen (UK) in 1997. The majority of women stabilise and reduce their drug use. By determining the needs and views of the women more appropriate services and prevention strategies may be developed. There has been little research conducted in this area and none in Scotland. Methods This is a qualitative study that aimed to gain an understanding of the experiences of women drug users, seeking and receiving prenatal care and drug services from a specialist clinic. Twelve women participated in semi-structured one-to-one interviews. Results The women preferred the multidisciplinary clinic (one-stop shop) to traditional prenatal care centred within General Practice. The relationships of the clients to the range of Clinic professionals and in hospital were explored as well as attitudes to Clinic care. The study participants attributed success in reducing their drug use to the combination of different aspects of care of the multi-agency clinic, especially the high level prenatal support. It is this arrangement of all aspects of care together that seem to produce better outcomes for mother and child than single care elements delivered separately. Some women reported that their pregnancy encouraged them to rapidly detoxify due to the guilt experienced. The most important aspects of the Clinic care were found to be non-judgemental attitude of staff, consistent staff, high level of support, reliable information and multi-agency integrated care. Conclusion There is an impetus for women drug users to change lifestyle during pregnancy. The study highlighted a need for women to have access to reliable information on the effects of drugs on the baby. Further research is required to determine whether positive outcomes related to clinic attendance in the prenatal period are sustained in the postnatal period. Early referral to a specialist clinic is of benefit to the women, as they reported to receive more appropriate care, especially in relation to their drug use. A greater awareness of needs of the pregnant drug user could help the design of more effective prevention strategies.

This paper provides rating norms for a set of symbols and icons selected from a wide variety of sources. These ratings enable the effects of symbol characteristics on user performance to be systematically investigated. The symbol characteristics that have been quantified are considered to be of central relevance to symbol usability research and include concreteness, complexity, meaningfulness, familiarity, and semantic distance. The interrelationships between each of these dimensions is examined and the importance of using normative ratings for experimental research is discussed.\ud \ud

BackgroundThe Internet has revolutionized the health world, enabling self-diagnosis and online support to take place irrespective of time or location. Alongside the positive aspects for an individual’s health from making use of the Internet, debate has intensified on how the increasing use of Web technology might have a negative impact on patients, caregivers, and practitioners. One such negative health-related behavior is Munchausen by Internet. ObjectiveMunchausen by Internet occurs when medically well individuals fake recognized illnesses in virtual environments, such as online support groups. This paper focuses on the aspect of Munchausen by Internet in which individuals actively seek to disrupt groups for their own satisfaction, which has not yet been associated with the wider phenomena of Internet trolls (users who post with the intention of annoying someone or disrupting an online environment). MethodsA wide-ranging review was conducted to investigate the causes and impacts of online identity deception and Munchausen by Internet drawing on academic research and case studies reported online and in the media. ResultsThe limited research relating to motivation, opportunity, detection, effects, and consequences of Munchausen by Internet is highlighted and it is formally linked to aspects of trolling. Case studies are used to illustrate the phenomenon. What is particularly worrying is the ease with which the deception can be carried out online, the difficulty in detection, and the damaging impact and potential danger to isolated victims. ConclusionsWe suggest ways to deal with Munchausen by Internet and provide advice for health group facilitators. We also propose that Munchausen by Internet and Munchausen by Internet trolling should be formally acknowledged in a revised version of the Diagnostic and Statistical Manual DSM-5. This will assist in effectively identifying and minimizing the growth of this behavior as more people seek reassurance and support about their health in the online environment. We also suggest directions for future research.