Search

Time-limited trials (TLTs) are used in the management of critical care patients undergoing potentially nonbeneficial interventions to improve prognostication and build trust and consensus between family and intensivists. When these trials are not well defined and executed, discordant views of the patient's prognosis, conflict, and continuation of nonbeneficial care can arise. The mnemonic TIME (truth about uncertainty in prognosis, interval of time, measurement of improvement, and end or extend) can help facilitate clear communication surrounding TLTs. This framework allows physicians and families to deal more effectively with the inherent uncertainty and required flexibility needed in caring for complex critical care patients. This can lead to patient-centered decision-making that improves patient-physician relationships and goal-concordant care and also potentially reduces nonbeneficial treatments at the end of life.

This paper develops a general method to execute orbital rendezvous in continuation of previous work, where a spacecraft’s orbit was represented using the angular momentum and eccentricity vectors o...

Background Understanding inequalities in breastfeeding practices may help to explain the UK’s persistently low breastfeeding rates. A recent study using the quinquennial UK Infant Feeding Surveys (IFS) found that sociodemographic inequalities in breastfeeding initiation persisted between 1985 and 2010. The present study investigates the sociodemographic inequalities in breastfeeding continuation at 6 weeks after birth among mothers who initiated and maintained breastfeeding at 1 week in 1985–2010. Methods Data were drawn from the 1985 to 2010 IFS and restricted to mothers who were breastfeeding at 1 week after birth. Time trends in the proportion of mothers in each sociodemographic group were examined. Logistic regression was used to estimate associations between breastfeeding at 6 weeks and sociodemographic factors, adjusting for confounders. Heterogeneity test was used to assess changes in these associations over time. Results Sociodemographic inequalities in breastfeeding continuation at 6 weeks persisted over the 25-year period. In most survey years, mothers were most likely to breastfeed at 6 weeks if they were 30 or older versus under 25 (OR 1.49–1.99 across survey years, I2 = 0%, heterogeneity P = 0.45); completed full-time education over age 18 compared to 18 or younger (OR 1.56-2.51, I2 = 58.7%, P = 0.03); or of Black, Asian, Mixed, or other ethnicity compared to White (OR 1.45–2.48, I2 = 44.8%, P = 0.16). Conclusions Among mothers breastfeeding at 1 week, those who were younger, White or had fewer years of full-time education were at greatest risk of discontinuing before 6 weeks. This risk persisted over time and was independent of their high risk of not initiating breastfeeding.

The current pandemic pointed toward a revision of the protection measures against infectious diseases. For any given new pathogen against which human species showed no immunity, isolation and personal protection equipment proved to reduce disease transmission. In medical settings, when there is inevitable contact with infected patients, these preventive measures have undoubtedly change the process of care delivery. The study aims to investigate the opinion of the healthcare workers about the utilization of the personal protective equipment after the pandemic stops. For this purpose, we conducted an online survey about changes related to the COVID-19 pandemic. For the healthcare workers, the survey also included several questions related to personal protective equipment. A total of 512 responders, doctors, and nurses answered to the survey. We performed comparisons between these two categories of personnel using the χ test. Overall, the results show that doctors are keener to follow the recommendations for the personal protective equipment in the future; there was a statistically significant difference (p

PURPOSE: The Kyleena® Satisfaction Study (KYSS) aimed to assess satisfaction and continuation with levonorgestrel-releasing intrauterine system (LNG-IUS) 12 (Kyleena®) in routine clinical practice and to evaluate factors that influence satisfaction. MATERIALS AND METHODS: This prospective, observational, multicentre, single-arm cohort study, with 1-year follow-up, was conducted in Belgium, Canada, Germany, Mexico, Norway, Sweden, Spain and the United States from 2017 to 2018. During routine counselling, women who independently selected to use LNG-IUS 12 were invited to participate in the study. KYSS assessed LNG-IUS 12 satisfaction, continuation and safety. RESULTS: Overall, there were 1126 successful LNG-IUS 12 placements, with insertion attempted in 1129 women. Most participants (833/968, 86.1%, 95% CI 83.7-88.2%, with satisfaction outcome data available) reported satisfaction with LNG-IUS 12 at 12 months (or at the final visit if the device was discontinued prematurely). Satisfaction was not associated with age, parity or motivation for choosing LNG-IUS 12. The majority of women (919/1129, 81.4%) chose to continue after 12 months. Discontinuation was not correlated with age or parity. Overall, 191 women (16.9%) reported a treatment-emergent adverse event. CONCLUSIONS: Results from KYSS provide the first real-world evidence assessing LNG-IUS 12, and demonstrate high satisfaction and continuation rates irrespective of age or parity. Clinical trial registration: NCT03182140. ispartof: EUROPEAN JOURNAL OF CONTRACEPTION AND REPRODUCTIVE HEALTH CARE vol:26 issue:6 pages:462-472 ispartof: location:England status: published

The present study employed a quantitative and network approach to detect alignment effects in second language (L2) continuation tasks designed on the xu-argument (Wang, 2016). The materials used in this study were 6 sub-corpora consisting of two selected input stories and two groups of L2 written production based on two continuation tasks. During continuation, the participants were required to continue in English a story with its ending removed, with one group reading and continuing the Chinese version and the other group the English version, and then switching their roles in the two tasks. Results show that the alignment effect differs across the two versions of continuation. Specifically, compared with the Chinese-version continuation, L2 learners produced more use of unigrams and bigrams similar to the input story in terms of lexical items, frequency and ranking correlations in the English-version task; on the other hand, the English-version continuation can facilitate generating linguistic networks that are much closer to the native English networks. Moreover, this research corroborates that written production in L2 continuation tasks can be influenced by input content.

I analyze project continuation decisions where firms may resolve uncertainty through news about competitors’ research and development (R&D) failures, as well as through their own results. I examine the tradeoffs and interactions between product-market competition and technological learning from parallel R&D projects. Leveraging the biopharmaceutical industry’s unique characteristics to overcome barriers to measuring project-level responses, I use a difference-in-differences strategy to evaluate how competitor exit news alters a firm’s own project discontinuation decisions. The findings reveal that technological learning dominates competition effects. Firms are most sensitive to competitor failure news from within the same market and same technology area—more than doubling their propensity to terminate drug development projects in the wake of this type of information. Finally, I explore how levels of competition, uncertainty, and opportunities to learn moderate the response to competitor failure news. This paper was accepted by Joshua Gans, business strategy.

Based on the xu-argument, this study investigated the use of translation continuation tasks in commercial translation instruction. Forty-four second-year Business English majors at a Chinese university participated in the study. They were divided into equal-sized control and experimental groups. Members of the experimental group were asked to read Chinese-English parallel texts from a user manual, while those of the control group were asked to read the Chinese text only. Subsequently, both groups were required to translate the continued Chinese text into English. The results indicated the following: 1) the experimental group’s translated text was of significantly higher quality than that of the control group; and 2) the experimental group’s translations were well-aligned with the original text in their use of terminology, sentence structure, and stylistic features. The study concludes by suggesting that translation continuation tasks can improve commercial translation instruction and hence should be further applied in practice.

Introduction: Identifying and understanding the factors on exclusive breastfeeding duration and continuation at the community level in a clinician’s setting is vital for designing interventions to improve. The objective of this study was to evaluate the factors associated with exclusive breastfeeding time and total continued breastfeeding period among mothers in the middle region of Turkey. Materials and Methods: A questionnaire form including; information about women’s and children’s socio-demographic characteristics and breastfeeding habits was used. Results: A total of 1041 mothers were included in the study. Exclusive breastfeeding time and total continued breastfeeding period were found as 5.45±1.98/month and 17.56±8.17/month, respectively. On the other hand, most of the mothers (74.9%) exclusively breastfed their children more than 6 months while only 35% of mothers continued breastfeeding over 24 months. Current study showed that types of first prelacteal feeds, maternity age (30-40 years of age), socioeconomic status, single child birth and doctor/nurse as the source of knowledge about benefits of breastfeeding were strongly associated with the exclusive breastfeeding time of ≥6 months. In addition, young mothers (20-30 years of age), primiparous, breast milk as the first prelacteal feed, lower educational level, low socioeconomic status, nuclear type of family status and doctor/nurse as the source of knowledge about benefits of breastfeeding were found to be strongly associated with total continued breastfeeding period of ≥24 months. Conclusions: Certain factors can be associated with exclusive breastfeeding duration and breastfeeding continuation. So, community-based proposals should be prepared by working on the determined factors to improve breastfeeding duration. Giriş: Bir toplumda, sadece anne sütü ile besleme süresi ve bunun devam ettirilmesine ilişkin faktörlerin belirlenmesi ve anlaşılması, anne sütü ile besleme süresini iyileştirmeye yönelik müdahalelerin planlanması açısından hayati önem taşır. Bu çalışmanın amacı, Türkiye’nin orta bölgesindeki annelerin sadece anne sütüyle besleme süresi ve toplam devam eden emzirme süresi ile ilişkili faktörleri değerlendirmektir. Gereç ve Yöntem: Çalışmaya alınan kadın ve çocukların sosyo-demografik özellikleri ve emzirme alışkanlıklarını içeren bir anket formu kullanılmıştır.Bulgular: Çalışmaya toplam 1041 anne dahil edildi. Sadece anne sütüyle besleme süresi ve toplam devam eden emzirme süresi sırasıyla 5,45±1,98 ay ve 17,56±8,17 ay olarak bulundu. Diğer taraftan, annelerin çoğu (%74,9) çocuklarını 6 aydan fazla anne sütüyle beslerken, annelerin yalnızca %35’i 24 ay boyunca emzirmeye devam etmişti. Mevcut çalışma; ilk beslenme türü, analık yaşı (30-40 yaş), sosyoekonomik durum, tek çocuk doğum ve emzirmenin faydaları hakkında bilgi kaynağı olarak doktor/hemşirenin olmasının 6 ay≤ sadece anne sütüyle beslenme süresi ile kuvvetli olarak ilişkili olduğunu göstermiştir. Ayrıca, genç anneler (20-30 yaş), primiparlar, ilk besin olarak anne sütü verilmesi, düşük eğitim düzeyi, düşük sosyoekonomik durum, çekirdek aile durumu ve emzirmenin faydaları hakkında bilgi kaynağı olarak doktor/hemşirenin olmasının 24 ay≤ toplam emzirme süresi ile güçlü bir şekilde ilişkili olduğu bulunmuştur. Sonuç: Belirli faktörler, sadece anne sütüyle besleme süresi ve emzirmenin devamı ile ilişkili olabilir. Bu nedenle emzirme süresini iyileştirmek için belirlenen faktörler üzerinde çalışılarak toplum temelli öneriler hazırlanmalıdır.

We study a continuous-time organization design problem. Each member's output is an imperfect signal of his underlying choice of effort, and each member's utility from remaining in the organization is endogenous to the output of other agents. Monetary transfers are assumed infeasible. Incentives can be provided only through two potential channels: removal due to poor performance (the stick) and rewarding good performance by allowing a "vacation" or respite (the carrot). We derive the steady-state distribution of continuation utilities of agents in the organization and show that both the stick and the carrot are used to provide incentives under an optimal design. Moreover, the optimal organization may be implemented by associating continuation utilities with a reputation system that tracks each member's performance over time.

Corresponding Author

As the scale of a disaster increases, many firefighters experience physical limitations. Physical strength and teamwork are of great importance in firefighting, and insufficient physical strength can cause a decline in teamwork during field activities through a decline in the ability to respond. This study analyzed the effect of physical fitness training on teamwork among employees who experienced CrossFit, a fitness training program, and found that the motivation to participate in firefighting CrossFit has an effect on the continuation of exercise. The factors promoting the continuation of exercise include firefighting officials. It was confirmed through hypothesis testing that CrossFit contributed to the improvement of teamwork, suggesting that improving teamwork through physical fitness is the most basic policy to strengthen firefighters’ field response capabilities. In addition, we conducted a survey of the actual condition of each firefighter’s exercise habits, exercise cycles, and preferences for the fitness improvement program and analyzed their physical fitness training to facilitate management program development and system improvement.

Purpose The objective was to assess the continuation and satisfaction of women who had copper IUDs inserted during caesarean delivery, in addition to possible factors associated with device positioning. Materials and methods A prospective, observational study was carried out involving 158 women who underwent copper IUD insertion during caesarean delivery in Fortaleza, Brazil. The women were followed up 6 weeks and 6 months after insertion of the IUD, at which time they completed a satisfaction questionnaire. We performed speculum and ultrasound examination. Results IUD continuation rates after 6 weeks and 6 months were 92% and 71.5%, respectively. Approximately 85% and 76% of the women were satisfied with the method after 6 weeks and 6 months, respectively. The rate of poor positioning on ultrasound was 5% and the rate of visible thread after 6 weeks was 29.1%, both without association with age, parity, gestational age or active labour. There were 2 cases of infection (1.3%) and no cases of perforation or pregnancy. Conclusions There was a good rate of continuation and satisfaction with the immediate post-caesarean IUD. There was no association between IUD malpositioning and age, parity, gestational age or active labour.

PurposeWhen a successful policy intervention for small firm growth is ending, a continuation decision may be relevant. However, immediately after program termination, solid analysis of the growth of the treated firms in comparison with similar firms cannot be produced, so decision makers rely on less valid data. Moreover, the decision process is challenging because many players, alternative programs, decision levels and financial sources tend to be part of the process. In such a complex and volatile policy environment, successful programs may well be discontinued despite a clear continuation need. The purpose of the paper is to explore this weakness.Design/methodology/approachThe paper identifies four fundamental principles that are conducive for a rational continuation choice: “additionality,” “substitution,” “need” and “success”. It argues that if these principles are fulfilled, the rational choice would be to continue the program. To demonstrate that this rational outcome does not always happen in practice, an extreme case fulfilling the four principles well was selected.FindingsThe program aimed to enhance growth in small firms through manager training. It encompassed about 700 growth-oriented small firms in three years and was comprehensively evaluated after program termination. This evaluation demonstrated a high success rate of the program in all respects, including in terms of achieved growth compared to a control group of similar firms.Originality/valueThis discontinuation case suggests that non-rational reasoning plays a significant role in contemporary complex and volatile policy environments, which again points to a need for reform in this policy area.

The Government of India has promoted the expansion of access to and uptake of intrauterine devices (IUDs), during both the interval (IIUD) and postpartum (PPIUD) periods, as part of its Family Planning 2020 initiative. This study, conducted by EngenderHealth as part of the Expanding Access to IUD Services in India project, examines IIUD and PPIUD continuation rates over time and investigates factors associated with IUD continuation. We recruited respondents (N = 5024) through a repeated cross-sectional household study between February and December 2019. We identified respondents using IUD client data from public health facility registers in 20 districts of Gujarat and Rajasthan. We compared continuation rates for IIUD and PPIUD adopters and used regression analyses to measure the association between continuation and demographic, quality of care, and counselling variables. IIUD continuation rates decreased from 85.6% to 78.3% and PPIUD rates decreased from 78.5% to 70.7% between month 3 and month 12. Clients experiencing side effects or other problems were 15 times more likely to discontinue IUD use than clients who did not. Clients who received IUD counselling prior to insertion were more likely to continue than those who did not. IUD continuation increased significantly in cases where both partners jointly selected the method compared to situations where women decided alone. Several sociodemographic factors were associated with continuation. Our study demonstrates the value and benefits of programmes offering IUD services emphasising quality counselling and client-centred care to increase access, uptake, and continuation.

AIM: Copper containing IUCDs are one of most effective mode of contraception for birth spacing. We conducted this prospective observational study to suggest a possible better period of insertion of IUCDs with cost-saving benefits. METHODS: All married women in the reproductive age group desirous of Copper-T 375 IUD insertion in either immediate postplacental (PP), immediate postabortal (PA) or interval (INT) period were recruited. The women were asked to return for scheduled follow-up visits at 6 weeks, 6 months and 12 months. They were advised to visit family planning clinic any time if they experienced pelvic pain, discharge per vaginum, unusual bleeding or missed periods. At each visit, women were interviewed for any side effects they have experienced and were asked to elaborate. Pelvic pain was assessed from visual analogue scale. Continuation rate was measured at the end of one year. RESULTS: Women in INT group (90.14%) had the highest continuation rate followed by PP (83.18%) and PA (80%) groups. Women in PP (AOR = 3.37, 95% CI 1.17–9.72) and PA (AOR = 4.53, 95% CI 1.33–14.04) groups had higher odds of discontinuation compared to INT group after adjusting for age, parity, working and education status. There was a significant difference between the groups when cumulative expulsion was considered (p = 0.045), but none when cumulative removal (p = 0.107) was taken into account. CONCLUSION: The continuation rate remained high in women who had insertion in the interval period compared to immediate postplacental and postabortal periods.

Aim: To compare secondary systemic treatment (SST) continuation and associated resource use and costs in chronic graft-versus-host disease (cGvHD) patients in the USA. Materials & methods: This was a retrospective study using Truven Health MarketScan database (2009–2016). cGvHD patients were classified as continuers or discontinuers if treated with SST for ≥180 days without or with a treatment gap (≥45 days), respectively. Results: Among 464 cGvHD patients with SST, mTOR inhibitors, extracorporeal photopheresis and imatinib were most frequently used. A total of 172 patients were SST continuers and 292 were discontinuers. Extracorporeal photopheresis treated patients were the highest continuers, followed by imatinib and mTOR inhibitors. SST continuers had lower monthly hospitalization costs versus discontinuers. Conclusion: This real-world analysis demonstrates high SST continuation rates in cGvHD patients are associated with lower resource utilization and cost.

Purpose: Aromatase inhibitors (AIs) are widely prescribed for postmenopausal women with breast cancer and are known to cause musculoskeletal pain. This study aimed to identify factors associated with AI continuation intention among breast cancer survivors (BCS). Methods: A cross-sectional survey was conducted on 123 BCS (stages I–III), who had been taking AIs for at least 6 weeks. Participants were recruited from a cancer center in Goyang, Korea, from September to November 2019. Descriptive statistics, Welch analysis of variance, Pearson correlation coefficients, and simple linear regression were used for the analysis.Results: Belief in endocrine therapy was a significant predictor of AI continuation intention (β=.66, p

This publication is a continuation of the article published in the 4 th issue of the journal Russian family doctor for 2020 “Heuristics, language and medical errors”, which described the ways of making medical decisions that can lead to errors in patient management tactics, in particular “affect of heuristics / visceral bias”, “attribution error”, “frame of reference”, “availability bias”, “one-word-one-meaning-fallacy”. This article discusses additional sources of diagnostic error, including “diagnosis momentum”, “confirmation bias”, “representativeness”, and “premature closure” also the conflict that arises from diagnostic uncertainty is discussed. All errors in the tactics and the diagnostic process are illustrated by clinical cases from the personal practice of the author of the article.

To conduct a secondary analysis of continuation, unwanted effects and cost consequences at 1 year in copper intrauterine device (IUD) users aged under 30 in the European Active Surveillance Study for Intrauterine Devices (EURAS-IUD study) based on IUD type.Descriptive and comparative analyses of copper IUD continuation, unwanted effects and estimated cost consequences at 1 year were performed in users aged under 30 based on IUD copper surface area, shape or design, width and arms' flexibility.5796 copper IUD users were identified to have been aged under 30 at EURAS-IUD study recruitment and data for 5762 users (99.4%) was analysed. Higher IUD continuation, fewer unwanted effects and lower costs were observed with IUDs of the lowest copper content (300mmSignificant differences in continuation, reported unwanted effects and estimated costs at 1 year between IUD types were observed in users aged under 30. Although further research is needed, clinicians should consider these findings when counselling and choosing IUD types for younger women.

A significant challenge currently facing the higher education sector is how to address differential student outcomes in terms of attainment and continuation gaps at various stages of students’ transitions. Worryingly, there appears to be a ‘deficit’ discourse among some university staff in which differential outcomes are perceived to be due to student deficiencies. This may be exacerbated by institutional analyses placing an over-emphasis on the presence of the gaps rather than the causes. The purpose of this primer is to provide advice about how institutions can carry out far more nuanced analyses of their institutional data without requiring specialist software or expertise. Drawing on a multi-level framework for explaining differential outcomes, we begin with guidance for gathering quantitative data on explanatory factors for attainment and continuation gaps, largely by linking sources of internal data that have not previously been connected. Using illustrative examples, we then provide tutorials for how to model explanatory factors employing IBM SPSS Statistics (IBM Corp., Armonk, NY, USA) to perform and interpret regression and meta-regression analyses of individual- and group-level (aggregated) student data, combined with data on micro- and meso-level factors. We propose that university staff with strategic responsibilities could use these approaches with their institutional data, and the findings could then inform the design of context-specific interventions that focus on changing practices associated with gaps. In doing so, institutions could enhance the evidence-base, raise awareness, and further ‘embed the agenda’ when it comes to understanding potential reasons for differential student outcomes during educational transitions.

The article is devoted to presenting the results of a comparative study of technical University of Bauman, MADI and MIREA. These results were obtained using a sociological questionnaire with closed-type questions. The questionnaire contained nine main thematic blocks: 1. Professional choice; 2. Profession; 3. Study and education; 4. Educating; 5. Professional and personal competence; 6. Teachers; Communication of students; 8. Humanitarian knowledge in the training of an engineer; 9. Intelligentsia. This article presents the results for the first three blocks. They were analyzed and interpreted.

This paper is a natural continuation of our previous joint paper [Albu, Kara, Tercan, Fully invariant-extending modular lattices, and applications (I), J. Algebra 517 (2019), 207-222], where we introduced and investigated the notion of a fully invariant-extending lattice, the latticial counterpart of a fully invariant-extending module. In this paper we introduce and investigate the latticial counter-part of the concept of a strongly FI-extending module defined by Birkenmeier, Park, Rizvi (2002) as a module M having the property that every fully invariant submodule of M is essential in a fully invariant direct summand of M. Our main tool in doing so, is again the very useful concept of a linear morphism of lattices introduced in the literature by Albu and Iosif (2013).

Recidivism is generally considered as a deficiency disease in which offenders recommend a crime or repeat an offence. Empirically committing the first crime at a very young age leads to a much higher rebound rate and the continuation of similar offensive behavior. Accordingly, prioritization must be given for the early assessment of recidivism behavior in first-time offender by law enforcing agencies. Different prison studies suggest that recidivism can be curtailed by early behavioral risk assessment in first-time offenders. Ideally, a psychologist conducts a manual risk assessment using standard psychological assessment tools, which has long been regarded as a standard method for recidivism risk assessment. However, such behavioral examination procedures are usually sluggish and constrained by subjective perceptions. Consequently, this study aims to develop a machine learning-based quantitative risk assessment tool for the recidivism behavioral gradation of first-time offenders. Quantitative gradation and prediction of future recidivism behavior in such offenders are achieved using an ensemble learning model and an advanced machine-learning approach. For the available behavioral data collected from multiple prison locations, simulations were performed, and the experimental results were obtained. It is ascertained that, the proposed three-member and five-member ensemble classifier models lead to 85.47% and 87.72% accuracy respectively in comparison to other standard individual classifiers.

—Results of the implementation of a single concept for the development of the double launch system (SDZ) are presented, in particular the SDZ-La5 for the Fregat-SBU upper stage. Design and functional solutions are defined for the SDZ-La5 application as a part of RBF2U-SBU which differs in its geometry and mass-inertia properties from the Fregat upper stage (RBF). Information is presented on the transformation system development for the scenario without separation of the upper frame of the SDZ construction. Ascent Units (AU) of some advanced programs using the SDZ-La2 as a part of the Fregat upper stage and the SDZ-La5 for the Fregat-SBU upper stage are presented taking into account the single concept application. This article is a continuation of the article “The Concept of Design & Development of the Spacecraft Double Launch System as a Part of the Upper Stages of the Fregat Family” (Kolmykov et al., 2019).

Rationale: For an incapacitated patient who is difficult to liberate from mechanical ventilation, surrogates and physicians will decide to continue life support if they believe doing so is consiste...

Alignment effect in language research refers to the social cognition process in which people cooperate, adjust, and adapt to each other in interaction. Through empirical study, this paper explores alignment effect in the continuation task of translation (CTOT) and its possible influence on learning of English as foreign languge (EFL). The study was carried out by means of a CTOT. Participants were chosen from non-English major freshmen of similar capacity from a university in Guangzhou. They were divided into two groups, the experimental group (EG) and the control group (CG), with 13 students each. The students in EG were asked to carefully read some English-Chinese bilingual material. Then, the 26 participants were tasked with translating the paragraphs, which followed from Chinese into English. After that, they were asked to write down the words and expressions which they found difficult. Some of the participants were interviewed one month later for a deeper understanding of their memories of the vocabulary and their opinions on the CTOT. The data were analyzed by direct comparison and non-parametric test. The results showed that vocabulary alignment does occur in CTOT. The EG members tended to take advantage of words that appeared in the bilingual reading text. If multiple words from the reading appeared, with the same contextual meaning, they tended to choose the repeated words. As for influence of vocabulary alignment on EFL learning, it seemed that CTOT could not improve the quality of the translation itself, but could assist short-term vocabulary learning though no significant help to long-term vocabulary learning was revealed. The findings of this study provide support and explanation for some features and effects of CTOT, an important form of CT. However, the nature of CTOT itself, and its role in EFL learning deserve further research.

Time matters the most in medical diagnosis. Therefore, ECG has been extensively used in diagnosis and precise identification of several cardiac conditions. As continuation to the previous work, which concerned about feature extraction and classification of ECG signals applying CNN on distinct datasets, this paper presents residual learning model that makes training of networks easier and substantially deeper since the deeper neural networks are difficult to train. The proposed solution is classified into two types, one with no residualconnection (Basic CNN) and the other analyzing the repetition of residual connections (Residual CNN) for displaying the variation in performance level of each model. The proposed model offers extensive observational proof indicating that residual model is an optimized framework that shows better results of accuracy from considerably increased depth. From the performance of the (Deep Residual CNN) we also see that we can better exploit these residual connections by making the model much deeper. Such a model can be conveniently used for constant monitoring of ECG in real time environment.

Background and Aims Anti-tumour necrosis factor alpha [anti-TNF] treatment accounts for 31% of health care expenditures associated with ulcerative colitis [UC]. Withdrawal of anti-TNF in patients with UC in remission may decrease side effects and infections, while promoting cost containment. Approximately 36% of patients relapse within 12–24 months of anti-TNF withdrawal, but reintroduction of treatment is successful in 80% of patients. We aimed to evaluate the cost-effectiveness of continuation versus withdrawal of anti-TNF in patients with UC in remission. Methods We developed a Markov model comparing cost-effectiveness of anti-TNF continuation versus withdrawal, from a health care provider perspective. Transition probabilities were calculated from literature, or estimated by an expert panel of 11 gastroenterologists. Deterministic and probabilistic sensitivity analyses were performed to account for assumptions and uncertainty. The cost-effectiveness threshold was set at an incremental cost-effectiveness ratio of €80,000 per quality-adjusted life-year [QALY]. Results At 5 years, anti-TNF withdrawal was less costly [-€10,781 per patient], but also slightly less effective [-0.04 QALY per patient] than continued treatment. Continuation of anti-TNF compared with withdrawal costs €300,390/QALY, exceeding the cost-effectiveness threshold. Continued therapy would become cost-effective if the relapse rate following anti-TNF withdrawal was ≥43% higher, or if adalimumab or infliximab [biosimilar] prices fell below €87/40 mg and €66/100 mg, respectively. Conclusions Continuation of anti-TNF in UC patients in remission is not cost-effective compared with withdrawal. A stop-and-reintroduction strategy is cost-saving but is slightly less effective than continued therapy. This strategy could be improved by identifying patients at increased risk of relapse.

Consumption-saving models with adjustment costs or discrete choices are typically hard to solve numerically due to the presence of non-convexities. This paper provides a number of tools to speed up the solution of such models. Firstly, I use that many consumption models have a nesting structure implying that the continuation value can be efficiently pre-computed and the consumption choice solved separately before the remaining choices. Secondly, I use that an endogenous grid method extended with an upper envelope step can be used to solve efficiently for the consumption choice. Thirdly, I use that the required pre-computations can be optimized by a novel loop reordering when interpolating the next-period value function. As an illustrative example, I solve a model with non-durable consumption and durable consumption subject to adjustment costs. Combining the provided tools, the model is solved almost 50 times faster than with standard value function iteration for a given level of accuracy. Software is provided in both Python and C++.

The need for an analysis of the predictions of continuation of student studies to college is a strong reason for this research. Because by knowing the number of students at a school who continue or not continue studies to universities become a reference to improve education services at the school concerned. Naive Bayes is an effective and efficient classification algorithm for data mining and machine learning. So in the research proposed Naive Bayes for predictions of continuation of student studies to college with k-fold validation and confusion matrix. And results from the algorithm Naive Bayes is 86.53%.

The purpose of this study is to explore how the executive team continuation affects the successor's investment decisions. To this end, we use data of Chinese A‐share listed heritage family enterprises. The findings reveal that executive team continuation has a negative impact on inefficient investment. At the same time, the successor's control rights have a moderating effect on the relationship between the executive team continuation and the successor's investment decisions. In addition, further research shows that the heterogeneity of senior executives' tenure, the number of independent directors, and the distribution of senior executives' professional backgrounds are conducive to explaining the internal mechanism of the continuation of the management team.

Background: Self-efficacy is a decisive psychological and motivational factor in maintaining exclusive breastfeeding (EBF). The aim of this study was to explore the impact of motivational interview...

Purpose: Opioids are one of the high-risk medication classes that are administered to critically ill patients during their intensive care unit (ICU) stay. However, little attention has been given to inpatient opioid prescribing practices, especially in critically ill patients. The purpose of our study was to characterize opioid prescribing practices across 2 transitions of care during an inpatient hospital stay: medical ICU (MICU)/intermediate care unit (IMC) to floor and floor to hospital discharge and identify potential patient-specific factors that impact opioid continuation. Methods: This is a retrospective cohort study evaluating opioid-naive adult patients with new opioid therapy initiated in MICU/IMC at a tertiary care academic medical center from December 1, 2016, to November 30, 2017. Opioid continuation rate was assessed twice: transition 1 (MICU/IMC to floor) and transition 2 (floor to hospital discharge). Results: In total, 112 opioid-naive patients with initial opioid administration in the MICU/IMC were included. Opioid therapy was continued in 56.1% (37/66) at transition 1 and 56.8% of patients (21/37) at transition 2. Patients with opioids continued at transition 1 had a longer hospital length of stay compared to those not continued on opioids, 22 (interquartile range [IQR] 11-36) vs 8 (IQR 6-14; P = .0004). Among the patients continued on opioids at hospital discharge, intubation during hospital stay and cumulative opioid dosage were greater than those not continued on opioids (17 [80.9%] vs 7 [43.8%], P = .019; and 3482 mcg [IQR 1690-9530] vs 732.5 mcg [IQR 187.5-1360.9], P = .0018, respectively). Conclusions: Opioid-naive patients receiving opioid therapy in the MICU/IMC had a continuation rate of >56% during transitions of care, including hospital discharge. Factors that contributed to the continuation of opioids at transitions of care included longer hospital length of stay, intubation, and cumulative hospital opioid dosage. These findings may help to provide health systems with guidance on targeted opioid stewardship programs.

Objective The aim of this study was to appropriately plan for rollout and monitor impact of oral preexposure prophylaxis (PrEP). It is important to understand PrEP continuation and come to a consensus on how best to measure PrEP continuation. This study reviews data on PrEP continuation to document how it is reported, and to compare continuation over time and across populations. Design A systematic review and meta-analysis. Methods We searched MEDLINE, Embase and Global Health and reviewed abstracts from HIV conferences from 2017 to 2018 for studies reporting primary data on PrEP continuation. Findings were summarized along a PrEP cascade and continuation was presented by population at months 1, 6 and 12, with random-effects meta-analysis. Results Of 2578 articles and 596 abstracts identified, 41 studies were eligible covering 22 034 individuals. Continuation data were measured and reported inconsistently. Results showed high discontinuation at month 1 and persistent discontinuation at later time points in many studies. Pooled continuation estimates were 66% at month 1 [n = 5348; 95% confidence interval (95% CI): 48-82], 63% at month 6 (n = 13 629; 95% CI: 48-77) and 71% at month 12 (n = 14 933; 95% CI: 60-81; higher estimate than previous timepoints due to inclusion of different studies). Adequate data were not available to reliably compare estimates across populations. Conclusion This review found that discontinuation at one month was high, suggesting PrEP initiations may be a poor measure of effectiveness. Continuation declined further over time in many studies, indicating existing cross-sectional indicators may not be adequate to understand PrEP use patterns. Studies do not measure continuation consistently, and consensus is needed.

Objective: Continuation treatment of major depression following an acute course of electroconvulsive treatment (ECT) may be often required to prevent relapse. Data on continuation phase of right unilateral ultrabrief ECT are sparse and there are doubts if it is inherently capable of relapse prevention. Methods: All consecutive adult patients with major depression who received the first ‘run’ of continuation phase of right unilateral ultrabrief ECT over a 10-year period were routinely followed up. ECT frequency varied from weekly to up to once every 4 weeks for a maximum period of 6 months. The data were extracted from a retrospective chart review. Results: 20 out of 22 patients persisted with ultrabrief pulses (0.3 ms) with two needing 0.5 ms pulse widths. The median duration of continuation treatment was 51 days (range: 14–460). At the end of 1 month ( n = 17), treatment gap in days mean (SD): 10.18 (7.08), widening to mean (SD): 20.11 (16.85) at 4 months ( n = 9). Stimulus dose increased throughout the continuation phase: p = 0.026. In 16 out of 22 patients, more than 70% of the visits were charted as being ‘in remission’. Conclusion: As most patients receiving ultrabrief ECT remained well, this study suggests that ultrabrief ECT can be used effectively in continuation therapy.

This article considers the development and systematization of methods and models for decision-making in systems engineering for creating (developing) distributed organizational information and control systems and is a continuation and development of the general provisions and results previously obtained and published by the authors. An improved formulation of the problem of decision-making in systems engineering for creating (developing) distributed organizational information and control systems and the approach to an evaluation of efficiency of the implementation of functional processes in these systems using a complex indicator that takes into account the completeness and quality of implementation of functional processes different stages of the system’s life cycle are proposed. The analysis of the algorithmic complexity of the solution of the formulated problem shows that it is impossible to use exact methods, which makes it necessary to develop approximate problem-solving methods. Methods and models for estimating the time and probabilistic time characteristics of the operation of distributed organizational information and control systems, as well as approaches to evaluate the technical and economic parameters of the process of their creation (development), are analyzed. A decision-making algorithm in systems engineering for creating (developing) distributed organizational information and control systems that combines all the considered and proposed methods and models is developed as a result of the research.

This study investigates the influence of the psychiatric day care on the continuation of treatments for the patients with bipolar disorder in Japan. Two-hundred twenty-one subjects with bipolar aff...

This is the timeframe during which couples hear the (most likely) diagnosis and have to make the decision to terminate or continue the pregnancy. This timeframe is often very short. During the course of only a few weeks, couples see a large number of health care professionals (HCPs) and have to learn to interpret new and complicated information. With this information, they, as (future) parents, have to make a decision with widespread and extensive consequences. In the Netherlands, couples are helped by a multidisciplinary team that determines the recommended option for perinatal management in the case of pregnancy continuation. In the second chapter, Wildschut and Bijma set out how such a multidisciplinary team operates, and how it supports couples in their decision toward terminating or continuing a pregnancy.

Purpose: We aimed to investigate the relationship between initiation/continuation of breastfeeding and socio-demographic, lifestyle-related, clinical and lactation-related factorsMaterials and Methods: This cross-sectional study was conducted in three hospitals in Turkey. A total of 360 mothers with children aged 0-24 months underwent face-to-face interview, using a structured questionnaire about the initiation of breastfeeding, exclusive and any breastfeeding, as well as potentially related characteristics and factors. Results: The mean age of mother was 28  5.36 years; the mean of parity was two years; and the percentage of vaginal birth frequency was 56.9. It was found out that 43.6% of babies were initiated early to breastmilk, the majority of the babies (78%) started additional food at 4-6 months and the first additional food started to be milk in the majority (49.6%). Mode of birth, breastfeeding information and first feeding style (exclusive breastmilk) affected babys’ feeding style in the last 24 hours. Mode of childbirth (vaginal), complicated pregnancy and birth, rooming-in, and breastfeeding information were found to be important for the initiation and continued breastfeedin.Conclusion: Breastfeeding practice is influenced by a variety of factors. Health professionals are significant people who are effective in women’s decision to breastfeed, to start breastfeeding and continue to breastfeed. Baby-friendly hospitals, which provide the highest level of medical care and which support rooming-in after delivery, must be established and training on breastfeeding should be increased and maintained., Amaç: Bu çalışmanın amacı, emzirmenin başlatılması/sürdürülmesi ile sosyo-demografik, yaşam tarzı, klinik ve emzirme sürecine yönelik özellikler arasındaki ilişkinin araştırılmasıdır.Gereç ve Yöntem: Bu kesitsel çalışma Türkiye’de yer alan 3 merkezde gerçekleştirilmiştir. Emzirmenin başlatılması, sadece anne sütü alımı ve bunları etkileyebilecek faktörlere ilişkin yarı yapılandırılmış bir anket kullanılarak veriler 360 anne ile yüzyüze görüşme yöntemi kullanılarak toplanmıştır. Bulgular: Annenin yaş ortalaması 28 5.36 yıl, ortalama doğum sayısı 2, vajinal doğum sıklığı %56.9 olarak belirlenmiştir. Bebeklerin% 43.6'sının emzirmeye erken sürede (ilk 1 saat) başladığı, çoğunluğunun (%78) 4-6 ayda ek gıdalara başladığı ve bunların yaklaşık yarısında (% 49.6) süt ve süt ürünlerinin ilk ek gıda olduğu tespit edildi. Doğum şekli, emzirme eğitimi alma durumu ve ilk beslenme yönteminin sadece anne sütü olması bebeğin son 24 saatte anne sütü ile beslenme ve sadece anne sütü alma durumunu etkilemiştir. Doğum şekli (vajinal), gebelikte komplikasyon olması, anne-bebek birlikteliği ve emzirme eğitimi, emzirmenin başlatılması ve sürdürülmesinde önemli bulunmuştur.Sonuç: Emzirme çeşitli faktörlerden etkilenebilmektedir. Sağlık çalışanları annelerin emzirmeye karar vermesinde, emzirmenin başlatılmasında ve emzirmenin sürüdürülmesinde etkili olan önemli kişilerdir. En üst düzeyde tıbbi bakım sağlayan ve doğum sonrası anne-bebek birlikteliğini destekleyen bebek dostu hastanelerin kurulmalı, emzirme eğitimleri artırılmalı ve devamlılığı sağlanmalıdır.

Objective:To identify factors associated with breast-feeding initiation and continuation in Canadian-born and non-Canadian-born women.Design:Prospective cohort of mothers and infants born from 2008 to 2012: the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study.Setting:General community setting in four Canadian provinces.Participants:In total, 3455 pregnant women from Vancouver, Edmonton, Winnipeg and Toronto between 2008 and 2012.Results:Of 3010 participants included in the current study, the majority were Canadian-born (75·5 %). Breast-feeding initiation rates were high in both non-Canadian-born (95·5 %) and Canadian-born participants (92·7 %). The median breast-feeding duration was 10 months in Canadian-born participants and 11 months in non-Canadian-born participants. Among Canadian-born participants, factors associated with breast-feeding initiation and continuation were older maternal age, higher maternal education, living with their partner and recruitment site. Rooming-in during the hospital stay was also associated with higher rates of breast-feeding initiation, but not continuation at 6-month postpartum. Factors associated with non-initiation of breast-feeding and cessation at 6-month postpartum were maternal smoking, living with a current smoker, caesarean birth and early-term birth. Among non-Canadian-born participants, maternal smoking during pregnancy was associated with lower odds of breast-feeding initiation and lower odds of breast-feeding continuation at 6 months, and older maternal age and recruitment site were associated with breast-feeding continuation at 6 months.Conclusions:Although Canadian-born and non-Canadian-born women in the CHILD cohort have similar breast-feeding initiation rates, breast-feeding initiation and continuation are more strongly associated with socio-demographic characteristics in Canadian-born participants. Recruitment site was strongly associated with breast-feeding continuation in both groups and may indicate geographic disparities in breast-feeding rates nationally.

Proceeding paper [Abstract] Information extracted from electronic health records (EHRs) is used for predictive tasks and clinical pattern recognition. Machine learning techniques also allow the extraction of knowledge from EHR. This study is a continuation of previous work in which EHRs were exploited to make predictions about patients with respiratory diseases. In this study, we will try to predict the recurrence of patients with respiratory diseases using four different machine learning algorithms. Centro de Investigación de Galicia CITIC and Campus Innova (agreement I+D+ 2019-20) is funded by Consellería de Educación, Universidade e Formación Profesional from Xunta de Galicia and European Union (European Regional Development Fund - FEDER Galicia 2014-2020 Program) by grant ED431G 2019/01 and Universidade da Coruña. Partially supported by the Spanish Ministry of Science (Challenges of Society 2019) PID2019-104323RB-C33 Xunta de Galicia; ED431G 2019/01

The unmet need for contraception is documented as a significant determinant of unintended pregnancies and high number of induced abortions. The period immediately after an abortion is recognised as a unique opportunity to offer contraceptive services. This paper explores the association between place of abortion and women's post-abortion contraceptive behaviour. The reproductive calendar data from the National Family Health Survey (NFHS-4) (2015-16) was used for this study. Multinomial logistic regression models were used to understand factors associated with post-abortion method choices. Single decrement life-tables were built to examine rates of contraceptive discontinuation and proportional hazard models were employed to examine probability and correlates of method discontinuation. About 20% of women who underwent an abortion adopted a contraceptive method by the end of one month following an abortion. The decision to choose methods like sterilisation or intrauterine contraceptive devices (IUCDs) was associated with the place of abortion, past contraceptive behaviour, number and sex of surviving children at the time of abortion, mass media exposure, and time of the abortion. Compared to women who underwent an abortion at private health facilities, women who sought abortion at public health facilities were more likely to choose permanent methods or IUCDs. Furthermore, women who opted for an IUCD were less likely to discontinue the method compared to those using short-acting modern methods. The lack of post-abortion contraceptive choices for women is evident in the low uptake of post-abortion contraceptives in private facilities and the predominant promotion of permanent methods and IUCDs in public health facilities.

IntroductionDespite calls for screening tools to help providers monitor long-term opioid therapy (LTOT) harms, and identify patients likely to experience harms of discontinuation, such screening tools do not yet exist. Current assessment tools are infeasible to use routinely in primary care and focus mainly on behaviours suggestive of opioid use disorder to the exclusion of other potential harms. This paper describes a study protocol to develop two screening tools that comprise one integrated instrument,Screen toEvaluate andTreat (SET). SET1 will indicate if LTOT may be harmful to continue (yes or no), and SET2 will indicate if tapering to discontinue opioids may be harmful to initiate (yes or no). Patients receiving LTOT who screen positive on the SET tools should receive subsequent additional assessment. SET will give providers methods that are feasible to implement routinely to facilitate more intensive and comprehensive monitoring of patients on LTOT and decision-making about discontinuation.Methods and analysisWe will develop the screening tools, SET1 and SET2, concurrently. Tool development will be done in stages: (1) comprehensive literature searches to yield an initial item pool for domains covered by each screening tool; (2) qualitative item analyses using interviews, expert review and cognitive interviewing, with subsequent item revision, to yield draft versions of each tool; and (3) field testing of the draft screening tools to assess internal consistency, test–retest reliability and convergent and discriminant validity.Ethics and disseminationEthical approval was obtained from the Institutional Review Boards of Stanford University and the University of California, San Francisco for the VA Palo Alto Health Care System, and the VA San Francisco Healthcare System, respectively. Findings will be disseminated through peer-reviewed manuscripts and presentations at research conferences.