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Background and Aims: Anxiety is one of the most important issues in the dental environment for children. The aim of this study was to investigate the effect of music on the level of anxiety and cooperation of children during dental treatment. Materials and Methods: In this study 58 children aged 6 to 8 years were randomly divided into two groups: the intervention group (music played) and the control group (no music played). Children's anxiety was assessed using the Venham Picture Test and Frankel Behavior Rating Scale, and their heart rate was also measured. Results: The results showed that in the intervention group, the level of anxiety based on the Venham Picture Test and Frankel Behavior Rating Scale was significantly lower. Additionally, the heart rate of children in this group was lower during the treatment (P<0.05). Conclusion: Based on the findings of this study, the use of music as a non-pharmacological method can be beneficial in reducing anxiety and improving the cooperation of children in the dental environment. [ABSTRACT FROM AUTHOR]

Background: Informal care features high on the policy agenda of many countries to deal with workforce shortages. As a consequence, care provision increasingly takes place in the care triad of care recipients, informal caregivers and care professionals. How collaboration between care partners takes shape depends on how the different partners perceive this collaboration. This paper aims to investigate the relative importance of the different aspects of collaboration from the perspectives of care recipients, informal caregivers and care professionals in the context of the care for older persons in The Netherlands. Methods: Using Q‐methodology, 32 participants ranked 28 statements that reflect different aspects of collaboration in the care triad and explained their ranking during a follow‐up interview. Participants comprised 9 older persons, 10 informal caregivers and 13 care professionals. Data were analysed using by‐person factor analysis to identify common patterns in the rankings of the statements. Emerging patterns were interpreted and described as views on collaboration using aggregated rankings and qualitative data from the interviews. Results: Five distinct views on collaboration were found: (1) Emphasizing warm collaboration, (2) trusting care professional's expertise, (3) open and compassionate care professionals, (4) responsive decision‐making by autonomous care professionals and (5) prioritizing care recipient's and informal caregiver's interests. Care recipients and/or informal caregivers were associated with views 1, 3 and, 5, whereas care professionals were associated with all five views. Conclusions: Our study highlights the importance of recognizing the potential diversity of views between and within different partner groups in care triads. Governmental and organizational policy makers, as well as healthcare professionals who aim to increase or support the involvement of informal caregivers, should take this heterogeneity into consideration. Patient or Public Contribution: An advisory board of older persons (care recipients and informal caregivers) was involved in the recruitment of the participants, the formulation of the statements and the reflection on the findings of the study and potential implications. [ABSTRACT FROM AUTHOR]

Through technological innovations, patient cohorts can be examined from multiple views with high-dimensional, multiscale biomedical data to classify clinical phenotypes and predict outcomes. Here, we aim to present our approach for analyzing multimodal data using unsupervised and supervised sparse linear methods in a COVID-19 patient cohort. This prospective cohort study of 149 adult patients was conducted in a tertiary care academic center. First, we used sparse canonical correlation analysis (CCA) to identify and quantify relationships across different data modalities, including viral genome sequencing, imaging, clinical data, and laboratory results. Then, we used cooperative learning to predict the clinical outcome of COVID-19 patients: Intensive care unit admission. We show that serum biomarkers representing severe disease and acute phase response correlate with original and wavelet radiomics features in the LLL frequency channel (cor(Xu1, Zv1) = 0.596, p value < 0.001). Among radiomics features, histogram-based first-order features reporting the skewness, kurtosis, and uniformity have the lowest negative, whereas entropy-related features have the highest positive coefficients. Moreover, unsupervised analysis of clinical data and laboratory results gives insights into distinct clinical phenotypes. Leveraging the availability of global viral genome databases, we demonstrate that the Word2Vec natural language processing model can be used for viral genome encoding. It not only separates major SARS-CoV-2 variants but also allows the preservation of phylogenetic relationships among them. Our quadruple model using Word2Vec encoding achieves better prediction results in the supervised task. The model yields area under the curve (AUC) and accuracy values of 0.87 and 0.77, respectively. Our study illustrates that sparse CCA analysis and cooperative learning are powerful techniques for handling high-dimensional, multimodal data to investigate multivariate associations in unsupervised and supervised tasks. [ABSTRACT FROM AUTHOR]

Introduction: Pediatric perioperative anxiety is a significant problem during mask induction for general anesthesia. Immersive technologies, such as extended reality headsets, are a promising strategy for alleviating anxiety. Our primary aim was to investigate mask acceptance during inhalational induction utilizing augmented reality (AR). Methods: This was a prospective, matched case-control study at a quaternary academic hospital. Fifty pediatric patients using AR for mask induction were matched to 150 standard-of-care (SOC) controls. The primary outcome was measured with the Mask Acceptance Scale (MAS). Secondary outcomes of cooperation and emergent delirium (ED) were assessed. Results: MAS scores ≥2 occurred at 4% (95% CI [0, 9.4%]) with AR versus 19.3%, (95% CI [13%, 25.7%]) with SOC (RR 0.21, 95% CI [0.05, 0.84], P =.027). Ninety-eight percent of AR patients were cooperative versus 91.3% with SOC (P =.457). Zero percent had ED with AR versus 0.7% with SOC (P = 1.000). Conclusions: AR during mask induction improved mask acceptance compared to SOC. No relationship was observed between AR and cooperation or ED. Future research will investigate the integration of AR into clinical practice as a nonpharmacologic intervention. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Pennsylvania's Student Assistance Program (SAP) began in the mid‐1980s to address student barriers to academic success. SAP teams, groups of trained school and community professionals, review referrals, and connect students to services. State leadership conducts an annual SAP team survey, but capacity to evaluate data and affect change is limited. In 2020, leadership partnered with [institution name] to collaboratively review the survey data. METHODS: Frequencies and percentages were calculated. Open responses were coded. Logistic regression models evaluated the association between SAP team size, team meeting frequency, and team maintenance. RESULTS: The 2019 to 2020 survey had 1003 respondents. Median number of SAP team members was 8 (range 1‐21). The majority (54%) indicated their SAP team met once per week/cycle for 30 to 90+ minutes. Larger teams met more often. Annual team maintenance occurred for 38% of teams, and was more common for larger teams. SAP team members identified mental health (68%), trauma (44%), and parent engagement (36%) as top training needs. CONCLUSIONS: An academic partnership successfully provided the capacity to review SAP survey responses, and informed evidenced‐based discussion of best practice guidelines and realignment of staff professional development opportunities. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to describe the conflict management styles and identify factors affecting the conflict management styles of nurse managers. Materials and Methods: A cross-sectional study was conducted by interviewing nurse managers with a questionnaire, including the Rahim Organizational Conflict Inventory-II Form B, used to assess an individual's approach to conflict management across five styles: cooperating, competing, compromising, obliging, and avoiding. Results: A total of 30 nurse managers participated in this study. The mean scores of the cooperating style were the highest at 4.3 ± 0.4, followed by a compromising style at 3.4 ± 0.5, an avoiding style at 3.1 ± 0.6, an accommodating style at 2.9 ± 0.7, and a competing style at 2.8 ± 0.8 (χ2 = 66.624, P < 0.001). The mean scores for avoiding style among bachelor's degree nurse managers (3.2 ± 0.6) were higher than those of master's degree nurse managers (2.7 ± 0.6) (P = 0.036). Nurse managers over 40 years old, holding a managerial position for ≥10 years, and frequent conflict handling rated higher mean scores for the cooperating style than their counterparts (P < 0.05). Conclusion: The cooperating style was the most commonly used conflict management style among nurse managers. Factors affecting the conflict management style were age, education level, and experience in management and conflict handling. These findings are useful for developing interventions that enhance the competencies of nurse managers in conflict management. [ABSTRACT FROM AUTHOR]

Many societies experienced pushback against governmental COVID‐19 measures. When the Norwegian government made it a punishable offence to spend the night at privately owned cabins in the first phase of the pandemic, this resulted in discussions and pushback. Basing our research on in‐depth interviews at three different time points during the pandemic, we ask how Norwegian participants discursively explain why the cabin ban was the first measure that evoked pushback in Norway. We conducted a Foucauldian discourse analysis (FDA), exploring three overarching explanations provided by the interview participants. In the first explanation, the pushback was presented as a result of the cultural importance of the cabin. Here, participants partly legitimised the pushback when constructing it as a predictable reaction in this cultural context. In the second explanation, participants constructed the pushback as an expression of 'cabin people' in particular and Norwegians in general being 'too privileged' to acknowledge the measure's necessity. Here, the pushback was constructed as an illegitimate reaction. In the third explanation, participants explained the pushback as a result of people seeing the measure as meaningless. This interpretation constructs pushback as a legitimate response to an illogical measure. These different constructions illustrate the complexity of compliance with COVID measures, where people negotiated individual freedom against solidarity, and compliance against critical thinking. The article contributes to the understanding of people's negotiations of resistance and pushback against restrictive measures. We argue that social psychological theory and research need to acknowledge the temporal, contextual and ideological specificities in understanding compliance and non‐compliance. [ABSTRACT FROM AUTHOR]

Assessing psychological indicators such as positive behavioral skills in the context of adolescent personality development during the pandemic era is highly relevant: the growing problem of peer disrespect among adolescents who participate in sports has recently become an undeniable scientific issue. This study aimed to analyze positive behavioral skills in the cadet (U16) and junior (U18) age groups of young basketball players during the COVID-19 pandemic. The participants were 378 male athletes (age 16.36 ± 1.15 years). Results revealed that U18 athletes are more capable of taking responsibility, positively evaluating themselves, behaving pro-socially with teammates, cooperating, demonstrating assertiveness, demonstrating self-control, and managing emotions than U16 adolescent athletes. When comparing the effect sizes in the current study during the pandemic with similar studies by other authors, the pandemic may have had a larger negative effect on some positive behavioral skills (ability to control emotions, social responsibility skills, cooperation skills) in U16 athletes than in U18 athletes, as the effect sizes were small before the pandemic and moderate during the pandemic in the current study. This study's results may be useful for developing and implementing a young athletes' education program based on a comprehensive model of positive behavioral skills that include the indicators analyzed. [ABSTRACT FROM AUTHOR]

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Abstract: In 1254 mentally disordered outpatients (941 women, 313 men) length of sick leave in the preceding 12 months was documented (median 2 weeks) and axis I and axis II disorder (SCID screening, clinical interview), psychological distress (SCL-90-R), work-related distress and personality (Temperament and Character Inventory (TCI)) were assessed. Compared to healthy controls (N=152) patients scored lower on self-directedness and higher on harm avoidance. Longer incapacitated patients were more often female. On the basis of absence duration (<2 weeks; ≥2<4 weeks; ≥4 weeks) male and female patients were analysed separately. Main findings showed that women longer on sick leave scored significantly higher on novelty seeking and cooperativeness. Further analysis yielded a significant contribution of personality dimensions, including novelty seeking and cooperativeness to work-related distress in women, explaining 21.5% of variance. An association between lower formal education, older age and duration of work incapacity could only be confirmed in male patients. Personality-based difficulties in adequate distancing from professional demands, as well as personality-based problems in interpersonal conflict management, are discussed as possible explanations for study findings. [Copyright &y& Elsevier]

Objective: To explore the clinical effect of the tuberculosis (TB) doctor–nurse integration management model Methods: This study is a retrospective historical cohort study. The clinical data of 180 patients with TB in our hospital from 2019 to 2020 were analyzed retrospectively. In a control group, 90 cases were treated with the traditional medical care model. An observation group of 90 cases received clinical diagnoses, treatments, and nursing under a doctor–nurse integration management model. Comparative analyses between the two groups were conducted on various aspects, including the awareness level of TB prevention and control, medication compliance and patient satisfaction. Comparisons between the two groups were evaluated using independent‐sample t‐tests or Chi‐squared tests Results: Compared with the control group, the knowledge awareness levels of TB prevention and medication compliance in the observation group were significantly higher (p <.05). The appointment waiting times and hospitalization times in the observation group were significantly lower than in the control group (p <.05). The total average satisfaction score of the patients in the observation group was significantly higher than in the control group (p <.05). Compared with the control group, the patients in the observation group were significantly more satisfied with their nursing methods, operating techniques, psychological techniques, service attitudes, and ward management (p <.05). In addition, in the observation group, medical–nursing relationships and doctor–patient communication were better than in the control group; additionally, the satisfaction of doctors with nursing work was also higher than in the control group, which was a statistically significant difference (p <.05) Conclusion: The implementation of an integrated medical–nursing cooperation model for TB will help increase the awareness of health knowledge in patients with TB, improve patient medication compliance and enhance patient satisfaction. [ABSTRACT FROM AUTHOR]

Background: Peer support is increasingly recognized as crucial for improving health and psychosocial outcomes in oncological care. The integration of cancer self‐help groups (SHGs) into cancer care facilities has gained importance in recent years. Yet, there is a lack of knowledge of the extent and quality of cooperation between cancer care facilities and SHGs and their integration into routine care. The concept of self‐help friendliness (SHF) provides a feasible instrument for the measurement of cooperation and integration. Methods: A cross‐sectional study across Germany investigates the experiences of 266 leaders of cancer SHGs concerning their cooperation with cancer care facilities based on the criteria for SHF. The participatory study was developed and conducted with representatives of the House of Cancer Self‐Help and the federal associations of cancer self‐help. Results: According to the SHG leaders, about 80% of their members primarily find their way to an SHG via other patients and only less than 50% more or less frequently via hospitals or rehabilitation clinics. The quality of cooperation with cancer centres, hospitals and rehabilitation clinics, however, is rated as good to very good by more than 70% of the respondents. Nine out of 10 quality criteria for SHF are fully or at least partially implemented, the values vary between 53% and 87%. Overall, 58% of the SHG leaders feel well to be very well integrated into care facilities. Conclusions: The results show a positive assessment of the involvement of SHGs in oncological care, but differences between inpatient and outpatient care and low referrals to SHGs are prominent. The concept of SHF is a feasible solution for a systematic and measurable involvement of SHGs. Patient or Public Contribution: The perspectives and insight of patient representatives obtained through qualitative interviews were directly incorporated into this study. Representatives of cancer self‐help organizations were involved in the development of the questionnaire, reviewed it for content and comprehensibility, and further helped to recruit participants. [ABSTRACT FROM AUTHOR]

Purpose: The purpose is to analyse the relationship between democratic accountability and how sustainable governance is achieved by horizontally integrating care services for older people through collaboration in a coordination body of key leaders from across the health and social care system. Design/methodology/approach: The data and measures come from two surveys with coordination body members in Sweden (politicians, administrators, professionals) from a sample of 73 bodies in 2015 (n = 549) and the same/corresponding 59 bodies in 2019 (n = 389). Findings: The governance of integrating care scale and the accountability scales repeatedly show consistency among individual members. Systematic progress is found among large coordination bodies: the greater the average perception of governance of horizontally integrating care in 2015, the greater it was in 2019 – and regardless of the period, the stronger the internal administrative or political monitoring and reviewing of the coordination body, the greater its governance (while the relationship to the external monitoring and reviewing is weak). However, the growing importance of external accountability is indirect, shown by stronger correlations between the internal political and external monitoring and reviewing, regardless of size. Research limitations/implications: The scales are based on self-reported perceptions that cannot be objectively verified, but they can be linked to changes in outcomes and user experiences in the later stages of the research. Originality/value: Repeatedly verified scales of internal and external accountability for analysing and evaluating governance of integrating care services horizontally, which is useful for improving strategic coordination of integrated care. [ABSTRACT FROM AUTHOR]

Fear dominates women and children's experience of domestic violence. Fear of harm, and the consequences of others finding out, can mean mothers are reluctant to seek help. Ironically, these survival behaviours can be understood as non-protective by child protection practitioners. This article describes research undertaken in New South Wales (NSW) Australia to determine the impact on child protection practitioner perceptions of child safety when Response-Based Practice (RBP) questions are combined with the standard NSW Structured Decision Making (SDM) safety assessment. RBP reflects core social work values through questions that explore how victims respond to, resist and manage violence. A vignette experiment with a between-subjects design was used to compare child safety assessments by practitioners who watched an interview guided by SDM alone and practitioners who watched an interview using the combined 'treatment' (SDM+RBP) approach. Participants (N =  1,041) were randomly assigned to SDM and treatment groups. Participants who watched the treatment approach were significantly more likely to assess the mother as cooperative and protective and significantly less likely to indicate that the children would be taken from her care. Thus, the results demonstrate that understanding how women manage violence changes practitioner views about maternal protectiveness and child safety. [ABSTRACT FROM AUTHOR]

Background: Depression, causes problems in social and individual aspects of life, so is the major disease burden in modern societies. There is complex relationship between personality and depression, so some special forms of personality may predispose the person to the depression, and depression and its symptoms may manifest different as a result of the various personalities. Methods: This research case control study consisted of 128 patients with major depressive disorder and 131 normal people. Data have been collected through TCI questionnaire and Hamilton scale for depression. Results: In patients with major depression the Harm-avoidance, Reward-dependence and persistence, Self- Directedness and Cooperativeness have significant differences with normal people. Patients with major depressive disorder experience high levels of Harm-avoidance and Reward-dependence and Persistence, with low levels of Self-directedness and Cooperativeness than normal people. Conclusion: The depressed patients and normal people are different with temperament and character, and these differences can influence severity of depression. [ABSTRACT FROM AUTHOR]

A team's cognitions of interpersonally coordinated actions are a crucial component for successful team performance. Here, we present an approach to practice team action by way of imagery and examine its impact on team cognitions in long-term memory. We investigated the impact of a 4-week team action imagery intervention on futsal players' mental representations of team-level tactics. Skilled futsal players were assigned to either an imagery training group or a no imagery training control group. Participants in the imagery training group practiced four team-level tactics by imagining team actions in specific game situations for three times a week. Results revealed that the imagery training group's representations were more similar to that of an expert representation after the intervention compared with the control group. This study indicates that team action imagery training can have a significant impact on players' tactical skill representations and thus order formation in long-term memory. [ABSTRACT FROM AUTHOR]

Purpose: Drafting in cycling influences collective behavior of pelotons. Although evidence for collective behavior in competitive running events exists, it is not clear if this results from energetic savings conferred by drafting. This study modeled the effects of drafting on behavior in elite 10,000-m runners. Methods: Using performance data from a men's elite 10,000-m track running event, computer simulations were constructed using Netlogo 5.1 to test the effects of 3 different drafting quantities on collective behavior: no drafting, drafting to 3 m behind with up to ~8% energy savings (a realistic running draft), and drafting up to 3 m behind with up to 38% energy savings (a realistic cycling draft). Three measures of collective behavior were analyzed in each condition: mean speed, mean group stretch (distance between first- and last-placed runner), and runner-convergence ratio (RCR), which represents the degree of drafting benefit obtained by the follower in a pair of coupled runners. Results: Mean speeds were 6.32 ± 0.28, 5.57 ± 0.18, and 5.51 ± 0.13 m/s in the cycling-draft, runner-draft, and no-draft conditions, respectively (all P < .001). RCR was lower in the cycling-draft condition but did not differ between the other 2. Mean stretch did not differ between conditions. Conclusions: Collective behaviors observed in running events cannot be fully explained through energetic savings conferred by realistic drafting benefits. They may therefore result from other, possibly psychological, processes. The benefits or otherwise of engaging in such behavior are as yet unclear. [ABSTRACT FROM AUTHOR]

Research has demonstrated that an understanding of and engagement in cooperative activities emerges early in life. However, little is known about the expectations infants hold about the consequences of cooperative action. We demonstrate that 14-month-old infants expect that cooperative partners will share the recently attained cooperative goal instead of keeping it for themselves. Interestingly, this prediction does not hold if infants saw the two individuals work towards individual goals. These findings contribute to the growing body of literature suggesting that infants possess at least a basic understanding of cooperation well before their second birthday. [ABSTRACT FROM AUTHOR]

Cooperation is a fundamental human ability that seems to be inversely related to aggressive behaviour in typical development. However, there is no knowledge whether similar association holds for children with autism spectrum disorder. A total of 27 boys with autism spectrum disorder and their gender, age and total score intelligence matched controls were studied in order to determine associations between cooperation, reactive aggression and autism spectrum disorder–related social impairments. The participants performed a modified version of the Prisoner's Dilemma task and the Pulkkinen Aggression Machine which measure dimensions of trust, trustworthiness and self-sacrifice in predisposition to cooperate, and inhibition of reactive aggression in the absence and presence of situational cues, respectively. Autism spectrum disorder severity–related Autism Diagnostic Interview-algorithm scores were ascertained by interviewing the parents of the participants with a semi-structured parental interview (Developmental, Dimensional and Diagnostic Interview). The results showed that albeit the boys with autism spectrum disorder were able to engage in reciprocation and cooperation regardless of their social impairments, their cooperativeness was positively associated with lower levels of reactive aggression and older age. Thus, strengthening inhibition mechanisms that regulate reactive aggression might make boys with autism spectrum disorder more likely to prefer mutual gain over self-interest in cooperation. [ABSTRACT FROM AUTHOR]

Affective response to exercise may mediate the effects of self-paced exercise on exercise adherence. Fiftynine low-active (exercise <60 min/week), overweight (body mass index: 25.0-39.9) adults (ages 18-65) were randomly assigned to self-paced (but not to exceed 76% maximum heart rate) or prescribed moderate intensity exercise (64-76% maximum heart rate) in the context of otherwise identical 6-month print-based exercise promotion programs. Frequency and duration of exercise sessions and affective responses (good/bad) to exercise were assessed via ecological momentary assessment throughout the 6-month program. A regression-based mediation model was used to estimate (a) effects of experimental condition on affective response to exercise (path a = 0.20, SE = 0.28, f2 = 0.02); (b) effects of affective response on duration/latency of the next exercise session (path b = 0.47, SE = 0.25, f2 = 0.04); and (c) indirect effects of experimental condition on exercise outcomes via affective response (path ab = 0.11, SE = 0.06, f2 = 0.10). Results provide modest preliminary support for a mediational pathway linking self-paced exercise, affective response, and exercise adherence. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted to compare the profile of temperament and character dimensions in patients with major depressive disorder and bipolar mood disorder with a control group. Method: In this causal-comparative study, the population consisted of 2 clinical groups (major depressive disorder and bipolar mood disorder) and a non-clinical group. The sample was 193 individuals (77 patients with major depressive disorder, 86 patients with bipolar mood disorder, and 30 controls), with an age range of 18 to 65 years and the mean age of 40.1. They were selected from Roozbeh psychiatric hospital using available sampling method. Tools used in this research included Temperament and Character Inventory-140 and General Health Questionnaire-28. Collected data were analyzed by independent t test and one-way analysis of variance using Statistical Package for the Social Sciences-22 software. Results: The results revealed a significant difference among groups in dimensions of novelty seeking, harm avoidance, persistence, self-directedness, and cooperativeness (P <0.05). The results showed that the mean was different in males and females only in the novelty seeking dimension (P <0.05). Conclusion: In general, our results revealed that patients with major depressive disorder and bipolar mood disorder have different personality profiles in some dimensions of temperament and character compared with the control group. [ABSTRACT FROM AUTHOR]

Background: Persistent pain during pregnancy is a significant health issue, which could be correlated with psychological distress resulting from inadequate social support. This study aims to investigate whether the relationship between poor social support and antenatal pain is mediated by psychological distress. We also aimed to examine whether social cohesion moderates the influence of psychological distress on the relationship between social support and antenatal pain.Methods: We analysed 94,517 pregnancies of women from a Japanese national birth cohort completed questionnaires assessing pain, psychological distress, social support and social cohesion. Psychological distress was assessed using the Kessler Psychological Distress Scale. Two types of models were used: the mediation model to examine whether the association between social support and pain was mediated by psychological distress; the moderated mediation model to analyse whether social cohesion buffered the negative effect of inadequate social support on pain. Demographic, socioeconomic and psychological factors were controlled for in all analyses.Results: Psychological distress was fully mediated the association between social support and pain. Social cohesion had a focal moderation effect on the inverse association between social support and psychological distress (unstandardized regression coefficient [β] = 0.09; 95% CI, 0.07-0.11) and functioned as moderator for the indirect effect of social support on antenatal pain (index of moderated mediation = 0.006; 95% CI, 0.004-0.007).Conclusions: Poor social support was related to antenatal pain through psychological distress, possibly buffered by social cohesion. During the antenatal period, social support and cohesion are important for women.Significance: In this study, poor social support was found to be associated with pain intensity during pregnancy, which was mediated by psychological distress and might be buffered by desirable social cohesion. This finding could potentially help healthcare providers and policy makers to understand the importance of desirable social cohesion in preventing pain among pregnant women. [ABSTRACT FROM AUTHOR]

We performed a quality improvement initiative to reduce unnecessary treatments for acute bronchiolitis (AB) in primary care (PC) and the referral paediatric emergency department (ED). The quality improvement initiative involved two seasons: 2016-2017 (preintervention) and 2017-2018 (postintervention). We distributed an evidence-based protocol, informative posters and badges with the slogan 'Bronchiolitis, less is more'. We also held interactive sessions, and paediatricians received weekly reports on bronchodilator prescription. The main outcome was the percentage of infants prescribed salbutamol. Secondary outcomes were epinephrine, antibiotic and corticosteroid prescription rates. Control measures were ED visit and hospitalisation rates, triage level, length of stay, intensive care admission and unscheduled returns with admission. We included 1878 ED and 1192 PC visits of which 855 (44.5%) and 534 (44.7%) occurred in the postintervention period, respectively. In the ED, salbutamol and epinephrine prescription rates fell from 13.8% (95% CI 11.8% to 16%) to 9.1% (95% CI 7.3% to 11.2%) (p<0.01) and 10.4% (95% CI 8.6% to 12.4%) to 9% (95% CI 7.2% to 11.1%) (n.s.), respectively. In PC, salbutamol, corticosteroid and antibiotic prescription rates fell from 38.3% (95% CI 34.6% to 42.0%) to 15.9% (95% CI 12.9% to 19.5%) (p<0.01), 12.9% (95% CI 10.5% to 15.7%) to 3.6% (95% CI 2.2% to 5.7%) (p<0.01) and 29.6% (95% CI 26.2% to 33.2%) to 9.5% (95% CI 7.2% to 12.5%) (p<0.01), respectively. No significant variations were noted in control measures. We safely decreased the use of unnecessary treatments for AB. Collaboration between PC and ED appears to be an important factor for success. [ABSTRACT FROM AUTHOR]

In this study, we aim to describe the pathways to care for patients with first-episode psychosis in Singapore. We analyzed data from 900 individuals accepted by the Singapore Early Psychosis Intervention Programme between 2007 and 2012. The most common first contacts were specialist care (59%), primary care (27%), and the police (12%). Multivariate regression models showed that first contact with services varied according to demographic variables and diagnosis. The duration of untreated psychosis, total number of contacts before referral, and rate of referral to the Early Psychosis Intervention Programme varied according to demographic and clinical variables and first contact. We hope that this information will enable clinicians, managers, and other service providers to target interventions to streamline referrals, reduce distress, and improve the treatment of young people with psychotic illnesses. [ABSTRACT FROM AUTHOR]

Background: Effective communication is critical for health care professionals, particularly in the Emergency Department (ED). However, currently, there is no standardized consultation model that is consistently practiced by physicians or used for training medical graduates. Recently, the 5Cs of Consultation model (Contact, Communicate, Core Question, Collaborate, and Close the Loop) has been studied in Emergency Medicine residents using simulated consultation scenarios.Objective: Using an experimental design, we aimed to evaluate the efficacy of the 5Cs consultation model in a novel learner population (medical students) and in a "real time and real world" clinical setting.Methods: A prospective, randomized, controlled study was conducted at eight large, academic, urban, tertiary-care medical centers (U.S. and Canada). Intervention involved two experimental groups (asynchronous and live training) compared to a baseline control group. All participants placed up to four consult phone calls. A senior physician observed and assessed each call using a preapproved 5Cs checklist and a Global Rating Scale (GRS).Results: Participants who received training (asynchronous or live) scored significantly higher on the 5Cs checklist total and GRS than the control group. Both training methods (asynchronous and live) were equally effective. Importantly, learning gains were sustained as students' 5Cs checklist total and GRS scores remained consistently higher at their second, third, and fourth consult (relative to their first consult). At posttest, all participants reported feeling more confident and competent in relaying patient information.Conclusion: Medical students can be trained to use the 5Cs model in a timely, inexpensive, and convenient manner and increase effectiveness of physician consultations originating from the ED. [ABSTRACT FROM AUTHOR]

Background: Assessing the fidelity of an implementation strategy is important to understand why and how the strategy influences the uptake of evidence-based interventions. The present study aims to assess the fidelity of the two procedures for engaging primary care (PC) professionals and for the deployment of an implementation strategy for optimizing type 2 diabetes prevention in routine PC within the PREDIAPS randomized cluster implementation trial. Method: We conducted a mixed-method fidelity evaluation study of the PVS-PREDIAPS implementation strategy. Nine PC centers from the Basque Health Service (Osakidetza) were allocated to two different procedures to engage physicians and nurses and deploy a implementation strategy to model and adapt the clinical intervention and its implementation to their specific contexts: a Global procedure, promoting the cooperation of all healthcare professionals from the beginning; or a Sequential procedure, centered first on nurses who then pursued the pragmatic cooperation of physicians. Process indicators of the delivery and receipt of implementation strategy actions, documented modifications to the planned implementation strategy, and a structured group interview with centers' leaders were all used to assess the following components of fidelity: adherence, dose, quality of delivery, professionals' responsiveness and program differentiation. Results: Generally, the procedures compared for professionals engagement and deployment of the implementation strategy were carried out with the planned differentiation. Nonetheless, some unexpected between-group differences were observed, the initial rate of collaboration of nurses being higher in the Sequential (93%) than in the Global (67%) groups. Exposure rate to the programed implementation actions (% of hours received out of those delivered) were similar in both groups by professional category, with nurses (86%) having a higher rate of exposure than physicians (75%). Professionals identified half of the planned discrete strategies and their rating of strategies' perceived usefulness was overwhelmingly positive, with few differences between Sequential and Global centers. Conclusions: The PVS-PREDIAPS implementation strategy has been implemented with high fidelity and minor unplanned reactive modifications. Professionals' exposure to the implementation strategy was high in both groups. The centers' organizational context (i.e., work overload) led to small mismatches between groups in participation and exposure of professionals to implementation actions. Trial registration: Clinicaltrials.gov identifier: NCT03254979. Registered 16 August 2017. [ABSTRACT FROM AUTHOR]

Background: Coronary heart disease (CHD) is the leading cause of death and years of life lost worldwide. While effective treatments are available for both acute and chronic disease stages there are unmet needs for effective interventions to support patients in health behaviors required for secondary prevention. Psychosocial distress is a common comorbidity in patients with CHD and associated with substantially reduced health-related quality of life (HRQoL), poor health behavior, and low treatment adherence.Methods: In a confirmatory, randomized, controlled, two-arm parallel group, multicenter behavioral intervention trial we will randomize 440 distressed CHD patients with at least one insufficiently controlled cardiac risk factor to either their physicians' usual care (UC) or UC plus 12-months of blended collaborative care (TeamCare = TC). Trained nurse care managers (NCM) will proactively support patients to identify individual sources of distress and risk behaviors, establish a stepwise treatment plan to improve self-help and healthy behavior, and actively monitor adherence and progress. Additional e-health resources are available to patients and their families. Intervention fidelity is ensured by a treatment manual, an electronic patient registry, and a specialist team regularly supervising NCM via videoconferences and recommending protocol and guideline-compliant treatment adjustments as indicated. Recommendations will be shared with patients and their physicians who remain in charge of patients' care. Since HRQoL is a recommended outcome by both, several guidelines and patient preference we chose a ≥ 50% improvement over baseline on the HeartQoL questionnaire at 12 months as primary outcome. Our primary hypothesis is that significantly more patients receiving TC will meet the primary outcome criterion compared to the UC group. Secondary hypotheses will evaluate improvements in risk factors, psychosocial variables, health care utilization, and durability of intervention effects over 18-30 months of follow-up.Discussion: TEACH is the first study of a blended collaborative care intervention simultaneously addressing distress and medical CHD risk factors conducted in cardiac patients in a European health care setting. If proven effective, its results can improve long-term chronic care of this vulnerable patient group and may be adapted for patients with other chronic conditions.Trial Registration: German Clinical Trials Register, DRKS00020824, registered on 4 June, 2020; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020824. [ABSTRACT FROM AUTHOR]

Objective To analyze the effect of preoperative nursing intervention on the degree of cooperation in day surgery patients. Methods The clinical data of 56 patients undergoing day surgery in Zhongshan People's Hospital from January 2019 to January 2020 were selected as the object of this study. According to the order of admission, the patients were divided into two groups. The control group had 28 cases and received routine nursing care. The observation group had 28 cases and had strengthened preoperative nursing intervention. The impact on the patient's surgical cooperation was analyzed. Results After the intervention, the pulse rate and blood pressure of patients undergoing day surgery decreased, which was lower in the observation group, and the diference between the two groups were statistically significant (both P <0.05). The S-AI score of day surgery patients decreased, and the observation group was lower. The diference between the two groups were statistically significant (both P <0.05). The surgical cooperation score of the observation group was higher than that of the control group, and the diference between the two groups were statistically significant (both P <0.05). Conclusion Carrying out preoperative nursing interventions for day surgery patients can improve patient cooperation and reduce preoperative stress and anxiety. [ABSTRACT FROM AUTHOR]

Importance: Mental health comorbidities are increasing worldwide and worsen outcomes for people with diabetes, especially when care is fragmented.Objective: To assess whether collaborative care vs usual care lowers depressive symptoms and improves cardiometabolic indices among adults with diabetes and depression.Design, Setting, and Participants: Parallel, open-label, pragmatic randomized clinical trial conducted at 4 socioeconomically diverse clinics in India that recruited patients with type 2 diabetes; a Patient Health Questionnaire-9 score of at least 10 (range, 0-27); and hemoglobin A1c (HbA1c) of at least 8%, systolic blood pressure (SBP) of at least 140 mm Hg, or low-density lipoprotein (LDL) cholesterol of at least 130 mg/dL. The first patient was enrolled on March 9, 2015, and the last was enrolled on May 31, 2016; the final follow-up visit was July 14, 2018.Interventions: Patients randomized to the intervention group (n = 196) received 12 months of self-management support from nonphysician care coordinators, decision support electronic health records facilitating physician treatment adjustments, and specialist case reviews; they were followed up for an additional 12 months without intervention. Patients in the control group (n = 208) received usual care over 24 months.Main Outcomes and Measures: The primary outcome was the between-group difference in the percentage of patients at 24 months who had at least a 50% reduction in Symptom Checklist Depression Scale (SCL-20) scores (range, 0-4; higher scores indicate worse symptoms) and a reduction of at least 0.5 percentage points in HbA1c, 5 mm Hg in SBP, or 10 mg/dL in LDL cholesterol. Prespecified secondary outcomes were percentage of patients at 12 and 24 months who met treatment targets (HbA1c <7.0%, SBP <130 mm Hg, LDL cholesterol <100 mg/dL [<70 mg/dL if prior cardiovascular disease]) or had improvements in individual outcomes (≥50% reduction in SCL-20 score, ≥0.5-percentage point reduction in HbA1c, ≥5-mm Hg reduction in SBP, ≥10-mg/dL reduction in LDL cholesterol); percentage of patients who met all HbA1c, SBP, and LDL cholesterol targets; and mean reductions in SCL-20 score, Patient Health Questionnaire-9 score, HbA1c, SBP, and LDL cholesterol.Results: Among 404 patients randomized (mean [SD] age, 53 [8.6] years; 165 [40.8%] men), 378 (93.5%) completed the trial. A significantly greater percentage of patients in the intervention group vs the usual care group met the primary outcome (71.6% vs 57.4%; risk difference, 16.9% [95% CI, 8.5%-25.2%]). Of 16 prespecified secondary outcomes, there were no statistically significant between-group differences in improvements in 10 outcomes at 12 months and in 13 outcomes at 24 months. Serious adverse events in the intervention and usual care groups included cardiovascular events or hospitalizations (4 [2.0%] vs 7 [3.4%]), stroke (0 vs 3 [1.4%]), death (2 [1.0%] vs 7 [3.4%]), and severe hypoglycemia (8 [4.1%] vs 0).Conclusions and Relevance: Among patients with diabetes and depression in India, a 12-month collaborative care intervention, compared with usual care, resulted in statistically significant improvements in a composite measure of depressive symptoms and cardiometabolic indices at 24 months. Further research is needed to understand the generalizability of the findings to other low- and middle-income health care settings.Trial Registration: ClinicalTrials.gov Identifier: NCT02022111. [ABSTRACT FROM AUTHOR]

Background Pulmonary hypertension is a rare, chronic and life-threatening group of diseases. Recent advances in pulmonary hypertension management prolong survival and improve quality-of-life. However, highly complex drug therapy enhances the risk of drug-related problems. Objective To assess the impact of involving clinical pharmacists in the collaborative care of pulmonary hypertension patients. Setting Ten French University Hospital Pneumology departments, all members of the French Network for Pulmonary Hypertension. Methods This prospective multicenter randomized controlled trial included incident pulmonary hypertension patients who were followed-up for 18 months. Randomization using an adapted Zelen method allocated patients to collaborative care (n = 41) or usual care groups (n = 51). A collaborative care program involving clinical pharmacists was developed through a close partnership between with physicians, nurses and pharmacists. Besides usual care, the program includes regular one-to-one interviews between the pharmacist and the patient. These interviews had following objectives: to perform an exhaustive medication history review; to identify the patient' needs, knowledge and skills; to define educational objectives and to provide patients with relevant information when needed. Following each interview, a standardized report form containing the pharmacist's recommendations was provided to physicians and nurses and discussed collaboratively. An ancillary economic analysis was performed. Main outcome measure Number of drug-related problems and their outcomes. Results The number of drug-related problems was not significantly different between groups (1.6 ± 1.5 vs. 1.9 ± 2.4; p = 0.41). More problems were resolved in the collaborative care group than in the usual care group (86.5% vs. 66.7%, p = 0.01). Time to clinical worsening, therapeutic adherence, satisfaction or quality-of-life were not statistically different between groups. Collaborative care decreased costs of drug-related hospitalizations. Conclusion Including clinical pharmacists in the multidisciplinary care of hospitalized patients with pulmonary hypertension improved the outcome of drug-related problems and reduced the costs of related hospitalization. However, we observed no efficacy on medication errors, clinical outcomes or medication adherence. Clinical Trial Registration ClinicalTrials.gov Identifier NCT01038284. [ABSTRACT FROM AUTHOR]

Objectives and Design: There is growing recognition of the need for effective behaviour change interventions to prevent chronic diseases that are feasible and sustainable and can be implemented within routine health care systems. Focusing on implementation from the outset of intervention development, and incorporating multiple stakeholder perspectives to achieve this, is therefore essential. This study explores the development of the Choosing Healthy Eating for Infant Health (CHErIsH) childhood obesity prevention intervention and implementation strategy to improve infant feeding behaviours.Methods: Five qualitative and quantitative evidence syntheses, two primary qualitative studies, and formal/informal consultations were conducted with practice, policy, research, and parent stakeholders. The Behaviour Change Wheel was used to guide the integration of findings.Results: The CHErIsH intervention targets parent-level behaviour change and comprises (1) brief verbal messages and (2) trustworthy resources, to be delivered by health care professionals (HCPs) during routine infant vaccination visits. The implementation strategy targets HCP-level behaviour change and comprises (1) a local opinion leader, (2) incentivized training, (3) HCP resources and educational materials, (4) electronic delivery prompts, (5) awareness-raising across all primary care HCPs, and (6) local technical support.Conclusions: This study provides a rigorous example of the development of an evidence-based intervention aimed at improving parental infant feeding behaviours, alongside an evidence-based behaviour change strategy to facilitate implementation and sustainability in primary care. This approach demonstrates how to systematically incorporate multiple stakeholder perspectives with existing literature and move from multiple evidence sources to clearly specified intervention components for both the intervention and implementation strategy. Statement of Contribution What is already known? Incorporating insights from practice, policy, and public/patient stakeholders plays a key role in developing behaviour change interventions that are feasible and sustainable and can be implemented within routine health care systems. However, there are limited examples that provide in-depth guidance of how to do this using a systematic approach. What this study adds? This study describes an innovative use of the Behaviour Change Wheel to integrate multiple sources of evidence collected from practice, policy, research, and parent stakeholders to concurrently develop an evidence-based intervention to improve parental infant feeding behaviours and an implementation strategy to facilitate sustainable delivery by health care professionals in routine primary care. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To gain knowledge of prevention and use of restraints in provision of medical care to people with intellectual disability. To this end, we explore how learning disability nurses in community services support the individual through medical examinations when facing resistance. Background: Despite increased focus on limiting restraints, there is a lack of knowledge of how restraints are prevented and used in the delivery of physical health care to people with intellectual disability. Design: We used an ethnographic comparative case design (n = 6). Methods: The study was carried out in Norway. The analysis is based on data from semi‐structured interviews, participant observation and document studies, in addition to health sociological perspectives on how to support individuals to make their body available for medical examination and intervention. The SRQR checklist was used. Results: Learning disability nurses strove to ensure that examinations were carried out on the individual's terms, supporting the individual in three phases: preparing for the examination, facilitating the examination and, when facing resistance, intervening to ensure safe and compassionate completion of the examination. Conclusions: Supporting the person was a precarious process where professionals had to balance considerations of voluntariness and coercion, progress and breakdown, safety and risk of injury, and dignity and violation. Through their support, learning disability nurses helped to constitute the "resistant" individual as "a cooperative patient," whose body could be examined within the knowledge and methods of medicine, but who could also be safeguarded as a human being through the strain of undergoing examination. Relevance to clinical practice: The article sheds light on how restraints are used in the medical examination and treatment of people with intellectual disabilities and demonstrates the significance of professional support workers' contributions, both in facilitating safe and efficient medical care and in ensuring the least restrictive and most compassionate care possible. [ABSTRACT FROM AUTHOR]

Universities around the world face a common challenge - producing graduates with the necessary practical skills for employment. Cooperative education and work-integrated learning (WIL) make a valuable contribution to increasing graduate employability, however, there are differences in the level of cooperation from industry and government commitment. A comparative study of WIL in Germany, Australia, and South Korea, focusing predominantly on three universities, showed differences in the approaches to achieving practical experience and increasing graduate employability. The data underlying the research was derived from questionnaires, a focus group session, and the development of a descriptive, multi-case study. This allowed comparisons and contrasts between the three universities to be identified. The results and conclusions outlined in this paper aim to highlight best practice in cooperative education and WIL and provide recommendations for the future development of cooperative education, in order to improve graduate employability. [ABSTRACT FROM AUTHOR]

Background: This study presents a way for health services to improve service access for hardly reached people through an exploration of how staff can find and collaborate with citizens (referred to as connectors) who span socio-cultural boundaries in their community. The study explored the local socio-cultural contexts of connectors' boundary spanning activities and if they are health related; boundary spanning occurring between connectors and health professionals at the interface of health systems and community; and the opportunities and barriers to actively seeking out and collaborating with community connectors to access marginalised and hardly reached people.Methods: We conducted a qualitative case comparison from rural Ireland and Australia. Following purposive snow-ball sampling techniques to recruit participants, semi-structured interviews were conducted with 34 community informants, 21 healthcare staff and 32 connectors. Transcripts were coded and analysed using an inductive approach to ascertain categories and overall themes.Results: We found a diverse sample of connectors relating to heterogenous, small and locally distinct groups of hardly reached people. Overall 26 connectors were active at the interface between health services and the community, with variation in how this occurred between cases. The majority (21) described one or more health related activities with hardly reached people. All connectors expressed a willingness to develop a relationship with local health services on issues they identified as relevant. Barriers to collaborations between connectors and health services related to bureaucracy, workload, and burnout.Conclusions: Collaborating with connectors has potential as one strategy to improve access to health services for hardly reached people. To enact this, health staff need to identify local socio-cultural boundaries and associated connectors, facilitate two-way connections at the boundary between health services and community and enable collaboration by attending to activities in the community, at the interface between health services and community, and within the health system. [ABSTRACT FROM AUTHOR]

Background: Many UK GP practices now employ a practice pharmacist, but little is known about how GPs and pharmacists work together to optimise medications for complex patients with multimorbidity.Aim: To explore GP and pharmacist perspectives on collaborative working within the context of optimising medications for patients with multimorbidity.Design and Setting: A qualitative analysis of semi-structured interviews with GPs and pharmacists working in the West of England, Northern England, and Scotland.Method: Thirteen GPs and 10 pharmacists were sampled from practices enrolled in the 3D trial (a complex intervention for people with multimorbidity). Participants' views on collaborative working were explored with interviews that were audiorecorded, transcribed, and analysed thematically. Saturation of data was achieved with no new insights arising from later interviews.Results: GPs from surgeries that employed a pharmacist tended to value their expertise more than GPs who had not worked with one. Three key themes were identified: resources and competing priorities; responsibility; and professional boundaries. GPs valued pharmacist recommendations that were perceived to improve patient safety, as opposed to those that were technical and unlikely to benefit the patient. Pharmacists who were not known to GPs felt undervalued and wanted feedback from the GPs about their recommendations, particularly those that were not actioned.Conclusion: A good working relationship between the GP and pharmacist, where each profession understood the other's skills and expertise, was key. The importance of face-to-face meetings and feedback should be considered in future studies of interdisciplinary interventions, and by GP practices that employ pharmacists and other allied health professionals. [ABSTRACT FROM AUTHOR]

Rationale: Lung-protective ventilation (LPV) improves outcomes in patients with acute respiratory distress syndrome (ARDS) and has also shown benefits in patients without ARDS. Despite this evidence, LPV use remains low.Objectives: To understand clinicians' perceptions of using behavioral economic strategies to improve rates of LPV use.Methods: We conducted semistructured interviews of clinicians across seven intensive care units within a university health system. We purposefully sampled clinicians of different professional backgrounds and experience levels. Each interview included descriptions of three of five strategies grounded in behavioral economic theory designed to facilitate clinicians' use of LPV: 1) an order set autopopulated with LPV settings ("default"), 2) an order set providing a choice between autopopulated LPV settings and open-ended order entry for alternative settings ("active choice"), 3) requirement of written justification if settings other than LPV were ordered or documented ("accountable justification"), 4) automated ARDS identification and clinician prompting ("alert"), and 5) provision of clinicians' and their peers' individual rates of LPV use ("peer comparison"). Descriptions were followed by open-ended questions to elicit perceptions about advantages, disadvantages, and acceptability. Initial interview transcripts were reviewed by two investigators to develop a thematic codebook, which was refined iteratively with the use of constant comparative methods.Results: We completed 17 interviews of physicians, nurse practitioners, and respiratory therapists. Strategies that prepopulated settings (default, active choice, and accountable justification) were perceived as providing benefit by reducing workloads and serving as cognitive prompts. The default and active choice strategies were more acceptable than accountable justification, which was perceived as potentially frustrating due to workflow impedance. The alert strategy was met with concerns about alert accuracy and alarm fatigue. The peer comparison strategy led to concerns about timing and fear of punitive measures. Participants believed that the default and active choice strategies would be highly acceptable, whereas few interviewees thought the alert would be acceptable. The active choice strategy was most consistently identified as potentially highly effective.Conclusions: Behavioral economic strategies have great potential as acceptable and potentially effective strategies to increase the use of LPV. [ABSTRACT FROM AUTHOR]

Abstract: Evolutionary games can model dilemmas for which cooperation can exist in rational populations. According to intuition, memory of the history can help individuals to overcome the dilemma and increase cooperation. However, here we show that no such general predictions can be made for dilemma games with memory. Agents play repeated prisoner’s dilemma, snowdrift, or stag hunt games in well-mixed populations or on a lattice. We compare the cooperation ratio and fitness for systems with or without memory. An interesting result is that cooperation is demoted in snowdrift and stag hunt games with memory when cost-to-benefit ratio is low, while system fitness still increases with memory in the snowdrift game. To illustrate this interesting phenomenon, two further experiments were performed to study , , and reciprocity and investigate 16 agent strategies for one-step memory. The results show that memory plays different roles in different dilemma games. [Copyright &y& Elsevier]

Objective: To characterize the nature and degree of hospitals' efforts to collaborate with skilled nursing facilities (SNFs) and associated patient outcomes.Data Sources/study Setting: Qualitative data were collected through 138 interviews with staff in 16 hospitals and 25 SNFs in eight markets across the United States in 2015. Quantitative data include Medicare claims data for the 290,603 patients discharged from those 16 hospitals between 2008 and 2015.Study Design/data Collection: Semi-structured interviews with hospital and SNF staff were coded and used to classify hospitals' collaboration efforts with SNFs into high versus low collaboration hospitals, and risk-adjusted, claims-based hospital readmission rates from SNF were compared.Principal Findings: Hospital collaboration efforts were defined as establishing SNF partners, transition management initiatives, and hospital staff visits to SNFs. High collaboration hospitals were more likely to send patients to SNFs (as opposed to home, home with home health, or other PAC settings), sent a higher share of patients to high quality SNFs, and had fewer hospital readmissions from SNF sooner than did low collaboration hospitals.Conclusions: Although collaboration with SNF requires significant administrative and clinical time investment, it is associated with positive patient outcomes. [ABSTRACT FROM AUTHOR]

Global health partnerships (GHPs) are the conceptual cousin of partnerships in the development sphere. Since their emergence in the 1990s, the GHP mode of working and funding has mainly been applied to single-disease, vertical interventions. However, GHPs are increasingly being used to enact Health Systems Strengthening and to address the global health worker shortage. In contrast to other critical explorations of GHPs, we explore in this article how the fact, act, and aspiration of binding different actors together around the ideology and modes of partnership working produces the perpetual state of being in a bind. This is an original analytical framework drawing on research in Sierra Leone and London. We offer new insights into the ways in which GHPs function and are experienced, showing that along with the successes of partnership work, such arrangements are often and unavoidably tense, uncomfortable, and a source of frustration and angst. [ABSTRACT FROM AUTHOR]

The GT3X+ worn at the wrist promotes greater compliance than at the hip. Minutes in SB and PA calculated from raw accelerations at the hip and wrist provide contrasting estimates and cannot be directly compared. Wear-time for the wrist (15.6 to 17.4 h.d-1) was greater than the hip (15.2 to 16.8 h.d-1) across several wear-time criteria (all P < 0.05). Moderate-strong associations were found between time spent in SB (r = 0.39), LPA (r = 0.33), MPA (r = 0.99), VPA (r = 0.82) and MVPA (r = 0.81) between the two device placements (All P < 0.001). The wrist device detected more minutes in LPA, MPA, VPA and MVPA whereas the hip detected more SB (all P = 0.001). Estimates of time in SB and all activity outcomes from the wrist and hip lacked equivalence. One hundred and eighty-eight 9-12-year-old children wore a wrist- and hip-mounted accelerometer for 7 days. Data were available for 160 (hip) and 161 (wrist) participants. Time spent in SB and PA was calculated using GGIR. This study examined the compliance of children wearing wrist- and hip-mounted ActiGraph GT3X+ accelerometers and compared estimates of sedentary behaviour (SB) and physical activity (PA) between devices. [ABSTRACT FROM AUTHOR]

This article reports on a cluster randomized trial of cooperative learning (CL) as a way to prevent escalation in alcohol use during middle school (N = 1,460 seventh-grade students, age 12-13, seven intervention and eight control schools). We hypothesized that CL, by bringing students together in group-based learning activities using positive interdependence, would interrupt the process of deviant peer clustering, provide at-risk youth with prosocial influences, and in turn, reduce escalations in alcohol use. Results indicated that CL significantly reduced growth in deviant peer affiliation and actual alcohol use, and effects for willingness to use alcohol were at the threshold of significance (p = .05). CL also attenuated the link between willingness to use alcohol and later alcohol use. [ABSTRACT FROM AUTHOR]

Aim: To record the types of conflict management that health professionals in Cyprus hospitals encounter in their daily work and to explore the conflicts, their parameters and causes, and the role ambiguity faced by the hospital employees. Material and Methods: This is a descriptive study in which data were collected with an anonymous self‐referral questionnaire. The study population consisted of 300 health professionals from six different hospitals in Cyprus. Data are presented with averages and standard deviations. Results: The health professionals identified the following causes of conflicts in the workplace in descending order: heavy workload, low pay, and varying instructions from different leaders. To deal with the conflict, 73.2% of the participants reported using avoidance, 54.2% engaged in negotiation for mutual benefit, and 40.5% cited compromise as a method. Conclusions: Identifying the way in which conflicts are managed contributes to the smooth functioning of organisations, and it improves the effectiveness of the services provided. Implications for Nursing Management: It is generally known that the high levels of conflict in hospitals are associated with increased mistakes and low employee satisfaction and performance levels. Managers deal with conflict‐management issues within organisations on a daily basis. It is therefore essential to comprehend the reasons behind conflicts and provide suitable training for the development of communication skills and conflict‐management strategies. [ABSTRACT FROM AUTHOR]

Objective: To characterize the motivations of stakeholders from diverse sectors who engaged in cross-sector collaboration with an academic medical center.Data Source: Primary qualitative data (2014-2015) were collected from 22 organizations involved in a cross-sector diabetes intervention on the South Side of Chicago.Study Design: In-depth, semistructured interviews; participants included leaders from all stakeholder organization types (e.g., businesses, community development, faith-based) involved in the intervention.Data Collection Methods: Data were transcribed verbatim from audio and video recordings. Analysis was conducted using the constant comparison method, derived from grounded theory.Principal Findings: All stakeholders described collaboration as an opportunity to promote community health in vulnerable populations. Among diverse motivations across organization types, stakeholders described collaboration as an opportunity for: financial support, brand enhancement, access to specialized skills or knowledge, professional networking, and health care system involvement in community-based efforts. Based on our findings, we propose a framework for implementing a working knowledge of stakeholder motivations to facilitate effective cross-sector collaboration.Conclusions: We identified several factors that motivated collaboration across diverse sectors with health care systems to promote health in a high-poverty, urban setting. Understanding these motivations will be foundational to optimizing meaningful cross-sector collaboration and improving diabetes outcomes in the nation's most vulnerable communities. [ABSTRACT FROM AUTHOR]

Publicly insured children needing referral to mental health (MH) services often do not access or receive services. The objective of this study was to identify gaps in communication and coordination between primary care providers (PCPs) and MH providers during the MH referral and care process for publicly insured children. Thirteen semi-structured interviews were conducted with 10 PCPs and staff from a federally qualified health center (FQHC) and 6 MH providers and staff from two local MH clinics. Interview participants identified multiple gaps in communication throughout the care process and different phases as priorities for improvement. PCPs described primary care-MH communication challenges during early phases, while MH providers described coordination challenges in transferring patients back to primary care for ongoing mental health management. Strategies are needed to improve primary care-specialty MH communication and coordination throughout all phases of the referral and care process, particularly at initial referral and transfer back to primary care. [ABSTRACT FROM AUTHOR]

Although cooperation is a widespread phenomenon in nature, human cooperation exceeds that of all other species with regard to the scale and range of cooperative activities. Here we review and discuss differences between humans and non-humans in the strategies employed to maintain cooperation and control free-riders. We distinguish forms of cooperative behaviour based on their influence on the immediate payoffs of actor and recipient. If the actor has immediate costs and only the recipient obtains immediate benefits, we term this investment. If the behaviour has immediate positive effects for both actor and recipient, we call this a self-serving mutually beneficial behaviour or mutual cooperation. We argue that humans, in contrast to all other species, employ a wider range of enforcement mechanisms, which allow higher levels of cooperation to evolve and stabilize among unrelated individuals and in large groups. We also discuss proximate mechanisms underlying cooperative behaviour and focus on our experimental work with humans and our closest primate relatives. Differences in the proximate mechanisms also seem to contribute to explaining humans' greater ability to cooperate and enforce cooperation. [ABSTRACT FROM AUTHOR]

Objectives: Effective communication is a critical component of quality health care, and to improve it we must understand its dynamics. This investigation examined the extent to which physicians' and patients' preferences for control in their relationship (e.g., shared control vs doctor control) were related to their communications styles and adaptations (i.e., how they responded to the communication of the other participant).Design: Stratified case-controlled study.Patients/participants: Twenty family medicine and internal medicine physicians and 135 patients.Measurements: Based on scores from the Patient-Practitioner Orientation Scale, 10 patient-centered physicians (5 male, 5 female) and 10 doctor-centered physicians (5 male, 5 female) each interacted with 5 to 8 patients, roughly half of whom preferred shared control and the other half of whom were oriented toward doctor control. Audiotapes of 135 consultations were coded for behaviors indicative of physician partnership building and active patient participation.Main Results: Patients who preferred shared control were more active participants (i.e., expressed more opinions, concerns, and questions) than were patients oriented toward doctor control. Physicians' beliefs about control were not related to their use of partnership building. However, physicians did use more partnership building with male patients. Not only were active patient participation and physician partnership building mutually predictive of each other, but also approximately 14% of patient participation was prompted by physician partnership building and 33% of physician partnership building was in response to active patient participation.Conclusions: Communication in medical encounters is influenced by the physician's and patient's beliefs about control in their relationship as well as by one another's behavior. The relationship between physicians' partnership building and active patient participation is one of mutual influence such that increases in one often lead to increases in the other. [ABSTRACT FROM AUTHOR]

Simulation has become increasingly important in teaching clinical nursing skills. Cooperative simulation practices based on social interdependence theory support skill acquisition by reducing student anxiety through practice. The aim of this experimental study, conducted with 60 junior nursing students, was to compare the effects of cooperative versus individual practice on psychomotor skill performance and student anxiety during simulation with a standardized patient. The results demonstrated that students who performed practice cooperatively had higher psychomotor skills scores and lower anxiety scores. [ABSTRACT FROM AUTHOR]

The Centipede game is an abstract model of reciprocal relationships in which two individuals alternate in helping each other at relatively small personal cost. Whereas mutual cooperation can benefit both individuals in the long run, a paradoxical but logically compelling backward induction argument suggests that cooperation is irrational. Empirical studies have reported reliable deviations from the non-cooperative backward induction solution, but their exclusively quantitative methods allow only a limited range of predefined motives to be explored. Our study uses verbal ('think aloud') protocols and qualitative data analysis to identify motives for cooperation in the Centipede game. The results provide little evidence for sophisticated backward induction reasoning. Instead, a wide range of motives emerged, their relative saliences varying according to the stage of the game. Activity bias affected decisions mainly at the beginning of the game, whereas cooperative and altruistic social value orientations most frequently accounted for cooperation towards its natural end. [ABSTRACT FROM AUTHOR]