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BACKGROUND Quality leaders are concerned that creation of multi-hospital health systems may lead to surgeons traveling to and from distant hospitals and thus to more fragmented surgical care and worse outcomes for their patients. Despite this concern, little empirical data exist on outcomes of multi-site vs. single-site surgeons. METHODS Using national Medicare data, we assessed trends in the number of multi-site vs. single-site surgeons from 2011 to 2016. We performed a multivariable regression analysis to compare overall 30-day mortality differences, stratified by system and rural status, and examined trends over time. RESULTS The number of multi-site surgeons and the percentage of multi-site surgeons per hospital decreased over time (24.2% to 19.0%; 44.3% to 41.8%). Overall, multi-site surgeons had lower 30-day mortality than single-site surgeons (2.24% vs. 2.50%, p < 0.01). When stratified by system status, multi-site surgeons performed better in-system (2.47% vs. 2.58%, p < 0.01); by rural status, multi-site surgeons had lower mortality in non-rural hospitals (2.42% vs. 2.51%, p < 0.01). The statistically significant but small mortality advantage of multi-site vs. single-site surgeons decreased over time, such that by 2016 there was no difference in outcomes between multi-site and single-site surgeons. CONCLUSION For the majority of study years, multi-site surgeons had lower 30-day mortality than single-site surgeons, but this trend narrowed until outcomes were equivalent by 2016. Surgeons operating at multiple hospitals can provide surgical care to patients without any evidence of increased mortality.

The purpose of this study was to analyse journalists’ routines and decision-making in gathering and publishing death-related visuals. Empirical data were collected by analysing visuals published in two cases: the death of a teen, and a person who had a mental illness. We conducted eight in-depth interviews with people involved in publishing the visuals. The data showed no guidelines in the newsroom of how journalists should act when covering sensitive topics. Although producing or publishing the visuals depended on various beliefs and professional norms of people involved, the reporter as the last link in the chain had to take responsibility for the visuals. Yet, reporters usually did not get to choose how the visuals were produced. The lack of instructions and internal agreements led to relying on routines that did not consider the ethical aspects of covering sensitive topics.

The subthalamic nucleus and internal pallidum are main target sites for deep brain stimulation in Parkinson’s disease. Multiple trials that investigated subthalamic versus pallidal stimulation were unable to settle on a definitive optimal target between the two. One reason could be that the effect is mediated via a common functional network. To test this hypothesis, we calculated connectivity profiles seeding from deep brain stimulation electrodes in 94 patients that underwent subthalamic and 28 patients with pallidal treatment based on a normative connectome atlas calculated from 1000 healthy subjects. In each cohort, we calculated connectivity profiles that were associated with optimal clinical improvements. The two maps showed striking similarity and were able to cross-predict outcomes in the respective other cohort (R = 0.37 at P < 0.001; R = 0.34 at P = 0.032). Next, we calculated an agreement map, which retained regions common to both target sites. Crucially, this map was able to explain an additional amount of variance in clinical improvements of either cohort when compared to the maps calculated on each cohort alone. Finally, we tested profiles and predictive utility of connectivity maps calculated from different motor symptom subscores with a specific focus on bradykinesia and rigidity. While our study is based on retrospective data and indirect connectivity metrics, it may deliver empirical data to support the hypothesis of a largely overlapping network associated with effective deep brain stimulation in Parkinson’s disease irrespective of the specific target.

Patient-centred outcomes are increasingly recognised as crucial measures of healthcare quality. Days alive and at home up to 30 days after surgery (DAH30 ) is a validated and readily obtainable patient-centred outcome measure that integrates much of the peri-operative patient journey. However, the minimal difference in DAH30 that is clinically important to patients is unknown. We designed and administered a 28-item survey to evaluate the minimal clinically important difference in DAH30 among adult patients undergoing inpatient surgery. Patients were approached pre-operatively or within 2 days postoperatively. We did not study patients undergoing day surgery or nursing home residents. Patients ranked their opinions on the importance of discharge home using a Likert scale (from 1, not important at all to 6, extremely important) and the minimum number of extra days at home that would be meaningful using this scale. We recruited 104 patients; the survey was administered pre-operatively to 45 patients and postoperatively to 59 patients. The mean (SD) age was 53.5 (16.5) years, and 51 (49%) patients were male. Patients underwent a broad range of surgery of mainly intermediate (55%) to major (33%) severity. The median minimal clinically important difference for DAH30 was 3 days; this was consistent across a broad range of scenarios, including earlier discharge home, complications delaying hospital discharge and the requirement for admission to a rehabilitation unit. Discharge home earlier than anticipated and discharge home rather than to a rehabilitation facility were both rated as important (median score = 5). Empirical data on the minimal clinically important difference for DAH30 may be useful to determine sample size and to guide the non-inferiority margin for future clinical trials.

Bullying is an increasingly common problem in schools, associated with negative educational outcomes for both bullies and victims. This study explored the socio-educational family and school variables related to bullying, victimization and positive behavior, such as age, gender, separation from parents, school results, and truancy. In this study 311 students (50.8% boys) have participated, they were aged between 6 and 16 years (M = 11.01, SD = 1.71), enrolled in primary school (47.3%) and in secondary school (52.7%), all were from urban areas. 43.8% of respondents were separated from one or both parents due to divorce (17.4%), parental death (6.1%), migration (20%) or abandonment (0.3%). Bullying, victimization and positive behavior were measured with one standardized scale; the data about school results and attendance of the students was collected from the school registers; family information was self-reported by participants. Because Cronbach’s Alpha for the positive behavior scale was 0.57, lower that 0.7, this scale was not considered for further data analysis. Empirical data for the study was collected before the outbreak of the COVID-19 pandemic. The Mann-Whitney U test showed significant age differences: secondary school students scored higher in aggression than primary school students. We also found significant gender differences in bullying behavior: boys’ reported higher level of aggression. The Independent Sample Student’s t-test indicated gender differences in school results: the boys obtained lower school results in Language and Mathematics than the girls. Separation from one or both parents did not lead to significant differences in bullying behavior, but pupils separated from their parents had fewer school absences than their colleagues not separated from their parents. Pearson’s correlation indicated that students with higher bullying scores, also scored higher on victimization and had higher number of school absences, but had scored lower grades in Language and Mathematics. One-way ANOVA indicated that victimization was influenced by age and bullying was influenced by gender. Also, one-way ANOVA indicated an effect of bullying on school results. Two-way ANOVA showed an interaction effect between gender and separation from parents on bullying. When living with both parents, boys had higher bullying scores, but under separation condition, the boys scored slightly lower than girls. The implications of the results for education and counseling are discussed.

This study measured the impacts of failure in Crisis and Emergency Risk Communication (CERC) during the outbreak of a contagious Corona viral disease. The study measured the impacts by the number of individuals and hospitals exposed to the virus. The 2015 Middle East Respiratory Syndrome (MERS) outbreak in South Korea was used to investigate the consequences of CERC failure, where the names of hospitals exposed to MERS‐CoV were withheld from the public during the early stage of virus diffusion. Empirical data analyses and simulated model tests were conducted. The findings of analyses and tests show that an early announcement of the hospital names and publicizing the necessary preventive measures could have reduced the rate of infection by approximately 85% and the number of contaminated healthcare facilities by 39% at maximum. This level of reduction is comparable to that of vaccination and of social distancing.

Aim: Against the background of the rising number of elderly people being incarcerated and the rare data on this special subgroup, the aim of our study was to collect first empirical data on the affective state of elderly prisoners in North Rhine Westphalia, Germany. Methods: Data were collected in nine German prisons. We included elderly prisoners from pretrial prevention, penal sentences, open enforcement, preventive detention and from special detention units for elderly inmates. For the evaluation of the affective state, we used the Patient Health Questionnaire (PHQ-9). Sociodemographic and crime-related characteristics were documented. Findings: In total, n=116 prisoners (91.4% male) were included. The age ranged from 53 to 91 years (65.6±6.3 years). In our sample, 48% reported at least mild depressive symptoms, which is a significantly higher prevalence of depressive symptomatology than in the general population aged 60 years and older. Differences were found with regard to the type of detention, as prisoners in open enforcement showed significantly less symptoms compared to those in pretrial prevention and preventive detention. The participants reported in general more somatic symptoms as sleep disturbances and fatigue compared to mood items as feelings of sadness. Originality: It is the first study assessing the affective state of older prisoners in Germany. The high rate of depressive symptoms in our sample is in line with findings from international studies underlining the need for adequate diagnostics and therapy. In addition, in a previous study depression was indirectly linked with a greater risk of re-incarceration, fortifying the need for successful treatment of depression in prison both for the individuum and for society.

Clinical cancer genomic testing based on next-generation sequencing can help select genotype-matched therapy and provide diagnostic and prognostic information. Pathological tissue from malignant tumors obtained during routine practice are frequently used for genomic testing. This article is aimed to standardize the proper handling of pathological specimens in practice for genomic medicine based on the findings established in "Guidelines on the handling of pathological tissue samples for genomic medicine (in Japanese)" published by The Japanese Society of Pathology (JSP) in 2018. The two-part practical guidelines are based on empirical data analyses; Part 1 describes the standard preanalytic operating procedures for tissue collection, processing, and storage of formalin-fixed paraffin-embedded (FFPE) samples, while Part 2 describes the assessment and selection of FFPE samples appropriate for genomic testing, typically conducted by a pathologist. The guidelines recommend that FFPE sample blocks be used within 3 years from preparation, and the tumor content should be >= 30% (minimum 20%). The empirical data were obtained from clinical studies performed by the JSP in collaboration with leading Japanese cancer genome research projects. The Japanese Ministry of Health, Labour, and Welfare (MHLW) recommended to comply with the JSP practical guidelines in implementing cancer genomic testing under the national health insurance system in over 200 MHLW-designated core and cooperative cancer genome medicine hospitals in Japan.

BACKGROUND: By the beginning of December 2020, some vaccines against COVID-19 already presented efficacy and security, which qualify them to be used in mass vaccination campaigns. Thus, setting up strategies of vaccination became crucial to control the COVID-19 pandemic. METHODS: We use daily COVID-19 reports from Chicago and New York City (NYC) from 01-Mar2020 to 28-Nov-2020 to estimate the parameters of an SEIR-like epidemiological model that accounts for different severity levels. To achieve data adherent predictions, we let the model parameters to be time-dependent. The model is used to forecast different vaccination scenarios, where the campaign starts at different dates, from 01-Oct-2020 to 01-Apr-2021. To generate realistic scenarios, disease control strategies are implemented whenever the number of predicted daily hospitalizations reaches a preset threshold. RESULTS: The model reproduces the empirical data with remarkable accuracy. Delaying the vaccination severely affects the mortality, hospitalization, and recovery projections. In Chicago, the disease spread was under control, reducing the mortality increment as the start of the vaccination was postponed. In NYC, the number of cases was increasing, thus, the estimated model predicted a much larger impact, despite the implementation of contention measures. The earlier the vaccination campaign begins, the larger is its potential impact in reducing the COVID-19 cases, as well as in the hospitalizations and deaths. Moreover, the rate at which cases, hospitalizations and deaths increase with the delay in the vaccination beginning strongly depends on the shape of the incidence of infection in each city.

Women were historically excluded from research participation partly due to the assumption that ovarian hormone fluctuations lead to variation, especially in emotion, that could not be experimentally controlled. Although challenged in principle and practice, relevant empirical data are limited by single measurement occasions. The current paper fills this knowledge gap using data from a 75-day intensive longitudinal study. Three indices of daily affective variability—volatility, emotional inertia, and cyclicity—were evaluated using Bayesian inferential methods in 142 men, naturally cycling women, and women using three different oral contraceptive formulations (that “stabilize” hormone fluctuations). Results provided more evidence for similarities between men and women—and between naturally cycling women and oral contraceptive users—than for differences. Even if differences exist, effects are likely small. Thus, there is little indication that ovarian hormones influence affective variability in women to a greater extent than the biopsychosocial factors that influence daily emotion in men.

In Germany, cognitive-behavioral therapy, psychodynamic therapy, and systemic therapy are scientifically and legally approved as suitable procedures for treating mental disorders. While all methods have provided empirical evidence of their effectiveness in adults according to defined criteria of the "Scientific Advisory Board for Psychotherapy" (in German: "Wissenschaftlicher Beirat Psychotherapie"), i. e., the official board which decides upon the formal scientific approval of psychotherapeutic approaches in Germany, an evaluation is lacking for the psychodynamic methods in children and adolescents. Against this background, we evaluated the available empirical data for psychodynamic therapy in children and adolescents based on the methods paper of the "Scientific Advisory Board for Psychotherapy" (2019; version 2.9). Published reviews served as the basis for identifying relevant studies, supplemented by a systematic literature search. We identified 91 potentially relevant studies but could not consider the majority of these due to formal exclusion criteria (mainly not disorder-specific, no control group). Up to 26 of the remaining studies provide evidence of efficacy as defined by the "Scientific Advisory Board for Psychotherapy". These cover 10 of the 18 areas of application as defined by the "Scientific Advisory Board for Psychotherapy". According to our evaluation, the reviewed studies provide empirical evidence for the three most relevant areas of application (i. e., affective disorders; anxiety disorders and obsessive-compulsive disorders; hyperkinetic disorders and conduct disorders). Thus, the available evidence supports the suitability of psychodynamic therapy as a method for the treatment of children and adolescents.

Background In Taekwondo competitions, the rule is that points are scored when the impact of the kick reaches a predetermined threshold of strength. This study aimed to explore the adequacy of the protector and scoring system (PSS) designed to determine taekwondo body scoring based on a reference group model (RGM). Specifically, the kicking impact of the PSS was calculated using data from 188 matches fought during of 2018 Jakarta Asian Games. The RGM was designed based on empirical data by classifying the victory and defeat groups by gender and weight class, and the scoring method was set according to these criteria. Result The result of this study are as follows. First, there was no difference in the average impact of kicks of taekwondo players by weight class. Second, result of setting up the kick scoring impact standards of taekwondo PSS by classifying the winning and non-winning groups, the kick scoring impact set by the WT was found to be high in all weight classes except 58 kg. Lastly, result of comparing the settings of impact to score according to weight classes, the kick scoring impact standard set by the WT was higher in heavyweight (men's: under 80 kg, + 80 kg, women's: under 67 kg, over 67 kg) than in the lightweight (men's: under 58 kg, under 63 kg, under 68 kg, women's: under 49 kg, under 53 kg, under 57 kg). Conclusion The kick scoring impact set by the WT was found to be high in all weight classes except for the under 58 kg class defining kick scoring impact based on the standards of WT-certified PSS by classifying the matches into winning and non-winning groups. Finally, as a result of comparing the scoring impact settings according to weight class, the kick scoring impact standard set by the WT was higher for the heavier weight classes than for the lighter weight classes.

A cross-sectional survey study was conducted to examine older adults hip surgery patients’ post-surgery quality of life, and to study the causal relationships that directly and indirectly influence it. A total of 447 patients who met the inclusion criteria were recruited from eight tertiary care hospitals and four universities in Thailand’ using convenience sampling. The results revealed that post-discharge quality of life in older adults patients following hip surgery was at a moderate level ( $$\overline{X}$$ = 79.40, SD = 12.41). The results of the final model fit well with the empirical data of all variables (X2 = 12.24, df = 15, p = .661, RMSEA = .000, GFI = .99, CFI = 1.00, X2/df = .816). The final model accounted for 16% of the total variance in QoL, 25% of the variance in self-management, and 3% of the variance in physical function recovery. Age, pain, comorbidity, family caregiver support and health service system factors had indirect effects on self-management through physical function recovery and quality of life. Self-management had a direct effect on physical function recovery. Comorbidities and health service system also had direct effects on quality of life. The findings suggest that appropriate health service system factors should be performed to help support self-management, including follow-up services with home or telephone visiting, in order to promote physical function recovery, particularly for female older adults hip surgery patients. This will improve patients’ quality of life.

Despite an international focus on gender inequality in the cultural and creative industries in recent years, there remains a lacuna of empirical data on the gendered dimension of work in opera. Thi...

Введение. Исследование направлено на изучение взаимосвязей между склонностью к различным формам киберагрессии, агрессивностью и эмпатией в подростковом возрасте. Киберагрессия понимается как преднамеренное нанесение вреда другим пользователям Интернета; формы киберагрессии выделяются на основании типологической модели киберагрессии, предложенной К. Рунионсом, которая впервые применена для анализа онлайн-поведения российских подростков. Методы. В исследовании приняли участие 196 подростков в возрасте 12–15 лет. Сбор эмпирических данных осуществлялся с помощью опросника «Типология киберагрессии», адаптированного для русскоязычной выборки в нашем исследовании, а также опросника уровня агрессивности Басса – Перри в адаптации С. Н. Ениколопова и шкалы эмоционального отклика А. Меграбяна в модификации Н. Эпштейна. Результаты. Результаты исследования не позволили зафиксировать взаимосвязей между склонностью к киберагрессии, агрессивностью и эмпатией, которые были бы универсальными на протяжении всего подросткового возраста. Статистически значимые корреляционные связи склонности к киберагрессии с агрессивностью начинают фиксироваться только с 14-летнего, с эмпатией – с 15-летнего возраста. Агрессивность не является значимым предиктором киберагрессии подростков, эмпатия детерминирует склонность к киберагрессии (с отрицательным знаком) только среди 15-летних подростков. Обсуждение результатов. Формулируется предположение о различном психологическом смысле киберагрессии на разных этапах подросткового возраста: киберагрессия как форма «социальных проб», не отражающая личностные особенности подростков, в начале подросткового возраста, и киберагрессия как форма проявления устойчивых личностных черт (прежде всего, дефицита эмпатии) в старшем подростковом возрасте. Заключение. На основании полученных результатов сделан вывод о необходимости дифференцированного подхода к профилактике и коррекции киберагресссии подростков с учетом ее психологического смысла на разных этапах подросткового возраста.

PurposeUtilizing affective event theory (AET), this paper aims to understand the affective reasoning behind choosing to speak up for or against abusive supervision. For this purpose, the authors examine the underlying mechanism of employee state paranoia in the relationship between abusive supervision and promotive and prohibitive voice of employees.Design/methodology/approachData from 307 microfinance bank employees were collected using supervisor–subordinate nested design and time-lag approach. The analysis was performed through partial least square (PLS) structural equation modeling using Smart PLS software.FindingsThe results support the direct relationship of abusive supervision with promotive and prohibitive voice. They also support the mediating relation of paranoia arousal between abusive supervision and promotive voice. However, the results do not support the mediating relationship of paranoia arousal between abusive supervision and prohibitive voice.Originality/valueIn light of the literature drawn from AET and empirical data, this study forwards robust recommendations for theory and practice and may assist future researchers interested in the role of employee paranoia arousal.

The study of factors influencing the success of rehabilitation of persons with acquired musculoskeletal disorders acquired in adulthood is determined by the increasing role in the psychological support and integration of such individuals into society, as well as the lack of methodological approaches and proven recommendations aimed at improving the rehabilitation process. The paper presents the psychological characteristics of people with musculoskeletal disorders acquired in adulthood. According to the results of psychodiagnostic examination, the program of psychological support for persons with musculoskeletal disorders has been developed. The aim of the study was to study the psychological characteristics of persons with acquired disorders of musculoskeletal disorders, to develop and evaluate the effectiveness of the program of psychological rehabilitation. We used the following research methods: clinical and psychological, psychodiagnostic, statistical, methods of analysis of empirical data. The ascertaining study was carried out with two groups: with disorders of the musculoskeletal disorders and without violations of the musculoskeletal disorders (the total number of participants was 60 people). Diagnostic tools: questionnaire Adaptability (A.G. Maklakov, S.V. Chermyanin), Freiburg personality questionnaire (modified by A.A. Krylov, T.I. Ronginskaya), Style of self-regulation of behavior (V.I. Morosanov), Test of resilience (S. Maddy, adaptation by DA Leontiev). Statistical data processing was carried out using the following criteria: Mann-Whitney U-test, Wilcoxon T-test using SPSS Statistics 19. It was revealed that persons with acquired disorders of musculoskeletal disorders are characterized by low adaptive abilities, an increased level of neuropsychic stress. Characterized by an insufficient level of self-regulation, the ability to consciously plan activities. It is determined that resilience is characterized by low involvement, insufficient ability to overcome life difficulties. It is shown that a personal factor that enhances maladjustment is low contact, emotional tension when interacting with others. The proposed program of psychological assistance to persons with disorders of the musculoskeletal system helps to overcome passivity, alienation; the formation of independence, responsibility, an active life position, a system of value orientations, strengthening of social position, and, ultimately, successful social adaptation.

Action-stopping in humans involves bursts of beta oscillations in prefrontal-basal ganglia regions. To determine the functional role of these beta bursts we took advantage of the Race Model framework describing action-stopping. We incorporated beta bursts in three race model variants, each implementing a different functional contribution of beta to action-stopping. In these variants, we hypothesized that a transient increase in beta could 1) modulate decision thresholds, 2) change stop accumulation rates, or 3) promote the interaction between the Stop and the Go process. We then tested the model predictions using EEG recordings in humans performing a Stop-signal task. We found that the model variant in which beta increased decision thresholds for a brief period of time best explained the empirical data. The model parameters fitted to the empirical data indicated that beta bursts involve a stronger decision threshold modulation for the Go process than for the Stop process. This suggests that prefrontal beta influences stopping by temporarily holding the response from execution. Our study further suggests that human action-stopping could be multi-staged with the beta acting as a pause, increasing the response threshold for the Stop process to modulate behavior successfully. Our novel approach of introducing transient oscillations into the race model and testing against human neurophysiological data allowed us to discover potential mechanisms of prefrontal beta, possibly generalizing its role in situations requiring executive control over actions.

The article discusses approaches to the study of the “emotional burnout syndrome” in national and foreign literature and the specifics of current studies. The concept of “professional burnout of psychologists working online” has been clarified. The relevance and necessity of the proposed research because of transition of psychologists’ professional activities to the online space are determined. The article purpose is to empirically investigate the state of the problem, to determine the causes of its occurrence and possible resources for the psychological prophylaxis of professional burnout for psychologists working online. To determine the deepness of psychologists’ professional burnout, the method diagnosing a burnout syndrome in “person-to-person” professions and the author’s questionnaire were used. The experiment involved psychologists engaged in online professional activities (n = 72) with various experience of online working (from 1 to 10 years). The empirical data showed that 17% of psychologists use rarely the Internet for their professional activities, 22% use it at an average level, and 61% use it often. 33% of the surveyed psychologists confirmed that they experience professional exhaustion from activities in the Internet. It was found that 11% of psychologists showed high emotional exhaustion, 67% did an average exhaustion and 22% had low one. 6% of the specialists showed high depersonalization, 61% did average one and 23% showed low depersonalization. 1% of the psychologists showed strong reduction of professional achievements, 78% did average reduction and 6% showed low reduction. The causes of burnout occurrence and the ways for it prevention were determined, and guidelines were developed for the psychological prophylaxis of professional burnout for psychologists working online. Prospects for further work are envisaged in the study of psychological factors developing communicative media competence of future psychologists.

Purpose: The purpose of this study was to statistically verify the effects of blood glucose, blood urea nitrogen (BUN), calcium, and chloride ions on the facial wrinkles of premenopausal women. Methods: Premenopausal women were recruited through the internet to be study participants. Those who had disease or who consumed drugs or health foods such as ginseng were excluded. The levels of blood glucose, BUN, calcium, and chloride ions were obtained, and facial wrinkles were measured with a skin meter. Multiple regression analysis was performed to evaluate the effects of blood glucose, BUN, calcium, and chloride ions on face wrinkles. Results: After excluding 13 people whose blood measurement variables deviated from the outliers, statistical analysis was performed for the remaining 64 participants. Analysis revealed the nonstandardization coefficient of blood glucose to be 0.019 and the significance probability was p =0.027. The nonstandardized coefficient of BUN was 0.108, and the significance probability was p =0.006, which means that when BUN increased by 1 mg/dL, wrinkles increased by 0.108. The explanatory power of R2 was 0.203. Conclusion: This is the first report to reveal, based on empirical data, that blood glucose and BUN, which are known factors affecting cardiovascular disease and diabetes, also affect facial wrinkles.

Routinely collected data have been increasingly used to assess long-term opioid therapy (LTOT) patterns, with very little guidance on how to measure LTOT from these data sources. We conducted a systematic review of studies published between January 2000 and July 2019 to catalogue LTOT definitions, the rationale for definitions and LTOT rates in observational research using routinely collected data in nonsurgical settings. We screened 4056 abstracts, 210 full-text manuscripts and included 128 studies, mostly from the United States (81%) and published between 2015 and 2019 (69%). We identified 78 definitions of LTOT, commonly operationalised as 90 days of use within a year (23%). Studies often used multiple criteria to derive definitions (60%), mostly based on measures of duration, such as supply days/days of use (66%), episode length (21%) or prescription fills within specified time periods (12%). Definitions were based on previous publications (63%), clinical judgment (16%) or empirical data (3%); 10% of studies applied more than one definition. LTOT definition was not provided with enough details for replication in 14 studies and 38 studies did not specify the opioids evaluated. Rates of LTOT within study populations ranged from 0.2% to 57% according to study design and definition used. We observed a substantial rise in the last 5 years in studies evaluating LTOT with large variability in the definitions used and poor reporting of the rationale and implementation of definitions. This variation impacts on research reproducibility, comparability of findings and the development of strategies aiming to curb therapy that is not guideline-recommended.

Modelling is a well-established concept for understanding the typical shape and pattern of age-specific fertility. The distribution of India’s age-specific fertility rate (ASFR) is unimodal and positively skewed and is distinct from the ASFR of the developed countries. The existing models (P-K model, Gompertz model, Skew-normal model and G-P model considered here) that were developed, based on the experiences of the developed countries, failed to fit the single-year age-specific fertility pattern for India as a whole and for the six selected states. Our study has proposed four flexible models, to capture the diverse age pattern of fertility, observed in the Indian states. The proposed models were compared in three ways; among themselves, with the original models and with the popular Hadwiger model. The parameters of these proposed models were estimated through the Non-Linear Least Squares Method. To find the model with best fit, we used the corrected version of Akaike’s Information Criterion (AICc). Optimization of the four original models was successfully done. When the model was fitted to the empirical data of the 4th round of the National Family Health Survey conducted in 2015–2016, the results of this study showed that all the four proposed models outperform their corresponding original models and the Hadwiger model. When comparison among the proposed models was done, the Modified Gompertz Model provided the best fit for India, Uttar Pradesh and Gujarat. Whereas, the Modified P-K model gave the best fit for West Bengal, Tripura and Karnataka. The Modified G-P model is the most suitable model for Punjab. Although our proposed models illustrated the fitting of ASFR for India as a whole and the selected six states only, it provides an important tool for the policymakers and the government authorities to project fertility rates and to understand the fertility transitions in India and various other states.

Numerous review studies were conducted in the past to understand the applicability of the technology acceptance model (TAM) in m-learning context by examining several issues. Although each of those studies provided a valuable synthesis of TAM, further issues are still uncovered and call for further research. Therefore, this research aims to systematically review the existing TAM-based m-learning studies through the analysis of various issues, including the factors affecting the m-learning adoption, research methods, TAM progress over publication years, online databases, active countries, and sample size. Out of 458 articles collected, a total of 64 studies published between 2017 and 2020 were critically analyzed. The main results indicated that self-efficacy is the most frequent factor affecting the m-learning adoption, followed by subjective norm, enjoyment, mobile anxiety, facilitating conditions, social influence, innovativeness, and satisfaction, respectively. Additionally, most of the analyzed studies have relied on questionnaire surveys in collecting their empirical data. Although it was developed in 1989, the results showed that the number of TAM-based m-learning studies is increasing year by year, which in turn, increases the credibility of the model in explaining the users’ intentions towards technology adoption. We have also discussed the contributions of this systematic review and the implications that it could yield for future attempts.

Although the role of evolutionary process in cancer progression is widely accepted, increasing attention is being given to the evolutionary mechanisms that can lead to differences in clinical outcome. Recent studies suggest that the temporal order in which somatic mutations accumulate during cancer progression is important. Single-cell sequencing (SCS) provides a unique opportunity to examine the effect that the mutation order has on cancer progression and treatment effect. However, the error rates associated with single-cell sequencing are known to be high, which greatly complicates the task. We propose a novel method for inferring the order in which somatic mutations arise within an individual tumor using noisy data from single-cell sequencing. Our method incorporates models at two levels in that the evolutionary process of somatic mutation within the tumor is modeled along with the technical errors that arise from the single-cell sequencing data collection process. Through analyses of simulations across a wide range of realistic scenarios, we show that our method substantially outperforms existing approaches for identifying mutation order. Most importantly, our method provides a unique means to capture and quantify the uncertainty in the inferred mutation order along a given phylogeny. We illustrate our method by analyzing data from colorectal and prostate cancer patients, in which our method strengthens previously reported mutation orders. Our work is an important step towards producing meaningful prediction of mutation order with high accuracy and measuring the uncertainty of predicted mutation order in cancer patients, with the potential to lead to new insights about the evolutionary trajectories of cancer.

Orthorexia nervosa (ON) has emerged as a new pattern of disordered eating behaviors characterized by preoccupations related to diet quality and health concerns, rather than driven by weight and shape concerns. A growing body of cross-sectional empirical data has documented associations between orthorexia nervosa symptoms and other indicators of disordered eating. However, little attention has been paid to the potential relationship between ON symptoms and indicators of healthy eating or positive eating behaviors. The aim of the present study was therefore to evaluate the relationships between ON symptomatology and the different facets of intuitive eating and eating competence. A sample of n = 605, 19% male, college students from the USA completed an online survey assessing orthorexia nervosa behaviors, the four facets of intuitive eating, and eating competence. Overall, orthorexia nervosa behaviors were found to be associated with lower levels of positive eating attitudes and behaviors. However, among men, curvilinear convex relationships emerged for two facets of intuitive eating, Body–Food Choice Congruence and Reliance on Hunger and Satiety Cues, such that the highest levels of intuitive eating were reported by those with mid-range levels of orthorexia nervosa behaviors. Taken together, these findings suggest that broadly, patterns of eating characterized by restriction, albeit for health reasons, are associated with less positive eating behaviors particularly among women. Further work focused on evaluating how drive for a healthy diet can be associated with flexible and positive eating patterns is warranted. Level of evidence Level V descriptive cross-sectional study.

Purpose of review To provide an update of recent studies describing the effects of transcranial direct current stimulation (tDCS) on patients with schizophrenia, with particular focus on auditory verbal hallucinations (AVH), cognitive deficits, and negative symptoms. Recent findings As a low-cost, easy-to-use neuromodulation technique, tDCS may have clinical implications for those suffering from treatment-persistent AVH, negative symptoms, and cognitive symptoms in schizophrenia. Over the past decade, tDCS has shown no effects for negative symptoms, except when used at a high frequency of sessions, and inconclusive results for AVH and cognitive symptoms. The treatment has little to no adverse effects. Summary The studies reviewed here support the need for further investigation and empirical data regarding the use of tDCS. The underlying mechanisms of tDCS as well as the most effective stimulation parameters must be better understood. Findings support the need for increased duration and frequency of tDCS sessions. One of the next steps is the investigation of effects of concomitant nonpharmacological treatments with tDCS.

People living with HIV experience a high level of stigma in our society. Public HIV-related stigma often leads to anxiety and depression and hinders access to social support and proper medical care. Technologies for HIV, however, have been mainly designed for treatment management and medication adherence rather than for helping people cope with public HIV-related stigma specifically. Drawing on empirical data obtained from semi-structured interviews and design activities with eight social workers and 29 people living with HIV, we unpack the ways in which needs for privacy and trust, intimacy, and social support create tensions around key coping strategies. Reflecting on these tensions, we present design implications and opportunities to empower people living with HIV to cope with public HIV-related stigma at the individual level.

Optimizing the positive end-expiratory pressure remains challenging for any clinician treating a patient with acute respiratory distress syndrome. This paper presents an approach to automate a PEEP titration maneuver and identify the best PEEP according to maximal compliance. The respiratory system was modeled by a single-compartment model, and parameters were estimated using multiple linear regression. A classifier identified the best PEEP using the scaled relative change in compliance between PEEP levels based on empirical data from previous manual PEEP titrations. An experimental system allows the in vivo testing of the automated PEEP titration, including additional safety measures. The complete system was tested in a single animal experiment and correctly identified the best PEEP. The introduced system is a step closer towards an automated, standardized PEEP optimization and closed-loop control of mechanical ventilation.

Background Condition-specific quality of life (QoL) instruments are more representative of the priorities of people with lived experience. As such, the development of the first and only bipolar disorder (BD) specific measurement instrument, the Quality of Life in Bipolar Disorder (QoL.BD) questionnaire, marked an important step forward for the literature. The present systematic review aims to characterise applications of the QoL.BD in the BD literature and review empirical findings obtained from studies using this measure. Methods A systematic search identified 37 peer-reviewed publications which reported original empirical data using the QoL.BD in a BD population. No restrictions were placed on language/study type. Results Adaptations to the QoL.BD displayed appropriate psychometric properties. Although clinical trials were typically underpowered, promising effect sizes for a number of treatment modalities were reported. QoL.BD scores were moderately correlated with depressive symptoms; a number of candidate predictors were identified. Limitations Due to resource limitations, the present review used one database (Google Scholar), and a single author reviewed articles for eligibility. On balance the risks of missing relevant studies were deemed minimal. Conclusion A sizeable, international body of evidence now exists regarding the measurement, presentation, and treatment of condition-specific aspects of QoL in BD. Key avenues for future research include large scale, randomized control clinical trials using the QoL.BD as a primary outcome, and granular exploration of potential correlates of QoL.BD domain scores. Finally, longer follow-up periods are required to inform understanding of the dynamic relationship between clinical variables and condition-specific aspects of QoL in BD.

Background: Informal caregivers are those providing care, which exceeds that which is typically provided, to a relative or friend with care needs. Informal caregiving constitutes the backbone of a society’s care supply and with ageing populations the need for informal care is growing. We know little as to why caregivers start caring and continue doing so, yet understanding of motivations and willingness to provide care is important if informal caregivers are to be supported. However, both motivations and willingness are inconsistently defined making it difficult to compare the empirical findings that do exist. Methods: This paper reviews and synthesises thinking about the theoretical constructs of motivations to provide care and willingness to perform informal care, and presents those in relation to existing theoretical and empirical literature. Results and Conclusions: Theoretical reflections based on various motivational frameworks and available empirical data are presented to illustrate that: caregiving motivations should be conceptualised as multifaceted and multiply determined; intrinsic and extrinsic motivations should not be treated as antagonistic and can occur simultaneously; the commonly applied model of extrinsic/intrinsic motivations is oversimplified and omits consideration of the diversity of caregiver motives; other motivational models can be discerned in the context of the empirical research; there are differences between motivations and willingness to provide care with the latter being more consequent to the motives; both should be considered dynamic in nature; and finally, that the two constructs may not inevitably lead to actual caregiver behaviour. The implications of these theoretical reflections for methodology and research as well as their relevance for practice and policy are indicated.

Objective The aim: Is to characterize the «Medico-sociological map» developed by us to identify systemic and local risk factors for periodontal disease in patients with type I and II diabetes mellitus as a resource to improve the treatment of generalized periodontitis. Patients and methods Materials and methods: We have developed a Medic-sociological map to identify systemic and local risk factors for periodontal disease in patients with type I and type II diabetes mellitus. Methods of accumulation of primary dental and endocrinological information, review and analytical methods. Statistical methods for comparing empirical data and their generalization. Results Results: Thanks to the «Medico-sociological map» developed by us, systemic and local risk factors for the development of periodontal tissue diseases in patients with type I and II diabetes mellitus have been identified. Factors for improving the well-being of patients in the treatment of periodontal diseases have been comprehensively studied. Patients with type 1 and type 2 diabetes mellitus have been shown to give up healthy habits (cigarette smoking) and lead a healthy lifestyle and reduce the health risks that can be caused by generalized periodontitis in combination with diabetes mellitus. Conclusion Conclusions: It has been demonstrated that resources to improve the effectiveness of periodontitis treatment in patients with diabetes mellitus include not only cooperation with endocrinologists, but also our «Medico-sociological map» to identify systemic and local risk factors for periodontal disease in patients with type I and II diabetes mellitus.

The article describes the state of the speech motor basis in children with autism spectrum disorder (hereinafter referred to as ASD). The term “autism spectrum disorder” is used in the article in accordance with the DSM-5. The authors analyze the results of observation of the state of the speech motor basis in 44 children with ASD aged from 2 years 0 months to 4 years 2 months. The study was limited to children with ASD who had no disorders of cognitive functions, analyzer systems, or the locomotor system. Based on theoretical and empirical data, the authors show that children with ASD demonstrate a specificity of their speech motor basis consisting in: difficulties in motor planning, problems with following a motor program, presence of self-stimulating behavior, and disorders of the sensory sphere with safe analyzer systems. Along with the presence of specific manifestations in the state of the speech motor basis, the authors note the presence of motor problems in children with ASD, similar to those in children with speech underdevelopment. The paper suggests that the peculiarities of the speech motor basis identified complicate the formation of speech in children with ASD, which, along with the specificity of the formation of verbal behavior, leads to the need for a special choice of methods and techniques of logopedic intervention.

Responding to the international call for strategic information to understand viral hepatitis, this study investigated the health communication practice on hepatitis B virus in Southwest Nigeria. Existing studies on HBV in Nigeria have primarily concentrated on health practitioners and their patients while neglecting detailed empirical data on semiurban and urban demographic information. This study examines health communication channels as predictors of knowledge, attitude, and behavioural practices with an emphasis on three Southwest states (Lagos, Oyo, and Ogun) in Nigeria that have the highest prevalence rate of HBV. Data were gathered through a survey from a total of 600 respondents of Southwest Nigeria randomly selected through the multistage sampling technique. The hypotheses were tested with the use of multiple regression. The result reveals that health communication channels for hepatitis B virus management had a significant influence on knowledge (F = 12.708, Df = 581, P < 0.05 , Sig. at 0.000), attitude (F = 3.430, Df = 581, P < 0.05 , Sig. at 0.000), and preventive practices (F = 11.075, Df = 581, P < 0.05 , Sig. at 0.000) of residents of Southwest Nigeria, respectively. The study concludes that health communication channels such as the television, Internet, radio, newspaper, and health workers positively influence the behavioural practices of residents of Southwest Nigeria. The study recommends the development of a nationwide communication system on HBV targeted at putting an end to the disease in line with the 2030 global elimination objective of Sustainable Development Goal 3.

Fast and accurate threat detection is critical for animal survival. Reducing perceptual ambiguity by integrating multiple sources of sensory information can enhance perception and reduce response latency. However, studies addressing the link between behavioral correlates of multisensory integration and its underlying neural basis are rare. Fish that detect an urgent threat escape with an explosive behavior known as C-start. The C-start is driven by an identified neural circuit centered on the Mauthner cell, an identified neuron capable of triggering escapes in response to visual and auditory stimuli. Here we demonstrate that goldfish can integrate visual looms and brief auditory stimuli to increase C-start probability. This multisensory enhancement is inversely correlated to the salience of the stimuli, with weaker auditory cues producing a proportionally stronger multisensory effect. We also show that multisensory stimuli reduced C-start response latency, with most escapes locked to the presentation of the auditory cue. We make a direct link between behavioral data and its underlying neural mechanism by reproducing the behavioral data with an integrate-and-fire computational model of the Mauthner cell. This model of the Mauthner cell circuit suggests that excitatory inputs integrated at the soma are key elements in multisensory decision making during fast C-start escapes. This provides a simple but powerful mechanism to enhance threat detection and survival.

BackgroundThe repercussions of the COVID-19 pandemic concern care in many clinical areas, including cardiology. We aim to assess the impact of the COVID-19 pandemic on hospital care for cardiac patients.MethodsScoping review. Performance indicators were extracted and collated to inform on changes in the use of health services and care provided during January - June 2020.ResultsDatabase searches yielded 6277 articles, of which 838 articles met the inclusion criteria during initial screening. After full-text screening, 94 articles were considered for data extraction. In total, 1637 indicators were retrieved, showing large variation in the indicators and their definitions. Most of the indicators that provided information on changes in number of admissions (n=118, 88%) signalled a decrease in admissions; 88% (n=15) of the indicators showed patients’ delayed presentation and 40% (n=54) showed patients in a worse clinical condition. A reduction in diagnostic and treatment procedures was signalled by 95% (n=18) and 81% (n=64) of the indicators reporting on cardiac procedures, respectively. Length of stay decreased in 58% (n=21) of the indicators and acute coronary syndromes treatment times increased in 61% (n=65) of the indicators. Outpatient activity decreased in 94% (n=17) of the indicators related with outpatient care, whereas telehealth utilization increased in 100% (n=6). Outcomes worsened in 40% (n=35) of the indicators, and mortality rates increased in 52% (n=31).ConclusionAll phases of the hospital cardiac care pathway were affected. This information could support the planning of care during the ongoing pandemic and in future events.

With the increasing prevalence of technology, the internet is often the first step for potential pet owners searching for an adoptable dog. However, best practices for the online portrayal of shelter and foster dogs remain unclear. Different online photo backgrounds appearing on adoption websites for shelter dogs may impact adoption speed by influencing viewer interest. Online clicking behaviour on pet profiles and human-directed sociability, broadly defined, has been previously linked to increased adoption likelihood. Therefore, the objective of this study was to determine the relationship between photo backgrounds of shelter dogs and online clicking as well as perceived human-directed sociability. In a virtual experiment, 680 participants were asked to rank the sociability and friendliness of four different adoptable dogs on a scale from 0–10. The photo background of each dog was digitally altered and randomly assigned to four experimental background conditions: 1) outdoor, 2) home indoor, 3) in-kennel, and 4) plain coloured. As a proxy for adoption interest, a link to the dog’s adoption profile was presented on each slide and the clicking behaviour of participants on this link was recorded. Mixed logistic regression and Poisson models revealed that background did not affect participants’ link-clicking behaviour (chisq = 3.55, df = 3, p = .314) nor perceptions of sociability (statistic = 6.19, df = 3, p = .103). Across all backgrounds, only 4.74% of presented slides culminated in participant link-clicking. Sociability scores also did not predict link clicking. Assessment of participant-related factors and dog ID revealed that link-clicking and sociability scores of photographs were influenced by differences between dogs themselves and unaffected by participants’ awareness of study hypotheses. We conclude that artificial background types did not affect participant responses. The results demonstrate the importance of empirical data in making marketing decisions in animal shelters. Understanding which aspects of online marketing materials impact viewer interest will provide guidance for both animal shelter personnel and foster families to improve the speed of adoption of the animals in their care.

Objective The aim is to evaluate whether smart worklist prioritization by artificial intelligence (AI) can optimize the radiology workflow and reduce report turnaround times (RTATs) for critical findings in chest radiographs (CXRs). Furthermore, we investigate a method to counteract the effect of false negative predictions by AI—resulting in an extremely and dangerously long RTAT, as CXRs are sorted to the end of the worklist. Methods We developed a simulation framework that models the current workflow at a university hospital by incorporating hospital-specific CXR generation rates and reporting rates and pathology distribution. Using this, we simulated the standard worklist processing “first-in, first-out” (FIFO) and compared it with a worklist prioritization based on urgency. Examination prioritization was performed by the AI, classifying eight different pathological findings ranked in descending order of urgency: pneumothorax, pleural effusion, infiltrate, congestion, atelectasis, cardiomegaly, mass, and foreign object. Furthermore, we introduced an upper limit for the maximum waiting time, after which the highest urgency is assigned to the examination. Results The average RTAT for all critical findings was significantly reduced in all prioritization simulations compared to the FIFO simulation (e.g., pneumothorax: 35.6 min vs. 80.1 min; p p p Conclusion Our simulations demonstrate that smart worklist prioritization by AI can reduce the average RTAT for critical findings in CXRs while maintaining a small maximum RTAT as FIFO. Key Points • Development of a realistic clinical workflow simulator based on empirical data from a hospital allowed precise assessment of smart worklist prioritization using artificial intelligence. • Employing a smart worklist prioritization without a threshold for maximum waiting time runs the risk of false negative predictions of the artificial intelligence greatly increasing the report turnaround time. • Use of a state-of-the-art convolution neural network can reduce the average report turnaround time almost to the upper limit of a perfect classification algorithm (e.g., pneumothorax: 35.6 min vs. 30.4 min).

Aim. The paper aims to substantiate the improvement of the All-Russian physical education and sports program “Ready for labor and defense” (GTO) for disabled people and persons with health limitations (PHL). Materials and methods. The research was carried out through the analysis of documentary materials and legal acts, questionnaires and expert assessments, as well as using testing, approximation, extrapolation, interpolation, and statistical processing of empirical data. Results. The concept of GTO for PHL was developed, which is fundamentally different from the general program for healthy citizens and is focused on basic physical qualities of PHL and their terminal values through healthy lifestyle. The implementation of the program after its approval by the Ministry of Sport of the Russian Federation in 2019 is analyzed. Based on the concept of the GTO program for PHL and its first results, prospects for program improvement and implementation are justified. Conclusion. The implementation of the GTO program for PHL will allow for the comprehensive rehabilitation and habilitation of disabled people, as well as children and persons with health limitations. The program itself will increase their motivation for regular (systematic) exercises in adaptive physical education and adaptive sports and contribute to the achievement of a better life quality.

In this paper, the impact of interference due to the geomagnetic field on a static magnetic localization setup for capsule endoscopy, which is suitable for a wearable application, was investigated. For this purpose, a study was carried out in which the average abdomen size of 15 subjects was evaluated. With the determined geometry values, a setup consisting of three elliptical sensor rings was modeled. Simulations were performed, where the magnetic flux density was evaluated at the sensors by using different-sized magnets. The measured values were compared with each other and the geomagnetic flux density. The results revealed that the measured values were for all evaluated magnet sizes of the order of the geomagnetic flux density, which is problematic since the calibration of sensors is no longer valid if the orientation of the wearable sensor array is changed. However, it is suggested that a differential measurement is suitable for the proposed system and could reduce static interference caused by the geomagnetic field.

Purpose of the study.To form proposals for improving the organization of the radiology diagnostics service in Oncology.Materials and methods.In 2019, the opinion of radiation diagnostics doctors (n=230) on the availability and quality of radiation studies for cancer patients was studied. The obtained empirical data were statistically processed with the calculation of intensive and extensive indicators, average values (M±δ) with a risk of error of 0.05. The student's t-test was used to assess the statistical significance of differences. The original data had a normal distribution. Individual parameters of the research results were given a score.Results.Radiologists highly rated the quality of their primary specialization for working with cancer patients (4.6 ± 0.3 points) and further postgraduate education (4.2 ± 0.8 points), but 38.6% need to deepen this knowledge. The respondents indicated that patients are not sufficiently informed about radiation studies, including: about the methods (67.3%); about contraindications (34.3%); about the procedure for obtaining a conclusion (30.8%); about the established waiting times (21.7%); about the procedure for pre-registration (15.6%). 33.9% of doctors pointed to the unreasonableness of radiological examinations in certain cases in cancer patients. According to the respondents, it will improve the quality and availability of medical care for cancer patients: additional training of radiologists (70.0%) and clinicians (42.6%); equipping medical institutions (38.2%), a separate procedure for routing cancer patients to radiological research (44.7%); increasing the staff of radiologists (36.1%) and nurses (17.4%); using telemedicine technologies (31,7%); excluding cases of unjustified referral of patients to research (27.3%); uninterrupted operation of medical equipment (27.3%).Conclusion.The results of the study revealed systemic shortcomings in the organization of the radiation diagnostics service in providing medical care to patients with cancer, the elimination of which will improve the system of organizing medical care for them, improve its quality and accessibility.

As the occurrence of traumatic events has increased in mainstream media the study of Trauma-Related Sleep Disturbance (TRSD) has gained more traction within the field of sleep health. TRSD is prevalent in youth and can have deleterious outcomes that impact function, yet empirical data that examine this topic are limited. This review seeks to highlight the extant literature focusing on TRSD and to identify critical areas of future research.

SUMMARY Super-spreading events in an outbreak can change the nature of an epidemic. Therefore, it is useful for public health teams to determine if an ongoing outbreak has any contribution from such events, which may be amenable to interventions. We estimated the basic reproductive number (R0) and the dispersion factor (k) from empirical data on clusters of epidemiologically-linked COVID-19 cases in Hong Kong, Japan and Singapore. This allowed us to infer the presence or absence of super-spreading events during the early phase of these outbreaks. The relatively large values of k implied that large cluster sizes, compatible with super-spreading, were unlikely.

© Hammill Institute on Disabilities 2020. There is a lack of empirical data on the experiences of people with mental illness (PMI) who transition from welfare to work, or how policy programs are designed to facilitate this outcome. We explore the factors that facilitate or hinder PMI from exiting disability income support programs in Ontario, Canada. Drawing on a grounded theory approach, we examine the process of exiting the Ontario Disability Support Program (ODSP). Data were collected from semi-structured interviews with current and former recipients with mental illness, service providers who support current and former recipients, and ministry staff. A metaphor for the work exit process emerged with four embedded themes: (a) picking yourself back up, (b) breaking the rules to get ahead, (c) stabilizing illness for employment success, and (d) displaying resiliency and resourcefulness for successful exits. The main finding is that system supports are not the determining factors in a successful transition. Rather, participants describe how recipients exit for employment by leveraging personal resources to successfully transition off income support benefits. A system redesign is needed to address the inherent tension between social and health programs if the policy intent is to promote successful welfare-to-work transitions for PMI.

Multiple studies have shown that pharmacologic treatments for attention-deficit hyperactivity disorder (ADHD), especially stimulants, are generally effective. There is yet a paucity of empirical data, however, for some common clinical conditions overlooked in the ADHD treatment guidelines. Some examples include: in cases of first line treatment failure, it is unclear whether switching from one type of stimulant to another is beneficial. In cases of comorbid ADHD and severe aggressive/disruptive behavior in children, it is unclear whether the best first-line treatment is stimulants or atypical antipsychotics like risperidone. In cases of ADHD with comorbid anxiety disorders, there is no clear evidence regarding optimal treatment. The objectives of this article are to review these issues and propose possible answers for such clinical dilemmas.

Objective:To assess the quantity and focus of recent empirical research regarding the effect of micronutrient supplementation on live birth outcomes in low-risk pregnancies from high-income countries.Design:A systematic quantitative literature review.Setting:Low-risk pregnancies in World Bank-classified high-income countries, 2019.Results:Using carefully selected search criteria, a total of 2475 publications were identified, of which seventeen papers met the inclusion criteria for this review. Data contributing to nine of the studies were sourced from four cohorts; research originated from ten countries. These cohorts exhibited a large number of participants, stable data and a low probability of bias. The most recent empirical data offered by these studies was 2011; the most historical was 1980. In total, fifty-five categorical outcome/supplement combinations were examined; 67·3 % reported no evidence of micronutrient supplementation influencing selected outcomes.Conclusions:A coordinated, cohesive and uniform empirical approach to future studies is required to determine what constitutes appropriate, effective and safe micronutrient supplementation in contemporary cohorts from high-income countries, and how this might influence pregnancy outcomes.

Empirical data from the past 50 years have illuminated some of the factors that influence pregnancy decision-making. Yet, formal models of pregnancy decision-making are uncommon and rarely incorporate cultural perspectives. In order to address this gap in the literature, we propose the Pregnancy Decision-Making Model (PDMM), a comprehensive model of the factors that are likely to affect pregnancy decisions in the context of unintended pregnancy, with special attention to relational and intersectional components of pregnancy decisions. The PDMM begins with three primary Evaluation factors: Evaluation of Capital, Evaluation of Values, and Evaluation of Narratives. Barriers to Access are proposed to be a key factor in limiting agency and autonomy and determining pregnancy outcomes. Social Influences are also hypothesized to influence Evaluation factors and their relationship with outcome variables, which include the Pregnancy Outcome, Decisional Certainty, and Decisional Satisfaction. As the PDMM is designed to be flexible in its prediction of a variety of outcomes, we consider a number of possible permutations of the model. Finally, we discuss the utility of the PDMM for inspiring future research, as well as the practical implications of the model.

It is well recognized that population heterogeneity plays an important role in the spread of epidemics. While individual variations in social activity are often assumed to be persistent, that is, constant in time, here we discuss the consequences of dynamic heterogeneity. By integrating the stochastic dynamics of social activity into traditional epidemiological models, we demonstrate the emergence of a new long timescale governing the epidemic, in broad agreement with empirical data. Our stochastic social activity model captures multiple features of real-life epidemics such as COVID-19, including prolonged plateaus and multiple waves, which are transiently suppressed due to the dynamic nature of social activity. The existence of a long timescale due to the interplay between epidemic and social dynamics provides a unifying picture of how a fast-paced epidemic typically will transition to an endemic state.

Beta diversity represents how species in the regional pool segregate among local communities and hence forms a link between local and regional species diversities. Therefore, the magnitude of beta diversity and its variation across geographic gradients can provide insights into mechanisms of community assembly. Along with limits on local or regional level diversities, effects of local abundance that lead to under-sampling of the regional species pool are important determinants of estimated beta diversity. We explore the effects of regional species pools, abundance distributions, and local abundance to show that patterns in beta diversity as well as the mean of species abundance distribution have distinct outcomes, depending on limits on species pools and under-sampling. We highlight the effect of under-sampling in some established relationships between gamma diversity and beta diversity using graphical methods. We then use empirical data on ant communities across an elevational gradient in the Eastern Himalayas to demonstrate a shift from effect of reduction in species pool to under-sampling at mid-elevations. Our results show that multiple processes with contrasting effects simultaneously affect patterns in beta diversity across geographic gradients.

Background There is limited empirical data quantifying the utility of genetic testing for families of children with autism spectrum disorder (ASD) or related neurodevelopmental disorders (NDD). We assessed the utility of clinical chromosomal microarray analysis (CMA), defined by diagnostic yield and parental empowerment, in population‐based sample of parents of affected children; and explored child, family, and health services factors predictive of empowerment. Methods Participants were families of children undergoing diagnostic assessments, between 2016 and 2019. Diagnostic yield of CMA in affected children was determined. Parental empowerment was measured through adapted version of the Genetics Counseling Outcome Scale‐24. Parents completed questionnaires to capture child, family, and health service factors. Results The diagnostic yield of CMA was 2.8% for pathogenic variants. Parental empowerment was significantly correlated with family functioning and aspects of perceived family‐centeredness of care. The model accounted for 49.8% of the variation in parental empowerment, F (10,37) = 3.67, p = 0.002. After accounting for other predictors, parental perception of the provision of general information remained significantly associated with empowerment. Conclusion The informational needs of families play an important role in their empowerment during genetic testing. Meeting these needs and monitoring empowerment can aid genomic technologies integration in personalized healthcare for ASD/NDD.