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BACKGROUND: Limited research has focused on the predictive nature of organizational culture and trust on registered nurses' perceived health care quality in reformed health care systems. PURPOSES: The purpose of this article was to investigate nurses' perceptions of organizational culture factors, trust in employer, and perceived health care quality during and 5 years after major organizational reform in the acute care setting and to test a model linking culture to perceived health care quality. METHODOLOGY: Survey data collected from two samples of nurses (N = 222,343) during and 5 years after major organizational reform in the acute care setting of one Canadian province were analyzed, and an exploratory model linking aspects of culture, trust, and quality was tested. FINDINGS: For both periods, most variable scores were in the low range and depicted moderately positive intercorrelations with each other. Support for the proposed model was mixed. Select culture variables predicted health care quality at both periods, but trust emerged as a significant predictor in 2000 only. The findings support the negative impact of system transformation on nurses and the link between culture and health care quality. PRACTICE IMPLICATIONS: The study findings suggest that managers and policy makers must develop and implement supportive and nurturing strategies that will enhance the organizational culture (emotional climate, collaborative relations), which should result in more positive perceptions of health care quality. However, further research is required to gain a better understanding of the relationships among trust, organizational culture, and perceptions of health care quality and what implications this may or may not have for nursing practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: Much of the comorbidity associated with chronic kidney disease (CKD) begins in the early stages. Interventions with proven efficacy exist to decrease progression, morbidity, and mortality. This study examines their use in patients with CKD before and at their first nephrologist encounter in Canada. STUDY DESIGN: Prospective multicenter cohort study. SETTING & PARTICIPANTS: 482 patients at their first nephrologist encounter enrolled from 13 Canadian centers. Inclusion criteria were measured or estimated glomerular filtration rate less than 50 mL/min/1.73 m(2). Exclusion criteria were patients with acute kidney failure or those likely to require dialysis therapy within 3 months of referral. OUTCOMES & MEASUREMENTS: Describe: (1) characteristics of patients at their first nephrology encounter in Canada; (2) the evaluation for cardiac risk factors, cardiac diseases and CKD complications and their management before the encounter; (3) changes in management initiated by nephrologists at the first encounter; and (4) the availability and use of allied health professional services for CKD care. RESULTS: Patients had a mean age of 69.7 years, estimated glomerular filtration rate of 29 mL/min/1.73 m(2) (0.48 mL/s/1.73 m(2), hemoglobin level of 12.1 g/dL (121 g/L), albumin level of 3.6 g/dL (36 g/L), and blood pressure of 147/76 mm Hg. Transmission of results from prior evaluation was variable. At the encounter, nephrologists had available or ordered albumin and calcium/phosphate tests in greater than 70% of patients. Nephrologists did not evaluate parathyroid hormone in 83% of patients, lipids in greater than 50%, iron studies (in those with anemia) in 57%, and urine studies in 30%. Despite a high prevalence of diabetes and coronary artery disease, only 46% were administered medications to interrupt the renin-angiotensin system, 37% were administered acetylsalicylic acid, and 32% were administered lipid medication after the encounter. Availability and use of allied health professional resources varied and was low in an unstructured setting. LIMITATIONS: External validity, referral bias, and inability to make causal inferences. CONCLUSIONS: In Canada, patients with CKD continue to be encountered late by nephrologists (stage IV CKD). Information for prior evaluation is incompletely transmitted. Finally, there appears to be room for improvement in evaluation and treatment at the first nephrologist encounter. Copyright © 2007 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

The development of clinical practice guidelines for the treatment of anemia in chronic kidney disease has been instrumental in identifying and reducing variations in the use of erythropoiesis-stimulating agents and iron replacement. Challenges to the effectiveness and safety of recommendations made in these guidelines were magnified when recent clinical trials showed no benefit or harm with respect to cardiovascular outcomes in subjects randomized to higher target hemoglobin levels. To address these concerns, Kidney Disease: Improving Global Outcomes (KDIGO) convened an international conference to examine the problems and shortcomings of existing anemia guidelines, which are a prime example of duplication of efforts to derive recommendations from a limited evidence base. The meeting was attended by representatives of the major guideline developing organizations, who agreed to avoid future duplicative efforts and to save resources in generating a common evidence report, whose recommendations could then be prioritized and implemented locally. This is a report to the international nephrology community of the recommendations for and timeline of the next anemia guidelines. It has been reviewed by the conference participants and approved as a position statement by the KDIGO Board of Directors.Kidney International (2008) 74, 1237-1240; doi:10.1038/ki.2008.299; published online 2 July 2008. [ABSTRACT FROM AUTHOR]

A growing body of evidence has provided support for the beneficial impact of human-animal interactions on a range of biological, social, and psychological outcomes for humans; however, less is conclusively known about the association between animal companionship and psycho-social health specifically among aging populations. In this study, we assessed the association between animal companionship and psycho-social well-being in a large sample (N = 30,865) of community dwelling Canadians aged 45 and older. Using cross-sectional data from the Canadian Community Health Survey-Healthy Aging, we conducted hierarchical multiple regression to assess the relationship between animal companionship and four domains of psycho-social well-being (satisfaction with life, loneliness, depression, and levels of social support) after controlling for socio-demographic factors and psycho-social measures. Results indicate that those with animal companionship report significantly higher levels of social support than aging Canadians without animal companionship; however, animal companionship was also associated with significantly lower levels of life satisfaction and higher levels of both loneliness and depression. These findings complicate the existing literature on human-animal interactions by suggesting the benefits associated with animal companionship may vary across distinct domains of psycho-social health. As such, results from this study highlight the need for more nuanced model specifications when assessing the relationship between animal companionship and psycho-social well-being. Implications of these findings for the provision of social services to older adults with pets are provided., Competing Interests: Declaration of competing interest The authors of this manuscript have no actual or potential conflicts of interest (personal, financial, or otherwise) to disclose in relation to the subject matter of this manuscript., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Recent proliferation of GPS technology has transformed animal movement research. Yet, time-series data from this recent technology rarely span beyond a decade, constraining longitudinal research. Long-term field sites hold valuable historic animal location records, including hand-drawn maps and semantic descriptions. Here, we introduce a generalised workflow for converting such records into reliable location data to estimate home ranges, using 30 years of sleep-site data from 11 white-faced capuchin (Cebus imitator) groups in Costa Rica. Our findings illustrate that historic sleep locations can reliably recover home range size and geometry. We showcase the opportunity our approach presents to resolve open questions that can only be addressed with very long-term data, examining how home ranges are affected by climate cycles and demographic change. We urge researchers to translate historical records into usable movement data before this knowledge is lost; it is essential to understanding how animals are responding to our changing world., (© 2024 The Author(s). Ecology Letters published by John Wiley & Sons Ltd.)

Tool-using primates often show sex differences in both the frequency and efficiency of tool use. In species with sex-biased dispersal, such within-group variation likely shapes patterns of cultural transmission of tool-use traditions between groups. On the Panamanian islands of Jicarón and Coiba, a population of white-faced capuchins (Cebus capucinus imitator)-some of which engage in habitual stone tool use-provide an opportunity to test hypotheses about why such sex-biases arise. On Jicarón, we have only observed males engaging in stone tool use, whereas on Coiba, both sexes are known to use tools. Using 5 years of camera trap data, we provide evidence that this variation likely reflects a sex difference in tool use rather than a sampling artifact, and then test hypotheses about the factors driving this pattern. Differences in physical ability or risk-aversion, and competition over access to anvils do not account for the sex-differences in tool-use we observe. Our data show that adult females are physically capable of stone tool use: adult females on Coiba and juveniles on Jicarón smaller than adult females regularly engage in tool use. Females also have ample opportunity to use tools: the sexes are equally terrestrial, and competition over anvils is low. Finally, females rarely scrounge on left-over food items either during or after tool-using events, suggesting they are not being provisioned by males. Although it remains unclear why adult white-faced capuchin females on Jicarón do not use stone-tools, our results illustrate that such sex biases in socially learned behaviors can arise even in the absence of obvious physical, environmental, and social constraints. This suggests that a much more nuanced understanding of the differences in social structure, diet, and dispersal patterns are needed to explain why sex-biases in tool use arise in some populations but not in others., (© 2024 The Authors. American Journal of Primatology published by Wiley Periodicals LLC.)

Terrestrial mammals exploiting coastal resources must cope with the challenge that resource availability and accessibility fluctuate with tidal cycles. Tool use can improve foraging efficiency and provide access to structurally protected resources that are otherwise unavailable (e.g. molluscs and fruits). To understand how variable accessibility of valuable resources shapes behavioural patterns, and whether tool use aids in the efficient exploitation of intertidal resources, we compared the relationship between tidal cycles and activity patterns of tool-using versus non-tool-using groups of white-faced capuchin monkeys on Jicarón Island in Coiba National Park, Panama. Although tool use on Jicarón is localized to a small stretch of coast (approx. 1 km), all coastal groups forage on intertidal resources. Using more than 5 years of camera trap data at varying distances from the coast, we found that capuchins on Jicarón showed increased coastal activity during specific parts of the tidal cycle, and that this relationship differed between tool-using and non-tool-using groups, as well as between seasons. Activity patterns of tool-using capuchins were more strongly and consistently tied to tidal cycles compared with non-tool-users, indicating that tool use might allow for more efficient exploitation of tidal resources. Our findings highlight the potential of tool use to aid niche expansion., Competing Interests: The authors have no conflicts of interest to declare that are relevant to the content of this article., (© 2023 The Authors.)

Two-option choice experimental designs are the most commonly employed framework for identifying evidence of social learning or social learning strategies in captive and wild populations. In nature, however, animals often choose from more than two behaviours, and multiple innovations may arise simultaneously. Studies of animal social learning are often constrained by small sample sizes, which limit researchers' ability to convincingly identify the proposed social learning strategy responsible for behavioural choice. In this study, I examine whether expanding behavioural options from k = 2 to k > 2 and increasing sample size affects inferential power in identifying social learning strategies. I focus on three frequency-dependent learning strategies: conformist transmission, unbiased transmission and anti-conformist transmission. I simulate 100 datasets for 72 parameter combinations, yielding 7200 simulations. I evaluate number of options (k = 2, 3, 4, 5), population size (n = 5, 10, 25, 50, 100, 250) and the logarithmic strength of frequency dependence (log(f) = log(1∕3), log(1), log(3)). I then fit a Bayesian social learning model to simulated data to evaluate the percent of the posterior consistent with type of frequency dependence, posterior standard deviations, highest posterior density intervals and posterior medians relative to the true simulated value of log(f). I show that increasing the number of options an animal can choose from increases the accuracy and certainty of identifying the type and magnitude of frequency-dependent social learning. These effects are particularly pronounced at small to intermediate sample sizes, which are common in empirical studies of animal social learning. These findings suggest that knowing what an animal did not choose is equally important as knowing what an animal did choose when identifying social learning strategies. By strategically increasing the number of behaviours from which an animal can choose, researchers can increase inferential power in identifying social learning strategies without increasing sample size, that is, adding additional animals or collecting more data., (© 2022 The Author. Journal of Animal Ecology published by John Wiley & Sons Ltd on behalf of British Ecological Society.)

Molecular charge doping involves the formation of donor-acceptor charge-transfer complexes (CTCs) through integer or partial electron transfer; understanding how local chemical environment impacts complexation is important for controlling the properties of organic materials. We present steady-state and temperature-dependent spectroscopic investigations of the p-dopant 2,3,5,6-tetrafluoro-7,7,8,8-tetracyanoquinodimethane (F 4 TCNQ) complexed with the electron donor and hole transport material N , N '-diphenyl- N , N '-di- p -tolylbenzene-1,4-diamine (MPDA). Equilibrium formation constants ( K CT ) were determined for donor-acceptor pairs dissolved in a series of solvents covering a range of values of permittivity. A threshold for highly favorable complex formation was observed to occur at ϵ ∼ 8-9, with large (>10 4 ) and small (<10 3 ) values of K CT obtained in solvents of higher and lower permittivity, respectively, but with chloroform (ϵ = 4.81) exhibiting an anomalously high formation constant. Temperature-dependent formation constants were determined in order to evaluate the thermodynamics of complex formation. In 1,2-dichloroethane (ϵ = 10.36) and chlorobenzene (ϵ = 5.62), complex formation is both enthalpically and entropically favorable, with higher enthalpic and entropic stabilization in the solvent with higher permittivity. Complexation in chloroform is exothermic and entropically disfavored, indicating that specific, inner-shell solvent-solute interactions stabilize the charge-separated complex and result in a net increase in local solution structure. Our results provide insight into how modification to the chemical environment may be utilized to support stable integer charge transfer for molecular doping applications and requiring only modest changes in local permittivity.

Culture is an outcome of both the acquisition of knowledge about behaviour through social transmission, and its subsequent production by individuals. Acquisition and production are often discussed or modelled interchangeably, yet to date no study has explored the consequences of their interaction for cultural diffusions. We present a generative model that integrates the two, and ask how variation in production rules might influence diffusion dynamics. Agents make behavioural choices that change as they learn from their productions. Their repertoires may also change, and the acquisition of behaviour is conditioned on its frequency. We analyse the diffusion of a novel behaviour through social networks, yielding generalizable predictions of how individual-level behavioural production rules influence population-level diffusion dynamics. We then investigate how linking acquisition and production might affect the performance of two commonly used inferential models for social learning; network-based diffusion analysis, and experience-weighted attraction models. We find that the influence that production rules have on diffusion dynamics has consequences for how inferential methods are applied to empirical data. Our model illuminates the differences between social learning and social influence, demonstrates the overlooked role of reinforcement learning in cultural diffusions, and allows for clearer discussions about social learning strategies.

Purpose: Iodinated contrast media is one of the most frequently administered pharmaceuticals. In Canada, over 5.4 million computed tomography (CT) examinations were performed in 2019, of which 50% were contrast enhanced. Acute kidney injury (AKI) occurring after iodinated contrast administration was historically considered a common iatrogenic complication which was managed by screening patients, prophylactic strategies, and follow-up evaluation of renal function. The Canadian Association of Radiologists (CAR) initially published guidelines on the prevention of contrast induced nephropathy in 2007, with an update in 2012. However, new developments in the field have led to the availability of safer contrast agents and changes in clinical practice, prompting a complete revision of the earlier recommendations., Information Sources: Published literature, including clinical trials, retrospective cohort series, review articles, and case reports, along with expert opinions from radiologists and nephrologists across Canada., Methods: The leadership of the CAR formed a working group of radiologists and nephrologists with expertise in contrast administration and patient management related to contrast-associated AKI. We conducted a comprehensive review of the published literature to evaluate the evidence about contrast as a cause of AKI, and to inform evidence-based recommendations. Based on the available literature, the working group developed consensus recommendations., Key Findings: The working group developed 21 recommendations, on screening, choice of iodinated contrast media, prophylaxis, medication considerations, and post contrast administration management. The key changes from the 2012 guidelines were (1) Simplification of screening to a simple questionnaire, and not delaying emergent examinations due to a need for creatinine measurements (2) Prophylaxis considerations only for patients with estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m2 (3) Not recommending the routine discontinuation of any drugs to decrease risk of AKI, except metformin when eGFR is less than 30 mL/min/1.73 m2 and (4) Not requiring routine follow up serum creatinine measurements post iodinated contrast administration., Limitations: We did not conduct a formal systematic review or meta-analysis. We did not evaluate our specific suggestions in the clinical environment., Implications: Given the importance of iodinated contrast media use in diagnosis and management, and the low risk of AKI after contrast use, these guidelines aim to streamline the processes around iodinated contrast use in most clinical settings. As newer evidence arises that may change or add to the recommendations provided, the working group will revise these guidelines., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

This article empirically examines the extent to which the co-occurrence of the maltreatment of companion animals and intimate partner violence (IPV) previously documented in samples of women accessing services from domestic violence shelters extends to a nationally representative sample of the general Canadian population, with a specific focus on emotional and financial abuse. Using data from the intimate partner victimization module of the 2014 Canadian General Social Survey ( n = 17,950), the authors find that reporting one's intimate partner threatened or abused companion animals in the home increased the probability that one had experienced at least one form of emotional abuse or financial abuse by 38.6% ( p ≤ .001) and 7.5% ( p ≤ .001), respectively, net of several key control variables. Moreover, the findings indicate that those who identify as women are significantly more likely to report their partner emotionally or financially abused them and threatened or mistreated their pet(s); the connection between animal maltreatment and IPV is particularly pronounced for emotional IPV when compared with other forms of IPV; challenge the commonplace conceptualization of animal abuse as a form of property abuse; and suggest a need for a more nuanced understanding of IPV perpetrators vis-à-vis animal maltreatment. This is the first study to use nationally representative data to assess the co-occurrence of animal abuse and IPV, and as such, it makes significant contributions to the interdisciplinary literature on animal abuse and IPV.

This article empirically examines if the relationship between animal abuse and intimate partner violence (often referred to as "the link") documented in samples of women accessing services from domestic violence shelters extends to a nationally representative sample of the general Canadian population. Nationally representative data from the 2014 Canadian General Social Survey are analyzed using hierarchical binary logistic regression models, with threats and actual abuse of pets as a predictor of physical and sexual intimate partner violence, controlling for several key sociodemographic variables. Actual and threatened abuse of pets by a romantic partner is a significant and sizable predictor of also reporting that partner perpetrated intimate partner violence, particularly physical and severe abuse. As the first study to use nationally representative data to assess the perpetration of animal abuse and IPV in current/recent relationships, this study makes significant contributions to the interdisciplinary literature on animal abuse and IPV., (© Copyright 2021 Springer Publishing Company, LLC.)

This study examines past-year unmet healthcare need due to cost experienced by transgender and gender-expansive (TGE) adults in the United States in the context of the Patient Protection and Affordable Care Act (ACA). It also aims to estimate the importance of having health insurance among TGE Americans (transgender men, transgender women, nonbinary/genderqueer people, and cross-dressers). Data were from the 2015 U.S. Transgender Survey (N = 19,157 adults, aged 25 to 64 years). Multivariable logistic regression models were used to determine the adjusted odds ratios (AOR) and 95 percent confidence intervals (CI) of TGE individuals' past-year unmet healthcare need due to cost. Although the majority (86.8 percent) reported seeing a doctor or healthcare provider in the past year, 32.1 percent reported past-year unmet healthcare need due to cost. One in six respondents (17.1 percent) was uninsured and almost one-third (29.8 percent) were at/near poverty. The prevalence of unmet healthcare need was greater among the uninsured (65.1 percent) than among the insured (25.2 percent). Compared with transgender women, nonbinary/genderqueer people (AOR = 1.31, 95% CI [1.18, 1.46]) and transgender men (AOR = 1.30, 95% CI [1.18, 1.42]) had greater odds of unmet healthcare need due to cost. Social workers can lobby to fully enact the ACA by underscoring affordability and availability as important dimensions of healthcare access for TGE populations., (© 2021 National Association of Social Workers.)

Multiphoton excitation promises opportunities for opening new photochemical reaction pathways and controlling photoproduct distributions. We demonstrate photonic control of the 6π photocyclization of ortho -terphenyl to make 4 a ,4 b -dihydrotriphenylene (DHT). Using pump-repump-probe spectroscopy we show that 1 + 1' excitation to a high-lying reactant electronic state generates a metastable species characterized by a red absorption feature that accompanies a repump-induced depletion in the one-photon trans -dihydro product ( trans -DHT); signatures of the new photoproduct are clearer for a structural analogue of the reactant that is sterically inhibited against one-photon cyclization. Quantum-chemical computations support assignment of this species to cis -DHT, which is accessible photochemically along a disrotatory coordinate from high-lying electronic states reached by 1 + 1' excitation. We use time-resolved spectroscopy to track photochemical dynamics producing cis -DHT. In total, we demonstrate that selective multiphoton excitation opens a new photoreaction channel in these photocyclizing reactants by taking advantage of state-dependent correlations between reactant and product electronic states.

We report on charge-transfer dynamics of newly designed acceptor-donor-acceptor organosilanes, with a specific focus on how donor-acceptor combination and local chemical environment can be used to control the lifetime for intramolecular charge-separation between silane electron donors and organic acceptors. In this work linear oligosilanes were capped with arene-vinyl end groups of variable electron-accepting strength: weak (diester vinyl), intermediate (ester,cyano vinyl), and strong (dicyanovinyl). Ultrafast transient absorption spectroscopy was used to characterize their structure-dependent charge-transfer and recombination behaviors. All structures exhibit similar photoinduced ultrafast spectral dynamics that we ascribe to relaxation of the nascent charge-separated excited state followed by a return to the ground state via charge recombination. We find that relaxation of the nascent "hot" charge-separated excited state scales with the strength of dipole-dipole interactions between solvent molecules and the polar arene-vinyl acceptor. Furthermore, electron-accepting strength governs whether electronic coupling dictates charge recombination rate: weak acceptors produce charge-separated states that exhibit relatively large electronic coupling for back-electron transfer (approaching the adiabatic limit) that result in fast recombination, whereas the strong and moderate-strength acceptors support more stable charge-separated states with weaker coupling and longer lifetimes. We find that recombination rates increase substantially for structures with weak and moderate-strength acceptors in cyclohexane (i.e., negligible solvent reorganization energy), which we attribute to an increased electronic coupling in a nonpolar solvent environment where charge pairs are weakly screened. In contrast, for structures with strong electron acceptors, the very low reorganization energy of cyclohexane places back-electron transfer even further into the Marcus inverted regime, with a resultant increase in charge-separation lifetime. Together these results provide critical insights on how to tune photoinduced charge-transfer behavior in organic-inorganic hybrids that have potential material applications in molecular electronics and optoelectronics.

Social learning-learning from others-is the basis for behavioural traditions. Different social learning strategies (SLS), where individuals biasedly learn behaviours based on their content or who demonstrates them, may increase an individual's fitness and generate behavioural traditions. While SLS have been mostly studied in isolation, their interaction and the interplay between individual and social learning is less understood. We performed a field-based open diffusion experiment in a wild primate. We provided two groups of vervet monkeys with a novel food, unshelled peanuts, and documented how three different peanut opening techniques spread within the groups. We analysed data using hierarchical Bayesian dynamic learning models that explore the integration of multiple SLS with individual learning. We (1) report evidence of social learning compared to strictly individual learning, (2) show that vervets preferentially socially learn the technique that yields the highest observed payoff and (3) also bias attention toward individuals of higher rank. This shows that behavioural preferences can arise when individuals integrate social information about the efficiency of a behaviour alongside cues related to the rank of a demonstrator. When these preferences converge to the same behaviour in a group, they may result in stable behavioural traditions.

Background: Induction of labor continues to become more common. We analyzed induction of labor and timing of obstetric and anesthesia work to create a model to predict the induction-anesthesia interval and the induction-delivery interval in order to co-ordinate workload to occur when staff are most available., Methods: Patients who underwent induction of labor at a single medical center were identified and multivariable linear regression was used to model anesthesia and delivery times. Data were collected on date of birth, race/ethnicity, body mass index, gestational age, gravidity, parity, indication for labor induction, number of prior deliveries, time of induction, induction agent, cervical dilation, effacement, and fetal station on admission, date and time of anesthesia administration, date and time of delivery, and delivery type., Results: A total of 1746 women met inclusion criteria. Associations which significantly influenced time from induction of labor to anesthesia and delivery included maternal age (anesthesia P <0.001, delivery P =0.002), body mass index (both P <0.001), prior vaginal delivery (both P <0.001), gestational age (anesthesia P <0.001, delivery P <0.018), simplified Bishop score (both P <0.001), and first induction agent (both P <0.001). Induction of labor of nulliparous women at 02:00 h and parous women at 04:00 or 05:00 h had the highest estimated probability of the mother having her first anesthesia encounter and delivering during optimally staffed hours when our institution's specialty personnel are most available., Conclusions: Time to obstetric and anesthesia tasks can be estimated to optimize induction of labor start times, and shift anesthesia and delivery workload to hours when staff are most available., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Today's clinical practice relies on the application of well-designed clinical research, the gold standard test of an intervention being the randomized controlled trial. Principles of the randomized control trial include emphasis on the principal research question, randomization, blinding; definitions of outcome measures, of inclusion and exclusion criteria, and of co-morbid and confounding factors; enrolling an adequate sample size; planning data management and analysis; preventing challenges to trial integrity such as drop-out, drop-in, and bias. The application of pre-trial planning is stressed to ensure the proper application of epidemiological principles resulting in clinical studies that are feasible and generalizable. In addition, funding strategies and trial team composition are discussed.

In longitudinal studies, the relationship between exposure and disease can be measured once or multiple times while participants are monitored over time. Traditional regression techniques are used to model outcome data when each epidemiological unit is observed once. These models include generalized linear models for quantitative continuous, discrete, or qualitative outcome responses, and models for time-to-event data. When data come from the same subjects or group of subjects, observations are not independent and the underlying correlation needs to be addressed in the analysis. In these circumstances, extended models are necessary to handle complexities related to clustered data, and repeated measurements of time-varying predictors and/or outcomes.

Biomarkers are characteristics that are measured as indicators of normal biological processes, pathogenic processes, or responses to an exposure or intervention, including therapeutic interventions. Biomarkers may serve a number of important uses, particularly in diagnosis and prognosis of disease, and as surrogates for clinical outcomes of disease (i.e., outcomes that measure how patient survives, functions, or feels). Establishing the validity of a given biomarker for a specific role requires the conduct of carefully designed clinical studies in which the biomarker and the outcome of interest are measured independently. The design and analysis of such studies is discussed. Surrogate outcomes in clinical trials consist of events or biomarkers intended to reflect important clinical outcomes. Surrogate outcomes may offer advantages in providing statistically robust estimates of treatment effects with smaller sample sizes. However, to be useful, surrogate outcomes have to be validated to ensure that the effect of therapy on them truly reflects the effect of therapy on the important clinical outcomes of interest.

Statistical models are used to study the relationship between exposure and disease while accounting for the potential role of other factors' impact upon outcomes. This adjustment is useful to obtain unbiased estimates of true effects or to predict future outcomes. Statistical models include a systematic and an error component. The systematic component explains the variability of the response variable as a function of the predictors and is summarized in the effect estimates (model coefficients). The error element of the model represents the variability in the data unexplained by the model and is used to build measures of precisions around the point estimates (Confidence Intervals).

Using data from the 2009 General Social Survey (GSS Cycle 23: Victimization main file), this study assessed the relationship between individual and neighborhood-level factors and police response to spousal violence in Canada. A total of 890 participants in the GSS reported experiences of spousal violence within the previous 5 years, with approximately 22% of these victims reporting direct contact with the police because of the violence. Among this subsample of victims who had police contact, we evaluated the extent to which individual-level factors (sociodemographic and violence characteristics) and neighborhood-level factors (perceptions of social disorder and the presence of police facilities in one's community) were related to distinct types of police response to reported spousal violence. Regression analyses suggest variations in police response based on sociodemographic, violence, and neighborhood characteristics; however, overall satisfaction with police actions taken were not found to be significantly different among victims based on these characteristics. Implications are relevant for policing practice as results suggest that different victims may have different safety needs and abilities to communicate these needs to the police.

Rational choice theory proposes that spousal violence survivors engage in a cost-benefit analysis when determining whether to contact the police in the aftermath of violence. Feminist intersectional frameworks contend that the perceived costs and benefits of police intervention differ among survivors based on their intersecting social identities. Normative theory further posits that it is not solely individual factors but also social norms derived from one's neighborhood context that may be related to reporting practices. Consistent with these perspectives, this study assessed the association between spousal violence survivors' sociodemographic, violence, and neighborhood characteristics and (a) police contact, (b) pathways to police contact, (c) motivations for contacting the police, and (d) motivations for not contacting the police. Data were drawn from the 2009 Canadian General Social Survey-Victimization main file, and included male and female survivors ( N = 890). Survivors most commonly contacted the police to stop the violence (89.4%) and most commonly did not contact the police because they did not believe it was important enough (35.3%). Results of multivariate regression analysis indicate that survivors who were visible minority, those who feared for their lives, and those who were injured were significantly more likely to self-report violence to police. Survivors were more likely to say the violence was not important enough to report if there was a police station in their neighborhood, and were less likely to say that violence was not important enough to report if they had experienced multiple incidents of violence. Implications for policing and criminal justice system engagement with spousal violence survivors are provided.

As technology advances, diagnostic tests continue to improve and each year, we are presented with new alternatives to standard procedures. Given the plethora of diagnostic alternatives, diagnostic tests must be evaluated to determine their place in the diagnostic armamentarium. The first step involves determining the accuracy of the test, including the sensitivity and specificity, positive and negative predictive values, likelihood ratios for positive and negative tests, and receiver operating characteristic (ROC) curves. The role of the test in a diagnostic pathway has then to be determined, following which the effect on patient outcome should be examined.

Although there is a growing body of literature documenting the co-occurrence of animal abuse and intimate partner violence (IPV), only a few studies have examined the relationship between animal maltreatment, types of IPV, and abuse severity. The results of those studies have been inconclusive and in some cases even contradictory. The current study contributes new findings to that specific segment of the literature and sheds some light on the inconsistent findings in previous studies. Data were gathered from 86 abused women receiving services from domestic violence shelters across Canada via a structured survey about pet abuse and the level and types of IPV perpetrated by abusive partners. Type and severity of IPV was measured using subscales of the Revised Conflict Tactics Scale (CTS2) and the Checklist of Controlling Behaviors (CCB). Animal maltreatment was measured using the Partner's Treatment of Animals Scale (PTAS). Participants were divided into three groups: women who did not have pets during their abusive relationship ( n = 31), women who had pets and reported little or no animal maltreatment ( n = 21), and women who had pets and reported frequent or severe animal maltreatment ( n = 34). Examining within-group variations in experiences of IPV and pet abuse using a series of one-way between-groups ANOVA tests, this study provides evidence to support the conclusion that women who report that their partner mistreated their pets are themselves at significantly greater risk of more frequent and severe forms of IPV, most specifically psychological, physical, and sexual abuse. The findings point to the urgency of better understanding and mitigating the unique barriers to leaving an abusive relationship faced by women with companion animals.

Objectives: Measuring blood urea at the same time as serum creatinine in stable ambulatory patients in family practice is largely unnecessary. The objective was to assess the relative impact of changing the laboratory requisition versus audit and feedback and academic detailing on the volume of orders for blood urea., Design and Methods: A natural experiment was observed over the period April 2015 to March 2018 in the Canadian province of Newfoundland where three health regions had different approaches to trying to reduce such urea testing. The Eastern and Western regions removed urea from the standard laboratory requisition but the test could still be ordered by writing it on the requisition. Central region requisitions continued to list urea. Audit and feedback was undertaken with family doctors in Eastern region after the requisition change and that was followed by academic detailing. A nephrologist gave presentations to groups of family doctors on one occasion in Central region., Results: The volume of serum creatinine testing was largely unchanged over time in each region. The volume of urea testing reduced by 73%, 48% and 28% in Eastern, Western and central regions. Interrupted time series analysis showed significant changes in test volume after requisition change in Eastern and Western regions as well as after audit and feedback in Eastern and the presentations in Central region. The incremental impact of academic detailing was not statistically significant., Conclusion: We conclude that removing urea from standard test order menus was the most effective in reducing test volumes, but combination with audit and feedback augmented the impact., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.)

Transgender people encounter interpersonal and structural barriers to healthcare access that contribute to their postponement or avoidance of healthcare, which can lead to poor physical and mental health outcomes. Using the 2015 U.S. Transgender Survey, this study examined avoidance of healthcare due to anticipated discrimination among transgender adults aged 25 to 64 ( N  = 19,157). Multivariable logistic regression analysis was conducted to test whether gender identity/expression, socio-demographic, and transgender-specific factors were associated with healthcare avoidance. Almost one-quarter of the sample (22.8%) avoided healthcare due to anticipated discrimination. Transgender men had increased odds of healthcare avoidance (AOR = 1.32, 95% CI = 1.21-1.45) relative to transgender women. Living in poverty (AOR = 1.52, 95% CI = 1.40-1.65) and visual non-conformity (AOR = 1.48, 95% CI = 1.33-1.66) were significant risk factors. Having health insurance (AOR = 0.87, 95% CI = 0.79-0.96) and disclosure of transgender identity (AOR = 0.77, 95% CI = 0.68-0.87) were protective against healthcare avoidance. A significant interaction of gender identity/expression with health insurance was found; having health insurance moderated the association between gender identity/expression and healthcare avoidance. Providers should consider gender differences, socio-demographic, and transgender-specific factors to improve accessibility of services to transgender communities. A multi-level and multi-faceted approach should be used to create safe, trans-affirmative environments in health systems., Competing Interests: None., (© 2020 The Author(s).)

This study tests the theoretically informed assumption that intimate partner violence (IPV) and animal abuse so frequently co-occur because animal maltreatment is instrumentalized by abusers to harm human victims. Using data from a survey of abused women in Canadian shelters, we find that threats to harm "pets," emotional animal abuse, and animal neglect are clearly perceived by these survivors as being intentionally perpetrated by their abuser and motivated by a desire to upset and control them; the findings related to physical animal abuse are not as straightforward. Building on these findings, we propose a more nuanced theorizing of the coexistence of animal maltreatment and IPV.

This study presents a novel multi-scale view-planning algorithm for automated targeted inspection using unmanned aircraft systems (UAS). In industrial inspection, it is important to collect the most relevant data to keep processing demands, both human and computational, to a minimum. This study investigates the viability of automated targeted multi-scale image acquisition for Structure from Motion (SfM)-based infrastructure modeling. A traditional view-planning approach for SfM is extended to a multi-scale approach, planning for targeted regions of high, medium, and low priority. The unmanned aerial vehicle (UAV) can traverse the entire aerial space and facilitates collection of an optimized set of views, both close to and far away from areas of interest. The test case for field validation is the Tibble Fork Dam in Utah. Using the targeted multi-scale flight planning, a UAV automatically flies a tiered inspection using less than 25% of the number of photos needed to model the entire dam at high-priority level. This results in approximately 75% reduced flight time and model processing load, while still maintaining high model accuracy where needed. Models display stepped improvement in visual clarity and SfM reconstruction integrity by priority level, with the higher priority regions more accurately modeling smaller and finer features. A resolution map of the final tiered model is included. While this study focuses on multi-scale view planning for optical sensors, the methods potentially extend to other remote sensors, such as aerial LiDAR.

Human-induced rapid environmental change (HIREC) has recently led to alterations in the fitness and behavior of many organisms. Game theory is an important tool of behavioral ecology for analyzing evolutionary situations involving multiple individuals. However, game theory bypasses the details by which behavioral phenotypes are determined, taking the functional perspective straight from expected payoffs to predicted frequencies of behaviors. In contrast with optimization approaches, we identify that to use existing game theoretic models to predict HIREC effects, additional mechanistic details (or assumptions) will often be required. We illustrate this in relation to the hawk-dove game by showing that three different mechanisms, each of which support the same ESS prior to HIREC (fixed polymorphism, probabilistic choice, or cue dependency), can have a substantial effect on behavior (and success) following HIREC. Surprisingly, an increase in the value of resources can lead to a reduction in payoffs (and vice versa), both in the immediate- and long-term following HIREC. An increase in expected costs also increases expected payoffs. Along with these counter-intuitive findings, this work shows that simply understanding the behavioral payoffs of existing games is insufficient to make predictions about the effects of HIREC.

Cultural systems exhibit equifinal behavior - a single final state may be arrived at via different mechanisms and/or from different initial states. Potential for equifinality exists in all empirical studies of cultural transmission including controlled experiments, observational field research, and computational simulations. Acknowledging and anticipating the existence of equifinality is important in empirical studies of social learning and cultural evolution; it helps us understand the limitations of analytical approaches and can improve our ability to predict the dynamics of cultural transmission. Here, I illustrate and discuss examples of equifinality in studies of social learning, and how certain experimental designs might be prone to it. I then review examples of equifinality discussed in the social learning literature, namely the use of s-shaped diffusion curves to discern individual from social learning and operational definitions and analytical approaches used in studies of conformist transmission. While equifinality exists to some extent in all studies of social learning, I make suggestions for how to address instances of it, with an emphasis on using data simulation and methodological verification alongside modern statistical approaches that emphasize prediction and model comparison. In cases where evaluated learning mechanisms are equifinal due to non-methodological factors, I suggest that this is not always a problem if it helps us predict cultural change. In some cases, equifinal learning mechanisms might offer insight into how both individual learning, social learning strategies and other endogenous social factors might by important in structuring cultural dynamics and within- and between-group heterogeneity., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Long-term male-female bonds and bi-parental investment in offspring are hallmarks of human society. A key question is how these traits evolved from the polygynandrously mating multimale multifemale society that likely characterized the Pan-Homo ancestor. In all three species of savanna baboons, lactating females form strong ties (sometimes called "friendships") with one or more adult males. For yellow baboons (Papio cynocephalus) and chacma baboons (Papio ursinus), several lines of evidence suggest that these relationships are a form of male parenting effort. In olive baboons (Papio anubis), females are thought to preferentially mate with their "friends", and male-female bonds may thus function as a form of mating effort. Here, we draw on behavioral and genetic data to evaluate the factors that shape male-female relationships in a well-studied population of olive baboons. We find support for the parenting effort hypothesis in that sires have stronger bonds with their infants' mothers than do other males. These bonds sometimes persist past weaning age and, in many cases, the sire of the previous infant is still a close partner of the female when she nurses her subsequent offspring. We find that males who have the strongest bonds with females that have resumed cycling, but are not currently sexually receptive, are more likely to sire the female's next offspring but the estimate is associated with large statistical uncertainty. We also find that in over one third of the cases, a female's successive infants were sired by the same male. Thus, in olive baboons, the development of stable breeding bonds and paternal investment seem to be grounded in the formation of close ties between males and anestrous females. However, other factors such as male dominance rank also influence paternity success and may preclude stability of these bonds to the extent found in human societies., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Adults sometimes disperse, while philopatric offspring inherit the natal site, a pattern known as bequeathal . Despite a decades-old empirical literature, little theoretical work has explored when natural selection may favor bequeathal. We present a simple mathematical model of the evolution of bequeathal in a stable environment, under both global and local dispersal. We find that natural selection favors bequeathal when adults are competitively advantaged over juveniles, baseline mortality is high, the environment is unsaturated, and when juveniles experience high dispersal mortality. However, frequently bequeathal may not evolve, because the fitness cost for the adult is too large relative to inclusive fitness benefits. Additionally, there are many situations for which bequeathal is an ESS, yet cannot invade the population. As bequeathal in real populations appears to be facultative, yet-to-be-modeled factors like timing of birth in the breeding season may strongly influence the patterns seen in natural populations., Competing Interests: 3.2The principle of comparative advantage will not uniquely determine the evolutionary result, unless the juvenile and adult have no conflict of interest. When ρ = 1, there is no conflict of interest, and selection favors allocating the adult to the more dangerous away site. The adult and juvenile always agree. But for ρ < 1, there is a conflict of interest, with bequeathal representing a costly action by the adult. As ρ gets smaller, selection favors adults choosing the easier battle, which is always the home site. However, large C A can compensate, allowing B to continue to be stable, even when ρ is so small that B can no longer invade the population. To appreciate how conflict of interest and comparative advantage interact, in Figure 2 we map regions of stability for B and S for combinations of ρ and C A. Focus for now on only the upper left, panel (a), the enlarged plot with labeled regions. The horizontal axis is the magnitude of C A, expressed as the base‐2 logarithm, a “fold” value. If you folded a piece of paper in half 10 times, then its thickness would be 210 layers, a 10‐fold increase in thickness. Likewise, you can read the value log 2 C A = 10 as a 10‐fold increase in adult competitive ability, relative to a juvenile. The vertical axis is ρ, from complete conflict at the bottom to complete agreement at the top. The colored regions represent different combinations of ρ and C A for which B and S are not evolutionarily stable. In the orange regions, S is not an ESS. In the blue regions, B is not an ESS. In the white region, both B and S are evolutionarily stable. The red and blue curves show the boundaries for the different dispersal models, with global dispersal represented by the solid curves and local by the dashed. Figure 2Effects of relatedness, ρ, and adult competitive ability, C A, on stability of Bequeath and Stay. In each panel, horizontal axis is the logarithm of C A and vertical axis is ρ. The shaded regions indicate combinations of C A and ρ for which either Bequeath (orange) or Stay (blue) is the only ESS. In the white region, both Bequeath and Stay are ESSs. Boundaries for the global dispersal model are solid. Boundaries for the local dispersal model are dashed. Each panel shows regions for different combinations of dispersal survival and baseline survival. Top row: s A = s J = 1. Bottom row: s A = s J = 0.75. Left column: d A = d J = 1. Right column: d A = d J = 0.75In Figure 2a, there is no dispersal mortality nor baseline mortality. At the top, the results correspond to the inferences in the previous section: The comparative advantage of adults renders Bequeath an ESS (and Stay not an ESS) for all C A > 1 (log 2 C A > 0). But as ρ decreases, the orange regions become increasingly restricted to large C A values. By the time ρ reaches 0.5, corresponding to sexual reproduction, either only S is an ESS (blue regions) or both B and S are ESSs. At the limit ρ = 0, B is never an ESS, although if C A is large enough, even tiny amounts of relatedness are sufficient for B to be an ESS. We prove this result in the Appendix. To understand these results, consider Stay to be a “selfish” strategy while Bequeath is “cooperative.” A Bequeath adult disperses at a personal cost, because there is more competition at the away site, leaving the easier home site for the juvenile to defend. When ρ = 1, the interests of the adult and juvenile are completely aligned, and so the adult favors the strategy that results in the greatest joint success (family growth). But when ρ < 1, the adult and juvenile will disagree. Provided C A is large enough, B can remain stable. But for small C A, B may not be an ESS. The reason B can be stable even when it cannot invade is because of positive frequency dependence. When B is rare, the adult is dispersing into a site with a resident S adult, in addition to any juvenile immigrants from other sites. For an adult, competing against another adult for the away site is much harder than defending the home site from invading juveniles. But as B increases in frequency, more and more away sites are occupied by juveniles left behind by B adults. It is simultaneously true that more adults enter the dispersal pool, and so adults invade the away site. But this effect happens at both the home and away site and so does not affect the relative cost of adult dispersal. This means that Bequeath does better the more common it becomes, because the away site becomes easier to win, reducing the costliness of adult dispersal. The boundaries for global and local dispersal, shown by the solid and dashed curves, sometimes differ greatly. The major effect of local dispersal is to make it harder for either strategy to invade the population. Local dispersal makes the white region larger, and so more combinations of parameters lead to both B and S being evolutionarily stable. To understand why, it is helpful to refer again to Figure 1. Under local dispersal, at most two individuals can immigrate into any site. Therefore, while the average number of immigrants remains the same as in the global model, the distribution is different. First, the probability of zero immigrants at the home site is reduced under local dispersal. Under global dispersal, the probability of zero immigrants is exp (−1) ≈ 0.37, while under local dispersal, it is only 0.25 (the chance of two coin flips coming up tails). This makes the effective amount of competition greater under local dispersal. Second, the focal disperser now counts for one of the immigrants at the away site. So a rare strategy disperser now competes against, on average, one resident and one‐half immigrant, instead of one resident and one immigrant, as under global dispersal. Indeed, the probability of no additional immigrants at the away site has increased to 0.5 under local dispersal, in contrast to 0.37 under global dispersal. This reduced competition at the away site and increased competition at the home site help Bequeath, by reducing the effective cost of adult dispersal. It is still true that average competition at the away site is greater than average competition at home. But a smaller difference under local dispersal means that B can be stable for smaller values of ρ than it can under global dispersal. Simultaneously, Stay becomes stable under local dispersal for larger values of ρ. The sword of local dispersal cuts both ways: A smaller cost for a dispersing adult is also a smaller benefit for a resident juvenile. This means that Bequeath gains less under local dispersal than it does under global, resulting in both dashed boundaries in Figure 2a receding and increasing the range of conditions for which both B and S are ESSs. The other plots in Figure 2 show the interaction of ρ and C A under different values of dispersal and baseline survival. In Figure 2c, baseline survival for both adults, s A, and juveniles, s J, is reduced by 25%. This creates open habitat, effectively reducing competition at the away site. Under global dispersal, the steady‐state residency becomes R ≈ 0.56. Under local dispersal, R ≈ 0.61. Competition at the home site is also reduced, as fewer other sites have residents to produce immigrants. But this reduction in the disperser pool applies equally to home and away sites. In aggregate, lowered baseline survival benefits Bequeath, by reducing the relative intensity of competition at the away site. This results in an increased orange region, a reduction in the region in which Stay can be an ESS. In Figure 2b, we instead reduce dispersal survival by 25%, setting d A = d J = 0.75. Dispersal mortality has the opposite effect, to aid Stay over Bequeath. Unlike a reduction in baseline survival, a reduction in dispersal survival does not necessarily result in open habitat. Here, the environment remains saturated at R = 1. Since residents always survive, as long as any individual arrives at a site, the site will remain occupied, eventually filling the environment. Now the cost of dispersal is greatly increased. If ρ = 1, this has no effect, because the adult will still agree to disperse, since both the adult and juvenile must pay the same dispersal cost (25%). But as long as ρ < 1, the cost quickly becomes too great for the adult, favoring Stay. The region in which B can be an ESS is greatly reduced. Combining 25% baseline and dispersal mortality, in panel (d), demonstrates a strong interaction between these two forms of mortality. To further understand the effects of the mortality parameters, we proceed in the next sections by fixing ρ = 0.5, representing sexual reproduction, and allowing adult and juvenile survival rates to vary independently.

Habitual reliance on tool use is a marked behavioural difference between wild robust (genus Sapajus ) and gracile (genus Cebus ) capuchin monkeys. Despite being well studied and having a rich repertoire of social and extractive foraging traditions, Cebus sp. rarely use tools and have never been observed using stone tools. By contrast, habitual tool use by Sapajus is widespread. We review theory and discuss factors which might explain these differences in patterns of tool use between Cebus and Sapajus . We then report the first case of habitual stone tool use in a gracile capuchin: a population of white-faced capuchins ( Cebus capucinus imitator ) in Coiba National Park, Panama who habitually rely on hammerstone and anvil tool use to access structurally protected food items in coastal areas including Terminalia catappa seeds, hermit crabs, marine snails, terrestrial crabs and other items. This behaviour has persisted on one island in Coiba National Park since at least 2004. From 1 year of camera trapping, we found that stone tool use is strongly male-biased. Of the 205 camera trap days where tool use was recorded, adult females were never observed to use stone tools, although they were frequently recorded at the sites and engaged in scrounging behaviour. Stone tool use occurs year-round in this population; over half of all identifiable individuals were observed participating. At the most active tool use site, 83.2% of days where capuchins were sighted corresponded with tool use. Capuchins inhabiting the Coiba archipelago are highly terrestrial, under decreased predation pressure and potentially experience resource limitation compared to mainland populations-three conditions considered important for the evolution of stone tool use. White-faced capuchin tool use in Coiba National Park thus offers unique opportunities to explore the ecological drivers and evolutionary underpinnings of stone tool use in a comparative within- and between-species context., Competing Interests: The authors declare no competing interests.