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Contending with sexism is associated with negative affective outcomes, including increased anger, anxiety, and depression. Prior research demonstrates that the use of emotion-regulation strategies, such as self-distanced reappraisal, when contending with general negative interpersonal experiences, can help people manage their emotions, attenuating the associated negative affect. The present research considers whether the affective benefits of reappraisal extend to past experiences of discrimination. Specifically, we examine whether using self-distanced reappraisal (Studies 1 and 2) or positive reappraisal (Study 2) when contending with sexism yields more positive and less negative affective outcomes, relative to engaging in self-immersion. Contrary to previous research examining more general negative interpersonal experiences, we find limited evidence that self-distanced reappraisal is an effective emotion-regulation strategy for women contending with sexism (N = 1,236). The present work offers preliminary evidence, however, that positive reappraisal may be a promising emotion-regulation strategy that reduces the negative affective consequences associated with reliving past instances of sexism, compared with either self-immersion or self-distanced reappraisal. We discuss the implications of these findings for understanding the efficacy of different emotion-regulation strategies in the context of discrimination. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The impact of preexposure prophylaxis uptake on sexual and injection-related behaviors among women who inject drugs is poorly understood. Over 24 weeks, preexposure prophylaxis uptake among women who inject drugs was associated with increased sharing of injection equipment but not syringes and no changes in condomless sex, providing limited evidence of risk compensation in this vulnerable population.

Background. Rapid sequence intubation (RSI) involves inducing unconsciousness and paralysis in rapid succession in order to facilitate endotracheal tube placement. RSI has recently been introduced to the scope of practice of South African prehospital emergency care practitioners (ECPs). Despite this, there remains limited evidence supporting the efficacy and safety of RSI within this context. While in-hospital studies have shown that it can take 20 minutes or more to perform an RSI, little is known about the time taken to perform the procedure in the prehospital setting. Objective. To measure the time taken to perform an RSI in a simulated prehospital environment. Methods. A sample of final-year ECP students were video-recorded performing RSIs on a mannequin within a simulated prehospital environment. Data were gathered through an analysis of the recordings, allowing for the capturing of times taken to complete each of the phases of a RSI. Results. A mean time of 15 minutes 5 seconds was recorded to complete the procedure. This was shorter than times reported for in-hospital studies. Conclusion. RSI is a potentially harmful procedure if improperly performed and has the potential to create delays in transport that may not always be in the patient’s best interest. With a mean time of 15 minutes 5 seconds, the performance of RSI by ECP students in the simulated prehospital environment was faster than expected. Further research is recommended to explore the relationship between the performances observed in this mannequin-based study with those in authentic prehospital settings.

Gastrointestinal (GI) symptoms often affect children with autism spectrum disorders (ASD) and GI symptoms have been associated with an abnormal fecal microbiome. There is limited evidence of Candida species being more prevalent in children with ASD. We enrolled 20 children with ASD and GI symptoms (ASD + GI), 10 children with ASD but no GI symptoms (ASD - GI), and 20 from typically developing (TD) children in this pilot study. Fecal mycobiome taxa were analyzed by Internal Transcribed Spacer sequencing. GI symptoms (GI Severity Index [GSI]), behavioral symptoms (Social Responsiveness Scale -2 [SRS-2]), inflammation and fungal immunity (fecal calprotectin and serum dectin-1 [ELISA]) were evaluated. We observed no changes in the abundance of total fungal species (alpha diversity) between groups. Samples with identifiable Candida spp. were present in 4 of 19 (21%) ASD + GI, in 5 of 9 (56%) ASD - GI, and in 4 of 16 (25%) TD children (overall P = 0.18). The presence of Candida spp. did not correlate with behavioral or GI symptoms (P = 0.38, P = 0.5, respectively). Fecal calprotectin was normal in all but one child. Finally, there was no significance in serum dectin-1 levels, suggesting no increased fungal immunity in children with ASD. Our data suggest that fungi are present at normal levels in the stool of children with ASD and are not associated with gut inflammation.

Background and aims Observational studies showed that coronavirus disease 2019 (COVID-19) attacks universally and its most menacing progression uniquely endangers the elderly with cardiovascular disease (CVD). The causal association between COVID-19 infection or its severity and susceptibility of atrial fibrillation (AF) remains unknown. Methods and results The bidirectional causal relations of COVID-19 (including COVID-19, hospitalized COVID-19 compared with not hospitalized COVID-19, hospitalized COVID-19 compared with population, and severe COVID-19) and AF are determined by using two-sample Mendelian randomization (MR) analysis. Genetically predicted severe COVID-19 was not significantly associated with risk of AF [odds ratio (OR), 1.037; 95% confidence interval (CI), 1.005-1.071; P = 0. 023, q = 0.115]. In addition, genetically predicted AF was also not causally associated with severe COVID-19 (OR, 0.993; 95% CI, 0.888-1.111; P = 0.905, q = 0.905). There was no evidence to support association between of genetically determined COVID-19 and risk of AF (OR, 1.111; 95% CI, 0.971-1.272; P = 0.127, q = 0.318), and vice versa (OR, 1.016; 95% CI, 0.976-1.058; P = 0.430, q = 0.851). Besides, no significant association was observed for hospitalized COVID-19 with AF. MR-Egger indicated no evidence of directional pleiotropy. Conclusion Overall, this MR study provides no clear support that COVID-19 is causally associated with the risk of AF.

Market-driving strategy (MDS) is defined as influencing the market structure and/or the market players’ behavior in a direction that reinforces a firm’s competitive edge. Hitherto, limited evidence exists regarding its consequences, while innovation is of profound importance for MDS. The objectives of this project are to identify: (1) the main firm-level and market-level outcomes of MDS, (2) mediating mechanisms among those outcomes, and (3) the influence of radical and incremental product innovation capabilities on MDS. A mixed-methods research design is applied, grounded in three complementary studies (a qualitative study [27 in-depth interviews], an online survey [241 participants], and a follow-up online survey [101 participants]). Findings suggest that: (a) the firm-level outcomes of MDS are financial and customer performance, organizational reputation, and sustained competitive advantage; (b) radical and incremental product innovation trigger MDS; (c) incremental innovation and organizational reputation are positively related to financial performance; and (d) MDS enhances market change.

Background: Venous thromboembolism (VTE) is common among patients with severe coronavirus disease 2019 (COVID-19). Anticoagulation in hospitalized COVID-19 patients has been associated with survival benefit; however, the optimal thromboprophylaxis strategy has not yet been defined. Objective: To identify published guidance reports by national and international societies regarding thromboprophylaxis strategies in COVID-19 patients in different settings (outpatients, hospitalized, post-discharge). Methods: A systematic review of the literature (Pubmed/EMBASE) was conducted independently by two investigators. Results: Among 1942 initially identified articles, 33 guidance documents were included: 20 published by national and 13 by international societies. These documents provide recommendations mainly for hospitalized (97% of reports) and post-discharge (75%) COVID-19 patients, and less so for outpatients (34%). Thrombotic and bleeding risk stratification prior to any treatment decision is the cornerstone of all suggested thromboprophylaxis strategies; 81% of the documents recommend thromboprophylaxis for all hospitalized patients with a prophylactic dosage of low molecular weight heparin irrespective of VTE risk. Intermediate or therapeutic dose intensity is recommended in high VTE risk patients by 56% and 28% of documents, respectively. Mechanical thromboprophylaxis is suggested in case of high bleeding risk or contraindication to pharmacological thromboprophylaxis (59% of documents). Extended pharmacological thromboprophylaxis is recommended for patients with high VTE risk after hospital discharge (63% of documents). For non-hospitalized outpatients, 28% of documents recommend pharmacological thromboprophylaxis for high VTE risk. Conclusion: The current guidance identifies thromboprophylaxis in COVID-19 patients, especially during hospitalization, as of major importance for the prevention of VTE. Recommendations are derived from limited evidence from observational studies.

In socially monogamous species, extrapair paternity typically results from extrapair copulations, but it can also be due to rapid mate switching. Oring, Fleischer, Reed, and Marsden (1992, Nature, 359 (6396), 631–633) proposed a mechanism to explain the occurrence of extrapair paternity in sequentially polyandrous species: sperm stored by females from within-pair copulations with a previous mate could fertilize eggs in the clutch of a subsequent male. Despite being proposed decades ago, evidence for this hypothesis remains limited. We studied social polyandry, extrapair paternity and copulation behaviour in a population of the red phalarope, Phalaropus fulicarius, a nonterritorial, sex role-reversed shorebird, with male-only care, in Utqiaġvik, Alaska. We tested multiple predictions from the ‘sperm storage’ hypothesis. Extrapair paternity occurred in 11% (37/334) of the nests and 4% (42/1182) of the eggs were sired by a male other than the incubating parent. Although a female's initial mate occasionally sired offspring in her next clutch, our results suggest that sperm stored from a previous mate does not play a major role in explaining the occurrence of extrapair paternity in this sequentially polyandrous species. Instead, extrapair paternity was generally due to extrapair copulations by both sexes during the period between pair establishment and early incubation and to rapid mate switching by females in the context of attempts to acquire multiple care-giving males.

Introduction: Limited evidence has been shown on ways to optimize the mechanical design of machines in order to minimize knee loads. Objective: This study compared six computer simulated models of open kinetic knee extension exercises for patellofemoral pressure and tibiofemoral forces. Methods: A musculoskeletal model of the lower limb was developed using six different cam radius to change resistive forces. A default machine, a constant cam radius, a torque-angle model, a free-weight model and two optimized models were simulated. Optimized models reduced cam radius at target knee flexion angles to minimize knee forces. Cam radius, human force, tibiofemoral compressive and shear force, and patellofemoral pressure were compared for the six models using data from five knee flexion angles. Results: Large reductions in cam radius comparing the free-weight model to other models (73-180%) were limited to the large human force for the constant cam model to other models (9-36%). Larger human force (13 -36%) was estimated to perform knee extension using a constant cam radius compared other models without large effects in knee joint forces. Conclusion: Changes in cam design effected human without a potential impact in knee loads. Resumo Introdução: As evidências são limitadas quanto às formas de otimização do arranjo mecânico das máquinas a fim de minimizar as forças na articulação do joelho. Objetivo: O presente estudo comparou seis modelos de extensão de joelhos realizados em cadeia cinética aberta sob a pressão aplicada nas articulações patelofemoral e tibiofemoral. Métodos: Um modelo do sistema musculo-esquelético do membro inferior foi desenvolvido utilizando seis desenhos de roldana com o objetivo de alterar as forças resistivas. Uma máquina referência foi utilizada, uma com uma roldana concêntrica, um modelo baseado na relação torque-ângulo dos extensores do joelho, um modelo de peso livre e dois modelos otimizando a aplicação de cargas foram simulados. A otimização foi aplicada visando reduzir o raio da roldana excêntrica e minimizar as forças aplicadas no joelho. O raio da roldana, a força produzida pelo executante, as forças compressivas e de cisalhamento nas articulações tibiofemoral e a pressão na articulação patelofemoral foram comparadas para os seis modelos de máquina utilizando cinco ângulos de flexão do joelho. Resultados: Reduções no raio da roldana foram observadas comparando o modelo de peso livre com os demais modelos (73-180%). Maior força produzida foi observada para o modelo de roldana constante comparado aos demais modelos (9-36%). Maior força produzida foi estimada para realizar a extensão do joelho utilizando a roldana constante comparada com os demais modelos (13-36%) sem efeitos sobre as forças no joelho. Conclusão: O arranjo mecânico das máquinas alterou a força produzida pelo executante sem afetar as forças aplicadas no joelho.

Injuries have a negative impact on the development of football players. Maturation is a potential risk factor for football injuries but available data on this topic provide limited evidence due to methodological shortcomings. The aim of this study was to describe the injury burden of male academy football players according to growth curve-derived maturity status and timing. Injury and growth data were collected from 2000 to 2020. Longitudinal height records for 110 individual players were fitted with the Super-Imposition by Translation and Rotation model to estimate age at peak height velocity (PHV). Players were clustered according to maturity status (pre-, circa-, post-PHV, or adults) and timing (early, on-time, late maturers). Overall and specific injury burdens (days lost/player-season) and rate ratios for comparisons between groups were calculated. Overall injury burden increased with advanced maturity status; pre-PHV players had 3.2-, 3.7-, and 5.5-times lower burden compared with circa-PHV, post-PHV, and adult players, respectively. Growth-related injuries were more burdensome circa-PHV, while muscle and joint/ligament injuries had a higher impact post-PHV and in adults. Further, in the pre-PHV period, late maturers showed lower burden of overall, growth-related, anterior inferior iliac spine osteochondrosis, and knee joint/ligament injuries compared with on-time maturers. In adult players, however, injuries were less burdensome for early maturers than on-time and late maturers. In addition, joint/ligament injuries of adult late maturers were 4.5-times more burdensome than those of early maturers. Therefore, monitoring maturity seems crucial to define each player's maturation profile and facilitate design of targeted injury prevention programmes.HighlightsInjury burden is significantly lower in football players at pre-peak height velocity (PHV). Growth-related injuries are most burdensome circa-PHV, while muscle and joint/ligament injuries are more burdensome post-PHV and especially in adults.Before PHV, growth-related and knee joint/ligament injuries have lower burden in players who mature late than those who mature on-time. Adult late maturers have greater burden of overall and joint/ligament injuries than early maturers.Football academies should regularly assess the maturity status and timing of young football players, as the impact of injuries varies with maturation status and timing.Management of the maturity-related injury risk profile, in combination with other relevant factors (training load, neuromuscular and biomechanical factors, physiotherapy, coaching, communication, psychosocial factors …), might help improve the success of player development programmes and protect the health of young football players.

Vasectomy is a safe, effective, and practical option for permanent contraception in men. Vasectomy is a surgical procedure used in men to disrupt and occlude the vas deferens, which delivers sperm from the testicles. By interrupting sperm transport, this procedure provides permanent sterilization. Vasectomies are typically done under local anesthesia in outpatient settings, and patients usually go home within an hour of the surgery. Surgical techniques used for vasectomy vary widely throughout the world, with limited evidence to guide the most effective approach. Current vasectomy guidelines largely rely on information from observational studies, with few controlled clinical trials.

Introduction Pharmacy graduates should be equipped for one inevitable aspect of health care, mortality, yet only 10% of United States pharmacy curricula courses cover end-of-life (EoL) with limited evidence of effectiveness. This study's objective was to evaluate the impact of an EoL elective on student pharmacists' empathy and attitudes toward mortality and caring for terminally ill persons. Methods First- through third-year student pharmacists enrolled in an EoL elective. Students completed pre- and post-course surveys on self-perceptions of empathy and mortality. Surveys included the following: Kiersma-Chen Empathy Scale (KCES), which assesses empathy of pharmacy and nursing students; revised Collett-Lester Fear of Death and Dying Scale (CL-FODS), which measures fear related to death; and Frommelt Attitudes Toward Care of the Dying Scale Form B (FATCOD-B), which measures health care professionals' attitudes toward EoL care. Anonymous identifiers were used to link pre- and post-course surveys and were collected with an online survey software. Data were analyzed using two-sided paired t-tests. Results Twenty-seven student pharmacists completed the elective. The change in overall mean scores for KCES, CL-FODS, and FATCOD-B correlated with increased empathy, reduced fear of death, and increased positive attitudes toward caring for terminal patients (KCES pre-course = 86.15 vs. post-course = 90.37; CL-FODS pre-course = 93.70 vs. post-course = 75.15; FATCOD-B pre-course = 115.89 vs. post-course = 124.04). Conclusions After the EoL elective, student empathy and attitudes toward mortality and caring for terminally ill persons improved. Implementing EoL concepts in pharmacy curricula should be explored to better prepare graduates in patient care.

BACKGROUND The guidelines published by the Papanicolaou Society of Cytopathology (PSC) intend to unify the reporting language in pancreaticobiliary specimens and improve communication between cytopathologists and clinicians. The six categories in the system will determine the best management for patients. However, there is limited evidence regarding the risk of malignancy (ROM) associated with each category. METHODS A retrospective search was performed for pancreaticobiliary fine-needle aspiration (FNA) reports with corresponding surgical follow-up. Cases were reclassified according to the PSC. The ROM, sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each category. RESULTS A total of 297 cases were identified and reclassified as: 30 nondiagnostic (category I), 45 negative for malignancy (II), 20 atypical (III), 42 neoplastic: other (IVB), 19 suspicious for malignancy (V), and 141 malignant (VI). The absolute ROM was 10% for category I, 8.9% for category II, 60% for category III, 4.8% for category IV when the neoplasms were not characterized as malignant, and 100% when categorized as malignant; 100% for category V, and 95.7% for category VI. Sensitivity, specificity, positive predictive value, and negative predictive value for neoplasia and malignancy, including categories IV to VI, were 96.6%, 88.4%, 97.5%, and 84.4%, respectively. CONCLUSIONS The categories developed by the PSC stratify the ROM. Aspirates designated as categories V and VI had the highest ROM. Our rate of atypical category complies with the recommended rate of

An underexplored question, and one with potentially far-reaching implications for the practice of written corrective feedback (WCF), is whether to mark a wide range of errors (comprehensive feedback) or to focus on a few error types (focused feedback) in learners’ L2 writing. Despite limited evidence, it is argued that comprehensive WCF is unsystematic, inconsistent, confusing, and intimidating; can cognitively and affectively overwhelm L2 learners and may dilute attention to WCF. This paper aims to first respond to and call into question these and other arguments against comprehensive WCF, and then it puts forward some arguments against focused WCF. In doing so, it draws on dominant SLA theories and empirical research findings to lend support to the rebuttals and arguments. Some concrete suggestions are made to help teachers fully exploit the potentials of a comprehensive feedback approach., Une question sous-explorée, et qui pourtant a des implications potentiellement profondes pour la pratique de la rétroaction corrective à l’écrit (RCE), est de savoir s'il faut corriger un large éventail d'erreurs (correction compréhensive) ou se concentrer sur quelques types d'erreurs (correction ciblée) lors de la rétroaction corrective des écrits des apprenants d’une langue seconde. Malgré des preuves limitées, il est fait valoir que la RCE est non systématique, inconsistante, déroutante et intimidante ; qu’elle peut cognitivement et affectivement submerger les apprenants d’une seconde langue ; qu’elle peut faire décroître l’attention portée à la RCE. Ceci tente de répondre et de remettre en question ces arguments, et bien d’autres, qui s’élèvent contre la RCE compréhensive, tout en apportant des arguments contre la RCE ciblée. Je m’appuierai sur les théories dominantes de l’acquisition des langues et sur les résultats de recherches empiriques pour soutenir les réfutations et les arguments avancés. Des suggestions concrètes seront apportées afin d’aider les enseignants à exploiter pleinement le potentiel de la rétroaction corrective compréhensive.

PURPOSE As part of the German interdisciplinary S3-guideline "Diagnosis, Treatment and Followup of Renal Cell Carcinoma", this article aimes to provide guidance regarding the use of supportive therapy and complementary medicine in patients with advanced or metastatic renal cell carcinoma. METHODS The German interdisciplinary S3-guidelines are national clinical practice guidelines that implement the highest methodological quality of evidence-based medicine. Recommendations and evidence-based statements are provided according to available evidence. RESULTS Supportive and palliative care are important areas of tumor treatment and require knowledge on the management of a variety of issues. This article outlines the management of tumor-related symptoms such as pain, undesired treatment-related effects, palliative care and end-of-life care in patients with renal cell carcinoma. CONCLUSION Patients with advanced or metastatic renal cell carcinoma should have access to supportive and palliative care according to their individual needs. There is very limited evidence regarding the impact of complementary medicine for the treatment of patients with renal cell carcinoma.

Atmospheric carbon dioxide (CO2 ) levels are currently at 418 parts per million (ppm), and by 2100 may exceed 900 ppm. The biological effects of lifetime exposure to CO2 at these levels is unknown. Previously we have shown that mouse lung function is altered by long-term exposure to 890 ppm CO2 . Here, we assess the broader systemic physiological responses to this exposure. Mice were exposed to either 460 or 890 ppm from preconception to 3 months of age, and assessed for effects on developmental, renal and osteological parameters. Locomotor, memory, learning and anxiety-like behaviours of the mice were also assessed. Exposure to 890 ppm CO2 increased birthweight, decreased female body weight after weaning, and, as young adults, resulted in reduced engagement in memory/learning tasks, and hyperactivity in both sexes in comparison to controls. There were no clear anxiety, learning or memory changes. Renal and osteological parameters were minimally affected. Overall, this study shows that exposure of mice to 890 ppm CO2 from preconception to young adulthood alters growth and some behaviours, with limited evidence of compensatory changes in acid-base balance. These findings highlight the potential for a direct effect of increased atmospheric CO2 on mammalian health outcomes. KEY POINTS: Long-term exposure to elevated levels of atmospheric CO2 is an uncontrolled experiment already underway. This is the first known study to assess non-respiratory physiological impacts of long-term (conception to young adulthood) exposure of mice to CO2 at levels that may arise in the atmosphere due to global emissions. Exposure to elevated CO2 , in comparison to control mice, altered growth patterns in early life and resulted in hyperactive behaviours in young adulthood. Renal and bone parameters, which are important to balance acid-base levels to compensate for increased CO2 exposure, remained relatively unaffected. This work adds to the body of evidence regarding the effects of carbon emissions on mammalian health and highlights a potential future burden of disease.

Background Since its legalization in Canada, cannabis use has expanded to include commercially available topical formations. Several scientifically unsupported claims regarding the therapeutic efficacy of topical cannabis are also being made. Developing an understanding of the consumer uses of topical cannabis is important for clinicians to provide appropriate counseling and inform potential areas of therapeutic development. We are examining the prevalence, purpose of use, and sources of information regarding topical cannabis in the Canadian population, with a focus on dermatologic uses. Method A cross-sectional, anonymous electronic, voluntary survey was developed to assess the use of topical cannabis amongst adults in Canada. Results Cannabis was used topically at least once by 24.3% of respondents who started the survey. The commonest form of topical cannabis were creams (26.2%). The most common dermatologic conditions being treated with topical cannabis included atopic dermatitis (25%), acne (19%), and anti-aging (16%); for non-dermatologic conditions, common uses were for joint stiffness or tendonitis (30%) and headaches and migraines (27%). Topical cannabis was reported to be most effective for joint stiffness and tendonitis, general muscular soreness, headaches, eczema, pruritus, acne, and psoriasis. Most respondents obtained and received information about topical cannabis from dispensaries. Conclusion Canadians use topical cannabis for a broad range of systemic and dermatologic purposes, most of which have limited evidence. Future clinical studies are required to elucidate the therapeutic efficacy and safety of topical cannabis. Dermatologists should screen their patients for topical cannabis use and be aware of the limited evidence of therapeutic potential.

This study aimed to identify patterns of opioid dispensing in Australian workers with low back pain (LBP) and determine the association of dispensing patterns with wage replacement duration. Australian workers' compensation claimants with LBP and at least 1 day of wage replacement were included. We used group-based trajectory modelling to identify opioid dispensing patterns over a two-and-a-half-year period from reported LBP onset and quantile regression to compare wage replacement duration between each dispensing pattern group. Opioids were dispensed to one-third of workers with LBP (N = 3205, 33.3%) at least once during their claim. Three dispensing patterns were identified. Most had a short-term low-volume opioid dispensing pattern (N = 2166, 67.6%), whereas 798 (24.9%) had a long-term moderate-volume pattern and 241 (7.5%) had a long-term high-volume pattern. Workers with dispensed opioids had significantly longer wage replacement duration than those without dispensed opioids (median [weeks]: 63.6 vs 7.1, respectively). In addition, moderate-volume and high-volume long-term dispensing groups had significantly longer wage replacement duration compared with the short-term dispensing group (median [weeks]: 126.9, 126.0, and 30.7, respectively). Without controlling for pain severity, these results offer limited evidence that opioids lead to longer wage replacement duration. Further research controlling for pain severity, psychosocial factors, and recovery expectations is required to confirm whether the relationship between opioid dispensing pattern and wage replacement duration is causal in nature.

Changing teachers’ practice is difficult, especially in low- and middle-income contexts (LMIC). Recently, with attention turning to improving early mathematics in addition to reading outcomes, donors, governments, and non-governmental organizations (NGOs) are grappling with the design of mathematics interventions and supportive policies. However, there is limited evidence showing how to change teachers’ practices in early mathematics classrooms in LMIC. For this exploratory study, the authors provided 15 kindergarten teachers in Ghana with sequenced mathematics activities, with some teachers receiving low-cost manipulatives (e.g., bottle-cap counters and number cards), and other teachers being asked to create or gather their own. The findings showed that teachers who were given the manipulatives were much more likely than teachers not given the manipulatives to use the activities provided. In addition, the character of the instruction was qualitatively different for teachers who were given the manipulatives. These results, while exploratory, suggest the need for classroom sets of manipulatives when designing an intervention that aims to change teachers’ practices.

To review the existing literature on PET/MR for musculoskeletal malignancies. PubMed (MEDLINE) was searched through July 2021. The search strategy focused on the keywords “PET/CT”, “PET/MR”, “MRI”, “attenuation correction”, “sarcoma”, “skeletal”, “metastases”, “myeloma”, “FDG”, “Sodium fluoride”, “PSMA”, “DOTATATE”, “fluciclovine”, and “FAPI”. 97 relevant papers were considered for review. Studies selected were primarily retrospective and prospective cohort studies. There is limited literature comparing PET/CT to PET/MR for evaluation of primary musculoskeletal malignancies and musculoskeletal metastatic disease. Most studies involve relatively small numbers of patients. Despite limited evidence and the lack of widespread application, PET/MR is a promising imaging technique for evaluating musculoskeletal malignancies. This is owing primarily to the strength of its constituent modalities. PET permits for acquisition of metabolic information using a variety of emerging novel radiopharmaceuticals. MR allows for assessment of bone marrow and for identification and characterization of soft-tissue lesions. Selection of appropriate radiopharmaceutical and MR protocol parameters is key for optimal evaluation. Although PET/MR has shown promise in evaluation of musculoskeletal involvement of multiple malignancies, it has not yet demonstrated broad superior to PET/CT. More research is needed to understand its value in the care of patients with such diseases.

Introduction: There is limited evidence describing utilization of clinic-based food referral programs intended to support healthy eating for food-insecure patients. To address this gap, this study aims to describe the utilization of the Mid-Ohio Farmacy (MOF). MOF is a partnership between a regional foodbank and local health care providers, including an academic medical center (AMC), that enables referrals of patients that experience food insecurity to a network of participating food pantries. Methods: This observational study uses data from 2 AMC family medicine clinics that offered the MOF referral from September 2019 to November 2020. Patients who screened positive for food insecurity and had an eligible chronic disease (eg, diabetes, hypertension, obesity) were referred to the MOF. We compared demographic and clinical characteristics of patients that filled their referral (ie, visitors) to those that did not (ie, non-visitors). Among visitors, we also assessed patterns of pantry utilization. Results: In total, 51% (164 of 322) of patients referred to the MOF visited a food pantry at least once. Visitors were more likely to be older, have diabetes, and have visited a food pantry before their referral. Patients with uncontrolled hypertension were less likely to visit a food pantry following their referral. Patients that had visited a food pantry before their referral had more visits in total and more produce-specific visits following their referral. Conclusions: Our results suggest that while the MOF can connect patients to food resources, further attention may be needed to encourage its use among patients who have not previously accessed pantries.

Introduction Agitation and impaired cognitive functioning are common symptoms of dementia, which require costly medication regimens that are associated with adverse effects. This study investigates the effects of dance interventions on agitation and cognitive function in people living with dementia in institutional care facilities. Methods Five electronic databases were searched for eligible studies on dance interventions for people living with dementia published between 2002 and 2021. Standard deviation and post mean values were extracted. Within-group Hedges’ g was computed for individual studies. Results Six randomised controlled trials and three non-randomised studies of satisfactory quality, with a total of 610 participants, were included. Statistical analysis found significant improvements in agitation and cognitive functioning with dance interventions. Discussion This review provided favourable evidence on the effects of dance interventions on agitation and cognitive functions in people with dementia. However, given the limited evidence, more studies are needed to confirm the effects.

The responsibilities of teachers and principals in Government Funded Religious Schools (GFRS) in Malaysia have become more demanding as the enrolment rates have risen over time. The principals’ transformational leadership (TL) potentially affects teachers’ trust (TT), which directly influences their work commitment (WC) in school. However, limited evidence is available to support this assertion. Thus, this study seeks to investigate: (a) the level of TL, TT, and WC and (b) the influence of TT as a mediator between TL and WC from the teachers’ perspective in the Government Funded Religious Schools (GFRS) in Selangor. This study employed a survey research design. A survey questionnaire was administered to 297 GFRS teachers in Selangor. These teachers were selected using a stratified random sampling technique. Descriptive (means, standard deviation, frequency, and percentage) and inferential statistics (analysis of regression and predictive accuracy) were employed to analyse the data. The findings suggested that the overall level TL (M = 4.077, SD = 0.533), TT (M = 4.070, SD = 0.521) and WC (M = 4.188, SD = 0.413) in GFRS in Selangor were ‘high’. It was also found that TL was a significant predictor of TT (B = 0.867, SE = 0.026, p B = 0.361, SE = 0.083, p R2 = 0.290). However, TT was not a significant predictor of WC (B = 0.064, SE = 0.085, p > 0.05), suggesting that TT did not mediate the relationship between TL and WC. Even though this study exemplified that the level of TL, TT and WC was at a high level, TT was found to have an insignificant effect on WC. This provides a new insight in understanding this complex relationship. The dynamic of relationships—among teachers, between teachers and staff, and with outside parties, might have an impact on developing TT and WC among these teachers.

Background Despite the benefits of physical activity (PA), the majority of Canadian youth are falling short of the recommended 60 min of moderate-to-vigorous physical activity (MVPA) per day. School-based physical activity programs such as intramurals, are important opportunities for youth to be physically active. There is limited evidence available on the impact of gender-specific (e.g., female-only, male-only) and co-ed intramurals on youth PA over time, however, evidence suggests female-only intramurals may be important for female MVPA. This research aims to capitalize on a natural experiment to generate practice-based evidence on the impact of changes in gender-specific and co-ed intramurals on youth MVPA over time. Methods This study used linked longitudinal school- and student-level data from Ontario secondary schools in year 5 (Y5:2016–2017), year 6 (Y6: 2017–2018) and year 7 (Y7: 2018–2019) of the COMPASS study. Data on intramurals from 55 schools were used to determine the changes to gender-specific and co-ed intramurals that occurred from Y5 to Y6. Baseline demographic characteristics were measured and data on PA and sport participation were collected in Y5, Y6 and Y7 on a sample of 4417 students. Hierarchical linear mixed regression models were used to estimate how changes in gender-specific and co-ed intramurals were associated with youth MVPA over time. Results Participation in intramural, varsity and community sport were all positively and significantly associated with youth MVPA. Changes in gender-specific and co-ed intramurals were not significantly associated with youth MVPA in Y6 or Y7. However, the positive association between maintaining the addition of gender-specific intramurals on female MVPA in Y7 was on par with the significance level of α = 0.05, suggesting that adding gender-specific intramurals may be important for female MVPA. Conclusions Adding gender-specific and co-ed intramurals may not be sufficient strategies to increase PA among youth. Further research should explore the effect of gender-specific intramurals on youth PA, as this study may have been underpowered at the school-level. Gender-specific intramurals may promote a supportive PA environment that promotes MVPA, especially among females. These intramurals may be an important component of more comprehensive strategies to increase youth MVPA.

The objective of this systematic review was to assess the methods to determine bicycle saddle height and the effects of saddle height on cycling performance and injury risk outcomes. The key motivator of this review was to update and expand the finding reported by a previous narrative review published in 2011. The literature search included all documents from the following databases: Medline, Scopus, CINAHL, OVID and Google Scholar. Studies were screened against the Appraisal tool for Cross-sectional Studies to assess methodological quality and risk of bias. After screening the initial 29,398 articles identified, full-text screening was performed on 66 studies with 41 of these included in the systematic review. Strong evidence suggests that saddle height should be configured using dynamic measurements of the knee angle, and limb kinematics is influenced by changes in saddle height. However, moderate evidence suggests that changes in saddle height less than 4% of the leg length results in trivial to small changes in lower limb loads, and no effect on oxygen uptake and efficiency. It is also possible to state that there is limited evidence on the effects from changes in saddle height on supramaximal cycling performance or injury risk.

The aim of this systematic review was to provide the required information regarding different aspects of the relationship between epilepsy/antiseizure medications and non-alcoholic drinks. The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were followed. MEDLINE and Scopus from the inception until 7 August 2021 were systematically searched. These key words were used: "epilepsy" OR "seizure" OR "antiepileptic" OR "antiseizure" OR "anticonvulsant" AND "coffee" OR "tea" OR "soda" OR "juice" OR "drink" OR "cola" OR "diet" (35 key word combinations). The primary search yielded 21 458 publications (PubMed, n = 4778; Scopus, n = 16 680). Only 50 studies met all the inclusion criteria and were included in the current systematic review. In total, 17 articles investigated various non-alcoholic drinks in human studies, 11 studies were case reports/series, and 22 articles were animal/in vitro studies. None of the studies provided a class 1 of evidence. There is limited evidence suggesting that certain drinks (eg, caffeinated energy drinks) might trigger seizures. Patients with epilepsy should avoid excessive consumption of certain fruit juices (eg, grapefruit, lime, pomegranate, kinnow, and star fruit) and caffeinated drinks. However, daily coffee and tea intake can be part of a healthy balanced diet, and their consumption does not need to be stopped in patients with epilepsy. Coffee/tea consumption is not harmful if consumed at levels of 200 mg (caffeine) in one sitting (about 2½ cups of coffee) or 400 mg daily (about five cups of coffee).

Examination of the efficacy of clinical supervision has accrued limited evidence, partially due to lack of a clarity or consensus on what constitutes supervision outcomes. This not only leads to inconsistency across studies evaluating supervision outcomes but also falls short of providing guidance for clinical supervisors to systematically evaluate the efficacy of their work. We present a practitioner-oriented, evidence-informed, and pan-theoretical framework that connects a broad range of outcomes to the supervision process, including proximal, intermediate, and distal outcomes. We discuss how several practitioner-friendly instruments related to these outcomes can be incorporated into supervision practice and contribute to a more holistic assessment of supervision outcomes. We also discussed supervisory strategies, such as strategically attending to and balancing multiple levels of outcomes and incorporating a theoretical lens to our framework.

Objectives Depression can impair decision-making capacity (DMC) for health care decisions. However, it is unclear whether DMC improves after treatments for depression such as electroconvulsive therapy (ECT). There is limited evidence available on DMC for treatment in patients with depression referred for ECT, and it is unknown whether ECT has any impact on DMC. We hypothesized that ECT will improve DMC in severely depressed patients and that this change will be associated with reduced depressive symptom severity. Methods Using the MacArthur Competence Assessment Tool-Treatment, 4 abilities related to DMC were evaluated: Understanding, Appreciation, Reasoning, and Expressing a choice. This prospective study compared DMC abilities, depression severity, and cognition scores in 24 patients hospitalized with a major depressive episode before and 3 to 5 days after a course of ECT. Results Although Understanding scores significantly improved after ECT (P = 0.004, r = 0.41), there was no change in other abilities related to DMC or cognition scores. As expected, there was a large improvement in mood ratings after ECT, but the change in DMC abilities was not associated with change in depressive symptoms. Conclusions To our knowledge, this is the first study to provide data on the effects of ECT on DMC in patients with depression. Abilities related to DMC that may be affected in this group before treatment include Understanding and Reasoning. Findings indicate that DMC to consent to treatment mostly does not change after a course of ECT and some aspects can improve in patients with depression.

Exposure to diesel exhaust particles (DEPs) and urban particles (UPs) increases the incidence of degenerative brain diseases as well as respiratory diseases. However, there is limited evidence on the mechanism of neurotoxicity on exposure to these particles. In the present study, the damage to blood–brain barrier (BBB) function by DEP or UP exposure was evaluated in bEnd.3 cells, which are derived from the brain tissue of Balb/c mice. It was demonstrated that DEP and UP exposure may induce oxidative stress via increasing reactive oxygen species (ROS) and decreasing total antioxidant capacity (TAC) level in bEnd.3 cells. In addition, cells exposed to DEP and UP demonstrated a resistance value of about 50% each compared to the value noted prior to exposure; additionally, Claudin-5 and ZO-1 expression levels were significantly decreased compared to the corresponding levels in the control. It was inferred that DEP or UP exposure diminishes the expression of tight junction proteins in endothelial cells through ROS generation, thereby enhancing endothelial membrane permeability. This study showed that DEPs or UPs induced cell permeability and oxidative stress by increasing ROS generation in bEnd.3 cells. This suggests the possibility that exposure to DEPs or UPs may compromise the integrity of the BBB and induce adverse effects in the CNS.

The Indonesian Government’s targets to reduce the prevalence of child malnutrition are unlikely to be met based on current progress. Adequate dietary intake is key to meeting these targets. This systematic review aimed to provide a comprehensive overview of the nutrient and food intake of Indonesian children under five years of age. Peer-reviewed and gray literature published between 2007 and 2019 were collected. Of 1500 records, 38 articles met the study inclusion criteria and a narrative analysis was conducted. Children under five years were reported to have ranging energy and macronutrient intakes, some with adequate protein intake. Micronutrient deficiencies, particularly iron, zinc, calcium, and vitamin C, were reported. Animal-source foods, fruits, and vegetables were consumed by children, but frequency and/or volume of consumption was low, and it is among the probable causes of micronutrient deficiency among children under five years. The absence of reporting micronutrient intake in the national survey limited evidence to inform nutrition-related policies. The implementation of a national micronutrient survey will be beneficial in informing policy and practice aimed at reducing the prevalence of child malnutrition in line with national targets, through improvement in dietary intake.

Adopting a circular economy requires an active engagement of enterprises, the government, and the consumers. However, the extant literature has limited evidence of government policies and enterpris...

This systematic review was performed to summarize existing research on the symptom validity scales within the Trauma Symptom Inventory–Second Edition (TSI-2), a relatively new self-report measure designed to assess the psychological sequelae of trauma. The TSI-2 has built-in symptom validity scales to monitor response bias and alert the assessor of non-credible symptom profiles. The Atypical Response scale (ATR) was designed to identify symptom exaggeration or fabrication. Proposed cutoffs on the ATR vary from ≥ 7 to ≥ 15, depending on the assessment context. The limited evidence available suggests that ATR has the potential to serve as measure of symptom validity, although its classification accuracy is generally inferior compared to well-established scales. While the ATR seems sufficiently sensitive to symptom over-reporting, significant concerns about its specificity persist. Therefore, it is proposed that the TSI-2 should not be used in isolation to determine the validity of the symptom presentation. More research is needed for development of evidence-based guidelines about the interpretation of ATR scores.

BACKGROUND: There is limited evidence on the efficacy of per-oral endoscopic myotomy (POEM) in patients with esophageal diverticula. AIMS: This meta-analysis aimed to assess the efficacy and safety profile of POEM in patients with Zenker’s (ZD) and epiphrenic diverticula. METHODS: With a literature search through August 2020, we identified 12 studies (300 patients) assessing POEM in patients with esophageal diverticula. Primary outcome was treatment success. Results were expressed as pooled rates and 95% confidence intervals (CI). RESULTS: Pooled rate of technical success was 95.9% (93.4%−98.3%) in ZD patients and 95.1% (88.8%−100%) in patients with epiphrenic diverticula. Pooled rate of treatment success was similar for ZD (90.6%, 87.1%−94.1%) and epiphrenic diverticula (94.2%, 87.3%−100%). Rates of treatment success were maintained at 1 year (90%, 86.4%−97.4%) and 2 years (89.6%, 82.2%−96.9%) in ZD patients. Pooled rate of symptom recurrence was 2.6% (0.9%−4.4%) in ZD patients and 0% in patients with epiphrenic diverticula. Pooled rates of adverse events and severe adverse events were 10.6% (4.6%−16.6%) and 3.5% (0%−7.4%) in ZD and 8.4% (0%−16.8%) and 8.4% (0%−16.8%) in epiphrenic diverticula, respectively. CONCLUSIONS: POEM represents an effective and safe therapy for the treatment of esophageal diverticula.

Suicides are among the leading causes of death in elderly Americans. The problem is expected to grow with an aging population in the U.S. Suicides in African-American elderly are not well studied. This article enumerates the risk factors for suicidal behaviors in elderly African-Americans; presents an epidemiological assessment of suicides in elderly African-Americans from 2010 to 2018 with gender-specific differences, and explores public health considerations for helping to reduce the growing numbers of suicides in elderly African-Americans. Currently, there are very limited evidence-based interventions to reduce or prevent suicides in older African-Americans. This article also provides implications and recommendations for prevention practice and research that is needed to help alleviate suicides in older African-Americans.

Background Locally recurrent disease following surgical resection of Ewing sarcoma (ES) confers a poor prognosis. Limited evidence is available evaluating non-selective use of pre-operative radiotherapy (RT) for patients with pelvic ES and its effect on local control and survival. Patients and methods 49 consecutive patients with pelvic ES were identified retrospectively from a prospectively collated database. Patients either received non-selective pre-operative RT and surgery (n = 27), or selective post-operative RT (n = 22) (surgery alone (n = 11) or surgery and post-operative RT (n = 11)). Results Patients who had non-selective pre-operative radiotherapy appeared to have a higher LRFS, 88.0% compared to 66.5% in the selective RT group (p = 0.096, Kaplan Meier; p = 0.028, Chi-squared). Administration of non-selective, pre-operative RT to all patients with pelvic ES elevates the LFRS to that of the good responder group (≥90% tumour necrosis and margins, p = 0.880). There was no difference in metastasis-free survival, 60.0% and 54.5% (p = 0.728) and overall survival (OS), 57.7% and 63.6% (p = 0.893). The majority of pre-operative RT patients had both good necrosis (≥90%) (p = 0.003) and widely excised tumours, 81.5% vs 59.1% (p = 0.080). Tumour volume ≥250 ml was associated with worse LRFS (p = 0.045) and post-operative complications (p = 0.017). There may be improved LRFS (p = 0.057) with pre-operative proton-beam RT compared to surgery and selective post-operative RT. Conclusion Pre-operative photon or proton-beam RT to all pelvic ES may improve LRFS compared to the selective delivery of post-operative RT. Radiotherapy delivered to all patients results in a greater percentage of highly necrotic tumours at surgical excision, enabling a greater proportion of patients with wide resection margins.

There is limited evidence to provide an insight on the VEMP characteristics to explain the association between chronic renal disease (CRD) and its effect on otolith structures.To compare the otolithic function of individuals with CRD and individuals with no known CRD. To investigate the relationship between disease duration and VEMP and creatine level and VEMP among individuals with CRD.A cross-sectional study design using convenient sampling method was adapted for the present study. A total of 50 adults aged between 40 and 60 years participated in the study. Group 1 included 25 individuals with CRD undergoing hemodialysis and Group 2 included 25 individuals with no known CRD. cVEMP and oVEMP were recorded from participants in both groups.cVEMP and oVEMP was absent in 28% and 44% of individuals with CRD respectively, while, both VEMPs were present among all participants in group 2. Further, peak-to-peak amplitude of VEMP was reduced in individuals with CRD suggesting abnormal otolith function. In addition, a negative correlation was found between disease duration and the peak-to-peak amplitude of VEMP.The abnormal VEMP findings in individuals with CRD shows presence of otolithic dysfunction along with amplitude is found to decrease with an increase in the disease duration.

Cognitive control deficits are one of three primary endophenotypes in depression, and the enhanced targeting of these deficits in clinical and research work is expected to lead to improved depression outcomes. Cognitive control is a set of self-regulatory processes responsible for goal-oriented behavior that predicts clinical/functional outcomes across the spectrum of brain-based disorders. In depression, cognitive control deficits emerge by the first depressive episode, persist during symptom remission, and worsen over the course of depression. In addition, the presence of these deficits predicts a poor response to evidence-based depression treatments, including psychotherapy and antidepressant medication. This is particularly relevant to childhood depression, as 1%-2% of children are diagnosed with depression, yet there are very limited evidence-based treatment options. Cognitive control deficits may be a previously underaddressed factor contributing to poor outcomes, although there remains a dearth of research examining the topic. The investigators describe the prior literature on cognitive control in depression to argue for the need for increased focus on this endophenotype. They then describe cognitive control-focused clinical and research avenues that would likely lead to improved treatments and outcomes for this historically undertreated aspect of childhood depression.

Fracture non-union results in serious morbidity for patients and a financial burden on healthcare services. Fracture healing is a complex process that involves many chemical signalling molecules and cells. This complexity means there are many stages at which the healing pathway can theoretically be influenced by biologic adjuvants. Biologic adjuvants can be either osteoconductive, osteoinductive or osteogenic. Many laboratory studies have shown success in manipulating the signalling pathways involved in fracture healing. The majority of biologics serve to increase the presence of certain cytokines to stimulate bone forming cells; some agents involve effecting the delivery of early progenitor cells. There have been clinical trials involving multiple biologics, usually in the treatment of tibial non-unions. The clinical trials have shown very limited evidence to support the use of adjuvants in clinical practice. There is a consistent problem translating encouraging laboratory results into similar clinical results with the majority of agents, therefore there remains a lack of clinical evidence to support their use in everyday trauma practice.

Despite the expanding literature in the last three decades on modes of implementation and the various forms of formal and informal assessments, there is limited evidence of academics’ knowledge and understanding of continuous assessment practice. Using a mixed methods sequential explanatory research design, this paper aimed to investigate academics’ knowledge and understanding of the structure of continuous assessment and its application in supporting students’ learning experiences at a South African University of Technology. The results of this study provide the basis to initiate deeper discussions on developing shared understandings of assessment literacy, assessment bunching, and assessment validity and reliability. These elements are all required for the enhancement of quality assurance and monitoring of fit for purpose continuous assessment practices.

Reliable and responsive tools for monitoring disease activity and treatment outcomes in patients with neuropathies are lacking. With the emergence of ultrasensitive blood bioassays, proteins released with nerve damage are potentially useful response biomarkers for many neurological disorders, including polyneuropathies. In this review, we provide an overview of the existing literature focusing on potential applications in polyneuropathy clinical care and trials. Whilst several promising candidates have been identified, no studies have investigated if any of these proteins can serve as response biomarkers of longitudinal disease activity, except for neurofilament light (NfL). For NfL, limited evidence exists supporting a role as a response biomarker in Guillain-Barré syndrome, vasculitic neuropathy, and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Most evidence exists for NfL as a response biomarker in hereditary transthyretin-related amyloidosis (hATTR). At the present time, the role of NfL is therefore limited to a supporting clinical tool or exploratory endpoint in trials. Future developments will need to focus on the discovery of additional biomarkers for anatomically specific and other forms of nerve damage using high-throughput technologies and highly sensitive analytical platforms in adequality powered studies of appropriate design. For NfL, a better understanding of cut-off values, the relation to clinical symptoms and long-term disability as well as dynamics in serum on and off treatment is needed to further expand and proceed towards implementation. Supplementary Information The online version contains supplementary material available at 10.1007/s13311-021-01136-0.

BackgroundNo previous review has assessed the extent and effect of industry interactions on medical oncologists and haematologists specifically.MethodsA systematic review investigated interactions with the pharmaceutical industry and how these might affect the clinical practice, knowledge and beliefs of cancer physicians. MEDLINE, Embase, PsycINFO and Web of Science Core Collection databases were searched from inception to February 2021.ResultsTwenty-nine cross-sectional and two cohort studies met the inclusion criteria. These were classified into three categories of investigation: (1) extent of exposure to industry for cancer physicians as whole (n = 11); (2) financial ties among influential cancer physicians specifically (n = 11) and (3) associations between industry exposure and prescribing (n = 9). Cancer physicians frequently receive payments from or maintain financial ties with industry, at a prevalence of up to 63% in the United States (US) and 70.6% in Japan. Among influential clinicians, 86% of US and 78% of Japanese oncology guidelines authors receive payments. Payments were associated with either a neutral or negative influence on the quality of prescribing practice. Limited evidence suggests oncologists believe education by industry could lead to unconscious bias.ConclusionsThere is substantial evidence of frequent relationships between cancer physicians and the pharmaceutical industry in a range of high-income countries. More research is needed on clinical implications for patients and better management of these relationships.RegistrationPROSPERO identification number CRD42020143353.

Violin bowing is a specialised sound-producing action, which may be affected by psychological performance techniques. In sport, attentional focus impacts motor performance, but limited evidence for this exists in music. We investigated the effects of attentional focus on acoustical, physiological, and physical parameters of violin bowing in experienced and novice violinists. Attentional focus significantly affected spectral centroid, bow contact point consistency, shoulder muscle activity, and novices’ violin sway. Performance was most improved when focusing on tactile sensations through the bow (somatic focus), compared to sound (external focus) or arm movement (internal focus). Implications for motor performance theory and pedagogy are discussed.

An evidence map is visualized as a starting point for deliberations by trans-disciplinary stakeholders, including microbiologists with interests in the evidence and its influence on health and safety. Available evidence for microbial benefits and risks of the breastmilk ecosystem was structured as an evidence map using established risk analysis methodology. The evidence map based on the published literature and reports included the evidence basis, pro- and contra-arguments with supporting and attenuating evidence, supplemental studies on mechanisms, overall conclusions, and remaining uncertainties. The evidence basis for raw breastmilk included one benefit–risk assessment, systematic review, and systematic review/meta-analysis, and two cohort studies. The evidence basis for benefits was clear, convincing, and conclusive, with supplemental studies on plausible mechanisms attributable to biologically active raw breastmilk. Limited evidence was available to assess microbial risks associated with raw breastmilk and pasteurized donor milk. The evidence map provides transparent communication of the ‘state-of-the-science’ and uncertainties for microbial benefits and risks associated with the breastmilk microbiota to assist in deeper deliberations of the evidence with decision makers and stakeholders. The long-term aims of the evidence map are to foster deliberation, motivate additional research and analysis, and inform future evidence-based policies about pasteurizing donor breastmilk.

Existing theories relate higher education to lower crime rates, yet we have limited evidence on the crime-reducing effect of education in developing countries. We contribute to this literature by examining the effect of education on homicide in Mexico, where homicide rates decreased by nearly 55 percent from 1992 to 2007, before the surge of drug-related violence. We argue that a large amount of this reduction followed a compulsory schooling law at the secondary level in 1993, when the government undertook key education reforms to promote development and economic integration. We employ different empirical strategies that combine regression analysis, placebo tests, and an instrumental variable approach, and find that attendance in secondary and tertiary schools has a negative effect on homicide rates before the onset of the Drug War, although the evidence for secondary enrolment is more robust. This effect vanishes after the drug war onset, indicating that school attendance has different effects on different types of criminal activity. These findings suggest that policy makers can reduce crime and traditional forms of interpersonal violence by strengthening the education system. This is supported by the British Academy and the Newton Found [AF150270], the Research Council of Norway [402635], and the European Research Council [ESRC ES/S009965/1 and ES/L011859/1].

Many older adults have difficulty opening food packages, and even though they comprise the fastest growing segment of our population, the development of easy to open food packaging has been overlooked by the food industry (Costa and Jongen in Crit Rev Food Sci Nutr 50(6):489–502. 10.1080/10408390802544553, 2010); Hensel in Food Technol 66(12):23–30, 2012). The ability to use pinch is required to open food packages, but there is limited evidence regarding how much pinch force is required for different types of food packaging. This study used sensor technology to identify the force required to open several types of food packages which are typically used by older adults. Individuals over the age of 50 opened 15 different food packages and the average force in pounds required to open each type was obtained. The average force employed differed by sex for many food products and ranged from 1.28 to 7.27 kg. The information obtained from this study is useful both for healthcare professionals working with older adults and individuals with pathology of the hand, and for the food packaging industry.

Background: Sleep disruptions in the intensive care unit (ICU) may lead to complications such as delirium. There is limited evidence addressing how sleep aid use before and during ICU admission affects outcomes. Objective: The purpose of this study is to evaluate the impact of prior-to-admission sleep aid prescribing practices in the ICU on delirium and sleep outcomes. Methods: A retrospective review was conducted of adult patients admitted to any ICU from January to June 2018 receiving a sleep aid prior to admission. Patients were categorized based on sleep aid continuation, discontinuation, or alteration during the ICU admission. The primary end point was the incidence of delirium. Secondary end points included the incidence of sleep-wake cycle disturbances, delirium scores, and ICU length of stay. Results: A total of 291 patients were included with 109 in the continued group, 121 in the discontinued group, and 61 in the altered group. There was a similar incidence of delirium at 24 hours ( P = 0.71), 48 hours ( P = 0.60), 72 hours ( P = 0.25), and 5 days ( P = 0.48) after ICU admission. There was also no statistical difference in sleep-wake cycle disturbances or delirium scores at any time point. ICU length of stay was similar between the groups. Conclusion and Relevance: The incidence of delirium and sleep-wake cycle disturbances was not affected by differences in prior-to-admission sleep aid prescribing patterns during ICU admission.