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Dopamine release in the nucleus accumbens has been hypothesized to signal reward prediction error, the difference between observed and predicted reward, suggesting a biological implementation for reinforcement learning. Rigorous tests of this hypothesis require assumptions about how the brain maps sensory signals to reward predictions, yet this mapping is still poorly understood. In particular, the mapping is non-trivial when sensory signals provide ambiguous information about the hidden state of the environment. Previous work using classical conditioning tasks has suggested that reward predictions are generated conditional on probabilistic beliefs about the hidden state, such that dopamine implicitly reflects these beliefs. Here we test this hypothesis in the context of an instrumental task (a two-armed bandit), where the hidden state switches repeatedly. We measured choice behavior and recorded dLight signals reflecting dopamine release in the nucleus accumbens core. Model comparison based on the behavioral data favored models that used Bayesian updating of probabilistic beliefs. These same models also quantitatively matched the dopamine measurements better than non-Bayesian alternatives. We conclude that probabilistic belief computation plays a fundamental role in instrumental performance and associated mesolimbic dopamine signaling.

ABSTRACT Background Apathy is a debilitating behavioral change in Huntington's disease (HD), but impulsivity in HD has not been well documented, and the co‐occurrence of these behaviors in HD has not been investigated. Objective Our objective was to determine whether apathy and impulsivity co‐occur in people with HD and their associations with quality of life. Methods Carriers of Huntington's gene expansion (premanifest to mild motor manifest disease; n = 42) along with healthy controls (n = 20) completed measures of apathy (Apathy Evaluation Scale and Apathy Motivation Index) and impulsivity (Barratt Impulsiveness Scale‐11 and UPPS‐P impulsivity scale), along with mood, cognition, clinical, and quality of life measures. Apathy and impulsivity measures were each reduced to a single metric per patient using principal component analysis. Correlations and multiple linear regression models determined associations between apathy and impulsivity and the potential influence of other covariates. Results Apathy and impulsivity were significantly correlated (r = 0.6, p

Summary: Background: Aotearoa New Zealand does not provide publicly-funded intensive autism support. While parent-mediated supports are promising, children and families may also benefit from direct clinician support. We tested the efficacy of a low-intensity programme involving parent- and clinician-delivered support for autistic children. Methods: This single-blind, two-arm randomised controlled trial assessed outcomes of a six-month low-intensity parent- and clinician-delivered support (2–3 h per week) based on the Early Start Denver Model compared to a control group who received monthly support calls and assistance with referrals. Children aged 1–4.5 years who were autistic or showing signs of autism and their parents were randomised to the low-intensity or control group by a blinded statistician using the Urn minimisation method. Assessments were conducted at baseline and immediately following the support period (24-weeks post-baseline). The primary outcome was child engagement during an interaction with their parent. The trial was pre-registered with ANZCTR: U1111-1260-2529. Findings: From March 2021 to May 2023, 56 families were randomised to either the low-intensity or control group. Following drop-outs, 21 families in the low-intensity group and 24 in the control group were included in analysis. There was large and significantly greater improvement in children's engagement in the low-intensity group compared to the control group (F (1, 43) = 21.47, p

Conventional diagnostic images from Magnetic Resonance Imaging (MRI) are typically qualitative and require subjective interpretation. Alternatively, quantitative MRI (qMRI) methods have become more prevalent in recent years with multiple clinical and preclinical imaging applications. Quantitative MRI studies on preclinical MRI scanners are being used to objectively assess tissues and pathologies in animal models and to evaluate new molecular MRI contrast agents. Low-field preclinical MRI scanners (≤3.0T) are particularly important in terms of evaluating these new MRI contrast agents at human MRI field strengths. Unfortunately, these low-field preclinical qMRI methods are challenged by long acquisition times, intrinsically low MRI signal levels, and susceptibility to motion artifacts. In this study, we present a new rapid qMRI method for a preclinical 3.0T MRI scanner that combines a Spiral Acquisition with a Matching-Based Algorithm (SAMBA) to rapidly and quantitatively evaluate MRI contrast agents. In this initial development, we compared SAMBA with gold-standard Spin Echo MRI methods using Least Squares Fitting (SELSF) in vitro phantoms and demonstrated shorter scan times without compromising measurement accuracy or repeatability. These initial results will pave the way for future in vivo qMRI studies using state-of-the-art chemical probes.

This study examined whether parent-reported atypical development in their child's first year was associated with age of diagnosis and age when parents first needed to consult a specialist about their child's development. It involved 423 children who participated in the Australian Autism Biobank. Most parents retrospectively identified [greater or equal to] 1 domain of atypical child development. Atypical development in most domains was associated with an earlier age when parents felt specialist consultation was needed. Atypical development in the "gaze abnormalities", "lack of response to social stimuli", and "no social communication" subdomains within the social domain was associated with an earlier age of diagnosis, as was atypical development in the "hypo/hypersensitivity" and "preoccupation with parts of objects" subdomains within the stereotyped/restricted behavior domain.

Abstract Background Cardiac repair and remodeling following myocardial infarction (MI) is a multifactorial process involving pro-reparative inflammation, angiogenesis and fibrosis. Noninvasive imaging using a radiotracer targeting these processes could be used to elucidate cardiac wound healing mechanisms. The alpha7 nicotinic acetylcholine receptor (ɑ7nAChR) stimulates pro-reparative macrophage activity and angiogenesis, making it a potential imaging biomarker in this context. We investigated this by assessing in vitro cellular expression of ɑ7nAChR, and by using a tritiated version of the PET radiotracer [18F]NS14490 in tissue autoradiography studies. Results ɑ7nAChR expression in human monocyte-derived macrophages and vascular cells showed the highest relative expression was within macrophages, but only endothelial cells exhibited a proliferation and hypoxia-driven increase in expression. Using a mouse model of inflammatory angiogenesis following sponge implantation, specific binding of [3H]NS14490 increased from 3.6 ± 0.2 µCi/g at day 3 post-implantation to 4.9 ± 0.2 µCi/g at day 7 (n = 4, P

Purpose: The purpose of this study was to understand student experiences of authentically assessed community partnership projects and reflect on authentic assessment from a social and environmental sustainability perspective. Design/methodology/approach: The authors present an elaborated case study including graduate-level courses at a university in Aotearoa, New Zealand. The authors draw on a thematic analysis of in-depth semi-structured interviews and written reflections from 18 students. Findings: Students appreciated the benefits of authentic assessment, such as workplace realism, a greater level of personal investment and opportunities to draw on diverse skills. Teams varied in how they navigated novel challenges and in their ability to develop focused projects capable of affecting change for sustainability. Students considered group work the greatest obstacle to achieving sustainability goals. Originality/value: The case study provides a novel contribution by exploring in-depth the student experience of authentic assessment activities designed to foster social and environmental sustainability outcomes. The authors provide practical limitations of authentic assessment and discuss tensions between authentic assessment and other education goals.

Nasal septal abscess is an uncommon otolaryngologic condition with little reported in the literature. Most commonly arising secondary to hematoma, idiopathic abscess formation is rare. A previously healthy 13-year-old male with no preceding nasal hematoma or trauma presented with rhinorrhea, nasal pain, and obstruction. Initial incision and drainage were not curative; the patient returned to care with complaints of new-onset headache. Neuroimaging revealed abscess recurrence alongside pansinusitis and epidural empyema. The patient was transferred to a tertiary care center for joint otolaryngologic and neurosurgical care. The patient’s postoperative course was uncomplicated. Nasal septal abscesses have become increasingly uncommon, but they still occur. Prompt treatment is warranted to mitigate the potential risk of further intracranial spread and facial deformity, as seen in this case.

ObjectivesThe aim of this study was to describe the potential of 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) to identify graft vasculopathy and to investigate the influence of coronary artery bypass graft (CABG) surgery on native coronary artery disease activity and progression.BackgroundAs well as developing graft vasculopathy, CABGs have been proposed to accelerate native coronary atherosclerosis.MethodsPatients with established coronary artery disease underwent baseline 18F-NaF PET, coronary artery calcium scoring, coronary computed tomographic angiography, and 1-year repeat coronary artery calcium scoring. Whole-vessel coronary microcalcification activity (CMA) on 18F-NaF PET and change in calcium scores were quantified in patients with and without CABG surgery.ResultsAmong 293 participants (mean age 65 ± 9 years, 84% men), 48 (16%) underwent CABG surgery 2.7 years [IQR: 1.4-10.4 years] previously. Although all arterial and the majority (120 of 128 [94%]) of vein grafts showed no 18F-NaF uptake, 8 saphenous vein grafts in 7 subjects had detectable CMA. Bypassed native coronary arteries had 3 times higher CMA values (2.1 [IQR: 0.4-7.5] vs 0.6 [IQR: 0-2.7]; P < 0.001) and greater progression of 1-year calcium scores (118 Agatston unit [IQR: 48-194 Agatston unit] vs 69 [IQR: 21-142 Agatston unit]; P = 0.01) compared with patients who had not undergone CABG, an effect confined largely to native coronary plaques proximal to the graft anastomosis. In sensitivity analysis, bypassed native coronary arteries had higher CMA (2.0 [IQR: 0.4-7.5] vs 0.8 [IQR: 0.3-3.2]; P < 0.001) and faster disease progression (24% [IQR: 16%-43%] vs 8% [IQR: 0%-24%]; P = 0.002) than matched patients (n = 48) with comparable burdens of coronary artery disease and cardiovascular comorbidities in the absence of bypass grafting.ConclusionsNative coronary arteries that have been bypassed demonstrate increased disease activity and more rapid disease progression than nonbypassed arteries, an observation that appears independent of baseline atherosclerotic plaque burden. Microcalcification activity is not a dominant feature of graft vasculopathy.

This study aimed to explore the rates of motor difficulties in children from the Australian Autism Biobank, and how early motor concerns impacted on children functionally. Children with autism aged 2-7 years, including 441 with a Vineland Adaptive Behavior Scale (VABS-II) motor subscale and 385 with a Mullen Scales of Early Learning (MSEL) fine motor subscale were included (n total = 514; 80% male). Approximately 60% of children on the MSEL and ~ 25% on the VABS-II had clinically significant motor impairments. More children with delayed sitting and walking motor milestones had early childhood parent reported motor difficulties (p < 0.001). Early motor delays or concerns may assist identifying individuals who will likely benefit from early ongoing developmental monitoring and early support.

Purpose: The long latency auditory evoked responses (LLAERs), originating in the auditory cortex, are often considered a biomarker for maturity in the central auditory system and may therefore be useful in the evaluation of children with central auditory processing disorder (CAPD). However, the characteristics of the LLAERs elicited in this population have not been widely described, and clinical applications remain unclear. The goal of this scoping review was to investigate if LLAERs can be used to identify children with CAPD. Method: A systematic search strategy was used to identify studies that analyzed the latencies and amplitudes of P1, N1, P2, and N2 waveforms of the LLAERs. The online databases, including Embase, Web of Science, MEDLINE, PubMed, ProQuest, and CINAHL, as well as the gray literature were searched for papers published in English and French between January 1980 and May 2021. Results: Seventeen papers met the eligibility criteria and were included in the study. Four papers had pre- and posttraining study designs, and the remaining studies were cross-sectional. Several studies reported significant differences in LLAERs between children with CAPD and their normal-hearing peers, and the results tended toward longer latencies and smaller amplitudes regardless of LLAER waves considered. N1 and/or N2 results were most likely to reveal significant differences between children with CAPD and normal-hearing controls and could potentially be considered a biomarker for CAPD. Conclusions: It seems that LLAER assessments, especially waves N1 and N2, might assist in better identification of CAPD children. However, considering heterogeneity in the methodology among the included studies, the results should be interpreted with caution. Well-designed studies on children with confirmed CAPD using standard diagnostic and assessment protocols are suggested.

Background: The application of robotic-assisted arthroplasty in revision knee scenarios continues to evolve. This study compares the pre- and post-revision implant positions in series of revision total knee arthroplasties (TKA) using a robotic arm system. Methods: Twenty-five consecutive off-label robotic-assisted revision TKA were performed. After virtual revision femoral and tibial components were positioned to achieve “balanced” medial and lateral flexion and extension gaps, the existing primary implants (PI) were removed, and bone cuts were executed with the robotic arm system. Preoperative coronal, sagittal, and axial position of the PI was compared to the final planned positions of the robotic revision implants (RRI) for each subject. A repeated measures ANOVA using the absolute difference in millimeters and degrees between the PI and RRI orientation was completed. Results: Intra-operatively, the virtual gaps were balanced within the planning software followed by successful execution of the plan. There was a statistically significant difference between posterior condylar offset and tibial component positioning for RRI compared to PI. There was no difference between the distal femoral component values between PI and RRI. Conclusions: The sagittal alignment of the revision implants, specifically the femoral posterior condylar offset and tibial component slope, are statistically significant considerations for a stable revision TKA with off-label use of a robotic-arm system. Other potential benefits may include appropriate implant sizing which can affect the resultant ligamentous tension important for a functional revision TKA. Future research and software iterations will be needed to determine the overall accuracy and utility of robotic-assisted revision TKA.

Compared to residential and commercial buildings, hotels use a high amount of resources in their operation, particularly electricity, water and gas. Resource use in hotels is influenced by both hosts and guests, however initiatives to reduce consumption are typically initiated by the host. To improve the effectiveness of host requests aimed at guests to use less resources, it is important to understand how hotel guests contribute to overall consumption. This study assesses quantitative resource consumption and occupancy data from two Australian case study hotels and investigates the impact of guest occupancy on net resource use. Agency theory is adopted as a framework to examine the host (principle) – guest (agent) exchange, and the agency costs associated with discretionary resource usage by the guest. It is found that guest numbers have little impact on net electricity consumption, however, are closely correlated with water consumption in both case studies. The findings suggest that strategies to reduce resource use are to be organised differently between electricity and water, with the former targeted at the hosts and the latter with the guests. Engaging with guests to reduce discretionary water consumption is expected to achieve greater reductions as compared to electricity and gas. The findings have implications for hotel operators and researchers toward designing and implementing effective resource use reduction strategies in hotels, and for understanding hotel resource use in the context of agency theory.

The TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) Statement includes a 22-item checklist, which aims to improve the reporting of studies developing, validating, or updating a prediction model, whether for diagnostic or prognostic purposes. The TRIPOD Statement aims to improve the transparency of the reporting of a prediction model study regardless of the study methods used. This explanation and elaboration document describes the rationale; clarifies the meaning of each item; and discusses why transparent reporting is important, with a view to assessing risk of bias and clinical usefulness of the prediction model. Each checklist item of the TRIPOD Statement is explained in detail and accompanied by published examples of good reporting. The document also provides a valuable reference of issues to consider when designing, conducting, and analyzing prediction model studies. To aid the editorial process and help peer reviewers and, ultimately, readers and systematic reviewers of prediction model studies, it is recommended that authors include a completed checklist in their submission. The TRIPOD checklist can also be downloaded from www.tripod-statement.org. This article is the translation in to Russian by Dr. Ruslan Saygitov (ORCID: https://orcid.org/0000-0002-8915-6153) from the original published in [Ann Intern Med. 2015;162:W1-W73. doi: https://doi.org/10.7326/M14-0698].

Pro-sustainability changes are slow and incremental at best in the tourism sector. Research on the topic can take the form of secondary data (e.g., content analysis of strategic documents, social media posts), survey-based intent studies (e.g., willingness to pay), survey-based studies of self-reported behaviors, observation of actual behaviors (e.g., benchmarking studies), lab-based experimental manipulations of measurable behaviors, and, finally, in situ, or field-based, experimental manipulations of measurable behaviors. The latter are some of the rarest studies and are held up as the gold standard for changing behaviors by providing evidence-based, measurable, and actionable sustainability interventions for tourism businesses. This study draws inspiration from a 4-year program of action research into pro-sustainability changes in tourist accommodations. It questions whether any of these approaches are sufficient for changing sustainability-oriented behaviors. This questioning extends to whether the theoretical approaches that underpin even “gold standard experiments” capture the operational contexts of accommodation businesses. It proposes instead that a scaffolded approach, built from a systems map of the theories, tools, experimental findings, interviews with stakeholders and operational context is necessary to create sustainability transformations in tourism businesses. This is a radical departure from the dependent/independent variable approach adopted in traditional scientific methods and that requires a different ontological approach to the science of sustainability. The study has implications for contextualizing intervention-based experimental studies within a wider system of influential factors within tourist accommodations.

Naturalistic developmental behavioural interventions are promising approaches for young children with, or suspected of having, autism spectrum disorder. Joint attention, symbolic play, engagement and regulation intervention (JASPER) is a well-researched naturalistic developmental behavioural intervention but, to date, no reviews have specifically evaluated its effects. This systematic literature review examined the effects of JASPER intervention and its components on child, parent and educator outcomes. Of the 96 articles screened, 19 were eligible for inclusion in the review. Most studies found that children who received JASPER intervention showed significantly greater improvements in at least one outcome related to child joint attention, joint engagement, play skills and language skills compared to the comparison group. Implementation outcomes for parents and educators were generally positive. There were no consistent predictors or mediators of treatment effects. None of the studies met all of the quality indicators outlined by the Council of Exceptional Children, and the majority of outcome measures were classified as proximal. Overall, JASPER intervention appears promising in improving child outcomes directly targeted during treatment. More research is needed to determine whether it is also effective in improving a wider range of outcomes for children with autism spectrum disorder.

Background: Efficient and effective preoperative identification of those patients with elevated risk may allow for more cost-effective interventions, accurate bundled payment adjustments, and overall improved patient care. Few comorbidity indices have provided clinical utility and adequate discriminative ability in the setting of complications after shoulder arthroplasty (SA). Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for anatomic and/or reverse SA procedures between 2010 and 2019. A subset of comorbidities were utilized including end-stage renal disease, history of hypertension, chronic obstructive pulmonary disease, functional status, history of bleeding disorder, and disseminated cancer. Results: A total of 25,927 patients with an average age of 69.2 (standard deviation ±9.5) years were included in the study. Patients with a comorbidity risk score (CRS) at or above 2 were indicated to have at least a 29.6% 30-day postoperative complication rate after undergoing total shoulder arthroplasty, significantly higher than the described average of approximately 15%. The area under receiver operator curve for the novel CRS scoring system was 0.595, indicating fair discriminative ability to predict 30-day postoperative complications after SA. This illustrates a discriminative ability similar to that of the American Society of Anesthesiologists classification (0.584, confidence interval [CI] 0.578-0.589), modified Charlson Comorbidity Index (0.567, CI 0.561-0.573), and modified Frailty Index (0.534, CI 0.529-0.539), each of which are common comorbidity indices used for the National Surgical Quality Improvement Program database. The average CRS for the population was 0.8537 (CI 0.8011-0.8150; P

The TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) Statement includes a 22-item checklist, which aims to improve the reporting of studies developing, validating, or updating a prediction model, whether for diagnostic or prognostic purposes. The TRIPOD Statement aims to improve the transparency of the reporting of a prediction model study regardless of the study methods used. This explanation and elaboration document describes the rationale; clarifies the meaning of each item; and discusses why transparent reporting is important, with a view to assessing risk of bias and clinical usefulness of the prediction model. Each checklist item of the TRIPOD Statement is explained in detail and accompanied by published examples of good reporting. The document also provides a valuable reference of issues to consider when designing, conducting, and analyzing prediction model studies. To aid the editorial process and help peer reviewers and, ultimately, readers and systematic reviewers of prediction model studies, it is recommended that authors include a completed checklist in their submission. The TRIPOD checklist can also be downloaded from www.tripod-statement.org. For members of the TRIPOD Group, see the Appendix. This article is the translation in to Russian by Dr. Ruslan Saygitov (ORCID: 0000-0002-8915-6153) from the original published in [Ann Intern Med. 2015; 162:W1-W73. doi: 10.7326/M14-0698 ].

Introduction: Rural health career outreach programs promote health careers to secondary school students and aim to address rural health workforce shortages. This study analyses student feedback data from Aspire2Health, a multidisciplinary rural health career outreach program conducted in Queensland Australia before COVID in 2019, and during COVID lockdown and isolation periods during 2020-2021. The study aims were to assess the suitability of the program and its elements, the program's short-term impact on students' interest in health careers and whether COVID restrictions on program delivery affected students' program experience and outcomes. Methods: We conducted statistical and semantic analysis of data collected pre- and peri-COVID from participating secondary school students living in regional, rural and remote Australian communities. Data validity was established by triangulating quantitative results from items using a five-point Likert scales, qualitative themes from short-response items and frequency analysis of themes. Data were collected pre-COVID (2019, n=125) and peri-COVID (2020-21, n=248). Results: Student responses to the program remained extremely positive despite COVID-imposed restrictions. Feedback scores indicated quite strong agreement in pre- and peri-COVID periods that the program motivated students to pursue a career in health (mean (M)=4.6 pre-COVID v M=4.5 peri-COVID) and that students would recommend the program to a friend (M=4.8 pre-COVID v M=4.7 peri-COVID). Overall ratings of the event were high, although a drop occurred during the peri-COVID period (M=4.8 pre-COVID v M=4.7 peri-COVID; p=0.043). Activity interest rankings indicated that, irrespective of the pandemic, clinical skills sessions, meeting health professionals and watching the emergency scenario were more interesting to students than ambulance and hospital tours (p

Abstract The respiratory muscle pressure generation and inspiratory and expiratory neuromuscular recruitment patterns in younger and older men were compared during exercise, alongside descriptors of dyspnea. Healthy younger (n = 8, 28 ± 5 years) and older (n = 8, 68 ± 4 years) men completed a maximal incremental cycling test. Esophageal, gastric (Pga) and transdiaphragmatic pressures, and electromyography (EMG) of the crural diaphragm were measured using a micro‐transducer and EMG catheter. EMG of the parasternal intercostals, sternocleidomastoids, and rectus abdominis were measured using skin surface electrodes. After the exercise test, participants completed a questionnaire to evaluate descriptors of dyspnea. Pga at end‐expiration, Pga expiratory tidal swings, and the gastric pressure–time product (PTPga) at absolute and relative minute ventilation were higher (p

Introduction Apathy is one of the most common neuropsychiatric manifestations in Parkinson's disease (PD). Recent proposals consider apathy as a multidimensional construct, which can manifest in behavioral, cognitive, emotional, and/or social dimensions. Apathy also overlaps conceptually and clinically with other non‐motor comorbidities, particularly depression. Whether all of these dimensions are applicable to the apathetic syndrome experienced by people with PD is unclear. In the present study, we investigated the multidimensional pattern of apathy associated with PD, using the recently developed Apathy Motivation Index (AMI) which probes behavioral, emotional, and social apathy dimensions. We then examined the relationship between these dimensions and other features of PD commonly associated with apathy, including depression, anxiety, cognition, and motor state. Methods A total of 211 participants were identified from the New Zealand Brain Research Institute (NZBRI) longitudinal PD cohort. One hundred eight patients and 45 controls completed the AMI, administered as an online questionnaire, and additional assessments including neuropsychiatric, neuropsychological, and motor scores. The pattern of dimensional apathy in PD was assessed using a repeated‐measured analysis of variance, while simple linear regressions were performed to evaluate relationships between these dimensions and other variables. Results We found a significant interaction between group (PD versus control) and apathy subscale, driven mainly by higher levels of social and behavioral—but not emotional—apathy in those with PD. This result was strikingly similar to a previous study investigating social apathy in PD. Distinct patterns of dimensional apathy were associated with depression and anxiety, with social and behavioral apathy positively associated with depression, and emotional apathy negatively associated with anxiety. Conclusion This work provides further evidence for a distinct pattern of apathy in people with PD in which deficits manifest in some—but not all—dimensions of motivated behavior. It emphasizes the importance of considering apathy as a multidimensional construct in clinical and research settings.

The face of Modern Foreign Language education (MFL) in Scotland is changing. A major policy shift in Scottish education in 2012 set out the aspiration that all students up to the end of third level education in Scottish schools would have the opportunity to learn not one but two languages, in addition to their mother tongue. Over the last 20 years, there has been, concurrently, an undertaking by the Scottish government, in a series of policy documents, committing to provision that will ensure that students with additional support needs (ASN) receive equality of access to a broad and balanced education. This paper draws upon policy documents and published research in the area to review the extent to which the vision of language learning of all has been made available to students with ASN and the documented benefits associated with MFL education for those with ASN. Drawing upon case studies of inclusive MFL pedagogies, it identifies successful strategies that can be deployed by teachers. It then considers some of the mechanisms by which the current gaps in provision have arisen and proposes possible remedial steps, drawing on both an analysis of policy and case studies of effective practice.

Student engagement is a key prognosticator of success, retention and perseverance in higher education. This study used structural equation modelling to evaluate a gain cycle of future time perspective (FTP), positive emotion and student engagement, derived from the broaden-and-build theory (BBT). A further objective was to examine changes within study variables over time. Participants were 217 UK undergraduates sampled at the beginning of the academic year, and the start of the second term. Analysis revealed that levels of positive emotion and engagement decreased, whereas FTP increased. At both time points, FTP predicted higher engagement, and engagement predicted greater positive emotion. Additionally, Time 1 positive emotion led to increased Time 2 FTP, engagement and positive emotion. This outcome was congruent with the 'build' hypothesis of BBT, suggesting that positive emotions enable the development of psychological resources. Relatedly, interventions designed to enhance FTP and positive emotion can facilitate student engagement and retention.

Purpose: The aim of this study is to develop a pre-operative prognostic model based on known pre-operative factors. Methods: A database of ultrasound (US) lesions undergoing biopsy documented US lesion size, stiffness, and patient source prospectively. Women with invasive cancer presenting between 2010 and 2015 were the study group. Breast and axillary core results and ER, PR and HER receptor status were collected prospectively. Assessment of US skin thickening, US distal enhancement and presence of chronic kidney disease (CKD) was performed retrospectively. Patient survival and cause of death were ascertained from computer records. Predictive models for (i) all-cause mortality (ACM) and (ii) breast cancer death (BCD) were built and then validated using bootstrap k-fold cross-validation. A comparison of predictive performance was made between a full cause-specific Cox model, a sub cause-specific Cox model, and a full Fine-Gray sub-distribution hazard model. Results: 1136 patients were included in the study. The median follow-up time was 6.2 years. 125 (11%) women died from breast cancer and 155 (14%) died from other causes. For the prediction of BCD, the cause-specific Cox sub-model performed the best. The time dependent AUC begins above 0.91 in year one to 3 reducing to 0.83 in year 6. The factors included in the Cox sub model were tumour size, skin thickening, source of detection, tumour grade, ER status, pre-operative nodal metastasis and CKD. Conclusion: We have shown that a model based on preoperative factors can predict BCD. Such prediction if externally validated and incorporating treatment data could be useful for treatment planning and patient counselling.

Total knee arthroplasty (TKA) is a highly successful operation for the treatment of end-stage osteoarthritis of the knee. Increasing use of computer-assisted and robotic-assisted total joint arthroplasty has been shown to improve component position, with short-term studies demonstrating improved survivability in unicompartmental knee arthroplasty. Robotic-assisted technology has been shown to be helpful in revising unicompartmental knee arthroplasty to TKA, as well as hip fusion to total hip arthroplasty, but few have described revision of a primary TKA. This case report describes the use of robotic-assisted technology in revision TKA. Robotic assistance during revision TKA may improve component alignment and increase prosthesis longevity. Future research is needed to investigate the effects on survivorship and cost.

The authors reveal a mechanism for regulation of behaviour during approach avoidance conflicts that relies on two specialized, parallel circuits that allow bidirectional hippocampal control of the prefrontal cortex.

BackgroundUnderstanding which group of patients with type 2 diabetes will have the most glucose lowering response to certain medications (which target different aspects of glucose metabolism) is the first step in precision medicine.AimsWe hypothesized that people with type 2 diabetes who generally have high insulin resistance, such as people of Māori/Pacific ethnicity, and those with obesity and/or hypertriglyceridemia (OHTG), would have greater glucose-lowering by pioglitazone (an insulin sensitizer) versus vildagliptin (an insulin secretagogue).MethodsA randomised, open-label, two-period crossover trial was conducted in New Zealand. Adults with type 2 diabetes, HbA1c>58mmol/mol (>7.5%), received 16 weeks of either pioglitazone (30mg) or vildagliptin (50mg) daily, then switched to the other medication over for another 16 weeks of treatment. Differences in HbA1c were tested for interaction with ethnicity or OHTG, controlling for baseline HbA1c using linear mixed models. Secondary outcomes included weight, blood pressure, side-effects and diabetes treatment satisfaction.Results346 participants were randomised (55% Māori/Pacific) between February 2019 to March 2020. HbA1c after pioglitazone was lower than after vildagliptin (mean difference -4.9mmol/mol [0.5%]; 95% CI -6.3, -3.5; p