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Creating a sustainable residency research program is necessary to develop a sustainable research pipeline, as highlighted by the recent Society for Academic Emergency Medicine 2024 Consensus Conference. We sought to describe the implementation of a novel, immersive research program for first-year emergency medicine residents. We describe the curriculum development, rationale, implementation process, and lessons learned from the implementation of a year-long research curriculum for first-year residents. We further evaluated resident perception of confidence in research methodology, interest in research, and the importance of their research experience through a 32-item survey. In two cohorts, 25 first-year residents completed the program. All residents met their scholarly project requirements by the end of their first year. Two conference abstracts and one peer-reviewed publication were accepted for publication, and one is currently under review. Survey responses indicated that there was an increase in residents’ perceived confidence in research methodology, but this was limited by the small sample size. In summary, this novel resident research curriculum demonstrated a standardized, reproducible, and sustainable approach to provide residents with an immersive research program.
Tools for analysing additive manufacturability often employ complex models that lack transparency; this impedes user understanding and has detrimental effects on the implementation of results. An expert system tool that transparently learns features for successful printing has been created. The tool uses accessible data from STL models and printer configurations to create explainable parameters and identify risks. Testing has shown good agreement to print behaviour and easy adaptability. The tool reduces the learning curves designers face in understanding design for additive manufacturing.
Major depression is a debilitating mental health condition that affects many people and causes a great deal of suffering worldwide. Yet, our understanding of its etiology and pathophysiology is still poor. Neuroscientists have studied depressive disorders from different perspectives and have reported a range of abnormalities on different levels of neurobiological description. Based on these findings, various, mutually not necessarily exclusive theories have been put forward to explain the development and maintenance of depressive symptoms. The clinical relevance of these theories and how they relate to each other will have to be the subject of future neuroscientific research on depression.
Societal problems are not solved by individualistic interventions, but nor are systemic approaches optimal given their neglect of the social psychology underpinning group dynamics. This impasse can be addressed through a group-level analysis (a “g-frame”) that social identity theorizing affords. Using a g-frame can make policy interventions more adaptive, inclusive, and engaging.
Older adults living in residential care often experience challenges in sustaining meaningful social relationships, which can result in compromised health and well-being. Online social networking has the potential to mitigate this problem, but few studies have investigated its implementation and its effectiveness in maintaining or enhancing well-being. This pilot study used a cluster-randomized pre–post design to examine the feasibility of implementing a 12-week group-based technology-training intervention for older adults (n = 48) living in residential care by exploring how cognitive health, mental health, and confidence in technology were impacted. Analysis of variance revealed significant increases in life satisfaction, positive attitudes toward computer use, and self-perceived competence among participants who received the intervention, but increased depressive symptoms for the control group. These findings suggest that, despite challenges in implementing the intervention in residential care, group-based technology training may enhance confidence among older adults while maintaining or enhancing mental health.
The hawksbill sea turtle Eretmochelys imbricata is categorized as Critically Endangered on the IUCN Red List and its population has declined by over 80% in the last century. The Eastern Pacific population is one of the most threatened hawksbill populations globally. Western Mexico is the northern distribution limit for hawksbill sea turtles in the Eastern Pacific and recent research indicates that the Mexican Pacific portion of the population is a separate management unit because of the restricted movements of these turtles. Here we use the most complete database of sighting records in the north-west Pacific of Mexico to identify sites where hawksbill turtles are present. We also develop a conservation index to determine the conservation status of hawksbill turtle sites. Our results demonstrate the importance of this region for juveniles and the relevance of rocky reefs and mangrove estuaries as habitats for hawksbill turtles. We identified 52 sites with records of hawksbill turtles. Most of these sites (71%) are not protected; however, sites with high conservation value included islands and coastal sites along the Baja California peninsula that are established as marine protected areas. Reefs and mangrove estuaries relevant for hawksbill turtles are probably also significant fish nursery areas that are important for local fishing communities, creating opportunities for conservation strategies that combine science, local engagement and policy to benefit both local fishing communities and hawksbill sea turtle conservation.
Neurocognitive testing may advance the goal of predicting near-term suicide risk. The current study examined whether performance on a Go/No-go (GNG) task, and computational modeling to extract latent cognitive variables, could enhance prediction of suicide attempts within next 90 days, among individuals at high-risk for suicide.
Method
136 Veterans at high-risk for suicide previously completed a computer-based GNG task requiring rapid responding (Go) to target stimuli, while withholding responses (No-go) to infrequent foil stimuli; behavioral variables included false alarms to foils (failure to inhibit) and missed responses to targets. We conducted a secondary analysis of these data, with outcomes defined as actual suicide attempt (ASA), other suicide-related event (OtherSE) such as interrupted/aborted attempt or preparatory behavior, or neither (noSE), within 90-days after GNG testing, to examine whether GNG variables could improve ASA prediction over standard clinical variables. A computational model (linear ballistic accumulator, LBA) was also applied, to elucidate cognitive mechanisms underlying group differences.
Results
On GNG, increased miss rate selectively predicted ASA, while increased false alarm rate predicted OtherSE (without ASA) within the 90-day follow-up window. In LBA modeling, ASA (but not OtherSE) was associated with decreases in decisional efficiency to targets, suggesting differences in the evidence accumulation process were specifically associated with upcoming ASA.
Conclusions
These findings suggest that GNG may improve prediction of near-term suicide risk, with distinct behavioral patterns in those who will attempt suicide within the next 90 days. Computational modeling suggests qualitative differences in cognition in individuals at near-term risk of suicide attempt.
This article tracks how a trope of middle-class household thrift, grounded on the autarchic Aristotelian oikos, has long fueled derogatory discourses in Britain aimed at low-income urban residents who practice quite different forms of thrift. Since the 1970s this trope has migrated across scales, proving a potent metaphor for national economic policy and planetary care alike, and morally and economically justifying both neoliberal welfare retraction compounded by austerity policies and national responses to excessive resource extraction and waste production. Both austerity and formal recycling schemes shift responsibility onto consumer citizens, regardless of capacity. Further, this model of thrift eclipses the thriftiness of low-income urban households, which emerges at the nexus of kin and waged labor, sharing, welfare, debt, conserving material resources through remaking and repair and, crucially, the fundamental need for decency expressed through kin care. Through a historicized ethnography of a London social housing estate and its residents, this paper excavates what happens as these different forms and scales of household thrift coexist, change over time, and clash. Ultimately, neoliberal policy centered on an inimical idiom of thrift delegitimizes and disentitles low-income urban households and undermines their ability to enact livelihood practices of sustainability and projects of dignity across generations.
Existing policy research has not comprehensively examined the processes by which young people experience social exclusion: that is, the relationships among different risk factors for exclusion, their actual experiences of exclusion, and outcomes that matter for their life chances. Drawing on data from a survey of Australian 13-14 year olds (N=3,535), this paper adapts the Bristol Social Exclusion Matrix to examine pathways from young people’s personal and family resources, their experience of participation (school engagement; bullying victimization; teacher support), and their life satisfaction – a predictive indicator of wellbeing and mental health in adulthood. The effects of other characteristics or risk factors for young people’s social exclusion (living with disability, being a young carer, identifying as Indigenous, and speaking a language other than English at home), are also examined. This paper shows that experience of exclusion mediates the relationship between young people’s personal and family resources and life satisfaction. Controlling for characteristics or risk factors does not change this relationship, suggesting that processes of social exclusion, enacted in interpersonal encounters, are driven by overarching structural factors. These findings are relevant for policy in Australia, and in other countries with similar policy regimes.
This chapter considers the contemporary social and military context of the composition of Coriolanus including civil unrest, governance, education, the influence of the classical world, and later conjecture that Shakespeare himself was a soldier. In considering the performance of the play and its afterlives, attention is paid to stage directions, sound, character, and the subsequent adaptation and appropriation of Coriolanus and his mother in other media – art, poetry, film – that focus on the military, civil, personal, and political conflicts at the heart of the play.
Depression treatments are typically less effective for young people than for adults. However, treatments rarely target loneliness, which is a key risk factor in the onset, maintenance and development of depression.
Aims
This study evaluated the efficacy of a novel loneliness intervention, Groups 4 Health (G4H), relative to the best-practice treatment of cognitive–behavioural therapy (CBT) in reducing loneliness and depression over a 12-month period (Australian New Zealand Clinical Trial Registry: ACTRN12618000440224).
Method
The study was a phase 3 randomised non-inferiority trial comparing G4H with dose-controlled group CBT. Participants were 174 people aged 15–25 years experiencing loneliness and clinically significant symptoms of depression, who were not in receipt of adjunct treatment. Participants were recruited from mental health services in Southeast Queensland, Australia. Randomisation was conducted using computer software. Follow-up assessments and statistical analyses were masked to allocation. Both interventions consisted of five 75 min group-based psychotherapy sessions. The primary outcomes were depression and loneliness, with a non-inferiority margin of 2.20 for depression.
Results
The trial enrolled 174 participants between 24 April 2018 and 25 May 2019, with 84 in the G4H condition and 90 in the CBT condition. All randomised participants were included in the intention-to-treat analyses (n = 174). The pre–post effect sizes for depression were dG4H = −0.71 and dCBT = −0.91. For loneliness, they were dG4H = −1.07 and dCBT = −0.89. At 12-month follow-up, the absolute difference between groups on depression was 1.176 (95% CI −1.94 to 4.29) and on loneliness it was −0.679 (95% CI −1.43 to 0.07). No adverse effects were observed.
Conclusions
G4H was non-inferior to CBT for depression and showed a slight advantage over CBT for loneliness that emerged after treatment completion.
The authors surveyed hospitals across the country on their policies regarding overlapping surgery, and found large variation between hospitals in how this practice is regulated. Specifically, institutions chose to define “critical portions” in a variety of ways, ultimately affecting not only surgical efficiency but also the autonomy of surgical trainees and patient experiences at these different hospitals.
Given the rising numbers of older adults in Canada experiencing falls, evidence-based identification of fall risks and plans for prevention across the continuum of care is a significant priority for health care providers. A scoping review was conducted to synthesize published international clinical practice guidelines (CPGs) and recommendations for fall risk screening and assessment in older adults (defined as 65 years of age and older). Of the 22 CPGs, 6 pertained to multiple settings, 9 pertained to community-dwelling older adults only, 2 each pertained to acute care and long-term care settings only, and 3 did not specify setting. Two criteria, prior fall history and gait and balance abnormalities, were applied either independently or sequentially in 19 CPG fall risk screening algorithms. Fall risk assessment components were more varied across CPGs but commonly included: detailed fall history; detailed evaluation of gait, balance, and/or mobility; medication review; vision; and environmental hazards assessment. Despite these similarities, more work is needed to streamline assessment approaches for heterogeneous and complex older adult populations across the care continuum. Support is also needed for sustainable implementation of CPGs in order to improve health outcomes.
Groups are increasingly used to deliver behavior change interventions, but such interventions are seldom based on theory and research on social group processes. A consequence of this is that existing group interventions are often heterogenous and difficult to evaluate. The social identity approach addresses important questions relevant to the design and delivery of group interventions for supporting behavior change. Drawing on this approach, the social identity model of behavior change explains how group processes can be harnessed in behavior change interventions. The model prioritizes the establishment of shared social identity among intervention group members and outlines how, through six core group resources, social identification can shape delivery of intervention content to achieve behavior change. Evidence for the key resources specified in the model is presented, and a step-by-step guide provided, to support the operationalization of the model’s principles in practice.
The Great Migration from the South and the rise of racial residential segregation strongly shaped the twentieth-century experience of African Americans. Yet, little attention has been devoted to how the two phenomena were linked, especially with respect to the individual experiences of the migrants. We address this gap by using novel data that links individual records from the complete-count 1940 Census to those in the 2000 Census long form, in conjunction with information about the level of racial residential segregation in metropolitan areas in 1940 and 2000. We first consider whether migrants from the South and their children experienced higher or lower levels of segregation in 1940 relative to their counterparts who were born in the North or who remained in the South. Next, we extend our analysis to second-generation Great Migration migrants and their segregation outcomes by observing their location in 2000. Additionally, we assess whether second-generation migrants experience larger decreases in their exposure to segregation as their socioeconomic status increases relative to their southern and/or northern stayer counterparts. Our study significantly advances our understanding of the Great Migration and the “segregated century.”
Edited by
Christophe Boesch, Max-Planck-Institut für Evolutionäre Anthropologie, Germany,Roman Wittig, Max-Planck-Institut für Evolutionäre Anthropologie, Germany
Edited in association with
Catherine Crockford, Max-Planck-Institut für Evolutionäre Anthropologie, Germany,Linda Vigilant, Max-Planck-Institut für Evolutionäre Anthropologie, Germany,Tobias Deschner, Max-Planck-Institut für Evolutionäre Anthropologie, Germany,Fabian Leendertz
The social life of female chimpanzees (Pan troglodytes) differs between subspecies, with females in East African field sites often described as avoiding association to avoid competition, while females in Taï have been shown to be more gregarious, spending most of their time in close contact with each other, probably to avoid predation. This close association leads to increased levels of direct competition for resources, possibly increasing the benefit of having a higher dominance rank and challenging dominant group members. Female chimpanzees in Gombe have been shown to queue for rank rather than challenge others. Here, we show that female dyads in Taï do change their dominance rank at times, with at least six clear rank changes recorded in the Taï North and South communities. We discuss life events that could facilitate rank challenges. The increased flexibility in the female dominance hierarchy potentially adds a level of complexity not seen in East African chimpanzees.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
Methods
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
Results
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
Conclusions
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.