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Transcranial direct current stimulation (tDCS), a noninvasive brain stimulation technique, has shown some promise as a novel treatment approach for a range of mental health disorders, including OCD. This study provides a systematic review of the literature involving randomized controlled trials of tDCS for OCD and evaluates the quality of reporting using the CONSORT (Consolidating Standards of Reporting Trials) statement. This study also examined the outcomes of tDCS as a therapeutic tool for OCD.
Methods:
This systematic review was prospectively registered with PROSPERO (CRD42023426005) and the data collected in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The quality of reporting of included studies was evaluated in accordance with the CONSORT statement.
Results:
Eleven randomized controlled trials were identified. Evaluation of the reviewed studies revealed low levels of overall compliance with the CONSORT statement highlighting the need for improved reporting. Key areas included insufficient information about - the intervention (for replicability), participant flow, recruitment, and treatment effect sizes. Study discussions did not fully consider limitations and generalizability, and the discussion/interpretation of the findings were often incongruent with the results and therefore misleading. Only two studies reported a significant difference between sham and active tDCS for OCD outcomes, with small effect sizes noted.
Conclusions:
The variability in protocols, lack of consistency in procedures, combined with limited significant findings, makes it difficult to draw any meaningful conclusions about the effectiveness of tDCS for OCD. Future studies need to be appropriately powered, empirically driven, randomized sham-controlled clinical trials.
A person’s chronotype reflects individual variability in diurnal rhythms for preferred timing of sleep and daily activities such as exercise and food intake. The aim of this review is to provide an overview of the evidence around the influence of chronotype on eating behaviour and appetite control, as well as our perspectives and suggestions for future research. Increasing evidence demonstrates that late chronotype is associated with adverse health outcomes. A late chronotype may exacerbate the influence of greater evening energy intake on overweight/obesity risk and curtail weight management efforts. Furthermore, late chronotypes tend to have worse diet quality, with greater intake of fast foods, caffeine and alcohol and lower intake of fruits and vegetables. Late chronotype is also associated with eating behaviour traits that increase the susceptibility to overconsumption such as disinhibition, food cravings and binge eating. Whether an individual’s chronotype influences appetite in response to food intake and exercise is an area of recent interest that has largely been overlooked. Preliminary evidence suggests additive rather than interactive effects of chronotype and meal timing on appetite and food reward, but that hunger may decrease to a greater extent in response to morning exercise in early chronotypes and in response to evening exercise in late chronotypes. More studies examining the interplay between an individual’s chronotype, food intake/exercise timing and sleep are required as this could be of importance to inform personalised dietary and exercise prescriptions to promote better appetite control and weight management outcomes.
Microplastic fibres are found everywhere that researchers have looked for them, from remote mountains to human lungs. However, data are not yet available to facilitate the design of low-shedding textiles. Effective use of standard test methods could establish the impact of processing variables on textile’s propensity to fragment or shed fibres into the environment, allowing industry to design and select lower-polluting materials. Three new test methods are recommended using the widely accessible accelerated laundering equipment used for colour fastness to wash tests. However, the recommended gravimetric analysis of results takes over 8 h per specimen batch, in addition to specimen preparation, testing and effluent filtration, making analysing test results prohibitively time-consuming, and expensive, for many brands. Visual ‘grey scales’ are very commonly used to grade colour fastness test results, and this article proposes the use of an equivalent ‘fibre fragmentation scale’ to dramatically increase the throughput of fibre fragmentation testing and reduce its cost without compromising accuracy or reliability. Mean fibre fragmentation scale grades given by sets of three observers correlated with gravimetric results at 99% confidence. Subjective grades assigned to test specimens, and photographs of test specimens, had significantly lower variability than gravimetric methods at small, ‘more acceptable’, levels of fibre fragmentation.
Limited data exists on the role of attachment in influencing the development and wellbeing of refugee children. Herein we describe patterning and correlates of attachment in an Australian sample of adolescent Tamil refugees. Sixty-eight adolescents, aged 10–18, were assessed for trauma exposure, mental health problems and pattern of attachment. Attachment representations were assessed by discourse analysis of structured attachment interviews. Mothers of the adolescents were assessed for post-migration family stressors, depression, and post-traumatic stress disorder (PTSD) using self-report measures. Inhbitory A and A+ patterns of attachment predominated. Attachment insecurity was associated with child trauma exposure (β = .417), post-migration family stressors (β = .297) and maternal PTSD (β = .409). Path modeling demonstrated that attachment insecurity mediated associations of child trauma exposure, family stressors and maternal PTSD with child mental health problems, the model yielding adequate fit (Comparative Fit Index [CFI] = .957; standardized root mean square residual [SRMR] = .066; R2 .449). Our cross-sectional findings suggest that compromised attachment security is one potential mechanism by which the adverse effects of refugee family trauma and adversity are transmitted to children. Resettlement policy and psychosocial services should aim to preserve and/or reestablish attachment security in child-caregiver relationships through policy that reduces family stressors and interventions that bolster parental mental health and caregiver sensitivity.
This study explores patterns of self-regulation and emotional well-being among Syrian refugee children in Lebanon, employing a person-centered approach, responding to theoretical challenges articulated by Dante Cicchetti and other psychologists. Using latent profile analysis with data from 2,132 children, we identified seven distinct profiles across cognitive regulation, emotional-behavioral regulation, interpersonal regulation, and emotional well-being. These profiles showed significant heterogeneity in patterns of self-regulation across domains and emotional well-being among Syrian children. Some profiles consistently exhibited either positive (“Well-regulated and Adjusted”) or negative (“Moody and Frustrated”) functioning across all domains, while others revealed domain-specific challenges, e.g., particularly sensitive to interpersonal conflict. This heterogeneity in the organization of self-regulatory skill and emotional well-being challenges the traditional homogeneous view of child development in conflict settings. The study also underscores the profiles’ differential associations with demographic characteristics and experiences, with school-related experiences being particularly salient. We discuss the implications of these findings for future research in developmental psychopathology on self-regulation and emotional well-being in conflict-affected contexts. In addition, we advocate for tailored interventions to meet the diverse needs of children affected by conflict.
This article proposes a theoretical framework for explaining the motivations behind the early adoption of international public policy innovations. While there has been a proliferation of transnational policy diffusion studies, there is less research on why some governments become early adopters when new international policy norms are promoted. Most research on the topic looks only at monocausal explanations without considering their interactions in a coherent, integrated framework. The article proposes four motivations for early adoption: normative, reputation, competition, and locking-in. The framework is then illustrated by application to the early adoption of business and human rights policy innovations, with Colombia and Ecuador serving as two cases for comparative analysis. The article advances understanding of early adoption and policy diffusion by highlighting particularly important explanations for what motivates early adopters to begin processes of subsequent diffusion and suggesting how motivations may interact to strengthen the case for early adoption.
In 2021, scientists published a preprint stating that the dugong population of Okinawa had declined below the minimum viable population and should be considered extinct. The publication led to an outcry amongst Japanese/Okinawan environmentalists and to criticism by international dugong specialists. Two issues were raised: 1) Declaring dugongs extinct, although feeding trails were found in several locations, misrepresented the reality in Okinawan waters, and could have negative impacts on conservation measures; 2) Three authors were sitting on the Environmental Monitoring Committee for a controversial military base construction project in an area where dugongs were frequently spotted before construction commenced. The presence/absence of dugongs at the site had become a political issue, as the animal’s protected status and its depiction in folklore gave it symbolic meaning in the anti-base movement. The declaration of dugong extinction reminded protesters of a former Environmental Impact Assessment conducted by Japan’s Ministry of Defence, declaring the site to be no relevant dugong habitat. The paper explores the implications of the preprint for the political situation in Okinawa and questions the certainty of dugong extirpation in the region. It argues that speculations about extinction cannot be divorced from the political contexts to which they are invariably tied.
In recent years, social scientists have “(re)discovered history” by visiting archives, collecting documents, and analyzing their findings to address concerns about the causes and consequences of violence. Nevertheless, social scientists frequently appear at their archives with little to no training on the methods and ethics of archival research as they increasingly rush to examine primary historical records. This has resulted in a dearth of discourse on how the practice of historical research influences the outcomes of our analyses. Our article, as a result, employs findings from research on political violence in sociology and political science, as well as insights from history and archival studies, to introduce three broad ethical concerns related to politics, interpretation, and harms and benefits that, we argue, have methodological implications for historical social science. These methodological implications are too often ignored in historical social science, but we contend they are necessary to consider prior to and during archival research, as well as afterward when analyzing data, in order to ensure that the results of that research are valid, reliable, and ethical despite the constraints involved in working with historical evidence. We also discuss contemporary conflicts and how data collection on violence influences our understanding of the past. The objective of this article is to identify and address the primary challenges that social scientists who work with archives encounter, as well as to advocate for increased transparency in archival research.
Three-dimensional vortex dynamics around two pitching foils arranged in side-by-side (parallel) configurations is numerically examined at a range of separation (gap) distances ($0.5c \leqslant y^* \leqslant 1.5c$). In-phase ($\phi =0$) and out-of-phase ($\phi ={\rm \pi}$) motions are considered for Strouhal numbers of $0.3$ and $0.5$ at a Reynolds number of $8000$. In this work, we show that the foil proximity effect, defined as the influence of one foil on the flow characteristics around the other, induces a spanwise instability in the braids of trailing-edge vortices (TEVs) during their roll-up. This is a newly identified instability that manifests itself in the form of secondary vortical structures with opposite circulation compared with the TEVs formed on the foils, which leads to the formation of double necking on the braids of the TEVs. We provide quantitative evidence linking the formation of these secondary structures to the braid instability. The first neck merges with the TEV, while the second neck detaches from the braid region and moves downstream independently. As the foil proximity effect intensifies (spacing between the foils decreases), secondary vortical structures, as well as the necks, become more prominent, leading to the emergence of three-dimensional wake features. Lastly, the influence of kinematics of the foils on three-dimensionality of the wake is investigated. At higher Strouhal numbers, broader regions of high strain are developed near the trailing edge, associated with the detachment of stronger structures from the braids of TEVs. The characterized instability demonstrates consistent properties for in-phase and out-of-phase motions, albeit with specific differences in dynamics of leading-edge vortices.
When working in homotopy type theory and univalent foundations, the traditional role of the category of sets, $\mathcal{Set}$, is replaced by the category $\mathcal{hSet}$ of homotopy sets (h-sets); types with h-propositional identity types. Many of the properties of $\mathcal{Set}$ hold for $\mathcal{hSet}$ ((co)completeness, exactness, local cartesian closure, etc.). Notably, however, the univalence axiom implies that $\mathsf{Ob}\,\mathcal{hSet}$ is not itself an h-set, but an h-groupoid. This is expected in univalent foundations, but it is sometimes useful to also have a stricter universe of sets, for example, when constructing internal models of type theory. In this work, we equip the type of iterative sets $\mathsf{V}^0$, due to Gylterud ((2018). The Journal of Symbolic Logic83 (3) 1132–1146) as a refinement of the pioneering work of Aczel ((1978). Logic Colloquium’77, Studies in Logic and the Foundations of Mathematics, vol. 96, Elsevier, 55–66.) on universes of sets in type theory, with the structure of a Tarski universe and show that it satisfies many of the good properties of h-sets. In particular, we organize $\mathsf{V}^0$ into a (non-univalent strict) category and prove that it is locally cartesian closed. This enables us to organize it into a category with families with the structure necessary to model extensional type theory internally in HoTT/UF. We do this in a rather minimal univalent type theory with W-types, in particular we do not rely on any HITs, or other complex extensions of type theory. Furthermore, the construction of $\mathsf{V}^0$ and the model is fully constructive and predicative, while still being very convenient to work with as the decoding from $\mathsf{V}^0$ into h-sets commutes definitionally for all type constructors. Almost all of the paper has been formalized in $\texttt{Agda}$ using the $\texttt{agda}$-$\texttt{unimath}$ library of univalent mathematics.
Adrenal vein sampling (AVS) is a complicated procedure requiring clinical expertise, collaboration, and patient involvement to ensure it occurs successfully. Implementation science offers unique insights into the barriers and enablers of service delivery of AVS. The primary aim of this review was to identify implementation components as described within clinical studies, that contribute to a successful AVS procedure. The secondary aim was to inform practice considerations to support the scale-up of AVS. A scoping review of clinical papers that discussed factors contributing to effective AVS implementation was included. A phased approach was employed to extract implementation science data from clinical studies. Implementation strategies were named and defined, allowing for implementation learnings to be synthesized, in the absence of dedicated research examining implementation process and findings only. Ten implementation components reported as contributing to a successful AVS procedure were identified. These components were categorized according to actions required pre-AVS, during AVS, and post-AVS. Using an implementation science approach, the findings of this review and analysis provide practical considerations to facilitate AVS service delivery design. Extracting implementation science information from clinical research has provided a mechanism that accelerates the translation of evidence into practice where implementation research is not yet available.
To describe the use of plasma next-generation sequencing (NGS) and determine if it provided additional information from routine tests or lead to change in antimicrobial management.
Design and Setting:
This retrospective cohort study evaluated patients with a NGS test performed who were admitted to a hospital health system in the greater Houston area between May 2022 and May 2023.
Patients:
In total, 143 NGS tests were ordered in the span of one year for 135 unique patients. Most patients were ≥ 18 years (74.1%), White/Caucasian (43.7%), male (61.5%), and immunocompetent (54.1%). Eight patients had repeat tests during the study period, four being after an initial rejected test, and the rest being greater than 7 days from the initial test.
Results:
Of the 139 NGS tests performed, 56 (40%) were positive. When compared to routine testing, 49 (35%) were negative when routine testing was negative, 15 (11%) positive were concordant with routine testing, 29 (21%) positive were discordant from routine testing, 17 (12%) negative while routine testing was positive, and 29 (21%) were positive while routine testing was negative. Documented changes in antimicrobial due to NGS occurred after 16 (13.6%) tests, with the majority of these changes occurring in immunocompromised patients (14/16 [88%]).
Conclusions:
NGS provided additional data when compared to routine testing but rarely resulted in antimicrobial changes. The majority of changes occurred in immunocompromised patients. Diagnostic stewardship is a vital component for this type of NGS testing and others in which guidelines do not exist.
This paper addresses the need for, and ultimately proposes, an educational framework to develop competencies in attending to ethical issues in mental health and substance use health (MHSUH) in healthcare ethics consultation (HCEC). Given the prevalence and stigma associated with MHSUH, it is crucial for healthcare ethicists to approach such matters skillfully. A literature review was conducted in the areas of bioethics, health professions education, and stigma studies, followed by quality improvement interviews with content experts to gather feedback on the framework’s strengths, limitations, and anticipated utility. The proposed framework describes three key concepts: first, integrating self-reflexive practices into formal, informal, and hidden curricula; second, embedding structural humility into teaching methods and contexts of learning; and third, striking a balance between critical consciousness and compassion in dialogue. The proposed educational framework has the potential to help HCEC learners enhance their understanding and awareness of ethical issues related to structural stigma and MHSUH. Moreover, context-specific learning, particularly in MHSUH, can play a significant role in promoting competency-building among healthcare ethicists, allowing them to address issues of social justice effectively in their practice. Further dialogue is encouraged within the healthcare ethics community to further develop the concepts described in this framework.
To assess the effectiveness of a 3-question decision-support tool to guide the diagnosis and treatment of urinary tract infections (UTIs) in acute care hospitalized patients as an antibiotic and diagnostic stewardship initiative.
Design:
Retrospective cohort study.
Setting:
Four acute care hospitals within the same health system in Miami, FL.
Patients:
124, admitted from the emergency department and hospitalized adult patients, treated with antibiotics for the indication of a UTI between March and April 2023.
Intervention:
We developed a 3-step clinical decision-support tool (CDST) to evaluate the appropriateness of urine cultures and antibiotic treatment. The tool’s recommendations when deciding to prescribe antibiotics were compared with the actual need for treatment throughout the hospitalization, up to the time of patient discharge.
Results:
Overall, 31% of antibiotics prescribed for UTIs were inappropriate and met the criteria for asymptomatic bacteriuria (ASB) based on the CDST. Prospective implementation of the decision-support tool could potentially reduce antibiotic use by 33.6%, corresponding to 265 days of unnecessary therapy. The sensitivity and specificity of the tool were calculated to be 98.6% and 100%, respectively, indicating high accuracy in identifying the need for antibiotic treatment. Urinalysis alone was insufficient to differentiate between symptomatic UTIs and ASB, with leukocyturia present in 95.3% of UTI cases and 94.6% of ASB cases (P = 0.87).
Conclusions:
Implementing a 3-question CDST may reduce unnecessary laboratory work-up and treatment for ASB improving the diagnostic and antimicrobial stewardship of UTIs.
Polycystic ovary syndrome (PCOS) is a common endocrine disorder amongst reproductive-aged women associated with cardiometabolic, reproductive and psychological abnormalities. Lifestyle modification, including a healthy diet, is considered first-line treatment for management of clinical symptoms. However, there is limited high-quality evidence to support one superior therapeutic dietary intervention for PCOS management that is beyond general population-based dietary guidelines. Adherence to a Mediterranean diet (MedDiet) has been shown to decrease cardiometabolic disease risk and attenuate depressive symptoms, particularly in patients with metabolic perturbations. This narrative review summarises the proposed biological mechanisms underpinning the potential therapeutic benefits of a MedDiet for the management of cardiometabolic, reproductive and psychological features related to PCOS. Observational evidence suggests an inverse relationship between MedDiet adherence and PCOS features, particularly insulin resistance and hyperandrogenemia. Although the exact mechanisms are complex and multifaceted, they are likely related to the anti-inflammatory potential of the dietary pattern. These mechanisms are underpinned by anti-inflammatory bioactive constituents present in the MedDiet, including carotenoids, polyphenols and n-3 polyunsaturated fatty acids (PUFAs). Synthesis of the available literature suggests the MedDiet could be a promising therapeutic dietary intervention to attenuate short and long-term symptoms associated with PCOS and may aid in reducing the longer-term risks associated with cardiometabolic diseases and reproductive and psychological dysfunction. Nevertheless, current evidence remains insufficient to inform clinical practice and well-designed clinical trials are needed. As such, we provide recommendations for the design and delivery of future MedDiet interventions in women with PCOS, including exploring the acceptability, and feasibility to enhance adherence.
Luminescence dating methods are widely used to date coastal sediments, while luminescence tracing methods are an upcoming approach to reconstruct coastal sediment pathways. Both methods rely on subaqueous resetting (bleaching) of luminescence signals and would benefit from quantification of this process in the natural coastal environment. We describe the set-up and outcomes of an in situ subaqueous bleaching experiment for luminescence signals of K-feldspar grains in the Dutch Wadden Sea. We deployed a full-day bleaching field experiment with irradiated feldspar samples tethered to a pole at various positions within and above the water column to quantify (1) the bleaching potential, that is, the light intensity and spectrum as a function of time, depth and tidal stage, and (2) the bleaching efficiency, that is, the degree of bleaching of infrared stimulated luminescence (IRSL) and post-infrared IRSL (pIRIR) signals measured at 150, 225 and 290°C after a full day of light exposure above and below water. Our bleaching-potential results show that the strongest subaqueous light attenuation took place during low tide when sediment concentrations are the highest. We also observed stronger attenuation of the ultraviolet part of the spectrum compared to other parts of the spectrum. Our bleaching-efficiency results show that bleaching reduces with depth, that pIRIR signals bleach slower than IRSL signals underwater and that bleaching efficiency reduces with pIRIR measurement temperature. None of the investigated signals were fully reset after 13.5 hours of light exposure, even for subaerially exposed samples. Our work provides the first quantitative data on pIRIR bleaching in a natural subaqueous environment, which is relevant for K-feldspar-based luminescence dating and tracing applications.
Traumatic brain injury (TBI), mental health conditions (e.g., posttraumatic stress disorder [PTSD]), and vascular comorbidities (e.g., hypertension, diabetes) are highly prevalent in the Veteran population and may exacerbate age-related changes to cerebral white matter (WM). Our study examined (1) relationships between health conditions—TBI history, PTSD, and vascular risk—and cerebral WM micro- and macrostructure, and (2) associations between WM measures and cognition.
Method:
We analyzed diffusion tensor images from 183 older male Veterans (mean age = 69.18; SD = 3.61) with (n = 95) and without (n = 88) a history of TBI using tractography. Generalized linear models examined associations between health conditions and diffusion metrics. Total WM hyperintensity (WMH) volume was calculated from fluid-attenuated inversion recovery images. Robust regression examined associations between health conditions and WMH volume. Finally, elastic net regularized regression examined associations between WM measures and cognitive performance.
Results:
Veterans with and without TBI did not differ in severity of PTSD or vascular risk (p’s >0.05). TBI history, PTSD, and vascular risk were independently associated with poorer WM microstructural organization (p’s <0.5, corrected), however the effects of vascular risk were more numerous and widespread. Vascular risk was positively associated with WMH volume (p = 0.004, β=0.200, R2 = 0.034). Higher WMH volume predicted poorer processing speed (R2 = 0.052).
Conclusions:
Relative to TBI history and PTSD, vascular risk may be more robustly associated with WM micro- and macrostructure. Furthermore, greater WMH burden is associated with poorer processing speed. Our study supports the importance of vascular health interventions in mitigating negative brain aging outcomes in Veterans.