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Meta-analyses traditionally compare the difference in means between groups for one or more outcomes of interest. However, they do not compare the spread of data (variability), which could mean that important effects and/or subgroups are missed. To address this, methods to compare variability meta-analytically have recently been developed, making it timely to review them and consider their strengths, weaknesses, and implementation. Using published data from trials in major depression, we demonstrate how the spread of data can impact both overall effect size and the frequency of extreme observations within studies, with potentially important implications for conclusions of meta-analyses, such as the clinical significance of findings. We then describe two methods for assessing group differences in variability meta-analytically: the variance ratio (VR) and coefficient of variation ratio (CVR). We consider the reporting and interpretation of these measures and how they differ from the assessment of heterogeneity between studies. We propose general benchmarks as a guideline for interpreting VR and CVR effects as small, medium, or large. Finally, we discuss some important limitations and practical considerations of VR and CVR and consider the value of integrating variability measures into meta-analyses.
We reviewed all diagnoses of Shigella species notified to the UK Health Security Agency from January 2016 to March 2023. An overall increase in notifications of shigellosis was seen between 2016 (n = 415/quarter) and 2023 (n = 1 029/quarter). However, notifications dramatically declined between March 2020 and September 2021 during the COVID-19 pandemic (n = 208/quarter) highlighting the impact of travel and social distancing restrictions on transmission. S. sonnei diagnoses were more affected by lockdown restrictions than S. flexneri, most likely due to a combination of species-specific characteristics and host attributes. Azithromycin resistance continued to be associated with epidemics of sexually transmissible S. flexneri (adult males = 45.6% vs. adult females = 8.7%) and S. sonnei (adult males = 59.5% vs. adult females = 14.6%). We detected resistance to ciprofloxacin in S. sonnei from adult male cases not reporting travel at a higher frequency (79.4%) than in travel-associated cases (61.7%). Extensively drug-resistant Shigella species associated with sexual transmission among men almost exclusively had ESBL encoded by blaCTX-M-27, whereas those associated with returning travellers had blaCTX-M-15. Given the increasing incidence of infections and AMR, we recommend that enhanced surveillance is used to better understand the impact of travel and sexual transmission on the acquisition and spread of MDR and XDR Shigella species.
When do politicians dog-whistle conspiracy theories (CTs), and when do they explicitly endorse – or ‘bark’ – a CT? Over time, does the use of dog-whistles shape the degree to which politicians bark? Drawing from the models of mass communication literature, we theorize that politicians who leverage CTs to garner political support have incentives to tailor their communication to their audience. When politicians speak to general audiences, they risk being punished for explicitly endorsing CTs. However, for parties that use CTs to rally their base, dog-whistling a CT may allow politicians to covertly signal support for a CT to party faithful. Conversely, amongst audiences primarily composed of party loyalists or CT believers, politicians have strong incentives to explicitly endorse CTs. We test our theory with data from Poland, where a series of CTs emerged following a 2010 plane crash in Smoleńsk, Russia that killed the Polish president and 95 other top officials. We draw on speeches and tweets discussing the crash from 2011 to 2022 by the Law and Justice (PiS) party, which sometimes endorses these CTs. We find descriptive evidence that PiS politicians both dog-whistle and ‘bark’. While they tend to dog-whistle more when the audience is more diverse, they tend to bark when the audience is more uniformly CT-supporting. We find some evidence that politicians bark more and dog-whistle less over time, which suggests that, with sustained use, dog-whistling may become understood by a wider array of audiences.
Escherichia albertii is an emerging foodborne enteropathogen associated with infectious diarrhoea in humans. In February 2023, an outbreak of acute gastroenteric cases was reported in a junior high school located in Hangzhou, Zhejiang province, China. Twenty-two investigated patients presented diarrhoea (22/22, 100%), abdominal pain (21/22, 95.5%), nausea (6/22, 27.3%), and vomiting (3/22, 13.6%). E. albertii strains were successfully isolated from anal swabs collected from six patients. Each isolate was classified as sequence type ST2686, harboured eae-β gene, and carried both cdtB-I and cdtB-II subtypes, being serotyped as EAOg32:EAHg4 serotype. A comprehensive whole-genome phylogenetic analysis revealed that the six isolates formed a distinct cluster, separate from other strains. These isolates exhibited minimal genetic variation, differing from one another by 0 to 1 single nucleotide polymorphism, suggesting a common origin from a single clone. To the best of our knowledge, this represented the first reported outbreak of gastroenteritis attributed to E. albertii outside of Japan on a global scale.
Research on legislative control dynamics has extensively examined how political parties use legislative tools to control portfolios and their respective heads in coalition governments. However, research has focused on partisan-run portfolios and has overlooked how control dynamics are affected when portfolio heads are independent, thus not affiliated with any party. This article addresses this gap by analysing parliamentary questions from 28 German city councils to determine how independent portfolios are controlled relative to partisan portfolios. The results show that all parties control independent portfolios more intensely than partisan portfolios. This is the case for both governing parties and opposition parties. However, while government parties control independent portfolios more than partisan portfolios, they still do so to a lesser extent than opposition parties.
Clostridioides difficile infection (CDI) is a common nosocomial infection and is associated with a high healthcare burden due to high rates of recurrence. In 2021 the IDSA/SHEA guideline update recommended fidaxomicin (FDX) as first-line therapy. Our medical center updated our institutional guidelines to follow these recommendations, prioritizing FDX use among patients at high risk for recurrent CDI (rCDI).
Methods:
This pre- post- quasi-experimental study included patients with a presumptive diagnosis of CDI at risk for recurrence (age >/= 65 years, immunocompromised, severe CDI) that received vancomycin (VAN) or FDX between October 2019 to October 2022. Patients who received bezlotoxumab, had fulminant CDI, or received <10 days of the same antibiotic for their full treatment course were excluded. Patients were evaluated for rCDI within 8 weeks of completion of therapy, subsequent episodes of CDI within 12 months, and CDI-related admissions within 30 days.
Results:
Of 397 CDI regimens evaluated, 196 received VAN and 201 received FDX. Rates of rCDI (9.2% vs 10%, P = 0.86), subsequent CDI within 12 months of therapy completion of therapy (19.4% vs 26%, P = 0.12) and 30-day CDI-related readmissions (3% vs 4.5%, P = 0.6) were similar between patients who received VAN versus FDX.
Conclusion:
Outcomes were similar between patients treated with FDX and VAN for the treatment of CDI among those at high risk for rCDI, using our outlined criteria. Although we observed a trend toward lower rates of rCDI among immunocompromised patients, this finding was not significant. Further investigation is needed to determine which patients with CDI may benefit from FDX.
Alexithymia (difficulties identifying and describing feelings) predicts increased risks for psychopathology, especially during the transition from childhood to adolescence. However, little is known of the early contributors to alexithymia. The language hypothesis of alexithymia suggests that language deficits play a primary role in predisposing language-impaired groups to developing alexithymia; yet longitudinal data tracking prospective relationship between language function and alexithymia are scarce. Leveraging data from the Surrey Communication and Language in Education cohort (N = 229, mean age at time point 1 = 5.32 years, SD = 0.29, 51.1% female), we investigated the prospective link between childhood language development and alexithymic traits in adolescence. Results indicated that boys with low language function at ages 4–5 years, and those who later met the diagnostic criteria for language disorders at ages 5–6 years, reported elevated alexithymic traits when they reached adolescence. Parent-reported child syntax abilities at ages 5–6 years revealed a dimensional relationship with alexithymic traits, and this was consistent with behavioral assessments on related structural language abilities. Empirically derived language groups and latent language trajectories did not predict alexithymic traits in adolescence. While findings support the language hypothesis of alexithymia, greater specificity of the alexithymia construct in developmental populations is needed to guide clinical interventions.
Early learning and childcare (ELCC) programmes play an important role in shaping children’s eating behaviours and long-term health by establishing a responsive feeding environment that encompasses not only mealtime behaviours but also extends to play activities and language used throughout the day. Despite their potential benefits, many ELCC centres do not consistently implement responsive feeding behaviours, facing challenges with organisational and behavioural changes within these environments. This study aims to identify influences on responsive feeding behaviours among early childhood educators prior to an intervention.
Design:
A qualitative study guided by the Behaviour Change Wheel framework and Capability Opportunity Motivation – Behaviour (COM-B) model. Semi-structured interviews and focus groups were conducted, recorded and transcribed verbatim. Thematic analysis was employed to identify themes, categorising them within the corresponding COM-B domains.
Setting:
Canada.
Participants:
Forty-one ELCC staff in various roles across eight centres from two provinces in eastern Canada.
Results:
Fifteen influences, spanning across all six domains of the COM-B model, were identified, highlighting gaps in educators’ knowledge and skills, varied approaches to food and feeding, and the interactions with children, parents, and co-workers on mealtimes dynamics. Additionally, costs, centre location and other physical resources emerged as enabling opportunities for responsive feeding behaviours.
Conclusions:
These findings offer a comprehensive exploration of the diverse factors influencing responsive feeding behaviours among educators, each varying in its potential for future behaviour change intervention.
Rates of acute mental health presentations in youth were increasing pre-pandemic internationally. Longitudinal studies following COVID-19 attest to ongoing deterioration in youth mental health, recognising adverse unintended consequences following public health restrictions.
Aims
To examine whether the initial post-COVID-19 increase in mental health presentations persisted following the reclassification of COVID-19 to endemic status, accompanied by the removal of most restrictions.
Method
All referrals to paediatric liaison psychiatry (PLP) between January 2018 and December 2022 in a Dublin tertiary children's hospital were included in the study. An interrupted time series analysis with autoregressive integrated moving average models was conducted, examining referrals with respect to different phases of COVID-19 and application of public health restrictions.
Results
Some 1385 referrals to PLP were received over the 5-year study. There was a significant decrease in PLP referrals immediately post-COVID-19, followed by a significant and sustained increase as the pandemic progressed and moved to endemic status. Public health restriction phases had a unique effect on those presenting with suicidal ideation, with a significant increase in the number of referrals. There was no effect of restrictions on other clinical profiles.
Conclusions
Increased referrals for youth with mental health difficulties, reported during the COVID-19 pandemic, persisted into the early endemic stage, after COVID-19 public health restrictions ceased. Specific impacts of restrictions on suicidal ideation referrals require further study. Investment in child and adolescent mental health services remains a priority, and future pandemic response strategies need to examine unintended consequences of any enforced public health measure.
Due to a result by Glasner and Downarowicz [Isomorphic extensions and applications. Topol. Methods Nonlinear Anal.48(1) (2016), 321–338], it is known that a minimal system is mean equicontinuous if and only if it is an isomorphic extension of its maximal equicontinuous factor. The majority of known examples of this type are almost automorphic, that is, the factor map to the maximal equicontinuous factor is almost one-to-one. The only cases of isomorphic extensions which are not almost automorphic are again due to Glasner and Downarowicz, who in the same article provide a construction of such systems in a rather general topological setting. Here, we use the Anosov–Katok method to provide an alternative route to such examples and to show that these may be realized as smooth skew product diffeomorphisms of the two-torus with an irrational rotation on the base. Moreover – and more importantly – a modification of the construction allows to ensure that lifts of these diffeomorphisms to finite covering spaces provide novel examples of finite-to-one topomorphic extensions of irrational rotations. These are still strictly ergodic and share the same dynamical eigenvalues as the original system, but show an additional singular continuous component of the dynamical spectrum.
The science of developmental psychopathology has made outstanding progress over the past 40 years in understanding adaptive and maladaptive developmental processes across the life span. Yet most of this work has been researcher driven with little involvement of community partners in the research process, limiting the potential public health significance of our work. To continue to advance the field we must move beyond the physical and conceptual walls of our research laboratories and into the real world. In this article, we define and describe the importance of community-engaged research, and present our overarching principles for engaging the community including practicing respect, shared power and decision-making, prioritizing the needs of the community, and engaging in consistent and transparent communication. We present several associated recommendations for best practice and highlight examples from our own research that is grounded in a developmental psychopathology perspective to illustrate these practices. Recommendations for the future of the discipline of development and psychopathology, with emphasis on training and continuing education, are described.
Sexual and gender minority (SGM) migrants’ disclosure of their identity or “coming out” has significant stakes. It can facilitate access to resources (institutional disclosure), cultivate intimacy and belonging (social disclosure), or support claims for legal protections (legal disclosure). This article analyzes SGM unaccompanied minors’ disclosures as shaped by the evolution of their legal consciousness in pursuing legal relief and incorporation in the United States. Ethnographic observations and in-depth interviews from 2014–2019 with 11 SGM unaccompanied minors reveal a striking pattern in their disclosure practices. During apprehension and detention, minors engaged in social, institutional, and legal disclosure of their SGM status. However, their interactions with agents from the Departments of Homeland Security and Health and Human Services led them to believe that SGM rights, support, and acceptance were contingent on legal status. Later, upon release from state custody, minors withheld legal disclosure from their deportation proceedings and immigration cases, even against the advisement of their attorneys. They also became more strategic in their social and institutional disclosure across other contexts. Post-legalization, however, minors broadened their disclosure practices and embarked on claims related to their SGM status. This study raises implications for research and policy. By analyzing shifts in legal consciousness over time, how certain experiences become reference points for how immigrants understand the law with respect to their identity and related behaviors are illustrated. It also extends the discussion of the far-reaching implications of SGM punishment and the disadvantages of immigration detention for children and youth.
This editorial discusses a study by Day and colleagues, in which the authors investigated the prevalence of resolution of alcohol and other drug problems in the UK and compared people who resolved their problems with and without treatment.
Previous studies show that maternal mind-mindedness positively impacts children’s social development. In the current studies, we examine the relation between mind-mindedness during parent–child interaction, oxytocin (OT), and postnatal depression in a sample of mothers (N = 62, ages 23–44) and their infant (ages 3–9 months). In Study 1, infant salivary OT was positively correlated with mothers’ appropriate mind-related comments, and negatively correlated (at trend level) with maternal depression scores. Mothers experiencing symptoms of depression used fewer appropriate mind-related comments than controls. Study 2 was a double-blind, placebo-controlled, experimental study, in which the same women who participated in Study 1 were administered nasal OT. This did not significantly influence levels of mind-mindedness. Study 2 warrants a larger trial to investigate the effect of OT on mind-mindedness further. Study 1 is the first to demonstrate an association between maternal mind-mindedness and variation in children’s OT levels. Since both OT and mind-mindedness have been repeatedly implicated in processes of maternal–infant attachment, this association highlights the centrality of mothers’ caregiving representations in facilitating the parent–child relationship and children’s early development.
Robots are with us, but law and legal systems are not ready. This book identifies the issues posed by human-robot interactions in substantive law, procedural law, and law's narratives, and suggests how to address them. When human-robot interaction results in harm, who or what is responsible? Part I addresses substantive law, including the issues raised by attempts to impose criminal liability on different actors. And when robots perceive aspects of an alleged crime, can they be called as a sort of witness? Part II addresses procedural issues raised by human-robot interactions, including evidentiary problems arising out of data generated by robots monitoring humans, and issues of reliability and privacy. Beyond the standard fare of substantive and procedural law, and in view of the conceptual quandaries posed by robots, Part III offers chapters on narrative and rhetoric, suggesting different ways to understand human-robot interactions, and how to develop coherent frameworks to do that. This title is also available as Open Access on Cambridge Core.
This Element examines two prominent public health crises – the emergence of bovine spongiform encephalopathy (BSE) in British cattle and the COVID-19 pandemic. It contends that a group of arguments called the informal fallacies functioned as cognitive heuristics and facilitated public health reasoning during both crises. These arguments, which include the argument from ignorance, the argument from authority, and circular argument, are particularly well adapted to the type of uncertainty that surrounds the emergence of novel infectious diseases. By bridging gaps in knowledge, these arguments can facilitate reasoning when evidence about these diseases is limited and the need to take action is urgent. The Element charts a public health journey beginning in the 1950s with a disease called kuru, then examines the response to the emergence of BSE in 1986 and extends to the present day with the COVID-19 pandemic. This title is also available as Open Access on Cambridge Core.
This study provides a first empirical test of Margaret Canovan's influential argument on the relationship between democracy and populism, which posits that populism emerges as a consequence of the unresolved conflict between the pragmatic and redemptive faces of democracy. Despite its impact on scholars of populism, the implications of her framework remain untested. Using data from the EVS/WVS Integrated Values Surveys, we test Canovan's claims about the effect of ‘pragmatic politics’ on support for populist parties, operationalized as consensual democracies, economic and political globalization, and checks on government. Our analyses predominantly reveal no significant effects, and where significant results are observed, they indicate directions contrary to Canovan's claims, thus providing no empirical support for her claims. These results challenge long-standing assumptions about the relationship between populism and democracy, urging scholars to reevaluate existing assumptions and explore this intricate connection further. We conclude by suggesting some directions for future research to deepen our understanding of populism.
In this paper we consider the workload of a storage system with the unconventional feature that the arrival times, rather than the interarrival times, are independent and identically distributed samples from a given distribution. We start by analyzing the ‘base model’ in which the arrival times are exponentially distributed, leading to a closed-form characterization of the queue’s workload at a given moment in time (i.e. in terms of Laplace–Stieltjes transforms), assuming the initial workload was 0. Then we consider four more general models, each of them having a specific additional feature: (a) the initial workload being allowed to have any arbitrary non-negative value, (b) an additional stream of Poisson arrivals, (c) phase-type arrival times, (d) balking customers. For all four variants the transform of the transient workload is identified in closed form.
The role of memory in supporting adolescents' sense of place and past is not well understood, but older adults offer a wealth of life stories and wisdom that they can share with younger generations. This in-depth pilot study positioned Australian high school students as oral historians to interview older Australians about their lives. Oral historian training and materials were provided, and pre- and post-intervention measures of adolescents' sense of everyday Australian history, well-being, and social connection were collected for an intervention school group (n = 17) and a waitlist control school group (n = 12). In-depth supplementary memory and well-being data were also collected for six participating older adults. In the intervention condition, scaffolded memory interviews took place during weekly aged care visits across one school term and were followed by an intergenerational celebration and memory book presentation. As hypothesised, older adults imbued their stories with life lessons for adolescents. Although no quantitative changes in participants' well-being emerged, qualitative data revealed the emergence of rich interpersonal relationships and bonding between adolescents and older adults. There were also benefits of the programme for older adults' reports of generativity and adolescents' understanding of everyday Australian history. The findings demonstrate the social and academic benefits of scaffolded intergenerational memory conversations and represent a scalable educational model and materials with downstream community benefits.