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Some individuals experience abnormally persistent and intense symptoms of grief that significantly interfere with daily functioning. This condition has been described using terms such as complicated or prolonged grief and prolonged grief disorder (PGD).
Aims
To identify the availability of evidence addressing a range of policy relevant issues related to grief, bereavement and PGD. In this paper we focus on the availability of evidence from systematic reviews.
Method
We searched 12 databases and the websites of 18 grief- or bereavement-related organisations. Using key characteristics extracted from included reviews, we produced a high-level overview of the available evidence that enabled potential research gaps to be identified.
Results
We identified 212 reviews – 103 focused on people’s experiences of grief/bereavement including service use; 22 reported on PGD prevalence, 42 on PGD risk factors, 37 on factors that influence grief more broadly and 80 on the effectiveness of grief-related interventions. Fifty-five reviews focused on multiple issues of interest. Half of reviews focused on a specific cause/type of death (n = 108). Of these reviews, most focused on three main causes/types of death: a specific health condition or terminal illness (n = 36), perinatal loss (n = 34) and suicide (n = 20).
Conclusions
We identified a large number of reviews, but key evidence gaps exist, particularly in relation to intervention cost-effectiveness and social, organisational or structural-level interventions that are needed for addressing inequities and other modifiable factors that can impair grieving and potentially increase the risk of PGD.
Teaching volumetric modulated arc therapy (VMAT) treatment planning to therapeutic radiography students faces challenges, including time constraints and resource limitations. Gamification, an active learning strategy incorporating game-based elements, may enhance engagement and understanding of VMAT treatment planning.
Methods:
A VMAT treatment planning session was implemented for 15 second-year undergraduate and postgraduate therapeutic radiography students using gamification. Participants were tasked with optimising a VMAT plan for a palliative prostate cancer patient using Eclipse treatment planning software. Students completed pre- and post-session questionnaires assessing perceived understanding and enjoyment. Plans were evaluated against clinical goals, and a leaderboard was used to rank top performers. Thematic analysis was applied to qualitative feedback.
Results:
About 86·7% of participants initially reported a limited understanding of VMAT planning structures. Post-session, all participants reported improved perceived understanding, with 93·3% finding the session beneficial and recommending its inclusion in the programme. While 66·6% enjoyed the gamified approach, technical issues limited individual optimisation time. Qualitative feedback highlighted increased confidence and engagement despite challenges.
Conclusions:
Gamification enhanced student-reported understanding, enjoyment and engagement in VMAT planning. While technical issues affected session efficiency, feedback supports the integration of gamification in treatment planning sessions but should not be overused as its usefulness can wear off.
Assessment of new genotypes in on-farm trials and under different tillage options is a current strategy for in-station experiments to enhance the breeding process and its final output in farmers’ fields, which can help increase productivity and sustainability in variable rainfed conditions. The objectives were to evaluate the agronomic performance of barley genotypes under different tillage systems in farmers’ fields and to provide suggestions to help farmers use resources more efficiently and sustainably for their proper field management. Five barley genotypes including four cultivars (Abider, Sararood1, Nader, Efes-3) and a promising breeding line (Yea168) were tested in three tillage methods, that is, conventional tillage (CT), reduced tillage (RT) and no tillage (NT) in on-farm trials in two locations (Sarabnilofar and Dalahoo) and three cropping seasons (2018–2021). The results revealed high variability in productivity and other studied traits in farmers’ conditions that were significantly affected by genotypes, tillage managements, locations, and years. Barley genotypes, except Efes-3, positively interacted with CT. The highest grain yield was observed in CT conditions (2613 kg/ha), followed by NT (2520 kg/ha) and RT (2470 kg/ha), showing about 5.8% and 3.6% better performance in CT than in RT and NT, respectively. Across locations and years, breeding line Yea168 outperformed all four cultivars in all three tillage systems and should be recommended for cultivation under rainfed conditions. The results of genotype by trait (GT) biplot analysis indicated that the traits relations and traits profiles of genotypes are different among tillage systems and locations. High-yielding genotypes had their own specific traits that resulted in their better performance. Breeding line Yea168, followed by Nader cultivar performed well in Sarabnilofar location, where 1000-kernel weight (TKW), plant height (PLH), number of grains per spike (NGPS), normalised difference vegetation index (NDVI) and spike per square metre (spike/m2) were the most important traits in deciding grain yield in this location, whereas in Dalahoo location, Sararood1 performed well and TKW, SPAD (chlorophyll content), NGPS, and spike/m2 had considerable contributions to grain yield. The findings demonstrated the breeding line Yea168 as the best-performing genotype across tillage systems, making it highly recommended for cultivation in rainfed areas of western Iran.
Contraceptive use among women of reproductive age has increased significantly worldwide. However, little is known about contraceptive use and mental health among women in sub-Saharan African countries.
Aims
This study sought to investigate contraceptive use and self-reported measures of depression and anxiety symptoms among reproductive-age women in Mozambique using the most recent national data.
Method
The study used secondary data from the 2022–2023 Demographic and Health Survey of Mozambique. A total of 6910 (weighted) sexually active women aged 15–49 years were included in this analysis. Anxiety and depression scores were measured using self-report questionnaires. Linear regression analysis was conducted to assess the associations between depression and anxiety and contraceptive use.
Results
The prevalence of contraceptive use was 36.41%. About half of the hormonal contraceptive users (49.38%) were using injectables and 25.99% were using implants. In total, 9.14 and 2.83% of the women had moderate or high scores of self-reported anxiety respectively. Additionally, 5.24 and 5.42% reported moderate or high scores of depressive symptoms respectively. The use of hormonal contraceptives decreased anxiety symptoms by 0.47 units (β = −0.47; 95% CI −0.75 to −0.18; P < 0.001) compared with no contraceptive use. The use of hormonal contraceptives decreased depressive symptoms by 0.75 units (β = −0.75; 95% CI −1.11 to −0.39; P < 0.001) compared with no contraceptive use.
Conclusions
This study has demonstrated a naturalistic association between contraceptive use, particularly hormonal contraceptives, and decreased anxiety and depression among Mozambican women of reproductive age. This likely reflects a complex, bi-directional relationship, the nature and mechanism of which should be investigated in further experimental research.
Modern market economies use competitions to distribute a range of social goods. Some theorists maintain that such competitions ought not to generate winner-takes-all outcomes. But the arguments that have been given against competitions with winner-takes-all outcomes fail to find fault with winner-takes-all outcomes per se (or so I argue). Is there, then, anything wrong with winner-takes-all outcomes? I argue that there is: winner-takes-all outcomes are wrong, in at least most distributive competitions, because they do not give people what they deserve.
We give a complete classification of links up to clasp-pass moves, which coincides with Habiro’s $C_3$-equivalence. We also classify links up to band-pass and band-$\#$ moves, which are versions of the usual pass- and $\#$-move, respectively, where each pair of parallel strands belong to the same component. This recovers and generalizes widely a number of partial results in the study of these local moves. The proofs make use of clasper theory.
To assess whether universal masking during the COVID-19 pandemic reduced neonatal acquisition of S. aureus.
Study design:
We performed a retrospective cohort study of neonates admitted to a level three regional NICU for three years before and after implementation of universal masking for the COVID-19 pandemic. Multivariable proportional hazards regression models evaluated the effect of masking on time-to-acquisition of methicillin-resistant and methicillin-sensitive S. aureus (MRSA and MSSA) while adjusting for fixed and time-varying neonatal characteristics.
Results:
We analyzed 2,728 neonates, 1,446 pre-pandemic and 1,282 post-pandemic; 84.9% were inborn, with mean gestational age of 34 weeks and 6 days (SD = 4.2) and mean birthweight of 2,500 grams (SD = 975). The mean number of screening cultures per neonate was 3.07 (SD = 3.31). When adjusting for covariates, universal masking was associated with decreased acquisition of MRSA (hazard ratio =0.43 (95% CI: 0.19–0.99), p = 0.04) but not MSSA (HR = 1.27 (95% CI: 00.87–1.85), p = 0.21). Among covariates, airway devices and maternal S. aureus status were associated with S. aureus acquisition.
Conclusions:
Universal masking decreased the rate of NICU MRSA acquisition by 60% while MSSA acquisition was unchanged. Masking may reduce MRSA spread via colonized healthcare personnel while MSSA may be more likely to be acquired from parental skin-to-skin contact and was thus unaffected by masking.
Mood disorders are among the leading causes of disease burden worldwide, with 20–70% of affected individuals experiencing comorbid premenstrual disorders. This systematic review and meta-analysis investigated the comorbidity of premenstrual dysphoric disorder (PMDD) or premenstrual syndrome (PMS) with non-reproductive mood disorders.
Aims
We aimed to determine the pooled prevalence of PMDD/PMS with adult mood disorders, assess the impact of comorbidity on clinical course and summarise the associated neurobiological findings.
Method
Eligible studies were identified through Embase, MEDLINE and APA PsycINFO from inception to 22 January 2024 (PROSPERO, no. CRD42021246796). Studies on women (‘females‘) with diagnoses of PMDD/PMS and mood disorders were included. Risk of bias was assessed using National Institutes of Health quality assessment tools. A random-effects, pooled-prevalence meta-analysis was conducted using the Comprehensive Meta-Analysis software, categorising diagnostic sampling strategies as follows: mood disorders diagnosed first, PMDD/PMS diagnosed first or concurrent diagnoses. A narrative synthesis explored secondary outcomes, including illness course and biomarkers.
Results
A total of 39 studies were included, with 36 of these (n = 3646) contributing to the meta-analysis. Seven studies focused on bipolar disorders, 18 on unipolar depressive disorders and 14 on mixed samples of bipolar and unipolar disorders. Random-effects pooled-prevalence meta-analyses showed consistently high comorbidity rates between PMDD/PMS and mood disorders, ranging from 42% (95% CI: 30%, 55%) to 49% (95% CI: 38%, 60%) across sampling strategies. Risk of bias varied, with methodological heterogeneity noted.
Conclusions
This review underscores high comorbidity rates between PMDD/PMS and mood disorders, regardless of sampling strategy, and highlights the need for research into clinical and neurobiological characteristics specific to this comorbidity. Limitations include study heterogeneity, reliance on cross-sectional designs and provisional PMDD/PMS diagnoses. Future research should address these gaps to inform diagnostic and therapeutic advancements tailored to this population.
In individuals with irritable bowel syndrome (IBS), eliminating dietary triggers can alleviate symptoms but may lead to nutrient deficiencies and overall health decline. Although various nutritional supplements show promising results in relieving IBS symptoms due to their potential to alter the microbiome, conclusive scientific evidence remains lacking. This exploratory study aims to assess the bifidogenic properties of four nutritional supplement interventions and their impact on IBS-symptoms, faecal microbiota composition, faecal short-chain fatty acid (SCFA) concentrations, stool pattern, and quality of life (QoL), compared to a placebo control. Seventy subjects with IBS, meeting the ROME IV criteria, participated in this randomised, double-blind, placebo-controlled parallel intervention study. Subjects were assigned to one of the four treatment groups, receiving either resistant starch, pea fibre, chondroitin sulfate, protein hydrolysate, or placebo daily for four weeks. Daily reports on stool pattern and gastrointestinal complaints were collected. Stool samples and questionnaires on dietary intake, symptom severity, QoL, and anxiety and depression were collected at baseline and after the 4-week intervention. The results show no significant increase in Bifidobacterium abundance or faecal SCFA levels after the 4-week intervention with any of the four nutritional supplement interventions. While some improvements in symptom severity and QoL were observed within-groups, these were not significantly different from changes observed with placebo. In conclusion, the tested nutritional supplements did not increase Bifidobacterium abundance in subjects with IBS within four weeks. Furthermore, we conclude that future studies should consider a run-in period and a larger sample size to study improvements in IBS symptoms.
South Dakota, home to nine federally and state-recognized tribes, bears witness to a rich Native American history that predates colonialism. Yet, the representation of Native Americans in institutional archives remains sparse, often curated through the lens of non-Native creators. Addressing this gap involved a collaborative effort among Augustana University, Native American students from a federally funded tribal boarding school, and a regional cultural institution to facilitate the reclamation of archival narratives and the re-presentation of Native American histories through an innovative public humanities initiative. This project aimed to re-present archival material through creative interventions by young Native American artists, adhering to the First Nations principles of ownership, control, access, and possession. By transforming existing archival material into new artworks, the project fostered a deeper understanding of Native American history and its contemporary implications. Public exhibitions of these reinterpretations facilitated engagement with historical traumas and challenged normative perceptions of Native American experiences. The interdisciplinary approach highlighted the importance of Native American agency in curatorial processes, resulting in reflective public exhibitions. This project exemplifies how public humanities research can bridge historical gaps, support cultural recognition, and facilitate the reclamation of institutionalized narratives.
We explore an overlooked phenomenon in mortgage markets: repayment of underwater mortgages. Using a sample of mortgages terminated between 2007 and 2016, we show that such repayment indeed occurs, and that it is affected by the same factors commonly used in studies of default: the magnitude of home equity and the borrower’s credit score, which captures default cost as well as liquidity. A novel insight is that underwater repayers, unlike most defaulters, are not liquidity constrained, providing a much cleaner environment to study default costs. We estimate lower bounds on these costs. Our results indicate that default costs are substantial.
We present a financial justification for an outpatient infectious diseases pharmacist, based on cost savings from decreases in length of stay for patients with Staphylococcus aureus infections and additional revenue generated by physicians and pharmacists while following patients discharged on outpatient parenteral antimicrobial therapy.
One of the fundamental challenges for the UN plastics treaty is to shift the current linear plastic economy into a more circular plastic economy. Transitioning to a circular plastic economy requires a profound transformation of socio-technical systems, and research suggests that disruptive policies must simultaneously destabilize the entrenched linear system and cultivate a new regime that supports circular business models. A major barrier to this transformation lies in the artificially low cost of primary plastics, maintained by substantial subsidies for fossil fuels and plastic production. These subsidies, alongside the failure to internalize negative externalities – such as extensive health impacts and environmental damage – mask the true cost of plastic use, thereby undermining the economic case for innovation in sustainable alternatives. The upcoming UN plastics treaty presents a unique opportunity to realign market incentives and drive the necessary transition toward a circular, regenerative plastic economy.
Although many contemporary theologians and philosophers of religion distinguish between ‘idolatry’ in a general sense and ‘conceptual idolatry’ as a distinct error, close attention to theorists of idolatry shows that ‘conceptual idolatry’ should not be considered distinct from idolatry proper. After discussing the relation between concepts and idolatry in key thinkers from the phenomenological and grammatical traditions, this article discusses analytic attempts to understand idolatry, showing how each falls short.
Ultimately, attention to the category of ‘conceptual idolatry’ shows the deficiencies present in contemporary framings of idolatry simpliciter. This article concludes with a proposal for a new framework by which to understand the dispute about idolatry: turning away from the question of whether we are worshipping the right God, towards the question of how God might (and might not) become apt to human thought and speech.
We propose a novel micro-level Cox model for incurred but not reported (IBNR) claims count based on hidden Markov models. Initially formulated as a continuous-time model, it addresses the complexity of incorporating temporal dependencies and policyholder risk attributes. However, the continuous-time model faces significant challenges in maximizing the likelihood and fitting right-truncated reporting delays. To overcome these issues, we introduce two discrete-time versions: one incorporating unsystematic randomness in reporting delays through a Dirichlet distribution and one without. We provide the EM algorithm for parameter estimation for all three models and apply them to an auto-insurance dataset to estimate IBNR claim counts. Our results show that while all models perform well, the discrete-time versions demonstrate superior performance by jointly modeling delay and frequency, with the Dirichlet-based model capturing additional variability in reporting delays. This approach enhances the accuracy and reliability of IBNR reserving, offering a flexible framework adaptable to different levels of granularity within an insurance portfolio.
Prospective memory (PM) relies on switching processes to change from the ongoing activity to the future intention. Similarly, bilinguals in dual-language contexts are frequently required to switch between languages. In this study, we experimentally simulated the exposure to a dual-language context in a sample of single-language context bilinguals to explore the effect of language switching on PM. Thus, a group of bilinguals practiced language switching previous to the PM task (practice group) and were compared to a homologous group that did not receive this practice (control group). Event-related potential results indicated that the practice group showed greater wave amplitudes than the control group in the components associated to monitoring and switching processes. Whereas, this practice did not affect the retrospective components associated with the retrieval of the intention. This suggested that the interactional context in which bilinguals are immersed modulates their cognitive control strategies in charge of recalling future intentions.
This paper studies public opinion towards the introduction of a universal basic income in the case of Germany. Using novel data from a vignette survey experiment conducted in the summer of 2022, we analyse to what extent variations in the policy design characteristics of a hypothetical basic income scheme affect levels of support. We find that support for basic income strongly depends on these characteristics, with support being highest for schemes that are relatively generous, paid to citizens and long-term residents, paid to individuals rather than households, unconditional and financed with taxing the rich. In a further step, we explore interaction effects between vignette dimensions and respondent characteristics, finding significant heterogenous treatment effects in the cases of income, age and ideology.
Coarctation of the aorta is characterised by narrowing of the descending aorta and is a rare cause of secondary hypertension in children and young adults. The aortic stenosis lesion is in a special location with severe consequences, and long-term survival is very low, with high rates of disability and mortality, and can be challenging to detect due to its few clinical manifestations. We report a case of a young patient with atrial fibrillation, renal infarction, and acute cerebral infarction, which are consequences of untreated hypertension due to coarctation of the aorta. The purpose of this report is to emphasize the importance of early diagnosis and management of coarctation of the aorta as a cause of secondary hypertension in children and young adults.