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This chapter reviews the imaging approach in suspected child physical abuse, including differing presentations of child physical abuse as well as recommendations for screening children at risk. Imaging strategy of the skeleton, including radiography, chest CT, ultrasound, whole-body MR and radionuclide bone imaging is reviewed.
In 2020, the American Academy of Clinical Neuropsychology (AACN) published consensus labels for the uniform description of normally distributed test results in the field of clinical neuropsychology. These consensus labels were developed in a North American context, but other countries have also struggled with the challenges of harmonizing verbal descriptive labels in neuropsychological reports. A recent effort in Norway has demonstrated that literal translations of the AACN labels do not always work in a different language and culture. Also, verbal labels may not be unequivocally understandable for patients, their significant others, and other healthcare professionals who refer patients for neuropsychological services. In this Commentary, we illustrate the process of coming to uniform descriptions for normally distributed test results for the Dutch language, spoken primarily in the Netherlands, the Flanders part of Belgium, the Dutch Caribbean, and Suriname. We also highlight the hurdles that need to be overcome to establish a global consensus.
Gestational weight gain (GWG) can be defined as the total weight gained throughout pregnancy and is required for healthy fetal growth; however, gaining excessive weight during pregnancy has been linked with several adverse effects. This review aims to consider the evidence on weight management during pregnancy, with a focus on the key challenges surrounding GWG and the practical considerations related to assessing weight changes. It is estimated that nearly 50% of women gain excessive weight during pregnancy; nevertheless, this can be difficult to quantify due to the lack of global consensus on recommended GWG guidelines. Currently, there are no GWG guidelines in the UK and Ireland, as reiterated in the recent National Institute for Health and Care Excellence guidelines, due to the lack of evidence about what the optimal total weight change in pregnancy should be. This is further complicated by the conflicting results of interventions aimed at preventing excessive GWG and their resultant inconsistent effects on adverse pregnancy outcomes. Accurate calculation of GWG requires measurement of pre-pregnancy weight and weight prior to the onset of labour. However, several practical considerations are associated with obtaining these weights, as in practice, estimated or self-recalled weights are often used as an alternate, thereby introducing variability into the measurement of GWG and the potential for inaccuracies in analysis. These limitations highlight the need for a more uniform approach in assessing GWG. The WHO is in the process of developing global GWG standards, and this could potentially establish a uniform gold standard for assessing GWG and reintroduce routine weighing.
Incorporating intangible aspects of prehistoric experience, including sound, has become increasingly important in rock art research, offering a more comprehensive interpretation of the past. Scholars suggest that the acoustic properties of certain rock art sites may have influenced not only artistic creation but also social and ritual practices. This article presents guidelines for recording, digitizing, and analyzing the acoustic features of open and semi-open rock art sites. The proposed protocol integrates two complementary approaches: a sonic exploration to gather subjective (person-centered) data, and experimental impulse response measurements based on room acoustics principles to obtain quantitative acoustic data. Given the lack of standardized methodologies for characterizing the acoustics of such sites, this protocol aims to enhance the reliability, reproducibility, and comparability of future archaeoacoustic research. By establishing a rigorous framework, it contributes to a deeper understanding of how sound shaped past human experiences.
This chapter explores bias and fairness in Swedish employment testing from legal, historical, and practical perspectives. Swedish labor laws, influenced by trade unions and the welfare state, emphasize non-discrimination under the Discrimination Act. The law prohibits bias based on sex, gender identity, ethnicity, religion, disability, sexual orientation, and age, and requires preventive action. It is enforced by the Equality Ombudsman and Labour Court. Although validity evidence is not explicitly required, selection decisions should be based on a job analysis. No proof of intent is required in discrimination claims, and the burden of proof is shared. Quotas are banned, but positive action is allowed for gender balance when qualifications are equal. Psychological test certification is voluntary in Sweden; the Psychological Association offers guidelines on validity, reliability, and fairness. However, these are not mandatory, and many employers develop their own policies. International standards offer best-practice guidance for fair assessments, including for emerging artificial intelligence tools.
Lipids are essential for child development. Nutritional recommendations are numerous, evolving over time and are often based on expert opinions more than evidence-based medicine. The objective of this review is to critically analyse the evolution of current nutritional recommendations, identify existing knowledge gaps and propose avenues for improvement to optimise infant nutrition and development. A narrative literature review on Pubmed, EMBASE and Cochrane databases (2001–22) was conducted with the keywords: ‘alpha-linolenic acid, arachidonic acid, children, cholesterol, docosahexaenoic acid, eicosapentaenoic acid, guidelines, infant, long-chain (LC) PUFA, linoleic acid, lipids and dietary intakes, newborn, palmitic acid and toddler’. Among 861 articles identified, 133 were selected. The main current recommendations are issued by the French Agency for Food Safety (AFSSA), French Agency for Food, Environmental and Occupational Health and Safety (ANSES) and the Food and Agriculture Organization and World Health Organization (FAO-WHO). In infants from 0 to 3 years of age the main challenge is to increase lipid intake while maintaining an optimal omega 6/omega 3 ratio. Current recommendations are focused on polyunsaturated fatty acids, emphasising the intake of linoleic, eicosapentaenoic and docosahexaenoic acids without any specific recommendation for arachidonic acid before the age of 6 months. Points of interest, but without any recommendation, are the incorporation of milk fat, cholesterol, monounsaturated fatty acids, and saturated fatty acids for infants under 6 months. In conclusion, this article identifies knowledge gaps regarding the structural aspect of lipids and the integration of new categories of lipids in future recommendations to promote the quality of infant formulas.
This review comprehensively examines the current evidence on the dietary management of chronic constipation, and the dietary recommendations presented in clinical guidelines for chronic constipation. Several randomised controlled trials (RCT) have investigated the effect of dietary supplements, foods and drinks in chronic constipation. Systematic reviews and meta-analyses of these RCTs have demonstrated that psyllium supplements, specific probiotic supplements, magnesium oxide supplements, kiwifruits, prunes, rye bread and high mineral water content may be effective in the management of constipation. However, despite the plethora of evidence, current clinical guidelines only offer a limited number of dietary recommendations. The most commonly recommended dietary strategy in clinical guidelines is dietary fibre, followed by senna supplements and psyllium supplements. The least commonly recommended dietary strategies are magnesium oxide, Chinese herbal supplements, prunes and high mineral-content water. Several evidence-based dietary strategies are omitted by current clinical guidelines (e.g. kiwifruits), while some strategies that are recommended are not always supported by evidence (e.g. insoluble fibre supplement). Dietary recommendations in clinical guidelines can also be ambiguous, lacking outcome-specific recommendations and information for appropriate implementation. Future RCTs are needed to assess currently under-investigated dietary approaches that are nevertheless commonly recommended, and future clinical guidelines should include dietary recommendations supported by available evidence.
We aimed to identify therapeutic approaches for managing schizophrenia in different phases and clinical situations – the prodromal phase, first-episode psychosis, cognitive and negative symptoms, pregnancy, treatment resistance, and antipsychotic-induced metabolic side effects – while assessing clinicians’ adherence to guidelines.
Methods
A cross-sectional online survey was conducted in 2023 as part of the Ambassador project among psychiatrists and trainees from 35 European countries, based on a questionnaire that included six clinical vignettes (cases A–F). Additionally, a review of multiple guidelines/guidance papers was performed.
Results
The final analysis included 454 participants. Our findings revealed a moderate to high level of agreement among European psychiatrists regarding pharmacological treatment preferences for first-episode psychosis and cognitive and negative symptoms, prodromal symptoms and pregnancy, with moderate adherence to clinical guidelines. There was substantial similarity in treatment preferences for antipsychotic-induced metabolic side effects and treatment resistance; however, adherence to guidelines in these areas was only partial. Despite guideline recommendations, non-pharmacological treatments, including psychotherapy and recovery-oriented care, were generally underutilized, except for psychoeducation and lifestyle recommendations, and cognitive behavioural therapy for treatment of the prodromal phase. Contrary to guidelines, cognitive remediation and physical exercise for cognitive symptoms were significantly neglected.
Conclusions
These discrepancies highlight the need for effective implementation strategies to bridge the gap between research evidence, clinical guidelines/guidance papers, and real-world clinical practice. Clinicians’ unique combination of knowledge and experience positions them to shape future guidelines, especially where real-world practice diverges from recommendations, reinforcing the need to integrate both research evidence and clinical consensus.
Globally, several health technology assessment (HTA) agencies have started to incorporate environmental considerations into their assessments, given healthcare systems’ substantial environmental footprint. In Canada, two HTA agencies, the Canadian Drug Agency and the Institut national d’excellence en santé et en services sociaux, have announced measures to help mitigate healthcare’s contribution to climate change. Our aim was to review reports from both agencies to identify those incorporating environmental considerations.
Methods
We retrieved reports published between 1 May 2023 and 1 December 2024 by the two agencies.
Results
We identifed 202 reports, of which eleven were included. These reports covered diverse technologies, with greenhouse gas emissions and waste production being the most frequently considered environmental dimensions. Parallel evaluation was the predominant method for integrating environmental considerations. We believe that the limited number of reports included may reflect the challenges of incorporating such considerations into HTAs.
Conclusion
By addressing these challenges, HTA agencies could play a pivotal role in guiding decisions that align with environmental goals.
Soft law instruments such as declarations, guidelines, directives, and codes of conduct significantly influence international human rights law. This chapter examines their functions, effects, and the interaction between soft law and customary or conventional norms. It discusses how soft law instruments contribute to the development and implementation of human rights norms, providing flexibility and adaptability. The chapter also explores the challenges and limitations of soft law, including issues of enforceability, legitimacy, and consistency. It highlights the role of soft law in complementing and reinforcing customary and conventional human rights norms, and the need for a comprehensive approach to integrate soft law into the human rights framework.
This article examines the recent work of the ILC on ‘Succession of States in Respect of State Responsibility’. While the ILC decided in 2024 to stop working on the topic, the five reports submitted by Special Rapporteur Šturma and the Guidelines provisionally adopted will have a long-lasting impact on state succession scholarship and may influence states in their practice. This article provides a critical analysis of the Guidelines by comparing its content with the Resolution adopted by the Institute of International Law in 2015 on the same issue. It will show that while the solutions which were initially put forward by Special Rapporteur Šturma in his reports followed many of the same features as the Institute’s Resolution, the final version of the Guidelines are significantly different in both content and tone. A major shift occurred when each provision was examined by the Drafting Committee. This is because some ILC members, and many states, rejected any presumption of succession to responsibility. Instead, they favoured the opposite general rule of nonsuccession. As a result, none of the provisions provisionally adopted by the ILC impose any obligations whatsoever on states. They only go so far as to encourage them to reach agreements on matters of succession to responsibility. Ultimately, the Guidelines leave wide open the possibility that a wrong remains unpunished in the context of a succession of states. As such, the Guidelines do little to protect the interests of injured states.
Competing with Integrity and Ethical Decision-Making challenges students to consider their responsibilities as a business leader more broadly than simply from financial, market, or legal perspective. There can also be human, social, or legal consequences from their decisions. The human and social impact of decisions should be considered at the time these decisions are being made. The distinction between integrity and ethics is explored, and differences between ethical and legal behavior are discussed. Major moral philosophies and ethical frameworks are presented and compared. Examples are provided from multiple industries. The Foreign Corrupt Practices Act (FCPA), the Corruption Perceptions Index from Transparency International, and the Integrative Social Contracts Theory (ISCT) are presented. Ethical use of artificial intelligence is seen as an emerging concern for global leaders. The chapter ends with a set of personal guidelines for dealing with ethical dilemmas for global leaders to consider.
It is very satisfying to teach in a classroom where students are actively participating in discussions, group projects and other activities. Learning spaces are complex – both teachers and students experience numerous pressures, wants and needs that accompany them into a classroom. For instance, both teachers and their students want to be heard, to learn, to be safe and to have positive relationships with their peers, just to name a few. However, the value and sources for satisfaction that you and they place on these needs and wants at any given time may be different from one another. You may want to get on with a brilliant geography lesson, while a sleep-deprived student may just want a bit of rest and believe the right place for it is the very same geography lesson. These possibilities remind us that your lesson is taking place in a social environment with multiple stakeholders actively reacting to each other. This is why it is very important to develop strategies that will help you manage both your and your students’ expectations in the classroom. This chapter focuses on how the use of rules and expectations lays the foundations for positive and engaging learning environments.
Insomnia is an ideal fit for treatment using CBT. Indeed, whereas good sleep is supported by largely automated sleep–wake processes, insomnia is driven by maladaptive thoughts and behaviours that inhibit optimal conditions for sleep. It conceptualises insomnia using well-established models with a focus on the attention–intention–effort pathway to describe the manner in which insomnia develops and perpetuates. This chapter sets forth the case as to why CBT is ideal for the treatment for insomnia, and provides a detailed summary of the unequivocal and robust evidence base supporting the effectiveness of CBT in the insomnia context. In addition to evaluating the data for traditional therapist-delivered CBT, it reviews and summarises findings from studies of digitally delivered CBT in the context of insomnia. The chapter goes on to describe the effects of CBT beyond the night-time symptoms of insomnia on both daytime impairments and broader benefits to mental health symptoms. Finally, in the context of the wealth of evidence supporting CBT, it reports on the universal recommendation that CBT should be the first-line treatment for insomnia by treatment guidelines internationally.
Health technology assessment (HTA) guidelines are intended to support the successful implementation of HTA by enhancing consistency and transparency in concepts, methods, processes, and use, thereby enhancing the legitimacy of the decision-making process. This report lays out good practices and practical recommendations for developing or updating HTA guidelines to ensure successful implementation.
Methods
The task force was established in 2022 and comprised experts and academics from various geographical regions, each with substantial experience in developing HTA guidelines for national health policy making. Literature reviews and key informant interviews were conducted to inform these good practices. Stakeholder consultations, open peer reviews, and expert opinions validated the recommendations. A series of teleconferences among task force members was held to iteratively refine the report.
Results
The recommendations cover six key aspects throughout the guideline development cycle: (1) setting objectives, scope, and principles of the guideline, (2) building a team for a quality guideline, (3) defining a stakeholder engagement plan, (4) developing content and utilizing available resources, (5) putting in place appropriate institutional arrangements, and (6) monitoring and evaluating guideline success.
Conclusion
This report presents a set of resources and context-appropriate practices for developing or updating HTA guidelines. Across all contexts, the recommendations emphasize transparency, building trust among stakeholders, and fostering a culture of ongoing learning and improvement. The report recommends timing development and revision of guidelines according to the HTA landscape and pace of HTA institutionalization. Because HTA is increasingly used to inform different kinds of decision making in a variety of country contexts, it will be important to continue to monitor lessons learned to ensure the recommendations remain relevant and effective.
Research on nutraceutical and dietary interventions in psychiatry has grown substantially, but progress is hindered by methodological inconsistencies and limited reporting standards. To address this, the International Society for Nutritional Psychiatry Research presents the first guidelines on clinical trial design, conduct, and reporting for future clinical trials in this area. Recommendations were developed using a Delphi process including eighteen researchers with considerable clinical trial expertise and experience in either methodology, nutraceutical, or dietary interventions in psychiatry. These guidelines provide forty-nine recommendations for clinical trial design and outcomes, five for trial reporting, and seven for future research priorities. The recommendations included in these guidelines are designed to inform both nutraceutical and dietary clinical trial interventions in Nutritional Psychiatry. Common themes include an emphasis on the importance of a multidisciplinary research team and integration of co-design processes into the conduct and design of clinical research, methods to improve transparency and replicability of trial outcomes, and measures to address common biases in nutrition trials. Furthermore, we provide recommendations for future research including examining a greater variety of nutraceutical and dietary interventions, scalable delivery models, effectiveness and implementation studies, and the need to investigate these interventions in the prevention and management of less studied psychiatric conditions (e.g. schizophrenia and bipolar disorder). Recommendations included within these guidelines are intended to improve the rigor and clinical relevance of ongoing and future clinical trials in Nutritional Psychiatry.
Health system spending, and the consequent impact on health are increasingly a focus of governments around the world. Given the strain on resources and systems, increasingly scarce resources require targeting more effectively. Measuring efficiency and productivity are increasingly the focus of government gepartments, both nationally and locally. Thus, assessing how efficiency is measured and how valid and robust results are is critical to those involved in policy and service delivery. This chapter presents revised guidelines as to how users should set up such studies to be as useful as possible and how end users can assess how useful they actually are to them in their specific setting. Conclusions are drawn as to how these can be used in a fast-changing world, and potential consequences of not following guidance are discussed.
Health technology assessment (HTA) organizations generate guidelines to inform healthcare practices toward improved health outcomes. This review sought to identify and classify outcomes of guidelines from HTA organizations within published research.
Methodology
We performed a systematic mixed studies review of empirical studies that (a) referred to a published guideline from an HTA organization and (b) reported an outcome resulting from a guideline. We searched the published literature in English or French within seven databases. Outcome types were classified within five dimensions of an existing framework for online health information (e.g., relevance, cognitive/affective impact, and use). Subdimensions were inductively developed. A two-phase sequential data synthesis was performed. Phase 1: a hybrid deductive–inductive thematic analysis identified the types of outcomes and displayed their relationships on a concept map. Phase 2: descriptive statistics were tabulated by the type of outcome.
Results
A total of 6,719 records were retrieved through searches on 6 February 2023. After screening, we included 120 observational studies (twenty-one qualitative, ninety-four quantitative, and five mixed methods). Phase 1 identified twenty-nine types of outcomes. The most frequently reported outcomes were within the organizational dimension (reported in ninety-four studies). The most common subdimensions were “Referrals” (thirty-eight occurrences), the “Quality of Prescriptions” (fifteen occurrences), and the “Quality of Diagnosis” (eight occurrences). For Phase 2, we could only generate descriptive statistics on seventeen outcomes. These were almost equally distributed among positive, neutral, and negative effects. Our results contribute to knowledge about the outcomes of HTA guidelines and options for documenting and measuring them in future evaluations.
One of the goals of open science is to promote the transparency and accessibility of research. Sharing data and materials used in network research is critical to these goals. In this paper, we present recommendations for whether, what, when, and where network data and materials should be shared. We recommend that network data and materials should be shared, but access to or use of shared data and materials may be restricted if necessary to avoid harm or comply with regulations. Researchers should share the network data and materials necessary to reproduce reported results via a publicly accessible repository when an associated manuscript is published. To ensure the adoption of these recommendations, network journals should require sharing, and network associations and academic institutions should reward sharing.