Challenges Posed by COVID-19 on Doctoral Students' Wellbeing in Russia: Of International and Domestic Doctoral Students, Who Suffers More?

Background

While universities closed, implementing remote teaching and learning in response to COVID-19, this change significantly impacted the lives of graduate students, given their exposure to unique and diverse experiences. It thus has become essential to understand the possible differences in regard to the pandemic's impact on international and domestic students.

Purpose

The aim of this study was to explore the consequences of the challenges posed by COVID-19 on doctoral students' wellbeing in Russia.

Methods

The study surveyed 4454 doctoral students across 249 Russian public universities.

Results

The challenges posed by COVID-19 negatively affected international doctoral students' learning experience (β= -0.269, p<0.001); students' satisfaction with supervision (β= -0.098, p<0.001); dissertation experience (β= -0.039, p<0.001); and doctoral program satisfaction (β= -0.034, p<0.001). Furthermore, the challenges posed by COVID-19 affected domestic doctoral students' learning experience (β=-0.368, p<0.001); students' satisfaction with supervision (β=-0.194, p<0.001) and doctoral program satisfaction (β=-0.034, p<0.001). However, the influence of the challenges posed by COVID-19 on communication frequency was relatively positive for both international (β=0.060, p<0.001) and domestic students (β=0.021, p<0.001), and dissertation experience (β=0.061, p<0.001) was also positive for only domestic students. Furthermore, controlled factors comprising field of study (β=-0.033, p<0.001); year of study (β=0.127, p<0.001); and university region (β=-0.056, p<0.001) influenced the effect of the challenges posed by COVID-19 on international doctoral students.

Conclusion

The COVID-19 challenges had the greatest impact on the wellbeing of international students. Furthermore, both international and domestic students' communication frequency with their supervisors underwent a relatively positive impact (which implies no effect on both categories of students). Furthermore, the challenges posed by COVID-19 had no effect on domestic students' dissertation experiences. Finally, among the controlled variables, field of study, year of study, and university region were discovered to be significant factors in relation to the challenges posed by COVID-19 for international students.

Establishing an International Interdisciplinary Research Network in Craniofacial Microsomia: The CARE Program

OBJECTIVE

Craniofacial microsomia (CFM) is a broad clinical term used to describe a congenital condition most commonly involving the underdevelopment of the external ear, mandible, soft tissues, and facial nerve. Despite medical advances, understanding of the psychological health and healthcare experiences of individuals with CFM and their caregivers remains limited. This article describes a research program designed to address these knowledge gaps, and identify opportunities for psychosocial intervention and improved healthcare provision.

DESIGN

The Craniofacial microsomia: Accelerating Research and Education (CARE) research program aims to: 1) Conduct up to 160 narrative interviews with individuals and caregivers to validate a conceptual framework; 2) Administer an online international survey of up to 800 individuals with CFM and caregivers to identify predictors of psychological distress; 3) Perform up to 60 semi-structured interviews with healthcare providers and advocacy leaders to examine the extent to which current healthcare provisions address identified patient needs; and 4) Establish a participant registry to build a longitudinal database and develop an international community.

RESULTS

Teams in the USA and UK have been established, alongside an international, interdisciplinary Advisory Committee. Data analysis for Aim 1 is ongoing and informing the delivery of Aims 2-3. Aim 4 is also in development. A dedicated website serves as a recruitment tool, educational resource, and mechanism for engaging with the CFM community.

CONCLUSIONS

The CARE program provides a comprehensive approach to understanding the experiences of individuals with CFM and their caregivers. Challenges encountered and lessons learned are shared for the benefit of the community.

Worldwide organ allocation systems for pediatric lung transplantation

Pediatric lung transplantation (LTX) remains limited by the scarcity of small donor lungs, particularly in less populated parts of the world. Optimal organ allocation, including the prioritization and ranking of pediatric LTX candidates, and the appropriate matching of pediatric donors to recipients have been crucial elements in improving pediatric LTX outcomes. We aimed to elucidate the various pediatric lung allocation practices worldwide. A global survey of current pediatric solid organ transplantation deceased donation allocation practices was conducted by the International Pediatric Transplant Association (IPTA), and these policies were subsequently analyzed if publicly available, with focus on pediatric lung transplantation. Significant variation was found in lung allocation systems worldwide both in terms of prioritization and distribution for children. Definition of pediatrics varied from <12 years of age to <18 years of age. While several countries performing LTX for young children do not have a formal system to prioritize pediatric candidates, many countries that perform LTX at higher rates do offer prioritization methods for children: including the United States, United Kingdom, France, Italy, Australia, and countries serviced by Eurotransplant. Certain lung allocation practices for pediatrics are highlighted herein, including the newly instituted Composite Allocation Score (CAS) system in the United States, pediatric matching with Eurotransplant, and pediatric prioritization in Spain. The systems highlighted here explicitly aim to provide judicious and high quality LTX care for children.

Healthcare seeking during travel: an analysis by the GeoSentinel surveillance network of travel medicine providers

BACKGROUND

International travellers may seek care abroad to address health problems that arise during their trip or plan healthcare outside their country of residence as medical tourists.

METHODS

Data were collected on travellers evaluated at GeoSentinel Network sites who reported healthcare during travel. Both unplanned and planned healthcare were analysed, including the reason and nature of healthcare sought, characteristics of the treatment provided and outcomes. Travellers that presented for rabies post-exposure prophylaxis were described elsewhere and were excluded from detailed analysis.

RESULTS

From May 2017 through June 2020, after excluding travellers obtaining rabies post-exposure prophylaxis (n= 415), 1093 travellers reported care for a medical or dental issue that was an unanticipated part of the travellers' planned itinerary (unplanned healthcare). Travellers who sought unplanned healthcare abroad had frequent diagnoses of acute diarrhoea, dengue, falciparum malaria and unspecified viral syndrome, and obtained care in 131 countries. Thirty-four (3%) reported subsequent deterioration and 230 (21%) reported no change in condition; a third (n = 405; 37%) had a pre-travel health encounter. Forty-one travellers had sufficient data on planned healthcare abroad for analysis. The most common destinations were the US, France, Dominican Republic, Belgium and Mexico. The top reasons for their planned healthcare abroad were unavailability of procedure at home (n = 9; 19%), expertise abroad (n = 9; 19%), lower cost (n = 8; 17%) and convenience (n = 7; 15%); a third (n = 13; 32%) reported cosmetic or surgical procedures. Early and late complications occurred in 14 (33%) and 4 (10%) travellers, respectively. Four travellers (10%) had a pre-travel health encounter.

CONCLUSIONS

International travellers encounter health problems during travel that often could be prevented by pre-travel consultation. Travellers obtaining planned healthcare abroad can experience negative health consequences associated with treatments abroad, for which pre-travel consultations could provide advice and potentially help to prevent complications.

Experiences of people with dementia and informal caregivers with post-diagnostic support: Data from the international COGNISANCE study

OBJECTIVES

The study aims to describe people with dementia and informal caregivers' respective experiences of support after diagnosis and compares these experiences. Additionally, we determine how people with dementia and informal caregivers who are satisfied with support differ from those dissatisfied.

METHODS

A cross-sectional survey study in Australia, Canada, the Netherlands, Poland, and United Kingdom was carried out to examine people with dementia and informal caregivers experience with support (satisfaction with information, access to care, health literacy, and confidence in ability to live well with dementia). The separate surveys contained closed questions. Analysis consisted of descriptive statistics and Chi-square tests.

RESULTS

Ninety people with dementia and 300 informal caregivers participated, and 69% of people with dementia and 67% of informal caregivers said support after diagnosis helped them deal more efficiently with their concerns. Up to one-third of people with dementia and informal caregivers were dissatisfied with information about management, prognosis, and strategies for living positively. Few people with dementia (22%) and informal caregivers (35%) received a care plan. People with dementia were more often satisfied with information, had more often confidence in their ability to live well with dementia, and were less often satisfied with access to care compared to informal caregivers. Informal caregivers who were satisfied with support were more satisfied with information and access to care compared to informal caregivers not satisfied with support.

CONCLUSIONS

Experience of dementia support can be improved and people with dementia and informal caregiver differ in their experiences of support.

Predicting child aggression: The role of parent and child endorsement of reactive aggression across 13 cultural groups in 9 nations

Parent and child endorsement of reactive aggression both predict the emergence of child aggression, but they are rarely studied together and in longitudinal contexts. The present study does so by examining the unique predictive effects of parent and child endorsement of reactive aggression at age 8 on child aggression at age 9 in 1456 children from 13 cultural groups in 9 nations. Multiple group structural equation models explored whether age 8 child and parent endorsement of reactive aggression predicted subsequent age 9 child endorsement of reactive aggression and child aggression, after accounting for prior child aggression and parent education. Results revealed that greater parent endorsement of reactive aggression at age 8 predicted greater child endorsement of aggression at age 9, that greater parent endorsement of reactive aggression at age 8 uniquely predicted greater aggression at age 9 in girls, and that greater child endorsement of reactive aggression at age 8 uniquely predicted greater aggression at age 9 in boys. All three of these associations emerged across cultures. Implications of, and explanations for, study findings are discussed.

Resilience to COVID-19 challenges: Lessons for school psychologists serving school-attending youth with experiences of marginalization

This special issue is focused on the lessons learned from the COVID-19 health crisis, showcasing new cross-cultural research from different countries, such as rural/urban US, South Africa, and Australia. The aim οf the special issue is to highlight new knowledge related to pandemic-related impacts, as well as underscore variables that will promote children's resilience and especially vulnerable and marginalized children. We argue that all adults associated with schools (e.g., teachers, school psychologists, administrators, aides, parents, and social workers) need to synergize in creating a caring school community that is purposefully committed to supporting student resilience, especially among students with experiences of marginalization. A multisystemic resilience approach has been adopted and the focus has been on caring adults in the school communities and how they can support the most vulnerable students if the adults (school psychologists parents, caregivers, teachers, and other role-players) take co-ownership of championing student resilience in times of crisis. The studies included in this special issue highlight important issues especially for school psychologists, such as girls' school engagement as a buffering factor to school disruptions, the value of multigenerational supports, the value of spirituality in dealing with crises, the sense of supportive connectedness with schools and finally teacher empowerment to support student wellbeing.

The Pandemic Paranoia Scale (PPS): factor structure and measurement invariance across languages

BACKGROUND

Globally, the corona virus disease 2019 (COVID-19) pandemic has created an interpersonally threatening context within which other people have become a source of possible threat. This study reports on the development and validation of a self-report measure of pandemic paranoia; that is, heightened levels of suspicion and mistrust towards others due to the COVID-19 pandemic.

METHODS

An international consortium developed an initial set of 28 items for the Pandemic Paranoia Scale (PPS), which were completed by participants from the UK (n = 512), USA (n = 535), Germany (n = 516), Hong Kong (n = 454) and Australia (n = 502) using stratified quota sampling (for age, sex and educational attainment) through Qualtrics and translated for Germany and Hong Kong.

RESULTS

Exploratory factor analysis in the UK sample suggested a 25-item, three-factor solution (persecutory threat; paranoid conspiracy and interpersonal mistrust). Confirmatory factor analysis (CFA) on the remaining combined sample showed sufficient model fit in this independent set of data. Measurement invariance analyses suggested configural and metric invariance, but no scalar invariance across cultures/languages. A second-order factor CFA on the whole sample indicated that the three factors showed large loadings on a common second-order pandemic paranoia factor. Analyses also supported the test-retest reliability and internal and convergent validity.

CONCLUSION

The PPS offers an internationally validated and reliable method for assessing paranoia in the context of a pandemic. The PPS has the potential to enhance our understanding of the impact of the pandemic, the nature of paranoia and to assist in identifying and supporting people affected by pandemic-specific paranoia.

Stability and Relevance of Marriage Desires: Importance of Age Norms and Partnering Opportunities

Objective

This study investigates shifts in marriage desires during singlehood and the potential consequences associated with these shifts in Japan, a country epitomizing later and less marriage without substantial increases in nonmarital childbearing.

Background

Despite researchers' long-standing interest in values potentially motivating demographic changes, few have systematically examined marriage desires among unmarried adults. Even fewer have considered how marriage desires may change during adulthood and how relevant such changes are to marriage and family behavior.

Method

The analysis uses 11 waves of the Japan Life Course Panel Survey, which tracks singles' marriage desires yearly. Fixed effects models are estimated to demonstrate factors associated with within-person changes and account for unobserved heterogeneity.

Results

Japanese singles' marriage desires decline with age but are stronger when they perceive greater opportunities to form romantic relationships or marriage. Singles experiencing an increase in the desire to marry are more likely to take actions to seek partners and to enter a romantic relationship or marriage subsequently. The associations between marriage desires and the various behavioral changes strengthen with age and feasibility of marriage. Increases in marriage desires also correspond to increases in single men's parenthood desires and ideal numbers of children, and the link between marriage desires and fertility preferences is stronger as they age.

Conclusion

Marriage desires are not always stable or equally relevant throughout singlehood. Our study suggests that age norms and partnering opportunities both contribute to the fluctuation of marriage desires and affect when such desires would have behavioral implications.

Survey of echocardiography practice across five continents

BACKGROUND AND AIM

The term echocardiography refers to a diverse range of cardiovascular ultrasound imaging methods, both inside and outside specialist cardiology practice. While guidelines exist, we hypothesized that there are significant worldwide differences in the way echocardiography is practiced. We surveyed echocardiography practitioners around the world to characterize the workforce and their practice.

METHOD

Social media and word of mouth were used in an explosive sampling approach to recruit echo users, who then completed an online survey that included personal demographics and questions about their practice, their resources, and daily use of echocardiography.

RESULTS

In total, 594 participants completed the survey: 54.9% sonographers; 30% cardiologists, with the remainder other physicians or trainees. Significant variation in the number of echoes performed and the time allocated to scanning was observed. There were also differences in the gathering of adjunct measures such as blood pressure and body size.

CONCLUSION

There is wide variation in echocardiography practices across the world. Differences are likely to be both clinician- and healthcare system-driven. Guidelines for practice developed in well-resourced western countries and intended for use in cardiology-based echocardiography laboratories may not be applicable to other countries or indeed to new echo users.

Surgical management of extremity rhabdomyosarcoma: A consensus opinion from the Children's Oncology Group, the European Pediatric Soft-Tissue Sarcoma Study Group, and the Cooperative Weichteilsarkom Studiengruppe

The treatment of extremity rhabdomyosarcoma remains a challenge due to several adverse prognostic factors frequently associated with this tumor site. The International Soft-Tissue Sarcoma Database Consortium (INSTRuCT) is a collaboration of the Children's Oncology Group Soft-Tissue Sarcoma Committee, the European Pediatric Soft-Tissue Sarcoma Study Group, and the Cooperative Weichteilsarkom Studiengruppe. The INSTRuCT surgical committee developed an internationally applicable consensus opinion document for the surgical treatment of extremity rhabdomyosarcoma. This document addresses surgical management, including biopsy, nodal staging, timing of therapy, resection and reexcision, reconstruction, and surgical approach at relapse.

Respect and reflexivity: international education partnerships in primary care

The UK general practice model has been described as the 'jewel in the crown' of the National Health Service and is widely respected and emulated around the world. In recent years, there has been a particular interest in the UK approach to primary care medical education, including at undergraduate and postgraduate levels, leading to a number of international education partnerships designed to draw on the best of UK experience and expertise in this area. Drawing on the limited academic literature in this area, and the authors' personal experiences of working across many international partnership projects with countries around the world, this article reflects on the central importance of respect and reflexivity when engaging in such work. A respectful approach relies on a genuine and deep curiosity for the local context, and a desire to empower partners to build their own solutions that are contextually authentic. A reflexive approach, meanwhile, relies on those engaging in partnerships to understand themselves as 'invited guests' and to remain mindful of current and historical power differentials and inequities when framing their engagement, looking both inwardly and outwardly as they conduct themselves. As primary care education around the world develops and expands, there may be a greater role for international partnerships and it is critically important that those engaging in such partnerships bring a thoughtful and scholarly lens to this work.

Dermatopathologic features of cutaneous squamous cell carcinoma and actinic keratosis: Consensus criteria and proposed reporting guidelines

BACKGROUND

There is considerable variation in the literature regarding the dermatopathologic diagnostic features of and reporting guidelines for actinic keratosis (AK) and cutaneous squamous cell carcinoma (cSCC).

OBJECTIVE

To develop consensus recommendations regarding diagnostic criteria, nomenclature, and reporting of AK and cSCC.

METHODS

Literature review and cross-sectional multiround Delphi process including an international group of expert dermatopathologists followed by a consensus meeting.

RESULTS

Consensus was achieved regarding the key dermatopathologic features necessary for diagnosing cSCC, AK, and associated variants; grading of degree of cellular differentiation in cSCC; utility of immunohistochemistry for diagnosis of cSCC; and pathologic features that should be reported for cSCC and AK.

LIMITATIONS

Consensus was not achieved on all questions considered.

CONCLUSION

Despite the lack of clarity in the literature, there is consensus among expert dermatopathologists regarding diagnostic criteria and appropriate reporting of AK and cSCC. Widespread implementation of these consensus recommendations may improve communication between dermatopathologists and clinicians, facilitating appropriate treatment of AK and cSCC.

Multiperspective Analysis of Pandemic Impacts on U.S. Import Trade: What Happened, and Why?

U.S. container ports have experienced unpresented congestion since mid-2020. The congestion is generally attributed to import surges triggered by heavy spending on consumer goods during the COVID-19 pandemic. Port congestion has been compounded by the inability of importers to retrieve, receive, and process all the inbound goods they have ordered, resulting in supply chain shortfalls and economic disruption. How can the shipping industry and government organizations predict the end of the current surge and anticipate future surges? Expected seasonal variations in import volume are associated with peak holiday shopping periods; nonseasonal import surges are signaled by other factors. The research goes beyond transportation data sources to examine broader connections between import volume and indicators of economic and retail industry conditions. The strongest and most useful relationship appears to be between retail inventory indicators and containerized import growth. From January 2018 through July 2021, there was a relatively strong negative correlation between retail inventory- and import TEU indices with a 4-month lag (corresponding roughly to the time between import orders and -arrival). In the 2020 to 2021 pandemic period the negative correlation was stronger, again with a 4-month lag. These findings suggest that observers might anticipate import surges after marked, nonseasonal drops in retail inventories, and that import surges are likely to last until target inventory levels are restored. In a broader sense, an awareness of the linkages between consumer demand, retail chain responses, and containerized import volumes could better inform port, freight transportation, and government planning and policy choices.

An online questionnaire exploring how recruiting organisations support international nurses and midwives undertake the OSCE and gain UK professional registration

Background: There is an active strategy to recruit international nurses and midwives to help manage vacancy gaps in the United Kingdom's healthcare system. However, there is little evidence detailing how recruiting organisations prepare new recruits for the Objective Structured Clinical Exam (OSCE) they are required to pass.Aims and objectives: To gather and analyse feedback from recruiting organisations on the preparation offered to international nurses and midwives on arrival in the United Kingdom, prior to undertaking an OSCE in order to gain Nursing and Midwifery Council professional registration.Design and methods: An online cross-sectional questionnaire. The data was analysed using thematic analysis.Results: Four main themes were generated from thematic analysis of the qualitative data: SAME IDEAS DIFFERENT PRACTICE; PASSING THE OSCE; INDIVIDUALISED SUPPORT; SUPPORT NETWORKS.Conclusion: Differences in how organisations prepare and support international nurses and midwives to undertake the OSCE suggest standardised approaches could benefit new recruits.Impact statement: Addressing an evidence gap, this research suggests recruits may benefit from standardised support around working and living in the UK.

English Language Medical Schools in China: An Analysis of International Medical Graduates Practicing in the UK

OBJECTIVES

From 2006, the Ministry of Education in China has approved universities to provide undergraduate medical training in English, targeting fee-paying international students. Students on these courses can face challenges in their clinical training, particularly in the domains of communication and professionalism. This study examines the proportion of doctors qualified from such medical schools who are currently listed on the UK medical register.

METHODS

The UK General Medical Council register of medical practitioners was searched to identify doctors qualified from 33 Chinese medical schools who provide education in the English language.

RESULTS

As of February 2022, 502 doctors whose primary medical qualification is from a university offering English language education in China were registered on the UK medical register. Four hundred twenty-five (84.7%) of these doctors were aged 39 and under, approximately double the proportion of doctors in this age bracket overall. Three hundred forty nine (69.5%) were staff grade and associate specialist doctors, 109 (21.7%) were doctors in training, 36 (7.2%) were on the General Practitioner (GP) register, and 20 (4.0%) were on the specialist register. Among doctors in training, the most common specialty areas were in general practice and psychiatry that are both facing recruitment shortages in the UK at present.

CONCLUSION

A small but significant number of graduates whose medical training was in the English language in China are practicing medicine in the UK. These doctors are in younger age groups than the overall medical workforce, and are less likely to be in training, and specialist or GP posts. Among those in training, a high proportion are in GP and psychiatry training and could contribute to alleviating UK medical workforce shortages. Policymakers and educators should be mindful of the growing numbers of doctors qualified from these schools, and the additional support they may require considering the unique training environments they have encountered.

Characteristics of Successful International Pharmacy Partnerships

Recommendations for global pharmacy collaborations are predominately derived from US institutions. This study utilized semi-structured interviews of global collaborators to assess important partnership components. Interviewees stated personal connections and understanding of each other's programs/systems were key components. Additionally, collaborators indicate that mutual benefits between partners can exist without the requirement for bidirectional exchange of learning experiences, and request and value partners and learners who are culturally aware, global citizens. This structured interview approach provided key insight into how to develop mutually beneficial, sustainable partnerships and provides additional confirmation that the five pillars of global engagement align with an international audience.

Investigating the role of residential migration history on the relationship between attachment and sense of belonging: A SEM approach

With the rate of both domestic and international migration steadily increasing, the psychological impact of residential migration remains largely unexplored. Attachment, the emotional bond we establish with those close to us, and sense of belonging, the feeling of connectedness to a community, may be vulnerable to frequent migration. This study investigates the association between individuals' early attachment style, sense of belonging, and migration history. A large international sample (N = 465) aged between 18 and 50 years old (M = 21.85; SD = 4.48), completed a survey on early attachment primary attachment style questionnaire (PASQ), sense of belonging (SOBI), and migration. Results comparing non-movers (n = 240) to domestic movers (n = 52), international movers (n = 109), and domestic-international movers (n = 64), indicate important group differences related to early attachment and its relationship to one's sense of belonging. Moreover, insecure attachment was associated with increased migration early in life and, more in general, predictive of a negative sense of belonging later in life. Implications for both research and practice are discussed.

Project Optimus, an FDA initiative: Considerations for cancer drug development internationally, from an academic perspective

Modern cancer therapeutics are increasingly targeted, bringing the promise of new and improved activity, alongside better tolerability. However, while many are indeed resulting in dramatic improvements in disease control and patient survival, short- and long-term tolerability has not always accompanied it. The choice of dose and schedule is often in the upper range of the therapeutic window, driven by the maximum tolerated dose (MTD) model of previous cytotoxic agents. There is increasing recognition that this needs to change, by taking a more holistic approach to determine the optimal dose for desired biological effects and tolerability early in clinical development. In the US, the FDA's Oncology Centre of Excellence is addressing this via the Project Optimus initiative: aiming to reform dose optimisation studies so that they can demonstrate the most appropriate dose selection. Early clinical development will need to demonstrate the dose-exposure, -pharmacodynamic, -toxicity and -activity relationships, including randomised evaluations for dose selection. Regulatory agencies outside the US are similarly exploring this. Along with Australia, Brazil, Canada, Israel, Singapore and Switzerland, the UK participates in Project Orbis, a collaborative program with the FDA to accelerate patient access to new cancer medicines through coordinated regulatory review. Close alignment with Project Optimus will be important internationally and will require changes across industry, including for academic units and small biotech. We discuss our perspective on the implications, and opportunities, for early phase oncology trials as a uniquely charity-funded drug development facility, the Centre for Drug Development within the Cancer Research UK charity.

USA Suicides Compared to Other Western Countries in the 21st Century: Is there a Relationship with Gun Ownership?

OBJECTIVES

Causes of suicide are complex indicating a nation's psycho-socio-economic well-being hence this population-based study explores whether USA suicides worsened compared to nineteen Other Western Countries (OWC) being possibly related to gun ownership in the 21st Century.

METHODS

Total suicide data are drawn from the latest WHO Age-Standardised-Death-Rates per million (pm) controlled for age, sex, and population, along with suicides in the five age- bands 15-34 years to 75 + years. National gun ownership data from the international Small Arms Survey. Chi-square tests any significant difference between American and OWC suicides during the century. Spearman Rank Order correlations are used to determine comparability of suicides and gun ownership per thousand person rates over the period 2000-15.

RESULTS

USA had the highest gun ownership, treble the rate of the next highest country. American Total suicides rose 27%, significantly more than eight other countries (p < 0.05). The USA had significantly worse suicide outcomes for Older (75+) people than three OWC; eleven for Mature Adults 55-74; eight for Adults 34-54 and for ten countries for Young Adults 15-34. Young Adult suicides numbered 12,438, 6,702 gun-related in 2015, exceeding recent USA military losses. Only Young Adult suicides positively correlated with gun ownership (<0.025).

CONCLUSIONS

The key finding is whilst most countries reduced suicides American rates rose substantially this century, raising questions about US society. Importantly the easy access to firearms in the USA makes Young Adult suicide more likely when facing psycho-social stress. This study exposes the vulnerability of distressed young American adults in a permissive gun culture, with its sequel, life-long grieving parents.HighlightsDuring 21st Century USA suicides rose substantially more than other Western nations.Only USA suicides rose >20% amongst Total suicides and in those aged 15-to-74years.USA Young Adult suicides 150,099 in 21st century, 12,438 in 2015, 6,702 were gun-related.

Impacts of learning experiences within an online extension initiative on application of research-based principles by beef stakeholders

The objective of this study was to evaluate, characterize and quantify the learning experiences and subsequent application of research-based technologies by beef producers upon conclusion of an online extension certification program (44 Farms International Beef Cattle Academy, IBCA). Upon conclusion of the program, paricipants were invited to complete a structured interview. Interview transcripts (n = 19) were coded, categorized, and merged into four overarching themes: Strengths, Struggles, Courses, and Geographical origin. Within Strengths, the most frequent codes were Connections, Application, and Instructor Experience, with 61, 53, and 50 coded segments respectively. Within Struggles, the most frequent codes were Time Management, Level of Knowledge, and Language issues, with 27, 18, and 15 coded segments, respectively. For Courses in the program, the most frequently mentioned were Nutrition, Reproduction, and Genetics, with 35, 28, and 24 coded segments respectively. Correlation between codes was evaluated using Pearson and only statistically significant (P ≤ 0.05) correlations were included in the matrices for network analysis. Interpretation of the generated network analysis map (P ≤ 0.05; Q = 0.468) including all four categories of codes revealed close relationships between Application and the Strengths of Time management, Instructor Experience, and Connections. Application was also directly related to the Courses of Reproduction and Genetics, and the Struggle of Student Engagement and Guidance. Geographical origin was an important factor mediating different correlations. Developing countries (Brazil, Panama, Dominican Republic, and South Africa) were more closely related to the Struggle of Tuition cost, which, in turn was related to the perceived Prestige of the program. In Europe (Romania, Germany, and Kazakhstan), a stronger correlation to the Struggles of Material Relevance and Language Issues was described. Collectively, these results support the positive impact of a comprehensive and interactive extension initiative to leverage application of research-based principles by beef stakeholders around the world. Further, these outcomes indicate that the most valued aspects of the program regarding application are related to interpersonal experience with faculty and peers of the industry (Instructor Experience and Connections) and that perception of struggles and strengths is greatly influenced by socio-cultural aspects of the learning community.

Human papillomavirus and Chinese international students in the United States: attitudes, knowledge, vaccination trends, healthcare behaviors, and sexual activity

Human papillomavirus (HPV) is the most common sexually transmitted infection in the world, with the ability to cause external genital warts and cancers. The HPV vaccine, first released in the United States of America (USA) in 2006, has been shown to protect against the highest risk HPV strains responsible for the majority of HPV-related cancers. In mainland China, the HPV vaccine was only recently approved in 2016 and is therefore not readily available. As a result, Chinese international students (CIS) studying in the USA continue to have low HPV vaccination rates. This study completed in person and online surveying of 396 CIS at a large Southern California university, with the goal of better understanding CIS knowledge and awareness of HPV disease, vaccination and healthcare behaviors, and sexual activity. Among participants, the reported HPV vaccination rate was 61% (females: 85%; males: 32%). HPV vaccination was significantly correlated with a past visit to the on-campus student health center, having university-sponsored student health insurance, higher self-perceived HPV knowledge, and increased willingness to pay for vaccination. A large portion of participants portrayed low levels of sexual activity, which suggests that CIS can take advantage of catch-up HPV vaccination recommendations through 26 years of age. The results of this study can be used to inform policy initiatives, particularly at the campus level, that attempt to improve HPV vaccination rates amongst CIS.

International oncology drug approvals for multiregional or single-country clinical trials: A systematic review

Background

Cancer remains one of the most common causes of morbidity and mortality worldwide. Multiregional (MRCTs) and single-country clinical trials are two common approaches to support new oncology drug approvals internationally. However, systematic reviews comparing MRCTs with single-country trials for international oncology drug approval are lacking.

Methods

We searched health agency websites to retrieve all approved oncology drugs from 2010 to 2022. ClinicalTrials.gov was used to retrieve all pivotal study information. We used an adapted version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) and Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) checklist to assess the risk-of-bias in randomized and non-randomized trials, respectively.

Results

A total of 48 new drugs and biologics (comprising 215 pivotal clinical trials) with initial marketing approval in the United States, European Union, Japan, and China were included. The reporting quality of MRCTs vs. single-country studies was similar. The median time interval for approval was significantly longer for MRCTs than for single-country bridging studies (1,399 vs. 975 days, P < 0.0001), whereas the median time interval for approval was shorter for MRCTs than for single-country standalone studies. The time gap for oncology drugs approved before 2015 was significantly longer than for those approved after 2015. The median timeline for approval in MRCTs involving 3 regions showed the shortest time-to-approval compared with MRCTs involving 4-5 and 1-2 regions. There was no significant difference in the time-to-approval among different tumor types and product types.

Conclusion

The median time-to-approval of MRCTs was significantly longer than that of single-country bridging studies but shorter than that of single-country standalone studies, primarily involving 3 regions as the most frequent pattern and the shortest time-to-approval to operate MRCTs as a pivotal trial. Single-country bridging studies still provide essential supplements for international oncology drug approvals if MRCTs do not apply. Future studies should explore how to shorten the time-to-approval for MRCTs.

Systematic review registration

[https://www.researchregistry.com/browsethe-registry#registryofsystematicreviewsmeta-analyses/], identifier [1390].

Towards Levelling the Playing Field for Prospective Overseas Applicants to Medical Schools in the United Kingdom

Many factors are taken into consideration when students apply to pursue medicine in the United Kingdom. For overseas applicants, the tuition fees of the medical course are a significant factor, particularly for those from lower socioeconomic backgrounds. The reasons why the fees in some medical schools are significantly higher than in others are unclear. Transparency on the use of the tuition fees as well as providing overseas medical students, which now include European students post-Brexit, with more financial support in their studies would be imperative. This is to ensure students are able to choose their medical schools based on more important factors such as the student-curriculum fit.

How can advance care planning support hope in patients with advanced cancer and their families: A qualitative study as part of the international ACTION trial

OBJECTIVE

Clinicians' fears of taking away patients' hope is one of the barriers to advance care planning (ACP). Research on how ACP supports hope is scarce. We have taken up the challenge to specify ways in which ACP conversations may potentially support hope.

METHODS

In an international qualitative study, we explored ACP experiences of patients with advanced cancer and their personal representatives (PRs) within the cluster-randomised control ACTION trial. Using deductive analysis of data obtained in interviews following the ACP conversations, this substudy reports on a theme of hope. A latent thematic analysis was performed on segments of text relevant to answer the research question.

RESULTS

Twenty patients with advanced cancer and 17 PRs from Italy, the Netherlands, Slovenia, and the United Kingdom were participating in post-ACP interviews. Three themes reflecting elements that provide grounds for hope were constructed. ACP potentially supports hope by being (I) a meaningful activity that embraces uncertainties and difficulties; (II) an action towards an aware and empowered position; (III) an act of mutual care anchored in commitments.

CONCLUSION

Our findings on various potentially hope supporting elements of ACP conversations provide a constructive way of thinking about hope in relation to ACP that could inform practice.