Further understanding the interaction between dark energy and dark matter: current status and future directions

The interaction between dark matter and dark energy (DE) can be incorporated into field theory models of DE that have proved successful in alleviating the coincidence problem. We review recent advances in this field, including new models and constraints from different astronomical data sets. We show that interactions are allowed by observations and can reduce the current tensions among different measurements of cosmological parameters. We extend our discussion to include constraints from non-linear effects and results from cosmological simulations. Finally, we discuss forthcoming multi-messenger data from current and future observational facilities that will help to improve our understanding of the interactions within the dark sector.

State of the art of the literature on definitions of self-criticism: a meta-review

Background

Several authors have developed important theoretical models on an important transdiagnostic factor in psychopathology: self-criticism (SC). Currently, there are substantial variations in the theoretical definition of SC. The lack of awareness of similarities and differences between models may in turn impact the comparison between empirical results, limiting their clinical implications.

Purpose

The purpose of this study was to identify current trends in the field of SC and to explore whether these were approached and shaped by different conceptualizations of SC.

Methods

Core components of the most influential models of SC were identified. A meta-review was conducted searching for systematic reviews and/or meta-analyses in the following databases: PsycINFO, PsycARTICLES, MEDLINE, Scopus, Web of Science, and PubMed (all years up to 28 April 2023).

Results

Contributions were heterogeneous with respect to the definition of SC and the theoretical framework. Almost all systematic reviews poorly addressed the multidimensionality of SC. In addition, discrepancies between the definitions of SC provided and their operationalizations emerged.

Conclusions

The lack of dialogue between the different theoretical perspectives emerged from key contributions in the field of SC. Potential research questions to answer to stimulate this dialogue are proposed.

Enhancing patient-centred care in dentistry: a narrative review

INTRODUCTION

Patient-centred care (PCC) is widely used within the medical setting, but there is a need for more research on PCC implementation in dentistry.

SOURCES OF DATA

A narrative review was conducted with literature identified from the Ovid Interface, including several databases such as Embase and Medline.

AREAS OF AGREEMENT

PCC is associated with better health outcomes for patients, and greater work satisfaction among healthcare professionals.

AREAS OF CONTROVERSY

Efforts to implement PCC in dentistry are lacking due to several issues including non-consensus about PCC definition and lack of explicit guidelines on how to implement PCC in dentistry.

GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH

A theory-derived model of PCC explicitly designed for the dental setting was identified. This serves as a starting point to enhance PCC in dentistry, though further research is needed to empirically test the implementation of this model.

New Function of Metal-Organic Framework: Structurally Ordered Metal Promoter

The remarkable roles of metal promoters have been known for nearly a century, but it is still a challenge to find a suitable structure model to reveal the action mechanism behind metal promoters. Herein, a new function of metal-organic frameworks (MOFs) is developed as an ideal model to construct structurally ordered metal promoters by a targeted post-modification strategy. MOFs as model not only favor clearing the real action mechanism behind metal promoters, but also can anchor one or multiple kinds of metal promoters especially noble metal promoters. Typically, the as-prepared Pd/bpy-UiO-Cu catalysts show high selectivity (>99%) toward 4-nitrophenylethane in 4-nitrostyrene hydrogenation, mainly due to the enhanced interaction between Pd nanoparticles and MOF carriers induced by Cu promoters, thus inhibiting the hydrogenation of 4-nitrophenylethane. This strategy with flexibility and universality will open up a new route to synthesize efficient catalysts with structurally ordered metal promoters.

Developing a single-session strategy for the implementation of take-home naloxone by community pharmacists using COM-B and design-thinking

Background

Despite the overwhelming evidence of its effectiveness, there is poor implementation of take-home naloxone by pharmacists. Barriers have been explored and mapped to the capability, opportunity, motivation-behaviour (COM-B) model of behaviour change, yet no theoretically informed implementation strategies that target known barriers have been developed. Single-session implementation strategies have been proposed as a simple, scalable way to target multiple barriers.

Methods

Qualitative participatory methods, incorporating design-thinking principles, were used to develop the key messages of a single-session implementation strategy. The key messages were drafted against COM-B mapped implementation barriers identified in the literature. A participatory workshop involving a pre-mortem exercise and incorporating design-thinking principles were used to refine the messages and generate methods for dissemination. Messages were mapped to interview questions to naturally illicit stories and delivered via storytelling from a pharmacist, a general practitioner, and a person with lived experience of using naloxone.

Results

A 3 minute 40 second video and a two-page printable infographic were developed and hosted on a website, with links to additional downloadable resources as a single-session implementation strategy. Email was the preferred method for receiving simple professional development communications, with social media also widely accessed.

Discussion

Implementation science, behavioural change theory, and participatory design methods are a complementary combination to develop implementation strategies. Some pharmacists questioned the participatory design approach to developing an implementation strategy, as it was outside of their comfort zone. However, the participatory process involving end-users resulted in unique ideas that are unlikely to have been generated using more traditional consultative approaches. The delivery as a single-session implementation strategy allows for widespread dissemination and delivery at scale.

Approach to theoretical perspectives of "sexual harassment": review and bibliometric analysis from social sciences

The main goal of this paper is to give an overlook of the current state of sexual harassment. In order to do so, we started making a synthesis of the main theoretical approaches to explain sexual harassment, trying to group the studies into different currents that have historically analyzed this type of violence, to see whether the bibliometric analysis shows a similar presence of the different approaches. To carry out the bibliographic analysis we extracted the documents from the Scopus databases (using the keyword "sexual harassment" up to the year 2021 in the field of social sciences), where after these texts were examined with the tool VOSviewer. A description was made of the evolution of the number of articles on sexual harassment and within the areas of research and, also, the coincidences of keywords and co-authorships, highlighting the nationality and the main authors in number of citations. The results show a growth in interest in researching sexual harassment, specifically after the allegations against producer Harvey Weinstein and the #metoo movement. In the keyword analysis, there is a trend towards studies focused on the work environment and with a gender perspective. Finally, in the cluster analysis of the authorship of the texts, the results suggest the different theoretical approaches most used in the analysis of sexual harassment: socio-cultural, organizational, and multi-dimensional.

Wetting-State-Induced Turning of Water Droplet Moving Direction on the Surface

The spontaneous directional movement of water droplets on a wedge-shaped groove has gained extensive attention due to the advantage of not requiring energy input and its potential wide applications. However, manipulating the direction of movement of water droplets on a wedge-shaped groove has been not fully achieved, and the fundamental understanding of its underlying mechanism remains unclear. Here, molecular dynamics simulations and theoretical analyses are combined to reveal the mechanism of movement in opposite directions of a water droplet at the same position on the wedge-shaped groove interface. It is shown that the moving direction of the water droplet is related to its wetting state on the surface, i.e., the Wenzel and the Cassie states. A water droplet initially in the Wenzel and Cassie states will move toward the diverging and the converging ends, respectively. This phenomenon is attributed to the opposite roles played by the groove substrate and the upper layers in the two wetting states. Moreover, it is found that the water droplet is likely to move faster on a surface with a higher groove, larger opening angle and stronger hydrophobicity. These findings are expected to be of benefit for fully understanding droplet movement and shedding light on the regulation of the direction of movement of the droplets on the groove surface.

A profile of practice: The occupational therapy process in community aged care in Australia

INTRODUCTION

Occupational therapists working in community aged care play a key role in service provision because of their expertise in considering the person, their occupations, and environmental context. To further understand occupational therapy practice in community aged care, this study aimed to explore the approaches, models, frames of reference, assessments, interventions, and outcome evaluation methods being used by Australian occupational therapists in aged care.

METHODS

An online questionnaire was developed, piloted, and delivered to occupational therapists working in community aged care in Australia. Responses to closed-ended questions were analysed using descriptive statistics, and a summative approach to content analysis was applied to open-ended questions.

RESULTS

Seventy-one occupational therapists employed in community aged care across Australia participated in the questionnaire. Almost half of the respondents were employed in private practice. All respondents used a compensatory approach to practice, whereas just over three-quarters used a restorative approach. The Person-Environment-Occupation (PEO) model was the most frequently used occupation-focused model (n = 45). The biomechanical and rehabilitative frames of reference were each used by over two thirds of respondents. Cognitive assessments were most common, followed by functional and environmental assessments. The interventions of equipment and home modifications were very common followed by remedial therapy.

CONCLUSION

Community aged care occupational therapists show coherence in theory-to-practice application, but there is wide diversity in practice decisions and possibly gaps in practice. Occupational therapists remain firmly client centred but apply compensatory approaches more than reablement approaches. This trend may be due to the influence of aged care funding models and limits on time. In addition to reacting to crisis, there is scope for occupational therapists to have a greater focus on early intervention to support dementia care and prevent falls.

Challenges in operationalizing conceptual models in aetiological research

Conceptual or theoretical models are crucial in developing causal hypotheses and interpreting study findings, but they have been underused and misused in aetiological research, particularly in dentistry and oral epidemiology. Good models should incorporate updated evidence and clarify knowledge gaps to derive logical hypotheses. Developing models and deriving testable hypotheses in operational models can be challenging, as seen in the four examples referred to in this commentary. One challenge concerns the theoretical validity of the model, while another relates to difficulties in operationalizing abstract concepts. A third challenge refers to the lack of sufficient information in the dataset to test partially or even the whole model. Finally, a common challenge is the application of a conceptual model to different contexts. Among the existing methodological approaches to operationalize conceptual models, causal graphs may be helpful, especially when combined with approaches from diverse disciplinary fields via triangulation.

Proposal for an Integrative Cognitive-Emotional Conception of ADHD

Although numerous efforts have been made to deepen our understanding of the etiology of Attention Deficit Hyperactivity Disorder (ADHD), no explanation of its origins, nor of its consequences, has yet found a consensus within the scientific community. This study performs a theoretical review of various research studies and provides a reflection on the role of emotions in the origin of the disorder, at the neuroanatomical and functional level. To this end, theoretical models (single and multiple origin) and applied studies are reviewed in order to broaden the perspective on the relevance of the executive system in ADHD; it is suggested that this construct is not only composed and activated by cognitive processes and functions, but also includes elements of an emotional and motivational nature. Consequently, it is shown that ADHD is involved in social development and in a person's ability to adapt to the environment.

Medical informatics and climate change: a framework for modeling green healthcare solutions

Objective

The aim of this study was to develop a theory-based framework to enhance and accelerate development, selection, and implementation of solutions mitigating the climate impact of healthcare organizations.

Materials and Methods

Existing frameworks were combined to develop the Green-MIssion (Medical Informatics Solutions) framework. It was further developed and refined by mapping solutions from project plans and reviewing it with an expert panel.

Results

The framework classifies solutions into three categories: (1) monitor and measure environmental impact of a healthcare setting; (2) help create and increase awareness among employees and patients; and (3) interventions to reduce environmental impacts.

Discussion and Conclusion

The framework combines concepts from healthcare information technology and environmental sciences and can be used to structure green medical informatics solutions for different healthcare settings. Furthermore, research should evaluate its application for measuring and assessing the impact of green medical informatics solutions on environmental sustainability and climate resilience.

A comparison of conceptual frameworks to examine health inequities in End-of-Life care

AIMS

To discuss existing conceptual frameworks that can be applied to the examination of health inequities in end-of-life care and related health outcomes. We used the Fawcett and Desanto-Madeya evaluation technique modified by the National Institute on Minority Health and Health Disparities Research Framework to include individual, interpersonal, community, and societal levels of influence.

DESIGN

Discussion paper.

DATA SOURCES

We performed a systematic review of PubMed, CINAHL and Embase for conceptual frameworks of health inequities in end-of-life care and health outcomes published as of February 2022.

IMPLICATIONS FOR NURSING

There is a strong need for research that can address multiple factors influencing end-of-life care inequities and health outcomes. To mitigate the complex nature of social determinants of health and structural inequities, researchers, clinicians, educators and administrators should have solid conceptualizations of these multi-level factors. Based on sound and comprehensive frameworks, nurses with interdisciplinary partnerships can promote health equity with a broader health care scope through addressing social determinants of health.

CONCLUSION

We identified and reviewed three frameworks. We concluded all three frameworks have the potential for use in the examination of health inequities in end-of-life care and health outcomes. However, the Conceptual Framework of Minority Access to End-of-Life Care was more applicable to diverse studies and settings when adapted to include fundamental characteristics such as sex and gender.

IMPACT

Despite the substantial rise in end-of-life care delivery, health inequities persist in end-of-life care access and utilization. Though some studies have been conducted to promote health equity by addressing social determinants of health, progress is hampered by their complex and multi-faceted nature. Through a concrete conceptual framework, researchers can comprehensively examine multi-level factors influencing health inequities in end-of-life care.

NO PATIENT OR PUBLIC CONTRIBUTION

This discussion paper focused on reviewing existing evidence.

Psychedelic-Assisted Psychotherapy-A Systematic Review of Associated Psychological Interventions

Modern clinical research on psychedelics is generating interesting outcomes in a wide array of clinical conditions when psychedelic-assisted psychotherapy is delivered to appropriately screened participants and in controlled settings. Still, a number of patients relapse or are less responsive to such treatments. Individual and contextual factors (i.e., set and setting) seem to play a role in shaping the psychedelic experience and in determining clinical outcomes. These findings, coupled with data from literature on the effectiveness of psychotherapy, frame the therapeutic context as a potential moderator of clinical efficacy, highlighting the need to investigate how to functionally employ environmental and relational factors. In this review, we performed a structured search through two databases (i.e., PubMed/Medline and Scopus) to identify records of clinical studies on psychedelics which used and described a structured associated psychotherapeutic intervention. The aim is to construct a picture of what models of psychedelic-assisted psychotherapy are currently adopted in clinical research and to report on their clinical outcomes. Ad-hoc and adapted therapeutic methods were identified. Common principles, points of divergence and future directions are highlighted and discussed with special attention toward therapeutic stance, degree of directiveness and the potential suggestive effects of information provided to patients.

High-Efficiency Capture of Cells by Softening Cell Membrane

The capture of circulating tumor cells (CTCs) by nanostructured substrate surface is a useful method for early diagnosis of cancer. At present, most methods used to improve the cell capture efficiency are based on changing substrate surface properties. However, there are still some gaps between these methods and practical applications. Here, a method is presented for improving cell capture efficiency from a different perspective, that is, changing the properties of the cells. Concretely, the mechanical properties of the cell membrane are changed by adding Cytochalasin D to soften the cell membrane. Furthermore, a corresponding theoretical model is proposed to explain the experimental results. It is found that cell softening can reduce the resistance of cell adhesion, which makes the adhesion ability stronger. The high-efficiency capture of cells by softening the cell membrane provides a potential method to improve the detection performance of CTCs.

Jute Fiber-Reinforced Polymer Tube-Confined Sisal Fiber-Reinforced Recycled Aggregate Concrete Waste

In this study, the compressive performance of sisal fiber-reinforced recycled aggregate concrete (SFRAC) composite, confined with jute fiber-reinforced polymer (JFRP) tube (the structure was termed as JFRP-SFRAC) was assessed. A total of 36 cylindrical specimens were tested under uniaxial compression. Three major experimental variables were investigated: (1) the compressive strength of concrete core (i.e., 25.0 MPa and 32.5 MPa), (2) jute fiber orientation angle with respect to the hoop direction of a JFRP tube (i.e., β = 0°, 30° and 45°), and (3) the reinforcement of sisal fiber (i.e., 0% and 0.3% by mass of cement). This study revealed that the prefabricated JFRP tube resulted in a significant enhancement of the compressive strength and deformation ability of RAC and SFRAC. The enhancements in strength and ultimate strain of the composite columns were more pronounced for concrete with a higher strength. The strength and ultimate strain of JFRP-confined specimens decreased with an increase in fiber orientation angle β from 0° to 45°. The sisal fiber reinforcement effectively improved the integrity of the RAC and reduced the propagation of cracks in RAC. The stress-strain behaviors of JFRP-RAC and JFRP-SFRAC were predicted by the Lam and Teng's model with the revised ultimate condition equations.

An unbiased test reveals no enrichment of sexually antagonistic polymorphisms on the human X chromosome

Mutations with beneficial effects in one sex can have deleterious effects in the other. Such 'sexually antagonistic' (SA) variants contribute to variation in life-history traits and overall fitness, yet their genomic distribution is poorly resolved. Theory predicts that SA variants could be enriched on the X chromosome or autosomes, yet current empirical tests face two formidable challenges: (i) identifying SA selection in genomic data is difficult; and (ii) metrics of SA variation show persistent biases towards the X, even when SA variants are randomly distributed across the genome. Here, we present an unbiased test of the theory that SA variants are enriched on the X. We first develop models for reproductive F_ST-a metric for quantifying sex-differential (including SA) effects of genetic variants on lifetime reproductive success-that control for X-linked biases. Comparing data from approximately 250 000 UK Biobank individuals to our models, we find F_ST elevations consistent with both X-linked and autosomal SA polymorphisms affecting reproductive success in humans. However, the extent of F_ST elevations does not differ from a model in which SA polymorphisms are randomly distributed across the genome. We argue that the polygenic nature of SA variation, along with sex asymmetries in SA effects, might render X-linked enrichment of SA polymorphisms unlikely.

Reference theories and future perspectives on robot-assisted rehabilitation in people with neurological conditions: A scoping review and recommendations from the Italian Consensus Conference on Robotics in Neurorehabilitation (CICERONE)

BACKGROUND

Robot-based treatments are developing in neurorehabilitation settings. Recently, the Italian National Health Systems recognized robot-based rehabilitation as a refundable service. Thus, the Italian neurorehabilitation community promoted a national consensus on this topic.

OBJECTIVE

To conceptualize undisclosed perspectives for research and applications of robotics for neurorehabilitation, based on a qualitative synthesis of reference theoretical models.

METHODS

A scoping review was carried out based on a specific question from the consensus Jury. A foreground search strategy was developed on theoretical models (context) of robot-based rehabilitation (exposure), in neurological patients (population). PubMed and EMBASE® databases were searched and studies on theoretical models of motor control, neurobiology of recovery, human-robot interaction and economic sustainability were included, while experimental studies not aimed to investigate theoretical frameworks, or considering prosthetics, were excluded.

RESULTS

Overall, 3699 records were screened and finally 9 papers included according to inclusion and exclusion criteria. According to the population investigated, structured information on theoretical models and indications for future research was summarized in a synoptic table.

CONCLUSION

The main indication from the Italian consensus on robotics in neurorehabilitation is the priority to design research studies aimed to investigate the role of robotic and electromechanical devices in promoting neuroplasticity.

An innovative General Practice based Pharmacy Longitudinal Clerkship: using theory to characterise its development, implementation and initial evaluation

BACKGROUND

Longitudinal Integrated Clerkships exist in undergraduate medicine courses. A pilot Pharmacy Longitudinal Clerkship (pPLC) was funded to investigate delivery of this model of clinical education for student pharmacists.

OBJECTIVE(S)

To investigate the development, implementation and initial evaluation of a pPLC.

METHODS

The 11-week pPLC was delivered to two students in two GP practices in Scotland. Mixed theory-based methods were used to gather information on the pPLC structures and processes required and qualitative semi-structured Theoretical Domains Framework (TDF) based interviews explored outcomes with key stakeholders. Informed written consent was obtained. Interviews were audio-recorded, transcribed verbatim and analysed thematically. University Ethics approval was granted.

RESULTS

Data were generated on resources and processes required for a pPLC including funds budgeted for and actually spent on staffing, student travel/subsistence and student clinical 'Kit Bags', learning outcomes, curriculum and training timetable, GP Practice/University contracts. Interviews were completed with the two students, three linked GP clinical supervisors and two Regional Tutors involved. The seven themes were identified and mapped to seven TDF domains including: increased levels of student confidence, and increased student enthusiasm for a career in pharmacy, need for definition of the role of the Regional Tutor for the PLC and GP positivity towards the expected outcomes of clerkship model versus traditional placements.

CONCLUSION

Findings are limited by the small number of participants and settings, but evaluation was positive and the work garnered information on requirements for resources and processes. This will inform 'roll out' of the PLC.

Molecular Modeling and Bioinformatics Analysis of Drug-Receptor Interactions in the System Formed by Glargine, Its Metabolite M1, the Insulin Receptor, and the IGF1 Receptor

Introduction

Insulin and insulin-like growth factor type 1 (IGF1) regulate multiple physiological functions by acting on the insulin receptor (IR) and insulin-like growth factor type 1 receptor (IGF1R). The insulin analog glargine differs from insulin in three residues (Gly^A21, Arg^B31, Arg^B32), and it is converted to metabolite M1 (lacks residues Arg^B31 and Arg^B32) by in vivo processing. It is known that activation of these receptors modulates pathways related to metabolism, cell division, and growth. Though, the structures and structural basis of the glargine interaction with these receptors are not known.

Aim

To generate predictive structural models, and to analyze the drug/receptor interactions in the system formed by glargine, its metabolite M1, IR, and IGF1R by using bioinformatics tools.

Methods

Ligand/receptor models were built by homology modeling using SWISSMODEL, and surface interactions were analyzed using Discovery Studio® Visualizer. Target and hetero target sequences and appropriate template structures were used for modeling.

Results

Our glargine/IR and metabolite M1/IR models showed an overall symmetric T-shaped conformation and full occupancy with four ligand molecules. The glargine/IR model revealed that the glargine residues Arg^B31 and Arg^B32 fit in a hydrophilic region formed by the α-chain C-terminal helix (αCT) and the cysteine-rich region (CR) domain of this receptor, close to the CR residues Arg270-Arg271-Gln272 and αCT residue Arg717. Regarding IGF1R, homologous ligand/receptor models were further built assuming that the receptor is in a symmetrical T-shaped conformation and is fully occupied with four ligand molecules, similar to what we described for IR. Our glargine/IGF1R model showed the interaction of the glargine residues Arg^B31 and Arg^B32 with Glu264 and Glu305 in the CR domain of IGF1R.

Conclusion

Using bioinformatics tools and predictive modeling, our study provides a better understanding of the glargine/receptor interactions.

Factors associated with the utilization of community assessment models among Japanese nurses

OBJECTIVES

This study aimed to identify factors related to the practical utilization of community health needs assessment (CHNA) models that public health nurses (PHNs) learned in their fundamental education.

DESIGN

A nationwide questionnaire survey was conducted via postal mail.

SAMPLE

We randomly selected 630 public health institutes in Japan. The participants were 3397 full-time novice and mid-level PHNs.

MEASUREMENTS

The questionnaire included the participants' basic personal information, six items regarding the perception of CHNA with a 4-point Likert scale, learned models in their undergraduate education, their utilization in practical settings, and the reasons for their answer in narrative form.

RESULTS

There were 951 valid responses. The results of logistic regression showed that the significant positively factors with model utilization were perception of CHNA as "not troublesome" or "not impossible as they learned," continuing education with 5 years of experience, and identification of the learned model in continuing education. Furthermore, the results of text mining showed the reasons for non-utilization of the model included being "busy" and having a lack of "opportunity."

CONCLUSIONS

This study showed the associated factors with rare utilization of a learned model for PHNs. These findings may suggest improvement of continuing education and development of an appropriate assessment model.

Mixed Micellization and Spectroscopic Studies of Anti-Allergic Drug and Non-Ionic Surfactant in the Presence of Ionic Liquid

In drug delivery, surfactants are used to reduce side effects and to increase drug efficiency. The present work aimed to study the interaction of diphenhydramine hydrochloride (anti-allergic drug) with TX–45 (non-ionic surfactant) in the absence and presence of ionic liquid (1-hexyl-3-methylimidazolium chloride). The physicochemical parameters were estimated by the surface tension measurement. Various theoretical models (Clint, Rubingh, Motomura, and Maeda) were applied to determine the attractive behavior between drug and surfactant mixtures at the surface and in bulk. The drug and surfactant mixtures exhibit synergistic behavior in the absence and presence of ionic liquid. Several energetic parameters were also estimated with the assistance of regular solution approximation and pseudo phase separation model that indicate micelle formation and adsorption of surfactant at the surface is thermodynamically advantageous. The morphology of pure and mixture of amphiphiles has been estimated by the Tanford and Israelachvili theories. UV-visible spectroscopy was used to quantify the attractive behavior of the drug with surfactant with the help of a binding constant (K).

Optimal management of patients with operable pancreatic head cancer: A Markov decision analysis

INTRODUCTION

Neoadjuvant therapy (NAT) is an emerging strategy for operable pancreatic ductal adenocarcinoma (PDAC). While NAT increases multimodal therapy completion, it risks functional decline and treatment dropout. We used decision analysis to determine optimal management of localized PDAC and consider risks faced by elderly patients.

METHODS

A Markov cohort decision analysis model evaluated treatment options for a 60-year-old patient with resectable PDAC: (1) upfront pancreaticoduodenectomy or (2) NAT. One-way and probabilistic sensitivity analyses were performed. A subanalysis considered the scenario of a 75-year-old patient.

RESULTS

For the base case, NAT offered an incremental survival gain of 4.6 months compared with SF (overall survival: 26.3 vs. 21.7 months). In one-way sensitivity analyses, findings were sensitive to recurrence-free survival for NAT patients undergoing adjuvant, probability of completing NAT, and probability of being resectable at exploration after NAT. On probabilistic analysis, NAT was favored in a majority of trials (97%) with a median survival benefit of 5.1 months. In altering the base case for the 75-year-old scenario, NAT had a survival benefit of 3.8 months.

CONCLUSIONS

This analysis demonstrates a significant benefit to NAT in patients with localized PDAC. This benefit persists even in the elderly cohort.

How Should Cancer Models Be Constructed?

Choosing and optimizing treatment strategies for cancer requires capturing its complex dynamics sufficiently well for understanding but without being overwhelmed. Mathematical models are essential to achieve this understanding, and we discuss the challenge of choosing the right level of complexity to address the full range of tumor complexity from growth, the generation of tumor heterogeneity, and interactions within tumors and with treatments and the tumor microenvironment. We discuss the differences between conceptual and descriptive models, and compare the use of predator-prey models, evolutionary game theory, and dynamic precision medicine approaches in the face of uncertainty about mechanisms and parameter values. Although there is of course no one-size-fits-all approach, we conclude that broad and flexible thinking about cancer, based on combined modeling approaches, will play a key role in finding creative and improved treatments.

Structural Disorder and Collective Behavior of Two-Dimensional Magnetic Nanostructures

Structural disorder has been shown to be responsible for profound changes of the interaction-energy landscapes and collective dynamics of two-dimensional (2D) magnetic nanostructures. Weakly-disordered 2D ensembles have a few particularly stable magnetic configurations with large basins of attraction from which the higher-energy metastable configurations are separated by only small downward barriers. In contrast, strongly-disordered ensembles have rough energy landscapes with a large number of low-energy local minima separated by relatively large energy barriers. Consequently, the former show good-structure-seeker behavior with an unhindered relaxation dynamics that is funnelled towards the global minimum, whereas the latter show a time evolution involving multiple time scales and trapping which is reminiscent of glasses. Although these general trends have been clearly established, a detailed assessment of the extent of these effects in specific nanostructure realizations remains elusive. The present study quantifies the disorder-induced changes in the interaction-energy landscape of two-dimensional dipole-coupled magnetic nanoparticles as a function of the magnetic configuration of the ensembles. Representative examples of weakly-disordered square-lattice arrangements, showing good structure-seeker behavior, and of strongly-disordered arrangements, showing spin-glass-like behavior, are considered. The topology of the kinetic networks of metastable magnetic configurations is analyzed. The consequences of disorder on the morphology of the interaction-energy landscapes are revealed by contrasting the corresponding disconnectivity graphs. The correlations between the characteristics of the energy landscapes and the Markovian dynamics of the various magnetic nanostructures are quantified by calculating the field-free relaxation time evolution after either magnetic saturation or thermal quenching and by comparing them with the corresponding averages over a large number of structural arrangements. Common trends and system-specific features are identified and discussed.

Digitization and health inequality and equity in nursing

Background: The use of information and communication technologies (ICT) in health care is increasing attention. To describe health inequalities and equity with regard to the use of digital health technologies in a care context and to understand interrelationships, it is of particular importance for the field of care research to use models and theories that explain health inequalities and equity in the use of digital technologies. Aims: This article aims to identify models and theories from the field of nursing and health research that explain the phenomenon of health inequalities and the influence of digital health technologies on the emergence of inequalities. Methods: Relevant articles were searched in electronic databases (MEDLINE, CINAHL & SocINDEX) between July and August 2019 in German and English, within the methodological framework of a scoping review. The systematic literature search and data extraction were performed by 2 reviewers. The description of data refers to standard criteria by 8-1Christiansen and Baum (1997). Results: From a total of 25 relevant articles, 2 were identified for inclusion in the current overview. One model is focusing on ICT for health and the other model focuses on eHealth. No nursing theory could be identified in the context of describing the phenomenon of digital inequality. Conclusions: In both models, there is a lack of discussion about the impact of nursing aspects on the use and acceptance of eHealth technologies. One point should also be the development of models and theories that consider the user perspective of vulnerable groups.

Responding to the ECHO trial results: modelling the potential impact of changing contraceptive method mix on HIV and reproductive health in South Africa

INTRODUCTION

Some observational data suggest that the progestogen injectable contraceptive depot medroxyprogesterone acetate (DMPA) may increase a woman's risk of HIV acquisition but a randomized clinical trial did not find a statistically significant increase in HIV risk for women using DMPA compared to two other methods. However, it could not rule out up to 30% increased HIV risk for DMPA users. We evaluate changes to contraceptive method mix in South Africa under different assumptions about the existence and strength of a possible undetected relationship between DMPA use and HIV risk.

METHODS

A mathematical model was developed to simulate the ongoing HIV epidemic and contraceptive method mix in South Africa to estimate how changes in method mix could impact HIV- and reproductive health-related outcomes. We made different assumptions about the relationship between DMPA use and HIV risk, from no relationship to a 30% increase in HIV risk for women using DMPA. Scenario analyses were used to investigate the impact of switching away from DMPA predominance to new patterns of contraceptive use.

RESULTS

In South Africa, the HIV-related benefits of reduced DMPA use could be as great as the harms of increased adverse reproductive health outcomes over 20 years, if DMPA did increase the risk of HIV acquisition by a relative hazard of infection of 1.1 or greater. A reduction in DMPA use among HIV-positive women would have no benefit in terms of HIV infections, but would incur additional negative reproductive health outcomes. The most important driver of adverse reproductive health outcomes is the proportion of women who switch away from DMPA to no contraceptive method.

CONCLUSIONS

If there is any real increased HIV risk for DMPA users that has not been detected by the recent randomized trial, a reduction in DMPA use could reduce the ongoing number of new HIV infections. However, such a change would place more women at risk of adverse reproductive health effects. It is imperative that these effects are minimized by focusing on expanding access to safe, effective and acceptable alternative contraceptive methods for all women.

Clinical Decision Support for Traumatic Brain Injury: Identifying a Framework for Practical Model-Based Intracranial Pressure Estimation at Multihour Timescales

BACKGROUND

The clinical mitigation of intracranial hypertension due to traumatic brain injury requires timely knowledge of intracranial pressure to avoid secondary injury or death. Noninvasive intracranial pressure (nICP) estimation that operates sufficiently fast at multihour timescales and requires only common patient measurements is a desirable tool for clinical decision support and improving traumatic brain injury patient outcomes. However, existing model-based nICP estimation methods may be too slow or require data that are not easily obtained.

OBJECTIVE

This work considers short- and real-time nICP estimation at multihour timescales based on arterial blood pressure (ABP) to better inform the ongoing development of practical models with commonly available data.

METHODS

We assess and analyze the effects of two distinct pathways of model development, either by increasing physiological integration using a simple pressure estimation model, or by increasing physiological fidelity using a more complex model. Comparison of the model approaches is performed using a set of quantitative model validation criteria over hour-scale times applied to model nICP estimates in relation to observed ICP.

RESULTS

The simple fully coupled estimation scheme based on windowed regression outperforms a more complex nICP model with prescribed intracranial inflow when pulsatile ABP inflow conditions are provided. We also show that the simple estimation data requirements can be reduced to 1-minute averaged ABP summary data under generic waveform representation.

CONCLUSIONS

Stronger performance of the simple bidirectional model indicates that feedback between the systemic vascular network and nICP estimation scheme is crucial for modeling over long intervals. However, simple model reduction to ABP-only dependence limits its utility in cases involving other brain injuries such as ischemic stroke and subarachnoid hemorrhage. Additional methodologies and considerations needed to overcome these limitations are illustrated and discussed.

Anhedonia, positive affect dysregulation, and risk and maintenance of binge-eating disorder

Low positive affect has been identified as an antecedent of binge-eating episodes among individuals with binge-eating disorder (BED), yet positive affect has received far less attention in eating disorders research than its counterpart, negative affect. In this article, we argue that the low levels of positive affect which occur with anhedonia (i.e., loss of interest or pleasure in activities) may contribute to the onset and maintenance of BED. We introduce a theoretical model in which anhedonia increases the risk for BED through its interrelationships with dysregulated eating and weight gain, and we describe potential direct (e.g., reward-related processes) as well as indirect (e.g., influences on depressive symptoms and physical activity) pathways by which anhedonia may lead to adverse eating- and weight-related outcomes. We also propose a momentary maintenance model in which low positive affect and positive affect dysregulation occurring with anhedonia maintain binge eating directly and indirectly through maladaptive health behaviors, such as decreased physical activity, less healthy eating, and fewer social interactions, which in turn maintain anhedonia. We draw upon outside literature to present evidence that aligns with the proposed risk and maintenance models and conclude by outlining avenues for future research-including methodological/measurement, theoretical, and clinical research directions.

Is the X chromosome a hot spot for sexually antagonistic polymorphisms? Biases in current empirical tests of classical theory

Females and males carry nearly identical genomes, which can constrain the evolution of sexual dimorphism and generate conditions that are favourable for maintaining sexually antagonistic (SA) polymorphisms, in which alleles beneficial for one sex are deleterious for the other. An influential theoretical prediction, by Rice (Rice 1984 Evolution38, 735-742), is that the X chromosome should be a 'hot spot' (i.e. enriched) for SA polymorphisms. While important caveats to Rice's theoretical prediction have since been highlighted (e.g. by Fry (2010) Evolution64, 1510-1516), several empirical studies appear to support it. Here, we show that current tests of Rice's theory-most of which are based on quantitative genetic measures of fitness (co)variance-are frequently biased towards detecting X-linked effects. We show that X-linked genes tend to contribute disproportionately to quantitative genetic patterns of SA fitness variation whether or not the X is enriched for SA polymorphisms. Population genomic approaches for detecting SA loci, including genome-wide association study of fitness and analyses of intersexual FST, are similarly biased towards detecting X-linked effects. In the light of our models, we critically re-evaluate empirical evidence for Rice's theory and discuss prospects for empirically testing it.

Understanding 'Non-genetic' Inheritance: Insights from Molecular-Evolutionary Crosstalk

Understanding the evolutionary and ecological roles of 'non-genetic' inheritance (NGI) is daunting due to the complexity and diversity of epigenetic mechanisms. We draw on insights from molecular and evolutionary biology perspectives to identify three general features of 'non-genetic' inheritance systems: (i) they are functionally interdependent with, rather than separate from, DNA sequence; (ii) precise mechanisms vary phylogenetically and operationally; and (iii) epigenetic elements are probabilistic, interactive regulatory factors and not deterministic 'epialleles' with defined genomic locations and effects. We discuss each of these features and offer recommendations for future empirical and theoretical research that implements a unifying inherited gene regulation (IGR) approach to studies of 'non-genetic' inheritance.

The mass transfer coefficient for oxygen transport from blood to tissue in cerebral cortex

The functioning of cerebral cortex depends on adequate tissue oxygenation. MRI-based techniques allow estimation of blood oxygen levels, tissue perfusion, and oxygen consumption rate (CMRO₂), but do not directly measure partial pressure of oxygen (PO₂) in tissue. To address the estimation of tissue PO₂, the oxygen mass transfer coefficient (KTO₂) is here defined as the CMRO₂ divided by the difference in spatially averaged PO₂ between blood and tissue, and is estimated by analyzing Krogh-cylinder type models. Resistance to radial diffusion of oxygen from microvessels to tissue is distributed within vessels and in the extravascular tissue. The value of KTO₂ is shown to depend strongly on vascular length density and also on microvessel tube hematocrits and diameters, but to be insensitive to blood flow rate and to transient changes in flow or oxygen consumption. Estimated values of KTO₂ are higher than implied by previous studies, implying smaller declines in PO₂ from blood to tissue. Average tissue PO₂ can be estimated from MRI-based measurements as average blood PO₂ minus the product of KTO₂ and CMRO₂. For oxygen consumption rates and vascular densities typical of mouse cortex, the predicted difference between average blood and tissue PO₂ is about 10 mmHg.

On Intersectionality: How Complex Patterns of Discrimination Can Emerge From Simple Stereotypes

Patterns of discrimination are often complex (i.e., multiplicative), with different identities combining to yield especially potent discrimination. For example, Black men are disproportionately stopped by police to a degree that cannot be explained by the simple (i.e., additive) effects of being Black and being male. Researchers often posit corresponding mental representations (e.g., intersectional stereotypes for Black men) to account for these complex outcomes. We suggest that complex discrimination can be explained by simple stereotypes combined with threshold models of behavior-for example, "if someone's threat level seems higher than X, stop that person." Simulations provide proof of this concept. We show how gender-by-race discrimination in both promotions and police stops can be explained by simple stereotypes. We also explore race-by-age discrimination in police stops, in which racial disparities are greater for young adolescents. This work suggests that complex behaviors can sometimes arise from relatively simple cognitions.

International Collaboration and New Research Evidence on Nanda International Terminology

OBJECTIVES

To discuss priorities and possibilities for promoting international collaboration and new research evidence on NANDA International, Inc. (NANDA-I).

METHODS

Theoretical reflection article based on the literature and the authors' opinions on the subject matter, carried out by six research nurses.

CONCLUSIONS

International research collaboration for NANDA-I allows the improvement of research production in an actual clinical setting, especially with multicenter and validation studies, conducted by researchers from different countries. This provides for improved understanding of patients' experiences and may help to produce robust scientific evidence.

IMPLICATIONS FOR NURSING KNOWLEDGE

The generation of new evidence may lead to an increase in NANDA-I visibility and in nurses' understanding of its meaning for clinical practice and for the formulation of diagnostic hypotheses.

Investigation on the Thermal Conductivity of Mineral Oil-Based Alumina/Aluminum Nitride Nanofluids

Al₂O₃/AlN–mineral oil nanofluids were prepared by dispersing commercially available Al₂O₃ and AlN nanoparticles into mineral oil. SEM measurements showed that the average diameter of the Al₂O₃ and AlN nanoparticles was about 55 and 50 nm, respectively. The experiments showed that the thermal conductivity systematically improved as the Al₂O₃ and AlN nanoparticles were introduced into the mineral oil. The thermal conductivity of the mineral oil-based nanofluids increased by 18% with a 1% volume fraction of Al₂O₃ and increased by 7% with a 0.5% volume fraction of AlN. The experimental data were compared with the values that were predicted by four typical thermal conductivity models, and a large disparity was disclosed between the models and the experimental data. After considering the thermal dynamic factors in the Al₂O₃/AlN–mineral oil nanofluids, a universal model is proposed that agrees well with the variation of thermal conductivity of the nanofluids.

Psychobehavioral risk factors for financial hardship and poor functional outcomes in survivors of multiple primary cancers

OBJECTIVE

Survivors of multiple primary cancers (MPC) are at increased risk for poor health outcomes compared with survivors of single cancers. Using an adapted psychobehavioral stress-response model, the study purpose was to identify pathways and individual risk factors associated with poor health outcomes in adults with MPC.

METHODS

Adult MPC survivors (N = 211) with first cancers (stages I-III) diagnosed within 1 to 10 years were recruited via tumor registry. Employing a cross-sectional design, established questionnaires were used to operationalize patient characteristics and theoretical constructs including perceived stress, psychological and behavioral responses, financial hardship, social role function, and physical health. Disease and treatment data were obtained via registry and medical records. Structural equation modeling (SEM) was performed to fit, test, and modify the hypothesized psychobehavioral model.

RESULTS

Following measurement model refinement, an SEM linking self-management behaviors, distress, financial hardship, and functional health demonstrated a good fit: χ² (200, N = 206) = 332.06, P < .01; Tucker-Lewis index (TLI) = .95, comparative fit index (CFI) = .96, standardized root mean residual (SRMR) = .06, root-mean-square error of approximation (RMSEA) = .06. Less use of self-management behaviors predicted higher distress which, in turn, predicted higher financial hardship; higher distress and financial hardship predicted poorer functional health. Several sociodemographic and personal factors predicted self-management behaviors and distress.

CONCLUSIONS

The hypothesized stress-response model was partially supported. Data supported pathways among self-management behaviors, distress, financial hardship, and functional health. Self-management and distress may represent modifiable intervention targets for MPC survivors. High body mass index (BMI), less education, greater neuroticism, and lower social support were associated with less use of self-management behaviors and higher distress and should be further evaluated as potential markers of vulnerability.

Behavior Change for Caries Prevention: Understanding Inconsistent Results

Most applied work on caries prevention acknowledges the role of oral hygiene and dietary control strategies in reducing the prevalence and incidence of caries. What we seldom address, however, is the necessity of initiating and sustaining behaviors that will ensure these strategies are implemented. Virtually every approach to prevention of caries requires the individual to do something, that is, to engage in different behavior. We are continually confronted by the fact that to improve oral health, individuals must behave in new ways. Strategies for achieving better oral health most often have relied on providing information or telling people what they should or should not do. These approaches have not proven highly effective, yet they continue to be the mainstay of efforts to improve oral health. Acknowledging this failure, dental behavioral scientists have turned to the health beliefs model or to other cognitive-behavioral models, with their emphases on relative risks, barriers, and readiness to change. These models help us to conceptualize what people are doing to keep themselves, or their children, orally healthy, but the success of these models has been only marginal, especially among groups where disparities are extreme. In response, increasingly complex models that require attention to social and environmental variables, as well as individual behavior, have been proposed. Acknowledgment of “upstream variables” has become common—especially when working with populations experiencing health disparities, but overcoming upstream influences can appear to require sweeping changes that we often are not in a position to address. Consequently, research only picks away at individual elements of models, seeking the behavioral “magic bullet.” In an effort to elucidate the challenges, this article introduces the construct of overdetermination of behavior and encourages more rigorous documentation of potential determinants, as well as personalized development of behavioral approaches for implementing strategies to improve oral health.

KNOWLEDGE TRANSFER STATEMENT

This article reexamines our inconsistent results in effecting behavior change for better oral health using 2 important psychological constructs: "upstream variables" and the "overdetermination" of behavior.

T-NDX Diagram: Educational Technology Used to Teach Diagnostic Reasoning Based on Nursing Theories

PURPOSE

To describe an educational technology to be applied to the teaching and learning of diagnostic judgment based on nursing theories.

METHODS

A methodological study with 10 stages for the development of educational technology.

FINDINGS

An innovative educational technology is proposed to incorporate theoretical and methodological domains in a V-shaped diagram for the diagnosis judgment.

CONCLUSIONS

The technology is innovative in integrating theory and method in a more comprehensive and original way, considering the philosophies and world views of students throughout the reasoning process.

IMPLICATIONS FOR NURSING PRACTICE

T-NDx Diagram may be useful in enhancing the integration of philosophical and theoretical knowledge and diagnostic judgment, especially for nursing undergraduate students.

Complexity of the Basic Reproduction Number (R0)

The basic reproduction number (R₀), also called the basic reproduction ratio or rate or the basic reproductive rate, is an epidemiologic metric used to describe the contagiousness or transmissibility of infectious agents. R₀ is affected by numerous biological, sociobehavioral, and environmental factors that govern pathogen transmission and, therefore, is usually estimated with various types of complex mathematical models, which make R₀ easily misrepresented, misinterpreted, and misapplied. R₀ is not a biological constant for a pathogen, a rate over time, or a measure of disease severity, and R₀ cannot be modified through vaccination campaigns. R₀ is rarely measured directly, and modeled R₀ values are dependent on model structures and assumptions. Some R₀ values reported in the scientific literature are likely obsolete. R₀ must be estimated, reported, and applied with great caution because this basic metric is far from simple.

Patients' Experience With Opioid Tapering: A Conceptual Model With Recommendations for Clinicians

Clinical guidelines discourage prescribing opioids for chronic pain, but give minimal advice about how to discuss opioid tapering with patients. We conducted focus groups and interviews involving 21 adults with chronic back or neck pain in different stages of opioid tapering. Transcripts were qualitatively analyzed to characterize patients' tapering experiences, build a conceptual model of these experiences, and identify strategies for promoting productive discussions of opioid tapering. Analyses revealed 3 major themes. First, owing to dynamic changes in patients' social relationships, emotional state, and health status, patients' pain and their perceived need for opioids fluctuate daily; this finding may conflict with recommendations to taper by a certain amount each month. Second, tapering requires substantial patient effort across multiple domains of patients' everyday lives; patients discuss this effort superficially, if at all, with clinicians. Third, patients use a variety of strategies to manage the tapering process (eg, keeping an opioid stash, timing opioid consumption based on planned activities). Recommendations for promoting productive tapering discussions include understanding the social and emotional dynamics likely to impact patients' tapering, addressing patient fears, focusing on patients' best interests, providing anticipatory guidance about tapering, and developing an individualized tapering plan that can be adjusted based on patient response. Perspective: This study used interview and focus group data to characterize patients' experiences with opioid tapering and identify communication strategies that are likely to foster productive, patient-centered discussions of opioid tapering. Findings will inform further research on tapering and help primary care clinicians to address this important, often challenging topic.

On the Interplay of the DNA Replication Program and the Intra-S Phase Checkpoint Pathway

DNA replication in eukaryotes is achieved by the activation of multiple replication origins which needs to be precisely coordinated in space and time. This spatio-temporal replication program is regulated by many factors to maintain genome stability, which is frequently threatened through stresses of exogenous or endogenous origin. Intra-S phase checkpoints monitor the integrity of DNA synthesis and are activated when replication forks are stalled. Their activation leads to the stabilization of forks, to the delay of the replication program by the inhibition of late firing origins, and the delay of G2/M phase entry. In some cell cycles during early development these mechanisms are less efficient in order to allow rapid cell divisions. In this article, we will review our current knowledge of how the intra-S phase checkpoint regulates the replication program in budding yeast and metazoan models, including early embryos with rapid S phases. We sum up current models on how the checkpoint can inhibit origin firing in some genomic regions, but allow dormant origin activation in other regions. Finally, we discuss how numerical and theoretical models can be used to connect the multiple different actors into a global process and to extract general rules.

Complexity of the Basic Reproduction Number (R0)

The basic reproduction number (R₀), also called the basic reproduction ratio or rate or the basic reproductive rate, is an epidemiologic metric used to describe the contagiousness or transmissibility of infectious agents. R₀ is affected by numerous biological, sociobehavioral, and environmental factors that govern pathogen transmission and, therefore, is usually estimated with various types of complex mathematical models, which make R₀ easily misrepresented, misinterpreted, and misapplied. R₀ is not a biological constant for a pathogen, a rate over time, or a measure of disease severity, and R₀ cannot be modified through vaccination campaigns. R₀ is rarely measured directly, and modeled R₀ values are dependent on model structures and assumptions. Some R₀ values reported in the scientific literature are likely obsolete. R₀ must be estimated, reported, and applied with great caution because this basic metric is far from simple.

Generating Expectations: What Pediatric Rehabilitation Can Learn From Mental Health Literature

Family-Centered Care (FCC) represents the ideal service delivery approach in pediatric rehabilitation. Nonetheless, implementing FCC as intended in clinical settings continues to be hindered by knowledge gaps. One overlooked gap is our understanding of clients' therapy expectations. This perspective article synthesizes knowledge from the mental health services literature on strategies recommended to service providers for generating transparent and congruent therapy expectations with clients, and applies this knowledge to the pediatric rehabilitation literature, where this topic has been researched significantly less, for the purpose of improving FCC implementation. Dimensions of the Measure of Processes of Care, an assessment tool that measures clients' perceptions of the extent a service is family-centered, inform the organization of therapy expectation-generating strategies: (1) Providing Respectful and Supportive Care (assessing and validating clients' expectations); (2) General and Specific Information (foreshadowing therapy journeys, explaining treatment rationale, and conveying service provider qualifications); (3) Coordinated and Comprehensive Care (socializing clients to roles and reflecting on past socialization); and (4) Enabling and Partnership (applying a negotiation framework and fostering spaces safe to critique). Strategies can help pediatric rehabilitation service providers work with families to reframe unrealistic expectations, establish congruent beliefs supporting effective partnerships, and prevent possible disillusionment with therapy over time.

Perspectives and Experiences with Engaging Youth and Families in Research

Engaging youth with disabilities and families in research is critical in facilitating knowledge utilization to impact processes and outcomes of services and interventions. Organizations such as INVOLVE in the United Kingdom, the Canadian Institutes of Health Research and the Patient-Centered Outcomes Research Institute in the United States advocate for engaging stakeholders in all aspects of the research process. Despite these efforts, there is a need for research to identify best practices and approaches for stakeholder engagement in research as current descriptions around processes are lacking. In this perspective paper, we share our insights and experiences with engaging youth with disabilities and families as members of the research team. We offer considerations and strategies for stakeholder engagement, as well as identify relevant frameworks to facilitate stakeholder engagement in research. We encourage researchers to share and document their experiences with stakeholder engagement in research to provide guidance for others with shared interests. We hope this paper will initiate conversations among researchers about best practices to maximize the full potential of stakeholders' time and input.

Cost-effectiveness of rapid on-site evaluation of the adequacy of FNA cytology samples performed by nonpathologists

BACKGROUND

Rapid on-site evaluation (ROSE) can increase adequacy and reduce needle passes in fine-needle aspiration cytology (FNAC) procedures. However, ROSE increases the cost of FNAC. Costs may be reduced if ROSE is performed by an alternate evaluator (AE), such as a cytotechnologist (CT), endoscopist, or pulmonologist, rather than a cytopathologist (CP). Studies have shown that AEs can perform ROSE with high accuracy but are generally not as accurate as CPs. The objective of this study was to evaluate the impact of AEs on the cost-effectiveness of ROSE.

METHODS

A cost model, based on a mathematical sampling model, was developed. The cost model was used to compare the impact of the evaluator type on overall costs.

RESULTS

CTs were likely to be cost-effective for simple procedures and were unlikely to be cost-effective for only the most complex procedures. The model demonstrated the tradeoff in cost savings from using AEs and the potential costs associated with repeated procedures due to the lower accuracy of AEs.

CONCLUSIONS

The cost-effectiveness of AEs is context-dependent. AEs can be cost-effective even if they are less accurate than CPs. AEs are likely to be cost-effective in most contexts.

A Systematic Review of the Technology Acceptance Model in Health Informatics

BACKGROUND

One common model utilized to understand clinical staff and patients' technology adoption is the technology acceptance model (TAM).

OBJECTIVE

This article reviews published research on TAM use in health information systems development and implementation with regard to application areas and model extensions after its initial introduction.

METHOD

An electronic literature search supplemented by citation searching was conducted on February 2017 of the Web of Science, PubMed, and Scopus databases, yielding a total of 492 references. Upon eliminating duplicates and applying inclusion and exclusion criteria, 134 articles were retained. These articles were appraised and divided into three categories according to research topic: studies using the original TAM, studies using an extended TAM, and acceptance model comparisons including the TAM.

RESULTS

The review identified three main information and communication technology (ICT) application areas for the TAM in health services: telemedicine, electronic health records, and mobile applications. The original TAM was found to have been extended to fit dynamic health service environments by integration of components from theoretical frameworks such as the theory of planned behavior and unified theory of acceptance and use of technology, as well as by adding variables in specific contextual settings. These variables frequently reflected the concepts subjective norm and self-efficacy, but also compatibility, experience, training, anxiety, habit, and facilitators were considered.

CONCLUSION

Telemedicine applications were between 1999 and 2017, the ICT application area most frequently studied using the TAM, implying that acceptance of this technology was a major challenge when exploiting ICT to develop health service organizations during this period. A majority of the reviewed articles reported extensions of the original TAM, suggesting that no optimal TAM version for use in health services has been established. Although the review results indicate a continuous progress, there are still areas that can be expanded and improved to increase the predictive performance of the TAM.

Living in Two Worlds. How 'Jungian' am I?

As a so-called 'Developmental Jungian' the author of this paper was raised bilingual - speaking both psychoanalytic and Jungian languages. Early on in her training an analysand brought a dream which seemed to capture an inherent tension regarding the analyst's role in the analytic relationship. The paper is a personal exploration of the potentially creative nature of this tension through focussing on the dream and the work with the dreamer.

Understanding Two Different Structures in the Dark Stable State of the Oxygen-Evolving Complex of Photosystem II: Applicability of the Jahn-Teller Deformation Formula

Tanaka et al. (J. Am. Chem. Soc., 2017, 139, 1718) recently reported the three-dimensional (3D) structure of the oxygen evolving complex (OEC) of photosystem II (PSII) by X-ray diffraction (XRD) using extremely low X-ray doses of 0.03 and 0.12 MGy. They observed two different 3D structures of the CaMn4O5 cluster with different hydrogen-bonding interactions in the S1 state of OEC keeping the surrounding polypeptide frameworks of PSII the same. Our Jahn-Teller (JT) deformation formula based on large-scale quantum mechanics/molecular mechanics (QM/MM) was applied for these low-dose XRD structures, elucidating important roles of JT effects of the MnIII ion for subtle geometric distortions of the CaMn4O5 cluster in OEC of PSII. The JT deformation formula revealed the similarity between the low-dose XRD and damage-free serial femtosecond X-ray diffraction (SFX) structures of the CaMn4O5 cluster in the dark stable state. The extremely low-dose XRD structures were not damaged by X-ray irradiation. Implications of the present results are discussed in relation to recent SFX results and a blue print for the design of artificial photocatalysts for water oxidation.

A Modified Tri-Exponential Model for Multi-b-value Diffusion-Weighted Imaging: A Method to Detect the Strictly Diffusion-Limited Compartment in Brain

Purpose: To present a new modified tri-exponential model for diffusion-weighted imaging (DWI) to detect the strictly diffusion-limited compartment, and to compare it with the conventional bi- and tri-exponential models.

Methods: Multi-b-value diffusion-weighted imaging (DWI) with 17 b-values up to 8,000 s/mm² were performed on six volunteers. The corrected Akaike information criterions (AICc) and squared predicted errors (SPE) were calculated to compare these three models.

Results: The mean f₀ values were ranging 11.9–18.7% in white matter ROIs and 1.2–2.7% in gray matter ROIs. In all white matter ROIs: the AICcs of the modified tri-exponential model were the lowest (p < 0.05 for five ROIs), indicating the new model has the best fit among these models; the SPEs of the bi-exponential model were the highest (p < 0.05), suggesting the bi-exponential model is unable to predict the signal intensity at ultra-high b-value. The mean ADC_very−slow values were extremely low in white matter (1–7 × 10⁻⁶ mm²/s), but not in gray matter (251–445 × 10⁻⁶ mm²/s), indicating that the conventional tri-exponential model fails to represent a special compartment.

Conclusions: The strictly diffusion-limited compartment may be an important component in white matter. The new model fits better than the other two models, and may provide additional information.