One of the numerous challenges preterm birth poses for parents and physicians is prognostic disclosure. Prognoses are based on scientific evidence and medical experience. They are subject to ...individual assessment and will generally remain uncertain with regard to the individual. This can result in differences in prognostic framing and thus affect the recipients' perception. In neonatology, data on the effects of prognostic framing are scarce. In particular, it is unclear whether parents prefer a more optimistic or a more pessimistic prognostic framing.
To explore parents' preferences concerning prognostic framing and its effects on parent-reported outcomes and experiences. To identify predictors (demographic, psychological) of parents' communication preferences.
Unblinded, randomized controlled crossover trial (RCT) at the Division of Neonatology of the University Medical Center Mainz, Germany, including German-speaking parents or guardians of infants born preterm between 2010 and 2019 with a birth weight < 1500 g. Inclusion of up to 204 families is planned, with possible revision according to a blinded sample size reassessment.
Embedded in an online survey and in pre-specified order, participants will watch two video vignettes depicting a more optimistic vs. a more pessimistic framing in prognostic disclosure to parents of a preterm infant. Apart from prognostic framing, all other aspects of physician-parent communication are standardized in both videos.
At baseline and after each video, participants complete a two-part online questionnaire (baseline and post-intervention). Primary outcome is the preference for either a more optimistic or a more pessimistic prognostic framing. Secondary outcomes include changes in state-anxiety (STAI-SKD), satisfaction with prognostic framing, evaluation of prognosis, future optimism and hope, preparedness for shared decision-making (each assessed using customized questions), and general impression (customized question), professionalism (adapted from GMC Patient Questionnaire) and compassion (Physician Compassion Questionnaire) of the consulting physician.
This RCT will explore parents' preferences concerning prognostic framing and its effects on physician-parent communication. Results may contribute to a better understanding of parental needs in prognostic disclosure and will be instrumental for a broad audience of clinicians, scientists, and ethicists.
German Clinical Trials Register DRKS00024466 . Registered on April 16, 2021.
IntroductionMany psychiatric illnesses have been linked to the gut microbiome, with supplements such as probiotics showing some efficacy in alleviating the symptoms of some psychiatric illnesses. ...Though probiotics alone have been found to be efficacious in alleviating the symptoms of psychiatric illnesses, the combination of probiotics and first-line psychotropic medications has not been investigated as thoroughly.ObjectivesThe primary objective of this review was to evaluate the current literature investigating the effects of adjuvant probiotic or synbiotic administration in combination with first-line psychotropic treatments for psychiatric illnesses.MethodsA systematic search of four databases was conducted using key terms related to treatments for psychiatric illnesses, the gut microbiome, and probiotics. All results were then evaluated based on specific eligibility criteria. The salient outcome measures from the studies that met this eligibility criteria were then extracted and analysed.ResultsEight studies met eligibility criteria and were analysed for reported changes in outcome measures used to assess the symptoms of psychiatric illness and the tolerability of treatment. All Major Depressive Disorder (MDD) (n=5) and Generalized Anxiety Disorder (GAD) (n=1) studies found adjuvant probiotic or synbiotic treatment to be more efficacious in improving the symptoms of psychiatric illness than the first-line treatment alone or with placebo. The schizophrenia studies (n=2) found adjuvant probiotic treatment to have no significant difference in clinical outcomes, but it was found to improve the tolerability of first-line antipsychotics.ConclusionsThe findings of the studies included in this review suggest the use of adjuvant probiotic treatment with selective serotonin reuptake inhibitors (SSRIs) for MDD and GAD to be superior to SSRI treatment alone. Probiotic adjuvant treatment with antipsychotics could be beneficial for improving the tolerability of the antipsychotics, but these findings do not suggest that adjuvant probiotic treatment would result in improved clinical outcomes for symptoms of schizophrenia.Disclosure of InterestNone Declared
Non-consensual intimate image dissemination (NCII), or else better known as “revenge pornography” is a form of technology-facilitated sexual violence that can have devastating effects on the victim. ...This is one of the first studies examining how demographic characteristics (gender, sexual orientation), personality traits (Dark Tetrad), and attitudes (aggrieved entitlement, sexual entitlement, sexual image abuse myth acceptance) predict NCII perpetration and victimization. In a sample of 810 undergraduate students (72.7% female and 23.3% male), 13.7% of the participants had at some point in their life, distributed nude, or sexual pictures of someone else without consent and 28.5% had experienced such victimization. NCII perpetration was predictive of NCII victimization and vice versa. Using binomial logistic regression, we found that women, members of the LGBQ+ community, those scoring higher in sadism, and participants with a history of NCII perpetration were more likely to report that someone had distributed their nude or sexual image without consent. Further, we found that those scoring higher in narcissism and sadism, along with those with a history of NCII victimization were more likely to report they had distributed the nude or sexual image of someone else without consent. Finally, the findings suggest that the relationship between victims and perpetrators is quite a bit more varied than the term “revenge pornography” implies.
Consideration of groundwater is a key element in almost every construction project. The design of deep excavations for basements or underground railway station concourses below the water table ...require that the water pressures are taken into account. Whilst these can be considered to be hydrostatic in soil, the decreasing permeability of rock with depth and the fact that groundwater flow is invariably along discrete fractures means that the water pressure is unlikely to be hydrostatic at depth.
Groundwater control for deep excavations can be achieved by a number of methods such as grouting, pumping or structural walls or a combination of these. For tunnelling projects grouting is extensively used, but the development of sophisticated tunnelling machines has led in many cases to the demise of compressed air as a means of groundwater control.
Psychopathy and Sexual Assault Brown, Shelley L; Forth, Adelle E
Journal of consulting and clinical psychology,
10/1997, Letnik:
65, Številka:
5
Journal Article
Recenzirano
This study compared psychopathic and nonpsychopathic rapists on static risk factors and on emotional and motivational precursors. Sixty incarcerated rapists were assessed for psychopathy with the ...Psychopathy Checklist-Revised (R. D.
Hare, 1991
), and they were classified according to the Massachusetts Treatment Center: Revised Rapist Typology, Version 3 (
R. A. Knight & R. A. Prentky, 1990b
). Psychopathy was positively associated with past nonsexual offenses and negatively associated with age onset for criminal offending, number of sexual victims, and the intensity of negative emotions experienced before sexual offending. However, psychopathy was not related to sexual offense history, age of onset for sexual offending, or victim harm. Last, psychopaths were most likely to be classified as opportunistic and pervasively angry rapists. The findings indicate that psychopathy should be considered when developing intervention strategies for rapists.
To assess the efficacy and safety of golimumab + methotrexate (MTX) in Japanese patients with active rheumatoid arthritis (RA).
269 Japanese patients with active RA despite treatment with MTX were ...randomised (1:1:1) to placebo + MTX (Group 1), golimumab 50 mg + MTX (Group 2) or golimumab 100 mg + MTX (Group 3). Subcutaneous golimumab/placebo was injected every 4 weeks; stable doses of oral MTX (6-8 mg/week) were continued. Patients were allowed to enter early escape (Group 1 added golimumab 50 mg, Group 2 increased golimumab to 100 mg, Group 3 continued golimumab 100 mg) based on swollen/tender joint counts at week 14. The primary study endpoint was achievement of at least 20% improvement in the American College of Rheumatology (ACR20) response criteria at week 14. To control for multiplicity of testing, treatment group comparisons were first made between combined Groups 2 and 3 versus Group 1, followed by comparisons of Group 2 and Group 3 versus Group 1.
The proportion of patients with an ACR20 response at week 14 was significantly higher in combined Groups 2 and 3 (73.4%, 127/173) and in each of Group 2 (72.1%, 62/86) and Group 3 (74.7%, 65/87) compared with Group 1 (27.3%, 24/88; p<0.0001 for all comparisons). Golimumab + MTX also elicited a significantly better response than placebo + MTX in other efficacy parameters, including disease activity score (DAS28) response/remission and radiographic assessments. During the 16-week fixed treatment regimen study period, 72.7%, 75.6% and 78.2% of patients had adverse events and 1.1%, 1.2% and 2.3% had serious adverse events in Groups 1, 2 and 3, respectively.
In Japanese patients with active RA despite MTX therapy, golimumab + MTX was significantly more effective than MTX monotherapy in reducing RA signs/symptoms and limiting radiographic progression with no unexpected safety concerns.
Although cyberflashing (the unsolicited sending of nude or sexual images) is common, it is typically met with a negative reaction from the receiver. This discrepancy could be interpreted as evidence ...that the cyberflasher is either unaware of the non-enthusiastic response to their image or that they enjoy making the receiver uncomfortable. To date, little research has examined the reasons behind cyberflashing, especially for sending sexual images that are not genital pictures from cisgender men (i.e., “dick pics”). In this study, we examined desire for power and control, partner hunting, personal/sexual gratification, and transactional mindset as reasons for cyberflashing and explored how gender, sexual orientation, expected responses from the receiver, and dark personality traits predicted each cyberflashing reason among those who report a history of sending unsolicited nude or sexual images. Among our sample of 816 undergraduate students (72.0% women; 81.4% heterosexual), 41.8% reported having sent an unsolicited nude or sexual image. Among cyberflashers, partner hunting was the most commonly reported reason to cyberflash (64.3%). When examining the predictors of each cyberflashing reason, expecting an affirming response, and not expecting a non-affirming response were significant for all four reasons among the cyberflashers in our sample. Moreover, higher sadism scores predicted endorsing transactional mindset, whereas higher psychopathy scores predicted power and control. Finally, identifying as a woman predicted endorsing partner hunting and personal/sexual gratification as a cyberflashing reason. Our results highlight the nuance and contradictions of the reasons behind cyberflashing, expand our understanding of the practice, and underscore the importance of education on consent in online sexual interactions.
•We examined reasons for the sending of unsolicited nude or sexual images.•Partner hunting was the most common reason for cyberflashing.•Power and control was the least common reason for cyberflashing.•Psychopathy was predictive of power and control and sadism of transactional mindset.•Being a woman was predictive of personal/sexual gratification and partner hunting.
In the neonatal intensive care unit, there is a lack of understanding about how best to communicate the prognosis of a serious complication to parents.
To examine parental preferences and the effects ...of optimistic vs pessimistic message framing when providing prognostic information about a serious complication.
This crossover randomized clinical trial was conducted at a single German university medical center between June and October 2021. Eligible participants were parents of surviving preterm infants with a birth weight under 1500 g. Data were analyzed between October 2021 and August 2022.
Alternating exposure to 2 scripted video vignettes showing a standardized conversation between a neonatologist and parents, portrayed by professional actors, about the prognosis of a hypothetical very preterm infant with severe intraventricular hemorrhage. The video vignettes differed in the framing of identical numerical outcome estimates as either probability of survival and probability of nonimpairment (optimistic framing) or a risk of death and impaired survival (pessimistic framing).
The primary outcome was preference odds (ratio of preference for optimistic vs pessimistic framing). Secondary outcomes included state anxiety, perceptions of communication, and recall of numerical estimates.
Of 220 enrolled parents (142 64.5% mothers; mean SD age: mothers, 39.1 5.6 years; fathers, 42.7 6.9 years), 196 (89.1%) preferred optimistic and 24 (10.1%) preferred pessimistic framing (preference odds, 11.0; 95% CI, 6.28-19.10; P < .001). Preference for optimistic framing was more pronounced when presented second than when presented first (preference odds, 5.41; 95% CI, 1.77-16.48; P = .003). State anxiety scores were similar in both groups at baseline (mean difference, -0.34; -1.18 to 0.49; P = .42) and increased equally after the first video (mean difference, -0.55; 95% CI, -1.79 to 0.69; P = .39). After the second video, state anxiety scores decreased when optimistic framing followed pessimistic framing but remained unchanged when pessimistic framing followed optimistic framing (mean difference, 2.15; 95% CI, 0.91 to 3.39; P < .001). With optimistic framing, participants recalled numerical estimates more accurately for survival (odds ratio, 4.00; 95% CI, 1.64-9.79; P = .002) but not for impairment (odds ratio, 1.50; 95% CI, 0.85-2.63; P = .16).
When given prognostic information about a serious complication, parents of very preterm infants may prefer optimistic framing. Optimistic framing may lead to more realistic expectations for survival, but not for impairment.
German Clinical Trials Register (DRKS): DRKS00024466.
The COVID-19 pandemic has catalyzed the development of online learning formats in virtually all areas of medical education. In pediatric ethics, online learning may not only substitute but also offer ...specific advantages over traditional classroom teaching. Many pediatricians rate their ethics education as poor and medical ethics education lacks evaluation, especially regarding the students' needs. The aim of this project was to implement and evaluate a novel interactive distance learning approach to engage medical students in pediatric ethics education.
An online ethics course was designed and delivered between May and June 2020. Core item of this course was a moderated, written forum discussion spanning several days. Evaluation was mixed methods. We evaluated the effectiveness of the course in terms of quality of the learning environment with a particular focus on relevance to students as well as interactive learning and reflective thinking. The Constructivist On-Line Learning Environment Survey (COLLES) was used to evaluate six different domains of the course. Data are presented as mean (standard deviation SD). The respective score range is 1-5, whereby a score of 4 or 5 means that the participants indicated the corresponding item as frequently or almost always present.
Responses were available from 104 (78.3%) of the 133 participating students. "Relevance" yielded a score of 4.17 (0.83), "reflective thinking" a score of 4.22 (0.83). "Interactivity" was scored 3.76 (0.99) and "tutor support" 4.72 (0.53). "Peer support" and "interpretation" scored 3.87 (0.98) and 4.49 (0.60), respectively. In qualitative analysis, students particularly valued the structure of the course, the relevance for their professional practice, their active participation and the incentive to reflective thinking. Students also indicated that this was an innovative and exciting format, which fills a current educational gap and should hence be continued beyond the pandemic.
In conclusion, students actively engaged in online learning and perceived this ethics course as highly relevant for their professional practice.
The Mad package described here facilitates the evaluation of first derivatives of multidimensional functions that are defined by computer codes written in MATLAB. The underlying algorithm is the ...well-known forward mode of automatic differentiation implemented via operator overloading on variables of the class fmad. The main distinguishing feature of this MATLAB implementation is the separation of the linear combination of derivative vectors into a separate derivative vector class derivvec. This allows for the straightforward performance optimization of the overall package. Additionally, by internally using a matrix (two-dimensional) representation of arbitrary dimension directional derivatives, we may utilize MATLAB's sparse matrix class to propagate sparse directional derivatives for MATLAB code which uses arbitrary dimension arrays. On several examples, the package is shown to be more efficient than Verma's ADMAT package Verma 1998a.
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