Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users (...) about potentially dangerous blood glucose trends, which can often be shared with ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D. (shrink)

BackgroundComorbidity between diabetes mellitus and depression is highly prevalent. The risk of depression in a person with diabetes is approximately twice that of a person without this disease. Depression has a major impact on patient well-being and control of diabetes. However, despite the availability of effective and specific therapeutic interventions for the treatment of depression in people with diabetes, 50% of patients do not receive psychological treatment due to insufficient and difficult accessibility to psychological therapies (...) in health systems. The use of information and communication technologies has therefore been proposed as a useful tool for the delivery of psychological interventions, but it continues to be a field in which scientific evidence is recent and controversial. This systematic review aims to update the available information on the efficacy of psychological interventions delivered through ICTs to improve depressive symptomatology in patients with diabetes.MethodsA systematic review of the literature was performed following the PRISMA guidelines and using MEDLINE, Embase, PubMed, Web of Science, PsycINFO, Scopus, and Cochrane Library databases to search for randomized clinical trials of eHealth treatments for patients with diabetes and comorbid depression from 1995 through 2020. In addition, studies related to follow-up appointments were identified. Inclusion criteria were as follows: randomized clinical trials ; patients with type 1 and type 2 diabetes; adult population over 18 years of age; presence of depressive symptomatology assessed with standardized instruments; treatments for depression based on established psychotherapeutic techniques and principles; delivered through eHealth technologies. We did not limit severity of depressive symptomatology, delivery setting or comparison group. Two coauthors independently reviewed the publications identified for inclusion and extracted data from the included studies. A third reviewer was involved to discuss discrepancies found. The PEDro scale was used to assess the quality of the RCTs. No meta-analysis of the results was performed. The protocol used for this review is available in PROSPERO.ResultsThe initial search identified 427 relevant scientific publications. After removing duplicates and ineligible citations, a total of 201 articles were analyzed in full text. Ten articles met the criteria of this review and were included, obtaining very good scientific quality after evaluation with the PEDro scale. The main results show that the eHealth psychological intervention for depression in patients with diabetes showed beneficial effects both at the end of treatment and in the short and long term for the improvement of depressive symptomatology. The methodology used was very heterogeneous. However, all studies were based on cognitive-behavioral tools and used standardized assessment instruments to evaluate depressive symptomatology or diagnosis of MDD. Glycemic control was assessed by glycosylated hemoglobin, but no benefits were found in improving glycemic control. Only four studies included psychoeducational content on diabetes and depression, but none used tools to improve or enhance adherence to medical prescriptions or diabetes self-care.ConclusionsICT-based psychological interventions for the treatment of depression in people with diabetes appear to be effective in reducing depressive symptomatology but do not appear to provide significant results with regard to glycemic control. Nonetheless, the scientific evidence reported to date is still very limited and the methodology very diverse. In addition, no studies have implemented these systems in routine clinical practice, and no studies are available on the economic analysis of these interventions. Future research should focus on studying and including new tools to ensure improvements in diabetes outcomes and not only on psychological well-being in order to advance knowledge about these treatments. Economic evaluations should also be undertaken to analyze whether these treatment programs implemented using eHealth technologies are cost-effective. (shrink)

Objective: To systematically analyze the effects of art therapy on the levels of depression, anxiety, blood glucose, and glycated hemoglobin in diabetic patients.Methods: We searched Cochrane Library, PubMed, Embase, and ClinicalTrials.gov databases from inception to January 24, 2021. The language of publication was limited to English. Randomized controlled trials that used art therapy to improve mental disorders in diabetic patients were involved. After selection of eligible studies, data were extracted, including the first author's full-name, year of publication, the (...) first author's country of residence, number of intervention and control groups, the mean age of participants, method of intervention, duration of follow-up, and outcome measures. Assessment of quality of the included studies and data extraction were independently carried out by two researchers. RevMan 5.3 software was used to perform statistical analysis.Results: A total of 396 samples from five studies were included, and the eligible studies were RCTs with a parallel design. Methods of art therapy included music therapy and painting therapy. The results showed that compared with the control group, art therapy could positively affect the levels of depression [standardized mean difference, −1.36; 95% confidence interval, ; P < 0.00001] and blood glucose in diabetic patients [mean difference, −0.90; 95% CI, ; P < 0.0001], while it had no influence on the levels of anxiety [SMD, −0.31; 95% CI, ; P = 0.32] and glycated hemoglobin [MD, 0.22; 95% CI, ; P = 0.07].Conclusion: Art therapy may have significant effects on the levels of depression and blood glucose for diabetic patients. (shrink)

Forecasting blood glucose values for patients can help prevent hypoglycemia and hyperglycemia events in advance. To this end, this study proposes an intelligent ensemble deep learning system to predict BG values in 15, 30, and 60 min prediction horizons based on historical BG values collected via continuous glucose monitoring devices as an endogenous factor and carbohydrate intake and insulin administration information as exogenous factors. Although there are numerous deep learning algorithms available, this study applied five (...) algorithms, namely, recurrent neural network, which is optimized for sequence data, and RNN-based algorithms, stacked LSTM, bidirectional LSTM, and gated recurrent unit). Then, a genetic algorithm was applied to the five prediction models to optimize their weights through ensemble techniques and to yield the final predicted BG values. The performance of the proposed model was compared to that of the autoregressive integrated moving average model as a baseline. The results show that the proposed model significantly outperforms the baseline in terms of the root mean square error and continuous glucose error grid analysis. For the valid 29 diabetic patients for the multivariate models, the RMSE was 11.08, 19.25, and 31.30 mg/DL for 15, 30, and 60 min PH, respectively. When the same data were applied to univariate models, the RMSE was 11.28, 19.99, and 33.13 mg/DL for 15, 30, and 60 min PH, respectively. Both the univariate and multivariate models showed a statistically significant difference compared with the baseline at a 5% statistical significance level. Instead of using a model with a single algorithm, applying a GA based on each output of a model with multiple algorithms was found to play a significant role in improving model performance. (shrink)

PurposeCodes of ethics are important instruments in journalism, as they promote transparency and self-regulation of media, in addition to monitoring the quality of information. The purpose of this paper is to analyse the perceptions that Spanish journalists have of the effectiveness of codes of ethics and to evaluate the different personal and professional variables which condition this vision.Design/methodology/approachThe methodology used in the present study is based on quantitative content analysis using the survey technique. This technique makes (...) it possible to obtain empirical data on various key aspects of the profession that are determining factors in ascertaining Spanish journalists’ views of one of the instruments of accountability that is external to the media: general ethical codes.FindingsThe results show that Spanish journalists are largely confident in the effectiveness of ethical codes in their profession. Likewise, it was seen that variables such as age, professional experience or the media with which they work influence the perceptions that professionals have of such instruments.Originality/valueIf understanding journalism as a profession whose mission is to guarantee the citizens their right to information, then it is essential to be familiar with the tools provided by the profession itself to be accountable to the public regarding this professional mission. Hence the importance of instruments of accountability and the perceptions of the professionals themselves regarding their effectiveness. (shrink)

Diabetes self-management is a crucial part in the management of diabetic patients. Most randomized controlled clinical trials reported significant benefits by diabetes self-management education on DSM behaviors and metabolic control. Although the randomized clinical trials are the gold standard method in assessing the effectiveness of any intervention, including DSME interventions, the outcomes of these studies may reflect exaggerated effects; because in most of these studies, subjects in control group receive usual care with no any DSME. (...) The lack of such education in the control group had many drawbacks: make blindness impossible; at which non blinded studies may result in false-positive findings; it may be unethical to recruit patients for participation in DSME studies as control subjects, most of these studies with long periods of follow up, without any direct benefit to them during the study period; the lack of direct benefit to control subjects in any clinical trial may results in high attrition rate. The high attrition rate in clinical trials especially in the control group can lower the statistical power of the study results; thus, the DSME program would appear to have positive effects even if the program had no real benefit. This problem of the DSME exaggerated effects can be solved partially through providing control subjects with education about some DSM behaviors or comparing the effect of DSME through different educational approaches. (shrink)

Most clinical neurofeedback studies based on functional magnetic resonance imaging use the patient's own neural activity as feedback. The objective of this study was to create a subject-independent brain state classifier as part of a real-time fMRI neurofeedback system that can guide patients with depression in achieving a healthy brain state, and then to examine subsequent clinical changes. In a first step, a brain classifier based on a support vector machine was trained from the neural information of happy (...) autobiographical imagery and motor imagery blocks received from a healthy female participant during an MRI session. In the second step, 7 right-handed female patients with mild or moderate depressive symptoms were trained to match their own neural activity with the neural activity corresponding to the “happiness emotional brain state” of the healthy participant. The training was carried out using the rt-fMRI NF system guided by the brain-state classifier we had created. Thus, the informative voxels previously obtained in the first step, using SVM classification and Effect Mapping, were used to classify the Blood-Oxygen-Level Dependent activity of the patients and converted into real-time visual feedback during the neurofeedback training runs. Improvements in the classifier accuracy toward the end of the training were observed in all the patients [Session 4–1 Median = 6.563%; Range = 4.10–27.34; Wilcoxon Test, 2-tailed p = 0.031]. Clinical improvement also was observed in a blind standardized clinical evaluation [HDRS CE2-1 Median = 7; Range 2 to 15; Wilcoxon Test, 2-tailed p = 0.016], and in self-report assessments [BDI-II CE2-1 Median = 8; Range 1–15; Wilcoxon Test, 2-tailed p = 0.031]. In addition, the clinical improvement was still present 10 days after the intervention [BDI-II CE3-2_Median = 0; Range −1 to 2; Wilcoxon Test, 2-tailed p = 0.50/ HDRS CE3-2 Median = 0; Range −1 to 2; Wilcoxon Test, 2-tailed p = 0.625]. Although the number of participants needs to be increased and a control group included to confirm these findings, the results suggest a novel option for neural modulation and clinical alleviation in depression using noninvasive stimulation technologies. (shrink)

We sought to assess formally the extent to which different control and elimination strategies for human African trypanosomiasis Trypanosoma brucei gambiense would exacerbate or alleviate experiences of societal disadvantage that traditional economic evaluation does not take into account. Justice-enhanced cost-effectiveness analysis is a normative approach under development to address social justice considerations in public health decision-making alongside other types of analyses. It aims to assess how public health interventions under analysis in comparative evaluation would be expected (...) to influence the clustering of disadvantage across three core dimensions of well-being: agency, association and respect. As a case study to test the approach, we applied it to five strategies for Gambiense HAT control and elimination, in combination with two different other evaluations: a cost-effectiveness analysis and a probability of elimination analysis. We have demonstrated how JE-CEA highlights the ethical importance of adverse social justice impacts of otherwise attractive options and how it indicates specific modifications to policy options to mitigate such impacts. JE-CEA holds promise as an approach to help decision makers and other stakeholders consider social justice more fully, explicitly and systematically in evaluating public health programs. (shrink)

Human gait is a complex activity that requires high coordination between the central nervous system, the limb, and the musculoskeletal system. More research is needed to understand the latter coordination's complexity in designing better and more effective rehabilitation strategies for gait disorders. Electroencephalogram and functional near-infrared spectroscopy are among the most used technologies for monitoring brain activities due to portability, non-invasiveness, and relatively low cost compared to others. Fusing EEG and fNIRS is a well-known and established methodology (...) proven to enhance brain–computer interface performance in terms of classification accuracy, number of control commands, and response time. Although there has been significant research exploring hybrid BCI involving both EEG and fNIRS for different types of tasks and human activities, human gait remains still underinvestigated. In this article, we aim to shed light on the recent development in the analysis of human gait using a hybrid EEG-fNIRS-based BCI system. The current review has followed guidelines of preferred reporting items for systematic reviews and meta-Analyses during the data collection and selection phase. In this review, we put a particular focus on the commonly used signal processing and machine learning algorithms, as well as survey the potential applications of gait analysis. We distill some of the critical findings of this survey as follows. First, hardware specifications and experimental paradigms should be carefully considered because of their direct impact on the quality of gait assessment. Second, since both modalities, EEG and fNIRS, are sensitive to motion artifacts, instrumental, and physiological noises, there is a quest for more robust and sophisticated signal processing algorithms. Third, hybrid temporal and spatial features, obtained by virtue of fusing EEG and fNIRS and associated with cortical activation, can help better identify the correlation between brain activation and gait. In conclusion, hBCI system is not yet much explored for the lower limb due to its complexity compared to the higher limb. Existing BCI systems for gait monitoring tend to only focus on one modality. We foresee a vast potential in adopting hBCI in gait analysis. Imminent technical breakthroughs are expected using hybrid EEG-fNIRS-based BCI for gait to control assistive devices and Monitor neuro-plasticity in neuro-rehabilitation. However, although those hybrid systems perform well in a controlled experimental environment when it comes to adopting them as a certified medical device in real-life clinical applications, there is still a long way to go. (shrink)

. This paper reports the preliminary results from a semester-long ethics project at an AACSB accredited, regional comprehensive undergraduate school. This project culminated in an Ethics Awareness Week, which highlight a case study of the controversial EverQuest® multi-player online game. Issues of project planning and design are outlined, the dynamics of a business program-wide approach to ethics are social responsibility are presented, student survey results are presented and analyzed, and issues related to ongoing research are discussed. Nonparametric survey results indicate (...) that the greatest effect in student’s self reported enhanced understanding and interest in issues of business ethics is present when multiple pedagogical methods, e.g., case studies, lectures, assignments, and an Oxford-style debate, are applied by a number of faculty members over an extended time period. The paper concludes with a discussion of future research issues as well as a series of prescriptions for planning, organizing, and implementing such an extended activity. (shrink)

The COVID-19 pandemic has generated an imbalance between the clinical needs of the population and the effective availability of advanced life support (ALS) resources. Triage protocols have thus become necessary. Triage decisions in situations of scarce resources were not extraordinary in the pre-COVID-19 era; these protocols abounded in the context of organ transplantation. However, this prior experience was not considered during the COVID-19 outbreak in Spain. Lacking national guidance or public coordination, each hospital has been forced to put forth (...) independent and autonomous triage protocols, most of which were, nonetheless, based on common ethical principles and clinical criteria. However, controversial, non-clinical criteria have also been defended by Spanish scientific societies and public institutions, including setting an age cut-off value for unilaterally withholding ALS, using ‘social utility’ criteria, prioritising healthcare professionals or using ‘first come, first served’ policies. This paper describes the most common triage criteria used in the Spanish context during the COVID-19 epidemic. We will highlight our missed opportunities by comparing these criteria to those used in organ transplantation protocols. The problems posed by subjective, non-clinical criteria will also be discussed. We hope that this critical review might be of use to countries at earlier stages of the epidemic while we learn from our mistakes. (shrink)

Children and adolescents are not indifferent to the dramatic impact of the COVID-19 pandemic, and the need to be forced to live in confinement. The change in life to which they have been abruptly subjected forces us to understand the state of their mental health in order to adequately address both their present and future needs. The present study was carried out with the intention of studying the consequences of confinement on anxiety, sleep routines and executive functioning of 1,028 children (...) and adolescents, aged from 6 to 18 years, residing in Spain to; assess if there are differences regarding these consequences in terms of sex and age; how anxiety affects executive functioning in males and females; and to examine the possible correlations between the measured variables. For this purpose, an online questionnaire containing five sections was designed: the first section gathers information on sociodemographic and health data, while the following sections gather information from different standardized scales which measure anxiety, sleep and executive functions, whose items were adapted in order to be completed by parents, and/or legal guardians. The statistical analyzes carried out highlights significant differences in executive functioning between males and females. In turn, in regards to age, greater difficulties were detected in anxiety in the 9 to 12 age group and greater sleep disturbances between 13 and 18 year olds. On the other hand, significant differences were found in intra-sexual executive functioning depending on whether they presented greater or lesser anxiety, with executive functioning being more tendentiously maladjusted in males than in females, revealing a significantly relevant effect size. Positive correlations are obtained between state anxiety and sleep and executive functioning alterations. Finally, through Path Analysis, it is verified that state anxiety is the variable with the greatest weight within the model that would explain the alteration in the executive functioning of the present sample. (shrink)

ObjectiveType 2 diabetes mellitus (T2DM) is a high risk of cognitive decline and dementia, but the underlying mechanisms are not yet clearly understood. This study aimed to explore the functional connectivity (FC) and topological properties among whole brain networks and correlations with impaired cognition and distinguish T2DM from healthy controls (HC) to identify potential biomarkers for cognition abnormalities.MethodsA total of 80 T2DM and 55 well-matched HC were recruited in this study. Subjects’ clinical data, neuropsychological tests and resting-state functional (...) magnetic resonance imaging data were acquired. Whole-brain network FC were mapped, the topological characteristics were analyzed using a graph-theoretic approach, the FC and topological characteristics of the network were compared between T2DM and HC using a general linear model, and correlations between networks and clinical and cognitive characteristics were identified. The support vector machine (SVM) model was used to identify differences between T2DM and HC.ResultsIn patients with T2DM, FC was higher in two core regions [precuneus/posterior cingulated cortex (PCC)_1 and later prefrontal cortex_1] in the default mode network and lower in bilateral superior parietal lobes (within dorsal attention network), and decreased between the right medial frontal cortex and left auditory cortex. The FC of the right frontal medial-left auditory cortex was positively correlated with the Montreal Cognitive Assessment scales and negatively correlated with the blood glucose levels. Long-range connectivity between bilateral auditory cortex was missing in the T2DM. The nodal degree centrality and efficiency of PCC were higher in T2DM than in HC (P < 0.005). The nodal degree centrality in the PCC in the SVM model was 97.56% accurate in distinguishing T2DM patients from HC, demonstrating the reliability of the prediction model.ConclusionFunctional abnormalities in the auditory cortex in T2DM may be related to cognitive impairment, such as memory and attention, and nodal degree centrality in the PCC might serve as a potential neuroimaging biomarker to predict and identify T2DM. (shrink)

School physical education has the potential to contribute to public-health promotion and well-being, but oftentimes students' lack of motivation toward PE or physical activity in general, especially during adolescence, diminishes, or eradicates the positive effects associated with PE. Therefore, practical approaches are required that help teachers to increase or awake students intrinsic motivation toward PE, for which self-determination theory may provide the conceptual framework. In that regard, the purpose of the present study was to examine whether the use of (...) real-time, heart rate feedback during regular PE lessons has the potential to increase students' autonomous motivation and physical effort. To achieve this, we had forty healthy adolescents between 16 and 17 years of age run for 30 min either with or without real-time, individualized heart rate feedback during a regular PE class and compared physical and perceived exertion as well as joy of running between the two groups. Participants were randomly assigned to the groups. Our data revealed that participants in the EG enjoyed running more than participants in the CG despite a higher physical and perceived exertion. That means, running with real-time, individualized heart rate feedback apparently increased participants' motivation to run and to enjoy running at higher levels of exertion. In that regard, real-time, individualized activity feedback should be implemented in regular PE classes systematically and repeatedly to create a controllable and attainable situation that allows students to actively adjust their own behavior to achieve appealing and realistic goals. (shrink)

This study examines whether Chinese complement coercion sentences with aspectual verbs will elicit processing difficulty during real-time comprehension. Complement coercion is a linguistic phenomenon in which certain verbs, requiring an event-denoting complement, are combined with an entity-denoting complement, as in The author started a book. Previous studies have reported that the entity-denoting complement elicited processing difficulty following verbs that require event argument compared with verbs that do not. While the processing of complement coercion has been extensively studied (...) in Indo-European languages such as English and German, it is relatively under-researched in Sino-Tibetan languages such as Mandarin Chinese. Given the fact that there are many linguistic elements behaving distinctly in the different language families, for instance, verbs with respect to their semantic properties and syntactic representations of the complement, it is meaningful to investigate whether or not the existing linguistic differences have any effect on the processing of complement coercion in Mandarin. With this research goal, we recorded self-paced reading time of 61 native Mandarin speakers to investigate the processing of the entity-denoting complement in sentences with three different verb types, as exemplified in 顾客开始/填写/查看这份问卷 gù-kè kāi-shǐ/tián-xiě/chá-kàn zhè-fèn wèn-juàn “The customer started/filled in/checked the questionnaire.” It was found that the entity noun complement elicited significantly longer reading times in coercion sentences than non-coercion counterparts. The results are compatible with the previous findings in English that complement coercion sentences impose processing cost during real-time comprehension. The study contributes empirical evidence to coercion studies cross-linguistically. (shrink)

This research concentrates on the design and analysis of an algorithm referred to as Virtual Network Configuration (VNC) which uses predicted future states of a system for faster network configuration and management. VNC is applied to the configuration of a wireless mobile ATM network. VNC is built on techniques from parallel discrete event simulation merged with constraints from real-time systems and applied to mobile ATM configuration and handoff. Configuration in a mobile network is a dynamic and (...) class='Hi'>continuous process. Factors such as load, distance, capacity and topology are all constantly changing in a mobile environment. The VNC algorithm anticipates configuration changes and speeds the reconfiguration process by pre-computing and caching results. VNC propagates local prediction results throughout the VNC enhanced system. The Global Positioning System is an enabling technology for the use of VNC in mobile networks because it provides location information and accurate time for each node. This research has resulted in well defined structures for the encapsulation of physical processes within Logical Processes and a generic library for enhancing a system with VNC. Enhancing an existing system with VNC is straight forward assuming the existing physical processes do not have side effects. The benefit of prediction is gained at the cost of additional traffic and processing. This research includes an analysis of VNC and suggestions for optimization of the VNC algorithm and its parameters. (shrink)

Pulmonary rehabilitation has demonstrated patients’ physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit. A 12-week community-based PR will be (...) implemented in primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers will compose the experimental group. The control group will include dyads age- and disease-matched willing to collaborate in data collection but not in PR. Patients/family-centred outcomes will be dyspnoea, fatigue, cough and sputum, impact of the disease, emotional state, number of exacerbations, healthcare utilisation, health-related quality of life and family adaptability/cohesion. Other clinical outcomes will be peripheral and respiratory muscle strength, muscle thickness and cross sectional area, exercise capacity, balance and physical activity. Data will be collected at baseline, at 12 weeks, at 3- and 6-months post-PR. Changes in the outcome measures will be compared between groups, after multivariate adjustment for possible confounders, and effect sizes will be calculated. A cost-benefit analysis will be conducted. This study will enhance patients access to PR, by training healthcare professionals in the local primary healthcare centres to conduct such programmes and actively involving caregivers. The cost-benefit analysis of this intervention will provide an evidence-based insight into the economic benefit of community-based PR in chronic respiratory diseases. The trial was registered in the ClinicalTrials. gov U.S. National Library of Medicine, on 10th January, 2019. (shrink)

The strict lockdown experienced in Spain during March–June 2020 as a consequence of the COVID-19 crisis has led to strong negative emotions. Music can contribute to enhancing wellbeing, but the extent of this effect may be modulated by both personal and context-related variables. This study aimed to analyze the impact of the two types of variables on the perceived efficacy of musical behaviors to fulfill adults’ emotional wellbeing-related goals during the lockdown established in Spain. Personal variables included age, (...) gender, musical training, personality, resilience, and perception of music’s importance. Contextual variables referred to living in a region with a high COVID-19 impact, perception of belonging to a risk group, being alone, having caring responsibilities during confinement, and amount of time of music listening as compared to prior to the crisis. The study was conducted retrospectively during August–December 2020, when the strict lockdown was over in Spain. An online survey was disseminated among the general population and groups of musicians, and the answers of 507 adults were analyzed. Only personal, but not COVID-19 context-related variables, showed an impact on music’s efficacy. The youngest age group of adults and those with musical training reported the highest efficacy of music for wellbeing enhancement, and music’s importance was found to be the main significant predictor of music’s perceived efficacy. Our findings suggest that the people who have been reported to be emotionally more vulnerable during the lockdown, due to either a strong impact on their daily lives or their lower resilience, perceive a higher benefit from musical behaviors. Being musically trained, even for a small number of years, also leads to a perception of higher efficacy of music for the achievement of emotional wellbeing goals. However, this effect is explained by the musically trained individuals’ higher perception of music’s importance. Although musical behaviors can be generally considered as important for wellbeing enhancement, our study highlights who are the potential individuals who could benefit the most from music-related activities for obtaining better levels of wellbeing, at least within the current context of the COVID-19 crisis. (shrink)

BackgroundAging and type 2 diabetes mellitus are important risk factors for the development of cognitive deterioration and dementia. The objective of this research was to investigate the effects of an exercise intervention on cognitive function in older T2DM patients.MethodsEight literature databases were searched from inception to 20 January 2022. The researchers examined randomized controlled trials that evaluated the impact of exercise on the cognitive performance of older T2DM patients. The Cochrane risk-of-bias tool for RCTs was used to assess (...) each study. The quality of evidence was assessed using the GRADE approach. The mini-mental state examination, Modified MMSE, and Montreal cognitive assessment were used to evaluate the cognitive outcomes. We performed a subgroup analysis with stratification according to exercise intervention modality, duration, and cognitive impairment.ResultsFive trials were eligible, with a total of 738 T2DM patients. The combined findings revealed that exercise improved global cognitive function significantly. In the studies that were included, no relevant adverse events were reported.ConclusionExercise is beneficial in improving global cognitive function in older adults with T2DM. Studies with bigger sample sizes and higher quality are additionally expected to draw more definite conclusions.Systematic Review Registration[https://www.crd.york.ac.uk/PROSPERO/#recordDetails], identifier [CRD42022296049]. (shrink)

This paper conducts a cost–benefit analysis of Australia’s Covid-19 lockdown strategy relative to pursuit of a mitigation strategy in March 2020. The estimated additional deaths from a mitigation strategy are 11,500 to 40,000, implying a Cost per Quality Adjusted Life Year saved by locking down of at least 11 times the generally employed figure of $100,000 for health interventions in Australia. The lockdowns do not then seem to have been justified by reference to the standard benchmark. Consideration (...) of the information available to the Australian government in March 2020 yields a similar ratio and therefore the same conclusion that lockdown was not warranted. If Australia experiences a new outbreak, and cannot contain it without resort to a nationwide lockdown, the death toll from adopting a mitigation strategy at this point would be even less than had it done so in March 2020, due to the vaccination campaign, lessons learned since March 2020, and because the period over which the virus would then inflict casualties would now be much less than the period from March 2020. This would favour a mitigation policy even more strongly than in March 2020. This approach of assessing the savings in quality adjusted life years and comparing them to a standard benchmark figure ensures that all quality adjusted life years saved by various health interventions are treated equally, which accords with the ethical principle of equity across people. (shrink)

Background The fourth section of the 1967 Abortion Act states that individuals (including health care practitioners) do not have to participate in an abortion if they have a conscientious objection. A conscientious objection is a refusal to participate in abortion on the grounds of conscience. This may be informed by religious, moral, philosophical, ethical, or personal beliefs. Currently, there is very little investigation into the impact of conscientious objection on service users in Britain. The perspectives of service users are imperative (...) in understanding the real-world consequences and potential impact of conscientious objection and should be considered when creating and reviewing policies and guidelines. This research provided a platform for women and those who can become pregnant to share their experiences and opinions at a time when these voices are largely excluded in the great tradition of Western political philosophy and law-making processes. Method Five service users were interviewed using a narrative interview approach to uncover their abortion journeys and experiences of conscientious objection. Findings The findings were presented as found poems and uncovered that doctors are not always: informing service users that they have a conscientious objection to abortion, giving service users enough information to access abortion (indirect referral), treating them non-judgmentally, and providing medically correct information. Service users did not experience burdens such as long waiting times and were still able to access legal abortion. However, service users did experience negative emotional effects, as they were often left feeling scared, angry, and hopeless when they were not referred and/or were mistreated. Conclusions Findings indicate that conscientious objection could work in practice. However, it is currently failing some individuals on an emotional level, as not all doctors are adhering to guidelines. Conscientious objection in Britain needs to be addressed, to ensure service users receive fair, impartial, non-judgmental care. (shrink)

Social entrepreneurship (SE) enables business consolidation, combined with the production of positive impact and improvements in society. Aligned with 2030 Agenda for the achievement of the United Nations Sustainable Development Goals, it is important to clarify the role of social entrepreneurs, as they are making visible the impact of their creative ideas in several areas, from civic engagement to the environment, health and learning. The main purpose of this study is to specify a model of social entrepreneurial intention (SEI) and (...) explore it by country, based on the dimensions of the Theory of Planned Behavior and how these are mediated by spirituality and optimism. With a convenience sample of 1476 Portuguese and Spanish students, Structural Equation Modeling (SEM) was used. For a deeply understanding, variables within the model were compared by country usingt-rest, and multivariate analysis was done by each one separately. The mean comparison between countries, demonstrated that there are differences only between perceived behavioral control (PBC), Spirituality, Optimism and SEI, with Portuguese students scoring the highest values, in all variables except Optimism. A mediation path was carried out, and Spirituality mediate a significant effect between the three TPB dimensions in Portuguese students, but not in students from Spain. Finally, after discussing the results, theoretical and practical contributions are analyzed, with regard to the field of SE in Portugal and Spain, and alternatives are pointed out for a more social and sustainable entrepreneurial future. (shrink)

Tetris provides a difficult, dynamic task environment within which some people are novices and others, after years of work and practice, become extreme experts. Here we study two core skills; namely, choosing the goal or objective function that will maximize performance and a feature-based analysis of the current game board to determine where to place the currently falling zoid so as to maximize the goal. In Study 1, we build cross-entropy reinforcement learning models to determine whether different goals result (...) in different feature weights. Two of these optimization strategies quickly rise to performance plateaus, whereas two others continue toward higher but more jagged heights. In Study 2, we compare the zoid placement decisions made by our best CERL models with those made by 67 human players. Across 370,131 human game episodes, two CERL models picked the same zoid placements as our lowest scoring human for 43% of the placements and as our three best scoring experts for 65% of the placements. Our findings suggest that people focus on maximizing points, not number of lines cleared or number of levels reached. They also show that goal choice influences the choice of zoid placements for CERLs and suggest that the same is true of humans. Tetris has a repetitive task structure that makes Tetris more tractable and more like a traditional experimental psychology paradigm than many more complex games or tasks. Hence, although complex, Tetris is not overwhelmingly complex and presents a right-sized challenge to cognitive theories, especially those of integrated cognitive systems. (shrink)

Tetris provides a difficult, dynamic task environment within which some people are novices and others, after years of work and practice, become extreme experts. Here we study two core skills; namely, choosing the goal or objective function that will maximize performance and a feature-based analysis of the current game board to determine where to place the currently falling zoid so as to maximize the goal. In Study 1, we build cross-entropy reinforcement learning models to determine whether different goals result (...) in different feature weights. Two of these optimization strategies quickly rise to performance plateaus, whereas two others continue toward higher but more jagged heights. In Study 2, we compare the zoid placement decisions made by our best CERL models with those made by 67 human players. Across 370,131 human game episodes, two CERL models picked the same zoid placements as our lowest scoring human for 43% of the placements and as our three best scoring experts for 65% of the placements. Our findings suggest that people focus on maximizing points, not number of lines cleared or number of levels reached. They also show that goal choice influences the choice of zoid placements for CERLs and suggest that the same is true of humans. Tetris has a repetitive task structure that makes Tetris more tractable and more like a traditional experimental psychology paradigm than many more complex games or tasks. Hence, although complex, Tetris is not overwhelmingly complex and presents a right-sized challenge to cognitive theories, especially those of integrated cognitive systems. (shrink)

Food advertising targeted at children is associated with the development of unhealthy eating habits and childhood obesity. In Spain, where one in every three children suffers from overweight, a voluntary regulation mechanism has been adopted to control such advertising, despite evidence of its ineffectiveness. This study's stated objective was to evaluate the grounds for implementing a policy that would ban the advertising of energy-dense, nutrient-poor food and beverages targeted at children in Spain, incorporating an ethical perspective in the (...) analysis. Using a bibliographic search of various databases, we reviewed the evidence for answering the seven questions posed by Walton et al.'s ethical evaluation framework, drawn up on the basis of the Nuffield Council on Bioethics Stewardship model. The results show that the proposed intervention is cost-effective, minimally intrusive, promotes healthy environments, acts on a vulnerable population, helps children lead healthy lifestyles, reduces social health inequalities, increases parents' individual freedom of choice and enjoys the support of scientists, health professionals and consumers alike. Accordingly, we feel that the time has come for food advertising directed to children in Spain to be statutorily regulated, by banning the promotion of EDNP products. (shrink)

The identification and analysis of the spatiotemporal dynamic traffic patterns in citywide road networks constitute a crucial process for complex traffic management and control. However, city-scale and synchronal traffic data pose challenges for such kind of quantification, especially during peak hours. Traditional studies rely on data from road-based detectors or multiple communication systems, which are limited in not only access but also coverage. To avoid these limitations, we introduce real-time, traffic condition digital maps as our input. The (...) digital maps keep spatiotemporal urban traffic information in nature and are open to access. Their pixel colors represent traffic conditions on corresponding road segments. We propose a stacked convolutional autoencoder-based method to extract a low-dimension feature vector for each input. We compute and analyze the distances between vectors. The statistical results show different traffic patterns during given periods. With the actual data of Chongqing city, we compare the feature extraction performance between our proposed method and histogram. The result shows our proposed method can extract spatiotemporal features better. For the same data set, there is little difference in the number distribution of red pixels found in the statistics result of the histogram, while differences do exist in the results of our proposed method. We find the most fluctuated morning is on Friday; the most fluctuated evening is on Tuesday; and the most stable evening is on Wednesday. The distance captured by our method can represent the evolution of different traffic conditions during the morning and evening peak hours. Our proposed method provides managers with assistance to sense the dynamics of citywide traffic conditions in quantity. (shrink)

It is common for visitors to have rich and varied experiences in the limited space of a classical Chinese garden. This leads to the sense that the garden’s scale is much larger than it really is. A main reason for this perceptual bias is the gardener’s manipulation of visual information. Most studies have discussed this phenomenon in terms of qualitative description with fragmented perspectives taken from static points, without considering ambient visual information or continuously changing observation points. A general question (...) arises, then, on why depth perception can vary from one observation point to another along a garden path. To better understand the spatial experience in classical Chinese gardens, this study focused on variations in perceived depth among different observation points and aimed to identify influential visual information through psychophysical experimentation. As stimuli for the experiment, panoramic photos of Liu garden were taken from three positions at Lvyin Pavilion. Considering the effects of pictorial visual cues on depth perception, the photos were processed to create 18 kinds of stimuli. Two tasks were presented to the participants. In Task 1, 71 participants were asked to rate the depth value of the garden using the magnitude estimation method in a cave automatic virtual environment. Statistical analysis of Task 1 revealed that depth values differed significantly among different viewpoints. In Task 2, participants were asked to compare 18 stimuli and 3D images presented on three connected monitors and to judge the depth of the garden using the adjustment method. The results of Task 2 again showed that depth values differed significantly among different viewpoints. In both tasks, ambient information significantly influenced depth perception. (shrink)

When assessing the cost effectiveness of health care programmes, health economists typically presume that distant events should be given less weight than present events. This article examines the moral reasonableness of arguments advanced for positive discounting in cost-effectiveness analysis both from an intergenerational and an intrapersonal perspective and assesses if arguments are equally applicable to health and monetary outcomes. The article concludes that behavioral effects related to time preferences give little or no reason for (...) why society at large should favour the present over the future when making intergenerational choices regarding health. The strongest argument for discounting stems from the combined argument of diminishing marginal utility in the presence of growth. However, this hinges on the assumption of actual growth in the relevant good. Moreover, current modern democracy may be insufficiently sensitive to the concerns of future generations. The second part of the article categorises preference failures (which justify paternalistic responses) into two distinct groups, myopic and acratic. The existence of these types of preference failures makes elicited time preferences of little normative relevance when making decisions regarding the social discount rate, even in an intrapersonal context. As with intergenerational discounting, the combined arguments of growth and diminishing marginal utility offer the strongest arguments for discounting in the intrapersonal context. However, there is no prima facie reason to assume that this argument should apply equally to health and monetary values. To be sure, selecting an approach towards discounting health is a complex matter. However, the life-or-death implications of any approach require that the discussion not be downplayed to merely a technical matter for economists to settle. (shrink)

Thomas Alured Faunce, College of Law, Fellows Road, Acton, Canberra ACT 0200, Australian National University, Fax: 61 2 61253971, Email: Thomas.Faunce{at}anu.edu.au ' + u + '@' + d + ' '//-->This paper sets out to analyse three different academic proposals for addressing the needs of the poor in relation to new, rather than ‘essential’ medicines. It focuses particularly on research and development prize funds, a health impact fund system and a multilateral treaty on health technology cost-effectiveness evaluation and (...) competitive tender. It compares the extent to which each responds to the ‘market fundamentalist’ philosophy and begins to analyse their respective strengths and weaknesses. CiteULike Connotea Del.icio.us What's this? (shrink)

Institutional investors, policy makers, and researchers have advocated for greater director independence in hopes of improving corporate governance and discouraging unethical behaviors such as corporate frauds, accounting irregularities, and other organizational failures. However, increasing demands upon directors and sitting CEOs, as well as constraints on the number of boards on which they can serve, has resulted in a dramatic increase in the use of retired independent directors. Compared to other directors with full-time job demands, we argue that RIDs (...) have lesser time constraints and greater attentional capacities with which to discharge their responsibilities, thereby improving overall board “bandwidth.” Using S&P 1500 firms for the period of 2000–2012, we find that enhanced board bandwidth associated with an increased proportion of RIDs on the board relates to greater resource provisioning through reducing costs of capital, improved monitoring through reducing disclosure-related weaknesses, and better accounting and market performance. We thereby advance traditional board bandwidth research by contemplating the available time that independent directors would have by virtue of being retired and relating this to board effectiveness. (shrink)

Children diagnosed with type 1 diabetes mellitus (T1DM) are at risk for neurocognitive sequelae, including impaired attention functioning. The specific nature of the cognitive deficit varies; current literature underscores early age of diabetes diagnosis and increased disease duration as primary risk factors for this neurocognitive decline. Forty-three children with T1DM were evaluated for Attention Deficit/Hyperactivity Disorder (ADHD) symptomatology using the MOXO continuous performance test (MOXO-CPT) performed during a routine outpatient evaluation. The study cohort demonstrated a significant (...) decline in all four domains of attention functioning. The effect was most pronounced with early age at T1DM diagnosis, a longer disease duration and with poorer glycemic control (represented by higher HbA1c values). With increased disease duration (of 5 plus years), acute hyperglycemia was associated with inattention in the real-time setting. These findings highlight the need for routine screening of neurocognitive function in children with T1DM so that early intervention can be employed during this crucial period of cognitive development. (shrink)

Multimedia learning theories suggest presenting associated pieces of information in spatial and temporal contiguity. New technologies like Augmented Reality allow for realizing these principles in science laboratory courses by presenting virtual real-time information during hands-on experimentation. Spatial integration can be achieved by pinning virtual representations of measurement data to corresponding real components. In the present study, an Augmented Reality-based presentation format was realized via a head-mounted display and contrasted to a separate display, which provided a well-arranged data (...) matrix in spatial distance to the real components and was therefore expected to result in a spatial split-attention effect. Two groups of engineering students performed six experiments exploring fundamental laws of electric circuits. Cognitive load and conceptual knowledge acquisition were assessed as main outcome variables. In contrast to our hypotheses and previous findings, the Augmented Reality group did not report lower extraneous load and the separate display group showed higher learning gains. The pre- and posttest assessing conceptual knowledge were monitored by eye tracking. Results indicate that the condition affected the visual relevancy of circuit diagrams to final problem completion. The unexpected reverse effects could be traced back to emphasizing coherence formation processes regarding multiple measurements. (shrink)

Efficiency as quantified and promoted by cost-effectiveness analysis sometimes conflicts with equity and other ethical values, such as the “rule of rescue” or rights-based ethical values. We describe the utilitarian foundations of cost-effectiveness analysis and compare it with alternative ethical principles. We find that while fallible, utilitarianism is usually superior to the alternatives. This is primarily because efficiency – the maximization of health benefits under a budget constraint – is itself an important ethical value. (...) Other ethical frames may be irrelevant, incompatible with each other, or have unacceptable implications. When alternatives to efficiency are considered for precedence, we propose that it is critical to quantify the trade-offs, in particular, the lost health benefits associated with divergence from strict efficiency criteria. Using an example from HIV prevention in a high-prevalence African country, we show that favoring a rights-based decision could result in 92–118 added HIV infections per $100,000 of spending, compared to one based on cost-effectiveness. (shrink)

Efficiency as quantified and promoted by cost-effectiveness analysis sometimes conflicts with equity and other ethical values, such as the “rule of rescue” or rights-based ethical values. We describe the utilitarian foundations of cost-effectiveness analysis and compare it with alternative ethical principles. We find that while fallible, utilitarianism is usually superior to the alternatives. This is primarily because efficiency – the maximization of health benefits under a budget constraint – is itself an important ethical value. (...) Other ethical frames may be irrelevant, incompatible with each other, or have unacceptable implications. When alternatives to efficiency are considered for precedence, we propose that it is critical to quantify the trade-offs, in particular, the lost health benefits associated with divergence from strict efficiency criteria. Using an example from HIV prevention in a high-prevalence African country, we show that favoring a rights-based decision could result in 92–118 added HIV infections per $100,000 of spending, compared to one based on cost-effectiveness. (shrink)

Democratic societies find it difficult to reach consensus concerning principles for healthcare distribution in the face of resource constraints. At the same time the need for legitimacy of allocation decisions has been recognised. Against this background, the National Institute for Health and Clinical Excellence (NICE) aspires to meet the principles of procedural justice, specifically the conditions of accountability for reasonableness as espoused by Daniels and Sabin, that is, publicity, relevance, revisions and appeal, and enforcement. Although NICE has adopted a (...) highly standardised approach and continuously publishes key documents on its website, its technology appraisal programme does not fulfil the publicity condition of accountability for reasonableness. Economic models are not made sufficiently transparent to enable public scrutiny, and decision criteria other than cost-effectiveness remain enigmatic. NICE’s reliance on cost-utility analysis and “plausible” cost-per-quality-adjusted life year (QALY) benchmarks further raises serious issues with regard to the relevance condition of accountability for reasonableness. This is illustrated by counterintuitive cost-per-QALY rankings that are difficult to justify using reflective equilibrium methods, and by the current debate surrounding expensive therapies for rare diseases (“orphan” treatments). In addition, an excessive focus on QALYs may stand in the way of exploiting the best available effectiveness evidence. The NICE mechanism for revision and appeals is also more restrictive than provided in accountability for reasonableness. As to the enforcement condition, no effective quality assurance processes are in place for technology assessments, and implementation of guidance remains imperfect. NICE, despite impressive efforts, appears to have a long way to go before meeting the conditions of accountability for reasonableness. (shrink)

Diabetes is a major public health issue that affects the nations of our time to a large extent and is described as a non-communicable epidemic. Diabetes mellitus is a common disease where there is too much sugar (glucose) floating around in your blood. This occurs because either the pancreas can’t produce enough insulin or the cells in body have become resistant to insulin. The concentration in this paper is on diagnosis diabetes by designing (...) a proposed expert system. The main goal of this expert system is to get the appropriate diagnosing of the illness, dealing with it quickly, and tips for permanent treatment whenever possible is given out. SL5 object expert system language was used for designing and implementing the proposed expert system. (shrink)

Background: Frailty is a common syndrome among older adults and patients with several comorbidities. Grip strength is a representative parameter of frailty because it is a valid indicator of current and long-term physical conditions in the general population and patients with severe mental illnesses. Physical and cognitive capacities of people with SMIs are usually impaired; however, their relationship with frailty or social functioning have not been studied to date. The current study aimed to determine if GS is a valid predictor (...) of changes in cognitive performance and social functioning in patients with type-2 diabetes mellitus and SMIs. Methods: Assessments of social functioning, cognitive performance, and GS were conducted in 30 outpatients with type 2 diabetes mellitus, 35 with major depressive disorder, 42 with bipolar disorder, 30 with schizophrenia, and 28 healthy controls, twice during 1-year, follow-up period. Descriptive analyses were conducted using a one-way analysis of variance for continuous variables and the chi-squared test for categorical variables. Differences between groups for the motor, cognitive, and social variables at T1 and T2 were assessed using a one-way analysis of covariance, with sex and age as co-variates. To test the predictive capacity of GS at baseline to explain the variance in cognitive performance and social functioning at T2, a linear regression analysis was performed. Results: Predictive relationships were found among GS when implicated with clinical, cognitive, and social variables. These relationships explained changes in cognitive performance after one year of follow-up; the variability percentage was 67.7%, in patients with type-2 diabetes mellitus and 89.1% in patients with schizophrenia. Baseline GS along with other variables, also predicted changes in social functioning in major depressive disorder, bipolar disorder, and schizophrenia, with variability percentages of 67.3, 36, and 59%, respectively. Conclusion: GS combined with other variables significantly predicted changes in cognitive performance and social functioning in people with SMIs or type-2 diabetes mellitus. Interventions aimed to improve the overall physical conditions of patients who have poor GS could be a therapeutic option that confers positive effects on cognitive performance and social functioning. (shrink)

Cardiovascular disease is a major complication of type 2 diabetes mellitus. In addition to traditional risk factors, psychological determinants play an important role in CVD risk. This study applied Deep Neural Network to develop a CVD risk prediction model and explored the bio-psycho-social contributors to the CVD risk among patients with T2DM. From 2017 to 2020, 834 patients with T2DM were recruited from the Department of Endocrinology, Affiliated Hospital of Harbin Medical University, China. In this cross-sectional study, the (...) patients' bio-psycho-social information was collected through clinical examinations and questionnaires. The dataset was randomly split into a 75% train set and a 25% test set. DNN was implemented at the best performance on the train set and applied on the test set. The receiver operating characteristic curve analysis was used to evaluate the model performance. Of participants, 272 were diagnosed with CVD. The developed ensemble model for CVD risk achieved an area under curve score of 0.91, accuracy of 87.50%, sensitivity of 88.06%, and specificity of 87.23%. Among patients with T2DM, the top five predictors in the CVD risk model were body mass index, anxiety, depression, total cholesterol, and systolic blood pressure. In summary, machine learning models can provide an automated identification mechanism for patients at CVD risk. Integrated treatment measures should be taken in health management, including clinical care, mental health improvement, and health behavior promotion. (shrink)

BackgroundIn the context of limited health care budgets in countries where Neglected Tropical Diseases (NTDs) are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost‐effectiveness analyses may lead to biased and insufficiently justified priorities.ObjectivesThe objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi‐criteria decision‐making matrix, and (...) 3) discuss the conditions under which this decision‐making procedure should be carried out in a real‐world decision‐making context.MethodsThis paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi‐criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases.DiscussionOur in vitro multi‐criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil‐transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision‐making process and we stress the limitations of this study exercise.ConclusionBy exploring how several criteria relevant to the multi‐facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised. (shrink)

Objective: The objective of our current research is to compare the different psychological interventions and distinguish the most effective way to treat psychological crisis according to different clinical manifestations in people affected by coronavirus disease 2019. No previous systematic review has provided a comprehensive overview by performing a Bayesian network meta-analysis of this current topic.Method: A systematic review and a Bayesian network meta-analysis were conducted on randomized controlled trials, non-RCTs, case–control studies, self-controlled case series, cohort studies, and (...) cross-sectional studies of all the available interventions for psychological crisis in people affected by COVID-19. We searched the electronic databases EMBASE, PubMed, Web of Science, PsycINFO, and Cochrane Library, as well as the Chinese databases such as Sinomed, Chinese Biomedicine Literature, Chinese Scientific Journal Database, WanFang Database, and China National Knowledge Infrastructure, from 2019 to April 30, 2020. The main outcomes were self-rating anxiety scale, self-rating depression scale, patient health questionnaire, and symptom checklist. The study is registered with Inplasy, number 202050076.Result: Sixteen self-controlled case series comprising 1,147 participants compared five different psychological interventions with four different measurement scales were included in this study. For effectiveness, all the psychological therapies were significantly more effective than before intervention. Our results showed that supportive therapy, which is adjusted to the COVID-19-related mental crisis, is the best treatment compared with behavioral therapy, nursing-based psychological therapy, traditional Chinese medicine therapy, and COVID-19-related standard training at reducing the anxiety-related symptoms assessed by SAS. When measured by SDS, BT was better than ST and NBPT treatment for reducing the depression symptoms. And ST was better than BT and ST+BT as assessed by PHQ-9. In the end, the last network meta-analysis indicated that NBPT was more effective than ST by the measurement of SCL-90.Conclusion: Our research suggested the potential effectiveness of psychological interventions for decreasing psychological crisis in people affected by COVID-19 and try to introduce the best effective treatment options for clinical practice according to the clinical manifestations of psychological problems, but further confirmation from high-quality RCTs is needed. (shrink)

Excellent performance in sport involves specialized and refined skills within very narrow applications. Choking throws a wrench in the works of finely tuned performances. Functionally, and reduced to its simplest expression, choking is severe underperformance when engaging already mastered skills. Choking is a complex phenomenon with many intersecting facets: its dysfunctions result from the multifaceted interaction of cognitive and psychological processes, neurophysiological mechanisms, and phenomenological dynamics. This article develops a phenomenological model that, complementing empirical and theoretical research, helps understand and (...) redress choking. It aims at describing the experience of choking as experience, and to discuss strategies to palliate or prevent its onset at the pragmatic level at which athletes engage the phenomenon experientially. An overview of current empirical research and theoretical models highlights key ideas and points out contentious issues. The model describes the common structure of the choking experience. It identifies four core constitutive elements: A) disruptive proprioceptive and kinesthetic dynamics, B) a malfunctioning background or Jamesian fringe of consciousness, C) dislocated time dynamics, and D) emotional disturbances. The novelty of the remedy is that it is designed to cross disciplinary boundaries between phenomenology, historiography, and hermeneutics, and moreover connects theory to praxis as it looks at Japanese dō, practices of self-cultivation. It focuses on actual do-or-die situations, not putative ones such as important business deals or competing for a medal. To this effect, it examines medieval Japanese swordsmanship and training manuals and also engages risk sports, where death is indeed a real possibility. The manuals, which arise in the context of choke-inducing life or death duels, and risk sports, afford keen phenomenological observations and practical advice that prove invaluable for today’s sports world and beyond. (shrink)

There is currently much debate in the economic literature about whether ethical investment involves a financial sacrifice or premium. One of the most common methods of testing this compares the financial performance of ethical investment funds with that of other funds not considered “socially responsible” or ethical. The majority of these research studies evaluate the performance of the ethical funds according to classic measures, whereby different financial markets, in different countries and for different periods of time serve as reference (...) for evaluation. The ultimate conclusion of all of these studies is that there are no significant differences between the performance results of one type of funds and the other. In Spain, ethical investment funds are still an incipient sector of investment. To date, the Spanish market has not been included in any type of analysis of these characteristics. Therefore the main objective of this article is to compare the financial performance of ethical investment funds to that of other funds in the Spanish retail market. We propose the aggregate type of analysis as the Spanish ethical investment funds have experienced a weaker development in comparison to those of other developed countries. In the first step we suggest the financial performance to be compared by style analysis since the asset distribution of the Spanish Social Return Investment (SRI) funds differs from the European trend. In particular, we use the multifactor regression model with style benchmarks. We found that their financial performance is in all cases superior or similar to that achieved by the rest of the funds. In the second step, to achieve a more robust and homogeneous comparison, we used the bootstrap method, comparing ethical and non-ethical fund subsamples by homogeneous groups. No significant differences between these two types of funds have been found. Thus, if we assume the positive o neutral effect of ethical investment on investor utility in the retail Spanish market the financial and social performance (FSP) of ethical funds will be, in aggregate, superior to the FSP achieved by conventional funds. In conclusion, the financial performance of ethical mutual funds in Spain is no sacrifice. (shrink)

Excellent performance in sport involves specialized and refined skills within very narrow applications. Choking throws a wrench in the works of finely tuned performances. Functionally, and reduced to its simplest expression, choking is severe underperformance when engaging already mastered skills. Choking is a complex phenomenon with many intersecting facets: its dysfunctions result from the multifaceted interaction of cognitive and psychological processes, neurophysiological mechanisms, and phenomenological dynamics. This article develops a phenomenological model that, complementing empirical and theoretical research, helps understand and (...) redress choking. It aims at describing the experience of choking as experience, and to discuss strategies to palliate or prevent its onset at the pragmatic level at which athletes engage the phenomenon experientially. An overview of current empirical research and theoretical models highlights key ideas and points out contentious issues. The model describes the common structure of the choking experience. It identifies four core constitutive elements: A) disruptive proprioceptive and kinesthetic dynamics, B) a malfunctioning background or Jamesian fringe of consciousness, C) dislocated time dynamics, and D) emotional disturbances. The novelty of the remedy is that it is designed to cross disciplinary boundaries between phenomenology, historiography, and hermeneutics, and moreover connects theory to praxis as it looks at Japanese dō, practices of self-cultivation. It focuses on actual do-or-die situations, not putative ones such as important business deals or competing for a medal. To this effect, it examines medieval Japanese swordsmanship and training manuals and also engages risk sports, where death is indeed a real possibility. The manuals, which arise in the context of choke-inducing life or death duels, and risk sports, afford keen phenomenological observations and practical advice that prove invaluable for today’s sports world and beyond. (shrink)

England, known as “the empire without sun settling down” and being among the final winners of the World War I (1914-1918), had one of the heaviest defeats of its history against the Ottoman Empire in the Kut al-Amara, which happened on 29 April 1916 close to Baghdad. Following the defeat of Kut al-Amara, which was the most important war trauma for England during the World War I, the Turks and Germans, as winner side of the battle were evaluated by British (...) prisoners from military, political, cultural and socio-psychological aspects in their memories. Content analysis method is used in the article for qualitative evalution of the data related to the Turkish and German image reflected in the memories of British prisoners after the siege of Kut al-Amara. The alliance between Turks and Germans is regarded as contrast in terms of important elements as national and ethnic identity, language, religion and culture in the main sources of the research as My Compain by Charles Townshend, Besieged in Kut and After by Barber, A Kut Prisoner by Bishop, In Kut and Captivity with the Sixth Indian Division by Sandes, The Secrets of a Kuttite by Mousley which occationally use exaggerated language and the subjective information due to the impact of traumatic defeat.Summary: Being a heroic epic in the war history of Turkey, Kūt al-‘Amāra has been the subject of very fewer researches until recently, despite its importance in Turkey’s history. This argument is supported by the fact that the memoirs by Ottoman soldiers related to the WWI, which also encompass information about Kūt al-‘Amāra, were published half a century after the war at the earliest. Unlike the records of Turkish soldiers participating in Kūt al-‘Amāra, the memoirs and the war diaries of British soldiers were published shortly after the war, as early as possible, between the years of 1918-1921. The authors of these memoirs and war diaries informed the public on the reasons for the defeat of Kūt al-‘Amāra on the one hand, and on the other hand created the Ottoman and Turkish image which was concidered differently in the British society in terms of culture and civilization. They also strengthened this image over that of German’s, with whom they shared many common values despite the fact that they represented the opposite fronts of the war.It is worthy mentioning that the role of the Ottoman army in the victory of Kūt al-‘Amāra was highly underestimated by the memoirs of the British prisoners. According to the authors, it is not the Turkish army that has achieved real victories over the British, but Germany’s support, notably General von der Goltz, the great strategist of Europe. The effects of bad weather conditions and geographical situation are also emphasized among the reasons of the defeat of Kūt al-‘Amāra. Consequently, the success of the Turkish army in the victory of Kūt al-‘Amāra was ignored, except for the role of Halil Pasha. The image of an army that knows the trench and defence techniques well, but fails to attack is one of the prominent evaluations in the memoirs related to the Turkish military characteristics.The British prisoners of war, who evaluate the Turkish and German image through the economic and political situation, draw a very desperate picture of the situation of the Turks in the mentioned areas. According to this image, corruption and bribery prevails at every stage of the Turkish government. The Turks are unable to repay their dept to Germany, which dominates the economy of the country completely. According to these records, besides ordinary people, the army is also facing great difficulties in meeting basic requirements. To convert the Ottoman Empire into their own property and keep the Turks under their control in military, economic and political spheres, the Germans lend a high amount of money.On the basis of Turkish soldiers encountered in Kūt al-‘Amāra, the British prisoners characterizes the Turks as physically large, hard and strong-bodied people. The authors also note that the Turks are not as cold-blooded, calm and obedient as they seem at first sight, rather they become rude people when they get angry. Another feature that British prisoners evaluate as a potential of the Turks, is their childish spirit. In as much as they are happy with small things and can be offended by small things. According to the memoirs, the Germans should not be allowed to benefit from these characteristics of the Turks, but the British should take the advantage of their potential power.The moral characteristics of the Turks and the Germans are among the most emphasized subjects. Written in exceptional time such as war, sometimes the diaries include exaggerated and sentimental phrases related to the moral attitudes enemy soldiers exhibited during siege, as well as captivity. Turks are regarded as negligent and careless rather than cruel or ruthless. They owe these characteristics to their Eastern identity, which is different from the Europeans having virtues such as task responsibility and diligence. The moral characteristic of the Turks regarding the duty, responsibility and kindness is evaluated comparatively with the civilized and humanistic behaviors of the Germans towards the prisoners. Being Europeans, the Germans often come to the fore because of their more polite treatment towards the British prisoners. Although the Germans as an enemy fought against the British on the front, they were kind to them in the Ottoman territories as the only civilized people among the barbarian peoples of the East.The Turks and the Germans are compared in the field of education, as well as other areas of development. The authors emphasize that the education level of the Turks is very low; Armenian and Greek subjects of the Empire are its brain and financial resources, which is the reason why the Turks are anxious about them. The Germans have the superiority in both transportation and communication technology in the Ottoman territories. One of the reasons they had a huge investment on the Ottoman territories is the Berlin-Istanbul-Baghdad-Basra railway. The British prisoners give details on the German communication technology they encountered during both the battle and the captivity days in Anatolia. In addition to the transport and communication technology, they also record much German-made military equipment, from weapons to maps.Evaluating the Turks and the Germans as opposites, the British prisoners draw an image for the latter, with whom they share a common cultural legacy, as a fully equipped enemy in terms of technology and strategy on the front, and the civilized Europeans characterized with their virtue in non-war situations. On the contrary, the Turks are described as a strong defender and daredevil soldiers on the front line, but strategically weak on the front. In terms of duties and responsibilities, the Turkish soldiers are presented with negligent and irresponsible approach towards their prisoners. The images of the Turks and the Germans, which are compared by the British prisoners, are often based on their Eastern and Western identity. The Turks symbolize the East with economic, political and cultural backwardness, yet quite the contrary, the Germans symbolize the West in terms of development, modernity and civilization. The British prisoners sometimes used exaggerated expressions in their approaches regarding both sides, as well as different details in terms of information and interpretation about the same event, due to the trauma of defeat. (shrink)

Background In the context of limited health care budgets in countries where Neglected Tropical Diseases are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost-effectiveness analyses may lead to biased and insufficiently justified priorities. Objectives The objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi-criteria decision-making (...) matrix, and 3) discuss the conditions under which this decision-making procedure should be carried out in a real-world decision-making context. Methods This paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi-criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases. Discussion Our in vitro multi-criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil-transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision-making process and we stress the limitations of this study exercise. Conclusion By exploring how several criteria relevant to the multi-facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised. (shrink)

View of future time orientation is a cognitive construct about future time. This view has its unique work of motivation and effect on academic performance. Previous studies have only explored the influence that future time orientation brings to the learning process at a single time, and most of them focus on cross-sectional studies. To further explore the cross-lagged relationship for freshmen between future time orientation and learning engagement during different periods, AMOS 23.0 was performed for (...) cross-lagged analysis in this study to explore the influence and effect among variables of different periods. This research was based on the theory of self-determination to discover the relationship between future time and learning involvement for freshmen in enrollment and the first summer vacation. In this research, there were 1,000 valid samples in the first stage and 840 valid samples in the second stage for the conduction of descriptive statistics, pair t-test, and cross-lagged analysis. The results show that: for learning engagement, freshmen at the end of the first year have a higher average score than at the beginning of the first year. View of students of future time orientation can affect their learning engagement of the future through self-determination of students. At last, we provide some suggestions as references for institutional research and future research. (shrink)

To better detect fish in an aquaculture environment, a high-accuracy real-time detection model is proposed. An experimental dataset was collected for fish detection in laboratory aquaculture environments using remotely operated vehicles. To overcome the inaccuracy of the You Only Look Once v3 algorithm in underwater farming environment, a suitable set of hyperparameters was obtained through multiple sets of experiments. Then, a real-time image recovery algorithm is applied before YOLOv3 to reduce the effects of both noise and (...) light on images whilst keeping the real-time capability, leading to a mean average precision of 0.85 and frame rate of 17.6 fps, respectively. Finally, compared with the base detection model using only the YOLOv3 algorithm, the enhanced detection model presented results in a reduction of miss detection rate from 23% to only 9% across different environments and with the detection accuracy of the target in different environments being improved from 8% to 37%. (shrink)

By registering different health benefits on a common scale, CEA allows us to assess the relative social importance of different health care interventions and opens the way for the allocation decisions of health care policy. If it is really to be effective, however, CEA must be recalibrated so that it better reflects some of our widely held beliefs about the merits of different kinds of treatment.