The growing prevalence of health care ethics consultation (HCEC) services in the U.S. has been accompanied by an increase in calls for accountability and quality assurance, and for the debates surrounding why and how HCEC is evaluated. The objective of this study was to evaluate the effectiveness of HCEC as indicated by several novel outcome measurements in East Asian medical encounters.

We explore the notion that culture influences people’s values, and their subsequent ideologies and ethical behaviors. We present the idea that culture itself changes with time, and explore the influence of culture and generational markers on consumer ethics by examining differences in these ethical dimensions between Australians, Indonesians, and Indonesian Migrants in Australia, as well as differences between Generation X versus Generations Y and Z. The present study addresses the need to investigate the role that culture plays in consumer ethics, (...) and the interaction between culture and generational attitudes in determining consumer ethics. Results established a distinct multiculturality in our three cultural samples, including a generational cohort differences. This suggests that culture and generational markers influence ethical beliefs, ideologies, and consumer ethics. It further indicates that Indonesian Migrants have acculturated to Australian society both in terms of their values and consumer behaviors, illustrating a crossvergence effect; scores indicate that these Migrants have the highest cultural intelligence among our samples. Implications of the findings for consumer ethics theory and practice are considered and future directions identified. (shrink)

As biomedical citizen science initiatives become more prevalent, the unique ethical issues that they raise are attracting policy attention. One issue identified as a significant concern is the ethical oversight of bottom-up biomedical citizen science projects that are designed and executed primarily or solely by members of the public. That is because the federal rules that require ethical oversight of research by institutional review boards generally do not apply to such projects, creating what has been called an ethics gap. -/- (...) Working to close this gap, practitioners and scholars have considered new mechanisms of ethical oversight for biomedical citizen science. To date, however, participants’ attitudes about ethics and oversight preferences have not been systematically examined. This information is useful to efforts to develop ethical oversight mechanisms because it provides a basis for evaluating the likely effectiveness of specific features of such mechanisms and their acceptability from the perspective of biomedical citizen scientists. -/- Here, we report data from qualitative interviews with 35 stakeholders in bottom-up biomedical citizen science about their general ethics attitudes and preferences regarding ethical oversight. Interviewees described ten ethical priorities and endorsed oversight mechanisms that are voluntary, community-driven, and offer guidance. Conversely, interviewees rejected mechanisms that are mandatory, hierarchical, and inflexible. Applying these findings, we conclude that expert consultation and community review models appear to align well with ethical priorities and oversight preferences of many biomedical citizen scientists, although local conditions should guide the development and use of mechanisms in specific communities. (shrink)

This article describes a number of human cohort studies based on the concept of brain‐science and education. These studies assess the potential effects of new technologies on babies, children and adolescents, and test hypotheses drawn from animal and genetic case studies to see if they apply to people. A flood of information, virtual media, individualism and the pursuit of efficiency might be transforming our brain and its functions. An environmental assessment from the metaphysical aspect could be essential to providing (...) an appropriate environment for future generations. (shrink)

Case-cohort design is a biased sampling method. Due to its cost-effective and theoretical significance, this design has extensive application value in many large cohort studies. The case-cohort data includes a subcohort sampled randomly from the entire cohort and all the failed subjects outside the subcohort. In this paper, the adjustment for the distorted covariates is considered to case-cohort data in Cox’s model. According to the existing adjustable methods of distorted covariates for linear and nonlinear models, (...) we propose estimating the distorting functions by nonparametrically regressing the distorted covariates on the distorting factors; then, the estimators for the parameters are obtained using the estimated covariates. The proof of consistency and being asymptotically normal is completed. For calculating the maximum likelihood estimates of the regression coefficients subject in Cox’s model, a minorization-maximization algorithm is developed. Simulation studies are performed to compare the estimations with the covariates undistorted, distorted, and adjusted to illustrate the proposed methods. (shrink)

IntroductionLittle is known about risk factors for both Long COVID and somatic symptoms that develop in individuals without a history of COVID-19 in response to the pandemic. There is reason to assume an interplay between pathophysiological mechanisms and psychosocial factors in the etiology of symptom persistence.ObjectiveTherefore, this study investigates specific risk factors for somatic symptom deterioration in a cohort of German adults with and without prior SARS-CoV-2 infection.MethodsGerman healthcare professionals underwent SARS-CoV-2 IgG antibody testing and completed self-rating questionnaires at (...) baseline and 21 months later between April 2020 and February 2022. Differences in variables between the time points were analyzed and a regression analysis was performed to predict somatic symptom deterioration at follow-up.ResultsSeven hundred fifty-one adults completed both assessments. Until follow-up, n = 58 had contracted SARS-CoV-2 confirmed by serology. Between baseline and follow-up, signs of mental and physical strain increased significantly in the sample. Symptom expectations associated with COVID-19 and a self-reported history of COVID-19, but not serologically confirmed SARS-CoV-2 infection, significantly predicted somatic symptom deterioration at follow-up. A further predictor was baseline psychological symptom burden.ConclusionsThis study supports a disease-overarching biopsychosocial model for the development of burdensome somatic symptoms during the COVID-19 pandemic and supports research findings that symptom burden may be more related to the psychosocial effects of the pandemic than to infection itself. Future studies on Long COVID should include SARS-CoV-2 negative control groups and consider symptom burden prior to infection in order to avoid an overestimation of prevalence rates. (shrink)

ObjectivesAs the largest cohort of healthcare workers and nurses can practice as psychotherapists to integrate the psychotherapeutic interventions as part of routine care. The present study aims to evaluate the effectiveness of supportive psychotherapy on patients who had been scheduled to undergo a fiberoptic bronchoscopy procedure.MethodsThis study retrospectively analyzed 92 patients who underwent FOB, which was divided into the SPT group and usual-care group based on whether patients were given SPT interventions or not. The Patient Health Questionnaire-9 and Hospital (...) Anxiety and Depression Scale were used to determine the severity of depression and anxiety, as well as the 36-Item Short-Form Health Survey questionnaire to evaluate the health-related quality of life. Moreover, the patients' satisfaction was assessed based on the Likert 5-Point Scale.ResultsThe baseline status of anxiety, depression, and HRQoL in patients was similar in the SPT group and the usual-care group with no significant difference. Both PHQ-9 score and HADS-D score in the SPT group after intervention were lower than that in the usual-care group, accompanied by the deceased HADS-A subscale. Moreover, the improved HRQoL was found in the patients undergoing FOB after SPT interventions as compared to those receiving conventional nursing care using the SF-36 score. Additionally, the patient satisfaction in the SPT group was higher than in the usual-care group.ConclusionsThe study demonstrated that anxiety and depression, as negative emotions, can be reduced by supportive psychotherapy in patients receiving FOB with improved mental health and satisfaction with nursing care. (shrink)

Transcutaneous auricular vagus nerve stimulation, a non-invasive alternative to vagus nerve stimulation with implantable devices, has shown promise in treating disorders such as depression, migraine, and insomnia. Studies of these disorders with resting-state functional magnetic resonance imaging have found sustained changes in resting-state functional connectivity in patients treated with low frequency taVNS. A recent study has reported reductions in pain scores in patients with rheumatoid arthritis after a 12-week treatment of high-frequency sub-threshold taVNS. However, no studies to date have examined (...) the effects of high-frequency sub-threshold taVNS on rsFC. The objective of this study was to determine whether high-frequency sub-threshold taVNS induces changes in rsFC using seed regions from the cingulate cortex and insula, brain regions that play a key role in interoception and processing of pain. With a single-blind placebo-controlled repeated measures experimental design, rsfMRI scans were acquired before and after 15 min of either sub-threshold taVNS treatment or a sham control. Significant taVNS-related changes in functional connections to the cingulate cortex were detected between the anterior cingulate cortex and right superior temporal gyrus and between the midcingulate cortex and right inferior parietal lobule. In addition, significant changes in functional connections to the insula were detected between the posterior insula and right precuneus and between the anterior insula and right cuneus gyrus. These results suggest that high-frequency sub-threshold taVNS can lead to sustained effects on the rsFC of brain regions involved in interoception and processing of pain in a cohort of healthy subjects. This study lays the foundation for future rsfMRI studies of high-frequency sub-threshold taVNS in clinical populations. (shrink)

_Aims:_ Cognitive and behavioral treatments (CBT) for sleep problems and chronic pain have shown good results, although these results could improve. More recent developments based on the psychological flexibility model, the model underlying Acceptance and Commitment Therapy (ACT) may offer a useful addition to traditional CBT. The aim of this study was to examine whether an ACT-based treatment for chronic pain is associated with improved sleep. Secondly, we examined the associations between changes on measures of psychological flexibility and sleep-related outcomes. (...) _Methods:_ The study used an observational cohort methodology. Participants were 252 patients (73.8% female) attending a 4-week, interdisciplinary, pain management program in London, United Kingdom. Participants completed standard self-report measures of pain and functioning, sleep outcomes, and processes of psychological flexibility. Pre- to post-treatment, and pre-treatment to follow-up measures were examined for statistically significant differences using paired samples t -tests. Secondarily, hierarchical multiple regression analyses were conducted to examine change in process measures in relation to change in treatment outcome. _Results:_ Participants showed statistically significant improvements (all p d = 0.45), sleep interference ( d = 0.61), and sleep efficiency ( d = 0.32). Significant improvements in insomnia severity and sleep interference were also observed at 9-month follow up. Small to medium effect sizes were observed across the sleep outcomes. Statistically significant changes were also observed on measures of psychological flexibility, and these improvements were significantly associated with improvements on sleep-related outcomes, independently contributing up to 19% of unique variance. _Conclusion:_ This study supports the potential usefulness of ACT-based treatments for chronic pain for addressing co-occurring sleep difficulties. Further research is needed to determine how to improve the impact of this treatment for co-morbid pain and sleep difficulties, possibly using a randomized-controlled trial design. (shrink)

The graduate course in research ethics in the Graduate School for Integrative Sciences and Engineering at the National University of Singapore consists of a semester long mandatory course titled: “Research Ethics and Scientific Integrity.” The course provides students with guiding principles for appropriate conduct in the professional and social settings of scientific research and in making morally weighted and ethically sound decisions when confronted with moral dilemmas. It seeks to enhance understanding and appreciation of the moral reasoning underpinning various rules (...) and legislative constraints associated with research subjects and procedures. Further, students are trained to critically analyse cases and issues associated with scientific misconduct preparing them to act in a responsible and effective manner should they encounter such cases. The diverse background and training of the cohort also provide a unique setting and opportunity for student-initiated collaborative interdisciplinary learning. This article offers a reflective account of the course and some preliminary insights into learning outcomes. (shrink)

Introduction: Motor evoked potentials (MEPs) to transcranial magnetic stimulation are known to be susceptible to several sources of variability. However, conflicting evidences on individual characteristics in relatively small sample sizes have been reported. We investigated the effect of age, height, and sex on MEPs of the motor cortex and spinal roots in a large cohort. Methods: A total of 587 subjects clinically and neuroradiologically intact were included. MEPs were recorded during mild tonic contraction through a circular coil applied (...) over the “hot spot” of the first dorsal interosseous and tibialis anterior muscles, bilaterally. Central motor conduction time (CMCT) was estimated as the difference between MEP cortical latency and the peripheral motor conduction time by cervical or lumbar magnetic stimulation. Peak-to-peak MEP amplitude to cortical stimulation and right-to-left difference of each parameter were also measured. Results: After Bonferroni correction, general linear (multiple) regression analysis showed that both MEP cortical latency and peripheral motor conduction time at four limbs positively correlated with age and height. At lower limbs, an independent effect of sex on the same measures was also observed (with females showing smaller values than males). CMCT correlated with both age (negatively) and height (positively) when analyzed by a single regression; however, with a multiple regression analysis this significance disappeared, due to the correction for the multicollinearity within the dataset. Conclusions: Physical individual features need to be considered for a more accurate and meaningful MEPs interpretation. Both in clinical practice and in research setting, patients and controls should be matched for age, height, and sex. (shrink)

Men's gender ideologies have changed more slowly than women's since the 1970s; this article analyzes the period and cohort processes that underlie men's attitude change and how the individual-level characteristics of conservative men differ by birth cohort. Using multidimensional measures of gender role attitudes from the 1974-1998 General Social Surveys, the author finds that changes in men's attitudes have been brought about both by period influences, especially during the 1970s, and by cohort replacement. Analyses of multivariate interaction (...) effects demonstrate that education has become a much less significant predictor of attitudes for men born after 1945. (shrink)

ObjectiveThe objective of this study was to validate the computerized Symbol Digit Modalities Test in a Swiss pediatric cohort, in comparing the Swiss sample to the Canadian norms. Secondly, we evaluated sex effects, age-effects, and test–retest reliability of the c-SDMT in comparison to values obtained for the paper and pencil version of the Symbol Digit Modalities Test.MethodsThis longitudinal observational study was conducted in a single-center setting at the University Children’s Hospital of Bern. Our cohort consisted of 86 children (...) aged from 8 to 16 years. The cohort included both healthy participants and patients hospitalized for a non-neurological disease. Forty eight participants were assessed during two testing sessions with the SDMT and the c-SDMT.ResultsTest–retest reliability was high in both tests. A reliable change index was calculated for the SDMT and the c-SDMT corrected for practice effects. While a significant age effect on information processing speed was observed, no such effect was found for sex. When data on the c-SDMT performance of the Swiss cohort was compared with that from a Canadian cohort, no significant difference was found for the mean time per trial in any age group. Norm values for age groups between 8 and 16 years in the Swiss cohort were established.ConclusionNorms for the c-SDMT between the Swiss and the Canadian cohort were comparable. The c-SDMT is a valid alternative to the SDMT. It is a feasible and easy to administer bedside tool due to high reliability and the lack of motor demands. (shrink)

BackgroundBilateral cerebral palsy is the most common type of CP in children and is often accompanied by different degrees of communication impairment. Several studies have attempted to identify children at high risk for communication impairment. However, most prediction factors are qualitative and subjective and may be influenced by rater bias. Individualized objective diagnostic and/or prediction methods are still lacking, and an effective method is urgently needed to guide clinical diagnosis and treatment. The aim of this study is to develop and (...) validate an objective, individual-based model for the prediction of communication impairment in children with BCP by the time they enter school.MethodsA multicenter prospective cohort study will be conducted in four Chinese hospitals. A total of 178 children with BCP will undergo advanced brain magnetic resonance imaging at baseline. At school entry, communication performance will be assessed by a communication function classification system. Three-quarters of children with BCP will be allocated as a training cohort, whereas the remaining children will be allocated as a test cohort. Multivariate lesion- and connectome-based approaches, which have shown good predictive ability of language performance in stroke patients, will be applied to extract features from MR images for each child with BCP. Multiple machine learning models using extracted features to predict communication impairment for each child with BCP will be constructed using data from the training cohort and externally validated using data from the test cohort. Prediction accuracy across models in the test cohort will be statistically compared.DiscussionThe findings of the study may lead to the development of several translational tools that can individually predict communication impairment in children newly diagnosed with BCP to ensure that these children receive early, targeted therapeutic intervention before they begin school.Trial registrationThe study has been registered with the Chinese Clinical Trial Registry. (shrink)

Hearing loss has been identified as a major modifiable risk factors for dementia. Adult candidates for cochlear implantation represent a population at risk of hearing loss-associated cognitive decline. This study investigated the effect of demographics, habits, and medical and psychological risk factors on cognition within such a cohort. Data from 34 consecutive adults with post-lingual deafness scheduled for CI were analyzed. Pure tone audiometry and Speech Discrimination Score were recorded. The Repeatable Battery for Assessment of Neuropsychological Status for (...) Hearing impaired individuals was used to measure cognition. Demographics, habits, and medical factors were evaluated. Depression was measured using the Hospital Anxiety and Depression Scale, and social inhibition with the Type D questionnaire. All participants suffered from severe to profound hearing loss. The mean RBANS-H total score was 83 ± 16. Participants reported a mean of years of formal education of 12 ± 5 years. The prevalence of habits and medical risk factors was: physical inactivity, body mass index >30, traumatic brain injury, hypertension, heavy alcohol consumption, smoking, and diabetes. Regarding psychological factors, the mean scores of social inhibition and depression were 10 ± 6 and 6 ± 5, respectively. The number of years of education was significantly correlated with the RBANS-H total score, and with the domains “Immediate memory”, “Visuospatial/constructional”, and “Attention”. The mean RBANS-H total score in participants who had university studies or higher level was 97 ± 9, with the remaining participants reporting a mean score of 75 ± 15. Men performed better in the “Visuospatial/constructional”. Physical inactivity was associated with lower scores in the “Delayed memory” ; hypertension correlated with lower RBANS-H total scores and “Attention”. Depression and social inhibition were negatively correlated with RBANS-H total score and with the “Immediate memory,” “Visuospatial/constructional,” and “Attention”. In adults with late-onset deafness scheduled to CI, educational level has a significant effect. Additionally, sex, physical inactivity, hypertension, and psychological traits of social inhibition and depression may also influence cognitive status. Long-term studies with more participants would enable us better understand the effects different risk factors on cognitive status. (shrink)

Analyses of height variation using the 1970 UK national cohort study (12,508 children at age 10 and 5470 at age 16) found clear evidence that children of higher socioeconomic status (as measured by social class, crowding, tenure, type of accommodation, income and receipt of government financial assistance) were on average taller than children of lower socioeconomic status but there was little or no difference in average stature between children living in urban or rural areas. Significant differences in height remained (...) for most of the variables after removing the effects of father’s social class suggesting that reliance on social class perse to explain height variation is inadvisable. (shrink)

Whilst previous observational studies have linked negative thought processes such as an external locus of control and holding negative cognitive styles with depression, the directionality of these associations and the potential role that these factors play in the transition to adulthood and parenthood has not yet been investigated. This study examined the association between locus of control and negative cognitive styles in adolescence and probable depression in young adulthood and whether parenthood moderated these associations. Using a UK prospective population-based birth (...) cohort study: the Avon Longitudinal Study of Parents and Children, we examined the association between external locus of control and negative cognitive styles in adolescence with odds of depression in 4,301 young adults using logistic regression models unadjusted and adjusted for potential confounding factors. Interaction terms were employed to examine whether parenthood moderated these associations. Over 20% of young adults in our sample were at or above the clinical threshold indicating probable depression. For each standard deviation increase in external locus of control in adolescence, there was a 19% higher odds of having probable depression in young adulthood, after adjusting for various confounding factors including baseline mood and different demographic and life events variables. Similarly, for each SD increase in negative cognitive styles in adolescence, there was a 29% higher odds of having probable depression in the adjusted model. We found little evidence that parenthood status moderated the relationship between external locus of control or negative cognitive styles in adolescence and probable depression following adjustment for confounding factors. Effect estimates were comparable when performed in the complete case dataset. These findings suggest that having an external locus of control and holding negative cognitive styles in mid- to late adolescence is associated with an increased likelihood of probable depression in young adulthood. (shrink)

BackgroundThe cognitive outcomes induced by subthalamic nucleus deep brain stimulation (STN-DBS) remain unclear, especially in PD patients with mild cognitive impairment (MCI). This study explored the cognitive effects of STN-DBS in PD patients with MCI.MethodsThis was a retrospective cohort study that included 126 PD patients who underwent STN-DBS; all patients completed cognitive and motor assessments before and at least 6 months after surgery. Cognitive changes were mainly evaluated by the Montreal cognitive assessment (MoCA) scale and the seven specific MoCA (...) domains, including visuospatial/executive function, naming, attention, language, abstract, delayed recall, and orientation. Motor improvement was evaluated by the UPDRS-III. Cognitive changes and motor improvements were compared between PD-MCI and normal cognitive (NC) patients. Logistic regression analyses were performed to explore predictors of post-operative cognitive change.ResultsAt the time of surgery, 61.90% of the included PD patients had MCI. Compared with the PD-MCI group, the PD-NC group had a significantly higher proportion of cases with post-operative cognitive decline during follow-up of up to 36 months (mean 17.34 ± 10.61 months), mainly including in global cognitive function, visuospatial/executive function and attention. Covariate-adjusted binary logistic regression analyses showed that pre-operative global cognitive status was an independent variable for post-operative cognitive decline. We also found that pre-operative cognitive specific function could predict its own decline after STN-DBS, except for the naming and orientation domains.ConclusionPD-MCI patients are at a lower risk of cognitive decline after STN-DBS compared with PD-NC patients. (shrink)

Background To describe the preferences for disclosure of individual biomarker results among mothers participating in a longitudinal birth cohort. Methods We surveyed 343 mothers that participated in the Health Outcomes and Measures of the Environment Study about their biomarker disclosure preferences. Participants were told that the study was measuring pesticide metabolites in their biological specimens, and that the health effects of these low levels of exposure are unknown. Participants were asked whether they wanted to receive their results and their (...) child's results. In addition, they were asked about their preferred method (letter vs in person) and format (more complex vs less complex) for disclosure of results. Results Almost all of the study participants wanted to receive their individual results (340/343) as well as their child's results (342/343). However, preferences for receiving results differed by education level. Mothers with less than a college degree preferred in-person disclosure of results more often than mothers with some college education or a college degree (34.3% vs 17.4% vs 7.9%, p<0.001). Similarly, mothers with less than a college education preferred a less complex disclosure format than mothers with some college education or a college degree (59.7% vs 79.1% vs 86.3%, p<0.0001). Conclusion While almost all study participants preferred to receive results of their individual biomarker tests, level of education was a key factor in predicting preferences for disclosure of biomarker results. To ensure effective communication of this information, disclosure of biomarker results should be tailored to the education level of the study participants. (shrink)

IntroductionThe present study aimed to evaluate the effects of the Active Communication Education program on the social/emotional impacts of hearing loss in a group of older adults with a cochlear implant.DesignProspective cohort study design, with a “within-subject” control procedure.Study SampleTwenty adults over-65 post-lingually deafened CI users. All subjects were required to be native Italian speakers, to have normal cognitive level, have no significant psychiatric conditions and/or diagnosed incident dementia, and used CI for at least 9 months.Materials and MethodsTwenty participants (...) were assessed using the Hearing Handicap Inventory for the Elderly, the Geriatric Depression Scale, and the Speech, Spatial, and Qualities of Hearing Scale before, during, and after ACE program, with a one and 6-month follow up. The cognitive and audiological evaluation was carried out before commencing the ACE program.ResultsThe ACE program had a positive impact by reducing HL’s social/emotional effects. Participants benefited from a rehabilitative approach by improving multilevel skills: comprehension of audiological and hearing dimensions, acquisition of communicative, pragmatic and problem-solving strategies, and interaction and sharing of experiences with peers.ConclusionAlthough targeting the older adults with moderate HL, the ACE program also seemed to benefit older adult CI users. An improvement in social and emotional adaptation to hearing difficulties can, in turn, significantly promote optimal use of CI in the older adults, thereby possibly reducing the risk of losing motivation and engagement in device use and in rehabilitation protocols. (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)

With the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), global researchers were confronted with major challenges. The German National Pandemic Cohort Network (NAPKON) was launched in fall 2020 to effectively leverage resources and bundle research activities in the fight against the coronavirus disease 2019 (COVID-19) pandemic. We analyzed the setup phase of NAPKON as an example for multicenter studies in Germany, highlighting challenges and optimization potential in connecting 59 university and nonuniversity study sites. We examined the ethics (...) application process of 121 ethics submissions considering durations, annotations, and outcomes. Study site activation and recruitment processes were investigated and related to the incidence of SARS-CoV-2 infections. For all initial ethics applications, the median time to a positive ethics vote was less than two weeks and 30 of these study sites (65%) joined NAPKON within less than three weeks each. Electronic instead of postal ethics submission (9.5 days (Q1: 5.75, Q3: 17) vs. 14 days (Q1: 11, Q3: 26), p value = 0.01) and adoption of the primary ethics vote significantly accelerated the ethics application process. Each study center enrolled a median of 37 patients during the 14-month observation period, with large differences depending on the health sector. We found a positive correlation between recruitment performance and COVID-19 incidence as well as hospitalization incidence. Our analysis highlighted the challenges and opportunities of the federated system in Germany. Digital ethics application tools, adoption of a primary ethics vote and standardized formal requirements lead to harmonized and thus faster study initiation processes during a pandemic. (shrink)

Because academic entrepreneurship is an innovation driving force in China’s economy, teachers are key knowledge creators in the process of entrepreneurship. Therefore, it is particularly important to give attention to the individual psychological mechanism factors at play in the process of teachers in higher education academic entrepreneurship. The purpose of this study is to identify individual psychological capital and role conflict issues among university teachers in China. To accomplish this aim, we investigated the emergence of positive academic entrepreneurial intents, continued (...) through the process of academic entrepreneurship, and clarified the impact of psychological capital and role conflict on entrepreneurial intent. Based on the theory of planned behavior, we constructed a research model from the perspective of entrepreneurial intent prior to entrepreneurial action. We established a cohort of teachers in 17 higher education institutions in southern China, with psychological capital and role conflict as the prior independent variables and the teachers’ academic entrepreneurial intent as the dependent variable. Using quantitative analysis, SPSS 22.0, and AMOS 23.0, we conducted reliability and validity tests, correlation analysis, and structural equation models on the collected data. We reached the following conclusions: psychological capital has a positive effect on attitudes toward academic entrepreneurship; psychological capital has a positive effect on perceived behavioral control; role conflict has a negative effect on perceived behavioral control; academic entrepreneurial attitudes have a positive effect on academic entrepreneurial intent; perceived behavioral control has a positive effect on academic entrepreneurial intent; subjective norms have a positive effect on academic entrepreneurial intent. We also provide some suggestions about academic entrepreneurship for university administrators. (shrink)

Grandparental presence is known to correlate with the number of grandchildren born, and this effect may vary according to grandparental sex and lineage. However, existing studies of grandparental effects on fertility mostly concern traditional subsistence societies, while evidence from contemporary developed societies is both scarce and mixed. Here, we explore how grandparents affect the transition to second and subsequent children in the contemporary United Kingdom. The longitudinal Millennium Cohort Study (n = 10,295 families) was used to study the (...) association between grandparental investment and parents’ probability of having a new child within 4.5 years. Results show that contact with paternal grandparents is associated with higher probability of parents having a second child. In contrast, contact with maternal grandparents is associated with lower probability of having a third or subsequent child. Kin may have opposite effects on fertility even in contemporary societies, which may explain the lack of consistent effects of grandparental investment on fertility in previous studies. (shrink)

The lexical–semantic organization of the mental lexicon is bound to change across the lifespan. Nevertheless, the effects of lexical–semantic factors on word processing are usually based on studies enrolling young adult cohorts. The current study aims to investigate to what extent age‐specific semantic organization predicts performance in referential word production over the lifespan, from school‐age children to older adults. In Study 1, we conducted a free semantic association task with participants from six age‐groups (ranging from 10 to 80 years old) (...) to compute measures that capture age‐specific properties of the mental lexicon across the lifespan. These measures relate to lifespan changes in the Available Richness of the mental lexicon and in the lexical–semantic Network Prototypicality of concrete words. In Study 2, we used the collected data to predict performance in a picture‐naming task on a new group of participants within the same age‐groups as for Study 1. The results show that age‐specific semantic Available Richness and Network Prototypicality affect word production speed while the semantic variables collected only in young adults do not. A richer and more prototypical semantic network across subjects from a given age‐group is associated with faster word production speed. The current results indicate that age‐specific semantic organization is crucial to predict lexical–semantic behaviors across the lifespan. Similarly, these results also provide cues to the understanding of the lexical–semantic properties of the mental lexicon and to lexical selection in referential tasks. (shrink)

Many parents worry over their children’s gaming habits, but to what extent do such worries match any detrimental effects of excessive gaming? We attempted to answer this question by comparing children of highly concerned parents with other adolescents of the same age. A cohort of parents who identified as highly concerned over their children’s video game habits were recruited for a public study in collaboration with a national television network. Using an online experimental platform in conjunction with surveys of (...) parents’ beliefs and attitudes, we compared their children to age-matched peers in an exploratory case-control study. The scores of children with highly concerned parents on tests of cognitive control and psychological wellbeing were statistically similar to controls, suggesting no selective cognitive or psychological detriments from gaming or otherwise in the cases with concerned parents. The case group, however, did spend more time gaming, and scored higher than controls on problem gaming indicators, which also correlated negatively with wellbeing. Within the case group, wellbeing effects seemed mainly to consist in issues of relaxation and sleep, and related to gaming addiction indicators of playing to forget real-world problems, and the feeling of neglecting non-gaming activities. Where most results of research staged for TV never get published, making it difficult to interpret both methods and results, this paper describes findings and participant recruitment in detail. The relationship between parental concern and children’s gaming is discussed, as is the merits and challenges of research conducted with media, such as TV programs and their recruited on-screen participants. (shrink)

Purpose: Tolerance for ambiguity (TFA) is a character trait that is associated with a multitude of benefits for physicians, including increased empathy, greater desire to work in underserved areas, fewer medical errors, enhanced psychological well-being, and lower rates of burnout. Furthermore, it has been shown that TFA is a malleable trait that can be enhanced with interventions such as art courses and group reflection. This study describes the utility of a six-week medical ethics elective course in increasing TFA in first- (...) and second-year medical students.Methods: First- and second-year medical students were enrolled in an elective medical ethics course at Cooper Medical School of Rowan University that guided students in critical thinking, group discussion, and respectful debate regarding various ethical dilemmas in medicine. Students took a validated survey before and after course completion to measure TFA. The average pre- and post-course scores for each semester, as well as the total cohort of 119 students, were compared using paired t-tests.Results: A statistically significant improvement in TFA scores was observed in the overall cohort, as well as in each individual semester of the medical ethics elective course offering.Conclusion: A six-week elective course in medical ethics can significantly improve medical students’ TFA. (shrink)

A child’s age in comparison to the age of her or his classmates (relative age) has been found to be an influential factor on academic achievement, particularly but not exclusively at the beginning of formal schooling. However, few studies have focused on the generalizability of relative age effects. To close this gap, the present study analyzes the generalizability across students with and without immigrant backgrounds, across three student cohorts that entered school under a changing law of school enrollment, and across (...) classes. To this end, we capitalized on representative large-scale data sets from three student cohorts attending public schools in Berlin, the capital of Germany. We analyzed the data using a multilevel framework. Our results for the overall student sample indicate relative age effects for reading and mathematics in favor of the relatively older students in Grade 2 that become somewhat smaller in size in Grade 3. By Grade 8, relative age effects had vanished in reading and had even reversed in favor of the relatively young in mathematics. Furthermore, relative age effects were not found to be systematically different among students with and without immigrant backgrounds, student cohorts, or across classes. Taken together, these results empirically underscore the broad generalizability of the findings as found for the overall student population and replicate the pattern of findings on relative effects as identified by the majority of previous studies. (shrink)

The random]ized clinical trial is widely accepted as the optimal approach to evaluating the safety and efficacy of medical treatments. Resistance to randomized treatment assignment arises regularly, most commonly in situations where the disease is life-threatening and treatments are either unavailable or unsatisfactory. Historical control designs, in which all participants receive the experimental treatment with results compared to a prior cohort, are advocated by some as more ethical in such circumstances; however, such studies are often highly biased in favor (...) of the new treatment and frequently yield misleading results. Alternative controlled designs motivated by the desire to maximize the number of patients with the treatment ultimately determined to be superior have been proposed, but have been challenged on both methodological and ethical grounds. Debates about appropriate and ethical study designs recurred during the recent Ebola Virus Disease epidemic in West Africa. Despite its devastating nature, the EVD epidemic showed the ongoing necessity of conducting randomized trials to obtain convincing evidence of the safety and efficacy of therapeutic interventions. (shrink)

Residual confounding is a common source of bias in observational studies. In this article, we build upon a series of sensitivity analyses methods for residual confounding developed by Brumback et al. and Chiba whose sensitivity parameters are constructed to quantify deviation from conditional exchangeability, given measured confounders. These sensitivity parameters are combined with the observed data to produce a “bias-corrected” estimate of the causal effect of interest. We provide important generalizations of these sensitivity analyses, by allowing for arbitrary exposures (...) and a wide range of different causal effect measures, through the specification of the target causal effect as a parameter in a generalized linear model with the arbitrary link function. We show how our generalized sensitivity analysis can be easily implemented with standard software, and how its sensitivity parameters can be calibrated against measured confounders. We demonstrate our sensitivity analysis with an application to publicly available data from a cohort study of behavior patterns and coronary heart disease. (shrink)

Comparative effectiveness research (CER) is one of the Patient Protection and Affordable Care Act's significant initiatives that aims to improve treatment outcomes and lower health care costs. This article takes CER a step further and suggests a novel clinical application for it. The article proposes the development of a national framework to enable physicians to rapidly perform, through a computerized service, medically sound personalized comparisons of the effectiveness of possible treatments for patients' conditions. A treatment comparison for a given patient (...) would be based on data from electronic health records of a cohort of clinically similar patients who received the treatments previously and whose outcomes were recorded. This framework has unique potential to simultaneously improve the quality of health care, reduce its cost, and alleviate public concerns about rationing and “one size fits all” medicine. (shrink)

ObjectivePrevious research has shown reduced interoceptive accuracy in depression. Attention deficit represents a key symptom of depression. Moreover, IAcc is positively correlated with attention. There is no study that investigates the effect of depression on IAcc and attention. The aim of this study is to examine the mediating effect of IAcc on depression and attention.MethodsThirty-six depressed patients from the Psychosomatic Clinic in Windach were matched with 36 healthy controls according to age and sex and were assessed at Ulm (...) University. All participants completed the Beck Depression Inventory-II, the heartbeat perception task to examine IAcc, and the d2 test assessing selective attention.ResultsDepressed patients showed attention deficits—both for general visual attention and IAcc—compared to healthy controls. The mediation analyses revealed that the relationship between depression and attention is not mediated via IAcc. Furthermore, depression predicts IAcc and attention, but these effects are direct and largely unaffected by the respective other variable.DiscussionThe results of the present study highlight both interoceptive as well as attention deficits in depressed patients. No clear mediation between these variables could be shown in this study. More elaborative research is needed to clarify whether different approaches to improve IAcc are effective for these deficits in depressed patients and could therefore be of importance as an additional aspect of therapy in depression. (shrink)

SummaryUsing a sample of 2090 father and son pairs, the regional variation in height, weight and body mass index with intra- and inter-generational migration within Britain was examined. Highly significant regional differences in means were found only for fathers. The overall mean height difference between regions ranged from about 2.7 cm to 3.1 cm, with the tallest fathers being found in the East & South-East region and the shortest in Wales. The variation in mean weight between regions was less significant, (...) with the difference between the heaviest region and lightest being about 3.5 kg. For BMI the highest mean was in the North and Wales and the lowest in the South-West. Intra-generational migrants were, on average, significantly taller than non-migrants for both fathers and sons, but BMI was only significant in fathers, with migrant fathers, on average, having a lower BMI. There were no significant differences in weight between geographically mobile groups for either fathers or sons. Differentiating between regional in- and out-migration revealed that in the fathers' generation in-migrants were taller, on average, in six of the nine regions. The tallest in-migrants among fathers came into the North region; the tallest out-migrants were from Yorkshire & Humberside and the shortest were from Scotland. The largest positive gain on fathers' height was in the West Midlands region and Scotland, while negative effects were found in the Yorkshire & Humberside, East Midlands and East & South-East regions. For sons in-migrants were taller in all regions except Wales, with the largest differences between in-migrants and non-migrants being in the South-East and South-West. For out-migrants, the tallest sons came from Wales, while the shortest came from the East Midlands region. The North, East Midlands, East & South-East and West Midlands regions were net gainers, while Wales and Scotland were net losers. For BMI among fathers, in-migrants were of lower BMI than non-migrants. For out-migrant fathers, the North-West and South-West regions were the only two regions showing positive values, with the largest negative values being found in the East Midlands and Yorkshire & Humberside. The net effect of migration indicated that the largest gains were in the East Midlands and Yorkshire & Humberside regions and the largest losses were in Scotland and Wales. The inter-generational migration for BMI showed that in-migrating sons into the North-West and Wales had higher BMI than sedentes, while in-migrants into Yorkshire & Humberside were lower in BMI. In all regions out-migrants had lower BMI than non-migrants. The net effect of migration revealed that six of the nine regions were net gainers, while the Yorkshire & Humberside region was a net loser. (shrink)

Background: Strengthening the sense of meaning in life and psychological well-being brings benefits for mental health. The group particularly vulnerable to mental problems are young adults, therefore the aim of our research was to explore how a gratitude intervention will affect the sense of meaning in life, psychological well-being, general health and perceived stress among them. The research also took into account the issue of expressing gratitude.Method: The study involved 80 young adults who were randomly assigned to the experimental group (...) that filled out the specially prepared diaries for a week or the control group. Participants completed the Meaning in Life Questionnaire, the General Health Questionnaire – 28, the Perceived Stress Scale, and the Ryff Scales of Psychological Well-Being twice.Results: In the experimental group significant increases were observed in three areas of psychological well-being: environmental mastery, relationships with others and purpose in life. The significant decrease was also noted in anxiety/insomnia and depression symptoms as well as in perceived stress. There were no differences in the level of meaning in life. There was a positive relationship between expressing gratitude and meaning in life and psychological well-being.Conclusion: Proposed gratitude intervention has the potential to enhance psychological well-being among young adults, however, it may not be effective in enhancing meaning in life. (shrink)

BackgroundInformation processing speed is a marker for cognitive function. It is associated with neural maturation and increases during development. Traditionally, IPS is measured using paper and pencil tasks requiring fine motor skills. Such skills are often impaired in patients with neurological conditions. Therefore, an alternative that does not need motor dexterity is desirable. One option is the computerized symbol digit modalities test, which requires the patient to verbally associate numbers with symbols.MethodsEighty-six participants were examined, 38 healthy and 48 hospitalized for (...) a non-neurological disease. All participants performed the written SDMT, c-SDMT, and the Test of Non-verbal Intelligence Fourth Edition. Statistical analyses included a multivariate analysis of covariance for the effects of intelligence and hospitalization on the performance of the SDMT and c-SDMT. A repeated measures analysis of variance was used to compare performance across c-SDMT trials between inpatients and outpatients.ResultsThe MANCOVA showed that hospitalization had a significant effect on IPS when measured with the SDMT but not with the c-SDMT, while IQ had no effect on IPS. Age was the best predictor of performance of both tests. The repeated measures ANOVA revealed no significant difference in within-test performance between outpatient and inpatient participants in the c-SDMT.ConclusionPerformance of the c-SDMT is not confounded by hospitalization and gives within-test information. As a valid and reliable measure of IPS for children and adolescents, it is suitable for use in both inpatient and outpatient populations. (shrink)

What kinds of evidence reliably support predictions of effectiveness for health and social care interventions? There is increasing reliance, not only for health care policy and practice but also for more general social and economic policy deliberation, on evidence that comes from studies whose basic logic is that of JS Mill's method of difference. These include randomized controlled trials, case–control studies, cohort studies, and some uses of causal Bayes nets and counterfactual-licensing models like ones commonly developed in econometrics. The (...) topic of this paper is the 'external validity' of causal conclusions from these kinds of studies. We shall argue two claims. Claim, negative: external validity is the wrong idea; claim, positive: 'capacities' are almost always the right idea, if there is a right idea to be had. If we are right about these claims, it makes big problems for policy decisions. Many advice guides for grading policy predictions give top grades to a proposed policy if it has two good Mill's-method-of difference studies that support it. But if capacities are to serve as the conduit for support from a method-of-difference study to an effectiveness prediction, much more evidence, and much different in kind, is required. We will illustrate the complexities involved with the case of multisystemic therapy, an internationally adopted intervention to try to diminish antisocial behaviour in young people. (shrink)

Educational reformers all around the globe are continuously searching for ways to make schools more effective and efficient. In Germany, this movement has led to reforms that reduced overall school time of high track secondary schools from 9 to 8 years, which was compensated for by increasing average instruction time per week in lower secondary school. Based on prior research, we assumed that this reform might increase gender disparities in STEM-related outcomes, stress, and health because it required students to learn (...) similar content in less amount of time. Therefore, we investigated how the school time reform affected gender disparities at the end of upper secondary school between 2011 and 2013. Specifically, we considered representative data of the last two cohorts who completed lower secondary school before the reform and the first two cohorts after the reform from the National Educational Panel Study. Potential differences in gender disparities were investigated for upper secondary school outcomes of subject-specific standardized test performance, self-concept, and interest in mathematics, biology and physics, as well as outcomes of school-related stress and health. Overall, we found substantial disparities between girls and boys, which seemed to change little after the reform. Exceptions were the statistically significant gender × reform interactions for one stress dimension and two health dimensions which increased for both boys and girls, but more strongly for girls. (shrink)

Prior research on the impact of ethics education within the business curriculum has yielded mixed results. Although the impact is often found to be positive, it appears to be both small and short-lived. Interpretation of these results, however, is subject to important methodological limitations. The present research employed a longitudinal methodology to evaluate the impact of an M.B.A. program versus a law program on the values and ethical decision making behavior of a cohort of students at two major universities (...) in the northeast. The results suggest that the M.B.A. curriculum remains a value-neutral experience for most students. In contrast, the law school program had a significant impact on both values and ethical decision making. (shrink)

It is well documented that the language skills of preschool children differ substantially and that these differences are highly predictive of their later academic success and achievements. Especially in the early phases of children’s lives, the importance of different structural and process characteristics of the home learning environment has been emphasized and research results have documented that process characteristics such as the quality of parental interaction behavior and the frequency of joint activities vary according to the socio-economic status of the (...) family. Further, both structural and process characteristics are associated with children’s language development. As most of the studies focus on single indicators or didn’t take the dynamics of parenting behavior across age into account, the present paper aims to investigate the associations of different characteristics of the home learning environment as well as their potentially changing impact on the language skills of 2-year-old children. Using data of 2.272 families of the infant cohort study of the German National Educational Panel Study, longitudinally assessed process characteristics and structural characteristics were considered. Language skills of the children at the age of two were measured by a standardized and validated parent report instrument. Results showed that all three process characteristics of the home learning environment are associated with the family’s SES; across three assessment waves nearly all process characteristics predicted children’s vocabulary and grammar skills with some process-specific changes across waves; despite separate direct effects of nearly all HLE-process characteristics in each wave, the amount of explained variance in a joint model including the HLE facets from each wave is hardly higher than in the separate models; and socioeconomic background predicted both language facets of the children in each model even when controlling for the assessed process characteristics of the home learning environment. (shrink)

This article focuses on the early years of children from immigrant families in Germany. Research has documented disparities in young children’s development correlating with their family background, making clear the importance of early intervention. Institutional childcare—as an early intervention for children at risk—plays an important role in Germany, as 34.3% of children below the age of three and 93% of children above that age are in external childcare. This paper focuses on the extent to which children from families with a (...) background of migration differ in their social development when considering their age of entry into early external childcare. Data from the infant cohort study of the German National Educational Panel Study is used to analyze the impact of early institutional childcare before the age of 3 years on children’s social competence at the age of 5 years, controlling for gender, siblings, temperament, home learning activities, and socioeconomic status. Results show the effects of duration of early external childcare on peer problems for children from families with a background of migration, in such a way that children who attend early external childcare for more than 1 year before the age of three show less problem behavior with peers than those who attend for less than a year. These findings have equity implications for children with a migration background living in Germany, especially as the proportion of these children is trending upwards. (shrink)

This study aims at contributing to literature by investigating characteristics of Generation Z's social media uses and gratifications and the moderation effect of economic capital. Specifically, we employed online survey as the main research method to examine the connections between the young generation cohort's online motivations, social media practices, and economic capital. A total of 221 Chinese Generation Z social media users were recruited in the survey. Results indicated that Generation Zs have different social media engagements depending on (...) whether they were connected for daily routine alternatives or socialization; the young cohorts from upper-mid-income families demonstrated a more instrumental-rational habitus to use social media more frequently as a communicative tool than those from low-income families; and motivations and family income interacted to influence Generation Z's social media practices. Findings here provide empirical reference to deepened understandings of the interactions between social media and digital generations, and their connections with digital social inequalities. (shrink)

We provide a model in which students must choose whether or not to cheat on a course exam. By assuming that the moral cost of acting dishonestly decreases as the number of other people who behave in the same way increases, our model explains one important channel by which unethical behavior of other individuals can influence observers’ behavior. Through the use of the Global Games approach of equilibrium selection, we build a framework that provides the micro-foundations of peer effects on (...) academic dishonesty and shows how better student technology of cheating and higher disutility of effort make the cheating equilibrium more likely to be selected. By extending the model, we find that the peer effect strength is not affected by the level of homogeneity of the cohort, but decreases in the size of the class. Our approach may be seen as an important step towards reduced-form models of peer effects on dishonest behavior. (shrink)