Dementia awareness raising forum: Improving attitudes towards people living with dementia.

Stigma surrounding dementia is a significant issue affecting individuals and communities leading to discrimination towards those living with the condition. However, the changing paradigm in dementia support to living well with dementia can reduce this stigma and improve community attitudes. A community initiative aimed to address this evaluated the impact of a two-hour education forum involving 92 community members. Presentations from experts, including a person with dementia, addressed dementia-related human rights issues and initiatives to live well with dementia. Attendees completed the new Dementia Community Attitudes Questionnaire (DCAQ) aligned with the evolving paradigm of living well with dementia before and after the forum. Participants with prior dementia education had higher initial scores while those without education showed more significant improvements. Almost all DCAQ items showed post-forum score improvements. This community Dementia Awareness Raising Forum provided an opportunity for people to come together and initiate conversations around dementia resulting in more positive community attitudes.

Advancing the science and practice of rare plant conservation with the Center for Plant Conservation Reintroduction Database.

Premise: Reintroductions or translocations are an increasingly important activity to recover and conserve at-risk plant species. Yet because many are not published in the scientific literature, learning from previous attempts may often require considerable time and effort. The Center for Plant Conservation Reintroduction Database (CPCRD; https://saveplants.org/reintroduction-database/), a new centralized and standardized repository of U.S.-based plant reintroductions, aims to improve the efficiency and effectiveness of accessing data on rare plant reintroductions. Methods: The CPCRD is the product of multiple efforts to assemble information on rare plant reintroductions in the United States. The database comprises a wealth of standardized data on the key stages of a reintroduction, from the planning and implementation phases, to monitoring and management techniques. Results: The CPCRD is a dynamic resource, allowing data contributors to continually update their entries as projects progress. While contributions are ongoing, the CPCRD currently includes 460 projects involving 201 plant taxa, spanning diverse growth forms, ecosystems, and regions. Discussion: The CPCRD and its well-documented and monitored projects provide a valuable practical resource for conservation practitioners, and have supported multiple scientific studies and contributed to the internationally recognized Center for Plant Conservation Best Practices Guidelines.

Restoration age affects microbial-herbaceous plant interactions in an oak woodland.

In degraded ecosystems, soil microbial communities (SMCs) may influence the outcomes of ecological restoration. Restoration practices can affect SMCs, though it is unclear how variation in the onset of restoration activities in woodlands affects SMCs, how those SMCs influence the performance of hard-to-establish woodland forbs, and how different woodland forbs shape SMCs. In this study, we quantified soil properties and species abundances in an oak woodland restoration chronosequence (young, intermediate, and old restorations). We measured the growth of three woodland forb species when inoculated with live whole-soil from young, intermediate, or old restorations. We used DNA metabarcoding to characterize SMCs of each inoculum treatment and the soil after conditioning by each plant species. Our goals were to (1) understand how time since the onset of restoration affected soil abiotic properties, plant communities, and SMCs in a restoration chronosequence, (2) test growth responses of three forb species to whole-soil inoculum from restoration sites, and (3) characterize changes in SMCs before and after conditioning by each forb species. Younger restored woodlands had greater fire-sensitive tree species and lower concentrations of soil phosphorous than intermediate or older restored woodlands. Bacterial and fungal soil communities varied significantly among sites. Forbs exhibited the greatest growth in soil from the young restoration. Each forb species developed a unique soil microbial community. Our results highlight how restoration practices affect SMCs, which can in turn affect the growth of hard-to-establish forb species. Our results also highlight that the choice of forb species can alter SMCs, which could have long-term potential consequences for restoration success.

Tactile cues are more intrinsically linked to motor timing than visual cues in visual-tactile sensorimotor synchronization.

Many tasks require precise synchronization with external sensory stimuli, such as driving a car. This study investigates whether combined visual-tactile information provides additional benefits to movement synchrony over separate visual and tactile stimuli and explores the relationship with the temporal binding window for multisensory integration. In Experiment 1, participants completed a sensorimotor synchronization task to examine movement variability and a simultaneity judgment task to measure the temporal binding window. Results showed similar synchronization variability between visual-tactile and tactile-only stimuli, but significantly lower than visual only. In Experiment 2, participants completed a visual-tactile sensorimotor synchronization task with cross-modal stimuli presented inside (stimulus onset asynchrony 80 ms) and outside (stimulus-onset asynchrony 400 ms) the temporal binding window to examine temporal accuracy of movement execution. Participants synchronized their movement with the first stimulus in the cross-modal pair, either the visual or tactile stimulus. Results showed significantly greater temporal accuracy when only one stimulus was presented inside the window and the second stimulus was outside the window than when both stimuli were presented inside the window, with movement execution being more accurate when attending to the tactile stimulus. Overall, these findings indicate there may be a modality-specific benefit to sensorimotor synchronization performance, such that tactile cues are weighted more strongly than visual information as tactile information is more intrinsically linked to motor timing than visual information. Further, our findings indicate that the visual-tactile temporal binding window is related to the temporal accuracy of movement execution.

Identifying predictors of translocation success in rare plant species.

The fundamental goal of a rare plant translocation is to create self-sustaining populations with the evolutionary resilience to persist in the long term. Yet, most plant translocation syntheses focus on a few factors influencing short-term benchmarks of success (e.g., survival and reproduction). Short-term benchmarks can be misleading when trying to infer future growth and viability because the factors that promote establishment may differ from those required for long-term persistence. We assembled a large (n = 275) and broadly representative data set of well-documented and monitored (7.9 years on average) at-risk plant translocations to identify the most important site attributes, management techniques, and species' traits for six life-cycle benchmarks and population metrics of translocation success. We used the random forest algorithm to quantify the relative importance of 29 predictor variables for each metric of success. Drivers of translocation outcomes varied across time frames and success metrics. Management techniques had the greatest relative influence on the attainment of life-cycle benchmarks and short-term population trends, whereas site attributes and species' traits were more important for population persistence and long-term trends. Specifically, large founder sizes increased the potential for reproduction and recruitment into the next generation, whereas declining habitat quality and the outplanting of species with low seed production led to increased extinction risks and a reduction in potential reproductive output in the long-term, respectively. We also detected novel interactions between some of the most important drivers, such as an increased probability of next-generation recruitment in species with greater seed production rates, but only when coupled with large founder sizes. Because most significant barriers to plant translocation success can be overcome by improving techniques or resolving site-level issues through early intervention and management, we suggest that by combining long-term monitoring with adaptive management, translocation programs can enhance the prospects of achieving long-term success.

Identificación de pronosticadores del éxito de reubicación en especies raras de plantas Resumen El objetivo fundamental de la reubicación de plantas raras es la creación de poblaciones autosuficientes con resiliencia evolutiva que persistan a la larga. De todas maneras, la mayoría de las síntesis de estas reubicaciones se enfocan en unos cuantos factores que influyen sobre los parámetros a corto plazo del éxito (supervivencia y reproducción). Los parámetros a corto plazo pueden ser engañosos si se intenta inferir el crecimiento y la viabilidad en el futuro ya que los factores que promueven el establecimiento pueden diferir de aquellos requeridos para la persistencia a largo plazo. Ensamblamos un conjunto grande de datos representativos en general (n = 275) de las reubicaciones de plantas en riesgo bien documentadas y monitoreadas (7.9 años en promedio) para identificar los atributos de sitio más importantes, las técnicas de manejo y los rasgos de las especies para seis parámetros de ciclos de vida y medidas poblacionales del éxito de reubicación. Usamos el algoritmo de bosque aleatorio para cuantificar la importancia relativa de las 29 variables de pronosticadores para cada medida del éxito. Los factores en los resultados de las reubicaciones variaron con los marcos temporales y las medidas de éxito. Las técnicas de manejo tuvieron la mayor influencia relativa sobre la obtención de parámetros de ciclos de vida y tendencias poblacionales a corto plazo, mientras que los atributos de sitio y los rasgos de la especie fueron más importantes para la persistencia poblacional y las tendencias a largo plazo. En específico, las grandes cantidades de fundadores incrementaron el potencial de reproducción y reclutamiento de la siguiente generación, mientras que la declinación de la calidad del hábitat incrementó el riesgo de extinción y el trasplante de especies con baja producción de semillas redujo el rendimiento del potencial reproductivo a la larga. También detectamos interacciones novedosas entre algunos de los factores más importantes, como el aumento en la probabilidad del reclutamiento en la siguiente generación en especies con tasas mayores de producción de semillas, pero sólo cuando se emparejó con grandes cantidades de fundadores. Ya que las barreras más significativas para el éxito de la reubicación de plantas pueden superarse al mejorar las técnicas o resolver los temas a nivel de sitio por medio de un manejo y una intervención temprana, sugerimos que con la combinación del monitoreo a largo plazo con el manejo adaptativo los programas de reubicación pueden aumentar el prospecto de lograr el éxito a largo plazo.

A pre-post interventional study to reduce time spent on clinical documentation by nurses and midwives.

AIM: To evaluate the impact of a co-designed intervention to reduce time spent on clinical documentation and increase time for direct patient care. DESIGN: A pre- and post-test interventional study with multi-method evaluation, reported according to the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs guidelines. METHODS: An intervention to decrease the burden of documentation was co-designed and implemented. Pre- and post-intervention data were collected via time and motion studies and the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey. Documentation audits were conducted to assess intervention fidelity. RESULTS: Twenty-six shifts were observed (13 pre-intervention, 13 post-intervention). Although the coronavirus pandemic contributed to decreases in staffing levels by 38% (from 118 to 73 staff), the number of task episodes completed increased post-intervention, across all shift patterns. Documentation took less time to complete post-intervention when assessing time per episode. A mean increase of 201 episodes was observed on morning shifts, 78 on evening shifts and 309 on night shifts. There were small increases for time spent on direct patient care compared to pre-intervention but there was less time per episode. Results from the BurDoNsaM survey indicated that participants felt documentation took less time post-intervention. Documentation audits found completion improved as staff gained familiarity, but deteriorated when staffing levels were reduced. CONCLUSION: The intervention was able to reduce time spent completing documentation, increasing the time available for direct patient care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Completing clinical documentation is part of the daily work of nurses and midwives. Clinical documentation needs to accurately capture key information in a concise and streamlined manner to avoid unnecessary burdens and release time for direct patient care. IMPACT: This study tested a co-designed intervention to address the burden of clinical documentation for nurses and midwives, The intervention reduced time spent on clinical documentation and increased time for direct patient care, This study could be replicated to reduce the burden of clinical documentation in other settings and benefit clinicians and patients by releasing more time for direct patient care. REPORTING METHOD: The study is reported using the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs (TREND) guidelines. PATIENT OR PUBLIC CONTRIBUTION: The research project and intervention evaluated in this study were co-designed through a clinician-researcher collaboration. A research team that consisted of clinically based nurses and midwives and nurse scientists was formed to address the burden of clinical documentation. As the end-users of clinical documentation, the clinically based nurse and midwife co-investigators were involved in the design, conduct, interpretation of the data, and preparation of the manuscript.

Investigating the Role of Leading Sensory Modality and Autistic Traits in the Visual-Tactile Temporal Binding Window.

Our ability to integrate multisensory information depends on processes occurring during the temporal binding window. There is limited research investigating the temporal binding window for visual-tactile integration and its relationship with autistic traits, sensory sensitivity, and unusual sensory experiences. We measured the temporal binding window for visual-tactile integration in 27 neurotypical participants who completed a simultaneity judgement task and three questionnaires: the Autism Quotient, the Glasgow Sensory Questionnaire, and the Multi-Modality Unusual Sensory Experiences Questionnaire. The average width of the visual-leading visual-tactile (VT) temporal binding window was 123 ms, significantly narrower than the tactile-leading visual-tactile (TV) window (193 ms). When comparing crossmodal (visual-tactile) stimuli with unimodal (visual-visual or tactile-tactile), the temporal binding window was significantly larger for crossmodal stimuli (VT: 123 ms; TV: 193 ms) than for unimodal pairs of stimuli (visual: 38 ms; tactile 42 ms). We did not find evidence to support a relationship between the size of the temporal binding window and autistic traits, sensory sensitivities, or unusual sensory perceptual experiences in this neurotypical population. Our results indicate that the leading sense presented in a multisensory pair influences the width of the temporal binding window. When tactile stimuli precede visual stimuli it may be difficult to determine the temporal boundaries of the stimuli, which leads to a delay in shifting attention from tactile to visual stimuli. This ambiguity in determining temporal boundaries of stimuli likely influences our ability to decide on whether stimuli are simultaneous or nonsimultaneous, which in turn leads to wider temporal binding windows.

The effects of caffeine and d-amphetamine on spatial span task in healthy participants.

Studies that examined the effect of amphetamine or caffeine on spatial working memory (SWM) and verbal working memory (VWM) have used various tasks. However, there are no studies that have used spatial span tasks (SSTs) to assess the SWM effect of amphetamine and caffeine, although some studies have used digit span tasks (DST) to assess VWM. Previous reports also showed that increasing dopamine increases psychosis-like experiences (PLE, or schizotypy) scores which are in turn negatively associated with WM performance in people with high schizotypy and people with schizophrenia. Therefore, the present study aimed to examine the influence of d-amphetamine (0.45 mg/kg, PO), a dopamine releasing stimulant, on SST, DST, and on PLE in healthy volunteers. In a separate study, we examined the effect of caffeine, a nonspecific adenosine receptor antagonist with stimulant properties, on similar tasks. METHODS: Healthy participants (N = 40) took part in two randomized, double-blind, counter-balanced placebo-controlled cross-over pilot studies: The first group (N = 20) with d-amphetamine (0.45 mg/kg, PO) and the second group (N = 20) with caffeine (200 mg, PO). Spatial span and digit span were examined under four delay conditions (0, 2, 4, 8 s). PLE were assessed using several scales measuring various aspects of psychosis and schizotypy. RESULTS: We failed to find an effect of d-amphetamine or caffeine on SWM or VWM, relative to placebo. However, d-amphetamine increased a composite score of psychosis-like experiences (p = 0.0005), specifically: Scores on Brief Psychiatric Rating Scale, Perceptual Aberrations Scale, and Magical Ideation Scale were increased following d-amphetamine. The degree of change in PLE following d-amphetamine negatively and significantly correlated with changes in SWM, mainly at the longest delay condition of 8 s (r = -0.58, p = 0.006). CONCLUSION: The present results showed that moderate-high dose of d-amphetamine and moderate dose of caffeine do not directly affect performances on DST or SST. However, the results indicate that d-amphetamine indirectly influences SWM, through its effect on psychosis-like experiences. CLINICAL TRIAL REGISTRATION NUMBER: CT-2018-CTN-02561 (Therapeutic Goods Administration Clinical Trial Registry) and ACTRN12618001292268 (The Australian New Zealand Clinical Trials Registry) for caffeine study, and ACTRN12608000610336 for d-amphetamine study.

Dexamphetamine widens temporal and spatial binding windows in healthy participants.

BACKGROUND: The pathophysiology of psychosis is complex, but a better understanding of stimulus binding windows (BWs) could help to improve our knowledge base. Previous studies have shown that dopamine release is associated with psychosis and widened BWs. We can probe BW mechanisms using drugs of specific interest to psychosis. Therefore, we were interested in understanding how manipulation of the dopamine or catecholamine systems affect psychosis and BWs. We aimed to investigate the effect of dexamphetamine, as a dopamine-releasing stimulant, on the BWs in a unimodal illusion: the tactile funneling illusion (TFI). METHODS: We conducted a randomized, double-blind, counterbalanced placebo-controlled crossover study to investigate funnelling and errors of localization. We administered dexamphetamine (0.45 mg/kg) to 46 participants. We manipulated 5 spatial (5-1 cm) and 3 temporal (0, 500 and 750 ms) conditions in the TFI. RESULTS: We found that dexamphetamine increased funnelling illusion (p = 0.009) and increased the error of localization in a delay-dependent manner (p = 0.03). We also found that dexamphetamine significantly increased the error of localization at 500 ms temporal separation and 4 cm spatial separation (p interaction = 0.009; p 500ms|4cm v. baseline = 0.01). LIMITATIONS: Although amphetamine-induced models of psychosis are a useful approach to understanding the physiology of psychosis related to dopamine hyperactivity, dexamphetamine is equally effective at releasing noradrenaline and dopamine, and, therefore, we were unable to tease apart the effects of the 2 systems on BWs in our study. CONCLUSION: We found that dexamphetamine increases illusory perception on the unimodal TFI in healthy participants, which suggests that dopamine or other catecholamines have a role in increasing tactile spatial and temporal BWs.

Dexamphetamine influences funneling illusion based on psychometric score.

OBJECTIVES: Our team previously showed that like the experience of the rubber hand illusion (RHI) in people with schizophrenia and their offspring¸ dexamphetamine administration to healthy volunteers increases the stimulus binding windows (BWs) in RHI. It is not clear if similar expansions of BWs are present for unimodal illusions. Studies have also shown that subjective or objective effects of amphetamine would be linked to between-person variations in personality measures. Therefore, we aimed to examine the effect of dexamphetamine (DEX), a dopamine-releasing stimulant, on illusory perception using unimodal sensory stimuli (Tactile Funneling Illusion [TFI]) across both temporal and spatial variables. We further examined the relationship between changes in psychometric scores and changes in illusion perception induced by dexamphetamine. METHODS: Healthy subjects (N = 20) participated in a randomized, double-blind, counter-balanced, placebo-controlled, cross-over study. The effects of dexamphetamine (0.45 mg/kg, PO, q.d.) on funneling and error of spatial localization (EL) were examined using TFI. Psychotomimetic effects were assessed using a battery of psychological measures. RESULTS: Dexamphetamine did not significantly increased the funneling illusion (p = 0.88) or EL (p = 0.5), relative to placebo. However, the degree of change in psychometric scores following dexamphetamine positively correlated with changes in funneling (ρ = 0.48, p = 0.03, n = 20), mainly at 0 ms delay condition (ρ = 0.6, p = 0.004, n = 20). CONCLUSION: Unlike multimodal illusions, alteration of BWs does not occur for unimodal illusions after administration of a dopamine-releasing agent. However, our findings indicate that moderate release of dopamine, through its psychotomimetic effect, indirectly influences unimodal illusion.

Risk factors associated with 30-day unplanned hospital readmission for patients with mental illness.

Unplanned hospital readmission rate is up to 43% in mental health settings, which is higher than in general health settings. Unplanned readmissions delay the recovery of patients with mental illness and add financial burden on families and healthcare services. There have been efforts to reduce readmissions with a particular interest in identifying patients at higher readmission risk after index admission; however, the results have been inconsistent. This systematic review synthesized risk factors associated with 30-day unplanned hospital readmissions for patients with mental illness. Eleven electronic databases were searched from 2010 to 30 September 2021 using key terms of 'mental illness', 'readmission' and 'risk factors'. Sixteen studies met the selection criteria for this review. Data were synthesized using content analysis and presented in narrative and tabular form because the extracted risk factors could not be pooled statistically due to methodological heterogeneity of the included studies. Consistently cited readmission predictors were patients with lower educational background, unemployment, previous mental illness hospital admission and more than 7 days of the index hospitalization. Results revealed the complexity of identifying unplanned hospital readmission predictors for people with mental illness. Policymakers need to specify the expected standards that written discharge summary must reach general practitioners concurrently at discharge. Hospital clinicians should ensure that discharge summary summaries are distributed to general practitioners for effective ongoing patient care and management. Having an advanced mental health nurse for patients during their transition period needs to be explored to understand how this role could ensure referrals to the general practitioner are eventuated.

Selecting the best candidates for resurrecting extinct-in-the-wild plants from herbaria.

Resurrecting extinct species is a fascinating and challenging idea for scientists and the general public. Whereas some theoretical progress has been made for animals, the resurrection of extinct plants (de-extinction sensu lato) is a relatively recently discussed topic. In this context, the term 'de-extinction' is used sensu lato to refer to the resurrection of 'extinct in the wild' species from seeds or tissues preserved in herbaria, as we acknowledge the current impossibility of knowing a priori whether a herbarium seed is alive and can germinate. In plants, this could be achieved by germinating or in vitro tissue-culturing old diaspores such as seeds or spores available in herbarium specimens. This paper reports the first list of plant de-extinction candidates based on the actual availability of seeds in herbarium specimens of globally extinct plants. We reviewed globally extinct seed plants using online resources and additional literature on national red lists, resulting in a list of 361 extinct taxa. We then proposed a method of prioritizing candidates for seed-plant de-extinction from diaspores found in herbarium specimens and complemented this with a phylogenetic approach to identify species that may maximize evolutionarily distinct features. Finally, combining data on seed storage behaviour and longevity, as well as specimen age in the novel 'best de-extinction candidate' score (DEXSCO), we identified 556 herbarium specimens belonging to 161 extinct species with available seeds. We expect that this list of de-extinction candidates and the novel approach to rank them will boost research efforts towards the first-ever plant de-extinction.

Nursing staff composition and its influence on seclusion in an adult forensic mental health inpatient setting: The truth about numbers.

INTRODUCTION: Research on the influence of nursing staff composition and use of seclusion in the forensic mental health inpatient settings is sparse. Nursing staff composition refers to staffing levels, roles, gender ratio and skill mix of the ward teams. Internationally, the rates of seclusion in some forensic mental health inpatient settings have increased over the past 10 years despite global efforts to reduce and eliminate its use. AIM: To examine whether the use of seclusion in a forensic mental health inpatient setting can be attributed to staffing composition or to contextual factors such as day of the week, month or other clinical factors. METHOD: Retrospective data collection was conducted using seclusion data, daily ward reports and staff rosters. Data were collected for all shifts in the hospital over a six-month period. RESULTS: Three staffing variables were identified as having an influence on the use of seclusion: the number of registered nurses on duty, the presence of the shift coordinator and having a lead nurse on shift. DISCUSSION: Senior nurse oversight and guidance are important factors in assisting staff to identify clinical deterioration and intervene early which may assist services reduce the use of seclusion. IMPLICATIONS FOR PRACTICE: As staffing levels and composition are modifiable, the results of this study may assist nurse leaders to consider workforce improvements to reduce seclusion use.

Nabilone Impairs Spatial and Verbal Working Memory in Healthy Volunteers.

Background: Memory impairments and psychosis-like experiences can be adverse effects of cannabis use. However, reports on the cognitive impact of cannabis use are not consistent. There are also limited studies on the psychotomimetic effects of cannabinoid compounds to reveal the association between cannabis and psychosis. Therefore, we investigated the effect of acute cannabinoid intoxication on verbal working memory (VWM) and spatial working memory (SWM) following oral doses of the synthetic cannabinoid agonist, nabilone (1-2 mg, oral). We further investigated the effect of nabilone on psychosis-like experiences (schizotypy scores) and associations of schizotypy with VWM and SWM. Methods: Healthy participants (n=28) completed spatial and digit span tasks across different delay conditions (0, 6, 12, and 18 sec) after receiving nabilone (1-2 mg, PO) or placebo in a randomized, double-blind, counterbalanced, crossover manner. A subset of participants completed a short battery of schizotypy measures (n=25). Results: Nabilone impaired VWM (p=0.03, weak effect size η2=0.02) and SWM (p=0.00016, η2=0.08). Nabilone did not significantly change overall schizotypy scores. Schizotypy scores were negatively correlated with working memory (WM) averaged across all delays and both modalities, under placebo (ρ=-0.41, p=0.04). In addition, there were significant negative correlations between occasions of cannabis use and overall WM averaged scores across drug treatments (ρ=-0.49, p=0.007) and under placebo (ρ=-0.45, p=0.004). The results showed that the drug effect in the less frequent cannabis users was more pronounced on the SWM (p<0.01) and VWM (p<0.01), whereas there appeared to be little drug effect in the frequent cannabis users. Conclusion: Low doses of synthetic cannabinoid impaired SWM and VWM, indicating that exogenous activation of the cannabinoid system influences cognitive performance. Further, the results replicated previous findings that schizotypy is correlated with deficits in WM. Clinical Trial Registry Name: Nabilone and caffeine effects on the perceptions of visually, auditory, tactile and multimodal illusions in healthy volunteers. Clinical Trial Registration Number: CT-2018-CTN-02561 (Therapeutic Goods Administration Clinical Trial Registry) and ACTRN12618001292268 (The Australian New Zealand Clinical Trials Registry).

Consistency of pediatric pain ratings between dyads: an updated meta-analysis and metaregression.

Accurate assessment of pediatric pain remains a challenge, especially for children who are preverbal or unable to communicate because of their health condition or a language barrier. A 2008 meta-analysis of 12 studies found a moderate correlation between 3 dyads (child-caregiver, child-nurse, and caregiver-nurse). We updated this meta-analysis, adding papers published up to August 8, 2021, and that included intraclass correlation/weighted kappa statistics (ICC/WK) in addition to standard correlation. Forty studies (4,628 children) were included. Meta-analysis showed moderate pain rating consistency between child and caregiver (ICC/WK = 0.51 [0.39-0.63], correlation = 0.59 [0.52-0.65], combined = 0.55 [0.48-0.62]), and weaker consistency between child and health care provider (HCP) (ICC/WK = 0.38 [0.19-0.58], correlation = 0.49 [0.34-0.55], combined = 0.45; 95% confidence interval 0.34-0.55), and between caregiver and HCP (ICC/WK = 0.27 [-0.06 to 0.61], correlation = 0.49 [0.32 to 0.59], combined = 0.41; 95% confidence interval 0.22-0.59). There was significant heterogeneity across studies for all analyses. Metaregression revealed that recent years of publication, the pain assessment tool used by caregivers (eg, Numerical Rating Scale, Wong-Baker Faces Pain Rating Scale, and Visual Analogue Scale), and surgically related pain were each associated with greater consistency in pain ratings between child and caregiver. Pain caused by surgery was also associated with improved rating consistency between the child and HCP. This updated meta-analysis warrants pediatric pain assessment researchers to apply a comprehensive pain assessment scale Patient-Reported Outcomes Measurement Information System to acknowledge psychological and psychosocial influence on pain ratings.

Simulator assessment of innovative intersection designs on driver speeds and trajectories.

Intersections are over-represented in crash statistics internationally, suggesting that treatments targeting intersections could substantially improve road safety. Aligning with a Safe Systems approach, several innovative intersection configurations have been proposed. We evaluated the effectiveness of five designs on reducing speed and modifying conflict angles using a driving simulator. The designs were 1) cut-through, 2) modified restricted squircle, 3) unrestricted squircle, 4) raised approach, and 5) raised intersection. For the higher speed green light condition, speed reductions for vehicles travelling straight through the intersection were seen for all five innovative designs on approach to the intersection and at critical conflict points within the intersection. Within the intersection specifically, speed reductions ranged from 1) 7-8 km/h for the modified restricted squircle, 2) 12.5-16.5 km/h for the unrestricted squircle, raised approach, and raised intersection, and 3) 15-19 km/h for the cut-through. In contrast, speeds for drivers turning right were either not substantially reduced (modified restricted squircle, unrestricted squircle, and raised intersection) or were increased (raised approach and cut-through). Beneficial modification of conflict angles were also observed at conflict points for three of the five designs: cut-through, and two variations of the squircle design. Innovative intersection designs may be effective in reducing intersection crash risk by reducing speeds and conflict angles.

The role of genus and life span in predicting seed and vegetative trait variation and correlation in Lathyrus, Phaseolus, and Vicia.

PREMISE: Annual and perennial life history transitions are abundant among angiosperms, and understanding the phenotypic variation underlying life span shifts is a key endeavor of plant evolutionary biology. Comparative analyses of trait variation and correlation networks among annual and perennial plants is increasingly important as new herbaceous perennial crops are being developed for edible seed. However, it remains unclear how seed to vegetative growth trait relationships correlate with life span. METHODS: To assess the relative roles of genus and life span in predicting phenotypic variation and trait correlations, we measured seed size and shape, germination proportion, and early-life-stage plant height and leaf growth over 3 mo in 29 annual and perennial, herbaceous congeneric species from three legume genera (Lathyrus, Phaseolus, and Vicia). RESULTS: Genus was the strongest predictor of seed size and shape variation, and life span consistently predicted plant height and leaf number at single time points. Correlation networks revealed that annual species had significant associations between seed traits and vegetative traits, whereas perennials had no significant seed-vegetative associations. Each genus also differed in the extent of integration between seed and vegetative traits, as well as within-vegetative-trait correlation patterns. CONCLUSIONS: Genus and life span were important for predicting aspects of early-life-stage phenotypic variation and trait relationships. Differences in phenotypic correlation may indicate that selection on seed size traits will impact vegetative growth differently depending on life span, which has important implications for nascent perennial breeding programs.

Improving species status assessments under the U.S. Endangered Species Act and implications for multispecies conservation challenges worldwide.

Despite its successes, the U.S. Endangered Species Act (ESA) has proven challenging to implement due to funding limitations, workload backlog, and other problems. As threats to species survival intensify and as more species come under threat, the need for the ESA and similar conservation laws and policies in other countries to function efficiently has grown. Attempts by the U.S. Fish and Wildlife Service (USFWS) to streamline ESA decisions include multispecies recovery plans and habitat conservation plans. We address species status assessment (SSA), a USFWS process to inform ESA decisions from listing to recovery, within the context of multispecies and ecosystem planning. Although existing SSAs have a single-species focus, ecosystem-based research can efficiently inform multiple SSAs within a region and provide a foundation for transition to multispecies SSAs in the future. We considered at-risk grassland species and ecosystems within the southeastern United States, where a disproportionate number of rare and endemic species are associated with grasslands. To initiate our ecosystem-based approach, we used a combined literature-based and structured World Café workshop format to identify science needs for SSAs. Discussions concentrated on 5 categories of threats to grassland species and ecosystems, consistent with recommendations to make shared threats a focus of planning under the ESA: (1) habitat loss, fragmentation, and disruption of functional connectivity; (2) climate change; (3) altered disturbance regimes; (4) invasive species; and (5) localized impacts. For each threat, workshop participants identified science and information needs, including database availability, research priorities, and modeling and mapping needs. Grouping species by habitat and shared threats can make the SSA process and other planning processes for conservation of at-risk species worldwide more efficient and useful. We found a combination of literature review and structured discussion effective for identifying the scientific information and analysis needed to support the development of multiple SSAs. Article impact statement: Species status assessments can be improved by an ecosystem-based approach that groups imperiled species by shared habitats and threats.

Mejoramiento de la Evaluación del Estado de una Especie bajo el Acta de Especies en Peligro de los Estados Unidos y Sus Consecuencias para los Retos de la Conservación Multiespecie a Nivel Mundial Resumen A pesar de su éxito, el Acta de Especies en Peligro de los E.U.A. (AEP) ha sido un reto de implementación por las limitaciones en su financiamiento, el retraso en la carga de trabajo y otros problemas. Conforme se intensifican las amenazas a la supervivencia de las especies y más especies resultan amenazadas, aumenta la necesidad de que la AEP y las políticas similares de otros países funcionen efectivamente. Los intentos por parte del Servicio Estadounidense de Pesca y Fauna (SEPF) para optimizar las decisiones de la AEP incluyen planes multiespecie de recuperación y planes de conservación de hábitat (PRH). Abordamos la evaluación del estado de las especies (EEE), un proceso del SEPF para orientar las decisiones del AEP desde el listado hasta la recuperación, dentro del contexto de la planeación multiespecie y de ecosistemas. Aunque las EEE existentes tienen un enfoque sobre una única especie, la investigación basada en el ecosistema puede orientar eficientemente a múltiples EEE dentro de una región y proporcionar una base para la transición a las EEE multiespecie en el futuro. Consideramos a las especies y los ecosistemas en riesgo de los pastizales del sureste de los Estados Unidos, en donde un número desproporcionado de especies raras y endémicas está asociado con los pastizales. Para iniciar nuestra estrategia basada en el ecosistema, usamos un formato de taller de World Café estructurado y basado en la literatura para identificar la necesidad de tener EEE. Las discusiones se centraron en cinco categorías de amenazas para las especies y ecosistemas de los pastizales, consistentes con las recomendaciones para volver a las amenazas compartidas un foco de la planeación bajo la AEP: (1) pérdida del hábitat, fragmentación y disrupción de la conectividad funcional; (2) cambio climático; (3) regímenes alterados de perturbación; (4) especies invasoras; y (5) impactos localizados. Para cada amenaza, los participantes del taller identificaron las necesidades científicas y de información, incluyendo la disponibilidad de bases de datos, prioridades de la investigación y necesidades de modelado y mapeado. La agrupación de las especies por hábitat y amenaza compartida puede hacer más eficientes y útiles el proceso de EEE y otros procesos de planeación de la conservación de especies en riesgo a nivel mundial. Encontramos una combinación de revisiones bibliográficas y discusiones estructuradas para identificar la información y el análisis necesarios para respaldar el desarrollo de múltiples EEE.

Using machine learning to predict paediatric 30-day unplanned hospital readmissions: a case-control retrospective analysis of medical records, including written discharge documentation.

Objectives To assess whether adding clinical information and written discharge documentation variables improves prediction of paediatric 30-day same-hospital unplanned readmission compared with predictions based on administrative information alone. Methods A retrospective matched case-control study audited the medical records of patients discharged from a tertiary paediatric hospital in Western Australia (WA) between January 2010 and December 2014. A random selection of 470 patients with unplanned readmissions (out of 3330) were matched to 470 patients without readmissions based on age, sex, and principal diagnosis at the index admission. Prediction utility of three groups of variables (administrative, administrative and clinical, and administrative, clinical and written discharge documentation) were assessed using standard logistic regression and machine learning. Results Inclusion of written discharge documentation variables significantly improved prediction of readmission compared with models that used only administrative and/or clinical variables in standard logistic regression analysis (χ2 17=29.4, P=0.03). Highest prediction accuracy was obtained using a gradient boosted tree model (C-statistic=0.654), followed closely by random forest and elastic net modelling approaches. Variables highlighted as important for prediction included patients' social history (legal custody or patient was under the care of the Department for Child Protection), languages spoken other than English, completeness of nursing admission and discharge planning documentation, and timing of issuing discharge summary. Conclusions The variables of significant social history, low English language proficiency, incomplete discharge documentation, and delay in issuing the discharge summary add value to prediction models. What is known about the topic? Despite written discharge documentation playing a critical role in the continuity of care for paediatric patients, limited research has examined its association with, and ability to predict, unplanned hospital readmissions. Machine learning approaches have been applied to various health conditions and demonstrated improved predictive accuracy. However, few published studies have used machine learning to predict paediatric readmissions. What does this paper add? This paper presents the findings of the first known study in Australia to assess and report that written discharge documentation and clinical information improves unplanned rehospitalisation prediction accuracy in a paediatric cohort compared with administrative data alone. It is also the first known published study to use machine learning for the prediction of paediatric same-hospital unplanned readmission in Australia. The results show improved predictive performance of the machine learning approach compared with standard logistic regression. What are the implications for practitioners? The identified social and written discharge documentation predictors could be translated into clinical practice through improved discharge planning and processes, to prevent paediatric 30-day all-cause same-hospital unplanned readmission. The predictors identified in this study include significant social history, low English language proficiency, incomplete discharge documentation, and delay in issuing the discharge summary.

Self-Management Group Education to Reduce Fear of Hypoglycemia as a Barrier to Physical Activity in Adults Living With Type 1 Diabetes: A Pilot Randomized Controlled Trial.

OBJECTIVES: The aim of this study was to evaluate the feasibility, acceptability and preliminary efficacy of a theory-driven group education intervention designed to reduce fear of hypoglycemia (FoH) as a barrier to physical activity (PA) in adults with type 1 diabetes (T1D). METHODS: This study was a single-blinded, pilot randomized controlled trial of adults aged 18 to 65 years and living with T1D in Western Australia. Participants were randomized (1:1) to standard care or intervention with self-management education. Primary outcomes were feasibility and acceptability of the study procedures, and change to barriers to PA and FoH. Secondary outcomes were change to attitudes and intentions toward PA, self-reported participation in PA, self-efficacy, diabetes distress and well-being. To calculate effect sizes, we used a Bayesian comparison of the between-group difference scores (i.e. [scoret2 - scoret1]TREATMENT vs [scoret2 - scoret1]CONTROL). RESULTS: We randomized 117 participants with T1D, 86 (74%) of whom provided baseline data and attended initial workshops. Of these participants, 81% attended the booster workshop 4 weeks later. They were 45±12 years of age, reported high levels of activity and had been living with T1D for 20±14 years. Small-to-moderate effect sizes [ESs] in favour of the intervention were observed at 12 weeks for overall barriers to PA (ES, -0.38; highest density interval, -0.92 to 0.17), self-efficacy for blood glucose management after PA (ES, 0.45; highest density interval, 0 to 0.91), diabetes distress (ES, -0.29; highest density interval, -0.77 to 0.15) and well-being (ES, 0.36; highest density interval, -0.12 to 0.8). CONCLUSIONS: Quantitative findings indicate study procedures were acceptable to participants and feasible to deliver. A future definitive trial is justified to replicate preliminary efficacy and to determine the utility of the intervention for improving PA participation.