Young Bereaved Siblings of Security Personnel in Israel: The Role of Parents and Professional Helpers in Satisfying Their Needs.

This paper addresses bereavement of young siblings of security personnel in Israel. It focuses on their needs and their satisfaction. It examines interactions between the siblings, their parents, and professional helpers in this respect. This paper is based on a qualitative study utilizing focus groups of adult bereaved siblings, bereaved parents, and professional helpers. The cross-referencing analysis of the findings revealed distinct patterns of behavior, family dynamics, and interactions with professional helpers, often causing the needs of young bereaved siblings to remain unmet. Professional intervention with young bereaved siblings is recommended through all stages of bereavement, in order to better meet their needs.

De-freezing frozen patient management.

OBJECTIVE: To compare the effectiveness of two methods in encouraging the consideration of a leap from one patient management routine to another: (i) real-time review of the facts by an external medical team (ii) implementation of the 're-thinking-protocol' ('de-Freezing') by both treating and external medical teams. DESIGN: Students accompanied doctors, nurses and patients as non-interrupting observers. When an obvious gap between the expected and actual findings occurred, it was discussed four times: by two teams (treating team, external medical team) in two discussion modes (real-time review, de-Freezing-questionnaire). The students then recorded if a leap was considered for each discussion. SETTING: The study was conducted in the emergency department of the Baruch Padeh Medical Centre, Poriya, Israel. PARTICIPANTS: All patients were included during times when both medical teams (treating, external) were present. INTERVENTION(S): During 14 periods of 5-7 h each, 459 patients were sampled. In 183 patients, 200 gaps were discovered. RESULTS: The external team considered a leap 76 times, compared with 47 by the treating team (P < 0.001). Using the de-Freezing-protocol, the treating team considered a leap 133 times. Interestingly, even the external team benefited from the de-Freezing protocol and considered a leap 140 times (NS compared to the treating team). CONCLUSIONS: While the importance of timely leaping from one patient management routine to another is emphasized in the training of physicians, medical teams too often fail to do so. The de-Freezing-protocol inexpensively encourages the consideration of a leap beyond what is evoked by the involvement of an external team. The protocol is applicable to all medical processes and should be incorporated into medical practice and education.

Efficacy of oral methotrexate in paediatric Crohn's disease: a multicentre propensity score study.

BACKGROUND: Oral methotrexate (MTX) administration avoids weekly injections, reduces costs and may improve quality of life of patients with Crohn's disease (CD), especially children. Routes of administration have never been systematically compared in CD. We aimed to compare effectiveness and safety of orally (PO) versus subcutaneously (SC) administered MTX in paediatric CD. METHODS: 226 children with CD treated with oral or subcutaneous MTX were included in a multicentre, retrospective 1-year cohort study (62% boys, mean age 13.8±2.8 years, 88% previous thiopurines). 38 (17%) were initially commenced on oral, 98 (43%) started subcutaneous and switched to oral and 90 (40%) were treated with subcutaneous only. Matching and 'doubly robust' weighted regression models were based on the propensity score method, controlling for confounding-by-indication bias. 11/23 pretreatment variables were different between the groups, but the propensity score modelling successfully balanced the treatment groups. RESULTS: 76 children (34%) had sustained steroid-free remission with a difference that did not reach significance between the PO and the SC groups (weighted OR=1.72 (95% CI 0.5 to 5.9); p=0.52). There were no differences in need for treatment escalation (p=0.24), elevated liver enzymes (p=0.59) or nausea (p=0.85). Height velocity was lower in the PO group (p=0.006) and time to remission was delayed in the PO group (p=0.036; Fleming (0, 1) test). CONCLUSIONS: In this largest paediatric CD cohort to date, SC administered MTX was superior to PO, but only in some of the outcomes and with a modest effect size. Therefore, it may be reasonable to consider switching children in complete remission treated with subcutaneous MTX to the oral route with close monitoring of inflammatory markers and growth.

Establishment of fetal biometric charts using quantile regression analysis.

OBJECTIVES: Fetal growth evaluation is an essential component of pregnancy surveillance. There have been several methods used to construct growth charts. The conventional charts used in current daily practice are based on small numbers and traditional statistical methods. The purpose of this study was to improve fetal biometric charts based on a much larger number of observations with an alternative statistical method: quantile regression analysis. A comparison between the charts is presented. METHODS: During the 12 years of study, 17,708 sonographic examinations of pregnant women from the north of Israel, between 12 and 42 weeks of pregnancy, were performed. Fetal measurements were obtained by several operators using various equipment and included head circumference, abdominal circumference, and femur length. RESULTS: Growth charts were established based on these measurements. CONCLUSIONS: In this study, we constructed biometric growth charts using a large cohort of pregnant women. These charts offer the advantages of specific estimated regression parameters for each specified percentile, thus better defining the normal range. We suggest using these new charts in routine daily obstetric practice.

Post-Natal Short-Term Home Visiting Programs: An Overview and a Volunteers-Based Program Pilot.

Post-natal home visits have been shown to be one of the most effective ways to prevent child maltreatment and reduce risks among children. Unfortunately, these programs tend to be expensive and thus not accessible or practical in many contexts. To address this problem, this paper reviews the literature on home visits conducted shortly after giving birth, considering different types of programs and their outcomes, while focusing on short-term and volunteer-based programs, two approaches that can answer the gap in accessibility. It then introduces a new, innovative, short-term, home visiting program that was developed in Israel. This post-natal program is uniquely structured as volunteer-based to allow it to be culturally informed and inexpensive and therefore accessible to municipalities. The paper describes how experts in the field developed the program and how the volunteers were trained. It elaborates on the protocol for the three defined home visits, each with a specific focus: (1) preventing risks at home, (2) providing parents with emotional support and tools to deal with stress, and (3) connecting them to community resources. We detail the pilot implementation process and some of the challenges that arise. Finally, we describe the design of the evaluation study that is currently collecting data in an Arab town in the north of Israel, with a final discussion on insights gained thus far from the overall process in light of the literature.

"Care About us First": Israeli Youths' Perspectives on Child Neglect.

Child neglect is considered the most common form of child maltreatment with severe implications for children's development. Nonetheless, there is a dearth of scholarly literature examining child neglect, possibly stemming from a lack of consistent definition. The current qualitative study addresses this gap by aiming to understand the phenomena of child neglect from the direct perspective of youth from the general population, a perspective that has so far barely been considered. Data were collected by 10 focus groups conducted among multicultural youth aged 12 to 15 years in the north of Israel. The qualitative-thematic analysis generated three main themes, each including several subthemes: (a) experience of neglectful behavior (lack of parental care, lack of parental priority, dynamics of blaming the child, rejection, and relinquishment of the child); (b) instrumental characteristics of neglect (lack of material and financial investment in the child, expressions of neglect in providing food and nutrition, poor appearance and hygiene of the child and home); (c) lack of parental involvement (lack of parental guidance, lack of communication and availability, lack of presence in the child's life). The perspectives of the Israeli youth resembled existing conceptualizations of child neglect. The youth also added a new dimension to the conceptualizations in their focus on the emotional context involved in the range of neglectful behaviors they described. This new conceptualization of child neglect is discussed together with some suggestions for how it can inform better professional practice.

Electrochemical Doping of Halide Perovskites by Noble Metal Interstitial Cations.

Metal halide perovskites are an attractive class of semiconductors, but it has proven difficult to control their electronic doping by conventional strategies due to screening and compensation by mobile ions or ionic defects. Noble-metal interstitials represent an under-studied class of extrinsic defects that plausibly influence many perovskite-based devices. In this work, doping of metal halide perovskites is studied by electrochemically formed Au+ interstitial ions, combining experimental data on devices with a computational analysis of Au+ interstitial defects based on density functional theory (DFT). Analysis suggests that Au+ cations can be easily formed and migrate through the perovskite bulk via the same sites as iodine interstitials (Ii + ). However, whereas Ii + compensates n-type doping by electron capture, the noble-metal interstitials act as quasi-stable n-dopants. Experimentally, voltage-dependent, dynamic doping by current density-time (J-t), electrochemical impedance, and photoluminescence measurements are characterized. These results provide deeper insight into the potential beneficial and detrimental impacts of metal electrode reactions on long-term performance of perovskite photovoltaic and light-emitting diodes, as well as offer an alternative doping explanation for the valence switching mechanism of halide-perovskite-based neuromorphic and memristive devices.

Community Change Programs for Children and Youth At-Risk: A Review of Lessons Learned.

The significant role of the community in the lives of children and youth at-risk has become increasingly clear to social work academics and professionals over the last three decades. Alongside the more traditional individual and family responses, community interventions have been designed to catalyze change in the environment of children and youth at-risk and supply holistic and sustainable responses to their needs. Ten such community intervention programs were identified from the United States, Australia, Canada, and Israel. Most employed the community development model, focused on developing leadership and social capital (improving community networking) and advancing coordination between the organizations and sectors in the field of risk among children and youth. The diverse programs reviewed focused both on at-risk children and youth in general or specifically on child abuse and neglect. The programs originated from different health, education, and welfare disciplines and sponsoring authorities. The majority were funded originally by private foundations; however, government involvement was significant, particularly in the adoption and support of initiatives after their development. The current analysis of the programs refers to core issues that arose from the review: professional orientation, main target unit, main initiator, and research and evaluation. Analysis of program characteristics enables identifying relevant aspects of these programs for use by policy, governmental, and nonprofit sector stakeholders seeking to develop similar programs. Conclusions and recommendations to advance the field are suggested considering the current context of government cuts in welfare funds.

SDM Training Modules for Health and Social Care Professionals in Israel.

While the strategy of Shared Decision Making (SDM) originated in the medical field and was later adopted into the mental health arena, little attention has been paid to practice in the broader fields of the allied health and social care professions. These professions are grounded in the recognition of a need for practice that reflects the partnership and collaboration of the professional and the service user working together to further the health and well-being of the user. A pilot training module was developed to introduce and support students in their journey from exposure to the co-production ideology and the SDM strategy into clinical practice in the allied health and social care professions. The aim of the present article is to describe the students' experiences while learning about SDM and their use of this knowledge in their field practice in Israel. The students' experiences highlighted the complexity of integrating SDM into practice both at the individual student level as well as the macro environment. Moreover, it pointed to the need to further develop this co-production paradigm and the SDM strategy into the education of the allied health and social care professions.

Choice of Transport to Hospital in Nonurban Areas in Life-Threatening Situations: A Qualitative Research.

The time it takes to begin treatment in life-threatening situations is critical. Ambulance transport to the hospital in such situations ensures quick and effective treatment but is not always readily available in nonurban areas, or not preferred by the public, for various reasons. The purpose of this qualitative study was to examine the factors that deter or encourage ambulance use in life-threatening situations in the geographic periphery from clients' perspectives. We conducted interviews with 71 patients in 3 medical centers who had arrived by ambulance or by private transport, and with the 3 emergency department directors. The findings revealed that awareness of the clinical situation and health literacy, accessibility of emergency services, geographical conditions, and social and economic factors are central in the decision to utilize this service. We detail research recommendations for strengthening public health literacy and access to services.

Mechanism and Timescales of Reversible p-Doping of Methylammonium Lead Triiodide by Oxygen.

Understanding and controlling the energy level alignment at interfaces with metal halide perovskites (MHPs) is essential for realizing the full potential of these materials for use in optoelectronic devices. To date, however, the basic electronic properties of MHPs are still under debate. Particularly, reported Fermi level positions in the energy gap vary from indicating strong n- to strong p-type character for nominally identical materials, raising serious questions about intrinsic and extrinsic defects as dopants. ​In this work, photoemission experiments demonstrate that thin films of the prototypical methylammonium lead triiodide (MAPbI3 ) behave like an intrinsic semiconductor in the absence of oxygen. Oxygen is then shown to be able to reversibly diffuse into and out of the MAPbI3 bulk, requiring rather long saturation timescales of ≈1 h (in: ambient air) and over 10 h (out: ultrahigh vacuum), for few 100 nm thick films. Oxygen in the bulk leads to pronounced p-doping, positioning the Fermi level universally ≈0.55 eV above the valence band maximum. The key doping mechanism is suggested to be molecular oxygen substitution of iodine vacancies, supported by density functional theory calculations. This insight rationalizes previous and future electronic property studies of MHPs and calls for meticulous oxygen exposure protocols.

COVID-19 related difficulties and perceived coping among university and college students: the moderating role of media-related exposure and stress.

Background: University and college students are not usually identified as a population at risk during the COVID-19 pandemic. Yet, there is growing evidence of their specific distress associated with facing multiple abrupt changes and the need for rapid adaptation to a variety of academic, social, and financial challenges. The extent of their exposure to COVID-19 media and the associated media-related stress may further impair students' perceived coping. Objective: This study assessed COVID-19-related functional difficulties and perceived coping among higher education students in Israel and explored the moderating role played by media coverage of the pandemic in inducing stress and exacerbating COVID-19-related difficulties in perceived coping among students. Method: Data was collected from 7,446 students from seven academic centres in Israel through online questionnaires about four to six weeks after the outbreak of the pandemic in Israel. Results: The findings showed positive associations between COVID-19-related difficulties, media exposure, media-related stress, and decreased levels of perceived coping with the pandemic. Moreover, media-related stress (but not the level of media exposure) moderated the relationship between COVID-19-related difficulties and perceived coping: the associations were significantly stronger for students reporting high media-related stress in comparison to individuals reporting low media-related stress. Conclusions: These results highlight the specific role of media-related stress and the need to distinguish this risk factor from the global impact of exposure to media coverage. The need for self-monitoring of the subjective level of stress associated with media exposure should be part of the psychoeducation efforts provided by public health authorities for promoting self-care during the COVID-19 pandemic.

Antecedentes: Los estudiantes universitarios generalmente no se identifican como una población en riesgo durante la pandemia de COVID-19. Sin embargo, existe una creciente evidencia de angustia específica asociada con enfrentar cambios abruptos múltiples y la necesidad de una rápida adaptación a una variedad de desafíos académicos, sociales y financieros. El alcance de la exposición a los medios de comunicación acerca del COVID-19, y el estrés relacionado a esta exposición, pueden afectar aún más a los estudiantes universitarios en sus estrategias de afrontamiento percibidas.Objetivo: Este estudio evaluó las dificultades funcionales relacionadas con el COVID-19 y el afrontamiento percibido entre los estudiantes de educación superior en Israel y exploró el papel moderador que desempeña la cobertura mediática de la pandemia para inducir estrés y exacerbar las dificultades relacionadas con el COVID-19 en el afrontamiento percibido entre los estudiantes.Método: Se recopilaron datos de 7.446 estudiantes de siete centros académicos en Israel a través de cuestionarios en línea entre cuatro y seis semanas después del estallido de la pandemia en Israel.Resultados: Los hallazgos mostraron asociaciones positivas entre las dificultades relacionadas con COVID-19, la exposición a los medios, el estrés relacionado con los medios y la disminución del nivel de afrontamiento percibido con la pandemia. Además, el estrés relacionado con los medios (pero no el nivel de exposición a los medios) moderó la relación entre las dificultades relacionadas con COVID-19 y el afrontamiento percibido: las asociaciones fueron significativamente más fuertes para los estudiantes que informaron un alto estrés relacionado con los medios en comparación con las personas que informaron un bajo nivel de estrés mediático relacionado.Conclusiones: Estos resultados destacan el papel específico del estrés relacionado con los medios y la necesidad de distinguir este factor de riesgo del impacto global de la exposición a la cobertura de los medios. La necesidad de autocontrol del nivel subjetivo de estrés asociado con la exposición a los medios debe ser parte de los esfuerzos de psicoeducación brindados por las autoridades de salud pública para promover el autocuidado durante la pandemia de COVID-19.

Autonomic function, gastroesophageal reflux in apparent life threatening event.

AIMS: To assess the autonomic function in infants with idiopathic apparent life threatening event (IALTE) with and without gastroesophageal reflux (GER) and to compare the autonomic activity in events of pure obstructive apnea and coupled events of apnea associated with GER. METHODS: Seventeen infants diagnosed with IALTE and GER and 17 matched infants with IALTE only between the ages of 3-28 weeks participated in the study. All infants underwent a polysomnography including esophageal pH measurements. Obstructive apneas with and without associated GER were identified. Heart rate variability (HRV) was evaluated employing time domain analysis for short- and long-term variability. Forty R-R intervals for each epoch preceding, during, and following the episodes, as well as 10 segments of 40 R-R intervals unrelated to apneic episodes were analyzed. RESULTS: A decreased baseline short-term variability among infants with IALTE and GER was found. Both short- and long-term variability were significantly increased in the period preceding the obstructive apnea when compared to the baseline values. No such autonomic activity was observed preceding coupled events of apnea and GER. While a significant increase in long-term variability following an obstructive apnea when compared to the apnea period was observed, no such changes were found following a coupled apnea-GER event. CONCLUSIONS: Infants with history of IALTE and GER have a significant abnormality in their autonomic control that is marked in the coupled events of apnea and GER. This finding is possibly related to medullary autonomic regulation.

Further Insight and Additional Inference Methods for Polynomial Regression Applied to the Analysis of Congruence.

In their seminal paper, Edwards and Parry (1993) presented the polynomial regression as a better alternative to applying difference score in the study of congruence. While this method is increasingly applied in congruence research, its complexity relative to other methods for assessing congruence (e.g., difference score methods) was one of the main claims against its use. The objective of this work is to gain additional insight into the use of polynomial regression in the area of social and behavioral sciences. First, we elaborate on the meaning and the inference based on the coefficients obtained by applying polynomial regression and explain the mathematical terms that are used to describe response surfaces. Then, we introduce additional inference methods and illustrate their application on a real life example from the area of supportive exchanges, using data collected by the Smithers Institute at Cornell University (supported by the National Institute on Alcohol Abuse and Alcoholism). Our work is aimed to provide a guide to researchers who apply polynomial regression in order to assess the effect of congruence between two constructs and enable better understanding and interpretation of the results obtained.

Assessment of end-tidal carbon dioxide during pediatric and adult sedation for endoscopic procedures.

BACKGROUND: Pulse oximetry has become the standard of care during endoscopic procedures, despite the fact that significant alveolar hypoventilation may be undetected. OBJECTIVE: To study the value of end-tidal carbon dioxide (EtCO(2)) measurement during pediatric and adult endoscopic procedures with the patient under general anesthesia (GA) and conscious sedation (CS). DESIGN AND SETTINGS: Oridion Microcap hand-held capnography by using Smart Bite Bloc with oxygen (O(2)) delivery were used for the procedures. Microstream nondispersive infrared (IR) spectroscopy is used to measure the concentration of molecules that absorb IR light in CO(2) exhaled by the subject. For each patient, we defined an "event" based on a combination of a >or=20% change (increase or decrease) in EtCO(2), with at least one of the following: O(2) saturation (SPO(2)) or=20% change of pulse rate or respiratory rate. PATIENTS: We studied 57 patients, with an age range of 4 to 62 years. Nineteen patients (33.3%) had CS and 38 (66.6%) had GA. RESULTS: Twenty patients had no events, 32 had 1 event, and 5 patients had 2 events. The highest observed frequency of an event was noted during upper endoscopy under GA (0.35), followed by upper endoscopy under CS (0.32). Fitted univariate logistic regression models indicated that higher variability in EtCO(2) is associated with a higher probability for an event (P < .0001) and that an increase in age is associated with a lower probability for an event (P < .0001). Significant differences in the frequencies of SPO(2) events were related to the type of procedure (P = .0002; highest estimated probability for upper endoscopy) and GA (P < .0001). Similar conclusions were obtained based on the fitted multivariate model. CONCLUSIONS: EtCO(2) contributes significantly to the prediction of events during endoscopy. A lower mean of EtCO(2), higher variability of EtCO(2), younger age, GA, and upper endoscopy increase the probability of an event.

Preferred sleep position and gross motor achievement in early infancy.

The aim of this study was to assess the effect of an infant's favoured position on their motor development at the age of six months. Seventy-five full-term infants were prospectively observed at home for their preferred sleep, awake, play and uninterrupted positions. A parental log was completed daily and then weekly up to the age of six months, when the Alberta Infant Motor Scale (AIMS) was administered. No significant relationship between the preferred or sleep positions as well as the awake and mutual play positions and gross motor developmental attainment at six months of age was noted. A significant change in the preferred recumbent posture with increased prone positioning both during sleep and awake time over the first six months was noted. A balanced positioning policy while awake, regardless of the infant's preference while recumbent, is not associated with gross motor delay.

Breakdown of the Static Picture of Defect Energetics in Halide Perovskites: The Case of the Br Vacancy in CsPbBr3.

We consider the Br vacancy in CsPbBr3 as a prototype for the impact of structural dynamics on defect energetics in halide perovskites (HaPs). Using first-principles molecular dynamics based on density functional theory, we find that the static picture of defect energetics breaks down; the energy level associated with a Br vacancy is found to be intrinsically dynamic, oscillating by as much as 1 eV on the picosecond time scale at room temperature. These significant energy fluctuations are correlated with the distance between the neighboring Pb atoms across the vacancy and with the electrostatic potential at these Pb atomic sites. We expect this unusually strong coupling of structural dynamics and defect energetics to bear important implications for both experimental and theoretical analyses of defect characteristics in HaPs. It may also hold significant ramifications for carrier transport and defect tolerance in this class of photovoltaic materials.

Predictive factors of early mortality in children with developmental disabilities: a case-comparison analysis.

The aim of this study was to identify the risk factors for early mortality in children with neurodevelopmental disabilities. Of 1000 children who were sequentially referred to the same child developmental center over the period 1975-1985, 81 children died between the ages of 6 months and 22 years (mean, 8.04 years; 6.1 SD). A group of 81 age-matched children and another group of 81 developmentally and age-matched children also referred to the center served as comparison groups. Following multivariate analysis, low developmental quotient, restricted mobility, assisted feeding, and genetic etiology were risk factors for early mortality when compared to the age-matched group (P < .01). In comparison to the developmentally matched group, restricted mobility, genetic etiology, and hearing deficit were identified as significant risk factors (P < .01). Comprehensive treatment at the child development center was demonstrated to be a significant protective factor (P = .004). Socioeconomic variables were not significant in predicting an increased mortality risk in disabled individuals. In conclusion, in addition to mobility and feeding skills, a genetic etiology and hearing deficit are risk factors for early mortality, whereas socioeconomic variables are not. A comprehensive treatment program was found to be a protective factor.

The Short-Term Placebo Response in Children With Attention-Deficit Hyperactivity Disorder (ADHD).

To assess short-term placebo response in 6- to 13-year-old children with ADHD, children who were administered a double-blind placebo-methylphenidate trial, 1 week each, were included in the analysis. Conners' parents and Teacher Rating scales, the Aggregate Neurobehavioral Student Health and Educational Review inventory, and the Matching Familiar Figure Test were employed. A reduction of 30% or more in one or more of the teachers report subscales was observed in 18.8% of the participants. Attention test performance resulted in 58% of children exhibiting reduction in error rates and 36.2% exhibited longer latency period. Significant correlations between placebo response and methylphenidate response in all of the teachers report subscales were found. Base line severity, learning problem and emotional status were found associated with placebo response. Short-term placebo response should be accounted for in children with ADHD.