The acceptability of early psychological interventions for adults with appearance concerns after burns.

INTRODUCTION: Appearance concerns are common following burns. However, there is a lack of research investigating early psychological interventions for appearance concerns. This qualitative study explored the acceptability of early psychological interventions for appearance concerns after burns. METHODS: Fifteen adults (nine female; 18-56 years) with appearance concerns were interviewed within three months post-burn to explore their views about the acceptability of early psychological interventions for these concerns. Interviews were audio-recorded and transcribed. Template analysis informed data collection and analysis. RESULTS: Three themes represented participants' views about the acceptability of early psychological interventions for appearance concerns: (1) early psychological interventions are absent; (2) early psychological interventions are acceptable within a therapeutic relationship (to manage upsetting emotions and thoughts about appearance, with therapists who are experienced in supporting burns patients); and (3) ambivalence and obstacles exist (e.g., difficulties accepting help, minimising injuries or concerns, and time restrictions following hospital discharge). CONCLUSION: Early psychological interventions for appearance concerns following burns are likely to be acceptable for some patients. However, ambivalence and potential barriers remain to be addressed. Embedding early psychological interventions for appearance concerns into routine burn care could increase acceptability through normalisation.

Most meta-analyses in oral health do not have conclusive and robust results.

OBJECTIVES: In meta-analyses with few studies, between-study heterogeneity is poorly estimated. The Hartung and Knapp (HK) correction and the prediction intervals can account for the uncertainty in estimating heterogeneity and the range of effect sizes we may encounter in future trials, respectively. The aim of this study was to assess the reported use of the HK correction in oral health meta-analyses and to compare the published reported results and interpretation i) to those calculated using eight heterogeneity estimators and the HK adjustment ii) and to the prediction intervals (PIs). METHODS: We sourced systematic reviews (SRs) published between 2021 and 2023 in eighteen leading specialty and general dental journals. We extracted study characteristics at the SR and meta-analysis level and re-analyzed the selected meta-analyses via the random-effects model and eight heterogeneity estimators, with and without the HK correction. For each meta-analysis, we re-calculated the overall estimate, the P-value, the 95 % confidence interval (CI) and the PI. RESULTS: We analysed 292 meta-analyses. The median number of primary studies included in meta-analysis was 8 (interquartile range [IQR] = [5.75-15] range: 3-121). Only 3/292 meta-analyses used the HK adjustment and 12/292 reported PIs. The percentage of statistically significant results that became non-significant varied across the heterogeneity estimators (7.45 %- 16.59 %). Based on the PIs, >60 % of meta-analyses with statistically significant results are likely to change in the future and >40 % of the PIs included the opposite pooled effect. CONCLUSIONS: The precision and statistical significance of the pooled estimates from meta-analyses with at least three studies is sensitive to the HK correction, the heterogeneity variance estimator, and the PIs. CLINICAL SIGNIFICANCE: Uncertainty in meta-analyses estimates should be considered especially when a small number of trials is available or vary notably in their precision. Misinterpretation of the summary results can lead to ineffective interventions being applied in clinical practice.

[Dose adjustment according to renal function in a polymedicated patient included in the medication reconditioning service using medication compliance aids (MCA)]. / Ajuste de dosis según función renal en una paciente polimedicada incluida en el servicio de reacondicionamiento de medicamentos utilizando sistemas personalizados de dosificación (SPD).

78-year-old patient, polymedicated and enrolled in the medication compliance aids service. When she went to pick up her medication, she informed us that for a few months she has been suffering from fatigue, weakness, dizziness and confusion. A medication review is performed, focused on the dosage of renal metabolism or elimination medications, based on the patient's estimated Glomerular Filtration Rate (eGFR). A referral was made to the Primary Care Physician (PCP) through a report, in which the dose reduction of losartan and manidipine was recommended according to the patient's eGFR. The PCP reduced the dose of antihypertensives. A follow-up of the case was carried out, which allowed to observe that the patient stopped presenting the symptoms initially described.

Multiple sclerosis and identity: a mixed-methods systematic review.

PURPOSE: This systematic review addressed the following topics: (1) psychometric measures used to evaluate the identity/self in MS patients; (2) impact of MS on the identity/self of patients; (3) relationships between the identity/self and the adjustment to MS. METHOD: Five electronic databases were searched for all peer-reviewed empirical studies published up to April 2024 (PROSPERO CRD42023485972). Studies were eligible if they included MS patients and examined identity/self through quantitative, qualitative, or mixed-method study design. MMAT (Mixed Method Appraisal Tool) checklist was used to assess the quality of included studies. After conducting narrative synthesis (quantitative studies) and thematic synthesis (qualitative studies), an integration was undertaken following a convergent segregated approach. RESULTS: Forty-three studies were included (13 quantitative, 26 qualitative, and four mixed methods). Studies used measures of "self" to refer to specific domains, and of "identity" to highlight the individual's uniqueness and continuity of experience over time. MS causes a loss of various aspects of self (physical, working, family, and social self) and identity discontinuity. Maintaining a positive self-concept and integrating MS into one's identity are associated with better adjustment to MS. CONCLUSION: Clinicians should consider the centrality of identity redefinition for the promotion of MS patients' adjustment to the illness.

The diverse, uncontrollable, and often invisible symptoms of multiple sclerosis (MS) lead to profound changes in the individual's sense of self and identity.Psychological support interventions for MS patients based on symptom management and/or other specific aspects should be placed in a broader framework that takes into account the issue of redefining identity given its importance for the adjustment to the illness.Healthcare professionals should provide tailored psychological interventions for MS patients that promote the integration of MS into their global self-image and ensure the continuity of their personal identity.Healthcare professionals should help MS patients to redefine their family, professional, and social roles to promote the redefinition of their identity.

Psychological impact of exceptional response in people with advanced cancer: a qualitative exploration.

BACKGROUND: In the cancer context, exceptional response incorporates unusual or unexpected response to anti-cancer treatment. For this study, exceptionally 'good' responses are defined as progression-free survival of more than three times the median from comparable trials. We aimed to explore how people meeting the definition of exceptional response to systemic cancer treatment experience adjust to their unexpected survivorship. METHODS: Individuals with 'exceptional response' to anti-cancer therapy nationally were referred by their treating clinicians to the Exceptional Responders Program. We conducted a qualitative sub-study involving semi-structured interviews with purposively selected participants. Those eligible had metastatic cancer, had survived at least 3 times the expected time since diagnosis, spoke English, and were aged > 18 years. Interviews were audiorecorded, transcribed and analysed thematically; and continued until thematic saturation was achieved. RESULTS: Twenty participants were interviewed. Thirteen were male (65%) with a median age of 63 years. Median time since cancer diagnosis was 6.5 years (range 3-18); survival times ranged between 3 and 10 times that expected. We identified four themes which varied in importance between individuals and over time. CONCLUSION: Exceptional responders may benefit from routine screening of distress and unmet needs to provide psychosocial support. Clinical services must focus on first capturing and then tailoring care to meet the diverse needs of this growing cohort. IMPLICATIONS FOR CANCER SURVIVORS: Adjustment to a diagnosis of advanced cancer and subsequent unexpected long-term survival is an often isolating experience and is common amongst exceptional responders. Seeking psychological and social support may assist with adjustment.

Development and psychometric testing of the clinical adjustment scale for student nurses (CAS-SN): A scale for assessing student nurses' adaptation in clinical settings.

BACKGROUND: Nurse education is critical for preparing student nurses for clinical practice, but the transition to clinical settings poses numerous challenges. A standardized scale to assess student nurses' adjustment in the clinical area is lacking in the Philippines. OBJECTIVE: This paper described the development and evaluation of the Clinical Adjustment Scale for Student Nurses (CAS-SN). DESIGN: An exploratory sequential research design. SETTINGS: Nursing schools in three government owned universities in the Philippines. METHODS: Expert panels and field pretesting established content and face validity. Inter-item and inter-total correlations and Cronbach's α were used to assess the reliability of the scale. Construct validity was evaluated using exploratory factor analysis (EFA). Criterion validity was evaluated with established measures. RESULTS: The CAS-SN comprises 15 items across three subscales: (1) Professional Growth and Interpersonal Engagement, (2) Clinical Competence and Confidence, and (3) Coping and Support Strategies Reliability was excellent and the validity was satisfactory, with significant correlations with academic adjustment, psychological distress, and dropout intention. CONCLUSION: The CAS-SN was found to be a valid and a reliable for assessing student nurses' clinical adjustment. IMPLICATIONS FOR NURSE EDUCATION: The CAS-SN provides a structured framework to assess and monitor student nurses' clinical adaptation, enhancing our understanding of their competence, resilience, and professional identity development. Its integration into nurse education programs can significantly improve the assessment of clinical learning experiences and contribute to better student learning outcomes.

Limitations of the Inter-Unit Reliability: A Set of Practical Examples.

Healthcare quality measures are statistics that serve to evaluate healthcare providers and identify those that need to improve their care. Before using these measures in clinical practice, developers and reviewers assess measure reliability, which describes the degree to which differences in the measure values reflect actual variation in healthcare quality, as opposed to random noise. The Inter-Unit Reliability (IUR) is a popular statistic for assessing reliability, and it describes the proportion of total variation in a measure that is attributable to between-provider variation. However, Kalbfleisch, He, Xia, and Li (2018) [Health Services and Outcomes Research Methodology, 18, 215-225] have argued that the IUR has a severe limitation in that some of the between-provider variation may be unrelated to quality of care. In this paper, we illustrate the practical implications of this limitation through several concrete examples. We show that certain best-practices in measure development, such as careful risk adjustment and exclusion of unstable measure values, can decrease the sample IUR value. These findings uncover potential negative consequences of discarding measures with IUR values below some arbitrary threshold.

Africa must create centres of educational excellence for innovation and development.

This paper explores the following development questions that perplex most Africans: "Why do African countries rely on foreign companies and foreign experts for almost all our development projects? Why can't we build our own roads, process our own food, and mine our own minerals, oil, and gas? Why don't we have world-class hospitals and industries? How can we have so much natural wealth and yet be so poor? Why do we invent so little?" The answer lies in our failure to implement idea number two. There are two major ideas in educational policy. Idea number one is the obligation to educate all children because it is their fundamental human right as enshrined in the 1948 United Nations Declaration of Human Rights. Idea number two is the strategy of establishing and sustaining world class schools and universities for the education of the most highly gifted and highly talented citizens. Developed countries deploy both ideas aggressively. Underdeveloped countries in Africa have not implemented idea number two. Countries that have deployed idea number two have at least one university ranked among the top 200 in the world. The presence of great universities (top 200) in a country is a 21st century indicator of the presence of high levels of innovation, technology, development and wealth in that country. According to the three major rankings of world universities (Shanghai-ARWU, THE, and QS-topuniversities.com), none of the world's top 100 great universities is in Africa. Although Africa was a pioneer among the continents in innovations such as human language, domestication of fire, making of tools, invention of agriculture, development of writing, and creation of great centers of learning in ancient times, it has fallen behind other continents over the last 500 years and it has been disrupted by enslavement and colonization, and the structural adjustment programs (SAPs) of the IMF and the World Bank. Ancient African centers of innovation included the Ancient City of Benin and Timbuktu in Western Africa, the Kingdom of Kush and ancient Egypt in northern Africa, Axum in Eastern Africa, Mapungubwe and Great Zimbabwe in Southern Africa, and the Kingdom of Kongo in central-Africa. An African renaissance will only occur when we implement idea number two by establishing world class schools and at least one great university per African country.

Cet article explore les questions de développement suivantes qui intriguent la plupart des Africains : « Pourquoi les pays africains s'appuient-ils sur des entreprises et des experts étrangers pour presque tous nos projets de développement ? Pourquoi ne pouvons-nous pas construire nos propres routes, transformer nos propres aliments et extraire nos propres minéraux, pétrole et gaz ? Pourquoi n'avons-nous pas d'hôpitaux et d'industries de classe mondiale ? Comment pouvons-nous avoir autant de richesses naturelles et pourtant être si pauvres ? Pourquoi inventons-nous si peu ? La réponse réside dans notre échec à mettre en œuvre l'idée numéro deux. Il y a deux idées majeures en politique éducative. L'idée numéro un est l'obligation d'éduquer tous les enfants, car il s'agit de leur droit humain fondamental tel que consacré dans la Déclaration des droits de l'homme des Nations Unies de 1948. L'idée numéro deux est la stratégie consistant à créer et à maintenir des écoles et des universités de classe mondiale pour l'éducation des citoyens les plus doués et les plus talentueux. Les pays développés déploient ces deux idées de manière agressive. Les pays sous-développés d'Afrique n'ont pas mis en œuvre l'idée numéro deux. Les pays qui ont déployé l'idée numéro deux comptent au moins une université classée parmi les 200 meilleures au monde. La présence de grandes universités (les 200 meilleures) dans un pays est un indicateur du XXIe siècle de la présence de niveaux élevés d'innovation, de technologie, de développement et de richesse dans ce pays. Selon les trois principaux classements des universités mondiales (Shanghai-ARWU, THE et QS-topuniversities.com), aucune des 100 meilleures universités mondiales ne se trouve en Afrique. Bien que l'Afrique ait été un continent pionnier en matière d'innovations telles que le langage humain, la domestication du feu, la fabrication d'outils, l'invention de l'agriculture, le développement de l'écriture et la création de grands centres d'apprentissage dans l'Antiquité, elle a pris du retard sur les autres continents au fil du temps. Ces 500 dernières années ont été perturbées par l'esclavage et la colonisation, ainsi que par les programmes d'ajustement structurel (PAS) du FMI et de la Banque mondiale. Les anciens centres d'innovation de l'Afrique comprenaient l'ancienne ville du Bénin et Tombouctou en Afrique de l'Ouest, le royaume de Kouch et l'Égypte ancienne en Afrique du Nord, Axum en Afrique de l'Est, Mapungubwe et le Grand Zimbabwe en Afrique australe et le royaume de Kongo en Afrique centrale. . Une renaissance africaine ne se produira que lorsque nous mettrons en œuvre l'idée numéro deux en créant des écoles de classe mondiale et au moins une grande université par pays africain.

Human movement strategies in uncertain environments: A synergy-based approach to the stability-agility tradeoff.

Humans frequently prepare for agile movements by decreasing stability. This facilitates transitions between movements but increases vulnerability to external disruptions. Therefore, humans might weigh the risk of disruption against the gain in agility and scale their stability to the likelihood of having to perform an agility-demanding action. We used the theory of motor synergies to investigate how humans manage this stability-agility tradeoff under uncertainty. This theory has long quantified stability using the synergy index, and reduction in stability before movement transitions using anticipatory synergy adjustment (ASA). However, the impact of uncertainty - whether a quick action should be executed or inhibited - on ASA is unknown. Furthermore, the impact of ASA on execution and inhibition of the action is unclear. We combined multi-finger, isometric force production with the go/no-go paradigm. Thirty participants performed constant force (no-go task), rapid force pulse (go task), and randomized go and no-go trials (go/no-go task) in response to visual cues. We measured the pre-cue finger forces and computed ASA using the uncontrolled manifold method and quantified the spatio-temporal features of the force after the visual cue. We expected ASA in both go/no-go and go tasks, but larger ASA for the latter. Surprisingly, we observed ASA only for the go task. For the go/no-go task, 53% of participants increased stability before the cue. The high stability hindered performance, leading to increased errors in no-go trials and lower peak forces in go trials. These results align with the stability-agility tradeoff. It is puzzling why some participants increased stability even though 80% of the trials demanded agility. This study indicates that individual differences in the effect of task uncertainty and motor inhibition on ASA is unexplored in motor synergy theory and presents a method for further development.

[Efficacy and safety of Aviandr in the treatment of anxiety in patients with adjustment disorders after COVID-19]. / Effektivnost' i bezopasnost' novogo preparata Aviandr v lechenii trevogi u patsientov s rasstroistvom adaptatsii posle perenesennoi ostroi koronovirusnoi infektsii.

OBJECTIVE: To investigate the efficacy and safety of Aviandr in the treatment of anxiety in patients with adjustment disorders after COVID-19. MATERIAL AND METHODS: A multicenter prospective open-label study included 109 patients of both sexes aged 18 to 65 years (70 women, 39 men, average age - 41.4±13.18 years) with a leading complaint of anxiety (Hamilton scale score, HAM-A ≥18 - ≤24), which arose after acute coronavirus infections. Clinical manifestations had to meet the diagnostic criteria F43.2 ICD-10. The drug Aviander was prescribed 20 mg 2 times a day for 4 weeks. At the end of taking the drug, patients were monitored for another 1 week (a delayed follow-up visit). Psychopathological, statistical and parametric research methods were used using standardized HAM-A, Montgomery-Asberg scales (MADRS), visual analog asthenia scale (VASH-A), Sheehan Disability Scale (SDS), digital character substitution test (DSST), general clinical impression scale (CGI). RESULTS: Data from 109\110 patients were analyzed to evaluate efficacy\safety. Aviandr was administered 20 mg 2 times daily for 4 weeks. Patients were followed for 1 week (delayed follow-up visit) at the end of treatment. Reducing the intensity of anxiety on the HAM-A scale was - 14.2±4.92 or 69.4±22.66% by the end of treatment. The response rate to therapy (responders are patients with a decrease in the total score on the HAM-A ≥50%) was 83.49%. Remission was achieved (sum of HAM-A scores ≤7) by the end of treatment 68.81% of patients, and 79.8% of patients at the follow-up visit. Significant changes were obtained on the MADRS, VAS-A, SDS and DSST scales. According CGI 45.9% of patients had «much improved¼ and 43.1% of patients had «very much improved¼ by the end of treatment; 58.7% of patients had «much improved¼ and of 33.9% patients had «very much improved¼ at the follow-up visit. 38 adverse events were reported in 27 (24.55%) patients during the study. A definite association with study drug was reported between 5 mild adverse events in 4 (3.64%) patients. No subjects withdrew from the study due to an adverse event. Positive dynamics (reduction of anxiety symptoms, decrease in asthenia) persisted after discontinuation of the study drug. No cases of withdrawal syndrome were observed. CONCLUSION: According to the results of the study, the anxiolytic, antidepressant, antiasthenic and pro-cognitive effects of Aviandr were observed. An increase in the social activity of patients was observed.

Transition, Adjustment, and Healthcare Avoidance: African Immigrant Women's Experiences and Perceptions of Navigating Primary Healthcare in the USA.

This study explores the transition and adjustment of African immigrant women, particularly Ethiopian immigrant women (EIW), as they navigate the U.S. healthcare system and their ability to access and utilize healthcare services. A qualitative cross-sectional design with a mix of purposive and snowball sampling techniques was utilized to recruit EIW (N = 21, ≥18 years) who arrived in the U.S. within the last five years. One-on-one in-depth interviews were conducted to collect data. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically using Nvivo12 software. The thematic analysis revealed three major themes: (1) settling into new life in the U.S. delays EIWs' ability to access primary healthcare; (2) adjusting to the U.S. healthcare system: confusions and mixed perceptions; and (3) avoidance of care: EIW's reasons for PHC visits changed in the U.S. Participants avoided healthcare, except for life-threatening conditions, general check-ups, and maternal healthcare services. Transitional support for legal, residential, employment, and health information could help tackle the challenges of accessing primary healthcare for EIW. Future research should analyze access to healthcare in relation to the everyday struggles of immigrant women, as well as legal and complex structural issues beyond acculturative issues.

Theory of mind skills and peer relationships in children's adjustment to preschool.

School adjustment affects children's future lives in many ways. This study examined the relationship between ToM skills, peer relationships, and school adjustment. Specifically, this study determined whether preschool children's school adjustment could be significantly predicted by theory of mind (ToM) skills and peer relationships. A total of 164 children aged 4 (34.5%), and 5 (38%) years of preschool attendance participated in the study. According to the research, children's age, theory of mind, peer relations, and school adjustment are closely related. It was also found that the theory of mind significantly predicted school adjustment (school liking/avoidance) and that prosocial and aggressive behavior predicted school liking.

Tolerance Mechanisms of Olive Tree (Olea europaea) under Saline Conditions.

The olive tree (Olea europaea L.) is an evergreen tree that occupies 19% of the woody crop area and is cultivated in 67 countries on five continents. The largest olive production region is concentrated in the Mediterranean basin, where the olive tree has had an enormous economic, cultural, and environmental impact since the 7th century BC. In the Mediterranean region, salinity stands out as one of the main abiotic stress factors significantly affecting agricultural production. Moreover, climate change is expected to lead to increased salinization in this region, threatening olive productivity. Salt stress causes combined damage by osmotic stress and ionic toxicity, restricting olive growth and interfering with multiple metabolic processes. A large variability in salinity tolerance among olive cultivars has been described. This paper aims to synthesize information from the published literature on olive adaptations to salt stress and its importance in salinity tolerance. The morphological, physiological, biochemical, and molecular mechanisms of olive tolerance to salt stress are reviewed.

Calcium-Dependent Protein Kinase GhCDPK16 Exerts a Positive Regulatory Role in Enhancing Drought Tolerance in Cotton.

Cotton is essential for the textile industry as a primary source of natural fibers. However, environmental factors like drought present significant challenges to its cultivation, adversely affecting both production levels and fiber quality. Enhancing cotton's drought resilience has the potential to reduce yield losses and support the growth of cotton farming. In this study, the cotton calcium-dependent protein kinase GhCDPK16 was characterized, and the transcription level of GhCDPK16 was significantly upregulated under drought and various stress-related hormone treatments. Physiological analyses revealed that the overexpression of GhCDPK16 improved drought stress resistance in Arabidopsis by enhancing osmotic adjustment capacity and boosting antioxidant enzyme activities. In contrast, silencing GhCDPK16 in cotton resulted in increased dehydration compared with the control. Furthermore, reduced antioxidant enzyme activities and downregulation of ABA-related genes were observed in GhCDPK16-silenced plants. These findings not only enhanced our understanding of the biological functions of GhCDPK16 and the mechanisms underlying drought stress resistance but also underscored the considerable potential of GhCDPK16 in improving drought resilience in cotton.

Predicting major clinical events among Canadian adults with laboratory-confirmed influenza infection using the influenza severity scale.

We developed and validated the Influenza Severity Scale (ISS), a standardized risk assessment for influenza, to estimate and predict the probability of major clinical events in patients with laboratory-confirmed infection. Data from the Canadian Immunization Research Network's Serious Outcomes Surveillance Network (2011/2012-2018/2019 influenza seasons) enabled the selecting of all laboratory-confirmed influenza patients. A machine learning-based approach then identified variables, generated weighted scores, and evaluated model performance. This study included 12,954 patients with laboratory-confirmed influenza infections. The optimal scale encompassed ten variables: demographic (age and sex), health history (smoking status, chronic pulmonary disease, diabetes mellitus, and influenza vaccination status), clinical presentation (cough, sputum production, and shortness of breath), and function (need for regular support for activities of daily living). As a continuous variable, the scale had an AU-ROC of 0.73 (95% CI, 0.71-0.74). Aggregated scores classified participants into three risk categories: low (ISS < 30; 79.9% sensitivity, 51% specificity), moderate (ISS ≥ 30 but < 50; 54.5% sensitivity, 55.9% specificity), and high (ISS ≥ 50; 51.4% sensitivity, 80.5% specificity). ISS demonstrated a solid ability to identify patients with hospitalized laboratory-confirmed influenza at increased risk for Major Clinical Events, potentially impacting clinical practice and research.

The adjustment disorder is not a wastebasket diagnosis: a grounded theory study of psychiatrists' and psychologists' clinical reasoning.

Background: the aim of this study is to understand the diagnostic process undertaken by psychiatrists and psychologists regarding adjustment disorder (AD) in their clinical practice and how they differentiate it from major depressive episode (MDE).Methods: A hermeneutic study using grounded theory techniques was carried out. Semi-structured interviews were conducted with twelve psychiatrists and eight psychologists in Colombia, and transcribed verbatim. Initial line-by-line coding was performed, followed by focused and axial coding to construct categories explaining the professionals' reasoning process.Results: The clinical reasoning of professionals regarding AD was understood through four major categories. (1) Difficulty in addressing the experience of stressful events, as there is a risk of pathologizing and medicalizing them. (2) Mental health diagnoses are necessary but not apodictic. (3) The diagnostic category of AD allows for the description of a fluctuating depressive and anxious syndrome occurring in reaction to a stressful event, whose abnormality criteria are based on intersubjective knowledge of the patient's life history and consequential reasoning regarding the need for professional support. (4) The AD label could potentially protect against overdiagnosis of MDE and overuse of antidepressants. Many clinicians in their practice thus subordinate the diagnosis of MDE to ensuring it is not AD, contrary to what is outlined in diagnostic manuals.Conclusion: This study allowed us to understand the clinical reasoning of psychiatrists and psychologists about AD as a diagnosis that inherently indicates the need to work on coping and intervene in the stressor and should be considered as a diagnostic possibility in the same hierarchy as MDE in reactive syndromes, rather than a residual category.

Clinicians use consequential and intersubjective reasoning to diagnose Adjustment Disorder (AD).Systemic pressures lead to overdiagnosis of Major Depressive Episode (MDE) and excessive antidepressant use.AD should be recognized as a valid non-residual diagnostic category.

Measure of Strength of Evidence for Visually Observed Differences between Subpopulations.

For measuring the strength of visually-observed subpopulation differences, the Population Difference Criterion is proposed to assess the statistical significance of visually observed subpopulation differences. It addresses the following challenges: in high-dimensional contexts, distributional models can be dubious; in high-signal contexts, conventional permutation tests give poor pairwise comparisons. We also make two other contributions: Based on a careful analysis we find that a balanced permutation approach is more powerful in high-signal contexts than conventional permutations. Another contribution is the quantification of uncertainty due to permutation variation via a bootstrap confidence interval. The practical usefulness of these ideas is illustrated in the comparison of subpopulations of modern cancer data.

End-of-life cohorts from the Dartmouth Institute: risk adjustment across health care markets, the relative efficiency of chronic illness utilization, and patient experiences near the end of life.

Since their inception, small area studies intended to measure health system performance have been challenged by concerns that regional variation in health care may be primarily explained by differences in patient health risk. Controlling for regional population differences depends on appropriate risk adjustment, but the adequacy of the methods used in early analyses was contested. A novel response to these concerns was the development of end-of-life cohorts by Dartmouth Atlas investigators. These were used initially to control for differences in population health status in studies investigating relative efficiency across regions. Later, they became useful for studying hospital-level variation in chronic illness care, and for measuring utilization and patient experiences at the very end of life. Altogether, end-of-life cohorts have been invaluable for clarifying the contribution of health system and provider factors to health care variation and outcomes.

Adjustment of the marine ecological red lines in China.

The marine ecological red lines (MERLs) is an institutional innovation of the Chinese government to seek a balance between ecological protection and social development. China's MERLs was designated in 2017, but there are problems such as insufficient consideration of areas of high ecological importance and lack of convergence with marine functional zoning. This paper carries out the adjustment of the MERLs in China by constructing the methods of marine ecological importance assessment and human activities disposal assessment, and the results show that after the adjustment, the type and distribution pattern of China's MERLs is more reasonable, the areas of high ecological importance in the MERLs increases significantly, the intensity of human activities in the MERLs declines significantly, and the unification with the use of marine space is realized. China's adjustment of the MERLs is based on scientific assessment and realizes the coordination of development and protection, which can provide a reference for global marine ecological protection.

Resilience in multicultural classrooms: School relationships can protect the school adjustment of immigrant, refugee and non-immigrant children.

BACKGROUND: According to the risk and resilience perspective, protective factors can attenuate the effect of risks and challenges on children's adjustment. For immigrant and refugee children, supportive relationships in the new context can be particularly beneficial. We expected that supportive school relationships play a protective role for the school adjustment of first-generation immigrant and refugee and non-immigrant children, by moderating the effect of one acculturative challenge (i.e., school language proficiency). AIMS: We investigated the moderating roles of teacher-child and peer relationship quality on the association between German language proficiency and school adjustment (i.e., school achievement and belongingness) among first-generation immigrant and refugee and non-immigrant children. SAMPLE: We recruited n = 278 fourth grade children (Mage = 10.47, SDage = .55, 53.24% female; 37% first-generation immigrant and refugee children). METHODS: Questionnaires assessed children's reported teacher-child and peer relationship quality and school belongingness. One vocabulary test measured children's German proficiency. School achievement was assessed by their grade point average (GPA) and by a reading comprehension test. To investigate our hypotheses, we performed path analyses. RESULTS: Teacher-child relationship mitigated the effect of German proficiency on children's reading comprehension among all children and on GPA among immigrant and refugee children only. Peer relationship buffered the negative effect of German proficiency on school belongingness. CONCLUSIONS: Teacher-child and peer relationship quality can be beneficial for the school adjustment of both first-generation immigrant and refugee children and non-immigrant children.