Social anxiety mediates between victimization experiences and internet addiction among adolescents: results from propensity score matching.

Background: Previous research has indicated that Victimization Experiences (VE) may be linked to a heightened likelihood of developing psychological symptoms and Internet Addiction (IA) among adolescents. However, the precise mechanism through which VE contributes to IA in adolescents remains uncertain. This study aimed to investigate whether Social Anxiety (SA) serves as a mediation between VE and IA, utilizing the framework of General Strain Theory. Methods: A cross-sectional survey among 11 middle schools or high schools in Macao was conducted from October to December 2022. Respondents in the victimized group and non-victimized group were 1:1 paired using Propensity Score Matching (PSM) to control the potential confounding factors. Results: A total of 1,089 questionnaires were valid for analysis and 311 pairs were generated through PSM. Respondents in the victimized group reported significantly higher IA than those in non-victimized group (23.5% vs. 12.5%, p < 0.001) after PSM treatment. Multivariate logistic regression analysis showed that VE (p = 0.015, OR = 1.750, 95% CI = 1.115 to 2.746, E-value = 2.90) and SA (p < 0.001, OR = 1.052, 95% CI = 1.030 to 1.074, E-value = 1.29) were the predictors of IA. The model successfully classified 81.7% of cases overall (R 2 N = 0.133). Further analysis indicated that SA mediates between VE and IA (Z = 3.644, p < 0.001). Conclusion: This study revealed the potential mediation effect of SA on the link between VE and IA. By acknowledging the mediating influence of SA, researchers and practitioners can develop more accurate and effective strategies to mitigate Internet Addiction among adolescents.

Routine Emergency Department Screening to Decrease Subsequent Physical Abuse.

STUDY OBJECTIVE: Emergency department (ED) screening for child physical abuse has been widely implemented, with uncertain effects on child abuse identification. Our goal was to determine the effect of screening on referrals to child protective services (CPS) identifying abuse. METHODS: We performed a retrospective cohort study of children younger than 6 years old with an ED encounter at 1 of 2 large health care systems, one of which implemented routine child abuse screening. The main outcome was initial (<2 days) or subsequent (3 to 180 days) referral to CPS identifying child abuse using linked records. We compared outcomes for the 2-year period after screening was implemented to the preperiod and nonscreening EDs using generalized estimating equations to adjust for sex, age, race/ethnicity, payor and prior ED encounters and clustered by center. RESULTS: Of the 331,120 ED encounters, 41,589 (12.6%) occurred at screening EDs during the screening period. Screening was completed in 34,272 (82%) and was positive in 188 (0.45%). Overall, 7,623 encounters (2.3%) had a subsequent referral, of which 589 (0.2%) identified moderate or severe abuse. ED screening did not change initial (adjusted odds ratio [aOR]=1.01, 95% confidence interval [CI] 0.89 to 1.15) or subsequent referral to CPS when compared to the prescreening period (aOR=1.05, 95% CI 0.9 to 1.18) or to the nonscreening EDs (aOR=1.06, 95% CI 0.92 to 1.21). CONCLUSION: Routine screening did not affect initial or subsequent referrals to CPS.

Design of nanoconstructs that exhibit enhanced hemostatic efficiency and bioabsorbability.

Hemorrhage is a prime cause of death in civilian and military traumatic injuries, whereby a significant proportion of death and complications occur prior to paramedic arrival and hospital resuscitation. Hence, it is crucial to develop hemostatic materials that are able to be applied by simple processes and allow control over bleeding by inducing rapid hemostasis, non-invasively, until subjects receive necessary medical care. This tutorial review discusses recent advances in synthesis and fabrication of degradable hemostatic nanomaterials and nanocomposites. Control of assembly and fine-tuning of composition of absorbable (i.e., degradable) hemostatic supramolecular structures and nanoconstructs have afforded the development of smart devices and scaffolds capable of efficiently controlling bleeding while degrading over time, thereby reducing surgical operation times and hospitalization duration. The nanoconstructs that are highlighted have demonstrated hemostatic efficiency pre-clinically in animal models, while also sharing characteristics of degradability, bioabsorbability and presence of nano-assemblies within their compositions.

Making the case for spirometry as part of the perioperative multidisciplinary team assessment.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and is significantly underdiagnosed in the community. Respiratory impairment is a key risk factor for perioperative morbidity and mortality. The National Institute for Health and Care Excellence (NICE) does not recommend routine spirometry before major surgery. However, in this article, we present the potential benefits of targeted spirometry in high-risk patient groups. Of 183 patients who underwent targeted preoperative spirometry, 25/70 (35.7%) of those with airflow obstruction had no previously known respiratory diagnosis. Of patients with known COPD, 20/46 (43.5%) were not prescribed optimum inhaled therapies for their degree of lung function deficit. Knowledge of lung function in respiratory disease helps to optimise patients perioperatively and facilitate shared decision making regarding the benefits and risk of surgeries. We propose that targeted spirometry should be used as part of the perioperative multidisciplinary team assessment of selected patients.

The Impact of the COVID-19 Pandemic on Child Protection System Referrals and Responses in Colorado, USA.

Although the coronavirus disease 2019 (COVID-19) has amplified risk factors known to increase children's vulnerability to abuse and neglect, emerging evidence suggests declines in maltreatment reporting and responding following COVID-19 social distancing protocols in the United States. Using statewide administrative data, this study builds on the current state of knowledge to better understand the volume of child protection system (CPS) referrals and responses in Colorado, USA before and during the early phase of the COVID-19 pandemic and to determine whether there were differences in referral and response rates by case characteristics. Results indicated an overall decline in referrals and responses during COVID-19 when compared to the previous year. Declines were specific to case characteristics, such as reporter and maltreatment type. Implications regarding the impact of the COVID-19 pandemic on child maltreatment reporting and CPS response are discussed.

A Tale of Drug-Carrier Optimization: Controlling Stimuli Sensitivity via Nanoparticle Hydrophobicity through Drug Loading.

Interactions between drug molecules, nanocarrier components, and surrounding media influence the properties and therapeutic efficacies of nanomedicines. In this study, we investigate the role that reversible covalent loading of a hydrophobic drug exerts on intra-nanoparticle physical properties and explore the utility of this payload control strategy for tuning the access of active agents and, thereby, the stimuli sensitivity of smart nanomaterials. Glutathione sensitivity was controlled via altering the degree of hydrophobic payload loading of disulfide-linked camptothecin-conjugated sugar-based nanomaterials. Increases in degrees of camptothecin conjugation (fCPT) decreased aqueous accessibility and reduced glutathione-triggered release. Although the lowest fCPT gave the fastest camptothecin release, it resulted in the lowest camptothecin concentration. Remarkably, the highest fCPT resulted in a 5.5-fold improved selectivity against cancer vs noncancerous cells. This work represents an advancement in drug carrier design by demonstrating the importance of controlling the amount of drug loading on the overall payload and its availability.

Child, Family, and Case Characteristics Associated With Reentry Into Out-of-Home Care Among Children and Youth Involved With Child Protection Services.

Many children and youth with child protection services (CPS) involvement enter out-of-home care. The aims of this study were to examine rates of reentry and risk factors associated with reentry into out-of-home care among children and youth involved in the child protection (reported for abuse/neglect) and youth-in-conflict (reported for behavioral issues) programs. This study used administrative data from Colorado's Statewide Automated Child Welfare Information System, which contains information on all children and youth who enter Colorado's CPS. Of the 14,461 children and youth in the child protection program and 2,353 children and youth in the youth-in-conflict program, 14.7% and 35.1%, respectively, reentered into out-of-home care. Families' prior history of CPS involvement and current CPS case characteristics better explained reentry into out-of-home care than child and family demographic characteristics alone. Understanding risk factors associated with reentry into out-of-home care is critical to inform the prevention of child maltreatment recurrence and ensure the safety, permanency, and well-being of children and youth.

Shared perioperative decision making: a shift in the doctor-patient paradigm.

The high-risk surgical patient only constitutes approximately 4% of the elective non-cardiac surgical population but contributes to the vast majority of in-hospital deaths following surgery. This, in conjunction with a high morbidity rate, can lead to a perioperative pathway fraught with challenges. It is incredibly difficult to anticipate which complications may arise and the risks involved before surgery. It is for this reason that patients need to be engaged in the decision-making processes regarding their perioperative care involved before major surgery. A combination of good medical practice, medicolegal influences and a governmental drive have begun to result in a shift away from paternalistic medicine to a shared decision-making approach. This article defines shared decision making, explores its benefits and limitations and addresses the relevant legal literature.

The effect of isolation, fragmentation, and population bottlenecks on song structure of a Hawaiian honeycreeper.

Little is known about how important social behaviors such as song vary within and among populations for any of the endemic Hawaiian honeycreepers. Habitat loss and non-native diseases (e.g., avian malaria) have resulted in isolation and fragmentation of Hawaiian honeycreepers within primarily high elevation forests. In this study, we examined how isolation of Hawai'i 'amakihi (Chlorodrepanis virens) populations within a fragmented landscape influences acoustic variability in song. In the last decade, small, isolated populations of disease tolerant 'amakihi have been found within low elevation forests, allowing us to record 'amakihi songs across a large elevational gradient (10-1800 m) that parallels disease susceptibility on Hawai'i island. To understand underlying differences among populations, we examined the role of geographic distance, elevation, and habitat structure on acoustic characteristics of 'amakihi songs. We found that the acoustic characteristics of 'amakihi songs and song-type repertoires varied most strongly across an elevational gradient. Differences in 'amakihi song types were primarily driven by less complex songs (e.g., fewer frequency changes, shorter songs) of individuals recorded at low elevation sites compared to mid and high elevation populations. The reduced complexity of 'amakihi songs at low elevation sites is most likely shaped by the effects of habitat fragmentation and a disease-driven population bottleneck associated with avian malaria, and maintained through isolation, localized song learning and sharing, and cultural drift. These results highlight how a non-native disease through its influence on population demographics may have also indirectly played a role in shaping the acoustic characteristics of a species.

Crimped Nanofibrous Biomaterials Mimic Microstructure and Mechanics of Native Tissue and Alter Strain Transfer to Cells.

To fully recapitulate tissue microstructure and mechanics, fiber crimping must exist within biomaterials used for tendon/ligament engineering. Existing crimped nanofibrous scaffolds produced via electrospinning are dense materials that prevent cellular infiltration into the scaffold interior. In this study, we used a sacrificial fiber population to increase the scaffold porosity and evaluated the effect on fiber crimping. We found that increasing scaffold porosity increased fiber crimping and ensured that the fibers properly uncrimped as the scaffolds were stretched by minimizing fiber-fiber interactions. Constitutive modeling demonstrated that the fiber uncrimping produced a nonlinear mechanical behavior similar to that of native tendon and ligament. Interestingly, fiber crimping altered strain transmission to the nuclei of cells seeded on the scaffolds, which may account for previously observed changes in gene expression. These crimped biomaterials are useful for developing functional fiber-reinforced tissues and for studying the effects of altered fiber crimping due to damage or degeneration.

Bioacoustics for species management: two case studies with a Hawaiian forest bird.

The management of animal endangered species requires detailed information on their distribution and abundance, which is often hard to obtain. When animals communicate using sounds, one option is to use automatic sound recorders to gather information on the species for long periods of time with low effort. One drawback of this method is that processing all the information manually requires large amounts of time and effort. Our objective was to create a relatively "user-friendly" (i.e., that does not require big programming skills) automatic detection algorithm to improve our ability to get basic data from sound-emitting animal species. We illustrate our algorithm by showing two possible applications with the Hawai'i 'Amakihi, Hemignathus virens virens, a forest bird from the island of Hawai'i. We first characterized the 'Amakihi song using recordings from areas where the species is present in high densities. We used this information to train a classification algorithm, the support vector machine (SVM), in order to identify 'Amakihi songs from a series of potential songs. We then used our algorithm to detect the species in areas where its presence had not been previously confirmed. We also used the algorithm to compare the relative abundance of the species in different areas where management actions may be applied. The SVM had an accuracy of 86.5% in identifying 'Amakihi. We confirmed the presence of the 'Amakihi at the study area using the algorithm. We also found that the relative abundance of 'Amakihi changes among study areas, and this information can be used to assess where management strategies for the species should be better implemented. Our automatic song detection algorithm is effective, "user-friendly" and can be very useful for optimizing the management and conservation of those endangered animal species that communicate acoustically.

Timing of acute kidney injury--does it matter? A single-centre experience from the United Kingdom.

BACKGROUND: Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is associated with high mortality and long-term dependence on RRT. However, there is limited information about the difference in outcome between patients who develop AKI in the community (c-AKI), and those who develop AKI in hospital (h-AKI). AIM: Identify differences in short- and long-term outcomes between patients admitted with c-AKI and h-AKI who require intermittent haemodialysis, and to identify factors that predict poor outcome. DESIGN & METHODS: Single-centre, retrospective analysis of 306 patients with AKI who received intermittent haemodialysis between 2009 and 2011. FOLLOW-UP: six months. Primary endpoints: patient and renal survival. Secondary endpoints: time on dialysis, length of hospital stay, and admission to the intensive care unit (ICU). RESULTS: Survival for patients in the h-AKI group was significantly lower, at 42.9% (compared to 72%). They had a significantly longer length of stay. However, at 6-month follow-up, the survival benefit of the c-AKI group was no longer significant. Patients with h-AKI were more likely to be dialysis independent at discharge and six months although this result did not reach statistical significance. Independent predictors of survival to discharge within the entire group included: renal/post-renal causes of AKI, younger age, pre-existing diabetes, and c-AKI. The only independent predictor for RRT dependence at discharge and six months was pre-existing chronic kidney disease. CONCLUSIONS: h-AKI is associated with high mortality and longer hospital stays during the acute admission. However, h-AKI patients who survive are more likely to be independent of RRT at discharge and follow-up.

Chronic otitis media and early speech development: a case study.

A case study of the speech development in a male infant with chronic otitis media is reported. The phonetic behavior characterizing the child's vocalizations was sampled monthly between the ages of 11 and 21 months, as he progressed from pre-speech to early speech periods of language development. Results of monthly phonetic inventory analyses indicated age-appropriate types of consonants in his pre-word and later-word vocalizations. However, the child's repertoire of consonants was considerably reduced as he first began to produce meaningful speech. Results of phonetic diversity analyses revealed an overall lack of phonetic complexity in his vocalizations throughout the course of study. In general, the child's early sound productions were characteristic of developmental delay, closely resembling the speech patterns found among severely hearing-imparied children. Findings are discussed with respect to the probable influence of chronic otitis media with effusion on a child's eventual speech development.

Relative timing characteristics of hearing-impaired speakers.

Speech duration characteristics of phrase-level utterances produced by 26 severely and profoundly hearing-impaired adults were examined acoustically using relative timing measures. The measures were then compared to the same utterances produced by 13 normal-hearing adults. Although absolute speech durations of the hearing-impaired subjects were significantly longer than their normal-hearing counterparts, relative timing did not differ between groups. Findings are discussed in relation to the biological constraint hypothesis associated with speech timing, as well as the role of auditory feedback in models of speech production.

Hearing levels of secondary school band directors.

Pure-tone AC HTLs were obtained from 52 secondary-school band directors aged 25-58 yrs with 1-28 yrs experience as directors. None reported any history of ear disease or excessive noise exposure other than their musical backgrounds. Groups I, II, and III had mean director experience of 5.3, 12,3, and 20.5 yrs, respectively. The hearing levels of Groups I, II, and III were, respectively, 5, 10, and 15 db less sensitive than those of comparably aged men with no noise exposure (Corso, 1963). SPLs in dbA of typical director locations were assessed. Though the 8-hr time-weighted exposures of the directors were below the "action level" for initiating a hearing conservation program, periodic audiometry was recommended.

Autoregressive analysis: a method for detecting electroencephalic changes in newborns to tones.

This report presents an autoregressive technique for detectiong statistically significant changes in brain activity to tones. The change detectin model is applied to stationary time series electroencephalogram samples from sleeping newborn infants. The electroencephalic responses of neonates to tones are quantified and analyzed in terms of t-statistics. Confidence limits applied to averaged t-statistics objectively and reliably defined statistically significant late components in newborns.

Development of a distinctive feature discrimination test.

Construction and standardization is described of a distinctive feature discrimination test (DFDT) incorporating a modified Miller-Nicely system of distinctive features. The test is a rhyme-type where error responses in a closed set were chosen to be one, two, and three distinctive features removed from the stimulus word. Performance-intensity (P.I) functions were established with 6 normal-hearing young women (12 ears) at SPLs or 20, 25, 30, 35, and 40 db under each of three filter bandpass conditions: .2-6, .2-1.2, and .2-.6 kc/s. P-I functions were presented for unweighted scores and for scores where error responses were weighted in terms of distinctive feature differences from stimulus items. The 4 DFDT lists generated, and their 3 randomizations each, appear to have a reasonable degree of inter-list reliability and it is felt that the 12 resultant list may be used interchangeably, This preliminary study indicated that the DFDT test may provide more diagnostic information than currently-used discrimination test.

A comparison of clinical behavioral audiometry and autoregression analysis of EEG and heart rate in hearing-impaired children.

Autoregressive analysis, a statistical technique for detecting changes in electroencephalic (EEG) and heart rate (HR) data was compared with clinical behavioral audiometric results on 10 hearing-impaired children in schools for the hard of hearing and deaf. EEG and HR data were collected in a screening paradigm involving tones of .5, 1, and 4 kc/s at 80 db SPL in a free field. An index of reliability, or acceptable level of agreement, was set at 70%. This criterion was met 5 out of 6 times. For the EEG, agreements exceeded 70% at 1 and at 4 kc/s, and for HR at all 3 frequencies. Results suggest that the autoregressive approach yields data very similar to behavioral audiometry in this population. Continued exploration of autoregressive analysis of electrophysiologic indices in determining reactivity to tones is warranted, particularly since the statistical method can be used with younger infants.