Choice Of Options Research Articles

(125) INVESTIGATING TRENDS IN MALE AND FEMALE STERILIZATION PROCEDURES AND FOLLOW-UP IN THE POST-DOBBS ERA

Abstract Introduction On June 24, 2022, the ruling of Dobbs vs. Jackson Women’s Health Organization (henceforth, Dobbs) by the Supreme Court of the United States (SCOTUS) led to the overturning of the 1973 Roe v. Wade decision (henceforth, Roe) which now gives individual states the autonomy to establish abortion access. This decision directly affected the reproductive rights of females nationwide; however, the effects may be more or less pronounced based on how individual states decide to either protect or restrict abortion access. Interestingly, these changes have also increased interest in vasectomies along with more consults and procedures. While data has shown an increase in consultations for tubal ligation, studies have been sparse on changes in contraception for females. Females and males have the choice of different contraceptive options based on their personal preferences and individual anatomy. To our knowledge, no single institution has done a comparative study that characterizes the different contraceptive options females and males elected for after the Dobbs decision. Objective In light of the recent ruling of Dobbs vs. Jackson Women’s Health Organization by the Supreme Court of the United States, we investigated sterilization and contraception utilization for both males and females at our institution in a state that protects abortion rights (New York). Methods We performed a retrospective review of all male and female patients seeking sterilization or contraceptives in the pre-Dobbs era (January 2021-May 2022) compared to the post-Dobbs era (July 2022-December 2022) at our institution. Demographic data for male and female patients was assessed along with contraceptive options utilized. Results We noted a change in contraceptive options utilized with more women selecting longer acting (IUD increased from 47 to 48%) and permanent options (salpingectomy increasing from 15 to 24%), pre- and post-Dobbs. Corresponding decreases are seen in shorter acting options like Nexplanon and Depo-Provera. Women undergoing permanent sterilization via salpingectomy had the highest average number of children out of all contraceptive procedures. The number of salpingectomies per month increased from an average of 9.7 pre-Dobbs to 18.3 (± 7.0) post-Dobbs (88.7% increase, p = 0.03). An increase in monthly vasectomies were noted however at a lower rate: 35.6 per month to 53 (49% increase, p = 0.02). Amongst women undergoing salpingectomy, the average number of children decreased post-Dobbs, 2.87 vs. 2.17 (p = <0.0001). The salpingectomy cohort also had the highest percentage of married women and lowest percentage of nulliparous women out of all contraceptive procedures although a trend towards more nulliparous women undergoing salpingectomy was noted (4.88% vs 9.09% pre- and post-Dobbs, p = 0.08). A change in contraceptive options utilized is noted for pre- and post-Dobbs. Completion of semen analysis after vasectomy was not affected by the Dobbs decision (46.6% vs. 46.3%, pre- and post-Dobbs). Conclusions Despite living in a state with continued abortion access after the Dobbs decision, women are electing for more invasive and longer acting contraceptive options. The increase in salpingectomy was the largest amongst male or female patients with a decrease in the average number of children for women pursuing salpingectomy. Disclosure No.

Ethical, Legal, and Practical Concerns Surrounding the Implemention of New Forms of Consent for Health Data Research: Qualitative Interview Study.

In Europe, within the scope of the General Data Protection Regulation, more and more digital infrastructures are created to allow for large-scale access to patients' health data and their use for research. When the research is performed on the basis of patient consent, traditional study-specific consent appears too cumbersome for many researchers. Alternative models of consent are currently being discussed and introduced in different contexts. This study explores stakeholder perspectives on ethical, legal, and practical concerns regarding models of consent for health data research at German university medical centers. Semistructured focus group interviews were conducted with medical researchers at German university medical centers, health IT specialists, data protection officers, and patient representatives. The interviews were analyzed using a software-supported structuring qualitative content analysis. Stakeholders regarded broad consent to be only marginally less laborious to implement and manage than tiered consent. Patient representatives favored specific consent, with tiered consent as a possible alternative. All stakeholders lamented that information material was difficult to understand. Oral information and videos were mentioned as a means of improvement. Patient representatives doubted that researchers had a sufficient degree of data security expertise to act as sole information providers. They were afraid of undue pressure if obtaining health data research consent were part of medical appointments. IT specialists and other stakeholders regarded the withdrawal of consent to be a major challenge and called for digital consent management solutions. On the one hand, the transfer of health data to non-European countries and for-profit organizations is seen as a necessity for research. On the other hand, there are data security concerns with regard to these actors. Research without consent is legally possible under certain conditions but deemed problematic by all stakeholder groups, albeit for differing reasons and to different degrees. More efforts should be made to determine which options of choice should be included in health data research consent. Digital tools could improve patient information and facilitate consent management. A unified and strict regulation for research without consent is required at the national and European Union level. Obtaining consent for health data research should be independent of medical appointments, and additional personnel should be trained in data security to provide information on health data research.

Net metering rolling credits vs. net billing buyback: An economic analysis of a policy option proposal for photovoltaic prosumers

There is a need for a methodology that allows the prosumer to implement a policy of choosing different compensation mechanisms. Thus, we propose the economic equivalence between net metering rolling credit (NM-RC) and net billing buyback (NB-BB) by defining a breakeven price (BP) for NB-BB that equals the Net Present Value (NPV) of these two options and using Discounted Payback Time (DPBT) as a tiebreaker metric. The Brazilian scenario was used for validation. When using the retail price, the NPV values for the NM-RC mechanism were lower in all scenarios (mean NPV of US$ 3958.66 in NM-RC against US$ 4372.17 in NB-BB). It is possible to observe that the BP that equalizes the two mechanisms is generally lower than the tariff charged by the utility (mean BP is US$ 0.1111 while mean tariff is US$ 0.1838), which reveals that offering this choice option does not burden the system. The NM-RC was selected in four cities, and the NB-BB was chosen in three cities. This policy could encourage potential prosumers, who often feel reluctant to invest in PV-DG owing to the long payback period. Thus, the political schemes complementing the compensation mechanism are relevant, especially for continental-sized countries with many utilities.

Young adults with kidney failure lived experiences of kidney replacement therapy decision-making.

Young adults living with kidney failure make decisions to select a kidney replacement therapy choice in partnership with healthcare professionals. However, little is known about how they experience kidney replacement therapy treatment decision-making and the impact this has on their well-being. To explore young adults living with kidney failure experiences of treatment decision-making. The treatment decision-making investigated is about the choice of dialysis and/or kidney transplant options. A qualitative interpretive hermeneutic phenomenology study. Purposeful sampling was used to recruit young adults with kidney failure from social media, electronic media such as local kidney group websites and word of mouth. Semistructured interviews were conducted with (n = 18) participants aged 18-30 years. Inductive analysis of the data were performed using Braun and Clarke's thematic analysis framework. The five themes generated were (1) awareness and anticipation of future kidney replacement therapy decision; (2) health information and education; (3) engaging in decision-making, support and choices; (4) implementation of kidney replacement therapy and transitioning into the new normal life and (5) the impact of decision-making and choice on well-being. Decision-making significantly affected young adults' psychosocial and mental well-being. Young adults had unmet informational and decisional needs and struggled to cope due to lack of support. A four-talk model, with an implement talk phase added to the existing three-talk (team talk, option talk, decision talk) shared decision-making model, would promote a focus on the implementation of choice and support the transitioning from previous life to long-term dependence on treatment.

A picture is worth a thousand words: Framing of food choice options affects decision conflict and mid-fontal theta in food choice task

In food choices, conflict arises when choosing between a healthy, but less tasty food item and a tasty, but less healthy food item. The underlying assumption is that people trade-off the health and taste properties of food items to reach a decision. To probe this assumption, we presented food items either as colored images (image condition, e.g. photograph of a granola bar) or as pre-matched percentages of taste and health values (text condition, e.g., 20% healthy and 80% tasty). We recorded choices, response times and electroencephalography activity to calculate mid-frontal theta power as a marker of conflict. At the behavioral level, we found higher response times for healthy compared to unhealthy choices, and for difficult compared to easy decisions in both conditions, indicating the experience of a decision conflict. At the neural level, mid-frontal theta power was higher for healthy choices than unhealthy choices and difficult choices compared to easy choices, but only in the image condition. Those results suggest that either conflict type and/or decision strategies differ between the image and text conditions. The present results can be helpful in understanding how dietary decisions can be influenced towards healthier food choices.

Feasibility and acceptability of studying full-time nurse faculty salaries

BackgroundThe nursing shortage is driven, in part, by the critical shortage of nursing faculty. Consequently, qualified potential nursing students are being turned away from nursing schools each year. The preeminent issue influencing the United States nurse faculty workforce shortage is salary; financial compensation is higher in clinical and private-sector settings than educational settings. The purpose of this study is to describe current full-time nurse faculty salary, sources of income, and perceived need for more income, as well as the feasibility and acceptability of research focused on full-time nurse faculty salaries, so to guide future nursing faculty workforce research.MethodsUsing a cross-sectional study design, full-time nursing faculty working in a Midwestern state in the United States completed a survey inclusive of fixed choice and free text response options focused on income (individual gross, faculty, and secondary), demographics, and feasibility/acceptability of the survey instrument. Descriptive statistics were used to describe salary, sources of income, and perceived need for additional income. Feasibility and acceptability were evaluated by descriptive statistics examining three feasibility and acceptability questions, and by comparing demographic differences between participants who answered income questions compared to those who did not using t tests, x2 tests, and Wilcoxon signed rank tests.ResultsOne hundred and eighty-three full-time nurse faculty completed the survey in six weeks, representing 27% of the full-time nurse faculty workforce in the state. Over half of participants, 57%, reported having another job(s) in addition to their full-time faculty position to support basic living expenses. Most respondents reported willingness to share financial/salary data and viewed the survey to be acceptable.ConclusionsResearch focused on nursing faculty salaries was feasible and acceptable to those who chose to participate in the study. Perceived income needs may be an important factor driving career decisions for nursing faculty. Future research should focus on delineating how salary influences the decision to enter or stay in the nursing faculty workforce. Further, this study can inform policy recommendations on how to best measure and report nurse faculty salary and the gap between clinical salaries and faculty salaries.

Information sources and congruency modulate preference-based decision-making processes

ABSTRACT Preference-based decisions often need to combine multiple pieces of information. This study investigated how the number of information sources and information congruency affect decision performance. Participants made preference-based choices between two groups of food items. Increasing the number of items in each option led to slower and less accurate decisions. Drift-diffusion modelling showed that more information sources relate to a slower rate of evidence accumulation. Therefore, the additional information impeded rather than improved the decision accuracy. In Experiment 2, each choice option contained either fully congruent information or one piece of incongruent information. Decisions with incongruent information is associated with a lower drift rate than that with congruent information, leading to inferior behaviorual performance. Further model simulations support that the change in attention weighting over information sources leads to the observed effects of item numbers and item congruency. Our results suggest a bounded combination of information sources during preference-based decisions.

Preferences of Recent Mums in Remote and Rural Areas for Type of Intrapartum Care: A Discrete Choice Experiment.

Pregnant women living in rural areas considering their preferred place of birth may have to 'trade-off' travel time/distance and other attributes of care (e.g. the full choice of birthplace options is rarely available locally). This study assesses the preferences and trade-offs of recent mothers who live in remote and rural areas of Great Britain. An online survey, informed by qualitative research, was administered to women living in rural areas who had given birth in the preceding 3 years. The survey included a discrete choice experiment (DCE) to elicit women's preferences and trade-offs for place of birth. The DCE presented women with a series of eight choice tasks in which place of birth was defined by four attributes: (1) type of facility, (2) familiarity with staff, (3) understanding options and feel relaxed and reassured and (4) the travel time to the place of intrapartum care. DCE data were analysed using an error components logit model to identify preferences. Across 251 survey responses, holding everything else equal, respondents preferred: intrapartum care in locations with more specialist staff and equipment, locations where they understood their options and felt reassured and where travel time was minimal. Women were willing to travel (92-183 min) to a well-staffed and equipped facility if they understood their options and felt relaxed and reassured. Willingness to travel was reduced if the care received at the specialist facility was such that they did not understand their options and felt tense and powerless (41-132 min). These insights into the preferences of recent mums from remote and rural areas could inform future planning of rural intrapartum care.

Long-Term Results of Percutaneous Balloon Aortic Valvuloplasty in Children With Aortic Stenosis: A Single-Center Experience.

Congenital aortic stenosis is a common pathology in the childhood age group and its clinical spectrum varies between asymptomatic and severe heart failure. In our study, we planned to evaluate the long-term results of patients who underwent balloon aortic valvuloplasty (BAV) due to critical aortic valve stenosis in our clinic. Patients aged 0-18 years who underwent aortic balloon valvuloplasty due to aortic stenosis in our clinic between January 2002 and January 2022 were retrospectively evaluated. Among the 48 patients who underwent balloon valvuloplasty due to aortic stenosis, 13 (27%) were female, and 35 (73%) were male. The median age at the time of the procedure was 27.5 months (IQR: 4-96), the median weight was 9.9 kg (IQR: 5.40-29.50), and the median height was 79 cm (IQR: 54-133). The median follow-up duration was 93.5 months (IQR: 38-132). Angiographic assessments in all patients revealed a median left ventricular pressure of 160 mmHg (IQR: 140-200) and a median pressure gradient between the left ventricle and the aorta of 60 mmHg (IQR: 42-80). The median balloon diameter used was 10 mm (IQR: 8-12). Post-procedural measurements showed a median mean gradient of 30 mmHg (IQR: 20-35) between the left ventricle and the aorta. The procedure was successful in 45 (93.5%) patients. During follow-up, 11 patients required surgical intervention. Ross procedure was performed in five patients, homograft in five patients, and mechanical valve implantation in one patient. Risk factors for the need for surgical intervention were evaluated in detail. During the follow-up, the risk factor for intervention was determined to be aortic insufficiency. Aortic valve balloon valvuloplasty is a safe and successful treatment method for critical aortic stenosis. It should be the first choice of treatment option in suitable patients.

Programmable delay cell based area efficient time-mode smart temperature sensor exploiting channel length modulation coefficient λ

This work presents an all-digital Programmable Delay Cell (PDC)-based time-domain smart temperature sensor exploiting the channel length modulation coefficient λ. For the first time the work has been described to establish the choice of multimode conversion options in the time-domain architecture of temperature sensor. The sensor incorporates a PDC and a time-to-digital converter (TDC) for the generation of temperature code. The different channel lengths of the PDC and Gated Ring Oscillator (GRO) delay elements of the TDC ensure the precise operation of the sensor. The proposed design provides a novel approach for the generation of variable resolution options having different sampling rates. At 90-nm CMOS process and 1.1 V supply voltage, the sensor occupies 0.015 mm2 and operates over a span of −60 °C to 120 °C. Additionally, multimode conversion time allows the sensor to be tuned to a small value of energy/conversion at 27 °C. This confirms to 0.38 nJ and 3.13 nJ at modes M0 and M7, respectively. Besides the sensor obtains a resolution 0.747 °C and 0.093 °C at a conversion time of 0.669 μs and 5.5 μs, respectively.

Dissociable Representations of Decision Variables within Subdivisions of the Macaque Orbital and Ventrolateral Frontal Cortex.

The ventral frontal cortex (VFC) in macaques is involved in many affective and cognitive processes and has a key role in flexibly guiding reward-based decision-making. VFC is composed of a set of anatomically distinct subdivisions that are within the orbitofrontal cortex, ventrolateral prefrontal cortex, and anterior insula. In part, because prior studies have lacked the resolution to test for differences, it is unclear if neural representations related to decision-making are dissociable across these subdivisions. Here we recorded the activity of thousands of neurons within eight anatomically defined subdivisions of VFC in male macaque monkeys performing a two-choice probabilistic task for different fruit juice outcomes. We found substantial variation in the encoding of decision variables across these eight subdivisions. Notably, ventrolateral Area 12l was unique relative to the other areas that we recorded from as the activity of single neurons integrated multiple attributes when monkeys evaluated the different choice options. Activity within Area 12o, in contrast, more closely represented reward probability and whether reward was received on a given trial. Orbitofrontal Area 11m/l contained more specific representations of the quality of the outcome that could be earned later on. We also found that reward delivery encoding was highly distributed across all VFC subdivisions, while the properties of the reward, such as its flavor, were more strongly represented in Areas 11m/l and 13m. Taken together, our work reveals the diversity of encoding within the various anatomically distinct subdivisions of VFC in primates.

Client experiences with "Dynamic Choice Prevention," a model for flexible patient-centred HIV prevention delivery in rural Eastern Africa.

Identifying the optimal approaches to offering HIV prevention to meet the needs of those at risk is a high priority, particularly given the expanding toolkit of biomedical HIV prevention options. An ongoing study in rural East African communities evaluated the uptake of choices in product, testing mode and location of care delivery through a structured patient-centred HIV prevention delivery model. In this qualitative study, we sought to understand clients' experiences of this "dynamic choice prevention model" (DCP) and highlight pathways of action to inform HIV prevention delivery models. In-depth semi-structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of n = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and n = 21 healthcare providers (total n = 77). A seven-person multi-regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes. Individuals taking up HIV pre-exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners' behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post-exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselves. Participants anticipated long-acting injectable PrEP could solve their challenges regarding pill size, daily pill burden and the likelihood of unwanted disclosure. Diverse preferences and barriers to uptake of prevention require a choice of HIV prevention options, locations and delivery modalities-but in addition, flexible, competent and friendly care provision is crucial to promote uptake. Helping clients feel valued, and addressing their unique needs and challenges, enables their agency to prioritize their health.

Multiple Myeloma: Simulation of Therapy Scenarios Using the Monte Carlo Method

AIM. To develop an information and retrieval system for hematologists which would enable effective decision making in multiple myeloma (MM) treatment through simulation and prediction of response to therapy considering a patient’s clinical profile-related characteristics and based on the analysis of data from public science sources. MATERIALS & METHODS. The analysis included 145 therapeutic options and 56,217 MM patients enrolled in 311 clinical studies, the results of which were published in the medical literature from 2003 to 2024. To simulate therapy scenarios, the Monte Carlo method was used for calculating the probability of achieving very good and even better partial response in patients with different characteristics that define not only their clinical profile but also the chemotherapy variants. RESULTS. This study introduces an interactive online application called М-BОТ (available at oncotriage.ru) enabling to predict response to therapy under certain specified conditions and to visualize the result as real-time ranking of therapeutic options via the user interface. Apart from a patient’s clinical profile-related characteristics underlying MM treatment decision making, it is possible to select trials by their types and numbers of patients enrolled. CONCLUSION. The therapy recommendations resulted from simulation of different MM therapy scenarios with the use of the Monte Carlo method considerably extend the potential for rapid retrieval of reliable science information which would confirm the optimal choice of a therapeutic option in the given clinical setting. In future, this approach can be regarded as a basis for building up a support system in individual and consensus decision making. It will allow for predicting the efficacy of multi-stage MM treatment strategies with several therapy lines and their safety as well.

Indiana

This report about Indiana school funding relates to budgetary changes in the state’s school funding priorities and technical changes to its state aid to schools formula. Pressing issues that affect school funding as well as public policy dimensions of alternatives to traditional public schools are considered. The most pressing need for the schooling system that is mediated by the school funding program remains increasing the labor market supply of highly credentialed teachers. The most evident public policy trend is the continuing expansion of free market-based school choice options.

Storage of evidence and delayed reporting after sexual assault: Rates and impact factors on subsequent reporting

BackgroundSexual assault (SA) is alarmingly prevalent, yet reporting rates remain disproportionately low. Forensic examinations (FE) play a crucial role in both immediate medical care and evidence collection, yet many victims/survivors may not report the crime initially, leading to the loss of vital forensic evidence. The storage of evidence “Option 3″ care alternative provides post-SA care including FE without initial police involvement. MethodsThis is a cross-sectional study analysing the attendances of people who chose to store evidence at the Dublin Sexual assault Treatment Unit (SATU) between January 1, 2017 and December 31, 2023. ResultsThere were 238 storage of evidence FEs (‘Option 3’) performed during the study period, which represented 12.8 % of all FEs. The majority identified as female (89.1 %), with an average age of 26.6 years. 31.9 % attended within 24 h of the incident, and 51.3 % self-referred. Most assaults occurred over weekends (64.7 %), with alcohol consumption reported in 82.2 % of cases and drug-facilitated SA concerns in 20.2 %. Genital injuries were present in 17.9 % of females and 19 % of males.Those that availed of storage of evidence (compared with those who initially reported to the police) were significantly more likely to have consumed alcohol (p < 0.001) and the assault was more likely to have occurred indoors (p = 0.002). There was no significant difference in care option choice for those ‘unsure’ of the assault occurrence (p = 0.353).Among storage of evidence cases, 20.2 % subsequently reported to the police, with females more likely to report (p = 0.02), while people who were uncertain whether an assault had occurred were less likely to report (p = 0.04). Genital injury (p = 0.822), victim-assailant relationship (p = 0.465), assault location (p = 0.487), and substance consumption (p = 0.332) did not significantly affect subsequent reporting rates. ConclusionsThe availability of storage of evidence has afforded people the opportunity to access prompt, responsive SATU care including collection of forensic evidence which may have significant evidential value. This approach provides further opportunity for comprehensive detection of a crime, even if reporting to the police is delayed.

Factors affecting Ethiopian Consumers’ Attitudes towards Purchasing Locally Produced Apparel: An Empirical Study

: Currently, customers have an ever-expanding choice of purchase options owing to globalization, which leads to increased competition. Globalization and current marketing trends have made consumers more sensitive and challenging than ever. As consumers are the most important asset any business has, organizations must understand consumers’ behavior to maintain a strategic advantage in today's increased competition and globalized marketing. In this regard, this study aimed to assess the determinants of Ethiopian consumers' purchasing behavior in locally-produced apparel by using the Theory of Planned Behavior (TPB) model. Cross-sectional data from 539 consumers were collected using convenience sampling and analyzed using structural equation modeling. The structural equation model results showed that all variables had a positive and significant effect on the dependent variables, which means that all hypotheses are supported. The results also indicate that consumers' attitude toward locally produced apparel was the most influential determinant of their purchasing intention towards locally produced apparel, followed by perceived behavioral control and subjective norms. Further, consumers' purchasing intention is more influential in their purchasing behavior than perceived behavioral control. The findings of this study provide insight into domestic apparel consumption, as well as the factors affecting consumer purchasing intentions and behavior in the Ethiopian context. The results from the measurement and structural models offer key inputs for policymakers, marketers, manufacturers, and retailers.

Метод оценки критериев оптимизации системы электробезопасности в инфраструктуре села

The article provides an analysis of the state of energy availability and equipment of electric installations for infrastructure facilities in rural settlements. The main type of technogenic hazards is marked – the electrical hazard that occurs in emergency modes of operation of electrical installations. The conditions for solving the safety problem and choosing the optimal variant of the electrical safety system are given. The indicators of the technical efficiency of the electrical safety system are determined, characterized by the likelihood of electrical injury to a person and the likelihood of a fire in electrical installations at facilities. The choice of the most appropriate options for the use of electrical protection equipment, providing for the joint use of automatic switches and protective shutdown devices, was made as a result of comparing the likelihood of electrical injury and fire with a normalized risk level of electrical and fire safety. A method for optimizing the electrical safety system is considered according to two particular criteria representing the average values of the probabilities of electrical injury and fire with the equivalence of their values. The task of optimizing the security system is indicated, which consists in constructing a vector criterion of optimality and converting it into a scalar criterion using the "assignment" method to obtain a normalized partial criterion. The normalized private criteria of electrical and fire safety are determined using a scalar criterion for the selection of electrical protection options for an agricultural facility. An algorithm for evaluating the effectiveness of the electrical safety system in dangerous situations of electrical injuries has been built. The description of the construction of an algorithm for modeling the state of fire safety of the system in the event of fires in electrical installations is given. A comprehensive assessment of the normalized criterion for optimizing the electrical safety system was obtained according to two normalized criteria for electrical and fire safety and the choice of optimal electrical protection options at the studied facility. Keywords: TECHNOGENIC HAZARD, ELECTRICAL INSTALLATION, ACCIDENT, ELECTRICAL INJURY, TECHNICAL EFFICIENCY, EVALUATION CRITERIA, OPTIMIZATION OF ELECTRICAL SAFETY SYSTEM, ELECTRICAL PROTECTION

Real-world evidence of a novel tetravalent immunoglobulin Y effectiveness and safety in patients with the refractory Helicobacter pylori infection

BackgroundRefractory Helicobacter pylori (H. pylori) infection inevitably increase the difficulty of drug selection. Here, we described our experience with the use of a novel tetravalent IgY against H. pylori for the treatment of patients with refractory H. pylori infection.MethodsPatients were randomly assigned to receive the standard quadruple therapy (amoxicillin, clarithromycin, omeprazole and bismuth potassium citrate ) for 2 weeks or 250 mg of avian polyclonal IgY orally twice a day for 4 weeks. The binding efficacy of IgY to H. pylori antigens was detected by western blotting13. C-urea breath test was performed to evaluate the eradication therap’s efficacy. The side effects of IgY were evaluated via various routine tests. The questionnaire was used to gather clinical symptoms and adverse reactions.ResultsWestern blot analysis showed that tetravalent IgY simultaneously bind to VacA, HpaA, CagA and UreB of H. pylori. Tetravalent IgY had an eradication rate of 50.74% in patients with refractory H. pylori and an inhibition rate of 50.04% against DOB (delta over baseline) of 13C-urea. The symptom relief rate was 61.76% in thirty-four patients with clinical symptoms, and no adverse reactions were observed during tetravalent IgY treatment period.ConclusionsPolyclonal avian tetravalent IgY reduced H. pylori infection, and showed good efficacy and safety in the treatment of refractory H. pylori infection patients, which represented an effective therapeutic option of choice for patients with refractory H. pylori infection.

Effect of Flexible Working Hours on Employee Performance of Isiolo County Government, Kenya

The study sought to evaluate the effect of flexible working hours on employee performance of Isiolo County Government, Kenya. The study adopted a descriptive research design whereby quantitative data was collected using close-ended questionnaires. Therefore, the target population included 1,662 employees of Isiolo County government in various departments. These employees were further sampled using a simple random method to obtain 43 directors, 48 managers, and 309 operational staff as the sample size. Further, the study undertook a pre-test study in Samburu County government whose feedback was assessed using Cronbach Alpha coefficient to test the reliability of the questionnaires. SPSS software version 25 was used during the analysis process to provide descriptive and inferential analysis. The findings of the questionnaire indicated that 86(25%) respondents, strongly agreed and 117(35%) agreed on a mean of 4.21, that there is a local arrangement between the staff and their supervisors on how to deliver the assigned tasks on remote working option However, 76(22%) respondents, strongly disagreed and 107(32%) disagreed on a mean of 2.43, Tasks are sub-divided using a job-sharing technique to allow employees attend to other areas of their lives and still manage to attain the departmental objectives. The correlation coefficient for flexible working hours r=0.741 at α &lt; 0.02 and 99% significance level. Flexible working hours had a positive effect on the performance of employees. It was established that there was a hybrid working method that included in-office and remote operations. That notwithstanding, the choice of hybrid options was based on an informal agreement between first-line supervisor and an employee. This brought about unprofessional favors and an unbalanced allocation of tasks to the staff. Consequently, the long-term effect was poor completion of tasks, late submission of assignments, and lack of adequate supervision leading to unsatisfactory work. The recommendations on flexible working hours are that there should be a formal policy structure formulation by the management that allows equality and fairness in allocation of tasks and the choice of either working in an office or remotely. Additionally, there should be empowerment of organization laws and regulations to support disciplinary actions by the management, to discourage late submission of assignments. There should be an encouragement of work contract signing an agreement between the workers and the supervisors that supports in job training to reduce work-related errors/ unsatisfactory work.

Neurocomputational Mechanisms Underlying Differential Reinforcement Learning From Wins and Losses in Obesity With and Without Binge Eating

BackgroundBinge-eating disorder (BED) is thought of as a disorder of cognitive control, but evidence regarding its neurocognitive mechanisms is inconclusive. Key limitations of previous research include a lack of consistent separation between effects of BED and obesity and a disregard for self-report evidence suggesting that neurocognitive alterations may emerge primarily in loss- or harm-avoidance contexts. MethodsTo address these gaps, in this longitudinal study we investigated behavioral flexibility and its underlying neurocomputational processes in reward-seeking and loss-avoidance contexts. Obese participants with BED, obese participants without BED, and healthy normal-weight participants (n = 96) performed a probabilistic reversal learning task during functional imaging, with different blocks focused on obtaining wins or avoiding losses. They were reinvited for a 6-month follow-up assessment. ResultsAnalyses informed by computational models of reinforcement learning showed that unlike obese participants with BED, obese participants without BED performed worse in the win than in the loss condition. Computationally, this was explained by differential learning sensitivities in the win versus loss conditions in the groups. In the brain, this was echoed in differential neural learning signals in the ventromedial prefrontal cortex per condition. The differences were subtle but scaled with BED symptoms, such that more severe BED symptoms were associated with increasing bias toward improved learning from wins versus losses. Across conditions, obese participants with BED switched more between choice options than healthy normal-weight participants. This was reflected in diminished representation of choice certainty in the ventromedial prefrontal cortex. ConclusionsOur study highlights the importance of distinguishing between obesity with and without BED to identify unique neurocomputational alterations underlying different styles of maladaptive eating behavior.