High Risk Of Detection Research Articles

Effectiveness of the perioperative encounter in promoting regular exercise and physical activity: a systematic review and meta-analysis.

Low levels of physical activity (PA) are associated with poorer health outcomes. The perioperative encounter (extending from initial contact in primary care to beyond discharge from hospital) is potentially a good time to intervene, but data regarding the effectiveness of interventions are scarce. To address this, we systematically reviewed existing literature to evaluate the effectiveness of interventions applied perioperatively to facilitate PA in the medium to long-term (at least six months after the intervention). In this systematic review and meta-analysis, we searched Central Register of Controlled Trials (CENTRAL, Cochrane Library), MEDLINE, CINAHL, Embase, PsycInfo, and SPORTDiscus from database inception to October 22nd 2020, with an updated search done on August 4th 2022. We searched clinical trials registers, and conducted forward- and backward-citation searches. We included randomised controlled trials and quasi-randomised trials comparing PA interventions with usual care, or another PA intervention, in adults who were scheduled for, or had recently undergone, surgery. We included trials which reported our primary outcomes: amount of PA or whether participants were engaged in PA at least six months after the intervention. A random effects meta-analysis was used to pool data across studies as risk ratios (RR), or standardised mean differences (SMDs), which we interpreted using Cohen. We used the Cochrane risk of bias tool and used GRADE to assess the certainty of the evidence. This study is registered with PROSPERO, CRD42019139008. We found 57 trials including 8548 adults and compared 71 interventions facilitating PA. Most interventions were started postoperatively and included multiple components. Compared with usual care, interventions may slightly increase the number of minutes of PA per day or week (SMD 0.17, 95% CI 0.09-0.26; 14 studies, 2172 participants; I2=0%), and people's engagement in PA at the study's end (RR 1.19, 95% CI 0.96-1.47; 9 studies, 882 participants; I2=25%); this was moderate-certainty evidence. Some studies compared two different types of interventions but it was often not feasible to combine data in analysis. The effect estimates generally indicated little difference between intervention designs and we judged all the evidence for these comparisons to be very low certainty. Thirty-six studies (63%) had low risk of selection bias for sequence generation, 27 studies (47%) had low risk of bias for allocation concealment, and 56 studies (98%) had a high risk of performance bias. For detection bias for PA outcomes, we judged 30 studies (53%) that used subjective measurement tools to have a high risk of detection bias. Interventions delivered in the perioperative setting, aimed at enhancing PA in the medium to long-term, may have overall benefit. However, because of imprecision in some of the findings, we could not rule out the possibility of no change in PA. National Institute for Health Research Health Services and Delivery Research programme (NIHR127879).

Regulating the Market for Audit Services: A Game Theoretic Approach

We apply game theory to model how alternative mandatory audit firm rotation regimes can affect the strategic interaction between auditee and auditor firms, and analyze potential consequences on detection risk and impairment of auditor scepticism. The major results suggest that: (1) relative to an initial state with no rotation requirement but high probability for impaired auditor scepticism, imposing either short‐term or long‐term mandatory audit firm rotation will remove the threat to auditor scepticism and lead to higher audit fees and lower detection risk; (2) relative to long‐term mandatory audit firm rotation, imposing a short‐term rotation will lead to lower audit fees and higher detection risk, resulting from greater informational frictions. We further find that imposing supplementary regulatory instruments, such as increased regulatory scrutiny of the auditee and/or auditor, can be used to lower the detection risk and increase audit quality. We discuss implications of these findings for empirical research.

Factors influencing therapeutic effectiveness of electroencephalogram-based neurofeedback against core symptoms of ADHD: a systematic review and meta-analysis

<h3>Background:</h3> Factors affecting the effectiveness of electroencephalogram-based neurofeedback (EEG-NF) against the core symptoms of attention-deficit/hyperactivity disorder (ADHD) remain unclear. <h3>Methods:</h3> We searched the PubMed, Embase, Web of Science, ClinicalKey, Cochrane CENTRAL, ScienceDirect, and ClinicalTrials.gov databases from inception to August 2022 for randomized controlled trials (RCTs) on patients with ADHD involving outcome assessments of improvements on behavioural rating scales of inattention, hyperactivity/impulsivity, and global symptoms. Comparators included nonactive (e.g., wait list/treatment as usual) and active (e.g., cognitive training) controls. <h3>Results:</h3> Our analyses included 21 RCTs comprising 1261 participants. Our results demonstrated significantly better improvement in symptoms of inattention, hyperactivity/impulsivity and global symptoms of ADHD associated with EEG-NF than comparators from both proximal (<i>p</i> = 0.01, <i>p</i> = 0.02 and <i>p</i> = 0.01, respectively; e.g., parents) and distal (<i>p</i> = 0.01, <i>p</i> &lt; 0.05 and <i>p</i> = 0.01; e.g., teachers) raters. Meta-regression revealed a positive association between therapeutic effects of EEG-NF and intelligence quotient (IQ) from observations of the most proximal raters. Subgroup analysis for studies combining 2 EEG-NF protocols showed better therapeutic effectiveness against symptoms of ADHD than those using a single NF protocol, whereas subgroup analysis adopting a double-blind design failed to demonstrate superiority of EEG-NF to sham control. Moreover, therapeutic effectiveness of EEG-NF was significantly better when wait list/treatment as usual comparators were used compared with sham/placebo EEG-NF controls on subgroup analysis. <h3>Limitations:</h3> Our findings are limited by the lack of a double-blind design in most of the studies included in our analyses. <h3>Conclusion:</h3> Our results support the effectiveness of EEG-NF for improving inattention, hyperactivity/impulsivity, and global symptoms in patients with ADHD. The high risk of detection and performance bias warrants further study.

An analysis of the effect of social norms on payment of speeding fines

ABSTRACT Fines are the most common form of formal speed limit enforcement applied in jurisdictions across the world. From a deterrence perspective, fines deter speeding through high risk of detection and swift enforcement of financial penalties. Yet, evidence on factors associated with fine payment compliance is limited. In this study, we consider the extent to which elements of deterrence and social behavioural norms influence the dynamics of speeding fine payment. We merge lifetime driving and fine payment records from over 10,000 drivers who received a speeding infringement notice during a one-week period in 2017 across communities in Queensland, Australia with community level socio-demographic data. We combine these data with our indicator of community level fine payment norms; the proportion of residents with an outstanding fine debt and conduct survival analysis to estimate the impact of social norms on days taken to pay speeding fines after controlling for community wealth and driving history. We find that individuals living in communities where a greater proportion of residents have outstanding fine debt take longer to pay fines after controlling for community disadvantage and social disorganisation. Our findings support the social norms perspective that speeding fine compliance is enhanced by normative community behaviours.

Black-Box Audio Adversarial Attack Using Particle Swarm Optimization

The development of artificial neural networks and artificial intelligence has helped to address problems and improve services in various fields, such as autonomous driving, image classification, medical diagnosis, and speech recognition. However, this technology has raised security threats that are different from existing ones. Recent studies have shown that artificial neural networks can easily malfunction by adversarial examples. The adversarial examples operate the neural network model as intended by the adversary. In particular, adversarial examples targeting speech recognition models is an area that has been actively studied in recent years. Existing studies have focused more on white-box methods. However, most speech recognition services are provided online and involve black-box, making it difficult or impossible for adversaries to attack. Black-box attacks have several challenges. Typically, they have a low success rate and a high risk of detection. In particular, previously proposed genetic algorithm (GA)-based attacks are at a high risk of detection because they require numerous queries. Therefore, we propose an adversarial attack system using particle swarm optimization (PSO) algorithms to address these problems. The proposed system uses adversarial candidates as particles to obtain adversarial examples through iterative optimization. PSO-based adversarial attacks are more efficient in queries and have a higher attack success rate than the adversarial methods using GAs. In particular, our key function is that temporary particle generation maximizes query efficiency to reduce detection risk and prevent wastage of system resources. On average, our system exhibits 96% attack success rates with 1416.17 queries, indicating that is 71.41% and 8% better in terms of query and success rates than existing GA-based attacks, respectively.

Degrees of formalization of agricultural entrepreneurs: going beyond registration

The dichotomous view of formalization – ‘registered’ versus ‘not registered’ – is a widely adopted approach for analyzing entrepreneurs and their businesses. It, however, fails to adequately capture the multiple dimensions of the formalization process and limits the scope of interventions to promote business formalization. Hence, this study expands the conceptualization of agribusinesses’ formalization from a dichotomic view to a richer and more dynamic perspective. Using data from a survey of 819 agribusinesses in Benin, we develop a framework that considers multiple dimensions of formalization, namely registration status, compliance with tax law, and compliance with labor law and examine factors that influence the position of entrepreneurs on the formalization continuum. The result shows that agricultural entrepreneurs operate at varying degrees of formalization. Among the surveyed businesses, we found that about 46% were wholly informal, 6% were largely informal, 22% were only registered, 24% were largely formal, and 3% were wholly formal. Entrepreneurs who displayed higher levels of formalization were largely based in urban areas and older, with higher incomes and educational levels. They were also associated with greater awareness of the formalization procedures, had higher tax morality, and perceive a high risk of detection. The result underscores the need to rethink the dichotomous view of formalization and offers insights for targeting policy efforts to increase formalization in agribusinesses.

Supervised maintenance programmes following pulmonary rehabilitation compared to usual care for chronic obstructive pulmonary disease.

Pulmonary rehabilitation benefits patients with chronic obstructive pulmonary disease (COPD), but gains are not maintained over time. Maintenance pulmonary rehabilitation has been defined as ongoing supervised exercise at a lower frequency than the initial pulmonary rehabilitation programme. It is not yet known whether a maintenance programme can preserve the benefits of pulmonary rehabilitation over time. Studies of maintenance programmes following pulmonary rehabilitation are heterogeneous, especially regarding supervision frequency. Furthermore, new maintenance models (remote and home-based) are emerging. To determine whether supervised pulmonary rehabilitation maintenance programmes improve health-related quality of life (HRQoL), exercise performance, and health care utilisation in COPD patients compared with usual care. Secondly, to examine in subgroup analyses the impact of supervision frequency and model (remote or in-person) during the supervised maintenance programme. We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, PEDro, and two additional trial registries platforms up to 31 March 2020, without restriction by language or type of publication. We screened the reference lists of all primary studies for additional references. We also hand-searched conference abstracts and grey literature through the Cochrane Airways Trials Register and CENTRAL. We included only randomised trials comparing pulmonary rehabilitation maintenance for COPD with attention control or usual care. The primary outcomes were HRQoL, exercise capacity and hospitalisation; the secondary outcomes were exacerbation rate, mortality, direct costs of care, and adverse events. Two review authors independently screened titles and abstracts, extracted data, and assessed the risk of bias. Results data that were similar enough to be pooled were meta-analysed using a random-effects model, and those that could not be pooled were reported in narrative form. Subgroup analyses were undertaken for frequency of supervision (programmes offered monthly or less frequently, versus more frequently) and those using remote supervision (e.g. telerehabilitation versus face-to-face supervision). We used the GRADE approach to assess the certainty of evidence. We included 21 studies (39 reports) with 1799 COPD patients. Participants ranged in age from 52 years to 88 years. Disease severity ranged from 24% to 88% of the predicted forced expiratory volume in one second. Programme duration ranged from four weeks to 36 months. In-person supervision was provided in 12 studies, and remote supervision was provided in six studies (telephone or web platform). Four studies provided a combination of in-person and remote supervision. Most studies had a high risk of performance bias due to lack of blinding of participants, and high risk of detection, attrition, and reporting bias. Low- to moderate-certainty evidence showed that supervised maintenance programmes may improve health-related quality of life at six to 12 months following pulmonary rehabilitation compared to usual care (Chronic Respiratory Questionnaire total score mean difference (MD) 0.54 points, 95% confidence interval (CI) 0.04 to 1.03, 258 participants, four studies), with a mean difference that exceeded the minimal important difference of 0.5 points for this outcome. It is possible that supervised maintenance could improve six-minute walk distance, but this is uncertain (MD 26 metres (m), 95% CI -1.04 to 52.84, 639 participants, 10 studies). There was little to no difference between the maintenance programme and the usual care group in exacerbations or all-cause hospitalizations, or the chance of death (odds ratio (OR) for mortality 0.73, 95% CI 0.36 to 1.51, 755 participants, six studies). Insufficient data were available to understand the impact of the frequency of supervision, or of remote versus in-person supervision. No adverse events were reported. This review suggests that supervised maintenance programmes for COPD patients after pulmonary rehabilitation are not associated with increased adverse events, may improve health-related quality of life, and could possibly improve exercise capacity at six to 12 months. Effects on exacerbations, hospitalisation and mortality are similar to those of usual care. However, the strength of evidence was limited because most included studies had a high risk of bias and small sample size. The optimal supervision frequency and models for supervised maintenance programmes are still unclear.

Acupuncture for chronic nonspecific low back pain.

Acupuncture for chronic nonspecific low back pain.

Mobile technologies to support healthcare provider to healthcare provider communication and management of care.

Mobile technologies to support healthcare provider to healthcare provider communication and management of care.

Selection of priority pesticides in Japanese drinking water quality regulation: Validity, limitations, and evolution of a risk prediction method

Several risk scoring and ranking methods have been applied for the prioritization of micropollutants, including pesticides, and in the selection of pesticides to be regulated regionally and nationally. However, the effectiveness of these methods has not been evaluated in Japan. We developed a risk prediction method to select pesticides that have a high probability of being detected in drinking water sources where no monitoring data is available. The risk prediction method was used to select new pesticides for the 2013 Primary List in the Japanese Drinking Water Quality Guidelines. Here, we examined the effectiveness of the method on the basis of the results of water quality examinations conducted by water supply authorities across Japan, and studied ways to improve the risk prediction method. Of the 120 pesticides in the 2013 Primary List, 80 were detected in drinking water sources (raw water entering water treatment plants). The rates of detection of the newly selected pesticides and previously listed pesticides were not significantly different: 64% and 68%, respectively. When the risk predictor was revised to incorporate degradability of dry-field pesticides and current pesticide sales data, the rate of detection of pesticides selected as having a high risk of detection improved from 72% to 88%. We prepared regional versions of the Primary List using the revised risk predictors and verified their utility. The number of listed pesticides varied greatly by region, ranging from 32 to 73; all regional lists were much shorter than the national Primary List. In addition, 55% to 100% of the pesticides detected in each region were included in a Regional Primary List. This work verifies the ability of the risk prediction method to screen pesticides and select those with a high risk of detection.

A paradoxical immigration restriction policy for unskilled illegal immigrants

We consider two types of illegal migrants to a developed country based on the expected lifetime income: low-risk entrance with high risk of detection during their stay (type A) and high-risk entrance with low risk of detection (type B). Following Japan’s new immigration policy introduced in 2019, we also consider two types of legal unskilled immigrants: those with a limited staying period without their families (Specific Skills #1) and those permitted permanent stay with their families (Specific Skills #2). Resulting from each individual’s choice, if all four types of immigrants exist, paradoxically, we found that policies encouraging the introduction of type B illegal immigrants would be the optimal policy for the host country that seeks to improve both foreign workers’ quality and the economic welfare of domestic residents.

Leprosy in the North and Northeast regions of Brazil: an integrated spatiotemporal approach.

To analyse the spatiotemporal patterns of leprosy occurrence in the North and Northeast regions of Brazil from 2001 to 2017. Mixed population-based ecological study with spatial and temporal trend analysis of epidemiological indicators based on new cases reported to the Information System for Notifiable Diseases of the Ministry of Health occurring in individuals residing in North and Northeast states of Brazil. A total of 396987 new cases were analysed; 9.2% of these involved children <15years of age, and 5.4% involved individuals with grade 2 disability (G2D). The Northeast region recorded 66.4% of the new cases. Most cases involved males between 15 and 59years of age and of brown race/colour. The temporal trend showed a reduction in most of the indicators and study variables. The G2D rate did not have trends over time in the Northeast Region, in individuals 0-14years of age, or in municipalities with 'very high' social vulnerability indexes. The spatial and spatiotemporal analysis showed the presence of hyperendemic foci with high detection risk involving municipalities in the states of Tocantins, Pará and Maranhão. Leprosy in the North and Northeast regions of Brazil persists as a critical public health problem. Temporal and spatiotemporal patterns identified in this study confirm that leprosy remains epidemiologically relevant in vulnerable areas. Surveillance and control interventions are needed in municipalities with low detection in the general population, in children and in individuals with G2D, to reduce late diagnosis.

Genetic testing for prevention of severe drug-induced skin rash.

Genetic testing for prevention of severe drug-induced skin rash.

Deep brain stimulation for dystonia.

Dystonia is a painful and disabling disorder, characterised by painful, involuntary posturing of the affected body region(s). Deep brain stimulation is an intervention typically reserved for severe and drug-refractory cases, although uncertainty exists regarding its efficacy, safety, and tolerability. To compare the efficacy, safety, and tolerability of deep brain stimulation (DBS) versus placebo, sham intervention, or best medical care, including botulinum toxin and resective or lesional surgery, in adults with dystonia. We identified studies by searching the CENTRAL, MEDLINE, Embase, three other databases, four clinical trial registries, four grey literature databases, and reference lists of included articles. We ran the last search of all elements of the search strategy, with no language restrictions, on 29 May 2018. Double-blind, parallel, randomised, controlled trials (RCTs) comparing DBS with sham stimulation, best medical care, or placebo in adults with dystonia. Two independent review authors assessed records, selected included studies, extracted data onto a standardised (or prespecified) data extraction form, and evaluated the risk of bias. We resolved disagreements by consensus or by consulting a third review author. We conducted meta-analyses using a random-effects model, to estimate pooled effects and corresponding 95% confidence intervals (95% CI). We assessed the quality of the evidence with GRADE methods. The primary efficacy outcome was symptom improvement on any validated symptomatic rating scale, and the primary safety outcome was adverse events. We included two RCTs, enrolling a total of 102 participants. Both trials evaluated the effect of DBS on the internal globus pallidus nucleus, and assessed outcomes after three and six months of stimulation. One of the studies included participants with generalised and segmental dystonia; the other included participants with focal (cervical) dystonia. We assessed both studies at high risk for performance and for-profit bias. One study was retrospectively registered with a clinical trial register, we judged the second at high risk of detection bias.Low-quality evidence suggests that DBS of the internal globus pallidus nucleus may improve overall cervical dystonia-related symptoms (mean difference (MD) 9.8 units, 95% CI 3.52 to 16.08 units; 1 RCT, 59 participants), cervical dystonia-related functional capacity (MD 3.8 units, 95% CI 1.41 to 6.19; 1 RCT, 61 participants), and mood at three months (MD 3.1 units, 95% CI 0.73 to 5.47; 1 RCT, 61 participants).Low-quality evidence suggests that In people with cervical dystonia, DBS may slightly improve the overall clinical status (MD 2.3 units, 95% CI 1.15 to 3.45; 1 RCT, 61 participants). We are uncertain whether DBS improves quality of life in cervical dystonia (MD 3 units, 95% CI -7.71 to 13.71; 1 RCT, 57 participants; very low-quality evidence), or emotional state (MD 2.4 units, 95% CI -6.2 to 11.00; 1 RCT, 56 participants; very low-quality evidence).Low-quality evidence suggests that DBS of the internal globus pallidus nucleus may improve generalised or segmental dystonia-related symptoms (MD 14.4 units, 95% CI 8.0 to 20.8; 1 RCT, 40 participants), overall clinical status (MD 3.5 units, 95% CI 2.33 to 4.67; 1 RCT, 37 participants), physical functioning-related quality of life (MD 6.3 units, 95% CI 1.06 to 11.54; 1 RCT, 33 participants), and overall dystonia-related functional capacity at three months (MD 3.1 units, 95% CI 1.71 to 4.48; 1 RCT, 39 participants). We are uncertain whether DBS improves physical functioning-related quality of life (MD 5.0 units, 95% CI -2.14 to 12.14, 1 RCT, 33 participants; very low-quality evidence), or mental health-related quality of life (MD -4.6 units, 95% CI -11.26 to 2.06; 1 RCT, 30 participants; very low-quality evidence) in generalised or segmental dystonia.We pooled outcomes related to safety and tolerability, since both trials used the same intervention and comparison. We found very low-quality evidence of inconclusive results for risk of adverse events (relative risk (RR) 1.58, 95% 0.98 to 2.54; 2 RCTs, 102 participants), and tolerability (RR 1.86, 95% CI 0.16 to 21.57; 2 RCTs,102 participants). DBS of the internal globus pallidus nucleus may reduce symptom severity and improve functional capacity in adults with cervical, segmental or generalised moderate to severe dystonia (low-quality evidence), and may improve quality of life in adults with generalised or segmental dystonia (low-quality evidence). We are uncertain whether the procedure improves quality of life in cervical dystonia (very low-quality evidence). We are also uncertain about the safety and tolerability of the procedure in adults with either cervical and generalised, or segmental dystonia (very-low quality evidence).We could draw no conclusions for other populations with dystonia (i.e. children and adolescents, and adults with other types of dystonia), or for other DBS protocols (i.e. other target nuclei or stimulation paradigms). Further research is needed to establish the long-term efficacy and safety of DBS of the internal globus pallidus nucleus.

Regulating the Market for Audit Services: A Game Theoretic Approach

We apply game theory to model how alternative mandatory audit firm rotation regimes can affect the strategic interaction between auditee and auditor firms, and analyze potential consequences on detection risk and impairment of auditor skepticism. The major results suggest that, (1) relative to an initial state with no rotation requirement but high probability for impaired auditor skepticism, imposing either short-term or long-term mandatory audit firm rotation will remove the threat to auditor skepticism and lead to higher audit fees and lower detection risk; (2) relative to long-term mandatory audit firm rotation, imposing a short-term rotation will lead to lower audit fees and higher detection risk, resulting from greater informational frictions. We further find that supplementary regulatory instruments such as increased scrutiny of the auditee and/or auditor can be used to lower the detection risk and increase the audit quality. The public policy and empirical implications of our findings are discussed.

Mindfulness-based stress reduction for family carers of people with dementia.

Caring for people with dementia is highly challenging, and family carers are recognised as being at increased risk of physical and mental ill-health. Most current interventions have limited success in reducing stress among carers of people with dementia. Mindfulness-based stress reduction (MBSR) draws on a range of practices and may be a promising approach to helping carers of people with dementia. To assess the effectiveness of MBSR in reducing the stress of family carers of people with dementia. We searched ALOIS - the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (all years to Issue 9 of 12, 2017), MEDLINE (Ovid SP 1950 to September 2017), Embase (Ovid SP 1974 to Sepetmber 2017), Web of Science (ISI Web of Science 1945 to September 2017), PsycINFO (Ovid SP 1806 to September 2017), CINAHL (all dates to September 2017), LILACS (all dates to September 2017), World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, and Dissertation Abstracts International (DAI) up to 6 September 2017, with no language restrictions. Randomised controlled trials (RCTs) of MBSR for family carers of people with dementia. Two review authors independently screened references for inclusion criteria, extracted data, assessed the risk of bias of trials with the Cochrane 'Risk of bias' tool, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information, then conducted meta-analyses, or reported results narratively in the case of insufficient data. We used standard methodological procedures expected by Cochrane. We included five RCTs involving 201 carers assessing the effectiveness of MBSR. Controls used in included studies varied in structure and content. Mindfulness-based stress reduction programmes were compared with either active controls (those matched for time and attention with MBSR, i.e. education, social support, or progressive muscle relaxation), or inactive controls (those not matched for time and attention with MBSR, i.e. self help education or respite care). One trial used both active and inactive comparisons with MBSR. All studies were at high risk of bias in terms of blinding of outcome assessment. Most studies provided no information about selective reporting, incomplete outcome data, or allocation concealment.1. Compared with active controls, MBSR may reduce depressive symptoms of carers at the end of the intervention (3 trials, 135 participants; standardised mean difference (SMD) -0.63, 95% confidence interval (CI) -0.98 to -0.28; P<0.001; low-quality evidence). We could not be certain of any effect on clinically significant depressive symptoms (very low-quality evidence).Mindfulness-based stress reduction compared with active control may decrease carer anxiety at the end of the intervention (1 trial, 78 participants; mean difference (MD) -7.50, 95% CI -13.11 to -1.89; P<0.001; low-quality evidence) and may slightly increase carer burden (3 trials, 135 participants; SMD 0.24, 95% CI -0.11 to 0.58; P=0.18; low-quality evidence), although both results were imprecise, and we could not exclude little or no effect. Due to the very low quality of the evidence, we could not be sure of any effect on carers' coping style, nor could we determine whether carers were more or less likely to drop out of treatment.2. Compared with inactive controls, MBSR showed no clear evidence of any effect on depressive symptoms (2 trials, 50 participants; MD -1.97, 95% CI -6.89 to 2.95; P=0.43; low-quality evidence). We could not be certain of any effect on clinically significant depressive symptoms (very low-quality evidence).In this comparison, MBSR may also reduce carer anxiety at the end of the intervention (1 trial, 33 participants; MD -7.27, 95% CI -14.92 to 0.38; P=0.06; low-quality evidence), although we were unable to exclude little or no effect. Due to the very low quality of the evidence, we could not be certain of any effects of MBSR on carer burden, the use of positive coping strategies, or dropout rates.We found no studies that looked at quality of life of carers or care-recipients, or institutionalisation.Only one included study reported on adverse events, noting a single adverse event related to yoga practices at home AUTHORS' CONCLUSIONS: After accounting for non-specific effects of the intervention (i.e. comparing it with an active control), low-quality evidence suggests that MBSR may reduce carers' depressive symptoms and anxiety, at least in the short term.There are significant limitations to the evidence base on MBSR in this population. Our GRADE assessment of the evidence was low to very low quality. We downgraded the quality of the evidence primarily because of high risk of detection or performance bias, and imprecision.In conclusion, MBSR has the potential to meet some important needs of the carer, but more high-quality studies in this field are needed to confirm its efficacy.

Music-based therapeutic interventions for people with dementia.

Dementia is a clinical syndrome with a number of different causes which is characterised by deterioration in cognitive, behavioural, social and emotional functions. Pharmacological interventions are available but have limited effect to treat many of the syndrome's features. Less research has been directed towards non-pharmacological treatments. In this review, we examined the evidence for effects of music-based interventions. To assess the effects of music-based therapeutic interventions for people with dementia on emotional well-being including quality of life, mood disturbance or negative affect, behavioural problems, social behaviour and cognition at the end of therapy and four or more weeks after the end of treatment. We searched ALOIS, the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG) on 19 June 2017 using the terms: music therapy, music, singing, sing, auditory stimulation. Additional searches were carried out on 19 June 2017 in the major healthcare databases MEDLINE, Embase, PsycINFO, CINAHL and LILACS; and in trial registers and grey literature sources. We included randomised controlled trials of music-based therapeutic interventions (at least five sessions) for people with dementia that measured any of our outcomes of interest. Control groups either received usual care or other activities with or without music. Two review authors worked independently to screen the retrieved studies against the inclusion criteria and then to extract data and assess methodological quality of the included studies. If necessary, we contacted trial authors to ask for additional data, including relevant subscales, or for other missing information. We pooled data using random-effects models. We included 22 studies with 1097 randomised participants. Twenty-one studies with 890 participants contributed data to meta-analyses. Participants in the studies had dementia of varying degrees of severity, and all were resident in institutions. Seven studies delivered an individual music intervention; the other studies delivered the intervention to groups of participants. Most interventions involved both active and receptive musical elements. The methodological quality of the studies varied. All were at high risk of performance bias and some were at high risk of detection or other bias.At the end of treatment, we found low-quality evidence that the interventions may improve emotional well-being and quality of life (standardised mean difference (SMD) 0.32, 95% confidence interval (CI) 0.02 to 0.62; 9 studies, 348 participants) and reduce anxiety (SMD -0.43, 95% CI -0.72 to -0.14; 13 studies, 478 participants). We found low-quality evidence that music-based therapeutic interventions may have little or no effect on cognition (SMD 0.15, 95% CI -0.06 to 0.36; 7 studies, 350 participants). There was moderate-quality evidence that the interventions reduce depressive symptoms (SMD -0.27, 95% CI -0.45 to -0.09; 11 studies, 503 participants) and overall behaviour problems (SMD -0.23, 95% CI -0.46 to -0.01; 10 studies, 442 participants), but do not decrease agitation or aggression (SMD -0.07, 95% CI -0.24 to 0.10; 14 studies, 626 participants). The quality of the evidence on social behaviour was very low, so effects were very uncertain.The evidence for long-term outcomes measured four or more weeks after the end of treatment was of very low quality for anxiety and social behaviour, and for the other outcomes, it was of low quality for little or no effect (with small SMDs, between 0.03 and 0.34). Providing people with dementia who are in institutional care with at least five sessions of a music-based therapeutic intervention probably reduces depressive symptoms and improves overall behavioural problems at the end of treatment. It may also improve emotional well-being and quality of life and reduce anxiety, but may have little or no effect on agitation or aggression or on cognition. We are uncertain about effects on social behaviour and about long-term effects. Future studies should examine the duration of effects in relation to the overall duration of treatment and the number of sessions.

Restriction policy and two co-existing types of illegal immigration

We consider two possible cases of illegal immigrants to a developed country based on their expected lifetime income: high-risk entrance with low risk of detection during their stay (type F migration) and low-risk entrance with high risk of detection (type S migration). We find that if medium productivity workers migrate illegally as type S immigrants, and if lower productivity workers migrate illegally as type F, internal investigation policies for type S immigrants will contribute to enhance the average productivity of illegal immigrants. On the other hand, if medium productivity workers migrate illegally as type F while lower productivity workers migrate illegally as type S, border control policies for type F immigrants will contribute to enhance the average productivity of illegal immigrants. Moreover, we find that the expansion of legal immigration (legalization of high productivity illegal immigrants) by the host country reduces the total number of illegal immigrants and enhances the average productivity of total immigrants in the two cases that were examined in this paper.

Physical activity for women with breast cancer after adjuvant therapy.

Women with a diagnosis of breast cancer may experience short- and long-term disease and treatment-related adverse physiological and psychosocial outcomes. These outcomes can negatively impact prognosis, health-related quality of life (HRQoL), and psychosocial and physical function. Physical activity may help to improve prognosis and may alleviate the adverse effects of adjuvant therapy. To assess effects of physical activity interventions after adjuvant therapy for women with breast cancer. We searched the Cochrane Breast Cancer Group (CBCG) Specialised Registry, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Physiotherapy Evidence Database (PEDro), SPORTDiscus, PsycINFO, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform, on 18 September 2015. We also searched OpenGrey and Healthcare Management Information Consortium databases. We searched for randomised and quasi-randomised trials comparing physical activity interventions versus control (e.g. usual or standard care, no physical activity, no exercise, attention control, placebo) after adjuvant therapy (i.e. after completion of chemotherapy and/or radiation therapy, but not hormone therapy) in women with breast cancer. Two review authors independently selected studies, assessed risk of bias, and extracted data. We contacted trial authors to ask for additional information when needed. We calculated an overall effect size with 95% confidence intervals (CIs) for each outcome and used GRADE to assess the quality of evidence for the most important outcomes. We included 63 trials that randomised 5761 women to a physical activity intervention (n = 3239) or to a control (n = 2524). The duration of interventions ranged from 4 to 24 months, with most lasting 8 or 12 weeks (37 studies). Twenty-eight studies included aerobic exercise only, 21 involved aerobic exercise and resistance training, and seven used resistance training only. Thirty studies described the comparison group as usual or standard care, no intervention, or control. One-fifth of studies reported at least 20% intervention attrition and the average physical activity adherence was approximately 77%.No data were available on effects of physical activity on breast cancer-related and all-cause mortality, or on breast cancer recurrence. Analysis of immediately postintervention follow-up values and change from baseline to end of intervention scores revealed that physical activity interventions resulted in significant small-to-moderate improvements in HRQoL (standardised mean difference (SMD) 0.39, 95% CI 0.21 to 0.57, 22 studies, 1996 women; SMD 0.78, 95% CI 0.39 to 1.17, 14 studies, 1459 women, respectively; low-quality evidence), emotional function (SMD 0.21, 95% CI 0.10 to 0.32, 26 studies, 2102 women, moderate-quality evidence; SMD 0.31, 95% CI 0.09 to 0.53, 15 studies, 1579 women, respectively; low-quality evidence), perceived physical function (SMD 0.33, 95% CI 0.18 to 0.49, 25 studies, 2129 women; SMD 0.60, 95% CI 0.23 to 0.97, 13 studies, 1433 women, respectively; moderate-quality evidence), anxiety (SMD -0.57, 95% CI -0.95 to -0.19, 7 studies, 326 women; SMD -0.37, 95% CI -0.63 to -0.12, 4 studies, 235 women, respectively; low-quality evidence), and cardiorespiratory fitness (SMD 0.44, 95% CI 0.30 to 0.58, 23 studies, 1265 women, moderate-quality evidence; SMD 0.83, 95% CI 0.40 to 1.27, 9 studies, 863 women, respectively; very low-quality evidence).Investigators reported few minor adverse events.Small improvements in physical activity interventions were sustained for three months or longer postintervention in fatigue (SMD -0.43, 95% CI -0.60 to -0.26; SMD -0.47, 95% CI -0.84 to -0.11, respectively), cardiorespiratory fitness (SMD 0.36, 95% CI 0.03 to 0.69; SMD 0.42, 95% CI 0.05 to 0.79, respectively), and self-reported physical activity (SMD 0.44, 95% CI 0.17 to 0.72; SMD 0.51, 95% CI 0.08 to 0.93, respectively) for both follow-up values and change from baseline scores.However, evidence of heterogeneity across trials was due to variation in intervention components (i.e. mode, frequency, intensity, duration of intervention and sessions) and measures used to assess outcomes. All trials reviewed were at high risk of performance bias, and most were also at high risk of detection, attrition, and selection bias. In light of the aforementioned issues, we determined that the evidence was of very low, low, or moderate quality. No conclusions regarding breast cancer-related and all-cause mortality or breast cancer recurrence were possible. However, physical activity interventions may have small-to-moderate beneficial effects on HRQoL, and on emotional or perceived physical and social function, anxiety, cardiorespiratory fitness, and self-reported and objectively measured physical activity. The positive results reported in the current review must be interpreted cautiously owing to very low-to-moderate quality of evidence, heterogeneity of interventions and outcome measures, imprecision of some estimates, and risk of bias in many trials. Future studies with low risk of bias are required to determine the optimal combination of physical activity modes, frequencies, intensities, and durations needed to improve specific outcomes among women who have undergone adjuvant therapy.

Coblation versus other surgical techniques for tonsillectomy.

Coblation versus other surgical techniques for tonsillectomy.