Low Levels Of Confidence Research Articles

A sustainable NEV manufacturer-retailer system under the Nash bargaining framework: considering the impact of the COVID-19 epidemic under the CVaR criterion

Suppose a new energy vehicle (NEV) manufacturer-retailer system where the wholesale price and the order quantity are determined through a negotiation procedure. Considering the impact of the COVID-19 epidemic, the manufacturer and the retailer are both assumed to be risk averse with Conditional Value-at-Risk (CVaR) as their performance measure. With the uniform distribution assumption, we derive the equilibrium solutions as well as the players’ profit shares in the Stackelberg game and Nash bargaining framework. We quantitatively address the impacts of the players’ confidence levels and government subsidy on the equilibrium order quantity, wholesale price and profit allocation in both negotiation frameworks. We find that, in both negotiation frameworks and considering the impact of the COVID-19 epidemic, a more risk-averse (i.e., with lower confidence level in CVaR model) manufacturer or retailer tends to occupy a higher profit share. On the other hand, a higher government subsidy aiming at offsetting the epidemic’s impact leads to a higher profit share for the manufacturer and a lower one for the retailer. A quantitive comparison of the equilibriums in the two negotiation frameworks indicates that more NEVs are ordered by the retailer and a higher system profit is generated in the Nash bargaining framework than the Stackelberg game. Thus, we analytically prove that the Nash bargaining framework is superior to the Stackelberg game for the NEV manufacturer-retailer system in terms of both quantity and profit with consideration of the epidemic impact. In addition, a series of numerical experiments is carried out to illustrate the effects of some significant parameters on the equilibrium order quantity and the system profit allocation in different negotiation frameworks. These numerical experiments also further demonstrate the superiority of the Nash bargaining framework for either NEV player—no matter how the epidemic trend and the government subsidy vary—and provide a quantitative scope for the retailer’s bargaining power to sustainably maintain the win-win cooperation between the NEV manufacturer and retailer in the superior Nash bargaining framework within the epidemic environment. From the perspective of policy, the government should increase subsidy within the epidemic environment to offset the negative effect and can degenerate subsidy when the epidemic dissipates. Furthermore, as the subsidy degenerates, both model results and numerical experiments show that the manufacturer suffers a more unfavorable effect, so the government can preferentially support the manufacturer by adjusting the subsidy to a higher level to alter players’ relative powers and profit shares.

Empowering future surgeons: a workshop bridging the gap between graduation and the operating room.

Feedback from foundation trainees in Blackpool highlighted low levels of confidence with the prospect of surgical on-call shifts. Key areas of concern were assessing and managing the acute surgical patient, identifying which patients need an operation and having the technical skills to proficiently assist in theatre. This lack of confidence prevents trainees engaging in what should be an educational and rewarding rotation. The authors designed and facilitated a day of workshops, addressing these key educational needs. Bespoke to the trust's services, lectures were delivered by core surgical trainees on the assessment and management of acute surgical patients in general surgery, urology and trauma and orthopaedics. For the development of technical skills, an afternoon of surgical skills workshops covered suturing, knot tying, laparoscopic principles and theatre etiquette. Small groups of foundation trainees rotated through each workshop, delivered by surgical registrars (ST3+), to ensure high fidelity training. Pre- and post-course questionnaires assessed the efficacy of teaching. Out of a total of 72 foundation trainees, 55 attended the teaching day, of which 45 (81.8%) completed pre- and post-course surveys using a six-point modified Likert scale. Rates for satisfactory confidence levels while on-call improved from 66 to 100% of participants after the course. Suturing skills satisfaction rose from 37.5 to 100%, among other impact markers. All trainees that attended the course displayed a marked improvement. This course is now being incorporated into foundation teaching programmes at a regional level and has scope to be expanded nationally.

Prevalence and nature of workplace bullying and harassment and associations with mental health conditions in England: a cross-sectional probability sample survey

BackgroundEvidence on workplace bullying and harassment (WBH) in the UK has not used probability-sample surveys with robust mental health assessments. This study aimed to profile the prevalence and nature of WBH in England, identify inequalities in WBH exposure, and quantify adjusted associations with mental health. MethodsData were from the 2014 Adult Psychiatric Morbidity Survey, a cross-sectional probability-sample survey of the household population in England, interviewed with verbal informed consent. Criteria for inclusion in the secondary analysis were being aged 16–70 years and in paid work in the past month (n=3838). Common mental disorders were assessed using the Clinical Interview Schedule-Revised and mental wellbeing using the Warwick-Edinburgh Mental Wellbeing Scale. Analyses were weighted. We examined associations between past-year WBH and current common mental disorders using multivariable regression modelling, adjusting for demographic and socioeconomic factors. Interaction terms tested for gender differences in associations. The study received ethics approval (ETH21220–299). FindingsOne in ten employees (10·6% (weighted), n=444/3838) reported past-year experience of WBH, with rates higher in women (12·2%, n=284/2189); those of mixed, multiple, and other ethnicity (21·0%, n=15/92); and people in debt (15·2%, n=50/281) or living in cold homes (14·6%, n=42/234). Most commonly identified perpetrators of WBH were line managers (53·6%, n=244/444) or colleagues (42·8%, n=194/444). Excessive criticism (49·3%, n=212/444), verbal abuse (42·6%, n=187/444), and humiliation (31·4%, n=142/444) were the most common types. WBH was associated with all adverse mental health indicators, including common mental disorders (adjusted odds ratio [aOR] 2·65, 95% CI 2·02–3·49), and 11 of 14 mental wellbeing indicators, including lower levels of confidence (aOR 0·57, 0·46–0·72) and of closeness to others (aOR 0·57, 0·46–0·72). Patterns of association between WBH and mental health were similar in men and women. InterpretationThese findings reinforce a need for more cohesive UK legislation at the national level; guidance on recognition of bullying behaviours for employees, managers, and human resources at the organisational level, focusing on prevention and early intervention, and increased awareness of the impact of WBH on mental health among health-service practitioners. Study limitations include reliance on cross-sectional data collected before pandemic-related and other major changes in workplace practices. Longitudinal data are needed to improve evidence on causality and the longevity of mental health impacts. FundingUK Prevention Research Partnership.

Profil Kemampuan Berpikir Kritis Siswa pada Materi Pencemaran Lingkungan Ditinjau Dari Self Confidence

This study aims to identify the profile of students’ critical thinking skills on environmental pollution material in therm of self confidence. The study used a mixed type of research (mix method) with an explanatory sequential model conducted on students of SMP Negeri 1 Sumenep with a total population of all seventh grade students of SMP Negeri 1 Sumenep and a total sample of 16 students for the 2020/2021 academic year. The sampling technique is done by purposive sampling technique. Data were collected through test techniques, questionnaires, interviews, and documentation. The research data was obtained from the analysis of students' answers to the critical thinking ability test in terms of self-confidence. Indicators of critical thinking skills used are providing simple explanations, building basic skills, drawing conclusions, providing further explanations and developing strategies and techniques. The results showed that: 1) The critical thinking ability of students with low criteria was 3 students, moderate criteria were 2 students, and high criteria were 11 students. So, it can be concluded that students' critical thinking skills tend to be diverse with the category of critical thinking skills with high criteria being the most dominating ability. 2) Self confidence 9 students have a high level of self confidence, 6 students have a moderate level of self confidence, and 1 student has a low level of self confidence. So, it can be concluded that the students' self-confidence ability is dominated by having very good self-confidence.

Social Work with No Recourse to Public Fund Migrants: Obstacles and Strategies

Abstract Migrants with no recourse to public funds (NRPFs) are vulnerable to destitution due to the NRPF condition attached to their immigration status. In this quantitative study, fifty-five social workers in England completed an anonymous online survey identifying the obstacles faced in their practice with NRPF migrants and any strategies they developed to overcome these impediments. Informed by the Theoretical Domains Framework, the study identified four main obstacles when working with NRPF migrants: lack of resources to support NRPF migrants; lack of knowledge/skills; negative attitudes from colleagues and insufficient institutional support. Compared to their local authority counterparts, NHS social workers expressed lower levels of confidence in their knowledge and skill level, and received less specific training, organisational guidance and support in their work with NRPF migrants. A 4-fold typology of strategies used by social workers to overcome obstacles was devised from responses to an open-ended question. In addition to the need for more resourcing, the findings suggest a need for social work education and training on how to effectively support NRPF migrants using extant legislation and agencies, and suggest knowledge exchange to promote inter-agency collaboration.

Co-Created Solutions for Perinatal Professionals and Childbearing Needs for People with Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders.

Individuals living with hypermobile Ehlers-Danlos syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) have reported feeling discredited and unsupported by healthcare professionals. However, the level of knowledge about hEDS/HSD among maternity staff remains unknown. Informed by patient and public involvement, this research aimed to investigate maternity staff's knowledge and confidence in supporting people with hEDS/HSD, examine people with hEDS/HSD's experiences of perinatal care, and co-create tools to help maternity staff support people childbearing with hEDS/HSD. Two online mixed-methods international surveys were completed by childbearing people with hEDS/HSD (N = 955) and maternity staff (N = 307). This was followed by the co-creation of three tools with 17 co-creators and a design team. Two main qualitative themes were identified through thematic analysis: (1) a need for recognition of hEDS/HSD in perinatal care and (2) the delivery of appropriate individualised perinatal care. Quantitatively, people with hEDS/HSD perceived maternity professionals to have a low level of knowledge about the conditions. Respectively, maternity staff reported low levels of confidence in supporting people with hEDS/HSD. The co-created tools provide applicable outputs for both education and practice and include an i-learn module hosted by the Royal College of Midwives, a tool for perinatal records, and infomercials.

Comparison of contrast-enhanced ultrasonography and MRI results obtained by expert and novice radiologists indicating short-term response after transarterial chemoembolisation for hepatocellular carcinoma

To evaluate inter-reader agreement between novice and expert radiologists in assessing contrast-enhanced ultrasonography (CEUS) and magnetic resonance imaging (MRI) images for detecting viable tumours with different sizes after conventional transarterial chemoembolisation (cTACE). This prospective study included patients who had less than five hepatomas and who underwent cTACE. Hepatomas with one or two feeding arteries were selected as target lesions. CEUS and MRI were performed within 1 week after cTACE to evaluate viable tumours. The expert group had higher kappa values in evaluating all tumour sizes via CEUS compared with MRI. The novice group had similar kappa values. In patients with tumours measuring ≤3 cm, the expert group had higher kappa values in reading CEUS compared with MRI images; however, in the novice group, the kappa value was lower in evaluating CEUS compared with MRI images. In patients with tumours measuring >3 cm, the expert and novice groups had good to excellent kappa values. The confidence level of the two groups in reading MRI images was high; however, the novice group had a lower confidence level. CEUS is a convenient, cost-effective, and easy to apply imaging tool that can help interventionists perform early detection of viable hepatocellular carcinoma post-TACE. It has a higher inter-rater agreement in interpreting CEUS images compared with MRI images among expert radiologists even when they are extremely familiar with post-cTACE MRI images. In novice radiologists, there may be a learning curve to achieve good consistency in CEUS interpretation.

Numerical experiment to evaluating two-sided tolerance limit for safety analysis

Uncertainty analysis is required to quantify uncertainties in safety evaluation for industrial applications when the best-estimate methodology is employed. The nonparametric order statics method suggested by the GRS (Gesellschaftfür Anlagen-und Reaktorsicherheit) is one of the uncertainty evaluation methodologies to obtain the figure of merits with a probability of 95 % and confidence of 95 %, namely 95/95 value. In this method, the number of repeated calculations with perturbation to acquire the 95/95 value is decided by a formula suggested by Wilks and is dependent on the number of uncertainty parameters. Thus, the method is effective when the reference system has a large number of parameters which bring uncertainty in the analysis. Previous studies indicate that the method can estimate the 95/95 value successfully when the figure of merit has one-sided tolerance limit where either the upper or lower limit exits. However, when it is necessary to cut off the tails of 2.5% evenly in both ends, namely the centered two-sided tolerance limit, the suggested formula results in a lower confidence level. Thus, a modified formula is suggested in this study to account for such characteristics, and, as a result, the number of repeated calculations required to obtain the 95/95 value is calculated. The validity of the formula and the number of repeated calculations are examined using numerical experiments for 21 different distributions. The numerical experiment has been conducted with one to ten million sample sets to estimate the confidence level. The results of the numerical experiments indicate that the 95/95 value is predicted successfully by the repeated calculations decided by the modified formula when the figure of merit has characteristics of the centered two-sided distribution, while the existing formula results in a confidence level of 80%.

Sexual Function and Dosimetric Relationships to Erectile Structures among Patients Treated Definitively with Pd-103 LDR Prostate Brachytherapy

Sexual potency and erectile function are important quality of life metrics for many men and is a significant consideration when planning and treating prostate cancer. There are limited long-term data correlating post-implant dosimetry with patient-reported sexual toxicity outcomes following LDR prostate brachytherapy using Pd-103, specifically as it pertains to genital substructures. Our aim was to correlate dosimetric patterns with quality-of-life outcomes to determine if dose to the pudendal arteries and neurovascular bundles is a significant consideration when planning prostate LDR brachytherapy. We analyzed a prospectively collected IRB-approved database of men receiving LDR prostate brachytherapy between 11/2014-04/2019 at our institution. Patients received either LDR brachytherapy only, or combined with intensity-modulated radiation therapy (IMRT) to the prostate with or without pelvic lymph node coverage. Patients were given quality of life questionnaires at consultation and at subsequent follow up visits. Outcomes data related to sexual toxicity were evaluated based on the Sexual Health Inventory (SHIM) Questionnaire. The right/left pudendal arteries, and right/left neurovascular bundles (NVB) were contoured retrospectively on CT-MRI fusion sequences. Dosimetric data for each of the erectile substructures was analyzed. Statistical analyses included generalized linear mixed effects models with random intercept for patient to explore the association between dose and SHIM confidence. A total of 50 patients met criteria for inclusion in the analysis. 5 patients received combined IMRT to 45 Gy with Pd-103 (90-100 Gy) and 45 patients received Pd-103 monotherapy (125 Gy). Median follow-up was 18 months for 50 patients; 40 (80%) patients had follow-up greater than 2 years, and 15 (30%) greater than 5 years. There were 344 individual questionnaires completed. 28% of records reported low or very low confidence level (Question #1 of SHIM questionnaire). Likelihood of moderate-very high confidence increased up to 2 years after beginning of treatment (p = 0.052) and then subsequently decreased between 2- and 5 years post treatment (p = 0.042). NVB doses were not associated with SHIM confidence level. D100 greater than 150 cGy to either pudendal artery was associated with worse SHIM confidence score after treatment (p = 0.003). Sexual function is variable in the post treatment setting following definitive prostate radiation with Pd-103 LDR-brachytherapy. Avoiding pudendal artery dose may improve sexual outcomes and should be considered when planning prostate brachytherapy. Further investigation with a larger prospective, cohort may be warranted.

Comprehensive school-based sexuality education: outcome evaluation results from Hong Kong

ABSTRACT This study evaluated the effects of a comprehensive school-based sexuality education programme in enhancing sexual health knowledge and understanding among adolescents, parents and school personnel in six secondary schools in Hong Kong. Study outcomes were evaluated through pre- and post-tests. A total of 1588 students, 40 parents and 271 school personnel participated. Baseline student knowledge scores were highest among younger students, with significant improvements observed in both years for all grades except one. Baseline student attitude scores were ≥ 85% for younger students, with no significant improvement, while older students showed significant improvements. Parents scored below 40% correct at baseline for knowledge items, while self-efficacy items were generally higher. Baseline teacher knowledge scores were higher than parents, but self-efficacy scores were comparable or lower. Baseline guidance counsellors’ surveys indicated low confidence levels and awareness of community resources to support students. This study identified a clear need for sexuality education in Hong Kong and a special focus on students in schools traditionally serving a high proportion of non-Chinese speaking students. The programme has significant potential for expansion in Hong Kong schools as well as for dissemination in Mainland China.

Confidence in Oral Cancer Awareness among Undergraduate Health Profession University Students at Al-Quds University

Background: Oral cancer is the sixth most commonly diagnosed cancer in the world. Still, awareness of this disease among undergraduate health profession university students is insufficient. Many students lack an understanding of risk factors and early signs of oral cancer. Therefore rises a need to increase awareness of oral cancer among health profession graduates so that they may be trained to recognize, diagnose, and properly manage this potentially deadly disease. Method: This study aimed to assess the current awareness and knowledge in oral cancer, focusing on prevention, early detection and adequate referral amongst undergraduate students studying a healthcare profession at Al-Quds University. This was a qualitative survey conducted among 64 senior students at various health profession undergraduate programs. The survey was distributed online and included questions about prevention, early detection, adequate referral, and overall confidence. Results: The results of the survey indicate that dental students had a higher confidence level in the subject of oral cancer than non-dental students, with the highest levels of confidence in prevention and lower levels of confidence in adequate referral. Additionally, the results suggest that a larger proportion of non-dental students showed lower confidence in the survey, and a higher proportion of dental students showed higher confidence. Conclusion: In conclusion, this survey revealed that dental students had a higher level of confidence in the areas of prevention, early detection, and overall confidence than non-dental students. Additionally, more emphasis on these aspects is recommended for all health profession students in necessary.

대학-고교 연계 고등학생 대상 찾아가는 진로교육 프로그램 설계 및 운영

Objectives In this study, career education in the form of visiting as a university-high school linkage education was designed and implemented for high school students to derive implications for effective career education.
 Methods To this end, career education program based on the career competencies was designed and implemented for 213 high school students in Seoul. The satisfaction survey and the career maturity inventory (Savickas, & Porfeli, 2011) were conducted to analyze their satisfaction based on their desired career and career maturity levels.
 Results The module for career education consisting of self-understanding(lecture) - career change in the future society(lecture)-career planing(activity) was designed. As a results of its implementation, students who wished to pursue a career in humanities and social sciences showed high satisfaction level with the lecture of self-understanding, while those who wished to pursue careers in science and engineering showed high satisfaction level with the lecture of career change in the future society. Students in the higher career maturity group showed the higher satisfaction in the categories of concern, curiosity, and consultation. However, in the category of confidence, students in the lower career maturity group showed higher satisfaction level.
 Conclusions Based on the results, the implications for the design and implementation of career education for high school students were discussed. These included diversifying career education content elements for different desired career and reinforcing career education for students who show a low level of confidence in the career maturity category.

ANALYSIS OF THE POSSIBILITY OF INFORMATION TECHNOLOGIES INTEGRATION INTO THE PROCESS OF CORPORATE TRAINING FOR EMPLOYEES OF MILK PROCESSING ENTERPRISES IN UKRAINE

Nowadays, the use of the latest IT technologies for educational purposes at milk processing enterprises is at a low level. That is why, to study the motives that have a significant impact on the intention to use technology in the process of training specialists of various directions and levels, a study was conducted based on one of the milk processing enterprises of the western region. The methodology of the analysis was based on the concept of TAM, 32 specialists of various services of the milk processing enterprise in the western region of Ukraine, who are engaged in personnel training in addition to the job, took part in the survey. To obtain primary data, a questionnaire was developed based on literature data of similar studies. The analysis includes testing for the adequacy of the data and the research model – the relationship between the six research elements. The obtained data indicate a relatively low level of confidence in the effectiveness of using computer technologies during corporate training, and the indicator of internal motivation or personal intentions (PI) is the lowest of all values - 3.44. Thus, it can be assumed that such data are related to certain internal beliefs of each member of the group of interviewed employees of the enterprise. To test this assumption, multiple-cause modeling (MIMIC) was used to assess whether there are correlations in respondents' intrinsic motivation with their age and level of education. The calculated coefficients will make it possible to assess the presence of a direct influence of these two variables on the level of employees’ motivation, and their value can be interpreted as the possible presence of an additional factor i.e. the presence of a degree or its absence, as well as the difference in the age of the respondents. The obtained results of the statistical analysis established a correlation between motivation and higher education among employees, indicating that the presence of a specialist or master's degree increases the probability of using computer technologies in the learning process. This is probably related to the use of electronic learning technologies in the programs of their training at the university. Thus, it is obvious that in order to increase the use of IT technologies in the process of corporate training, it is necessary to form among the company's employees computer literacy skills necessary for life in modern society and to develop the ability to use the latest technologies for searching, analyzing, using and transmitting information.

Literalism in Autistic People: a Predictive Processing Proposal

AbstractAutistic individuals are commonly said – and also consider themselves – to be excessively literalist, in the sense that they tend to prefer literal interpretations of words and utterances. This literalist bias seems to be fairly specific to autism and still lacks a convincing explanation. In this paper we explore a novel hypothesis that has the potential to account for the literalist bias in autism. We argue that literalism results from an atypical functioning of the predictive system: specifically, an atypical balance between predictions and error signals in language processing may make individuals more uncertain about their own predictions. Such uncertainty is then often resolved by resorting to the safest interpretation, that is, the literal one. We start by reviewing existing explanations of other autistic traits that appeal to predictive processing. We then apply these insights to language, by showing that predictions play a key role in everyday comprehension and that a low level of confidence in one’s own predictions is likely to escalate comprehension difficulties. Finally, we take a deeper look at non-literal uses of language by discussing the case of metaphors, to illustrate how a predictive processing account offers a promising explanation of the literalist bias in autism.

Barriers and facilitators to the participation and engagement of primary care in shared-care arrangements with community mental health services for preventive care of people with serious mental illness: a scoping review

BackgroundPeople with serious mental illness die about 20 years earlier than the general population from preventable diseases. Shared-care arrangements between general practitioners and mental health services can improve consumers’ access to preventive care, but implementing shared care is challenging. This scoping review sought to describe current evidence on the barriers and facilitators to the participation and engagement of primary care (specifically general practitioners) in shared-care arrangements with community mental health services for preventive health care of this population.MethodsWe searched Medline, Embase, CINAHL, Scopus, APA PsychINFO and EBM Reviews from 2010 to 2022. Data was extracted against a Microsoft Excel template developed for the review. Data was synthesised through tabulation and narrative methods.ResultsWe identified 295 records. After eligibility screening and full-text review, seven studies were included. Facilitators of engagement included a good fit with organisation and practice and opportunities to increase collaboration, specific roles to promote communication and coordination and help patients to navigate appointments, multidisciplinary teams and teamwork, and access to shared medical/health records. Barriers included a lack of willingness and motivation on the part of providers and low levels of confidence with tasks, lack of physical structures to produce capacity, poor alignment of funding/incentives, inability to share patient information and challenges engaging people with severe mental illness in the service and with their care.ConclusionOur results were consistent with other research on shared care and suggests that the broader literature is likely to be applicable to the context of general practitioner/mental health services shared care. Specific challenges relating to this cohort present difficulties for recruitment and retention in shared care programs. Sharing “goals and knowledge, mutual respect” and engaging in “frequent, timely, accurate, problem-solving communication”, supported by structures such as shared information systems are likely to engage primary care in shared care arrangements more than the traditional focus on incentives, education, and guidelines.

Methods for the quantification of uncertainties in thermo–hydro–mechanical simulations for safety analyses and influence of modelling decisions

Abstract. The simulation of thermal, hydraulic, and mechanical coupled processes can be a decisive factor in the integrity assessment of geotechnical and geological barriers. Modelling decisions, such as the representation of heterogeneity and the constitutive models used, significantly impact the simulation outcome (Wagener and Pianosi, 2019). Furthermore, numerical inputs to the simulation, i.e. material parameters and boundary conditions, are subject to uncertainty. This results in a lower confidence level of the outcome, even if the overall simulation framework is well validated. To derive robust conclusions from such analyses, it is important to quantify the relative impact of modelling decisions and inputs on certain quantities of interest. Parameter uncertainties can be quantified by their forward propagation through the discretized problem (Helton, 1994), providing a natural frame of reference for quantifying structural uncertainty (Bond et al., 2007), such as the representation of heterogeneity, and for model validation. This contribution will focus on the latter aspects. We present research on workflows for the unification of evaluating uncertainty in experimental data and certain modelling decisions. We first focus on parameter uncertainty quantification and the resulting conclusions concerning the chosen modelling approach. Hereafter, scale questions are addressed in the context of heterogeneity and anisotropy, based on selected case studies. We close by discussing two example applications, namely one at the Underground Research Laboratory (URL) scale (Mount Terri Full-Scale Emplacement (FE) experiment) and one at the repository scale (ANSICHT Ton Nord model). This work is done as part of the Bundesministerium für Umwelt, Naturschutz, nukleare Sicherheit und Verbraucherschutz (BGE URS) research cluster.

Intolerance to uncertainty among the medical professionals in Central Kerala – Did COVID-19 make us intolerant?

Abstract Background: With the COVID-19 threat that was looming large, uncertainty prevailed in every sphere of life. Medical professionals were feverishly trying to contain the pandemic and were under tremendous mental pressure. Intolerance to uncertainty (IU) is well known to affect the behavior of health-care professionals and is associated with lower levels of confidence and a propensity to behave overcautiously, leading to undue stress and anxiety. We assessed the IU and worry of health-care workers in a teaching institute in Central Kerala, during the COVID pandemic. Methodology: An online cross-sectional survey was done using the IU survey-12 scale and an ultra-brief version of the Penn State Worry Questionnaire, after conducting a pilot study. The form was sent to the doctors’ and nurses’ WhatsApp groups both in English and Malayalam translation attached to each question. Data were analyzed using the SPSS software version 21. The Chi-square test and logistic regression analysis were done. Results: A total of 431 participants took part in the survey. Their mean age was 34.54 ± 8.6 years. The study showed that 27.8% of the participants had high levels of IU. Troublesome worry was a problem in 10.4%. Logistic regression analysis showed that “Worry” and “being a nurse” were the factors that were significantly associated with high levels of IU. Conclusion: Although some IU is expected at the time of a pandemic, 27.8% of health-care professionals being intolerant is a matter of concern. It is high time we break the cycle of events – Worry and IU, that leads to stress but rather make the health workers resilient and tolerant, spreading positive uplifting influences throughout our communities, much faster than the virus.

Opinion Dynamics with Preference Matching: How the Desire to Meet Facilitates Opinion Exchange

The paper reexamines an agent-based model of opinion formation under bounded confidence with heterogeneous agents. The paper is novel in that it extends the standard model of opinion dynamics with the assumption that interacting agents share the desire to exchange opinion. In particular, the interaction between agents in the paper is modeled via a dynamic preferential-matching process wherein agents reveal their preferences to meet according to three features: coherence, opinion difference, and agents’ positive sentiments towards others. Only preferred matches meet and exchange opinion. Through an extensive series of simulation treatments, it follows that the presence of sentiments, on one hand, hardens the matching process between agents, which leads to less communication. But, on the other hand, it increases the diversity in preferred matches between agents and thereby leads to a better-integrated social network structure, which reflects in a reduction of the opinion variance between agents. Moreover, at combinations of (a) high tolerance, (b) low sensitivity of agents to opinion volatility, and (c) low levels of confidence, agents are occasionally drawn away from the consensus, forming small groups that hold extreme opinions.

Improving Clinician Confidence in Insulin Prescriptions at Discharge for Individuals With Newly Diagnosed Type 1 Diabetes.

Background In a questionnaire, we found that pediatric clinicians at Basildon and Thurrock University Hospital (BTUH) have low confidence levels in prescribing multiple daily injections (MDI) for newly diagnosed pediatric patients with type 1 diabetes mellitus. We designed and evaluated locally tailored prescription guidance to improve confidence in MDI discharge prescriptions for pediatric doctors of all grades. Methods We designed a prescription guidance tool by adapting existing local guidelines to improve clinician familiarity with MDI prescriptions and prevent prescription errors. The intervention was delivered in a single pediatric unit to doctors of all levels. Feedback was collected, and the clinicians' confidence in their MDI prescriptions was evaluated before and after the intervention. Questionnaires were distributed to all pediatric doctors within the unit to assess their confidence in prescribing MDIs using a five-point Likert Scale. Furthermore, the questionnaires aimed to determine whether clinicians regularly consulted the existing local guidelines. Local guidelines were adapted in consultation with the local pediatric diabetic multidisciplinary team (MDT) and with reference to the East of England Pediatric Diabetes Network to present MDI guidance in a more concise format, which includes an example MDI discharge medication checklist. Following approval by the local guidelines management group, additional changes were made to enhance the practicality and accessibility of the discharge prescription guidance for clinicians. These guidelines were distributed to the pediatric MDT via email and displayed in visible areas of the department. Results Out of the 13 doctors surveyed, 10 provided pre- and post-intervention feedback (77%). Statistical significance was calculated using unpaired t-tests. Ninety percent of pediatric doctors routinely refer to local guidelines for guidance on MDI prescriptions. However, 50% of respondents felt that existing local guidelines were not easily accessible, given the time and effort required to locate them. The mean confidence score for completing MDI prescriptions at discharge before the intervention was 1.9 (SD: 0.83). After the intervention, it increased to 4 (SD: 0.63) (95% CI: 2.79-1.41, p<0.0001). Ninety percent of pediatric doctors felt that the design and display of the MDI guidelines optimized patient care. Conclusions Following the presentation of the project at a local audit and quality improvement (QI) meeting, the adapted guidelines were included in the junior doctor induction program at BTUH and made accessible on the local intranet. The production of locally tailored prescription guidance for MDI prescriptions at discharge has led to an increase in the confidence of pediatric doctors when writing their prescriptions. We aimed to continue updating this guidance as necessary and making further developments to enhance clinician confidence.

Surgical Rehabilitation for Research Residents: A Pilot Program to Offset Surgical Skill Decay

Select general surgery residents in the surgeon-scientist pipeline dedicate time away from clinical residency to conduct research. However, these research residents (RR) are vulnerable to operative skill decay. The aim of this study is to assess the feasibility of implementation and impact of an organized intervention designed to combat skill decay experienced by RR. RR were enrolled in a pilot Surgical Rehabilitation Program (SRP). The SRP is comprised of 12 cadaver-based simulation sessions and supplemented with Fundamentals of Laparoscopic Surgery-based simulation workouts. The RR were integrated with the clinical residents (CR) during the cadaver sessions and were subsequently performance tested, surveyed, and interviewed. One academic general surgery residency program graduating 8 chief residents yearly in New York. General surgery CR and residents on dedicated research years. Data were collected for all local RR (n = 8) and 77% (n = 37) of CR. Local RR conducted research within the same health system that sponsors the residency. RR experienced gaps in training ranging from 2 to 4 years. All RR were permitted to moonlight on surgical services, however performed 0 operations and only 0.88 procedures on average per shift. Although RR performed similarly to level-matched CR on basic laparoscopic tasks, they required significantly more time on laparoscopic suturing-based skills than CR (p < 0.001). RR had significantly lower confidence levels precadaver sessions but gained confidence postcadaver sessions (p < 0.05), whereas CR confidence was unchanged. Regarding the SRP, qualitative interviews revealed major themes emphasizing the integration of RR, exposure to CR and faculty, technical skill development, maintenance of surgical know-how, and improved confidence for RR. The implementation of such structured interventions, like our SRP, aimed at supporting RR over gap years is essential to help residents maintain skills and confidence needed to achieve their goals of becoming surgeon scientists.