Individual Residents Research Articles

Taxation of foreign trusts in Greece /Tax incentives for the transfer of residence of individuals to Greece

Abstract The present overview provides a summary of the Greek tax regime applicable to foreign trusts. Up until 2017, the taxation of foreign trusts was largely left unregulated in the Greek tax system, which can be attributed to the fact that trusts, being a common-law concept, are not recognized by Greek legislation. Despite the uncertainties, foreign trusts were often used as structures for wealth management or estate planning. The guidelines provided in 2017 were thus eagerly awaited to provide clarity on a matter that was left unregulated for decades and can therefore only be considered as a very positive development. Nevertheless, certain aspects raise concern. This overview also summarizes the Greek Tax Incentive Regimes, which have been met with great demand from foreign residents seeking to transfer their (tax) residence to Greece.

Survival time analysis of the relationship between the residential environment and residents’ health status

Based on numerous cross-sectional analyses, the residential environment has been identified to have an impact on residents’ health status. However, there has been little study of whether these impacts persist in the long term or diminish over time. Accordingly, the present study used data tracking of more than 15,000 residents for nearly 10 years to examine the long-term relationships between the residential environment and residents’ health status using the Kaplan–Meier method and discrete time logit models. The results revealed that higher comprehensive assessment of the thermal, acoustic, light, hygiene, safety, and security environment in the residence is likely to extend the period until health deteriorates. Specifically, the period until low subjective health perception was about 2 years longer for residents in the top 16% of assessments of the residential environment compared with the national average assessment. This trend was also supported by supplementary analyses using the incidence of 10 types of non-communicable diseases: diabetes mellitus, cerebrovascular diseases, disorders of conjunctiva, hypertensive diseases, heart diseases, upper respiratory tract disorders, chronic obstructive pulmonary disease, asthma, dermatitis and eczema, and inflammatory arthropathies. These findings are relevant for a wide range of stakeholders, from individual residents to policymakers, and highlight that a good residential environment effectively promotes healthy longevity. This study will serve as a starting point for further long-term studies.

The use and usefulness of the Peninsula Health Falls Risk Assessment Tool (PHFRAT) process in residential aged care: a mixed methods study across 25 aged care facilities

BackgroundFalls remain a persistent problem in residential aged care (RAC) facilities. Fall screening and assessment tools such as the Peninsula Health Falls Risk Assessment Tool (PHFRAT) are widely used to inform falls risk and guide fall prevention interventions. However, it is unclear how it is used in practice and whether clinicians believe it supports resident care. This study aimed to measure the extent of use of PHFRAT to understand clinicians’ perceptions of its value and usefulness.MethodsThis mixed method study involved an analysis of PHFRAT assessment from 25 RAC facilities in New South Wales, Australia, and interviews with seven RAC staff about how PHFRAT information is used in practice. In the quantitative component, descriptive statistics were applied to PHFRAT data to summarise how RAC staff use the PHFRAT including the completeness and content of the three parts. In the qualitative component, thematic analysis techniques were applied to interview data.ResultsThe sample included 215 RAC residents with 703 PHFRATs, of which 617 documented fall prevention interventions. Among these 617 PHFRATs, 593 (96.1%) included strategies related to staff assistance and 283 (45.9%) recorded strategies related to device provision. While nearly all residents (96.74%) received at least one PHFRAT assessment over the study period, many PHFRAT assessments were incomplete (part 1: 11.5% of information missing; part 2: 10.8%; part 3: 17.1%). There were few variations in fall interventions prescribed to individual residents by their fall risk level. Interviews with RAC staff indicated that PHFRAT assessments are the responsibility of registered nurses with limited input from other staff or residents. While the structured process was viewed positively in guiding risk assessment and intervention assessment, a lack of input from others prevented strategies from being tailored to residents’ specific needs and preferences. A shortage of resources, lack of communication, and limited staff education were identified as the main barriers to PHFRAT guideline implementation.ConclusionThe PHFRAT provides a useful structure for clinicians to assess falls risk factors and plan falls prevention strategies. In the future, increased multidisciplinary input into fall prevention strategy development may improve the comprehensiveness of fall prevention plans.

Association Between Modifiable Structural and Process Factors and the Quality Indicator Pain in Nursing Home Residents: A MultiCentre Cross-Sectional Survey.

The aim of this study is to examine the association between modifiable structural and process factors and self-reported as well as observed pain in Swiss residential long-term care residents. Sub-study of a multicentre cross-sectional survey. Institution, unit, and staff data were collected from September 2018 to October 2019 in 118 residential long-term care institutions in Switzerland's German- and French-speaking regions using paper questionnaires. Resident data were exported during the same period from routine data sets. In this study, 6213 residents from 86 residential long-term care institutions were included. Modifiable structural factors such as institutions having access to geriatricians, nursing experts and a palliative care team, the presence of a pain guideline on the unit and good teamwork among care workers were associated to less pain in residents. It is possible for residential long-term care institutions to improve pain in residents and to optimise the quality of care by providing access to geriatricians, nursing experts and a palliative care team, working with a pain guideline and fostering teamwork. Residential long-term care institutions can modify and implement modifiable structural factors which can reduce pain in residents to optimise residents' quality of life and quality of care. Improved pain management in residential long-term care institutions can lead to optimised quality of care and quality of life for individual residents. STROBE checklist. No patient or public contribution.

To Achieve Carbon Neutrality, What Do Individual Residents Say? A Case Study of Yunnan Province of China Based on Spatial Analysis

This study aims to explore factors that affect individual residents’ behaviors contributing to reducing carbon emissions (low-carbon behaviors), based on the empirical analysis of the choice of adoption and the extent of adoption of low-carbon practices, such as using low-carbon transportation and energy-saving, in Kunming, China. We use spatial econometric regression models to consider positive spillover of low-carbon behaviors amongst residents as people tend to obtain knowledge and learn good actions from those located nearby. The results show the existence of positive spillover effects of low-carbon behaviors across several types of low-carbon practices. We find that location effects, such as access to parks, residents’ knowledge of carbon neutrality, and science communications in the local community are the most important determinants of residents’ low-carbon behaviors. The findings may provide insights into designing supporting policies to incentivize residents’ low-carbon behaviors and contribute to the pathway toward carbon neutrality from the micro-perspective.

Clinical characteristics, treatment, and outcomes for elderly patients in a dedicated Covid-19 ward at a primary health care facility in western Norway: a retrospective observational study

BackgroundThe coronavirus pandemic has hit the oldest and frailest individuals hard, particularly patients and residents in nursing homes. In March 2020, we established a Covid-19 ward at a nursing home in Bergen, western Norway for elderly patients with Sars-CoV-2 infection and in the need of treatment and care in a primary health care facility. The aims of this study were to describe the organization of the ward, the clinical outcomes of infection, treatment, mortality rates in the population, the level of advanced care planning, and end-of-life care for those who died.MethodsWe present patient characteristics, outcomes, vaccination status, treatment, decisions regarding treatment intensity upon clinical deterioration, and mortality for the patients in the ward. Clinical factors possibly related to a fatal outcome were analysed with chi square test (categorical variables) or t-test (continuous variables).Results257 patients were included from March 2020 to April 2022. Fifty-nine patients (23.0%) developed respiratory failure. Ten patients (3.9%) were admitted to hospital. Advance care planning was undertaken for 245 (95.3%) of the patients. 30-day mortality rate decreased from 42 to 4% during the study period. Of the 29 (11.3%) patients who died, all were well alleviated in the terminal phase, and 26 (89.7%) of them had a Clinical Frailty Scale (CFS) value ≥ 7. A high score for CFS, respiratory failure and respiratory co-infection were significantly associated with Covid-19 related death within 30 days.ConclusionsCovid-19-related mortality markedly decreased during the study period, and a high score for CFS was related to a fatal outcome. Thorough planning of treatment intensity upon deterioration, low hospitalization rates, and good relief for those who died suggest that dedicated Covid-19 wards in nursing homes can provide good treatment for the patients and relieve other nursing homes and specialist health care services.

Understanding herpes zoster vaccine hesitancy and information asymmetry: a qualitative study in China.

Herpes zoster is more prevalent among the older adult due to the age-related immune decline, leading to significant pain and complications. Although vaccination effectively prevents viral infections, vaccine hesitancy remains a major barrier to achieving high vaccination rates.To address this, we conducted a qualitative survey using Vaccine Hesitancy Determinants Matrix and 5C model to understand and improve vaccination rates in this group. Descriptive qualitative research design based on the philosophical underpinnings of naturalistic inquiry and purposive sampling methodology was conducted on adults aged 50 and above, as well as community health workers. Data were collected through semi-structured, in-depth personal interviews. The interview outline was constructed following a comprehensive review of the literature and consideration of the theoretical framework. Seventeen adults over 50 years and four community healthcare workers were included in this study. The study found that information asymmetry in immunization planning was evident at all stages of vaccine supply, dissemination and demand. The main manifestations included limited access to authoritative information, insufficient community awareness of herpes zoster as a route of vaccination, insufficient vocational training, significant gaps in vaccine knowledge, and high levels of complacency among individual residents. Herpes zoster vaccine hesitancy is prevalent among middle-aged and older adults in China due to information asymmetry, vaccine complacency, inadequate community services, and other multiple layers of factors. Public health strategies should aim to reduce cognitive biases and information gaps by disseminating diverse and credible vaccine information through social media, medical institutions, and offline channels to promote higher vaccination rates.

Modeling the relationship between living in informal dwellings and fear of crime in Gauteng Province, South Africa

ABSTRACT Information from the fifth wave of the Quality-of-Life Survey conducted by the Gauteng City-Region Observatory was used in this paper to investigate the relationship between living in informal dwellings and fear of crime. This examination is based on existing theories, including victimization/vulnerability, neighborhood disorder, and diffuse anxiety theories. Given the prominence of informal dwellings in most urban areas in South Africa, including Gauteng Province, this study examines whether living in informal dwellings determines fear of crime or feelings of unsafety. Multilevel cumulative logistic models were therefore estimated to account for similarities between individuals in the same wards while at the same time modeling for differences between wards. The results indicate that an individual residing in an informal dwelling is less likely to feel safe than one who resides in a formal dwelling in Gauteng Province. By focusing on informal dwellings as the predictor of interest, the present paper attempts to extend the panoply of predictors that can be used in empirical research when testing the above-mentioned theories.

Toward precision medical education: Characterizing individual residents' clinical experiences throughout training.

Despite the central role of experiential learning in residency training, the actual clinical experiences residents participate in are not well characterized. A better understanding of the type, volume, and variation in residents' clinical experiences is essential to support precision medical education strategies. We sought to characterize the entirety of the clinical experiences had by individual internal medicine residents throughout their time in training. We evaluated the clinical experiences of medicine residents (n = 51) who completed training at NYU Grossman School of Medicine's Brooklyn campus between 2020 and 2023. Residents' inpatient and outpatient experiences were identified using notes written, orders placed, and care team sign-ins; principal ICD-10 codes for each encounter were converted into medical content categories using a previously described crosswalk tool. Of 152,426 clinical encounters with available ICD-10 codes, 132,284 were mapped to medical content categories (94.5% capture). Residents' clinical experiences were particularly enriched in infectious and cardiovascular disease; most had very little exposure to allergy, dermatology, oncology, or rheumatology. Some trainees saw twice as many cases in a given content area as did others. There was little concordance between actual frequency of clinical experience and expected content frequency on the ABIM certification exam. Individual residents' clinical experiences in training vary widely, both in number and in type. Characterizing these experiences paves the way for exploration of the relationships between clinical exposure and educational outcomes, and for the implementation of precision education strategies that could fill residents' experiential gaps and complement strengths with targeted educational interventions.

“What Is Your Primary Language?”: Spatial Considerations of Primary Language Identification in a Multilingual Rural Region

In small-scale multilingual societies, an individual uses a large number of languages and usually identifies one of them as the primary language. Although empirically observable, primary language has been significantly underexplored, particularly the spatiality of its identification. It is not clear whether and how place is related to why one language might be seen as being more significant than other languages. This study predicts the primary language used by multilingual individuals in an indigenous rural region of Cameroon based on two types of place: the residence of multilingual individuals and the birthplace of their family members. The research goals are supported by a random forest model using spatial-sociolinguistic data of the region. Results show that primary language can be predicted at a high accuracy. The residence of multilingual individuals and the birthplace of their family members capture the spatiality behind primary language identification. This work adds to the current discussion of the space–language connection and is valuable for maintaining the endangered languages in small-scale rural societies.

Two Novel Antibiotic Use Metrics for Facilities and Individual Prescribers in Post-Acute and Long-Term Care Settings

Background: Measuring and reporting antibiotic use are essential to antimicrobial stewardship activities. The most common metric to assess facility-level use is days of antibiotic therapy per 1000 days of care (DOT/1000 DOC). This metric may be difficult to calculate, not be readily comparable, or not provide actionable data to individual prescribers, particularly those that work in post-acute and long-term care (PALTC) settings. Here we use data from a centralized dispensing pharmacy to develop antibiotic use metrics suitable for offering individualized feedback to prescribers working in PALTC settings. Methods: We obtained medication dispensing data and resident census data for 13 PALTC settings within the same network. After omitting non-pharmacologic items and limiting the data to medications dispensed from 1/2020 – 12/2022, we determined the following metrics by month: days of antibiotic therapy (DOT), number of medications prescribed, number of antibiotic courses prescribed (antibiotic starts), and the number of individual residents issued a prescription for any medication (unique residents). These metrics were assessed for each facility (2020 – 2022) and for prescribers responsible for > 1% of prescriptions within that facility (2022 only). Prescriber-level unique residents was the number of residents issued a prescription by the given provider. We obtained facility-level census data to calculate antibiotic DOT/1000 resident days of care (DOC) as a standard to which we compared novel metrics. Results: During the 3-year study period, 1718 prescribers at 13 PALTC settings wrote for 672256 medications, including 31087 antibiotic courses. At the facility level, the correlation between monthly antibiotic starts (courses)/unique residents and antibiotic DOT/1000 DOC was 0.83 (p < 0 .0001). The correlation between monthly antibiotic DOT/unique residents and antibiotic DOT/1000 DOC was 0.98 (p < 0 .0001). Trends in monthly values of both novel metrics and DOT/1000 DOC were consistent across the examined period (Figure 1). For individual prescribers, both novel metrics permit assessment and comparison of antibiotic prescription rates over time (Figure 2). Conclusions: Pharmacy dispensing data can be used to determine antibiotic DOT/unique residents and antibiotic starts/unique residents at the facility level and for individual providers. The novel metric antibiotic DOT/unique residents demonstrated strong correlation with antibiotic DOT/1000 DOC at the facility level. In addition to supporting tracking and reporting of antibiotic use among PALTC settings, these new metrics permit visualization of the antibiotic prescribing rates of individuals prescribers, as well as peer comparison, which in turn can lead to actionable feedback that helps improve antibiotic use in the care of PALTC.

Longitudinal look at individual resident preferences to prevent burnout: Which matter the most?

ABSTRACT A longitudinal look at individual resident preferences to prevent burnout: Which matter the most? Background and Objectives Burnout among residents-in-training is being reported more frequently. Previous studies have shown that lower measures of emotional intelligence, mindfulness, emotional regulation, and gratitude earlier in residency were associated with higher burnout scores later. Many studies have reported interventions intended to lessen burnout but not chosen by the residents with variable results on subsequent burnout measures. This paper reports an individually paired longitudinal analysis of strategies ranked by the resident as important with a subsequent burnout measure. Methods From 2017 through 2021, 32 residents completed a survey ranking their preference of ten approaches to preventing burnout at the beginning of the academic year. Then they later completed a burnout survey at the end of each year. Results With a usable response rate of 94% and calculating Spearman’s Correlation, residents completing their first year of training after medical school (PG-1) who gave a higher rank to a workplace supporting their personal values (p=.016), self-care (p=.031), and administrative support (p=.046) showed less burnout at the end of the year. PG-3s (those completing their third year of training after medical school) who gave a higher rank to spending time with family and friends (p=.002) showed less burnout. For all three years, the most powerful correlation was with adopting a healthy philosophical outlook (p=.014, .008, <.001). Conclusions In this group of residents, the correlations of preferred strategies for lessening burnout differed by training level. Rather than faculty choosing an intervention, we propose these ten strategies as a potential menu, allowing the individual resident to focus on their preferences working with a mentor. Group discussion of methods used by individual residents to adopt a healthy philosophical outlook would also be helpful.

Evaluating the uncertainty in mean residual times: Estimators based on residence times from discrete time processes

In this work, we propose estimators for the variance of mean residual times, which rely on individual residence times. The latter are assumed to be described by independent and identically distributed random variables, generated by a discrete-time stochastic process. We examine their performance through numerical experiments involving well-known probability distributions, and an application example using molecular dynamics simulation results, from an aqueous NaCl solution, is provided. These computationally inexpensive estimators, capable of achieving very accurate outcomes, serve as useful tools for assessing and reporting uncertainties in mean residual times across a wide range of simulations.

Contextual Action Theory in Nursing Home Settings: A Conceptual Framework for Considering the Active Role of Residents

AbstractNursing home (NH) residents are often considered passive recipients of care with a limited role in shaping their experience. This perspective is often reproduced in NH research, which restricts resident participation, thereby upholding ageist views that cause discrimination of older adults living in NH settings. In this article, we propose using Contextual Action Theory (CAT) as a conceptual framework for exploring NH experiences in a way that incorporates the active role of residents. CAT supports the active role of NH residents by emphasizing the capabilities of human beings to form preferences and act on those preferences, without assumptions of rationality. The emphasis on human action allows researchers to consider NH experiences as co-constructed between residents, care providers, and family members, which means placing an emphasis on the actions and goals of NH residents, no matter their cognitive or physical impairments. CAT also supports personhood and social citizenship concerns in NH research, by acknowledging the differing preferences and thereby differing experiences of NH care by individual residents. We argue that CAT should be considered a useful framework for putting residents in the center of NH research.

Screening for Conscientiousness at Start of Residency: Early Detection of Professionalism Concerns.

Early identification of residents who may require remediation could help prevent problems for both individual residents and their programs. Our aim in this project was to identify whether residents prone to challenges with professionalism could be identified early. For 3 years we tracked onboarding tasks completed by residents between official match and the first day of residency to develop a tool that would help identify residents who may be at risk for problems with timely chart completion and subsequent remediation. We compared residents' "at risk" scores with in-training exam (ITE) scores to differentiate between professionalism (task completion issues) and medical knowledge. Our at-risk tool successfully predicted timely chart completion rates and need for remediation within our residency program (Fischer's exact P<.001), but was not predictive of ITE scores. Using readily accessible information, we can identify residents at risk for poor task completion performance, who may benefit from extra support and development in the area of organizational skill. Early identification may increase opportunities for early intervention.

Testing the Effects of Individual Residents' Retrieval Practice on Standardized Examination Scores.

Residents have limited time and much to learn. Retrieval practice-studying using exam-style review questions-is a powerful educational tool for aggregate groups of learners, but it has not been tested for individual graduate medical education (GME) trainees. We conducted a retrospective observational study examining how individual residents' self-directed retrieval practice affected their learning. We used linear regression models to compare the number of exam-style multiple-choice practice questions each resident answered per year to their scores on annual In-Training Exams (ITE). We found that the higher a resident's ITE score was at the start of a year, the fewer practice questions they answered that year for both first- (p = 0.023) and second-year (p = 0.020) trainees. Then, the more questions a resident answered in a year, the more their ITE score increased over that year for both first- and second-year trainees (p = 0.026 and 0.025, respectively). Residents' prior ITE scores also independently predicted their subsequent ITE scores (p = 0.024 in the first and 0.007 in the second year), and the effect of their baseline scores was larger than the effect of the number of practice questions they answered. Individual residents' prior exam scores significantly predict their future exam scores, and their independent retrieval practice using exam-style review questions also significantly predicts the annual improvement in their scores. These findings add to the growing evidence supporting retrieval practice in GME, and they can inform individualized educational coaching for GME trainees.

Evaluation of the Residency of Black Rockfish (Sebastes schlegelii) in Artificial Reef Areas Based on Stable Carbon Isotopes

Evaluation of the Residency of Black Rockfish (Sebastes schlegelii) in Artificial Reef Areas Based on Stable Carbon Isotopes

Radiology advocacy: Promoting collaboration between trainees and professional societies

From mammographic screening guidelines to resident work hour regulations, public policy affects every aspect of the practice of radiology and ultimately determines how radiological care is delivered to patients. Shaping public policy through advocacy is therefore critical to ensure patient access to equitable, high-quality radiological care. In advocacy, individual practicing radiologists and radiology trainees can increase the scope of their influence by collaborating with professional radiology societies. When radiology trainees participate in organized radiology advocacy, they learn about regulatory and legislative issues that will affect their careers, and they learn how to effect policy change. Radiology societies in turn benefit from trainee involvement, as engaging trainees early in their careers leads to more robust future participation and leadership. To encourage trainee involvement, radiology societies can engage individual residency programs and medical student radiology interest groups, invest in trainee-focused events, and maximize the number of positions of responsibility open to trainees. To circumvent the barriers to participation that many trainees face, radiology societies can make meeting proceedings free and available through virtual mediums. Through active collaboration, trainees and professional societies can help assure a bright future for radiologists and patients in need of radiological care.

Human PRH1, PRH2 susceptibility and resistance and Streptococcus mutans virulence phenotypes specify different microbial profiles in caries

Lifestyle- and sucrose-dependent polymicrobial ecological shifts are a primary cause of caries in populations with high caries prevalence. In populations with low prevalence, PRH1, PRH2 susceptibility and resistance phenotypes may interact with the Streptococcus mutans adhesin cariogenicity phenotype to affect caries progression, but studies are lacking on how these factors affect the microbial profile of caries. We analysed how the residency and infection profiles of S.mutans adhesin (SpaP A/B/C and Cnm/Cbm) phenotypes and commensal streptococci and lactobacilli influenced caries progression in a prospective case-referent sample of 452 Swedish adolescents with high (P4a), moderate (P6), and low (P1) caries PRH1, PRH2 phenotypes. Isolates of S.mutans from participants were analysed for adhesin expression and glycosylation and invitro and in situ mechanisms related to caries activity. Among adolescents with the resistant (P1) phenotype, infection with S.mutans high-virulence phenotypes was required for caries progression. In contrast, with highly (P4a) or moderately (P6) susceptible phenotypes, caries developed from a broader polymicrobial flora that included moderately cariogenic oral commensal streptococci and lactobacilli and S.mutans phenotypes. High virulence involved unstable residency and fluctuating SpaP ABC, B-1, or Cnm expression/glycosylation phenotypes, whereas low/moderate virulence involved SpaP A phenotypes with stable residency. Adhesin phenotypes did not display changes in individual host residency but were paired within individuals and geographic regions. These results suggest that receptor PRH1, PRH2 susceptibility and resistance and S.mutans adhesin virulence phenotypes specify different microbial profiles in caries. Swedish Research Council and funding bodies listed in the acknowledgement section.

Sex and size shape the ontogeny of partial migration.

The arrival-time hypothesis of partial seasonal migration proposes that over-winter residence is driven by reproductive benefits of early presence on the breeding grounds. Thus, it predicts increased occurrence of residence at reproductive age. In contrast, the body size hypothesis proposes age-independent benefits of residence for large individuals, who should exhibit greater winter tolerance. Despite different expectations in age patterns for the two hypotheses in long-lived partially migrant species, there is little empirical work investigating the ontogeny of migratory phenotypic expression, that is the expression of residence or migration. We investigated the influence of age, sex and body size on migratory phenotype throughout ontogeny (from first year to early adulthood) in a long-lived partially migrant species, the red kite Milvus milvus. We GPS-tracked 311 individuals tagged as juveniles and 70 individuals tagged as adults over multiple years, yielding 881 observed annual cycles. From this data, we estimated age-dependent probabilities of the transition to residence and of survival in migrants and residents using a Bayesian multistate capture-recapture model, as well as the probability of resuming migration once resident. We then calculated the resulting proportion of residents per age class. In both sexes, almost all juveniles migrated in their first winter, after which the probability of becoming resident gradually increased with age class to approximately 0.3 in adults (>3 calendar years). A size effect in third calendar year females suggests that large females adopt residence earlier in life than small females. The transition from residence back to migration only occurred with a probability of 0.15 across all resident individuals. In addition, survival was notably reduced in adult male migrants compared to adult male residents. These results are largely consistent with the arrival-time and body size hypotheses, simultaneously. Our results reveal a plastic, yet primarily directional within-individual change in migratory phenotype towards more residence with increasing age, varying between sexes and between individuals of different size. This study highlights that different individual characteristics can jointly shape the ontogeny of migratory behaviour and result in complex within-population patterns and persistence of migratory phenotypes.