Secondary Questions Research Articles

Student and faculty perceptions on an entrepreneurship course: an exploratory study from Oman

PurposeEntrepreneurship-oriented courses are increasingly being offered in higher education institutions (HEIs) around the world. However, in the case of Oman, where this study was conducted, little or no research has been conducted, to date, to explore the perceptions of students and faculty members regarding the entrepreneurship-oriented courses they participate in, which is a serious gap in the literature. This study aims to fill this gap by examining the beliefs and conceptions that learners and faculty at a private HEI in Muscat, Oman, had about the course entitled Entrepreneurship and New Venture Creation (ENVC).Design/methodology/approachThe primary and secondary research questions are addressed using a mixed-methods approach that includes an online student questionnaire answered by 110 students who had studied the ENVC course, a focus group discussion with eight students facilitated by MS Teams and semi-structured interviews with two faculty members.FindingsThe findings revealed that the study participants had a very positive view of the ENVC course discussed here as they pointed to several benefits, including improved knowledge of business and entrepreneurship concepts, increased familiarity with the local business environment, development of entrepreneurial intention and improvement of their critical thinking, creativity and innovation skills. In addition, the results revealed some concerns among the participating students, particularly regarding the lack of adequate training sessions on risk management and financial planning. The participants also requested hands-on experience through industrial entrepreneurship training and in-residence-entrepreneurship programs.Research limitations/implicationsThis study raises a number of possibilities for further research on this type of course in terms of students’ employability skills, know-how and agency when the time comes for them to enter the real world of business and employment. Future work would benefit from using a longitudinal survey on a group of alumni to triangulate and compare the various findings that were reached here. It would certainly be even more fruitful if conducted at two or more HEIs and with larger population samples to ensure broad coverage, representation and generalization. Work along these lines would certainly refine and extend our findings.Practical implicationsThis study has significant pedagogical implications for future graduate students seeking employment, entrepreneurship course developers and faculty. Relatively, the educational outcomes of entrepreneurship education will also rely on the way entrepreneurship is being taught to students. It is recommended that entrepreneurship teaching should focus on cognitive development and active implementation of in-house incubation for well-planned innovative business ideas. This will provide opportunities for students to gain real-life experiences and identify their strengths and weaknesses, as well as the areas and skills that need to be maintained; hence, further research on the effectiveness of in-house incubation could best be considered for the next study. Another concern raised in this study is the lack of training in financial planning. Hence, further research can be considered on how to improve the financial planning skills of students for a start-up journey.Social implicationsThis course is designed in alignment with Oman Vision 2040, which places great emphasis on entrepreneurship as it plays an important role in the planned economic diversification and sustainability, in which innovation derived from entrepreneurship development will be used as the main driver for the development of infrastructure and educational systems that encourage entrepreneurship. Moreover, the ENVC course focuses on the concept of social entrepreneurship. It inculcates a sense of responsibility for supporting the immediate society among students. Learning the perceptions of students and teachers will provide opportunities to achieve their academic goals, which will reap economic and financial returns in the long run. The development of entrepreneurial skills and intentions of students will eventually help in boosting the country’s economy and its social fabric, thus improving the overall quality of life of Omani society.Originality/valueEven though this study is an exploratory investigation, the framework sets out clear empirical insights into the entrepreneurship course development, its main contents, assessments and learners’ and faculty members’ perceptions of the design, intent, content and delivery of the ENVC course and has crucial implications for all the stakeholders. The originality of this case study lies in the fact that it is the first of its kind in the body of research as it links theory to practice and will be a useful reference for entrepreneurship course developers, higher education faculty and students.

Exposure to stereotype-relevant stories shapes children's implicit gender stereotypes.

Implicit math = male stereotypes have been found in early childhood and are linked to girls' disproportionate disengagement from math-related activities and later careers. Yet, little is known about how malleable children's automatic stereotypes are, especially in response to brief interventions. In a sample of 336 six- to eleven-year-olds, we experimentally tested whether exposure to a brief story vignette intervention with either stereotypical, neutral, or counter-stereotypical content (three conditions: math = boy vs. neutral vs. math = girl) could change implicit math-gender stereotypes. Results suggested that children's implicit math = male stereotypes were indeed responsive to brief stories that either reinforced or countered the widespread math = male stereotype. Children exposed to the counter-stereotypical stories showed significantly lower (and non-significant) stereotypes compared to children exposed to the stereotypical stories. Critically, exposure to stories that perpetuated math = male stereotypes significantly increased math-gender stereotypes over and above baseline, underscoring that implicit gender biases that are readily formed during this period in childhood and even brief exposure to stereotypical content can strengthen them. As a secondary question, we also examined whether changes in stereotypes might also lead to changes in implicit math self-concept. Evidence for effects on implicit self-concept were not statistically significant.

Comparing the Effects of Thought Suppression and Focused Distraction on Pain-Related Attentional Biases in Men and Women

Increasing attentional focus away from pain can affect pain experience, suggesting that cognitive strategies that move attentional allocation may be a moderator of pain. In a pre-post-design, the present study examined the effects of 2 cognitive strategies used in pain contexts, thought suppression and focused distraction, on subsequent pain-related attention. Thought suppression was hypothesized to increase pain-related attention, whereas focused distraction was expected to reduce it. Influences of both anxiety and sex were also considered, as secondary questions. 139 (86 women, 53 men) healthy, pain-free participants were randomly assigned to use either thought suppression or focused distraction during a mild cold pressor test (CPT). Pain-related attention was examined using a dot-probe and an attentional blink task, pre-and post-CPT. Questionnaires about relevant cognitive and emotional aspects, demographics, and pain were completed. Results showed no difference in the effect of the 2 pain inhibition strategies on pain-related attention. The hypothesized rebound effect in thought suppression on pain-related attention did not emerge. However, thought suppression showed a short-term benefit in comparison to focused distraction regarding reported pain and perceived threat during the cold pressor test. Few sex differences were found. Thus, the cognitive strategies affected pain outcomes, but did not influence pain-related attention. PerspectiveCognitive strategies could help with pain through changing attention allocation. In this study, the effects of the 2 cognitive strategies thought suppression and focused distraction on pain-related attention in men and women were examined. Elucidating mechanisms that lie behind pain strategies that focus on changing attention may help improve treatments.

The Association of Selective Serotonin Reuptake Inhibitors With Delirium in Critically Ill Adults: A Secondary Analysis of the Bringing to Light the Risk Factors and Incidence of Neuropsychologic Dysfunction in ICU Survivors ICU Study.

OBJECTIVES:To assess the association between selective serotonin reuptake inhibitors (SSRI) and delirium in the subsequent 24 hours after drug administration in critically ill adults.DESIGN:Retrospective cohort study utilizing the Bringing to Light the Risk Factors and Incidence of Neuropsychologic Dysfunction in ICU Survivors dataset.SETTING:Two large U.S. ICUs.PATIENTS:Critically ill adults admitted to a medical or surgery ICU between March 2007 and May 2010 with respiratory failure or shock.INTERVENTIONS:Our primary outcome was the occurrence rate of delirium or coma during each day in the ICU. Our exposure variable was SSRI administration on the prior day in the ICU. As a secondary question, we assessed the association of SSRI administration and delirium the same day of SSRI administration in the ICU.MEASUREMENTS AND MAIN RESULTS:We analyzed 821 patients. The median age was 61.2 years old (interquartile range, 50.9–70.7), and 401 (48.8%) were female. A total of 233 patients (28.4%) received prescribed SSRIs at least once during their ICU admission. Delirium was present in 606 (74%) of the patients at some point during hospitalization in the ICU. Coma was present in 532 (64.8%) of the patients at some point during hospitalization in the ICU. After adjusting for multiple potential confounding factors, we found that SSRI administration in the ICU was associated with lower odds of delirium/coma (odds ratio [OR], 0.75; 95% CI, 0.57–1.00) the next day. An SSRI administered on the same day reduced the odds of delirium/coma as well (OR, 0.66; 95% CI, 0.50–0.87).CONCLUSIONS:SSRI administration is associated with decreased risk of delirium/coma in 24 hours and on the same day of administration in critically ill patients in a medical or surgical ICU.

Costs of multimorbidity: a systematic review and meta-analyses

BackgroundMultimorbidity is a rising global phenomenon, placing strains on countries’ population health and finances. This systematic review provides insight into the costs of multimorbidity through addressing the following primary and secondary research questions: What evidence exists on the costs of multimorbidity? How do costs of specific disease combinations vary across countries? How do multimorbidity costs vary across disease combinations? What “cost ingredients” are most commonly included in these multimorbidity studies?MethodsWe conducted a systematic review (PROSPERO: CRD42020204871) of studies published from January 2010 to January 2022, which reported on costs associated with combinations of at least two specified conditions. Systematic string-based searches were conducted in MEDLINE, The Cochrane Library, SCOPUS, Global Health, Web of Science, and Business Source Complete. We explored the association between costs of multimorbidity and country Gross Domestic Product (GDP) per capita using a linear mixed model with random intercept. Annual mean direct medical costs per capita were pooled in fixed-effects meta-analyses for each of the frequently reported dyads. Costs are reported in 2021 International Dollars (I$).ResultsFifty-nine studies were included in the review, the majority of which were from high-income countries, particularly the United States. (1) Reported annual costs of multimorbidity per person ranged from I$800 to I$150,000, depending on disease combination, country, cost ingredients, and other study characteristics. (2) Our results further demonstrated that increased country GDP per capita was associated with higher costs of multimorbidity. (3) Meta-analyses of 15 studies showed that on average, dyads which featured Hypertension were among the least expensive to manage, with the most expensive dyads being Respiratory and Mental Health condition (I$36,840), Diabetes and Heart/vascular condition (I$37,090), and Cancer and Mental Health condition in the first year after cancer diagnosis (I$85,820). (4) Most studies reported only direct medical costs, such as costs of hospitalization, outpatient care, emergency care, and drugs.ConclusionsMultimorbidity imposes a large economic burden on both the health system and society, most notably for patients with cancer and mental health condition in the first year after cancer diagnosis. Whether the cost of a disease combination is more or less than the additive costs of the component diseases needs to be further explored. Multimorbidity costing studies typically consider only a limited number of disease combinations, and few have been conducted in low- and middle-income countries and Europe. Rigorous and standardized methods of data collection and costing for multimorbidity should be developed to provide more comprehensive and comparable evidence for the costs of multimorbidity.

Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review.

Introduction Proximal row carpectomy (PRC) is a motion-sparing procedure for radiocarpal arthritis with reliable results. Traditionally, proximal capitate arthritis is a contraindication to PRC; however, PRC with modifications are proposed to circumvent this contraindication. PRC modifications can be broadly grouped into capitate resurfacing (CR) and capsular interposition (CI) procedures which could expand PRC indications. Our primary question was to characterize the outcomes achievable with various PRC modifications. Our secondary question was to determine which PRC modification was the optimal procedure when capitate arthritis was present. Methods A systematic review was conducted to examine the outcomes of modified PRC procedures. Independent reviewers appraised multiple databases for PRC studies with modifications for capitate arthritis in adult patients (age >18 years) with a minimum of three cases and extractable outcomes. Modified PRC procedures included capsular/allograft interposition, resurfacing capitate pyrocarbon implants, and osteochondral grafting. Pertinent outcomes included patient demographics, range-of-motion, grip strength, patient-reported outcomes, and complications, including salvage rates. Results Overall, 18 studies met the inclusion criteria-10 studies ( n = 147) on CI and 8 studies on CR ( n = 136). PRC with CI had the greatest flexion-extension arc and grip strength. Complications were marginally higher in the CR group (4%), while the CI group had a higher conversion to total wrist arthrodesis (10%). Conclusion Techniques to address capitate arthritis center around resurfacing or soft tissue interposition. PRC modifications with CI produces better range-of-motion and grip strength but higher conversion to total wrist arthrodesis. Higher conversion rates may be attributable to longer follow-up periods in studies examining CI compared with CR. Level of Evidence This is a Level III study.

RESEARCH ON THE RELATIONSHIP BETWEEN THE NEW MODEL OF STATE-OWNED ENTERPRISE REFORM AND PSYCHOLOGICAL IDENTITY AND EMOTIONAL REGULATION

RESEARCH ON THE RELATIONSHIP BETWEEN THE NEW MODEL OF STATE-OWNED ENTERPRISE REFORM AND PSYCHOLOGICAL IDENTITY AND EMOTIONAL REGULATION

Trust and Go: Enhancing Collaborative School Cultures Through Improv

Contemporary educational leaders are tasked with supporting their teams, with limited time and resources, to unite and thrive through political, social, economic, and environmental instability. Educational scholars and leaders agree upon the need to foster collaboration within school communities; the practices for achieving this outcome are not always clear. The primary research question of my integrative literature review is: How can improvisational theory support educational leaders to enhance collaboration within school cultures? Secondary questions include: What are the guiding principles of improvisation? What does the research reveal about leading collaboration within schools? What practices surface because of this research? I conducted an integrative literature review and used thematic analysis within a constructivist approach to examine whether the principles of improvisation can offer leaders insight into practices for establishing and sustaining collaborative school cultures. Improvisational theatre offers leaders a lens to examine the work of developing and sustaining collaborative cultures. After an extensive review of two bodies of literature, I identified four themes common to improvisation and leading collaborative school cultures: Connect, Define the Rules, Share the Lead, and Play the Game. Nested within each of these themes, I uncovered eight practices school-based leaders can apply to enhance their school’s collaborative cultures: Use Time and Space Creatively; Create Opportunities for Meaningful Dialogue; Co-create Norms; Articulate Vision, Values, and Goals; Integrate Evidence-Informed Pedagogical Practices; Provide Shared Leadership; Amplify Strengths; and Fail Forward. The model that emerged from this research will prove useful to school-based administrators and other leaders looking to empower their teams to solve problems and innovate in community.

A Smarter Health through the Internet of Surgical Things.

(1) Background: In the last few years, technological developments in the surgical field have been rapid and are continuously evolving. One of the most revolutionizing breakthroughs was the introduction of the IoT concept within surgical practice. Our systematic review aims to summarize the most important studies evaluating the IoT concept within surgical practice, focusing on Telesurgery and surgical Telementoring. (2) Methods: We conducted a systematic review of the current literature, focusing on the Internet of Surgical Things in Telesurgery and Telementoring. Forty-eight (48) studies were included in this review. As secondary research questions, we also included brief overviews of the use of IoT in image-guided surgery, and patient Telemonitoring, by systematically analyzing fourteen (14) and nineteen (19) studies, respectively. (3) Results: Data from 219 patients and 757 healthcare professionals were quantitively analyzed. Study designs were primarily observational or based on model development. Palpable advantages from the IoT incorporation mainly include less surgical hours, accessibility to high quality treatment, and safer and more effective surgical education. Despite the described technological advances, and proposed benefits of the systems presented, there are still identifiable gaps in the literature that need to be further explored in a systematic manner. (4) Conclusions: The use of the IoT concept within the surgery domain is a widely incorporated but less investigated concept. Advantages have become palpable over the past decade, yet further research is warranted.

Remote assessment of DMFT and number of implants with intraoral digital photography in an elderly patient population - a comparative study.

ObjectivesThis comparative study aimed to evaluate intraoral digital photography (IODP) as assessment-tool for DMFT and number of implants (IMPL) compared to clinical diagnosis (CLIN) in an elderly population with high restorative status. Secondary research questions were whether an additional evaluation of panoramic radiographs (PAN-X) or raters’ clinical experience influence the agreement.MethodsFifty patients (70.98±7.60 years) were enrolled for standardized CLIN and IODP. The clinical reference examiner and ten blinded raters evaluated the photographs without and with a PAN-X regarding DMFT and IMPL. CLIN were used as reference standard and differences to IODP and IODP-PAN-X findings were analysed descriptively. To assess intra-rater agreement, pairwise Gwet’s AC1s of the three diagnostic methods CLIN, IODP and IODP+PAN-X were calculated.ResultsCompared to a DMFT of 22.10±3.75 (CLIN), blinded raters evaluated a DMFT of 21.54±3.40 (IODP) and 22.12±3.45 (IODP+PAN-X). Mean values for “Decayed” were 0.18±0.52 (CLIN), 0.45±0.46 (IODP) and 0.48±0.47 (IODP-PAN-X), while 11.02±5.97 (CLIN), 10.66±5.78 (IODP) and 10.93±5.91 (IODP+PAN-X) were determined for “Missing” and 10.90±5.61 (CLIN), 10.43±4.85 (IODP) and 10.71±5.11 (IODP+PAN-X) for “Filled”. IMPL were 0.78±2.04 (CLIN), 0.58±1.43 (IODP), 0.78±2.04 (IODP+PAN-X). Gwet’s AC1 using the mode of the blinded raters’ assessment of "Decayed", "Missing" and IMPL compared to CLIN ranged from 0.81 to 0.89 (IODP) and 0.87 to 1.00 (IODP+PAN-X), while for "Filled" and DMFT they were 0.29 and 0.36 (IODP) as well as 0.33 and 0.36 (IODP+PAN-X), respectively. Clinical experience did not influence the agreement.ConclusionsAssessment of “Decayed”, “Missing” and IMPL by IODP showed almost perfect agreement, whereas of “Filled” and DMFT revealed fair to moderate agreement with clinical findings. Additional PAN-X-evaluation increased agreement compared to IODP-diagnostics alone. IODP for the assessment of DMFT and IMPL might be a suitable method in large-scale epidemiological studies, considering high agreement in total values and miscellaneous agreement at patient-level.

Effects of degraded speech processing and binaural unmasking investigated using functional near-infrared spectroscopy (fNIRS).

The present study aimed to investigate the effects of degraded speech perception and binaural unmasking using functional near-infrared spectroscopy (fNIRS). Normal hearing listeners were tested when attending to unprocessed or vocoded speech, presented to the left ear at two speech-to-noise ratios (SNRs). Additionally, by comparing monaural versus diotic masker noise, we measured binaural unmasking. Our primary research question was whether the prefrontal cortex and temporal cortex responded differently to varying listening configurations. Our a priori regions of interest (ROIs) were located at the left dorsolateral prefrontal cortex (DLPFC) and auditory cortex (AC). The left DLPFC has been reported to be involved in attentional processes when listening to degraded speech and in spatial hearing processing, while the AC has been reported to be sensitive to speech intelligibility. Comparisons of cortical activity between these two ROIs revealed significantly different fNIRS response patterns. Further, we showed a significant and positive correlation between self-reported task difficulty levels and fNIRS responses in the DLPFC, with a negative but non-significant correlation for the left AC, suggesting that the two ROIs played different roles in effortful speech perception. Our secondary question was whether activity within three sub-regions of the lateral PFC (LPFC) including the DLPFC was differentially affected by varying speech-noise configurations. We found significant effects of spectral degradation and SNR, and significant differences in fNIRS response amplitudes between the three regions, but no significant interaction between ROI and speech type, or between ROI and SNR. When attending to speech with monaural and diotic noises, participants reported the latter conditions being easier; however, no significant main effect of masker condition on cortical activity was observed. For cortical responses in the LPFC, a significant interaction between SNR and masker condition was observed. These findings suggest that binaural unmasking affects cortical activity through improving speech reception threshold in noise, rather than by reducing effort exerted.

Transactional sex, HIV and health among young cisgender men and transgender women who have sex with men in Thailand

To examine how recent sex work is identified and the HIV risk factors and service needs among Thai cisgender men who have sex with men (MSM) and transgender women (TGW) who exchange sex. MSM and TGW in Bangkok and Pattaya who exchanged sex in the last year (n=890) were recruited through social media, outreach, and word-of-mouth. Recent sex exchange was based on the primary question, "In the last 30 days, have you sold or traded sex"; secondary questions (regarding income source and client encounters) were also investigated. Overall, 436 (48%) participants engaged in sex work in the last 30 days; among those, 270 (62%) reported exchanging sex by the primary question, and 160 (37%) based on secondary questions only. Recent sex exchange was associated with gonorrhea, syphilis, discussing PrEP with others, and using condoms, alcohol, methamphetamine, amyl nitrate, and Viagra. Exchanging sex based on secondary questions only was associated with being in a relationship, social media recruitment, less recent anal intercourse, and not discussing PrEP. Thai MSM and TGW who exchange sex need regular access to HIV/STI prevention, testing, and treatment services, and multiple approaches to assessing sex work will help identify and serve this diverse and dynamic population.

\u201cLike before, but not exactly\u201d: the Qualy-REACT qualitative inquiry into the lived experience of long COVID

BackgroundPost-acute sequelae of SARS-CoV-2 infection (PASC) affect millions of individuals worldwide. Rehabilitation interventions could support individuals during the recovery phase of COVID-19, but a comprehensive understanding of this new disease and its associated needs is crucial. This qualitative study investigated the experience of individuals who had been hospitalized for COVID-19, focusing on those needs and difficulties they perceived as most urgent.MethodsThis naturalistic qualitative study was part of a single-center mix-method cross-sectional study (REACT) conducted in Italy during the first peak of the SARS-CoV-2 pandemic. The qualitative data collection took place through a telephone interview conducted 3 months after hospital discharge. The experience of individuals discharged after hospitalization for COVID-19 was investigated through the main research question – “Tell me, how has it been going since you were discharged?”. Two secondary questions investigated symptoms, activities, and participation. Data were recorded and transcribed verbatim within 48 h. An empirical phenomenological approach was used by the researchers, who independently analyzed the data and, through consensus, developed an interpretative model to answer the research question. Translation occurred after data was analyzed.ResultsDuring the first peak of the COVID-19 pandemic, 784 individuals with COVID-19 were discharged from the hospitals of the Local Health Authority of the Province of Reggio Emilia (Italy); 446 were excluded due to the presence of acute or chronic conditions causing disability other than COVID-19 (n. 339), inability to participate in the study procedures (n. 56), insufficient medical documentation to allow for screening (n. 21), discharge to residential facilities (n. 25), and pregnancy (n. 5). Overall, 150 individuals consented to participate in the REACT study, and 56 individuals (60.7% male, average age 62.8 years ±11.8) were interviewed in June–July 2020, up to data saturation.Persistent symptoms, feelings of isolation, fear and stigma, emotional distress, a fatalistic attitude, and return to (adapted) life course were the key themes that characterized the participants’ experience after hospital discharge.ConclusionsThe experience as narrated by the participants in this study confirms the persistence of symptoms described in PASC and highlights the sense of isolation and psychological distress. These phenomena may trigger a vicious circle, but the participants also reported adaptation processes that allowed them to gradually return to their life course. Whether all individuals are able to rapidly activate these mechanisms and whether rehabilitation can help to break this vicious circle by improving residual symptoms remain to be seen.Trial registrationClinicalTrials.com NCT04438239.

Impact of the COVID-19 pandemic on oral health and psychosocial factors

The objective of this study was to investigate oral health-related quality of life (OHRQoL) in times of the COVID-19 pandemic and to examine a possible association to psychosocial factors like psychological stress and symptoms of depression and anxiety disorders. Secondary research questions were whether people changed oral hygiene regimens during the COVID-19 pandemic and to what extent dental symptoms existed and developed compared to pre-pandemic. For this cross-sectional study a survey has been conceptualized to determine OHRQoL, stress, depression and anxiety and their specific confounders in a German cohort. Validated questionnaires as OHIP-G14, PHQ-Stress and PHQ-4 have been implemented. Altogether 1178 participants completed the survey between May and August 2020. The overall OHIP-G14 sum score of 4.8 ± 7.5 indicated good OHRQoL. 21% of the participants (n = 248) reported toothache, 23% (n = 270) mucosal problems, 31% (n = 356) hypersensitivity of the teeth and 27% (n = 305) myofacial pain. The PHQ-Stress score (4.5 ± 3.5) demonstrated a mild severity of stress. Depression and anxiety level has been mild to moderate (PHQ-4 score: 2.4 ± 2.6). 38% of the participants stated subjectively greater emotional burden compared to pre-pandemic. Statistically significant differences exist for OHRQoL, stress, anxiety and depression levels between participants with greater, equal or less emotional burden compared to pre-pandemic. COVID-19 history and aggravated levels of depression, anxiety, and stress seem to associate with lower OHRQoL. Psychosocial consequences during pandemic times and their association to oral health should be further investigated.

Accurate identification of cohort study designs in perinatal research: a practical guide

Study designs are often mischaracterized in the obstetrics literature; in particular, the designation of studies as retrospective (historical) cohorts is frequently in error to describe studies that are prospective cohorts. This is especially true for studies based on electronic health records, which often should be properly considered as prospective cohorts. Epidemiologic study designs were developed in earlier eras of research and healthcare when researchers directly contacted study participants or relied on data from paper medical records. Accordingly, standard epidemiologic study design definitions are difficult to apply to digitized data, which have become common in the modern era of healthcare and computing. In this article, we briefly review the characteristics of the 3 main types of cohort studies. Afterward, we build on existing definitions by proposing several subdesignations of prospective cohort studies that we believe will reduce the confusion in terminology. We provide illustrative examples from obstetrics to concretely demonstrate connections and distinctions among study designs. First, a prospective cohort study can be "active" (participants are deliberately and explicitly enrolled in a prospective research study) or "passive" (participants are followed up in real time for some nonresearch activity, such as clinical care or quality improvement). An active prospective cohort study never stops being a prospective cohort study; however, when reused to answer a new, secondary question, we propose that this should be called a "reused (active) prospective cohort." The de novo cohort study that answered the original question should be considered an "intended (active) prospective cohort." Lastly, when a randomized controlled trial is reused to study some new questions where the randomization variable is not under study, this is also a subtype of a prospective cohort study, a "repurposed randomized controlled trial." The use of more detailed descriptors to describe prospective cohort studies will enable more accurate identification of this study design going forward. It is likely that further refinements will be needed in the future, given the ongoing evolution of how we engage with patients or participants and how data are collected, stored, and linked.

Associations between mental illness and non-medical use of prescription opioids among a sample of people who use drugs in Australia and New Zealand

Non-medical use of prescription opioids (NUPO) is an increasing public health concern in Australia and New Zealand. In response to a lack of research on NUPO in this setting, we investigated the associations between NUPO, mental illnesses, and other substance use, using data from the 2019 Global Drug Survey (GDS). Strategies to reduce NUPO-related harm were also discussed. Socio-demographic characteristics, mental illnesses, NUPO, and other substance use among 2019 GDS respondents were examined. Logistic regression was used to identify factors associated with past year NUPO. Data from 2752 Australian and New Zealand respondents who used drugs were analysed. Pastyear use of heroin, benzodiazepines, cannabis (containing THC), and ecstasy were associated with a greater odds of NUPO, while bipolar disorder managed with medications was associated with a lower odds of NUPO. All other mental illnesses, including co-morbid mental illnesses, were not associated with NUPO after adjusting for potential confounders. Of respondents who reported NUPO and answered secondary questions, 38.8% obtained opioids from a friend or family member. This study provides a unique understanding of potential risk factors for NUPO among people who report mental illness and drug use in Australia and New Zealand, and establishes a basis for future research that is aimed at reducing NUPO-related harm.

Zoster Eye Disease Study: Rationale and Design.

The purpose of this study was to describe the rationale and design of the Zoster Eye Disease Study (ZEDS). ZEDS is a National Eye Institute-supported randomized clinical trial designed to determine whether 1 year of suppressive valacyclovir in patients with herpes zoster ophthalmicus (HZO) reduces complications because there is currently no high-quality evidence to support its use. Eligible patients are 18 years and older, immunocompetent, have a history of a typical rash at disease onset, and have had a record of active epithelial or stromal keratitis or iritis within 1 year before enrollment. Exclusion criteria include estimated glomerular filtration rate less than 45 or pregnancy. The primary endpoint is the time to first occurrence of new or worsening dendriform epithelial keratitis, stromal keratitis without or with ulceration, endothelial keratitis, or iritis due to HZO during 12 months of study treatment requiring prespecified treatment changes. The study has 80% power to detect a 30% difference between treatment groups, with a 30% rate of endpoints by 1 year assumed among controls. Secondary and exploratory questions include whether there is a persistent treatment benefit during the 6 months after treatment, whether development of postherpetic neuralgia varies by treatment group, and whether vaccinations against herpes zoster affect study outcomes and coronavirus disease 19 status. Over approximately 4 years, over 400 study participants have been enrolled. ZEDS aims to provide scientific evidence on whether suppressive valacyclovir treatment improves outcomes in HZO and should become the standard of care.

PROTOCOL: Testing frequency and student achievement: A systematic review.

This is the protocol for a Campbell review. Our primary research question is: What are the effects of different testing frequencies on student achievement? Our secondary research question is: What are the effects of different testing frequencies on measures of students' testing anxiety? Our third research question is: How are the effects of different testing frequencies on student achievement and testing anxiety moderated by subject, grade, type of test, duration of the intervention, and gender?

Effects of artificial light on bird movement and distribution: a systematic map

BackgroundArtificial light is ubiquitous in the built environment with many known or suspected impacts on birds. Birds flying at night are known to aggregate around artificial light and collide with illuminated objects, which may result from attraction and/or disorientation. In other contexts, birds are repelled by light-based deterrents, including lasers and spotlights. Artificial light can also change birds’ perceptions of habitat quality, resulting in selection or avoidance of illuminated areas. Studies documenting aggregation, deterrence, and habitat selection are typically considered separate literature bodies, but they actually study a common set of populations, interventions/exposures, and responses. Our systematic map provides a comprehensive, searchable database of evidence of the effects of artificial light on bird movement and distribution, increasing both the quantity and diversity of studies that are accessible for further comparison and synthesis. We identify and describe the evidence available for four secondary questions relevant to conservation or management: aggregation/mortality at structures with artificial lights, evidence that light attracts and/or disorients birds, light-based deterrent efficacy, and the influence of continuous illumination on habitat selection.MethodsUsing the principles of systematic reviews and methods published in an earlier protocol, we conducted an extensive and interdisciplinary literature search. We searched multidisciplinary citation indices as well as databases and websites specific to conservation, pest management, transportation, and energy. In our map, we included all studies reporting eligible populations (birds), interventions/exposures (artificial light), and outcomes (movement through space, behaviour preceding movement, or distribution). We evaluated the quantity of available evidence based on meta-data fields related to study context, population traits, light source characteristics, and outcome variables. We used these meta-data to identify relevant evidence for each secondary question and describe aspects of our secondary questions that may support reviews (evidence clusters) and others that require more research (knowledge gaps).Review findingsWe manually screened 26,208 articles and coded meta-data for 490 eligible studies in a searchable database, organizing the literature to facilitate future reviews and evidence-based management. Much of the evidence was concentrated in particular locations (Northern hemisphere), taxonomic orders (Passeriformes, Charadriiformes, and others), and light wavelengths (red and white). We identified 56 distinct response variables and organized them into 3 categories (behaviour, distribution, and avian community), showing the diversity in bird responses to light.ConclusionsOur database can be used to answer the secondary questions we identified and other questions about the effects of artificial light on bird movement and resulting changes to distribution. There may be sufficient evidence for a review of the weather and lunar conditions associated with collisions, which could help identify nights when reduction of artificial light is most important. Further experiments should investigate whether specific types of light can reduce collisions by increasing the detectability of structures with artificial lights. The efficacy of lasers as deterrents could be evaluated through systematic review, though more studies are needed for UV/violet lasers. To reduce the impacts of outdoor lighting on birds, research should investigate how spectral composition of white light influences bird attraction, orientation, and habitat selection.

The Value of Merging Medical Data from Ambulance Services and General Practice Cooperatives Using Triple Aim Outcomes.

Background:Acute care services are currently overstretched in many high income countries. Overcrowding also plays a major role in acute care in the Netherlands. In a region of the Netherlands, the general practice cooperative (GPC) and ambulance service have begun to integrate their care, and the rapid and complete transfer of information between these two care organisations is now the basis for delivering appropriate care. The primary aim of this mixed-methods study is to evaluate the Netherlands Triage System (NTS) merger project and answering the question: What is the added value of implementing a digital NTS merger in terms of healthcare use and healthcare costs? A secondary question is: What are the experiences of patients and care professionals in different acute healthcare organisations following implementation of the digital NTS merger?Methods:Patients who made an acute care request during the 12 months before the NTS merge intervention (control period) were compared with matched patients in the 12 months following the start of the NTS merge. Outcomes included difference in healthcare use 30 days after an acute event and patient’ and care professional’ experiences during the intervention period. To assess healthcare costs, we used reference prices updated to 2021.Results:Compared to patients in the control period, patients in the intervention period were hospitalized less often (52.9% vs 64.4%, p = 0.061) and had fewer emergency department (ED) visits (58.7% vs 69.3%, p = 0.074) in the 30 days following the acute care request. The ED costs were significantly lower during the intervention period compared to the control period (p = 0.042). Furthermore, patients in the intervention period were very satisfied overall with the acute care network (4.63 of 5) and care professionals were fairly satisfied with the cooperation to date (2.73 of 4).Conclusion:The Triple Aim for acute care can be met using relatively simple interventions, but medical data merging is a prerequisite for achieving more robust results covering on the various aspects of the Triple Aim. These successes should be communicated so that a common language can be developed that will support the successful further implementation of larger scale initiatives.