One-year anti-VEGF therapy outcomes in diabetic macular edema based on treatment intensity: Data from the FRB! registry

PURPOSE

To compare one-year outcomes of eyes with diabetic macular edema (DME) treated in routine clinical practice based on the proportion of visits where intravitreal vascular endothelial growth factor (VEGF) inhibitor injections were delivered.

DESIGN

Cohort study PARTICIPANTS: There were 2288 treatment-naïve eyes with DME starting intravitreal VEGF inhibitor therapy from 31 October 2015 to 31 October 2021 from the Fight Retinal Blindness! international outcomes registry.

METHODS

Eyes were grouped according to the proportion of visits at which an injection was received, Group A with less than the median of 67% (n=1172) versus Group B with greater than the median (n=1116).

MAIN OUTCOME MEASURE

Mean visual acuity (VA) change after 12 months of treatment.

RESULTS

The mean (95% confidence interval [CI]) VA change after 12 months of treatment was 3.6 (2.8, 4.4) letters for eyes in Group A versus 5.2 (4.4, 5.9) letters for eyes in Group B (p=0.005). The mean (95% CI) central subfield thickness (CST) change was -69 (-76, -61) μm and -85 (-92, -78) μm for eyes in Group A versus Group B, respectively (p=0.002). A moderate positive correlation was observed between the number of injections received over 12 months of treatment and the change in VA (p<0.001). Additionally, eyes that received more injections had a moderately greater CST reduction.

CONCLUSIONS

This registry analysis found that overall VA and anatomic outcomes tended to be better in DME eyes treated at a greater proportion of visits in the first year of intravitreal VEGF inhibitor therapy.

Patient and Medical Unit Staff Experiences of Proactive and Integrated Consultation-Liaison Psychiatry in The HOME Study: A Qualitative Investigation

BACKGROUND

Consultation-liaison (C-L) psychiatry services aim to help general hospital staff provide better care for their patients. Recently, many inpatient C-L psychiatry services have adopted proactive and integrated approaches to achieve this aim. Despite these developments, there have been no interview-based studies of patients' and staff members' experiences of the new approaches.

OBJECTIVE

To gain an in-depth understanding of patients' and medical unit staff members' experiences of a proactive and integrated C-L psychiatry service for older medical inpatients (Proactive Integrated C-L Psychiatry [PICLP]).

METHODS

We conducted an interview-based qualitative study with thematic analysis. The participants were patients and staff who had experienced PICLP during The HOME Study, a randomized trial that evaluated PICLP in 24 medical units of three UK general hospitals.

RESULTS

We conducted 97 interviews: 43 with patients or their proxies (family members who were interviewed on behalf of patients with significant cognitive impairment) and 54 with staff members of all relevant disciplines. Patients and staff both described how PICLP was a helpful addition to medical care and discharge planning. It enhanced the medical unit team's ability to address psychological, psychiatric, and social needs and provide patient-centered care. They welcomed proactive biopsychosocial assessments and the broader perspective that these offered on patients' complex problems. They also valued the integration of C-L psychiatrists into the unit teams and their daily contact with them. For patients, it fostered a therapeutic relationship and helped them to be more engaged in decisions about their medical care and discharge planning. For staff, it enabled ready access to psychiatric expertise and training opportunities. The few reported experiences of PICLP being unhelpful were mainly about the greater number of clinicians involved in patients' care and a lack of clarity about professional roles in the integrated team.

CONCLUSIONS

We found that older inpatients and medical unit staff experienced PICLP as both acceptable and generally helpful. Our findings add to the existing evidence for the benefits of proactive and integrated C-L psychiatry services.

Development and external validation of the eFalls tool: a multivariable prediction model for the risk of ED attendance or hospitalisation with a fall or fracture in older adults

BACKGROUND

Falls are common in older adults and can devastate personal independence through injury such as fracture and fear of future falls. Methods to identify people for falls prevention interventions are currently limited, with high risks of bias in published prediction models. We have developed and externally validated the eFalls prediction model using routinely collected primary care electronic health records (EHR) to predict risk of emergency department attendance/hospitalisation with fall or fracture within 1 year.

METHODS

Data comprised two independent, retrospective cohorts of adults aged ≥65 years: the population of Wales, from the Secure Anonymised Information Linkage Databank (model development); the population of Bradford and Airedale, England, from Connected Bradford (external validation). Predictors included electronic frailty index components, supplemented with variables informed by literature reviews and clinical expertise. Fall/fracture risk was modelled using multivariable logistic regression with a Least Absolute Shrinkage and Selection Operator penalty. Predictive performance was assessed through calibration, discrimination and clinical utility. Apparent, internal-external cross-validation and external validation performance were assessed across general practices and in clinically relevant subgroups.

RESULTS

The model's discrimination performance (c-statistic) was 0.72 (95% confidence interval, CI: 0.68 to 0.76) on internal-external cross-validation and 0.82 (95% CI: 0.80 to 0.83) on external validation. Calibration was variable across practices, with some over-prediction in the validation population (calibration-in-the-large, -0.87; 95% CI: -0.96 to -0.78). Clinical utility on external validation was improved after recalibration.

CONCLUSION

The eFalls prediction model shows good performance and could support proactive stratification for falls prevention services if appropriately embedded into primary care EHR systems.

How to improve treatment-free remission eligibility in chronic myeloid leukaemia?

The achievement of treatment-free remission (TFR) has become a significant clinical end-point in the management of patients with chronic myeloid leukaemia (CML), providing an opportunity to discontinue therapy with tyrosine kinase inhibitors (TKIs) while maintaining deep molecular response (DMR). Early studies, such as the French STIM trial, have demonstrated that a portion of patients can maintain DMR after treatment cessation, with rates ranging from 40% to 50%, and most relapses occurring within the first 6 months. Key prognostic factors for successful TFR, including treatment duration, duration of DMR, risk scores, and transcript type, have been identified. Optimal patient selection for TFR remains a challenge, but recent research provides insights into potential strategies to increase TFR eligibility. Evidence suggests that early intervention switching to achieve optimal response, treatment combinations, proactive switch in the case of absence of DMR, dose-optimization and induction-maintenance approach can improve molecular responses and, consequently, enhance TFR eligibility. In this review, we report and discuss all the potential therapeutic strategies that may enhance eligibility for a first attempt at TFR, with a particular emphasis on potential future approaches.

Exploring Counselor Practices and Risk Assessment in a Proactive Digital Intervention Through Instagram in Young People: Qualitative Study

BACKGROUND

Suicide is one of the leading causes of preventable death in young people, and the way young people are communicating suicidality has evolved to include web-based disclosures and help-seeking. To date, mental health intervention services, both on the web and in person, have been conceived in the traditional model, whereby support is provided if a young person (or their family) actively seeks out that support when distressed. On the other hand, proactive outreach is an innovative approach to intervention that has been shown to be effective in other areas of health care. Live for Tomorrow chat was delivered on Instagram and comprised of counselors who reach out to provide brief person-centered intervention to young people who post content indicating distress or suicidality.

OBJECTIVE

Our aim was to explore how counselors engaged young people in a proactive digital intervention and how risk assessment was conducted in this context.

METHODS

We analyzed 35 transcripts of conversations between counselors and young people aged 13-25 years using the 6-step approach of Braun and Clarke's reflexive thematic analysis. These transcripts included a counseling intervention and a follow-up chat that was aimed at collecting feedback about the counseling intervention.

RESULTS

A total of 7 themes emerged: using microskills to facilitate conversations, building confidence and capacity to cope with change, seeking permission when approaching conversations about suicidality or self-harm, conversations about suicidality following a structured approach, providing assurances of confidentiality, validation of the experience of suicidality, and using conversations about suicidality to identify interventions. Counselors were able to translate counseling microskills and structured questioning regarding suicidality into a digital context. In particular, in the digital context, counselors would use the young person's post and emojis to further conversations and build rapport.

CONCLUSIONS

The findings highlight the importance of the counselor's role to listen, empathize, validate, and empower young people and that all these skills can be transferred to a digital text counseling intervention. Counselors used a structured approach to understanding suicidality in a permission-seeking, validating, and confidential manner to identify interventions with the young person. These practices allowed the conversation to move beyond traditional risk assessment practices to meaningful conversations about suicidality. Moving beyond traditional risk assessment practices and into conversations about suicidality allowed for the validation of the young person's experience and exploration of interventions and support that made sense and were seen to be helpful to the young person. This study highlighted the benefits of a proactive digital chat-based intervention, which is a novel approach to engaging with young people experiencing psychological distress and suicidality. Furthermore, this research demonstrates the feasibility and benefit of moving mental health intervention and support to a medium where young people are currently disclosing distress and intervening proactively.

Prevalence of Aggressive Behavior in Greek Elementary School Settings from Teachers' Perspectives

The present study aims to estimate the prevalence of bullying in Greek elementary schools and to study the risk factors that lead to bullying episodes. A structured questionnaire was given to 221 teachers of elementary schools and 71 kindergarten teachers from urban and rural Greek schools. They were asked to note the forms and the frequency of aggressive behaviors that they had witnessed during the school years 2020-2021 and 2021-2022, as well as the sociodemographic characteristics of the aggressive children involved. Statistical analyses of the data were conducted, and the obtained results show that specific forms of aggression are significantly correlated with gender and low academic performance. In addition, there is no form of aggressive behavior that is associated with the perpetrator's age, nationality or family status. Further, the results of the factor analysis revealed four dominant factors in the aggressive behavior observed by teachers. The forms of bullying and the prevailing factors of aggressive behavior that dominate in Greek school settings are reported in the present study. Furthermore, a novel evaluation tool for teachers could potentially be developed based on the results of the present study.

The memory clinic and psychosocial intervention: Translating past promise into current practices

Disproportionate negative effects since the pandemic have amplified the already limited post-diagnostic support for older people with dementia. This paper summarizes an exploratory randomized controlled study of a proactive family-based intervention compared with "usual" post-diagnostic dementia care. Memory clinic practitioners collaborated with the family doctor (GP) to coordinate this. At 12-month follow-up, positive effects on mood, behavior, carer coping and maintenance of care at home were found. Current approaches to deliver post-diagnostic support in primary care may require rethinking since (i) GP workloads have increased with low numbers of GPs per head of population in parts of England; and (ii) unlike many other long-term conditions, ongoing stigma, fear and uncertainty associated with dementia adds to the huge complexity of timely care provision. There is a case for return to a "one-stop facility", with a single pathway of continuing multidisciplinary coordinated care for older people with dementia and families. Future longitudinal research could compare structured post-diagnostic psychosocial intervention coordinated by skilled practitioners in a single locality memory service "hub", against other approaches such support organized mostly within primary care. Dementia-specific instruments for outcome measurement are available for use in routine practice, and should be included in such comparative studies.

The Synergistic Effect of Nurse Proactive Phone Calls With an mHealth App Program on Sustaining App Usage: 3-Arm Randomized Controlled Trial

BACKGROUND

Although mobile health application (mHealth app) programs have effectively promoted disease self-management behaviors in the last decade, usage rates have tended to fall over time.

OBJECTIVE

We used a case management approach led by a nurse and supported by a health-social partnership team with the aim of sustaining app usage among community-dwelling older adults and evaluated the outcome differences (i.e, self-efficacy, levels of depression, and total health service usages) between those who continued to use the app.

METHODS

This was a 3-arm randomized controlled trial. A total of 221 older adults with hypertension, diabetes, or chronic pain were randomized into 3 groups: mHealth (n=71), mHealth with interactivity (mHealth+I; n=74), and the control (n=76). The mHealth application was given to the mHealth and mHealth+I groups. The mHealth+I group also received 8 proactive calls in 3 months from a nurse to encourage use of the app. The control group received no interventions. Data were collected at preintervention (T1), postintervention (T2), and at 3 months' postintervention (T3) to ascertain the sustained effect.

RESULTS

A total of 37.8% of mHealth+I and 18.3% of mHealth group participants continued using the mHealth app at least twice per week until the end of the sixth month. The difference in app usage across the 2 groups between T2 and T3 was significant (χ²₁=6.81, P=.009). Improvements in self-efficacy (β=4.30, 95% CI 0.25-8.35, P=.04) and depression levels (β=-1.98, 95% CI -3.78 to -0.19, P=.03) from T1 to T3 were observed in the mHealth group participants who continued using the app. Although self-efficacy and depression scores improved from T1 to T2 in the mHealth+I group, the mean values decreased at T3. Health service usage decreased for all groups from T1 to T2 (β=-1.38, 95% CI -1.98 to -0.78, P<.001), with a marginal increase at T3.

CONCLUSIONS

The relatively low rates of mHealth app usage at follow-up are comparable to those reported in the literature. More work is needed to merge the technology-driven and in-person aspects of mHealth.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03878212; https://clinicaltrials.gov/ct2/show/NCT03878212.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1159/000509129.

Examining the role of road safety audits worldwide: exploring road safety expert's opinions

Road safety audit (RSA) is a method used to proactively identify safety risks in road projects from planning, design, and construction stages. The effectiveness of the implementation of RSAs varies across the globe. This paper provides an understanding of road safety auditor's opinions and attitudes by using data collected from an online questionnaire filled by 408 road safety experts with varying demographic and technical backgrounds. Results demonstrated that majority of respondents agreed that RSA is an effective tool to improve road safety. Compared to high-income countries, respondents from low- and middle-income countries had less knowledge about RSA and less access to RSA guidelines. The results also indicate that many road safety auditors have a misunderstanding of the independence requirement for conducting RSA. The results of this paper can be used to inform and develop improved guidance to improve RSA generally and promote RSA as an effective road safety engineering tool.

Sex Does Not Sell: The Effect of Sexual Content on Advertisement Effectiveness and Interference with Memory for Program Information

Does increasing the sexual content of advertisements lead, though memory processes, to greater sales? By employing a between-participants design, we aimed to explore how sexual advertising affects explicit and implicit memory, and whether it impairs memory for information preceding the commercials (retroactive interference) or following the commercials (proactive interference). We randomly assigned 182 young participants in the UK to one of two groups who watched the same TV program containing an advertisement break during which either sexual or nonsexual advertisements were shown, while brands were held constant across conditions. Participants were then tested on their explicit and implicit memory for both the advertising content and program information. Results revealed that implicit memory was better for nonsexual than for sexual advertisements. Unexpectedly, there was no group difference in participants' explicit memory for the advertisements. Further, sexual advertising resulted in retroactive interference with program information, whereas proactive memory for program information was not impaired. We acknowledge various study limitations and discuss proposals for future research.

Applying a bifactor model to the functions of relational aggression: Associations with hostile attribution biases and difficulties with emotion regulation

Previous research suggests that reactive and proactive aggression likely have distinct underlying mechanisms that uniquely contribute to the perpetration of each as a result of faulty cognitive and emotional processes. Still, very little work has examined the association of the functions of relational aggression with emotion dysregulation and hostile attribution biases. In addition, it is important to examine relational aggression in its pure and co-occurring functions given that past work finds reactive and proactive aggression to occur both jointly and distinctly. Thus, the current study employed a bifactor model to distinguish between pure reactive, pure proactive, and co-occurring relational aggression in emerging adulthood (N = 647, M_age  = 19.92, SD = 2.83), a developmental time period for which relational aggression is particularly prominent. To further address gaps in the relational aggression literature, indirect pathway models revealed that relational hostile attribution biases emerged as a concurrent indirect path in the relationship between emotion dysregulation and pure reactive relational aggression. Furthermore, emotion dysregulation was directly positively associated with both pure functions as well as co-occurring relational aggression, and hostile attribution biases for relational provocations were directly associated with both pure functions of relational aggression, though the association was negative for pure proactive and positive for pure reactive relational aggression. Findings highlight the potential influence of emotion dysregulation and attributing hostile intent to social situations on engaging in the different functions of relational aggression.

Cortical theta-gamma coupling governs the adaptive control of motor commands

Motor control requires the adaptive updating of internal models to successfully target desired outcomes. This adaptive control can be proactive, such that imminent actions and corresponding sensorimotor programmes are anticipated prior to movement, or reactive, such that online error correction is necessary to adjust to sudden changes. While substantial evidence implicates a distributed cortical network serving adaptive control when behavioural changes are required (e.g. response inhibition), the neural dynamics serving such control when the target motor commands are to remain intact are poorly understood. To address this, we developed a novel proactive-reactive cued finger tapping paradigm that was performed during magnetoencephalography by 25 healthy adults. Importantly, to ensure condition-wise differences in adaptive cueing were not attributable to changes in movement kinematics, motor selection and planning processes were held constant despite changes in task demands. All data were imaged in the time-frequency domain using a beamformer to evaluate the effect of proactive and reactive cues on movement-related oscillations and subsequent performance. Our results indicated spectrally specific increases in low (i.e. theta) and high (i.e. gamma) frequency oscillations during motor execution as a function of adaptive cueing. Additionally, we observed robust cross-frequency coupling of theta and gamma oscillatory power in the contralateral motor cortex and further, the strength of this theta-gamma coupling during motor execution was differentially predictive of behavioural improvements and decrements during reactive and proactive trials, respectively. These data indicate that functional oscillatory coupling may govern the adaptive control of movement in the healthy brain and importantly, may serve as effective proxies for characterizing declines in motor function in clinical populations in the future.

Gender Differences in the Personality Correlates of Reactive and Proactive Aggression in a Spanish Sample of Young Adults

Since the conceptual distinction of reactive and proactive aggression has been proposed, numerous studies have tried to disentangle the correlates of each function of aggression. While reactive aggression tends to be more strongly related to impulsivity, angry reactivity, or hostility, proactive aggression has proved to be more associated with psychopathic traits and goal-directed behaviors. However, in addition to the current debate about the actual distinction of reactive and proactive aggression, the study of gender differences is still scarce. Thus, the aim of the current study is to evaluate the distinctiveness of reactive and proactive aggression by means of the examination of their differential personality correlates (i.e., HEXACO, psychopathic traits, and impulsivity facets), as well as the assessment of gender differences in those relationships. To that end, a sample composed of 326 young adults aged 18-34 was recruited in Spain. The results evidenced unique associations of reactive and proactive aggression with a set of personality traits, including the HEXACO factors, psychopathic traits, and impulsivity facets, both at raw and residual level. Furthermore, when all the variables were entered in the model, proactive aggression remained strongly related to the factor of Honesty/humility and Emotionality, whereas reactive aggression remained associated with the impulsive/irresponsive factor of psychopathy and, specifically, with the facet of negative urgency, as well as with lack of Agreeableness. Likewise, some gender differences emerged as regards certain correlates. Specifically, proactive aggression was related with lack of Agreeableness and sensation seeking only in males and with the impulsive/irresponsive factor of psychopathy only in females, although these differences were not statistically significant. The conceptual and practical implications of these finding are discussed in terms of prevention.

Therapeutic drug monitoring for biological medications in inflammatory bowel disease

Therapeutic drug monitoring (TDM) is the measurement of serum drug concentrations and anti-drug-antibodies (ADA) for biologic therapies used to treat inflammatory bowel disease (IBD). The aim of this article is to review the current literature concerning reactive and proactive TDM for both adults and children with IBD. Although optimal trough concentration windows for some of these medications are not well defined, there is mounting evidence to suggest that reactive TDM is associated with favorable therapeutic outcomes, including less immunogenicity, greater drug exposure, and a decreased risk of treatment failure. Moreover, while the exact mechanism of loss of response is not fully elucidated, the vast majority of studies have reported a decreased incidence of nonresponse and secondary loss of response when TDM is implemented. Proactive TDM, while even less understood in the literature, employs a schedule of preemptive analysis of serum trough concentrations to accordingly adjust the patient's biologic dosage. Proactive TDM may decrease the need for IBD-related surgery/hospitalization, and therefore merits future studies of investigation.

Ultra-proactive Therapeutic Drug Monitoring of Infliximab Based on Point of Care Testing in Inflammatory Bowel Disease: Results of a Pragmatic Trial

BACKGROUND

With point of care testing [POCT] for infliximab [IFX], ultraproactive therapeutic drug monitoring [TDM] with ad-hoc dose optimisation is possible in patients with inflammatory bowel disease [IBD].

AIM

To compare the clinical outcomes of an ultraproactive TDM algorithm of IFX based on POCT with reactive TDM in patients with IBD, in a pragmatic clinical trial.

METHODS

All patients with IBD and maintenance IFX treatment were included between June and August 2018 in two centres. Centre A applied an ultra-proactive TDM algorithm incorporating POCT, and centre B applied reactive TDM. Primary endpoint was failure of IFX therapy after 1 year. Secondary endpoints included sustained clinical remission and mucosal remission.

RESULTS

In total 187 patients [n = 115/72 cohort A/B] were included. Cohort A had more trough level [TL] measurements compared with cohort B [8.8 vs 1/patient/year; p <0.0001], leading to a significant higher number of dose optimisations. POCT testing was required in 27% after the first round of ultra-proactive TDM and in a mean of 6.3% (standard deviation [SD] 1.9) in the subsequent rounds. Ad-hoc extra dosing was needed in 13% of the POCT. After 1 year, no difference was seen between cohort A and cohort B in IFX failure [19% vs 10%; p = 0.08], nor in sustained clinical remission [75% vs 83%; p = 0.17]. Mucosal remission was evaluated in 71 patients [38%], and was more frequent in the reactive TDM cohort [p = 0.02].

CONCLUSIONS

Ultra-proactive TDM in patients with IBD and maintenance IFX treatment leads to equal clinical outcomes as reactive TDM after 1 year of follow-up.

Seasonal calving UK dairy herds: A farmer survey of fertility and veterinary services

BACKGROUND

There is a lack of literature concerning dairy farmers' use of veterinary services and how satisfied they are with them. This study aimed to fill this gap for seasonal calving UK herds, with a focus on fertility, and included farmer perceived barriers to veterinary involvement.

METHODS

A cross-sectional questionnaire (convenience sample), with 166 useable responses.

RESULTS

Opportunities exist for further veterinary involvement in seasonal herds. Areas vets are least involved in currently are nutrition, breeding and genetics, growth rate monitoring and infrastructure changes. Current veterinary input was rated neutral or poor value by 21% of respondents. Over 90% of farmers want vets to ask questions to elicit their needs. Frequently mentioned barriers were 'lack of veterinary knowledge of our system', 'not enough cost-benefit of veterinary involvement' and 'we get our fertility information elsewhere'. Along with clinical ability and being approachable, 'understanding our system' and being 'proactive' were qualities participants most valued in a vet. After cost, 'pushing sales and interventions' were the least liked.

CONCLUSION

Findings highlight the critical importance of clearly demonstrating the full cost-benefit of veterinary services to farmers. The results contain many details concerning farmer perceptions and values that can help veterinary businesses to strengthen existing services and develop new services.

A Proactive Approach to Identify the Exposure Risk to COVID-19: Validation of the Pandemic Risk Exposure Measurement (PREM) Model Using Real-World Data

Purpose

To statistically validate the PREM (Pandemic Risk Exposure Measurement) model devised in a previous paper by the authors and determine the model’s relationship with the level of current COVID-19 cases (NLCC) and the level of current deaths related to COVID-19 (NLCD) based on the real country data.

Methods

We used perceived variables proposed in a previous study by the same lead authors and applied the latest available real data values for 154 countries. Two endogenous real data variables (NLCC) and (NLCD) were added. Data were transformed to measurable values using a Likert scale of 1 to 5. The resulting data for each variable were entered into SPSS (Statistical Package for the Social Sciences) version 26 and Amos (Analysis of a Moment Structures) version 21 and subjected to statistical analysis, specifically exploratory factor analysis, Cronbach’s alpha and confirmatory factor analysis.

Results

The results obtained confirmed a 4-factor structure and that the PREM model using real data is statistically reliable and valid. However, the variable Q14 – hospital beds available per capita (1000 inhabitants) had to be excluded from the analysis because it loaded under more than one factor and the difference between the factor common variance was less than 0.10. Moreover, its Factor 1 and Factor 3 with NLCC and Factor 1 with NLCD showed a statistically significant relationship.

Conclusion

Therefore, the developed PREM model moves from a perception-based model to reality. By proposing a model that allows governments and policymakers to take a proactive approach, the negative impact of a pandemic on the functioning of a country can be reduced. The PREM model is useful for decision-makers to know what factors make the country more vulnerable to a pandemic and, if possible, to manage or set tolerances as part of a preventive measure.

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Valued Insight or Act of Insubordination? How Context Shapes Coaches' Perceptions of Challenge-Oriented Followership

Effective leadership is a collaborative effort, requiring a degree of complementarity in how people enact roles of leadership and followership. Using a novel online vignette methodology, we experimentally tested how three contextual factors influenced coaches' responses to challenge-oriented acts of followership, as well as investigated two potential mechanisms. Coaches (N = 232) watched videos of an athlete provided unsolicited challenge-oriented feedback to a coach. Videos varied by the (a) athlete's status, (b) presence of third-party observers, and (c) stage of the decision-making process. Following the video, we assessed coaches' evaluations of the athlete. Challenge-oriented followership was perceived more favorably when enacted by an athlete in one-on-one (vs. in a group) and before a decision has been reached (vs. after a decision is reached). Coaches may appreciate proactivity from athletes in positions of followership, but challenge-oriented followership behaviors enacted at the wrong time and place can elicit negative reactions.

Proactive measures to eradicate Malaysia's poverty in IR4.0 era: a shared prosperity vision

Background: In the country's shared prosperity vision, Malaysia aspires to uplift the bottom 40% household income group (B40) by addressing wealth and income disparities. By 2030, the nation seeks to eradicate poverty through the provision of employment opportunities and career progression plans. A grey area between the nation's aspirations and actions in practice can be observed because the goals have not been achieved despite numerous efforts aimed at the upliftment of the B40 group. The nation is still way behind its targeted outcomes despite various policies being implemented, which could be attributed to the mismatch between government policies and that of organisational practice. Thus, this study explores the rationale of strategic government intervention in managing B40 talent in the IR4.0 era. Methods: A general qualitative inquiry method that used 11 semi-structured interviews was carried out with representatives of Malaysia's policy makers', training providers, and trainees. All Interview questions centred around measures, importance and outcomes of B40 youth training from a multi-stakeholder perspective. Data were thematically analysed in five stages using NVivo. Results: Training, which includes IR4.0 era digital skills, is the key to uplifting the B40 youth to eradicate poverty. Proactive measures are imperative in the success of B40 youth training towards poverty eradication. Conclusions: This study contributes to the existing literature and helps practitioners by addressing the current gap in Malaysia's aspirations versus organisational practice. Stakeholders should formulate proactive strategies to ensure that the right trainees are matched with the right training providers and government policies. A linkage between government policies and industry requirements needs to be established as opposed to the present discontinuity. A structured training needs analysis should be applied through a collaboration between industries and governments. Then, B40 individuals commonly found in lower-level positions can be pooled into the career pathway towards a shift into M40.

Proactive measures to eradicate Malaysia's poverty in IR4.0 era: a shared prosperity vision

Background: In the country's shared prosperity vision, Malaysia aspires to uplift the bottom 40% household income group (B40) by addressing wealth and income disparities. By 2030, the nation seeks to eradicate poverty through the provision of employment opportunities and career progression plans. A grey area between the nation's aspirations and actions in practice can be observed because the goals have not been achieved despite numerous efforts aimed at the upliftment of the B40 group. The nation is still way behind its targeted outcomes despite various policies being implemented, which could be attributed to the mismatch between government policies and that of organisational practice. Thus, this study explores the rationale of strategic government intervention in managing B40 talent in the IR4.0 era. Methods: A general qualitative inquiry method that used 11 semi-structured interviews was carried out with representatives of Malaysia's policy makers', training providers, and trainees. All Interview questions centred around measures, importance and outcomes of B40 youth training from a multi-stakeholder perspective. Data were thematically analysed in five stages using NVivo. Results: Training, which includes IR4.0 era digital skills, is the key to uplifting the B40 youth to eradicate poverty. Proactive measures are imperative in the success of B40 youth training towards poverty eradication. Conclusions: This study contributes to the existing literature and helps practitioners by addressing the current gap in Malaysia's aspirations versus organisational practice. Stakeholders should formulate proactive strategies to ensure that the right trainees are matched with the right training providers and government policies. A linkage between government policies and industry requirements needs to be established as opposed to the present discontinuity. A structured training needs analysis should be applied through a collaboration between industries and governments. Then, B40 individuals commonly found in lower-level positions can be pooled into the career pathway towards a shift into M40.

Motivations and Barriers for Veterinarians When Facilitating Fertility Management on UK Dairy Farms

It is economically essential, but challenging, for dairy farmers to manage bovine fertility. Vets can help farmers to improve fertility, and this is cost-effective bringing benefits for production, animal health and welfare, and the environment. However, the extent to which vets are involved in fertility varies considerably between farms, for reasons that are unclear. This study investigated the motivators and barriers that vets perceive when trying to increase their involvement with fertility management on UK dairy farms. Interviews were conducted with 20 vets and four themes identified. The first, "clinical baggage," highlighted vets' disillusionment due to past experiences of low uptake of their advice by farmers. Consequently, some vets made assumptions about farmer needs and behaviours, and exhibited ageist stereotyping. These issues, along with concerns and fatigue associated with repeatedly offering the same advice which was not acted upon, negatively influenced vets' engagement with farmers. The second theme "stuck in the comfort zone" revealed a loss of enthusiasm by some senior vets, whilst others lacked confidence to engage due to perceived gaps in their knowledge. Vets also reported farmers not perceiving their problems and lack of farm data or facilities, as barriers. The "vet-farmer relationship" theme highlighted building trust and developing strong relationships which were key drivers for vets to proactively engage and to "go the extra mile" for their clients. The final theme "money matters" explored vets' motivations to improve their clients' profitability and included the future sustainability of their own businesses. Our themes provide useful insight into the challenges vets face and provide key areas that can be targeted in future interventions to improve veterinary involvement in fertility management. For example, post-graduate training and support for vets needs to consider factors such as reflection, mentorship, stereotyping, relationships, communication, and leadership skills. This type of postgraduate support is currently limited for vets and requires investment from stakeholders if improvements in production, animal health and welfare, and the environment are to be achieved. Our findings are informative for facilitating veterinary involvement in any disease context, and are relevant for stakeholders including governments, educators, charities, farmer representatives, environmentalists, and veterinary leaders.

Effects of a brief alcohol intervention addressing the full spectrum of drinking in an adult general population sample: a randomized controlled trial

BACKGROUND AND AIMS

Evidence for efficacy of brief alcohol interventions (BAIs) is mainly limited to primary care and at-risk drinkers. The aim was to test the efficacy of a BAI addressing the full spectrum of alcohol use in a general population sample and across alcohol risk groups.

DESIGN

Two-parallel-group randomized controlled trial (allocation ratio 1:1) with post-baseline assessments at months 3, 6 and 12.

SETTING

One municipal registry office in Germany responsible for registration, passport and vehicle admission issues.

PARTICIPANTS

A total of 1646 proactively recruited 18-64-year-old adults with past year alcohol use (56% women, 66% low-risk drinkers) were randomized to intervention (n = 815) or control (n = 831).

INTERVENTION AND COMPARATOR

The intervention consisted of assessment plus computer-generated individualized feedback letters at baseline and months 3 and 6. Comparator was assessment only.

MEASUREMENTS

Primary outcome was change in the self-reported number of drinks/week from baseline to 12 months. Changes at 3 and 6 months were secondary outcomes. Moderator was alcohol risk group (low-risk versus at-risk drinking) according to the Alcohol Use Disorders Identification Test-Consumption, with scores from 1-3 (women) and from 1-4 (men) indicating low-risk drinking.

FINDINGS

For the whole sample, significant group differences were observed neither at 12-month follow-up [incidence rate ratio (IRR) = 1.01, 95% confidence interval (CI) = 0.87-1.17, Bayes factor (BE) = 0.52] nor at previous assessments (month 3: IRR = 1.01, 95% CI = 0.92-1.12, BE = 0.41; month 6: IRR = 0.93, 95% CI = 0.81-1.07, BE = 1.10). Moderator analyses revealed that low-risk drinkers were more likely to benefit from BAI only at month 6 than at-risk drinkers (IRR = 0.77, 95% CI = 0.70-0.86).

CONCLUSIONS

In a randomized controlled trial, there was no clear evidence for efficacy of a computer-based brief alcohol intervention in a general population sample, but there was some evidence of medium-term benefits in the large but understudied group of low-risk drinkers.

Clinical, patient and estimated cost benefits of proactive management versus reactive management with calcipotriol/betamethasone dipropionate foam for the treatment of plaque psoriasis in Finland

BACKGROUND

Proactive management of plaque psoriasis with twice-weekly topical calcipotriol/betamethasone dipropionate (Cal/BD) foam has a demonstrated clinical benefit in preventing disease relapse compared to reactive management, where Cal/BD foam is only given as rescue therapy once-daily for four weeks after relapse. The impact of proactive management with Cal/BD foam on a wider range of clinical responses is not yet known, nor is its potential cost-effectiveness in the healthcare system of Finland.

METHODS

This study involved a post-hoc analysis exploring the clinical and patient-reported benefits of proactive versus reactive management with Cal/BD foam observed in the PSO-LONG trial (NCT02899962). A range of response criteria based on modified psoriasis area and severity index (mPASI) and dermatology life quality index (DLQI) were analyzed, and the cost-effectiveness of proactive versus reactive management was estimated in a Finnish healthcare setting.

RESULTS AND CONCLUSION

The analysis found a consistent clinical benefit of proactive management compared to reactive management on all response criteria, and a markedly lower cost-per-responder for the response criteria of mPASI 75, mPASI ≤ 2 and DLQ1 ≤ 1. The analysis was robust to sensitivity analyses on key inputs and demonstrates the cost and clinical benefits of proactive over reactive management of plaque psoriasis with Cal/BD foam in the Finnish healthcare setting.

Preparing to React: A Behavioral Study on the Interplay between Proactive and Reactive Action Inhibition

Motor preparation, based on one's goals and expectations, allows for prompt reactions to stimulations from the environment. Proactive and reactive inhibitory mechanisms modulate this preparation and interact to allow a flexible control of responses. In this study, we investigate these two control mechanisms with an ad hoc cued Go/NoGo Simon paradigm in a within-subjects design, and by measuring subliminal motor activities through electromyographic recordings. Go cues instructed participants to prepare a response and wait for target onset to execute it (Go target) or inhibit it (NoGo target). Proactive inhibition keeps the prepared response in check, hence preventing false alarms. Preparing the cue-coherent effector in advance speeded up responses, even when it turned out to be the incorrect effector and reactive inhibition was needed to perform the action with the contralateral one. These results suggest that informative cues allow for the investigation of the interaction between proactive and reactive action inhibition. Partial errors' analysis suggests that their appearance in compatible conflict-free trials depends on cue type and prior preparatory motor activity. Motor preparation plays a key role in determining whether proactive inhibition is needed to flexibly control behavior, and it should be considered when investigating proactive/reactive inhibition.

Twice-weekly topical calcipotriene/betamethasone dipropionate foam as proactive management of plaque psoriasis increases time in remission and is well tolerated over 52 weeks (PSO-LONG trial)

BACKGROUND

Topical psoriasis treatment relies on a reactive rather than a long-term proactive approach to disease relapse.

OBJECTIVE

Assess long-term efficacy and safety of proactive psoriasis management with twice-weekly calcipotriene 0.005%/betamethasone dipropionate 0.064% (Cal/BD) foam.

METHODS

Phase III trial (NCT02899962) included a 4-week open-label lead-in phase (Cal/BD foam once daily) and a 52-week, randomized, double-blind, maintenance phase. A total of 545 patients achieved treatment success (physician's global assessment "clear"/"almost clear," ≥2-grade improvement from baseline) and were randomized to proactive management (Cal/BD foam; n = 272) or reactive management (vehicle foam; n = 273) twice-weekly, with rescue treatment of Cal/BD foam once daily for 4 weeks upon relapse. Primary endpoint was time to first relapse (physician's global assessment "mild" or higher).

RESULTS

A total of 251 randomized patients (46.1%) completed the trial. Median time to first relapse was 56 days (proactive) and 30 days (reactive). Patients in the proactive group had an additional 41 days in remission compared with the reactive group over 1 year (P < .001). Number of relapses per year of exposure was 3.1 (proactive) and 4.8 (reactive). Cal/BD foam was well tolerated.

LIMITATIONS

Maintenance phase dropout rate (53.9%) was within the expected range but provides challenges in statistical analysis.

CONCLUSION

Long-term proactive management with Cal/BD foam demonstrated superior efficacy vs reactive management.

Variations in the Behavior of Pigs During an Open Field and Novel Object Test

Tail biting is a serious welfare concern in pig production. It not only causes distress for victims, but may occur where pigs are unable to cope, and become biters. An animal's ability to cope with stressful situations may vary between individuals, but the behavioral response could be consistent across different fear eliciting situations. We exposed 75 pigs to open field (OF) and novel object (NO) tests at 14 weeks of age. Within each pen of pigs (n = 16 pens, 55 pigs/pen), 6 pigs were selected for testing using the following criteria: 3 pigs that had severe bite wounds (BITTEN), 1 confirmed biter (BITER), 1 pig which could be easily approached and trained to provide a saliva sample (BOLD) and 1 pig which was extremely evasive, and was unable to be trained to willingly provide a saliva sample (SHY). Given that responses may be consistent in different scenarios, we hypothesized that SHY pigs would display more characteristics of a fear response (i.e., less movement in the open field, more time spent by the door, and longer latency to approach the novel object) than human BOLD pigs. We also hypothesized that BITTEN pigs would behave similarly to SHY and BITERS similarly to BOLD. The BOLD and BITER pigs spent more time exploring (P < 0.05) and less time by the door (P < 0.01) than the BITTEN and SHY pigs. Although there was an overall increase in cortisol level from before to after the tests (P < 0.001), this was only significant for BITTEN (P < 0.001) and SHY (P < 0.05) pigs. Therefore, as hypothesized, for several measures, BOLD, and BITER pigs behaved similarly, and differently to SHY and BITTEN. However, the low sample size potentially meant that for several measures, although numeric differences were in the direction hypothesized, there were no statistical differences. Further work in which a greater number of BITER pigs were included in the sample, may elucidate our hypotheses more clearly, as to whether responses to fear tests in pigs could be associated with the likelihood of being a tail biter, or victim.

Self-Organized Proactive Routing Protocol for Non-Uniformly Deployed Underwater Networks

Electromagnetic (EM) waves cannot propagate more than few meters in sea water due to the high absorption rate. Acoustic waves are more suitable for underwater communication, but they travel very slowly compared to EM waves. The typical speed of acoustic waves in water is 1500 m/s, whereas speed of EM waves in air is approximately 3 × 10⁸ m/s. Therefore, the terrestrial wireless sensor network (WSN) protocols assume that the propagation delay is negligible. Hence, reactive protocols are deemed acceptable for WSNs. Other important issues related to underwater wireless sensor networks (UWSNs) are determining the position of the underwater nodes and keeping a time synchronization among the nodes. Underwater nodes can neither determine their position nor synchronize using Global Navigation Satellite Systems (GNSS) because of the short penetration of EM waves in sea water. The limited mobility of UWSN nodes and variation in the propagation speed of acoustic waves make time synchronization a challenging task for underwater acoustic networks (UASNs). For all these reasons, WSN protocols cannot be readily used in UASNs. In this work, a protocol named SPRINT is designed to achieve high data throughput and low energy operation in the nodes. There is a tradeoff between the throughput and the energy consumption in the wireless networks. Longer links mean higher energy consumption. On the other hand, the number of relay nodes or hops between the source node and the final destination node is a key factor which affects the throughput. Each hop increases the delay in the packet forwarding and, as a result, decreases the throughput. Hence, energy consumption requires the nearest nodes to be chosen as forwarding nodes, whereas the throughput requires the farthest node to be selected to minimize the number of hops. SPRINT is a cross-layer, self-organized, proactive protocol which does not require positioning equipment to determine the location of the node. The routing path from the node to the gateway is formed based on the distance. The data sending node prefers to choose the neighbor node which is closest to it. The distance is measured by the signal strength between the two nodes.

Anticipation of drop height affects neuromuscular control and muscle-tendon mechanics

This study examined the effect of drop height on neuromechanical control of the plantarflexors in drop jumps (DJs) before and during ground contact (GC). The effect of anticipation on muscle mechanical configurations was investigated in 22 subjects in three conditions (20, 30, and 40 cm): (i) known, (ii) unknown, or (iii) cheat falling heights (announced 40 cm, but actual drop height was 20 cm). Electromyographic (EMG) activity of the m. gastrocnemius medialis (GM) and other shank muscles was recorded and analyzed before GC and during GC separately for the short-, medium-, and long-latency responses (SLR, MLR, and LLR). Changes in GM fascicle length (L_M ) were determined via B-mode ultrasound, and muscle-tendon unit length (L_MTU ) was estimated. Peak force (P < .001), rate of force development (RFD) (P = .001) and GM EMG activity prior to (P = .003) and during GC (P = .007) was reduced in the unknown compared with the known conditions (P < .05). The amount of shortening in L_MTU during GC in unknown and cheat was less compared with the known conditions (P = .005; P = .049). Changes in L_MTU lengthening negatively correlated with changes in GM activity around SLR and MLR (P = .006; P = .02) in known and unknown conditions. Taken together, it seems that the central nervous system applies a protective strategy in the unknown condition by reducing muscle activity to result in a lower muscular stiffness and increased tendinous lengthening prior to and during GC. This might be a mechanism to absorb greater elastic energy in the tendon and reduce the magnitude and rate of muscle lengthening and subsequent stretch-induced muscle damage.

Frequency and origin (reactive/proactive) of aggressive behavior in young people with intellectual disability and autism spectrum disorder

BACKGROUND

The aim was to investigate the aggressive behavior of young people in specialized institutions with intellectual disability (ID) with or without autism spectrum disorder (ASD).

METHOD

Data on 305 institutionalized young people were collected using two aggression scales, the 'Children's Scale of Hostility and Aggression: Reactive/Proactive', and the 'Behavior Problems Inventory - Short Form'.

FINDINGS

Our results show that the behavioral manifestations differ between the clinical groups (ID/ID with ASD). In addition, they reveal a decrease in all aggressive and stereotyped behaviors at 16 years in participants with ID but not in those with the dual diagnosis (ID and ASD). There would be an increase in self-injury with age in people with ID and ASD. Finally, the aggressive behaviors (verbal, relational, bullying) of people with only ID are significantly more proactive than reactive.

Differences in stress reactivity between zebrafish with alternative stress coping styles

Animals experience stress in a variety of contexts and the behavioural and neuroendocrine responses to stress can vary among conspecifics. The responses across stressors often covary within an individual and are consistently different between individuals, which represent distinct stress coping styles (e.g. proactive and reactive). While studies have identified differences in peak glucocorticoid levels, less is known about how cortisol levels differ between stress coping styles at other time points of the glucocorticoid stress response. Here we quantified whole-body cortisol levels and stress-related behaviours (e.g. depth preference, movement) at time points representing the rise and recovery periods of the stress response in zebrafish lines selectively bred to display the proactive and reactive coping style. We found that cortisol levels and stress behaviours are significantly different between the lines, sexes and time points. Further, individuals from the reactive line showed significantly higher cortisol levels during the rising phase of the stress response compared with those from the proactive line. We also observed a significant correlation between individual variation of cortisol levels and depth preference but only in the reactive line. Our results show that differences in cortisol levels between the alternative stress coping styles extend to the rising phase of the endocrine stress response and that cortisol levels may explain variation in depth preferences in the reactive line. Differences in the timing and duration of cortisol levels may influence immediate behavioural displays and longer lasting neuromolecular mechanisms that modulate future responses.

Subtypes of aggression and their relation to anxiety in Barbary macaques

Human aggression can be differentiated into reactive aggression (RA), displayed in face of a real or perceived threat and associated with high levels of anxiety, and proactive aggression (PA), displayed to achieve a certain goal and linked to lower anxiety levels. To study the origins of these aggression subtypes and their relation to anxiety, we tested if both subtypes can be distinguished in a nonhuman primate species, characterized their occurrence within the study group, and examined the link between aggression subtype and anxiety. Data were collected on 29 individuals of a semi-free ranging group of Barbary macaques (Macaca sylvanus) at Affenberg Salem, Germany, via focal animal (303 hr) and event sampling (1,222 agonistic events). Using a priori definitions, each aggressive event was classified as either reactive or proactive. We found both aggression types in our study population as well as individual differences in the proportion at which they occurred. The predominant use of one subtype of aggression was linked to the individual's dominance rank, age and sex, but not related to standard behavioral and physiological measures of anxiety. Our results suggest that reactive and proactive subtypes of aggression also exist in Barbary macaques, indicating a deeper evolutionary history of these aggression types observed in humans.

Proactive multipurpose health risk screening in health care settings: Methods, design, and reach

OBJECTIVES

Real world implementation of proactive screening and brief intervention in health care is threatened by high cost. Using e-health interventions and screening for multiple health risk factors may provide more efficiency. We describe methodological details of a proactive multipurpose health risk screening in health care settings and report on participation rates, participants' characteristics, and participation factors.

METHODS

Patients between 18 and 64 years from ambulatory practices and hospitals were proactively approached by study assistants at three sites for a computerized screening on harmful alcohol and tobacco consumption, depressive symptoms, insufficient fruit/vegetable consumption, physical inactivity and overweight. On the basis of their health risk pattern, a computerized algorithm allocated patients to one of five studies each of them addressing a psychiatric research question.

RESULTS

Among all eligible patients, 13,763 (86.5%) were screened. Younger age and being female predicted screening participation. Of those with complete data (n = 12,828), 82.9% reported at least two health risks and 34.0% were eligible for a study. Study participation ranged between 35.2% and 50.8%, and was associated with socio-demographics and problem severity.

CONCLUSIONS

This study supports the use of systematic proactive screening for multiple health risks in health care settings as it is more resource-saving than single focused screening.

A campaign aimed at increasing seasonal influenza vaccination coverage among post graduate medical residents in an Italian teaching hospital

We analysed the impact of several strategies aimed at increasing influenza immunisation rates among Medical Residents (MRs) of an Italian teaching Hospital. During the 2015-16 and 2016-17 influenza seasons we carried out several interventions: ambulatory doubling where vaccination was offered, ambulatory opening hour extension, email invitations, informative materials, forum theatre and vaccination campaign conference. In addition, during the 2016-17 the OSV was carried out: MRs who go to specific wards where they perform influenza immunisation counselling and eventually vaccinate the personnel. 99/1041 (9.5%) and 184/1013 (18.2%) MRs received the vaccine in 2015-16 and in 2016-17 respectively (p < 0.0001). Significant difference was found among three specialisation areas (medicine, surgery, "services"; p < 0.001) and among years of residency (p < 0.001). The highest coverage was found among Infectious Diseases, Paediatrics, Haematology and Hygiene MRs (80%, 67%, 52% and 52% respectively) in 2016-2017 season. The highest coverage increase was found among MRs in Pneumology and Geriatrics (566% and 268%, respectively). The coverage rate has increased even though important differences among specialties persist. The study shows a significant increase in immunisation rate among MRs after the implementation of these strategies.

Adaptation of a Proactive Smoking Cessation Intervention to Increase Tobacco Quitline Use by LGBT Smokers

PURPOSE

The study purpose was to evaluate the content of a proactive population health management intervention aimed at promoting uptake of smoking cessation treatments offered by the Illinois Tobacco Quitline (ITQL) among lesbian, gay, bisexual, and transgender (LGBT)-identified smokers.

METHODS

This study represents a partnership between a community-based health center and university researchers. As part of the study, focus groups and in-depth interviews were conducted with LGBT smokers (N = 30). First, we conducted focus groups to obtain feedback on the readability, acceptability, and motivational salience of a targeted and nontargeteed proactive outreach letter. After revisions, a series of in-depth interviews were conducted to evaluate finalized materials. Focus groups and interviews were systematically analyzed.

RESULTS

Based on feedback, the revised intervention letter was rated more positively than the initial version, with 80% of participants indicating that they found the information in the letter to be useful. Further, more participants reported that the letter would motivate them to accept a call from a quitline counselor compared with the initial version (47.6% vs. 60.0%, respectively). In the final iteration, 60% of participants preferred the targeted letter, 30% preferred the non-targeted letter, and 10% had no preference. In the first iteration, outreach text messages were rated as unacceptable or completely unacceptable by 54% of participants. The revised text messages and protocols were seen as unacceptable by only 10% of participants.

CONCLUSIONS

The development and testing of population-based and cost-effective interventions is critical to the reduction of LGBT smoking disparities. The study protocol and intervention materials were well-received by participants. In a future study, we will evaluate the efficacy of the intervention in increasing use of the quitline among LGBT smokers.

Self-Organized Fast Routing Protocol for Radial Underwater Networks

An underwater wireless sensor networks (UWSNs) is an emerging technology for environmental monitoring and surveillance. One of the side effects of the low propagation speed of acoustic waves is that routing protocols of terrestrial wireless networks are not applicable. To address this problem, routing strategies focused on different aspects have been proposed: location free, location based, opportunistic, cluster based, energy efficient, etc. These mechanisms usually require measuring additional parameters, such as the angle of arrival of the signal or the depth of the node, which makes them less efficient in terms of energy conservation. In this paper, we propose a cross-layer proactive routing initialization mechanism that does not require additional measurements and, at the same time, is energy efficient. The algorithm is designed to recreate a radial topology with a gateway node, such that packets always use the shortest possible path from source to sink, thus minimizing consumed energy. Collisions are avoided as much as possible during the path initialization. The algorithm is suitable for 2D or 3D areas, and automatically adapts to a varying number of nodes, allowing one to expand or decrease the networked volume easily.

Proactive Inhibition Activation Depends on Motor Preparation: A Single Pulse TMS Study

In everyday life, environmental cues are used to predict and respond faster to upcoming events. Similarly, in cueing paradigms (where, on cued trials, a cued target requires a speeded response), cues are known to speed up response times (RTs), suggesting that motor preparation has occurred. However, some studies using short cue-target intervals (<300 ms) have found slower RTs on cued, compared to uncued trials (namely, the “paradoxical warning cost”). One explanation of this paradoxical effect is proactive inhibition, a motor gating mechanism that prevents false alarms, also called “the default state of executive control.” Alternative hypotheses claim that, with such short cue-target delays, participants cannot fully prepare the motor response, thus producing slower RTs. In studies of action inhibition, it is often assumed that participants prepare a response on each trial, a prerequisite to induce and measure (proactive) motor inhibition. In this study, we psychophysically manipulated stimulus’ duration in a simple RT task, and measured a duration threshold at which participants responded on time on 80% of the trials. When participants are tested at their stimulus’ duration threshold, they are more likely to prepare the motor response on each trial. Furthermore, we directly measured participants’ readiness to respond by recording transcranial-magnetic stimulation (TMS)-elicited motor evoked potentials (MEPs), a direct measure of corticospinal excitability. Participants performed cued and uncued trials on a simple RT task with short cue-target intervals. We expected lower MEPs’ amplitude on cued than uncued trials with short cue-target intervals, as it would be predicted by the proactive inhibition account. However, when conditions are equated so that motor preparation is induced both under cued and uncued trials, the paradoxical warning cost disappears, as RTs were always faster on cued than uncued trials. Moreover, MEPs recorded from the task-relevant muscle were never suppressed at target onset compared to baseline, a result that does not support the proactive inhibition hypothesis. These results suggest that proactive inhibition is not active by default and that its activation depends on motor preparation.

A Survey on Proactive, Active and Passive Fault Diagnosis Protocols for WSNs: Network Operation Perspective

Although wireless sensor networks (WSNs) have been the object of research focus for the past two decades, fault diagnosis in these networks has received little attention. This is an essential requirement for wireless networks, especially in WSNs, because of their ad-hoc nature, deployment requirements and resource limitations. Therefore, in this paper we survey fault diagnosis from the perspective of network operations. To the best of our knowledge, this is the first survey from such a perspective. We survey the proactive, active and passive fault diagnosis schemes that have appeared in the literature to date, accenting their advantages and limitations of each scheme. In addition to illuminating the details of past efforts, this survey also reveals new research challenges and strengthens our understanding of the field of fault diagnosis.

HIV status disclosure rate and reasons for non-disclosure among infected children and adolescents in Enugu, southeast Nigeria

Aims: To determine the rate of HIV status disclosure, caregivers’ reasons for non-disclosure, and factors influencing disclosure among a sample of HIV-infected children in Enugu, southeast Nigeria. Methods: Data were collected prospectively via a questionnaire on HIV-infected children and their caregivers who visited the pediatric HIV clinic of the University of Nigeria Teaching Hospital between July 1, 2012, and June 30, 2013. The data analysis was performed using Statistical Package for the Social Sciences version 19 software. Results: Caregivers of 107 children (age 5–16 years; mean 10.1 ± 3.2 years) were enrolled in the study. There were 53 (49.5%) boys and 54 (50.5%) girls. HIV status had been disclosed to 31 (29%) of them. The major reason for non-disclosure was the child being considered too young. Age (p < .001), age at HIV diagnosis (p < .001) and baseline CD4 count (p = .008) were seen as significant predictors of HIV disclosure. Conclusions: There is a low rate of HIV disclosure to infected children, and it was found to be lower for younger children. We recommend improving efforts for disclosure counseling to caregivers in pediatric HIV clinics.

Foresight beats hindsight: The neural correlates underlying motor preparation in the pro-/anti-cue paradigm

BACKGROUND

Human motor behaviors are characterized by both, reactive and proactive mechanisms. Yet, studies investigating the neural correlates of motor behavior almost exclusively focused on reactive motor processes. Here, we employed the pro-/anti-cue motor preparation paradigm to systematically study proactive motor control in an imaging environment. In this paradigm, either pro- or anti-cues are presented in a blocked design. Four fingers (two from each hand) are mapped onto four visual target locations. Visual targets require a speeded response by one corresponding finger, but, most importantly, they are preceded by visual cues that are congruent ("pro-cue"), incongruent ("anti-cue"), or neutral with respect to the responding hand. With short cue-target intervals, congruence effects are based on automatic motor priming of the correct hand (in case of pro-cues) or incorrect hand (in case of anti-cues), generating, respectively, reaction time benefits or reaction time costs relative to the neutral-cue. With longer cue-target intervals, slower top-down processes become effective, transforming early anti-cue interference into late anti-cue facilitation.

METHODS

We adapted this paradigm to be compatible with neuroimaging, tested and validated it behaviorally-both inside and outside the imaging environment-and implemented it in a whole-brain functional magnetic resonance imaging study.

RESULTS AND CONCLUSION

Our imaging results indicate that pro-cues elicited much less neural activation than did anti-cues, the latter recruiting well-known cognitive top-down networks related to attention, response inhibition, and error monitoring/signaling, thereby revealing high-level influences on proactive motor processes.

Temporal Dynamics of Proactive and Reactive Motor Inhibition

Proactive motor inhibition refers to endogenous preparatory mechanisms facilitating action inhibition, whereas reactive motor inhibition is considered to be a sudden stopping process triggered by external signals. Previous studies were inconclusive about the temporal dynamics of involved neurocognitive processes during proactive and reactive motor control. Using electroencephalography (EEG), we investigated the time-course of proactive and reactive inhibition, measuring event-related oscillations and event-related potentials (ERPs). Participants performed in a cued go/nogo paradigm with cues indicating whether the motor response might or might not have to be inhibited. Based on the dual mechanisms of control (DMC) framework by Braver, we investigated the role of attentional effects, motor preparation in the sensorimotor cortex and prefrontal cognitive control mechanisms, separating effects before and after target onset. In the cue-target interval, proactive motor inhibition was associated with increased attention, reflected in reduced visual alpha power and an increased contingent negative variation (CNV). At the same time, motor inhibition was modulated by reduced sensorimotor beta power. After target onset, proactive inhibition resulted in an increased N1, indicating allocation of attention towards relevant stimuli, increased prefrontal beta power and a modulation of sensorimotor mu activity. As in previous studies, reactive stopping of motor actions was associated with increased prefrontal beta power and increased sensorimotor beta activity. The results stress the relevance of attentional mechanisms for proactive inhibition and speak for different neurocognitive mechanisms being involved in the early preparation for and in later implementation of motor inhibition.

Integrating Statistical Machine Learning in a Semantic Sensor Web for Proactive Monitoring and Control

Proactive monitoring and control of our natural and built environments is important in various application scenarios. Semantic Sensor Web technologies have been well researched and used for environmental monitoring applications to expose sensor data for analysis in order to provide responsive actions in situations of interest. While these applications provide quick response to situations, to minimize their unwanted effects, research efforts are still necessary to provide techniques that can anticipate the future to support proactive control, such that unwanted situations can be averted altogether. This study integrates a statistical machine learning based predictive model in a Semantic Sensor Web using stream reasoning. The approach is evaluated in an indoor air quality monitoring case study. A sliding window approach that employs the Multilayer Perceptron model to predict short term PM2.5 pollution situations is integrated into the proactive monitoring and control framework. Results show that the proposed approach can effectively predict short term PM2.5 pollution situations: precision of up to 0.86 and sensitivity of up to 0.85 is achieved over half hour prediction horizons, making it possible for the system to warn occupants or even to autonomously avert the predicted pollution situations within the context of Semantic Sensor Web.

Telephone care co-ordination for tobacco cessation: randomised trials testing proactive versus reactive models

OBJECTIVES

We conducted two parallel studies evaluating the effectiveness of proactive and reactive engagement approaches to telephone treatment for smoking cessation.

METHODS

Patients who smoked and were interested in quitting were referred to this study and were eligible if they were current smokers and had an address and a telephone number. The data were collected at 35 Department of Veterans Affairs (VA) sites, part of four VA medical centres in both California and Nevada. In study 1, participants received multisession counselling from the California Smokers' Helpline (quitline). In study 2, they received self-help materials only. Patients were randomly assigned by week to either proactive or reactive engagement, and primary care staff were blind to this assignment. Providers gave brief advice and referred them via the electronic health record to a tobacco co-ordinator. All patients were offered cessation medications.

OUTCOME

Using complete case analysis, in study 1 (quitline), patients in the proactive condition were more likely than those in the reactive condition to report abstinence at 6 months (21.0% vs 16.4%, p=0.03). No difference was found between conditions in study 2 (self-help) (16.9% vs 16.5%, p=0.88). Proactive outreach resulted in increased use of cessation medications in both the quitline (70.1% vs 57.6%, p<0.0001) and the self-help studies (74.5% vs 48.2%, p<0.0001).

CONCLUSION

Proactive outreach with quitline intervention was associated with greater long-term abstinence. Both studies resulted in high rates of medication use. Sites should use a proactive outreach approach and provide counselling whenever possible.

TRIAL REGISTRATION NUMBER

NCT00123682.

Let's all get home safely: a commentary on NICE and SCIE guidelines (NG27) transition between inpatient hospital settings and community or care home settings

Safe and appropriate transition between inpatient settings and the community is one of the major challenges facing the modern NHS. The National Institute for Health and Care Excellence in conjunction with the Social Care Institute for Excellence published guidance on this challenging area in December 2015. This commentary provides context, summary and discussion of the key areas covered. The guidance particularly emphasises the importance of a person-centred approach in which patients are individuals and equal partners in the multidisciplinary team who should be treated with dignity and respect. Additionally, communication and information sharing is crucial both on admission and when taking a proactive approach to discharge, including the role of the discharge coordinator in liaising with community teams and arranging follow-up post-discharge. Self-care and the significance of carers are also highlighted as valuable in facilitating safe discharge and reducing readmissions. It is clear that in older people with complex needs, safe appropriate transition between hospital and community settings has a positive impact on patients and their carers. Given the financial and capacity pressures facing the NHS, strategies to reduce readmissions and prevent delays in discharge are increasingly important. These guidelines are therefore both timely and advocated to improve care for older people.

An Algorithm Approach to Determining Smoking Cessation Treatment for Persons Living With HIV/AIDS: Results of a Pilot Trial

BACKGROUND

Smoking now represents one of the biggest modifiable risk factors for disease and mortality in people living with HIV (PLHIV). To produce significant changes in smoking rates among this population, treatments will need to be both acceptable to the larger segment of PLHIV smokers and feasible to implement in busy HIV clinics. The purpose of this study was to evaluate the feasibility and effects of a novel proactive algorithm-based intervention in an HIV/AIDS clinic.

METHODS

PLHIV smokers (N = 100) were proactively identified through their electronic medical records and were subsequently randomized at baseline to receive a 12-week pharmacotherapy-based algorithm treatment or treatment as usual. Participants were tracked in-person for 12 weeks. Participants provided information on smoking behaviors and associated constructs of cessation at each follow-up session.

RESULTS

The findings revealed that many smokers reported using prescribed medications when provided with a supply of cessation medication as determined by an algorithm. Compared with smokers receiving treatment as usual, PLHIV smokers prescribed these medications reported more quit attempts and greater reduction in smoking. Proxy measures of cessation readiness (eg, motivation, self-efficacy) also favored participants receiving algorithm treatment.

CONCLUSIONS

This algorithm-derived treatment produced positive changes across a number of important clinical markers associated with smoking cessation. Given these promising findings coupled with the brief nature of this treatment, the overall pattern of results suggests strong potential for dissemination into clinical settings and significant promise for further advancing clinical health outcomes in this population.

Low heart rate as a risk factor for child and adolescent proactive aggressive and impulsive psychopathic behavior

Although low resting heart rate has been viewed as a well-replicated biological correlate of child and adolescent antisocial behavior, little is known about how it interacts with psychosocial adversity in predisposing to both reactive-proactive aggression and psychopathy, and whether this relationship generalizes to an East Asian population. This study tests the hypothesis that low resting heart rate will be associated with aggression and psychopathic traits, and that heart rate will interact with adversity in predisposing to these antisocial traits. Resting heart rate was assessed in 334 Hong Kong male and female schoolchildren aged 11-17 years. A social adversity index was calculated from a psychosocial interview of the parent, while parents assessed their children on the Reactive-Proactive Aggression Questionnaire and the Antisocial Personality Screening Device. Low resting heart rate was significantly associated with higher proactive aggression, impulsive features of psychopathy, and total child psychopathy. Low resting heart rate interacted with high psychosocial adversity in explaining higher reactive (but not proactive) aggression, as well as impulsive psychopathy. These findings provide support for a biosocial perspective of reactive aggression and impulsive psychopathy, and document low resting heart rate as a robust correlate of both childhood impulsive psychopathic behavior and proactive aggression. To our knowledge, this study is the first to document low resting heart rate as a correlate of child psychopathy and the second to establish low heart rate as a risk factor of antisocial behavior in an East Asian population. The findings provide further evidence for both low resting heart rate as a potential biomarker for childhood psychopathic and aggressive behavior, and also a biosocial perspective on childhood antisocial behavior.

Proactive and reactive inhibitory control in rats

Inhibiting actions inappropriate for the behavioral context, or inhibitory control, is essential for survival and involves both reactively stopping the current prepared action and proactively adjusting behavioral tendencies to increase future performance. A powerful paradigm widely used in basic and clinical research to study inhibitory control is the stop signal task (SST). Recent years have seen a surging interest in translating the SST to rodents to study the neural mechanisms underlying inhibitory control. However, significant differences in task designs and behavioral strategies between rodent and primate studies have made it difficult to directly compare the two literatures. In this study, we developed a rodent-appropriate SST and characterized both reactive and proactive control in rats. For reactive inhibitory control, we found that, unlike in primates, incorrect stop trials in rodents result from two independent types of errors: an initial failure-to-stop error or, after successful stopping, a subsequent failure-to-wait error. Conflating failure-to-stop and failure-to-wait errors systematically overestimates the covert latency of reactive inhibition, the stop signal reaction time (SSRT). To correctly estimate SSRT, we developed and validated a new method that provides an unbiased SSRT estimate independent of the ability to wait. For proactive inhibitory control, we found that rodents adjust both their reaction time and the ability to stop following failure-to-wait errors and successful stop trials, but not after failure-to-stop errors. Together, these results establish a valid rodent model that utilizes proactive and reactive inhibitory control strategies similar to primates, and highlight the importance of dissociating initial stopping from subsequent waiting in studying mechanisms of inhibitory control using rodents.

Proactive enteral tube feeding in pediatric patients undergoing chemotherapy

BACKGROUND

To determine feasibility and safety of proactive enteral tube feeding (ETF) in pediatric oncology patients.

METHODS

Pediatric patients with newly diagnosed brain tumors, myeloid leukemia or high-risk solid tumors were eligible. Subjects agreeing to start ETF before cycle 2 chemotherapy were considered proactive participants (PPs). Those who declined could enroll as chart collection receiving nutritional standard of care. Nutritional status was assessed using standard anthropometric measurements. Episodes of infection and toxicity related to ETF were documented from diagnosis to end of therapy. A descriptive comparison between PPs and controls was conducted.

RESULTS

One hundred four eligible patients were identified; 69 enrolled (20 PPs and 49 controls). At diagnosis, 17% of all subjects were underweight and 26% overweight. Barriers to enrollment included physician, subject and/or family refusal, and inability to initiate ETF prior to cycle 2 of chemotherapy. Toxicity of ETF was minimal, but higher percentage of subjects in the proactive group had episodes of infection than controls. Thirty-nine percent of controls eventually started ETF and were twice as likely to receive parenteral nutrition. PPs experienced less weight loss at ETF initiation than controls receiving ETF and were the only group to demonstrate improved nutritional status at end of study.

CONCLUSIONS

Proactive ETF is feasible in children with cancer and results in improved nutritional status at end of therapy. Episodes of infection in this study are concerning; therefore, a larger randomized trial is required to further delineate infectious risks and toxicities that may be mitigated by improved nutritional status.

Combining animal personalities with transcriptomics resolves individual variation within a wild-type zebrafish population and identifies underpinning molecular differences in brain function

Resolving phenotype variation within a population in response to environmental perturbation is central to understanding biological adaptation. Relating meaningful adaptive changes at the level of the transcriptome requires the identification of processes that have a functional significance for the individual. This remains a major objective towards understanding the complex interactions between environmental demand and an individual's capacity to respond to such demands. The interpretation of such interactions and the significance of biological variation between individuals from the same or different populations remain a difficult and under-addressed question. Here, we provide evidence that variation in gene expression between individuals in a zebrafish population can be partially resolved by a priori screening for animal personality and accounts for >9% of observed variation in the brain transcriptome. Proactive and reactive individuals within a wild-type population exhibit consistent behavioural responses over time and context that relates to underlying differences in regulated gene networks and predicted protein-protein interactions. These differences can be mapped to distinct regions of the brain and provide a foundation towards understanding the coordination of underpinning adaptive molecular events within populations.

The relationship between emergence from spawning gravel and growth in farmed rainbow trout Oncorhynchus mykiss

The relationship between the timing of emergence from spawning gravel and growth after emergence was investigated in farmed Oncorhynchus mykiss. A relationship between the time of emergence and growth became evident after 6 months of rearing, where individuals with an intermediate emergence time had grown larger compared with early and late emerging individuals.

Peer victimization partially mediates the schizotypy-aggression relationship in children and adolescents

While persuasive evidence has accumulated over the past 15 years documenting an association between schizophrenia and violence, there are 3 unresolved issues. First, does a downward extension of this relationship exist at the nonclinical level with respect to schizotypal personality and aggression in children? Second, is aggression more associated with impulsive reactive aggression or with more planned proactive aggression. Third and importantly, does peer victimization mediate the relationship between schizotypy and aggression? A further aim of this cross-sectional study was to examine the utility of a new child self-report measure of schizotypal personality. These issues were examined in a sample of 3804 schoolchildren assessed on schizotypy using the Schizotypal Personality Questionnaire-Child (SPQ-C), reactive-proactive aggression, and peer victimization. A confirmatory factor analysis confirmed the 3-factor structure (cognitive-perceptual, interpersonal, and disorganized) of the SPQ-C. Schizotypy was positively associated with total aggression and reactive aggression but not with proactive aggression. Peer victimization was found to significantly mediate the schizotypy-aggression relationship, accounting for 58.9% of the association. Results are broadly consistent with the hypothesis that schizotypal features elicit victimization from other children, which in turn predisposes to reactive retaliatory aggression. Findings are to the authors' knowledge the first to document any mediator of the schizotypy-aggression relationship and have potential treatment implications for violence reduction in schizophrenia-spectrum disorders. This study also provides initial evidence for the factorial and discriminant validity of a brief and simple measure of schizotypal personality in children as young as 8 years.