Comparison of proactive and reactive interaction modes in a mobile robotic telecare study

Mobile robotic telepresence systems require that information about the environment, the task, and the robot be presented to a remotely located user (operator) who controls the robot for a specific task. In this study, two interaction modes, proactive and reactive, that differ in the way the user receives information from the robot, were compared in an experimental system simulating a healthcare setting. The users controlled a mobile telepresence robot that delivered and received items (medication, food, or drink), and also obtained metrics (vital signs) from a simulated patient while the users performed a secondary healthcare-related task (they compiled health records which were displayed to them on the screen and answered related questions). The effect of the two interaction modes on overall performance and user perception was evaluated through a within-participant study design conducted with 50 participants belonging to two different types of populations (with and without a technological background). Efficiency, effectiveness, understanding, satisfaction, and situation awareness were defined as the dependent variables measured both objectively and subjectively. The proactive mode increased user performance, and understanding of the system and reduced the workload compared to the reactive mode. However, several of the users valued the option of increased user control experienced in the reactive mode. We, therefore, proposed design suggestions to highlight some of the benefits of factoring the reactive mode into the design as a hybrid mode.

Implementation of a critical care outreach team in a children's hospital

Introduction

Proactive surveillance by a critical care outreach team (CCOT) can promote early recognition of deterioration in hospitalized patients but is uncommon in pediatric rapid response systems (RRSs). After our children's hospital introduced a CCOT in 2019, we aimed to characterize early implementation outcomes. We hypothesized that CCOT rounding would identify additional children at risk for deterioration.

Methods

The CCOT, staffed by a dedicated critical care nurse (RN), respiratory therapist, and attending, conducts daily in-person rounds with charge RNs on medical-surgical units, to screen RRS-identified high-risk patients for deterioration. In this prospective study, observers tracked rounds discussion content, participation, and identification of new high-risk patients. We compared 'identified-patient-discussions' (IPD) about RRS-identified patients, and 'new-patient-discussions' (NPD) about new patients with Fisher's exact test. For new patients, we performed thematic analysis of clinical data to identify deterioration related themes.

Results

During 348 unit-rounds over 20 days, we observed 383 discussions - 35 (9%) were NPD. Frequent topics were screening for clinical concerns (374/383, 98%), active clinical concerns (147/383, 39%), and watcher activation (66/383, 17%). Most discussions only included standard participants (353/383, 92%). Compared to IPD, NPD more often addressed active concerns (74.3% vs 34.8%, p < 0.01) and staffing resource concerns (5.7% vs 0.6%, p < 0.04), and more often incorporated extra participants (25.7% vs 6%, p < 0.01). In thematic analysis of 33 new patients, most (29/33, 88%) had features of deterioration.

Conclusion

A successfully implemented CCOT enhanced identification of clinical deterioration not captured by existing RRS resources. Future work will investigate its impact on operational safety and patient-centered outcomes.

Corticospinal excitability reductions during action preparation and action stopping in humans: Different sides of the same inhibitory coin?

Motor functions and cognitive processes are closely associated with each other. In humans, this linkage is reflected in motor system state changes both when an action must be prepared and stopped. Single-pulse transcranial magnetic stimulation showed that both action preparation and action stopping are accompanied by a reduction of corticospinal excitability, referred to as preparatory and response inhibition, respectively. While previous efforts have been made to describe both phenomena extensively, an updated and comprehensive comparison of the two phenomena is lacking. To ameliorate such deficit, this review focuses on the role and interpretation of single-coil (single-pulse and paired-pulse) and dual-coil TMS outcome measures during action preparation and action stopping in humans. To that effect, it aims to identify commonalities and differences, detailing how TMS-based outcome measures are affected by states, traits, and psychopathologies in both processes. Eventually, findings will be compared, and open questions will be addressed to aid future research.

Proactive and integrated consultation-liaison psychiatry for older medical inpatients: A mixed methods description of training, care provided and clinician experience in the HOME study

OBJECTIVES

To describe the practical experience of delivering a proactive and integrated consultation-liaison (C-L) psychiatry service model (PICLP). PICLP is designed for older medical inpatients and is explicitly biopsychosocial and discharge-focused. In this paper we report: (a) observations on the training of 15 clinicians (seven senior C-L psychiatrists and eight assisting clinicians) to deliver PICLP; (b) the care they provided to 1359 patients; (c) their experiences of working in this new way.

METHOD

A mixed methods observational study using quantitative and qualitative data, collected prospectively over two years as part of The HOME Study (a randomized trial comparing PICLP with usual care).

RESULTS

The clinicians were successfully trained to deliver PICLP according to the service manual. They proactively assessed all patients and found that most had multiple biopsychosocial problems impeding their timely discharge from hospital. They integrated with ward teams to provide a range of interventions aimed at addressing these problems. Delivering PICLP took a modest amount of clinical time, and the clinicians experienced it as both clinically valuable and professionally rewarding.

CONCLUSION

The experience of delivering PICLP highlights the special role that C-L psychiatry clinicians, working in a proactive and integrated way, can play in medical care.

Vision Zero for industrial workplace safety innovative model development for metal manufacturing industry

This study target is to investigate Vision Zero strategy & develop a model that contributes to the reduction of injuries, accidents, and fatalities. In turn, this model aims to enhance the well-being, safety, and productivity of the manufacturing sector. The study has conducted comprehensive theoretical reviews from reputable journals that are relevant to Vision Zero, manufacturing industries in general, and specifically the metal manufacturing industries. The study also underwent a validation of the Vision Zero strategy model by discussing with a selected professional team in this field from the industry. The results of this study shows that research related to the Vision Zero strategy has not been widely disseminated or popularized. It further reveals that manufacturing industries predominantly operate based on traditional work environmental principles, rather than actively embracing the concepts and principles of Vision Zero. The study has also uncovered that previous research on Vision Zero primarily focused on road accidents, injuries, and fatalities. In contrast, studies conducted in the manufacturing sector primarily examined aspects related to safety, health, and worker well-being. However, these studies often failed to sufficiently align their objectives with the overarching priority of enhancing productivity, especially within the context of the industrial revolution. Due to the limited studies related to Vision Zero and a new area for the research database, setting comparative goals and developing a stringent strategy may not be the final outcome here with the developed model. The results of this research could provide valuable insights to policymakers & lawmakers in order to enhance workplace health and safety regulations which support industries' productivity. This study represents a pioneering effort in developing a new Vision Zero strategy model that aligns with productivity goals and emphasizes knowledge-based approaches for reducing or eliminating injuries, accidents, and fatalities.

E-Health intervention for subthreshold depression: Reach and two-year effects of a randomized controlled trial

BACKGROUND

There is evidence for e-Health interventions for full-blown depression. Little is known regarding commonly untreated subthreshold depression in primary care. This randomized controlled multi-centre trial assessed reach and two-year-effects of a proactive e-Health intervention (ActiLife) for patients with subthreshold depression.

METHODS

Primary care and hospital patients were screened for subthreshold depression. Over 6 months, ActiLife participants received three individualized feedback letters and weekly messages promoting self-help strategies against depression, e.g., dealing with unhelpful thoughts or behavioural activation. The primary outcome depressive symptom severity (Patient Health Questionnaire;PHQ-8) and secondary outcomes were assessed 6, 12 and 24 months.

RESULTS

Of those invited, n = 618(49.2 %) agreed to participate. Of them, 456 completed the baseline interview and were randomized to ActiLife (n = 227) or assessment only (n = 226). Generalised estimation equation analyses adjusting for site, setting and baseline depression revealed that depressive symptom severity declined over time, with no significant group differences at 6 (mean difference = 0.47 points; d = 0.12) and 24 months (mean difference = -0.05 points; d = -0.01). Potential adverse effects were observed at 12 months, with higher depressive symptom severity for ActiLife than control participants (mean difference = 1.33 points; d = 0.35). No significant differences in rates of reliable deterioration or reliable improvement of depressive symptoms were observed. ActiLife increased applied self-help strategies at 6 (mean difference = 0.32; d = 0.27) and 24 months (mean difference = 0.22; d = 0.19), but not at 12 months (mean difference = 0.18; d = 0.15).

LIMITATIONS

Self-report measures and lack of information on patients' mental health treatment.

DISCUSSION

ActiLife yielded satisfactory reach and increased the use of self-help strategies. Data were inconclusive in terms of depressive symptom changes.

Testing and treatment for malaria elimination: a systematic review

BACKGROUND

Global interest in malaria elimination has prompted research on active test and treat (TaT) strategies.

METHODS

A systematic review and meta-analysis were conducted to assess the effectiveness of TaT strategies to reduce malaria transmission.

RESULTS

A total of 72 empirical research and 24 modelling studies were identified, mainly focused on proactive mass TaT (MTaT) and reactive case detection (RACD) in higher and lower transmission settings, respectively. Ten intervention studies compared MTaT to no MTaT and the evidence for impact on malaria incidence was weak. No intervention studies compared RACD to no RACD. Compared to passive case detection (PCD) alone, PCD + RACD using standard diagnostics increased infection detection 52.7% and 11.3% in low and very low transmission settings, respectively. Using molecular methods increased this detection of infections by 1.4- and 1.1-fold, respectively.

CONCLUSION

Results suggest MTaT is not effective for reducing transmission. By increasing case detection, surveillance data provided by RACD may indirectly reduce transmission by informing coordinated responses of intervention targeting.

Unintended reductions in assaults near sobriety checkpoints: A longitudinal spatial analysis

BACKGROUND

Sobriety checkpoints are a form of proactive policing in which law enforcement officers concentrate at a point on the roadway to systematically perform sobriety tests for all passing drivers. We investigated whether sobriety checkpoints unintentionally reduce assaults in surrounding areas.

METHODS

Exposures of interest were sobriety checkpoints conducted by the Los Angeles Police Department between 2012 and 2017. Comparison units were matched 1:2 to sobriety checkpoints, selected as the same point location temporally lagged by exactly ±168 hours. The outcome was the density of police-reported assaults around the checkpoint location.

RESULTS

In mixed effects regression analyses, assault incidence was lower when sobriety checkpoints were in operation compared to the same location ±168 hours [b= -0.0108, 95% CI: (-0.0203, -0.0012)].

CONCLUSIONS

Sobriety checkpoints were associated with decreased assault incidence, but estimated effect sizes were small and effects did not endure long after checkpoints ended.

The influence of context representations on cognitive control states

Cognitive control operates via two distinct mechanisms, proactive and reactive control. These control states are engaged differentially, depending on a number of within-subject factors, but also between-group variables. While research has begun to explore if shifts in control can be experimentally modulated, little is known about whether context impacts which control state is utilized. Thus, we test if contextual factors temporarily bias the use of a particular control state long enough to impact performance on a subsequent task. Our methodology involves two parts: first participants are exposed to a context manipulation designed to promote proactive or reactive processing through amount or availability of advanced preparation within a task-switching paradigm. Then, they complete an AX-CPT task, where we assess immediate transfer on preferential adoption of one control mode over another. We present results from a Pilot Study that revealed anecdotal evidence of proactive versus reactive processing for a context manipulation using long and short preparation times. We also present data from a follow-up Registered Experiment that implements a context manipulation using long or no preparation times to assess if a more extreme context leads to pronounced differences on AX-CPT performance. Together, the results suggest that contextual representations do not impact the engagement of a particular control state, but rather, there is a general preference for the engagement of proactive control.

Proactive Health: An Imperative to Achieve the Goal of Healthy China

Proactive Health has become a new service model to improve human health. Although the concept of Proactive Health has been proposed by the Outline of the Healthy China 2030 Plan and the Healthy China Initiative, the lack of a unified definition of Proactive Health in China's academic community is still the most fundamental and critical deficiency. Therefore, based on the concepts of Proactive Health, this study analyzed and described the natural characteristics and implications of Proactive Health to establish an exact definition.

Toward an effective occupational health and safety culture: A multiple stakeholder perspective

INTRODUCTION

This paper uses an extensive review of the safety culture literature to identify three key themes (a) role of new employees, (b) absence of a pro-active approach, and (c) need for a 'No-blame' culture, and explores their impact on the occupational health and safety culture (OHS).

METHOD

We use a qualitative study with a constructivist phenomenological approach consisting of 55 in-depth interviews with a diverse range of participants, including business owners, line managers and supervisors, OHS advisors, workers, and union representatives in Western Australia. A workplace vignette was used to elicit cultural norms derived from the participants' attitudes and beliefs, which were analyzed using NVivo software to conduct a thematic analysis to classify the interview text into specific concepts and phrases.

RESULTS

Findings confirm the three themes identified from our literature review and provide useful insights into the challenges faced by the participants in the implementation of safety policies.

PRACTICAL APPLICATIONS

Besides extending the occupational health and safety literature, these findings have important managerial implications in view of the evolving nature of work and workplaces.

Therapeutic drug monitoring in inflammatory bowel disease treatments

Recently, biological drugs have played a leading role in the treatment of inflammatory bowel disease, and therapeutic drug monitoring (TDM) may be useful in maximizing their effectiveness. TDM involves the measurement of serum drug and anti-drug antibodies concentrations as the basis for dosage adjustments or drug conversions to achieve a higher response rate. We believe that concentration thresholds should be individualized based on patients’ disease severity, extent and phenotype, and therapeutic purposes should also be considered, with higher cut-offs mainly needed for endoscopic and fistula healing than for symptomatic remission. Proactive and reactive TDM can help optimize treatment, especially in patients receiving anti-tumour necrosis factor, and guide dose adjustment or drug conversion with lower cost. TDM is a promising approach to achieve precision medicine and targeted medicine in the future.

Adapting to change: Clalit's response to the COVID-19 pandemic

The COVID-19 pandemic is the most significant global health event of the past century. The profound and unexpected changes that it brought about have forced healthcare organizations to make far-reaching adjustments to accommodate the new reality. With the outbreak of the pandemic in Israel and the understanding of its consequences, Clalit Health Services (Clalit), the largest healthcare organization in Israel, rapidly mobilized in order to provide the best response possible from the perspective of both its patients and its employees. In the short term, four designated workgroups were established just days into the pandemic. Their task was to prepare operational work plans to achieve the following goals: providing the best possible treatment for COVID patients; maintaining the level of care for non-COVID patients; protecting healthcare personnel without compromising their competence and level of functioning; and beginning the process of post-crisis planning. In the context of the long term, and with the understanding that the changes in healthcare brought about by the COVID-19 pandemic would be long-lasting and irreversible, and would act as a catalyst in Clalit’s preparations for the future, Clalit has carried out the called-for modifications in its organizational strategy. This was based on the need to shift service and treatment foci from the hospitals to the community and the patient’s home and his cellular device, by means of strengthening Clalit’s strategic abilities to become more proactive, more digital and more home-based. In this article, we present a survey of Clalit’s preparations for the new reality in the short and medium terms, as well as the leveraging of insights gained during the first wave of the pandemic, with goal of revising Clalit’s long-term strategic plan. We conclude and point out the organizational abilities required for optimal response to future large-scale emergencies: The ability to quickly identify the need for change, respond quickly while harnessing the various parts of the organization in order to provide an agile and adaptive response, and facilitate long-term planning activity in parallel to providing an operational response in the short and medium terms.

Therapeutic drug monitoring in inflammatory bowel disease: The dawn of reactive monitoring

Inflammatory bowel disease (IBD) is a chronic condition that significantly affects the quality of life of its patients. Biologic drugs have been the mainstay treatment in the management of IBD patients but despite their significant contribution, there remains a proportion of patients that do not respond or lose response to treatment. Therapeutic drug monitoring (TDM) involves measuring levels of serum drug concentrations and anti-drug antibodies. TDM of biologic drugs initially emerged to understand treatment failure in other immune mediated inflammatory diseases. This was then introduced in IBD to rationalize primary non-response or secondary loss of response, given that low serum drug concentrations or the formation of anti-drug antibodies are variably associated with treatment failure. The aim of this narrative review is to provide an overview regarding the current use of TDM in clinical practice and to present the evidence available regarding its use in both proactive and reactive clinical settings in preventing and managing treatment failure. This review also presents the existing evidence regarding the association of various clinical outcomes with specific thresholds of drug concentrations, in everyday practice. A narrative review of published articles and conference abstracts regarding the use of TDM in IBD management, through an electronic search using PubMed and ScienceDirect. TDM has proven to be superior and more cost effective in guiding management of patients with treatment failure compared to empiric dose escalation or change in treatment. Despite a trend towards an association between clinical outcomes and drug concentrations, proactive TDM based strategies have not been shown to achieve clear benefit in long-term outcomes. In the clinical setting, TDM has proven to be useful in managing IBD patients, and its use in the reactive setting, as an additional tool to help manage patients with treatment failure, is being promoted as newer guidelines and consensus groups implement TDM as part of the management plan.

Patient and radiographer acceptability of prophylactic skin care for breast patients receiving radiotherapy

INTRODUCTION

This study aimed to: • Address the lack of information surrounding patient preference within radiotherapy skin care. • Identify if prophylactic skin care is the preferred approach of patients and staff. • Establish if patients and staff are accepting of the use of a type of barrier film, such as 3M™ Cavilon™ No Sting Barrier Film.

METHODS

Twelve patients undergoing standard whole breast radiotherapy and four staff members who were based mainly on a breast-specific treatment unit were interviewed using semi-structured techniques. The interview transcripts were coded for areas of interest and a thematic map generated using the qualitative data analysis software (NVivo V12, QSR International).

RESULTS

One Hundred percent of patients (n = 12) would have preferred a proactive approach to skin care management over the reactive one currently implemented. Staff were also in favour of a proactive approach to skin care with 100% (n = 4) supportive of a trial into the film's effectiveness. Three key themes were identified: • Theme 1: Patient Ownership of Own care - all patients identified they preferred a prophylactic approach and that more specific skin care guidance from healthcare professionals would be beneficial. • Theme 2: Product Practicality - 93% of patients and 100% of staff accepted the product and would be open to the use of it clinically. • Theme 3: Staff Acknowledgement of Skin Care - all staff identified a patient group in need of prophylaxis and that Cavilon No Sting may be a product of interest.

CONCLUSION

Patients and staff were in support of prophylactic skin care, both approved of the proposed product. However, there is a significant lack of clinical evidence to support the use of any topical products within radiotherapy skincare due to the lack of high-quality studies.

IMPLICATIONS FOR PRACTICE

Changes to skin care practice could be considered due to patient preference in favour of proactive management.

An exploratory analysis of testosterone, cortisol, and aggressive behavior type in men and women

Increasing evidence indicates that the interaction between testosterone and cortisol is associated with variation in aggressive behavior. However, results are mixed. The current study further explored the association between testosterone, cortisol, and both reactive and proactive aggression in a large sample of university students. Models considered direct and interactive effects between baseline measures of testosterone and cortisol as well as change in hormones in response to a social stressor. In women, baseline cortisol had a negative direct association with reactive aggression and was further associated with reactive aggression in interaction with baseline testosterone (positive interaction). Hormones were unrelated to reactive aggression in men. Baseline cortisol had a negative direct association with proactive aggression in women. In contrast, the association between change in cortisol and proactive aggression was positive. Cortisol was not associated with proactive aggression in men. In addition, testosterone was not related to proactive aggression either directly or in interaction with cortisol in either men or women. Collectively, these results show that the association between hormones and aggression varies across aggressive behavior type and across sex.

Analysis across diverse fish species highlights no conserved transcriptome signature for proactive behaviour

Background

Consistent individual differences in behaviour, known as animal personalities, have been demonstrated within and across species. In fish, studies applying an animal personality approach have been used to resolve variation in physiological and molecular data suggesting a linkage, genotype-phenotype, between behaviour and transcriptome regulation. In this study, using three fish species (zebrafish; Danio rerio, Atlantic salmon; Salmo salar and European sea bass; Dicentrarchus labrax), we firstly address whether personality-specific mRNA transcript abundances are transferrable across distantly-related fish species and secondly whether a proactive transcriptome signature is conserved across all three species.

Results

Previous zebrafish transcriptome data was used as a foundation to produce a curated list of mRNA transcripts related to animal personality across all three species. mRNA transcript copy numbers for selected gene targets show that differential mRNA transcript abundance in the brain appears to be partially conserved across species relative to personality type. Secondly, we performed RNA-Seq using whole brains from S. salar and D. labrax scoring positively for both behavioural and molecular assays for proactive behaviour. We further enriched this dataset by incorporating a zebrafish brain transcriptome dataset specific to the proactive phenotype. Our results indicate that cross-species molecular signatures related to proactive behaviour are functionally conserved where shared functional pathways suggest that evolutionary convergence may be more important than individual mRNAs.

Conclusions

Our data supports the proposition that highly polygenic clusters of genes, with small additive effects, likely support the underpinning molecular variation related to the animal personalities in the fish used in this study. The polygenic nature of the proactive brain transcriptome across all three species questions the existence of specific molecular signatures for proactive behaviour, at least at the granularity of specific regulatory gene modules, level of genes, gene networks and molecular functions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12864-020-07317-z.

Decreased dendritic spine density in posterodorsal medial amygdala neurons of proactive coping rats

There are large individual differences in the way animals, including humans, behaviorally and physiologically cope with environmental challenges and opportunities. Rodents with either a proactive or reactive coping style not only differ in their capacity to adapt successfully to environmental conditions, but also have a differential susceptibility to develop stress-related (psycho)pathologies when coping fails. In this study, we explored if there are structural neuronal differences in spine density in brain regions important for the regulation of stress coping styles. For this, the individual coping styles of wild-type Groningen (WTG) rats were determined using their level of offensive aggressiveness assessed in the resident-intruder paradigm. Subsequently, brains from proactive (high-aggressive) and reactive (low-aggressive) rats were Golgi-cox stained for spine quantification. The results reveal that dendritic spine densities in the dorsal hippocampal CA1 region and basolateral amygdala are similar in rats with proactive and reactive coping styles. Interestingly, however, dendritic spine density in the medial amygdala (MeA) is strikingly reduced in the proactive coping rats. This brain region is reported to be strongly involved in rivalry aggression which is the criterion by which the coping styles in our study are dissociated. The possibility that structural differences in spine density in the MeA are involved in other behavioral traits of distinct coping styles needs further investigation.

Identifying Patients With Inflammatory Bowel Diseases at High vs Low Risk of Complications

People with Crohn's disease and ulcerative colitis have varying presentations and clinical consequences of their disease. Patients commonly ask about their prognosis, and what this diagnosis means for them. They are asking their clinicians to predict the future. The importance of predicting the course of any disease is to guide patient expectations and to guide treatment decisions. In the past decade the strategy of inflammatory bowel disease (IBD) treatment has shifted to treat patients earlier in the course of their disease, before irreversible damage occurs. Treatment approaches for disease categorized as mild, moderate or severe has most often been based on a current assessment of symptoms or disease activity without including a longitudinal assessment of a patient's disease course including past disease complications and surgeries. While a patient's current disease activity most typically drives these treatment decisions, optimally, treatment decisions would be made accounting for past disease activity and complications and the predicted future disease course. When developing a treatment plan for an individual patient, the immediate goal is to treat the current disease activity for relief of symptoms, and the long-term goal is to prevent progression of their disease due to complications. Since not all patients will progress to a complicated disease course, it is important to be able to select the right patients for the right therapy. Therefore, developing methods of stratifying patients into low-risk versus high-risk of complications will be an important aspect of treating IBD now and in the future.

Proactive community case management in Senegal 2014-2016: a case study in maximizing the impact of community case management of malaria

The Senegal National Malaria Control Programme (NMCP) introduced home-based malaria management for all ages, with diagnosis by rapid diagnostic test (RDT) and treatment with artemisinin-based combination therapy (ACT) in 2008, expanding to over 2000 villages nationwide by 2014. With prise en charge à domicile (PECADOM), community health workers (CHWs) were available for community members to seek care, but did not actively visit households to find cases. A trial of a proactive model (PECADOM Plus), in which CHWs visited all households in their village weekly during transmission season to identify fever cases and offer case management, in addition to availability during the week for home-based management, found that CHWs detected and treated more cases in intervention villages, while the number of cases detected weekly decreased over the transmission season. The NMCP scaled PECADOM Plus to three districts in 2014 (132 villages), to a total of six districts in 2015 (246 villages), and to a total of 16 districts in 2016 (708 villages). A narrative case study with programmatic results is presented. During active sweeps over approximately 20 weeks, CHWs tested a mean of 77 patients per CHW in 2014, 89 patients per CHW in 2015, and 90 patients per CHW in 2016, and diagnosed a mean of 61, 61 and 43 patients with malaria per CHW in 2014, 2015 and 2016, respectively. The number of patients who sought care between sweeps increased, with a 104% increase in the number of RDTs performed and a 77% increase in the number of positive tests and patients treated with ACT during passive case detection. While the number of CHWs increased 7%, the number of patients receiving an RDT increased by 307% and the number of malaria cases detected and treated by CHWs increased 274%, from the year prior to PECADOM Plus introduction to its first year of implementation. Based on these results, approximately 700 additional CHWs in 24 new districts were added in 2017. This case study describes the process, results and lessons learned from Senegal’s implementation of PECADOM Plus, as well as guidance for other programmes considering introduction of this innovative strategy.

Proactive and reactive modes of cognitive control can operate independently and simultaneously

Cognitive control enables optimal biasing of attention, perception, and actions in the service of mental or behavioral goals. To understand the variability of applied cognitive control, we need to unravel the relation between two underlying mechanisms: proactive and reactive modes. During proactive cognitive control, goal-relevant information is selected before the occurrence of a cognitively demanding event, and is actively maintained for as long as required by the task. During reactive mode, cognitive control is transiently activated only after the cognitively demanding event has occurred. Mechanistically, proactive and reactive control modes may be at least semi-independent and engaged simultaneously, but this has so far not been demonstrated empirically. Situational demands and an individual's cognitive capacity and motivation may bias behavior towards one or the other mode. Reward induces more proactive processing in the AX-CPT task, whereas context load induces reactive processing. We combined these manipulations to investigate the extent to which proactive and reactive control modes can operate independently and simultaneously. The results replicated already published effects of reward incentives and context load. Most importantly, these effects were essentially independent of each other, suggesting that proactive and reactive cognitive control modes depend on separate information-processing and neural mechanisms. The results also show that while proactive processing is influenced by reward, reactive processing seems independent of such factor. These findings have implications for our understanding of the structure of cognitive control and cognitive motivation, and are relevant for the design of interventions to improve cognitive control in various developmental and neuropsychiatric groups.

The neuromoral theory of antisocial, violent, and psychopathic behavior

The neuromoral theory of antisocial behaviors argues that impairment to the neural circuitry underlying morality provides a common foundation for antisocial, violent, and psychopathic behavior in children, adolescents, and adults. This article reviews new findings in two research fields since this theory was first proposed: brain mechanisms underlying moral decision-making, and brain systems subserving antisocial behaviors. The neuromoral theory is updated to take into account new empirical findings. Key areas implicated in both moral decision-making and the spectrum of antisocial behaviors include fronto-polar, medial, and ventral prefrontal cortical regions, and the anterior cingulate, amygdala, superior temporal gyrus, and angular gyrus / temporoparietal junction. It is hypothesized that different manifestations of antisocial behavior are characterized by differing degrees of neuromoral dysfunction, with primary psychopathy, proactive aggression, and life-course persistent offending being more affected, and secondary psychopathy, reactive aggression, and crimes involving drugs relatively less affected by neuromoral dysfunction. Limitations of the current model, social contextual factors, neural remediation interventions, ascertaining whether the affective or cognitive component of empathy is most implicated, and directions for future research are outlined. One forensic implication of the model is that significant impairment to the neuromoral circuit could constitute diminished criminal responsibility.

Reactive and proactive control mechanisms of response inhibition in gambling disorder

Response inhibition, one component of cognitive control, refers to the ability to inhibit automatic responses and has been found to be impaired in gambling disorder. Recent models of cognitive control distinguish between two mechanisms: reactive control, the ability to stop in response to a stop-stimulus, and proactive control, the ability to anticipate and prepare for a stop. Previous studies have primarily focused on reactive modes of control in gambling disorder. The aim of the current study was to assess both reactive and proactive modes of response inhibition in individuals with gambling disorder (n = 27) and community controls (n = 21) using a variant of the stop-signal task. Second, the relationship between trait impulsivity, and reactive and proactive control was examined. No group differences in reactive or proactive control were found. However, premeditation, one domain of trait impulsivity, was associated with worse proactive control in the gambling group. These results suggest that difficulties with response inhibition may not be a core deficit in all forms of gambling disorder. Future research should continue to develop and test tasks that involve cognitive control processes in different presentations of gambling disorder.

Non-responders in a quitline evaluation are more likely to be smokers - a drop-out and long-term follow-up study of the Swedish National Tobacco Quitline

Background

A previous randomized controlled trial (RCT) of the Swedish National Tobacco Quitline detected no significant differences in smoking cessation outcomes between proactive and reactive services at 12-month follow-up. However, the response rate was only 59 % and non-responders were over-represented in the proactive service. We performed a drop-out analysis to assess the smoking status of initial responders and non-responders.

Methods

At 29–48 months after the first call, a postal questionnaire with six questions was sent to 150 random clients from the RCT database, with equal numbers from the proactive and reactive services as well as responders and non-responders at 12-month follow-up. Clients who did not return the questionnaire were contacted by telephone. The outcome measures were point prevalence (PP) and 6-month continuous abstinence (CA), and their associations with response status at 12 months were assessed by logistic regression.

Results

The response rate was 74 % (111/150). Abstinence was significantly higher among initial responders than non-responders (PP 54 % vs. 32 %, p = .023 and CA 49 % vs. 21 %, p = .003). The odds ratios for initial responders vs. initial non-responders were, for PP = 2.5 (95 % CI 1.1–5.6, p = .024), and for CA = 3.7 (95 % CI 1.5–8.9, p = .004), after adjusting for proactive/reactive service.

Conclusions

Non-responders to a 12-month follow-up smoking cessation questionnaire in a quitline setting were more likely to be smokers 1.5–3 years later. We propose a conservative correction factor of 0.8 for self-reported abstinence in telephone-based cessation studies if the response rate is approximately 55–65 %.

Assessing Reactive and Proactive Aggression in Detained Adolescents Outside of a Research Context

The Reactive Proactive Aggression Questionnaire (RPQ) is a self-report tool for assessing reactive aggression (RA) and proactive aggression (PA). This study contributes to the literature by testing the psychometric properties of the RPQ across detained boys from various ethnicities whilst using data that were gathered during clinical assessments. The factorial, convergent, and criterion validity, and the internal consistency of the RPQ scores received strong support in the total sample and across four ethnicity groups. Also, three groups of boys were identified, with the group including boys with high levels of both RA and PA including the most severe boys in terms of anger, delinquency, alcohol/drug use, and psychopathic traits, and having the highest prevalence rate of conduct disorder and substance use disorder. Together, these findings suggest that the RPQ may hold promise for assessing RA and PA in detained boys, even when confidentiality and anonymity of the information is not guaranteed.

Generalization of treadmill perturbation to overground slip during gait: Effect of different perturbation distances on slip recovery

Treadmill-perturbation training (TM-training) may improve a person׳s fall-resistance, whereby adjusting slip distance can be a simple way to manipulate training intensity. The purpose of this study was to determine the effects of different slip distances in TM-training (12-cm vs. 18-cm) on its generalization to the recovery from a novel "free" slip during overground walking. Generalization here means the ability to apply learned skill from TM-training to slip recovery during overground walking. Thirty-six young adults in the TM_12 or the TM_18 group underwent either a 12-cm or an 18-cm slip during the treadmill walking for seven times, or in the control group were not exposed to any perturbation. Their responses were also contrasted with previously reported results from overground-perturbation training (OG-training) in which participants received either a 12-cm or an 18-cm slip during level walking with the same number of repetitions. Everyone was then exposed to the same generalization test during a novel "free" slip in overground walking. Their proactive and reactive control of stability was measured and compared. TM-training displayed a significant training effect in comparison to the control group (p<0.05), while most of the improvements were found in the reactive control of stability and were much-limited in comparison to that of OG-training. Also unlike OG-training, no significant differences were found between the results obtained from the TM_12 and the TM_18 groups (p>0.05). These results underscore the further needs to investigate the potential of the treadmill as a convenient instrument that can effectively deliver perturbation training.

Ionic liquid biodegradability depends on specific wastewater microbial consortia

Complete biodegradation of a newly-synthesized chemical in a wastewater treatment plant (WWTP) eliminates the potential for novel environmental pollutants. However, differences within- and between-WWTP microbial communities may alter expectations for biodegradation. WWTP communities can also serve as a source of unique consortia that, when enriched, can metabolize chemicals that tend to resist degradation, but are otherwise promising green alternatives. We tested the biodegradability of three ionic liquids (ILs): 1-octyl-3-methylpyridinium bromide (OMP), 1-butyl-3-methylpyridinium bromide (BMP) and 1-butyl-3-methylimidazolium chloride (BMIM). We performed tests using communities from two WWTPs at three time points. Site-specific and temporal variation both influenced community composition, which impacted the success of OMP biodegradability. Neither BMP nor BMIM degraded in any test, suggesting that these ILs are unlikely to be removed by traditional treatment. Following standard biodegradation assays, we enriched for three consortia that were capable of quickly degrading OMP, BMP and BMIM. Our results indicate WWTPs are not functionally redundant with regard to biodegradation of specific ionic liquids. However, consortia can be enriched to degrade chemicals that fail biodegradability assays. This information can be used to prepare pre-treatment procedures and prevent environmental release of novel pollutants.

Intensity and generalization of treadmill slip training: High or low, progressive increase or decrease?

The purpose of this study was to investigate the efficacy of different treadmill slip training protocols on the transfer of reactive and proactive control of center of mass stability to a novel, over-ground slip. Four training protocols were investigated: high-intensity (HI; acceleration of all treadmill slips=12m/s(2)), low-intensity (LO; acceleration of all treadmill slips=6m/s(2)), progressively increasing intensity (INCR; acceleration of treadmill slips increasing from 6m/s(2) to 12m/s(2) over the course of training), and progressively decreasing intensity (DECR; acceleration of treadmill slips decreasing from 12m/s(2) to 6m/s(2) over the course of training). From a pool of 36 young subjects, nine were randomly assigned to each training protocol (HI, LO, INCR, and DECR). In each protocol, subjects underwent a series of 24 treadmill slips before they experienced a novel slip during over-ground walking. Measures from these subjects were compared across groups and to data from control subjects (CTRL, n=9) who had experienced a novel over-ground slip without treadmill training as part of a previous experiment. The results showed that treadmill slip training improved balance control on over-ground slip and had a larger effect on subjects׳ reactive control of stability (44.3%) than on proactive control (27.1%) in comparison with the CTRL group. HI yielded stronger generalization than LO, while INCR was only marginally better than DECR. Finally, the group means of stability displayed a clear ascending order from CTRL, LO, DECR, INCR, to HI.

ERP evidence of cognitive strategy change in motivational conditions with varying level of difficulty

Recent research suggests that motivation improves cognitive functions but the particular mechanisms and precise behavioural conditions involved in such improvement still remain unknown. Particularly, it is unclear when in time and in which conditions these mechanisms are engaged. In the present study, we aimed to look at the neural markers of cognitive control strategies in different motivational conditions (motivation vs neutral) with different levels of difficulty (high vs low). Twenty-five adults completed a newly designed task in the four conditions above. Three ERP components were analysed: the CNV, LRP and P3b. We found that a motivational situation triggers the use of a proactive strategy when low cognitive control is required. A reactive strategy was used in a non-motivational situation and for difficult trials. Our study is also the first to provide evidence that the difference between proactive and reactive strategies occurs after the first stimulus (cue) is processed.

Students' and teachers' perceptions of aggressive behaviour in adolescents with intellectual disability and typically developing adolescents

This study investigated aggressive behaviour in Serbian adolescents with intellectual disability (ID) compared to typically developing peers. The sample consisted of both male and female adolescents aged 12-18 years. One hundred of the adolescents had ID, and 348 adolescents did not have ID. The adolescents were asked to complete the Reactive-Proactive Aggression Questionnaire (RPQ), and their teachers provided ratings of aggression for the adolescents using the Children's Scale of Hostility and Aggression: Reactive-Proactive (C-SHARP). Results indicated that adolescents reported a higher prevalence of aggressive behaviour than their teachers. Reactive aggression was more prevalent than proactive aggression in both subsamples. In the subsample of adolescents with ID, there were no sex or age differences for aggression. However, in the normative subsample, boys and older adolescents scored significantly higher on aggression. According to adolescent self-reports the prevalence of aggression was higher in adolescents without ID, while teachers perceived aggressive behaviour to be more prevalent in adolescents with ID. Scientific and practical implications are discussed.