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Traditional pen and paper based neuropsychological tests (NPT) for cognition assessment have several challenges limiting their use. They are time consuming, expensive, and require highly trained specialists to administer. This leads to testing being available to only a small portion of the population and often with wait times of several months. In clinical practice, we have found results tend not to be integrated effectively into assessment and plans of the ordering provider. Here we compared several tests using BrainCheck (BC), a computer-based NPT battery, to traditional paper-based NPT, by evaluating individual tests as well as comparing composite scores to scores on traditional screening tools. 26 volunteers took both paper-based tests and BC. We found scores of four assessments (Ravens Matrix, Digit Symbol Modulation, Stroop Color Word Test and Trails Making A&B Test) were highly correlated. The Balance Examination and Immediate/Delayed Hopkins Verbal Learning, however, were not correlated. The BC composite score was correlated to results of the Saint Louis University Mental Status (SLUMS) exam [1], the Mini-Mental State Examination (MMSE) [2], and the Montreal Cognitive Assessment (MoCA). Our results suggest BC may offer a computer-based avenue to address the gap between basic screening and formal neuropsychological testing.

Citations are an important, but often overlooked, part of every scientific paper. They allow the reader to trace the flow of evidence, serving as a gateway to relevant literature. Most scientists are aware of citations errors, but few appreciate the prevalence or consequences of these problems. The purpose of this study was to examine how often frequently cited papers in biomedical scientific literature are cited inaccurately. The study included an active participation of first authors of frequently cited papers; to first-hand verify the citations accuracy. The approach was to determine most cited original articles and their parent authors, that could be able to access, and identify, collect and review all citations of their original work. Findings from feasibility study, where we collected and reviewed 1,540 articles containing 2,526 citations of 14 most cited articles in which the 1st authors were affiliated with the Faculty of Medicine University of Belgrade, were further evaluated for external confirmation in an independent verification set of articles. Verification set included 4,912 citations identified in 2,995 articles that cited 13 most cited articles published by authors affiliated with the Mayo Clinic Division of Nephrology and Hypertension (Rochester, Minnesota, USA), whose research focus is hypertension and peripheral vascular disease. Most cited articles and their citations were determined according to SCOPUS database search. A citation was defined as being accurate if the cited article supported or was in accordance with the statement by citing authors. A multilevel regression model for binary data was used to determine predictors of inaccurate citations. At least one inaccurate citation was found in 11% and 15% of articles in the feasibility study and verification set, respectively, suggesting that inaccurate citations are common in biomedical literature. The main findings were similar in both sets. The most common problem was the citation of nonexistent findings (38.4%), followed by an incorrect interpretation of findings (15.4%). One fifth of inaccurate citations were due to “chains of inaccurate citations,” in which inaccurate citations appeared to have been copied from previous papers. Reviews, longer time elapsed from publication to citation, and multiple citations were associated with higher chance of citation being inaccurate. Based on these findings, several actions that authors, mentors and journals can take to reduce citation inaccuracies and maintain the integrity of the scientific literature have been proposed.

Working memory training improves children’s cognitive performance on untrained tasks; however, little is known about the underlying neural mechanisms. We investigated this in 32 typically developing children aged 10-14 years (19 girls and 13 boys; Devon, UK) using a randomized controlled design and multi-modal MRI. Training improved working memory performance and increased intrinsic functional connectivity between the bilateral intraparietal sulci. Furthermore, improvements in working memory were associated with greater recruitment of the left middle frontal gyrus on a complex span task. The repeated engagement of fronto-parietal regions during training may increase their activity and functional connectivity over time, affording greater working memory performance. We discuss the plausibility of generalizable cognitive benefits from a neurobiological perspective and implications for neurodevelopmental theory. This is not the version of record.

IntroductionWe will use a sub-sample of a current longitudinal study to investigate the impact of COVID-19 on the health and wellbeing of ex-service personnel in the UK. The study will provide evidence for the UK Office of Veterans’ Affairs (OVA), UK stakeholders supporting the ex-service community, and evidence to inform our international counterparts working with ex-service communities in allied countries regarding the impact of COVID-19 on the health and wellbeing of ex-service personnel.Methods and analysisParticipants were eligible to participate if they lived in the UK, had Regular service history from the UK Armed Forces and had previously completed the King’s Centre for Military Health Research (KCMHR) Health and Wellbeing survey between 2014–2016. Participants who met these criteria were recruited through email to take part in an online questionnaire. The study provides additional quantitative longitudinal data on this sub-sample. Data are being collected June 2020-September 2020. Specific measures are used to capture participants’ COVID-19 experiences, health and wellbeing status and lifestyle behaviours. Other key topics will include questions regarding the impact of COVID-19 pandemic on employment, finances, volunteering, charitable giving, accommodation and living arrangements, help-seeking behaviours, as well as any potential positive changes during this period.Ethics and DisseminationEthical approval has been gained from King’s College London Research Ethics Committee (Ref: HR-19/20–18626). Participants were provided with information and agreed to a series of consent statements before enrolment. Data are kept on secure servers with access to personally identifiable information limited. Findings will be disseminated to the OVA, UK ex-service stakeholders and international research institutions through stakeholder meetings, project reports and scientific publications.Strengths and limitations of this studyStrengths include recruitment from a population where underlying characteristics are known, and longitudinal data is held on their health and wellbeing.There has been rapid roll-out of the survey to ensure relevance for participants’ COVID-19 experiences and use of validated measures for mental health and wellbeing outcomes.Study limitations include recruitment from a specific cohort; hence the study cannot comment on the impact of COVID-19 in other veteran populations.

IntroductionWe will use an occupational sample to study the impact of COVID-19 on current staff and postgraduate research students at a large UK university. The cohort study will address some of the key questions about COVID-19 for the international community, while also providing feedback to the employer and educator.Methods and analysisParticipants were recruited via email to their University email address. Administrative records were available to compare the composition of volunteer participants to underlying staff and postgraduate student populations of the University. The study comprises a baseline survey, longitudinal follow-up surveys and a viral antibody study. Baseline information was collected in April 2020 including demographics, working situation, current stresses and worries, mental health and neurological symptoms. Personal experiences of COVID-19, indirect experiences and attitudes towards the pandemic were queried, as well as satisfaction with communication and support at work. Longitudinal surveys will assess changes in COVID-19 exposure and mental health. A viral antibody detection component is being planned and will also be longitudinal in nature.Ethics and disseminationEthical approval has been gained from KCL’s Psychiatry, Nursing and Midwifery Research Ethics Committee (HR-19/20-18247). Participants were provided with information and agreed to a series of consent statements before enrolment. Data are kept on secure servers with access to personally identifiable information limited. Researchers may apply to have access to pseudonymised data. Findings will be disseminated internally to the University and participants, and externally through scientific publications.

Biomedical researchers have lamented the lengthy timelines from manuscript submission to publication and highlighted potential detrimental effects on scientific progress and scientists’ careers. In 2015, Himmelstein identified the mean time from manuscript submission to acceptance in biomedicine as approximately 100 days. The length of publication timelines in health professions education (HPE) is currently unknown.This study replicates Himmelstein’s work with a sample of 14 HPE journals published between 2008-2018. Using PubMed, 19,182 article citations were retrieved. Open metadata for each was downloaded, including the date the article was received by the journal, the date the authors resubmitted revisions, the date the journal accepted the article, and date of entry into PubMed. Journals without publication history metadata were excluded.Publication history data was available for 55% (n=8) of the journals sampled. The publication histories of 4,735 (25%) articles were analyzed. Mean time from: (1) author submission to journal acceptance was 180.93 days (SD=103.89), (2) author submission to posting on PubMed was 263.55 days (SD=157.61), and (3) journal acceptance to posting on PubMed was 83.15 days (SD=135.72).This study presents publication metadata for journals that openly provide it—a first step towards understanding publication timelines in HPE. Findings confirm the replicability of the original study, and the limited data suggest that, in comparison to biomedical scientists broadly, medical educators may experience longer wait times for article acceptance and publication. Reasons for these delays are currently unknown and deserve further study; such work would be facilitated by increased public access to journal metadata.What this article addsPublication delays can negatively impact science and researchers’ careers. A previous study, in biomedicine, leveraged publicly available data to identify a 100-day waiting period between manuscript submission and acceptance. However, this study provides limited information on timelines for health professions education (HPE) articles. Thus, the current study replicates the original investigation with publication timeline data for eight HPE journals, which make their data publicly accessible, finding the mean time from submission to acceptance to be 181 days. Reasons for these delays are currently unknown and deserve further study; such work would be facilitated by increased public access to journal metadata.

It is commonly hypothesized that scientists are more likely to engage in data falsification and fabrication when they are subject to pressures to publish, when they are not restrained by forms of social control, when they work in countries lacking policies to tackle scientific misconduct, and when they are male. Evidence to test these hypotheses, however, is inconclusive due to the difficulties of obtaining unbiased data.Here we report a pre-registered test of these four hypotheses, conducted on papers that were identified in a previous study as containing problematic image duplications through a systematic screening of the journal PLoS ONE. Image duplications were classified into three categories based on their complexity, with category 1 being most likely to reflect unintentional error and category 3 being most likely to reflect intentional fabrication. Multiple parameters connected to the hypotheses above were tested with a matched-control paradigm, by collecting two controls for each paper containing duplications.Category 1 duplications were mostly not associated with any of the parameters tested, in accordance with the assumption that these duplications were mostly not due to misconduct. Category 2 and 3, however, exhibited numerous statistically significant associations. Results of univariable and multivariable analyses support the hypotheses that academic culture, peer control, cash-based publication incentives and national misconduct policies might affect scientific integrity. Significant correlations between the risk of image duplication and individual publication rates or gender, however, were only observed in secondary and exploratory analyses.Country-level parameters generally exhibited effects of larger magnitude than individual-level parameters, because a subset of countries was significantly more likely to produce problematic image duplications. Promoting good research practices in all countries should be a priority for the international research integrity agenda.

Knowing how school reopenings affect the spread of COVID-19 is crucial when balancing children’s right to schooling with contagion management. This paper considers the effects on COVID-19 testing prevalence and the positive test rate of reopening Norwegian schools after a 6-week closure aimed at reducing contagion. We estimate the effects of school reopening on teachers, parents and students using an event study/difference-in-differences design that incorporates comparison groups with minimal exposure to in-person schooling. We find no evidence that COVID-19 incidence increased following reopening among students, parents or teachers pooled across grade levels. We find some suggestive evidence that infection rates among upper secondary school teachers increased; however, the effects are small and transitory. At low levels of contagion, schools can safely be reopened when other social distancing policies remain in place.

Background COVID-19 has continued to spread in the United States and globally. Closely monitoring public engagement and perceptions of COVID-19 and preventive measures using social media data could provide important information for understanding the progress of current interventions and planning future programs. Objective The aim of this study is to measure the public’s behaviors and perceptions regarding COVID-19 and its effects on daily life during 5 months of the pandemic. Methods Natural language processing (NLP) algorithms were used to identify COVID-19–related and unrelated topics in over 300 million online data sources from June 15 to November 15, 2020. Posts in the sample were geotagged by NetBase, a third-party data provider, and sensitivity and positive predictive value were both calculated to validate the classification of posts. Each post may have included discussion of multiple topics. The prevalence of discussion regarding these topics was measured over this time period and compared to daily case rates in the United States. Results The final sample size included 9,065,733 posts, 70% of which were sourced from the United States. In October and November, discussion including mentions of COVID-19 and related health behaviors did not increase as it had from June to September, despite an increase in COVID-19 daily cases in the United States beginning in October. Additionally, discussion was more focused on daily life topics (n=6,210,255, 69%), compared with COVID-19 in general (n=3,390,139, 37%) and COVID-19 public health measures (n=1,836,200, 20%). Conclusions There was a decline in COVID-19–related social media discussion sourced mainly from the United States, even as COVID-19 cases in the United States increased to the highest rate since the beginning of the pandemic. Targeted public health messaging may be needed to ensure engagement in public health prevention measures as global vaccination efforts continue.

PurposeStuttering is characterized by intermittent speech disfluencies, which are dramatically reduced when speakers synchronize their speech with a steady beat. The goal of this study was to characterize the neural underpinnings of this phenomenon using functional magnetic resonance imaging.MethodData were collected from 16 adults who stutter and 17 adults who do not stutter while they read sentences aloud either in a normal, self-paced fashion or paced by the beat of a series of isochronous tones (“rhythmic”). Task activation and task-based functional connectivity analyses were carried out to compare neural responses between speaking conditions and groups after controlling for speaking rate.ResultsAdults who stutter produced fewer disfluent trials in the rhythmic condition than in the normal condition. Adults who stutter did not have any significant changes in activation between the rhythmic condition and the normal condition, but when groups were collapsed, participants had greater activation in the rhythmic condition in regions associated with speech sequencing, sensory feedback control, and timing perception. Adults who stutter also demonstrated increased functional connectivity among cerebellar regions during rhythmic speech as compared to normal speech and decreased connectivity between the left inferior cerebellum and the left prefrontal cortex.ConclusionsModulation of connectivity in the cerebellum and prefrontal cortex during rhythmic speech suggests that this fluency-inducing technique activates a compensatory timing system in the cerebellum and potentially modulates top-down motor control and attentional systems. These findings corroborate previous work associating the cerebellum with fluency in adults who stutter and indicate that the cerebellum may be targeted to enhance future therapeutic interventions.Supplemental Materialhttps://doi.org/10.23641/asha.14417681

The two best predictors of children's educational achievement available from birth are parents’ socioeconomic status (SES) and, recently, children's inherited DNA differences that can be aggregated in genome‐wide polygenic scores (GPS). Here, we chart for the first time the developmental interplay between these two predictors of educational achievement at ages 7, 11, 14 and 16 in a sample of almost 5,000 UK school children. We show that the prediction of educational achievement from both GPS and SES increases steadily throughout the school years. Using latent growth curve models, we find that GPS and SES not only predict educational achievement in the first grade but they also account for systematic changes in achievement across the school years. At the end of compulsory education at age 16, GPS and SES, respectively, predict 14% and 23% of the variance of educational achievement. Analyses of the extremes of GPS and SES highlight their influence and interplay: In children who have high GPS and come from high SES families, 77% go to university, whereas 21% of children with low GPS and from low SES backgrounds attend university. We find that the associations of GPS and SES with educational achievement are primarily additive, suggesting that their joint influence is particularly dramatic for children at the extreme ends of the distribution., Genome‐wide polygenic scores (GPS) and socioeconomic status (SES) accounted together for 27% of the variance in educational achievement from age 7 through 16 years. The prediction of GPS and SES on educational achievement was primarily additive, with their joint influence being particularly pronounced at the extreme ends of the distribution.77% of children with high GPS from high SES families went on to university, compared to 21% of children with low GPS from low SES homes.

AimTo investigate factors associated with intention to be vaccinated against COVID-19.MethodsOnline cross-sectional survey of 1,500 UK adults, recruited from an existing online research panel. Data were collected between 14th and 17th July 2020. We used linear regression analyses to investigate associations between intention to be vaccinated for COVID-19 “when a vaccine becomes available to you” and socio-demographic factors, previous influenza vaccination, general vaccine attitudes and beliefs, attitudes and beliefs about COVID-19, and attitudes and beliefs about a COVID-19 vaccination.Results64% of participants reported being likely to be vaccinated against COVID-19; 27% were unsure and 9% reported being unlikely to be vaccinated. Personal and clinical characteristics, previous influenza vaccination, general vaccination beliefs, and beliefs and attitudes about COVID-19 and a COVID-19 vaccination explained 77% of the variance in vaccination intention. Intention to be vaccinated was associated with more positive general COVID-19 vaccination beliefs and attitudes, weaker beliefs that the vaccination would cause side effects or be unsafe, greater perceived information sufficiency to make an informed decision about COVID-19 vaccination, greater perceived risk of COVID-19 to others but not oneself, older age, and having been vaccinated for influenza last winter (2019/20).ConclusionsDespite uncertainty around the details of a COVID-19 vaccination, most participants reported intending to be vaccinated for COVID-19. Actual uptake will likely be lower. Vaccination intention reflects general vaccine beliefs and attitudes. Campaigns and messaging about a COVID-19 vaccination should emphasize the risk of COVID-19 to others and necessity for everyone to be vaccinated.

The unique circumstances created by the COVID-19 pandemic pose serious challenges to mood stability and emotional regulation at all ages. Although many people tend to react resiliently to stress, others appear to display emotional anxiety and depression-related symptoms. In this study, we carried out a survey (N = 10,053) during the first week of the general lockdown (quarantine) in Argentina to measure early affective reactions in Argentine adults. Respondents showed substantial anxious and depressive symptoms, with 33 % and 23% of participants reporting possible depressive and anxious syndromes, respectively, with the youngest group (18 to 25 y.o.) showing the highest prevalence of symptoms. Even if prior mental health problems predisposed or aggravated the reaction, participants without prior complaints showed signs of psychological impact. Using linear regression, the most important independent variables related to depressive symptoms was the feeling of loneliness followed by daily stress. In the case of anxious states, the strongest variables were negative repetitive thinking and feeling of loneliness. Other psychological, economic, and social factors are discussed.This study is in line with previous literature that highlight the importance of the psychological impact of pandemics, but additionally demonstrates that these reactions are present at a large scale immediately after the start of quarantine with very low infectious rates as an early anticipatory adaptive reaction leading to potential negative outcomes from adjustment disorders to major disorders. In addition, the present results provide potentially relevant information about sudden environmental impacts on affective states and specific pathways for anxiety and depression to be expressed. We end by discussing implications for public policy based on considering the most vulnerable groups.Key FindingsMore than a third of the studied sample (n = 10,053) showed substantial depressive and anxious symptoms between 5 and 7 days after the start of the national quarantine.33.7% of the sample scored above the PHQ-9 cutoff for possible diagnosis of a depressive disorder and 23.2% for an anxiety disorder.28.6% of the participants showed moderate and severe levels of depressive symptoms and 23.2% showed moderate and severe levels of anxiety.The youngest participants were affected the most by the situation.The most important factor related to depressive symptoms was the feeling of loneliness followed by daily stress.The most important factor related to anxious states was negative repetitive thinking followed by feeling of loneliness.The existence of previous mental health difficulties aggravated the reactions, but even people who had not sought out treatment previously showed signs of psychological impact.

COVID-19 has joined the long list of human disorders with sexually dimorphic expression. Increased lethality in men was evident in the first large reports from ChinaCDC and WHO-China, and the gender gap appeared even wider in the early Italian outbreak. Newspapers and scientific journals alike have commented on this finding and the preexisting conditions, biological processes, and gender role behavior differences that may underlie it. However, as for other diseases, and in spite of years of advocating for the collection of raw epidemiological data and the analysis of clinical trial data sets by sex, very little appeared to be released about sex differences in characteristics of the epidemics beyond infection and death rates, such as severity of disease, comorbidities, rate of recovery, length of hospital stay, or number of tests for the SARS-CoV-2 coronavirus. These data are critical not only for scientists to understand the pathophysiology of disease, but also to inform decision-making by countries and healthcare systems on how to prioritize testing and best allocate scarce resources and relief funds.Systematic analysis of official websites for the 20 countries and 6 US states reporting the highest number of cases on March 21, 2020, revealed a wide disparity in sex-disaggregated data made available to the public and scholars. Only a handful of the countries reported cases by sex separately. None of the other characteristics, including fatality rates, were stratified by sex at the time. Beyond suboptimal sex disaggregation, our analysis found a paucity of usable raw data sets and a generalized lack of standardization of captured data, making comparisons difficult. A second round of data capture in April found more complete, but even more disparate, information.Our analysis revealed a wide range of sex ratios among confirmed cases, which changed over time. In countries where a male-biased sex ratio was initially reported, the reported proportion of women among cases dramatically increased in under 3 weeks. In contrast, men were consistently over-represented in severe cases, intensive care admissions, and deaths. We also show that the sex ratio varies with age, with a complex pattern, reproduced across the 6 countries for which data were found.Accurate, peer-reviewed, statistical analysis of harmonized, sex-disaggregated data for other characteristics of epidemics, such as availability of testing, suspected source of infection, or comorbidities will be critical to understand where the observed disparities come from and to generate evidence-based recommendations for decision-making by institutions and governments around the world.

Extinction learning, the process of ceasing an acquired behavior in response to altered reinforcement contingencies, is not only essential for survival in a changing environment, but also plays a fundamental role in the treatment of pathological behaviors. During therapy and other forms of training involving extinction, subjects are typically exposed to several sessions with a similar structure. The effects of this repeated exposure are not well understood. Here, we studied the behavior of pigeons across several sessions of a discrimination-learning task in context A, extinction in context B, and a return to context A to test the context-dependent return of the learned responses (ABA renewal). By focusing on individual learning curves across animals, we uncovered a session-dependent variability of behavior: (1) during extinction, pigeons preferred the unrewarded alternative choice in one-third of the sessions, predominantly during the first one. (2) In later sessions, abrupt transitions of behavior at the onset of context B emerged, and (3) the renewal effect decayed as sessions progressed. We show that the observed results can be parsimoniously accounted for by a computational model based only on associative learning between stimuli and actions. Our work thus demonstrates the critical importance of studying the trial-by-trial dynamics of learning in individual sessions, and the power of “simple” associative learning processes. Supplementary Information The online version contains supplementary material available at 10.1007/s10071-021-01521-4.

As we fall sleep, our brain traverses a series of gradual changes at physiological, behavioural and cognitive levels, which are not yet fully understood. The loss of responsiveness is a critical event in the transition from wakefulness to sleep. Here we seek to understand the electrophysiological signatures that reflect the loss of capacity to respond to external stimuli during drowsiness using two complementary methods: spectral connectivity and EEG microstates. Furthermore, we integrate these two methods for the first time by investigating the connectivity patterns captured during individual microstate lifetimes. While participants performed an auditory semantic classification task, we allowed them to become drowsy and unresponsive. As they stopped responding to the stimuli, we report the breakdown of frontoparietal alpha networks and the emergence of frontoparietal theta connectivity. Further, we show that the temporal dynamics of all canonical EEG microstates slow down during unresponsiveness. We identify a specific microstate (D) whose occurrence and duration are prominently increased during this period. Employing machine learning, we show that the temporal properties of microstate D, particularly its prolonged duration, predicts the response likelihood to individual stimuli. Finally, we find a novel relationship between microstates and brain networks as we show that microstate D uniquely indexes significantly stronger theta connectivity during unresponsiveness. Our findings demonstrate that the transition to unconsciousness is not linear, but rather consists of an interplay between transient brain networks reflecting different degrees of sleep depth.Author summaryHow do we lose responsiveness as we fall asleep? As we become sleepy, our ability to react to external stimuli disappears gradually. Here we sought to understand the rapid fluctuations in brain electrical activity that predict the loss of responsiveness as participants fell asleep while performing a word classification task. We analysed the patterns of connectivity between anterior and posterior brain regions observed during wakefulness in alpha band and showed that this connectivity shifted to slower theta frequencies as participants became unresponsive. We also investigated the dynamics of brain electrical microstates, which represent an alphabet of quasi-stable global brain states with lifetimes of 10-100 milliseconds, and found that the temporal dynamics of microstates slowed down when participants became unresponsive. Using machine learning, we further showed that microstate dynamics prior to a stimulus predict whether subjects will respond to it. We integrated microstates and connectivity for the first time to show that a specific microstate captures connectivity patterns correlated with unresponsiveness during this transition. We conclude that falling asleep is accompanied by a millisecond-level interplay between distinct brain networks, and suggest a renewed focus on fine-grained temporal scales in the study of transitions between levels of consciousness.

Memory formation is thought to occur via enhanced synaptic connectivity between populations of neurons in the brain. However, it has been difficult to localize and identify the neurons that are directly involved in the formation of any specific memory. We have previously used fos-tau-lacZ (FTL) transgenic mice to identify discrete populations of neurons in amygdala and hypothalamus, which were specifically activated by fear conditioning to a context. Here we have examined neuronal activation due to fear conditioning to a more specific auditory cue. Discrete populations of learning-specific neurons were identified in only a small number of locations in the brain, including those previously found to be activated in amygdala and hypothalamus by context fear conditioning. These populations, each containing only a relatively small number of neurons, may be directly involved in fear learning and memory.

Different mnemonic outcomes have been observed when associative memories are reactivated by CS exposure and followed by amnestics. These outcomes include mere retrieval, destabilization–reconsolidation, a transitional period (which is insensitive to amnestics), and extinction learning. However, little is known about the interaction between initial learning conditions and these outcomes during a reinforced or nonreinforced reactivation. Here we systematically combined temporally specific memories with different reactivation parameters to observe whether these four outcomes are determined by the conditions established during training. First, we validated two training regimens with different temporal expectations about US arrival. Then, using Midazolam (MDZ) as an amnestic agent, fear memories in both learning conditions were submitted to retraining either under identical or different parameters to the original training. Destabilization (i.e., susceptibly to MDZ) occurred when reactivation was reinforced, provided the occurrence of a temporal prediction error about US arrival. In subsequent experiments, both treatments were systematically reactivated by nonreinforced context exposure of different lengths, which allowed to explore the interaction between training and reactivation lengths. These results suggest that temporal prediction error and trace dominance determine the extent to which reactivation produces the different outcomes. ispartof: Learning & Memory vol:22 issue:8 pages:385-400 ispartof: location:United States status: published

A secure parent-infant relationship lays the foundations for children’s development, however there are currently no measurement tools recommended for clinical practice. We evaluate the clinical utility of a structured assessment of the parent-infant relationship (the Maternal Postnatal Attachment Scale, MPAS) in a deprived, multi-ethnic urban community in England. This paper answers the question: what are health visitors’ views on the parent-infant relationship, and experiences of piloting the MPAS? It explores the barriers and facilitators to implementation, and complements the paper on psychometric properties and representativeness reported in Dunn et al (submitted).Semi-structured interviews were conducted with 11 health visitors and data were analysed using thematic analysis. Health visitors stressed the importance of the parent-infant relationship and reported benefits of the MPAS, including opening conversation, and identifying and reporting concerns. Challenges included timing, workload, the appropriateness and understanding of the questions and the length of the tool. Suggestions for improvements to the tool were identified.Our findings help to explain results in Dunn et al, and challenges identified would hinder routine assessment of the parent-infant relationship. Further work with health professionals and parents has been undertaken to co-produce an acceptable, feasible and reliable tool for clinical practice.Key findings and points for practitionersHealth visitors saw identification and support of the parent-infant relationship as an important part of their role, however there are currently no recommended tools for this.Health visitors report some benefits to using the MPAS, but also several challenges to using this tool in practice, including the length of time required, the complexity of the language, potential to trigger distress and perceived intrusiveness of some questions.Further work in collaboration with health professionals and parents is needed to develop an acceptable, feasible and reliable tool to assess the parent-infant relationship.Statement of relevance to the field of infant and early childhood mental healthA secure parent-infant relationship lays the foundations for children’s development, and identification of concerns and provision of support is a priority in the UK and internationally. However, no tools are currently recommended for assessing the relationship in clinical practice. Our findings on experiences, benefits and challenges of piloting a tool to assess the parent-infant relationship provide important directions for development of a short, clinically relevant and valid tool in clinical practice.Statement explaining how the research reflects an appreciation for diversity and an anti-racist approachThis pilot was conducted with a diverse, multi-ethnic community (half of new mothers are from Asian/Asian British Pakistani backgrounds, a quarter White British, and a quarter from other ethnic backgrounds). The health visiting service engages with the whole population in a culturally sensitive way, including ensuring staff speak key community languages and using interpreters. None of the authors spoke community languages, but we purposively selected the health visitors to include experience of using the MPAS in community languages. Our findings reflect experiences implementing the tool with women from different ethnic backgrounds, and we report detailed findings on language. We hope our findings can inform appropriate and equitable implementation of tools in diverse communities.

Stress-activated p38 kinases control a plethora of functions and their dysregulation has been linked to development of steatosis, obesity, immune disorders and cancer. Therefore, they have been identified as potential targets for novel therapeutic strategies. There are four p38 family members (p38α, p38β, p38γ, and p38δ) that are activated by MKK3 and MKK6. Here we demonstrate that lack of MKK6 reduces the life span in mice. Longitudinal study of cardiac function in Mkk6-/- mice showed that young mice have cardiac hypertrophy which progresses to cardiac dilatation and fibrosis with age. Mechanistically, lack of MKK6 blunts p38α activation while causing MKK3-p38γ/δ hyperphosphorylation and increased mTOR signaling, resulting in cardiac hypertrophy. Cardiac hypertrophy in Mkk6-/- mice is reverted by knocking out either p38γ or p38δ, or by inhibiting mTOR pathway with rapamycin. In conclusion, we have identified a key role for the MKK3/6-p38γ/δ pathway in the development of cardiac hypertrophy, which has important implications for the clinical use of p38α inhibitors in the long-term treatment since they might result in cardiotoxicity.eLife’s Review ProcesseLife works to improve the process of peer review so that it more effectively conveys the assessment of expert reviewers to authors, readers and other interested parties. In the future we envision a system in which research is first published as a preprint and the outputs of peer review are the primary way research is assessed, rather than journal title.Our editorial process produces two outputs: i) an assessment by peers designed to be posted alongside a preprint for the benefit of the readers; ii) detailed feedback on the manuscript for the authors, including requests for revisions and suggestions for improvement.Therefore we want to change how we construct and write peer reviews to make them useful to both authors and readers in a way that better reflects the work you put into reading and thinking about a paper.eLife reviews now have three parts: An evaluation summary (in two or three sentences) that captures the major conclusions of the review in a concise manner, accessible to a wide audience.A public review that details the strengths and weaknesses of the manuscript before you, and discusses whether the authors’ claims and conclusions are justified by their data.A set of private recommendations for the authors that outline how you think the science and its presentation could be strengthened.All three sections will be used as the basis for an eLife publishing decision, which will, as always, be made after a consultation among the reviewers and editor. Each of the public reviews will be published (anonymously) alongside the preprint, together with a response from the authors if they choose. In the case of papers we reject after review, the authors can choose to delay posting until their paper has been published elsewhere.If this is your first time going through this new process, we ask that you take some time to read our Reviewer Guide, which discusses how we see each section will be used, what it should contain, and what we hope it accomplishes. And we remind you that, with the shift of reviews from private correspondence to public discourse, it is more important than ever that reviews are written in a clear and constructive manner appropriate for a public audience and mindful of the impact language choices might have on the authors.

ObjectivesCourier jobs are characterised as high demand, low control with lack of support, meaning that job burnout is a serious concern. Burnout could have negative influences on safety, performance, turnover and work engagement. This paper aims to review existing evidence about the level of and risk factors for burnout among couriers. DesignSystematic review and narrative synthesis Primary and secondary outcome measuresBurnout, risk factors The review followed PRISMA to search studies published in English and Chinese. English databases included MEDLINE, EMBASE, PsycINFO, Cochrane Library, Web of Science (Core Collection), Open Science Framework and Google Scholar. Chinese databases included CNKI, WANFANG data, Sino Med and CQVIP. ResultsThe search yielded nine papers, of which eight studied Chinese couriers and one Malaysian. Two of them were published in English language and seven were published in Chinese. Seven studies reported moderate to high levels of burnout, such as mean scores of 2.45 on a 1-5 scale, 4.02 on a 0-7 scale, and 49 where the total score is between 15 and 75. The included studies demonstrated that burnout is associated with low income, work stress, physical demands, emotional demands and organizational constraints. Some of them also measured factors that ameliorate the negative effect of work stress on burnout, such as job resources, decision latitude, social support and organizational support. Individual psychological processes, such as emotional regulation and psychological empowerment also play a role in ameliorating or exacerbating burnout. Level of burnout also varies significantly among different socio-demographic groups, such as age, income and marital status. ConclusionsJob burnout is moderate to high among couriers, but there is a dearth of literature in the English language. Interventions to prevent or reduce burnout are currently lacking but could include increasing job autonomy and offering more organizational support. PROSPEROregistration number: CRD42021247644 Strengths and limitations of this study{blacktriangleright} Given the importance of China in global e-commerce, comprehensive search strategies were employed to review publications in both English and Chinese languages {blacktriangleright}Outcome measures investigated have been clearly defined and referenced. {blacktriangleright}This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. {blacktriangleright}However, due to the heterogeneity of included studies, it was not meaningful to perform meta-analysis.

Executive SummaryIntroductionPrimary health care has a central role in the workings of the health care system and health of the American public. Thus, a high-performing, high-quality primary care system is essential. As a result, measurement frameworks are needed to assess the quality of the infrastructure, workforce configurations, and processes available in primary care practices due to the complexity of primary care. As part of a larger project supported by AHRQ (grant no. 1 R01 HS 025982), our research team reports the use of an evidence-based approach to compile a targeted set of existing care measures. These measures are prioritized according to their overall contribution and value to primary care. Within this paper, we describe the process by which the performance measures were selected and present the final set of measures resulting from the process.Defining Primary careThe study centers around general primary care settings, which have been defined as, “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.” (1)Using PROMESWe adapted an evidence-based approach for measure development, The Productivity Measurement and Enhancement System, or ProMES, to select (modify, when appropriate) and rank existing primary care measures according to value to the primary care clinic. ProMES is a comprehensive performance measure development approach firmly grounded in motivational theory and performance measurement.(2, 3) Through a facilitated focus-group based process, these measures are defined, weighted, and prioritized to create indicators of both overall effectiveness and specific aspects of daily work. This alignment helps individuals and teams to focus their effort more clearly on the most important aspects of their work (i.e., clinical performance) resulting in greater productivity, reduced stress, and less waste of effort.(2, 3) We utilize the ProMES definition of productivity, which is how effectively an organization uses its resources to achieve its goals.One unique feature of ProMES is the resulting measures include contingency curves, or non-linear functions that explicitly tie performance levels on a given measure to its contribution to the organization’s values; in this way, the application of ProMES yields a more nuanced approach to prioritizing work than simple linear weights, while allowing direct comparison(s) between measure(s).ResultsThe design team identified three fundamental objectives for delivery of high-quality primary care. The design team also selected sixteen performance indicators from the 44 pre-vetted measures that already exist in three different data sources for primary care. One indicator, Team 2 Day Post Discharge Contact Ratio, was selected as an indicator for both Objective 2 and 3. In addition, contingency curves were created for each of the indicators using the contingency functions developed by the design team.Objective 1. Ensure patient has appropriate access to preventive, acute, or chronic health care services when needed.–Indicators:New Primary Care Patient Average Wait Time in DaysEstablished Primary Care Patient Average Wait Time in DaysAverage 3rd Next Available Appointment in PC ClinicsTotal Inbound PC Secure Messages to Total Outbound PC Secure Messages (Ratio)Urgent Care Utilization RateObjective 2. Build a trusting, effective, sustained partnership between the health-care team, the patient, and his/her caregiver(s) towards shared goals.–Indicators:Patient’s Satisfaction Rating of Primary Care ProviderTeam 2 Day Post Discharge Contact RatioPatient-Centered Medical Home Stress DiscussedObjective 3. Deliver safe and effective care that comprehensively addresses a given patient’s particular ecological, biological, and/or psychosocial needs.–Indicators:Ambulatory Care Sensitive Conditions (ACSC) Hospitalizations Rate Per 1000 PatientsDiabetes Patients with HbA1c Poor ControlDiabetes Electronic Composite MeasureStatin Medication for Patients with Cardiovascular DiseaseControlling High Blood PressureRenal Testing for NephropathyEffective Continuation Phase Treatment for depressionHospital-wide all cause 30-day Readmission RateTeam 2 Day Post Discharge Contact RatioSummaryPerformance measures selected as part of our modified-ProMES process assist in the implementation of targeted care quality measures prioritized in accordance to their value in primary care. By deriving high-value metrics, organized by care objective with numerically assigned prioritization, we anticipate the results of this paper will apply to a diverse set of stakeholders, including but not limited to policy-makers, primary care clinicians, and administrators in healthcare organizations. Our design team of nationally recognized SMEs joined together in a national panel that consists of diverse stakeholder groups to collectively identify three primary care team objectives, 16 indicators of primary care quality, and 13 indicators which require modification and further work to address gaps which exist in the primary care performance measurement domain. Measures selected as part of this study aim were constructed independent of clinic size or configuration, so that clinics of many configurations (e.g., public vs. private, large vs. small, rural vs urban, team-based vs. traditional) could benefit from their use.Our measure set provides an actionable catalogue of measures that can serve as a first step toward interoperability of electronic health record systems. Future work toward this goal should address both logistical considerations (e.g., data capture, common data/programming language) and lingering measurement challenges, such as the best way to operationalize these measures for teams working in complex and shifting situations (e.g., rotating team members).Acronyms and Definitions

BackgroundThere is evidence that the COVID-19 pandemic has affected the mental health of the UK population, but this needs synthesising to guide effective policy recommendations and ensure support is targeted to populations most at risk. We conducted a rapid systematic review of the evidence of the impact of COVID-19 and associated restrictions on the mental health of UK adults, including risk and protective factors.MethodA range of databases were searched to identify eligible studies. Studies were eligible if they reported primary quantitative or qualitative research on the mental health of UK adults between March 2020 and March 2021. Journal publications and pre-prints were included. Reviews, position papers, protocol papers and studies published in languages other than English were excluded. The study authors screened papers for eligibility and included 102 papers in the analysis.ResultsThe evidence from this review indicates that the mental health of UK adults has declined since the start of the pandemic, with different populations being unequally affected. Populations particularly affected are women, young adults, ethnic minorities, people from lower socio-economic backgrounds, people with pre-existing conditions and people who have had COVID-19. Other risk factors include having to isolate and time spent watching pandemic related news. Protective factors include social contact and maintaining healthy behaviours, such as physical activity.ConclusionsPolicy should aim to discourage risky behaviours while ensuring support is available for people to engage in protective behaviours. Interventions should be directed towards populations that have been most adversely affected. Addressing the decline in mental health across the UK population since the COVID-19 pandemic will require increasing mental health provision and ensuring equitable access to support.

BackgroundMany people who have self-harmed prefer informal sources of support, or support from those with lived experience. However, little is known about whether peer support improves outcomes for people who have self-harmed, and what might be the risks of peer support interventions in non-clinical settings.ObjectivesThe aims of this review are to examine the effectiveness, acceptability and potential risks of peer support for self-harm, and how these risks might be mitigated.MethodsWe searched two bibliographic databases and grey literature for papers published since 2000. We included peer support for self-harm that occurred in voluntary sector organisations, providing one-to-one or group support, or via moderated online peer support forums. We excluded peer support within clinical settings, peer support provided by relatives or friends who self-harm, or peer support from unmoderated online forums. Quality appraisal was conducted on included papers, and study findings were summarised using a narrative synthesis.ResultsTen papers met the inclusion criteria for this review, and most (n=8) were conducted in the United Kingdom. Eight of the papers focused on peer support that was delivered through online mediums and two examined face-to-face self-harm recovery/support groups. Limited conclusions about the effectiveness of peer support interventions for self-harm can be made, as we found no studies comparing this to other treatments or a control group. Peer support for self-harm was found to be acceptable and was viewed as having a range of benefits including a reduction of loneliness, a sense of community and empowerment, improvements in interpersonal skills, and access to information and support. The most commonly perceived risk associated with peer support for self-harm was the potential for triggering self-harm. Other potential risks identified were being re-traumatised by listening to other people’s stories, not having the knowledge or skills to help others, and misunderstandings or disagreements with other peers/group members.ConclusionsOur findings highlighted a range of benefits of being part of a group with very specific shared experiences. This justifies investment in the provision of such resources, supported by safeguards to mitigate the potential risks from peer support interventions. Suggestions include organisations using professional facilitators for groups, including trigger warnings for online forums, and providing regular supervision and training so that peers are prepared and feel confident to support vulnerable people whilst maintaining their own emotional health.

Releasing preprints is a popular way to hasten the speed of research but may carry hidden risks for public discourse. The COVID-19 pandemic caused by the novel SARS-CoV-2 infection highlighted the risk of rushing the publication of unvalidated findings, leading to damaging scientific miscommunication in the most extreme scenarios. Several high-profile preprints, later found to be deeply flawed, have indeed exacerbated widespread skepticism about the risks of the COVID-19 disease – at great cost to public health. Here, preprint article quality during the pandemic is examined by distinguishing papers related to COVID-19 from other research studies. Importantly, our analysis also investigated possible factors contributing to manuscript quality by assessing the relationship between preprint quality and gender balance in authorship within each research discipline. Using a comprehensive data set of preprint articles from medRxiv and bioRxiv from January to May 2020, we construct both a new index of manuscript quality including length, readability, and spelling correctness and a measure of gender mix among a manuscript’s authors. We find that papers related to COVID-19 are less well-written than unrelated papers, but that this gap is significantly mitigated by teams with better gender balance, even when controlling for variation by research discipline. Beyond contributing to a systematic evaluation of scientific publishing and dissemination, our results have broader implications for gender and representation as the pandemic has led female researchers to bear more responsibility for childcare under lockdown, inducing additional stress and causing disproportionate harm to women in science.

ObjectivesPrevious virtual care literature within the field of speech-language pathology has focused primarily on validating the virtual use of intervention programs. There are fewer articles addressing the validity of conducting standardized paediatric oral language and literacy assessments virtually. Additionally, there is a lack of practical recommendations available on how best to conduct these assessment measures virtually. Given the rapid rise in virtual care as a result of the COVID-19 pandemic, clinicians and researchers require guidance on best practices for virtual administration of these tools imminently.MethodsWe identified six key themes for recommendations based on two sources (1) our lab meeting discussions and (2) the outcomes of a narrative review of the extant literature. We then conducted semi-structured interviews with a group of 12 clinicians, students and researchers who had administered standardized language and literacy assessments with a variety of monolingual and multilingual school-aged children, with and without speech and language difficulties, in clinical and research settings to generate recommendations within these themes. Subsequently, in line with the Guidelines International Network, these recommendations were rated by group members, and reviewed by external stakeholders. A quasi-delphi consensus procedure was used to reach agreement on ratings for recommendations.ResultsWe have developed recommendations for the use of standardized language and literacy assessments in virtual care, across six key themes: candidacy for virtual assessment, communication and collaboration with caregivers, technology and equipment, virtual administration, ethics, consent and confidentiality, and considerations for bilingual populations.ConclusionsThis paper is one of the first to share practical recommendations for virtual assessment in the domain of paediatric oral language and literacy assessment. We hope these recommendations will facilitate future clinical research and that as the body of research grows, that this paper will act as a basis for the development of formal Clinical Practice Guidelines.

Agrammatic aphasia is an acquired language disorder characterized by slow, non-fluent speech that include primarily content words. It is well-documented that people with agrammatism (PWA) have difficulty with production of verbs and verb morphology, but it is unknown whether these deficits occur at the single word-level, or are the result of a sentence-level impairment. The first aim of this paper is to determine the linguistic level that verb morphology impairments exist at by using magnetoencephalography (MEG) scanning to analyze neural response to two language tasks (one word-level, and one sentence-level). It has also been demonstrated that PWA benefit from a morphosemantic intervention for verb morphology deficits, but it is unknown if this therapy induces neuroplastic changes in the brain. The second aim of this paper is to determine whether or not neuroplastic changes occur after treatment, and explore the neural mechanisms by which this improvement occurs.

ObjectiveIn this umbrella systematic review, we screen existing reviews on using artificial intelligence (AI) techniques to diagnose COVID-19 in patients of any age and sex (both hospitalised and ambulatory) using medical images and assess their methodological quality.MethodsWe searched seven databases (MEDLINE, EMBASE, Web of Science, Scopus, dblp, Cochrane Library, IEEE Xplore) and two preprint services (arXiv, OSF Preprints) up to September 1, 2020. Eligible studies were identified as reviews or surveys where any metric of classification of detection of COVID-19 using AI was provided. Two independent reviewers did all steps of identification of records (titles and abstracts screening, full texts assessment, essential data extraction, and quality assessment). Any discrepancies were resolved by discussion. We qualitatively analyse methodological credibility of the reviews using AMSTAR 2 and evaluate reporting using PRISMA-DTA tools, leaving quantitative analysis for further publications.ResultsWe included 22 reviews out of 725 records covering 165 primary studies. This review covers 416,254 participants in total, including 50,022 diagnosed with COVID-19. The methodological quality of all eligible studies was rated as critically low. 91% of papers had significant flaws in reporting quality. More than half of the reviews did not comment on the results of previously published reviews at all. Almost three fourth of the studies included less than 10% of available studies.DiscussionIn this umbrella review, we focus on the descriptive summary of included papers. Much wasting time and resources could be avoided if referring to previous reviews and following methodological guidelines. Due to the low credibility of evidence and flawed reporting, any recommendation about automated COVID-19 clinical diagnosis from medical images using AI at this point cannot be provided.FundingPO was supported by NIH grant AI116794 (the funding body had no role in the design, in any stage of the review, or in writing the manuscript); PJ and DS did not receive any funding.RegistrationThe protocol of this review was registered on the OSF platform [1].

BackgroundThe current pandemic, COVID-19, caused by a novel coronavirus SARS-CoV-2, has claimed over a million lives worldwide in a year, warranting the need for more research into the wider determinants of COVID-19 outcomes to support evidence-based policies.ObjectiveThis study aimed to investigate what factors determined the mortality and length of hospitalisation in individuals with COVID-19.Data SourceThis is a systematic review with data from four electronic databases: Scopus, Google Scholar, CINAHL and Web of Science.Eligibility CriteriaStudies were included in this review if they explored determinants of COVID-19 mortality or length of hospitalisation, were written in the English Language, and had available full-text.Study appraisal and data synthesisThe authors assessed the quality of the included studies with the Newcastle□Ottawa Scale and the Agency for Healthcare Research and Quality checklist, depending on their study design. Risk of bias in the included studies was assessed with risk of bias assessment tool for non-randomised studies. A narrative synthesis of the evidence was carried out. The review methods were informed by the Joana Briggs Institute guideline for systematic reviews.ResultsThe review included 22 studies from nine countries, with participants totalling 239,830. The included studies’ quality was moderate to high. The identified determinants were categorised into demographic, biological, socioeconomic and lifestyle risk factors, based on the Dahlgren and Whitehead determinant of health model. Increasing age (ORs 1.04-20.6, 95%CIs 1.01-22.68) was the common demographic determinant of COVID-19 mortality while living with diabetes (ORs 0.50-3.2, 95%CIs −0.2-0.74) was one of the most common biological determinants of COVID-19 length of hospitalisation.Review limitationMeta-analysis was not conducted because of included studies’ heterogeneity.ConclusionCOVID-19 outcomes are predicted by multiple determinants, with increasing age and living with diabetes being the most common risk factors. Population-level policies that prioritise interventions for the elderly population and the people living with diabetes may help mitigate the outbreak’s impact.PROSPERO registration numberCRD42021237063.Strength and limitations of this reviewThis is the first systematic review synthesising the evidence on determinants of COVID-19 LOS outcome.It is also the first review to provide a comprehensive investigation of contextual determinants of COVID-19 outcomes, based on the determinants of health model; thus, presenting with crucial gaps in the literature on the determinants of COVID-19 outcomes that require urgent attention.The review was restricted in conducting meta-analysis due to included studies’ heterogeneity.The review focused on only papers published in the English Language; hence, other relevant papers written on other languages could have been omitted.

This paper explores the level of knowledge, attitude and practices of COVID-19 guidelines among the students in Bangladesh. In achieving this objective, this paper uses primary data collected from 1822 students and three different Likert scales and a one-way ANOVA test are used to assess knowledge, attitudes, and practice (KAP) scores and mean differences with respect to different variables. The research reveals that the majority of students have a higher level of knowledge and a positive attitude towards the COVID-19 guidelines. In contrary, only 0.22 percent students show strong compliance towards COVID-19 guidelines while majority students (60.54 percent) have rather a poor adherence which is an alarming finding. Reopening the educational institutions in Bangladesh is, therefore, not advisable yet and reinforcing the preventive measures through campaigns and online discussion to persuade people to follow the preventive guidelines is highly recommended to contain this global disease.What We Already KnowMajority papers revealed the KAP of general people or medical related people.Majority people have moderate level of knowledge towards COVID-19.No research is found on KAP of the students in Bangladesh.What This Article AddsThe KAP of COVID-19 guidelines among the students in Bangladesh.Majority students have the higher level of knowledge towards COVID-19 guideline among students.Only 0.22 percent students show strong compliance towards COVID-19 guidelines which recommends not reopening educational institutions now.

IntroductionThe COVID-19 pandemic has resulted in significant morbidity and mortality, and has devastated economies in many countries. Amongst the groups identified as being at increased risk from COVID-19 are healthcare workers (HCWs) and ethnic minority groups. Emerging evidence suggests HCWs from ethnic minority groups are at increased risk of adverse COVID-19-related physical and mental health outcomes. To date there has been no large-scale analysis of these risks in UK healthcare workers or ancillary workers in healthcare settings, stratified by ethnicity or occupation type, and adjusted for potential confounders. This paper reports the protocol for a prospective longitudinal questionnaire study of UK HCWs, as part of the UK-REACH programme (The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers).Methods and analysisA baseline questionnaire with follow-up questionnaires at 4 and 8 months will be administered to a national cohort of UK healthcare workers and ancillary workers in healthcare settings, and those registered with UK healthcare regulators. With consent, data will be linked to health records, and participants followed up for 25 years.Univariate associations between ethnicity and primary outcome measures (clinical COVID-19 outcomes, and physical and mental health) and key confounders/explanatory variables will be tested, followed by multivariable analyses to test for associations between ethnicity and key outcomes adjusted for the confounder/explanatory variables, with interactions included as appropriate. Using follow-up data, multilevel models will be used to model changes over time by ethnic group, facilitating understanding of absolute and relative risks in different ethnic groups, and generalisability of findings.Ethics and disseminationThe study is approved by Health Research Authority (reference 20/HRA/4718), and carries minimal risk to participants. We aim to manage the small risk of participant distress due to being asked questions on sensitive topics by clearly indicating on the participant information sheet that the questionnaire covers sensitive topics and that participants are under no obligation to answer these, or indeed any other, questions, and by providing links to support organisations. Results will be disseminated with reports to Government and papers uploaded to pre-print servers and submitted to peer reviewed journals.Registration detailsTrial ID: ISRCTN11811602STRENGTHS AND LIMITATIONS OF THIS STUDYNational, UK-wide, study, aiming to capture variety of healthcare worker job roles including ancillary workers in healthcare settings.Longitudinal study including three waves of questionnaire data collection, and linkage to administrative data over 25 years, with consent.Unique support from all major UK healthcare worker regulators, relevant healthcare worker organisations, and a Professional Expert Panel to increase participant uptake and the validity of findings.Potential for self-selection bias and low response rates, and the use of electronic invitations and online data collection makes it harder to reach ancillary workers without regular access to work email addresses.

ContextConvergent analyses in different disciplines support the use of the Percentage of Papers by the Most Prolific author (PPMP) as a red flag to identify journals that can be suspected of questionable editorial practices. We examined whether this index, complemented by the Gini index, could be useful for identifying cases of potential editorial bias, using a large sample of biomedical journals.MethodsWe extracted metadata for all biomedical journals referenced in the National Library of Medicine, with any attributed Broad Subject Terms, and at least 50 authored (i.e. by at least one author) articles between 2015 and 2019, identifying the most prolific author (i.e. the person who signed the most papers in each particular journal). We calculated the PPMP and the 2015-2019 Gini index for the distribution of articles across authors. When the relevant information was reported, we also computed the median publication lag (time between submission and acceptance) for articles authored by any of the most prolific authors and that for articles not authored by prolific authors. For outlier journals, defined as a PPMP or Gini index above the 95th percentile of their respective distributions, a random sample of 100 journals was selected and described in relation to status on the editorial board for the most prolific author.Results5 468 journals that published 4 986 335 papers between 2015 and 2019 were analysed. The PPMP 95th percentile was 10.6% (median 2.9%). The Gini index 95th percentile was 0.355 (median 0.183). Correlation between the two indices was 0.35 (95CI 0.33 to 0.37). Information on publication lag was available for 2 743 journals. We found that 277 journals (10.2%) had a median time lag to publication for articles by the most prolific author(s) that was shorter than 3 weeks, versus 51 (1.9%) journals with articles not authored by prolific author(s). Among the random sample of outlier journals, 98 provided information about their editorial board. Among these 98, the most prolific author was part of the editorial board in 60 cases (61%), among whom 25 (26% of the 98) were editors-in-chief.DiscussionIn most journals publications are distributed across a large number of authors. Our results reveal a subset of journals where a few authors, often members of the editorial board, were responsible for a disproportionate number of publications. The papers by these authors were more likely to be accepted for publication within 3 weeks of their submission. To enhance trust in their practices, journals need to be transparent about their editorial and peer review practices.

The lockdown and social distancing policy imposed due to the COVID-19 pandemic has had a substantial impact on both mental health service delivery, and the ways in which people are accessing these services. Previous reports from the South London and Maudsley NHS Trust (SLaM; a large mental health service provider for around 1.2m residents in South London) have highlighted increased use of virtual contacts by mental health teams, with dropping numbers of face-to-face contacts over the first wave of the pandemic. There has been concern that the impact of the COVID-19 pandemic would lead to higher mental health emergencies, particularly instances of self-harm. However, with people advised to stay at home during the ‘first wave’ lockdown, it is as yet unclear whether this impacted mental health service presentations. Taking advantage of SLaM’s Clinical Records Interactive Search (CRIS) data resource with daily updates of information from its electronic mental health records, this paper describes overall presentations to Emergency Department (ED) mental health liaison teams, and those with self-harm. The paper focussed on three periods: i) a pre-lockdown period 1st February to 15th March, ii) a lockdown period 16th March to 10th May and iii) a post-lockdown period 11th May to 28th June. In summary, all attendances to EDs for mental health support decreased during the lockdown period, including those with self-harm. All types of self-harm decreased during lockdown, with self-poisoning remaining the most common. Attendances to EDs for mental health support increased post-lockdown, although were only just approaching pre-lockdown levels by the end of June 2020.

PurposeThis paper illustrates initial steps of an intervention optimisation process. Self-sampling packs for sexually transmitted infections (STIs) and blood borne viruses (BBVs) are widely offered within the UK, yet have problems with reach and sample return rates. They have arisen without any formal intervention development.MethodsEleven focus groups and seven interviews were conducted with convenience samples of patients recruited from sexual health clinics and members of the public in late 2017 (n=57). To enable intervention optimisation firstly we formulated initial programme theory situating the intervention. Secondly, we conducted an inductive appraisal of the behavioural system of using the pack to understand meaningful constituent behavioural domains. Subsequently we conducted a thematic analysis of barriers and facilitators to enacting each sequential behavioural domain in preparation for future behaviour change wheel analysis.ResultsOverall, we found that self-sampling packs were acceptable. Our participants understood their overall logic and value as a pragmatic intervention that simultaneously reduced barriers to, and facilitated, individuals being tested for STIs. However, at the level of each behavioural domain (e.g., reading leaflets, returning samples), problems with the pack were identified as well as a series of potential optimisations which might widen the reach of self-sampling and increase the return of viable samples.ConclusionsThis paper provides an example of a pragmatic approach to optimising an intervention already widely offered across the UK. The paper demonstrates the added value health psychological approaches make; systematically considering the context of the intervention, in addition to illuminating granular areas for improvement.What is already known on this subject?The use of self-sampling packs for sexually transmitted infections (STIs) and blood borne viruses (BBVs) has been widely implemented without in-depth assessment of user engagement or theorisationSome evidence suggests that the uptake of self-sampling packs, and the concomitant return of samples to enable diagnosis, are socially patternedDespite increasing and widespread use of self-sampling packs across the UK, relatively little is currently known about their acceptability, or how they could be improvedWhat does this study add?This study provides an illustrative example of using a preliminary programme theory to situate the problem to be addressed by intervention optimisationThe thematic analyses show that self-sampling packs offer a largely acceptable means to enabling STI and BBV testing and diagnosis; they remove many barriers to testing. However, several modifiable barriers to use endure, potentially reducing sample return and amplifying health inequalitiesThis study presents a range of barriers and facilitators to the various behavioural domains included within the use of self-sampling packs. It summarises the findings ready for subsequent behaviour change wheel analyses

ObjectiveTo examine the preferred response mode (internet, phone, paper)to a Medicaid enrollee survey.Data SourceData was obtained from survey responses for a sub-sample of Flint Water Crisis Medicaid Expansion Waiver enrollees (N=2584).Study DesignEnrollees were offered the choice of utilizing the internet, telephone, or mail to respond to a survey evaluating health services. Analyses were stratified by age, residency, race, and income. Chi-square was utilized to detect categorical differences.Principal FindingsThe majority (pRespondents at 200% Federal Poverty Level (FPL) or higher used internet at greater rates than those below 200% FPL (pConclusionsOverall, this low-income population preferred the web-based response mode compared to paper or telephone, the variation by race and FPL suggests the continued presence of a digital divide in the population. Nevertheless, our findings revealed greater utilization of web-based tools for survey administration in vulnerable populations than was expected. This is a valuable finding that may inform future health programming and telehealth efforts particularly in the advent of COVID-19.What this study addsActive health care participation using internet connectivity is increasing and may be associated with improved quality and costs of health care services yet access and usage vary among populations.Research suggests that persons of low income and resources are unable to participate with internet based activities due to access and literacy issues that may further exacerbate health disparities.This study revealed enrollees of the Flint Michigan Section 1115 Demonstration utilized the internet for survey participation at a greater rate than responding by mail or phone.Finding that vulnerable populations have greater access to the internet via digital technology than assumed may expand opportunities to participate in their health care through health information portals and telehealth.

BackgroundThere is a recognised need to develop clear service models and pathways to provide high quality care in the community for people with complex emotional needs, who may have been given a “personality disorder” diagnosis. Services should be informed by the views of people with these experiences.AimsTo systematically review and synthesise qualitative studies on service user experiences of community mental health care for Complex Emotional Needs.MethodsWe searched six bibliographic databases for papers published since 2003. We included peer reviewed studies reporting data on service user experiences and views about good care from community-based mental health services for adults with CEN, including generic mental health services and specialist “personality disorder” services. Studies using any qualitative method were included and thematic synthesis used to identify over-arching themes.ResultsForty-seven papers were included. Main themes were: 1) The need for a long-term perspective on treatment journeys; 2) The need for individualised and holistic care; 3) Large variations in accessibility and quality of mental health services; 4) The centrality of therapeutic relationships; 5) Impacts of ‘personality disorder’ diagnosis. Themes tended to recur across studies from different countries and years.DiscussionRecurrent major themes included wanting support that is individualised and holistic, provides continuity over long journeys towards recovery, and that is delivered by empathetic and well-informed clinicians who are hopeful but realistic about the prospects of treatment. Care that met these simple and clearly stated priorities tended to be restricted to often limited periods of treatment by specialist “personality disorder” services: generic and primary care services were often reported as far from adequate. There is an urgent need to co-design and test strategies for improving long-term support and treatment care for people with “personality disorders” throughout the mental health care system.

IntroductionThe number of bacterial sexually transmitted infections diagnosed among men who have sex with men (MSM) continues to rise annually. Innovative public health interventions are needed to address this. Partner notification (PN), is important in reducing STI transmission by identifying, testing and treating the sex partners of people with STIs. Outcomes of PN in MSM are sub-optimal; some MSM with STIs report high numbers of “one-off” sex partners (where sex occurs on one occasion only) who appear to contribute disproportionately to community transmission but are poorly reached by current PN interventions.Aims/ObjectivesThis paper describes the protocol for development of a novel, co-produced, multi-level, PN intervention for MSM with “one-off” partners. The process described will ensure the intervention is evidence-based, theoretically informed and acceptable to users, service providers, commissioners and those with community interest.Methods and AnalysisOur three-phase approach draws on the revised Medical Research Council (MRC) guidance for developing and evaluating complex interventions. First, we combine evidence synthesis with stakeholder engagement to understand the barriers and enablers to PN to co-produce preliminary intervention ideas. Next, we further develop our intervention ideas and adapt our emerging programme theory by collecting detailed data through focus groups and interviews with purposively sampled stakeholders. Data analysis using the theoretical domains framework and the behaviour change wheel will detail the relationship between putative causal mechanisms and optimal intervention components involved in enhancing PN amongst MSM. Finally, we refine our programme theory, map and clarify our intervention and its intersecting components. We will share our intervention with a panel of expert clinicians, third sector organisations and a lay audience of MSM to detail a co-produced PN intervention.OutcomeCo-produced intervention and programme theory suitable for testing in a future feasibility study.Ethics and disseminationThis protocol received ethical approval from Glasgow Caledonian University HLS/NCH/19/059. Findings will be published with open access licenses.SUMMARYPartner notification for men who have sex with men is suboptimal this paper describes a protocol to develop a co-produced multi-level partner notification intervention.

ObjectivesTo test authors’ experience of applying the STrengthening the Reporting of Observational Studies in Epidemiology-nutritional epidemiology (STROBE-nut) on a recently published paper. Correct understanding of the items on the reporting guidelines could lead to appropriate use.Designa cross sectional study, with a convenient sample.SettingParticipants were asked to return the STROBE-nut data collection template filled on recently published papers. Next, an interview was organised to collect feedback on the process of applying the guidelines. Two researchers involved in the development of STROBE-nut completed the template using the participant’s respective published papers. The filled templates were then compared to assess the measure of agreement of the STROBE-nut items as a proxy of understanding.ParticipantsAuthors who recently published papers reporting dietary assessment or food intake data.ResultsWe recruited 12 participants between May 2018 and June 2019. Five participants never used reporting guidelines before, while ten reported intention of future use. Half of the participants reported that the use of filling STROBE nut was useful, but some modifications are needed. Agreement between participants and experts on items reporting was generally low. Only two items had moderate weighted kappa agreement nut 1 (Kappa= 0.4, P 0.02) and nut 22.1 (Kappa= 0.47, P 0.01).ConclusionsThere is need to ensure correct understanding of STROBE-nut by authors. Revisions of STROBE-nut that make the items shorter and simpler can increase understanding. Training researchers at early stage on the aim of reporting guidelines could potentially increase proper use and decrease subjective interpretation.

Discrimination against racial and ethnic minority groups exists in the academy, and the associated biases impact hiring and promotion, publication rates, grant funding, and awards. Precisely how racial and ethnic bias impacts the manner in which the scientific community engages with the ideas of academics in minority groups has yet to be fully elucidated. Citations are a marker of such community engagement, as well as a currency used to attain career milestones. Here we assess the extent and drivers of racial and ethnic imbalance in the reference lists of papers published in five top neuroscience journals over the last 25 years. We find that reference lists tend to include more papers with a White person as first and last author than would be expected if race and ethnicity were unrelated to referencing. We show that this imbalance is driven largely by the citation practices of White authors, and is increasing over time even as the field diversifies. To further explain our findings, we examine co-authorship networks and find that while the network has become markedly more integrated in general, the current degree of segregation by race/ethnicity is greater now than it has been in the past. Citing further from oneself on the network is associated with greater balance, but White authors’ preferential citation of White authors remains even at high levels of network exploration. We also quantify the effects of intersecting identities, determining the relative costs of gender and race/ethnicity, and their combination in women of color. Our findings represent a call to scientists and journal editors of all disciplines to consider the ethics of citation practices, and actions to be taken in support of an equitable future.

Depression and sleep problems go hand-in-hand, while clinical improvement often emerges along the normalization of sleep architecture and realignment of the circadian rhythm. Antidepressant effects of sleep deprivation and cognitive behavioral therapy targeted at insomnia further demonstrate the confluence of sleep and mood. Moreover, recent literature showing that ketamine influences many processes related to sleep-wake neurobiology, have led to novel hypotheses explaining rapid and sustained antidepressant effects. Surprisingly, studies addressing ketamine’s antidepressant effects have had a narrow focus on solely on pharmacological aspects and often ignore the role of physiology. To illustrate this discrepancy, we conducted a literature review on articles around rapid-acting antidepressants published between 2009-2019. A gross keyword check indicated overall ignorance of sleep in most studies. To investigate the topic closer, we focused on the most cited preclinical and clinical research papers. Circadian rhythm, timing of drug administration and behavioral tests relative to light cycles, sleep, and their potential association with experimental observations were mentioned only in a handful of the papers. Most importantly, in preclinical reports the treatments have been preferentially delivered during the inactive period, which is polar opposite to clinical practice and research. We hope this report serves as a wake-up call for sleep in the field and urges (re)examining rapid-acting antidepressant effects from the perspective of wake-sleep physiology.

ObjectiveTo evaluate the consistency of causal statements in the abstracts of observational studies published in The BMJ.DesignResearch on research study.Data sourceAll cohort or longitudinal studies describing an exposure-outcome relationship published in The BMJ during 2018. We also had access to the submitted papers and reviewer reports.Main outcome measures:Proportion of published research papers with ‘inconsistent’ use of causal language in the abstract. Papers where language was consistently causal or non-causal were classified as ‘consistently causal’ or ‘consistently not causal’, respectively; those where causality may be inferred were classified as ‘suggests causal’. For the ‘inconsistent’ papers, we then compared the published and submitted version.ResultsOf 151 published research papers, 60 described eligible studies. Of these 60, we classified the causal language used as ‘consistently causal’ (13%), ‘suggests causal’ (35%), ‘inconsistent’ (20%) and ‘consistently not causal’(32%). The majority of the ‘Inconsistent’ papers (92%) were already inconsistent on submission. The inconsistencies found in both submitted and published versions was mainly due to mismatches between objectives and conclusions. One section might be carefully phrased in terms of association while the other presented causal language. When identifying only an association, some authors jumped to recommending acting on the findings as if motivated by the evidence presented.ConclusionFurther guidance is necessary for authors on what constitutes a causal statement and how to justify or discuss assumptions involved. Based on screening these abstracts, we provide a list of expressions beyond the obvious ‘cause’ word which may inspire a useful more comprehensive compendium on causal language.Strengths and limitations of this studyWe present examples of ambiguous causal statements in published abstracts of observational studies in a high impact journalWe focused on the abstract where clear messages are especially important, as many readers just read the abstract of a studyThe focus on the abstract may miss further discussion on the validity of underlying assumptions justifying causal inference in the setting studied.The prevalence and nature of the problems found is a call for better instruction on and consideration of causal language throughout the editorial process in clinical and epidemiological research.We provide a list of words and study elements that could point in the direction of causality or otherwise, which may inspire a more comprehensive compendium.

AimTo systematically review qualitative literature on social distancing in order to identify and describe factors that enable or prevent its implementation.MethodsA rapid systematic qualitative review was conducted in accordance with PRISMA and ENTREQ guidelines. A comprehensive systematic search was carried out in MEDLINE, EMBASE, PsychINFO, Global Health, CINAHL and Web of Science. Included papers (i) report on primary qualitative studies (ii) of the barriers and facilitators to the implementation of social distancing measures (iii) in potentially epidemic infectious diseases. After critical appraisal and standardised data extraction, a meta-ethnographical approach was used for synthesis. Review findings were assessed for strength and reliability using CerQUAL.Results28 papers were included from the systematic search that yielded 5620 results. One additional paper was found by searching references. The review identifies two broad categories of barriers to social distancing measures: individual- or community-level psychological or sociological phenomena, and perceived shortcomings in governmental action. Based on this, 25 themes are identified that can be addressed to improve the implementation of social distancing.ConclusionThere are many barriers, on different levels, to the implementation of social distancing measures. Among other findings, the review identifies the need for good communication as well as the need for authorities to provide comprehensive support as two key opportunities to increase acceptability and adherence. High-quality research is needed during the COVID-19 pandemic to better describe mechanisms by which implementation of social distancing can be improved, and, more importantly, what is already known has to be put into practice.

Managing COVID-19 within a university setting presents unique challenges. At the start of term, students arrive from geographically diverse locations and potentially have higher numbers of social contacts than the general population, particularly if living in university halls of residence accommodation. Mathematical models are useful tools for understanding the potential spread of infection and are being actively used to inform policy about the management of COVID-19. Our aim was to provide a rapid review and appraisal of the literature on mathematical models investigating COVID-19 infection in a university setting. We searched PubMed, Web of Science, bioRxiv/ medRxiv and sought expert input via social media to identify relevant papers. BioRxiv/ medRxiv and PubMed/Web of Science searches took place on 3 and 6 July 2020, respectively. Papers were restricted to English language. Screening of peer-reviewed and pre-print papers and contact with experts yielded five relevant papers – all of which were pre-prints. All models suggest a significant potential for transmission of COVID-19 in universities. Testing of symptomatic persons and screening of the university community regardless of symptoms, combined with isolation of infected individuals and effective contact tracing were critical for infection control in the absence of other mitigation interventions. When other mitigation interventions were considered (such as moving teaching online, social/physical distancing, and the use of face coverings) the additional value of screening for infection control was limited. Multiple interventions will be needed to control infection spread within the university setting and the interaction with the wider community is an important consideration. Isolation of identified cases and quarantine of contacts is likely to lead to large numbers of students requiring educational, psychological and behavioural support and will likely have a large impact on the attendance of students (and staff), necessitating online options for teaching, even where in-person classes are taking place. Models were highly sensitive to assumptions in the parameters, including the number and type of individuals’ contacts, number of contacts traced, frequency of screening and delays in testing. Future models could aid policy decisions by considering the incremental benefit of multiple interventions and using empirical data on mixing within the university community and with the wider community where available. Universities will need to be able to adapt quickly to the evolving situation locally to support the health and wellbeing of the university and wider communities.

The gender gap in chemistry has been the topic of much debate, with many perspectives stating that the field has improved, and outdated sexist views are behind us. While these views are common, we wanted to assess the accuracy of these comments from a data-driven perspective. In this study, we use PubMed to obtain the names of first and last authors for every paper published since 2005 across 15 journals. Each name was cross-referenced with a name-based gender API to give a predicted binary gender and a confidence score based on population data. We show that historically there has been an extensive overrepresentation of men in both first and corresponding authorship, and that there is no strong trend towards parity since 2005. We demonstrate that papers with female corresponding authors have more equitable gender representation of first authors. Finally, we find that there is significant variability among journals in the gender make-up of their editorial boards. We hope this analysis spurs creative discussions on how we can improve equitable gender representation in chemistry publications.

IntroductionSocial distancing measures (SDMs) protect public health from the outbreak of coronavirus disease 2019 (COVID-19). However, the impact of SDMs has been inconsistent and unclear. This study aims to assess the effects of SDMs (e.g. isolation, quarantine) for reducing the transmission of COVID-19.Methods and analysisWe will conduct a systematic review meta-analysis research of both randomised controlled trials and non-randomised controlled trials. We will search MEDLINE, EMBASE, Allied & Complementary Medicine, COVID-19 Research and WHO database on COVID-19 for primary studies assessing the effects of SDMs (e.g. isolation, quarantine) for reducing the transmission of COVID-19, and will be reported in accordance with PRISMA statement. The PRISMA-P checklist will be used while preparing this protocol. We will use Joanna Briggs Institute guidelines (JBI Critical Appraisal Checklists) to assess the methodological qualities and synthesised performing thematic analysis. Two reviewers will independently screen the papers and extracted data. If sufficient data are available, the random-effects model for meta-analysis will be performed to measure the effect size of SDMs or the strengths of relationships. To assess the heterogeneity of effects, I2 together with the observed effects (Q-value, with degrees of freedom) will be used to provide the true effects in the analysis.Ethics and disseminationEthics approval and consent will not be required for this systematic review of the literature as it does not involve human participation. We will be able to disseminate the study findings using the following strategies: we will be publishing at least one paper in peer-reviewed journals, and an abstract will be presented at suitable national/international conferences or workshops. We will also share important information with public health authorities as well as with the World Health Organization. In addition, we may post the submitted manuscript under review to bioRxiv, medRxiv, or other relevant pre-print servers.Strengths and limitations of this studyTo our knowledge, this study will be the first systematic review to examine the impact of social distancing measures to reduce transmission of COVID-19.This study will offer highest level of evidence for informed decisions, drawing a broader framework.This protocol reduces the possibility of duplication, provides transparency to the methods and procedures that will be used, minimise potential biases and allows peer-review.This research is not externally funded, and therefore time and resource will be constrained.If included studies will be variable in sample size, quality and population, which may open to bias, and the heterogeneity of data will preclude a meaningful meta-analysis to measure the impact of specific SDMs

Calculated A-level grades will replace actual, attained A-levels and other Key Stage 5 qualifications in 2020 in the UK as a result of the COVID-19 pandemic. This paper assesses the likely consequences for medical schools in particular, beginning with an overview of the research literature on predicted grades, concluding that calculated grades are likely to correlate strongly with the predicted grades that schools currently provide on UCAS applications. A notable absence from the literature is evidence on whether predicted grades are better or worse than actual grades in predicting university outcomes. This paper provides such evidence on the reduced predictive validity of predicted A-level grades in comparison with actual A-level grades.The present study analyses the extensive data on predicted and actual grades which are available in UKMED (United Kingdom Medical Education Database), a large-scale administrative dataset containing longitudinal data from medical school application, through undergraduate and then postgraduate training. In particular, predicted A-level grades as well as actual A-level grades are available, along with undergraduate outcomes and postgraduate outcomes which can be used to assess predictive validity of measures collected at selection. This study looks at two UKMED datasets. In the first dataset we compare actual and predicted A-level grades in 237,030 A-levels taken by medical school applicants between 2010 and 2018. 48.8% of predicted grades were accurate, grades were over-predicted in 44.7% of cases and under-predicted in 6.5% of cases. Some A-level subjects, General Studies in particular, showed a higher degree of over-estimation. Similar over-prediction was found for Extended Project Qualifications, and for SQA Advanced Highers.The second dataset considered 22,150 18-year old applicants to medical school in 2010 to 2014, who had both predicted and actual A-level grades. 12,600 students entered medical school and had final year outcomes available. In addition there were postgraduate outcomes for 1,340 doctors. Undergraduate outcomes are predicted significantly better by actual, attained A-level grades than by predicted A-level grades, as is also the case for postgraduate outcomes.Modelling the effect of selecting only on calculated grades suggests that because of the lesser predictive ability of predicted grades, medical school cohorts for the 2020 entry year are likely to under-attain, with 13% more gaining the equivalent of the current lowest decile of performance, and 16% fewer gaining the equivalent of the current top decile, effects which are then likely to follow through into postgraduate training. The problems of predicted/calculated grades can to some extent, although not entirely, be ameliorated, by taking U(K)CAT, BMAT, and perhaps other measures into account to supplement calculated grades. Medical schools will probably also need to consider whether additional teaching is needed for entrants who are struggling, or might have missed out on important aspects of A-level teaching, with extra support being needed, so that standards are maintained.“… the … exam hall [is] a level playing field for all abilities, races and genders to get the grades they truly worked hard for and in true anonymity (as the examiners marking don’t know you). [… Now we] are being given grades based on mere predictions.” Yasmin Hussein, letter to The Guardian, March 29th 2020 [1].“[Let’s] be honest, this year group will always be different.” Dave Thomson, blogpost on FFT Educational Lab [2]“One headmistress commented that ‘entrance to university on teachers’ estimates may be fraught with unimagined difficulties’. … If there is in the future considerable emphasis on school assessment, some work of calibration is imperatively called for.” James Petch, December 1964[3].

BackgroundNeuropsychological tests of executive function have limited real-world predictive and functional relevance. An emerging solution for this limitation is to adapt the tests for implementation in virtual reality (VR). We thus developed two VR-based versions of the classic Color-Trails Test (CTT), a well-validated pencil-and-paper executive function test assessing sustained (Trails A) and divided (Trails B) attention - one for a large-scale VR system (DOME-CTT) and the other for a portable head-mount display VR system (HMD-CTT). We then evaluated construct validity, test-retest reliability, and age-related discriminant validity of the VR-based versions and explored effects on motor function.MethodsHealthy adults (n=147) in three age groups (young: n=50; middle-aged: n=80; older: n=17) participated. All participants were administered the original CTT, some completing the DOME-CTT (14 young, 29 middle-aged) and the rest completing the HMD-CTT. Primary outcomes were Trails A and B completion times (tA, tB). Spatiotemporal characteristics of upper-limb reaching movements during VR test performance were reconstructed from motion capture data. Statistics included correlations and repeated measures analysis of variance.ResultsConstruct validity was substantiated by moderate correlations between the ‘gold standard’ pencil-and-paper CTT and the VR adaptations (DOME-CTT: tA 0.58, tB 0.71; HMD-CTT: tA 0.62, tB 0.69). VR versions showed relatively high test-retest reliability (intraclass correlation; VR: tA 0.60-0.75, tB 0.59-0.89; original: tA 0.75-0.85, tB 0.77-0.80) and discriminant validity (area under the curve; VR: tA 0.70-0.92, tB 0.71-0.92; original: tA 0.73-0.95, tB 0.77-0.95). VR completion times were longer than for the original pencil-and-paper test; completion times were longer with advanced age. Compared with Trails A, Trails B target-to-target VR hand trajectories were characterized by delayed, more erratic acceleration and deceleration, consistent with the greater executive function demands of divided vs. sustained attention; acceleration onset later for older participants.ConclusionsThe present study demonstrates the feasibility and validity of converting a neuropsychological test from two-dimensional pencil-and-paper to three-dimensional VR-based format while preserving core neuropsychological task features. Findings on the spatiotemporal morphology of motor planning/execution during the cognitive tasks may lead to multimodal analysis methods that enrich the ecological validity of VR-based neuropsychological testing, representing a novel paradigm for studying cognitive-motor interactions.

The human body is exceptional for many reasons, not the least of which is the wide variety of movements it is capable of executing. Because our species is able to execute so many discrete activities, researchers often disagree on which were the movements most essential to the evolution of our species. This paper continues a recently introduced analysis, that the performance gap between female and male athletes narrows in sports which most reflect the movements humans evolved to do. Here, I examine the performance gap in rock climbing. Female climbers are some of the best in the world irrespective of gender, a trend that is not found in any other major sport. I conclude that the exceptional ability of female rock climbers relative to male rock climbers is further evidence of the existence of sex-blind musculoskeletal adaptations, which developed over the course of human evolution – as a result of external (non-sexual) selection forces – to facilitate essential movements. These adaptations abate some of the general physical sexual dimorphism which exists in humans. This paper provides more evidence that the human body was shaped, in part, by pressure to climb well., Graphical abstract Image 1, Highlights • Rock climbing is the sport most similar to tree climbing, a movement essential to human development. • Multiple women can be found in the list of top 100 rock climbers, a trend not found in any other major sport. • Sports with a higher degree of gender equity, may reflect movements with a greater degree of evolutionary importance. • Rock climbing’s gender gap provides further evidence that early humans faced external selection pressure to climb well. • Thus, the importance of climbing to the survival of humans - even after the onset of genus Homo - may be understated.

It has extensively been documented that human memory exhibits a wide range of systematic distortions, which have been associated with resource constraints. Resource constraints on memory can be formalised in the normative framework of lossy compression, however traditional lossy compression algorithms result in qualitatively different distortions to those found in experiments with humans. We argue that the form of distortions is characteristic of relying on a generative model adapted to the environment for compression. We show that this semantic compression framework can provide a unifying explanation of a wide variety of memory phenomena. We harness recent advances in learning deep generative models, that yield powerful tools to approximate generative models of complex data. We use three datasets, chess games, natural text, and hand-drawn sketches, to demonstrate the effects of semantic compression on memory performance. Our model accounts for memory distortions related to domain expertise, gist-based distortions, contextual effects, and delayed recall., Author summary Human memory performs surprisingly poorly in many everyday tasks, which have been richly documented in laboratory experiments. While constraints on memory resources necessarily imply a loss of information, it is possible to do well or badly in relation to available memory resources. In this paper we recruit information theory, which establishes how to optimally lose information based on prior and complete knowledge of environmental statistics. For this, we address two challenges. 1, The environmental statistics is not known for the brain, rather these have to be learned over time from limited observations. 2, Information theory does not specify how different distortions of original experiences should be penalised. In this paper we tackle these challenges by assuming that a latent variable generative model of the environment is maintained in semantic memory. We show that compression of experiences through a generative model gives rise to systematic distortions that qualitatively correspond to a diverse range of observations in the experimental literature.

Programs to manage long term conditions in developed countries seek greater integration and communication between health professionals to improve health outcomes. But more empirical evidence is needed to measure integration and influence for health those who are involved in these programs. This paper analyses the way in which health professionals interact at the primary and secondary care interface, based on integrated care design in a program of chronic care in New Zealand. The frequency, quality and perceived value of the interactions between general practitioners, practices nurses, medical specialists and specialist nurses are used as explanatory variables in graphical models which take a social network analysis approach. The paper shows the configuration of the network between health professionals in an integrated care context and explains the academic and policy implication of the findings. Keywords: Organizational networks, Inter-professional networks, Interaction patterns, integrated care, Primary and secondary care interface