Living on Site While Renovating; Flexible Instructional Design of Post-Graduate Medical Training.

Background: Developing theoretical courses for post-graduate medical training that are aligned to current workplace-based learning practices and adaptive to change in the field is challenging, especially in (sub) specialties where time for re-design is limited and needs to be performed while education continues. Approach: An instructional design method was applied based on flexible co-design to improve post-graduate theoretical courses in child and adolescent psychiatry (CAP) in the Netherlands. In four phases over a period of three years, courses were re-designed at a national level. Evaluation: Once common vision and learning goals were agreed upon and the prototype was developed (phases 1 and 2), the first courses could be tested in daily practice (phase 3). Phase 4 refined these courses in brief iterative cycles and allowed for designing additional courses building on and adding to previous experiences in brief iterative cycles. The resulting national theoretical courses re-allocated resources previously spent on a local level using easily accessible online tools. This allowed trainees to align content with their clinical rotations, personal preferences and training schedules. Reflection: The development of theoretical courses for post-graduate medical training in smaller medical (sub-)specialties with limited resources may profit from a flexible instructional design method. We consider the potential merit of such a method to other medical specialties and other (inter-)national efforts to develop theoretical teaching courses. A longer-term implementation evaluation is needed to show to what extent the investment made in the re-design proves to be future-proof and enables rapid adaptation to changes in the field.

Impact of Social Media Addiction and Internet Gaming Disorder on Sleep Quality: Serial Mediation Analyses.

Poor sleep quality is a concerning and prevalent consequence of social media addiction (SMA) and internet gaming disorder (IGD). Due to the lack of research examining how SMA and IGD lead to poor sleep quality, the current study aimed to understand the relationship between SMA and sleep quality, as well as that between IGD and sleep quality, through impulse control and bedtime procrastination. The study tested the hypotheses that higher levels of SMA and IGD would predict lower levels of impulse control, which would then predict higher levels of bedtime procrastination, leading to poorer sleep quality. A serial mediation analysis was performed with a sample of 221 participants (63.3% females, 34.4% males, and 2.3% prefer not to say) aged 18 to 53 years (M = 23.64, SD = 5.72). Participants completed questionnaires that assessed for social media addiction, internet gaming disorder, impulse control factor, bedtime procrastination, and sleep quality. There was a full serial mediation of impulse control and bedtime procrastination in the relationship between SMA and sleep quality, as well as that between IGD and sleep quality, providing support for the hypotheses. The findings provide the knowledge needed to develop and implement strategies that target impulse control issues and reduce bedtime procrastination to improve sleep quality.

Psychosocial risk factors of youth suicide in the Western Pacific: a scoping review.

INTRODUCTION:  The Western Pacific region accounts for 25% of global suicide rates globally. In the last decade, however, there is a rising concern over the rate of youth suicides in the region. In line with the regional vision of reducing the rate of non-communicable diseases by 2025, the study contributes to the literature by utilizing a scoping review approach to identify psychosocial risk factors associated with youth suicide in the region. METHOD: Publications on youth suicide in the Western Pacific region between 2010 and 2021 were reviewed. A total of 43 publications met the inclusion criteria and were read in full. RESULTS: Psychosocial risk factors associated with suicide in each publication were identified and thematically classified into five themes: interpersonal factors, history of abuse, academic factors, work factors, and minority status. DISCUSSION: Findings showed discrepancies in youth suicide research across member nations in the Western Pacific. Implications for regional policies on suicide prevention and future research were discussed.

Water binding and hygroscopicity in π-conjugated polyelectrolytes.

The presence of water strongly influences structure, dynamics and properties of ion-containing soft matter. Yet, the hydration of such matter is not well understood. Here, we show through a large study of monovalent π-conjugated polyelectrolytes that their reversible hydration, up to several water molecules per ion pair, occurs chiefly at the interface between the ion clusters and the hydrophobic matrix without disrupting ion packing. This establishes the appropriate model to be surface hydration, not the often-assumed internal hydration of the ion clusters. Through detailed analysis of desorption energies and O-H vibrational frequencies, together with OPLS4 and DFT calculations, we have elucidated key binding motifs of the sorbed water. Type-I water, which desorbs below 50 °C, corresponds to hydrogen-bonded water clusters constituting secondary hydration. Type-II water, which typically desorbs over 50-150 °C, corresponds to water bound to the anion under the influence of a proximal cation, or to a cation‒anion pair, at the cluster surface. This constitutes primary hydration. Type-III water, which irreversibly desorbs beyond 150 °C, corresponds to water kinetically trapped between ions. Its amount varies strongly with processing and heat treatment. As a consequence, hygroscopicity-which is the water sorption capacity per ion pair-depends not only on the ions, but also their cluster morphology.

Outcome of Absence Epilepsy With Onset at 8-11 Years of Age: Watershed Ages When Syndromes Overlap.

Introduction: Absence seizures occur in various epilepsy syndromes, including childhood and juvenile absence epilepsy and juvenile myoclonic epilepsy. When children present with absence seizures at ages when syndromes overlap, initial syndrome designation is not always possible, making early prognostication challenging. For these children, the study objective is to determine clinical and initial electroencephalograph (EEG) findings to predict the development of generalized tonic-clonic seizures, which is a factor that affects outcome. Methods: Children with new-onset absence seizures between 8 and 11 years of age with at least 5 years of follow-up data were studied through the review of medical records and initial EEG tracings. Results: Ninety-eight patients were included in the study. The median age of absence seizure onset was 9 years (interquartile range [IQR] = 8.00, 10.00) and follow-up was 15 years (IQR = 13.00, 18.00). Forty-six percent developed generalized tonic-clonic seizures and 20% developed myoclonic seizures. On multiple regression analysis, a history of myoclonic seizures, anxiety, as well as bifrontal slowing and mild background slowing on initial EEG (P < .05) were associated with generalized tonic-clonic seizures. Although not statistically significant, a shorter duration of shortest EEG burst on baseline EEG was also associated with generalized tonic-clonic seizures. Conclusion: On initial EEG, bifrontal and background slowing and myoclonic seizures and anxiety are associated with developing generalized tonic-clonic seizures, which is of prognostic significance when early syndrome designation is difficult.

Tissue-resident memory T cells in the era of (Neo) adjuvant melanoma management.

Tissue-resident memory T (TRM) cells have emerged as key players in the immune control of melanoma. These specialized cells are identified by expression of tissue retention markers such as CD69, CD103 and CD49a with downregulation of egress molecules such as Sphingosine-1-Phosphate Receptor-1 (S1PR1) and the lymphoid homing receptor, CD62L. TRM have been shown to be integral in controlling infections such as herpes simplex virus (HSV), lymphocytic choriomeningitis virus (LCMV) and influenza. More recently, robust pre-clinical models have also demonstrated TRM are able to maintain melanoma in a dormant state without progression to macroscopic disease reminiscent of their ability to control viral infections. The discovery of the role these cells play in anti-melanoma immunity has coincided with the advent of immune checkpoint inhibitor (ICI) therapy which has revolutionized the treatment of cancers. ICIs that target programmed death protein-1 (PD-1) and cytotoxic T lymphocyte antigen-4 (CTLA-4) have led to substantial improvements in outcomes for patients with metastatic melanoma and have been rapidly employed to reduce recurrences in the resected stage III setting. While ICIs mediate anti-tumor activity via CD8+ T cells, the specific subsets that facilitate this response is unclear. TRM invariably exhibit high expression of immune checkpoints such as PD-1, CTLA-4 and lymphocyte activating gene-3 (LAG-3) which strongly implicates this CD8+ T cell subset as a crucial mediator of ICI activity. In this review, we present pre-clinical and translational studies that highlight the critical role of TRM in both immune control of primary melanoma and as a key CD8+ T cell subset that mediates anti-tumor activity of ICIs for the treatment of melanoma.

Adult medulloblastoma in an Australian population.

Medulloblastoma in adult patients is a rare condition with limited contemporary demographic and treatment outcome data available in an Australian population. We conducted a retrospective review of patterns of care and outcomes of adult patients diagnosed with medulloblastoma treated at major neuro-oncology centres across Australia between January 2010 and December 2019. A total of 80 patients were identified and the median follow-up after diagnosis was 59.2 (range 0.5-204) months. A variety of chemotherapy regimens were used in the adjuvant and recurrent settings. The median overall survival (mOS) was 78 months (IQR 17.5-94.8). Patients who had no residual disease post-resection or with SHH-subtype tumours had a numerically longer 5-year survival rate than those with residual disease post resection or non-SHH subtypes respectively. The median time to recurrence from diagnosis was 18.4 months. The median OS from 1st relapse was 22.1 months (95% CI 11.7-31.4) and mOS from second relapse was 10.2 months (95% CI 6.6 - NR). This is the largest dataset examining patterns of care of adult patients with medulloblastoma in an Australian population. Substantial variation existed in the chemotherapy agents used in the adjuvant and recurrent setting. As has been demonstrated in a paediatric population, trials such as the upcoming EORTC 1634-BTG/NOA-23 trial (PersoMed-1 study) which are tailoring treatments to molecular profiles are likely to improve outcome in adult medulloblastoma.

Double-type-I charge-injection heterostructure for quantum-dot light-emitting diodes.

Enforcing balanced electron-hole injection into the emitter layer of quantum-dot light-emitting diodes (QLEDs) remains key to maximizing the quantum efficiency over a wide current density range. This was previously thought not possible for quantum dot (QD) emitters because of their very deep energy bands. Here, we show using Mesolight® blue-emitting CdZnSeS/ZnS QDs as a model that its valence levels are in fact considerably shallower than the corresponding band maximum of the bulk semiconductor, which makes the ideal double-type-I injection/confinement heterostructure accessible using a variety of polymer organic semiconductors as transport and injection layers. We demonstrate flat external quantum efficiency characteristics that indicate near perfect recombination within the QD layer over several decades of current density from the onset of device turn-on of about 10 µA cm-2, for both normal and inverted QLED architectures. We also demonstrate that these organic semiconductors do not chemically degrade the QDs, unlike the usual ZnMgO nanoparticles. However, these more efficient injection heterostructures expose a new vulnerability of the QDs to in device electrochemical degradation. The work here opens a clear path towards next-generation ultra-high-performance, all-solution-processed QLEDs.

Mortality Salience Effects of Critical Incidents - A Systematic Literature Review and Research Agenda.

Critical incidents (CI) trigger acute stress reactions and psychological trauma because of direct or vicarious exposure. These events include natural disasters, wars, terrorist attacks and pandemics, and usually result in deaths and serious physical injuries. Their life-threatening nature makes them reasonable candidates to induce mortality salience (MS). The current review aims to consolidate Terror Management Theory (TMT) research using CIs as MS. A systematic literature review was conducted. Overall, 74 articles with 113 studies were included. Through this review, strong support for MS effects of CI has been found. Consistent with TMT, CIs tend to trigger worldview defence, self-esteem enhancement and relationship seeking. CIs have also been found to impact negatively on individual well-being and organisational health. Recommendations specific to crisis interventions and well-being will be discussed. The review concludes with potential future research directions to strengthen and expand empirical knowledge in CI salience.

Big Data Analysis of Terror Management Theory's Predictions in the COVID-19 Pandemic.

The current study aimed to address the limitations of the terror management theory literature by using big data analysis to examine the theory's predictions in the COVID-19 pandemic. Specifically, Google Trends were examined before and after the first COVID-19 case was identified in Singapore. The results showed that there was a significant increase in mortality salience, intergroup conflict, and prosocial behavior, and a significant decrease in materialism after the first COVID-19 case was identified. However, no significant differences were found for anxiety. Limitations include the assumption that search terms reflect intentions that would eventually lead to a relevant behavior and the lack of data from other sources to corroborate with the results from Google Trends. Future research could use data from other sources to examine the effects of COVID-19 on theoretically relevant behaviors.

School performance in children at the time of new-onset seizures and at long-term follow-up: A retrospective cohort study.

OBJECTIVE: School-performance difficulties (SPD) are common in children with epilepsy. The objectives of this study were to determine if the rate of SPD in children with seizures change from seizure-onset to follow-up and differ from children with psychiatric disorders. METHODS: School-aged children who required an initial electroencephalography (EEG) test in 2016 were reviewed and separated into two groups based on the presence or absence of seizures. Developmental delay and SPD were compared between groups at initial assessment and SPD was assessed after 2-4 years of follow-up. Analysis was also performed on a sub-set of patients with psychiatric disorders. RESULTS: At baseline, the rate of SPD was similar between the seizure (n = 146) and non-seizure (n = 332) groups [26% vs. 27%]. At follow-up, the seizure (n = 119) group had a significantly higher rate of SPD than the non-seizure (n = 215) group (54% vs. 43%). There was no difference in the rate of SPD between the seizure (n = 119) and psychiatric (n = 69) groups at baseline (31% vs. 43%) or follow-up (54% vs. 55%). CONCLUSION: Over time, children with recurrent seizures experience more SPD than children without seizures, but similar SPD to children with psychiatric disorders.

Role of Linker Functionality in Polymers Exhibiting Main-Chain Thermally Activated Delayed Fluorescence.

Excellent performance has been reported for organic light-emitting diodes (OLEDs) based on small molecule emitters that exhibit thermally activated delayed fluorescence. However, the necessary vacuum processing makes the fabrication of large-area devices based on these emitters cumbersome and expensive. Here, the authors present high performance OLEDs, based on novel, TADF polymers that can be readily processed from a solution. These polymers are based on the acridine-benzophenone donor-acceptor motif as main-chain TADF chromophores, linked by various conjugated and non-conjugated spacer moieties. The authors' extensive spectroscopic and electronic analysis shows that in particular in case of alkyl spacers, the properties and performance of the monomeric TADF chromophores are virtually left unaffected by the polymerization. They present efficient solution-processed OLEDs based on these TADF polymers, diluted in oligostyrene as a host. The devices based on the alkyl spacer-based TADF polymers exhibit external quantum efficiencies (EQEs) ≈12%, without any outcoupling-enhancing measures. What's more, the EQE of these devices does not drop substantially upon diluting the polymer down to only ten weight percent of active material. In contrast, the EQE of devices based on the monomeric chromophore show significant losses upon dilution due to loss of charge percolation.

A meta-analytic review of Internet gaming disorder and the Big Five personality factors.

Two systematic reviews have been conducted to summarize the literature on Internet Gaming Disorder (IGD) and personality. However, the data was not synthesized statistically, imposing a limit to their conclusions. The current study aimed to extend on the two reviews by conducting a series of five meta-analyses, one for each of the Big Five personality factors, to examine their relationships with IGD. A comprehensive search was conducted on the databases PsycArticles, PsycInfo, and Web of Science from inception to 29 July 2021. The data was analyzed using Meta-Essentials and the random effects model was used to obtain the pooled estimate of the effect size. A total of 12 articles were included (n = 145 to 3389). IGD was not significantly correlated with openness to experience (r = -0.05). However, IGD was negatively correlated with conscientiousness (r = -0.29), extraversion (r = -0.15), and agreeableness (r = -0.17), and positively correlated with neuroticism (r = 0.20). Age moderated the relationships between IGD and openness to experience and conscientiousness. The results were broadly consistent with the DSM-5 IGD criteria and the Big Five personality framework. Future research directions might include examining age as moderator variables, and using appropriate instruments based on the DSM-5 IGD criteria.

Mortality salience in an offline and online setting.

The current study aims to examine the effects of mortality salience effects on worldview defense in an offline and online setting. Participants were 146 (66 offline and 80 online) Singaporeans. Participants were randomly assigned to either the mortality salience condition or the control condition and after a delay completed a Worldview Defense Assessment. No significant mortality salience effects on worldview defense occurred in either setting. The results might be explained by the Asian sample, Singapore's culture of tolerance, and data collection during the Coronavirus Disease 2019 (COVID-19) pandemic. Future research directions include examining the effects of COVID-19 in activating worldview defense.

Overcoming the water oxidative limit for ultra-high-workfunction hole-doped polymers.

It is widely thought that the water-oxidation reaction limits the maximum work function to about 5.25 eV for hole-doped semiconductors exposed to the ambient, constrained by the oxidation potential of air-saturated water. Here, we show that polymer organic semiconductors, when hole-doped, can show work functions up to 5.9 eV, and yet remain stable in the ambient. We further show that de-doping of the polymer is not determined by the oxidation of bulk water, as previously thought, due to its general absence, but by the counter-balancing anion and its ubiquitously hydrated complexes. The effective donor levels of these species, representing the edge of the 'chemical' density of states, can be depressed to about 6.0 eV below vacuum level. This can be achieved by raising the oxidation potential for hydronium generation, using large super-acid anions that are themselves also stable against oxidation. In this way, we demonstrate that poly(fluorene-alt-triarylamine) derivatives with tethered perfluoroalkyl-sulfonylimidosulfonyl anions can provide ambient solution-processability directly in the ultrahigh-workfunction hole-doped state to give films with good thermal stability. These results lay the path for design of soft materials for battery, bio-electronic and thermoelectric applications.

Improving organic photovoltaic cells by forcing electrode work function well beyond onset of Ohmic transition.

As electrode work function rises or falls sufficiently, the organic semiconductor/electrode contact reaches Fermi-level pinning, and then, few tenths of an electron-volt later, Ohmic transition. For organic solar cells, the resultant flattening of open-circuit voltage (Voc) and fill factor (FF) leads to a 'plateau' that maximizes power conversion efficiency (PCE). Here, we demonstrate this plateau in fact tilts slightly upwards. Thus, further driving of the electrode work function can continue to improve Voc and FF, albeit slowly. The first effect arises from the coercion of Fermi level up the semiconductor density-of-states in the case of 'soft' Fermi pinning, raising cell built-in potential. The second effect arises from the contact-induced enhancement of majority-carrier mobility. We exemplify these using PBDTTPD:PCBM solar cells, where PBDTTPD is a prototypal face-stacked semiconductor, and where work function of the hole collection layer is systematically 'tuned' from onset of Fermi-level pinning, through Ohmic transition, and well into the Ohmic regime.

Do Distinct Groups of Reactively and Proactively Aggressive Children Exist? A Confirmatory Latent Profile Approach.

The present study examined whether there are distinct groups of children with reactive versus proactive motives for their aggressive behavior. We extended previous research by using a person-based analytical approach on data from a questionnaire assessing children's motives independently from the severity of their aggression. Two competing hypotheses were tested. The both subtypes hypothesis holds that both reactive and proactive subtypes exist, as well as a mixed subtype. The reactive only hypothesis holds that only reactive and mixed subtypes exist. Hypotheses were tested on existing data from a community sample of children displaying aggression (Study 1: n = 228, ages 10-13, 54% boys), and two clinical samples of children with aggressive behavior problems (Study 2: n = 115, ages 8-13, 100% boys; Study 3: n = 123, ages 6-8, 78% boys). Teachers reported on children's reactive and proactive motives. We selected measures available from peers, parents, teachers, and children themselves to compare the supported subtypes on variables that previous literature suggests uniquely correlate with reactive versus proactive aggression. Confirmatory latent profile analyses revealed that the both subtypes hypothesis best fit the data of all three samples. Most children were classified as reactive (55.7-61.8% across samples), with smaller percentages classified as proactive (10.4-24.1%) and mixed (18.0-33.9%). However, these subtypes only differed in expected directions on 7 out of 34 measures. Overall, results support the existence of both reactive and proactive subtypes of aggressive children, but the distinctiveness of these subtypes in terms of social-emotional characteristics warrants further study.

Surface Doping of Organic Single-Crystal Semiconductors to Produce Strain-Sensitive Conductive Nanosheets.

A highly periodic electrostatic potential, even though established in van der Waals bonded organic crystals, is essential for the realization of a coherent band electron system. While impurity doping is an effective chemical operation that can precisely tune the energy of an electronic system, it always faces an unavoidable difficulty in molecular crystals because the introduction of a relatively high density of dopants inevitably destroys the highly ordered molecular framework. In striking contrast, a versatile strategy is presented to create coherent 2D electronic carriers at the surface of organic semiconductor crystals with their precise molecular structures preserved perfectly. The formation of an assembly of redox-active molecular dopants via a simple one-shot solution process on a molecularly flat crystalline surface allows efficient chemical doping and results in a relatively high carrier density of 1013 cm-2 at room temperature. Structural and magnetotransport analyses comprehensively reveal that excellent carrier transport and piezoresistive effects can be obtained that are similar to those in bulk crystals.

Infantile Spasms and Trisomy 21: Unfavorable Outcomes with First-line Vigabatrin Therapy.

INTRODUCTION: Among children with infantile spasms (ISs), those with trisomy 21 (T21) and those with normal development at onset and no identifiable etiology (previously referred to as "idiopathic") are expected to have relatively favorable outcomes. The study objective is to determine if differences exist in treatment response, relapse, and subsequent epilepsy between these two groups when vigabatrin is used as first-line treatment. METHODS: In this retrospective study, patients were classified into the following groups and clinical features were compared: T21 (n = 24) and IS with normal development at onset and no identified etiology (n = 40; control group). RESULTS: There was no significant difference in the age of IS onset, sex distribution, or treatment lag between the groups. The T21 compared to the control group required a higher mean number of anti-seizure therapies (3.6 vs. 1.9, p < 0.001), had more relapses [10 (42%) vs. 4 (10%), p < 0.005)], and had higher risk of subsequent epilepsy [11 (46%) vs. 8 (20%), p < 0.003]. Relapses were often delayed in the T21 group, with a mean of 8 months after IS cessation. CONCLUSION: Our results differ from most studies using steroids as first-line treatment where the groups were shown to have similar treatment response and T21 patients had a low risk of relapse and subsequent epilepsy. Therefore, our results suggest that vigabatrin as first-line treatment in T21 with IS may be less favorable than steroids.