Somatic symptoms in the general population of Spain: Validation and normative data of the Patient Health Questionnaire-15 (PHQ-15).

OBJECTIVE: The Patient Health Questionnaire (PHQ-15) has been widely used to assess somatic symptoms. This study aimed to analyze the psychometric properties of the Spanish version of the PHQ-15, its structure and score distribution across demographic variables in a Spanish sample. In addition, we examined variations in somatic symptoms among different demographic subgroups. METHOD: 1495 individuals from the Spanish population answered a series of self-reported measures, including PHQ-15. To examine the factorial structure of the PHQ-15, Confirmatory Factor Analysis (CFA) was performed. Additionally, a bifactor CFA model was examined using the Exploratory Structural Equation Modeling (ESEM) framework. RESULTS: Women showed more somatic symptoms than men, and younger individuals showed more somatic symptoms than the older ones. It was also revealed positive associations between somatic symptoms and levels of depression, anxiety, and suspiciousness, while negative associations were found between somatic symptoms and perceived resilience and happiness. Regarding the factorial structure of the PHQ-15, although the one-factor and bifactor models were suitable, the bifactor model underscores the presence of a robust general factor. LIMITATIONS: It is a cross-sectional study, not including non-institutionalized individuals. CONCLUSION: Somatic symptoms are more frequent in women and younger individuals. Furthermore, the presence of physical symptoms is associated to other psychological aspects, such as depression or anxiety. Finally, bifactor model was the most appropriate to explain the factorial structure of the PHQ-15.

Exploring the Perspective of Oral Microbiome Studies in PubMed Database: A Bibliometric Appraisal.

This research aims to postulate an exhaustive sketch of the current research background on the oral microbiome to emphasize prevailing research trends. On November 25, 2023, a digital exploration was conducted on the PubMed platform. The search strategy employed was- '(Microbiome, Microbiota, Microorganisms, Bacteria, Virus, Fungi) AND (Oral, Dental, Saliva, Plaque, Gingival Crevicular Fluid)'. Inclusive criteria comprised review articles, clinical trials, and meta-analyses. The Biblioshiny app and VOSviewer software were used to create and visualize bibliometric maps for network, thematic, and factorial analyses. The PubMed database search unveiled 215,068 published research studies on the oral microbiome, indicating a fluctuating publication pattern with an all-embracing mounting trajectory. Notably, there was a substantial increase in publications in 2020 and 2021, succeeded by a marked decline in 2022 and 2023. Sichuan University and the International Journal of Molecular Sciences emerged as the most prolific contributors among organizations and relevant sources. Keyword analysis revealed a research emphasis on the COVID-19 pandemic and the SARS-CoV-2 virus since 2019. Thematic mapping categorized key terms into motor, primary, niche, and emerging themes. The emerging terms identified are viral immunogenicity, antibodies, and vaccines, which support the revelation that COVID-19 and related terms will be the most pertinent subjects in oral microbiome studies in the future. Factorial analysis delineated the relationships between topics and subtopics in this domain.

A factorial-analysis-based Bayesian neural network method for quantifying China's CO2 emissions under dual-carbon target.

Energy-structure transformation and CO2-emission reduction are becoming particularly urgent for China and many other countries. Development of effective methods that are capable of quantifying and predicting CO2 emissions to achieve carbon neutrality is desired. This study advances a factorial-analysis-based Bayesian neural network (abbreviated as FABNN) method to reflect the complex relationship between inputs and outputs as well as reveal the individual and interactive effects of multiple factors affecting CO2 emissions. FABNN is then applied to analyzing CO2 emissions of China (abbreviated as CEC), where multiple factors involve in energy (e.g., the consumption of natural gas, CONG), economic (e.g., Gross domestic product, GDP) and social (e.g., the rate of urbanization, ROU) aspects are investigated and 512 scenarios are designed to achieve the national dual carbon targets (i.e., carbon peak before 2030 and carbon neutrality by 2060). Comparing to the conventional machine learning methods, FABNN performs better in calibration and validation results, indicating that FABNN is suitable for CEC simulation and prediction. Results disclose that the top three factors affecting CEC under the dual­carbon target are GDP, CONG, and ROU; energy, economic and social contributions are 43.5 %, 34.6 % and 21.9 %, respectively. CEC reaches its carbon peak during 2027-2032 and achieve carbon neutrality during 2053-2057 under all scenarios. Under the optimal scenario (S195), the CO2-emission reduction potential is about 772.2 million tonnes and the consumptions of coal, petroleum and natural gas can be respectively reduced by 3.1 %, 9.9 % and 23.0 % compared to the worst scenario (S466). The results can provide solid support for national energy-structure transformation and CO2-emission reduction to achieve carbon-peak and carbon-neutrality targets.

Validación de constructo de un algoritmo hipnoterapéutico para niños con enuresis nocturna monosintomática

Introducción: La enuresis nocturna es un motivo frecuente de consulta en pediatría, psiquiatría infantil, psicología y medicina familiar, con mayor porcentaje en los niños de 5 años de edad, seguidos por los de 7 y 9, en ese orden. Objetivo: Determinar la validez de constructo del algoritmo hipnoterapéutico para pacientes con enuresis nocturna monosintomática. Métodos: Se realizó una investigación compleja de 97 pacientes, atendidos en la Clínica de Hipnosis Terapéutica de la Universidad de Ciencias Médicas de Santiago de Cuba, desde febrero del 2021 hasta julio del 2022, la cual estuvo estructurada en 3 etapas metodológicas de validación de constructo para dar continuidad a la etapa IV de la validación de contenido del algoritmo hipnoterapéutico, sobre la base de 2 cuasi-experimentos sin grupo de control y un estudio cuasiexperimental con grupo de control no equivalente de la segunda etapa de dicha investigación. Resultados: El análisis factorial sobre el estudio de componentes principales fue factible, pues los factores 1, 2 y 3 debían mantenerse, lo cual se expresó en el gráfico de sedimentación y en la varianza total explicada, a través de los porcentajes acumulados en los autovalores iniciales y la suma de las saturaciones al cuadrado de la extracción y la rotación con 64,24 %. Conclusiones: La validación de constructo del algoritmo diseñado mostró pertinencia, dada por la idoneidad del análisis factorial y la prueba de esfericidad de Bartlett.

Introduction: Bedwetting is a frequent reason to visit pediatric, infant psychiatry, psychology and family medicine services, with more percentage in 5 years children, followed by 7 and 9 years children, in that order. Objective: To determine the construct validity of the hypnotherapeutic algorithm for patients with monosymptomatic bedwetting. Methods: A complex investigation of 97 patients was carried out, who were assisted in the Therapeutic Hypnosis Clinic of the University of Medical Sciences in Santiago de Cuba, from February, 2021, to July, 2022 which was structured in 3 methodological phases of construct validation to continue the phase IV of hypnotherapeutic algorithm content validation, on the base of 2 quasi-experiments without control group and a quasi-experiment with non equivalent control group of the second phase of this investigation. Results: The factorial analysis on the study of main components was possible, because the factors 1, 2 and 3 should stay, which was expressed in the sedimentation graph and in the explained total variance, through the percentages accumulated in the initial auto values and the sum of saturations to the square of extraction and rotation with 64.24%. Conclusions: The construct validation of the designed algorithm showed relevancy, given by the suitability of the factorial analysis and the Bartlett test of spherical form.

Using a centered general linear model for detection of interactions among biomarkers.

The dummy variable based general linear model (gLM) is commonly used to model categorical factors and their interactions. However, the main factors and their interactions in a general linear model are often correlated even when the factors are independently distributed. Alternatively, the classical two-way factorial analysis of variance (ANOVA) model can avoid the correlation between the main factors and their interactions when the main factors are independent. But the ANOVA model is hardly applicable to a regular linear regression model especially in the presence of other covariates due to constraints on its model parameters. In this study, a centered general linear model (cgLM) is proposed for modeling interactions between categorical factors based on their centered dummy variables. We show that the cgLM can avoid the correlation between the main factors and their interactions as the ANOVA model when the main factors are independent. Meanwhile, similar to gLM, it can be used in regular regression and fitted conveniently using the standard least square approach by choosing appropriate baselines to avoid constraints on its model parameters. The potential advantage of cgLM over gLM for detection of interactions in model building procedures is also illustrated and compared via a simulation study. Finally, the cgLM is applied to a postmortem brain gene expression data set.

Screening for post-traumatic stress disorder following childbirth using the Peritraumatic Distress Inventory.

BACKGROUND: Post-traumatic stress disorder (PTSD) following traumatic childbirth may undermine maternal and infant health, but screening for maternal childbirth-related PTSD (CB-PTSD) remains lacking. Acute emotional distress in response to a traumatic experience strongly associates with PTSD. The Peritraumatic Distress Inventory (PDI) assesses acute distress in non-postpartum individuals, but its use to classify women likely to endorse CB-PTSD is unknown. METHODS: 3039 women provided information about their mental health and childbirth experience. They completed the PDI regarding their recent childbirth event, and a PTSD symptom screen to determine CB-PTSD. We employed Exploratory Graph Analysis and bootstrapping to reveal the PDI's factorial structure and optimal cutoff value for CB-PTSD classification. RESULTS: Factor analysis revealed two strongly correlated stable factors based on a modified version of the PDI: (1) negative emotions and (2) bodily arousal and threat appraisal. A score of 15+ on the modified PDI produced high sensitivity and specificity: 88 % with a positive CB-PTSD screen in the first postpartum months and 93 % with a negative screen. LIMITATIONS: In this cross-sectional study, the PDI was administered at different timepoints postpartum. Future work should examine the PDI's predictive utility for screening women as closely as possible to the time of childbirth, and establish clinical cutoffs in populations after complicated deliveries. CONCLUSIONS: Brief self-report screening concerning a woman's emotional reactions to childbirth using our modified PDI tool can detect those likely to endorse CB-PTSD in the early postpartum. This may serve as the initial step of managing symptoms to ultimately prevent chronic manifestations.

Escala de medición de resiliencia en adolescentes cubanos entre 15 y 19 años de edad

Introducción: La resiliencia en la adolescencia se relaciona con la capacidad de resolver el problema de la identidad, en contextos en los cuales esta no posee las condiciones para construirse de modo positivo. Objetivo: Diseñar un instrumento para evaluar resiliencia en adolescentes de 15 a 19 años de edad. Métodos: Investigación de tipo instrumental, en el Instituto Preuniversitario "Martín Dihigo" de Cienfuegos, de marzo a septiembre de 2022. Muestreo no probabilístico (n= 450). La validez de contenido se llevó a cabo a través del criterio de expertos, la validez de constructo a partir del análisis factorial y la validez de criterio mediante correlación con la Escala de Resiliencia de Connor-Davidson. La fiabilidad se realizó a través de la consistencia interna y la estabilidad temporal mediante el test-retest. Resultados: El instrumento presenta validez de contenido. El análisis factorial arrojó 7 factores que explican el 64,8 % de la varianza. La correlación con la Escala de Resiliencia de Connor-Davidson fue de 0,333 (p< 0,01). Se obtuvo un alfa de Cronbach global α= 0,839; se demostró la estabilidad temporal. Conclusiones: La Escala de Resiliencia en Adolescentes Cubana tiene adecuados criterios de validez y fiabilidad que justifican su aplicación en la población de adolescentes de Cuba.

Introduction: Resilience in adolescence is related to the ability to solve the problem of identity in contexts where it does not have the conditions to be built in a positive way. Objective: To design an instrument to assess resilience in adolescents from 15 to 19 years of age. Methods: Instrumental research, at the Martín Dihigo Pre-University Institute in Cienfuegos, from March to September 2022. Non-probabilistic sampling (n= 450). Content validity was carried out through expert criteria, construct validity from factorial analysis and criterion validity through correlation with the Connor-Davidson Resilience Scale. Reliability was carried out through internal consistency, and temporal stability through test-retest. Results: The instrument presents content validity. The factorial analysis yielded 7 factors which explain 64.8% of the variance. The correlation of the instrument with the Connor-Davidson Resilience Scale was 0.333 (p< 0.01). A global Cronbach's alpha α= 0.839 was obtained; temporal stability was demonstrated. Conclusions: The Cuban Adolescent Resilience Scale has adequate validity and reliability criteria that justify its application in the population of Cuban adolescents.

Adequacy of the WHOQoL-BREF to Assess the Quality of Life of Victims of Armed Conflicts.

There is a deterioration in the quality of life (QoL) of survivor victims of warlike conflicts. Because there is a need to guarantee the effectiveness of assessment tools for these populations, we studied the adequacy of the World Health Organization Quality of Life Questionnaire (WHOQoL-BREF) to assess the QoL of 1,136 surviving victims of the armed conflict in Colombia. Although this questionnaire has yielded promising results, questions remain about its psychometric suitability for specific populations. We used model modification at the item level, comparisons of models with different factor structures, and dimensionality analysis to address the psychometric problems encountered. Dimensionality analysis using a bifactor model suggests that WHOQoL-BREF total scores might be a more appropriate way of reporting results when model fit adequacy is not reached. Conclusions are offered on the psychometric properties of the WHOQoL-BREF, the evaluation of special populations, and possible strategies to address future questionnaire modifications.

Perceptions of bariatric surgery in patients with type 2 diabetes: data from a self-administered questionnaire.

BACKGROUND: Although bariatric surgery (BS) is recommended for patients with type 2 diabetes (T2D) and moderate to severe obesity, only approximately 2% of patients undergo surgery. OBJECTIVE: To compare the knowledge and perception of BS with that of other treatments for diabetes among patients with diabetes. SETTING: French social media platforms. METHODS: A self-administered questionnaire was distributed from May 13 to June 3, 2020, via different French social media, including patients with T2D (main target), and patients with type 1 diabetes (control population). Different profiles of reluctance to BS were identified using a factorial analysis. RESULTS: Of the 4481 responders (50.4% women, 33.9% aged over 65), 60% had T2D. Of the 1736 patients who had heard of BS (38.7%), 1493 declared they never addressed it with their physician. Among T2D patients, BS is the treatment that elicits the most negative response, with more than 10% showing reluctance. Four reluctance profiles were identified: (1) cluster 1 (43.4%), fear of consequences on their eating habits and irreversibility of the procedure; (2) cluster 2 (34.9%), fear of poorer diabetes control; (3) cluster 3 (9.3%), fear of surgical risk; and (4) cluster 4 (12.4%), fear of side effects. In all clusters, the opinion of their physician would be the most important factor to change their mind. CONCLUSION: Bariatric surgery for T2D is rarely addressed in routine medical visits. Fear of operative risks and irreversibility of the procedure largely explains the reluctance to BS. Information and education campaigns on the benefit of metabolic surgery for patients with T2D remain necessary.

Toxicity and mechanism of nanoplastics to phytoplankton in high-latitude aquatic ecosystems of Canadian prairie: Effects of multiple environmental factors.

The potential ecological risks of nanoplastics (NPs) may be inaccurately assessed in some studies as they fail to consider the impact of environmental factors and their interactive effects. Here, the effects of six representative environmental factors (N, P, salinity, DOM (dissolved organic matter), pH and hardness) on NPs' toxicity and mechanism to microalgae are investigated based on the surface water quality data in Saskatchewan watershed, Canada. Our 10 sets of 26-1 factorial analysis reveal the significant factors and their interactive complexity towards 10 toxic endpoints from cellular and molecular levels. This is the first time to study the toxicity of NPs to microalgae under interacting environmental factors in high-latitude aquatic ecosystems of Canadian prairie. We find that microalgae become more resistant to NPs in N-rich or higher pH environments. Surprisingly, with the increase of N concentration or pH, the inhibitory effect of NPs on microalgae growth even became a promotion effect with the decreased inhibition rate from 10.5 % to -7.1 % or from 4.3 % to -0.9 %, respectively. Synchrotron-based Fourier transform infrared spectromicroscopy analysis reveals that NPs can induce alterations in the content and structure of lipids and proteins. DOM, N*P, pH, N*pH and pH*hardness have a statistically significant effect on NPs' toxicity to biomolecular. The toxicity levels of NPs across Saskatchewan watersheds are evaluated and we find that NPs could have the greatest inhibition on microalgae growth in Souris River. Our findings indicate that multiple environmental factors should be considered during the ecological risk assessment of emerging pollutants.

Toward a new model of human resource management practices: construction and validation of the High Wellbeing and Performance Work System Scale.

Introduction: The integrated mutual gains model suggests five provisional sets of human resource management (HRM) practices that should benefit both employees and organizations and, as such, be explicitly designed to have a positive impact on wellbeing, which, in turn, can affect performance. Methods: An extensive review of the literature on scales that used a high-performance work system to assess HRM practices, as well as an extraction of items related to the theoretical dimensions of the integrated mutual gains model, were performed. Based on these preliminary steps, an initial scale with the 66 items found most relevant in the literature was developed and assessed regarding its factorial structure, internal consistency, and reliability over a two-week period. Results: Exploratory factorial analysis following test -retest resulted in a 42-item scale for measuring 11 HRM practices. Confirmatory factor analyses resulted in a 36-item instrument for measuring 10 HRM practices and showed adequate validity and reliability. Discussion: Even though the five provisional sets of practices were not validated, the practices that emerged from them were assembled into alternative sets of practices. These sets of practices reflect HRM activities that are considered conducive to employees' wellbeing and, consequently, their job performance. Consequently, the "High Wellbeing and Performance Work System Scale" was created. Nonetheless, future research is necessary to evaluate the predictive capacity of this new scale.

Screening for Post-Traumatic Stress Disorder following Childbirth using the Peritraumatic Distress Inventory.

Background: Maternal psychiatric morbidities include a range of psychopathologies; one condition is post-traumatic stress disorder (PTSD) that develops following a traumatic childbirth experience and may undermine maternal and infant health. Although assessment for maternal mental health problems is integrated in routine perinatal care, screening for maternal childbirth-related PTSD (CB-PTSD) remains lacking. Acute emotional distress in response to a traumatic event strongly associates with PTSD. The brief 13-item Peritraumatic Distress Inventory (PDI) is a common tool to assess acute distress in non-postpartum individuals. How well the PDI specified to childbirth can classify women likely to endorse CB-PTSD is unknown. Objectives: We sought to determine the utility of the PDI to detect CB-PTSD in the early postpartum period. This involved examining the psychometric properties of the PDI specified to childbirth, pertaining to its factorial structure, and establishing an optimal cutoff point for the classification of women with high vs. low likelihood of endorsing CB-PTSD. Study Design: A sample of 3,039 eligible women who had recently given birth provided information about their mental health and childbirth experience. They completed the PDI regarding their recent childbirth event, and a PTSD symptom screen to determine CB-PTSD. We employed Exploratory Graph Analysis (EGA) and bootstrapping analysis to reveal the factorial structure of the PDI and the optimal PDI cutoff value for CB-PTSD classification. Results: Factor analysis of the PDI shows two strongly correlated stable factors based on a modified 12-item version of the PDI consisting of (1) negative emotions and (2) bodily arousal and threat appraisal in regard to recent childbirth. This structure largely accords with prior studies of individuals who experienced acute distress resulting from other forms of trauma. We report that a score of 15 or higher on the modified PDI produces strong sensitivity and specificity. 88% of women with a positive CB-PTSD screen in the first postpartum months and 93% with a negative screen are identified as such using the established cutoff. Conclusions: Our work reveals that a brief self-report screening concerning a woman's immediate emotional reactions to childbirth that uses our modified PDI tool can detect women likely to endorse CB-PTSD in the early postpartum period. This form of maternal mental health assessment may serve as the initial step of managing symptoms to ultimately prevent chronic symptom manifestation. Future research is needed to examine the utility of employing the PDI as an assessment performed during maternity hospitalization stay in women following complicated deliveries to further guide recommendations to implement maternal mental health screening for women at high risk for developing CB-PTSD.

Brief COPE Short Version (Mini-COPE): A Proposal of Item and Factorial Reduction in Mexican Population.

The factorial reduction of Brief COPE has not been successfully replicated by independent studies, and few have been performed in Spanish-speaking populations; therefore, the objective of this study was to perform a factorial reduction of the instrument in a large sample of the Mexican population and perform a convergent and divergent validity of the factors obtained. We distributed a questionnaire via social networks with sociodemographic and psychological variables, including the Brief COPE and the scales of the CPSS, GAD-7, and CES-D to measure stress, anxiety, and depression. A total of 1283 persons were included, most of whom (64.8%) were women and had a bachelor's degree (55.2%). After performing the exploratory factorial analysis, we did not find a model with an adequate fit and a reduced number of factors; therefore, we decided to reduce the number of items according to the most representative ones of adaptive, maladaptive, and emotional coping strategies. The resulting model with three factors showed good fit parameters and good internal consistency of the factors. In addition, the nature and naming of the factors were confirmed by convergent and divergent validity, with significant negative correlations between factor 1 (active/adaptive) and stress, depression, and anxiety, significant positive correlations between factor 2 (avoidant/maladaptive) and these three variables, and no significant correlation between factor 3 (emotional/neutral) and stress or depression. This shortened version of the brief COPE (Mini-COPE) is a good option to evaluate adaptive and maladaptive coping strategies in Spanish-speaking populations.

Estandarización de la batería de Evaluación de la Memoria Semántica (EMSEA) en adultos mayores institucionalizados de Lima / Standardization of the Semantic Memory Evaluation Battery (EMSEA) in institutionalized elderly adults of Lima

Objetivo: Determinar si la memoria semántica es un factor asociado al deterioro cognitivo en adultos mayores de Lima. Método: Se aplicaron la batería de Evaluación de la Memoria Semántica para Adultos Mayores (EMSEA), el Mini-mental State Examination (MMSE) y otros instrumentos que fueron utilizados como criterios externos. La muestra estuvo constituida por 158 adultos mayores de Lima Metropolitana entre 60 a 95 años de edad. La EMSEA diferencia entre una muestra normal y clínica, siendo la sensibilidad de 80% y la especificidad de 100% para un punto de corte de 251. Se evidencia validez concurrente y se demuestra un modelo EMSEA de dos factores. La confiabilidad fue adecuada con valor Alfa de Cronbach de .75 y Theta de .80. Resultados: Los datos descriptivos señalaron un 28% de prevalencia de deterioro cognitivo y 23% de nivel de memoria semántica bajo. El modelo predictivo señala que tres áreas de la memoria semántica están asociadas al deterioro cognitivo con un R2 de 25%, quedando el modelo establecido por: Verificación, denominación de dibujos y analogías. Conclusión: Se concluye que la batería EMSEA presenta evidencia de validez de criterio y constructo, así como consistencia interna. (AU)

Objective: To determine if semantic memory is a factor associated with cognitive impairment in older adults in Lima. Method: The Semantic Memory Assessment Battery for Older Adults (EMSEA), the Mini-mental State Examination (MMSE) and other instruments that were used as external criteria were applied. The sample consisted of 158 older adults from Metropolitan Lima between 60 and 95 years of age. EMSEA differentiates between a normal and clinical sample, with a sensitivity of 80% and a specificity of 100% for a cut-off point of 251. Concurrent validity is evidenced and a two-factor EMSEA model is demonstrated. Cronbach's Alpha value is .75 and Theta is .80. Results: Descriptive data indicated a 28% prevalence of cognitive impairment and a 23% low semantic memory level. The predictive model indicates that three areas of semantic memory are associated with cognitive impairment with an R2 of 25%, leaving the model established by: Verification, naming of drawings and analogies. Conclusion: It is concluded that the EMSEA battery presents evidence of criterion and construct validity, internal consistency and a predictive. (AU)

The determinants of expert opinion in the development of care pathways: insights from an exploratory cluster analysis.

BACKGROUND: We performed a secondary exploratory cluster analysis on the data collected from the validation phase of the study leading to the development of the model care pathway (CP) for Myasthenia Gravis (MG), in which a panel of 85 international experts were asked some characteristics about themselves and their opinion about the model CP. Our aim was to identify which characteristics of the experts play a role in the genesis of their opinion. METHODS: We extracted the questions probing an opinion and those describing a characteristic of the expert from the original questionnaire. We performed a multiple correspondence analysis (MCA) and a subsequent hierarchical clustering on principal component (HCPC) on the opinion variables, integrating the characteristic variables as supplementary (predicted). RESULTS: After reducing the dimensionality of the questionnaire to three dimensions we noticed that the not-appropriateness judgement of the clinical activities may overlap with the completeness one. From the HCPC it seems that the working setting of the expert may play a crucial role in determining the opinion about the setting of the sub-processes of MG: shifting from a cluster where the experts do not work in sub-specialist settings to one where the experts are working in them, the opinion changes accordingly from a mono-disciplinary setting to a multi-disciplinary one. Another interesting result is that the experience in neuromuscular diseases (NMD) measured in years and the expert typology (whether general neurologist or NMD expert) seem not to contribute significantly to the opinions. CONCLUSIONS: These findings might indicate a poor ability of the expert to discriminate what is not appropriate from what is not complete. Also, the opinion of the expert might be influenced by the working setting, but not by the experience in NMD (as measured in years).

Willingness to Compromise Scale: Italian Validation and Assessment of the Relationship with Career Decision Self-Efficacy and Career Adaptability during School-to-Work Transition.

Willingness to compromise is defined as the propensity to accept an alternative career-related option that was not the one initially desired. In the literature, there is a validated scale for measuring willingness to compromise but not an Italian validation. Thus, Study 1 aimed to test the psychometric proprieties of the Willingness to Compromise Scale in a sample of 282 Italian university students. Confirmatory factor analyses were performed showing a second-order factorial structure with two well-separated first-order factors, i.e., compromising and adapting. Study 2 focused on the predicting role of willingness to compromise on career decision self-efficacy and the mediating role of career adaptability in this relationship. The sample consisted of 237 Italian university students. A mediation analysis with a 5000-bootstrap resampling procedure was computed. The results showed that willingness to compromise predicts both career decision self-efficacy and career adaptability, while career adaptability mediates the relationship between willingness to compromise and career decision self-efficacy. These findings allowed the discussion of practical implications for career guidance intervention aimed to support school-to-work transitions.

A factorial stepwise-clustering input-output model for unveiling water-carbon nexus from multi-policy perspectives.

Water-carbon nexus exerts significant influence on environmental sustainability. The demand-side patterns of water-carbon nexus in supply chains have been extensively conducted. However, there is still research gap in unveiling supply-side complex relationships among various sectors from multi-policy perspectives. In this study, a factorial stepwise-clustering input-output (FSCIO) model is developed to uncover the complicated water-carbon nexus accompanied by analyses of multi-element, multi-sector and multi-policy. This is the first time that input-output analysis (IOA), stepwise cluster analysis (SCA) and factorial analysis (FA) are integrated to explore water-carbon nexus. Water-carbon flows along supply chains are tracked through IOA. SCA helps identify key sectors through evaluating the complexities in water-carbon nexus. FA helps examine different supply-side policies (i.e., input- and allocation-oriented policies, abbreviated as IOP and AOP) through quantifying the effects of multiple sectors and their interactions. We find that China's water-carbon characteristics in supply side differ greatly from those in demand side (e.g., construction is a significant final consumer and other service is more prominent as a primary supplier). The impacts of supply-side policies on different sectors vary significantly and AOP is generally better than IOP in the trade-off between water-carbon pressures mitigation and economic development. The effects of multiple sectors and their interactions on water and carbon shouldn't be neglected and the appropriate policy combinations could have good synergistic effects (e.g., IOP on electricity-gas-water supply, and AOP on chemical, machinery and other service). This study not only provides insight into the multifaceted features of China's water-carbon nexus, but also provides guidance for the supply-side policies.

Learning-by-Concordance of Perception: A Novel way to Learn to Read Thoracic Images.

RATIONALE AND OBJECTIVE: Learning to interpret thoracic images requires intensive instructor support. Given current cohort sizes at teaching hospitals in North America, instructor availability is rare. A Learning-by-concordance of perception (LbCP) online tool was introduced in a second-year course on lung and oxygenation. The LbCP tool presents thoracic images, students must point or outline abnormal structures directly on the screen and name the lesion. Thereafter, images with correct outline are superimposed on student's work and three key-messages are provided. We aimed to measure student perception of LbCP tool's usefulness and ease of use. MATERIALS AND METHODS: The online tool was developed and implemented for second year students for cohorts in 2016, 2017 and 2018 (n = 296; 303; and 280; N = 879). A survey, comprisingsix questions on a Likert scale was designed to measure perceptions about tool utility and ease of use. An ANOVA analysis was carried out to ensure the normality of the data, and a principal axis factor analysis was used to confirm the presence of the two expected clusters corresponding to our two dimensions. RESULTS: The ANOVA conducted on the combined three year data set revealed an F value of 7.688 (p = 0.001), and principal axis factorial analysis revealed a one factor solution. The percentage of variance explained by the factor was 44.5%, with factor loadings leaning heavily in favor of the tool's perceived utility. A second factor was just shy of the eigenvalue threshold of 1.0 and could provide support for the tool's ease of use. CONCLUSION: The online LbCP tool shows promising impact over three cohorts of students in three consecutive years. Students recognize the pedagogical value of the tool and express their willingness to use more of it in their training.

Validation of a Greek adaptation of the Anti-Fat Attitudes Questionnaire.

The Anti-Fat Attitudes Questionnaire (AFA) measures prejudicial attitudes that are held about individuals with overweight BMI or obesity. Despite increased interest in research on anti-fat attitudes worldwide, the psychometric properties of the AFA have rarely been examined in non-English speaking populations. The present study aimed to address this gap in the literature by translating and validating the AFA in the Greek language. An online, community-based sample of 642 individuals (364 women) responded to the Greek translation of the AFA and measures of appearance satisfaction and appreciation, disordered eating, self-esteem and depression. Results indicated that the original three-factor solution of the AFA was maintained in both the Principal and Confirmatory Factor Analyses. Additionally, internal consistency, test-retest reliability and convergent validity all showed adequate results. These findings provide support for the use of the AFA in Greek-speaking populations. The availability of the Greek AFA adds to the toolbox of body image scholars working in the Greek context.