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Terrorist Attacks Against Health Care Facilities, Health Care Workers, and First Responders:A Scoping Review
No full textIntroduction: Since 2001, the world has encountered an increase in terrorist attacks on civilian targets, during which conventional as well as unconventional modalities are being used. Terrorist attacks put immediate strains on health care systems, whilst they may also directly threaten the safety of first responders, health care workers, and health care facilities.Study Objective: This scoping review aimed to systematically map the existing research on terrorist attacks targeting health care facilities, health care workers, and first responders, and to identify opportunities to improve future research and health care response to terrorist attacks.Methods: A scoping review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. A systematic search for relevant literature was conducted through electronic databases including PubMed, Cochrane, and Embase. Inclusion and exclusion criteria were applied to check eligibility. Extracted data from the articles included the title, first author, year of publication, journal, study design, number of attacks, number of injured, number of fatalities, target type, and weapon modalities. Furthermore, methodological quality assessment was performed.Results: The initial search within three major databases yielded 4,656 articles, including 2,777, 1,843, and 36 articles from PubMed, Embase, and Cochrane Library, respectively. Finally, 11 studies were included, which were all database reviews.Conclusions: This scoping review included 11 studies focusing on terrorist attacks against health care facilities, health care workers, and first responders. Nearly all studies were exclusively based on the Global Terrorism Database (GTD). An increase of attacks on health care-related targets was consistently reported by all studies in this review, but there were significant discrepancies in reported outcomes. In order to improve counter-terrorism preparedness and the future protection of health care workers, counter-terrorism medicine (CTM) research may benefit from a more standardized and transparent approach to document and analyze terrorist attacks, as well as the inclusion of additional databases other than the GTD
Open pilot study of a guided digital self-help intervention targeting sleep and the biological clock in university students using a pre-test post-test design
No full textInsomnia is common among university students and is associated with mental health problems. Students often have irregular day/night rhythms, which contribute to circadian rhythm disruptions. This open pilot study investigated the feasibility, acceptability, and preliminary effectiveness of a 5-week digital guided self-help intervention in university students with self-reported insomnia. The intervention is based on cognitive behavioural therapy for insomnia with specific emphasis on the biological clock (‘i-Sleep & BioClock’). We assessed feasibility and acceptability. Pre- to post-intervention (7-week) changes in insomnia, depression, anxiety, chronotype, and quality of life were evaluated. Of 101 included students, 81 accessed the platform, 41 initiated the intervention, and 13 completed the intervention. Post-test response was 39%. Students rated the intervention with good acceptability and the platform with excellent usability. Study completers (n = 39) showed large improvements in insomnia severity (p < 0.001, d = 1.04), and moderate improvements in depression (p < 0.001, d = 0.63), anxiety (p < 0.001, d = 0.35), and functioning (p < 0.001, d = 0.56). No significant changes were found in quality of life (p = 0.07, d = 0.19). To summarize, the intervention had low uptake but moderate adherence and fairly good acceptability along with important improvements in sleep, mental health, and functioning. Trial registration: ClinicalTrials.gov: NCT05363995
Function focused care in hospital among nurses and patients from geriatric and neurology wards:A mixed method process evaluation
No full textBackground: Function Focused Care is a promising approach stimulating physical activity of patients admitted to hospital. In studying the effectiveness, patients receiving Function Focused Care in Hospital were admitted 3.3 days shorter than patients receiving usual care. However, no differences were found in functional status. Process evaluations alongside an effect studies create an understanding implementation fidelity, of mechanisms of impact, contextual factors. Objective: to gain insight into the experiences of nurses and patients, and to give insight into implementation fidelity, mechanisms of impact, and contextual factors while implementing Function Focused Care in Hospital on geriatric and neurologic hospital wards. Design: convergent parallel mixed-methods study, alongside a stepped wedge clinical trial. Setting(s): four hospital wards of two Dutch hospitals Participants: nurses, nursing students and care assistants (n = 123), and patients (n = 24). Methods: Data for the process evaluation was collected before the implementation of Function Focused Care in Hospital (T0), directly after implementation (T1), and four months after implementation (T2). Data was obtained from patient interviews, focus group interviews with nurses, questionnaires, observations, screening of electronic patients’ records, and logbook notes. For the qualitative data thematic analyses and for quantitative data descriptive statistics were used. The results of these analyses were synthesized into overarching findings. Results: Findings from the observations showed the care delivery according to the Function Focused Care in Hospital principles increased from 60 % in the control condition to 75 % in the intervention condition. Moreover, nurses stated that patients were only assisted when needed and nurses often asked about their abilities to perform ADL and then encouraged them to do as much as they could themselves. Nevertheless, patients don't recognize Function Focused Care in Hospital. The results suggest that the implementation fidelity was influenced by different working mechanisms and contextual factors which led to different experiences from nurses, coaches and patients in promoting patient engagement and functional independence. The synthesized findings show that lessons can be learned with regards to continuity of the care provided in the interprofessional collaboration, the challenge in providing personalized care given the current time constraints, the phenomenon of being unconscious incompetent observed in the nurses, and difficulties in demonstrating nursing leadership and autonomy. Conclusions: Implementation of Function Focused Care in Hospital improved care delivery but highlighted challenges in personalized care, interprofessional collaboration, and nursing leadership, influenced by various contextual factors and working mechanisms. Registration: https://onderzoekmetmensen.nl/en/trial/24287 (date of first recruitment: 05–02–2016
A response to EA-4/23 INF:2025 “The Assessment and Accreditation of Opinions and Interpretations using ISO/IEC 17025
No full textObservation of the Very Rare Σ^{+}→pμ^{+}μ^{-} Decay
No full textThe first observation of the Σ^{+}→pμ^{+}μ^{-} decay is reported with high significance using proton-proton collision data, corresponding to an integrated luminosity of 5.4 fb^{-1}, collected with the LHCb detector at a center-of-mass energy of 13 TeV. A yield of 237±16 Σ^{+}→pμ^{+}μ^{-} decays is obtained, where the uncertainty is statistical only. A branching fraction of (1.08±0.17)×10^{-8} is measured, where the uncertainty includes statistical and systematic sources. No evidence of resonant structures is found in the dimuon invariant-mass distribution. All results are compatible with standard model expectations. This represents the rarest decay of a baryon ever observed.</p
Quantum Annealing for Optimizing Unit Scheduling in Renewable Energy Systems:Formulation and Evaluation
No full textThis paper investigates the use of Quantum Annealing (QA) devices for optimizing unit scheduling in renewable energy systems, addressing the challenge of energy balancing with intermittent generation. We compare two approaches for encoding inequality constraints in Quadratic Unconstrained Binary Optimization (QUBO) formulations: (a) the conventional slack-variable-based method and (b) a novel soft-encoding technique called unbalanced penalization. This first application of unbalanced penalization in the energy and power systems domain, aims to disseminate knowledge about near-term applications of quantum-computing and how to make best use of it within the community. Through computational experiments, we find that Unbalanced Penalization consistently outperforms the conventional method of using slack variables by reducing the number of variables in the QUBO formulation. Despite this, its inherent nature penalizes feasible solutions unevenly, preventing the ability to handle much larger problem sizes. More broadly, we observe that both methods-like most pure quantum approaches-struggle with scalability on current QA hardware, as solution quality declines with increasing problem size. In light of these limitations, we assess the feasibility of purely quantum solutions and argue that hybrid approaches remain the most practical path forward
Publisher Correction:fNIRS reproducibility varies with data quality, analysis pipelines, and researcher experience
No full textShared and distinct alterations in brain structure of youth with internalizing or externalizing disorders:Findings from the ENIGMA Antisocial Behavior, ADHD, MDD, and Anxiety Working Groups
No full textBACKGROUND: Externalizing and internalizing disorders are common in youth but are often studied separately, preventing researchers from identifying shared (i.e., transdiagnostic) alterations in brain structure. Using data from the ENIGMA Consortium, we conducted a mega-analysis to identify shared and distinct cortical and subcortical brain alterations across internalizing (anxiety disorders and depression) and externalizing disorders (attention-deficit/hyperactivity disorder [ADHD] and conduct disorder [CD]) in youth. METHODS: 3D T1-weighted MRI data from youth (aged 4-21 years) with anxiety disorders (n=1,044), depression (n=504), ADHD (n=1,317), and CD (n=1,172), along with healthy controls (n=4,743) were analyzed. We assessed group differences in regional cortical thickness, surface area, and subcortical volume using linear models, adjusted for site, age, and sex, and total intracranial volume in the surface area and subcortical volume models. RESULTS: We observed transdiagnostic associations, with both internalizing and externalizing disorders characterized by lower surface area in the insula, entorhinal cortex, and middle temporal gyrus, and lower amygdala volume (Cohen's ds=-0.07 to -0.24), as well as total surface area and intracranial volume (ds=-0.11 to -0.25). Externalizing-specific reductions in surface area were observed in fronto-parietal regions (ds=-0.08 to -0.13), but no internalizing-specific associations were identified. Disorder-specific alterations were identified for ADHD, CD, and anxiety disorders, but not depression. CONCLUSIONS: Both common and disorder-specific alterations were identified, with regions involved in salience attribution and emotion processing implicated across internalizing and externalizing disorders. These findings can guide future research targeting common biological processes across youth psychiatric disorders as well as features unique to individual disorders
Receptor Discordance During the Treatment Course of Patients With Metastatic Breast Cancer:Results From the SONABRE Registry
No full textPURPOSE: The aim was to evaluate factors associated with taking 2 biopsies during the disease course of metastatic breast cancer (mBC) and to assess discordance rates for the oestrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). METHODS: Patients diagnosed with mBC in ten Dutch hospitals between 2007 and 2020 were retrieved from the SONABRE Registry (NCT-03577197). Patients were identified if they had at least 2 biopsies at different time points during their mBC disease course. Last follow-up was collected in September 2023. Frequencies and factors related to a second biopsy were studied using competing risk analysis with subdistribution hazard ratios (sHR). Discordance rates and factors associated with receptor subtype discordance were analysed using logistic regression using odds ratios (OR). RESULTS: Of 4,470 patients with mBC, 65% had 1 and 10% 2 biopsies during the course of mBC. Having 2 biopsies for mBC was related to age (sHR: 0.61), comorbidity (sHR: 0.76), WHO performance score (sHR: 0.30 for =2), initial TN subtype (sHR: 0.67), and initial metastatic site (sHR: 3.68 for soft tissue only), compared with the reference categories. Patients had an overall receptor subtype discordance of 23% compared to the second biopsy. Only HR+/HER2+ status was related to receptor subtype discordance (OR: 6.45). CONCLUSION: Only the minority of patients with mBC underwent a second biopsy during their mBC disease course. Receptor subtype heterogeneity is however frequent, particularly in patients with initially HR+/HER2+ mBC. Future studies are needed to guide treatment decisions as heterogeneity may play a role