Enumeration of disease is a key management tool. Setting of targets, like for hepatitis C elimination, have deep meaning and effect. We use the case of elimination in New South Wales (NSW), Australia to examine key informants' understandings of the use of targets, and the evidence that informs them, to drive action in elimination. Twenty-eight key informants working in NSW, elsewhere in Australia and internationally in high-income countries participated in a semi-structured qualitative interview in 2022. Analysis was informed by scholarship calling for examination of the ways in which science constructs what is thought possible in action. Participants pointed to the power of quantified evidence and targets and their complex effects, and questioned the usefulness and certainty derived from these at the "pointy end" of elimination. Although a range of targets exist in global and local strategies, reaching testing targets was the assumed solution to achieving elimination. Achieving elimination was thought to require "off piste" and experimental approaches that went beyond available evidence. The different types of work that participants felt necessary for late-stage elimination may require additional metrics to explain return on investment ratios. What threshold would be used to reduce efforts in elimination was a major concern. These data indicate that understandings of the evidence underpinning elimination targets and how to achieve them are far from settled. At this point, elimination efforts may need to rely on locally produced and community-driven evidence and shift from evidence-based to evidence-making paradigm.
The importance of emotions within medical practice is well documented. Research suggests that how clinicians deal with negative emotions can affect clinical decision-making, health service delivery, clinician well-being, attentiveness to patient care and patient satisfaction. Previous research has identified the transition from student to junior doctor (intern) as a particularly challenging time. While many studies have highlighted the presence of emotions during this transition, how junior doctors manage emotions has rarely been considered. We conducted a secondary analysis of narrative data in which 34 junior doctors, within a few months of transitioning into practice, talked about situations for which they felt prepared or unprepared for practice (preparedness narratives) through audio diaries and interviews. We examined these data deductively (using Gross' theory of emotion regulation: ER) and inductively to answer the following research questions: (RQ1) what ER strategies do junior doctors describe in their preparedness narratives? and (RQ2) at what point in the clinical situation are these strategies narrated? We identified 406 personal incident narratives: 243 (60%) contained negative emotion, with 86 (21%) also containing ER. Overall, we identified 137 ER strategies, occurring prior to (n = 29, 21%), during (n = 74, 54%) and after (n = 34, 25%) the situation. Although Gross' theory captured many of the ER strategies used by junior doctors, we identify further ways in which this model can be adapted to fully capture the range of ER strategies participants employed. Further, from our analysis, we believe that raising medical students' awareness of how they can handle stressful situations might help smooth the transition to becoming a doctor and be important for later practice.
Recent research in the geography of health care moves beyond distributive concerns focusing more sensitively on the nature of health care settings. As part of this, a growing number of studies explore the importance of individuals' personal circumstances on their emplaced experiences and agency. Extending this line of inquiry, and drawing on ideas in emotional geographies, the current study illustrates how experiences and agency can be impacted profoundly by needle phobia. Interviews with 11 self-identifying sufferers explore the physical, emotional, behavioral and spatial manifestations of their condition. Specifically how their fear of, and reactions to, clinical objects and procedures (needles and their insertion by health professionals into the body) and health care settings (that possess the risk of encountering or host the encounters with, these objects and procedures), can combine as a single spatial affect.
Transitioning to fatherhood for the first time is a significant milestone in a man's life, especially among first-time expectant fathers having couvade syndrome, which causes them to experience changes both physically and psychologically. However, there is a lack of existing research on the process of transition to fatherhood among first-time expectant fathers having couvade syndrome. This study aimed to explore the process of transition to fatherhood among first-time expectant fathers having couvade syndrome. This study adopted a constructivist grounded theory methodology. Participants included 20 first-time expectant fathers having couvade syndrome who were purposively selected from antenatal clinics of two hospitals in northern Thailand. Data were collected between March 2021 and October 2023 using in-depth interviews following Charmaz's steps. Data were corrected and analyzed until theoretical saturation. "Evolving new father's role over couvade syndrome" emerged as the core category representing their transition into fatherhood. This process consisted of three phases. Phase I was experiencing couvade syndrome that involved confirming couvade syndrome and responding to couvade syndrome. Phase II focused on handling couvade syndrome by accepting it and adapting behaviors. Phase III was stepping into the father's role as couvade syndrome symptoms resolved, encompassing freaking out about the new father's role, dealing with it, and planning for raising the baby. This study generated new knowledge regarding the transition to fatherhood among first-time expectant fathers experiencing couvade syndrome that involves three phases: in early pregnancy, around the middle of pregnancy, and towards the end of pregnancy. The insights can be used to inform nursing interventions to provide comprehensive, phase-specific antenatal care for these fathers.
Creativity encompasses a wide range of topics and practically all aspects of life (arts, schools, workplaces, inventions etc.). The new theme, which is a negative and malevolent type of creativity, has piqued people's interest. And, despite the fact that the number of studies on the issue has expanded in recent years, its relationship with most constructions or predictability has yet to be explored. Aggression (Meshkova, 2018; Hao et al., 2016; Harris & Reiter-Palmon, 2015; Harris, 2013; Lee & Dow, 2011), emotional intelligence (Harris & Reiter-Palmon, 2013), resilience (Wang, Wang & Chen, 2022), humor (Perchtold-Stefan et al., 2020/a), childhood neglect (Jia, Wang & Lin, 2020), and other factors have already been studied in relationship with malevolent creativity. It has also been investigated with adolescents (Wang, Wang, Chen, 2022), adults (Hao et al., 2016, 2020; Baas et al., 2019; Harris & Reiter-Palmon, 2015; Harris, 2013; Lee & Dow, 2011), and was less studied on the prison population (Meshkova et al, 2018, Bochkova, 2020). The most significant goal of this paper is to paint a complete picture of malevolent creativity, from its link to creativity to the concept's freaking out to the study of malevolent creativity's measuring stones. To accomplish so, he looks for material in the most recent professional journals and employs a critical mindset. What's crucial, and what some writers are doing already, is that they use both scientific instruments in their research, thus balancing the measuring instru ments' weaknesses (Perchtold-Stefan, 2021/a,b).
The Blood Profiling Atlas in Cancer (BLOODPAC) Consortium is a collaborative effort involving stakeholders from the public, industry, academia, and regulatory agencies focused on developing shared best practices on liquid biopsy. This report describes the results from the JFDI (Just Freaking Do It) study, a BLOODPAC initiative to develop standards on the use of contrived materials mimicking cell-free circulating tumor DNA, to comparatively evaluate clinical laboratory testing procedures. Nine independent laboratories tested the concordance, sensitivity, and specificity of commercially available contrived materials with known variant-allele frequencies (VAFs) ranging from 0.1% to 5.0%. Each participating laboratory utilized its own proprietary evaluation procedures. The results demonstrated high levels of concordance and sensitivity at VAFs of >0.1%, but reduced concordance and sensitivity at a VAF of 0.1%; these findings were similar to those from previous studies, suggesting that commercially available contrived materials can support the evaluation of testing procedures across multiple technologies. Such materials may enable more objective comparisons of results on materials formulated in-house at each center in multicenter trials. A unique goal of the collaborative effort was to develop a data resource, the BLOODPAC Data Commons, now available to the liquid-biopsy community for further study. This resource can be used to support independent evaluations of results, data extension through data integration and new studies, and retrospective evaluation of data collection.
Prevalence of cigar use has been increasing among youth. Research indicates that youth are modifying cigar products either by "freaking" (ie, removing the filter paper) or "blunting" (removing the tobacco and supplementing or replacing with marijuana), yet little is known about youth who engage in this behavior. Thus, this study examines demographic and concurrent substance use behaviors of youth who modify cigars. Data from the 2013 Cuyahoga County Youth Risk Behavior survey were examined (n = 16 855). The survey collected data on demographics, cigar product use, cigar modification behaviors, and current cigarette, hookah and marijuana use. Responses to cigar product use items were used to create a composite to classify youth in one of eight unique user categories. Univariate and bivariate statistics were calculated using SPSS complex samples procedures. Overall, 15.2% reported current cigar product use, 11.0% reported current freaking, and 18.5% reported current blunt use; taken together, 25.3% of respondents reported any current use of a cigar product. When examined by user category, of those who endorsed any cigar product use, cigars, cigarillos, and little cigars use only was most endorsed (26.3%), followed by Blunt only (25.2%) and all three (ie, cigars, cigarillos, and little cigars, freaking, and blunting; 17.4%). A substantial proportion of high school youth who report using cigar products are modifying them in some way, with nearly half freaking and nearly two-thirds blunting. Given the FDA Center for Tobacco products recent extension of its regulatory authority to include cigar products, it is imperative to understand more about the prevalence of and reasons for cigar modification behaviors. Although the FDA has recently enacted regulatory authority over cigar products, little is known about cigar product modification. This is the first study to concurrently examine two unique cigar modification behaviors, "freaking" (ie, removing the filter paper) and "blunting" (removing the tobacco and supplementing or replacing with marijuana). A significant proportion of high school youth are modifying cigar products to be used as a tobacco product and as a mechanism to smoke marijuana. More research is needed to understand these behaviors to prevent and reduce the use of cigar products among youth.
To examine high school youths' perceptions of health risks, and personal and parental attitudes toward cigarette, cigar, and marijuana use among youth who use or modify cigars. The 2013 Cuyahoga County Youth Risk Behavior Survey used a two-stage cluster sample design to randomly sample public high schools and classrooms. Students in selected classrooms were eligible; 16,855 students completed the survey. This study examines the association between risk perceptions of and youths' personal and parental attitudes toward smoking cigarettes, cigars, and marijuana with current use of cigars, cigarillos or little cigars (CCLCs) or modified CCLCs (ie, freaking or blunting). 23.5% of youth reported current use of CCLCs in some way; 11.0% reported current freaking and 18.5% reported current blunt use. CCLC users tended to be male and Black. Perceiving all smoking behaviors as risky, wrong, or wrong by parents reduced odds of using CCLCs. After multivariate analysis, Blacks had increased odds of using CCLCs if they perceived smoking cigarettes as harmful, which was not found among other race/ethnicity categories. Having parents who believed that smoking CCLCs is wrong increased the odds of youth freaking or blunting among all CCLC users. Odds of blunting was greater for those who believed CCLCs were more risky among all CCLC users. Findings suggest that CCLC users may think cigars are safer than cigarettes, and that modifiers may think their use is safer and more in line with their parents' views than non-modified CCLCs.
Cigar smoking is increasingly common among adolescents who perceive cigars as less harmful than cigarettes. This perception of reduced harm is especially true for cigars that are user-modified by removing the tobacco binder through a process called 'freaking'. Little is known about 'freaking' and this multi-study, mixed-methods analysis sought to understand better the rationale and prevailing beliefs about this smoking practice using YouTube videos. In Study 1, we conducted a descriptive content analysis on the characteristics of 26 randomly sampled cigar product modification (CPM) videos posted during 2006-10. In Study 2, a thematic analysis was performed on the transcripts of commentary associated with each video to characterize viewers' comments about video content. Study 1 results revealed that 90% of videos illustrated a four-step CPM technique: 'Loosening the tobacco'; 'Dumping the tobacco'; 'Removing the cigar binder' and 'Repacking the tobacco'. Four themes related to the purpose of CPM were also derived from video content: 'Easier to smoke' (54%), 'Beliefs in reduction of health risks' (31%), 'Changing the burn rate' (15%) and 'Taste enhancement' (12%). Study 2 results concerning the content characteristics of video comments were categorized into three themes: 'Disseminating information/answering questions' (81%), 'Seeking advice/asking questions' (69%) and 'Learning cigar modification techniques' (35%). Favorable comments were more common (81%) compared to unfavorable (58%) and comment content suggested low-risk perceptions and poor understanding of smoking harms. These findings highlight a novel means for youth to access information concerning CPM that may have important implications for tobacco control policy and prevention.
Over the past 20 years, there has been a tripling in the consumption of small cigars and cigarillos, with further increases expected because cigar products are not subject to Food and Drug Administration regulations. Acute toxin exposure from cigar smoking is difficult to assess because unlike cigarettes, cigars vary widely in size, design, composition, and in the smoking behavior of their consumers. For example, a recent practice among urban youth is to remove the paper liner (i.e., "freaking") of a small cigar in the belief that it is this paper liner that leads to addiction and cancer. We examined acute exposure (CO and nicotine boosts) and puffing behavior in 12 participants (10 men) who smoked (ad lib) their usual conventional cigarette, a Black & Mild cigar (B&M) and a B&M without the paper liner (i.e., "freaked" [B&Mf]). All products (cigarettes, B&M, and B&Mf) significantly increased heart rate and CO with a trend for plasma nicotine. Nicotine boost was significantly higher after cigarette smoking than both B&M and B&Mf, while CO boost was significantly greater after B&M and B&Mf than cigarettes. The CO boost after B&M was larger than after B&Mf. These findings suggest that small cigar smoking is associated with smoke inhalation that leads to significant exposure to nicotine, CO, and presumably other components of tobacco smoke and that removing the inner liner does not substantially reduce toxin exposure.
Multimodal Large Language Models (MLLMs) suffer from hallucinations. Existing hallucination evaluation benchmarks are often limited by over-simplified tasks leading to saturated metrics, or insufficient diversity that fails to adequately assess the hallucination extent in state-of-the-art multimodal models. To address this gap, we propose FREAK, a comprehensive multimodal benchmark designed for fine-grained hallucination assessment in MLLMs. Through high-quality photorealistic images featuring fine-grained counter-commonsense edits, FREAK innovatively evaluates hallucination phenomena in detailed visual perception of MLLMs. Extensive experiments on FREAK show severe hallucination issues in SOTA models regarding detailed visual perception. To enable deeper investigation, we curate a controlled subset to indirectly evaluate the model's ability to perceive target detailed information. Through systematic evaluation of prevailing Chain-of-Thought (CoT) prompting techniques within this task, we reveal critical insights regarding hallucination patterns and model reasoning processes.
The purpose of this short note is to explain how the existing results on the validity of the NLS approximation can be extended from Sobolev spaces $H^s(\mathbb{R})$ to the spaces of functions $u = v + w$ where $v \in H_{per}^s$ and $w \in H^s(\mathbb{R})$. This allows us to use the Peregrine solution of the NLS equation to find freak or rogue wave dynamics in more complicated systems.
Waves propagating through weakly disordered smooth linear media undergo a universal phenomenon called branched flow. Branched flow has been observed and studied experimentally in various systems by considering coherent waves. Recent experiments have reported the observation of optical branched flow by using an incoherent light source, thus revealing the key role of coherent phase-sensitive effects in the development of incoherent branched flow. By considering the paraxial wave equation as a generic representative model, we elaborate a stochastic theory of both coherent and incoherent branched flow. We derive closed-form equations that determine the evolution of the intensity correlation function, as well as the value and the propagation distance of the maximum of the scintillation index, which characterize the dynamical formation of incoherent branched flow. We report accurate numerical simulations that are found in quantitative agreement with the theory without free parameters. Our theory highlights the important impact of coherence and interference on branched flow, thereby providing a framework for exploring branched flow in nonlinear media, in relation with the formation of fre
Achieving high-fidelity lip-speech synchronization in audio-driven talking portrait synthesis remains challenging. While multi-stage pipelines or diffusion models yield high-quality results, they suffer from high computational costs. Some approaches perform well on specific individuals with low resources, yet still exhibit mismatched lip movements. The aforementioned methods are modeled in the pixel domain. We observed that there are noticeable discrepancies in the frequency domain between the synthesized talking videos and natural videos. Currently, no research on talking portrait synthesis has considered this aspect. To address this, we propose a FREquency-modulated, high-fidelity, and real-time Audio-driven talKing portrait synthesis framework, named FREAK, which models talking portraits from the frequency domain perspective, enhancing the fidelity and naturalness of the synthesized portraits. FREAK introduces two novel frequency-based modules: 1) the Visual Encoding Frequency Modulator (VEFM) to couple multi-scale visual features in the frequency domain, better preserving visual frequency information and reducing the gap in the frequency spectrum between synthesized and natural
In this paper we investigate the frequency sensitivity of Deep Neural Networks (DNNs) when presented with clean samples versus poisoned samples. Our analysis shows significant disparities in frequency sensitivity between these two types of samples. Building on these findings, we propose FREAK, a frequency-based poisoned sample detection algorithm that is simple yet effective. Our experimental results demonstrate the efficacy of FREAK not only against frequency backdoor attacks but also against some spatial attacks. Our work is just the first step in leveraging these insights. We believe that our analysis and proposed defense mechanism will provide a foundation for future research and development of backdoor defenses.
Fisheye lens, which is suitable for panoramic imaging, has the prominent advantage of a large field of view and low cost. However, the fisheye image has a severe geometric distortion which may interfere with the stage of image registration and stitching. Aiming to resolve this drawback, we devise a stronger stitching algorithm for fisheye images by combining the traditional image processing method with deep learning. In the stage of fisheye image correction, we propose the Attention-based Nonlinear Activation Free Network (ANAFNet) to deblur fisheye images corrected by Zhang calibration method. Specifically, ANAFNet adopts the classical single-stage U-shaped architecture based on convolutional neural networks with soft-attention technique and it can restore a sharp image from a blurred image effectively. In the part of image registration, we propose the ORB-FREAK-GMS (OFG), a comprehensive image matching algorithm, to improve the accuracy of image registration. Experimental results demonstrate that panoramic images of superior quality stitching by fisheye images can be obtained through our method.
Pair soliton interactions play a significant role in the dynamics of soliton turbulence. The interaction of solitons with different polarities is particularly crucial in the context of abnormally large wave formation, often referred to as freak or rogue waves, as these interactions result in an increase in the maximum wave field. In this article, we investigate the features and properties of bipolar soliton interactions within the framework of the non-integrable Schamel equation, contrasting them with the integrable modified Korteweg-de Vries equation. We examine variations in moments and extrema of the wave fields. Additionally, we identify scenarios in which, in the bipolar solitary wave interaction, the smaller solitary wave transfers a portion of its energy to the larger one, causing an increase in the amplitude of the larger solitary wave and a decrease in the amplitude of the smaller one, returning them to their pre-interaction state. Notably, we observe that non-integrability can be considered a factor that triggers the formation of rogue waves.