BackgroundResearchers often file unsolicited comments included in data collection in the bottom drawer and exclude them from data analysis, despite such comments capturing raw and unfiltered perspectives. Research on psychological reactance often relies on direct measures, such as surveys or self-reports. While useful, these methods overlook spontaneous unsolicited comments, which are a critical source of unfiltered emotional insight that provides the explanatory context necessary to interpret observed outcomes, rather than merely describe them.ObjectiveThe aim of this study was to analyse unsolicited comments from employees in a workplace behavioural change intervention that used a choice default option design.MethodThe study sample comprised 139 desk-based employees working across government sites. The data consisted of unsolicited comments included in email correspondence from employees requesting withdrawal from the study.ResultsWe identified two themes that reflected the presence of reactance motivation. These were negative cognitions (e.g., thoughts of unfairness) and anger (e.g., aggressive feelings towards the nudge), which are consistent with reactance models. Various sub-themes such as hyperbolic discounting and anxiety indicated the various emotional pathways for the development of reactance.ConclusionsOur findings indicate that the use of a choice default option nudge as a design to bridge the gap between intention and action to change health behaviour can trigger negative spill-over effects which led to non-compliance. Given the unsolicited comments were accrued over a 12-month period, the trade-off between perceptions of a loss of freedom of choice and improved health might be acceptable to some individuals.
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Too much work on graphene and related materials cannot be repeated, a problem that wastes time and holds back commercialization. New rules could help solve it.
Camouflaging of autistic traits has gained increasing attention as a psychological construct capturing strategies used to conceal or compensate for autistic characteristics in social contexts. Given the cultural specificity of social behavior, the adaptation and validation of measurement instruments across diverse populations are essential. The present study aimed to culturally adapt and validate the Persian version of the Camouflaging Autistic Traits Questionnaire (CAT-Q) and to examine its measurement invariance and group differences between adults with high and low autistic traits in Iran. Following a standardized forward-backward translation procedure and expert panel review, the Persian CAT-Q was administered to 1,100 individuals, of whom 948 (aged 15-50 years) met the inclusion criteria after data screening. Construct validity was examined using confirmatory factor analysis (CFA). Convergent validity was assessed through correlations with the social camouflage subscale of the Comprehensive Autistic Trait Inventory (CATI), and reliability was evaluated using Cronbach's alpha and mean inter-item correlations. CFA supported the original three-factor structure of the CAT-Q (compensation, masking, and assimilation) with acceptable fit indices (Comparative Fit Index [CFI] = 0.91, Root Mean Square Error of Approximation [RMSEA] = 0.06). Measurement invariance testing supported configural, metric, and scalar invariance across high and low autistic traits groups, indicating comparable measurement properties. Convergent validity was confirmed through significant correlations with the social camouflage subscale of the CATI. Internal consistency was strong, with Cronbach's alpha coefficients ranging from .66 to .89 across subscales and .89 for the total scale, although the assimilation subscale showed comparatively lower reliability. The Persian version of the CAT-Q demonstrates satisfactory psychometric properties and measurement equivalence across groups, supporting its use in research contexts within Iran. Findings should be interpreted with attention to cultural context and the relatively lower reliability of the assimilation subscale.Lay AbstractMany autistic people use "camouflaging" to cope in social situations. Camouflaging means trying to hide autistic traits or to compensate for social difficulties so that others will not notice differences. These efforts may help someone blend in, but they can also be tiring and may affect wellbeing. Because social rules and expectations differ across cultures, researchers and clinicians need tools that are carefully adapted for each language and society. This study adapted the Camouflaging Autistic Traits Questionnaire (CAT-Q) into Persian and examined whether it works well for adults in Iran. The questionnaire was translated using a standard forward-backward process, reviewed by specialists for clarity and cultural suitability, and then tested in a large Iranian sample recruited online. We examined whether the Persian CAT-Q keeps the same three parts found in earlier research: (1) compensation (actively managing social situations), (2) masking (hiding autistic traits), and (3) assimilation (trying to fit in by suppressing one's natural style). We also tested whether the questionnaire measures camouflaging in the same way for people with higher versus lower levels of autistic traits, so that comparisons between these groups are fair. Overall, results showed that the Persian CAT-Q is a useful and consistent measure of camouflaging in Iranian adults. The "Assimilation" part was somewhat less consistent than the other parts, so it should be interpreted with extra care. This Persian version can support future research and may help improve understanding of hidden social effort and support needs in Iran.
Anhedonia (loss of pleasure) is a core feature of both depression and psychosis and yet the experience is not well understood. This limits our ability to effectively target it with psychological or pharmacological interventions. The aim of this study was to explore the experience of anhedonia, for the first time from a transdiagnostic perspective. Semi-structured interviews, co-facilitated by lived-experience experts, were conducted among 17 adults with a diagnosis of depression or psychosis and who were experiencing anhedonia. Reflexive thematic analysis was employed to generate themes. Six themes were identified: (a) no longer experiencing pleasure or joy in previously enjoyable activities; (b) grieving for the joyful times that have been missed; (c) the dilemma before trying an activity again; (d) the significant social impact of anhedonia, and the power of lived-experience connections; (e) uncertainty around what causes anhedonia; and (f) the lack of acknowledgement or support from services around this experience. The words disconnection and frustration were those most used to describe what people felt when experiencing anhedonia. The results highlight the negative impact of expectation and social pressure on joy, and the importance of the anticipatory period prior to trying an activity again. The clinical implications highlight the importance of discussing anhedonia with patients: by not doing so is contributing to stigma. This is the first study to directly explore anhedonia in adults, with lived-experience input throughout, and the findings support further work adopting a wider transdiagnostic approach.
To perform an updated systematic review and meta-analysis of the efficacy and safety of intensive (INT) vs. conventional (CONV) blood glucose (BG) targets for critically ill adults on insulin infusions. We conducted a comprehensive search of Embase and OVID Medline databases from inception to October 16, 2023. We manually excluded studies published before 2000 due to potential lack of relevance as glycemic control in the ICU was not routinely practiced before 2000. We included randomized controlled trials (RCTs) evaluating adult, critically ill patients on insulin infusions comparing INT vs. CONV targets for efficacy and safety outcomes. Data were screened and extracted with accuracy confirmed by a second reviewer. Study methodological characteristics, patient population, interventions, and outcome data were recorded. Studies without numerical outcomes were summarized as text statements. Forty-five RCTs were included involving 32,215 patients. No differences were seen between INT and CONV targets for hospital mortality or ICU mortality. INT targets were associated with lower ICU length of stay (LOS), infections, and critical illness polyneuropathy (CIP); however, INT targets demonstrated a 3.6-fold higher risk of severe hypoglycemia. Most of the studies with significant differences contained serious inconsistencies or risk of bias. In the subgroup analyses, INT targets demonstrated favorable neurologic outcomes in neurologic ICU patients, lower ICU LOS in mixed ICU patients, and lower ICU mortality in the cardiac surgery subgroup. INT BG targets demonstrated mild to moderate improvements in several important morbidity secondary outcomes, including LOS, infections, and CIP, but were associated with a 3.6-fold higher risk of severe hypoglycemia. No differences were seen in ICU or hospital mortality. INT targets should not be routinely used over CONV targets when trying to minimize hypoglycemia as a marker of patient safety. However, as stated in the Society of Critical Care Medicine guidelines, a lower target within the INT range (110-140 mg/dL; 6.1-7.8 mmol/L) may be considered acceptable in select centers where the risk of hypoglycemia is documented to be negligible based on routine assessment and with the use of optimized glycemic management protocols.
Programmed death-1 (PD-1) antibody-drug conjugates (ADCs) are a new generation of immune checkpoint blockers, which incorporate the delivery of cytotoxic drug targets. The objectives of these ADCs are to selectively target cells in the tumor microenvironment expressing PD-1, causing tumor cells to die, rejuvenating T cell exhaustion, and destroying immunosuppressive cells. PD-1 ADCs aim to address the shortcomings of conventional PD-1 inhibitors, which may be resistant in certain cancers, by harnessing a two-pronged mechanism. This method can also be used to boost antitumor immunity by stimulating the activation and expansion of immune effector cells. Despite promising preclinical and early clinical outcomes, multiple issues remain in the development of PD-1 ADCs, including heterogeneity in tumor antigens, the development of resistance mechanisms, and instability of the ADC linker. Current studies are trying to overcome these challenges by improving ADC engineering, cytotoxic payload optimization, and investigating combination therapy. PD-1 ADCs, with their capacity to specifically regulate immunity and deliver potent cytotoxic drugs directly to tumor cells, have the potential to provide a valuable treatment modality. This would be beneficial for clinical outcomes, especially in cancers resistant to traditional treatment methods, and it represents a great step forward in cancer immunotherapy.
Accounts of emotional dysregulation in autism and attention-deficit/hyperactivity disorder (ADHD) are typically based on external adult observations anchored in neurotypical notions of emotional responding. These often fail to place neurodivergent people's emotional responses in the context of the upsetting experiences they face; information best provided by the young people themselves. We interviewed 57 adolescents (11-15 years; 19 females) with diagnoses of ADHD (n = 24), autism (n = 21) or both (n = 12), about their experience of upsetting events using a co-designed semi-structured interview schedule. Reflexive thematic analysis generated shared themes with diagnosis-specific nuances. Four themes were extracted: social dislocation, alienation and conflict; need to mask; self-doubt, loathing, embarrassment; and over stimulation/sensory mismatch. Upsetting experiences, for ADHD participants, were typically perceived as instigated by external agents trying to impose control, and/or a sense of injustice; for autistic participants they often related to feelings of 'not belonging' and alienation. Masking, for autistic participants, included 'hiding' negative emotions to protect others from their intensity; whereas in ADHD, masking usually involved supressing emotional upset to protect oneself from conflict or consequences. Those with a joint diagnosis reported a combination of these experiences, often felt more intensely. First-person accounts of emotional responding could provide new insights with potential to refine current dysregulation-based accounts of ADHD or autism.
Little is known about how differences in economic pressure in life worlds shape understandings of mental illness and stigmatization toward people with mental illness. We conducted an explorative study using five focus groups with three to five participants selected through purposive theoretical sampling. Each focus group represented a different life world (operationalized through shared occupational and sociopolitical life goals). Using the method of maximum contrasts, we conducted a qualitative content analysis of 2 focus groups (group 1: n = 4, mean age: 37.7y, volunteer fire fighters; group 2: n = 4, mean age: 41.3y, self-employees working in the service and media sector). Different life worlds corresponded with different manifestations of stigma and interactions with people with mental illness. Self-employed entrepreneurs rationalized their social behavior using a cost-benefit-analysis that considers possible costs regarding performance and self-optimization. In contrast, volunteer fire fighters described trying to integrate people with mental illness in a familial way. Life worlds not only interrelate with stigmatizing attitudes but shape the process of stigmatization itself. These first results can be used to design modern questionnaires to examine stigmatization and support targeted intervention and prevention strategies.
The COVID-19 pandemic dramatically increased pressure on healthcare staff who were trying to manage and adjust to the novel situation. For many healthcare workers, this came at a cost to their wellbeing. However, as research is predominantly focused on the Western world, less is known about the experiences of healthcare staff in places such as Africa. Using qualitative interviews, this study investigated the experiences of seven doctors in Lesotho regarding their wellbeing during the pandemic. Through interpretative phenomenological analysis, five themes were identified: under pressure, unprepared and out of control; constant uncertainty and threat; isolation and connection; attempts to cope independently and new perspectives. These results indicate that these doctors experienced multiple challenges whilst working during the pandemic which extended beyond the work environment and negatively impacted their wellbeing. Despite this, they experienced support from friends, family and colleagues, found ways to support themselves, and found points of learning from the experience. Implications for how doctors are supported at a national and local level are discussed. Further research should continue to explore doctors' wellbeing in relation to any long-term implications of the COVID-19 pandemic and during more typical work.
Establishing healthy dietary patterns in childhood lowers the risk of developing non-communicable diseases. After-school programs are important settings in public health work, as they reach a majority of young students and shape everyday food and meal practices.The aim of this study was to explore students' experiences of being "food agents", a central role in an intervention aiming to increase food literacy competencies. The after-school program employees' experiences with students as food agents during the intervention were included in the analysis, to broaden the perspectives. Qualitative focus groups and individual interviews. Qualitative focus groups with 19 students from 2nd (7-8 years old) to 4th grade (10-11 years old) and individual interviews with six after-school program employees in Norway. The anonymous transcripts were uploaded to Nvivo 15 and analysed inductively using Braun and Clarkes reflexive thematic analysis approach. The students enjoyed being part of the intervention and acting as food agents. They reported joy of preparing and serving food, learning new cooking skills and trying new foods. Gaining responsibility and receiving positive feedback from peers on their work is something which provided them with a sense of growth and mastering. This feedback was supported by the staff who observed positive engagement among the students. Our results suggest that including students in preparing and serving meals in after-school programs can provide students with valuable experiences related to both food literacy competencies and personal growth.
During restorative justice conferencing, post conferencing instructor surveys of online nurse practitioner (NP) instructors indicated many emotional and cognitive responses when discussing academic integrity events with students. The current literature has not explored the perceptions of online NP faculty when dealing with academic integrity events. This study was designed to explore the effect of academic integrity events on professional morale, view of students, and the perception of teaching as a profession. A mixed-methods survey was sent to instructors currently teaching in an online NP program. The 14 quantitative questions were proposed in a Likert scale format and analyzed for hierarchical themes. The three open-ended qualitative responses were analyzed for common nodes of expression. Instructors reported no control over the prevalence of academic misconduct and expressed lack of confidence in handling academic misconduct conversations. Strong emotional responses occurred when submitting academic misconduct events for institutional review. Initial feelings were disappointment, shock, frustration, and annoyance with the additional duties. Instructors described the anticipation and apprehension of students' reactions while trying to care for students and addressing the event. Online NP faculty experience role strain and distress when confronted with academic integrity events. In addition, the stressor of anticipating these high-stakes conversations compounded the feelings of inadequacy in conducting these discussions with students. These perceptions point to the need for educational institutions to provide practical support to online NP instructors regarding high stake conversation skills and resiliency in the face of academic events.
The Default Mode Network was a key finding for cognitive neuroscience, but being the result of a data-driven analysis of resting-state fMRI data, its psychological and clinical implications have been difficult to elucidate. This is because in the resting-state paradigm we cannot directly correlate an observable specific task with specific brain connectivity patterns, and therefore inferences about the relationship between particular cognitive domains and the resting-state networks are limited. A similar problem arises when trying to link the network with personality traits: the DMN, as other intrinsic networks, is not a simple metric to compare with the results of a psychological test, but a complex composite of spatio-temporal features. Although over the last two decades several research works have provided insights about these relationships, we still lack a consensus on the methodology that best captures these interactions. In this context, we propose an alternative method to model the psycho-physiological relationships of the resting state components with behavioral data, based on the dimensionality reduction of an extensive psychological evaluation and the spatial dimension of the intrinsic connectivity components. Our results show that the connectivity networks are low to moderately related with behavioral and personality traits, or at least this relation is not in a direct way. This integration of neuroimaging and psychological assessment data creates valuable pathways for cognitive neuroscience, potentially revealing with precision how intrinsic brain network organization relates to individual variations in cognitive functioning and personality dimensions.
We assessed dietary intake and sources of sodium and potassium, and salt-related knowledge, attitudes, and behaviours (KAB) among rural adults in four Chinese provinces. This cross-sectional study was conducted in four provinces in China, with two counties per province and eight villages per county purposively selected. Participants (18-69 years) were enrolled using stratified random sampling by sex and age in each village. Sodium and potassium intake were estimated using eligible 24-h urine samples, with a 24-h dietary recall collected from a 25% subsample to assess dietary sources. Salt-related KAB was assessed using an interviewer-administered questionnaire. Data were summarized using sampling weights as means (SE) for continuous variables and weighted proportions for categorical variables. A total of 2,669 participants were recruited between August 2021 and May 2023. Mean sodium and potassium intake was 5.8 g/day (SE 0.1) and 2.39 g/day (SE 0.04), respectively, equivalent to 14.7 g/day of salt (SE 0.2). Overall, 77.7% of participants were aware of the health risks of excessive salt or salty sauce intake, 67.3% recognized the importance of reducing salt in cooking, and 50.1% reported trying to reduce salt intake. We find that 72.1% of sodium intake came from salt added during home cooking, while cereals and tubers were the main sources of potassium. Rural Chinese adults consume excessive sodium and insufficient potassium relative to World Health Organization recommendations, with generally poor attitudes and adoption of salt-reduction behaviours. These findings highlight the need for interventions that strengthen salt-reduction education, provide practical tools, and improve supportive food environments.
ObjectiveThe purpose of this perspective is to provide a critical reflection on the current systemic and sociocultural influences on autism diagnostic practice, which create clinical challenges for specialists in autism diagnosis.ConclusionsMany people are being referred for autism diagnostic assessments for increasingly non-specific emotional, behavioural or academic difficulties or concerns about functioning. The widespread availability of information about autism online, especially on social media platforms, is often unreliable or misrepresentative, adding complexity both to the clinical landscape and for those individuals presenting for assessment who are trying to make sense of their personal experiences in these forums. In such an environment, adherence to evidence-based diagnostic practices is essential, within a context that recognises the importance of establishing a history of typical versus atypical development and differential diagnosis, to ensure diagnostic accuracy and facilitate access to tailored and timely support.
Large population databases frequently include complicated family structures that are amenable to modern biometric methods: allowing for intergenerational and extended pedigree analyses. To date, much of the latent potential of these resources remains untapped due to numerous complexities that arise in their analysis. Two difficult and critical problems are (1) finding independent extended families within larger population databases, and (2) determining coefficients of relatedness among all pairs of individuals within those extended families. If these problems were solved, researchers could more fully utilize data on extended families for biometric modeling. In this paper, we provide fast, computationally efficient algorithms for both of these problems and several more that are applicable to arbitrarily large and complex pedigrees. The algorithms rely solely on mother-child and father-child relationships that form the basis of many large population databases. These methods will be invaluable to any researcher trying to segment standard pedigree data files into independent extended family units, compute relatedness coefficients within extended families, and conduct intergenerational and other biometric modeling.
People with Hoarding Disorder (PWHD) can experience enforced removal of their possessions by others, often with the intention of trying to improve an individual's situation. To date, there has been no research exploring PWHD's experiences of this. The study qualitatively explored people's experiences of forced clearances within the context of HD. Nine participants meeting DSM-5 criteria for HD completed a semi-structured interview about their experience of forced clearances; this included a description of the clearance, impact upon self and hoarding behaviours and recommendations on what improved support could look like. Participants also completed questionnaires measuring hoarding severity and distress caused by a forced clearance. Three themes and six subthemes were generated: (1) Power Imbalance (subthemes: Criminalisation of Mental Health Difficulties; Clearance as the Lesser of Two Evils); (2) The Trauma of Clearance (subthemes: Losing Belongings is Like Losing Myself; 'Trauma on top of Trauma'); (3) Picking Up the Pieces (subthemes: Clearance Weighs Heavily on the Mind; Replacing the Shield). Participant recommendations included the importance of early intervention, the need to build trust and seeing the person behind the belongings. Most scores on the measure of distress were high, consistent with participant reports that the event was typically a traumatic experience. Findings suggest that forced clearances are a traumatic experience with a long-lasting impact for PWHD. The study has theoretical implications for how traumatic events are defined in the context of HD and clinical implications for how to support PWHD and their experience of forced clearances.
Within social sciences, the concept of time has gained some attention in migration studies, among other fields, especially in the last couple of decades. While a few articles and books have focused on reviewing and conceptualizing the time dimension within the broader field of migration studies, they have rarely focused specifically on the subfield of refugee studies, even though many works in this subfield, mostly of empirical nature, have touched upon the concept of time explicitly or implicitly. This paper first reflects on what unpacking the time dimension would add to the study of refugee experiences and policies. Subsequently, the paper examines how some key conceptualizations of time in social theory have been addressed in and are relevant for some selected works within refugee studies. It specifically focuses on reviewing how different dimensions of time - timing; sequence (or order); frequency (or rhythm), including (a)synchronization; speed (or tempo); duration; and past, present and future - manifest at the micro, meso and macro levels of the social world pertaining to forced displacement. Recognizing the intertwined nature of these levels, the paper ends with some brief initial reflections on why and how to advocate for a balanced approach between mobility and immobility, agency and structure, informality and formality, and haphazardness and purposiveness, when studying or trying to understand temporalities in refugee lives and policies.
To explore the facilitators and barriers to staff providing psychologically safe care in inpatient mental healthcare when restrictive practices are used. Qualitative descriptive interview study. Twenty semi-structured interviews were conducted with staff with experience working in inpatient mental healthcare in England. Analysis included principles of framework analysis, informed by the Theoretical Domains Framework. Access to resources and a safe environment for both patients and staff were recognised as important (environmental context and resources) but access was impacted by competing organisational priorities and expectations (beliefs about capabilities). Participants recognised knowledge gaps in themselves and their colleagues (knowledge). Being able to confidently make decisions about risk was seen as central to the staff role (social/professional role and identity). Collaboration between staff is needed to make positive change and progression towards psychologically safe care (social influences). Empathy and compassion were driving factors in participants trying to use psychologically informed alternatives, but burnout hindered this (emotions). Ensuring that staff feel supported in their role to implement psychosocial informed alternatives to restrictive practices, as well as providing safe environments for both patients and staff, could support the integration of psychologically safe care on inpatient mental health wards. Key facilitators and barriers to staff providing psychologically safe care are identified to support practice and improvements to patient care. Consolidated criteria for reporting qualitative studies (COREQ). Former patients and members of the public were involved in the conceptualisation of key concepts and design of this study.