Evaluation of headache service quality indicators: pilot implementation in two specialist-care centres

Background Evaluating quality of health care is increasingly recognized as an important contributor to the advancement of health-care delivery. We recently developed a set of quality indicators for headache care, intended to be applicable across countries, cultures and settings so that deficiencies in headache care worldwide might be recognized and rectified. These indicators themselves require evaluation and proof of fitness for purpose. This pilot study begins this process. Methods We tested the quality indicators in the tertiary headache centres of the University of Duisburg-Essen in Essen, Germany, and the Hospital da Luz in Lisbon, Portugal. Using seven previously-developed enquiry instruments, we interrogated health-care providers (HCPs), including doctors, nurses, psychologists and physiotherapists, as well as consecutive patients and their medical records. Results The questionnaires were easily understood by both HCPs and patients and were not unduly time-consuming. The results from the two headache centres were comparable despite their differences in structure, staffing and language. These findings met the purpose of the study. Diagnoses were made according to ICHD criteria and critically evaluated during follow-up. However, diagnostic diaries and instruments assessing burden and response to treatment were not always in place or routinely utilised. Triage systems adjusted waiting times to urgency of need. Treatment plans included pathways to other specialities. Patients felt welcomed, reassured and educated, and were mostly satisfied. Discussion points arose over inclusion of psychological therapies in treatment plans; over recording of outcomes; over indicators of efficiency and equitability (protocols to limit wastage of resources, systems to measure input costs and means of ensuring equal access to the services); and over protocols for reporting serious adverse events. Conclusion This pilot study to assess feasibility of the methods and acceptability of the instruments of headache service quality evaluation was successful. The project is ready to be taken into its next stages

METGAN: Generative Tumour Inpainting and Modality Synthesis in Light Sheet Microscopy

Novel multimodal imaging methods are capable of generating extensive, super high resolution datasets for preclinical research. Yet, a massive lack of annotations prevents the broad use of deep learning to analyze such data. So far, existing generative models fail to mitigate this problem because of frequent labeling errors. In this paper, we introduce a novel generative method which leverages real anatomical information to generate realistic image-label pairs of tumours. We construct a dual-pathway generator, for the anatomical image and label, trained in a cycle-consistent setup, constrained by an independent, pretrained segmentor. The generated images yield significant quantitative improvement compared to existing methods. To validate the quality of synthesis, we train segmentation networks on a dataset augmented with the synthetic data, substantially improving the segmentation over baseline

The Role of Infant Temperament in Stability and Change in Coparenting Across the First Year of Life

The current study investigated the role of infant temperament in stability and change in coparenting behavior across the infant’s first year. Specifically, bidirectional relations between infant temperament and coparenting were examined and temperament was further considered as a moderator of longitudinal stability in coparenting behavior

Parental beliefs, infant temperament, and marital quality: Associations with infant–mother and infant–father attachment.

The present research examined parental beliefs about the importance of the paternal caregiving role, mothers’ and fathers’ reports of infant temperament, and observed marital quality as predictors of infant-mother and infant-father attachment security, over and above the effects of parental sensitivity. Infants’ attachment security to mothers and fathers were observed in the Strange Situation at 12- and 13-months, respectively (N = 62 two-parent families). Hierarchical regression models revealed that mothers who viewed the paternal caregiving role as important were less likely to have securely attached infants, but only when infant fussiness was high. Additionally, fathers who viewed the paternal caregiving role as important were more likely to have securely attached infants, but only when infants’ fussiness or marital quality was high

a Função de Orientador Argumentativo dos Rotulos em Artigo de Opinião: uma Questão de Entonação de Valores Sociais

À luz de uma perspectiva sociointeracionista, este trabalho tem como objetivo pesquisar o processo referenciação através dos rótulos (expressões nominais que sumarizam porções de texto), evidenciando a função de orientador argumentativo desempenhada por essas expressões. Assumida a perspectiva teórica, entendemos que o real é fabricado através de nossas práticas sociais e discursivas. Assim, ao contrário de concebermos que a relação entre linguagem e mundo se dá de forma direta e especular, defendemos as versões públicas do mundo (MONDADA e DUBOIS 2003[1995]). A fim de buscar o objetivo proposto, trazemos para o nosso texto a concepção filosófica bakthiniana de valoração (BAKTHIN, 1993[1920-24]), com o intuito de mostrar que, ao construir o objeto de discurso, o sujeito seleciona as formas linguísticas que melhor se adaptem ao seu projeto de dizer. No entanto, essas escolhas não emanam de um sujeito solitário; pelo contrário, são usadas por um sujeito que é singular e social, simultaneamente, que rejeita e assume diversos valores sociais, os quais determinam a forma e o conteúdo de seu enunciado e com os quais convive. Os textos utilizados exemplificar o que é discutido nessa pesquisa são três artigos de opinião publicados no jornal A Gazeta, selecionados no período de agosto a dezembro de 2009. Para a análise dos textos tomamos uma postura dialógica a fim de explicitar que o posicionamento assumido pelo articulista na construção do objeto de discurso é dialógico, pois responde a outros enunciados e entoa uma avaliação que não emana de um sujeito isolado, mas social. Desse modo, acreditamos que a função de orientador argumentativo dos rótulos é mais bem compreendida se levarmos em consideração a corrente dialógica na qual se insere o uso dessas expressões. Palavras-chave: Referenciação; Objeto de discurso; Rotulação; Dialogia; Valoração

Parents’ differential susceptibility to the effects of marital quality on sensitivity across the first year

The current investigation examined the differential susceptibility of parents to the effects of marital quality on changes in parenting. We predicted that parents who were high on the personality constructs Negative Affect and Constraint would be more susceptible to the effects of marital quality on their level of sensitivity. Sensitivity was assessed at 3.5 and 13 months for both mothers and fathers during a triadic interaction. Consistent with the differential susceptibility theory, results suggested that when mothers were high on Negative Affect and when fathers were high on Constraint, their marital quality was associated with changes in sensitivity. This investigation suggests that personality factors may create “vulnerabilities” in parents that make them differentially susceptible to the effects of the family environment on parentin

Examining Ecological Constraints on the Intergenerational Transmission of Attachment Via Individual Participant Data Meta-analysis

Parents\u2019 attachment representations and child\u2013parent attachment have been shown to be associated, but these associations vary across populations (Verhage et al., 2016). The current study examined whether ecological factors may explain variability in the strength of intergenerational transmission of attachment, using individual participant data (IPD) meta-analysis. Analyses on 4,396 parent\u2013child dyads (58 studies, child age 11\u201396 months) revealed a combined effect size of r =.29. IPD meta-analyses revealed that effect sizes for the transmission of autonomous-secure representations to secure attachments were weaker under risk conditions and weaker in adolescent parent\u2013child dyads, whereas transmission was stronger for older children. Findings support the ecological constraints hypothesis on attachment transmission. Implications for attachment theory and the use of IPD meta-analysis are discusse

Conceptual comparison of constructs as first step in data harmonization: Parental sensitivity, child temperament, and social support as illustrations

This article presents a strategy for the initial step of data harmonization in Individual Participant Data syntheses, i.e., making decisions as to which measures operationalize the constructs of interest - and which do not. This step is vital in the process of data harmonization, because a study can only be as good as its measures. If the construct validity of the measures is in question, study results are questionable as well. Our proposed strategy for data harmonization consists of three steps. First, a unitary construct is defined based on the existing literature, preferably on the theoretical framework surrounding the construct. Second, the various instruments used to measure the construct are evaluated as operationalizations of this construct, and retained or excluded based on this evaluation. Third, the scores of the included measures are recoded on the same metric. We illustrate the use of this method with three example constructs focal to the Collaboration on Attachment Transmission Synthesis (CATS) study: parental sensitivity, child temperament, and social support. This process description may aid researchers in their data pooling studies, filling a gap in the literature on the first step of data harmonization. • Data harmonization in studies using combined datasets is of vital importance for the validity of the study results. • We have developed and illustrated a strategy on how to define a unitary construct and evaluate whether instruments are operationalizations of this construct as the initial step in the harmonization process. • This strategy is a transferable and reproducible method to apply to the data harmonization process

The Impact of Augmented Information on Visuo-Motor Adaptation in Younger and Older Adults

BACKGROUND: Adjustment to a visuo-motor rotation is known to be affected by ageing. According to previous studies, the age-related differences primarily pertain to the use of strategic corrections and the generation of explicit knowledge on which strategic corrections are based, whereas the acquisition of an (implicit) internal model of the novel visuo-motor transformation is unaffected. The present study aimed to assess the impact of augmented information on the age-related variation of visuo-motor adjustments. METHODOLOGY/PRINCIPAL FINDINGS: Participants performed aiming movements controlling a cursor on a computer screen. Visual feedback of direction of cursor motion was rotated 75 degrees relative to the direction of hand motion. Participants had to adjust to this rotation in the presence and absence of an additional hand-movement target that explicitly depicted the input-output relations of the visuo-motor transformation. An extensive set of tests was employed in order to disentangle the contributions of different processes to visuo-motor adjustment. Results show that the augmented information failed to affect the age-related variations of explicit knowledge, adaptive shifts, and aftereffects in a substantial way, whereas it clearly affected initial direction errors during practice and proprioceptive realignment. CONCLUSIONS: Contrary to expectations, older participants apparently made no use of the augmented information, whereas younger participants used the additional movement target to reduce initial direction errors early during practice. However, after a first block of trials errors increased, indicating a neglect of the augmented information, and only slowly declined thereafter. A hypothetical dual-task account of these findings is discussed. The use of the augmented information also led to a selective impairment of proprioceptive realignment in the younger group. The mere finding of proprioceptive realignment in adaptation to a visuo-motor rotation in a computer-controlled setup is noteworthy since visual and proprioceptive information pertain to different objects