Children diagnosed with Autism Spectrum Disorder (ASD) often engage in impulsive, dysfunctional, and maladaptive behaviors (Dawson, Matson, & Cherry, 1998). Research has shown the individuals diagnosed with ASD often exhibit problem behavior when they are required to wait for a preferred item. In fact, research has demonstrated that individuals diagnosed with ASD often choose smaller, immediate reinforcer over larger, delayed reinforcer. Most of the research conducted, however, has previously focused on teaching waiting for a preferred item within the ADHD population. The purpose of the current literature review was to evaluate recent research utilizing behavior interventions to increase socially appropriate waiting with individuals diagnosed with ASD. This review assessed the age of participants, setting(s), research design, independent variables, results, and effectiveness. This review also evaluated the rigor of those studies included utilizing the Quality and Rigor Checklist (Ledford, Lane, & Tate, 2018). Lastly, this review provides recommendations to clinicians currently practicing with the field. / Applied Behavioral Analysis

This thesis examines different components of ethical research: vulnerability, sensitive research topics, Indigenous participants, informed consent, protecting participant privacy, and minimizing harm. Each element is examined in general and in the context of a case study, with the analysis focusing on solutions for addressing each ethical component. This thesis then examines the current state of the literature on child protection mediation, concluding that there is a gap in the literature regarding the timing of child protection mediations. The literature review provides context for the case study that is presented in the thesis. The case study examines the timing of child protection mediation in British Columbia. It is presented to provide an example for future researchers of how ethical dilemmas can arise and be addressed. Each ethical element is discussed on how the issue came to the attention of the research team, what options were considered, and what was added to the research protocol to manage ethical concerns. / Graduate

Introduction: Improvements in the delivery of intensive care have led to a growing number of children with chronic medical conditions at significant risk of recurrent and prolonged critical illness. These patients are increasingly described as having pediatric chronic critical illness (CCI). To date, pediatric CCI is without an accepted consensus case definition. Objective: To evaluate how pediatric CCI has been defined in the current literature, including the concept of prolonged PICU admission, and describe the methodologies used to develop any existing definitions. Secondary aims included describing patient characteristics and outcomes evaluated in included studies. Methods: We searched four electronic databases for studies evaluating children identified with “CCI.” We also searched for studies describing prolonged PICU admission, as this concept is related to pediatric CCI. We developed a hybrid crowdsourcing and machine-learning (ML) methodology to complete citation screening. Screening and data abstraction were performed by two reviewers, independently and in duplicate. We completed data abstraction including details of population definitions, demographic and clinical characteristics of children with CCI, and outcomes evaluated. Results: Twenty-eight reviewers from 11 countries performed citation screening, with a mean sensitivity of 92%. Of 24,729 unique citations assessed for eligibility, 453 full-texts were reviewed and 67 studies were included. Of these, 12 studies (18%) defined CCI, most commonly by a prolonged PICU length of stay (LOS), either in isolation or in addition related to medical complexity patient characteristics and/or readmissions rate. The concept of prolonged PICU admission was defined in an additional 55 (82%) studies by a median of 14 days (range, 1 day-6 weeks). Conclusion: To our knowledge, this scoping review provides the most comprehensive epidemiologic evidence addressing pediatric CCI. Our results suggest a uniform consensus definition is needed in order to advance this emerging and important area of pediatric critical care research. / Thesis / Master of Science (MSc)

Background: Internationally educated nurses (IENs) have become a significant source of nursing supply as a result of nursing workforce shortages, the aging population and patient acuity. However, IENs face substantial delays and barriers obtaining licensure and employment equivalent to their skills and experience. When IENs are unable to practice their profession, they experience a considerable loss of professional identity, earning potential and financial stability. The purpose of this scoping review was to identify and map key themes in the existing literature on the barriers and strategies to timely nursing registration for IENs. Methods: Arksey and O’Malley’s methodological framework was used for this study. Seven electronic databases were searched along with several grey literature sources in order to capture articles that discussed barriers and strategies to timely nursing registration for IENs. A numerical and thematic analysis was conducted to explore the scope of the literature and to present the findings. Results: After full-text screening, 38 pieces of relevant literature were selected for inclusion in the review. The majority (53%) were studies and most (42%) were qualitative. Seven key themes emerged from the thematic analysis: timely information, credential assessment, obtaining documents, language requirements, nursing registration costs, bridging programs and the nursing registration exam. Conclusion: While some IENs are able to successfully navigate the process for obtaining nursing licensure, it is clear that many IENs face obstacles at every step of the process and some never become registered as nurses. Further research is required about whether the various bridging programs and initiatives meet the needs of IENs and help them become registered as nurses. Findings from this scoping review have significant implications for nurse staffing and policies and practices to improve the strength, stability, and diversity of the nursing workforce. / Thesis / Master of Science in Nursing (MSN) / This study explores the literature on internationally educated nurses (IENs) and the difficulties they face, as well as the strategies they use to obtain nursing registration. Arksey and O’Malley’s framework was used to guide this scoping review. Seven databases were searched along with many grey literature sources in order to find articles on barriers and strategies to nursing registration for IENs. A numerical and thematic analysis was conducted to present the findings. Seven main themes emerged from the thematic analysis: timely information, credential assessment, obtaining documents, language requirements, nursing registration costs, bridging programs and the nursing registration exam. More research is required about whether the various bridging programs and initiatives meet the needs of IENs and help them become registered as nurses. Findings from this study are important for nurse staffing and policies and practices to improve the stability and diversity of the nursing workforce.

Sweden's aging population makes the need for a viable health care urgent and telemedicine can be a solution to enable older people to receive or give themselves care in their homes. Furthermore, implementation of telemedicine has the potential to realise profits in society by increasing the accessibility of health care and minimizing travel costs. Sweden’s low population density and geographical configuration makes the advantages of telemedicine even more appealing.   To illustrate the differences between the county councils’ use of telemedicine and thus increasing the possibility for coordinated care between them, the authors have on behalf of the Innovation Centre at the Karolinska University hospital mapped the amount of telemedicine technologies that are available in the Swedish county councils’ today. To collect information an electronic survey and video or telephone interviews were used. This report answers the question of how the use of telemedicine differ between Sweden's county councils in terms of techniques used, how well implemented the technologies are and to what extent the guidelines for development, implementation and use of telemedicine is available. The report also investigated whether the county councils geographic characteristics, in terms of population density and the number of hospitals and health centers, influenced the development of telemedicine.   Of the 21 regional councils information has been collected from 10 counties in seven weeks and the results that were collocated indicated that there are major differences between the county councils' use of telemedicine. It is clear that the northern region and especially Västerbotten and Norrbotten County Council have come a long way in implementing telemedicine technology.   When the results of the electronic survey and interviews were compared with the county councils’ geographical features no correlation could be detected between population density and the use of telemedicine. This can be a result of the low number of participating counties and that we have not examined all departments in health care. The county councils which have university hospitals use multidisciplinary rounds more so than others. In summary, the Swedish county councils are at different stages in the implementation of telemedicine due to several external and internal factors that makes it possible for counties to benefit a lot from collaboration and sharing each other's knowledge. / Sveriges åldrande befolkning gör behovet av en fungerande vård stor och telemedicin kan vara en lösning för att ge äldre möjlighet att få eller ge sig själva vård i hemmet. Genom implementering av telemedicin har Sverige på grund av sin låga befolkningstäthet och geografisk utformning potential att öka tillgängligheten av vård och minska resekostnader.   För att belysa skillnader mellan landstingens användning av telemedicin och på så sätt öka möjligheten för samordnad vård mellan landstingen har författarna på uppdrag av Innovationsplatsen på Karolinska Universitetssjukhuset med hjälp av elektronisk enkät och video- eller telefonintervjuer kartlagt hur mycket telemedicinsk teknik som finns tillgänglig på Sveriges landsting idag. I rapporten besvaras frågeställningen hur användningen av telemedicin skiljer sig mellan Sveriges landsting i avseende på vilka tekniker som används, hur väl implementerade i verksamheten teknikerna är samt i vilken omfattning riktlinjer för utveckling, implementering och användning av telemedicin är tillgängliga. Rapporten har även undersökt om landstingens geografiska egenskaper i form av befolkningstäthet samt antal sjukhus och vårdcentraler påverkat utvecklingen av telemedicin inom landstingen.   Av Sveriges 21 landsting har information samlats in från 10 landsting under sju veckor och resultatet som sammanställdes tydde på att det finns stora skillnader mellan landstingens användning av telemedicin. Det är tydligt att norra regionen och speciellt Västerbottens- och Norrbottens läns landsting har kommit långt i implementering av telemedicinsk teknik.   Då resultaten från den elektroniska enkäten och intervjuerna jämfördes med landstingens geografiska egenskaper drogs slutsatsen att inget tydligt samband kunde upptäckas mellan befolkningstäthet och användandet av telemedicin. Slutsatsen kan bero på för få deltagande landsting och att undersökningen inte utfördes på varje avdelning. En annan slutsats som var tydlig var att landsting som har universitetssjukhus i större utsträckning använder multidisciplinära ronder via videokonferensteknik. Sammanfattningsvis har Sveriges landsting kommit olika långt i utvecklingen av telemedicin på grund av flera yttre och inre faktorer vilket gör det möjligt för landstingen att dra stor nytta av varandras kunskap vid samarbete.

The aim of this systematic review is to present the current literature on the therapeutic potential of the classic psychedelic compound psilocybin for depressive disorders and the neurocognitive mechanisms involved recorded with functional magnetic resonance imaging (fMRI). A comprehensive literature search was conducted in the electronic databases Web of Science, Scopus and Medline EBSCO using a Boolean search string containing the keywords psilocybin, depression, fMRI, MRI and PET. Our inclusion criteria require original neuroimaging research articles published in scientific peer-reviewed journals involving participants diagnosed with depression receiving psilocybin in conjunction with psychological support. Five articles were identified including a total of 104 participants with depression and 75 who received treatment, resulting in significant reduction of depressive symptoms associated with observable changes in neural activity. Specifically reduced cerebral blood flow (CBF) in amygdala, decreased brain modularity along with functional changes in default mode network (DMN), executive network (EN), salience network (SN), decrease in functional connectivity (FC) between ventromedial prefrontal cortex (vmPFC) to amygdala and increased amygdala reactivity to fearful faces. Limitations of our systematic review include a currently limited amount of articles published and thus lack of control groups in most studies. The current evidence indicates that the therapeutic potential of psilocybin-assisted therapy may provide fast acting and efficient amelioration of depressive symptoms and the effects may be mediated by neurocognitive changes acute and post-treatment. The preliminary results warrants further research in order to optimize treatment and establish safety and efficacy long term.

京都大学 / 新制・論文博士 / 博士(社会健康医学) / 乙第13455号 / 論社医博第17号 / 新制||社医||11(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 長尾 美紀, 教授 近藤 尚己, 教授 中川 一路 / 学位規則第4条第2項該当 / Doctor of Public Health / Kyoto University / DFAM

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Growing evidence suggests that adipokines may be therapeutic targets for cardiometabolic diseases such as type 2 diabetes mellitus (T2DM). C1q TNF Related Protein 3 (CTRP3) is a newly discovered adipokine which shares properties with adiponectin. The literature about the association between circulating levels of CTRP3 and T2DM has been conflicting. The present study reassessed the data on circulating CTRP3 levels in T2DM patients compared to controls through a systematic review and meta-analysis. A literature search was performed in Medline, Embase, Scopus, and Web of science to identify studies that measured circulating CTRP3 levels in T2DM patients and controls. The search identified 124 studies of which 59 were screened for title and abstract and 13 were subsequently screened at the full text stage and 12 studies included into the meta-analysis. Subgroup analyses, depending on the presence of T2DM complications, matching for BMI, age, and cut off value of fasting blood sugar and HOMA-IR, were performed. The results show that circulating CTRP3 levels are negatively associated with T2DM status (SMD: −0.837; 95% CI: (−1.656 to −0.017); p = 0.045). No publication bias was identified using the Begg's rank correlation and Egger's linear regression tests (P = 1 and P = 0.44, respectively). Meta-regression demonstrated significant association between CRTP3 levels with BMI (slope: 0.11; 95% CI: 0.04–0.19; p = 0.001) and sex (slope: −0.07; 95% CI: −0.12 to −0.01; p = 0.008). The present systematic review and meta-analysis evidences a negative association between circulating level of CTRP3 and T2DM status. BMI and sex may modify this association.

Background: Cleft lip and/or palate (CL/P) is a complex, heterogeneous disorder which occurs due to the interplay between environmental and biological risk factors. Individuals in lower-middle-income countries (LMICs) are exposed to a multitude of risk factors resulting in a greater occurrence of CL/P. Research and knowledge of which risk factors are associated with CL/P in LMICs may aid health care professionals such as speech-language therapists in low-income countries in the early identification of at-risk infants. Objective: To identify and review published data on the risks associated with CL/P in LMICs. Design: A systematic review of literature was performed on electronic databases using the PRISMA-P. Literature on risks associated with CL/P in LMICs, from 2010 to 2020 was included. Results: Seventeen studies met the inclusion criteria. All studies adopted an observational study design. Biological and environmental risks were identified. Maternal and paternal age (n=7) and low socioeconomic status (n=5) were the most prominently associated environmental risk factors. Regarding biological risk factors, a strong association was identified between family history of cleft (n=7) and CL/P occurrence. Conclusion: Environmental risk factors are now being investigated more than biological risk factors in LMICs, hindering health care workers in the early identification (EI) of the possible cumulative effects of risks in CL/P. Contextually-relevant tools are recommended to promote the EI of at-risk infants. / Dissertation (MA (Speech-Language Pathology))--University of Pretoria, 2021. / Speech-Language Pathology and Audiology / MA (Speech-Language Pathology) / Unrestricted