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The coronavirus disease (COVID-19) pandemic and associated infection control measures have introduced significant uncertainty, and the unbearable nature of this uncertainty has heightened the risk of mental health issues among college students. This study aimed to assess the impact of unbearable uncertainty during the COVID-19 pandemic on college students' depression and investigate the mediating role of coping strategies between unbearable uncertainty and depression. A cross-sectional survey was conducted with 714 Chinese university students using the Intolerance of Uncertainty Scale (IUS-12), Brief Coping Style Questionnaire, and Beck Depression Inventory (BDI-II). SPSS PROCESS was used for the partial correlation analyses and structural equation modeling. (1) Negative coping strategies were significantly positively correlated with intolerable uncertainty and depressive symptoms, while positive coping strategies were negatively correlated with both intolerable uncertainty and depressive symptoms. Intolerable uncertainty was significantly and positively correlated with depressive symptoms. (2) Intolerance to uncertainty significantly predicted depressive symptoms. Both negative and positive coping strategies played parallel mediating roles in the relationship between unbearable uncertainty and depressive symptoms among college students. This study found that coping strategies played a mediating role in the relationship between unbearable uncertainty and depression during the pandemic in 2019. Future research and interventions should focus on enhancing tolerance of uncertainty and promoting positive coping strategies.

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BACKGROUND: Intolerance of uncertainty (IU) is widely accepted as a transdiagnostic vulnerability factor for a range of mental health problems. It is considered a transsituational vulnerability factor associated with a range of responses to different stressful life situations. The aim of this systematic review and meta-analysis is to examine the association between IU and specific psychological responses to the COVID-19 pandemic and the moderators of this relationship drawn from IU research and other studies on COVID-19. METHOD: The studies included were as follows: (i) English-language articles published in peer-reviewed journals or thesis/dissertations; (ii) reporting specific psychological impacts of COVID-19; (c) reporting IU; (iii) case-control studies, prospective cohort studies, experimental studies and cross-sectional studies of large populations and (iv) reporting correlation coefficients between the variables of interest. Studies on participants with a diagnosis of neurological and/or organic impairment were excluded. The databases searched were Google Scholar, PubMed, ScienceDirect, and ProQuest, up until 31 December 2022. The risk of bias was assessed using the Risk of Bias Utilized for Surveys Tool (ROBUST, Nudelman et al., 2020). Sensitivity analysis was conducted using the one-study remove method, and studentized residuals and Cook's distance were examined. A random effects model was used. RESULTS: We examined the association between IU and COVID-19-related psychological impacts across 85 studies from 22 countries (N = 69,997; 64.95% female; mean sample age, 32.90 ± 9.70). There was no evidence of publication bias. We found a medium and positive association between IU and COVID-19-related psychological impacts (N = 69,562, r = 0.35, k = 89, 95% CI [0.32, 0.37]), which was independent of the IU measure used or whether the psychological impact was measured in relation to the virus alone or broader aspects of the pandemic. It was also independent of severity, publication year, sample type and size, study quality, age and sample levels of anxiety, depressive symptoms, stress, mental well-being and social support. However, the observed association varied significantly between countries and country income levels (stronger among low-incomes) and across genders (stronger among males) and was stronger for measures with greater reliability and more items, but lower among samples with more people who had been exposed to COVID-19. CONCLUSIONS: The findings support that IU is a higher order transsituational vulnerability factor related to cognitive, behavioural and distress responses during the pandemic. Limitations include English-language-only sources, reliance on a wide range of measures that were coded using a novel system and variable risk of bias across studies. The implications are considered in relation to the management of psychological consequences of major situational stressors experienced at a global scale, but the variations at a national and socioeconomic level also have implications for different or localized stressors at a regional or community level.

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Governments have been concerned with balancing economic growth and environmental sustainability. Nevertheless, it has been noted that sustainable development is interconnected with economic variables, the institutional framework, and the efficacy of ecological regulatory measures. This study experimentally examines the correlation of economic policy uncertainty (EPU), financial development (FD), ecological innovation (EI), corruption (IQ), foreign direct investment (FDI), trade openness (TR), natural resource rent (NRR), and CO2 emission. We utilized longitudinal data from the Organization for Economic Cooperation and Development (OECD) countries from 2003 to 2021 to address the existing research void. This study used sequential processes of the linear panel data model (SELPDM) and the SYS-GMM approaches in obtaining consistent and efficient results. The inverse U-shaped relationship between FD and environmental degradation (ED) is confirmed by the long-term elasticity estimates generated by the SELPDM method Elasticity estimates for the long-run show that rigorous ecological regulations, higher renewable energy utilization, higher FD and less corruption, an interaction between FD and rigorous ecological regulations all contribute to reduced ED. Its also being observed that both EPU, FDI and trade openness are positively affecting the ED. It confirms the idea of pollution refuge between the OECD countries. The causality test results show that corruption and FD had reciprocal links with ED, while FDI, trade openness and strict environmental policies were also found to have bidirectional linkage with ED. To achieve sustainable development and prevent environmental degradation in the long term, we propose implementing an institutional financial framework and FD in OECD nations. This may be accomplished by focusing on the effectiveness of environmental regulatory laws and creating a conducive institutional environment.

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INTRODUCTION: Communication failings may compromise the diagnostic process and pose a risk to quality of care and patient safety. With a focus on emergency care settings, this project aims to examine the critical role and impact of communication in the diagnostic process, including in diagnosis-related health and research policy, and diagnostic patient-clinician interactions in emergency departments (EDs). METHODS AND ANALYSIS: This project uses a qualitatively driven multimethod design integrating findings from two research studies to gain a comprehensive understanding of the impact of context and communication on diagnostic excellence from diverse perspectives. Study 1 will map the diagnostic policy and practice landscape in Australia, New Zealand and the USA through qualitative expert interviews and policy analysis. Study 2 will investigate the communication of uncertainty in diagnostic interactions through a qualitative ethnography of two metropolitan Australian ED sites incorporating observations, field notes, video-recorded interactions, semistructured interviews and written medical documentation, including linguistic analysis of recorded diagnostic interactions and written documentation. This study will also feature a description of clinician, patient and carer perspectives on, and involvement in, interpersonal diagnostic interactions and will provide crucial new insights into the impact of communicating diagnostic uncertainty for these groups. Project-spanning patient and stakeholder involvement strategies will build research capacity among healthcare consumers via educational workshops, engage with community stakeholders in analysis and build consensus among stakeholders. ETHICS AND DISSEMINATION: The project has received ethical approvals from the Human Research Ethics Committee at ACT Health, Northern Sydney Local Health District and the Australian National University. Findings will be disseminated to academic peers, clinicians and healthcare consumers, health policy-makers and the general public, using local and international academic and consumer channels (journals, evidence briefs and conferences) and outreach activities (workshops and seminars).

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When making decisions in everyday life, we often rely on an internally generated sense of confidence to help us revise and direct future behaviours. For instance, confidence directly informs whether further information should be sought prior to commitment to a final decision. Many studies have shown that aging and both clinical and sub-clinical symptoms of psychopathology are associated with systematic alterations in confidence. However, it remains unknown whether these confidence distortions influence information-seeking behaviour. We investigated this question in a large general population sample (N = 908). Participants completed a battery of psychiatric symptom questionnaires and performed a perceptual decision-making task with confidence ratings in which they were offered the option to seek helpful information (at a cost) before committing to a final decision. Replicating previous findings, an 'anxious-depression' (AD) symptom dimension was associated with systematically low confidence, despite no detriment in objective task accuracy. Conversely, a 'compulsive behaviour and intrusive thoughts' (CIT) dimension was associated with impaired task accuracy but paradoxical over-confidence. However, neither symptom dimension was significantly associated with an increased or decreased tendency to seek information. Hence, participants scoring highly for AD or CIT did not use the option to information seek any more than average to either increase their confidence (AD) or improve the accuracy of their decisions (CIT). In contrast, older age was associated with impaired accuracy and decreased confidence initially, but increased information seeking behaviour mediated increases in both accuracy and confidence for final decisions. Hence, older adults used the information seeking option to overcome initial deficits in objective performance and to increase their confidence accordingly. The results show an appropriate use of information seeking to overcome perceptual deficits and low confidence in healthy aging which was not present in transdiagnostic psychopathology.

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OBJECTIVE: to analyze the meaning attributed by parents to the extended and permanent survival of childhood cancer. METHOD: qualitative narrative inquiry, developed with parents of adolescents and young adults who survived childhood cancer. Recruitment and data collection involved virtual and in-person approaches. The data were collected through semi-structured interviews. Data were analyzed according to reflective thematic analysis. RESULTS: a total of ten parents were included in the study. Two thematic narrative syntheses were constructed: "Times of war"; and "Time of uncertain peace", with their respective sub-themes. The cancer diagnosis marks the beginning of times of war in the parents' lives. They experience cancer treatment as "highs and lows" with potential threats to their children's lives. After that, "Time of uncertain peace" are reached, and the balance of the family unit is reestablished. However, the fear of recurrence makes the family peace uncertain, and its maintenance requires constant vigilance and attention to the signs and symptoms of a possible new battle. CONCLUSION: the results highlight the experience of being a parent of a childhood cancer survivor and can be applied to develop models of care centered on the survivors' family.

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This research explores prospective determinants of trust in the recommendations of artificial agents regarding decisions to kill, using a novel visual challenge paradigm simulating threat-identification (enemy combatants vs. civilians) under uncertainty. In Experiment 1, we compared trust in the advice of a physically embodied versus screen-mediated anthropomorphic robot, observing no effects of embodiment; in Experiment 2, we manipulated the relative anthropomorphism of virtual robots, observing modestly greater trust in the most anthropomorphic agent relative to the least. Across studies, when any version of the agent randomly disagreed, participants reversed their threat-identifications and decisions to kill in the majority of cases, substantially degrading their initial performance. Participants' subjective confidence in their decisions tracked whether the agent (dis)agreed, while both decision-reversals and confidence were moderated by appraisals of the agent's intelligence. The overall findings indicate a strong propensity to overtrust unreliable AI in life-or-death decisions made under uncertainty.

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Climate policy uncertainty (CPU) may have an adverse impact on the environment by interfering with the effectiveness of environmental policies, but there is currently little evidence to support this indirect effect. By incorporating CPU into the transition function, this paper utilizes the panel smooth transition regression (PSTR) to dynamically analyze how CPU affects the relationship between environmental taxes (ETR) and energy transition. When CPU exceeds the threshold, the promoting effect of ETR on energy transition weakens or reverses. The robustness of the main conclusions is demonstrated by establishing a PSTR estimator with the instrumental variable. This paper also constructs a counterfactual scenario, showing that CPU reduces the positive impact of ETR on renewable energy consumption and generation by 7.6% and 3.5%, respectively. Further analysis indicates that this negative effect arises because CPU likely increases investment risk, particularly for long-term green projects, thereby inhibiting the clean energy market and energy-related green technological innovation. Heterogeneity analysis find that the weakening effect of CPU on the effectiveness of ETR is stronger in countries with low energy resource endowment, high energy intensity, and lower economic development levels, underscoring the need for tailored policy approaches. This research emphasizes that for countries with ambitious energy transition goals, climate policy stability is crucial for ensuring the healthy development of environmental taxes policy and renewable energy markets.

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Retrograde extrapolations, known as back calculations are widely used in forensic toxicology to estimate the blood alcohol concentration of an individual at some prior time. In the UK guidelines have been issued by the United Kingdom and Ireland Association of Forensic Toxicologists) and the Organization of Scientific Area Committees (OSAC) for Forensic Science. However, these guidelines are not fully agreed and open tointerpretation. Alcohol elimination rates have been discussed in numerous publications since Widmark's original data was published. The current guidance from UKIAFT, is to report the most likely back calculated result together with a range of results based on the 95% confidence limit elimination rates (9 to 29 mg/100 mL/hour).The Divisional Court, upheld by the House of Lords, ruled that in order to convict someone for being over the prescribed limit on the basis of any back calculation, the case must be proven beyond reasonable doubt. A 99.73% confidence interval increased to 3 standard deviations at the lower end would provide a greater factual basis for the court and cover alarger proportion of the population, this can be achieved by increasing the elimination range to 8 to 29 mg/100 mL/hour. Retrograde extrapolations also rely on the subject being post absorptive at the prior time. In the UK, back calculations are validif the subject has not eaten or consumed alcohol withinonehour ofthe back calculation time. Where the subject has eatenprior to the back calculation, experts are instructed to consider whether the back calculation is applicable. In Germany and the United States back calculations are not permitted to a time within 2 h after last drink consumed. The 2 h limit would better meet the highest standard of 'beyond reasonable doubt' burden of proof, and should be used. These proposed changes would decrease the uncertainty associated with retrograde calculations carried out by UK toxicologists.

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Adaptive behavior depends on appropriate responses to environmental uncertainty. Incidental sensory events might simply be distracting and increase errors, but alternatively can lead to stereotyped responses despite their irrelevance. To evaluate these possibilities, we test whether task-irrelevant sensory prediction errors influence risky decision making in humans across seven experiments (total n = 1600). Rare auditory sequences preceding option presentation systematically increase risk taking and decrease choice perseveration (i.e., increased tendency to switch away from previously chosen options). The risk-taking and perseveration effects are dissociable by manipulating auditory statistics: when rare sequences end on standard tones, including when rare sequences consist only of standard tones, participants are less likely to perseverate after rare sequences but not more likely to take risks. Computational modeling reveals that these effects cannot be explained by increased decision noise but can be explained by value-independent risky bias and perseveration parameters, decision biases previously linked to dopamine. Control experiments demonstrate that both surprise effects can be eliminated when tone sequences are presented in a balanced or fully predictable manner, and that surprise effects cannot be explained by erroneous beliefs. These findings suggest that incidental sounds may influence many of the decisions we make in daily life.

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Background: Industry 4.0 is a significant technical revolution that combines big data analytics, the Internet of Things (IoT), and cyber-physical systems to improve manufacturing productivity. This study investigates the impact of digital trust and sustainable attitude on perceived value and the intention to adopt Industry 4.0 technologies. It also examines the moderating role of uncertainty avoidance in these relationships. Methods: Data were collected from 189 employees of leading manufacturing companies in Indonesia that are recognized for their Industry 4.0 practices. The data were analyzed using Partial Least Squares (PLS) methodology with SmartPLS software to test the proposed hypotheses and explore the moderating effects. Results: The findings reveal that both digital trust and sustainable attitude significantly influence perceived value. However, these factors do not directly affect the intention to adopt Industry 4.0 technologies. Uncertainty avoidance moderates the relationship between digital trust and adoption intention. Specifically, in environments with high uncertainty avoidance, digital trust becomes a critical factor influencing the decision to adopt Industry 4.0 technologies. Conclusions: The study provides valuable insights for organizations aiming to implement Industry 4.0 initiatives. It highlights the importance of fostering digital trust and considering cultural dimensions, such as uncertainty avoidance, in their technology adoption strategies.

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Clustering is widely used in bioinformatics and many other fields, with applications from exploratory analysis to prediction. Many types of data have associated uncertainty or measurement error, but this is rarely used to inform the clustering. We present Dirichlet Process Mixtures with Uncertainty (DPMUnc), an extension of a Bayesian nonparametric clustering algorithm which makes use of the uncertainty associated with data points. We show that DPMUnc out-performs existing methods on simulated data. We cluster immune-mediated diseases (IMD) using GWAS summary statistics, which have uncertainty linked with the sample size of the study. DPMUnc separates autoimmune from autoinflammatory diseases and isolates other subgroups such as adult-onset arthritis. We additionally consider how DPMUnc can be used to cluster gene expression datasets that have been summarised using gene signatures. We first introduce a novel procedure for generating a summary of a gene signature on a dataset different to the one where it was discovered, which incorporates a measure of the variability in expression across signature genes within each individual. We summarise three public gene expression datasets containing patients with a range of IMD, using three relevant gene signatures. We find association between disease and the clusters returned by DPMUnc, with clustering structure replicated across the datasets. The significance of this work is two-fold. Firstly, we demonstrate that when data has associated uncertainty, this uncertainty should be used to inform clustering and we present a method which does this, DPMUnc. Secondly, we present a procedure for using gene signatures in datasets other than where they were originally defined. We show the value of this procedure by summarising gene expression data from patients with immune-mediated diseases using relevant gene signatures, and clustering these patients using DPMUnc.

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Electronic wastes are a valuable resource due to their critical and precious metal content. To include these wastes in recycling or recovery chains, it is necessary to precisely determine their metal content. Because analysing the whole sample of a batch of electronic waste is not practical, different preparation and sampling or subsampling steps are necessary. Sampling induces an error in the composition of the final sample compared to that of the initial batch, which finally leads to uncertainty in the final metal content measurement as compared to the "actual" batch metal content. The aim was to characterize the uncertainty in metal content of a batch of 372 kg of WPCB. Thirty-nine metals were analysed and thirty-two were considered: base, precious, rare-earths and critical metals. An empirical method (i.e. replicated measurement tests) was thus applied, based on statistical calculations according to Eurachem Guidelines. Uncertainty arising during the 3 different stages of the preparation process (primary, secondly and tertiary sampling steps) was calculated. For the analysed given weight (0.5 g), the shredding efficiency, which directly affects metal particle size distribution, was found to be the most important factor influencing the uncertainty. Uncertainties in base metal content, which is often concentrated in the coarsest particles, arose mainly from the last preparation step (tertiary sampling). Conversely, precious metals and rare-earths were finely ground during the 3 preparation steps, which led to low uncertainties, despite their low concentration in the waste (<337 mg/t for precious and < 35 mg/t for rare-earths).

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Background: Paying attention to palliative care has accelerated in Iran in the last 10 years. Considering the trend of aging, increasing burden of chronic diseases and increasing health costs, planning and development of palliative care is necessary in the future. This study was conducted with the aim of explaining the alternative scenarios of palliative care in the health system of Iran until the horizon of 2030. Methods: This study was a multi-method scenario planning with a qualitative using multiple methods design, which was conducted in 3 phases in 2018-2020. In the first phase, a list of driving forces was extracted using qualitative interviews and literature review. In the second phase, all factors identified in the previous phase were examined in terms of degree of uncertainty and cross-impact analysis, and two key uncertainties were extracted. In the third phase, based on two key uncertainties, four future scenarios of palliative care were formulated, validated and scenario strategies were presented. Results: The results indicate two uncertainties, including "governance of palliative care in the health system" and "acceptance of palliative care by society," based on which, four scenarios with the names "climbing to the top," "excruciating climb," "edge of the abyss" and "The bottom of the valley" were compiled. Conclusion: The development of palliative care in health system of Iran is faced with serious uncertainties that it is necessary to focus the developmental activities of palliative care on the two axes of acceptance by society and need for coherent governance by considering all the dimensions and influential components by ministry of health. The application of the results of this research can provide reasonable options for effective interventions and implementation of this category of services to the beneficiaries of palliative care.

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Previous studies on reinforcement learning have identified three prominent phenomena: (1) individuals with anxiety or depression exhibit a reduced learning rate compared to healthy subjects; (2) learning rates may increase or decrease in environments with rapidly changing (i.e. volatile) or stable feedback conditions, a phenomenon termed learning rate adaptation; and (3) reduced learning rate adaptation is associated with several psychiatric disorders. In other words, multiple learning rate parameters are needed to account for behavioral differences across participant populations and volatility contexts in this flexible learning rate (FLR) model. Here, we propose an alternative explanation, suggesting that behavioral variation across participant populations and volatile contexts arises from the use of mixed decision strategies. To test this hypothesis, we constructed a mixture-of-strategies (MOS) model and used it to analyze the behaviors of 54 healthy controls and 32 patients with anxiety and depression in volatile reversal learning tasks. Compared to the FLR model, the MOS model can reproduce the three classic phenomena by using a single set of strategy preference parameters without introducing any learning rate differences. In addition, the MOS model can successfully account for several novel behavioral patterns that cannot be explained by the FLR model. Preferences for different strategies also predict individual variations in symptom severity. These findings underscore the importance of considering mixed strategy use in human learning and decision-making and suggest atypical strategy preference as a potential mechanism for learning deficits in psychiatric disorders.

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