The nonmeek inherit the earth: Children generalize dominance, but not submissiveness

Children and even infants have clear intuitions about power early in development; they can infer who is dominant and subordinate from observing a single interaction. However, it is unclear what children infer about each individual's status from these interactions-do they think dominants and subordinates will maintain their status when interacting with novel partners? In three experiments, we investigate this question. Children (4- to 10-year-olds, N = 365) heard stories about a dominant and subordinate agent and predicted the dominant or subordinate agent's behavior with a novel agent. In all studies, we found that 7- to 10-year-olds generalized dominance, thinking the dominant would again be dominant or "in charge," both for social power (e.g., granting permission) in Study 1 and physical dominance (e.g., a fistfight) in Studies 2 and 3. Furthermore, although they believed dominant agents would win dominance contests (fistfights), they did not believe they would win contests unrelated to dominance (math contests). Younger children did not generalize social power (Study 1) but did generalize physical dominance (Studies 2 and 3). However, even for physical dominance, their generalizations were less selective (i.e., they believed the dominant would win fistfights and math contests). Notably, neither age group generalized an agent's submissiveness in any of the studies-they did not believe a subordinate agent would again be subordinate when paired with a novel partner. We discuss how these results extend past work on children's developing intuitions about dominance and prompt deeper questions about the inferences children draw from dominance interactions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Moral paragons, but crummy friends: The case of snitching

Loyalty to friends is an important moral value, but does that mean snitching on friends is considered immoral? Across six preregistered studies, we examine how loyalty obligations impact people's moral evaluations of snitching (i.e., turning in others who commit transgressions). In vignette and incentivized partner choice paradigms, we find that witnesses who snitch (vs. do not snitch) are seen as more moral and as better leaders (Studies 1-6), regardless of whether they snitch on a friend or an acquaintance (Studies 1-3). We find that a willingness to turn in one's friends increases perceived morality, while an unwillingness to do so diminishes it, with the latter effect exhibiting a stronger impact than the former (Study 2). Our experiments also demonstrate that snitches receive less moral credit when snitching on nonmoral (vs. moral) transgressions (Study 3) and when snitching aligns with self-interest (Study 4). We demonstrate that although snitching is often seen as morally right, turning in transgressors entails important reputational trade-offs: Snitching makes one appear disloyal and a bad friend but boosts perceptions of morality and leadership. This reveals a context in which what is loyal is no longer considered moral. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Thrombosis with thrombocytopenia syndrome (TTS) following adenovirus vector COVID-19 vaccination in Canada

INTRODUCTION

Identifying and monitoring adverse events following vaccination contributed to the safety and effectiveness of COVID-19 mass vaccination campaigns. In March 2021, international reports emerged of an adverse event following vaccination with adenovirus vector COVID-19 vaccines (ChAdOx1-S [recombinant] and Ad26.COV2.S) of thrombosis with low platelet counts, referred to as thrombosis with thrombocytopenia syndrome (TTS). We described TTS reports in Canada following adenovirus vector COVID-19 vaccines and investigated whether the observed number of events were higher than expected.

METHODS

Reports of TTS following receipt of ChAdOx1-S [recombinant] or Ad26.COV2.S meeting the Canadian case definition for TTS and diagnostic certainty levels 1-3 of the Brighton Collaboration case definition, submitted to the Canadian Adverse Events Following Immunization Surveillance System and Canada Vigilance Database between February 26, 2021 and October 31, 2022 were included. Demographics and characteristics of the TTS reports are described along with an analysis comparing the observed number of reports to the expected number.

RESULTS

As of October 31, 2022, 56 reports of TTS following administration of ChAdOx1-S [recombinant] and no reports following Ad26.COV2.S vaccines were reported in Canada, of which 37 had functionally positive anti-PF4 antibodies. The median age was 56 years; males accounted for 54 % of reports. Five deaths were reported. The observed number of reports exceeded the expected for all ages and sexes combined, as well as for males aged 30-49 and 60-69 years, and females aged 40-59 years.

CONCLUSION

Based on international surveillance data, Canada evaluated a statistical signal of TTS following adenovirus vector vaccines. The investigation of this signal demonstrated how post-market vaccine safety surveillance systems were successful in investigating rare adverse events during the rollout of COVID-19 vaccines in Canada. As adenovirus vector vaccines continue to be administered, characterization of the association between the vaccine and TTS informs immunization programs and policies.

P-043 A RETROSPECTIVE OUTCOME REVIEW OF THE USE OF EGIS ACELLULAR DERMAL MATRIX DURING ABDOMINAL WALL RECONSTRUCTION

Aim

We aimed to demonstrate the relative safety profile of an established non-crosslinked porcine acellular dermal matrix (ADM) during abdominal wall reconstruction.

Material & Methods

Individual real-world safety data on specific mesh products are often lacking. With recent media scrutiny over the use of mesh, we sought to quantify outcomes and demonstrate the safety of a specific ADM (reference 1). A retrospective casenote-based outcome analysis was performed on patients who underwent mesh augmentation during abdominal wall reconstruction from two NHS institutions. Both elective and emergency patients were included from January 2018 to December 2021.

Results

Fifty-five patients were included in the study across two NHS specialist hernia centres. We identified a mean wound infection rate of 14.2% (range 2–22%) with a median follow up of 9 months (range 3–18 months). Hernia recurrence rate was 10.4% (range 5–22%). We found 7 patients (12%) developed a seroma, 1 of whom required seroma aspiration. Only 4 patients (7%) had post-operative dehiscence requiring further intervention, all of whom had Ventral Hernia Working Group (VHWG) Grade 3 or 4 wounds pre-operatively.

Conclusions

Our data supports the continued use of a widely available ADM for abdominal wall reconstruction in both elective and emergency cases, highlighting its positive relative safety profile.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Experiences of Multidisciplinary Working: Perspectives from the Wessex Ghana Stroke Partnership

INTRODUCTION

Substantial gaps remain in our understanding of stroke in Africa as well as in stroke care, practice and policy on the continent. The effective organization of preventative, therapeutic and rehabilitative stroke services continue to be challenging in many African countries.

METHODOLOGY

In this article we define the nature, function and benefits of effective multidisciplinary team (MDT) working. The experiences and perspectives of members of the MDT were collated by focus group discussions as well as individual and country specific contributions.

RESULTS

The experiences and perspectives of multidisciplinary team members from the United Kingdom and Ghana implementing these practices at the first stroke unit in Korle Bu Teaching Hospital, Accra, with a transparent discussion of successes and challenges faced throughout development of the service, is presented. MDT working has improved outcomes for patients and families who use the services, including encouraging better shared treatment planning and compliance. More stroke rehabilitation services are provided than previously, including greater self-management education and better secondary prevention care.

CONCLUSION

It is hoped that this article will provide an inspirational model for others working to provide stroke care in low-resource settings in Africa and worldwide.

When and why "staying out of it" backfires in moral and political disagreements

People care where others around them stand on contentious moral and political issues. Yet when faced with the prospect of taking sides and the possibility of alienating observers with whom they might disagree, actors often try to "stay out of it"-communicating that they would rather not to take a side at all. We demonstrate that despite its intuitive appeal for reducing conflict, opting not to take sides over moralized issues can harm trust, even relative to siding against an observer's viewpoint outright. Across eleven experiments (N = 4,383) using controlled scenarios, real press video clips, and incentivized economic games, we find that attempts to stay out of the fray are often interpreted as deceptive and untrustworthy. When actors choose not to take sides, observers often ascribe concealed opposition, an attribution of strategic deception which provokes distrust and undermines real-stakes cooperation and partner choice. We further demonstrate that this effect arises only when staying out of it seems strategic: Actors who seem to hold genuine middle-ground beliefs or who lack incentives for impression management are not distrusted for avoiding conflict. People are often asked to take sides in moral and political disagreement. Our findings outline a reputational risk awaiting those who opt not to do so. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

P101 BIOSYNTHETIC MESH LIMITS ADHESION FORMATION FOLLOWING INCISIONAL HERNIA REPAIR

Aim

Adhesions are fibrous bands of scar tissue that form following peritoneal injury, commonly intra-abdominal surgery, and are associated with serious morbidity such as small bowel obstruction and pain. Surgical meshes used for incisional hernia repair are associated with increased incidence and severity of adhesions. There is limited consensus on which mesh may induce the least adhesions following incisional hernia repair, and most previous data has come from experimental animal models. We aimed to evaluate existing primary research to investigate whether biological mesh limits adhesion formation compared to synthetic or biosynthetic mesh when used in patients for incisional hernia repair and also to assess whether there is correlation with existing animal model data.

Material and Methods

A systematic search was conducted on PubMed and EMBASE. The number of mesh-related adhesions, character of adhesions and adhesion-related complications were documented. Results were compared to previously published results from animal models.

Results

Thirty-two studies were included, 11 of which did not document whether the adhesions were mesh related. A total of 14,161 participants underwent incisional hernia repair, 8,526 of whom were included in follow-up analysis. Overall, 9.7% developed adhesions. Biological mesh induced a high rate of dense adhesions, whereas biosynthetic mesh induced loose, filmy adhesions suggested to cause fewer complications. These findings were similar to findings from experimental animal models.

Conclusions

Bio-synthetic mesh was superior in causing fewer and less dense adhesions. Further analysis of mesh-induced adhesion formation on a larger scale is required to fully understand the consequences of different mesh types.

748 Case Series: Experience of Using External Fixation as An Adjunct in The Management of MRONJ Affecting the Mandible

Introduction

External fixation was first described by Malgaigne and Rigaud in 1870 for use on long bones, then adapted for OMFS in 1934 and used for treating comminuted fractures. In recent times, popularity of external fixators has decreased with the use of mini-plates, often only used in major trauma, for example gunshot wounds. This is a case series of patients who have been treated by external fixation for medication related osteonecrosis (MRONJ) of the jaw and could be a fairly simple alternative to major reconstructive surgery in such cases. This method of treatment has been particularly useful during the Covid-19 pandemic as a non-aerosol generating procedure.

Method

A single centre, retrospective study of 5 cases between December 2018 - December 2020. The MRONJ cases were graded using the AAOMS classification. All cases treated with external fixation of mandible were included. Pre-operative condition, medical history, treatment complications, pain management, length of treatment and follow-up results were recorded.

Results

Of the 5 cases treated for MRONJ, 4 of these had pathological fractures. All were AAOMS stage 3. The mean duration of treatment was 78 days, with regular clinical reviews monitoring progress. Of these cases, 4 cases healed well with significant improvement or closure of intraoral and extra-oral wounds.

Conclusions

In this small case series the technique has shown positive results; being well received by patients and allowing function while in situ. It allows treatment of pathological fractures as well as stabilising the mandible as a preventative measure whilst debriding severely atrophic mandibles.

Continuous-flow electrocoagulation (EC) process for iron removal from water: Experimental, statistical and economic study

The process of Electrocoagulation (EC), the in-situ production of coagulants by passing an electric current through sacrificial electrodes, is free of chemical additives and cost-effective. This makes it the most widely used water and wastewater treatment method. However, the literature highlights some significant drawbacks of this method including EC unit design limitations. This research therefore aimed to develop a new EC unit design using drilled plates (electrodes) to mix the solution being treated without using external mixers, this minimising power consumption. The performance of the new EC unit was validated by applying it to remove iron from water taking into account the effects of applied current density (ACD), the pH of the water (PoW), iron concentration (IC) and treatment time (TT). The effects of these parameters were optimised using the Box-Behnken model. Synthetic water samples containing different concentrations of iron (10-30 mg/l), were treated in a continuous flow, using the new EC reactor at different ACD (1.5-4.5 mA/cm²), PoW (4-10) and TT (10-50 min). The results revealed that the removal of 99.9% of iron was achieved by keeping PoW, ACD, IC and TT at 7, 3 mA/cm², 10 mg/l and 50 min, respectively. The effects of ACD, POW, IC and TT on iron removal could be successfully simulated with R² = 0.9788. The cost of removing iron using the proposed EC unit was 0.623 £/m³.

Achieving a good impression: Reputation management and performance goals

Whether a student wants to improve their ability (i.e., has learning goals) or demonstrate it (i.e., has performance goals) plays an important role in their learning and motivation; students focused on the latter tend to avoid taking on challenges and seeking help when they need it. In the achievement literature, these different goals are thought to result primarily from holding different mindsets about whether one's ability is malleable or fixed. We argue, however, that this traditional framework has largely overlooked the powerful role that reputational concerns play in influencing which achievement goals students pursue. Specifically, reputational concerns may drive students to pursue performance goals and "prove" their ability to others, irrespective of their mindsets. We argue that closely investigating these concerns may help uncover new mechanisms by which performance goals are fostered and maintained as well as new strategies for developing interventions aimed at encouraging learning goals. Finally, we offer suggestions for how the achievement and reputation management literatures can be productively brought to bear on one another in future research. This article is categorized under: Psychology > Reasoning and Decision Making Psychology > Emotion and Motivation Psychology > Development and Aging.

ENDF/B-VIII.0 CROSS SECTION TESTING FOR COPPER NUCLEAR CRITICALITY SAFETY APPLICATIONS

In the update from ENDF/B-VII.1 to ENDF/B-VIII.0, copper cross sections were significantly altered in the intermediate and fast spectrum of the ENDF-VIII.0 library. Performance of this ENDF data requires validation to determine whether recent evaluation has proven beneficial. To examine the performance of the new library, particularly new copper data, critical benchmarks from the ICSBEP handbook were chosen for their sensitivity to copper cross section changes and modeled using SCALE continuous energy Monte Carlo simulations. Selected benchmarks were modeled in ENDF-VII.1 and ENDF-VIII.0 to compute keff within a statistical uncertainty of 10 pcm and compared in reference to the benchmark experimental criticality. Due to spectrum choices in selection based on the changes to cross section data, the set of benchmarks consist of intermediately enriched uranium, highly enriched uranium, or plutonium systems. 11 separate benchmark evaluations containing 32 individual configurations highly sensitive to copper were selected, modelled, and compared to benchmark experimental criticality. This work demonstrates a significant decrease in the deviation between calculated and experimental criticality as a result of the ENDF-VIII.0 library; a decrease in absolute mean deviation from 522.5±39.3 to 249.6±39.3, and a decrease in root mean square deviation from 630.8±46.1 to 338.1±74.9. Additionally, the role of recently evaluated copper data in this improved agreement is presented, confirming the benefit of reaffirming cross section data.

Giving a larger amount or a larger proportion: Stimulus format impacts children's social evaluations

Young children show remarkably sophisticated abilities to evaluate others. Yet their abilities to engage in proportional moral evaluation undergoes protracted development. Namely, young children evaluate someone who shares absolutely more as being "nicer" than someone who shares proportionally more (e.g., sharing 3-out-of-6 is nicer than sharing 2-out-of-3, because 3 > 2, even though 3/6 < 2/3), whereas adults think the opposite. We investigate the hypothesis that this prior work underestimates children's proportional social reasoning by relying on discrete and spatially separated quantities (e.g., individual stickers), which can hinder proportional reasoning even outside social contexts. In three experiments we examine whether 4- and 5-year-old children's social evaluations are impacted by the discreteness and spatial separation of the resource and compare their behavior to adults (18 to 63 years; across all samples: 38% girls/women, 62% boys/men; no other demographic data was collected). We find that children are sensitive to these features: when the resource was divided into discrete units (Experiment 1) or spatially separated (Experiment 2) children were more likely to use absolute amount, as opposed to proportion, relative to when the resources were not divided and remained spatially connected. However, adults were highly sensitive to proportion regardless of the display's perceptual features (Experiment 3), and children's use of proportion remained below adult-levels. These results suggest that perceptual features influence children's use of absolute versus proportional information in their social evaluations, which has theoretical and methodological implications for understanding children's conceptions of fairness. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Microbiota Supplementation with Bifidobacterium and Lactobacillus Modifies the Preterm Infant Gut Microbiota and Metabolome: An Observational Study

Supplementation with members of the early-life microbiota as “probiotics” is increasingly used in attempts to beneficially manipulate the preterm infant gut microbiota. We performed a large observational longitudinal study comprising two preterm groups: 101 infants orally supplemented with Bifidobacterium and Lactobacillus (Bif/Lacto) and 133 infants non-supplemented (control) matched by age, sex, and delivery method. 16S rRNA gene profiling on fecal samples (n = 592) showed a predominance of Bifidobacterium and a lower abundance of pathobionts in the Bif/Lacto group. Metabolomic analysis showed higher fecal acetate and lactate and a lower fecal pH in the Bif/Lacto group compared to the control group. Fecal acetate positively correlated with relative abundance of Bifidobacterium, consistent with the ability of the supplemented Bifidobacterium strain to metabolize human milk oligosaccharides into acetate. This study demonstrates that microbiota supplementation is associated with a Bifidobacterium-dominated preterm microbiota and gastrointestinal environment more closely resembling that of full-term infants.

Bifidobacterium dominates the gut microbiota in supplemented preterm infants

Supplemented preterm infants have lower abundance of potential pathobionts

Metabolomic analysis show higher fecal acetate and lower pH in supplemented infants

In vitro and genomic analysis confirm HMO metabolism in Bifidobacterium supplement

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

The impact of the COVID-19 pandemic on renal transplantation in the UK

COVID-19 is impacting provision of renal transplantation in the UK with a reduction in clinical activity. Publicly available Renal Registry and NHS Blood and Transplant reports were analysed to model the number of missed transplant opportunities, waiting list size and change in dialysis population over a six-month period starting 5 March 2020. An estimated 1,670 kidney transplant opportunities may be lost, which will lead to 6,317 active patients on the kidney-alone waiting list, compared to 4,649 based on usual activity estimates. This will result in 1,324 additional patients on dialysis who would otherwise have been transplanted. COVID-19 will lead to a marked loss of transplant opportunities and a significantly larger national waiting list. The existing strain on dialysis capacity will be exacerbated as patients remain on dialysis as the only available form of renal replacement therapy. These findings will help inform policy and service specific strategies.

Even his friend said he's bad: Children think personal alliances bias gossip

Children learn about other people through gossip. Although gossip can be a valuable and efficient way to learn about others, evaluating gossip's credibility requires understanding when people may be biased, and using this information to update the truth-value placed on the gossip. For instance, people may be motivated to improve their and their friends' reputations (or to worsen their enemies' reputations). Therefore, testimony that cuts against these social motivations may be more credible. Here, in four studies with 3- to 13-year-old children (total N = 860), we examined (1) children's expectations about the type of gossip people were likely to spread about friends versus enemies, and (2) children's ability to discount testimony that is in line with a speaker's social biases (e.g., negative testimony about a friend). We found that children expect speakers to say nice things about their friends, and mean things about their enemies. And, children were less likely to endorse potentially biased testimony, though the strength of their ability to avoid endorsing biased testimony varied based on the domain of testimony. Overall, these studies suggest that children expect a speaker's testimony to be systematically biased based on her relationships. Our results underscore the importance of tracking and using relationships when evaluating testimony, because relationships have immense power for helping us effectively make sense of an ambiguous world.

Understanding and optimising patient and public involvement in trial oversight: an ethnographic study of eight clinical trials

BACKGROUND

Trial oversight is important for trial governance and conduct. Patients and/or lay members of the public are increasingly included in trial oversight committees, influenced by international patient and public involvement (PPI) initiatives to improve the quality and relevance of research. However, there is a lack of guidance on how to undertake PPI in trial oversight and tokenistic PPI remains an issue. This paper explores how PPI functions in existing trial oversight committees and provides recommendations to optimise PPI in future trials. This was part of a larger study investigating the role and function of oversight committees in trials facing challenges.

METHODS

Using an ethnographic study design, we observed oversight meetings of eight UK trials and conducted semi-structured interviews with members of their trial steering committees (TSCs) and trial management groups (TMGs) including public contributors, trial sponsors and funders. Thematic analysis of data was undertaken, with findings integrated to provide a multi-perspective account of how PPI functions in trial oversight.

RESULTS

Eight TSC and six TMG meetings from eight trials were observed, and 66 semi-structured interviews conducted with 52 purposively sampled oversight group members, including three public contributors. PPI was reported as beneficial in trial oversight, with public members contributing a patient voice and fulfilling a patient advocacy role. However, public contributors were not always active at oversight meetings and were sometimes felt to have a tokenistic role, with trialists reporting a lack of understanding of how to undertake PPI in trial oversight. To optimise PPI in trial oversight, the following areas were highlighted: the importance of planning effective strategies to recruit public contributors; considering the level of oversight and stage(s) of trial to include PPI; support for public contributors by the trial team between and during oversight meetings.

CONCLUSIONS

We present evidence-based recommendations to inform future PPI in trial oversight. Consideration should be given at trial design stage on how to recruit and involve public contributors within trial oversight, as well as support and mentorship for both public contributors and trialists (in how to undertake PPI effectively). Findings from this study further strengthen the evidence base on facilitating meaningful PPI within clinical trials.

(Un)common knowledge: Children use social relationships to determine who knows what

Socially savvy individuals track what they know and what other people likely know, and they use this information to navigate the social world. We examine whether children expect people to have shared knowledge based on their social relationships (e.g., expecting friends to know each other's secrets, expecting members of the same cultural group to share cultural knowledge) and we compare children's reasoning about shared knowledge to their reasoning about common knowledge (e.g., the wrongness of moral violations). In three studies, we told 4- to 9-year-olds (N = 227) about what a child knew and asked who else knew the information: The child's friend (Studies 1-3), the child's schoolmate (Study 1), another child from the same national group (Study 2), or the child's sibling (Study 3). In all three studies, older children reliably used relationships to infer what other people knew. Moreover, with age, children increasingly considered both the type of knowledge and an individual's social relationships when reporting who knew what. The results provide support for a 'Selective Inferences' hypothesis and suggest that children's early attention to social relationships facilitates an understanding of how knowledge transfers - an otherwise challenging cognitive process.

Ex vivo specimen MRI and pathology confirm a rectosigmoid mesenteric waist at the junction of the mesorectum and mesocolon

AIM

Continuity of the mesentery has recently been established and may provide an anatomical basis for optimal colorectal resectional surgery. Preliminary data from operative specimen measurements suggest there is a tapering in the mesentery of the distal sigmoid. A mesenteric waist in this area may be a risk factor for local recurrence of colorectal cancer. This study aimed to investigate the anatomical characteristics of the mesentery at the colorectal junction.

METHOD

In this cross-sectional study, 20 patients were recruited. After planned colorectal resection, the surgical specimens were scanned in a MRI system and subsequently dissected and photographed as per national pathology guidelines. Mesenteric surface area and linear measurements were compared between MRI and pathology to establish the presence and location of a mesenteric waist.

RESULTS

Specimen analysis confirmed that a narrowing in the mesenteric surface area was consistently apparent at the rectosigmoid junction. Above the anterior peritoneal reflection, the surface area and posterior distance of the mesentery of the upper rectum initially decreased before increasing as the mesentery of the sigmoid colon. These anatomical properties created the appearance of a mesenteric 'waist' at the rectosigmoid junction. Using the anterior reflection as a reference landmark, the rectosigmoid waist occurred at a mean height of 23.6 and 21.7 mm on MRI and pathology, respectively.

CONCLUSION

A rectosigmoid waist occurs at the junction of the mesorectum and mesocolon, and is a mesenteric landmark for the rectum that is present on both radiology and pathology.

The effect of hunger on children's sharing behavior and fairness preferences

How does feeling hungry affect children's sharing and evaluations of others' moral decision making? To examine this question, we gave 4- to 9-year-old children the opportunity to share resources with an anonymous other child and to evaluate third-party resource allocation decisions between hungry and full recipients. We also measured children's subjective reports of their own hunger, predicting that hungry children would be less generous in their own sharing and more likely to prefer distributions that favor the hungry recipient. Children's sharing increased with age, as did positive evaluations of equitable third-party distributions. Hungrier children were less likely to share overall, but particularly when sharing food-relevant resources. Hunger did not influence third-party resource allocation evaluations, and children still expected fairness from others even when behaving differently themselves.

Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy

Background

Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge.

Methods

The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level.

Results

A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly frail (CFS 5) and 7·88 (2·97 to 20·79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit.

Conclusion

Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision-making and discharge planning.

Chronic Dyrk1 Inhibition Delays the Onset of AD-Like Pathology in 3xTg-AD Mice

There is a critical need for new treatment approaches that can slow or prevent the progression of Alzheimer's disease (AD). Targets that act simultaneously on multiple relevant pathways could have significant therapeutic potential. Dual-specificity tyrosine phosphorylation-regulated kinase 1A (Dyrk1a) phosphorylates both amyloid precursor protein (APP) and tau. Dyrk1a is upregulated in post-mortem brains of AD patients, and such elevated expression is associated with cognitive deficits. We previously demonstrated that small molecule inhibition of Dyrk1 is well-tolerated and reduces amyloid plaques and pathological forms of tau in 3xTg-AD mice if administered after formation of these pathologies. However, while insoluble forms of hyperphosphorylated tau were reduced by Dyrk1 inhibition, overt neurofibrillary tangle (NFT) pathology remained unchanged. Herein, we specifically test the hypothesis that inhibition of Dyrk1 prior to NFT formation will delay the onset of pathology. 3xTg-AD mice were treated chronically, beginning at 6 months of age, prior to NFT pathology. Mice were dosed daily for either 3 or 6 months and amyloid and tau pathology were assessed. We show that chronic Dyrk1 inhibition reduces insoluble forms of amyloid beta peptides (Aβ) and hyper-phosphorylated tau long-term and that these reductions are associated with dramatic delay in the onset of both amyloid plaques and NFTs. In addition, we show that DYR219, a potent and selective small molecule Dyrk1 inhibitor, induces degradation of Dyrk1a protein, likely contributing to the efficacy of this small molecule approach in vivo. Collectively, these results suggest that therapeutic strategies targeting tau phosphorylation will show the greatest effect if administered very early in the pathogenesis of AD.

When Children Treat Condemnation as a Signal: The Costs and Benefits of Condemnation

Condemnation is ubiquitous in the social world and adults treat condemnation as a costly signal. We explore when children begin to treat condemnation as a signal by presenting 4- to 9-year-old children (N = 435) with stories involving a condemner of stealing and a noncondemner. Children were asked to predict who would be more likely to steal as well as who should be punished more harshly for stealing. In five studies, we found that 7- to 9-year-old children treat condemnation as a signal-thinking that a condemner is less likely to steal and should be punished more harshly if caught hypocritically stealing later. We discuss the implications of these results for children's emerging understanding of signaling and moral condemnation.

Hypokalaemia with flaccid paralysis following high-voltage electrical injury in an adolescent patient

The authors present a case report of a previously healthy 15-year-old male who experienced global weakness in the presence of profound hypokalaemia following a high-voltage electrical arc injury. The clinical picture is discussed in the context of our evolving understanding of electrical injuries and potassium homeostasis.

Genomic Analysis of Clostridium perfringens BEC/CPILE-Positive, Toxinotype D and E Strains Isolated from Healthy Children

Clostridium perfringens toxinotype D, toxinotype E, and gastroenteritis-linked BEC/CPILE-positive strains have never been reported in healthy children. We isolated, whole-genome sequenced and bioinformatically characterised three C. perfringens isolates-type D (IQ1), type E (IQ2) and BEC/CPILE-positive (IQ3), recovered from the stools of three healthy two-year-olds, which were further compared to 128 C. perfringens genomes available from NCBI. The analysis uncovered a previously under-described putative toxin gene alv (alveolysin) encoded by isolates IQ2 and IQ3, which appeared to be a clade-specific trait associated with strains from domestic animals. A plasmid analysis indicated that the iota-toxin was encoded on a near-intact previously described plasmid pCPPB-1 in type E strain IQ2. The BEC genes becA and becB were carried on a near-identical pCPOS-1 plasmid previously associated with Japanese gastroenteritis outbreaks. Furthermore, a close phylogenetic relatedness was inferred between the French C. perfringens type E isolates cp515.17 and newly sequenced IQ2, suggesting geographical links. This study describes novel C. perfringens isolates from healthy individuals which encode important toxin genes, indicating the potential spread of these veterinary and clinically important strains and mobile genetic elements, and highlights areas for future research.