Strengthening couple relationships through a digital connection

The proliferation of technology has accelerated exponentially over the past 50 years. Contemporarily, researchers have explored the influences technology use is having on individuals and relationships. Theoretical frameworks such as the couple, family, and technology (CFT) Framework have been applied to individuals and couples in committed relationships to better understand the implications of technology adoption and use within this relational subsystem. Research examining technology's impact on couple relationships recognizes the potential for technology use to be either helpful or unhelpful to the relationship but fails to fully examine the helpful aspects of technology use. This study addresses this gap with the creation of a theory grounded in data from N = 45 couples (n = 90 individuals) in committed relationships. Results indicate couples' technology use can augment emotional connection and unity within the relationship as couples manage the influence of technology in a way that is relationally helpful.

Adaptation of digital navigation training for integrated behavioral health providers: Interview and survey study

Despite effective treatment options, people who experience mental health conditions often do not receive needed care. E-mental health, for instance the use of mobile apps, is emerging as a way to increase access to and extend care. However, little formal training is available to increase the digital literacy level among behavioral healthcare providers (BHPs), seeking to employ such technology. The purpose of this study was to explore the acceptability and usability of an adapted in-person Digital Navigation Training (DNT) curriculum into e-Learning modules focused on the integrated environment for BHPs. BHP confidence to serve as digital navigators was also explored. E-Learning modules were adapted from an existing in-person DNT. A purposeful sampling strategy was used to recruit BHPs (n = 8) to complete the modules. Acceptability, usability, and confidence were assessed via survey and semi-structured interviews. Descriptive statistics were calculated for survey data and qualitative data were analyzed using a directed content analysis approach. BHPs who completed the training (n = 8) felt the modules were usable, enjoyed the structure, and felt the amount of time to complete the modules was acceptable. All participants thought the structure of the training worked well and enjoyed learning new information. While participants' confidence in their digital navigation skills increased, they desired more information and/or experience with screening apps prior to increasing their use of apps within their care. E-Learning modules were an acceptable method of educating BHPs with digital navigation skills. Future research is needed to explore incentives needed for training along with if participating in these modules can increase use of quality mobile apps to augment care within BHP treatment plans.

Addressing and evaluating health literacy in mHealth: a scoping review

BACKGROUND

Recent surveys have revealed many adults have basic or below basic health literacy, which is linked to medical errors, increased illness, and compromised public health. Health literacy as a concept is multi-faceted extending beyond the individual to include social structures and the context in which health information is being accessed. Delivering health information via mobile devices (mHealth) expands the amount of information available while presenting challenges to ensuring these materials are suitable for a variety of literacy needs. The aims of this study are to discover how health literacy is addressed and evaluated in mHealth app development.

METHODS

A scoping review of 5 peer-reviewed databases was conducted. Eligible articles were written in English, addressed general literacy or mHealth/digital/eHealth literacy, and collected literacy information in order to incorporate literacy into the design and/or modification of an app or collected literacy information to describe the population being studied. The "Health Literacy Online" (HLO) United States (U.S.) government guide was used as a framework.

RESULTS

Thirty-two articles were reviewed. Articles included health literacy recommendations for all HLO categories and some recommendations not aligned with these categories. Most articles addressed health literacy using specific HLO categories though none incorporated every HLO category. The most common categories addressed engagement and testing of mHealth content. Though several studies addressed health literacy through a formal assessment tool, most did not. Evaluation of health literacy in mHealth was end-user focused and did not extensively evaluate content for fit to a variety of individuals with limited health literacy.

CONCLUSIONS

The recommendations seen consistently in our results in conjunction with formal HLO categories can act as beginning steps towards development of a health literacy evaluation tool for mHealth apps themselves. It is clear efforts are being made to reduce barriers to using mHealth for those with literacy deficits, however, it was also clear that this space has room to be more pragmatic in evaluation of mHealth tools for literacy. End user engagement in design and testing is necessary in future mHealth literacy tool development.

Cognitive Control and the Implicit Association Test: A Replication of Siegel, Dougherty, and Huber (2012)

The implicit association test (IAT) is widely used to measure evaluative associations towards groups or the self but is influenced by other traits. Siegel, Dougherty, and Huber (2012, Journal of Experimental Social Psychology) found that manipulating cognitive control via false feedback (Study 3) changed the degree to which the IAT was related to cognitive control versus evaluative associations. We conducted two replications of this study and a mini meta-analysis. Null-hypothesis tests, meta-analysis, and a small telescope approach demonstrated weak to no support for the original hypotheses. We conclude that the original findings are unreliable and that both the original study and our replications do not provide evidence that manipulating cognitive control affects IAT scores.

A qualitative exploration of the feasibility of incorporating depression apps into integrated primary care clinics

The use of mobile applications or "apps" is beginning to be identified as a potential cost-effective tool for treating depression. While the use of mobile apps for health management appears promising, little is known on how to incorporate these tools into integrated primary care settings-especially from the viewpoints of patients and the clinic personnel. The purpose of this study was to explore patient- and clinic-level perceptions of the use of depression self-management apps within an integrated primary care setting. Patients (n = 17), healthcare providers, and staff (n = 15) completed focus groups or semi-structured interviews in-person or via Zoom between January and July 2020. Participants were asked about barriers and facilitators to app use, how to best integrate it into care, and reviewed pre-selected mental health apps. Data were analyzed using a directed content analysis approach. From a patient perspective, features within the app such as notifications, the provision of information, easy navigation, and a chat/support function as well as an ability to share data with their doctor were desirable. Providers and staff identified integration of app data into electronic health records to be able to share data with patients and the healthcare team as well as clear evidence of effectiveness as factors that could facilitate implementation. All participants who reviewed apps identified at least one of them they would be interested in continuing to use. Overall, patients, healthcare providers, and staff believed depression apps could be beneficial for both patients and the clinic.

Category salience and racial bias in weapon identification: A diffusion modeling approach

Stereotypes linking Black Americans with guns can have life-altering outcomes, making it important to identify factors that shape such weapon identification biases and how they do so. We report 6 experiments that provide a mechanistic account of how category salience affects weapon identification bias elicited by male faces varying in race (Black, White) and age (men, boys). Behavioral analyses of error rates and response latencies revealed that, when race was salient, faces of Black versus White males (regardless of age) facilitated the classification of objects as guns versus tools. When a category other than race was salient, racial bias in behavior was reduced, though not eliminated. In Experiments 1-4, racial bias was weaker when participants attended to a social category besides race (i.e., age). In Experiments 5 and 6, racial bias was weaker when participants attended to an applicable, yet nonsubstantive category (i.e., the color of a dot on the face). Across experiments, process analyses using diffusion models revealed that, when race was salient, seeing Black versus White male faces led to an initial bias to favor the "gun" response. When a category besides race (i.e., age, dot color) was salient, racial bias in the relative start point was reduced, though not eliminated. These results suggest that the magnitude of racial bias in weapon identification may differ depending on what social category is salient. The collective findings also highlight the utility of diffusion modeling for elucidating how category salience shapes processes underlying racial biases in behavior. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Sleep Deprivation and Racial Bias in the Decision to Shoot: A Diffusion Model Analysis

The current study examines the effect of sleep deprivation and caffeine use on racial bias in the decision to shoot. Participants deprived of sleep for 24 hr (vs. rested participants) made more errors in a shooting task and were more likely to shoot unarmed targets. A diffusion decision model analysis revealed sleep deprivation decreased participants’ ability to extract information from the stimuli, whereas caffeine impacted the threshold separation, reflecting decreased caution. Neither sleep deprivation nor caffeine moderated anti-Black racial bias in shooting decisions or at the process level. We discuss how our results clarify discrepancies in past work testing the impact of fatigue on racial bias in shooting decisions.

Your Brain Is Not an Onion With a Tiny Reptile Inside

A widespread misconception in much of psychology is that (a) as vertebrate animals evolved, “newer” brain structures were added over existing “older” brain structures, and (b) these newer, more complex structures endowed animals with newer and more complex psychological functions, behavioral flexibility, and language. This belief, although widely shared in introductory psychology textbooks, has long been discredited among neurobiologists and stands in contrast to the clear and unanimous agreement on these issues among those studying nervous-system evolution. We bring psychologists up to date on this issue by describing the more accurate model of neural evolution, and we provide examples of how this inaccurate view may have impeded progress in psychology. We urge psychologists to abandon this mistaken view of human brains.

The Digital Divide: Couple and Family Therapy Programs' Integration of Teletherapy Training and Education

The mental health field is increasingly integrating and growing a teletherapy presence, and couple and family therapists are uniquely situated to offer these services based on our history of innovative approaches to therapeutic services. To do so successfully, careful consideration of training and education must occur. To evaluate current teletherapy training and education opportunities of COAMFTE accredited couple, marriage, and family therapy programs, an inductive qualitative content analysis was conducted on the responses of 95 faculty at COAMFTE accredited programs. Findings indicate that more than two thirds of the participants were in favor of teletherapy integration in training programs; however, most programs currently do not offer such opportunities. Barriers that prevent such integration were highlighted as well as existing concerns to training graduate students in teletherapy. Implications for training programs, policies, and regulations are discussed.

Crowdsourcing hypothesis tests: Making transparent how design choices shape research results

To what extent are research results influenced by subjective decisions that scientists make as they design studies? Fifteen research teams independently designed studies to answer five original research questions related to moral judgments, negotiations, and implicit cognition. Participants from 2 separate large samples (total N > 15,000) were then randomly assigned to complete 1 version of each study. Effect sizes varied dramatically across different sets of materials designed to test the same hypothesis: Materials from different teams rendered statistically significant effects in opposite directions for 4 of 5 hypotheses, with the narrowest range in estimates being d = -0.37 to + 0.26. Meta-analysis and a Bayesian perspective on the results revealed overall support for 2 hypotheses and a lack of support for 3 hypotheses. Overall, practically none of the variability in effect sizes was attributable to the skill of the research team in designing materials, whereas considerable variability was attributable to the hypothesis being tested. In a forecasting survey, predictions of other scientists were significantly correlated with study results, both across and within hypotheses. Crowdsourced testing of research hypotheses helps reveal the true consistency of empirical support for a scientific claim. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Racial Bias in Perceptions of Size and Strength: The Impact of Stereotypes and Group Differences

Recent research has shown that race can influence perceptions of men’s size and strength. Across two studies (Study 1: N = 1,032, Study 2: N = 303) examining men and women from multiple racial groups (Asian, Black, and White adults), we found that although race does impact judgments of size and strength, raters’ judgments primarily track targets’ objective physical features. In some cases, racial stereotypes actually improved group-level accuracy, as these stereotypes aligned with racial-group differences in size and strength according to nationally representative data. We conclude that individuals primarily rely on individuating information when making physical judgments but do not completely discount racial stereotypes, which reflect a combination of real group-level differences and culturally transmitted beliefs.

How race affects evidence accumulation during the decision to shoot

The biasing role of stereotypes is a central theme in social cognition research. For example, to understand the role of race in police officers' decisions to shoot, participants have been shown images of Black and White males and instructed to shoot only if the target is holding a gun. Findings show that Black targets are shot more frequently and more quickly than Whites. The decision to shoot has typically been modeled and understood as a signal detection process in which a sample of information is compared against a criterion, with the criterion set for Black targets being lower. We take a different approach, modeling the decision to shoot as a dynamic process in which evidence is accumulated over time until a threshold is reached. The model accounts for both the choice and response time data for both correct and incorrect decisions using a single set of parameters. Across four studies, this dynamic perspective revealed that the target's race did not create an initial bias to shoot Black targets. Instead, race impacted the rate of evidence accumulation with evidence accumulating faster to shoot for Black targets. Some participants also tended to be more cautious with Black targets, setting higher decision thresholds. Besides providing a more cohesive and richer account of the decision to shoot or not, the dynamic model suggests interventions that may address the use of race information in decisions to shoot and a means to measure their effectiveness.

A Total Offloading Foot Brace for Treatment of Diabetic Foot Ulcers: Results From a Halted Randomized Controlled Trial

INTRODUCTION

Foot offloading is the mainstay treatment for plantar diabetic foot ulcers (DFUs).

OBJECTIVE

This multicenter, single-blinded, randomized controlled trial evaluates the efficacy of a total offloading foot brace for healing plantar DFUs.

MATERIALS AND METHODS

Seventeen patients were randomized to standard therapy (ie, reducing stress and pressure via mechanical offloading) or offloading foot brace. Comparison of plantar pressures was performed using digital pressure sensing films. The ulcers were assessed by physical inspection and digital planimetry of photographs.

RESULTS

Reductions in peak plantar pressures ranged from 67.3% to 89.4% (P = .09). Healing at weeks 12 to 15 had minimal differences (brace vs. control: 71.7% vs. 80.3%, respectively). Although not significant, earlier periods of the brace versus the control demonstrated faster wound healing in weeks 2 to 5 (36.0% vs. 6.8%, respectively) and weeks 6 to 9 (50.7% vs. 17.0%, respectively).

CONCLUSIONS

The total offloading foot brace minimizes plantar pressure, allowing for early healing of DFUs, and optimizations in brace design may enhance healing of plantar DFUs.

Geographic Variation in the Black-Violence Stereotype

The stereotype that Blacks are violent is pervasive in the United States. Yet little research has examined whether this stereotype is linked to violent behavior from members of different racial groups. We examined how state-level violent crime rates among White and Black Americans predicted the strength of the Black-violence stereotype using a sample of 348,111 individuals from the Project Implicit website. State-level implicit and explicit stereotypes were predicted by crime rates. States where Black people committed higher rates of violent crime showed a stronger Black-violence stereotype, whereas states where White people committed higher rates of violent crime showed a weaker Black-violence stereotype. These patterns were stronger for explicit stereotypes than implicit stereotypes. We discuss the implications of these findings for the development and maintenance of stereotypes.

Registered Replication Report: Dijksterhuis and van Knippenberg (1998)

Dijksterhuis and van Knippenberg (1998) reported that participants primed with a category associated with intelligence ("professor") subsequently performed 13% better on a trivia test than participants primed with a category associated with a lack of intelligence ("soccer hooligans"). In two unpublished replications of this study designed to verify the appropriate testing procedures, Dijksterhuis, van Knippenberg, and Holland observed a smaller difference between conditions (2%-3%) as well as a gender difference: Men showed the effect (9.3% and 7.6%), but women did not (0.3% and -0.3%). The procedure used in those replications served as the basis for this multilab Registered Replication Report. A total of 40 laboratories collected data for this project, and 23 of these laboratories met all inclusion criteria. Here we report the meta-analytic results for those 23 direct replications (total N = 4,493), which tested whether performance on a 30-item general-knowledge trivia task differed between these two priming conditions (results of supplementary analyses of the data from all 40 labs, N = 6,454, are also reported). We observed no overall difference in trivia performance between participants primed with the "professor" category and those primed with the "hooligan" category (0.14%) and no moderation by gender.

Age Differences in Age Perceptions and Developmental Transitions

Is 50 considered “old”? When do we stop being considered “young”? If individuals could choose to be any age, what would it be? In a sample of 502,548 internet respondents ranging in age from 10 to 89, we examined age differences in aging perceptions (e.g., how old do you feel?) and estimates of the timing of developmental transitions (e.g., when does someone become an older adult?). We found that older adults reported older perceptions of aging (e.g., choosing to be older, feeling older, being perceived as older), but that these perceptions were increasingly younger than their current age. The age to which individuals hope to live dramatically increased after age 40. We also found that older adults placed the age at which developmental transitions occurred later in the life course. This latter effect was stronger for transitions involving middle-age and older adulthood compared to transitions involving young adulthood. The current study constitutes the largest study to date of age differences in age perceptions and developmental timing estimates and yielded novel insights into how the aging process may affect judgments about the self and others.

Power Poseur

Strong claims have been made that power poses can significantly improve one’s life. Starting from an evolutionary perspective, we reason that expansive poses will have no impact in more realistic situations, as in the presence of an interaction partner or when participants are aware of what the pose should accomplish. Across four dyadic studies including both commonly used outcomes and a negotiation task (which could actually have direct benefits for one’s life), we find nearly uniform null effects of holding expansive poses, despite checks confirming the success of the manipulation. For example, in two of the studies, participants watched a popular TED talk on power poses, held an expansive pose, and then completed a negotiation in the presence of a partner, as might happen in real life. We argue that researchers should stop recommending power poses as an empirically supported strategy for improving one’s life.

Carotid occlusion is associated with more frequent neurovascular events than moderately severe carotid stenosis

OBJECTIVE

Asymptomatic internal carotid artery occlusion (CO) presents a clinical dilemma, and presently, the natural history, stroke risk, and optimal management remain ill defined. This study compared outcomes, including neurovascular events (NVEs) and health care costs, between patients with CO and patients with asymptomatic carotid artery stenosis (CS).

METHODS

A prospectively maintained database was queried to identify patients with CO and CS with at least >50% carotid stenosis by duplex. We identified and reviewed 622 consecutive patients with asymptomatic carotid artery disease at one academic medical center between 2011 and 2013. Patients with CO (n = 97) were identified and propensity matched by age and gender in a 1:2 ratio with CS patients (n = 194) for further analyses. Univariate and multivariate models were used to analyze baseline characteristics, clinical variables, and 1-year follow-up data from the date of diagnosis. Multivariate analysis was performed by multiple linear regression modeling. Institutional Review Board approval was obtained.

RESULTS

Follow-up data were available for 99% of matched patients. CO patients were younger (72 vs 75 years; P < .01) and more likely male (67% vs 53%; P = .01) compared with CS patients. After propensity matching, baseline characteristics were similar between groups, with a trend toward higher use of statin therapy among patients with CO. Antiplatelet therapy was used in 79% of patients with CS and in 74% of patients with CO (P = .45). The rate of NVE among CO patients was higher than among CS patients at 1 year of follow-up (14% vs 7%; P = .03). Among those with NVE, neither antiplatelet therapy (64% vs 77%; P = .49) nor statin therapy (86% vs 77%; P = .58) appeared to have a significant effect. Health care costs ($14,361 vs $12,142; P = .44) and hospital admission rate (63% vs 71%; P = .18) were similar between groups. Not surprisingly, the rate of vascular procedures was higher in the CS group (55% vs 27%; P = .04).

CONCLUSIONS

Patients with asymptomatic CO experience more NVEs compared with similar patients with moderately severe CS. Further study of preventative strategies, including intensity of medical therapy, is warranted.

Advancing Research on Cognitive Processes in Social and Personality Psychology

We provide a primer on a hierarchical extension of the drift diffusion model (DDM). This formal model of decisions is frequently used in the cognitive sciences but infrequently used in social and personality research. Recent advances in model estimation have overcome issues that previously made the hierarchical DDM impractical to implement. Using examples from two paradigms, the first-person shooter task and the flash gambling task, we demonstrate that the hierarchical DDM can provide novel insights into cognitive processes underlying decisions. Finally, we compare the DDM to dual-process models of decision-making. We hope this primer will provide researchers a new tool for investigating psychological processes.

Incidence and outcomes of ventral hernia repair after robotic retropubic prostatectomy: A retrospective cohort of 570 consecutive cases

BACKGROUND

Robotic retropubic prostatectomy (RRP) has become one of the most commonly performed robotic procedures in the United States. Ventral hernia (VH) has been increasingly recognized as an important complication after laparoscopic procedures, in general. However, data related to VH after robotic procedures is relatively scarce, especially after RRP. With increasing popularity of RRP, the purpose of this study was to look at the incidence of VH and outcomes of ventral hernia repair (VHR) after RRP.

METHODS

All patients who underwent RRP at a single institution between January 2012 and June 2014 were studied retrospectively using electronic medical records.

RESULTS

A total of 570 patients underwent RRP, of which 33 (5.8%) developed VH during the study period. Fourteen (42%) patients were obese and five (15%) had diabetes. One patient (3%) had a surgical site infection after RRP and two (6%) patients were on immunomodulators/steroids. Median duration to develop VH after RRP was 12 (1-25) months. Out of the 33 patients with VH, ten (33%) underwent VHR; five laparoscopic and five open. Median size of hernia defect and mesh used was 25 (1-144) cm² and 181 (15-285) cm², respectively. Median length of hospital stay and follow up was 0 (0-4) days and 12 (1-14) months, respectively. One patient who had initial VHR done at an outside institution had a recurrence. Thirty-two (97%) patients were alive at their last follow up. One patient died secondary to progression of prostate cancer. There was no significant 30 day morbidity (surgical site infection, fascial dehiscence, pneumonia, acute kidney injury, myocardial infarction). Of patients who decided non-operative management of VH (n = 23, 67%), none developed a complication requiring emergent surgical intervention.

CONCLUSION

The incidence of VH after RRP is likely underreported in prior studies. Repair, either laparoscopic or open, is safe and effective in experienced hands. Patients who decide on watchful waiting can be followed with minimal risk of incarceration/strangulation. Further studies are needed to analyze the extraction techniques after RRP and correlate with incidence of VH.

The difficult gall bladder: Outcomes following laparoscopic cholecystectomy and the need for open conversion

INTRODUCTION

Surgery for the difficult gallbladder (DGB) is associated with increased risk compared to more routine laparoscopic cholecystectomies (LC). Laparoscopic "damage control" methods including cholecystostomy, fundus-down approach and subtotal cholecystectomy (SC) have been proposed to avoid conversion to open. We hypothesized that a Total LC (TLC) for DBG can be completed safely with an acceptably low conversion rate.

MATERIAL AND METHODS

All patients that underwent LC from January 2005-June 2015 were retrospectively reviewed. Cases met criteria for DGB if they were necrotic/gangrenous, involved Mirizzi syndrome, had extensive adhesions, were converted to open, lasted more than 120 min, had prior tube cholecystostomy or known GB perforation.

RESULTS

A total of 2212 patients underwent LC during the study time period, of which 351 (15.8%) met criteria for DGB. Of these cases, 213 (60.7%) were admitted from the emergency department and 67 (19.1%) underwent urgent/emergent cholecystectomy (within 24 h). Additionally 18 (5.1%) had pre-operative tube cholecystostomies. Seventy patients (19.9%) were converted to open. Indications for conversion included severe inflammation/adhesion (n = 31, 46.3%), difficult anatomy (n = 14, 20.9%) and bleeding (n = 6, 9.0%). Predictors for conversion included urgent/emergent intervention (OR, 0.80; 95% CI 0.351-0.881, p = 0.032), previous abdominal surgery (OR, 2.18; 95% CI, 1.181-4.035, p = 0.013) and necrotic/gangrenous cholecystitis (OR, 1.92; 95% CI, 1.356-4.044, p = 0.033). Comparing the TLC and the conversion groups, mean operative time and length of hospital stay were significantly different; 147 ± 47 min vs 185 ± 71 min; p < 0.005 and 3 ± 2 days vs 5 ± 3 days; p = 0.011, respectively. There was no significant difference in postoperative hemorrhage, subhepatic collection, cystic duct leak, wound infection, reoperation and 30 day mortality. There was no bile duct injury in either group.

CONCLUSION

Total laparoscopic cholecystectomy can be safely performed in difficult gallbladder situations with a lower conversion rate than previously reported. Possible predictors of conversion include urgency, necrotic gallbladder and history of prior abdominal surgeries. For patients converted to open, similar morbidity and mortality can be expected.

The Effects of Disgust on Moral Judgments

There is evidence that inducing feelings of disgust increases the severity of moral judgments, but the size of this association has been questioned by a recent meta-analysis. Based on prior research and theory, we tested whether the effects of disgust on moral judgments might be moderated by sensitivity to bodily states (Studies 1 and 2) and the accessibility of mood (Study 2) in two large samples (total N = 1,412). We did not find that disgust directly increased the severity of moral judgments nor did we find evidence that these moderators influenced the effect of disgust. Thus, the current studies do not support large effects for induced disgust and for two presumed moderators of these effects.

Nomogram to predict perioperative blood transfusion for hepatopancreaticobiliary and colorectal surgery

Background

Predictive tools assessing risk of transfusion have not been evaluated extensively among patients undergoing complex gastrointestinal surgery. In this study preoperative variables associated with blood transfusion were incorporated into a nomogram to predict transfusion following hepatopancreaticobiliary (HPB) or colorectal surgery.

Methods

A nomogram to predict receipt of perioperative transfusion was developed using a cohort of patients who underwent HPB or colorectal surgery between January 2009 and December 2014. The discriminatory ability of the nomogram was tested using the area under the receiver operating characteristic (ROC) curve and internal validation performed via bootstrap resampling.

Results

Among 4961 patients undergoing either a HPB (56·3 per cent) or colorectal (43·7 per cent) resection, a total of 1549 received at least 1 unit of packed red blood cells, giving a perioperative transfusion rate of 31·2 per cent. On multivariable analysis, age 65 years and over (odds ratio (OR) 1·52), race (versus white: black, OR 1·58; Asian, OR 1·86), preoperative haemoglobin 8·0 g/dl or less (versus over 12·0 g/dl: OR 26·79), preoperative international normalized ratio more than 1·2 (OR 2·44), Charlson co-morbidity index score over 3 (OR 1·86) and procedure type (versus colonic surgery: major hepatectomy, OR 1·71; other pancreatectomy, OR 2·12; rectal surgery, OR 1·39; duodenopancreatectomy, OR 2·65) were associated with a significantly higher risk of transfusion and were included in the nomogram. A nomogram was constructed to predict transfusion using these seven variables. Discrimination and calibration of the nomogram revealed good predictive abilities (area under ROC curve 0·756).

Conclusion

The nomogram predicted blood transfusion in major HPB and colorectal surgery.

Development and validation of the Australian Aboriginal racial identity and self-esteem survey for 8-12 year old children (IRISE_C)

INTRODUCTION

In Australia, there is little empirical research of the racial identity of Indigenous children and youth as the majority of the current literature focuses on adults. Furthermore, there are no instruments developed with cultural appropriateness when exploring the identity and self-esteem of the Australian Aboriginal population, especially children. The IRISE_C (Racial Identity and Self-Esteem of children) inventory was developed to explore the elements of racial identity and self-esteem of urban, rural and regional Aboriginal children. This paper describes the development and validation of the IRISE_C instrument with over 250 Aboriginal children aged 8 to 12 years.

METHODS

A pilot of the IRISE C instrument was combined with individual interviews and was undertaken with 35 urban Aboriginal children aged 8-12 years. An exploratory factor analysis was performed to refine the survey and reduce redundant items in readiness for the main study. In the main study, the IRISE C was employed to 229 Aboriginal children aged 6-13 years across three sites (rural, regional and urban) in Western Australia. An exploratory factor analysis using Principal axis factoring was used to assess the fit of items and survey structure. A confirmatory factor analysis was then employed using LISREL (diagonally weighted least squares) to assess factor structures across domains. Internal consistency and reliability of subscales were assessed using Cronbach's co-efficient alpha.

RESULTS

The pilot testing identified two key concepts - children's knowledge of issues related to their racial identity, and the importance, or salience, that they attach to these issues. In the main study, factor analyses showed two clear factors relating to: Aboriginal culture and traditions; and a sense of belonging to an Aboriginal community. Principal Axis Factoring of the Knowledge items supported a 2-factor solution, which explained 38.7% of variance. Factor One (Aboriginal culture) had a Cronbach's alpha of 0.835; Factor 2 (racial identity) had a Cronbach's alpha of 0.800, thus demonstrating high internal reliability of the scales.

CONCLUSION

The IRISE_C has been shown to be a valid instrument useful of exploring the development of racial identity of Australian Aboriginal children across the 8-12 year old age range and across urban, rural and regional geographical locations.

Balancing drug resistance and growth rates via compensatory mutations in the Plasmodium falciparum chloroquine resistance transporter

The widespread use of chloroquine to treat Plasmodium falciparum infections has resulted in the selection and dissemination of variant haplotypes of the primary resistance determinant PfCRT. These haplotypes have encountered drug pressure and within-host competition with wild-type drug-sensitive parasites. To examine these selective forces in vitro, we genetically engineered P. falciparum to express geographically diverse PfCRT haplotypes. Variant alleles from the Philippines (PH1 and PH2, which differ solely by the C72S mutation) both conferred a moderate gain of chloroquine resistance and a reduction in growth rates in vitro. Of the two, PH2 showed higher IC50 values, contrasting with reduced growth. Furthermore, a highly mutated pfcrt allele from Cambodia (Cam734) conferred moderate chloroquine resistance and enhanced growth rates, when tested against wild-type pfcrt in co-culture competition assays. These three alleles mediated cross-resistance to amodiaquine, an antimalarial drug widely used in Africa. Each allele, along with the globally prevalent Dd2 and 7G8 alleles, rendered parasites more susceptible to lumefantrine, the partner drug used in the leading first-line artemisinin-based combination therapy. These data reveal ongoing region-specific evolution of PfCRT that impacts drug susceptibility and relative fitness in settings of mixed infections, and raise important considerations about optimal agents to treat chloroquine-resistant malaria.

Commentary and Rejoinder on

Johnson, Cheung, and Donnellan (2014a) reported a failure to replicate Schnall, Benton, and Harvey (2008) ’s effect of cleanliness on moral judgment. However, inspection of the replication data shows that participants provided high numbers of severe moral judgments – a ceiling effect. In the original data percentage of extreme responses per moral dilemma correlated negatively with the effect of the manipulation. In contrast, this correlation was absent in the replications, due to almost all items showing a high percentage of extreme responses. Therefore the parametric statistics reported by Johnson et al. (2014a) are inconclusive regarding the reproducibility of the original effect. Direct replications are prone to error when reviewers only judge similarity of methods, but not resulting data and conclusions. It is my conclusion that preventable problems can arise if publication decisions are made without independent post-data peer evaluation.

Does Cleanliness Influence Moral Judgments?

Schnall, Benton, and Harvey (2008) hypothesized that physical cleanliness reduces the severity of moral judgments. In support of this idea, they found that individuals make less severe judgments when they are primed with the concept of cleanliness (Exp. 1) and when they wash their hands after experiencing disgust (Exp. 2). We conducted direct replications of both studies using materials supplied by the original authors. We did not find evidence that physical cleanliness reduced the severity of moral judgments using samples sizes that provided over .99 power to detect the original effect sizes. Our estimates of the overall effect size were much smaller than estimates from Experiment 1 (original d = −0.60, 95% CI [−1.23, 0.04], N = 40; replication d = −0.01, 95% CI [−0.28, 0.26], N = 208) and Experiment 2 (original d = −0.85, 95% CI [−1.47, −0.22], N = 43; replication d = 0.01, 95% CI [−.34, 0.36], N = 126). These findings suggest that the population effect sizes are probably substantially smaller than the original estimates. Researchers investigating the connections between cleanliness and morality should therefore use large sample sizes to have the necessary power to detect subtle effects.

Inguinal hernia repair in women: is the laparoscopic approach superior?

PURPOSE

Laparoscopic inguinal hernia repair is associated with reduced post-operative pain and earlier return to work in men. However, the role of laparoscopic hernia repair in women is not well reported. The aim of this study was to review the outcomes of the laparoscopic versus open repair of inguinal hernias in women and to discuss patients' considerations when choosing the approach.

METHODS

A retrospective chart review of all consecutive patients undergoing inguinal hernia repair from January 2005 to December 2009 at a single institution was conducted. Presentation characteristics and outcome measures including recurrence rates, post-operative pain and complications were compared in women undergoing laparoscopic versus open hernia repair.

RESULTS

A total of 1,133 patients had an inguinal herniorrhaphy. Of these, 101 patients were female (9 %), with a total of 111 hernias. A laparoscopic approach was chosen in 44 % of patients. The majority of women (56 %) presented with groin pain as the primary symptom. Neither the mode of presentation nor the presenting symptoms significantly influenced the surgical approach. There were no statistically significant differences in hernia recurrence, post-operative neuralgia, seroma/hematoma formation or urinary retention between the two approaches (p < 0.05). A greater proportion of patients with bilateral hernias had a laparoscopic approach rather than an open technique (12 vs. 2 %, p = 0.042).

CONCLUSIONS

Laparoscopic herniorrhaphy is as safe and efficacious as open repair in women, and should be considered when the diagnosis is in question, for management of bilateral hernias or when concomitant abdominal pathology is being addressed.

Cytochrome b mutation Y268S conferring atovaquone resistance phenotype in malaria parasite results in reduced parasite bc1 catalytic turnover and protein expression

Atovaquone is an anti-malarial drug used in combination with proguanil (e.g. Malarone(TM)) for the curative and prophylactic treatment of malaria. Atovaquone, a 2-hydroxynaphthoquinone, is a competitive inhibitor of the quinol oxidation (Q(o)) site of the mitochondrial cytochrome bc(1) complex. Inhibition of this enzyme results in the collapse of the mitochondrial membrane potential, disruption of pyrimidine biosynthesis, and subsequent parasite death. Resistance to atovaquone in the field is associated with point mutations in the Q(o) pocket of cytochrome b, most notably near the conserved Pro(260)-Glu(261)-Trp(262)-Tyr(263) (PEWY) region in the ef loop). The effect of this mutation has been extensively studied in model organisms but hitherto not in the parasite itself. Here, we have performed a molecular and biochemical characterization of an atovaquone-resistant field isolate, TM902CB. Molecular analysis of this strain reveals the presence of the Y268S mutation in cytochrome b. The Y268S mutation is shown to confer a 270-fold shift of the inhibitory constant (K(i)) for atovaquone with a concomitant reduction in the V(max) of the bc(1) complex of ∼40% and a 3-fold increase in the observed K(m) for decylubiquinol. Western blotting analyses reveal a reduced iron-sulfur protein content in Y268S bc(1) suggestive of a weakened interaction between this subunit and cytochrome b. Gene expression analysis of the TM902CB strain reveals higher levels of expression, compared with the 3D7 (atovaquone-sensitive) control strain in bc(1) and cytochrome c oxidase genes. It is hypothesized that the observed differential expression of these and other key genes offsets the fitness cost resulting from reduced bc(1) activity.

Probing the multifactorial basis of Plasmodium falciparum quinine resistance: evidence for a strain-specific contribution of the sodium-proton exchanger PfNHE

Quinine (QN) continues to be an important treatment option for severe malaria, however resistance to this drug has emerged in field isolates of the etiologic agent Plasmodium falciparum. Quantitative trait loci investigations of QN resistance have mapped three loci of this complex trait. Two coincide with pfcrt and pfmdr1, involved in resistance to chloroquine (CQ) and other quinoline-based antimalarials. A third locus on chromosome 13 contains the sodium-proton exchanger (pfnhe) gene. Previous studies have associated pfnhe polymorphisms with reduced QN sensitivity in culture-adapted field isolates. Here, we provide direct evidence supporting the hypothesis that pfnhe contributes to QN resistance. Using allelic exchange, we reduced pfnhe expression by introducing a truncated 3' untranslated region (UTR) from pfcrt into the endogenous pfnhe 3'UTR. Transfections were performed with 1BB5 and 3BA6 (both CQ- and QN-resistant) as well as GC03 (CQ- and QN-sensitive), all progenies of the HB3xDd2 genetic cross. RNA and protein analyses of the ensuing recombinant clones demonstrated a approximately 50% decrease in pfnhe expression levels. A statistically significant 30% decrease in QN IC(50) values was associated with these decreased expression levels in 1BB5 and 3BA6 but not in GC03. CQ, mefloquine and lumefantrine IC(50) values were unaltered. Cytosolic pH values were similar in all parental lines and recombinant clones. Our observations support a role for pfnhe in QN resistance in a strain-dependent manner, which might be contingent on pre-existing resistance to CQ and/or QN. These data bolster observations that QN resistance is a complex trait requiring the contribution of multiple transporter proteins.

Toxicity and hazard of a mixture of SSRIs to zooplankton communities evaluated in aquatic microcosms

The toxicity and hazard of a mixture of selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, fluvoxamine, and sertraline, to zooplankton communities were evaluated using 120,00l outdoor microcosms. Acute (day 4) and chronic (day 35) zooplankton abundance and species richness were assessed for Rotifera, Cladocera, and Copepoda. For acute SSRI exposures, rotifers were the most sensitive zooplankton taxa to changes in abundance (predicted no effect concentration (PNEC)=19 nM); however, no effects in zooplankton species richness were observed for this treatment period. A decrease in Copepoda abundance and species richness was observed following chronic exposures of SSRIs (PNEC=9.1 nM). A 99th-centile predicted environmental concentration (PEC=0.51 nM) yielded HQs at least two orders of magnitude below 1. Therefore, mixtures of SSRIs do not appear to present a hazard to zooplankton communities at environmentally relevant concentrations.

Toxicity and hazard of selective serotonin reuptake inhibitor antidepressants fluoxetine, fluvoxamine, and sertraline to algae

The toxicity of SSRIs to algae/phytoplankton was investigated using the US EPA ECOSAR, acute single-species growth inhibition assays, species sensitivity distributions (SSDs), and an outdoor microcosm mixture experiment. Worst-case ECOSAR estimates of SSRI toxicity to algae ranged from 0.73 to 13.08 mg/L. Sertraline was the most toxic SSRI tested in single-species growth inhibition assays followed by fluoxetine and fluvoxamine with worst-case 96-h IC10s of 4.6, 31.3, and 1662 microg/L, respectively. HC5s of 2.4, 3.6, and 1100 microg/L were estimated, respectively, for sertraline, fluoxetine, and fluvoxamine toxicity to algae-using SSDs. Microcosm phytoplankton structural endpoints were more sensitive than functional endpoints in the short term. However, in the long term, structural endpoints were resilient and functional endpoints remained impacted even after a period of recovery. The worst-case EC10 determined from the outdoor microcosm mixture toxicity to phytoplankton communities was 15.2 nM. Although SSRIs are toxic to algae, hazard quotients using worst-case PECs represent a margin of safety of 20 to phytoplankton. Although SSRIs do not appear to pose a hazard to primary production, this assessment is not protective of higher aquatic organisms and further research into the chronic toxicity to low levels of SSRIs to higher-level aquatic species is recommended.

PfCRT and the trans-vacuolar proton electrochemical gradient: regulating the access of chloroquine to ferriprotoporphyrin IX

It is accepted that resistance of Plasmodium falciparum to chloroquine (CQ) is caused primarily by mutations in the pfcrt gene. However, a consensus has not yet been reached on the mechanism by which resistance is achieved. CQ-resistant (CQR) parasite lines accumulate less CQ than do CQ-sensitive (CQS) parasites. The CQR phenotype is complex with a component of reduced energy-dependent CQ uptake and an additional component that resembles energy-dependent CQ efflux. Here we show that the required energy input is in the form of the proton electrochemical gradient across the digestive vacuole (DV) membrane. Collapsing the DV proton gradient (or starving the parasites of glucose) results in similar levels of CQ accumulation in CQS and CQR lines. Under these conditions the accumulation of CQ is stimulated in CQR parasite lines but is reduced in CQS lines. Energy deprivation has no effect on the rate of CQ efflux from CQR lines implying that mutant PfCRT does not function as an efflux pump or active carrier. Using pfcrt-modified parasite lines we show that the entire CQ susceptibility phenotype is switched by the single K76T amino acid change in PfCRT. The efflux of CQ in CQR lines is not directly coupled to the energy supply, consistent with a model in which mutant PfCRT functions as a gated channel or pore, allowing charged CQ species to leak out of the DV.

Effects of a mixture of tetracyclines to Lemna gibba and Myriophyllum sibiricum evaluated in aquatic microcosms

The impact of a mixture of oxytetracycline, chlortetracycline, tetracycline and doxycycline on Myriophyllum sibiricum and Lemna gibba was investigated using fifteen 12,000-L microcosms (k=5, n=3). Significant concentration-response relationships were only found for M. sibiricum, where dry mass was 69, 47, 30, and 7% of controls at respective treatment concentrations of 0.080, 0.218, 0.668, and 2.289 micromol/L. Somatic endpoints were strongly and negatively correlated with percent light transmission, except plant length, which was positively correlated. Treated microcosms experienced a reduction in the percent of surface irradiance penetrating the water column as high as 99.8% at a depth of 70 cm, relative to controls. Position relative to the water column was likely responsible for the differential effects observed between floating (L. gibba) and submerged (M. sibiricum) species of macrophytes. A hazard quotient assessment of the lowest EC10 value indicated significant risk, exceeding the critical HQ value, but not the lowest EC25 value.

Exposure assessment and microcosm fate of selected selective serotonin reuptake inhibitors

The exposure and fate of selective serotonin reuptake inhibitors (SSRIs) was evaluated using modeled predicted environmental concentrations (PECs) according to the U.S. and the European Union (EU) guidelines and microcosm model ecosystems. According to the U.S. guidance, crude environmental introduction concentrations, the only SSRI that would require environmental assessment would be sertraline. However, the more conservative EU draft guidance PEC would require further assessment of all five SSRIs. Refined PECs developed using the U.S. and the EU guidelines along with estimates of removal by sewage treatment and receiving water dilution factors indicate that the U.S. methodology corresponds better to MEC data determined in the U.S. and Canada. Worst-case (99th centile) PECs for citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline were 30, 19, 30, 65, and 122 ng/L, respectively, using the U.S. methodology and 142, 182, 841, 144, and 575 ng/L, respectively, using the EU draft methodology. The dissipation of fluoxetine and fluvoxamine from the water column in aquatic microcosms was best described using a two-compartment model while sertraline followed a one-compartment model. Fluoxetine and fluvoxamine water concentrations initially dissipated with first phase half-lives of 3.8 and 1.8 days, respectively, but levelled off at concentrations around 10 microg/L with second phase half-lives of 76.7 and 59.3 days, respectively, not including those estimated as infinity. Sertraline dissipation tended toward the detection limit with a half-life of 3.4 days. Fluoxetine was found to be the most persistent followed by fluvoxamine and sertraline. Estimated log(K(OC)) values for all SSRIs were >4.3 indicating that SSRIs are expected to adsorb to sediment or sludge. Partitioning into other environmental compartments such as this may act as a reservoir from which SSRIs may be re-released into surface waters and indicates the potential susceptibility of benthos.

Dissipation of oxytetracycline, chlortetracycline, tetracycline and doxycycline using HPLC-UV and LC/MS/MS under aquatic semi-field microcosm conditions

A mixture of four tetracyclines; oxytetracycline (OTC), chlortetracycline (CTC), tetracycline (TC), and doxycycline (DC) was applied in fifteen 12000l outdoor microcosms at four treatment levels plus controls each with three replicates (n = 3). The dissipation times of parent compounds were monitored and half-lives (DT50) of 1-4 days, depending on treatment level were recorded. This is in accordance with half-lives from previous findings in bench-top experiments. Parent compound DT50, were determined using HPLC-UV. Furthermore, the samples were analyzed for ten different tetracycline products using LC/MS/MS. Two products were found for chlortetracycline; 4-epi-anh-chlortetracyline and the iso-chlortetracycline. Iso-forms were only found for CTC and only at the highest treatment (300 microg l(-1)). The half-lives, trajectories, and relative amounts of the products were analogous for all four tetracyclines. DT50 for products were less than 1.2 days. Formation of 4-epi-anh-tetracyclines, occurred at neutral to weak alkaline conditions.

A critical role for PfCRT K76T in Plasmodium falciparum verapamil-reversible chloroquine resistance

Chloroquine resistance (CQR) in Plasmodium falciparum is associated with mutations in the digestive vacuole transmembrane protein PfCRT. However, the contribution of individual pfcrt mutations has not been clarified and other genes have been postulated to play a substantial role. Using allelic exchange, we show that removal of the single PfCRT amino-acid change K76T from resistant strains leads to wild-type levels of CQ susceptibility, increased binding of CQ to its target ferriprotoporphyrin IX in the digestive vacuole and loss of verapamil reversibility of CQ and quinine resistance. Our data also indicate that PfCRT mutations preceding residue 76 modulate the degree of verapamil reversibility in CQ-resistant lines. The K76T mutation accounts for earlier observations that CQR can be overcome by subtly altering the CQ side-chain length. Together, these findings establish PfCRT K76T as a critical component of CQR and suggest that CQ access to ferriprotoporphyrin IX is determined by drug-protein interactions involving this mutant residue.

Aquatic microcosm assessment of the effects of tylosin on Lemna gibba and Myriophyllum spicatum

Tylosin is a macrolide antibiotic commonly used for therapeutic treatment and prophylaxis in livestock. As part of a larger ecotoxicological study, the potential phytotoxic effects of tylosin on the rooted macrophyte Myriophyllum spicatum and the floating macrophyte Lemna gibba were assessed under semi-field conditions using 15 12 000-L microcosms. Concentrations of 0, 10, 30, 300 microg/L (n = 3), and 600, 1000, and 3000 microg/L (n = 1) were evaluated as part of separate ANOVA and regression analyses over an exposure period of 35 days. Fate of tylosin was monitored over time in the highest three treatments, where dissipation followed pseudo-first order kinetics with associated half-lives ranging from 9 to 10 days. For both M. spicatum and L. gibba, tylosin was found to cause no biologically significant changes to any endpoint assessed compared to controls at a Type I error rate of 0.1. However, subsequent power analyses revealed that there was generally insufficient power to declare that there were no significant differences at a Type II error rate of 0.2. Conclusions concerning biologically significant impacts were therefore further assessed based on other statistical criteria including comparisons of percent differences between replicated treatments and controls, minimum significant and minimum detectable differences, and coefficients of variation. Based on these criteria, at an ecological effect size of >20% change, tylosin was concluded to elicit no biologically or ecologically significant toxicity to M. spicatum or L. gibba. A hazard quotient assessment indicated that tylosin poses little risk to either species of macrophyte, with an HQ value calculated to be nearly three orders of magnitude below 1 (0.002).

Structural and functional responses of plankton to a mixture of four tetracyclines in aquatic microcosms

Pharmaceuticals are routinely detected at low concentrations in surface waters, but effects on non-target organisms are not well understood. Microcosms were used to assess ecological responses in freshwater ecosystems to a mixture offourtetracyclines commonly used in veterinary and human medicine. Triplicate microcosms were treated with tetracycline, oxytetracycline, doxycycline, and chlortetracycline, resulting in measured time-weighted average total mixture concentrations of 0, 0.080, 0.218, 0.662, and 2.29 microM, respectively. Responses were assessed in terms of structure and function based on measurements of zooplankton and phytoplankton communities, ecosystem productivity, and water quality. Effects were observed for some endpoints > or = the 0.218 microM treatment. The largest responses were concentration-dependent reductions in total phytoplankton abundance and species richness. Phytoplankton abundance recovered to control levels in all microcosms after treatment was terminated, and resilience (time to return to normal operating range during stress) was observed with respectto phytoplankton species richness. Zooplankton were generally unaffected by the tetracyclines. Responses also included decreased water clarity, lower oxygen concentration, and water temperature. Functional endpoints showed varying sensitivity. On the basis of dissolved oxygen concentrations, community respiration (R) increased while primary productivity (P) was unchanged with increased treatment concentration. The effects observed occurred at considerably greater concentrations than are currently measured in the environment, indicating minimal risk to aquatic organisms.

Evidence for a central role for PfCRT in conferring Plasmodium falciparum resistance to diverse antimalarial agents

Chloroquine resistance in Plasmodium falciparum is primarily conferred by mutations in pfcrt. Parasites resistant to chloroquine can display hypersensitivity to other antimalarials; however, the patterns of crossresistance are complex, and the genetic basis has remained elusive. We show that stepwise selection for resistance to amantadine or halofantrine produced previously unknown pfcrt mutations (including S163R), which were associated with a loss of verapamil-reversible chloroquine resistance. This was accompanied by restoration of efficient chloroquine binding to hematin in these selected lines. This S163R mutation provides insight into a mechanism by which PfCRT could gate the transport of protonated chloroquine through the digestive vacuole membrane. Evidence for the presence of this mutation in a Southeast Asian isolate supports the argument for a broad role for PfCRT in determining levels of susceptibility to structurally diverse antimalarials.