Implicit intertemporal trajectories in cognitive representations of the self and nation.

Individual selves and the collectives to which people belong can be mentally represented as following intertemporal trajectories-progress, decline, or stasis. These studies examined the relation between intertemporal trajectories for the self and nation in American and British samples collected at the beginning and end of major COVID-19 restrictions. Implicit temporal trajectories can be inferred from asymmetries in the cognitive availability of positive and negative events across different mentally represented temporal periods (e.g., memory for the past and the imagined future). At the beginning of COVID-19 restrictions, both personal and collective temporal thought demonstrated implicit temporal trajectories of decline, in which future thought was less positive than memory. The usually reliable positivity biases in personal temporal thought may be reversable by major public events. This implicit trajectory of decline attenuated in personal temporal thought after the lifting of COVID-19 restrictions. However, collective temporal thought demonstrated a pervasive negativity bias across temporal domains at both data collection points, with the collective future more strongly negative than collective memory. Explicit beliefs concerning collective progress, decline, and hope for the national future corresponded to asymmetries in the cognitive availability of positive and negative events within collective temporal thought.

The Role of Progestogens in Menopausal Hormone Therapy.

Progestogens are steroid compounds that have the ability to induce secretory transformation in the endometrium and are utilized in menopausal hormone therapy to prevent endometrial hyperplasia and endometrial cancer. Progestogens can be derived from 21-carbon or 19-carbon steroid cytoskeletons and thus have different properties and metabolic effects beyond the progestational effects on the endometrium. This limited review will focus on the available progestogens utilized in combination hormone therapy including progesterone, medroxyprogesterone acetate, norethindrone, norethindrone acetate, levonorgestrel, and drospirenone. The impact of progestogens on a variety of target tissues including the endometrium, breast, cardiovascular system, brain, and bone, will be reviewed. Last, the current clinical regimens that can be utilized by clinicians will be discussed.

Qualitative Assessment of a Medical Protocols Mobile Application at the Boston Marathon 2016.

OBJECTIVE: To examine the creation of a medical protocols mobile application for the Boston Marathon and its use by medical volunteers for the 2016 Boston Marathon. DESIGN: Anonymous questionnaire. SETTING: 2016 Boston Marathon. PARTICIPANTS: Two hundred ninety-four marathon medical volunteers. MAIN OUTCOME MEASURES: Responses regarding ease of use, acceptability, and usefulness of the International Institute of Race Medicine mobile application. RESULTS: In total, 88% of medical volunteers who participated in the study felt that the medical protocols mobile application was easy to use. Approximately 72% would use the app again, and 79% would recommend the app to others. However, only 15% of volunteers consistently used the app during the event, and 37% felt like it contributed to clinical decision-making. CONCLUSIONS: A medical protocols app was found to be useful and well accepted among medical volunteers who reported using the app, but only a minority of respondents used the app on marathon day or felt like it contributed to clinical care. Although new, mobile apps in race medicine should continue to be an area of development as providers increasingly integrate their use into clinical practice.

Parochial trust and cooperation across 17 societies.

International challenges such as climate change, poverty, and intergroup conflict require countries to cooperate to solve these complex problems. However, the political tide in many countries has shifted inward, with skepticism and reluctance to cooperate with other countries. Thus, cross-societal investigations are needed to test theory about trust and cooperation within and between groups. We conducted an experimental study in 17 countries designed to test several theories that explain why, who, and where people trust and cooperate more with ingroup members, compared with outgroup members. The experiment involved several interactions in the trust game, either as a trustor or trustee. We manipulated partner group membership in the trust game (ingroup, outgroup, or unknown) and if their reputation was at stake during the interaction. In addition to the standard finding that participants trust and cooperate more with ingroup than outgroup members, we obtained findings that reputational concerns play a decisive role for promoting trust and cooperation universally across societies. Furthermore, men discriminated more in favor of their ingroup than women. Individual differences in cooperative preferences, as measured by social value orientation, predicted cooperation with both ingroup and outgroup members. Finally, we did not find support for three theories about the cross-societal conditions that influence the degree of ingroup favoritism observed across societies (e.g., material security, religiosity, and pathogen stress). We discuss the implications for promoting cooperation within and between countries.

Central venous catheter placement after ultrasound guided peripheral IV placement for difficult vascular access patients.

OBJECTIVES: Ultrasound guided peripheral intravenous catheters (USPIV) are frequently utilized in the Emergency Department (ED) and lead to reduced central venous catheter (CVC) placements. USPIVs, however, are reported to have high failure rates. Our primary objective was to determine the proportion of patients that required CVC after USPIV. Our secondary objective was to determine if classic risk factors for difficult vascular access were predictive of future CVC placement. METHODS: We performed a retrospective review for patients treated at a large academic hospital. Patients were identified by electronic health record and were restricted to age older than 21 years, had received USPIV, and admittance. Exclusion criteria included an existing CVC. Descriptive statistics, t-tests, chi-square proportions, and logistic regression were performed to test associations. RESULTS: Of 363 eligible patients, 20 were excluded allowing for 343 for analysis. Of 343, 45 (13.1% 95% CI 9.9-17.1%) required CVC after USPIV. For secondary outcomes, no expected characteristics (diabetes, end-stage renal disease, IV drug abuse, peripheral vascular disease, or sickle cell disease) were predictive of CVC placement. The only predictive variables were admission to ICU/stepdown and length of stay. Each additional day of hospitalization had an OR 1.11 (95% CI 1.06-1.16%) of having a CVC placed. CONCLUSION: Of those admitted after USPIV placement, approximately 7 out of every 8 patients did not require a subsequent CVC. Of the nearly 1 in 8 patients that required a CVC, factors associated with CVC placement were admission to a higher level of care and length of stay.

Point-of-care influenza testing does not significantly shorten time to disposition among patients with an influenza-like illness.

INTRODUCTION: Availability of anti-viral agents and need to isolate infected patients increases the need to confirm the diagnosis of influenza before determining patient disposition. OBJECTIVES: We sought to determine if time-to-disposition (TTD) was shorter among patients tested for influenza using an Emergency Department (ED) Point-of-care (POC) test compared to core laboratory (lab) test and to determine difference in antibiotic use between groups. METHODS: We prospectively enrolled a convenience sample of ED patients for whom influenza testing was ordered during influenza season 2017. Participants were randomized to POC or lab. Data collected included demographics, chief complaint, influenza test results, turnaround time (TAT), whether antibiotics were given, and TTD. Descriptive statistics were calculated and group comparisons conducted using chi squared and Wilcoxon Rank Sum tests. RESULTS: Study population included 100 in the POC group and 97 in the lab group. Demographics were similar between POC and lab participants. More flu positive results were reported in the POC group compared to the lab group (51.0% vs. 33.0% p = 0.01). The median TTD was 146.5 min (IQR 98.5) for POC group and 165.5 min (IQR 127) for lab group (p = 0.26). The median TAT was 30.5 min (IQR 7.5) for POC group and 106.0 min (IQR 55) for core lab group (p = 0.001). Antibiotics were given to 14.0% of POC participants and 14.4% of lab participants (p = 0.93). CONCLUSIONS: Although use of a POC influenza test provided more rapid TAT than use of a core lab test, there was no significant difference in TTD or antibiotic use between groups.

Stochastic simulation of multiscale complex systems with PISKaS: A rule-based approach.

Computational simulation is a widely employed methodology to study the dynamic behavior of complex systems. Although common approaches are based either on ordinary differential equations or stochastic differential equations, these techniques make several assumptions which, when it comes to biological processes, could often lead to unrealistic models. Among others, model approaches based on differential equations entangle kinetics and causality, failing when complexity increases, separating knowledge from models, and assuming that the average behavior of the population encompasses any individual deviation. To overcome these limitations, simulations based on the Stochastic Simulation Algorithm (SSA) appear as a suitable approach to model complex biological systems. In this work, we review three different models executed in PISKaS: a rule-based framework to produce multiscale stochastic simulations of complex systems. These models span multiple time and spatial scales ranging from gene regulation up to Game Theory. In the first example, we describe a model of the core regulatory network of gene expression in Escherichia coli highlighting the continuous model improvement capacities of PISKaS. The second example describes a hypothetical outbreak of the Ebola virus occurring in a compartmentalized environment resembling cities and highways. Finally, in the last example, we illustrate a stochastic model for the prisoner's dilemma; a common approach from social sciences describing complex interactions involving trust within human populations. As whole, these models demonstrate the capabilities of PISKaS providing fertile scenarios where to explore the dynamics of complex systems.

Is hallway care dangerous? An observational study.

OBJECTIVES: In response to crowding the use of hallway beds has become an increasingly prevalent practice in Emergency Departments (EDs). There is limited research on whether caring for patients in hallways (HP) is associated with adverse outcomes. The goal of this study was to examine the effects of HP triage on 30 day outcomes for ED return, readmission, and mortality. METHODS: We performed a retrospective cohort study at an urban, academic ED comparing HPs (defined as HP for ≥30 min) to matched controls triaged to standard ED beds from 9/30/14 to 10/1/15. We analyzed data from the hospital's clinical data warehouse. Matched controls were selected by gender, age, ethnicity, and language. We used McNemar's test to assess the association between triage location and 30 day study outcomes. We also examined adverse outcomes by triage severity using McNemar's test. RESULTS: A total of 10,608 HPs were matched to control patients. Compared to controls, HPs had 2.0 times the odds of returning to the ED in 30 days (95% CI: 1.8-2.1), 1.6 times the odds of inpatient readmission (95% CI: 1.4-1.9), and 1.7 times the odds of readmission to observation (95% CI: 1.4-2.0). The odds ratio for mortality in HPs versus controls was 0.80, (95% CI: 0.50-1.3). CONCLUSIONS: Patients initially triaged to the hallway have an increased odds of 30 day return to the ED, observation and inpatient admission. After adjusting for ESI, the increased odds for return remained similar. The small sample size precluded testing effects of HP status on mortality.

The Effect of Age and Body Mass Index on the Surgical Anatomy of Supraumbilical Port Insertion: Implications for Laparoscopic and Robotic Surgery.

BACKGROUND: Minimally invasive surgery is the preferred approach for performing many gynecologic procedures. Occasionally, supraumbilical port placement may be preferable to optimize visibility and maneuverability although the risks of complications are less well characterized compared to umbilical entry. METHODS: We conducted a retrospective review of computed tomograms from 92 patients to evaluate the anatomic considerations for umbilical and supraumbilical port entry based on patient age, body mass index (BMI), parity, abdominal wall thickness, and distance to the great vessels. RESULTS: Supraumbilical entry was not associated with differences in distance to the great vessels compared to the umbilicus. However, supraumbilical location and BMI were associated with greater abdominal wall thickness. Age and BMI were associated with greater distance to the great vessels, while age was associated with thinner abdominal wall. Multiple linear regression confirmed independent effects of age and BMI. No association between parity and distance to retroperitoneal vessels was observed. CONCLUSION: Younger patients may be at increased risk for great vessel injury and pre-peritoneal insufflation. Obese patients may be at risk for pre-peritoneal insufflation, while patients with BMI < 30, particularly with a skin-to-aorta distance < 7 cm, may be at an increased risk for great vessel injury. Surgeons should consider these factors when considering supraumbilical port entry.

Are Geriatric Patients Placed in an Emergency Department Observation Unit on a Chest Pain Pathway More Likely Than Non-Geriatric Patients to Re-Present to the Hospital within 30 Days?

BACKGROUND: Emergency department observation units (EDOUs) are used frequently for low-risk chest pain evaluations. OBJECTIVE: The purpose of this study was to determine whether geriatric compared to non-geriatric patients evaluated in an EDOU for chest pain have differences in unscheduled 30-day re-presentation, length of stay (LOS), and use of stress testing. METHODS: We conducted an exploratory, retrospective, cohort study at a single academic, urban ED of all adult patients placed in an EDOU chest pain protocol from June 1, 2014 to May 31, 2015. Our primary outcome was any unscheduled return visits within 30 days of discharge from the EDOU. Secondary outcomes included EDOU LOS and stress testing. We used Wilcoxon non-parametric and χ2 tests to compare geriatric to non-geriatric patients. RESULTS: There were 959 unique EDOU placements of geriatric (n = 219) and non-geriatric (n = 740) patients. Geriatric compared to non-geriatric patients had: no significant difference in unscheduled 30-day return visits after discharge from the EDOU (15.5% vs. 18.5%; p = 0.31); significantly longer median EDOU LOS (22.1 vs. 20.6 h; p < 0.01) with a greater percentage staying longer than 24 h (42% vs. 29.1%; p < 0.01). Geriatric patients had significantly fewer stress tests (39.7% vs. 51.4%; p < 0.01), more of which were nuclear stress tests (78.2% vs. 39.5%; p < 0.01). CONCLUSIONS: In this exploratory retrospective study, geriatric EDOU chest pain patients did not have an increased rate of re-presentation to the hospital within 30 days compared to non-geriatric patients. Geriatric patients had a longer EDOU LOS than non-geriatric patients. Geriatric patients in the EDOU had fewer stress tests, but more of those were nuclear stress tests.

Does progesterone supplementation improve pregnancy rates in clomiphene citrate and intrauterine insemination treatment cycles?

AIM: To investigate the effect of empiric use of luteal phase progesterone supplementation to improve endometrial receptivity in women undergoing treatment with clomiphene citrate in combination with intrauterine insemination (CC-IUI). DESIGN: Retrospective cohort analysis. SETTING: University fertility center. PATIENTS: 426 CC-IUI cycles from 292 patients with unexplained infertility. INTERVENTIONS: Patients were treated with micronized intravaginal progesterone 100 mg twice daily beginning approximately three days after CC-IUI. MAIN OUTCOME MEASURE(S): Clinical pregnancy per initiated cycle as defined by presence of fetal heart rate on ultrasound. RESULTS: Clinical pregnancy rate was higher in patients receiving luteal phase support compared to patients not receiving luteal phase support (odds ratio: 2.04; 95% confidence interval: 1.01-4.14) after adjusting for all factors in the analysis using a multivariate logistic regression model. Age at the start of the cycle, BMI and CC dose were not shown to have an effect on clinical pregnancy rates. Patients with endometrial lining (EML) thickness 6-8 mm and >8 mm had increased clinical pregnancy rates compared to EML <6 mm independent of luteal phase progesterone use. Patients who appear to receive the greatest benefit of progesterone supplementation are in the 6-8 mm EML cohort. CONCLUSIONS: Luteal phase progesterone supplementation in CC-IUI cycles can improve endometrial receptivity as judged by the improved clinical pregnancy rates as the primary outcome.

Attitudes toward Arab ascendance: Israeli and global perspectives.

Arab nations are decades behind many other previously colonized nations in developing stronger economies, more democratic institutions, and more autonomy and self-government, in part as a result of external interference. The year 2011 brought the potential for greater Arab autonomy through popular uprisings against autocratic governments in Tunisia, Egypt, and Yemen, and through the Palestinian request for state recognition by the United Nations. We examined the psychology of support for Arab ascendancy among adults in 14 nations in the Balkans, the Middle East, Asia, Oceania, Europe, and North America. We predicted and found that people low on social dominance orientation endorsed forming an independent Palestinian state and desired that the Arab uprisings succeed. Rejection of ideologies that legitimize outside interference with Arabs mediated this support. Measures and model results were robust across world regions. We discuss theoretical implications regarding the advent of new ideologies and extending social dominance theory to address international relations.

Misperception of estrogen activity in patients treated with an estrogen receptor antagonist.

Measurement of estradiol is an important marker of ovarian function. At low levels, accurate measurement has been difficult because of unique characteristics of immunoassay kits. We present this case to emphasize the importance of accurate estimation of estrogen activity and estradiol levels to avoid unnecessary surgical intervention.

Relationship between human chorionic gonadotropin serum levels and the risk of ovarian hyperstimulation syndrome.

The object of this retrospective cohort study was to determine if hCG levels correlate with ovarian hyperstimulation syndrome (OHSS) risk after adjustment for other risk factors during in vitro fertilization (IVF). We measured serum hCG approximately 12 h after hCG trigger in women undergoing 406 cycles of controlled ovarian hyperstimulation for IVF between June 2006 and December 2009. Serum hCG levels were measured 12 h after trigger. Bivariate logistic regression was used to assess the association between patient and cycle characteristics and OHSS. In our series, mild to moderate OHSS occurred in 9% (38/406), and severe OHSS diagnosed in 1.5% (6/406) of IVF cycles. OHSS risk was increased in younger women (<30 years old: adjusted odds ratio: aOR 2.46, 95% confidence interval: CI 1.14-5.34), increased number of oocytes (11-20: aOR 6.79, 95% CI 1.97-23.40; >20: aOR 17.55, 95% CI 4.84-63.70), and increase E2 levels (≥3,000 pg/mL: aOR 2.59, 95% CI 1.33-5.05), but was unrelated to hCG level (100-200 IU/L: aOR 1.53, 95% CI 0.60-3.91; ≥200 IU/L: aOR 1.42 95% CI 0.48-4.20). These results indicate that OHSS risk during IVF is unrelated to serum hCG level measured approximately 12 h after trigger.

Continuities and discontinuities in the cultural evolution of global consciousness.

Global consciousness (GC), encompassing cosmopolitan orientation, global orientations (i.e. openness to multicultural experiences) and identification with all humanity, is a relatively stable individual difference that is strongly associated with pro-environmental attitudes and behaviours, less ingroup favouritism and prejudice, and greater pandemic prevention safety behaviours. Little is known about how it is socialized in everyday life. Using stratified samples from six societies, socializing institution factors correlating positively with GC were education, white collar work (and its higher income) and religiosity. However, GC also decreased with increasing age, contradicting a 'wisdom of elders' transmission of social learning, and not replicating typical findings that general prosociality increases with age. Longitudinal findings were that empathy-building, network-enhancing elements like getting married or welcoming a new infant, increased GC the most across a three-month interval. Instrumental gains like receiving a promotion (or getting a better job) also showed positive effects. Less intuitively, death of a close-other enhanced rather than reduced GC. Perhaps this was achieved through the ritualized management of meaning where a sense of the smallness of self is associated with growth of empathy for the human condition, as a more discontinuous or opportunistic form of culture-based learning. This article is part of the theme issue 'Evolution and sustainability: gathering the strands for an Anthropocene synthesis'.

A Longitudinal Test of the Conservative-Liberal Well-Being Gap.

In this article, we test if conservatism predicts psychological well-being longitudinally. We based the study on previous findings showing that conservatives score higher on different measures of well-being, such as life satisfaction and happiness. Most explanations in the literature have assumed that conservatism antecedes well-being without considering the alternative-that well-being may predict conservatism. In Study 1, using multilevel cross-lagged panel models with a two-wave longitudinal sample consisting of data from 19 countries (N = 8,740), we found that conservatism did not predict well-being over time. We found similar results in Study 2 (N = 2,554), using random-intercept cross-lagged panel models with a four-wave longitudinal sample from Chile. We discuss the main implications of these results for the literature examining the association between conservatism and well-being.

Individual uniqueness in trust profiles and well-being: Understanding the role of cultural tightness-looseness from a representation similarity perspective.

This paper provides a unique perspective for understanding cultural differences: representation similarity-a computational technique that uses pairwise comparisons of units to reveal their representation in higher-order space. By combining individual-level measures of trust across domains and well-being from 13,823 participants across 15 nations with a measure of society-level tightness-looseness, we found that any two countries with more similar tightness-looseness tendencies exhibit higher degrees of representation similarity in national interpersonal trust profiles. Although each individual's trust profile is generally similar to their nation's trust profile, the greater similarity between an individual's and their society's trust profile predicted a higher level of individual life satisfaction only in loose cultures but not in tight cultures. Using the framework of representation similarity to explore cross-cultural differences from a multidimensional, multi-national perspective provide a comprehensive picture of how culture is related to the human activities.

Behavioral evidence for global consciousness transcending national parochialism.

While national parochialism is commonplace, individual differences explain more variance in it than cross-national differences. Global consciousness (GC), a multi-dimensional concept that includes identification with all humanity, cosmopolitan orientation, and global orientation, transcends national parochialism. Across six societies (N = 11,163), most notably the USA and China, individuals high in GC were more generous allocating funds to the other in a dictator game, cooperated more in a one-shot prisoner's dilemma, and differentiated less between the ingroup and outgroup on these actions. They gave more to the world and kept less for the self in a multi-level public goods dilemma. GC profiles showed 80% test-retest stability over 8 months. Implications of GC for cultural evolution in the face of trans-border problems are discussed.

Global Consciousness Predicts Behavioral Responses to the COVID-19 Pandemic: Empirical Evidence From 35 Cultures.

COVID-19 has drastically changed human behaviors and posed a threat to globalism by spurring a resurgence of nationalism. Promoting prosocial behavior within and across borders is of paramount importance for global cooperation to combat pandemics. To examine both self-report and actual prosocial behavior, we conducted the first empirical test of global consciousness theory in a multinational study of 35 cultures (N = 18,171 community adults stratified by age, gender, and region of residence). Global consciousness encompassed cosmopolitan orientation, identification with all humanity, and multicultural acquisition, whereas national consciousness reflected ethnic protection. Both global consciousness and national consciousness positively predicted perceived risk of coronavirus and concern about coronavirus, after controlling for interdependent self-construal. While global consciousness positively predicted prosocial behavior in response to COVID-19, national consciousness positively predicted defensive behavior. These findings shed light on overcoming national parochialism and provide a theoretical framework for the study of global unity and cooperation.