Blepharoplasty Online: Critical Analysis of Content and Patient Comprehensibility.

INTRODUCTION: Patients frequently turn to online information for decision-making factors about aesthetic procedures. The quality of online medical content is an essential supplement to clinical education. These resources assist patients in understanding the risks, benefits, and appropriateness of their desired procedure. This study examines the breadth and readability of online blepharoplasty information, elucidating its educational utility. METHODS: A depersonalized Google search was conducted using the Startpage Search Engine, investigating key phrases, "blepharoplasty decision making factors", "eye lift decision making factors", and "eyelid lift decision making factors". The first three pages of results for each search term, totaling 90 links were screened. Data were extracted for various decision-making factors, subspecialty, gender, and readability. RESULTS: Twenty-six websites met inclusion for analysis. Thirteen websites were plastic surgery based, five otolaryngology (ENT), five ophthalmology/oculoplastic, one oral-maxillofacial (OMFS), and two mixed-based practices. Most blepharoplasty webpages identified were that of private practice and male surgeons. Half were subspecialties other than plastic surgery. Thirteen common decision-making factors were identified. The most common factors addressed across all texts were recovery followed by cosmetic and functional goals. The least discussed were genetic factors. Average Readability exceeded the 12th grade. There were no significant differences in readability means among subspecialties. CONCLUSION: This study examines the online blepharoplasty sphere among US-based practices providing clinical education to patients. No appreciable differences among gender, subspecialty, and readability on decision-making factors were found, highlighting a consistency among surgeons. Most websites fell short of readability standards, however, emphasizing a need for clearer information to patients. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Ethical judgments of poverty depictions in the context of charity advertising.

Aid organizations, activists, and the media often use graphic depictions of human suffering to elicit sympathy and aid. While effective, critics have condemned these practices as exploitative, objectifying, and deceptive, ultimately labeling them 'poverty porn.' This paper examines people's ethical judgments of portrayals of poverty and the criticisms surrounding them, focusing on the context of charity advertising. In Studies 1 and 2, we find that tactics that have been decried as deceptive (i.e., using an actor or staging a photograph) are judged to be less acceptable than those that have been decried as exploitative and objectifying (i.e., depicting an aid recipient's worst moments). This pattern occurs both when evaluating the tactics themselves (Studies 1a-1c) and when directly evaluating critics' arguments about them (Study 2). Studies 3 and 4 unpack the objection to deceptive tactics and find that participants' chief concern is not about manipulating the audience's responses or about distorting perceptions of reality. Participants report less concern about non-deceptive manipulation (using emotion to compel donations) and 'cherry-picked' portrayals of poverty (an ad showing an extreme, but real image) so long as there is some truth to the portrayal. Yet they are more sensitive to artificial images (e.g., an actor posing as poor), even when the image resembles reality. Thus, ethical judgments hinge more on whether poverty portrayals are genuine than whether they are representative. This work represents the first empirical investigation into ethical judgments of poverty portrayals. In doing so, this work sheds light on how people make sense of morally questionable tactics that are used to promote social welfare and deepens our understanding of reactions to deception.

Lying is sometimes ethical, but honesty is the best policy: The desire to avoid harmful lies leads to moral preferences for unconditional honesty.

People believe that some lies are ethical, while also claiming that "honesty is the best policy." In this article, we introduce a theory to explain this apparent inconsistency. Even though people view prosocial lies as ethical, they believe it is more important-and more moral-to avoid harmful lies than to allow prosocial lies. Unconditional honesty (simply telling the truth, without finding out how honesty will affect others) is therefore seen as ethical because it prevents the most unethical actions (i.e., harmful lies) from occurring, even though it does not optimize every moral decision. We test this theory across five focal experiments and 10 supplemental studies. Consistent with our account, we find that communicators who tell the truth without finding out how honesty will affect others are viewed as more ethical, and are trusted more, than communicators who look for information about the social consequences of honesty before communicating. However, the moral preference for unconditional honesty attenuates when it is certain that looking for more information will not lead to harmful lies. Overall, this research provides a holistic understanding of how people think about honesty and suggests that moral rules are not valued because people believe all rule violations are wrong, but rather, because they believe some violations must be avoided entirely. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Targeted Toxicities: Protocols for Monitoring the Adverse Events of Targeted Therapies Used in the Treatment of Non-Small Cell Lung Cancer.

Targeted therapies have revolutionized the treatment for many patients with non-small cell lung cancer (NSCLC). Multiple new oral targeted therapies have been approved in the last decade; however, their overall efficacy may be reduced by poor adherence, treatment interruptions, or dose reductions due to adverse events. Most institutions lack standard monitoring protocols for toxicities from these targeted agents. This review describes important adverse events observed in clinical trials and reported by the U.S. Food and Drug Administration for both currently approved and upcoming promising therapies in the treatment of NSCLC. These agents cause a range of toxicities, including dermatologic, gastroenteric, pulmonary, and cardiac toxicities. This review proposes protocols for routine monitoring of these adverse events, both prior to initiation of therapy and while on treatment.

On being honest about dishonesty: The social costs of taking nuanced (but realistic) moral stances.

Despite the well-documented costs of word-deed misalignment, hypocrisy permeates our personal, professional, and political lives. Why? We explore one potential explanation: the costs of moral flexibility can outweigh the costs of hypocrisy, making hypocritical moral absolutism a preferred social strategy to admissions of moral nuance. We study this phenomenon in the context of honesty. Across six studies (total N = 3545), we find that communicators who take flexible honesty stances ("It is sometimes okay to lie") that align with their behavior are penalized more than hypocritical communicators who take absolute honesty stances ("It is never okay to lie") that they fail to uphold. Although few people take absolute stances against deception themselves, they are more trusting of communicators who take absolute honesty stances, relative to flexible honesty stances, because they perceive absolute stances as reliable signals of communicators' likelihood of engaging in future honesty, regardless of inconsistent behavior. Importantly, communicators-including U.S. government officials-also anticipate the costs of flexibility. This research deepens our understanding of the psychology of honesty and helps explain the persistence of hypocrisy in our social world. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Test performance metrics for breast, cervical, colon, and lung cancer screening: a systematic review.

BACKGROUND: Multiple quality metrics have been recommended to ensure consistent, high-quality execution of screening tests for breast, cervical, colorectal, and lung cancers. However, minimal data exist evaluating the evidence base supporting these recommendations and the consistency of definitions and concepts included within and between cancer types. METHODS: We performed a systematic review for each cancer type using MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from 2010 to April 2020 to identify guidelines from screening programs or professional organizations containing quality metrics for tests used in breast, cervical, colorectal, and lung cancer screening. We abstracted metrics' definitions, target performance levels, and related supporting evidence for test completeness, adequacy (sufficient visualization or collection), accuracy, and safety. RESULTS: We identified 11 relevant guidelines with 20 suggested quality metrics for breast cancer, 5 guidelines with 9 metrics for cervical cancer, 13 guidelines with 18 metrics for colorectal cancer (CRC), and 3 guidelines with 7 metrics for lung cancer. These included 54 metrics related to adequacy (n = 6), test completeness (n = 3), accuracy (n = 33), and safety (n = 12). Target performance levels were defined for 30 metrics (56%). Ten (19%) were supported by evidence, all from breast and CRC, with no evidence cited to support metrics from cervical and lung cancer screening. CONCLUSIONS: Considerably more guideline-recommended test performance metrics exist for breast and CRC screening than cervical or lung cancer. The domains covered are inconsistent among cancers, and few targets are supported by evidence. Clearer evidence-based domains and targets are needed for test performance metrics. REGISTRATION: PROSPERO 2020 CRD42020179139.

Content and Readability of Online Recommendations for Breast Implant Size Selection.

Breast augmentation is one of the most frequently performed aesthetic procedures in the United States. Online information is often used by patients to make decisions when undergoing cosmetic procedures. It is vital that online medical information includes relevant decision-making factors and uses language that is understandable to broad patient audiences. Ideally, online resources should aid patient decisions in aesthetic surgical planning, especially implant size selection for breast augmentation. We describe patient decision-making factors and readability of breast implant size selection recommended by private practice plastic surgery webpages. Methods: Using a depersonalized, anonymous query to Google search engine, the terms "breast implant size factors" and "breast implant size decision" were searched, and 52 plastic surgery private practice webpages were identified. Webpages were analyzed for reported decision-making factors of implant size selection. Readability analyses of webpages were performed with Readability Studio and Hemingway Editor. Results: The two major decision-making factors for implant size selection reported by webpages were body/tissue-based measurements and surgeon input. Ten factors related to patient lifestyle, surgical goals, and procedural options were also identified. Average webpage scores for five readability measures exceeded recommended levels for medical information. Conclusions: Reported decision-making factors for implant size selection emphasize a plastic surgeon's expertise but may enhance the patient's role in preoperative planning. Webpages describing breast implant size selection exceed the sixth and eighth grade reading levels recommended by the AMA and NIH, respectively. Improving the readability of webpages will refine the role of online medical information in preoperative planning of breast augmentation.

Outcomes of catheter ablation of atrial tachyarrhythmia guided exclusively by activation mapping.

INTRODUCTION: Complex atrial tachyarrhythmias (CATs) are commonly observed in patients with prior catheter ablation or cardiac surgery. These arrhythmias are challenging to map and ablate. Historically, entrainment mapping was utilized to characterize CAT. With the advent of high-definition mapping (HDM), full visualization of the CAT circuit is possible which may obviate the need for entrainment mapping. METHODS: We sought to investigate the outcomes of catheter ablation of CAT guided only by HDM. Consecutive patients who underwent CAT ablation from 2017 to 2021 were included in our study (excluding right atrial tachyarrhythmias). Patients were sorted by the type of mapping performed. Group I consisted of patients where HDM alone was utilized with no attempt of entrainment. Group II consisted of patients where both entrainment and HDM were utilized. RESULTS: A total of 67 patients were included in our study, with 40 patients in HDM group (I) and 27 patients in entrainment group (II). No statistically significant difference regarding 1-year freedom from atrial arrhythmias was found between the two groups (80% vs 77.8%, p = 0.819). Four CATs were terminated by entrainment during procedure versus none in the HDM-only group (p = 0.011). CONCLUSIONS: CAT ablation with HDM alone yielded similar 1-year freedom from atrial arrhythmias compared to ablation with HDM and entrainment. Entrainment combined with HDM was associated with higher undesired CAT interruption rate. Further validation is needed with randomized control trials.

Variability of antiplatelet response in patients with peripheral artery disease.

OBJECTIVE: Antiplatelet therapy has been a pillar of management for peripheral artery disease (PAD). However, a significant subset of patients with PAD will be resistant to certain antiplatelet medications and, therefore, have an increased risk of graft and/or stent thrombosis unknown to the surgeon. At present, no point-of-care testing to identity which patients will experience benefit from these medications has been incorporated into the treatment guidelines. Thromboelastography with platelet mapping affords an opportunity to evaluate real-time coagulation dynamics and platelet function. In the present prospective, observational study, we aimed to delineate the variation in response to antiplatelet therapy in patients with PAD undergoing revascularization. METHODS: All patients who were undergoing named vessel revascularization during December 2020 through April 2022 were prospectively enrolled. Platelet mapping assays were performed in three clinical phases: preoperative, postoperative inpatient, and postoperative outpatient. The distribution of platelet reactivity within patients receiving mono- vs dual antiplatelet therapy was assessed, and a between-group inferential analysis was performed. The effect of comorbidities and intervention subtype on platelet inhibition was also analyzed. RESULTS: A total of 521 platelet mapping samples from 143 individual patients were analyzed using thromboelastography with platelet mapping. We found wide variability in the distribution of platelet inhibition, with a range of 0 to 100 and an interquartile range of 37.6. Although platelet inhibition with clopidogrel 75 mg was higher on average (44.8 ± 30.2) than that with aspirin 81 mg (24.6 ± 23.7) or aspirin 325 mg (27.1 ± 26.4; P = .001), clopidogrel at 75 mg demonstrated the highest variability in response. CONCLUSIONS: These data have demonstrated significant variability in the response to both mono- and dual antiplatelet therapy in PAD patients undergoing lower extremity revascularization. Future research on the effect of this variability in response on the clinical outcomes could provide invaluable understanding of the perioperative thrombotic risk.

Community standards of deception: Deception is perceived to be ethical when it prevents unnecessary harm.

We frequently claim that lying is wrong, despite modeling that it is often right. The present research sheds light on this tension by unearthing systematic cases in which people believe lying is ethical in everyday communication and by proposing and testing a theory to explain these cases. Using both inductive and experimental approaches, the present research finds that deception is perceived to be ethical and individuals want to be deceived when deception is perceived to prevent unnecessary harm. This research identifies eight community standards of deception: rules of deception that most people abide by and recognize once articulated, but have never previously been codified. These standards clarify systematic circumstances in which deception is perceived to prevent unnecessary harm, and therefore, circumstances in which deception is perceived to be ethical. This work also documents how perceptions of unnecessary harm influence the use and judgment of deception in everyday life, above and beyond other moral concerns. These findings provide insight into when and why people value honesty and paves the way for future research on when and why people embrace deception. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Prosocial lies: Causes and consequences.

Prosocial lies-lies that are intended to benefit others-are ubiquitous. This article reviews recent research on the causes and consequences of prosocial lies. Prosocial lies are often motivated by the desire to spare others from emotional harm. Therefore, prosocial lies are frequently told in situations in which honesty would cause heightened emotional harm (e.g. when a target is fragile) and by people who are sensitive to others' emotional suffering (e.g. those high in compassion). However, targets only react positively to prosocial lies when they prevent emotional harm and when honesty lacks instrumental value (i.e. when they prevent unnecessary harm). Outside of these situations, targets typically view prosocial lies as paternalistic and therefore penalize those who tell them.

Hiding success.

Self-promotion is common in everyday life. Yet, across 8 studies (N = 1,687) examining a broad range of personal and professional successes, we find that individuals often hide their successes from others and that such hiding has relational costs. We document these effects among close relational partners, acquaintances, and within hypothetical relationships. Study 1 finds that targets feel less close to and more insulted by communicators who hide rather than share their successes. Study 2 finds that hiding success harms relationships both when the success is eventually discovered and when it is not. Studies 3 and 4 explore the mechanism underlying these relational costs: Targets infer that communicators have paternalistic motives when they hide their success, which leads them to feel insulted. Studies 5-7 explore the contextual cues that elicit inferences of paternalistic motives, such as private (vs. public) settings (Study 5), direct (vs. indirect) questions (Study 6), and close (vs. distant) relationships (Study 7). Across our studies, we also explore the emotional and impression-management consequences of hiding success. Although the relational consequences of hiding success are universally negative, the emotional and impression-management consequences are mixed. Whereas previous research highlights the negative consequences of sharing one's accomplishments with others, we find that sharing is superior to hiding for maintaining one's relationships. Thus, we shed new light on the consequences of paternalism and the relational costs of hiding information in everyday communication. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

"I'm just being honest." When and why honesty enables help versus harm.

Although honesty is typically conceptualized as a virtue, it often conflicts with other equally important moral values, such as avoiding interpersonal harm. In the present research, we explore when and why honesty enables helpful versus harmful behavior. Across 5 incentive-compatible experiments in the context of advice-giving and economic games, we document four central results. First, honesty enables selfish harm: people are more likely to engage in and justify selfish behavior when selfishness is associated with honesty than when it is not. Second, people are selectively honest: people are more likely to be honest when honesty is associated with selfishness than when honesty is associated with altruism. Third, these effects are more consistent with genuine, rather than motivated, preferences for honesty. Fourth, even when individuals have no selfish incentive to be honest, honesty can lead to interpersonal harm because people avoid information about how their honest behavior affects others. This research unearths new insights on the mechanisms underlying moral choice, and consequently, the contexts in which moral principles are a force of good versus a force of evil. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Forgoing earned incentives to signal pure motives.

Policy makers, employers, and insurers often provide financial incentives to encourage citizens, employees, and customers to take actions that are good for them or for society (e.g., energy conservation, healthy living, safe driving). Although financial incentives are often effective at inducing good behavior, they've been shown to have self-image costs: Those who receive incentives view their actions less positively due to the perceived incompatibility between financial incentives and intrinsic motives. We test an intervention that allows organizations and individuals to resolve this tension: We use financial rewards to kick-start good behavior and then offer individuals the opportunity to give up some or all of their earned financial rewards in order to boost their self-image. Two preregistered studies-an incentivized online experiment (n = 763) on prosocial behavior and a large field experiment (n = 17,968) on exercise-provide evidence that emphasizing the intrinsic rewards of a past action leads individuals to forgo or donate earned financial rewards. Our intervention allows individuals to retroactively signal that they acted for the right reason, which we call "motivation laundering." We discuss the implications of motivation laundering for the design of incentive systems and behavioral change.

Decisional autonomy undermines advisees' judgments of experts in medicine and in life.

Over the past several decades, the United States medical system has increasingly prioritized patient autonomy. Physicians routinely encourage patients to come to their own decisions about their medical care rather than providing patients with clearer yet more paternalistic advice. Although political theorists, bioethicists, and philosophers generally see this as a positive trend, the present research examines the important question of how patients and advisees in general react to full decisional autonomy when making difficult decisions under uncertainty. Across six experiments (N = 3,867), we find that advisers who give advisees decisional autonomy rather than offering paternalistic advice are judged to be less competent and less helpful. As a result, advisees are less likely to return to and recommend these advisers and pay them lower wages. Importantly, we also demonstrate that advisers do not anticipate these effects. We document these results both inside and outside the medical domain, suggesting that the preference for paternalism is not unique to medicine but rather is a feature of situations in which there are adviser-advisee asymmetries in expertise. We find that the preference for paternalism holds when advice is solicited or unsolicited, when both paternalism and autonomy are accompanied by expert guidance, and it persists both before and after the outcomes of paternalistic advice are realized. Lastly, we see that the preference for paternalism only occurs when decision makers perceive their decision to be difficult. These results challenge the benefits of recently adopted practices in medical decision making that prioritize full decisional autonomy.

Difficult conversations: navigating the tension between honesty and benevolence.

Difficult conversations are a necessary part of everyday life. To help children, employees, and partners learn and improve, parents, managers, and significant others are frequently tasked with the unpleasant job of delivering negative news and critical feedback. Despite the long-term benefits of these conversations, communicators often approach them with trepidation, in part, because they perceive them as involving intractable moral conflict between being honest and being kind. In this article, we review recent research on egocentrism, ethics, and communication to explain why communicators overestimate the degree to which honesty and benevolence conflict during difficult conversations, document the conversational missteps people make as a result of this erred perception, and propose more effective conversational strategies that honor the long-term compatibility of honesty and benevolence. This review sheds light on the psychology of moral tradeoffs in conversation, and provides practical advice on how to deliver unpleasant information in ways that improve recipients' welfare.

Alterations in the Gut Microbiome at 6 Months of Age in Obese Latino Infants.

Objective: To investigate gut microbial composition in Latino infants in relation to breastfeeding, obesity, and antibiotic exposure.Method: We analyzed the gut microbiome in 6-month-old Latino infants from an ongoing urban mother-child cohort. Alpha and beta diversity were assessed in relation to infants' early dietary exposure and anthropometrics including obesity.Results: Infants exclusively breastfed at 4 to 6 weeks had lower alpha diversity and less bacterial abundance compared with those who did not. Breastfeeding status at 4 to 6 weeks and 6 months of age accounted for differences in alpha and beta diversity. Infants who were obese at 6 months of age had higher levels of alpha diversity compared with non-obese infants.Conclusions: Early exclusive breastfeeding and obesity impacts microbial diversity by 6 months of age in Latino infants, a group at high risk for future obesity.

Effect of Sex, Age, and Positivity Threshold on Fecal Immunochemical Test Accuracy: A Systematic Review and Meta-analysis.

BACKGROUND & AIMS: Quantitative fecal immunochemical tests (FITs) for hemoglobin are commonly used for colorectal cancer (CRC) screening. We aimed to quantify the change in CRC and advanced adenoma detection and number of positive test results at different positivity thresholds and by sex and age. METHODS: We searched MEDLINE and EMBASE, selecting articles of FIT for CRC detection in asymptomatic adults undergoing screening. We calculated sensitivity and specificity, as well as detected number of cancers, advanced adenomas, and positive test results at positivity thresholds ≤10 µg hemoglobin/g feces, 10 to ≤20 µg/g, 20 to ≤30 µg/g, and >30 µg/g. We also analyzed results from stratified by patient sex, age, and reference standard. RESULTS: Our meta-analysis comprised 46 studies with 2.4 million participants and 6478 detected cancers. Sensitivity for detection of CRC increased from 69% (95% confidence interval [CI], 63%-75%) at thresholds >10 µg/g and ≤20 µg/g to 80% (95% CI, 76%-83%) at thresholds ≤10 µg/g. At these threshold values, sensitivity for detection of advanced adenomas increased from 21% (95% CI, 18%-25%) to 31% (95% CI, 27%-35%), whereas specificity decreased from 94% (95% CI, 93%-96%) to 91% (95% CI, 89%-93%). In 3 studies stratified by sex, sensitivity of CRC detection was 77% in men (95% CI, 75%-79%) and 81% in women (95% CI, 60%-100%) (P = .68). In 3 studies stratified by age groups, sensitivity of CRC detection was 85% for ages 50-59 years (95% CI, 71%-99%) and 73% for ages 60-69 years (95% CI, 71%-75%) (P = .10). All studies with colonoscopy follow-up had similar sensitivity levels for detection of CRC to studies that analyzed 2-year registry follow-up data (74%; 95% CI, 68%-78% vs 75%; 95% CI, 73%-77%). CONCLUSIONS: In a meta-analysis of studies that analyzed detection of CRC and advanced adenomas at different FIT positivity thresholds, we found the sensitivity and specificity of detection to vary with positive cutoff value. It might be possible to decrease positive threshold values for centers with sufficient follow-up colonoscopy resources. More research is needed to precisely establish FIT thresholds for each sex and age subgroup. PROTOCOL: PROSPERO CRD42017068760.

You can handle the truth: Mispredicting the consequences of honest communication.

People highly value the moral principle of honesty, and yet, they frequently avoid being honest with others. In the present research, we explore the actual and predicted consequences of honesty in everyday life. We use field and laboratory experiments that feature 2 types of honesty interventions: (1) instructing individuals to focus on complete honesty across their interactions for a period of time and (2) instructing individuals to engage in specific honest conversations that they frequently avoid in everyday life. In Studies 1a and 1b, we randomly assigned individuals to either be (or imagine being) honest, kind, or conscious of their communication in every conversation with every person in their life for 3 days. We find that people significantly mispredict the consequences of honesty: Focusing on honesty (but not kindness or communication-consciousness) is more pleasurable, socially connecting, and does less relational harm than individuals expect. We extend our investigation by examining the consequences of specific well-controlled honest conversations for both communicators and their relational partners in 2 preregistered laboratory experiments. In Study 2, we examine the predicted and actual consequences of honestly disclosing personal information, and in Study 3 we examine the predicted and actual consequences of honestly sharing negative feedback. Our results suggest that individuals misunderstand the intrapersonal consequences of increased honesty because they misunderstand the interpersonal consequences of honesty: communicators overestimate how negatively others will react to their honesty. Overall, this research contributes to our understanding of affective forecasting processes and uncovers fundamental insights on how communication and moral values shape well-being. (PsycINFO Database Record