Children endorse deterrence motivations for third-party punishment but derive higher enjoyment from compensating victims.

Children's punishment behavior may be driven by both retribution and deterrence, but the potential primacy of either motive is unknown. Moreover, children's punishment enjoyment and compensation enjoyment have never been directly contrasted. Here, British, Colombian, and Italian 7- to 11-year-old children (N = 123) operated a Justice System in which they viewed different moral transgressions in Minecraft, a globally popular video game, either face-to-face with an experimenter or over the internet. Children could respond to transgressions by punishing transgressors and compensating victims. The purpose of the system was framed in terms of retribution, deterrence, or compensation between participants. Children's performance, endorsement, and enjoyment of punishment and compensation were measured, along with their endorsement of retribution versus deterrence as punishment justifications, during and/or after justice administration. Children overwhelmingly endorsed deterrence over retribution as their punishment justification irrespective of age. When asked to reproduce the presented frame in their own words, children more reliably reproduced the deterrence frame rather than the retribution frame. Punishment enjoyment decreased while compensation enjoyment increased over time. Despite enjoying compensation more, children preferentially endorsed punishment over compensation, especially with increasing age and transgression severity. Reported deterrent justifications, superior reproduction of deterrence framing, lower enjoyment of punishment than of compensation, and higher endorsement of punishment over compensation together suggest that children felt that they ought to mete out punishment as a means to deter future transgressions. Face-to-face and internet-mediated responses were not distinguishable, supporting a route to social psychology research with primary school-aged children unable to physically visit labs.

Service Workers' Well-Being During COVID-19: A Strengths-Based Inclusive Theory of Work Perspective.

This study tested the Strengths-Based Inclusive Theory of Work (S-BIT of Work), a vocational theory that emphasizes positive psychological and cultural factors, among a sample of service industry workers during COVID-19. Service industry workers (N = 320) were recruited via social media sources across the United States, and structural equation modeling was used to examine the model. This model included privilege and COVID-19 impact as contextual variables; organizational support and workplace dignity as promotive workplace variables; hope, strengths use, adaptability, empowerment, and perceived COVID-19 threat as individual variables; and fulfilling work and psychological distress as outcome variables. Privilege and workplace dignity were identified as particularly important variables; results suggested privilege was positively associated with a promotive work context and negatively related to psychological distress. Additionally, the greater the amount of privilege and dignity the service industry workers experienced, the greater their positive individual characteristics were able to flourish.

Are work well-being variables distinct? A bifactor model of fulfilling work.

The strengths-based inclusive theory of work and psychology of working theory propose that fulfilling work is a key outcome of the vocational intervention. Scholars have further argued that fulfilling work is the holistic experience of well-being in the workplace and can be assessed with meaningful work, work engagement, workplace positive emotions, and job satisfaction. This theoretical perspective suggests a bifactor model would best explain the relations among these variables, but this claim remains untested. Therefore, the purpose of this study was to investigate whether a bifactor model best explained the relations among the four components of fulfilling work, in comparison to other plausible models. We also examined the concurrent and convergent validity of the fulfilling work construct, using other well-being variables, symptoms of distress, and contextual factor variables drawn from vocational theories. Supporting hypotheses, we found that a bifactor model best fit the data. We also found that fulfilling work positively related to eudaimonic work well-being, hedonic work well-being, and life satisfaction and negatively related to symptoms of distress. Finally, fulfilling work positively related to income and subjective social class. These findings offer conceptual and statistical implications of fulfilling work for research, counseling, organizations, and social advocacy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Influence of New York's SAFE Act on Individuals Seeking Mental Health Treatment.

Responding to mass shootings, some states have passed gun removal laws (e.g., NYS' SAFE Act), requiring that mental health professionals report patients who might potentially harm themselves/others. The purpose of this study was to assess whether knowledge of the SAFE Act impacts patients' mental health treatment-seeking and symptom-reporting behaviors. Patients at two mental health centers were surveyed during 2014-2018. Participants were asked if they would be concerned about being reported to county government, likelihood of seeking mental health treatment, and willingness to report mental health symptoms/behaviors given the SAFE Act's provisions. 228 patients (71.5% response rate) completed questionnaires. About 18% were concerned about being reported to county government, 9% would be less likely to seek mental health treatment, and about 23% would be less willing to report mental health symptoms/behaviors. Although these behaviors were not affected for most participants, there was a small minority who were concerned and less willing to report mental health symptoms/behaviors.

CARDIAC EXAMINATIONS OF ANESTHETIZED STELLER SEA LIONS (EUMETOPIAS JUBATUS), NORTHERN FUR SEALS (CALLORHINUS URSINUS), AND A WALRUS (ODOBENUS ROSMARUS).

Pinniped hearts have been well described via dissection, but in vivo measurements of cardiac structure, function, and electrophysiology are lacking. Electrocardiograms (ECGs) were recorded under anesthesia from eight Steller sea lions (Eumetopias jubatus), five northern fur seals (Callorhinus ursinus), and one walrus (Odobenus rosmarus) to investigate cardiac electrophysiology in pinnipeds. In addition, echocardiograms were performed on all eight anesthetized Steller sea lions to evaluate in vivo cardiac structure and function. Measured and calculated ECG parameters included P-wave, PQ, QRS, and QT interval durations, P-, R-, and T-wave amplitudes, P- and T-wave polarities, and the mean electrical axis (MEA). Measured and calculated echocardiographic parameters included left ventricular internal diameter, interventricular septum thickness, and left ventricular posterior wall thickness in systole and diastole (using M-mode), left atrium and aortic root dimensions (using 2D), and maximum aortic and pulmonary flow velocities (using pulsed-wave spectral Doppler). ECG measurements were similar to those reported for other pinniped species, but there was considerable variation in the MEAs of Steller sea lions and northern fur seals. Echocardiographic measurements were similar to those reported for southern sea lions (Otaria flavenscens), including five out of eight Steller sea lions having a left atrial to aortic root ratio <1, which may indicate that they have an enlarged aortic root compared to awake terrestrial mammals. Isoflurane anesthesia likely affected some of the measurements as evidenced by the reduced fractional shortening found in Steller sea lions compared to awake terrestrial mammals. The values reported are useful reference points for assessing cardiac health in pinnipeds under human care.

Providing adolescent sexual health care in the pediatric emergency department: views of health care providers.

OBJECTIVES: The purpose of this study was to explore health care providers' (HCPs') attitudes and beliefs about adolescent sexual health care provision in the emergency department (ED) and to identify barriers to a health educator-based intervention. METHODS: We conducted focused, semistructured interviews of HCPs from the ED and adolescent clinic of a children's hospital. The interview guide was based on the theory of planned behavior and its constructs: attitudes, subjective norms, perceived behavioral control, and intention to facilitate care. We used purposive sampling and enrollment continued until themes were saturated. Interviews were recorded and transcribed. Transcripts were analyzed using directed content analysis. RESULTS: Twenty-nine interviews were required for saturation. Participants were 12 physicians, 12 nurses, 3 nurse practitioners, and 2 social workers; the majority (83%) were female. Intention to facilitate care was influenced by HCP perception of (1) their professional role, (2) the role of the ED (focused vs expanded care), and (3) need for patient safety. Health care providers identified 3 practice referents: patients/families, peers and administrators, and professional organizations. Health care providers perceived limited behavioral control over care delivery because of time constraints, confidentiality issues, and comfort level. There was overall support for a health educator, and many felt the educator could help overcome barriers to care. CONCLUSIONS: Despite challenges unique to the ED, HCPs were supportive of the intervention and perceived the health educator as a resource to improve adolescent care and services. Future research should evaluate efficacy and costs of a health educator in this setting.

Ultrasound images of the ascending aorta of anesthetized northern fur seals and Steller sea lions confirm that the aortic bulb maintains continuous blood flow.

The increased size and enhanced compliance of the aortic bulb-the enlargement of the ascending aorta-are believed to maintain blood flow in pinnipeds during extended periods of diastole induced by diving bradycardia. The aortic bulb has been described ex vivo in several species of pinnipeds, but in vivo measurements are needed to investigate the relationship between structure and function. We obtained ultrasound images using electrocardiogram-gated transesophageal echocardiography during anesthesia and after atropine administration to assess the relationship between aortic bulb anatomy and cardiac function (heart rate, stroke volume, cardiac output) in northern fur seals (Callorhinus ursinus) and Steller sea lions (Eumetopias jubatus). We observed that the aortic bulb in northern fur seals and Steller sea lions expands during systole and recoils over the entire diastolic period indicating that blood flow is maintained throughout the entire cardiac cycle as expected. The stroke volumes we measured in the fur seals and sea lions fit the values predicted based on body size in mammals and did not change with increased heart rates, suggesting that greater stroke volumes are not needed for aortic bulb function. Overall, our results suggest that peripheral vasoconstriction during diving is sufficient to modulate the volume of blood in the aortic bulb to ensure that flow lasts over the entire diastolic period. These results indicate that the shift of blood into the aortic bulb of pinnipeds is a fundamental mechanism caused by vasoconstriction while diving, highlighting the importance of this unique anatomical adaptation.

Aquaculture related humpback whale entanglements in coastal waters of British Columbia from 2008-2021.

Over the past two decades, increasing numbers of humpback whales have been returning to feed in the inshore waters of British Columbia (BC) where marine aquaculture farms are situated. This has led to growing concerns that the presence of aquaculture farms may pose an entanglement threat to humpback whales. However, it is not known whether aquaculture facilities attract humpback whales, or whether there are factors that increase the likelihood of humpback whale, becoming entangled and dying. We examined eight reports of humpback whales interacting with Atlantic salmon farms in BC from 2008 to 2021 to evaluate the conditions that may have contributed to their entanglements. Of the eight entangled humpbacks, three individuals died and five were successfully disentangled and released. All were young animals (1 calf, 7 subadults). Multiple factors were associated with two or more of the reported incidents. These included facility design, environmental features, seasonality, humpback whale age, and feeding behaviour. We found that humpback whales were most commonly entrapped in the predator nets of the aquaculture facilities (6/8 incidents), and were less often entangled in anchor support lines (2/8). The presence of salmon smolts did not appear to be an attractant for humpback whales given that half of the reported entanglements (4/8) occurred at fallowed salmon farms. Almost all of the entanglements (7/8) occurred in late winter (prior to the seasonal return of humpbacks) and during late fall (after most humpbacks have migrated south). Overall, the number of humpback whales impacted by fish farms was small compared to the numbers that return to BC (> 7,000) and accounted for <6% of all types of reported entanglements in BC. Human intervention was required to release humpback whales at fish farms, which points to the need to have well-established protocols to minimize entanglements and maximize successful releases.

Positive psychological interventions for children: a comparison of gratitude and best possible selves approaches.

Many studies have found benefits of positive psychological interventions, such as gratitude promotion or thinking about best possible selves, for adolescents and adults. Almost no research, however, has been conducted on the efficacy of such interventions for children. The authors' primary goal was to compare the outcomes of gratitude promotion and best possible selves interventions to a control condition, using a sample of elementary school-aged children (N = 62, ages 5-11 years). Children participated in once-weekly intervention sessions in which they were asked to draw a picture of something for which they were grateful that day (gratitude condition), a future version of themselves as happy and engaged (best possible selves condition), or something they had done that day (control condition). Analyses of the content of children's drawings indicated that children of this age were capable of articulating things for which they were grateful and positive future selves. Outcomes for the gratitude condition did not differ from the control condition; however, participants in the best possible selves condition showed greater gains in self-esteem than those in the gratitude or control conditions.

Medical management of retained products of conception: A prospective observational study.

OBJECTIVE(S): To measure the success rate of primary medical therapy in managing retained products of conception (RPOC) in women with secondary postpartum haemorrhage (PPH) and to identify factors associated with need for surgical management. STUDY DESIGN: Postpartum patients presenting to a tertiary women's hospital Emergency Department between July 2020 and December 2022 with secondary PPH and evidence of RPOC on ultrasound were recruited. Clinical information relating to the presentation was collected prospectively. Antenatal and intrapartum data were collected from medical record and Birthing Outcome System database review. The primary outcome was the success of medical management for RPOC, defined by the implementation of medical or expectant management without subsequent need for surgical intervention. RESULTS: Forty-one patients with RPOC underwent primary medical or expectant management. Twelve patients (29%) were managed successfully with medical management, while twenty-nine (71%) proceeded to surgical management. Medical management involved antibiotics (n = 37, 90%), prostaglandin E1 analogue (n = 14, 34%) and other uterotonics (n = 3, 7%). A greater endometrial thickness on ultrasound was significantly associated with a requirement for secondary surgical intervention (p < 0.05). There was an association approaching statistical significance between a higher sonographic volume of RPOC and the failure of medical management (p = 0.07). There was no statistically significant association between the mode of delivery or the number of days postpartum with the success of medical management. CONCLUSION(S): For patients presenting with secondary PPH and sonographic RPOC, over two thirds required surgical management. Increased endometrial thickness was associated with an increased requirement for surgical management.

Standard vs total keratometry for intraocular lens power calculation in cataract surgery combined with DMEK.

PURPOSE: To compare the prediction accuracy of standard keratometry (K) and total keratometry (TK) for intraocular lens (IOL) power calculation in eyes undergoing combined cataract surgery and Descemet membrane endothelial keratoplasty (triple DMEK). SETTING: Tertiary care academic referral center. DESIGN: Retrospective case series. METHODS: Review of 83 eyes (63 patients) that underwent triple DMEK between 2019 and 2021. Biometry measurements were obtained using a swept-source optical biometer (IOLMaster 700). 63 eyes were used for statistical analysis. Mean error, mean absolute error (MAE), SD, median absolute error, maximum absolute error, root mean squared prediction error, and the percentage of eyes within prediction errors of ±0.50 diopters (D) and ±1.00 D were calculated for 9 multivariate and third-generation formulas using K and TK values (Barrett Universal II, Yeo EVO 2.0, Cooke K6, Kane, Pearl-DGS, Haigis, Holladay 1, Hoffer Q, and SRK/T). Formulas were additionally tested by using the prediction for an IOL power 1 D below the IOL used (IOLup1D). RESULTS: For all formulas, MAE was lower for K than for TK by an average of 0.21 D. The lowest MAE value observed was 0.67 D for "adjusted" SRK/T using K, and the highest MAE values observed were 1.24 D and 1.24 D for nonadjusted Hoffer Q and Haigis using TK, respectively. Overall, lower MAE values were observed for multivariate formulas and SRK/T. CONCLUSIONS: In triple DMEK eyes, the prediction accuracy of K was higher than that of TK. The most accurate formulas were SRK/T and multivariate formulas using K with the IOLup1D adjustment.

Diagnostic Utility of CDC DPDx for an Atypical Presentation of Infectious Crystalline Keratopathy-Like Infiltrate Secondary to Microsporidia.

PURPOSE: To report a case of atypical infectious crystalline keratopathy-like stromal infection secondary to microsporidia wherein diagnosis of the causative organism was aided by use of the Center for Disease Control (CDC) DPDx program. METHODS: We report the case of a 73-year-old woman who presented with atypical infectious crystalline keratopathy-like corneal infection without previous surgical history. RESULTS: The patient had previously been treated for recalcitrant corneal infection with topical antibiotics and steroids at an outside provider before referral. Further treatment with topical fortified antibiotics failed to improve the infection. Corneal biopsy was performed and sent to the CDC DPDx for diagnostic confirmation for presumptive microsporidia. The patient underwent therapeutic penetrating keratoplasty without recurrence of ocular infection. CONCLUSIONS: Utilization of the DPDx resource may help guide appropriate and timely diagnosis and management strategies in atypical presentations of infectious keratitis.

PROMIS scores of patients undergoing neoadjuvant and adjuvant radiation therapy for surgically excised soft tissue sarcoma.

INTRODUCTION: Few recent studies have examined patient reported outcomes (PROs) during pre- or post-operative radiation therapy (RT) for soft tissue sarcoma (STS), and none have used PROMIS. This study aims to examine PROMIS scores across peri-operative time points for patients receiving pre- or post-operative RT. METHODS: Anxiety, depression, pain interference, and physical function PROMIS domains were collected at the pre-operative (1), immediate post-operative (2), and post-treatment completion (3) timepoints for patients undergoing surgery and either pre-operative or post-operative RT. Median scores were compared between groups using the Kruskal-Wallis test. The reliable change index was used to determine minimum important change in PROMIS scores and to compare scores between timepoints. RESULTS: 95 patients were included (19 pre-operative, 76 post-operative). Both groups had significant decreases in function during treatment. Patients with wound complications were more likely to have significant increases in anxiety (36.4% vs. 8.3%; p = 0.020) and decreases in physical function (57.1% vs. 16.2%; p = 0.011) independent of RT timing. CONCLUSIONS: This study demonstrates minimum significant change thresholds to detect PROMIS changes in STS patients undergoing pre- and post-operative radiotherapy. As expected, more patients with pre-operative RT than post-operative RT had wound complications (p = 0.06), but patients with complications in both groups had worse anxiety and function at the completion of treatment compared with those that did not. The association of wound complications with worse anxiety and physical function at completion of treatment should be considered when making individualized treatment recommendations regarding the timing of RT.

Moral duty and equalization concerns motivate children's third-party punishment.

Although children enact third-party punishment, at least in response to harm and fairness violations, much remains unknown about this behavior. We investigated the tendency to make the punishment fit the crime in terms of moral domain; developmental patterns across moral domains; the effects of audience and descriptive norm violations; and enjoyment of inflicting punishment. We tested 5- to 11-year-olds in the United Kingdom (N = 152 across two experiments, 55 girls and 97 boys, predominantly White and middle-class). Children acted as referees in a computer game featuring teams of players: As these players violated fairness or loyalty norms, children were offered the opportunity to punish them. We measured the type (fining or banning) and severity of punishment children chose and their enjoyment in doing so. Children only partially made the punishment fit the crime: They showed no systematic punishment choice preference for disloyal players, but tended to fine rather than ban players allocating resources unfairly-a result best explained by equalization concerns. Children's punishment severity was not affected by audience presence or perpetrators' descriptive norm violations, but was negatively predicted by age (unless punishment could be used as an equalization tool). Most children did not enjoy punishing, and those who believed they allocated real punishment reported no enjoyment more often than children who believed they pretended to punish. Contrary to predictions, retribution was not a plausible motive for the observed punishment behavior. Children are likely to have punished for deterrence reasons or because they felt they ought to. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Detection of Optic Neuritis on Routine Brain MRI without and with the Assistance of an Image Postprocessing Algorithm.

BACKGROUND AND PURPOSE: At times, there is a clinical need for using routine brain MR imaging performed close to the time of onset of patients' visual symptoms to firmly establish the diagnosis of optic neuritis. Our aim was to assess the diagnostic performance of radiologists in detecting optic neuritis on routine brain MR images and whether this performance could be enhanced using a postprocessing algorithm. MATERIALS AND METHODS: In this retrospective case-control study of 60 patients (37 women, 23 men; mean age, 47.2 [SD, 17.9] years), 2 blinded neuroradiologists evaluated T2-weighted FLAIR and contrast-enhanced T1WI from brain MR imaging for the presence of imaging evidence of optic neuritis. Images were processed using an image-processing algorithm that aimed to selectively accentuate the signal intensity of diseased optic nerves. We assessed the effect of image processing on the contrast-to-noise ratio between the optic nerves and normal-appearing white matter and on the diagnostic performance of the neuroradiologists, including the interobserver reliability. RESULTS: The average sensitivity of readers was 55%, 56.5%, and 30.0% on FLAIR, coronal contrast-enhanced T1WI, and axial contrast-enhanced T1WI, respectively. Sensitivities were lower in the absence of fat saturation on FLAIR (P = .001) and coronal contrast-enhanced T1WI (P = .04). Processing increased the contrast-to-noise ratio of diseased (P value range = .03 to <.001) but not of control optic nerves. Processing did not improve the sensitivity but improved the specificity and positive predictive value. Interobserver agreement improved from slight to good. CONCLUSIONS: Detection of optic neuritis on routine brain MR imaging is challenging. Specificity, positive predictive value, and interobserver agreement can be improved by postprocessing of MR images.

Electrocardiographic Scaling Reveals Differences in Electrocardiogram Interval Durations Between Marine and Terrestrial Mammals.

Although the ability of marine mammals to lower heart rates for extended periods when diving is well documented, it is unclear whether marine mammals have electrophysiological adaptations that extend beyond overall bradycardia. We analyzed electrocardiographic data from 50 species of terrestrial mammals and 19 species of marine mammals to determine whether the electrical activity of the heart differs between these two groups of mammals. We also tested whether physiological state (i.e., anesthetized or conscious) affects electrocardiogram (ECG) parameters. Analyses of ECG waveform morphology (heart rate, P-wave duration, and PQ, PR, QRS, and QT intervals) revealed allometric relationships between body mass and all ECG intervals (as well as heart rate) for both groups of mammals and specific differences in ECG parameters between marine mammals and their terrestrial counterparts. Model outputs indicated that marine mammals had 19% longer P-waves, 24% longer QRS intervals, and 21% shorter QT intervals. In other words, marine mammals had slower atrial and ventricular depolarization, and faster ventricular repolarization than terrestrial mammals. Heart rates and PR intervals were not significantly different between marine and terrestrial mammals, and physiological state did not significantly affect any ECG parameter. On average, ECG interval durations of marine and terrestrial mammals scaled with body mass to the power of 0.21 (range: 0.19-0.23) rather than the expected 0.25-while heart rate scaled with body mass to the power of -0.22 and was greater than the widely accepted -0.25 derived from fractal geometry. Our findings show clear differences between the hearts of terrestrial and marine mammals in terms of cardiac timing that extend beyond diving bradycardia. They also highlight the importance of considering special adaptations (such as breath-hold diving) when analyzing allometric relationships.

Darolutamide for treatment of castration-resistant prostate cancer.

Darolutamide is a novel, nonsteroidal androgen receptor (AR)-signaling inhibitor. It serves as a second-generation antiandrogen and is currently indicated for the treatment of patients with nonmetastatic castration-resistant prostate cancer (nmCRPC). The product was approved by the United States Food and Drug Administration (FDA) in July 2019 and by the Japanese Ministry of Health, Labour and Welfare (MHLW) in January 2020 for the treatment of men with nmCRPC, and is awaiting approval in the E.U. for the same indication. This review will cover the background, preclinical development, safety, pharmacokinetics, pharmacodynamics and clinical studies that led to the approval of darolutamide. The key clinical data, ongoing trials and future directions for darolutamide are also discussed herein.

Ocular manifestations of mycoplasma-induced rash and mucositis.

A 13-year-old girl presented with a 5-day history of fever and cough followed by new-onset oral ulcers and conjunctival injection. Clinical examination revealed bilateral 360-degree subconjunctival hemorrhages, which later evolved to corneal epithelial defects, pseudo-membrane formation, and extensive oral mucosal ulceration. Mycoplasma pneumoniae serum IgG and IgM were positive. Treatment with topical prednisolone acetate, moxifloxacin, preservative-free artificial tears, and erythromycin ointment was initiated. A self-retaining amniotic membrane was placed. The ocular and oral lesions resolved within 2 weeks of treatment, and the patient's vision returned to baseline. Mycoplasma-induced rash and mucositis is a newly defined entity that mainly affects children and has a favorable prognosis with early detection and treatment.

Reproducibility of Ocular Surface Staining in the Assessment of Sjögren Syndrome-Related Keratoconjunctivitis Sicca: Implications on Disease Classification.

OBJECTIVE: The objective of this study was to assess the performance and reproducibility of the two currently used ocular surface staining scores in the assessment of keratoconjunctivitis sicca in Sjögren syndrome (SS) research classification. METHODS: In a multidisciplinary clinic for the evaluation of sicca, we performed all tests for the American European Consensus Group (AECG) and the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria, including the van Bijsterveld score (vBS) and the Ocular Staining Score (OSS), in 994 participants with SS or with non-SS sicca. We analyzed the concordance between the scores, the diagnostic accuracy and correlation with clinical variables, and interrater and intrasubject reproducibility. RESULTS: A total of 308 (31.1%) participants had a discordant vBS and OSS that was due to extra corneal staining points in the OSS. The presence of one or more of the additional points was highly predictive of SS classification (odds ratio = 3.66; P = 1.65 × 10e-20) and was associated with abnormal results of all measures of autoimmunity and glandular dysfunction. Receiver operating characteristic curves showed optimal cutoff values of four for the vBS (sensitivity = 0.62; specificity = 0.71; Youden's J = 0.33) and five for the OSS (sensitivity = 0.56; specificity = 0.75; Youden's J = 0.31). Notably, there was very poor consistency in interobserver mean scores and distributions (P < 0.0001) and in intrasubject scores after a median of 5.5 years (35% changed status of the ocular criterion). CONCLUSION: Ocular surface staining scores are useful for SS research classification; however, they are subject to significant interrater and intrasubject variability, which could result in changes in classification in 5%-10% of all subjects. These results highlight the need for objective and reproducible markers of disease that have thus far remained elusive for SS.

Petting away pre-exam stress: The effect of therapy dog sessions on student well-being.

Recently, many universities have implemented programmes in which therapy dogs and their handlers visit college campuses. Despite the immense popularity of therapy dog sessions, few randomized studies have empirically tested the efficacy of such programmes. The present study evaluates the efficacy of such a therapy dog programme in improving the well-being of university students. This research incorporates two components: (a) a pre/post within-subjects design, in which 246 participants completed a brief questionnaire immediately before and after a therapy dog session and (b) an experimental design with a delayed-treatment control group, in which all participants completed baseline measures and follow-up measures approximately 10 hr later. Only participants in the experimental condition experienced the therapy dog session in between the baseline and follow-up measures. Analyses of pre/post data revealed that the therapy dog sessions had strong immediate benefits, significantly reducing stress and increasing happiness and energy levels. In addition, participants in the experimental group reported a greater improvement in negative affect, perceived social support, and perceived stress compared with those in the delayed-treatment control group. Our results suggest that single, drop-in, therapy dog sessions have large and immediate effects on students' well-being, but also that the effects after several hours are small.