Children's and adults' evaluations of self-enhancement and self-deprecation depend on the usual performance of the self-presenter.

This study examined how evaluations of self-presentation vary with age depending on the self-presenter's usual performance. People's usual performance is a key factor because it generally influences the social evaluations and judgments that others make about them. Children aged 7 and 8 years (second graders) and 10 and 11 years (fifth graders), as well as adults, were presented with scenarios in which protagonists responded to praise after a good performance using either self-enhancement or self-deprecation. The other person in scenarios knew that the protagonist's usual performance on the task was either good or poor. After the protagonist responded to praise in a self-enhancing or self-deprecating way, the participants judged how the other person would evaluate the protagonist's ability (good/poor) and character (nice/mean). For ability evaluations specifically concerning protagonists who usually performed poorly, the results showed that by around 10 years of age children no longer tended to give more positive ability evaluations for self-enhancement than for self-deprecation. Adults gave less positive ability evaluations for self-deprecation than for self-enhancement, but only when the protagonists usually performed well. In relation to the character evaluations, by around 10 years of age self-enhancement led to less positive character evaluations than self-deprecation, but only when the protagonists usually performed poorly. Overall, second graders evaluated self-presenters as more competent and nicer. These results indicate that the expected evaluation of self-enhancement and self-deprecation is influenced by the usual level of performance but that there are developmental changes in this aspect of social cognition.

Twelve tips for optimising learning for postgraduate doctors in the operating theatre.

Learning in the operating theatre forms a critical part of postgraduate medical education. Postgraduate doctors present a diverse cohort of learners with a wide range of learning needs that will vary by their level of experience and curriculum requirements. With evidence of both trainee dissatisfaction with the theatre learning experience and reduced time spent in the operating theatre, which has been exacerbated by the effects of the Covid-19 pandemic, it is vital that every visit to the operating theatre is used as a learning opportunity. We have devised 12 tips aimed at both learners and surgeons to optimise learning in the operating theatre, set out into four domains: educational context, preparation, learning in theatre, feedback and reflection. These tips have been created by a process of literature review and acknowledgment of established learning theory, with further discussion amongst surgical trainees, senior surgical faculty, surgical educators and medical education faculty.

Clinical and cost-effectiveness of social recovery therapy for the prevention and treatment of long-term social disability among young people with emerging severe mental illness (PRODIGY): randomised controlled trial.

BACKGROUND: Young people with social disability and severe and complex mental health problems have poor outcomes, frequently struggling with treatment access and engagement. Outcomes may be improved by enhancing care and providing targeted psychological or psychosocial intervention. AIMS: We aimed to test the hypothesis that adding social recovery therapy (SRT) to enhanced standard care (ESC) would improve social recovery compared with ESC alone. METHOD: A pragmatic, assessor-masked, randomised controlled trial (PRODIGY: ISRCTN47998710) was conducted in three UK centres. Participants (n = 270) were aged 16-25 years, with persistent social disability, defined as under 30 hours of structured activity per week, social impairment for at least 6 months and severe and complex mental health problems. Participants were randomised to ESC alone or SRT plus ESC. SRT was an individual psychosocial therapy delivered over 9 months. The primary outcome was time spent in structured activity 15 months post-randomisation. RESULTS: We randomised 132 participants to SRT plus ESC and 138 to ESC alone. Mean weekly hours in structured activity at 15 months increased by 11.1 h for SRT plus ESC (mean 22.4, s.d. = 21.4) and 16.6 h for ESC alone (mean 27.7, s.d. = 26.5). There was no significant difference between arms; treatment effect was -4.44 (95% CI -10.19 to 1.31, P = 0.13). Missingness was consistently greater in the ESC alone arm. CONCLUSIONS: We found no evidence for the superiority of SRT as an adjunct to ESC. Participants in both arms made large, clinically significant improvements on all outcomes. When providing comprehensive evidence-based standard care, there are no additional gains by providing specialised SRT. Optimising standard care to ensure targeted delivery of existing interventions may further improve outcomes.

Schematic beliefs, negative affect and paranoia in at-risk youth.

OBJECTIVES: Attenuated symptoms of psychosis are a core feature of At-Risk Mental States. However, subthreshold levels of paranoia are also common among nonpsychosis populations. At present, little is known about whether the processes underpinning the experience of paranoid ideation in high-risk youth differ as a consequence of meeting At-Risk Mental States (ARMS) for psychosis criteria. METHODS: This study utilized path analysis techniques to examine the relationships between schematic beliefs, negative affect and the experience of paranoia for two groups: a group meeting criteria for ARMS (n = 133) and a group presenting with emerging complex mental health difficulties who did not meet the criteria for ARMS (n = 137). RESULTS: While the ARMS group displayed significantly greater maladaptive schematic beliefs and more severe symptomatology, the associations between schematic beliefs, symptoms of negative affect and paranoia did not differ as a consequence of ARMS status. CONCLUSIONS: While meeting the ARMS criteria is associated with experiencing more maladaptive cognitions and more negative symptomatology among at-risk youth, the associations between these cognitive beliefs and symptoms may be similar for youth who do not meet ARMS. These findings have implications for broadening the scope of at-risk/high-risk and for developing effective interventions for young people presenting with emerging difficulties.

"This Is What a Mechanic Sounds Like": Children's Vocal Control Reveals Implicit Occupational Stereotypes.

In this study, we explored the use of variation in sex-related cues of the voice to investigate implicit occupational stereotyping in children. Eighty-two children between the ages of 5 and 10 years took part in an imitation task in which they were provided with descriptions of nine occupations (three traditionally male, three traditionally female, and three gender-neutral professions) and asked to give voices to them (e.g., "How would a mechanic say . . . ?"). Overall, children adapted their voices to conform to gender-stereotyped expectations by masculinizing (lowering voice pitch and resonance) and feminizing (raising voice pitch and resonance) their voices for the traditionally male and female occupations, respectively. The magnitude of these shifts increased with age, particularly in boys, and was not mediated by children's explicit stereotyping of the same occupations. We conclude by proposing a simple tool based on voice pitch for assessing levels of implicit occupational-gender stereotyping in children.

Physiological and perceptual correlates of masculinity in children's voices.

Low frequency components (i.e. a low pitch (F0) and low formant spacing (ΔF)) signal high salivary testosterone and height in adult male voices and are associated with high masculinity attributions by unfamiliar listeners (in both men and women). However, the relation between the physiological, acoustic and perceptual dimensions of speakers' masculinity prior to puberty remains unknown. In this study, 110 pre-pubertal children (58 girls), aged 3 to 10, were recorded as they described a cartoon picture. 315 adults (182 women) rated children's perceived masculinity from the voice only after listening to the speakers' audio recordings. On the basis of their voices alone, boys who had higher salivary testosterone levels were rated as more masculine and the relation between testosterone and perceived masculinity was partially mediated by F0. The voices of taller boys were also rated as more masculine, but the relation between height and perceived masculinity was not mediated by the considered acoustic parameters, indicating that acoustic cues other than F0 and ΔF may signal stature. Both boys and girls who had lower F0, were also rated as more masculine, while ΔF did not affect ratings. These findings highlight the interdependence of physiological, acoustic and perceptual dimensions, and suggest that inter-individual variation in male voices, particularly F0, may advertise hormonal masculinity from a very early age.

Conversations about mental states and theory of mind development during middle childhood: A training study.

Despite 30years of productive research on theory of mind (ToM), we still know relatively little about variables that influence ToM development during middle childhood. Recent experimental studies have shown that conversations about the mind affect ToM abilities, but they have not explored the mechanisms underlying this developmental effect. In the current study, we examined two potential mechanisms through which conversations about mental states are likely to influence ToM: an increased frequency of references to mental states when explaining behavior and an increased accuracy of mental-state attributions. To this aim, we conducted a training study in which 101 children were assigned to either an intervention condition or a control condition. The conversation-based intervention was made up of four sessions scheduled over 2weeks. Children completed a battery of assessments before and after the intervention as well as 2months later. The groups were equivalent at Time 1 (T1) for age, family affluence, vocabulary, and executive functions. The ToM group showed an improvement in ToM skills (as evaluated on both the practiced tasks and a transfer task). Mediation analyses demonstrated that the accuracy of mental-state attributions, but not the mere frequency of mental-state references, mediated the positive effect of conversations about the mind on ToM development. Our results indicate that conversational experience can enhance mental-state reasoning not by simply drawing children's attention to mental states but rather by scaffolding a mature understanding of social situations.

Lateralization of infant holding by mothers: A longitudinal evaluation of variations over the first 12 weeks.

The maternal preference to hold infants on the left rather than right side of the body was examined longitudinally, with attention to 4 explanations: maternal monitoring of infant state, maternal handedness, infant proximity to the mother's heartbeat, and preferred infant head position. The side and site of holding were measured over the first 12 weeks of the lives of 24 infants. Information about group and individual consistency in holding side allowed novel evaluation of the theories. A strong bias to hold on the left dropped below significance when the infants were aged 12 weeks and was limited to specific holding positions. Findings were generally consistent with the monitoring hypothesis, and little support was found for the 3 alternative explanations.

Promoting theory of mind during middle childhood: a training program.

Evidence that conversations about the mind foster improvements in theory of mind (ToM) is growing, but their efficacy in typically developing school-aged children has yet to be demonstrated. To address this gap, we designed a conversation-based training program for 9- and 10-year-olds and measured its effectiveness by pre- and post-test comparisons of performance on age-appropriate ToM tasks for two groups (matched at pre-test for gender, age, socioeconomic background, verbal ability, reading comprehension, executive functions, and ToM) who were assigned to either the intervention condition (n=45) or an active control condition (n=46). The intervention group showed significantly greater gains in ToM than the control group; this contrast was stable over 2 months, and (in a subsample) the improvement in ToM was independent of any changes in executive functions. Implications for the role of conversations about the mind in children's mental state reasoning are discussed.

Identification and optimisation of perioperative factors for patients with von Willebrand disease undergoing elective total hip and knee arthroplasty.

Von Willebrand disease stands as the most prevalent bleeding disorder seen in both medical and surgical practice. Due to recurrent bleeding episodes within the joints, many patients endure arthropathy, leading to substantial pain and restricted function. Total joint arthroplasty emerges as a final option for managing such cases. Nevertheless, the existence of von Willebrand disease presents several challenges in this regard. This review aims to explore the perioperative strategies tailored for patients with von Willebrand disease undergoing elective total joint arthroplasty.

An overview of bone cement: Perioperative considerations, complications, outcomes and future implications.

Polymethyl methacrylate is commonly known as bone cement and is widely used for implant fixation in various orthopaedic arthroplasty and trauma surgery. The first bone cement use in orthopaedics is widely accredited to the famous English surgeon, John Charnley, who in 1958, used it for total hip arthroplasty. Since then, there have been many developments in cementing techniques in arthroplasty surgery. This overview aims to cover the perioperative considerations of bone cement, including cementing techniques, current outcomes and complications such as bone cement implantation syndrome. The overview will additionally consider future developments involving bone cement in orthopaedic arthroplasty.

Five historical innovations that have shaped modern orthopaedic surgery.

Throughout history, many innovations have contributed to the development of modern orthopaedic surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern orthopaedic surgery: X-ray imaging, bone cement, the Thomas splint, the Pneumatic tourniquet and robotic-assisted surgery. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of orthopaedic surgery and their ongoing relevance in contemporary and perioperative practice.

Five historical innovations that have shaped modern otolaryngological surgery.

Throughout history, many innovations have contributed to the development of modern otolaryngological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern otolaryngological surgery: Operative Microscope, Hopkins Rigid Endoscope, Laryngeal Nerve monitoring, Cochlear implants and Laser surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of otolaryngological surgery and their ongoing relevance in contemporary and perioperative practice.

"I miss the normalness": Mother and child perspectives of well-being and effective remote support from primary schools during Covid-19 school closures.

BACKGROUND: Covid-19 related school closures radically disrupted children's access to social and educational opportunities and changed daily life for millions of families across the world. Emerging evidence indicates that, overall, closures were associated with a decline in children's mental health and well-being, although individual experiences varied widely. The extent to which primary schools adapted remote well-being support is likely to have contributed to child and family adjustment, although this has not yet been fully explored in Covid related research. METHODS: This longitudinal qualitative study examines variability in remote well-being provision in primary schools during the pandemic, and following school reopening, from the perspective of mothers and children using a whole school approaches framework. Twenty-one primary school aged children and their mothers took part in a semi-structured interview at two time points: time one during the first UK national lockdown and time two approximately seven months later after most children had returned to school. A hybrid inductive-deductive thematic analysis approach identified key themes relating to trajectories of well-being and remote school approaches over this period. RESULTS: School closures were associated with a decline in well-being for most children. Disrupted contact with friends and teachers, and limited opportunities for enriched, meaningful activity were identified as key risk factors. Protective factors included family and child characteristics that mitigated against the loss of wider systems of support, including family socioeconomic status, parental availability, child temperament, and structured daily routines. Four key dimensions of effective remote well-being provision were identified (the 4Cs). The 4Cs - contact, content, creativity and community - provide an accessible framework for schools to foster children's social relationships and sense of belonging during periods of closure. Analysis of pupil reintegration outcomes suggest that post-Covid support priorities should include extending social and play-based universal interventions in schools. CONCLUSION: Remote well-being support for children during Covid-related school closures varied in quality with implications for children's mental health and well-being. Findings from this study highlight the importance of ongoing social contact and enriched daily activities to protect children's well-being and development and present a framework of effective remote wellbeing support for primary schools in the event of future closures or prolonged pupil absence.

The incidence and risk factors for abnormal postoperative blood tests following primary total joint replacement.

Aims: We aim to evaluate the usefulness of postoperative blood tests by investigating the incidence of abnormal results following total joint replacement (TJR), as well as identifying preoperative risk factors for abnormal blood test results postoperatively, especially pertaining to anaemia and acute kidney injury (AKI). Methods: This is a retrospective cohort study of patients who had elective TJR between January and December 2019 at a tertiary centre. Data gathered included age at time of surgery, sex, BMI, American Society of Anesthesiologists (ASA) grade, preoperative and postoperative laboratory test results, haemoglobin (Hgb), white blood count (WBC), haematocrit (Hct), platelets (Plts), sodium (Na+), potassium (K+), creatinine (Cr), estimated glomerular filtration rate (eGFR), and Ferritin (ug/l). Abnormal blood tests, AKI, electrolyte imbalance, anaemia, transfusion, reoperation, and readmission within one year were reported. Results: The study included 2,721 patients with a mean age of 69 years, of whom 1,266 (46.6%) were male. Abnormal postoperative bloods were identified in 444 (16.3%) patients. We identified age (≥ 65 years), female sex, and ASA grade ≥ III as risk factors for developing abnormal postoperative blood tests. Preoperative haemoglobin (≤ 127 g/dl) and packed cell volume (≤ 0.395 l/l) were noted to be significant risk factors for postoperative anaemia, and potassium (≤ 3.7 mmol/l) was noted to be a significant risk factor for AKI. Conclusion: The costs outweigh the benefits of ordering routine postoperative blood tests in TJR patients. Clinicians should risk-stratify their patients and have a lower threshold for ordering blood tests in patients with abnormal preoperative haemoglobin (≤ 127 g/l), blood loss > 300 ml, chronic kidney disease, ASA grade ≥ III, and clinical concern.

Greater trochanteric pain syndrome: focused shockwave therapy versus an ultrasound guided injection: a randomised control trial.

BACKGROUND: Greater trochanteric pain syndrome (GTPS) is a common problem with an incidence of 1.8-5.6 per 1000 population. Physiotherapy, anti-inflammatories, corticosteroid injections and surgery have all been described in the management of GTPS, with limited, temporal success. Extracorporeal shockwave therapy (ESWT) has been proposed as a potential non-invasive management option for this difficult presentation. METHOD: We ran a prospective, 2-arm, single-blinded, randomised control trial comparing focused shockwave therapy (f-ESWT) to an ultrasound guided corticosteroid injection. Primary outcome measure was the visual analogue pain score. Secondary outcome measures included the Harris Hip Score (HHS) and Trendelenburg test for function; SF-36 for quality of life (QoL); and a Likert scale question for subjective assessment of symptom improvement. RESULTS: 104 patients (10 males and 94 females), of mean age 61.5 years were recruited. 53 were randomised to receive ESWT and 51 to receive an image-guided injection. 11 patients were lost to follow-up. There were no significant differences in baseline scores between groups.At 3 months, pain, function and QoL scores had improved in both groups but were not statistically significant. The Trendelenburg test was significantly improved in the f-ESWT group with 80% patients being negative compared to 20% at baseline (p < 0.001).At 12 months, across all outcomes, the ESWT group had significantly improved scores compared to the injection group; VAS 37.1 versus 55.0 (p = 0.007, 95% confidence interval [CI], 6.3-30.8), HHS 69.7 versus 57.5 (p = 0.002, 95% CI, -20.0 to -4.6) and SF-36 52.4 versus 47.7 (p = 0.048, 95% CI, -9.31 to -0.04). The improvement in Trendelenburg test was maintained in the ESWT group, but the injection group had reverted to baseline (p < 0.001). CONCLUSIONS: We have shown f-ESWT is an effective treatment for patients with GTPS. We would advocate f-ESWT as an effective non-invasive treatment modality for this challenging patient population.Trial Registration No. ISRCTN8338223.

The Upscale Manufacture of Chondrocytes for Allogeneic Cartilage Therapies.

Allogeneic chondrocyte therapies need to be developed to allow more individuals to be treated with a cell therapy for cartilage repair and to reduce the burden and cost of the current two-stage autologous procedures. Upscale manufacture of chondrocytes using a bioreactor could help provide an off-the-shelf allogeneic chondrocyte therapy with many doses being produced in a single manufacturing run. In this study, we assess a good manufacturing practice-compliant hollow-fiber bioreactor (Quantum®) for adult chondrocyte manufacture. Chondrocytes were isolated from knee arthroplasty-derived cartilage (n = 5) and expanded in media supplemented with 10% fetal bovine serum (FBS) or 5% human platelet lysate (hPL) on tissue culture plastic (TCP) for a single passage. hPL-supplemented cultures were then expanded in the Quantum bioreactor for a further passage. Matched, parallel cultures in hPL or FBS were maintained on TCP. Chondrocytes from all culture conditions were characterized in terms of growth kinetics, morphology, immunoprofile, chondrogenic potential (chondrocyte pellet assays), and single telomere length analysis. Quantum expansion of chondrocytes resulted in 86.4 ± 38.5 × 106 cells in 8.4 ± 1.5 days, following seeding of 10.2 ± 3.6 × 106 cells. This related to 3.0 ± 1.0 population doublings in the Quantum bioreactor, compared with 2.1 ± 0.6 and 1.3 ± 1.0 on TCP in hPL- and FBS-supplemented media, respectively. Quantum- and TCP-expanded cultures retained equivalent chondropotency and mesenchymal stromal cell marker immunoprofiles, with only the integrin marker, CD49a, decreasing following Quantum expansion. Quantum-expanded chondrocytes demonstrated equivalent chondrogenic potential (as assessed by ability to form and maintain chondrogenic pellets) with matched hPL TCP populations. hPL manufacture, however, led to reduced chondrogenic potential and increased cell surface positivity of integrins CD49b, CD49c, and CD51/61 compared with FBS cultures. Quantum expansion of chondrocytes did not result in shortened 17p telomere length when compared with matched TCP cultures. This study demonstrates that large numbers of adult chondrocytes can be manufactured in the Quantum hollow-fiber bioreactor. This rapid, upscale expansion does not alter chondrocyte phenotype when compared with matched TCP expansion. Therefore, the Quantum provides an attractive method of manufacturing chondrocytes for clinical use. Media supplementation with hPL for chondrocyte expansion may, however, be unfavorable in terms of retaining chondrogenic capacity.

Children's reasoning about self-presentation following rule violations: the role of self-focused attention.

Rule violations are likely to serve as key contexts for learning to reason about public identity. In an initial study with 91 children aged 4-9years, social emotions and self-presentational concerns were more likely to be cited when children were responding to hypothetical vignettes involving social-conventional rather than moral violations. In 2 further studies with 376 children aged 4-9years, experimental manipulations of self-focused attention (either by leading children to believe they were being video-recorded or by varying audience reactions to transgressions) were found to elicit greater attention to social evaluation following moral violations, although self-presentational concerns were consistently salient in the context of social-conventional violations. The role of rule transgressions in children's emerging self-awareness and social understanding is discussed.

Bicultural adolescents' anger regulation: in between two cultures?

This study explored the anger-regulation strategies of bicultural individuals who are brought up with two distinct cultures that might carry contradictory demands about how to regulate emotions. With a sample of 525 adolescents in the Netherlands and Morocco, we found that bicultural Moroccan-Dutch adolescents' anger regulation in response to hypothetical peer conflict were largely similar to those of their Dutch peers. In fact, both the Dutch and the Moroccan-Dutch adolescents' anger regulation differed in the same ways from the Moroccan group, with greater acting out and less calm verbalisation, reflection, and diversion in the former than in the latter. Additionally, our findings indicate that Moroccan-Dutch adolescents' identification with the Dutch as well as with the Moroccan culture is related to more anger verbalisation and less externalising anger regulation. These results are interpreted in light of the complex cultural position faced by bicultural adolescents.

"Are They Going to Play Nicely?" Parents' Evaluations of Young Children's Play Dates.

Over the last 20 years, opportunities for young children to engage in self-directed free play with peers outdoors or during the school day has dramatically declined. Consequently, it is likely that play dates, defined as pre-arranged social contact at home, have become increasingly significant play environments for children. Preliminary research suggests that play dates are positively associated with young children's social and emotional development, but that access can be strongly influenced by parental social networking priorities. However, little is currently known about the nature and frequency of play dates, the types of play children engage in, or the impact of parental management and supervision on children's play in this context. Exploratory qualitative research is essential to understand the extent to which parental gatekeeping may limit opportunities for children and families perceived to have low social capital, and to begin to define the nature and content of young children's play dates more broadly. Parents of children aged 5-6 years old took part in a semi-structured interview to describe common practices and attitudes (N = 11). Inductive thematic analysis indicated that play dates are complex play environments that parents associate with a range of social, emotional, and cognitive benefits for children. However, close parental monitoring and supervision may limit the extent to which play dates provide opportunities for self-directed free play. Findings also show that access to play dates is strongly influenced by parents' motivations to enhance children's social status which restricts access to some children. Implications for future research are discussed.