The Reasoning through Evidence versus Advice (EvA) Scale: Scale Development and Validation.

Our well-being can improve when people heed evidence rather than simply follow familiar or charismatic advisors who neglect evidence. We developed the Reasoning through Evidence versus Advice (EvA) scale to measure individual differences in reasoning through evidence like science and statistics versus following advisors such as politicians and celebrities. No existing scales directly measure these tendencies; moreover, it was theoretically unknown whether they reflect a single dimension (from evidence- to advice-based) or distinct tendencies to value or distrust each. Our scale validation process included qualitative interviews and four studies that involved 1583 respondents (753 college graduates, 830 non-college graduates) in which we conducted exploratory and confirmatory factor analyses and tests of convergent validity, discriminant validity, and measurement invariance by gender and education. This process yielded a 16-item EvA scale with four dimensions: Pro-evidence, Anti-evidence, Pro-advice, and Anti-advice. In assessing criterion validity, these tendencies identified individual differences in important, real-world attitudes and behaviors, including susceptibility to health misinformation, adherence to CDC guidelines on social distancing, confidence in the COVID vaccine, science curiosity, and religiosity. The EvA scale extends our understanding of individual differences in reasoning tendencies that shape critical attitudes, decisions, and behaviors and can help promote informed decisions.

Using effective psychological techniques to subvert a US sociopolitical context.

Chater & Loewenstein argue for a shift in focus from individual- to structural-level approaches to societal ills. This is valid and important but overlooks the barriers inherent in the current US partisan context. Psychology can be applied to help people of mixed allyship join together, to effectively and quickly force institutions and corporations to accept structural change.

Mammalian empathy: behavioural manifestations and neural basis.

Recent research on empathy in humans and other mammals seeks to dissociate emotional and cognitive empathy. These forms, however, remain interconnected in evolution, across species and at the level of neural mechanisms. New data have facilitated the development of empathy models such as the perception-action model (PAM) and mirror-neuron theories. According to the PAM, the emotional states of others are understood through personal, embodied representations that allow empathy and accuracy to increase based on the observer's past experiences. In this Review, we discuss the latest evidence from studies carried out across a wide range of species, including studies on yawn contagion, consolation, aid-giving and contagious physiological affect, and we summarize neuroscientific data on representations related to another's state.

Sensate total clitoris reconstruction via microneurovascular dorsal foot web space flap with pudendal nerve coaptation.

Revision surgery after gender-affirming genitoplasty is becoming more and more common as more patients gain access to surgical treatment. The complexity of genitoplasty and extensive dissection of delicate tissues predisposes patients to necrosis of the flap(s) employed, which can leave patients with complications ranging from poor aesthetics to total lack of genital sensation. The purpose of this report is to detail the revision surgery of a 32-year-old transgender woman who underwent vaginoplasty at an outside institution and presented to our clinic for clitoral reconstruction following necrosis and near-total loss of the neoclitoris. Physical exam showed extensive necrosis, and 3-Tesla magnetic resonance (MRI) revealed significant scarring of the pudendal nerve branches at the level of the pubic symphysis. Healthy nerve was identified at the level of the right inferior pubic ramus, and total clitoral reconstruction with an innervated first dorsal web space free flap anastamosed to the deep inferior epigastric vessels was performed. Complications included donor site cellulitis with partial loss of the skin graft and formation of hypertrophic scar tissue. This was treated 6 months postoperatively with excision of scar tissue in the webspace and placement of an additional full-thickness skin graft. At follow-up, the patient reported tactile and erogenous sensation of the neoclitoris itself and subjective satisfaction with the aesthetic outcome. Our results provide evidence that this flap is a feasible option to create an aesthetic and sensate neoclitoris in the setting of previous neoclitoral necrosis. This case report also describes the novel use of 3-Tesla MRI in target selection for nerve coaptation.

Diagnostic Utilization and Accuracy of Pediatric Appendicitis Imaging at Adult and Pediatric Centers.

BACKGROUND: Diagnostic imaging in pediatric appendicitis may decrease rates of negative appendectomy and identify alternate pathologies. We compared imaging practices for children transferred from nonpediatric facilities versus directly admitted to our tertiary children's hospital for laparoscopic appendectomy, and assessed the diagnostic accuracy in each population based on final pathologic diagnosis. MATERIALS AND METHODS: After institutional review board approval, all cases of laparoscopic appendectomy at our children's hospital during 2015 were reviewed. Demographic and clinical data were collected, including age, transfer status, imaging studies, and pathologic diagnosis. Imaging practices in patients transferred from adult centers were compared with those directly admitted. RESULTS: There were 1153 included patients who underwent laparoscopic appendectomy for acute appendicitis during the study period, with 242 (20.9%) presenting as transfers from nonpediatric facilities. Of these, 73.5% underwent preoperative computed tomography (CT), compared with 26.4% of nontransfer patients (P < 0.000). All remaining patients received ultrasound (US). Despite variation in imaging strategies, rates of negative appendectomy were similar in transfer and nontransfer groups (1.7% versus 2.0%, respectively, P = 0.744). There were marginal differences in sensitivity of US and CT to detect appendix features between the transferring and referral centers. CONCLUSIONS: Our results show that nonpediatric facilities use CT more frequently to diagnose pediatric appendicitis. Rates of nontherapeutic surgery were equivalent between transferred and directly admitted patients, which is likely related to high performance of both imaging strategies. Transferring centers should strive to rely more heavily on US, which may require education and development of improved pediatric US capacity.

Clinical and Imaging Correlates of Pediatric Mucosal Appendicitis.

BACKGROUND: Mucosal appendicitis is a controversial entity that is histologically distinct from transmural appendicitis. There is mixed opinion regarding mucosal inflammation as a spectrum of appendicitis versus a negative appendectomy. The ability to distinguish these diagnoses preoperatively is of importance to prevent unnecessary surgery. We hypothesize that patients with mucosal appendicitis can be discriminated from those with transmural disease based on specific preoperative clinical and imaging findings. MATERIALS AND METHODS: After IRB approval, all patients who underwent laparoscopic appendectomy at our institution during 2015 were reviewed in the electronic medical record. Patients with mucosal appendicitis were identified and matched 2:1 to a random cohort of nonperforated transmural appendicitis cases. Demographic and clinical data were collected, including history, examination, laboratory, and imaging findings. Preoperative factors associated with mucosal appendicitis were modeled using binomial logistic regression analysis. RESULTS: Of 1153 appendectomies performed during 2015, 103 patients had pathologic diagnosis of mucosal appendicitis. When compared with patients with mucosal infection, leukocytosis >10,000 per microliter led to 5.9 times higher likelihood of transmural pathology (P = 0.000). Noncompressibility on ultrasound was associated with 7.3 times higher likelihood of transmural disease (P = 0.015). Echogenic changes were predictive of transmural appendicitis, conferring 3.9 times the risk (P = 0.007). Presence of free fluid led to 2.3 times the rate of transmural pathology (P = 0.007). Finally, for every millimeter decrease in appendiceal diameter, patients were half as likely to exhibit transmural disease (P = 0.000). Together, these variables can successfully predict presence of mucosal appendicitis on final pathology report at a rate of 82.1%, and explain 60% of the variance in diagnosis of mucosal versus transmural appendicitis (P = 0.000). CONCLUSIONS: Mucosal appendicitis remains a controversial pathologic entity, but is not associated with greater complications compared with transmural appendicitis when treated with laparoscopic appendectomy. Transmural disease can be predicted by leukocytosis, noncompressible appendix, presence of free fluid, larger appendiceal diameter and echogenicity.

Emotion and reward are dissociable from error during motor learning.

Although emotion is known to reciprocally interact with cognitive and motor performance, contemporary theories of motor learning do not specifically consider how dynamic variations in a learner's affective state may influence motor performance during motor learning. Using a prism adaptation paradigm, we assessed emotion during motor learning on a trial-by-trial basis. We designed two dart-throwing experiments to dissociate motor performance and reward outcomes by giving participants maximum points for accurate throws and reduced points for throws that hit zones away from the target (i.e., "accidental points"). Experiment 1 dissociated motor performance from emotional responses and found that affective ratings tracked points earned more closely than error magnitude. Further, both reward and error uniquely contributed to motor learning, as indexed by the change in error from one trial to the next. Experiment 2 manipulated accidental point locations vertically, whereas prism displacement remained horizontal. Results demonstrated that reward could bias motor performance even when concurrent sensorimotor adaptation was taking place in a perpendicular direction. Thus, these experiments demonstrate that affective states were dissociable from error magnitude during motor learning and that affect more closely tracked points earned. Our findings further implicate reward as another factor, other than error, that contributes to motor learning, suggesting the importance of incorporating affective states into models of motor learning.

Inter-observer agreement of canine and feline paroxysmal event semiology and classification by veterinary neurology specialists and non-specialists.

BACKGROUND: Advances in mobile technology mean vets are now commonly presented with videos of paroxysmal events by clients, but the consistency of the interpretation of these videos has not been investigated. The objective of this study was to investigate the level of agreement between vets (both neurology specialists and non-specialists) on the description and classification of videos depicting paroxysmal events, without knowing any results of diagnostic workup. An online questionnaire study was conducted, where participants watched 100 videos of dogs and cats exhibiting paroxysmal events and answered questions regarding: epileptic seizure presence (yes/no), seizure type, consciousness status, and the presence of motor, autonomic and neurobehavioural signs. Agreement statistics (percentage agreement and kappa) calculated for each variable, with prevalence indices calculated to aid their interpretation. RESULTS: Only a fair level of agreement (κ = 0.40) was found for epileptic seizure presence. Overall agreement of seizure type was moderate (κ = 0.44), with primary generalised seizures showing the highest level of agreement (κ = 0.60), and focal the lowest (κ =0.31). Fair agreement was found for consciousness status and the presence of autonomic signs (κ = 0.21-0.40), but poor agreement for neurobehavioral signs (κ = 0.16). Agreement for motor signs ranged from poor (κ = ≤ 0.20) to moderate (κ = 0.41-0.60). Differences between specialists and non-specialists were identified. CONCLUSIONS: The relatively low levels of agreement described here highlight the need for further discussions between neurology experts regarding classifying and describing epileptic seizures, and additional training of non-specialists to facilitate accurate diagnosis. There is a need for diagnostic tools (e.g. electroencephalogram) able to differentiate between epileptic and non-epileptic paroxysms.

Checklists and safety in pediatric cardiac surgery.

In rebuilding Tulane's pediatric heart center after Hurricane Katrina, the use of checklists proved to be essential, not only in rebuilding inventory and systems, but the culture of continued debriefing around their use was seminal in establishing a culture of safety and trust between caregivers; safety that ultimately benefitted our patients.

Legislation, medicine, and politics: care for gender diverse youth.

PURPOSE OF REVIEW: A recent increase in legislation in the United States prohibiting gender-affirming care (GAC) for transgender youth follows a wave of its politicization despite support from all pertinent mainstream medical associations. This review describes the standards of GAC for transgender youth, the origins of legislation prohibiting this care, a review of current legislation in the United States and a discussion on the impact on patients, providers, and the medical field. RECENT FINDINGS: A critical evaluation of historical parallels and current organizations supporting this legislation reveals it stems not from concerns within the medical field but from political and religious interests. This intrusion sets a dangerous precedent, undermining evidence-based medicine, providers' ability to practice according to standards of care, and patients' and guardians' autonomy and medical decision-making. This wave of antitrans rhetoric and legislation has resulted in threats to health providers and hospitals, 'moral distress" in providers, and migration of providers and patients from hostile states. SUMMARY: Similar to antiabortion legislation, these legislative efforts will likely result in negative health outcomes and worsening disparities. The medical community must confront these forces directly through an understanding of the political and structural forces at play and adopting strategies to leverage collective power.

High-utility conserved avian microsatellite markers enable parentage and population studies across a wide range of species.

BACKGROUND: Microsatellites are widely used for many genetic studies. In contrast to single nucleotide polymorphism (SNP) and genotyping-by-sequencing methods, they are readily typed in samples of low DNA quality/concentration (e.g. museum/non-invasive samples), and enable the quick, cheap identification of species, hybrids, clones and ploidy. Microsatellites also have the highest cross-species utility of all types of markers used for genotyping, but, despite this, when isolated from a single species, only a relatively small proportion will be of utility. Marker development of any type requires skill and time. The availability of sufficient "off-the-shelf" markers that are suitable for genotyping a wide range of species would not only save resources but also uniquely enable new comparisons of diversity among taxa at the same set of loci. No other marker types are capable of enabling this. We therefore developed a set of avian microsatellite markers with enhanced cross-species utility. RESULTS: We selected highly-conserved sequences with a high number of repeat units in both of two genetically distant species. Twenty-four primer sets were designed from homologous sequences that possessed at least eight repeat units in both the zebra finch (Taeniopygia guttata) and chicken (Gallus gallus). Each primer sequence was a complete match to zebra finch and, after accounting for degenerate bases, at least 86% similar to chicken. We assessed primer-set utility by genotyping individuals belonging to eight passerine and four non-passerine species. The majority of the new Conserved Avian Microsatellite (CAM) markers amplified in all 12 species tested (on average, 94% in passerines and 95% in non-passerines). This new marker set is of especially high utility in passerines, with a mean 68% of loci polymorphic per species, compared with 42% in non-passerine species. CONCLUSIONS: When combined with previously described conserved loci, this new set of conserved markers will not only reduce the necessity and expense of microsatellite isolation for a wide range of genetic studies, including avian parentage and population analyses, but will also now enable comparisons of genetic diversity among different species (and populations) at the same set of loci, with no or reduced bias. Finally, the approach used here can be applied to other taxa in which appropriate genome sequences are available.

Genetic analysis reveals diverse kin-directed routes to helping in the rifleman Acanthisitta chloris.

The social organization of cooperatively breeding species is extremely variable, with diverse social group composition and patterns of relatedness. Species that exhibit alternative routes to helping within the same population are potentially useful systems to investigate the causes and fitness consequences of diverse evolutionary pathways to cooperative behaviour. In this study, we use microsatellite markers and field observations to describe helping behaviour and patterns of relatedness in the unusual cooperative breeding system of the rifleman Acanthisitta chloris. First, we show that rifleman helpers consist of a remarkably diverse demographic, including males and females, who may be adult or juvenile, failed breeders or nonbreeders, or even successful breeders that simultaneously feed their own brood. Adult helpers mostly helped at first-brood nests, while first-brood juveniles assisted their parents at second broods. Second, we show that rifleman pairs are strictly sexually monogamous, and helpers did not gain any current reproductive success through helping. Third, genotyping showed that contrary to previous assumptions, helpers were closely related to the recipients of their care and preferentially directed care towards relatives over contemporaneous nests of nonrelatives. Finally, we show that variation in helper provisioning effort was attributed to age: juvenile helpers provisioned less than adults and were less responsive to the demands of a growing brood. Overall, our results show that the diverse routes to helping in this unusual species are driven by the common theme of kinship between helper and recipients, resulting in a previously underestimated potential for helpers to gain indirect fitness benefits.

Public perception of epilepsy in dogs is more favorable than in humans.

OBJECTIVES: With the use of YouTube™, this study provides results on both the demographics and public perception for a sample of videos of canine epilepsy. METHODS: A random sample of 150 videos was collected, the uploader description was recorded, and viewers' comments were coded according to their emotional and informational content. RESULTS: More comments were found to be sympathetic than derogatory, and there were more information-providing than information-seeking comments. The number of sympathetic comments was found to correlate positively with the number of derogatory comments, and the number of information-providing comments correlated positively with the number of information-seeking comments. CONCLUSION: These findings shed light on the variation in perceptions of seizures in dogs, which are interestingly more sympathetic towards dogs with epilepsy than towards humans with epilepsy. This highlights the potential future use of YouTube in investigating public views as well as in informing and educating.

Environmental impassivity: Blunted emotionality undermines concern for the environment.

The average American believes in climate change, worries about it, and supports related policy, but there are still considerable differences-across individuals and with political ideology-that limit the ability to foster change. Researchers and practitioners often increase concern and action for others through feelings of empathy, which also increases pro-environmentalism. However, some people appear less emotionally impacted by environmental destruction-particularly more ideologically conservative and less pro-environmental individuals. To determine why some people appear to be impassive to environmental destruction, we conducted 3 online studies to measure beliefs and emotional processes in political liberals versus conservatives. Across 3 studies, we replicated the link between impassivity and conservatism, and found that more impassive people acknowledge our negative impact on the environment but are less concerned about it and more confident in an eventual solution. Impassivity, however, is not specific to the environment. People who are more impassive about the environment also respond less emotionally to positive and negative images that are unrelated to the environment, including human suffering and hedonic reward. They also report reduced trait empathy, perspective taking, and daily emotional expression and experience. Impassivity is not linked to differences in trait personal distress, anxiety, psychopathy (apart from low empathy), or trouble appreciating consequences. Impassivity is not associated with deficits in processing others' facial emotion during early perceptual decoding but is associated with the later suppression of emotion. Everyone will not respond to emotional appeals to help a distressed environment. Other strategies are recommended to reach a broad audience. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Below the surface of a touch.

How the body and brain respond to a gentle stroke dynamically changes depending on how familiar someone is with the other person.

Initial Assessment of VECTRA Three-Dimensional Imaging to Accurately Simulate Breast Volume Changes in Transfeminine Patients: A Mannequin Study.

Background: Methods that aim to accurately measure and predict breast development can be utilized in gender-affirming treatment planning, patient education, and research. Objectives: The authors sought to evaluate whether three-dimensional (3D) stereophotogrammetry accurately measures transfeminine breast volume changes on a masculine frame when simulating anticipated changes in soft tissue after gender-affirming surgical therapy. Then, we describe the innovative application of this imaging modality in a transgender patient to illustrate the potential role of 3D imaging in gender-affirming surgical care. Methods: A 3D VECTRA scanner (Canfield, Fairfield, NJ) was used to measure anthropometric breast measurements. Postoperative changes in breast volume were simulated on a cardiopulmonary resuscitation mannequin using 450 cc MENTOR breast implants (Mentor Worldwide LLC, Irvine, CA). To demonstrate the ability of the VECTRA to accurately simulate transfeminizing augmentation in practice, we describe its use in a 30-year-old transgender female with a 2-year history of gender-affirming hormone therapy, presenting for gender-affirming surgical care. Results: In the mannequin, mean breast volumes were 382 cc on the right (range 375-388 cc), and 360 cc on the left (range 351-366 cc). The average calculated difference in volume between the 2 sides was 22 cc (range 17-31 cc). There were no instances where the left side was calculated to be larger than the right or where the calculated size was smaller than the actual implant size. Conclusions: The VECTRA 3D camera is a reliable and reproducible tool for preoperative assessment, surgical planning, and simulating breast volume changes after gender-affirming surgery.

Neural correlates of overvaluation and the effort to save possessions in a novel decision task: An exploratory fMRI study.

Introduction: People exhibit a strong attachment to possessions, observed in behavioral economics through loss aversion using new items in the Endowment or IKEA effects and in clinical psychology through pathological trouble discarding domestic items in Hoarding Disorder. These fields rarely intersect, but both document a reticence to relinquish a possessed item, even at a cost, which is associated with feelings of loss but can include enhanced positive states as well. Methods: To demonstrate the shared properties of these loss-related ownership effects, we developed the Pretzel Decorating Task (PDT), which concurrently measures overvaluation of one's own over others' items and feelings of loss associated with losing a possession, alongside enhanced positive appraisals of one's items and an effort to save them. The PDT was piloted with 31 participants who decorated pretzels and responded to their own or others' items during functional neuroimaging (fMRI). Participants observed one item per trial (self or other) and could work to save it (high or low probability loss) before learning the fate of the item (trashed or saved). Finally, participants rated items and completed hoarding tendency scales. Results: The hypotheses were supported, as even non-clinical participants overvalued, viewed as nicer, feared losing, and worked harder to save their items over others'-a response that correlated with hoarding tendencies and motor-motivational brain activation. Our region of interest in the nucleus accumbens (NAcc) was engaged when viewing one's own items to the extent that people worked harder to save them and was more active when their items were saved when they felt emotionally attached to possessions in real life. When their items were trashed, NAcc activity negatively correlated with trouble discarding and emotional attachments to possessions. Right anterior insula was more active when working to save one's own over others' items. Extensive motor-motivational areas were engaged when working to save one's own over others' items, including cerebellum, primary motor and somatosensory regions, and retrosplenial/parahippocampal regions-even after controlling for tapping. Discussion: Our attachments to items are emotional, continuous across typical and pathological populations, and drive us to save possessions that we value.

3D CT Urethrography With Cinematic Rendering (3DUG): A New Modality for Evaluation of Complex Urethral Anatomy and Assessment of the Postoperative Phalloplasty Urethra.

OBJECTIVE: To develop an imaging modality for the postoperative phalloplasty urethra. Despite high urologic complication rates after masculinizing genital surgery, existing methods for postsurgical evaluation after phalloplasty have drawbacks. Fluoroscopic studies like the retrograde urethrogram have limitations like user-dependence and need for meticulous positioning but also are inadequate for the evaluation of the anatomically complex postphalloplasty urethra. We developed a novel protocol utilizing CT urethrography with 3D reconstruction using cinematic rendering (3DUG) for neo-urethral imaging. MATERIALS AND METHODS: Patients who underwent 3DUG after either phalloplasty, metoidioplasty, or prior to revision surgery were included. Low-dose imaging protocols were used to avoid any increases in radiation exposure. The first iteration of our protocol utilized retrograde contrast administration via the penile urethra, whereas the second iteration of our protocol utilized an antegrade technique with contrast instillation via the suprapubic catheter and a voiding scan. Imaging was initially obtained according to symptoms and then per protocol at 3 weeks after urethral lengthening. RESULTS: Twenty-six patients were included in the series. Among postoperative phalloplasty patients imaged for symptoms, contrast extravasation/fistula was identified in 5 (63%), vaginal remnant in 3 (38%), and stricture in 2 (25%) compared to 5 (45%), 1 (9%), and zero respectively for patients imaged routinely. When intervention was required, operative findings correlated to anatomy on imaging. CONCLUSION: We present a new protocol for the use of 3D CT urethrography with cinematic rendering for neo-urethral reconstruction. This technique has the potential to improve surgical planning and surveillance of urologic complications in postphalloplasty patients.