A lasting impact? Exploring the immediate and longitudinal impact of an emergency department service learning help desk program.

Background: The emergency department (ED) help desk is an undergraduate-run service learning program that screens ED patients for social needs, connects them to community resources, and follows-up to promote connections with resources. Students accepted to the program participate in a didactic course on the fundamentals of social emergency medicine as well as available community resources. Students also receive training around interviewing patients and use of screening software. Students commit to at least three quarters of service, during which they attend weekly team meetings. Methods: This qualitative study explores the impact of this service learning experience for students. Current and former students were identified by the director of the program. Purposive and snowball sampling was used to select a sample of participants that participated in a semistructured interview. Our codebook was developed inductively using thematic analysis. Themes were presented and discussed with the entire research team for further analysis and refinement. Data collection and analysis used a constant comparative approach, and data collection ceased when saturation was achieved. Results: Study participants consisted of current and former ED help desk student volunteers (n = 21). All participants believed that the ED help desk service learning experience prepared them for future careers by providing an experience that filled a gap in their education. We identified four main themes: (1) participants' perceived impact on patients, (2) learning from patients' experiences and differences, (3) appreciating patients' vulnerability and collaboratively addressing patients' needs, and (4) learning to navigate patients' social needs within the broader health care system. Conclusions: Our ED help desk service learning program offers a unique experience for students to learn about patients' social needs, participate in meaningfully interactions with patients, and empower themselves and patients to work together as coproducers of patients' care.

Are Emotions Natural Kinds After All? Rethinking the Issue of Response Coherence.

The synchronized co-activation of multiple responses-motivational, behavioral, and physiological-has been taken as a defining feature of emotion. Such response coherence has been observed inconsistently however, and this has led some to view emotion programs as lacking biological reality. Yet, response coherence is not always expected or desirable if an emotion program is to carry out its adaptive function. Rather, the hallmark of emotion is the capacity to orchestrate multiple mechanisms adaptively-responses will co-activate in stereotypical fashion or not depending on how the emotion orchestrator interacts with the situation. Nevertheless, might responses cohere in the general case where input variables are specified minimally? Here we focus on shame as a case study. We measure participants' responses regarding each of 27 socially devalued actions and personal characteristics. We observe internal and external coherence: The intensities of felt shame and of various motivations of shame (hiding, lying, destroying evidence, and threatening witnesses) vary in proportion (i) to one another, and (ii) to the degree to which audiences devalue the disgraced individual-the threat shame defends against. These responses cohere both within and between the United States and India. Further, alternative explanations involving the low-level variable of arousal do not seem to account for these results, suggesting that coherence is imparted by a shame system. These findings indicate that coherence can be observed at multiple levels and raise the possibility that emotion programs orchestrate responses, even in those situations where coherence is low.

How pride works.

The emotion of pride appears to be a neurocognitive guidance system to capitalize on opportunities to become more highly valued and respected by others. Whereas the inputs and the outputs of pride are relatively well understood, little is known about how the pride system matches inputs to outputs. How does pride work? Here we evaluate the hypothesis that pride magnitude matches the various outputs it controls to the present activating conditions - the precise degree to which others would value the focal individual if the individual achieved a particular achievement. Operating in this manner would allow the pride system to balance the competing demands of effectiveness and economy, to avoid the dual costs of under-deploying and over-deploying its outputs. To test this hypothesis, we measured people's responses regarding each of 25 socially valued traits. We observed the predicted magnitude matchings. The intensities of the pride feeling and of various motivations of pride (communicating the achievement, demanding better treatment, investing in the valued trait and pursuing new challenges) vary in proportion: (a) to one another; and (b) to the degree to which audiences value each achievement. These patterns of magnitude matching were observed both within and between the USA and India. These findings suggest that pride works cost-effectively, promoting the pursuit of achievements and facilitating the gains from others' valuations that make those achievements worth pursuing.

Do pride and shame track the evaluative psychology of audiences? Preregistered replications of Sznycer et al. (2016, 2017).

Are pride and shame adaptations for promoting the benefits of being valued and limiting the costs of being devalued, respectively? Recent findings indicate that the intensities of anticipatory pride and shame regarding various potential acts and traits track the degree to which fellow community members value or disvalue those acts and traits. Thus, it is possible that pride and shame are engineered to activate in proportion to others' valuations. Here, we report the results of two preregistered replications of the original pride and shame reports (Sznycer et al. 2016 Proc. Natl Acad. Sci. USA 113, 2625-2630. (doi:10.1073/pnas.1514699113); Sznycer et al. 2017 Proc. Natl Acad. Sci. USA 114, 1874-1879. (doi:10.1073/pnas.1614389114)). We required the data to meet three criteria, including frequentist and Bayesian replication measures. Both replications met the three criteria. This new evidence invites a shifting of prior assumptions about pride and shame: these emotions are engineered to gain the benefits of being valued and avoid the costs of being devalued.