Improving Access to Care, Patient Costs, and Environmental Impact Through a Community Outreach Lung Cancer Rapid Assessment Clinic.

PURPOSE: In Southeastern Ontario, increased patient distance from the regional lung cancer diagnostic assessment program (LDAP) is associated with a lower likelihood of patient care via LDAP while receiving care via LDAP is associated with improved survival. We implemented an LDAP outreach clinic to provide specialist assessment for patients with suspected lung cancer at a regional community hospital and assessed the impact on timeliness and accessibility of care. MATERIALS AND METHODS: The Kingston Health Sciences Centre LDAP team engaged with community hospital partners to develop and launch the LDAP outreach clinic. We performed a retrospective chart review of LDAP patients (N = 1,070) before (August-November 2021; n = 234) and after implementation of the outreach clinic (November 2021-October 2022; n = 836). Descriptive data are reported as No. (%). Unpaired t tests and statistical process control charts assess for significance. A cost analysis of out-of-pocket patient costs related to travel and parking is presented in 2022 Canadian dollars (CAD). RESULTS: Compared with a 3-month matched time period before (August-October 2021) and after outreach clinic (August-October 2022), the mean time from referral to assessment and time from referral to diagnosis decreased from 20.3 to 14.4 days (P = .0019) and 40.0 to 28.9 days (P = .0007), respectively. Over 12 months, the total patient travel was reduced by 8,856 km, which combined with parking cost-savings, resulted in patient out-of-pocket savings of CAD $5,755.60 (CAD $47.60/patient). Accounting for physician travel, the total travel saved was 5,688 km, corresponding to reduced CO2 emissions by 1.9 tCO2. CONCLUSION: Implementation of a lung cancer outreach clinic led to improved timeliness of care, patient cost-savings, and reduced carbon footprint while serving patients in their community.

Maternal neighbourhood-level social determinants of health and their association with paediatric hepatitis C screening among children exposed to hepatitis C in pregnancy.

BACKGROUND: Current guidelines recommend HCV screening by 18 months of age for those exposed to HCV in utero; yet, screening occurs in the minority of children. OBJECTIVES: To evaluate the association between maternal neighbourhood-level social determinants of health (SDOH) and paediatric HCV screening in the general population in a publicly funded healthcare system in Canada. METHODS: Retrospective cohort study using administrative healthcare data held at ICES. Children born to individuals positive for HCV RNA in pregnancy from 2000 to 2016 were identified and followed for 2 years. Major SDOH were identified, and the primary outcome was HCV screening in exposed children (HCV antibody and/or RNA). Associations between SDOH and HCV screening were determined using multivariate Poisson regression models adjusting for confounding. RESULTS: A total of 1780 children born to persons with +HCV RNA were identified, and 29% (n = 516) were screened for HCV by age two. Most mothers resided in the lowest income quintile (42%), and most vulnerable quintiles for material deprivation (41%), housing instability (38%) and ethnic diversity (26%) with 11% living in rural locations. After adjustment for confounding, maternal rural residence (risk ratio [RR] 0.82, 95% confidence interval [CI] 0.62, 1.07) and living in the highest dependency quintile (RR 0.83, 95% CI 0.65, 1.07) were the SDOH most associated with paediatric HCV screening. Younger maternal age (RR 0.98 per 1-year increase, 95% CI 0.97, 0.99), HIV co-infection (RR 1.69, 95% CI 1.16, 2.48) and GI specialist involvement (RR 1.18, 95% CI 1.00, 1.39) were associated with higher probabilities of screening. CONCLUSIONS: Among children exposed to HCV during pregnancy, rural residences and living in highly dependent neighbourhoods showed a potential association with a lower probability of HCV screening by the age of 2. Future work evaluating barriers to paediatric HCV screening among rural residing and dependent residents is needed to enhance the screening.

Trends in the proportion of women speakers at North American Allergy and Immunology conferences, 2008 to 2020.

BACKGROUND: Women in medicine continue to be underrepresented at medical conferences. Previous studies have evaluated the proportion of invited female speakers across multiple specialties and evaluated factors that may have led to this disparity. The field of Allergy and Immunology has often been excluded and analyses have not illustrated how the trends have changed over the past decade. OBJECTIVE: To evaluate the distribution of invited speakers by gender over time at the 3 largest North American Allergy and Immunology conferences. METHODS: This retrospective longitudinal analysis used conference programs from 2008 to 2020 from the American Academy of Allergy, Asthma, and Immunology (AAAAI), the American College of Allergy, Asthma, and Immunology (ACAAI), and the Canadian Society of Allergy and Clinical Immunology (CSACI). The gender (binary definition, man or woman, based on names, photos, pronouns, from conference programs and institutional profiles) of invited speakers was analyzed as the primary outcome, and planning committee members, and multispeaker sessions as secondary outcomes. These data were compared with publicly available data on the composition of the specialty by gender in the United States and Canada. RESULTS: Women speakers at AAAAI, ACAAI, and CSACI conferences have historically been lower than male speakers and underrepresented compared with specialty composition. However, there has been a significant increase in the proportion of women speakers over time for all 3 conferences individually (AAAAI: 23.7% in 2008, 41.1% by 2020; ACAAI: 16.7% in 2008, 37.3% by 2020; CSACI: 19.4% in 2008, 54.8% by 2020; P < .001 for each) and combined (21.3% in 2008, 40.7% by 2020, P < .001). This trend coincides with a significant increase in women on the planning committee (all conferences: 20% in 2008, 50.6% by 2020; P < .001). There is also a decreasing trend over time for men-only multispeaker sessions. CONCLUSION: This study sheds light on the trends of women speaker representation at Allergy and Immunology conferences and provides clarity on future needs to reach equal representation in this field.

Promoting reflective practice in an infant and early childhood training program.

Reflective practices provide a supportive base through which preservice infant and early childhood teachers and allied professionals can achieve knowledge, skills, and professional dispositions to support young children and their families. This paper is a program description that describes the rationale for infusing reflective practices into the learning goals for preservice early childhood training, highlighting the specific reflection skills from the Infant and Early Childhood Mental Health Competency Guidelines. We describe how one university early childhood training program promotes student reflection skills referencing three distinct perspectives: (1) why reflection is essential to developing knowledge and skills; (2) the role group reflection plays in sustaining deep knowledge and skill development for students and faculty; (3) how faculty promote students' awareness of the connection between personal experience and professional dispositions through reflection during practicum experiences. The benefits and challenges of embedding reflective practices in preservice early childhood training are also discussed.

Las prácticas de reflexionar proveen una base de apoyo a través de la cual los maestros y profesionales aliados en el pre-servicio de infantes y la temprana niñez pueden lograr conocimientos, habilidades y disposiciones profesionales para apoyar a los pequeños niños y sus familias. Este ensayo es la descripción de un programa que describe la razón fundamental para incluir las prácticas de reflexionar dentro de los objetivos de aprendizaje para el entrenamiento del pre-servicio en la temprana niñez, subrayando las habilidades de reflexionar específicas que parten de los Preceptos Guías para la Competencia en la Salud Mental de la Infancia y la Temprana Niñez. Describimos cómo el programa de entrenamiento en la temprana niñez en una universidad promueve las habilidades de reflexionar en el estudiante, haciendo referencia a tres perspectivas distintas: 1. Por qué el reflexionar es esencial para desarrollar el conocimiento y las habilidades; 2. El papel que juega el grupo de reflexión para sostener el profundo desarrollo del conocimiento y las habilidades para estudiantes y profesores; 3. Cómo el profesorado promueve la concienciación de los estudiantes sobre la conexión entre la experiencia personal y las disposiciones profesionales a través de la reflexión durante las experiencias de práctica. También se discuten los beneficios y retos de incluir prácticas de reflexión en el entrenamiento del pre-servicio en la temprana niñez.

Les pratiques de réflexion offrent une base de soutien au travers de laquelle les enseignants et professionnels allies de la petite enfance et des services aux nourrissons peuvent développer et acquérir des connaissances, des compétences et des dispositions professionnelles afin de soutenir les jeunes enfants et leurs familles. Cet article est une description qu'un programme qui décrit la rationnelle pour l'infusion de compétences de réflexions dans les objectifs d'apprentissage pour la formation pré-service de la petite enfance, mettant en évidence les compétences de réflexion spécifiques qui se trouvent dans les Grandes Lignes de Compétence en Santé Mentale de la Petite Enfance. Nous décrivons la manière dont le programme de formation pour la petite enfance d'une université promeut des compétences de réflexion des étudiants en faisant référence à trois perspectives distinctes: 1. Pourquoi la réflexion est essentielle au développement des connaissances et des compétences; 2. Le rôle que joue la réflexion de groupe pour le maintien de connaissances profondes et le développement des compétences pour les étudiants et les professeurs; 3. La manière dont les professeurs promeuvent la prise de conscience de la part des étudiants du lien entre l'expérience personnelle et les dispositions professionnelles au travers de la réflexion durant les expériences en stages. Les bénéfices et les défis qu'il y a à intégrer des pratiques de réflexion dans la formation pré-service de la petite enfance sont aussi discutés.

Centenarians and extremely old people living with frailty can elicit durable SARS-CoV-2 spike specific IgG antibodies with virus neutralization functions following virus infection as determined by serological study.

BACKGROUND: The SARS-CoV-2 (Severe Acute Respiratory Syndrome coronavirus 2) has led to more than 165 million COVID-19 cases and >3.4 million deaths worldwide. Epidemiological analysis has revealed that the risk of developing severe COVID-19 increases with age. Despite a disproportionate number of older individuals and long-term care facilities being affected by SARS-CoV-2 and COVID-19, very little is understood about the immune responses and development of humoral immunity in the extremely old person after SARS-CoV-2 infection. Here we conducted a serological study to investigate the development of humoral immunity in centenarians following a SARS-CoV-2 outbreak in a long-term care facility. METHODS: Extreme aged individuals and centenarians who were residents in a long-term care facility and infected with or exposed to SARS-CoV-2 were investigated between April and June 2020 for the development of antibodies to SARS-CoV-2. Blood samples were collected from positive and bystander individuals 30 and 60 days after original diagnosis of SARS-CoV-2 infection. Plasma was used to quantify IgG, IgA, and IgM isotypes and subsequent subclasses of antibodies specific for SARS-CoV-2 spike protein. The function of anti-spike was then assessed by virus neutralization assays against the native SARS-CoV-2 virus. FINDINGS: Fifteen long-term care residents were investigated for SARS-CoV-2 infection. All individuals had a Clinical Frailty scale score ≥5 and were of extreme older age or were centenarians. Six women with a median age of 98.8 years tested positive for SARS-CoV-2. Anti-spike IgG antibody titers were the highest titers observed in our cohort with all IgG positive individuals having virus neutralization ability. Additionally, 5 out of the 6 positive participants had a robust IgA anti-SARS-CoV-2 response. In all 5, antibodies were detected after 60 days from initial diagnosis.

Sex and age bias viral burden and interferon responses during SARS-CoV-2 infection in ferrets.

SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) hospitalizations and deaths disportionally affect males and older ages. Here we investigated the impact of male sex and age comparing sex-matched or age-matched ferrets infected with SARS-CoV-2. Differences in temperature regulation was identified for male ferrets which was accompanied by prolonged viral replication in the upper respiratory tract after infection. Gene expression analysis of the nasal turbinates indicated that 1-year-old female ferrets had significant increases in interferon response genes post infection which were delayed in males. These results provide insight into COVID-19 and suggests that older males may play a role in viral transmission due to decreased antiviral responses.

Geography is more important than life history in the recent diversification of the tiger salamander complex.

The North American tiger salamander species complex, including its best-known species, the Mexican axolotl, has long been a source of biological fascination. The complex exhibits a wide range of variation in developmental life history strategies, including populations and individuals that undergo metamorphosis; those able to forego metamorphosis and retain a larval, aquatic lifestyle (i.e., paedomorphosis); and those that do both. The evolution of a paedomorphic life history state is thought to lead to increased population genetic differentiation and ultimately reproductive isolation and speciation, but the degree to which it has shaped population- and species-level divergence is poorly understood. Using a large multilocus dataset from hundreds of samples across North America, we identified genetic clusters across the geographic range of the tiger salamander complex. These clusters often contain a mixture of paedomorphic and metamorphic taxa, indicating that geographic isolation has played a larger role in lineage divergence than paedomorphosis in this system. This conclusion is bolstered by geography-informed analyses indicating no effect of life history strategy on population genetic differentiation and by model-based population genetic analyses demonstrating gene flow between adjacent metamorphic and paedomorphic populations. This fine-scale genetic perspective on life history variation establishes a framework for understanding how plasticity, local adaptation, and gene flow contribute to lineage divergence. Many members of the tiger salamander complex are endangered, and the Mexican axolotl is an important model system in regenerative and biomedical research. Our results chart a course for more informed use of these taxa in experimental, ecological, and conservation research.

Male sex and age biases viral burden, viral shedding, and type 1 and 2 interferon responses during SARS-CoV-2 infection in ferrets.

SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) hospitalizations and deaths disportionally affect males and the elderly. Here we investigated the impact of male sex and age by infecting adult male, aged male, and adult female ferrets with SARS-CoV-2. Aged male ferrets had a decrease in temperature which was accompanied by prolonged viral replication with increased pathology in the upper respiratory tract after infection. Transcriptome analysis of the nasal turbinates and lungs indicated that female ferrets had significant increases in interferon response genes (OASL, MX1, ISG15, etc.) on day 2 post infection which was delayed in aged males. In addition, genes associated with taste and smell such as RTP1, CHGA, and CHGA1 at later time points were upregulated in males but not in females. These results provide insight into COVID-19 and suggests that older males may play a role in viral transmission due to decreased antiviral responses.

Preparing for a student with a service animal.

This article offers guidance to nursing programs to assist in planning for a quality educational experience for a student with a service animal while ensuring patient safety and the continuation of efficient clinical operations. Nursing faculty should be aware of misperceptions about service animals in the workplace, address fears, concerns, and communicate plans for educating the student with the service animal to all faculty, staff and clinical personnel involved with the student. Examples are provided from experiences with multiple students using service dogs at two schools of nursing. Query: Embase, CINAHL, PubMed.

An Open Letter from Past Presidents of the American Nurses Association.

Eight former ANA presidents urge nurses to consider nursing's values when they vote.

The Power of First Impressions: Can Influenza Imprinting during Infancy Inform Vaccine Design?

Influenza virus infection causes severe respiratory illness in people worldwide, disproportionately affecting infants. The immature respiratory tract coupled with the developing immune system, and lack of previous exposure to the virus is thought to synergistically play a role in the increased disease severity in younger age groups. No influenza vaccines are available for those under six months, although maternal influenza immunization is recommended. In children aged six months to two years, vaccine immunogenicity is dampened compared to older children and adults. Unlike older children and adults, the infant immune system has fewer antigen-presenting cells and soluble immune factors. Paradoxically, we know that a person's first infection with the influenza virus during infancy or childhood leads to the establishment of life-long immunity toward that particular virus strain. This is called influenza imprinting. We contend that by understanding the influenza imprinting event in the context of the infant immune system, we will be able to design more effective influenza vaccines for both infants and adults. Working through the lens of imprinting, using infant influenza animal models such as mice and ferrets which have proven useful for infant immunity studies, we will gain a better understanding of imprinting and its implications regarding vaccine design. This review examines literature regarding infant immune and respiratory development, current vaccine strategies, and highlights the importance of research into the imprinting event in infant animal models to develop more effective and protective vaccines for all including young children.

The role of goals and outcomes in young children's memory for actions.

Four- to six-year-old children participated in three experiments designed to investigate action features that may contribute to the self-enactment effect and help clarify contradictory findings in the literature. Although activity is important in young children's learning and development, preschoolers' memory for self-actions is often found to be no better than memory for another person's actions. In the few studies in which the self-enactment effect has been found for this age group, the actions included as test materials differ markedly from those in the studies in which no differences occur. Specifically, the actions in studies finding the effect are goal-directed and enable outcomes whereas the actions in studies that don't find the effect have no instrumental goals, other than to perform the action, and often do not enable outcomes external to the action carried out. In Experiment 1 source memory and in Experiment 2 free recall were better for children's own actions than those of the experimenter when children participated in actions that produced outcomes in a game-like context. Findings from these two studies suggested that action outcomes were particularly important in these self-enactment effects which were then verified in Experiment 3. Our results support the role of self-directed actions for learning in early childhood classrooms, but highlight the contribution of goal-based activities that lead to instrumental and enabling outcomes in that learning.

Is it all in the details? Description content and false recognition errors.

In three experiments, we examined the effect of embellished content on memory errors for thematically related items as well as whether an encoding manipulation, specifically instructions to visualize content, further affects those errors. Using a modified Deese-Roediger-McDermott (DRM) paradigm, participants listened to subsets of DRM items embedded within scene descriptions. Some descriptions embellished item connections, weaving them into cohesive scenes. Other descriptions only made general reference to scenes, mentioning the items in list-like format. Listening to more detailed descriptions, compared to general scene references, elicited higher false recognition errors (Experiments 1 and 3). However, when description details varied within the same encoding series, as expected, false recognition errors did not differ significantly (Experiments 2 and 3). Results further suggest that more detailed content was more vividly imagined, providing one possible mechanism for increases in false recognition (Experiment 3). Implications for theoretical discussions of encoding task effects on false recognition errors are discussed.

Healthcare Professionals' and Patients' Views of Discussing Sexual Well-being Poststroke.

PURPOSE: Stroke can cause physical and emotional problems affecting sexual well-being; healthcare professionals (HCPs) are often uncomfortable discussing this topic with patients. We explored the perspectives of HCPs and stroke survivors about barriers to discussing sexual well-being poststroke. DESIGN: A mixed methodology was employed. METHODS: A postal survey of stroke survivors (n = 50), a focus group with HCPs on a stroke unit (n = 6), and a focus group with community-living stroke survivors (n = 6) were used in this study. Focus group data were analyzed thematically. FINDINGS: No patient surveyed (60% response rate) had discussed sexual well-being with an HCP. Focus groups revealed barriers on multiple levels: structural, HCP, patient, and professional-patient interface. CONCLUSIONS: Healthcare professionals were poorly trained, adopted a passive role, and addressed sexual activity based on individual beliefs rather than having an agreed team approach. CLINICAL RELEVANCE: Relatively simple steps like inclusion in policy, training to empower HCPs, and the provision of written information for patients could help to improve practice.

Historical H1N1 Influenza Virus Imprinting Increases Vaccine Protection by Influencing the Activity and Sustained Production of Antibodies Elicited at Vaccination in Ferrets.

Influenza virus imprinting is now understood to significantly influence the immune responses and clinical outcome of influenza virus infections that occur later in life. Due to the yearly cycling of influenza viruses, humans are imprinted with the circulating virus of their birth year and subsequently build a complex influenza virus immune history. Despite this knowledge, little is known about how the imprinting strain influences vaccine responses. To investigate the immune responses of the imprinted host to split-virion vaccination, we imprinted ferrets with a sublethal dose of the historical seasonal H1N1 strain A/USSR/90/1977. After a +60-day recovery period to build immune memory, ferrets were immunized and then challenged on Day 123. Antibody specificity and recall were investigated throughout the time course. At challenge, the imprinted vaccinated ferrets did not experience significant disease, while naïve-vaccinated ferrets had significant weight loss. Haemagglutination inhibition assays showed that imprinted ferrets had a more robust antibody response post vaccination and increased virus neutralization activity. Imprinted-vaccinated animals had increased virus-specific IgG antibodies compared to the other experimental groups, suggesting B-cell maturity and plasticity at vaccination. These results should be considered when designing the next generation of influenza vaccines.

Microbial assemblages reflect environmental heterogeneity in alpine streams.

Alpine streams are dynamic habitats harboring substantial biodiversity across small spatial extents. The diversity of alpine stream biota is largely reflective of environmental heterogeneity stemming from varying hydrological sources. Globally, alpine stream diversity is under threat as meltwater sources recede and stream conditions become increasingly homogeneous. Much attention has been devoted to macroinvertebrate diversity in alpine headwaters, yet to fully understand the breadth of climate change threats, a more thorough accounting of microbial diversity is needed. We characterized microbial diversity (specifically Bacteria and Archaea) of 13 streams in two disjunct Rocky Mountain subranges through 16S rRNA gene sequencing. Our study encompassed the spectrum of alpine stream sources (glaciers, snowfields, subterranean ice, and groundwater) and three microhabitats (ice, biofilms, and streamwater). We observed no difference in regional (γ) diversity between subranges but substantial differences in diversity among (ß) stream types and microhabitats. Within-stream (α) diversity was highest in groundwater-fed springs, lowest in glacier-fed streams, and positively correlated with water temperature for both streamwater and biofilm assemblages. We identified an underappreciated alpine stream type-the icy seep-that are fed by subterranean ice, exhibit cold temperatures (summer mean <2°C), moderate bed stability, and relatively high conductivity. Icy seeps will likely be important for combatting biodiversity losses as they contain similar microbial assemblages to streams fed by surface ice yet may be buffered against climate change by insulating debris cover. Our results show that the patterns of microbial diversity support an ominous trend for alpine stream biodiversity; as meltwater sources decline, stream communities will become more diverse locally, but regional diversity will be lost. Icy seeps, however, represent a source of optimism for the future of biodiversity in these imperiled ecosystems.

Broken smiles: The impact of untreated dental caries and missing anterior teeth on employment.

OBJECTIVES: We aimed to quantify the impact of dental caries and missing anterior teeth on employment, estimate the impact of a routine dental visit on the health of anterior teeth, and the benefits of expanding dental coverage for nonelderly adults. METHODS: We used the 2013-2014 Continuous National Health and Nutritional Examination Survey to develop a dental problem index (DPI) using tooth counts and tooth surface conditions. We estimated the impact of DPI on employment with logistic regression, controlling for seven demographic and socioeconomic covariates. We used a routine dental visit within 6 months as a proxy for access to dental services, and a linear regression to predict the DPI score for an average individual with and without a recent routine dental visit. We then computed the incremental probability of employment associated with a recent routine dental visit. Finally, we estimated the additional number of working age adults who might become employed due to improved access to dental services. RESULTS: The probability of being employed was negatively associated with poor oral health: a one-point increase in DPI decreased the odds of being employed by 7.70 percent (CI: 5.15-10.19%). Having a routine dental visit had a negative and statistically significant impact on DPI [-0.41 (CI: -0.68 to -0.14)]. The incremental probability of employment associated with a routine dental visit was 0.62 percent (CI: 0.21-1.03%). CONCLUSIONS: Oral health in the United States is worse among minorities and poor than among other residents. The benefits associated with access to dental care should justify expanding dental services.

Kindergarten children's event memory: the role of action prediction in remembering.

In two studies, kindergarteners participated in a series of staged events immediately preceded by pre-event interactions that were designed to identify factors relevant to improving recall. The events were based on preschool science-related activities and the experimental pre-event involved predicting actions to occur during a target event, manipulating types of cues available to support these predictive inferences. Action prediction did improve free recall, and effects may have influenced attentional processes evoked by actions generated and enacted. Although children effectively used outcome cues to predict actions, a one-to-one relation between pre-event action prediction patterns and recall did not occur. In combination with other findings, this result may suggest that increased attention during the target event may have supported the pre-event effect rather than integration of information between the pre-event and target event. Early childhood teachers engaging children in science activities should provide explicit cues to enhance usefulness of preparatory activities for recall.

Innovative Models of Dental Care Delivery and Coverage: Patient-Centric Dental Benefits Based on Digital Oral Health Risk Assessment.

Innovative models of dental care delivery and coverage are emerging across oral health care systems causing changes to treatment and benefit plans. A novel addition to these models is digital risk assessment, which offers a promising new approach that incorporates the use of a cloud-based technology platform to assess an individual patient's risk for oral disease. Risk assessment changes treatment by including risk as a modifier of treatment and as a determinant of preventive services. Benefit plans are being developed to use risk assessment to predetermine preventive benefits for patients identified at elevated risk for oral disease.

Reflecting on how we remember the personal past: missing components in the study of memory appraisal and theoretical implications.

The current paper offers a selective review of the study of memory appraisal, focusing on recollections of the personal past, with the goal to bring attention to a missing component in this study. To date, memory appraisal studies have concentrated on participants' assessments of the content of their personal recollections (e.g., their perceptual detail and story-like feel), including beliefs about the accuracy of that content. Participants' assessments of reflection processes accompanying their recollections (e.g., a sense of piecing-together recollection fragments) have yet to be extensively examined. The lack of information on process-based appraisals is related to prior studies' procedural constraints (e.g., kinds of cue prompts and their timing, minimal opportunities for reflection). Reasons for addressing this missing component provide the central themes of the paper. The reasons emerge from the analysis of autobiographical cueing studies, including integration of narrative research studies and autobiographical works. The analysis leads to suggestions for future research involving the use of personal narratives that are intended to address critiques of reconstruction accounts and unresolved questions in the study of memory appraisal.