A Practical Significance Bias in Laypeople's Evaluation of Scientific Findings.

People often rely on scientific findings to help them make decisions-however, failing to report effect magnitudes might lead to a potential bias in assuming findings are practically significant. Across two online studies (Prolific; N = 800), we measured U.S. adults' endorsements of expensive interventions described in media reports that led to effects that were small, large, or of unreported magnitude between groups. Participants who viewed interventions with unreported effect magnitudes were more likely to endorse interventions compared with those who viewed interventions with small effects and were just as likely to endorse interventions as those who viewed interventions with large effects, suggesting a practical significance bias. When effect magnitudes were reported, participants on average adjusted their evaluations accordingly. However, some individuals, such as those with low numeracy skills, were more likely than others to act on small effects, even when explicitly prompted to first consider the meaningfulness of the effect.

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.

The power of rotation schedules on the career selection decisions of medical students.

Choosing a career pathway in medicine is a high stakes decision for both medical students and the field of medicine as a whole. While past research has examined how characteristics of the medical student or specialties influence this decision, we introduce temporal elements as novel variables influencing career selection decisions in medicine. Specifically, we investigate how timing and duration of residency options, based on a rotation schedule that medical students have limited control over, influence their career selection decisions. An archival study investigating 5 years of medical student rotation schedules (N = 115) reveals that clinical rotation options appearing earlier and more often in the schedule were more likely to be selected. Moreover, timing and duration of exposure interacted such that residency options appearing later in the schedules were more likely to be selected if they also appeared more often. Conditional logistic regressions using student fixed-effects to control for idiosyncratic medical student differences (i.e., gender, & debt, etc.), and residency fixed-effects to control for idiosyncratic residency differences (income, and lifestyle, etc.), revealed the rotation schedule had a significant impact on residency selection decisions even when controlling for factors typically influencing this decision. Medical students' career decisions are influenced by when and how long different choice options appear in their rotation schedule, especially when they have limited influence over this schedule. The results have implications for healthcare policy by highlighting a tool for adjusting physician workforce composition by broadening exposure to a greater array of career options.

How well do ordinary Americans forecast the growth of COVID-19?

Across three experiments (N = 1565), we investigated how forecasts about the spread of COVID 19 are impacted by data trends, and whether patterns of misestimation predict adherence to social-distancing guidelines. We also investigated how mode of data presentation influences forecasting of future cases by showing participants data on the number of COVID-19 cases from a 5-week period in either graphical, tabular, or text-only form. We consistently found that people shown tables produced more accurate forecasts compared to people shown line-graphs of the same data; yet people shown line-graphs were more confident in their estimates. These findings suggest that graphs engender false-confidence in the accuracy of forecasts, that people's forecasts of future cases have important implications for their attitudes concerning social distancing, and that tables may be better than graphs for informing the public about the trajectory of COVID-19.

The Impact of Preoperative Breast Volume on Development of Mastectomy Skin Flap Necrosis in Immediate Breast Reconstruction.

BACKGROUND: Mastectomy skin flap necrosis (MSFN) can significantly impact outcome after immediate breast reconstruction. Several techniques exist to predict MSFN, but these may require additional testing and information, and they are often not available before surgery. We aim to identify whether breast volume, as calculated from preoperative mammography, can be used as a preoperative predictor of MSFN. METHODS: A retrospective chart review from 2010 to 2020 resulted in 378 patients who underwent immediate implant-based breast reconstruction. Complete imaging data were available for 278 patients and 441 reconstructed breasts. Demographic, perioperative, and outcomes data were collected. Measurements from preoperative diagnostic mammograms were used to calculate breast volume. Univariate and multivariate analyses were used to evaluate the association of variables available preoperatively, including breast volume from mammogram and MSFN. Secondary analyses were performed for need for reoperation and loss of reconstruction. RESULTS: On univariate analysis of MSFN development, demographic variables found to be significantly associated with MSFN included body mass index (P = 0.04), diabetes (P = 0.03), and breast volume calculated from routine mammography (P ≤ 0.0001). Average preoperative breast volume via mammography without and with MSFN was 970.6 mL (95% confidence interval [CI], 908.9-1032.3) and 1298.3 mL (95% CI, 1140.0-1456.5) (P < 0.0001), respectively. Statistically significant intraoperative variables for MSFN development included prolonged operative time (P = 0.005), greater initial tissue expander fill volumes (P ≤ 0.001), and prepectoral implant location (P = 0.02). Higher initial tissue expander fill volumes in implant-based reconstructions were associated with increased rates of MSFN, 264.1 mL (95% CI, 247.2-281.0) without MSFN and 349.9 mL (95% CI, 302.0-397.8) in the group with MSFN, respectively (P < 0.001). On multivariate analysis, preoperative imaging volume (P = 0.02) was found to be significant, whereas body mass index and diabetes lost significance (P = 0.40) in association with MSFN. CONCLUSIONS: The results of this study establish an association between larger breast volume on preoperative imaging and development of MSFN. This may be useful as a tool for more appropriate patient selection and guidance in the setting of immediate breast reconstruction.

How to play 20 questions with nature and lose: Reflections on 100 years of brain-training research.

Despite dozens of empirical studies and a growing body of meta-analytic work, there is little consensus regarding the efficacy of cognitive training. In this review, we examine why this substantial corpus has failed to answer the often-asked question, "Does cognitive training work?" We first define cognitive training and discuss the general principles underlying training interventions. Next, we review historical interventions and discuss how findings from this early work remain highly relevant for current cognitive-training research. We highlight a variety of issues preventing real progress in understanding the underlying mechanisms of training, including the lack of a coherent theoretical framework to guide training research and methodological issues across studies and meta-analyses. Finally, suggestions for correcting these issues are offered in the hope that we might make greater progress in the next 100 y of cognitive-training research.

Breast Implants: A Historical Review With Implications for Diagnosis and Modern Surgical Planning.

ABSTRACT: Modern breast surgery was first introduced in the United States in 1962 with the use of silicone gel-filled breast implants. Over the past 6 decades, development of breast implants has been challenged by a variety of influencers including aesthetic appeal in shape, texture, and material; challenges in managing outcomes such as contracture, disease, and rupture; and public perception of risks associated with implants. In 1992, silicone breast prostheses were banned by the US Food and Drug Administration with exception for use in breast reconstruction, congenital deformities, or to replace existing implants.The ban led to heightened concerns about implants and possible disease manifestations. Knowledge of the historical evolution of breast prostheses is useful for understanding the associated risks and outcomes unique to each breast implant era. This article aimed to explore characteristics of breast implants by generation, with implications for diagnosis and assistance to modern surgical planning for novice plastic surgeons.

Population-Based Assessment of Clinical Risk Factors for Legionnaires' Disease.

We used US population-based surveillance data to characterize clinical risk factors for Legionnaires' disease (LD). The LD incidence increased by age and the risk was elevated for 12 clinical conditions, when compared to healthy adults. This information can be used to guide testing, treatment, and public health prevention efforts.

Identification of patients and plaques vulnerable to future coronary events with near-infrared spectroscopy intravascular ultrasound imaging: a prospective, cohort study.

BACKGROUND: Near-infrared spectroscopy (NIRS) intravascular ultrasound imaging can detect lipid-rich plaques (LRPs). LRPs are associated with acute coronary syndromes or myocardial infarction, which can result in revascularisation or cardiac death. In this study, we aimed to establish the relationship between LRPs detected by NIRS-intravascular ultrasound imaging at unstented sites and subsequent coronary events from new culprit lesions. METHODS: In this prospective, cohort study (LRP), patients from 44 medical centres were enrolled in Italy, Latvia, Netherlands, Slovakia, UK, and the USA. Patients with suspected coronary artery disease who underwent cardiac catheterisation with possible ad hoc percutaneous coronary intervention were eligible to be enrolled. Enrolled patients underwent scanning of non-culprit segments using NIRS-intravascular ultrasound imaging. The study had two hierarchal primary hypotheses, patient and plaque, each testing the association between maximum 4 mm Lipid Core Burden Index (maxLCBI4mm) and non-culprit major adverse cardiovascular events (NC-MACE). Enrolled patients with large LRPs (≥250 maxLCBI4mm) and a randomly selected half of patients with small LRPs (<250 maxLCBI4mm) were followed up for 24 months. This study is registered with ClinicalTrials.gov, NCT02033694. FINDINGS: Between Feb 21, 2014, and March 30, 2016, 1563 patients were enrolled. NIRS-intravascular ultrasound device-related events were seen in six (0·4%) patients. 1271 patients (mean age 64 years, SD 10, 883 [69%] men, 388 [31%]women) with analysable maxLCBI4mm were allocated to follow-up. The 2-year cumulative incidence of NC-MACE was 9% (n=103). Both hierarchical primary hypotheses were met. On a patient level, the unadjusted hazard ratio (HR) for NC-MACE was 1·21 (95% CI 1·09-1·35; p=0·0004) for each 100-unit increase maxLCBI4mm) and adjusted HR 1·18 (1·05-1·32; p=0·0043). In patients with a maxLCBI4mm more than 400, the unadjusted HR for NC-MACE was 2·18 (1·48-3·22; p<0·0001) and adjusted HR was 1·89 (1·26-2·83; p=0·0021). At the plaque level, the unadjusted HR was 1·45 (1·30-1·60; p<0·0001) for each 100-unit increase in maxLCBI4mm. For segments with a maxLCBI4mm more than 400, the unadjusted HR for NC-MACE was 4·22 (2·39-7·45; p<0·0001) and adjusted HR was 3·39 (1·85-6·20; p<0·0001). INTERPRETATION: NIRS imaging of non-obstructive territories in patients undergoing cardiac catheterisation and possible percutaneous coronary intervention was safe and can aid in identifying patients and segments at higher risk for subsequent NC-MACE. NIRS-intravascular ultrasound imaging adds to the armamentarium as the first diagnostic tool able to detect vulnerable patients and plaques in clinical practice. FUNDING: Infraredx.

The influence of environmental reliability in the marshmallow task: An extension study.

This study is an extension of an experiment where the reliability of children's environment was manipulated before children completed the Marshmallow Task (Cognition, 2013, Vol. 126, pp. 109-114). In that experiment, Kidd, Palmeri, and Aslin found a significant difference in waiting time between two conditions in which the experimenter demonstrated reliability (by returning with promised reward) or unreliability (by not returning with rewardP). Children who had an unreliable experimenter did not wait as long during the Marshmallow Task, suggesting that delay gratification performance may be, in part, based on a rational decision. Due to the important theoretical and practical implications of this finding, we repeated the procedure of this experiment with 60 3- to 5-year-old children (twice as many as in the original study), but in a more familiar context (e.g., children's school instead of a lab). Using Bayesian analyses, we found an effect (albeit smaller than in the original study) of experimenter reliability as well as a significant gender by condition interaction effect.

Attention in Urban and Natural Environments.

With advances in technology and increases in global urbanization, the complexity of our sensory environment has increased dramatically in the last few hundred years. However, our brains have remained essentially unchanged. The cognitive resources that support complex goal-directed behaviors operate differently in urban versus natural environments. In this short perspective, we consider how the attention system, designed for interacting with nature, is taxed by urban environments and discuss how exposure to nature may support its rejuvenation.

The Lipid-Rich Plaque Study of vulnerable plaques and vulnerable patients: Study design and rationale.

BACKGROUND: It has been hypothesized that the outcome post-PCI could be improved by the detection and subsequent treatment of vulnerable patients and lipid-rich vulnerable coronary plaques (LRP). A near-infrared spectroscopy (NIRS) catheter capable of detecting LRP is being evaluated in The Lipid-Rich Plaque Study. STUDY DESIGN: The LRP Study is an international, multicenter, prospective cohort study conducted in patients with suspected coronary artery disease (CAD) who underwent cardiac catheterization with possible ad hoc PCI for an index event. Patient level and plaque level events were detected by follow-up in the subsequent 2 years. Enrollment began in February 2014 and was completed in March 2016; a total of 1,562 patients were enrolled. Adjudication of new coronary event occurrence and de novo culprit lesion location during the 2-year follow-up is performed by an independent clinical end-points committee (CEC) blinded to NIRS-IVUS findings. The first analysis of the results will be performed when at least 20 de novo events have occurred for which follow-up angiographic data and baseline NIRS-IVUS measurements are available. It is expected that results of the study will be announced in 2018. SUMMARY: The LRP Study will test the hypotheses that NIRS-IVUS imaging to detect LRP in patients can identify vulnerable patients and vulnerable plaques. Identification of vulnerable patients will assist future studies of novel systemic therapies; identification of localized vulnerable plaques would enhance future studies of possible preventive measures.

Vital Signs: Health Care-Associated Legionnaires' Disease Surveillance Data from 20 States and a Large Metropolitan Area - United States, 2015.

BACKGROUND: Legionnaires' disease, a severe pneumonia, is typically acquired through inhalation of aerosolized water containing Legionella bacteria. Legionella can grow in the complex water systems of buildings, including health care facilities. Effective water management programs could prevent the growth of Legionella in building water systems. METHODS: Using national surveillance data, Legionnaires' disease cases were characterized from the 21 jurisdictions (20 U.S. states and one large metropolitan area) that reported exposure information for ≥90% of 2015 Legionella infections. An assessment of whether cases were health care-associated was completed; definite health care association was defined as hospitalization or long-term care facility residence for the entire 10 days preceding symptom onset, and possible association was defined as any exposure to a health care facility for a portion of the 10 days preceding symptom onset. All other Legionnaires' disease cases were considered unrelated to health care. RESULTS: A total of 2,809 confirmed Legionnaires' disease cases were reported from the 21 jurisdictions, including 85 (3%) definite and 468 (17%) possible health care-associated cases. Among the 21 jurisdictions, 16 (76%) reported 1-21 definite health care-associated cases per jurisdiction. Among definite health care-associated cases, the majority (75, 88%) occurred in persons aged ≥60 years, and exposures occurred at 72 facilities (15 hospitals and 57 long-term care facilities). The case fatality rate was 25% for definite and 10% for possible health care-associated Legionnaires' disease. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Exposure to Legionella from health care facility water systems can result in Legionnaires' disease. The high case fatality rate of health care-associated Legionnaires' disease highlights the importance of case prevention and response activities, including implementation of effective water management programs and timely case identification.

The role of individual differences in cognitive training and transfer.

Working memory (WM) training has recently become a topic of intense interest and controversy. Although several recent studies have reported near- and far-transfer effects as a result of training WM-related skills, others have failed to show far transfer, suggesting that generalization effects are elusive. Also, many of the earlier intervention attempts have been criticized on methodological grounds. The present study resolves some of the methodological limitations of previous studies and also considers individual differences as potential explanations for the differing transfer effects across studies. We recruited intrinsically motivated participants and assessed their need for cognition (NFC; Cacioppo & Petty Journal of Personality and Social Psychology 42:116-131, 1982) and their implicit theories of intelligence (Dweck, 1999) prior to training. We assessed the efficacy of two WM interventions by comparing participants' improvements on a battery of fluid intelligence tests against those of an active control group. We observed that transfer to a composite measure of fluid reasoning resulted from both WM interventions. In addition, we uncovered factors that contributed to training success, including motivation, need for cognition, preexisting ability, and implicit theories about intelligence.

Short- and long-term benefits of cognitive training.

Does cognitive training work? There are numerous commercial training interventions claiming to improve general mental capacity; however, the scientific evidence for such claims is sparse. Nevertheless, there is accumulating evidence that certain cognitive interventions are effective. Here we provide evidence for the effectiveness of cognitive (often called "brain") training. However, we demonstrate that there are important individual differences that determine training and transfer. We trained elementary and middle school children by means of a videogame-like working memory task. We found that only children who considerably improved on the training task showed a performance increase on untrained fluid intelligence tasks. This improvement was larger than the improvement of a control group who trained on a knowledge-based task that did not engage working memory; further, this differential pattern remained intact even after a 3-mo hiatus from training. We conclude that cognitive training can be effective and long-lasting, but that there are limiting factors that must be considered to evaluate the effects of this training, one of which is individual differences in training performance. We propose that future research should not investigate whether cognitive training works, but rather should determine what training regimens and what training conditions result in the best transfer effects, investigate the underlying neural and cognitive mechanisms, and finally, investigate for whom cognitive training is most useful.

The effect of pressure on high- and low-working-memory students: an elaboration of the choking under pressure hypothesis.

SAMPLE: Fifty-three third and fourth graders from China participated in this study. METHOD: Participants' working memory (WM) was assessed by the Automated Operation Span task. Then, they solved mental addition problems of different types under low- and high-pressure conditions. Performance was analysed as a function of pressure condition, working memory capacity, and problem type. RESULTS: On 'no carry' mental addition problems, there was no difference between the two groups of children regardless the presence of pressure. For problems with carries, low WM (LWM) children performed worse on all tasks compared with high WM (HWM) children in the no-pressure condition, but pressure influenced the LWM and HWM differently depending on the nature of the carrying task. On 'hidden carry' mental addition trials (for which guessing strategies were minimally effective), LWM performance was much lower than HWM performance under pressure. By contrast, performance was similar between LWM and HWM groups under pressure on the 'normal carry' trials that allowed for non-resource-intensive heuristic strategies. CONCLUSION: Whether high- or low-working-memory elementary-school-aged children were more or less affected by pressure was dependent on task-difficulty and the types of strategies that could be used to solve the problems.

Syphilis Among U.S.-Bound Refugees, 2015 - 2018.

We assessed syphilis screening data from overseas medical examinations among U.S.-bound refugees to characterize seropositive syphilis cases and treatment from January 1, 2015, to December 31, 2018. During this time period, all refugees 15 years and older were required to undergo syphilis screening prior to resettlement to the United States. Of the 160,381 refugee arrivals who had a syphilis screening performed, 697 (434 per 100,000) were diagnosed with any stage (infectious or non-infectious) of syphilis. Among the 697 persons with seropositive syphilis, a majority (63%) were from the Africa region and were male (58%), and 53 (7.6%) were diagnosed with an infectious stage of syphilis. All infectious cases were treated prior to resettlement. This information suggests a comparable risk of infection among U.S.-bound refugees compared to a report of syphilis among U.S.-bound refugees from 2009 to 2013, indicating low rates in this population for at least a decade.

Pneumatosis and portal venous gas: do CT findings reassure?

BACKGROUND: Small, single-institution studies have suggested risk factors for bowel ischemia/necrosis (I/N) in patients with computed tomography (CT) findings of pneumatosis (PN) and portal venous gas (PVG). Here, analysis has been expanded in a large, multicenter study. MATERIALS & METHODS: Logistic regression models and receiver operating characteristic curves were used to construct a scoring system for I/N in cases of PN/PVG. RESULTS: Of 265 patients with PN/PVG identified, 209 had adequate data. In unadjusted analyses the following variables were significantly associated with I/N: age, peritoneal signs, ascites, the presence of both PVG and PN, blood urea nitrogen (BUN), CO2, albumin, and a history of hypertension, myocardial infarction, or stroke. In contrast, the CT findings of mesenteric stranding, bowel-wall thickening, and type of PN were not associated with I/N. In adjusted analyses, three variables were significantly associated with I/N: age ≥60 y (odds ratio = 2.51, 95% confidence interval: 1.26-4.97), peritoneal signs (10.58, 4.23-26.4), and BUN >25 mg/dL (3.08, 1.54-6.17), whereas presence of both PN and PVG (versus only one) was associated with an increase (but not statistically significant increase) in odds (2.01, 0.94-4.36). Although several ad hoc models were used to maximize diagnostic ability, with maximal odds ratio = 174, the areas of receiver operating characteristic curves were all below 0.80, revealing suboptimal accuracy to diagnose I/N. CONCLUSIONS: Older age, peritoneal signs, and high BUN are associated with I/N, suggesting an ability to predict which patients need operation. CT findings traditionally suggestive of ischemic PN/PVG, however, do not diagnose I/N accurately enough to reliably identify patients needing operation.

How essentialist reasoning about language acquisition relates to educational myths and policy endorsements.

How people conceptualize learning is related to real-world educational consequences across many domains of education. Despite its centrality to the educational system, we know little about how the public reasons about language acquisition, and the potential consequences for their thinking about real-world issues (e.g., policy endorsements). The current studies examined people's essentialist beliefs about language acquisition (e.g., that language is innate and biologically based), then investigated how individual differences in these beliefs related to the endorsement of educational myths and policies. We probed several dimensions of essentialist beliefs, including that language acquisition is innate, genetically based, and wired in the brain. In two studies, we tested specific hypotheses regarding the extent to which people use essentialist thinking when reasoning about: learning a specific language (e.g., Korean), learning a first language more generally, and learning two or more languages. Across studies, participants were more likely to essentialize the ability to learn multiple languages than one's first language, and more likely to essentialize the learning of multiple languages and one's first language than the learning of a particular language. We also found substantial individual differences in the degree to which participants essentialized language acquisition. In both studies, these individual differences correlated with an endorsement of language-related educational neuromyths (Study 1 and pre-registered Study 2), and rejection of educational policies that promote multilingual education (Study 2). Together, these studies reveal the complexity of how people reason about language acquisition and its corresponding educational consequences.

A d factor? Understanding trait distractibility and its relationships with ADHD symptomatology and hyperfocus.

People differ substantially in their vulnerability to distraction. Yet, many types of distractions exist, from external stimulation to internal thoughts. How should we characterize individual differences in their distractibility? Two samples of adult participants (total N = 1220) completed a large battery of questionnaires assessing different facets of real-world distractibility. Latent modeling revealed that these measures could be explained by three correlated-yet-distinct factors: external distraction, unwanted intrusive thoughts, and mind-wandering. Importantly, about 80% of the total variance in these three factors could be explained by a single higher-order factor (d) that could be construed in terms of a person's general distractibility, and this general distractibility model was replicated across the two samples. We then applied the general distractibility model to understand the nature of ADHD symptomatology and hyperfocus (an intense state of long-lasting and highly focused attention). d was substantially associated with self-reported ADHD symptoms. Interestingly, d was also positively associated with hyperfocus, suggesting that hyperfocus may, to some degree, reflect attention problems. These results also show marked consistencies across the two samples. Overall, the study provides an important step toward a comprehensive understanding of individual differences in distractibility and related constructs.