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Background: Empathy declines during medical training, despite its importance. Methodology: In this randomized controlled trial, we assessed the impact of Zoom improv on medical student empathy using a concurrent mixed-methods approach. Quantitative assessment with three survey tools and qualitative assessment by content analysis of Zoom session field notes were conducted. Results: Zoom improv participants had higher empathy scores in perspective-taking and fantasy and lower scores in personal distress compared with the control group. Medical students who participated in Zoom improv exercised emotional expression, active listening, and giving "gifts," which apply to healthcare settings in which affirming team members with empathic concern can advance communication, patient rapport, and teamwork. Discussion: This pilot study highlights promising findings for the incorporation of Zoom improv in medical education, including enhanced empathy, self-reflection, and understanding how these skills impact work in healthcare. Future studies may expand on the optimal timing to teach improv. Future studies conducted on virtual platforms may also further investigate our finding that the fantasy domain of empathy increases after Zoom improv sessions, whereas this increase in fantasy was absent from previous in-person studies. Given the increase in telehealth and virtual medical visits, exercising empathy skills through a screen during training may be an important addition to medical curricula. [ABSTRACT FROM AUTHOR]

We argue that the importance of family relationships for individual well-being varies across societies as a function of a society’s degree of cultural heterogeneity. To examine the role of family relationships, we analyzed the responses from 13,009 participants in 50 societies on their life satisfaction across societies varying in their levels of historical and contemporary cultural heterogeneity. Such heterogeneity creates differences in the frequency of interacting with unfamiliar groups, which leads families to become more central to their members’ satisfaction with life. Multi-level analyses showed that historical and contemporary cultural heterogeneity moderated the pattern such that greater historical or contemporary cultural heterogeneity of society promoted a stronger positive relation between family relationship satisfaction and individual life satisfaction. Our results also revealed that the moderating role of historical cultural heterogeneity was more reliable than that of contemporary cultural heterogeneity. These findings demonstrate the importance of societal demography in shaping people’s psychological processes in different historical periods, suggesting a universal, trans-historical cultural process. [ABSTRACT FROM AUTHOR]

Women and underrepresented-in-medicine applicants value a climate for diversity when selecting graduate medical education training programs. Climate may not be accurately represented during virtual recruitment. Optimizing program websites may help overcome this barrier. We reviewed websites for adult infectious disease fellowships that participated in the 2022 National Resident Matching Program for emphasis on diversity, equity, and inclusion (DEI). Fewer than half expressed DEI language in their mission statement or had a dedicated DEI statement or webpage. Programs should consider emphasizing their commitment to DEI prominently on their websites, which may help recruit candidates from diverse backgrounds. [ABSTRACT FROM AUTHOR]

Background: Burnout is prevalent in medical training. While some institutions have implemented employee-to-employee recognition programs to promote wellness, it is not known how such programs are perceived by resident physicians, or if the experience differs among residents of different genders. Methods: We used convergent mixed methods to characterize how residents in internal medicine (IM), pediatrics, and general surgery programs experience our employee-to-employee recognition ("Hi-5″) program. We collected Hi-5s received by residents in these programs from January 1, 2021–December 31, 2021 and coded them for recipient discipline, sex, and PGY level and sender discipline and professional role. We conducted virtual focus groups with residents in each training program. Main measures and approach: We compared Hi-5 receipt between male and female residents; overall and from individual professions. We submitted focus group transcripts to content analysis with codes generated iteratively and emergent themes identified through consensus coding. Results: Over a 12-month period, residents received 382 Hi-5s. There was no significant difference in receipt of Hi-5s by male and female residents. Five IM, 3 surgery, and 12 pediatric residents participated in focus groups. Residents felt Hi-5s were useful for interprofessional feedback and to mitigate burnout. Residents who identified as women shared concerns about differing expectations of professional behavior and communication based on gender, a fear of backlash when behavior does not align with gender stereotypes, and professional misidentification. Conclusions: The "Hi-5" program is valuable for interprofessional feedback and promotion of well-being but is experienced differently by men and women residents. This limitation of employee-to-employee recognition should be considered when designing equitable programming to promote well-being and recognition. [ABSTRACT FROM AUTHOR]

Interprofessional education during medical training may improve communication by promoting collaboration and the development of shared mental models between professions. We implemented a novel discussion-based intervention for surgical residents and nurses to promote mutual understanding of workflows and communication practices. General surgery residents and inpatient nurses from our institution were recruited to participate. Surveys and paging data were collected prior to and following the intervention. Surveys contained original questions and validated subscales. Interventions involved facilitated discussions about workflows, perceptions of urgency, and technology preferences. Discussions were recorded and transcribed for qualitative content analysis. Pre and post-intervention survey responses were compared with descriptive sample statistics. Group characteristics were compared using Fisher's exact tests. Eleven intervention groups were conducted (2–6 participants per group) (n = 38). Discussions achieved three aims: Information-Sharing (learning about each other's workflows and preferences), 2) Interpersonal Relationship-Building (establishing rapport and fostering empathy) and 3) Interventional Brainstorming (discussing strategies to mitigate communication challenges). Post-intervention surveys revealed improved nurse-reported grasp of resident schedules and tailoring of communication methods based on workflow understanding; however, communication best practices remain limited by organizational and technological constraints. Systems-level changes must be prioritized to allow intentions toward collegial communication to thrive. [ABSTRACT FROM AUTHOR]

Previous research has reported that females are more likely than males to do pro-environmental behaviors. This research focused on understanding this relationship by exploring individual difference characteristics that may explain the sex difference, specifically traits and psychological barriers to pro-environmental action. Two studies (N = 246 and N = 357) confirm that males were less likely to report doing pro-environmental behaviors; males also reported more of Gifford's (2011) Dragons of Inaction Psychological Barriers (DIP-Barriers) to pro-environmental action than females. Broad traits predicted pro-environmental attitudes and behaviors similar to past research, but they did not account for the sex difference. In addition, we suggest a new psychological barrier for males: perceptions of femininity may dissuade males from some pro-environmental behaviors. Results provide preliminary support for this idea and complement previous suggestions that environmentalism is perceived as more feminine. We discuss ways that future research can build on these suggestions with the ultimate goal of more effectively promoting environmentalism to males. [ABSTRACT FROM AUTHOR]

Background The decision between local and free tissue coverage for distal lower leg defects has long been dictated by the location and size of defects. Recent reports of distal defects treated successfully with pedicled perforator flaps demonstrate equivalent clinical outcomes; however, the complication rate can be high. The goal of this study was to evaluate the cost equivalence of free versus pedicled perforator flap to assist decision-making and guide clinical care. Methods The institutional database was searched for patients with acute injury over the distal lower extremity requiring free or pedicled perforator flap. Demographic, clinical, and total resource cost was gathered. Patients were matched to Gustilo–Anderson or Arbeitsgemeinschaft fur Osteosynthesefragen classification as well as size of defect and outcomes, and cost compared. Results We have included 108 free flaps and 22 pedicled perforator flaps in the study. There was no difference in complication rate between groups. Free flaps had significantly more reoperations, required longer operative time, and had longer intensive care unit (ICU) care with higher cost of surgery and overall cost than pedicled flaps. When controlling for size of defect, surgical cost remained significantly different between groups (p = 0.013), but overall cost did not. Multivariable regression analysis indicated flap type to be the primary driver of cost of surgery, while body mass index elevated the total cost. Conclusion Pedicled perforator flap coverage for small to medium-sized defects (< 70 cm 2) is a viable and cost-effective option for distal lower leg soft tissue reconstruction after acute traumatic injury with similar clinical outcomes and shorter operative duration and ICU stay. [ABSTRACT FROM AUTHOR]

Background Restoring elbow function is challenging after late presenting brachial plexus birth injury (BPBI). Free functioning muscle transplantation (FFMT) using the gracilis muscle is a reliable procedure to restore elbow flexion in patients with impaired function after spontaneous recovery or failed surgical reconstruction. Methods A retrospective review was performed on BPBI patients more than 2 years of age who received a FFMT between January 1993 and January 2018, with the aim of improving elbow flexion as the primary or secondary functional goal. Patients with preoperative elbow flexion Medical Research Council (MRC) grades less than 3 with more than or equal to 18 months of follow-up duration were included in the analysis. Patient demographic information and pre/postoperative clinical parameters including elbow flexion MRC scale, passive elbow range of motion, and complications were recorded. Surgical data including donor nerve choice, site of the FFMT tendon attachment, and necessity of concomitant procedures or reoperation were also analyzed. Results Fifty-six FFMTs were performed for the primary (29 patients) or secondary (26 patients) objective of restoring elbow flexion. The mean age at the time of the procedure was 9.6 years (standard deviation [SD] = 6.29, R = 3-35). Mean follow-up was 7.9 years (SD = 5.2). Elbow flexion improved from a median MRC grade 2 to 4 after a FFMT (p < 0.05). Patients who had a FFMT to restore two functions had 86% lower elbow flexion MRC grades than those who had a FFMT to restore flexion only (p < 0.05). Patients less than 12 years old at the time of surgery had more complications, reoperations, and rates of a flexion contracture more than or equal to 30 degrees than those aged more than 12 years (p < 0.05). Conclusion FFMT is a reliable option for upper extremity reanimation. Patients aged less than 12 years old at the time of FFMT had significantly more complications, reoperations, and rates of postoperative elbow flexion contracture more than or equal to 30 degrees, but equivalent elbow flexion MRC grades. Level of Evidence III [ABSTRACT FROM AUTHOR]

Hierarchy and status and power differentials in current health care practice persist, despite recognition of their ethical issues and movement toward collaborative practice. As interprofessional education continues to emphasize shifting from individual siloed practice to teambased approaches to improving patient safety and outcomes, addressing status and power is key to mutual respect and trust cultivation. What has become known as medical improv applies techniques of theater improvisation to health professions education and practice. This article shares how an improv exercise called Status Cards prompts participants to recognize their responses to status and how this awareness can be applied to improve their interactions in real encounters with patients, colleagues, and others in health care contexts. [ABSTRACT FROM AUTHOR]

Introduction: Surgeons are entrusted with providing patients with information necessary for deliberation about surgical intervention. Ideally, surgical consultations generate a shared understanding of the treatment experience and determine whether surgery aligns with a patient's overall health goals. In-depth assessment of communication patterns might reveal opportunities to better achieve these objectives. Methods: We performed a secondary analysis of audio-recorded consultations between surgeons and patients considering high-risk surgery. For 43 surgeons, we randomly selected 4 transcripts each of consultations with patients aged ≥60 y with at least 1 comorbidity. We developed a coding taxonomy, based on principles of informed consent and shared decision making, to categorize surgeon speech. We grouped transcripts by treatment plan and recorded the treatment goal. We used box plots, Sankey diagrams, and flow diagrams to characterize communication patterns. Results: We included 169 transcripts, of which 136 discussed an oncologic problem and 33 considered a vascular (including cardiac and neurovascular) problem. At the median, surgeons devoted an estimated 8 min (interquartile range 5–13 min) to content specifically about intervention including surgery. In 85.5% of conversations, more than 40% of surgeon speech was consumed by technical descriptions of the disease or treatment. "Fix-it" language was used in 91.7% of conversations. In 79.9% of conversations, no overall goal of treatment was established or only a desire to cure or control cancer was expressed. Most conversations (68.6%) began with an explanation of the disease, followed by explanation of the treatment in 53.3%, and then options in 16.6%. Conclusions: Explanation of disease and treatment dominate surgical consultations, with limited time spent on patient goals. Changing the focus of these conversations may better support patients' deliberation about the value of surgery. Trial registration: ClinicalTrials.gov Identifier: NCT02623335. Highlights: In decision-making conversations about high-risk surgical intervention, surgeons emphasize description of the patient's disease and potential treatment, and the use of "fix-it" language is common. Surgeons dedicated limited time to eliciting patient preferences and goals, and 79.9% of conversations resulted in no explicit goal of treatment. Current communication practices may be inadequate to support deliberation about the value of surgery for individual patients and their families. Graphical Abstract This is a visual representation of the abstract. [ABSTRACT FROM AUTHOR]

Background Loss of elbow flexion is a common sequela of acute brachial plexus injuries (BPIs). The Mackinnon/Oberlin-II double fascicular transfer (DFT) is a widely used method to restore this function in acute C5–6 or C5–7 injuries. This study attempted to evaluate if this technique can be applied reliably for cases involving C8 and/or T1 injuries. Methods Adult patients with acute BPIs who underwent the Mackinnon/Oberlin-II DFT in our center between 2008 and 2018 were retrospectively identified. Group I (n = 37) included patients with only C5–6 or C5–7 injury, while group II (n = 32) patients presented C5–8 ± T1 injuries. The demographic data, pre- and postoperative neurologic evaluations, electrodiagnostic studies, and grip strength assessment were collected. Results A total of 69 patients met the inclusion criteria. Preoperatively, the patients in group II presented poorer nerve conduction and electromyography in both the median and the ulnar nerves and the supply muscles. The percentage of M3 achievement in both groups was 91.9 versus 87.5% and M4 was 73.0 and 71.9%, respectively, which both were not statically significant but the achievement of group II was slower than the group I, 1 to 2 months slower, respectively. Both groups had 57.57 and 46.0% of the postoperative grip power compared with the healthy side, the result of shoulder abduction was not different (p = 0.480). Conclusion With careful preoperative evaluation, early intervention, appropriate intraoperative functional fascicle selection, and aggressive postoperative rehabilitation, indications for the Mackinnon/Oberlin-II DFT technique can safely include acute C5–8 injuries and even partial T1 acute BPIs. [ABSTRACT FROM AUTHOR]

People care about their own well-being and about the well-being of their families. It is currently, however, unknown how much people tend to value their own versus their family's well-being. A recent study documented that people value family happiness over personal happiness across four cultures. In this study, we sought to replicate this finding across a larger sample size (N = 12,819) and a greater number of countries (N = 49). We found that the strength of the idealization of family over personal happiness preference was small (average Cohen's d s =.20, range −.02 to.48), but present in 98% of the studied countries, with statistical significance in 73% to 75%, and variance across countries <2%. We also found that the size of this effect did vary somewhat across cultural contexts. In Latin American cultures highest on relational mobility, the idealization of family over personal happiness was very small (average Cohen's d s for Latin America =.15 and.18), while in Confucian Asia cultures lowest on relational mobility, this effect was closer to medium (d s >.40 and.30). Importantly, we did not find strong support for traditional theories in cross-cultural psychology that associate collectivism with greater prioritization of the family versus the individual; country-level individualism–collectivism was not associated with variation in the idealization of family versus individual happiness. Our findings indicate that no matter how much various populists abuse the argument of "protecting family life" to disrupt emancipation, family happiness seems to be a pan-culturally phenomenon. Family well-being is a key ingredient of social fabric across the world, and should be acknowledged by psychology and well-being researchers and by progressive movements too. [ABSTRACT FROM AUTHOR]

The vast and growing challenges for human health and all life on Earth require urgent and deep structural changes to the way in which we live. Broken relationships with nature are at the core of both the modern health crisis and the erosion of planetary health. A declining connection to nature has been implicated in the exploitative attitudes that underpin the degradation of both physical and social environments and almost all aspects of personal physical, mental, and spiritual health. It is increasingly clear that the entwined challenges of biodiversity loss, climate change, and human health cannot be addressed without addressing selfishness, greed, apathy, and the value systems that created these global problems. Calls for a spiritual and cultural transformation recognize that "inner" development is important and necessary for meaningful "outward" transitions with a shared purpose for wiser, more sustainable societies. Many of these emotional and spiritual assets appear to be facilitated by a connection to nature, which is also strongly associated with community cohesion, prosocial attitudes, and pro-environmental actions. Restoring the human connection to nature may therefore provide a critical common pathway to promote the physical and spiritual wellbeing of individuals and communities as well as personal and social environmental responsibility. In this paper, we summarize and reflect on the discussions of the Nova Network planetary health community with respect to nature-based solutions as pathways to promote both personal and planetary health with a more mutualistic mindset. These discussions spanned biological to psychological interactions with nature—including the critical relationships with environmental microbes that influence the physical, emotional, and behavioral aspects of health. We consider the ways in which stronger relationships with nature promote "inner assets" to support "outward actions" for personal and planetary health. [ABSTRACT FROM AUTHOR]

How can one conclude that well-being is higher in country A than country B, when well-being is being measured according to the way people in country A think about well-being? We address this issue by proposing a new culturally sensitive method to comparing societal levels of well-being. We support our reasoning with data on life satisfaction and interdependent happiness focusing on individual and family, collected mostly from students, across forty-nine countries. We demonstrate that the relative idealization of the two types of well-being varies across cultural contexts and are associated with culturally different models of selfhood. Furthermore, we show that rankings of societal well-being based on life satisfaction tend to underestimate the contribution from interdependent happiness. We introduce a new culturally sensitive method for calculating societal well-being, and examine its construct validity by testing for associations with the experience of emotions and with individualism-collectivism. This new culturally sensitive approach represents a slight, yet important improvement in measuring well-being. [ABSTRACT FROM AUTHOR]

In the face of mounting environmental issues, people around the world are reporting the experience of difficult emotions such as anxiety and worry, or what is increasingly referred to as eco-anxiety. It is often acknowledged that symptoms of eco-anxiety can range in severity or fall along a continuum. Such a proposition has important implications, as it may help to explain why some forms of eco-anxiety are more mal(adaptive) than others. In five studies (Total N = 2939) across three countries (Canada, China, United Kingdom), we examined how measures that may encompass a continuum of environment-related worry and anxiety were associated with each other and with measures of environmental concern, an older concept that may capture the less severe end of eco-anxiety responses. We also explored if these various measures were differentially linked to aspects of mental health and a pro-environmental orientation. Results revealed that measures of eco-anxiety and environmental concern were often moderately-strongly correlated. Eco-anxiety measures exhibited relatively consistent relationships with greater ill-being but mixed relationships with indices of well-being. There was some evidence of more severe eco-anxiety measures being associated with poorer mental health and environmental concern measures being associated with better mental health. Measures of both eco-anxiety and environmental concern evidenced larger and more consistent relationships with indices of a pro-environmental orientation, with the most severe eco-anxiety measure exhibiting some notably weaker relationships. Together, the present work provides preliminary insights into the nomological network of the continuum of eco-anxiety responses and its integration into future work on eco-anxiety. [ABSTRACT FROM AUTHOR]

Cultural sensitivity in societal development has been advocated for since at least the 1960s but has remained understudied. Our goal is to address this gap and to investigate folk theories of societal development. We aimed to identify both universal and culturally specific lay beliefs about what constitutes good societal development. We collected data from 2,684 participants from Japan, Hong Kong (China), Poland, Turkey, Brazil, France, Nigeria, the USA, and Canada. We measured preferences for 28 development aims. We used multidimensional scaling, analysis of variance, and pairwise comparisons to identify universal and country‐specific preferences. Our results demonstrate that what people understand as modernization is fairly universal across countries, but specific pathways of development and preferences towards these pathways tend to vary between countries. We distinguished three facets of modernization—foundational aims (e.g., trust, economic development), welfare aims (e.g., poverty eradication, education), and inclusive aims (e.g., openness, gender equality)—and incorporated them into a folk meta‐theory of modernization. In all nine countries, the three facets of modernization were preferred more than conventional aims (e.g., military, demographic growth). We propose a method of implementing our findings into a culturally sensitive modernization index. [ABSTRACT FROM AUTHOR]

The cardiovascular and skeletal muscle systems are intrinsically interconnected, sharing the goal of delivering oxygen to metabolically active tissue. Deficiencies within those systems that affect oxygen delivery to working tissues are a hallmark of advancing age. Oxygen delivery and utilization are reflected as muscle oxygen saturation (SmO2) and are assessed using near-infrared resonance spectroscopy (NIRS). SmO2 has been observed to be reduced by ~38% at rest, ~24% during submaximal exercise, and ~59% during maximal exercise with aging (>65 y). Furthermore, aging prolongs restoration of SmO2 back to baseline by >50% after intense exercise. Regulatory factors that contribute to reduced SmO2 with age include blood flow, capillarization, endothelial cells, nitric oxide, and mitochondrial function. These mechanisms are governed by reactive oxygen species (ROS) at the cellular level. However, mishandling of ROS with age ultimately leads to alterations in structure and function of the regulatory factors tasked with maintaining SmO2. The purpose of this review is to provide an update on the current state of the literature regarding age-related effects in SmO2. Furthermore, we attempt to bridge the gap between SmO2 and associated underlying mechanisms affected by aging. [ABSTRACT FROM AUTHOR]

Background: Intraosseous ganglia of the carpal bones are uncommon with sparse publications to guide treatment. The purpose of this study was to review a single-institution experience to determine the outcomes of patients with surgically treated intraosseous carpal ganglia. Methods: Skeletally mature patients with intraosseous carpal ganglia between 1995 and 2016 treated operatively were identified. Demographic information, clinical data, and radiographic studies were evaluated. Results: Thirty-three ganglia in 31 patients were identified. Intraosseous ganglia were located in the lunate (23), scaphoid (9), and trapezoid (1). Patients who presented with pathologic fracture or collapse had larger intraosseus ganglia than those presenting with pain alone. Surgery significantly improved pain. Patients treated with debridement with autograft bone graft had a higher consolidation rate compared with allograft bone but no difference in pain. Conclusions: Patients with large or symptomatic lesions can be treated successfully with curettage and debridement, which leads to relief of pain. The use of bone grafting remains controversial. [ABSTRACT FROM AUTHOR]

Oxidized fluids in the subduction zone may convert polyvalent elements in the mantle to their higher valence states. The most abundant polyvalent element in the mantle is Fe, a significant part of which is contained in olivine as Fe2+. Results of the study of arc mantle xenoliths, in lab high-pressure–high-temperature experiments, and thermodynamic modeling have shown that at pressures of ~ 50–2000 MPa and temperatures of 1000–1250 °C, well above the serpentine stability field, Fe2+ from olivine reacts with free aqueous fluid according to the following simplified reaction: 3Fe2SiO4 + 2H2O ⇆ 3SiO2 + 2Fe3O4 + 2H2. The resulting ferric iron is preserved in spinel of a certain composition, Mg,Fe 2 + Fe 2 3 + O 4 , whereas new high-Mg olivine, with magnesium number up to 96 in natural samples and 99.9 in experiments, forms in the reaction zone. SiO2 produced in the reaction either dissolves in the fluid or, with a small amount of water, reacts with olivine to form orthopyroxene as follows: (Mg,Fe)2SiO4 + SiO2 = (Mg,Fe)2Si2O6. The released H2 may decrease the oxidation state of polyvalent elements present in the fluid (e.g., S4+, S6+). Traces of high-temperature water–olivine interaction appear as swarms of fluid-spinel inclusions and are ubiquitous in olivine from ultramafic arc xenoliths. The described process is similar to serpentinization but occurs at higher pressure and temperature conditions and yields different reaction products. The reducing capacity of olivine is relatively low; however, given the large volume of mantle (and crustal) peridotites, the overall effect may be significant. [ABSTRACT FROM AUTHOR]

In the face of mounting environmental issues, people around the world are reporting the experience of difficult emotions such as anxiety and worry, or what is increasingly referred to as eco-anxiety. It is often acknowledged that symptoms of eco-anxiety can range in severity or fall along a continuum. Such a proposition has important implications, as it may help to explain why some forms of eco-anxiety are more mal(adaptive) than others. In five studies (Total N = 2939) across three countries (Canada, China, United Kingdom), we examined how measures that may encompass a continuum of environment-related worry and anxiety were associated with each other and with measures of environmental concern, an older concept that may capture the less severe end of eco-anxiety responses. We also explored if these various measures were differentially linked to aspects of mental health and a pro-environmental orientation. Results revealed that measures of eco-anxiety and environmental concern were often moderately-strongly correlated. Eco-anxiety measures exhibited relatively consistent relationships with greater ill-being but mixed relationships with indices of well-being. There was some evidence of more severe eco-anxiety measures being associated with poorer mental health and environmental concern measures being associated with better mental health. Measures of both eco-anxiety and environmental concern evidenced larger and more consistent relationships with indices of a pro-environmental orientation, with the most severe eco-anxiety measure exhibiting some notably weaker relationships. Together, the present work provides preliminary insights into the nomological network of the continuum of eco-anxiety responses and its integration into future work on eco-anxiety. [ABSTRACT FROM AUTHOR]

In this paper, we introduce the concept of 'societal emotional environment': the emotional climate of a society (operationalized as the degree to which positive and negative emotions are expressed in a society). Using data collected from 12,888 participants across 49 countries, we show how societal emotional environments vary across countries and cultural clusters, and we consider the potential importance of these differences for well-being. Multilevel analyses supported a 'double-edged sword' model of negative emotion expression, where expression of negative emotions predicted higher life satisfaction for the expresser but lower life satisfaction for society. In contrast, partial support was found for higher societal life satisfaction in positive societal emotional environments. Our study highlights the potential utility and importance of distinguishing between positive and negative emotion expression, and adopting both individual and societal perspectives in well-being research. Individual pathways to happiness may not necessarily promote the happiness of others. [ABSTRACT FROM AUTHOR]

Well-being is recognized as a fundamental human goal and a universal human aspiration. However, some cross-country studies suggest that the desirability of the most often studied concept of well-being—personal life satisfaction—varies across countries, and we know little about the desirability of other types of well-being. Extending this novel area of research, we argue that focusing on the family (as compared to the individual) as the subject of well-being may be another important distinction in how well-being is conceptualized and valued. With data collected in four countries that tend to occupy different positions in rankings of personal life satisfaction (i.e., Canada, Colombia, Japan, and Poland), we document that, irrespective of cultural context, family well-being is valued over personal well-being. These findings suggest that policy makers and scientists may need to pay more attention to family well-being than they currently do. [ABSTRACT FROM AUTHOR]

Numerous studies document that societal happiness is correlated with individualism, but the nature of this phenomenon remains understudied. In the current paper, we address this gap and test the reasoning that individualism correlates with societal happiness because the most common measure of societal happiness (i.e., country-level aggregates of personal life satisfaction) is individualism-themed. With the data collected from 13,009 participants across fifty countries, we compare associations of four types of happiness (out of which three are more collectivism-themed than personal life satisfaction) with two different measures of individualism. We replicated previous findings by demonstrating that societal happiness measured as country-level aggregate of personal life satisfaction is correlated with individualism. Importantly though, we also found that the country-level aggregates of the collectivism-themed measures of happiness do not tend to be significantly correlated with individualism. Implications for happiness studies and for policy makers are signaled. [ABSTRACT FROM AUTHOR]

Although empathy is widely recognized as an important trait for healthcare professionals, little research has examined empathy attributes in genetic counselors. Decreases in empathy levels have been recognized in other healthcare professionals over the span of their professional education program. This research sought to characterize empathy levels in first‐ and second‐year genetic counseling students and recent (2017) graduates, and to determine whether there are differences in empathy levels displayed by genetic counseling students at different points in their training. Additionally, this research examined whether experiences prior to graduate school, including specific aspects of advocacy experience, correlated with differences in self‐reported empathy levels among genetic counseling students and new genetic counselors. An online survey was administered to first‐ and second‐year genetic counseling students and practicing genetic counselors to determine whether there were differences in empathy levels between these groups, and to analyze for associations between pre‐graduate school advocacy work and levels of empathy as measured by the Interpersonal Reactivity Index (IRI). We identified significant differences in self‐reported empathy levels in several of the subscales of the IRI between first‐year students and second‐year students, and between first‐year students and recent graduates. Furthermore, we identified significantly lower scores on the personal distress subscale of the IRI in participants who engaged in advocacy work for longer than 12 months when compared to participants who engaged in advocacy work for between 6 and 12 months. Other advocacy and educational characteristics were also examined for correlations with IRI scores, and no significant associations were identified between these additional factors and self‐reported empathy scores. Practice implications and recommendations for future research are discussed. [ABSTRACT FROM AUTHOR]

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Objective: Determine if differences in T1ρ would be detected in specific regions or layers of patellofemoral cartilage between patients with symptomatic patellofemoral pain syndrome and asymptomatic control subjects. Materials and methods: Ten subjects diagnosed with patellofemoral pain syndrome were compared with ten age-, gender-, and BMI-matched control subjects with no knee pain or prior trauma. Conventional turbo (fast) spin echo sequences and T1ρ-weighted imaging were performed on the symptomatic knee in each of the ten subjects. At the patella and distal femur, cartilage regions of interest were divided into medial and lateral sub-regions, each then further sub-divided by layer (superficial, middle, or deep). Two-tailed t test and chi-squared tests were used to analyze demographic data. A mixed effect model was run for each sub-region of T1ρ imaging. Statistical significance was determined using the likelihood ratio test against reduced models without patellofemoral pain syndrome symptomatic status as a fixed effect. Results: There was no difference in age, sex, or BMI between symptomatic and control patients. T1ρ values were significantly higher among patellofemoral pain syndrome patients when compared with controls in the superficial zone of the lateral patella (58.43 vs. 50.83, p = 0.03) and the middle zone of the lateral patella (52.67 vs. 43.60, p = 0.03). T1ρ was also higher in the superficial zone of the medial femur (50.94 vs. 46.70, p = 0.09) with a value approaching statistical significance. Conclusion: We report statistically significant differences in the T1ρ value in the superficial and middle zones of the lateral patella in patients with patellofemoral pain syndrome who had no abnormalities seen on conventional MRI sequences, suggesting an alteration the macromolecular structure of the cartilage in this population. [ABSTRACT FROM AUTHOR]

Background: Lack of awareness about the life-limiting nature of renal failure is a significant barrier to palliative care for older adults with end-stage renal disease. Objective: To train nephrologists to use the best case/worst case (BC/WC) communication tool to improve shared decision making about dialysis initiation for older patients with limited life expectancy. Design: This is a pre-/postinterventional pilot study. Setting/Subjects: There were 16 nephrologists and 30 patients of age 70 years and older with estimated glomerular filtration rate (eGFR) <20 mL/min per 1.73 m2 in outpatient nephrology clinics, in Madison, WI. Measurements: Performance of tool elements, content of communication about dialysis, shared decision making, acceptability of the intervention, decisions to pursue dialysis, and palliative care referrals were measured. Results: Fifteen of 16 nephrologists achieved competence performing the BC/WC tool with standardized patients, executing at least 14 of 19 items. Nine nephrologists met with 30 patients who consented to audio record their clinic visit. Before training, clinic visits focused on laboratory results and preparation for dialysis. After training, nephrologists noted that declining kidney function was "bad news," presented dialysis and "no dialysis" as treatment options, and elicited patient preferences. Observer-measured shared decision-making (OPTION 5) scores improved from a median of 20/100 (interquartile range [IQR] 15–35) before training to 58/100 (IQR 55–65). Patients whose nephrologist used the BC/WC tool were less likely to make a decision to initiate dialysis and were more likely to be referred to palliative care. Conclusions: Nephrologists can learn to use the BC/WC tool with older patients to improve shared decision making about dialysis, which may increase access to palliative care. [ABSTRACT FROM AUTHOR]

Intense emission of volcanic aerosol accompanied the 2012–2013 basaltic effusive eruption of Tolbachik volcano, Kamchatka. The aerosols sampled contain sulfuric acid droplets, glassy particles, and 70 mineral phases. All aerosol particles may be classified by their origin. The fragmentation aerosol includes magma fragments: silicate glass clasts, silicate microspheres, and small phenocrysts (olivine, pyroxene, and magnetite). The alteration aerosol comprises particles of quenched silicate melt covered with secondary minerals (fluorides, sulfates, and oxides/hydroxides of rock‐forming elements) and fragments of altered rocks composed solely of secondary minerals. The condensation aerosol dominated the mass during the later stages of the eruption when the explosive activity had ceased, and was characterized by the greatest variety of particle compositions. Na‐K sulfate and Fe (III) oxide comprised more than 95% of the solid fraction of the condensation aerosol. The remaining 5% was represented by native elements (Au, Ag‐Pt alloy, and Pt); sulfides of Fe, Cu, Ag, and Re; oxides and hydroxides of Al, Fe, Cu, Zn, Mo, W, Ta, and Zr; halides of Al, Mg, Na, K, Ca, Cd, Pb, Ag, and Tl; and sulfates of Na, K, Pb, Ca, and Ba; the only silicate was As‐bearing orthoclase. Droplets of H2SO4 formed the liquid phase of the condensation aerosol. Some of the aerosol components, such as magnetite spherules or phosphate‐carbonate‐fluorite association, likely had a nonvolcanic origin (country rocks and wood fly ash). The volcanic aerosols and their contained minerals, discharged at Tolbachik and elsewhere, result in a physical and chemical effect on the environment in the region of such volcanoes. Key Points: Seventy three phases were identified in Tolbachik aerosol, including droplets of H2SO4, silicate clasts and microspheres, and 70 mineralsFragmentation, alteration, and condensation aerosol are three main classes of Tolbachik aerosol particles according to their originVolcanic emission of the condensation aerosol may be a noticeable factor in the redistribution of elements between geological environments [ABSTRACT FROM AUTHOR]

Subvolcanic environments in supra‐subduction zones are renowned for hosting epithermal deposits that often contain electrum and native gold, including bonanza examples. This study examined mineral assemblages and processes occurring in shallow‐crust volcanic settings using recent eruption (2012–2013) of the basaltic Tolbachik volcano in the Kamchatka arc. The Tolbachik eruptive system is characterized by an extensive system of lava tubes. After cessation of magma input, the tubes maintained the flow of hot oxidized gases that episodically interacted with the lava surfaces and sulphate‐chloride precipitates from volcanic gases on these surfaces. The gas‐rock interaction had strong pyrometamorphic effects that resulted in the formation of molten salt, oxidized (tenorite, hematite, Cu‐rich magnesioferrite) and skarn‐like silicate mineral assemblages. By analogy with experimental studies, we propose that a combination of these processes was responsible for extraction of metals from the basaltic wall rocks and deposition of Cu‐, Fe‐ and Cu‐Fe‐oxides and native gold. [ABSTRACT FROM AUTHOR]

Studies repeatedly have documented that societal well‐being is associated with individualism. Most of these studies, however, have conceptualized/measured well‐being as individual life satisfaction—a type of well‐being that originates in Western research traditions. Drawing from the latest research on interdependent happiness and on family well‐being, we posit that people across cultures pursue different types of well‐being, and test whether more collectivism‐themed types of well‐being that originate in Confucian traditions also are associated with individualism. Based on data collected from 2,036 participants across 12 countries, we find support for the association between individual life satisfaction and individualism at the societal level, but show that well‐being's association with individualism is attenuated when some collectivism‐themed measures of well‐being are considered. Our article advances knowledge on the flourishing of societies by suggesting that individualism may not always be strongly linked with societal well‐being. Implications for public policies are signaled. [ABSTRACT FROM AUTHOR]

High-quality feedback is necessary for learners' development. It is most effective when focused on behavior and should also provide learners with specific next steps and desired outcomes. Many faculty struggle to provide this high-quality feedback. To improve the quality of written feedback by faculty in a department of medicine, we conducted a 1-hour session using a novel framework based on education literature, individual review of previously written feedback, and deliberate practice in writing comments. Sessions were conducted between August 2015 and June 2018. Participants were faculty members who teach medical students, residents, and/or fellows. To measure the effects of our intervention, we surveyed participants and used an a priori coding scheme to determine how feedback comments changed after the session. Faculty from 7 divisions participated (n = 157). We surveyed 139 participants postsession and 55 (40%) responded. Fifty-three participants (96%) reported learning new information. To more thoroughly assess behavioral changes, we analyzed 5976 feedback comments for students, residents, and fellows written by 22 randomly selected participants before the session and compared these to 5653 comments written by the same participants 1 to 12 months postsession. Analysis demonstrated improved feedback content; comments providing nonspecific next steps decreased, and comments providing specific next steps, reasons why, and outcomes increased. Combining the learning of a simple feedback framework with an immediate review of written comments that individual faculty members previously provided learners led to measured improvement in written comments. [ABSTRACT FROM AUTHOR]

The trait-state isomorphism hypothesis holds that personality traits and states (i.e., trait-related behavior) are characterized by similar outcomes (Fleeson, 2001). Openness is associated with creative thinking, personal growth, and positive affect. Engaging in behavior associated with openness has also been found to covary with feelings of authenticity. In the present experiment, participants (N = 210) completed a pre-test assessment, five daily exercises designed to either be inert (control condition) or engage the behaviors and cognitions associated with openness (experimental condition), a post-test assessment, and a 2 week follow up assessment. Results supported the isomorphism hypothesis for positive affect but not creative thinking ability or personal growth. Furthermore, open behavior was only associated with authenticity for individuals high on trait openness. [ABSTRACT FROM AUTHOR]