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This piece offers a space for critical debate and reflection on the methodological and epistemological foundations that underpin feminist research on conflict, violence and peace. Taking stock of the variety of approaches and theoretical standpoints, we examine the (feminist) politics of knowledge production in academia and its limitations. We discuss how ontological and epistemological assumptions shape what counts as (feminist) academic knowledge and what is considered to be possible in (policy) practice. The article makes three contributions. First, we argue that the production of knowledge within disciplinary boundaries, and in particular, International Relations, is closely related to the discipline's history of positivism and exclusion. Second, to counter that, we propose a close engagement with Black and decolonial feminist methods of feeling-knowing, storytelling and collaboration. Third, we highlight that embracing uncertainty means accepting incommensurability and heterogeneity, as well as a shift away from the urge to accumulate knowledge towards paying attention to the process of co-constructing it., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

The perception of two (or more) simultaneous musical notes, depending on their pitch interval(s), could be broadly categorized as consonant or dissonant. Previous literature has suggested that musicians and non-musicians adopt different strategies when discerning music intervals: while musicians rely on the frequency ratios between the two fundamental frequencies, such as "perfect fifth" (3:2) as consonant and "tritone" (45:32) as dissonant intervals; non-musicians may rely on the presence of 'roughness' or 'beats', generated by the difference of fundamental frequencies, as the key elements of 'dissonance'. The separate Event-Related Potential (ERP) differences in N1 and P2 along the midline electrodes provided evidence congruent with such 'separate reliances'. To replicate and to extend, in this study we reran the previous experiment, and separately collected fMRI data of the same protocol (with sparse sampling modifications). The behavioral and EEG results largely corresponded to our previous finding. The fMRI results, with the joint analyses by univariate, psycho-physiological interaction, and representational similarity analysis (RSA) approaches, further reinforce the involvement of central midline-related brain regions, such as ventromedial prefrontal and dorsal anterior cingulate cortex, in consonant/dissonance judgments. The final spatiotemporal searchlight RSA provided convincing evidence that the medial prefrontal cortex, along with the bilateral superior temporal cortex, is the joint locus of midline N1 and dorsal anterior cingulate cortex for the P2 effect (for musicians). Together, these analyses reaffirm that musicians rely more on experience-driven knowledge for consonance/dissonance perception; but also demonstrate the advantages of multiple analyses in constraining the findings from both EEG and fMRI., Competing Interests: Declaration of competing interest The authors declare no competing conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

The spike protein determines the host-range specificity of coronaviruses. In particular, the Receptor-Binding Motif in the spike protein from SARS-CoV-2 contains the amino acids involved in molecular recognition of the host Angiotensin Converting Enzyme 2. Therefore, to understand how SARS-CoV-2 acquired its capacity to infect humans it is necessary to reconstruct the evolution of this important motif. Early during the pandemic, it was proposed that the SARS-CoV-2 Receptor-Binding Domain was acquired via recombination with a pangolin infecting coronavirus. This proposal was challenged by an alternative explanation that suggested that the Receptor-Binding Domain from SARS-CoV-2 did not originated via recombination with a coronavirus from a pangolin. Instead, this alternative hypothesis proposed that the Receptor-Binding Motif from the bat coronavirus RaTG13, was acquired via recombination with an unidentified coronavirus. And as a consequence of this event, the Receptor-Binding Domain from the pangolin coronavirus appeared as phylogenetically closer to SARS-CoV-2. Recently, the genomes from coronaviruses from Cambodia (bat_RShST182/200) and Laos (BANAL-20-52/103/247) which are closely related to SARS-CoV-2 were reported. However, no detailed analysis of the evolution of the Receptor-Binding Motif from these coronaviruses was reported. Here we revisit the evolution of the Receptor-Binding Domain and Motif in the light of the novel coronavirus genome sequences. Specifically, we wanted to test whether the above coronaviruses from Cambodia and Laos were the source of the Receptor-Binding Domain from RaTG13. We found that the Receptor-Binding Motif from these coronaviruses is phylogenetically closer to SARS-CoV-2 than to RaTG13. Therefore, the source of the Receptor-Binding Domain from RaTG13 is still unidentified. In accordance with previous studies, our results are consistent with the hypothesis that the Receptor-Binding Motif from SARS-CoV-2 evolved by vertical inheritance from a bat-infecting population of coronaviruses., (© 2024. The Author(s).)

Introduction: Musical roundness perception relies on consonance/dissonance within a rule-based harmonic context, but also on individual characteristics of the listener. The present work tackles these aspects in a combined psychoacoustic and neurophysiological study, taking into account participant's musical aptitude., Methods: Our paradigm employed cadence-like four-chord progressions, based on Western music theory. Chord progressions comprised naturalistic and artificial sounds; moreover, their single chords varied regarding consonance/dissonance and harmonic function. Thirty participants listened to the chord progressions while their cortical activity was measured with magnetoencephalography; afterwards, they rated the individual chord progressions with respect to their perceived roundness., Results: Roundness ratings differed according to the degree of dissonance in the dominant chord at the progression's third position; this effect was pronounced in listeners with high musical aptitude. Interestingly, a corresponding pattern occurred in the neuromagnetic N1m response to the fourth chord (i.e., at the progression's resolution), again with somewhat stronger differentiation among musical listeners. The N1m magnitude seemed to increase during chord progressions that were considered particularly round, with the maximum difference after the final chord; here, however, the musical aptitude effect just missed significance., Discussion: The roundness of chord progressions is reflected in participant's psychoacoustic ratings and in their transient cortical activity, with stronger differentiation among listeners with high musical aptitude. The concept of roundness might help to reframe consonance/dissonance to a more holistic, gestalt-like understanding that covers chord relations in Western music., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wöhrle, Reuter, Rupp and Andermann.)

Background: This study tested whether the dissonance-based Body Project eating disorder prevention program reduced onset of subthreshold/threshold anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD) over long-term follow-up., Methods: Data were combined from three prevention trials that targeted young women at high-risk for eating disorders ( N = 1092; M age = 19.3). Participants were randomized to Body Project groups led by peer educators or expressive writing/educational controls and completed masked diagnostic interviews over 2- to 4-year follow-ups. Logistic regressions tested whether onset of each eating disorder over follow-up differed between Body Project and control participants., Results: Peer-led Body Project groups produced a 46% reduction in onset of subthreshold/threshold BN and a 62% reduction in onset of PD relative to controls over follow-up. Rates of onset of subthreshold/threshold AN and BED did not significantly differ between peer-led Body Project participants and control participants., Conclusions: Results support the dissemination of the peer-led Body Project for reducing future onset of BN and PD. This study and recent research suggest that thin-ideal internalization, the risk factor for eating disorders targeted in the Body Project , may be more relevant for predicting onset of BN and PD compared to AN and BED. Findings support the development of a version of the Body Project aimed to reduce risk factors that have predicted future onset of all four types of eating disorders (e.g. overvaluation of weight/shape, fear of weight gain), which may more effectively prevent all eating disorder types.

This article considers the normative and critical value of popular comedy. I begin by assembling and evaluating a range of political theory literature on comedy. I argue that popular comedy can be conducive to both critical and transformative democratic effects, but that these effects are contingent on the way comedic performances are received by audiences. I illustrate this by means of a case study of a comedic climate change 'debate' from the television show, Last Week Tonight . Drawing from recent scholarship on deliberation, judgment and rhetoric, I highlight both critical and transformative dimensions of the performance. I attribute these to the vignette's likely reception, which I describe as 'dissonant' - unresolved, affectively turbulent and aesthetically attuned. I argue that comedy is uniquely positioned to spur such 'dissonant' modes of engagement and, in so doing, to promote acknowledgement and reflective judgment., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

In this article, we examine the ways in which the notion of interdisciplinarity was understood, implemented and experienced by researchers at a government-funded Chilean climate research centre. Our multi-site ethnography, consisting of interviews, participant observations, and document analysis, was motivated by three key aims. First, to generate an inductive, multi-faceted picture of the lived meaning of "interdisciplina" at the Centre; second, to explore whether and to what extent the "peripheral" features of the research context would exacerbate the challenges associated with practicing interdisciplinarity, and third, to see whether frictions between disciplines at the Centre could be considered productive "dissonances" in Stark's sense of the term. We found that despite the centre efforts to produce a common framework to regulate interdisciplinary research, its researchers nevertheless understood, enacted and experienced it in diverse ways. More specifically, we found that researcher´s conceptions of interdisciplinarity were coloured by their lived experiences of attempting to practice it, and in particular by the benefits and costs they associated with doing so. This in turn was linked to several variables, including the specific balance between disciplines, the absence or presence of shared, clearly-defined goals, the affirmation of a common research ethic or motivational commitment, and the structural-material conditions of the research in question. We also found that the research conditions characteristic of the Global South do tend to exacerbate the well-documented challenges associated with interdisciplinarity, yet that the adversities associated with precarious conditions were often met by increased resilience and bonding among researchers, who use creative and collaborative strategies to adapt to adversity., (© The Author(s), under exclusive licence to Springer Nature B.V. 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Findings from brain imaging studies with small samples can show limited reproducibility. Thus, we tested whether the evidence that a transdiagnostic eating disorder treatment reduces responsivity of brain valuation regions to thin models and high-calorie binge foods, the intervention targets, from a smaller earlier trial emerged when we recruited additional participants., Methods: Women with DSM-5 eating disorders ( N = 138) were randomized to the dissonance-based body project treatment (BPT) or a waitlist control condition and completed functional magnetic resonance imaging (fMRI) scans assessing neural response to thin models and high-calorie foods at pretest and posttest., Results: BPT v. control participants showed significantly greater reductions in responsivity of regions implicated in reward valuation (caudate) and attentional motivation (precuneus) to thin v. average-weight models, echoing findings from the smaller sample. Data from this larger sample also provided novel evidence that BPT v. control participants showed greater reductions in responsivity of regions implicated in reward valuation (ventrolateral prefrontal cortex) and food craving (hippocampus) to high-calorie binge foods v. low-calorie foods, as well as significantly greater reductions in eating disorder symptoms, abstinence from binge eating and purging behaviors, palatability ratings for high calorie foods, monetary value for high-calorie binge foods, and significantly greater increases in attractiveness ratings of average weight models., Conclusions: Results from this larger sample provide evidence that BPT reduces valuation of the thin ideal and high-calorie binge foods, the intervention targets, per objective brain imaging data, and produces clinically meaningful reductions in eating pathology.

Background: Melanoma is the second most common cancer in young adults. Social media may be a means to conduct interventions to increase sun safety in young adults., Purpose: We conducted a randomized proof-of-concept pilot trial to evaluate the feasibility and acceptability of a dissonance-based social media intervention designed to promote sun safety in young adult tanners., Methods: Young adult tanners (N = 66) were randomized into two 4-week interventions in which participants were incentivized to create content for a social media campaign on healthy skin or healthy lifestyle. Feasibility outcomes included retention, participation, acceptability, and contamination. We also examined the impact of participation on motivation to engage in the target health behaviors and outdoor tanning intentions., Results: Retention was 100%. Most Healthy Skin (88%) and Healthy Lifestyle participants (91%) created ≥1 post. Acceptability was high with 94% and 97% of participants in Healthy Skin and Healthy Lifestyle conditions, respectively, agreeing they would recommend the campaign to a friend. At 4 weeks, Healthy Skin participants reported greater declines in motivation to tan indoors (p = .0017) and outdoors (p = .0003), and greater increases in motivation to wear sunscreen (p = .0009) and protective clothing (p = .0342). Healthy Skin participants reported greater declines in intentions to tan outdoors in the next year (p = .0286)., Conclusions: A dissonance-based, social media sun safety intervention was feasible and acceptable. Future research should examine the efficacy and longer-term effects of this intervention in young adults at elevated risk for skin cancer., Trial Registration: Clinicaltrials.gov NCT03834974 https://clinicaltrials.gov/ct2/show/NCT03834974., (© Society of Behavioral Medicine 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The perception of consonance and dissonance in intervals and chords is influenced by psychoacoustic and cultural factors. Past research has provided conflicting observations about the role of frequency in assessing musical consonance that may stem from comparisons of limited frequency bands without much theorizing or modeling. Here we examine the effect of register on perceptual consonance of chords. Based on two acoustic principles, we predict a decrease in consonance at low frequencies (roughness) and a decrease of consonance at high frequencies (sharpness). Due to these two separate principles, we hypothesize that frequency will have a curvilinear impact on consonance. A selection of tetrads varying in consonance were presented in seven registers spanning 30 to 2600 Hz. Fifty-five participants rated the stimuli in an online experiment. The effect of register on consonance ratings was clear and largely according to the predictions; The low registers impacted consonance negatively and the highest two registers also received significantly lower consonance ratings than the middle registers. The impact of register on consonance could be accurately described with a cubic relationship. Overall, the influence of roughness was more pronounced on consonance ratings than sharpness. Together, these findings clarify previous empirical efforts to model the effect of frequency on consonance through basic acoustic principles. They further suggest that a credible account of consonance and dissonance in music needs to incorporate register., (© 2021. The Author(s).)

Animal minds are of central importance to debates about their rights and welfare. Remaining ignorant of evidence that animals have minds is therefore likely to facilitate their mistreatment. Studying samples of adults and students from the UK and US we found that, consistent with motivational perspectives on meat consumption, those who were more (vs. less) committed to eating meat were more motivated to avoid exposure to information about food-animals' sentience (Studies 1), showed less interest in exposure to articles about intelligent food animals (Studies 2a and 2b), and were quicker to terminate exposure to internet pop-ups containing information about food-animals' minds (Studies 3a and 3b). At the same time, those who were more (vs. less) committed to eating meat approached information about companion-animals' minds (Studies 2a-3b) and unintelligent food animals (Studies 2a and 2b) in largely the same ways. The findings demonstrate that, within the UK and US, the desire to eat meat is associated with strategies to avoid information that is likely to challenge meat consumption., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

An incongruity between what is said and done can be harmful. Cultivating consonance is a place to bring organizations and nurses together.

Sexual minority adolescents from religious contexts may be at high risk of mental health issues due to religious identity dissonance. This study investigated the cognitive strategies used to manage antihomosexual religious messages and resolve religious identity dissonance among sexual minority adolescents. In 2014, 46 adolescents were interviewed in Los Angeles, CA. Youths were prompted to discuss experiences with religion, antihomosexual messages, and their strategies for managing these messages. Ninety-one percent of the sample reported hearing antihomosexual religious messages. Messages came from multiple sources (e.g., parents, pastors) and contained three types of content (i.e., creation, sin, and afterlife). A quarter of the sample reported religious identity dissonance. Three primary strategies to manage antihomosexual messages emerged. Findings indicate that all youths, including nonreligious youths, use cognitive strategies to manage negative messages and that these strategies relate to current religious identification.

The majority of research in the field of music perception has been conducted with Western participants, and it has remained unclear which aspects of music perception are culture dependent, and which are universal. The current study compared how participants unfamiliar with Western music (people from the Khowar and Kalash tribes native to Northwest Pakistan with minimal exposure to Western music) perceive affect (positive versus negative) in musical chords compared with United Kingdom (UK) listeners, as well as the overall preference for these chords. The stimuli consisted of four distinct chord types (major, minor, augmented, and chromatic) and were played as both vertical blocks (pitches presented concurrently) and arpeggios (pitches presented successively). The results suggest that the Western listener major-positive minor-negative affective distinction is opposite for Northwest Pakistani listeners, arguably because of the reversed prevalence of these chords in the two music cultures. The aversion to the harsh dissonance of the chromatic cluster is present cross-culturally, but the preference for the consonance of the major triad varies between UK and Northwest Pakistani listeners, depending on cultural familiarity. Our findings imply not only notable cultural variation but also commonalities in chord perception across Western and non-Western listeners., (© 2020 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals LLC on behalf of New York Academy of Sciences.)

Self-compassion interventions have been suggested as a potentially more acceptable way to address body image distress compared to interventions that emphasize challenging (often firmly entrenched) thin-ideals. In the current randomized controlled trial, young adult women endorsing body image concerns were randomized to a self-compassion (SC) intervention consisting of one in-person session plus one week of self-guided practice (n = 50), a similarly-structured dissonance-based (DB) intervention (n = 50), or a waitlist (WL) control (n = 51). Both brief interventions were acceptable and were more effective than WL. The two interventions did not differ significantly from each other in reducing the global measure of body dissatisfaction, improving body appreciation, or reducing appearance-contingent self-worth. The DB intervention alone decreased thin-ideal internalization, but only among participants with initially high scores. More participants initially expressed a preference for the SC rationale, and at post-test SC participants reported a higher likelihood of recommending the intervention they had received to others. Change in self-compassion emerged as a possible mechanism of action within both interventions, suggesting it may be useful to integrate aspects of both approaches to enhance acceptability and provide the greatest benefits., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

There is growing evidence demonstrating that nursing students encounter unsafe and poor clinical practice when on clinical placement. The impact on nursing students remains relatively under-explored, especially in the Australian context. This two-phased qualitative study used Interpretive Description to explore 53 pre-registration nursing students' perceptions and experiences of speaking up for patient safety. Results of the study identified students believe speaking up is the right thing to do, and their professional responsibility. The study results add to previous research by describing the dissonance students experience due to the inconsistencies between what is taught at university and performed in practice. Student's distress arises when observing nurses taking short cuts, justifying such actions and making excuses about poor practice. Students report experiencing dissonance, bewilderment and confusion and at times, anger when observing poor practice. The clinical environment culture influences students' decisions to speak up or remain silent. Understanding students' perceptions and responses will promote awareness and discussion essential to the future development of curricula and clinical support strategies that will enable students to speak up., (© 2020 John Wiley & Sons Ltd.)

Clinical trials routinely involve multiple hypothesis testing. The closed testing procedure (CTP) is a fundamental principle in testing multiple hypotheses. This article presents an improved CTP in which intersection hypotheses can be tested at a level greater than α such that the control of the familywise error rate at level α remains. Consequently, our method uniformly improves the power of discovering false hypotheses over the original CTP. We illustrate that an improvement by our method exists for many commonly used tests. An empirical study on the effectiveness of a glucose-lowering drug is provided., (© 2020 John Wiley & Sons, Ltd.)

In tonal music, musical tension is strongly associated with musical expression, particularly with expectations and emotions. Most listeners are able to perceive musical tension subjectively, yet musical tension is difficult to be measured objectively, as it is connected with musical parameters such as rhythm, dynamics, melody, harmony, and timbre. Musical tension specifically associated with melodic and harmonic motion is called tonal tension. In this article, we are interested in perceived changes of tonal tension over time for chord progressions, dubbed tonal tension profiles . We propose an objective measure capable of capturing tension profile according to different tonal music parameters, namely, tonal distance, dissonance, voice leading, and hierarchical tension. We performed two experiments to validate the proposed model of tonal tension profile and compared against Lerdahl's model and MorpheuS across 12 chord progressions. Our results show that the considered four tonal parameters contribute differently to the perception of tonal tension. In our model, their relative importance adopts the following weights, summing to unity: dissonance (0.402), hierarchical tension (0.246), tonal distance (0.202), and voice leading (0.193). The assumption that listeners perceive global changes in tonal tension as prototypical profiles is strongly suggested in our results, which outperform the state-of-the-art models.

Aims: To examine whether compensatory health beliefs (CHB) on breastfeeding vary as a function of breastfeeding status among mothers of infants., Methods: Participants included 773 women aged 18 and older (M = 32.8) who gave birth in the last two years; 445 were breastfeeding exclusively, 165 were breastfeeding partially, and 163 were not breastfeeding. They responded to a survey posted on social media sites' closed groups that focused on post-natal issues. Design was cross-sectional, with CHB as the outcome variable (14 items) and demographics and feeding status as the explanatory variables., Results: The internal reliability of the CHB scale was α = 0.87. There was a statistically significant difference in the level of CHB between non-breastfeeding women, breastfeeding women, and women who combined breastfeeding with infant formula, so that non- breastfeeding women had the highest level of CHB. There was no significant difference in CHB by either birth experience or demographic characteristics., Conclusion: This study extended CHB to breastfeeding, documenting the minimization of the disadvantages of not breastfeeding by non-breastfeeding women, attempting to neutralize or reduce the cognitive dissonance between non-nursing and optimal infant care. Possible uses of the scale for counselling were suggested, both in the prenatal and post-natal period, proactively bringing forward and addressing ambivalence towards breastfeeding.

Background: Previous studies have shown that music preferences are influenced by cultural "rules", and some others have suggested a universal preference for some features over others., Methods: We investigated cultural differences on the "consonance effect", consisting in higher pleasantness judgments for consonant compared to dissonant chords-according to the Western definition of music: Italian and Himalayan participants were asked to express pleasantness judgments for consonant and dissonant chords. An Italian and a Nepalese sample were tested both at 1,450 m and at 4,750 m of altitude, with the further aim to evaluate the effect of hypoxia on this task. A third sample consisted of two subgroups of Sherpas: lowlanders (1,450 m of altitude), often exposed to Western music, and highlanders (3,427 m of altitude), less exposed to Western music. All Sherpas were tested where they lived., Results: Independently from the altitude, results confirmed the consonance effect in the Italian sample, and the absence of such effect in the Nepalese sample. Lowlander Sherpas revealed the consonance effect, but highlander Sherpas did not show this effect., Conclusions: Results of this pilot study show that neither hypoxia (altitude), nor demographic features (age, schooling, or playing music), nor ethnicity per se influence the consonance effect. We conclude that music preferences are attributable to music exposure., Competing Interests: Luca Tommasi is an Academic Editor for PeerJ, (© 2020 Prete et al.)

In major-minor tonal music, the hierarchical relationships and patterns of tension/release are essential for its composition and experience. For most listeners, tension leads to an expectation of resolution. Thus, when musical expectations are broken, they are usually perceived as erroneous and elicit specific neural responses such as the early right anterior negativity (ERAN). In the present study, we explored if different degrees of musical violations are processed differently after long-term musical training in comparison to day-to-day exposure. We registered the ERPs elicited by listening to unexpected chords in both musicians and nonmusicians. More specifically, we compared the responses of strong violations by unexpected dissonant endings and mild violations by unexpected but consonant endings (Neapolitan chords). Our results show that, irrespective of training, irregular endings elicited the ERAN. However, the ERAN for dissonant endings was larger in musicians than in nonmusicians. More importantly, we observed a modulation of the neural responses by the degree of violation only in musicians. In this group, the amplitude of the ERAN was larger for strong than for mild violations. These results suggest an early sensitivity of musicians to dissonance, which is processed as less expected than tonal irregularities. We also found that irregular endings elicited a P3 only in musicians. Our study suggests that, even though violations of harmonic expectancies are detected by all listeners, musical training modulates how different violations of the musical context are processed., (© 2019 Society for Psychophysiological Research.)

Background: Harmony is an important part of tonal music that conveys context, form and emotion. Two notes sounded simultaneously form a harmonic interval. In normal-hearing (NH) listeners, some harmonic intervals (e.g., minor 2nd, tritone, major 7th) typically sound more dissonant than others (e.g., octave, major 3rd, 4th). Because of the limited spectro-temporal resolution afforded by cochlear implants (CIs), music perception is generally poor. However, CI users may still be sensitive to relative dissonance across intervals. In this study, dissonance ratings for harmonic intervals were measured in 11 unilaterally deaf CI patients, in whom ratings from the CI could be compared to those from the normal ear., Methods: Stimuli consisted of pairs of equal amplitude MIDI piano tones. Intervals spanned a range of two octaves relative to two root notes (F3 or C4). Dissonance was assessed in terms of subjective pleasantness ratings for intervals presented to the NH ear alone, the CI ear alone, and both ears together (NH + CI). Ratings were collected for both root notes for within- and across-octave intervals (1-12 and 13-24 semitones). Participants rated the pleasantness of each interval by clicking on a line anchored with "least pleasant" and "most pleasant." A follow-up experiment repeated the task with a smaller stimulus set., Results: With NH-only listening, within-octave intervals minor 2nd, major 2nd, and major 7th were rated least pleasant; major 3rd, 5th, and octave were rated most pleasant. Across-octave counterparts were similarly rated. With CI-only listening, ratings were consistently lower and showed a reduced range. Mean ratings were highly correlated between NH-only and CI-only listening ( r = 0.845, p < 0.001). Ratings were similar between NH-only and NH + CI listening, with no significant binaural enhancement/interference. The follow-up tests showed that ratings were reliable for the least and most pleasant intervals., Discussion: Although pleasantness ratings were less differentiated for the CI ear than the NH ear, there were similarities between the two listening modes. Given the lack of spectro-temporal detail needed for harmonicity-based distinctions, temporal envelope interactions (within and across channels) associated with a perception of roughness may contribute to dissonance perception for harmonic intervals with CI-only listening.

Adolescence represents a high-risk period for eating disorder development, and there is great need for effective prevention programs targeted at this population. The Body Project, a dissonance-based eating disorder prevention program, has robust literature showing reductions in body dissatisfaction and eating disorder symptoms. However, many additional factors (i.e., comorbid symptoms, transdiagnostic factors) have not yet been examined in relation to the Body Project. Additionally, there is little known about how to most effectively and broadly disseminate this intervention. The current study (N = 332 adolescents) examines eating disorder symptoms, comorbidities, and transdiagnostic risk factors pre- and post-Body Project and at 1-month follow-up. This study is the first examination of the effectiveness of the Body Project implemented within school programming in southern, all-female high schools. Social appearance anxiety, physical and social anxiety sensitivity, rumination, worry, perfectionism, and guilt, but not depression, cognitive anxiety sensitivity, shame, or exercise dependence, decreased pre- to post-intervention and/or 1-month follow-up. These results support the effectiveness of the Body Project in addressing eating disorder symptoms and suggest it may aid in the prevention of comorbid conditions. Additionally, the effectiveness of the intervention was comparable to past investigations, supporting its use in schools across the United States., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Few trials have investigated factors that moderate the effects of eating disorder and obesity prevention programs, which may inform inclusion criteria and intervention refinements. We examined factors hypothesized to moderate the effects of the Healthy Weight eating disorder/obesity prevention program that promotes gradual healthy changes, and Project Health that adds cognitive dissonance activities. College students at risk for both outcomes because of weight concerns (N = 364, 72% female) were randomized to these interventions or an educational video condition, completing pretest, posttest, and 6, 12, and 24-month follow-up assessments. Healthy Weight and Project Health produced significantly larger reductions in eating disorder symptoms versus video controls for individuals with higher negative affect, emotional eating, dietary fat/sugar intake, and perceived pressure to be thin. Project Health also produced significantly less increases in BMI versus video controls for individuals with lower negative affect. Results suggest that these interventions produce larger eating disorder symptom reductions for individuals at elevated risk for eating pathology but hint that weight gain prevention effects may be attenuated by elevated negative affect. Results imply that larger eating disorder symptom reductions will result when implemented with individuals with both weight concerns and one of the additionally identified risk factors., (Copyright © 2019. Published by Elsevier Ltd.)

Background: Given that most young women with eating disorders do not receive treatment, implementing effective prevention programs is a public health priority. The Body Project is a group-based eating disorder prevention program with evidence of both efficacy and effectiveness. This trial evaluated the efficacy of this prevention program with Brazilian girls, as no published study has tested whether this intervention is culturally sensitive and efficacious with Latin-American adolescents., Methods: Female students were allocated to a dissonance-based intervention (n = 40) or assessment-only (n = 22) condition. The intervention was a dissonance-based program, consisted of four group sessions aimed to reduce thin-ideal internalization. The sessions included verbal, written, and behavioral exercises. The intervention group was evaluated at pretest and posttest; assessment-only controls completed measures at parallel times., Results: Compared to assessment-only controls, intervention participants showed a significantly greater reduction in body dissatisfaction, sociocultural influence of the media, depressive symptoms, negative affect, as well as significantly greater increases in body appreciation. There were no significant effects for disordered eating attitudes and eating disorder symptoms., Conclusions: These results suggest that this dissonance-based eating disorder prevention program was culturally sensitive, or at least culturally adaptive, and efficacious with Brazilian female adolescents. Indeed, the average effect size was slightly larger than has been observed in the large efficacy trial of this prevention program and in recent meta-analytic reviews., Trial Registration: RBR-7prdf2 . Registered 13 August 2018 (retrospectively registered).

Meat consumption is conflicted, because meat provides pleasure to many people, but it also causes animals to suffer. This so-called meat paradox elicits discomfort in meat-eaters and they try to reduce their discomfort, for example, by means of moral disengagement. In the present investigation, we tried to scrutinize this process and examine the boundary conditions that increase moral disengagement. We assumed that, due to a domain general action-oriented state, people tend to resolve the meat paradox via moral disengagement, even if inconsistency is elicited in a different, not food-related domain. Two experiments were conducted, in which we assessed people's moral disengagement efforts via ambivalence measures after we induced inconsistency using different threats in meat-unrelated domains. Supporting our assumptions, people showed reduced ambivalence towards food in affective priming (Experiment 1) and Mouse-Tracker tasks (Experiment 2) after experiencing inconsistency. In fact, plant-based dishes became more positive and meat dishes more negative after inconsistency was induced, indicating that people disguise their endorsement of meat. This provides first convergent evidence that an inconsistency induced action-oriented state may influence cognitions regarding the meat paradox., (Copyright © 2019. Published by Elsevier Ltd.)

Previous research demonstrates that biomedicalisation and diagnostic processes are intertwined in American mental health care, but few studies examine practitioners' negotiations. This study examines how Mental Health Practitioners (MHPs) negotiate the Diagnostic and Statistical Manual (DSM), diagnosis, standardisation and biomedicalisation-in-practice. Feminist grounded theory analysis of 42 semi-structured interviews with licensed adolescent MHPs reveals accounts of discursive, everyday resistance to the DSM technology and standardisation, which I regard as key aspects of biomedicalisation. Findings demonstrate MHPs seemingly practice what I term diagnostic dissonance: a deep conflict between their professional theoretical orientations and the biomedical model legitimated in the DSM technology and insurers' diagnostic standardisation. MHPs enact dissonance by undermining the DSM, working around standardisation and by coding the social. Coding the social refers to the employment of V-codes - illegitimate secondary diagnoses - which convey social and relational conditions of mental distress. MHPs' contestations of the DSM and standardisation are responses to a healthcare infrastructure that decontextualises mental health. Practitioner resistance to biomedicalisation-in-diagnosis is important because the biomedicalisation of mental health takes focus away from the social and relational conditions and solutions to individual and community health and illness., (© 2019 Foundation for the Sociology of Health & Illness.)

Many trials have provided support for dissonance-based eating disorder prevention programs. This meta-analytic review characterized the average intervention effects and tested whether various intervention, participant, and facilitator features correlated with larger effects to guide implementation of optimally effective versions of this program. We identified 56 trials that evaluated 68 dissonance-based eating disorder prevention programs (7808 participants). Average intervention effect sizes (d) relative to minimal intervention control conditions and credible alternative interventions (respectively) were 0.57 and 0.31 for thin-ideal internalization, 0.42 and 0.18 for body dissatisfaction, 0.37 and 0.17 for dieting, 0.29 and 0.21 for negative affect, and 0.31 and 0.13 for eating disorder symptoms. As hypothesized, effects were larger for interventions with more dissonance-inducing activities, more group sessions, and larger group sizes, as well as when delivered in-person versus on-line, sessions were recorded, participation was voluntary, body dissatisfaction was required, participants were mid-adolescents or adults (versus older adolescence), there were more ethnic minority participants, groups were led by clinicians versus researchers and at least two facilitators, and when facilitators received more training and supervision. Unexpectedly from a dissonance-induction perspective, effects were larger when participants were compensated. Results offer directions for maximizing the benefits of implementation efforts with dissonance-based eating disorder prevention programs, and may hold lessons for preventing other public health problems with dissonance-based interventions., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: The development of efficacious, cost-effective, and widely accessible programs for the prevention of eating disorders (EDs) is crucial in order to reduce the ED-related burden of illness. Programs using dissonance-based and cognitive behavioral approaches are most effective for the selective prevention of ED. Internet-based delivery is assumed to maximize the reach and impact of preventive efforts. However, the current evidence for Internet-based ED prevention is limited. The present trial evaluates the efficacy and cost-effectiveness of two new interventions (based on dissonance theory and principles of cognitive behavioral therapy (CBT)) that are implemented as add-ons to the existing Internet-based ED prevention program ProYouth., Methods: The trial is one of five sub-projects of the German multicenter consortium ProHEAD. It is a three-arm, parallel, randomized controlled superiority trial. Participants will be randomized to (1) the online program ProYouth (active control condition) or (2) ProYouth plus a structured dissonance-based module or (3) ProYouth plus a CBT-based chat group intervention. As part of ProHEAD, a representative school-based sample of N = 15,000 students (≥ 12 years) will be screened for mental health problems. N = 309 participants at risk for ED (assessed with the Weight Concerns Scale (WCS) and the Short Evaluation of Eating Disorders (SEED)) will be included in the present trial. Online assessments will be conducted at baseline, at end of intervention (6 weeks), at 6 months follow-up, and - as part of ProHEAD - at 12 and 24 months follow-up. The primary outcome is ED-related impairment (assessed with the Child version of the Eating Disorder Examination-Questionnaire (ChEDE-Q)) at the end of the intervention. Secondary outcomes include ED-related symptomatology at follow-up, ED-related stigma, ED-related help-seeking, and acceptance of and compliance with the interventions. For the health economic evaluation data on costs of the interventions, healthcare utilization and health-related quality of life will be assessed., Discussion: This is the first study augmenting a flexible prevention approach such as ProYouth with structured evidence-based modules in order to overcome some of the key limitations in the current practice of ED prevention., Trial Registration: German Clinical Trials Register (DRKS), DRKS00014679 . Registered on 25 April 2018.

Meat consumption elicits highly ambivalent feelings. On the one hand, it is associated with sensory pleasure and tradition; on the other hand, it is linked to moral, ecological, and health-related issues. This conflict is referred to as the meat paradox and it is hypothesized that people who experience the meat paradox resolve resulting discomfort by moral disengagement. However, ambivalence-a central process variable underlying the meat paradox-has never been measured directly, and theorizing on the meat paradox, so far, remains rather elusive. In the present investigation, we assessed meat-related ambivalence by tracking mouse trajectories of people who evaluated meat and plant-based dishes. By using this behavioral measure, our findings support the assumption that omnivores experience greater meat-related ambivalence and use moral disengagement strategies more frequently than non-omnivores. Importantly, our findings also show that experiencing meat-related ambivalence has far-reaching consequences: the larger behavioral ambivalence in omnivores, the higher the use of moral disengagement strategies. Thereby, our findings indicate the importance of ambivalence as a central process variable underlying the meat paradox and highlight how process-orientated research may contribute to our understanding of dietary practices and other potentially harmful behaviors., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Emerging research on implicit bias recognition and management within health professions describes individually focused educational interventions without considering workplace influences. Workplace learning theories highlight how individual agency and workplace structures dynamically interact to produce change within individuals and learning environments. Promoting awareness of individual biases shaped by clinical learning environments may therefore represent a unique type of workplace learning. We sought to explore how individuals and the workplace learning environment interact once awareness of implicit biases are triggered within learners. In accordance with longitudinal case study methodology and informed by constructivist grounded theory, we conducted multiple longitudinal interviews with physician and nurse participants over 12 months. Our results suggest that implicit bias recognition provokes dissonance among participants leading to frustration, and critical questioning of workplace constraints. Once awareness is triggered, participants began reflecting on their biases and engaging in explicit behavioural changes that influenced the perception of structural changes within the learning environment itself. Collaboration, communication and role modeling within teams appeared to facilitate the process as individual and workplace affordances were gradually transformed. Our findings suggest a potential model for understanding how individual learners adaptively reinvent their role in response to disruptions in their learning environment.

Consonant musical intervals tend to be more readily processed than dissonant intervals. In the present study, we explore the neural basis for this difference by registering how the brain responds after changes in consonance and dissonance, and how formal musical training modulates these responses. Event-related brain potentials (ERPs) were registered while participants were presented with sequences of consonant intervals interrupted by a dissonant interval, or sequences of dissonant intervals interrupted by a consonant interval. Participants were musicians and non-musicians. Our results show that brain responses triggered by changes in a consonant context differ from those triggered in a dissonant context. Changes in a sequence of consonant intervals are rapidly processed independently of musical expertise, as revealed by a change-related mismatch negativity (MMN, a component of the ERPs triggered by an odd stimulus in a sequence of stimuli) elicited in both musicians and non-musicians. In contrast, changes in a sequence of dissonant intervals elicited a late MMN only in participants with prolonged musical training. These different neural responses might form the basis for the processing advantages observed for consonance over dissonance and provide information about how formal musical training modulates them., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

There were many anecdotal reports of injuries to humans, animals and plants following the Three Mile Island, Chernobyl and Fukushima accidents that were indicative of radiation exposures that delivered a dose of at least 0.5 Sieverts, but studies that attempted to relate observed increases of cancer rates and other injuries with exposure to the radioactive releases from these accidents have failed to find an association. To resolve this dissonance, it was assumed that an analysis of knowledge about accident releases and health effects gathered from one of these accidents could lead to the identification of an unrecognized exposure that could be inferred to have caused a specific observed injury that required a dose of at least 0.5 Sieverts. Because there is considerably more useful knowledge of reactor releases of radionuclides and observed health effects related to the Three Mile Island accident, that knowledge is analyzed. A relationship is inferred to exist between exposure to particulates in plumes released from the station vent stack and severe prolonged immunosuppression, a known effect of an exposure that delivers a dose of at least 0.5 Sieverts. More than ninety percent of the particulates were comprised of Strontium 89 nuclides, essentially pure beta emitters. Because Strontium is a metal, the nuclides in the particulates were configured as stable crystals which, when coming to rest in body tissue, functioned as intense point sources of chronic beta irradiation. The inference led to the hypothesis "particulates comprised of Strontium 89 nuclides provided the exposure that caused the health effects that were observed following the Three Mile Island accident". The hypothesis was tested for validity against two requirements; that only the humans beneath the plumes, who would have inhaled the particulates, expressed the abrupt and persistent rise in the health parameter Deaths from all Causes that would result from the severe prolonged immunosuppression that follows a 0.5 Sievert dose, and that they expressed the excess cancers that would be expected following organ doses of 0.5 or more Sieverts. These effects were found. The Hypothesis is therefore valid and leads to knowledge of the heretofore unknown mechanisms and effects of low LET beta irradiation by a particulate., (Copyright © 2018. Published by Elsevier Ltd.)

A jazz paradigm is applied to traditional psychotherapy practice, illuminating the links between psychotherapy and the Romantic aesthetic tradition, primarily in the centrality of concepts such as attunement. Modernist disruptions of realism during the early 20 th century, such as jazz, elaborated dissonant and improvisational artistic impulses that brought new vitality to their art forms. The psychotherapeutic relationship also has potential avenues for multilevel and discrepant communication that open possibilities of freedom. However, the limitations imposed by the single channel nature of comprehended language, compared with the capacity of artistic media to express multiple sensory information simultaneously, remain the most significant obstacle to dimensionalizing the psychotherapeutic dialogue. Psychotherapy may have much to gain from embracing some of the concepts underlying the jazz aesthetic., (© 2018 Wiley Periodicals, Inc.)

A majority of people the world over eat meat, yet many of these same people experience discomfort when the meat on their plate is linked to the death of animals. We draw on this common form of moral conflict-the meat-paradox-to develop insights into the ways in which morally troublesome behaviors vanish into the commonplace and every day. Drawing on a motivational analysis, we show how societies may be shaped by attempts to resolve dissonance, in turn protecting their citizens from discomfort associated with their own moral conflicts. To achieve this, we build links between dissonance reduction, habit formation, social influence, and the emergence of social norms and detail how our analysis has implications for understanding immoral behavior and motivations underpinning dehumanization and objectification. Finally, we draw from our motivational analysis to advance new insights into the origins of prejudice and pathways through which prejudice can be maintained and resolved.

Objective: Pressures for men to conform to a lean, muscular ideal have, in part, contributed to eating disorder and muscle dysmorphia symptoms, yet few programs have been developed and empirically evaluated to help men. This study investigated the acceptability and efficacy of a cognitive dissonance-based (DB) intervention in reducing eating disorder and muscle dysmorphia risk factors in men with body dissatisfaction., Method: Men were randomized to a two-session DB intervention (n = 52) or a waitlist control condition (n = 60). Participants completed validated measures assessing eating disorder risk factors preintervention, postintervention, and at 1-month follow-up., Results: Program ratings indicated high acceptability. The DB condition demonstrated greater decreases in body-ideal internalization, dietary restraint, bulimic symptoms, drive for muscularity, and muscle dysmorphia symptoms compared with controls (p values <  .02; between-condition Cohen's d = .30-1.11) from pre- to postintervention. At one-month follow-up, the DB condition demonstrated significantly lower scores for all variables (p values <  .03; between-condition d = .29-1.16). Body-ideal internalization mediated intervention outcomes on bulimic and muscle dysmorphia symptoms., Discussion: Results support the acceptability and efficacy of The Body Project: More Than Muscles up to 1-month postintervention and should be examined against active control conditions., (© 2017 Wiley Periodicals, Inc.)

Music can evoke powerful emotions in listeners. Here we provide the first empirical evidence that the principles of auditory scene analysis and evolutionary theories of emotion are critical to a comprehensive theory of musical emotion. We interpret these data in light of a theoretical framework termed "the source dilemma hypothesis," which predicts that uncertainty in the number, identity or location of sound objects elicits unpleasant emotions by presenting the auditory system with an incoherent percept, thereby motivating listeners to resolve the auditory ambiguity. We describe two experiments in which source location and timbre were manipulated to change uncertainty in the auditory scene. In both experiments, listeners rated tonal and atonal melodies with congruent auditory scene cues as more pleasant than melodies with incongruent auditory scene cues. These data suggest that music's emotive capacity relies in part on the perceptual uncertainty it produces regarding the auditory scene., (Copyright © 2016. Published by Elsevier B.V.)

Aim: This preliminary randomized controlled trial assessed the feasibility of a pilot mindfulness-based intervention with respect to reducing the risk of eating disorders in young women., Methods: Forty-four young adult women with body image concerns (Mage  = 20.57, SD = 3.22) were randomly allocated to a mindfulness-based or a dissonance-based intervention (3 × 1 h weekly sessions), or to assessment-only control. Self-report measures of eating disorder risk factors, symptoms and related psychosocial impairment were compared at baseline, post-intervention, and at 1- and 6-month follow up., Results: At post-intervention, acceptability ratings for both interventions were high. Mindfulness participants demonstrated statistically significant improvements relative to control at post-intervention for weight and shape concern, dietary restraint, thin ideal internalization, eating disorder symptoms and related psychosocial impairment; however, these gains were largely lost over follow up. Dissonance participants did not show statistically significant improvements relative to control on any outcomes, despite small to moderate effect sizes., Conclusions: These preliminary findings demonstrate the acceptability and short-term efficacy of a mindfulness-based approach to reducing the risk of disordered eating in young women. This provides support for the continued evaluation of mindfulness in the prevention and early intervention of eating disorders, with increased efforts to produce maintenance of intervention gains., (© 2014 Wiley Publishing Asia Pty Ltd.)

We evaluated whether task-irrelevant inharmonic music produces greater interference with cognitive performance than task-irrelevant harmonic music. Participants completed either an auditory (Experiment 1) or a visual (Experiment 2) version of the cognitively demanding 2-back task in which they were required to categorize each digit in a sequence of digits as either being a target (a digit also presented two positions earlier in the sequence) or a distractor (all other items). They were concurrently exposed to either task-irrelevant harmonic music (judged to be consonant), task-irrelevant inharmonic music (judged to be dissonant), or no music at all as a distraction. The main finding across both experiments was that performance on the 2-back task was worse when participants were exposed to inharmonic music than when they were exposed to harmonic music. Interestingly, performance on the 2-back task was generally the same regardless of whether harmonic music or no music was played. We suggest that inharmonic, dissonant music interferes with cognitive performance by requiring greater cognitive processing than harmonic, consonant music, and speculate about why this might be.

Low empathy is a criterion for most externalizing disorders, and empathy training is a regular component of treatment for aggressive people, from school bullies to sex offenders. However, recent meta-analytic evidence suggests that current measures of empathy explain only 1% of the variance in aggressive behavior. A new assessment of empathy was developed to more fully represent the empathy construct and better predict important outcomes--particularly aggressive behavior and externalizing psychopathology. Across three independent samples (N = 210-708), the 36-item Affective and Cognitive measure of Empathy (ACME) was internally consistent, structurally reliable, and invariant across sex. The ACME bore significant associations to important outcomes, which were incremental relative to other measures of empathy and generalizable across sex. Importantly, the affective scales of the ACME-particularly a new "Affective Dissonance" scale--yielded moderate to strong associations with aggressive behavior and externalizing disorders. The ACME is a short, reliable, and useful measure of empathy., (© The Author(s) 2015.)

Objective: Gay males have increased risk for eating disorders compared to heterosexual males, establishing a need to develop and empirically evaluate programs to reduce risk for this population. The present study investigated the acceptability and efficacy of a cognitive dissonance-based (DB) intervention (The PRIDE Body Project(©)) in reducing eating disorder risk factors among gay males in a university-based setting., Method: Eighty-seven gay males were randomized to either a 2-session DB intervention (n = 47) or a waitlist control condition (n = 40). Participants completed eating disorder risk factor assessments pre-intervention, post-intervention, and at 4-week follow-up, and those receiving the intervention completed post-treatment acceptability measures., Results: Acceptability ratings were highly favorable. Regarding efficacy, the DB condition was associated with significantly greater decreases in body dissatisfaction, drive for muscularity, self-objectification, partner-objectification, body-ideal internalization, dietary restraint, and bulimic symptoms compared to waitlist control from pre- to post-intervention. Improvements in the DB group were maintained at 4-week follow-up, with the exception of body-ideal internalization. Body-ideal internalization mediated treatment effects on bulimic symptoms., Conclusion: Results support the acceptability and efficacy of The PRIDE Body Project(©) and provide support for theoretical models of eating pathology in gay men., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Previous studies suggested that listening to different types of music may modulate differently psychological mood and physiological responses associated with the induced emotions. In this study the effect of listening to instrumental classical vs. atonal contemporary music was examined in a group of 50 non-expert listeners. The subjects' heart rate and diastolic and systolic blood pressure values were measured while they listened to music of different style and emotional typologies. Pieces were selected by asking a group of composers and conservatory professors to suggest a list of the most emotional music pieces (from Renaissance to present time). A total of 214 suggestions from 20 respondents were received. Then it was asked them to identify which pieces best induced in the listener feelings of agitation, joy or pathos and the number of suggested pieces per style was computed. Atonal pieces were more frequently indicated as agitating, and tonal pieces as joyful. The presence/absence of tonality in a musical piece did not affect the affective dimension of pathos (being touching). Among the most frequently cited six pieces were selected that were comparable for structure and style, to represent each emotion and style. They were equally evaluated as unfamiliar by an independent group of 10 students of the same cohort) and were then used as stimuli for the experimental session in which autonomic parameters were recorded. Overall, listening to atonal music (independent of the pieces' emotional characteristics) was associated with a reduced heart rate (fear bradycardia) and increased blood pressure (both diastolic and systolic), possibly reflecting an increase in alertness and attention, psychological tension, and anxiety. This evidence fits with the results of the esthetical assessment showing how, overall, atonal music is perceived as more agitating and less joyful than tonal one.

Objectives: To identify and describe common sources of dissonance which arise for treating teams in older person's mental health and the strategies for addressing them., Methods: A literature review was conducted with the terms: 'family conflict and treatment team', 'family therapy and old age' and 'family caregiver'., Results: We discuss the importance of an alliance with families regarding older people's mental health, and the contribution of engagement, attachment and family dynamics to dissonance. We offer strategies to prevent and address dissonance., Conclusions: To prevent and manage dissonance, its causes need to be identified and understood. Routinely 'thinking family' first, then 'knowing' and 'hearing' the family are crucial steps to enhancing communication with families., (© The Royal Australian and New Zealand College of Psychiatrists 2015.)

Objective: An efficacy trial found that a dissonance-based prevention program reduced risk factors, eating disorder symptoms, and future eating disorder onset, but smaller effects emerged when high school clinicians recruited students and delivered the program under real-world conditions in an effectiveness trial. The current report describes results at 2- and 3-year follow-up from an effectiveness trial that tested whether a new enhanced dissonance version of this program produced larger effects when college clinicians recruit students and deliver the intervention using improved train and supervision procedures., Method: Young women from eight universities (N = 408, M age = 21.6, SD = 5.64) were randomized to the prevention program or an educational brochure control condition., Results: Dissonance participants showed greater decreases in risk factors, eating disorder symptoms, and psychosocial impairment by 3-year follow-up than controls, but not healthcare utilization, BMI, or eating disorder onset., Conclusions: This novel multisite effectiveness trial found that the enhanced dissonance intervention and improved training and supervision procedures produced an average effect size at 3-year follow-up that was 290% and 160% larger than effects observed in the high school effectiveness trial and efficacy trial respectively. Yet, the lack of eating disorder onset effects may imply that factors beyond pursuit of the thin ideal now contribute to eating disorder onset., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: The footprint of drug distribution is multinational, but the regulatory frameworks supporting drug development, review, and approval remain largely regional. As a result, industry faces regulatory standards that may be complementary, additive, or contradictory, resulting in global regulatory dissonance (GRD)., Methods: Global regulatory dissonance was explored through a case study of drug development (postmenopausal osteoporosis) using survey methodology., Results: In the feedback received, respondents generally agreed that GRD increases the complexity, timelines, and size of registration studies. Dissonant regulatory feedback on proposed labeling, applications, and benefit-risk assessments was also reported. Multiple causes of GRD were identified, including dissonant drug regulatory authority advice, guidelines, benefit-risk assessments, drug approval precedents, medical standards of care, and health technology assessments. Harmonization of guidelines, scientific advice, benefit-risk procedures, and expanded use of mutual recognition agreements were identified as mechanisms thought to reduce GRD., Conclusions: The results suggest that global access to new drugs may be enhanced through a greater understanding of GRD.

The authors conducted a pilot trial of a new dissonance-based group eating disorder treatment designed to be a cost-effective front-line transdiagnostic treatment that could be more widely disseminated than extant individual or family treatments that are more expensive and difficult to deliver. Young women with a DSM-5 eating disorder (N = 72) were randomized to an 8-week dissonance-based Counter Attitudinal Therapy group treatment or a usual care control condition, completing diagnostic interviews and questionnaires at pre, post, and 2-month follow-up. Intent-to-treat analyses revealed that intervention participants showed greater reductions in outcomes than usual care controls in a multivariate multilevel model (χ(2)[6] = 34.1, p < .001), producing large effects for thin-ideal internalization (d = .79), body dissatisfaction (d = 1.14), and blinded interview-assessed eating disorder symptoms (d = .95), and medium effects for dissonance regarding perpetuating the thin ideal (d = .65) and negative affect (d = .55). Midway through this pilot we refined engagement procedures, which was associated with increased effect sizes (e.g., the d for eating disorder symptoms increased from .51 to 2.30). This new group treatment produced large reductions in eating disorder symptoms, which is encouraging because it requires about 1/20th the therapist time necessary for extant individual and family treatments, and has the potential to provide a cost-effective and efficacious approach to reaching the majority of individuals with eating disorders who do not presently received treatment., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Role dissonance is an uncomfortable experience for graduate paramedics, and some blame their university education for the problem. For paramedics the conflict is between identifying as a rescuer and acting largely as a care giver. With vocational pathways into so many uniformed professions closing down in preference for graduate entrants, young new professionals have to negotiate a rapidly changing work culture. Their older colleagues may be challenged and threatened by the new order. For paramedics the problem is compounded by the newness of its place in the tertiary landscape. Since 9/11 young people have been increasingly attracted to rescue roles. Yet in Australia there is increasing need and scope for health workers in remote and aging populations, a preference not immediately attractive to young people hoping for a more heroic future. While the near professions such as nursing have established their discourses around culture, role and pedagogy, paramedics is still trying to chisel its identity. The myths of paramedic glories past tend to add to the confusion of graduates. Due to a lack of empirical studies of non-clinical aspects of paramedicine, a bricolage methodology was used to refresh data from two discrete qualitative research projects conducted in 2011. Both projects had originally been interested in optimal paramedic preceptorship before and after graduation, but neither had explored the implicit theme which revealed the role of rescue experiences in paramedic culture and identity. The bricolage included a new search of literature from near professions and applied new theoretical frameworks to the analysis of the extant data, to demonstrate how storytelling as an element of paramedic collegiality perpetuates rescue stories that are then used to define paramedic work., (Copyright © 2014 Elsevier Ltd. All rights reserved.)