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Contrasting fantasies about the future with reflections on reality that impedes fantasy realization creates a tight link between expectations of success and forming commitments to self-improvement goals. This effect applies to both fantasies about a positive future contrasted with impeding negative reality as well as fantasies about a negative future contrasted with impeding positive reality. In Study 1, with 63 student participants, contrasting positive fantasies about benefiting from a vocational training with negative reflections on reality impeding such benefits led to expectancy-dependent willingness to invest in the training, more so than indulging in the positive future and than dwelling on the negative reality. In Study 2, with 158 high school students from former East Berlin, contrasting negative, xenophobic fantasies about suffering from the influx of immigrants with positive reflections on reality impeding such suffering led to expectancy-dependent tolerance and willingness to integrate the immigrants. Findings are discussed in terms of how mental contrasting facilitates self-improvement and personal development by making people form expectancy-dependent goal commitments to approach positively-perceived as well as negatively-perceived futures. [ABSTRACT FROM AUTHOR]

The article expresses gratitude for the invaluable contributions of peer reviewers in 2023, emphasizing the crucial role of peer review in the foundation of scientific publication.

Background: Benzodiazepines, opioids, proton-pump inhibitors (PPIs), and antibiotics are frequently prescribed inappropriately by primary care physicians (PCPs), without sufficient consideration of alternative options or adverse effects. We hypothesized that distinct groups of PCPs could be identified based on their propensity to prescribe these medications.Objective: To identify PCP groups based on their propensity to prescribe benzodiazepines, opioids, PPIs, and antibiotics, and patient and PCP characteristics associated with identified prescribing patterns.Design: Retrospective cohort study using VA data and latent class regression analyses to identify prescribing patterns among PCPs and examine the association of patient and PCP characteristics with class membership.Participants: A total of 2524 full-time PCPs and their patient panels (n = 2,939,636 patients), from January 1, 2017, to December 31, 2018.Main Measures: We categorized PCPs based on prescribing volume quartiles for the four drug classes, based on total days' supply dispensed of each medication by the PCP to their patients (expressed as days' supply per 1000 panel patient-days). We used latent class analysis to group PCPs based on prescribing and used multinomial logistic regression to examine patient and PCP characteristics associated with latent class membership.Key Results: PCPs were categorized into four groups (latent classes): low intensity (23% of cohort), medium-intensity overall/high-intensity PPI (36%), medium-intensity overall/high-intensity opioid (20%), and high intensity (21%). PCPs in the high-intensity group were predominantly in the highest quartile of prescribers for all four drugs (68% in the highest quartile for benzodiazepine, 86% opioids, 64% PPIs, 62% antibiotics). High-intensity PCPs (vs. low intensity) were substantially less likely to be female (OR: 0.30, 95% CI: 0.21-0.42) or practice in the northeast versus other census regions (OR: 0.10, 95% CI: 0.06-0.17).Conclusions: VA PCPs can be classified into four clearly differentiated groups based on their prescribing of benzodiazepines, opioids, PPIs, and antibiotics, suggesting an underlying typology of prescribing. High-intensity PCPs were more likely to be male. [ABSTRACT FROM AUTHOR]

Several philosophers, known as situationists, have argued that evidence in social psychology threatens to undermine Aristotelian virtue ethics. An impressively large amount of empirical evidence suggests that most people do not consistently act virtuously and lack the ability to exercise rational control over their behavior. Since possessing moral virtues requires these features, situationists have argued that Aristotelianism does not accurately describe the character traits possessed by most people, and so the theory cannot lay claim to various theoretical advantages such as explanatory power and egalitarian character education. In contrast to previous defenses which either downplay the relevance of psychological evidence or revise philosophical conceptions of virtue to fit the data, this paper appeals to previously neglected psychological evidence on self-efficacy and mental contrasting in combination with "non-idealized" interpretations of Aristotelian moral virtue to support the view that the available empirical evidence is compatible with widespread possession of virtuous character. These "non-idealized" interpretations of virtuous character allow for serious deviations from virtuous conduct, especially in the contexts described by the psychology experiments. Furthermore, decades of research on mental contrasting and self-efficacy suggest that subjects in the psychology experiments acted for reasons and possessed the ability to exercise rational control over their behavior. Hence, situationists are mistaken in thinking that, based on the empirical data, Aristotelianism is deprived of various theoretical advantages. [ABSTRACT FROM AUTHOR]

Placenta percreta is the abnormal invasion of the placenta through the myometrium and serosa of the uterus. It is the most invasive of the placenta accreta spectrum followed by placenta increta. This paper presents a case of a maternal and fetal death in the second trimester due to rupture of the uterus at the site of placenta percreta in a C-section scar. Postmortem MRI showed a large hemoperitoneum and thinning of the anterolateral uterine wall. Internal examination revealed two liters of blood in the abdomen and rupture of the anterolateral uterine wall at the site of placenta percreta in a previous C-section scar. Placenta percreta is a rare complication of pregnancy, however, it is becoming more common with the increasing rate of C-section, the most common and significant risk factor. [ABSTRACT FROM AUTHOR]

Depression is responsible for a large burden of disability in the USA. We estimated the prevalence of depression in the New York City (NYC) adult population in 2013-14 and examined associations with demographics, health behaviors, and employment status. Data from the 2013-14 New York City Health and Nutrition Examination Survey, a population-based examination study, were analyzed, and 1459 participants met the inclusion criteria for this analysis. We defined current symptomatic depression by a Patient Health Questionnaire (PHQ-9) score ≥ 10. Overall, 8.3% of NYC adults had current symptomatic depression. New Yorkers with current symptomatic depression were significantly more likely to be female, Latino, and unemployed yet not looking for work; they were also significantly more likely to have less than a high school education and to live in a high-poverty neighborhood. Socioeconomic inequalities in mental health persist in NYC and highlight the need for better diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: The Department of Veterans Affairs (VA) has implemented robust strategies to monitor prescription opioid dispensing, but these strategies have not accounted for opioids prescribed by non-VA providers. State-based prescription drug monitoring programs (PDMPs) are a potential tool to identify VA patients' receipt of opioids from non-VA prescribers, and recent legislation requires their use within VA.Objective: To evaluate VA physicians' perspectives and experiences regarding use of PDMPs to monitor Veterans' receipt of opioids from non-VA prescribers.Design: Qualitative study using semi-structured interviews.Participants: Forty-two VA primary care physicians who prescribed opioids to 15 or more Veterans in 2015. We sampled physicians from two states with PDMPs (Massachusetts and Illinois) and one without prescriber access to a PDMP at the time of the interviews (Pennsylvania).Approach: From February to August 2016, we conducted semi-structured telephone interviews that addressed the following topics regarding PDMPs: overall experiences, barriers to optimal use, and facilitators to improve use.Key Results: VA physicians broadly supported use of PDMPs or desired access to one, while exhibiting varying patterns of PDMP use dictated by state laws and their clinical judgment. Physicians noted administrative burdens and incomplete or unavailable prescribing data as key barriers to PDMP use. To facilitate use, physicians endorsed (1) linking PDMPs with the VA electronic health record, (2) using templated notes to document PDMP use, and (3) delegating routine PDMP queries to ancillary staff.Conclusions: Despite the time and administrative burdens associated with their use, VA physicians in our study broadly supported PDMPs. The application of our findings to ongoing PDMP implementation efforts may strengthen PDMP use both within and outside VA and improve the safe prescribing of opioids. [ABSTRACT FROM AUTHOR]