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The Narrative Categorical Content Analysis toolkit (abbreviated as NarrCat) decomposes narratives into distinct, quantifiable psychological processes. In this study, NarrCat was applied to analyze New Zealand’s historical “Speeches from the Throne” from 1854 to 1913 (68 speeches). Specifically, NarrCat’s cognition, emotion, and intention modules were applied to analyze patterns of psychological perspective, or psychological states, attributed to various groups in the speeches (Māori, British settlers, and British governing elites). This allowed us to examine infrahumanization bias, as denoted by patterns of language, in New Zealand’s governing discourses during colonization. Results showed that Māori were infrahumanized compared with the British settlers overall. However, only British Governing elites were attributed significantly greater agency (i.e., cognition and intention) in inferences of their psychological perspective compared with other groups. Theoretical implications of these findings are discussed through the lens of infrahumanization theory, as well as colonizing discourses like the British Enlightenment and Good Māori–Bad Māori discourse.

Introduction: E-learning is widely used in medical education. To maximize the potential of E-learning tools, every effort should be made to encourage adoption by optimizing usability. We created Learning Moment (LM), a web-based application that integrates principles of asynchronous learning and learning portfolios into a platform on which students can document and share learning experiences that occur during clinical work. We sought to evaluate the usability of LM and identify features that optimize adoption by users. Methods: We implemented LM in August 2016 at a busy, urban, tertiary care emergency department that hosts an emergency medicine residency, robust third and fourth year medical student clerkships as well as a physician assistant student rotation. We conducted a single-center, mix-methods study using the System Usability Scale (SUS) questionnaire and qualitative interviews. We sent e-mail invitations with subsequent reminders to all students who rotated in our emergency medicine clerkship from August 2016 to April 2017 to complete the SUS questionnaire anonymously and to participate in qualitative interviews. We employed purposive sampling to recruit students who used LM during their rotation to participate in our qualitative interviews. We conducted semi-structured interviews with 13 participants (10 individual interviews and one 3-person group interview) between January and March 2017 using an ethnographic approach and utilized a general inductive method to analyze and code for potential themes. Results: Thirty of the seventy students invited to participate completed the SUS questionnaire (Response rate of 42.8%). The mean SUS score is 80.9 (SD 18.2, 80% CI 76.5 – 85.3). The internal consistency of the responses achieved the Cronbach’s Alpha of 0.95. The participants stressed the importance of the following in the adoption of LM: maximal simplicity and usability, compatibility with learning preferences, and department-wide acceptance and integration. Conclusion: The overall perceived usability of LM was high. Our qualitative data revealed important implications for future designers to maximize adoption: include target users in every step of the design and development process to maximize simplicity and usability; build features that cater to a diversity of learning preferences; involve the entire department and find ways to incorporate the tool into the educational infrastructure and daily workflow.

Background Resident attrition negatively affects residents and programs. The incidence of attrition in emergency medicine (EM) and program-specific factors associated with attrition remain unclear. Objective We quantified the percentage of EM residencies affected by attrition between 2007 and 2016 and identified program-specific factors associated with attrition. Methods We performed a retrospective analysis of data derived from the American Medical Association National Graduate Medical Education Census. We defined attrition as any postgraduate who left their residency training program prior to completion. We calculated the percentage of residency programs that experienced attrition and the overall incidence of attrition. We used Fisher's exact tests, Wilcoxon rank sum tests, and t tests, as well as multivariable logistic regression, to identify program-specific factors associated with attrition. Results Between 2007 and 2016, 139 EM residency programs (82%) experienced attrition of at least 1 resident. An average of 23% of EM training programs experienced attrition annually. The incidence of EM resident attrition averaged 0.85% per year. Program-specific factors associated with attrition include 4-year residencies (P = .031), programs with medium class size (P = .0003), more female residents (P = .002), and more female faculty (P = .003). After analysis, only medium class size (compared to small) was associated with attrition (odds ratio = 4.96, 95% confidence interval 1.65–14.91). Conclusions Between 2007 and 2016, while the incidence of resident attrition in EM was low (< 1%), the majority of programs experienced resident attrition. Medium class size (7 to 12 residents) was the only program-specific factor associated with increased attrition.

Progestogens are steroid compounds that have the ability to induce secretory transformation in the endometrium and are utilized in menopausal hormone therapy to prevent endometrial hyperplasia and endometrial cancer. Progestogens can be derived from 21-carbon or 19-carbon steroid cytoskeletons and thus have different properties and metabolic effects beyond the progestational effects on the endometrium. This limited review will focus on the available progestogens utilized in combination hormone therapy including progesterone, medroxyprogesterone acetate, norethindrone, norethindrone acetate, levonorgestrel, and drospirenone. The impact of progestogens on a variety of target tissues including the endometrium, breast, cardiovascular system, brain, and bone, will be reviewed. Last, the current clinical regimens that can be utilized by clinicians will be discussed.

This paper provides a unique perspective for understanding cultural differences: representation similarity - a computational technique that uses pairwise comparisons of units to reveal their representation in higher-order space. By combining individual-level measures of trust across domains and well-being from 13,823 participants across 15 nations with a measure of society-level tightness-looseness, we found that any two countries with more similar tightness-looseness tendencies exhibit higher degrees of representation similarity in national interpersonal trust profiles. Although each individual’s trust profile is generally similar to their nation’s trust profile, the greater similarity between an individual’s and their society’s trust profile predicted a higher level of individual life satisfaction only in loose cultures, but not in tight cultures. Using the framework of representation similarity to explore cross-cultural differences from a multidimensional, multi-national perspective can provide a new and fuller understanding of culture and its influence on human well-being.

Cooperation within and across borders is of paramount importance for the provision of public goods. Parochialism – the tendency to cooperate more with ingroup than outgroup members – limits contributions to global public goods. National parochialism (i.e., greater cooperation among members of the same nation) could vary across nations and has been hypothesized to be associated with rule of law, exposure to world religions, relational mobility and pathogen stress. We conduct an experiment in participants from 42 nations (N = 18,411), and observe cooperation in a prisoner’s dilemma with ingroup, outgroup, and unidentified partners. We observe that national parochialism is a ubiquitous phenomenon: it is present to a similar degree across the nations studied here, is independent of cultural distance, and occurs both when decisions are private or public. These findings inform existing theories of parochialism and suggest it may be an obstacle to the provision of global public goods., National parochialism is the tendency to cooperate more with people of the same nation. In a 42-nations study, the authors show that national parochialism is a pervasive phenomenon, present to a similar degree across all the studied nations, and occurs both when decisions are private or public.

In the fifteen minutes it takes to read this short commentary, more than 400 babies will have been born too early, another 300 expecting mothers will develop preeclampsia, and 75 unborn third trimester fetuses will have died in utero (stillbirth). Given the lack of meaningful progress in understanding the physiological changes that occur to allow a healthy, full term pregnancy, it is perhaps not surprising that effective therapies against these great obstetrical syndromes that include prematurity, preeclampsia, and stillbirth remain elusive. Meanwhile, pregnancy complications remain the leading cause of infant and childhood mortality under age five. Does it have to be this way? What more can we collectively, as a biomedical community, or individually, as clinicians who care for women and newborn babies at high risk for pregnancy complications, do to protect individuals in these extremely vulnerable developmental windows? The problem of pregnancy complications and neonatal mortality is extraordinarily complex, with multiple unique, but complementary perspectives from scientific, epidemiological and public health viewpoints. Herein, we discuss the epidemiology of pregnancy complications, focusing on how the outcome of prior pregnancy impacts the risk of complication in the next pregnancy — and how the fundamental immunological principle of memory may promote this adaptive response.

This study explores the individual- and country-level factors that influence how getting news from social media relates to people’s beliefs about anthropogenic climate change. Concepts of psychological distance and motivated reasoning are tested using multilevel analysis with survey data in 20 countries (N = 18,785). Results suggest that using social media for news is associated with a decrease in climate skepticism across the sample. However, social context at the individual-level (conservative political ideology and low trust in science) and at the macro-level (high gross domestic product and individualism) moderate the effect, and therefore reduce social media’s potential to inform the public about climate change. This study contributes to conversations about the ability of emerging media to address science issues, particularly in developing countries.

The growing importance of social media for getting science news has raised questions about whether these online platforms foster or hinder public trust in science. Employing multilevel modeling, this study leverages a 20-country survey to examine the relationship between social media news use and trust in science. Results show a positive relationship between these variables across countries. Moreover, the between-country variation in this relationship is related to two cultural characteristics of a country, individualism/collectivism and power distance.

Supplemental Digital Content is available in the text, Objective: The aim of the study was to systematically review studies that evaluated endometrial hyperplasia or cancer incidence with unopposed vaginal estrogens. Methods: PubMed and EMBASE were searched from inception to August 2017 for relevant articles and abstracts. Bibliographies of review articles and abstracts of major women's health medical meetings were examined. Eligible studies (independently reviewed by 4 authors) had to report menopausal vaginal estrogen use and endometrial histology, or incidence of endometrial hyperplasia or cancer. Results: Of 5,593 abstracts from the literature search and 47 articles from other sources, 36 articles and 2 abstracts were eligible, describing 20 randomized controlled studies, 8 interventional studies, and 10 observational studies. Collectively, the studies did not support an increased risk of endometrial hyperplasia or cancer with low-dose vaginal estrogens. Rates of endometrial cancer and hyperplasia were 0.03% and 0.4%, respectively, from 20 randomized controlled trials (2,983 women) of vaginal estrogens. Overall, reports of endometrial hyperplasia were observed with various doses and durations and appeared sporadic (except 1.25 mg conjugated equine estrogens), consistent with endometrial hyperplasia rates in the general population. A Denmark registry study was an exception and may be of limited applicability to the United States. The Women's Health Initiative Observational Study showed no association (1.3 cases/1,000 women-years with vaginal estrogens versus 1.0/1,000 women-years for nonuse). Conclusion: This systematic review supports the use of low-dose vaginal estrogens for treating vulvar and vaginal atrophy in menopausal women without a concomitant progestogen. This review does not support increased endometrial hyperplasia or cancer risk with low-dose, unopposed vaginal estrogens; however, longer-term, real-world data are needed.

Objective: In the REPLENISH trial, women receiving TX-001HR—an oral, softgel capsule, combining 17β-estradiol (E2) and progesterone (E2 mg/P4 mg 1/100, 0.5/100), had significantly improved vasomotor symptoms, while having their endometrium protected from hyperplasia. The objective here was to describe P4 levels sufficient to counteract the potential endometrial effects of 1 or 0.5 mg oral E2 with TX-001HR. Methods: In REPLENISH (phase 3; NCT01942668), serum P4, E2, and estrone (E1) levels were characterized in postmenopausal women treated with TX-001HR (E2 mg/P4 mg: 1/100, 0.5/100, [0.5/50, 0.25/50 and placebo not reported here]) at baseline, week 12, and month 12 for P4, and at baseline, weeks 4 and 12, and months 6, 9, and 12 for E2 and E1. In a phase 1 study, pharmacokinetic parameters were assessed after 7 daily doses of oral E2 mg/P4 mg (1/100 and 0.5/100). Results: In REPLENISH (n = 1,835), mean P4 levels were 0.39 to 0.55 ng/mL with 100-mg P4 doses; E2 levels were 42.3 to 45.6 pg/mL and 23.0 to 27.4 pg/mL for the 1-mg and 0.5-mg E2 doses, respectively; E1 levels were 214 to 242 pg/mL and 114 to 129 pg/mL for the 1-mg and 0.5-mg E2 doses. In the phase 1 study (n = 40; day 7), mean Cavg for P4 was 0.66 ng/mL with 100-mg P4 doses; E2 was 38.1 pg/mL and 29.2 pg/mL for 1 mg and 0.5 mg E2, respectively; and E1 was 211 and 106 pg/mL for 1 mg and 0.5 mg E2. All three analytes reached steady state within 7 days; accumulation ratios were 1.36 to 1.94. Conclusions: P4 levels observed with TX-001HR were similar in the phase 1 and 3 studies, and were associated with no endometrial hyperplasia with either E2 daily dose over 1 year in the REPLENISH phase 3 study, which showed significant improvements in menopausal vasomotor symptoms.

Following a survey asking many questions about world history, 6185 students from 35 countries were asked, “What contribution do you think the country you are living in has made to world history?” They provided an estimate from 0 to 100%, where 0% indicated that the country made no contribution to world history and 100% indicated that all contributions came from the country. U.S. students provided an estimate of 30%, quite high in some regards, but modest compared to other countries (e.g., 39% by Malaysians). Country-level estimates varied widely, ranging from 11% (Switzerland) to 61% (Russia). The total estimate (summing for all countries) was 1156%. We argue that students’ exaggerated estimates provide evidence for national narcissism and may be caused by several mechanisms, such as the availability heuristic—when students think about world history, they mostly think about the history of their country and thus assume their country must be important.

Political ideology has been hypothesized to be associated with cooperation and national parochialism (i.e. greater cooperation with members of one's nation), with liberals thought to have more cooperation with strangers and less national parochialism, compared to conservatives. However, previous findings are limited to few—and predominantly western—nations. Here, we present a large-scale cross-societal experiment that can test hypotheses on the relation between political ideology, cooperation and national parochialism around the globe. To do so, we recruited 18 411 participants from 42 nations. Participants made decisions in a prisoner's dilemma game, and we manipulated the nationality of their interaction partner (national ingroup member, national outgroup member or unidentified stranger). We found that liberals, compared to conservatives, displayed slightly greater cooperation, trust in others and greater identification with the world as a whole. Conservatives, however, identified more strongly with their own nation and displayed slightly greater national parochialism in cooperation. Importantly, the association between political ideology and behaviour was significant in nations characterized by higher wealth, stronger rule of law and better government effectiveness. We discuss the implications of these findings for understanding the association between political ideology and cooperation.This article is part of the theme issue ‘The political brain: neurocognitive and computational mechanisms’.

The spread of coronavirus disease 2019 (COVID-19) has affected both physical health and mental well-being around the world. Stress-related reactions, if prolonged, may result in mental health problems. We examined the consequences of the COVID-19 pandemic on mental health in a multinational study and explored the effects of government responses to the outbreak. We sampled 18,171 community adults from 35 countries/societies, stratified by age, gender, and region of residence. Across the 35 societies, 26.6% of participants reported moderate to extremely severe depression symptoms, 28.2% moderate to extremely severe anxiety symptoms, and 18.3% moderate to extremely severe stress symptoms. Coronavirus anxiety comprises two factors, namely Perceived Vulnerability and Threat Response. After controlling for age, gender, and education level, perceived vulnerability predicted higher levels of negative emotional symptoms and psychological distress, whereas threat response predicted higher levels of self-rated health and subjective well-being. People in societies with more stringent control policies had more threat response and reported better subjective health. Coronavirus anxiety exerts detrimental effects on subjective health and well-being, but also has the adaptive function in mobilizing safety behaviors, providing support for an evolutionary perspective on psychological adaptation.

Leading up to the 2017 New Zealand general election, Stuff.co.nz and Massey University collaborated in two online surveys of public opinion to test the mood of the nation and seek opinions about a range of relevant political and social issues. Given their success, two more surveys were conducted in 2020. This article summarises results from the 2020 data, and reflects on the methodological advantages, disadvantages and challenges of conducting people-driven online surveys that need to meet the differing needs of academic researchers, journalists and the public. While the surveys produced very large samples, they were not representative. Moreover, the choices of items were influenced by what happened to be newsworthy at the time. Naturally, Covid-19 was a significant theme during the 2020 surveys. The results reveal predictable left–right polarization of opinions, a minority support for conspiracy theories, some areas of wide agreement across the political spectrum, and some unexpected nuances of opinions within and across ethnic groups.

United Nations and World Health Organization data show a positive correlation, r = .53, p

Progestogens such as micronized progesterone and the synthetic progestins are defined by their ability to transform the estrogen-primed proliferative endometrium into secretory endometrium. More than 200 progestogens have been synthesized, but only a few are used clinically in hormone therapy. Clinicians caring for menopausal women should be familiar with the clinical properties and characteristics of the three most-used progestogens for hormone therapy: micronized progesterone, medroxyprogesterone acetate, and norethindrone acetate.

Objective To predict serum segesterone (SA) and ethinyl estradiol (EE) levels after 364 days of hypothetical continuous use (without removal) of a cyclic contraceptive vaginal system (CVS) containing 0.15 mg SA and 0.013 mg EE. Study design We used pharmacokinetic (PK) data (n = 37) from a multicenter, open-label, nonrandomized study of healthy women (18–38 years) that used the CVS for 13 cycles in a 21 days-in/7 days-out regimen to develop a linear regression model to predict daily serum SA and EE levels for 364 days of continuous CVS use. We then determined residual SA/EE levels in vitro from 18 randomly chosen CVS used by women who completed 13 cycles. Serum SA and EE levels were also predicted for 364 days of continuous CVS use in another in vitro study. Results After a hypothetical 364 days of continuous CVS use, we predicted daily mean serum levels to be 184 pmol/L (95% confidence interval [CI], 102‒332 pmol/L) for SA and 43 pmol/L (95% CI, 19‒95 pmol/L) for EE. We did predict that serum EE levels would not accumulate over time. Residual SA and EE in the CVS were 60% and 80% of the original load after 13 cycles, respectively. Conclusion The predicted serum SA level after 364 days of hypothetical continuous CVS use was comparable to reported levels at which no pregnancy occurred (>100 pmol/L), showing the potential of the CVS for one year of continuous use. Clinical trials on continuous CVS use are planned. Implications Based on statistical modeling, the long-term, user-controlled contraceptive vaginal system containing segesterone acetate and ethinyl estradiol may have the potential to provide effective pregnancy prevention if used continuously (without removal) for one year. Further investigation is warranted.

Objective: To evaluate the effect of a single-capsule, bioidentical 17β-estradiol (E2) and progesterone (P4) hormone therapy on mammograms and breasts in postmenopausal women after 1 year of use. Methods: In the 12-month, phase 3, randomized, double-blind, placebo-controlled, multicenter REPLENISH trial, postmenopausal women (40-65 y) with moderate to severe vasomotor symptoms and a uterus were randomized to four active daily dose groups of E2/P4 (TX-001HR) or a placebo group. Mammograms were performed and read locally at screening (or ≤6 months before first dose) and at study end using BI-RADS classification. Incidence of abnormal mammograms and breast adverse events was evaluated. Results: All but 8 (0.4%) mammograms at screening were normal (BI-RADS 1 or 2). At 1 year, 39 (2.9%) of the 1,340 study-end mammograms were abnormal (BI-RADS 3 or 4); incidence was 1.7% to3.7% with active doses and 3.1% with placebo. Breast cancer incidence was 0.36% with active doses and 0% with placebo. Breast tenderness was reported at frequencies of 2.4% to 10.8% with active doses versus 0.7% with placebo, and led to eight study discontinuations (1.6% of discontinuations in active groups). Conclusions: In this phase 3 trial of a combined E2/P4, results of secondary outcomes suggest that E2/P4 may not be associated with increased risk of abnormal mammograms versus placebo, and the incidence of breast tenderness was low relative to most of the rates reported in other studies using hormone therapy.

This chapter posits that responses to collective victimization that are maladaptive at the intergroup level may be adaptive at the intragroup level. Specifically, the endorsement of conspiracy theories could be seen as an adaptive response in societies that were historically frequently victimized and at the receiving end of actual conspiracies. In such contexts, hypervigilance and mistrust may prevent future victimization. To test this role of history and macro influences more generally on collective victimhood and endorsement of conspiracy theories, the authors use data from nationally representative samples in countries that are at the center or periphery of the global world order (United Kingdom and Spain, Ukraine and Poland, respectively). In peripheral countries with a history of collective victimization, perceived collective victimhood was associated with endorsement of conspiracy theories and mistrust of the government. These relationships were not significant in central countries with a history of imperialism and domination.

The novel, ring-shaped, contraceptive vaginal system (CVS; Annovera™), contains 103 mg of SA and 17.4 mg of EE, and delivers a mean dose of SA 0.15/EE 0.013 mg/day. The CVS was designed to last thirteen cycles in a 21 day-in/7 day-out regimen. Objectives of these analyses were to determine the amount of SA/EE remaining in the CVS after 13 cycles of use and to estimate the SA level in serum after 1 year of continuous use. Residual SA/EE levels from CVS used by women (n=18) for 13 cycles of 21/7 regimen in a phase 3 clinical trial were further analyzed in vitro. Hypothetical SA level in serum after 1 year of continuous use was estimated using data from 39 women who participated in a 13-cycle pharmacokinetic study of the 21/7 CVS regimen. The serum data were used to construct a statistical model for the change in serum SA concentrations from cycle 1 to cycle 13. The data from each individual subject was modeled to estimate the serum SA level based on days of use. Each subject’s model was then used to estimate the serum SA level after 364 days of continuous CVS use. The average of all 364-day values from valid models was then calculated. After 13 cycles of a 21/7 regimen, the amount of SA/EE remaining in the CVS was 61.7 mg/14.0 mg (60%/80% of the original SA/EE load), which established the release of 0.15 mg SA and 0.013 mg EE per day for a total of 273 days. The model predicted that the mean serum SA level after 364 days of continuous use was 71 pmol/L with a lower limit of the 90% CI of 52 pmol/L. A high percentage of SA/EE remained in the CVS after 13 cycles of use. Serum SA levels predicted by the model following 1 year of continuous use were similar to those previously observed (mean 73 pmol/L) at 1 year in a SA silicone implant trial in which there were no reported pregnancies at 1 year (Sivin et al, Contraception. 2004;69:137-144). No pregnancy or PK data with continuous use of the CVS is available at this time. Further study on the continuous use of the CVS is warranted.

The softgel, vaginal 17β-estradiol (E2) insert (TX-004HR) significantly improved the maturation index of the vaginal epithelium, dyspareunia and vaginal dryness in menopausal women with vulvar and vaginal atrophy (VVA) and moderate to severe dyspareunia, without histological changes to the endometrium (Constantine G et al, Menopause 2017;24:409-416). The 4-μg and 10-μg E2 doses were FDA approved as Imvexxy® (TherapeuticsMD, Boca Raton, FL), for the treatment of moderate to severe dyspareunia, a symptom of VVA, due to menopause. The progesterone receptor (PR) is an estrogen-regulated gene with expression that is very sensitive to E2 exposure (Xiao CW and Goff AK, J Reprod Fertil.1999;115:101-109). Endometrial PR expression in the biopsies of women using the softgel vaginal 4-µg E2 insert was used as a marker of E2 exposure to determine whether sufficient E2 applied with the vaginal insert reaches the endometrium to upregulate PR expression. Our hypothesis posits that there would be insufficient E2 from the 4-µg E2 insert to stimulate an increase in endometrial PR expression. In this post hoc analysis of the REJOICE trial, endometrial biopsies from 25 women who had a normal baseline biopsy, an on-therapy biopsy after study day 70, and tissue readings from all pathologists were randomly selected from the 4-µg E2 vaginal insert and placebo groups. Endometrial tissue sections were stained to visualize PR expression using PgR1294 (Agilent; Santa Clara, CA). Cell staining was quantified using a trainable feature-recognition algorithm and mean expression levels between baseline and week 12 were analyzed by 2-sided t-tests. Acceptable PR expression results were available for 22 women in the 4-µg E2 group (three had insufficient tissue for analysis) and 25 women in the placebo group. For the 4-µg E2 group, mean ± SD (pmol/mg) PR expression was 0.455 ± 0.203 at baseline and 0.506 ± 0.226 at week 12. For the placebo group, mean PR expression was 0.579 ± 0.196 at baseline and 0.563 ± 0.213 at week 12. Mean PR expression levels at baseline and week 12 were not significantly different from each other within the 4-µg E2 (P=0.438) or placebo (P=0.783) group. No meaningful difference in endometrial PR expression was observed with the vaginal 4-µg E2 insert at week 12. These data support our hypothesis and the assertion that low-dose, local vaginal E2 exposure with the insert placed in the lower part of the vagina, does not pose an endometrial safety issue in postmenopausal women.

Increasing numbers of women experience early menopause due in part to surgical treatment for benign gynecologic disorders and the rise in risk-reducing bilateral salpingo-oophorectomy in women with BRCA mutations. Unfortunately, the adverse health consequences of early loss of ovarian function accelerate the menopausal state and affect multiple systems, including cardiovascular, neurologic, bone, and connective tissue, and affect quality of life owing to vasomotor symptoms, mood, sleep, and sexual function. Yet many clinicians and women remain reluctant to use hormone therapy because of the Women's Health Initiative's adverse findings, even though they are not applicable to women with early menopause. This review examines the effects of early menopause and highlights the critical role of hormone therapy in this population.

This study examines age and sex differences in human values, with GDP, GGI (Gender Gap Index), and individualism-collectivism as culture-level moderators, using representative data for age and sex across 20 countries with substantial cultural variability (N = 21,362). Cross-sectional findings revealed that all values dimensions varied in importance over the life span and that men and women are slightly different across most life stages. Specifically, older adults scored higher than young adults in values with social (interactive and normative) and central goals (suprapersonal and existence), whereas values with personal goals (excitement and promotion) showed the opposite pattern. In general, women were higher on social and central goals and men were higher on personal goals. Interactions between age and sex showed that men and women were identical in excitement values when young, and in interactive values when old, but there were significant differences between them in almost all other life stages. There was almost no moderation effect of culture, supporting the life span development psychology idea that values reflect a universal pattern of human agency in facing challenges over the life span. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

This chapter comments on commentaries on prospects for a more equitable Global Psychology as envisioned by Kuo-shu Yang. Yang was a quantitative empirical researcher, committed to quantitative survey methods even though he moved away from cross-cultural psychology toward indigenous psychology (IP). His instructive list of do’s and don’t provides a practical guide for constructing indigenous compatibility with decolonizing capabilities. He was committed to inductive research, where different IPs constituting semi-autonomous bodies of knowledge were to be integrated into a greater whole. As noted by commentators, especially Teo and Asfin, this aim is/was not realizable, given the power distribution in actually existing psychology. Yang was deeply committed to psychological science, and had no affinity for the emancipatory approaches advocated by Teo and Asfin, nor a focus on understanding poverty and its psychological correlates, as emphasized by Moghaddam and Kendricks. His goal to construct IP comprehensively suited for Chinese speaking peoples was not fully realizable. But he and his colleagues accomplished much in building a large body of both descriptive and theoretical knowledge, captured in 51 volumes of the journal Indigenous Psychological Research in Chinese Societies. Only time will tell how enduring the legacy of this scientific research will be.

Live streaming is becoming popular and has attracted large numbers of online viewers. It becomes a social commerce venue where streamers can gain commercial benefits from building the relationship with viewers. Before building relationship with more viewers, how to attract more viewers is the essential foundation in the live streaming industry. This article explores and evaluates what strategies and techniques streamers use to attract more viewers through data source triangulation and methodological triangulation. In details, data were collected from streamers’ self-reports, viewers’ self-reports and online actual behavior; interviews, focus groups and online observation were applied, based on the characteristics of data. Through multiple triangulation, we identified three strategies and techniques for attracting viewers: (i) to increase streamer-viewer interactions, (ii) to create synergy with other streamers, and (iii) to conduct self-promotion. Findings were indicated by the popular streamers and verified by both focus groups and online observations. Our paper contributes to understanding streamer-viewer interactions in computer mediated communication. Live streaming platforms also benefit from this study in terms of platform design and marketing.

Background There is limited research on loop drainage (LD) compared to incision and drainage (I&D) for treatment of cutaneous abscesses. We investigated whether LD was noninferior to I&D for abscess resolution and whether there was any difference in repeat ED visits or complication rates between these techniques. Methods We performed a prospective randomized controlled trial, using a convenience sample at an urban academic emergency department (ED). Subjects over 18 years who presented for first-time management of an abscess were eligible. Patients requiring specialist drainage or hospital admission or had previous treatment for the abscess were excluded. Enrolled subjects were seen 2 weeks after treatment for blinded reevaluation of abscess resolution, and the electronic medical record was reviewed for return ED visits/abscess complications. Results Of 2,889 patients screened, 238 subjects consented and were randomized to LD or I&D. Abscess resolution was achieved in 53/65 (81.5%) of patients in the I&D arm, compared to 66/75 (88%) in the LD arm. Fewer patients in the LD group compared to the I&D group returned to the ED for abscess-related management during the following 14 days (37.3% vs 67.1%, p = 0.002). Among returning subjects, there was a significant difference in mean visits per subject between LD and I&D groups (0.5 vs. 1.2, p = 0.001). There were fewer complications among LD than I&D subjects (9.3% vs. 24.6%, p = 0.01). Conclusion Our study provides evidence that LD is noninferior to I&D in achieving complete abscess resolution at 14 days and is associated with fewer return ED visits and fewer complications. This makes it an attractive alternative treatment option for abscesses.

Objectives In response to crowding the use of hallway beds has become an increasingly prevalent practice in Emergency Departments (EDs). There is limited research on whether caring for patients in hallways (HP) is associated with adverse outcomes. The goal of this study was to examine the effects of HP triage on 30 day outcomes for ED return, readmission, and mortality. Methods We performed a retrospective cohort study at an urban, academic ED comparing HPs (defined as HP for ≥30 min) to matched controls triaged to standard ED beds from 9/30/14 to 10/1/15. We analyzed data from the hospital's clinical data warehouse. Matched controls were selected by gender, age, ethnicity, and language. We used McNemar's test to assess the association between triage location and 30 day study outcomes. We also examined adverse outcomes by triage severity using McNemar's test. Results A total of 10,608 HPs were matched to control patients. Compared to controls, HPs had 2.0 times the odds of returning to the ED in 30 days (95% CI: 1.8–2.1), 1.6 times the odds of inpatient readmission (95% CI: 1.4–1.9), and 1.7 times the odds of readmission to observation (95% CI: 1.4–2.0). The odds ratio for mortality in HPs versus controls was 0.80, (95% CI: 0.50–1.3). Conclusions Patients initially triaged to the hallway have an increased odds of 30 day return to the ED, observation and inpatient admission. After adjusting for ESI, the increased odds for return remained similar. The small sample size precluded testing effects of HP status on mortality.

The Global Trust Inventory (GTI), conceptually assessing trust in others ranging from close interpersonal relationships to relationships with government and financial institutions as a whole, was administered to representative online samples in 11 democratic states ( N = 11,917 from Europe, the Americas, and New Zealand). A seven-factor solution had configural, metric, and reasonable scalar invariance in multi-group confirmatory factor analysis. Using latent profile analysis, individual-level measures of trust were derived that complement existing measures of social capital in their impact and implications. Western societies had proportionately more people with high propensity to trust, Catholic/European intermediate, and Latin American societies the least. A High Trust Profile had virtues associated with social capital: greater participation in political discussion, greater elaboration of political thinking, more community engagement, less prejudice, and greater participation in elections. A Low Trust Profile exhibited opposite tendencies. Demographically, high trust was associated with higher self-reported social status, home ownership, older age, and political conservatism. A more complex set of relationships differentiated two intermediate profiles, dubbed Moderate and Low Institutional Trust. Conceptually, the GTI operationalizes a holistic view of trust as a “synthetic force” that holds various aspects of society together, ranging from interpersonal to institutionalized relationships.

In the context of the United States, research shows a positive relationship between network heterogeneity and political expression on social media at the individual level. This study builds on that research, relying on multilevel analysis that (1) leverages a twenty-country comparative survey and (2) includes country-level data on freedom of expression. Results show a positive relationship between network heterogeneity and political expression on social media across countries, but that relationship is stronger where freedom of expression is more limited.

Objectives The objective was to examine emergency medicine (EM) residents' perceptions of gender as it intersects with resuscitation team dynamics and the experience of acquiring resuscitation leadership skills. Methods This was an exploratory, qualitative study using grounded theory and a purposive sample of postgraduate year (PGY) 2-4 EM residents who function as resuscitation team leaders in two urban EM programs. One-on-one interviews were conducted by a single experienced researcher. Audiotaped interviews were transcribed and deidentified by two research assistants. A research team composed of a PhD educational researcher, a research nurse, an MPH research assistant, and an EM resident reviewed the transcripts and coded and analyzed data using MAXQDA v12. Themes and coding schema were discussed until consensus was reached. We used member checking to assess the accuracy of our report and to confirm that the interpretations were fair and representative. Results Theme saturation was reached after interviewing 16 participants: 10 males and 6 females. The three major themes related to gender that emerged included leadership style, gender inequality, and relationship building. Both male and female residents reported that a directive style was more effective when functioning in the resuscitation leadership role. Female residents more often expressed discomfort with a directive style of leadership, preferring a more communicative and collaborative style. Both female and male residents identified several challenges as disproportionately affecting female residents, including negotiating interactions with nurses more and "earning the respect" of the team members. Conclusions Residents acknowledged that additional challenges exist for female residents in becoming resuscitation team leaders. Increasing awareness in residency program leadership is key to affecting change to ensure all residents are trained in a similar manner, while also addressing gender-specific needs of residents where appropriate. We present suggestions for addressing these barriers and incorporating discussion of leadership styles into residency training.

This study tests specific competing hypotheses from social dominance theory/realistic conflict theory (RCT) versus system justification theory about the role of social status. In particular, it examines whether system justification belief and effects are stronger among people with low socioeconomic status, and in less socially developed and unequal nations than among better-off people and countries. A cross-national survey was carried out in 19 nations from the Americas, Western and Eastern Europe, Asia, and Oceania using representative online samples ( N = 14,936, 50.15% women, Mage = 41.61 years). At the individual level, system justification beliefs, right-wing authoritarianism, social dominance orientation, national identification, sociopolitical conservatism, sex, age, and social status were measured. At the national level, the human development index and the Gini index were used. Multilevel analyses performed indicated that results fit better with the social dominance/RCT approach, as system justification was higher in high-status and developed nations; further, associations between legitimizing ideologies and system justification were stronger among high-status people.

Computational simulation is a widely employed methodology to study the dynamic behavior of complex systems. Although common approaches are based either on ordinary differential equations or stochastic differential equations, these techniques make several assumptions which, when it comes to biological processes, could often lead to unrealistic models. Among others, model approaches based on differential equations entangle kinetics and causality, failing when complexity increases, separating knowledge from models, and assuming that the average behavior of the population encompasses any individual deviation. To overcome these limitations, simulations based on the Stochastic Simulation Algorithm (SSA) appear as a suitable approach to model complex biological systems. In this work, we review three different models executed in PISKaS: a rule-based framework to produce multiscale stochastic simulations of complex systems. These models span multiple time and spatial scales ranging from gene regulation up to Game Theory. In the first example, we describe a model of the core regulatory network of gene expression in Escherichia coli highlighting the continuous model improvement capacities of PISKaS. The second example describes a hypothetical outbreak of the Ebola virus occurring in a compartmentalized environment resembling cities and highways. Finally, in the last example, we illustrate a stochastic model for the prisoner's dilemma; a common approach from social sciences describing complex interactions involving trust within human populations. As whole, these models demonstrate the capabilities of PISKaS providing fertile scenarios where to explore the dynamics of complex systems.

Objective: Vulvovaginal atrophy (VVA) is characterized by vaginal changes, dyspareunia, and itching/irritation. Efficacy and safety of a lower-dose estradiol vaginal cream (0.003%) were evaluated in postmenopausal women with VVA-related dyspareunia. Methods: This was a phase 3, randomized, double-blind, placebo-controlled study. Sexually active postmenopausal women with moderate–severe dyspareunia as the most bothersome symptom, ≤5% vaginal superficial cells, and vaginal pH >5.0 were randomized (1:1) to 0.003% estradiol vaginal cream (15 μg estradiol; 0.5 g cream) or placebo (0.5 g cream) applied daily for 2 weeks followed by three applications/week for 10 weeks. Coprimary outcomes were changes in dyspareunia severity, vaginal cytology, and vaginal pH from baseline to final assessment. Additional efficacy outcomes and safety were assessed. Results: A total of 550 participants (average age, 58 y) were randomized. Compared with placebo, estradiol reduced dyspareunia severity (mean change from baseline ± SD: −1.5 ± 1.0 estradiol vs −1.2 ± 0.9 placebo), decreased vaginal pH (−1.36 ± 0.89 vs −0.53 ± 0.92), and improved vaginal cytology (percentage superficial and parabasal cells 10.1 ± 16.7 vs 1.4 ± 6.1 and −48.5 ± 45.1 vs −14.6 ± 39.6; P

Background: Minimally invasive surgery is the preferred approach for performing many gynecologic procedures. Occasionally, supraumbilical port placement may be preferable to optimize visibility and maneuverability although the risks of complications are less well characterized compared to umbilical entry. Methods: We conducted a retrospective review of computed tomograms from 92 patients to evaluate the anatomic considerations for umbilical and supraumbilical port entry based on patient age, body mass index (BMI), parity, abdominal wall thickness, and distance to the great vessels. Results: Supraumbilical entry was not associated with differences in distance to the great vessels compared to the umbilicus. However, supraumbilical location and BMI were associated with greater abdominal wall thickness. Age and BMI were associated with greater distance to the great vessels, while age was associated with thinner abdominal wall. Multiple linear regression confirmed independent effects of age and BMI. No association between parity and distance to retroperitoneal vessels was observed. Conclusion: Younger patients may be at increased risk for great vessel injury and pre-peritoneal insufflation. Obese patients may be at risk for pre-peritoneal insufflation, while patients with BMI < 30, particularly with a skin-to-aorta distance < 7 cm, may be at an increased risk for great vessel injury. Surgeons should consider these factors when considering supraumbilical port entry.

The Treaty of Waitangi (1840), signed between Māori (indigenous people) and the British Crown is today narrated as the foundation of New Zealand’s sovereignty. The theory of history and identity is mobilized to (1) articulate how historical narratives such as the story of the encounter between Māori and Pākehā (European New Zealanders) and the signing and subsequent violation of the Treaty between them furnish symbolic resources and possibility spaces that construct, mobilize, and manage ethnic identities; (2) deploy this historical narrative to make sense of the changes to Māori identity in the 20th century and its status and construction today; (3) consider the implications of this historical trajectory in describing mental health situations for Māori people today, including how indigenous values, processes, and constructs might be employed in mainstream, bicultural, and indigenous spaces (from clinical therapy and community-based interventions to social welfare delivery). Indigenous values such as whanaunganga (family relationships), wairua (spirituality), and whakapapa (geneology) are introduced as indigenous concepts in mental health therapy, and linked to recent initiatives by government and iwi (tribes) to improve health and mental health for Māori through different implementation pathways involving more collectivistic structures.

Author(s): Sheng, Alexander Y.; Sullivan, Ryan; Kleber, Kara; Mitchell, Patricia M.; Liu, James H.; McGreevy, Jolion; McCabe, Kerry; Atema, Annemieke; Schneider, Jeffrey I. | Abstract: Introduction: Experiential learning is crucial for the development of all learners. Literature exploring how and where experiential learning happens in the modern clinical learning environment is sparse. We created a novel, web-based educational tool called “Learning Moment” (LM) to foster experiential learning among our learners. We used data captured by LM as a research database to determine where learning experiences were occuring within our emergency department (ED). We hypothesized that these moments would occur more frequently at the physician workstations as opposed to the bedside.Methods: We implemented LM at a single ED’s medical student clerkship. The platform captured demographic data including the student’s intended specialty and year of training as well as “learning moments,” defined as logs of learner self-selected learning experiences that included the clinical “pearl,” clinical scenario, and location where the “learning moment” occurred. We presented data using descriptive statistics with frequencies and percentages. Locations of learning experiences were stratified by specialty and training level.Results: A total of 323 “learning moments” were logged by 42 registered medical students (29 fourth-year medical students (MS 4) and 13 MS 3 over a six-month period. Over half (52.4%) intended to enter the field of emergency medicine (EM). Of these “learning moments,” 266 included optional location data. The most frequently reported location was patient rooms (135 “learning moments”, 50.8%). Physician workstations hosted the second most frequent “learning moments” (67, 25.2%). EM-bound students reported 43.7% of “learning moments” happening in patient rooms, followed by workstations (32.8%). On the other hand, non EM-bound students reported that 66.3% of “learning moments” occurred in patient rooms and only 8.4% at workstations (pl0.001).Conclusion: LM was implemented within our ED as an innovative, web-based tool to fulfill and optimize the experiential learning cycle for our learners. In our environment, patient rooms represented the most frequent location of “learning moments,” followed by physician workstations. EM-bound students were considerably more likely to document “learning moments” occurring at the workstation and less likely in patient rooms than their non EM-bound colleagues.