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Children with language disorders have higher than average rates of peer relationship problems, suggesting that they are also at risk for loneliness. A review of research' on loneliness as an emotional consequence of peer relationship difficulties in childhood is preceded by a discussion of the particular relevance of this literature for children with language difficulties. Evidence from research on loneliness indicates that peer acceptance. participation in friendship. friendship quality. and victimization by peers each contribute to children's feelings of loneliness at school. Suggestions are made concerning intervention efforts to reduce loneliness for children with language problems. Copyright (c) 1999 by Aspen Publishers, Inc. [ABSTRACT FROM AUTHOR]

Introduction There are projected workforce shortages within anesthesiology exacerbated by an increase in demand for anesthesia services and an aging anesthesia workforce. Given this mismatch, it is critical for the specialty to recruit the next generation of anesthesiologists and understand the factors affecting medical students' decision to apply to anesthesiology. This study aims to evaluate the impact of establishing a new anesthesiology residency program at a single institution on the number of medical students that match into anesthesiology in the subsequent years. Methods A single-center, retrospective longitudinal study examined the number of medical students matching into anesthesiology at a single institution between 2013 and 2023, five years before and after the establishment of an accredited anesthesiology residency program. The data were compared to aggregated data on all US medical student applicants through the National Resident Matching Program. Results The pre-anesthesiology residency match rate (2013-2018) of medical students from Alpert Medical School (AMS) was 2.47% while the post-anesthesiology residency match rate (2019-2023) was 4.30%. This represents a 74% increase in the average proportion of medical students matching into anesthesiology after the start of the residency program compared to a 20% increase nationally over the same time period. The rate of change of AMS matched applicants after the implementation of the AMS anesthesia residency program increased compared to the national applicant pool (p= 0.002). Conclusion The establishment of a new accredited anesthesiology residency program increased the proportion of medical students matching into anesthesiology at the affiliated medical school in the subsequent five years. Exposure to an academic anesthesiology program improves medical student interest and ultimately matches rates in anesthesiology, a vital tool to address the projected shortages in the anesthesiology workforce., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Sawka et al.)

Objectives: It is uncertain whether concurrent mitral valve repair or replacement for moderate or greater secondary mitral regurgitation at the time of coronary artery bypass graft or aortic valve replacement surgery improves long-term survival., Methods: Patients undergoing coronary artery bypass graft and/or aortic valve replacement surgery with moderate or greater secondary mitral regurgitation were reviewed. The effect of concurrent mitral valve repair or replacement upon long-term mortality was assessed while accounting for patient and operative characteristics and mitral regurgitation severity., Results: Of 1,515 patients, 938 underwent coronary artery bypass graft or aortic valve replacement surgery alone and 577 underwent concurrent mitral valve repair or replacement. Concurrent mitral valve repair or replacement did not alter the risk of postoperative mortality for patients with moderate mitral regurgitation (hazard ratio = 0.93; 0.75-1.17) or more-than-moderate mitral regurgitation (hazard ratio = 1.09; 0.74-1.60) in multivariable regression. Patients with more-than-moderate mitral regurgitation undergoing coronary artery bypass graft-only surgery had a survival advantage from concurrent mitral valve repair or replacement in the first two postoperative years ( P  = 0.028) that did not persist beyond that time. Patients who underwent concurrent mitral valve repair or replacement had a higher rate of later mitral valve operation or reoperation over the five subsequent years (1.9% vs. 0.2%; P  = 0.0014) than those who did not., Conclusions: These observations suggest that mitral valve repair or replacement for more-than-moderate mitral regurgitation at the time of coronary artery bypass grafting may be reasonable in a suitably selected coronary artery bypass graft population but not for aortic valve replacement, with or without coronary artery bypass grafting. Our findings are supportive of 2021 European guidelines that severe secondary mitral regurgitation "should" or be "reasonabl[y]" intervened upon at the time of coronary artery bypass grafting but do not support 2020 American guidelines for performing mitral valve repair or replacement concurrent with aortic valve replacement, with or without coronary artery bypass grafting., 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., (© 2023 Asher, Ong, Malapero, Heydarpour, Malzberg, Shahram, Nguyen, Shook, Shernan, Shekar, Kaneko, Citro, Muehlschlegel and Body.)

Building on social needs theory (Weiss, 1974), this study introduces the construct of classroom provision richness and examines the association between the exchange of social provisions among children in classrooms and children's feelings of loneliness in school. We examined the receipt of provisions from reciprocally nominated friends versus unilateral (one-sided) and non-friend classmates and examined associations between social provisions and loneliness at the child and classroom levels. Participants were 998 third- through fifth-grade children (468 girls, 530 boys; 88.5% White) in 38 classrooms who indicated which classmates they played with, helped, validated, and provided opportunities for self-disclosure. In addition to the social provisions nomination measure, children responded to (a) a measure of loneliness that avoided content overlapping with social provisions, (b) a rating-scale sociometric measure of peer acceptance, and (c) a measure that asked them to indicate which classmates engaged in prosocial, aggressive, or withdrawn-type behaviors. Multilevel analyses indicated that social provisions received from reciprocal friends and from unilateral-received friends were associated with children's feelings of loneliness in school. Furthermore, a measure of the provision richness of classrooms moderated the association between child-level provisions received and feelings of loneliness, such that children who received fewer provisions were less lonely in classrooms that were more provision-rich. Classroom provision richness was also associated with the general level of prosocial behavior and peer acceptance in the classroom. Together, findings suggest that efforts to foster the exchange of social provisions in classrooms could reduce loneliness and facilitate a more caring classroom environment., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.)

Objectives: Functional mitral regurgitation (MR) is observed with ischaemic heart disease or aortic valve disease. Assessing the value of mitral valve repair or replacement (MVR/P) is complicated by frequent discordance between preoperative transthoracic echocardiographic (pTTE) and intraoperative transoesophageal echocardiographic (iTOE) assessment of MR severity. We examined the association of pTTE and iTOE with postoperative mortality in patients with or without MR, at the time of coronary artery bypass grafting (CABG) and/or aortic valve replacement without MVR/P., Methods: Medical records of 6629 patients undergoing CABG and/or aortic valve replacement surgery with or without functional MR and who did not undergo MVR/P were reviewed. MR severity assessed by pTTE and iTOE were examined for association with postoperative mortality using proportional hazards regression while accounting for patient and operative characteristics., Results: In 72% of 709 patients with clinically significant (moderate or greater) functional MR detected by pTTE, iTOE performed after induction of anaesthesia demonstrated a reduction in MR severity, while 2% of patients had increased severity of MR by iTOE. iTOE assessment of MR was better associated with long-term postoperative mortality than pTTE in patients with moderate MR [hazard ratio (HR) 1.31 (1.11-1.55) vs 1.02 (0.89-1.17), P-value for comparison of HR 0.025] but was not different for more than moderate MR [1.43 (0.96-2.14) vs 1.27 (0.80-2.02)]., Conclusions: In patients undergoing CABG and/or aortic valve replacement without MVR/P, these findings support intraoperative reassessment of MR severity by iTOE as an adjunct to pTTE in the prediction of mortality. Alone, these findings do not yet provide evidence for an operative strategy., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

In order to better understand why some children retaliate when they feel provoked and others do not, the present study identified "pacifistically-oriented" children who made negative interpretations in response to unambiguous provocations, yet did not endorse revenge goals, and compared them to "revenge-seeking" children who also made negative interpretations but did endorse revenge goals. Groups were identified based on seventh graders' (N = 367; 54.77% male; 22.89% racial/ethnic minority) responses to hypothetical situations in which a peer excluded and insulted them. Comparing these groups revealed that Pacifists endorsed relationship-maintaining goals and emotion regulation goals more highly than Revenge-Seekers. Revenge-Seekers reported more anger and endorsed beliefs about negative reciprocity and aggression being legitimate more highly than Pacifists. Additionally, Revenge-Seekers were more disrespect sensitive than were Pacifists, based on a measure of vigilance for signs of disrespect and expectations that others would disrespect them. Together these findings point to social-cognitive and emotion-related processes that may inhibit revenge-seeking in unambiguous provocation situations, even when children interpret the peer's behavior quite negatively.

Self-assessment is a critical skill for health care professionals. Because these professionals must be lifelong, self-directed learners and self-regulating practitioners, the ability to self-assess is essential for them. The aims of this study were to measure how dental students self-assessed and peer-assessed their performance in preclinical operative procedures and to evaluate any relationship between their assessment ability and preclinical skills or academic performance. The study was conducted from 2015 to 2016. Third-year students at Harvard School of Dental Medicine self-assessed their work on four preclinical practical exams: Class II amalgam preparation, Class II amalgam restoration, Class III composite preparation, and Class III composite restoration. Three faculty members graded the same preparations and restorations. The difference between the students' self-assessment and the mean faculty assessment was calculated as the student-faculty (S-F) gap. An absolute S-F gap was also calculated with absolute values of differences. A total of 71 students completed these practical exams: 36 in the Class of 2016 and 35 in the Class of 2017. All 71 self-assessments for each of the four practical exams were collected for a response rate of 100%. The results showed that the mean S-F gap ranged from 2% to 8%, and the absolute S-F gap ranged from 7% to 12%. Preclinical performance was correlated with self-assessment accuracy. Low-performing students significantly overestimated their self-assessments compared to the rest of the class. High-performing students had more accurate self-assessments and tended to underestimate themselves. Overall, these results showed that the students had room for improving the accuracy of their self-assessments.

A person's right to access his or her protected health information is a core feature of the U.S. Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. If the information is stored electronically, covered entities must be able to provide patients with some type of machine-readable, electronic copy of their data. The aim of this study was to understand how academic dental institutions execute the Privacy Rule's right of access in the context of electronic health records (EHRs). A validated electronic survey was distributed to the clinical deans of 62 U.S. dental schools during a two-month period in 2014. The response rate to the survey was 53.2% (N=33). However, three surveys were partially completed, and of the 30 completed surveys, the 24 respondents who reported using axiUm as the EHR at their dental school clinic were the ones on which the results were based (38.7% of total schools at the time). Of the responses analyzed, 86% agreed that clinical modules should be considered part of a patient's dental record, and all agreed that student teaching-related modules should not. Great variability existed among these clinical deans as to whether administrative and financial modules should be considered part of a patient record. When patients request their records, close to 50% of responding schools provide the information exclusively on paper. This study found variation among dental schools in their implementation of the Privacy Rule right of access, and although all the respondents had adopted EHRs, a large number return records in paper format.

The goal of this study was to identify mechanisms associated with chronic loneliness by examining the effect of adolescents' accumulated history of loneliness on responses to new social situations. Specifically, this study investigated whether attributions and emotions in situations of social inclusion and exclusion differ between chronically lonely adolescents and adolescents with a different loneliness history. A total of 730 adolescents (Mage at Wave 1 = 15.43 years) participated in a 4-wave longitudinal study with annual loneliness assessments. A chronic loneliness trajectory was identified, in addition to low-stable, moderate-stable, moderate-increasing, and high-decreasing loneliness trajectories. At Wave 4, vignettes depicting social inclusion and exclusion were presented, and participants rated a set of attributions and emotions following each vignette. Compared with individuals following other trajectories, chronically lonely adolescents were characterized by hypersensitivity to social exclusion (i.e., higher levels of negative emotions) and hyposensitivity to social inclusion (i.e., lower levels of enthusiasm). Further, chronically lonely adolescents had a stronger tendency to attribute social inclusion to circumstantial factors and social exclusion to internal and stable characteristics. This maladaptive attribution style partially mediated their emotional experiences. Together, results indicate that chronically lonely individuals respond to social situations in ways that may perpetuate rather than reduce their loneliness., ((c) 2015 APA, all rights reserved).)

Residential college environments provide young people with distinctive relationship opportunities and challenges. A major purpose of the present study was to learn whether college students respond differently to conflict-of-interest vignettes in three different relationship contexts. Students were more likely to make negative interpretations about their romantic partner's behavior than they did about their friend's or roommate's behavior. They were also more likely to feel angry and hurt and to endorse hostile goals and strategies with romantic partners. A second major purpose was to learn about the types of interpretations and emotions associated with revenge goals in conflict-of-interest situations. Results indicated that interpreting the other person's actions as disrespectful and as rejecting was related to revenge goals and also predicted to revenge goals beyond the contributions of anger and hurt feelings.

Background: Hypoxemia can adversely affect outcome after traumatic brain injury (TBI). However, the effect of high PaO2 on TBI outcomes is controversial. The primary aim of this study was to identify the optimal PaO2 range early after severe TBI., Methods: In this single-center retrospective study conducted at a level-1 trauma center, patients with severe TBI (head Abbreviated Injury Scale score >3, admission Glasgow Coma Scale score ≤8) were included. The crude and adjusted (including chest injuries and acute respiratory distress syndrome) effects of 50 mm Hg incremental PaO2 thresholds during the first 72 hours on discharge survival were examined., Results: Data from 193 patients (44±18 y; 77% male; admission Glasgow Coma Scale score 4±2) were reviewed. Overall survival was 57%. PaO2 thresholds in increments of 50 mm Hg between 250 and 486 mm Hg (68%) were associated with discharge survival in patients with severe TBI compared with PaO2 60 mm Hg

Although girls disclose to friends about problems more than boys, little is known about processes underlying this sex difference. Four studies (Ns = 526, 567, 769, 154) tested whether middle childhood to mid-adolescent girls and boys (ranging from 8 to 17 years old) differ in how they expect that talking about problems would make them feel. Girls endorsed positive expectations (e.g., expecting to feel cared for, understood) more strongly than boys. Despite common perceptions, boys did not endorse negative expectations such as feeling embarrassed or worried about being made fun of more than girls. Instead, boys were more likely than girls to expect to feel "weird" and like they were wasting time. Sex differences in outcome expectations did help to account for girls' greater disclosure to friends., (© 2012 The Authors. Child Development © 2012 Society for Research in Child Development, Inc.)

In this study, the prevailing view that girls are pervasively more skilled in their friendships than boys was challenged by examining whether girls respond more negatively than boys when a friend violates core friendship expectations. Fourth- and fifth-grade children (n = 267) responded to vignettes depicting transgressions involving a friend's betrayal, unreliability, or failure to provide support or help. Results indicated that girls were more troubled by the transgressions, more strongly endorsed various types of negative relationship interpretations of the friend's actions, and reported more anger and sadness than did boys. Girls also endorsed revenge goals and aggressive strategies just as much as boys. These findings lead to a more complex view of boys' and girls' friendship competencies., (© 2011 The Authors. Child Development © 2011 Society for Research in Child Development, Inc.)

Loneliness is a sad, even painful emotional experience that is thought to result from deficiencies in the quantity or quality of one's social relationships. Assessments of loneliness have evolved to typically include diverse item content that assesses the causes of loneliness as well as the emotional experience of loneliness itself. This embedding of hypothesized causes in the assessment of loneliness creates pervasive problems in drawing valid conclusions from empirical research on loneliness. In this chapter, we review major historical and contemporary perspectives on loneliness and then describe how widely used assessments have led to the development of a literature in which key questions about the causes of loneliness, the influence of gender on the experience of loneliness, and the developmental course of loneliness remain unanswered. We argue for the use of loneliness assessments that focus purely on the emotional experience of loneliness without including hypothesized causes.

Previous studies have demonstrated that children's goals are associated with their success in peer relationships. The current study extends earlier findings by examining changes in children's goals during hypothetical conflicts. Participants were 252 children ages 9 to 12 years old (133 boys, 119 girls). As predicted, children's goals changed significantly when they encountered obstacles to conflict resolution, and these changes were predictive of their subsequent strategy choices. Both aggressive- and submissive-rejected children were more likely to evidence antisocial changes in their goals, including an increased desire to retaliate. They also showed reluctance to forego instrumental objectives. Other findings highlighted the need to investigate the combinations of goals children pursue as predictors of their strategies and the quality of their peer relationships.

This study investigated whether the perception of self as socially rejected might contribute to increased physical aggression among elementary-school children. It was hypothesized that physically aggressive children would become more physically aggressive over time if they perceived that they were rejected and tended to blame peers for social failure experiences. Third-grade boys and girls (n = 941) were assessed in the Fall and Spring of the school year. Peer-report data on physical aggression and social preference were collected, along with self-report data on perceived rejection and attributions for social failure experiences. Results for boys were consistent with hypotheses, whereas the results for girls revealed a different pattern of relations. These results constitute prospective evidence that children's self-perceptions of social rejection can uniquely influence externalizing behavior. Results are discussed in terms of mechanisms that might mediate the relation between perceived rejection and physical aggression.

The present research tested whether children's responses to help-giving and help-seeking friendship tasks predicted how many friends they had and the quality of their best friendship. Fifth-grade children (N=511; typically 10 or 11 years old) responded to vignettes in which they could either give help to a friend or seek help from a friend. Children's strategies and goals in both contexts were significantly correlated with the number of friends children had. Responses in the help-giving context but not in the help-seeking context were significantly associated with friendship quality. Although gender differences in strategies and goals were found, strategies and goals were related to the number of friends and friendship quality for both boys and girls.

Little is known about the skills required for friendship, as distinct from those required for peer acceptance. The present study examined whether children's goals and strategies in friendship conflict situations are predictive of their friendship adjustment, after accounting for level of peer acceptance. Fourth- and 5th-grade children (N = 696) responded to 30 hypothetical situations in which they were having a conflict with a friend. Results indicated that children's goals were highly related to their strategies and that children's goals and strategies were predictive of their real-life friendship adjustment. Pursuing the goal of revenge toward a friend was the goal or strategy most strongly associated with lacking friends and having poor-quality friendships. Gender differences were also found for each goal and strategy, with girls displaying a more prosocial goal and strategy orientation than boys.

This study examined whether children who vary in their behavioral responses (aggression vs. withdrawal vs. problem solving) to ambiguous provocation but who are similar in their attributional processes differ in their social goals and self-efficacy perceptions. In response to 10 hypothetical situations involving ambiguous provocation, fourth- and fifth-grade students (n = 781) indicated whether or not the protagonist intended to cause the harm and reported how they would respond to the protagonist's action. Newly developed measures assessed children's situated social goals and self-efficacy perceptions. Results indicated that the aggressive, withdrawn, and problem-solving responders differed in their social goals and self-efficacy perceptions. The strength of the findings, compared to earlier work on children's goals and self-efficacy perceptions, suggests the importance of a situated social-cognitive assessment in which children's thoughts are measured in a specific kind of social situation and are related to their reported behavior in the same type of situation.

The purposes of this study were to examine academically relevant characteristics of different sociometric status groups and to learn about the academic orientations of behavioral subgroups of rejected children. Results from a sample of 423 sixth and seventh graders (ages 11-13) suggested that sociometrically neglected children have quite positive academic profiles. When compared with average status children, these students reported higher levels of motivation, were described by teachers as more self-regulated learners, as more prosocial and compliant, and as being better liked by teachers. Analyses of two behavioral subgroups of rejected children indicated that aggressive-rejected but not submissive-rejected children have problematic academic profiles. Relations of neglected and aggressive-rejected status to academic adjustment in young adolescents' lives is discussed.

Recent studies indicate that feelings of loneliness and social dissatisfaction can be reliably assessed with third- through sixth-grade children, and that children who are sociometrically rejected by their peers are significantly more lonely than other children. The present research was designed (a) to examine whether loneliness could be reliably assessed in a population younger than previously studied, (b) to learn whether young children who are poorly accepted by peers report elevated levels of loneliness and social dissatisfaction, (c) to assess whether young children understand the concept of loneliness, and (d) to examine the behavioral characteristics of lonely young children. Kindergarten and first-grade children (N = 440) responded to a questionnaire about feelings of loneliness and social dissatisfaction in school. A subset of children (N = 46) were individually interviewed to assess their understanding of loneliness. To assess sociometric status and behavior, peers were asked to respond to various sociometric measures and behavioral assessment items. Teachers also provided behavioral information about children using a newly developed instrument. Results indicated that nearly all children understood loneliness, that loneliness was reliably assessed in young children, and that poorly accepted children were more lonely than other children. In addition, children who reported the most loneliness were found to differ from others on several behavioral dimensions.

This study was designed to determine whether children with mild mental retardation understand the concept of loneliness, whether their feelings of loneliness at school can be reliably assessed, and whether there are differences in loneliness between children with and without mental retardation. Results from a sample of 62 students with mild mental retardation and 62 students without retardation, ages 8 through 13, indicated that (a) high percentages of both groups understood what loneliness means, (b) a loneliness questionnaire yielded satisfactory internal reliability with both groups, and (c) boys but not girls with mental retardation reported significantly more loneliness than did children without mental retardation. Suggestions were made for future research on loneliness in school settings.

The purpose of the present study was to assess the social adaptation of mainstreamed mildly retarded children, comparing them to a matched sample of regular education students. Results indicated that mildly retarded children were quite rejected by their peers, and, compared to nonretarded classmates, they reported significantly more dissatisfaction and anxiety about their peer relations. With respect to behavioral style, there were no group differences in peer- or teacher-reported aggressiveness or disruptiveness. However, retarded children were perceived as more shy and avoidant, as less cooperative, and as less likely to exhibit leadership skills. Further analysis of the behavioral assessment data, via cluster analysis, revealed 2 subtypes of rejected retarded children: an internalizing group perceived as displaying high levels of shy/avoidant behavior and an externalizing group perceived as high in aggressive and/or disruptive behavior. In addition, the internalizing group reported higher social anxiety than did the externalizing group. Implications for school-based intervention research with mildly retarded children are discussed.