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Moral dumbfounding is the phenomenon that is observed when people defend a moral judgement even though they cannot provide a reason for this judgement. Dumbfounded responding may include admitting to not having reasons, or the use of unsupported declarations (e.g., “It’s just wrong”) as justification for a judgement. Published evidence for dumbfounding has drawn exclusively on samples of WEIRD backgrounds (Western, educated, industrialised, rich, and democratic), and it remains unclear whether the phenomenon is generalilsable to other populations. In three studies we apply a standardised moral dumbfounding task, and show evidence for moral dumbfounding in a Chinese sample (Study 1), an Indian sample (Study 2), and a mixed sample primarily from North Africa and the Middle East (MENA region, Study 3).

Background The limited availability of proton beam therapy (PBT) requires individual treatment selection strategies that can be based on normal tissue complication probability (NTCP) models. We developed and externally validated NTCP models for common late side-effects following PBT in brain tumour patients to optimise patients’ quality of life. Methods Cohorts from three PBT centres (216 patients) were investigated for several physician-rated endpoints at 12 and 24 months after PBT: alopecia, dry eye syndrome, fatigue, headache, hearing and memory impairment, and optic neuropathy. Dose-volume parameters of associated normal tissues and clinical factors were used for logistic regression modelling in a development cohort. Statistically significant parameters showing high area under the receiver operating characteristic curve (AUC) values in internal cross-validation were externally validated. In addition, analyses of the pooled cohorts and of time-dependent generalised estimating equations including all patient data were performed. Results In the validation study, mild alopecia was related to high dose parameters to the skin [e.g. the dose to 2% of the volume (D2%)] at 12 and 24 months after PBT. Mild hearing impairment at 24 months after PBT was associated with the mean dose to the ipsilateral cochlea. Additionally, the pooled analyses revealed dose-response relations between memory impairment and intermediate to high doses to the remaining brain as well as D2% of the hippocampi. Mild fatigue at 24 months after PBT was associated with D2% to the brainstem as well as with concurrent chemotherapy. Moreover, in generalised estimating equations analysis, dry eye syndrome was associated with the mean dose to the ipsilateral lacrimal gland. Conclusion We developed and in part validated NTCP models for several common late side-effects following PBT in brain tumour patients. Validation studies are required for further confirmation.

Purpose: To investigate late physician-rated side effects and their association with dosimetric parameters of various organs at risk (OARs) as well as clinical cofactors in adult brain tumour patients following proton beam therapy (PBT). Material and methods: Adult patients with brain tumours who underwent PBT at three different institutes were included in this study (N1=57, N2=47, N3=63). The radiation-induced side effects alopecia, fatigue, headache, memory impairment, hearing impairment, optic nerve disorder, dry eye and seizure (CTCAE v4.0) at 12 and 24 months after PBT were investigated. Side effects with sufficiently high incidence were dichotomised and correlated to different dose-volume histogram (DVH) parameters of associated OARs, such as skin, remaining brain, brainstem, cerebellum, hippocampi and cochlea. Clinical parameters comprised age, gender, tumour volume, prescribed dose, concomitant chemotherapy, resection of the tumour, diagnosis and WHO grading. Normal tissue complication probability (NTCP) models were developed on a combined cohort from two institutes (N=104) using logistic regression. The area under the receiver operating characteristic curve (AUC) was used to assess the prognostic ability in external validation on the remaining cohort. Results: In all cohorts, low toxicity rates were observed at 12 and 24 months after PBT. Most common side effects were fatigue (grade≥1: 32%/27%, grade≥2: 14%/6% at 12/24 months), alopecia (grade≥1: 30%/22%) and mild memory impairment (grade≥1: 23% at 24 months). Mild headache and hearing impairment (grade≥1) occurred in 20%/19% and 8%/9% of all patients at 12/24 months, respectively. Logistic regression revealed significant correlations between the incidence of alopecia grade≥1 at both times and high dose regions of the skin (D2%, p

Buraa Kubaisi,1,2 Arash Maleki,1,2 Aseef Ahmed,1,2 Neel Lamba,1,2 Haitham Sahawneh,1,2 Andrew Stephenson,1,2 Alyssa Montieth,1,2 Shobha Topgi,3 C Stephen Foster1,2,4 1Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; 2Ocular Immunology & Uveitis Foundation, Waltham, MA, USA; 3The State University of New York Downstate, Brooklyn, NY, USA; 4Harvard Medical School, Boston, MA, USA Purpose: To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) in eyes with noninfectious uveitis that had fluocinolone acetonide intravitreal implant (Retisert™)-induced glaucoma. Methods: This retrospective study reviewed the safety and efficacy of AGV implantation in patients with persistently elevated intraocular pressure (IOP) after implantation of a fluocinolone acetonide intravitreal implant at the Massachusetts Eye Research and Surgery Institution between August 2006 and November 2015. Results: Nine patients with 10 uveitic eyes were included in this study, none of which had preexisting glaucoma in the study eye. Mean patient age was 42 years; 6 patients were female and 3 were male. Baseline mean IOP was 30.6 mmHg prior to AGV placement while mean IOP-lowering medications were 2.9. In the treatment groups, there was a statistically significant reduction in post-AGV IOP. IOP was lowest at 1-week after AGV implantation (9.0 mmHg). Nine out of 10eyes achieved an IOP below target value of 22 mmHg and/or a 20% reduction in IOP from baseline 1 month and 1 year following AGV placement. All other postoperative time points showed all 10 eyes reaching this goal. A statistically significant decrease in IOP-lowering medication was seen at the 1-week, 1-month, and 3-year time points compared to baseline, while a statistically significant increase was seen at the 3-month, 6-month, and 2-year post-AGV time points. No significant change in retinal nerve thickness or visual field analysis was found. Conclusion: AGV is an effective and safe method of treatment in fluocinolone acetonide intravitreal implant-induced glaucoma. High survival rate is expected for at least 3 years. Keywords: uveitis, glaucoma, Ahmed glaucoma valve, fluocinolone acetonide intravitreal implant, ocular inflammation

Arash Maleki,1,2 Neerav Lamba,1,2 Lina Ma,1,2 Stacey Lee,1,2 Alexander Schmidt,1,2 C Stephen Foster1–3 1Massachusetts Eye Research and Surgery Institution, 2Ocular Immunology and Uveitis Foundation, Waltham, 3Harvard Medical School, Boston, MA, USA Purpose: To examine the efficacy of rituximab as a monotherapy or in combination therapy for the treatment of patients with non-paraneoplastic autoimmune retinopathy. Methods: Twelve eyes of six patients with non-paraneoplastic autoimmune retinopathy who were treated with rituximab and had at least 6 months of follow-up were included. Demographic data, clinical data, visual field parameters, electroretinography parameters, and anti-retinal and anti-optic nerve autoantibody bands were collected from the Massachusetts Eye Research and Surgery Institution database between September 2010 and January 2015. Changes in visual acuity, visual field parameters, electroretinography parameters, and anti-retinal and anti-optic nerve autoantibody bands from the initial visit to the most recent visit were examined. Results: From the initial visit to the last visit, visual acuity was stable in eight (66.7%) eyes. Visual field was stable in six (50%) eyes and improved in two (16.7%) eyes. Electroretinography was stable or improved in eight (66.7%) eyes. The average number of anti-retinal and anti-optic nerve antibody bands was reduced. Conclusion: Stabilization and/or improvement of visual acuity, visual field parameters, and electroretinography parameters were observed in a high number of patients (75%) on rituximab, as a monotherapy (one patient) or in combination therapy. Keywords: birdshot retinochoroidopathy, bortezomib, CD20, cyclophosphamide, HLA-A29, HLA-B27, immunomodulatory therapy, systemic lupus erythematosus

More children than ever before are conceived with the use of assisted reproductive technologies and many are raised in families that are structurally different from most. Research on the experiences of children growing up in diverse families has shown that children may face disapproval, a lack of understanding, and in some cases, bullying by those outside of their home environment, including from their peers at school This study evaluated the use of theatrical performance and post-performance discussions as a method of informing young people about different families. Findings indicated that performance was an effective and engaging learning tool, as it presented first-hand experiences of family diversity. Post-performance discussions were important in enabling young people to improve their understanding of different methods of Assisted Reproductive Technologies and diverse family forms. Young people were found to value engagement activities that are unbiased, interactive, and do not make them feel awkward or uncomfortable.

Study question: How does the psychological well-being and prenatal bonding of Indian surrogates differ from a comparison group of mothers? Summary answer: Surrogates had higher levels of depression during pregnancy and post-birth, displayed lower emotional connection with the unborn baby, and greater care towards the healthy growth of the foetus, than the comparison group of mothers. What is already known: Studies in the West have found that surrogates do not suffer long-term psychological harm. One study has shown that surrogates bond less with the foetus than expectant mothers. Study, design, size, duration: This study uses a prospective, longitudinal and cross-sectional design. Surrogates and a matched group of expectant mothers were seen twice, during 4-9 months of pregnancy and 4-6 months after the birth. Participants/materials, setting, methods: Semi-structured interviews and standardized questionnaires were administered to 50 surrogates and 69 expectant mothers during pregnancy and 45 surrogates and 49 expectant mothers post-birth. All gestational surrogates were hosting pregnancies for international intended parents. Main results and the role of chance: Surrogates had higher levels of depression compared to the comparison group of mothers, during pregnancy and post-birth (p < 0.02). Low social support during pregnancy, hiding surrogacy, and criticism from others were found to be predictive of higher depression in surrogates post-birth (p < 0.05). Regarding prenatal bonding, surrogates interacted less with and thought less about the foetus but adopted better eating habits and were more likely to avoid unhealthy practices during pregnancy, than expectant mothers (p < 0.05). No associations were found between greater prenatal bonding and greater psychological distress during pregnancy or after relinquishment. Limitations, reasons for caution: All surrogates were recruited from one clinic in Mumbai, and thus the representativeness of this sample is not known. Also, the possibility of socially desirable responding from surrogates cannot be ruled out. Wider implications of the findings: As this is the first study of the psychological well-being of surrogates in low-income countries, the findings have important policy implications. Providing support and counselling to surrogates, especially during pregnancy, may alleviate some of the psychological problems faced by surrogates.