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Terminal digit preference has been shown to be associated with inaccurate blood pressure (BP) recording.To evaluate whether converting from manual BP measurement with aneroid sphygmomanometers to automated BP measurement was associated with terminal digit preference, mean levels of recorded BP, and the rate at which hypertension was diagnosed.This quality improvement study was conducted from May 9, 2021, to March 24, 2022, using interrupted time series analysis of medical record data from 11 primary care clinics in a single health care system from April 2008 to April 2015. The study population was patients aged 18 to 75 years who had their BP measured and recorded at least once during the study period.Manual BP measurement before April 2012 vs automated BP measurement with the Omron HEM-907XL monitor from May 2012 to April 2015.The main outcome was the distribution of terminal digits and mean systolic BP (SBP) values obtained during 4 years of manual measurement vs 3 years of automated measurement, assessed using a generalized linear mixed regression model with a random intercept for clinic and adjusted for seasonal fluctuations and patient demographic and clinical characteristics.The study included 1 541 227 BP measurements from 225 504 unique patients during the entire study period, with 849 978 BP measurements from 165 137 patients (mean [SD] age, 47.1 [15.2] years; 58.2% female) during the manual measurement period and 691 249 measurements from 149 080 patients (mean [SD] age, 48.4 [15.3] years; 56.3% female) during the automated measurement period. With manual measurement, 32.8% of SBP terminal digits were 0 (20% was the expected value because nursing staff was instructed to record BP to the nearest even digit). This proportion decreased to 12.4% during the automated measurement period (expected value, 10%) when both even and odd digits were to be recorded. After automated measurement was implemented, the mean SBP estimated with statistical modeling increased by 5.09 mm Hg (95% CI, 4.98-5.19 mm Hg). Fewer BP values recorded during the automated than the manual measurement period were below 140/90 mm Hg (69.9% vs 84.3%; difference, -14.5%; 95% CI, -14.6% to -14.3%) and below 130/80 mm Hg (42.1% vs 60.0%; difference, -17.9%; 95% CI, -18.0% to -17.7%). The proportion of patients with a diagnosis of hypertension was 4.3 percentage points higher (23.4% vs 19.1%) during the automated measurement period.In this quality improvement study, automated BP measurement was associated with decreased terminal digit preference and significantly higher mean BP levels. The method of BP measurement was also associated with the rate at which hypertension was diagnosed. These findings may have implications for pay-for-performance programs, which may create an incentive to record BP levels that meet a particular goal and a disincentive to adopt automated measurement of BP.

This study investigated relational uncertainty as a mechanism through which perceived partner humor use affects recipient’s relationship satisfaction. Two hundred individuals completed measures of their partners’ perceived positive and negative humor use, their relational uncertainty and relationship satisfaction. Results reveal that perceived partner’s positive relational humor use predicted greater relationship satisfaction, and perceived partner’s negative relational humor use predicted diminished relationship satisfaction. Further, relational uncertainty mediated relationships between perceived partner positive humor and satisfaction and perceived partner negative humor and satisfaction.

Social network sites such as Facebook offer opinion leaders an unprecedented ability to attempt to persuade people about politics. This survey (N = 295) sought to explore opinion leader types of an...

This study examined a persistent problem among young people across the nation: poor sleep habits. Using regulatory focus as a theoretical framework, this study evaluated components of persuasive sleep fear appeal messages. Specifically, the factor of regulatory focus is evaluated as a component in the processing of sleep deprivation fear appeals. After reporting regulatory focus and hedonic relevance information, participants (N = 306) read fear appeal messages and reported behavior intentions, message complexity, message derogation, persuasiveness, and agitation. Results show participants in a prevention focus, compared to those in a promotion focus, were less agitated by the message and were more likely to be persuaded by the message. Implications for fear appeals research and persuasive sleep messages are discussed.

The uses of indirect argument strategies, such as irony, remain understudied. This study examined a variety of ironic arguments and the production and suppression rather than reception of those arguments. Hyperbole, understatement, rhetorical question, jocularity, and sarcasm were examined in close versus distant relationships. Findings point to a tendency to use more negative arguments in closer relationships than those that are more casual. In sum, we are more likely to be negative in closer relationships despite what our typical behavior would indicate.

For much of inoculation theory's 50-year history, research has focused on intrapersonal processes of resistance such as threat and subvocal counterarguing. More recently, attention has shifted to interpersonal processes of inoculation-conferred resistance, specifically, postinoculation talk (PIT). This study examined the substance of PIT, and how people may talk to one another for reassurance and advocacy following an inoculation. Findings indicate advocacy attempts were significantly greater within the inoculation condition. Those inoculated were more likely to a) pass along material included in the inoculation treatment, b) share issue-relevant novel material, c) talk about topics related to the target issue, and d) be challenged by conversational partners when attempting advocacy. Results help explain what inoculated individuals talk about following an inoculation treatment, and how PIT may spread the process of resistance along social networks.

The use of controlling language by physicians is examined to further understand congruence between doctor and patient language use. Language expectancy theory (LET) provides the framework for making predictions about expectations for controlling language. This study adds to our understanding of LET by examining personality variables to predict language expectations. Effects of interactions between expectancy violations and patient–physician orientation on anger, behavior change, source credibility, and controlling language are predicted. Positively violating expectations for controlling language use resulted in less anger, negative behavior change, and higher ratings of controllingness. Future directions are offered studying controlling language in doctor–patient interactions.

One hundred seventeen college students recalled a serial argument with a family member. The type of serial argument (whether a public- or personal-issue argument, Johnson, 2002) and level of argumentativeness predicted beliefs about family serial arguments. Whether the serial argument was believed to be ego-involving, enjoyable, or related to dysfunctional outcomes predicted the level of personal harm (stress and stress-related symptoms) related to the argument.

This research uses language expectancy theory (LET; Burgoon, Jones, & Stewart, 1975; Miller & Burgoon, 1979) to explore message design effectiveness as a function of syntactic and lexical complexity, in a 2 (lexical: simple vs. complex) × 2 (syntactic: simple vs. complex) design. Pilot test and main study findings indicate optimal message features include the use of lexically simple language combined with syntactically simple sentence structure for receivers who are more likely to think on concrete as opposed to abstract levels, since such an arrangement makes integration of new information easier. Future directions are discussed for message design and for advancement of the theoretical contributions offered by examining syntactic complexity and lexical complexity within the explanatory framework of LET.

Online reviews play a significant role in forming and shaping perceptions about a product. With the credibility of online reviewers a frequent question, this research investigates how potential buyers assess the credibility of anonymous reviewers. Technology separates the reviewer from the review, and potential buyers are left to rely on characteristics of the review itself to determine the credibility of the reviewer. By extending the language expectancy theory to the online setting, we develop hypotheses about how expectancy violations of lexical complexity, two-sidedness (highlighting positive and negative aspects of a product), and affect intensity influence credibility attributions. We present an experiment in which favorable experimental reviews were generated based on actual reviews for a digital camera. The results indicate that two-sidedness caused a positive expectancy violation resulting in greater credibility attribution. High affect intensity caused a negative expectancy violation resulting i...

Individuals vary greatly in how they approach an argument. Some fear it as though it will kill them, and others seek it out for it may be the only joy they can find in life (Hample, 2005). Some individuals do struggle with the ability to separate arguments against a position from arguments against their character (Rancer, Baukus, & Infante, 1985). Aside from antagonistic approaches to verbal communication, irony has enjoyed a significant amount of attention in the communication discipline. Studies have varied from employing irony as a theoretical lens to examine the discursive space of organizations (Trethewey, 1999) to more specific studies of irony in argumentation (Tindale & Gough, 1987). Despite irony being prevalent in our everyday speech, there is little evidence concerning the efficacy of ironic arguments in everyday speech. Pexman and Olineck (2002) examined irony and insults, specifically. Not only did they find insults that used irony were common, they also found insults are a common way for irony to appear in everyday conversations. Although there are some people who take ironic statements literally, there are still instances where irony has been of some utility (Tindale & Gough, 1987). Disguising harmful speech in some acceptable form is not a new idea. In fact, devices like humor have been used to bring people together and drive people apart (Miczo, 2004). The field of argumentation needs to turn its attention to the use of such tropes as irony and humor to examine their potential utility and/or destructive potential. By examining these devices in the context of argumentation, we can begin to understand the process of ironic arguing more fully and develop a broader understanding of argument acceptability by including arguments that use figurative language. Even though many researchers have studied irony, few have clearly articulated a definition of the concept despite utilizing irony as a central variable. Indeed, Fahnestock (2011) argues the definition of irony is often too loose. Rather, she contends the conceptualization should include some level of understanding of why one meaning would be understood while another meaning would not. Such loose definitions are common problems present in most of the studies of irony (Averbeck & Hample, 2008). Due to a lack of clarity in the understanding of irony, there exists much confusion over how and whether its use differs from sarcasm. Despite irony being prevalent in our everyday speech (Gibbs, 2000; Pexman & Olineck, 2002), there are currently no definitive answers to such questions (Averbeck & Hample, 2008). Due to disagreement over conceptualizations of irony and sarcasm, I offer working definitions to examine whether irony and sarcasm can be distinguished based on people's perceptions of argument effectiveness and/or appropriateness in the interpersonal context. Others have taken up this task (Roberts & Kreuz, 1994; Kreuz & Glucksberg, 1989), but the findings of such research do not address the effectiveness of these arguments during interpersonal interaction. In general, previous research attempting to distinguish irony from sarcasm has stopped at the point of conceptualization and relied upon research participants to generate examples or define the differences between irony and sarcasm. However useful this descriptive information may be, it does not inform argumentation scholars and users of figurative language which message strategy is more effective and/or appropriate for use in interpersonal situations. The present study seeks to explore such differences in the interpersonal context. The approach taken here is receiver focused. One of the ways in which an individual can distinguish between ironic and sarcastic arguments is on the basis of appropriateness and/or effectiveness. These two variables are of particular importance because they are indicative of interpersonal argumentative competence (Yingling & Trapp, 1985). …

The efficacy of inoculation theory has been confirmed by decades of empirical research, yet optimizing its effectiveness remains a vibrant line of investigation. The present research turns to psychological reactance theory for a means of enhancing the core mechanisms of inoculation--threat and refutational preemption. FINDINGS from a multisite study indicate reactance enhances key resistance outcomes, including: threat, anger at attack message source, negative cognitions, negative affect, anticipated threat to freedom, anticipated attack message source derogation, perceived threat to freedom, perceived attack message source derogation, and counterarguing. Most importantly, reactance-enhanced inoculations result in lesser attitude change--the ultimate measure of resistance. Language: en

Contemporary inoculation scholarship has focused on the process of resistance to persuasion, and recently begun to examine various incidental effects that may accompany inoculation treatments. This study considers how talk fits within both of these areas, not only as a byproduct of inoculation, but also as a potentially important contributor to the process of resistance. Results indicate inoculation not only enhances talk about the target issue, but such talk appears to bolsters resistance to subsequent counterattitudinal messages. Les effets de la discussion postinoculation sur la resistance aux influences La litterature contemporaine sur l’inoculation s’est concentree sur le mecanisme de la resistance a la persuasion, et a recemment commencea examiner differents effets contingents qui pourraient accompagner des traitements d’inoculation. Cette etude examine les manieres par lesquelles la discussion correspond a ces deux domaines, non seulement comme effet secondaire de l’inoculation, mais aussi comme un participant possiblement important au mecanisme de resistance. Les resultats indiquent que l’inoculation ne fait pas qu’augmenter la discussion a propos de l’enjeu cible, mais que cette discussion semble renforcer la resistance a des messages de contre-attitude subsequents. Mots cles : inoculation, resistance, discussion, contre-argumentation, modelisation par equation structurelle Der Wirkung von Postinokulationsgesprachen auf den Widerstand gegen Beeinflussung Die aktuelle Inokulationsforschung fokussiert auf den Prozess des Widerstands gegen Persuasion und begann unlangst damit, die verschiedenen zufalligen Effekte, die bei Inokulationstreatments auftreten konnen, zu untersuchen. Die vorliegende Studie untersucht integriert Gesprache in beide dieser Forschungsfelder, und zwar nicht nur als Nebenprodukt von Inokulation, sondern als potentiell wichtiger Faktor im Prozess des Widerstands. Die Ergebnisse verdeutlichen, dass Inokulation nicht nur Gesprache uber das Zielthema anregt, sondern dass Gesprache den Widerstand gegen nachfolgende Botschaften gegen die eigene Einstellung zu stutzen scheinen. Schlusselbegriffe: Inokulation, Widerstand, Gesprache, Counterarguing, Strukturgleichungsmodelle

This study examines features of serial arguments that predict whether these arguments lead to perceived relational harm and perceived harm to the arguing individual. Similar variables predicted perceived personal and relational harm from a serial argument. Personal-issue arguments with low levels of perceived resolvability had higher levels of perceived harm than public-issue arguments. The two types of arguments did not differ in perceived harm at levels of high perceived resolvability. Whether the argument functioned to resolve behavioral incompatibility was positively related to both relational and personal harm. The function of gaining and giving knowledge was negatively related to relational harm, and the function of portraying oneself in a positive light was positively related to personal harm. Low and conflicted-feeling moderate argumentatives had higher levels of perceived personal harm from the serial argument than high and apathetic moderate argumentatives. High argumentatives perceived less rel...

This study examines the role prior knowledge plays in the cognitive processing of and response to fear appeals. The Heuristic-Systematic Model (HSM) is used as the theoretical frame with results strengthening the HSM by demonstrating that having prior knowledge about a topic reduced the impact of fear arousal and led to systematic processing. Conversely, a lack of prior knowledge resulted in high fear arousal and heuristic processing. The influence of prior knowledge on systematic and heuristic processing provides greater clarity to the HSM as well as suggests future directions for health campaign practitioners that use fear appeals.

Language expectancy theory (LET) provides the basis for a study of the relationship of ironic and literal messages in terms of persuasiveness and expectedness. The experimental design was a 2 (literal vs. ironic) × 2 (compliment vs. criticism) factor design. The expectation was that literal messages would be more expected and criticisms less preferred to compliments. The results indicated that the ironic messages tended to be negative, unexpected, and attributed to the situation as opposed to the sender. Compliments were associated with fewer behavioral intentions than were criticisms. The interaction also revealed that the ironic messages were a safe middle ground between literal criticisms and compliments in terms of fostering behavioral changes.

This article reviews research that has used the conversation argument coding scheme (CACS) (Canary, 1992; Seibold, McPhee, Poole, Tanita, & Canary, 1981) to examine conflict interaction between romantic partners and friends. By reviewing this body of literature, one can see the impact of examining relational partners instead of strangers, of investigating dyads rather than groups, and the importance of examining interaction rather than predicting outcomes of arguments based on each relational partner's individual characteristics. This literature also connects argument sequences and structure to relational variables such as relational satisfaction and control mutuality. Three suggested areas for further development of this research include the following topics: family conflict, interpersonal conflict that occurs over mediated channels, and serial arguments in interpersonal relationships.

This study examined humor production in relation to attachment dimensions and interaction goals. Participants (N = 172) completed measures of attachment dimensions (anxiety, avoidance), humor production (affiliative humor, aggressive humor), and primary and secondary goals. Anxiety was negatively related to affiliative humor, whereas avoidance was positively related to aggressive humor. Affiliative humor was related to effectiveness and being playful in the interaction, as well as the secondary goals of arousal management and clarity. Aggressive humor was not related to any of the goals.

This paper addresses the conceptualization and production of irony. Specifically, psychological predispositions are used to identify what makes the production of an ironic message likely. Reasons for endorsing and suppressing ironic messages are discussed based on individuals’ goals in a situation. The importance of common ground between individuals during ironic message productions is also discussed. Results suggest (a) the suppression of ironic messages due to concern for both the other and the self, (b) there is a need for mutual understanding of an attitude for ironic messages to be understood as ironic, and (c) the endorsement of ironic messages is designed to inflict harm to others.

Article-at-a-Glance Background A study was conducted to test whether patient reports of medical errors via surveys could produce sufficiently accurate information to be used as a measure of patient safety. Methods A survey mailed regularly by a large multispecialty medical group to recent patients to assess their satisfaction and error experiences was expanded to collect more details about the patient-perceived errors. Following an initial mailing to 3,109 patients and parents of child patients soon after they had office visits in June 2005, usable mailed or phone follow-up responses were obtained from 1,998 respondents (65.1% adjusted). Responses were reviewed through a two-stage process that included chart audits and implicit physician reviewer judgments. The analysis categorized the review results and compared patient-reported errors with satisfaction. Results Of the 1,998 respondents, 219 (11.0%) reported 247 separate incidents, for a rate of 12.4 errors per 100 patients. After complete review, only 5 (2.0%) of these incidents were judged to be real clinician errors. Most appeared to represent misunderstandings or behavior/communication problems, but 15.4% lacked sufficient information to categorize. Women, Hispanics, and those aged 41–60 years were most likely to report errors. Those respondents making error reports were much more likely to report visit dissatisfaction than those not reporting them (odds ratio [OR] = 13.8, p Discussion Although patient reports of perceived errors might be useful to improve the patient experience of care, they cannot be used to measure technical medical errors and patient safety reliably without added evaluation. This study's findings need to be replicated elsewhere before generalizing from one metropolitan region and a patient population that is about two-thirds members of one health plan.

Globalization of the food industry has led to widespread exposure to new nondomestic fish species; therefore, identification of potential allergens is necessary in order to diagnose allergic reactions.Contact with a patient who was allergic to Nile perch (Lates niloticus) prompted us to investigate the immunoglobulin (Ig) E-reactive proteins that could be allergens of this species.2D gel electrophoresis was used to separate the muscle proteins of L niloticus and Gadus morhua. Immunoblotting was performed with sera from 12 patients with a history of immediate-type allergic reaction to fish and from atopic and nonatopic controls. IgE-reactive proteins were detected and identified using mass spectrometry.The index patient had low levels of IgE binding to parvalbumins. However, 8 putative allergens other than parvalbumin from L niloticus and 5 from G morhua were identified. Further investigation revealed cross-sensitivity to enolase 3 from L niloticus in 7 of the 12 fish-allergic individuals (58%), whereas 11 of the 12 patients (92%) were sensitized to enolase 3 from G morhua. However, atopic control patients were also sensitized to enolase 3 from L niloticus and G morhua.Identification of species-specific allergens and individual sensitization could help us to improve avoidance strategies.

Cutaneous angiosarcoma (AS) is a rare aggressive malignant vascular tumour of the skin.We analysed the cases of cutaneous AS in two large dermatological departments of Saxony during the last 10 years.A total of eight AS cases were identified, mostly with head and neck involvement. Because of age and late diagnosis, only a minor part was completely resectable. As a palliative therapy pegylated liposomal doxorubicin was used. The drug was well tolerated. Our cases and those published in the literature suggest a high rate of responses and a possible sensitisation to subsequent radiation therapy.Although complete surgical resection followed by wide-field radiation therapy has been established as a therapeutic standard for AS, delay in diagnosis and older age with comorbidities warrant for a safe and effective adjuvant treatment. Pegylated liposomal doxorubicin combined with radiotherapy seems to be a useful and safe alternative.

Zusammenfassend kann sowohl durch die in-vitro und in-vivo Ergebnisse als auch in Konsequenz unserer Computersimulationen eine aktive Rolle von CD97 bei der Invasion von Karzinomen propagiert werden. Die Kombination von Experimenten und Computersimulationen ermoglicht neue Einsichten, wie Variationen von Zelleigenschaften zu verschiedenen Mustern der Zellinvasion fuhren. Unsere Ergebnisse zeigen, dass die proteolytische Aktivitat an der Tumorfront in Verbindung mit einer gesteigerten und gerichteten Zellmotilitat Schlusselschritte in der Tumorinvasion darstellen.

An important aim of supportive care for cancer patients (pts) is the maintenance or improvement of their life quality. Therefore it is interesting to measure pts' LQ while testing new cytotoxic drugs or palliative therapy like artificial nutrition. A short questionnaire also is helpful in order to inform physicians and psychooncologists about pts' needs for psychosocial intervention. Based on coping-research, gerontology and well-being-psychology we have developed a 69-item-questionnaire "Scales for Measuring LQ" with good test-statistics. This instrument emphasizes pts' life experiences and subjective appraisal of objective life conditions. Basic state, internalized life experiences and life orientations in a sample of 179 pts with chemo- or radiotherapy are more important for LQ than objective symptoms, subjectively perceived physical condition and mood. The surprisingly high LQ scores in cancer pts can best be explained by their reduced aspiration levels. Correlations with emotional and belonging support obtained from the partner or confidant are significant. Social support is before all related to our pts' positive life experiences (.68; .59) and to their life satisfaction (.58; .47).

Background: Medical homes are widely viewed as a partial answer to the problems of inadequate care quality and patient experiences plus excessive healthcare costs, even though there is very limited evidence about whether they can affect these issues. We evaluated the relationship between degree of medical home-ness and measures of quality and patient satisfaction among 21 primary care clinics certified as level III medical homes by the National Committee for Quality Assurance (NCQA). Methods: We used the research version of the NCQA certification survey to measure the degree to which each clinic exemplified the medical home, with scores (0–100) overall as well as for each of five domains from the Chronic Care Model. These scores were then tested for associations with clinic-specific performance measures, cost data, and patient satisfaction. Results: Despite common NCQA level III attainment, we found considerable variance in scores among these clinics. Total and domain mean scores ranged from 58.6 to 81.8 with SD of 15.0–41.2 on medical home measures. Mean composite diabetes outcome rates ranged from 16.4–41.9%. Clinic-level correlations were highest for Delivery System Redesign and Healthcare Organization domains, and among the five specific components of the composite diabetes measure, blood pressure