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Abstract Background Intimate partner violence (IPV) is a leading threat to women’s health and safety globally. Women in abusive relationships make critical decisions about safety and harm reduction while weighing multiple competing priorities, such as safety of children, housing and employment. In many low- and middle-income countries (LMIC), IPV prevention and response services are limited and women lack access to safety planning resources. In high-resource settings, an interactive safety decision aid app (myPlan) has been found valuable in reducing decisional conflict and empowering women to take action in accordance with their safety priorities. This paper describes 1) the community-participatory formative process used to adapt the myPlan app content, interface, and implementation for the Kenya context, and 2) the randomized clinical trial study protocol for efficacy evaluation of myPlan Kenya. Methods A community-participatory formative process engaged service providers and stakeholders, as well as IPV survivors for adaptation, followed by an in-depth pilot and final refinements. A randomized clinical trial design will then be used to determine efficacy of the myPlan Kenya app compared to standard care among women reporting IPV or fear of partner and living in an urban settlement. myPlan Kenya app provides and solicits information on a) relationship health; b) safety priorities; and c) severity of relationship violence. Based on the woman’s inputs, the evidence-based algorithm developed for myPlan Kenya generates a tailored safety plan. Outcome measures are assessed at baseline, immediate post-intervention, and 3-month post-baseline. Difference-in-differences analysis compares primary (e.g. safety preparedness, safety behavior, IPV), and secondary outcomes (e.g. resilience, mental health, service utilization, self-blame) across timepoints by group. Discussion Formative phase revealed high feasibility and acceptability of a technology-based intervention for safety planning in this LMIC setting. This phase generated essential refinements to myPlan Kenya app readability, content and implementation, including increased visualization of messaging, and implementation via community health volunteers (CHVs). The resulting trial will be the first to evaluate efficacy of a community-partnered technology-based IPV intervention in a LMIC. Our adaptation process and trial results will inform researchers and interventionists to integrate multiple data sources to adapt IPV intervention content and interface in settings where technology-based interventions for IPV are novel and literacy is limited. Trial registration Pan African Clinical Trial Registry approval received 25 April 2018 ( PACTR201804003321122 ); retrospectively registered.

Introduction Intimate partner violence (IPV) threatens women’s health and safety globally, yet services remain underdeveloped and inaccessible. Technology-based resources exist, however, few have been adapted and tested in low-resource settings. We evaluate the efficacy of a community-partnered technology solution: culturally and linguistically adapted version of the myPlan app, a tailored safety decision-making and planning intervention, administrated by trained lay professionals.Methods This randomised, controlled, participant-blinded superiority trial compares safety-related outcomes at baseline, immediate post intervention and 3-month follow-up among women at risk of and experiencing IPV in Nairobi, Kenya. Women were randomised (1:1 ratio) to: (1) myPlan Kenya (intervention); or (2) standard IPV referrals (control). Primary outcomes were safety preparedness, safety behaviour and IPV; secondary outcomes include resilience, mental health, service utilisation and self-blame.Results Between April 2018 and October 2018, 352 participants (n=177 intervention, n=175 control) were enrolled and randomly assigned; 312 (88.6%, n=157 intervention, n=155 control) were retained at 3 months. Intervention participants demonstrated immediate postintervention improvement in safety preparedness relative to control participants (p=0.001). At 3 months, intervention participants reported increased helpfulness of safety strategies used relative to control participants (p=0.004); IPV reduced in both groups. Among women reporting the highest level of IPV severity, intervention participants had significant increase in resilience (p

The impairment in diabetic wound healing represents a significant clinical problem. Chronic inflammation is thought to play a central role in the pathogenesis of this impairment. We have previously shown that treatment of diabetic murine wounds with mesenchymal stem cells (MSCs) can improve healing, but the mechanisms are not completely defined. MicroRNA-146a (miR-146a) has been implicated in regulation of the immune and inflammatory responses. We hypothesized that abnormal miRNA-146a expression may contribute to the chronic inflammation. To test this hypothesis, we examined the expression of miRNA-146a and its target genes in diabetic and nondiabetic mice at baseline and after injury. MiR-146a expression was significantly downregulated in diabetic mouse wounds. Decreased miR-146a levels also closely correlated with increased gene expression of its proinflammatory target genes. Furthermore, the correction of the diabetic wound-healing impairment with MSC treatment was associated with a significant increase in the miR-146a expression level and decreased gene expression of its proinflammatory target genes. These results provide the first evidence that decreased expression of miR-146a in diabetic wounds in response to injury may, in part, be responsible for the abnormal inflammatory response seen in diabetic wounds and may contribute to wound-healing impairment. [ABSTRACT FROM AUTHOR]

This study examines the relationship between bicultural individuals' identity structure and their friendship network. A key dimension of identity structure for first-generation immigrants is the degree to which the secondary, host-culture identity is integrated into the primary, ethnic identity. Among first-generation Chinese Americans, regression analyses controlling for cultural identification strengths show that more integrated identity structures are associated with larger and more richly interconnected circles of non-Chinese friends. [ABSTRACT FROM AUTHOR]

Results from two groups of biculturals (Hong Kong undergraduates, Chinese Americans) and a group of European Americans in two studies showed that in the presence of applicable cues of a culture, individuals with expert knowledge in the culture spontaneously make inferences about the culture's moral values, producing a Stroop-like effect. Although both biculturals and European Americans made spontaneous cultural inferences from American cultural cues, only biculturals made spontaneous inferences from Chinese cultural cues. Moreover, American-Chinese bicultural individuals can switch between correspondent cultural inferences from American and Chinese cultural cues numerous times within one experimental session. Implications on cultural adaptation and cultural competence are discussed. [ABSTRACT FROM AUTHOR]

The authors propose that cultural frame shifting-shifting between two culturally based interpretative lenses in response to cultural cues-is moderated by perceived compatibility (vs. opposition)between the two cultural orientations, or bicultural identity integration (BII). Three studies found that Chinese American biculturals who perceived their cultural identities as compatible (high BII) responded in culturally congruent ways to cultural cues: They made more external attributions (a characteristically Asian behavior) after being exposed to Chinese primes and more internal attributions (a characteristically Western behavior) after being exposed to American primes. However, Chinese American biculturals who perceived their cultural identities as oppositional (low BII) exhibited a reverse priming effect. This trend was not apparent for noncultural primes. The results show that individual differences in bicultural identity affect how cultural knowledge is used to interpret social events. [ABSTRACT FROM AUTHOR]

The effects of justice and dispositional attribution on reactions to negative supervisory feedback were examined in two studies. Study 1 showed that criticism delivered with greater interpersonal fairness resulted in more favourable dispositional attributions about the supervisor, more acceptance of the feedback, and more favourable reactions towards the superior and the organization. The beneficial influence of just interpersonal treatment was general across various feedback contexts, although the magnitude varied. Study 2 clarified the causal ordering: just interpersonal treatment reduced negative dispositional attribution, which in turn increased feedback acceptance and improved attitudes towards the supervisor. Study 2 also distinguished the consequences of perceived fairness in the formal procedures applied to forming the feedback, as opposed to interpersonal treatment during its delivery. [ABSTRACT FROM AUTHOR]

Biliary cystadenoma (BCA) is a rare cystic tumor which originates from intrahepatic or extrahepatic biliary ducts. Intrahepatic BCAs are more common, demonstrate a female predominance, and generally asymptomatic. Radiographic evaluation assists in the preoperative differentiation of these tumors from other cystic liver masses while resection remains the only means for definitive diagnosis. We report a case of massive mucinous intrahepatic BCA initially diagnosed as a nonresectable malignancy presenting in a female patient with progressively increasing abdominal pain and girth. Enucleation of the mass with non-anatomic resection was employed for surgical management of this intrahepatic BCA. [ABSTRACT FROM PUBLISHER]

Eight studies ( N = 2,561) reveal that how we perceptually process a person's face affects our capacity to understand their mind. Studies 1A and B indicate this relationship functions via two separate pathways: (a) indirectly by increasing our sensitivity to the cues of a mind in a face and (b) directly by changing the way we relate to the mind behind the face. Six additional studies adopt perspective taking paradigms to provide further support for a direct effect of configural processing on mentalization. Studies 2 and 3 find that processing faces configurally increases perspective taking on spatial tasks compared to processing faces featurally. Study 4 demonstrates configural face processing gives rise to inferences about the target's mental states such as beliefs and desires. Study 5 finds manipulation of a target's face that heightens configural processing increases perspective taking. Using a positive control, Study 6 demonstrates real-world consequences. Taken together, these findings document that the multiple and complex consequences of configural processing are critical to the social function of mentalization. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Past theories have linked science denial to religiosity but have not explained its geographic variability. We hypothesize that it springs not only from religious intensity but also from religious intolerance, which depends greatly on the experience of religious diversity and hence on geography. The belief that one's religion trumps other faiths precipitates the stance that it trumps science too. This psychological process is most likely to operate in regions or countries with low religious heterogeneity. We measure the rejection of science not only in people's refusal to follow specific health recommendations, such as taking COVID-19 vaccines, but also in general measures of scientific engagement and attainment. We rule out alternative explanations, including reverse causality and spurious correlations, by conducting controlled experiments and running robustness checks on our statistical models., (© The Author(s) 2024. Published by Oxford University Press on behalf of National Academy of Sciences.)

An inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm of borderline malignant potential. Nearly half of all IMTs have rearrangement of anaplastic lymphoma kinase (ALK) locus on chromosome 2p23 which can be treated with targeted therapy. Herein, we describe an unusual presentation of IMT involving an anatomical region rarely implicated in this disease process. A 15-year-old male patient came to the ER with dysphagia and coffee ground emesis. On esophagogastroscopy, a nodular luminal obstructing 30 × 50 mm mass in the lower esophagus was found, which was continuous with a large, partially circumferential gastric mass extending from the mid-body to the proximal antrum. Biopsies from esophageal and gastric masses revealed submucosal lesions composed of cytologically bland spindle and epithelioid cells, intermingled with inflammatory infiltrate, for which several immunohistochemical (IHC) stains were performed. The molecular study demonstrated ATIC::ALK fusion. Based on morphological, IHC, and molecular study findings, the diagnosis of ALK-positive IMT was rendered. Because surgical excision was deemed infeasible, the patient was started on ALK-inhibiting therapy with crizotinib. The patient responded well with no evidence of residual or recurrent disease on follow-up imaging or surveillance esophagogastroduodenoscopy. Crizotinib was ultimately discontinued after 10 months of therapy, and the patient continues to undergo surveillance imaging for monitoring of disease burden., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Rural pediatric firearm injuries require regional pediatric and trauma expertise. We evaluated county-level population density associations with transport, hospital interventions, and patient outcomes at a Level I pediatric trauma center serving a rural, statewide catchment area., Material and Methods: The trauma registry of the only in-state pediatric trauma center was reviewed for firearm injuries in patients < 18 between 1/2013 and 3/2020. County-level population density was classified according to the United States Office of Management and Budget definitions for rural, micropolitan, and metropolitan areas., Results: 364 patients were identified, including 7 patients who were re-injured. Mean age was 11.3 ± 4.5 y and patients were 79.4% male. 59.3% were transferred from a referring hospital. Median injury severity score was 5 (IQR 1-10); 88.0% required trauma center admission, and 48.2% required operative intervention. 7.4% were injured in a rural county, 46.4% in a micropolitan county, and 46.2% in a metropolitan county. Patients from rural counties were more likely to be unintentionally injured (72.0%) than those from micropolitan (54.4%) or metropolitan counties (44.0%, P = .04). While need for inpatient admission and length of stay were similar, those transported from rural counties had significantly longer transport times ( P < .01) and less frequent need for operative intervention ( P = .03), as well as trends toward lower injury severity ( P = .08) and mortality ( P = .06)., Conclusion: Management of pediatric firearm injury is a unique challenge with significant regional variability. Opportunities exist for outreach, telehealth, and decision support to ensure equitable distribution of resources in rural trauma systems., Level of Evidence: Epidemiological, Level III., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background/Objectives: Palliative care (PC) has been associated with reduced patient symptom burden, improved physician satisfaction, and reduced cost of care. However, its use in primary bone tumors has not been well classified. Design/Setting and Subjects: Patients diagnosed with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma, and chordoma) between 2004 and 2018 were identified in the National Cancer Database. Cross tabulations with chi-square analysis were performed to evaluate frequencies of PC use by patient, facility, and tumor characteristics. Multivariate logistic binary regression was performed to evaluate relationships between patient, treatment facility, and tumor characteristics and the use of PC. Results: Around 24,401 patients were identified. Overall, 2.52% had any form of PC utilization. Of those receiving PC, 55.5-65.1% were treated with only noncurative surgery, radiation, chemotherapy, or any combination of these modalities. Odds of PC utilization were decreased for patients with chordomas, patients living >24 miles from the treatment facility, or patients with private insurance, Medicare, or unknown insurance status. Odds of PC utilization were increased in patients with greater tumor diameter or unknown tumor size, tumors in midline, increased tumor grade, stage IV tumors, or living in urban areas. Conclusion: PC use in patients with primary bone tumors increases with tumor stage, tumor grade, tumor size, and if the tumor is midline, and in patients living in urban areas. However, overall utilization remains markedly low. Future studies should be done to investigate these patterns of care and help expand the utilization of PC.

How should I greet her? Should I do what he requests? Newcomers to a culture learn its interpersonal norms at varying rates, largely through trial-and-error experience. Given that the culturally correct response often depends on conditions that are subtle and complex, we propose that newcomers' rate of acculturation depends on not only their explicit aptitude (e.g., reasoning ability) but also their implicit aptitude (e.g., pattern recognition ability). In Studies 1-3, participants experienced a range of influence situations sourced from a foreign culture. Across many trials, they decided whether or not to comply and then received accuracy feedback (based on what a majority of locals indicated to be the appropriate action in each situation). Across the 3 studies, stronger implicit aptitude was associated with greater improvement from trial-and-error experience, whereas stronger explicit aptitude was not. In Studies 4-6, participants experienced a range of greeting situations from a foreign culture. Across many trials, implicit aptitude predicted experiential learning, especially under conditions that impede reasoning: multiple cues, subliminal feedback, or inconsistent feedback. Study 7 found that the predictiveness of implicit aptitude was weaker under a condition that impedes associative processing: delayed feedback. These findings highlight the important role of implicit aptitude in helping people learn interpersonal norms from trial-and-error experience, particularly because in real-life intercultural interactions, the relevant cues are often complex, and the feedback is often fleeting and inconsistent but immediate. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

An Amyand's hernia is defined by the presence of the vermiform appendix in the inguinal hernia sac. Most cases of Amyand's hernia are incidentally diagnosed intraoperatively while surgically reducing a right inguinal hernia. Right-sided Amyand's hernias are more common than left-sided Amyand's hernias for two reasons: the appendix is naturally located on the right side and right inguinal hernias are more common. The prevalence of an Amyand's hernia has been reported as 1%, but the true prevalence is much lower than that. We report a particularly rare case of a 5-month-old boy with a left-sided Amyand's hernia surgically repaired without appendectomy.

SignificanceTo date, researchers and practitioners have focused on the academic challenges of underrepresented ethnic groups in the United States. In comparison, Asians have received limited attention, as they are commonly assumed to excel across all educational stages. Six large studies challenge this assumption by revealing that East Asians (but not South Asians) underperform in US law schools and business schools. This is not because East Asians are less academically motivated or less proficient in English but because their low verbal assertiveness is culturally incongruent with the assertiveness prized by US law and business schools. Online classes (via Zoom) mitigated East Asians' underperformance in courses emphasizing assertiveness and class participation. Educators should reexamine pedagogical practices to create a culturally inclusive classroom.

How does the cultural construct of collectivism impact social interactions? Two accounts of collectivism offer diverging predictions. The collectivism-as-values account proposes that people in collectivistic cultures prioritize their ingroup relationships; accordingly, this account predicts that collectivistic cultures will have more harmonious ingroup interactions than individualistic cultures. The socioecological account holds that individualistic cultures have high relational mobility, which requires people to invest in their ingroup relationships, whereas collectivistic cultures feature more fixed relationships that do not require positive engagement. To test these competing hypotheses about ingroup relationships across cultures, we sampled the daily interactions of college students in China and the United States. Results revealed that the individualistic culture (United States) had more positive ingroup interactions, more gratitude, and more emotional support than the collectivistic culture (China). The current findings are consistent with the socioecological account of collectivism and the effects of relational mobility on social relationships.

Well-educated and prosperous, Asians are called the "model minority" in the United States. However, they appear disproportionately underrepresented in leadership positions, a problem known as the "bamboo ceiling." It remains unclear why this problem exists and whether it applies to all Asians or only particular Asian subgroups. To investigate the mechanisms and scope of the problem, we compared the leadership attainment of the two largest Asian subgroups in the United States: East Asians (e.g., Chinese) and South Asians (e.g., Indians). Across nine studies ( n = 11,030) using mixed methods (archival analyses of chief executive officers, field surveys in large US companies, student leader nominations and elections, and experiments), East Asians were less likely than South Asians and whites to attain leadership positions, whereas South Asians were more likely than whites to do so. To understand why the bamboo ceiling exists for East Asians but not South Asians, we examined three categories of mechanisms-prejudice (intergroup), motivation (intrapersonal), and assertiveness (interpersonal)-while controlling for demographics (e.g., birth country, English fluency, education, socioeconomic status). Analyses revealed that East Asians faced less prejudice than South Asians and were equally motivated by work and leadership as South Asians. However, East Asians were lower in assertiveness, which consistently mediated the leadership attainment gap between East Asians and South Asians. These results suggest that East Asians hit the bamboo ceiling because their low assertiveness is incongruent with American norms concerning how leaders should communicate. The bamboo ceiling is not an Asian issue, but an issue of cultural fit., Competing Interests: The authors declare no competing interest.

Background: Laparoscopic appendectomy is a preferred approach in children with appendicitis. Patient characteristics associated with open appendectomy are poorly characterized, although such information can help optimize the care., Material and Methods: To characterize the factors associated with open appendectomy, we performed a retrospective analysis using the 2014 Nationwide Readmissions Database, capturing 49.3% of US hospitalizations. We identified surgically managed appendicitis using International Classification of Diseases, Ninth Revision, Clinical Modification among patients aged 18 or younger. Factors associated with open appendectomy, 30-d readmission rate, and hospitalization length were assessed using logistic regression, Cox proportional hazards regression, and Poisson regression, respectively., Results: Of 46,147 children with surgically managed appendicitis, 85.2% had laparoscopic appendectomy. Low-volume hospitals (odds ratio, OR: 3.01 [95% confidence interval, CI: 1.81-5.01]), rural hospitals (OR: 2.36 [95%CI: 1.63-3.40]), public insurance (OR: 1.19 [95%CI: 1.03-1.36]), lower-income neighborhood residence (OR: 1.40 [95%CI: 1.06-1.86]), younger age (OR: 5.00 [95%CI: 3.64-6.86] in <5 year-old), and abscess complicating appendicitis (OR: 1.91 [95%CI: 1.58-2.31]) were associated with open appendectomy. Laparoscopic appendectomy was associated with shorter hospitalization (incidence rate ratio: 0.77 [95%CI: 0.69-0.87]) and less readmission with wound infection, but not with 30-d readmission, or readmission with intraabdominal abscess., Conclusions: Along with clinical factors, non-clinical factors including appendicitis volume and rural/teaching status of the treating hospitals play a role in the choice of surgical approach. Awareness of the patient- and hospital-level factors associated with open appendectomy may allow for future resource distribution or improvement in access to care, resulting in population-level impact., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Collectivistic cultures have been characterized as having harmonious, cooperative ingroup relationships. However, we find evidence that people in collectivistic cultures are more vigilant toward ingroup members, mindful of their possible unethical intentions. Study 1 found that Chinese participants were more vigilant than Americans in within-group competitions, anticipating more unethical behaviors from their peers. Study 2 replicated this finding by comparing areas within China, finding that people from China's collectivistic rice-farming regions exhibit greater ingroup vigilance than people from the less collectivistic wheat-farming regions. The rice/wheat difference was mediated by greater perceived within-group competition. Study 3 found that Chinese participants were more likely than Americans to interpret a peer's friendly behavior as sabotage in disguise. We also manipulated within-group competition and found that it increased ingroup vigilance in both cultures. Finally, study 3 identified two boundary conditions where cultural differences in ingroup vigilance decrease: an unambiguously competitive win-lose situation where Americans also exhibit vigilance, and an unambiguously cooperative win-win situation where Chinese participants relax their vigilance. This research contributes to a more balanced view of collectivism, revealing its interpersonal tensions in the forms of within-group competition and ingroup vigilance., Competing Interests: The authors declare no conflict of interest.

We investigated the role of metacognition in the process by which people learn new cultural norms from experiential feedback. In a lab paradigm, participants received many trials of simulated interpersonal situations in a new culture, each of which required them to make a choice, and then provided them with evaluative feedback about the accuracy of their choice with regard to local norms. Studies 1 to 3 found that participants higher on an individual difference dimension of metacognitive proclivity learned to adhere to the local norms faster. This relationship held up in simple and complex situations, that is, when the feedback was noisy rather than completely reliable, and it also held up when possibly confounding individual differences were controlled (Study 2). Further evidence suggested that the underlying mechanism is the largely implicit process of error monitoring and reactive error-based updating. A measure of surprise (an indicator of error monitoring) mediated the link between metacognitive proclivity and faster learning (Study 3). In experiments that varied the task so as to afford different kinds of metacognitive processing, participants learned faster with posterror prompts but not with postaccuracy prompts (Study 4). Further, they learned faster with nondirected prompts that merely provided a break for processing rather with prompts that directly instructed them to reason explicitly (Study 5). We discuss the implications of these findings for models of culture, first- and second-culture learning, and for training and selecting people for foreign or intercultural roles. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Background: The Crohn's Disease Activity Index (CDAI), a scoring index including patient-reported outcomes (PROs), has known limitations for measuring intestinal inflammatory disease burden. Noninvasive markers of inflammation could prove more accurate than PROs; thus, regulatory authorities are exploring the use of PROs and endoscopic data as coprimary end points in clinical trials. The aim of this study was to assess the predictive ability of individual components of the CDAI, along with biomarker concentrations, to create models for predicting endoscopic disease activity., Methods: Between 2004 and 2006, 164 patients with established Crohn's disease (CD) undergoing clinically indicated ileocolonoscopy were recruited. Individual CDAI variables and fecal calprotectin (FC) were selected to explore their predictive accuracy for endoscopic disease activity, with the Simple Endoscopic Score-Crohn's Disease (SES-CD) as the outcome variable. Simple Poisson regression was performed on each variable, and 2 multivariate models were created (PRO-exclusive and PRO+FC [PRO+]). Additional analyses explored the patient-level agreement between models., Results: Number of liquid stools, abdominal pain, hematocrit (Hct), FC, and high-sensitivity C-reactive protein (hsCRP) correlated significantly with the SES-CD. For the prediction of SES-CD (>7 vs ≤6), the area under the curve (AUC) was 0.81, with 63% and 88% sensitivity and specificity, for the PRO+ model, compared with a 0.56 AUC, with 61% and 55%, respectively, for the PRO model. Intra-individual comparison revealed the PRO+ model to be superior in the prediction of endoscopically active disease., Conclusions: The inclusion of biomarkers significantly improved predictive accuracy for endoscopic disease activity compared with PRO-exclusive models., (© 2018 Crohn’s & Colitis Foundation of America. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com)

Women's underperformance in MBA programs has been the subject of recent debate and policy interventions, despite a lack of rigorous evidence documenting when and why it occurs. The current studies document a performance gap, specifying its contours and contributing factors. Two behaviors by female students that may factor into the gap are public conformity and private internalization. We predicted that women conform to the norm associating maleness with technical prowess by minimizing their public assertiveness in class discussions and meetings, but that they do not internalize the norm by reducing private effort. Data from multiple cohorts of a top-ranked MBA program reveal female underperformance occurred in technical subjects (e.g., accounting), but not social subjects (e.g., marketing). As predicted, the gender effect ran not through private effort but through public assertiveness, even controlling for gender differences in interests and aptitudes. These findings support some current policy interventions while casting doubt on others.

Prior research suggests that stress can be harmful in high-stakes contexts such as negotiations. However, few studies actually measure stress physiologically during negotiations, nor do studies offer interventions to combat the potential negative effects of heightened physiological responses in negotiation contexts. In the current research, we offer evidence that the negative effects of cortisol increases on negotiation performance can be reduced through a reappraisal of anxiety manipulation. We experimentally induced adaptive appraisals by randomly assigning 97 male and female participants to receive either instructions to appraise their anxiety as beneficial to the negotiation or no specific instructions on how to appraise the situation. We also measured participants' cortisol responses prior to and following the negotiation. Results revealed that cortisol increases were positively related to negotiation performance for participants who were told to view anxiety as beneficial, and not detrimental, for negotiation performance (appraisal condition). In contrast, cortisol increases were negatively related to negotiation performance for participants given no instructions on appraising their anxiety (control condition). These findings offer a means through which to combat the potentially deleterious effects of heightened cortisol reactivity on negotiation outcomes., Competing Interests: The authors have declared that no competing interests exist.

The study of multicultural identity has gained prominence in recent decades and will be even more urgent as the mobility of individuals and social groups becomes the 'new normal'. This paper reviews the state-of-the-art theoretical advancements and empirical discoveries of multicultural identity processes at the intrapersonal, interpersonal, and collective (e.g., organizational, societal) levels. First, biculturalism has more benefits for individuals' psychological and sociocultural adjustment than monoculturalism. Bicultural individuals' racial essentialist beliefs and Bicultural Identity Integration affect cultural frame switching, racial categorization, and creativity. Second, identity denial and identity-based discrimination by other people or groups threaten multicultural individuals' psychological health and performance. Third, multiculturalism and interculturalism policies are associated with different conceptions of and attitudes toward diversity, and have distinct outcomes for multicultural individuals and societies., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Endoplasmic reticulum (ER) stress and autophagy each play important roles in hepatocyte cell injury. We hypothesized that gene expression of C/EBP-homologous protein (CHOP) and the BH3 proteins Bcl2-interacting mediator of cell death (BIM) and BH3-interacting domain death agonist (BID) are involved in a complex interplay that regulates ER stress-induced autophagy and cell death., Materials and Methods: Hepatocytes were cultured from lean Zucker rats. Confluent hepatocytes were incubated with single or combined small interfering RNA for CHOP, BIM, and/or BID for 24 h providing gene inhibition. Incubation with tunicamycin (TM) for another 24 h stimulated ER stress. Quantitative real-time polymerase chain reaction determined the expression levels of CHOP, BIM, and BID. Immunostaining with microtubule-associated protein 1 light chain 3 measured autophagy activity. Trypan blue exclusion determined the cell viability., Results: TM treatment increased the messenger RNA levels of CHOP and BIM but decreased the messenger RNA levels of BID. TM increased autophagy and decreased cell viability. Individual inhibition of CHOP, BIM, or BID protected against autophagy and cell death. However, simultaneous treatment with any combination of CHOP, BIM, and BID small interfering RNAs reduced autophagy activity but increased cell death independent of ER stress induction., Conclusions: Autophagy in hepatocytes results from acute ER stress and involves interplay, at the gene expression level, of CHOP, BIM, and BID. Inhibition of any one of these individual genes during acute ER stress is protective against cell death. Conversely, inhibition of any two of the three genes results in increased nonautophagic cell death independent of ER stress induction. This study suggests interplay between CHOP, BIM, and BID expression that can be leveraged for protection against ER stress-related cell death. However, disruption of the CHOP/BH3 gene expression homeostasis is detrimental to cell survival independent of other cellular stress., (Copyright © 2015 Elsevier Inc. All rights reserved.)

We review limitations of the traditional paradigm for cultural research and propose an alternative framework, polyculturalism. Polyculturalism assumes that individuals' relationships to cultures are not categorical but rather are partial and plural; it also assumes that cultural traditions are not independent, sui generis lineages but rather are interacting systems. Individuals take influences from multiple cultures and thereby become conduits through which cultures can affect each other. Past literatures on the influence of multiple cultural identities and cultural knowledge legacies can be better understood within a polyculturalist rubric. Likewise, the concept elucidates how cultures are changed by contact with other cultures, enabling richer psychological theories of intercultural influence. Different scientific paradigms about culture imply different ideologies and policies; polyculturalism's implied policy of interculturalism provides a valuable complement to the traditional policy frames of multiculturalism and colorblindness.

Background: In adults, myocardial infarction (MI) results in a brisk inflammatory response, myocardium loss, and scar formation. We have recently reported the first mammalian large-animal model of cardiac regeneration after MI in fetal sheep. We hypothesize that the ability of the fetus to regenerate functional myocardium after MI is owing to differential gene expression regulating the response to MI in the fetus compared with the adult., Methods: Myocardial infarction was created in adult (n=4) or early gestation fetal (n=4) sheep. Tissue was harvested after 3 or 30 days, and RNA was extracted for microarray, followed by principal component analysis and global gene expression analysis for the following gene ontology terms: response to wounding, inflammatory response, extracellular matrix, cell cycle, cell migration, cell proliferation, and apoptosis., Results: Principal component analysis demonstrated that the global gene expression pattern in adult infarcts was distinctly different from the uninfarcted region at 3 days and remained different at 30 days after MI. In contrast, gene expression in the fetal infarct was different from the uninfarcted region at 3 days, but by 30 days it returned to a baseline expression pattern similar to the uninfarcted region. Three days after MI there was an increase in the expression of genes related to all gene ontology terms in fetal and adult infarcts, but this increase was much more pronounced in adults. By 30 days, the fetal gene expression returned to baseline, whereas in the adult it remained significantly elevated., Conclusions: These data demonstrate that the global gene expression pattern is dramatically different in the fetal regenerative response to MI compared with the adult response and may partly be responsible for the regeneration., (Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Wound size impacts the threshold between scarless regeneration and reparative healing in the fetus with increased inflammation showed in fetal scar formation. We hypothesized that increased fetal wound size increases pro-inflammatory and fibrotic genes with resultant inflammation and fibroplasia and that transition to scar formation could be reversed by overexpression of interleukin-10 (IL-10). To test this hypothesis, 2-mm and 8-mm dermal wounds were created in mid-gestation fetal sheep. A subset of 8-mm wounds were injected with a lentiviral vector containing the IL-10 transgene (n = 4) or vehicle (n = 4). Wounds were harvested at 3 or 30 days for histology, immunohistochemistry, analysis of gene expression by microarray, and validation with real-time polymerase chain reaction. In contrast to the scarless 2-mm wounds, 8-mm wounds showed scar formation with a differential gene expression profile, increased inflammatory cytokines, decreased CD45+ cells, and subsequent inflammation. Lentiviral-mediated overexpression of the IL-10 gene resulted in conversion to a regenerative phenotype with decreased inflammatory cytokines and regeneration of dermal architecture. In conclusion, increased fetal wounds size leads to a unique gene expression profile that promotes inflammation and leads to scar formation and furthermore, these results show the significance of attenuated inflammation and IL-10 in the transition from fibroplasia to fetal regenerative healing., (© 2014 by the Wound Healing Society.)

Background: Perineal gangrene was first described in healthy, young males more than two and one-half centuries ago. This disease, referred to commonly as Fournier gangrene, was marked by rapid progression, high mortality, and unknown etiology. In the last century the pathologic processes were described and accounts of perineal gangrene were reported in females. This disease still demonstrates a male predominance, but mortality does not demonstrate a gender predilection., Case Report: We present a case of a Bartholin abscess progressing to necrotizing fasciitis of the perineum in a 53-year-old female following drainage and marsupialization. Perineal gangrene was treated successfully with serial debridements and a targeted antimicrobial regimen, with wound closure by secondary intention., Results: Following retrospective case review, the exact pathophysiologic cause of progression to necrotizing fasciitis of the perineum is unclear though antibiotic resistance was a likely contributor., Conclusion: Clinical studies are necessary to investigate the differential incidence of this disease, which may result from diagnostic unawareness of necrotizing fasciitis of the perineum in females due to adherence to Fournier's original description or coding bias. Future clinical studies may define risk factors for disease better, and allow for standardized management and improved outcomes regardless of gender.

Hepatic adenomas are benign tumors typically diagnosed in women of reproductive age, however, these tumors occur in the pediatric population although rare. We present the case of a giant hepatic adenoma in an 8-year-old female without established risk factors with progressive abdominal pain, and po intolerance, biliary obstruction, anemia, and fever. Right trisegmentectomy afforded extirpation of the 16 × 14.5 × 8.5 cm mass. The postoperative course was complicated by transient encephalopathy and a bile leak which resolved with appropriate care. The patient is well over 1 year from resection. She demonstrates age appropriate mental and physical function without disease recurrence or complication.

Laboratory measurements of dissolved oxygen (DO) uptake by Glossosoma nigrior Banks were conducted in a sealed, recirculating flume under variable fluid flow velocities. Measurements were performed in similar water temperatures, DO concentrations and fluid flow velocities to field conditions in the stream where the larvae were obtained. Total oxygen uptake by both cased larvae and corresponding cases without larvae were quantified. An increased fluid flow velocity corresponded to an increased larval DO uptake rate. Oxygen uptake by the larval cases alone was not as sensitive to changes in the Peclet (Pe) number, the dimensionless ratio of advective to diffusive DO transport, as uptake by larvae themselves. The flux of DO to larvae and their cases was up to seven times larger in a moving fluid in comparison to non-moving fluid conditions in the proximity of larvae for 087, larvae typically remained in their cases. This indicates that oxygen delivery to the larvae at low Pe is insufficient to satisfy the respiratory demands of cased larvae.

Background: Both endoplasmic reticulum (ER) stress and autophagy have been shown to display dual roles in cell survival in multiple cell lines. There is a reported but poorly understood link between ER stress, autophagy, and cell death. We hypothesized that autophagy plays a role in ER stress-dependent cell death in rat hepatocytes., Materials and Methods: Primary hepatocytes isolated from both lean and obese male Zucker rats were cultured and treated with tunicamycin (TM), tauroursodeoxycholic acid, 3-methyladenine, and wortmannin for 12 h. The ER stress-associated genes glucose-regulated protein 78 and C/EBP homologous protein were examined via quantitative real time polymerase chain reaction. Immunostaining with microtubule-associated protein 1 light chain 3 as well as electron microscopy were used to evaluate autophagy activity. Trypan blue exclusion was used to determine hepatocyte cell viability., Results: In both lean and steatotic hepatocytes, we found that TM induced both C/EBP homologous protein and glucose-regulated protein 78 messenger RNA expression. Cells with increased ER stress were undergoing increased autophagy and had a significant decrease in cell viability. Both tauroursodeoxycholic acid and 3-methyladenine treatments attenuated TM induced ER stress, autophagy, and cell death, whereas wortmannin treatment reduced autophagy and cell death but without changing ER stress., Conclusions: These data suggest that autophagy is a likely downstream mediator of ER stress-induced cell death in rat hepatocytes. Further exploration of the link between autophagy and ER stress in hepatocyte injury will yield important information that may be leveraged for treatment of liver injuries such as ischemia/reperfusion., (Copyright © 2013 Elsevier Inc. All rights reserved.)

For bicultural individuals, visual cues of a setting's cultural expectations can activate associated representations, switching the frames that guide their judgments. Research suggests that cultural cues may affect judgments through automatic priming, but has yet to investigate consequences for linguistic performance. The present studies investigate the proposal that heritage-culture cues hinder immigrants' second-language processing by priming first-language structures. For Chinese immigrants in the United States, speaking to a Chinese (vs. Caucasian) face reduced their English fluency, but at the same time increased their social comfort, effects that did not occur for a comparison group of European Americans (study 1). Similarly, exposure to iconic symbols of Chinese (vs. American) culture hindered Chinese immigrants' English fluency, when speaking about both culture-laden and culture-neutral topics (study 2). Finally, in both recognition (study 3) and naming tasks (study 4), Chinese icon priming increased accessibility of anomalous literal translations, indicating the intrusion of Chinese lexical structures into English processing. We discuss conceptual implications for the automaticity and adaptiveness of cultural priming and practical implications for immigrant acculturation and second-language learning.

Liver herniation with gastroschisis is an uncommon occurrence that is associated with a poor prognosis. This report presents a single case of complex gastroschisis complicated by herniation of the left hepatic lobe. In the subject case, the abdominal wall defect was successfully closed by sequential closure with negative pressure wound therapy after the initial application of a preformed silo. As there are no established standards for the management of gastroschisis with liver herniation, there exists an opportunity for multicenter review to define approaches to optimize clinical outcomes with this complex congenital issue. As a result of the complexity and rarity of this congenital abnormality, reports with a positive prognosis carry clinical relevance., (Copyright © 2013 Elsevier Inc. All rights reserved.)