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The importance of personality for predicting life outcomes in the domains of love, work, and health is well established, as is evidence that personality traits, while relatively stable, can change. However, little is known about the sources and processes that drive changes in personality traits and how such changes might impact important life outcomes. In this paper, we make the case that the research paradigms and methodological approaches commonly used in personality psychology need to be revised to advance our understanding of the sources and processes of personality change. We propose Longitudinal Experience-Wide Association Studies as a framework for studying personality change that can address the limitations of current methods, and we discuss strategies for overcoming some of the challenges associated with Longitudinal Experience-Wide Association Studies. © 2020 European Association of Personality Psychology.

This special issue of Foundations of Physics collects together articles representing some recent new perspectives on the hole argument in the history and philosophy of physics. Our task here is to introduce those new perspectives.

Objectives: Fear of enacted stigma (fear of discrimination or being treated unfairly) is associated with decreased health care-seeking behaviors among patients with opioid use disorder (OUD). We sought to describe the prevalence of fear of enacted stigma among patients presenting to the emergency department (ED) with OUD and to test whether experiencing greater compassion from ED staff is associated with lower fear of enacted stigma., Methods: We conducted a cross-sectional study in the ED of an academic medical center between February and August 2023. We included adult patients with OUD presenting to the ED and assessed patient experience of compassion from ED staff using a previously validated 5-item compassion measure (score range 5-20). The primary outcome measure was fear of enacted stigma in the ED, measured using the validated 9-item subscale of the Substance Abuse Self-Stigma Scale (score range 9-45)., Results: Of the 116 subjects enrolled, 97% (95% confidence interval [CI] 91%-99%) reported some degree of stigma, with a median (interquartile range) score of 23 (16-31). In a multivariable model adjusting for potential confounders, patient experience of greater ED compassion was independently associated with lower fear of enacted stigma, β = -0.66 (95% CI -1.03 to -0.29), suggesting that every 1-point increase in the 5-item compassion measure score is associated with a 0.66-point decrease in the fear of enacted stigma score., Conclusions: Among ED patients with OUD, fear of enacted stigma is common. Patient experience of compassion from ED staff is associated with lower fear of enacted stigma. Future research is warranted to test if interventions aimed at increasing compassion from ED staff reduce patient fear of enacted stigma among patients with OUD., (© 2024 The Author(s). Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)

Introduction: Transfusion of packed red blood cells (PRBC) or low-titer group O whole blood (LTOWB) has become standard practice in trauma patients with significant blood loss. As blood ages, it undergoes metabolic and structural changes. This study aimed to test the association between age of PRBC/LTOWB and mortality among adult trauma patients., Materials and Methods: This is a retrospective cohort study at an academic level one trauma center. Adult trauma patients who received at least one unit of PRBC or LTOWB within the first hour of arrival to the emergency department (ED) between January 2016 and December 2019 were included. The primary outcome was in-hospital mortality. Multivariable logistic regression models were used to test the associations between the mean age of PRBC and LTOWB units transfused during the initial 24 hours and in-hospital mortality., Results: Of 388 patients included, 362 received PRBC and 121 received LTOWB. In-hospital mortality occurred in 31% of patients. The median (interquartile range) mean age of transfused PRBC units was 21 (16-26) days and LTOWB units was 11 (9-12) days. Neither age of PRBC nor LTOWB were found to be associated with in-hospital mortality: PRBC adjusted odds ratio (aOR) = 0.99 (95% CI 0.95 to 1.03) and LTOWB aOR = 1.12 (95% CI 0.88 to 1.41)., Conclusions: The mean age of LTOWB or PRBC units transfused during the first 24 hours after presenting to the ED for a traumatic injury was not found to be associated with in-hospital mortality., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Social, emotional, and behavioral (SEB) skills encompass a broad range of interpersonal and intrapersonal abilities that are crucial for establishing and maintaining relationships, managing emotions, setting and pursuing goals, and exploring new learning opportunities. To address the lack of consensus regarding terminology, definition, and assessment of SEB skills, Soto et al. developed the Behavioral, Emotional, and Social Skills Inventory (BESSI), which consists of 192 items, 32 facets, and 5 domains. The objective of the current study was to adapt the BESSI to Spanish (referred to as BESSI-Sp) and enhance the overall understanding of the BESSI framework. A sample of 303 people was employed with a mean age of 30.35 years ( SD = 14.73), ranging from 18 to 85 years. The results indicate that the BESSI-Sp demonstrates strong psychometric properties. Its facet- and domain-level structure aligns with the theoretical expectations and closely resembles the English-language source version. The facets exhibit high reliability (mean ω = .89), and the scores demonstrate adequate stability after 3 to 4 weeks (mean r ICC = .77). The BESSI-Sp also displays evidence of convergent validity and integrates well with the Big Five framework, providing incremental validity for various outcomes. We discuss the implications of these findings for the assessment of SEB skills and future research in this field., 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.

Trait self-control is highly valued, often equated with moral righteousness and associated with numerous positive life outcomes. This paper challenges the conventional conflation of trait self-control and state self-control. We suggest that while trait self-control is consistently linked to success, state self-control is not the causal mechanism driving these benefits. Trait self-control, sometimes also referred to as conscientiousness, grit, and the ability to delay gratification, predicts better health, wealth, and academic achievement. Conventional wisdom has it that people high in trait self-control reap all these benefits because they engage in more state self-control, defined as the momentary act of resolving conflict between goals and fleeting desires. Despite its intuitive appeal, there are problems with extolling state self-control because of our love for trait self-control. First, empirical evidence suggests that individuals high in trait self-control do not engage in more state self-control but engage it less. Second, changes to state self-control do not reliably and sustainably improve people's outcomes, as least in the long-term. And third, despite the possibility of dramatic improvements in trait self-control, these improvements are often short lived, with people returning to their baseline trait level over longer time horizons. The roots of this problem are numerous: Imprecise and inaccurate naming of our constructs that lead to construct drift and contamination; ignoring the numerous other facets of conscientiousness like orderliness or industriousness; and not appreciating that traits are sometimes not reducible to states. We suggest that the celebrated benefits of trait self-control arise from mechanisms beyond state self-control and highlight the need for a broader conceptualization of self-control in psychological research and practical interventions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Patient perception of physician compassion may be associated with improved health outcomes, yet it is unclear whether it is associated with postoperative pain reduction or improved patient experience metrics in same-day surgery patients. We hypothesized that higher anesthesiologist compassion during the preanesthesia interview, rated by patients, is associated with lower postoperative pain via the anxiety pathway in same-day surgery patients. We also performed exploratory correlation analysis to assess whether compassion was associated with less opioid consumption and improved patient experience in same-day surgery patients., Methods: We conducted a single-center, prospective, observational cohort study in American Society of Anesthesiologists (ASA) physical status I to III patients scheduled to undergo same-day surgery with anesthesia. Compassion was scored using a validated 5-item tool. State anxiety (SA) and trait anxiety (TA) were measured using the State-Trait Anxiety Inventory. Pain scores were obtained using a 0 to 10 Likert scale. Daily opioid use was recorded. Patient experience was assessed using the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) and the Surgical Care CAHPS. Mediation analysis was used to assess the association between compassion and pain scores via the anxiety pathway. Spearman correlation was performed to test for association between the compassion score and the secondary outcomes., Results: A total of 147 subjects completed the study with a median age of 50 years and 81% female. Fifty percent underwent breast surgery, 35% abdominal surgery, and the rest underwent gynecological and urological surgeries. The median (Q1-Q3) postoperative pain scores on postoperative days 0 and 3 days later were 4 (1.5-6) and 3 (1-5), respectively.Mediation analysis results showed a same-day anxiety-mediated effect (95% confidence interval [CI]) of compassion on pain of -0.08 (-0.13 to -0.02), attributing to 9% of the total effect. On postoperative day 0, an increase in compassion was associated with a significant average drop in pain of between 0.02 and 0.13. In addition, higher compassion was correlated with better patient experience metrics (ρ= -0.53 [95% CI, -0.64 to -0.39])., Conclusions: The study results suggest that an anxiety-mediated pathway exists through which compassionate care may help improve the patient's perception of postoperative pain on the day of surgery (before discharge from the hospital). Higher compassion was also associated with better patient experience metrics., Competing Interests: Conflicts of Interest: See Disclosures at the end of the article., (Copyright © 2024 International Anesthesia Research Society.)

Social, emotional, and behavioral (SEB) skills matter for individuals' well-being and success. The behavioral, emotional, and social skills inventory (BESSI) uses 192 items to assess 32 specific SEB skills across five broad skill domains. This research developed three short forms of the BESSI-192 and explored their measurement properties, predictive validity, and cross-cultural comparability. We found that BESSI-96, BESSI-45, and BESSI-20 largely captured the psychological content of the BESSI-192 measure, retained a robust multidimensional structure, and demonstrated adequate reliability. At the domain and facet level, the BESSI short forms showed patterns of associations with external criteria that were similar to the BESSI-192 and preserved most of the BESSI-192's predictive power. The BESSI short forms also demonstrated full or partial measurement invariance between the primarily U.S.-based and German adult samples. We conclude by discussing contexts in which the short forms may be useful for researchers and practitioners., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Christopher J. Soto, Christopher M. Napolitano, and Brent W. Roberts hold the copyright for the Behavioral, Emotional, and Social Skills Inventory (BESSI), which was used in the present research.

We evaluated how the number of response options affects the psychometric properties of the Big Five Inventory-2 (BFI-2). Using two large samples collected from a market research company ( N s = 893 and 1,213), we tested how different response options of the BFI-2 influenced scale score distributions, internal consistency estimates, convergent validity correlations, and criterion validity correlations. Results suggest that score distributions were impacted by the number of response options such that ceiling and floor effects were more common when using two or three response options than when using more options. Estimates of Cronbach's alpha were generally lower with fewer scale points as compared with more scale points, but these effects disappeared when ordinal alpha was used. There were no systematic effects of response options on convergent validity and criterion validity correlations. Given these results, there seems to be few psychometric reasons for deciding whether to administer personality items with five, six, or seven scale points., 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.

Objectives: There is currently conflicting data as to the effects of hypercapnia on clinical outcomes among mechanically ventilated patients in the emergency department (ED). These conflicting results may be explained by the degree of acidosis. We sought to test the hypothesis that hypercapnia is associated with increased in-hospital mortality and decreased ventilator-free days at lower pH, but associated with decreased in-hospital mortality and increased ventilator-free days at higher pH, among patients requiring mechanical ventilation in the emergency department (ED)., Methods: Secondary analysis of patient level data from prior clinical trials and cohort studies that enrolled adult patients who required mechanical ventilation in the ED. Patients who had a documented blood gas while on mechanical ventilation in the ED were included in these analyses. The primary outcome was in-hospital mortality, and secondary outcome was ventilator-free days. Mixed-effects logistic, linear, and survival-time regression models were used to test if pH modified the association between partial pressure of carbon dioxide (pCO 2 ) and outcome measures., Results: Of the 2348 subjects included, the median [interquartile range (IQR)] pCO2 was 43 (35-54) and pH was 7.31 (7.22-7.39). Overall, in-hospital mortality was 27%. We found pH modified the association between pCO 2 and outcomes, with higher pCO 2 associated with increased probability of in-hospital mortality when pH is below 7.00, and decreased probability of in-hospital mortality when pH is above 7.10. These results remained consistent across multiple sensitivity and subgroup analyses. A similar relationship was found with ventilator-free days., Conclusions: Higher pCO 2 is associated with decreased mortality and greater ventilator-free days when pH is >7.10; however, it is associated with increased mortality and fewer ventilator-free days when the pH is below 7.00. Targeting pCO 2 based on pH in the ED may be a potential intervention target for future clinical trials to improve clinical outcomes., Competing Interests: Declaration of competing interest On behalf of all authors, the corresponding author states that there is no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Is Conscientiousness a useful construct across cultures? Using the 2012 Program for International Student Assessment data, we examined whether perseverance, a measure of Conscientiousness, was related to achievement and truancy across 62 countries/regions ( N > 470,000). We investigated whether these relationships were linear or curvilinear in nature and assessed the utility of item-level information. After establishing partial metric invariance of the perseverance measure across various countries/regions and cultural regions, our findings unveiled that perseverance consistently predicted both math achievement and truancy, with predominantly linear associations. Notably, among the five items of the Perseverance scale, the item reflecting one's tendency to give up easily in the face of challenges emerged as the strongest and most consistent predictor of math achievement. Further, country-level correlations between perseverance and both math achievement and truancy displayed contradictory patterns compared to individual-level correlations, suggesting the presence of biasing factors in how people respond to these measures. Nonetheless, it appears reasonable to conclude that measures of Conscientiousness are pan-cultural predictors of achievement and truancy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Personality traits and social, emotional, and behavioral (SEB) skills share the same behavioral referents, but whereas traits refer to a person's typical or average performance, skills refer to their capacity or maximal performance. Given their shared behavioral foundations, an important question to address is whether personality traits and SEB skills independently predict important outcomes. In this study (N = 642), we examined whether subscales of the Behavioral, Emotional, and Social Skills Inventory (BESSI), a measure of SEB skills, provided incremental validity in the prediction of the ACT composite score, an important academic outcome for American adolescents, over the Big Five personality traits. Consistent with our expectations, on average, SEB skills showed stronger associations with ACT achievement scores than personality traits. Moreover, SEB skills added incremental validity over and above personality traits in predicting ACT achievement scores. The findings reinforce the importance of conceptually distinguishing and measuring traits and skills., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Background: Awareness with paralysis (AWP) is memory recall during neuromuscular blockade (NMB) and can cause significant psychological harm. Decades of effort and rigorous trials have been conducted to prevent AWP in the operating room, where prevalence is 0.1-0.2%. By contrast, AWP in mechanically ventilated emergency department (ED) patients is common, with estimated prevalence of 3.3-7.4% among survivors given NMB. Longer-acting NMB use is a critical risk for AWP, and we have shown an association between ED rocuronium use and increased AWP prevalence. As NMB are given to more than 90% of ED patients during tracheal intubation, this trial provides a platform to test an intervention aimed at reducing AWP. The overall objective is to test the hypothesis that limiting ED rocuronium exposure will significantly reduce the proportion of patients experiencing AWP., Methods: This is a pragmatic, stepped wedge cluster randomized trial conducted in five academic EDs, and will enroll 3090 patients. Per the design, all sites begin in a control phase, under observational conditions. At 6-month intervals, sites sequentially enter a 2-month transition phase, during which we will implement the multifaceted intervention, which will rely on use of nudges and defaults to change clinician decisions regarding ED NMB use. During the intervention phase, succinylcholine will be the default NMB over rocuronium. The primary outcome is AWP, assessed with the modified Brice questionnaire, adjudicated by three independent, blinded experts. The secondary outcome is the proportion of patients developing clinically significant symptoms of post-traumatic stress disorder at 30 and 180 days after hospital discharge. We will also assess for symptoms of depression and anxiety, and health-related quality of life. A generalized linear model, adjusted for time and cluster interactions, will be used to compare AWP in control versus intervention phases, analyzed by intention-to-treat., Discussion: The ED-AWARENESS-2 Trial will be the first ED-based trial aimed at preventing AWP, a critical threat to patient safety. Results could shape clinical use of NMB in the ED and prevent more than 10,000 annual cases of AWP related to ED care., Trial Registration: ClinicalTrials.gov identifier NCT05534243 . Registered 06, September 2022., (© 2023. The Author(s).)

Purpose: To evaluate early measurement of the arterial to end-tidal carbon dioxide (PaCO 2 -PetCO 2 ) gap, a surrogate for physiologic dead space, and its association with clinical outcomes in intubated adults in the emergency department (ED)., Materials and Methods: Observational cohort study of invasively mechanically ventilated adults in an academic medical center (years 2009 to 2016). The association of the PaCO 2 -PetCO 2 gap was evaluated with respect to clinical outcomes; the primary outcome was in-hospital mortality., Results: 519 patients were included. 325 (63%) patients had an elevated (>5 mmHg) PaCO 2 -PetCO 2 . Patients with an elevated PaCO 2 -PetCO 2 were significantly older, had higher APACHE II scores, more frequently had chronic obstructive pulmonary disease (COPD), had lower arterial oxygen to fraction of inspired oxygen (P:F) ratios, and were more likely to be intubated for exacerbation of COPD or sepsis. There was no difference in mortality for patients with an elevated PaCO 2 -PetCO 2 (25% vs 26%) in unadjusted analysis (p = 0.829) or adjusted analysis (aOR = 0.81 [95% CI: 0.53-1.26]), as compared to a non-elevated PaCO 2 -PetCO 2 ., Conclusions: An elevated PaCO 2 -PetCO 2 gap is common in the post-intubation period in the ED, but not significantly associated with clinical outcomes., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Age and gender differences in narcissism have been studied often. However, considering the rich history of narcissism research accompanied by its diverging conceptualizations, little is known about age and gender differences across various narcissism measures. The present study investigated age and gender differences and their interactions across eight widely used narcissism instruments (i.e., Narcissistic Personality Inventory, Hypersensitive Narcissism Scale, Dirty Dozen, Psychological Entitlement Scale, Narcissistic Personality Disorder Symptoms from the Diagnostic and Statistical Manual of Mental Disorders , Version IV, Narcissistic Admiration and Rivalry Questionnaire-Short Form, Single-Item Narcissism Scale, and brief version of the Pathological Narcissism Inventory). The findings of Study 1 (N = 5,736) revealed heterogeneity in how strongly the measures are correlated. Some instruments loaded clearly on one of the three factors proposed by previous research (i.e., Neuroticism, Extraversion, Antagonism), while others cross-loaded across factors and in distinct ways. Cross-sectional analyses using each measure and meta-analytic results across all measures (Study 2) with a total sample of 270,029 participants suggest consistent linear age effects (random effects meta-analytic effect of r = -.104), with narcissism being highest in young adulthood. Consistent gender differences also emerged (random effects meta-analytic effect was -.079), such that men scored higher in narcissism than women. Quadratic age effects and Age × Gender effects were generally very small and inconsistent. We conclude that despite the various conceptualizations of narcissism, age and gender differences are generalizable across the eight measures used in the present study. However, their size varied based on the instrument used. We discuss the sources of this heterogeneity and the potential mechanisms for age and gender differences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The disruptions to community functioning caused by the COVID-19 pandemic spurred individuals to action. This empirical study investigated the social, emotional, and behavioral (SEB) skill antecedents to college students' volunteering during the COVID-19 pandemic (N = 248, Mage = 20.6). We assessed eight SEB skills at the onset of a volunteering program, and students' volunteer hours were assessed 10-weeks later. Approximately 41.5% of the sample did not complete any volunteer hours. Higher levels of perspective taking skill, abstract thinking skill, and stress regulation were associated with more time spent volunteering. These results suggest that strength in particular SEB skills can prospectively predict prosocial civic behaviors., (© 2023 Society for Research on Adolescence.)

The current study presented the first meta-analytic review on the associations between the Big Five personality traits and stress measured under different conceptualizations (stressor exposure, psychological and physiological stress responses) using a total of 1,575 effect sizes drawn from 298 samples. Overall, neuroticism was found to be positively related to stress, whereas extraversion, agreeableness, conscientiousness, and openness were negatively linked to stress. When stress assessed under different conceptualizations was tested, only neuroticism, agreeableness, and conscientiousness were related to stressor exposure. All of the Big Five personality traits were significantly associated with psychological stress perception, whereas the five personality traits showed weak to null associations with physiological stress response. Further moderation analyses suggested that the associations between personality traits and stress under different conceptualizations were also contingent upon different characteristics of stress, sample, study design, and measures. The results supported the important role of personality traits in individual differences in stress.

Objectives: Mechanically ventilated emergency department (ED) patients experience high morbidity and mortality. In a prior trial at our center, ED-based lung-protective ventilation was associated with improved care delivery and outcomes. Whether this strategy has persisted in the years after the trial remains unclear. The objective was to assess practice change and clinical outcomes associated with ED lung-protective ventilation., Design: Secondary analysis of individual patient-level data from prior clinical trials and cohort studies., Setting: ED and ICUs of a single academic center., Patients: Mechanically ventilated adults., Interventions: A lung-protective ventilator protocol used as the default approach in the ED., Measurements and Main Results: The primary ventilator-related outcome was tidal volume, and the primary clinical outcome was hospital mortality. Secondary outcomes included ventilator-, hospital-, and ICU-free days. Multivariable logistic regression, propensity score (PS)-adjustment, and multiple a priori subgroup analyses were used to evaluate outcome as a function of the intervention. A total of 1,796 patients in the preintervention period and 1,403 patients in the intervention period were included. In the intervention period, tidal volume was reduced from 8.2 mL/kg predicted body weight (PBW) (7.3-9.1) to 6.5 mL/kg PBW (6.1-7.1), and low tidal volume ventilation increased from 46.8% to 96.2% ( p < 0.01). The intervention period was associated with lower mortality (35.9% vs 19.1%), remaining significant after multivariable logistic regression analysis (adjusted odds ratio [aOR], 0.43; 95% CI, 0.35-0.53; p < 0.01). Similar results were seen after PS adjustment and in subgroups. The intervention group had more ventilator- (18.8 [10.1] vs 14.1 [11.9]; p < 0.01), hospital- (12.2 [9.6] vs 9.4 [9.5]; p < 0.01), and ICU-free days (16.6 [10.1] vs 13.1 [11.1]; p < 0.01)., Conclusions: ED lung-protective ventilation has persisted in the years since implementation and was associated with improved outcomes. These data suggest the use of ED-based lung-protective ventilation as a means to improve outcome., Competing Interests: Dr. Kollef is supported by the Barnes-Jewish Hospital Foundation. Dr. Fuller is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number R34HL150404. Dr. Carpenter is supported by the National Institute of Aging under award numbers R21/R33AG058926 and R61/R33 AG069822. Drs. Fuller, Yan, and Roberts received support for article research from the National Institutes of Health. Dr. Mohr’s institution received funding from ESSOS. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Objectives: In mechanically ventilated patients, awareness with paralysis (AWP) can have devastating consequences, including post-traumatic stress disorder (PTSD), depression, and thoughts of suicide. Single-center data from the emergency department (ED) demonstrate an event rate for AWP factors higher than that reported from the operating room. However, there remains a lack of data on AWP among critically ill, mechanically ventilated patients. The objective was to assess the proportion of ED patients experiencing AWP and investigate modifiable variables associated with its occurrence., Design: An a priori planned secondary analysis of a multicenter, prospective, before-and-after clinical trial., Setting: The ED of three academic medical centers., Patients: Mechanically ventilated adult patients that received neuromuscular blockers., Interventions: None., Measurements and Main Results: All data related to sedation and analgesia were collected. AWP was the primary outcome, assessed with the modified Brice questionnaire, and was independently adjudicated by three expert reviewers. Perceived threat, in the causal pathway for PTSD, was the secondary outcome. A total of 388 patients were studied. The proportion of patients experiencing AWP was 3.4% ( n = 13), the majority of whom received rocuronium ( n = 12/13; 92.3%). Among patients who received rocuronium, 5.5% ( n = 12/230) experienced AWP, compared with 0.6% ( n = 1/158) among patients who did not receive rocuronium in the ED (odds ratio, 8.64; 95% CI, 1.11-67.15). Patients experiencing AWP had a higher mean ( sd ) threat perception scale score, compared with patients without AWP (15.6 [5.8] vs 7.7 [6.0]; p < 0.01)., Conclusions: AWP was present in a concerning proportion of mechanically ventilated ED patients, was associated with rocuronium exposure in the ED, and led to increased levels of perceived threat, placing patients at greater risk for PTSD. Studies that aim to further quantify AWP in this vulnerable population and eliminate its occurrence are urgently needed., Competing Interests: Dr. Fuller is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) under award number R34HL150404. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Dr. Kollef is supported by the Barnes-Jewish Hospital Foundation. Funders played no role in the following features of the study: study design, data collection, data management, data analysis, data interpretation, writing of the article, or decision to submit the article for publication. Drs. Fuller’s, Mohr’s, and Roberts’ institutions received funding from the National Heart, Lung, and Blood Institute. Drs. Fuller, Mohr, Roberts, Faine, Drewry, and Yan received support for article research from the NIH. Dr. Drewry’s institution received funding from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Social, emotional, and behavioral (SEB) skills comprise a broad set of abilities that are essential for building and maintaining relationships, regulating emotions, selecting and pursuing goals, or exploring novel stimuli. Toward an improved SEB skill assessment, Soto and colleagues recently introduced the Behavioral, Emotional, and Social Skills Inventory (BESSI). Measuring 32 facets from 5 domains with 192 items (assessment duration: ~15 min), BESSI constitutes the most extensive SEB inventory to date. However, so far, BESSI exists only in English. In three studies, we comprehensively validated a novel German-language adaptation, BESSI-G. Moreover, we expanded evidence on BESSI in three ways by (1) assessing the psychometric properties of the 32 individual skill facets, in addition to their domain-level structure; (2) providing first insights into the temporal stabilities of the 32 facets over 1.5 and 8 months; and (3) investigating the domains' and facets' associations with intelligence, in addition to personality traits. Results show that BESSI-G exhibits good psychometric properties (unidimensionality, reliability, factorial validity). Its domain-level structure is highly similar to that of the English-language source version. The facets show high temporal stabilities, convergent validity with personality traits, and discriminant validity with fluid and crystallized intelligence. We discuss implications for research on SEB skills.

Objectives: Deep sedation in the emergency department (ED) is common, increases deep sedation in the ICU, and is negatively associated with outcome. Limiting ED deep sedation may, therefore, be a high-yield intervention to improve outcome. However, the feasibility of conducting an adequately powered ED-based clinical sedation trial is unknown. Our objectives were to assess trial feasibility in terms of: 1) recruitment, 2) protocol implementation and practice change, and 3) safety. Patient-centered clinical outcomes were assessed to better plan for a future large-scale clinical trial., Design: Pragmatic, multicenter ( n = 3), prospective before-after pilot and feasibility trial., Setting: The ED and ICUs at three medical centers., Patients: Consecutive, adult mechanically ventilation ED patients., Interventions: An educational initiative aimed at reliable ED sedation depth documentation and reducing the proportion of deeply sedated patients (primary outcome)., Measurements and Main Results: Sedation-related data in the ED and the first 48 ICU hours were recorded. Deep sedation was defined as a Richmond Agitation-Sedation Scale of -3 to -5 or a Sedation-Agitation Scale of 1-3. One thousand three hundred fifty-six patients were screened; 415 comprised the final population. Lighter ED sedation was achieved in the intervention group, and the proportion of deeply sedated patients was reduced from 60.2% to 38.8% ( p < 0.01). There were no concerning trends in adverse events (i.e., inadvertent extubation, device removal, and awareness with paralysis). Mortality was 10.0% in the intervention group and 20.4% in the preintervention group ( p < 0.01). Compared with preintervention, the intervention group experienced more ventilator-free days [22.0 (9.0) vs 19.9 (10.6)] and ICU-free days [20.8 (8.7) vs 18.1 (10.4)], p < 0.05 for both., Conclusions: This pilot trial confirmed the feasibility of targeting the ED in order to improve sedation practices and reduce deep sedation. These findings justify an appropriately powered clinical trial regarding ED-based sedation to improve clinical outcomes., Competing Interests: Drs. Fuller’s, Roberts’, and Mohr’s institutions received funding from the National Heart, Lung, and Blood Institute. Drs. Fuller, Roberts, Mohr, Faine, and Yan received support for article research from the National Institutes of Health. Dr. Fuller is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number R34HL150404. Dr. Kollef is supported by the Barnes-Jewish Hospital Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Abstract: Providing a valid and reliable measure of conscientiousness constitutes a worthwhile endeavor to allow research and intervention in Brazil. This study aimed to adapt the Chernyshenko Conscientiousness Scales (CCS) into Brazilian Portuguese, evaluate their psychometric properties, and investigate the relationship between conscientiousness and academic involvement, taking into account the possible confound effect of subjective well-being (SWB). Two samples were studied to cross-validate the CCS's internal structure. Participants were university students (N1 = 332, N2 = 684) who answered the CCS and measures of SWB and academic involvement. Exploratory factor analysis showed that the CCS presented a five-factor solution corresponding to the previously replicated facets of industriousness, orderliness, self-control, traditionalism, and virtue. Most facets related positively to life satisfaction, positive affect, and involvement in academic activities, and negatively to negative affect. A structural model indicated strong associations of conscientiousness with SWB and academic engagement, suggesting more conscious students are happier and engage more in academic tasks. These results support the use of the CCS in Brazil., Trial Registration Number and Date of Registration: 32732820.6.0000.5334, July 8th, 2020., Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03552-7., Competing Interests: Conflicts of interest/Competing interestsOn behalf of all authors, the corresponding author states that there is no conflict of interest., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

People differ in their social, emotional, and behavioral (SEB) skills: their capacities to maintain social relationships, regulate emotions, and manage goal- and learning-directed behaviors. In five studies using data from seven independent samples ( N = 6,309), we address three key questions about the nature, structure, assessment, and outcomes of SEB skills. First, how can SEB skills be defined and distinguished from other kinds of psychological constructs, such as personality traits? We propose that SEB skills represent how someone is capable of thinking, feeling, and behaving when the situation calls for it, whereas traits represent how someone tends to think, feel, and behave averaged across situations. Second, how can specific SEB skills be organized within broader domains? We find that many skill facets can be organized within five major domains representing Social Engagement, Cooperation, Self-Management, Emotional Resilience, and Innovation Skills. Third, how should SEB skills be measured? We develop and validate the Behavioral, Emotional, and Social Skills Inventory (BESSI) to measure individuals' capacity to enact specific behaviors representing 32 skill facets. We then use the BESSI to investigate the nomological network of SEB skills. We show that both skill domains and facets converge in conceptually meaningful ways with socioemotional competencies, character and developmental strengths, and personality traits, and predict consequential outcomes including academic achievement and engagement, occupational interests, social relationships, and well-being. We believe that this work provides the most comprehensive model currently available for conceptualizing SEB skills, as well as the most psychometrically robust tool available for assessing them. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Past research syntheses provided evidence that personality traits are both stable and changeable throughout the life span. However, early meta-analytic estimates were constrained by a relatively small universe of longitudinal studies, many of which tracked personality traits in small samples over moderate time periods using measures that were only loosely related to contemporary trait models such as the Big Five. Since then, hundreds of new studies have emerged allowing for more precise estimates of personality trait stability and change across the life span. Here, we updated and extended previous research syntheses on personality trait development by synthesizing novel longitudinal data on rank-order stability (total k = 189, total N = 178,503) and mean-level change (total k = 276, N = 242,542) from studies published after January 1, 2005. Consistent with earlier meta-analytic findings, the rank-order stability of personality traits increased significantly throughout early life before reaching a plateau in young adulthood. These increases in stability coincide with mean-level changes in the direction of greater maturity. In contrast to previous findings, we found little evidence for increasing rank-order stabilities after Age 25. Moreover, cumulative mean-level trait changes across the life span were slightly smaller than previously estimated. Emotional stability, however, increased consistently and more substantially across the life span than previously found. Moderator analyses indicated that narrow facet-level and maladaptive trait measures were less stable than broader domain and adaptive trait measures. Overall, the present findings draw a more precise picture of the life span development of personality traits and highlight important gaps in the personality development literature. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: Mechanically ventilated patients have experienced greater periods of prolonged deep sedation during the coronavirus disease (COVID-19) pandemic. Multiple studies from the pre-COVID era demonstrate that early deep sedation is associated with worse outcome. Despite this, there is a lack of data on sedation depth and its impact on outcome for mechanically ventilated patients during the COVID-19 pandemic. We sought to characterize the emergency department (ED) and intensive care unit (ICU) sedation practices during the COVID-19 pandemic, and to determine if early deep sedation was associated with worse clinical outcomes., Study Design and Methods: Dual-center, retrospective cohort study conducted over 6 months (March-August, 2020), involving consecutive, mechanically ventilated adults. All sedation-related data during the first 48 h were collected. Deep sedation was defined as Richmond Agitation-Sedation Scale of - 3 to - 5 or Riker Sedation-Agitation Scale of 1-3. To examine impact of early sedation depth on hospital mortality (primary outcome), we used a multivariable logistic regression model. Secondary outcomes included ventilator-, ICU-, and hospital-free days., Results: 391 patients were studied, and 283 (72.4%) experienced early deep sedation. Deeply sedated patients received higher cumulative doses of fentanyl, propofol, midazolam, and ketamine when compared to light sedation. Deep sedation patients experienced fewer ventilator-, ICU-, and hospital-free days, and greater mortality (30.4% versus 11.1%) when compared to light sedation (p < 0.01 for all). After adjusting for confounders, early deep sedation remained significantly associated with higher mortality (adjusted OR 3.44; 95% CI 1.65-7.17; p < 0.01). These results were stable in the subgroup of patients with COVID-19., Conclusions: The management of sedation for mechanically ventilated patients in the ICU has changed during the COVID pandemic. Early deep sedation is common and independently associated with worse clinical outcomes. A protocol-driven approach to sedation, targeting light sedation as early as possible, should continue to remain the default approach., (© 2022. The Author(s).)

Background: The management of mechanical ventilation critically impacts outcome for patients with acute respiratory failure. Ventilator settings in the early post-intubation period may be especially influential on outcome. Low tidal volume ventilation in the prehospital setting has been shown to impact the provision of low tidal volume after admission and influence outcome. However, there is an overall paucity of data on mechanical ventilation for air medical transport patients. The objectives of this study were to characterize air medical transport ventilation practices and assess variables associated with nonprotective ventilation., Methods: This was a multi-center, nationwide (approximately 130 bases) retrospective cohort study conducted on consecutive, adult mechanically ventilated air medical transport patients treated in the prehospital environment. Descriptive statistics were used to assess the cohort; the chi-square test compared categorical variables, and continuous variables were compared using independent samples t test or Mann-Whitney U test. To assess for predictors of nonprotective ventilation, a multivariable logistic regression model was constructed to adjust for potentially confounding variables. Low tidal volume ventilation was defined as a tidal volume of ≤ 8 mL/kg predicted body weight (PBW)., Results: A total of 68,365 subjects were studied. Height was documented in only 4,186 (6.1%) subjects. Significantly higher tidal volume/PBW (8.6 [8.3-9.2] mL vs 6.5 [6.1-7.0] mL) and plateau pressure (20.0 [16.5-25.0] cm H 2 O vs 18.0 [15.0-22.0] cm H 2 O) were seen in the nonpro-tective ventilation group (P < .001 for both). According to sex, females received higher tidal volume/PBW compared to males (7.4 [6.6-8.0] mL vs 6.4 [6.0-6.8] mL, P < .001) and composed 75% of those subjects with nonprotective ventilation compared to 25% male, P < .001. After multivariable logistic regression, female sex was an independent predictor of nonprotective ventilation (adjusted odds ratio 6.79 [95% CI 5.47-8.43], P < .001)., Conclusions: The overwhelming majority of air medical transport subjects had tidal volume set empirically, which may be exposing patients to nonprotective ventilator settings. Given a lack of PBW assessments, the frequency of low tidal volume use remains unknown. Performance improvement initiatives aimed at indexing tidal volume to PBW are easy targets to improve the delivery of mechanical ventilation in the prehospital arena, especially for females., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2022 by Daedalus Enterprises.)

Objectives: Data suggest that low tidal volume ventilation (LTVV) initiated in the emergency department (ED) has a positive impact on outcome. This systematic review and meta-analysis quantify the impact of ED-based LTVV on outcomes and ventilator settings in the ED and ICU., Data Sources: We systematically reviewed MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, references, conferences, and ClinicalTrials.gov., Study Selection: Randomized and nonrandomized studies of mechanically ventilated ED adults were eligible., Data Extraction: Two reviewers independently screened abstracts. The primary outcome was mortality. Secondary outcomes included ventilation duration, lengths of stay, and occurrence rate of acute respiratory distress syndrome (ARDS). We assessed impact of ED LTVV interventions on ED and ICU tidal volumes., Data Synthesis: The search identified 1,023 studies. Eleven studies (n = 12,912) provided outcome data and were meta-analyzed; 10 additional studies (n = 1,863) provided descriptive ED tidal volume data. Overall quality of evidence was low. Random effect meta-analytic models revealed that ED LTVV was associated with lower mortality (26.5%) versus non-LTVV (31.1%) (odds ratio, 0.80 [0.72-0.88]). ED LTVV was associated with shorter ICU (mean difference, -1.0; 95% CI, -1.7 to -0.3) and hospital (mean difference, -1.2; 95% CI, -2.3 to -0.1) lengths of stay, more ventilator-free days (mean difference, 1.4; 95% CI, 0.4-2.4), and lower occurrence rate (4.5% vs 8.3%) of ARDS (odds ratio, 0.57 [0.44-0.75]). ED LTVV interventions were associated with reductions in ED (-1.5-mL/kg predicted body weight [PBW] [-1.9 to -1.0]; p < 0.001) and ICU (-1.0-mL/kg PBW [-1.8 to -0.2]; p = 0.01) tidal volume., Conclusions: The use of LTVV in the ED is associated with improved clinical outcomes and increased use of lung protection, recognizing low quality of evidence in this domain. Interventions aimed at implementing and sustaining LTVV in the ED should be explored., Competing Interests: Dr. Fuller is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) under award number R34HL150404. Dr. Palmer’s institution received funding from the Barnes Jewish Foundation grant and Washington University Department of Anesthesia; he disclosed he is an Omnicure seed investor. Dr. Ablordeppey’s institution received funding from the National Heart, Lung, and Blood Institute. Dr. Fuller’s institution received funding from the National Institutes of Health NIH (R34HL150404); he received support for article research from the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Funders played no role in the following features of the study: study design, data collection, data management, data analysis, data interpretation, writing of the manuscript, or decision to submit the article for publication. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Objective: Are treatment effects on personality trait change ephemeral and attributable to change in clinical states? Data of an intervention study were used to examine if change in clinical states (e.g., stress or depression) accounts for change in personality traits and to test whether both changes in traits and clinical states were independently associated with substance use., Method: Seventy-nine substance use patients (M age = 25.3, SD = 2.7; 35% female) took part at a 4-week intervention and completed a total of 15 bi-monthly assessments across 28 weeks to measure change in traits and states during and after treatment., Results: The results suggest that participants showed large trait and state changes over time, which happened rapidly with the majority occurring during the first four weeks. Trait and state changes were highly correlated, but not perfectly redundant. Significant variance in personality trait change remained after controlling for change in clinical states. Moreover, both trait and state change independently predicted substance use., Conclusion: Personality trait change occurred relatively fast and was maintained until the last follow-up assessment six months after the end of the intervention. Also, the findings point to the notion that the conceptual distinction between traits and states may not be as important as originally thought., (© 2021 Wiley Periodicals, LLC.)

Background: Twenty-five percent of patients presenting to the emergency department (ED) for a respiratory or cardiovascular medical emergency develop clinically significant posttraumatic stress disorder (PTSD) symptoms. It is possible that development of PTSD symptoms in this cohort is associated with subsequent adverse physical health events. Our objective was to test whether clinically significant PTSD symptoms 30 days postdischarge are associated with increased risk for hospital readmission within 24 months after discharge among patients presenting to the ED for a respiratory or cardiovascular emergency., Methods: This was a prospective cohort study conducted between January 1, 2018, and December 31, 2020, at a U.S. academic medical center, including adult patients presenting with acute respiratory failure or cardiovascular instability requiring a potentially life-sustaining intervention in the ED. PTSD symptoms 30 days postdischarge were measured using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders-5. The primary outcome was all-cause hospital readmission over the subsequent 24 months after hospital discharge from the index ED visit., Results: Of the 99 patients included, 73% (95% confidence interval [CI] = 63% to 81%) had a hospital readmission within 24 months. In a multivariable Cox proportional hazards model adjusting for potential confounders (e.g., age, severity of illness during index ED visit, preexisting comorbid conditions) presence of clinically significant PTSD symptoms at 30 days was independently associated with increased risk for all-cause hospital readmission at 24 months (hazards ratio = 2.19, 95% CI = 1.30 to 3.69). These results remained statistically significant across multiple sensitivity analyses., Conclusions: Hospital readmission is common among survivors of acute respiratory failure and cardiovascular instability, and PTSD symptoms 30 days postdischarge are an independent predictor of hospital readmission. Survivors of medical emergencies may warrant follow-up evaluation for PTSD symptoms, and future research is warranted to better understand the relationship between psychological trauma and hospital readmission., (© 2022 Society for Academic Emergency Medicine.)

Background: We previously validated a 5-item compassion measure to assess patient experience of clinician compassion in the outpatient setting. However, currently, there is no validated and feasible method for health care systems to measure patient experience of clinician compassion in the inpatient setting across multiple hospitals., Objective: To test if the 5-item compassion measure can validly and distinctly measure patient assessment of physician and nurse compassion in the inpatient setting., Design: Cross-sectional study between July 1 and July 31, 2020, in a US health care network of 91 community hospitals across 16 states consisting of approximately 15,000 beds., Patients: Adult patients who had an inpatient hospital stay and completed the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey., Measurements: We adapted the original 5-item compassion measure to be specific for physicians, as well as for nurses. We disseminated both measures with the HCAHPS survey and used confirmatory factor analysis for validity testing. We tested reliability using Cronbach's alpha, as well as convergent validity with patient assessment of physician and nursing communication and overall hospital rating questions from HCAHPS., Results: We analyzed 4756 patient responses. Confirmatory factor analysis found good fit for two distinct constructs (i.e., physician and nurse compassion). Both measures demonstrated good internal consistency (alpha > 0.90) and good convergent validity but reflected a construct (compassionate care) distinct from what is currently captured in HCAHPS., Conclusion: We validated two 5-item tools that can distinctly measure patient experience of physician and nurse compassion for use in the inpatient hospital setting in conjunction with HCAHPS., (© 2021. The Author(s).)

Background: Approximately 80% of people with COVID-19 do not require hospitalization. Studies examining the outpatient experience have not tracked symptoms to resolution leading to unknown expected symptom duration. Our objectives were to (1) determine symptom duration among patients with COVID-19 who do not require hospitalization and (2) identify potential risk factors associated with prolonged symptom duration., Design: This is a retrospective cohort study conducted across an academic healthcare system including adult patients with laboratory-confirmed SARS-CoV-2 infection between March 18th and April 28th, 2020 who were not hospitalized. Symptom duration encompassed time from patient-reported symptom onset as documented in the chart until documented symptom resolution. We calculated the median symptom duration and tested if demographics, comorbidities, or reported symptoms were associated with symptom duration., Key Results: Of 294 patients meeting inclusion criteria, 178 (60.5%) had documented symptom resolution. The median [interquartile range (IQR)] symptom duration for included patients was 15 (8-24) days. No associations were found between comorbidities and symptom duration. Factors associated with prolonged symptom duration were presence vs lack of lower respiratory symptoms [median (IQR) 16.5 (10.75-33.5) vs 14.5 (7-21.75) days respectively, P < .001] and neurologic symptoms [median (IQR) 17 (9-28) vs 9.5 (4-17) days, P < .001] at disease onset., Conclusions: The median symptom duration in outpatients is 15 days and over 25% of patients have symptoms longer than 21 days., (Copyright © 2021 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives: Theoretical and empirical evidence suggests the existence of a general perceived stress factor overarching different life domains. The present study investigated the general perceived stress relative to domain-specific perceived stress as predictors of 26 diverse health outcomes, including mental and physical health, health behaviors, cognitive functioning, and physiological indicators of health., Method: A bifactor exploratory structural equational modeling approach was adopted in 2 aging samples from the Health and Retirement Study (N = 8,325 in Sample 1 and N = 7,408 in Sample 2)., Results: Across the 2 samples, perceived stress was well represented by a bifactor structure where there was a robust general perceived stress factor representing a general propensity towards stress perception. Meanwhile, after controlling for the general perceived stress factor, specific factors that represent perceived stress in different life domains were still clearly present. Results also suggested age, sex, race, education, personality traits, and past and recent stressor exposure as possible factors underlying individual differences in the general perceived stress factor. The general perceived stress factor was the most robust predictor of the majority of health outcomes, as well as changes in mental health outcomes. The specific factor of perceived neighborhood stress demonstrated incremental predictive effects across different types of health outcomes., Discussion: The current study provides strong evidence for the existence of a general perceived stress factor that captures variance shared among stress across life domains, and the general perceived stress factor demonstrated substantial prospective predictive effects on diverse health outcomes in older adulthood., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The data presented in this article- originally reported by Soto and colleagues (Soto et al., in press)- assess social, emotional, and behavioral (SEB) skills, indexed by the Behavioral, Emotional, and Social Skills Inventory (BESSI), across seven independent samples ( N  = 6,309). Four of the datasets ( N  = 5000) were collected using an online survey housed on PersonalityLab.org. In two of these internet datasets, participants provided their responses to sociodemographic items, subsets of BESSI items (45 - 102 items), and the Big Five Inventory-2 (BFI-2, 60 items). In the other two internet datasets, participants answered the same sociodemographic items and the full BESSI questionnaire (192 - 200 items). The fifth dataset was collected via an online survey sponsored by the Character Lab Research Network and included responses from 499 high school students. The High School Student Sample completed sociodemographic items, the full BESSI (192 items), and measures of academic engagement, occupational interests, peer acceptance, friendship quality, romantic relationship satisfaction, family relationship satisfaction, volunteerism, physical exercise, and life satisfaction (96 total items). The sixth dataset was collected using the Qualtrics Online Sample service, and 488 adult respondents completed an extended, observer-report version of the BESSI (284 items), sociodemographic items, and information regarding their relationship with the person whom they were reporting on (7 items). The seventh data set consisted of college students ( N  = 322) from Colby College. The College Student Sample completed a survey on Qualtrics that included sociodemographic items, the full BESSI (192 items), the BFI-2 (60 items), and four other SEB skill inventories (116 items). All datasets, questionnaires, and scoring forms are hosted on OSF. The data can be used to (1) understand the structure and organization of SEB skills, (2) model the relationship between SEB skills and conceptually adjacent constructs such as personality traits and character strengths, and (3) explore the associations between SEB skills and consequential outcomes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors. Published by Elsevier Inc.)

Personality psychology, which seeks to study individual differences in thoughts, feelings, and behaviors that persist over time and place, has experienced a renaissance in the last few decades. It has also not been reviewed as a field in the Annual Review of Psychology since 2001. In this article, we seek to provide an update as well as a meta-organizational structure to the field. In particular, personality psychology has a prescribed set of four responsibilities that it implicitly or explicitly tackles as a field: ( a ) describing what personality is-i.e., what the units of analysis in the field are; ( b ) documenting how it develops; ( c ) explaining the processes of personality and why they affect functioning; and ( d ) providing a framework for understanding individuals and explaining their actions, feelings, and motivations. We review progress made over the last 20 years to address these four agendas and conclude by highlighting future directions and ongoing challenges to the field.

Objectives: To characterize prehospital air medical transport sedation practices and test the hypothesis that modifiable variables related to the monitoring and delivery of analgesia and sedation are associated with prehospital deep sedation., Design: Multicenter, retrospective cohort study., Setting: A nationwide, multicenter (approximately 130 bases) air medical transport provider., Patients: Consecutive, adult mechanically ventilated air medical transport patients treated in the prehospital environment (January 2015 to December 2020)., Interventions: None., Measurements and Main Results: All data involving sedation (medications, monitoring) were recorded. Deep sedation was defined as: 1) Richmond Agitation-Sedation Scale of -3 to -5; 2) Ramsay Sedation Scale of 5 or 6; or 3) Glasgow Coma Scale of less than or equal to 9. Coma was defined as being unresponsive and based on median sedation depth: 1) Richmond Agitation-Sedation Scale of -5; 2) Ramsay of 6; or 3) Glasgow Coma Scale of 3. A total of 72,148 patients were studied. Prehospital deep sedation was observed in 63,478 patients (88.0%), and coma occurred in 42,483 patients (58.9%). Deeply sedated patients received neuromuscular blockers more frequently and were less likely to have sedation depth documented with a validated sedation depth scale (i.e., Ramsay or Richmond Agitation-Sedation Scale). After adjusting for covariates, a multivariable logistic regression model demonstrated that the use of longer-acting neuromuscular blockers (i.e., rocuronium and vecuronium) was an independent predictor of deep sedation (adjusted odds ratio, 1.28; 95% CI, 1.22-1.35; p < 0.001), while use of a validated sedation scale was associated with a lower odds of deep sedation (adjusted odds ratio, 0.29; 95% CI, 0.27-0.30; p < 0.001)., Conclusions: Deep sedation (and coma) is very common in mechanically ventilated air transport patients and associated with modifiable variables related to the monitoring and delivery of analgesia and sedation. Sedation practices in the prehospital arena and associated clinical outcomes are in need of further investigation., Competing Interests: Dr. Kollef is supported by the Barnes-Jewish Hospital Foundation. Dr. Fuller is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number R34HL150404. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

Introduction: Management of sedation, analgesia, and anxiolysis are cornerstone therapies in the emergency department (ED). Dexmedetomidine (DEX), a central alpha-2 agonist, is increasingly being used, and intensive care unit (ICU) data demonstrate improved outcomes in patients with respiratory failure. However, there is a lack of ED-based data. We therefore sought to: 1) characterize ED DEX use; 2) describe the incidence of adverse events; and 3) explore factors associated with adverse events among patients receiving DEX in the ED., Methods: This was a single-center, retrospective, cohort study of consecutive ED patients administered DEX (January 1, 2017-July 1, 2019) at an academic, tertiary care ED with an annual census of ~90,000 patient visits. All included patients (n= 103) were analyzed for characterization of DEX use in the ED. The primary outcome was a composite of adverse events, bradycardia and hypotension. Secondary clinical outcomes included ventilator-, ICU-, and hospital-free days, and hospital mortality. To examine for variables associated with adverse events, we used a multivariable logistic regression model., Results: We report on 103 patients. Dexmedetomidine was most commonly given for acute respiratory failure, including sedation for mechanical ventilation (28.9%) and facilitation of non-invasive ventilation (17.4%). Fifty-four (52.4%) patients experienced the composite adverse event, with hypotension occurring in 41 patients (39.8%) and bradycardia occurring in 18 patients (17.5%). Dexmedetomidine was stopped secondary to an adverse event in eight patients (7.8%). Duration of DEX use in the ED was associated with an increase adverse event risk (adjusted odds ratio, 1.004; 95% confidence interval, 1.001, 1.008)., Conclusion: Dexmedetomidine is most commonly administered in the ED for patients with acute respiratory failure. Adverse events are relatively common, yet DEX is discontinued comparatively infrequently due to adverse events. Our results suggest that DEX could be a viable option for analgesia, anxiolysis, and sedation in ED patients.

Background: Pandemic events often trigger a surge of clinical trial activity aimed at rapidly evaluating therapeutic or preventative interventions. Ensuring rapid public access to the complete and unbiased trial record is particularly critical for pandemic research given the urgent associated public health needs. The World Health Organization (WHO) established standards requiring posting of results to a registry within 12 months of trial completion and publication in a peer reviewed journal within 24 months of completion, though compliance with these requirements among pandemic trials is unknown., Methods: This cross-sectional analysis characterizes availability of results in trial registries and publications among registered trials performed during the 2009 H1N1 influenza, 2014 Ebola, and 2016 Zika pandemics. We searched trial registries to identify clinical trials testing interventions related to these pandemics, and determined the time elapsed between trial completion and availability of results in the registry. We also performed a comprehensive search of MEDLINE via PubMed, Google Scholar, and EMBASE to identify corresponding peer reviewed publications. The primary outcome was the compliance with either of the WHO's established standards for sharing clinical trial results. Secondary outcomes included compliance with both standards, and assessing the time elapsed between trial completion and public availability of results., Results: Three hundred thirty-three trials met eligibility criteria, including 261 H1N1 influenza trials, 60 Ebola trials, and 12 Zika trials. Of these, 139 (42%) either had results available in the trial registry within 12 months of study completion or had results available in a peer-reviewed publication within 24 months. Five trials (2%) met both standards. No results were available in either a registry or publication for 59 trials (18%). Among trials with registered results, a median of 42 months (IQR 16-76 months) elapsed between trial completion and results posting. For published trials, the median elapsed time between completion and publication was 21 months (IQR 9-34 months). Results were available within 24 months of study completion in either the trial registry or a peer reviewed publication for 166 trials (50%)., Conclusions: Very few trials performed during prior pandemic events met established standards for the timely public dissemination of trial results.

Introduction: Patients diagnosed with cancer commonly have a high degree of anxiety during an initial oncology consultation, which may interfere with a patient's ability to retain information required to make informed treatment decisions. A previous study randomised breast cancer survivors (volunteers) to view either (a) a brief video depicting a standard initial consultation from an oncologist or (b) an identical consultation with the addition of compassionate statements from the oncologist, and found the compassionate statements reduced anxiety among the volunteers. However, while compassionate statements reduced anxiety during simulation, it is currently unknown whether watching a video containing compassionate statements from an oncologist prior to an initial oncology consultation will reduce anxiety among patients referred to a cancer centre. The aim of this randomised control trial is to test whether watching a brief video containing compassionate statements from an oncologist, compared with watching a standard introduction video, prior to an initial oncology consultation will reduce the degree of anxiety among patients referred to a cancer centre., Methods and Analysis: This is a prospective, randomised controlled clinical trial at an academic cancer centre. We will enrol adult patients scheduled for an initial oncology consultation. Subjects will be randomly assigned to receive a standard introduction video or enhanced compassion video for viewing prior to the initial oncology consultation. On arrival to the cancer centre, we will measure anxiety severity using the Hospital Anxiety and Depression Scale (HADS). The HADS has two 7-item subscales (HADS anxiety and HADS depression) and is well-validated among oncology patients. We will use Wilcoxon rank-sum test to test for a difference in the HADS subscales between the two video groups., Ethics and Dissemination: The Cooper University Hospital Institutional Review Board approved this study. The results from this randomised control trial will be submitted for publication to a peer-reviewed journal., Trial Registration Number: NCT04503681., Competing Interests: Competing interests: Drs ST and AM are co-authors of a book on compassion science entitled ‘Compassionomics’. None of the other authors have disclosures., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Study Objective: Awareness with paralysis is a devastating complication for patients receiving mechanical ventilation and risks long-term psychological morbidity. Data from the emergency department (ED) demonstrate a high rate of longer-acting neuromuscular blocking agent use, delayed analgosedation, and a lack of sedation depth monitoring. These practices are discordant with recommendations for preventing awareness with paralysis. Despite this, awareness with paralysis has not been rigorously studied in the ED population. Our objective is to assess the prevalence of awareness with paralysis in ED patients receiving mechanical ventilation., Methods: This was a single-center, prospective, observational cohort study on 383 mechanically ventilated ED patients. After extubation, we assessed patients for awareness with paralysis by using the modified Brice questionnaire. Three expert reviewers independently adjudicated awareness with paralysis. We report the prevalence of awareness with paralysis (primary outcome); the secondary outcome was perceived threat, a mediator for development of posttraumatic stress disorder., Results: The prevalence of awareness with paralysis was 2.6% (10/383). Exposure to rocuronium at any point in the ED was significantly different between patients who experienced awareness with paralysis (70%) versus the rest of the cohort (31.4%) (unadjusted odds ratio 5.1; 95% confidence interval 1.30 to 20.1). Patients experiencing awareness with paralysis had higher mean values on the threat perception scale, denoting a higher degree of perceived threat, compared with patients who did not experience awareness with paralysis (13.4 [SD 7.7] versus 8.5 [SD 6.2]; mean difference 4.9; 95% confidence interval 0.94 to 8.8)., Conclusion: Awareness with paralysis occurs in a significant minority of ED patients who receive mechanical ventilation. Potential associations of awareness with paralysis with ED care and increased perceived threat warrant further evaluation., (Copyright © 2020 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

The association between personality traits and motivational units, such as life goals, has been a long-standing interest of personality scientists. However, little research has investigated the longitudinal associations between traits and life goals beyond young adulthood. In the present study ( N = 251), we examined the rank-order stability of, and mean-level changes in, the Big Five and major life goals (Aesthetic, Economic, Family/Relationship, Hedonistic, Political, Religious, Social) from college (age 18) to midlife (age 40), as well as their co-development. Findings showed that personality traits and major life goals were both moderately-to-highly stable over 20 years. On average, there were mean-level increases in the Big Five and mean-level decreases in life goals over time. Patterns of co-development suggest people formulate goals consistent with their personality traits, and conversely, investing in goal-relevant contexts is associated with trait change. We discuss the results in light of Social Investment Theory and the developmental regulation literature.

Cumulative evidence has been found for the associations between personality traits and stress experiences in adulthood. However, less is known about the moderating mechanisms underlying these associations. The present study tested whether the stress sensitization and stress inoculation hypotheses could be applied to the relationship between early adversity and personality in adulthood. Specifically, we tested the linear and curvilinear relations between early adversity (measured retrospectively) and adulthood personality traits, as well as the linear and curvilinear moderating effects of early adversity on the associations between adulthood stress and personality traits. Samples of older adults from the Health and Retirement Study (HRS; N = 6098) and middle-aged adults from the Midlife in the United States Survey (MIDUS; N = 6186) were used. Across the two samples, positive linear associations were found between retrospective early adversity and neuroticism. The results also suggested significant linear effects of early adversity on the association between ongoing chronic stressors and neuroticism such that individuals with moderate exposure to early adversity showed stronger associations between ongoing chronic stressors and neuroticism. Results from the current research were more in line with the stress sensitization model. No support was found for the stress inoculation effects on personality., Competing Interests: The authors have declared that no competing interests exist.

Background: Perform a scoping review of (1) pre-clinical studies testing the physiological effects of higher PaCO 2 levels in the setting of sepsis models and (2) clinical investigations testing the effects of hypercapnia on clinical outcomes in mechanically ventilated patients with sepsis., Methods: We performed a search of CENTRAL, PUBMED, CINAHL, and EMBASE. Study inclusion criteria for pre-clinical studies were: (1) bacterial sepsis model (2) measurement of PaCO 2 , and (3) comparison of outcome measure between different PaCO 2 levels. Inclusion criteria for clinical studies were: (1) diagnosis of sepsis, (2) receiving invasive mechanical ventilation, (3) measurement of PaCO 2 , and (4) comparison of outcomes between different PaCO 2 levels. We performed a qualitative analysis to collate and summarize the physiological and clinical effects of hypercapnia according to the recommended methodology from the Cochrane Handbook., Results: Fifteen pre-clinical and nine clinical studies were included. Among pre-clinical studies, the individual studies found higher PaCO 2 augments tissue blood flow and oxygenation, and attenuates inflammation and lung injury; however, all pre-clinical studies were found to have some degree of risk of bias. Six of the nine clinical studies were deemed to be good quality. Among clinical studies hypercapnia was associated with increased cerebral perfusion and oxygenation; however, there were conflicting results testing the association between hypercapnia and mortality., Conclusion: While individual pre-clinical studies identified potential mechanisms by which changes in PaCO 2 levels could affect pathophysiology in sepsis, there is a paucity of clinical data as to the optimal PaCO 2 range, demonstrating a need for future research., Registration: PROSPERO number CRD42018086703., (© 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)