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To defend or burnish our moral reputation, we often tell moral narratives. Moral narratives describe morally relevant actions and explanations of those actions, detailing how people acted and why they did so. When and why does communication about moral events include descriptions of peoples’ actions and explanations? We hypothesize that informational, reputational, and presentational goals of narrators shape whether their communication contains clear actions and explanations. We asked a group of “narrators” to communicate with other people following a moral decision. Another group of “audience” members judged them based on their chosen statement. We find that the informational and reputational goals of narrators can explain what information they decide to reveal. Narrators choose what to say based on inferring the audience’s likely perceptions but underestimate how much audiences in fact expect answers to “what” and “why”. Audiences, however, do not always perceive the lack of expected information as indicative of deceit.

Supplemental Material, sj-docx-1-ptd-10.1177_0896860820975596 for How do patients and their family members experience the transition from peritoneal dialysis to incentre haemodialysis? A multisite qualitative study in England and Australia by Kerry Allen, Sarah L Damery, Kim Sein, David W Johnson, Simon J Davies, Mark Lambie, Els Holvoet and Gill M Combes in Peritoneal Dialysis International

Empiricist philosophers such as Locke famously argued that people born blind could only acquire shallow, fragmented facts about color. Contrary to this intuition, we report that blind and sighted people share an in-depth understanding of color, despite disagreeing about arbitrary color facts. Relative to the sighted, blind individuals are less likely to generate ‘yellow’ for banana and ‘red’ for stop-sign. However, blind and sighted adults are equally likely to infer that two bananas (natural kinds) and two stop-signs (artifacts with functional colors) are more likely to have the same color than two cars (artifacts with non-functional colors), make similar inferences about novel objects’ colors, and provide similar causal explanations. We argue that people develop inferentially-rich and intuitive “theories” of color regardless of visual experience. Linguistic communication is more effective at aligning people’s theories than their knowledge of verbal facts.

An in vitro screening system for anti-cancer drugs cannot exactly reflect the efficacy of drugs in vivo, without mimicking the tumour microenvironment (TME), which comprises cancer cells interacting with blood vessels and fibroblasts. Additionally, the tumour size should be controlled to obtain reliable and quantitative drug responses. Herein, we report a bioprinting method for recapitulating the TME with a controllable spheroid size. The TME was constructed by printing a blood vessel layer consisting of fibroblasts and endothelial cells in gelatine, alginate, and fibrinogen, followed by seeding multicellular tumour spheroids (MCTSs) of glioblastoma cells (U87 MG) onto the blood vessel layer. Under MCTSs, sprouts of blood vessels were generated and surrounding MCTSs thereby increasing the spheroid size. The combined treatment involving the anti-cancer drug temozolomide (TMZ) and the angiogenic inhibitor sunitinib was more effective than TMZ alone for MCTSs surrounded by blood vessels, which indicates the feasibility of the TME for in vitro testing of drug efficacy. These results suggest that the bioprinted vascularized tumour is highly useful for understanding tumour biology, as well as for in vitro drug testing.

Supplemental Material, Supplemental_Material for How do patients and their family members experience the transition from peritoneal dialysis to incentre haemodialysis? A multisite qualitative study in England and Australia by Kerry Allen, Sarah L Damery, Kim Sein, David W Johnson, Simon J Davies, Mark Lambie, Els Holvoet and Gill M Combes in Peritoneal Dialysis International

Background Pre-dialysis education (PDE) is provided to thousands of patients every year, helping them decide which renal replacement therapy (RRT) to choose. However, its effectiveness is largely unknown, with relatively little previous research into patients’ views about PDE, and no research into staff views. This study reports findings relevant to PDE from a larger mixed methods study, providing insights into what staff and patients think needs to improve. Methods Semi-structured interviews in four hospitals with 96 clinical and managerial staff and 93 dialysis patients, exploring experiences of and views about PDE, and analysed using thematic framework analysis. Results Most patients found PDE helpful and staff valued its role in supporting patient decision-making. However, patients wanted to see teaching methods and materials improve and biases eliminated. Staff were less aware than patients of how informal staff-patient conversations can influence patients’ treatment decision-making. Many staff felt ill equipped to talk about all treatment options in a balanced and unbiased way. Patient decision-making was found to be complex and patients’ abilities to make treatment decisions were adversely affected in the pre-dialysis period by emotional distress. Conclusions Suggested improvements to teaching methods and educational materials are in line with previous studies and current clinical guidelines. All staff, irrespective of their role, need to be trained about all treatment options so that informal conversations with patients are not biased. The study argues for a more individualised approach to PDE which is more like counselling than education and would demand a higher level of skill and training for specialist PDE staff. The study concludes that even if these improvements are made to PDE, not all patients will benefit, because some find decision-making in the pre-dialysis period too complex or are unable to engage with education due to illness or emotional distress. It is therefore recommended that pre-dialysis treatment decisions are temporary, and that PDE is replaced with on-going RRT education which provides opportunities for personalised education and on-going review of patients’ treatment choices. Emotional support to help overcome the distress of the transition to end-stage renal disease will also be essential to ensure all patients can benefit from RRT education.

The present study attempted to estimate the value of the environmental improvement programs using a CVM model. The CVM model included economic variables, socio-demographic variables, and proxy variables measuring survey participants' familiarity with the coastal areas. We conducted an online survey during August 2018 with 3428 participants and received 1000 usable responses (final response rate of 29.1%). According to the survey, 73.2% of the households were willing to pay to support the environmental improvement programs in the aquaculture zones. The weighted average value of willingness to pay (WTP), taking into account the participation rate, was estimated at USD 9.05 per household; the aggregated WTP in 2019 was calculated at USD 182,049,800; a five-year net present value of the aggregate value of the improvement project was calculated at USD 837,411,929.

Background Despite healthcare policies and evidence which promote home dialysis, uptake rates have been falling for over 10 years in England. A target introduced by commissioners in the West Midlands provided a unique opportunity to study how hospitals can increase home-based treatment for a group of patients with complex life-threatening conditions. Methods Quantitative changes in home treatment uptake rates in seven hospitals in the West Midlands were compared with the rest of England for 3 years pre and post the introduction of the target in 2010, using a logistic regression model. Qualitative interviews in four hospitals with 96 clinical and managerial staff and 93 dialysis patients explored the barriers and facilitators to increasing the uptake of home treatment and the impact of the target. Results Home treatment uptake rates increased significantly in the seven study hospitals compared with the 3 years prior to the introduction of the target and compared with the rest of England where rates remained static. The four main factors facilitating increased uptake were as follows: the commissioner’s target, linked to financial penalties; additional funding for specialist staff and equipment; committed, visible clinical champions and good systems for patient training and ongoing healthcare support at home. The three main barriers were as follows: lack of training for non-specialist staff, poorly developed patient education and considerable unrecognised and unmet emotional and psychological patient needs. Conclusions This study shows the impact of using targets with financial penalties to achieve change and how hospitals can increase significantly the uptake of home-based self-care for a group of patients with complex medical needs. It provides useful pointers to the main barriers and facilitators, which are likely to be relevant to other groups of patients who could be treated at home. It also highlights two neglected areas which need to improve if patients with life-threatening long-term conditions are to be encouraged to take up home treatment: individualised patient education which allows exploration of the impacts of treatment options and the provision of ongoing emotional support.