Development of a Novel Patient-Reported Outcome Measure to Assess Symptoms and Impacts of Androgen Deprivation Therapy for Advanced Prostate Cancer.

INTRODUCTION: This qualitative research study was conducted to develop a novel, comprehensive, patient-reported outcome measure (PRO), the "Symptoms and Impacts of Androgen Deprivation Therapy (ADT) for Prostate Cancer" (SIADT-PC), assessing hormonal therapy-related symptoms and their impacts on men with advanced prostate cancer. METHODS: Concept elicitation (CE) interviews were conducted among adult men with prostate cancer to evaluate their experiences with ADT. Based on key symptom and impact concepts mentioned, an initial PRO measure was developed. The draft measure was further assessed in cognitive debriefing (CD) interviews with men with prostate cancer, in which participants reviewed items, response options, and recall periods. Initial item-based psychometric analyses were conducted using interview data. The draft questionnaire was revised on the basis of participant feedback, quantitative psychometric results, and consultation with clinical experts. RESULTS: A total of 21 participants were interviewed (CE concept elicitation, n = 12; CD cognitive debriefing, n = 17; n = 8 completed both). Mean participant age (SD) was 59.7 (8.7) years and 76.2% were white. The de novo SIADT-PC measure consists of 27 items: 11 symptoms (e.g., fatigue, hot flashes, and erectile dysfunction), 2 long-term symptoms (e.g., weight gain), 10 impacts (e.g., impacts on physical activities and relationships), and 4 related to mode of administration (i.e., injection-site reactions). Items were assessed with a 5-point verbal rating scale, with answer choices that capture frequency or severity. CONCLUSIONS: Once fully validated, this de novo measure may be used in clinical studies and clinical practice to assess hormone therapy-related symptoms and impacts, enabling physicians to identify timely and appropriate interventions.

Tolerability of Otic Solutions Containing Different Enrofloxacin Concentrations in Dogs with Healthy Ears.

Otitis externa (OE) is a common disease in dogs, and topical medications are the preferred treatment. Compounded solutions of enrofloxacin are commonly used in practice to treat bacterial OE; however, the tolerability of different concentrations of this antibiotic in the ear canals of dogs has not been evaluated. The objective of this study is to determine if a higher concentration of enrofloxacin applied to the external ear canal is clinically tolerated in dogs with healthy ears. Sixteen client-owned dogs with bilateral healthy ears and no previous history of OE were enrolled. Injectable enrofloxacin 2.27% diluted with sterile sodium chloride in 1:1 (11.35 mg/mL) and 2:1 (15 mg/mL) ratios were applied into the dogs' right and left ears, respectively, q 12 hr for 14 days. Based on video otoscopic examination, clinical score for canine OE (OTIS3) results before application were ≤1 for all dogs. During the study and at the conclusion, all scores remained ≤2, which is considered normal. No cytologic inflammatory cells were seen in any of the dogs' ears throughout the study. Different concentrations of enrofloxacin solution applied topically were well tolerated by dogs with healthy ears and can be considered for the treatment of dogs with bacterial OE.

Expressions of uncertainty in invisible scientific and religious phenomena during naturalistic conversation.

Across cultures, studies report more confidence in the existence of unobservable scientific phenomena, such as germs, as compared to unobservable religious phenomena, such as angels. We investigated a potential cultural mechanism for the transmission of confidence in the existence of invisible entities. Specifically, we asked whether parents in societies with markedly different religious profiles-Iran and China-signal differential confidence across the domains of science and religion during unmoderated conversations with their children (N = 120 parent-child dyads in total; 5- to 11-year-olds). The results revealed that parents used fewer lexical cues to uncertainty when discussing scientific phenomena, as compared to religious phenomena. Unsurprisingly, this cross-domain distinction was observed among majority belief, secular parents in China (Study 2). More importantly, however, the same pattern was observed among parents in Iran, a highly religious society (Study 1), as well as among minority belief, religious parents in China (Study 2). Thus, adults in markedly different belief communities spontaneously express less confidence in religious, as compared to scientific, invisible entities in naturalistic conversation. These findings contribute to theories on the role of culture and testimony in the development of beliefs about unobservable phenomena.

Otitis media with effusion in two Boston terrier dogs.

Otitis media (OM) in dogs can occur as a primary condition instead of as an extension of an otitis externa (OE), characterized by the presence of fluid in the middle ear (ME) referred to as OM with effusion (OME). OME has been reported in a brachycephalic breed (boxer), and the same condition is described as primary secretory OM in Cavalier King Charles Spaniels. These dogs can be asymptomatic or present with pain, facial nerve paralysis and reduced hearing. This report describes two cases of OME with associated neurologic signs in Boston terriers with no previous history of OE, normal external ear canals and tympanic membranes. Neurologic evaluation revealed right head tilt along with vestibular ataxia and frequent walking tight circles to the right in case 1, and a dull mentation with a right-sided head tilt and torticollis, vestibular tetra-ataxia, ambulatory tetraparesis and circling to the right in case 2. MRI imaging of the brain was performed. Results showed bilateral OM with right-sided otitis interna and equivocal associated otogenic meningitis in case 1 and right-sided OM in case 2. Myringotomy was performed, and both dogs' ME sampled for cytology that only revealed inflammatory cells; and bacterial cultures which revealed a light growth of Pseudomonas aeruginosa in case 1. ME were flushed with sterile saline. Oral glucocorticoids and antibiotics based on the susceptibility results, and a compound antibiotic and glucocorticoid ear solution were prescribed to case 1. Neurologic improvement was observed a few days after the appointment, but a mild right-sided head tilt remained evident. Owner of case two elected humane euthanasia due to patient respiratory difficulties upon anaesthetic recovery and other concurrent healthy concerns. Current findings reinforce that brachycephalic dogs may be prone to develop OME, and advanced imaging tests are key to the diagnosis.

Miraculous, magical, or mundane? The development of beliefs about stories with divine, magical, or realistic causation.

Children's naïve theories about causal regularities enable them to differentiate factual narratives describing real events and characters from fictional narratives describing made-up events and characters (Corriveau, Kim, Schwalen, & Harris, Cognition 113 (2): 213-225, 2009). But what happens when children are consistently presented with accounts of miraculous and causally impossible events as real occurrences? Previous research has shown that preschoolers with consistent exposure to religious teaching tend to systematically judge characters involved in fantastical or religious events as real (Corriveau et al., Cognitive Science, 39 (2), 353-382, 2015; Davoodi et al., Developmental Psychology, 52 (2), 221, 2016). In the current study, we extended this line of work by asking about the scope of the impact of religious exposure on children's reality judgments. Specifically, we asked whether this effect is  domain-general or domain-specific. We tested children in Iran, where regular exposure to uniform religious beliefs might influence children's reasoning about possibility in non-religious domains, in addition to the domain of religion. Children with no or minimal schooling (5- to 6-year-olds) and older elementary school students (9- to 10-year-olds) judged the reality status of different kinds of stories, notably realistic, unusual (but nonetheless realistic), religious, and magical stories. We found that while younger children were not systematic in their judgments, older children often judged religious stories as real but rarely judged magical stories as real. This developmental pattern suggests that the impact of religious exposure on children's reality judgments does not extend beyond their reasoning about divine intervention. Children's justifications for their reality judgments provided further support for this domain-specific influence of religious teaching.

Everyone's a Critic (Sometimes): Young Children Show High Awareness of, But Lower Adherence to, Prosocial Lying Norms.

From an early age, children are taught norms about socially-acceptable behaviors; however, children's ability to recognize these norms often predates their tendency to follow them. This conflict between understanding and action has been predominantly studied in cases when enacting the norm would be costly for the child (i.e. when sharing would result in forgoing resources), but is underexplored in more low-cost scenarios. The current study examined the gap between children's knowledge and behavior in a context with a low personal cost: telling a prosocial, or white, lie. Children (N = 46) evaluated objectively poor drawings in three contexts: in one context, children were asked how a third-party character should act in a story (to assess knowledge) and in the other two contexts, children were asked to provide real-time feedback to another person and to a puppet (to assess behavior). Results indicated that children endorsed prosocial lying norms (i.e. said the story character should give the drawing a good rating) at a significantly higher rate than they demonstrated through their own lie-telling behaviors (i.e. their willingness to give social partners good ratings). These data indicate that the discrepancy between children's knowledge of social norms and their actual behaviors cannot simply be attributed to the personal costs of enacting social norms. Instead, this competence-performance gap may be due to the fact that children are often taught social rules via hypothetical situations but enacting behaviors in real-world situations may require additional skills, such as inhibition and the processing of complex, multimodal social cues.

Culture is an optometrist: Cultural contexts adjust the prescription of social learning bifocals.

The "prescription" of humans' social learning bifocals is fine-tuned by cultural norms and, as a result, the readiness with which the instrumental or conventional lenses are used to view behavior differs across cultures. We present evidence for this possibility from cross-cultural work examining children's imitation and innovation.

Cognitive flexibility supports the development of cumulative cultural learning in children.

The scale of cumulative cultural evolution (CCE) is a defining characteristic of humans. Despite marked scientific interest in CCE, the cognitive underpinnings supporting its development remain understudied. We examined the role cognitive flexibility plays in CCE by studying U.S. children's (N = 167, 3-5-year-olds) propensity to relinquish an inefficient solution to a problem in favor of a more efficient alternative, and whether they would resist reverting to earlier versions. In contrast to previous work with chimpanzees, most children who first learned to solve a puzzlebox in an inefficient way switched to an observed, more efficient alternative. However, over multiple task interactions, 85% of children who switched reverted to the inefficient method. Moreover, almost all children in a control condition (who first learned the efficient method) switched to the inefficient method. Thus, children were keen to explore an alternative solution but, like chimpanzees, are overall conservative in reverting to their first-learned one.

Content validity of a newly developed observer-reported measure for pediatric asthma in children aged 2-5 years.

BACKGROUND: An observer-reported outcome (ObsRO) measure assessing both symptom control and health-related quality of life (HRQoL) in children with asthma younger than 6 years is lacking. The objective of this study was to evaluate the content validity of the Pediatric Asthma Questionnaire (PAQ), a newly developed 6-item ObsRO measure for caregivers of children aged 2-5 years diagnosed with asthma. RESULTS: In-depth, qualitative interviews were conducted with 15 parents or caregivers. The first part of the interview was an open-ended discussion whereby participants were asked to describe their observations of their child's asthma symptoms and HRQoL impacts followed by a cognitive debriefing of a draft version of the PAQ. The most frequently reported symptoms were coughing (n = 15, 100%), wheezing (n = 14, 93%), and trouble breathing (n = 10, 67%). Overall, participants found the PAQ easy to complete and relevant to their child's experience with asthma, with most reporting the instructions, response scales, and recall period for the items to be appropriate. The majority of participants (93%) believed they could accurately report on the items included in the PAQ based on their observations of their child's asthma symptoms and impacts, or reliably get the information from the child's teacher, school, or caregiver when their child was not in their presence. One item was modified based on feedback about the phrase "oral steroids" to clarify modes of administration. A few other minor changes were incorporated into the PAQ following suggestions from participants, including replacing the phrase "how often" with "how many days" in one of the items to improve clarity and overall consistency with the response options. CONCLUSION: Qualitative data support the content validity of the PAQ as a fit-for-purpose and well-understood 6-item observer-reported outcome measure to evaluate both symptoms and asthma-specific HRQoL impacts experienced by pediatric asthma patients aged 2-5 years for use in clinical and real-world studies.

If I told you everyone picked that (non-affordant) tool, would you? Children attend to conventional language when imitating and transmitting tool use.

This study explored how conventional versus instrumental language influenced children's imitation and transmission of non-affordant tool use. Rather than examining children's imitation of unnecessary actions that do not impede goal completion, we examined children's conformity with a modeled behavior that may result in sacrificing goal completion. Children (N = 96 4- to 6-year-olds) were presented with either a conventional or instrumental description of a model's actions before watching the model choose a non-affordant tool. Children who heard conventional language imitated and transmitted the model's non-affordant tool choice at significantly higher rates than when they heard instrumental language. The results have implications for children, parents, and teachers regarding the extent to which children will conform with what "we" are "supposed" to do.

Children's Ideas About What Can Really Happen: The Impact of Age and Religious Background.

Five- to 11-year-old U.S. children, from either a religious or secular background, judged whether story events could really happen. There were four different types of stories: magical stories violating ordinary causal regularities; religious stories also violating ordinary causal regularities but via a divine agent; unusual stories not violating ordinary causal regularities but with an improbable event; and realistic stories not violating ordinary causal regularities and with no improbable event. Overall, children were less likely to judge that religious and magical stories could really happen than unusual and realistic stories although religious children were more likely than secular children to judge that religious stories could really happen. Irrespective of background, children frequently invoked causal regularities in justifying their judgments. Thus, in justifying their conclusion that a story could really happen, children often invoked a causal regularity, whereas in justifying their conclusion that a story could not really happen, they often pointed to the violation of causal regularity. Overall, the findings show that children appraise the likelihood of story events actually happening in light of their beliefs about causal regularities. A religious upbringing does not impact the frequency with which children invoke causal regularities in judging what can happen, even if it does impact the type of causal factors that children endorse.

A qualitative study to explore symptoms and impacts of pediatric and adolescent Crohn's disease from patient and caregiver perspective.

BACKGROUND: Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract that affects people across the age spectrum but often starts in childhood or early adulthood. Despite this, almost all published research examining the symptomatic and health-related quality of life (HRQL) experiences of CD has been conducted in an adult population. Studies providing a comprehensive overview of the lived experience of pediatric and adolescent CD are virtually non-existent. The experiences of younger children aged 2-7 years are especially unknown. RESULTS: A total of 49 participants (31 children and 18 parents) were interviewed. This included 11 dyads (i.e., parents and children from the same family). Analyses were conducted based on reporter-type (patient self-report vs parent observer-report) and age subgroups (ages 2-4 vs 5-7 vs 8-11 vs 12-17). Key symptoms were identified across the age subgroups and reporter types. Abdominal/stomach pain, passing gas/feeling gassy, diarrhea/liquid stools, fatigue/tiredness, bowel urgency, blood in stools, stomach cramping, constipation, and incomplete evacuation were discussed most frequently. The most common HRQL impacts included impact on physical activity, school, social life, and mood (i.e., feeling sad/low), and were mostly consistent between reporter type and across age spectrum. Concept agreement between parents and children in the dyad analysis was > 60% for most symptoms and impacts. CONCLUSIONS: Qualitative interviews revealed the substantial symptom and HRQL burden of pediatric CD from the child and parent perspectives and that disease experiences were largely consistent across the age range and based on both reporter perspectives. This is an important first step towards implementing a robust measurement strategy for the assessment of symptoms and HRQL impacts in pediatric CD.

Teaching Through Collaboration: Flexibility and Diversity in Caregiver-Child Interaction Across Cultures.

Teaching supports the high-fidelity transmission of knowledge and skills. This study examined similarities and differences in caregiver teaching practices in the United States and Vanuatu (N = 125 caregiver and 3- to 8-year-old child pairs) during a collaborative problem-solving task. Caregivers used diverse verbal and nonverbal teaching practices and adjusted their behaviors in response to task difficulty and child age in both populations. U.S. caregivers used practices consistent with a direct active teaching style typical of formal education, including guiding children's participation, frequent praise, and facilitation. In contrast, Ni-Vanuatu caregivers used practices associated with informal education and divided tasks with children based on difficulty. The implications of these findings for claims about the universality and diversity of caregiver teaching are discussed.

Are high levels of religiosity inconsistent with a high valuation of science? Evidence from the United States, China and Iran.

We asked whether high levels of religiosity are inconsistent with a high valuation of science. We explored this possibility in three countries that diverge markedly in the relation between the state and religion. Parents in the United States (n = 126), China (n = 234) and Iran (n = 77) completed a survey about their personal and parental stance towards science. The relation between religiosity and the valuation of science varied sharply by country. In the U.S. sample, greater religiosity was associated with a lower valuation of science. A similar but weaker negative relation was found in the Chinese sample. Parents in the Iranian sample, by contrast, valued science highly, despite high levels of religiosity. Given the small size of our United States and Iranian samples, and the non-probabilistic nature of our samples in general, we caution readers not to generalise our findings beyond the current samples. Despite this caveat, these findings qualify the assumption that religiosity is inconsistent with the valuation of science and highlight the role of sociocultural context in shaping adults' perception of the relation between religion and science.

Patient-reported outcomes in paediatric cancer survivorship: a qualitative study to elicit the content from cancer survivors and caregivers.

OBJECTIVES: Content elucidation for patient-reported outcomes (PROs) in paediatric cancer survivorship is understudied. We aimed to compare differences in the contents of five PRO domains that are important to paediatric cancer survivorship through semistructured interviews with paediatric cancer survivors and caregivers, and identified new concepts that were not covered in the item banks of the Patient-Reported Outcomes Measurement Information System (PROMIS). DESIGN: Semistructured interviews to collect qualitative PRO data from survivors and caregivers. SETTING: A survivorship care clinic of a comprehensive cancer centre in the USA. PARTICIPANTS: The study included 51 survivors (<18 years old) and 35 caregivers who completed interviews between August and December 2016. Content experts coded the transcribed interviews into 'meaningful concepts' per PROMIS item concepts and identified new concepts per a consensus. Frequencies of meaningful concepts used by survivors and caregivers were compared by Wilcoxon rank-sum test. RESULTS: For pain and meaning and purpose, 'Hurt a lot' and 'Purpose in life' were top concepts for survivors and caregivers, respectively. For fatigue and psychological stress, 'Needed to sleep during the day'/'Trouble doing schoolwork' and 'Felt worried' were top concepts for survivors, and 'Felt tired' and 'Felt distress'/'Felt stressed' for caregivers. Survivors reported more physically relevant contents (eg, 'Hard to do sport/exercise'; 0.78 vs 0.23, p=0.007) for pain, fatigue and stress, whereas caregivers used more emotionally relevant concepts (eg, 'Too tired to enjoy things I like to do'; 0.31 vs 0.05, p=0.025). Both groups reported positive thoughts for meaning and purpose (eg, 'Have goals for myself'). One (psychological stress, meaning and purpose) to eleven (fatigue) new concepts were generated. CONCLUSIONS: Important PRO contents in the form of meaningful concepts raised by survivors and caregivers were different and new concepts emerged. PRO measures are warranted to include survivorship-specific items by accounting for the child's and the caregiver's viewpoints.

Epistemic justifications for belief in the unobservable: The impact of minority status.

Children hold beliefs about religious and scientific entities, such as angels or germs, that they cannot directly observe or interact with. Given their limited opportunities for first-hand observation, children's beliefs in these entities are a clear example of cultural learning and are likely to vary based on cultural factors. In the present study, we investigated variation in the epistemic stance of 4-11-year-old children growing up in a religious minority in China (N = 47), a religious majority in Iran (N = 85), and a religious majority in the U.S. (N = 74). To assess the role of community status as a domain-specific, as opposed to a domain-general, factor contributing to children's beliefs about unobservable entities, we compared children's beliefs about religious unobservable entities with their beliefs about scientific unobservable entities in these three communities. In all three communities, younger and older children were confident that unobservable religious and scientific entities exist. However, compared to children in Iran and the U.S., children from the religious minority group in China were more likely to justify their ontological beliefs about religious entities by appealing to the source of their beliefs. These results highlight the impact of community status on learning from testimony about unobservable entities. Additionally, the results show that under certain circumstances - notably when holding minority beliefs - tracking the source of beliefs serves as a central epistemic justification.

Establishing the content validity of PROMIS Pediatric pain interference, fatigue, sleep disturbance, and sleep-related impairment measures in children with chronic kidney disease and Crohn's disease.

BACKGROUND: PROMIS Pediatric patient-reported outcome measures were developed with children from the general population, and their content validity has not been established in children with chronic disease. This study was done to evaluate the content validity of the PROMIS Pediatric Pain Interference and Fatigue measures in children 8-17 years-old with Crohn's disease and the PROMIS Pediatric Fatigue, Sleep Disturbance, and Sleep-related Impairment measures for children 8-17 years-old with chronic kidney disease. METHODS: We conducted semi-structured interviews with individuals affected by Crohn's disease and chronic kidney disease. The interviews were done to elicit children's lived experiences of the PROMIS outcomes of interest. We used deductive content analysis to contrast the participants' reports of their symptoms and impacts on daily life with existing conceptual frameworks for the PROMIS measures, each of which was developed with input from children in the general population. RESULTS: On average, we elicited an average of 7 pain interference and 7 fatigue concepts from Crohn's disease participants (n = 37), while chronic kidney disease participants (n = 26) provided 9 concepts for fatigue, 4 for sleep disturbance, and 7 for sleep-related impairment. Concept saturation was achieved after 16-19 interviews across the four PROMIS measures. Children with these two chronic health conditions reported the same breadth and types of lived experiences as children from the development samples drawn from the general population. CONCLUSION: The study supports the content validity of several PROMIS Pediatric measures for children with Crohn's disease and chronic kidney disease. These findings provide evidence that PROMIS Pediatric measures, developed as universally relevant patient-reported outcomes, may be more broadly applicable to children with chronic disease.

Religious testimony in a secular society: Belief in unobservable entities among Chinese parents and their children.

When learning about the existence of unobservable scientific phenomena such as germs or religious phenomena such as God, children are receptive to the testimony of other people. Research in Western cultures has shown that by 5 to 6 years of age, children-like adults-are confident about the existence of both scientific and religious phenomena. We examined the beliefs of secular and Christian children growing up in China as well as the beliefs of their parents. All participants-secular and Christian children, as well as their parents-were confident about the existence of the scientific phenomena. No such consensus emerged for religious phenomena. Whereas secular children and their parents were skeptical, Christian children and their parents were confident about the existence of the religious phenomena. Moreover, a similar pattern was found for Christian children in preschools and for Christian children with more extensive exposure to the secular state curriculum. Indeed, for religious phenomena, a positive association was found between the beliefs of Christian children and their parents, highlighting the potential influence of parental input in a predominantly secular society. Overall, the results indicate that children's religious beliefs are related to the beliefs of their parents, even when those beliefs go against the majority view. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Trust me, I'm a competent expert: Developmental differences in children's use of an expert's explanation quality to infer trustworthiness.

In this study, we examined how 3-, 4-, 5-, and 7-year-old children respond when informants who are labeled as experts fail to provide high-quality explanations about phenomena within their realm of expertise. We found that 4-, 5-, and 7-year-olds discounted their initial trust in an expert who provided low-quality explanations in a task related to the expert's area of expertise. The 5-year-olds' distrust of the expert who provided low-quality explanations also generalized to additional learning tasks. When an expert provided explanations consistent with the expert's labeled expertise, 5-year-olds maintained a similar level of trust in the expert, but 7-year-olds displayed an increased level of trust in the expert within the expert's area of expertise. We did not find consistent preferences in 3-year-olds' judgments. We discuss the implications of these findings for age-based differences in children's relative weighting of trait-based versus real-time epistemic cues when evaluating informant reliability.

God, Germs, and Evolution: Belief in Unobservable Religious and Scientific Entities in the U.S. and China.

Adults in the U.S. and China were asked to make judgments about the existence of a variety of scientific and religious entities, including God, germs, and evolution. Overall, participants expressed more confidence in the existence of scientific as compared to religious entities. This differential confidence in the two domains emerged in China as well as in the U.S. Moreover, it emerged even when participants were questioned about items attracting a lower overall level of consensus. Nevertheless, the religious beliefs of individual participants moderated the degree of differentiation between scientific and religious entities. Adults reporting low levels of religiosity expressed greater belief in the existence of scientific than religious entities but adults reporting high levels of religiosity expressed equivalent levels of belief in the existence of each domain. This pattern emerged in both China and the U.S. Testimony about unobservable phenomena has a similar impact on adults' pattern of beliefs across two historically distinct cultures.