Hydrocortisone versus vasopressin for the management of adult patients with septic shock refractory to norepinephrine: A multicenter retrospective study.

STUDY OBJECTIVE: Significant practice variation exists when selecting between hydrocortisone and vasopressin as second line agents in patients with septic shock in need of escalating doses of norepinephrine. The goal of this study was to assess differences in clinical outcomes between these two agents. DESIGN: Multicenter, retrospective, observational study. SETTING: Ten Ascension Health hospitals. PATIENTS: Adult patients with presumed septic shock receiving norepinephrine prior to study drug initiation between December 2015 and August 2021. INTERVENTION: Vasopressin (0.03-0.04 units/min) or hydrocortisone (200-300 mg/day). MEASUREMENTS AND MAIN RESULTS: A total of 768 patients were included with a median (interquartile range) SOFA score of 10 (8-13), norepinephrine dose of 0.3 mcg/kg/min (0.1-0.5 mcg/kg/min), and lactate of 3.8 mmol/L (2.4-7.0 mmol/L) at initiation of the study drug. A significant difference in 28-day mortality was noted favoring hydrocortisone as an adjunct to norepinephrine after controlling for potential confounding factors (OR 0.46 [95% CI, 0.32-0.66]); similar results were seen following propensity score matching. Compared to vasopressin, hydrocortisone initiation was also associated with a higher rate of hemodynamic responsiveness (91.9% vs. 68.2%, p < 0.01), improved resolution of shock (68.8% vs. 31.5%, p < 0.01), and reduced recurrence of shock within 72 h (8.7% vs. 20.7%, p < 0.01). CONCLUSIONS: Addition of hydrocortisone to norepinephrine was associated with a lower 28-day mortality in patients with septic shock, compared to the addition of vasopressin.

Factors that influence parental and caregiver acceptance of routine childhood vaccination: Summary of a qualitative evidence synthesis.

We summarise a Cochrane review of qualitative evidence that explored parents' views and practices around routine childhood vaccination, and provide implications for research and practice that are relevant to the South African (SA) context. Many public health interventions to encourage vaccination are informed by an assumption that vaccine hesitancy is due to a lack of knowledge or irrational forms of thinking. The findings from this review suggest that childhood vaccination views and practices are complex social processes that are shaped by multiple factors and carry a variety of meanings. As such, we suggest that biomedical approaches must be supplemented by more nuanced and sociopolitically informed strategies for enhancing and sustaining childhood vaccination practices in SA.

'If you are found taking medicine, you will be called names and considered less of a man': young men's engagement with HIV treatment and care during ulwaluko (traditional initiation and circumcision) in the Eastern Cape Province of South Africa.

This paper explores how HIV-positive abakhwetha (young male initiates) undergoing ulwaluko (traditional Xhosa initiation and circumcision) engage with HIV-related biomedical care and treatment. Health-focused life history narratives (n = 36), semi-structured interviews (n = 32) and analysis of health facility files (n = 41) with adolescent boys and young men (ages 13-24) living with HIV, and semi-structured interviews with traditional and biomedical health practitioners (n = 14) were conducted in 2017 and 2018. This research was part of the Mzantsi Wakho study, a longitudinal, mixed methods study of adolescents living with HIV (n = 1060). Findings demonstrate that ulwaluko rules of not engaging with biomedical care and treatment pose a challenge for initiates who are taking chronic medicine. Fears of inadvertent disclosure of their HIV-positive status collide with the pressure to successfully complete ulwaluko in order to be legitimised as men. In response to this dilemma, they engage a variety of strategies - including taking medicine in secret by hiding them, having a trusted person deliver them discretely, and stopping medicine-taking altogether. The three months following ulwaluko also pose a challenge in accessing biomedical treatment and care. In this time of high surveillance, amakrwala (new men) do not present at health facilities for fear of being thought to have had a botched circumcision or to have contravened 'manhood rules' and left ulwaluko before having healed properly. To get around this, those who continued taking medicine engaged caregiver pick-ups. Beyond suggesting that ulwaluko is a high-risk time for disengagement from biomedical treatment and care, this paper builds on a robust scholarship on the importance of locality and context in gender and health research. It documents the creativity, agency and resilience of initiates and their families as they subvert and re-signify health-related masculine norms.

The meaning of guilt: Reconciling the past to inform the future.

Despite decades of empirical research, a deceptively simple question remains unanswered: Is guilt good? Whereas some researchers assert that routine experiences of guilt (i.e., "trait guilt") are maladaptive and indicative of poor psychological adjustment, others assert trait guilt to be adaptive and indicative of a prosocial disposition. In the current research we outline the theoretical underpinnings of 2 of the most commonly employed measures of trait guilt: unsituated measures (e.g., the Personal Feelings Questionnaire (PFQ; Harder & Lewis, 1987) and situated scenario-based measures (e.g., the Test of Self-Conscious Affect [TOSCA]; Tangney, Wagner, & Gramzow, 1989). We examine the construct validity of both measure types across 3 studies using a variety of traits (self- and informant-reported), states, and behaviors. Results provide overwhelming support for a "2-construct" argument, with PFQ guilt (our unsituated measure of choice) and TOSCA guilt (our situated measure of choice) displaying divergent results across nearly all traits, states, and behaviors measured. While the correlates of PFQ guilt were consistently maladaptive, the correlates of TOSCA guilt were consistently adaptive. Furthermore, only the PFQ predicted daily experiences of negative affect and state guilt. TOSCA guilt was unrelated to negative affective experience in daily life, thereby calling into question its conceptualization as an affective trait. Findings using the TOSCA and PFQ shame scales are also presented. We conclude by presenting a preliminary process model of guilt that may have utility for designing future research studies and developing new guilt questionnaires. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Defining the research agenda to measure and reduce tuberculosis stigmas.

Crucial to finding and treating the 4 million tuberculosis (TB) patients currently missed by national TB programmes, TB stigma is receiving well-deserved and long-delayed attention at the global level. However, the ability to measure and evaluate the success of TB stigma-reduction efforts is limited by the need for additional tools. At a 2016 TB stigma-measurement meeting held in The Hague, The Netherlands, stigma experts discussed and proposed a research agenda around four themes: 1) drivers: what are the main drivers and domains of TB stigma(s)?; 2) consequences: how consequential are TB stigmas and how are negative impacts most felt?; 3) burden: what is the global prevalence and distribution of TB stigma(s) and what explains any variation? 4): intervention: what can be done to reduce the extent and impact of TB stigma(s)? Each theme was further subdivided into research topics to be addressed to move the agenda forward. These include greater clarity on what causes TB stigmas to emerge and thrive, the difficulty of measuring the complexity of stigma, and the improbability of a universal stigma 'cure'. Nevertheless, these challenges should not hinder investments in the measurement and reduction of TB stigma. We believe it is time to focus on how, and not whether, the global community should measure and reduce TB stigma.

The Interpersonal Adaptiveness of Dispositional Guilt and Shame: A Meta-Analytic Investigation.

Despite decades of empirical research, conclusions regarding the adaptiveness of dispositional guilt and shame are mixed. We use meta-analysis to summarize the empirical literature and clarify these ambiguities. Specifically, we evaluate how guilt and shame are uniquely related to pro-social orientation and, in doing so, highlight the substantial yet under-acknowledged impact of researchers' methodological choices. A series of meta-analyses was conducted investigating the relationship between dispositional guilt (or shame) and pro-social orientation. Two main methodological moderators of interest were tested: test format (scenario vs. checklist) and statistical analysis (semi-partial vs. zero-order correlations). Among studies employing zero-order correlations, dispositional guilt was positively correlated with pro-social orientation (k = 63, Mr = .13, p < .001), whereas dispositional shame was negatively correlated, (k = 47, Mr = -.05, p = .07). Test format was a significant moderator for guilt studies only, with scenario measures producing significantly stronger effects. Semi-partial correlations resulted in significantly stronger effects among guilt and shame studies. Although dispositional guilt and shame are differentially related to pro-social orientation, such relationships depend largely on the methodological choices of the researcher, particularly in the case of guilt. Implications for the study of these traits are discussed.

Accuracy of Judging Affect and Accuracy of Judging Personality: How and When Are They Related?

OBJECTIVES: The present research is concerned with the relation between accuracy in judging targets' affective states and accuracy in judging the same targets' personality traits. In two studies, we test the link between these two types of accuracy with the prediction that accuracy of judging traits and of judging states will be associated when fundamental affective qualities are shared. METHOD: In Study 1, affective states and personality traits of 29 targets were rated by 124 judges whose individual accuracy was scored as the correlation between their ratings and target criterion scores (across targets). In Study 2, a comparable analysis was done using 30 different targets and 330 different judges. RESULTS: Accuracy in judging distressed affect was significantly positively correlated with accuracy in judging Neuroticism in both studies, as well as in a meta-analysis across the two studies. Accuracy in judging positive affect was significantly positively correlated with accuracy in judging Extraversion in one of the two studies, with the meta-analysis across the two studies being significant. CONCLUSIONS: These findings provide preliminary evidence for a new model (State and Trait Accuracy Model) that outlines when concordance in accuracy across traits and states should be expected.

Global-to-local policy transfer in the introduction of new molecular tuberculosis diagnostics in South Africa.

SETTING: Lack of innovation in diagnostics has contributed to tuberculosis (TB) remaining a global health challenge. It is critical to understand how new diagnostic technologies are translated into policies and how these are implemented. OBJECTIVE: To examine policy transfer for two rapid molecular diagnostic tests, GenoType(®) MDRTBplus and Xpert(®) MTB/RIF, to understand policy development, uptake and implementation in South Africa. METHODS: A policy transfer analysis framework integrating the key dimensions of policy transfer into one coherent model was used. Two phases of key informant interviews were undertaken with a wide range of stakeholders. RESULTS: Both tests were developed through innovative partnerships and responded to urgent public health needs. GenoType was introduced through a process that was more inclusive than that for Xpert. National policy and planning processes were opaque for both tests. Their implementation, maintenance and expansion suffered from poor communication and coordination, insufficient attention to resource implications, technical challenges and a lack of broader health systems thinking. CONCLUSION: Our analysis identified the risks and benefits of partnerships for technological innovation, the complex intersections between global and national actors and the impact of health systems on policy transfer, and the risks of rescue- and technology-focused thinking in addressing public health challenges.

Narcissism and other-derogation in the absence of ego threat.

The relation between narcissism and other-derogation has been examined primarily in the context of ego threat. In three studies, we investigated whether narcissistic individuals derogate others in the absence of ego threat. In Study 1, 79 judges watched four videotaped dyadic interactions and rated the personality of the same four people. In Study 2, 66 judges rated the personality of a friend. In Study 3, 72 judges considered the average Northeastern University student and rated the personality of this hypothetical person. Across the three studies, targets' personality characteristics were described on the 100-item California Adult Q-Sort (CAQ; Block, 2008). Judges' ratings of targets were compared to a CAQ prototype of the optimally adjusted person to assess target-derogation. Judges' narcissism and other-derogation were positively related in Studies 1 and 2. Narcissism positively predicted and self-esteem negatively predicted target-derogation after controlling for each other in Study 3. Narcissistic individuals derogate others more than non-narcissistic individuals regardless of whether ego threat is present or absent.

Narcissism and discrepancy between self and friends' perceptions of personality.

Most research on narcissism and person perception has used strangers as perceivers. However, research has demonstrated that strangers' ratings are influenced by narcissists' stylish appearance (Back, Schmukle, & Egloff, 2010). In the present study, we recruited participants and their close friends, individuals whose close relationship should immunize them to participants' superficial appearance cues. We investigated the relation between narcissism and personality ratings by self and friends. Participants (N = 66; 38 women; Mage = 20.83 years) completed the Narcissistic Personality Inventory (Raskin & Terry, 1988) and described their personality on the 100-item California Adult Q-Sort (CAQ; Block, 2008). Participants' personality was also described on the CAQ by close friends. The "optimally adjusted individual" prototype was used to summarize participant and friend personality ratings (Block, 2008). Participants with high narcissism scores were ascribed higher optimal adjustment by self than by friends. Narcissistic individuals' self-ratings were extremely positive and more favorable than friends' ratings of them.

A relationship between tolerance of blur and personality.

PURPOSE: To determine whether tolerance of dioptric spherical defocus is related to measures of personality. Clinical observations suggest that there is individual variability in tolerance of blur. METHODS: A computer-controlled Badal optometer was used to measure just-noticeable blur and just-objectionable blur responses to positive lens defocus. Blur tolerance was defined as the difference between these two responses. A personality battery was administered consisting of the NEO-FFI (Neuroticism-Extroversion-Openness-Five Factor Inventory) and the California Adult Q-sort (general measures), as well as individual measures (hypothesis-driven scales) of perfectionism, neuroticism, highly sensitive person, ego resiliency, need for structure, and negative emotionality. Ninety-nine normally sighted subjects (median age, 21 years, median refractive error 0.6 DS) completed both parts of the study. RESULTS: Within-subject blur tolerance measures with three different pupil sizes correlated highly (r(s) = 0.79-0.86), implying good repeatability. There was a wide range of individual blur tolerance (0.0-2.7 D). The personality questionnaires exhibited acceptable reliability (Cronbach's α = 0.67-0.91). Two perfectionism scales correlated significantly with blur tolerance (r = 0.25 and 0.27). The 15 questionnaire items that correlated most with blur tolerance were factor analyzed and yielded two conceptually meaningful factors (both α = 0.76). The "low self confidence" and "disorganization" factors correlated positively with blur tolerance (r = 0.38 and 0.36, respectively) and their composite correlated with blur tolerance (r = 0.46). CONCLUSIONS: These results provide the first evidence of a relationship between personality and tolerance of blur. Tolerance of blur may be related to perception of image quality. If so, personality may influence refractive error correction and development and other choices that are made when presented with degraded images.

Cationic and neutral amino acid transporter transcript abundances are differentially expressed in the equine intestinal tract.

To test the hypothesis that AA transporter transcripts are present in the large intestine and similarly expressed along the intestinal tract, mRNA abundance of candidate AA transporter genes solute carrier (SLC) family 7, member 9 (SLC7A9), SLC7A1, SLC7A8, and SLC43A1 encoding for b(0,+)-type AA transporter (b(0,+)AT), cationic AA transporter-1 (CAT-1), L-type AA transporter-2 (LAT-2), and L-type AA transporter-3 (LAT-3), respectively, was determined in small and large intestinal segments of the horse. Mucosa was collected from the equine small (jejunum and ileum) and large intestine (cecum, left ventral colon, and left dorsal colon), flash frozen in liquid nitrogen, and stored at -80 degrees C. Messenger RNA was isolated from tissue samples, followed by manufacture of cDNA. Relative quantitative reverse transcription-PCR was conducted using the 2(-DeltaDeltaCT) method, with glyceraldehyde-3-phosphate dehydrogenase serving as the housekeeping gene. Compared with the jejunum, cationic and neutral AA transporter SLC7A9 mRNA abundance was similar in the ileum, cecum, and large intestinal segments. Compared with the jejunum, cationic AA transporter SLC7A1 mRNA abundance was similar in the ileum and decreased in the cecum, left ventral colon, and left dorsal colon (P < 0.001). Neutral AA transporter SLC7A8 mRNA abundance decreased from the cranial to caudal end of the intestinal tract (P < 0.001). Neutral AA transporter SLC43A1 mRNA abundance was similar in the ileum and left dorsal colon and increased in the cecum (P < 0.01) and left ventral colon (P < 0.1) compared with the jejunum. Cationic and neutral AA transporter SLC7A9 mRNA abundance was similarly expressed in the large compared with small intestine, whereas cationic AA transporter SLC7A1 was of low abundance in the large intestine; neutral AA transporters SLC7A8 and SLC43A1 were differentially expressed with decreased abundance of SLC7A8 and increased abundance of SLC43A1 in the large intestine. Results indicate that the large intestine might contribute to both cationic and neutral AA uptake and absorption predominantly via transporters LAT-3 and b(0,+)AT.

Development of a standardised multidrug-resistant/extensively drug-resistant tuberculosis assessment and monitoring tool.

Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) threaten global TB control. The MDR/XDR-TB Assessment and Monitoring Tool was developed to standardise evaluations of country capacity to prevent, diagnose and treat MDR/XDR-TB and identify program gaps. It provides data to guide national plans, generates baseline data to measure progress, provides information for Green Light Committee (GLC) and Global Fund to Fight AIDS, Tuberculosis and Malaria applications, guides technical assistance and informs donor investment. In field testing, the tool scoring system performed equally well in high- and low-prevalence settings. This GLC-endorsed tool supports global efforts to contain MDR/XDR-TB and is useful in developing national MDR/XDR-TB control strategies.

Assessment of accurate self-knowledge.

Despite ongoing theoretical interest in the accuracy of self-knowledge and its implications for mental health, few researchers have yet to tackle this topic directly. This may be due, in part, to several factors that make assessing individual differences in accurate self-knowledge especially difficult. In this article, we present a method for the assessment of accurate self-knowledge that relies on information gathered from the self, knowledgeable others, and observations of behavior in the laboratory, and we provide psychometric support for this newly developed assessment procedure. Specifically, we present evidence for internal consistency reliability, convergent and discriminant validity, and criterion-related validity. Other researchers interested in studying the accuracy of self-knowledge might wish to adopt this procedure in their own research endeavors.

Accurate intelligence assessments in social interactions: mediators and gender effects.

Research indicates that people can assess a stranger's measured intelligence more accurately than expected by chance, based on minimal information involving appearance and behavior. The present research documents behavioral correlates of perceived and measured intelligence and identifies behaviors that mediate the relationship between perceived and measured intelligence. In particular, when judges rated targets with video and auditory stimuli available, responsiveness to conversation partner, eye-gaze, and looking at partner while speaking were each significant mediators in the accurate assessment of intelligence. Each of those behaviors, as well as the percentage of looking at partner while speaking as a function of the target's own speaking time, were significant mediators in the video silent condition. Additionally, judge and target gender contributed to accurate intelligence assessments.

Interpersonal orientation and the accuracy of personality judgments.

Are those who are more invested in developing and maintaining interpersonal relationships able to provide more accurate judgments of others' personality characteristics? Previous research has produced mixed findings. In the present study, a conceptual framework was presented and methods were used that overcome many of the problems encountered in past research on judgmental accuracy. On four occasions, 102 judges watched a 12-min videotaped dyadic interaction and described the personality of a designated target person. Judges' personality characteristics were described by self, parents, and friends. Results revealed that psychological communion was positively associated with judges' accuracy in rating targets' personality characteristics. In addition, whereas women were more communal and provided more accurate judgments than men, the relationship between communion and accuracy held after controlling for the effect of gender. Finally, preliminary findings suggested that interpersonally oriented individuals may sometimes draw on information about themselves and about stereotypical others to facilitate accurate judgments of others.

The Riverside Behavioral Q-sort: a tool for the description of social behavior.

The Riverside Behavioral Q-sort (RBQ) is a flexible technique for gathering a wide-ranging description of the behavior of individuals in dyadic social interaction. Ratings of RBQ items can attain adequate reliability to reflect behavioral effects of experimental manipulations and to manifest meaningful correlations with a variety of personality characteristics. The RBQ's flexibility, validity, and relative ease of use may facilitate the more frequent inclusion of behavioral data in personality and social psychology.

Behaviour therapy for obsessive compulsive disorder in a 78-year-old woman.

OBJECTIVE: To describe a case of late onset obsessive compulsive disorder (OCD) and determine the impact of a behavioural intervention on OCD symptoms. DESIGN: A single case design was undertaken in which the severity of the patient's OCD symptoms was measured before and after treatment. SETTING: The intervention was undertaken in the patient's home. PATIENT: A 78-year-old woman with a history of depression who experienced sudden onset and rapid escalation of OCD following a domestic accident. INTERVENTION: A behavioural procedure involving continuous in vivo exposure and response prevention over an 8-hour period. MEASURES: The Y-BOCS self-rating scale (Yale Brown Obsessive Compulsive Scale) and clinical observation. RESULTS: Y-BOCS score improved from 35 prior to treatment to 12 post treatment (mean for OCD population = 25.1; SD = 6, Goodman et al., 1989). Improvement was maintained at 2 months follow-up (Y-BOCS = 11). Improvements in confusion and agitation were also observed. CONCLUSIONS: This case study supports the use of behavioural interventions for elderly patients suffering from OCD. Risk factors and treatment designs are discussed in view of the literature.

Comparing the accuracy of personality judgements by the self and knowledgeable others.

In this article we compare the accuracy of personality judgements by the self and by knowledgeable others. Self- and acquaintance judgements of general personality attributes were used to predict general, videotaped behavioral criteria. Results slightly favored the predictive validity of personality judgements made by single acquaintances over self-judgements, and significantly favored the aggregated personality judgements of two acquaintances over self-judgements. These findings imply that the most valid source for personality judgements that are relevant to patterns of overt behavior may not be self-reports but the consensus of the judgement of the community of one's peers.