The costs and benefits of kindness for kids.

What do children think makes an act kind? Which kind acts are children likely to perform? Previous research with adults suggests that the kindness of acts depends largely on the benefit provided and to a lesser extent on the cost incurred, and that adults are more likely to perform low-cost, high-benefit kind acts. In the current study, children (9-12 years, n = 945) and teens (13-17 years, n = 939) rated the benefit, cost, kindness, and likelihood of performing 173 acts of kindness, and adults (18+ years, n = 891) rated how beneficial, costly, kind, and likely the acts would be for young people to perform. Among children and teens, benefit but not cost predicted the kindness of acts, and benefit positively predicted, but cost negatively predicted, performance (for "kindness quotients" of 61% and 65%, respectively). Among adults, benefit and cost predicted the kindness of acts, and cost, but not benefit, negatively predicted performance (for a kindness quotient of 59%). The results for children and teens are similar to those from previous research with adults; however, adults are more sensitive to cost when rating kindness, are less sensitive to benefit when rating performance by young people, and are less likely to think young people will perform acts of kindness overall. In practical terms, the results suggest that recommending cost-effective acts may be the best way to encourage children to be kinder.

The hidden professionalism curriculum: Teach it, see it, do it and repeat!

Background: Professionalism is a complex and multifaceted component of medical education. Historically, students have learned about professionalism informally and as part of the hidden curriculum. Currently, professionalism is increasingly prominent in formal curricula, but uncertainty remains regarding optimal professionalism pedagogies. In this study, the authors explored medical students' exposure to professional topics and considered factors that enabled students to correctly recognize and manage these issues. Methods: Convenience sampling was used to recruit medical students from existing clinical attachments at the authors' hospital. A semi-structured interview format was used to explore participants' awareness of professional issues within fictional vignettes created using published regulatory guidance. The interview transcripts and interview guide field notes were then analyzed. Results: The data suggest that students require a combination of didactic teaching and experiential learning to reliably recognize and manage professional issues. Didactic teaching alone enabled topic recognition, but with uncertainty about management strategies. Experiential learning alone led to erratic recognition of the subject and reliance upon role modeling to guide its management. This work stimulates faculty development to enhance teaching professionalism. Conclusions: Undergraduate medical education on professionalism must be introduced into the formal curriculum. Didactic teaching is required to scaffold experiential learning. Failure to do so renders students unable to reliably recognize or manage professional issues encountered in clinical practice. Further research questions were identified to progress this work.

Silver 2,4'-Bipyridine Coordination Polymer for the High-Capacity Trapping of Perrhenate, A Pertechnetate Surrogate.

Pertechnetate, the most stable form of the radionuclide 99Tc in aerobic aqueous systems, is a hazardous anion present in nuclear waste. Its high mobility in water makes the remediation of the anion challenging. In the past decade, significant effort has been placed into finding materials capable of adsorbing this species. Here, we present the synthesis and high-resolution crystal structure of the coordination polymer [Ag(2,4'-bipyridine)]NO3, which is capable of sequestering perrhenate─a pertechnetate surrogate─through anion exchange to form another new coordination polymer, [Ag(2,4'-bipyridine)]ReO4. Both the beginning and end structures were solved by single-crystal X-ray diffraction and the adsorption reaction was monitored through inductively coupled plasma-optical emission spectroscopy and UV-vis spectroscopy. The exchange reaction follows a pseudo-second-order mechanism and the maximum adsorption capacity is 764 mg ReO4/g [Ag(2,4'-bipyridine)]NO3, one of the highest recorded for a coordination polymer or metal-organic framework. A solvent-mediated recrystallization mechanism was determined by monitoring the ion-exchange reaction by scanning electron microscopy-energy-dispersive spectroscopy and powder X-ray diffraction.

An evaluation of the West of Scotland in-programme Chief Resident role.

Background: Postgraduate leadership education is an evolving field. Locally we have an established 'Chief Residency' programme where centres have two to four senior trainees completing leadership duties alongside clinical workload, supported by local directors of medical education. This is twinned with a 4-day central training programme and peer-support network. Methods: To assess perspectives of the CR role, we adopted a qualitative case-study design using an electronic questionnaire delivered to previous chief residents between 2020 and 2023. Results were analysed using thematic analysis. Results: Trainees valued involvement within quality improvement and trainee support, demonstrating successful multi-departmental projects. Leadership education was viewed ubiquitously positively but participants felt further work is needed to address role legitimacy locally. A proposed solution was junior doctor leadership teams to address workload and emotional challenges. Conclusion: This model provides further evidence of the value in investing in trainee leadership positions, demonstrating organisational impact. Future work will research hospital peer leadership teams.

Moral universals: A machine-reading analysis of 256 societies.

What is the cross-cultural prevalence of the seven moral values posited by the theory of "morality-as-cooperation"? Previous research, using laborious hand-coding of ethnographic accounts of ethics from 60 societies, found examples of most of the seven morals in most societies, and observed these morals with equal frequency across cultural regions. Here we replicate and extend this analysis by developing a new Morality-as-Cooperation Dictionary (MAC-D) and using Linguistic Inquiry and Word Count (LIWC) to machine-code ethnographic accounts of morality from an additional 196 societies (the entire Human Relations Area Files, or HRAF, corpus). Again, we find evidence of most of the seven morals in most societies, across all cultural regions. The new method allows us to detect minor variations in morals across region and subsistence strategy. And we successfully validate the new machine-coding against the previous hand-coding. In light of these findings, MAC-D emerges as a theoretically-motivated, comprehensive, and validated tool for machine-reading moral corpora. We conclude by discussing the limitations of the current study, as well as prospects for future research.

Angioleiomyoma - A Case Report.

Angioleiomyoma is a rare benign soft tissue tumour arising from smooth muscle, representing <1% of upper limb soft tissue tumours. We report a 54-year-old male presenting with a progressively enlarging atraumatic lesion along the palmar side of the base of the ring and little finger. A biopsy was done to determine the diagnosis. Intraoperatively, the lump was found to be intimately related to the radial digital artery, it could not be excised en-bloc without transecting the radial digital artery of the little finger. Following excision, the ends of the digital artery were anastomosed. At 10-months follow-up, the hand was fully functional without any evidence of cold-intolerance or neurological deficit along the distribution of the digital nerve. We review the literature on angioleiomyoma and report careful resection of the tumour with digital artery transection and repair as a treatment option for angioleiomyoma of the digital artery. Level of Evidence: Level V (Therapeutic).

Limited English Proficiency Is Associated With Diabetic Retinopathy in Patients Presenting for Cataract Surgery.

Purpose: To investigate the relationship between limited English proficiency (LEP) and diabetic retinopathy (DR) in patients presenting for cataract surgery. Methods: This is a retrospective observational study of patients who underwent cataract surgery between January 2014 and February 2020. Patients who self-identified as needing or preferring an interpreter were defined as having LEP. Differences in demographics, characteristics, and outcomes including history of type 2 diabetes (T2DM), DR, preoperative best corrected visual acuity (BCVA), macular edema, and anti-vascular endothelial growth factor injections were analyzed. Statistical comparisons were assessed using logistic regression with generalized estimating equations. Results: We included 13,590 eyes. Of these, 868 (6.4%) were from LEP patients. Patients with LEP were more likely to be Hispanic (P < 0.001), female sex (P = 0.008), or older age (P = 0.003) and have worse mean BCVA at presentation (P < 0.001). Patients with LEP had a significantly higher rate of T2DM (P < 0.001), macular edema (P = 0.033), and DR (18.1% vs. 5.8%, P < 0.001). Findings remained significant when controlling for age, sex, race/ethnicity, and type of health insurance. Patients with LEP and DR were more likely to have had later stages of DR (P = 0.023). Conclusions: Patients with LEP presenting for cataract surgery had a higher rate of DR and associated complications compared to patients with English proficiency. Further studies are needed to understand how language disparities influence health and what measures could be taken to improve healthcare in this vulnerable population. Translational Relevance: Our study highlights healthcare disparities within ophthalmology and emphasizes the importance of advocating for improved healthcare delivery for patients with LEP.

A broader theory of cooperation can better explain "purity".

Self-control provides one cooperative explanation for "purity." Other types of cooperation provide additional explanations. For example, individuals compete for status by displaying high-value social and sexual traits, which are moralised because they reduce the mutual costs of conflict. As this theory predicts, sexually unattractive traits are perceived as morally bad, aside from self-control. Moral psychology will advance more quickly by drawing on all theories of cooperation.

Selective Chromium(VI) Trapping by an Acetate-Releasing Coordination Polymer.

We report the high-capacity and selective uptake of Cr(VI) from water using the coordination polymer silver bipyridine acetate (SBA, [Ag(4,4'-bipy)][CH3CO2]·3H2O). Cr capture involves the release of acetate, and we have structurally characterized two of the product phases that form: silver bipyridine chromate (SBC, SLUG-56, [Ag(4,4'-bipy)][CrO4]0.5·3.5H2O) and silver bipyridine dichromate (SBDC, SLUG-57, [Ag(4,4'-bipy)][Cr2O7]0.5·H2O). SBA maintains a high Cr uptake capacity over a wide range of pH values (2-10), reaching a maximum of 143 mg Cr/g at pH 4. This Cr uptake capacity is one of the highest among coordination polymers. SBA offers the additional benefits of a one-step, room temperature, aqueous synthesis and its release of a non-toxic anion following Cr(VI) capture, acetate. Furthermore, SBA capture of Cr(VI) remains >97% in the presence of a 50-fold molar excess of sulfate, nitrate, or carbonate. We also investigated the Cr(VI) sequestration abilities of silver 1,2-bis(4-pyridyl)ethane nitrate (SEN, [Ag(4,4'-bpe)][NO3]) and structurally characterized the silver 1,2-bis(4-pyridyl)ethane chromate (SEC, SLUG-58, [Ag(4,4'-bpe)][CrO4]0.5) product. SEN was, however, a less effective Cr(VI) sequestering material than SBA.

An intraocular solitary fibrous tumor/hemangiopericytoma with extrascleral extension: Case report and review of literature.

Purpose: To report a case of intraocular solitary fibrous tumor/hemangiopericytoma (SFT/HPC) complicated by extrascleral extension and to review the current literature regarding intraocular SFT/HPC. Observations: A twenty-two year old male presented with decreased vision in his left eye and was found to have a subretinal mass with extrascleral extension. He underwent enucleation of his left eye and histopathology confirmed a diagnosis of SFT/HPC. Conclusions and importance: To our knowledge, this is the seventh case of intraocular SFT/HPC ever reported and the first to report extrascleral extension. At the time of publication, there was no evidence of metastases. Extensive clinical, ophthalmic and radiographic imaging, and histopathologic data are presented to contribute to the current understanding of intraocular SFT/HPC.

A crystal-structural study of Pauling-Corey rippled sheets.

Following the seminal theoretical work on the pleated ß-sheet published by Pauling and Corey in 1951, the rippled ß-sheet was hypothesized by the same authors in 1953. In the pleated ß-sheet the interacting ß-strands have the same chirality, whereas in the rippled ß-sheet the interacting ß-strands are mirror-images. Unlike with the pleated ß-sheet that is now common textbook knowledge, the rippled ß-sheet has been much slower to evolve. Much of the experimental work on rippled sheets came from groups that study aggregating racemic peptide systems over the course of the past decade. This includes MAX1/DMAX hydrogels (Schneider), L/D-KFE8 aggregating systems (Nilsson), and racemic Amyloid ß mixtures (Raskatov). Whether a racemic peptide mixture is "ripple-genic" (i.e., whether it forms a rippled sheet) or "pleat-genic" (i.e., whether it forms a pleated sheet) is likely governed by a complex interplay of thermodynamic and kinetic effects. Structural insights into rippled sheets remain limited to only a very few studies that combined sparse experimental structural constraints with molecular modeling. Crystal structures of rippled sheets are needed so we can rationally design rippled sheet architectures. Here we report a high-resolution crystal structure, in which (l,l,l)-triphenylalanine and (d,d,d)-triphenylalanine form dimeric antiparallel rippled sheets, which pack into herringbone layer structures. The arrangements of the tripeptides and their mirror-images in the individual dimers were in excellent agreement with the theoretical predictions by Pauling and Corey. A subsequent mining of the PDB identified three orphaned rippled sheets among racemic protein crystal structures.

Trends in Retinopathy of Prematurity over 12 Years in a Colorado Cohort.

PURPOSE: To determine trends in retinopathy of prematurity (ROP) in a Colorado cohort between 2006 and 2017 and compare trends in risk factors between our cohort and statewide data. METHODS: A retrospective cohort study was conducted by the use of records from two registry databases: 1) an academic center's ROP registry, and 2) vital statistics birth data from the Colorado Department of Public Health and Environment (CDPHE). ROP was categorized as severe (type 1 or type 2), low grade (not type 1 or type 2), or no ROP. Other variables included in the analyses were gestational age and birth weight at delivery, and infant mortality. Trends over time were evaluated for both registry databases using generalized linear models. RESULTS: In our ROP registry cohort of 1,267 eligible infants, 134 (10.6%) developed severe ROP and 279 (22%) developed low-grade ROP. We found no overall trend in severe ROP rates (p = .23), and a decreasing trend in rates of low-grade ROP (p < .01) over the study period. Trends in gestational age, birth weight, and mortality rates remained stable during the study period in both the ROP registry and the CDPHE cohorts. CONCLUSION: The rate of severe ROP in our ROP registry cohort did not change over time. There was evidence of a decreasing trend in low grade ROP during the 12-year study period that was not explained by a change in the primary ROP risk factors in either the ROP registry cohort or the Colorado statewide data.

Managing Access by Generating Improvements in Cannulation: A national quality improvement project.

Cannulation is essential for haemodialysis with arteriovenous access, but also damages the arteriovenous access making it prone to failure, is associated with complications and affects patients' experiences of haemodialysis. Managing Access by Generating Improvements in Cannulation is a national UK quality improvement project, designed to improve cannulation practice in the United Kingdom, ensuring it reflects current needling recommendations. It uses a simple quality improvement method, the Model for Improvement, to structure improvement to cannulation practice. It assists units in the practical implementation of the British Renal Society and Vascular Access Society of Britain and Ireland needling recommendations, ensuring actual cannulation practice reflects what is defined as best practice in cannulation. An eLearning package and awareness materials have been developed, to assist units in changing their cannulation practice. The Kidney Quality Improvement Partnership provides a structure for Managing Access by Generating Improvements in Cannulation that promotes development and dissemination. It is hoped that Managing Access by Generating Improvements in Cannulation will raise an understanding about the cannulation of arteriovenous access and change behaviours and beliefs around correct cannulation practice, to ensure longevity of this lifeline.

Prospective evaluation of risk-appropriate management of uveal melanoma patients informed by gene expression profiling.

AIM: The Clinical Application of DecisionDx-UM Gene Expression Assay Results study aimed to evaluate the clinical utility of the prognostic 15-gene expression profile (15-GEP) test for uveal melanoma (UM) patients in a large, prospective multicenter cohort. PATIENTS & METHODS: Nine centers prospectively enrolled 138 UM patients clinically tested with the 15-GEP. Physician-recommended specialty referrals and metastatic surveillance regimens were collected. RESULTS: A total of 93% of high-risk class 2 patients were referred to medical oncology for follow-up, compared with 51% of class 1 patients. A majority (62%) of class 2 patients were recommended overall high-intensity metastatic surveillance, while 85% of class 1 patients were recommended low-intensity metastatic surveillance. CONCLUSION: Treatment plan recommendations for UM patients are aligned with GEP-informed metastatic risk, consistent with prior studies.

RATES OF EXUDATIVE RECURRENCE FOR EYES WITH INACTIVATED WET AGE-RELATED MACULAR DEGENERATION ON 12-WEEK INTERVAL DOSING WITH BEVACIZUMAB THERAPY.

PURPOSE: To determine the recurrence rate of exudative age-related macular degeneration (wet AMD) in patients on 12-week dosing interval anti-vascular endothelial growth factor (anti-VEGF) bevacizumab therapy. METHODS: A retrospective chart review was performed on wet AMD patients treated with anti-VEGF therapy using a "treat-and-extend" methodology at one physician's practice site over 2 years (2012-2014). Charts were evaluated for visual acuity, anti-VEGF agent used, treatment interval, duration of treatment, trials off of anti-VEGF therapy, evidence of exudation, and wet AMD recurrence characteristics. RESULTS: Three hundred and twenty-one wet AMD patients were treated. Fifty-seven eyes were without active exudation by clinical examination or optical coherence tomography (OCT) and were maintained on repeating 12-week interval suppressive anti-VEGF therapy. Sixteen percent (8/49) showed exudation recurrence with an average 10% cumulative recurrence rate per year for eyes on bevacizumab. Eight eyes without active exudation were discontinued off of bevacizumab therapy. Sixty-three percent (5/8) demonstrated recurrence on average 4 months after stopping therapy. CONCLUSION: The findings in this study suggest that if a patient can be extended to 12-week interval bevacizumab therapy, there is on average a 10% chance of recurrence with each successive year. If anti-VEGF therapy is discontinued in these patients, there is an increased chance of recurrence by 4 months.

Predictors for recovery of macular function after surgery for primary macula-off rhegmatogenous retinal detachment.

PURPOSE: To determine predictors of best-corrected postoperative visual acuity (VA) in patients who underwent surgical intervention for macula-off rhegmatogenous retinal detachment. MATERIALS AND METHODS: Primary macula-off retinal detachments from the University of Colorado Primary Rhegmatogenous Retinal Detachment Database (2012-2017) were reviewed. The primary outcome measure was a postoperative VA of 20/40 or better at least 6 months after surgery. Patient demographics, medical history, duration of central vision loss before surgery, examination findings, operative technique, and postoperative findings were analyzed as possible predictors of postoperative visual recovery to 20/40 or better. Chi-square or Fisher's exact test was used to compare categorical variables, and Wilcoxon rank sum test was used for continuous variables. A multivariable logistic regression analysis was used to determine the adjusted odds ratios and 95% confidence intervals for variables that were significant in the univariable analyses. Statistical significance was set at p < 0.05. RESULTS: One hundred thirty-one patients met inclusion criteria. Eighty-one (61.8%) patients achieved a postoperative VA of 20/40 or better 6 or more months after surgery. Patients with a single retinal break were more likely than patients with more than one break to reach a postoperative VA of 20/40 or better (76.9% vs. 55.4%, p = 0.021). Patients with a better preoperative logMAR VA had better postoperative VA (p = 0.021). Duration of central vision loss prior to surgical repair was not related to final postoperative VA in this particular study. CONCLUSION: Postoperative recovery of visual acuity to 20/40 or better was significantly more common in patients with a single retinal break as well as in patients with better preoperative visual acuity. Duration of central vision loss prior to surgical repair was not significantly associated with postoperative VA.

A Cationic Silver Pyrazine Coordination Polymer with High Capacity Anion Uptake from Water.

We report the first example of linker modification for an N-donor Ag-based cationic material while maintaining and in some cases increasing the anion exchange capacity. Cationic silver(I) pyrazine nitrate selectively traps harmful oxo-anions from water such as permanganate, perrhenate and a variety of α,ω-alkanedicarboxylates. We chose these anions as initial examples of exchange for potential water purification. The host-guest interaction between the cationic layers of π-stacked silver pyrazine polymers and the incoming/outgoing interlamellar anions allows for the exchange. The exchange capacity over 24 h reached 435 and 818 mg/g for permanganate and perrhenate, respectively, a record for a crystalline metal-organic material and over five times the exchange capacity compared to commercial resin. The material also undergoes organic exchange as an analog for pharmaceutical waste, some of which have a carboxylate functionality at the neutral pH range typical of natural water sources. Both the as-synthesized and exchanged materials are characterized by a variety of analytical techniques.

Exchange Capability of Cationic Silver 4,4'-Bipyrdine Materials for Potential Water Remediation: Structure, Stability, and Anion Exchange Properties.

An in-depth study of the class of cationic materials [Ag(4,4'-bipy)+][X-] (where X- = CH3CO2-, NO3-, BF4-, ClO4-, and MnO4-) has led to key insights on the relationship between anion hydration energy, material structure, solubility, and stability. Since these materials show promise for their potential as water remediation tools, understanding their properties in detail is of significant importance. The structure of the starting and ending materials is the main driving force behind the resultant stability and solubility and can be successfully used to predict the ion exchange capabilities. The solubility trend was determined to be, from most soluble to least soluble, X- = CH3CO2- > NO3- ∼ BF4- > ClO4- > MnO4-. Kinetics and thermal stability also follow predictable trends but involve additional factors. For instance, the kinetics of NO3- to MnO4- exchange was much slower than expected based on that seen for NO3- to ClO4-. Powder X-ray diffraction (PXRD) and Fourier transform infrared spectroscopy (FTIR) were used to characterize the materials. Solubility was determined by inductively coupled plasma optical emission spectroscopy (ICP-OES) analysis. Ion exchange was analyzed with ion chromatography (IC) and ultraviolet-visible spectroscopy (UV-vis), and thermal stability was determined with thermogravimetric analysis (TGA).

A range of kindness activities boost happiness.

This experiment investigates the effects of a seven-day kindness activities intervention on changes in subjective happiness. The study was designed to test whether performing different types of kindness activities had differential effects on happiness. Our recent systematic review and meta-analysis of the psychological effects of kindness (Curry, et al. 2018) revealed that performing acts of kindness boosts happiness and well-being. However, we noted in that review that rarely had researchers specifically compared the effects of kindness to different recipients, such as to friends or to strangers. Thus in a single factorial design (n=683) we compare acts of kindness to strong social ties, weak social ties, novel acts of self kindness, and observing acts of kindness, against a no acts control group. The results indicate that performing kindness activities for seven days increases happiness. In addition, we report a positive correlation between the number of kind acts and increases in happiness. Neither effect differed across the experimental the groups, suggesting that kindness to strong ties, to weak ties, and to self, as well as observing acts of kindness, have equally positive effects on happiness.