Parents' Journeys of Mastery and Knowledge Construction After Their Infant's First Stage of Surgery for Complex Congenital Heart Disease

BACKGROUND

A growing body of conceptual evidence over the last decade has increased our understanding of parents' experiences of having an infant with complex congenital heart disease. These concepts include parents' feelings of uncertainty, fear, excitement, and mastery. However, little is known about parents' experiences, confidence, and knowledge acquisition during transition from hospital to home with their infant after the first stage of complex cardiac surgery. A theoretical framework to assess, plan and implement child and family centered care would assist children's cardiac nurses responsible for parental education, discharge planning and coordination.

AIM

To explore parents' experiences of the transition from hospital to home with their infant, following the first stage of cardiac surgery.

DESIGN

A prospective mixed methods longitudinal design. Semi-structured interviews were undertaken, including administration of the Maternal Confidence Questionnaire at four timepoints: before discharge following stage one cardiac surgery (T0), 2 weeks' post discharge (T1), 8 weeks' post discharge (T2) and after stage two surgery (T3). Qualitative data were thematically analyzed. Descriptive statistics were used to characterize the sample and non-parametric repeated measures analysis of variance was used to analyze changes over time in maternal confidence scores.

RESULTS

Sixteen parents of 12 infants participated. Four "patterns of transition experience" emerged, the fourth "Mastery", is discussed in this paper. Mastery can be contextualized in terms of the parents' journeys of knowledge construction, gaining confidence and reflection. Learning was dynamic and transformational, but successful learning and acquisition of knowledge was also dependent upon the parents' ability to absorb, integrate and adjust at any given time. Confidence at T0 was significantly lower than at T1 (p = .011), T2 (p = .018) and T3 (p = .012). There were no significant differences between scores at T1, T2 and T3. Liminality, as a concept, described the between and betwixt time that parents experienced as they were preparing for discharge from hospital; excitement to be going home balanced with the fear of being alone and confidence in looking after their fragile infant.

CONCLUSION

Parents of infants with complex congenital heart disease obtain knowledge, confidence, and mastery dependent upon their transition experience and their personal journey through pre-liminal, liminal, and post-liminal phases of discharge from hospital to home. A conceptual framework "Parenting through Transitions - hospital to home" emerged that could assist in structuring assessment of parents' knowledge and support needs within a coordinated discharge process. Identifying individualized support would promote adaptation and adjustment during transition from the pre to post liminal phase, following their infant's first stage of complex cardiac surgery.

The Academic Impact of Congenital Heart Surgeons' Society (CHSS) Studies

PURPOSE

We reviewed all 64 articles ever published by The Congenital Heart Surgeons' Society (CHSS) Data Center to estimate the academic impact of these peer-reviewed articles.

MATERIALS AND METHODS

The Congenital Heart Surgeons' Society has performed research based on 12 Diagnostic Inception Cohorts. The first cohort (Transposition) began enrolling patients on January 1, 1985. We queried PubMed to determine the number of publications that referenced each of the 64 journal articles generated by the datasets of the 12 Diagnostic Inception Cohorts that comprise the CHSS Database. Descriptive summaries of the data were tabulated using mean with standard deviation and median with range.

RESULTS

Sixty-four peer-reviewed papers have been published based on the CHSS Database. Fifty-nine peer-reviewed articles have been published based on the 12 Diagnostic Inception Cohorts, and five additional articles have been published based on Data Science. Excluding the recently established Diagnostic Inception Cohort for patients with Ebstein malformation of tricuspid valve, the number of papers published per cohort ranged from 1 for coarctation to 11 for transposition of the great arteries. The 11 articles generated from the CHSS Transposition Cohort were referenced by a total of 111 articles (median number of references per journal article = 9 [range = 0-22, mean = 10.1]). Overall, individual articles were cited by an average of 11 (mean), and a maximum of 41 PubMed-listed publications. Overall, these 64 peer-reviewed articles based on the CHSS Database were cited 692 times in PubMed-listed publications. The first CHSS peer-reviewed article was published in 1987, and during the 35 years from 1987 to 2022, inclusive, the annual number of CHSS publications has ranged from 0 to 7, with a mean of 1.8 publications per year (median = 1, mode = 1).

CONCLUSION

Congenital Heart Surgeons' Society studies are widely referenced in the pediatric cardiac surgical literature, with over 10 citations per published article. These cohorts provide unique information unavailable in other sources of data. A tool to access this analysis is available at: [https://data-center.chss.org/multimedia/files/2022/CAI.pdf].

Body appreciation around the world: Measurement invariance of the Body Appreciation Scale-2 (BAS-2) across 65 nations, 40 languages, gender identities, and age

The Body Appreciation Scale-2 (BAS-2) is a widely used measure of a core facet of the positive body image construct. However, extant research concerning measurement invariance of the BAS-2 across a large number of nations remains limited. Here, we utilised the Body Image in Nature (BINS) dataset - with data collected between 2020 and 2022 - to assess measurement invariance of the BAS-2 across 65 nations, 40 languages, gender identities, and age groups. Multi-group confirmatory factor analysis indicated that full scalar invariance was upheld across all nations, languages, gender identities, and age groups, suggesting that the unidimensional BAS-2 model has widespread applicability. There were large differences across nations and languages in latent body appreciation, while differences across gender identities and age groups were negligible-to-small. Additionally, greater body appreciation was significantly associated with higher life satisfaction, being single (versus being married or in a committed relationship), and greater rurality (versus urbanicity). Across a subset of nations where nation-level data were available, greater body appreciation was also significantly associated with greater cultural distance from the United States and greater relative income inequality. These findings suggest that the BAS-2 likely captures a near-universal conceptualisation of the body appreciation construct, which should facilitate further cross-cultural research.

Impact of a quality improvement initiative with a dedicated anesthesia team on outcomes after surgery for adult congenital heart disease

Objectives

A quality improvement initiative was introduced to the adult congenital cardiac surgery program at Toronto General Hospital in January 2016. A dedicated Adult Congenital Anesthesia and intensive care unit team was introduced within the cardiac group. The use of factor concentrates was introduced. The study compares perioperative mortality, adverse events, and transfusion burden before and after this process change.

Methods

We performed a retrospective analysis of all adult congenital cardiac surgeries from January 2004 to July 2019. Two groups were analyzed: patients undergoing operation before and after 2016. The primary outcome was in-hospital mortality. One-year mortality and prevalence of key morbidities were analyzed as secondary outcomes. A separate analysis looked at patients who had and had not attended an anesthesia-led preassessment clinic.

Results

In-hospital mortality was significantly reduced in patients undergoing operation after 2016 (1.1% vs 4.3%, P = .003) despite a higher risk profile. One-year mortality (1.3% vs 5.8%, P = .003) and ventilation times (5.5 hours [3.4-13.0] vs 6.3 hours [4.2-16.2], P = .001) were also reduced. The incidence of stroke and renal failure was similar between groups. Blood product exposure was comparable, but the incidence of chest reopening decreased (1.8% vs 4.8%, P = .022), despite more patients with multiple previous chest wall incisions, on anticoagulation, and with more complex cardiac anatomy. There were no significant outcome differences between those who did or did not attend the preassessment clinic.

Conclusions

Both in-hospital and 1-year mortality were significantly reduced after the introduction of a quality improvement program, despite a higher risk profile. Blood product exposure remained unchanged, but there were less chest reopenings.

Impact of cardiopulmonary bypass on cerebrovascular autoregulation assessed by ultrafast ultrasound imaging

Newborns with congenital heart disease undergoing cardiac surgery are at risk of neurodevelopmental impairment with limited understanding of the impact of intra-operative cardiopulmonary bypass (CPB), deep hypothermia and selective cerebral perfusion on the brain. We hypothesized that a novel ultrasound technique, ultrafast power Doppler (UPD), can assess variations of cerebral blood volume (CBV) in neonates undergoing cardiac surgery requiring CPB. UPD was performed before, during and after surgery in newborns with hypoplastic left heart syndrome undergoing a Norwood operation. We found that global CBV was not significantly different between patients and controls (P = 0.98) and between pre- and post-surgery (P = 0.62). UPD was able to monitor changes in CBV throughout surgery, revealing regional differences in CBV during hypothermia during which CBV correlated with CPB flow rate (R²  = 0.52, P = 0.021). Brain injury on post-operative magnetic resonance imaging was observed in patients with higher maximum variation in CBV. Our findings suggest that UPD can quantify global and regional brain perfusion variation during neonatal cardiac surgery with this first intra-operative application demonstrating an association between CBV and CPB flow rate, suggesting loss of autoregulation. Therefore, the measurement of CBV by UPD could enable optimization of cerebral perfusion during cardiac surgery in neonates. KEY POINTS: The impact of cardiopulmonary bypass (CPB) on the neonatal brain undergoing cardiac surgery is poorly understood. Ultrafast power Doppler (UPD) quantifies cerebral blood volume (CBV), a surrogate of brain perfusion. CBV varies throughout CPB surgery and is associated with variation of the bypass pump flow rate during deep hypothermia. Association between CBV and bypass pump flow rate suggests loss of cerebrovascular autoregulatory processes. Quantitative monitoring of cerebral perfusion by UPD could provide a direct parameter to optimize CPB flow rate.

Longitudinal assessment of cerebral blood volume variation in human neonates using ultrafast power Doppler and diverging waves

Longitudinal assessment of brain perfusion is a critical parameter for neurodevelopmental outcome of neonates undergoing cardiopulmonary bypass procedure. In this study, we aim to measure the variations of cerebral blood volume (CBV) in human neonates during cardiac surgery, using Ultrafast Power Doppler and freehand scanning. To be clinically relevant, this method must satisfy three criteria: being able to image a wide field of view in the brain, show significant longitudinal CBV variations, and present reproducible results. To address the first point, we performed for the first time transfontanellar Ultrafast Power Doppler using a hand-held phased-array transducer with diverging waves. This increased the field of view more than threefold compared to previous studies using linear transducers and plane waves. We were able to image vessels in the cortical areas as well as the deep grey matter and temporal lobes. Second, we measured the longitudinal variations of CBV on human neonates undergoing cardiopulmonary bypass. When compared to a pre-operative baseline acquisition, the CBV exhibited significant variation during bypass: on average, +20±3% in the mid-sagittal full sector (p<0.0001), -11±3% in the cortical regions (p<0.01) and -10±4% in the basal ganglia (p<0.01). Third, a trained operator performing identical scans was able to reproduce CBV estimates with a variability of 4% to 7.5% depending on the regions considered. We also investigated whether vessel segmentation could further improve reproducibility, but found that it actually introduced greater variability in the results. Overall, this study demonstrates the clinical translation of ultrafast power Doppler with diverging-waves and freehand scanning.

Long-term survival and center volume for functionally single-ventricle congenital heart disease in England and Wales

OBJECTIVES

Long-term survival is an important metric for health care evaluation, especially in functionally single-ventricle (f-SV) congenital heart disease (CHD). This study's aim was to evaluate the relationship between center volume and long-term survival in f-SV CHD within the centralized health care service of England and Wales.

METHODS

This was a retrospective cohort study of children born with f-SV CHD between 2000 and 2018, using the national CHD procedure registry, with survival ascertained in 2020.

RESULTS

Of 56,039 patients, 3293 (5.9%) had f-SV CHD. Median age at first intervention was 7 days (interquartile range [IQR], 4, 27), and median follow-up time was 7.6 years (IQR, 1.0, 13.3). The largest diagnostic subcategories were hypoplastic left heart syndrome, 1276 (38.8%); tricuspid atresia, 440 (13.4%); and double-inlet left ventricle, 322 (9.8%). The survival rate at 1 year and 5 years was 76.8% (95% confidence interval [CI], 75.3%-78.2%) and 72.1% (95% CI, 70.6%-73.7%), respectively. The unadjusted hazard ratio for each 5 additional patients with f-SV starting treatment per center per year was 1.04 (95% CI, 1.02-1.06), P < .001. However, after adjustment for significant risk factors (diagnostic subcategory; antenatal diagnosis; younger age, low weight, acquired comorbidity, increased severity of illness at first procedure), the hazard ratio for f-SV center volume was 1.01 (95% CI, 0.99-1.04) P = .28. There was strong evidence that patients with more complex f-SV (hypoplastic left heart syndrome, Norwood pathway) were treated at centers with greater f-SV case volume (P < .001).

CONCLUSIONS

After adjustment for case mix, there was no evidence that f-SV center volume was linked to longer-term survival in the centralized health service provided by the 10 children's cardiac centers in England and Wales.

Appearance Orientation and Dating Anxiety in Emerging Adults: Considering the Roles of Appearance-Based Rejection Sensitivity, Social Physique Anxiety, and Self-Compassion

Emerging research has suggested that appearance-related factors, such as greater appearance orientation, are associated with dating anxiety in emerging adults, but much more could be done to understand mechanistic pathways and potential buffers. Here, we tested a moderated mediation model in which appearance-based rejection sensitivity and social physique anxiety were explored as mediators, and self-compassion was explored as a moderator, of the relationship between appearance orientation and dating anxiety. A total of 501 heterosexual emerging adults (248 women, 253 men) from the UK completed instruments measuring the aforementioned constructs. Relationships among all variables were largely similar across women and men, with only the association between social physique anxiety and appearance-based rejection sensitivity being significantly stronger in women. Mediation analysis in the total sample indicated that both social physique anxiety and appearance-based rejection anxiety were significant mediators. Additionally, we confirmed a serial mediation involving appearance orientation → appearance-based rejection sensitivity → social physique anxiety → dating anxiety. Conversely, self-compassion did not moderate the effects of either social physique anxiety or appearance-based rejection sensitivity on dating anxiety, although greater self-compassion was moderately associated lower dating anxiety. We suggest ways in which existing interventions aimed at reducing dating anxiety could be combined with body image interventions to reduce dating anxiety in heterosocial contexts.

Associations between Schizotypal Facets and Symptoms of Disordered Eating in Women

Research has suggested that schizotypy-a personality organisation representing latent vulnerability for schizophrenia-spectrum disorders-may be elevated in women with symptoms of disordered eating. However, studies have not fully considered associations between symptoms of disordered eating and multidimensional schizotypy. To overcome this limitation, we asked an online sample of 235 women from the United States to complete measures of symptoms of disordered eating (drive for thinness, body dissatisfaction, and bulimic symptoms) and multidimensional schizotypy. Correlational analyses indicated significant associations between drive for thinness and bulimic symptoms, respectively, and most schizotypal facets. Body dissatisfaction was significantly associated with only two schizotypal facets. Overall, the strength of correlations was weak-to-moderate. Regression results indicated that only the schizotypal feature of excessive social anxiety was significantly associated with all risk for disordered eating factors. These results are consistent with aetiological models of disordered eating that highlight socio-affective difficulties as risk factors for symptoms of disordered eating.

Psychometric properties of a Bahasa Malaysia (Malay) translation of the Body and Appearance Self-Conscious Emotions Scale (BASES): An assessment using exploratory structural equation modelling

The Body and Appearance Self-Conscious Emotions Scale (BASES) measures self-conscious emotions in relation to the body and appearance. While scores have been shown to support a hypothesised 4-factor model consisting of facets of shame, guilt, authentic pride, and hubristic pride, previous studies are limited in their sole reliance on confirmatory factor analysis. Here, we assessed the psychometric properties of a novel Bahasa Malaysia translation of the BASES using an exploratory structural equation modelling (ESEM) framework. Malaysian adults (N = 1049) completed the BASES along with measures of body appreciation, psychological well-being, and secure non-striving. The results of exploratory factor analysis and ESEM in separate split-half subsamples supported a 2-dimensional model consisting of Shame-Guilt and Authentic-Hubristic Pride. This 2-dimensional model was broadly invariant across ethnicity, gender, and age, had adequate internal consistency, and evidenced adequate construct validity in relation to the Authenthic-Hubristic Pride subscale. We interpret our findings as consistent with the view that cultural factors shape the way in which body and appearance-related self-conscious emotions are manifested. Our results also highlight the importance of considering alternative conceptualisations of body and appearance-related self-conscious emotions, which previous studies may have obscured through their reliance on confirmatory factor analyses.

Fate of the liver in the survivors of adult heart transplant for a failing Fontan circulation

The Fontan circulation has inherent long-term vulnerabilities such that adult Fontan patients now comprise the largest, most rapidly growing subgroup of adult congenital heart disease referred for transplant assessment. Almost all have Fontan Associated Liver Disease (FALD). There is an absence of mid to late hepatic outcome data after heart transplant alone. Therefore, we analyzed outcomes of survivors of heart only transplant in patients with failing Fontan circulation. Including all 10 of our adult Fontan patients surviving >1 year after isolated heart transplant, we report evolution of their clinical features, bloodwork, hemodynamic data, and liver ultrasound findings over a median of 4.7 years. Nonprogression of FALD, resolution of ascites and freedom from hepatocellular carcinoma in the mid-term highlight the outcomes in this selected group once normal cardiac output and venous pressures are established by heart transplant.

A cluster of children with facial nerve palsy in a high prevalence area for COVID-19

BACKGROUND

COVID-19 is a disease of varying presentation and neurological sequelae of the disease are being studied. Following a cluster of paediatric facial nerve palsy (FNP) cases in an area of South Wales with a high prevalence of COVID-19, we conducted an opportunistic study to determine whether there has been an increase of incidence of FNP and if there is an association between the FNP and COVID-19 in children.

METHODS

We performed a retrospective review of the incidence of FNP between 2015 and 2020 across two hospitals within the health board. The incidence was compared with that in 2020 including a cluster of six children in 14 weeks, presenting to Royal Glamorgan Hospital between June and October.

RESULTS

There were 48 cases of children with FNP across both hospital within the study years. Seven (7) cases in 2020. The incidence was not statistically different in comparison to other years. Five out of six of these children in 2020 had antibody testing for COVID-19. All serology testing (100%) returned negative for SARS-CoV- 2 antibodies.

CONCLUSIONS

In high prevalence area for COVID-19, cases of children with FNP have not shown a commensurate increase. we have found no causal link between COVID-19 and FNP in children. While this is a small study, larger cohort studies are needed to support this finding. As new strains of COVID-19 are being reported in UK, South Africa and Brazil, physicians need to continue to be vigilant for consistent pattern of signs and symptoms, especially in children.

The Body Acceptance by Others Scale-2 (BAOS-2): Psychometric properties of a Bahasa Malaysia (Malay) translation and an assessment of invariance across Malaysia, the United Kingdom, and the United States

The Body Acceptance by Others Scale-2 (BAOS-2) is a 13-item instrument measuring generalised perceptions of body acceptance by others. Here, we first demonstrate that a Bahasa Malaysia (Malay) translation of the BAOS-2 is psychometrically valid in a sample of 1,049 Malaysian adults (Study 1). Using exploratory and confirmatory factor analysis, we extracted a unidimensional model of BAOS-2 scores that retained all 13 items. BAOS-2 scores had adequate internal consistency and indices of validity (convergent, construct, concurrent, and incremental), and were scalar invariant across gender and ethnicity (Malaysian Malays vs. Chinese). Next, we assessed invariance of BAOS-2 scores across samples from Malaysia, the United Kingdom, and the United States (total N = 2,575; Study 2). Multi-group confirmatory factor analysis showed that partial scalar invariance was achieved. Participants in the interdependent cultural context of Malaysia had significantly higher scores - with small effect sizes - than their counterparts in the independent contexts of the United Kingdom and United States. In addition, women had significantly higher scores than men, but the effect size was negligible. The present study indicates that the Malay BAOS-2 is a psychometrically valid instrument and presents the first comparison of BAOS-2 scores across interdependent and independent contexts.

Rational thinking style, rejection of coronavirus (COVID-19) conspiracy theories/theorists, and compliance with mandated requirements

Faced with the threat posed by the COVID-19 pandemic, many nations have mandated sets of requirements, such as social-distancing measures. However, compliance with such measures is likely to be shaped by a range of factors. Here, we proposed and tested a mediation model in which rejection of COVID-19 conspiracy theories and/or theorists mediates the relationship between rational thinking style and compliance with mandated requirements. An online, nationally representative sample of the adult population in the United Kingdom ( N = 520) completed a previously validated measure of rational thinking style, as well as novel measures of rejection of COVID-19 conspiracy theories/theorists and compliance with mandated requirements. Intercorrelations between scores on all three measures were significant and positive. Mediation analysis indicated that rational thinking style and rejection of COVID-19 conspiracy theories/theorists, respectively, were directly associated with compliance, and that the mediated association was also significant. These results may have implications for practical policy aimed at promoting greater compliance with mandated requirements, including social distancing.

A Cluster of Children with Facial Nerve Palsy in High Prevalence Area for COVID-19

OBJECTIVES

COVID-19 is a disease of varying presentation and neurological sequelae of the disease are being studied. Following a cluster of paediatric facial nerve palsy (FNP) cases in an area of South Wales with a high prevalence of COVID-19, we conducted an opportunistic study to determine whether there has been an increase in incidence of FNP and if there is an association between the FNP and COVID-19 in children.

STUDY DESIGN

A retrospective cohort study. Using the case series from 2020 and comparing it with previous years.

METHODS

We reviewed the incidence of FNP between 2015-2020 across two hospitals within the health board. The incidence was compared with that in 2020 including a cluster of six children in 14 weeks, presenting to the Royal Glamorgan Hospital between June and October.

RESULTS

There were 48 cases of children with FNP across both hospital within the study years. Seven (7) cases in 2020. The incidence was not statistically different in comparison to other years.Five out of six of these children in 2020 had antibody testing for COVID-19. All serology testing (100%) returned negative for SARS-CoV- 2 antibodies.In high prevalence area for COVID-19, cases of children with FNP have not shown a commensurate increase. we have found no causal link between COVID-19 and FNP in children. While this is a small study, larger cohort studies are needed to support this finding.

CONCLUSION

As new strains of COVID-19 are being reported in UK, South Africa and Brazil, physicians need to continue to be vigilant for consistent pattern of signs and symptoms, especially in children.

Translation and validation of body image instruments: An addendum to Swami and Barron (2019) in the form of frequently asked questions

Test adaptation - the translation and validation of source instruments for use in new social identity groups - plays a vital role in body image research. Previously, Swami and Barron (2019) developed a set of good practice recommendations and reporting guidelines for the test adaptation of body image instruments. However, a number of issues in that article were not covered in depth and new issues have emerged as a result of developments in theory and practice. Here, we offer an addendum to Swami and Barron in the form of frequently asked questions. Issues discussed in this article include various methods for achieving good translations, the appropriateness of revising instrument components prior to empirical analyses, determining the number of factors to extract in exploratory factor analyses (EFA), and the usefulness of EFA versus confirmatory factor analyses (CFA) in determining factorial validity. We also cover methods of analyses that have been infrequently utilised by body image scholars, including exploratory structural equation modelling (ESEM), bifactor model analyses, and various methods for establish measurement invariance. When read as an addendum to Swami and Barron, we hope this article helps to clarify issues of importance for body image researchers interested in conducting test adaptation work.

Psychometric properties of a Romanian translation of the Functionality Appreciation Scale (FAS)

The Functionality Appreciation Scale (FAS; Alleva et al., 2017) is a 7-item measure of an individual's appreciation of their body for what it can do and is capable of doing. Although the instrument is increasingly used in interventionist studies, its psychometric properties have been infrequently investigated outside Anglophone populations. Here, we examined psychometric properties of a novel Romanian translation of the FAS. An online sample of 959 Romanian adults (18-73 years old) completed the Romanian FAS, and validated measures of positive body image (body appreciation), negative body image (weight discrepancy in women, drive for muscularity in men), eating disorder symptomatology, and psychological well-being (self-esteem, gratitude). Exploratory factor analyses led to the extraction of a 1-dimensional model of FAS scores, which we confirmed using confirmatory factor analysis. FAS scores achieved scalar invariance across sex, but the sex difference in latent FAS scores did not reach significance (d = 0.15). FAS scores had adequate internal consistency and test-retest reliability up to four weeks, and further analyses provided evidence of convergent, construct, and incremental validity. These results support the psychometric properties of the Romanian FAS and present evidence of the importance of functionality appreciation in relation to healthier body image and psychological well-being.

3D Modeling and Printing in Congenital Heart Surgery: Entering the Stage of Maturation

3D printing allows the most realistic perception of the surgical anatomy of congenital heart diseases without the requirement of physical devices such as a computer screen or virtual headset. It is useful for surgical decision making and simulation, hands-on surgical training (HOST) and cardiovascular morphology teaching. 3D-printed models allow easy understanding of surgical morphology and preoperative surgical simulation. The most common indications for its clinical use include complex forms of double outlet right ventricle and transposition of the great arteries, anomalous systemic and pulmonary venous connections, and heterotaxy. Its utility in congenital heart surgery is indisputable, although it is hard to "scientifically" prove the impact of its use in surgery because of many confounding factors that contribute to the surgical outcome. 3D-printed models are valuable resources for morphology teaching. Educational models can be produced for almost all different variations of congenital heart diseases, and replicated in any number. HOST using 3D-printed models enables efficient education of surgeons in-training. Implementation of the HOST courses in congenital heart surgical training programs is not an option but an absolute necessity. In conclusion, 3D printing is entering the stage of maturation in its use for congenital heart surgery. It is now time for imagers and surgeons to find how to effectively utilize 3D printing and how to improve the quality of the products for improved patient outcomes and impact of education and training.

Costs of postoperative morbidity following paediatric cardiac surgery: observational study

OBJECTIVE

Early mortality rates for paediatric cardiac surgery have fallen due to advancements in care. Alternative indicators of care quality are needed. Postoperative morbidities are of particular interest. However, while health impacts have been reported, associated costs are unknown. Our objective was to calculate the costs of postoperative morbidities following paediatric cardiac surgery.

DESIGN

Two methods of data collection were integrated into the main study: (1) case-matched cohort study of children with and without predetermined morbidities; (2) incidence rates of morbidity, measured prospectively.

SETTING

Five specialist paediatric cardiac surgery centres, accounting for half of UK patients.

PATIENTS

Cohort study included 666 children (340 with morbidities). Incidence rates were measured in 3090 consecutive procedures.

METHODS

Risk-adjusted regression modelling to determine marginal effects of morbidities on per-patient costs. Calculation of costs for hospital providers according to incidence rates. Extrapolation using mandatory audit data to report annual financial burden for the health service.

OUTCOME MEASURES

Impact of postoperative morbidities on per-patient costs, hospital costs and UK health service costs.

RESULTS

Seven of the 10 morbidity categories resulted in significant costs, with mean (95% CI) additional costs ranging from £7483 (£3-£17 289) to £66 784 (£40 609-£103 539) per patient. On average all morbidities combined increased hospital costs by 22.3%. Total burden to the UK health service exceeded £21 million each year.

CONCLUSION

Postoperative morbidities are associated with a significant financial burden. Our findings could aid clinical teams and hospital providers to account for costs and contextualise quality improvement initiatives.

Nature exposure and positive body image: (Re-)examining the mediating roles of connectedness to nature and trait mindfulness

Previous studies have reported a significant association between nature exposure and positive body image, but understandings of the mechanisms that help to explain this link remain nascent. Here, we considered the extent to which trait mindfulness and connectedness to nature, respectively, mediate the aforementioned relationship both in parallel and serially. An online sample of 398 participants (199 women, 196 men, 3 other; age M = 28.1 years) from the United Kingdom completed measures of self-reported nature exposure, mindful awareness and acceptance, connectedness to nature, and body appreciation. Results indicated that inter-correlations between scores on all measures were significant and positive. Following the elimination of non-significant pathways, path analysis resulted in an adequately-fitting model in which the direct relationship between nature exposure and body appreciation was significant. In addition, connectedness to nature - but not trait mindfulness - significantly mediated the direct relationship. Finally, we also found evidence of a serial mediation, where the association between nature exposure and body appreciation was mediated by mindful awareness followed by connectedness to nature. The implications of these results for scholarly and practitioner understanding of the impact of nature exposure on positive body image are discussed in conclusion.

Greater gastric interoception is associated with more positive body image: Evidence from adults in Malaysia and the United Kingdom

Gastric interoception refers to the processing of sensory stimuli originating in the gut. Previous research has found that gastric interoception (measured using a water load task) is associated with drive for thinness in young Western women. However, associations with broader facets of body image and in diverse national groups have not been previously investigated. To address these issues, we asked samples of adults in the United Kingdom (UK; N = 91, women n = 54) and Malaysia (N = 100, women n = 50) to complete a 2-stage water load task (WLT) and measures of positive body image (i.e., body appreciation, functionality appreciation). The results indicated that a greater change in the intensity of self-reported WLT-related sensations was associated with significantly higher body appreciation and functionality appreciation after accounting for gender identity, body mass index, and national group. Behavioural performance on the WLT was significantly associated with body appreciation and functionality appreciation for the Malaysian sample, but not the UK adults, after accounting for gender identity and body mass index. These findings extend previous research by demonstrating that there are significant associations between facets of gastric interoception and previously unexplored facets of body image in both Western and non-Western settings.

Internal Delensing of Cosmic Microwave Background Polarization B-Modes with the POLARBEAR Experiment

Using only cosmic microwave background polarization data from the polarbear experiment, we measure B-mode polarization delensing on subdegree scales at more than 5σ significance. We achieve a 14% B-mode power variance reduction, the highest to date for internal delensing, and improve this result to 22% by applying for the first time an iterative maximum a posteriori delensing method. Our analysis demonstrates the capability of internal delensing as a means of improving constraints on inflationary models, paving the way for the optimal analysis of next-generation primordial B-mode experiments.

Translation and validation of a Bahasa Malaysia (Malay) version of the Multidimensional Assessment of Interoceptive Awareness (MAIA)

OBJECTIVES

The 32-item Multidimensional Assessment of Interoceptive Awareness (MAIA) is a widely-used measure of multidimensional interoception. In the present study, we examined the psychometric properties of a Bahasa Malaysia (Malay) translation of the MAIA.

METHODS

An online sample of 815 Malaysian Malays (women n = 403) completed a novel translation of the MAIA. Validated measures of trait mindfulness and self-esteem were also completed to facilitate a preliminary assessment of convergent validity.

RESULTS

Exploratory factor analysis indicated that the MAIA items reduced to a 19-item, 3-factor model. The 3-factor model was further tested using confirmatory factor analysis (CFA) alongside the parent 8-factor model. Both models had good fit on some indices, but less-than-ideal fit on other indices. The 3-factor model evidenced comparatively better fit, with fit indices being adequate following modification. Multi-group CFA indicated both the 3-factor model and the 8-factor model had full strict invariance across sex. However, evidence for construct and convergent validity was mixed.

CONCLUSIONS

Overall the 3-dimensional Malay MAIA was demonstrated to be both internally consistent and invariant across sex, but further evidence of construct and convergent validity is required. Issues that affect the dimensionality of MAIA scores in the present and extant work are discussed in conclusion.

The Breast Size Satisfaction Survey (BSSS): Breast size dissatisfaction and its antecedents and outcomes in women from 40 nations

The Breast Size Satisfaction Survey (BSSS) was established to assess women's breast size dissatisfaction and breasted experiences from a cross-national perspective. A total of 18,541 women were recruited from 61 research sites across 40 nations and completed measures of current-ideal breast size discrepancy, as well as measures of theorised antecedents (personality, Western and local media exposure, and proxies of socioeconomic status) and outcomes (weight and appearance dissatisfaction, breast awareness, and psychological well-being). In the total dataset, 47.5 % of women wanted larger breasts than they currently had, 23.2 % wanted smaller breasts, and 29.3 % were satisfied with their current breast size. There were significant cross-national differences in mean ideal breast size and absolute breast size dissatisfaction, but effect sizes were small (η² = .02-.03). The results of multilevel modelling showed that greater Neuroticism, lower Conscientiousness, lower Western media exposure, greater local media exposure, lower financial security, and younger age were associated with greater breast size dissatisfaction across nations. In addition, greater absolute breast size dissatisfaction was associated with greater weight and appearance dissatisfaction, poorer breast awareness, and poorer psychological well-being across nations. These results indicate that breast size dissatisfaction is a global public health concern linked to women's psychological and physical well-being.

Dimensional structure, psychometric properties, and sex and ethnic invariance of a Bahasa Malaysia (Malay) translation of the Intuitive Eating Scale-2 (IES-2)

The Intuitive Eating Scale-2 (IES-2; Tylka & Kroon Van Diest, 2013) is a widely-used measure of facets of intuitive eating. We examined the psychometric properties of a Bahasa Malaysia (Malay) translation of the IES-2 in a sample of Malaysian Malay and Chinese adults (N = 921). Participants completed a Malay translation of the IES-2 along with demographic items and measures of psychological well-being, positive and negative body image, and internalisation of appearance ideals. Exploratory factor analyses (EFAs) with Malay subsamples indicated that IES-2 scores reduced to 4 factors in women and 3 in men, both of which diverged from the parent model. Confirmatory factor analysis failed to confirm the parent 4-factor model, and indices for the EFA-derived models were acceptable but not ideal. Of the models tested, the EFA-derived 3-factor model had the best fit indices. Scores on this model had adequate internal consistency and were invariant across sex and ethnicity, but between-group differences in subscale scores were non-significant or negligible. Evidence of the construct validity of Malay IES-2 scores was mixed, particularly in men. These results lead us to question the degree to which intuitive eating as a construct is applicable to Malaysian populations specifically and non-Western populations generally.

An exploration of the associations between facets of interoceptive awareness and body image in adolescents

Previous research suggests that lower interoceptive awareness is associated with more negative body image during adolescence. However, studies have not distinguished between adaptive and maladaptive modes of attention toward interoceptive signals, and relationships between interoceptive awareness and positive body image remain unexplored. To address these issues, a sample of 265 British adolescents (140 girls, 125 boys) aged 13-16 years completed measures of interoceptive awareness, body appreciation, functionality appreciation, body pride, body shame, and body surveillance. Correlational analyses broadly indicated that greater interoceptive awareness was significantly associated with more positive body image. Multiple regressions revealed significant predictive relationships between interoceptive awareness and all facets of body image in both girls and boys, except body surveillance, which was not statistically significant for girls. At the univariate level, the interoceptive awareness facets of Attention Regulation, Body Listening, Self-Regulation, and Trusting emerged as significant predictors for at least one facet of positive body image, whilst the Noticing and Emotional Awareness facets did not. These findings broadly align with previous research with adults, which has indicated that the way interoceptive stimuli are appraised and responded to might be more closely associated with facets of body image than the tendency to notice interoceptive stimuli.

Translation and validation of body image instruments: Challenges, good practice guidelines, and reporting recommendations for test adaptation

Body image research has grown rapidly to include new cultural and linguistic populations, but this gives rise to a need for measurement instruments that are sensitive to local contextual variations while remaining equivalent across groups. Test adaptation, or the translation and validation of a source instrument for use in a new cultural group, is an important part of this process. Here, we offer an operational framework for conducting effective test adaptation. We cover good-practice guidelines for instrument translation and suggest effective strategies for achieving semantic equivalence of translated instruments. We also focus on measurement invariance and provide good-practice and reporting guidelines for conducting exploratory and confirmatory factor analyses. Finally, we suggest good-practice guidelines for demonstrating that scores on translated measures have good reliability and validity. It is our hope that the availability of this article will assist body image scholars seeking to conduct robust test adaptations of existing measurement tools.

Evaluating the Factor Structure and Construct Validity of the Intensions Health-Related Masculine Values Scale: Is It Really a Measure of Health-Related Masculine Values?

The Intensions Health-Related Masculine Values Scale (IHRMVS) was recently developed to address the growing interest in examining the associations between strengths-based masculinity and men’s health. However, while the original development and validation work was promising, replication and extension of several aspects of the scale’s validity should be undertaken before the scale can be adopted for widespread use. Using a large sample of British men, aged 18-80 years, exploratory factor analyses revealed a single factor for both the original age grouping (18-29 years, n = 166) and an older group of men (? 30 years, n = 404), failing to replicate the two-factor structure proposed in the parent study. Additionally, correla-tions between scores on the IHRMVS and scores on a measure of traditional male role norms were mostly non-significant or very small. Similar findings emerged in our analyses of the associations between scores on the IHRMVS and indices of depression, anxiety, help-seeking attitudes, sleep disturbance, and smok-ing. These findings draw into question the utility of the IHRMVS as a measure of positive, health-related masculine values.

The Current and Retrospective Intentional Nature Exposure Scales: Development and Factorial Validity

Both nature exposure and green exercise (GE) can improve health. However, there are no scales examining frequency of engagement; or that consider interaction with nature. There are also no scales assessing these variables during childhood. The aim of this study was to develop a modified (NES-II) and retrospective (RNES-II) version of the Nature Exposure Scale to incorporate GE and to examine their factor structure and reliability. Exploratory factor analysis (EFA) explored the factor structure of the scales; followed by confirmatory factor analysis to confirm the model fit. Fit indices for the one factor five item NES-II and RNES-II models identified by EFA were poor. Use of modification indices resulted in a good model fit; NES-II: χ(5, n = 385) = 2.638; χ_normed = 0.879; CFI= 1.000; RMSEA < 0.001 with 90%CI = 0.000–0.082; SRMR = 0.009; AIC = 36.638. RNES-II: χ(2, n = 385) = 7.149; χ_normed = 3.574; CFI = 0.995; RMSEA = 0.082 with 90%CI = 0.023–0.151; SRMR = 0.015; AIC = 43.149. Both models demonstrated very good reliability (α = 0.84; 89 respectively). These findings indicate that the scales can be used to assess current and retrospective nature exposure. However, due to the removal of item one, the authors recommend that the scales be named the ‘intentional nature exposure scale’ and ‘retrospective intentional nature exposure scale’.

The POLARBEAR Fourier transform spectrometer calibrator and spectroscopic characterization of the POLARBEAR instrument

We describe the Fourier Transform Spectrometer (FTS) used for in-field testing of the POLARBEAR receiver, an experiment located in the Atacama Desert of Chile which measures the cosmic microwave background (CMB) polarization. The POLARBEAR-FTS (PB-FTS) is a Martin-Puplett interferometer designed to couple to the Huan Tran Telescope (HTT) on which the POLARBEAR receiver is installed. The PB-FTS measured the spectral response of the POLARBEAR receiver with signal-to-noise ratio >20 for ∼69% of the focal plane detectors due to three features: a high throughput of 15.1 sr cm², optimized optical coupling to the POLARBEAR optics using a custom designed output parabolic mirror, and a continuously modulated output polarizer. The PB-FTS parabolic mirror is designed to mimic the shape of the 2.5 m-diameter HTT primary reflector, which allows for optimum optical coupling to the POLARBEAR receiver, reducing aberrations and systematics. One polarizing grid is placed at the output of the PB-FTS and modulated via continuous rotation. This modulation allows for decomposition of the signal into different harmonics that can be used to probe potentially pernicious sources of systematic error in a polarization-sensitive instrument. The high throughput and continuous output polarizer modulation features are unique compared to other FTS calibrators used in the CMB field. In-field characterization of the POLARBEAR receiver was accomplished using the PB-FTS in April 2014. We discuss the design, construction, and operation of the PB-FTS and present the spectral characterization of the POLARBEAR receiver. We introduce future applications for the PB-FTS in the next-generation CMB experiment, the Simons Array.

Translation and validation of a Bahasa Malaysia (Malay) version of the Functionality Appreciation Scale

The Functionality Appreciation Scale (FAS; Alleva et al., 2017) is a 7-item measure of an individual's appreciation of their body for what it can do and is capable of doing. To date, its psychometric properties have not been examined beyond the parent study and outside English-speaking samples. To rectify this, we examined the psychometric properties of a Bahasa Malaysia (Malay) translation of the FAS. An online sample of 815 Malaysia citizens completed a Malay translation of the FAS, along with validated measures of body appreciation, weight discrepancy, drive for muscularity, perceived pressure from and internalisation of appearance ideals, self-esteem, and trait mindfulness. Exploratory factor analyses supported a 1-dimensional factor structure of FAS scores, which was upheld using confirmatory factor analysis. FAS scores were also invariant across sex and there was no significant sex difference in scores. Construct validity was generally supported through significant associations with the additional measures included in the study. Incremental validity was also established insofar as functionality appreciation predicted self-esteem over-and-above the variance accounted for by other body image measures. The availability of the Malay FAS will be of use to scholars in Malaysia, but establishing cross-linguistic invariance will be an important next step.

Multiple dimensions of interoceptive awareness are associated with facets of body image in British adults

Previous research has identified a relationship between interoception and body image, where lower interoceptive awareness (IA) is associated with negative body image. However, relationships between facets of interoception and positive body image remain unexplored, and men and older adults remain underrepresented. To overcome these limitations, we assessed relationships between multiple dimensions of interoceptive awareness (IA) and multiple facets of body image in community adults. An online sample of 646 British adults (447 women) aged 18-76 years completed the Multidimensional Assessment of Interoceptive Awareness (MAIA), the Body Appreciation Scale-2, the Functionality Appreciation Scale, the Authentic Pride subscale from the Body and Appearance Self-Conscious Emotions Scale, and the Appearance Orientation and Overweight Preoccupation subscales from the Multidimensional Body-Self Relations Questionnaire. Hierarchical regressions revealed significant predictive relationships between IA and all five facets of body image after controlling for sex, body mass index, and age. In the final models, the MAIA subscales emerged as significant predictors for at least one facet of body image, with the exception of the MAIA Body Listening subscale. These findings extend previous work by demonstrating significant relationships between IA and previously unexplored facets of body image, which may hold promise for practitioner-based interventions.

Mental health literacy of maternal and paternal postnatal (postpartum) depression in British adults

Background: Postnatal depression affects between 6 and 13% of new parents, but only a small proportion of individuals who meet diagnostic criteria receive optimal treatment. One reason for this is poor mental health literacy of postnatal depression.Aims: Studies have examined mental health literacy of maternal postnatal depression, but there are no similar studies of paternal postnatal depression, which we sought to rectify.Methods: A sample of 406 British adults was presented with vignettes describing cases of either maternal or paternal postnatal depression. Based on the vignettes, participants were asked to report if they thought anything was wrong with the targets and, if so, to describe what they thought was wrong. Participants also rated the targets on a range of attitudinal dimensions.Results: Participants were more likely to indicate that something was wrong when the target was female (97.0%) compared to male (75.9%). Of those who believed something was wrong, 90.1% of participants correctly described the female target as experiencing postnatal depression, but only 46.3% did so for the male target. Participants also held more positive attitudes toward the female target than the male target.Conclusions: There is a gender binary in symptom recognition of postnatal depression, which highlights the need for greater awareness of paternal postnatal depression.

Congenitally corrected transposition of great arteries

Congenitally corrected transposition of great arteries (ccTGA) may essentially present as two clinical phenotypes viz. with left ventricular outflow tract obstruction (LVOTO), presenting as Tetralogy of Fallot (TOF) physiology, or sans LVOTO, presenting with systemic ventricular dysfunction. The natural history and treatment, especially the role of pulmonary artery (PA) band, have been discussed.

Dimensional structure, psychometric properties, and sex invariance of a Bahasa Malaysia (Malay) translation of the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS) in Malaysian Malay adults

The 34-item Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS) is a widely-used measure of multidimensional body image. Here, we examined the psychometric properties of a Bahasa Malaysia (Malay) translation of the MBSRQ-AS. A sample of 629 Malaysian Malays (women n = 315) completed the MBSRQ-AS, as well as measures of body appreciation, psychological well-being, perceptions of appearance ideals, and internalisation of appearance ideals. Exploratory factor analysis indicated that the MBSRQ-AS items reduced to four dimensions, although one factor had less-than-adequate internal consistency. Omitting this factor resulted in a 23-item 3-factor solution, which we tested for fit using confirmatory factor analysis (CFA) alongside the parent 5-factor model. CFA indicated that both models had good fit on some indices, but less-than-ideal fit on other indices, with the 3-factor model showing comparatively better fit. Multi-group CFA indicated that it was not possible to achieve scalar invariance across sex, but internal consistency coefficients were adequate. Evidence of construct validity, as assessed through correlations between MBSRQ-AS scores and additional measures, was mixed. We discuss reasons that complicate interpretation of the dimensionality of MBSRQ-AS scores in this and previous studies, and call for further research on this issue.

Factor structure and psychometric properties of a Bahasa Malaysia (Malay) translation of the Body Appreciation Scale-2 (BAS-2)

The 10-item Body Appreciation Scale-2 (BAS-2) is a widely-used measure of a facet of positive body image. Here, we examined the psychometric properties of a Bahasa Malaysia (Malay) translation of the BAS-2 in a community sample of Malaysian Malay and Chinese adults (N = 781). Participants completed the Malay BAS-2 alongside demographic items and measures of subjective happiness, life satisfaction, actual-ideal weight discrepancy (women only), drive for muscularity (men only), and internalisation of appearance ideals. Exploratory factor analyses with a Malay subsample indicated that BAS-2 scores reduced to a single dimension with all 10 items in women and men, although the factor structure was similar but not identical across sex. Confirmatory factor analysis indicated that the one-dimensional factor structure had adequate fit following modifications. BAS-2 scores were partially scalar invariant across sex (with no significant sex differences) and ethnicity (Malay participants had significantly higher body appreciation than Chinese participants), as well as had adequate internal consistency. Evidence of construct and incremental validity was also provided through associations with additional measures and the prediction of subjective happiness over-and-above other variables, respectively. The availability of the Malay BAS-2 should help advance research on the body appreciation construct in Malay-speaking populations.

A reassessment of the higher-order factor structure of the German Schizotypal Personality Questionnaire (SPQ-G) in German-speaking adults

The Schizotypal Personality Questionnaire (SPQ) is a widely-used self-report instrument for the assessment of schizotypal personality traits. However, the factor structure of scores on English and non-English translations of the SPQ has been a matter of debate. With little previous factorial evaluation of the German version of the SPQ (SPQ-G), we re-assessed the higher-order factor structure of the measure. A total of 2,428 German-speaking adults from Central Europe (CE) and the United Kingdom (UK) completed the SPQ-G. Confirmatory factor analysis - testing proposed 2-, 3-, and 4-factor models of SPQ-G scores - indicated that the 4-factor solution had best fit. Partial measurement invariance across cultural group (CE and UK) and sex was obtained for the 4-factor model. Further analyses showed CE participants had significantly higher scores than UK participants on one schizotypal facet. These results suggest that scores on the SPQ-G are best explained in terms of a higher-order, 4-factor solution in German migrant and non-migrant adults.

Genomic Differences Between "Primary" and "Secondary" Muscle-invasive Bladder Cancer as a Basis for Disparate Outcomes to Cisplatin-based Neoadjuvant Chemotherapy

BACKGROUND

Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is the standard of care for patients with muscle-invasive bladder cancer (MIBC). It is unknown whether this treatment strategy is appropriate for patients who progress to MIBC after treatment for prior noninvasive disease (secondary MIBC).

OBJECTIVE

To determine whether clinical and genomic differences exist between primary and secondary MIBC treated with NAC and RC.

DESIGN, SETTING, AND PARTICIPANTS

Clinicopathologic outcomes were compared between 245 patients with clinical T2-4aN0M0-stage primary MIBC and 43 with secondary MIBC treated with NAC and RC at Memorial Sloan Kettering Cancer Center (MSKCC) from 2001 to 2015. Genomic differences were assessed in a retrospective cohort of 385 prechemotherapy specimens sequenced by whole-exome or targeted exon capture by the Cancer Genome Atlas or at MSKCC. Findings were confirmed in an independent validation cohort of 94 MIBC patients undergoing prospective targeted exon sequencing at MSKCC.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Pathologic response rates, recurrence-free survival (RFS), bladder cancer-specific survival (CSS), and overall survival (OS) were measured. Differences in somatic genomic alteration rates were compared using Fisher's exact test and the Benjamini-Hochberg false discovery rate method.

RESULTS AND LIMITATIONS

Patients with secondary MIBC had lower pathologic response rates following NAC than those with primary MIBC (univariable: 26% vs 45%, multivariable: odds ratio=0.4 [95% confidence interval=0.18-0.84] p=0.02) and significantly worse RFS, CSS, and OS. Patients with secondary MIBC treated with NAC had worse CSS compared with cystectomy alone (p=0.002). In a separate genomic analysis, we detected significantly more likely deleterious somatic ERCC2 missense mutations in primary MIBC tumors in both the discovery (10.9% [36/330] vs 1.8% [1/55], p=0.04) and the validation (15.7% [12/70] vs 0% [0/24], p=0.03) cohort.

CONCLUSIONS

Patients with secondary MIBC treated with NAC had worse clinical outcomes than similarly treated patients with primary MIBC. ERCC2 mutations predicted to result in increased cisplatin sensitivity were enriched in primary versus secondary MIBC. Prospective validation is still needed, but given the lack of clinical benefit with cisplatin-based NAC in patients with secondary MIBC, upfront RC or enrollment in clinical trials should be considered.

PATIENT SUMMARY

A retrospective cohort study of patients with "primary" and "secondary" muscle-invasive bladder cancer (MIBC) treated with chemotherapy before surgical removal of the bladder identified lower response rates and shorter survival in patients with secondary MIBC. Tumor genetic sequencing of separate discovery and validation cohorts revealed that chemotherapy-sensitizing DNA damage repair gene mutations occur predominantly in primary MIBC tumors and may underlie the greater sensitivity of primary MIBC to chemotherapy. Prospective validation is still needed, but patients with secondary MIBC may derive greater benefit from upfront surgery or enrollment in clinical trials rather than from standard chemotherapy.

Brief assessment of schizotypal traits: A multinational study

The Schizotypal Personality Questionnaire-Brief (SPQ-B) was developed with the aim of examining variations in healthy trait schizotypy, as well as latent vulnerability to psychotic-spectrum disorders. No previous study has studied the cross-cultural validity of the SPQ-B in a large cross-national sample. The main goal of the present study was to analyze the reliability and the internal structure of SPQ-B scores in a multinational sample of 28,426 participants recruited from 14 countries. The mean age was 22.63years (SD=7.08; range 16-68years), 37.7% (n=10,711) were men. The omega coefficients were high, ranging from 0.86 to 0.92 for the total sample. Confirmatory factor analysis revealed that SPQ-B items were grouped either in a theoretical structure of three first-order factors (Cognitive-Perceptual, Interpersonal, and Disorganized) or in a bifactor model (three first-order factors plus a general factor of schizotypal personality). In addition, the results supported configural but not strong measurement invariance of SPQ-B scores across samples. These findings provide new information about the factor structure of schizotypal personality, and support the validity and utility of the SPQ-B, a brief and easy tool for assessing self-reported schizotypal traits, in cross-national research. Theoretical and clinical implications for diagnostic systems, psychosis models, and cross-national mental health strategies are derived from these results.

Factor structure and psychometric properties of a Romanian translation of the drive for Muscularity Scale (DMS) in university men

We examined the psychometric properties of a Romanian translation of the 15-item Drive for Muscularity Scale (DMS). Male university students from Romania (N = 343) completed the DMS, as well as measures of self-esteem, body appreciation, and muscle discrepancy. Exploratory factor analysis indicated that DMS scores reduced to two factors that related to muscularity-oriented attitudes and behaviours, with both first-order factors loading onto a higher-order factor. However, confirmatory factor analysis indicated that a model with two first-order factors and a higher-order factor had poor fit. A two-factor model without a higher-order construct achieved acceptable but mediocre fit. Scores on the two-factor DMS model had adequate internal consistency and demonstrated acceptable convergent validity (significant correlations with self-esteem, body appreciation, and muscle discrepancy). These results provide support for a two-factor model of DMS scores in a Romanian-speaking sample and extends the availability of the DMS to a rarely-examined linguistic group.

Exposure to natural environments, and photographs of natural environments, promotes more positive body image

Five studies were conducted to understand the impact of nature exposure on body image. In three studies using different designs and outcome measures, British university students were exposed to photographs of natural or built environments. Results indicated that exposure to images of natural, but not built, environments resulted in improved state body image. In Study 4, British community participants went on a walk in a natural or built environment, with results indicating that the walk in a natural environment resulted in significantly higher state body appreciation, whereas the walk in a built environment resulted in significantly lower scores. In Study 5, British participants were recruited as they were entering a designed green space on their own volition. Results indicated that spending time in the green space led to improved state body appreciation. These results indicate that exposure to isomorphic or in-situ natural environments has positive effects on state body image.