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I wrote Ruby for years (for fun). I always had to stop and think twice about 'unless' and translate it into 'if not'.

Exactly the same here. I write Ruby for a living and use 'unless' where it makes sense or fits with existing code.

That said, when reading code, I often have to pause and mentally translate "unless" to "if not". This is especially true for more complex logic.

Elegant, yes. Additional mental overhead at times, certainly.