A guide for multilevel modeling of dyadic data with binary outcomes using SAS PROC NLMIXED

Positive and negative emotion are associated with generalized transcriptional activation in immune cells

Alterations in immune system gene expression have been implicated in psychopathology, but it remains unclear whether similar associations occur for intraindividual variations in emotion. The present study examined whether positive emotion and negative emotion were related to expression of pro-inflammatory and antiviral genes in circulating leukocytes from a community sample of 90 adolescents (M_age = 16.3 years, SD = 0.7; 51.1% female). Adolescents reported their positive emotion and negative emotion and provided blood samples twice, five weeks apart. Using a multilevel analytic framework, we found that within-individual increases in positive emotion were associated with reduced expression of both pro-inflammatory and Type I interferon (IFN) response genes, even after adjusting for demographic and biological covariates, and for leukocyte subset abundance. By contrast, increases in negative emotion were related to higher expression of pro-inflammatory and Type I IFN genes. When tested in the same model, only associations with positive emotion emerged as significant, and increases in overall emotional valence were associated with both lower pro-inflammatory and antiviral gene expression. These results are distinct from the previously observed Conserved Transcriptional Response to Adversity (CTRA) gene regulation pattern characterized by reciprocal changes in pro-inflammatory and antiviral gene expression and may reflect alterations in generalized immunologic activation. These findings highlight one biological pathway by which emotion may potentially impact health and physiological function in the context of the immune system, and future studies can investigate whether fostering positive emotion may promote adolescent health through changes in the immune system.

Understanding eating disorder symptoms in same-gender couples: social environmental factors

BACKGROUND

Sexual minority individuals are at disproportionately greater risk for eating disorders, yet little is known about the ways in which factors in the social environment relate to eating disorder symptoms in this population. Utilizing an ecological systems theory framework, we investigated the relative relationships of macro level (i.e., internalization of sociocultural attitudes about appearance) and micro level (i.e., quality of romantic relationship) social environment influences.

METHODS

Men (n = 144) and women (n = 144) in committed same-gender relationships were recruited as a dyad and completed study questionnaires, including multiple measures of eating disorder symptoms. Multilevel models controlling for key variables (e.g., body mass index) were used to examine gender differences, main effects, and interactions.

RESULTS

Men reported greater internalization of sociocultural attitudes and uncontrolled eating. Greater internalization of sociocultural attitudes was related to greater eating pathology across all measures. For men, greater relationship quality was related to less uncontrolled eating.

CONCLUSIONS

Individuals in same-gender relationships experience macro (e.g., sociocultural) level vulnerability factors in relation to disordered eating; however, internalization of sociocultural attitudes may be greater for men. Support at the microsystem level in the form of a high quality committed romantic relationship appears to be helpful protection against uncontrolled eating for men.

Predictors of neurological outcome after out-of-hospital cardiac arrest: sex-based analysis: do males derive greater benefit from hypothermia management than females?

Background

Previous studies of the effect of sex on after out-of-hospital cardiac arrest (OHCA) outcomes focused on survival to hospital discharge and 1-month survival. Studies on the effect of sex on neurological function after OHCA are still limited. The objective of this study was to identify the predictors of favorable neurological outcome and to examine the association between sex as a biological variable and favorable neurological outcome OHCA.

Methods

Retrospective analyses of clustered data from the Resuscitation Outcomes Consortium multi-center randomized controlled trial (2011–2015). We included adults with non-traumatic OHCA and EMS-attended OHCA. We used multilevel logistic regression to examine the association between sex and favorable neurological outcomes (modified Rankin Scale) and to identify the predictors of favorable neurological outcome.

Results

In total, 22,416 patients were included. Of those, 8109 (36.2%) were females. The multilevel analysis identified the following variables as significant predictors of favorable neurological outcome: younger age, shorter duration of EMS arrival to the scene, arrest in public location, witnessed arrest, bystander CPR, chest compression rate (CCR) of 100–120 compressions per minute, induction of hypothermia, and initial shockable rhythm. Two variables, insertion of an advanced airway and administration of epinephrine, were associated with poor neurological outcome. Our analysis showed that males have higher crude rates of survival with favorable neurological outcome (8.6 vs. 4.9%, p < 0.001). However, the adjusted rate was not significant. Further analyses showed that hypothermia had a significantly greater effect on males than females.

Conclusions

Males had significantly higher crude rates of survival with favorable neurological outcome. However, the adjusted rate was not statistically significant. Males derived significantly greater benefit from hypothermia management than females, but this can possibly be explained by differences in arrest characteristics or in-hospital treatment. In-depth confirmatory studies on the hypothermia effect size by sex are required.

Multilevel Hidden Markov Models for Behavioral Data: A Hawk-and-Dove Experiment

Motivated by the analysis of behavioral data taken from an economic experiment based on the Hawk-and-Dove game, this article describes a multilevel hidden Markov model, that includes covariates, autoregression, and endogenous initial conditions under a unified framework. The data at hand are affected by multiple sources of latent heterogeneity, due to multilevel unobserved factors that operate in conjunction with observed covariates at all the levels of the data hierarchy. We fit a multilevel logistic regression model for repeated measurements of player behaviors, nested within groups of interacting players. The model integrates discrete random effects at the group level and Markovian sequences of discrete random effects at the player level. Parameters are estimated by a computationally feasible expectation-maximization algorithm. We model the probability of playing the Hawk strategy, which implies fighting aggressively for controlling an asset, and test the role played by initial possession, property, and other player-specific characteristics in driving hawkish behaviors. The results from our study suggest that crucial factors in determining hawkish behavior are both the way possession is achieved - which depends on our treatment manipulation- and possession itself. Furthermore, a clear time-dependence is observed in the data at the player level as accounted for by the Markovian random effects.

Contingency management and cognitive behavior therapy for smoking cessation among veterans with posttraumatic stress disorder: Design and methodology of a randomized clinical trial

BACKGROUND

Smoking is a prevalent concern among Veterans, especially those with posttraumatic stress disorder (PTSD). Despite the availability of interventions for smoking cessation, these treatments have not been as effective among Veteran populations, particularly Veterans with PTSD. The present study seeks to describe the methods of a randomized clinical trial examining the efficacy of CPT-SMART, a multidimensional treatment combining cognitive processing therapy (CPT) for PTSD, smoking cessation counseling, pharmacotherapy, and contingency management (CM) compared to a yoked comparison group.

METHODS

One hundred twenty Veterans with PTSD who smoke cigarettes will be enrolled. All participants will receive CPT in addition to counseling and pharmacotherapy for smoking cessation. Participants will be randomized to the CPT-SMART condition, which includes monetary reinforcement that is contingent on bioverification of smoking abstinence (i.e., contingency management), or a yoked comparison with monetary reinforcement matched to the participant to whom they are yoked. The primary outcome is bioverified smoking abstinence at the 6-month follow-up appointment.

CONCLUSION

If shown efficacious, a combined PTSD and smoking treatment plus incentive-based approach for smoking could be implemented into specialty PTSD programs. The positive public health impact of reducing smoking among Veterans with PTSD could be enormous as it would prevent significant smoking-related morbidity and mortality.

Couples-focused intervention to improve engagement in HIV care: protocol for a randomised controlled trial

INTRODUCTION

Advances in HIV treatment have proven to be effective in increasing virological suppression, thereby decreasing morbidity, and increasing survival. Medication adherence is an important factor in reducing viral load among people living with HIV (PLWH) and in the elimination of transmission of HIV to uninfected partners. Achieving optimal medication adherence involves individuals taking their medications every day or as prescribed by their provider. However, not all PLWH in the USA are engaged in care, and only a minority have achieved suppressed viral load (viral load that is lower than the detectable limit of the assay). Sexual and gender minorities (SGM; those who do not identify as heterosexual or those who do not identify as the sex they were assigned at birth) represent a high-risk population for poor clinical outcomes and increased risk of HIV transmission, as they face barriers that can prevent optimal engagement in HIV care. Research in dyadic support, specifically within primary romantic partnerships, offers a promising avenue to improving engagement in care and treatment outcomes among SGM couples. Dyadic interventions, especially focused on primary romantic partnerships, have the potential to have a sustained impact after the structured intervention ends.

METHODS AND ANALYSIS

This paper describes the protocol for a randomised control trial of a theory-grounded, piloted intervention (DuoPACT) that cultivates and leverages the inherent sources of support within primary romantic relationships to improve engagement in HIV care and thus clinical outcomes among persons who are living with HIV and who identify as SGM (or their partners). Eligible participants must report being in a primary romantic relationship for at least 3 months, speak English, at least one partner must identify as a sexual or gender minority and at least one partner must be HIV+ with suboptimal engagement in HIV care, defined as less than excellent medication adherence, having not seen a provider in at least the past 8 months, having a detectable or unknown viral load or not currently on antiretroviral therapy. Eligible consenting couples are allocated equally to the two study arms: a structured six-session couples counselling intervention (DuoPACT) or a three-session individually-delivered HIV adherence counselling intervention (LifeSteps). The primary aim is to evaluate the efficacy of DuoPACT on virological suppression among HIV+ members of SGM couples with suboptimal engagement in care. The DuoPACT study began its target enrolment of 150 couples (300 individuals) in August 2017, and will continue to enrol until June 2021.

ETHICS AND DISSEMINATION

All procedures are approved by the Institutional Review Board at the University of California, San Francisco. Written informed consent is obtained from all participants at enrolment, and study progress is reviewed twice yearly by an external Safety Monitoring Committee. Dissemination activities will include formal publications and report back sessions with the community.

TRIAL REGISTRATION NUMBER

NCT02925949; Pre-results.

Facial expressions contribute more than body movements to conversational outcomes in avatar-mediated virtual environments

This study focuses on the individual and joint contributions of two nonverbal channels (i.e., face and upper body) in avatar mediated-virtual environments. 140 dyads were randomly assigned to communicate with each other via platforms that differentially activated or deactivated facial and bodily nonverbal cues. The availability of facial expressions had a positive effect on interpersonal outcomes. More specifically, dyads that were able to see their partner’s facial movements mapped onto their avatars liked each other more, formed more accurate impressions about their partners, and described their interaction experiences more positively compared to those unable to see facial movements. However, the latter was only true when their partner’s bodily gestures were also available and not when only facial movements were available. Dyads showed greater nonverbal synchrony when they could see their partner’s bodily and facial movements. This study also employed machine learning to explore whether nonverbal cues could predict interpersonal attraction. These classifiers predicted high and low interpersonal attraction at an accuracy rate of 65%. These findings highlight the relative significance of facial cues compared to bodily cues on interpersonal outcomes in virtual environments and lend insight into the potential of automatically tracked nonverbal cues to predict interpersonal attitudes.

Nonprofessional Peer Support to Improve Mental Health: Randomized Trial of a Scalable Web-Based Peer Counseling Course

BACKGROUND

Millions of people worldwide are underserved by the mental health care system. Indeed, most mental health problems go untreated, often because of resource constraints (eg, limited provider availability and cost) or lack of interest or faith in professional help. Furthermore, subclinical symptoms and chronic stress in the absence of a mental illness diagnosis often go unaddressed, despite their substantial health impact. Innovative and scalable treatment delivery methods are needed to supplement traditional therapies to fill these gaps in the mental health care system.

OBJECTIVE

This study aims to investigate whether a self-guided web-based course can teach pairs of nonprofessional peers to deliver psychological support to each other.

METHODS

In this experimental study, a community sample of 30 dyads (60 participants, mostly friends), many of whom presented with mild to moderate psychological distress, were recruited to complete a web-based counseling skills course. Dyads were randomized to either immediate or delayed access to training. Before and after training, dyads were recorded taking turns discussing stressors. Participants' skills in the helper role were assessed before and after taking the course: the first author and a team of trained research assistants coded recordings for the presence of specific counseling behaviors. When in the client role, participants rated the session on helpfulness in resolving their stressors and supportiveness of their peers. We hypothesized that participants would increase the use of skills taught by the course and decrease the use of skills discouraged by the course, would increase their overall adherence to the guidelines taught in the course, and would perceive posttraining counseling sessions as more helpful and their peers as more supportive.

RESULTS

The course had large effects on most helper-role speech behaviors: helpers decreased total speaking time, used more restatements, made fewer efforts to influence the speaker, and decreased self-focused and off-topic utterances (ds=0.8-1.6). When rating the portion of the session in which they served as clients, participants indicated that they made more progress in addressing their stressors during posttraining counseling sessions compared with pretraining sessions (d=1.1), but they did not report substantive changes in feelings of closeness and supportiveness of their peers (d=0.3).

CONCLUSIONS

The results provide proof of concept that nonprofessionals can learn basic counseling skills from a scalable web-based course. The course serves as a promising model for the development of web-based counseling skills training, which could provide accessible mental health support to some of those underserved by traditional psychotherapy.

Association between job-related stress and experience of presenteeism among Korean workers stratified on the presence of depression

Background

Presenteeism refers to the phenomenon of working while sick. Its development can be attributed to not only somatic symptoms but also underlying social agreements and workplace atmosphere. In this study, we analyzed presenteeism among workers from various industries, focusing on job-related stress with stratification on the presence of depression.

Methods

We conducted the study with data from questionnaires filled in by different enterprises enrolled in the Federation of Korean Trade Unions. Workers' depressive symptoms were investigated using the Patient Health Questionnaire-2, while questions on job-related stress and presenteeism were derived from the short form of the Korean Occupational Stress Scale and the official Korean version of the Work-Productivity and Activity Impairment Questionnaire-General Health, respectively. Multilevel logistic analysis was conducted to determine the statistical differences derived from the differences between companies.

Results

In total, 930 participants (753 men and 177 women) from 59 enterprises participated in the research. We conducted multilevel logistic regression to determine the association between the variables and presenteeism, with stratification by the presence of depression. Higher job demands and higher interpersonal conflict showed significantly elevated odds ratios (ORs) in univariate models and in the multivariate multilevel model. In the final model of total population, fully adjusted by general and work-related characteristics, higher job demands (OR: 3.29, 95% confidence interval [CI]: 2.08-5.21) and interpersonal conflict (OR: 1.87, 95% CI: 1.29-2.71) had significantly higher ORs-a tendency that remained in participants without depression.

Conclusions

This study reflected the factors associated with presenteeism among workers from various enterprises. The findings revealed that job-related stress was closely related to presenteeism in both the total population and in the population without depression. Thus, it emphasized interventions for managing job stress among workers to reduce presenteeism in general workers' population.

A New Multilevel CART Algorithm for Multilevel Data with Binary Outcomes

The multilevel logistic regression model (M-logit) is the standard model for modeling multilevel data with binary outcomes. However, many assumptions and restrictions should be considered when applying this model for unbiased estimation. To overcome these limitations, we proposed a multilevel CART (M-CART) algorithm which combines the M-logit and single level CART (S-CART) within the framework of the expectation-maximization. Simulation results showed that the proposed M-CART provided substantial improvements on classification accuracy, sensitivity, and specific over the M-logit, S-CART, and single level logistic regression model when modeling multilevel data with binary outcomes. This benefit of using M-CART was consistently found across different conditions of sample size, intra-class correlation, and when relationships between predictors and outcomes were nonlinear and nonadditive.

Social interaction in augmented reality

There have been decades of research on the usability and educational value of augmented reality. However, less is known about how augmented reality affects social interactions. The current paper presents three studies that test the social psychological effects of augmented reality. Study 1 examined participants' task performance in the presence of embodied agents and replicated the typical pattern of social facilitation and inhibition. Participants performed a simple task better, but a hard task worse, in the presence of an agent compared to when participants complete the tasks alone. Study 2 examined nonverbal behavior. Participants met an agent sitting in one of two chairs and were asked to choose one of the chairs to sit on. Participants wearing the headset never sat directly on the agent when given the choice of two seats, and while approaching, most of the participants chose the rotation direction to avoid turning their heads away from the agent. A separate group of participants chose a seat after removing the augmented reality headset, and the majority still avoided the seat previously occupied by the agent. Study 3 examined the social costs of using an augmented reality headset with others who are not using a headset. Participants talked in dyads, and augmented reality users reported less social connection to their partner compared to those not using augmented reality. Overall, these studies provide evidence suggesting that task performance, nonverbal behavior, and social connectedness are significantly affected by the presence or absence of virtual content.

The Impact of Quality Assurance Initiatives and Workplace Policies and Procedures on HIV/AIDS-Related Stigma Experienced by Patients and Nurses in Regions with High Prevalence of HIV/AIDS

Stigma is commonly experienced by people living with HIV/AIDS and by those providing care to HIV/AIDS patients. Few intervention studies have explored the impact of workplace policies and/or quality improvement on stigma. We examine the contribution of health care workplace policies, procedures and quality assurance initiatives, and self- and peer-assessed individual nurse practices, to nurse-reported HIV/AIDS-stigma practices toward patients living with HIV/AIDS and nurses in health care settings. Our sample of survey respondents (n = 1157) included managers (n = 392) and registered/enrolled nurses (n = 765) from 29 facilities in 4 countries (South Africa, Uganda, Jamaica, Kenya). This is one of the first studies in LMIC countries to use hierarchical linear modeling to examine the contributions of organizational and individual factors to HIV/AIDS stigma. Based on our results, we argue that organizational interventions explicitly targeting HIV/AIDS stigma are required to reduce the incidence, prevalence and morbidity of HIV/AIDS.

I remember emotional content better, but I'm struggling to remember who said it!

The joint impact of emotion and production on conversational memory was examined in two experiments where pairs of participants took turns producing verbal information. They were instructed to produce out loud sentences based on either neutral or emotional (Experiment 1: negative; Experiment 2: positive) words. Each participant was then asked to recall as many words as possible (content memory) and to indicate who had produced each word (reality monitoring). The analyses showed that both self-production and emotion boost content memory, although emotion also impairs reality monitoring. This study sheds light on how both factors (emotion and production) may constrain language interaction memory through information saliency.

Syringe Sharing in Drug Injecting Dyads: A Cross-Classified Multilevel Analysis of Social Networks

We examined the association of dyadic-level factors with syringe sharing among people who inject drugs (PWID) in Kerman, Iran. In a cross-sectional study, we collected data on 329 drug-injecting dyads by individual face-to-face interviews. An injecting dyad was defined as 2 PWID who knew each other and injected drugs together during the last 6 months. If they reported at least 1 occasion of syringe sharing, the dyad was considered high-risk. Dyadic-level factors associated with syringe sharing were assessed using cross-classified multilevel logistic regression. The rate of syringe sharing was significantly higher for dyads who were more intimate (adjusted odds ratio [AOR] 4.5, CI 95%, 2.3-8.6), who had instrumental support (AOR 2.1, 95% CI 1.1-4.5), and who pooled money for drugs (AOR 4.1, 95% CI 2.0-8.3). The rate was lower in same-sex dyads (AOR 0.4, 95% CI 0.2-0.9) and in dyads who shared health information (AOR 0.5, 95% CI 0.2-0.9). Findings highlight close-peer influences on syringe-sharing behavior.

[Approach to the Development of Mind and Persona]

OBJECTIVES

To access medical specialists by health specialists working in the regional health field, the possibility of utilizing the voice approach for dissociative identity disorder (DID) patients as a health assessment for medical access (HAMA) was investigated. The first step is to investigate whether the plural personae in a single DID patient can be discriminated by voice analysis.

METHODS

Voices of DID patients including these with different personae were extracted from YouTube and were analysed using the software PRAAT with basic frequency, oral factors, chin factors and tongue factors. In addition, RAKUGO story teller voices made artificially and dramatically were analysed in the same manner. Quantitive and qualitative analysis method were carried out and nested logistic regression and a nested generalized linear model was developed.

RESULTS

The voice from different personae in one DID patient could be visually and easily distinquished using basic frequency curve, cluster analysis and factor analysis. In the canonical analysis, only Roy's maximum root was <0.01. In the nested generalized linear model, the model using a standard deviation (SD) indicator fit best and some other possibilities are shown here.

CONCLUSIONS

In DID patients, the short transition time among plural personae could guide to the risky situation such as suicide. So if the voice approach can show the time threshold of changes between the different personae, it would be useful as an Access Assessment in the form of a simple HAMA.

Post-migration employment changes and health: A dyadic spousal analysis

Prospective studies have found unemployment and job loss to be associated with negative psychological and physical health outcomes. For immigrants, the health implications of employment change cannot be considered apart from pre-migration experiences. While immigrants demonstrate relative success in securing employment in the United States, their work is often not commensurate with their education or expertise. Previous research has linked downward employment with adverse health outcomes among immigrants, but with gender differences. We extended this literature by considering a wider range of employment states and accounting for the interdependence of husbands' and wives' employment trajectories. We examined the relationships between personal and spousal post-migration employment changes and self-rated health and depressive symptoms using dyadic data from the 2003 New Immigrant Survey (NIS) (n = 5682 individuals/2841 spousal pairs). We used the Actor Partner Interdependence Model (APIM) to model cross-partner effects and account for spousal interdependence. In general, men's downward employment trajectories were associated with poorer health for themselves. Women's employment trajectories had fewer statistically significant associations with their own or their husbands' health, underscoring the generally more peripheral nature of women's work in the household. However, women's current unemployment in particular was associated with poorer health outcomes for themselves and their husbands, suggesting that unmet need for women's work can produce health risks within immigrant households. Our findings suggest that employment change should be considered a household event that can impact the wellbeing of linked individuals within.

The crossover effect of spouses' long working hours on depressive symptoms and suicidal ideation

To examine the association between spouses' weekly working hours (SWWH) and psychological symptoms such as depressive symptom and suicidal ideation. We used data from the fourth and fifth Korean National Health and Nutrition Examination Survey (2007-2012). We collected information about general characteristics, depressive symptoms, suicidal ideation, and working hours. After inclusion and exclusion criteria were applied, a sample of 8,056 house units was used for analysis. A multiple logistic regression was conducted to investigate the association between SWWH and depressive symptoms, as well as suicidal ideation, to estimate the odds ratio (OR). The relationship between SWWH and psychological symptoms were linear in husbands, and J-shaped in wives. ORs for husbands' depressive symptoms and suicidal ideation increased according to increase in SWWH (p-values for trend were 0.0045 and <0.001, respectively). Crude ORs for wives' depressive symptoms and suicidal ideation decreased until SWWH of 40 to 49 hours, but increased after SWWH of 40 to 49 hours (all p-values were below 0.01). Similar trends were observed after adjustment for age, obesity, household income, and one's own weekly working hours, up to 1.33 and 1.57 in husbands, and 1.29 and 1.32 in wives, respectively. SWWH is negatively associated with mental health.

Let the Avatar Brighten Your Smile: Effects of Enhancing Facial Expressions in Virtual Environments

Previous studies demonstrated the positive effects of smiling on interpersonal outcomes. The present research examined if enhancing one's smile in a virtual environment could lead to a more positive communication experience. In the current study, participants' facial expressions were tracked and mapped on a digital avatar during a real-time dyadic conversation. The avatar's smile was rendered such that it was either a slightly enhanced version or a veridical version of the participant's actual smile. Linguistic analyses using the Linguistic Inquiry Word Count (LIWC) revealed that participants who communicated with each other via avatars that exhibited enhanced smiles used more positive words to describe their interaction experience compared to those who communicated via avatars that displayed smiling behavior reflecting the participants' actual smiles. In addition, self-report measures showed that participants in the 'enhanced smile' condition felt more positive affect after the conversation and experienced stronger social presence compared to the 'normal smile' condition. These results are particularly striking when considering the fact that most participants (>90%) were unable to detect the smiling manipulation. This is the first study to demonstrate the positive effects of transforming unacquainted individuals' actual smiling behavior during a real-time avatar-networked conversation.

Generating References in Naturalistic Face-to-Face and Phone-Mediated Dialog Settings

During dialog, references are presented, accepted, and potentially reused (depending on their accessibility in memory). Two experiments were conducted to examine reuse in a naturalistic setting (a walk in a familiar environment). In Experiment 1, where the participants interacted face to face, self-presented references and references accepted through verbatim repetition were reused more. Such biases persisted after the end of the interaction. In Experiment 2, where the participants interacted over the phone, reference reuse mainly depended on whether the participant could see the landmarks being referred to, although this bias seemed to be only transient. Consistent with the memory-based approach to dialog, these results shed light on how differences in accessibility in memory (due to how these references were initially added to the common ground or the media used) affect the unfolding of the interaction.

BRAF Mutation Is Associated with Improved Local Control of Melanoma Brain Metastases Treated with Gamma Knife Radiosurgery

OBJECTIVES

Evidence has implicated a possible role of tumor mutation status on local control (LC) with radiotherapy. BRAF is a proto-oncogene that is mutated in approximately 50% of patients with melanoma. We sought to analyze the influence of BRAF status on LC of melanoma brain metastases (MBM) following Gamma Knife radiosurgery (GK).

METHODS

Among 125 patients treated with GK for MBM at our institution between 2006 and 2015, we identified 19 patients with 69 evaluable metastases whose BRAF mutation status was known and follow-up imaging was available. LC of individual metastases was compared based on BRAF mutation status using statistical techniques to control for measurements of multiple metastases within each patient. CNS progression was defined as either local failure or development of new lesions.

RESULTS

Of the 69 metastases, BRAF was mutated in 30 and wild-type in 39. With a median follow-up of 30 months for all patients and a median follow-up of 5.5 months for treated lesions, 1-year LC was significantly better among metastases with mutated vs. wild-type BRAF (69 vs. 34%, RR = 0.3, 95% CI = 0.1-0.7, p = 0.01). BRAF mutation was found to be a significant predictor of LC after stereotactic radiosurgery (SRS) in both univariate [RR = 0.3 (95% CI 0.1-0.7, p = 0.01)] and multivariate [RR = 0.2 (95% CI 0.1-0.7, p = 0.01)] analyses. There was also a trend toward improved CNS progression free survival (PFS) at 1 year (26 vs. 0%, p = 0.06), favoring BRAF-mutated patients.

CONCLUSION

In this retrospective study, MBM treated with GK had significantly improved LC for patients with BRAF mutation vs. wild-type. Our data suggest that BRAF mutation may sensitize tumors to radiosurgery, and that BRAF wild-type tumors may be more radioresistant.

Expectations of barriers to psychosocial care: views of parents and adolescents in the community

Parents with a child suffering from psychosocial problems frequently experience barriers to psychosocial care, which may hinder access. Expectations of barriers may have the same effect, but evidence is lacking. The aim of this study is to examine parents' and adolescents' expectations of barriers regarding psychosocial care for the child, along with associated child and family characteristics. We obtained data on an age-stratified random sample of school children/pupils aged 4-18 via questionnaires (N = 666; response rate 70.3 %). Expectations of barriers to psychosocial care were measured with the "Barriers to Treatment Participation Scale-Expectancies" questionnaire (BTPS-exp). Results showed that 64 % of the parents of children below age 12, 59 % of the parents of adolescents (age 12-18), and 84 % of the adolescents expected one or more barriers. Parents and adolescents expected barriers most frequently with respect to irrelevance of treatment. Mainly parents with low educational level and their adolescents expected barriers regarding treatment, and quite a few characteristics of parents of adolescents were associated with expecting multiple barriers regarding treatment demands and issues, for example, single parents, parents of lower educational level and of adolescent boys, and parents of adolescents with psychosocial problems. We conclude that adolescents especially, but also their parents and parents of younger children, expect major barriers to psychosocial care, which may greatly hinder appropriate care seeking. This evidence may support professionals and policymakers in their attempts to improve access to psychosocial care.

Individual and Partner Correlates of Sexual Satisfaction and Relationship Happiness in Midlife Couples: Dyadic Analysis of the International Survey of Relationships

The current research reports a dyadic analysis of sexual satisfaction, relationship happiness, and correlates of these couple outcomes in a large multinational dataset consisting of 1,009 midlife heterosexual couples (2,018 individuals) recruited in Japan, Brazil, Germany, Spain, and the United States (Heiman et al., 2011). Actor-Partner Interdependence Models (Kenny, Kashy, & Cook, 2006) identified correlates of sexual satisfaction that included individuals' reports of good health; frequent kissing, cuddling, and caressing; frequent recent sexual activity; attaching importance to one's own and one's partner's orgasm; better sexual functioning; and greater relationship happiness. Even after controlling for individual-level effects, partners' reports of good health; frequent kissing, cuddling, and caressing; frequent recent sexual activity; attaching importance to one's own and one's partner's orgasm; better sexual functioning; and greater relationship happiness contributed significantly to predicting and understanding individuals' sexual satisfaction. Correlates of relationship happiness included individuals' reports of good health; frequent kissing, cuddling, and caressing; frequent recent sexual activity; attaching importance to one's own and one's partner's orgasm; better sexual functioning; and greater sexual satisfaction, and once again, even after controlling for individual-level effects, partners' reports of each of these correlates contributed significantly to predicting and understanding individuals' relationship happiness. Interactions of individual and partner effects with participant gender are also reported. Current results demonstrate empirically that the partner "matters" to an individual's sexual satisfaction and relationship happiness and indicate that a comprehensive understanding of factors contributing to these couple outcomes requires a couple-level research strategy. Partner effects, even when controlling for individual effects, were consistently observed, and explanation of sexual satisfaction and relationship happiness always depended on identifying and understanding mutual and concurrent individual and partner influences.

STI/HIV test result disclosure between female sex workers and their primary, non-commercial male partners in two Mexico-US border cities: a prospective study

OBJECTIVES

Disclosure of sexually transmitted infections (STI)/HIV diagnoses to sexual partners is not mandated by public health guidelines in Mexico. To assess the feasibility of couples-based STI/HIV testing with facilitated disclosure as a risk-reduction strategy within female sex workers' (FSW) primary partnerships, we examined STI/HIV test result disclosure patterns between FSWs and their primary, non-commercial male partners in two Mexico-US border cities.

METHODS

From 2010 to 2013, 335 participants (181 FSWs and 154 primary male partners) were followed for 24 months. At semiannual visits, participants were tested for STIs/HIV and reported on their disclosure of test results from the previous visit. Multilevel logistic regression was used to identify individual-level and partnership-level predictors of cumulative (1) non-disclosure of ≥1 STI test result and (2) non-disclosure of ≥1 HIV test result within couples during follow-up.

RESULTS

Eighty-seven percent of participants reported disclosing all STI/HIV test results to their primary partners. Non-disclosure of ≥1 STI test result was more common among participants who reported an STI diagnosis as part of the study (adjusted OR=3.05, 95% CI 1.13 to 8.25), while non-disclosure of ≥1 HIV test result was more common among participants in longer-duration partnerships (AOR=1.15 per year, 95% CI 1.03 to 1.28). Drug use before/during sex within partnerships was associated with non-disclosure of both STI (AOR=5.06, 95% CI 1.64 to 15.62) and HIV (AOR=4.51, 95% CI: 1.32 to 15.39) test results.

CONCLUSIONS

STI/HIV test result disclosure was highly prevalent within FSWs' primary partnerships, suggesting couples-based STI/HIV testing with facilitated disclosure may be feasible for these and potentially other high-risk, socially marginalised couples.

Clinical risk factor analysis for breast cancer: 568,000 subjects undergoing breast cancer screening in Beijing, 2009

OBJECTIVES

Although there are many reports about the risk of breast cancer, few have reported clinical factors including history of breast-related or other diseases that affect the prevalence of breast cancer. This study explores these risk factors for breast cancer cases reported in Beijing in 2009.

MATERIALS AND METHODS

Data were derived from a Beijing breast cancer screening performed in 2009, of 568,000 women, from 16 districts of Beijing, all aged between 40 and 60 years. In this study, multilevel statistical modeling was used to identify clinical factors that affect the prevalence of breast cancer and to provide more reliable evidence for clinical diagnostics by using screening data.

RESULTS AND CONCLUSION

Those women who had organ transplants, compared with those with none, were associated with breast cancer with an odds ratio (OR) = 65.352 [95% confidence interval (CI): 8.488-503.165] and those with solid breast mass compared with none had OR = 1.384 (95% CI: 1.022- 1.873). Malignant tendency was strongly associated with increased risk of breast cancer, OR = 207.999(95% CI: 151.950-284.721). The risk of breast cancer increased with age, OR1 = 2.759 (95% CI: 1.837-4.144, 56-60 vs. 40-45), OR2 = 2.047 (95% CI: 1.394-3.077, 51-55 vs. 40-45), OR3 = 1.668 (95% CI: 1.145-2.431). Normal results of B ultrasonic examination show a lower risk among participants, OR= 0.136 (95% CI: 0.085-0.218). Those women with ductal papilloma compared with none were associated with breast cancer, OR=6.524 (95% CI: 1.871-22.746). Therefore, this study suggests that clinical doctors should pay attention to these high-risk factors.

Actor-partner effects associated with experiencing intimate partner violence or coercion among male couples enrolled in an HIV prevention trial

Background

Intimate partner violence (IPV) and coercion have been associated with negative health outcomes, including increased HIV risk behaviors, among men who have sex with men (MSM). This is the first study to describe the prevalence and factors associated with experiencing IPV or coercion among US MSM dyads using the actor-partner interdependence model (APIM), an analytic framework to describe interdependent outcomes within dyads.

Methods

Among MSM couples enrolled as dyads in an HIV prevention randomized controlled trial (RCT), two outcomes are examined in this cross-sectional analysis: 1) the actor experiencing physical or sexual IPV from the study partner in the past 3-months and 2) the actor feeling coerced to participate in the RCT by the study partner. Two multilevel APIM logistic regression models evaluated the association between each outcome and actor, partner, and dyad-level factors.

Results

Of 190 individuals (95 MSM couples), 14 reported experiencing physical or sexual IPV from their study partner in the past 3 months (7.3%) and 12 reported feeling coerced to participate in the RCT by their study partner (6.3%). Results of multivariate APIM analyses indicated that reporting experienced IPV was associated (p < 0.1) with non-Black/African American actor race, lower actor education, and lower partner education. Reporting experienced coercion was associated (p < 0.1) with younger actor age and lower partner education.

Conclusions

These findings from an HIV prevention RCT for MSM show considerable levels of IPV experienced in the past 3-months and coercion to participate in the research study, indicating the need for screening tools and support services for these behaviors. The identification of factors associated with IPV and coercion demonstrate the importance of considering actor and partner effects, as well as dyadic-level effects, to improve development of screening tools and support services for these outcomes.

Sexual Transmission of Hepatitis C Virus Between HIV Infected Subjects and Their Main Heterosexual Partners

BACKGROUND

Overall, 60-70% of the hepatitis c virus (HCV) transmission routes is parenteral, and in 30-40% of the cases is unknown (e.g. sexual route). Knowing these routes in HIV infected dyads is very important due to clinical and methodological reasons.

OBJECTIVES

The present study aimed to identify and quantitatively investigate HIV-infected individuals and their main heterosexual partners regarding the risk factors of HCV transmission.

PATIENTS AND METHODS

One hundred sixty eight of 984 couples were chosen through random generated numbers using a computer program from behavioral consultation center in Shiraz, Iran. We used actor partner independent model (APIM) and multilevel analysis to assess multiple risk factors for HCV, while partitioning the source of risk at the individual and couple levels.

RESULTS

Age of the index samples was 38.71 ± 7 years, and 33.2 ± 6.3 for their main heterosexual partners; the mean duration of sexual relationship for couples was 11.9 (median = 8.5) years. Multivariate analysis showed that actor risk factor of intravenous drug using (IDU) (AOR= 13.03; 95% CI: 3.9- 43.82) and actor cofactors of HIV positivity (AOR = 7.1; 95% CI: 1.37- 36.97), razor sharing (AOR = 4.81; 95% CI: 1.84- 12.55), sex (AOR = 8.83; 95% CI: 3.16- 24.87), and condom use in sexual activity with main partner (AOR = 0.15; 95% CI: 0.02- 0.44) were associated with actor HCV positivity.

CONCLUSIONS

Health care providers need to pay special attention to sexual transmission of HCV among HIV-infected individuals, and should recommend control/preventive measures for HCV sexual transmission.

Actor-partner effects of demographic and relationship factors associated with HIV risk within gay male couples

Recent research has investigated the association of relationship factors and dynamics with sexual behaviors and HIV risk among gay male couples. However, few studies with gay male couples have used the Actor-Partner Interdependence Model framework to examine whether factors influence an individual and his partner's sexual risk behaviors. None of these studies analyzed whether relationship factors had influenced the sexual risk behaviors of both partners within the couple. Our cross-sectional study used dyadic data from 142 gay male couples to assess actor-partner effects of relationship commitment, trust, and investment in one's sexual agreement for HIV risk. Multilevel modeling was used to examine which actor-partner effects of these factors were predictive of individuals and their partners having had UAI within and outside the relationship. Results indicated that participants' likelihood of having had UAI within and outside of the relationship significantly decreased with: (1) actor effects of value in and commitment to a sexual agreement, and quality of alternatives to the relationship and (2) partner effects of participant's age, dependability of trust, quality of alternatives to the relationship, and investment of relationship commitment. No significant actor-partner effects were detected for having had UAI within the relationship. Our findings suggest that future HIV prevention strategies should take into account how relationship factors influence an individual and his main partners' sexual risk behaviors and in turn, the couple's risk for HIV. However, more research is needed to examine how actor-partner effects of relationship factors influence a variety of sexual risk behaviors within gay male couples.

Agreement between aging parent's bequest intention and middle-aged child's inheritance expectation

PURPOSE

This study investigated discrepancies in expectations of aging parents and their middle-aged offspring regarding future inheritances.

METHODS

Data from 327 older parent-adult child dyads were analyzed. Using multilevel models, we examined factors (e.g., economic resources, family characteristics, current support exchanges, and beliefs about family obligation) associated with expectations of inheritance. We also explored patterns of correspondence in expectations over inheritance within dyads and what factors are associated with these patterns.

RESULTS

We found a significant generational difference in expectations of inheritance, with children less likely to expect inheritances than parents expected to give. Parent's income, number of siblings, and support currently given to children were significantly associated with both parents' and children's positive expectations of inheritance. The effects of child's income, support given to parent, and parent's gender on inheritance expectations differed between parents and children. Compared with discordant dyads (parents intended to leave a bequest, but their child did not expect an inheritance), correspondent dyads (both parents and children expected a bequest) showed higher income of parents and children, more support given to the child, and lower levels of child's filial obligation.

IMPLICATIONS

Although bequest decisions are circumscribed by parent's financial resources, our findings suggest that they are also a continuation of established patterns of exchanges. Parents and children form their intention or expectation about inheritance based on different factors, leaving open the possibility of misunderstandings between the generations.

A multilevel approach for assessing the variability of hepatitis C prevalence in injection drug users by their gathering places

OBJECTIVES

The aim of this study was to investigate the variation in hepatitis C virus (HCV) prevalence in injection drug users (IDUs) by their gathering places, using a multilevel approach.

METHODS

IDUs recruited from their gathering places were invited to respond to a questionnaire on demographics, drug use history, injection behaviors, and methadone treatment. Dried blood spots were collected for HCV antibody testing by ELISA. Factors associated with the anti-HCV test result were explored by linear logistic regression, followed by the evaluation of heterogeneity between gathering places by multilevel analysis.

RESULTS

A total of 622 respondents from 19 gathering places in Hong Kong, recruited between August and September 2011, were evaluated. Anti-HCV seroprevalence was 81.7% (95% confidence interval 78.6-84.7%), ranging from 67% to 100% by gathering place. HCV infection was associated with current practice of injection, needle-sharing, and midazolam injection. On multilevel analysis, there was a modest but significant variation in HCV antibody prevalence by gathering place, adjusted by midazolam injection (adjusted odds ratio (AOR) 3.91) and current injection (AOR 2.88) or injection over a long duration (AOR 3.17).

CONCLUSIONS

There was heterogeneity in HCV antibody prevalence in IDUs by gathering place, while the influence of injection behaviors varied, suggesting interactivity between factors at the individual and group levels.

The impact of dietary folate intake on reproductive function in premenopausal women: a prospective cohort study

Background

Folic acid is recommended to reproductive-aged women to prevent birth defects, though little is known about the effects of dietary intake on other reproductive outcomes. Improved pregnancy rates have been documented after folic acid supplement use, suggesting a possible link with ovulation, however research is limited. Our objective was to evaluate the association between dietary folate intake, hormone levels, and sporadic anovulation in healthy, regularly menstruating women.

Methodology/Principal Findings

The BioCycle study (2005–2007) prospectively followed 259 healthy women aged 18–44 years from the western New York region for up to 2 menstrual cycles. Total folate and specific sources of folate were assessed up to 4 times per cycle by 24-hour recall. Estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone were measured in serum up to 8 times per cycle, timed using fertility monitors. Anovulation was defined as a cycle with peak progesterone concentration ≤5 ng/mL and no LH peak in the mid/late luteal phase. Higher intake of dietary folate (in dietary equivalents) across tertiles had a marginally significant association with greater luteal progesterone levels (P trend 0.08). Higher intake of synthetic folate was significantly associated with higher luteal progesterone levels (P trend 0.05). Specifically, women in the 3^rd tertile of synthetic folate intake had, on average, 16.0% (95% CI, 0.5–33.8%) higher luteal progesterone levels compared to women in the 1^st tertile. Moreover, consumption of synthetic folate was significantly and inversely associated with anovulation such that women in the 3^rd tertile had a 64% (95% CI, 8–86%) decreased odds of anovulation compared to the women in the 1^st tertile (P trend 0.03).

Conclusions/Significance

These findings suggest that a diet high in synthetic folate may be associated with increased progesterone levels and lower risk of sporadic anovulation. Further study of the effect of dietary folate and folic acid supplement use on reproductive health is warranted.

Marriage Expectations Among African American Couples in Early Adulthood: A Dyadic Analysis

Using Family and Community Health Study data consisting of 168 unmarried, primarily African American couples, the current study sought to understand the dyadic interplay among school, work, and partner-specific marriage expectations in early adulthood. Drawing on the economic prospects, adult transitions, and work - family literatures, the authors hypothesized and found ample support that expectations to marry a romantic partner were linked not only to one's own school and work-related experiences but also to those of a partner. These associations held while controlling for relationship satisfaction, general views of marriage, and other covariates that have been posited to explain racial inequalities in relationship and marriage patterns. Furthermore, the authors found that actor covariates of marital expectations differed from partner covariates, a finding that highlights the advantages of dyadic analyses in helping researchers understand marriage as both a developmental and interpersonal process.

Validity for an integrated laboratory analogue of sexual aggression and bystander intervention

This study sought to develop and validate an integrated laboratory paradigm of sexual aggression and bystander intervention. Participants were a diverse community sample (54% African American) of heterosexual males (N = 156) between 21 and 35 years of age who were recruited to complete the study with a male friend and an ostensibly single, heterosexual female who reported a strong dislike of sexual content in the media. Participants viewed a sexually explicit or nonsexually explicit film clip as part of contrived media rating task and made individual choices of which film clip to show the female confederate. Immediately thereafter, participants were required to reach consensus on a group decision of which film clip to show the female confederate. Subjecting a target to an unwanted experience with a sexual connotation was operationalized as selection of the sexually explicit video, whereas successful bystander intervention was operationalized as the event of one partner individually selecting the sexually explicit video but then selecting the nonsexually explicit video for the group choice. Results demonstrated that a 1-year history of sexual aggression and endorsement of pertinent misogynistic attitudes significantly predicted selection of the sexually-explicit video. In addition, bystander efficacy significantly predicted men's successful prevention of their male peer's intent to show the female confederate a sexually explicit video. Discussion focused on how these data inform future research and bystander intervention programming for sexual aggression.

Social support, attachment, and chronic stress as correlates of Latina mother and daughter drug use behaviors

This cross-sectional study examined three social determinants (sociodemographics, chronic stress, and social support) and the quality of attachment among a community-based sample of Latina mother-daughter dyads (N = 158 dyads) to document the relationship between those factors and their respective drug use. Hypotheses were: (a) the quality of mother-daughter attachment will mediate the relationship between their social support and drug use and (b) the effects of mothers' and daughters' chronic stress on their drug use is mediated by their social support which, in turn, is also mediated by the quality of their attachment after taking into account socio-demographic variables. Structural equation modeling was used with dyads as the units of analyses. Our preliminary results show: (a) transgenerational dyadic concordance among the variables, (b) mothers' higher quality of attachment scores mediated the relationship between their chronic stress and social support scores on their lower drug use scores, and (c) daughters' attachment scores mediated the relationship between their social support scores and their lower drug use scores. Limitations are discussed. Our preliminary results provide a useful first step towards understanding the processes linking stress, social support, and attachment with drug use behaviors among Latina mothers and daughters from a culturally relevant and transgenerational perspective.

Rurality and nursing home quality: evidence from the 2004 National Nursing Home Survey

PURPOSE OF THE STUDY

To evaluate the impact of rural geographic location on nursing home quality of care in the United States.

DESIGN AND METHODS

The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used multilevel regression models to predict risk-adjusted rates of hospitalization, influenza and pneumococcal vaccination, and moderate to severe pain while controlling for resident and facility characteristics.

RESULTS

Adjusting for covariates, residents in rural facilities were more likely to experience hospitalization (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.16-1.94) and moderate to severe pain (OR = 1.68, 95% CI = 1.35-2.09). Significant facility-level predictors of higher quality included higher percentage of Medicaid beneficiaries, accreditation status, and special care programs. Medicare payment findings were mixed. Significant resident-level predictors included dementia diagnosis and being a "long-stay" resident.

IMPLICATIONS

Rural residents were more likely to reside in facilities without accreditations or special care programs, factors that increased their odds of receiving poorer quality of care. Policy efforts to enhance Medicare payment approaches as well as increase rural facilities' accreditation status and provision of special care programs will likely reduce quality of care disparities in facilities.

Parents who influence their children to become scientists: effects of gender and parental education

In this paper we report on testing the 'role-model' and 'opportunity-structure' hypotheses about the parents whom scientists mentioned as career influencers. According to the role-model hypothesis, the gender match between scientist and influencer is paramount (for example, women scientists would disproportionately often mention their mothers as career influencers). According to the opportunity-structure hypothesis, the parent's educational level predicts his/her probability of being mentioned as a career influencer (that is, parents with higher educational levels would be more likely to be named). The examination of a sample of American scientists who had received prestigious postdoctoral fellowships resulted in rejecting the role-model hypothesis and corroborating the opportunity-structure hypothesis. There were a few additional findings. First, women scientists were more likely than men scientists to mention parental influencers. Second, fathers were more likely than mothers to be mentioned as influencers. Third, an interaction was found between the scientist's gender and parental education when predicting a parent's nomination as influencer.

Effect of daily fiber intake on reproductive function: the BioCycle Study

BACKGROUND

High-fiber diets have been associated with decreased breast cancer risk, likely mediated by the effect of fiber on lowering circulating estrogen concentrations. The influence of fiber on aspects of reproduction, which include ovulation, has not been well studied in premenopausal women.

OBJECTIVE

The objective was to determine if fiber consumption is associated with hormone concentrations and incident anovulation in healthy, regularly menstruating women.

DESIGN

The BioCycle Study was a prospective cohort study conducted from 2004 to 2006 that followed 250 women aged 18-44 y for 2 cycles. Dietary fiber consumption was assessed < or =4 times/cycle by using 24-h recall. Outcomes included concentrations of estradiol, progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH), which were measured < or =8 times/cycle, and incident anovulation.

RESULTS

Dietary fiber consumption was inversely associated with hormone concentrations (estradiol, progesterone, LH, and FSH; P < 0.05) and positively associated with the risk of anovulation (P = 0.003) by using random-effects models with adjustment for total calories, age, race, and vitamin E intake. Each 5-g/d increase in total fiber intake was associated with a 1.78-fold increased risk (95% CI: 1.11, 2.84) of an anovulatory cycle. The adjusted odds ratio of 5 g fruit fiber/d was 3.05 (95% CI: 1.07, 8.71).

CONCLUSIONS

These findings suggest that a diet high in fiber is significantly associated with decreased hormone concentrations and a higher probability of anovulation. Further study of the effect of fiber on reproductive health and of the effect of these intakes in reproductive-aged women is warranted.

Exploring the interdependence of couples' rest-wake cycles: an actigraphic study

Within western societies, it is commonplace for couples to share a bed. Yet there has been remarkably little research carried out on couples' sleep. This paper draws upon actigraphy, audio diary, and questionnaire data from both partners of 36 heterosexual couples (age 20-59 yrs) and aims to quantify the extent to which it is important to take into account the dyadic nature of sleep-wake cycles. It achieves this through two interrelated aims: to use hierarchical linear models to measure dyadic interdependence in actigraphically recorded variables, and to investigate how much of this dyadic interdependence truly results from couple dynamics. The variables with the most significant couple interdependency were actual bed time, sleep latency, light/dark ratio, and wake bouts. The paper concludes by suggesting that interdependence may be the defining feature of couples' sleep, and that we need to employ analytic approaches that both acknowledge this and are sensitive to the possibilities that not all aspects of sleep will behave in the same way.