The effects of Facebook and Instagram on the 2020 election: A deactivation experiment

We study the effect of Facebook and Instagram access on political beliefs, attitudes, and behavior by randomizing a subset of 19,857 Facebook users and 15,585 Instagram users to deactivate their accounts for 6 wk before the 2020 U.S. election. We report four key findings. First, both Facebook and Instagram deactivation reduced an index of political participation (driven mainly by reduced participation online). Second, Facebook deactivation had no significant effect on an index of knowledge, but secondary analyses suggest that it reduced knowledge of general news while possibly also decreasing belief in misinformation circulating online. Third, Facebook deactivation may have reduced self-reported net votes for Trump, though this effect does not meet our preregistered significance threshold. Finally, the effects of both Facebook and Instagram deactivation on affective and issue polarization, perceived legitimacy of the election, candidate favorability, and voter turnout were all precisely estimated and close to zero.

Reducing annotation burden in MR: A novel MR-contrast guided contrastive learning approach for image segmentation

BACKGROUND

Contrastive learning, a successful form of representational learning, has shown promising results in pretraining deep learning (DL) models for downstream tasks. When working with limited annotation data, as in medical image segmentation tasks, learning domain-specific local representations can further improve the performance of DL models.

PURPOSE

In this work, we extend the contrastive learning framework to utilize domain-specific contrast information from unlabeled Magnetic Resonance (MR) images to improve the performance of downstream MR image segmentation tasks in the presence of limited labeled data.

METHODS

The contrast in MR images is controlled by underlying tissue properties (e.g., T1 or T2) and image acquisition parameters. We hypothesize that learning to discriminate local representations based on underlying tissue properties should improve subsequent segmentation tasks on MR images. We propose a novel constrained contrastive learning (CCL) strategy that uses tissue-specific information via a constraint map to define positive and negative local neighborhoods for contrastive learning, embedding this information in the representational space during pretraining. For a given MR contrast image, the proposed strategy uses local signal characteristics (constraint map) across a set of related multi-contrast MR images as a surrogate for underlying tissue information. We demonstrate the utility of the approach for downstream: (1) multi-organ segmentation tasks in T2-weighted images where a DL model learns T2 information with constraint maps from a set of 2D multi-echo T2-weighted images (n = 101) and (2) tumor segmentation tasks in multi-parametric images from the public brain tumor segmentation (BraTS) (n = 80) dataset where DL models learn T1 and T2 information from multi-parametric BraTS images. Performance is evaluated on downstream multi-label segmentation tasks with limited data in (1) T2-weighted images of the abdomen from an in-house Radial-T2 (Train/Test = 30/20), (2) public Cartesian-T2 (Train/Test = 6/12) dataset, and (3) multi-parametric MR images from the public brain tumor segmentation dataset (BraTS) (Train/Test = 40/50). The performance of the proposed CCL strategy is compared to state-of-the-art self-supervised contrastive learning techniques. In each task, a model is also trained using all available labeled data for supervised baseline performance.

RESULTS

The proposed CCL strategy consistently yielded improved Dice scores, Precision, and Recall metrics, and reduced HD95 values across all segmentation tasks. We also observed performance comparable to the baseline with reduced annotation effort. The t-SNE visualization of features for T2-weighted images demonstrates its ability to embed T2 information in the representational space. On the BraTS dataset, we also observed that using an appropriate multi-contrast space to learn T1+T2, T1, or T2 information during pretraining further improved the performance of tumor segmentation tasks.

CONCLUSIONS

Learning to embed tissue-specific information that controls MR image contrast with the proposed constrained contrastive learning improved the performance of DL models on subsequent segmentation tasks compared to conventional self-supervised contrastive learning techniques. The use of such domain-specific local representations could help understand, improve performance, and mitigate the scarcity of labeled data in MR image segmentation tasks.

Translating the user-avatar bond into depression risk: A preliminary machine learning study

Research has shown a link between depression risk and how gamers form relationships with their in-game figure of representation, called avatar. This is reinforced by literature supporting that a gamer's connection to their avatar may provide broader insight into their mental health. Therefore, it has been argued that if properly examined, the bond between a person and their avatar may reveal information about their current or potential struggles with depression offline. To examine whether the connection with an individuals' avatars may reveal their risk for depression, longitudinal data from 565 adults/adolescents (Mage = 29.3 years, SD = 10.6) were evaluated twice (six months apart). Participants completed the User-Avatar-Bond [UAB] scale and Depression Anxiety Stress Scale to measure avatar bond and depression risk. A series of tuned and untuned artificial intelligence [AI] classifiers analyzed their responses concurrently and prospectively. This allowed the examination of whether user-avatar bond can provide cross-sectional and predictive information about depression risk. Findings revealed that AI models can learn to accurately and automatically identify depression risk cases, based on gamers' reported UAB, age, and length of gaming involvement, both at present and six months later. In particular, random forests outperformed all other AIs, while avatar immersion was shown to be the strongest training predictor. Study outcomes demonstrate that UAB can be translated into accurate, concurrent, and future, depression risk predictions via trained AI classifiers. Assessment, prevention, and practice implications are discussed in the light of these results.

Clinical Trials in Facial Plastic and Reconstructive Surgery

Many facial plastic and reconstructive surgery providers are interested in incorporating clinical trials into their own practice. Clinical trials in facial plastics have made key contributions to current practices. Clinical trials range from investigating the safety and efficacy of Juvederm filler to reducing pain associated with injecting Juvederm. This article summarizes landmark clinical trials in facial plastic and reconstructive surgery and provides a framework for providers to get involved in clinical trials.

Design and development of microformulations for rapid release of small molecules and oligonucleotides

A systemic delivery of therapeutics frequently results in sub-optimal exposure of the targeted locus and undesired side effects. To address these challenges, a platform for local delivery of diverse therapeutics by remotely controlled magnetic micro-robots was introduced. The approach involves micro-formulation of active molecules using hydrogels that exhibit wide range of loading capabilities and predictable release kinetics. This work introduces two specific hydrogels based on thiol-maleimide and PEG-PLA-diacrylate chemistries that afford high, reliable and reproducible loading and release of several model molecules including doxorubicin, 25-mer poly-dT oligonucleotide and a 5.4 kBp GFP DNA plasmid. The described formulations are suitable for micro-dosing using both conventional or remote delivery devices.

Roadmap for Trauma-Informed Medical Education: Introducing an Essential Competency Set

Research has established that trauma is nearly universal and a root cause of numerous health and social problems, including 6 of the 10 leading causes of death, with devastating consequences across the life course. Scientific evidence now recognizes the complex injurious nature of structural and historical trauma (i.e., racism, discrimination, sexism, poverty, and community violence). Meanwhile, many physicians and trainees grapple with their own trauma histories and face direct and secondary traumatization on the job. These findings substantiate the profound impact of trauma on the brain and body and why trauma training is critical to the education and practice of physicians. However, a critical lag remains in translating essential research insights into clinical teaching and care. Recognizing this gap, the National Collaborative on Trauma-Informed Health Care Education and Research (TIHCER) formed a task force charged with developing and validating a summary of core trauma-related knowledge and skills for physicians. In 2022, TIHCER released the first-ever validated set of trauma-informed care competencies for undergraduate medical education. The task force focused on undergraduate medical education so that all physicians would be taught these foundational concepts and skills from the outset of training, recognizing that faculty development is needed to achieve this goal. In this Scholarly Perspective, the authors offer a roadmap for implementation of trauma-informed care competencies starting with medical school leadership, a faculty-student advisory committee, and sample resources. Medical schools can use the trauma-informed care competencies as a scaffold to customize integration of curricular content (what is taught) and efforts to transform the learning and clinical environments (how it is taught). Using the lens of trauma will ground undergraduate medical training in the latest science about the pathophysiology of disease and provide a framework to address many of our greatest challenges, including health disparities and professional burnout.

Pyomyositis of the Biceps Brachii in a Young Adult Male

Pyomyositis is a skeletal muscle infection mainly found in tropical regions. It commonly affects larger muscles, especially those of the hips. MRI tends to be the gold standard for diagnosis. Staphylococcus aureus remains the predominant causal organism in most cases of pyomyositis. Immunocompromised patients are more likely to be susceptible to this infection. In our case, an immunocompetent 27-year-old male in rural southwest Virginia was found to have a large abscess in his upper arm. Contrast-enhanced CT scan was acquired prior to drainage, leading to the diagnosis of pyomyositis. Empiric treatment with IV vancomycin 1 g q 24 hours and piperacillin/tazobactam 3.375 mg q 8 hours, prompt incision and drainage, and negative pressure wound VAC led to a complete resolution of the infection.

Like-minded sources on Facebook are prevalent but not polarizing

Many critics raise concerns about the prevalence of 'echo chambers' on social media and their potential role in increasing political polarization. However, the lack of available data and the challenges of conducting large-scale field experiments have made it difficult to assess the scope of the problem1,2. Here we present data from 2020 for the entire population of active adult Facebook users in the USA showing that content from 'like-minded' sources constitutes the majority of what people see on the platform, although political information and news represent only a small fraction of these exposures. To evaluate a potential response to concerns about the effects of echo chambers, we conducted a multi-wave field experiment on Facebook among 23,377 users for whom we reduced exposure to content from like-minded sources during the 2020 US presidential election by about one-third. We found that the intervention increased their exposure to content from cross-cutting sources and decreased exposure to uncivil language, but had no measurable effects on eight preregistered attitudinal measures such as affective polarization, ideological extremity, candidate evaluations and belief in false claims. These precisely estimated results suggest that although exposure to content from like-minded sources on social media is common, reducing its prevalence during the 2020 US presidential election did not correspondingly reduce polarization in beliefs or attitudes.

How do social media feed algorithms affect attitudes and behavior in an election campaign?

We investigated the effects of Facebook's and Instagram's feed algorithms during the 2020 US election. We assigned a sample of consenting users to reverse-chronologically-ordered feeds instead of the default algorithms. Moving users out of algorithmic feeds substantially decreased the time they spent on the platforms and their activity. The chronological feed also affected exposure to content: The amount of political and untrustworthy content they saw increased on both platforms, the amount of content classified as uncivil or containing slur words they saw decreased on Facebook, and the amount of content from moderate friends and sources with ideologically mixed audiences they saw increased on Facebook. Despite these substantial changes in users' on-platform experience, the chronological feed did not significantly alter levels of issue polarization, affective polarization, political knowledge, or other key attitudes during the 3-month study period.

Reshares on social media amplify political news but do not detectably affect beliefs or opinions

We studied the effects of exposure to reshared content on Facebook during the 2020 US election by assigning a random set of consenting, US-based users to feeds that did not contain any reshares over a 3-month period. We find that removing reshared content substantially decreases the amount of political news, including content from untrustworthy sources, to which users are exposed; decreases overall clicks and reactions; and reduces partisan news clicks. Further, we observe that removing reshared content produces clear decreases in news knowledge within the sample, although there is some uncertainty about how this would generalize to all users. Contrary to expectations, the treatment does not significantly affect political polarization or any measure of individual-level political attitudes.

Trauma-Informed Care for Acute Care Settings: A Novel Simulation Training for Medical Students

Introduction

Physicians often care for patients who have experienced traumatic events including abuse, discrimination, and violence. Trauma-informed care (TIC) is a framework that recognizes the prevalence of trauma, promotes patient empowerment, and minimizes retraumatization. There are limited education curricula on how to apply TIC to acute care settings, with simulation-based training presenting a novel educational tool for this aim.

Methods

Students participated in a didactic on TIC principles and its applications in acute care settings. Learners participated in three simulation cases where they performed physical exams and gathered history on patients with urgent medical needs related to intimate partner violence, transgender health, and health care discrimination. Debriefing followed each simulation.

Results

Seventeen medical students participated across four sessions. The sessions were evaluated with pre- and postparticipation surveys, including Likert scales and free-response questions. After participation, individuals' self-assessed confidence improved across multiple domains, including identifying situations for trauma screenings, inquiring about trauma, and responding as a bystander. Learners also felt more familiar with TIC-specific history taking and physical exam skills. Finally, simulation was perceived as a beneficial educational tool. All findings were statistically significant (p ≤ .01).

Discussion

Our simulation-based training enabled students to practice conversations and interventions related to trauma. This novel training represents a feasible and effective means for teaching TIC for acute care settings, including in the emergency department and in-patient settings. Development and evaluation were supported by the Society for Academic Emergency Medicine.

Asymmetric ideological segregation in exposure to political news on Facebook

Does Facebook enable ideological segregation in political news consumption? We analyzed exposure to news during the US 2020 election using aggregated data for 208 million US Facebook users. We compared the inventory of all political news that users could have seen in their feeds with the information that they saw (after algorithmic curation) and the information with which they engaged. We show that (i) ideological segregation is high and increases as we shift from potential exposure to actual exposure to engagement; (ii) there is an asymmetry between conservative and liberal audiences, with a substantial corner of the news ecosystem consumed exclusively by conservatives; and (iii) most misinformation, as identified by Meta's Third-Party Fact-Checking Program, exists within this homogeneously conservative corner, which has no equivalent on the liberal side. Sources favored by conservative audiences were more prevalent on Facebook's news ecosystem than those favored by liberals.

Trauma-informed care (TIC) best practices for improving patient care in the emergency department

A patient's current or previous experience of trauma may have an impact on their health and affect their ability to engage in health care. Every year, millions of patients who have experienced physically or emotionally traumatic experiences present to emergency departments (ED) for care. Often, the experience of being in the ED itself can exacerbate patient distress and invoke physiological dysregulation. The physiological reactions that lead to fight, flight, or freeze responses can make providing care to these patients complex and can even lead to harmful encounters for providers. There is a need to improve the care provided to the vast number of patients in the ED and create a safer environment for patients and healthcare workers. One solution to this complex challenge is understanding and integrating trauma-informed care (TIC) into emergency services. The federal Substance Abuse and Mental Health Service Administration's (SAMHSA) six guiding principles of TIC offer a universal precaution framework that ensures quality care for all patients, providers, and staff in EDs. While there is growing evidence that TIC quantitatively and qualitatively improves ED care, there is a lack of practical, emergency medicine-specific guidance on how to best operationalize TIC. In this article, using a case example, we outline how emergency medicine providers can integrate TIC into their practice.

Comorbidity and Severity in Childhood Apraxia of Speech: A Retrospective Chart Review

PURPOSE

The purpose of this study was to investigate comorbidity prevalence and patterns in childhood apraxia of speech (CAS) and their relationship to severity.

METHOD

In this retroactive cross-sectional study, medical records for 375 children with CAS (M age = 4;9 [years;months], SD = 2;9) were examined for comorbid conditions. The total number of comorbid conditions and the number of communication-related comorbidities were regressed on CAS severity as rated by speech-language pathologists during diagnosis. The relationship between CAS severity and the presence of four common comorbid conditions was also examined using ordinal or multinomial regressions.

RESULTS

Overall, 83 children were classified with mild CAS; 35, with moderate CAS; and 257, with severe CAS. Only one child had no comorbidities. The average number of comorbid conditions was 8.4 (SD = 3.4), and the average number of communication-related comorbidities was 5.6 (SD = 2.2). Over 95% of children had comorbid expressive language impairment. Children with comorbid intellectual disability (78.1%), receptive language impairment (72.5%), and nonspeech apraxia (37.3%; including limb, nonspeech oromotor, and oculomotor apraxia) were significantly more likely to have severe CAS than children without these comorbidities. However, children with comorbid autism spectrum disorder (33.6%) were no more likely to have severe CAS than children without autism.

CONCLUSIONS

Comorbidity appears to be the rule, rather than the exception, for children with CAS. Comorbid intellectual disability, receptive language impairment, and nonspeech apraxia confer additional risk for more severe forms of CAS. Findings are limited by being from a convenience sample of participants but inform future models of comorbidity.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22096622.

The association of racial and ethnic disparities and frailty in geriatric patients undergoing revascularization for peripheral artery disease

Frailty is defined as a state of decreased physiologic reserve contributing to functional decline and adverse outcomes. Racial disparities in frail patients have been described sparsely in the literature. We aimed to assess whether race influences frailty status in geriatric patients undergoing revascularization for peripheral artery disease (PAD) with chronic limb-threatening ischemia (CLTI). A 5-year analysis of the National Surgical Quality Improvement Program database included all geriatric (65 years and older) patients who underwent revascularization for lower extremity PAD with CLTI. The frailty index was calculated using a 11-variable modified frailty index and a cutoff of 0.27 indicated frail status. The primary outcome was an association of race or ethnicity with frailty status. We included 7,837 geriatric patients who underwent a surgical procedure (open: 55.2%) for PAD with CLTI. Mean age of patients was 75.4 years, 63.8% were male, 24.1% (n = 1,889) were frail, and 21.8% (n = 1,710) were African American (AA). Overall complication rate was 11.2% (n = 909) and overall mortality rate was 1.9% (n = 148). AA patients were more likely to be frail than White patients (29.6% v 23.9%; P = .03). AA and Hispanic patients were more likely to have complications (P = .03 and P = .001) and require readmission (P = .015 and P = .001) compared with White and non-Hispanic patients, respectively. Frail AA and frail Hispanic patients were more likely to have 30-day complications and readmission compared with frail White and frail non-Hispanic patients, respectively. Race and ethnicity influence frailty status in geriatric patients with PAD and CLTI. These disparities exist regardless of age, sex, comorbid conditions, and type of operative procedure. Additional studies are needed to highlight disparities by race and ethnicity to identify potentially modifiable risk factors to improve outcomes.

Extrapulmonary COVID-19 Presents As Spontaneous Small Bowel Perforation

SARS-CoV2 is a well-recognized pathogen with a myriad of presenting symptoms. Well-documented pulmonary, neurological, gastrointestinal, and hematologic complications have occurred during the global COVID-19 pandemic. While gastrointestinal symptoms are the most commonly reported extrapulmonary symptom of COVID-19, the incidence of primary perforation has not been widely reported. In this case report, we describe a spontaneous small bowel perforation in a patient who was incidentally found to be COVID-19 positive. This peculiar case underlies the continued evolution of SARS-CoV2 understanding and potential unknown complications of the virus.

Volatile and Dissolved Organic Carbon Sources Have Distinct Effects on Microbial Activity, Nitrogen Content, and Bacterial Communities in Soil

Variation in microbial use of soil carbon compounds is a major driver of biogeochemical processes and microbial community composition. Available carbon substrates in soil include both low molecular weight-dissolved organic carbon (LMW-DOC) and volatile organic compounds (VOCs). To compare the effects of LMW-DOC and VOCs on soil chemistry and microbial communities under different moisture regimes, we performed a microcosm experiment with five levels of soil water content (ranging from 25 to 70% water-holding capacity) and five levels of carbon amendment: a no carbon control, two dissolved compounds (glucose and oxalate), and two volatile compounds (methanol and α-pinene). Microbial activity was measured throughout as soil respiration; at the end of the experiment, we measured extractable soil organic carbon and total extractable nitrogen and characterized prokaryotic communities using amplicon sequencing. All C amendments increased microbial activity, and all except oxalate decreased total extractable nitrogen. Likewise, individual phyla responded to specific C amendments-e.g., Proteobacteria increased under addition of glucose, and both VOCs. Further, we observed an interaction between moisture and C amendment, where both VOC treatments had higher microbial activity than LMW-DOC treatments and controls at low moisture. Across moisture and C treatments, we identified that Chloroflexi, Nitrospirae, Proteobacteria, and Verrucomicrobia were strong predictors of microbial activity, while Actinobacteria, Bacteroidetes, and Thaumarcheota strongly predicted soil extractable nitrogen. These results indicate that the type of labile C source available to soil prokaryotes can influence both microbial diversity and ecosystem function and that VOCs may drive microbial functions and composition under low moisture conditions.

Co-occurrence of Common Biological and Behavioral Addictions: Using Network Analysis to Identify Central Addictions and Their Associations with Each Other

The present study used network analysis to examine the network properties (network graph, centrality, and edge weights) comprising ten different types of common addictions (alcohol, cigarette smoking, drug, sex, social media, shopping, exercise, gambling, internet gaming, and internet use) controlling for age and gender effects. Participants (N = 968; males = 64.3%) were adults from the general community, with ages ranging from 18 to 64 years (mean = 29.54 years; SD = 9.36 years). All the participants completed well-standardized questionnaires that together covered the ten addictions. The network findings showed different clusters for substance use and behavioral addictions and exercise. In relation to centrality, the highest value was for internet usage, followed by gaming and then gambling addiction. Concerning edge weights, there was a large effect size association between internet gaming and internet usage; a medium effect size association between internet usage and social media and alcohol and drugs; and several small and negligible effect size associations. Also, only 48.88% of potential edges or associations between addictions were significant. Taken together, these findings must be prioritized in theoretical models of addictions and when planning treatment of co-occurring addictions. Relatedly, as this study is the first to use network analysis to explore the properties of co-occurring addictions, the findings can be considered as providing new contributions to our understanding of the co-occurrence of common addictions.

Temperature-controlled Laminar Airflow (TLA) in symptomatic severe asthma – a post hoc analysis of severe exacerbations, quality of life and health economics

Purpose

Uncontrolled severe asthma constitutes a major economic burden to society. Add-ons to standard inhaled treatments include inexpensive oral corticosteroids and expensive biologics. Nocturnal treatment with Temperature-controlled Laminar Airflow (TLA; Airsonett®) could be an effective, safe and cheaper alternative. The potential of TLA in reducing severe asthma exacerbations was addressed in a recent randomised placebo-controlled trial (RCT) in patients with severe asthma (Global Initiative for Asthma (GINA) step 4/5), but the results were inconclusive. We re-analysed the RCT with severe exacerbations stratified by the level of baseline asthma symptoms and Quality of Life.

Methods

More uncontrolled patients, defined by Asthma Control Questionnaire 7 (ACQ7) > 3, EuroQoL 5-Dimension Questionnaire Visual Analogue Scale (EQ5D-VAS) ≤ 65 and Asthma Quality of Life Questionnaire (AQLQ) ≤ 4 were selected for re-analysis. The rates of severe asthma exacerbations, changes in QoL and health-economics were analysed and compared between TLA and placebo.

Results

The study population included 226 patients (113 TLA / 113 placebo.) The rates of severe asthma exacerbations were reduced by 33, 31 and 25% (p = 0.083, 0.073, 0.180) for TLA compared to placebo, dependent on selected control measures (ACQ7, EQ5D-VAS, AQLQ, respectively). For patients with less control defined by AQLQ≤4, the difference in mean AQLQ0-12M between TLA and placebo was 0.31, 0.33, 0.26 (p = 0.085, 0.034, 0.150), dependent on selected covariate (AQLQ, EQ5D-VAS, ACQ7, respectively). For patients with poor control defined by ACQ7 > 3, the difference in EQ5D-5 L utility scores between TLA and placebo was significant at 9 and 12 months with a cost-effective ICER. The results from the original study did not demonstrate these differences.

Conclusion

This post hoc analysis demonstrated an effect of TLA over placebo on severe exacerbations, asthma control and health economics in a subgroup of patients with more symptomatic severe allergic asthma. The results are consistent with the present recommendations for TLA. However, these differences were not demonstrated in the full study. Several explanations for the different outcomes have been outlined, which should be addressed in future studies.

Funding

NIHR Health Technology Assessment Programme and Portsmouth Hospitals NHS Trust.

Inter-relationships between ADHD, ODD and impulsivity dimensions in emerging adults revealed by network analysis: extending the ‘trait impulsivity hypothesis’

Background

The trait-impulsivity hypothesis posits impulsivity as the underlying substrate of Attention-deficit/hyperactivity disorder (ADHD) and Oppositional defiant disorder (ODD) symptom expressions. The current study applied network analysis to evaluate the inter-relationships of dimensions within ADHD (inattention and hyperactivity/impulsivity) and ODD (anger/irritable, vindictiveness, and argumentative/defiant behavior) with components of impulsivity as captured by the UPPS-P model (negative urgency, lack of premeditation, lack of perseverance, sensation seeking, and positive urgency).

Method

A total of 324 emerging adults (women = 246) from the general community completed questionnaires covering these dimensions.

Results

Our findings showed that the ADHD and ODD dimensions were associated differentially with different types of impulsivity, in their unique patterns of network connectivities, a possibility that has had little attention in the trait-impulsivity hypothesis literature.

Conclusions

This study is the first to tease out the unique associations of the ADHD and ODD dimensions with different types of impulsivity, and in that way provide new contributions to our understanding of the existing trait impulsivity theory. Our findings would be especially relevant to those interested in understanding how different dimensions of trait impulsivity underly the ADHD and ODD dimensions.

Factor structure of ten psychoactive substance addictions and behavioural addictions

Over the past two decades, many problematic/excessive behaviours have increasingly been conceptualized as addictions due to their similarity with more traditional psychoactive substance addictions. The primary aim of the present study was to simultaneously examine the factor structure of three psychoactive substance addictions (alcohol use, cigarette smoking, and substance use) and seven behavioural addictions (sex, social media use, shopping, exercise, online gambling, internet gaming, and internet use), using exploratory factor analysis (EFA; N = 481) and confirmatory factor analysis (CFA; N = 487). A total of 968 participants completed an online survey including ten psychometric scales assessing the ten different potentially addictive behaviours. EFA supported a two-factor solution, with different factors for the psychoactive substance and behavioural addictions (excluding exercise addiction). CFA supported the two-factor model in a separate sample. There was good support for the concurrent and discriminant validities of the CFA latent factors and the reliability of the behavioural latent factor in the two-factor CFA model. While there was support for the concurrent and discriminant validities of the psychoactive substance latent factor, there was insufficient support for its reliability. The taxonomic, theoretical, and clinical implications of the findings are discussed.

Abstract 52: Analytical validation of the Resolution HRD plasma assay used to identify mCRPC patients with mutations, including homozygous deletions, in DNA repair genes as a companion diagnostic for niraparib

Tumor cells of metastatic castration-resistant prostate cancer (mCRPC) patients with homologous recombination deficiency (HRD) are highly sensitive to the blockade of DNA single-strand break repair via the inhibition of the poly(adenosine diphosphate-ribose) polymerase (PARP) family of nuclear proteins. Niraparib is a highly selective PARP inhibitor, with activity against PARP-1/2 DNA-repair polymerases, and the Resolution HRD assay is being developed as a companion diagnostic for niraparib. Detection of HRD in cell free DNA (cfDNA) isolated from blood is minimally invasive and is of special benefit to mCRPC patients, many without accessible lesions. The Resolution HRD assay identifies patients with substitutions, insertions, deletions, and homozygous deletions of the ATM, BRCA1, BRCA2, BRIP1, CDK12 (except homozygous deletions), CHEK2, FANCA, HDAC2, and PALB2 genes by targeted NGS sequencing of cfDNA isolated from plasma. Analytical performance of the Resolution HRD assay was validated using cfDNA from mCRPC patient plasma, cfDNA from healthy donor plasma, and contrived samples with a wide spectrum of technically challenging genetic aberrations along with CRISPR-engineered human cell lines with ATM and BRCA2 gene deletions. The LOD95 was established for substitutions, insertions, deletions, and homozygous deletions for genes represented in the HRD panel with variant types including complex indels, long indels, and challenging genomic settings including homopolymeric and GC-rich regions. mCRPC specimens were used to confirm an acceptable level of precision near 1X LOD and 2-3X LOD concentrations for all 4 variant types. No false-positives were detected in any samples from healthy donors. Resolution HRD has been validated to give consistent results across the 15-30 ng input range. Studies to confirm accuracy of the Resolution HRD test results using a validated orthogonal method will be presented. The Resolution HRD assay offers highly sensitive, specific, and robust test results, and meets analytical requirements for clinical applications. It is intended as a companion diagnostic to niraparib in combination with abiraterone acetate plus prednisone (AAP) for the treatment of mCRPC patients.

Citation Format: Julia Pollak, Kristy Potts, PuiYee Chan, Chen-Hsun Tsai, Angela Liao, Carly Garrison, Taylor Brown, Paul Stull, Zhen Li, Christine Baker, Kavita Garg, Ira Pekker, Michael Farabaugh, Michael Gormley, Lesley Farrington, Katherine Bell, Usha Singh. Analytical validation of the Resolution HRD plasma assay used to identify mCRPC patients with mutations, including homozygous deletions, in DNA repair genes as a companion diagnostic for niraparib [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 52.

Resolution ctDx FIRST plasma assay as a companion diagnostic for adagrasib and its application to longitudinal monitoring

3057

Background: KRAS is one of the most commonly mutated oncogenes in cancer. There is a significant need for new treatment options for patients with non–small cell lung cancer (NSCLC) harboring the KRAS G12C mutation. Adagrasib is an investigational, highly selective, oral small molecule inhibitor of KRAS G12C that has demonstrated clinical benefit in patients with KRAS G12C–mutant NSCLC and CRC. Detection of KRAS G12C in cfDNA is minimally invasive and is of benefit to NSCLC patients, many without lesions accessible by tissue biopsy testing. Methods: Resolution ctDx FIRST is a 113 gene comprehensive genomic profiling assay that identifies oncogenic alterations including substitutions, insertions, deletions, gene fusions, and homozygous deletions using targeted NGS sequencing of cfDNA. The Resolution ctDx FIRST assay is being developed as a companion diagnostic for adagrasib in NSCLC patients of the Mirati Study 849-001. Results: The LOD95 for SNVs and indels in KRAS and EGFR at a cfDNA input level of 15ng ranged from 0.34% to 0.82%. No false positives were detected in any samples from healthy donors (N = 60). A total of 230 NSCLC plasma samples were orthogonally tested using a ddPCR assay for KRAS G12C, using 76 plasma samples from Study 849-001 where KRAS G12C positive results had previously been obtained by a tissue assay, and 154 commercially procured NSCLC samples representative of the trial population. The PPA and NPA for Resolution ctDx FIRST plasma testing relative to ddPCR assay (95% CI) were 87.0% (75.1–94.6%) and 97.6% (94.1–99.4%) respectively. Of 112 Study 849-001 patients, 71 (63.4%) were tested for KRAS G12C mutations with Resolution ctDx FIRST in pretreatment plasma samples. Seventy-four commercially procured matched tissue and plasma samples were tested by Resolution ctDx FIRST and tissue assay. The PPA and NPA for Resolution ctDx FIRST plasma testing relative to tissue assay (95% CI) were 66.2% (54.0-77.0%) and 100% (94.7-100%) respectively. The detection of EGFR variants in the Resolution ctDx FIRST assay was compared to results from a ddPCR assay for each variant. A total of 165 NSCLC plasma samples generated a total of 317 comparative valid results. PPA was 100% for EGFR L858R, 88.9% for EGFR T790M, and 91.3% for EGFR Exon 19 Deletions. NPA was 97.8% for EGFR L858R, 100% for EGFR T790M, and 100% for EGFR Exon 19 Deletions. Application of the assay in longitudinally collected NSCLC and CRC patient samples will be presented highlighting changes of VAF over time including identification of oncogenes involved in emerging resistance. Conclusions: The Resolution ctDx FIRST assay offers highly sensitive, specific, and robust test results, and meets analytical requirements for clinical applications. [Table: see text]

Trauma-informed Care Interventions in Emergency Medicine: A Systematic Review

Introduction

Trauma exposure is a highly prevalent experience for patients and clinicians in emergency medicine (EM). Trauma-informed care (TIC) is an effective framework to mitigate the negative health impacts of trauma. This systematic review synthesizes the range of TIC interventions in EM, with a focus on patient and clinician outcomes, and identifies gaps in the current research on implementing TIC.

Methods

The study was registered with PROSPERO (CRD42020205182). We systematically searched peer-reviewed journals and abstracts in the PubMed, EMBASE (Elsevier), PsycINFO (EBSCO), Social Services Abstract (ProQuest), and CINAHL (EBSCO) databases from 1990 onward on August 12, 2020. We analyzed studies describing explicit TIC interventions in the ED setting using inductive qualitative content analysis to identify recurrent themes and identify unique trauma-informed interventions in each study. Studies not explicitly citing TIC were excluded. Studies were assessed for bias using the Newcastle-Ottawa criteria and Critical Appraisal Skills Programme (CASP) Checklist.

Results

We identified a total of 1,372 studies and abstracts, with 10 meeting inclusion criteria for final analysis. Themes within TIC interventions that emerged included educational interventions, collaborations with allied health professionals and community organizations, and patient and clinician safety interventions. Educational interventions included lectures, online modules, and standardized patient exercises. Collaborations with community organizations focused on addressing social determinants of health. All interventions suggested a positive impact from TIC on either clinicians or patients, but outcomes data remain limited.

Conclusion

Trauma-informed care is a nascent field in EM with limited operationalization of TIC approaches. Future studies with patient and clinician outcomes analyzing universal TIC precautions and systems-level interventions are needed.

Network analyses of Oppositional Defiant Disorder (ODD) symptoms in children

Based on parent and teacher ratings of their children, this study used regularized partial correlation network analysis (EBIC glasso) to examine the structure of DSM-5 Oppositional Defiant Disorder (ODD) symptoms. Parent and teachers (N = 934) from the general community in Malaysia completed questionnaires covering DSM-5 ODD symptoms. The most central ODD symptom for parent ratings was anger, followed by argue. For teacher ratings, it was anger, followed by defy. For both parent and teacher ratings, the networks revealed at least medium effect size connections for temper and argue, defy, and argue, blames others, and annoy, and spiteful and angry. Overall, the findings were highly comparable across parent and teacher ratings, and they showed a novel understanding of the structure of the ODD symptoms. The clinical implications of the findings for assessment and treatment of ODD are discussed.

Personality inventory for DSM–5-Brief Form (PID-5-BF): Measurement invariance across men and women

The study examined the measurement invariance (configural, metric, scalar, and residual) of the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Brief Form (PID-5-BF; Krueger et al., 2013) across gender for the theorized Five-Factor oblique model. A large group of adults (N = 502), with ages ranging from 18 to 67 years, from the Australian general community completed the PID-5-BF. When the Δχ² test was applied, multiple-group confirmatory factor analysis supported configural invariance and full metric and residual invariance. For scalar invariance, at least seven items (constituting 13 thresholds) across the different dimensions lacked invariance for one or more of its thresholds. In addition, controlling all these noninvariance thresholds, women had higher latent mean scores for Negative Affect, and men had higher scores for Antagonism and Disinhibition. When the Δcomparative fit index (ΔCFI) test was applied, the findings also supported the configural invariance model and the full metric and residual invariance models. With the exception of one threshold, all the other thresholds were also invariant. The psychometric and practical implications of the findings are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Confirmatory factor analysis and exploratory structural equation modeling of the factor structure of the Questionnaire of Cognitive and Affective Empathy (QCAE)

The Questionnaire of Cognitive and Affective Empathy (QCAE) is a multiple dimensional measure of cognitive empathy [comprising primary factors for perspective taking (PT), online simulation (OS)], and affective empathy [comprising primary factors for emotion contagion (EC), proximal responsivity (PRO), and peripheral responsivity (PER)]. This study used independent clusters confirmatory factor analysis (ICM-CFA) and exploratory structural equation modeling (ESEM) to examine the scale’s factor structure. A general community sample of 203 (men = 43, women = 160) between 17 and 63 years completed the QCAE. Although both the five-factor oblique and second order factor models showed good model fit, and clarity in the pattern of factor loadings, in the second-order factor model, none of the primary factors loaded significantly on their respective secondary factors, thereby favoring the five-factor oblique model. The factors in this model were supported in terms of external validity. Despite this, the factor for PRO in this model showed low reliability for meaning interpretation. A revised four-factor oblique model without the PRO factor showed good fit, clarity in the pattern of factor loadings, and reliability and validity for the factors in this model, thereby suggesting this to be the best model to represent ratings on the QCAE.

Longitudinal Associations of Physical Touch with Loneliness among Older Adults

Older adults in the US face heightened risks for social disconnection, and the COVID-19 pandemic has further exacerbated this crisis. Physical touch is a key dimension of social connection that uniquely predicts physical and mental health benefits. However, most studies have been limited by cross-sectional designs, and no prior work has examined the long-term effects of physical touch on loneliness. To investigate the prospective association between physical touch and loneliness among older adults, this study utilized data from 1626 older adults (Mean age = 68, range = 57-85) who participated in Waves 1 and 2 of the National Social Life, Health, and Aging Project (NSHAP). Participants reported on their loneliness and physical contact with family and friends, as well as with pets, at both waves. Results revealed that more frequent physical contact with family and friends predicted larger decreases in loneliness over the subsequent five years (p<.0001), controlling for age, race, gender, health conditions, marital status, frequency of social interaction, and baseline levels of loneliness. Physical contact with pets had no unique effect (p=.136). To further assess directionality, models tested whether lonelier people experienced decreased touch over time, and the effects were null (p>.250). Taken together, this longitudinal study is the first to identify the unique contribution of human physical touch to prospective changes in loneliness, beyond the well-established effects of covariates, including social interaction frequency. Touch represents a compelling mechanism by which social isolation may lead to loneliness, which in turn raises risks for poor health and premature mortality.

Overcrowding and COVID-19 mortality across U.S. counties: Are disparities growing over time?

A growing line of research underscores that sociodemographic factors may contribute to disparities in the impact of COVID-19. Further, stages of disease theory suggests that disparities may grow as the pandemic unfolds and more advantaged areas are better able to apply growing knowledge and mitigation strategies. In this paper, we focus on the role of county-level household overcrowding on disparities in COVID-19 mortality in U.S. counties. We examine this relationship across three theoretically important periods of the pandemic from April–October 2020, that mark both separate stages of community knowledge and national mortality levels. We find evidence that the percentage of overcrowded households is a stronger predictor of COVID-19 mortality during later periods of the pandemic. Moreover, despite a relationship between overcrowding and poverty at the county-level, overcrowding plays an independent role in predicting COVID-19 mortality. Our findings underscore that areas disadvantaged by overcrowding may be more vulnerable to the effects of COVID-19 and that this vulnerability may lead to changing disparities over time.

•

County-level overcrowding is positively associated with COVID-19 mortality rates.

•

The overcrowding-mortality relationship is strongest during June and July.

•

Overcrowding and poverty additively shape county-level COVID-19 mortality.

•

Social disparities in mortality may change with new knowledge and disease spread.

•

Policies must consider how social disadvantages shape COVID-19 mortality over time.

A Trauma-Informed Approach to the Medical History: Teaching Trauma-Informed Communication Skills to First-Year Medical and Dental Students

INTRODUCTION

Trauma is ubiquitous and associated with negative effects on physical and mental health. Trauma-informed care (TIC) is a framework for mitigating these health effects and improving patients' engagement with medical care. Despite these clinical benefits, TIC is not routinely taught in undergraduate medical education.

METHODS

We designed a session for first-year medical and dental students to introduce TIC principles and their application in patient care. The session focused on screening for and inquiring about trauma and responding to disclosures of trauma. Using live patient interviews, small-group discussions, and case-based role-plays, the session offered expert instruction and hands-on practice. Students completed pre- and postsession surveys and a 5-month follow-up survey. Students reported their comfort with screening for trauma and responding to disclosures of trauma before and after the session and at 5 months following the session.

RESULTS

Of the 164 student participants, 76% completed surveys during the session, and 50% completed the follow-up survey. More than one-third (34%) of respondents reported having received at least one disclosure of trauma from a patient within the first 5 months of medical school. Students' comfort with screening for trauma increased from 30% to 56%, and their comfort with responding to disclosure of trauma increased from 35% to 55%. These improvements persisted on reevaluation at 5 months.

DISCUSSION

We present a model for teaching trauma-informed communication skills to first-year medical and dental students. The intervention significantly increased students' comfort level and self-reported clinical skills, and benefits persisted at 5 months.

Internet gaming disorder behaviours: a preliminary exploration of individualism and collectivism profiles

BACKGROUND

Internet Gaming Disorder (IGD) behaviours involve excessive use of Internet games to the extent that one's everyday life is compromised. It has been suggested that IGD symptoms are dependent on whether one is more individualistic or collectivistic. However, the range of potential individualism-collectivismeffects on IGD presentations remains largely unknown. The current study aims to further understanding of the role of individualistic and collectivistic tendencies in IGD, allowing us to develop more gamer centredIGD prevention and intervention strategies.

METHODS

One thousand and thirty-twocommunity participants withinternet gaming experience were measured online for IGD symptom's severity using the Internet Gaming Disorder Scale - Short Form (IGDS9-SF) andindividualism-collectivism behavioursvia the Individualism & Collectivism Scale (ICS). Latent Class Analysis (LCA) and T-Tests were performed in relation to their responses.

RESULTS

Upon inspection of the LCA output, two profiles of internet gamers were identified. These includedthe Collectivism Aversivegamers (CA; 11%) and the Collectivism Neutral gamers (CN; 89%). The CA gamers displayed significantly higher IGD behaviours overall, and, were higher inpreoccupation, withdrawal symptoms, tolerance, relapse, deception, escapism/mood modification, and functional impairment compared to CN gamers. There were no differences between CA and CN gamers in loss of interest and conflicts with others.

CONCLUSIONS

The findings suggest that one's individualism-collectivism orientation can influence the presentation of IGD. Specifically, those who are less collectivistic or are less influenced by social groups willdisplay greater IGD symptoms and present a profile that requires a different intervention from gamers who are more collectivistic. Researchers and clinicians should emphasize the value of belonging in a collective and experiencing equality with others in relation to mental health and gaming patterns.

Characteristics of Restart a Heart 2019 event locations in the UK

Introduction

Restart a Heart (RSAH) is an annual CPR mass training initiative delivered predominantly by ambulance services in the UK. The aim of this study was to identify to what extent voluntary participation in the 2019 initiative delivered training to the population with the highest need.

Methods

A cross-sectional observational study of location characteristics for RSAH training events conducted by UK ambulance services. Descriptive statistics were used to analyse event and area characteristics. National cardiac arrest registry data were used to establish proportions of training coverage in “hot spot” areas with above national median incidence of cardiac arrest and below median bystander CPR rates. The significance of observed differences were tested using chi-square for proportions and t-test for means.

Results

Twelve of 14 UK ambulance services participated, training 236,318 people. Most of the events (82%) were held in schools, and schoolchildren comprised most participants (81%). RSAH events were held in areas that were less densely populated (p < 0.001), were more common in affluent areas (p < 0.001), and had a significantly lower proportion of black residents (p < 0.05) and higher proportion of white residents (p < 0.05). Events were held in 28% of known “hot spot” areas in England.

Conclusion

With mandatory CPR training for school children in England, Scotland and Wales there is an opportunity to re-focus RSAH resources to deliver training for all age groups in OHCA “hot spots”, communities with higher proportions of black residents, and areas of deprivation. In Northern Ireland, we recommend targeting schools in areas with similar characteristics.

Trauma-Informed Medical Education (TIME): Advancing Curricular Content and Educational Context

The majority of patients and medical students experience some form of psychological trauma or adversity across their life course. All forms of trauma can be associated with adverse health consequences and can negatively affect learning and professional development. Trauma-informed care (TIC) offers a framework to address and mitigate these consequences and promote safety and health. The Substance Abuse and Mental Health Services Administration describes 6 domains of TIC: safety; trust and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historic, and gender issues. At present, TIC is not taught routinely in undergraduate medical education (UME)-a crucial educational gap given that UME grounds the development of key perspectives and practices that students use throughout their careers. Further, given the prevalence of preexisting trauma among learners and the likelihood of new traumatic exposures during training, medical schools' processes, practices, and learning environments may risk exacerbating or even causing trauma. To address this educational need and support students and their future patients, the authors propose a trauma-informed medical education (TIME) framework. TIME informs medical schools' curricular content and educational context. In UME, curricular content should address trauma epidemiology, physiology, and effects; trauma-informed clinical skills including sensitive communication and physical exam techniques; and trauma-informed self-care techniques including education on organizational resources, how to elicit supports, and personal self-care practices. A trauma-informed educational context encompasses curricular development, including student-faculty coproduction of educational content; curricular delivery, including faculty development on TIC principles; and learning environment, including trauma-informed educational practices, medical student advising, institutional policies, and recruitment. TIME offers practical strategies to support teaching, learning, educational administration, and professional development and aims to inspire new strategies for effective learner and faculty engagement. TIME aims to foster students' development of competency in TIC and promote student engagement, learning, health, and well-being.

Anatomy as a Model Environment for Acquiring Professional Competencies in Medicine: Experiences at Harvard Medical School

Anatomy education provides students with opportunities to learn structure and function of the human body, to acquire professional competencies such as teamwork, interpersonal skills, self-awareness, and to reflect on and practice medical ethics. The fulfillment of this wide potential can present challenges in courses that are part of an integrated curriculum and shorter than traditional courses. This new reality, together with students' increasing concern about the stresses within medical education, led to efforts at Harvard Medical School to implement practical steps toward an optimal learning environment in anatomy. These were based on core elements of ethical anatomy education and principles of trauma-informed care. Anatomy is conceptualized here as the "first clinical discipline," with relational interactions between anatomical educators, medical students, and body donors/patients. Essential prerequisites for the implementation of this work were support by the medical school leadership, open partnership between engaged students and faculty, faculty coordination, and peer-teaching. Specific interventions included pre-course faculty development on course philosophy and invitations to students to share their thoughts on anatomy. Student responses were integrated in course introductions, combined with a pre-dissection laboratory visit, an introductory guide, and a module on the history and ethics of anatomy. During the course, team-building activities were scheduled, and self-reflection encouraged, for example, through written exercises, and elective life-body drawing. Students' responses to the interventions were overall positive, but need further evaluation. This first attempt of a systematic implementation of an optimal learning environment in anatomy led to the identification of areas in need of adjustment.