Social Media Users' Engagement with Fear Appeal Elements in Government's Health Crisis Communication via State-Owned Media

Government health messaging is significant to the containment of public health crises. Such communication may benefit from using fear appeal, a message strategy for promoting health and preventing diseases. Yet little scholarly attention has been paid to how fear appeal is employed in government messaging to promote social media engagement through online actions including likes, shares, and comments. These actions play a meaningful role in addressing communication exigencies within the context of health crises. In this study, quantitative content analysis and corpus linguistics methods were employed to analyze fear appeal-related elements in COVID-19 messages sent by a state-owned media outlet on social media. The results show that when compared to messages without threat, messages conveying threat elicited significantly more comments, in which emotions and perceptions to threat and efficacy were exhibited, while messages containing both threat and efficacy generated more engagement in comparison to messages with threat alone. Moreover, while subdimensions under efficacy were positive predictors of engagement, those under threat were primarily found to have exerted negative effects. The findings provide insights into how fear appeal elements can be employed in government health crisis communication to engage the public.

Accuracy of Healthcare Professionals' Estimations of Health Literacy and Numeracy of Patients Visiting Metabolic Bariatric Surgery Clinic

INTRODUCTION

To effectively support patients through their weight loss journey, it is vital that healthcare professionals (HCPs) understand the health literacy skills of their patients and communicate in a way that meets these needs. This is the first study looking at the accuracy of HCPs' estimations of their patients' health literacy and numeracy attending a metabolic bariatric surgery (MBS) clinic.

METHOD

A cross-sectional study was completed at a tertiary-level MBS clinic in London. Patients completed a demographic questionnaire and a validated measure of health literacy and numeracy, the Medical Term Recognition Test (METER) and General Health Numeracy Test-Short Form (GHNT-6), respectively. HCPs provided estimations of their patient's health literacy and numeracy based on each questionnaire's scoring categories.

RESULTS

Data was collected for 31 patients. A 80.6% of patients had functional health literacy based on METER. HCPs estimated patients' health literacy correctly 61.1% of the time; inter-rater agreement was poor (ICC = 0.14; 95% CI =  - 0.19, 0.443; p = 0.202). A total of 22.6% of patients scored 0 out of 6 on GHNT-6. HCPs estimated health numeracy correctly 13.9% of the time and were more likely to overestimate than underestimate health numeracy. Inter-rater agreement for health numeracy was poor (ICC =  - 0.2; 95% CI =  - 0.49, 0.14; p = 0.878).

CONCLUSION

There is poor agreement between HCPs' perception of their patients' health literacy and numeracy and their assessed ability. HCPs' understanding of their patient's health literacy and numeracy skills is vital in ensuring HCPs can support patients through the challenging bariatric surgical pathway, consenting process and post-operative course.

Flipping the script: Action-plan modification during single- and multiple-action control

In this paper, we tested the idea that local changes in action demands (e.g., due to an invalid cue or trial-by-trial) result in frugal modifications of existing action plans via action-plan-modification operations. We implemented an experimental procedure making use of a cue that indicates the action requirements for an upcoming signal with a certain degree of reliability. Crucially, incongruent cue-stimulus pairs either require action-plan modification or "resetting" the prepared action plan and reselecting a new response from scratch. We systematically varied the proportion of valid cues over four experiments. There were four most basic response conditions: left button press, right button press, dual button presses, no action. Results support the concept of action-plan modification rather than reset-reselect: switching between a left and a right response was faster and less error-prone than any other type of switch, both between trials and between cue and signal. Thus, it appears that given two responses that can be conceived of as polar opposites (within the same single-action category), there is an action-plan-modification operation ("invert") that transforms one into the other at a comparatively low cost. Furthermore, we observed a mixed pattern of dual-action costs and benefits. This indicates that participants represented dual actions holistically, that is, not based on a conjunction of single-action plans as building blocks. In addition, switching from null actions to overt actions appeared to require very similar action-plan-modification operations as other types of switches - thus, null actions are apparently not coded as empty sets, but rather represent actions in their own right. Finally, we observed strikingly similar patterns of results for trial-by-trial changes in action demands and intra-trial cue-signal incongruency. This implies that the mere cue-based formulation of an action plan - which is not actually executed - is sufficient to produce action-switching-like effects.

Emotional and functional well-being in long-term breast cancer survivorship

PURPOSE

Emotional and functional well-being (EWB and FWB) are important components of mental health and quality of life. This study aims to evaluate long-term EWB and FWB in breast cancer (BC) survivors.

METHODS

The Carolina Breast Cancer Study Phase 3 oversampled Black and younger (< 50 years in age) women so that they each represent approximately 50% of the study population and assessed participants' EWB and FWB with the Functional Assessment of Cancer Therapy-Breast (FACT-B) at 5- (baseline), 25-, and 84-months post diagnosis. Multinomial logit models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for associations between demographic and clinical characteristics and well-being change relative to baseline.

RESULTS

Among 2,781 participants with BC, average EWB and FWB improved with time since diagnosis. Persistent FWB decrements were associated with Black race [OR 1.4 (95% CI 1.2-1.7) and 1.3 (95% CI 1.1-1.6), at 25-months and 84-months respectively], older age [OR 1.4 (95% CI 1.1-1.7) and 1.5 (95% CI 1.2-1.8), respectively], no chemotherapy, and recurrence [OR 2.9 (95% CI 1.8-4.8) and 3.1 (95% CI 2.1-4.6), respectively]. EWB decrements were associated with advanced stage and recurrence. Decrements in combined (FWB+EWB) well-being were associated with recurrence at both follow-up survey timepoints [ORs 4.7 (95% CI 2.7-8.0) and 4.3 (95% CI 2.8-6.6), respectively].

CONCLUSIONS

Long-term well-being varies by demographics and clinical features, with Black women and women with aggressive disease at greatest risk of long-term decrements.

Probing the effect of perceptual (dis)fluency on metacognitive judgments

Despite research showing that perceptually fluent stimuli (i.e., stimuli that are easier to process) are given higher judgment of learning (JOL) ratings than perceptually disfluent stimuli, it remains unknown whether the influence of perceptual fluency on JOLs is driven by the fluent or disfluent items. Moreover, it is unclear whether this difference hinges on relative differences in fluency. The current study addressed these unanswered questions by employing (Fiacconi et al., Journal of Experimental Psychology: Learning, Memory, and Cognition 46:926-944, 2020), Journal of Experimental Psychology: Learning, Memory, and Cognition, 46[5], 926-944) letter set priming procedure. In this procedure, participants are first exposed to words containing only a subset of letters. Following this exposure, JOLs to new words composed of the same letters (i.e., fluent), and new words composed of nonexposed letters (i.e., disfluent) are compared with isolate the contribution of perceptual fluency. Because this procedure does not rely on parametric variations in perceptual features, we can directly assess the potential benefit and/or cost of fluent and disfluent items, respectively, by including neutral baseline conditions. Moreover, implementing both a mixed- and pure-list design allowed us to assess the comparative nature of perceptual fluency on JOLs. Counter to previous assumptions, our results are the first to demonstrate that perceptual disfluency decreases JOLs. Moreover, we found that the influence of perceptual disfluency on JOLs hinges on the relative differences in fluency between items even in the absence of a belief about the mnemonic impact of the fluency manipulation. These findings have important implications as they provide evidence that the difficulty, rather than ease, of information form the basis of individuals metacognitive judgments.

Power to Detect What? Considerations for Planning and Evaluating Sample Size

ACADEMIC ABSTRACT

In the wake of the replication crisis, social and personality psychologists have increased attention to power analysis and the adequacy of sample sizes. In this article, we analyze current controversies in this area, including choosing effect sizes, why and whether power analyses should be conducted on already-collected data, how to mitigate the negative effects of sample size criteria on specific kinds of research, and which power criterion to use. For novel research questions, we advocate that researchers base sample sizes on effects that are likely to be cost-effective for other people to implement (in applied settings) or to study (in basic research settings), given the limitations of interest-based minimums or field-wide effect sizes. We discuss two alternatives to power analysis, precision analysis and sequential analysis, and end with recommendations for improving the practices of researchers, reviewers, and journal editors in social-personality psychology.

PUBLIC ABSTRACT

Recently, social-personality psychology has been criticized for basing some of its conclusions on studies with low numbers of participants. As a result, power analysis, a mathematical way to ensure that a study has enough participants to reliably "detect" a given size of psychological effect, has become popular. This article describes power analysis and discusses some controversies about it, including how researchers should derive assumptions about effect size, and how the requirements of power analysis can be applied without harming research on hard-to-reach and marginalized communities. For novel research questions, we advocate that researchers base sample sizes on effects that are likely to be cost-effective for other people to implement (in applied settings) or to study (in basic research settings). We discuss two alternatives to power analysis, precision analysis and sequential analysis, and end with recommendations for improving the practices of researchers, reviewers, and journal editors in social-personality psychology.

The Intrarater and Interrater Reliability of the OMT Classification Among Physicians With a Different Background

BACKGROUND

The Oberg-Manske-Tonkin (OMT) classification established excellent reliability scores in several validation studies. However, one study published in 2022 found much lower scores in a subanalysis of their sample when very simple anomalies were excluded. Our study assessed the reliability of the OMT among physicians with a different background, all involved in congenital hand anomaly care, and analyzed codes with less agreement. Time required for classification was recorded to give an indication on its usability.

METHODS

One hundred digital cases were classified twice with a minimal 1-month time interval, with the use of the 2020 version of the OMT. Two pediatric hand surgeons, 2 rehabilitation specialists, and 2 plastic surgery residents participated in this reliability analysis. The use of multiple codes was allowed. The intra- and interrater reliability was assessed for all 15 possible rater couples by calculating percentage of agreement. Cohen's kappa was calculated along with a 95% confidence interval. For the analysis of individual codes with less agreement, we calculated positive agreement with the use of a summed agreement table. Time necessary for classification was documented in seconds.

RESULTS

The inter- and intrarater agreement was moderate with a mean Cohen's kappa of 0.45 and 0.60 retrospectively. On average, 39 seconds per case were necessary for the first and 24 seconds for the second rating. Background did not influence the level of agreement. Lowest agreement levels (ie, lowest positive agreement) were observed with all the arthrogryposis multiplex congenita subgroups, the "other" subgroups of isolated congenital contractures, syndromic syndactyly, and synpolydactyly. Codes commonly used interchangeably were symbrachydactyly and transverse deficiency and the distinction between these anomalies of only the hand or the entire upper limb; symbrachydactyly and brachydactyly; and camptodactyly and distal arthrogryposis.

CONCLUSIONS

Our study showed a moderate reliability, emphasizing the complexity of this heterogeneous patient population. Despite its imperfections, the OMT remains the best and most versatile classification tool at hand. Its main purpose may lie in contributing to a universal language for research.

LEVEL OF EVIDENCE

I.

Quasi-critical dynamics in large-scale social systems regulated by sudden events

How do heterogeneous individual behaviors arise in response to sudden events and how do they shape large-scale social dynamics? Based on a five-year naturalistic observation of individual purchasing behaviors, we extract the long-term consumption dynamics of diverse commodities from approximately 2.2 million purchase orders. We subdivide the consumption dynamics into trend, seasonal, and random components and analyze them using a renormalization group. We discover that the coronavirus pandemic, a sudden event acting on the social system, regulates the scaling and criticality of consumption dynamics. On a large time scale, the long-term dynamics of the system, regardless of arising from trend, seasonal, or random individual behaviors, is pushed toward a quasi-critical region between independent (i.e., the consumption behaviors of different commodities are irrelevant) and correlated (i.e., the consumption behaviors of different commodities are interrelated) phases as the pandemic erupts. On a small time scale, short-term consumption dynamics exhibits more diverse responses to the pandemic. While the trend and random behaviors of individuals are driven to quasi-criticality and exhibit scale-invariance as the pandemic breaks out, seasonal behaviors are more robust against regulations. Overall, these discoveries provide insights into how quasi-critical macroscopic dynamics emerges in heterogeneous social systems to enhance system reactivity to sudden events while there may exist specific system components maintaining robustness as a reflection of system stability.

Changes in limb bone diaphyseal structure in chimpanzees during development

OBJECTIVES

This study tests if femoral and humeral cross-sectional geometry (CSG) and cross-sectional properties (CSPs) in an ontogenetic series of wild-caught chimpanzees (Pan troglodytes ssp.) reflect locomotor behavior during development. The goal is to clarify the relationship between limb bone structure and locomotor behavior during ontogeny in Pan.

MATERIALS AND METHODS

The latex cast method was used to reconstruct cross sections at the midshaft femur and mid-distal humerus. Second moments of area (SMAs) (Ix, Iy, Imax, Imin), which are proportional to bending rigidity about a specified axis, and the polar SMA (J), which is proportional to average bending rigidity, were calculated at section locations. Cross-sectional shape (CSS) was assessed from Ix/Iy and Imax/Imin ratios. Juvenile and adult subsamples were compared.

RESULTS

Juveniles and adults have significantly greater femoral J compared to humeral J. Mean interlimb proportions of J are not significantly different between the groups. There is an overall decreasing trend in diaphyseal circularity between the juvenile phase of development and adulthood, although significant differences are only found in the humerus.

DISCUSSION

Juvenile chimpanzee locomotion includes forelimb- and hindlimb-biased behaviors. Juveniles and adults preferentially load their hindlimbs relative to their forelimbs. This may indicate similar locomotor behavior, although other explanations including a diversity of hindlimb-biased locomotor behaviors in juveniles cannot be ruled out. Different ontogenetic trends in forelimb and hindlimb CSS are consistent with limb bone CSG reflecting functional adaptation, albeit the complex nature of bone functional adaptation requires cautious interpretations of skeletal functional morphology from biomechanical analyses.

Genetic and environmental influences on structural brain development from childhood to adolescence: A longitudinal twin study on cortical thickness, surface area, and subcortical volume

The human brain undergoes structural development from childhood to adolescence, with specific regions in the sensorimotor, social, and affective networks continuing to grow into adulthood. While genetic and environmental factors contribute to individual differences in these brain trajectories, the extent remains understudied. Our longitudinal study, utilizing up to three biennial MRI scans (n=485), aimed to assess the genetic and environmental effects on brain structure (age 7) and development (ages 7-14) in these regions. Heritability estimates varied across brain regions, with all regions showing genetic influence (ranging from 18 % to 59 %) with additional shared environmental factors affecting the primary motor cortex (30 %), somatosensory cortex (35 %), DLPFC (5 %), TPJ (17 %), STS (17 %), precuneus (10 %), hippocampus (22 %), amygdala (5 %), and nucleus accumbens (10 %). Surface area was more genetically driven (38 %) than cortical thickness (14 %). Longitudinal brain changes were primarily driven by genetics (ranging from 1 % to 29 %), though shared environment factors (additionally) influenced the somatosensory cortex (11 %), DLPFC (7 %), cerebellum (28 %), TPJ (16 %), STS (20 %), and hippocampus (17 %). These findings highlight the importance of further investigating brain-behavior associations and the influence of enriched and deprived environments from childhood to adolescence. Ultimately, our study can provide insights for interventions aimed at supporting children's development.

Highly Involved Parenting of Adolescents With ADHD: Examination of the Psychometric Properties of a Measure of "Helicopter Parenting"

OBJECTIVE

The concept of the "helicopter parent" was popularized in the 2000s and 2010s by Western culture, and it has recently begun to be examined by researchers to describe parental over-involvement and intrusive behavior that impedes transition into adulthood. Research has yet to investigate the viability of this construct for adolescents when parenting is needed to facilitate the development of autonomy. The present study examined the psychometric structure of a modified "helicopter parenting" measure adapted for use in a sample with increased likelihood of highly involved parenting: adolescents with ADHD.

METHODS

Adolescents (n = 333; age 13-18 years; 25% female) and their parents (n = 341, 91% female) completed a survey for a study on provider training in stimulant diversion prevention in 2016 and 2017. We modified a previously validated measure of "helicopter parenting" for young adults. Other previously established parenting measures were included. We conducted principal component analysis for both informants' reports of the modified measure. We examined associations between the components and informants' demographic characteristics and parenting measures to begin to examine convergent and discriminant validity.

RESULTS

Two components were identified for adolescent and parent reports and labeled parental Intervention and Day-to-day Monitoring and Planning. These components were differentially associated with demographic characteristics and other measures of parenting. For example, across reporters, parents exhibited less Day-to-Day Monitoring and Planning for older adolescents. Racially/ethnically minoritized parents and male adolescents reported more Intervention parenting. Modest-sized statistically significant associations were found between these indicators of highly involved parenting and the other measures of parenting.

CONCLUSION

Findings provide initial evidence of construct validity. Future work with more heterogeneous samples should examine if this measure captures adaptive parenting, or behaviors that interfere with developing independence, for adolescents with ADHD and neurotypically developing adolescents.

ChatGPT and retinal disease: a cross-sectional study on AI comprehension of clinical guidelines

OBJECTIVE

To evaluate the performance of an artificial intelligence (AI) large language model, ChatGPT (version 4.0), for common retinal diseases, in accordance with the American Academy of Ophthalmology (AAO) Preferred Practice Pattern (PPP) guidelines.

DESIGN

A cross-sectional survey study design was employed to compare the responses made by ChatGPT to established clinical guidelines.

PARTICIPANTS

Responses by the AI were reviewed by a panel of three vitreoretinal specialists for evaluation.

METHODS

To investigate ChatGPT's comprehension of clinical guidelines, we designed 130 questions covering a broad spectrum of topics within 12 AAO PPP domains of retinal disease These questions were crafted to encompass diagnostic criteria, treatment guidelines, and management strategies, including both medical and surgical aspects of retinal care. A panel of 3 retinal specialists independently evaluated responses on a Likert scale from 1 to 5 based on their relevance, accuracy, and adherence to AAO PPP guidelines. Response readability was evaluated using Flesch Readability Ease and Flesch-Kincaid grade level scores.

RESULTS

ChatGPT achieved an overall average score of 4.9/5.0, suggesting high alignment with the AAO PPP guidelines. Scores varied across domains, with the lowest in the surgical management of disease. The responses had a low reading ease score and required a college-to-graduate level of comprehension. Identified errors were related to diagnostic criteria, treatment options, and methodological procedures.

CONCLUSION

ChatGPT 4.0 demonstrated significant potential in generating guideline-concordant responses, particularly for common medical retinal diseases. However, its performance slightly decreased in surgical retina, highlighting the ongoing need for clinician input, further model refinement, and improved comprehensibility.

Normal ovarian sizes on MRI in pediatric patients: a preliminary study

BACKGROUND

Ovarian enlargement is one of several findings of pathology, including ovarian torsion. With increasing use of MRI for acute abdominal pain in children, data for normal ovary size and appearance are needed.

OBJECTIVE

To provide preliminary data on normal sizes of ovaries on MRI in pediatric patients.

MATERIALS AND METHODS

This retrospective IRB-approved study included girls (5 to 17 years of age) with MRI examinations performed for indications not related to the ovaries from 2018 to 2022. For each MRI, coronal T2-weighted single shot fast spin echo and axial T2-weighted fat-saturated images were independently reviewed by three pediatric radiologists who recorded ovary visualization and ovarian linear measurements (3 planes). Ovarian volumes were calculated from linear measurements. Agreement among observers was calculated using kappa statistics and intraclass correlation coefficients.

RESULTS

A total of 181 MRIs were reviewed. The left ovary was visualized in 166-176 (92-97%) cases (R1-R3) and the right ovary was visualized in 165-174 (91-96%) cases with excellent agreement among reviewers (left: K = 0.89 [0.84-0.94], right: K = 0.85 [0.79-0.91]). Interrater class coefficient (ICC) for largest single dimension of the ovary was left: 0.83 (CI 0.79-0.87) and right: 0.85 (CI 0.81-0.89). There were significant moderate to strong correlations between ovarian volume and age (left: 0.67 [0.58-0.75], right: 0.66 [0.57-0.74]).

CONCLUSION

The ovaries can be adequately visualized and measured on MRI with excellent inter-reader agreement. This study serves as the foundation for developing normative values for ovarian volumes by age on MRI.

Pulp Survival of Cracked Teeth with Reversible Pulpitis after Orthodontic Banding and Coronal Coverage - A Prospective Cohort Study with One Year Follow Up

INTRODUCTION

The aim of this prospective study was to investigate the 1-year pulp survival of cracked teeth with reversible pulpitis managed with initial stabilization using orthodontic bands, followed by coronal coverage restorations.

METHODS

One-hundred-and-twenty-five patients with a cracked tooth with reversible pulpitis each were recruited. Preoperative patient and tooth data were collected. After definitive pulp diagnoses were determined following an interim period of orthodontic banding, coronal coverage restorations were placed. Cox and logistic regression analyses were used to assess possible prognostic factors and to correlate initial time to pulp stabilization while in orthodontic bands with eventual outcome. Pulp survival was determined using both clinical and radiographic findings.

RESULTS

One-hundred-and-six cracked teeth were followed up at 1 year. Pulp survival based on clinical and radiographic findings was found in 81 teeth (76.4%). Out of 25 failures, 11 (44%) required root canal treatment (RCT) in the orthodontic band stage and 10 (40%) required RCT during the process of or after coronal coverage restorations. Four teeth (16%) had incidental findings of periapical radiolucencies at the 1-year review without clinical symptoms. Teeth requiring RCT were found to have required longer periods in orthodontic bands prior to a definitive pulp diagnosis (P < .05).

CONCLUSION

A step-by-step approach by using orthodontic banding to monitor pulp status may reduce the incidence of RCT required through definitive coronal coverage restorations for cracked teeth with reversible pulpitis.

The validity of pathology codes for biopsy-confirmed kidney disease in the Danish National Patobank

Background

This study validates the application of Systematized Nomenclature of Medicine second edition (SNOMED II) codes used to describe medical kidney biopsies in Denmark in encoded form, aiming to support robust epidemiological research on the causes, treatments and prognosis of kidney diseases.

Methods

Kidney biopsy reports from 1 January 1998 to 31 December 2018 were randomly extracted from the Danish National Patobank, using SNOMED codes. A 5% sample was selected, and nephrologists assessed the corresponding medical records, assigning each case the applied clinical diagnoses. Sensitivity, specificity, positive predictive values (PPV), negative predictive values and Cohen's kappa coefficient for the retrieved SNOMED codes were calculated.

Results

A total of 613 kidney biopsies were included. The primary clinical disease groups were glomerular disease (n = 368), tubulointerstitial disease (n = 67), renal vascular disease (n = 51), diabetic nephropathy (n = 51) and various renal disorders (n = 40). Several SNOMED codes were used to describe each clinical disease group and PPV for the combined SNOMED codes were high for glomerular disease (94%), diabetic nephropathy (85%) and systemic diseases affecting the kidney (96%). Conversely, tubulointerstitial disease (62%), renal vascular disease (60%) and other renal disorders (17%) showed lower PPV.

Conclusions

SNOMED codes have a high PPV for glomerular diseases, diabetic nephropathy and systemic diseases affecting the kidney, in which they could be applied for future epidemiological research.

Development of the Life-Worldly Communication Scale to Improve Quality of Life: Daily Conversation as Care for Older Adults

The lack of daily conversation may lead to the deterioration of quality of life and cognitive function in older adults requiring long-term care. This study aimed to develop a scale to measure daily conversation among them, the Life-Worldly Communication Scale: LWCS, and to test its structural, convergent, and discriminant validity. The subjects were 539 older adults requiring long-term care in facilities and at home. A 24-item provisional scale was created, using a panel of experts. Structural validity of LWCS was examined from exploratory factor analysis to establish the factor structure, two confirmatory factor analyses for cross-validation, and measurement invariance between the institutional and home setting. Convergent validity was examined from the average variance extracted: AVE, composite reliability: CR, and simple regression analysis between LWCS and Interdependent Happiness Scale: IHS. Discriminant validity was examined using the heterotrait-monotrait ratio of correlations: HTMT. Multiple imputations were used to deal with missing data on these scales. The results showed that the goodness of fit of the three-factor, 11-item model obtained from the two-step CFA was SRMR = .043, RMSEA = .059, CFI = .978, and AGFI = .905. The model was confirmed for structural validity by measurement invariance tests: configural invariance (CFI=.973, RMSEA = .047), metric invariance (ΔCFI= .001, ΔRMSEA=-.004), scalar invariance (ΔCFI =-0.002, RMSEA = -0.003). Convergent validity was confirmed by AVE = .503~.772, CR = .801~.910, and simple regression analysis between LWCS and IHS (adjusted r2=.18, p < .001). Discriminant validity was also confirmed among the three factors (HTMT=.496~.644). LWCS can contribute to the assessment of daily conversation in geriatric settings and research regarding its promotion.

HIV Activist Identity, Commitment, and Orientation Scale (HAICOS): Psychometric Evaluation to Assess Clinician's Propensity Towards HIV Activism in Malaysia

HIV activism has a long history of advancing HIV treatment and is critical in dismantling HIV-related stigma. This study evaluated the psychometric quality of the HIV Activist Identity, Commitment, and Orientation Scale (HAICOS) to assess clinicians' propensity towards HIV activism in Malaysia. From November 2022 to March 2023, 74 general practitioners and primary care physicians in Malaysia participated in the study. The exploratory factor analysis (EFA) extracted an internally consistent three-factor solution with 13 items: (1) HIV activist identity and commitment, orientation towards (2) day-to-day, and (3) structural activism. The Cronbach's alpha value was 0.91, and intra-class correlation coefficient for test-retest reliability was 0.86. Stigma-related (prejudice and discrimination intent) and clinical practice (comfort in performing clinical tasks with key populations and knowledge about HIV pre-exposure prophylaxis) measures supported the construct validity of the scale. The study provided concise, structurally valid, and reliable measures to evaluate HIV activism among clinicians.

Trajectory and Determinants of Quality of Life Among Postpartum Women

BACKGROUND

The postpartum period is a critical phase in which postpartum women experience dynamic changes in their physiology, psychology, and family status.

OBJECTIVE

This study investigated the changes in women's quality of life (QoL) during the first, third, and sixth months of the postpartum period and their associated factors.

METHODS

A single-group repeated-measure design was used to collect data from 282 postpartum women recruited from a regional hospital in Taiwan. We used the brief World Health Organization Quality of Life scale, Social Support Scale, and Edinburgh Postnatal Depression Scale to assess postpartum women's quality of life, social support, and postpartum depressive symptoms, respectively. The data were analyzed using trajectory analysis and generalized estimating equations.

RESULTS

The trajectory analysis indicated that postpartum women could be categorized into low, medium, and high QoL groups. Although the medium and high QoL groups maintained stable QoL levels, the low QoL group experienced a linear decrease in QoL over time. Moreover, the determinants of postpartum women's QoL were immigrant status, employment status, family type, social support, and postpartum depression.

CONCLUSIONS

Health care providers should assess these determinants of postpartum QoL in perinatal women to identify those at risk of low postpartum quality of life. Early assessment and intervention by health care providers could significantly improve the health status of women after childbirth.

Inter-reader Agreement for Prostate Cancer Detection Using Micro-ultrasound: A Multi-institutional Study

Background and objective

Micro-ultrasound (MUS) uses a high-frequency transducer with superior resolution to conventional ultrasound, which may differentiate prostate cancer from normal tissue and thereby allow targeted biopsy. Preliminary evidence has shown comparable sensitivity to magnetic resonance imaging (MRI), but consistency between users has yet to be described. Our objective was to assess agreement of MUS interpretation across multiple readers.

Methods

After institutional review board approval, we prospectively collected MUS images for 57 patients referred for prostate biopsy after multiparametric MRI from 2022 to 2023. MUS images were interpreted by six urologists at four institutions with varying experience (range 2-6 yr). Readers were blinded to MRI results and clinical data. The primary outcome was reader agreement on the locations of suspicious lesions, measured in terms of Light's κ and positive percent agreement (PPA). Reader sensitivity for identification of grade group (GG) ≥2 prostate cancer was a secondary outcome.

Key findings and limitations

Analysis revealed a κ value of 0.30 (95% confidence interval [CI] 0.21-0.39). PPA was 33% (95% CI 25-42%). The mean patient-level sensitivity for GG ≥2 cancer was 0.66 ± 0.05 overall and 0.87 ± 0.09 when cases with anterior lesions were excluded. Readers were 12 times more likely to detect higher-grade cancers (GG ≥3), with higher levels of agreement for this subgroup (κ 0.41, PPA 45%). Key limitations include the inability to prospectively biopsy reader-delineated targets and the inability of readers to perform live transducer maneuvers.

Conclusions and clinical implications

Inter-reader agreement on the location of suspicious lesions on MUS is lower than rates previously reported for MRI. MUS sensitivity for cancer in the anterior gland is lacking.

Patient summary

The ability to find cancer on imaging scans can vary between doctors. We found that there was frequent disagreement on the location of prostate cancer when doctors were using a new high-resolution scan method called micro-ultrasound. This suggests that the performance of micro-ultrasound is not yet consistent enough to replace MRI (magnetic resonance imaging) for diagnosis of prostate cancer.

Scene construction ability in neurotypical and autistic adults

LAY ABSTRACT

People with autism spectrum conditions (ASC) have difficulties imagining events, which might result from difficulty mentally generating and maintaining a coherent spatial scene. This study compared this scene construction ability between autistic (N = 55) and neurotypical (N = 63) adults. Results showed that scene construction was diminished in autistic compared to neurotypical participants, and participants with fewer autistic traits had better scene construction ability. ASC diagnosis did not influence the frequency of mentions of the self or of sensory experiences. Exploratory analysis suggests that scene construction ability is associated with the ability to understand our own and other people's mental states, and that these individual-level preferences/cognitive styles can overrule typical group-level characteristics.

How workload and availability of spatial reference shape eye movement coupling in visuospatial working memory

Eyes are active in memory recall and visual imagination, yet our grasp of the underlying qualities and factors of these internally coupled eye movements is limited. To explore this, we studied 50 participants, examining how workload, spatial reference availability, and imagined movement direction influence internal coupling of eye movements. We designed a visuospatial working memory task in which participants mentally moved a black patch along a path within a matrix and each trial involved one step along this path (presented via speakers: up, down, left, or right). We varied workload by adjusting matrix size (3 × 3 vs. 5 × 5), manipulated availability of a spatial frame of reference by presenting either a blank screen (requiring participants to rely solely on their mental representation of the matrix) or spatial reference in the form of an empty matrix, and contrasted active task performance to two control conditions involving only active or passive listening. Our findings show that eye movements consistently matched the imagined movement of the patch in the matrix, not driven solely by auditory or semantic cues. While workload influenced pupil diameter, perceived demand, and performance, it had no observable impact on internal coupling. The availability of spatial reference enhanced coupling of eye movements, leading more frequent, precise, and resilient saccades against noise and bias. The absence of workload effects on coupled saccades in our study, in combination with the relatively high degree of coupling observed even in the invisible matrix condition, indicates that eye movements align with shifts in attention across both visually and internally represented information. This suggests that coupled eye movements are not merely strategic efforts to reduce workload, but rather a natural response to where attention is directed.

Biochar production from various low-cost marine wastes using different production methods: Characterization of biochar and marine feedstock for agricultural purposes

Studies on the conversion of organic materials into biochar have been preferred due to the effectiveness of biochar. Aquatic ecosystems harbor a significant amount of organic biomass, much of which is transferred to terrestrial systems, but often remains as waste. In this study, Posidonia oceanica (PO), Halidrys siliquosa (HS), Ulva lactuca (UL), and Codium fragile (CF), commonly found as marine waste along coastlines globally, were used as feedstocks for biochar production under four different pyrolysis conditions. Several analyses were conducted to characterize both marine waste and biochar forms in order to evaluate their potential for agricultural applications. The results showed that marine wastes and biochars contain almost all the necessary nutrients required for plant nutrition in varying proportions. The CF feedstock has a higher nitrogen (N) content than other feedstocks, while the UL contains greater phosphorus (P), potassium (K), and magnesium (Mg). Additionally, the PO exhibits high calcium (Ca), boron (B), and manganese (Mn) contents. Carbon (C) content also varied significantly depending on the biochar production technique. Temperature had a greater influence than holding time on the disparities in the elemental composition of biochars. The pH values of all types of biochar increased with rising temperature. However, the electrical conductivity (EC) values of HS and PO biochars decreased with increasing temperature. The highest mean BET surface area was observed in PO biochars. However, UL biochar has the most significant proportional increase compared to the UL feedstock by 218 times. All characteristics determined for all materials (feedstock, biochar) were within acceptable limits for application to soil. In conclusion, both marine waste and biochar forms may be confidently used for agricultural purposes, particularly in soil applications, when considering the characterization parameters within the scope of this research. Additionally, supporting and developing these results with more comprehensive analysis and research would be more suitable to reveal the potential of these marine wastes for agricultural systems.

Can templates-for-rejection suppress real-world affective objects in visual search?

Previous evidence has suggested that feature-based templates-for-rejection can be maintained in working memory to suppress matching features in the environment. Currently, this effect has only been demonstrated using abstract neutral shapes, meaning that it is unclear whether this generalizes to real-world images, including aversive stimuli. In the current investigation, participants searched amongst an array of real-world objects for a target, after being precued with either a distractor template, target template, or a no template baseline. In Experiment 1, where both distractor and target template cues were presented randomly on a trial-by-trial basis, there was moderate evidence of increased capture by aversive distractors after the distractor template cue. In Experiment 2a, however, when distractor templates were the only available cue and more time was given to encode the cue features, there was moderate evidence of effective distractor inhibition for real-world aversive and neutral stimuli. In Experiment 2b, when the task required a slower more effortful comparison of target features to stereotypical object representations, there was weaker evidence of inhibition, though there was still modest evidence suggesting effective inhibition of aversive distractors. A Bayesian meta-analysis revealed that across Experiment 2, aversive distractors showed strong cumulative evidence of effective inhibition, but inconsistent inhibition for neutral distractors. The results are interpreted from a rational search behaviour framework, which suggests that individuals utilize informative cues when they enable the most beneficial strategy and are accessible, and apply these to distractors when they cause sufficient disruption, either to search speed or emotional state.

Gambling participation and risk after COVID-19: Analysis of a population representative longitudinal panel of Australians

BACKGROUND AND AIMS

The impact of the COVID-19 pandemic on gambling participation and levels of gambling harm across populations during the pandemic is now addressed in a well-established body of empirical literature. This study aimed to measure the longer-term implications of COVID-19 on gambling participation and levels of gambling harm.

DESIGN

Population-based cohort study using group-based trajectory modelling.

SETTING

Australia, using gambling participation, problem gambling risk, sociodemographic and psychosocial data from 2019 (pre COVID-19), 2020, 2021 (during COVID-19) and 2023 (post COVID-19).

PARTICIPANTS

A population representative survey of Australian adults, including four waves collected in April 2019 (n = 2054), November 2020 (n = 3029), October 2021 (n = 3474) and January 2023 (n = 3370), with a subset (n = 3160) of the sample having longitudinal data available.

MEASUREMENTS

Participants were asked which gambling activities they participated in over the past 12 months for money. Problem gambling risk was measured by the nine-item Problem Gambling Severity Index (PGSI).

FINDINGS

There was an overall reduction in gambling participation during COVID-19 and return to pre-pandemic levels for most gambling activities by 2023. The longitudinal analysis yielded four trajectories of gambling participation from 2019 to 2023, including individuals who (1) never gambled (25.0% of the longitudinal sample; n = 789); (2) engaged in non-problematic gambling (59.8%; n = 1888); (3) ceased gambling during COVID-19 and started again post pandemic (10.7%; n = 337); and (4) engaged in high risk gambling (4.6%; n = 146), with particular demographic and psychosocial profiles and patterns of participation in specific gambling activities related to these trajectories.

CONCLUSIONS

Although overall gambling participation rates decreased at the population level in Australia during COVID-19, by 2023 participation in gambling appeared to have nearly returned to pre-pandemic levels. Patterns of gambling behavior before, during and after the pandemic appear to be heterogeneous.

Observational learning of threat-related attentional bias

Attentional bias to threat has been almost exclusively examined after participants experienced repeated pairings between a conditioned stimulus (CS) and an aversive unconditioned stimulus (US). This study aimed to determine whether threat-related attentional capture can result from observational learning, when participants acquire knowledge of the aversive qualities of a stimulus without themselves experiencing aversive outcomes. Non-clinical young-adult participants (N = 38) first watched a video of an individual (the demonstrator) performing a Pavlovian conditioning task in which one colour was paired with shock (CS+) and another colour was neutral (CS-). They then carried out visual search for a shape-defined target. Oculomotor measures evidenced an attentional bias toward the CS+ colour, suggesting that threat-related attentional capture can ensue from observational learning. Exploratory analyses also revealed that this effect was positively correlated with empathy for the demonstrator. Our findings extend empirical and theoretical knowledge about threat-driven attention and provide valuable insights to better understand the formation of anxiety disorders.

Identification and validation of gestational diabetes subgroups by data-driven cluster analysis

AIMS/HYPOTHESIS

Gestational diabetes mellitus (GDM) is a heterogeneous condition. Given such variability among patients, the ability to recognise distinct GDM subgroups using routine clinical variables may guide more personalised treatments. Our main aim was to identify distinct GDM subtypes through cluster analysis using routine clinical variables, and analyse treatment needs and pregnancy outcomes across these subgroups.

METHODS

In this cohort study, we analysed datasets from a total of 2682 women with GDM treated at two central European hospitals (1865 participants from Charité University Hospital in Berlin and 817 participants from the Medical University of Vienna), collected between 2015 and 2022. We evaluated various clustering models, including k-means, k-medoids and agglomerative hierarchical clustering. Internal validation techniques were used to guide best model selection, while external validation on independent test sets was used to assess model generalisability. Clinical outcomes such as specific treatment needs and maternal and fetal complications were analysed across the identified clusters.

RESULTS

Our optimal model identified three clusters from routinely available variables, i.e. maternal age, pre-pregnancy BMI (BMIPG) and glucose levels at fasting and 60 and 120 min after the diagnostic OGTT (OGTT0, OGTT60 and OGTT120, respectively). Cluster 1 was characterised by the highest OGTT values and obesity prevalence. Cluster 2 displayed intermediate BMIPG and elevated OGTT0, while cluster 3 consisted mainly of participants with normal BMIPG and high values for OGTT60 and OGTT120. Treatment modalities and clinical outcomes varied among clusters. In particular, cluster 1 participants showed a much higher need for glucose-lowering medications (39.6% of participants, compared with 12.9% and 10.0% in clusters 2 and 3, respectively, p<0.0001). Cluster 1 participants were also at higher risk of delivering large-for-gestational-age infants. Differences in the type of insulin-based treatment between cluster 2 and cluster 3 were observed in the external validation cohort.

CONCLUSIONS/INTERPRETATION

Our findings confirm the heterogeneity of GDM. The identification of subgroups (clusters) has the potential to help clinicians define more tailored treatment approaches for improved maternal and neonatal outcomes.

Investigating the Visual Utility of Differentially Private Scatterplots

Increasingly, visualization practitioners are working with, using, and studying private and sensitive data. There can be many stakeholders interested in the resulting analyses-but widespread sharing of the data can cause harm to individuals, companies, and organizations. Practitioners are increasingly turning to differential privacy to enable public data sharing with a guaranteed amount of privacy. Differential privacy algorithms do this by aggregating data statistics with noise, and this now-private data can be released visually with differentially private scatterplots. While the private visual output is affected by the algorithm choice, privacy level, bin number, data distribution, and user task, there is little guidance on how to choose and balance the effect of these parameters. To address this gap, we had experts examine 1,200 differentially private scatterplots created with a variety of parameter choices and tested their ability to see aggregate patterns in the private output (i.e. the visual utility of the chart). We synthesized these results to provide easy-to-use guidance for visualization practitioners releasing private data through scatterplots. Our findings also provide a ground truth for visual utility, which we use to benchmark automated utility metrics from various fields. We demonstrate how multi-scale structural similarity (MS-SSIM), the metric most strongly correlated with our study's utility results, can be used to optimize parameter selection.

Determinants of pharmacists' confidence to participate in antimicrobial stewardship: A confirmatory factor analysis

AIM

Pharmacists are essential members of hospital antimicrobial stewardship (AMS) teams. A lack of self-perceived confidence can limit pharmacists' involvement and contributions. Pharmacists working in AMS have reported a lack of confidence. There is currently a lack of validated measures to assess pharmacists' self-perceived confidence when working in AMS and contributors to this confidence. This study aimed to identify variables contributing to pharmacist self-perceived confidence and validate an AMS hospital pharmacist survey tool using confirmatory factor analysis (CFA).

METHODS

Responses from a survey of Australian and French hospital pharmacists were used to undertake CFA and path analysis on factors related to pharmacists' self-perceived confidence. It was hypothesized that pharmacists' self-perceived confidence would be impacted by time working in AMS, perceived importance of AMS programmes, perceived barriers to participating in AMS and current participation.

RESULTS

CFA demonstrated a good model fit between the factors. Items included in the model loaded well to their respective factors with acceptable reliability. Path analysis demonstrated that time working in AMS had a significant impact on pharmacists' self-perceived confidence, while perceived barriers had a negatively significant relationship. Pharmacy participation in AMS and perceived importance of AMS programmes had a non-significant impact.

CONCLUSION

Findings demonstrated that the survey tool showed good validity and identified factors that can impact pharmacists' self-perceived confidence when working in hospital AMS programmes. Having a validated survey tool can identify factors that can reduce pharmacists' self-perceived confidence. Strategies can then be developed to address these factors and subsequently improve pharmacists' self-perceived confidence.

Give me enough time to rehearse: presentation rate modulates the production effect

This paper uses the production effect to test one of the important predictions of a view of memory that is embodied in the Revised Feature Model (RFM). When to-be-recalled lists contain items both read aloud and silently, words read aloud are less well recalled at the beginning of the list and better recalled at the end. According to the RFM, producing the items by reading them aloud adds distinctive features which supports recall, but production also interferes with rehearsal - a process that operates more significantly at the start of a list. This critical role assigned to rehearsal has never been systematically tested. We do this here through a systematic literature review and an experiment that manipulates presentation rate. With a faster presentation rate, rehearsal is less likely; the implication is that the advantage observed for silently read items in the primacy positions should vanish, while the recency advantage for produced items should remain. The systematic review collected an initial sample of 422 unique articles on the production effect in immediate serial recall and revealed the predicted pattern. In addition, in our experiment, the presentation rate was manipulated within an immediate serial recall task (500, 1,000, and 2,000 ms/word). As predicted, the recency advantage for produced items was observed for all presentation speeds. Critically, the production disadvantage for early serial positions was only present for the two slowest rates, but not at the fastest speed. Results were successfully modeled by calling upon the RFM.

Neurexin 3 is Essential for the Specific Wiring of a Color Pathway in the Mammalian Retina

Precise wiring within sensory systems is critical for the accurate transmission of information. In the visual system, S-cone photoreceptors specialize in detecting short-wavelength light, crucial to color perception and environmental cue detection. S-cones form specific synapses with S-cone bipolar cells (SCBCs), a connection that is remarkably consistent across species. Yet, the molecular mechanisms guiding this specificity remain unexplored. To address this, we used the cone-dominant ground squirrel for deep-sequencing of cone subtype transcriptomes and identified Nrxn3 as an essential molecule for the S-cone to SCBC synapse. Using transgenic mouse models, we further examined the role of Nrxn3 in S-cones and discovered a significant reduction of SCBC connections in the absence of Nrxn3. This finding extends the known functions of neurexins, typically associated with synapse regulation, by highlighting their essential role in a specific synaptic connection for the first time. Moreover, the differentially expressed genes identified here pave the way for further investigations into the unique functions of cone subtypes.

Public perception vs ecological quality status: Examining the ecological restoration of the Congost River's Environment

This study examines the public's perceptions of the ecological restoration of the Congost River over the past thirty years, focusing on the period between 2010 and 2022. We conducted a survey of 112 river users across five key zones identified through a pilot study for their high pedestrian density, aiming to analyse how different sociodemographic groups perceive the river's ecological state. A structured questionnaire was distributed along both sides of the river to engage a diverse range of individuals typically utilizing the river environment. The collected data were analysed using regression models and Mann-Whitney U tests to assess differences between groups, with Bonferroni adjustments applied to control for multiple comparisons. The results reveal a broad increase in appreciation for the river since 2010, alongside measurable ecological improvements supported by scientific data. Despite these positive changes, a majority of surveyed users remain sceptical about the river's recovery, with less pronounced scepticism among older respondents, those with higher education, and environmental volunteers. These groups' perceptions align more closely with empirical evidence, highlighting the influence of sociodemographic factors on environmental awareness. Individuals living closer to natural settings and frequent river visitors were found to be more attuned to changes in the river's environment, particularly in aesthetic and sensory aspects. The study underscores the persistence of a perceptual gap between scientific assessments of ecological health and public sentiment, emphasizing the complex relationship between community perceptions and objective environmental indicators. These insights underline the complex relationship between community perceptions and objective environmental indicators, reflecting a broader trend in environmental awareness and the importance of factual communication in ecological issues.

Population Performance and Individual Agreement of Coronary Artery Disease Polygenic Risk Scores

Importance

Polygenic risk scores (PRSs) for coronary artery disease (CAD) are a growing clinical and commercial reality. Whether existing scores provide similar individual-level assessments of disease liability is a critical consideration for clinical implementation that remains uncharacterized.

Objective

Characterize the reliability of CAD PRSs that perform equivalently at the population level at predicting individual-level risk.

Design

Cross-sectional Study.

Setting

All of Us Research Program (AOU), Penn Medicine Biobank (PMBB), and UCLA ATLAS Precision Health Biobank.

Participants

Volunteers of diverse genetic backgrounds enrolled in AOU, PMBB, and UCLA with available electronic health record and genotyping data.

Exposures

Polygenic risk for CAD from previously published PRSs and new PRSs developed separately from the testing cohorts.

Main Outcomes and Measures

Sets of CAD PRSs that perform population prediction equivalently were identified by comparing calibration and discrimination (Brier score and AUROC) of generalized linear models of prevalent CAD using Bayesian analysis of variance. Among equivalently performing scores, individual-level agreement between risk estimates was tested with intraclass correlation (ICC) and Light's Kappa, measures of inter-rater reliability.

Results

50 PRSs were calculated for 171,095 AOU participants. When included in a model of prevalent CAD, 48 scores had practically equivalent Brier scores and AUROCs (region of practical equivalence = 0.02). Across these scores, 84% of participants had at least one score in both the top and bottom risk quintile. Continuous agreement of individual risk predictions from the 48 scores was poor, with an ICC of 0.351 (95% CI; 0.349, 0.352). Agreement between two statistically equivalent scores was moderate, with an ICC of 0.649 (95% CI; 0.646, 0.652). Light's Kappa, used to evaluate consistency of assignment to high-risk thresholds, did not exceed 0.56 (interpreted as 'fair') across statistically and practically equivalent scores. Repeating the analysis among 41,193 PMBB and 50,748 UCLA participants yielded different sets of statistically and practically equivalent scores which also lacked strong individual agreement.

Conclusions and Relevance

Across three diverse biobanks, CAD PRSs that performed equivalently at the population level produced unreliable individual risk estimates. Approaches to clinical implementation of CAD PRSs must consider the potential for discordant individual risk estimates from otherwise indistinguishable scores.

The interaction of top-down and bottom-up attention in visual working memory

Understanding the interplay between top-down and bottom-up attention in visual working memory (VWM) is crucial, although the specific challenges arising from this interaction remain ambiguous. In this study, we address this complexity by examining how cue informativeness and probe status of the salient items influence this interaction. Through three experiments, we manipulated top-down attention by varying probe frequencies using pre-cues and bottom-up attention by varying the visual salience of memory items. Experiment 1 explored cue informativeness at 100% and 50%, while Experiments 2 and 3 maintained cue informativeness at 80% and 50%. Additionally, Experiment 1 tested a few of the salient items, Experiment 2 excluded them, and Experiment 3 tested half of them in each cue condition. Across all experiments, we consistently observed cueing benefits for cue-directed items, albeit with costs to non-cued items. Furthermore, cue informativeness and the probe status of salient items emerged as critical factors influencing the interaction between top-down and bottom-up attention in VWM. These findings underscore the pivotal roles of cue informativeness and salient item relevance in shaping the dynamics of top-down and bottom-up attention within VWM.

Diagnostic validity of ICDAS clinical criteria on digital 3D models

OBJECTIVE

To assess the diagnostic validity of ICDAS clinical criteria on 3D dental models from intraoral scanning.

METHODS

This is a retrospective analysis on part of the baseline sample collected in a cohort study and included 73 participants (12-19 years) from Denmark and Greece. The assessment was made by visual inspection, and then by visual inspection associated with radiographs. All participants were scanned with TRIOS 4 which uses white light to obtain the 3D models with tooth color, as well as blue light source (415 nm) for fluorescence. The 3D models' evaluation was conducted using tooth-color texture and subsequently fluorescence. Two scores were obtained for the 3D model examination: i) ICDAS based on tooth-color information; ii) ICDAS based on tooth-color information supplemented with fluorescence. For the analysis, weighted kappa, sensitivity (SE), specificity (SP) and accuracy (ACC) were calculated.

RESULTS

Regarding all lesions the values for SE, SP, and ACC were respectively 0.804, 0.801, and 0.802 for tooth-color, and 0.819, 0.808, and 0.810 for tooth-color supplemented with fluorescence. In terms of accuracy parameters for moderate-extensive lesions, the values for SE, SP, and ACC for tooth color were 0.709, 0.948, and 0.944, while for fluorescence they were 0.815, 0.937, and 0.934.

CONCLUSION

Caries assessment with ICDAS criteria on 3D dental models produces reliable scores. Visual caries analysis using 3D models demonstrates commendable diagnostic accuracy and reasonable consistency with traditional methods. The use of intraoral scanners may be beneficial in evaluating occlusal caries.

CLINICAL SIGNIFICANCE

The importance of this study is to prove the diagnostic accuracy of caries lesions diagnosis made using and intraoral scanner and to offer greater confidence to professionals who use this diagnosis tool in their daily clinical practice. Intraoral scanners demonstrate to be an accurate tool for diagnosing occlusal caries.

Development and Validation of the Sexual and Negative Dating Inventory (SANDI): A Measure of Dating and Sexual Protective Behaviors

Adverse sexual experiences are highly prevalent among college students and associated with increased mental health symptoms and decreased use of protective behavioral strategies (PBS). The current study developed and validated a measure of dating and sexual PBS: the Sexual and Negative Dating Inventory (SANDI). Participants (64.28% female, 19.59 [2.90 SD] years old, 68.90% non-Hispanic, 71.42% white, and 76.06% heterosexual) responded to baseline (n = 1,298) and one-month (n = 336) surveys. Exploratory Structural Equation Modeling identified a 24-item measure with five-factors: Location Sharing, Assertiveness, Self-Protection, Risk Reduction, and Privacy. The model revealed good fit: χ2(242) = 2115.52, p < .001, CFI = .977, RMSEA = .077 (90% CI = .074, .080), SRMR = .043. Test-retest reliability revealed acceptable reliability of 0.74 at follow-up. Overall, SANDI showed acceptable reliability and adequate convergent and discriminant validity among college students.

Developing an Ethical Perspectives Scale

Many theories hold that ethical perspectives inform moral judgments, but few such theories have corresponding individual difference scales. The present research aimed to develop an Ethical Perspectives Scale (EPS) reflecting specifically the five-perspective Markkula framework: utilitarianism; rights; fairness/justice; common good; and virtue. The authors wrote and progressively revised five sets of three items, each set intended to represent one and only one Markkula perspective, before obtaining responses from the present convenience sample (n = 621; 463 female, 157 male, 1 unspecified; Mage = 19.13, SD = 1.44) of university students. Kaiser-Meyer-Olkin (KMO = 0.867) and Bartlett's sphericity tests (χ2 = 3211.5, p < .001) showed that the data were suitable for factor analysis. An EFA with Direct Oblimin rotation yielded a five-factor structure corresponding to the five Markkula perspectives. A CFA yielded satisfactory indices of fit (χ2(80) = 92.81, p = .155, CFI = 0.991, TLI = 0.989, SRMR = 0.039, RMSEA = 0.023, HI90 ≤ .001, and LO90 = 0.041). The five subscales displayed satisfactory internal consistency (M subscale α = .76). Responses from a separate student sample (n = 148) yielded satisfactory three-week test-retest reliability (M subscale r = .72). EPS sub-scales significantly predicted evaluations of contemporary moral dilemma decisions that involved drug legalization, free speech, and pandemic restrictions. The results were interpreted as promising first steps toward an EPS useful for future research and application.

Burnout Profiles Among French Pediatric Health Care Professionals: A Cluster Analysis

The aim of our study was to identify burnout profiles among pediatric nurses and physicians, and their specificities concerning sociodemographic characteristics, occupational stress, stress specific to pediatric caregivers, and coping. Conducted on a sample of 195 French pediatric health care professionals, a cluster analysis showed 2 endpoint profiles (Engagement, Burnout) and 3 intermediate profiles (Overextended, Disengaged, Ineffective). The Burnout profile showed the highest median scores on hours worked per week, occupational stress, stress related to working conditions, and relationships with colleagues and superiors. The Overextended profile reported more stress related to working conditions than did other intermediate profiles. The Disengaged profile showed the second lowest median score on stress related to relationships with colleagues and superiors and less social support-seeking than other profiles. The Ineffective profile used less problem-focused coping than the Engagement and intermediate profiles. Intervention for the well-being of these professionals should focus primarily on improving their working conditions.

Examining the Role of Sports Betting Marketing in Youth Problem Gambling

BACKGROUND

Sports betting is becoming increasingly common among young people in the UK and Australia. There is a need to understand how the marketing of sports betting may influence risky and pathological gambling to inform policies aimed at reducing harm. This study examines whether sports betting advertising may predict problem gambling scores among young people, while accounting for non-marketing variables.

METHODS

We recruited 567 participants (53.1% male) aged 18-24 years from an online research panel. Participants were eligible if they had an active betting account and regularly bet on sports. We conducted a hierarchical regression analysis to examine whether four marketing-related measures (exposure to advertising, ad-driven betting decisions, use of betting inducements, and perceived susceptibility to betting inducements) could predict PGSI scores. We controlled for several demographic, psychological, and behavioural variables, including gender, gambling participation, spend per session, participation in in-play betting, normative beliefs about sports betting, and impulsivity.

RESULTS

The study revealed that sports betting marketing was positively associated with PGSI scores after controlling for non-marketing variables. Significant marketing predictors included ad-driven betting decisions and perceived influence from betting inducements. Other significant predictors included participation in non-sports betting gambling activities, spend per session, involvement in in-play betting, and the impulsivity trait of negative urgency.

CONCLUSION

Sports betting marketing appears to be implicated in young people's gambling problems. Specifically, young people who have gambling problems may be more likely to bet in response to advertising, and betting incentives may contribute to an intensification of their gambling behaviour. This study supports the implementation of regulations and restrictions on advertising as a measure to protect young problem gamblers.

Validity and Reliability of Dysphagia Outcome Severity Scale (DOSS) When Used to Rate Flexible Endoscopic Evaluations of Swallowing (FEES)

The Dysphagia Outcome and Severity Scale is used both clinically and within dysphagia research, internationally. Although it was developed using videofluoroscopic swallowing studies, it is frequently used to rate Flexible Endoscopic Evaluations of Swallowing. The validity and reliability of DOSS-use with FEES, however, has not previously been evaluated. This study investigated the validity and rater reliability of clinicians using DOSS to rate FEES. Eleven Speech-Language Pathologists (SLPs) with varied dysphagia experience were recruited to review and DOSS-rate 17 soundless FEES (198 bolus swallows) recorded from 11 heterogenic dysphagic patients (2 cases with repeat FEES) and 4 healthy adults. The SLPs DOSS-ratings were compared against the initial comprehensive dysphagia evaluation (including patient diagnosis, interview, cranial nerve and complete FEES assessment) with Functional Oral Intake Scale (FOIS) and DOSS outcome measures. The SLPs were blinded to patient details and comprehensive dysphagia examination. Re-randomised rating of FEES cases occurred two weeks later (intra rater reliability). Criterion validity for DOSS-ratings (compared against comprehensive dysphagia evaluation with FOIS and DOSS) were strong-very strong (rs = 0.858 and 0.936 respectively; p < 0.001). Inter rater reliability demonstrated high agreement (α = 0.891), also intra rater reliability demonstrated almost perfect agreement (Kw = 0.945). This study's results, with strong-very strong criterion validity and high rater reliability by SLPs, adds to the evidence for DOSS-use with FEES. Future validity research comparing DOSS with both FEES and VFSS simultaneously is recommended.

Evidence That Pervasive Body Gaze Behavior in Heterosexual Men Is a Social Marker for Implicit, Physiological, and Explicit Sexual Assault Propensities

Deliberate and effortful attempts to gaze at the bodies of women is emerging as a valuable marker of sexual objectification in men. Some preliminary evidence suggests that pervasive body gaze behavior may also accompany insidious attitudes which can facilitate sexual assault. The present study aimed to further explore this potential by examining pervasive body gaze associations with explicit, implicit, and physiological sexual assault propensity measures. We presented 110 heterosexual male participants with images of fully and partially dressed women with and without injuries while measuring their skin conductance responses. We also captured implicit and explicit sexual assault measures in addition to self-reported pervasive body gaze behavior. Pervasive body gaze behavior was significantly correlated with rape myth acceptance attitudes, prior perpetration of sexual assault, a stronger implicit association between erotica and aggression, and lower physiological reactivity during exposure to partially dressed injured women. These findings suggest that body gaze towards women could be a behavioral marker for inclinations to victim blame, preferences for rough sexual conduct, and a physiological desensitization towards female victims. This study further validates a five item self-reported body gaze measure as a valuable tool for detecting deviant sexual objectification attitudes and affective states. As such, measurement and observation of body gaze behavior could be useful for developing risk assessments, estimating intervention efficacy, and enhancing public awareness.

Symptom burden and quality of life among patient and family caregiver dyads in advanced cancer

PURPOSE

Symptom management among patients diagnosed with advanced cancer is a high priority in clinical care that often involves the support of a family caregiver. However, limited studies have examined parallel patient and caregiver symptom burden and associations with their own and each other's quality of life (QOL). This study seeks to identify patient and caregiver symptom clusters and investigate associations between identified clusters and demographic, clinical, and psychosocial factors (cognitive appraisals and QOL).

METHODS

This study was a secondary analysis of self-reported baseline survey data collected from a randomized clinical trial of 484 adult advanced cancer patients and their caregivers. Latent class analysis and factor analysis were used to identify symptom clusters. Bivariate statistics tested associations between symptom clusters and demographic, clinical, and psychosocial variables.

RESULTS

The most prevalent symptom for patients was energy loss/fatigue and for caregivers, mental distress. Low, moderate, and high symptom burden subgroups were identified at the patient, caregiver, and dyad level. Age, gender, race, income, chronic conditions, cancer type, and treatment type were associated with symptom burden subgroups. Higher symptom burden was associated with more negative appraisals of the cancer and caregiving experience, and poorer QOL (physical, social, emotional, functional, and overall QOL). Dyads whose caregivers had more chronic conditions were more likely to be in the high symptom burden subgroup.

CONCLUSION

Patient and caregiver symptom burden influence their own and each other's QOL. These findings reinforce the need to approach symptom management from a dyadic perspective.

Improving responsible Media Reporting on Student Suicide to Reduce Negative Public Opinion: Text Mining Based on Sina Weibo in China

The aims of this study were to explore whether student suicide reporting is consistent with media recommendations for suicide reporting; analyze public opinion and sentiments toward student suicide reports. A keyword search was performed on the WeiboReach platform. This study included 113 student suicide report posts and 176,262 readers' comments on suicide news reports. Hierarchical generalized linear modeling was used to analyze the relationships between adherence to reporting recommendations and negative emotions in readers' comments. None of the media reporting of student suicide was consistent with all of the media recommendations for suicide reporting. Netizens were less likely to post negative comments when the reports describe the suicide method used (OR 1.169, 95% CI 1.022∼1.337), and not specifying the cause of suicide was a protective factor for public negative emotion (OR 0.799, 95% CI 0.707, 0.905). The findings suggest improving responsible media reporting on student suicide to reduce negative public emotion.

Association of Changes in C-Reactive Protein Level Trajectories Through Early Adulthood With Cognitive Function at Midlife: The CARDIA Study

BACKGROUND AND OBJECTIVES

Late-life inflammation has been linked to dementia risk and preclinical cognitive decline, but less is known about early adult inflammation and whether this could influence cognition in midlife. We aimed to identify inflammation levels through early adulthood and determine association of these trajectories with midlife cognition.

METHODS

We used data from the Coronary Artery Risk Development in Young Adults study to identify inflammation trajectories (C-reactive protein [CRP] level <10 mg/L) over 18 years through early adulthood (age range 24-58) in latent class analysis and to assess associations with cognition 5 years after the last CRP measurement (age range 47-63). Six cognitive domains were evaluated from tests of verbal memory, processing speed, executive function, verbal and category fluency, and global cognition; poor cognitive performance was defined as a decline of ≥1 SD less than the mean on each domain. The primary outcome was poor cognitive performance. Logistic regression was used to adjust for demographics, smoking, alcohol use, physical activity, and APOE 4 status.

RESULTS

Among 2,364 participants, the mean (SD) age was 50.2 (3.5) years; 55% were female, and 57% were White. Three CRP trajectories emerged over 18 years: lower stable (45%), moderate/increasing (16%), and consistently higher (39%). Compared with lower stable CRP, both consistently higher (adjusted odds ratio [aOR] 1.67, 95% CI 1.23-2.26) and moderately/increasing (aOR 2.04, 95% CI 1.40-2.96) CRP had higher odds of poor processing speed; consistently higher CRP additionally had higher odds of poor executive function (aOR 1.36, 95% CI 1.00-1.88). For memory (moderately/increasing aOR 1.36, 95% CI 1.00-1.88; consistently higher aOR 1.18, 95% CI 0.90-1.54), letter fluency (moderately/increasing aOR 1.00, 95% CI 0.69-1.43; consistently higher aOR 1.05, 95% CI 0.80-1.39), category fluency (moderately/increasing aOR 1.16, 95% CI 0.82-1.63; consistently higher aOR 1.11, 95% CI 0.85-1.45), or global cognition (moderately/increasing aOR 1.16, 95% CI 0.82-1.63; consistently higher aOR 1.11, 95% CI 0.85-1.45), no association was observed.

DISCUSSION

Consistently higher or moderate/increasing inflammation starting in early adulthood may lead to worse midlife executive function and processing speed. Study limitations include selection bias due to loss to follow-up and reliance on CRP as the only inflammatory marker. Inflammation is important for cognitive aging and may begin much earlier than previously known.

Does generative artificial intelligence pose a risk to performance validity test security?

OBJECTIVE

We examined the performance validity test (PVT) security risk presented by artificial intelligence (AI) chatbots asking questions about neuropsychological evaluation and PVTs on two popular generative AI sites.

METHOD

In 2023 and 2024, multiple questions were posed to ChatGPT-3 and Bard (now Gemini). One set started generally and refined follow-up questions based on AI responses. A second set asked how to feign, fake, or cheat. Responses were aggregated and independently rated for inaccuracy and threat. Responses not identified as inaccurate were assigned a four-level threat rating (no, mild, moderate, or high threat). Combined inaccuracy and threat ratings were examined cross-sectionally and longitudinally.

RESULTS

Combined inaccuracy rating percentages were 35 to 42% in 2023 and 16 to 28% in 2024. Combined moderate/high threat ratings were observed in 24 to 41% of responses in 2023 and in 17 to 31% of responses in 2024. More ChatGPT-3 responses were rated moderate or high threat compared to Bard/Gemini responses. Over time, ChatGPT-3 responses became more accurate with a similar threat level, but Bard/Gemini responses did not change in accuracy or threat. Responses to how to feign queries demonstrated ethical opposition to feigning. Responses to similar queries in 2024 showed even stronger ethical opposition.

CONCLUSIONS

AI chatbots are a threat to PVT test security. A proportion of responses were rated as moderate or high threat. Although ethical opposition to feigning guidance increased over time, the natural language interface and the volume of AI chatbot responses represent a potentially greater threat than traditional search engines.

Acceptance of AI in Health Care for Short- and Long-Term Treatments: Pilot Development Study of an Integrated Theoretical Model

BACKGROUND

As digital technologies and especially artificial intelligence (AI) become increasingly important in health care, it is essential to determine whether and why potential users intend to use related health information systems (HIS). Several theories exist, but they focus mainly on aspects of health care or information systems, in addition to general psychological theories, and hence provide a small number of variables to explain future behavior. Thus, research that provides a larger number of variables by combining several theories from health care, information systems, and psychology is necessary.

OBJECTIVE

This study aims to investigate the intention to use new HIS for decisions concerning short- and long-term medical treatments using an integrated approach with several variables to explain future behavior.

METHODS

We developed an integrated theoretical model based on theories from health care, information systems, and psychology that allowed us to analyze the duality approach of adaptive and nonadaptive appraisals and their influence on the intention to use HIS. We applied the integrated theoretical model to the short-term treatment using AI-based HIS for surgery and the long-term treatment of diabetes tracking using survey data with structured equation modeling. To differentiate between certain levels of AI involvement, we used several scenarios that include treatments by physicians only, physicians with AI support, and AI only to understand how individuals perceive the influence of AI.

RESULTS

Our results showed that for short- and long-term treatments, the variables perceived threats, fear (disease), perceived efficacy, attitude (HIS), and perceived norms are important to consider when determining the intention to use AI-based HIS. Furthermore, the results revealed that perceived efficacy and attitude (HIS) are the most important variables to determine intention to use for all treatments and scenarios. In contrast, abilities (HIS) were important for short-term treatments only. For our 9 scenarios, adaptive and nonadaptive appraisals were both important to determine intention to use, depending on whether the treatment is known. Furthermore, we determined R² values that varied between 57.9% and 81.7% for our scenarios, which showed that the explanation power of our model is medium to good.

CONCLUSIONS

We contribute to HIS literature by highlighting the importance of integrating disease- and technology-related factors and by providing an integrated theoretical model. As such, we show how adaptive and nonadaptive appraisals should be arranged to report on medical decisions in the future, especially in the short and long terms. Physicians and HIS developers can use our insights to identify promising rationale for HIS adoption concerning short- and long-term treatments and adapt and develop HIS accordingly. Specifically, HIS developers should ensure that future HIS act in terms of HIS functions, as our study shows that efficient HIS lead to a positive attitude toward the HIS and ultimately to a higher intention to use.

Placebo treatment affects brain systems related to affective and cognitive processes, but not nociceptive pain

Drug treatments for pain often do not outperform placebo, and a better understanding of placebo mechanisms is needed to improve treatment development and clinical practice. In a large-scale fMRI study (N = 392) with pre-registered analyses, we tested whether placebo analgesic treatment modulates nociceptive processes, and whether its effects generalize from conditioned to unconditioned pain modalities. Placebo treatment caused robust analgesia in conditioned thermal pain that generalized to unconditioned mechanical pain. However, placebo did not decrease pain-related fMRI activity in brain measures linked to nociceptive pain, including the Neurologic Pain Signature (NPS) and spinothalamic pathway regions, with strong support for null effects in Bayes Factor analyses. In addition, surprisingly, placebo increased activity in some spinothalamic regions for unconditioned mechanical pain. In contrast, placebo reduced activity in a neuromarker associated with higher-level contributions to pain, the Stimulus Intensity Independent Pain Signature (SIIPS), and affected activity in brain regions related to motivation and value, in both pain modalities. Individual differences in behavioral analgesia were correlated with neural changes in both modalities. Our results indicate that cognitive and affective processes primarily drive placebo analgesia, and show the potential of neuromarkers for separating treatment influences on nociception from influences on evaluative processes.

Perceptions of patients and their relatives about schadenfreude towards doctors

Background

Violence in healthcare is a global issue that healthcare professionals experience. The concerning increase in violent incidents in Turkiye particularly makes it a significant problem to explore by examining the underlying psychological factors. In this sense, this study focuses on the concept of Schadenfreude, the malicious joy of someone else's misfortune, towards doctors, which is an under-researched topic in healthcare violence. Particularly, there is a lack of research on patients' and relatives' perceptions of doctors.

Objective

This study aims to determine the level of schadenfreude in Turkish society towards the violence experienced by doctors and to develop a model revealing the underlying causes.

Methods

Using a convenience sampling method, we recruited 402 participants, who are not first-degree relatives of healthcare professionals, for this quantitative study. For data collection, we developed a survey instrument to measure the level of schadenfreude and six different psychological factors including empathy, sympathy, anger, aggression, and deservingness. For data analysis, we used structural equation modeling.

Results

The results showed that the lower the levels of empathy and sympathy towards doctors were, the higher the levels of both schadenfreude and aggression were. Envy had no significant effect on either schadenfreude or aggression, while deservingness directly affected aggression. The perceptions of participants regarding doctors that they deserve violence increased their aggression levels. Schadenfreude had a positive and significant effect on anger and aggression.

Implications

The examination of underlying factors of violence towards doctors points to a lack of mutual understanding between patients and doctors. The results of this study indicate a need for increasing empathy towards health professionals by creating societal awareness of their experiences. Local authorities and healthcare organizations can create environments that bring together the public and health professionals to share their experiences with each other or conduct campaigns to draw public attention to the issue. Moreover, training sessions on effective communication can be offered for health professionals to help improve patient-doctor relationships and healthcare outcomes.

Protocol for a longitudinal study examining the trajectory of COVID-19, post-COVID, multidimensional disadvantage and health-related quality of life in India: the IndiQol Project

INTRODUCTION

The COVID-19 pandemic has raised concerns about the persistence of symptoms after infection, commonly referred to as 'post-COVID' or 'long-COVID'. While countries in high-resource countries have highlighted the increased risk of disadvantaged communities, there is limited understanding of how COVID-19 and post-COVID conditions affect marginalised populations in low-income and middle-income countries. We study the longitudinal patterns of COVID-19, post-COVID symptoms and their impact on the health-related quality of life through the IndiQol Project.

METHODS AND ANALYSIS

The IndiQol Project conducts household surveys across India to collect data on the incidence of COVID-19 and multidimensional well-being using a longitudinal design. We select a representative sample across six states surveyed over four waves. A two-stage sampling design was used to randomly select primary sampling units in rural and urban areas of each State. Using power analysis, we select an initial sample of 3000 household and survey all adult household members in each wave. The survey data will be analysed using limited dependent variable models and matching techniques to provide insights into the impact of COVID-19 pandemic and post-COVID on health and well-being of individuals in India.

ETHICS AND DISSEMINATION

Ethics approval for the IndiQol Project was obtained from the Macquarie University Human Research Ethics Committee in Sydney, Australia and Institutional Review Board of Morsel in India. The project results will be published in peer-reviewed journals. Data collected from the IndiQol project will be deposited with the EuroQol group and will be available to use by eligible researchers on approval of request.

Inter- and Intra-Observer Variability of the AMADEUS Tool for Osteochondral Lesions of the Talus

BACKGROUND

Managing osteochondral cartilage defects (OCDs) of the talus is a common daily challenge in orthopaedics as they predispose patients to further cartilage damage and progression to osteoarthritis. Therefore, the implementation of a reliable tool to quantify the amount of cartilage damage that is present is of the essence.

METHODS

We retrospectively identified 15 adult patients diagnosed with uncontained OCDs of the talus measuring <150 mm2, which were treated arthroscopically with bone marrow stimulation. Five independent assessors evaluated the pre-operative MRI scans with the AMADEUS scoring system (i.e., MR-based pre-operative assessment system) and the intra-/inter-observer variability was then calculated by means of the intraclass correlation coefficients (ICC) and Kappa (κ) statistics, respectively. In addition, the correlation between the mean AMADEUS scores and pre-operative self-reported outcomes as measured by the Manchester-Oxford foot questionnaire (MOxFQ) was assessed.

RESULTS

The mean ICC and the κ statistic were 0.82 (95% CI [0.71, 0.94]) and 0.42 (95% CI [0.25, 0.59]). The Pearson correlation coefficient was found to be r = -0.618 (p = 0.014).

CONCLUSIONS

The AMADEUS tool, which was originally designed to quantify knee osteochondral defect severity prior to cartilage repair surgery, demonstrated good reliability and moderate inter-observer variability for small OCDs of the talar shoulder. Given the strong negative correlation between the AMADEUS tool and pre-operative clinical scores, this tool could be implemented in clinical practise to reliably quantify the extent of the osteochondral defects of the talus.

Multicenter CT Image-Based Anatomic Assessment of Patients with Aortoiliac Aneurysm Undergoing Endovascular Repair with Iliac Branch Devices

BACKGROUND

The Global Iliac Branch Study (NCT05607277) is an international, multicenter, retrospective cohort study of anatomic predictors of adverse iliac events (AIEs) in aortoiliac aneurysms treated with iliac branch devices (IBDs).

METHODS

Patients with pre-IBD and post-IBD computed tomography imaging were included. We measured arterial diameters, stenosis, calcification, bifurcation angles, and tortuosity indices using a standardized, validated protocol. A composite of ipsilateral AIE was defined, a priori, as occlusion, type I or III endoleak, device constriction, or clinical event requiring reintervention. Paired t-test compared tortuosity indices and splay angles pretreatment and post-treatment for all IBDs and by device material (stainless steel and nitinol). Two-sample t-test compared anatomical changes from pretreatment to post-treatment by device material. Logistic regression assessed associations between AIE and anatomic measurements. Analysis was performed by IBD.

RESULTS

We analyzed 297 patients (286 males, 11 females) with 331 IBDs (227 stainless steel, 104 nitinol). Median clinical follow-up was 3.8 years. Iliac anatomy was significantly straightened with all IBD treatment, though stainless steel IBDs had a greater reduction in total iliac artery tortuosity index and aortic splay angle compared to nitinol IBDs (absolute reduction -0.20 [-0.22 to -0.18] vs. -0.09 [-0.12 to -0.06], P < 0.0001 and -19.6° [-22.4° to -16.9°] vs. -11.2° [-15.3° to -7.0°], P = 0.001, respectively). There were 54 AIEs in 44 IBDs in 42 patients (AIE in 13.3% of IBD systems), requiring 35 reinterventions (median time to event 41 days; median time to reintervention 153 days). There were 18 endoleaks, 29 occlusions, and 5 device constrictions. There were no strong associations between anatomic measurements and AIE overall, though internal iliac diameter was inversely associated with AIE in nitinol devices (nAIE, nitinol = 8).

CONCLUSIONS

Purpose-built IBDs effectively treat aortoiliac disease, including that with tortuous anatomy, with a high patency rate (91.5%) and low reintervention rate (9.1%) at 4 years. Anatomic predictors of AIE are limited.