A semi-structured interview for the dimensional assessment of internalizing and externalizing symptoms in children and adolescents: Interview Version of the Symptoms and Functioning Severity Scale (SFSS-I)

BACKGROUND

This study evaluates the psychometric properties of the newly developed semi-structured interview, Interview Version of the Symptoms and Functioning Severity Scale (SFSS-I), which is designed to provide a dimensional assessment of internalizing and externalizing symptoms.

METHODS

Multi-informant baseline data from the OPTIE study was used, involving 358 children and adolescents aged 6 to 17 years (M = 11.54, SD = 3.4, n = 140 [39.1%] were female). Participants were screened for internalizing and externalizing symptoms. For validity analyses, caregiver (Child Behavior Checklist), youth (Youth Self Report), and teacher ratings (Teacher Report Form) were used. We performed Receiver Operating Characteristic (ROC) analyses to evaluate the effectiveness of the SFSS-I subscales in distinguishing between children and adolescents diagnosed with internalizing and externalizing disorders, as determined by clinical judgement in routine care.

RESULTS

Confirmatory factor analyses supported a correlated two-factor model for internalizing and externalizing symptoms. Acceptable to good internal consistencies (α = 0.76 to 0.89; ω = 0.76 to 0.90) and excellent interrater reliability on the scale level (ICC ≥ 0.91) was found. The ROC analyses showed an acceptable accuracy in identifying internalizing diagnoses (AUC = 0.76) and excellent accuracy for externalizing diagnoses (AUC = 0.84).

CONCLUSION

The SFSS-I demonstrates potential as a clinically-rated instrument for screening and routine outcome monitoring, offering utility in both clinical practice and research settings for the dimensional assessment of broad psychopathological dimensions.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS) DRKS00016737 ( https://www.drks.de/DRKS00016737 ). Registered 17 September, 2019.

Trajectories of Treatment Burden Among Primary Care Patients with Long-Term Conditions in Southern China: A Latent Class Growth Analysis

Background

Treatment burden is a patient-centred, dynamic concept. However, longitudinal data on the changing pattern of treatment burden among patients with one or more long-term conditions (LTCs) are relatively scanty. We aimed to explore the longitudinal trajectories of treatment burden and associated risk factors in a large, patient population in primary care settings.

Methods

We analysed data from 5573 primary care patients with long-term conditions (LTCs) recruited using a multistage sampling method in Shenzhen, southern China. The treatment burden was assessed by the Mandarin Chinese version of the Treatment Burden Questionnaire (TBQ). We used latent class growth mixture modelling (LCGMM) to determine trajectories of treatment burden across four time points, ie, at baseline, and at 6, 12, and 18 months. Predictors of trajectory classes were explored using multivariable logistic regression analysis.

Results

The mean TBQ scores of patients with a single LTC (n = 2756), 2 LTCs (n = 1871), 3 LTCs (n = 699), and ≥4 LTCs (n = 247) were 18.17, 20.28, 21.32, and 26.10, respectively, at baseline. LCGMM identified three discrete classes of treatment burden trajectories over time, ie, a high-increasing class, a low-stable class, and a high-decreasing class. When controlling for individual-level factors including age, education, monthly household income per head, smoking, alcohol consumption, and attendance in health education, patients who had a clinical diagnosis of 3 LTCs (adjusted odds ratio [aOR] = 1.49, 95% CI = 1.21-1.86, P < 0.001) or ≥4 LTCs (aOR = 1.97, 95% CI = 1.44-2.72, P < 0.001) were more likely to belong to the high-increasing class. Sensitivity analysis using propensity score methods obtained similar results.

Conclusion

Our study revealed the presence of discrete patterns of treatment burden over time in Chinese primary care patients with LTCs, providing directions for tailored interventions to optimise disease management. Patients with 3 or more LTCs should receive close attention in healthcare delivery as they tend to experience a greater treatment burden.

Can transcutaneous auricular vagus nerve stimulation mitigate vigilance loss? Examining the effects of stimulation at individualized versus constant current intensity

According to the arousal model of vigilance, the locus coeruleus-norepinephrine (LC-NE) system modulates sustained attention over long periods by regulating physiological arousal. Recent research has proposed that transcutaneous auricular vagus nerve stimulation (taVNS) modulates indirect physiological markers of LC-NE activity, although its effects on vigilance have not yet been examined. Aiming to develop a safe and noninvasive procedure to prevent vigilance failures in prolonged tasks, the present study examined whether taVNS can mitigate vigilance loss while modulating indirect markers of LC-NE activity. Following a preregistered protocol (https://osf.io/tu2xy/), 50 participants completed three repeated sessions in a randomized order, in which either active taVNS at individualized intensity set by participant, active taVNS set at 0.5 mA for all participants, or sham taVNS, was delivered while performing an attentional and vigilance task (i.e., ANTI-Vea). Changes in salivary alpha-amylase and cortisol concentrations were measured as markers of LC-NE activity. Self-reports of feelings associated with stimulation and guessing rate of active/sham conditions supported the efficacy of the single-blind procedure. Contrary to our predictions, the observed vigilance decrement was not modulated by active taVNS. Pairwise comparisons showed a mitigation by active taVNS on cortisol reduction across time. Interestingly, Spearman's correlational analyses showed some interindividual effects of taVNS on indirect markers of LC-NE, evidenced by positive associations between changes in salivary alpha-amylase and cortisol in active but not sham taVNS. We highlight the relevance of replicating and extending the present outcomes, investigating further parameters of stimulation and its effects on other indirect markers of LC-NE activity.

Modelling bluetongue and African horse sickness vector (Culicoides spp.) distribution in the Western Cape in South Africa using random forest machine learning

BACKGROUND

Culicoides biting midges exhibit a global spatial distribution and are the main vectors of several viruses of veterinary importance, including bluetongue (BT) and African horse sickness (AHS). Many environmental and anthropological factors contribute to their ability to live in a variety of habitats, which have the potential to change over the years as the climate changes. Therefore, as new habitats emerge, the risk for new introductions of these diseases of interest to occur increases. The aim of this study was to model distributions for two primary vectors for BT and AHS (Culicoides imicola and Culicoides bolitinos) using random forest (RF) machine learning and explore the relative importance of environmental and anthropological factors in a region of South Africa with frequent AHS and BT outbreaks.

METHODS

Culicoides capture data were collected between 1996 and 2022 across 171 different capture locations in the Western Cape. Predictor variables included climate-related variables (temperature, precipitation, humidity), environment-related variables (normalised difference vegetation index-NDVI, soil moisture) and farm-related variables (livestock densities). Random forest (RF) models were developed to explore the spatial distributions of C. imicola, C. bolitinos and a merged species map, where both competent vectors were combined. The maps were then compared to interpolation maps using the same capture data as well as historical locations of BT and AHS outbreaks.

RESULTS

Overall, the RF models performed well with 75.02%, 61.6% and 74.01% variance explained for C. imicola, C. bolitinos and merged species models respectively. Cattle density was the most important predictor for C. imicola and water vapour pressure the most important for C. bolitinos. Compared to interpolation maps, the RF models had higher predictive power throughout most of the year when species were modelled individually; however, when merged, the interpolation maps performed better in all seasons except winter. Finally, midge densities did not show any conclusive correlation with BT or AHS outbreaks.

CONCLUSION

This study yielded novel insight into the spatial abundance and drivers of abundance of competent vectors of BT and AHS. It also provided valuable data to inform mathematical models exploring disease outbreaks so that Culicoides-transmitted diseases in South Africa can be further analysed.

Decisional components of motor responses are not related to online response control: Evidence from lexical decision and speed-accuracy tradeoff manipulations

Evidence suggests that decision processes can propagate to motor-response execution. However, the functional characterization of motor decisional components is not yet fully understood. By combining a classic lexical decision experiment with manipulations of speed-accuracy tradeoff (SAT), the present experiment assessed the hypothesis that decisional effects on chronometric measures of motor-response execution are related to online response control. The electromyographic (EMG) signal associated with manual button-press responses was used to dissociate the premotor component (from stimulus onset until the onset of the EMG activity) from the motor component (from EMG onset until the button-press), thus enabling the assessment of decision-related effects in terms of motor-response duration within single-trial reaction times. Other than replicating all the previously reported SAT effects, the experiment revealed hindered control processes when the instructions emphasized speed over accuracy, as indicated by measures of response control such as partial errors, fast errors, and correction likelihood. Nonetheless, the lexicality effect on motor responses, consisting of slower motor times for pseudowords compared to words, was impervious to any SAT modulation. The results suggest that SAT-induced variations in decision and response control policies may not be the prominent determinant of decision-related effects on motor times, highlighting the multiple "cognitive" components that affect peripheral response execution.

Prostate cancer: unmet supportive and palliative care needs: national survey of patients and family carers

OBJECTIVES

Men living with prostate cancer have supportive and palliative needs. However, few studies detail unmet needs (vs quality of life measurement) or include data from those with advanced disease. We aimed to identify unmet needs of people living with prostate cancer (men, family carers), including those with advanced disease.

METHODS

Mixed-methods national survey (patient Supportive Care Needs Survey; Carer Support Needs Assessment Tool) and health status (EuroQol Visual Analogue Scale). Quantitative data were explored using regression analysis. Free text data were subjected to thematic analysis.

RESULTS

216 men (mean age 65±8.5 years; active cancer 136 [63%]) and 97 carers (68 (70%) spouse/partner) provided data. 133 men (62%) reported moderate-to-high need which was more likely in advanced disease. Men's health status was worse with active vs remitted disease (mean difference -11; 95% CI -17 to -5; p<0.001). 85 (88%) carers reported at least one unmet need relating to 'enabling them to care' and 83 (86%) relating to 'their own well-being'. Carers with chronic illnesses had more unmet needs (p=0.01 to p=0.04) and patient receipt of palliative care independently predicted higher unmet carer needs (p=0.02).Free text data demonstrated widespread burden with: (1) poor communication/information, including about palliative care; (2) poorly managed symptoms/concerns and (3) poor care co-ordination. Incontinence, sexual dysfunction and hormone side-effects were serious problems, often left unaddressed.

CONCLUSIONS

Many living with prostate cancer continue with wide-ranging concerns. Lack of systematic, ongoing needs assessment and poor communication compound inadequate clinical pathways. Person-centred care, interdisciplinary working and integrated palliative care should be resourced.

The long-term effects of perceived instructional leadership on teachers' psychological well-being during COVID-19

The COVID-19 outbreak led to widespread school closures and the shift to remote teaching, potentially resulting in lasting negative impacts on teachers' psychological well-being due to increased workloads and a perceived lack of administrative support. Despite the significance of these challenges, few studies have delved into the long-term effects of perceived instructional leadership on teachers' psychological health. To bridge this research gap, we utilized longitudinal data from 927 primary and secondary school teachers surveyed in two phases: Time 1 in mid-November 2021 and Time 2 in early January 2022. Using hierarchical linear modeling (HLM), our findings revealed that perceptions of instructional leadership, especially the "perceived school neglect of teaching autonomy" at Time 1 were positively correlated with burnout levels at Time 2. Additionally, burnout at Time 2 was positively associated with psychological distress and acted as a mediator between the "perceived school neglect of teaching autonomy" and psychological distress. In light of these findings, we recommend that schools prioritize teachers' teaching autonomy and take proactive measures to mitigate burnout and psychological distress, aiming for the sustainable well-being of both teachers and students in the post-pandemic era.

The Relation between Parental Locus of Control and Willingness to Implement Parent Management Training Strategies

In child disruptive behavior treatment, successful parent management training (PMT) outcomes are dependent on parents' use of strategies outside of sessions. This study aimed to identify the influence of parental locus of control (PLOC) on a key treatment acceptability variable: parents' willingness to implement PMT strategies. We sought to investigate this relationship for individual strategies within PMT, given the composite nature of the intervention. In this study, 109 parents of children (ages 2-12) with disruptive behavior watched brief videos detailing three proactive PMT strategies (child-directed interaction, effective commands, positive attention) and three reactive PMT strategies (ignoring, time out, and removal of privileges) and rated their willingness to implement each strategy. Internal PLOC predicted greater overall willingness to use PMT strategies, above and beyond the influence of child age, child gender, and disruptive behavior severity. Notably, the relationship between willingness and PLOC differed across individual strategies. PLOC predicted willingness to implement proactive PMT strategies to a greater degree than willingness to implement reactive strategies. External PLOC may be a greater barrier to use of proactive strategies because of these strategies' misalignment with external PLOC-related beliefs. Results have implications for the personalization of PMT based on parent cognitions, as well as for the separate analysis of individual components of PMT in future research.

Mind over matter: mindfulness as a buffer against workplace incivility

This study examines the relationship between co-worker incivility, emotional exhaustion, mindfulness, and turnover intention among nurses in public and private hospitals in North Cyprus. Drawing upon the Job Demand-Resources theory, the research aims to contribute to the existing literature by investigating the mediating role of emotional exhaustion and the moderating effect of mindfulness on the relationship between co-worker incivility and turnover intention. Data were collected from 238 nurses through questionnaires, and structural equation modeling was employed for data analysis. The results indicate a positive association between co-worker incivility and emotional exhaustion, as well as between co-worker incivility and turnover intention. Emotional exhaustion was found to mediate the relationship between co-worker incivility and turnover intention. Furthermore, mindfulness was identified as a moderator, attenuating the negative impact of co-worker incivility on turnover intention. The findings underscore the importance of addressing workplace incivility and promoting mindfulness to mitigate turnover intentions among nurses. Practical implications include the implementation of interventions to foster a supportive work environment and enhance nurses' emotional wellbeing.

Integrated Perceptual Decisions Rely on Parallel Evidence Accumulation

The ability to make accurate and timely decisions, such as judging when it is safe to cross the road, is the foundation of adaptive behavior. While the computational and neural processes supporting simple decisions on isolated stimuli have been well characterized, decision-making in the real world often requires integration of discrete sensory events over time and space. Most previous experimental work on perceptual decision-making has focused on tasks that involve only a single, task-relevant source of sensory input. It remains unclear, therefore, how such integrative decisions are regulated computationally. Here we used psychophysics, electroencephalography, and computational modeling to understand how the human brain combines visual motion signals across space in the service of a single, integrated decision. To that purpose, we presented two random-dot kinematograms in the left and the right visual hemifields. Coherent motion signals were shown briefly and concurrently in each location, and healthy adult human participants of both sexes reported the average of the two motion signals. We directly tested competing predictions arising from influential serial and parallel accounts of visual processing. Using a biologically plausible model of motion filtering, we found evidence in favor of parallel integration as the fundamental computational mechanism regulating integrated perceptual decisions.

Assessment of 'Golden Delicious' Apples Using an Electronic Nose and Machine Learning to Determine Ripening Stages

Consumers often face a lack of information regarding the quality of apples available in supermarkets. General appearance factors, such as color, mechanical damage, or microbial attack, influence consumer decisions on whether to purchase or reject the apples. Recently, devices known as electronic noses provide an easy-to-use and non-destructive assessment of ripening stages based on Volatile Organic Compounds (VOCs) emitted by the fruit. In this study, the 'Golden Delicious' apples, stored and monitored at the ambient temperature, were analyzed in the years 2022 and 2023 to collect data from four Metal Oxide Semiconductor (MOS) sensors (MQ3, MQ135, MQ136, and MQ138). Three ripening stages (less ripe, ripe, and overripe) were identified using Principal Component Analysis (PCA) and the K-means clustering approach from various datasets based on sensor measurements in four experiments. After applying the K-Nearest Neighbors (KNN) model, the results showed successful classification of apples for specific datasets, achieving an accuracy higher than 75%. For the dataset with measurements from all experiments, an impressive accuracy of 100% was achieved on specific test sets and on the evaluation set from new, completely independent experiments. Additionally, correlation and PCA analysis showed that choosing two or three sensors can provide equally successful results. Overall, the e-nose results highlight the importance of analyzing data from several experiments performed over a longer period after the harvest of apples. There are similarities and differences in investigated VOC parameters (ethylene, esters, alcohols, and aldehydes) for less or more mature apples analyzed during autumn or spring, which can improve the determination of the ripening stage with higher predicting success for apples investigated in the spring.

Development and validation of a patient-centered communication scale for nurses

BACKGROUND

Patient-centered care aims to prevent disease and promote well-being by actively involving patients in treatment and decision-making that is based on respecting the patients and their families. However, no scales have been developed to assess patient-centered care from the nurse's perspective. This study aimed to develop a scale to measure nurses' level of patient-centered communication and confirm its validity and reliability.

METHODS

A methodological cross-sectional study was adopted to develop and validate the Patient-Centered Communication Scale (PCCS). The items were developed through a literature review and online interviews with nurses. Content validity was assessed by experts and the content validity index was calculated. A pretest of the questionnaire was conducted with 10 clinical nurses. To evaluate the factor structure and internal consistency reliability, the PCCS was administered online to 325 nurses in South Korea. Data were analyzed using descriptive statistics, explanatory factor analysis (EFA), and confirmatory factor analysis (CFA).

RESULTS

The final instrument consisted of 12 items and three factors: (1) information sharing, (2) patient-as-person, and (3) therapeutic alliance. EFA revealed a distinct three-factor structure, explaining 59.0% of the total variance. CFA confirmed the adequacy of the model fit and validated the inclusion of the final items. The Cronbach's alpha values ranged from 0.60 to 0.77, indicating acceptable internal consistency. Convergent validity was evidenced by the correlation between the PCCS and a measure of interpersonal communication competence.

CONCLUSIONS

The 12-item PCCS showed good reliability, construct validity, and convergent validity. The scale has utility for measuring the level of patient-centered communication skills in nurses.

Development and validation of a novel questionnaire to describe and assess sensations and triggers associated with refractory and unexplained chronic cough

INTRODUCTION

Refractory or unexplained chronic cough (RUCC) is a common clinical problem with no effective diagnostic tools. The Sensations and Triggers Provoking Cough questionnaire (TOPIC) was developed to characterise cough in RUCC versus cough in other conditions.

METHODS

Content analysis of participant interviews discussing the sensations and triggers of chronic cough informed TOPIC development. Participants with chronic cough completed the draft-TOPIC (a subset repeating 5-7 days later), St George's Respiratory Questionnaire (SGRQ), Cough Severity Diary (CSD) and Global Rating of Change Scale. The draft-TOPIC item list was reduced in hierarchical and Rasch analysis to refine the questionnaire to the TOPIC.

RESULTS

49 items describing the triggers and sensations of cough were generated from participant interviews (RUCC n=14, chronic obstructive pulmonary disease (COPD) n=11, interstitial lung disease (ILD) n=10, asthma n=11, bronchiectasis n=3, cystic fibrosis n=7). 140 participants (median age 60.0 (19.0-88.0), female 56.4%; RUCC n=39, ILD n=38, asthma n=45, COPD n=6, bronchiectasis n=12) completed draft-TOPIC, where items with poor 'fit' for RUCC were removed to create TOPIC (8 trigger items, 7 sensation items). Median TOPIC score was significantly higher in RUCC (37.0) vs ILD (24.5, p=0.009) and asthma (7.0, p<0.001), but not bronchiectasis (20.0, p=0.318) or COPD (18.5, p=0.238), likely due to small sample sizes. The Rasch model demonstrated excellent fit in RUCC (χ2=22.04, p=0.85; PSI=0.88); as expected. When all participant groups were included, fit was no longer demonstrated (χ2=66.43, p=0.0001, PSI=0.89) due to the increased heterogeneity (CI=0.077). TOPIC correlated positively with SGRQ (r=0.47, p<0.001) and CSD (r=0.63, p<0.001). The test-retest reliability of TOPIC (intraclass correlation coefficient) was excellent (r=0.90, p<0.001).

CONCLUSIONS

High TOPIC scores in the RUCC patients suggest their cough is characterised by specific sensations and triggers. Validation of TOPIC in cough clinics may demonstrate value as an aid to identify features of RUCC versus cough in other conditions.

Investigating Expert-Rater Agreement and Inter/Intra-Rater Reliability of Two Fundamental Movement Skills for the Locomotor Subscale of the FG-COMPASS

The Furtado-Gallagher Children Observational Movement Pattern Assessment System (FG-COMPASS) is an observational tool using sequential decisions to assess fundamental movement skill proficiency. The current version of the test has three locomotor and five manipulative skills. Adding two more locomotor skills to the assessment tool enriches its scope, enabling a more comprehensive and nuanced evaluation of individual movement skills. We assessed expert-non-expert rater agreement and inter/intra non-expert rater reliability of two new scales for the locomotor subscale. We divided this study into two parts. In Part I, we filmed 60 children aged 5-10 years old who performed gallop and vertical jump skills. A motor behavior expert then classified the videotapes using our newly created rating scales. Next, we selected eight videos for training purposes and 24 videos for testing purposes. In Part II, 30 undergraduate students underwent rater training. Rating data were analyzed using weighted kappa (Kw) and the intra-class correlation coefficient (ICC), and these indices showed 'very good' agreement between the expert and the non-expert raters for vertical jump (Kw = .96) and gallop (Kw = .89). The ICC expert to non-expert rater values for vertical jump and gallop were .98 and .94, respectively; and mean kappa values for inter-rater reliability between non-experts were considered 'very good' for vertical jump (MKw = .92) and 'good' for gallop (MKw = .78). The ICC inter-rater values were .98 and .95 (considered 'excellent') for vertical jump and gallop, respectively; and the kappa intra-rater values were .96 and .85, respectively, with intra-rater ICC values .98 and .92. Thus, the proposed rating scales were reliable for assessing vertical jump and gallop. Future studies should focus on criterion-related validity and reliability evidence from live performances.

Cross-modal interactions in language production: evidence from word learning

Literate adults are able to produce the same word in different language modalities-for instance, through speaking and writing. Yet how speaking and writing interact is not well understood. The present study takes a new perspective on the question of the co-activation of phonological and orthographic representations in speaking and writing by examining the acquisition of novel words. We tested how novel words get integrated into modality-specific lexicons by biasing novel word acquisition toward speaking or writing and assessing cross-modal transfer at the first stages of learning. Participants learned novel words paired with pictures of novel objects and practiced them overtly through speaking or typing. At test, typed training led to higher recall accuracy than spoken training whether words were recalled through typing or speaking. Performance in typing (RT and durations) benefited more from typed than spoken training. Crucially, performance in speaking did not benefit specifically from spoken training and was similar after spoken or typed training. Results are compatible with an asymmetric integration in the phonological and orthographic lexicons according to the modality of training, with representations created in the orthographic lexicon directly transferring to the phonological lexicon, while the opposite doesn't seem to occur. Cross-modal transfer dynamics are discussed according to the level of lexical activation.

Evaluating the Impact of Seated Pilates on Functional Outcomes Among Those With Mild, Moderate, and Severe Multiple Sclerosis Impairment: A Pilot Feasibility Trial

This pilot study assessed the feasibility and functional benefits of a twice-weekly, 12-week, virtual, seated, group-based Pilates program in persons with mild to severe multiple sclerosis (MS). Participants were randomized into either a Pilates-only group or a Pilates group, which also incorporated hip and shoulder-cuff activation exercises. Process, management, and scientific-feasibility metrics were analyzed descriptively. Functional outcomes, physical activity, and MS-related outcomes (impact, fatigue, and quality of life) were measured pre- and postintervention and analyzed using mixed-effects models, analysis of variance, and cluster analysis. Twenty-two participants completed baseline testing. Sixteen completed the intervention and postintervention testing. Collapsed across groups, analyses demonstrated improvements in the Timed 25-Foot Walk (36%), Timed Up-and-Go (13%), and the Berg Balance Scale (10%, statistically significant). Neither between-groups differences nor physical activity or MS outcome changes were significant. Participants reported high satisfaction. Findings suggest that virtual, seated Pilates is feasible and may confer balance benefits to individuals with MS.

Physiotherapists' Perception of and Readiness to Use, Telerehabilitation for Musculoskeletal Disorders in Malaysia: A Cross-Sectional Study

Introduction: Musculoskeletal ailments exert a significant impact on global populations. To address challenges posed by geographical constraints and financial limitations, physiotherapists have explored and found telerehabilitation to be a viable solution. Despite its proven effectiveness in clinical practice, the integration of telerehabilitation has been sluggish. This cross-sectional survey sought to delve into the perspectives and readiness of physiotherapists in Malaysia regarding telerehabilitation for musculoskeletal disorders. Methods: A customized survey instrument was developed and evaluated for face validity and reliability. The 36-item questionnaire was distributed through the Google Form platform, targeting respondents via social media channels such as Facebook and WhatsApp. Data analysis used descriptive statistics (frequency and percentage). Results: The survey garnered responses from 271 physiotherapists. A majority (76.3%, n = 202) expressed agreement regarding the potential benefits of telerehabilitation in physiotherapy practice. About 77% of the respondents also showcased greater readiness for monitoring client progress through telerehabilitation as opposed to assessment and treatment. Notable benefits identified by respondents included preventing cross-infection (98.5%) and reducing travel time for both clients (94.0%) and physiotherapists (90.6%). Conclusion: The study reveals that physiotherapists in Malaysia exhibit positive attitudes and preparedness for implementing telerehabilitation in managing musculoskeletal conditions.

Using machine learning to analyze mental health in distance education during the COVID-19 pandemic: an opinion study from university students in Mexico

In times of lockdown due to the COVID-19 pandemic, it has been detected that some students are unable to dedicate enough time to their education. They present signs of frustration and even apathy towards dropping out of school. In addition, feelings of fear, anxiety, desperation, and depression are now present because society has not yet been able to adapt to the new way of living. Therefore, this article analyzes the feelings that university students of the Instituto Tecnológico Superior de Misantla present when using long distance education tools during COVID-19 pandemic in Mexico. The results suggest that isolation, because of the pandemic situation, generated high levels of anxiety and depression. Moreover, there are connections between feelings generated by lockdown and school performance while using e-learning platforms. The findings of this research reflect the students' feelings, useful information that could lead to the development and implementation of pedagogical strategies that allow improving the students' academic performance results.

Precious2GPT: the combination of multiomics pretrained transformer and conditional diffusion for artificial multi-omics multi-species multi-tissue sample generation

Synthetic data generation in omics mimics real-world biological data, providing alternatives for training and evaluation of genomic analysis tools, controlling differential expression, and exploring data architecture. We previously developed Precious1GPT, a multimodal transformer trained on transcriptomic and methylation data, along with metadata, for predicting biological age and identifying dual-purpose therapeutic targets potentially implicated in aging and age-associated diseases. In this study, we introduce Precious2GPT, a multimodal architecture that integrates Conditional Diffusion (CDiffusion) and decoder-only Multi-omics Pretrained Transformer (MoPT) models trained on gene expression and DNA methylation data. Precious2GPT excels in synthetic data generation, outperforming Conditional Generative Adversarial Networks (CGANs), CDiffusion, and MoPT. We demonstrate that Precious2GPT is capable of generating representative synthetic data that captures tissue- and age-specific information from real transcriptomics and methylomics data. Notably, Precious2GPT surpasses other models in age prediction accuracy using the generated data, and it can generate data beyond 120 years of age. Furthermore, we showcase the potential of using this model in identifying gene signatures and potential therapeutic targets in a colorectal cancer case study.

Psychometric properties of the chinese version of the value-based stigma inventory (VASI): a translation and validation study

OBJECTIVE

This study aimed to develop a culturally adapted Chinese version of the Value-based Stigma Inventory (VASI) and to evaluate its psychometric properties, including reliability and validity, among the general Chinese population.

METHODS

This study is a cross-sectional study. Convenience sampling was used to recruit 708 general citizens from Shenyang City, Liaoning Province, China. The VASI's internal consistency, split-half reliability, and test-retest reliability were tested to assess the translated scale's reliability. Several validity tests were performed, including expert consultation, exploratory factor analysis, and confirmatory factor analysis. Data were analyzed using SPSS 25.0 (IBM Corp., Armonk, NY, United States) and AMOS 23.0 (IBM Corp., Armonk, NY, United States).

RESULTS

The Chinese version of the VASI showed good reliability, with a Cronbach's α value of 0.808, and the dimensions ranged from 0.812 to 0.850. Test-retest reliability showed good temporal stability with a value of 0.855, and the split-half reliability value was 0.845, indicating a high degree of consistency. The scale also demonstrated good content validity with a content validity index of 0.952. After conducting exploratory factor analysis, a five-factor structure was identified, including factors of self-realization, personal enrichment, reputation, meritocratic values, and security. In the confirmatory factor analysis, all recommended fit indicators were found to be within the acceptable range, including χ2/DF = 1.338, GFI = 0.960, AGFI = 0.940, RMSEA = 0.031, TLI = 0.985, CFI = 0.989, IFI = 0.989, PGFI = 0.640, and PNFI = 0.729.

CONCLUSION

The Chinese version of the VASI is valid and reliable among the Chinese general public. The five-factor structured scale effectively assessed public stigma against mental illness, including the value orientations associated with personal stigma. Given the harsh and widespread public stigma against mental illness, the findings from the questionnaire may inform the development of future public health education programs. Public health education is needed to reduce the stigma of mental illness, increase public awareness of mental health issues, and mitigate the continued stigmatization of mental illness.

Echoes from Sensory Entrainment in Auditory Working Memory for Pitch

Ongoing neural oscillations reflect cycles of excitation and inhibition in local neural populations, with individual neurons being more or less likely to fire depending upon the oscillatory phase. As a result, the oscillations could determine whether or not a sound is perceived and/or whether its neural representation enters into later processing stages. While empirical support for this idea has come from sound detection studies, large gaps in knowledge still exist regarding memory for sound events. In the current study, it was investigated how sensory entrainment impacts the fidelity of working memory representations for pitch. In two separate experiments, an 8 Hz amplitude modulated (AM) entraining stimulus was presented prior to a multitone complex having an f0 between 270 and 715 Hz. This "target" sound could be presented at phases from 0 to 2π radians in relation to the previous AM. After a retention interval of 4 s (Experiment 1; n = 26) or 2 s (Experiment 2; n = 28), listeners were tasked to reproduce the target sound's pitch by moving their finger along the horizontal axis of a response pad. It was hypothesized that if entrainment modulates auditory working memory fidelity, reproductions of a target's pitch would be more accurate and precise when targets were presented in phase with the entrainment. Cosine fits of the average data for both experiments showed a significant entrainment "echo" in the accuracy of pitch matches. There was no apparent echo in the matching precision. Fitting of the individual data accuracy showed that the optimal phase was consistent across individuals, aligning near the next AM peak had the AM continued. The results show that sensory entrainment modulates auditory working memory in addition to stimulus detection, consistent with the proposal that ongoing neural oscillatory activity modulates higher-order auditory processes.

Using Wearables to Study Biopsychosocial Dynamics in Couples Who Cope With a Chronic Health Condition: Ambulatory Assessment Study

BACKGROUND

Technology has become an integral part of our everyday life, and its use to manage and study health is no exception. Romantic partners play a critical role in managing chronic health conditions as they tend to be a primary source of support.

OBJECTIVE

This study tests the feasibility of using commercial wearables to monitor couples' unique way of communicating and supporting each other and documents the physiological correlates of interpersonal dynamics (ie, heart rate linkage).

METHODS

We analyzed 617 audio recordings of 5-minute duration (384 with concurrent heart rate data) and 527 brief self-reports collected from 11 couples in which 1 partner had type II diabetes during the course of their typical daily lives. Audio data were coded by trained raters for social support. The extent to which heart rate fluctuations were linked among couples was quantified using cross-correlations. Random-intercept multilevel models explored whether cross-correlations might differ by social contexts and exchanges.

RESULTS

Sixty percent of audio recordings captured speech between partners and partners reported personal contact with each other in 75% of self-reports. Based on the coding, social support was found in 6% of recordings, whereas at least 1 partner self-reported social support about half the time (53%). Couples, on average, showed small to moderate interconnections in their heart rate fluctuations (r=0.04-0.22). Couples also varied in the extent to which there was lagged linkage, that is, meaning that changes in one partner's heart rate tended to precede changes in the other partner's heart rate. Exploratory analyses showed that heart rate linkage was stronger (1) in rater-coded partner conversations (vs moments of no rater-coded partner conversations: rdiff=0.13; P=.03), (2) when partners self-reported interpersonal contact (vs moments of no self-reported interpersonal contact: rdiff=0.20; P<.001), and (3) when partners self-reported social support exchanges (vs moments of no self-reported social support exchange: rdiff=0.15; P=.004).

CONCLUSIONS

Our study provides initial evidence for the utility of using wearables to collect biopsychosocial data in couples managing a chronic health condition in daily life. Specifically, heart rate linkage might play a role in fostering chronic disease management as a couple. Insights from collecting such data could inform future technology interventions to promote healthy lifestyle engagement and adaptive chronic disease management.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/13685.

Early Boost of Linguistic Skills? Individualized Non-Invasive Brain Stimulation in Early Postacute Aphasia

Non-invasive brain stimulation, such as transcranial direct current stimulation (tDCS), has been shown to increase the outcome of speech and language therapy (SLT) in chronic aphasia. Only a few studies have investigated the effect of add-on tDCS on SLT in the early stage of aphasia; this may be due to methodological reasons, in particular the influence of spontaneous remission and the difficulty of establishing stimulation protocols in clinical routines. Thirty-seven participants with subacute aphasia (PwA) after stroke (23 men, 14 women; mean age 62 ± 12 years; mean duration 49 ± 28 days) were included in two consecutive periods of treatment lasting two weeks each. During the first period (P1) the participants received 10 sessions of SLT, during the second period (P2) the aphasia therapy was supplemented by anodal left hemispheric 2 mA tDCS over the left hemisphere. Severity-specific language tests (Aachen Aphasia Test (AAT), n = 27 and Bielefeld Aphasia Screening-Reha (BIAS-R), n = 10) were administered before P1, between P1 and P2, and after P2. Where information was available, the results were corrected for spontaneous remission (AAT sample), and the therapy outcomes of P1 and P2 were compared. Participants' overall language abilities improved significantly during P1 and P2. However, improvement-as measured by the AAT profile level or the BIAS-R mean percentage value-during P2 (with tDCS) was significantly higher than during P1 (p < 0.001; AAT sample and p = 0.005; BIAS-R sample). Thus, tDCS protocols can be implemented in early aphasia rehabilitation. Despite the limitations of the research design, which are also discussed from an implementation science perspective, this is preliminary evidence that an individually tailored anodal tDCS can have a significant add-on effect on the outcome of behavioral aphasia therapy in subacute aphasia.

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.

Factors Affecting the Perceived Social Support of Adolescent Girls and Women Aged 10-45 Years With Disabilities in Selected Sub-districts of Bangladesh

Background Perceived social support is crucial for the well-being of women and adolescent girls with disabilities. In Bangladesh, social support can significantly influence their quality of life, yet it remains understudied. This study aims to identify the factors affecting perceived social support among women and adolescent girls with disabilities in selected sub-districts of Bangladesh. Methodology In this cross-sectional study, a total of 152 women and adolescent girls with disabilities participated. The study was conducted in Bogura Sadar and Chapainawabganj Sadar upazilas of Bangladesh. The implementation timeline of the study was from March to April 2023. The chi-square test and multiple linear regression analysis were conducted to explore the factors affecting perceived social support among the participants in the selected sub-districts of Bangladesh. Results In the chi-square test, associations were noted between menarche age, male education, and household income categories with perceived social support categories. In Fisher's exact test, an association was observed between females with partial hearing disability and perceived social support categories. The multiple linear regression analysis showed that better levels of education in men, high household income, and a younger age of menarche and partial hearing disability were the predictors of higher perceived social support among women and adolescent girls with disabilities. Conclusions This study underscores the multifaceted nature of perceived social support among women and adolescent girls with disabilities in Bangladesh. Interventions aimed at enhancing social support should consider identified predictors to provide tailored support for women and adolescent girls with disabilities. Enhanced social support can lead to overall well-being for this vulnerable population.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.