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Robles M, Ramos-Grille I, Hervás A, Duran-Tauleria E, Galiano-Landeira J, Wormwood JB, Falter-Wagner CM, Chanes L. Reduced stereotypicality and spared use of facial expression predictions for social evaluation in autism. Int J Clin Health Psychol 2024; 24:100440. [PMID: 38426036 PMCID: PMC10901834 DOI: 10.1016/j.ijchp.2024.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/08/2024] [Indexed: 03/02/2024] Open
Abstract
Background/Objective Autism has been investigated through traditional emotion recognition paradigms, merely investigating accuracy, thereby constraining how potential differences across autistic and control individuals may be observed, identified, and described. Moreover, the use of emotional facial expression information for social functioning in autism is of relevance to provide a deeper understanding of the condition. Method Adult autistic individuals (n = 34) and adult control individuals (n = 34) were assessed with a social perception behavioral paradigm exploring facial expression predictions and their impact on social evaluation. Results Autistic individuals held less stereotypical predictions than controls. Importantly, despite such differences in predictions, the use of such predictions for social evaluation did not differ significantly between groups, as autistic individuals relied on their predictions to evaluate others to the same extent as controls. Conclusions These results help to understand how autistic individuals perceive social stimuli and evaluate others, revealing a deviation from stereotypicality beyond which social evaluation strategies may be intact.
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Affiliation(s)
- Marta Robles
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Germany
| | - Irene Ramos-Grille
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
- Division of Mental Health, Consorci Sanitari de Terrassa, Terrassa, Catalunya, Spain
| | - Amaia Hervás
- Child and Adolescent Mental Health Service, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
- Institut Global d'Atenció Integral del Neurodesenvolupament (IGAIN), Barcelona, Spain
| | - Enric Duran-Tauleria
- Institut Global d'Atenció Integral del Neurodesenvolupament (IGAIN), Barcelona, Spain
| | - Jordi Galiano-Landeira
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Lorena Chanes
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain
- Serra Húnter Programme, Generalitat de Catalunya, Barcelona, Spain
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Kleckner IR, Wormwood JB, Jones RM, Culakova E, Barrett LF, Lord C, Quigley KS, Goodwin MS. Adaptive thresholding increases sensitivity to detect changes in the rate of skin conductance responses to psychologically arousing stimuli in both laboratory and ambulatory settings. Int J Psychophysiol 2024; 196:112280. [PMID: 38104772 PMCID: PMC10872538 DOI: 10.1016/j.ijpsycho.2023.112280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/03/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
Psychophysiologists recording electrodermal activity (EDA) often derive measures of slow, tonic activity-skin conductance level (SCL)-and faster, more punctate changes-skin conductance responses (SCRs). A SCR is conventionally considered to have occurred when the local amplitude of the EDA signal exceeds a researcher-determined threshold (e.g., 0.05 μS), typically fixed across study participants and conditions. However, fixed SCR thresholds can preferentially exclude data from individuals with low SCL because their SCRs are smaller on average, thereby reducing statistical power for group-level analyses. Thus, we developed a fixed plus adaptive (FA) thresholding method that adjusts identification of SCRs based on an individual's SC at the onset of the SCR to increase statistical power and include data from more participants. We assess the utility of applying FA thresholding across two independent samples and explore age and race-related associations with EDA outcomes. Study 1 uses wired EDA measurements from 254 healthy adults responding to evocative images and sounds in a laboratory setting. Study 2 uses wireless EDA measurements from 20 children with autism in a clinical environment while they completed behavioral tasks. Compared to a 0.01, 0.03, and 0.05 μS fixed threshold, FA thresholding at 1.9% modestly increases statistical power to detect a difference in SCR rate between tasks with higher vs. lower subjective arousal and reduces exclusion of participants by up to 5% across both samples. This novel method expands the EDA analytical toolbox and may be useful in populations with highly variable basal SCL or when comparing groups with different basal SCL. Future research should test for reproducibility and generalizability in other tasks, samples, and contexts. IMPACT STATEMENTS: This article is important because it introduces a novel method to enhance sensitivity and statistical power in analyses of skin conductance responses from electrodermal data.
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Affiliation(s)
| | | | - Rebecca M Jones
- Weill Cornell Medicine, The Center for Autism and the Developing Brain, White Plains, NY, USA
| | - Eva Culakova
- University of Rochester Medical Center, Rochester, NY, USA
| | - Lisa Feldman Barrett
- Northeastern University, Boston, MA, USA; Department of Psychiatry and the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Catherine Lord
- Weill Cornell Medicine, The Center for Autism and the Developing Brain, White Plains, NY, USA; Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
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Vimalananda VG, Meterko M, Sitter KE, Qian S, Wormwood JB, Fincke BG. Patients' Experience of Specialty Care Coordination: Survey Development and Validation. J Patient Cent Res Rev 2023; 10:219-230. [PMID: 38046998 PMCID: PMC10688916 DOI: 10.17294/2330-0698.2027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Purpose Specialty care coordination relies on information flowing bidirectionally between all three participants in the "specialty care triad" - patients, primary care providers (PCPs), and specialists. Measures of coordination should strive to account for the perspectives of each. As we previously developed two surveys to measure coordination of specialty care as experienced by PCPs and specialists, this study aimed to develop and evaluate the psychometric properties of a related survey of specialty care coordination as experienced by the patient, thereby completing the suite of surveys among the triad. Methods We developed a draft survey based on literature review, patient interviews, adaptation of existing measures, and development of new items. Survey responses were collected via mail and online in two waves, August 2019-November 2019 and September 2020-May 2021, among patients (N=939) receiving medical specialty care and primary care in the Veterans Affairs health system. Exploratory and confirmatory factor analysis were used to assess scale structure. Multiple linear regression was used to examine the relationship of the final coordination scales to patients' overall experience of specialty care coordination. Results A 38-item measure representing 10 factors that assess the patient's experience of coordination in specialty care among the patient, PCP, and specialist was finalized. Scales demonstrated good internal consistency reliability and, together, explained 59% of the variance in overall coordination. Analyses revealed an unexpected construct describing organization of care between patient and specialist that accounted for patient goals and preferences; this 10-item scale was named Patient-Centered Care Coordination. Conclusions The final survey, Coordination of Specialty Care - Patient, or CSC-Patient for short, is a reliable instrument that can be used alone or with its companions (CSC-PCP, CSC-Specialist) to provide a detailed assessment of specialty care coordination and identify targets for coordination improvement.
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Affiliation(s)
- Varsha G. Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
- Section of Endocrinology, Diabetes and Metabolism, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Mark Meterko
- Office of Reporting, Analytics, Performance, Improvement and Deployment, Veterans Health Administration (based at VA Bedford Healthcare System), Bedford, MA
| | - Kailyn E. Sitter
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
| | - Shirley Qian
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
| | | | - B. Graeme Fincke
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
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Kressin NR, Wormwood JB, Battaglia TA, Slanetz PJ, Gunn CM. Sociodemographic Variations in Women's Reports of Discussions With Clinicians About Breast Density. JAMA Netw Open 2023; 6:e2344850. [PMID: 38010653 PMCID: PMC10682834 DOI: 10.1001/jamanetworkopen.2023.44850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/14/2023] [Indexed: 11/29/2023] Open
Abstract
Importance Breast density notifications advise women to discuss breast density with their clinicians, yet little is known about such discussions. Objectives To examine the content of women's reports of breast density discussions with clinicians and identify variations by women's sociodemographic characteristics (age, income, state legislation status, race and ethnicity, and literacy level). Design, Setting, and Participants This US nationwide, population-based, random-digit dial telephone survey study was conducted from July 1, 2019, to April 30, 2020, among 2306 women aged 40 to 76 years with no history of breast cancer who underwent mammography in the prior 2 years and had heard the term dense breasts or breast density. Results were analyzed from a subsample of 770 women reporting a conversation about breast density with their clinician after their last mammographic screening. Statistical analysis was conducted in April and July 2023. Main Outcomes and Measures Survey questions inquired whether women's clinicians had asked about breast cancer risk or their worries or concerns about breast density, had discussed mammography results or other options for breast cancer screening or their future risk of breast cancer, as well as the extent to which the clinician answered questions about breast density. Results Of the 770 women (358 [47%] aged 50-64 years; 47 Asian [6%], 125 Hispanic [16%], 204 non-Hispanic Black [27%], 317 non-Hispanic White [41%], and 77 other race and ethnicity [10%]) whose results were analyzed, most reported that their clinicians asked questions about breast cancer risk (88% [670 of 766]), discussed mammography results (94% [724 of 768]), and answered patient questions about breast density (81% [614 of 761]); fewer women reported that clinicians had asked about worries or concerns about breast density (69% [524 of 764]), future risk of breast cancer (64% [489 of 764]), or other options for breast cancer screening (61% [459 of 756]). Women's reports of conversations varied significantly by race and ethnicity; non-Hispanic Black women reported being asked questions about breast cancer risk more often than non-Hispanic White women (odds ratio [OR], 2.08 [95% CI, 1.05-4.10]; P = .04). Asian women less often reported being asked about their worries or concerns (OR, 0.42 [95% CI, 0.20-0.86]; P = .02), and Hispanic and Asian women less often reported having their questions about breast density answered completely or mostly (Asian: OR, 0.28 [95% CI, 0.13-0.62]; P = .002; Hispanic: OR, 0.48 [95% CI, 0.27-0.87]; P = .02). Women with low literacy were less likely than women with high literacy to report being asked about worries or concerns about breast density (OR, 0.64 [95% CI, 0.43-0.96]; P = .03), that mammography results were discussed with them (OR, 0.32 [95% CI, 0.16-0.63]; P = .001), or that their questions about breast density were answered completely or mostly (OR, 0.51 [95% CI, 0.32-0.81]; P = .004). Conclusions and Relevance In this survey study, although most women reported that their clinicians counselled them about breast density, the unaddressed worries or concerns and unanswered questions, especially among Hispanic and Asian women and those with low literacy, highlighted areas where discussions could be improved.
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Affiliation(s)
- Nancy R. Kressin
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | | | - Tracy A. Battaglia
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Priscilla J. Slanetz
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Christine M. Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Dartmouth Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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Vimalananda VG, Wormwood JB, Sitter KE, Fincke BG, Qian S, Tait MN, Meterko M. Adaptations for remote research work: a modified web-push strategy compared to a mail-only strategy for administering a survey of healthcare experiences. BMC Med Res Methodol 2023; 23:244. [PMID: 37858034 PMCID: PMC10588167 DOI: 10.1186/s12874-023-02066-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic required that our research team change our mail-only (MO) strategy for a research survey to a strategy more manageable by staff working remotely. We used a modified web-push approach (MWP), in which patients were mailed a request to respond online and invited to call if they preferred the questionnaire by mail or phone. We also changed from a pre-completion gift to a post-completion gift card incentive. Our objective is to compare response patterns between modes for a survey that used an MO strategy pre-pandemic followed by an MWP strategy peri-pandemic for data collection. METHODS Observational study using data from a national multi-scale survey about patients' experience of specialty care coordination administered via MO in 2019 and MWP from 2020 to 2021 to Veterans receiving primary care and specialty care within the Veterans Health Administration (VA). We compared response rates, respondent characteristics and responses about care coordination between MO and MWP, applying propensity weights to account for differences in the underlying samples. RESULTS The response rate was lower for MWP vs. MO (13.4% vs. 36.6%), OR = 0.27, 95% CI = 0.25-0.30, P < .001). Respondent characteristics were similar across MO and MWP. Coordination scale scores tended to be slightly higher for MWP, but the effect sizes for these differences between modes were small for 9 out of 10 scales. CONCLUSIONS While the logistics of MWP survey data collection are well-suited to the remote research work environment, response rates were lower than those for the MO method. Future studies should examine addition of multi-mode contacts and/or pre-completion incentives to increase response rates for MWP.
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Affiliation(s)
- Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, 200 Springs Road, Building 70, Bedford, MA, 01730, USA.
- Section of Endocrinology, Diabetes and Metabolism, Boston University School of Medicine, Boston, MA, USA.
| | - Jolie B Wormwood
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, 200 Springs Road, Building 70, Bedford, MA, 01730, USA
- Department of Psychology, University of New Hampshire, Durham, NH, USA
| | - Kailyn E Sitter
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, 200 Springs Road, Building 70, Bedford, MA, 01730, USA
| | - B Graeme Fincke
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, 200 Springs Road, Building 70, Bedford, MA, 01730, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Shirley Qian
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, 200 Springs Road, Building 70, Bedford, MA, 01730, USA
| | - Maya N Tait
- International School of Boston, Cambridge, MA, USA
| | - Mark Meterko
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Analytics and Performance Integration, Office of Quality and Patient Safety, Department of Veterans Affairs, Bedford, MA, USA
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Vimalananda VG, Arao K, Qian S, Leibowitz A, Zupa MF, Benzer J, Fincke BG, Zocchi M, Meterko M, Berlowitz D, Sitter KE, Wormwood JB. Variation in telehealth use for endocrine care: Patterns and predictors under the "new normal". J Telemed Telecare 2023:1357633X231203144. [PMID: 37828749 DOI: 10.1177/1357633x231203144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Use of telehealth for outpatient endocrine care remains common since onset of the COVID-19 pandemic, though the context for its use has matured. We aimed to describe the variation in telehealth use for outpatient endocrine visits under these "new normal" conditions and examine the patient, clinician-, and organization-level factors predicting use. METHODS Retrospective cross-sectional study using data from the U.S. Department of Veterans Affairs (VA) Corporate Data Warehouse on 167,017 endocrine visits conducted between 3/9/21 and 3/8/22. We used mixed effects logistic regression models to examine 1) use of telehealth vs. in-person care among all visits and 2) use of telephone vs. video among the subsample of telehealth visits. RESULTS Visits were in person (58%), by telephone (29%), or by video (13%). Unique variability in telehealth use at each level of the analysis was 56% patient visit, 24% clinician, 18% facility. The strongest predictors were visit type (first vs. follow up) and clinician and facility characteristics. Among telehealth visits, unique variability in telephone (vs. video) use at each level was 44% patient visit, 24% clinician, 26% facility. The strongest predictors of telephone vs. video were visit type, patient age, and percent of the facility's population that was rural. CONCLUSIONS We found wide variation in use of telehealth for endocrinology under the "new normal". Future research should examine clinician and facility factors driving variation, as many may be amenable to influence by clinical leaders and leveraged to enhance the availability of telehealth for all clinically appropriate patients.
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Affiliation(s)
- Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Section of Endocrinology, Diabetes and Metabolism, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Kevin Arao
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Section of Endocrinology, Diabetes and Metabolism, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Shirley Qian
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Alison Leibowitz
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Margaret F Zupa
- Division of Endocrinology & Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Justin Benzer
- VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas VA Health Care System, Waco, TX, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin TX, USA
| | - B Graeme Fincke
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Mark Zocchi
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Mark Meterko
- VHA Office of Reporting, Analytics, Performance, Improvement and Deployment, (RAPID-10EA), Field-Based At The VA Bedford Healthcare System, Bedford, MA, USA
| | - Dan Berlowitz
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Department of Public Health, University of Massachusetts, Lowell, MA, USA
| | - Kailyn E Sitter
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Jolie B Wormwood
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Department of Psychology, University of New Hampshire, Durham, NH, USA
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Hoemann K, Wormwood JB, Barrett LF, Quigley KS. Multimodal, Idiographic Ambulatory Sensing Will Transform our Understanding of Emotion. Affect Sci 2023; 4:480-486. [PMID: 37744967 PMCID: PMC10513989 DOI: 10.1007/s42761-023-00206-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 07/17/2023] [Indexed: 09/26/2023]
Abstract
Emotions are inherently complex - situated inside the brain while being influenced by conditions inside the body and outside in the world - resulting in substantial variation in experience. Most studies, however, are not designed to sufficiently sample this variation. In this paper, we discuss what could be discovered if emotion were systematically studied within persons 'in the wild', using biologically-triggered experience sampling: a multimodal and deeply idiographic approach to ambulatory sensing that links body and mind across contexts and over time. We outline the rationale for this approach, discuss challenges to its implementation and widespread adoption, and set out opportunities for innovation afforded by emerging technologies. Implementing these innovations will enrich method and theory at the frontier of affective science, propelling the contextually situated study of emotion into the future.
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Affiliation(s)
- Katie Hoemann
- Department of Psychology, KU Leuven, Tiensestraat 102, Box 3727, 3000 Leuven, BE Belgium
| | - Jolie B. Wormwood
- Department of Psychology, University of New Hampshire, Durham, NH USA
| | - Lisa Feldman Barrett
- Department of Psychology, Northeastern University, Boston, MA USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Cambridge, MA USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA USA
| | - Karen S. Quigley
- Department of Psychology, Northeastern University, Boston, MA USA
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Arao KA, Wong DH, Wormwood JB, Vimalananda VG. Use of Structured Templates to Improve Completeness of Endocrinology Referrals. Endocr Pract 2023:S1530-891X(23)00423-8. [PMID: 37263393 DOI: 10.1016/j.eprac.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Endocrinology referrals frequently lack important clinical information, which may increase the risk of inefficiency and adverse outcomes. This quality improvement project aimed to improve the completeness of new referrals by utilizing structured referral templates for common endocrine conditions at a large Veterans Health Administration (VA) medical center. Our target was at least a 30% improvement in referral completeness for each condition after the intervention. METHODS Electronic structured referral templates were designed utilizing existing resources and input from primary care providers (PCPs) and endocrinologists. Essential elements were identified and included in the templates. We conducted a retrospective chart review to compare referrals for 125 patients referred between 1/1/2021-9/1/2021 (pre-intervention) and 125 patients referred between 10/1/2021-9/30/2022 (post-intervention). Each referral was rated using a scoring system derived from the criteria in the data abstraction tool formulated by the investigators. RESULTS On average, pre-intervention referrals included 52% of the essential elements and post-intervention referrals included 93%. Improvements in referral scores for each condition all met the pre-specified 30% improvement target. The greatest improvement was for the element "type of visit preference". A separate analysis excluding that element showed an average improvement from 64% of essential elements pre-intervention to 92% post-intervention. CONCLUSION Structured referral templates, designed with the input of PCPs and endocrinologists and embedded into an electronic referral system, can improve availability of essential information and increase the quality of referrals. Future work should examine the effect of structured referral templates on efficiency, specialist experience, patient experience of care, and clinical outcomes.
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Affiliation(s)
- Kevin A Arao
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA; Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, MA.
| | - Denise H Wong
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Jolie B Wormwood
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA; Department of Psychology, University of New Hampshire, Durham, NH
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA; Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
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Kressin NR, Wormwood JB, Battaglia TA, Slanetz PJ, Gunn CM. Women's Reactions to Breast Density Information Vary by Sociodemographic Characteristics. Womens Health Issues 2023:S1049-3867(23)00070-1. [PMID: 37087312 DOI: 10.1016/j.whi.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Breast density information aims to increase awareness of breast density and its risks and to foster more informed future breast screening decisions among women with dense breasts. We explored associations between such information and outcomes including anxiety, confusion, or feeling informed, and whether they varied by race/ethnicity or literacy, or differentially affected future mammography plans. METHODS A national telephone survey of a diverse sample of women previously informed of personal breast density (N = 1,322) assessed reactions to receipt of breast density information and future mammography plans. RESULTS Most women (86%) felt informed after receiving personal breast density information; however, some felt anxious (15%) or confused (11%). Reactions varied significantly by sociodemographics; non-Hispanic Black, Asian, and Hispanic women and women with low literacy were nearly two to three times more likely to report anxiety than non-Hispanic White women (all ps < .05). Asian women and those with low literacy less often felt informed and more often felt confused. Non-Hispanic Black and Asian women were nearly twice as likely to report that knowing their breast density made them more likely to have future mammograms. Women with low literacy were more likely to change mammography plans, with some being more likely and others less likely to plan to have future mammograms. Greater anxiety and confusion were associated with higher likelihood of planning future mammograms; those feeling informed were less likely to plan future mammography. CONCLUSIONS Differential reactions to breast density information are concerning if associated with disparate future screening plans. Future breast density education efforts should ensure that such information is readily accessible and understandable to all women in order to lead to desired effects.
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Affiliation(s)
- Nancy R Kressin
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts.
| | - Jolie B Wormwood
- Department of Psychology, University of New Hampshire, Durham, New Hampshire
| | - Tracy A Battaglia
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts
| | - Priscilla J Slanetz
- Department of Radiology, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts; The Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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Graham K, LaChance A, Wormwood JB. Bystander Intervention in Intimate Partner Violence: An Audio Vignette Study of Heterosexual, Gay, and Lesbian Dating Partners. J Interpers Violence 2023; 38:3979-4006. [PMID: 35869600 DOI: 10.1177/08862605221111412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Intimate partner violence (IPV) is a prolific and growing issue that can have long-lasting negative consequences for the health and safety of those involved. Bystander intervention is one method for helping to combat incidents of IPV, as research suggests that bystanders are frequently present at the scene of assaults and incidents of IPV. This study explored individual differences of bystanders that may influence whether they decide to intervene in an unfolding incident of IPV, as well as how the likelihood of intervening may vary as a function of the apparent gender or sexual orientation of the individuals involved in an incident of IPV. Participants were recruited from an online survey platform to obtain a balanced sample of heterosexual and sexual minority individuals. Participants completed a bystander task where they listened to an audio vignette of an unfolding IPV incident and were instructed to stop the audio if/when they would intervene in a real-life context. Participants were randomly assigned to listen to one of four versions of the vignette in which the apparent gender of the aggressor and victim were manipulated. Results revealed participants were more likely to intervene if they identified as a sexual minority (vs. as a heterosexual), reported less rape myth acceptance, or had greater endorsement of gender equality. Results also revealed that associations between bystander characteristics and intervening behavior largely did not differ across vignette conditions, suggesting that they may influence the likelihood of intervening consistently across incidents of IPV regardless of the apparent gender and sexual orientation of the aggressor and victim. However, participants in general were most likely to intervene in the male aggressor/female victim vignette. Implications for IPV prevention programming-including the need to include more diverse and less heteronormative depictions of IPV-are discussed.
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11
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Beidler LB, Kressin NR, Wormwood JB, Battaglia TA, Slanetz PJ, Gunn CM. Perceptions of Breast Cancer Risks Among Women Receiving Mammograph Screening. JAMA Netw Open 2023; 6:e2252209. [PMID: 36689223 PMCID: PMC9871800 DOI: 10.1001/jamanetworkopen.2022.52209] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/02/2022] [Indexed: 01/24/2023] Open
Abstract
Importance Breast density is an independent risk factor for breast cancer. Despite the proliferation of mandated written notifications about breast density following mammography, there is little understanding of how women perceive the relative breast cancer risk associated with breast density. Objective To assess women's perception of breast density compared with other breast cancer risks and explore their understanding of risk reduction. Design, Setting, and Participants This mixed-methods qualitative study used telephone surveys and semistructured interviews to investigate perceptions about breast cancer risk among a nationally representative, population-based sample of women. Eligible study participants were aged 40 to 76 years, reported having recently undergone mammography, had no history of prior breast cancer, and had heard of breast density. Survey participants who had been informed of their personal breast density were invited for a qualitative interview. Survey administration spanned July 1, 2019, to April 30, 2020, with 2306 women completing the survey. Qualitative interviews were conducted from February 1 to May 30, 2020. Main Outcomes and Measures Respondents compared the breast cancer risk associated with breast density with 5 other risk factors. Participants qualitatively described what they thought contributed to breast cancer risk and ways to reduce risk. Results Of the 2306 women who completed the survey, 1858 (166 [9%] Asian, 503 [27%] Black, 268 [14%] Hispanic, 792 [43%] White, and 128 [7%] other race or ethnicity; 358 [19%] aged 40-49 years, 906 [49%] aged 50-64 years, and 594 [32%] aged ≥65 years) completed the revised risk perception questions and were included in the analysis. Half of respondents thought breast density to be a greater risk than not having children (957 [52%]), having more than 1 alcoholic drink per day (975 [53%]), or having a prior breast biopsy (867 [48%]). Most respondents felt breast density was a lesser risk than having a first-degree relative with breast cancer (1706 [93%]) or being overweight or obese (1188 [65%]). Of the 61 women who were interviewed, 6 (10%) described breast density as contributing to breast cancer risk, and 43 (70%) emphasized family history as a breast cancer risk factor. Of the interviewed women, 17 (28%) stated they did not know whether it was possible to reduce their breast cancer risk. Conclusions and Relevance In this qualitative study of women of breast cancer screening age, family history was perceived as the primary breast cancer risk factor. Most interviewees did not identify breast density as a risk factor and did not feel confident about actions to mitigate breast cancer risk. Comprehensive education about breast cancer risks and prevention strategies is needed.
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Affiliation(s)
- Laura B. Beidler
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Nancy R. Kressin
- Section of General Internal Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts
| | | | - Tracy A. Battaglia
- Section of General Internal Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts
| | - Priscilla J. Slanetz
- Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Christine M. Gunn
- Dartmouth Cancer Center, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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12
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Ramos-Grille I, Weyant J, Wormwood JB, Robles M, Vallès V, Camprodon JA, Chanes L. Predictive processing in depression: Increased prediction error following negative valence contexts and influence of recent mood-congruent yet irrelevant experiences. J Affect Disord 2022; 311:8-16. [PMID: 35550829 DOI: 10.1016/j.jad.2022.05.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/19/2022] [Accepted: 05/05/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Novel theoretical models of depression have recently emerged based on an influential new perspective in neuroscience known as predictive processing. In these models, depression may be understood as an imbalance of predictive signals in the brain; more specifically, a dominance of predictions leading to a relative insensitivity to prediction error. Despite these important theoretical advances, empirical evidence remains limited, and how expectations are generated and used dynamically in individuals with depression remains largely unexplored. METHODS In this study, we induced facial expression predictions using emotion contexts in 34 individuals with depression and 34 healthy controls. RESULTS Compared to controls, individuals with depression perceived displayed facial expressions as less similar to their expectations (i.e., increased difference between expectations and actual sensory input) following contexts evoking negative valence emotions, indicating that depressed individuals have increased prediction error in such contexts. This effect was amplified by recent mood-congruent yet irrelevant experiences. LIMITATIONS The clinical sample included participants with comorbid psychopathology and taking medication. Additionally, the two groups were not evaluated in the same setting, and only three emotion categories (fear, sadness, and happiness) were explored. CONCLUSIONS Our results shed light on potential mechanisms underlying processing abnormalities regarding negative information, which has been consistently reported in depression, and may be a relevant point of departure for exploring transdiagnostic vulnerability to mental illness. Our data also has the potential to improve clinical practice through the implementation of novel diagnostic and therapeutic tools based on the assessment and modulation of predictive signals.
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Affiliation(s)
- Irene Ramos-Grille
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Catalunya, Spain; Division of Mental Health, Consorci Sanitari de Terrassa, Terrassa, Catalunya, Spain
| | - Jennifer Weyant
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Catalunya, Spain
| | | | - Marta Robles
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Catalunya, Spain
| | - Vicenç Vallès
- Division of Mental Health, Consorci Sanitari de Terrassa, Terrassa, Catalunya, Spain
| | - Joan A Camprodon
- Division of Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lorena Chanes
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Catalunya, Spain; Institut de Neurociències, Universitat Autònoma de Barcelona, Catalunya, Spain; Serra Húnter Programme, Generalitat de Catalunya, Catalunya, Spain.
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13
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Smith SL, Ward RT, Allen LK, Wormwood JB, Mills C. Mind your words: Affective experience during reading mediates the effect of textual valence on comprehension. Applied Cognitive Psychology 2022. [DOI: 10.1002/acp.3983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shelby L. Smith
- Department of Psychology University of New Hampshire Durham New Hampshire USA
| | - Richard T. Ward
- Department of Psychology University of Florida, Gainesville Florida USA
- Center for the Study of Emotion and Attention University of Florida, Gainesville Florida USA
| | - Laura K. Allen
- Department of Psychology University of New Hampshire Durham New Hampshire USA
| | - Jolie B. Wormwood
- Department of Psychology University of New Hampshire Durham New Hampshire USA
| | - Caitlin Mills
- Department of Psychology University of New Hampshire Durham New Hampshire USA
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14
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Kressin NR, Wormwood JB, Battaglia TA, Slanetz PJ, Gunn CM. A letter is not enough: Women's preferences for and experiences of receiving breast density information. Patient Educ Couns 2022; 105:2450-2456. [PMID: 35534300 PMCID: PMC9250336 DOI: 10.1016/j.pec.2022.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Despite evidence of disparate uptake of breast density (BD) information, little is known about diverse women's preferences for and experiences learning about BD. METHODS Telephone survey among 2306 racially/ethnically and literacy diverse women; qualitative interviews with 61 survey respondents. Responses by participant race/ethnicity and literacy were examined using bivariate, then multivariable analyses. Interviews were content-analyzed for themes. RESULTS Most women (80%) preferred learning of personal BD from providers, with higher rates among Non-Hispanic Black (85%) than Non-Hispanic White women (80%); and among Non-Hispanic White than Asian women (72%, all ps<0.05). Women with low literacy less often preferred receiving BD information from providers (76% v. 81%), more often preferring written notification (21% vs. 10%); women with high literacy more often preferred learning through an online portal (9% vs 3%). Most women (93%) received BD information from providers (no between group differences). Qualitative findings detailed women's desires for obtaining BD information from providers, written information, and visual depictions of BD. CONCLUSIONS When educating women about BD, one size does not fit all. PRACTICE IMPLICATIONS Additional educational methods are needed beyond written BD notifications to sufficiently address the varying informational needs and preferences of all USA women.
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Affiliation(s)
- Nancy R Kressin
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
| | - Jolie B Wormwood
- Department of Psychology, University of New Hampshire, Durham, NH, USA
| | - Tracy A Battaglia
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Priscilla J Slanetz
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
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15
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Feldman MJ, Siegel E, Barrett LF, Quigley KS, Wormwood JB. Affect and Social Judgment: The Roles of Physiological Reactivity and Interoceptive Sensitivity. Affect Sci 2022; 3:464-479. [PMID: 36046009 PMCID: PMC9382998 DOI: 10.1007/s42761-022-00114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 03/11/2022] [Indexed: 06/03/2023]
Abstract
Humans imbue the objects of their perception with affective meaning, a phenomenon called affective realism. The affective realism hypothesis proposes that a brain continually predicts the meaning of sensations (e.g., identifying a sound as a siren, or a visual array as a face) in part by representing the current state of the body and the immediate physiological impact that similar sensory events have entailed in the past. However, the precise contribution of physiological activity to experiences of affective realism remains unknown. In the present study, participants' peripheral physiological activity was recorded while they made social evaluative judgments of target faces displaying neutral expressions. Target faces were shown concurrent with affective images that were suppressed from reportable awareness using continuous flash suppression. Results revealed evidence of affective realism-participants judged target faces more positively when paired with suppressed positive stimuli than suppressed negative stimuli-but this effect was significantly less pronounced among individuals higher in cardiac interoceptive sensitivity. Moreover, while some modest differences in peripheral physiological activity were observed across suppressed affective stimulus conditions, physiological reactivity to affective stimuli did not directly predict social evaluative judgments. We explore the implications of these findings with respect to both theories of emotion and theories detailing a role for interoception in experiences of first-person subjectivity. Supplementary Information The online version contains supplementary material available at 10.1007/s42761-022-00114-9.
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Affiliation(s)
- Mallory J. Feldman
- University of North Carolina at Chapel Hill, 231 E. Cameron Ave, Chapel Hill, NC 27514 USA
| | | | - Lisa Feldman Barrett
- Department of Psychology, Northeastern University, Boston, MA 02115 USA
- Department of Psychiatry and the Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General Hospital, Boston, MA USA
| | - Karen S. Quigley
- Department of Psychology, Northeastern University, Boston, MA 02115 USA
| | - Jolie B. Wormwood
- Department of Psychology, University of New Hampshire, Durham, NH 03824 USA
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16
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Kressin NR, Wormwood JB, Battaglia TA, Maschke AD, Slanetz PJ, Pankowska M, Gunn CM. Women's Understandings and Misunderstandings of Breast Density and Related Concepts: A Mixed Methods Study. J Womens Health (Larchmt) 2022; 31:983-990. [DOI: 10.1089/jwh.2021.0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nancy R. Kressin
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jolie B. Wormwood
- Department of Psychology, University of New Hampshire, Durham, New Hampshire, USA
| | - Tracy A. Battaglia
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ariel D. Maschke
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Priscilla J. Slanetz
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Magdalena Pankowska
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Christine M. Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
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17
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Azari B, Westlin C, Satpute AB, Hutchinson JB, Kragel PA, Hoemann K, Khan Z, Wormwood JB, Quigley KS, Erdogmus D, Dy J, Brooks DH, Barrett LF. Author Correction: Comparing supervised and unsupervised approaches to emotion categorization in the human brain, body, and subjective experience. Sci Rep 2021; 11:10241. [PMID: 33967274 PMCID: PMC8107176 DOI: 10.1038/s41598-021-89878-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Bahar Azari
- Department of Electrical & Computer Engineering, College of Engineering, Northeastern University, Boston, MA, USA
| | - Christiana Westlin
- Department of Psychology, College of Science, Northeastern University, Boston, MA, USA
| | - Ajay B Satpute
- Department of Psychology, College of Science, Northeastern University, Boston, MA, USA
| | | | - Philip A Kragel
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Katie Hoemann
- Department of Psychology, College of Science, Northeastern University, Boston, MA, USA
| | - Zulqarnain Khan
- Department of Electrical & Computer Engineering, College of Engineering, Northeastern University, Boston, MA, USA
| | - Jolie B Wormwood
- Department of Psychology, University of New Hampshire, Durham, NH, USA
| | - Karen S Quigley
- Department of Psychology, College of Science, Northeastern University, Boston, MA, USA.,Edith Nourse Rogers Veterans Hospital, Bedford, MA, USA
| | - Deniz Erdogmus
- Department of Electrical & Computer Engineering, College of Engineering, Northeastern University, Boston, MA, USA
| | - Jennifer Dy
- Department of Electrical & Computer Engineering, College of Engineering, Northeastern University, Boston, MA, USA
| | - Dana H Brooks
- Department of Electrical & Computer Engineering, College of Engineering, Northeastern University, Boston, MA, USA.
| | - Lisa Feldman Barrett
- Department of Psychology, College of Science, Northeastern University, Boston, MA, USA. .,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. .,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA.
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18
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Yoon SS, Wong DH, Wormwood JB, Reisman JI, Vimalananda VG. Impact of Electronic Consultation on Timeliness and Guideline Concordance of Workups Leading to Thyroid Nodule Fine-Needle Aspiration Biopsy. Endocr Pract 2021; 27:1011-1016. [PMID: 33766654 DOI: 10.1016/j.eprac.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Electronic consultations (e-consults) are commonly used to obtain endocrinology input on clinical questions without a face-to-face visit, but sparse data exist on the resultant quality of care for specific conditions. We examined workups resulting in a thyroid nodule fine-needle aspiration (FNA) biopsy to investigate whether endocrinology e-consults were more timely and similarly guideline-concordant compared with endocrinology face-to-face visits and whether endocrinology e-consults were more guideline-concordant compared with workups without endocrinology input. METHODS We retrospectively reviewed charts of 302 thyroid FNA biopsies conducted in the Veterans Affairs health system between May 1, 2017, and February 4, 2020 (e-consult, n = 99; face-to-face visit, n = 100; no endocrinology input, n = 103). We used t tests to compare timeliness, χ2 tests to compare the proportion of guideline-concordant workups, and multivariable linear and logistic models to control for demographic factors. RESULTS FNAs preceded by an endocrinology e-consult had more timely workups compared with those preceded by endocrinology face-to-face visits in terms of days elapsed between referral and FNA biopsy (geometric mean 44.7 days vs 61.7 days, P = .01). The difference in the summary measure of guideline concordance across groups was not statistically significant (P =.38). CONCLUSION E-consults were faster than face-to-face consults and similarly guideline-concordant compared with both face-to-face consults and no endocrinology input for workups resulting in FNA. Decisions about the appropriate use of e-consults for thyroid nodules should take into account these data while also considering the potential benefits of direct patient-endocrinologist interaction for complex situations.
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Affiliation(s)
- Samuel S Yoon
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts; Advocate Aurora Health, Division of Endocrinology, Diabetes, and Metabolism, Aurora Wilkinson Medical Clinic, Hartland, Wisconsin.
| | - Denise H Wong
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts; Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, Massachusetts
| | - Jolie B Wormwood
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts; Department of Psychology, University of New Hampshire, Durham, New Hampshire
| | - Joel I Reisman
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts; Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, Massachusetts
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19
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Kressin NR, Battaglia TA, Wormwood JB, Slanetz PJ, Gunn CM. Dense Breast Notification Laws' Association With Outcomes in the US Population: A Cross-Sectional Study. J Am Coll Radiol 2020; 18:685-695. [PMID: 33358722 DOI: 10.1016/j.jacr.2020.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Understanding whether states' breast density notifications are associated with desired effects, or disparities, can inform federal policy. We examined self-reported receipt of personal breast density information, breast density discussions with providers, knowledge about density's masking effect, and association with increased breast cancer risk by state legislation status and women's sociodemographic characteristics. METHODS Cross-sectional observational population-based telephone survey of women aged >40 years who underwent mammography within prior 2 years, had no history of breast cancer, and had heard the term "breast density." RESULTS Among 2,306 women, 57% received personal breast density information. Multivariate regression models adjusted for covariates indicated that women in notification states were 1.5 times more likely to receive density information, and older Black and Asian women of lower income and lower health literacy were less likely. Overall, only 39% of women discussed density with providers; women in notification states were 1.75 times as likely. Older and Asian women were less likely to have spoken with providers; women with high literacy or prior biopsy were more likely. State legislation status was not associated with differences in density knowledge, but Hispanic women and women of lower income or low health literacy had less knowledge regarding density's masking effects; older women were more knowledgeable. Hispanic women and women of lower income or low health literacy were more likely, and middle-aged women less likely, to recognize increased breast cancer risk. DISCUSSION Some positive effects were observed, but sociodemographic disparities suggest tailoring of future breast density communications for specific populations of women to ensure equitable understanding.
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Affiliation(s)
- Nancy R Kressin
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
| | - Tracy A Battaglia
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Associate Director of the Belkin Breast Health Center, Boston Medical Center, and Director, Women's Health Group, Boston Medical Center
| | - Jolie B Wormwood
- Department of Psychology, University of New Hampshire, Durham, New Hampshire
| | - Priscilla J Slanetz
- Vice Chair of Academic Affairs and Associate Program Director of the Diagnostic Radiology Residency, Department of Radiology, Boston University Medical Center; President-Elect of the Massachusetts Radiological Society and Chair of the ACR Appropriateness Criteria Committee Breast Imaging Panel; Department of Radiology, Boston University School of Medicine, Boston, Massachusetts
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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Azari B, Westlin C, Satpute AB, Hutchinson JB, Kragel PA, Hoemann K, Khan Z, Wormwood JB, Quigley KS, Erdogmus D, Dy J, Brooks DH, Barrett LF. Comparing supervised and unsupervised approaches to emotion categorization in the human brain, body, and subjective experience. Sci Rep 2020; 10:20284. [PMID: 33219270 PMCID: PMC7679385 DOI: 10.1038/s41598-020-77117-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/16/2020] [Indexed: 12/05/2022] Open
Abstract
Machine learning methods provide powerful tools to map physical measurements to scientific categories. But are such methods suitable for discovering the ground truth about psychological categories? We use the science of emotion as a test case to explore this question. In studies of emotion, researchers use supervised classifiers, guided by emotion labels, to attempt to discover biomarkers in the brain or body for the corresponding emotion categories. This practice relies on the assumption that the labels refer to objective categories that can be discovered. Here, we critically examine this approach across three distinct datasets collected during emotional episodes—measuring the human brain, body, and subjective experience—and compare supervised classification solutions with those from unsupervised clustering in which no labels are assigned to the data. We conclude with a set of recommendations to guide researchers towards meaningful, data-driven discoveries in the science of emotion and beyond.
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Affiliation(s)
- Bahar Azari
- Department of Electrical & Computer Engineering, College of Engineering, Northeastern University, Boston, MA, USA
| | - Christiana Westlin
- Department of Psychology, College of Science, Northeastern University, Boston, MA, USA
| | - Ajay B Satpute
- Department of Psychology, College of Science, Northeastern University, Boston, MA, USA
| | | | - Philip A Kragel
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Katie Hoemann
- Department of Psychology, College of Science, Northeastern University, Boston, MA, USA
| | - Zulqarnain Khan
- Department of Electrical & Computer Engineering, College of Engineering, Northeastern University, Boston, MA, USA
| | - Jolie B Wormwood
- Department of Psychology, University of New Hampshire, Durham, NH, USA
| | - Karen S Quigley
- Department of Psychology, College of Science, Northeastern University, Boston, MA, USA.,Edith Nourse Rogers Veterans Hospital, Bedford, MA, USA
| | - Deniz Erdogmus
- Department of Electrical & Computer Engineering, College of Engineering, Northeastern University, Boston, MA, USA
| | - Jennifer Dy
- Department of Electrical & Computer Engineering, College of Engineering, Northeastern University, Boston, MA, USA
| | - Dana H Brooks
- Department of Electrical & Computer Engineering, College of Engineering, Northeastern University, Boston, MA, USA.
| | - Lisa Feldman Barrett
- Department of Psychology, College of Science, Northeastern University, Boston, MA, USA. .,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. .,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA.
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21
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Anderson E, Solch AK, Fincke BG, Meterko M, Wormwood JB, Vimalananda VG. Concerns of Primary Care Clinicians Practicing in an Integrated Health System: a Qualitative Study. J Gen Intern Med 2020; 35:3218-3226. [PMID: 32918198 PMCID: PMC7661604 DOI: 10.1007/s11606-020-06193-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/08/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Clinician well-being is a major priority for healthcare organizations. However, the impact of workplace environment on clinicians' well-being is poorly understood. Integrated health systems are a particularly relevant type of practice environment to focus on, given the increasing rates of practice consolidation and integration. OBJECTIVE To improve understanding of the concerns of primary care clinicians (PCCs) practicing in an integrated health system. DESIGN We analyzed free-text comment box responses offered on a national survey about care coordination by 555 PCCs in the Veterans Health Administration, one of the largest integrated health systems in the USA. PARTICIPANTS A total of 555 PCCs who left free-text comments on a national survey of care coordination in the VHA (30% out of 1862 eligible respondents). Demographics and coordination scale scores were similar between respondents who left comments vs. those who did not. APPROACH The data were coded and analyzed in line with the grounded theory approach. Key themes were identified by team consensus and illustrative quotations were chosen to illustrate each theme. KEY RESULTS VHA PCCs described some pressures shared across practice environments, such as prohibitive administrative burden, but also reported several concerns particular to integrated settings, including "dumping" by specialists and moral distress related to a concern for patients. Frustrations due to several aspects of responsibility around referrals may be unique to integrated health systems with salaried clinicians and/or where specialists have the ability to reject referrals. CONCLUSION PCCs in integrated health systems feel many of the same pressures as their counterparts in non-integrated settings, but they are also confronted with unique stressors related to these systems' organizational features that restrict clinicians' autonomy. An understanding of these concerns can guide efforts to improve the well-being of PCCs in existing integrated health systems, as well as in practices on their way to integration.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA.
| | - Amanda K Solch
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
| | - B Graeme Fincke
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Mark Meterko
- VHA Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID), Bedford, MA, USA
| | - Jolie B Wormwood
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
- University of New Hampshire, Durham, NH, USA
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
- Boston University School of Medicine, Boston, MA, USA
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22
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Dryden EM, Hyde JK, Wormwood JB, Wu J, Calloway R, Cutrona SL, Elwyn G, Fix GM, Orner MB, Shimada SL, Bokhour BG. Assessing Patients' Perceptions of Clinician Communication: Acceptability of Brief Point-of-Care Surveys in Primary Care. J Gen Intern Med 2020; 35:2990-2999. [PMID: 32748346 PMCID: PMC7572926 DOI: 10.1007/s11606-020-06062-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Improving patient-centered (PC) communication is a priority in many healthcare organizations. Most PC communication metrics are distal to the care encounter and lack clear attribution, thereby reducing relevance for leaders and clinicians. OBJECTIVE We assessed the acceptability of measuring PC communication at the point-of-care. DESIGN A brief patient survey was conducted immediately post-primary care appointments at one Veterans Affairs Medical Center. Audit-feedback reports were created for clinicians and discussed in qualitative interviews. PARTICIPANTS A total of 485 patients completed the survey. Thirteen interviews were conducted with clinicians and hospital leaders. MAIN MEASURE(S) Measures included collaboRATE (a 3-item tool measuring PC communication), a question about how well needs were met, and overall visit satisfaction. Data were analyzed using descriptive statistics to characterize the mean and distribution of collaboRATE scores and determine the proportion of patients giving clinicians a "top score" on each item. Associations among responses were examined. Interviews focused on the value of measuring PC communication and were analyzed using a framework approach. KEY RESULTS The proportion of patients giving PC communication "top scores" ranged from 41 to 92% for 16 clinicians who had ≥ 25 completed surveys. Among patients who gave "top scores" for PC communication, the odds of reporting that needs were "completely met" were 10.8 times higher (p < .001) and the odds of reporting being "very satisfied" with their care were 13.3 times higher (p < .001) compared with patients who did not give "top scores." Interviewees found clinician-specific feedback useful; concerns included prioritizing this data when other measures are used to evaluate clinicians' performance. Difficulties improving PC communication given organizational structures were noted. Recommendations for interventions included peer-to-peer education and mentoring by top-scoring clinicians. CONCLUSIONS Assessing provider communication at the point-of-care is acceptable and useful to clinicians. Challenges remain to properly incentivize and support the use of this data for improving PC communication.
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Affiliation(s)
- Eileen M Dryden
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
| | - Justeen K Hyde
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Jolie B Wormwood
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Department of Psychology, University of New Hampshire, Durham, NH, USA
| | - Juliet Wu
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Rodney Calloway
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Sarah L Cutrona
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Gemmae M Fix
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Michelle B Orner
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Stephanie L Shimada
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Barbara G Bokhour
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
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23
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Vimalananda VG, Meterko M, Qian S, Wormwood JB, Solch MSW A, Fincke BG. Development and psychometric assessment of a survey to measure specialty care coordination as experienced by primary care providers. Health Serv Res 2020; 55:660-670. [PMID: 33460075 PMCID: PMC7518815 DOI: 10.1111/1475-6773.13310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess the psychometric properties and construct validity of a survey of primary care providers' (PCPs') experience of specialty care coordination, which is a counterpart to our existing survey ("CSC-Specialist") that measures specialists' experience of specialty care coordination. DATA SOURCES We surveyed PCPs from Veterans Health Administration medical centers and community-based outpatient clinics nationwide (N = 1576) in April 2018. STUDY DESIGN We developed candidate items through literature review, existing surveys, PCP interviews, and expert opinion. We used exploratory and confirmatory factor analysis to develop scales and multivariable linear regression to determine their association with PCPs' overall experience of coordination. DATA COLLECTION The online survey included 23 candidate scale items about specialty care coordination and a single item asking respondents to rate their overall experience of specialty care coordination on a 0-10 scale. All VA PCPs were eligible. We sent survey invitations to PCPs following local Section Chiefs' email introduction (N = 926) and by directly emailing two random samples (N = 400 and N = 6653), overall response rate across the three nonoverlapping samples = 24 percent. PRINCIPAL FINDINGS Analyses identified 20 items forming 6 scales with strong psychometric properties and predictive power for overall coordination. Two scales are identical to CSC-Specialist scales: "Communication" (k = 3, α = 0.87) and "Data Transfer" (k = 2, α = 0.92); one is similar: "Relationships and Collaboration" (k = 6, α = 0.90). The three remaining scales address the PCP's unique perspective: "Role Clarity" (k = 3, α = 0.85), "Role Agreement" (k = 3, α = 0.75), and "Making Referrals" (k = 3, α = 0.75). The six scales together explained 67 percent of the variance in PCPs' overall coordination experience with specialists. CONCLUSIONS The Coordination of Specialty Care-Primary Care Provider Survey (CSC-PCP) is a novel 20-item survey that can be used in quality improvement or health services research, alone or in combination with the CSC-Specialist, to evaluate coordination of care as experienced by either or both participants.
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Affiliation(s)
- Varsha G. Vimalananda
- Center for Healthcare Organization and Implementation Research (CHOIR)Edith Nourse Rogers Memorial VA Medical CenterBedfordMassachusettsUSA
- Section of Endocrinology, Diabetes and MetabolismBoston University School of MedicineBostonMassachusettsUSA
| | - Mark Meterko
- VHA Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID – 10EA)Field‐Based at the Edith Nourse Rogers Memorial VA Medical CenterBedfordMassachusettsUSA
- Department of Health Law, Policy and ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Shirley Qian
- Center for Healthcare Organization and Implementation Research (CHOIR)Edith Nourse Rogers Memorial VA Medical CenterBedfordMassachusettsUSA
| | - Jolie B. Wormwood
- Center for Healthcare Organization and Implementation Research (CHOIR)Edith Nourse Rogers Memorial VA Medical CenterBedfordMassachusettsUSA
- Department of PsychologyUniversity of New HampshireDurhamNew HampshireUSA
| | - Amanda Solch MSW
- Center for Healthcare Organization and Implementation Research (CHOIR)Edith Nourse Rogers Memorial VA Medical CenterBedfordMassachusettsUSA
| | - Benjamin Graeme Fincke
- Center for Healthcare Organization and Implementation Research (CHOIR)Edith Nourse Rogers Memorial VA Medical CenterBedfordMassachusettsUSA
- Department of Health Law, Policy and ManagementBoston University School of Public HealthBostonMassachusettsUSA
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24
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Mitchell NS, Stolzmann K, Benning LV, Wormwood JB, Linsky AM. Effect of a Scoring Rubric on the Review of Scientific Meeting Abstracts. J Gen Intern Med 2020; 36:2483-2485. [PMID: 32748347 PMCID: PMC8342698 DOI: 10.1007/s11606-020-05960-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Nia S Mitchell
- Division of General Internal Medicine, Duke University School of Medicine, 200 Morris St., 3rd Floor, Durham, NC, USA.
- Center for Community and Population Health Improvement, Duke University School of Medicine, Durham, NC, USA.
| | - Kelly Stolzmann
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Lauren V Benning
- Family Medicine Residency, McLeod Regional Medical Center, Florence, SC, USA
| | - Jolie B Wormwood
- Department of Psychology, University of New Hampshire, Durham, NH, USA
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, USA
| | - Amy M Linsky
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Section of General Internal Medicine, VA Boston Healthcare System, Boston, MA, USA
- Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
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25
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Hoemann K, Khan Z, Feldman MJ, Nielson C, Devlin M, Dy J, Barrett LF, Wormwood JB, Quigley KS. Context-aware experience sampling reveals the scale of variation in affective experience. Sci Rep 2020; 10:12459. [PMID: 32719368 PMCID: PMC7385108 DOI: 10.1038/s41598-020-69180-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022] Open
Abstract
Emotion research typically searches for consistency and specificity in physiological activity across instances of an emotion category, such as anger or fear, yet studies to date have observed more variation than expected. In the present study, we adopt an alternative approach, searching inductively for structure within variation, both within and across participants. Following a novel, physiologically-triggered experience sampling procedure, participants' self-reports and peripheral physiological activity were recorded when substantial changes in cardiac activity occurred in the absence of movement. Unsupervised clustering analyses revealed variability in the number and nature of patterns of physiological activity that recurred within individuals, as well as in the affect ratings and emotion labels associated with each pattern. There were also broad patterns that recurred across individuals. These findings support a constructionist account of emotion which, drawing on Darwin, proposes that emotion categories are populations of variable instances tied to situation-specific needs.
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Affiliation(s)
| | | | | | | | | | | | - Lisa Feldman Barrett
- Northeastern University, Boston, USA
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, USA
| | - Jolie B Wormwood
- University of New Hampshire, Durham, USA
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, USA
| | - Karen S Quigley
- Northeastern University, Boston, USA
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, USA
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26
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Kressin NR, Wormwood JB, Battaglia TA, Gunn CM. Differences in Breast Density Awareness, Knowledge, and Plans Based on State Legislation Status and Sociodemographic Characteristics. J Gen Intern Med 2020; 35:1923-1925. [PMID: 31845108 PMCID: PMC7280429 DOI: 10.1007/s11606-019-05578-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/26/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Nancy R Kressin
- Veterans Affairs Boston Healthcare System, Boston, MA, USA. .,Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
| | - Jolie B Wormwood
- Department of Psychology, University of New Hampshire, Durham, NH, USA
| | - Tracy A Battaglia
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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27
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Yoon SS, Vimalananda VG, Meterko M, Solch AL, Qian S, Wormwood JB, Greenlee CM, Smith CD, Fincke BG. MON-138 Coordination of Care: National Survey of Endocrinologists’ Experience with PCPs. J Endocr Soc 2020. [PMCID: PMC7208454 DOI: 10.1210/jendso/bvaa046.1049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Coordination of care between primary care physicians (PCPs) and specialists is crucial in providing safe, efficient specialty care for referred patients, but shortcomings in coordination are common. Objective: Examine endocrinologists’ experience of coordination with PCPs and examine the relationship of a shared EHR to coordination. Methods: We surveyed a national sample of US endocrinologist members of the Endocrine Society (ES) or American Association of Clinical Endocrinologists (AACE), using a previously-developed online survey for specialists about care coordination1. ES and AACE included a link in a web-based newsletter and dedicated email. Four multi-item scales included 18 items measuring aspects of coordination with PCPs in the past 3 months: Communication (timeliness and helpfulness), Data Transfer (timeliness and usability), Relationships (mutually respectful), and Roles and Responsibilities (referral clarity, sufficiency, and appropriateness). Item responses and scale scores were on a 7-point frequency scale. A single-item measure of overall coordination with PCPs was measured on a 10-point scale (0 worst possible to 10 best possible). We asked “With about how many referring PCPs do you share an EHR?”. We examined frequencies of individual item responses (≤30%, about 50%, or ≥ 70% of the time) and extent of shared EHR with PCPs (None, Some, All), calculated mean scale scores (range 1-7) and used ANOVA to examine the relationship of a shared EHR to coordination scales and overall coordination. Results: Of 236 respondents: 35% age ≥ 60, 44% female, 80% ≥ 75% clinical effort. The highest frequency of good coordination (≥70% of the time) was reported for: aligned expectations of roles (84%), feeling valued by PCPs (80%) and clear division of responsibilities (70%). The lowest frequency of good coordination was for: kept informed by PCP about relevant issues (14%), and PCPs adequately evaluated prior to referring (18%). Mean (SD) for scale scores were: Communication 4.2 (1.0), Data Transfer 4.2 (1.1), Relationships 4.9 (0.8), Roles and Responsibilities 4.2 (0.9). The score for overall coordination with PCPs was 6.0 (1.9). Sharing an EHR with more PCPs was associated with higher Data Transfer scores (None, N=59, 3.9 (1.0), Some, N=126, 4.1 (0.9), All, N=26, 5.4 (0.8), P for trend <0.001). The effect size (Cohen’s d) for the difference between None and All EHR sharing was 1.6, well over the threshold for “large” effect size (d = 0.8). Conclusions: There are opportunities for improvement across all aspects of inter-clinician coordination for endocrinology referrals. Use of a shared EHR improves data transfer, but not other aspects of coordination. 1. Vimalananda VG, Fincke BG, Qian S, et al. Development and psychometric assessment of a novel survey to measure care coordination from the specialist’s perspective. Health Serv Res. 2019;54(3):689-699.
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Affiliation(s)
- Samuel S Yoon
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA
| | - Mark Meterko
- VHA Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID –EA), Field-based at the Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA
| | - Amanda L Solch
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA
| | - Shirley Qian
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA
| | - Jolie B Wormwood
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA
| | | | - Cynthia D Smith
- VHA Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID –EA), Field-based at the Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA
| | - Benjamin G Fincke
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA
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28
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Fridman J, Barrett LF, Wormwood JB, Quigley KS. Applying the Theory of Constructed Emotion to Police Decision Making. Front Psychol 2019; 10:1946. [PMID: 31572250 PMCID: PMC6749088 DOI: 10.3389/fpsyg.2019.01946] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/08/2019] [Indexed: 11/23/2022] Open
Abstract
Law enforcement personnel commonly make decisions in stressful circumstances, where the costs associated with errors are high and sometimes fatal. In this paper, we apply a powerful theoretical approach, the theory of constructed emotion (TCE), to understand decision making under evocative circumstances. This theory posits that the primary purpose of a brain is to predictively regulate physiological resources to coordinate the body's motor activity and learning in the short term, and to meet the body's needs for growth, survival, and reproduction in the long term. This process of managing the brain and body's energy needs, called allostasis, is based on the premise that a brain anticipates bodily needs and attempts to meet those needs before they arise (e.g., vestibular activity that raises sympathetic nervous system activity before standing), because this is more efficient than responding to energetic needs after the fact. In this view, all mental events-cognition, emotion, perception, and action-are shaped by allostasis, and thus all decision making is embodied, predictive, and concerned with balancing energy needs. We also posit a key role for the autonomic nervous system (ANS) in regulating short-term energy expenditures, such that the ANS influences experience and behavior under stressful circumstances, including police decision making. In this paper, we first explain the core features of the TCE, and then offer insights for understanding police decision making in complex, real-world situations. In so doing, we describe how the TCE can be used to guide future studies of realistic decision making in occupations in which people commonly make decisions in evocative situations or under time pressure, such as in law enforcement.
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Affiliation(s)
- Joseph Fridman
- Department of Psychology, Northeastern University, Boston, MA, United States
| | - Lisa Feldman Barrett
- Department of Psychology, Northeastern University, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Jolie B. Wormwood
- Department of Psychology, University of New Hampshire, Durham, NH, United States
| | - Karen S. Quigley
- Department of Psychology, Northeastern University, Boston, MA, United States
- Edith Nourse Rogers Memorial Veterans Hospital, Center for Healthcare Organization and Implementation Research, Bedford, MA, United States
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29
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Kelley DC, Siegel E, Wormwood JB. Understanding Police Performance Under Stress: Insights From the Biopsychosocial Model of Challenge and Threat. Front Psychol 2019; 10:1800. [PMID: 31447738 PMCID: PMC6696903 DOI: 10.3389/fpsyg.2019.01800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/19/2019] [Indexed: 12/04/2022] Open
Abstract
We examine when and how police officers may avoid costly errors under stress by leveraging theoretical and empirical work on the biopsychosocial (BPS) model of challenge and threat. According to the BPS model, in motivated performance contexts (e.g., test taking, athletics), the evaluation of situational and task demands in relation to one’s perceived resources available to cope with those demands engenders distinct patterns of peripheral physiological responding. Individuals experience more challenge-like states in which blood circulates more efficiently in the periphery when they evaluate their coping resources as meeting or exceeding the task demands. Conversely, individuals experience more threat-like states in which blood circulates less efficiently in the periphery when they view the situation or task demands as exceeding their coping resources. Patterns of response consistent with challenge and threat states have been shown to predict important performance and decision-making outcomes in stressful contexts, and repeated experiences of threat-like patterns of physiological activity are thought to have detrimental effects on long-term cardiovascular health. To date, however, research has not used the biopsychosocial model to understand police decision-making under stress. Here, we review relevant empirical work from the perspective of the BPS model concerning how minority status and power can shape challenge and threat responding and contribute to decision-making under stress. We then detail a research agenda aimed at improving the translational value of research being conducted within the BPS model for understanding complex performance and decision-making in the real world, including among law enforcement personnel.
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Affiliation(s)
- Donovan C Kelley
- Department of Psychology, University of New Hampshire, Durham, NH, United States
| | - Erika Siegel
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Jolie B Wormwood
- Department of Psychology, University of New Hampshire, Durham, NH, United States
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30
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Wormwood JB, Khan Z, Siegel E, Lynn SK, Dy J, Barrett LF, Quigley KS. Physiological indices of challenge and threat: A data-driven investigation of autonomic nervous system reactivity during an active coping stressor task. Psychophysiology 2019; 56:e13454. [PMID: 31407813 DOI: 10.1111/psyp.13454] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 06/09/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022]
Abstract
We utilized a data-driven, unsupervised machine learning approach to examine patterns of peripheral physiological responses during a motivated performance context across two large, independent data sets, each with multiple peripheral physiological measures. Results revealed that patterns of cardiovascular response commonly associated with challenge and threat states emerged as two of the predominant patterns of peripheral physiological responding within both samples, with these two patterns best differentiated by reactivity in cardiac output, pre-ejection period, interbeat interval, and total peripheral resistance. However, we also identified a third, relatively large group of apparent physiological nonresponders who exhibited minimal reactivity across all physiological measures in the motivated performance context. This group of nonresponders was best differentiated from the others by minimal increases in electrodermal activity. We discuss implications for identifying and characterizing this third group of individuals in future research on physiological patterns of challenge and threat.
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Affiliation(s)
- Jolie B Wormwood
- Department of Psychology, University of New Hampshire, Durham, New Hampshire
| | - Zulqarnain Khan
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts
| | - Erika Siegel
- Department of Psychiatry, University of California San Francisco, San Francisco, California
| | - Spencer K Lynn
- Department of Psychology, Northeastern University, Boston, Massachusetts.,Charles River Analytics, Inc, Cambridge, Massachusetts
| | - Jennifer Dy
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts
| | - Lisa Feldman Barrett
- Department of Psychology, Northeastern University, Boston, Massachusetts.,Massachusetts General Hospital, Cambridge, Massachusetts
| | - Karen S Quigley
- Department of Psychology, Northeastern University, Boston, Massachusetts.,Edith Nourse Rogers Memorial (VA) Medical Center, Bedford, Massachusetts
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31
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Vimalananda VG, Meterko M, Waring ME, Qian S, Solch A, Wormwood JB, Fincke BG. Tools to improve referrals from primary care to specialty care. Am J Manag Care 2019; 25:e237-e242. [PMID: 31419100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Referrals from primary to specialty care are a critical first step in coordination of specialty care, but shortcomings in the appropriateness, clarity, or completeness of referrals are common. We examined (1) whether 3 tools to coordinate specialty care are associated with better referral characteristics and (2) whether greater perceived helpfulness of these tools is associated with better referral characteristics among specialists who use all 3 of them. STUDY DESIGN National online survey about care coordination among medical specialists receiving referrals in the Veterans Health Administration. METHODS Adjusted odds ratios (ORs) for associations between use and helpfulness of 3 coordination tools (service agreements, referral templates, and e-consults) and perceived frequency of 3 referral characteristics (appropriateness, clarity, and completeness). RESULTS Among specialists (N = 497), use of referral templates was associated with perceptions that referrals were more frequently appropriate (adjusted OR, 1.5; 95% CI, 1.0-2.4), clear (adjusted OR, 1.6; 95% CI, 1.0-2.5), and complete (adjusted OR, 1.9; 95% CI, 1.1-3.2). Use of e-consults was associated with more frequent referral clarity (adjusted OR, 1.7; 95% CI, 1.0-3.0). Among specialists using all 3 tools, those reporting that templates were very helpful also perceived more frequent referral clarity (adjusted OR, 3.1; 95% CI, 1.1-8.5) and completeness (adjusted OR, 3.6; 95% CI, 1.5-8.7). Service agreements were not associated with any referral characteristic. CONCLUSIONS Well-designed referral templates may help improve the clarity and completeness of primary care-specialty care referrals. Existing templates may provide models that can be adapted in collaboration with primary care and broadly applied to improve referrals. Work is needed to improve the impact of service agreements and e-consults on referrals.
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Affiliation(s)
- Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Medical Center, Bldg 70 (152), 200 Springs Road, Bedford, MA 01730.
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Kleckner IR, Anderson EC, Betz NJ, Wormwood JB, Eskew RT, Barrett LF. Conscious awareness is necessary for affective faces to influence social judgments. J Exp Soc Psychol 2018; 79:181-187. [PMID: 31097841 DOI: 10.1016/j.jesp.2018.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A growing body of research claims that stimuli presented outside conscious awareness can influence affect, speech perception, decision-making, eating behavior, and social judgments. However, research has shown that conscious awareness is a continuous phenomenon. Using a continuous flash suppression (CFS) paradigm to suppress awareness of affective faces (smiling and scowling), we demonstrate that some awareness of suppressed stimuli is required for the stimuli to influence social judgments. We discovered this using a rigorous within-participants psychophysics method that allowed us to assess awareness at very low levels, which is difficult using traditional methods. Our findings place boundary conditions on claims (made previously by us and others) that stimuli presented completely outside conscious awareness influence judgments. This work contributes to the literature highlighting the need to study conscious awareness as a continuous phenomenon and provides a framework for researchers to ask and answer questions regarding conscious awareness and its relation to judgment and behavior.
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Affiliation(s)
- Ian R Kleckner
- Department of Psychology, Northeastern University, Boston, MA.,University of Rochester Medical Center, Rochester, NY
| | - Eric C Anderson
- Department of Psychology, Northeastern University, Boston, MA.,Center for Outcomes Research and Evaluation, Maine Medical Center.,Tufts University School of Medicine
| | - Nicole J Betz
- Department of Psychology, Northeastern University, Boston, MA
| | | | - Rhea T Eskew
- Department of Psychology, Northeastern University, Boston, MA
| | - Lisa Feldman Barrett
- Department of Psychology, Northeastern University, Boston, MA.,Department of Psychiatry and the Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General Hospital, Boston, MA
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Wormwood JB, Devlin M, Lin YR, Barrett LF, Quigley KS. When Words Hurt: Affective Word Use in Daily News Coverage Impacts Mental Health. Front Psychol 2018; 9:1333. [PMID: 30116210 PMCID: PMC6084044 DOI: 10.3389/fpsyg.2018.01333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/11/2018] [Indexed: 12/27/2022] Open
Abstract
Media exposure influences mental health symptomology in response to salient aversive events, like terrorist attacks, but little has been done to explore the impact of news coverage that varies more subtly in affective content. Here, we utilized an existing data set in which participants self-reported physical symptoms, depressive symptoms, and anxiety symptoms, and completed a potentiated startle task assessing their physiological reactivity to aversive stimuli at three time points (waves) over a 9-month period. Using a computational linguistics approach, we then calculated an average ratio of words with positive vs. negative affective connotations for only articles from news sources to which each participant self-reported being exposed over the prior 2 weeks at each wave of data collection. As hypothesized, individuals exposed to news coverage with more negative affective tone over the prior 2 weeks reported significantly greater physical and depressive symptoms, and had significantly greater physiological reactivity to aversive stimuli.
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Affiliation(s)
- Jolie B Wormwood
- Department of Psychology, Northeastern University, Boston, MA, United States
| | - Madeleine Devlin
- Department of Psychology, Northeastern University, Boston, MA, United States
| | - Yu-Ru Lin
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lisa Feldman Barrett
- Department of Psychology, Northeastern University, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States
| | - Karen S Quigley
- Department of Psychology, Northeastern University, Boston, MA, United States.,Edith Nourse Rogers Memorial (VA) Medical Center, Center for Healthcare Organization and Implementation Research, Bedford, MA, United States
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Abstract
Affective realism, the phenomenon whereby affect is integrated into an individual's experience of the world, is a normal consequence of how the brain processes sensory information from the external world in the context of sensations from the body. In the present investigation, we provided compelling empirical evidence that affective realism involves changes in visual perception (i.e., affect changes how participants see neutral stimuli). In two studies, we used an interocular suppression technique, continuous flash suppression, to present affective images outside of participants' conscious awareness. We demonstrated that seen neutral faces are perceived as more smiling when paired with unseen affectively positive stimuli. Study 2 also demonstrated that seen neutral faces are perceived as more scowling when paired with unseen affectively negative stimuli. These findings have implications for real-world situations and challenge beliefs that affect is a distinct psychological phenomenon that can be separated from cognition and perception.
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Affiliation(s)
- Erika H Siegel
- 1 Department of Health Psychology, University of California, San Francisco
| | | | - Karen S Quigley
- 2 Department of Psychology, Northeastern University.,3 Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts
| | - Lisa Feldman Barrett
- 2 Department of Psychology, Northeastern University.,4 Massachusetts General Hospital, Boston, Massachusetts.,5 Harvard Medical School, Boston, Massachusetts
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Kleckner IR, Jones RM, Wilder-Smith O, Wormwood JB, Akcakaya M, Quigley KS, Lord C, Goodwin MS. Simple, Transparent, and Flexible Automated Quality Assessment Procedures for Ambulatory Electrodermal Activity Data. IEEE Trans Biomed Eng 2017; 65:1460-1467. [PMID: 28976309 DOI: 10.1109/tbme.2017.2758643] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Electrodermal activity (EDA) is a noninvasive measure of sympathetic activation often used to study emotions, decision making, and health. The use of "ambulatory" EDA in everyday life presents novel challenges-frequent artifacts and long recordings-with inconsistent methods available for efficiently and accurately assessing data quality. We developed and validated a simple, transparent, flexible, and automated quality assessment procedure for ambulatory EDA data. METHODS A total of 20 individuals with autism (5 females, 5-13 years) provided a combined 181 h of EDA data in their home using the Affectiva Q Sensor across 8 weeks. Our procedure identified invalid data using four rules: First, EDA out of range; second, EDA changes too quickly; third, temperature suggests the sensor is not being worn; and fourth, transitional data surrounding segments identified as invalid via the preceding rules. We identified invalid portions of a pseudorandom subset of our data (32.8 h, 18%) using our automated procedure and independent visual inspection by five EDA experts. RESULTS Our automated procedure identified 420 min (21%) of invalid data. The five experts agreed strongly with each other (agreement: 98%, Cohen's κ: 0.87) and, thus, were averaged into a "consensus" rating. Our procedure exhibited excellent agreement with the consensus rating (sensitivity: 91%, specificity: 99%, accuracy: 92%, κ: 0.739 [95% CI = 0.738, 0.740]). CONCLUSION We developed a simple, transparent, flexible, and automated quality assessment procedure for ambulatory EDA data. SIGNIFICANCE Our procedure can be used beyond this study to enhance efficiency, transparency, and reproducibility of EDA analyses, with free software available at http://www.cbslab.org/EDAQA.
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Ruben MA, Wormwood JB, Neumann AE, Quigley KS. Remember how this feels: Inconsistency in recalled impact of a mass violence incident is related to poorer mental health outcomes. Translational Issues in Psychological Science 2016. [DOI: 10.1037/tps0000095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lynn SK, Wormwood JB, Barrett LF, Quigley KS. Decision making from economic and signal detection perspectives: development of an integrated framework. Front Psychol 2015; 6:952. [PMID: 26217275 PMCID: PMC4495727 DOI: 10.3389/fpsyg.2015.00952] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 06/24/2015] [Indexed: 11/25/2022] Open
Abstract
Behavior is comprised of decisions made from moment to moment (i.e., to respond one way or another). Often, the decision maker cannot be certain of the value to be accrued from the decision (i.e., the outcome value). Decisions made under outcome value uncertainty form the basis of the economic framework of decision making. Behavior is also based on perception-perception of the external physical world and of the internal bodily milieu, which both provide cues that guide decision making. These perceptual signals are also often uncertain: another person's scowling facial expression may indicate threat or intense concentration, alternatives that require different responses from the perceiver. Decisions made under perceptual uncertainty form the basis of the signals framework of decision making. Traditional behavioral economic approaches to decision making focus on the uncertainty that comes from variability in possible outcome values, and typically ignore the influence of perceptual uncertainty. Conversely, traditional signal detection approaches to decision making focus on the uncertainty that arises from variability in perceptual signals and typically ignore the influence of outcome value uncertainty. Here, we compare and contrast the economic and signals frameworks that guide research in decision making, with the aim of promoting their integration. We show that an integrated framework can expand our ability to understand a wider variety of decision-making behaviors, in particular the complexly determined real-world decisions we all make every day.
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Affiliation(s)
- Spencer K. Lynn
- Interdisciplinary Affective Science Laboratory, Department of Psychology, Northeastern UniversityBoston, MA, USA
| | - Jolie B. Wormwood
- Interdisciplinary Affective Science Laboratory, Department of Psychology, Northeastern UniversityBoston, MA, USA
| | - Lisa F. Barrett
- Interdisciplinary Affective Science Laboratory, Department of Psychology, Northeastern UniversityBoston, MA, USA
- Department of Psychiatry, Martinos Center for Biomedical Imaging, Massachusetts General HospitalBoston, MA, USA
| | - Karen S. Quigley
- Interdisciplinary Affective Science Laboratory, Department of Psychology, Northeastern UniversityBoston, MA, USA
- Edith Nourse Rogers Memorial Veterans HospitalBedford, MA, USA
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Abstract
We present a computational model capable of predicting—above human accuracy—the degree of trust a person has toward their novel partner by observing the trust-related nonverbal cues expressed in their social interaction. We summarize our prior work, in which we identify nonverbal cues that signal untrustworthy behavior and also demonstrate the human mind's readiness to interpret those cues to assess the trustworthiness of a social robot. We demonstrate that domain knowledge gained from our prior work using human-subjects experiments, when incorporated into the feature engineering process, permits a computational model to outperform both human predictions and a baseline model built in naiveté of this domain knowledge. We then present the construction of hidden Markov models to investigate temporal relationships among the trust-related nonverbal cues. By interpreting the resulting learned structure, we observe that models built to emulate different levels of trust exhibit different sequences of nonverbal cues. From this observation, we derived sequence-based temporal features that further improve the accuracy of our computational model. Our multi-step research process presented in this paper combines the strength of experimental manipulation and machine learning to not only design a computational trust model but also to further our understanding of the dynamics of interpersonal trust.
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Affiliation(s)
- Jin Joo Lee
- Media Lab, Massachusetts Institute of Technology Cambridge, MA, USA
| | - W Bradley Knox
- Media Lab, Massachusetts Institute of Technology Cambridge, MA, USA
| | - Jolie B Wormwood
- Department of Psychology, Northeastern University Boston, MA, USA
| | - Cynthia Breazeal
- Media Lab, Massachusetts Institute of Technology Cambridge, MA, USA
| | - David Desteno
- Department of Psychology, Northeastern University Boston, MA, USA
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