Measuring the Impact of AI in the Diagnosis of Hospitalized Patients: A Randomized Clinical Vignette Survey Study.

Importance: Artificial intelligence (AI) could support clinicians when diagnosing hospitalized patients; however, systematic bias in AI models could worsen clinician diagnostic accuracy. Recent regulatory guidance has called for AI models to include explanations to mitigate errors made by models, but the effectiveness of this strategy has not been established. Objectives: To evaluate the impact of systematically biased AI on clinician diagnostic accuracy and to determine if image-based AI model explanations can mitigate model errors. Design, Setting, and Participants: Randomized clinical vignette survey study administered between April 2022 and January 2023 across 13 US states involving hospitalist physicians, nurse practitioners, and physician assistants. Interventions: Clinicians were shown 9 clinical vignettes of patients hospitalized with acute respiratory failure, including their presenting symptoms, physical examination, laboratory results, and chest radiographs. Clinicians were then asked to determine the likelihood of pneumonia, heart failure, or chronic obstructive pulmonary disease as the underlying cause(s) of each patient's acute respiratory failure. To establish baseline diagnostic accuracy, clinicians were shown 2 vignettes without AI model input. Clinicians were then randomized to see 6 vignettes with AI model input with or without AI model explanations. Among these 6 vignettes, 3 vignettes included standard-model predictions, and 3 vignettes included systematically biased model predictions. Main Outcomes and Measures: Clinician diagnostic accuracy for pneumonia, heart failure, and chronic obstructive pulmonary disease. Results: Median participant age was 34 years (IQR, 31-39) and 241 (57.7%) were female. Four hundred fifty-seven clinicians were randomized and completed at least 1 vignette, with 231 randomized to AI model predictions without explanations, and 226 randomized to AI model predictions with explanations. Clinicians' baseline diagnostic accuracy was 73.0% (95% CI, 68.3% to 77.8%) for the 3 diagnoses. When shown a standard AI model without explanations, clinician accuracy increased over baseline by 2.9 percentage points (95% CI, 0.5 to 5.2) and by 4.4 percentage points (95% CI, 2.0 to 6.9) when clinicians were also shown AI model explanations. Systematically biased AI model predictions decreased clinician accuracy by 11.3 percentage points (95% CI, 7.2 to 15.5) compared with baseline and providing biased AI model predictions with explanations decreased clinician accuracy by 9.1 percentage points (95% CI, 4.9 to 13.2) compared with baseline, representing a nonsignificant improvement of 2.3 percentage points (95% CI, -2.7 to 7.2) compared with the systematically biased AI model. Conclusions and Relevance: Although standard AI models improve diagnostic accuracy, systematically biased AI models reduced diagnostic accuracy, and commonly used image-based AI model explanations did not mitigate this harmful effect. Trial Registration: ClinicalTrials.gov Identifier: NCT06098950.

Sweet liker status in children and adults: Consequences for beverage intake in adults.

Different patterns of sweet liking exist. For some, liking increases as concentration increases up to a point at which it typically plateaus. These individuals are referred to as sweet likers. How sweet likers' beverage intake, especially sugar sweetened beverage intake, differs from sweet dislikers' beverage intake is not well characterized. A total of 953 visitors (650 adults; 62.0% women; 303 children; 58.7% girls) to the Denver Museum of Nature & Science rated the taste intensity and liking of 5 sucrose solutions that spanned concentrations typically encountered in sugar-sweetened beverages (0.0-13.7% w/v) using visual analog scales. Beverage intake by adults was quantified using the validated BEVQ-15 questionnaire. Among adults, hierarchical cluster analysis identified three clusters of liking patterns (likers, dislikers, and neutrals). Among children, two clusters of liking patterns were identified (likers and dislikers). For both adults and children, BMI, percent body fat, age, and sex did not differ between clusters. Concentration by cluster interaction effects were observed for both adults and children. Adult sweet likers consumed more energy from all beverages, more sweetened juice and tea, and less water than those in other clusters. Sweet liker status may be a useful predictor of increased energy intake from beverages, but prospective trials are necessary to confirm this utility.

Embedding the Family Check Up and Evidence-Based Parenting Programs in Head Start to Increase Parent Engagement and Reduce Conduct Problems in Young Children.

Parent engagement (i.e., enrollment, ongoing attendance, participation quality) remains a major obstacle to fully realizing the benefits of evidence-based preventive parent management training in community settings. We describe an approach to parent engagement that addresses the myriad motivational, cognitive, and pragmatic barriers parents face by embedding services in Head Start and applying a parent engagement model, the Family Check Up, as a pre-intervention to augment parent training. In this article, we present the rationale for applying FCU to advance parent readiness for engagement and we describe the process by which we partnered with the community to modify FCU to be most impactful for enhancing parent engagement in one specific program, the Incredible Years Parenting Series. We conclude with preliminary data from our ongoing pilot trial that supports our approach.

Preventive intervention for early childhood behavioral problems: an ecological perspective.

The purpose of this article is to highlight the importance of preventive interventions targeting parents when addressing early childhood behavior problems. The authors briefly review evidence-based parent management training programs, focusing on one particular program, the Incredible Years (IY) Series. Next, the authors discuss the barriers to embedding evidence-based practice such as IY in community contexts and demonstrate how early childhood mental health consultation can be used to enhance community capacity to adopt evidence-based practice and improve outcomes for the large number of young children and their families in need.

Relation of emotion-related regulation to children's social competence: a longitudinal study.

The differential relations of children's emotion-related regulation (i.e., effortful control and impulsivity) to their personality resiliency, adult-rated popularity, and social competence were examined in children who were 4.5-7.9 years old and who were remeasured 2 years later. Parents and teachers reported on all constructs, and children's attentional persistence was observed. Structural equation modeling was used to test the mediating role of resiliency on the relations between regulation/control and popularity using two-wave longitudinal data. The results provide some evidence of the mediating role of resiliency in the relations between effortful control and popularity, provide some evidence of bidirectional effects, and also buttress the view that emotional regulation should be differentiated into effortful and reactive forms of control.

The relations of problem behavior status to children's negative emotionality, effortful control, and impulsivity: concurrent relations and prediction of change.

The relations of children's internalizing and externalizing problem behaviors to their concurrent regulation, impulsivity (reactive undercontrol), anger, sadness, and fearfulness and these aspects of functioning 2 years prior were examined. Parents and teachers completed measures of children's (N = 185; ages 6 through 9 years) adjustment, negative emotionality, regulation, and behavior control; behavioral measures of regulation also were obtained. In general, both internalizing and externalizing problems were associated with negative emotionality. Externalizers were low in effortful regulation and high in impulsivity, whereas internalizers, compared with nondisordered children, were low in impulsivity but not effortful control. Moreover, indices of negative emotionality, regulation, and impulsivity with the level of the same variables 2 years before controlled predicted stability versus change in problem behavior status.

Age Changes in Prosocial Responding and Moral Reasoning in Adolescence and Early Adulthood.

Age changes' measures of prosocial responding and reasoning were examined. Participants' reports of helping, empathy-related responding, and prosocial moral reasoning were obtained in adolescence (from age 15-16 years) and into adulthood (to age 25-26 years). Perspective taking and approval/interpersonal oriented/stereotypic prosocial moral reasoning increased from adolescence into adulthood, whereas personal distress declined. Helping declined and then increased (a cubic trend). Prosocial moral judgment composite scores (and self-reflective empathic reasoning) generally increased from late adolescence into the early 20s (age 17-18 to 21-22) but either leveled off or declined slightly thereafter (i.e., showed linear and cubic trends); rudimentary needs-oriented reasoning showed the reverse pattern of change. The increase in self-reflective empathic moral reasoning was for females only. Thus, perspective taking and some aspects of prosocial moral reasoning-capacities with a strong sociocognitive basis-showed the clearest increases with age, whereas simple prosocial proclivities (i.e., helping, sympathy) did not increase with age.

Prediction of children's empathy-related responding from their effortful control and parents' expressivity.

In this study, the linear and interactive relations of children's effortful control and parents' emotional expressivity to children's empathy-related responses were examined. Participants were 214 children, 4.5 to 8 years old. Children's effortful control was negatively related to their personal distress and was positively related to their sympathy. Parents' positive expressivity was marginally negatively related to children's personal distress and was marginally positively related to children's dispositional sympathy. Parents' negative expressivity was positively related to children's personal distress, but primarily at high levels of children's effortful control. Moreover, parents' negative expressivity was negatively related to children's situational sympathy at low levels of effortful control but was positively related to children's dispositional sympathy at high levels of effortful control. There were also quadratic relations between the measures of parents' expressivity and children's empathy-related responses.

The relations of effortful control and impulsivity to children's resiliency and adjustment.

The unique relations of effortful control and impulsivity to resiliency and adjustment were examined when children were 4.5 to 8 years old, and 2 years later. Parents and teachers reported on all constructs and children's attentional persistence was observed. In concurrent structural equation models, effortful control and impulsivity uniquely and directly predicted resiliency and externalizing problems and indirectly predicted internalizing problems (through resiliency). Teacher-reported anger moderated the relations of effortful control and impulsivity to externalizing problems. In the longitudinal model, all relations held at T2 except for the path from impulsivity to externalizing problems. Evidence of bidirectional effects also was obtained. The results indicate that effortful control and impulsivity are distinct constructs with some unique prediction of resiliency and adjustment.

The relative contribution of sibling deviance and peer deviance in the prediction of substance use across middle childhood.

This study investigated the quality of sibling relationships and sibling deviancy in a sample of children at-risk for substance use and antisocial behavior. Based on a history of empirical and theoretical models suggesting strong associations between children's development in the context of relationships and the emergence of delinquency and drug use, this research extends previous efforts by including sibling relationships in this developmental model, linking siblings with later substance use. Sibling relationship quality as well as peer deviance were examined using a multirater, multimethod assessment procedure. We tested 3 constructs (deviancy, warmth, and conflict) related to sibling behavior. Only sibling deviance and peer deviance directly predicted substance use. When both sibling deviance and peer deviance were examined as predictors of changes in substance use over time, only sibling deviance was significant. Implications for the development of substance use behavior in middle childhood are discussed.

The relations of mothers' negative expressivity to children's experience and expression of negative emotion.

Guided by the heuristic model proposed by Eisenberg et al. [Psychol. Inq. 9 (1998) 241], we examined the relations of mothers' reported and observed negative expressivity to children's (N = 159; 74 girls; M age = 7.67 years) experience and expression of emotion. Children's experience and/or expression of emotion in response to a distressing film were measured with facial, heart rate, and self-report measures. Children's heart rate and facial distress were modestly positively related. Children's facial distress was significantly positively related to mothers' reports of negative (dominant and submissive) expressivity; the positive relation between children's facial distress and mothers' observed negative expressivity approached the conventional level of significance. Moreover, mothers' observed negative expressivity was significantly negatively related to children's heart rate reactivity during the conflict film. The positive relation between children's reported distress and mothers' observed negative expressivity approached the conventional level of significance. Several possible explanations for the pattern of findings are discussed.

The relations of effortful control and ego control to children's resiliency and social functioning.

The relations of effortful control and ego control to children's (mean age = 137 months) resiliency, social status, and social competence were examined concurrently (Time 3) and over time. Adults reported on the constructs, and a behavioral measure of persistence was obtained. At Time 3, resiliency mediated the unique relations of both effortful and reactive control to social status, and effortful control directly predicted socially appropriate behavior. Negative emotionality moderated the relations of ego and effortful control to socially appropriate behavior. When levels of the variables 2 years prior were accounted for, all relations held at Time 3 except that effortful control did not predict resiliency (even though it was the stronger predictor at Time 3) and ego control directly predicted socially appropriate behavior.

The relations of parenting, effortful control, and ego control to children's emotional expressivity.

The relations of observed parental warmth and positive expressivity and children's effortful control and ego control with children's high versus low emotional expressivity were examined in a 2-wave study of 180 children (M age = 112.8 months). There were quadratic relations between adults' reports of children's emotional expressivity and effortful control; moderate expressivity was associated with high effortful control. Structural equation models supported the hypothesis that children's ego overcontrol (versus undercontrol) mediated the relation between parental warmth or positive expressivity and children's emotional expressivity, although parenting at the follow-up did not uniquely predict in children's expressivity after controlling for the relations in these constructs over time. The alternative hypothesis that children's ego overcontrol elicited positive parenting and expressivity also was supported.

Longitudinal relations among parental emotional expressivity, children's regulation, and quality of socioemotional functioning.

The role of regulation as a mediator of the relations between maternal emotional expressivity and children's adjustment and social competence was examined when children (N = 208) were 4.5 to just 8 years old (Time 1, T1) and 2 years later (Time 2, T2). At T2, as at T1, regulation mediated the relation between positive maternal emotional expressivity and children's functioning. When T1 relations and the stability of variables over time were controlled for in a structural equation model, T2 relations generally were nonsignificant, although parents' dominant negative expressivity predicted high regulation. In contrast, in regressions, the findings for parent positive expressivity, but not negative expressivity, held at T2 when T1 variables were controlled. Thus, relations for negative expressivity, but not positive expressivity, changed with age.

The relations of parental warmth and positive expressiveness to children's empathy-related responding and social functioning: a longitudinal study.

This study examined the concurrent and cross-time relations of parental observed warmth and positive expressivity to children's situational facial and self-reported empathic responding, social competence, and externalizing problems in a sample of 180 elementary school children. Data was collected when the children were in second to fifth grades (age: M = 112.8 months), and again 2 years later. Cross-sectional and longitudinal structural equation models supported the hypothesis that parents' (mostly mothers') positive expressivity mediated the relation between parental warmth and children's empathy, and children's empathy mediated the relation between parental positive expressivity and children's social functioning. These relations persisted after controlling for prior levels of parenting and child characteristics. Moreover, concurrent and cross-time consistencies were found on measures of parenting, children's situational empathic responding, and social functioning.

Prosocial development in early adulthood: a longitudinal study.

Consistency of measures of a prosocial personality and prosocial moral judgment over time, and the interrelations among them, were examined. Participants and friends' reports of prosocial characteristics were obtained at ages 21-22, 23-24, and 25-26 years. In addition, participants' prosocial judgment was assessed with interviews and with an objective measure of prosocial moral reasoning at several ages. Reports of prosocial behavior and empathy-related responding in childhood and observations of prosocial behavior in preschool also were obtained. There was interindividual consistency in prosocial dispositions, and prosocial dispositions in adulthood related to empathy/sympathy and prosocial behavior at much younger ages. Interview and objective measures of moral reasoning were substantially interrelated in late adolescence/early adulthood and correlated with participants' and friends' reports of a prosocial disposition.