A holistic lifestyle mobile health intervention for the prevention of type 2 diabetes and common mental disorders in Asian women with a history of gestational diabetes: a randomised control trial with 3-year follow-up protocol.

BACKGROUND: Women with a history of gestational diabetes mellitus (GDM) are 12-fold more likely to develop type 2 diabetes (T2D) 4-6 years after delivery than women without GDM. Similarly, GDM is associated with the development of common mental disorders (CMDs) (e.g. anxiety and depression). Evidence shows that holistic lifestyle interventions focusing on physical activity (PA), dietary intake, sleep, and mental well-being strategies can prevent T2D and CMDs. This study aims to assess the effectiveness of a holistic lifestyle mobile health intervention (mHealth) with post-GDM women in preventing T2D and CMDs in a community setting in Singapore. METHODS: The study consists of a 1-year randomised controlled trial (RCT) with a 3-year follow-up period. Post-GDM women with no current diabetes diagnosis and not planning to become pregnant will be eligible for the study. In addition, participants will complete mental well-being questionnaires (e.g. depression, anxiety, sleep) and their child's socio-emotional and cognitive development. The participants will be randomised to either Group 1 (Intervention) or Group 2 (comparison). The intervention group will receive the "LVL UP App", a smartphone-based, conversational agent-delivered holistic lifestyle intervention focused on three pillars: Move More (PA), Eat Well (Diet), and Stress Less (mental wellbeing). The intervention consists of health literacy and psychoeducational coaching sessions, daily "Life Hacks" (healthy activity suggestions), slow-paced breathing exercises, a step tracker (including brisk steps), a low-burden food diary, and a journaling tool. Women from both groups will be provided with an Oura ring for tracking physical activity, sleep, and heart rate variability (a proxy for stress), and the "HAPPY App", a mHealth app which provides health promotion information about PA, diet, sleep, and mental wellbeing, as well as display body mass index, blood pressure, and results from the oral glucose tolerance tests. Short-term aggregate effects will be assessed at 26/27 weeks (midpoint) and a 1-year visit, followed by a 2, 3, and 4-year follow-up period. DISCUSSION: High rates of progression of T2D and CMDs in women with post-GDM suggest an urgent need to promote a healthy lifestyle, including diet, PA, sleep, and mental well-being. Preventive interventions through a holistic, healthy lifestyle may be the solution, considering the inextricable relationship between physical and psychological health. We expect that holistic lifestyle mHealth may effectively support behavioural changes among women with a history of GDM to prevent T2D and CMDs. TRIAL STATUS: The protocol study was approved by the National Healthcare Group in Singapore, Domain Specific Review Board (DSRB) [2023/00178]; June 2023. Recruitment began on October 18, 2023. TRIAL REGISTRATION: ClinicalTrials.gov NCT05949957. The first submission date is June 08, 2023.

Evaluating Dental Monitoring effectiveness compared with conventional monitoring of clear aligner therapy using the Peer Assessment Rating index.

INTRODUCTION: This study aimed to evaluate the effectiveness of Dental Monitoring (DM) (Dental Monitoring SAS, Paris, France) compared with conventional monitoring (CM) during active orthodontic treatment. METHODS: The Peer Assessment Rating (PAR) index was used to evaluate the pretreatment and posttreatment records of 51 patients, with 26 in the CM group and 25 in the DM group. The change in weighted PAR was analyzed to assess the effectiveness of treatment. RESULTS: The chi-square test revealed that the CM group had a higher percentage of patients in the great improvement category compared with the DM group. However, this difference was not statistically significant (P = 0.192). A repeated measures general linear model demonstrated significant improvement over time (P <0.001), with no statistically significant group differences noted between CM and DM (P = 0.181) and no statistically significant time-by-group interaction (P = 0.299). CONCLUSIONS: Both CM and DM showed significant improvements in weighted PAR scores, but no statistically significant difference is present between the 2 groups.

Face and context integration in emotion inference is limited and variable across categories and individuals.

The ability to make nuanced inferences about other people's emotional states is central to social functioning. While emotion inferences can be sensitive to both facial movements and the situational context that they occur in, relatively little is understood about when these two sources of information are integrated across emotion categories and individuals. In a series of studies, we use one archival and five empirical datasets to demonstrate that people could be integrating, but that emotion inferences are just as well (and sometimes better) captured by knowledge of the situation alone, while isolated facial cues are insufficient. Further, people integrate facial cues more for categories for which they most frequently encounter facial expressions in everyday life (e.g., happiness). People are also moderately stable over time in their reliance on situational cues and integration of cues and those who reliably utilize situation cues more also have better situated emotion knowledge. These findings underscore the importance of studying variability in reliance on and integration of cues.

Aberrant cognitive empathy in individuals with elevated social anxiety and regulation with emotional working memory training.

Social anxiety may disrupt the empathic process, and well-regulated empathy is critical for navigating the social world. Two studies aimed to further understand empathy in the context of social anxiety. Study 1 compared individuals with elevated or normative social anxiety on a measure assessing cognitive and affective empathy for positive and negative emotions conveyed by other people ("targets"), completed under social threat. Relative to individuals with normative social anxiety, individuals with elevated social anxiety had greater cognitive empathy and no differences in affective empathy, regardless of emotion type. As greater cognitive empathy can be maladaptive, Study 2 tested whether this could be down-regulated. Individuals with elevated social anxiety underwent emotional working memory training (eWMT) for negative emotional information, or control training (CT). Effects on an empathy measure completed under social threat were assessed. Cognitive empathy for negative emotions decreased following eWMT but not CT, and this was only evident for those with higher pre-training working memory capacity. Cognitive empathy for positive emotions and affective empathy were not affected. Overall, social anxiety is associated with aberrant elevated cognitive empathy for negative and positive emotions, and the deviation in cognitive empathy for negative emotions can be regulated with eWMT for certain individuals.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12618001196235..

Variant-specific IgA protects against Omicron infection.

BACKGROUND: The emergence of rapidly evolving SARS-CoV-2 variants, coupled with waning vaccine-induced immunity, has contributed to the rise of vaccine breakthrough infections. It is crucial to understand how vaccine-induced protection is mediated. METHODS: We examined two prospective cohorts of mRNA-vaccinated-and-boosted individuals during the Omicron wave of infection in Singapore. RESULTS: We found that, individuals, who remain uninfected over the follow-up period, had a higher variant-specific IgA, but not IgG, antibody response at 1-month post booster vaccination, compared with individuals who became infected. CONCLUSIONS: We conclude that IgA may have a potential contributory role in protection against Omicron infection.

Neural signatures of emotional inference and experience align during social consensus.

Humans seamlessly transform dynamic social signals into inferences about the internal states of the people around them. To understand the neural processes that sustain this transformation, we collected fMRI data from participants (N = 100) while they rated the emotional intensity of people (targets) describing significant life events. Targets rated themselves on the same scale to indicate the intended "ground truth" emotional intensity of their videos. Next, we developed two multivariate models of observer brain activity- the first predicted the "ground truth" (r = 0.50, p < 0.0001) and the second predicted observer inferences (r = 0.53, p < 0.0001). When individuals make more accurate inferences, there is greater moment-by-moment concordance between these two models, suggesting that an observer's brain activity contains latent representations of other people's emotional states. Using naturalistic socioemotional stimuli and machine learning, we developed reliable brain signatures that predict what an observer thinks about a target, what the target thinks about themselves, and the correspondence between them. These signatures can be applied in clinical data to better our understanding of socioemotional dysfunction.

Waning of specific antibodies against Delta and Omicron variants five months after a third dose of BNT162b2 SARS-CoV-2 vaccine in elderly individuals.

The emergence of new SARS-CoV-2 variants, such as the more transmissible Delta and Omicron variants, has raised concerns on efficacy of the COVID-19 vaccines. Here, we examined the waning of antibody responses against different variants following primary and booster vaccination. We found that antibody responses against variants were low following primary vaccination. The antibody response against Omicron was almost non-existent. Efficient boosting of antibody response against all variants, including Omicron, was observed following a third dose. The antibody response against the variants tested was significantly higher at one month following booster vaccination, compared with two months following primary vaccination, for all individuals, including the low antibody responders identified at two months following primary vaccination. The antibody response, for all variants tested, was significantly higher at four months post booster than at five months post primary vaccination, and the proportion of low responders remained low (6-11%). However, there was significant waning of antibody response in more than 95% of individuals at four months, compared to one month following booster. We also observed a robust memory B cell response following booster, which remained higher at four months post booster than prior to booster. However, the memory B cell responses were on the decline for 50% of individuals at four months following booster. Similarly, while the T cell response is sustained, at cohort level, at four months post booster, a substantial proportion of individuals (18.8 - 53.8%) exhibited T cell response at four months post booster that has waned to levels below their corresponding levels before booster. The findings show an efficient induction of immune response against SARS-CoV-2 variants following booster vaccination. However, the induced immunity by the third BNT162b2 vaccine dose was transient. The findings suggest that elderly individuals may require a fourth dose to provide protection against SARS-CoV-2.

Management of a patient with a severely infraoccluded primary molar and hypodontia.

Infraocclusion of a primary molar is a relatively common occurrence which seldom leads to serious complications, particularly when the succedaneous permanent tooth is present. Despite the relative infrequency of unfavorable outcomes, an infraoccluded primary molar may be associated with other dental anomalies, including hypodontia. If diagnosis is delayed, infraocclusion of a primary molar can become severe, with associated negative effects on the adjacent teeth and alveolar bone. This emphasizes the need for routine and periodic orthodontic assessment of growing patients. Any deviation from the normal eruption sequence of teeth should be diagnosed and managed in a timely manner, to preserve dental arch integrity and reduce the potential for undesirable outcomes. This case report demonstrates how comprehensive assessment of the dentition, logical treatment planning and careful management of challenging orthodontic tooth movements can combine to provide a pleasing treatment outcome.

Interdisciplinary diagnosis and treatment planning for Class III malocclusion and determining the appropriate anterior tooth positions for individual patients.

Patients presenting with Class III malocclusion often present significant challenges for the orthodontist and restorative clinician. The characteristic anterior crossbite is commonly associated with a maxillo-mandibular skeletal base discrepancy leading to both functional and esthetic issues. Three potential incisal tooth positions are discussed using clinical examples including implants.

Real-world effectiveness of a social-psychological intervention translated from controlled trials to classrooms.

Social-psychological interventions have raised the learning and performance of students in rigorous efficacy trials. Yet, after they are distributed "in the wild" for students to self-administer, there has been little research following up on their translational effectiveness. We used cutting-edge educational technology to tailor, scale up, and track a previously-validated Strategic Resource Use intervention among 12,065 college students in 14 STEM and Economics classes. Students who self-administered this "Exam Playbook" benefitted by an average of 2.17 percentage points (i.e., a standardized effect size of 0.18), compared to non-users. This effect size was 1.65 percentage points when controlling for college entrance exam scores and 1.75 [-1.88] for adding [dropping] the Exam Playbook in stratified matching analyses. Average benefits differed in magnitude by the conduciveness of the class climate (including peer norms and incentives), gender, first-generation status, as well as how often and how early they used the intervention. These findings on how, when, and who naturally adopts these resources address a need to improve prediction, translation, and scalability of social-psychological intervention benefits.

Lower vaccine-acquired immunity in the elderly population following two-dose BNT162b2 vaccination is alleviated by a third vaccine dose.

Understanding the impact of age on vaccinations is essential for the design and delivery of vaccines against SARS-CoV-2. Here, we present findings from a comprehensive analysis of multiple compartments of the memory immune response in 312 individuals vaccinated with the BNT162b2 SARS-CoV-2 mRNA vaccine. Two vaccine doses induce high antibody and T cell responses in most individuals. However, antibody recognition of the Spike protein of the Delta and Omicron variants is less efficient than that of the ancestral Wuhan strain. Age-stratified analyses identify a group of low antibody responders where individuals ≥60 years are overrepresented. Waning of the antibody and cellular responses is observed in 30% of the vaccinees after 6 months. However, age does not influence the waning of these responses. Taken together, while individuals ≥60 years old take longer to acquire vaccine-induced immunity, they develop more sustained acquired immunity at 6 months post-vaccination. A third dose strongly boosts the low antibody responses in the older individuals against the ancestral Wuhan strain, Delta and Omicron variants.

Heterologous booster vaccination with CoronaVac following prime vaccination with mRNA vaccine.

Objective: Despite the high vaccine efficacy of mRNA COVID-19 vaccines, there are individuals who developed excessive reactogenic and/or allergic responses after the first mRNA dose and were considered ineligible for further mRNA doses. CoronaVac, an inactivated SARS-CoV-2 vaccine, is recommended in Singapore as an alternative. Methods: Individuals, ineligible for further mRNA vaccines (BNT162b2 or mRNA-1273) because of excessive reactive responses to prime mRNA vaccination, were recruited and offered two doses of CoronaVac as booster vaccination 38-224 days post their mRNA vaccine dose. Individuals who did not develop any excessive reactive responses after the prime mRNA vaccination were also recruited and given another mRNA vaccine as booster vaccination. Blood samples were collected at days 0, 21 and 90 post first CoronaVac dose and mRNA dose, respectively, for analysis. Results: We showed that two CoronaVac booster doses induced specific immunity in these mRNA vaccine-primed individuals. Although the spike-specific antibody response was lower, their memory B cell response against the receptor-binding domain (RBD) of the spike protein was similar, compared with individuals who received two BNT162b2 injections. The spike-specific memory T cell response also increased following CoronaVac booster doses. However, specific immunity against the Omicron variant was low, similar to individuals with two BNT162b2 doses. Conclusion: Our findings showed that while mRNA vaccine-primed individuals can opt for two subsequent doses of CoronaVac, an additional dose may be necessary to achieve protection, especially against newly emerging immune escape variants such as Omicron.

Impaired empathic accuracy following damage to the left hemisphere.

Failing to understand others accurately can be extremely costly. Unfortunately, events such as strokes can lead to a decline in emotional understanding. Such impairments have been documented in stroke patients and are widely hypothesized to be related to right-hemisphere lesions, as well as to the amygdala, and are thought to be driven in part by attentional biases, for example, less fixation on the eyes. Notably, most of the previous research relied on measurements of emotional understanding from simplified cues, such as facial expressions or prosody. We hypothesize that chronic damage to the left hemisphere could hinder empathic accuracy and emotion recognition in naturalistic social settings that require complex language comprehension, even after a patient regains core language capacities. To assess this notion, we use an empathic accuracy task and eye-tracking measurements with chronic stroke patients with either right (N = 13) or left (N = 11) hemispheric damage-together with aged-matched controls (N = 15)-to explore the patients' understanding of others' affect inferred from stimuli that separates audio and visual cues. While we find that patients with right-hemisphere lesions showed visual attention bias compared to the other two groups, we uncover a disadvantage for patients with left-hemisphere lesions in empathic accuracy, especially when only auditory cues are present. These results suggest that patients with left-hemisphere damage have long-lasting difficulties comprehending real-world complex emotional situations.

A brief intervention to motivate empathy among middle school students.

Empathy tracks socioemotional adjustment during early adolescence, yet adolescents this age tend to show reductions in empathy compared with younger children. Here we took a novel approach to building empathy among early adolescents in four middle schools (n = 857). Rather than addressing the ability to empathize, we targeted the motivation to empathize. To do so, we leveraged strategies demonstrated to change motivation among early adolescents: social norms and mindsets. Compared with those in other conditions, students who received a norms-based intervention reported greater motivation to empathize with others, which was in turn associated with increased peer-reported prosocial behaviors, as well as lower levels of loneliness and aggression. The effects of this norms condition were strongest at schools with relatively high engagement with the intervention. Findings suggest a novel avenue for increasing empathy among early adolescents-focusing on peer-driven motivation-and underscore the importance of context in shaping intervention outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Amplification in the evaluation of multiple emotional expressions over time.

Social interactions are dynamic and unfold over time. To make sense of social interactions, people must aggregate sequential information into summary, global evaluations. But how do people do this? Here, to address this question, we conducted nine studies (N = 1,583) using a diverse set of stimuli. Our focus was a central aspect of social interaction-namely, the evaluation of others' emotional responses. The results suggest that when aggregating sequences of images and videos expressing varying degrees of emotion, perceivers overestimate the sequence's average emotional intensity. This tendency for overestimation is driven by stronger memory of more emotional expressions. A computational model supports this account and shows that amplification cannot be explained only by nonlinear perception of individual exemplars. Our results demonstrate an amplification effect in the perception of sequential emotional information, which may have implications for the many types of social interactions that involve repeated emotion estimation.

BREAst screening Tailored for HEr (BREATHE)-A study protocol on personalised risk-based breast cancer screening programme.

Routine mammography screening is currently the standard tool for finding cancers at an early stage, when treatment is most successful. Current breast screening programmes are one-size-fits-all which all women above a certain age threshold are encouraged to participate. However, breast cancer risk varies by individual. The BREAst screening Tailored for HEr (BREATHE) study aims to assess acceptability of a comprehensive risk-based personalised breast screening in Singapore. Advancing beyond the current age-based screening paradigm, BREATHE integrates both genetic and non-genetic breast cancer risk prediction tools to personalise screening recommendations. BREATHE is a cohort study targeting to recruit ~3,500 women. The first recruitment visit will include questionnaires and a buccal cheek swab. After receiving a tailored breast cancer risk report, participants will attend an in-person risk review, followed by a final session assessing the acceptability of our risk stratification programme. Risk prediction is based on: a) Gail model (non-genetic), b) mammographic density and recall, c) BOADICEA predictions (breast cancer predisposition genes), and d) breast cancer polygenic risk score. For national implementation of personalised risk-based breast screening, exploration of the acceptability within the target populace is critical, in addition to validated predication tools. To our knowledge, this is the first study to implement a comprehensive risk-based mammography screening programme in Asia. The BREATHE study will provide essential data for policy implementation which will transform the health system to deliver a better health and healthcare outcomes.

Mu rhythm suppression over sensorimotor regions is associated with greater empathic accuracy.

When people encounter others' emotions, they engage multiple brain systems, including parts of the sensorimotor cortex associated with motor simulation. Simulation-related brain activity is commonly described as a 'low-level' component of empathy and social cognition. It remains unclear whether and how sensorimotor simulation contributes to complex empathic judgments. Here, we combine a naturalistic social paradigm with a reliable index of sensorimotor cortex-based simulation: electroencephalography suppression of oscillatory activity in the mu frequency band. We recruited participants to watch naturalistic video clips of people ('targets') describing emotional life events. In two experiments, participants viewed these clips (i) with video and sound, (ii) with only video or (iii) with only sound and provided continuous ratings of how they believed the target felt. We operationalized 'empathic accuracy' as the correlation between participants' inferences and targets' self-report. In Experiment 1 (US sample), across all conditions, right-lateralized mu suppression tracked empathic accuracy. In Experiment 2 (Israeli sample), this replicated only when using individualized frequency-bands and only for the visual stimuli. Our results provide novel evidence that sensorimotor representations-as measured through mu suppression-play a role not only in low-level motor simulation, but also in higher-level inferences about others' emotions, especially when visual cues are crucial for accuracy.

Modeling emotion in complex stories: the Stanford Emotional Narratives Dataset.

Human emotions unfold over time, and more affective computing research has to prioritize capturing this crucial component of real-world affect. Modeling dynamic emotional stimuli requires solving the twin challenges of time-series modeling and of collecting high-quality time-series datasets. We begin by assessing the state-of-the-art in time-series emotion recognition, and we review contemporary time-series approaches in affective computing, including discriminative and generative models. We then introduce the first version of the Stanford Emotional Narratives Dataset (SENDv1): a set of rich, multimodal videos of self-paced, unscripted emotional narratives, annotated for emotional valence over time. The complex narratives and naturalistic expressions in this dataset provide a challenging test for contemporary time-series emotion recognition models. We demonstrate several baseline and state-of-the-art modeling approaches on the SEND, including a Long Short-Term Memory model and a multimodal Variational Recurrent Neural Network, which perform comparably to the human-benchmark. We end by discussing the implications for future research in time-series affective computing.

Interdisciplinary management of a partially dentate adult patient with a complex malocclusion.

Adult patients may present with complex malocclusions requiring extensive oral rehabilitation. This case report demonstrates how carefully planned interdisciplinary management can provide pleasing outcomes despite the considerable initial clinical challenges.

Applying Probabilistic Programming to Affective Computing.

Affective Computing is a rapidly growing field spurred by advancements in artificial intelligence, but often, held back by the inability to translate psychological theories of emotion into tractable computational models. To address this, we propose a probabilistic programming approach to affective computing, which models psychological-grounded theories as generative models of emotion, and implements them as stochastic, executable computer programs. We first review probabilistic approaches that integrate reasoning about emotions with reasoning about other latent mental states (e.g., beliefs, desires) in context. Recently-developed probabilistic programming languages offer several key desidarata over previous approaches, such as: (i) flexibility in representing emotions and emotional processes; (ii) modularity and compositionality; (iii) integration with deep learning libraries that facilitate efficient inference and learning from large, naturalistic data; and (iv) ease of adoption. Furthermore, using a probabilistic programming framework allows a standardized platform for theory-building and experimentation: Competing theories (e.g., of appraisal or other emotional processes) can be easily compared via modular substitution of code followed by model comparison. To jumpstart adoption, we illustrate our points with executable code that researchers can easily modify for their own models. We end with a discussion of applications and future directions of the probabilistic programming approach.