The need for an intersectionality framework in precision medicine research.

Precision medicine research has seen growing efforts to increase participation of communities that have been historically underrepresented in biomedical research. Marginalized racial and ethnic communities have received particular attention, toward the goal of improving the generalizability of scientific knowledge and promoting health equity. Against this backdrop, research has highlighted three key issues that could impede the promise of precision medicine research: issues surrounding (dis)trust and representation, challenges in translational efforts to improve health outcomes, and the need for responsive community engagement. Existing efforts to address these challenges have predominantly centered on single-dimensional demographic criteria such as race, ethnicity, or sex, while overlooking how these and additional variables, such as disability, gender identity, and socioeconomic factors, can confound and jointly impact research participation. We argue that increasing cohort diversity and the responsiveness of precision medicine research studies to community needs requires an approach that transcends conventional boundaries and embraces a more nuanced, multi-layered, and intersectional framework for data collection, analyses, and implementation. We draw attention to gaps in existing work, highlight how overlapping layers of marginalization might shape and substantiate one another and affect the precision-medicine research cycle, and put forth strategies to facilitate equitable advantages from precision-medicine research to diverse participants and internally heterogeneous communities.

A Scientist's Oath.

Data on the perceptions of scientists suggest a moderate public distrust of scientist's motivations. Bettridge et al. suggest scientist's reluctance to engage the public on controversial ethical issues may be a contributing factor. The authors propose a Scientist's Oath to send a clear message to the public about our ideals.

Transcultural pathways to the will to fight.

In 2022, the "Will to Fight Act" was referred to the US Congress urging attention to measuring and assessing will to fight. That Bill was not enacted, and evaluation efforts within the political and military establishment remain contentious, fragmented, and meager. This likely will persist, along with attendant policy failures and grievous costs, without awareness of research that the social and psychological sciences reveal on the will to fight [S. Atran, Science 373, 1063 (2021)]. We illustrate such research using converging data from a multimethod and multicultural approach, including field and online studies from the Middle East, North Africa, and Europe. These studies reveal specific psychosocial pathways, within a general causal framework, that predict willingness to make costly sacrifices, including to cooperate, fight, and die in war and sustained conflict. From the continuing strife in Iraq to embattled Ukraine, 31 studies were conducted in 9 countries with nearly 12,000 participants. These include people in longstanding conflicts, refugees, imprisoned jihadists and gangs, US military, studies in Ukraine before and during the current war, and rolling studies with a European ally of Ukraine. Results provide evidence for a mediation model of transcultural pathways to the will to fight. Building on our previous behavioral and brain research, on the battlefield in Iraq, with violent extremists, and with US military, the linear mediation yielding the will to fight involves identity fusion, perceived spiritual formidability, and trust. The model, a variation on "The Devoted Actor Framework," applies to primary reference groups, core cultural values, and leaders.

The links between physical activity and prosocial behavior: an fNIRS hyperscanning study.

The prevalence of physically inactive lifestyles in modern society raises concerns about the potential association with poor brain health, particularly in the lateral prefrontal cortex, which is crucial for human prosocial behavior. Here, we explored the relationship between physical activity and prosocial behavior, focusing on potential neural markers, including intra-brain functional connectivity and inter-brain synchrony in the lateral prefrontal cortex. Forty participants, each paired with a stranger, completed two experimental conditions in a randomized order: (i) face-to-face and (ii) face stimulus (eye-to-eye contact with a face stimulus of a fictitious person displayed on the screen). Following each condition, participants played economic games with either their partner or an assumed person displayed on the screen. Neural activity in the lateral prefrontal cortex was recorded by functional near-infrared spectroscopy hyperscanning. Sparse multiset canonical correlation analysis showed that a physically inactive lifestyle was covaried with poorer reciprocity, greater trust, shorter decision-making time, and weaker intra-brain connectivity in the dorsal lateral prefrontal cortex and poorer inter-brain synchrony in the ventral lateral prefrontal cortex. These associations were observed exclusively in the face-to-face condition. Our findings suggest that a physically inactive lifestyle may alter human prosocial behavior by impairing adaptable prosocial decision-making in response to social factors through altered intra-brain functional connectivity and inter-brain synchrony.

Pursuing Safety in Social Connection: A Flexibly Fluid Perspective on Risk Regulation in Relationships.

People are fundamentally motivated to be included in social connections that feel safe, connections where they are consistently cared for and protected, not hurt or exploited. Romantic relationships have long played a crucial role in satisfying this fundamental need. This article reconceptualizes the risk-regulation model to argue that people draw on experiences from inside and outside their romantic relationships to satisfy their fundamental need to feel safe depending on others. We first review the direct relational cues (i.e., a partner's affectionate touch, responsive versus unresponsive behavior, and relative power) and indirect cues (i.e., bodily sensations, collective value in the eyes of others, and living conditions) that signal the current safety of social connection and motivate people to connect to others or protect themselves against them. We then review how people's chronic capacity to trust in others controls their sensitivity and reactivity to the safety cues. The article concludes with future research directions.

Impression management attenuates the effect of ability on trust in economic exchange.

Are competent actors still trusted when they promote themselves? The answer to this question could have far-reaching implications for understanding trust production in a variety of economic exchange settings in which ability and impression management play vital roles, from succeeding in one's job to excelling in the sales of goods and services. Much social science research assumes an unconditional positive impact of an actor's ability on the trust placed in that actor: in other words, competence breeds trust. In this report, however, we challenge this assumption. Across a series of experiments, we manipulated both the ability and the self-promotion of a trustee and measured the level of trust received. Employing both online laboratory studies (n = 5,606) and a field experiment (n = 101,520), we find that impression management tactics (i.e., self-promotion and intimidation) can substantially backfire, at least for those with high ability. An explanation for this effect is encapsuled in attribution theory, which argues that capable actors are held to higher standards in terms of how kind and honest they are expected to be. Consistent with our social attribution account, mediation analyses show that competence combined with self-promotion decreases the trustee's perceived benevolence and integrity and, in turn, the level of trust placed in that actor.

COVID-19 infection induces higher trust in strangers.

How does the COVID-19 pandemic affect interpersonal trust? Most evidence shows that natural disasters reinforce trust and cooperation, but the COVID-19 virus differs from other calamities, since it spreads through contact with people, potentially increasing suspicion and distrust, as, according to contemporaneous writers' accounts, seems to have been the case with the Black Death, the London plague, and the Spanish influenza. We investigate the link between interpersonal trust and individuals exposed to COVID-19, either vicariously through their community or networks or directly by becoming infected. We rely on an original panel survey, including a survey experiment, with a representative sample of adults in Italy, one of the countries hardest struck by the pandemic. Our experimental findings reveal that priming people about the risk that the pandemic poses to their health leads to a substantial increase in their trust in strangers. Our panel data analysis of within-individual effects shows that those who become infected trust strangers more than those who are not infected. Our findings could be explained by people observing higher than expected altruistic behavior or becoming more dependent on other people's support, consistent with the "emancipation theory of trust." When people recover from COVID-19, however, they drop to trusting strangers as much as those who were not directly exposed to the virus, an indication that the positive effects on trust during the pandemic have an emotional source. Nonetheless, the evidence suggests that, in the aggregate, there has been a small but significant increase in trust among the general population relative to prepandemic levels.

Aging is associated with maladaptive episodic memory-guided social decision-making.

Older adults are frequent targets and victims of financial fraud. They may be especially susceptible to revictimization because of age-related changes in both episodic memory and social motivation. Here we examined these factors in a context where adaptive social decision-making requires intact associative memory for previous social interactions. Older adults made more maladaptive episodic memory-guided social decisions but not only because of poorer associative memory. Older adults were biased toward remembering people as being fair, while young adults were biased toward remembering people as being unfair. Holding memory constant, older adults engaged more with people that were familiar (regardless of the nature of the previous interaction), whereas young adults were prone to avoiding others that they remembered as being unfair. Finally, older adults were more influenced by facial appearances, choosing to interact with social partners that looked more generous, even though those perceptions were inconsistent with prior experience.

Opposition to voluntary and mandated COVID-19 vaccination as a dynamic process: Evidence and policy implications of changing beliefs.

SignificanceThe challenge of securing adherence to public health policies is compounded when an emerging threat and a set of unprecedented remedies are not fully understood among the general public. The evolution of citizens' attitudes toward vaccination during the COVID-19 pandemic offers psychologically and sociologically grounded insights that enrich the conventional incentives- and constraints-based approach to policy design. We thus contribute to a behavioral science of policy compliance during public health emergencies of the kind that we may increasingly face in the future. From early in the pandemic, we have tracked the same individuals, providing a lens into the conditions under which people's attitudes toward voluntary and mandated vaccinations change, providing essential information for COVID-19 policy not available from cross-section data.

The moral filter of patriotic prejudice: How Americans view Chinese in the COVID-19 era.

About one in six Asian Americans have fallen victim to anti-Asian racism during the COVID-19 pandemic [J. Lee, K. Ramakrishnan, aapidata.com/blog/discrimination-survey-2022/]. By examining anti-Asian racism in the United States primarily as a domestic issue, most prior studies have overlooked the connections between shifting US-China relations and Americans' prejudices against the Chinese in China and, by extension, East Asian Americans. This study investigates the patterns and perceptual bases of nationality-based prejudices against Chinese amid the COVID-19 pandemic in the United States. Our nationally representative online survey experiment reveals that Americans assess a hypothetical Chinese person in China as inferior in multiple social and psychological characteristics to an otherwise identical Japanese person in Japan or East Asian American. Furthermore, subjects who perceive China as more threatening to America's national interests assess Chinese more negatively, especially in terms of trustworthiness and morality, suggesting that perceived China threats propel Americans' negative stereotypes about Chinese. A contextual analysis further indicates that counties with a higher share of Trump voters in 2016 tend to perceive all East Asian-origin groups similarly as a racial outgroup. By contrast, residents in predominantly Democrat-voting counties tend to perceive Chinese in China more negatively relative to Asian Americans, despite broadly viewing East Asians more favorably. Overall, this study underscores the often-overlooked relationships between the prevailing anti-Asian sentiments in the United States and the US-China geopolitical tensions and America's domestic political polarization.

Connectome-based prediction of decreased trust propensity in older adults with mild cognitive impairment: A resting-state functional magnetic resonance imaging study.

Trust propensity (TP) relies more on social than economic rationality to transform the perceived probability of betrayal into positive reciprocity expectations in older adults with normal cognition. While deficits in social rationality have been observed in older adults with mild cognitive impairment (MCI), there is limited research on TP and its associated resting-state functional connectivity (RSFC) mechanisms in this population. To measure TP and related psychological functions (affect, motivation, executive cognition, and social cognition), MCI (n = 42) and normal healthy control (NHC, n = 115) groups completed a one-shot trust game and additional assessments of related psychological functions. RSFC associated with TP was analyzed using connectome-based predictive modeling (CPM) and lesion simulations. Our behavioral results showed that the MCI group trusted less (i.e., had lower TP) than the NHC group, with lower TP associated with higher sensitivity to the probability of betrayal in the MCI group. In the MCI group, only negative CPM models (RSFC negatively correlated with TP) significantly predicted TP, with a high salience network (SN) contribution. In contrast, in the NHC group, positive CPM models (RSFC positively correlated with TP) significantly predicted TP, with a high contribution from the default mode network (DMN). In addition, the total network strength of the NHC-specific positive network was lower in the MCI group than in the NHC group. Our findings demonstrated a decrease in TP in the MCI group compared to the NHC group, which is associated with deficits in social rationality (social cognition, associated with DMN) and increased sensitivity to betrayal (affect, associated with SN) in a trust dilemma. In conclusion, our study contributes to understanding MCI-related alterations in trust and their underlying neural mechanisms.

Sowing "seeds of trust": How trust in normothermic regional perfusion is built in a continuum of care.

Normothermic regional perfusion (NRP) is a promising technology to improve organ transplantation outcomes by reversing ischemic injury caused by controlled donation after circulatory determination of death. However, it has not yet been implemented in Canada due to ethical questions. These issues must be resolved to preserve public trust in organ donation and transplantation. This qualitative, constructivist grounded theory study sought to understand how those most impacted by NRP perceived the ethical implications. We interviewed 29 participants across stakeholder groups of donor families, organ recipients, donation and transplantation system leaders, and care providers. The interview protocol included a short presentation about the purpose of NRP and procedures in abdomen versus chest and abdomen NRP, followed by questions probing potential violations of the dead donor rule and concerns regarding brain reperfusion. The results present a grounded theory placing NRP within a trust-building continuum of care for the donor, their family, and organ recipients. Stakeholders consistently described both forms of NRP as an ethical intervention, but their rationales were predicated on assumptions that neurologic criteria for death had been met following circulatory death determination. Empirical validation of these assumptions will help ground the implementation of NRP in a trust-preserving way.

Conceptualizing and Measuring Trust, Mistrust, and Distrust: Implications for Advancing Health Equity and Building Trustworthiness.

Trust is vital to public confidence in health and science, yet there is no consensus on the most useful way to conceptualize, define, measure, or intervene on trust and its related constructs (e.g., mistrust, distrust, and trustworthiness). In this review, we synthesize literature from this wide-ranging field that has conceptual roots in racism, marginalization, and other forms of oppression. We summarize key definitions and conceptual frameworks and offer guidance to scholars aiming to measure these constructs. We also review how trust-related constructs are associated with health outcomes, describe interventions in this field, and provide recommendations for building trust and institutional trustworthiness and advancing health equity. We ultimately call for future efforts to focus on improving the trustworthiness of public health professionals, scientists, health care providers, and systems instead of aiming to increase trust in these entities as they currently exist and behave.

Trusting information on cancer varies by source of information and political viewpoint.

PURPOSE: This study investigated how trusting information on cancer varies by the source of information and political viewpoint. METHODS: This study used cross-sectional survey data from the 2020 Health Information National Trends Survey (HINTS). The study comprised a sample of 2949 adults 18 years and older. The outcome variable was measured by assessing respondents' trust in cancer-related information from various sources, including religious organizations and leaders, government health agencies, charitable organizations, family or friends, and doctors. Political viewpoint was measured as liberal, moderate, and conservative. Multivariate linear probability models were estimated and adjusted for individual-level characteristics. RESULTS: Multivariate analysis found that conservatives (73%, 95% CI = 68-78%) were significantly less likely to trust information on cancer from government health agencies compared to liberals (84%, 95% CI = 80-88%). There was no statistically significant difference in trusting government health agencies between liberals and moderates (80%, 95% CI = 76-84%). Both moderates (27%, 95% CI = 21-34%) and conservatives (34%, 95% CI = 29-39%) were more likely to trust information on cancer from religious organizations and leaders compared to liberals (19%, 95% CI = 13-24%). The relationship between political viewpoint and trust of doctors, family or friends, and charitable organizations were not statistically significant. CONCLUSION: Compared to liberals, conservatives are more likely to trust information on cancer from religious organizations and leaders and less likely to trust government health agencies when adjusting for other covariates. This finding emphasizes the role of political viewpoint in shaping individuals' perceptions of information sources and cancer-related information.

Variety Is the Spice of Life: Diverse Social Networks Are Associated With Social Cohesion and Well-Being.

Both homophily and heterophily are observed in humans. Homophily reinforces homogeneous social networks, and heterophily creates new experiences and collaborations. However, at the extremes, high levels of homophily can cultivate prejudice toward out-groups, whereas high levels of heterophily can weaken in-group support. Using data from 24,726 adults (M = 46 years; selected from 10,398 English neighborhoods) and the composition of their social networks based on age, ethnicity, income, and education, we tested the hypothesis that a middle ground between homophily and heterophily could be the most beneficial for individuals. We found that network homophily, mediated by perceived social cohesion, is associated with higher levels of subjective well-being but that there are diminishing returns, because at a certain point increasing network homophily is associated with lower social cohesion and, in turn, lower subjective well-being. Our results suggest that building diverse social networks provides benefits that cannot be attained by homogeneous networks.

Understanding the mechanisms underlying cognitive control in psychosis.

BACKGROUND: Cognitive control (CC) involves a top-down mechanism to flexibly respond to complex stimuli and is impaired in schizophrenia. METHODS: This study investigated the impact of increasing complexity of CC processing in 140 subjects with psychosis and 39 healthy adults, with assessments of behavioral performance, neural regions of interest and symptom severity. RESULTS: The lowest level of CC (Stroop task) was impaired in all patients; the intermediate level of CC (Faces task) with explicit emotional information was most impaired in patients with first episode psychosis. Patients showed activation of distinct neural CC and reward networks, but iterative learning based on the higher-order of CC during the trust game, was most impaired in chronic schizophrenia. Subjects with first episode psychosis, and patients with lower symptom load, demonstrate flexibility of the CC network to facilitate learning, which appeared compromised in the more chronic stages of schizophrenia. CONCLUSION: These data suggest optimal windows for opportunities to introduce therapeutic interventions to improve CC.

Effect of Attending Rheumatologists' Big 5 Personality Traits on Patient Trust in Patients With Systemic Lupus Erythematosus: The TRUMP2-SLE Project.

OBJECTIVE: Differences in communication styles based on physicians' personality traits have been identified, particularly in primary care, and these physician-related factors can be important in building patient-physician trust. This study examined the effects of rheumatologists' personality traits on patients' trust in their attending rheumatologists. METHODS: This cross-sectional study included adult Japanese patients with systemic lupus erythematosus (SLE) at 5 academic medical centers between June 2020 and August 2021. The exposures were the Big 5 personality traits (ie, extraversion, agreeableness, openness, conscientiousness, and emotional stability) of attending rheumatologists using the Japanese version of the 10-Item Personality Inventory scale (1-7 points each). The outcome was the patients' trust in their attending rheumatologist using the Japanese version of the 5-item Wake Forest Physician Trust Scale (0-100 points). A general linear model was fitted. RESULTS: The study included 505 patients with a mean age of 46.8 years; 88.1% were women. Forty-three attending rheumatologists (mean age: 39.6 years; 23.3% female) were identified. After multivariable adjustment, higher extraversion and agreeableness were associated with higher trust (per 1-point increase, 3.76 points [95% CI 1.07-6.45] and 4.49 points [95% CI 1.74-7.24], respectively), and higher conscientiousness was associated with lower trust (per 1-point increase, -2.17 points [95% CI -3.31 to -1.03]). CONCLUSION: Whereas higher extraversion and agreeableness of attending rheumatologists led to higher patient trust in their rheumatologist, overly high conscientiousness may lead to lower trust resulting from the physicians' demand of responsibility and adherence to instructions from patients with SLE.

Attachment and Political Personality are Heritable and Distinct Systems, and Both Share Genetics with Interpersonal Trust and Altruism.

The attachment and caregiving domains maintain proximity and care-giving behavior between parents and offspring, in a way that has been argued to shape people's mental models of how relationships work, resulting in secure, anxious or avoidant interpersonal styles in adulthood. Several theorists have suggested that the attachment system is closely connected to orientations and behaviors in social and political domains, which should be grounded in the same set of familial experiences as are the different attachment styles. We use a sample of Norwegian twins (N = 1987) to assess the genetic and environmental relationship between attachment, trust, altruism, right-wing authoritarianism (RWA), and social dominance orientation (SDO). Results indicate no shared environmental overlap between attachment and ideology, nor even between the attachment styles or between the ideological traits, challenging conventional wisdom in developmental, social, and political psychology. Rather, evidence supports two functionally distinct systems, one for navigating intimate relationships (attachment) and one for navigating social hierarchies (RWA/SDO), with genetic overlap between traits within each system, and two distinct genetic linkages to trust and altruism. This is counter-posed to theoretical perspectives that link attachment, ideology, and interpersonal orientations through early relational experiences.

Trust and stakeholder perspectives on the implementation of AI tools in clinical radiology.

OBJECTIVES: To define requirements that condition trust in artificial intelligence (AI) as clinical decision support in radiology from the perspective of various stakeholders and to explore ways to fulfil these requirements. METHODS: Semi-structured interviews were conducted with twenty-five respondents-nineteen directly involved in the development, implementation, or use of AI applications in radiology and six working with AI in other areas of healthcare. We designed the questions to explore three themes: development and use of AI, professional decision-making, and management and organizational procedures connected to AI. The transcribed interviews were analysed in an iterative coding process from open coding to theoretically informed thematic coding. RESULTS: We identified four aspects of trust that relate to reliability, transparency, quality verification, and inter-organizational compatibility. These aspects fall under the categories of substantial and procedural requirements. CONCLUSIONS: Development of appropriate levels of trust in AI in healthcare is complex and encompasses multiple dimensions of requirements. Various stakeholders will have to be involved in developing AI solutions for healthcare and radiology to fulfil these requirements. CLINICAL RELEVANCE STATEMENT: For AI to achieve advances in radiology, it must be given the opportunity to support, rather than replace, human expertise. Support requires trust. Identification of aspects and conditions for trust allows developing AI implementation strategies that facilitate advancing the field. KEY POINTS: • Dimensions of procedural and substantial demands that need to be fulfilled to foster appropriate levels of trust in AI in healthcare are conditioned on aspects related to reliability, transparency, quality verification, and inter-organizational compatibility. •Creating the conditions for trust to emerge requires the involvement of various stakeholders, who will have to compensate the problem's inherent complexity by finding and promoting well-defined solutions.

Trust in the Transplant Team Associated With the Level of Chronic Illness Management-A Secondary Data Analysis of the International BRIGHT Study.

A trustful relationship between transplant patients and their transplant team (interpersonal trust) is essential in order to achieve positive health outcomes and behaviors. We aimed to 1) explore variability of trust in transplant teams; 2) explore the association between the level of chronic illness management and trust; 3) investigate the relationship of trust on behavioral outcomes. A secondary data analysis of the BRIGHT study (ID: NCT01608477; https://clinicaltrials.gov/ct2/show/NCT01608477?id=NCT01608477&rank=1) was conducted, including multicenter data from 36 heart transplant centers from 11 countries across four different continents. A total of 1,397 heart transplant recipients and 100 clinicians were enrolled. Trust significantly varied among the transplant centers. Higher levels of chronic illness management were significantly associated with greater trust in the transplant team (patients: AOR= 1.85, 95% CI = 1.47-2.33, p < 0.001; clinicians: AOR = 1.35, 95% CI = 1.07-1.71, p = 0.012). Consultation time significantly moderated the relationship between chronic illness management levels and trust only when clinicians spent ≥30 min with patients. Trust was significantly associated with better diet adherence (OR = 1.34, 95%CI = 1.01-1.77, p = 0.040). Findings indicate the relevance of trust and chronic illness management in the transplant ecosystem to achieve improved transplant outcomes. Thus, further investment in re-engineering of transplant follow-up toward chronic illness management, and sufficient time for consultations is required.