Assessment of the Surgical Oncology Case Volume Within the Public Sector in Tanzania.

PURPOSE: Surgery provides vital services to diagnose, treat, and palliate patients suffering from malignancies. However, despite its importance, there is little information on the delivery of surgical oncology services in Tanzania. METHODS: Operative logbooks were reviewed at all national referral hospitals that offer surgery, all zonal referral hospitals in Mainland Tanganyika and Zanzibar, and a convenience sampling of regional referral hospitals in 2022. Cancer cases were identified by postoperative diagnosis and deidentified data were abstracted for each cancer surgery. The proportion of the procedures conducted for patients with cancer and the total number of cancer surgeries done within the public sector were calculated and compared with a previously published estimate of the surgical oncology need for the country. RESULTS: In total, 69,195 operations were reviewed at 10 hospitals, including two national referral hospitals, five zonal referral hospitals, and three regional referral hospitals. Of the cases reviewed, 4,248 (6.1%) were for the treatment of cancer. We estimate that 4,938 cancer surgeries occurred in the public sector in Tanzania accounting for operations conducted at hospitals not included in our study. Prostate, breast, head and neck, esophageal, and bladder cancers were the five most common diagnoses. Although 387 (83%) of all breast cancer procedures were done with curative intent, 506 (87%) of patients with prostate and 273 (81%) of patients with esophageal cancer underwent palliative surgery. CONCLUSION: In this comprehensive assessment of surgical oncology service delivery in Tanzania, we identified 4,248 cancer surgeries and estimate that 4,938 likely occurred in 2022. This represents only 25% of the estimated 19,726 cancer surgeries that are annually needed in Tanzania. These results highlight the need to identify strategies for increasing surgical oncology capacity in the country.

Automated segmentation of ablated lesions using deep convolutional neural networks: A basis for response assessment following laser interstitial thermal therapy.

BACKGROUND: Laser interstitial thermal therapy (LITT) of intracranial tumors or radiation necrosis enables tissue diagnosis, cytoreduction, and rapid return to systemic therapies. Ablated tissue remains in situ, resulting in characteristic post-LITT edema associated with transient clinical worsening and complicating post-LITT response assessment. METHODS: All patients receiving LITT at a single center for tumors or radiation necrosis from 2015 to 2023 with ≥9 months of MRI follow-up were included. An nnU-Net segmentation model was trained to automatically segment contrast-enhancing lesion volume (CeLV) of LITT-treated lesions on T1-weighted images. Response assessment was performed using volumetric measurements. RESULTS: Three hundred and eighty four unique MRI exams of 61 LITT-treated lesions and 6 control cases of medically managed radiation necrosis were analyzed. Automated segmentation was accurate in 367/384 (95.6%) images. CeLV increased to a median of 68.3% (IQR 35.1-109.2%) from baseline at 1-3 months from LITT (P = 0.0012) and returned to baseline thereafter. Overall survival (OS) for LITT-treated patients was 39.1 (9.2-93.4) months. Lesion expansion above 40% from volumetric nadir or baseline was considered volumetric progression. Twenty-one of 56 (37.5%) patients experienced progression for a volumetric progression-free survival of 21.4 (6.0-93.4) months. Patients with volumetric progression had worse OS (17.3 vs 62.1 months, P = 0.0015). CONCLUSIONS: Post-LITT CeLV expansion is quantifiable and resolves within 6 months of LITT. Development of response assessment criteria for LITT-treated lesions is feasible and should be considered for clinical trials. Automated lesion segmentation could speed the adoption of volumetric response criteria in clinical practice.

Behavioral and psychiatric correlates of brain responses to social feedback.

Maladaptive responses to peer acceptance and rejection arise in numerous psychiatric disorders in adolescence; yet, homogeneity and heterogeneity across disorders suggest common and unique mechanisms of impaired social function. We tested the hypothesis that social feedback is processed similarly to other forms of feedback (e.g., monetary) by examining the correspondence between the brain's response to social acceptance and rejection and behavioral performance on a separate reward and loss task. We also examined the relationship between these brain responses and depression and social anxiety severity. The sample consisted of one hundred and thirteen 16-21-year olds who received virtual peer acceptance/rejection feedback in an event-related potential (ERP) task. We used temporospatial principal component analysis and identified a component consistent with the reward positivity (RewP) or feedback negativity (FN). RewP to social acceptance was not significantly related to reward bias or the FN to social rejection related to loss avoidance. The relationship between RewP and depression severity, while nonsignificant, was of a similar magnitude to prior studies. Exploratory analyses yielded a significant relationship between lower socioeconomic status (SES) and blunted RewP and between lower SES and heightened loss avoidance and blunted reward bias. These findings build on prior work to improve our understanding of the function of the brain's response to social feedback, while also suggesting a pathway for further study, whereby poverty leads to depression via social and reward learning mechanisms.

Exposure to automation explains religious declines.

The global decline of religiosity represents one of the most significant societal shifts in recent history. After millennia of near-universal religious identification, the world is experiencing a regionally uneven trend toward secularization. We propose an explanation of this decline, which claims that automation-the development of robots and artificial intelligence (AI)-can partly explain modern religious declines. We build four unique datasets composed of more than 3 million individuals which show that robotics and AI exposure is linked to 21st-century religious declines across nations, metropolitan regions, and individual people. Key results hold controlling for other technological developments (e.g., electricity grid access and telecommunications development), socioeconomic indicators (e.g., wealth, residential mobility, and demographics), and factors implicated in previous theories of religious decline (e.g., individual choice norms). An experiment also supports our hypotheses. Our findings partly explain contemporary trends in religious decline and foreshadow where religiosity may wane in the future.

Persuading republicans and democrats to comply with mask wearing: An intervention tournament.

Many people practiced COVID-19-related safety measures in the first year of the pandemic, but Republicans were less likely to engage in behaviors such as wearing masks or face coverings than Democrats, suggesting radical disparities in health practices split along political fault lines. We developed an "intervention tournament" which aimed to identify the framings that would promote mask wearing among a representative sample of Republicans and Democrats in the U.S. from Oct 14, 2020, to Jan 14, 2021 (N = 4931). Seven different conditions reflecting different moral values and factors specific to COVID-19-including protection from harm (self), protection from harm (community), patriotic duty, purity, reviving the economy, threat, and scientific evidence-were implemented to identify which framings would "win" in terms of promoting mask wearing compared to a baseline condition. We found that Republicans had significantly more negative attitudes toward masks, lower intentions to wear them, and were less likely to sign or share pledges on social media than Democrats, which was partially mediated by Republicans, compared to Democrats, perceiving that the threat of COVID-19 was lower. None of our framing conditions significantly affected Republicans' or Democrats' attitudes, intentions, or behaviors compared to the baseline condition, illustrating the difficulty in overcoming the strength of political polarization during COVID-19.

Do correctional facilities correct our youth?: Effects of incarceration and court-ordered community service on personality development.

Millions of individuals are currently incarcerated in the United States. However, little is known about the effects of incarceration on personality development, particularly during the critical life stage of adolescence. In a large longitudinal sample, adolescents and young adults (N = 7,736) regularly completed personality measures and assessments of court-ordered punishments over more than 10 years. Using propensity score weighting and multilevel growth curve modeling, we found that personality prospectively predicted the likelihood of incarceration and court-ordered community service. Specifically, individuals who were higher in sensation seeking, impulsivity, and depressive symptoms were more likely to be incarcerated-results for community service youth mostly mirrored these findings. Mixed evidence was found for patterns of trait change. Incarcerated, community service, and nonoffending youth were similar in several ways-all increased on sensation seeking and self-esteem and decreased on impulsivity over the 10-year period. However, between-person models found that incarcerated youth evidenced a greater decrease in depressive symptoms and a slower decrease in impulsivity, and youth assigned community service increased more quickly on sensation seeking than their nonoffending peers. Within-person analyses also suggested personality differences; for example, sensation seeking was lower after incarceration while impulsivity was higher compared with before. Overall, this work highlights that personality predicts incarceration and court-ordered community service in youth and that personality changes linked with these experiences do not have a uniformly "corrective" pattern of change, with few effects observed overall and some in seemingly unfavorable directions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mechanisms of Black-White disparities in health among older adults: Examining discrimination and personality.

We tested whether personality traits help explain the association between discrimination and racial health disparities in a sample of 1033 Black and White older adults. Participants completed measures of discrimination, personality, and self-reported physical and mental health. Elevated discrimination among Black participants was indirectly linked to worse physical and mental health outcomes through elevated neuroticism and lower agreeableness, controlling income, education, and gender. The specific facets of depression, impulsiveness, and trust were the most robust intervening personality factors. Interventions that target cognitive, emotional, and behavioral sequelae of discrimination may lessen its impact on health disparities.

Association of high profile football matches in Europe with traffic accidents in Asia: archival study.

OBJECTIVE: To investigate the association between popular football games played in Europe and the incidence of traffic accidents in Asia. DESIGN: Study based on 41 538 traffic accidents involving taxis in Singapore and 1 814 320 traffic accidents in Taiwan, combined with 12 788 European club football games over a seven year period. SETTING: Singapore and Taiwan. PARTICIPANTS: The largest taxi company in Singapore, with fine grained traffic accident records in a three year span; all traffic accident records in Taiwan in a six year span. EXPOSURE: Days when high profile football games were played or not played. MAIN OUTCOME MEASURE: Number of traffic accidents. RESULTS: Regression based and time series models suggest that days with high profile European football matches were more positively associated with traffic accidents than days with less popular European football matches. For an approximate €134.74m (£120.25m; $159.76m) increase in average market value for matches played on a given day, approximately one extra accident would occur among Singapore taxi drivers, and for an approximate €7.99m increase in average market value of matches, approximately one extra accident would occur among all drivers in Taiwan. This association remained after control for weather conditions, time of the year, weekend versus weekday effects, driver demographics, and underlying temporal trends. It was also stronger for daytime traffic accidents than for night time traffic accidents, suggesting that the association between high profile football matches and traffic accidents cannot be attributed to night time celebration or attention deficits while watching and driving. Annually, this increased rate of traffic accidents may translate to approximately 371 accidents among taxi drivers in Singapore and approximately 41 079 accidents among the Taiwanese public, as well as economic losses of approximately €821 448 among Singapore taxi drivers and approximately €13 994 409 among Taiwanese drivers and insurers. The total health and economic impact of this finding is likely to be much higher because GMT+8 is the most populous time zone, encompassing 24% of the world's population. CONCLUSIONS: Days featuring high profile football matches in Europe were associated with more traffic accidents in Taiwan and Singapore than were days with lower profile football matches. A potential causal mechanism may be Asian drivers losing sleep by watching high profile European matches, which are often played in the middle of the night in Asia.

Assessment of Neighborhood Poverty, Cognitive Function, and Prefrontal and Hippocampal Volumes in Children.

Importance: The association between poverty and unfavorable cognitive outcomes is robust, but most research has focused on individual household socioeconomic status (SES). There is increasing evidence that neighborhood context explains unique variance not accounted for by household SES. Objective: To evaluate whether neighborhood poverty (NP) is associated with cognitive function and prefrontal and hippocampal brain structure in ways that are dissociable from household SES. Design, Setting, and Participants: This cross-sectional study used a baseline sample of the ongoing longitudinal Adolescent Brain Cognitive Development (ABCD) Study. The ABCD Study will follow participants for assessments each year for 10 years. Data were collected at 21 US sites, mostly within urban and suburban areas, between September 2019 and October 2018. School-based recruitment was used to create a participant sample reflecting the US population. Data analysis was conducted from March to June 2019. Main Outcomes and Measures: NP and household SES were included as factors potentially associated with National Institutes of Health Toolbox Cognitive Battery subtests and hippocampal and prefrontal (dorsolateral prefrontal cortex [DLPFC], dorsomedial PFC [DMPFC], superior frontal gyrus [SFG]) volumes. Independent variables were first considered individually and then together in mixed-effects models with age, sex, and intracranial volume as covariates. Structural equation modeling (SEM) was used to assess shared variance in NP to brain structure and cognitive task associations. The tested hypotheses were formulated after data collection. Results: A total of 11 875 children aged 9 and 10 years (5678 [47.8%] girls) were analyzed. Greater NP was associated with lower scores across all cognitive domains (eg, total composite: ß = -0.18; 95% CI, -0.21 to -0.15; P < .001) and with decreased brain volume in the DLPFC (eg, right DLPFC: ß = -0.09; 95% CI, -0.12 to -0.07; P < .001), DMPFC (eg, right DMPC: ß = -0.07; 95% CI, -0.09 to -0.05; P < .001), SFG (eg, right SFG: ß = -0.05; 95% CI, -0.08 to -0.03; P < .001), and right hippocampus (ß = -0.04; 95% CI, -0.06 to -0.01; P = .01), even when accounting for household income. Greater household income was associated with higher scores across all cognitive domains (eg, total composite: ß = 0.30; 95% CI, 0.28 to 0.33; P < .001) and larger volume in all prefrontal and hippocampal brain regions (eg, right hippocampus: ß = 0.04; 95% CI, 0.02 to 0.07; P < .001) even when accounting for NP. The SEM model was a good fit across all cognitive domains, with prefrontal regions being associated with NP relations to language (picture vocabulary: estimate [SE], -0.03 [0.01]; P < .001; oral reading: estimate [SE], -0.02 [0.01]; P < .001), episodic memory (picture sequence: estimate [SE], -0.02 [0.01]; P = .008), and working memory (dimensional card sort: estimate [SE], -0.02 [0.01]; P = .001; flanker inhibitory control: estimate [SE], -0.01 [0.01]; P = .01; list sorting: estimate [SE], -0.03 [0.01]; P < .001) and hippocampal regions being associated with NP associations with language (picture vocabulary: estimate [SE], -0.01 [0.004]; P < .001) and episodic memory (picture sequence: estimate [SE], -0.01 [0.004]; P < 0.001). Conclusions and Relevance: In this study, NP accounted for unique variance in cognitive function and prefrontal and right hippocampal brain volume. These findings demonstrate the importance of including broader environmental influences when conceptualizing early life adversity.

The impact of the Syrian conflict on population well-being.

The United Nations described the Syrian conflict as the worst man-made disaster since World War II. We adopted a global perspective in examining the impact of the Syrian conflict on Syrians' physical, mental, and social well-being using the Gallup World Poll. Face-to-face interview data of 11,452 Syrian participants from 2008 to 2015 show that Syrians' physical (e.g., access to shelter), mental (e.g., life satisfaction), and social (e.g., social support) well-being decline substantially. Syrians who reported being exposed to the conflict are similarly affected compared to those without direct exposure, suggesting country-wide spillover effects. Global data covering 1.7 million participants across 163 countries from 2006 to 2016 show during the conflict, Syria's precipitous decline in well-being is unparalleled in the world, even when compared to countries similarly experiencing war, protests, and disasters. Our findings reinforce the vital importance of an accelerated peace process to restore well-being in Syria.

Ecological and cultural factors underlying the global distribution of prejudice.

Prejudiced attitudes and political nationalism vary widely around the world, but there has been little research on what predicts this variation. Here we examine the ecological and cultural factors underlying the worldwide distribution of prejudice. We suggest that cultures grow more prejudiced when they tighten cultural norms in response to destabilizing ecological threats. A set of seven archival analyses, surveys, and experiments (∑N = 3,986,402) find that nations, American states, and pre-industrial societies with tighter cultural norms show the most prejudice based on skin color, religion, nationality, and sexuality, and that tightness predicts why prejudice is often highest in areas of the world with histories of ecological threat. People's support for cultural tightness also mediates the link between perceived ecological threat and intentions to vote for nationalist politicians. Results replicate when controlling for economic development, inequality, conservatism, residential mobility, and shared cultural heritage. These findings offer a cultural evolutionary perspective on prejudice, with implications for immigration, intercultural conflict, and radicalization.

The loosening of American culture over 200 years is associated with a creativity-order trade-off.

For many years, scientists have studied culture by comparing societies, regions or social groups within a single point in time. However, culture is always changing, and this change affects the evolution of cognitive processes and behavioural practices across and within societies. Studies have now documented historical changes in sexism1, individualism2,3, language use4 and music preferences5 within the United States and around the world6. Here we build on these efforts by examining changes in cultural tightness-looseness (the strength of cultural norms and tolerance for deviance) over time, using the United States as a case study. We first develop a new linguistic measure to measure historical changes in tightness-looseness. Analyses show that America grew progressively less tight (i.e., looser) from 1800 to 2000. We next examine how changes in tightness-looseness relate to four indicators of societal order: debt (adjusted for inflation), adolescent pregnancies and crime, and high school attendance, as well as four indicators of creative output: registered patents, trademarks, feature films produced, and baby-naming conformity. We find that cultural tightness correlates negatively with each measure of creativity, and correlates positively with three out of four measures of societal order (fewer adolescent pregnancies, less debt and higher levels of school attendance). These findings imply that the historical loosening of American culture was associated with a trade-off between higher creativity but lower order.

Trajectories of racial and gender health disparities during later midlife: Connections to personality.

OBJECTIVE: We examined race/gender effects on initial levels and trajectories of self-reported physical and mental health, as well as the moderating role of personality. We hypothesized that health disparities would remain stable or decrease over time, and that at-risk personality traits (e.g., neuroticism) would have a more robust negative impact on health for Black participants. METHOD: Analyses utilized 6 waves of data from a community sample of 1,577 Black and White adults (mean age 60 years), assessed every 6 months for 2.5 years. Using multigroup latent growth curve modeling, we examined initial levels and changes in health among White men, White women, Black men, and Black women. RESULTS: Black participants reported lower initial physical health than Whites. Women's physical health was stable over time, whereas men's declined. There were no disparities in mental health. Higher agreeableness was associated with higher initial levels of physical health only among Black men and White women. All other personality traits were associated with physical and mental health similarly across race and gender. CONCLUSIONS: Race and gender influence health trajectories. Most personality- health associations replicated across race and gender, except for agreeableness with physical health. An intersectional framework considering more than one aspect of social identity is crucial for understanding health disparities. Future studies may benefit from including large, diverse samples of participants and further examining the moderating effects of race and gender on personality associations with a variety of health outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The relative impact of socioeconomic status and childhood trauma on Black-White differences in paranoid personality disorder symptoms.

The current study examines mechanisms of racial differences in symptoms of paranoid personality disorder (PPD) in a sample of adults ages 55-64 from the St. Louis, MO area. Socioeconomic status (SES) and childhood trauma were tested as intervening variables in the association between race and PPD symptoms using structural equation modeling. PPD symptoms were modeled as a latent variable composed of items from the PPD scales of the Multi-Source Assessment of Personality Pathology self and informant reports and the Structured Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Personality. Childhood trauma was measured using the Traumatic Life Events Questionnaire, and SES was a composite of parent education, participant education, and annual household income. Blacks exhibited higher levels of PPD symptoms across the 3 personality measures, reported significantly lower SES, and reported greater childhood trauma. The proposed model was a good fit to the data, and the effect of race on PPD symptoms operated mainly through SES. The indirect effect through SES was stronger for males. Findings suggest that racial differences in PPD symptoms are partly explained by problems more commonly experienced by Black individuals.

Connecting social environment variables to the onset of major specific health outcomes.

OBJECTIVE: The present research examined the effects of the social environment on the onset of specific health ailments. DESIGN: Using data from the Health and Retirement Study, we examined participants' responses to social environment questions in 2006 as predictors of onset of different health conditions over the next four years. MAIN OUTCOME MEASURES: Healthy participants (n = 7514) reported on their number of social partners, interaction frequency, positive social support and negative social support with respect to both their family and friends. These variables were used to predict onset of seven conditions in 2010: high blood pressure, heart condition, lung disease, cancer, stroke, diabetes and arthritis. RESULTS: Logistic regressions indicated that the social environment provided some predictive value for onset of most health outcomes, with more positive and less negative social support appearing to buffer against onset. Social environmental variables related to friendships appeared to play a greater role than the family indicators. However, no variable proved universally adaptive, and social indicators had little value in predicting onset of chronic conditions. CONCLUSION: The current findings point to the potential for the social environment to influence later health, while demonstrating the nuanced role that our social lives play with respect to health.

Personality Measurement and Assessment in Large Panel Surveys*

Personality tests are being added to large panel studies with increasing regularity, such as the Health and Retirement Study (HRS). To facilitate the inclusion and interpretation of these tests, we provide some general background on personality psychology, personality assessment, and the validity of personality tests. In this review, we provide background on definitions of personality, the strengths and weaknesses of the self-report approaches to personality testing typically used in large panel studies, and the validity of personality tests for three outcomes: genetics, income, and health. We conclude with recommendations on how to improve personality assessment in future panel studies.

Serotonin transporter gene associations with psychopathic traits in youth vary as a function of socioeconomic resources.

Although prior research has examined the genetic correlates of antisocial behavior, molecular genetics influences on psychopathic traits remain largely unknown. Consequently, we investigated the influence of polymorphic variation at the serotonin transporter protein gene (SLC6A4) and socioeconomic resources (SES) on psychopathic traits in youth across two distinct samples in two separate studies. In Study 1, a main effect of serotonin transporter (5-HTTLPR) genotype was associated with the impulsivity dimension of psychopathy. That is, individuals homozygous for the short allele evidenced more impulsivity than did those homozygous for the long allele. In contrast, a gene-environment interaction was associated with the callous-unemotional and narcissistic features of psychopathy. Callous-unemotional and narcissistic traits increased as SES decreased only among youths with the homozygous-long (l/l) genotype, a novel finding replicated and extended in Study 2. These studies provide preliminary results that the l/l genotype confers risk for the emotional deficits and predatory interpersonal traits associated with psychopathy among youths raised in disadvantaged environments.