Social feedback biases emerge during recall but not prediction and shift across the development of social anxiety.

Memory is a reconstructive process that can result in events being recalled as more positive or negative than they actually were. While positive recall biases may contribute to well-being, negative recall biases may promote internalizing symptoms, such as social anxiety. Adolescence is characterized by increased salience of peers and peak incidence of social anxiety. Symptoms often wax and wane before becoming more intractable during adulthood. Open questions remain regarding how and when biases for social feedback are expressed and how individual differences in biases may contribute to social anxiety across development. Two studies used a social feedback and cued response task to assess biases about being liked or disliked when retrieving memories vs. making predictions. Findings revealed a robust positivity bias about memories for social feedback, regardless of whether memories were true or false. Moreover, memory bias was associated with social anxiety in a developmentally sensitive way. Among adults (study 1), more severe symptoms of social anxiety were associated with a negativity bias. During the transition from adolescence to adulthood (study 2), age strengthened the positivity bias in those with less severe symptoms and strengthened the negativity bias in those with more severe symptoms. These patterns of bias were isolated to perceived memory retrieval and did not generalize to predictions about social feedback. These results provide initial support for a model by which schemas may infiltrate perceptions of memory for past, but not predictions of future, social events, shaping susceptibility for social anxiety, particularly during the transition into adulthood.

Neural response to monetary and social rewards in adolescent girls and their parents.

Functional magnetic resonance imaging (fMRI) studies have indicated that the mesocorticolimbic dopamine system is heavily involved in all stages of reward processing. However, the majority of research has been conducted using monetary rewards and it is unclear to what extent other types of rewards, such as social rewards, evoke similar or different neural activation. There have also been few investigations into potential differences or similarities between reward processing in parents and offspring. The present study examined fMRI neural activation in response to monetary and social reward in a sample of 14-22-year-old adolescent girls (N = 145) and a biological parent (N = 124) and compared activation across adolescent-parent dyads (N = 82). Across all participants, both monetary and social reward elicited bilateral striatal activation, which did not differ between reward types or between adolescents and their parents. Neural activation in response to the different reward types were positively correlated in the striatum among adolescents and in the mPFC and OFC among parents. Overall, the present study suggests that both monetary and social reward elicit striatal activation regardless of age and provides evidence that neural mechanisms underlying reward processing may converge differentially among youth and adults.

Neural response to monetary and social rewards and familial risk for psychopathology in adolescent females.

BACKGROUND: Adolescence is a key developmental period for the emergence of psychopathology. Reward-related brain activity increases across adolescence and has been identified as a potential neurobiological mechanism of risk for different forms of psychopathology. The reward positivity (RewP) is an event-related potential component that indexes reward system activation and has been associated with both concurrent and family history of psychopathology. However, it is unclear whether the RewP is also associated with higher-order psychopathology subfactors and whether this relationship is present across different types of reward. METHODS: In a sample of 193 adolescent females and a biological parent, the present study examined the association between adolescent and parental psychopathology subfactors and adolescent RewP to monetary and social reward. RESULTS: Results indicated that the adolescent and parental distress subfactors were negatively associated with the adolescent domain-general RewP. The adolescent and parental positive mood subfactors were negatively associated with the adolescent domain-general and domain-specific monetary RewP, respectively. Conversely, the adolescent and parental fear/obsessions subfactors were positively associated with the adolescent domain-general RewP. The associations between parental and adolescent psychopathology subfactors and the adolescent RewP were independent of each other. CONCLUSIONS: The RewP in adolescent females is associated with both concurrent and parental psychopathology symptoms, suggesting that it indexes both severity and risk for higher-order subfactors.

Barriers, Facilitators and Opportunities for HIV Status Disclosure Among Young Men Who Have Sex With Men: Qualitative Findings from the Tough Talks Intervention.

Disclosing one's HIV status can involve complex individual and interpersonal processes interacting with discriminatory societal norms and institutionalized biases. To support disclosure decision-making among young men who have sex with men (YMSM) living with HIV, we developed Tough Talks™, an mHealth intervention that uses artificially intelligent-facilitated role-playing disclosure scenarios and informational activities that build disclosure skills and self-efficacy. Qualitative interviews were conducted with 30 YMSM living with HIV (mean age 24 years, 50% Black) who were enrolled in a randomized controlled trial assessing Tough Talks™ to understand their experiences with HIV status disclosure. Interviews were recorded, transcribed, and thematically coded. Barriers to disclosure focused on fear, anxiety, stigma, and trauma. Facilitators to disclosure are described in the context of these barriers including how participants built comfort and confidence in disclosure decisions and ways the Tough Talks™ intervention helped them. Participants' narratives identified meaning-making within disclosure conversations including opportunities for educating others and advocacy. Findings revealed ongoing challenges to HIV status disclosure among YMSM and a need for clinical providers and others to support disclosure decision-making and affirm individuals' autonomy over their decisions to disclose. Considering disclosure as a process rather than discrete events could inform future intervention approaches.

Recent advances and current challenges in CAR-T cell therapy.

Rapid advancements in the field of immunotherapy have significantly improved cancer treatments. Specifically, an individualized cell-based modality which involves the removal of some of the patient's own white blood cells, including T cells, has revolutionized research in this field. This study focuses on the recent advances and current challenges of Chimeric Antigen Receptor- T (CAR-T) cell therapy and its regulations in the United States (US) and European Union (EU). Understanding the regulatory regimes of CAR-T cell therapy is critical for researchers and manufacturers as they navigate the hurdles of bringing CAR-T cell therapy to the global market. Benefits of CAR-T cell therapy include high response rates and the potential of long-term remissions in some haematological malignancies. However, the drawbacks are still evident including high costs, adverse reactions, and limited efficacy to solid tumours. CAR-T cell therapy is rapidly advancing, with 1231 clinical trials launched globally according to www.clinicalTrial.gov . The future of CAR-T cell therapy holds enormous promise but improving its safety, effectiveness, and availability are still barriers to its successful implementation.

Principles of digital professionalism for the metaverse in healthcare.

BACKGROUND: Experts are currently investigating the potential applications of the metaverse in healthcare. The metaverse, a groundbreaking concept that arose in the early 21st century through the fusion of virtual reality and augmented reality technologies, holds promise for transforming healthcare delivery. Alongside its implementation, the issue of digital professionalism in healthcare must be addressed. Digital professionalism refers to the knowledge and skills required by healthcare specialists to navigate digital technologies effectively and ethically. This study aims to identify the core principles of digital professionalism for the use of metaverse in healthcare. METHOD: This study utilized a qualitative design and collected data through semi-structured online interviews with 20 medical information and health informatics specialists from various countries (USA, UK, Sweden, Netherlands, Poland, Romania, Italy, Iran). Data analysis was conducted using the open coding method, wherein concepts (codes) related to the themes of digital professionalism for the metaverse in healthcare were assigned to the data. The analysis was performed using the MAXQDA software (VER BI GmbH, Berlin, Germany). RESULTS: The study revealed ten fundamental principles of digital professionalism for the metaverse in healthcare: Privacy and Security, Informed Consent, Trust and Integrity, Accessibility and Inclusion, Professional Boundaries, Evidence-Based Practice, Continuous Education and Training, Collaboration and Interoperability, Feedback and Improvement, and Regulatory Compliance. CONCLUSION: As the metaverse continues to expand and integrate itself into various industries, including healthcare, it becomes vital to establish principles of digital professionalism to ensure ethical and responsible practices. Healthcare professionals can uphold these principles to maintain ethical standards, safeguard patient privacy, and deliver effective care within the metaverse.

ChatGPT in medical libraries, possibilities and future directions: An integrative review.

BACKGROUND: The emergence of the artificial intelligence chatbot ChatGPT in November 2022 has garnered substantial attention across diverse disciplines. Despite widespread adoption in various sectors, the exploration of its application in libraries, especially within the medical domain, remains limited. AIMS/OBJECTIVES: Many areas of interest remain unexplored like ChatGPT in medical libraries and this review aims to synthesise what is currently known about it to identify gaps and stimulate further research. METHODS: Employing Cooper's integrative review method, this study involves a comprehensive analysis of existing literature on ChatGPT and its potential implementations within library contexts. RESULTS: A systematic literature search across various databases yielded 166 papers, with 30 excluded for irrelevance. After abstract reviews and methodological assessments, 136 articles were selected. Critical Appraisal Skills Programme qualitative checklist further narrowed down to 29 papers, forming the basis for the present study. The literature analysis reveals diverse applications of ChatGPT in medical libraries, including aiding users in finding relevant medical information, answering queries, providing recommendations and facilitating access to resources. Potential challenges and ethical considerations associated with ChatGPT in this context are also highlighted. CONCLUSION: Positioned as a review, our study elucidates the applications of ChatGPT in medical libraries and discusses relevant considerations. The integration of ChatGPT into medical library services holds promise for enhancing information retrieval and user experience, benefiting library users and the broader medical community.

Don't worry, it won't be fine. Contributions of worry and anxious arousal to startle responses and event-related potentials in threat anticipation.

A widely shared framework suggests that anxiety maps onto two dimensions: anxious apprehension and anxious arousal. Previous research linked individual differences in these dimensions to differential neural response patterns in neuropsychological, imaging, and physiological studies. Differential effects of the anxiety dimensions might contribute to inconsistencies in prior studies that examined neural processes underlying anxiety, such as hypersensitivity to unpredictable threat. We investigated the association between trait worry (as a key component of anxious apprehension), anxious arousal, and the neural processing of anticipated threat. From a large online community sample (N = 1,603), we invited 136 participants with converging and diverging worry and anxious arousal profiles into the laboratory. Participants underwent the NPU-threat test with alternating phases of unpredictable threat, predictable threat, and safety, while physiological responses (startle reflex and startle probe locked event-related potential components N1 and P3) were recorded. Worry was associated with increased startle responses to unpredictable threat and increased attentional allocation (P3) to startle probes in predictable threat anticipation. Anxious arousal was associated with increased startle and N1 in unpredictable threat anticipation. These results suggest that trait variations in the anxiety dimensions shape the dynamics of neural processing of threat. Specifically, trait worry seems to simultaneously increase automatic defensive preparation during unpredictable threat and increase attentional responding to threat-irrelevant stimuli during predictable threat anticipation. The current study highlights the utility of anxiety dimensions to understand how physiological responses during threat anticipation are altered in anxiety and supports that worry is associated with hypersensitivity to unpredictable, aversive contexts.

Neurobiological sensitivity to unpredictable threat and familial risk for the internalizing and externalizing spectra in adolescents.

BACKGROUND: Adolescence is a key developmental period for the emergence of psychiatric disorders. However, there is still no consensus on the core mechanisms of dysfunction in youth. Neurobiological sensitivity to unpredictable threat has been associated with several psychiatric disorders in adults. The present study examined adolescent defensive motivation (startle reflex) and attention (event-related potentials) in anticipation of unpredictable threat in relation to both adolescent and maternal (i.e. familial risk) internalizing and externalizing spectra. METHODS: The sample included 395 15-year-old adolescents and their biological mothers. Adolescent startle potentiation and probe P300 suppression (indicating increased attention to threat) were measured in anticipation of predictable and unpredictable threat. Adolescent and maternal lifetime history of psychiatric disorders were assessed via semi-structured diagnostic interviews, and confirmatory factor analysis was used to model internalizing and externalizing spectra. RESULTS: The adolescent internalizing spectrum was positively associated with adolescent startle potentiation and probe P300 suppression to unpredictable threat. Conversely, the adolescent externalizing spectrum was negatively associated with adolescent P300 suppression to unpredictable threat. The maternal internalizing spectrum was positively associated with adolescent startle potentiation to unpredictable threat and P300 suppression to both predictable and unpredictable threat. The maternal externalizing spectrum was negatively associated with adolescent startle potentiation to unpredictable threat and P300 suppression to both predictable and unpredictable threat. Adolescent and maternal internalizing and externalizing spectra were independently related to adolescent startle potentiation and P300 suppression. CONCLUSIONS: Adolescent neurobiological sensitivity to unpredictable threat is associated with both personal history and familial risk for the internalizing and externalizing spectra.

Thrombotic outcomes in patients in a large clinical enterprise following COVID-19 vaccination.

Vaccination against COVID-19 reduces infection-related mortality. Unfortunately, reports of vaccine-induced immune thrombotic thrombocytopenia (VITT) in individuals administered adenovirus-vector-based vaccines (ChAdOx1 nCoV-19 and Ad26.COV2.S) have spurred side effect concerns. To address vaccine hesitancy related to this, it is essential to determine the incidence of VITT (defined by a 50% decrease in platelet count and positive anti-PF4 immunoassay within 4-28 days after vaccination) among patients administered two doses of an mRNA-based COVID-19 vaccination. We identified a retrospective cohort of 223,345 patients in the Cleveland Clinic Enterprise administered a COVID-19 vaccine at any location in Northeast Ohio and Florida from 12/4/2020 to 6/6/2021. 97.3% of these patients received an mRNA-based vaccination. Patients with: (1) a serial complete blood count both before and after vaccination and (2) a decrease in platelet count of ≥ 50% were selected for chart review. The primary outcome was the incidence of thrombotic events, including venous thromboembolism (VTE) and arterial thrombosis, 4-28 days post vaccination. Of 74 cohort patients with acute thrombosis, 72 (97.3%) demonstrated clear etiologies, such as active malignancy. Of two patients with unprovoked thrombosis, only one had findings concerning for VITT, with a strongly positive anti-PF4 antibody assay. In this large, multi-state, retrospective cohort, of 223,345 patients (97.2% of whom received the mRNA-based mRNA-1273 or BNT162b2 vaccines), we detected a single case that was concerning for VITT in a patient who received an mRNA vaccine. The overwhelming majority of patients with a thrombotic event 4-28 days following vaccination demonstrated clear etiologies.

Sex-specific effects of calving season on joint health and biomarkers in Montana ranchers.

BACKGROUND: Agricultural workers have a higher incidence of osteoarthritis (OA), but the etiology behind this phenomenon is unclear. Calving season, which occurs in mid- to late-winter for ranchers, includes physical conditions that may elevate OA risk. Our primary aim was to determine whether OA biomarkers are elevated at the peak of calving season compared to pre-season, and to compare these data with joint health survey information from the subjects. Our secondary aim was to detect biomarker differences between male and female ranchers. METHODS: During collection periods before and during calving season, male (n = 28) and female (n = 10) ranchers completed joint health surveys and provided samples of blood, urine, and saliva for biomarker analysis. Statistical analyses examined associations between mean biomarker levels and survey predictors. Ensemble cluster analysis identified groups having unique biomarker profiles. RESULTS: The number of calvings performed by each rancher positively correlated with plasma IL-6, serum hyaluronic acid (HA) and urinary CTX-I. Thiobarbituric acid reactive substances (TBARS), a marker of oxidative stress, was significantly higher during calving season than pre-season and was also correlated with ranchers having more months per year of joint pain. We found evidence of sexual dimorphism in the biomarkers among the ranchers, with leptin being elevated and matrix metalloproteinase-3 diminished in female ranchers. The opposite was detected in males. WOMAC score was positively associated with multiple biomarkers: IL-6, IL-2, HA, leptin, C2C, asymmetric dimethylarginine, and CTX-I. These biomarkers represent enzymatic degradation, inflammation, products of joint destruction, and OA severity. CONCLUSIONS: The positive association between number of calvings performed by each rancher (workload) and both inflammatory and joint tissue catabolism biomarkers establishes that calving season is a risk factor for OA in Montana ranchers. Consistent with the literature, we found important sex differences in OA biomarkers, with female ranchers showing elevated leptin, whereas males showed elevated MMP-3.

Integrating LGBTQIA + Community Member Perspectives into Medical Education.

ProblemLGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexual and gender minorities) people have unique health care needs related to their sexual orientation, gender identity and expression, and sex development. However, medical education has historically excluded LGBTQIA + health-related content in formal curricula. It is common for medical students to interact with diverse patient populations through clinical rotations; however, access to and knowledge about LGBTQIA + patients is inconsistently prioritized in medical schools. This is especially true for LGBTQIA + patients with intersecting historically marginalized identities, such as people of color and people with disabilities. Learning from and listening to medically underserved community members can help both medical students and educators better understand the unique health needs of these communities, and address implicit biases to improve health care and outcomes for their patients. Intervention: To address the lack of LGBTQIA + health-related content in medical education and improve access to and knowledge about LGBTQIA + patients, LGBTQIA + community members' perspectives and lived experiences were integrated into undergraduate medical education via four primary methods: Community Advisory Groups, community panel events, standardized patients, and community member interviews. Context: LGBTQIA + community members' perspectives and lived experiences were integrated into medical education at Harvard Medical School (HMS) as part of the HMS Sexual and Gender Minority Health Equity Initiative. Impact: LGBTQIA + community members' perspectives and lived experiences were successfully integrated into multiple aspects of medical education at HMS. During this process, we navigated challenges in the following areas that can inform similar efforts at other institutions: representation of diverse identities and experiences, meeting and scheduling logistics, structural barriers in institutional processes, and implementation of community member recommendations. Lessons Learned: Based on our experiences, we offer recommendations for integrating LGBTQIA + community members' perspectives into medical education. Engaging community members and integrating their perspectives into medical education will better enable medical educators at all institutions to teach students about the health care needs of LGBTQIA + communities, and better prepare medical students to provide affirming and effective care to their future patients, particularly those who are LGBTQIA+.

Gender and Racial/Ethnic Disparities in Undergraduate and Graduate Students' Mental Health and Treatment Use Amid the COVID-19 Pandemic.

The COVID-19 pandemic has negatively impacted numerous people?s mental health and created new barriers to services. To address the unknown effects of the pandemic on accessibility and equality issues in mental health care, this study aimed to investigate gender and racial/ethnic disparities in mental health and treatment use in undergraduate and graduate students amid the COVID-19 pandemic. The study was conducted based on a largescale online survey (N = 1,415) administered during the weeks following a pandemic-related university-wide campus closure in March 2020. We focused on the gender and racial disparities in current internalizing symptomatology and treatment use. Our results showed that in the initial period of the pandemic, students identified as cis women (p < .001), non-binary/genderqueer (p < .001), or Hispanic/Latinx (p = .002) reported higher internalizing problem severity (aggregated from depression, generalized anxiety, intolerance of uncertainty, and COVID-19-related stress symptoms) compared to their privileged counterparts. Additionally, Asian (p < .001) and multiracial students (p = .002) reported less treatment use than White students while controlling for internalizing problem severity. Further, internalizing problem severity was associated with increased treatment use only in cisgender, non-Hispanic/Latinx White students (pcis man = 0.040, pcis woman < 0.001). However, this relationship was negative in cis-gender Asian students (pcis man = 0.025, pcis woman = 0.016) and nonsignificant in other marginalized demographic groups. The findings revealed unique mental health challenges faced by different demographic groups and served as a call that specific actions to enhance mental health equity, such as continued mental health support for students with marginalized gender identities, additional COVID-related mental and practical support for Hispanic/Latinx students and promotion of mental health awareness, access, and trust in non-White, especially Asian, students are desperately needed.

Increases in depression and anxiety symptoms in adolescents and young adults during the COVID-19 pandemic.

BACKGROUND: The coronavirus [coronavirus disease 2019 (COVID-19)] pandemic has introduced extraordinary life changes and stress, particularly in adolescents and young adults. Initial reports suggest that depression and anxiety are elevated during COVID-19, but no prior study has explored changes at the within-person level. The current study explored changes in depression and anxiety symptoms from before the pandemic to soon after it first peaked in Spring 2020 in a sample of adolescents and young adults (N = 451) living in Long Island, New York, an early epicenter of COVID-19 in the U.S. METHODS: Depression (Children's Depression Inventory) and anxiety symptoms (Screen for Child Anxiety Related Symptoms) were assessed between December 2014 and July 2019, and, along with COVID-19 experiences, symptoms were re-assessed between March 27th and May 15th, 2020. RESULTS: Across participants and independent of age, there were increased generalized anxiety and social anxiety symptoms. In females, there were also increased depression and panic/somatic symptoms. Multivariable linear regression indicated that greater COVID-19 school concerns were uniquely associated with increased depression symptoms. Greater COVID-19 home confinement concerns were uniquely associated with increased generalized anxiety symptoms, and decreased social anxiety symptoms, respectively. CONCLUSIONS: Adolescents and young adults at an early epicenter of the COVID-19 pandemic in the U.S. experienced increased depression and anxiety symptoms, particularly amongst females. School and home confinement concerns related to the pandemic were independently associated with changes in symptoms. Overall, this report suggests that the COVID-19 pandemic is having multifarious adverse effects on the mental health of youth.

The Hierarchical Taxonomy of Psychopathology (HiTOP) in psychiatric practice and research.

The Hierarchical Taxonomy of Psychopathology (HiTOP) has emerged out of the quantitative approach to psychiatric nosology. This approach identifies psychopathology constructs based on patterns of co-variation among signs and symptoms. The initial HiTOP model, which was published in 2017, is based on a large literature that spans decades of research. HiTOP is a living model that undergoes revision as new data become available. Here we discuss advantages and practical considerations of using this system in psychiatric practice and research. We especially highlight limitations of HiTOP and ongoing efforts to address them. We describe differences and similarities between HiTOP and existing diagnostic systems. Next, we review the types of evidence that informed development of HiTOP, including populations in which it has been studied and data on its validity. The paper also describes how HiTOP can facilitate research on genetic and environmental causes of psychopathology as well as the search for neurobiologic mechanisms and novel treatments. Furthermore, we consider implications for public health programs and prevention of mental disorders. We also review data on clinical utility and illustrate clinical application of HiTOP. Importantly, the model is based on measures and practices that are already used widely in clinical settings. HiTOP offers a way to organize and formalize these techniques. This model already can contribute to progress in psychiatry and complement traditional nosologies. Moreover, HiTOP seeks to facilitate research on linkages between phenotypes and biological processes, which may enable construction of a system that encompasses both biomarkers and precise clinical description.

Prioritizing COVID-19 Contact Tracing During a Surge Using Chatbot Technology.

When COVID-19 cases surge, identifying ways to improve the efficiency of contact tracing and prioritize vulnerable communities for isolation and quarantine support services is critical. During a fall 2020 COVID-19 resurgence in San Francisco, California, prioritization of telephone-based case investigation by zip code and using a chatbot to screen for case participants who needed isolation support reduced the number of case participants who would have been assigned for a telephone interview by 31.5% and likely contributed to 87.5% of Latinx case participants being successfully interviewed. (Am J Public Health. 2022;112(1):43-47. https://doi.org/10.2105/AJPH.2021.306563).

Current trends in biopharmaceuticals production in Escherichia coli.

Since the manufacture of the first biotech product for a fledgling biopharmaceutical industry in 1982, Escherichia coli, has played an important role in the industrial production of recombinant proteins. It is now 40 years since the introduction of Humulin® for the treatment of diabetes. E. coli remains an important production host, its use as a cell factory is well established and it has become the most popular expression platform particularly for non-glycosylated therapeutic proteins. A number of significant inherent obstacles in the use of prokaryotic expression systems to produce biologics has always restricted production. These include codon usage, the absence of post-translational modifications and proteolytic processing at the cell envelope. In this review, we reflect on the contribution that this model organism has made in the production of new biotech products for human medicine. This will include new advancements in the E. coli expression system to meet the biotechnology industry requirements, such as novel engineered strains to glycosylate heterologous proteins, add disulphide bonds and express complex proteins. The biopharmaceutical market is growing rapidly, with two production systems competing for market dominance: mammalian cells and microorganisms. In the past 10 years, with increased growth of antibody-based therapies, mammalian hosts particularly CHO cells have dominated. However, with new antibody like scaffolds and mimetics emerging as future proteins of interest, E. coli has again the opportunity to be the selected as the production system of choice.

SARS-CoV-2 Testing and Patient Waiting Times in the Emergency Department.

Aim Emergency Departments (EDs) were impacted early in the coronavirus disease 2019 (COVID-19) pandemic, with high attendance numbers. EDs relied upon SARS-CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR) tests to triage patients and facilitate admission to appropriate wards, meaning positive patients were isolated as early as possible. In October 2020, we introduced a 24-hour SARS-CoV-2 testing service. We examined the impact of this on patient experience times (PETs) in the ED, and on healthcare-associated (HA) COVID-19 infections. Methods Data on PETs before and after the introduction of 24-hour testing were available from the ED. HA COVID-19 infections were reported weekly to the Health Services Executive as a key performance indicator. Results Mean PET prior to the pandemic was 20 hours and dropped to 10 and 13 hours respectively in the first and second wave. A surge in case numbers and ED attendances during the third wave was not reflected in a rise in PETs, with a mean PET of 11 hours, significantly below pre-pandemic levels. HA-COVID-19 infections remained stable between wave one and three (83 v 92). Conclusion The introduction of 24-hour SARS-CoV-2 testing in our ED contributed to a reduction in PETs, facilitated appropriate patient placement at ward level, and kept HA-COVID-19 infections at acceptably low levels.

Neural Response to Rewards, Stress and Sleep Interact to Prospectively Predict Depressive Symptoms in Adolescent Girls.

Blunted reward processing both characterizes major depressive disorder and predicts increases in depressive symptoms. However, little is known about the interaction between blunted reward processing and other risk factors in relation to increases in depressive symptoms. Stressful life events and sleep problems are prominent risk factors that contribute to the etiopathogenesis of depression and have been linked to reward dysfunction; these factors may interact with reward dysfunction to predict increased depressive symptoms. In a large sample of 8- to 14-year-old adolescent girls, the current study examined how blunted reward processing, stressful life events, and sleep problems at baseline interacted to predict increases in depressive symptoms 1 year later. Reward processing was indexed by the reward positivity (RewP), an event-related potential elicited during a simple monetary reward paradigm (i.e., Doors task). Two-way interactions confirmed that a blunted RewP predicted increased depressive symptoms at (a) high levels of stress but not average or low levels of stress, and (b) high and average levels of sleep problems but not low levels of sleep problems. Finally, a 3-way interaction confirmed that a blunted RewP predicted increased depressive symptoms at high levels of stress and sleep problems but not average or low levels of stress and sleep problems. Thus, adolescents characterized by low reward response (i.e., blunted RewP) were at an increased risk of developing depressive symptoms if they experienced increased stressful life events or sleep problems; moreover, risk was greatest among adolescents characterized by all 3.

Reliability of reward- and error-related brain activity in early childhood.

Event-related potential (ERP) measures of reward- and error-related brain activity have emerged as potential biomarkers of risk for the development of psychopathology. However, the psychometric properties of reward- and error-related brain activity have been primarily investigated in adolescents and adults. It is critical to also establish the reliability of ERPs in younger children, particularly if they are used as individual difference measures of risk during key developmental periods. The present study examined the reliability of the reward positivity (RewP) and error-related negativity (ERN) among 80 children (Mage  = 6.9 years old; 50% female). Participants completed the doors, flanker, and go/no-go tasks twice, separated by approximately 8 months, while electroencephalography (EEG) was recorded. Results indicated that the RewP demonstrated strong internal consistency and test-retest reliability. The ERN also demonstrated strong internal consistency, but test-retest reliability was only significant for the ERN measured during the flanker task and not the go/no-go task. These results are largely consistent with reported psychometric properties of reward- and error related ERPs in adolescents and adults, suggesting that the ERN and RewP may be appropriate biomarkers of individual differences in populations ranging from early childhood to adulthood.