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1.
Phys Rev Lett ; 132(22): 220602, 2024 May 31.
Article in English | MEDLINE | ID: mdl-38877952

ABSTRACT

We show that universal parity quantum computing employing a recently introduced constant depth decoding procedure is equivalent to measurement-based quantum computation (MBQC) on a bipartite graph using only yz-plane measurements. We further show that any unitary MBQC using only yz-plane measurements must occur on a bipartite graph. These results have a number of consequences and open new research avenues for both frameworks.

2.
J Rheumatol ; 51(8): 759-764, 2024 Aug 01.
Article in English | MEDLINE | ID: mdl-38749564

ABSTRACT

OBJECTIVE: Telehealth has been proposed as a safe and effective alternative to in-person care for rheumatoid arthritis (RA). The purpose of this study was to evaluate factors associated with telehealth appropriateness in outpatient RA encounters. METHODS: A prospective cohort study (January 1, 2021, to August 31, 2021) was conducted using electronic health record data from outpatient RA encounters in a single academic rheumatology practice. Rheumatology providers rated the telehealth appropriateness of their own encounters using the Encounter Appropriateness Score for You (EASY) immediately following each encounter. Robust Poisson regression with generalized estimating equations modeling was used to evaluate the association of telehealth appropriateness with patient demographics, RA clinical characteristics, comorbid noninflammatory causes of joint pain, previous and current encounter characteristics, and provider characteristics. RESULTS: During the study period, 1823 outpatient encounters with 1177 unique patients with RA received an EASY score from 25 rheumatology providers. In the final multivariate model, factors associated with increased telehealth appropriateness included higher average provider preference for telehealth in prior encounters (relative risk [RR] 1.26, 95% CI 1.21-1.31), telehealth as the current encounter modality (RR 2.27, 95% CI 1.95-2.64), and increased patient age (RR 1.05, 95% CI 1.01-1.09). Factors associated with decreased telehealth appropriateness included moderate (RR 0.81, 95% CI 0.68-0.96) and high (RR 0.57, 95% CI 0.46-0.70) RA disease activity and if the previous encounters were conducted by telehealth (RR 0.83, 95% CI 0.73-0.95). CONCLUSION: In this study, telehealth appropriateness was most associated with provider preference, the current and previous encounter modality, and RA disease activity. Other factors like patient demographics, RA medications, and comorbid noninflammatory causes of joint pain were not associated with telehealth appropriateness.


Subject(s)
Arthritis, Rheumatoid , Telemedicine , Humans , Arthritis, Rheumatoid/therapy , Female , Male , Middle Aged , Prospective Studies , Aged , Adult , Outpatients , Rheumatology , Electronic Health Records , Ambulatory Care
3.
PLoS Genet ; 17(11): e1009881, 2021 11.
Article in English | MEDLINE | ID: mdl-34780472

ABSTRACT

Many tissue-specific stem cells maintain the ability to produce multiple cell types during long periods of non-division, or quiescence. FOXO transcription factors promote quiescence and stem cell maintenance, but the mechanisms by which FOXO proteins promote multipotency during quiescence are still emerging. The single FOXO ortholog in C. elegans, daf-16, promotes entry into a quiescent and stress-resistant larval stage called dauer in response to adverse environmental cues. During dauer, stem and progenitor cells maintain or re-establish multipotency to allow normal development to resume after dauer. We find that during dauer, daf-16/FOXO prevents epidermal stem cells (seam cells) from prematurely adopting differentiated, adult characteristics. In particular, dauer larvae that lack daf-16 misexpress collagens that are normally adult-enriched. Using col-19p::gfp as an adult cell fate marker, we find that all major daf-16 isoforms contribute to opposing col-19p::gfp expression during dauer. By contrast, daf-16(0) larvae that undergo non-dauer development do not misexpress col-19p::gfp. Adult cell fate and the timing of col-19p::gfp expression are regulated by the heterochronic gene network, including lin-41 and lin-29. lin-41 encodes an RNA-binding protein orthologous to LIN41/TRIM71 in mammals, and lin-29 encodes a conserved zinc finger transcription factor. In non-dauer development, lin-41 opposes adult cell fate by inhibiting the translation of lin-29, which directly activates col-19 transcription and promotes adult cell fate. We find that during dauer, lin-41 blocks col-19p::gfp expression, but surprisingly, lin-29 is not required in this context. Additionally, daf-16 promotes the expression of lin-41 in dauer larvae. The col-19p::gfp misexpression phenotype observed in dauer larvae with reduced daf-16 requires the downregulation of lin-41, but does not require lin-29. Taken together, this work demonstrates a novel role for daf-16/FOXO as a heterochronic gene that promotes expression of lin-41/TRIM71 to contribute to multipotent cell fate in a quiescent stem cell model.


Subject(s)
Caenorhabditis elegans Proteins/physiology , Caenorhabditis elegans/cytology , Cell Lineage , Forkhead Transcription Factors/physiology , Transcription Factors/physiology , Animals , Caenorhabditis elegans/growth & development , Caenorhabditis elegans Proteins/genetics , Collagen/metabolism , Forkhead Transcription Factors/genetics , Larva/cytology , Larva/metabolism , Transcription Factors/genetics
4.
Am J Otolaryngol ; 45(5): 104433, 2024.
Article in English | MEDLINE | ID: mdl-39067093

ABSTRACT

OBJECTIVE: This review summarizes the approaches to pediatric sialorrhea management from least-to-most invasive: non-pharmacological management, anticholinergic medications, botulinum neurotoxin, non-invasive surgery, and invasive surgical intervention. REVIEW METHODS: An electronic literature review identified English-language articles on sialorrhea management in pediatric patients. Publications between 1982 and 2022 were used, with a focus on articles published from 2012 to 2022. Additional augmentation of pharmacologic information was obtained from the latest editions of medical textbooks supplemented with official package inserts of investigated medications. CONCLUSIONS: Sialorrhea is abnormal in patients greater than four years of age. Severe cases warrant intervention to improve patient quality of life and reduce caregiver burden. Management starts with conservative approaches. Viable candidates begin with non-pharmacological management options. Anticholinergic medications can decrease saliva production, but adverse side effects may outweigh benefits. Botulinum neurotoxin injection of the salivary glands decreases salivary flow rate; however, relief is transient and thus multiple treatments are required. Non-invasive sclerotherapy is an emerging treatment option showing promising results for sialorrhea. In contrast, surgical intervention is reserved as a last-resort treatment for patients with severe symptoms, due to its higher risk for adverse consequences. IMPLICATIONS FOR PRACTICE: Physicians should be familiar with the different pediatric sialorrhea management options, including advantages and disadvantages, to adequately facilitate shared decision making with caretakers of pediatric patients who require treatment.


Subject(s)
Cholinergic Antagonists , Sialorrhea , Humans , Sialorrhea/therapy , Sialorrhea/etiology , Child , Cholinergic Antagonists/therapeutic use , Child, Preschool , Quality of Life , Salivary Glands , Female , Adolescent , Botulinum Toxins/therapeutic use , Botulinum Toxins/administration & dosage , Male
5.
Article in English | MEDLINE | ID: mdl-38206536

ABSTRACT

To understand how anxious parents' global psychopathology increases children's risks for depression and suicidality, we tested mediational pathways through which parent global psychopathology was associated with youth depression and suicidality over a six-year period. Parents (n = 136) who had an anxiety disorder at baseline reported global psychopathology and youth internalizing problems. Youth did not have any psychiatric disorder at baseline and they reported self-esteem, perceived control, and perceived parental warmth and rejection at baseline and 1-year follow-up. At 6-year follow-up, youth depression and suicidality were assessed via multiple reporters including the self, parent, and/or an independent evaluator. Results showed that parental psychopathology had an indirect but not direct effect on youth depression and suicidality via perceived control. No associations were found for the other hypothesized mediators. Perceived control might be a transdiagnostic intervention target in depression and suicide prevention programs for youth exposed to parental anxiety.

6.
J Clin Rheumatol ; 30(2): 46-51, 2024 Mar 01.
Article in English | MEDLINE | ID: mdl-38169348

ABSTRACT

OBJECTIVE: This study aims to explore the factors associated with rheumatology providers' perceptions of telehealth utility in real-world telehealth encounters. METHODS: From September 14, 2020 to January 31, 2021, 6 providers at an academic medical center rated their telehealth visits according to perceived utility in making treatment decisions using the following Telehealth Utility Score (TUS) (1 = very low utility to 5 = very high utility). Modified Poisson regression models were used to assess the association between TUS scores and encounter diagnoses, disease activity measures, and immunomodulatory therapy changes during the encounter. RESULTS: A total of 481 telehealth encounters were examined, of which 191 (39.7%) were rated as "low telehealth utility" (TUS 1-3) and 290 (60.3%) were rated as "high telehealth utility" (TUS 4-5). Encounters with a diagnosis of inflammatory arthritis were significantly less likely to be rated as high telehealth utility (adjusted relative risk [aRR], 0.8061; p = 0.004), especially in those with a concurrent noninflammatory musculoskeletal diagnosis (aRR, 0.54; p = 0.006). Other factors significantly associated with low telehealth utility included higher disease activity according to current and prior RAPID3 scores (aRR, 0.87 and aRR, 0.89, respectively; p < 0.001) and provider global scores (aRR, 0.83; p < 0.001), as well as an increase in immunomodulatory therapy (aRR, 0.70; p = 0.015). CONCLUSIONS: Provider perceptions of telehealth utility in real-world encounters are significantly associated with patient diagnoses, current and prior disease activity, and the need for changes in immunomodulatory therapy. These findings inform efforts to optimize the appropriate utilization of telehealth in rheumatology.


Subject(s)
Arthritis , Rheumatology , Telemedicine , Humans , Outpatients , Academic Medical Centers
7.
Dev Med Child Neurol ; 2023 Oct 02.
Article in English | MEDLINE | ID: mdl-37786292

ABSTRACT

AIM: To systematically review the effectiveness of caregiver and parent skills training programs, including caregiver-mediated interventions, for caregivers of individuals with neurodevelopmental disorders. METHOD: We conducted a systematic review with a random-effects meta-analysis. We searched 11 electronic databases through July 2021 and used a snowball methodology to locate relevant articles of randomized controlled trials. Effect size estimates were pooled using Hedges' g from data extracted from study reports and through author requests using random-effects meta-analyses for three child outcome categories (child development, adaptive behavior, and problem behavior) and three caregiver outcome categories (parenting skills and knowledge, psychological well-being, and interpersonal family relations). RESULTS: We located 44 910 records, from which 75 randomized controlled trials involving 4746 individuals with neurodevelopmental disorders and their caregivers were included. Random-effects meta-analyses showed improvements in child development (g = 0.30; 99% confidence interval [CI] = 0.07-0.53) and reduction in reported problem behaviors (g = 0.41; 99% CI = 0.24-0.59), but not a statistically significant improvement in adaptive behavior (g = 0.28; 99% CI = -0.42 to 0.98). Caregivers showed improvements in parenting skills and knowledge (g = 0.72; 99% CI = 0.53-0.90), psychological well-being (g = 0.52; 99% CI = 0.34-0.71), and interpersonal family relations (g = 0.76; 99% CI = 0.32-1.20). INTERPRETATION: Caregiver skills training programs benefit both caregivers and children with neurodevelopmental disorders. Skills training programs improve child development and behavior, improve parenting skills, reduce caregiver mental health issues, and improve family functioning. Programs using culturally appropriate training material to improve the development, functioning, and participation of children within families and communities should be considered when caring for children with neurodevelopmental disorders.

8.
Clin Exp Rheumatol ; 40(9): 1754-1761, 2022 Sep.
Article in English | MEDLINE | ID: mdl-35084303

ABSTRACT

OBJECTIVES: Many studies have found that moderate alcohol consumption is associated with lower risks of mortality and myocardial infarction (MI). Our aim was to examine the potential effects of alcohol on all-cause mortality and MI in rheumatoid arthritis (RA), a risk factor condition. METHODS: A cohort study (1995-2017) was conducted using medical records of RA patients from The Health Improvement Network in the United Kingdom (UK). Alcohol exposure was divided into non-drinkers, mild (1-7 UK units/week), moderate (8-14 UK units/week), moderate-high (15-21 UK units/week), and high (>21 UK units/week) consumption levels. We calculated hazard ratios (HRs) for the relation of alcohol consumption to all-cause mortality and MI, adjusting for covariates. RESULTS: Of 30,320 RA patients, 5,994 deaths and 1,098 MI cases occurred over 236,188 person-years. Mild-to-moderate alcohol use was associated with lower all-cause mortality in RA patients, including those taking methotrexate. The multivariable HRs (95% CI) for mortality by alcohol use category were non-drinkers 1.0, mild 0.80 (0.75-0.85), moderate 0.74 (0.67-0.82), moderate-high 0.84 (0.72-0.98), and high 0.99 (0.86-1.15). Mild, moderate-high, and high levels of alcohol use were associated with lower risk of MI among RA patients. The HRs MI risk by alcohol use category were non-drinkers 1.0, mild 0.81 (0.70-0.94), moderate 0.84 (0.68-1.04), moderate-high 0.51 (0.35-0.74), and high 0.59 (0.42-0.84). CONCLUSIONS: These findings suggest that mild-to-moderate alcohol use is associated with a lower mortality risk and overall alcohol use is associated with a lower MI risk in RA patients, similar to the general population.


Subject(s)
Arthritis, Rheumatoid , Myocardial Infarction , Alcohol Drinking/adverse effects , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , Cohort Studies , Humans , Methotrexate , Risk Factors
9.
J Med Genet ; 58(6): 392-399, 2021 06.
Article in English | MEDLINE | ID: mdl-32591342

ABSTRACT

BACKGROUND: Height and other anthropometric measures are consistently found to associate with differential cancer risk. However, both genetic and mechanistic insights into these epidemiological associations are notably lacking. Conversely, inherited genetic variants in tumour suppressors and oncogenes increase cancer risk, but little is known about their influence on anthropometric traits. METHODS: By integrating inherited and somatic cancer genetic data from the Genome-Wide Association Study Catalog, expression Quantitative Trait Loci databases and the Cancer Gene Census, we identify SNPs that associate with different cancer types and differential gene expression in at least one tissue type, and explore the potential pleiotropic associations of these SNPs with anthropometric traits through SNP-wise association in a cohort of 500,000 individuals. RESULTS: We identify three regulatory SNPs for three important cancer genes, FANCA, MAP3K1 and TP53 that associate with both anthropometric traits and cancer risk. Of particular interest, we identify a previously unrecognised strong association between the rs78378222[C] SNP in the 3' untranslated region (3'-UTR) of TP53 and both increased risk for developing non-melanomatous skin cancer (OR=1.36 (95% 1.31 to 1.41), adjusted p=7.62E-63), brain malignancy (OR=3.12 (2.22 to 4.37), adjusted p=1.43E-12) and increased standing height (adjusted p=2.18E-24, beta=0.073±0.007), lean body mass (adjusted p=8.34E-37, beta=0.073±0.005) and basal metabolic rate (adjusted p=1.13E-31, beta=0.076±0.006), thus offering a novel genetic link between these anthropometric traits and cancer risk. CONCLUSION: Our results clearly demonstrate that heritable variants in key cancer genes can associate with both differential cancer risk and anthropometric traits in the general population, thereby lending support for a genetic basis for linking these human phenotypes.


Subject(s)
Body Weights and Measures , Neoplasms/genetics , Oncogenes , Polymorphism, Single Nucleotide , Adult , Aged , Anthropometry , Cohort Studies , Female , Genetic Linkage , Genetic Pleiotropy , Genetic Predisposition to Disease , Genome-Wide Association Study , Humans , Male , Middle Aged , Quantitative Trait Loci , Quantitative Trait, Heritable , Risk Assessment
10.
J Clin Child Adolesc Psychol ; 50(2): 187-201, 2021.
Article in English | MEDLINE | ID: mdl-31609666

ABSTRACT

Emerging adulthood is a period of heightened risk for young people with autism spectrum disorder (ASD). Due in part to a lack of evidence-based services and supports during the transition to adulthood, many emerging adults fail to matriculate into postsecondary education or thrive in productive employment. The Stepped Transition in Education Program for Students with ASD (STEPS) was developed to address the psychosocial, transition-related needs of emerging adults with ASD. Adolescents and emerging adults (n = 59) with ASD were randomly assigned to either STEPS or transition as usual (TAU). Results indicate that STEPS is acceptable to young people with ASD and their parents and that it can be implemented with high fidelity. Among secondary school students, those who completed STEPS exhibited significantly greater gains in transition readiness from high school, and these gains were largely sustained after program completion. Among students enrolled in postsecondary education, STEPS resulted in increased levels of student adaptation to college relative to those in TAU. Programming to address ASD-related challenges can promote successful educational transitions.


Subject(s)
Autism Spectrum Disorder , Students/psychology , Transition to Adult Care , Adolescent , Autistic Disorder , Female , Humans , Male , Universities , Young Adult
11.
J Clin Child Adolesc Psychol ; 48(3): 393-399, 2019.
Article in English | MEDLINE | ID: mdl-28715237

ABSTRACT

As reported prevalence and public awareness of Autism Spectrum Disorder (ASD) have grown in recent years, clinicians will likely see increased referrals for suspected ASD. The current study sought to elucidate factors associated with referral for possible ASD, as well as diagnostic outcome among youth referred for suspected ASD. Youth referred for psychological evaluations at an outpatient clinic (N = 69, 6-18 years, 48 male) were categorized into four groups: referred for suspected ASD and diagnosed as such, referred for ASD and not diagnosed as such, not referred for ASD but diagnosed as such, and neither referred for nor diagnosed with ASD. Approximately half of cases referred for suspected ASD did not meet diagnostic criteria. A significant effect of group was found for cognitive ability and anxiety. Youth receiving ASD diagnoses, regardless of whether they were referred for suspected ASD, demonstrated lower cognitive ability than children not receiving ASD diagnoses. Youth neither referred for nor diagnosed with ASD demonstrated lower anxiety than those who were referred and diagnosed. Maternal education significantly differed among the four groups. Although group differences are seen for youth cognitive ability, anxiety, and maternal education, we found no clear indicators differentiating referrals that were "accurate" (i.e., those diagnosed with ASD) and those that were not (i.e., those who did not receive ASD diagnosis). Comorbidity was high in all groups, including those referred primarily for ASD assessment, underscoring the importance of comprehensive assessment regardless of specificity of the referral.


Subject(s)
Autism Spectrum Disorder/diagnosis , Adolescent , Autism Spectrum Disorder/psychology , Child , Child, Preschool , Female , Humans , Male , Referral and Consultation
12.
Curr Psychiatry Rep ; 20(10): 82, 2018 08 28.
Article in English | MEDLINE | ID: mdl-30155584

ABSTRACT

PURPOSE OF REVIEW: This synthesis of treatment research related to anxiety and depression in adolescents and adults with autism spectrum disorder (ASD) focuses on the scientific support for various forms of psychosocial interventions, useful adaptations to standard interventions, and engagement of candidate therapeutic mechanisms. RECENT FINDINGS: There is considerable evidence for the efficacy of cognitive-behavioral therapy (CBT) to treat co-occurring problems with anxiety, but there has been relatively little research on treatment of co-occurring depression. Multiple mechanisms of treatment effect have been proposed, but there has been little demonstration of target engagement via experimental therapeutics. Comorbidity between ASD and anxiety and/or mood problems is common. Although there is evidence for the use of CBT for anxiety, little work has addressed how to effectively treat depression. There is emerging support for alternative treatment approaches, such as mindfulness-based interventions. We encourage rigorous, collaborative approaches to identify and manipulate putative mechanisms of change.


Subject(s)
Anxiety Disorders/complications , Anxiety Disorders/therapy , Anxiety/therapy , Autism Spectrum Disorder/complications , Depression/therapy , Depressive Disorder/complications , Depressive Disorder/therapy , Adolescent , Adult , Anxiety/complications , Anxiety/psychology , Anxiety Disorders/psychology , Autism Spectrum Disorder/psychology , Cognitive Behavioral Therapy , Depression/complications , Depression/psychology , Depressive Disorder/psychology , Humans , Mindfulness
13.
Nature ; 465(7297): 450-3, 2010 May 27.
Article in English | MEDLINE | ID: mdl-20505722

ABSTRACT

The landscape of the north polar layered deposits of Mars (NPLD) is dominated by a pinwheel array of enigmatic spiral troughs. The troughs have intrigued planetary scientists since the Mariner 9 spacecraft returned the first close-up image in 1972, but conclusive evidence of their origin has remained elusive. Debate continues regarding all aspects of the troughs, including the possibility that they have migrated, their age in relation to the current NPLD surface, and whether they are fundamentally erosional or constructional features. The troughs are probably related to climatic processes, yet the nature of this relationship has remained a mystery. Previous data characterizing only the exposed NLPD surface were insufficient to test these hypotheses. Here we show that the central spiral troughs initiated after deposition of three-quarters of the NPLD, quickly reached a stable morphology and migrated approximately 65 kilometres poleward and 600 metres in altitude over the past two million years or so. Our radar stratigraphy rules out hypotheses of erosional incision post-dating deposition, and instead largely validates an early hypothesis for constructional trough migration with wind transport and atmospheric deposition as dominant processes. These results provide hard constraints for palaeo-climate models and a new context for evaluating imagery, spectral data, and now radar sounding data, the better to understand the link between orbital parameters and climate, the role of climate in shaping the polar ice of Mars, and eventually, the age of the polar deposits themselves.

14.
Psychol Sci ; 25(1): 95-102, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24166855

ABSTRACT

Are people more moral in the morning than in the afternoon? We propose that the normal, unremarkable experiences associated with everyday living can deplete one's capacity to resist moral temptations. In a series of four experiments, both undergraduate students and a sample of U.S. adults engaged in less unethical behavior (e.g., less lying and cheating) on tasks performed in the morning than on the same tasks performed in the afternoon. This morning morality effect was mediated by decreases in moral awareness and self-control in the afternoon. Furthermore, the effect of time of day on unethical behavior was found to be stronger for people with a lower propensity to morally disengage. These findings highlight a simple yet pervasive factor (i.e., the time of day) that has important implications for moral behavior.


Subject(s)
Deception , Morals , Adult , Female , Humans , Male , Time Factors , Young Adult
15.
Psychol Sci ; 25(8): 1554-62, 2014 Aug.
Article in English | MEDLINE | ID: mdl-24919511

ABSTRACT

Throughout history, principles such as obedience, loyalty, and purity have been instrumental in binding people together and helping them thrive as groups, tribes, and nations. However, these same principles have also led to in-group favoritism, war, and even genocide. Does adhering to the binding moral foundations that underlie such principles unavoidably lead to the derogation of out-group members? We demonstrated that for people with a strong moral identity, the answer is "no," because they are more likely than those with a weak moral identity to extend moral concern to people belonging to a perceived out-group. Across three studies, strongly endorsing the binding moral foundations indeed predicted support for the torture of out-group members (Studies 1a and 1b) and withholding of necessary help from out-group members (Study 2), but this relationship was attenuated among participants who also had a strong moral identity.


Subject(s)
Cooperative Behavior , Culture , Group Processes , Interpersonal Relations , Morals , Social Identification , Adult , Female , Humans , Male , Young Adult
16.
Hand Clin ; 40(2): 189-198, 2024 05.
Article in English | MEDLINE | ID: mdl-38553090

ABSTRACT

The profunda artery perforator (PAP) flap provides a good option for hand and upper extremity reconstruction. The reliable quality, caliber, and number of perforators in the posteromedial thigh support large flaps with long pedicles. The PAP flap has been widely used for breast reconstruction, although its use in the extremities has been slower to catch on due to the bulk and thickness of the subcutaneous tissue. The authors discuss evolution of thin flaps and our application of the thin and superthin PAP flap for upper extremity reconstruction.


Subject(s)
Mammaplasty , Perforator Flap , Humans , Perforator Flap/blood supply , Arteries/surgery , Upper Extremity/surgery , Hand/surgery , Retrospective Studies
17.
Arthritis Care Res (Hoboken) ; 76(1): 63-71, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37781782

ABSTRACT

OBJECTIVE: We aimed to develop a decision-making tool to predict telehealth appropriateness for future rheumatology visits and expand telehealth care access. METHODS: The model was developed using the Encounter Appropriateness Score for You (EASY) and electronic health record data at a single academic rheumatology practice from January 1, 2021, to December 31, 2021. The EASY model is a logistic regression model that includes encounter characteristics, patient sociodemographic and clinical characteristics, and provider characteristics. The goal of pilot implementation was to determine if model recommendations align with provider preferences and influence telehealth scheduling. Four providers were presented with future encounters that the model identified as candidates for a change in encounter modality (true changes), along with an equal number of artificial (false) recommendations. Providers and patients could accept or reject proposed changes. RESULTS: The model performs well, with an area under the curve from 0.831 to 0.855 in 21,679 encounters across multiple validation sets. Covariates that contributed most to model performance were provider preference for and frequency of telehealth encounters. Other significant contributors included encounter characteristics (current scheduled encounter modality) and patient factors (age, Routine Assessment of Patient Index Data 3 scores, diagnoses, and medications). The pilot included 201 encounters. Providers were more likely to agree with true versus artificial recommendations (Cohen's κ = 0.45, P < 0.001), and the model increased the number of appropriate telehealth visits. CONCLUSION: The EASY model accurately identifies future visits that are appropriate for telehealth. This tool can support shared decision-making between patients and providers in deciding the most appropriate follow-up encounter modality.


Subject(s)
Rheumatology , Telemedicine , Humans , Pandemics
18.
Article in English | MEDLINE | ID: mdl-36741741

ABSTRACT

Background: Adolescents and young adults with autism spectrum disorder (ASD) are prone to experience co-occurring mental health conditions such as mood or anxiety disorders, as well as impairments in emotion regulation and executive functioning. However, little research has examined inter-relationships among these constructs, despite evidence of additional stressors and increased risk of internalizing disorders at this age, relative to non-autistic individuals. If either emotion regulation or executive functioning are shown to have patterns of association with mental health, this can inform mechanism-based intervention. Method: Fifty-seven autistic adolescents and adults (16-25 years) with ASD in a transition intervention completed questionnaires and clinician-administered measures at baseline. Analyses assessed whether executive functioning impairment, above and beyond emotion regulation impairment, were associated with depression and anxiety symptoms. Results: ASD characteristics, emotion regulation, anxiety, and depression were significantly correlated. ASD characteristics was a significant contributor to depression and emotion regulation impairments were significant contributors to anxiety and depression. Findings indicated that inhibition difficulties did not uniquely contribute to depression or anxiety above emotion regulation impairment. Difficulties in cognitive flexibility were associated with depression above and beyond ASD characteristics, IQ, and emotion regulation, but not associated with anxiety. Conclusions: Although preliminary, findings suggest that inflexibility and regulatory impairment should be considered in depression remediation approaches. Improving ER, on the other hand, may have broader transdiagnostic impact across both mood and anxiety symptoms in ASD.

19.
Anxiety Stress Coping ; 36(3): 304-319, 2023 05.
Article in English | MEDLINE | ID: mdl-35576123

ABSTRACT

INTRODUCTION: Stress generation suggests a reciprocal relationship between depression and prospective stressful life events. However, the applicability of stress generation to anxiety disorders has been understudied, particularly among youth. We address this gap by examining stress generation in youth at high-risk of developing anxiety disorders. METHODS: Participants were one-hundred thirty-six at-risk youth (M age = 8.69, 84.6% Caucasian; 55.9% female), each of whom had a parent with an anxiety disorder. We examined the role of an anxiety disorder diagnosis, anxiety symptoms, and cognitive distortions in youth's prospective one and six-year stressful life events (i.e., stress generation). RESULTS: Anxiety symptoms and cognitive distortions were significant predictors of one-year total dependent stress. Anxiety diagnosis and anxiety symptoms were significant predictors of one-year dependent interpersonal stress. Anxiety diagnosis and anxiety symptoms were significant predictors of six-year independent stress. CONCLUSION: Support for the stress generation model was found in high-risk youth, but only over a one-year period. This suggests important effects of anxiety and cognitive distortions on stress generation, though their implications might be time-capped.


Subject(s)
Anxiety , Depression , Humans , Female , Adolescent , Male , Prospective Studies , Depression/psychology , Anxiety/psychology , Anxiety Disorders , Cognition
20.
Drug Saf ; 46(3): 309-318, 2023 03.
Article in English | MEDLINE | ID: mdl-36826707

ABSTRACT

INTRODUCTION: Detection of adverse reactions to drugs and biologic agents is an important component of regulatory approval and post-market safety evaluation. Real-world data, including insurance claims and electronic health records data, are increasingly used for the evaluation of potential safety outcomes; however, there are different types of data elements available within these data resources, impacting the development and performance of computable phenotypes for the identification of adverse events (AEs) associated with a given therapy. OBJECTIVE: To evaluate the utility of different types of data elements to the performance of computable phenotypes for AEs. METHODS: We used intravenous immunoglobulin (IVIG) as a model therapeutic agent and conducted a single-center, retrospective study of 3897 individuals who had at least one IVIG administration between 1 January 2014 and 31 December 2019. We identified the potential occurrence of four different AEs, including two proximal AEs (anaphylaxis and heart rate alterations) and two distal AEs (thrombosis and hemolysis). We considered three different computable phenotypes: (1) an International Classification of Disease (ICD)-based phenotype; (2) a phenotype-based on EHR-derived contextual information based on structured data elements, including laboratory values, medication administrations, or vital signs; and (3) a compound phenotype that required both an ICD code for the AE in combination with additional EHR-derived structured data elements. We evaluated the performance of each of these computable phenotypes compared with chart review-based identification of AEs, assessing the positive predictive value (PPV), specificity, and estimated sensitivity of each computable phenotype method. RESULTS: Compound computable phenotypes had a high positive predictive value for acute AEs such as anaphylaxis and bradycardia or tachycardia; however, few patients had both ICD codes and the relevant contextual data, which decreased the sensitivity of these computable phenotypes. In contrast, computable phenotypes for distal AEs (i.e., thrombotic events or hemolysis) frequently had ICD codes for these conditions in the absence of an AE due to a prior history of such events, suggesting that patient medical history of AEs negatively impacted the PPV of computable phenotypes based on ICD codes. CONCLUSIONS: These data provide evidence for the utility of different structured data elements in computable phenotypes for AEs. Such computable phenotypes can be used across different data sources for the detection of infusion-related adverse events.


Subject(s)
Anaphylaxis , Immunoglobulins, Intravenous , Humans , Immunoglobulins, Intravenous/adverse effects , Retrospective Studies , Electronic Health Records , Hemolysis , Phenotype , Algorithms
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