Identifying Person-Specific Drivers of Depression in Adolescents: Protocol for a Smartphone-Based Ecological Momentary Assessment and Passive Sensing Study.

BACKGROUND: Adolescence is marked by an increasing risk of depression and is an optimal window for prevention and early intervention. Personalizing interventions may be one way to maximize therapeutic benefit, especially given the marked heterogeneity in depressive presentations. However, empirical evidence that can guide personalized intervention for youth is lacking. Identifying person-specific symptom drivers during adolescence could improve outcomes by accounting for both developmental and individual differences. OBJECTIVE: This study leverages adolescents' everyday smartphone use to investigate person-specific drivers of depression and validate smartphone-based mobile sensing data against established ambulatory methods. We describe the methods of this study and provide an update on its status. After data collection is completed, we will address three specific aims: (1) identify idiographic drivers of dynamic variability in depressive symptoms, (2) test the validity of mobile sensing against ecological momentary assessment (EMA) and actigraphy for identifying these drivers, and (3) explore adolescent baseline characteristics as predictors of these drivers. METHODS: A total of 50 adolescents with elevated symptoms of depression will participate in 28 days of (1) smartphone-based EMA assessing depressive symptoms, processes, affect, and sleep; (2) mobile sensing of mobility, physical activity, sleep, natural language use in typed interpersonal communication, screen-on time, and call frequency and duration using the Effortless Assessment of Risk States smartphone app; and (3) wrist actigraphy of physical activity and sleep. Adolescents and caregivers will complete developmental and clinical measures at baseline, as well as user feedback interviews at follow-up. Idiographic, within-subject networks of EMA symptoms will be modeled to identify each adolescent's person-specific drivers of depression. Correlations among EMA, mobile sensor, and actigraph measures of sleep, physical, and social activity will be used to assess the validity of mobile sensing for identifying person-specific drivers. Data-driven analyses of mobile sensor variables predicting core depressive symptoms (self-reported mood and anhedonia) will also be used to assess the validity of mobile sensing for identifying drivers. Finally, between-subject baseline characteristics will be explored as predictors of person-specific drivers. RESULTS: As of October 2023, 84 families were screened as eligible, of whom 70% (n=59) provided informed consent and 46% (n=39) met all inclusion criteria after completing baseline assessment. Of the 39 included families, 85% (n=33) completed the 28-day smartphone and actigraph data collection period and follow-up study visit. CONCLUSIONS: This study leverages depressed adolescents' everyday smartphone use to identify person-specific drivers of adolescent depression and to assess the validity of mobile sensing for identifying these drivers. The findings are expected to offer novel insights into the structure and dynamics of depressive symptomatology during a sensitive period of development and to inform future development of a scalable, low-burden smartphone-based tool that can guide personalized treatment decisions for depressed adolescents. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43931.

What CBT Modules Work Best for Whom? Identifying Subgroups of Depressed Youths by Their Differential Response to Specific Modules.

Prior research suggests that the effects of specific cognitive-behavioral therapy (CBT) modules on symptom outcomes can be estimated. We conducted a study utilizing idiographic and nomothetic methods to clarify which CBT modules are most effective for youth depression, and for whom they are most effective. Thirty-five youths received modular CBT for depression. Interrupted time series models estimated whether the introduction of each module was associated with changes in internalizing symptoms, whereby significant symptom reduction would suggest a therapeutic response to the module. Regression models were used to explore whether participant characteristics predicted subgroups of youths based on their estimated response to certain types (e.g., cognitive) of modules, and whether group membership was associated with posttreatment outcomes. Thirty youths (86%) had at least one module associated with a significant change in internalizing symptoms from premodule delivery to postmodule delivery. The specific modules associated with these changes varied across youths. Behavioral activation was most frequently associated with symptom decreases (34% of youths). No participant characteristics predicted estimated response to module type, and group membership was not significantly associated with posttreatment outcomes. Youths display highly heterogeneous responses to treatment modules, indicating multiple pathways to symptom improvement for depressed youths.

Building an Infectious Disease Diversity, Equity, and Antiracism (ID2EA) Curriculum: A Single Center's Experience and Reflections.

In response to longstanding healthcare inequities unmasked by the Coronavirus Disease 2019 pandemic, the infectious diseases (ID) section at the Yale School of Medicine designed and implemented a pilot curriculum integrating Infectious Disease Diversity, Equity, and Antiracism (ID2EA) into ID educational training and measured program outcomes. We herein describe a mixed-methods assessment of section members on whether the ID2EA curriculum affected their beliefs and behaviors regarding racism and healthcare inequities. Participants rated the curriculum as useful (92% averaging across sessions) and effective in achieving stated learning objectives (89% averaging across sessions), including fostering understanding of how inequities and racism are linked to health disparities and identifying strategies to effectively deal with racism and inequities. Despite limitations in response rates and assessment of longer-term behavioral change, this work demonstrates that training in diversity, equity, and antiracism can be successfully integrated into ID physicians' educational activities and affect physicians' perspectives on these topics.

What Four Decades of Meta-Analysis Have Taught Us About Youth Psychotherapy and the Science of Research Synthesis.

Intervention scientists have published more than 600 randomized controlled trials (RCTs) of youth psychotherapies. Four decades of meta-analyses have been used to synthesize the RCT findings and identify scientifically and clinically significant patterns. These meta-analyses have limitations, noted herein, but they have advanced our understanding of youth psychotherapy, revealing (a) mental health problems for which our interventions are more and less successful (e.g., anxiety and depression, respectively); (b) the beneficial effects of single-session interventions, interventions delivered remotely, and interventions tested in low- and middle-income countries; (c) the association of societal sexism and racism with reduced treatment benefit in majority-girl and majority-Black groups; and, importantly, (d) the finding that average youth treatment benefit has not increased across five decades of research, suggesting that new strategies may be needed. Opportunities for the future include boosting relevance to policy and practice and using meta-analysis to identify mechanisms of change and guide personalizing of treatment.

Do specific modules of cognitive behavioral therapy for depression have measurable effects on youth internalizing symptoms? An idiographic analysis.

OBJECTIVE: Understanding the efficacy of each module of cognitive behavioral therapy (CBT) may inform efforts to improve outcomes for youth depression, but effects of specific modules have been difficult to examine. Idiographic interrupted time series models offer a robust way to estimate module effects on an individual's symptoms. This study examined the association of specific CBT modules for depression on internalizing symptoms among depressed youths who received modular CBT in a randomized trial. METHODS: Individual models were created for three youths who met study criteria. Youths completed weekly symptom reports, and clinicians completed records of modules delivered. First order auto-regressive models quantified the change in average internalizing symptom severity between pre- and post-module delivery. RESULTS: All youths had 1-3 modules that were significantly associated with symptom reduction and 1-3 modules associated with deterioration. The 5 modules associated with improvement in at least one youth also lacked association (engagement, relaxation, cognitive reframing), or were associated with worsening (activity selection, parent psychoeducation) in others. Seven modules showed no measurable benefit, or detriment to any youth. CONCLUSION: This study demonstrated that specific modules have measurable effects, but more work is needed to build an evidence base of specific module effects to inform treatment personalization for youth depression.

Step by step: How to perform a fluoroless cryoballoon ablation for atrial fibrillation.

INTRODUCTION: Pulmonary vein isolation is the cornerstone of ablation of atrial fibrillation. With widespread use of 3D Electroanatomic Mapping Systems and advances in intracardiac echo imaging, fluoroless ablation has been possible. METHODS: Fluoroless ablation with cryoballoon (CB), however, has not been widely performed because of the need to prove occlusion of the vein with contrast dye and fluoroscopy. RESULTS AND CONCLUSION: In this step-by-step guide, the authors will show how a CB ablation can be performed without the use of fluoroscopy.

Mapping associations between polygenic risks for childhood neuropsychiatric disorders, symptoms of attention deficit hyperactivity disorder, cognition, and the brain.

There are now large-scale data on which common genetic variants confer risk for attention deficit hyperactivity disorder (ADHD). Here, we use mediation analyses to explore how cognitive and neural features might explain the association between common variant (polygenic) risk for ADHD and its core symptoms. In total, 544 participants participated (mean 21 years, 212 (39%) with ADHD), most with cognitive assessments, neuroanatomic imaging, and imaging of white matter tract microstructure. We found that polygenic risk for ADHD was associated with symptoms of hyperactivity-impulsivity but not inattention. This association was mediated across multiple PRS thresholds by white matter microstructure, specifically by axial diffusivity of the right corona radiata, (maximum indirect effect ß = -0.034 (CI: -0.065 to -0.01), by thickness of the left dorsomedial prefrontal (ß = -0.029; CI: -0.061 to -0.0047) and area of the right lateral temporal cortex (ß = 0.024; CI: 0.0034-0.054). In addition, modest serial mediation was found, mapping a pathway from polygenic risk, to white matter microstructure of the anterior corona radiata, then cognition (working memory, focused attention), and finally to hyperactivity-impulsivity (working memory ß = -0.014 (CI: -0.038 to -0.0026); focused attention ß = -0.011 (CI: -0.033 to -0.0017). These mediation pathways were diagnostically specific and were not found for polygenic risk for ASD or schizophrenia. In conclusion, using a deeply phenotyped cohort, we delineate a pathway from polygenic risk for ADHD to hyperactive-impulsive symptoms through white matter microstructure, cortical anatomy, and cognition.

Development and outcomes of an immersive obesity summit workshop for medical resident and fellow education.

Physicians need better training to manage patients with obesity. Our study capitalized on the intimate nature of an extracurricular obesity workshop, creating an interactive educational programme. We assessed the short- and long-term impact of the workshop on trainees' knowledge, competence and confidence in caring for patients with obesity in an outpatient setting. This is a cross-sectional study, involving regionally diverse mix of resident and fellow physicians. A live 2.5-day continuing medical education summit was held 11 to 13 March 2016. Obesity-related topics were reviewed using state-of-the art pedagogical techniques. Pre-/post-levels of knowledge, competence and clinical practice strategies were analysed. Sixty-three candidates interested in additional obesity medicine training were nominated by US residency and fellowship programme directors and selected to attend the summit. On average, learners experienced a 110% relative increase in knowledge and competence. The overall effect size was 0.95, with participants being ~54% more knowledgeable about the management of patients with obesity. All participants self-reported that this activity increased their knowledge about the subject matter, improving their performance in caring for patients when asked about their practice in a follow-up survey 6 months following the workshop. This immersive summit promoted robust gains in knowledge and confidence, ultimately translating to reported practice improvements at the individual and health system levels. Future research is warranted on the sustainability of gained skills.

Supports: A Key Factor in Faculty Implementation of Evidence-Based Teaching.

Evidence-based teaching (EBT), such as active learning and formative assessment, benefits student learning but is not present in many college science classrooms. The choices faculty make about how to teach their science courses are influenced by their personal beliefs and motivations, as well as their departmental structures and institutional cultures. With data from 584 science, technology, engineering, and mathematics (STEM) faculty trained in EBT, we compare which of the following factors most relate to faculty's use of EBT: 1) faculty's personal motivations (e.g., teaching value, confidence, beliefs about intelligence); and 2) their experiences with their institutional teaching environments (e.g., departmental support, student enthusiasm). Faculty's perceived supports in their teaching environments (e.g., having supportive colleagues, being able to access curricular resources) were by far most predictive of their use of EBT. Faculty's personal motivations had little to no relationship when supports were included in these models. The effects were robust, even when controlling for faculty gender, minority status, and teaching experience. Much of the literature has focused on perceived barriers to EBT implementation (e.g., lack of time, constrained teaching space). The current data indicate that a focus on building supports for faculty may have the greatest impact on increasing the presence of EBT in college STEM courses.

Perceived supports and evidence-based teaching in college STEM.

BACKGROUND: Evidence-based teaching, such as active learning, is associated with increases in student learning and engagement. Although many faculty are beginning to adopt innovative practices, traditional lecture-based teaching tends to dominate college science education. What are the factors associated with faculty's decision to incorporate evidence-based teaching? While there are known barriers that limit adoption of evidence-based practices in science classrooms (e.g., lack of time, student resistance), the present work reveals that instructors' perceptions of supports (e.g., access to teaching resources, encouragement from colleagues) shows a stronger relationship to instructors' use of evidence-based teaching. RESULTS: These results come from a uniquely large dataset of college science faculty and instructors from across the USA (n = 584), who received training in evidence-based teaching. Multiple linear regression analyses of the relationship among perceived supports, barriers, and reported implementation of evidence-based practices showed that instructors report greater implementation when they perceive more social, personal, and resource supports even when barriers are also indicated as present. CONCLUSION: Faculty's perceived supports, not perceived barriers, are most strongly related to their reported implementation of evidence-based teaching. These findings suggest relevant stakeholders devote increased attention identifying and building the factors that promote evidence-based teaching in addition to reducing what inhibits it.

Trust, Growth Mindset, and Student Commitment to Active Learning in a College Science Course.

There is growing consensus regarding the effectiveness of active-learning pedagogies in college science courses. Less is known about ways that student-level factors contribute to positive outcomes in these contexts. The present study examines students' (N = 245) trust in the instructor-defined as perceptions of their instructor's understanding, acceptance, and care-and students' attitudes toward learning within an anatomy and physiology course featuring active learning. Analyses indicate that student trust of instructor and students' views of their own intelligence are both associated with student commitment to, and engagement in, active learning. Student-reported trust of the instructor corresponded to final grade, while students' views of their own intelligence did not. In an active-learning context in which students are more fully engaged in the learning process, student trust of the instructor was an important contributor to desired student outcomes.

Does Context Matter? Convergent and Divergent Findings in the Cross-Institutional Evaluation of Graduate Teaching Assistant Professional Development Programs.

Graduate teaching assistants (GTAs) play important instructional roles in introductory science courses, yet they often have little training in pedagogy. The most common form of teaching professional development (PD) for GTAs is a presemester workshop held at the course, department, or college level. In this study, we compare the effectiveness of presemester workshops at three northeastern research universities, each of which incorporated scientific teaching as the pedagogical content framework. The comparison of GTA PD program outcomes at three different institutions is intended to test theoretical assertions about the key role of contextual factors in GTA PD efficacy. Pretest and posttest surveys were used to assess changes in GTA teaching self-efficacy and anxiety following the workshops, and an objective test was used to assess pedagogical knowledge. Analysis of pretest/posttest data revealed statistically significant gains in GTA teaching self-efficacy and pedagogical knowledge and reductions in teaching anxiety across sites. Changes in teaching anxiety and self-efficacy, but not pedagogical knowledge, differed by training program. Student ratings of GTAs at two sites showed that students had positive perceptions of GTAs in all teaching dimensions, and relatively small differences in student ratings of GTAs were observed between institutions. Divergent findings for some outcome variables suggest that program efficacy was influenced as hypothesized by contextual factors such as GTA teaching experience.

Taking the Plunge: Next Steps in Engaged Learning: Project Kaleidoscope-Connecticut Conference of Independent Colleges Conference for Science Educators.

College and university science educators from across Connecticut gathered at Yale's West Campus in April 2010 for a Project Kaleidoscope (PKAL) program entitled "Taking the Plunge: Next Steps in Engaged Learning." Funded by the National Science Foundation (NSF) and co-sponsored by the Connecticut Conference of Independent Colleges (CCIC) and Yale's McDougal Graduate Teaching Center, the event was the latest in a PKAL series of one-day conferences aimed at equipping science, technology, engineering, and math (STEM) instructors with effective approaches to engaging students and training future scientists.