A longitudinal investigation of parenting, depression, and counseling use among Asian American adolescents.

INTRODUCTION: Asian American adolescents are equally or more likely to experience depression but less likely to seek treatment for depression than adolescents from other racial and ethnic groups in the US. The current study examined the long-term effects of parental care, parental control, and parental closeness on depression and counseling use among Asian American adolescents. METHODS: Using data from the National Longitudinal Study of Adolescent Health (Add Health), we conducted a cross-lagged path analysis with 270 Asian American adolescents (48.1% female; 51.9% male). The study used data from Waves I, II, and III (1994-2002) with participants' mean ages ranging from 14 to 23. RESULTS: Findings indicated that the cross-sectional relationships between parenting characteristics and depression were stronger than the longitudinal relationships suggesting that parenting practices may be a stronger proximal, rather than distal, predictor of depression. Specifically, parental closeness was associated with less depression in early and mid-adolescence (age 12-18), but the relationship changed direction in young adulthood (age 18-26). Additionally, a significant interaction suggested that parental care was related to fewer depressive symptoms for those who reported high, compared to low, parental control in mid-adolescence (age 14-18). Furthermore, high parental care was associated with more counseling use at high levels of control. However, high parental care was associated with less counseling use at low levels of parental control in early adolescence. CONCLUSION: These results highlight the importance of understanding parenting characteristics using longitudinal designs when examining the development of depression and help-seeking behaviors among Asian American adolescents.

A chart-based test of contrast sensitivity in noise: reference ranges, effects of age and optical abnormality.

CLINICAL RELEVANCE: Contrast sensitivity plays an important role in the comprehensive assessment of visual function; however, measurement with standard eye charts can be affected by age and optical abnormality. BACKGROUND: This study describes a novel chart-based test of letter contrast sensitivity (CS) in luminance noise (the Illinois Eye and Ear Noise CS test), defines normal reference ranges, estimates test-retest repeatability, and assesses the effects of age and simulated optical abnormalities. METHODS: Seventy-five individuals with normal visual function (age 18-85 years) participated. Subjects identified letter optotypes that spanned a broad contrast range (0.9% to 59.6%) printed in a book-based test. Letters were presented against a grey background (no-noise condition) and in luminance noise that consisted of light and dark checks (noise condition). A subset of 10 subjects repeated the test to define short-term variability and performed the test under three additional conditions: simulated cataract, +2.00D defocus, and low room illuminance. RESULTS: In the no-noise condition, CS was independent of age (mean log CS of 1.74) until approximately 54 years, and declined for older subjects (CS loss of 0.1 log unit/decade). CS measured in noise was independent of age across the range of ages tested (mean log CS of 0.91). The 95% limits of agreement for test-retest repeatability was 0.19 log units. Simulated cataract, +2.00D defocus, and reduced illumination significantly reduced CS in the no-noise condition (F = 102.6, p < 0.001), whereas these optical manipulations did not significantly affect CS in noise (F = 2.58, p = 0.074). CONCLUSIONS: Measurements of CS in luminance noise may be valuable, as these measures are largely independent of age and certain forms of optical degradation. CS measurements in noise may provide useful insight into visual function in patients who have combined neural and optical abnormality, as noise minimises CS loss from optical defects.

Nudging for improving mental health treatment-seeking.

Underutilization of mental health services is a complex problem that requires the investigation of new strategies to facilitate treatment-seeking. Nudging is a relatively new approach which has shown promise in promoting healthy behaviors in a variety of domains, though little work has investigated how nudges may be applied to the initiation of mental health treatment. In this paper, we review the limited work examining nudging related to treatment initiation and discuss findings from a study evaluating the impact of nudges on treatment-seeking. Findings provide insights into the acceptability and efficacy of nudging as a strategy for increasing treatment, and implications for future work exploring this approach for improving treatment access are discussed.

Trustworthy High-Performance Multiplayer Games with Trust-but-Verify Protocol Sensor Validation.

Multiplayer online video games are a multibillion-dollar industry, to which widespread cheating presents a significant threat. Game designers compromise on game security to meet demanding performance targets, but reduced security increases the risk of potential malicious exploitation. To mitigate this risk, game developers implement alternative security sensors. The alternative sensors themselves become a liability due to their intrusive and taxing nature. Online multiplayer games with real-time gameplay are known to be difficult to secure due to the cascading exponential nature of many-many relationships among the components involved. Behavior-based security sensor schemes, or referees (a trusted third party), could be a potential solution but require frameworks to obtain the game state information they need. We describe our Trust-Verify Game Protocol (TVGP), which is a sensor protocol intended for low-trust environments and designed to provide game state information to help support behavior-based cheat-sensing detection schemes. We argue TVGP is an effective solution for applying an independent trusted referee capability to trust-lacking subdomains and demands high-performance requirements. Our experimental results validate high efficiency and performance standards for TVGP. We identify and discuss the operational domain assumptions of the TVGP validation testing presented here.

Direct Combat-related U.S. Army Aviation Injuries 2003-2014.

INTRODUCTION: The U.S. Army Aeromedical Research Laboratory (USAARL), a partner in the Joint Trauma Analysis for the Prevention of Injury in Combat (JTAPIC) partnership, conducted a series of retrospective reviews to investigate injuries sustained by occupants of U.S. Army rotary-wing aircraft involved in combat damage incidents. The reviews were conducted to provide occupant survivability information to the Aviation Survivability Development and Tactics team, an agency within the U.S. Army Aviation Center of Excellence. For these reviews, combat damage incidents that produced casualties were separated into direct events (i.e., events in which an enemy weapon system directly injured occupants) and indirect events (i.e., incidents in which occupants were injured as a result of a crash caused by the enemy weapon system). The previous USAARL reviews provided an overview of injuries sustained during direct and indirect events. The objective of this review was to conduct a detailed analysis of injuries occurring during direct events. MATERIALS AND METHODS: A descriptive retrospective review was conducted on injuries sustained by occupants of U.S. Army rotary-wing aircraft involved in combat damage incidents between 2003 and 2014. All Black Hawk, Apache, and Chinook combat aviation damage incidents for the study period were reviewed. Personnel casualty information from the Defense Casualty Information Processing System (DCIPS) was linked to combat damage incident information by matching the aircraft platform, incident date, and circumstantial information found in incident narratives. Injury information for personnel identified in DCIPS as being wounded in action was obtained from the JTAPIC partnership; injury data for personnel killed in action were retrieved from the Armed Forces Medical Examiner System. All injuries were coded using the Abbreviated Injury Scale (AIS). Descriptive statistics were used to describe the frequency and distribution of injuries to personnel involved in direct events. RESULTS: Overall, the extremities were the most commonly injured body regions, with lower extremities suffering more injuries than upper extremities. Penetrating injuries were identified as the primary injury mechanism for all body regions. Injuries to each AIS body region were predominantly of minor (AIS 1) and moderate (AIS 2) severity. CONCLUSIONS: Although injury severities were generally low (AIS 1 or AIS 2), the results of this effort indicate which body regions may benefit from additional protection during rotary-wing operations in hostile environments. The influence of occupant position within the aircraft and the use and effectiveness of personal protective equipment could not be effectively analyzed due to a lack of information.

Infra-Hisian Conduction Disturbance and Alternating Left Anterior/Posterior Fascicular Block.

We present an unusual case of alternating left anterior and left posterior fascicular block. Given the known risk for progression to complete atrioventricular block with alternating right bundle and left bundle branch block, we performed an electrophysiological study. Findings were consistent with infra-Hisian disease, and the patient underwent pacemaker implantation.

Comorbidity and Quality of Life in DSM-5 Social Anxiety Disorder Among a Nationally Representative Sample.

Objective: Social anxiety disorder (SAD) is a prevalent and debilitating psychiatric disorder that is associated with impairments in functioning and detrimental outcomes such as suicide, poor physical quality of life (QOL), and overall mental health. The goal of the present study was to examine the past year comorbidities of DSM-5 SAD among a large nationally representative sample of US adults (N = 36,309) and to examine correlates of physical QOL and overall mental health among individuals with past-year SAD (N = 980).Methods: The study utilized data from the National Epidemiologic Survey on Alcohol and Related Conditions-III to examine diagnostic correlates of SAD as well as how symptoms and features of SAD are related to QOL using survey-weighted regression analyses.Results: We found that comorbid depression, anxiety disorders, posttraumatic stress disorder, and borderline personality disorder were positively associated with SAD. Further, presence of these disorders was also associated with poorer mental health among those with SAD. We also found that specific feared situations (eg, eating and drinking in public) and social anxiety symptoms (panic attack and avoidance) were linked to both forms of QOL (all ps <0.01).Conclusion: The present findings highlight that SAD is comorbid with other impairing disorders and that these comorbidities, specific feared situations, and SAD symptoms are related to worse QOL in individuals with SAD.

Richard M. Suinn (1933-2024).

Richard M. Suinn, an eminent psychologist known for his work in cognitive behavioral therapy (CBT), sports psychology, ethnic minority issues, and professional association leadership, passed away on January 5, 2024, in Fort Collins, Colorado, at the age of 90 years. Suinn was born on May 8, 1933, in Hawai'i. Suinn was an expert in anxiety management and developed the widely used Mathematics Anxiety Rating Scale. He was the first psychologist appointed team psychologist to a U.S. Olympic team, applying his CBT expertise to five Olympic teams. Suinn developed the Suinn-Lew Asian Self-Identity Acculturation Scale, the most widely used measure of Asian American acculturation. He served as a president of the American Psychological Association (APA) where he opened the door for APA presidents of color, and the Association of Behavioral and Cognitive Therapies (ABCT) and a member of the Board of Directors of APA, the American Psychological Foundation, American Board of Professional Psychology, Association for the Advancement of Psychology, ABCT, and the Asian American Psychological Association (AAPA). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impact of artificial intelligence arrhythmia mapping on time to first ablation, procedure duration, and fluoroscopy use.

INTRODUCTION: Artificial intelligence (AI) ECG arrhythmia mapping provides arrhythmia source localization using 12-lead ECG data; whether this information impacts procedural efficiency is unknown. We performed a retrospective, case-control study to evaluate the hypothesis that AI ECG mapping may reduce time to ablation, procedural duration, and fluoroscopy. MATERIALS AND METHODS: Cases in which system output was used were retrospectively enrolled according to IRB-approved protocols at each site. Matched control cases were enrolled in reverse chronological order beginning on the last day for which the technology was unavailable. Controls were matched based upon physician, institution, arrhythmia, and a predetermined complexity rating. Procedural metrics, fluoroscopy data, and clinical outcomes were assessed from time-stamped medical records. RESULTS: The study group consisted of 28 patients (age 65 ± 11 years, 46% female, left atrial dimension 4.1 ± 0.9 cm, LVEF 50 ± 18%) and was similar to 28 controls. The most common arrhythmia types were atrial fibrillation (n = 10), premature ventricular complexes (n = 8), and ventricular tachycardia (n = 6). Use of the system was associated with a 19.0% reduction in time to ablation (133 ± 48 vs. 165 ± 49 min, p = 0.02), a 22.6% reduction in procedure duration (233 ± 51 vs. 301 ± 83 min, p < 0.001), and a 43.7% reduction in fluoroscopy (18.7 ± 13.3 vs. 33.2 ± 18.0 min, p < 0.001) versus controls. At 6 months follow-up, arrhythmia-free survival was 73.5% in the study group and 63.3% in the control group (p = 0.56). CONCLUSION: Use of forward-solution AI ECG mapping is associated with reductions in time to first ablation, procedure duration, and fluoroscopy without an adverse impact on procedure outcomes or complications.

eMIFS: A Normalized Hyperbolic Ransomware Deterrence Model Yielding Greater Accuracy and Overall Performance.

Early detection of ransomware attacks is critical for minimizing the potential damage caused by these malicious attacks. Feature selection plays a significant role in the development of an efficient and accurate ransomware early detection model. In this paper, we propose an enhanced Mutual Information Feature Selection (eMIFS) technique that incorporates a normalized hyperbolic function for ransomware early detection models. The normalized hyperbolic function is utilized to address the challenge of perceiving common characteristics among features, particularly when there are insufficient attack patterns contained in the dataset. The Term Frequency-Inverse Document Frequency (TF-IDF) was used to represent the features in numerical form, making it ready for the feature selection and modeling. By integrating the normalized hyperbolic function, we improve the estimation of redundancy coefficients and effectively adapt the MIFS technique for early ransomware detection, i.e., before encryption takes place. Our proposed method, eMIFS, involves evaluating candidate features individually using the hyperbolic tangent function (tanh), which provides a suitable representation of the features' relevance and redundancy. Our approach enhances the performance of existing MIFS techniques by considering the individual characteristics of features rather than relying solely on their collective properties. The experimental evaluation of the eMIFS method demonstrates its efficacy in detecting ransomware attacks at an early stage, providing a more robust and accurate ransomware detection model compared to traditional MIFS techniques. Moreover, our results indicate that the integration of the normalized hyperbolic function significantly improves the feature selection process and ultimately enhances ransomware early detection performance.

Implementation of One Health surveillance systems: Opportunities and challenges - lessons learned from the OH-EpiCap application.

As the complexity of health systems has increased over time, there is an urgent need for developing multi-sectoral and multi-disciplinary collaborations within the domain of One Health (OH). Despite the efforts to promote collaboration in health surveillance and overcome professional silos, implementing OH surveillance systems in practice remains challenging for multiple reasons. In this study, we describe the lessons learned from the evaluation of OH surveillance using OH-EpiCap (an online evaluation tool for One Health epidemiological surveillance capacities and capabilities), the challenges identified with the implementation of OH surveillance, and the main barriers that contribute to its sub-optimal functioning, as well as possible solutions to address them. We conducted eleven case studies targeting the multi-sectoral surveillance systems for antimicrobial resistance in Portugal and France, Salmonella in France, Germany, and the Netherlands, Listeria in The Netherlands, Finland and Norway, Campylobacter in Norway and Sweden, and psittacosis in Denmark. These evaluations facilitated the identification of common strengths and weaknesses, focusing on the organization and functioning of existing collaborations and their impacts on the surveillance system. Lack of operational and shared leadership, adherence to FAIR data principles, sharing of techniques, and harmonized indicators led to poor organization and sub-optimal functioning of OH surveillance systems. In the majority of studied systems, the effectiveness, operational costs, behavioral changes, and population health outcomes brought by the OH surveillance over traditional surveillance (i.e. compartmentalized into sectors) have not been evaluated. To this end, the establishment of a formal governance body with representatives from each sector could assist in overcoming long-standing barriers. Moreover, demonstrating the impacts of OH-ness of surveillance may facilitate the implementation of OH surveillance systems.

Prospective exploration of the role of combined internalizing symptoms in self-reported memory among older adults during the COVID-19 pandemic.

OBJECTIVES: A growing literature suggests depression and anxiety increase risk of cognitive decline. However, few studies have examined their combined effects on cognition, among older adults, especially during periods of high stress. METHOD: Based on a sample of community dwelling older adults (N = 576), we evaluated the effects of pre-pandemic anxiety and depressive symptoms, obtained in September 2018, to changes in self-reported memory (SRM) assessed 3 months into the COVID-19 pandemic. RESULTS: In separate models, we found participants with depression scores at least 1-SD above the mean and participants with anxiety scores at least 2-SD above the mean to report a significant decline in SRM. Moderation analyses revealed those with high depressive symptoms (at or above the mean) showed a decrease in SRM regardless of anxiety. The extent to which high pre-pandemic anxiety symptoms influenced SRM is dependent on whether pre-pandemic depression was at or above the mean. CONCLUSIONS: Pre-pandemic depression predicted a decline in SRM regardless of anxiety. Moderation analyses revealed that the extent to which anxiety symptoms influenced SRM was dependent on depression being at or above the mean. Those with high anxiety and depression are at highest risk of experiencing cognitive consequences related to stressful exposures like COVID-19.

Frailty and associated outcomes in patients undergoing percutaneous left atrial appendage occlusion: findings from the NCDR LAAO registry.

BACKGROUND: Frailty is associated with significant morbidity and mortality and may have clinical implications in an advanced age population with atrial fibrillation undergoing left atrial appendage occlusion (LAAO). We sought to develop a novel frailty scale to predict worse outcomes in patients undergoing LAAO. METHODS: Patients in the NCDR LAAO Registry between 2016 and 2021 receiving percutaneous LAAO devices were categorized as non-frail (0 points), pre-frail (1-3 points), or frail (4-5 points) based on a 5-point scale representing multiple domains of frailty: hemoglobin <13.0 g/dL in male, <12.0 g/dL in female; creatinine ≥1.2 mg/dL; albumin <3.5 g/dL; body mass index <20 kg/m2; and increased risk of falls. RESULTS: Of 57,728 patients, 44,360 (76.8%) were pre-frail and 7693 (13.3%) were frail. Compared to non-frail, pre-frail and frail patients were older, had a higher burden of co-morbidities, and more disability based on the Modified Rankin Scale. Compared to non-frail patients after adjustment, frail patients were at higher risk of in-hospital major complication (OR 1.29, 95% 1.02-1.62, p = 0.01), any complication (OR 1.29, 95% CI 1.09-1.52, p = 0.0005), and death (OR 5.79, 95% CI 1.75-19.17, p = 0.001), while no difference was observed in pre-frail patients. At 45-day follow-up, there was no difference in the risk of complications in frail patients as compared to non-frail, although mortality was significantly higher (OR 3.01, 95% CI 1.97-4.85, p < 0.0001). CONCLUSION: A simple and practical frailty scale accurately predicts adverse events in patients undergoing LAAO. The 13% of patients considered frail were at significantly higher risk of in-hospital adverse events and 45-day mortality.

Pulsed field ablation versus thermal energy ablation for atrial fibrillation: a systematic review and meta-analysis of procedural efficiency, safety, and efficacy.

BACKGROUND: Pulsed field ablation (PFA) induces cell death through electroporation using ultrarapid electrical pulses. We sought to compare the procedural efficiency characteristics, safety, and efficacy of ablation of atrial fibrillation (AF) using PFA compared with thermal energy ablation. METHODS: We performed an extensive literature search and systematic review of studies that compared ablation of AF with PFA versus thermal energy sources. Risk ratio (RR) 95% confidence intervals (CI) were measured for dichotomous variables and mean difference (MD) 95% CI were measured for continuous variables, where RR < 1 and MD < 0 favor the PFA group. RESULTS: We included 6 comparative studies for a total of 1012 patients who underwent ablation of AF: 43.6% with PFA (n = 441) and 56.4% (n = 571) with thermal energy sources. There were significantly shorter procedures times with PFA despite a protocolized 20-min dwell time (MD - 21.95, 95% CI - 33.77, - 10.14, p = 0.0003), but with significantly longer fluroscopy time (MD 5.71, 95% CI 1.13, 10.30, p = 0.01). There were no statistically significant differences in periprocedural complications (RR 1.20, 95% CI 0.59-2.44) or recurrence of atrial tachyarrhythmias (RR 0.64, 95% CI 0.31, 1.34) between the PFA and thermal ablation cohorts. CONCLUSIONS: Based on the results of this meta-analysis, PFA was associated with shorter procedural times and longer fluoroscopy times, but no difference in periprocedural complications or rates of recurrent AF when compared to ablation with thermal energy sources. However, larger randomized control trials are needed.

Safety and acute efficacy of catheter ablation for atrial fibrillation with pulsed field ablation vs thermal energy ablation: A meta-analysis of single proportions.

Background: Pulsed field ablation (PFA) has emerged as a novel energy source for the ablation of atrial fibrillation (AF) using ultrarapid electrical pulses to induce cell death via electroporation. Objective: The purpose of this study was to compare the safety and acute efficacy of ablation for AF with PFA vs thermal energy sources. Methods: We performed an extensive literature search and systematic review of studies that evaluated the safety and efficacy of ablation for AF with PFA and compared them to landmark clinical trials for ablation of AF with thermal energy sources. Freeman-Tukey double arcsine transformation was used to establish variance of raw proportions followed by the inverse with the random-effects model to combine the transformed proportions and generate the pooled prevalence and 95% confidence interval (CI). Results: We included 24 studies for a total of 5203 patients who underwent AF ablation. Among these patients, 54.6% (n = 2842) underwent PFA and 45.4% (n = 2361) underwent thermal ablation. There were significantly fewer periprocedural complications in the PFA group (2.05%; 95% CI 0.94-3.46) compared to the thermal ablation group (7.75%; 95% CI 5.40-10.47) (P = .001). When comparing AF recurrence up to 1 year, there was a statistically insignificant trend toward a lower prevalence of recurrence in the PFA group (14.24%; 95% CI 6.97-23.35) compared to the thermal ablation group (25.98%; 95% CI 15.75-37.68) (P = .132). Conclusion: Based on the results of this meta-analysis, PFA was associated with lower rates of periprocedural complications and similar rates of acute procedural success and recurrent AF with up to 1 year of follow-up compared to ablation with thermal energy sources.

Preliminary Head-Supported Mass Performance Guidance for Dismounted Soldier Environments.

INTRODUCTION: The helmet is an ideal platform to mount technology that gives U.S. Soldiers an advantage over the enemy; the total system is recognized quantitatively as head-supported mass (HSM). The stress placed on the head and neck is magnified by adding mass and increasing the center of mass offset away from the atlanto-occipital complex, the head's pivot point on the spine. Previous research has focused on HSM-related spinal degeneration and performance decrement in mounted environments. The increased capabilities and protection provided by helmet systems for dismounted Soldiers have made it necessary to determine the boundaries of HSM and center of mass offset unique to dismounted operations. MATERIALS AND METHODS: A human subject volunteer study was conducted to characterize the head and neck exposures and assess the impact of HSM on performance in a simulated field-dismounted operating environment. Data were analyzed from 21 subjects who completed the Load Effects Assessment Program-Army obstacle course at Fort Benning, GA, while wearing three different experimental HSM configurations. Four variable groups (physiologic/biomechanical, performance, kinematic, and subjective) were evaluated as performance assessments. Weight moments (WMs) corresponding to specific performance decrement levels were calculated using the quantitative relationships developed between each metric and the study HSM configurations. Data collected were used to develop the performance decrement HSM threshold criteria based on an average of 10% total performance decrement of dismounted Soldier performance responses. RESULTS: A WM of 134 N-cm about the atlanto-occipital complex was determined as the preliminary threshold criteria for an average of 10% total performance decrement. A WM of 164 N-cm was calculated for a corresponding 25% average total performance decrement. CONCLUSIONS: The presented work is the first of its kind specifically for dismounted Soldiers. Research is underway to validate these limits and develop dismounted injury risk guidance.

Comment on Rosa et al. Optic Nerve Drusen Evaluation: A Comparison between Ultrasound and OCT. J. Clin. Med. 2022, 11, 3715.

We read with interest the paper by Rosa et al., entitled "Optic Nerve Drusen Evaluation: A Comparison between Ultrasound and OCT", published in June of 2022 [...].

Safety and efficacy of catheter ablation of atrial fibrillation in the very elderly (≥80 years old): Insights from the UC San Diego AF Ablation Registry.

BACKGROUND: Catheter ablation improves outcomes in symptomatic atrial fibrillation (AF) patients. However, its safety and efficacy in the very elderly (≥80 years old) is not well described. HYPOTHESIS: Ablation of AF in the very elderly is safe and effective. METHODS: We performed a retrospective study of all patients who underwent catheter ablation enrolled in the University of California, San Diego AF Ablation Registry. The primary outcome was freedom from atrial arrhythmias on or off antiarrhythmic drugs (AADs). RESULTS: Of 847 patients, 42 (5.0%) were 80 years of age or greater with a median age of 81.5 (80-82.3) and 805 (95.0%) were less than 80 years of age with a median age of 64.4 (57.6-70.2). Among those who were ≥80 years old, 29 were undergoing de novo ablation (69.0%), whereas in the younger cohort, 518 (64.5%) were undergoing de novo ablation (p = .548). There were no statistically significant differences in fluoroscopy (p = .406) or total procedure times (p = .076), AAD use (p = .611), or procedural complications (p = .500) between groups. After multivariable adjustment, there were no statistically significant differences in recurrence of any atrial arrhythmias on or off AAD (adjusted hazard ratio [AHR]: 0.75; 95% confidence interval [CI]: 0.45-1.23; p = .252), all-cause hospitalizations (AHR: 0.86; 95% CI: 0.46-1.60; p = .626), or all-cause mortality (AHR: 4.48; 95% CI: 0.59-34.07; p = .147) between the very elderly and the younger cohort. CONCLUSION: In this registry analysis, catheter ablation of AF appears similarly effective and safe in patients 80 years or older when compared to a younger cohort.