Facial Appearance as Core Expression Scale: Benchmarks and Properties.

Objective: Patients presenting for corrective facial surgery may have ideals that are not congruent with their surgeon's expectations for surgical outcomes. To identify and reduce disparities in expectations, the Facial Appearance as Core Expression Scale (FACES) was developed to assess the extent to which individuals identify their own faces as representing their ideal self. Method: In Study 1, 504 healthy young adult participants answered online questions about their own faces. In Study 2, 165 participants rated their own faces, digitally manipulated images of four patients before and after surgery, and two digitally averaged benchmark images. Results: In Study 1, the final FACES instrument had seven items and was highly reliable across genders and races. Study 2 replicated reliability findings. The before surgery and after surgery pictures yielded significant improvements in ratings, suggesting scale validity. Conclusions: The FACES consists of 14 items including a benchmark image to detect unusual responding. Results indicate the measure is reliable and sensitive to perceptions of surgical changes to faces. While the scale needs to be validated in a clinical sample, the measure may help identify patients with atypical ideal expectations for their face and may be used to quantify surgical outcomes.

Measuring Arterial Oxygen Saturation Using Wearable Devices Under Varying Conditions.

INTRODUCTION: Recently developed wearable monitoring devices can provide arterial oxygen saturation (Spo2) measurements, offering potential for use in aerospace operations. Pilots and passengers are already using these technologies, but their performance has not yet been established under conditions experienced in the flight environment such as environmental hypoxia and concurrent body motion.METHODS: An initial evaluation was conducted in 10 healthy subjects who were studied in a normobaric chamber during normoxia and at a simulated altitude of 15,000 ft (4572 m; 11.8% oxygen). Spo2 was measured simultaneously using a standard pulse oximeter and four wearable devices: Apple Watch Series 6; Garmin Fenix 6 watch; Cosinusso Two in-ear sensor; and Oxitone 1000M wrist-worn pulse oximeter. Measurements were made while stationary at rest, during very slight body motion (induced by very low intensity cycling at 30 W on an ergometer), and during moderate body motion (induced by moderate intensity cycling at 150 W).RESULTS: Missed readings, defined as failure to record an Spo2 value within 1 min, occurred commonly with all wearables. Even with only very slight body motion, most devices missed most readings (range of 12-82% missed readings) and the rate was higher with greater body motion (range 18-92%). One device tended to under-report Spo2, while the other devices tended to over-report Spo2. Performance decreased across the devices when oxygenation was reduced.DISCUSSION: In this preliminary evaluation, the wearable devices studied did not perform to the same standard as a traditional pulse oximeter. These limitations may restrict their utility in flight and require further investigation.Hearn EL, Byford J, Wolfe C, Agyei C, Hodkinson PD, Pollock RD, Smith TG. Measuring arterial oxygen saturation using wearable devices under varying conditions. Aerosp Med Hum Perform. 2023; 94(1):42-47.

Understanding the landscape of web-based medical misinformation about vaccination.

Given the high rates of vaccine hesitancy, web-based medical misinformation about vaccination is a serious issue. We sought to understand the nature of Google searches leading to medical misinformation about vaccination, and guided by fuzzy-trace theory, the characteristics of misinformation pages related to comprehension, inference-making, and medical decision-making. We collected data from web pages presenting vaccination information. We assessed whether web pages presented medical misinformation, had an overarching gist, used narrative, and employed emotional appeals. We used Search Engine Optimization tools to determine the number of backlinks from other web pages, monthly Google traffic, and Google Keywords. We used Coh-Metrix to measure readability and Gist Inference Scores (GIS). For medical misinformation web pages, Google traffic and backlinks were heavily skewed with means of 138.8 visitors/month and 805 backlinks per page. Medical misinformation pages were significantly more likely than other vaccine pages to have backlinks from other pages, and significantly less likely to receive at least one visitor from Google searches per month. The top Google searches leading to medical misinformation were "the truth about vaccinations," "dangers of vaccination," and "pro con vaccines." Most frequently, pages challenged vaccine safety, with 32.7% having an overarching gist, 7.7% presenting narratives, and 17.3% making emotional appeals. Emotional appeals were significantly more common with medical misinformation than other high-traffic vaccination pages. Misinformation pages had a mean readability grade level of 11.5, and a mean GIS of - 0.234. Low GIS scores are a likely barrier to understanding gist, and are the "Achilles' heel" of misinformation pages.

Healing Hanuman's Army: Veterinary Care as a Core Component of One Health Principles in a Southeast Asian Monkey Forest.

Wildlife that inhabit urban landscapes face the dual challenge of negotiating their positions in their group while navigating obstacles of anthropogenically modified landscapes. The dynamics of urban environments can result in novel injuries and mortalities for these animals. However, these negative impacts can be mitigated through planning, and onsite veterinary care like that provided by the Ubud Monkey Forest in Bali, Indonesia. We examined 275 recorded injuries and mortalities among six social groups of long-tailed macaques (Macaca fascicularis) brought to the veterinary clinic from 2015-2018. We fit the probabilities of injury vs. death among macaques brought to the clinic using a multilevel logistic regression model to infer the relationship between injury vs. death and associated demographic parameters. Males were more likely to sustain injuries and females were more likely to die. The frequency of injuries and mortalities changed over the four-year study period, which was reflected in our model. The odds of mortality were highest among young macaques and the odds of injury vs. mortality varied across the six social groups. We categorized injuries and mortalities as "natural" or "anthropogenic". Most injuries and mortalities were naturally occurring, but powerlines, motorized vehicles, and plastic present ongoing anthropogenic threats to macaque health. Most wounds and injuries were successfully treated, with healthy animals released back to their group. We suggest other sites with high levels of human-alloprimate interplays consider the Ubud Monkey Forest veterinary office as a model of care and potentially adopt their approaches.

Adapting a Theoretically-Based intervention for underserved clinical populations at increased risk for hereditary Cancer: Lessons learned from the BRCA-Gist experience.

Background: Minorities at increased risk for Hereditary Breast and Ovarian Cancer (HBOC) frequently have low awareness and use of genetic counseling and testing (GCT). Making sure that evidence-based interventions (EBIs) reach minorities is key to reduce disparities. BRCA-Gist is a theory-informed EBI that has been proven to be efficacious in mostly non-Hispanic White non-clinical populations. We conducted formative work to inform adaptations of BRCA-Gist for use in clinical settings with at-risk diverse women. Methods: Genetic counselors (n = 20) were recruited nationally; at-risk Latinas and Blacks (n = 21) were recruited in Washington DC and Virginia. They completed the BRCA-Gist EBI between April 2018 - September 2019. Participants completed an acceptability scale and an interview to provide suggestions about implementation adaptations. T-tests for independent samples compared acceptability between at-risk women and genetic counselors. The Consensual Qualitative Research Framework was used to code adaptation suggestions. Suggested adaptations were discussed by a multidisciplinary team to integrate fidelity and adaptation considerations. Results: At-risk women had a significantly higher acceptability (M = 4.17, SD = 0.47 vs. M = 3.24, SD = 0.64; p = 0.000; scale 1-5) and satisfaction scores (M = 8.3, SD = 1.3 vs. M = 4.2, SD = 2.0; p = 0.000; scale 1-10) than genetic counselors. Genetic counselors and at-risk women suggested contextual (e.g. format) and content (e.g. shortening) adaptations to enhance the fit of BRCA-Gist for diverse clinical populations. Conclusions: Findings illustrate the process of integrating fidelity and adaptation considerations to ensure that EBIs retain their core components while enhancing the fit to minoritized clinical populations. Future studies will test the efficacy of the adapted BRCA-Gist in a Randomized Controlled Trial.

Agreement and error rates associated with standardized data collection protocols for skeletal and dental data on 3D virtual subadult crania.

Observer error and agreement rates for craniometrics, odontometrics, and cranial and dental morphological traits have been inconsistently evaluated on three-dimensional cranial reconstructions and almost never assessed on subadult individuals. This study uses a computed tomography (CT) scan sample of 12 subadults aged between birth and 20 years from the Subadult Virtual Anthropology Database (SVAD) to evaluate intra- and inter-observer error and agreement rates associated to these four types of data on virtual crania. Forty-eight cranial landmarks, 33 standard inter-landmark distances (ILDs), 13 cranial macromorphoscopic traits, four permanent and four deciduous dental landmarks and measurements per tooth, and 21 permanent and 12 deciduous dental morphological traits were collected on each individual. Results matched or improved on published standards for dry bones, teeth, or dental casts. Technical Error of Measurement (TEM) associated with metric data ranged from 0.00 mm to 0.99 mm and relative TEM ranged from 0% to 5.76%. Cohen's kappa coefficient values for agreement on morphological traits scores were above K = 0.5 for 90% of the traits. Type III cranial landmarks showed higher error rates than Type I and II cranial landmarks. Agreement on dental morphology scores seemed influenced by observer experience and rater agreement improved when using di- or tri-chotomized grades. Skeletal maturity did not significantly affect error rates, meaning most craniofacial and dental metrics and morphological traits can be reliably obtained from virtual subadult crania.

Interpreting error in the estimation of skeletal growth profiles from past populations: An example demonstrating skeletal growth in historic African American communities.

OBJECTIVES: The study of growth in the past is a critical component of bioarcheological analyses. However, our understanding of growth in the past is subject to a number of methodological challenges. This study aims to model the skeletal growth of past populations by considering the challenges associated with the data collection process and the challenges associated with the age estimation procedures. MATERIALS AND METHODS: We use skeletal remains from two historic African American cemeteries in the American South to model femoral diaphyseal length-for-age. We estimate the age of each individual using dental development techniques and present growth curves as both a product of the maximum likelihood (MLE) age estimate and the estimated posterior age distribution. Growth was compared against a reference sample from the University of Colorado Child Research Council Study. RESULTS: The results of our analyses showed that femoral diaphyseal length in two historic African American communities is small-for-estimated age as compared to a modern reference sample. However, the magnitude and characterization of this difference is variable when taking into account the broader posterior age distribution. DISCUSSION: Both samples may be small-for-age due to physiological stress associated with racism, inequality, and the compounding effects of early urbanization. However, the interpretation of growth in the past is muddled when considering the relationship between the study sample and the reference sample, when accounting for uncertainty in the age estimation procedure, and the error-inducing steps taken during the data collection process. Future interpretation of skeletal growth in the past must include a full account of the possible sources of error in order to present an accurate representation of growth.

Gist Inference Scores Predict Cloze Comprehension "In Your Own Words" for Native, Not ESL Readers.

Three patient education texts from the National Cancer Institute (NCI) were subjected to a Coh-Metrix analysis, then further analyzed to obtain Gist Inference Scores (GIS), a new measure of the likelihood that readers will make appropriate inferences about a text's bottom-line meaning. In the GIS formula, the Coh-Metrix psycholinguistic variables referential cohesion, deep cohesion, and latent semantic analysis (LSA) verb overlap increase GIS because cohesive texts that describe related actions are likely to induce gist representations. The Coh-Metrix variables word concreteness, imagability for content words, and hypernymy for nouns and verbs are negatively weighted because they tend to promote verbatim mental representations. NCI texts were modified for a cloze procedure with every tenth word replaced by a blank starting with the second sentence. Participants in two studies received all three cloze-modified texts. Fuzzy-Trace Theory suggests that people are more likely to comprehend high GIS texts "in their own words," and thus fill-the-blanks with multiple words that differ from those omitted by the cloze procedure expressing comparable meaning. In Study One, non-native English speakers appropriately filled blanks with different words at the same rate for all three texts of low-, medium-, and high-GIS. In Study Two, replicating previous findings, for high GIS texts, native English speakers filled blanks appropriately with words other than those removed significantly more often than for medium- or low-GIS texts. High GIS texts apparently afford readers more semantic and lexical flexibility, but non-native English speakers may be ill-equipped to capitalize on this characteristic of high GIS texts.

Individual differences in risk perception and misperception of COVID-19 in the context of political ideology.

The COVID-19 pandemic has been characterized by misinformation, politicization of public health, and extreme differences in risk assessment. In two studies, we sought to understand factors that contribute to differences in people's understanding of the virus and associated risks. We found that conservative participants reported higher levels of acceptable risk, have lower risk estimates of activities, and endorsed more misinformation. Participants with personal health risk factors rated COVID-19 risks as higher, more reflective participants had lower acceptable risk levels, and impulsive participants endorsed more misinformation. In our second study, we also found that reflective participants were more likely to wear a mask, get vaccinated, and maintain social distancing, and that participants judged arguments about COVID-19 measures largely based on the claim rather than supporting reasons. By clarifying these individual differences, public health experts can more effectively create targeted interventions for at risk populations, and be better prepared for future outbreaks.

Vismodegib as Eye-Sparing Neoadjuvant Treatment for Locally Advanced Periocular Basal Cell Carcinoma.

Locally-advanced periocular basal cell carcinoma (BCC) pose many therapeutic challenges due to the need to preserve functionality and cosmesis of the orbit and periocular area. Surgical excision and subsequent orbital exenteration are two recognized modalities of treatment. Vismodegib is currently an FDA-approved monotherapy for locally-advanced and metastatic BCC. We present a case of the use of vismodegib as neoadjuvant therapy prior to surgical excision of a locally-advanced periocular recurrent BCC in a 75-year-old male. The patient’s tumor successfully responded to vismodegib allowing surgical excision with clear margins. The orbit was saved in a patient who otherwise would have required complete orbital exenteration. J Drugs Dermatol. 20(5):552-554. doi:10.36849/JDD.5661.

Random quasi-phase-matching in polycrystalline media and its effects on pulse coherence properties.

Polycrystalline materials can mediate efficient frequency up-conversion for mid-infrared light. Motivated by the need to understand the properties of the harmonic and supercontinuum radiation from such media, we utilize realistic numerical simulations to reveal its complex temporal and spatial structure. We show that the generated radiation propagates in the form of long-duration pulse trains that can be difficult to compress and that optical filamentation in high-energy pulses gives rise to fine-structured beam profiles. We identify trends concerning pulse energy, sample length, and the microstructure of the material that can inform optimization for different applications.

A comparison of subadult skeletal and dental development based on living and deceased samples.

OBJECTIVES: A fundamental assumption in biological anthropology is that living individuals will present with different growth than non-survivors of the same population. The aim is to address the question of whether growth and development data of non-survivors are reflective of the biological consequences of selective mortality and/or stress. MATERIALS AND METHODS: The study compares dental development and skeletal growth collected from radiographic images of contemporary samples of living and deceased individuals from the United States (birth to 20 years) and South Africa (birth to 12 years). Further evaluation of deceased individuals is used to explore differential patterns among manners of death (MOD). RESULTS: Results do not show any significant differences in skeletal growth or dental development between living and deceased individuals. However, in the South African deceased sample the youngest individuals exhibited substantially smaller diaphyseal lengths than the living sample, but by 2 years of age the differences were negligible. In the US sample, neither significant nor substantial differences were found in dental development or diaphyseal length according to MOD and age (>2 years of age), though some long bones in individuals <2 years of age did show significant differences. No significant differences were noted in diaphyseal length according to MOD and age in the SA sample. DISCUSSION: The current findings refute the idea that contemporary deceased and living individuals would present with differential growth and development patterns through all of ontogeny as well as the assumptions linking short stature, poor environments, and MOD.

Comparison of Grenz ray and photodynamic therapy for field treatment of actinic keratoses on the forearm: A case series.

BACKGROUND: Actinic Keratosis is an intraepidermal neoplasm that represents the second most common reason for dermatologic visits in the United States. Sustained clearance with existing therapies is highly variable. OBJECTIVE: To assess the effects of combination and monotherapy with photodynamic therapy (PDT), grenz ray therapy, and PDT with microneedling (microchannel skin system) for actinic damage of the dorsal forearms and hands. METHODS: Full ethics approval was obtained through a Human Subjects Committee. Four patients with diffuse actinic field damage on their forearms and hands were recruited for the study. The dorsal forearm and hand from the elbow to the metacarpophalangeal joint were divided into four equal sections. Section 1 was treated with PDT. Section 2 was treated with grenz ray. Section 3 was treated with PDT plus microneedling. Section 4 was treated with grenz ray and PDT with microneedling. Lesion counts were recorded with transparent grids, photographed and evaluated by the same investigator at baseline, 1, 2, 3 and 6 months. RESULTS: At month 6 post treatment, lesion counts, as a per cent reduction from baseline, were 91.7% in section 1 (PDT); 97.3% in section 2 (grenz ray); 92.9% in section 3 (PDT + microneedle); and 93.9% in section 4 (grenz ray + PDT + microneedle). CONCLUSION: The greatest reduction occurred in the grenz ray monotherapy section and the second greatest reduction in the grenz ray, PDT, microneedling section. Further research on the efficacy of grenz ray therapy for field treatment of actinic keratosis of the forearms and hands is needed.

Cystic Fibrosis Point of Personalized Detection (CFPOPD): An Interactive Web Application.

BACKGROUND: Despite steady gains in life expectancy, individuals with cystic fibrosis (CF) lung disease still experience rapid pulmonary decline throughout their clinical course, which can ultimately end in respiratory failure. Point-of-care tools for accurate and timely information regarding the risk of rapid decline is essential for clinical decision support. OBJECTIVE: This study aims to translate a novel algorithm for earlier, more accurate prediction of rapid lung function decline in patients with CF into an interactive web-based application that can be integrated within electronic health record systems, via collaborative development with clinicians. METHODS: Longitudinal clinical history, lung function measurements, and time-invariant characteristics were obtained for 30,879 patients with CF who were followed in the US Cystic Fibrosis Foundation Patient Registry (2003-2015). We iteratively developed the application using the R Shiny framework and by conducting a qualitative study with care provider focus groups (N=17). RESULTS: A clinical conceptual model and 4 themes were identified through coded feedback from application users: (1) ambiguity in rapid decline, (2) clinical utility, (3) clinical significance, and (4) specific suggested revisions. These themes were used to revise our application to the currently released version, available online for exploration. This study has advanced the application's potential prognostic utility for monitoring individuals with CF lung disease. Further application development will incorporate additional clinical characteristics requested by the users and also a more modular layout that can be useful for care provider and family interactions. CONCLUSIONS: Our framework for creating an interactive and visual analytics platform enables generalized development of applications to synthesize, model, and translate electronic health data, thereby enhancing clinical decision support and improving care and health outcomes for chronic diseases and disorders. A prospective implementation study is necessary to evaluate this tool's effectiveness regarding increased communication, enhanced shared decision-making, and improved clinical outcomes for patients with CF.

Treatment of keloids with a single dose of low-energy superficial X-ray radiation to prevent recurrence after surgical excision: An in vitro and in vivo study.

BACKGROUND: Although keloids have been empirically treated with steroids and radiation, evidence-based radiation parameters for keloid therapy are lacking. OBJECTIVE: To determine evidence-based radiation parameters for blocking keloid fibroblast proliferation in vitro and apply them to patients. METHODS: The effects of various radiation parameters and steroids on cell proliferation, cell death, and collagen production in keloid explants and fibroblasts were evaluated with standard assays. Effective radiation parameters were then tested on patients. RESULTS: No differences were observed between the effects of 50 and 320 kV radiation or between single and fractionated radiation doses on keloid fibroblasts. A 3 Gy, 50 kV dose inhibited keloid fibroblast proliferation in culture, whereas 9 Gy completely blocked their outgrowth from explants by inducing multiple cell death pathways and reducing collagen levels. Thirteen of 14 keloids treated with a single 8 Gy, 50 kV dose of radiation did not recur, although 4 patients with 6 keloids were lost to follow-up. LIMITATIONS: Seventy-five percent of patients received steroids for pruritus, whereas approximately 25% of patients were lost to follow-up. CONCLUSIONS: A single 8 Gy dose of superficial 50 kV radiation delivered an average of 34 days after keloid excision maybe sufficient to minimize recurrence, including in individuals resistant to steroids. Higher radiation energies, doses, or fractions may be unnecessary for keloid therapy.

Gist Inference Scores predict gist memory for authentic patient education cancer texts.

OBJECTIVES: Develop a tool to evaluate and improve written medical communication to patients. Determine how effectively Gist Inference Scores (GIS) predict comprehension of patient education texts independently of health literacy. Explicate the text characteristics and psychological mechanism underlying GIS. METHODS: For study 1, a nationally representative sample of older women (N = 61) completed a fill-in-the-blank comprehension task on authentic National Cancer Institute (NCI) texts of varying GIS levels. In study 2, participants (N = 198) read NCI texts (high or low GIS) then recalled what they read. RESULTS: Study 1 showed that a higher percentage of different words yielding semantically similar sentence meaning were used to correctly fill-the-blanks on high GIS texts and there was no significant interaction with health literacy. In study 2, a greater proportion of decision-relevant information was recalled for high GIS texts. CONCLUSIONS: GIS predicts the likelihood that readers will form gist representations of medical texts on free recall and fill-in-the-blank tasks. High GIS texts allow for more semantic flexibility to mentally represent the same meaning, and more strongly emphasizes gist rather than verbatim representations. PRACTICAL IMPLICATIONS: GIS provides medical communicators with an automated and user-friendly method to evaluate medical texts for their ability to convey the bottom-line meaning.

Reported Prevalence of Maternal Hepatitis C Virus Infection in the United States.

OBJECTIVE: To quantify the reported prevalence and trend of maternal hepatitis C virus (HCV) infection in the United States (2009-2017) and identify maternal characteristics and obstetric outcomes associated with HCV infection during pregnancy. METHODS: We conducted a population-based retrospective cohort study of all live births in the United States for the period 2009 through 2017 using National Center for Health Statistics birth records. We estimated reported prevalence and trends over this time period for the United States. We also evaluated demographic factors and pregnancy outcomes associated with maternal HCV infection for a contemporary U.S. cohort (2014-2017). RESULTS: During the 9-year study period, there were 94,824 reported cases of maternal HCV infection among 31,207,898 (0.30%) live births in the United States. The rate of maternal HCV infection increased from 1.8 cases per 1,000 live births to 4.7 cases per 1,000 live births (relative risk [RR] 2.7, 95% CI 2.6-2.8) in the United States. After adjusting for various confounders in the contemporary U.S. cohort (2014-2017), demographic characteristics associated with HCV infection included non-Hispanic white race (adjusted RR 2.8, 95% CI 2.7-2.8), Medicaid insurance (adjusted RR 3.3, CI 3.2-3.3), and cigarette smoking (adjusted RR 11.1, CI 10.9-11.3). Co-infection during pregnancy with hepatitis B (adjusted RR 19.2, CI 18.1-20.3), gonorrhea, chlamydia, or syphilis were also associated with maternal HCV infection. Obstetric and neonatal outcomes associated with maternal HCV infection included cesarean delivery, preterm birth, maternal intensive care unit admission, blood transfusion, having small-for-gestational-age neonates (less than the 10th percentile) birth weight, neonatal intensive care unit admission, need for assisted neonatal ventilation, and neonatal death. CONCLUSION: The reported prevalence of maternal HCV infection has increased 161% from 2009 to 2017.