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PURPOSE: Objective structured clinical examinations (OSCE) are a valuable assessment within healthcare education, as they provide the opportunity for students to demonstrate clinical competency, but can be resource intensive to provide faculty graders. The purpose of this study was to determine how overall OSCE scores compared between faculty, peer, and self-evaluations within a Doctor of Pharmacy (PharmD) curriculum. METHODS: This study was conducted during the required nonprescription therapeutics course. Seventy-seven first-year PharmD students were included in the study, with 6 faculty members grading 10-15 students each. Students were evaluated by 3 graders: self, peer, and faculty. All evaluators utilized the same rubric. The primary endpoint of the study was to compare the overall scores between groups. Secondary endpoints included interrater reliability and quantification of feedback type based on the evaluator group. RESULTS: The maximum possible score for the OSCE was 50 points; the mean scores for self, peer, and faculty evaluations were 43.3, 43.5, and 41.7 points, respectively. No statistically significant difference was found between the self and peer raters. However, statistical significance was found in the comparison of self versus faculty (p = 0.005) and in peer versus faculty (p < 0.001). When these scores were correlated to a letter grade (A, B, C or less), higher grades had greater similarity among raters compared to lower scores. Despite differences in scoring, the interrater reliability, or W score, on overall letter grade was 0.79, which is considered strong agreement. CONCLUSIONS: This study successfully demonstrated how peer and self-evaluation of an OSCE provides a comparable alternative to traditional faculty grading, especially in higher performing students. However, due to differences in overall grades, this strategy should be reserved for low-stakes assessments and basic skill evaluations.
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INTRODUCTION: Suicide is a major public health concern within the United States, and prevention efforts are essential for decreasing the suicide rate. Researchers and clinicians have knowledge and effective treatments for preventing suicide; however, their impact is limited to those with access to services. Science Communication (SciComm) is an effective tool that can be integrated into the field of suicide prevention and can bridge the gap between scientific findings and the general population. SciComm can help disseminate evidence-based strategies for suicide prevention, dispel misinformation on suicide, and normalize help-seeking. PURPOSE: In this article, we propose specific, tangible ways that SciComm can be integrated into graduate school programs, mentorship, career advancement requirements and can help enact systemic change within the field of suicide prevention. Additionally, we discuss why it is important that the field of suicide prevention, specifically, adopts a SciComm framework. Embracing SciComm can help the field of suicide prevention to have a broader impact and can help to reduce rates of suicide.
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Stress generation posits that (a) individuals at-risk for psychopathology may inadvertently experience higher rates of prospective dependent stress (i.e., stressors that are in part influenced by their thoughts and behaviors) but not independent stress (i.e., stressors occurring outside their influence), and (b) this elevated dependent stress, in some measure, is what places these individuals at-risk for future psychopathology. In recognition of 30 years of stress generation research, we conducted a systematic review and meta-analysis using frequentist and Bayesian approaches (102 articles with 104 eligible studies, N = 31,541). Generally strong support was found for psychopathology predicting dependent stress (e.g., dsOverall psychopathology = 0.36-0.52, BF10 = 946.00 to 4.65 × 10¹8). Moderator analyses for dependent stress revealed larger effects for briefer assessments periods, shorter follow-ups, and self-report measures than for interviews. Among risk factors, depressogenic cognitive styles (ds = .26-.50, BF10 = 47.50 to 1.00 × 105) and general interpersonal vulnerability (ds = .26-.44, BF10 = 2.72 to 2708.00) received the strongest support as stress generation mechanisms, and current evidence is modest for protective factors predicting dependent stress. Overall, larger effects were generally found for prospective prediction of dependent stress than independent stress. Evaluations of mediation in the research literature were relatively few, limiting the current review to qualitative analysis of the mediation component of stress generation. General support was found, however, for dependent stress as a mediator for psychopathology and associated risk factors in relation to subsequent psychopathology. The current review ends with recommendations for future research and integration of stress generation within minority stress frameworks. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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BACKGROUND: Social media (SM) has received considerable attention as a potential risk factor for adolescent suicide. Few empirical studies, however, have examined adolescents' daily negative and positive experiences on SM and its proximal impacts on suicidal ideation (SI), particularly using intensive monitoring designs. METHOD: Adolescents (N = 60; 14-17 years; 49% girls; 62% LGBTQ+) recruited using SM across the United States and participated in an 8-week intensive monitoring protocol. Ecological momentary assessment (three brief surveys per day) asked about negative and positive SM experiences and SI (passive and active). Multilevel modelling was used to evaluate the within-person relationships between daily SM experiences (e.g. individual fluctuations compared to a person's average) and SI, controlling for average levels of SM experiences, SM use screen time, and lifetime SI. RESULTS: Significant within-person effects of negative and positive SM experiences were associated with days when adolescents had SI. Specifically, on days when teens endorsed more frequent negative SM experiences than usual, they were more likely to report SI. However, more positive SM experiences than usual were associated with a lower likelihood of having SI. There were no significant effects of SM use ('screen time') on SI or on the reverse associations of SI on next-day SM experiences. CONCLUSIONS: Results indicate that SM experiences may be dynamic and modifiable risk and protective factors for SI in adolescents, whereas there is no effect of SM screen time on SI. Our results highlight that targeting negative SM experiences and augmenting the positive experiences on SM may be critical targets to improve teens' mental health and prevent suicide, rather than focusing on limiting SM screen time.
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Youth of color are often exposed to racism at both systemic and individual levels. Interpersonal racial/ethnic discrimination is the behavioral manifestation of individual racism.1,2 While direct individual experiences of racism (eg, comments directed at the individual) have deleterious effects for the socioemotional well-being of youth of color,3 research also points to the negative effects of broader exposure to racism (eg, viewing racist comments, images, or videos online1,2) that is not experienced directly. Now that social media (SM) has become a prominent and ubiquitous source of social interactions for adolescents, research on the influence of racism on youth must contend with this new medium. This is especially the case for youth of color, particularly Black and Hispanic/Latine youth, who report more SM use than White youth who do not identify as Hispanic/Latine.4 The unique features of SM, including its permanence, publicness, and personalized algorithms, may increase both direct and indirect experiences of online racism for youth of color, particularly due to its constant availability and highly visual nature, which likely expose and re-expose youth of color to a variety of online racist experiences. Approximately 20% of all Black adolescents sampled in a large national survey reported that they were the target of online bullying or harassment because of their racial or ethnic identity.4 Indeed, exposure to direct and indirect online racism is associated with negative mental health outcomes for youth of color,5,6 including posttraumatic symptoms, depression, and anxiety.
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Negro o Afroamericano , Hispánicos o Latinos , Racismo , Medios de Comunicación Sociales , Humanos , Adolescente , Racismo/etnología , Masculino , Femenino , Hispánicos o Latinos/psicología , Suicidio/etnología , Suicidio/psicologíaRESUMEN
INTRODUCTION: Although social media (SM) use is nearly ubiquitous among adolescents, there is a lack of clarity concerning the relationship between SM use and mental health outcomes like depression and suicidal ideation (SI), which increase during adolescence. Much of the previous literature has focused on the frequency of SM use; however, the current study examined the relationship between the perceived importance of three types of interactions and functions of SM use and depressive symptoms and suicidal ideation. METHODS: A sample of 4057 adolescents (M age = 14.6; 47.0% girls; 69.0% Non-Hispanic/Latine White) were recruited via an online survey manager between February and March 2019. Participants completed the Adolescent Digital Technology Interactions and Importance (ADTI) Scale, which assessed the perceived importance of bridging online and offline experiences (bridging), going outside one's identity or offline experience (identity), and facilitating social connections (social). Participants also completed measures of depressive symptoms and SI and a self-report measure of SM use. A series of path analyses were conducted to examine the relationship between bridging, identity, social, and depressive symptoms and SI. RESULTS: After accounting for covariates (gender identity, racial identity, age, and SM use), bridging was negatively associated with depressive symptoms, whereas identity was positively associated with depressive symptoms. Bridging and social connection were negatively associated with SI, whereas identity was positively associated with SI. Gender moderated these relationships; however, racial identity did not. CONCLUSION: The results highlight the importance of understanding adolescent SM use beyond screen time in relation to depression and SI.
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Depresión , Medios de Comunicación Sociales , Ideación Suicida , Humanos , Adolescente , Femenino , Masculino , Depresión/psicología , Medios de Comunicación Sociales/estadística & datos numéricos , Conducta del Adolescente/psicología , Uso de Internet/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
Pre-surgical psychological evaluations (PSPE) are required by many insurance companies and used to help identify risk factors that may compromise bariatric post-surgical outcomes. These evaluations, however, are not yet standardized. The present study investigated the utility of a semi-structured assessment, Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), on post-surgical outcomes across 18 months. A total of 272 adult patients underwent a psychosocial evaluation and received bariatric surgery November 2017 to September 2020 at a Midwestern academic medical center. Average age at pre-surgical evaluation was 45.2 (SD = 10.7) years and 82.3% of patients were female (n = 224). With an a priori α of 0.05, multi-level modeling with weight as the outcome and regression with complications as the outcome were used. Higher SIPAT Patient Readiness, indicating difficulty with adhering to health behaviors and a reduced understanding of bariatric surgery, was associated with elevated patient weight at the 18-month follow-up (ð½ = 0.129, p = 0.03). Higher SIPAT Social Support, was associated with patient weight at the 18-month follow-up, with reduced support associated with greater weight (ð½ = 0.254, p = 0.004). Higher SIPAT Social Support also was associated with a greater risk of complications across the 18-month follow-up window (ð½ = -0.108, p = 0.05). Patients with higher readiness to adhere to behavioral changes, and those reporting an intact social support system, generally weighed less at 18 months. The SIPAT may be considered as part of the standardized pre-surgical assessment, however, further research is required to elucidate its utility.
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Cirugía Bariátrica , Obesidad Mórbida , Adulto , Humanos , Femenino , Masculino , Factores de RiesgoRESUMEN
PURPOSE: We investigated the relationship between various forms of firearm violence exposure and sleep problems among nationally representative samples of Black (N = 3015) and American Indian and Alaska Native (AI/AN) (N = 527) adults, focusing on difficulties falling asleep, staying asleep, and waking too early. Survey data were collected in April and May 2023. METHODS: We employed negative binomial regression models to analyze the associations between the different types of firearm violence exposure and sleep problems. We further examined associations between cumulative firearm violence exposure and sleep outcomes. RESULTS: A substantial proportion of Black (59%) and AI/AN (56%) adults reported experiencing some form of firearm violence exposure. Being threatened with a firearm emerged as a consistent factor associated with sleep problems for both racial groups. Witnessing or hearing about shootings was linked to sleep problems in the Black sample, while cumulative firearm violence exposure was associated with all sleep problems in both groups. CONCLUSIONS: Individual and cumulative firearm violence exposure is associated with increased sleep problems among Black and AI/AN adults.
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Armas de Fuego , Violencia con Armas , Trastornos del Sueño-Vigilia , Adulto , Humanos , Indio Americano o Nativo de Alaska , Sueño , Trastornos del Sueño-Vigilia/epidemiología , Negro o AfroamericanoRESUMEN
Problems with sleep, emotion regulation, and externalizing psychopathology are interrelated, but little is known about their day-to-day associations in youth. We examined self-reported daily sleep quality as a bidirectional predictor of next-day positive and negative affect (PA/NA), with externalizing symptoms as a moderator. Data were drawn from an ecological momentary assessment (EMA) study involving 82 youths (ages 9-13; 50% female; 44% White, 37% Black/African American) at high (n = 41) or low (n = 41) familial risk for psychopathology. Parents rated youths' externalizing symptoms at baseline. Youths then completed a 9-day EMA protocol, reporting sleep quality 1x/day and affect 4-8x/day. Daily means, peaks, and variability in PA and NA were computed. Multilevel models examined bidirectional associations between sleep and affect (between- and within-person), testing externalizing symptoms as a moderator and controlling for age and sex. In models of sleep predicting affect: Within-person, poorer-than-usual sleep quality predicted greater variability and higher peaks in next-day NA, but only for youth with higher levels of externalizing symptoms. Between-person, poor sleep quality and higher levels of externalizing symptoms predicted lower mean and peak PA. In models of affect predicting sleep: Within-person, lower-than-usual mean PA predicted poorer subsequent sleep quality, but only for youth with higher levels of externalizing symptoms. Between-person, youths with higher mean and peak PA had better sleep quality. These findings suggest that affective functioning is bidirectionally linked to daily self-reported sleep quality among high- and low-risk youth. Specific disturbances in daily sleep-affect cycles may be distinctly associated with externalizing psychopathology.
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Afecto , Trastornos del Inicio y del Mantenimiento del Sueño , Humanos , Adolescente , Femenino , Masculino , Sueño , Psicopatología , AutoinformeRESUMEN
Adolescents often experience heightened socioemotional sensitivity warranting their use of regulatory strategies. Yet, little is known about how key socializing agents help regulate teens' negative emotions in daily life and implications for long-term adjustment. We examined adolescent girls' interpersonal emotion regulation (IER) with parents and peers in response to negative social interactions, defined as parent and peer involvement in the teen's enactment of emotion regulation strategies. We also tested associations between rates of daily parental and peer IER and depressive symptoms, concurrently and one year later. Adolescent girls (N = 112; Mage = 12.39) at temperamental risk for depressive disorders completed a 16-day ecological momentary assessment protocol measuring reactivity to negative social interactions, parental and peer IER, and current negative affect. Results indicated that adolescents used more adaptive strategies with peers and more maladaptive strategies with parents in daily life. Both parental and peer IER down-regulated negative affect, reflected by girls' decreased likelihood of experiencing continued negative affect. Higher proportions of parental adaptive IER predicted reduced depressive symptoms one year later. Findings suggest that both parents and peers effectively help adolescent girls down-regulate everyday negative emotions; however, parents may offer more enduring benefits for long-term adjustment.
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BACKGROUND: Sleep problems are common in adolescents and have detrimental impacts on physical and mental health and daily functioning. Evidence-based treatment like cognitive behaviour therapy for insomnia (CBT-I) is often hard to access, and adolescents may not engage in and adhere to longer, clinician-delivered interventions. Brief, self-guided, and accessible sleep interventions are needed. OBJECTIVE: To explore the user experience of a prototype online self-help single session sleep intervention developed for adolescents. METHODS: Eleven participants aged 17-19 years (8 females, 3 males) took part in online retrospective think-aloud interviews. Participants first completed the prototype intervention independently and were then shown the intervention page by page and asked to verbalise their thoughts and experiences. Transcripts were analyzed thematically. RESULTS: Participants found the intervention helpful. Four themes were generated - 'Educative: Learning, but more fun', 'Effortless: Quicker and Easier', 'Personalization: Power of Choice', and 'Positivity: Just Good Vibes'. The theme 'Educative: Learning, but more fun' encompassed two sub-themes 'Opportunity to Learn' and 'Aesthetics and Learning'. These themes reflected participants' views that the intervention was educative, personalised, solution-oriented and easy to use, but could incorporate more graphics and visuals to aid in learning and could be made more effortless and positive through modifications to its design. CONCLUSIONS: Findings convey the importance of ensuring educative well-designed content, personalization, a positive tone, and ease of use while designing interventions targeting adolescents's sleep and mental health. They also indicate areas for further developing the intervention.
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Centering the perspectives of youth with lived experience (YWLE) in psychopathology is critical to engaging in impactful clinical research to improve youth mental health outcomes. Over the past decade there has been a greater push in clinical science to include community members, and especially community members with lived experience, in all aspects of the research process. The goal of this editorial is to highlight the need for and importance of integrating YWLE into every stage of clinical science research, from idea generation to interpretation and dissemination of research findings. We identify five key problems associated with pursuing research on adolescent mental health without involvement of YWLE and propose strategies to overcome barriers to youth engagement in clinical science research. We conclude with a call to action, providing guidance to clinical scientists, institutions, and funding agencies in conducting research on youth psychopathology with YWLE.
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Social media use became central to adolescents' lives and development during the COVID-19 pandemic, with some adolescents first initiating social media use in this period. The unique circumstances of the pandemic contributed to changing patterns of social media use among teens and popularity of features. The pandemic also facilitated use and engagement with social media to strengthen social connection, emerging identities, and access to information and resources. It also impacted teens' online experiences and exposure to broader societal problems on SM. Recent research, with a focus in the United States, is presented on how the pandemic has shaped adolescents' experiences with social media in meaningful ways across development. We argue that research on adolescent social media use needs to consider how the COVID-19 pandemic has shaped the use and influence of social media in adolescents today.
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Conducta del Adolescente , COVID-19 , Medios de Comunicación Sociales , Humanos , Adolescente , Estados Unidos , PandemiasRESUMEN
This study describes the capabilities and limitations of carrying out total scattering experiments on the Powder Diffraction (PD) beamline at the Australian Synchrotron, ANSTO. A maximum instrument momentum transfer of 19â Å-1 can be achieved if the data are collected at 21â keV. The results detail how the pair distribution function (PDF) is affected by Qmax, absorption and counting time duration at the PD beamline, and refined structural parameters exemplify how the PDF is affected by these parameters. There are considerations when performing total scattering experiments at the PD beamline, including (1) samples need to be stable during data collection, (2) highly absorbing samples with a µR > 1 always require dilution and (3) only correlation length differences >0.35â Å may be resolved. A case study comparing the PDF atom-atom correlation lengths with EXAFS-derived radial distances of Ni and Pt nanocrystals is also presented, which shows good agreement between the two techniques. The results here can be used as a guide for researchers considering total scattering experiments at the PD beamline or similarly setup beamlines.
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Methotrexate-induced liver fibrosis is not a well-defined pathology, and many of the reported cases can instead be classified as nonalcoholic fatty liver disease by current diagnostic criteria, which is particularly common in the psoriasis cohort. Liver fibrosis usually takes many years to progress; therefore, screening for liver fibrosis should be done no more regularly than annually at the very most in dermatology practice. An algorithm is presented about how to investigate abnormal liver blood tests and screening tools for liver fibrosis are compared.
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Enfermedad del Hígado Graso no Alcohólico , Psoriasis , Humanos , Dermatólogos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/inducido químicamente , Metotrexato/efectos adversos , Psoriasis/complicaciones , Psoriasis/diagnóstico , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , FibrosisRESUMEN
BACKGROUND: Identifying proximal risk factors for suicidal ideation that are modifiable and relevant for adolescents and young adults is critical for suicide prevention. This study used an intensive monitoring approach to examine whether objectively- and subjectively- measured sleep characteristics predict next-day suicidal ideation occurrence and intensity through affective reactivity to interpersonal events in young people at high risk for suicide. METHODS: Participants included 59 (13-23 years; 76% White; 75% female) adolescents and young adults undergoing intensive outpatient program treatment for depression and suicidality. Participants completed daily ratings of suicidal ideation, sleep quality, and affective reactivity to positive and negative interpersonal events for up to 3 months (M = 56 days, SD = 24.13). Actigraphy captured behavioral sleep duration and timing. Multilevel modeling was used to evaluate within-person fluctuations in sleep and affective reactivity as predictors of suicidal ideation, and multilevel mediation tested the indirect effects of sleep on suicidal ideation via affective reactivity to interpersonal events. RESULTS: Results indicate significant indirect effects of objectively measured sleep duration and subjective sleep quality on next-day suicidal ideation via affective reactivity to negative and positive interpersonal events, respectively. Shorter-than-usual sleep predicted the presence and intensity of next-day suicidal ideation via heightened affective reactivity to negative interpersonal events. Worse sleep quality than usual predicted next-day suicidal ideation via reduced affective reactivity to positive interpersonal events. CONCLUSIONS: Affectivity reactivity is a proximal mechanism through which sleep indices may influence risk for suicidal thinking on a daily basis. Findings highlight the utility of targeting sleep and emotion regulation in suicide prevention among adolescents and young adults at high-risk for suicide.
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Trastornos del Inicio y del Mantenimiento del Sueño , Suicidio , Adulto Joven , Adolescente , Femenino , Humanos , Masculino , Ideación Suicida , Suicidio/psicología , Sueño , Actigrafía , Factores de RiesgoRESUMEN
Adolescents' daily lives have been disrupted during the Coronavirus disease 2019 (COVID-19) pandemic. It remains unclear how changes in adolescents' daily physical and social behaviours affect their sleep. The present study examined the daily and average effects of physical activity and social media use (i.e., video chatting, texting, and social networking sites) on adolescent girls' sleep during the COVID-19 pandemic. Adolescent girls aged 12-17 years (N = 93; 69% White) from a larger longitudinal study completed a 10-day daily diary protocol during state-mandated stay-at-home orders. Girls reported on daily sleep (duration, timing, quality), physical activity, and social media use during COVID-19. Multilevel modelling was used to examine the within- and between-person effects of physical activity and social media on sleep duration, timing, and quality during the 10-day period. Between-person associations indicate that youth with greater social media use (texting, video chatting, and social networking) and less physical activity had later sleep timing across the 10-day study period. Only video chatting was associated with shorter sleep duration. There were no within-person effects of physical activity or social media activities on sleep outcomes. Findings indicate that physical activity and social media use may impact later adolescent sleep timing during the COVID-19 pandemic. It will be critical for research to examine the potential long-term costs of delayed sleep timing, and whether targeting specific youth behaviours associated with sleep and circadian disruption improve mental and physical health during the COVID-19 pandemic and beyond.
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COVID-19 , Medios de Comunicación Sociales , Femenino , Humanos , Adolescente , Pandemias , Estudios Longitudinales , Sueño , Ejercicio FísicoRESUMEN
PURPOSE: Determine the dosimetric quality and the planning time reduction when utilizing a template-based automated planning application. METHODS: A software application integrated through the treatment planning system application programing interface, QuickPlan, was developed to facilitate automated planning using configurable templates for contouring, knowledge-based planning structure matching, field design, and algorithm settings. Validations are performed at various levels of the planning procedure and assist in the evaluation of readiness of the CT image, structure set, and plan layout for automated planning. QuickPlan is evaluated dosimetrically against 22 hippocampal-avoidance whole brain radiotherapy patients. The required times to treatment plan generation are compared for the validations set as well as 10 prospective patients whose plans have been automated by QuickPlan. RESULTS: The generations of 22 automated treatment plans are compared against a manual replanning using an identical process, resulting in dosimetric differences of minor clinical significance. The target dose to 2% volume and homogeneity index result in significantly decreased values for automated plans, whereas other dose metric evaluations are nonsignificant. The time to generate the treatment plans is reduced for all automated plans with a median difference of 9' 50â³ ± 4' 33â³. CONCLUSIONS: Template-based automated planning allows for reduced treatment planning time with consistent optimization structure creation, treatment field creation, plan optimization, and dose calculation with similar dosimetric quality. This process has potential expansion to numerous disease sites.
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Planificación de la Radioterapia Asistida por Computador , Radioterapia de Intensidad Modulada , Humanos , Estudios Prospectivos , Planificación de la Radioterapia Asistida por Computador/métodos , Radioterapia de Intensidad Modulada/métodos , Dosificación Radioterapéutica , Programas InformáticosRESUMEN
Examination of stable Fe isotopes is a powerful tool to explore Fe cycling in a range of environments. However, the isotopic fractionation of Fe in acid mine drainage (AMD) has received little attention and is poorly understood. Here, we analyze Fe isotopes in waters and Fe(III)-rich solids along an AMD flow-path. Aqueous Fe spanned a concentration and δ56Fe range of â¼420 mg L-1 and + 0.04 at the AMD source to â¼100 mg L-1 and -0.81 at â¼450 m downstream. Aqueous As (up to â¼33 mg L-1) and SO42- (up to â¼2000 mg L-1), like aqueous Fe, decreased in concentration down the flow-path. X-ray absorption spectroscopy indicated that downstream attenuation in aqueous Fe, As, and SO42- was due to the precipitation of amorphous ferric arsenate (AFA), schwertmannite, and jarosite. The Fe(III) in these solids displayed extreme variability in δ56Fe, spanning +3.95 in AFA near the AMD source to -1.34 in schwertmannite at â¼450 m downstream. Similarly, the isotopic contrast between solid Fe(III) precipitates and aqueous Fe (Δ56Feppt-aq) dropped along the flow-path from about +4.1 to -1.1. The shift from positive to negative Δ56Feppt-aq reflects divergence between competing equilibrium versus kinetic fractionation processes.