Patient and care team perspectives on an app to support Hospital at Home admission decision making.

BACKGROUND: Hospital at Home (HaH) programs are used throughout the United States and are beneficial in both providing patients care in environments most comfortable to them and freeing up inpatient beds. Better informing patients about HaH programs, while promoting shared decision-making (SDM), should be prioritized by health systems. SDM apps may promote increased patient agency and understanding of complex HaH care decisions. We previously developed, usability tested, and refined a HaH SDM app. OBJECTIVES: To evaluate the utility of SDM apps in assisting pneumonia patients with HaH admission. METHODS: Usability surveys (N = 16) and semistructured interviews with patients (N = 9) and nurse navigators (N = 3) were utilized to evaluate our app in assisting pneumonia patients as they contemplated HaH admission. Recruitment occurred at three hospitals in the southeastern United States. Surveys were analyzed consistent with their validated measures, while interviews were analyzed using inductive coding methodologies. RESULTS: Patients supported receiving HaH information via an app, with many noting that presenting content via multiple modalities (e.g., videos, pictures, text) was helpful and that the app assisted their care decision. App-guided inquiries into patients' care preferences helped patients visualize their priorities and promoted feelings of agency, while providing important information to care teams. Participants found visuals effective at conveying program details, for example, HaH's in-home setup, which may assist with health literacy challenges. Potential barriers included the need to expand app accessibility for vision impaired and non-English speaking patients. CONCLUSIONS: SDM apps may better inform patients' HaH care decisions, allowing patients self-directed access to information and engagement with visual content, which may address challenges related to health literacy and navigating complex, time-sensitive decisions.

Buffering anti-fat attitudes using contact: The roles of contact quantity, duration, favorability, and intergroup anxiety.

Decades of intergroup contact research have found that contact with outgroups reduces negative attitudes. Yet, few studies have examined the association between contact and anti-fat attitudes. Furthermore, testing different facets of contact, namely contact quantity versus contact duration, provides more precise theoretical predictions for their effectiveness in this under-tested context. This study examined whether intergroup anxiety was indirectly related to and contact favorability moderated the relationship between contact and anti-fat attitudes, tested through the constructs of contact quantity (i.e., how many individuals interacted with) and contact duration (i.e., how often time was spent). Undergraduates (N = 343; 260 women) based in the United States completed an online survey assessing intergroup contact, contact favorability, intergroup anxiety, and anti-fat attitudes. Analyses of conditional indirect effects showed that longer contact but not more contact reduced intergroup anxiety, which lowered anti-fat attitudes. The indirect paths for both contact types were not conditional upon contact favorability. Contact favorability moderated the association between contact duration and anti-fat attitudes such that longer and more favorable contact lowered anti-fat attitudes. Findings are discussed within the contact hypothesis, and future research should explore the distinct elements of the hypothesis as applicable to anti-fat prejudice in in-person and online contexts.

Experimental Examination of Social Transmission of Health Information using an Online Platform.

The "viral" nature of information transmission has the potential to transmit both accurate and inaccurate information. The present experiment examines the social transmission of health information, focusing on disorder etiology. Participants were placed in one of three generations of social transmission chains. The first generation read information concerning one of four fictitious disorders, pairing one disorder (Physiological or Psychological) with one etiology (Genetic or Environmental). Then, to ensure minimal loss of information (which is common in open-ended recollections), participants recalled key aspects of the disorders through multiple-choice questions. Their selections were used to modify the vignettes for the second generation and the third generation read the second's recollections. All participants also evaluated diagnosed patients on social distance and disgust. Findings suggest that genetic etiology was better recalled when paired with a psychological disorder than a physiological one. Participants desired more social distance from psychological disorders' patients (regardless of etiology) and showed higher disgust for environmental etiological patients (regardless of disorder). Implications focus on the role of content biases in the transmission of health information and misinformation.

Transmission of disorder and etiological information: Effects on health knowledge recollection and health-related cognition.

Biased transmission of health knowledge has far-reaching effects on information reproduction and health-related cognitions. We examined whether transmissions of different types of disorder and etiological information influence recollections of health knowledge and evaluations of patients, by simulating the digital transmission of information. Transmission chains of four non-interacting persons (i.e., four generations) were formed. The first generation read three vignettes describing fictitious patients with one of three disorders (physiological, psychological, culture-bound) uniquely paired with one of three etiologies (genetic, environmental, unknown etiology). Next, they evaluated patients' well-being, rated desired social distance, and recalled the vignettes. These written recollections replaced the original vignettes for a second-generation of participants, whose recollections were used for the third generation and so on. The framing of disorders affected recollections of etiology, in which culture-bound framings resulted in the poorest recall of etiologies. Participants also perceived the culture-bound disorder as the least serious but desired the most social distance from patients diagnosed with it, when compared to other disorders. The study showed that health information is selectively attended to and reproduced, possibly affected by perceived self-relevance. Faulty recollections and framing of disorders affect health cognitions, potentially instigating biased transmission of disorder- and patient-related narratives.

Genetic Knowledge within a National Australian Sample: Comparisons with Other Diverse Populations.

BACKGROUND: Genetic knowledge, which plays important functions in our understanding of science, health, social groupings, and even behaviour, has been evaluated in past studies with various populations. This wide reach of genetics means that different types of items are used to assess genetic knowledge, which restricts meaningful comparisons across time- and locale-based studies. AIM: The present study addresses this limitation by recruiting an Australia-wide sample and evaluating their genetic knowledge using items sourced from four diverse samples. METHOD: Seven hundred and eighty Australians completed a variety of items assessing their genetic knowledge as well as several demographic indicators. RESULTS: The results show superior overall genetic knowledge in the current sample compared with previous samples. Additionally, the study finds that genetic knowledge about health and illness seems to be the most accurate, whereas such knowledge about social categorisations and behaviours seems to be the most error-prone. In the current sample, being a female and having interest in genetics were positive predictors of genetic knowledge; surprisingly educational attainment was not a significant predictor. CONCLUSION: Compared with previous surveys, the current sample showed significantly better genetic knowledge. However, certain areas that relate to public understating still indicate rampant misperceptions.

The elucidation of non-classical MHC class II antigen processing through the study of viral antigens.

By convention, CD4+ T cells are activated predominantly by Major Histocompatibility Complex class II-bound peptides derived from extracellular (exogenous) antigens. It has been known for decades that alternative sources of antigen, particularly those synthesized within the antigen-presenting cell, can also supply peptides but the impact on TCD4+ responses, sometimes considerable, has only recently become appreciated. This review focuses on the contributions that studies of viral antigen have made to this shift in perspective, concluding with discussions of relevance to rational vaccine design, autoimmunity and cancer immunotherapy.

Endogenous antigen processing drives the primary CD4+ T cell response to influenza.

By convention, CD4+ T lymphocytes recognize foreign and self peptides derived from internalized antigens in combination with major histocompatibility complex class II molecules. Alternative pathways of epitope production have been identified, but their contributions to host defense have not been established. We show here in a mouse infection model that the CD4+ T cell response to influenza, critical for durable protection from the virus, is driven principally by unconventional processing of antigen synthesized within the infected antigen-presenting cell, not by classical processing of endocytosed virions or material from infected cells. Investigation of the cellular components involved, including the H2-M molecular chaperone, the proteasome and γ-interferon-inducible lysosomal thiol reductase revealed considerable heterogeneity in the generation of individual epitopes, an arrangement that ensures peptide diversity and broad CD4+ T cell engagement. These results could fundamentally revise strategies for rational vaccine design and may lead to key insights into the induction of autoimmune and anti-tumor responses.

Epigenomic analysis of primary human T cells reveals enhancers associated with TH2 memory cell differentiation and asthma susceptibility.

A characteristic feature of asthma is the aberrant accumulation, differentiation or function of memory CD4(+) T cells that produce type 2 cytokines (TH2 cells). By mapping genome-wide histone modification profiles for subsets of T cells isolated from peripheral blood of healthy and asthmatic individuals, we identified enhancers with known and potential roles in the normal differentiation of human TH1 cells and TH2 cells. We discovered disease-specific enhancers in T cells that differ between healthy and asthmatic individuals. Enhancers that gained the histone H3 Lys4 dimethyl (H3K4me2) mark during TH2 cell development showed the highest enrichment for asthma-associated single nucleotide polymorphisms (SNPs), which supported a pathogenic role for TH2 cells in asthma. In silico analysis of cell-specific enhancers revealed transcription factors, microRNAs and genes potentially linked to human TH2 cell differentiation. Our results establish the feasibility and utility of enhancer profiling in well-defined populations of specialized cell types involved in disease pathogenesis.

Toward a Network Model of MHC Class II-Restricted Antigen Processing.

The standard model of Major Histocompatibility Complex class II (MHCII)-restricted antigen processing depicts a straightforward, linear pathway: internalized antigens are converted into peptides that load in a chaperone dependent manner onto nascent MHCII in the late endosome, the complexes subsequently trafficking to the cell surface for recognition by CD4(+) T cells (TCD4+). Several variations on this theme, both moderate and radical, have come to light but these alternatives have remained peripheral, the conventional pathway generally presumed to be the primary driver of TCD4+ responses. Here we continue to press for the conceptual repositioning of these alternatives toward the center while proposing that MHCII processing be thought of less in terms of discrete pathways and more in terms of a network whose major and minor conduits are variable depending upon many factors, including the epitope, the nature of the antigen, the source of the antigen, and the identity of the antigen-presenting cell.

An integrated nano-scale approach to profile miRNAs in limited clinical samples.

Profiling miRNA expression in cells that directly contribute to human disease pathogenesis is likely to aid the discovery of novel drug targets and biomarkers. However, tissue heterogeneity and the limited amount of human diseased tissue available for research purposes present fundamental difficulties that often constrain the scope and potential of such studies. We established a flow cytometry-based method for isolating pure populations of pathogenic T cells from bronchial biopsy samples of asthma patients, and optimized a high-throughput nano-scale qRT-PCR method capable of accurately measuring 96 miRNAs in as little as 100 cells. Comparison of circulating and airway T cells from healthy and asthmatic subjects revealed asthma-associated and tissue-specific miRNA expression patterns. These results establish the feasibility and utility of investigating miRNA expression in small populations of cells involved in asthma pathogenesis, and set a precedent for application of our nano-scale approach in other human diseases. The microarray data from this study (Figure 7) has been submitted to the NCBI Gene Expression Omnibus (GEO; http://ncbi.nlm.nih.gov/geo) under accession no. GSE31030.

Negative social reaction to strabismus in school children ages 8-12 years.

PURPOSE: To investigate children's willingness to sit next to a child with noticeable exotropia as a measure of social alienation. METHODS: This was a cross-sectional, mixed-design study. Children in primary grades 3-6 (8-12 years old) were asked to view 8 digitally modified images of exotropic or orthotropic children in classroom settings and rate their willingness to sit next to the child in each image. RESULTS: A total of 157 children participated. A 4 × 2 × 2 mixed-design analysis of variance revealed a significant main effect for primary level (F [3, 151] = 4.06, P = .01, partial η(2) = .08) and for image type, exotropic versus orthotropic, (F [1, 151] = 108.45, P = .00, partial η(2) = .42). The results of the main effects were qualified by a significant primary level X image type interaction (F [3, 151] = 4.00, P = .01, partial η(2) = .08). Children were less willing to sit next to a person with noticeable exotropia. Although this phenomenon was consistent across all primary levels, the magnitude of the effect diminished in strength for children in higher primary levels. CONCLUSIONS: This study further strengthens existing evidence for strabismus-related prejudice that suggests that children with noticeable strabismus may be subjected to social alienation by other children.