Assessing Usability of Untethered Head-Mounted Displays for Medical Education: A Within-Person Randomized Trial.

INTRODUCTION: Recent meta-analyses have found immersive technology to be effective for training, yet there is limited research on user experience with head-mounted displays (HMDs) in the medical domain. If emerging immersive displays do not meet usability standards in the context of healthcare simulation, the technology may cause frustration or hinder learning outcomes. This is the first experimental comparison of usability in commercial untethered, "all-in-one" HMDs for healthcare simulation. METHODS: The usability and comfort of three commercial untethered HMDs (Oculus Go, Oculus Quest, and Lenovo Mirage Solo) were tested using a randomized within-person design such that each headset was evaluated by all participants in a random sequence. During the experiment, participants (n = 9) interacted with a simulated healthcare environment in each headset and then responded to usability and comfort surveys. RESULTS: All of the HMDs were rated as having higher than average usability compared with an industry benchmark scale, the System Usability Scale. Only one of the headsets had a usability rating in the highest range, which was significantly higher than the lowest rated headset ( P = 0.047, Cohen d = 0.901). In addition, feelings of discomfort with the headsets were low, and comfort ratings did not differ significantly between headsets ( P > 0.05). CONCLUSIONS: Untethered HMDs had acceptable user experience ratings during a healthcare simulation task, but some headsets were rated higher on usability. Because usability is important for learner engagement and training outcomes, educators should confirm that immersive displays meet usability standards before implementation.

Risks of decoupling from China on low-carbon technologies.

For most technologies, the cure is likely worse than the disease.

Risk and Lag-time for Development of Lacrimal Gland Carcinoma Expleomorphic Adenoma: Observations and Conjectural Study.

AIMS: To estimate the proportion of de novo lacrimal gland pleomorphic adenomas (PAs) and carcinomas expleomorphic adenomas (CEPAs), together with age at presentation and first symptom. Conjectural models of tumor growth are considered. METHODS: Retrospective review of patients with orbital lobe PA or CEPA. The presenting age was examined for conformation to a Gaussian distribution and the cumulative distribution function derived for both tumor types. The risk of CEPA with age was estimated by logistic regression. RESULTS: About one-sixth (27/172; 16%) of these primary orbital lobe tumors were CEPAs, with 145 PAs (76/145 male; 52%) and 27 CEPAs (12/27 male; 44%). The mean presenting age for PAs was 48.3 years (median 47.7; range 11-84 years) and 57.7 years for CEPAs (median 61.2, range 27-91 years) ( p = 0.0062), and the standard deviations for each group are almost identical (16.3 for PAs, 15.9 for CEPAs; p = 0.92). Five (3.4%) PAs and 1 (3.7%) CEPA were asymptomatic: otherwise, the median symptom duration was 24 months for both PAs and CEPAs ( U test: p = 0.65). The odds of CEPA rises significantly with age, increasing 1.04-fold annually ( p = 0.0079). CONCLUSION: The almost identical measures of dispersion for the presenting ages of PA and CEPA suggests that, once malignant transformation occurs, there might be a relatively constant period before it is evident. CEPAs present about a decade after PAs, this unexpectedly later presentation for the malignancy possibly being explained by a gradual replacement of the PA by the newly arising carcinoma within the preceding benign tumor.

Three Years of X + Y Scheduling: Longitudinal Assessment of Resident and Faculty Perceptions.

OBJECTIVE: Five pediatric residency programs implemented true X + Y scheduling in 2018 where residents have continuity clinic in "blocks" rather than half-day per week experiences. We report the impact X + Y scheduling has on pediatric resident and faculty perceptions of patient care and other educational experiences over a 3-year timeframe. METHODS: Electronic surveys were sent to residents and faculty of the participating programs prior to implementing X + Y scheduling and annually thereafter (2018-2021). Survey questions measured resident and faculty perception of continuity clinic schedule satisfaction and the impact of continuity clinic schedules on inpatient and subspecialty rotations. Data were analyzed using z-tests for proportion differences. RESULTS: One hundred and eight six residents were sent the survey preimplementation and 254 to 289 postimplementation with response rates ranging from 47% to 69%. Three hundred and seventy-eight to 395 faculty members were sent the survey with response rates ranging from 26% to 51%. Statistically significant (P < .05) sustained perceived improvements over 3 years with X+Y were seen in outpatient continuity, inpatient workflow, and time for teaching both inpatient and in continuity clinic. CONCLUSIONS: X + Y scheduling can lead to perceived improvements in various aspects of pediatric residency programs. Our study demonstrates these improvements have been sustained over 3 years in the participating programs.

Effect of a Novel Mindfulness Curriculum on Burnout During Pediatric Internship: A Cluster Randomized Clinical Trial.

IMPORTANCE: Mindfulness curricula can improve physician burnout, but implementation during residency presents challenges. OBJECTIVE: To examine whether a novel mindfulness curriculum implemented in the first 6 months of internship reduces burnout. DESIGN, SETTING, AND PARTICIPANTS: This pragmatic, multicenter, stratified cluster randomized clinical trial of a mindfulness curriculum randomized 340 pediatric interns to the intervention or control arm within program pairs generated based on program size and region. Fifteen US pediatric training programs participated from June 14, 2017, to February 28, 2019. INTERVENTIONS: The intervention included 7 hour-long sessions of a monthly mindfulness curriculum (Mindfulness Intervention for New Interns) and a monthly mindfulness refresher implemented during internship. The active control arm included monthly 1-hour social lunches. MAIN OUTCOMES AND MEASURES: The primary outcome was emotional exhaustion (EE) as measured by the Maslach Burnout Inventory 9-question EE subscale (range, 7-63; higher scores correspond to greater perceived burnout). Secondary outcomes were depersonalization, personal accomplishment, and burnout. The study assessed mindfulness with the Five Facet Mindfulness Questionnaire and empathy with the Interpersonal Reactivity Index subscales of perspective taking and empathetic concern. Surveys were implemented at baseline, month 6, and month 15. RESULTS: Of the 365 interns invited to participate, 340 (93.2%; 255 [75.0%] female; 51 [15.0%] 30 years or older) completed surveys at baseline; 273 (74.8%) also participated at month 6 and 195 (53.4%) at month 15. Participants included 194 (57.1%) in the Mindfulness Intervention for New Interns and 146 (42.9%) in the control arm. Analyses were adjusted for baseline outcome measures. Both arms' EE scores were higher at 6 and 15 months than at baseline, but EE did not significantly differ by arm in multivariable analyses (6 months: 35.4 vs 32.4; adjusted difference, 3.03; 95% CI, -0.14 to 6.21; 15 months: 33.8 vs 32.9; adjusted difference, 1.42; 95% CI, -2.42 to 5.27). None of the 6 secondary outcomes significantly differed by arm at month 6 or month 15. CONCLUSIONS AND RELEVANCE: A novel mindfulness curriculum did not significantly affect EE, burnout, empathy, or mindfulness immediately or 9 months after curriculum implementation. These findings diverge from prior nonrandomized studies of mindfulness interventions, emphasizing the importance of rigorous study design and suggesting that additional study is needed to develop evidence-based methods to reduce trainee burnout. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03148626.

Training detection of camouflaged targets in natural scenes: Backgrounds and targets both matter.

As target-background similarity increases, search performance declines, but this pattern can be attenuated with training. In the present study we (1) characterized training and transfer effects in visual search for camouflaged targets in naturalistic scenes, (2) evaluated whether transfer effects are preserved 3 months after training, (3) tested the suitability of the perceptual learning hypothesis (i.e., using learned scene statistics to aid camouflaged target detection) for explaining camouflage search improvements over training, and (4) provide guidance for camouflage detection training in practice. Participants were assigned to one of three training groups: adaptive camouflage (difficulty varied by performance), massed camouflage (difficulty increased over time), or an active control (no camouflage), and trained over 14 sessions. Additional sessions measured transfer (immediately post training) and retention of training benefits (10 days and 3 months post training). Both the adaptive and massed training groups showed improved camouflaged target detection up to 3 months following training, relative to the control. These benefits were observed only with backgrounds and targets that were similar to those experienced during training and are broadly consistent with the perceptual learning hypothesis. In practice, training interventions should utilize stimuli similar to the operational environment in which detection is expected to occur.

Non-nutritive suck and voice onset time: Examining infant oromotor coordination.

The variability of a child's voice onset time (VOT) decreases during development as they learn to coordinate upper vocal tract and laryngeal articulatory gestures. Yet, little is known about the relationship between VOT and other early motor tasks. The aims of this study were to evaluate the relationship between infant vocalization and another early oromotor task, non-nutritive suck (NNS). Twenty-five full-term infants (11 male, 14 female) completed this study. NNS was measured with a customized pacifier at 3 months to evaluate this early reflex. Measures of mean VOT and variability of VOT (measured via coefficient of variation) were collected from 12-month-old infants using a Language Environmental Analysis device. Variability of VOTs at 12 months was significantly related to NNS measures at 3-months. Increased VOT variability was primarily driven by increased NNS intraburst frequency and increased NNS burst duration. There were no relationships between average VOT or range of VOT and NNS measures. Findings from this pilot study indicate a relationship between NNS measures of intraburst frequency and burst duration and VOT variability. Infants with increased NNS intraburst frequency and NNS burst duration had increased VOT variability, suggesting a relationship between the development of VOT and NNS in the first year of life. Future work is needed to continue to examine the relationship between these early oromotor actions and to evaluate how this may impact later speech development.

Impact of X+Y Scheduling on Pediatric Resident and Faculty Perceptions of Education and Patient Care.

PURPOSE: Traditional half-day per week continuity clinic experiences can lead to fragmented education in both the inpatient and outpatient arenas. Five pediatric residency programs were granted the ability from the ACGME to create X+Y scheduling where residents have continuity clinic in "blocks" rather than half-day per week experiences. The aim of this study is to assess the impact X+Y scheduling has on pediatric resident and faculty perceptions of patient care and other educational experiences. METHODS: Electronic surveys were sent to residents and faculty of the participating programs both prior to and 12 months after implementing X+Y scheduling. Survey questions measured resident and faculty perception of continuity clinic schedule satisfaction and the impact of continuity clinic schedules on inpatient and subspecialty rotation experiences using a 5-point Likert Scale. Data were analyzed using z-tests for proportion differences for those answering Agree or Strongly Agree between baseline and post-implementation respondents. RESULTS: Hundred and twenty-six out of 186 residents (68%) responded preimplementation and 120 out of 259 residents (47%) responded post-implementation. 384 faculty members were sent the survey with 51% response pre-implementation and 26% response at 12 months. Statistically significant (P < .05) improvements were noted in resident and faculty perceptions of ability to have continuity with patients and inpatient workflow affected by clinic scheduling. CONCLUSIONS: From both resident and faculty perspectives, X+Y scheduling may improve several aspects of patient care and education. X+Y scheduling could be considered as a potential option by pediatric residency programs, especially if validated with more objective data.

Per-partnership transmission probabilities for Chlamydia trachomatis infection: evidence synthesis of population-based survey data.

BACKGROUND: Chlamydia is the most commonly diagnosed sexually transmitted infection worldwide. Mathematical models used to plan and assess control measures rely on accurate estimates of chlamydia's natural history, including the probability of transmission within a partnership. Several methods for estimating transmission probability have been proposed, but all have limitations. METHODS: We have developed a new model for estimating per-partnership chlamydia transmission probabilities from infected to uninfected individuals, using data from population-based surveys. We used data on sexual behaviour and prevalent chlamydia infection from the second UK National Study of Sexual Attitudes and Lifestyles (Natsal-2) and the US National Health and Nutrition Examination Surveys 2009-2014 (NHANES) for Bayesian inference of average transmission probabilities, across all new heterosexual partnerships reported. Posterior distributions were estimated by Markov chain Monte Carlo sampling using the Stan software. RESULTS: Posterior median male-to-female transmission probabilities per partnership were 32.1% [95% credible interval (CrI) 18.4-55.9%] (Natsal-2) and 34.9% (95%CrI 22.6-54.9%) (NHANES). Female-to-male transmission probabilities were 21.4% (95%CrI 5.1-67.0%) (Natsal-2) and 4.6% (95%CrI 1.0-13.1%) (NHANES). Posterior predictive checks indicated a well-specified model, although there was some discrepancy between reported and predicted numbers of partners, especially in women. CONCLUSIONS: The model provides statistically rigorous estimates of per-partnership transmission probability, with associated uncertainty, which is crucial for modelling and understanding chlamydia epidemiology and control. Our estimates incorporate data from several sources, including population-based surveys, and use information contained in the correlation between number of partners and the probability of chlamydia infection. The evidence synthesis approach means that it is easy to include further data as it becomes available.

Factors associated with cytomegalovirus serostatus in young people in England: a cross-sectional study.

BACKGROUND: Human cytomegalovirus (CMV) is a common herpesvirus which is estimated to infect 83% of the global population. Whilst many infections are asymptomatic, it is an important cause of morbidity and mortality, particularly for immunocompromised people and for infants who are congenitally infected. A vaccine against CMV has been stated as a public health priority, but there are gaps in our understanding of CMV epidemiology. To guide potential future vaccination strategies, our aim was to examine risk factors for CMV seropositivity in young people in England. METHODS: The Health Survey for England (HSE) is an annual, cross-sectional representative survey of households in England during which data are collected through questionnaires, and blood samples are taken. We randomly selected individuals who participated in the HSE 2002, aiming for 25 participants of each sex in each single year age group from 11 to 24 years. Stored samples were tested for CMV antibodies. We undertook descriptive and regression analyses of CMV seroprevalence and risk factors for infection. RESULTS: Demographic data and serostatus were available for 732 individuals, of whom 175 (23.7%) were CMV-seropositive. CMV seroprevalence was associated with age, with 18.3% seropositive at 11-14 years compared to 28.3% at 22-24 years. CMV serostatus was also higher in people of non-white ethnicity (adjusted odds ratio [aOR] 6.22, 95% confidence interval [CI] 3.47-11.14), and in adults who were seropositive for EBV (aOR 2.08 [1.06-4.09]). There was no evidence that smoking status, occupation, body mass index and region of England were associated with CMV serostatus. CONCLUSIONS: CMV seroprevalence is strongly associated with ethnicity, and modestly increases with age in 11-24-year-olds. A greater understanding of the transmission dynamics of CMV, and the impact of this on CMV-associated morbidity and mortality, is necessary to inform effective vaccination strategies when a vaccine for CMV becomes available.

Evaluation of a novel multiplexed assay for determining IgG levels and functional activity to SARS-CoV-2.

BACKGROUND: The emergence of SARS-CoV-2 has led to the development of serological assays that could aid in an understanding of the burden of COVID-19 disease. Many available tests lack rigorous evaluation and therefore results may be misleading. OBJECTIVES: The aim of this study was to assess the performance of a novel multiplexed immunoassay for the simultaneous detection of antibodies against SARS-CoV-2 trimeric spike (S), spike receptor binding domain (RBD), spike N terminal domain and nucleocapsid antigen and a novel pseudo-neutralisation assay. METHODS: A multiplexed solid-phase chemiluminescence assay (Meso Scale Discovery) was evaluated for the simultaneous detection of IgG binding to four SARS-CoV-2 antigens and the quantification of antibody-induced ACE-2 binding inhibition (pseudo-neutralisation assay). Sensitivity was evaluated with a total of 196 COVID-19 serum samples (169 confirmed PCR positive and 27 anti-nucleocapsid IgG positive) from individuals with mild symptomatic or asymptomatic disease. Specificity was evaluated with 194 control serum samples collected from adults prior to December 2019. RESULTS: The specificity and sensitivity of the binding IgG assay was highest for S protein with a specificity of 97.4 % and sensitivity of 96.2 % for samples taken 14 days and 97.9 % for samples taken 21 days following the onset of symptoms. IgG concentration to S and RBD correlated strongly with percentage inhibition measured by the pseudo-neutralisation assay. CONCLUSION: Excellent sensitivity for IgG detection was obtained over 14 days since onset of symptoms for three SARS-CoV-2 antigens (S, RBD and N) in this multiplexed assay which can also measure antibody functionality.

Incidence of Pelvic Inflammatory Disease Associated With Mycoplasma genitalium Infection: Evidence Synthesis of Cohort Study Data.

We synthesized evidence from the POPI sexual-health cohort study and estimated that 4.9% (95% credible interval, .4-14.1%) of Mycoplasma genitalium infections in women progress to pelvic inflammatory disease versus 14.4% (5.9-24.6%) of chlamydial infections. For validation, we predicted PID rates in 4 age groups that agree well with surveillance data.

Predictors of Epstein-Barr virus serostatus and implications for vaccine policy: A systematic review of the literature.

BACKGROUND: Epstein-Barr virus (EBV) is an important human pathogen; it infects >90% people globally and is linked to infectious mononucleosis and several types of cancer. Vaccines against EBV are in development. In this study we present the first systematic review of the literature on risk factors for EBV infection, and discuss how they differ between settings, in order to improve our understanding of EBV epidemiology and aid the design of effective vaccination strategies. METHODS: MEDLINE, Embase, and Web of Science were searched on 6th March 2017 for observational studies of risk factors for EBV infection. Studies were excluded if they were published before 2008 to ensure relevance to the modern day, given the importance of influencing future vaccination policies. There were no language restrictions. After title, abstract and full text screening, followed by checking the reference lists of included studies to identify further studies, data were extracted into standardised spreadsheets and quality assessed. A narrative synthesis was undertaken. RESULTS: Seventy-seven papers met our inclusion criteria, including data from 31 countries. There was consistent evidence that EBV seroprevalence was associated with age, increasing throughout childhood and adolescence and remaining constant thereafter. EBV was generally acquired at younger ages in Asia than Europe/North America. There was also compelling evidence for an association between cytomegalovirus infection and EBV. Additional factors associated with EBV seroprevalence, albeit with less consistent evidence, included ethnicity, socioeconomic status, other chronic viral infections, and genetic variants of HLA and immune response genes. CONCLUSIONS: Our study is the first systematic review to draw together the global literature on the risk factors for EBV infection and includes an evaluation of the quality of the published evidence. Across the literature, the factors examined are diverse. In Asia, early vaccination of infants would be required to prevent EBV infection. In contrast, in Western countries a vaccine could be deployed later, particularly if it has only a short duration of protection and the intention was to protect against infectious mononucleosis. There is a lack of high-quality data on the prevalence and age of EBV infection outside of Europe, North America and South-East Asia, which are essential for informing effective vaccination policies in these settings.

Risk factors for Epstein Barr virus-associated cancers: a systematic review, critical appraisal, and mapping of the epidemiological evidence.

BACKGROUND: Epstein Barr Virus (EBV) infects 90%-95% of all adults globally and causes ~ 1% of all cancers. Differing proportions of Burkitt's lymphoma (BL), gastric carcinoma (GC), Hodgkin's lymphoma (HL) and nasopharyngeal carcinoma (NPC) are associated with EBV. We sought to systematically review the global epidemiological evidence for risk factors that (in addition to EBV) contribute to the development of the EBV-associated forms of these cancers, assess the quality of the evidence, and compare and contrast the cancers. METHODS: MEDLINE, Embase and Web of Science were searched for studies of risk factors for EBV-associated BL, GC, HL and NPC without language or temporal restrictions. Studies were excluded if there was no cancer-free comparator group or where analyses of risk factors were inadequately documented. After screening and reference list searching, data were extracted into standardised spreadsheets and quality assessed. Due to heterogeneity, a narrative synthesis was undertaken. RESULTS: 9916 hits were retrieved. 271 papers were retained: two BL, 24 HL, one GC and 244 NPC. The majority of studies were from China, North America and Western Europe. Risk factors were categorised as dietary, environmental/non-dietary, human genetic, and infection and clinical. Anti-EBV antibody load was associated with EBV-associated GC and BL. Although the evidence could be inconsistent, HLA-A alleles, smoking, infectious mononucleosis and potentially other infections were risk factors for EBV-associated HL. Rancid dairy products; anti-EBV antibody and EBV DNA load; history of chronic ear, nose and/or throat conditions; herbal medicine use; family history; and human genetics were risk factors for NPC. Fresh fruit and vegetable and tea consumption may be protective against NPC. CONCLUSIONS: Many epidemiological studies of risk factors in addition to EBV for the EBV-associated forms of BL, GC, HL and NPC have been undertaken, but there is a dearth of evidence for GC and BL. Available evidence is of variable quality. The aetiology of EBV-associated cancers likely results from a complex intersection of genetic, clinical, environmental and dietary factors, which is difficult to assess with observational studies. Large, carefully designed, studies need to be strategically undertaken to harmonise and clarify the evidence. REGISTRATION: PROSPERO CRD42017059806.

Which Phish Is on the Hook? Phishing Vulnerability for Older Versus Younger Adults.

OBJECTIVE: To determine if there are age-related differences in phishing vulnerability and if those differences exist under various task conditions (e.g., framing and time pressure). BACKGROUND: Previous research suggests that older adults may be a vulnerable population to phishing attacks. Most research exploring age differences has used limiting designs, including retrospective self-report measures and restricted email sets. METHOD: The present studies explored how older and younger adults classify a diverse sample of 100 legitimate and phishing emails. In Experiment 1, participants rated the emails as either spam or not spam. Experiment 2 explored how framing would alter the results when participants rated emails as safe or not safe. In Experiment 3, participants performed the same task as Experiment 1, but were put under time pressure. RESULTS: No age differences were observed in overall classification accuracy across the three experiments, rather all participants exhibited poor performance (20%-30% errors). Older adults took significantly longer to make classifications and were more liberal in classifying emails as spam or not safe. Time pressure seemed to remove this bias but did not influence overall accuracy. CONCLUSION: Older adults appear to be more cautious when classifying emails. However, being extra careful may come at the cost of classification speed and does not seem to improve accuracy. APPLICATION: Age demographics should be considered in the implementation of a cyber-training methodology. Younger adults may be less vigilant against cyber threats than initially predicted; older adults might be less prone to deception when given unlimited time to respond.

Understanding Relationships Between Chlamydial Infection, Symptoms, and Testing Behavior: An Analysis of Data from Natsal-3.

BACKGROUND: Genital chlamydia is the most commonly diagnosed sexually transmitted infection worldwide and can have serious long-term sequelae. Numerous countries invest substantially in testing but evidence for programs' effectiveness is inconclusive. It is important to understand the effects of testing programs in different groups of people. METHODS: We analyzed data on sexual behavior and chlamydia tests from 16-to 24-year olds in Britain's third National Survey of Sexual Attitudes and Lifestyles, considering test setting, reason, and result. We conducted descriptive analysis accounting for survey design and nonresponse, and Bayesian analysis using a mathematical model. RESULTS: Most men testing due to symptoms tested in sexual health settings (63%; 95% confidence interval 43%-84%) but most women testing due to symptoms were tested by general practitioners (59%; 43%-76%). Within behavioral groups, positivity of chlamydia screens (tests not prompted by symptoms or partner notification) was similar to population prevalence. Screening rates were higher in women and in those reporting more partners: median (95% credible interval) rates per year in men were 0.30 (0.25-0.36) (0 new partners), 0.45 (0.37-0.54) (1 new partner), and 0.60 (0.50-0.73) (≥2 new partners). In women, they were 0.61 (0.53-0.69) (0 new partners), 0.89 (0.75-1.04) (1 new partner), and 1.2 (1.0-1.4) (≥2 new partners). CONCLUSIONS: Proportion of testing occurring in sexual health is not a proxy for proportion prompted by symptoms. Test positivity depends on a combination of force of infection and screening rate and does not simply reflect prevalence or behavioral risk. The analysis highlights the value of recording testing reason and behavioral characteristics to inform cost-effective control.

Predictors of Epstein-Barr virus serostatus in young people in England.

BACKGROUND: Epstein-Barr virus (EBV) is an important human pathogen which causes lifelong infection of > 90% people globally and is linked to infectious mononucleosis (arising from infection in the later teenage years) and several types of cancer. Vaccines against EBV are in development. In order to determine the most cost-effective public health strategy for vaccine deployment, setting-specific data on the age at EBV acquisition and risk factors for early infection are required. Such data are also important to inform mathematical models of EBV transmission that can determine the required target product profile of vaccine characteristics. We thus aimed to examine risk factors for EBV infection in young people in England, in order to improve our understanding of EBV epidemiology and guide future vaccination strategies. METHODS: The Health Survey for England (HSE) is an annual, cross-sectional representative survey of households in England during which data are collected via questionnaires and blood samples. We randomly selected individuals who participated in the HSE 2002, aiming for 25 participants of each sex in each single year age group from 11 to 24 years. Stored samples were tested for EBV and cytomegalovirus (CMV) antibodies. We undertook descriptive and regression analyses of EBV seroprevalence and risk factors for infection. RESULTS: Demographic data and serostatus were available for 732 individuals. EBV seroprevalence was strongly associated with age, increasing from 60.4% in 11-14 year olds throughout adolescence (68.6% in 15-18 year olds) and stabilising by early adulthood (93.0% in those aged 22-24 years). In univariable and multivariable logistic regression models, ethnicity was associated with serostatus (adjusted odds ratio for seropositivity among individuals of other ethnicity versus white individuals 2.33 [95% confidence interval 1.13-4.78]). Smoking was less strongly associated with EBV seropositivity. CONCLUSIONS: By the age of 11 years, EBV infection is present in over half the population, although age is not the only factor associated with serostatus. Knowledge of the distribution of infection in the UK population is critical for determining future vaccination policies, e.g. comparing general versus selectively targeted vaccination strategies.

Modelling the dynamics of EBV transmission to inform a vaccine target product profile and future vaccination strategy.

Epstein-Barr virus (EBV) is one of the most common human viruses and the cause of pathologies such as infectious mononucleosis (IM) and certain cancers. No vaccine against EBV infection currently exists, but such vaccines are in development. Knowledge of how EBV is transmitted at the population level is critical to the development of target product profiles (TPPs) for such vaccines and future vaccination strategies. We present the first mathematical model of EBV transmission, parameterised using data from England, and use it to compare hypothetical prophylactic vaccines with different characteristics and the impact of vaccinating different age groups. We found that vaccine duration had more impact than vaccine efficacy on modelled EBV and IM prevalence. The age group vaccinated also had an important effect: vaccinating at a younger age led to a greater reduction in seroprevalence but an increase in IM cases associated with delayed infection. Vaccination had impact on cancer incidence only in the long run, because in England most EBV-related cancers arise in later life. Durability of protection should be a key factor to prioritise in EBV vaccine development and included in vaccine TPPs. These findings are timely and important for vaccine developers and policy-makers alike.

The psychological interaction of spam email features.

This study explored distinct perceptual and decisional contributions to spam email mental construal. Participants classified spam emails according to pairings of three stimulus features - presence or absence of awkward prose, abnormal message structure, and implausible premise. We examined dimensional interactions within general recognition theory (GRT; a multidimensional extension of signal detection theory). Classification accuracy was highest for categories containing either two non-normal dimension levels (e.g. awkward prose and implausible premise) or two normal dimension levels (e.g. normal prose and plausible premise). Modelling indicated both perceptual and decisional contributions to classification responding. In most cases, perceptual discriminability was higher along one dimension when stimuli contained a non-normal level of the paired dimension (e.g. prose discriminability was higher with abnormal structure). Similarly, decision criteria along one dimension were biased in favour of the non-normal response when stimuli contained a non-normal level of the paired dimension. Potential applications for training are discussed. Practitioner summary: We applied general recognition theory (i.e. multivariate signal detection theory) to spam email classification at low or high levels of three stimulus dimensions: premise plausibility, prose quality, and email structure. Relevant to training, this approach helped identify perceptual and decisional biases that could be leveraged to individualise training.

Depth benefits now loading: Visual working memory capacity and benefits in 3-D.

The present studies explored how performance in multidimensional displays varies as a function of visual working memory load, item distribution across depths, and individual capacity differences. In Experiment 1, the benefit of depth information (one depth vs. two depths) was examined across seven set sizes within a change-detection paradigm. Multiple depth planes engendered performance benefits with five items, but elicited performance decrements with three items. These effects were associated with working memory capacity, such that benefits were only observed when the working memory load exceeded an individual's max capacity. Experiment 2 evaluated how the distribution of items in depth aids working memory performance. Equal distribution of items across depths produced higher accuracy compared with when the target was isolated in depth. Lastly, Experiment 3 explored how differences in working memory capacity affect an individual's ability to use depth information to improve their performance. The results indicate that both low-capacity and high-capacity individuals can benefit from depth information, but this may vary as a function of working memory load. Overall, the results indicate that multidimensional displays can improve performance with sufficient working memory load, possibly through some sort of depth tag.