Equitable implementation of S.A.F.E. Firearm: A multi-method pilot study.

Attention to health equity is critical in the implementation of firearm safety efforts. We present our operationalization of equity-oriented recommendations in preparation for launch of a hybrid effectiveness-implementation trial focused on firearm safety promotion in pediatric primary care as a universal suicide prevention strategy. In Step 1 of our process, pre-trial engagement with clinican partners and literature review alerted us that delivery of a firearm safety program may vary by patients' medical complexity, race, and ethnicity. In Step 2, we selected the Health Equity Implementation Framework to inform our understanding of contextual determinants (i.e., barriers and facilitators). In Step 3, we leveraged an implementation pilot across 5 pediatric primary care clinics in 2 health system sites to study signals of inequities. Eligible well-child visits for 694 patients and 47 clinicians were included. Our results suggested that medical complexity was not associated with program delivery. We did see potential signals of inequities by race and ethnicity but must interpret with caution. Though we did not initially plan to examine differences by sex assigned at birth, we discovered that clinicians may be more likely to deliver the program to parents of male than female patients. Seven qualitative interviews with clinicians provided additional context. In Step 4, we interrogated equity considerations (e.g., why and how do these inequities exist). In Step 5, we will develop a plan to probe potential inequities related to race, ethnicity, and sex in the fully powered trial. Our process highlights that prospective, rigorous, exploratory work is vital for equity-informed implementation trials.

Cortical semantization of autobiographical memory over subjective chronological time: An fMRI study.

The content and neural representation of autobiographical memories change over time; however, these changes are poorly understood. We hypothesize that the content of memories becomes semanticized, while the neural representation moves from mesial to cortical structures. We conducted an fMRI (functional magnetic resonance imaging) study on the effects of time on autobiographical memory retrieval. Twenty healthy participants were cued by a selection of photographs that represented distinct episodic memories from 1, 2, 6, and 14 years prior to scanning. Our behavioural data of self-report measures of memory qualia suggests a loss of episodic content over time. GLM (general linear model) results demonstrate that across all time points, visual association cortices and mesial temporal lobes were activated. However, we did not observe any GLM differences between memory time points. We used SVM (support vector machine) in order to predict memory time point based on neural activation patterns. We were able to accurately predict classification accuracy for the 1-year (66.7%), 2-year (66.7%), and 14-year (33.4%) memory time points, with an overall classification accuracy of 55.6%. We suggest that our findings can be interpreted in light of cortical semantization; as memories age, they become more semanticized and shift in representation towards cortical structures.