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Artificial intelligence conversational agents in mental health: Patients see potential, but prefer humans in the loop
Get PDFBACKGROUND: Digital mental health interventions, such as artificial intelligence (AI) conversational agents, hold promise for improving access to care by innovating therapy and supporting delivery. However, little research exists on patient perspectives regarding AI conversational agents, which is crucial for their successful implementation. This study aimed to fill the gap by exploring patients' perceptions and acceptability of AI conversational agents in mental healthcare.
METHODS: Adults with self-reported mild to moderate anxiety were recruited from the UMass Memorial Health system. Participants engaged in semi-structured interviews to discuss their experiences, perceptions, and acceptability of AI conversational agents in mental healthcare. Anxiety levels were assessed using the Generalized Anxiety Disorder scale. Data were collected from December 2022 to February 2023, and three researchers conducted rapid qualitative analysis to identify and synthesize themes.
RESULTS: The sample included 29 adults (ages 19-66), predominantly under age 35, non-Hispanic, White, and female. Participants reported a range of positive and negative experiences with AI conversational agents. Most held positive attitudes towards AI conversational agents, appreciating their utility and potential to increase access to care, yet some also expressed cautious optimism. About half endorsed negative opinions, citing AI's lack of empathy, technical limitations in addressing complex mental health situations, and data privacy concerns. Most participants desired some human involvement in AI-driven therapy and expressed concern about the risk of AI conversational agents being seen as replacements for therapy. A subgroup preferred AI conversational agents for administrative tasks rather than care provision.
CONCLUSIONS: AI conversational agents were perceived as useful and beneficial for increasing access to care, but concerns about AI's empathy, capabilities, safety, and human involvement in mental healthcare were prevalent. Future implementation and integration of AI conversational agents should consider patient perspectives to enhance their acceptability and effectiveness.No embarg
Childhood adversity is associated with longitudinal white matter changes after adulthood trauma [preprint]
Get PDFThis article is a preprint. Preprints are preliminary reports of work that have not been certified by peer review.Background: Childhood adversity is associated with susceptibility to posttraumatic stress disorder (PTSD) in adulthood. Both PTSD and adverse experiences in childhood are linked to disrupted white matter microstructure, yet the role of white matter as a potential neural mechanism connecting childhood adversity to PTSD remains unclear. The present study investigated the potential moderating role of previous childhood adversity on longitudinal changes in white matter microstructures and posttraumatic stress symptoms following a recent traumatic event in adulthood.
Methods: As part of the AURORA Study, 114 recent trauma survivors completed diffusion weighted imaging at 2-weeks and 6-months after exposure. Participants reported on prior childhood adversity and PTSD symptoms at 2-weeks, 6-months, and 12-months post-trauma. We performed both region-of-interest (ROI) and whole-brain correlational tractography analyses to index associations between white matter microstructure changes and prior adversity.
Results: Whole-brain correlational tractography revealed that greater childhood adversity moderated the changes in quantitative anisotropy (QA) over time across threat and visual processing tracts including the cingulum bundle and inferior fronto-occipital fasciculus (IFOF). Further, QA changes within cingulum bundle, IFOF, and inferior longitudinal fasciculus were associated with changes in PTSD symptoms between 2-weeks and 6-months.
Conclusions: Our findings suggest temporal variability in threat and visual white matter tracts may be a potential neural pathway through which childhood adversity confers risk to PTSD symptoms after adulthood trauma. Future studies should take the temporal properties of white matter into consideration to better understand the neurobiology of childhood adversity and PTSD.No embarg
Outcomes of Witnessed Versus Unwitnessed Patients With Stroke After Endovascular Therapy in the Extended Time Window
Get PDFBackground: It remains unclear whether outcomes of patients treated with endovascular thrombectomy with large-vessel occlusion and unwitnessed onset of stroke differ from those with witnessed onset in the extended time window.
Methods: We enrolled patients with anterior circulation large-vessel occlusion (internal carotid artery, M1, or M2 segment of the middle cerebral artery) undergoing endovascular thrombectomy within 6 to 24 hours from the time last seen well, from 2014 to 2022, at 66 sites in Europe, North America, and Asia. Patients with a prestroke modified Rankin Scale score of >3 or age <18 were excluded. We categorized patients by onset mode as witnessed or unwitnessed. The primary outcome was the modified Rankin Scale shift at 90 days. Secondary outcomes were functional independence, a composite of functional independence or return of Rankin to prestroke level, symptomatic intracranial hemorrhage, mortality, and a composite of severe disability or mortality at 90 days. We applied inverse probability of treatment weighting to compare outcomes between the groups.
Results: Of 5098 patients assessed for eligibility, we included 2073, of whom 1760 (84.9%) had unwitnessed onset, and 313 (15.1%) were witnessed. In the univariate comparison (before inverse probability of treatment weighting), 38.8% of the unwitnessed and 45.7% of the witnessed patients achieved functional independence (P=0.022). Mortality was 21.6% among unwitnessed and 22.0% among witnessed (P=0.847), and symptomatic intracranial hemorrhage rates were 6.6% and 5.8%, respectively (P=0.623). The primary outcome (modified Rankin Scale shift) showed no difference comparing unwitnessed to witnessed patients (odds ratio, 1.35 [95% CI, 0.82-2.20]; P=0.235) in the inverse probability of treatment weighting. Unwitnessed patients were more likely to achieve functional independence or return of Rankin (1.53 [1.01-2.33]; P=0.045). Other secondary outcomes did not differ between the witnessed and unwitnessed patients.
Conclusions: In the extended time window, unwitnessed patients with large-vessel occlusion undergoing endovascular thrombectomy have at least the same likelihood of favorable outcomes as witnessed patients.
Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04096248.No embarg
Measuring Burnout in Pediatric ICU Nurses: Development and Pilot Validation of a PICU RN Burnout Scale
No full textN/ABackground. Burnout among Pediatric Intensive Care Unit (PICU) nurses is a significant issue. Existing Burnout scales are limited and fail to address factors like moral distress and resource constraints or the emotionally frought nature of pediatric critical care. There is a need for a more specific tool to assess burnout in PICU nurses, which often exceeds 50%.
Objectives. This study aimed to develop and validate the first PICU RN Burnout Scale, designed to assess burnout specific to PICU nursing practice.
Methods. A cross-sectional, observational design was used to pilot the PICU RN Burnout Scale nationwide. Validity was assessed through comparison with the MBI and McCloskey/Mueller Satisfaction Scale. Reliability was measured using Cronbach’s alpha, and factor structure was evaluated via Exploratory Factor Analysis (EFA).
Results. Seventy-one nurses participated. EFA revealed a three-factor structure: Peer Incivility, Psychophysical Stress, and Leadership Support, explaining 74% of the variance. The scale showed excellent internal consistency (α = 0.93) and moderate concurrent validity with the MBI (ρ = 0.56, p < 0.001). Discriminant validity was confirmed with a negative correlation (ρ = -0.61, p < 0.001) with the McCloskey-Mueller Scale.
Conclusions. The PICU RN Burnout Scale offers a tailored assessment of burnout, addressing unique stressors not captured by the MBI. It demonstrated strong reliability and validity, suggesting its utility in identifying burnout in PICU nurses. Further research is needed to validate the scale and inform targeted future interventions.No embarg
Longitudinal cognitive outcomes are strongly correlated with the Alzheimer’s Disease microbiome
Get PDFBackground: It has been shown that dysbiosis, or dysfunction of the gastrointestinal
(gut) microbiome is associated with Alzheimer’s disease (AD). Here, we aimed to
expand on beyond our previously reported findings of the gut microbiome associating
with AD and explore if the gut microbiome is predictive of cognitive performance in
individuals with AD. We sought to identity what cognitive domains are associated with
the microbiome in our cohort of AD patients and healthy controls without dementia.
Method: Older individuals residing in the general community of central Massachusetts
were enrolled in our study. At each visit, fecal samples and clinical variables were
collected in addition to cognitive testing using the ADAS-Cog-13 tool, such as
delayed memory, word recall, recognition etc. Metagenomic profiling was performed
on longitudinal fecal samples. Z-scores for different cognitive domains, including
memory, executive function and language were generated for the study population.
Mixed-effect random forest regression (MERFR) models were created to identify
metagenomic features informative of cognitive performance across these different
cognitive tests and domains.
Result: Replicating our previous work, among AD diagnosed individuals, MERFR
models predicted performance on ADAS-Cog 13 from microbial abundance and
pathways with a strong accuracy. The ADAS-Cog 13 was not well predicted by the
microbiome in the healthy controls. Additionally, in our new analysis across different
cognitive domains, Z-Scores were well predicted by MERFR models using microbial
abundance and encoded pathways.
Conclusion: Not only is the gut microbiome composition highly predictive of
AD diagnosis, but there is also a strong correlation of the gut microbiome and
cognitive functioning. This is true across the multiple domains of cognition including
memory, executive function and language, however different bacterial species were
significant in associating with each domain. This work highlights the complexity of the microbiome-gut-brain axis and how the microbiome community makeup might play a
role in cognitive decline.No embarg
A deep learning framework for comprehensive segmentation of deep grey nuclei [preprint]
Get PDFThis article is a preprint. Preprints are preliminary reports of work that have not been certified by peer review.BACKGROUND: Deep grey matter structures such as the thalamus and basal nuclei are implicated in numerous neurological disorders, yet accurate segmentation of these structures from standard T1-weighted MRI remains challenging due to poor intra-subcortical contrast, long preprocessing pipelines, and fragmented toolsets.
METHODS: We introduce THOMASINA a deep learning pipeline for comprehensive subcortical segmentation from standard T1-weighted (T1w) as well as white-matter-nulled (WMn) MRI. The method leverages labels derived from a recently published state-of-the-art multi-atlas segmentation method to train multiple 3D deep learning-based segmentation models including SwinUNETR, DiNTS, and SegResNet. All networks were trained on cropped volumes and tested on held-out and out-of-distribution datasets. For T1-weighted MRI, an additional synthesis step was used to generate WMn-like contrast prior to segmentation.
RESULTS: SegResNet achieved the best performance (mean Dice = 0.89 on with in-domain test data, 0.85 on out-of-domain test data), outperforming DiNTS and SwinUNETR in both accuracy and robustness. It also had the highest mean, median, and minimum Dice and lowest SD in most nuclei compared to the DiNTS and SwinUNETR. Synthetic WMn contrast provided comparable segmentation to actual WMn images. The proposed networks reduced per-subject segmentation time to the order of seconds versus tens of minutes using traditional multi-atlas segmentation. THOMASINA also generalized well across field strengths, scanner vendors, and disease cohorts.
CONCLUSIONS: THOMASINA offers a fast, reproducible, and scalable solution for comprehensive subcortical segmentation from standard T1w MRI. By combining synthetic WMn contrast with state-of-the-art deep learning-based segmentation models, our method addresses key barriers to deployment and sets a foundation for biomarker discovery in clinical and population-scale imaging studies.No embarg
Percutaneous transabdominal plug-assisted antegrade and retrograde transvenous embolization for the treatment of ruptured paraumbilical varices with concurrent flood syndrome: A case report
No full textRuptured paraumbilical varices and Flood syndrome (umbilical hernia rupture with ascites leakage) are both life-threatening conditions, each carrying >30% mortality. Co-occurrence of the 2 requires immediate portal decompression and variceal hemostasis for a chance of survival. This report presents a case of concurrent paraumbilical variceal rupture and Flood syndrome with massive leakage of ascites and blood in a 52-year-old male with alcohol-related cirrhosis. A strategy combining transjugular intrahepatic portosystemic shunt (TIPS) with direct percutaneous transvenous paraumbilical variceal embolization enabled immediate cessation of bleeding and eventual survival. Direct percutaneous transvenous access was the key to rapid hemostatic control, overcoming tortuous anatomy and difficult venous manipulation. This technique expands therapeutic options for complex ectopic varices and supports the safety of direct percutaneous access for portal interventions.No embarg
"What Program Directors Think" VI: Results of the 2024 Survey of the APDR Part 2
No full textRationale and objectives: The Association of Program Directors in Radiology (APDR) surveys its members for data gathering on impediments to resident education, variations in resource allocation and recent changes to the American Board of Radiology (ABR) certifying examination.
Materials and methods: This was an observational, cross-sectional study using a Web-based survey. Members of the 2022-2023 Annual Survey Committee developed survey questions resulting in 40 items, including demographic data. The survey was distributed by email to all active members of the APDR in January and February of 2024. In this paper, challenges and potential solutions to residency education, current state of resource allocation, PD's opinion on return of the ABR's oral examination, and procedural skills necessary for graduating trainees are presented.
Results: The total survey response rate was 31% (84/247). The top five challenges to education were high clinical volumes (88%), insufficient protected time for teaching (64%), remote reaching on clinical rotations (58%) and high focus on relative value units (RVU) (50%). Proposed solutions included dedicated teaching faculty on the rotation schedule, RVU balancing to better value teaching, incentivize on-site faculty, universal, validated teaching resources and increasing the number of residency slots. The results of this survey were presented at the annual Association of Academic Radiology meeting in Boston, MA (April 2024).
Conclusion: Survey results find that a quarter of radiology PDs do not receive the full administrative time allocation mandated by the ACGME. The majority of the respondents favor the transition to the ABR oral examination and approve of the 10 procedures created by the APDR Procedures Taskforce. The greatest challenges facing Radiology residency education are a shortage of the radiology workforce, high clinical volumes impeding the balance between education and clinical work, and a lack of engagement and desire for remote work on the part of teaching faculty. Potential solutions to the challenges in Radiology residency education that are likely to decrease burnout and promote faculty interest in education include standardizing work RVUs to account for teaching, developing a cadre of dedicated in-person teaching faculty granted clinical RVU reductions, and facilitating asynchronous teaching.No embarg
National Estimates of Opioid Overdose Hospitalizations Resulting in Hypoxic-ischemic Brain Injury
No full textNo embarg
Thirty-Year Trends (1991-2020) in Breast Cancer Incidence Rates: Hanoi, Vietnam
Get PDFPurpose: Breast cancer is the most common cancer in Vietnam, yet there are limited data on long-term trends and factors influencing its incidence. This study examines 30-year trends (1991-2020) in breast cancer incidence among women in Hanoi, focusing on age, period, and cohort effects.
Methods: Data from 28,298 breast cancer cases registered in the Hanoi Cancer Registry between 1991 and 2020 were analyzed. Trend analysis using Joinpoint regression was performed to calculate the average annual percent change (AAPC) in incidence rates, and an age-period-cohort analysis was used to explore underlying trends.
Results: The age-standardized incidence rate of breast cancer rose from 15.2 per 100,000 in 1991 to 40.6 per 100,000 in 2020, with an overall AAPC of 4.1% (95% CI, 2.9 to 5.4). Women age 70 years and older experienced the highest increase (AAPC, 6.4% [95% CI, 2.5 to 10.4]) compared with those age 40-49 years (AAPC, 2.6% [95% CI, 2.1 to 3.1]). Incidence rates during 2016-2020 were 1.6 times higher than in 2001-2005. Women born between 1976 and 1980 exhibited significantly higher incidence rates compared with earlier cohorts.
Conclusion: Breast cancer incidence in Hanoi has more than doubled over three decades, with significant age, period, and cohort effects. These findings provide insights for the development of targeted breast cancer control strategies, including tailored screening, prevention efforts, and resource allocation to address the growing burden of this disease in Vietnam.No embarg