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Therapist's Assessment of Their Patient's Session‐Level Emotional Processes: Validation of the In‐Session Patient Affective Reactions Questionnaire–Clinician Form
Get PDFBACKGROUND: The current study aimed to evaluate a therapist version of the in-Session Patient Affective Reactions Questionnaire (SPARQ). The SPARQ was developed to assess a pattern of emotions, thoughts, and behaviors experienced by a patient toward their therapist during a session. The SPARQ has existed only as a patient self-report measure and has demonstrated promise as a psychotherapy process measure. This study intended to validate a complementary clinician-report version of the questionnaire: the SPARQ-C. METHODS: A sample of licensed mental health clinicians (N = 151) completed the SPARQ-C along with other measures. Data analysis involved exploratory and confirmatory factor analyses (CFA). Reliability and convergent and criterion-related validity of the SPARQ-C were also evaluated. RESULTS: The SPARQ-C preserved the two-factor structure: positive affect (k = 4, ω total = 0.84) and negative affect (k = 4, ω total = 0.70), which correlated r = 0.26. CFA using the a priori model two-factor model based on the patient-report version provided the following fit indices: χ2 [19] = 26.01, CFI = 0.98; TLI = 0.97, RMSEA = 0.05 (90% CI [0.00, 0.09]), and SRMR = 0.05. The SPARQ-C scales demonstrated convergent and criterion-related validity with measures of other elements of the therapeutic relationship, session outcome, and demographic-clinical variables. DISCUSSION: The SPARQ-C is a reliable measure suitable for both clinical and research purposes. It allows for a nuanced assessment of patients' session-level affective responses towards their therapist from the clinician's perspective
SARS-CoV-2 testing behavior in symptomatic adults in a U.S. national cohort, 2020–2023: influence of exposure risk, susceptibility and healthcare access
Get PDFBackground COVID-19 continues to circulate and cause illness, hospitalizations and death in the U.S, underscoring the importance of understanding SARS-CoV-2 testing behavior among symptomatic adults. Yet few studies have evaluated testing frequency in this population. We examined SARS-CoV-2 testing patterns, including at-home and laboratory tests, among adults with COVID-like symptoms from 2020 to 2023, and assessed the influence of exposure risk, susceptibility to COVID-19 complications, and barriers to healthcare access on frequency of testing when ill. Methods The CHASING COVID Cohort study comprises a diverse sample of U.S. adults, with data collected quarterly from March 2020 to December 2023. We categorized participants with COVID-like symptoms as ‘frequent testers’ if they tested ≥ 66% of the time when symptomatic, ‘occasional testers’ if they tested > 33% and < 66% of the time, and ‘infrequent testers’ if they tested ≤ 33% of the time. Informed by the Blumenshine Pandemic Disease Framework, we examined the impact of SARS-CoV-2 exposure risk, susceptibility to COVID-19 complications if infected, and barriers to healthcare access on testing frequency using crude and adjusted log-binomial regression models. Results A total of 3929 participants reported symptoms of COVID-like illness in at least two assessments. A quarter (25%) of participants were frequent testers, 47% were occasional testers, and 29% were infrequent testers. One-third (30%) had greater risk of SARS-CoV-2 exposure, 51% were susceptible to COVID-19 complications, 24% were uninsured, and 34% had no regular provider of care. Testing frequency was positively correlated with household income, educational attainment, COVID-19 vaccination, willingness to take antivirals, trust in public health agencies and healthcare providers for COVID-19 vaccine information. Those with more (versus less) exposure risk (aRR 1.14, 95% CI [1.01, 1.26]), COVID-19 susceptibility (aRR 1.17, 95% CI [1.05, 1.30]), no insurance (aRR 1.52, 95% CI [1.37, 1.70]), and no regular healthcare provider (aRR 1.32, 95% CI [1.19, 1.46]) were more likely to test infrequently. Conclusions Individuals with the greatest risk of SARS-CoV-2 exposure, susceptibility to COVID-19 complications, and barriers to healthcare access were the least likely to test when ill. Public health initiatives should prioritize improving testing uptake among these populations
Home sputum collection for Aspergillus fumigatus detection in adults with cystic fibrosis
Get PDFBackground Elexacaftor/tezacaftor/ivacaftor (ETI) has impacted the ability for people with cystic fibrosis (PwCF) to spontaneously expectorate sputum, leading to lower respiratory sampling rates and infection detection challenges. Home sampling may permit a potential strategy for fungal detection in PwCF. Methods We conducted a prospective decentralised cohort study of PwCF to test the feasibility of home sputum collection and ambient temperature transport for Aspergillus fumigatus (Af) detection. Participants collected and shipped weekly sputum samples from home to the laboratory for fungal culture and completed electronic questionnaires. Descriptive statistics were calculated for patient factors, sputum characteristics and Af-positive cultures. We used a generalised estimating equations model to determine the association between highly effective modulator therapy (HEMT) and sputum volume. Results We enrolled 76 adults with cystic fibrosis (CF) with a median (interquartile range) forced expiratory volume in 1 s (FEV1) % predicted of 72.5% (53.8–86.3). 60 (79%) were on ETI and 44 (58%) had a history of Aspergillus. 70 (92%) successfully collected and shipped three or more sputum samples. Of 284 samples received, 83% arrived within one day. Sputum collection was reported as easy in 83 (29%) and somewhat easy in 114 (40%) collection events. Sputum volume from PwCF on HEMT was 36% lower than those not on HEMT (36%, 95% CI 3–58; p=0.03), adjusting for covariates. Af was detected in 205 (73%) of home sputum samples. Conclusion Home sputum collection is feasible in adults with CF. Af was detected in remotely collected sputum samples. Further work to assess the validity of home sputum samples in PwCF is necessary to determine the value of remote specimens in clinical and research settings
Enhancing hip and knee arthroplasty outcomes with immunonutrition: A review of the evidence
Get PDFTotal hip and knee arthroplasty are common surgical procedures aimed at improving mobility and quality of life. Despite surgical advances, postoperative complications remain a concern, particularly for patients with comorbidities and poor nutritional status. Immunonutrition, the targeted administration of nutrients that modulate inflammation, such as arginine, omega-3 fatty acids, and antioxidants, has been shown to reduce infections, complications in wound healing, and shorten hospital length of stay. This review examines current evidence on the role of immunonutrition in hip and knee arthroplasty, focusing on the mechanisms of key nutrients, clinical application of supplementation, and areas for future investigation. Despite promising outcomes, further research is needed within orthopedics to establish guidelines for patient screening, nutrient dosage, and timing of administration
Evaluation of a no-code AI model for detecting periapical radiolucencies: impact of anatomical region on diagnostic performance
Get PDFBackground To develop a no-code artificial intelligence (AI) model for the detection of apical radiolucent lesions and to assess how lesion location influences the model’s diagnostic performance. Methods 312 periapical radiographs were retrospectively collected, each accompanied by a corresponding cone-beam computed tomography (CBCT) scan obtained within six months and a radiology report authored by board-certified oral and maxillofacial radiologists. These reports served as the reference standard, and all findings were cross-verified by the primary investigator through CBCT review. The dataset included 181 images with at least one apical radiolucent lesion and 131 lesion-free controls. Using the no-code AI platform LandingLens (Landing AI LLC, Palo Alto, CA), a diagnostic model was developed. De-identified radiographs were manually annotated with bounding boxes around lesions and automatically divided into training (70%), validation (20%), and testing (10%) subsets. Model performance was evaluated at the tooth level using sensitivity, specificity, accuracy, precision, and F1 score. To investigate the influence of anatomical sites, data were stratified by region and analyzed using chi-square and pairwise chi-square tests (α = 0.05). Results The AI model demonstrated robust diagnostic performance, achieving 88.7% sensitivity, 93.0% specificity, 76.6% precision, 92.1% accuracy, and an F1 score of 0.822. Sensitivity was significantly higher in the maxilla (93.1%) compared to the mandible (83.8%; p = 0.049), whereas specificity was greater in the mandible (95.4%) than in the maxilla (90.8%; p = 0.01). No differences in performance were found between anterior and posterior teeth (p > 0.05). Regionally, the highest sensitivity was observed in the anterior maxilla (97.7%), while specificity peaked in the anterior mandible (97.9%; p < 0.05). Other diagnostic metrics did not vary significantly across regions (p > 0.05). Conclusions This no-code AI model demonstrated high accuracy in detecting apical radiolucent lesions and revealed that diagnostic performance can vary based on anatomical location. The model's increased sensitivity in the maxilla and higher specificity in the mandible highlight the relevance of regional anatomy in AI-assisted diagnostics. These findings support the potential of no-code AI platforms as accessible tools for building clinically meaningful diagnostic models and underscore the importance of anatomical considerations in their implementation
Prevalence and Risk Factors for Suicidal Ideation and Attempts Among Black LGBTQ+ Young Adults
Get PDFBACKGROUND Young people who hold both a Black and LGBTQ+ identity (e.g., lesbian, gay, bisexual, transgender, queer) are facing increasingly high levels of suicide risk. Very few studies have investigated risk factors that contribute to suicidality among Black LGBTQ+ young adults, many of whom live in the southeastern United States, including North Carolina. This study aims to investigate the risk factors that impact the Black LGBTQ+ young adult population. METHODS Data were collected through a cross-sectional survey in North Carolina from June–October 2023. The analytic sample includes 361 Black LGBTQ+ young people aged 18–34 years, a developmental period where individuals transition out of adolescence and into adulthood. Analyses include descriptive statistics and binary logistic regression modeling predicting suicidal ideation and suicide attempts as outcomes using predictor variables from multiple domains (i.e., demographics, psychological disorders, substance use, exposure to discrimination and violence, and poverty). RESULTS About one-third of participants considered suicide at some point in their lives, and nearly one-fifth of participants attempted suicide. Results also show that food scarcity was associated with suicidal ideation. Among substances, alcohol consumption increased risk for suicidal ideations while cocaine/crack use increased risk for suicide attempts. Having a psychological disorder (i.e., depression, bipolar disorder, post-traumatic stress disorder, anxiety disorder, gender dysphoria, and eating disorder) increased risk for suicidal ideation and/or attempt. Implications for suicide prevention and future research are discussed. LIMITATIONS Study limitations included convenience sampling, cross-sectional data, lack of variables unique to the population group, and measurement of lifetime suicidality. CONCLUSIONS Black LGBTQ+ young people report high rates of suicidality. Intervening to mitigate food scarcity, alcohol consumption, cocaine use, and mental health challenges may reduce suicidality among Black LGBTQ+ young people
Impact of digital fabrication techniques on the color stability of complete dentures base and artificial teeth
Get PDFBackground This study evaluated the color stability of digitally fabricated complete dentures compared to conventional ones. Materials and methods Forty-five specimens were fabricated using 3 different manufacturing methods (injection mold, one-piece milling, and two-piece 3D printing and milling techniques), with 15 specimens per group. After implementing a standardized polishing protocol, each group was randomly subdivided into three subgroups (n = 5) and immersed in distilled water, coffee, and red wine for seven days at a controlled temperature of 37 °C. Color changes in denture teeth and base materials were evaluated utilizing VITA Easyshade and ImageJ software before and after immersion. Subsequently, all specimens underwent a manufacturer-recommended denture cleansing regimen for seven days, followed by a repeated staining cycle. Two-way ANOVA and Tukey post-hoc tests were used for statistical analysis (α = 0.05), while the prevalence of denture tooth shade change was reported descriptively. Results The finding revealed that coffee caused more discoloration than red wine. Milled specimens showed better color stability against red wine than conventionally fabricated dentures. While initial staining was noted, the cleaning protocol successfully restored the original colors. This pattern persisted with repeated staining, highlighting the importance of material selection and maintenance in maintaining denture aesthetics. Conclusions Exposure to coffee and red wine leads to noticeable color changes in both denture teeth and base materials. The degree of staining depends on the specific material composition, highlighting the importance of selecting stain-resistant materials for better long-term color stability .Supplementary Information The online version contains supplementary material available at 10.1186/s12903-025-07197-3
RATIONAL DESIGN AND ENGINEERING OF A BIPARATOPIC ANTIBODY TARGETING CCR2 IN TRIPLE NEGATIVE BREAST CANCER
Get PDFChemokine signaling plays a pivotal role in cancer progression, shaping the tumormicroenvironment and influencing disease outcomes. Among these, interactions between thechemokine CCR2 receptor and its ligand CCL2 has been shown to be a key driver of cancerprogression by recruiting immune-suppressive cells to the tumor microenvironment. MostCCR2-targeting antibodies block the N-terminal domain (NTD) of the receptor as this is theprimary binding site of its ligand CCL2. However, CCR2 contains three additional extracellularloops that also participate in binding interactions, thus mediating downstream signaling. Here,we developed a biparatopic antibody that targets two distinct, non-overlapping epitopes onCCR2: the NTD and the extracellular loop 3 (ECL3). We hypothesized that simultaneouslyblocking two distinct epitopes on CCR2 would more effectively inhibit the CCR2/CCL2signaling axis, thus curtailing tumor progression. Binding interactions were modeled usingAlphaFold and HADDOCK and validated by ELISA and surface plasmon resonance assays.When compared to monospecific constructs, the biparatopic antibody demonstrated strongerbinding affinity to a CCR2-mimicking peptide. Functional studies showed that treatment with thebiparatopic antibody enhanced macrophage polarization to a pro-inflammatory (anti-tumor) state,with up to 70-fold improvement in M1/M2 ratios in bone marrow-derived macrophages relativeto single-epitope blockers for as long as 24 hours after treatment. In a murine model of triple-iiinegative breast cancer, the biparatopic antibody demonstrated a significant reduction in tumorgrowth. These findings highlight its potential as a therapeutic agent for reshaping macrophagepolarization and inhibiting tumor progression.Doctor of Philosoph
UNVEILING RELATIONS: STATISTICAL INDEPENDENCE TEST AND LOW-DIMENSIONAL MANIFOLD LEARNING
Get PDFDetermining dependence between two continuous random vectors in high dimensions (d>>1) from noisy observations is a fundamental problem in scientific research. Inspired by the recent work on non-parametric tests of independence using Hadamard matrices (Walsh wavelets) in search of dependencies between random variables of a noisy sample, we present a frequency domain analysis-based framework and design a class of non-parametric tests of independence. This dissertation first expands the Walsh wavelets to other basis function choices. We found that the polynomial-based basis choices often perform better when the underlying relations can be approximatedby polynomial equation-based relations. When the Legendre polynomial basisfunctions are used, we apply the canonical component analysis (CCA) to find an optimal algebraic variety (zeros of a polynomial equation) on which data may be located. Rigorous mathematical analysis is performed to justify the optimization problem and its CCA-based solution. Numerical experiments were performed to understand the stability of this low-dimensional manifold learning algorithm. To address high-dimensional challenges, we explored hierarchical tree-based Haar wavelet basis and corresponding fast transforms, randomized algorithms, and k-nearest neighbors based sensor functions. Extensive numerical experiments were performed in 2+1 dimensionsto understand the mathematical and statistical properties of different approaches.Finally, out of curiosity, we study the application of modern deep neural network (DNN)approaches for independence tests. We discovered that the convolutional neural network (CNN) architecture can effectively distinguish between different distributions, however, in its current training settings and with the current feature inputs, it is unable to handle independence testing for arbitrary distributions in high dimensions.Doctor of Philosoph
THE IMPACT OF NEW AWARENESS OF A SEXUALLY TRANSMITTED INFECTION ON INTERNALIZED HIV STIGMA AND DEPRESSIVE SYMPTOMS AMONG WOMEN LIVING WITH HIV IN THE UNITED STATES
Get PDFWomen living with HIV (WLWH) experience internalized HIV stigma (hereafter stigma) and increased depressive symptoms compared to women without HIV and men with HIV in the United States (US). Both psychological experiences impact WLWH’s mental health, but their drivers remain underexplored. I postulated a new non-HIV sexually transmitted infection (STI) may increase stigma and depressive symptoms via retraumatization. Separately, causal effect estimates of a stigma reduction intervention on depressive symptoms remain unknown and warrant further investigation.Data from the Women’s Interagency HIV Study (WIHS) included new STI awareness (chlamydia, gonorrhea, syphilis, herpes simplex 2, genital warts, or trichomoniasis), stigma scores, and depressive symptom scores. I modeled mean differences in stigma and depressive symptom scores, separately, at visits with an STI versus visits without using generalized linear models with generalized estimating equations, weighted for confounding and censoring. Results were stratified by race/ethnicity categories, and 95% confidence intervals (CIs) were bootstrapped. The g-formula simulated the effects of a stigma reduction intervention on depressive symptoms. The effect of the hypothetical intervention was calculated, at varying point reductions, for the total analysis population and a subset population with probable depression (CES-D ≥ 16). Mean differences in stigma scores between visits with and without an STI varied by race/ethnicity and ranged from -0.43 (95% CI: -1.18, 0.32) to 0.42 (-0.10, 0.93). All Hispanic ethnicity groups (White, Hispanic; Black, Hispanic; and Other, Hispanic) experienced increased scores at visits with STIs. Mean differences in CES-D scores between visits with and without an STI also varied by race/ethnicity. Black, non-Hispanic participants had a 1.46 (0.57, 2.34) point increase in CES-D scores at visits with a reported STI versus visits without. In the total population, decreases in stigma decreased depressive symptoms by varying degrees. A 0.50 decrease led to a mean difference in -1.45 (-2.33, 0.57) in CES-D scores in the total population. For WLWH, an STI affected stigma and CES-D scores differently by race/ethnicity group. Analyses suggested that increased mental health support following a new STI may reduce depressive symptom burden in some WLWH. Interventions focusing on stigma reduction are one potential way to improve WLWH’s mental health.Doctor of Philosoph