Engineers have come up with a new way to teach robots to know when they don’t know. The technique involves quantifying the fuzziness of human language and using that measurement to tell robots when to ask for further directions. Telling a robot to pick up a bowl from a table with only one bowl is fairly clear. But telling a robot to pick up a bowl when there are five bowls on the table generates a much higher degree of uncertainty — and triggers the robot to ask for clarification.
JMIR Form Res. 2023 Nov 29;7:e50367. doi: 10.2196/50367.
ABSTRACT
BACKGROUND: Vaccine hesitancy poses a substantial threat to efforts to mitigate the harmful effects of the COVID-19 pandemic. To combat vaccine hesitancy, officials in the United States issued vaccine mandates, which were met with strong antivaccine discourse on social media platforms such as Reddit. The politicized and polarized nature of COVID-19 on social media has fueled uncivil discourse related to vaccine mandates, which is known to decrease confidence in COVID-19 vaccines.
OBJECTIVE: This study examines the moral foundations underlying uncivil COVID-19 vaccine discourse. Moral foundations theory poses that individuals make decisions to express approval or disapproval (ie, uncivil discourse) based on innate moral values. We examine whether moral foundations are associated with dimensions of incivility. Further, we explore whether there are any differences in the presence of incivility between the r/coronaviruscirclejerk and r/lockdownskepticism subreddits.
METHODS: Natural language processing methodologies were leveraged to analyze the moral foundations underlying uncivil discourse in 2 prominent antivaccine subreddits, r/coronaviruscirclejerk and r/lockdownskepticism. All posts and comments from both of the subreddits were collected since their inception in March 2022. This was followed by filtering the data set for key terms associated with the COVID-19 vaccine (eg, “vaccinate” and “Pfizer”) and mandates (eg, “forced” and “mandating”). These key terms were selected based on a review of existing literature and because of their salience in both of the subreddits. A 10% sample of the filtered key terms was used for the final analysis.
RESULTS: Findings suggested that moral foundations play a role in the psychological processes underlying uncivil vaccine mandate discourse. Specifically, we found substantial associations between all moral foundations (ie, care and harm, fairness and cheating, loyalty and betrayal, authority and subversion, and sanctity and degradation) and dimensions of incivility (ie, toxicity, insults, profanity, threat, and identity attack) except for the authority foundation. We also found statistically significant differences between r/coronaviruscirclejerk and r/lockdownskepticism for the presence of the dimensions of incivility. Specifically, the mean of identity attack, insult, toxicity, profanity, and threat in the r/lockdownskepticism subreddit was significantly lower than that in the r/coronaviruscirclejerk subreddit (P<.001).
CONCLUSIONS: This study shows that moral foundations may play a substantial role in the presence of incivility in vaccine discourse. On the basis of the findings of the study, public health practitioners should tailor messaging by addressing the moral values underlying the concerns people may have about vaccines, which could manifest as uncivil discourse. Another way to tailor public health messaging could be to direct it to parts of social media platforms with increased uncivil discourse. By integrating moral foundations, public health messaging may increase compliance and promote civil discourse surrounding COVID-19.
PMID:38019581 | DOI:10.2196/50367
J Med Internet Res. 2023 Nov 29;25:e49257. doi: 10.2196/49257.
ABSTRACT
BACKGROUND: Metabolic syndrome (MetS) is a common public health challenge. Health-promoting behaviors such as diet and physical activity are central to preventing and controlling MetS. However, the adoption of diet and physical activity behaviors has always been challenging. An individualized mobile health (mHealth)-based intervention using the Behavior Change Wheel is promising in promoting health behavior change and reducing atherosclerotic cardiovascular disease (ASCVD) risk. However, the effects of this intervention are not well understood among people with MetS in mainland China.
OBJECTIVE: We aimed to evaluate the effects of the individualized mHealth-based intervention using the Behavior Change Wheel on behavior change and ASCVD risk in people with MetS.
METHODS: We conducted a quasi-experimental, nonrandomized study. Individuals with MetS were recruited from the health promotion center of a tertiary hospital in Zhejiang province, China. The study involved 138 adults with MetS, comprising a control group of 69 participants and an intervention group of 69 participants. All participants received health education regarding diet and physical activity. The intervention group additionally received a 12-week individualized intervention through a WeChat mini program and a telephone follow-up in the sixth week of the intervention. Primary outcomes included diet, physical activity behaviors, and ASCVD risk. Secondary outcomes included diet self-efficacy, physical activity self-efficacy, knowledge of MetS, quality of life, and the quality and efficiency of health management services. The Mann-Whitney U test and Wilcoxon signed rank test were primarily used for data analysis. Data analysis was conducted based on the intention-to-treat principle using SPSS (version 25.0; IBM Corp).
RESULTS: Baseline characteristics did not differ between the 2 groups. Compared with the control group, participants in the intervention group showed statistically significant improvements in diet behavior, physical activity behavior, diet self-efficacy, physical activity self-efficacy, knowledge of MetS, physical health, and mental health after a 12-week intervention (P=.04, P=.001, P=.04, P=.04, P=.001, P=.04, P=.04, and P<.05). The intervention group demonstrated a statistically significant improvement in outcomes from pre- to postintervention evaluations (P<.001, P=.03, P<.001, P=.04, P<.001, P<.001, and P<.001). The intervention also led to enhanced health management services and quality.
CONCLUSIONS: The individualized mHealth-based intervention using the Behavior Change Wheel was effective in promoting diet and physical activity behaviors in patients with MetS. Nurses and other health care professionals may incorporate the intervention into their health promotion programs.
PMID:38019579 | DOI:10.2196/49257
J Med Internet Res. 2023 Nov 29;25:e49639. doi: 10.2196/49639.
ABSTRACT
BACKGROUND: Several systematic reviews have addressed digital technology use for treatment and monitoring of chronic obstructive pulmonary disease (COPD).
OBJECTIVE: This study aimed to assess if systematic reviews considered the effects of sex, gender, or age on the outcomes of digital technologies for treatment and monitoring of COPD through an overview of such systematic reviews. The objectives of this overview were to (1) describe the definitions of sex or gender used in reviews; (2) determine whether the consideration of sex, gender, or age was planned in reviews; (3) determine whether sex, gender, or age was reported in review results; (4) determine whether sex, gender, or age was incorporated in implications for clinical practice in reviews; and (5) create an evidence map for development of individualized clinical recommendations for COPD based on sex, gender, or age diversity.
METHODS: MEDLINE, the Cochrane Library, Epistemonikos, Web of Science, and the bibliographies of the included systematic reviews were searched to June 2022. Inclusion was based on the PICOS framework: (1) population (COPD), (2) intervention (any digital technology), (3) comparison (any), (4) outcome (any), and (5) study type (systematic review). Studies were independently selected by 2 authors based on title and abstract and full-text screening. Data were extracted by 1 author and checked by another author. Data items included systematic review characteristics; PICOS criteria; and variables related to sex, gender, or age. Systematic reviews were appraised using A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2). Data were synthesized using descriptive statistics.
RESULTS: Of 1439 records, 30 systematic reviews published between 2010 and 2022 were included in this overview. The confidence in the results of 25 of the 30 (83%) reviews was critically low according to AMSTAR 2. The reviews focused on user outcomes that potentially depend on sex, gender, or age, such as efficacy or effectiveness (25/30, 83%) and acceptance, satisfaction, or adherence (3/30, 10%) to digital technologies for COPD. Reviews reported sex or gender (19/30 systematic reviews) or age (25/30 systematic reviews) among primary study characteristics. However, only 1 of 30 reviews included age in a subgroup analysis, and 3 of 30 reviews identified the effects of sex, gender, or age as evidence gaps.
CONCLUSIONS: This overview shows that the effects of sex, gender, or age were rarely considered in 30 systematic reviews of digital technologies for COPD treatment and monitoring. Furthermore, systematic reviews did not incorporate sex, gender, nor age in their implications for clinical practice. We recommend that future systematic reviews should (1) evaluate the effects of sex, gender, or age on the outcomes of digital technologies for treatment and monitoring of COPD and (2) better adhere to reporting guidelines to improve the confidence in review results.
TRIAL REGISTRATION: PROSPERO CRD42022322924; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=322924.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/40538.
PMID:38019578 | DOI:10.2196/49639
JAMA Dermatol. 2023 Nov 29. doi: 10.1001/jamadermatol.2023.4579. Online ahead of print.
ABSTRACT
IMPORTANCE: Isotretinoin is hypothesized to contribute to the development of psychiatric disorders, but the epidemiological association and risk factors associated with psychiatric disorders among isotretinoin users remain unclear.
OBJECTIVE: To clarify the absolute and relative risk and risk factors associated with suicide and psychiatric disorders among isotretinoin users.
DATA SOURCES: PubMed, Embase, Web of Science, and Scopus were searched from inception until January 24, 2023.
STUDY SELECTION: Randomized trials and observational studies were selected if they reported the absolute risk, relative risk, and risk factors for suicide and psychiatric disorders among isotretinoin users.
DATA EXTRACTION AND SYNTHESIS: Relevant data were extracted and risk of bias was evaluated at the study level using the Newcastle-Ottawa Scale. Data were pooled using inverse variance-weighted meta-analyses. Heterogeneity was measured using the I2 statistic, and meta-regression analyses were performed.
MAIN OUTCOMES AND MEASURES: Absolute risk (percentage), relative risks (risk ratios [RR]), and risk factors (RR) of suicide and psychiatric disorders among isotretinoin users.
RESULTS: A total of 25 studies including 1 625 891 participants were included in the review and 24 in the meta-analysis. Among the included studies, participants’ average age ranged from 16 to 38 years, and distribution by sex ranged from 0% to 100% male. The 1-year pooled absolute risk from between 2 and 8 studies of completed suicide, suicide attempt, suicide ideation, and self-harm were each less than 0.5%, while that of depression was 3.83% (95% CI, 2.45-5.93; I2 = 77%) in 11 studies. Isotretinoin users were less likely than nonusers to attempt suicide at 2 years (RR, 0.92; 95% CI, 0.84-1.00; I2 = 0%), 3 years (RR, 0.86; 95% CI, 0.77-0.95; I2 = 0%), and 4 years (RR, 0.85; 95% CI, 0.72-1.00; I2 = 23%) following treatment. Isotretinoin was not associated with the risk of all psychiatric disorders (RR, 1.08; 95% CI, 0.99-1.19; I2 = 0%). Study-level meta-regression found that studies with participants of older age reported lower 1-year absolute risk of depression, while those with a higher percentage of male participants reported a higher 1-year absolute risk of completed suicide.
CONCLUSIONS AND RELEVANCE: The findings suggest that at a population level, isotretinoin users do not have increased risk of suicide or psychiatric conditions but may instead have a lower risk of suicide attempts at 2 to 4 years following treatment. While these findings are reassuring, clinicians should continue to practice holistic psychodermatologic care and monitor patients for signs of mental distress during isotretinoin treatment.
PMID:38019562 | DOI:10.1001/jamadermatol.2023.4579
Quintessence Int. 2023 Nov 29;0(0):0. doi: 10.3290/j.qi.b4706089. Online ahead of print.
ABSTRACT
OBJECTIVE: The aim of this study was to investigate whether psoriasis disease constitutes a comorbity of OLP and to elucidate the effect of depression and anxiety treatment.
METHODS AND MATERIAL: We analyzed a cohort of consecutive patients diagnosed clinical and histologically of OLP from years 2014-2022. The results were contrasted with those obtained in control series matched for age and sex. The correlation between OLP and gender, age, tobacco, alcohol, psoriasis, treatment of depression and anxiety was assessed using Chi-square of Pearson test. Multivariate regression analysis was performed to evaluate the association between psoriasis and OLP. For the assessment of the quality of the statistical models, the Akaike Information Criterion (AIC) was used.
RESULTS: The study involved 1016 patients, being 738 women (72.6%), and 278 men (27.4%). The average age was 59.38 (±12.55) years. From 508 patients with OLP 16 (3.15%) had comorbid psoriasis and in the control group 5 (0.98%). Age, gender, smoking and alcoholic habits are not predictive variables in the relationship between association of psoriasis and OLP patients. According to the multivariate analysis, the odd ratio (OR) of OLP were for psoriasis (OR 3.13, 1.20-9.68), and when compared to univariate analysis was higher for depression drugs (OR 1.88, 1.13-3.19] and for treatment of anxiety (OR 2.06, 1.18-2.70].
CONCLUSIONS: As far as we are aware, this is the first study showing the potential risk of psoriasis in OLP patients and our results should be taken into account to improve knowledge of comorbidity of OLP.
PMID:38019555 | DOI:10.3290/j.qi.b4706089
Traffic Inj Prev. 2023 Nov 29:1-8. doi: 10.1080/15389588.2023.2286429. Online ahead of print.
ABSTRACT
OBJECTIVE: Driver characteristics have been linked to the frequency and severity of car crashes. Among these, age and gender have been shown to impact both the possibility and severity of a crash. Previous studies have used standard ordered probit (OP) models to analyze crash data, and some research has suggested heteroskedastic ordered probit (HETOP) could provide improved model fit. The objective of this paper is to evaluate potential improvements of the heteroskedastic ordered probit (HETOP) model compared to the standard ordered probit (OP) model in crash analysis, by examining the effect of gender across age on injury severity among drivers. This paper hypothesizes that the HETOP model can provide a better fit to crash data, by allowing heteroskedasticity in the distribution of injury severity across driver age and gender.
METHODS: Data for 20,222 crashes were analyzed for North Carolina from 2016 to 2018, which represents the state with the highest number of fatalities per 100 million vehicle miles traveled amongst available crash data from the Highway Safety Information System.
RESULTS: Darker lighting conditions, severe road surface conditions, and less severe weather were associated with increased injury severity. For driver demographics, the probability of severe injuries increased with age and for male drivers. Moreover, the variance of severity increased with age disproportionately within and across genders, and the HETOP was able to account for this.
CONCLUSIONS: The results of the two applied approaches revealed that HETOP model outperformed the standard OP model when measuring the effects of age and gender together in injury severity analysis, due to the heteroskedasticity in injury severity within gender and age. The HETOP statistical method presented in this paper can be more broadly applied across other contexts and combinations of independent variables for improved model prediction and accuracy of causal variables in traffic safety.
PMID:38019532 | DOI:10.1080/15389588.2023.2286429
Traffic Inj Prev. 2023 Nov 29:1-6. doi: 10.1080/15389588.2023.2282948. Online ahead of print.
ABSTRACT
OBJECTIVE: A driver’s active emergency response in dangerous traffic scenes consists of two parts, including reaction behavior and physiological state. In dangerous traffic scenes, the driver’s active emergency response has an important impact on human collision injury. Clarifying the driver’s active emergency response is an important prerequisite for the study of human collision injury under nonstandard posture. Therefore, this study investigates the driver’s active emergency response in different inevitable collision scenes using driving simulator.
METHODS: A driving simulator with a high-speed camera system and human physiological signal acquisition system was first built. Then, three typical vehicle dangerous collision scenes were developed, including frontal collision, side collision, and rear-end collision. Finally, twenty participants (15 males and 5 females) were recruited for a driving experiment, and their active emergency responses were recorded and analyzed.
RESULTS: All subjects would rotate the steering wheel to the left or right in the active emergency state, and the rotation of the hand would also cause the subject’s upper body to tilt in the same direction. The maximum angle for male subjects to rotate the steering wheel was 59.98°, while for the female subjects, it was 44.28°. In addition, the maximum grip force between the male subjects and the steering wheel was 280.5 N, compared to 192.5 N for female subjects. Compared to the female participants, the male participants not only have a greater rotation angle and a greater grip force on the steering wheel, but also have greater pressure on the brake pedal, and the foot moves quickly from the accelerator pedal to the brake pedal and presses the brake pedal.
CONCLUSIONS: Drivers have different active emergency responses to different vehicle collision scenes. Quantitative statistics of driver’s active emergency response will have important guiding significance for the analysis of the impact of human active emergency response on human injury characteristics in subsequent vehicle collision experiments.
PMID:38019530 | DOI:10.1080/15389588.2023.2282948
JAMA Netw Open. 2023 Nov 1;6(11):e2344722. doi: 10.1001/jamanetworkopen.2023.44722.
ABSTRACT
IMPORTANCE: Neighborhood segregation and poverty may be important drivers of health inequities. Epigenomic factors, including DNA methylation clocks that may mark underlying biological aging, have been implicated in the link between social factors and health.
OBJECTIVE: To examine the associations of neighborhood segregation and poverty with 4 DNA methylation clocks trained to capture either chronological age or physiological dysregulation.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study uses data from the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal study that started in 2000 to 2002, with follow-up in 2002 to 2004, 2004 to 2005, 2005 to 2007, and 2010 to 2012. In 2000 to 2002, adults who identified as White or Black race or Hispanic or Chinese ethnicity in 6 US sites (Baltimore, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles County, California; Northern Manhattan, New York; and St. Paul, Minnesota) were sampled for recruitment. A random subsample of 4 sites (Maryland, North Carolina, New York, and Minnesota) were selected for inclusion in the MESA epigenomics ancillary study at examination 5 (2010-2012). Participants who identified as White or Black race or Hispanic ethnicity, were aged 45 to 84 years, and did not have clinical cardiovascular disease were included in this analysis. Data were analyzed from May 2021 to October 2023.
EXPOSURE: Information on 2000 census tract poverty and Getis-Ord G statistic segregation of Hispanic residents, non-Hispanic Black residents, or non-Hispanic White residents were linked to participant addresses at examination 1 (2000-2002).
MAIN OUTCOMES AND MEASURES: At examination 5, DNA methylation was measured in purified monocytes. DNA methylation age acceleration was calculated using 4 clocks trained on either chronological age or physiological dysregulation. Linear regressions were used to test associations.
RESULTS: A total of 1102 participants (mean [SD] age, 69.7 [9.4] years; 562 [51%] women) were included, with 348 Hispanic participants, 222 non-Hispanic Black participants, and 533 non-Hispanic White participants. For non-Hispanic Black participants, living in tracts with greater segregation of Black residents was associated with GrimAge DNA methylation age acceleration, a clock designed to capture physiological dysregulation. A 1-SD increase in segregation was associated with 0.42 (95% CI, 0.20-0.64) years age acceleration (P < .001); this association was not observed with other clocks. This association was particularly pronounced for participants living in high poverty tracts (interaction term, 0.24; 95% CI, 0.07-0.42; P = .006). In the overall sample, census tract poverty level was associated with GrimAge DNA methylation age acceleration (β = 0.45; 95% CI, 0.20-0.71; adjusted P = .005).
CONCLUSIONS AND RELEVANCE: These findings suggest that epigenomic mechanisms may play a role in the associations of segregated and poor neighborhoods with chronic conditions.
PMID:38019517 | DOI:10.1001/jamanetworkopen.2023.44722
JAMA Netw Open. 2023 Nov 1;6(11):e2345540. doi: 10.1001/jamanetworkopen.2023.45540.
ABSTRACT
IMPORTANCE: Knowledge of medical care in US Immigration and Customs Enforcement (ICE) detention centers is limited. Reviews show high rates of preventable deaths while in detention due to substandard medical care within detention centers.
OBJECTIVE: To describe characteristics of medical emergencies at ICE detention centers in California.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed emergency medical services (EMS)-reported medical emergencies activated through 911 from January 1, 2018, to December 31, 2022, at 3 of the 5 ICE detention centers in California: Adelanto ICE Processing Center, Imperial Regional Detention Facility, and Otay Mesa Detention Center.
EXPOSURE: Medical services requiring 911 activation.
MAIN OUTCOMES AND MEASURES: Data included the number of EMS-reported medical emergencies; ICE-reported medical emergencies; patient age and sex; and medical data in the EMS report, including primary symptom, EMS provider (emergency medical technician or paramedic) impression, vital signs, and interventions performed, using descriptive statistics.
RESULTS: In this analysis of 3 detention centers with a mean daily census of 775 (range, 504-1001) individuals per center, there was a median of 68 (IQR, 10-88) EMS-reported emergencies per center per year for a total of 1224 emergencies. The EMS-reported emergencies involved 881 males (72%) and 338 females (28%) with a median age of 39.0 (IQR 30.0-49.0) years. The ratios of female-to-male EMS-reported emergencies were 0.51 (95% CI, 0.31-0.87) at Adelanto, 0.86 (95% CI, 0.31-2.43) at Imperial, and 1.60 (95% CI, 1.40-1.83) at Otay Mesa. Pregnancy-related emergencies accounted for 12.4% (42 of 338) of emergencies in females. A total of 357 individuals (29.2%) had at least 1 abnormal vital sign during their EMS encounter. Psychiatric emergencies comprised 48 EMS responses (3.9%), despite higher rates of ICE-reported psychiatric-related complaints. The median number of monthly EMS-reported emergencies across all 3 centers was 3 (IQR, 0-9) vs 4 ICE-reported emergencies (IQR, 1-15).
CONCLUSIONS AND RELEVANCE: In this study of medical emergencies at 3 of 5 ICE detention facilities in California, there were discrepancies in EMS vs ICE reported emergencies. The data suggested that vulnerable populations, such as pregnant women, had an increased number of medical emergencies, while individuals with psychiatric emergencies accounted for fewer reported emergencies. Based on these findings, emergency medical care provision in ICE detention centers requires increased transparency to ensure appropriate delivery of care.
PMID:38019513 | DOI:10.1001/jamanetworkopen.2023.45540