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This study tested a psychosocial model of suicide risk in a sample of 156 Latino college students. Specifically, depression and loneliness were hypothesized to be important predictors of suicide risk (namely, hopelessness and suicidal behaviors) in Latino students. Results of conducting regression analyses indicated that, independent of age and gender, depression and loneliness were significant predictors of both indices of suicide risk examined in the present study. It is noteworthy that within the psychosocial predictor set of depression and loneliness, depression was consistently found to be nearly twice as strong a predictor than was loneliness. Moreover, we found evidence for a significant depression-loneliness interaction effect in predicting suicide risk. That is, the highest level of suicide risk was found among dysphoric Latino students who were also socially isolated. Our findings indicate that depression and loneliness are important factors to consider in understanding suicide risk among Latino college students.

Herpes simplex virus 2 (HSV-2) causes a persistent, lifelong infection that increases risk for sexually transmitted infection acquisition. Both the lack of a vaccine and the need for chronic suppressive therapies to control infection presents the need to further understand immune mechanisms in response to acute HSV-2 infection. The IL-36 cytokines are recently identified members of the IL-1 family and function as inflammatory mediators at epithelial sites. Here, we first used a well-characterized three-dimensional (3-D) human vaginal epithelial cell (VEC) model to understand the role of IL-36γ in the context of HSV-2 infection. In 3-D VEC, IL-36γ is induced by HSV-2 infection, and pretreatment with exogenous IL-36γ significantly reduced HSV-2 replication. To assess the impact of IL-36γ treatment on HSV-2 disease pathogenesis, we employed a lethal genital infection model. We showed that IL-36γ treatment in mice prior to lethal intravaginal challenge significantly limited vaginal viral replication, delayed disease onset, decreased disease severity, and significantly increased survival. We demonstrated that IL-36γ treatment transiently induced pro-inflammatory cytokines, chemokines, and antimicrobial peptides in murine lower female reproductive tract (FRT) tissue and vaginal lavages. Induction of the chemokines CCL20 and KC in IL-36γ treated mice also corresponded with increased polymorphonuclear (PMN) leukocyte infiltration observed in vaginal smears. Altogether, these studies demonstrate that IL-36γ drives the transient production of immune mediators and promotes PMN recruitment in the vaginal microenvironment that increases resistance to HSV-2 infection and disease. Our data indicate that IL-36γ may participate as a key player in host defense mechanisms against invading pathogens in the FRT.

Multimorbidity is a defining challenge for health systems and requires coordination of care delivery and care management. Care management is a clinical service designed to remotely engage patients between visits and after discharge in order to support self-management of chronic and emergent conditions, encourage increased use of scheduled care and address the use of unscheduled care. Care management can be provided using digital technology - digital care management. A robust methodology to assess digital care management, or any traditional or digital primary care intervention aimed at longitudinal management of multimorbidity, does not exist outside of randomized controlled trials (RCTs). RCTs are not always generalizable and are also not feasible for most healthcare organizations. We describe here a novel and pragmatic methodology for the evaluation of digital care management that is generalizable to any longitudinal intervention for multimorbidity irrespective of its mode of delivery. This methodology implements propensity matching with bootstrapping to address some of the major challenges in evaluation including identification of robust outcome measures, selection of an appropriate control population, small sample sizes with class imbalances, and limitations of RCTs. We apply this methodology to the evaluation of digital care management at a U.S. payor and demonstrate a 9% reduction in ER utilization, a 17% reduction in inpatient admissions, and a 29% increase in the utilization of preventive medicine services. From these utilization outcomes, we drive forward an estimated cost saving that is specific to a single payor's payment structure for the study time period of $641 per-member-per-month at 3 months. We compare these results to those derived from existing observational approaches, 1:1 and 1:n propensity matching, and discuss the circumstances in which our methodology has advantages over existing techniques. Whilst our methodology focuses on cost and utilization and is applied in the U.S. context, it is applicable to other outcomes such as Patient Reported Outcome Measures (PROMS) or clinical biometrics and can be used in other health system contexts where the challenge of multimorbidity is prevalent.

There have been numerous reports of neurological assessments of post-concussed athletes. However, the majority of the methods commonly deployed are either qualitative assessments that are simply symptom based or are psycho-social questionnaires. The information provided from those studies does not provide insight into the neural mechanisms impacted by concussion, and more importantly, does not contribute to a prognostic view of overall brain health that would facilitate or predict the recovery of the concussed individual. Cortical metrics are measures that were designed to probe brain function via the somatosensory system (i.e., with high fidelity tactile inputs) and have been demonstrated to be both objective, quantifiable and physiologically based. The methods have also been recently reported to parallel findings in a neurophysiological animal model of brain injury (Challener et al, 2020) that support the concept that these metrics parallel alterations in specific neural mechanisms post-injury. In this report, the battery of tactile based measures are reaction time (RT), reaction time variability (RTvar), sequential and simultaneous amplitude discrimination, temporal order judgement (TOJ) and duration discrimination (DD). These methods are administered with a computer mouse sized tactile stimulator (the Brain Gauge) that delivers sinusoidal stimuli to digits 2 and 3 with precision control of both amplitude and frequency. The results obtained during the first week of observation post-injury predict the recovery trajectory of the concussed individual. Interestingly, some of the metrics of the individuals who take longer to recover from injury obtained during the first week outperform the metrics of individuals that recover quickly, and these findings parallel the findings from the animal model.

ObjectivesWith the increasing emphasis on developing effective telemedicine approaches in Otolaryngology, this study explored whether a single composite image stitched from a digital otoscopy video provides acceptable diagnostic information to make an accurate diagnosis, as compared with that provided by the full video.MethodsFive Ear, Nose, and Throat (ENT) physicians reviewed the same set of 78 digital otoscope eardrum videos from four eardrum conditions: normal, effusion, retraction, and tympanosclerosis, along with the composite images generated by a SelectStitch method that selectively uses video frames with computer-assisted selection, as well as a Stitch method that incorporates all the video frames. Participants provided a diagnosis for each item along with a rating of diagnostic confidence. Diagnostic accuracy for each pathology of SelectStitch was compared with accuracy when reviewing the entire video clip and when reviewing the Stitch image.ResultsThere were no significant differences in diagnostic accuracy for physicians reviewing SelectStitch images and full video clips, but both provided better diagnostic accuracy than Stitch images. The inter-reader agreement was moderate.ConclusionEqual to using full video clips, composite images of eardrums generated by SelectStitch provided sufficient information for ENTs to make the correct diagnoses for most pathologies. These findings suggest that use of a composite eardrum image may be sufficient for telemedicine approaches to ear diagnosis, eliminating the need for storage and transmission of large video files, along with future applications for improved documentation in electronic medical record systems, patient/family counseling, and clinical training.Level of EvidenceLevel 3

Background: Data on the effect of the COVID-19 pandemic on fibromyalgia (FM) patients are lacking. FM patients often experience clinical impairment with stress situations.The objective of this study was to determine whether severity of FM increases because of confinement due to the COVID-19 pandemic.Methods: Prospective study including patients from the Combined Index of Severity of Fibromyalgia (ICAF) cohort who met the 2010 ACR FM criteria. In this cohort, all patients have a periodical evaluation of their quality of life through two questionnaires, the ICAF -which assesses the ability to perform daily living activities, anxiety and depression-, and through the Patient Global Impression of Change (PGIC), which assesses overall change after a therapeutical intervention. Pre and post-confinement measurements were analyzed. Inferential statistical analysis and ANOVA for repeated measurements were used.Results: A total of 93 patients received a phone consultation, (95.5% females), mean (SD) age of 48.23 (8.38) years. Four patients were excluded as presenting COVID-19 and 51 (57%) completed the post-confinement ICAF. Following confinement, 25 (49%) patients got worse (group worse) and 26 (51%) patients experienced no change or improved (group stable). Comparisons between pre and post confinement ICAF did not show significant differences in both groups. Passive coping was significantly different in group worse in pre-confinement evaluation. In the 80% of patients with passive coping predominance there were no change in coping strategy.Conclusions: No clinical impairment due to COVID-19 confinement occurred. The perceived worsening among FM patients relies primarily on how patients cope with their disease, without a real impact on clinical manifestations.

Intraoperative electrocochleography (ECochG) has provided insight regarding inner ear pathophysiology during neurotologic procedures. In this study, intraoperative ECochG findings are reported in patients who presented with episodic aural and vestibular symptoms during resection of posterior fossa neoplasms.Three patients with episodic vertigo who underwent resection of posterior fossa tumors.Intraoperative ECochG was performed before and after tumor resection with the active electrode at the round window. Acoustic stimuli consisted of click and tone bursts presented in alternating polarity.ECochG responses including summation potential (SP), action potential (AP), and SP:AP ratio values to evaluate for endolymphatic hydrops.All subjects presented with asymmetric sensorineural hearing loss (SNHL), episodic vertigo, and tinnitus. Subject 1 was a 63-year-old woman who underwent left translabyrinthine excision of an endolymphatic sac (ELS) tumor and demonstrated no measurable responses until fenestration of the lateral semicircular canal, suggesting severe hydrops relieved by labyrinthotomy. Subject 2 was a 44-year-old woman who underwent right ELS tumor resection and exhibited an elevated SP:AP ratio. Subject 3 was a 55-year-old woman who underwent right retrolabyrinthine resection of a meningioma and exhibited robust responses without hydrops.Endolymphatic hydrops secondary to mechanical obstruction by a posterior fossa neoplasm may be demonstrated using intraoperative ECochG. Immediate improvement of hydrops may not be demonstrated after tumor resection.

There have been numerous reports of neurological assessments of post-concussed athletes and many deploy some type of reaction time assessment. However, most of the assessment tools currently deployed rely on consumer-grade computer systems to collect this data. In a previous report, we demonstrated the inaccuracies that typical computer systems introduce to hardware and software to collect these metrics with robotics (Holden et al, 2020). In that same report, we described the accuracy of a tactile based reaction time test (administered with the Brain Gauge) as approximately 0.3 msec and discussed the shortcoming of other methods for collecting reaction time. The latency errors introduced with those alternative methods were reported as high as 400 msec and the system variabilities could be as high as 80 msec, and these values are several orders of magnitude above the control values previously reported for reaction time (200-220msec) and reaction time variability (10-20 msec). In this report, we examined the reaction time and reaction time variability from 396 concussed individuals and found that there were significant differences in the reaction time metrics obtained from concussed and non-concussed individuals for 14-21 days post-concussion. A survey of the literature did not reveal comparable sensitivity in reaction time testing in concussion studies using alternative methods. This finding was consistent with the prediction put forth by Holden and colleagues with robotics testing of the consumer grade computer systems that are commonly utilized by researchers conducting reaction time testing on concussed individuals. The significant difference in fidelity between the methods commonly used by concussion researchers is attributed to the differences in accuracy of the measures deployed and/or the increases in biological fidelity introduced by tactile based reaction times over visually administered reaction time tests. Additionally, while most of the commonly used computerized testing assessment tools require a pre-season baseline test to predict a neurological insult, the tactile based methods reported in this paper did not utilize any baselines for comparisons. The reaction time data reported was one test of a battery of tests administered to the population studied, and this is the first of a series of papers that will examine each of those tests independently.

In previous publications we have reported methods for applying multi-site vibratory stimuli to the fingertips. Typically, this involves the use of multiple, individual vibrotactile stimulator and limitations of such an arrangement include difficulty with both positioning the stimuli as well as ensuring that stimuli are delivered in a synchronized and deliberate manner. The device that we reported is a significant improvement on multiple independent stimulators (Holden et al, 2011), and due to both the success of that stimulator and the consequent need to validate a number of findings that have been made with both that device and the precursor of that device (Tannan et al, 2007a), we designed and fabricated a four-site stimulator that could be used in MRI and MEG compatible environments. The device can stimulate four independent skin sites and is primarily designed for stimulating the digit tips. The device is similar to the previously reported device in that it is portable and is ergonomically suited for delivering stimuli to the finger tips, but it has the advantage of being MRI and MEG compatible. However, the fundamental mechanisms of the device are significantly different from the device that we recently reported since the device is piezo-based rather than VCA based. The device was tested in both MEG and MRI environments and demonstrated that no detectable signal (or noise) was introduced by the stimulator in those environments. To demonstrate the reliability of the device for delivering tactile stimulation in a magnetic field, tactile stimuli were presented in an MRI to a single individual. The study produced results that were consistent with prior studies that produced activation of cortical ensembles.

Objective: Gratitude, or thankfulness for positive aspects of life, is related to psychosocial well-being and decreased psychopathology, and may reduce suicide risk. We explored four potential hypotheses purported to explain the beneficial outcomes of gratitude (schematic, positive affect, broaden-and-build, and coping), hypothesizing that hopelessness (schematic), depression (positive affect), social support (broaden-and-build), and substance use (coping) would mediate the gratitude-suicide linkage. Participants: 913 undergraduate students from a mid-size, southeastern U.S. university. Methods: Respondents completed online self-report questionnaires including the Suicidal Behaviors Questionnaire-Revised, Gratitude Questionnaire, Beck Hopelessness Scale, Beck Depression Inventory, Duke Social Support Index, Alcohol Use Disorders Identification Test, and Drug Abuse Screening Test. Results: Supporting theory and hypotheses, gratitude was related to less suicide risk via beneficial associations with hopelessness, depression, social support, and substance misuse. Conclusions: The linkage between gratitude and suicide risk appears to be predicated on the beneficial association of gratitude to negative mood and interpersonal functioning.

Hypothesis Intraoperative electrocochleography (ECochG) can differentiate hair cell and neural dysfunction caused by a vestibular schwannoma (VS) and help define the site of lesion as peripheral or central to the spiral ganglion. Background Hearing loss in patients with a VS can be caused by both sensory (cochlear) and neural dysfunction. Methods Round-window ECochG using low and high-frequency tone bursts was performed in 49 subjects with a VS. Responses were analyzed for magnitude, spectrum, and shape of the time waveform. Components examined included the cochlear microphonic, auditory nerve neurophonic, compound action potential (CAP), and summating potential (SP). Results Variability in the summed response magnitudes across frequency, or "total response" (ECochG-TR), varied from 0.1 to 100 μV. Responses were larger for lower frequencies. Subjective estimates revealed a wide range of neural contributions from the auditory nerve neurophonic to low frequencies and the CAP to high frequencies. Cases with larger CAPs had smaller SPs. The correlation of ECochG-TR, with word recognition score (WRS), was moderate (r = 0.67), as well as the correlation between pure-tone averages and ECochG (r = 0.63). The cochlea remained functional in two cases of sudden sensorineural hearing loss with 0% WRS. Conclusion Reduced ECochG-TR and neural activity in many cases indicates both sensory and neural deficits. Smaller SPs when CAPs are present indicate a neural contribution to the SP. Good cochlear function with 0% WRS, and cases of sudden sensorineural hearing loss with retained cochlear function, indicate retrocochlear effects, typically proximal to the spiral ganglion cells.

Supporting info item, per2098-sup-0001-SI for A Meta–Analytic and Conceptual Update on the Associations between Procrastination and Multidimensional Perfectionism by Sirois Fuschia M., Molnar Danielle S., Hirsch Jameson K. and Back MitjaProf. in European Journal of Personality

Problem-solving deficits and poor health–related quality of life are associated with suicide risk; yet, little is known about the interrelations between these variables. In 220 primary care patients, we examined the potential mediating role of physical and mental health–related quality of life on the relation between social problem–solving ability and suicidal behavior. Participants completed the Suicidal Behaviors Questionnaire-Revised, Social Problem Solving Inventory-Revised, and Short-Form 36 Health Survey. Utilizing bootstrapped mediation, our hypotheses were partially supported; mediating effects were found for mental health–related quality of life on the relation between social problem-solving and suicidal behavior. Physical health–related quality of life was not a significant mediator. Greater social problem–solving ability is associated with better mental health–related quality of life and, in turn, to less suicidal behavior. Interventions promoting social problem–solving ability may increase quality of life and reduce suicide risk in primary care patients.

Hypothesis Electrocochleography (ECochG) patterns observed during cochlear implant (CI) electrode insertion may provide information about scalar location of the electrode array. Background Conventional CI surgery is performed without actively monitoring auditory function and potential damage to intracochlear structures. The central hypothesis of this study was that ECochG obtained directly through the CI may be used to estimate intracochlear electrode position and, ultimately, residual hearing preservation. Methods Intracochlear ECochG was performed on 32 patients across 3 different implant centers. During electrode insertion, a 50-ms tone burst stimulus (500 Hz) was delivered at 110 dB SPL. The ECochG response was monitored from the apical-most electrode. The amplitude and phase changes of the first harmonic were imported into an algorithm in an attempt to predict the intracochlear electrode location (scala tympani [ST], translocation from ST to scala vestibuli [SV], or interaction with basilar membrane). Anatomic electrode position was verified using postoperative computed tomography (CT) with image processing. Results CT analysis confirmed 25 electrodes with ST position and 7 electrode arrays translocating from ST into SV. The ECochG algorithm correctly estimated electrode position in 26 (82%) of 32 subjects while 6 (18%) electrodes were wrongly identified as translocated (sensitivity = 100%, specificity = 77%, positive predictive value = 54%, and a negative predictive value = 100%). Greater hearing loss was observed postoperatively in participants with translocated electrode arrays (36 ± 15 dB) when compared with isolated ST insertions (28 ± 20 dB HL). This result, however, was not significant (p = 0.789). Conclusion Intracochlear ECochG may provide information about CI electrode location and hearing preservation.

In the present study, we examined the role of ethnoracial discrimination, social support (viz., family & friends), and hope (viz., agency & pathways) in accounting for negative psychological adjust...

In the present study, we examined the role of racial discrimination, social support (viz., family and friends), and hope (viz., agency and pathways) in accounting for negative psychological adjustment (viz., anxious and depressive symptoms) and positive psychological adjustment (viz., vitality and life satisfaction) in a sample of 249 African Americans. Overall, results of conducting a series of hierarchical regression analyses provided some evidence for the role of racial discrimination and social support in accounting for both negative and positive psychological adjustment. Noteworthy, the inclusion of hope was found to significantly augment the prediction models of psychological adjustment. Within the hope set, agency was consistently found to uniquely account for adjustment. In contrast, pathways was only found to uniquely account for vitality. Beyond affirming the importance of racial discrimination and social support, the present findings highlight the added value of considering hope, especially agency, in understanding positive and negative psychological adjustment in African Americans. Implications of the present findings for understanding the role of racial discrimination, social support, and hope in the psychological adjustment of African American adults are discussed.

Objective: Suicide risk is a significant public health concern for college students and may be exacerbated by hopelessness resulting from negative life events (NLE), yet may be ameliorated by self-compassion. We examined the mediating role of hopelessness in the relation between NLE and suicidal behavior, and the moderating influence of self-compassion on all model paths. Participants: Participants were 338 undergraduates (89% white; 67% female). Data were collected from December 2014 to December 2015. Methods: Participants completed the Life Events Checklist for College Students, Beck Hopelessness Inventory, Self-Compassion Scale, and Suicidal Behaviors Questionnaire - Revised. Results: Negative life events were related to greater hopelessness and, in turn, to more suicidal behavior, yet self-compassion attenuated this effect. Conclusions: Self-compassion may buffer the NLE-hopelessness linkage, thereby reducing suicide risk among college students. Therapeutic promotion of self-compassion, and reduction of hopelessness, may be important suicide prevention strategies on college campuses.

Forgiveness, a cognitive-emotional and behavioral reduction of negative responses to offenses, is directly related to less suicide risk, but may be indirectly related via its relation with future orientation, the ability to envision a positive future. In 100 rural primary care patients, we examined the association between self-forgiveness, other-forgiveness, and forgiveness by God and suicidal behavior, with future orientation as a mediator. Forgiveness was related to greater future orientation and, in turn, to, less suicidal behavior. Addressing the past may promote adaptive views of the future and reduce suicide risk, results suggesting potential temporal and forgiveness-based points for suicide prevention.

Marketing executives operate in increasingly complex marketplaces characterized by global competition, accelerating sustainability concerns, and an increased focus on innovation. This complexity risks a fragmentation of thought more severe than that which Theodore Levitt discussed in his seminal article on marketing myopia. Indeed, we’ve become market myopic as a discipline and lost focus on the generalities that apply to markets and exchange more broadly. Our goal is to provide a description of the modern marketplace that allows us to re-envision this complexity as a symptom of a more general phenomenon. We do this by arguing that market complexity can (and should) be understood as a consequence of the circular relationship between exchange and shared understanding. We then show how this relationship can be expressed in simple terms using vectors to symbolize the degree to which this understanding is shared across actors and the rate at which this “shared-ness” is changing in time. The resulting model allows us to cast the variety and variability of the complex modern marketplace as a symptom of shared understanding dynamics. This, in turn, helps us move beyond the morass of contextual idiosyncrasy and toward a more parsimonious description of the market.

The present study sought to examine optimism and hope as predictors of suicidal behaviors (viz., suicide ideation and suicide attempt) in a sample of 179 adult primary care patients. Furthermore, we aimed to determine if the combination of hope and optimism would account for additional variance in the prediction model for suicidal behaviors among this population. In this cross-sectional study, participants completed measures of hope (viz., agency and pathways), optimism, and suicidal behaviors, as well as a series of demographics questions. Hierarchical regression analyses were conducted to test the aforementioned hypotheses. Results indicated that hope and optimism were both significant and unique predictors of suicidal behaviors among adult primary care patients. However, the hope-by-optimism interaction terms were not found to be significant. Some implications of the present findings are discussed.

Emerging evidence indicates self-compassion can be beneficial for medical populations and for medical adherence; yet, research to date has not fully examined the reasons for this association. This study examined the association of dispositional self-compassion to adherence across five medical samples and tested the extent to which perceived stress accounted for this association. Five medical samples (total N = 709), including fibromyalgia, chronic fatigue syndrome, and cancer patients, recruited from various sources, completed online surveys. Self-compassion was positively associated with adherence in all five samples. A meta-analysis of the associations revealed a small average effect size (average r = .22, [0.15, 0.29]) of self-compassion and adherence and non-significant heterogeneity among the effects (Q (4) = 3.15, p = .532). A meta-analysis of the kappa2 values from the indirect effects of self-compassion on adherence revealed that, on average, 11% of the variance in medical adherence that was explained by self-compassion could be attributed to lower perceived stress. Overall, findings demonstrate that dispositional self-compassion is associated with better medical adherence among people with fibromyalgia, chronic fatigue syndrome, and cancer, due in part to lower stress. This research contributes to a growing evidence base indicating the value of self-compassion for health-related behaviours in a variety of medical populations.

Given past findings that have linked trauma and lack of personal control to greater suicidal risk in adults, the present study examined how trauma presence and personal control are uniquely involved in predicting suicidal risk in a sample of 469 college students. Regression analyses indicated that both trauma presence and personal control were significant predictors of suicidal risk, as was their interaction. The present findings suggest a need to consider both trauma presence and low personal control in assessing for suicidal risk in college students.

As marketers, we are confronted by an increasingly complex world—one characterized by markets that emerge and evolve at an unprecedented rate. This has led to an increased need for methods that can help researchers translate this complexity and dynamism into actionable intelligence. In the current work, I introduce one such method, and show how it can be applied to the emergence and evolution of the biotechnology industry during the 1990s and early 2000s. I conclude with a discussion of how this method can be applied more broadly to areas like content marketing, trend spotting, and the interface between qualitative and quantitative market research.