Closing the Gap on COVID-19 Vaccinations in First Responders and Beyond: Increasing Trust

Although COVID-19 vaccines are widely available in the U.S. and much of the world, many have chosen to forgo this vaccination. Emergency medical services (EMS) professionals, despite their role on the frontlines and interactions with COVID-positive patients, are not immune to vaccine hesitancy. Via a survey conducted in April 2021, we investigated the extent to which first responders in the U.S. trusted various information sources to provide reliable information about COVID-19 vaccines. Those vaccinated generally trusted healthcare providers as a source of information, but unvaccinated first responders had fairly low trust in this information source—a group to which they, themselves, belong. Additionally, regardless of vaccination status, trust in all levels of government, employers, and their community as sources of information was low. Free-response explanations provided some context to these findings, such as preference for other COVID-19 management options, including drugs proven ineffective. A trusted source of COVID-19 vaccination information is not readily apparent. Individuals expressed a strong desire for the autonomy to make vaccination decisions for themselves, as opposed to mandates. Potential reasons for low trust, possible solutions to address them, generalizability to the broader public, and implications of low trust in official institutions are discussed.

Interpretation Biases in Pain: Validation of Two New Stimulus Sets

Adults with chronic pain interpret ambiguous information in a pain and illness related fashion. However, limitations have been highlighted with traditional experimental paradigms used to measure interpretation biases. Whilst ambiguous scenarios have been developed to measure interpretation biases in adolescents with pain, no scenario sets exist for use with adults. Therefore, the present study: (i) sought to validate a range of ambiguous scenarios suitable for measuring interpretation biases in adults, whilst also allowing for two response formats (forced-choice and free response); and (ii) investigate paradigm efficacy, by assessing the effects of recent pain experiences on task responding. A novel ambiguous scenarios task was administered to adults (N = 241). Participants were presented with 62 ambiguous scenarios comprising 42 that could be interpreted in a pain/pain-illness or non-pain/non-pain illness manner: and 20 control scenarios. Participants generated their own solutions to each scenario (Word Generation Task), then rated how likely they would be to use two researcher-generated solutions to complete each scenario (Likelihood Ratings Task). Participants also rated their subjective experiences of pain in the last 3 months. Tests of reliability, including inter-rater agreement and internal consistency, produced two ambiguous scenario stimulus sets containing 18 and 20 scenarios, respectively. Further analyses revealed adults who reported more recent pain experiences were more likely to endorse the pain/pain-illness solutions in the Likelihood Ratings Task. This study provides two new stimulus sets for use with adults (including control items) in pain research and/or interventions. Results also provide evidence for a negative endorsement bias in adults.

Drawing Kafka’s Castle

We investigated the effects of narrative perspective on mental imagery by comparing responses to an English translation of Franz Kafka’s Das Schloß (The Castle) in the published version (narrated in the third person) versus an earlier (first-person) draft. We analysed participants’ pencil drawings of their imaginative experience for presence/absence of specific features (K. and the castle) and for image entropy (a proxy for image unpredictability). We also used word embeddings to perform cluster analysis of participants’ verbal free-response testimony, generating thematic clusters independently of experimenter expectations. We found no effects of text version on feature presence or overall entropy, but an effect on entropy variance, which was higher in the third-person condition. There was also an effect of text version on free responses: Readers of the third-person version were more likely to use words associated with mood and atmosphere. We offer conclusions on “Kafkaesque” aesthetics, cognitive realism, and the future of experimental literary studies.

A Motivational-Developmental Free Response Assessment Through a Bifactor Lens

The Motivational-Developmental Assessment (MDA) measures a university student’s motivational and developmental attributes by utilizing overlapping constructs measured across four writing prompts. The MDA’s format may lead to the violation of the local item independence (LII) assumption for unidimensional item response theory (IRT) scoring models, or the uncorrelated errors assumption for scoring models in classical test theory (CTT) due to the measurement of overlapping constructs within a prompt. This assumption violation is known as a testlet effect, which can be viewed as a method effect. The application of a unidimensional IRT or CTT model to score the MDA can result in imprecise parameter estimates when this effect is ignored. To control for this effect in the MDA responses, we first examined the presence of local dependence via a restricted bifactor model and Yen’s Q3 statistic. Second, we applied bifactor models to account for the testlet effect in the responses, as this effect is modeled as an additional latent variable in a factor model. Results support the presence of local dependence in two of the four MDA prompts, and the use of the restricted bifactor model to account for the testlet effect in the responses. Modeling the testlet effect through the restricted bifactor model supports a scoring inference in a validation argument framework. Implications are discussed.

Reporting of Concussion Symptoms by a Nationwide Survey of United States Parents of Middle School Children

This cross-sectional study assessed concussion symptom knowledge of parents of middle school (MS) children (aged 10–15 years) through a free-response item that solicited concussion symptoms and compared findings to a pre-validated scale-based measure. A self-administered online questionnaire was sent to a panel of randomly selected United States residents who were recruited by a third-party company, aged ≥ 18 years, and identified as parents of MS children. Via a free-response item, parents listed what they believed were concussion symptoms. Multiple sections later, parents identified potential concussion symptoms via a scale measure, which featured 25 items (22 actual symptoms, three distractor symptoms) with three response options: yes, no, maybe. Free-response item responses were coded into specific symptoms. The 1062 eligible parents that provided complete data commonly identified the symptoms of dizziness (90.2%), blurred vision (87.4%), and balance problems (86.4%) on the scale-based measure. However, these and other symptoms were less commonly identified via the free-response item (dizziness: 44.4%; blurred vision: 16.5%; balance problems: 3.5%). Concussion symptoms commonly reported via the scale-based measure were reported less frequently within the free-response item. Future research must explore strategies to help clinicians working with parents and their children to measure and assess concussion symptom reporting and knowledge.

Deep learning–assisted prostate cancer detection on bi-parametric MRI: minimum training data size requirements and effect of prior knowledge

Objectives To assess Prostate Imaging Reporting and Data System (PI-RADS)–trained deep learning (DL) algorithm performance and to investigate the effect of data size and prior knowledge on the detection of clinically significant prostate cancer (csPCa) in biopsy-naïve men with a suspicion of PCa. Methods Multi-institution data included 2734 consecutive biopsy-naïve men with elevated PSA levels (≥ 3 ng/mL) that underwent multi-parametric MRI (mpMRI). mpMRI exams were prospectively reported using PI-RADS v2 by expert radiologists. A DL framework was designed and trained on center 1 data (n = 1952) to predict PI-RADS ≥ 4 (n = 1092) lesions from bi-parametric MRI (bpMRI). Experiments included varying the number of cases and the use of automatic zonal segmentation as a DL prior. Independent center 2 cases (n = 296) that included pathology outcome (systematic and MRI targeted biopsy) were used to compute performance for radiologists and DL. The performance of detecting PI-RADS 4–5 and Gleason > 6 lesions was assessed on 782 unseen cases (486 center 1, 296 center 2) using free-response ROC (FROC) and ROC analysis. Results The DL sensitivity for detecting PI-RADS ≥ 4 lesions was 87% (193/223, 95% CI: 82–91) at an average of 1 false positive (FP) per patient, and an AUC of 0.88 (95% CI: 0.84–0.91). The DL sensitivity for the detection of Gleason > 6 lesions was 85% (79/93, 95% CI: 77–83) @ 1 FP compared to 91% (85/93, 95% CI: 84–96) @ 0.3 FP for a consensus panel of expert radiologists. Data size and prior zonal knowledge significantly affected performance (4%, $$p<0.05$$ p < 0.05 ). Conclusion PI-RADS-trained DL can accurately detect and localize Gleason > 6 lesions. DL could reach expert performance using substantially more than 2000 training cases, and DL zonal segmentation. Key Points • AI for prostate MRI analysis depends strongly on data size and prior zonal knowledge. • AI needs substantially more than 2000 training cases to achieve expert performance.

Extended Multivariate Generalizability Theory With Complex Design Structures

This article extends multivariate generalizability theory (MGT) to tests with different random-effects designs for each level of a fixed facet. There are numerous situations in which the design of a test and the resulting data structure are not definable by a single design. One example is mixed-format tests that are composed of multiple-choice and free-response items, with the latter involving variability attributable to both items and raters. In this case, two distinct designs are needed to fully characterize the design and capture potential sources of error associated with each item format. Another example involves tests containing both testlets and one or more stand-alone sets of items. Testlet effects need to be taken into account for the testlet-based items, but not the stand-alone sets of items. This article presents an extension of MGT that faithfully models such complex test designs, along with two real-data examples. Among other things, these examples illustrate that estimates of error variance, error–tolerance ratios, and reliability-like coefficients can be biased if there is a mismatch between the user-specified universe of generalization and the complex nature of the test.

93. Developing Urinary Tract Infection Clinical Vignettes for the Nursing Home Setting: A Mixed-Methods Approach

Background Little is known about how providers choose antibiotics for nursing home residents when concerned about urinary tract infections. To better assess this in a simulated setting, we used a mixed-methods approach to develop robust clinical vignettes. Methods First, we developed 7 vignettes and distributed them to resident physicians as a survey, randomizing participants’ response type to rank-order or free-text entry. Second, we shared 5 vignettes with nursing home prescribers and conducted semi-structured interviews that asked providers to explain their thinking out loud (Think Aloud structure). Interviews were continued until content saturation was achieved. Two authors (LT & RJ) determined appropriateness of decisions about antibiotic initiation and antibiotic choice; two authors (LT & JI) coded feedback on the vignettes with adjudication by a third (RJ). Results Of 23 residents (11 rank-choice; 12 free-response) that participated in the pilot survey, only 6 (26%) completed 7 vignettes, with a mean completion of 69.4%. Completion of all vignettes was similar between groups, however, greater attrition at the first question was observed in respondents randomized to rank-choice (4/11) compared to free-response (6/12). Of the original 7 vignettes, 5 free-response cases were chosen for further development. We conducted semi-structured interviews with 7 nursing home prescribers, 4 of whom were physicians. The prescribers had a median age 39 (range 34 to 54) and a median of 10 years of post-graduation experience. Figure 1 summarizes appropriateness of respondents’ answers regarding antibiotic initiation and antibiotic choice. The most common inappropriate choice was a fluoroquinolone. Vignettes were edited iteratively based on participant feedback on each case’s realistic characteristics, missing necessary clinical data, formatting changes, and clarity (Figure 2). Figure 1. Appropriateness of antibiotic initiation and antibiotic choice per clinical vignette. Figure 2. Example of vignette editing process based on Think Aloud interview responses Conclusion This mixed-methods approach effectively captured prescribers’ feedback about length, response method, and case characteristics for our clinical vignettes. Responses assessed differences in prescribers’ decision to initiate antibiotic treatment and antibiotic choice. The refined vignettes will be used in a national survey. Disclosures Robin L. Jump, MD, PhD, Pfizer (Individual(s) Involved: Self): Consultant

Anomalous Cognition: An Umbrella Review of the Meta-Analytic Evidence

Objective: The aim of this study was to assess the results of all meta-analyses on anomalous cognition conducted between 1989 and 2021 in order to find moderators associated with greater effect sizes. Method: We included all meta-analyses of studies related to anomalous cognition published up to 2021. Results: Our dataset, accumulated over more than 80 years of investigation, refers to 11 meta-analyses related to six different states of consciousness. The evidence clearly shows that anomalous cognition seems possible and its effects can be enhanced by using a combination of some non-ordinary or altered states of consciousness (e.g., dreaming, ganzfeld, etc.), coupled with free-response procedures, or neurophysiological dependent variables. These conditions facilitate an alternative form of cognition seemingly unconstrained by the known biological characteristics of the sense organs and the brain. Conclusion: The accumulated evidence expands our understanding of the mind-brain relation and the nature of the human mind.

Antiemetic Prophylaxis for Chemoradiotherapy-induced Nausea and Vomiting (C-RINV) in Locally Advanced Head and Heck Squamous Cell Carcinoma: a Prospective Phase Ⅱ Trial

Background There is sparse research reporting effective interventions for preventing nausea and emesis caused by concurrent chemoradiotherapy (CCRT) in locally advanced head and neck squamous cell carcinoma (LA-HNSCC). This phase Ⅱ trial was conducted to provide the direct evidence for the current practice of prescribing antiemetic in patients with LA-HNSCC receiving CCRT.Methods Treatment-naïve LA-HNSCC patients received intensity-modulated radiotherapy with concomitant cisplatin 100 mg/m² every 3 weeks for two cycles. All patients were given orally aprepitant 125 mg once on d1, then 80mg once on d2-5; ondansetron 8 mg once on d1; and dexamethasone 12 mg once on d1, then 8mg on d2-5. The primary endpoint was complete response (CR). Pursuant to δ=0.2 and α=0.05, the expected CR rate was 80%. Results A total of 43 patients with LA-HNSCC were enrolled. The median age was 53 years old, and 86.0% were male. All patients received radiotherapy and 86.0% of patients completed both cycles as planned. The overall CR rate was 86.0% (95% CI: 72.1-94.7). The CR rates for cycles 1 and 2 were 88.4% (95% CI: 74.9-96.1) and 89.2% (95% CI: 74.6-97.0). The complete protection rate in the overall phase was 72.1% (95% CI: 56.3-84.7). The emesis-free response and nausea-free response in overall phase were 88.4% (95% CI: 74.9-96.1) and 60.5% (95% CI: 44.4-75.0), respectively. The adverse events related to antiemetics were constipation (65.1%) and hiccups (16.3%), but both were grade 1-2. There was no grade 4 or 5 treatment-related adverse event with antiemetic usage. Conclusion The addition of aprepitant into ondansetron and dexamethasone provided effective protection from nausea and emesis in patients with LA-HNSCC receiving radiotherapy and concomitant high-dose cisplatin chemotherapy. Randomised phase 3 studies are required to further define the potential role of NK1RA in chemoradiotherapy setting.Trial registration: ClinicalTrials.gov, number NCT03572829. Registered 28 June 2018, https://clinicaltrials.gov/ct2/show/NCT03572829?term=NCT03572829&draw=2&rank=1.