Facial Appearance as Core Expression Scales (FACES) was designed to assess maxillofacial surgery patients’ perceptions of their faces. We used FACES to study ratings of non-patient participant’s own faces, and faces produced by the generative AI application DALL·E. DALL·E was used to generate 16 photo-realistic faces of males and females aged 20, 30, 40, and 50 of differing apparent ethnicities. Four stem descriptions were used for four sets of four images, for example “The face of a 40-year-old male (or female) of mixed South American and African ancestry wearing something dark in the style of a professional photo portrait.” This was followed by descriptions taken from all seven FACES items, such as “the face is (not) like I want others to see me.” Image generation instructions differed only in “not” being used for half of the images. Participants (n = 333) rated images using FACES to test the hypothesis that FACES can distinguish between faces generated by positively and negatively worded instructions. That hypothesis was confirmed for all 8 image pairs. We also found that Rosenberg Self-Esteem and State Self Esteem Scale scores predicted FACES ratings of participants’ own faces. However, DALL·E was unable to depict realistic maxillofacial anomalies.

During the COVID-19 pandemic, it was important for people to be able to comprehend information about mRNA vaccination. Moderna and Pfizer were two of the largest distributors of mRN vaccinations, and their websites provided information about how mRNA vaccinations work. Applying the tenets of Fuzzy-trace Theory (FTT), we calculated Gist Inference Scores (GIS) to assess the extent to which texts taken from Moderna and Pfizer websites facilitate gist comprehension. We then rewrote the Moderna and Pfizer texts to increase GIS and tested their ability to facilitate a reader's understanding of how mRNA vaccinations work. We conducted two experiments in which participants read original Moderna and Pfizer texts, a High GIS-version presenting the same content, or control texts on unrelated topics. Findings indicate that the High GIS-version increased comprehension. We conclude that this theory-driven approach can help subject-matter experts better communicate important information, allowing readers to "get the gist" of it.

Guided by argumentation schema theory, we conducted five psychological studies in the United States and China on arguments about vaccination. Study 1 replicated research about arguments on several topics, finding that agreement judgments are weighted toward claims, whereas quality judgments are weighted toward reasons. However, consistent with recent research, when this paradigm was extended to arguments about vaccination (Study 2), claims received more weight than reasons in judgments about agreement and quality. Studies 3 and 4 were conducted in the United States and China on how people process counterarguments against anti-vaccination assertions. Rebuttals did not influence agreement but played a role in argument quality judgments. Both political position (in the United States) and medical education (in China) predicted differences in argument evaluation. Bad reasons lowered agreement (Study 5), especially among participants studying health care. Political polarization apparently heightens the impact of claim side in the argumentation schema, likely to the detriment of public discourse.

Background: Minorities at increased risk for Hereditary Breast and Ovarian Cancer (HBOC) frequently have low awareness and use of genetic counseling and testing (GCT). Making sure that evidence-based interventions (EBIs) reach minorities is key to reduce disparities. BRCA-Gist is a theory-informed EBI that has been proven to be efficacious in mostly non-Hispanic White non-clinical populations. We conducted formative work to inform adaptations of BRCA-Gist for use in clinical settings with at-risk diverse women. Methods: Genetic counselors (n = 20) were recruited nationally; at-risk Latinas and Blacks (n = 21) were recruited in Washington DC and Virginia. They completed the BRCA-Gist EBI between April 2018 - September 2019. Participants completed an acceptability scale and an interview to provide suggestions about implementation adaptations. T-tests for independent samples compared acceptability between at-risk women and genetic counselors. The Consensual Qualitative Research Framework was used to code adaptation suggestions. Suggested adaptations were discussed by a multidisciplinary team to integrate fidelity and adaptation considerations. Results: At-risk women had a significantly higher acceptability (M = 4.17, SD = 0.47 vs. M = 3.24, SD = 0.64; p = 0.000; scale 1-5) and satisfaction scores (M = 8.3, SD = 1.3 vs. M = 4.2, SD = 2.0; p = 0.000; scale 1-10) than genetic counselors. Genetic counselors and at-risk women suggested contextual (e.g. format) and content (e.g. shortening) adaptations to enhance the fit of BRCA-Gist for diverse clinical populations. Conclusions: Findings illustrate the process of integrating fidelity and adaptation considerations to ensure that EBIs retain their core components while enhancing the fit to minoritized clinical populations. Future studies will test the efficacy of the adapted BRCA-Gist in a Randomized Controlled Trial.

Objective:Patients presenting for corrective facial surgery may have ideals that are not congruent with their surgeon's expectations for surgical outcomes. To identify and reduce disparities in expectations, the Facial Appearance as Core Expression Scale (FACES) was developed to assess the extent to which individuals identify their own faces as representing their ideal self.Method:In Study 1, 504 healthy young adult participants answered online questions about their own faces. In Study 2, 165 participants rated their own faces, digitally manipulated images of four patients before and after surgery, and two digitally averaged benchmark images.Results:In Study 1, the final FACES instrument had seven items and was highly reliable across genders and races. Study 2 replicated reliability findings. The before surgery and after surgery pictures yielded significant improvements in ratings, suggesting scale validity.Conclusions:The FACES consists of 14 items including a benchmark image to detect unusual responding. Results indicate the measure is reliable and sensitive to perceptions of surgical changes to faces. While the scale needs to be validated in a clinical sample, the measure may help identify patients with atypical ideal expectations for their face and may be used to quantify surgical outcomes.

Decision making theories such as Fuzzy-Trace Theory (FTT) suggest that individuals tend to rely on gist, or bottom-line meaning, in the text when making decisions. In this work, we delineate the process of developing GisPy, an open-source tool in Python for measuring the Gist Inference Score (GIS) in text. Evaluation of GisPy on documents in three benchmarks from the news and scientific text domains demonstrates that scores generated by our tool significantly distinguish low vs. high gist documents. Our tool is publicly available to use at: https://github.com/phosseini/GisPy.

Given the high rates of vaccine hesitancy, web-based medical misinformation about vaccination is a serious issue. We sought to understand the nature of Google searches leading to medical misinformation about vaccination, and guided by fuzzy-trace theory, the characteristics of misinformation pages related to comprehension, inference-making, and medical decision-making. We collected data from web pages presenting vaccination information. We assessed whether web pages presented medical misinformation, had an overarching gist, used narrative, and employed emotional appeals. We used Search Engine Optimization tools to determine the number of backlinks from other web pages, monthly Google traffic, and Google Keywords. We used Coh-Metrix to measure readability and Gist Inference Scores (GIS). For medical misinformation web pages, Google traffic and backlinks were heavily skewed with means of 138.8 visitors/month and 805 backlinks per page. Medical misinformation pages were significantly more likely than other vaccine pages to have backlinks from other pages, and significantly less likely to receive at least one visitor from Google searches per month. The top Google searches leading to medical misinformation were "the truth about vaccinations," "dangers of vaccination," and "pro con vaccines." Most frequently, pages challenged vaccine safety, with 32.7% having an overarching gist, 7.7% presenting narratives, and 17.3% making emotional appeals. Emotional appeals were significantly more common with medical misinformation than other high-traffic vaccination pages. Misinformation pages had a mean readability grade level of 11.5, and a mean GIS of - 0.234. Low GIS scores are a likely barrier to understanding gist, and are the "Achilles' heel" of misinformation pages.

Three patient education texts from the National Cancer Institute (NCI) were subjected to a Coh-Metrix analysis, then further analyzed to obtain Gist Inference Scores (GIS), a new measure of the likelihood that readers will make appropriate inferences about a text's bottom-line meaning. In the GIS formula, the Coh-Metrix psycholinguistic variables referential cohesion, deep cohesion, and latent semantic analysis (LSA) verb overlap increase GIS because cohesive texts that describe related actions are likely to induce gist representations. The Coh-Metrix variables word concreteness, imagability for content words, and hypernymy for nouns and verbs are negatively weighted because they tend to promote verbatim mental representations. NCI texts were modified for a cloze procedure with every tenth word replaced by a blank starting with the second sentence. Participants in two studies received all three cloze-modified texts. Fuzzy-Trace Theory suggests that people are more likely to comprehend high GIS texts "in their own words," and thus fill-the-blanks with multiple words that differ from those omitted by the cloze procedure expressing comparable meaning. In Study One, non-native English speakers appropriately filled blanks with different words at the same rate for all three texts of low-, medium-, and high-GIS. In Study Two, replicating previous findings, for high GIS texts, native English speakers filled blanks appropriately with words other than those removed significantly more often than for medium- or low-GIS texts. High GIS texts apparently afford readers more semantic and lexical flexibility, but non-native English speakers may be ill-equipped to capitalize on this characteristic of high GIS texts.

Scientists employ a range of research methods including dissection, field observation, and laboratory experimentation; they construct scientific theories ranging from mathematical models to reliable qualitative generalizations. One of the “basic” research issues studied is the relationship of aspects of play to performance on scientific achievement tests and other tasks. The body of “applied” literature addresses play-oriented curriculum reforms in kindergarten and elementary science education. The spirit of inquiry places curiosity and questioning at the heart of what it means to be a scientist. Play is a construct that subsumes a wide range of behaviors. Assimilation and accommodation are the “twin engines” of intellectual development from a Piagetian perspective. Although some Vygotskians may disagree, it is conceivable that exploratory representational play encourages children to play at tasks at the edges of their current competencies, and thus promotes development even in the absence of interactions with older peers. Exploratory representational play changes one’s representation of the world.

The COVID-19 pandemic has been characterized by misinformation, politicization of public health, and extreme differences in risk assessment. In two studies, we sought to understand factors that contribute to differences in people's understanding of the virus and associated risks. We found that conservative participants reported higher levels of acceptable risk, have lower risk estimates of activities, and endorsed more misinformation. Participants with personal health risk factors rated COVID-19 risks as higher, more reflective participants had lower acceptable risk levels, and impulsive participants endorsed more misinformation. In our second study, we also found that reflective participants were more likely to wear a mask, get vaccinated, and maintain social distancing, and that participants judged arguments about COVID-19 measures largely based on the claim rather than supporting reasons. By clarifying these individual differences, public health experts can more effectively create targeted interventions for at risk populations, and be better prepared for future outbreaks.

BACKGROUND:Despite steady gains in life expectancy, individuals with cystic fibrosis (CF) lung disease still experience rapid pulmonary decline throughout their clinical course, which can ultimately end in respiratory failure. Point-of-care tools for accurate and timely information regarding the risk of rapid decline is essential for clinical decision support. OBJECTIVE:This study aims to translate a novel algorithm for earlier, more accurate prediction of rapid lung function decline in patients with CF into an interactive web-based application that can be integrated within electronic health record systems, via collaborative development with clinicians. METHODS:Longitudinal clinical history, lung function measurements, and time-invariant characteristics were obtained for 30,879 patients with CF who were followed in the US Cystic Fibrosis Foundation Patient Registry (2003-2015). We iteratively developed the application using the R Shiny framework and by conducting a qualitative study with care provider focus groups (N=17). RESULTS:A clinical conceptual model and 4 themes were identified through coded feedback from application users: (1) ambiguity in rapid decline, (2) clinical utility, (3) clinical significance, and (4) specific suggested revisions. These themes were used to revise our application to the currently released version, available online for exploration. This study has advanced the application's potential prognostic utility for monitoring individuals with CF lung disease. Further application development will incorporate additional clinical characteristics requested by the users and also a more modular layout that can be useful for care provider and family interactions. CONCLUSIONS:Our framework for creating an interactive and visual analytics platform enables generalized development of applications to synthesize, model, and translate electronic health data, thereby enhancing clinical decision support and improving care and health outcomes for chronic diseases and disorders. A prospective implementation study is necessary to evaluate this tool's effectiveness regarding increased communication, enhanced shared decision-making, and improved clinical outcomes for patients with CF.

ABSTRACT We examine the use of intuition versus analytical thinking in auditor risk assessment using a task that requires auditors to assess a group of impairment indicators. We expect that auditor intuition, rooted in the subconscious, more likely reacts to impairment indicator risk than does auditor analytical thinking. Results from two different experiments support this expectation for less‐experienced audit seniors. These seniors are more likely to assess step‐zero impairment indicators as signaling potential impairment when prompted to think intuitively versus analytically . In contrast, a third experiment finds that experienced seniors are more likely to assess step‐zero impairment indicators as signaling potential impairment when prompted to think analytically versus intuitively . This is consistent with the more experienced but still non‐expert seniors possessing developed analytical thinking, but struggling to effectively use their intuition. Our results inform theory by suggesting under what conditions auditor intuition and analytical thinking produce differential risk sensitivity. Furthermore, our results inform practice, given regulators' stated focus on auditor skepticism and impairment assessments.

ABSTRACTBackground and Objectives:Nonalcoholic fatty liver disease (NAFLD) is linked to obesity. Obesity is associated with lower socioeconomic status (SES). An independent link between pediatric NAFLD and SES has not been elucidated. The objective of this study was to evaluate the distribution of socioeconomic deprivation, measured using an area‐level proxy, in pediatric patients with known NAFLD and to determine whether deprivation is associated with liver disease severity.Methods:Retrospective study of patients <21 years with NAFLD, followed from 2009 to 2018. The patients’ addresses were mapped to census tracts, which were then linked to the community deprivation index (CDI; range 0‐‐1, higher values indicating higher deprivation, calculated from six SES‐related variables available publicly in US Census databases).Results:Two cohorts were evaluated; 1 with MRI (magnetic resonance imaging) and/or MRE (magnetic resonance elastography) findings indicative of NAFLD (n = 334), and another with biopsy‐confirmed NAFLD (n = 245). In the MRI and histology cohorts, the majority were boys (66%), non‐Hispanic (77%–78%), severely obese (79%–80%), and publicly insured (55%–56%, respectively). The median CDI for both groups was 0.36 (range 0.15–0.85). In both cohorts, patients living above the median CDI were more likely to be younger at initial presentation, time of MRI, and time of liver biopsy. MRI‐measured fat fraction and liver stiffness, as well as histologic characteristics were not different between the high‐ and low‐deprivation groups.Conclusions:Children with NAFLD were found across the spectrum of deprivation. Although children from more deprived neighborhoods present at a younger age, they exhibit the same degree of NAFLD severity as their peers from less deprived areas.

Early life exposure to air pollution poses a significant risk to brain development from direct exposure to toxicants or via indirect mechanisms involving the circulatory, pulmonary or gastrointestinal systems. In children, exposure to traffic related air pollution has been associated with adverse effects on cognitive, behavioral and psychomotor development. We aimed to determine whether childhood exposure to traffic related air pollution is associated with regional differences in brain volume and cortical thickness among children enrolled in a longitudinal cohort study of traffic related air pollution and child health. We used magnetic resonance imaging to obtain anatomical brain images from a nested subset of 12 year old participants characterized with either high or low levels of traffic related air pollution exposure during their first year of life. We employed voxel-based morphometry to examine group differences in regional brain volume, and with separate analyses, changes in cortical thickness. Smaller regional gray matter volumes were determined in the left pre- and post-central gyri, the cerebellum, and inferior parietal lobe of participants in the high traffic related air pollution exposure group relative to participants with low exposure. Reduced cortical thickness was observed in participants with high exposure relative to those with low exposure, primarily in sensorimotor regions of the brain including the pre- and post-central gyri and the paracentral lobule, but also within the frontal and limbic regions. These results suggest that significant childhood exposure to traffic related air pollution is associated with structural alterations in brain.

OBJECTIVES:Develop a tool to evaluate and improve written medical communication to patients. Determine how effectively Gist Inference Scores (GIS) predict comprehension of patient education texts independently of health literacy. Explicate the text characteristics and psychological mechanism underlying GIS. METHODS:For study 1, a nationally representative sample of older women (N = 61) completed a fill-in-the-blank comprehension task on authentic National Cancer Institute (NCI) texts of varying GIS levels. In study 2, participants (N = 198) read NCI texts (high or low GIS) then recalled what they read. RESULTS:Study 1 showed that a higher percentage of different words yielding semantically similar sentence meaning were used to correctly fill-the-blanks on high GIS texts and there was no significant interaction with health literacy. In study 2, a greater proportion of decision-relevant information was recalled for high GIS texts. CONCLUSIONS:GIS predicts the likelihood that readers will form gist representations of medical texts on free recall and fill-in-the-blank tasks. High GIS texts allow for more semantic flexibility to mentally represent the same meaning, and more strongly emphasizes gist rather than verbatim representations. PRACTICAL IMPLICATIONS:GIS provides medical communicators with an automated and user-friendly method to evaluate medical texts for their ability to convey the bottom-line meaning.

Background. It is difficult to write about cancer for laypeople such that everyone understands. One common approach to readability is the Flesch-Kincaid Grade Level (FKGL). However, FKGL has been shown to be less effective than emerging discourse technologies in predicting readability. Objective. Guided by fuzzy-trace theory, we used the discourse technology Coh-Metrix to create a Gist Inference Score (GIS) and applied it to texts from the National Cancer Institute website written for patients and health care providers. We tested the prediction that patient cancer texts with higher GIS scores are likely to be better understood than others. Design. In study 1, all 244 cancer texts were systematically subjected to an automated Coh-Metrix analysis. In study 2, 9 of those patient texts (3 each at high, medium, and low GIS) were systematically converted to fill-the-blanks (Cloze) tests in which readers had to supply the missing words. Participants (162) received 3 texts, 1 at each GIS level. Measures. GIS was measured as the mean of 7 Coh-Metrix variables, and comprehension was measured through a Cloze procedure. Results. Although texts for patients scored lower on FKGL than those for providers, they also scored lower on GIS, suggesting difficulties for readers. In study 2, participants scored higher on the Cloze task for high GIS texts than for low- or medium-GIS texts. High-GIS texts seemed to better lend themselves to correct responses using different words. Limitations. GIS is limited to text and cannot assess inferences made from images. The systematic Cloze procedure worked well in aggregate but does not make fine-grained distinctions. Conclusions. GIS appears to be a useful, theoretically motivated supplement to FKGL for use in research and clinical practice.