Background:MediLinker is a blockchain-based application for identity verification and personal health information management. To prepare for its clinical deployment, the perceptions of health consumers toward MediLinker should be examined. Objective:Guided by a conceptual model derived from the theory of reasoned action, privacy calculus, protection motivation theory, and regulatory uncertainty, the study identifies U.S. adults' willingness to use MediLinker for health information management and the factors associated with this willingness. Methods:We conducted a cross-sectional online survey in August 2022 among U.S. adults recruited on Amazon Mechanical Turk. The analytic sample includes data from 913 respondents who nearly reflect U.S. demographic characteristics by gender and race/ethnicity. Descriptive statistics were used to identify respondents' willingness to use MediLinker, while structural equation modeling (SEM) was used to identify direct and indirect factors associated with willingness. Results:Most respondents were willing to use MediLinker to store and manage health information (76.7%), share health information with providers (79.3%), and provide consent for clinical research (78.4%). SEM results show that attitude toward MediLinker has a direct positive association with willingness to use MediLinker in general. We also identified several indirect predictors of willingness. For instance, perceived liability issues and perceived vulnerability have a negative indirect effect on willingness through perceived risks and attitude. On the other hand, perceived vulnerability and perceived severity have a positive indirect effect on willingness via perceived benefits and attitude. Conclusion:Our sample of U.S. adults is willing to use MediLinker for health information management. Moreover, our conceptual model shows direct and indirect pathways influencing U.S. adults' willingness to use MediLinker. The results inform the deployment of blockchain-based health information management applications among health consumers. Overall, the study contributes to the literature on how healthcare consumers perceive blockchain technologies for medical decision making involving their online health information.

Scientific progress today is increasingly realized through collaboration. Recent global crises and shifting geopolitical and funding landscapes have shown that collaboration is not immune to shocks. These disturbances call for a deeper examination of the resilience of science, specifically how the scientific community sustains its functionality and collaborative output amid potential shocks and failures. In this study, we conceptualize resilience as a structural property of scientific collaboration and quantify it using an interpretable, network-theoretic measure. Using a large-scale bibliographic dataset, we construct coauthorship networks across multiple disciplines from 1985 to 2014 and perform stress-test experiments that simulate stylized perturbations to identify the structural elements that support system resilience. Our findings show that discipline-level resilience is positively associated with higher collaboration intensity and, more strongly, with greater variance in scientists' collaboration outcomes. Moreover, we find that persistent collaborations-stable and strong collaborations between scientists-play a central role in fostering resilient network structures across fields; they comprise only a small share of links yet are disproportionately held by scientists in the top decile of productivity. Overall, this study offers a network-based framework for understanding the structural resilience of scientific collaboration and implies the important role of persistent collaboration in supporting that resilience.

Background Chronic spinal (back/neck) pain is common and costly. Psychosocial treatments are available but have modest effects. Knowledge of treatment mechanisms (mediators and moderators) can be used to enhance efficacy. Trials that directly compare different treatments are needed to determine which mechanisms are treatment-specific, which are shared across treatments, and which contribute the most to outcomes. Methods We will conduct a 4-arm randomized, controlled clinical trial to compare the main effects, mediators, and moderators of three pain therapies: Cognitive-Behavioral Therapy, Acceptance and Commitment Therapy, and Emotional Awareness and Expression Therapy in adults with chronic spinal pain. Following baseline assessment of outcomes variables (two primary outcomes: pain intensity and pain interference) and potential mediators and moderators, we will randomize participants (up to 460) to one of the treatments or usual care control. Treatments will be conducted individually each week for 8 weeks via telehealth. We will conduct weekly assessments of both potential mediators and outcomes, as well as post-treatment and 6-month follow-up assessments. We will test whether any of the therapies is superior to the others (Aim 1); identify mediators that are specific to treatments and those that are shared across treatments (Aim 2); and identify baseline moderators that are specific to treatments or shared across treatments, and moderated mediators of treatments (Aim 3). Discussion The findings from this project can be used to improve the effects of psychosocial chronic pain treatments by identifying the most powerful specific and shared mechanisms and revealing for whom the mediator-outcome pathways are strongest.

INTRODUCTION:Assessing military medical teams' ability to respond to large-scale mass casualty (MASCAL) events has become a priority in preparing for future conflicts. MASCAL exercises rely on large numbers of simulated patients with limited medical training. Role-players must be appropriately prepared to ensure that medical exercises adequately assess the expected capabilities of military medical units. The Uniformed Services University of the Health Sciences (USUHS) has evaluated future military providers for decades using a large-scale, multiday, immersive simulation called Bushmaster. Despite a robust casualty training system, the fidelity of the portrayals remained limited. MATERIALS AND METHODS:Through collaboration with national military medical experts, a comprehensive casualty depiction system was developed. This system relied on structured casualty cards linked to time-based illness scripts. Structured casualty cards included an appropriate balance of disease non-battle injuries and trauma, included multipatient presentations based on shared events (i.e., multiple injured personnel due to an aircraft crash), normal and pathologic combat stress, population/unit considerations, requirements for different roles within the medical unit, and expected clinical outcomes. Illness scripts, supplemented by video guides, included time-based courses of illness/injury and prescribed responses to different typical treatments. This system was piloted during an annual MASCAL exercise (Operation Bushmaster) at USUHS. Clinical faculty were queried on the fidelity of this new system while role-players were evaluated on feasibility. RESULTS:Three hundred casualty cards linked to 49 illness scripts were created, peer-reviewed, and piloted at Bushmaster. A total of 170 military members with limited medical training portrayed simulated patients utilizing the new casualty depiction system. Clinical faculty members strongly agreed that the improved casualty depiction system improved the realism of individual patient presentations (96%). Eighty-three percent of role-players strongly agreed that the casualty depiction system was easy to understand. CONCLUSIONS:This improved casualty depiction system was a feasible approach to enhance the fidelity of a MASCAL exercise. It has since been shared with military medical units around the globe to assist with their MASCAL exercises, making future multisite evaluations of this casualty depiction system possible.

School inclusion of children with Autism Spectrum Disorder represents a challenge for all parties involved (family, school and out-of-school actors such as health care professionals). Existing tools focus either on the pupil, or the relationships between two parties, and notably parent-professional relationships. Considering a systemic approach, the authors designed the web-based app CoEd to enhance and facilitate communication and information sharing among them, using participatory methods. They used (fictitious) realistic cases to create scenarios that contain tasks to do on the web application, adapted to each participant role (parent, teacher and external actors). They used objective (interaction annotations, website navigation inspection) and subjective (questionnaires) measures to assess the usability, user experience, cognitive load and elicited self-determination. Results indicated that CoEd was very usable, with an excellent user experience and a relatively low cognitive demand. Some design mistakes were identified and corrected for the enhanced final release.

Delay discounting—the extent to which individuals show a preference for smaller immediate rewards over larger delayed rewards—has been proposed as a transdiagnostic neurocognitive process across mental health conditions, but its examination in relation to posttraumatic stress disorder (PTSD) is comparatively recent. To assess the aggregated evidence for elevated delay discounting in relation to posttraumatic stress, we conducted a meta-analysis on existing empirical literature. Bibliographic searches identified 209 candidate articles, of which 13 articles with 14 independent effect sizes were eligible for meta-analysis, reflecting a combined sample size of N = 6897. Individual study designs included case-control (e.g. examination of differences in delay discounting between individuals with and without PTSD) and continuous association studies (e.g. relationship between posttraumatic stress symptom severity and delay discounting). In a combined analysis of all studies, the overall relationship was a small but statistically significant positive association between posttraumatic stress and delay discounting ( r = .135, p < .0001). The same relationship was statistically significant for continuous association studies ( r = .092, p = .027) and case-control designs ( r = .179, p < .001). Evidence of publication bias was minimal. The included studies were limited in that many did not concurrently incorporate other psychiatric conditions in the analyses, leaving the specificity of the relationship to posttraumatic stress less clear. Nonetheless, these findings are broadly consistent with previous meta-analyses of delayed reward discounting in relation to other mental health conditions and provide further evidence for the transdiagnostic utility of this construct.

We examined beliefs and practices regarding firearm assessment and lethal means safety counseling (LMSC) among U.S. Air Force (USAF) mental health providers (MHPs) and behavioral health technicians (BHTs). Data were collected from 204 USAF MHPs (74.0%; n = 151) and BHTs (26.0%; n = 53) via an anonymous, voluntary survey. A modest proportion indicated they strongly/extremely believe that firearm ownership (42.2%) and storage practices (58.3%) are related to suicide risk. A minority indicated they "strongly"/"extremely" believe that LMSC will yield changes in storage practices (30.9%) and decreases in suicide risk (29.9%). Across patient scenarios, most indicated that "most of the time"/"always" they assess for firearm access (74.5%-99.5%) and provide LMSC (57.8%-95.6%). About half (52.5%) reported having distributed cable locks. Most (59.3%) indicated they are somewhat interested/very interested in receiving additional training on LMSC. MHPs, compared with BHTs, were significantly more likely to report believing a link between firearm ownership and storage practices and suicide risk, believing LMSC is effective at reducing suicide risk, providing LMSC to female patients and patients with current suicidal ideation, and having distributed cable locks. Findings suggest that there is not widespread agreement among USAF MHPs and BHTs that personal firearm ownership and nonsecure storage practices are associated with elevated suicide risk, and there were low levels of confidence in the effectiveness of LMSC. Yet, most USAF MHPs and BHTs reported they integrate firearm access assessment and LMSC as part of their routine clinical care, particularly for patients with identified suicide risk. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

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Firefighters protect the public despite significant risk to their health and well-being stemming from frequent trauma exposure and other occupational stressors. A minority of firefighters develop posttraumatic stress disorder (PTSD), alcohol use disorder (AUD), or related mental health problems, such as depression or anxiety. These problems frequently co-occur and are linked with high neuroticism and difficulties with emotion regulation. Thus, efficient treatment for this population should be transdiagnostic and target neuroticism. Moreover, logistical challenges and stigma represent barriers to care in firefighters. We addressed these challenges by culturally adapting the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders and delivering it to 61 firefighters via videoconferencing, of whom 49 completed treatment. The adaptation process is described, and two case vignettes are presented. In the total sample, large effect size improvements were observed in symptoms of PTSD, depression, and psychological aspects of quality of life at posttreatment and 1month follow-up. For anxiety, improvements were medium at posttreatment and large at follow-up. Medium effects were observed on reductions in AUD symptoms and in the other aspects of quality of life (physical health, social relationships, and environmental) at posttreatment and follow-up. Reductions in suicide risk were small in the total sample and moderate among those who screened positive for being at suicide risk at pretreatment. Similarly promising results were observed in the subsamples of participants who screened positive for PTSD, AUD, and co-occurring PTSD-AUD at pretreatment, with large improvements in AUD symptoms observed in those who screened positive for AUD at pretreatment. This is the first study to report on the unified protocol delivered via telehealth. The treatment completion rate was high (80.3%). The current study contributes to the emerging literature on the unified protocol for PTSD and AUD. The current findings support the utility of this treatment for PTSD and AUD, consistent with the underlying approach of targeting neuroticism across diagnostic categories.

Lack of evidence to guide medication treatments for mild traumatic brain injury (mTBI) in veterans too often results in polypharmacy practices attempting to provide symptomatic relief from multiple postconcussive syndrome symptoms. Therefore, the field needs to find an effective medication that reduces the burden of postconcussive symptoms without complicating the treatment burden of veterans. This clinical trial seeks to determine whether switching veterans to quetiapine monotherapy (intervention) is superior to continuing to receive treatment as usual (TAU, control) polypharmacy for veterans with symptoms of postconcussive syndrome and posttraumatic stress disorder who are receiving rehabilitation treatment for mTBI. This study will test the conceptual mediation model hypothesis that quetiapine monotherapy may enhance recovery from mTBI by (1) increasing engagement in rehabilitation services, and/or (2) reducing the adverse effects of TAU polypharmacy. This study will enroll 146 patients from two Veterans Administration Medical Centers into a 12- week phase III, randomized, pragmatic clinical trial comparing outcomes from treatment with quetiapine monotherapy and TAU. Quetiapine will be cross tapered up to a maximum dose of 200 mg (as tolerated) as other medications are discontinued. The primary outcome measures are postconcussive syndrome symptoms (Neurobehavioral Symptom Inventory), functional disability (World Health Organization Disability Assessment), and quality of life (World Health Organization Quality of Life Assessment). Overall, this study aims to determine whether quetiapine monotherapy is superior to TAU polypharmacy and improves the quality of life for veterans with comorbid postconcussive syndrome and posttraumatic stress disorder symptoms who are receiving rehabilitation treatment for mTBI.

Leadership is evolving dynamically from an individual endeavor to shared efforts. This paper aims to advance our understanding of shared leadership in scientific teams. We define three kinds of leaders, junior (10-15), mid (15-20), and senior (20+) based on career age. By considering the combinations of any two leaders, we distinguish shared leadership as heterogeneous when leaders are in different age cohorts and homogeneous when leaders are in the same age cohort. Drawing on 1,845,351 CS, 254,039 Sociology, and 193,338 Business teams with two leaders in the OpenAlex dataset, we identify that heterogeneous shared leadership brings higher citation impact for teams than homogeneous shared leadership. Specifically, when junior leaders are paired with senior leaders, it significantly increases team citation ranking by 1-2 in comparison with two leaders of similar age. We explore the patterns between homogeneous leaders and heterogeneous leaders from team scale, expertise composition, and knowledge recency perspectives. Compared with homogeneous leaders, heterogeneous leaders are more adaptive in large teams, have more diverse expertise, and trace both the newest and oldest references.

Background: Recent findings indicate that firefighters may be at increased risk for death by suicide; however, there has been only limited suicide prevention work in fire service to date. Aim: The objective of this program evaluation project was to develop and evaluate a web-based Safety Planning Intervention (SPI) training course for firefighter peer support specialists. Method: Peer support specialists who completed the web-based SPI training were administered evaluation questionnaires before the training and then again at a 3-month follow-up assessment. Results: A total of 213 peer support specialists completed the SPI training. Most participants took 2-3 h to complete the training. Participants generally reported high levels of satisfaction with the course, with the vast majority (94.4%) indicating they would recommend it to their peers. Course completers also demonstrated significant gains in SPI knowledge and self-efficacy from baseline to 3-month follow-up (all p's < .001). Moreover, the percentage of participants who reported completing a safety plan with someone they suspected at being of risk for suicide increased approximately 7-fold from baseline (3.5%) to 3-month follow-up (25.2%; p < .001). Participants further reported that 97.6% of the safety plans that they completed resulted in a positive outcome. Limitations: This was a program evaluation project that did not include a control group. Thus, causality cannot be inferred. Conclusions: The present findings suggest that web-based SPI training is a feasible and scalable approach for training peer support specialists to deliver the SPI to at-risk individuals.

BackgroundEnhancing resiliency and optimizing readiness in military personnel is a high priority for the U.S. Department of Defense. Most military resiliency-enhancement programs are evidence-informed interventions. However, few randomized studies have demonstrated efficacy of any intervention or training program to enhance resiliency and prevent the development of psychological health symptoms in military personnel when exposed to operational stressors. This manuscript provides an overview of the theoretical foundation, research design, and research methods of a preventive intervention trial designed to evaluate the efficacy of a training program to enhance resiliency and prevent psychological health symptoms in military personnel. The resiliency training intervention is based on Acceptance and Commitment Therapy (ACT), an evidence-based intervention with broad empirical support for improving functioning in those living with psychological and medical conditions.Method/designThis study will evaluate the efficacy of a two-day training program based on ACT for fostering psychological flexibility, the central target in ACT, for enhancing resiliency, and for preventing the development of psychological health symptoms. The research participants will be a non-clinical population of active duty military personnel (N = 600). The ACT-based training program (n = 300) will be compared to a military resiliency training as usual, known as Master Resilience Training (n = 300). Assessment measures will be administered at the baseline assessment, after training, prior to a military deployment, and after returning from a deployment. Qualitative interviews will be conducted to provide feedback on the training program.Clinical Trial Registration: NCT05094115.

Background: First responders, including firefighters and emergency medical technicians (EMTs), are under extreme stress from repeated exposure to potentially traumatic events. To optimize treatment for this population, it is critical to understand how the various posttraumatic stress disorder (PTSD) symptom factors are associated with one another so these relations may be targeted in treatment.Method: Using a sample of treatment-seeking firefighters/EMTs (N = 342), we conducted a partial correlation network analysis of the eight-factor model. A Bayesian directed acyclic graph (DAG) was used to estimate causal associations between clusters.Results: Approximately 37 % of the sample screened positive for probable PTSD. Internal re-experiencing and external re-experiencing had the strongest edges. In the DAG, internal re-experiencing was the parent node and was potentially predictive of external re-experiencing, negative affect, dysphoric arousal, and avoidance.Limitations: Data were drawn from a treatment-seeking sample that may not generalize to all firefighters/EMTs.Conclusions: The current findings are consistent with prior research suggesting re-experiencing plays a critical role in developing and maintaining PTSD symptoms. Future research should investigate non-treatment-seeking first responders, as well as EMTs and firefighters as individual populations.

L’environnement socio-éducatif d’un élève avec Trouble du Spectre de l’Autisme (TSA) est principalement tripartite avec : sa famille, l’école, et les services médico-sociaux. Chacune des parties, les personnes impliquées et leurs interactions ont une influence directe sur le jeune. Bien que formellement instituée comme requise pour favoriser l’inclusion scolaire, la coéducation est rarement opérationnelle, et chacune des parties rapportent des difficultés de communication et de coordination des projets de l’élève liées à l’absence d’unité de temps et d’espace pour échanger. Pour parfaire cette absence, l’action recherche TousEnsemble a consisté à coconcevoir une application web interactive pour la collaboration entre les acteurs de l’inclusion scolaire des élèves avec TSA. Une méthode de conception participative a été choisie pour permettre la codécision, l’engagement citoyen, et la responsabilisation éthique des parties prenantes à la conception du futur outil. Les besoins des utilisateurs ont été collectés, différents prototypes ont été créés en intégrant itérativement leurs retours, jusqu’à aboutir à un consensus. L’inspection ergonomique de l’outil final a satisfait les principaux besoins initiaux, aboutissant à un outil de soutien à la coéducation centrée sur les compétences, solutions éducatives et un partage de l’expertise de chacun au bénéfice de l’élève.

ABSTRACTEarly social informatics research focused primarily on ethnographic, site‐specific observations within organizations and was based on smaller case studies. The rising of social media and big data availability have made large‐scale data analysis accessible and easier. This has informed social informatics perspectives by examining the roles and impacts of social media in our work and social lives. The panel aims to utilize principles of social informatics approach to understand emerging issues related to social media, which are pervasive in almost every aspect of our daily lives, and to Information and Communication Technologies (ICTs) more broadly. To push social informatics research forward, the panelists will address the questions regarding the future of social informatics.

extracted from the Jisc UK Web Domain Dataset (Jisc, n.d.- a) covering the period from 1996 to 2010 to undertake a longitudinal analysis of the United Kingdom (UK) national web domain, .uk, focusing on the four largest second level domains: .co.uk, .org.uk, .gov.uk, and .ac.uk. We explore the growth of these domains, and examine the link density within and between them. Next we look in more detail at the academic second-level domain, .ac.uk, to understand the relationship between link density among UK academic institutions and measures of affiliation, status, performance and geographic distance. Overall, these results are used both to understand the growth and structure of the .uk domain, but also to demonstrate the benefits and challenges of this type of analysis more generally

Patients' control over how their health information is stored has been an ongoing issue in health informatics. Currently, most patients' health information is stored in centralized but siloed health information systems of healthcare institutions, rarely connected to or interoperable with other institutions outside of their specific health system. This centralized approach to the storage of health information is susceptible to breaches, though it can be mitigated using technology that allows for decentralized access. One promising technology that offers the possibility of decentralization, data protection, and interoperability is blockchain. In 2019, our interdisciplinary team from the University of Texas at Austin's Dell Medical School, School of Information, Department of Electrical and Computer Engineering, and Information Technology Services developed MediLinker-a blockchain-based decentralized health information management platform for patient-centric healthcare. This paper provides an overview of MediLinker and outlines its ongoing and future development and implementation. Overall, this paper contributes insights into the opportunities and challenges in developing and implementing blockchain-based technologies in healthcare.

IMPORTANCE Improved, efficient, and acceptable treatments are needed for combat-related posttraumatic stress disorder (PTSD). OBJECTIVE To determine the efficacy of 2 compressed prolonged exposure (PE) therapy outpatient treatments for combat-related PTSD. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted among military personnel and veterans at 4 sites in Texas from 2017 to 2019. Assessors were blinded to conditions. Data were analyzed from November 2020 to October 2022. INTERVENTIONS The interventions were massed-PE, which included 15 therapy sessions of 90 minutes each over 3 weeks, vs intensive outpatient program PE (IOP-PE), which included 15 full-day therapy sessions over 3 weeks with 8 treatment augmentations. The IOP-PE intervention was hypothesized to be superior to massed-PE. MAIN OUTCOMES AND MEASURES Coprimary outcomes included the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) (CAPS-5) and the PTSD Checklist for DSM-5 (PCL-5) administered at baseline and posttreatment follow-ups. Measures ranged from 0 to 80, with higher scores indicating greater severity. Diagnostic remission and reliable change were secondary outcomes. RESULTS Among 319 military personnel and veterans screened, 234 were randomized (mean [SD] age, 39.20 [7.72] years; 182 [78%] male participants), with 117 participants randomized to IOP-PE and 117 participants randomized to massed-PE. A total of 61 participants (26%) were African American, 58 participants (25%) were Hispanic, and 102 participants (44%) were White; 151 participants (65%) were married. Linear mixed-effects models found that CAPS-5 scores decreased in both treatment groups at the 1-month follow-up (IOP-PE: mean difference, -13.85 [95% CI, -16.47 to -11.23]; P<.001; massed-PE: mean difference, -14.13 [95% CI, -16.63 to -11.62]; P<.001). CAPS-5 change scores differed from 1- to 6-month follow-ups (mean difference, 4.44 [95% CI, 0.89 to 8.01]; P=.02). PTSD symptoms increased in massed-PE participants during follow-up (mean difference, 3.21 [95% CI, 0.65 to 5.77]; P=.01), whereas IOP-PE participants maintained treatment gains (mean difference, 1.23 [95% CI, -3.72 to 1.27]; P=.33). PCL-5 scores decreased in both groups from baseline to 1-month follow-up (IOP-PE: mean difference, -21.81 [95% CI, -25.57 to -18.04]; P<.001; massed-PE: mean difference, -19.96 [95% CI, -23.56 to -16.35]; P<.001) and were maintained at 6 months (IOP-PE: mean change, -0.21 [95% CI, -3.47 to 3.06]; P=.90; massed-PE: mean change, 3.02 [95% CI, -0.36 to 6.40]; P=.08). Both groups had notable PTSD diagnostic remission at posttreatment (IOP-PE: 48% [95% CI, 36% to 61%] of participants; massed-PE: 62% [95% CI, 51% to 73%] of participants), which was maintained at 6 months (IOP-PE: 53% [95% CI, 40% to 66%] of participants; massed-PE: 52% [95% CI, 38% to 66%] of participants). Most participants demonstrated reliable change on the CAPS-5 (61% [95% CI, 52% to 69%] of participants) and the PCL-5 (74% [95% CI, 66% to 81%] of participants) at the 1-month follow-up. CONCLUSIONS AND RELEVANCE These findings suggest that PE can be adapted into compressed treatment formats that effectively reduce PTSD symptoms.