DELTA AND THETA: A TIME-FREQUENCY FRAMEWORK FOR MEASURING ERPS

Time-frequency methodologies, which allow for the examination of spatially and temporally overlapping subprocesses, have shown that delta and theta can be used to explain the majority of variance in many traditional ERP components. Furthermore, prior work suggests that traditional ERPs likely contain separable activity associated with the salience and central executive networks, which indexed by theta amplitude and theta ICPS, respectively. The present study sought to validate a core set of measures in the theta and delta bands (amplitude, ICPS and ITPS measures) using a novelty oddball task, which allowed us to assess the separability of SN and CEN activity indexed by medial-frontal theta. Our results indicated that time-frequency amplitude, ICPS and ITPS each represent separable processes, such that delta amplitude indexes task-based elaborative processes, theta indexes relevant SN-related information, and ICPS indexes activity associated with the CEN; therefore, all can be used to more fully characterize ERP data

A search algorithm for identifying likely users and non-users of marijuana from the free text of the electronic medical record

Background The harmful effects of marijuana on health and in particular cardiovascular health are understudied. To develop such knowledge, an efficient method of developing an informative cohort of marijuana users and non-users is needed. Methods We identified patients with a diagnosis of coronary artery disease using ICD-9 codes who were seen in the San Francisco VA in 2015. We imported these patients’ medical record notes into an informatics platform that facilitated text searches. We categorized patients into those with evidence of marijuana use in the past 12 months and patients with no such evidence, using the following text strings: “marijuana”, “mjx”, and “cannabis”. We randomly selected 51 users and 51 non-users based on this preliminary classification, and sent a recruitment letter to 97 of these patients who had contact information available. Patients were interviewed on marijuana use and domains related to cardiovascular health. Data on marijuana use collected from the medical record was compared to data collected as part of the interview. Results The interview completion rate was 71%. Among the 35 patients identified by text strings as having used marijuana in the previous year, 15 had used marijuana in the past 30 days (positive predictive value = 42.9%). The probability of use in the past month increased from 8.8% to 42.9% in people who have these keywords in their medical record compared to those who did not have these terms in their medical record. Conclusion Methods that combine text search strategies for participant recruitment with health interviews provide an efficient approach to developing prospective cohorts that can be used to study the health effects of marijuana

MENTAL HEALTH TREATMENT UTILIZATION: THE INTERSECTIONAL EFFECTS OF RACE, SEX, AND AREA-LEVEL DEPRIVATION AMONG VETERANS WITH PTSD

Background: PTSD is a debilitating disorder impacting approximately 10-30% of veterans within their lifetime. While multiple efficacious treatment for PTSD have been developed, access to and utilization of mental health care remains a significant barrier. Models of health care utilization (e.g., Andersen, 1995; Fortney, 2011) implicate predisposing and enabling factors such as sex, race and/or ethnicity, and socioeconomic status (SES) or socioeconomic deprivation in healthcare access and utilization decisions. Although each of these factors has been examined in isolation, research on race and/or ethnicity and SES is limited, and almost no studies have examined the intersectional impacts of these factors on mental health service utilization among veterans. This study does so, hypothesizing that each will predict mental health service utilization individually, as well as show two and three-way interaction effects. Methods: All variables of interest were derived from the VA medical record, excepting area-level deprivation and geospatial access. Area-level deprivation was determined by linking veteran residential address to the Area Deprivation Index. Geospatial access was calculated by employing kernel density estimation, and linking ZIP-code level values to veteran residential address. All hypotheses were tested using negative binomial regression. Multiple imputation was employed for missingness. Results: Of the 245,574 veterans newly diagnosed with PTSD in 2017 or 2018, 75% attended at least one mental health appointment following diagnosis. The average number of follow-up appointments was 8.9 (mode = 1, median = 3). Sex, race-ethnicity, and area-level deprivation all predicted mental health service utilization individually. There was only one significant two-way interaction effect: identifying as a Black or African American male was positively associated with greater mental health service utilization following diagnosis (0.68, p=.007). There were no three-way interaction effects. Discussion: 1 in 4 veterans with PTSD in this sample did not attend any mental health appointments following diagnosis, highlighting the formidable gap between need and utilization. Furthermore, of those who did attend a follow up appointment, the modal number of appointments was 1, suggesting that entering care is not sufficient to ensure adequate treatment. Sex, race-ethnicity, and area-level deprivation all predicted mental health service utilization individually, but, with a singular exception, did not do so in combination with one another. It is possible that any variance explained by the well-documented compounding effects of societal bias, injustice, and disparities on (mental) health determinants and (mental) healthcare outcomes is more accurately measured by the covariates included in our models, rather than the socially-constructed identities themselves. Taken together, these study findings highlight the need for continued work in lowering barriers to mental health care for this population, as well as a greater understanding of the multitude of factors that influence access to and utilization of services

A search algorithm for identifying likely users and non-users of marijuana from the free text of the electronic medical record.

BackgroundThe harmful effects of marijuana on health and in particular cardiovascular health are understudied. To develop such knowledge, an efficient method of developing an informative cohort of marijuana users and non-users is needed.MethodsWe identified patients with a diagnosis of coronary artery disease using ICD-9 codes who were seen in the San Francisco VA in 2015. We imported these patients' medical record notes into an informatics platform that facilitated text searches. We categorized patients into those with evidence of marijuana use in the past 12 months and patients with no such evidence, using the following text strings: "marijuana", "mjx", and "cannabis". We randomly selected 51 users and 51 non-users based on this preliminary classification, and sent a recruitment letter to 97 of these patients who had contact information available. Patients were interviewed on marijuana use and domains related to cardiovascular health. Data on marijuana use collected from the medical record was compared to data collected as part of the interview.ResultsThe interview completion rate was 71%. Among the 35 patients identified by text strings as having used marijuana in the previous year, 15 had used marijuana in the past 30 days (positive predictive value = 42.9%). The probability of use in the past month increased from 8.8% to 42.9% in people who have these keywords in their medical record compared to those who did not have these terms in their medical record.ConclusionMethods that combine text search strategies for participant recruitment with health interviews provide an efficient approach to developing prospective cohorts that can be used to study the health effects of marijuana

Unique and Transdiagnostic Dimensions of Reward Functioning in Attention-Deficit/Hyperactivity Disorder and Alcohol Use Disorder Symptoms

AIMS: Contemporary theories of attention-deficit/hyperactivity disorder (ADHD) and alcohol use disorder (AUD) emphasize core dysfunctions in reward-related processes and behaviors as pathognomonic characteristics. However, to date, it is unclear which domains of reward functioning are unique to ADHD versus AUD symptom dimensions, and which represent underlying shared correlates. METHODS: The current study employed secondary data analyses from a large community sample of emerging adults (N = 602; 57.3% female) and novel transdiagnostic modeling (i.e. bi-factor confirmatory factor analyses and structural equation modeling) of ADHD, AUD and shared symptom dimensions to identify unique and common reward-related dimensions: environmental suppressors, reward probability, hedonic capacity, proportionate substance-related reinforcement and delay discounting. RESULTS: The presence of environmental suppressors was the only reward-related construct that correlated with the underlying ADHD-AUD shared dimension. The AUD symptom dimension was uniquely associated with proportionate substance-related reinforcement, whereas the ADHD symptom dimension was uniquely associated with limited reward probability. No significant associations were found for delay discounting or hedonic capacity. CONCLUSIONS: These novel findings highlight specific aspects of reward-related functioning in ADHD, AUD and shared symptom dimensions. In so doing, this work meaningfully advances theoretical conceptualizations of these two commonly co-occurring presentations and suggests future directions for research on transdiagnostic correlates. Future longitudinal studies should include clinical samples with diagnoses of AUD and ADHD to further identify underlying correlates over time

Parental Views of Social Worker and Chaplain Involvement in Care and Decision Making for Critically Ill Children with Cancer

Background: Social workers (SWs) and chaplains are trained to support families facing challenges associated with critical illness and potential end-of-life issues. Little is known about how parents view SW/chaplain involvement in care for critically ill children with cancer. Methods: We studied parent perceptions of SW/chaplain involvement in care for pediatric intensive care unit (PICU) patients with cancer or who had a hematopoietic cell transplant. English- and Spanish-speaking parents completed surveys within 7 days of PICU admission and at discharge. Some parents participated in an optional interview. Results: Twenty-four parents of 18 patients completed both surveys, and six parents were interviewed. Of the survey respondents, 66.7% and 75% interacted with SWs or chaplains, respectively. Most parents described SW/chaplain interactions as helpful (81.3% and 72.2%, respectively), but few reported their help with decision making (18.8% and 12.4%, respectively). Parents described SW/chaplain roles related to emotional, spiritual, instrumental, and holistic support. Few parents expressed awareness about SW/chaplain interactions with other healthcare team members. Conclusions: Future work is needed to determine SWs’/chaplains’ contributions to and impact on parental decision making, improve parent awareness about SW/chaplain roles and engagement with the healthcare team, and understand why some PICU parents do not interact with SWs/chaplains

Self reported marijuana use categorized by marijuana use in the chart.

<p>Self reported marijuana use categorized by marijuana use in the chart.</p

Concordance between text search method and patient interview.

<p>Concordance between text search method and patient interview.</p