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As the use of guided digitally-delivered cognitive-behavioral therapy (GdCBT) grows, pragmatic analytic tools are needed to evaluate coaches’ implementation fidelity.
Aims
We evaluated how natural language processing (NLP) and machine learning (ML) methods might automate the monitoring of coaches’ implementation fidelity to GdCBT delivered as part of a randomized controlled trial.
Method
Coaches served as guides to 6-month GdCBT with 3,381 assigned users with or at risk for anxiety, depression, or eating disorders. CBT-trained and supervised human coders used a rubric to rate the implementation fidelity of 13,529 coach-to-user messages. NLP methods abstracted data from text-based coach-to-user messages, and 11 ML models predicting coach implementation fidelity were evaluated.
Results
Inter-rater agreement by human coders was excellent (intra-class correlation coefficient = .980–.992). Coaches achieved behavioral targets at the start of the GdCBT and maintained strong fidelity throughout most subsequent messages. Coaches also avoided prohibited actions (e.g. reinforcing users’ avoidance). Sentiment analyses generally indicated a higher frequency of coach-delivered positive than negative sentiment words and predicted coach implementation fidelity with acceptable performance metrics (e.g. area under the receiver operating characteristic curve [AUC] = 74.48%). The final best-performing ML algorithms that included a more comprehensive set of NLP features performed well (e.g. AUC = 76.06%).
Conclusions
NLP and ML tools could help clinical supervisors automate monitoring of coaches’ implementation fidelity to GdCBT. These tools could maximize allocation of scarce resources by reducing the personnel time needed to measure fidelity, potentially freeing up more time for high-quality clinical care.
We present a 1000 km transect of phase-sensitive radar measurements of ice thickness, basal reflection strength, basal melting and ice-column deformation across the Ross Ice Shelf (RIS). Measurements were gathered at varying intervals in austral summer between 2015 and 2020, connecting the grounding line with the distant ice shelf front. We identified changing basal reflection strengths revealing a variety of basal conditions influenced by ice flow and by ice–ocean interaction at the ice base. Reflection strength is lower across the central RIS, while strong reflections in the near-front and near-grounding line regions correspond with higher basal melt rates, up to 0.47 ± 0.02 m a−1 in the north. Melting from atmospherically warmed surface water extends 150–170 km south of the RIS front. Melt rates up to 0.29 ± 0.03 m a−1 and 0.15 ± 0.03 m a−1 are observed near the grounding lines of the Whillans and Kamb Ice Stream, respectively. Although troublesome to compare directly, our surface-based observations generally agree with the basal melt pattern provided by satellite-based methods but provide a distinctly smoother pattern. Our work delivers a precise measurement of basal melt rates across the RIS, a rare insight that also provides an early 21st-century baseline.
Previous studies identified clusters of first-episode psychosis (FEP) patients based on cognition and premorbid adjustment. This study examined a range of socio-environmental risk factors associated with clusters of FEP, aiming a) to compare clusters of FEP and community controls using the Maudsley Environmental Risk Score for psychosis (ERS), a weighted sum of the following risks: paternal age, childhood adversities, cannabis use, and ethnic minority membership; b) to explore the putative differences in specific environmental risk factors in distinguishing within patient clusters and from controls.
Methods
A univariable general linear model (GLS) compared the ERS between 1,263 community controls and clusters derived from 802 FEP patients, namely, low (n = 223) and high-cognitive-functioning (n = 205), intermediate (n = 224) and deteriorating (n = 150), from the EU-GEI study. A multivariable GLS compared clusters and controls by different exposures included in the ERS.
Results
The ERS was higher in all clusters compared to controls, mostly in the deteriorating (β=2.8, 95% CI 2.3 3.4, η2 = 0.049) and the low-cognitive-functioning cluster (β=2.4, 95% CI 1.9 2.8, η2 = 0.049) and distinguished them from the cluster with high-cognitive-functioning. The deteriorating cluster had higher cannabis exposure (meandifference = 0.48, 95% CI 0.49 0.91) than the intermediate having identical IQ, and more people from an ethnic minority (meandifference = 0.77, 95% CI 0.24 1.29) compared to the high-cognitive-functioning cluster.
Conclusions
High exposure to environmental risk factors might result in cognitive impairment and lower-than-expected functioning in individuals at the onset of psychosis. Some patients’ trajectories involved risk factors that could be modified by tailored interventions.
The association between cannabis and psychosis is established, but the role of underlying genetics is unclear. We used data from the EU-GEI case-control study and UK Biobank to examine the independent and combined effect of heavy cannabis use and schizophrenia polygenic risk score (PRS) on risk for psychosis.
Methods
Genome-wide association study summary statistics from the Psychiatric Genomics Consortium and the Genomic Psychiatry Cohort were used to calculate schizophrenia and cannabis use disorder (CUD) PRS for 1098 participants from the EU-GEI study and 143600 from the UK Biobank. Both datasets had information on cannabis use.
Results
In both samples, schizophrenia PRS and cannabis use independently increased risk of psychosis. Schizophrenia PRS was not associated with patterns of cannabis use in the EU-GEI cases or controls or UK Biobank cases. It was associated with lifetime and daily cannabis use among UK Biobank participants without psychosis, but the effect was substantially reduced when CUD PRS was included in the model. In the EU-GEI sample, regular users of high-potency cannabis had the highest odds of being a case independently of schizophrenia PRS (OR daily use high-potency cannabis adjusted for PRS = 5.09, 95% CI 3.08–8.43, p = 3.21 × 10−10). We found no evidence of interaction between schizophrenia PRS and patterns of cannabis use.
Conclusions
Regular use of high-potency cannabis remains a strong predictor of psychotic disorder independently of schizophrenia PRS, which does not seem to be associated with heavy cannabis use. These are important findings at a time of increasing use and potency of cannabis worldwide.
OBJECTIVES/GOALS: Contingency management (CM) procedures yield measurable reductions in cocaine use. This poster describes a trial aimed at using CM as a vehicle to show the biopsychosocial health benefits of reduced use, rather than total abstinence, the currently accepted metric for treatment efficacy. METHODS/STUDY POPULATION: In this 12-week, randomized controlled trial, CM was used to reduce cocaine use and evaluate associated improvements in cardiovascular, immune, and psychosocial well-being. Adults aged 18 and older who sought treatment for cocaine use (N=127) were randomized into three groups in a 1:1:1 ratio: High Value ($55) or Low Value ($13) CM incentives for cocaine-negative urine samples or a non-contingent control group. They completed outpatient sessions three days per week across the 12-week intervention period, totaling 36 clinic visits and four post-treatment follow-up visits. During each visit, participants provided observed urine samples and completed several assays of biopsychosocial health. RESULTS/ANTICIPATED RESULTS: Preliminary findings from generalized linear mixed effect modeling demonstrate the feasibility of the CM platform. Abstinence rates from cocaine use were significantly greater in the High Value group (47% negative; OR = 2.80; p = 0.01) relative to the Low Value (23% negative) and Control groups (24% negative;). In the planned primary analysis, the level of cocaine use reduction based on cocaine-negative urine samples will serve as the primary predictor of cardiovascular (e.g., endothelin-1 levels), immune (e.g., IL-10 levels) and psychosocial (e.g., Addiction Severity Index) outcomes using results from the fitted models. DISCUSSION/SIGNIFICANCE: This research will advance the field by prospectively and comprehensively demonstrating the beneficial effects of reduced cocaine use. These outcomes can, in turn, support the adoption of reduced cocaine use as a viable alternative endpoint in cocaine treatment trials.
The frontiers of network analysis keep expanding with new data sources and new ways to see structure and model relations. Traces of interactions and relations are now constantly streaming and being recorded through social network platforms. New technologies are affording new ways to visualize and analyze massive online data sets, as well as flowing interactions using video and sensor data. These new data sources are being met with new data mining approaches, giving us a deeper and wider view of social structure. Moreover, these new technologies are undoubtedly changing aspects of social structure itself, as people form ties and influence one another in ways that were unimaginable a generation ago. What is missing, we contend, is a systematic way of linking these projects to a theory of social structure (as outlined in Chapter 2). We conclude by proposing three strategies for addressing open problems and moving forward in modeling social structure.
Whereas in one-mode data, individuals or groups are connected directly with one another through interactions or relations, in two-mode data, individuals are indirectly connected with one another through affiliations (events, organizations, associations, alliances, and so on). Affiliation data are often used as a proxy for detecting ties among social actors when direct evidence of ties is difficult to obtain. For example, it is generally easier to know that two people belong to the same club or work in the same department than to know that they have lunch together every Thursday. But affiliation data can also be used to see aspects of social structures not visible in one-mode networks. Duality is a kind of structural relation that shows how levels of social structure intersect with one another. We discuss the classic approach to duality as well as two generalizations that extend the duality approach in hierarchical, temporal, and spatial directions.
When does a collection of individuals become a group or a community? What holds groups, communities, and societies together, even as individuals come and go? These questions concern social cohesion, the bonds through which otherwise disconnected individuals become part of something larger and more lasting than themselves. Social cohesion is perhaps the most central issue in the founding of sociology as a discipline, and its relevance persists today. Social network analysis has much to offer in making the study of social cohesion more formal and precise. Whereas in the previous chapter, we examined structures from the standpoint of their constituent elements of dyads and triads, here we step back to try to see more of the bigger structural picture through the overall pattern of ties in a network.
By looking at networks as collections of smaller elementary structural forms – mainly all combinations of two nodes (dyads) and three nodes (triads) among whom ties may or may not exist – one can learn much about the larger structure. This is especially useful when that structure is very large and therefore difficult to see as a whole. And yet, these most elementary forms of social structure are not simply mathematical constructs; they reflect the fundamental ways that social actors relate with one another as individuals and as social units (i.e., sociality). Thus, a network with many social elements of one type, and fewer of another, suggests a certain way of relating involved in how the network has formed and where it might be going. In this chapter, we introduce the reader to dyads and triads as forms of interacting and relating. We cover techniques for decomposing networks into these constituent elements and connecting variation at the micro level as a way of seeing macro-level structures.
The primary aim of social network analysis is building and evaluating theories of social structure – that is, enduring patterns of human interaction and ways of thinking about and organizing human groups. The sheer complexity of social structure prevents encapsulation in any single model, and this complexity is compounded as we incorporate cultural beliefs and social expectations in addition to interactions. Networks link actors to one another in systems, raising tricky questions about the locus of control and activity, particularly regarding the extent to which people are active agents or passive puppets (to put it bluntly) of social structure. While acknowledging deep and ultimately unsettled issues in the field, we provide readers with an overarching though still evolving theoretical account of social structure that can guide both inductive and deductive social network research and allow plug-in points for different perspectives on agency, culture, and constraint.
We outline key conceptual issues and strategies in social network data collection, focusing on the differences between realist and nominalist approaches. Given that most networks are incomplete in some way, we discuss ways to anticipate and assess problems with missing data.
Some people take orders all day. Others give them. And most people are somewhere in the middle. While relations of “who orders whom” are generally established through formalized hierarchies of authority, informal relations such as business partnerships and even friendships are also frequently hierarchical in some way: some business partners have more control over important resources, some friends have more clout. Indeed, status and reputation structure almost all areas of social life. To understand social structure, we must attend to both horizontal relations in which individuals are connected through frequently mutual feelings of belonging, as well as vertical relations of power, authority, deference, and status that are asymmetric. Ultimately, how community and hierarchy combine is one of the most vexing concerns in the social sciences. Building on the previous chapter’s focus on groups and cohesion, this chapter focuses on aspects of social structures that are more asymmetric, centralized, or hierarchical.
Connectionist approaches to social networks often speak of flows of ideas, attitudes, and behaviors through ties as social influence and as peer influence in the specific case of flows among friends and acquaintanceships. Modeling social influence is no easy task. How do we determine where a particular idea came from in a network and who influenced whom? In establishing the presence of social influence, a researcher must theoretically and empirically address many potentially confounding factors and alternate explanations. In the previous chapter, we covered network approaches to generic flows at scale. In this chapter, we more thoroughly cover some of the thorny issues involved in tracing interpersonal influences and key modeling strategies in obtaining more detailed views of what flows and to whom.
Is culture the glue that holds the social structures of society together? Or are there “culture wars” that fundamentally divide us? Clearly, the answer is somewhere in the middle, and trying to understand precisely how culture and social structure interrelate to unite or divide remains a core sociological endeavor. Social network analysis alone cannot resolve such an enormous puzzle, but its methods provide important tools for formalizing a jointly structural and cultural approach to studying society. In this chapter, we conclude Part II on Seeing Structure by outlining efforts to see dualities in the connections between structure and culture – that is, to study how enduring patterns of interaction interrelate with shared understandings, tastes, meanings, and other attitudinal measures. We also discuss the structural analysis of meanings themselves and the application of social network techniques to cultural phenomena.
Social structure is enacted by individuals. At the same time, social structure channels individuals into opportunities for action and provides schemas for helping them make sense of these actions. Structure is therefore both the medium through which individuals realize fundamental human drives as well as the collective outcome of the actions that others take and have taken in the past. This ongoing interplay of agency and structure is called structuration. While predictive models outlined in Part III test specific structuration mechanisms, here we cover more inductive approaches and present various micro-level ideas about what drives people to form and break (certain types of) ties. We then introduce the reader to ego-centric network analysis as an important technique that illuminates many of these structuration processes with individual-level data.