University at Albany, State University of New York

Despite the compounded adversities that displaced youth must navigate throughout their forced migration, they consistently exhibit steadfastness in caring for themselves and their families. Extant scholarship, however, often frames these individuals as needy and inept at informing the models of mental health care they are offered. In this study, we use semistructured interviews to learn from the experiences of Afghan refugee youth ( N = 34; M age = 19; range 18–24) who were resettled in the United States after the United States withdrawal from Afghanistan in August of 2021 and explore their insights that can inform decolonial and equitable mental health services. Specifically, we elucidate their most salient sources of psychological distress, current coping mechanisms, and priorities for treatment, with a specific focus on the unique experiences of accompanied versus unaccompanied youth. Unaccompanied youth reported more frequent and intense sources of distress, including pre‐resettlement (e.g., exposure to life‐threatening sociopolitical conflicts) and post‐resettlement challenges (e.g., limited access to basic resources and legal status precarity). Youth used faith‐based, relationship‐based, and ethnocultural‐based mechanisms of coping. While 62% of participants reported doubts about the usefulness of mental health care, most of those who expressed an openness to treatment prioritized clinicians who have personal experience in navigating common challenges among refugees. We situate these findings within decolonial and intersectional theoretical frameworks that capture the nuances of Afghan refugee experiences and offer recommendations for ensuring refugee youth's rights to access equitable mental health services.

This paper focuses on the epistemic situation one faces when using a Large Language Model based chatbot like ChatGPT: When reading the output of the chatbot, how should one decide whether or not to believe it? By surveying strategies we use with other, more familiar sources of information, I argue that chatbots present a novel challenge. This makes the question of how one could trust a chatbot especially vexing.

Complementing the oft-studied construct of interpersonal isolation, research has increasingly focused on existential isolation (EI), or the subjective feeling of separateness in one’s experience. In the clinical realm, several studies have demonstrated that higher EI is associated with more severe mental health problems at a single cross-section of time. Moreover, one study showed that higher pretreatment EI predicted worse psychotherapy outcomes. However, it remains unknown whether an average level of EI across all of psychotherapy (a type of during-treatment “trait”) and/or fluctuations in EI during psychotherapy (a type of during-treatment “state”) relate to broader treatment outcomes. Addressing EI in this more nuanced and complex manner, the present study parsed the EI–outcome association in its between- (trait) and within-patient (state) components in the context of naturalistic outpatient psychotherapy (Constantino et al., 2021). Participants were 46 therapists treating 144 patients who provided enough EI and outcome data to establish average, longitudinal, and temporal associations across treatment. Using a random intercept cross-lagged panel model, the between-patient results showed that higher average EI was associated with worse average outcomes (standardized association = .60, p < .001). However, although within-patient EI demonstrated significant variability over time, such fluctuations were unexpectedly unrelated to subsequent changes in outcome—when accounting for prior EI and outcome changes (p = .617). The findings suggest that although EI seems to possess both traitlike and statelike qualities, the former component may have the greatest influence on treatment outcomes, whereas the latter may be more of an outcome in itself.

Importance Delivery of mental health care through telehealth (telemental health care) increased after the onset of the COVID-19 pandemic. Little is known about the speed of adoption (diffusion) of telemental health in the care in the care of individuals with schizophrenia. Objectives To characterize telemental health care diffusion in mental health agencies serving Medicaid beneficiaries with schizophrenia and the beneficiary-level association of telemental health care use with race and ethnicity. Design, Setting, and Participants This retrospective cohort study used New York State Medicaid data from March 1, 2019, to February 29, 2020 (prepandemic period), and from March 11, 2020, to March 31, 2021 (pandemic period), from 261 agencies serving 30 990 beneficiaries with schizophrenia with 1 or more mental health visits during the pandemic period. Statistical analysis was performed from November 2021 through September 2024. Exposure Agency percentage of patients belonging to racial and ethnic minority groups among all Medicaid-covered patients between March 2019 and February 2020; agency type, categorized as freestanding, hospital affiliated, or state operated; beneficiary-level race and ethnicity, categorized as Asian or other (American Indian or Alaska Native; Native Hawaiian or Other Pacific Islander), Black, Latinx, White, and unknown; and pandemic severity, operationalized as COVID-19 hospitalization rates per 10 000 population in administratively defined catchment areas. Main Outcomes and Measures Days to 10% cumulative telemental health care use within agencies, as well as beneficiary-level time to first telemental health care visit and any telemental health care visit in catchment areas in times of varying pandemic severity. Results In this cohort study of 261 agencies (18 [7%] state operated, 79 [30%] hospital affiliated, and 164 [63%] free standing) and 30 990 beneficiaries with schizophrenia (mean [SD] age, 43 [13] years; 59% male; 7% Asian or other, 38% Black, 20% Latinx, and 25% White), 6 agencies (2%) never adopted telemental health care, and 248 (95%) reached 10% cumulative telemental health care visits in a mean of 18 days. Mean (SD) agency prepandemic shares of beneficiaries belonging to racial or ethnic minority groups (56% [23%]) were not associated with telemental health care diffusion. Diffusion was faster in state-operated vs free-standing agencies (hazard ratio [HR], 2.44 [95% CI, 1.21-4.95]). Relative to White beneficiaries, time to first telemental health care visit was slower in every racial and ethnic minority group (Asian or other: HR, 0.93 [95% CI, 0.88-0.98]; Black: HR, 0.90 [95% CI, 0.87-0.93]; Latinx: HR, 0.95 [95% CI, 0.91-0.99]). Beneficiaries from at least 1 racial or ethnic minority group were less likely than White beneficiaries to have a telemental health care visit regardless of pandemic severity and area; differences narrowed when pandemic severity was higher (eg, in New York City, the odds ratio of Black beneficiaries having a telemental health care visit relative to White beneficiaries when the pandemic severity was high was 0.70 [95% CI, 0.63-0.79] but decreased to 0.59 [95% CI, 0.53-0.67] when the pandemic severity was low). Conclusions and Relevance In this cohort study of Medicaid beneficiaries with schizophrenia, telemental health care diffused rapidly after the onset of the COVID-19 pandemic, particularly in state-operated agencies. Together, agency-level and beneficiary-level race and ethnicity findings suggest within-agency racial and ethnic differences in diffusion of telemental health care. States should monitor the diffusion of innovations across vulnerable populations.

The two‐fold reduction of tetrabenzo[a,c,e,g]cyclooctatetraene (TBCOT, or tetraphenylene, 1) with K, Rb, and Cs metals reveals a distinctive core transformation pathway: a newly formed C−C bond converts the central eight‐membered ring into a twisted core with two fused five‐membered rings. This C−C bond of 1.589(3)–1.606(6) Å falls into a single σ‐bond range and generates two perpendicular π‐surfaces with dihedral angles of 110.3(9)°–117.4(1)° in the 1TR²⁻ dianions. As a result, the highly contorted 1TR²⁻ ligand exhibits a “butterfly” shape and could provide different coordination sites for metal‐ion binding. The K‐induced reduction of 1 in THF affords a polymeric product with low solubility, namely [{K⁺(THF)}2(1TR²⁻)] (K2‐1TR²⁻). The use of a secondary ligand facilitates the isolation of discrete complexes with heavy alkali metals, [Rb⁺(18‐crown‐6)]2[1TR²⁻] (Rb2‐1TR²⁻) and [Cs⁺(18‐crown‐6)]2[1TR²⁻] (Cs2‐1TR²⁻). Both internal and external coordination are observed in K2‐1TR²⁻, while the bulky 18‐crown‐6 ligand only allows external metal binding in Rb2‐1TR²⁻ and Cs2‐1TR²⁻. The reversibility of the two‐fold reduction and bond rearrangement is demonstrated by NMR spectroscopy. Computational analysis shows that the heavier alkali metals enable effective charge transfer from the 1TR²⁻TBCOT dianion, however, the aromaticity of the polycyclic ligand remains largely unaffected.

When COVID-19 vaccines were publicly distributed, there was inaccurate information about their efficacy and safety. Why is it that some people came to believe claims that were not corroborated by evidence and held such misbeliefs? Based on the belief gap hypothesis, we expect partisan-based gaps in misbeliefs about COVID-19 vaccines to grow over time as a function of partisan news exposure. Data from a three-wave survey fielded shortly after the COVID-19 vaccine public rollout showed no change in misbeliefs by political identity. However, data showed three-way interaction effects, such that levels of misbeliefs decreased during the study period for respondents with right-leaning political identities as they were exposed to vaccine-related news in both conservative and liberal news outlets. We discuss theoretical and practical implications of findings.

Importance Although sharing care with local oncologists after allogeneic hematopoietic cell transplantation (HCT) has been proposed for patients living far from HCT centers, it is not known whether a shared strategy is safe or improves patient quality of life (QOL). Objective To determine the efficacy and safety of sharing follow-up care after HCT between the HCT specialty center and local oncologists. Design, Setting, and Participants This was a multicenter collaborative randomized clinical trial of patients undergoing HCT at Dana-Farber Cancer Institute (DFCI)—a high volume HCT center in Boston (Massachusetts)—and 8 local oncology practices. Eligible patients were enrolled from December 2017 to December 2021 and were randomized 1:1 to shared vs usual care after neutrophil engraftment, stratified by local sites in Massachusetts, Rhode Island, New Hampshire, New York, and Maine. Data analyses were performed in January 2024. Intervention Shared care involved alternating post-HCT visits at DFCI and local oncology practices through day 100; for usual care, all post-HCT visits occurred only at DFCI. Main Outcomes and Measures Coprimary outcomes were nonrelapse mortality (NRM) at day 100, and QOL measured by the FACT-BMT (Functional Assessment of Cancer Therapy–Bone Marrow Transplantation) instrument and the QLQ-C30 (European Organization for Research and Treatment of Cancer’s Quality of Life Questionnaire) at day 180. Prespecified secondary outcomes included day 100 QOL and 1-year overall survival. Results A total of 302 participants (median [range] age, 63 [20-79] years; 117 [38.7%] females; 185 [61.3%] males) were included in the analysis; 152 were randomized to shared care and 150 to usual care. Day 100 NRM was noninferior for shared vs usual care (2.6% [95% CI, 0.7% to 6.6%] vs 2.7% [95% CI, 0.7% to 6.7%]; P = .98). There were no differences at day 180 for the FACT-BMT total score (mean difference, 3.8; 95% CI, −2.1 to 9.6; P = .20) or QLQ-C30 global score (1.9; 95% CI, −4.9 to 8.8; P = .58). At day 100, the FACT-BMT total score was better for shared care (mean difference, 6.6; 95% CI, 1.0 to 12.1; P = .02) as was the QLQ-C30 global score (8.8; 95% CI, 1.8 to 15.7; P = .02). Conclusions and Relevance This randomized clinical trial found that shared care resulted in noninferior NRM at day 100 but similar QOL at day 180, with improved QOL at day 100. These data suggest that shared care is safe, improves QOL early on, and has the potential to become a routine model for post-HCT care. Trial Registration ClinicalTrials.gov Identifier: NCT03244826

GaN is an important semiconductor for energy-efficient light-emitting devices. Hydrogen plays a crucial role in gallium nitride (GaN) growth and processing. It can form electrically neutral complexes with acceptors during growth, which significantly increases the acceptor incorporation. Post-growth annealing dissociates these complexes and is widely utilized for activating Mg acceptors and achieving conductive p-type GaN. In this work, we demonstrate that other acceptors, such as C and Be, also form complexes with hydrogen similar to Mg. The effect of thermal annealing of GaN on photoluminescence (PL) was investigated. In samples moderately doped with Be, the BeGa-related yellow luminescence (YLBe) band intensity decreased by up to an order of magnitude after annealing in N2 ambient at temperatures Tann = 400 °C–900 °C. This was explained by the release of hydrogen from unknown traps and the passivation of the BeGa acceptors. A similar drop of PL intensity at Tann = 350 °C–900 °C was observed for the CN-related YL1 band in unintentionally C-doped GaN and also attributed to passivation of the CN acceptors by hydrogen released from unknown defects. In this case, the formation of the CNHi complexes was confirmed by the observation of the rising BL2 band associated with these complexes. At Tann > 900 °C, both the YLBe and YL1 intensities were restored, which was explained by the removal of hydrogen from the samples. Experimental results were compared to the first principles calculations of complex dissociation and hydrogen diffusion paths in GaN.

Cognitive scientists and neuroscientists are increasingly deploying computational models to develop testable theories of psychological functions and make quantitative predictions about cognition, brain activity, and behavior. Computational models are used to explain target phenomena such as experimental effects, individual, and/or population differences. They do so by relating these phenomena to the underlying components of the model that map onto distinct cognitive mechanisms. These components make up a “cognitive state space,” where different positions correspond to different cognitive states that produce variation in behavior. We examine the rationale and practice of such model-based inferences and argue that model-based explanations typically miss a key ingredient: They fail to explain why and how agents occupy specific positions in this space. A critical insight is that the agent’s position in the state space is not fixed, but that the behavior they produce is the result of a trajectory. Therefore, we discuss (a) the constraints that limit movement in the state space; (b) the reasons for moving around at all (i.e., agents’ objectives); and (c) the information and cognitive mechanisms that guide these movements. We review existing research practices, from experimental design to the model-based analysis of data, and through simulations we demonstrate some of the inferential pitfalls that arise when we ignore these dynamics. By bringing the agent’s perspective into sharp focus, we stand to gain better and more complete explanations of the variation in cognition and behavior over time, between different environmental conditions, and between different populations or individuals.

Convergent transcription, that is, the collision of sense and antisense transcription, is ubiquitous in mammalian genomes and believed to diminish RNA expression. Recently, antisense transcription downstream of promoters was found to be surprisingly prevalent. However, functional characteristics of affected promoters are poorly investigated. Here we show that convergent transcription marks an unexpected positively co-regulated promoter constellation. By assessing transcriptional dynamic systems, we identified co-regulated constituent promoters connected through a distinct chromatin structure. Within these cis-regulatory domains, transcription factors can regulate both constituting promoters by binding to only one of them. Convergent promoters comprise about a quarter of all active transcript start sites and initiate 5′-overlapping antisense RNAs—an RNA class believed previously to be rare. Visualization of nascent RNA molecules reveals convergent cotranscription at these loci. Together, our results demonstrate that co-regulated convergent promoters substantially expand the cis-regulatory repertoire, reveal limitations of the transcription interference model and call for adjusting the promoter concept.

We are concerned with the similarity problem for Cowen-Douglas operator tuples. The unitary equivalence of single Cowen-Douglas operators was already investigated in the 1970’s and geometric concepts including vector bundles and curvature appeared in the description. Soon after, a relationship between the corresponding reproducing kernels was formulated to determine the unitary equivalence of Cowen-Douglas operator tuples. As the Cowen-Douglas conjecture indicates, the similarity problem study has not been so successful until now. The latest results reveal the close correlation between complex geometry, the corona problem, and the similarity problem for single Cowen-Douglas operators. Without making use of the corona theorems that no longer hold in the multi-variable setting, we prove that the single operator results for similarity remain true for Cowen-Douglas operator tuples as well.

Background About two‐thirds of those with Alzheimer’s disease (AD) are women, most of whom are post‐menopausal. Menopause accelerates the risk for dementia by increasing the risk for metabolic, cardiovascular, and cerebrovascular diseases. Mid‐life metabolic disease (e.g. obesity, diabetes, or prediabetes) is a well‐known risk factor for dementia. A high fat diet can lead to poor metabolic health in both humans and rodents. The goal of this study was to determine the effects of menopause and high fat diet on metabolic, cognitive, and pathological outcomes in the AppNL‐F knock‐in mouse model of Alzheimer’s disease. Method To model menopause, we used an accelerated ovarian failure model (4‐vinylcyclohexene diepoxide, VCD). This ovary‐intact model is more clinically relevant than an ovariectomy model, as mice go through a perimenopausal period. At 3 months of age, AppNL‐F mice were administered VCD or vehicle (oil) and then placed on either a control diet (10% fat) or a high fat diet (HF; 60% fat) and maintained on the diets until 10 months of age. Result Menopause led to metabolic impairment (weight gain and glucose intolerance) and further exacerbated obesity in response to a high fat diet. Menopause had independent effects on some serum metabolic health biomarkers (insulin) and synergic effects with HF diet on other markers (glucagon). An interaction between HF diet and menopause led to an impaired episodic‐like memory. When examining the underlying pathology, we did not detect any changes in amyloid levels, however, we observe changes in neurogenesis and microglia response. Conclusion Menopause and HF diet have independent and synergistic effects on metabolic, cognitive and pathological aspects of AD. This work highlights the need to model endocrine aging in animal models of dementia and will contribute to further understanding the interaction between menopause and metabolic health in the context of AD.

Background Stress is a common modifiable risk factor for AD, which increases dementia risk 2‐fold. During the stress response, the hypothalamic‐pituitary adrenal (HPA) axis is activated which stimulates the release of stress hormones called glucocorticoids into the blood stream. Studies on early‐life stress have shown a glucocorticoid dependent vulnerability towards late‐life inflammation. However, adolescence may be a more critical period for stress‐induced vulnerability for late‐life neurodegenerative diseases given that adolescents experience longer circulating levels of glucocorticoids following stress exposure and greater stress responsivity. Additionally, sex is an important biological variable because there are sex differences in AD prevalence and stress vulnerability with women being affected more than men. We hypothesized that adolescent stress would exacerbate AD pathology later in life and that this effect will be stronger in females. Method Male and female WT and Tg‐SwDI mice underwent a chronic social stress paradigm during adolescence (1‐1.5 months of age). The paradigm consists of alternating social isolation and change in group composition for 20 days. Mice were assessed longitudinally at 2, 4, and 6 months of age for anxiety‐like behavior, cognitive function, and social behavior. Brains were collected at 6 months of age to assess neuropathology. Result Adolescent stress had an age‐dependent effect on anxiety‐like behavior and cognitive function whereby mice who experienced adolescent stress had greater anxiety and worse cognitive function as they aged compared to control mice. Further, there were sex differences in both anxiety‐like behavior and social behavior at 6 months of age, with females showing greater anxiety‐like behavior and social avoidance compared to male mice. Neuropathology assessments are ongoing. Conclusion This data suggests that adolescent stress may exacerbate AD pathology later in life, with females being more susceptible than males to these effects. This data is in line with clinical studies showing that females are more likely to develop AD and suffer from anxiety disorders.

Background Candida auris is an emerging multidrug-resistant pathogen. Interpretation of susceptibility testing can be difficult since minimum inhibitory concentration (MIC) breakpoints have not been fully established. Methods All C. auris isolates from unique patients identified at a large urban hospital between 2020 and 2024 (n = 66) underwent whole-genome sequencing (WGS). Genomic DNA was extracted from pure culture isolates and underwent PCR-free library preparation. WGS was performed on an Illumina platform (NextSeq2000) with an average coverage of 50×. Genomic analysis was conducted via an adapted GATK-based pipeline using the B11205 strain as the reference genome based on the CDC (MycoSNP) protocol. All isolates underwent FKS1 gene Sanger sequencing for confirmation of WGS results. Genotypic results were correlated with antifungal susceptibility testing. Results All clinical isolates were part of Clade I and carried azole resistance mutations in ERG11, TAC1b, and CDR1, consistent with 100% phenotypic fluconazole resistance. Across all isolates, 5 distinct missense variants in FKS1 were identified: one case with p.Ser639Tyr, one case with both a p.Arg1354Ser and a p.Asp642His, 7 cases with p.Met690Ile, and 9 cases with p.Val1818Ile. Isolates with known echinocandin resistance conferring mutations p.Ser639Tyr and p.Arg1354Ser were resistant to micafungin and anidulafungin. Two isolates with Met690Ile were resistant to caspofungin alone. Conclusions With potential resistance to all 3 major antifungal classes of drugs, C. auris is an emerging public health threat. Early detection of echinocandin resistance by molecular methods could impact treatment course to include novel antifungal agents. Further study of the FKS1 Met690Ile variant is warranted.

The COVID-19 pandemic created unprecedented pressure on public budgets worldwide, as surging demand for public spending coincided with declining revenues. This study uses panel data from U.S. state governments to analyze the factors driving their fiscal responses and compares strategies employed during the COVID-19 pandemic to those used in the Great Recession. Findings reveal that during the pandemic, states used fewer strategies, were less likely to implement across-the-board cuts, and avoided workforce-related measures. Projected budget gaps influenced the number of strategies adopted and the likelihood of expenditure cuts, but not the choice of specific measures. Federal aid showed limited association with the number or type of strategies employed, suggesting the need for more timely and flexible assistance. Political ideology similarly was not systematically related to the type or number of balancing strategies employed.