**Abstract:**

Kin-based social institutions (KBSI) shape human social networks, norms of property ownership, and marriage patterns, among other things, and have played an important role in the evolution of human psychology and social systems. Among the Karo of Indonesia, the rate of preferential matrilateral cross-cousin (impal) marriage, one of the most important KBSIs for that society, decreased drastically from at least the first half of the 20th century to recent times. We used a sample of 176 marriages from 62 villages and epidemiological methods (case-control study design and structural equation modeling) to measure the effect of various risk factors for impal marriage. With 88 cases (individuals ever married to their impal) and 88 controls (those never married to impal) matched by sex and age, we built models to assess risk factors in five groupings related to demography, religion, alliance, co-socialization, and modernization. There were significant factors with direct or indirect effects on the risk of impal marriage in four of the five groupings. Our results have implications for understanding the role of various factors on the decline of impal marriage among the Karo, but also for understanding the dynamics of social change and cultural evolution more generally.

**Speaker's social media:**

Twitter: @gkushnick

LIVE - Explaining the decline of preferential matrilateral cross-cousin (impal) marriage among the Karo of Indonesia: An epidemiological approach to cultural evolution

Depressive disorders constitute a severe public health issue worldwide. However, public health systems have limited capacity for case detection and diagnosis. In this regard, the widespread use of social media has opened up a way to access public information on a large scale. Computational methods can serve as support tools for rapid screening by exploiting this user-generated social media content. This paper presents an efficient semantic pipeline to study depression severity in individuals based on their social media writings. We select test user sentences for producing semantic rankings over an index of representative training sentences corresponding to depressive symptoms and severity levels. Then, we use the sentences from those results as evidence for predicting symptoms severity. For that, we explore different aggregation methods to answer one of four Beck Depression Inventory (BDI-II) options per symptom. We evaluate our methods on two Reddit-based benchmarks, achieving improvement over state of the art in terms of measuring depression level.

Semantic Similarity Models for Depression Severity Estimation | VIDEO

We present Dolphin, a novel benchmark that addresses the need for a natural language generation (NLG) evaluation framework dedicated to the wide collection of Arabic languages and varieties. The proposed benchmark encompasses a broad range of 13 different NLG tasks, including dialogue generation, question answering, machine translation, summarization, among others. Dolphin comprises a substantial corpus of 40 diverse and representative public datasets across 50 test splits, carefully curated to reflect real-world scenarios and the linguistic richness of Arabic. It sets a new standard for evaluating the performance and generalization capabilities of Arabic and multilingual models, promising to enable researchers to push the boundaries of current methodologies. We provide an extensive analysis of Dolphin, highlighting its diversity and identifying gaps in current Arabic NLG research. We also offer a public leaderboard that is both interactive and modular and evaluate several Arabic and multilingual models on our benchmark, allowing us to set strong baselines against which researchers can compare.

Dolphin: A Challenging and Diverse Benchmark for Arabic NLG

In very recent years more attention has been placed on probing the role of pre-training data in Large Language Models (LLMs) downstream behaviour. Despite the importance, there is no public tool that supports such analysis of pre-training corpora at large scale. To help research in this space, we launch Koala, a searchable index over large pre-training corpora using lossless compressed suffix arrays with highly efficient compression rate and search support. In its first release we index the public proportion of OPT 175B, GPT-3, GPT-Neo, GPT-Neo, LLaMA, BERT, ELECTRA, RoBERTA, XLNet pre-training corpora. Koala provides a framework to do forensic analysis on the current and future benchmarks as well as to assess the degree of memorization in the output from the LLMs. Koala is available for public use at https://koala-index.erc.monash.edu/.

Koala: An Index for Quantifying Overlaps with  Pre-training Corpora

Background: Social media (SoMe) has revolutionized the way people communicate and transformed various aspects of modern life. The COVID-19 pandemic necessitated reduced in person interaction and the ACGME recommended a shift to virtual residency interviews. This shift increased the reliance of residency programs and medical school graduates on SoMe for recruitment and information. This study aims to determine the impact of social media during the anesthesiology residency application cycle and characterize the content that anesthesiology residency programs can use to most effectively optimize programs’ ability to recruit applicants.
Methods: This project was approved by the Augusta University Institutional Review Board. An anonymous online survey was distributed to residency program directors and coordinators at all US ACGME-accredited anesthesiology residency programs for dissemination to their residents. This 17-question survey was created on Qualtrics and included questions regarding demographics, current PGY year, type of medical degree, interview type, social media use, and social media impact. Microsoft Excel was used to perform descriptive statistics and t-tests where applicable. Responses were summarized using frequencies and percentages for categorical data. The chi-square test (or Fisher exact test, as appropriate) was used to examine the association between categorical variables. Theme analysis was used for the open-ended questions.

Results: A total of 109 respondents completed the survey. Respondents were similarly distributed among the four PGY years. Participants under 30 years older were significantly more likely to look at SoMe while applying for residency compared to individual older than 35 years old (p<0.01). Female respondents used Instagram significantly more often than males, and males used YouTube and Reddit significantly more often than females (p < 0.05). Participants primarily sought information regarding program culture (58%) and lifestyle (50%) from SoMe. Regarding improving efficacy of SoMe outreach, common themes identified include resident-made content, using different elements of SoMe posts to increase engagement, and increasing accessibility to SoMe via increasing number of platforms.

Conclusion: This study presents a national analysis of SoMe impact on the anesthesiology residency application process. To cultivate a more purposeful approach to SoMe usage among anesthesiology residency programs, a meticulous examination of the content that is most beneficial to residency applicants is paramount. This study underscores the importance of using social media’s original "social" function by crafting posts that spotlight program culture and residency lifestyle in a clear and welcoming manner, all with the goal of engaging and appealing to anesthesiology residency applicants.

Making Social Media “Social” May Improve Anesthesiology Residency Program Outreach

INTRODUCTION 
Preoperative anemia is associated with increased postoperative transfusion and complication rates after total knee arthroplasty (TKA). We aimed to create TKA-specific data-driven preoperative hemoglobin strata that quantify the likelihood of 90-day postoperative blood transfusion and evaluate whether these strata are associated with increased risk of 90-day major complications and 2-year prosthetic joint infection (PJI).  

METHODS 
Primary TKA patients from 2013-2022 were identified using a national database. Stratum-specific likelihood ratio (SSLR) analysis defined hemoglobin strata associated with the risk of 90-day blood transfusion. Each stratum was propensity-score matched to the highest identified hemoglobin strata. Unmatched incidence rates and matched risk of 90-day major complications and 2-year PJI between strata were compared.   

RESULTS 
SSLR identified four 90-day blood transfusion hemoglobin strata for males [Strata (g/dL), Likelihood Ratio (5.0-11.4, 8.06; 11.5-11.9, 4.34; 12.0-12.9, 1.70; 13.0-17.0, 0.54)] and females (5.0-10.4, 8.22; 10.5-11.4, 2.84; 11.5-12.4, 1.38; 12.5-17.0, 0.50). Increased 2-year PJI risk was associated with three male strata (12.0-12.9, 11.5-11.9, 5.0-11.4; all p<0.001) and three female strata (11.5-12.4, 10.5-11.4, 5.0-11.4; all p<0.001). Increased 90-day major complication risk was associated with three male strata (12.0-12.9, 11.5-11.9, 5.0-11.4; all p<0.001) and three female strata (11.5-12.4, 10.5-11.4, 5.0-10.4; all p<0.001). 

CONCLUSION 
We identified TKA-specific hemoglobin strata that maximize the likelihood of 90-day blood transfusions and predict the risk of 90-day major complications and 2-year PJI. When using preoperative hemoglobin as a target for anemia optimization, we recommend using these thresholds, noting the increase in complication risk with hemoglobin (g/dL) below 13.0 in males and 12.5 in females.  

Stratum-Specific Preoperative Hemoglobin Intervals Quantify the Likelihood of Blood Transfusion, Major Complications, and Periprosthetic Joint Infection Following Total Knee Arthroplasty

Background
Tobacco use is a risk factor for head and neck squamous cell carcinomas (HNSCC) and is associated with poorer treatment outcomes. Patients who continue smoking after a cancer diagnosis are more likely to have tumor recurrence. Rural populations have higher tobacco use rates and higher observed incidence rates of tobacco-associated cancers. The goal is to identify smoking cessation barriers to improve treatment outcomes and overall survival for rural patients. 

Methods
Patients with a head and neck cancer diagnosis who were receiving care within the University of Rochester Medical system were consented. They completed a quantitative RedCap survey and/or a qualitative semi-structured interview. Head and neck cancer providers were also interviewed, and together, the responses were coded for themes related to cessation barriers and possible interventions. 

Results
The qualitative analysis identified a patient theme of self-determinism and support for smoking cessation. This includes both emotional support and information on external cessation resources. Patients made comments such as “There are people that can decide to quit and that's it. And there are people that need encouragement, right? There are people that need strength outside of themselves.” 

Providers identified a theme of developing standardized smoking cessation care. They spoke at length of the benefits of team members such as nurse navigators and dedicated smoking cessation staff. 

Quantitatively, rural patients were more likely to be smokers when compared to urban patients. Only 10% of interviewed rural patients (n=19) were likely to join a smoking cessation program if convinced by their PCP, whereas 38% of urban patients (n=29) could be convinced by their PCP (p<0.04). 

Discussion
Rural patients are less likely to respond favorably when counselled by their PCP. However, they value support from medical professionals. Cancer providers value a dedicated team member to deploy a standardized workflow for cessation counseling. Together, the qualitative and quantitative data both favor additional non-PCP team members when convincing rural patients to quit smoking. One novel solution, the “Rochester Model,” utilizes medical students to provide bedside smoking cessation to smoking patients. Preliminary results suggest that students are as effective as nurses in providing counseling when assessing smoking outcomes 1-, 3-, and 6-months post treatment. 

Conclusion
Non-PCP care members are essential to engaging rural smokers in cessation programs. Medical students are a possible new demographic of counselors. Further investigation is needed to assess their efficacy when counseling rural HNC patients.

Barriers to Smoking Cessation for Rural Head and Neck Cancer Patients

Background
Wound complications are well documented following spine tumor surgery due to risk factors including prior radiation therapy, poor nutritional status, and immunocompromise. Increasing evidence has shown that a multidisciplinary approach to complex oncological spine reconstruction surgery can decrease wound complication rates. The goal of this study is to assess whether plastic surgery wound closure in the setting of spine tumor surgery can lead to a decreased rate of wound complications.

Methods
A retrospective analysis of 157 consecutive patients who underwent spine tumor surgery between October 2012 and October 2022 at a Level 1 Trauma Center was performed. Clinical data regarding pre- and post-operative oncological treatment, surgical management, intra- and post-operative complications, and quality of life surveys were collected. Patients were stratified based on plastic surgery involvement in soft-tissue reconstruction and wound closure. Post-operative complications and outcomes were analyzed between groups. Statistical significance was set at p < 0.05.

Results
130 (82.8%) oncological spine surgeries underwent closure by spine surgeons (SS) and 27 (17.2%) underwent closure by plastic surgeons (PS). The PS group was 33% (N=9) female compared to 38% (N=50) female for the SS group. The PS group was younger compared to SS group (55.3 ± 18.3 vs. 62.5 ± 16.1 years; p=0.035). The PS group had a greater number of levels fused (3.3 ± 4.5 vs. 2.3 ± 2.1; p= 0.049) but a lower number of levels decompressed (1.48 ± 1.5 vs. 2.4 ± 1.2; p<0.001) compared to the SS group.

Patients in the PS group had a longer operative time (362.6 ± 278.3 vs. 225 ± 84.5 minutes; p<0.001), greater blood loss (631.8 ± 576.3 vs. 480.6 ± 454.9 mL; p=0.048), and greater length of stay (57 ± 132 vs. 10 ± 15 days; p<0.001) compared to SS group, which could be attributed to increased complexity of the PS cases. Pre-operative and post-operative Day 3 Albumin (p=0.82), Hematocrit (p=0.095), Glucose (p=0.367) and HA1c (p=0.417) had no effect on wound healing in both surgical groups. The most common coverage performed in the PS group were local paraspinal advancement flaps. The PS group had 0% post-op wound complications, wound infections, or wound-related reoperations, while the SS group had 4% (N=5) wound-related reoperations.


Conclusion
Spine tumor patients are at increased risk for impaired wound healing and post-operative wound complications. A multidisciplinary approach to oncological spine surgery, involving both spine surgeons and plastic surgeons, can improve surgical outcomes and wound healing.

Outcomes and Spine Oncology Surgery With and Without Plastic Surgery Reconstruction

Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) is a rare congenital anomaly that is characterized by the triad of uterus didelphys, obstructed hemivagina, and ipsilateral renal dysplasia. It is also known as Herlyn-Werner-Wunderlich syndrome. 

OHVIRA is typically diagnosed after menarche and is often associated with recurrent severe dysmenorrhea and vague lower abdominal pain, although the presentation can be variable. Due to the normal onset of menarche from the non-obstructed side, diagnosis of OHVIRA can easily be missed, which can lead to complications such as infection, pelvic inflammatory disease, and endometriosis. 

In this report, we present a case of OHVIRA syndrome in a 16-year-old girl who presented with lower abdominal pain and constipation. This case underscores the importance of maintaining a high index of suspicion for OHVIRA syndrome in adolescents with non-specific abdominal or pelvic symptoms.



When Constipation is More than Just Constipation: A Rare Case of OHVIRA Syndrome

Background. Dialogue is recognized as a crucial medical competency that promotes adherence to medical regimens and health outcomes. Pain and substance use disorders (SUD) are frequently stigmatized, and its education in medical schools is currently fragmented across other courses. The LICENSE (Language, Impact, Communication, Engagement, Non-Stigmatizing, Effectiveness) curriculum is a longitudinal course, with the overall goal of teaching medical students how to better communicate with patients with SUDs. It describes the intersection of SUD with Social Determinants of Health (SDH) and treatment adherence, and how to conduct effective clinical interviews with this patient population.

Method. Students interact with this curriculum across the three phases of Stony Brook’s medical curriculum. At each phase, the Substance Abuse Attitude Survey (SAAS), a validated survey assessing attitudes about SUD, is administered. A 60-minute didactic session is then followed by case presentations and reflection questions. 

Results. Currently, this curriculum has been implemented across four years of medical students, with 290 participants for our data collection. Thus far, the qualitative data has shown an increase in awareness of SUD and of potential concerns of SUD. More, the SAAS values are trending toward less stigmatizing answers. For example, in phase 2, the statement “drug addiction is a treatable illness” is more strongly supported relative to phase 1. 

Future Directions. This study hopes to show that increased education on SUD and SDH helps to decrease stigma in these patient populations. We plan to continue this data collection and compare the SAAS data across all the phases of the curriculum to determine if attitudes change over time. We plan to also implement the Phase III portion of the curriculum starting with the graduating class of 2024. This portion will be developed and carried out in the spring of 2024.

Innovative Learning and Teaching About Substance Use/Opioid Use Disorders

Background
The presence of wounds, from either acute or chronic circumstances, places a significant burden on a patient’s quality of life (QoL). In the US, as the number of patients with chronic health conditions such as diabetes mellitus, vascular disease, and obesity continues to rise, so does the risk of complications of wounds. Some of these complications include the increased risk of infection and further issues with tissue revascularization, both of which are associated with worse morbidity. The increasing patient population signifies the necessity for proper community education on wound care in the home and after in-office procedures to reduce the risk of further complications. Our study gathered community knowledge from a student-run free-dermatology clinic, according to AAD guidelines, to better assess community knowledge of wound care.

Methods
Using a 6-question paper survey with five multiple-choice questions and one 5-point Likert scale rating for confidence assessment of wound care knowledge (1 equating not confident and 5 equating very confident) was voluntarily answered by patients aged 18 years and older at a Free Student-Faculty Collaborative Dermatology Clinic. A quantitative analysis was run to interpret the 30 results. A one-tailed T-test was used to evaluate the responses to the multiple-choice questions under the assumption that getting three out of four questions indicated sufficient knowledge. 

Results
Although the average confidence from the responses was 4.33 using a Likert scale rating, further inquiry showed only 7.4% were using a method consistent with current AAD guidelines. Our results showed 51.85% of respondents were able to identify all the characteristics of an infected wound and 66.7% correctly chose the use of mild soap and water for washing. Only 23.1% of responses correctly identified that wounds need to be kept moist. Analyzing the multiple-choice questions, only 37.03% demonstrated sufficient knowledge of wound care (p<0.0005).

Conclusion
Our study demonstrated the importance of providing patients with standardized wound care education. Presently at our clinic, a wound care recommendation sheet in accordance with AAD recommendations is offered to patients who recieve biopsies or in-office procedures. The initiative was implemented to help close the education gap for patients regarding wound care. Clinics and providers can similarly provide materials or have posters in the office to highlight similar wound care recommendations. A limitation of this study was the small sample size and possible misinterpretation of the questions based on individual comprehension. 


Wound Care Knowledge in the Community Setting: Closing the Patient Education Gap


Introduction: Readmission within the first 90 days following total joint arthroplasty (TJA) is both a predictor of postoperative complications as well as a cause of increased financial burden. Patients living in socioeconomically disadvantaged areas are known to be at increased risk for worse healthcare outcomes. This study hypothesized that 90- day readmission rates following aseptic TJA were associated with Area Deprivation Index (ADI), a surrogate marker for patients living in economically disadvantaged neighborhoods. 

Methods: All primary and aseptic revision TJAs performed in 2019 at one academic center were reviewed. A total of 1,084 patients were included with home addresses in 11 different states. The Neighborhood Atlas was used to calculate both the national (0-100 scale) and state (0-10 scale) ADIs for all patients, using metrics that include income, education, employment and housing quality. Chi-square tests were used for statistical analysis to calculate logistic regression models and odds ratios (OR) for examining the relationship between state and national ADIs and hospital readmission within the first 90 days following TJA. 

Results: There were a total of 82 readmissions found in the patient cohort. Of these readmissions, 27 were due to infection. The average state ADI was 4.75 and the average national ADI was 65.30. Logistic regression models showed no significant trends in 90-day readmissions based on state ADI (P=0.29). There was a statistically significant positive correlation between national ADI and 90-day readmission rates (Unit OR 1.01, P< 0.05). 

Conclusions: This study demonstrated that as a patient’s national ADI increased, there was a positive association with a patient’s odds of readmission within 90 days of an aseptic TJA. State ADIs did not have a significant association with 90- day readmission rates. Further investigations are required to understand the impact of patients’ socioeconomic status on post-operative complications and causes for readmission.


Underline digital video library

LIVE - Explaining the decline of preferential matrilateral cross-cousin (impal) marriage among the Karo of Indonesia: An epidemiological approach to cultural evolution

Semantic Similarity Models for Depression Severity Estimation | VIDEO

Dolphin: A Challenging and Diverse Benchmark for Arabic NLG

Koala: An Index for Quantifying Overlaps with Pre-training Corpora

Making Social Media “Social” May Improve Anesthesiology Residency Program Outreach

Stratum-Specific Preoperative Hemoglobin Intervals Quantify the Likelihood of Blood Transfusion, Major Complications, and Periprosthetic Joint Infection Following Total Knee Arthroplasty

Barriers to Smoking Cessation for Rural Head and Neck Cancer Patients

Outcomes and Spine Oncology Surgery With and Without Plastic Surgery Reconstruction

When Constipation is More than Just Constipation: A Rare Case of OHVIRA Syndrome

Innovative Learning and Teaching About Substance Use/Opioid Use Disorders

Wound Care Knowledge in the Community Setting: Closing the Patient Education Gap

Area Deprivation Index as a Predictor of 90-day Readmission Rates in Total Joint Arthroplasty

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