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Rheumatoid arthritis (RA) patients have almost twice the risk of heart failure (HF) as individuals without RA, even with adjustment for the presence of ischemic heart disease. Moreover, RA patients remain at a 2-fold higher risk of mortality from HF compared to non-RA patients. These observations suggest that RA-specific inflammatory pathways are significant contributors to this increased risk of HF. Herein we summarize the epidemiology of HF in RA patients, the differences in myocardial structure or function between RA patients and non-RA patients without clinical signs of HF, and data on the role of systemic and local inflammation in RA HF pathophysiology. We also discuss the impact of subduing inflammation through the use of RA disease-modifying therapies on HF and myocardial structure and function, emphasizing gaps in the literature and areas needing further research.

This study examines the impact of a comprehensive college transition program, the Thompson Scholars Learning Communities (TSLC), on psychosocial outcomes using an experimental design. We estimate o...

OBJECTIVE The objectives of this study were to assess the 1-year persistence to methotrexate (MTX) initiated as the first ever conventional synthetic disease-modifying antirheumatic drug in new-onset rheumatoid arthritis (RA) and to investigate the marginal gains and robustness of the results by increasing the number and nature of covariates and by using data-driven, instead of hypothesis-based, methods to predict this persistence. METHODS Through the Swedish Rheumatology Quality Register, linked to other data sources, we identified a cohort of 5475 patients with new-onset RA in 2006-2016 who were starting MTX monotherapy as their first disease-modifying antirheumatic drug. Data on phenotype at diagnosis and demographics were combined with increasingly detailed data on medical disease history and medication use in four increasingly complex data sets (48-4162 covariates). We performed manual model building using logistic regression. We also performed five different machine learning (ML) methods and combined the ML results into an ensemble model. We calculated the area under the receiver operating characteristic curve (AUROC) and made calibration plots. We trained on 90% of the data, and tested the models on a holdout data set. RESULTS Of the 5475 patients, 3834 (70%) remained on MTX monotherapy 1 year after treatment start. Clinical RA disease activity and baseline characteristics were most strongly associated with the outcome. The best manual model had an AUROC of 0.66 (95% confidence interval [CI] 0.60-0.71). For the ML methods, Lasso regression performed best (AUROC = 0.67; 95% CI 0.62-0.71). CONCLUSION Approximately two thirds of patients with early RA who start MTX remain on this therapy 1 year later. Predicting this persistence remains a challenge, whether using hypothesis-based or ML models, and may yet require additional types of data. https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/acr2.11266 Westerlind H, Maciejewski M, Frisell T, Jelinsky SA, Ziemek D, Askling J. What is the persistence to methotrexate in rheumatoid arthritis, and does machine learning outperform hypothesis-based approaches to its prediction? ACR Open Rheumatol 2021;3:457-463.

We use regression discontinuity design to examine the impact of placing into developmental math on science, technology, engineering, and mathematics (STEM) participation in community colleges and whether these relationships differ for underrepresented racially minoritized (URM), women, STEM-oriented, and STEM-aspiring students. Results show that lower math placement was a deterrent to both math progression and STEM participation, especially for those at the margin of placement in transfer-level math. Subgroup analyses suggest that lower math placement may have supported women, and to a lesser extent URM students, in completing transferable STEM credits. For STEM-oriented students, we find suggestive evidence that lower placement deterred them from accumulating transferable credits. We discuss how community colleges can support these students and bolster the community college STEM pathway.

Limited attention has been placed on the relationship between developmental math and STEM outcomes in community college. We therefore examine one particular experience during the transition from high school to college called math misalignment, which occurs when college students are placed lower in math than is warranted given their high-school course-taking history and record of achievement. Drawing on analysis of linked high school and community college student records, we find that a majority of students in the study sample experienced math misalignment in community college. Moreover, math misalignment especially hindered STEM-aspiring students from pursuing STEM pathways. STEM-aspiring students who experienced math misalignment were less likely to complete STEM courses than STEM-aspiring students who were directly placed in transfer-level math. This study underscores the importance of aligning academic standards across high-school and postsecondary institutions as a means of improving STEM participation.

Coronavirus disease 2019 (COVID-19) is a respiratory and systemic disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Since the start of the COVID-19 pandemic, pneumothorax (PTX) has only been reported as a complication of the virus-induced pneumonia in less than 1% of cases. The majority of them developed symptoms in the setting of either an underlying history of lung disease or being placed on a mechanical ventilator during admission. The authors report a unique case of PTX in a patient with a recent COVID pneumonia that did not fit the aforementioned clinical picture - a 41-year-old male with a complete collapse of his right lung who was previously admitted for COVID pneumonia with no known pulmonary history and was not intubated. A chest tube was placed with the resolution of the PTX and the patient is being monitored on the medicine floor.

Chapter 10|18 pages Community College as a Gateway to Baccalaureate Success for International Students By Veronika Rozhenkova, Elizabeth S. Park The number of international students in the United States that transfer from community college to university continues to increase; yet, few studies have examined the college experiences of these students. Upon enrollment in a four-year institution, they become a part of the campus’s international student population and are frequently not being recognized as a potentially different subgroup of students with their own academic characteristics, challenges and needs. In this chapter, we aim to contribute to this knowledge by examining a case of a selective four-year public research university and comparing its international transfer students’ characteristics with those of traditional international students. Additionally, we identify potential ways of providing more adequate institutional support services for the targeted student population. We conclude with thoughts on extending this line of literature to better support transfer international students in their academic trajectory towards baccalaureate success.

Background Hydroxychloroquine (HCQ) is a cornerstone therapy for systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). However, reports of its use and subsequent fatal arrhythmias in patients with coronavirus disease 19 (COVID-19) have raised concern regarding its cardiovascular (CV) safety. Therefore, we examined the relationship between HCQ use and corrected QT (QTc) length in SLE and RA patients without clinical CV disease (CVD). Methods SLE patients from the Columbia University Lupus Cohort registry (n = 352) and two RA cohorts (n = 178; ESCAPE-RA and RHYTHM-RA) with electrocardiograms (ECGs) collected as part of study data were analyzed. RA cohort participants were recruited from tertiary referral centers with additional referrals from community rheumatologists, while SLE subjects originated from the Columbia University Lupus Cohort. All patients met American College of Rheumatology (ACR) classification criteria for SLE or RA and lacked known CVD. The exposure of interest was HCQ use and main outcome measure was QTc length [continuous or categorical (≥ 440 ms and ≥ 500 ms)]. Results Of the combined SLE and RA cohorts (n = 530), 70% were HCQ users and 44% had a QTc ≥ 440 ms. The adjusted mean QTc length was comparable between HCQ users vs non-users (438 ms vs 437 ms). In multivariable logistic models, HCQ use was not a significant predictor of a QTc ≥ 440 ms for the entire cohort (OR 0.77; 95% CI 0.48–1.23; p = 0.27). Importantly, a QTc ≥ 500 ms was inversely associated with HCQ use and not associated with arrhythmias or deaths. A significant interaction was found between HCQ use and use of anti-psychotics. Ultimately, the use of HCQ combined with any QTc prolonging medication as a group was associated with a QTc length (434 ms; 95% CI 430, 439) which was comparable to that of use of HCQ alone (433 ms; 95% CI 429-437). Conclusion In a combined cohort of SLE and RA patients without clinical CVD, adjusted QTc length was comparable between HCQ and non-HCQ users, supporting its CV safety in patients with rheumatic diseases.

Background: Radiology and oncology clinical guidelines recommend that people with high-risk of breast cancer should be offered screening with magnetic resonance imaging (MRI). Rates of appropriate screening remain low, which could also be related to patient awareness and knowledge about optimal screening modalities/schedules. Appropriate screening is even more critical for African-American women, in whom there are higher rates of genetic mutations (e.g., BRCA) conferring a greater risk of high-risk breast cancer. Southern United States (US) states have a higher proportion of African-American women. We sought to explore the availability of information on high-risk breast cancer screening using breast MRI across the websites of the top 20 cancer centers in the US (as per US News data) as well as the top US News cancer center in each of 5 representative southern US states where the average annual breast cancer-related death rate is greater than 20 per 100,000 people, age adjusted to the 2000 US standard population. Methods:We utilized publicly available data from the 2020-2021 US News website to identify top 20 cancer centers. We performed a google search using two separate keyword phrases (“high-risk breast cancer screening” and “breast MRI”), and the name of the cancer center. US News 2020-21 online ranking data was also used to identify the top cancer center in each of the five representative US states (Alabama, Georgia, Louisiana, Mississippi and South Carolina) and a similar search methodology was adopted for these five cancer centers. We then reviewed each cancer center’s website(s) and webpages to ascertain the availability of information regarding the availability of specific high-risk breast cancer clinic/programs and specific information on screening with breast MRI. Results: Of the top 20 US cancer centers, 15 (75%) have an established high-risk breast cancer clinic/program per their website. Two (2/15) of these cancer centers only had a general high-risk cancer assessment/genetics clinic and two (2/15) had no additional information available about the high-risk clinics. Information on high-risk factors was available on 12/20 (60%) websites. Seventeen centers (85%) included information on breast MRI, but only 8 (40%) had patient-centered detailed information on breast MRI for high-risk patients and 4 (20%) centers included an online, personalized, risk assessment tool. Among the top cancer center in each of the 5 representative Southern states, only 1 (20%) had information regarding a high-risk breast cancer evaluation program. While 4 (80%) had information on breast MRI information, there was no specific information available for high risk screening. Conclusions: These findings underscore the unmet need of easy access to online information from the websites of the top cancer centers nationally as well as the top state level cancer centers in the five representative southern US states for women with high risk of developing breast cancer. These limitations are particularly relevant for African-American women living in the South. Limitations of this study include the cross-sectional assessment of online data and that discrepancies may exist between websites and actual availability of clinical services. Citation Format: Jaspreet Singh Batra, Elizabeth Park, Arjun Gupta. Information availability about screening for high-risk breast cancer on cancer center websites [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-04-01.

Objective: Although immigrant students placed in English as a Second Language (ESL) sequence at community colleges are a growing student population, there is a dearth of research focused on these students in college. This study provides descriptive estimates of community college students’ progression through the credit-earning ESL sequence and disaggregates the findings by Generation 1.5/2.0 status. As community colleges seek to better support students whose primary language is not English, this study provides some of the first empirical evidence on who is placing where and how long it takes students to progress through the ESL sequence. Method: This study uses transcript data from a community college in California that enrolls a large proportion of students in the ESL sequence and estimates a Cox proportional hazards model with time to completing English 101 as the dependent variable. Results: Most Generation 1.5/2.0 students who take the ESL placement test start three levels or below college-level English. Furthermore, Generation 1.5/2.0 students attempt and complete English 101 at a lower rate than international students. Results from the Cox proportional hazards model show that international students are more likely to complete English 101 than U.S. citizens at any given point in time. Among the Generation 1.5/2.0 subsample, female permanent residents are more likely to complete English 101 than citizens. Conclusion: The findings suggest a need to reassess the ESL placement process so that all students placed in ESL are able to successfully progress toward college-level English.

Using a randomized control trial design, this study examines the extent to which a comprehensive college transition program (CCTP) shapes students’ time-use during their first 3 years in college. The CCTP provides comprehensive student-centered support as well as a generous scholarship. We compare students who had access to the CCTP with those who only received the scholarship. Findings indicate that both student groups spent similar amounts of time working for pay, studying, and on social media, and time-use had no differential bearing on college GPA by treatment status. In an exploratory analysis of program components, we find correlational evidence that academic-related interactions with faculty are positively associated with hours spent studying. We consistently find that the strongest predictor of time-use in college is how students spend their time in high school, suggesting that interventions aimed at shaping students’ time-use may be most effective if they are targeted at students’ precollege years.

Background Small cell lung cancer (SCLC) is a highly aggressive neuroendocrine malignancy that accounts for 15% of lung cancer diagnoses. The severity of this disease is exacerbated by the fact that there are few therapeutic options, which mostly offer limited clinical benefit, culminating in a 5-year survival rate of Methods To identify transcriptional subtypes, we used non-negative matrix factorization of gene expression data from 81 SCLC tumors and identified four subtypes largely based on differential expression of the transcription factors ASCL1, NEUROD1, and POU2F3. We hypothesized that these subtypes may underlie unique therapeutic vulnerabilities. We examined differential expression of genes that encode surface-expressed proteins that may be targetable by reagents such as therapeutic antibodies or antibody-drug conjugates (ADCs). Results Our four subtypes are defined either by high expression of ASCL1 (SCLC-A), NEUROD1 (SCLC-N), POU2F3 (SCLC-P), or an absence of those transcription factors and instead a prevalence of immunological factors (SCLC-Inflamed, or SCLC-I). We curated a list of approximately 60 candidate genes encoding surface proteins that are differentially expressed across the four subtypes. Within these 60 candidates, we have identified a few specific to each subtype for which there exist clinically available, targeted ADCs. The most prevalent subtype, SCLC-A, showed high expression of targets such as DLL3 (SCLC-A) and CEACAM5 (SCLC-A). SCLC-N highly expressed SSTR2, a somatostatin receptor that is being actively targeted in SCLC clinical trials. The two non-neuroendocrine subtypes, SCLC-P and SCLC-I shared some common hits such as the NK cell ligand MICA and B7H6. All of the identified and highlighted hits have been or are actively being pursued in clinical trials, highlighting the importance of understanding their expression levels pre- and post-treatment so that novel therapies can be developed that will be effective over the course of disease progression Conclusions The underlying biology defining our four identified subtypes of SCLC has revealed a striking number of targetable, differentially expressed surface protein encoding genes many of which already have clinically available reagents that could be repurposed for treatment of SCLC on a subtype-specific basis.

Background/ContextMost community colleges across the country use a placement test to determine students’ readiness for college-level coursework, yet these tests are admittedly imperfect instruments. Researchers have documented significant problems stemming from overreliance on placement testing, including placement error and misdiagnosis of remediation needs. They have also described significant consequences of misplacement, which can hinder the educational progression and attainment of community college students.Purpose/Objective/Research QuestionWe explore possibilities for placing community college students in mathematics courses using a holistic approach that considers measures beyond placement test scores. This includes academic background measures, such as high school GPA and math courses taken, and indicators of noncognitive constructs, such as motivation, time use, and social support.SettingThe study draws upon administrative data from a large urban community college district in California that serves over 100,000 students each semester. The data enable us to link students’ placement testing results, survey data, background information, and transcript records.Research DesignWe first use the supplemental survey data gathered during routine placement testing to conduct predictive exercises that identify severe placement errors under existing placement practices. We then move beyond prediction and evaluate student outcomes in two colleges where noncognitive indicators were directly factored into placement algorithms.Findings/ResultsUsing high school background information and noncognitive indicators to predict success reveals as many as one quarter of students may be misassigned to their math courses by status quo practices. In our subsequent analysis we find that students placed under a holistic approach that considered noncognitive indicators in addition to placement test scores performed no differently from higher scoring peers in the same course.Conclusions/RecommendationsThe findings suggest a holistic approach to mathematics course placement may improve placement accuracy and provide access to higher level mathematics courses for community college students without compromising their likelihood of success.

Context The journey through medical school can be challenging, especially for undergraduate medical students who must deal with a demanding curriculum, coupled with the demands of transitioning into adulthood. Despite experiencing learning challenges, most students succeed with appropriate learning support. Many medical schools offer learning support programmes, particularly in the latter years, but it has been suggested that such support could be more beneficial, especially during the initial years. Objectives This review explores learning support intervention programmes used to address learning challenges and deficits in the first year of medical school. Additionally, we propose a potential framework for supporting learning during the first year of medical school. Methods We searched PubMed, Web of Science, MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ERIC (Educational Resources Information Centre), Academic Search Premier and Google Scholar using the search terms ‘learning support’, ‘learning challenge’, ‘remediation’, ‘change’, ‘medical education’ and ‘first year’. We developed and used a review matrix to record the main elements of each article. We also coded the matrix to identify emerging themes. Results The main themes that emerged from the study were ‘intervention approaches’, ‘area of intervention’, ‘intervention strategies’, ‘intervention dose’ and ‘intervention outcomes’. Interventions: (i) used proactive-deficit, reactive-deficit and proactive-developmental approaches; (ii) addressed content knowledge, academic success skills, personal and professional skills and programme-related elements; (iii) utilised faculty staff-facilitated, peer-facilitated, support staff-facilitated, experiential placement, self-study and reduced-load strategies; (iv) varied in length from 5 weeks to 2 years, and (v) generally showed positive results. Conclusions This review has identified the main components of learning support interventions used for Year 1 medical students. Interventions, however, are generally not grounded on empirical assessment that elucidates the nature of the challenges faced by students. Future research should provide empirical understanding of the learning challenges to be addressed.

OBJECTIVES: Approximately 1.4 million people suffer from inflammatory bowel disease, which is a major risk factor for developing colitis associated colorectal cancer (CAC). Dietary interventions with the goal to reduce colon inflammation and encourage gut microbiome homeostasis may be a strategy to reduce the risk of CAC. The antioxidants and anti-inflammatory compounds present in black raspberries (BRB) have demonstrated protective effects in the colon epithelium and may alter the composition of the gut microbiome. Previously, we showed that dietary supplementation with black raspberries significantly suppressed colitis and colon tumorigenesis promoted by the consumption of a Western type diet in mice. The goal of this study was to compare the efficacy of dietary intervention with whole, freeze-dried black raspberries on colitis and colon tumorigenesis in mice consuming either a standard diet or a Western type diet that emulates typical U.S. nutrient intakes. METHODS: C57BL/6 J male and female mice were fed a standard diet (AIN93G) or the total Western diet (TWD) supplemented with 0 to 10% (w/w) black raspberry powder for a total of 16 weeks. All mice were dosed with axozymethane and provided 1% dextran sodium sulfate in drinking water for 10 days to promote colonic inflammation and tumorigenesis. RESULTS: As previously observed, mice fed TWD experienced more pronounced symptoms of colitis with a 40% increase in the disease activity index (DAI) score. Preliminary analyses suggest that dietary supplementation with 10% BRB suppressed the DAI score in mice fed TWD such that the colitis symptoms in these mice were not apparently different compared to the AIN93G-fed controls. However, addition of 10% BRB did not appear to provide a benefit to mice fed the AIN basal diet. Composition of the fecal microbiome over the course of disease development will be determined by standard 16S rRNA sequencing, and assessment of tumor outcome is ongoing. CONCLUSIONS: Consumption of a Western type diet increased symptoms of colitis, whereas dietary supplementation with 10% BRB appeared to ameliorate TWD-enhanced colitis in mice. FUNDING SOURCES: USDA NIFA Grant# 2018-67017-27516 and UAES Project UTA-1178.

Purpose Comparison of medical specialization of repeated exposure to secondary trauma and Post-Traumatic Stress Disorder (PTSD) symptoms in pediatric nurses was examined. Design and methods The PTSD Checklist-Civilian Version (PCL-C) was administered to 182 nurses over their first year on the job at a pediatric hospital (three time-points: baseline, 3 month follow-up, and 1 year follow-up). Demographic characteristics (age groups, gender, education, and race) and previous healthcare experience on whether nurses met criteria for no, partial, or full PTSD across all three time-points was examined. Differences in unit assignment on total PTSD symptoms and symptoms of each criterion of PTSD (re-experiencing, avoidance, and arousal) were also examined. Results No significant differences of both demographic characteristics and previous healthcare experience were found on these PTSD categories. However, both ICU and Hematology/Oncology units were more at risk for developing partial and full PTSD, respectively compared to other units. Nurses in the rehabilitation units had significantly higher re-experiencing, avoidance, and arousal symptoms than those assigned to medical/surgical and intensive care units. Conclusions Results demonstrate a need for hospitals to assess why nurses from certain units are reporting more PTSD symptoms and screen for PTSD symptoms and other mental health concerns throughout their career. Practice implications Being aware of which units may be more at-risk should inform unit-specific prevention and intervention programs to decrease negative outcomes, including burnout, compassion fatigue, and job dissatisfaction.

Background Since the UN Human Rights Council's recognition on the subject in 2011, the right to access the Internet and information is now considered one of the most basic human rights of global citizens [1,2]. Despite this, an information gap between developed and resource-limited countries remains, and there is scant research on actual information needs of workers themselves. The Republic of Botswana represents a fertile ground to address existing gaps in research, policy, and practice, due to its demonstrated gap in access to information and specialists among rural health care workers (HCWs), burgeoning mHealth capacity, and a timely offer from Orange Telecommunications to access Wikipedia for free on mobile platforms for Botswana subscribers. Objectives In this study, we sought to identify clinical information needs of HCWs of Botswana and their perception of Wikipedia as a clinical tool. Methods Twenty-eight facilitated focus groups, consisting of 113 HCWs of various cadres based at district hospitals, clinics, and health posts around Botswana, were employed. Transcription and thematic analysis were performed for those groups. Results Access to the Internet is limited at most facilities. Most HCWs placed high importance upon using Botswana Ministry of Health (MoH) resources for obtaining credible clinical information. However, the clinical applicability of these materials was limited due to discrepancies amongst sources, potentially outdated information, and poor optimization for time-sensitive circumstances. As a result, HCWs faced challenges, such as loss of patient trust and compromises in patient care. Potential solutions posed by HCWs to address these issues included: multifaceted improvements in Internet infrastructure, access to up-to-date information, transfer of knowledge from MoH to HCW, and improving content and applicability of currently available information. Topics of clinical information needs were broad and encompassed: HIV, TB (Tuberculosis), OB/GYN (Obstetrics and Gynecology), and Pediatrics. HCW attitudes towards Wikipedia were variable; some trusted Wikipedia as a reliable point of care information resource whereas others thought that its use should be restricted and monitored by the MoH. Conclusions There is a demonstrated need for accessible, reliable, and up-to-date information to aid clinical practice in Botswana. Attitudes towards Wikipedia as an open information resource tool are at best, split. Therefore, future studies are necessary to determine the accuracy, currency, and relevancy of Wikipedia articles on the health topics identified by health care workers as areas of information need. More broadly speaking, future efforts should be dedicated to configure a quality-controlled, readily accessible mobile platform based clinical information application tool fitting for Botswana.

Paclitaxel is a widely used chemotherapy agent that has rarely been associated with ophthalmic toxicities. Cystoid macular edema is one such rare side effect of paclitaxel therapy. Its pathophysiology remains poorly understood. Here, we report on a 69-year-old woman who developed cystoid macular edema associated with the albumin-bound formulation of paclitaxel after several months of therapy for breast cancer. After 2 months of drug withdrawal, her vision improved and there was a significant improvement in the macular edema by imaging with spectral-domain optical coherence tomography. Oncologists using taxane agents should be aware of this rare adverse outcome for timely patient referral to an ophthalmologist and appropriate treatment to preserve a patient's visual acuity.

Objectives: Prescription writing is a basic clinical skill for all doctors; however, errors in prescriptions are frequent and can result in significant harm to patients both from sub-therapeutic dosages and from over prescribing. This study examines the prescribing practices of ‘as required’ medications in an acute psychiatric inpatient unit attached to a university teaching hospital.Method: A clinical audit was conducted to examine both prescribing practices of ‘as required’ medication and recording of ‘as required’ medication in nursing notes. A series of educational interventions were undertaken in an attempt to improve prescribing practices in relation to ‘as required’ medication and two further audits were completed to assess any change in practice and whether such changes were sustained.Results: Psycho-education led to an improvement in a number of prescribing practices, including increased generic prescribing, improved documentation of indications for medication administration and increased writing of medication dosages in acceptable abbreviations. These benefits were maintained four months after the education interventions. Rates of documenting the frequency of medication correctly and recording the administration of medication in nursing notes remained low.Conclusion: Our audit cycle clearly demonstrates that education can ameliorate prescribing practices and these improvements were maintained four months after education was delivered. However some aspects of prescribing practice remained deficient, and more focused educational interventions are required in these areas.

The purpose of this exploratory single-case study is to investigate the affordances of iPad transpired within a technological pedagogical and content knowledge (TPACK) framework by four early childhood educators with varying Technological Knowledge (TK) at a low-income preschool. Pre/post and follow-up survey, group and follow-up interviews, classroom observations and document of iPad workshop data were analyzed using coding methods in two cycles. The exploration in how teachers discovered the iPad affordances indicated parallel progression in TK and change in their value system. The exploration in the progression of TK and change in their value system suggest a relationship between progression of TK towards TPACK and of affective-valuing (AV) towards affective-characterization (AC).