Emotions and Incivility in Vaccine Mandate Discourse: Natural Language Processing Insights.

Background: Despite vaccine availability, vaccine hesitancy has inhibited public health officials' efforts to mitigate the COVID-19 pandemic in the United States. Although some US elected officials have responded by issuing vaccine mandates, others have amplified vaccine hesitancy by broadcasting messages that minimize vaccine efficacy. The politically polarized nature of COVID-19 information on social media has given rise to incivility, wherein health attitudes often hinge more on political ideology than science. Objective: To the best of our knowledge, incivility has not been studied in the context of discourse regarding COVID-19 vaccines and mandates. Specifically, there is little focus on the psychological processes that elicit uncivil vaccine discourse and behaviors. Thus, we investigated 3 psychological processes theorized to predict discourse incivility-namely, anxiety, anger, and sadness. Methods: We used 2 different natural language processing approaches: (1) the Linguistic Inquiry and Word Count computational tool and (2) the Google Perspective application programming interface (API) to analyze a data set of 8014 tweets containing terms related to COVID-19 vaccine mandates from September 14, 2021, to October 1, 2021. To collect the tweets, we used the Twitter API Tweet Downloader Tool (version 2). Subsequently, we filtered through a data set of 375,000 vaccine-related tweets using keywords to extract tweets explicitly focused on vaccine mandates. We relied on the Linguistic Inquiry and Word Count computational tool to measure the valence of linguistic anger, sadness, and anxiety in the tweets. To measure dimensions of post incivility, we used the Google Perspective API. Results: This study resolved discrepant operationalizations of incivility by introducing incivility as a multifaceted construct and explored the distinct emotional processes underlying 5 dimensions of discourse incivility. The findings revealed that 3 types of emotions-anxiety, anger, and sadness-were uniquely associated with dimensions of incivility (eg, toxicity, severe toxicity, insult, profanity, threat, and identity attacks). Specifically, the results showed that anger was significantly positively associated with all dimensions of incivility (all P<.001), whereas sadness was significantly positively related to threat (P=.04). Conversely, anxiety was significantly negatively associated with identity attack (P=.03) and profanity (P=.02). Conclusions: The results suggest that our multidimensional approach to incivility is a promising alternative to understanding and intervening in the psychological processes underlying uncivil vaccine discourse. Understanding specific emotions that can increase or decrease incivility such as anxiety, anger, and sadness can enable researchers and public health professionals to develop effective interventions against uncivil vaccine discourse. Given the need for real-time monitoring and automated responses to the spread of health information and misinformation on the web, social media platforms can harness the Google Perspective API to offer users immediate, automated feedback when it detects that a comment is uncivil.

A systems immunology study comparing innate and adaptive immune responses in adults to COVID-19 mRNA and adenovirus vectored vaccines.

Identifying the molecular mechanisms that promote optimal immune responses to coronavirus disease 2019 (COVID-19) vaccination is critical for future rational vaccine design. Here, we longitudinally profile innate and adaptive immune responses in 102 adults after the first, second, and third doses of mRNA or adenovirus-vectored COVID-19 vaccines. Using a multi-omics approach, we identify key differences in the immune responses induced by ChAdOx1-S and BNT162b2 that correlate with antigen-specific antibody and T cell responses or vaccine reactogenicity. Unexpectedly, we observe that vaccination with ChAdOx1-S, but not BNT162b2, induces an adenoviral vector-specific memory response after the first dose, which correlates with the expression of proteins with roles in thrombosis with potential implications for thrombosis with thrombocytopenia syndrome (TTS), a rare but serious adverse event linked to adenovirus-vectored vaccines. The COVID-19 Vaccine Immune Responses Study thus represents a major resource that can be used to understand the immunogenicity and reactogenicity of these COVID-19 vaccines.

COVID-19 thromboembolism is reduced in ambulatory, but not hospitalized patients, following COVID-19 vaccination Short title: COVID-19 thromboembolism.

Not available.

Constituents' Inferences of Local Governments' Goals and the Relationship Between Political Party and Belief in COVID-19 Misinformation: Cross-sectional Survey of Twitter Followers of State Public Health Departments.

Background: Amid the COVID-19 pandemic, social media have influenced the circulation of health information. Public health agencies often use Twitter to disseminate and amplify the propagation of such information. Still, exposure to local government-endorsed COVID-19 public health information does not make one immune to believing misinformation. Moreover, not all health information on Twitter is accurate, and some users may believe misinformation and disinformation just as much as those who endorse more accurate information. This situation is complicated, given that elected officials may pursue a political agenda of re-election by downplaying the need for COVID-19 restrictions. The politically polarized nature of information and misinformation on social media in the United States has fueled a COVID-19 infodemic. Because pre-existing political beliefs can both facilitate and hinder persuasion, Twitter users' belief in COVID-19 misinformation is likely a function of their goal inferences about their local government agencies' motives for addressing the COVID-19 pandemic. Objective: We shed light on the cognitive processes of goal understanding that underlie the relationship between partisanship and belief in health misinformation. We investigate how the valence of Twitter users' goal inferences of local governments' COVID-19 efforts predicts their belief in COVID-19 misinformation as a function of their political party affiliation. Methods: We conducted a web-based cross-sectional survey of US Twitter users who followed their state's official Department of Public Health Twitter account (n=258) between August 10 and December 23, 2020. Inferences about local governments' goals, demographics, and belief in COVID-19 misinformation were measured. State political affiliation was controlled. Results: Participants from all 50 states were included in the sample. An interaction emerged between political party affiliation and goal inference valence for belief in COVID-19 misinformation (∆R 2=0.04; F 8,249=4.78; P<.001); positive goal inference valence predicted increased belief in COVID-19 misinformation among Republicans (ß=.47; t 249=2.59; P=.01) but not among Democrats (ß=.07; t 249=0.84; P=.40). Conclusions: Our results reveal that favorable inferences about local governments' COVID-19 efforts can accelerate belief in misinformation among Republican-identifying constituents. In other words, accurate COVID-19 transmission knowledge is a function of constituents' sentiment toward politicians rather than science, which has significant implications on public health efforts for minimizing the spread of the disease, as convincing misinformed constituents to practice safety measures might be a political issue just as much as it is a health one. Our work suggests that goal understanding processes matter for misinformation about COVID-19 among Republicans. Those responsible for future COVID-19 public health messaging aimed at increasing belief in valid information about COVID-19 should recognize the need to test persuasive appeals that address partisans' pre-existing political views in order to prevent individuals' goal inferences from interfering with public health messaging.

Natural Language Processing Insight into LGBTQ+ Youth Mental Health During the COVID-19 Pandemic: Longitudinal Content Analysis of Anxiety-Provoking Topics and Trends in Emotion in LGBTeens Microcommunity Subreddit.

BACKGROUND: Widespread fear surrounding COVID-19, coupled with physical and social distancing orders, has caused severe adverse mental health outcomes. Little is known, however, about how the COVID-19 crisis has impacted LGBTQ+ youth, who disproportionately experienced a high rate of adverse mental health outcomes before the COVID-19 pandemic. OBJECTIVE: We aimed to address this knowledge gap by harnessing natural language processing methodologies to investigate the evolution of conversation topics in the most popular subreddit for LGBTQ+ youth. METHODS: We generated a data set of all r/LGBTeens subreddit posts (n=39,389) between January 1, 2020 and February 1, 2021 and analyzed meaningful trends in anxiety, anger, and sadness in the posts. Because the distribution of anxiety before widespread social distancing orders was meaningfully different from the distribution after (P<.001), we employed latent Dirichlet allocation to examine topics that provoked this shift in anxiety. RESULTS: We did not find any differences in LGBTQ+ youth anger and sadness before and after government-mandated social distancing; however, anxiety increased significantly (P<.001). Further analysis revealed a list of 10 anxiety-provoking topics discussed during the pandemic: attraction to a friend, coming out, coming out to family, discrimination, education, exploring sexuality, gender pronouns, love and relationship advice, starting a new relationship, and struggling with mental health. CONCLUSIONS: During the COVID-19 pandemic, LGBTQ+ teens increased their reliance on anonymous discussion forums when discussing anxiety-provoking topics. LGBTQ+ teens likely perceived anonymous forums as safe spaces for discussing lifestyle stressors during COVID-19 disruptions (eg, school closures). The list of prevalent anxiety-provoking topics in LGBTQ+ teens' anonymous discussions can inform future mental health interventions in LGBTQ+ youth.

U.S. adolescents' attitudes toward school, social connection, media use, and mental health during the COVID-19 pandemic: Differences as a function of gender identity and school context.

The COVID-19 pandemic changed school contexts and social opportunities dramatically for adolescents around the world. Thus, certain adolescents may have been more susceptible to the stress of the pandemic as a function of differences in schooling. We present data from 1256 United States adolescents (ages 14-16) to examine how the 2020-2021 school context (in-person, hybrid, or virtual) related to feelings of school satisfaction and success, social connection, mental health, and media use. We also examine differences as a function of gender identity. Results demonstrate that school context, particularly in-person compared to virtual schooling, was related to higher school satisfaction and academic success, stronger feelings of social connection and inclusion, lower levels of anxiety and depression, and less problematic media use. Interestingly, adolescents did seem to use media as a tool to support social connection when in hybrid or virtual school contexts, but they also reported higher rates of problematic media use, thus suggesting that media use needs to be examined more carefully to understand its role as a potential protective mechanism for adolescents' social connection and mental health. These findings provide baseline information about how schools' responses to the COVID-19 pandemic may have created disparities among youth. These findings have implications for current school interventions.

C-reactive protein, immunothrombosis and venous thromboembolism

C-reactive protein (CRP) is a member of the highly conserved pentraxin superfamily of proteins and is often used in clinical practice as a marker of infection and inflammation. There is now increasing evidence that CRP is not only a marker of inflammation, but also that destabilized isoforms of CRP possess pro-inflammatory and pro-thrombotic properties. CRP circulates as a functionally inert pentameric form (pCRP), which relaxes its conformation to pCRP* after binding to phosphocholine-enriched membranes and then dissociates to monomeric CRP (mCRP). with the latter two being destabilized isoforms possessing highly pro-inflammatory features. pCRP* and mCRP have significant biological effects in regulating many of the aspects central to pathogenesis of atherothrombosis and venous thromboembolism (VTE), by directly activating platelets and triggering the classical complement pathway. Importantly, it is now well appreciated that VTE is a consequence of thromboinflammation. Accordingly, acute VTE is known to be associated with classical inflammatory responses and elevations of CRP, and indeed VTE risk is elevated in conditions associated with inflammation, such as inflammatory bowel disease, COVID-19 and sepsis. Although the clinical data regarding the utility of CRP as a biomarker in predicting VTE remains modest, and in some cases conflicting, the clinical utility of CRP appears to be improved in subsets of the population such as in predicting VTE recurrence, in cancer-associated thrombosis and in those with COVID-19. Therefore, given the known biological function of CRP in amplifying inflammation and tissue damage, this raises the prospect that CRP may play a role in promoting VTE formation in the context of concurrent inflammation. However, further investigation is required to unravel whether CRP plays a direct role in the pathogenesis of VTE, the utility of which will be in developing novel prophylactic or therapeutic strategies to target thromboinflammation.

COVID-19 Vaccine Fact-Checking Posts on Facebook: Observational Study.

BACKGROUND: Effective interventions aimed at correcting COVID-19 vaccine misinformation, known as fact-checking messages, are needed to combat the mounting antivaccine infodemic and alleviate vaccine hesitancy. OBJECTIVE: This work investigates (1) the changes in the public's attitude toward COVID-19 vaccines over time, (2) the effectiveness of COVID-19 vaccine fact-checking information on social media engagement and attitude change, and (3) the emotional and linguistic features of the COVID-19 vaccine fact-checking information ecosystem. METHODS: We collected a data set of 12,553 COVID-19 vaccine fact-checking Facebook posts and their associated comments (N=122,362) from January 2020 to March 2022 and conducted a series of natural language processing and statistical analyses to investigate trends in public attitude toward the vaccine in COVID-19 vaccine fact-checking posts and comments, and emotional and linguistic features of the COVID-19 fact-checking information ecosystem. RESULTS: The percentage of fact-checking posts relative to all COVID-19 vaccine posts peaked in May 2020 and then steadily decreased as the pandemic progressed (r=-0.92, df=21, t=-10.94, 95% CI -0.97 to -0.82, P<.001). The salience of COVID-19 vaccine entities was significantly lower in comments (mean 0.03, SD 0.03, t=39.28, P<.001) than in posts (mean 0.09, SD 0.11). Third-party fact checkers have been playing a more important role in more fact-checking over time (r=0.63, df=25, t=4.06, 95% CI 0.33-0.82, P<.001). COVID-19 vaccine fact-checking posts continued to be more analytical (r=0.81, df=25, t=6.88, 95% CI 0.62-0.91, P<.001) and more confident (r=0.59, df=25, t=3.68, 95% CI 0.27-0.79, P=.001) over time. Although comments did not exhibit a significant increase in confidence over time, tentativeness in comments significantly decreased (r=-0.62, df=25, t=-3.94, 95% CI -0.81 to -0.31, P=.001). In addition, although hospitals receive less engagement than other information sources, the comments expressed more positive attitudinal valence in comments compared to other information sources (b=0.06, 95% CI 0.00-0.12, t=2.03, P=.04). CONCLUSIONS: The percentage of fact-checking posts relative to all posts about the vaccine steadily decreased after May 2020. As the pandemic progressed, third-party fact checkers played a larger role in posting fact-checking COVID-19 vaccine posts. COVID-19 vaccine fact-checking posts continued to be more analytical and more confident over time, reflecting increased confidence in posts. Similarly, tentativeness in comments decreased; this likewise suggests that public uncertainty diminished over time. COVID-19 fact-checking vaccine posts from hospitals yielded more positive attitudes toward vaccination than other information sources. At the same time, hospitals received less engagement than other information sources. This suggests that hospitals should invest more in generating engaging public health campaigns on social media.

Erratum: Metadata Correction: "Desensitization to Fear-Inducing COVID-19 Health News on Twitter: Observational Study".

[This corrects the article DOI: 10.2196/26876.].

Desensitization to Fear-Inducing COVID-19 Health News on Twitter: Observational Study.

BACKGROUND: As of May 9, 2021, the United States had 32.7 million confirmed cases of COVID-19 (20.7% of confirmed cases worldwide) and 580,000 deaths (17.7% of deaths worldwide). Early on in the pandemic, widespread social, financial, and mental insecurities led to extreme and irrational coping behaviors, such as panic buying. However, despite the consistent spread of COVID-19 transmission, the public began to violate public safety measures as the pandemic got worse. OBJECTIVE: In this work, we examine the effect of fear-inducing news articles on people's expression of anxiety on Twitter. Additionally, we investigate desensitization to fear-inducing health news over time, despite the steadily rising COVID-19 death toll. METHODS: This study examined the anxiety levels in news articles (n=1465) and corresponding user tweets containing "COVID," "COVID-19," "pandemic," and "coronavirus" over 11 months, then correlated that information with the death toll of COVID-19 in the United States. RESULTS: Overall, tweets that shared links to anxious articles were more likely to be anxious (odds ratio [OR] 2.65, 95% CI 1.58-4.43, P<.001). These odds decreased (OR 0.41, 95% CI 0.2-0.83, P=.01) when the death toll reached the third quartile and fourth quartile (OR 0.42, 95% CI 0.21-0.85, P=.01). However, user tweet anxiety rose rapidly with articles when the death toll was low and then decreased in the third quartile of deaths (OR 0.61, 95% CI 0.37-1.01, P=.06). As predicted, in addition to the increasing death toll being matched by a lower level of article anxiety, the extent to which article anxiety elicited user tweet anxiety decreased when the death count reached the second quartile. CONCLUSIONS: The level of anxiety in users' tweets increased sharply in response to article anxiety early on in the COVID-19 pandemic, but as the casualty count climbed, news articles seemingly lost their ability to elicit anxiety among readers. Desensitization offers an explanation for why the increased threat is not eliciting widespread behavioral compliance with guidance from public health officials. This work investigated how individuals' emotional reactions to news of the COVID-19 pandemic manifest as the death toll increases. Findings suggest individuals became desensitized to the increased COVID-19 threat and their emotional responses were blunted over time.

The Emerging Threat of (Micro)Thrombosis in COVID-19 and Its Therapeutic Implications.

The recent emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the ensuing global pandemic has presented a health emergency of unprecedented magnitude. Recent clinical data has highlighted that coronavirus disease 2019 (COVID-19) is associated with a significant risk of thrombotic complications ranging from microvascular thrombosis, venous thromboembolic disease, and stroke. Importantly, thrombotic complications are markers of severe COVID-19 and are associated with multiorgan failure and increased mortality. The evidence to date supports the concept that the thrombotic manifestations of severe COVID-19 are due to the ability of SARS-CoV-2 to invade endothelial cells via ACE-2 (angiotensin-converting enzyme 2), which is expressed on the endothelial cell surface. However, in patients with COVID-19 the subsequent endothelial inflammation, complement activation, thrombin generation, platelet, and leukocyte recruitment, and the initiation of innate and adaptive immune responses culminate in immunothrombosis, ultimately causing (micro)thrombotic complications, such as deep vein thrombosis, pulmonary embolism, and stroke. Accordingly, the activation of coagulation (eg, as measured with plasma D-dimer) and thrombocytopenia have emerged as prognostic markers in COVID-19. Given thrombotic complications are central determinants of the high mortality rate in COVID-19, strategies to prevent thrombosis are of critical importance. Several antithrombotic drugs have been proposed as potential therapies to prevent COVID-19-associated thrombosis, including heparin, FXII inhibitors, fibrinolytic drugs, nafamostat, and dipyridamole, many of which also possess pleiotropic anti-inflammatory or antiviral effects. The growing awareness and mechanistic understanding of the prothrombotic state of COVID-19 patients are driving efforts to more stringent diagnostic screening for thrombotic complications and to the early institution of antithrombotic drugs, for both the prevention and therapy of thrombotic complications. The shifting paradigm of diagnostic and treatment strategies holds significant promise to reduce the burden of thrombotic complications and ultimately improve the prognosis for patients with COVID-19.