Connectivity Changes Following Episodic Future Thinking in Alcohol Use Disorder.

[Please note that in order to respond to reviewers request we had exceed the 300 word limit. The following is NOT revised from the first submission, please see the actual revised manuscript file for the reviewer-driven changes]. INTRODUCTION: Recent addiction and obesity-related research suggest that episodic future thinking (EFT) can serve as a promising intervention to promote healthy decision making. This study investigated the neural effects of EFT in alcohol use disorder (AUD). METHODS: Participants received either a brief EFT or control intervention to examine differences in resting-state connectivity. We then used these findings to characterize psychophysiological interaction (PPI) differences during a delay discounting (DD) fMRI task. In addition, we used a second control group of AUD participants without any intervention to reproduce and aid in interpreting our key findings. RESULTS: EFT participants, but not controls, showed statistically improved discounting rates - a behavioral marker for addiction. Resting state analyses of the left hippocampus revealed connectivity differences in the frontal poles. The directionality of this difference suggested that EFT reduced a hypoconnectivity relationship between these regions in AUD. We also found resting state connectivity differences between the salience network and the right dorsolateral prefrontal cortex (R DLPFC), which then led us to discover R-to-L DLPFC PPI differences during DD. Moreover, the resting state salience-to-DLPFC functional connectivity showed an inverse relationship to discounting rate while hyperconnectivity between left and right DLPFC reflected slower reaction times during difficult DD trials. DISCUSSION: These findings suggest that EFT produces beneficial changes in neural connectivity patterns in AUD. The alterations in connectivity highlight potential mechanisms underlying the effectiveness of EFT in improving decision-making in AUD. Understanding these neural effects may contribute to the further development of targeted interventions for AUD and related disorders.

Cannabis expectancies and associations with cannabis use and health functioning among adults with chronic pain.

INTRODUCTION: Cannabis is increasingly available to individuals in the United States, with the majority of states legalizing medical or recreational cannabis use. Cannabis expectancies (e.g., positive expectations from cannabis use) are related to more frequent cannabis use and associated with greater odds of lapse following a cessation attempt. METHODS: To evaluate the relationship between expectancies and cannabis- and health-related outcomes, we surveyed adults who used medical cannabis for chronic pain (n = 633; 52.2 % female; 82.1 % white) over a two-year period. Then, we performed a principal components analysis (PCA) on the Cannabis Expectancies Questionnaire to derive components of cannabis expectancies. We performed k-means clustering to identify subgroups with similar expectancies. The relationship between subgroup assignment and cannabis use outcomes (frequency, quantity), and physical and mental health functioning were evaluated. RESULTS: The PCA identified a three-component solution and k-means clustering identified four subgroups: low expectancies, negative expectancies, amotivation expectancies, and positive expectancies. Participants' cannabis expectancies were dynamic over time. After adjusting for demographics, expectancy subgroup was able to predict six-month cannabis use frequency (χ2(3) = 11.244; p = 0.010) and mental health functioning (χ2(3) = 24.926; p < 0.001), but not quantity (χ2(3) = 2.741, p = 0.433) or physical health functioning (χ2(3) = 5.110, p = 0.164). CONCLUSION: In a large cohort of individuals who use medical cannabis, four subgroups with differing cannabis expectancies emerged: low expectancies, negative expectancies, amotivation expectancies, and positive expectancies. These subgroups predicted subsequent outcomes and may be important for targeted intervention approaches to reduce cannabis use and improve functioning.

Vitamin D deficiency trends, risk factors, and occupational risk in active component service members of the U.S. Armed Forces, 2018-2022.

Vitamin D contains 2 related fat-soluble substances, D3 and D2, that are essential for bone health and overall well-being. The burden of vitamin D deficiency within the active component of the armed forces is unknown. This study describes trends of vitamin D deficiency diagnoses in the active component of the U.S. Armed Forces. Risk factors for vitamin D, such as military occupation, were examined to see if preventive measures and targeted vitamin D screening would be beneficial, as the United States Preventive Task Force does not recommend universal screening for vitamin D, nor does TRICARE cover screening for asymptomatic individuals. The surveillance period covered January 1, 2018 through December 31, 2022. The data were derived from the Defense Medical Surveillance System (DMSS). Vitamin D deficiency was measured using ICD-9-CM and ICD-10-CM diagnoses recorded in inpatient and outpatient medical encounters. Incidence rate and average annual prevalence were calculated. A logistic regression was performed to obtain adjusted odds ratios. The rates of vitamin D deficiency diagnoses among active component service members (ACSMs) remained steady during the study period, with an incidence rate of 16.4 per 1,000 person-years and an average annual prevalence of 2.2%. Female service members, those of older age groups, and indoor workers demonstrated higher rates of vitamin D deficiency. Previously described demographic risk factors such as indoor work and history of obesity or malabsorption syndrome were also associated in this study with vitamin D deficiency in ACSMs, although older age groups in this study were not associated with vitamin D deficiency. Pilots and air crew had the lowest rates of vitamin D deficiency, while health care workers had the highest, when evaluating by occupation.

DNA Methylation-Derived Immune Cell Proportions and Cancer Risk in Black Participants.

Prior cohort studies assessing cancer risk based on immune cell subtype profiles have predominantly focused on White populations. This limitation obscures vital insights into how cancer risk varies across race. Immune cell subtype proportions were estimated using deconvolution based on leukocyte DNA methylation markers from blood samples collected at baseline on participants without cancer in the Atherosclerosis Risk in Communities (ARIC) Study. Over a mean of 17.5 years of follow-up, 668 incident cancers were diagnosed in 2,467 Black participants. Cox proportional hazards regression was used to examine immune cell subtype proportions and overall cancer incidence and site-specific incidence (lung, breast, and prostate cancers). Higher T regulatory cell proportions were associated with higher lung cancer risk (hazard ratio [HR] = 1.22, 95% confidence interval [CI]= 1.06-1.41 per 1% increase in cell proportion) and a borderline increase in overall cancer risk (p=0.06). Increased memory B cell proportions were associated with significantly higher risk of prostate cancer and all cancers (HR=1.17, 95% CI=1.04-1.33 and HR=1.13, 95% CI=1.05-1.22, per 1% increase in cell proportion, respectively). Other immune cell subtypes did not display statistically significant associations with cancer risk in the main analyses. These results in Black participants align closely with prior findings in largely White populations. Our results add to the growing evidence demonstrating the important role of adaptive immunity in cancer risk.

Positive intonation increases the perceived value of smaller rewards in a quantity discrimination task with dogs (Canis familiaris).

Like many other species, dogs have a natural quantity judgment system to assist with decision making to maximize resources. Additionally, dogs are highly sensitive to, and influenced by, human-delivered ostensive (i.e., social) cues. Here, we assessed the influence of one such cue-a high, rising, positive "Oooh!" sound-on dogs' choice of differing quantities of pieces of food presented on two different plates. Subjects (N = 29) received 16 randomized trials of four conditions: 1 versus 1 paired with experimenter "Oooh!" while looking at the one plate, 1 versus 3, 3 versus 1 paired with experimenter "Oooh!," and 1 versus 1. As predicted, dogs chose the larger quantity more often in 1 versus 3 conditions. Contrary to one of our predictions, subjects chose the 1 versus 1+ "Oooh!" at chance levels. However, in support of another prediction, pairing the smaller reward with a positive intonation in 3 versus 1+ "Oooh!" significantly reduced dogs' choice of the larger reward. That is to say, without the presence of words, eye contact, or facial expressions, dogs followed a misguiding cue and chose a smaller reward that a stranger had deemed more valuable than a larger one. Local enhancement as well as a drive to increase social capital with the human are discussed as possible explanations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Restrictions of cigarette and e-cigarette flavor and filter ventilation on demand and substitution in the Experimental Tobacco Marketplace.

SIGNIFICANCE: Tobacco product design features, including flavors and cigarette filter ventilation, are subject to regulation. This study examined the effects of cigarette and e-cigarette flavors on demand and substitution by preferred cigarette flavor and ventilation in the Experimental Tobacco Marketplace (ETM). METHODS: In a mixed between-group (usual cigarette flavor and ventilation)/within-subject design (policy conditions), individuals who use tobacco (n=176 cigarette (60.5 % female); n=91 multiple products (26.7 % female)) were recruited using Ipsos and InnovateMR, completed purchasing trials with increasing cigarette prices in the ETM. Participants were exposed to four conditions in a 2×2 factorial design with cigarette flavors restricted or unrestricted and e-cigarette flavors restricted or unrestricted. RESULTS: In individuals who exclusively smoke cigarettes: 1) Cigarette menthol restrictions decreased willingness to purchase cigarettes (OR: 0.001; 95 % CI: 0.00002, 0.015) for individuals that prefer menthol cigarettes and increased willingness to purchase NRT (OR: 4.02; 95 % CI: 1.47, 11.0), 2) cigarette menthol restrictions reduced demand for cigarettes in individuals who smoke menthol cigarettes (p<0.001), 3) e-cigarette flavor restrictions reduced the degree of e-cigarette substitution in individuals who smoke menthol cigarettes (p=0.028), and 4) preference for higher cigarette filter ventilation was associated with higher demand for cigarettes (p=0.003) and lowered substitution of smokeless tobacco products (p=0.028). In individuals who use multiple tobacco products, restrictions did not impact product purchasing. CONCLUSION: Strategies to reduce flavored product sales and increase cessation resource accessibility may improve population health by reducing smoking and increasing NRT use in individuals who use menthol cigarettes.

An assessment of compositional methods for the analysis of DNA methylation-based deconvolution estimates.

DNA methylation (DNAm)-based deconvolution estimates contain relative data, forming a composition, that standard methods (testing directly on cell proportions) are ill-suited to handle. In this study we examined the performance of an alternative method, analysis of compositions of microbiomes (ANCOM), for the analysis of DNAm-based deconvolution estimates. We performed two different simulation studies comparing ANCOM to a standard approach (two sample t-test performed directly on cell proportions) and analyzed a real-world data from the Women's Health Initiative to evaluate the applicability of ANCOM to DNAm-based deconvolution estimates. Our findings indicate that ANCOM can effectively account for the compositional nature of DNAm-based deconvolution estimates. ANCOM adequately controls the false discovery rate while maintaining statistical power comparable to that of standard methods.

DNA methylation (DNAm)-based deconvolution provides highly accurate estimates of the proportion of each cell type in a mixed-cell type biological sample (e.g., whole-blood). These estimates can be used for examining the association between cell type proportions and biological or clinical end points; for example, comparing the estimated neutrophil proportion in whole blood between smokers and non-smokers. Cell proportion data has unique features which present challenges for traditional and widely used statistical methods. In response to this issue, our work presents two simulation studies and a real-world analysis that benchmark the performance of current standard statistical methods against an alternative method called analysis composition of microbes (ANCOM), which was originally developed for the analysis of microbiome data. In our real-world analysis we used DNAm data collected from Women's Health Initiative Long Life Study I and compared the results of each method against a gold-standard that is typically not available for these analyses. In each of our simulation studies, ANCOM was able to detect true differences in cell proportions between the groups being compared but had a much lower rate of false discovery compared with the standard statistical methods. Our real-world analysis demonstrated similar findings. Overall, our study highlights the potential of ANCOM as a powerful and robust method for analyzing DNAm-derived deconvolution estimates when the interest is comparisons of cell type proportions and biological or clinical end points. ANCOM's ability to minimize false discovery while maintaining robust statistical power positions it as a valuable addition to the epigenomic analysis toolkit.

Anti-TRPM1 autoantibody-positive unilateral melanoma associated retinopathy (MAR) triggered by immunotherapy recapitulates functional and structural details of TRPM1-associated congenital stationary night blindness.

Purpose: To describe the retinal phenotype of an unusual case of anti-TRPM1 autoantibody-positive unilateral melanoma-associated retinopathy (MAR) triggered by nivolumab therapy and compare with the phenotype of TRPM1-associated Congenital Stationary Night Blindness (TRPM1-CSNB). Observations: Unilateral MAR was diagnosed 3 months after starting nivolumab therapy for consolidation of a successfully treated melanoma. Retinal autoantibodies against TRPM1 were identified. ffERG, microperimetry and static chromatic perimetry confirmed unilateral ON-Bipolar Cell (ON-BPC) dysfunction and central rod sensitivity losses in the left eye; the contralateral eye was normal. There was borderline ganglion cell (GCL) and inner nuclear layer (INL) thinning, but a significantly thinner inner plexiform layer (IPL) in the affected compared to the unaffected eye. Longitudinal reflectivity profiles (LRPs) demonstrated an abnormal inner plexiform layer (IPL) lamination in the involved eye. Nearly identical changes were documented in two cases of TRMP1-cCSNB and in a case of anti-TRPM1 autoantibody-negative MAR. The functional changes partially recovered with discontinuation of the medication without added immunosuppression. Conclusions and Importance: Comparisons between the affected and unaffected eye in this unilateral MAR case revealed inner retinal abnormalities and abnormal lamination of the IPL associated with the classical retina-wide ON-BPC dysfunction, and localized central rod-mediated sensitivity losses. A nearly identical structural phenotype in two cases of cCSNB and a case of anti-TRPM1 autoantibody-negative MAR supports a specific structural-functional phenotype for these conditions with ON-BPC dysfunction.

Appearance and resolution of numerous bilateral gass plaques in probable Susac syndrome.

Purpose: To describe a patient with a unique retinal phenotype of probable Susac syndrome. Observations: A 47-year-old female who presented with bilateral tinnitus and vision changes was found to have bilateral sensorineural hearing loss and many bilateral retinal arteriolar Gass plaques. She had bilateral scotomas corresponding with temporal thinning and atrophy of the inner nuclear layer (INL) on OCT. Retinal examination and fluorescein angiography demonstrated minimal arteriolar wall hyperfluorescence with no evidence of acute branch retinal artery occlusion. She developed daily headaches. MRI of the brain was normal with no corpus callosal lesions. She was diagnosed with probable Susac syndrome based on the above findings. Conclusions and importance: Our patient's bilateral high frequency sensorineural hearing loss, numerous bilateral Gass plaques, and headaches are most likely attributable to Susac syndrome. While BRAO is considered a cornerstone of retinal involvement in Susac syndrome, it may only be appreciable angiographically in the acute setting, and it is important to recognize Gass plaques as a significant diagnostic marker of disease.

Immunomethylomic profiles of long-term head and neck squamous cell carcinoma survivors on immune checkpoint inhibitors.

Aim: This study addresses the challenge of predicting the response of head and neck squamous cell carcinoma (HNSCC) patients to immunotherapy.Methods: Using DNA methylation cytometry, we analyzed the immune profiles of six HNSCC patients who showed a positive response to immunotherapy over a year without disease progression.Results: There was an initial increase in CD8 T memory cells and natural killer cells during the first four cycles of immunotherapy, which then returned to baseline levels after a year. Baseline CD8 T cell levels were lower in HNSCC immunotherapy responders but became similar to those in healthy subjects after immunotherapy.Conclusion: These findings suggest that monitoring fluctuations in immune profiles could potentially identify biomarkers for immunotherapy response in HNSCC patients.

[Box: see text].

Proteomic profiling of bronchoalveolar lavage fluid uncovers protein clusters linked to survival in idiopathic forms of interstitial lung disease.

Background: Idiopathic interstitial pneumonias (IIPs) such as idiopathic pulmonary fibrosis (IPF) and interstitial pneumonia with autoimmune features (IPAF), present diagnostic and therapeutic challenges due to their heterogeneous nature. This study aimed to identify intrinsic molecular signatures within the lung microenvironment of these IIPs through proteomic analysis of bronchoalveolar lavage fluid (BALF). Methods: Patients with IIP (n=23) underwent comprehensive clinical evaluation including pre-treatment bronchoscopy and were compared to controls without lung disease (n=5). Proteomic profiling of BALF was conducted using label-free quantitative methods. Unsupervised cluster analyses identified protein expression profiles which were then analyzed to predict survival outcomes and investigate associated pathways. Results: Proteomic profiling successfully differentiated IIP from controls. k-means clustering, based on protein expression revealed three distinct IIP clusters, which were not associated with age, smoking history, or baseline pulmonary function. These clusters had unique survival trajectories and provided more accurate survival predictions than the Gender Age Physiology (GAP) index (C-index 0.794 vs. 0.709). The cluster with the worst prognosis featured decreased inflammatory signaling and complement activation, with pathway analysis highlighting altered immune response pathways related to immunoglobulin production and B cell-mediated immunity. Conclusions: The unsupervised clustering of BALF proteomics provided a novel stratification of IIP patients, with potential implications for prognostic and therapeutic targeting. The identified molecular phenotypes underscore the diversity within the IIP classification and the potential importance of personalized treatments for these conditions. Future validation in larger, multi-ethnic cohorts is essential to confirm these findings and to explore their utility in clinical decision-making for patients with IIP.

Review of the U.S. Air Force Academy Hepatitis C Virus Screening Program to Ensure High-Value Care.

INTRODUCTION: Hepatitis C virus (HCV) is primarily transmitted through blood-to-blood contact. Leading health agencies have called for the elimination of HCV as a public health threat, with universal screening considered a part of the strategy. Hepatitis C virus screening among incoming cadets and cadet candidates at the United States Air Force Academy (USAFA) was implemented in 2023. The purpose of this quality improvement project was to determine the results of this screening and the associated fiscal costs, benefits, and harms to make a recommendation for future incoming classes. MATERIALS AND METHODS: The prevalence of HCV antibody positivity and confirmed HCV infections were calculated among the incoming cadets and cadet candidates at USAFA in summer 2023. Screening was conducted with a highly sensitive HCV total antibody test, and those who screened positive were further tested with a quantitative HCV polymerase chain reaction. The screening and follow-up care costs were calculated, and the potential harm of receiving a false positive notification was considered. RESULTS: Of the 1,360 persons screened at USAFA in 2023, no confirmed HCV infections were identified. There was one false positive on screening in the cadet population (n = 1,131) and one false positive in the cadet candidate population (n = 229). The fiscal cost of universal HCV screening upon accession of cadets and cadet candidates, including medical follow-up, was at least $5,279. The opportunity cost was minimal because blood was drawn for other mandatory programs, although screening may have caused social and psychological harm to those receiving a false positive notification. CONCLUSIONS: The prevalence of chronic HCV infection among incoming USAFA cadets and cadet candidates was 0%, below the population screening threshold that warrants screening, according to the Centers for Disease Control and Prevention. The harms of screening, including fiscal costs and potential psychological harm to individuals with a false positive screen, likely outweigh the benefits. We recommend against universal HCV screening in 2024 upon accession of USAFA cadets and cadet candidates.

DNA Methylation-Derived Immune Cell Proportions and Cancer Risk, Including Lung Cancer, in Black Participants.

Prior cohort studies assessing cancer risk based on immune cell subtype profiles have predominantly focused on White populations. This limitation obscures vital insights into how cancer risk varies across race. Immune cell subtype proportions were estimated using deconvolution based on leukocyte DNA methylation markers from blood samples collected at baseline on participants without cancer in the Atherosclerosis Risk in Communities (ARIC) Study. Over a mean of 17.5 years of follow-up, 668 incident cancers were diagnosed in 2,467 Black participants. Cox proportional hazards regression was used to examine immune cell subtype proportions and overall cancer incidence and site-specific incidence (lung, breast, and prostate cancers). Higher T regulatory cell proportions were associated with statistically significantly higher lung cancer risk (hazard ratio = 1.22, 95% confidence interval = 1.06-1.41 per percent increase). Increased memory B cell proportions were associated with significantly higher risk of prostate cancer (1.17, 1.04-1.33) and all cancers (1.13, 1.05-1.22). Increased CD8+ naïve cell proportions were associated with significantly lower risk of all cancers in participants ≥55 years (0.91, 0.83-0.98). Other immune cell subtypes did not display statistically significant associations with cancer risk. These results in Black participants align closely with prior findings in largely White populations. Findings from this study could help identify those at high cancer risk and outline risk stratifying to target patients for cancer screening, prevention, and other interventions. Further studies should assess these relationships in other cancer types, better elucidate the interplay of B cells in cancer risk, and identify biomarkers for personalized risk stratification.

Selective Reduction of Socioeconomic Disparities in the Experimental Tobacco Marketplace: Effects of Cigarette and E-cigarette Flavor Restrictions.

INTRODUCTION: Cigarette smoking accounts for >30% of the socioeconomic gap in life expectancy. Flavored restrictions claim to promote equity; however, no previous studies have compared the effect of cigarette and e-cigarette flavor restrictions among individuals who smoke with lower and higher socioeconomic status (SES). AIMS AND METHODS: In a between-group within-subject design, individuals with lower (n = 155) and higher (n = 125) SES completed hypothetical purchasing trials in the experimental tobacco marketplace (ETM). Conditions were presented in a 2 × 2 factorial design (cigarette flavors restricted or unrestricted and e-cigarette flavors restricted or unrestricted) with increasing cigarette prices across trials. RESULTS: Results show (1) SES differences in cigarette, e-cigarette, and NRT purchases under unrestricted policies, with lower SES showing higher cigarette demand and lower e-cigarette and NRT substitution than higher SES, (2) cigarette restrictions decreased cigarette and increased NRT purchases among lower SES, but no significant changes among higher SES, (3) decreased SES differences in cigarette demand under cigarette restrictions, but persistence under e-cigarette restrictions or their combination, (4) persistence of SES differences in e-cigarette purchases when all restrictions were enforced, and (5) waning of SES differences in NRT purchasing under all restrictions. CONCLUSIONS: Flavor restrictions differentially affected individuals based on SES. Within-group comparisons demonstrated restrictions significantly impacted lower SES, but not higher SES. Between-group comparisons showed SES differences in cigarette purchasing decreased under cigarette restrictions, but persisted under e-cigarette-restrictions or their combination. Additionally, SES differences in NRT substitution decreased under flavor restrictions. These findings highlight the utility of the ETM to investigate SES disparities. IMPLICATIONS: With increasing trends of socioeconomic differences in smoking prevalence and cessation rates, smoking-related health disparities are expected to continue to widen. Restricting menthol flavor in cigarettes while enhancing the availability and affordability of NRT have the potential to alleviate SES disparities in tobacco use, therefore, positively impacting health equity. However, this effect may depend on flavor availability in other tobacco products.

The influence of biopsy site and pregnancy on stable isotope ratios in humpback whale skin.

RATIONALE: Stable isotope analysis (SIA) of free-swimming mysticetes using biopsies is often limited in sample size and uses only one sample per individual, failing to capture both intra-individual variability and the influence of demographic and physiological factors on isotope ratios. METHODS: We applied SIA of δ13C and δ15N to humpback whale (Megaptera novaeangliae) biopsies taken during the foraging season along the western Antarctic Peninsula to quantify intra-individual variation from repeatedly sampled individuals, as well as to determine the effect of biopsy collection site, sex, and pregnancy on isotope ratios. RESULTS: There was substantial variability in δ13C from multiple biopsies taken from the same individuals, though δ15N was much more consistent. Side of the body (left versus right) and biopsy location (dorsal, anterior, ventral, and posterior) did marginally affect the isotopic composition of δ15N but not δ13C. Pregnancy had a significant effect on both δ13C and δ15N, where pregnant females were depleted in both when compared to non-pregnant females and males. CONCLUSIONS: These results indicate that isotopic signatures are influenced by multiple endogenous and exogenous factors and emphasize value in accounting for intra-individual variability and pregnancy status within a sampled population. Placed within an ecological context, the endogenous variability in δ13C observed here may be informative for future isotopic analyses.

Summer Cancer Research Experience for High School Students from Historically Marginalized Populations in Kansas City.

The Accelerate Cancer Education (ACE) summer research program at The University of Kansas Cancer Center (KUCC) is a six-week, cancer-focused, summer research experience for high school students from historically marginalized populations in the Kansas City metropolitan area. Cancer affects all populations and continues to be the second leading cause of death in the United States, and a large number of disparities impact racial and ethnic minorities, including increased cancer incidence and mortality. Critically, strategies to bolster diversity, equity, inclusion, and accessibility are needed to address persistent cancer disparities. The ACE program offers an educational opportunity for a population of students who otherwise would not have easy access onto a medical center campus to make connections with cancer physicians and researchers and provides a vital response to the need for a more diverse and expansive oncology workforce. Students grow their technical, social, and professional skills and develop self-efficacy and long-lasting connections that help them matriculate and persist through post-secondary education. Developed in 2018, the ACE program has trained 37 high school junior and senior students. This article describes the need for and how we successfully developed and implemented the ACE program.

"You're Someone Different Now": An Autoethnography on Identity and Occupational Identity Disruption After Traumatic Brain Injury.

IMPORTANCE: Identity disruption and occupational identity disruption are common after traumatic brain injury (TBI), but the relationship between these two phenomena is underexplored. Occupational therapy practitioners should be knowledgeable about identity challenges after TBI and ways to reconstruct a sense of self. OBJECTIVE: To sensitize readers to the experience of identity disruption and occupational identity disruption and describe how those two experiences are interrelated and transactional in nature. DESIGN: We completed an autoethnography, because this method privileges the insider perspective of participants as members of the research team. We interviewed Andi's family and friends, with textual and nontextual data being reviewed during team meetings that occurred 3 times per month over 3 yr. Data were analyzed by hand-coding transcripts to organize findings until we identified themes and salient text for constructing a narrative.  Setting: Community. PARTICIPANTS: TBI survivor. RESULTS: Identity disruption after TBI occurs because of physiological difficulties, psychological changes, and cognitive deficits. Additionally, survivors face interruptions in occupational participation that affect their identity as doers. Andi experienced identity disruption that was exacerbated by being unable to engage in written expression. When he was able to resume writing and regain his occupational identity, Andi was able to reconstruct his sense of self. CONCLUSIONS AND RELEVANCE: Identity is created by occupational engagement. Occupational therapy practitioners can better serve their clients by exploring identity disruption and occupational identity disruption after TBI. Plain-Language Summary: This article describes the lived experience of identity disruption and occupational identity disruption with an emphasis on the transformative nature of occupation. Occupational therapists should work collaboratively with clients to identify key occupations that support their sense of identity.

SWOG S1820: A pilot randomized trial of the Altering Intake, Managing Bowel Symptoms Intervention in Survivors of Rectal Cancer.

BACKGROUND: Survivors of rectal cancer experience persistent bowel dysfunction after treatments. Dietary interventions may be an effective approach for symptom management and posttreatment diet quality. SWOG S1820 was a pilot randomized trial of the Altering Intake, Managing Symptoms in Rectal Cancer (AIMS-RC) intervention for bowel dysfunction in survivors of rectal cancer. METHODS: Ninety-three posttreatment survivors were randomized to the AIMS-RC group (N = 47) or the Healthy Living Education attention control group (N = 46) after informed consent and completion of a prerandomization run-in. Outcome measures were completed at baseline and at 18 and 26 weeks postrandomization. The primary end point was total bowel function score, and exploratory end points included low anterior resection syndrome (LARS) score, quality of life, dietary quality, motivation, self-efficacy, and positive/negative affect. RESULTS: Most participants were White and college educated, with a mean age of 55.2 years and median time since surgery of 13.1 months. There were no statistically significant differences in total bowel function score by group, with the AIMS-RC group demonstrating statistically significant improvements in the exploratory end points of LARS (p = .01) and the frequency subscale of the bowel function index (p = .03). The AIMS-RC group reported significantly higher acceptability of the study. CONCLUSIONS: SWOG S1820 did not provide evidence of benefit from the AIMS-RC intervention relative to the attention control. Select secondary end points did demonstrate improvements. The study was highly feasible and acceptable for participants in the National Cancer Institute Community Oncology Research Program. Findings provide strong support for further refinement and effectiveness testing of the AIMS-RC intervention.

Latent profiles of regulatory flexibility in alcohol use disorder: Associations with delay discounting and symptoms of depression, anxiety, and stress.

BACKGROUND: Regulatory flexibility (RF) involves three distinct components of self-regulation: context sensitivity, repertoire, and feedback responsiveness. Subgroups based on differences in RF have been identified in a general sample and are differentially associated with symptoms of anxiety and depression. However, potential RF profiles have not been examined in individuals with substance use disorders. This study examined RF subtypes in individuals with alcohol use disorder (AUD) and their associations with psychosocial outcomes (i.e., depression, anxiety, and stress) and delay discounting (a core feature of addiction). METHODS: Individuals (n = 200) with an Alcohol Use Disorders Identification Test score of >16 (mean = 24.12 (±6.92)) were recruited from Amazon Mechanical Turk (mean = 37.26 years old (±11.41); 94 (47%) women). Participants completed the Context Sensitivity Index, the Flexible Regulation of Emotional Expression Scale, and the Coping Flexibility Scale to assess RF. Participants also completed an Adjusting Amount Delay Discounting Task and the Depression, Anxiety, and Stress Scale (DASS-21). Latent profile analyses (LPA) were used to identify patterns in RF deficits. Kruskal-Wallis and Dunn's tests were performed to examine differences in discounting rates and symptoms of depression, anxiety, and stress across RF profiles. RESULTS: The LPA revealed a 2-profile characterization, including (1) context sensitive regulators (CSR; n = 39) and (2) moderate flexibility regulators (MFR; n = 161). CSR demonstrated significantly lower symptoms of depression (p = 0.004), anxiety (p < 0.001), and stress (p < 0.001) than MFR. CSR also displayed significantly lower AUDIT scores (p = 0.031). CONCLUSIONS: Findings illustrate that among individuals with moderate-severe AUD, those high in context sensitivity coupled with moderate abilities in repertoire and feedback responsiveness have fewer symptoms of depression, anxiety, and stress. Together, context sensitivity may be an important and protective component of RF among individuals with AUD.