A randomised controlled trial of Standard Of Care versus RadioAblaTion in Early Stage HepatoCellular Carcinoma (SOCRATES HCC).

BACKGROUND: Therapeutic options for early-stage hepatocellular carcinoma (HCC) in individual patients can be limited by tumor and location, liver dysfunction and comorbidities. Many patients with early-stage HCC do not receive curative-intent therapies. Stereotactic ablative body radiotherapy (SABR) has emerged as an effective, non-invasive HCC treatment option, however, randomized evidence for SABR in the first line setting is lacking. METHODS: Trans-Tasman Radiation Oncology Group (TROG) 21.07 SOCRATES-HCC is a phase II, prospective, randomised trial comparing SABR to other current standard of care therapies for patients with a solitary HCC ≤ 8 cm, ineligible for surgical resection or transplantation. The study is divided into 2 cohorts. Cohort 1 will compromise 118 patients with tumors ≤ 3 cm eligible for thermal ablation randomly assigned (1:1 ratio) to thermal ablation or SABR. Cohort 2 will comprise 100 patients with tumors > 3 cm up to 8 cm in size, or tumors ≤ 3 cm ineligible for thermal ablation, randomly assigned (1:1 ratio) to SABR or best other standard of care therapy including transarterial therapies. The primary objective is to determine whether SABR results in superior freedom from local progression (FFLP) at 2 years compared to thermal ablation in cohort 1 and compared to best standard of care therapy in cohort 2. Secondary endpoints include progression free survival, overall survival, adverse events, patient reported outcomes and health economic analyses. DISCUSSION: The SOCRATES-HCC study will provide the first randomized, multicentre evaluation of the efficacy, safety and cost effectiveness of SABR versus other standard of care therapies in the first line treatment of unresectable, early-stage HCC. It is a broad, multicentre collaboration between hepatology, interventional radiology and radiation oncology groups around Australia, coordinated by TROG Cancer Research. TRIAL REGISTRATION: anzctr.org.au, ACTRN12621001444875, registered 21 October 2021.

Electroanatomical adaptations in the guinea pig heart from neonatal to adulthood.

AIMS: Electroanatomical adaptations during the neonatal to adult phase have not been comprehensively studied in preclinical animal models. To explore the impact of age as a biological variable on cardiac electrophysiology, we employed neonatal and adult guinea pigs, which are a recognized animal model for developmental research. METHODS AND RESULTS: Electrocardiogram recordings were collected in vivo from anaesthetized animals. A Langendorff-perfusion system was employed for the optical assessment of action potentials and calcium transients. Optical data sets were analysed using Kairosight 3.0 software. The allometric relationship between heart weight and body weight diminishes with age, it is strongest at the neonatal stage (R2 = 0.84) and abolished in older adults (R2 = 1E-06). Neonatal hearts exhibit circular activation, while adults show prototypical elliptical shapes. Neonatal conduction velocity (40.6 ± 4.0 cm/s) is slower than adults (younger: 61.6 ± 9.3 cm/s; older: 53.6 ± 9.2 cm/s). Neonatal hearts have a longer action potential duration (APD) and exhibit regional heterogeneity (left apex; APD30: 68.6 ± 5.6 ms, left basal; APD30: 62.8 ± 3.6), which was absent in adults. With dynamic pacing, neonatal hearts exhibit a flatter APD restitution slope (APD70: 0.29 ± 0.04) compared with older adults (0.49 ± 0.04). Similar restitution characteristics are observed with extrasystolic pacing, with a flatter slope in neonates (APD70: 0.54 ± 0.1) compared with adults (younger: 0.85 ± 0.4; older: 0.95 ± 0.7). Neonatal hearts display unidirectional excitation-contraction coupling, while adults exhibit bidirectionality. CONCLUSION: Postnatal development is characterized by transient changes in electroanatomical properties. Age-specific patterns can influence cardiac physiology, pathology, and therapies for cardiovascular diseases. Understanding heart development is crucial to evaluating therapeutic eligibility, safety, and efficacy.

Expanding midwifery care in the United States: Implications for clinical outcomes and cost.

BACKGROUND: This study compared clinical and financial outcomes for low-risk birthing people between those attended by midwives and those attended by obstetricians during hospital births. METHODS: We conducted a retrospective cohort analysis of births from January 1, 2016 to December 31, 2020 at hospitals participating in a perinatal quality improvement collaborative, Obstetrical Care Outcomes Assessment Program (OB COAP), in the Northwest region of the United States and estimated risk ratios using a multivariate regression approach with a modified Poisson binomial for mode of delivery, labor interventions, and newborn outcomes comparing midwife-led to obstetrician-led care. Using publicly available data on average costs of vaginal and cesarean births, we then extrapolated the cost differences in care between midwives and obstetricians. RESULTS: Births in the midwife group were less likely to be associated with induction (17.6% vs. 20.3% RR 0.74; 95% CI 0.70-0.78), epidural use (58.9% vs. 76.3% RR 0.78; 95% CI 0.77-0.80), and episiotomy (2.2% vs. 3.4% RR 0.68; 95% CI 0.58-0.81). Cesarean birth was also lower in the midwifery group (7.8% vs. 12.3% RR 0.68, 95% CI 0.62-0.73), without a corresponding increase in risk in adverse neonatal outcomes. We estimated that expanding midwifery care to 100% of low-risk births across the United States could save as much as $340 million per year. CONCLUSIONS: Midwifery care is associated with a lower risk of cesarean birth and other interventions versus care provided by obstetricians and is therefore likely lower-cost.

"You gotta give them hope": A structural psychobiography of Harvey Milk (1930-1978).

OBJECTIVE: In this psychobiographical study, we examined the life and times of social change agent Harvey Milk, one of the first openly gay public officials in the United States. Milk is remembered as a gay hero who fought for the rights of marginalized people, often by invoking the importance of hope. Milk was assassinated less than 1 year after his election. METHOD: We adopt a structural psychobiographical approach, foregrounding social, cultural, political, and historical forces that intersect with personal factors to explain Milk's ascension to the status of social change agent. RESULTS: This psychobiography tells the story of a man not destined to become a social change agent but who became one anyway because of shifting tides in the political climate of San Francisco in the 1970s, because of a series of catalytic events that started him down this path, because of a history of persecution as a gay Jew, and because of his enduring need for a stage upon which he could express his generative concern. CONCLUSIONS: Our analysis raises questions about the story that "belongs" to the agent of social change, and the story that "belongs" to the rest of us, as we remember him.

Creating something new from past experiences-The meaning of change in repeated narratives.

OBJECTIVE: Narrative identity is an essential level of personality, and to develop, the life narrative should entail both stability and change. In this study, we examine the meaning of change in repeated narratives about occupational experiences. METHOD: Fifty-nine individuals were interviewed at age 25, 29, and 33. In these interviews 544 narratives and 142 sets of repeated narratives were identified, of these 39 sets of repeated narratives had changed between interviews. A thematic narrative analysis was conducted focusing on the meaning of change in repeated narratives. RESULTS: The analysis resulted in five narrative themes: Gaining insights about one's identity, transforming views of past challenges, increasing agency, increasing motivation for occupational commitments, and accentuating competence and importance. In the context of occupational experiences, the results from the narrative themes illuminate how narrators repeatedly engage with the same narrative to elaborate their narrative identity. CONCLUSION: This study presents a novel method for capturing identity development, which show that changes in repeated narratives can entail important information about identity growth as well as the way narrators create new stories of their previous experiences in order to continue to make sense of their lives.

Master narrative methodology: A primer for conducting structural-psychological research.

OBJECTIVE: The emphasis placed on individual-level analysis throughout psychological science in general, and diversity science in particular, has left the role of structural factors undertheorized. Moreover, the field suffers from a lack of research methods that fully investigate structural-individual relations. This article outlines one structural-psychological approach, the master narrative framework, and details various methods for taking social structures into account while still maintaining the focus on the individual. CONCLUSION: These methods, including event narratives, in-depth interviews, life-script analysis, focus groups, experiments, and conversation analysis, allow for an understanding of both the nature and substance of the structures and how individuals interact with them. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Early Impacts of College, Interrupted: Considering First-Year Students' Narratives About COVID and Reports of Adjustment During College Shutdowns.

The COVID-19 pandemic has threatened lives and livelihoods, imperiled families and communities, and disrupted developmental milestones globally. Among the critical developmental disruptions experienced is the transition to college, which is common and foundational for personal and social exploration. During college shutdowns (spring 2020), we recruited 633 first-year U.S. students (mean age = 18.83 years, 71.3% cisgender women) to provide narratives about the impacts of the pandemic. We tested the ways narrative features were associated with concurrent and longitudinal COVID stressors, psychosocial adjustment, and identity development. Narrative growth expressed in spring 2020 was positively associated with psychosocial adjustment and global identity development and was negatively associated with mental health concerns. Associations were supported concurrently and at 1-year follow-up. Growth partly explained associations between COVID stressors and students' adjustment. Our findings reinforce the importance of growth for resilience and underscore the importance of connective reasoning as people navigate a chronic stress.

Stability and change in autobiographical reasoning: A 4-year longitudinal study of narrative identity development.

OBJECTIVE: Research on personality development has traditionally focused on rank-order stability and mean-level change in the context of personality traits. The present study expands this approach to the examination of change and stability at another level of personality-narrative identity-by focusing on autobiographical reasoning. Drawing from theory in personality and developmental science, we examine stability and change in exploratory processing and positive and negative self-event connections. METHOD: We take advantage of a longitudinal study of emerging adult personality and identity development, which includes four waves of data across 4 years, examining reasoning in two domains of identity, academics, and romance (n = 1520 narratives; n = 176-638 participants, depending on the analysis). RESULTS: We found moderate rank-order stability in autobiographical reasoning, but more so for exploratory processing than self-event connections. We found mean-level increases for exploratory processing in the context of romance and stability in the context of academics. For self-event connections, we saw a decrease for positive connections, and for negative connections about romance, with stability for negative connections about academics. CONCLUSIONS: Implications include developmental differences in types of reasoning as well as the sensitivity of narrative identity to revealing the contextual nature of personality development.

Disentangling paradigm and method can help bring qualitative research to post-positivist psychology and address the generalizability crisis.

For decades, psychological research has heavily favored quantitative over qualitative methods. One reason for this imbalance is the perception that quantitative methods follow from a post-positivist paradigm, which guides mainstream psychology, whereas qualitative methods follow from a constructivist paradigm. However, methods and paradigms are independent, and embracing qualitative methods within mainstream psychology is one way of addressing the generalizability crisis.

The inter- and intrarater reliability and feasibility of dietetic assessment of sarcopenia and frailty in potential liver transplant recipients: A mixed-methods study.

Sarcopenia and frailty are associated with poorer outcomes in potential liver transplant (LT) recipients. We examined the reliability and feasibility of dietitians assessing sarcopenia and frailty. Seventy-five adults referred for LT underwent assessments of muscle mass (abdominal CTs), physical function (handgrip strength; HGS, short physical performance battery; SPPB), and frailty (Liver Frailty Index; LFI). Inter- and intrarater reliability and agreement were assessed in subsets of patients using intraclass correlation coefficients (ICCs) and Bland-Altman plots. CTs were analyzed by a dietitian and two independent experts, two dietitians assessed function and frailty. Feasibility assessed system, patient, and profession factors (staff survey). Inter- and intrarater reliability for CT-defined low muscle were excellent (ICCs > 0.97). Reliability between dietitians was excellent for HGS (0.968, 95% CI, 0.928-0.986), SPPB (0.932, 95% CI, 0.798-0.973), and LFI (0.938, 95% CI 0.861-0.973). Bland-Altman analysis indicated excellent agreement for HGS. All transplant clinicians valued sarcopenia and frailty in LT assessments and considered the dietitian appropriate to perform them. Seven saw no barriers to implementation into practice, while five queried test standardization, learning from repeat testing, and resource cost. Dietetic assessments of sarcopenia and frailty are reliable, feasible, and valued measures in the assessment of potential LT recipients.

Post-traumatic growth as positive personality change: Challenges, opportunities, and recommendations.

OBJECTIVE: Post-traumatic growth typically refers to enduring positive psychological change experienced as a result of adversity, trauma, or highly challenging life circumstances. Critics have challenged insights from much of the prior research on this topic, pinpointing its significant methodological limitations. In response to these critiques, we propose that post-traumatic growth can be more accurately captured in terms of personality change-an approach that affords a more rigorous examination of the phenomenon. METHOD: We outline a set of conceptual and methodological questions and considerations for future work on the topic of post-traumatic growth. RESULTS: We provide a series of recommendations for researchers from across the disciplines of clinical/counseling, developmental, health, personality, and social psychology and beyond, who are interested in improving the quality of research examining resilience and growth in the context of adversity. CONCLUSION: We are hopeful that these recommendations will pave the way for a more accurate understanding of the ubiquity, durability, and causal processes underlying post-traumatic growth.

Adolescents' Identity Formation: Linking the Narrative and the Dual-Cycle Approach.

The narrative and dual-cycle approach conceptualize and operationalize adolescents' identity formation in different ways. While the narrative approach focuses on the construction of an autobiographical life story, the dual-cycle approach focuses on the formation of identity commitments. Although these approaches have different emphases, they are conceptually complementary. Yet, their empirical links and distinctions have only scarcely been investigated. Empirical knowledge on these links in adolescence and across time has been especially lacking. In the present research, it was therefore examined whether key characteristics of adolescents' narration (autobiographical reasoning and agency) were concurrently and prospectively related to engagement in the dual-cycle processes of commitment making, identification with commitment, exploration in breadth, exploration in depth, and ruminative exploration. The findings from a cross-sectional sample of 1,580 Dutch adolescents (Mage = 14.7 years, 56% female) demonstrated that autobiographical reasoning was significantly positively associated with the commitment and more adaptive exploration processes (i.e., in breadth and in depth). In addition, agency was significantly positively associated with the commitment processes and exploration in depth. Yet, these associations between the narrative characteristics and dual-cycle processes were only weak. Subsequently, the findings from a two-year longitudinal subsample (n = 242, Mage = 14.7 years, 62% female) indicated that on average commitment strength remained stable but exploration increased across middle adolescence. A stronger increase in identification with commitment and adaptive exploration (i.e., in breadth and in depth) was predicted by a higher degree of agency in adolescents' narratives. Overall, these findings indicate that both approaches to identity formation are associated, but the small size of these associations suggests that they predominantly capture unique aspects of identity formation. Both approaches could thus complement and inform each other.

Giving Voice to Silence: Empowerment and Disempowerment in the Developmental Shift from Trauma 'Victim' to 'Survivor-Advocate'.

In the past several years, a public conversation in the United States about interpersonal violence has flourished, sustained by the work of advocates who are themselves survivors. This surge in public sharing of trauma stories is a rhetorical form of resistance to ideologies in mainstream American culture that impose silence on survivors (e.g., the "just world" belief). However, the developmental progression from trauma 'victim' to empowered public 'survivor/advocate' accommodates to dominant American cultural preferences that stories of adversity have a redemptive story line. In a redemptive story, negative experiences are followed by something positive (e.g., personal growth, lessons learned, strength gained). In this paper, we draw from theory and the sparse relevant literature across multiple disciplines to conceptualize when and for whom the redemptive storying of trauma (or, redemptive master narrative) is available, advantageous, and systemically encouraged. Among the proposed advantages of redemptive storying are its psychological health benefits; potential to empower self and others; promotion of meaning-making, mission, and communal solidarity; and the larger social/political changes that can emerge from giving voice to silenced experiences. Proposed challenges to redemptive storying include layers of societal oppression and marginalization that shape the redemption stories of many survivor-advocates; ongoing connection to or dependence on relationships and communities that enable abuse; and the reality of historical trauma and other forms of intergenerational trauma, which complicate the linear, individualistic story of redemption. With this theory-driven framework, we wish to promote compassion for survivors, along with interdisciplinary, inclusive, and intersectional research in this understudied area.

Identity development in cultural context: The role of deviating from master narratives.

OBJECTIVE: The great majority of research on identity and personality development has focused on individual processes of development, to the relative neglect of the cultural context of development. We employ a recently articulated framework for the examination of identity development in context, centered on the construct of master narratives, or culturally shared stories. METHOD: Across four studies, we asked emerging and midlife adults (N = 512) to narrate personal experiences of deviations from these master narratives. RESULTS: Across three quantitative studies, we show that (a) those who elaborated their deviation experiences were more likely to be in structurally marginalized positions in society (e.g., ethnic or sexual minorities); (b) those who elaborated an empowering alternative to the master narrative were more likely to be engaged in identity processes; and (c) master narratives maintain their rigidity by the frequency of their use. In study 4, using qualitative analyses, we illustrate the rigidity of master narratives, as well as the degree to which they take shape in social and group experiences. CONCLUSIONS: These studies emphasize the importance of cultural context in considering personality and identity development.

Understanding identity integration: Theoretical, methodological, and applied issues.

Identity integration is one of the foundational theoretical concepts in Erikson's (1968) theory of lifespan development. However, the topic is understudied relative to its theoretical and practical importance. The extant research is limited in quantity and scope, and there is considerable heterogeneity in how identity integration is conceptualized and measured. Accordingly, the purpose of this paper is to 1) provide a conceptual discussion of different forms of identity integration 2) highlight the different methodological approaches represented in the literature, and 3) detail the implications of integration for psychological functioning. In particular, we provide a conceptual and methodological discussion of four forms of integration: two that are widely recognized, contextual integration and temporal integration, and two that have received less attention, ego integration and person-society integration. We see this paper as filling a need in the literature for those interested in how complex identity processes are related to psychological functioning.

Shift-and-Persist Strategies: Associations With Socioeconomic Status and the Regulation of Inflammation Among Adolescents and Their Parents.

OBJECTIVE: Shift-and-persist is a resilience construct hypothesized to be beneficial to physical health among individuals with low socioeconomic status (SES). This shift-and-persist construct entails a combination of reframing stressors more positively while also enduring adversity through finding purpose in life. In this study, we investigated how shift-and-persist relates to key inflammatory processes that are implicated in cardiovascular and other diseases. We also obtained validation information on a new shift-and-persist measure. METHOD: A sample of 122 adolescents and 122 parents from a diverse range of SES backgrounds completed our shift-and-persist measure, a battery of other psychosocial questionnaires and interviews, and provided blood samples. Parents also provided SES information. RESULTS: Reliability and validity of the shift-and-persist measure were demonstrated across both adolescents and adults. Shift-and-persist moderated the association between SES and indicators of inflammatory regulation. Specifically, as SES declined, shift-and-persist was associated with greater sensitivity to glucocorticoids' anti-inflammatory properties (interaction in adolescents: [beta] = .21, p = .033; interaction in adults: [beta] = .25, p = .011), and also with less low-grade, chronic inflammation (interaction in adolescents: [beta] = .18, p = .044). Conversely, as SES increased, the opposite pattern was evident. CONCLUSIONS: These findings suggest that adaptive psychosocial characteristics have the potential to regulate inflammatory processes in ways that may mitigate risk for a number of chronic diseases, particularly among disadvantaged groups.

Physiological Reactivity During Parent-Adolescent Discussions: Associations with Scaffolding Behaviors and Relationship Quality.

BACKGROUND: Parents and adolescents commonly discuss stressful experiences. However, little is known about the features of these conversations that may have implications for health. METHODS: One hundred five adolescents and their parents engaged in conversations about two challenging events, with parental contributions to the discussions coded for four scaffolding behaviors (reiterations, negations, move alongs, and new interpretations). Systolic blood pressure, diastolic blood pressure, and heart rate were measured in both participants at baseline and throughout the conversation. Parent-reported relationship quality was also assessed. RESULTS: For both parents and adolescents, negative scaffolding behaviors were associated with increased physiological reactivity, whereas positive scaffolding behaviors were associated with decreased reactivity. Furthermore, children in higher quality parent-child relationships showed greater reactivity to reiterations and lower reactivity to new interpretations, but those in lower quality relationships demonstrated the opposite patterns. CONCLUSIONS: Specific aspects of parent-child interactions appear to contribute to physiological responses to challenging events, which in turn may have implications for health.

Fishing with bed nets on Lake Tanganyika: a randomized survey.

BACKGROUND: Malaria is among the most common causes of death along Lake Tanganyika, a problem which many aid organizations have attempted to combat through the distribution of free mosquito bed nets to high-risk communities. The Lake Tanganyika Floating Health Clinic (LTFHC), a health-based non-governmental organization (NGO), has observed residents of the Lake Tanganyika basin using bed nets to fish small fry near the shoreline, despite a series of laws that prohibit bed net use and other fine-gauge nets for fishing, implemented to protect the near-shore fish ecology. The LTFHC sought to quantify the sources of bed nets and whether they were being used for fishing. METHODS: The LTFHC conducted a survey of seven lakeside villages in Lagosa Ward, Tanzania. The government has divided each village into two to six pre-existing geographic sub-villages depending on population size. Seven households per sub-village were chosen at random for survey administration. The survey consisted of 23 questions regarding mosquito bed net practices, including the use of bed nets for fishing, as well as questions pertaining to any perceived changes to the fish supply. RESULTS: A total of 196 surveys were administered over a four-week period with a 100% response rate. Over 87% of households surveyed have used a mosquito bed net for fishing at some point. The majority of respondents reported receiving their bed net for free (96.4%), observing "many" residents of their village using bed nets for fishing (97.4%), and noticing a subjective decrease in the fish supply over time (64.9%). CONCLUSIONS: The findings of this study raise concerns that the use of free malaria bed nets for fishing is widespread along Lake Tanganyika, and that this dynamic will have an adverse effect on fish ecology. Further studies are indicated to fully define the scope of bed net misuse and the effects of alternative vector control strategies in water-based communities.

Intergenerational Storytelling as a Developmental Resource in LGBTQ+ Communities.

LGBTQ+ people continue to be threatened by systemic censorship and erasure in public spaces and discourses, making community-based resources for positive development crucial. In this study, we examined one such developmental resource-LGBTQ+ intergenerational storytelling about cultural-historical events. LGBTQ+ adults (N = 495) ranging in age from 17 to 80 years (M = 39.22, SD = 19.89) responded to an online survey about LGBTQ+ intergenerational storytelling and relationships. Results showed that although LGBTQ+ intergenerational storytelling was reported to occur infrequently, sharing stories across generations was considered important, and LGBTQ+ people desired even greater intergenerational connection. Intergenerational narratives reported by participants were primarily about cultural-historical events involving adversity and oppression (e.g. AIDS crisis), policy and legislation (e.g. marriage equality), and protest, resistance, and activism (e.g. Stonewall uprising). Stories were mostly told by older friends in private or social settings for the purpose of passing on LGBTQ+ history. Lessons learned through storytelling were diverse but tended to focus on appreciation and affirmation. Valuing intergenerational storytelling was associated with positive psychosocial identity. This study suggests that intergenerational storytelling may be an important developmental resource for LGBTQ+ people and other marginalized communities.

Testing exploratory narrative processing as a mechanism of change in identity status processes over 4 years in college-going emerging adults.

We examined the critical task of emerging adulthood-identity development-via analyses of trajectories of identity exploration and commitment over the college years, as well as whether narrative processing of important events during this period served as a mechanism of identity exploration and commitment. We took advantage of a unique and comprehensive longitudinal design, which included 12 waves of data, both quantitative and qualitative assessments, collected over 4 years, on two distinct college campuses in the Northwestern and Northeastern regions of the United States (Wave 1, n = 639; growth models using all waves, n = 251). Analyses for this study were preregistered after data collection was complete. We first examined trajectories of exploration and commitment via the dual-cycle identity model. Second, we examined whether exploratory processing in the narration of future self-defining memories at specific waves predicted changes in exploration and commitment in subsequent waves. Findings indicated that exploration and commitment showed trajectories typically viewed as normative (e.g., increasing adaptive forms of exploration and commitment), although trajectories for those at higher socioeconomic statuses differed by showing more exploration and less commitment. We failed to find evidence that exploratory processing predicted changes in exploration and commitment. Implications include distinctions in measurement and theoretical approaches to the study of identity development, the need for greater understanding of what is developing before theorizing how it develops, and the limitations of what is considered normative without attention to structural constraints, such as social class. (PsycInfo Database Record (c) 2024 APA, all rights reserved).