Control Beliefs after a Diagnosis of Alzheimer's Disease and Related Dementias: The Need to Foster Resilience.

Objectives: Positive adaptation, like higher control beliefs, following a disability diagnosis is important to buffer against excess disability; however, no study has examined how the recent diagnosis of Alzheimer's disease and related dementias (ADRD) impacts control beliefs. The current study addresses this gap in the literature. Method: We use data from the 2012-2016 waves of the Health and Retirement Study. Propensity score weighting was used to address the systematic selection of an ADRD diagnosis to understand how control beliefs (perceived constraints and mastery) are impacted two years following a diagnosis. Results: A new diagnosis of ADRD was associated with a lower mastery score two years later, regardless of baseline functional ability (b = -0.652, p < .001). No associations were noted between a new ADRD diagnosis and perceived constraints. Conclusions: Our results suggest that a recent diagnosis of ADRD has negative implications for mastery, which may facilitate excess disability.

Investigating first instinct fallacy in cytology education and cytomorphology examination.

INTRODUCTION: The specific aims of the study are to assess whether answer changing on a high-stakes cytomorphology examination will lower the cytology examinees' scores and to examine whether there is a difference in the frequency of responses changed between high-, average-, and low-performing cytology learners. The paper also seeks to explore if there is a correlation between outcomes of answer changes (success rates) and cytology learner's levels of performance. MATERIALS AND METHODS: The eraser marks and pen cross-outs on the cytology final image examinations from 2019-2023 were reviewed and the number of changes made by the examinees and the frequency to which scores were raised or lowered as a result was recorded. Moreover, the response change patterns and outcomes across low-, medium-, and high-performing cytology learners were further analyzed for possible relationships. RESULTS: Among the total number of questions where answer(s) were changed (n = 98), close to half (n = 47, 48.0%) of the changes resulted in raising the score, compared with about one-third (n = 34, 34.7%) that lowered it. When the students were classified into academic abilities, there was a significant correlation between the success rates of answers changed across low-, medium-, and higher-performing learners χ2 (df = 24, n = 24) = 10.24, P < 0.05. Our data also showed the average student group to have the highest "scores raised" to "scores lowered" ratio. CONCLUSIONS: Based on these findings, those cytology examinees who are overly cautious about changing initial responses during a high-stake multiple-choice question BOC test may put themselves at a disadvantage.

An evaluation of pathology laboratory workforce performance during mergers and acquisitions.

The effects of laboratory mergers and acquisitions on the clinical performance of its workforce remain largely unknown. This study examined laboratory professionals' work engagement and productivity, and investigated the role of social support as a moderator during mergers and acquisitions. A 51 question on-line survey was designed to cover demographics, work engagement, productivity, and levels of social support. A sample t test was used to measure work engagement levels between laboratory professionals with higher social support to others with lower support. The finding that laboratory professionals with higher levels of social support are more engaged and productive at the workplace has important policy implications for leaders managing laboratories in times of mergers and acquisitions.

Neuropsychological Profiles of Deployment-Related Mild Traumatic Brain Injury: A LIMBIC-CENC Study.

BACKGROUND AND OBJECTIVES: Traumatic brain injury (TBI) is a concern for US service members and veterans (SMV), leading to heterogeneous psychological and cognitive outcomes. We sought to identify neuropsychological profiles of mild TBI (mTBI) and posttraumatic stress disorder (PTSD) among the largest SMV sample to date. METHODS: We analyzed cross-sectional baseline data from SMV with prior combat deployments enrolled in the ongoing Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study. Latent profile analysis identified symptom profiles using 35 indicators, including physical symptoms, depression, quality of life, sleep quality, postconcussive symptoms, and cognitive performance. It is important to note that the profiles were determined independently of mTBI and probable PTSD status. After profile identification, we examined associations between demographic variables, mTBI characteristics, and PTSD symptoms with symptom profile membership. RESULTS: The analytic sample included 1,659 SMV (mean age 41.1 ± 10.0 years; 87% male); among them 29% (n = 480) had a history of non-deployment-related mTBI only, 14% (n = 239) had deployment-related mTBI only, 36% (n = 602) had both non-deployment and deployment-related mTBI, and 30% (n = 497) met criteria for probable PTSD. A 6-profile model had the best fit, with separation on all indicators (p < 0.001). The model revealed distinct neuropsychological profiles, representing a combination of 3 self-reported functioning patterns: high (HS), moderate (MS), and low (LS), and 2 cognitive performance patterns: high (HC) and low (LC). The profiles were (1) HS/HC: n=301, 18.1%; (2) HS/LC: n=294, 17.7%; (3) MS/HC: n=359, 21.6%; (4) MS/LC: n=316, 19.0%; (5) LS/HC: n=228, 13.7%; and (6) LS/LC: n=161, 9.7%. SMV with deployment-related mTBI tended to be grouped into lower functioning profiles and were more likely to meet criteria for probable PTSD. Conversely, SMV with no mTBI exposure or non-deployment-related mTBI were clustered in higher functioning profiles and had a lower likelihood of meeting criteria for probable PTSD. DISCUSSION: Findings suggest varied symptom and functional profiles in SMV, influenced by injury context and probable PTSD comorbidity. Despite diagnostic challenges, comprehensive assessment of functioning and cognition can detect subtle differences related to mTBI and PTSD, revealing distinct neuropsychological profiles. Prioritizing early treatment based on these profiles may improve prognostication and support efficient recovery.

Factor structure of posttraumatic stress disorder (PTSD) in persons with serious mental illness.

BACKGROUND: Trauma and posttraumatic stress disorder (PTSD) are common among individuals with serious mental illness (SMI; e.g., schizophrenia, schizoaffective disorder, bipolar disorder, treatment refractory major depressive disorder), with resultant functional impairment. Previous studies have not evaluated the factor structure of the PTSD Checklist (PCL) among persons with SMI. AIMS: This study evaluated the factor structure of the PCL in two large SMI samples from public mental health treatment sectors screened for PTSD using the PCL. METHODS: Four different models of PTSD were tested using confirmatory factor analyses. RESULTS: Results indicated that the DSM-5 4-factor model (intrusion, avoidance, numbing, and hyperarousal) had the best fit. Further, the DSM-5 4-factor model demonstrated measurement invariance. CONCLUSIONS: Results supported the suitability of the DSM-5 4-factor model of PTSD among people with SMI.

The dynamic and reciprocal relationship between perceived everyday discrimination and cognitive function in later life.

OBJECTIVES: This study, based on socioemotional selectivity theory and cognitive theory, investigates the dynamic and reciprocal relationship between perceived discrimination and cognitive function in later life. METHODS: Data were drawn from four waves of the Health and Retirement Study (HRS 2006, 2010, 2014, and 2018). A total of 4,125 people who were 51 and older were included. Cognitive function was measured by the telephone interview for cognitive status (TICS-27). Perceived discrimination was measured using scores of the perceived everyday discrimination scale. Random intercept cross-lagged panel model (RI-CLPM) was utilized. The model was adjusted for a range of covariates. Subgroup analysis by ethnoracial groups was conducted. RESULTS: Cross-sectionally, while lower cognitive function was associated with higher perceived discrimination, this relationship was unidirectional. Longitudinally, higher perceived discrimination predicted lower cognitive function in later waves only among non-Hispanic White individuals. CONCLUSION: Results suggested that a decline in cognitive function may precede and contribute to the worsening of perceived discrimination, which may result in further decline in cognitive function. Lifetime experience of discrimination was discussed as a possible source of the racial/ethnic variations in the relationship. Further study is needed to examine whether this relationship holds among people with cognitive impairment and dementia.

Validation of the Awareness Atlas-a new measure of the manifestation of consciousness.

Consciousness has intrigued philosophers and scholars for millennia and has been the topic of considerable scientific investigation in recent decades. Despite its importance, there is no unifying definition of the term, nor are there widely accepted measures of consciousness. Indeed, it is likely that consciousness-by its very nature-eludes measurement. It is, however, possible to measure how consciousness manifests as a lived experience. Yet here, too, holistic measures are lacking. This investigation describes the development and validation of the Awareness Atlas, a measure of the manifestation of consciousness. The scale was informed by heart-based contemplative practices and the resulting lived experience with a focus on the impacts of manifestation of consciousness on daily life. Four hundred forty-nine individuals from the USA, Canada, India, and Europe participated in psychometric testing of the scale. Exploratory and confirmatory factor analyses were used for validation, demonstrating excellent validity in measuring manifestation of consciousness. The final model fit exceeded all required thresholds, indicating an excellent fitted model with a single dimensionality to measure the manifestation of consciousness comprised of four subscales: Relationship to Others; Listening to the Heart; Connection with Higher Self; and Acceptance and Letting Go. Number of years meditating and practicing Heartfulness meditation were positively related to the total and subscale scores. Test-retest reliability was excellent for the total scale, and good to excellent for the four subscales. Findings demonstrate that the Awareness Atlas is a well-constructed tool that will be useful in examining changes in manifestation of consciousness with various experiences (e.g., meditation, life-altering conditions).

A mixed-methods study on the use of a nongynecological virtual microscopy platform in cytology education.

OBJECTIVES: Expanding the virtual microscopy (VM) slide collection for nongynecological cytology is important to teaching. In a mixed-methods approach, this study evaluated VM's performance and user experience to determine its feasibility and usage in an educational setting. METHODS: From September through October 2022, the students reviewed 44 whole-slide imaged nongynecological slides. The concordance rate with reference diagnosis was compared with that from light microscopy (LM) from 4 months earlier. In addition to assessing the overall performance from VM, imaged urinary cytology's accuracy was reviewed for both urinary and nonurinary cytology. Finally, the students' weekly feedback logs were analyzed to gain insights for improving the digital screening experience. RESULTS: The overall nongynecological diagnostic accuracy was significant between the 2 screening platforms (P < .001), favoring LM over the VM platform. Light microscopy also performed better than VM in urine cytology cases, with 84.2% concordance against reference diagnosis, compared with 61.1% for the VM platform (P = .03). As for the accuracy of nonurinary cases, its glass slide (LM) agreement with the reference diagnosis was also superior at 84.8%, compared with 58.8% for VM (P = .03). Finally, the overarching theme discerned from reviewing the user logs was concern over image quality, which was mentioned 76 times. CONCLUSIONS: The VM results were poorer compared with LM in our validation. Its use seems promising, but more focus is needed to improve the VM screening platform.

An outcome-wide analysis of the effects of diagnostic labeling of Alzheimer's disease and related dementias on social relationships.

INTRODUCTION: This study examines how receiving a dementia diagnosis influences social relationships by race and ethnicity. METHODS: Using data from the Health and Retirement Study (10 waves; 7,159 observations) of adults 70 years and older predicted to have dementia using Gianattasio-Power scores (91% accuracy), this study assessed changes in social support, engagement, and networks after a dementia diagnosis. We utilized quasi-experimental methods to estimate treatment effects and subgroup analyses by race/ethnicity. RESULTS: A diagnostic label significantly increased the likelihood of gaining social support but reduced social engagement and one measure of social networks. With some exceptions, the results were similar by race and ethnicity. DISCUSSION: Results suggest that among older adults with assumed dementia, being diagnosed by a doctor may influence social relationships in both support-seeking and socially withdrawn ways. This suggests that discussing services and supports at the time of diagnosis is important for healthcare professionals.

Using latent class growth analysis to detect group developmental trajectories in preclinical medical education.

Medical educators and programs are deeply interested in understanding and projecting the longitudinal developmental trajectories of medical students after these students are matriculated into medical schools so appropriate resources and interventions can be provided to support students' learning and progression during the process. As students have different characteristics and they do not learn and progress at the same pace, it is important to identify student subgroups and address their academic needs to create more equitable learning opportunities. Using latent class growth analysis, this study explored students' developmental trajectories and detected group differences based on their coursework performance in Anatomy within the two years of preclinical education in one medical school. Four subgroups were identified with various intercepts and slopes. There were significant group differences between these subgroups and their standardized scores in MCAT and UCMLE Step 1. The study provides evidence about the heterogeneity of the student population and points out future research directions.

The impact of community of inquiry and self-efficacy on student attitudes in sustained remote health professions learning environments.

BACKGROUND: Sustained remote learning environments, like those experienced in late 2020 due to the COVID-19 pandemic, share characteristics with online courses but were not intentionally designed to delivered virtually. The purpose of this study was to investigate the impact of Community of Inquiry, a widely used online learning environment framework, and self-efficacy on perceived student attitudes within sustained remote learning environments. METHODS: An interinstitutional team of health professions education researchers collected survey data from 205 students representing a wide range of health professions in five U.S. institutions. Latent mediation models under structural equation modeling framework were used to examine whether student self-efficacy mediates the relationship between Community of Inquiry presence and student's favorability of sustained remote learning delivered in the prolonged stages of the COVID-19 pandemic. RESULTS: Higher levels of teaching presence and social presence in the remote learning environment were associated with higher levels of remote learning self-efficacy which, in turn, predicts variance in positive attitudes toward remote learning. When mediated by self-efficacy, significant variance in student's favorability of sustained remote learning was explained by teaching presence (61%), social presence (64%), and cognitive presence (88%) and self-efficacy. Significant direct and indirect effects for teaching and social presence, and only direct effects for cognitive presence were observed. CONCLUSIONS: This study establishes the Community of Inquiry and its three presence types as a relevant and stable framework for investigating sustained remote health professions teaching and learning environments, not only carefully designed online learning environments. Faculty may focus course design strategies which enhance presence and increase student self-efficacy for the sustained remote learning environment.

Post-Traumatic Cognitions Inventory (PTCI): psychometric properties in clients with serious mental illness and co-occurring PTSD.

BACKGROUND: People with post-traumatic stress disorder (PTSD) exhibit negative cognitions, predictive of PTSD severity. The Post-Traumatic Cognitions Inventory (PTCI) is a widely used instrument measuring trauma-related cognitions and beliefs with three subscales: negative thoughts of self (SELF), negative cognitions about the world (WORLD), and self-blame (BLAME). AIMS: The current study attempted to validate the use of the PTCI in people with serious mental illness (SMI), who have greater exposure to trauma and elevated rates of PTSD, using confirmatory factor analysis (CFA) and examining convergent and divergent correlations with relevant constructs. METHOD: Participants were 432 individuals with SMI and co-occurring PTSD diagnosis based on the Clinician Administered PTSD Scale, who completed PTCI and other clinical ratings. RESULTS: CFAs provided adequate support for Foa's three-factor model (SELF, WORLD, BLAME), and adequate support for Sexton's four-factor model that also included a COPE subscale. Both models achieved measurement invariance at configural, metric and scalar levels for three diagnostic groups: schizophrenia, bipolar and major depression, as well as for ethnicity (White vs Black), and gender (male vs female). Validity of both models was supported by significant correlations between PTCI subscales, and self-reported and clinician assessed PTSD symptoms and associated symptoms. CONCLUSIONS: Findings provide support for the psychometric properties of the PTCI and the conceptualization of Sexton's four-factor and Foa's three-factor models of PTCI among individuals diagnosed with SMI (Foa et al., ).

Evaluating the use of virtual microscopy in cytology education.

INTRODUCTION: Whole slide imaging is a promising tool for cytology. In the present study, we assessed the performance of and user experience with virtual microscopy (VM) to determine its feasibility and usage in an educational setting. MATERIALS AND METHODS: From January 1 through August 31, 2022, 46 Papanicolaou slides, of which 22 (48%) were abnormal, 23 (50%) were negative, and 1 (2%) was unsatisfactory, were reviewed by the students using both VM and light microscopy (LM) platforms. In addition to assessing VM's overall performance, the SurePath imaged slides' accuracy was reviewed as a potential alternative to ThinPrep because of its cloud storage advantage. Finally, the students' weekly feedback logs were analyzed to gain insights for improving the digital screening experience. RESULTS: The overall diagnostic concordance difference was significant between the 2 screening platforms (Z = 5.38; P < 0.001), favoring LM (86% correct diagnosis) over VM (70% correct diagnosis). The overall sensitivity of VM and LM was 54.0% and 89.6%, respectively. VM also had an overall higher specificity (91.8%) compared with LM (81.3%). LM performed better than whole slide imaging for the correct identification of an organism when one was present, with 77.6% sensitivity compared with 58.9% for the digital platform. The rate of agreement for the SurePath imaged slides with the reference diagnosis was 74.3% compared with 65.7% for the ThinPrep slides. Finally, 4 themes were discerned from reviewing the user logs, with issues about image quality and the lack of fine focus functionality most frequently mentioned, followed by themes associated with a higher learning curve and novelty associated with the digital screening. CONCLUSIONS: Although the VM results were poorer than the LM results in our validation, its use in an educational setting is promising considering the continued technological improvements and the renewed focus on improving the digital user experience.

Workplace Bullying in Pathology and Laboratory Medicine.

OBJECTIVES: The specific aims of the study are to explore the prevalence of workplace bullying and to understand the impact of bullying on individual wellness in order to facilitate the development of future organizational solutions to mitigate workplace incivility. METHODS: Cross-sectional data were collected via a web-based survey to gather exploratory demographic information and to assess the relationships between intensity of the exposure to the negative acts with laboratory productivity. Associations between laboratories offering resources to employees and their impacts on productivity and professional job fulfillment were also explored. RESULTS: Results of the survey showed that over two-thirds of laboratorians (68.56%) were classified as victims of workplace bullying, and the perpetrator is most likely a peer of the victim (55.3%). The study revealed the intensity of workplace incivility was positively correlated with the number of sick days taken by the laboratory practitioner (F(2, 217) = 24.245, P < .001). Facilities with a supportive work environment were also associated with a reduction in the number of sick mental days taken (P < .001), a proxy for improved work and health outcomes. CONCLUSIONS: The results of this study shed light on the prevalence of incivility at the workplace and offer evidence on the importance of providing a supportive work environment toward reducing workplace bullying.

Financial and Other Life Stressors, Psychological Distress, and Food and Beverage Consumption among Students Attending a Large California State University during the COVID-19 Pandemic.

The novel coronavirus disease 2019 (COVID-19) pandemic abruptly disrupted the daily lives and health of college students across the United States. This study investigated several stressors (e.g., financial strain/uncertainty), psychological distress, and dietary behaviors among college students attending a large state university during the pandemic. A cross-sectional online survey was administered to students from the California State University, Los Angeles between April and May 2021 (final analytic sample n = 736). Differences in gender and race/ethnicity were examined using chi-square, t-test, and one-way ANOVA tests. Paired t-tests were performed to compare variables before and during the pandemic. Negative binomial regression models examined the associations between various stressors, psychological distress, and three key dietary outcomes. Descriptive results showed that the consumption of fruits and vegetables, fast food, and sugary beverages, along with psychological distress, all increased during the pandemic. Significant differences in fruit and vegetable and fast food consumption by gender and race/ethnicity were also observed. In the regression models, several stressors, including financial strain and psychological distress, were associated with unfavorable food and beverage consumption, thereby suggesting that college students may need more support in mitigating these stressors so they do not manifest as poor dietary behaviors. Poor diet quality is associated with poor physical health outcomes such as premature development of type 2 diabetes or hypertension.

Discriminating Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Using Latent Neuroimaging and Neuropsychological Profiles in Active-Duty Military Service Members.

OBJECTIVE: Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) commonly occur among military Service Members and Veterans and have heterogenous, but also overlapping symptom presentations, which often complicate the diagnoses of underlying impairments and development of effective treatment plans. Thus, we sought to examine whether the combination of whole brain gray matter (GM) and white matter (WM) structural measures with neuropsychological performance can aid in the classification of military personnel with mTBI and PTSD. METHODS: Active-Duty US Service Members ( n = 156; 87.8% male) with a history of mTBI, PTSD, combined mTBI+PTSD, or orthopedic injury completed a neuropsychological battery and T1- and diffusion-weighted structural neuroimaging. Cortical, subcortical, ventricular, and WM volumes and whole brain fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were calculated. Latent profile analyses were performed to determine how the GM and WM indicators, together with neuropsychological indicators, classified individuals. RESULTS: For both GM and WM, respectively, a 4-profile model was the best fit. The GM model identified greater ventricular volumes in Service Members with cognitive symptoms, including those with a diagnosis of mTBI, either alone or with PTSD. The WM model identified reduced FA and elevated RD in those with psychological symptoms, including those with PTSD or mTBI and comorbid PTSD. However, contrary to expectation, a global neural signature unique to those with comorbid mTBI and PTSD was not identified. CONCLUSIONS: The findings demonstrate that neuropsychological performance alone is more robust in differentiating Active-Duty Service Members with mTBI and PTSD, whereas global neuroimaging measures do not reliably differentiate between these groups.

Exploring the impacts of learning modality changes: Validation of the learning modality change community of inquiry and self-efficacy scales.

The rapid learning environment transition initiated by the COVID-19 pandemic impacted students' perception of, comfort with, and self-efficacy in the online learning environment. Garrison's Community of Inquiry framework provides a lens for examining students' online learning experiences through three interdependent elements: social presence, cognitive presence, and teaching presence. Researchers in this study developed and validated the Learning Modality Change Community of Inquiry and Self-Efficacy scales to measure health professions students' self-efficacy with online learning, while exploring how cognitive, social, and teaching presence is experienced by students who transition from one learning environment to another. The two scales demonstrate strong validity and reliability evidence and can be used by educators to explore the impacts of learning modality changes on student learning experiences. As learning environments continue to evolve, understanding the impact of these transitions can inform how educators consider curriculum design and learning environment changes.

On building cytomorphology skills: Influence of slide reviewing habits on diagnostic competency in cytology.

OBJECTIVES: The specific aims of the study are to assess whether the amount of time a cytology learner spends reviewing slides correlates with increased diagnostic competency and to determine whether time spent reviewing slides immediately after the multi-head sessions correlates with a higher level of proficiency. The paper also seeks to explore the impacts of the time of day at which slides were reviewed on diagnostic learning outcome. METHODS: Data obtained through the cytology laboratory screening logs were reviewed, and the number of hours per day and the times of the day at which the students were present at the glass slide library were tabulated and compared against each of the seven-unit slide exam scores in the semester to explore possible relationships. RESULTS: There was a positive linear relationship (r = 0.29) between the number of hours students spent in the laboratory reviewing cases and competency. When the students' unit diagnostic test scores were classified into low and high categories for each test, there was a significant correlation (P = 0.008) between a lack of time spent screening slides in the lab and the number of times a student was ranked at the bottom of the class. Our data do not support a recency effect nor a difference in test scores between those who reviewed cases in the morning vs in the afternoon. CONCLUSIONS: While educating and training a strong cytology workforce may be challenging, our study provides new insights and sheds light on the importance of spending time reviewing slides, and provides guidance for struggling students on how best to improve. Inside this month's Cytopathology: The aims of this study are to assess whether the amount of time a cytology learner spent reviewing slides correlates with increased diagnostic competency, and to determine whether time spent reviewing slides immediately after the multi-head sessions correlates with a higher level of proficiency. The paper also seeks to explore the impacts of the time of day at which slides were reviewed on diagnostic learning outcome.

Latent Neuropsychological Profiles to Discriminate Mild Traumatic Brain Injury and Posttraumatic Stress Disorder in Active-Duty Service Members.

OBJECTIVE: To determine whether cognitive and psychological symptom profiles differentiate clinical diagnostic classifications (eg, history of mild traumatic brain injury [mTBI] and posttraumatic stress disorder [PTSD]) in military personnel. METHODS: US Active-Duty Service Members ( N = 209, 89% male) with a history of mTBI ( n = 56), current PTSD ( n = 23), combined mTBI + PTSD ( n = 70), or orthopedic injury controls ( n = 60) completed a neuropsychological battery assessing cognitive and psychological functioning. Latent profile analysis was performed to determine how neuropsychological outcomes of individuals clustered together. Diagnostic classifications (ie, mTBI, PTSD, mTBI + PTSD, and orthopedic injury controls) within each symptom profile were examined. RESULTS: A 5-profile model had the best fit. The profiles differentiated subgroups with high (34.0%) or normal (21.5%) cognitive and psychological functioning, cognitive symptoms (19.1%), psychological symptoms (15.3%), and combined cognitive and psychological symptoms (10.0%). The symptom profiles differentiated participants as would generally be expected. Participants with PTSD were mainly represented in the psychological symptom subgroup, while orthopedic injury controls were mainly represented in the high-functioning subgroup. Further, approximately 79% of participants with comorbid mTBI and PTSD were represented in a symptomatic group (∼24% = cognitive symptoms, ∼29% = psychological symptoms, and 26% = combined cognitive/psychological symptoms). Our results also showed that approximately 70% of military personnel with a history of mTBI were represented in the high- and normal-functioning groups. CONCLUSIONS: These results demonstrate both overlapping and heterogeneous symptom and performance profiles in military personnel with a history of mTBI, PTSD, and/or mTBI + PTSD. The overlapping profiles may underscore why these diagnoses are often difficult to diagnose and treat, but suggest that advanced statistical models may aid in identifying profiles representing symptom and cognitive performance impairments within patient groups and enable identification of more effective treatment targets.

Family Systems Cultural and Resilience Dimensions to Consider in Nutrition Interventions: Exploring Preschoolers' Eating and Physical Activity Routines During COVID-19.

OBJECTIVE: To describe the weight-related family functioning of racial minority families with low income using family systems theory as an interpretive framework. DESIGN: Primarily a qualitative study with interviews plus; descriptive demographics, anthropometrics, a family functioning measure, and food insecurity screening. SETTING: Telephone interviews with families of preschool-aged children in an urban setting. PARTICIPANTS: Primary caregivers of preschool-aged children. PHENOMENON OF INTEREST: Cultural impacts on family systems. ANALYSIS: Interviews were audio-recorded, transcribed verbatim, and loaded into NVivo 12 for thematic analysis. Descriptive statistics. RESULTS: The 23 participants were mothers and 2 maternal grandmothers. Seventy-four percent were African American, most children were normal weight (n = 15, 65%), mean family function scores were high, and more than half the families were at risk for food insecurity (n = 13, 56%). Acculturation and intergenerational eating-related cultural dimensions were discerned as the overarching themes influencing family cohesion. Family cohesion appeared to have helped the families adapt to the impact of coronavirus disease 2019. CONCLUSIONS AND IMPLICATIONS: Cultural dimensions such as acculturation and intergenerational influences appeared to be associated with social cohesion and family functioning around weight-related behaviors for these families. These findings add cultural and family resilience dimensions to family systems theory in nutrition interventions.