Childhood adversity and co-occurring post-traumatic stress and externalizing symptoms among a predominantly low-income, African American sample of early adolescents.

Although there is strong evidence supporting the association between childhood adversity and symptomatology during adolescence, the extent to which adolescents present with distinct patterns of co-occurring post-traumatic stress (PTS) and externalizing symptoms remains unclear. Additionally, prior research suggests that experiencing nonviolent, negative life events may be more salient risk factors for developing some forms of psychopathology than exposure to violence. The current study used latent profile analysis to identify subgroups of early adolescents with distinct patterns of PTS, physical aggression, delinquency, and substance use, and examined subgroup differences in exposure to three forms of violent and nonviolent childhood adversity. Participants were a predominantly low-income, African American sample of 2,722 urban middle school students (M age = 12.9, 51% female). We identified four symptom profiles: low symptoms (83%), some externalizing (8%), high PTS (6%), and co-occurring PTS and externalizing symptoms (3%). A higher frequency of witnessing violence was associated with increased odds of membership in subgroups with externalizing symptoms, whereas a higher frequency of nonviolent, negative life events was associated with increased odds of membership in subgroups with PTS symptoms. Interventions aimed to address childhood adversity may be most effective when modules addressing both PTS and externalizing symptoms are incorporated.

Ecological promotive and protective factors deterring gun carriage for young adults living in communities with high rates of community violence.

This study identified promotive and protective factors that lessened the likelihood of handgun carriage in a sample of 141 predominantly Black (97%) young adults (ages 18-22) living in high burden communities experiencing elevated rates of violence. Participants completed surveys assessing overall risk and protective factors for violence across ecological contexts (e.g., individual/peer, family, school, and community). A series of regression and moderation analyses were conducted to ascertain direct (promotive) and indirect (protective) relations between factors across the ecological model and likelihood of gun carriage. Results indicated that (1) consistent with previous studies, both witnessing violence and violence victimization were significant risk factors for handgun carriage, (2) ethnic identity was a significant promotive factor related to a lower likelihood of handgun carriage, and (3) lack of family conflict, student status, and community assets were significant protective factors where higher levels of these factors attenuated the relation between exposure to community violence and likelihood of gun carriage. This is one of the first strengths-based studies examining factors that may mitigate the likelihood of gun carriage for young adults in high risk contexts. Our findings suggest that gun violence prevention efforts for high burden communities should support young adults by strengthening factors across the ecological model (e.g., individual, family, school, and community).

Wound Healing Profile After 1064- and 532-nm Picosecond Lasers With Microlens Array of In Vivo Human Skin.

BACKGROUND AND OBJECTIVES: The aim of this study is to histologically characterize the wound healing process of in vivo human skin treated with 1064- and 532-nm microlens array (MLA)-type picosecond lasers. STUDY DESIGN/MATERIALS AND METHODS: Three patients (Fitzpatrick skin types II-IV), who were undergoing future cosmetic abdominoplasties, were treated with 1064- and 532-nm MLA-type lasers under different fluence settings. Treatments were performed 2 weeks, 1 week, and immediately prior to surgery. Skin samples were harvested from the resected tissue with 8 mm punch biopsies immediately after the abdominoplasties were performed. RESULTS: The study demonstrates that intraepidermal vacuoles, created from tissue damage induced by the laser, are histologically resolved within 1 week without persistent damage to the dermoepidermal junction or vasculature. After 2 weeks, all foci of microscopic epidermal necrotic debris had either resolved or migrated to more superficial levels in the stratum corneum. There was no evidence of persistent vascular damage, increased melanophages, or accumulation of melanin in the dermis at 2 weeks. Furthermore, the 1064-nm picosecond laser with the high fluence setting demonstrated the capacity to fractionally ablate the epidermis and induce multifocal fibrosis in the papillary dermis in lighter skin types. CONCLUSION: This is the first study to demonstrate the wound healing profile of in vivo human skin after treatment with the picosecond 1064- and 532-nm MLA-type lasers. It shows that laser-induced tissue damage is histologically resolved within 2 weeks, clinically reflecting a favorable safety profile and short downtime. The study also shows that the picosecond laser can be used to induce either fractional ablative or non-ablative effects, depending on the fluence settings used. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.

"Hurt people hurt people": Relations between adverse experiences and patterns of cyber and in-person aggression and victimization among urban adolescents.

This study identified subgroups of adolescents with distinct patterns of involvement with overt and relational in-person and cyber aggression and victimization. We also assessed subgroup similarities and differences in exposure to adverse childhood experiences (ACEs), exposure to community violence, and trauma symptoms. Using latent class analysis, we identified three subgroups among 265 adolescents (Mage = 14.3 years; 57% female; 96% African American) residing in three urban high-burden communities that included youth who reported: (a) combined (cyber and in-person) aggression and victimization (17%), (b) in-person aggression and victimization (51%), and (c) adolescents with limited involvement (32%). Youth in the combined aggressive-victims subgroup had the highest probability of endorsing exposure to community violence, trauma symptoms, and a higher number of ACEs overall as well as higher rates of both verbal and physical abuse compared to the other subgroups. Our results indicated that the adolescents who reported the highest frequencies of aggressive behavior were also the most victimized and traumatized. These findings provide context to aggressive behavior among adolescents living in high-burden, urban communities and underscore the need for trauma-informed prevention interventions.

A community-specific framework of risk factors for youth violence: A qualitative comparison of community stakeholder perspectives in a low-income, urban community.

This study offers a qualitative comparison of risk factors for youth violence from the perspectives of community stakeholders in a low-income, urban community experiencing elevated rates of violence. One-on-one interviews were conducted with 36 community stakeholders across three key categories: 10 community residents who cared for youth living in the community, 15 program or service providers, and 11 leaders in community agencies and organizations. A grounded theory approach was used for data collection and analysis to extract themes that emerged from the question, "What are the things in the community that lead to youth violence?" While there was significant overlap in stakeholders' beliefs about precursors to youth violence, important differences also emerged. In order for youth violence prevention strategies to be successful, they must consider and address risk factors identified by community stakeholders involved in the implementation and sustainability.

Patterns of Parental Messages Supporting Fighting and Nonviolence Among Urban Middle School Students.

The purpose of this study was to identify subgroups of adolescents with distinct perceptions of parental messages supporting fighting and nonviolence. Latent class analysis identified four subgroups among 2,619 urban middle school students (90% African American; 52% female): messages supporting fighting (32%), messages supporting nonviolence (29%), mixed messages (23%), and no messages (16%). We found significant differences across subgroups in their frequency of physical aggression and peer victimization and beliefs about the use of aggressive and nonviolent responses to peer provocation. Beliefs significantly mediated the relation between parental messages subgroups and both aggression and victimization. Findings illustrate the heterogeneity in the messages urban adolescents perceive from their parents, as well as relations with adolescents' beliefs and behavior.

Social and Emotional Adjustment Across Aggressor/Victim Subgroups: Are Aggressive-Victims Distinct?

Despite prior studies supporting the existence of "aggressive-victims", it remains unclear if they possess unique risk factors from adolescents who are mostly aggressive or victimized. The present study sought to determine whether aggressive-victims differ from adolescents with distinct patterns of involvement in aggression and victimization in their social and emotional adjustment. Secondary analyses were conducted on baseline data from 984 seventh grade students (54% female) from three schools. Most participants identified their race as White (49%) or African American (19%), with 24% identifying as Latino/a. Latent class analysis identified four subgroups: predominant-aggressors (25%), predominant-victims (17%), aggressive-victims (12%), and limited-involvement (47%). The findings did not provide evidence of unique social-emotional characteristics of aggressive-victims that were not accounted for by their involvement in both aggression and victimization. Further evidence of unique differences in risk factors is needed to support targeted interventions for aggressive-victims.

Adaptive Management as an Effective Strategy: Interdisciplinary Perceptions for Natural Resources Management.

Adaptive management is a well-established approach to managing natural resources, but there is little evidence demonstrating effectiveness of adaptive management over traditional management techniques. Peer-reviewed literature attempts to draw conclusions about adaptive management effectiveness using social perceptions, but those studies are largely restricted to employees of US federal organizations. To gain a more comprehensive insight into perceived adaptive management effectiveness, this study aimed to broaden the suite of disciplines, professional affiliations, and geographic backgrounds represented by both practitioners and scholars. A questionnaire contained a series of questions concerning factors that lead to or inhibit effective management, followed by another set of questions focused on adaptive management. Using a continuum representing strategies of both adaptive management and traditional management, respondents selected those strategies that they perceived as being effective. Overall, characteristics (i.e., strategies, stakeholders, and barriers) identified by respondents as contributing to effective management closely aligned with adaptive management. Responses were correlated to the type of adaptive management experience rather than an individual's discipline, occupational, or regional affiliation. In particular, perceptions of characteristics contributing to adaptive management effectiveness varied between respondents who identified as adaptive management scholars (i.e., no implementation experience) and adaptive management practitioners. Together, these results supported two concepts that make adaptive management effective: practitioners emphasized adaptive management's value as a long-term approach and scholars noted the importance of stakeholder involvement. Even so, more communication between practitioners and scholars regarding adaptive management effectiveness could promote interdisciplinary learning and problem solving for improved resources management.

Emergency Department Expansion Versus Patient Flow Improvement: Impact on Patient Experience of Care.

BACKGROUND: Most strategies used to help improve the patient experience of care and ease emergency department (ED) crowding and diversion require additional space and personnel resources, major process improvement interventions, or a combination of both. OBJECTIVES: To compare the impact of ED expansion vs. patient flow improvement and the establishment of a rapid assessment unit (RAU) on the patient experience of care in a medium-size safety net ED. METHODS: This paper describes a study of a single ED wherein the department first undertook a physical expansion (2006 Q2 to 2007 Q2) followed by a reorganization of patient flow and establishment of an RAU (2009 Q2) by the use of an interrupted time series analysis. RESULTS: In the time period after ED expansion, significant negative trends were observed: decreasing Press Ganey percentiles (-4.1 percentile per quarter), increasing door-to-provider time (+4.9 minutes per quarter), increasing duration of stay (+13.2 minutes per quarter), and increasing percent of patients leaving without being seen (+0.11 per quarter). After the RAU was established, significant immediate impacts were observed for door-to-provider time (-25.8 minutes) and total duration of stay (-66.8 minutes). The trends for these indicators further suggested the improvements continued to be significant over time. Furthermore, the negative trends for the Press Ganey outcomes observed after ED expansion were significantly reversed and in the positive direction after the RAU. CONCLUSIONS: Our results demonstrate that the impact of process improvement and rapid assessment implementation is far greater than the impact of renovation and facility expansion.

Mental health symptoms and engagement in a stepped-care mental health service among patients with a violent versus nonviolent injury.

BACKGROUND: Few studies have examined mental health symptom trajectories and engagement in mental health follow-up in relation to mechanism of injury. This study examined differences in engagement between survivors of nonviolent and violent injury in the Trauma Resilience and Recovery Program (TRRP), a stepped-care, technology-enhanced model that provides evidence-based mental health screening and treatment to patients admitted to our Level I trauma service. METHODS: This study analyzed data from 2,527 adults enrolled in TRRP at hospital bedside between 2018 and 2022, including 398 patients (16%) with a violent injury and 2,129 patients (84%) with a nonviolent injury. Bivariate and hierarchical logistic regression analyses examined relations between injury type (violent vs. nonviolent) engagement in TRRP and mental health symptoms at 30 day follow-up. RESULTS: Engagement in services at bedside was similar across survivors of violent and nonviolent traumatic injury. Patients with violent injury had higher levels of posttraumatic stress disorder and depressive symptoms 30 days postinjury but were less likely to engage in mental health screening. Among patients who screened positive for posttraumatic stress disorder and depression, patients with violent injury were more likely to accept treatment referrals. CONCLUSION: Patients with a violent traumatic injury have higher levels of mental health needs yet face greater barriers to accessing mental health services following their injury relative to those with a nonviolent injury. Effective strategies are needed to ensure continuity of care and access to mental health care to promote resilience and emotional and functional recovery. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

Short-changing the future: The systemic gap between psychology internship stipends and living wages.

Introduction: Providing doctoral internship stipends below living wages may harm interns, the clinical services they provide, and the field of health service psychology as a whole. This study evaluated the extent to which doctoral psychology internship stipends from the 2021-2022 training year for APA-accredited, APPIC-member programs in the US are consistent with living wages in the geographic region where sites are located. Methods: We obtained data reflecting internship sites' geographic location and stipends for the 2021-2022 academic year. Using the Massachusetts Institute of Technology Living Wage Calculator, we computed a living wage for the county in which each internship site is located. Descriptive statistics, discrepancies, ratios, and correlations were calculated to reflect the associations between internship sites' stipends and their local living wages. Results: The average internship stipend was $31,783, which was lower than the average living wage by $2,091. Stipends ranged widely, from a low of $15,000 to a high of $94,595-reflecting a six-fold difference in wages. Although internship sites in higher cost of living areas paid higher stipends, over two-thirds (67.0%) of sites did not pay a stipend that equaled or exceeded a living wage. Ninety-eight sites (15.3%) had deficits of over $10,000 when comparing their stipends to local living wages, with $33,240 as the highest deficit. Discussion: Eliminating obstacles to educating health service psychologists by decreasing the financial burden of training will likely have subsequent critical benefits towards bridging the workforce gap between mental healthcare service needs and available providers, ultimately leading to improved population health.

Individual- and Peer-Level Risk and Protective Factors for Gun Carriage Among Adolescents Living in Low-Income Urban Communities.

Carrying a handgun is an established risk factor for firearm violence, with detrimental and too often irreversible consequences for adolescents including injury and mortality. Although researchers identified a number of risk factors for adolescent handgun carriage, little is known regarding the role of strengths or developmental assets in buffering against risk. The goal of this study was to identify both risk and protective factors for handgun carriage among a predominantly African American (88%) community-based sample of adolescents (Mage = 14.3) who resided in urban communities with high rates of poverty and exposure to violence. Consistent with prior work, we found that adolescents with access to a handgun or with friends who had carried a handgun had higher odds of carrying a handgun themselves in the past 3 months. Handgun access, friends' handgun carriage, and beliefs supporting reactive aggression were identified as risk factors for handgun carriage. Although personal and social assets and positive outlook moderated these relations, the direction was contrary to our hypotheses. We believe that these findings are in part due to structural inequities and social norms impacting adolescents in urban communities characterized by concentrated poverty and high rates of violence. Our findings highlight the value of moving beyond a deficit-oriented framework to gain a more nuanced understanding of the dynamics among both positive and negative factors that alter risk for handgun carriage among African American youth living in low-income urban areas.

Cyclical 10-day dosing of melphalan for canine multiple myeloma.

Canine multiple myeloma (MM) is typically treated with melphalan chemotherapy. A protocol with repeated 10-day cyclical dosing of melphalan has been used at our institution but has not been described in the literature. Our objectives were to describe the outcome and adverse events of this protocol in a retrospective case series. We hypothesised the cyclical 10-day protocol would have similar outcomes compared to other reported chemotherapy protocols. Dogs diagnosed with MM that received melphalan treatment at Cornell University Hospital for Animals were identified through a database search. Records were retrospectively reviewed. Seventeen dogs met inclusion criteria. Lethargy was the most common presenting complaint. The median duration of clinical signs was 53 days (range, 2-150 days). Seventeen dogs had hyperglobulinemia with 16/17 having monoclonal gammopathies. Sixteen dogs had bone marrow aspiration and cytology performed at initial diagnosis and plasmacytosis was diagnosed in all. Based on serum globulin concentrations, 10 of 17 dogs (59%) achieved complete response (CR), and 3 dogs (18%) achieved partial response (PR), for an overall response rate of 76%. The median overall survival time was 512 days (range, 39-1065). Retinal detachment (n = 3) and maximum response of CR/PR (n = 13) were associated with overall survival on multivariate analysis (p = .045 and .046, respectively). Adverse events were minimal with diarrhoea being the most reported (n = 6). This cyclical 10-day protocol was better-tolerated with fewer adverse events than with other reported chemotherapy protocols, but response rate was also lower, likely due to a lower dosing intensity.

Transgender and gender expansive emerging adults: The moderating role of thwarted belongingness on mental health.

Transgender and gender expansive emerging adults experience multiple forms of gender minority stress, which affect their mental health and wellbeing. Belongingness has been identified as a factor that fosters resilience among this population, with potential protective effects. Few studies have explored the role of thwarted belongingness and its potential moderating effect on the relation between gender minority stress and mental health. This study recruited a sample of 93 transgender and gender expansive emerging adults between the ages of 18 and 21 to examine whether thwarted belongingness significantly moderates the relations between gender minority stressors and mental health symptoms. We found evidence that thwarted belongingness moderates the relation between social rejection and depressive symptoms and the interaction effect between thwarted belongingness and victimization was significantly associated with psychological stress. For both of these associations, high levels of thwarted belongingness amplified the positive relation between gender minority stress and mental health symptoms. In contrast, at low levels of thwarted belongingness, the relation between rejection and depression was negative and the association between victimization and psychological stress was no longer statistically significant. Findings suggest that factors that minimize or interrupt thwarted belongingness among transgender and gender expansive emerging adults may be points of intervention to improve mental health outcomes in this population.

Peer Factors as Mediators of Relations Between Exposure to Violence and Physical Aggression in Middle School Students in a Low-Income Urban Community.

Objective: Although prior research has demonstrated that peers influence both physical aggression and exposure to violence during adolescence, few studies have investigated the extent to which peers play a role in relations between physical aggression and violence exposure. This longitudinal study examined peer pressure for fighting, friends' delinquent behavior, and friends' support for fighting as mediators of relations between exposure to violence through witnessing and victimization, and adolescents' frequency of physical aggression. Method: Participants were 2,707 adolescents attending three urban middle schools (Mage = 12.4; 52% female; 79% African American, 17% Hispanic/Latino). Participants completed measures of their frequency of physical aggression, witnessing community violence, victimization by violence, and negative life events, and peer variables at four waves within the same school year. Results: Cross-lagged analyses indicated that the role of peer variables as mediators varied as a function of the type of exposure and the direction of effects. Whereas peer pressure for fighting mediated relations between witnessing violence and changes in physical aggression, friends' delinquent behavior mediated relations between physical aggression and changes in witnessing violence and victimization. In contrast, violent victimization was not associated with changes in any of the peer factors when included in the same model as witnessing violence. Conclusions: These findings highlight the role of peers as both a cause and a consequence of adolescents' aggressive behavior and exposure to violence. They suggest focusing on peer variables as targets for interventions to disrupt connections between exposure to violence and physical aggression during early adolescence.

Positive Engagement with Pets Buffers the Impact of Intimate Partner Violence on Callous-Unemotional Traits in Children.

Childhood exposure to intimate partner violence (IPV) is associated with serious psychological outcomes including increased odds of developing callous-unemotional (CU) traits and behaviors. Recent studies suggest that concomitant exposure to animal cruelty (AC) may increase this risk. However, even under these circumstances, bonds with companion animals may still be a protective factor that buffers the deleterious impact of IPV on child adjustment. This cross-sectional study evaluates whether, and to what extent, the association between exposure to IPV and children's CU and empathic-prosocial (EP) traits vary as a function of children's positive engagement with pets and exposure to AC. Participants included 204 children (aged 7-12 years; 57% Latinx) and their maternal caregiver who were recruited from domestic violence agencies in a western US state. We conducted multiple moderation analyses to evaluate each outcome individually (i.e., CU traits, EP traits), adjusting for the effects of child age, gender, and Hispanic ethnicity. Positive engagement with pets significantly moderated the relationship between IPV and CU traits, ∇R = 0.03, F (1, 195) = 7.43, ß = -0.17, t(195) = -2.73, p = .007. Specifically, when high levels of positive engagement with pets is present, IPV is negatively associated with CU traits, whereas the reverse was true at low levels of positive engagement with pets. Evidence of moderation by AC was not supported. Our findings suggest that children who form close relationships with their pets in the context of IPV appear to derive important support from these animals; safeguarding the well-being of these animals may be critical to their long-term emotional health.

Endoplasmic reticulum stress is a target for therapy in Waldenstrom macroglobulinemia.

Waldenstrom macroglobulinemia (WM) is an incurable low-grade lymphoma characterized by bone marrow (BM) involvement of IgM secreting lymphoplasmacytic cells. The induction of unfolded protein response (UPR) genes ("physiologic" UPR) enables cells to differentiate into professional secretory cells capable of production of high amounts of endoplasmic reticulum (ER)-processed proteins, such as immunoglobulins. Ultimately, the initially cytoprotective UPR triggers an apoptotic cascade if ER stress is not corrected, called proapoptotic/terminal UPR. We show that WM cells inherently express the physiologic UPR machinery compared with normal BM cells, and that increased ER stress leads to proapoptotic/terminal UPR in WM cells. We therefore examined tunicamycin, ER stress inducer, for potential antitumor effects in WM. Tunicamycin induced significant cytotoxicity, apoptosis and cell-cycle arrest, and inhibited DNA synthesis in WM cell lines and primary BM CD19(+) cells from patients with WM with an inhibitory concentration (IC(50)) of 0.5 microg/mL to 1 microg/mL, but not in healthy donor cells. Importantly, coculture of WM cells in the context of the BM microenvironment did not inhibit tunicamycin-induced cytotoxicity. Finally, we demonstrate that ER stress inducer synergizes with other agents used in the treatment of WM. These preclinical studies provide a framework for further evaluation of ER stress inducing agents as therapeutic agents in WM.

Psychosocial Adjustment Across Aggressor/Victim Subgroups: A Systematic Review and Critical Evaluation of Theory.

Theoretical conceptualizations of "aggressive-victims" portray them as more emotionally dysregulated and socially inept than adolescents who are either aggressive or victimized. The purpose of this systematic review is to synthesize the literature comparing the psychosocial adjustment of aggressor/victim subgroups (i.e., aggressive-victims, predominant-aggressors, predominant-victims, and youth with limited involvement) and determine whether empirical findings are consistent with theory, particularly regarding whether aggressive-victims possess unique and shared characteristics relative to those with other patterns of involvement in aggression. This review focuses on studies with early adolescent samples given the heightened vulnerability for aggression and victimization and the need for more effective interventions during this developmental period. A systematic search of three databases (PubMed, PsycINFO, Academic Search Complete) identified 25 studies, which varied in their sample characteristics, approach to defining subgroups, and findings regarding the unique and shared characteristics of aggressive-victims. I propose several guidelines for future research in this area and highlight several gaps in our existing knowledge. Implications for theory and prevention efforts are discussed.

Nutrition and hair.

Healthy hair results from a combination of good generalized health and mindful health care practices. Many nutritional deficiencies lead to poor hair health and include changes to hair structure, texture, and viability. Although the mechanisms by which individual nutrients contribute to hair growth and maintenance have yet to be fully resolved, there are a variety of risk factors that predispose an individual to a nutritional deficiency; age, malnutrition, malabsorption, and medication use are among the most common. A thorough history should be taken in a patient with a hair disturbance to identify risk factors for a nutritional deficiency, which will then guide directed laboratory testing and treatment.

Attachment to Pets Moderates Transitions in Latent Patterns of Mental Health Following the Onset of the COVID-19 Pandemic: Results of a Survey of U.S. Adults.

This cross-sectional study examined whether, and to what extent, attachment to pets was associated with changes in latent patterns of adults' perceived mental health symptoms during the COVID-19 pandemic (n = 1942). We used latent transition analysis to determine the stability of subgroup membership pre- and post-COVID and the effect of attachment to pets on transition probabilities. Mental health before COVID-19 was measured retrospectively. Five subgroups were identified: low symptoms, mild symptoms, moderate symptoms, high symptoms, and severe symptoms. Among individuals in the moderate and high symptoms subgroups, those who reported high attachment to pets generally had greater odds of transitioning to a less severe symptom profile (OR = 2.12) over time than those with low attachment to pets (OR = 1.39). However, those who had a severe symptom profile and high attachment to pets had lower odds of transitioning to a less severe symptom profile (OR = 0.30) and higher odds of maintaining a severe symptom profile (OR = 3.33) than those with low attachment to pets. These findings suggest that the protective and risk effects of attachment to pets differ based on individuals' psychological symptom patterns across multiple indicators. We discuss the implications of these findings for research, policy, and practice.