Climatic, oceanic, freshwater, and local environmental drivers of New Zealand estuarine macroinvertebrates.

Understanding the responses of organisms to different environmental drivers is critical for improving ecosystem management and conservation. Estuarine ecosystems are under pressure from multiple anthropogenic stressors (e.g. increasing sediment and nutrient loads, pollution, climate change) that are affecting the functions and services these ecosystems provide. Here, we used long-term estuarine benthic invertebrate monitoring data (∼30 year time-series) to evaluate the responses of macrobenthic invertebrate communities and indicator species to climatic, oceanic, freshwater, and local environmental drivers in New Zealand estuaries. We aimed to improve our ability to predict ecosystem change and understand the effects of multiple environment drivers on benthic communities. Our analyses showed that the abundance and richness of macrobenthic fauna and four indicator taxa (bivalves known to have differing tolerances to sediment mud content: Austrovenus stutchburyi, Macomona liliana, Theora lubrica, and Arthritica bifurca) responded to unique combinations of multiple environmental drivers across sites and times. Macrobenthic responses were highly mixed (i.e., positive and negative) and site-dependent. We also show that responses of macrobenthic fauna were lagged and most strongly related to climatic and oceanic drivers. The way the macrobenthos responded has implications for predicting and understanding the ecological consequences of a rapidly changing environment and how we conserve and manage coastal ecosystems.

Impact of Anti-Estrogen Therapy on Early Cardiovascular Referrals, Tests and Medications in Premenopausal Women with Operable Breast Cancer.

INTRODUCTION: Premenopausal women with high-risk hormone receptor (HR)-positive breast cancer often receive ovarian function suppression (OFS) and anti-estrogen therapy which induces near complete estrogen deprivation (NCED). This treatment improves recurrence-free survival but may increase cardiovascular risk. We sought to identify patterns of cardiovascular care and outcomes in premenopausal women with operable breast cancer. METHODS: Premenopausal women ≤ 50 years of age with stage I-III HR-positive or triple negative breast cancer (TNBC) were identified by retrospective review. We categorized women into 3 groups based on anti-estrogen therapy approach: NCED (HR + OFS), anti-estrogen therapy without OFS (HRnoOFS), and no anti-estrogen therapy (TNBC). Baseline characteristics, post-diagnosis cardiovascular events and cardiovascular actions (tests, referrals and medications) were recorded. Categorical variables were compared among the groups using chi-square and Fisher's exact tests; continuous outcomes were compared using ANOVA. RESULTS: 82, 83, and 52 women were identified in the HR + OFS, HRnoOFS, and TNBC groups respectively; mean follow-up was 5.0 years. Mean number of cardiovascular actions per year were highest in the HR + OFS group compared with HRnoOFS and TNBC groups (0.35 vs. 0.20 and 0.27, respectively; P = .036). The HR + OFS group had significantly more referrals and tests per year than the other groups. Cardiovascular medication initiation did not differ among groups. CONCLUSIONS: In this early follow-up period, there were meaningful numbers of cardiovascular actions, with women on NCED experiencing the most per year. Future work should seek to further understand the impact of anti-estrogen therapy on the cardiovascular health of premenopausal women and test strategies to mitigate cardiotoxicity.

Cardiovascular impact of near complete estrogen deprivation in premenopausal women with breast cancer: The CROWN study.

Survival with operable breast cancer has improved markedly in recent decades, however, treatment-related cardiovascular toxicities threaten to offset these gains. Ovarian function suppression paired with aromatase inhibition, for premenopausal women with hormone receptor (HR)-positive breast cancer, is a newer widely adopted therapy with the potential for significant long-term cardiovascular toxicity. Abrupt estrogen deprivation for non-cancer reasons is associated with accelerated coronary artery disease. Women with breast cancer treated with aromatase inhibition in addition to ovarian function suppression experience a dual hit with regards to estrogen exposure. The CaRdiac Outcomes With Near-complete estrogen deprivation (CROWN) study seeks to understand the early, subclinical natural history of cardiovascular compromise in young women undergoing near-complete estrogen deprivation (NCED) therapy. It is critical to understand the early subclinical development of cardiovascular disease to identify a window for therapeutic intervention before overt cardiovascular events occur. This three-site regional study (Atrium Health Wake Forest, Duke, and Virginia Commonwealth University) uses serial stress cardiac magnetic resonance (CMR) imaging and cardiac computed tomography angiography (CCTA) obtained during the initial two years of NCED therapy to study myocardial prefusion reserve (MPR), large cardiovascular vessel changes, left ventricular function, and other cardiovascular parameters. The CROWN cohort will consist of 90 premenopausal women with breast cancer, 67 with HR-positive disease receiving NCED and 23 comparators with HR-negative disease. Participants will undergo three annual CMR scans and 2 CCTA scans during the 2-year study period. After initial activation hurdles, accrual has been brisk, and the study is expected to complete accrual in December 2024. Efforts are in place to encourage participant retention with the study primary outcome, change in MPR between the two groups, to be reported in 2026 to 2027. The results of this study will enable premenopausal women with breast cancer to balance the health burdens of cancer at a young age and treatment-related cardiovascular morbidity. Finally, the tools developed here can be utilized to study cardiovascular risk across a range of cancer types and cancer therapies with the ultimate goals of both developing generalizable risk stratification tools as well as validating interventions which prevent overt cardiovascular compromise.

Metaplastic Breast Cancer: Current Understanding and Future Directions.

Metaplastic breast cancers (MBC) encompass a group of highly heterogeneous tumors which share the ability to differentiate into squamous, mesenchymal or neuroectodermal components. While often termed rare breast tumors, given the relatively high prevalence of breast cancer, they are seen with some frequency. Depending upon the definition applied, MBC represents 0.2% to 1% of breast cancers diagnosed in the United States. Less is known about the epidemiology of MBC globally, though a growing number of reports are providing information on this. These tumors are often more advanced at presentation relative to breast cancer broadly. While more indolent subtypes exist, the majority of MBC subtypes are associated with inferior survival. MBC is most commonly of triple-negative phenotype. In less common hormone receptor positive MBCs, hormone receptor status appears not to be prognostic. In contrast, relatively rare HER2-positive MBCs are associated with superior outcomes. Multiple potentially targetable molecular features are overrepresented in MBC including DNA repair deficiency signatures and PIK3/AKT/mTOR and WNT pathways alterations. Data on the prevalence of targets for novel antibody-drug conjugates is also emerging. While chemotherapy appears to be less active in MBC than in other breast cancer subtypes, efficacy is seen in some MBCs. Disease-specific trials, as well as reports of exceptional responses, may provide clues for novel approaches to this often hard-to-treat breast cancer. Strategies which harness newer research tools, such as large data and artificial intelligence hold the promise of overcoming historic barriers to the study of uncommon tumors and could markedly advance disease-specific understanding in MBC.

Reproducibility assessment of a biomechanical model-based elasticity imaging method for identifying changes in left ventricular mechanical stiffness.

Purpose: Cardiotoxicity of antineoplastic therapies is increasingly a risk to cancer patients treated with curative intent with years of life to protect. Studies highlight the importance of identifying early cardiac decline in cancer patients undergoing cardiotoxic therapies. Accurate tools to study this are a critical clinical need. Current and emerging methods for assessing cardiotoxicity are too coarse for identifying preclinical cardiac degradation or too cumbersome for clinical implementation. Approach: In the previous work, we developed a noninvasive biomechanical model-based elasticity imaging methodology (BEIM) to assess mechanical stiffness changes of the left ventricle (LV) based on routine cine cardiac magnetic resonance (CMR) images. We examine this methodology to assess methodological reproducibility. We assessed a cohort of 10 participants that underwent test/retest short-axis CMR imaging at baseline and follow-up sessions as part of a previous publicly available study. We compare test images to retest images acquired within the same session to assess within-session reproducibility. We also compare test and retest images acquired at the baseline imaging session to test and retest images acquired at the follow-up imaging session to assess between-session reproducibility. Results: We establish the within-session and between-session reproducibility of our method, with global elasticity demonstrating repeatability within a range previously demonstrated in cardiac strain imaging studies. We demonstrate increased repeatability of global elasticity compared to segmental elasticity for both within-session and between-session. Within-subject coefficients of variation for within-session test/retest images globally for all modulus directions and a mechanical fractional mechanical stiffness anisotropy metric ranged from 11% to 28%. Conclusions: Results suggest that our methodology can reproducibly generate estimates of relative mechanical elasticity of the LV and provides a threshold for distinguishing true changes in myocardial mechanical stiffness from experimental variation. BEIM has applications in identifying preclinical cardiotoxicity in breast cancer patients undergoing antineoplastic therapies.

Dynamic characterization of breast cancer response to neoadjuvant therapy using biophysical metrics of spatial proliferation.

Current tools to assess breast cancer response to neoadjuvant chemotherapy cannot reliably predict disease eradication, which if possible, could allow early cessation of therapy. In this work, we assessed the ability of an image data-driven mathematical modeling approach for dynamic characterization of breast cancer response to neoadjuvant therapy. We retrospectively analyzed patients enrolled in the I-SPY 2 TRIAL at the Atrium Health Wake Forest Baptist Comprehensive Cancer Center. Patients enrolled on the study received four MR imaging examinations during neoadjuvant therapy with acquisitions at baseline (T0), 3-weeks/early-treatment (T1), 12-weeks/mid-treatment (T2), and completion of therapy prior to surgery (T3). We use a biophysical mathematical model of tumor growth to generate spatial estimates of tumor proliferation to characterize the dynamics of treatment response. Using histogram summary metrics to quantify estimated tumor proliferation maps, we found strong correlation of mathematical model-estimated tumor proliferation with residual cancer burden, with Pearson correlation coefficients ranging from 0.88 and 0.97 between T0 and T2, representing a significant improvement from conventional assessment methods of change in mean apparent diffusion coefficient and functional tumor volume. This data shows the significant promise of imaging-based biophysical mathematical modeling methods for dynamic characterization of patient-specific response to neoadjuvant therapy with correlation to residual disease outcomes.

Spatial and Temporal Distance Between the Victim and Offender as a Factor in Protective Order Violations: How Much Distance is Enough?

Research on the effectiveness of protective orders indicates that they have only marginal protective value for the victim. This exploratory study investigated how the physical distance and temporal distance between the victim and offender corresponds to the percent of protective order violations. Results indicated that the percent of protective order violations was reduced to virtually zero when the victim and offender lived 25 miles or more apart. Surprisingly, this condition held for all types of contacts examined (physical, telephone, and cyber). The study concludes with a discussion of the policy implications of the findings and suggestions for future research.

Internal and External Barriers to Help Seeking: Voices of Men Who Experienced Abuse in the Intimate Relationships.

This qualitative study explores internal and external barriers to help seeking among 41 men from four English-speaking countries who self-reported victimization from a female intimate partner. Twelve online focus groups were conducted and themes were identified inductively at a semantic level. Six identified themes represented four internal (blind to the abuse, maintaining relationships, male roles, and excuses) and two external barriers to help seeking (fear of seeking help and nowhere to go). Most participants who avoided seeking help did so due to their own lack of recognition of abuse and ability to assess their risk of harm, attempts to keep the family intact, masculine stereotypes, and excuses for their partner's abuse. Some men who expressed an interest in seeking help were discouraged from it due to fear for their personal safety, a potential revictimization in the legal system, and the lack of support services available to men. This research suggests that the individuals who are abused in relationships, service providers, and the public at large could benefit from professional training about gender inclusive approaches to intimate partner abuse.

Examining Men's Experiences of Abuse From a Female Intimate Partner in Four English-Speaking Countries.

This qualitative study explores the experiences of men who self-report victimization from a female intimate partner in four English-speaking countries. Forty-one men who reported any type of intimate partner abuse (IPA) from a female partner were recruited via targeted advertising in Australia, Canada, the United Kingdom, and the United States. Twelve online focus groups were conducted across countries using a phenomenologically informed design. Thematic analysis was carried out from an inductive and realist epistemological position and themes identified at a semantic level. This approach was taken to directly reflect the men's experiences and perspectives, ensuring the voices of this hard-to-reach and overlooked population were heard. Three themes were identified across the countries: an imbalanced experience of harm; living with sustained abuse; and knowledge is power for men experiencing IPA. It was found that most participants underwent physical harm in the context of coercive control and experienced abuse over long periods of time. They were slow to recognize the magnitude of their partners' behavior and act upon it for a range of reasons that are described in detail. In addition, promoting knowledge about the victimization of men by women, using appropriate language and active learning, was found to be important in helping the men gain autonomy and agency to break the pattern of abuse and aid their recovery. The implications of the findings for developing male-friendly IPA policy, practice, and services are discussed, in addition to the need for innovative research methodology to access hard-to-reach populations.

An Exploratory Study of the Prosecution of Fatal Child Maltreatment: Criminal Charges Filed Against Presumed Perpetrators in the United States in 2017.

In the United States child maltreatment fatalities (CMFs) do not usually meet the standard for manslaughter or murder, resulting in convictions of lesser crimes and little jail time. This exploratory study examined the charges brought against suspected CMF perpetrators in 2017. Univariate and bivariate analyses were conducted using data obtained from the Nexis Uni newspaper database, that has over 40,000 high quality media sources, for the year 2017. We found that the most frequently used charges were endangering the welfare of a child and murder, the former of which was more related to neglect-deaths and the latter to physical abuse-deaths. There was no difference between charges for male and female perpetrators. Practical implications for research, policy, and practice are discussed.

Myocardial Function in Premenopausal Women Treated With Ovarian Function Suppression and an Aromatase Inhibitor.

Background: Premenopausal women with high-risk hormone receptor (HR)-positive breast cancer often receive ovarian function suppression (OFS) with aromatase inhibitor therapy; however, abrupt menopause induction, together with further decrements in estrogen exposure through aromatase inhibition, may affect cardiovascular microcirculatory function. We examined adenosine-induced changes in left ventricular (LV) myocardial T1, a potential subclinical marker of LV microcirculatory function in premenopausal women undergoing treatment for breast cancer. Methods: Twenty-one premenopausal women (14 with HR-positive breast cancer receiving OFS with an aromatase inhibitor and 7 comparator women with triple-negative breast cancer [TNBC] who had completed primary systemic therapy) underwent serial resting and adenosine cardiovascular magnetic resonance imaging measurements of LV myocardial T1 and LV volumes, mass, and ejection fraction. All statistical tests were 2-sided. Results: After a median of 4.0 months (range = 3.1-5.7 months), the stress to resting ratio of LV myocardial T1 declined in women with HR-positive breast cancer (-1.3%, 95% confidence interval [CI] = -3.4% to 0.7%) relative to those with TNBC (3.2%, 95% CI = -1.2% to 7.6%, P = .02). After accounting for age, LV stroke volume, LV ejection fraction, diastolic blood pressure, and breast cancer subtype women with HR-positive breast cancer experienced a blunted T1 response after adenosine relative to women with TNBC (difference = -4.7%, 95% CI = -7.3% to -2.1%, P difference = .002). Conclusions: Over the brief interval examined, women with HR-positive breast cancer receiving OFS with an aromatase inhibitor experienced reductions in adenosine-associated changes in LV myocardial T1 relative to women who received nonhormonal therapy for TNBC. These findings suggest a possible adverse impact on LV myocardial microcirculatory function in premenopausal women with breast cancer receiving hormone deprivation therapy.

Epidemiology of De Novo Metastatic Breast Cancer.

Most cases of metastatic breast cancer (MBC) arise as a recurrence of a previously treated early breast cancer. Distinct from recurrent MBC is de novo MBC (dnMBC), which describes patients who present with distant sites of disease at initial diagnosis and is reviewed here. dnMBC represents approximately 3% to 6% of new breast cancer diagnoses in high-income countries. This incidence has not declined despite decades of widespread use of population-based mammography screening. Overrepresentation of both biologically aggressive tumors and patients negatively impacted by social determinants of health are characteristics of dnMBC. Survival has generally been superior for patients with dnMBC compared with those with recurrent MBC, although it is similar to that for patients with recurrent MBC with long disease-free intervals. Subgroups of patients with dnMBC who experience prolonged survival include those with human epidermal growth factor receptor-2-positive disease or hormone receptor-positive bone-only disease. Opportunities to decrease dnMBC presentation may include novel screening modalities suited for biologically aggressive breast tumors and improved access to health care. Recognizing that there will remain some women diagnosed with dnMBC, refining our ability to identify those likely to be long-term survivors could allow for appropriate escalation or de-escalation of care. Finally, evaluation of tumor genomics in robust sample sizes has the potential to advance our knowledge of the biology of dnMBC as an entity distinct from recurrent MBC.

Using Technology to Conduct Focus Groups With a Hard-to-Reach Population: A Methodological Approach Concerning Male Victims of Partner Abuse in Four English-Speaking Countries.

Research shows that the experiences of male victims of partner abuse (PA) are often denied by the public and the professionals who are charged to support PA victims. Recruiting female victims for research on PA victimization is relatively easy because there are existing structures to serve this group of victims. Thus, male victims are considered a hard-to-reach (HTR) population, and studying them can be difficult. This article focuses on the use of technology to collect qualitative data from male PA victims in an international study focusing on male victims. The researchers used their own professional networks to recruit and screen a convenience sample of male victims of female-to-male PA, in four different English-speaking countries: Australia, Canada, England, and the United States. Four web-based, video-enabled, focus groups were held for each country-for a total of 12 groups and 41 male participants. This article addresses recruitment methods, the use of technology in data collection, protecting the confidentiality of male victims, methods for informed consent, and lessons learned to facilitate future research.

Cumulative stressors reduce the self-regulating capacity of coastal ecosystems.

Marine ecosystems are prone to tipping points, particularly in coastal zones where dramatic changes are associated with interactions between cumulative stressors (e.g., shellfish harvesting, eutrophication and sediment inputs) and ecosystem functions. A common feature of many degraded estuaries is elevated turbidity that reduces incident light to the seafloor, resulting from multiple factors including changes in sediment loading, sea-level rise and increased water column algal biomass. To determine whether cumulative effects of elevated turbidity may result in marked changes in the interactions between ecosystem components driving nutrient processing, we conducted a large-scale experiment manipulating sediment nitrogen concentrations in 15 estuaries across a national-scale gradient in incident light at the seafloor. We identified a threshold in incident light that was related to distinct changes in the ecosystem interaction networks (EIN) that drive nutrient processing. Above this threshold, network connectivity was high with clear mechanistic links to denitrification and the role of large shellfish in nitrogen processing. The EIN analyses revealed interacting stressors resulting in a decoupling of ecosystem processes in turbid estuaries with a lower capacity to denitrify and process nitrogen. This suggests that, as turbidity increases with sediment load, coastal areas can be more vulnerable to eutrophication. The identified interactions between light, nutrient processing and the abundance of large shellfish emphasizes the importance of actions that seek to manage multiple stressors and conserve or enhance shellfish abundance, rather than actions focusing on limiting a single stressor.

Incidence and Survival in Reproductive-Aged Women with Differentiated Thyroid Cancer: United States SEER 18 2000-2016.

Background: Incidence of differentiated thyroid cancer has increased in the United States and globally with disproportionate increases observed among women. Recent data suggest that factors other than increased detection may underlie this increase. To understand incidence and survival patterns in differentiated thyroid cancer during a time period of increasing imaging, we examined data from a contemporary population-based sample of U.S. reproductive-aged women. Methods: Women aged 20-49 years (N = 61,552) diagnosed with papillary thyroid cancer (PTC) or follicular thyroid cancer (FTC) during 2000-2016 were identified from the U.S. National Cancer Institute Surveillance, Epidemiology, and End Results 18 registries database. For each age decade (20-29, 30-39, 40-49 years), we estimated age-adjusted average annual percentage changes in incidence using segmented and unsegmented regression models and 15-year survival. Results were stratified by race/ethnicity and cancer stage. Results: The estimated incidence of PTC increased during 2000-2016 among women aged 20-29 years and during 2000-2012 among women aged 30-49 years. During 2012-2016, incidence stabilized among women aged 30-39 years and decreased among women aged 40-49 years. For FTC, incidence decreased slightly among women aged 20-29 years and was rather stable among those aged 30-49 years during 2000-2016, although increases were observed among non-Hispanic black women aged 30-49 years. By stage, the percentage increase in PTC incidence was largest for regional disease. Fifteen-year estimated survival was generally high but somewhat lower among women aged 40-49 years than those aged 20-39 years. Survival was similar for PTC and FTC except among women aged 20-29 years, for whom survival was modestly lower with FTC than PTC. Conclusions: Our findings confirm increasing incidence of PTC among U.S. women aged 20-29 years, a recent stabilization of PTC incidence in women 30-49 years, and stable to decreasing incidence of FTC. Increased detection based on imaging is unlikely to fully explain the continued increase in PTC incidence, given the increasing incidence of regional disease and routine imaging occurring less often among premenopausal than postmenopausal women. Although survival is generally high, treatment often requires surgery and lifelong medications. Further investigations into contributors to these trends are warranted to reduce future morbidity in reproductive-aged women.

Mapping the estuarine ecosystem service of pollutant removal using empirically validated boosted regression tree models.

Humans rely on the natural environment and benefit from the goods and services provided by natural ecosystems. Quantification and mapping of ecosystem services (ES) is required to better protect valued ES benefits under pressure from anthropogenic activities. The removal of excess nitrogen, a recognized catchment-derived pollutant, by biota in estuarine soft sediments is an important ES that potentially ameliorates the development of eutrophication symptoms. Here, we quantified estuarine benthic sediment characteristics and denitrification enzyme activity (DEA), a proxy of inorganic N removal, at 109 sites in four estuaries to develop a general ("global") model for predicting DEA. Our initial global model for linking DEA and environmental characteristics had good explanatory power, with sediment mud content having the strongest influence on DEA (60%), followed by sediment organic matter content (≈35%) and sediment chlorophyll a content (≈5%). Predicted and empirically evaluated DEA values in a fifth estuary (Whitford, n = 90 validation sites) were positively correlated (r = 0.77), and the fit and certainty of the model (based on two types of uncertainty measures) increased further after the validation sites were incorporated into it. The model tended to underpredict DEA at the upper end of its range (at the muddier, more organically enriched sites), and the relative roles of the three environmental predictors differed in Whitford relative to the four previously sampled estuaries (reducing the explained deviance relative to the initial global model). Our detailed quantification of DEA and methodological description for producing empirically validated maps, complete with uncertainty information, represents an important first step in the construction of nutrient pollution removal ES maps for use in coastal marine spatial management. This technique can likely be adapted to map other ecosystem functions and ES proxies worldwide.

Male Victims of Female-Perpetrated Partner Violence: A Qualitative Analysis of Men's Experiences, the Impact of Violence, and Perceptions of Their Worth.

There has been a recent increase in the amount of research on male victims of female-perpetrated partner violence (PV) but research needs to be conducted to understand how the patterns of abuse persist in these relationships. In the current study, the experiences of 59 male PV victims in the USA, recruited through online advertisements in professional networks and websites (e.g., agencies that specialize in male victims of PV), were explored through a thematic analysis. Analyses suggested that the help seeking process of male PV victims is complex and heterogeneous and can often lead to further negative consequences due to various structural, cultural, social, and organizational factors. The findings also highlight the potential societal issues that male victims perceived as contributing to male victimization and lack of available resources for them. The results are discussed in terms of its implications for agencies, service providers, and general societal attitudes that are relevant to raising awareness about this phenomenon.

Biodiversity breakpoints along stress gradients in estuaries and associated shifts in ecosystem interactions.

Denitrification in coastal sediments can provide resilience to eutrophication in estuarine ecosystems, but this key ecosystem function is impacted directly and indirectly by increasing stressors. The erosion and loading of fine sediments from land, resulting in sedimentation and elevated sediment muddiness, presents a significant threat to coastal ecosystems worldwide. Impacts on biodiversity with increasing sediment mud content are relatively well understood, but corresponding impacts on denitrification are uncharacterised. Soft sediment ecosystems have a network of interrelated biotic and abiotic ecosystem components that contribute to microbial nitrogen cycling, but these components (especially biodiversity measures) and their relationships with ecosystem functions are sensitive to stress. With a large dataset spanning broad environmental gradients this study uses interaction network analysis to present a mechanistic view of the ecological interactions that contribute to microbial nitrogen cycling, showing significant changes above and below a stressor (mud) threshold. Our models demonstrate that positive biodiversity effects become more critical with a higher level of sedimentation stress, and show that effective ecosystem management for resilience requires different action under different scenarios.

Concordance Between Parents in Perpetration of Child Mistreatment: How Often Is It by Father-Only, Mother-Only, or by Both and What Difference Does It Make?

Research on child mistreatment tends to focus on the mother or the father as the abusing parent, even though there is wide agreement that both theory and practice should deal with child maltreatment as a family system problem. Most children have the benefit or the risk of more than one caretaker for substantial periods of their lives, most often two parents or stepparents. This article is intended to illustrate the value of research which uses concordance analysis (CA) to identify children who experienced three dyadic concordance types (DCTs) of mistreatment: father-only, mother-only, or both parents, including single-parent combinations of caretakers. A concordance approach that identifies possible abusers in addition to the presenting parent using the three DCTs is a practical first step toward a family system perspective to enhance child abuse theory, research, and practice.