Incorporation of suvorexant and lemborexant into hair and their distributions after a single intake.

PURPOSE: This study examined the applicability of hair analysis as an approach to identify suvorexant (SUV) and lemborexant (LEM) intake by analyzing black hair specimens collected from study participants after a single oral administration. METHODS: Hair specimens were collected form participants who took a single dose of 10 mg SUV or 5 mg LEM. Identification of the dual orexin receptor antagonists (DORAs) and their metabolites was performed by liquid chromatography-tandem mass spectrometry. Reference standards of S-M9 and L-M4, the metabolites of SUV and LEM, respectively, were synthesized in our laboratory. Sectional analysis of 1-mm segments of the single-hair strands was also performed to investigate the incorporation behavior of the drugs into hair. RESULTS: Unchanged SUV and LEM, and their metabolites S-M9 and L-M4 were detected even in the single-hair specimens. Results of the segmental hair analysis showed predominant incorporation of the drugs into hair through the hair bulb region rather than through the upper dermis zone of the hair root. The drug concentrations in the hair specimens, collected about 1 month after intake, were 0.033-0.037 pg/hair strand (0.17-0.19 pg/mg) for SUV and 0.054-0.28 pg/hair strand (0.28-1.5 pg/mg) for LEM. The calculated distribution ratios of the DORAs into hair to the oral doses were much lower than those of benzodiazepines and zolpidem reported in a previous study. CONCLUSIONS: This is the first report of the detection of the DORAs in hair. The incorporation behavior of the DORAs into hair revealed herein are crucial for proper interpretation of hair test results.

Coformulated Bictegravir/Emtricitabine/Tenofovir Alafenamide for Postexposure Prophylaxis After Sexual Assault: A Retrospective Real-World Study.

We report the experience of bictegravir/emtricitabine/tenofovir alafenamide for nonoccupational postexposure prophylaxis in sexual assault cases. Between June 2021 and October 2023, 39 individuals completed the 28-day follow-up; 41% experienced some side effects, and 1 person discontinued the drug because of a rash. No individuals seroconverted to HIV during the follow-up period.

Defining military sexual trauma: establishing parameters and perspectives.

Background: The term military sexual trauma [MST] is increasingly used to describe instances of sexual harassment/assault that occur between serving personnel during military service. However, in the absence of a clear universal definition, MST is an increasingly contested term, with confusion about its scope, application to differing jurisdictions and implications for responses and treatment.Objective: This editorial provides a universal definition of MST, decoupled from any national system or framework.Method: Drawing on existing international evidence about the nature and impact of MST.Results and Conclusion: We argue that MST terminology provides a unique framing which recognises the institutional nature of MST victimisation and situates the context, behaviours, and impact on a continuum of violence.

MST terminology provides understanding and acknowledgement of the nuances of sexual harassment/assault in the military institution.MST terminology should encompass a continuum of sexual violence.Drawing on existing military health research, the authors contend that MST should be considered as a distinctive traumatic stressor.

Social Connections as a Protective Factor for Sexual Violence-Related Attitudes.

Endorsing problematic sexual violence-related attitudes including rape myth acceptance (RMA), hostile sexism, and disapproval of sexual consent is associated with negative outcomes, including the perpetration of sexual violence. This study examined social connections as a protective factor for sexual violence-related attitudes among a sample of 770 participants. Results indicate that in the full sample, connections to a workplace were protective for RMA and hostile sexism while family connections were protective for disapproval of sexual consent, RMA, and hostile sexism. Patterns of other social connections differed in separate models for men and women. Unexpected findings indicating that connections to a religious social group are a risk, not a protective, factor are discussed.

Does No Mean No? Situational and Dispositional Factors Influence Emerging Adult Men's Intentions to Use Assault Tactics in Response to Women's Sexual Refusal During Hookups.

Hookups can result in sexual assault when men do not listen to requests from women to stop. It is thus important to identify factors that influence men's decisions to override direct refusals in these situations. Presently, we administered first-person vignettes depicting a prototypical hookup wherein the woman refuses the man's attempt to escalate intimacy. Using a national sample of emerging adult men (N = 420), we found that they on average did not completely rule out coercive or forcible tactics, but those elevated on rape myth acceptance, hypermasculinity, and psychopathy were uniquely at risk of assault when controlling for several other traits known to correlate with rape. Participants also reported being likelier to use coercive sexual practices when refusals occurred at higher levels of sexual intimacy already attained. Notably, diagnostic analyses revealed that a subset of men had a disproportionate influence on the regression estimates, and that these men were not only elevated across a range of assault-relevant traits, but also endorsed higher likelihoods of using coercion and force in the face of female sexual refusal. Although removal of these cases did not substantively alter the results, exploratory analyses revealed that these individuals responded differently to situational factors in ways that suggested sexual opportunism. Theoretical and practical implications of these findings are discussed.

Innovative Services for Survivors of Sexual Violence: Mapping New Pathways Forward.

Ensuring that support and services are meeting the needs of survivor-victims (SV) of sexual assault requires that policymakers, service providers, and advocates seek their insight directly. This article reports qualitative results on self-perceived needs from SV focus groups conducted in the fifth-largest metropolitan area in the United States (Phoenix, Arizona). Interviews with key informants (KIs) drawn from the service and justice sector were also obtained for system-level perspectives of SV priority needs. The major themes of the SV conversations demonstrated that they use a holistic wellness perspective. Their narratives mapped across the social-ecological model and demonstrated a wide range of wants and needs beyond justice. KI narratives identified options typically listed on a grant menu. SVs spoke of what they needed in their daily lives. Typically, KIs focused on increased funds to offer more of the same interventions currently available. The findings open opportunities to better align services with what SVs seek, and further underscore the need to engage them in planning and implementation.

"I'll Try and Make Myself as Small as Possible": Women and Gender-Diverse People's Safety Work on Public Transport.

Public transport is a known hotspot for sexual violence and harassment. Through 41 interviews with women and gender-diverse people who have experienced sexual violence and harassment on public transport, we found that women and gender-diverse people engage in extensive "safety work," such as changing their behavior, strategizing, and planning. Safety work takes considerable time and effort, often leaving participants feeling stressed. However, participants advocated for changes to public transport to reduce the work they do to stay safe. We argue that significant changes, including primary prevention of gender-based violence, are needed to reduce their safety work.

Myths of trauma memory: on the oversimplification of effects of attention narrowing under stress.

The present article addresses claims commonly made by prosecution witnesses in sexual assault trials: that attention narrows under stress, and that these attended aspects of the event are encoded in a way that ensures accuracy and resistance to fading and distortion. We provide evidence to contradict such claims. Given that what is encoded is largely the gist of one's interpretation of experience, we discuss the way in which attention and emotion can bias the interpretation of experience. We illustrate with issues of memory reports in cases of acquaintance rape, where the primary issue is the presence or absence of consent. We provide some specific illustrations concerning effects of emotion on interpretation of sexual consent. Finally, based on what is known regarding priming effects on memory retrieval and judgment, we conclude with discussion of the potential of some "trauma-informed" interviewing strategies to promote false memories (such as FETI: Forensic Experiential Trauma Interview).

The Insidiousness of Institutional Betrayal: An Ecological Systematic Review of Campus Sexual Violence Response Literature.

Recently, post-secondary institutions have been under increased public and academic scrutiny regarding their ability to prevent and respond to instances of campus sexual violence. Emerging research has explored institutional betrayal (IB), which is a theoretical framework that states that actions and inactions on the part of the institution can cause further harm to survivors of violence. The goals of this review were, using an ecological systems lens, to identify what specific behaviors, policies, responses, and other factors constitute IB or institutional support (IS) as defined by the existing literature. A search of 16 databases across 8 disciplines led to the identification of 100 articles that mentioned either IB or IS verbatim. Factors that can be categorized as IB and IS were identified across nine levels: (1) the individual level, (2) the interpersonal level, (3) within institutional spaces, (4) within institutional procedures, (5) within institutional policies, (6) at the institutional structural level, (7) at the institutional culture level, (8) at a government and public policy level, and (9) within greater societal cultural values and established social norms. IB itself manifests across all levels of the institution and is, in fact, quite insidious-it is largely invisible and deeply rooted in systemic oppression, woven into the structure of institutions of higher education. IB remains a looming, almost inevitable outcome of the structural violence that occurs in post-secondary settings. Yet, IS and the related concept of institutional courage are emerging fields of study that pose important implications for institutional change.

The prevalence of selected licit and illicit drugs in drug facilitated sexual assaults.

Little is known about the prevalence of incapacitating substances present in drug facilitated sexual assaults (DFSA). Presented here is a literature review conducted to provide background information, such as symptoms, exacerbations, and drug interactions, on drugs typically implicated in DFSA, namely gamma-hydroxybutyrate (GHB), gamma-butyrolactone (GBL), 1,4-butanediol (1,4-BD), ketamine, diazepam, oxycodone, methamphetamine, and alcohol. Literature found through Scopus and Pubmed was reviewed to determine the current prevalence of these substances in DFSA with a focus on Australian data. The global literature revealed that there is a wide variety of substances used in DFSA and the prevalence varied by country. For example, it was found that in Northern Ireland, opioids were most prevalent whereas in France, benzodiazepines were most prevalent. In Australia the review revealed a lack of contemporary data with the most recent report in Victoria using data collected during 2011-2013. The literature also revealed there can be an important difference between self-reported substance use and substances discovered via toxicological analysis. This can be due to the challenges of biological detection, reliability of self-reporting, and the possibility of a substance being introduced to a person's food or drink without their knowledge. This review highlights the need for the collection and analysis of current data pertaining to DFSA reports and the drugs detected, and due to the constantly evolving picture of both licit and illicit drug use an assessment of the role of prescription medications in DFSA due to drug-drug interactions as well as potential to incapacitate is warranted.

Gender-based violence and harassment at work and health and occupational outcomes. A systematic review of prospective studies.

BACKGROUND: Many people experience forms of gender-based violence and harassment (GBVH) in the context of their work. This includes a wide range of experiences, from subtle expressions of hostility to physical assault, that can also be of a sexual nature (e.g., sexual harassment or assault). This systematic review aimed to summarize findings about the prospective associations of work-related GBVH with people's health and occupational situation. METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Scopus, Web of Science, MEDLINE and PsycINFO were searched for prospective studies in English from 1990 to May 24, 2023. Studies were included if they concerned a working population, exposure to any form of GBVH in the work context, and a health outcome or manifest occupational outcome. Quality was assessed with a modified version of the Cochrane 'Tool to Assess Risk of Bias in Cohort Studies', and studies assessed as low quality were excluded from the narrative synthesis. For the narrative synthesis, we grouped the results by similar exposures and outcomes and reported the strength and statistical significance of the associations. RESULTS: Of the 1 937 screened records, 29 studies were included in the narrative synthesis. Studies were mainly conducted in the USA and northern Europe and investigated exposure to sexual violence or harassment (SVH). Only two included studies investigated non-sexual kinds of GBVH. Consistently, studies showed associations of work-related SVH with poor mental health and there were indications of an association with hazardous substance use. There was no consistent evidence for an association of SVH with subsequent sickness absence, and there were too few studies concerning physical health and occupational outcomes to synthesize the results. CONCLUSIONS: There is consistent evidence of work-related SVH as a risk factor for subsequent poor mental health. There is no indication that the health consequences of SVH differ between women and men, although women are more often affected. There is a need for conceptual consistency, the consideration of non-sexual behaviors and prospective studies that test clear hypotheses about the temporal sequence of events.

Sexual Victimization and Sexually Transmitted Infections Among a Nationally Representative Sample of Adolescents and Young Adults in Haiti.

Sexual assault victims are at major risk of being infected by sexually transmitted infections (STI). This article aims to examine and compare the prevalence of eight STIs (e.g., chlamydia, gonorrhea, hepatitis B, HIV/AIDS, human papillomavirus) among victims and non-victims of sexual abuse. A national cross-sectional study was conducted in Haiti, using a multistage sampling frame, stratified by geographical department, urban or rural setting, gender, and age groups (15-19 and 20-24 years). The final sample included 3586 household participants (47.6% female). A weighted sample of 3945 individuals was obtained and used in the following analyses. Overall, 21.75% (95% CI 19.91-23.59) of participants reported having been diagnosed with at least one STI in their lifetime, with a higher prevalence among men (25.70%; 95% CI 22.89-28.52), compared to women (18.11%; 95% CI 15.73-20.49), χ2 = 16.43; p < 0.001). Sexual abuse victims were more likely to report STIs (31.27%; 95% CI 29.21-33.34), compared to non-victims (18.40%; 95% CI 16.68-20.13), χ2 = 27.89; p < .001. Sexual abuse was associated to an increased risk of contracting at least one STI (OR = 1.74; 95% CI 1.35, 2.24). The results demonstrate that sexual abuse is associated with a general increase of reporting STIs. They indicate the need for national sexual abuse prevention programs at early ages. These programs should be implemented in schools and churches, focusing on the role of families in sexuality education. Finally, programs must be developed to eradicate community violence-especially in the cities-as increased political and social violence has always been associated with increased sexual abuse in Haiti.

Logistics and Interdisciplinary Expertise of a Sexual Assault Response Team: A Case Study Through Observations and Interviews.

To more effectively respond to sexual assault in the United States, some jurisdictions have created sexual assault response teams (SARTs). SARTs involve members of multiple agencies tasked with responding to sexual assault within a jurisdiction, such as law enforcement, advocates, prosecutors, and sexual assault nurse examiners (SANEs). Despite hundreds of jurisdictions utilizing SARTs, and the Department of Justice establishing guidelines, SARTs vary across jurisdictions in their form and function. To clarify this, the current research outlines two studies to better understand the logistics and functioning of one SART. In Study 1, for over nearly 2 years, SART meetings were observed and notes were taken on representation of agencies, time spent on cases, and possible challenges. Overall, the SART met consistently, with representation of major stakeholders at each meeting. Stakeholder agencies remained consistent and most time spent in the meetings was on case review. In Study 2, 10 members of SART were interviewed to assess perceptions of SART. These interviews were independently qualitatively coded for both factual and thematic codes. Areas of focus included perceived logistics of the SART and expertise of members that make up an effective SART. Overall, on average, members had been part of the SART for 3.5 years, felt required to attend the meetings as part of their role, and shared that all members (i.e., law enforcement, district attorney, victim advocates, and SANEs) had expertise on differing subjects that effectively made the SART work well. Importantly, qualitative perceptions from members of the SART (Study 2) lined up with the independent observation of SART meetings (Study 1). Ultimately, the results from this body of research could delineate specific actions that a jurisdiction implementing a SART could utilize.

Advancements in differentiation between sperm cells and epithelial cells for efficient forensic DNA analysis in sexual assault cases.

Most of the sexual assault casework samples are of mixed sources. Forensic DNA laboratories are always in the requirement of a precise technique for the efficient separation of sperm and non-sperm DNA from mixed samples. Since the introduction of the differential extraction technique in 1985, it has seen significant advancements in the form of either chemicals used or modification of incubation times. Several automated and semi-automated techniques have also adopted the fundamentals of conventional differential extraction techniques. However, lengthy incubation, several manual steps, and carryover over non-sperm material in sperm fraction are some of the major limitations of this technique. Advanced cell separation techniques have shown huge promise in separating sperm cells from a mixture based on their size, shape, composition, and membrane structure and antigens present on sperm membranes. Such advanced techniques such as DEParray, ADE, FACS, LCM, HOT and their respective pros and cons have been discussed in this article. As current-day forensic techniques should be as per the line of Olympic slogan i.e., faster, higher, stronger, the advanced cell separation techniques show a huge potential to be implemented in the casework samples.

Adult attachment style, perceived social support, and post-traumatic stress among female victims of sexual assault.

The present study aimed to investigate the interplay between adult attachment style, perceived social support, and post-traumatic stress (PTS) symptoms among adult female victims of sexual assault)SA(. While prior research has established the link between insecure attachment style and PTS, the underlying mechanisms are not well understood. The potential role of perceived social support as a mediator in this relationship has been largely neglected and there is a dearth of studies investigating this mediation among victims of SA. The present study sought to address this gap in literature. Two hundred twenty-six women who have endured SA completed self-report measures of attachment style, perceived social support, and PTS, using an online survey. The results confirmed the anticipated pattern, showing a positive correlation between insecure attachment styles and PTS, as well as a negative correlation with perceived social support. A mediation analysis indicated that perceived social support may be a mechanism linking attachment styles to PTS. Following SA, insecurely attached women, especially those with avoidant attachment, have difficulties relying on and utilizing support from their environment, which may render them more susceptible to PTS. Nevertheless, the mediation was partial, indicating that attachment anxiety and attachment avoidance independently contribute to the development and maintenance of PTS.

Evaluation of the Define It! Program for Raising Critically Conscious Bystander Behaviors.

Across two studies with cohorts of undergraduate students who previously completed a bystander intervention program, a consciousness-raising intervention called Define It! was evaluated for its efficacy in increasing critically conscious intentions. Data were collected pre, post, and one-month using the Illinois Rape Myth Acceptance Scale (IRMAS-SF; Payne et al., 1999) and Critically Conscious Bystander Scale (CCBS; Johnson et al., 2019). Following recommendations for novel intervention research by Rounsaville et al., we present our findings across two studies. Study 1 demonstrated that the program was feasible, acceptable, and specified the CCBS as an adequate measure of change. Study 2, (n = 38) randomly assigned student participants to control or intervention groups. Results demonstrated significant increases on CBBS for intervention participants compared to the control.

Trauma, PTSD, and Self-Efficacy: Predictors of Cervical Cancer Screening in Sexual Violence Survivors.

Sexual violence is highly prevalent in the United States and is associated with a host of negative physical and mental health outcomes. Specifically, sexual violence is associated with increased rates of cervical cancer, one of the most common cancers found in women. Furthermore, sexual violence survivors report reduced participation in preventive healthcare behaviors (e.g., Pap tests) which may reduce individuals' risk of developing reproductive health conditions such as cancer. Sexual violence exposure is also associated with increased symptoms of posttraumatic stress disorder (PTSD) and reduced trauma-coping self-efficacy (TCSE), two factors that may impact trauma-exposed individuals' level of avoidance of cervical cancer screens. Current research on the connection between sexual violence and reproductive healthcare often fails to examine potential underlying mechanisms behind this association, nor does it account for confounding factors such as healthcare accessibility and need. Accordingly, the present study tested a proposed moderated mediation model to explore the association between sexual violence and cervical cancer screening participation, including analysis of the indirect effect of TCSE and potential moderation of this effect by PTSD symptoms. Participants were 554 participants who reported experiences of sexual violence on Amazon's Mechanical Turk. Severity of sexual violence was significantly associated with reduced likelihood of participation in recommended cervical cancer screening. TCSE did not mediate nor did PTSD moderate this association. Findings of this study suggest that individuals' reproductive healthcare behaviors are influenced by their experiences of sexual trauma, as well as by structural factors such as insurance and income. Limitations, directions for future research, and clinical implications of study findings are discussed.

Going Beyond Childhood and Gender-Based Violence: Epigenetic Modifications and Inheritance.

Being exposed to childhood or gender-based violence is associated with subsequent adverse events in individual lives. Not only can it cause psychological distress but violence survivors suffer from a range of long-term adverse health outcomes, including higher morbidity, higher mortality, and higher risk of chronic diseases. Epigenetics may be involved in the determinisms of these long-term detrimental effects. A large body of evidence supports this biological mechanism to explain violence-related health impairment in the long term. However, studies specifically focusing on violence are scant and nonunivocal. Epigenetic modifications of genes involved in stress response and in the hypothalamus-pituitary-adrenal axis regulation are the most commonly and consistently reported. Promising evidence also emerged for the use of epigenetic clocks. Finally, although very limited, there is evidence supporting the notion that long-term health impairment may be transmitted from one generation to the other. Overall, despite promising, available evidence is yet incomplete. The overlap with pure psychological mechanisms of health impairment exposes the findings to confounders and hampers strong conclusions. Based on a literature search on PubMed/Embase, our narrative review aims to illustrate the evidence concerning the potential bond between epigenetics and violence, including also possible impacts on later generations. The goal is to encourage further research to help the development of a more holistic approach for such a vulnerable and often neglected population. Further research is warranted to precisely disentangle the role of epigenetics in mediating the long-term health impairment associated with childhood or gender-based violence. Advances in this area may open new avenues of treatment. Epigenetic modifications may indeed be reversible and could be an attractive therapeutic target to minimize the long-term consequences of childhood or gender-based violence.

Male rape: survivors, support and the law in late twentieth-century England and Wales.

Until 1994, men were not recognized legally as victims of rape in England and Wales. This article explores the history of male survivors of rape there, establishing the uneven patchwork of support services available to them prior to 1994. It argues that a growing psychiatric literature which studied male survivors of sexual violence was a major factor in convincing lawmakers to include men as potential victims of rape in updated sexual offence legislation. Other medical professionals played key roles in bringing male survivors to police attention, but psychiatric research was most influential in changing the policy agenda in this arena.

Silenced Survivors: A Systematic Review of the Barriers to Reporting, Investigating, Prosecuting, and Sentencing of Adult Female Rape and Sexual Assault.

Sexual victimization of adult women remains an underreported crime. This systematic review identified and synthesized the barriers to reporting, investigating, prosecuting, and sentencing cases of sexual assault and rape against adult women in Western countries. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search was conducted on August 3, 2023, across databases including PsycINFO, MEDLINE, Cochrane Library, Scopus, ProQuest Central, Web of Science, MedNar, and ProQuest Dissertations & Theses. Studies meeting the inclusion criteria provided relevant information on the decision not to formally disclose, investigate, prosecute, or convict incidents of sexual assault and rape of adult women. We included 28 studies and identified 70 barriers in total. Identified barriers were most prevalent to reporting, followed by investigating, prosecuting, and, lastly, sentencing. Key themes in the barriers included lack of trust in the criminal justice system, internal reactions, rape myths and societal norms, and perpetrator characteristics. The identified barriers emphasize an urgent need for reform of the criminal justice system's response to sexual assault and rape. Prioritizing victim-survivors' needs, enhancing transparency of the criminal justice system, and addressing attrition rates are crucial. Future studies need to engage with diverse population to address all victim-survivors' needs and provide further insights into the challenges across all stages of the criminal justice system to enhance the outcome of rape and sexual assault cases.