Relational Factors Associated With Posttraumatic Stress Among Emerging Adults of Color Exposed to Community Violence.

The relationship between trauma exposure and posttraumatic stress symptoms (PTSS) is well-documented, but less is known about factors that contribute to the expression of PTSS following community violence exposure, particularly among emerging adults of color. Utilizing the Person-Environment Interaction model (Slaug et al., 2018), this study examined the role of relational factors, specifically ethnic identity, community cohesion, and social support, associated with PTSS following exposure to community violence. Participants included 243 emerging adult university students of color (Mage = 20.27, SD = 1.95, 83.5% female). Linear regression analyses indicated that less frequent trauma exposure and greater perceived social support were related to lower PTSS. A significant interaction was also found between social support and exposure to community violence, such that at low levels of social support, individuals with more community violence exposure had the highest levels of PTSS. Regression and moderation analyses indicated that ethnic identity and community cohesion were not significantly associated with PTSS in this sample. Findings highlight the importance of incorporating social support strategies in treatments for PTSS following community violence exposure.

The Function of Connection: Examining Social Supports in the Lives of Parentally Bereaved Youth.

Through reflexive thematic analysis, this study explored three forms of social support in the lives of parentally bereaved youth: support derived from one's spirituality, caregiver support via parent-child communication, and therapist support from grief counseling (N = 30 youth, Mage = 12.5 years, SD = 2.8 years). Results showed that these sources of support serve varied and vital functions in the lives of parentally bereaved youth. Namely, the benefits of grief counseling and spirituality were consistently identified by youth as critical in facilitating their coping with the loss of a parent; while parent-child communication regarding the deceased varied widely, highlighting the need for additional supports beyond their surviving caregiver. Findings also revealed differences among these supports across youth gender, race, ethnicity, and age. Adolescents were more likely to disengage from counseling services and reported less parental and spiritual support. Males and minoritized youth experienced more benefits from spiritual and therapist supports.

Associations between Substance Use and Depressive Symptoms among Women Experiencing Intimate Partner Violence.

Associations between substance use and depression among women experiencing intimate partner violence (IPV) have received limited empirical attention. This study examined how demographics, frequency of IPV and problematic substance use were related to depressive symptoms among women exposed to recent IPV. Participants included 112 women (Mage = 32.26; 67% Black) recruited from community organizations in the U.S. Midsouth, many of whom had used substances (80.2%) and were living below the poverty threshold (71.3%). Results from a hierarchical multiple regression analysis revealed that, after accounting for age and income, more frequent IPV and more problematic tobacco use were associated with higher depressive symptoms. Neither alcohol nor illicit substance use were significantly associated with depressive symptoms. These findings highlight a meaningful connection between problematic tobacco use and depressive symptoms, indicating the potential benefits of incorporating tobacco use psychoeducation and cessation strategies into treatment programs for women experiencing depression in the context of IPV.

The protective roles of ethnic identity and community cohesion on substance use among Black women experiencing adversity.

This study employs a strengths-based approach to explore associations of ethnic identity and community cohesion with substance use among Black women experiencing adversity. Black women (N = 107; Mage = 34.2, SD = 7.7) completed interviews about their sociodemographics, HIV status, intimate partner violence exposure, ethnic identity, community connectedness, and substance use. Hierarchical linear regression analysis was used to examine associations of ethnic identity and community cohesion with substance use, accounting for age and socioeconomic status. The overall model was significant, with greater ethnic identity (ß = -.25, p < .01) and more community cohesion (ß = -.29, p < .01) associated with lower substance use. Findings highlight the value of contextual factors in substance use prevention among Black women.

Effect of time since loss on grief, resilience, and depression among bereaved emerging adults.

Grief research has typically centered on one time point, without considering the impact of multiple losses over time. In this study, 546 bereaved emerging adults were divided into three groups: those who experienced a recent loss (0-2 years ago), a past loss (>2 years ago), or a combination of both recent and past losses. Differences between the groups on resilience, depression, and grief symptomatology were examined. Those who had experienced both losses (recent and past) and recent losses endorsed significantly more grief symptoms than those in the past loss group. Findings highlight how multiple losses impact grief.

Immunohistochemical localization of renin-containing cells in two elasmobranch species.

Renin immunoreactivity was localized at the light and electron microscopic level in two elasmobranch fish species, the Atlantic stingray, Dasyatis sabina, and river ray, Potamotrygon humerosa. At the light microscopic level, the peroxidase-anti-peroxidase method showed a positive immunoreactivity in modified smooth muscle cells in kidney afferent arterioles as well as in arterioles of several organs: rectal gland, inter-renal gland, conus arteriosus, and gill. Electron microscopic renin-positive immunogold localization was confined to the contents of membrane bound granules in the modified smooth muscle cells of these arterioles. The presence of renin-containing granules in the modified smooth muscle, "granular cells," of the renal glomerular afferent arteriole of these two stingray species adds support to earlier studies which showed the structural components of a complete juxtaglomerular apparatus and some of the biochemical and molecular components of a renin-angiotensin system (RAS) as found in teleost fish, reptiles, birds, and mammals. A notable result, however, was the renin-positive immunoreaction in the arteriolar wall of all other organs studied here. The presence of this "diffuse renin system" in the connective tissue of various organs suggests that in these two stingray species in addition to local organ-specific functions, the RAS may act as a systemic mechanism to regulate blood pressure and blood flow in the body.

Picking Apart a Program Evaluation Committee: A Multiple Case Study Characterizing Primary Care Residency Program Evaluation Committee Structure, Program Improvement, and Outcomes.

BACKGROUND: As of 2014, the Accreditation Council for Graduate Medical Education (ACGME) mandates initiating a Program Evaluation Committee (PEC) to guide ongoing program improvement. However, little guidance nor published reports exist about how individual PECs have undertaken this mandate. OBJECTIVE: To explore how four primary care residency PECs configure their committees, review program goals and undertake program evaluation and improvement. METHODS: We conducted a multiple case study between December 2022 and April 2023 of four purposively selected primary care residencies (e.g., family medicine, pediatrics, internal medicine). Data sources included semi-structured interviews with four PEC members per program and diverse program artifacts. Using a constructivist approach, we utilized qualitative coding to analyze participant interviews and content analysis for program artifacts. We then used coded transcripts and artifacts to construct logic models for each program guided by a systems theory lens.  Results: Programs adapt their PEC structure, execution, and outcomes to meet short- and long-term needs based on organizational and program-unique factors such as size and local practices. They relied on multiple data sources and sought diverse stakeholder participation to complete program evaluation and improvement. Identified deficiencies were often categorized as internal versus external to delineate PEC responsibility, boundaries, and feasibility of interventions. CONCLUSION: The broad guidance provided by the ACGME for PEC configuration allows programs to adapt the committee based on individual needs. However, further instruction on program evaluation and organizational change principles would augment existing PEC efforts.

The amnionless gene, essential for mouse gastrulation, encodes a visceral-endoderm-specific protein with an extracellular cysteine-rich domain.

Fate-mapping experiments in the mouse have revealed that the primitive streak can be divided into three functional regions: the proximal region gives rise to germ cells and the extra-embryonic mesoderm of the yolk sac; the distal region generates cardiac mesoderm and node-derived axial mesendoderm; and the middle streak region produces the paraxial, intermediate and lateral plate mesoderm of the trunk. To gain insight into the mechanisms that mediate the assembly of the primitive streak into these functional regions, we have cloned and functionally identified the gene disrupted in the amnionless (amn) mouse, which has a recessive, embryonic lethal mutation that interferes specifically with the formation and/or specification of the middle primitive streak region during gastrulation. Here we report that the gene Amn encodes a novel type I transmembrane protein that is expressed exclusively in the extra-embryonic visceral endoderm layer during gastrulation. The extracellular region of the Amn protein contains a cysteine-rich domain with similarity to bone morphogenetic protein (BMP)-binding cysteine-rich domains in chordin, its Drosophila melanogaster homolog (Short gastrulation) and procollagen IIA (ref. 3). Our findings indicate that Amn may direct the production of trunk mesoderm derived from the middle streak by acting in the underlying visceral endoderm to modulate a BMP signaling pathway.

The Role of Dimensions of Emotion Dysregulation Following Exposure to Maltreatment and Adult Victimization.

Child maltreatment is related to a host of negative consequences, including difficulties with emotion regulation (ER), posttraumatic stress symptoms (PTSS), and greater risk for revictimization. Yet, the literature has largely focused on sexual revictimization, while relations between maltreatment and other adult victimization types (e.g., intimate partner violence [IPV]) are less clear. Further, associations between emotion dysregulation and both child and adult trauma exposure have been identified, but aspects of dysregulation (i.e., nonacceptance of emotional responses, difficulties engaging in goal-directed behavior, impulsivity, lack of emotional awareness, limited access to ER strategies, and lack of emotional clarity) have received less attention. This study aimed to: (1) investigate the associations between maltreatment and adult victimization and the six ER dimensions while accounting for PTSS, and (2) determine whether there are indirect effects between maltreatment and adult victimization through each ER component. Seven hundred and forty-four undergraduates from two universities participated in the study (Mage = 21.48, SD = 4.12; 80.9% women; 56.2% white). Maltreatment and PTSS were directly linked with adult victimization (B = 0.14, B = 0.01, respectively). PTSS was inversely associated with each ER aspect (Bs = 0.02-0.10). Unexpectedly, neither maltreatment nor adult victimization was related to the ER dimensions, and no indirect effects were observed between maltreatment and adult victimization through emotion dysregulation. These findings suggest that specific components of emotion dysregulation may not be tied to trauma exposure outside of PTSS. Further, it may be that the ER dimensions are not differentially related to increased risk for adult victimization.

Patterns and predictors of perinatal posttraumatic stress symptoms: A latent transition analysis.

BACKGROUND: Pregnancy is a time of increased risk for intimate partner violence (IPV), yet there is a dearth of prospective research examining the relationship between IPV and posttraumatic stress symptoms (PTSS) in the perinatal period. Further, relationships among different types of IPV and perinatal PTSS remain understudied. METHODS: Latent class and transition analyses were used to examine classes of PTSS in pregnancy and postpartum, the longitudinal patterns of transitions across these classes, and the role of IPV types, childhood adversity, and depressive symptoms in PTSS presentation. Participants (N = 238) were drawn from two longitudinal studies of high-risk perinatal women. RESULTS: Four latent PTSS classes emerged: High, Avoidant, Hypervigilant, and Low. Childhood adversity (χ2(3) = 13.09, p = .004), prenatal depression (χ2(3) = 17.58, p = .001), and psychological IPV (χ2(3) = 10.51, p = .01) were associated with membership in High, Avoidant, and Hypervigilant classes. Women with low prenatal PTSS continued to have low levels at postpartum. Women in higher severity classes during pregnancy tended to transition into classes with adjacent, and often lower, levels of symptom severity postpartum. Women in the High PTSS class in pregnancy with elevated levels of depression were significantly more likely to remain in the High PTSS class or transition into the Avoidant class at postpartum, compared to the Low PTSS class, χ2(3) = 11.84, p = .008. LIMITATIONS: Relatively modest sample size precluded examination of a broader range of symptoms consistent with PTSD. CONCLUSIONS: Findings highlight the importance of individualized approaches to assessing, monitoring, and treating perinatal PTSS.

Demographic factors, personal life experiences, and types of intimate partner violence.

OBJECTIVE: This study examines how demographic factors (i.e., age, employment, or income) and personal life experiences (i.e., witnessing intimate partner violence [IPV] in childhood, number of violent partners, violence perpetration, or stressful life events) are related to IPV frequency across types of IPV (i.e., physical assault, psychological aggression, or sexual coercion) in a racially diverse sample. METHOD: Participants included 126 women recruited from community organizations in the Mid-South, United States who experienced IPV in the past 6 months (Mage = 32.90, SD = 6.82). The majority of the sample self-identified as Black or African American (66%) and reported an annual income below $20,000 (73%). Three linear regressions were run to assess relations between age, employment status, annual income, witnessing IPV in childhood, number of violent partners, violence perpetration, and stressful life events for each type of IPV; all three models also accounted for the other forms of IPV. RESULTS: Psychological aggression was significantly associated with a higher income as well as more frequent physical assault and sexual coercion. Physical assault was linked with younger age, lower income, not witnessing IPV in childhood, IPV perpetration, more psychological aggression, and more sexual coercion. Sexual coercion was associated with more stressful life events, having multiple violent partners, higher psychological aggression, and higher physical assault. CONCLUSIONS: Results suggest that interventions should target mutable demographic factors and screen for personal life events to reduce IPV frequency and revictimization across types of IPV. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Low-Dose vs Standard Warfarin After Mechanical Mitral Valve Replacement: A Randomized Trial.

BACKGROUND: Current guidelines recommend a target international normalized ratio (INR) range of 2.5 to 3.5 in patients with a mechanical mitral prosthesis. The Prospective Randomized On-X Anticoagulation Clinical Trial (PROACT) Mitral randomized controlled noninferiority trial assessed safety and efficacy of warfarin at doses lower than currently recommended in patients with an On-X (Artivion, Inc) mechanical mitral valve. METHODS: After On-X mechanical mitral valve replacement, followed by at least 3 months of standard anticoagulation, 401 patients at 44 North American centers were randomized to low-dose warfarin (target INR, 2.0-2.5) or standard-dose warfarin (target INR, 2.5-3.5). All patients were prescribed aspirin, 81 mg daily, and encouraged to use home INR testing. The primary end point was the sum of the linearized rates of thromboembolism, valve thrombosis, and bleeding events. The design was based on an expected 7.3% event rate and 1.5% noninferiority margin. RESULTS: Mean patient follow-up was 4.1 years. Mean INR was 2.47 and 2.92 (P <.001) in the low-dose and standard-dose warfarin groups, respectively. Primary end point rates were 11.9% per patient-year in the low-dose group and 12.0% per patient-year in the standard-dose group (difference, -0.07%; 95% CI, -3.40% to 3.26%). The CI >1.5%, thus noninferiority was not achieved. Rates (percentage per patient-year) of the individual components of the primary end point were 2.3% vs 2.5% for thromboembolism, 0.5% vs 0.5% for valve thrombosis, and 9.13% vs 9.04% for bleeding. CONCLUSIONS: Compared with standard-dose warfarin, low-dose warfarin did not achieve noninferiority for the composite primary end point. (PROACT Clinicaltrials.gov number, NCT00291525).

An Examination of Study Time Allocation as a Contributor to Sex Differences in Multitrial Verbal Learning Performance.

Researchers have noted sex differences in verbal memory performance with females showing a memory superiority effect. Research paradigms have largely incorporated experimenter-timed materials. Therefore, the extent to which self-regulating study time influences this pattern of sex differences is unclear. The researcher reexamined data from a published paper to determine whether sex differences in multitrial verbal learning are minimized when individuals self-regulate their study time, or if sex differences would still remain. The results from this study showed that females outperformed males on subsequent test trials, and they allocated more study time. Controlling for the influence of study time allocation reduced or eliminated sex differences in memory performance, and only study time allocation was related to whether items were gained or lost across trials. These findings suggest the importance of self-regulated learning in reducing sex differences on a verbal memory task and the contribution of study time allocation to memory performance.

WITHDRAWN: Low-Dose Versus Standard Warfarin After Mechanical Mitral Valve Replacement: A Randomized Controlled Trial.

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Influence of cognitive abilities and age on word recall performance across trials and list segments.

The influence of cognitive abilities and age on multitrial word recall performance was examined for different list segments (i.e., first, middle, and last) and across trials by having 2497 participants ages 18-98 complete a multitrial word list test along with reference cognitive ability tests. As expected, higher episodic memory ability was associated with better recall on all list segments but with a smaller influence for the last items on the early trials. Performance improved across trials, but there were no relations of the fluid intelligence construct that might be postulated to be associated with effective strategy implementation with any of the recall measures. Advanced age was associated with lower levels of performance, but very few of the age relations were significant after the variation in the reference cognitive abilities was controlled for.

Guillain-Barré Syndrome Presenting as an Acute Back Pain.

Acute inflammatory demyelinating polyneuropathy (AIDP), characterized by the autoimmune destruction of Schwann cells with resultant myelin degradation, is the most common subtype of Guillain-Barré Syndrome (GBS). GBS encompasses a myriad of autoimmune polyradiculoneuropathies, typically following an antecedent infectious process. Symptom onset is typically 1-3 weeks following an upper respiratory or gastrointestinal illness and consists of rapidly progressive ascending areflexic motor paralysis. Lower cranial nerves are often involved, leading to bulbar weakness and respiratory compromise. Autonomic dysregulation is common and must be managed carefully to avoid potentially fatal autonomic dysregulation. Contrary to the potential severity of the condition, 66% of GBS cases present with the initial complaint of lower back pain. Intravenous Immunoglobulin (IVIg) and/or plasmapheresis coupled with supportive management is the mainstay of GBS treatment. The majority of patients make a full recovery in up to one year. The rapid and serious nature of the disease coupled with the often benign presentation can make the diagnosis a difficult but vital challenge.

Systemic Factors Associated With Prosocial Skills and Maladaptive Functioning in Youth Exposed to Intimate Partner Violence.

Children are frequently present in homes in which intimate partner violence (IPV) occurs. Following exposure to IPV, children may develop behavioral health difficulties, struggle with regulating emotions, or exhibit aggression. Despite the negative outcomes associated with witnessing IPV, many children also display resilience. Guided by Bronfenbrenner's bioecological model, this study examined person-level, process-level (microsystem), and context-level (mesosystem) factors associated with positive and negative functioning among youth exposed to IPV. Participants were 118 mothers who reported on their 6- to 14-year-old children. All mothers experienced severe physical, psychological, and/or sexual IPV in the past 6 months. Linear regression modeling was conducted separately for youth maladaptive functioning and prosocial skills. The linear regression model for maladaptive functioning was significant, F(6, 110) = 9.32, p < .001, adj R2 = 27%, with more severe IPV (ß = .18, p < .05) and more negative parenting practices (ß = .34, p < .001) associated with worse child outcomes. The model for prosocial skills was also significant, F(6, 110) = 3.34, p < .01, adj. R2 = 14%, with less negative parenting practices (ß = -.26, p < .001) and greater community connectedness (ß = .17, p < .05) linked to more prosocial skills. These findings provide critical knowledge on specific mutable factors associated with positive and negative functioning among children in the context of IPV exposure. Such factors could be incorporated into strength-based interventions following family violence.

I'll catch you when you fall: Social safety nets and housing instability in IPV-exposed pregnant women.

BACKGROUND: Intimate partner violence (IPV) has significant consequences for women's mental health, and it also compromises women's economic security and livelihood, including housing stability. There is a dearth of research, however, on protective factors in the link between housing instability and psychopathology in IPV-exposed women. METHODS: The current study examines the protective role of social support in the association between housing instability and mental health (depression, posttraumatic stress) in a sample of pregnant, IPV-exposed women (N = 137). RESULTS: Overall models for both depression and posttraumatic stress were significant (F = 6.42, p<.001; R2=16.3%; F = 15.09, p<.001; R2=31.0%, respectively). Housing instability was significantly associated with higher levels of depressed mood (ß=0.20, p<.016), but not posttraumatic stress symptoms. Social support was significantly associated with lower levels of depressed mood (ß=-0.17, p<.036) and posttraumatic stress (ß=-0.38, p =0.001). The addition of the interaction term (housing instability*social support) resulted in a significant improvement in variance explained from the main effects model for depression (F = 4.90, p<.028, ∆R2=3.0%) and the interaction term was significant (ß=-0.60, p=.029). An interaction effect of housing instability and social support on posttraumatic stress was not identified. LIMITATIONS: Although the current study is the first to examine protective factors in the relationship between housing instability and psychopathology in IPV-exposed pregnant women, data were cross-sectional and therefore directionality and temporality cannot be inferred. CONCLUSIONS: Results suggest that housing instability may play a greater role in women's depressed mood than in their experience of posttraumatic stress symptoms, and the presence of social support may substantially ameliorate the effect of this adversity.