A Logic Model for Evaluating the Academic Health Department.

Academic Health Departments (AHDs) are collaborative partnerships between academic programs and practice settings. While case studies have informed our understanding of the development and activities of AHDs, there has been no formal published evaluation of AHDs, either singularly or collectively. Developing a framework for evaluating AHDs has potential to further aid our understanding of how these relationships may matter. In this article, we present a general theory of change, in the form of a logic model, for how AHDs impact public health at the community level. We then present a specific example of how the logic model has been customized for a specific AHD. Finally, we end with potential research questions on the AHD based on these concepts. We conclude that logic models are valuable tools, which can be used to assess the value and ultimate impact of the AHD.

Assessing the mediating role of emotion regulation and experiential avoidance within a posttraumatic stress disorder and racial trauma framework.

OBJECTIVE: Theoretical and empirical evidence has begun to delineate posttraumatic stress disorder (PTSD) and racial trauma, but the degree to which individual psychological processes differ in the development of these two outcomes remains limited. Despite key distinctions in etiology and phenotypic presentations, prominent PTSD risk factors such as difficulties in emotion regulation and experiential avoidance (EA) may also contribute to the development of racial trauma. The goal of the present cross-sectional study was to investigate how difficulties in emotion regulation and EA differ in their associations with PTSD and racial trauma. METHOD: For this study, racial and ethnic minority undergraduate students completed a battery of questionnaires including the Everyday Discrimination Scale, Brief Experiential Avoidance Questionnaire, Difficulties in Emotion Regulation Scale, Trauma Symptoms of Discrimination Scale, and the PTSD checklist for DSM-5. RESULTS: A path model suggested emotion regulation difficulties and EA significantly mediated the relationship between perceived discrimination and PTSD symptoms. However, only emotion regulation difficulties mediated the relationship between perceived discrimination and racial trauma symptoms. Compared to racial trauma, pairwise comparisons suggested that emotion regulation difficulties and EA indirect effects were significantly greater when predicting PTSD symptoms. Additionally, the effects of emotion regulation difficulties were greater than EA when predicting PTSD symptoms and racial trauma. CONCLUSION: Findings of the present study suggest individual psychological factors may play a lesser role in the development of racial trauma compared to PTSD symptoms. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Examining the psychometric properties of the expressions of moral injury scale in a sample of first responders.

OBJECTIVE: There is emerging evidence that first responders, like military personnel, are at risk for exposure to potentially morally injurious events. However, studies examining expressions of moral injury in first responders are nascent, in large part due to the limited number of measures validated for use in this population. To address this gap, the present study sought to investigate the psychometric properties of the Expressions of Moral Injury Scale-Military Version (EMIS-M) in a sample of first responders. METHOD: The psychometric properties of the EMIS-M were investigated in a sample of 228 first responders to determine reliability, convergent validity, discriminative validity, and divergent validity. In addition, confirmatory factor analysis was conducted to test the bifactor model identified in a veteran sample (Currier et al., 2018). RESULTS: Results yielded an excellent fit for the bifactor model with correlated self-directed and other-directed subscales identified in the EMIS-M development study. In addition, the measure evidenced strong reliability, convergent validity, discriminative validity, and divergent validity. CONCLUSIONS: The findings of the present study suggest that the Expressions of Moral Injury Scale-First Responder Version is a psychometrically sound measure capable of assessing self- and other-directed expressions of moral injury in first responders. The significance of these findings to our understanding of moral injury in first responders and their implications for future research are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Fear of sleep in first responders: associations with trauma types, psychopathology, and sleep disturbances.

Study Objectives: Fear of sleep contributes to insomnia in some individuals with posttraumatic stress disorder (PTSD) but remains uncharacterized in first responders, a population with high rates of insomnia and PTSD. We evaluated the clinical relevance of fear of sleep in first responders by (1) examining its relationship with trauma types and clinical symptoms and (2) assessing differences in fear of sleep severity between those reporting provisional PTSD, insomnia, or both. Methods: A cross-sectional study of 242 first responders across the United States (59.2% male, 86.4% white, 56.2% law enforcement officers, 98.7% active duty, and Myears of service = 17). Participants completed the Fear of Sleep Inventory-Short Form and measures of trauma history, psychopathology (e.g. PTSD), and sleep disturbances (insomnia and trauma-related nightmares). Results: Fear of sleep was associated with trauma types characterized by interpersonal violence and victimization, as well as symptoms of PTSD, depression, anxiety, stress, alcohol use problems, insomnia, and trauma-related nightmares. Fear of sleep was most pronounced among first responders reporting provisional PTSD comorbid with insomnia compared to those with PTSD or insomnia only. Post hoc analyses revealed PTSD hyperarousal symptoms and trauma-related nightmares were independently associated with fear of sleep, even after adjusting for the remaining PTSD clusters, insomnia, sex, and years of service. Conclusions: Fear of sleep is a clinically relevant construct in first responders that is associated with a broad range of psychopathology symptoms and is most severe among those with cooccurring PTSD and insomnia. Fear of sleep may merit targeted treatment in first responders. This paper is part of the Sleep and Circadian Health in the Justice System Collection.

COVID-19 cumulative incidence, asymptomatic infections, and fatality in Long Island, NY, January-August 2020: A cohort of World Trade Center responders.

BACKGROUND: New York City and Long Island, NY were early foci of the COVID-19 epidemic in the US. The effects of COVID-19 on different sub-populations, and its key epidemiologic parameters remain unknown or highly uncertain. We investigated the epidemiology of COVID-19 from January to August of 2020 in an established academic monitoring cohort of N = 9,697 middle-aged World Trade Center responders residing in Long Island, NY. METHODS: A seroprevalence survey and a series of cross-sectional surveys were nested in a prospective cohort study. Measures included IgG antibody testing, SARS-CoV-2 polymerase chain reaction (PCR) testing, review of electronic medical records, and surveys of symptoms. Correlates of infection were analyzed with multivariable logistic regression. RESULTS: The cohort was predominantly men in their mid-fifties; 6,597 cohort members were successfully contacted (68%); 1,042 (11%) individuals participated in the seroprevalence survey; and 369 individuals (5.6% of 6,597 study participants) underwent PCR testing. The estimated standardized cumulative incidence was 21.9% (95%CI: 20.1-23.9%), the asymptomatic proportion was 16.4% (36/219; 95%CI: 11.8-22.0%), the case hospitalization ratio was 9.4% (36/385; 95%CI: 6.6-12.7%), the case fatality ratio was 1.8% (7/385; 95%CI: 0.7-3.7%), and the hospitalization fatality ratio was 8.3% (3/36; 95%CI: 1.8-22.5%). Confirmed SARS-CoV-2 infection was associated with younger age, race/ethnicity, and being currently employed. CONCLUSIONS: The results of the present study suggest a high cumulative incidence of SARS-CoV-2 among WTC responders in the spring and summer of 2020 and contribute to narrowing the plausible range of the proportion of infections that exhibit no symptoms. An increased risk of infection among younger employed individuals is likely to reflect a higher probability of exposure to the virus, and the racial disparities in the infection risk warrant further investigation.

Comparing Care for Dual-Eligibles Across Coverage Models: Empirical Evidence From Oregon.

Dual-eligible beneficiaries or "duals" are individuals enrolled in both the Medicare and Medicaid programs. For both Medicare and Medicaid, they may be enrolled in fee-for-service or managed care, creating a mix of possible coverage models. Understanding these different models is essential to improving care for duals. Using All-Payer All-Claims data, we empirically described health service use and quality of care for Oregon duals across five coverage models with different combinations of fee-for-service, managed care, and plan alignment status across Medicare and Medicaid. We found substantial heterogeneity in care across these five coverage models. We also found that duals in plans with aligned financial incentives for Medicare and Medicaid experienced more improvement in their care relative to those with nonaligned Medicare Advantage and Medicaid managed care plans. These results highlight the importance of developing policies that account for the heterogeneity of the dual population and their coverage options.

Reduced volume PCR amplification reactions using the AmpFlSTR Profiler Plus kit.

The forensic community continues to seek improvements in DNA typing methods on aspects such as sensitivity and efficacy. Reducing the volume of the AmpFlSTR Profiler Plus reagents offered greater sensitivity and improved the chance of obtaining useful results for samples with very low quantities of DNA and multiple source samples. On the downside, amplifications initiated with less than 0.4 ng of DNA exhibited a twofold increase in the standard deviation of peak ratios. This research suggested a twofold approach to analyzing samples. For samples with greater than 0.25 ng of DNA, a 25 microL reaction is appropriate. Samples that did not demonstrate quantifiable results, or that have less than 0.25 ng, can be amplified by drying the sample directly in the PCR tube and amplifying in a 5 microL reaction. The analyst can expect at least limited results with as little as 0.03 ng of DNA in the 5 microL reaction.