OBJECTIVE:Use measurement-based care to assess symptom change across diagnostic categories for adolescents receiving acute-care psychiatric inpatient treatment including both psychopharmacology and dialectical behavior therapy. METHODS:Adolescents were aged 12-17 and hospitalized on a coeducational, acute-care inpatient unit within a psychiatric hospital in New York City. We conducted a retrospective chart review to analyze symptoms across two or more timepoints from the first 15 days of admission using mixed effects regression models to estimate linear change on five outcome measures including Generalized Anxiety Disorder-7 (GAD-7), General Behavior Inventory-Mania subscale (GBI-10M), Patient Health Questionnaire-9 (PHQ-9), Prodromal Questionnaire Brief-21 (PQB-21), and Schwartz Outcome Scale-10 (SOS-10). RESULTS:There were improvements on all five measures. For the GAD-7, GBI-10M, PHQ-9, and PQB-21, the change is negative, indicating a decrease in symptoms. For the SOS-10, the change is positive, suggesting an increase in well-being. The covariance parameters indicate that there is generally significant individual variation around the adolescent's initial assessment as well as significant individual variation around the slope, suggesting that patients change at different rates. The Days × Intercept covariance parameter is generally negative, indicating that adolescents who started with higher symptom severity showed greater symptom reduction. For well-being, the negative change indicates that adolescents with higher well-being on the first assessment showed smaller increases in well-being over time. CONCLUSION:Adolescents experienced improvements in their symptoms of anxiety, mania, depression, psychosis, and well-being during acute psychiatric inpatient treatment. These are notable findings, particularly for demonstrating the impact of psychiatric inpatient treatment on improving symptoms/diagnoses.

OBJECTIVE:Firefighters are exposed to carcinogens from combustion, necessitating decontamination practices. This study developed and validated the Firefighter Exposure to Carcinogens Scale (FECS) to assess exposure-mitigating behaviors. METHODS:The sample included 179 volunteer firefighters from across Canada, comprising both English and French speakers, evaluated 20 items on exposure prevention across the following three dimensions: perceived importance, past behavior, and future intention. Principal axis factor analysis was conducted, and parallel analysis based on principal components determined the number of factors. McDonald's Omega measured internal consistency, and item-total correlations were examined. RESULTS:A one-factor solution was acceptable for all scales, with high coefficient omega values indicating strong internal consistency. Small mean differences between language groups were nonsignificant, and no correlations were found with demographic variables. CONCLUSIONS:The FECS is a reliable, valid one-factor model for both languages, supporting cancer prevention efforts.

Aggressive behavior in toddlers is a significant concern for parents and caregivers. Although aggressive behaviors commonly occur during early development, research suggests that early aggression, particularly when frequent, may signal risk for adverse developmental outcomes. Therefore, understanding how specific aggressive behaviors and their frequencies contribute to overall aggression severity warrants attention. In this study, we employed item response theory (IRT) to examine how both the type and frequency of reported aggressive behaviors relate to underlying (latent) aggression severity. Mothers of 4- to 24-month-old infants and toddlers (n = 874) reported the frequency of 10 physically aggressive behaviors using the Child Behavior Record (CBR). Most children displayed some form of aggression, with "pull hair" and "hit or smack" as the most frequently endorsed behaviors, whereas "hurt animals" was the least frequently endorsed behavior. IRT analyses revealed that "push or shove" was the best indicator for distinguishing toddlers with high and low underlying levels of aggression. For most behaviors, scores above the 95th percentile typically corresponded to high-frequency occurrence (most days to many times each day), whereas scores above the 68th percentile corresponded to lower frequency patterns (some days or higher). However, these thresholds varied by behavior type, with some behaviors (e.g., hurting animals) indicating higher severity even at low frequencies. The results of this investigation provide an empirically derived framework for understanding how both the type and frequency of aggressive behaviors relate to overall severity, potentially informing early identification and intervention strategies.

Executive function (EF) is represented by a multidimensional set of measures. The central EFs considered are inhibitory control, working memory and cognitive flexibility (task shifting). Unlike other ability constructs, it has proven difficult to identify latent factors that underlie EF. Research has often taken a factor analytic approach for grouping executive functioning tasks. However, this approach has often proven unsuccessful. We aimed to compare factor analysis to a network analytic approach, as network analysis can summarize the pattern of relationships among elements without creating latent constructs. One hundred and thirteen undergraduate students completed a series of nine executive functioning tasks. In comparing exploratory factor analysis to network analysis, we found neither approach provided a compelling higher order grouping of EF measures.

Background: Self-guided Internet-based cognitive behavior therapy (iCBT) for migraine interventions could improve access to care, but there is poor evidence of their efficacy. Methods: A three-arm randomized controlled trial compared: iCBT focused on psychoeducation, self-monitoring and skills training (SPHERE), iCBT focused on identifying and managing personal headache triggers (PRISM) and a waitlist control. The primary treatment outcome was a >= 50% reduction in monthly headache days at 4 months post- randomization. Results: 428 participants were randomized (mean age = 30.1). 240 participants (56.2%) provided outcome data at 4 months. Intention-to-treat (ITT) analysis with missing data imputed demonstrated that the proportion of responders with a >= 50% reduction was similar between combined iCBTs and waitlist (48.5/285, 17% vs. 16.6/143, 11.6%, p = 0.20), but analysis of completers showed both iCBT programs to be superior to the waitlist (24/108, 22.2% vs. 13/113, 11.5%, p = 0.047). ITT analysis with missing data imputed showed no difference between the two iCBTs (SPHERE: 24.8/143, 17.3% vs. PRISM: 23.7/142, 16.7%, p=0.99). Uptake rates of the iCBTs were high (76.9% and 81.69% logged in at least once into SPHERE and PRISM, respectively), but adherence was low (out of those who logged in at least once, 19.01% [21/110] completed at least 50% modules in SPHERE and 7.76% [9/116] set a goal for trying out a given trigger-specific recommendation in PRISM). Acceptability ratings were intermediate. Conclusions: Self-guided iCBTs were not found to be superior in our primary ITT analysis. Low adherence could explain the lack of effects as completer analysis showed effects for both interventions. Enhancement of adherence should be a focus of future research.

Background Provoked anger is associated with an increased risk of cardiovascular disease events. The underlying mechanism linking provoked anger as well as other core negative emotions including anxiety and sadness to cardiovascular disease remain unknown. The study objective was to examine the acute effects of provoked anger, and secondarily, anxiety and sadness on endothelial cell health. Methods and Results Apparently healthy adult participants (n=280) were randomized to an 8‐minute anger recall task, a depressed mood recall task, an anxiety recall task, or an emotionally neutral condition. Pre−/post‐assessments of endothelial health including endothelium‐dependent vasodilation (reactive hyperemia index), circulating endothelial cell‐derived microparticles (CD62E+, CD31+/CD42−, and CD31+/Annexin V+) and circulating bone marrow‐derived endothelial progenitor cells (CD34+/CD133+/kinase insert domain receptor+ endothelial progenitor cells and CD34+/kinase insert domain receptor+ endothelial progenitor cells) were measured. There was a group×time interaction for the anger versus neutral condition on the change in reactive hyperemia index score from baseline to 40 minutes ( P =0.007) with a mean±SD change in reactive hyperemia index score of 0.20±0.67 and 0.50±0.60 in the anger and neutral conditions, respectively. For the change in reactive hyperemia index score, the anxiety versus neutral condition group by time interaction approached but did not reach statistical significance ( P =0.054), and the sadness versus neutral condition group by time interaction was not statistically significant ( P =0.160). There were no consistent statistically significant group×time interactions for the anger, anxiety, and sadness versus neutral condition on endothelial cell‐derived microparticles and endothelial progenitor cells from baseline to 40 minutes. Conclusions In this randomized controlled experimental study, a brief provocation of anger adversely affected endothelial cell health by impairing endothelium‐dependent vasodilation.

"Development of a Word Paired-Associates Task for Longitudinal Assessment of Memory Overnight." Multivariate Behavioral Research, ahead-of-print(ahead-of-print), pp. 1–2

Research on the effect of cultural cues, such as language, on response patterns to personality measures of bilingual speakers has produced contradictory results. However, previous research was constrained by small sample sizes that were limited to either English-Spanish or English- Chinese bilingual speakers. The current research included bilingual speakers from four different language pairs and examined whether differences in personality scores between the languages would align with differences in social desirability ratings of those personality traits in their two associated cultures. In examining each of the four language pairs, we found contradictory and weak support for the phenomenon of cultural frame switching or accommodation. Moreover, English-Chinese and English-German pairs showed opposite effects, in which a trait that was rated as less desirable in a culture was endorsed more highly in the associated language. Secondly, we looked at the aggregated data across all specific languages to examine first-versus- second-language effects. When we controlled for relevant covariates in language acquisition, language fluency was the strongest predictor of the valence of personality scores: holding other variables constant, fluent participants reported more positive personality profiles – high Agreeableness, Conscientiousness, and Openness – compared to participants with lower reported language proficiency.

BackgroundThis study aims to provide insight into the specific cognitive constructs that are most strongly correlated with disturbed anger and could guide the development of more effective cognitive-behavioral treatments. The Anger Cognitions Scale-Revised (ACS-R) presents participants with nine scenarios of anger-provoking events and asks them to indicate the degree to which the situations would trigger the experience of seven different cognitive processes: hostile attributions, negative consequences of anger, inflammatory labeling, demandingness, frustration intolerance, awfulizing, and overgeneralization. The current study tested the factor structure and the construct validity of the ACS-R in a diverse sample to examine which cognitive constructs best predict dysfunctional anger and, consequently should be targeted when treating angry clients.Method1024 participants with an average age of 20.4 years (SD = 6.15) completed the ACS-R and measures of dysfunctional anger and anger outcomes via online administration.ResultsConfirmatory factor analyses found that ACS-R scores best fit a bifactor model, with 7-factors representing the seven cognitive constructs with a separate set of 9-factors in which items loaded on their respective scenarios. Multiple regression analyses revealed that negative consequences of anger, hostile attributions, and inflammatory labeling contributed more significant variance in models predicting dysfunctional anger.DiscussionAlthough additional research should replicate these results, our findings suggest that cognitive-behavioral treatment for dysfunctional anger might improve their outcomes if they targeted negative cognitions most strongly associated with dysfunctional anger. In addition, the inclusion of situational factors in our best-fitting CFA models suggests that assessing the circumstances in which one experiences distressing and unhelpful anger is essential in clinical practice.

BACKGROUND Transfusion in acute aortic syndromes has been studied in a limited fashion. We sought to describe contemporary transfusion practice for root replacement in acute (Stanford) type A aortic dissection. METHODS The Society of Thoracic Surgeons Adult Cardiac Surgery Database was interrogated to identify patients who underwent primary aortic root replacement for acute (Stanford) type A aortic dissection (July 2014 to June 2017). Pa-tients (n = 1558) were stratified by type of root replacement. Multivariate regression was used to determine those variables associated with transfusion and postoperative morbidity. RESULTS Transfusion was required in 90.5% of cases (n = 1410). Operative mortality for all patients was 17.3% (261 deaths). Intraoperative red blood cell transfusion portended reduced short-term survival (odds ratio [OR] 2.00, P = .025). Massive postoperative transfusion was associated with prolonged ventilation (OR 13.47, P < .001), sepsis (OR 4.13, P < .001), and new dialysis-dependent renal failure (OR 2.43, P < .001). Women were more likely to require transfusion (OR 3.03, P < .001), as were patients who had coronary artery bypass (OR 1.57, P = .009), and those in shock (OR 2.27, P < .001). Valve-sparing aortic root replacement was associated with reduced transfusion requirements vs composite roots. Institutional case volume was not appreciably correlated with transfusion. CONCLUSIONS Most patients undergoing root replacement for aortic dissection require blood products. Composite root replacement is associated with a greater likelihood of transfusion than a valve-sparing operation. Transfusion independently foreshadows greater operative mortality.

EXPLORING EMOTION REGULATION AND ALTRUISM WHEN EXPERIENCING COMPASSION FATIGUE FROM HUMANITARIAN CRISES, INCLUDING COVID19.

Background: Traumatic experiences are common in youth and can be classified as acute (one incident or short-term) or complex (chronic exposure to multiple traumas) experiences. Posttraumatic stress disorder (PTSD) is a common response to trauma, often co-occurring with other mental health symptoms. According to the International Classification of Diseases, 11th Edition (World Health Organization, 2018), complex PTSD includes difficulties with affect regulation, interpersonal relationships, and self-blame. Objective: The aims of this study were to evaluate trauma chronicity and PTSD presentation as moderators of outcomes of trauma-focused cognitive behavior therapy (TF-CBT). Participants and Setting: Participants included 176 youth and caregiver dyads who were participants in an ongoing effectiveness study of TF-CBT at a community-based clinic in NYC. Methods: Multilevel modeling was used to examine longitudinal, within-subject variability. Moderation analyses were used to assess the role of trauma chronicity and levels of PTSD on change in the outcomes. Results: There were no baseline differences between youth with acute versus chronic trauma. At baseline, participants who had PTSD plus 2 or 3 of the ICD-11 Complex PTSD symptom domains had significantly worse functioning than those with simple PTSD. We found significant improvement on most measures of PTSD and complex PTSD domains. Level of improvement was found to vary based on PTSD presentation at baseline. Conclusions: This is the first study to evaluate both trauma chronicity and PTSD presentation in the context of evidence-based treatment, and findings support the effectiveness of TF-CBT for simple and complex PTSD for youth who have experienced acute and chronic trauma.

Despite numerous interventions targeting medication adherence in patients with uncontrolled hypertension, practice-based trials in Latino patients are scant. To evaluate the effect of a systems-level adherence intervention, delivered by medical assistants (MAs), versus a comparison condition on medication adherence and blood pressure (BP) in 119 hypertensive Latino patients who were initially non-adherent to their antihypertensive medications. Randomized control trial. Patients (50% women; mean age, 61 years) were recruited from April 2013 to August 2015 in a community-based practice in New York. Systems-level approach that included an office system component built into the electronic health record and a provider support component consisting of nine MA-delivered health coaching sessions for improving medication adherence. The comparison group received the standard health coaching procedures followed at the clinic. The primary outcome was rate of medication adherence measured by an electronic monitoring device (EMD) across 6 months. The secondary outcomes were self-reported medication adherence measured by the eight-item Morisky Medication Adherence Scale (MMAS-8) and BP reduction from baseline to 6 months. Adherence as measure by EMD worsened for both groups (p = 0.04) with no between-group difference (− 9.6% intervention and − 6.6% control, p = 0.66). While systolic BP improved in both groups, the difference between groups was not significant (− 6 mmHg in intervention vs. − 2.7 mmHg in control, p = 0.34). In contrast, the intervention group had a greater improvement in self-reported adherence (mean change 1.98 vs. 1.26, p = 0.03) when measured using the MMAS-8. Among Latinos with poorly controlled BP who were non-adherent to their antihypertensive medications, a systems-level intervention did not improve adherence as measured by EMD nor blood pressure. However, many patients reported challenges to using the EMD. Improvements in self-reported adherence suggest that this measure captures different aspects of adherence behavior than EMD. NCT03560596

Background Physician shortage is a major barrier to hypertension (HTN) control in Ghana, with only one physician to 10,000 patients in 2015, thus limiting its capacity for HTN control at the primary care level such as the Community Health Planning and Services (CHPS) compounds, where most Ghanaians receive care. A Task-Shifting Strategy for HTN control (TASSH) based on the WHO Cardiovascular (CV) Risk Package is an evidence-based strategy for mitigating provider- and systems-level barriers to optimal HTN control. Despite its effectiveness, TASSH remains untested in CHPS zones. Additionally, primary care practices in low- and middle-income countries (LMICs) lack resources and expertise needed to coordinate multilevel system changes without assistance. The proposed study will evaluate the effectiveness of practice facilitation (PF) as a quality improvement strategy for implementing TASSH within CHPS zones in Ghana. Methods Guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we will evaluate, in a hybrid clinical effectiveness-implementation design, the effect of PF on the uptake of an evidence-based TASSH, among 700 adults who present to 70 CHPS zones with uncontrolled HTN. Components of the PF strategy include (a) an advisory board that provides leadership support for implementing the intervention within the CHPS zones and (b) trained task-strengthening facilitators (TSFs) who serve as practice coaches to provide training, and performance feedback to community health officers (CHOs) who will deliver TASSH at the CHPS zones. For this purpose, the TSFs are trained to identify, counsel, and refer adults with uncontrolled HTN to community health centers in Bono East Region of Ghana. Discussion Uptake of community-based evidence-supported interventions for hypertension control in Ghana is urgently needed to address the CVD epidemic and its associated morbidity, mortality, and societal costs. Findings from this study will provide policymakers and other stakeholders the “how to do it” empirical literature on the uptake of evidence-based task-strengthening interventions for HTN control in Ghana and will serve as a model for similar action in other low, middle-income countries. Trial registration ClinicalTrials.gov, NCT03490695 . Registered on 6 April 2018. Protocol version and date Version 1, date: 21 August, 2019.

Research suggests that personality may change due to important life events, such as psychotherapy, and that personality and attitudes may predict treatment progress. Longitudinal data in a community mental health clinic showed positive changes in Emotional Stability, Hope, Gratitude, and Motivation during the course of psychotherapy. The static approach relating baseline personality and attitudes to treatment progress did not yield fruitful results. The dynamic approach was more effective, in which we treated personality and attitudes as malleable and used changes in these variables as predictors of progress. Treatment progress correlated with an increase in Emotional Stability. Positive changes in general life attitudes (Hope, Gratitude, Quality of Life) more so than therapy-specific attitudes (Motivation, Working Alliance) predicted symptom reduction.

Although previous research indicates that both parental attributions for child misbehavior and parenting discipline are associated with child problem behavior, there is a lack of research examining the relationship between these variables in parents of young children with Autism Spectrum Disorder (ASD). This study investigated the relations between parental attributions, parenting discipline, and child problem behavior in parents of preschoolers with ASD (n = 67) as compared to parents of neurotypically developing preschoolers (n = 57). Group differences in levels of parental attributions of child internality, child stability, and child controllability, as well as lax and overreactive discipline and level of parent-reported child problem behavior, were analyzed. Additionally, child ASD status, parental attributions of controllability, lax discipline, and child problem behavior were examined within a serial multiple mediator model. Results indicated that, compared to parents of neurotypical preschoolers, parents of preschoolers with ASD were more likely to use lax discipline and attribute their child's problem behavior to factors that were uncontrollable by the child and stable over time. There were no significant group differences in attributions of child internality or overreactive discipline. The relation between child ASD status and level of child problem behavior was mediated through attributions of low child controllability and lax discipline, although controllability was the primary pathway to child problem behavior. The findings contribute to the limited literature on parental attributions, parenting discipline, and child problem behavior, and can inform future intervention for child problem behavior, particularly in the area of parent training.

The study was an evaluation of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT; Cohen et al. 2017 ) with child-caregiver dyads who experienced the death of a loved one from terrorism, using a hybrid efficacy/effectiveness design in which there were no required minimum symptom levels. Forty children ages 4–17 years old whose fathers died in the line of duty on 9/11/2001 and their mothers participated in an RCT comparing TF-CBT and Client-Centered Therapy (CCT). At baseline, mothers’ PTSD, depression, and prolonged grief symptoms were highly elevated, whereas children’s were at normative levels. Using intent-to-treat analysis, condition-by-time interactions showed significantly greater symptom reduction for mothers receiving CBT than those receiving CCT. For the children, both treatments led to significant symptom improvements.

Background: Therapeutic lifestyle change (TLC) is a recommended treatment for patients with hypertension, but its effectiveness in community-based settings remains untested, particularly in black churches—an influential institution for health promotion in black communities. Methods and Results: The FAITH study (Faith-Based Approaches in the Treatment of Hypertension) evaluated the comparative effectiveness of a TLC intervention plus motivational interviewing (MINT) sessions versus health education (HE) alone, on blood pressure (BP) reduction among blacks with uncontrolled hypertension. Data were collected on 373 participants meeting eligibility criteria (self-identification as black, age ≥18 years, self-reported diagnosis of hypertension, and uncontrolled BP [BP ≥140/90 or ≥130/80 mm Hg with diabetes mellitus or chronic kidney disease]) from 32 New York City churches. The MINT-TLC intervention plus motivational interviewing treatment comprised 11 weekly group sessions on TLC plus 3 MINT sessions delivered monthly by lay health advisors. The HE control group received 1 TLC session plus 10 sessions on health topics delivered by local experts. The outcomes were BP reduction at 6 months (primary) and BP control and BP reduction at 9 months (secondary). The sample mean age was 63 years; 76% women, with mean BP of 153/87 mm Hg. Using linear mixed-effects regression models, the MINT-TLC intervention plus motivational interviewing group had a significantly greater systolic BP reduction of 5.79 mm Hg compared with the HE group at 6 months ( P =0.029). The treatment effect on systolic BP persisted at 9 months but had reduced significance (5.21 mm Hg; P =0.068). The between-group differences in diastolic BP reduction (0.41 mm Hg) and mean arterial pressure (2.24 mm Hg) at 6 months were not significant. Although the MINT-TLC intervention plus motivational interviewing group had greater BP control than the HE group at 9 months, the difference was not statistically significant (57.0% versus 48.8%; odds ratio, 1.43; 95% CI, 0.90–2.28). Conclusions: A community-based lifestyle intervention delivered in churches led to significantly greater reduction in systolic BP in hypertensive blacks compared with HE alone. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01065831.

OBJECTIVE:Threat perceptions in the emergency department (ED; e.g., patients' subjective feelings of helplessness or lack of control) during evaluation for an acute coronary syndrome (ACS) are associated with the development of posttraumatic stress disorder (PTSD), and PTSD has been associated with medication nonadherence, cardiac event recurrence, and mortality. This study reports the development and validation of a seven-item measure of ED threat perceptions in English- and Spanish-speaking patients evaluated for ACS.METHODS:Participants were drawn from an observational cohort study of 1,000 patients evaluated for ACS between 2013 and 2016 in a large New York City hospital. Participants reported on threat perceptions in the ED and during inpatient stay (using 12 items previously identified as predictive of PTSD) and reported on cardiac-induced PTSD 1 month postdischarge. Exploratory and confirmatory factor analyses were used to establish the factor structure and test measurement invariance. Validity and reliability were examined, as was the association of ED threat perceptions with cardiac-induced PTSD.RESULTS:Factor analyses identified a seven-item measure of ED threat perceptions (e.g., "I feel helpless," "I am worried that I am going to die") for both English- and Spanish-speaking patients. ED threat perceptions demonstrated convergent validity, correlating with ED stress and ED crowdedness (r = 0.29 and r = 0.14), good internal consistency (α = 0.82), and stability (r = 0.61). Threat perceptions were associated with cardiac-induced acute stress at inpatient and PTSD symptoms at 1 month (r = 0.43 and r = 0.39).CONCLUSIONS:This brief tool assessing ED threat perceptions has clinical utility for providers to identify patients at risk for developing cardiac-induced PTSD and is critical to inform research on whether threat may be modified in-ED to reduce PTSD incidence.