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Purpose: Esophageal perforation (EP) can be a diagnostic challenge. Computed tomography (CT) and CT esophagography (CTE) are often used to rule out EP in the emergency setting with promising diagnostic performance, but the standard of care remains fluoroscopic esophagography (FE). We assess the diagnostic performance of CT and CTE when interpreted by expert and generalist radiologists and created an imaging workflow guide. Methods: Retrospective study of patients presenting with suspected EP. Two expert radiologists independently reviewed blinded CT/CTE studies, recorded CT findings, and assigned an esophageal injury grade. We also collected initial (general radiologist) CT findings and interpretation and FE diagnoses. We assessed inter-reader reliability and diagnostic performance. Results: EP was diagnosed in 46/139 (33%) encounters. The most common CT/CTE findings in EP were esophageal wall thickening (46/46, 100%), pneumomediastinum (42/46, 91%), and mediastinal stranding (39/46, 85%). CT and CTE sensitivity for detecting EP was 89% and 89% for expert radiologists, respectively, and 79% and 82% for general radiologists, compared with 46% for FE. Inter-reader agreement for detecting EP by CT and CTE was kappa 0.35 and 0.42 (both p <.001) between expert and generalist radiologists. We present radiographic images for key CT/CTE findings and a suggested workflow for the evaluation of possible EP. Conclusion: CT and CTE are more sensitive than FE for EP in the emergency setting. Due to the rarity of EP and current wide variability in imaging interpretation, an imaging workflow and injury grading system based on esophageal and mediastinal CT findings are offered to help guide management. [ABSTRACT FROM AUTHOR]

Peers are critical influencers of adolescent behavior, including defending against peer victimization. The current research explored peer influence processes associated with four different types of peer‐defending behaviors (comforting, reporting, solution‐focused, and aggressive defending behaviors) within early adolescent friendship networks. Links with peer victimization, friendship ties, and gender were also explored. Data were collected from 334 early adolescents ages 11–14 in Canada. Participants self‐reported on defending behaviors, victimization, and friendships over two time‐points, 8–10 weeks apart. Data were analyzed using Stochastic Actor‐Oriented Models (SAOMs). After controlling for friendship network structure and peer selection for defending behaviors, results indicated significant peer socialization effects for comforting, reporting, and solution‐focused defending. For solution‐focused defending only, the peer socialization effect was significantly stronger for girls than for boys. There were no significant selection effects across defending behaviors. In terms of social outcomes, youth with higher levels of reporting tended to have higher levels of peer victimization (and vice versa). Peer victimization was also positively associated with aggressive defending. Defending behaviors were generally unrelated to changes in friendship ties. Overall, these results highlight how friendships contribute to the development of peer‐defending behaviors and emphasize the need to examine defending as a multidimensional behavior. [ABSTRACT FROM AUTHOR]

Peers are present for most bullying episodes. Peers who witness bullying can play an important role in either stopping or perpetuating the behavior. Defending can greatly benefit victimized peers. Empathy is strongly associated with defending. Yet, less is known about defenders' neural response to witnessing social distress, and how this response may relate to the link between empathy and defending. Forty-six first-year undergraduate students (Mage = 17.7; 37 women), with varied history of peer defending, underwent fMRI scanning while witnessing a depiction of social exclusion. Functional connectivity analysis was performed across brain regions that are involved in cognitive empathy, empathetic distress, and compassion. History of defending was positively associated with functional connectivity (Exclusion > Inclusion) between the left orbitofrontal cortex (OFC) – medial prefrontal cortex (MPFC), and right OFC – left and right amygdalae. Defending was negatively associated with functional connectivity between the left OFC – anterior cingulate cortex. The relationship between history of defending and empathy (specifically, empathetic perspective taking) was moderated by functional connectivity of the right OFC – left amygdala. These findings suggest that coactivation of brain regions involved in compassionate emotion regulation and empathetic distress play a role in the relationship between empathy and peer defending. [ABSTRACT FROM AUTHOR]

Cystic fibrosis (CF) may predispose patients to urinary stone disease (USD), but reported prevalence of USD in patients with CF in previous small studies is variable. To date, analysis of risk factors for USD within the CF population has been limited. We studied 29,396 patients in the Cystic Fibrosis Foundation Patient Registry to calculate age and sex-stratified prevalence of USD. For adult patients, we examined age and multivariable-adjusted cross-sectional associations between demographic and clinical factors, CFTR mutation class, and prevalent USD. Prevalence of USD was 0.4% (95% CI 0.3–0.5%) under age 18 years, 3.1% (2.7–3.6%) at 18–24 years, 6.4% (5.8–7.1%) at 25–34 years, 7.5% (6.5–8.5%) at 35–44 years, and 6.7% (5.8–7.8%) at 45 years and older. Prevalence for women was higher than men at younger (< 45 years) but not older ages (P value for interaction < 0.0005). Multivariable odds of prevalent USD were significantly increased for severe CFTR mutations, OR 1.53 (1.14–2.06), diabetes, OR 1.24 (1.03–1.50), hypertension, OR 1.58 (1.29–1.93), and chronic macrolide therapy, OR 1.27 (1.07–1.52). BMI was not associated with USD. USD prevalence in CF is similar to that in the general population. With the exception of BMI, known risk factors for USD in the general population also appear to be important for patients with CF. We identified several novel associations in CF patients, including greater prevalence of USD in individuals with severe CFTR mutations and among young women. [ABSTRACT FROM AUTHOR]

Different patterns of sexting behaviors were examined to provide a more nuanced understanding of the context in which sexting occurs among adolescents. Participants were 1,000 Canadian adolescents (50.2% girls) between 12 and 18 years (M age = 15.21, SD = 2.00) who completed measures of sexting, cyber bullying and victimization, problematic social media use, self-regulation, and demographics. Contrary to our hypotheses, three latent profiles of sexting represented the frequency of sexting rather than whether the sexting was consensual versus non-consensual or with a partner versus non-partner. Participants in the moderate and high sexting profiles representing one fifth of youth, reported less self-regulation, experienced more cyber victimization, and engaged in more cyber bullying and problematic social media use than those in the no/low sexting profile. Our findings support the normalcy approach to education, which considers some sexting among healthy developmental behaviors. [ABSTRACT FROM AUTHOR]

This preliminary study explored a person-group dissimilarity hypothesis in the context of adolescent sexual harassment. Theory suggests that victimized youth are expected to experience worse outcomes if they perceive victimization to be a rare experience among their peers. This study comprised 435 middle school students who reported on their experiences of sexual harassment (victimization and witnessing), shame, and depressive symptoms. We tested a cross-sectional conditional indirect-effects model, with shame mediating the relationship between victimization and depressive symptoms (the indirect effect) and with witnessing as a moderator of the indirect effect. For all students, shame mediated the relationship between victimization and depressive symptoms. For female students, there was a buffering effect of witnessing, whereby the indirect effect was weaker at high levels of witnessing. These findings have potential implications for theory and intervention, suggesting the importance of examining young people's social contexts to better understand their responses to sexual harassment. [ABSTRACT FROM AUTHOR]

Defending represents any prosocial behavior taken to assist an individual being victimized. Like other forms of prosocial behavior, defending may be best conceptualized as a multidimensional set of behaviors, including both direct and indirect forms of defending. The objective of the current research was to design and validate the Defending Behaviors Scale (DBS), a multidimensional self-report scale of defending behaviors. Data were collected from 572 early adolescents in Grades 6 to 8. Participants completed the DBS as well as established measures of bullying, victimization, empathy, aggression, social self-efficacy, social support, and prosocial behavior. Data were analyzed using an exploratory structural equation modeling framework. A four-factor model provided the best fit to the data. Direct defending included aggressive and solution-focused behaviors, whereas indirect defending included comforting and reporting to authority. Girls were more likely to defend others by offering comfort and reporting to authority, whereas aggressive defending was more common among boys. Each subscale demonstrated good internal consistency (α's 0.80–0.92) and was uniquely associated with empathy, aggression, and other types of prosocial behavior. The DBS is a new, psychometrically-valid measure that will aid in the assessment of heterogenous defending behaviors. [ABSTRACT FROM AUTHOR]

Bullying and peer victimization are stressful experiences for youth, and are associated with increased risk for psychopathology. Physiological differences in the body's stress response system may help us to understand vulnerability for depressive symptoms among youth involved with bullying. The current study examined both sympathetic and parasympathetic activity using skin conductance (SCL) and respiratory sinus arrhythmia (RSA) at a neutral baseline and during Cyberball, a stressful social exclusion paradigm. Participants consisted of 175 youth in grades 6-11 (mean age 13.6 years, 51% girls). Multilevel modeling was used to examine changes in both positive and negative affect, and physiological stress reactivity over time. Logistic regression was used to examine the associations between bullying, victimization, and RSA on depressive symptoms. Peer victimization was negatively associated with resting RSA. Bullying others was negatively associated with SCL during Cyberball. Additionally, RSA reactivity during acute stress moderated the link between victimization and depressive symptoms. Victimization was more strongly associated with depressive symptoms when youth also demonstrated blunted RSA reactivity. These results suggest that both victimized youth and those who bully others have differences in their autonomic responses to acute stress. Individual differences in stress physiology may help us to understand vulnerability and resilience to depressive symptoms in the context of bullying and victimization. [ABSTRACT FROM AUTHOR]

Emotion socialization by close relationship partners plays a role in adolescent depression. In the current study, a microsocial approach was used to examine how adolescents' emotions are socialized by their mothers and close friends in real time, and how these interpersonal emotion dynamics are related to adolescent depressive symptoms. Participants were 83 adolescents aged 16 to 17 years who participated in conflict discussions with their mothers and self-nominated close friends. Adolescents' positive and negative emotions, and mothers' and peers' supportive regulation of adolescent emotions, were coded in real time. Two multilevel survival analyses in a 2-level Cox hazard regression framework predicted the hazard rate of (1) mothers' supportive regulation of adolescents' emotions, and (2) peers' supportive regulation of adolescents' emotions. The likelihood of maternal supportiveness, regardless of adolescent emotions, was lower for adolescents with higher depressive symptoms. In addition, peers were less likely to up-regulate adolescent positive emotions at higher levels of adolescent depressive symptoms. The results of the current study support interpersonal models of depression and demonstrate the importance of real-time interpersonal emotion processes in adolescent depressive symptoms. [ABSTRACT FROM AUTHOR]

Objective. Oral and injected steroids are used commonly in the treatment of cervical radicular pain despite a paucity of data demonstrating their efficacy. The purpose of this study is to assess whether the response to orally administered steroids among patients with acute cervical radicular pain who develop recurrent pain is associated with their subsequent response to cervical epidural steroid injections. Methods. Patients referred to our center were evaluated and then referred for cervical epidural steroid injections at the clinical discretion of the provider; those who met inclusion criteria were offered participation in the study. After the injectionwas administered, patients were contacted by telephone and asked to complete the Brief Pain Inventory Short Form at one week, one month, threemonths, and sixmonths postinjection. Results. Pain reduction after cervical steroid injection was not significantly different between 49 patients who reported pain reduction with a prior course of oral steroids and 22 patients who reported no pain reduction. Average pain scores decreased over six months (P< 0.001) among 72 patients treated with epidural steroid injection for cervical radicular pain. Of the 55 who provided baseline and six-month data, 14 (25.5%) reported complete relief at six months and 20 (36.4%) reported decreased pain. Conclusions. Patients can be reassured that they may experience pain reduction after a cervical epidural steroid injection even if oral steroid therapy was not effective. The majority of patients treated for cervical radicular pain with epidural steroid injection have reduced or absent pain for at least six months after treatment. [ABSTRACT FROM AUTHOR]

Current practices of identifying and treating small indolent thyroid cancers constitute an important but in some ways unusual form of overdiagnosis. Overdiagnosis refers to diagnoses that generally harm rather than benefit patients, primarily because the diagnosed condition is not a harmful form of disease. Patients who are overdiagnosed with thyroid cancer are harmed by the psycho-social impact of a cancer diagnosis, as well as treatment interventions such partial or total thyroidectomy, lifelong thyroid replacement hormone, monitoring, surgical complications and other side effects. These harms seem to outweigh any putative benefit of knowing about a cancer that would not have caused problems if left undiscovered. In addition to harms to patients, thyroid cancer overdiagnosis leads to significant opportunity costs at a societal level, due to costs of diagnosis and treatment. Unlike many other overdiagnosed cancers, accurate risk stratification is possible with thyroid cancer. At the individual patient level, use of this risk information might support informed choice and/or shared decision-making, as mandated by clinical ethics frameworks. And this approach might, to some extent, help to reduce rates of diagnosis and intervention. In practice, however, it is unlikely to stem the rising incidence and associated harms and costs of overdiagnosed thyroid cancer, especially in situations where health professionals have conflicts of interest. We argue in this article that thyroid cancer overdiagnosis may be usefully understood as a public health problem, and that some public health approaches will be readily justifiable and are more likely to be effective in minimising its harms. [ABSTRACT FROM AUTHOR]

Background: Youth involved with school bullying are vulnerable to many negative outcomes, including substance use. Research has yet to examine how this vulnerability operates in the context of other individual and neighbourhood differences. The current study aimed to fill this gap by using multilevel modeling to investigate both the individual and neighbourhood risk factors associated with frequent drunkenness and frequent cannabis use among adolescents.Methods: Data from the 2010 Canadian Health Behaviours in School-Aged Children (HBSC) survey were analyzed. Participants consisted of 8971 students from 173 neighbourhoods across Canada. Multilevel modeling was used to examine both individual (age, gender, bullying, victimization, peer deviancy, negative affect) and neighbourhood (socioeconomic status, crime, physical neighbourhood disorder, residential instability) risk factors. We tested whether the links between bullying involvement and frequent substance use were mediated by other risk factors.Results: Both individual and neighbourhood risk factors were associated with an increased likelihood of frequent substance use. Specifically, bullying served as a unique risk factor for frequent substance use over and above more traditional risk factors. A cross-level interaction was observed between residential instability and peer deviancy, such that the link between peer deviancy and frequent drunkenness was stronger in more residentially-unstable neighbourhoods. Peer deviancy partially mediated the link between bullying and both types of frequent substance use, whereas both peer deviancy and negative affect mediated the link between victimization and both types of frequent substance use.Conclusions: Youth who bully others are vulnerable to frequent substance use across peer and neighbourhood contexts. [ABSTRACT FROM AUTHOR]

• The frequency of clinical failure was similar in the continued IV and PO step-down groups (24.2% vs. 18.0%, P =0.23). • Hospital length of stay was longer in the IV group compared with the PO group (7 [5-13.5] vs. 4 [3–5] days, P <0.001). • The incidence of antibiotic adverse events was similar in the IV and PO groups (1.3% vs. 1.8%, P =0.74). The purpose of this study was to compare the clinical outcomes of adults with uncomplicated streptococcal bacteremia who received either oral (PO) step-down or continued intravenous (IV) therapy. This was a retrospective, single-center, cohort study, including adults admitted with Streptococcal bloodstream infection between January 1, 2013, and December 31, 2020. Only patients with uncomplicated Streptococcal bloodstream infections were included. Patients who transitioned to PO therapy within 5 days from bacteremia onset were compared to patients receiving continued IV therapy. The primary outcome was clinical failure, defined by either 90-day hospital readmission or mortality. Secondary outcomes included hospital length of stay (LOS) and antibiotic-related adverse events (AAEs). Of the 264 patients included, 42% were transitioned to PO therapy. Group B Streptococcus (22.7%) was the most common isolate. The most common sources of infection were skin and soft tissue (35%) and pulmonary (25%). Intensive care unit (ICU) stay was more common in the continued IV therapy group (22.2%) than in the PO step-down group (5.4%). The frequency of clinical failure was similar in the IV and PO groups (24.2% vs. 18.0%, P =0.23). The IV group had longer hospital LOS (median, [interquartile range (IQR)]) compared with the PO group (7 [5-13.5] vs. 4 [3–5] days, P <0.001). The incidence of AAEs was similar in the IV and PO groups (1.3% vs. 1.8%, P =0.74). Oral antibiotic step-down therapy may be appropriate for the treatment of uncomplicated Streptococcal bacteremia, with consideration of factors such as patient comorbidities, type of infection, source control and clinical progress. [ABSTRACT FROM AUTHOR]

Introduction: Previous research shows that adolescents who experience dating violence most often disclose their victimization to a peer or friend, more so than to other sources of support. However, surprisingly little research has explored how adolescents respond to peer disclosures of dating violence. Addressing this gap, the present study assessed variations in adolescents' perceptions of blame, interpretations of the incident as violence, and intentions to respond across physical, psychological, sexual, cyber‐psychological, and cyber‐sexual dating violence scenarios. Methods: As part of a national research project across Canada, 663 high school adolescents (432 girls, 65.2%) between the ages of 14‐17 were randomly assigned to complete a questionnaire which included one of five different hypothetical dating violence scenarios. Next, participants responded to questions about their perceptions of the incident, as well as victim and perpetrator blame and responsibility, and their intentions to respond. Results: Results indicated that the type of dating violence experienced and the age and gender of participants all played a role in perceptions of blame, understandings of violence, and intentions to respond. Conclusions: As one of the first studies to explore how adolescents perceived and responded to dating violence, considering both in‐person and cyber forms of dating violence, this study fills an important gap in the literature. Findings underscore the uniqueness of cyber forms of dating violence and how pre/intervention programs must address the specific contexts and issues unique to each type of dating violence. [ABSTRACT FROM AUTHOR]

Several studies have now reported associations between gestational diabetes mellitus (GDM) and low free thyroxine (fT4) during the second and third trimesters, but not in the first trimester. The present study further examines relationships between low fT4, maternal weight, and GDM among women in the FaSTER (First and Second Trimester Evaluation of Risk) trial, in an effort to determine the extent to which thyroid hormones might contribute to causality. The FaSTER cohort includes 9351 singleton, euthyroid women; 272 of these women were subsequently classified as having GDM. Thyrotropin (TSH), fT4, and thyroid antibodies were measured at 11–14 weeks’ gestation (first trimester) and 15–18.9 weeks’ gestation (second trimester). An earlier report of this cohort documented an inverse relationship between fT4 in the second trimester and maternal weight. In the current analysis, women with GDM were significantly older (32 vs. 28 years) and weighed more (75 vs. 64.5 kg). Maternal weight and age (but not TSH) were significantly associated univariately with fT4 (dependent variable), in the order listed. Second trimester fT4 odds ratios (OR) for GDM were 2.06 [95% CI 1.37–3.09] (unadjusted); and 1.89 [95% CI 1.26–2.84] (adjusted). First trimester odds ratios were not significant: OR 1.45 [95%CI 0.97–2.16] (unadjusted) and 1.11 [95% CI 0.74–1.62] (adjusted). The second trimester fT4/GDM relationship thus appeared to strengthen as gestation progressed. In FaSTER, high maternal weight was associated with both low fT4 and a higher GDM rate in the second trimester. Peripheral deiodinase activity is known to increase with high caloric intake (represented by high weight). We speculate that weight-related low fT4 (the metabolically inactive prohormone) is a marker for deiodinase activity, serving as a substrate for conversion of fT4 to free triiodothyronine (fT3), the active hormone responsible for glucose-related metabolic activity. [ABSTRACT FROM AUTHOR]

To compare the live birth rates (LBRs) in modified natural and programmed single blastocyst frozen embryo transfer (FET) cycles. Retrospective cohort study. University-affiliated fertility practice. Patients who underwent single blastocyst FETs between January 2014 and December 2019. A total of 15,034 FET cycles from 9,092 patients were reviewed; 1,186 modified natural and 5,496 programmed FET cycles from 4,532 patients met the inclusion criteria for analysis. No intervention. The primary outcome measure was the LBR. There was no difference in live birth after programmed cycles using intramuscular (IM) progesterone or a combination of vaginal progesterone and IM progesterone compared with that after modified natural cycles (adjusted relative risks, 0.94 [95% confidence interval {CI}, 0.85–1.04] and 0.91 [95% CI, 0.82–1.02], respectively). The relative risk of live birth decreased in programmed cycles that used exclusively vaginal progesterone compared with that in modified natural cycles (adjusted relative risk, 0.77 [95% CI, 0.69–0.86]). The LBR decreased in programmed cycles that used only vaginal progesterone. However, no difference in the LBRs existed between modified natural and programmed cycles if programmed cycles used either IM progesterone or a combination of IM and vaginal progesterone protocols. This study demonstrates that modified natural FET cycles and optimized programmed FET cycles have equivalent LBRs. [ABSTRACT FROM AUTHOR]

For emerging adults, high-quality friendships can be an important source of companionship and support. The most commonly studied negative interaction between friends is conflict, yet work with youth suggests more serious victimization also occurs in friendship. In the current study, we developed and obtained preliminary psychometric evidence for the Friendship Victimization Scale, a measure that assesses physical, sexual, relational, and verbal forms of victimization in the friendships of emerging adults, as well as coercive and controlling behaviors. Emerging adults (N = 316, M age = 21.27 years, SD = 1.47; 60.4% women, 37.0% men; 59.2% White) completed the Friendship Victimization Scale along with measures to examine construct validity. The majority of the sample reported experiencing at least one act of victimization by a friend, and men reported more victimization than did women. Results supported a 2-factor structure, with relational and verbal victimization loading on one factor and physical and sexual victimization and controlling behaviors loading on the other. Cronbach's alphas exceeded.90 for the total score and both subscales. Greater friendship victimization was predicted by negative features in each of a best and a challenging friendship, even after accounting for negative features in a dating relationship, and was unrelated to positive features in any of these relationships. Overall, results indicate that victimization is common in emerging adults' friendships. The findings provide preliminary evidence for the utility of the Friendship Victimization Scale as a measure of this understudied source of risk in the interpersonal lives of emerging adults. [ABSTRACT FROM AUTHOR]

A substantial minority of adolescents experience and use dating violence in their sexual and/or romantic relationships. Limited attention has been paid to exploring theory-driven questions about use and experience of adolescent dating violence (ADV), restricting knowledge about promising prevention targets for diverse groups of youth. To address this gap, this paper investigates whether factors tied to power imbalances (bullying, risk of social marginalization) are associated with patterns of ADV victimization and perpetration in a large sample of Canadian mid-adolescents. We used data from the 2017/2018 Health-Behavior in School-Aged Children (HBSC) study, a nationally representative sample of Canadian youth. Our study was comprised of adolescents who were in grades 9 or 10, and who had dated in the past 12 months (N = 3779). We assessed multiple forms of ADV and bullying victimization and perpetration. We also included six variables assessing adolescents' risk of social marginalization: gender, race/ethnicity, immigration status, family structure, food insecurity, and family affluence. We used latent class analysis to explore the ways adolescents experience and use different forms of ADV, and then examined whether factors tied to power imbalances (bullying, social marginalization) were associated with classes of ADV. Three ADV classes emerged in our sample: uninvolved (65.7%), psychological and cyber victimization only (28.9%), and mutual violence (5.4%). Bullying was most strongly associated with the mutual violence class, suggesting a transformation of power from peer to romantic contexts. Social marginalization variables were associated with ADV patterns in different ways, highlighting the need to use a critical and anti-oppressive lens in ADV research and prevention initiatives. [ABSTRACT FROM AUTHOR]

Background: Transversus abdominis plane blocks are an established method of postoperative analgesia for abdominopelvic surgeries. Liposomal bupivacaine is an extended‐release formulation of bupivacaine providing up to 72 h of analgesia. This study aims to determine if transversus abdominis plane blocks performed with liposomal bupivacaine are associated with reduced opioid consumption and level of pain intensity compared to conventional bupivacaine in patients undergoing lower abdominal surgery. Methods: This retrospective cohort study was conducted at a single institution between December 2020 and December 2021. After institutional review board approval, we identified patients who underwent lower abdominopelvic surgery with transversus abdominis plane blocks done with liposomal or conventional bupivacaine and collected demographic, clinical, and procedural information for analysis. We compared total opioid consumption over 72‐h postoperatively in milligram morphine equivalents (MME), frequency of opioid utilization, and average level of pain intensity between groups. These outcomes were also evaluated after adjusting for covariates. Data were presented as mean ± SD, median [IQR] or frequency (%), as appropriate; p < 0.05 was accepted as significant. Results: A total of 178 patients met inclusion criteria, with 79 patients receiving an admixture of liposomal bupivacaine and conventional bupivacaine and 99 patients receiving conventional bupivacaine. The liposomal bupivacaine group had a median opioid consumption 72‐h postoperatively of 47.5 [18–91.8] MME compared to 88 [43.8–160] MME in the conventional bupivacaine group, p = 0.045. Differences in opioid consumption between the groups did not reach statistical significance after adjustment for demographic and clinical characteristics, p = 0.11. There was no significant difference in frequency of opioid use or average pain intensity. Conclusion: Transversus abdominis plane blocks using an admixture of liposomal bupivacaine conventional bupivacaine are not associated with decreased opioid consumption or reduced pain up to 72 h following elective abdominopelvic surgery. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has had a profound impact on the academic work environment. Studies have documented cross-sectional associations between COVID-related stress and mental health symptoms in university faculty and staff. However, longitudinal studies that can establish temporal associations are needed. Further, it is important to determine if relations to mental health symptoms are driven by worries about COVID-19 (i.e., perceptions of stress) or actual impacts of COVID-19 across domains of health, job, and relationships. The present study included 100 faculty and 265 staff at a medium-sized Canadian University who completed an adapted version of the electronic U-Flourish well-being survey at two time points (October, 2020 and March, 2021). Cross-lagged panel modeling provided evidence that levels of COVID-19 worries and COVID-19 impacts at baseline significantly positively predicted follow-up levels of anxiety over and above baseline levels. Further, baseline levels of anxiety were positively associated with follow-up levels of COVID-19 worries, but not with follow-up COVID-19 impacts. In contrast, none of the cross-lagged associations with depressive symptoms were significant. We suggest from these results that post-COVID-19 mental health recovery can be promoted by academic leadership in two main ways. First, reducing the impact of COVID-19 on anxiety could be achieved through strategies that enhance individuals' sense of control and predictability in their environment, including clear, consistent, and consolidated communication. Second, reducing worry about COVID-19 for faculty and staff with preexisting mental health symptoms might be achieved by broadening access to mental health support. [ABSTRACT FROM AUTHOR]

The current study evaluated factors that can help to account for the links between peer victimization and distress among 1039 adolescents. We assessed whether rejection sensitivity and self-esteem mediate the longitudinal associations between peer victimization and mental health problems. High school students completed a series of self-report questionnaires assessing forms of peer victimization, rejection sensitivity, self-esteem, depressive symptoms, and substance use at two time points. The key finding was that both rejection sensitivity and self-esteem mediated the associations between peer victimization at Time 1 and mental health problems 1-year later. These results help illuminate the mechanisms through which peer victimization is associated with mental health problems in adolescents. The theoretical and practical implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Pre‐market/prospective environmental risk assessments (ERAs) contribute to risk analyses performed to facilitate decisions about the market introduction of regulated stressors. Robust ERAs begin with an explicit problem formulation, which involves among other steps: (1) formally devising plausible pathways to harm that describe how the deployment of a regulated stressor could be harmful; (2) formulating risk hypotheses about the likelihood and severity of such events; (3) identifying the information that will be useful to test the risk hypotheses; and (4) developing a plan to acquire new data for hypothesis testing should tests with existing information be insufficient for decision‐making. Here, we apply problem formulation to the assessment of possible adverse effects of RNA interference‐based insecticidal genetically modified (GM) plants, GM growth hormone coho salmon, gene drive‐modified mosquitoes and classical biological weed control agents on non‐target organisms in a prospective manner, and of neonicotinoid insecticides on bees in a retrospective manner. In addition, specific considerations for the problem formulation for the ERA of nanomaterials and for landscape‐scale population‐level ERAs are given. We argue that applying problem formulation to ERA maximises the usefulness of ERA studies for decision‐making, through an iterative process, because: (1) harm is defined explicitly from the start; (2) the construction of risk hypotheses is guided by policy rather than an exhaustive attempt to address any possible differences; (3) existing information is used effectively; (4) new data are collected with a clear purpose; (5) risk is characterised against well‐defined criteria of hypothesis corroboration or falsification; and (6) risk assessment conclusions can be communicated clearly. However, problem formulation is still often hindered by the absence of clear policy goals and decision‐making criteria (e.g. definition of protection goals and what constitutes harm) that are needed to guide the interpretation of scientific information. We therefore advocate further dialogue between risk assessors and risk managers to clarify how ERAs can address policy goals and decision‐making criteria. Ideally, this dialogue should take place for all classes of regulated stressors, as this can promote alignment and consistency on the desired level of protection and maximum tolerable impacts across regulated stressors. [ABSTRACT FROM AUTHOR]

We propose that self-esteem importance has utility in research involving adolescents. Canadian adolescents ages 11–14 years (N =334) were compared to a large sample (N= 1792) and a validation subsample (n= 437) of young adults. Supplementary analyses established that our scale of self-esteem importance showed good psychometric performance among adolescents and adults. Structural equation modeling revealed that self-esteem and self-esteem importance had unique associations with bullying and victimization experiences, defending behaviors, and prosocial motivations. These associations were very similar across age groups. We propose that assessing young people's beliefs about self-esteem's importance provides useful information, not captured by self-esteem alone, about their identity and social experience. [ABSTRACT FROM AUTHOR]

Objectives: Universal screening for substance use during pregnancy, brief intervention, and referral to treatment (SBIRT) is recommended by ACOG and the USPSTF. Here we present the implementation of SBIRT into the electronic health record (EHR) to inform clinical intervention and collect data on the prevalence of substance use during pregnancy at three prenatal clinics. Methods: A literature-based SBIRT instrument was developed. The tool was integrated into the EHR of a resident Ob/Gyn clinic, an MFM practice, and an Ob/Gyn generalist practice at our institution, an academic, tertiary care medical center in an urban area, and automated reports of aggregate retrospective EHR data were used to monitor patient responses to SBIRT over time. Data reports included patient responses to screening for substance use, brief intervention, and referral to treatment from January to December 2018 Results: An interprofessional team of health care providers and systems analysts guided the SBIRT implementation process. As of December 2018, overall SBIRT performance during prenatal care encounters was 1797/2619 (69%), 432/1350 (32%), and 1290/1518 (85%) in the resident clinic, MFM practice, and generalist practice, respectively. Eighty (5.1%) women in the resident clinic, 2 (0.5%) in the MFM practice and 14 (1%) in the generalist practice reported past or present substance use. Conclusions for Practice: Integrating universal SBIRT into prenatal care using the EHR requires a multi-disciplinary approach. The SBIRT tool facilitates reportable substance use screening, brief intervention, and referral to treatment during prenatal care. Future reports will further characterize substance use in our prenatal practices and inform intervention strategies in this population. [ABSTRACT FROM AUTHOR]

The number of patients maintained on buprenorphine is steadily increasing. To date, no study has reported buprenorphine management practices for these patients during critical illness, nor its relationship with supplemental full‐agonist opioid administration during their hospital stay. In this single‐center retrospective study, we have explored the incidence of buprenorphine continuation during critical illness among patients receiving buprenorphine for the treatment of opioid use disorder. Additionally, we investigated the relationship between nonbuprenorphine opioid exposure and buprenorphine administration during the intensive care unit (ICU) and post‐ICU phases of care. Our study included adults maintained on buprenorphine for opioid use disorder admitted to the ICU between December 1, 2014, and May 31, 2019. Nonbuprenorphine, full agonist opioid doses were converted to fentanyl equivalents (FEs). Fifty‐one (44%) patients received buprenorphine during the ICU phase of care, with an average dose of 8 (8–12) mg/day. During the post‐ICU phase of care, 68 (62%) received buprenorphine, with an average dose of 10 (7–14) mg/day. Lack of mechanical ventilation and acetaminophen use were also associated with buprenorphine use. Full agonist opioid use was more frequent on days when buprenorphine was not given (odds ratio [OR], 6.2 [95% CI, 2.3–16.4]; P <.001). Additionally, the average cumulative dose of opioids given on nonbuprenorphine administration days was significantly higher both in the ICU (OR, 1803 [95% CI, 1271–2553] vs OR, 327 [95% CI, 152–708] FEs/day; P < 0.001) and after ICU discharge (OR, 1476 [95% CI, 962–2265] vs OR, 238 [95% CI, 150‐377] FEs/day; P <.001). Given these findings, buprenorphine continuation during critical illness should be considered, as it is associated with significantly decreased full agonist opioid use. [ABSTRACT FROM AUTHOR]

Supportive parenting is known to protect against psychosomatic manifestations of distress, yet the mechanisms through which this association operates are less clear. The present study evaluates children's self-esteem as a mediator, partially explaining the association between parent–child relationship quality and psychosomatic problems from late childhood to mid-adolescence. Results from a large, nationally-representative Canadian sample indicated that self-esteem partially mediated these associations, and self-esteem accounted for more shared variance between parent–child relationship quality and psychosomatic problems among younger children. Among older children, shared variance with self-esteem explained a smaller portion of this association, but the remaining direct effect of parent–child relationship on psychosomatic problems was larger. These findings suggest that supportive parents protect against psychosomatic problems, and that they do so by promoting self-esteem for younger children and through other mechanisms as children age. Results are discussed in the context of attachment theory and age-related trends in self-esteem development. [ABSTRACT FROM AUTHOR]

Youth who experience peer victimization are at risk of developing mental health problems. However, little is known about the emotional causal mechanisms linking peer victimization with these negative outcomes. This study investigated whether shame mediated this relationship. At three time points (T1-T3), 396 10- to 13-year-olds completed measures of peer victimization, shame (characterological, bodily, and behavioral; shame proneness), and mental health (depression, social anxiety, and externalizing behavior). Three multiple mediation models tested the indirect effects of T1 victimization on T3 mental health through the four T2 shame-related variables. Analyses revealed indirect effects for the shame-related mediators on depression, social anxiety, and externalizing behaviors. Specifically, indirect positive effects for characterological and bodily shame on depression and social anxiety were found, with greater bodily shame linked to higher levels of social anxiety in girls but not boys. In addition, an indirect negative effect for behavioral shame on externalizing problems was found, with higher levels of externalizing problems in victimized boys but not in girls. Finally, an indirect positive effect for shame proneness and externalizing problems was found. To clarify the directionality, three additional mediation models were run with mental health symptoms as predictors of shame and subsequent victimization. Indirect effects for the shame-related mediators were found for all outcomes, specifically bodily shame and shame proneness as mediators between internalizing and externalizing symptoms and victimization. These three models were compared and contrasted with the hypothesized models. In sum, findings support the role of shame as an underlying emotional mechanism of peer victimization, and may guide intervention programs to address the mental health concerns of victimized youth. [ABSTRACT FROM AUTHOR]

Introduction: The study objective was to compare the mental health and risk-taking behaviour of Canadian youth in military-connected families to those not in militaryconnected families in a contemporary sample. We hypothesized that youth in militaryconnected families have worse mental health, lower life satisfaction and greater engagement in risk-taking behaviours than those not in military-connected families. Methods: This cross-sectional study used 2017/18 Health Behaviour in School-aged Children in Canada survey data, a representative sample of youth attending Grades 6 to 10. Questionnaires collected information on parental service and six indicators of mental health, life satisfaction and risk-taking behaviour. Multivariable Poisson regression models with robust error variance were implemented, applying survey weights and accounting for clustering by school. Results: This sample included 16 737 students; 9.5% reported that a parent and/or guardian served in the Canadian military. After adjusting for grade, sex and family affluence, youth with a family connection to the military were 28% more likely to report low well-being (95% CI: 1.17-1.40), 32% more likely to report persistent feelings of hopelessness (1.22-1.43), 22% more likely to report emotional problems (1.13-1.32), 42% more likely to report low life satisfaction (1.27-1.59) and 37% more likely to report frequent engagement in overt risk-taking (1.21-1.55). Conclusion: Youth in military-connected families reported worse mental health and more risk-taking behaviours than youth not in military-connected families. The results suggest a need for additional mental health and well-being supports for youth in Canadian military-connected families and longitudinal research to understand underlying determinants that contribute to these differences. [ABSTRACT FROM AUTHOR]

Bullying is a form of interpersonal trauma that impacts all parties involved, including the youth who witness the bullying. Some bystanders choose to intervene and defend the child being bullied. Defending may be positively associated with psychosocial difficulties because youth are becoming more involved in a traumatic event, or because youth may be actively coping with the distress elicited from witnessing bullying; however, the link between defending and psychosocial difficulties has not yet been examined. The current study investigated the age-related differences and psychosocial difficulties associated with defending behaviour in school bullying. Data were collected from 5071 Canadian youth from Grades 4–12. Participants completed an online survey at school, which assessed demographic information, recent defending behaviour, location and frequency of witnessing bullying, and psychosocial difficulties (internalizing, anger, psychosomatic, academic, and relationship difficulties). A subsample of 1443 pure bystanders (no current bullying involvement) was used for regression analyses. Defending behaviour was more common among girls and among younger students. For boys, defending behaviour was associated with more psychosocial difficulties compared to boys who only witnessed the bullying. This relationship was less consistent for girls. Defending behaviour was also associated with more psychosocial difficulties at high levels of bullying exposure. These associations suggest that defending may come at a cost for youth, or that youth are defending their peers to cope with negative emotions associated with witnessing interpersonal trauma. More longitudinal research is needed to clarify these associations. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to conduct a systematic review of cyberbullying intervention programs that are either in current practice and/or have been well documented. There are negative effects associated with cyberbullying including, poor academic, social, and mental health outcomes. Consequently, there is a need to develop evidence-based interventions. Critical content and evaluation elements of traditional bullying interventions provided a framework, due to the limited evidence on effective features for addressing cyberbullying. The review is based on a set of criteria for traditional bullying by Craig, Pepler, and Shelley (2004), which emphasizes scientific merit and ease of implementation. Results suggest that most studies are lacking in scientific merit, with most studies meeting less than half of the criteria. The average ease of implementation score was higher than that of scientific merit, however only 3 programs provided maintenance after implementation. Recommendations are made for best practices for cyberbullying interventions. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol is the most common substance use disorder in the United States. Despite this prevalence, there remains significant heterogeneity in medical management of alcohol withdrawal syndrome (AWS). While the 2020 American Society of Addition Medicine continues to recommend the use of benzodiazepines as first-line therapy for AWS, there is increasing use of phenobarbital in patients at high risk of severe AWS. Despite phenobarbital’s favorable pharmacologic profile, historically, clinical utilization on general medicine services has been low and often restricted. In this project, we have examined practice patterns and associated clinical outcomes in adult patients experiencing AWS on the general medicine service pre and post implementation of a phenobarbital-based protocol for the treatment of severe AWS at our institution. Methods: This quality improvement study evaluated changes in management of AWS on general medicine units associated with implementation of a phenobarbital-based protocol and order set in the electronic medical record (EMR). Our primary outcome measures were receipt of a phenobarbital loading dose, concomitant benzodiazepine administration, and total benzodiazepine dose. Safety outcomes were also explored to assess clinical impacts of this protocol implementation. The project was determined “not research” by our Institutional Review Board. Results: Phenobarbital-protocol implementation was associated with increased frequency of receiving a phenobarbital loading dose (49.5% vs 9.4%; P < .001), decreased use of concomitant benzodiazepine/phenobarbital (4.3% vs 28.9%; P < .001), and decreased total benzodiazepine dose (7.8 vs 15.5 mg; P < .001). Regarding safety, there was no significant pre/post difference in the rate of ICU transfer, but among those transferred there was a trend toward decreased mechanical ventilation rate (100% vs 28.6%; P = .051), and a significantly reduced ICU length of stay (median 11 vs 3 days; P = .04). There were no pre/post differences in seizures, delirium or use of adjunct medications. Conclusions: This quality improvement study demonstrates a marked change in provider prescribing practices for treating AWS after implementation of an institutional phenobarbital-based protocol. We observed no difference in overall clinical outcomes after protocol implementation, although a larger follow-up study is needed to confirm this and to further explore the shorter ICU length of stay for patients with AWS postimplementation. [ABSTRACT FROM AUTHOR]

Introduction: Adolescents typically spend decreasing amounts of time with family members, but the COVID-19 pandemic changed this pattern for many youth. The objective of the current study was to better understand adolescents' perceived change in family relationship quality, and how these perceptions were related to psychosocial functioning during the COVID-19 pandemic, accounting for more traditional measures of family relationship quality. Understanding how adolescents perceived change in relationship quality with family members during the pandemic offers novel insight into adolescents' relationships with their families and psychosocial functioning during this period.Method: A sample of Canadian adolescents (N = 605, ages 14 to 18, 53% girls), was employed to examine patterns of adolescents' perceived change in relationship quality with parents and siblings since the start of the pandemic, accounting for relationship quality, pandemic-related characteristics, and demographic variables.Results: Four latent profiles were identified: youth who perceived (1) low change, (2) improvement only, (3) moderate instability and (4) high instability in relationship quality. Higher perceived instability was associated with poorer functioning, with youth who reported only improvement reporting the highest overall level of functioning.Conclusions: Adolescent perceptions of change in relationship quality were heterogeneous, and contribute to psychosocial functioning over and above their general evaluations of relationship quality. In particular, youth who perceive considerable change in their relationships with siblings and parents may require additional support in response to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Purpose Despite its availability for more than 70 years, many details concerning methadone remain contentious, such as the dosing equivalents for intravenous and enteral administration. A scoping review was performed to evaluate whether existing literature on methadone bioavailability in human subjects support the current recommendation that an equivalent enteral dose is twice the intravenous dose. Methods A librarian-assisted search of the PubMed and EMBASE databases identified all English-language articles with the terms methadone and bioavailability and/or conversion in the title or abstract published from inception though December 2019. A manual search of references was also performed to identify any additional articles. Studies were included in a scoping review if they were published in English and evaluated methadone bioavailability in human subjects. Results Among 65 publications initially identified, 6 studies involving a total of 50 patients were included in the review. Bioavailability data for healthy volunteers and patients with opioid use disorder, metastatic cancer, chronic pain from malignant or nonmalignant disease were available for analysis. The pooled mean (95% confidence interval) bioavailability (F) was 85.4% (75.2%-95.6%), with heterogeneity (I 2) of 0. In the 4 studies that provided individual patient–level data, F was >50% in 40 of 42 patient measurements (95.2%) and ≥75% in 33 of 42 patient measurements (78.6%). Conclusion Available evidence suggests the bioavailability of methadone is generally more than 75%, there is limited evidence for the currently recommended 1:2 ratio (intravenous:enteral), and a more appropriate dosing ratio may be 1:1.3. This scoping review underscores the need for further research to establish an effective and safe ratio when converting between intravenous and enteral dosing formulations of methadone. [ABSTRACT FROM AUTHOR]

Simulation offers a high fidelity modality to deliver and study team-based interprofessional education. Debriefing the following simulated scenarios is a critical component of this training. Little data exist to inform best practices to optimize interprofessional engagement during debriefing. This pilot study analyzed interprofessional debriefing events following 20 pediatric simulation-based team trainings to identify associations between modifiable factors and learner engagement. Reviewers observed a total of 236 learners, using a previously published tool to assess learner engagement. Data related to the scenario, debriefing, learners, and facilitators were collected. Spearman’s correlation was used to analyze the association between factors of interest and average learner engagement scores for each debriefing event. Mean engagement did not differ between physicians and nurses, but was lower for other professionals. Average learner engagement was inversely related to learner group size, but not to the proportion of learners in each profession. Oral participation differed significantly between professions for both learners and co-facilitators, with physicians speaking more in both groups. Students of all professions had lower engagement and spoke less frequently. This study identifies several modifiable factors, including total group size, learner level, and facilitator behavior that were associated with interprofessional engagement during debriefing following simulation-based team training. [ABSTRACT FROM AUTHOR]

Exposure to violence is recognized as a major health concern among adolescent populations. The evidence base that links religious involvement with risks for child violence is inconsistent. In a national analysis involving a weighted sample of 24,307 young people, we studied the perpetration of violence (fighting and bullying), as well as victimization by violence (bullying only), among young people who were affiliated with religious groups. One in four young Canadians reported involvement in such groups. Study findings confirmed some unique patterns among this group. First, these religiously involved children reported the same or greater levels of perpetration of violence than other children. Second, religiously involved children reported the same or greater levels of experiencing victimization from violence. Third, religious involvement appeared to protect against engagement in certain overt risk-taking behaviors, but not violence. These patterns were consistent even after adjustment for family, community, socioeconomic, and school-related determinants. If religious communities are to fulfill mandates that foster the protection and nurturing of children into healthy relationships, violence is best addressed using evidence-based strategies. Development of such effective preventive strategies requires the incorporation of contemporary evidence about the distribution, determinants, and possible effects of violence in such groups. Findings from our study suggest that a silence around the issue of violence may in fact be true in the context of some Canadian religious communities. Yet, if these communities make an intentional commitment to protecting children from violence and promoting healthy relationships, and are willing to learn from evidence-based practices that have shown to protect children from participating in and experiencing violent and victim behaviors, perhaps these disturbing trends could be reversed. This message is germane for all levels of leadership in Canadian religious communities. [ABSTRACT FROM AUTHOR]

Buprenorphine is highly effective for the treatment of opioid use disorder (OUD), and, in recent years, the rates of patients maintained on buprenorphine requiring critical care have been steadily increasing. Currently, no unified guidance exists for buprenorphine management during critical illness. Likewise, we do not know if patients maintained on buprenorphine for OUD are prescribed medications for OUD (MOUD) following hospital discharge or if buprenorphine management influences mu opioid agonist dispensing. In our cohort of adults over the age of 18 with OUD, receiving buprenorphine formulations in the 3 months preceding their ICU admission, we sought to investigate the relationship between receipt of MOUD and non-MOUD opioid prescribing up to 12 months following hospital discharge. This was a single-center, retrospective cohort study approved by the MaineHealth institutional review board. The study analyzed differences in prescription rates between discharge and subsequent time points using chi square or Fisher's exact test, as appropriate. We performed analyses using SPSS Statistical Software version 28 (IBM SPSS Inc., Armonk, NY) with significance set at p < 0.05. We identified a statistically significant increase in MOUD prescribing 3 months posthospital discharge in patients who received MOUD at time of discharge (87.9 % vs 40 % p = 0.002.) The study found a significant increase in nonbuprenorphine opioid prescribing in patients who did not receive an MOUD prescription at time of discharge (24.2 % vs 70 % p = 0.007). This trend persisted at the 6-month and 12-month time points; however, it did not reach statistical significance. Additionally, the study identified a significant reduction in the incidence of non-MOUD opioid dispensing in patients prescribed MOUD at each time point measured (p = 0.007, p < 0.001. p < 0.001 and p = 0.008 at discharge, 3, 6, and 12 months, respectively). These findings support continuing buprenorphine dispensing following hospital discharge. • MOUD prescribing at hospital discharge associated with increased MOUD dispensing • Outpatient opioid agonist prescribing more likely when MOUD not prescribed at discharge • Decreased opioid agonist dispensing 12 months post-discharge in patients given MOUD [ABSTRACT FROM AUTHOR]

Background The value of positive follow-up blood cultures (FUBCs) in streptococcal bacteremia has not been well defined. Therefore, we explored the frequency of and risk factors for positive FUBC in a retrospective cohort of patients with streptococcal bacteremia. Methods Adults ≥18 years of age, admitted with at least 1 positive blood culture for Streptococcus spp between 2013 and 2018 followed by at least 1 FUBC, were potentially eligible. Positive FUBCs were defined as cultures positive for the same streptococcal species drawn >24 hours after the index culture. We excluded patients with polymicrobial bacteremia. We compared the characteristics of patients with and without a positive FUBC. Results In our single-center cohort, we identified 590 patients with streptococcal bacteremia, and 314 patients met inclusion criteria. Ten patients had FUBC with Streptococcus spp (3.2%), 4 (1.3%) had a contaminant identified, and 3 (1.0%) had a new pathogen isolated. Endocarditis (5 of 10 [50.0%] vs 35 of 304 [11.5%]), epidural abscess (2 of 10 [20%] vs 4 of 304 [1.3%]), and discitis or vertebral osteomyelitis (3 of 10 [30.0%] vs 14 of 304 [4.6%]) were associated with positive FUBC. Patients with positive FUBC had a longer median length of stay (12.9 vs 7.1 days, P  = .004) and longer duration of antibiotic treatment (14.9 vs 43.2 days, P  = .03). Conclusions Follow-up blood cultures among patients with streptococcal BSI are rarely positive. Clinicians could consider limiting follow-up blood cultures in patients at low risk for deep-seated streptococcal infections, persistent bacteremia, or endovascular infection. [ABSTRACT FROM AUTHOR]

Although there is evidence to suggest that adolescents with autism spectrum disorder (ASD) have difficulty interpreting complex social situations, little is known about their understanding of bullying. Given the high rates of victimization in this population, it is important to investigate how adolescents with ASD comprehend bullying. Male adolescents with ASD and IQ-matched typically-developing (TD) controls (Mage = 14.62, SD = 1.91) watched six videos portraying bullying scenarios and were interviewed after each video. The interviews were coded for the participants' understanding of the bullying scenarios. Results indicated that adolescents with ASD had significantly lower bullying understanding scores than TD adolescents. These novel findings suggest that male adolescents with ASD understand bullying differently than their TD peers. Implications for experiences with victimization are discussed. [ABSTRACT FROM AUTHOR]

Peer victimization is a chronic stressor that occurs within the context of peer interactions and has been robustly associated with numerous negative psychological and social adjustment problems. Although increased frequency of peer victimization has been linked to psychosocial problems, few researchers have studied the role of duration and pervasiveness of victimization (i.e., number of places it occurs). The objective of this study was to examine how frequency, duration, and pervasiveness of peer victimization are associated with youth adjustment. Canadian adolescents (N = 879), ages 12–18 completed an online survey about experiences with peer victimization. Youth also answered questions about internalizing problems, distress, relationship quality with family, friends, and adults in their school and community, as well as academic functioning. Data were analyzed using multinomial logistic regression modeling. Both duration and pervasiveness of peer victimization were predictive of increased internalizing problems, distress, relationship problems, and academic difficulties. Duration and pervasiveness of peer victimization were identified as important factors to consider when predicting youth psychosocial adjustment. By asking questions about these situational factors, parents, teachers, and healthcare providers may more effectively identify youth who are at risk for experiencing mental health problems associated with peer victimization. [ABSTRACT FROM AUTHOR]

Background: Peer victimization is associated with increased risk for depression, as well as increased neural response to social exclusion in the anterior cingulate cortex (ACC) and the amygdala. Altered functional connectivity (FxC) of fronto-limbic circuitry is associated with risk for various affective disorders. The present study examined the relationship between fronto-limbic FxC during social exclusion, prior peer victimization experience and depressive symptoms.Methods: Three mutually exclusive groups were formed: peer victimized (with a history of peer victimization), defenders (history of defending peers), and controls (no prior peer victimization experience) (n = 15/group; Mage = 17.7 years). Functional Magnetic Resonance Imaging data were collected while participants completed the Cyberball paradigm (simulating the experience of social exclusion). FxC between the Medial Prefrontal Cortex (MPFC), ACC, right insula and left amygdala, was compared between groups and examined in relation to depressive symptoms.Results: Prior peer victimization experience was associated with differences in fronto-limbic FxC across social inclusion and exclusion. Defenders displayed distinct shifts in FxC across the transition from being included to excluded. Peer victimized individuals exhibited a unique pattern of amygdala-specific FxC during inclusive interaction with peers, and in the continuous FxC across inclusion and exclusion. FxC of the MPFC-amygdala across inclusion and exclusion moderated the relationship between peer victimization and depressive symptoms.Limitations: Small sample size and cross-sectional design limit interpretation of the findings.Conclusions: Peer victimized individuals who exhibit continuous positive FxC of the MPFC-left amygdala across inclusion and exclusion may be at greater risk for depressive symptoms. [ABSTRACT FROM AUTHOR]

Abstract Bullying is a relationship problem that most often occurs in the presence of peers. Peers who witness bullying play a critical role in intervening. Peer intervention, or defending, is a complex behavior. Defending a victimized peer can occur offline and online, with many similarities between the two contexts. This paper, guided by the Social Ecological Model, systematically reviewed the correlates associated with defending at different levels including: individual, peer, family, and school. Inclusion criteria retrieved a final sample of 130 original, peer-reviewed research articles on offline defending, and 25 articles for online defending. Consistent results across both contexts reveal that individuals who defend tend to be girls, have high empathy and low moral disengagement, are popular and well-liked by their peers, and perceive supportive relationships with their parents, teachers, and schools. More research is needed to understand interactions that may occur between levels of the model, as defending is a complex behavior that cannot be characterized by isolated correlates. Highlights • Both offline and online defending are associated with individual, peer, family, and school correlates. • Empathy was the most researched individual correlate, with all significant findings (75%) positively related to defending. • For offline defending, sociometric status was the most researched correlate, and its association may be bidirectional. • The bystander model was the most studied correlate of online defending, with most research (84%) noting a positive link. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of the study was to evaluate the prognostic value of a two-tiered chemotherapy response score (CRS) system on progression-free and overall survival in high-grade serous ovarian cancer patients using traditional survival type analysis. Methods: Retrospective chart data were collected from all patients aged 18 and older with FIGO stage III or IV tubo-ovarian high-grade serous carcinoma undergoing neoadjuvant chemotherapy (NACT) at a single institution from January 2017 to January 2021. A two-tier scoring system was used in which patients were stratified to either CRS 1-2 (no or minimal response to neoadjuvant chemotherapy) or CRS 3 (appreciable or near-complete response). These data were used to compare progression-free and overall survival between the patients in each subgroup using survival analysis (log-rank test). Survival data were adjusted for covariates as appropriate with a Cox regression model. Results: We identified 80 women who met the inclusion criteria above; 97% (n =78) were Caucasian, and the mean age was 66 years (range: 25-87). Baseline demographic data were similar between patients with CRS 1-2 (n =58) and patients with CRS 3 (n =22). More women with CRS 3 underwent an aborted attempt at cytoreduction or surgery for bowel obstruction at the time of diagnosis (n =3 compared to none in the CRS 1-2 cohort). Overall, 74% (n =58) of patients achieved a partial response on platinum-based NACT. About 23% (n =5) of patients with CRS 3 had a complete response compared to only 12.5% (n =7) of CRS 1-2. Overall a greater percentage of patients in the CRS 3 group (95%, n =21) achieved optimal cytoreduction compared with patients in CRS 1-2 (74%, n =43). BRCA1 or 2 mutation frequencies were similar in both CRS subgroups. The majority of women recurred (73%, n =59) regardless of the CRS subgroup. Ultimately five patients were excluded from the analysis of progression-free and overall survival due to pertinent missing information such as documented CRS or missing vital statistics. The mean time from diagnosis to recurrence was 16 months versus 19 months for CRS 1-2 compared to CRS 3, but this difference was not significant. Median time from interval debulking to recurrence was not different between groups (11 months for CRS 1-2 vs 13 months for CRS 3, p=0.21). There was no difference in overall survival between the two groups; mean survival was 35 months in CRS 1-2 versus 34 months in CRS 3 (p=0.86). Conclusions: Previous studies have suggested a difference in progression-free survival for women who had CRS 1-2 versus CRS 3, indicating that this scoring system can inform disease prognosis and may help to guide adjuvant treatment strategies. Our preliminary analysis revealed no statistically significant difference in progression-free or overall survival for patients with CRS 1-2 versus CRS 3 and did not replicate the findings of other studies, a discrepancy that warrants further investigation. [ABSTRACT FROM AUTHOR]

Peer victimization is associated with increased risk for mental health problems. These adverse psychological outcomes are linked with altered cognitive and emotional processes and their related neural functioning. In the present study, by using functional magnetic resonance imaging (fMRI), we examined whether peer victimization was associated with heightened neural response to social exclusion. Participants (N = 45; M age = 17.7 years, SD = 0.60; 36 women) included three mutually exclusive groups: peer-victimized individuals (targets of bullying), cyberdefenders (defended peers who were being cyberbullied), and controls (not involved as targets or cyberdefenders). All participants underwent an fMRI scan while playing Cyberball, an experimental paradigm that simulates social exclusion. Peer victimization was associated with increased neural response in the left amygdala, left parahippocampal gyrus, left inferior frontal operculum, and right fusiform gyrus. Understanding the acute neural response to social exclusion in peer-victimized individuals may provide insight into their increased risk for poor mental health. [End Page 135] [ABSTRACT FROM AUTHOR]