Teen dating violence and the COVID-19 pandemic: trends from a longitudinal study in Texas

PURPOSE

Teen dating violence (TDV) is a global public health and safety issue causing health impacts to youth people. This study aimed to examine: (1) the impact of the pandemic on TDV victimisation rates and (2) socioecological factors associated with sustained risk for TDV victimisation during the first year of COVID-19.

METHODS

Data are from an ongoing randomised controlled trial of a TDV prevention programme in Texas (n=2768). We conducted annual assessments in 2019-2021. We used regression modelling to assess demographic, individual, peer and family factors associated with TDV risks.

RESULTS

TDV rates declined from 11.9% in 2019 to 5.2% in 2021. While demographic, peer and family/household factors were not associated with TDV victimisation during the pandemic, individual-level factors (ie, early sexual debut, substance use, acceptance of violence and prior TDV involvement) were related to COVID-era risks. Only early sexual debut was uniquely linked to TDV victimisation risk the first year of COVID-19.

CONCLUSIONS

While TDV rates declined during the pandemic, previous victimisation, substance use and early sexual debut remained potent risks for relationship harm.

Firearm access, carriage and use in an ethnically diverse sample of young adults in Texas, USA

Background Despite the high rates of firearm ownership and firearm-related injuries and mortalities in Southern US states, understandings on the factors contributing to these are lacking.Methods Using wave 10 (2021) data from a longitudinal study, we examined firearm-related experiences among 636 ethnically diverse young adults (mean age=26 years; 62% female) in Texas, USA.Results Just over half of participants had ready access to firearms, with 22.3% having carried a firearm outside of their home, 4.9% having been threatened with a firearm by a romantic partner and 4.4% by a non-romantic partner. More firearm access and carriage were reported in males, white participants and those with >US$50 000 income. More females than males had been threatened with a firearm by a romantic partner, but more males than females had been threatened by a non-partner. Participants with recent financial difficulties were proportionally more likely to be threatened with a firearm than those without difficulties.Conclusion Findings emphasise the alarming rate of firearm access and carriage in Texas and highlight the disparities in firearms experiences by sociodemographic characteristics.

Risk Factors for Post-Discharge Adverse Outcomes Following Hospitalization Among Older Adults Diagnosed With Elder Mistreatment

Using 100% Medicare data files, this study explored whether primary elder mistreatment (EM) diagnosis, EM type, and facility type were associated with 3-year mortality and 1-year unplanned hospital readmission among older patients diagnosed with EM with hospital discharge from 10/01/2015 through 12/31/2018 (n = 11,023). We also examined outcome differences between older patients diagnosed with EM and matched non-EM patient controls. Neglect by others was the most common EM diagnosis. Three-year mortality was 56.7% and one-year readmission rate was 53.8%. Compared to matched non-EM patient controls, older EM patients were at an increased risk of mortality and readmission. Among patients diagnosed with EM, patients with a secondary (vs. primary) diagnosis and those discharged from a skilled nursing facility (vs. acute hospital) were at an increased risk for both mortality and readmission. Compared to other EM types, patients diagnosed with neglect by others had a greater risk for mortality following discharge.

Racial Discrimination and Interpersonal Violence in Asian American Adolescents During the COVID-19 Pandemic

PURPOSE

Racial discrimination targeting Asians in the United States has increased sharply since the COVID-19 pandemic. Despite a well-established link with mental/physical health outcomes, little is known about how racial discrimination relates to interpersonal violence, particularly in adolescents. To address this gap in knowledge, we examined cross-sectional and longitudinal (1-year follow-up) associations between racial discrimination and interpersonal violence perpetration and victimization in Asian American adolescents in a large US city.

METHODS

Data from Waves 3 (2020) and 4 (2021) of a randomized clinical trial of a school-based violence prevention program were examined. We limited our sample to participants who identified as Asian American (n = 344; 48.3% female; Meanage = 14.6 years at Wave 3).

RESULTS

At Wave 3, 26.5% of the adolescents reported experiencing some form of racial discrimination, including 18.3% experiencing verbal harassment due to race and 16.0% reporting inequitable treatment due to race. Relative to their nonvictimized counterparts, adolescents who experienced racial discrimination were more likely to report being a victim of bullying and teen dating violence cross-sectionally and being a bullying victim longitudinally. Moreover, those who experienced racial discrimination reported more bullying and teen dating violence perpetration concurrently, as well as more dating violence perpetration 1 year later.

DISCUSSION

In the understudied population of Asian American adolescents, we found that experiencing racial discrimination contributes to both interpersonal violence victimization and perpetration. Youth violence prevention could include strategies addressing racial discrimination.

Safety and Academic Outcomes of College Campus-Based Advocacy Services

Intimate partner violence (IPV), sexual assault, and stalking are consequential public health and safety issues with wide reaching impacts on emerging adults, including those on college campuses in the United States. In response to high rates of violence among college student populations, universities are developing campus-based advocacy (CBA) programs, which aim to support survivors of interpersonal violence through supportive connections, resource acquisition, and safety planning. However, little data exists related to their impact on key student-survivor outcomes. Thus, this study aims to understand (a) the approach CBA programs use to address safety and academic concerns of student-survivors, and (b) the initial outcomes of CBA programs on safety and academics among students engaged in CBA services at five universities in one Southwestern state. The project used a longitudinal mixed-methods approach, with data collection activities including qualitative interviews with student survivors (n = 29) and a longitudinal, web-based, quantitative survey with matched analyses of safety and academic outcome measures from 115 student survivors who participated in an initial survey and follow-up survey after 6 months. Findings demonstrate key pathways through which CBA programs support survivors and facilitate positive safety and academic outcomes. These pathways include education, supportive connection, and resource access. Analysis of longitudinal survivor data demonstrate substantial reductions in sexual violence, IPV, stalking, and school sabotage at 6-month follow-up compared to initial survey, as well as significant reductions in academic disengagement for student survivors. The findings of the study powerfully demonstrate the positive impact of CBA programs on survivor and campus outcomes. Furthermore, programs not only enhance individual survivor safety and academic outcomes but also support the overall climate and safety of hosting universities.

The mental health of undergraduate women majoring in STEM

Objective: Women in STEM often experience gender-based micro-aggressions and harassment. This is particularly true in male-dominated STEM disciplines. Such victimizations may place women at heightened risk for psychopathology. Yet, there has been little research examining the mental health of women in STEM. We compare anxiety/depression, trauma symptoms, and suicide risk for women majoring in gender-balanced/unbalanced STEM compared to non-STEM disciplines at institutions of higher education (IHEs). Methods: Data were collected from undergraduate women (N = 318) at five IHEs in the U.S. Sampling was stratified by male-dominated STEM, gender-balanced STEM, male-dominated non-STEM, and gender-balanced non-STEM majors. Data were analyzed with fixed effects linear regression. Results: Contrary to expectation, women in male-dominated STEM did not report more trauma or psychopathology than their peers. However, women in gender-balanced STEM majors reported more anxiety/depression and trauma symptoms than non-STEM women and women in male-dominated STEM majors. Conclusions: These data suggest that matriculating into certain STEM fields may have an impact on women's mental health. IHEs should ensure women in STEM are provided the structural supports to maintain their health, academic success, and professional trajectories.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Help-seeking among college survivors of dating and sexual violence: a qualitative exploration of utilization of university-based victim services

Objective: Study uses qualitative data to examine help-seeking decisions as well as the drivers and barriers to utilization of university-based victim services through the accounts of survivors. Participants: The current study involves the analysis of 33 semi-structured interviews that were conducted with dating and sexual violence (DSV) survivors at a large, Mid-Atlantic University who both did and did not utilize university-based victim services. Methods: Data were analyzed using a thematic analysis approach. Results: Analysis shows that while survivors of DSV undergo a process of help-seeking that is similar to those described in previous help-seeking models, there are additional factors that contribute to a reluctancy to seek services at a university-based victim services center in particular that must be accounted for in the literature. Conclusions: The findings from the current study underscore the importance of understanding the specific drivers and barriers to utilization of university-based victim services.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Cumulative Incidence of Physical and Sexual Dating Violence: Insights From A Long-term Longitudinal Study

Decades of inquiry on intimate partner violence show consistent results: violence is woefully common and psychologically and economically costly. Policy to prevent and effectively intervene upon such violence hinges upon comprehensive understanding of this phenomenon at a population level. The current study prospectively estimates the cumulative incidence of sexual and physical dating violence (DV) victimization/perpetration over a 12-year timeframe (2010-2021) using diverse participants assessed annually from age 15 to 26. Data are from Waves 1-13 of an ongoing longitudinal study. Since 2010 (except for 2018 and 2019), participants were assessed on past-year physical and sexual DV victimization and perpetration. Participants (n = 1,042; 56% female; Mage baseline = 15) were originally recruited from seven public high schools in southeast Texas. The sample consisted of Black/African American (30%), White (31%), Hispanic (31%), and Mixed/Other (8%) participants. Across 12 years of data collection, 27.3% experienced sexual DV victimization and 46.1% had experienced physical DV victimization by age 26. Further, 14.8% had perpetrated at least one act of sexual DV and 39.0% had perpetrated at least one act of physical DV against a partner by this age. A 12-year cumulative assessment of physical and sexual DV rendered prevalence estimates of both victimization and perpetration that exceeded commonly and consistently reported rates in the field, especially on studies that relied on lifetime or one-time specified retrospective reporting periods. These data suggest community youth are at continued and sustained risk for DV onset across the transition into emerging adulthood, necessitating early adolescent prevention and intervention efforts that endure through late adolescence, emerging adulthood, and beyond. From a research perspective, our findings point to the need for assessing DV on a repeated basis over multiple timepoints to better guage the full extent of this continued public health crisis.

The effects of the DASH dietary pattern on clinical outcomes and quality of life in adults with uncontrolled asthma: Design and methods of the ALOHA Trial

BACKGROUND

Poor diet quality is an important risk factor for increased asthma prevalence and poor asthma control. To address the question of whether adults with asthma can benefit from following a healthy diet, this trial will test the efficacy and mechanisms of action of a behavioral intervention promoting the Dietary Approaches to Stop Hypertension (DASH) dietary pattern with sodium reduction among patients with uncontrolled asthma.

METHODS

In this 2-arm randomized clinical trial, 320 racially/ethnically and socioeconomically diverse adults with uncontrolled asthma on standard controller therapy will be randomized to either a control or an intervention group and assessed at baseline, 3, 6 and 12 months. Control and intervention participants will receive education on lung health, asthma, and other general health topics; additionally, the intervention group will receive DASH behavioral counseling over 12 months. The primary hypothesis is that the DASH behavioral intervention, compared with the education-only control, will lead to significantly more participants with minimum clinically important improvement (responders) in asthma-specific quality of life at 12 months. Secondary hypotheses will test the intervention effects on other asthma (e.g., asthma control, lung function) and non-asthma outcomes (e.g., quality of life). Additionally, therapeutic (e.g., short chain fatty acids, cytokines) and nutritional biomarkers (e.g., dietary inflammatory index, carotenoids) will be assessed to understand the mechanisms of the intervention effect.

CONCLUSION

This trial can substantially advance asthma care by providing rigorous evidence on the benefits of a behavioral dietary intervention and mechanistic insights into the role of diet quality in asthma.

CLINICALTRIALS

gov #: NCT05251402.

Sexual Violence against Women in STEM: A Test of Backlash Theory Among Undergraduate Women

It has been argued that increasing the number of women in the science, technology, engineering, and math (STEM) fields could mitigate violence against women by advancing gender equality. However, some research points to a "backlash" effect wherein gains in gender equality are associated with heighted sexual violence (SV) against women. In this study, we compare SV against undergraduate women majoring in STEM disciplines to those majoring in non-STEM disciplines. Data were collected between July and October of 2020 from undergraduate women (N = 318) at five institutions of higher education in the United States. Sampling was stratified by STEM versus non-STEM majors and male-dominated versus gender-balanced majors. SV was measured using the revised Sexual Experiences Survey. Results indicated that women majoring in STEM disciplines that are gender balanced reported more SV victimization in the form of sexual coercion, attempted sexual coercion, attempted rape, and rape compared to their peers in both gender-balanced and male-dominated non-STEM and male-dominated STEM majors. These associations held even after controlling for age, race/ethnicity, victimization prior to college, sexual orientation, college binge drinking, and hard drug use during college. These data suggest that the risk of repeated SV victimization within STEM populations may be a threat to sustained gender parity in these fields and ultimately to gender equality and equity. Gender balance in STEM should not be furthered without addressing the potential use of SV as a potential means of social control over women.

Suicidal ideation and psychological dating violence victimization-A short report

As the second leading cause of death among Americans aged 10 to 34, suicide is a serious public health concern. One potential predictor of suicidality is dating violence (DV) victimization, such as any physical, psychological, or sexual abuse by a current or former intimate partner. However, little longitudinal data exists on the relationship between suicidal ideation and DV. To address this gap in knowledge, we leverage data from two years of our longitudinal study Dating It Safe. Specifically, we examine whether physical and psychological DV victimization is associated with subsequent suicidal ideation in our ethnically diverse sample of young adults (n = 678; mean age = 25 at Wave 9; 63.6% female). While physical DV victimization was not linked to suicidal ideation over time, psychological DV victimization was (χ2 = 7.28, p = 0.007 for females; χ2 = 4.87, p = 0.027 for males). That psychological abuse was potentially as or more impactful than physical violence is consistent with the broader literature on the deleterious impacts of psychological violence, as well as the limited longitudinal literature looking at DV and suicidality specifically. These findings reinforce the notion that psychological abuse is as consequential as physical violence in the long-term, has unique impacts on mental health, and points to the need for both suicide and violence intervention programs to address this form of dating violence victimization.

Campus interpersonal violence survivor advocacy services

Objective: Although there has been increased attention to campus interpersonal violence, there is limited information on survivor advocacy services. Participants: We recruited participants from 155 U.S. institutions of higher education responsible for advocacy services on their campus. Methods: We used a community participatory action approach in partnership with the Campus Advocacy and Prevention Professionals Association to develop and disseminate a survey regarding campus advocacy services. Results: Participants shared critical insights about (a) advocacy staffing/caseload, (b) program structure, (c) advocacy practices, and (d) connection to services for people who had caused harm. We found that advocacy programs are often providing best practice services for survivors of violence but operating with few staff and unclear privacy protections. Conclusions: This study provided crucial preliminary information about how campuses provide advocacy services, but more researcher-practitioner engagement is needed to build on this study and establish clear practice guidelines.

Experiencing Moral Distress Within the Intimate Partner Violence & Sexual Assault Workforce

Purpose

Moral distress (MD) refers to the psychological disequilibrium that emerges when institutional policies and/or practices conflict with an individual's professional values and ethics. MD has been interrogated frequently in health care and ancillary medical settings, and has been identified as a critical barrier to enhanced organizational climate and patient care. However, little work has investigated experiences of MD among members of the intimate partner violence (IPV) and sexual violence (SV) workforce.

Methods

This study investigates MD in a sample of IPV and SV service providers via secondary analysis of 33 qualitative interviews conducted with service providers in the summer and fall of 2020 as the COVID-19 pandemic response was unfolding.

Results

Qualitative content analysis revealed multiple overlapping vectors of MD experienced by IPV and SV service providers related to institutional resource constraints, providers working beyond their capacity and/or competency, shifting responsibilities within service agencies creating burdens among staff; and breakdowns in communication. Impacts of these experiences at individual, organizational, and client levels were identified by participants.

Conculsions

The study uncovers the need for further investigation of MD as a framework within the IPV/SV field, as well as potential lessons from similar service settings which could support IPV and SV agencies in addressing staff experiences of MD.

Risk for dating violence and sexual assault over time: The role of college and prior experiences with violence

Objective: Despite increased research on emerging adults and interpersonal violence, evidence on the role of college attendance in risk for dating violence and sexual assault is mixed. We examined the role of college attendance on victimization risk in emerging adulthood. Participants: Participants were a diverse longitudinal sample of 630 emerging adults. Methods: We conducted regression analyses to examine the association of college attendance by type (community and public/private four year) with subsequent victimization, controlling for prior victimization and other factors. Results: Participants who attended public and private four-year colleges had significantly less risk for physical dating violence (OR = 0.35, p < 0.001), but not prior sexual or psychological dating violence or other sexual assault. Prior victimization was the most significant predictor of victimization in emerging adulthood. Conclusions: The context of higher education and prior victimization experience should be considered for addressing dating violence and sexual assault in emerging adulthood.

"So many extra safety layers:" Virtual service provision and implementing social distancing in interpersonal violence service agencies during COVID-19

The coronavirus pandemic necessitated rapid shifts in approach for service providers working with survivors of interpersonal violence. To reduce the spread of the virus, providers and agencies implemented a rapid and unplanned expansion of virtual services while also developing new protocols to support safe and socially distant in-person services. To understand how these shifts have impacted victim service professionals and the survivors they serve, to provide guidance for on-going efforts, and to inform planning for future public health emergencies, this study asks the question: What approaches did the interpersonal violence workforce use to address social distancing needs during COVID-19? Semi-structured interviews were conducted from July to December 2020 with 33 interpersonal violence service providers from across the United States, and data were analyzed via conventional content analysis with additional steps for data credibility. Findings fall within two primary categories: 1) Technology and Virtual Service Provision; and 2) Social Distancing for In-person Services. Within each category, a number of themes emerged illustrating strengths and challenges of each approach, and the complex web of technological, safety, and public health considerations being balanced in interpersonal violence service agencies. These results provide guidance for the implementation of virtual services in an on-going manner, as well as underscoring the importance of future planning to facilitate effective in-person but physically distant services. There is also a clear need for agencies to support the interpersonal violence workforce to reduce occupational stress and enhance skills and capacities with new forms of services.

ELDER MISTREATMENT, MORTALITY, AND HOSPITAL READMISSION AMONG MEDICARE BENEFICIARIES, 2015–2018

Elder mistreatment (EM) is a growing public health and safety crisis, with long-term consequences for individuals, families, and communities. We explored whether older adults hospitalized with a primary diagnosis of EM was associated with an increased risk of mortality and unplanned hospital readmission compared to those with a secondary EM diagnosis. We further examined whether EM type and hospital setting was associated with risk of mortality and unplanned hospital readmission. Using 100% of 2015-2018 Medicare files of hospitalized Medicare Fee-for-Service beneficiaries aged 66 and over, we used Kaplan-Meier and Cox proportional hazard models to estimate mortality and unplanned readmission rates by primary versus secondary EM diagnosis, EM type, and facility type. 11,023 patients were hospitalized with an EM diagnosis. The majority were female (64.1%) and Non-Hispanic/Latinx White (74.3%). Neglect was the most common EM type. The three-year mortality rate was 56.7% and one-year readmission rate was 53.8%. Compared to other EM types, patients diagnosed with neglect had a 2.20 (95% Confidence Interval [CI]=1.88-2.56) and 3.21 (95% CI=2.32-4.43) times greater risk for mortality within and after 50-days from discharge, respectively. Patients discharged from a skilled nursing facility (SNF) were at an increased risk of mortality and unplanned readmission compared to those discharged from an acute hospital. Hospitalized patients with a primary EM diagnosis were associated with an increased risk of mortality and readmission compared to those with a secondary diagnosis. Future work should explore care patterns before and after EM diagnosis to identify potential time points for medical and social intervention.

"Everyone is Living in the Same Storm, but our Boats are all Different": Safety and Safety Planning for Survivors of Intimate Partner and Sexual Violence During the COVID-19 Pandemic

Survivors of intimate partner violence (IPV) and sexual assault (SA) faced increased violence, new safety risks, and reduced services access in the face of the COVID-19 pandemic. IPV and SA service providers have a critical role in safety planning and advocacy with survivors; however their patterns of working were dramatically impacted by changes brought on by the pandemic. Little is known about safety planning strategies and service adaptations employed in this context. Through semi-structured interviews with 33 service providers from across the United States, this study explores the experiences and perspectives of victim service agency staff with IPV and SA survivor safety and safety planning from March to December 2020. Qualitative data were analyzed using conventional content analysis. Four overarching themes related to survivor safety and safety planning emerged, including (1) "The violence is more severe, it's more escalated," describing an increase in the severity and frequency of violence; (2) "Perpetrating the violence through [technology]," describing a specific surge in technology based abuse (TBA) as the world shifted to virtual communication to facilitate social distancing; (3) "COVID-19 is now a tool in their toolbox," describing the emergence of the COVID-19 pandemic and health guidance as a life generated risk that abusive partners used to further control and isolate their partner; and (4) "You just get real crafty," highlighting the wide range of "work-arounds" and safety planning adaptations employed by victim service professionals trying to maintain services in a disrupted environment and in the face of evolving safety risks and increasing violence severity. These findings highlight the safety and safety planning challenges encountered as the COVID-19 pandemic unfolded and the many creative strategies employed by service providers to adapt in the moment.

Creating a Digital Trauma Informed Space: Chat and Text Advocacy for Survivors of Violence

There is little research on virtual service models like chat and text services in agencies that work with survivors of intimate partner violence (IPV) and sexual assault (SA). This study fills a gap in the research by exploring how chat and text services are provided in one IPV and SA-focused community organization. We analyzed chat and text transcripts (n = 392) from a large multiservice, multivictimization focused agency, and conducted interviews with 11 advocates providing chat and text services through the agency hotline. Staff interviews were analyzed using grounded theory and transcripts were analyzed using content analysis. Results indicate chat/text services provide a space for connection, resource provision, education, and access to resource gain in a timely, concise, and survivor-centered way. The five major goals for chat/text advocacy models include the following: (1) rapid access to support and connection; (2) identification of options and needs for each service user; (3) increased access to resources and supports; (4) expanded understanding of violence, abuse, and harm; and (5) improvement of survivor safety. The research team identified 15 general advocacy skills and 4 chat and text specific skills used by chat/text advocates to reach program goals. Findings highlight the utility of chat/text services for increasing access to support services for survivors of violence, particularly adolescents, emerging adults, those living with an abusive individual, and during times of emergency. Future research should continue to explore the promising practice modality of chat/text services for providing advocacy to underserved and hard-to-reach populations.

The Impact of the COVID-19 Pandemic on Adolescent Mental Health and Substance Use

PURPOSE

The aim of this study is to determine whether COVID-19-induced financial impact, stress, loneliness, and isolation were related to perceived changes in adolescent mental health and substance use.

METHODS

Data were from Baseline (2018) and Wave 3 (2020; mean age = 14.8; 50% female) of 1,188 adolescents recruited from 12 Texas public middle schools as part of a randomized controlled trial. Participants were primarily Black (23%), Latinx (41%), Asian (11%), and White (9%). We assessed mental health and substance use (Baseline and Wave 3) and pandemic-related physical interaction, loneliness, stress, family conflict, and economic situation (Wave 3).

RESULTS

COVID-19-induced stress and loneliness were linked to depression (beta = 0.074, p ≤ .001; beta = 0.132, p ≤ .001) and anxiety (beta = 0.061, p = .001; beta = 0.088, p ≤ .001) among ethnically diverse adolescents. Adolescents who did not limit their physical interactions due to COVID-19 had fewer symptoms of depression (beta = -0.036, p = .03); additionally, adolescents who did not restrict their socializing were substantially more likely to report using a variety of substances (e.g., for episodic heavy drinking; odds ratio = 1.81, p = .001). Increased use of a food bank was linked to depression (beta = 0.063, p ≤ .001) and a negative change in financial situation was linked to increased alcohol use (odds ratio = 0.70, p = .04) among adolescents.

DISCUSSION

After controlling for prepandemic psychopathology and race/ethnicity, COVID-19 induced isolation, loneliness, stress, and economic challenges were linked to poor mental health and substance misuse. Substantial structural, community, school, and individual level resources are needed to mitigate the impact of the COVID-19 pandemic on adolescent psychosocial health.

"I Felt Better When I Moved Into My Own Place": Needs and Experiences of Intimate Partner Violence Survivors in Rapid Rehousing

Accessing stable housing is a basic need for intimate partner violence (IPV) survivors, and rapid rehousing programs are a critical way to address homelessness. However, little is known about survivor experiences, needs, and outcomes in rapid rehousing services within IPV agencies. This study uses an exploratory approach to understand the needs and experiences of 31 survivors using vouchers facilitated by an IPV program in the U.S. Southwest. Thematic analysis of structured interviews resulted in four summary themes: getting to housing, managing multiple needs, accessing support, and facing barriers. Practice and evaluation implications are discussed.

On the Front Lines of the COVID-19 Pandemic: Occupational Experiences of the Intimate Partner Violence and Sexual Assault Workforce

In the face of increasing risk for intimate partner violence (IPV) and sexual assault during the COVID-19 pandemic, there is an urgent need to understand the experiences of the workforce providing support to survivors, as well as the evolving service delivery methods, shifting safety planning approaches, and occupational stress of frontline workers. We addressed this gap by conducting an online survey of members of IPV and sexual assault workforce using a broad, web-based recruitment strategy. In total, 352 staff from 24 states participated. We collaborated with practitioner networks and anti-violence coalitions to develop the brief survey, which included questions about work and health, safety planning, and stress. We used chi-square, t-test, and ANOVA analysis techniques to analyze differences within position and demographic variables. For qualitative data, we used thematic analysis to analyze responses from four open-ended questions. The sample was majority female-identified (93.7%) and essential workers in dual IPV and sexual assault programs (80.7%). Findings demonstrated that since the pandemic began, IPV and sexual assault staff are experiencing more personal and professional stressors, perceive a decrease in client safety, and lack resources needed to help survivors and themselves. Common problems included a lack of food or supplies at home and work and housing and financial support for survivors. There was a 51% increase in the use of video conference for work, which contributed to workforce strain. Reductions in overall service capacity and a shift to remote service provision have implications for both survivors and staff. These findings suggest a critical need for additional training, infrastructure, and support for the IPV and sexual assault workforce. There is an urgent need to classify IPV and sexual assault staff as first responders and address the occupational stress associated with the COVID-19 pandemic.

What Helps and Hinders Students' Intervening in Incidents of Dating Violence On Campus? an Exploratory Study Using Focus Groups

Dating violence is a problem occurring on college campuses that requires unique prevention and intervention needs. Despite the widespread prevalence and pervasive impact of dating violence victimization, formal disclosure and utilization of on-campus support services for student survivors remain low and often survivors who do tell someone disclose to an informal source of support, most often a friend. Many current educational efforts on college campuses regarding dating violence, including bystander intervention programming, fail to increase students' understanding of how to safely address a situation where a peer is experiencing an abusive relationship or to provide students with information about their role as potential responders to disclosures of violence from friends. In the present exploratory study, a series of qualitative focus groups were conducted to better understand students' perspectives on dating violence on campus. Data were analyzed according to processes of thematic analysis to examine how students' understanding and knowledge of dating violence impact their decision about whether to intervene as prosocial bystanders within their social networks using focus groups. Emergent findings reveal that students undergo a multistage process of intervening that relies heavily on their existing knowledge and attitudes toward dating violence. The findings from this article are consistent with Banyard's Action Coils model. Suggestions for future research are also discussed.

The link between school climate and mental health among an ethnically diverse sample of middle school youth

School climate consistently relates to adolescent adjustment across academic, socioemotional, and behavioral domains. Although past research highlights the impact of school climate on youths' experience of internalizing symptoms and violent behavior, examination of potential links with specific externalizing processes is limited. The current study examined associations between middle school students' perceived school climate and internalizing and externalizing mental health symptoms. A positive school climate was hypothesized to be inversely related to all mental health measures. Seventh grade students (N = 2768; 50% female) were recruited from 24 Texas middle schools. Participants completed baseline self-reports of perceived school climate across three dimensions (student-student relationships, student-teacher relationships, and awareness/need of reporting violence) as well as self-reports of internalizing (i.e., depression and anxiety) and externalizing (i.e., impulsivity and hostility) symptoms. Multilevel regression analyses were implemented to test all hypotheses, controlling for participant sex and race/ethnicity. Results indicated student-student relationships were negatively related to depressive symptoms, student-teacher relationships were positively related to anxiety and negatively linked to hostility, and help-seeking/reporting awareness was inversely related to all four indices of mental health. The current research underscores the impact of school climate on adolescents' psychological adjustment and emphasizes the need to address awareness and responsivity in reporting concerning school behavior.

"The Propellers of My Life" The Impact of Domestic Violence Transitional Housing on Parents and Children

Housing and homelessness are frequent issues facing domestic violence (DV) survivors and their children. Several DV programs provide transitional housing (DVTH) to address the housing needs of DV survivors and their children. Despite wide use, little is known about the impact of DVTH, especially on child and parenting related needs and outcomes. Multiple structured interviews (82) were conducted with 27 parents with minor children living in DVTH in order to explore housing program experiences. Thematic analysis techniques produced three themes and seven subthemes about DVTH impact on parenting and child wellness. Overarching themes include: (1) DVTH helps to strengthen the parent-child relationship through a focus on family connection and health; (2). Transitional housing provides an opportunity for family stability via housing, material, and economic stability; (3). Time at DVTH allows family to access a diverse range of trauma-informed resources and social support to meet family goals. Barriers to these potential impacts are explored. Implications for practice with youth and parents include the need for extensive mental health and legal advocacy, programmatic models that emphasize resources, safety and the transition to permanent housing, and build on family strengths. Further research is needed to evaluate DVTH program outcomes.

"Don't Know where to Go for Help": Safety and Economic Needs among Violence Survivors during the COVID-19 Pandemic

The COVID-19 pandemic and related quarantine has created additional problems for survivors of interpersonal violence. The purpose of this study is to gain a preliminary understanding of the health, safety, and economic impacts of the COVID-19 pandemic on people that are experiencing or have previously experienced violence, stalking, threats, and/or abuse. An online survey, open from April to June 2020, was taken by people with safety concerns from interpersonal violence. Participants were recruited from IPV and sexual assault-focused agencies, state coalitions, and social media. Quantitative data were summarized using descriptive methods in SPSS and coding methods from thematic and content analysis was used to analyze qualitative data from open-ended questions. A total of 53 participants were recruited for the survey. Individuals with safety concerns have experienced increased challenges with health and work concerns, stress from economic instability, difficulties staying safe, and access resources and support. Over 40% of participants reported safety had decreased. Use of social media and avoidance strategies were the most common safety approaches used. Participants reported mixed experiences with virtual services. The COVID-19 pandemic has exacerbated existing structural concerns for survivors of violence like IPV and sexual assault. Increased support and economic resource access, coupled with modified safety planning and improved virtual approaches, would better help meet survivor needs.

Advocate and Survivor Perspectives on the Role of Technology in Help Seeking and Services with Emerging Adults in Higher Education

Emerging adults, aged 18-25, have come of age in a technology oriented world. The internet has been critical in mediating their personal relationships and their understanding of daily life. Emerging adults are also at unique risk of experiencing intimate partner and sexual violence (IPV & SV) Given the increasing infusion of information communication technology (ICT) into anti-violence advocacy, and the broad use of ICT among college-attending emerging adults, this study aimed to explore how both survivors and advocates are leveraging technology for support. Using a QUAL + qual methodology (Morse and Niehaus, 2009), data were collected as part of an evaluation of campus-based advocacy as implemented in five programs. Interviews took place with 23 campus and community-based advocates, and 25 survivors of interpersonal violence who had accessed campus-based advocacy services. Additionally, 63 survivors who engaged in campus-based advocacy services responded to an online survey. Key domains identified were: 1) technology as a means of informing potential clients about services; 2) the role of technology in help-seeking, including its role in tailoring and extending the reach of services; and 3) the importance of recognizing technology facilitated abuse in the advocacy and education process with emerging adults. As advocacy programs are rapidly shifting to technology facilitated services in the wake of COVID-19, this study provides data on advocate and survivor experiences with technology, which can inform these changes across the spectrum of IPV & SV services.

A Dating Violence Prevention Program for Middle School Youth: A Cluster Randomized Trial

OBJECTIVES

We conducted a cluster randomized controlled trial to test the a priori hypothesis that students attending an intervention middle school would be less likely to report physical adolescent relationship abuse (ARA) 1 year later compared with students attending a control school. Secondary objectives were to determine if the intervention reduced substance misuse, bullying, and fighting.

METHODS

Twenty-four Texas public middle schools were matched by the size of student enrollment, number of economically disadvantaged students, and race and ethnicity of the student body and randomly assigned to the intervention (n = 12; 1237 participants) or the control (n = 12; 1531participants) group. The intervention, Fourth R, is a classroom-based curriculum delivered by existing teachers and consists of 21 lessons on injury prevention, substance use, and growth and development.

RESULTS

Participants (50% female) self-reported ethnicity as Hispanic or Latinx (35%), Black or African American (24%), Asian American (17%), White (8%), and multiethnicity or other (16%). Among those who have dated, students in the intervention schools were less likely to report perpetrating physical ARA (intervention = 14.9% versus control = 18.3%) relative to students in the control schools (adjusted odds ratio, 0.66; 95% confidence interval, 0.43-1.00; P = .05). In the overall sample, no significant differences emerged between control and intervention groups with respect to substance misuse, fighting, and bullying.

CONCLUSIONS

The middle school version of Fourth R is effective in reducing physical ARA perpetration over at least 1 year. The intervention did not have an effect on bullying perpetration, physical fighting with peers, and substance misuse. Long-term assessment, especially follow-up that covers the transition to high school, is needed to examine the program benefit on key outcomes.

Sexual Harassment at Institutions of Higher Education: Prevalence, Risk, and Extent

Sexual harassment is a pervasive problem on college campuses. Across eight academic campuses, 16,754 students participated in an online study that included questions about sexual harassment victimization by a faculty/staff member or by a peer since enrollment at their Institution of Higher Education (IHE). Utilizing an intersectional theory and hurdle models, this study explored the effects of gender, race/ethnicity, sexual orientation, age at enrollment, student status, and time spent at institution on students' risk for peer- and faculty/staff-perpetrated sexual harassment victimization, as well as the extent of victimization for students who experience harassment. Across institutions, 19% of students reported experiencing faculty/staff-perpetrated sexual harassment and 30% reported experiencing peer-perpetrated sexual harassment. Hypotheses related to intersectional impacts were partially supported, with most significant findings in main effects. Time at institution was found to increase both risk and extent of victimization of both types of harassment. Traditional undergraduate students, non-Latinx White students, female students, and gender and sexual minority students were found to be at increased risk for harassment. Being female increases the odds of experiencing both faculty/staff and peer sexual harassment by 86% and 147%, respectively. Latinx students and students with an ethnicity other than White reported less victimization, but those who reported sexual harassment faced greater extent of harassing behaviors. A discussion of these findings for institutional program planning and policy is explored.

"At Least They're Workin' on My Case?" Victim Notification in Sexual Assault "Cold" Cases

Sexual assault is a significantly under-reported, -investigated, and -prosecuted crime in the United States, which criminal justice and advocacy actors across the country are working to address. Law enforcement procedures often involve providing crime victims, including sexual assault victims, with written notification by mail about the status of their case, but little is known about the best practices for victim notification in sexual assault "cold" cases. This qualitative research explored whether this standard law enforcement practice was appropriate for sexual assault victims in "cold cases" particularly when there had been no contact from law enforcement, despite forensic evidence having been tested. The research questions were what do sexual assault victims in cold cases have to say about victim notification protocols and practices? and What do sexual assault victims in cold cases have to say about hypothetical written victim notification protocols? Twenty-three sexual assault victims were asked in focus groups and individual interviews to respond to hypothetical written notification letters for content and the sending authority and to give input on alternative modes of communication. The data were analyzed using grounded theory. Themes related to trust, personal agency, and decision making from notification examples emerged. Recommendations on notification included respecting privacy, including specifics, identifying next steps, normalizing, translating, and providing resources. Implications for developing notification protocols include use of emerging evidence about neurobiology of trauma, use of victim input, and patience for the varying reactions and needs of sexual assault victims.

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

The Impact of a Bedside Medication Scanning Device on Administration Errors in the Hospital Setting: A Prospective Observational Study

Introduction

The medication administration process is complex and influenced by interruptions, multi-tasking and responding to patient’s needs and is consequently prone to errors.1 Over half (54.4%) of the 237 million medication errors estimated to have occurred in England each year were found to have taken place at the administration stage and 7.6% were associated with moderate or severe harm. The implementation of a Closed Loop Medication Administration solution aims to reduce medication administration errors and prevent patient harm.

Aim

We conducted the first evaluation to assess the impact of a novel optical medication scanning device, MedEye, on the rate of medication administration errors in solid oral dosage forms.

Methods

We performed a before and after study on one ward at a tertiary-care teaching hospital that used a commercial electronic prescribing and medication administration system and was implementing MedEye (a bedside tool for stopping and preventing medication administration errors). Pre-MedEye data collection occurred between Aug-Nov 2019 and post-MedEye data collection occurred between Feb-Mar 2020. We conducted direct observations of nursing drug administration rounds before and after the MedEye implementation. Observers recorded what they observed being administered (e.g., drug name, form, strength and quantity) and compared this to what was prescribed. Errors were classified as either a ‘timing’ error, ‘omission’ error or ‘other’ error. We calculated the rate and type of medication administration errors (MAEs) before and after the MedEye implementation. A sample size calculation suggested that approximately 10,000 medication administrations were needed. Data collection was reduced due to the COVID 19 pandemic and implementation delays.

Results

Trained pharmacists or nurses observed a total of 1,069 administrations of solid oral dosage forms before and 432 after the MedEye intervention was implemented. The percentage of MAEs pre-MedEye (69.1%) and post-MedEye (69.9%) remained almost the same. Non-timing errors (combination of ‘omission’ + ‘other’ errors) reduced from 51 (4.77%) to 11 (2.55%), which had borderline significance (p=0.05) however after adjusting for confounders, significance was lost. We also saw a non-significant reduction in ‘other’ error types (e.g., dose and documentation errors) following the implementation of MedEye from 34 (3.2%) to 7 (1.62%). An observer witnessed a nurse dispense the wrong medication (prednisolone) instead of the intended medication (furosemide) in the post-MedEye period. After receiving a notification from MedEye that an unexpected medication had been dispensed, the nurse corrected the dose thus preventing an error. We also identified one instance where the nurse correctly dispensed a prescribed medication (amlodipine) but this was mistakenly identified by the MedEye scanner as another prescribed medication (metoclopramide).

Conclusions

This is the first evaluation of a novel optical medication scanning device, MedEye on the rate of MAEs in one of the largest NHS trusts in England. We found a non-statistically significant reduction in non-timing error rates. This was notable because incidents within this category e.g., dose errors, are more likely to be associated with harm compared to timing errors.2 However, further research is needed to investigate the impact of MedEye on a larger sample size and range of medications.

References

1. Elliott, R., et al., Prevalence and economic burden of medication errors in the NHS in England. Rapid evidence synthesis and economic analysis of the prevalence and burden of medication error in the UK, 2018.

2. Poon, E.G., et al., Effect of bar-code technology on the safety of medication administration. New England Journal of Medicine, 2010. 362(18): p. 1698–1707.

Sexual Harassment Among Medical Students: Prevalence, Prediction, and Correlated Outcomes

BACKGROUND

Few studies are dedicated to understanding the extent and impact of sexual harassment among medical students. The aim of this study was to use behaviorally specific measures to examine prevalence of sexual harassment toward medical students. Associated mental health and academic impacts were also studied.

METHODS

A multisite survey was conducted at four medical schools. Sexual harassment was measured using the Sexual Experiences Questionnaire (SEQ), a valid and reliable instrument. Students were also surveyed about depressive and post-traumatic stress disorder (PTSD) symptoms and their level of academic engagement. We also assessed their perceptions of institutional response and whether they felt safe at their institution.

FINDINGS

The final sample included 524 medical students (response rate = 13%). Findings revealed that 36.6% reported sexual harassment by a faculty/staff member and 38.5% reported harassment by a fellow student. The odds of harassment by faculty/staff, as well as peers, were significantly higher for women with an adjusted odds ratio (AOR) = 9.83, 95% confidence interval (CI) = [3.74, 25.80] and multiracial students with an AOR: 2.93, 95% CI: [1.16, 7.39]. Those who experienced sexual harassment were more likely to report academic disengagement and symptoms of depression and PTSD.

CONCLUSION/APPLICATION TO PRACTICE

Sexual harassment in medical schools can potentially limit a student's academic success and negatively impact their mental health. Supportive services and efforts to address peer and professional cultures that promote harassment are needed. Experiences of harassment require swift and competent responses by medical school leadership in collaboration with occupational and/or student health services to mitigate detrimental impacts and support medical students throughout their training.

Epicardial adipose tissue CD4+ T cells as novel drivers in the development of atrial fibrillation

Background

Epicardial adipose tissue (EAT) is now a well-established independent risk factor for all forms of atrial fibrillation (AF). However, the cellular profile and immune mediators within EAT remain poorly defined.

Purpose

This study sought to define the immunological signature of EAT critical to its role in the development of both persistent AF and de novo post-operative AF (POAF).

Methods

Adult patients undergoing elective cardiac surgery with no prior AF history and those with pre-existing AF were recruited to undergo EAT sampling alongside subcutaneous adipose tissue (SAT) and pre-operative blood (adipose tissue and systemic controls respectively) sampling. The blood and tissue samples were immediately taken to the laboratory for immune cell isolation, flow cytometry and quantitative polymerase chain reaction (qPCR) analysis.

Results

A total of 71 patients were recruited including 9 patients with a prior history of AF. Of the 62 a priori sinus rhythm (SR) patients, 42 remained in SR post-operatively and 20 developed de novo POAF. No differences in absolute numbers of immune cells in the blood, EAT or SAT were detected on flow cytometry analysis between the three groups of patients. However, there was a significant increase (p&lt;0.01) in EAT-resident CD4+ memory T cell populations in pre-existing AF patients and a trend towards significance (p=0.09) in POAF patients. qPCR analysis of immune mediator expression in EAT demonstrated pre-existing AF patients uniquely showed a significant reduction (p&lt;0.005) in the pro-fibrotic mediator transforming growth factor-β (TGF-β) compared to the pre-existing AF patients (graph 1).

Conclusions and implications

Resident CD4+ memory T cell populations are locally and exclusively elevated in the EAT of pre-existing AF and POAF patients. This would suggest primed antigen-specific CD4+ T cells are present prior to the development of AF in patients who go on to develop de novo POAF. The reduced TGF-β levels observed in the EAT of AF patients indicates the EAT immune mediator profile differs to the underlying myocardial tissue, where increased TGF-β levels have previously been described in the persistent AF cohort. Therapies targeting this EAT-resident CD4+ T cell population would provide a novel approach to the management of the inflammatory components of AF genesis.

Graph 1

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Barts Charity, Abbott

Playing by the Rules: Agency Policy and Procedure in Service Experience of IPV Survivors

More than 1,800 programs exist in the United States, providing not only shelter but also transitional housing, advocacy and support, transportation, legal aid, and group and individual counseling for women who have experienced intimate partner violence (IPV). Shelter and transitional housing provide critical support for survivors, but have also been critiqued for having too many restrictive rules and code of conduct. More information is needed about the impact of rules and agency policy on women seeking services in IPV residential settings. This qualitative study explored the central research question, "How do rules shape IPV residential environment and survivor experiences in services?" Twenty-five women in four programs in two states who were currently residing in IPV residential services were interviewed about their experiences. Data were analyzed using grounded theory methods. Findings indicated rules affect individual survivors' and families' experiences and responses in services and of healing from IPV (micro), the relationships among residents and between residents and staff (mezzo), and participants' relationships with the agency as an institution and the help-seeking community (macro). An intriguing paradox is noted in that at their best, rules provide stability and motivation for some survivors. At their worst, rules create isolation and force exit from shelter into unsafe circumstances, causing a ripple effect of impact. Implications include the need to restructure rules and policies collaboratively with residents, and reduce the amount of rules used in services. Addressing rules will better enable IPV services to be survivor-centered and trauma-informed, ultimately increasing safety and healing.

Prevalence and sociodemographic factors associated with stalking victimization among college students

Objective: This study's purpose was to examine the prevalence and sociodemographic factors associated with stalking victimization among a diverse sample of college students. Participants: Data were collected through a cross-sectional survey administered in November 2015 to students 18 and older on 8 academic universities in a Southwestern university system (N = 26,417). Methods: Descriptive statistics were used to assess the prevalence of stalking experiences across student populations. Multivariate logistic regression was used to examine associations between sociodemographic factors and stalking victimization. Results: A total of 17.4% of students reported stalking victimization since entering college. Cisgender females, transgender/gender-nonconforming, and sexual minority students had higher odds of stalking victimization than their counterparts, whereas Latino/a students had lower odds of stalking victimization compared to White nonHispanic students. Conclusions: A notable proportion of college students have experienced stalking. Disparities found among student populations are concerning and warrant further investigation.

Responding to Campus Climate Data: Developing an Action Plan to Reduce Campus Sexual Misconduct

Hundreds of U.S. institutions of higher education have conducted campus climate surveys recently to assess students' experiences with sexual misconduct and perceptions of institutions' related policies and procedures. Many of these surveys were implemented in response to the recommendation by the 2014 White House Task Force to Protect Students from Sexual Assault. The several options for campus climate surveys, ranging from free measures campuses can implement themselves to full-service survey implementation packages, have streamlined and facilitated the climate data collection process. Unfortunately, there is little guidance on how institutions can use and respond to their climate data. This article presents a framework that institutions could use to develop an action plan based on findings from their campus climate survey, predicated on a process that begins before the survey is implemented and lasts long after data collection concludes. Each institution of higher education is different, and individual campus action plans can vary based on campus structure, dynamics, and climate survey findings.

Mental health and academic impacts of intimate partner violence among IHE-attending women

Objective: The study assesses the prevalence of physical, psychological, sexual, and cyber forms of intimate partner violence (IPV) among female college students, and associated mental health and academic outcomes.Participants: Participants (n = 6,818) were randomly selected female students attending one of eight campuses of a University System in the Southwest. Their mean age was 25, and 45% identified as Hispanic/Latina. Data collection concluded in November of 2015.Methods: Students completed anonymous online surveys of behavioral-specific measures assessing victimization and potential impacts. Descriptive, bivariate, and multiple regression analyses were employed.Results: Since enrollment, 31% had experienced IPV. Significant correlations were observed between severity of IPV and extent of PTSD, depression, school disengagement, and academic impacts. Higher levels of psychological, sexual, and cyber violence were associated with increased PTSD and depression symptoms.Conclusion: IPV is a significant indicator of mental health and academic impacts, meriting attention from Institutions of Higher Education.