Design of a randomized superiority trial of a brief couple treatment for PTSD.

Interpersonal difficulties are common among veterans with posttraumatic stress disorder (PTSD) and are associated with poorer treatment response. Treatment outcomes for PTSD, including relationship functioning, improve when partners are included and engaged in the therapy process. Cognitive-behavioral conjoint therapy for PTSD (CBCT) is a manualized 15-session intervention designed for couples in which one partner has PTSD. CBCT was developed specifically to treat PTSD, engage a partner in treatment, and improve interpersonal functioning. However, recent research suggests that an abbreviated CBCT protocol may lead to sufficient gains in PTSD and relationship functioning, and yield lower dropout rates. Likewise, many veterans report a preference for receiving psychological treatments through clinical videoteleconferencing (CVT) rather than traditional face-to-face modalities that require travel to VA clinics. This manuscript describes the development and implementation of a novel randomized controlled trial (RCT) that examines the efficacy of an abbreviated 8-session version of CBCT ("brief CBCT," or B-CBCT), and compares the efficacy of this intervention delivered via CVT to traditional in-person platforms. Veterans and their partners were randomized to receive B-CBCT in a traditional Veterans Affairs office-based setting (B-CBCT-Office), CBCT through CVT with the veteran and partner at home (B-CBCT-Home), or an in office-delivered, couple-based psychoeducation control condition (PTSD Family Education). This study is the first RCT designed to investigate the delivery of B-CBCT specifically to veterans with PTSD and their partners, as well as to examine the delivery of B-CBCT over a CVT modality; findings could increase access to care to veterans with PTSD and their partners

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Trauma-related treatment gains among women with histories of interpersonal violence and co-occurring mental health and substance abuse disorders

Interpersonal violence directed against girls and women is both widespread and can lead to serious long-term consequences, including the development of co-occurring mental health and substance abuse disorders. This two-part study investigated psychosocial gains following trauma-focused treatment among women with histories of interpersonal violence and co-occurring disorders. The data are drawn from the Los Angeles site of the national Women, Comorbid Disorders and Violence Study (WCDVS), which assessed the effects of integrated substance abuse and mental health treatment using an intent-to-treat quasi-experimental design. A diverse sample of 370 women was interviewed up to five times over 12-months. The first part of the present study established the longitudinal consistency of a measure of posttraumatic stress symptoms. Results indicated that five of the 17 items performed inconsistently across time and were dropped. The second part investigated the impact of a trauma-focused treatment program (Seeking Safety; Najavits, 2002) on posttraumatic stress symptoms and unsafe events. The impact of attendance on outcome measures was assessed using longitudinal structural equation models, and statistically adjusted for days in residential treatment and WCDVS treatment group. Results indicated that while there were significant decreases in posttraumatic stress symptoms across time, level of trauma-focused treatment did not predict these changes. Significant reductions in posttraumatic stress symptoms were predicted by greater use of residential treatment services early in the woman's enrollment in the study. Women in both treatment conditions showed significant reductions in unsafe events at six months. For women in the integrated services group, greater exposure to trauma-focused treatment was associated with fewer unsafe events. Finally, greater participation in trauma-focused treatment predicted greater use of residential services, even after women had completed the trauma-focused treatment program. While the reduction in unsafe events suggests increased use of safety behaviors and coping skills like those taught in Seeking Safety, the reductions in posttraumatic stress symptoms across different residential treatment programs was unexpected. Increased awareness of the negative impact of traumatic experiences and availability of trauma-informed service providers may lead to dissemination of trauma-relevant information into the general treatment programs

Alcohol Expectancies For Social Facilitation: A Short Form With Decreased Bias

The social facilitation scale of the Alcohol Expectancy Questionnaire-Adolescent version predicts subsequent drinking behavior and covaries with other important constructs. An examination of the interval-level measurement properties and potential biases of items could help improve the scale. Responses in a large sample (N = 518) of undergraduates confirmed that the items fit a Rasch model for a single-factor, interval scale. Two items were biased when comparing non-drinkers, social drinkers and extreme drinkers. Four additional items showed gender bias. Removal of these items shortened the scale without decreasing correlations with two measures associated with drinking, while the strength with one measure was slightly decreased. This short form of the questionnaire should prove useful in the study of alcohol expectancies for social facilitation without drinking- or gender-related bias. These results also support the utility of Rasch modeling. © 2005 Elsevier Ltd. All rights reserved

Air Ground Integration Study

A simulation was conducted to examine the effect of shared air/ground authority when each is equipped with enhanced traffic- and conflict-alerting systems. The potential benefits of an advanced air traffic management (ATM) concept referred to as "free flight" include improved safety through enhanced conflict detection and resolution capabilities, increased flight-operations management, and better decision-making tools for air traffic controllers and flight crews. One element of the free-flight concept suggests shifting aircraft separation responsibility from air traffic controllers to flight crews, thereby creating an environment with "shared-separation" authority. During FY00. NASA, the Federal Aviation Administration (FAA), and the Volpe National Transportation Systems Center completed the first integrated, high-fidelity, real-time, human-in-the-loop simulation

4. Title and Subtitle Air-Ground Integration Experiment

DOT/FAA/CT-TN02/0

Re-Examination of Mixed Media Communication: The Impact of Voice, Data Link, and Mixed Air Traffic Control Environments on the Flight Deck

A simulation in the B747-400 was conducted at NASA Ames Research Center that compared how crews handled voice and data link air traffic control (ATC) messages in a single medium versus a mixed voice and data link ATC environment The interval between ATC messages was also varied to examine the influence of time pressure in voice, data link, and mixed ATC environments. For messages sent via voice, transaction times were lengthened in the mixed media environment for closely spaced messages. The type of environment did not affect data link times. However, messages times were lengthened in both single and mixed-modality environments under time pressure. Closely spaced messages also increased the number of requests for clarification for voice messages in the mixed environment and review menu use for data link messages. Results indicated that when time pressure is introduced, the mix of voice and data link does not necessarily capitalize on the advantages of both media. These findings emphasize the need to develop procedures for managing communication in mixed voice and data link environments

Effects Of Military Service On Marital Stability Among World War Ii U.S. Veterans Of Japanese Descent

INTRODUCTION: This study had two goals. First, we investigated how World War II (WW II) military service impacted marital stability during men\u27s young and middle adulthood in a large community sample of American men of Japanese descent. Second, within a subgroup of WW II veterans, we assessed how the level of combat exposure affected marital stability. MATERIAL AND METHODS: The Honolulu Heart Program and later Honolulu-Asia Aging Project were longitudinal, community-based studies of Japanese-American men living in Hawai\u27i. This study is a secondary data analysis of 1,249 male WW II veterans and 3,489 men of Japanese descent who were civilians during WW II, born 1910-1919, who completed interviews at the first (1965-1968) and third (1971-1975) exams. Data from a subsample of veterans who completed a military service interview during the sixth exam (1997-1999) also were used. In the first set of analyses, we compared veterans to civilians on three marital outcomes for ages 15-59: (1) likelihood of never marrying, (2) age at first marriage, and (3) likelihood of divorce. Next, we investigated the negative consequences of increasing combat exposure on the same marital outcomes. All analyses controlled for age in 1941 and occupation. RESULTS: Overall, 88% of the sample remained in their first marriage with no differences between veterans and civilians. We found no effects of military service on the timing of first marriages on the likelihood of divorce during young and middle adulthood. However, among those who had not married before WW II, veterans were significantly more likely to remain unmarried compared with civilians; odds ratio = 1.52 (1.10, 2.09). The level of combat exposure did not predict any of the three marital outcomes among WW II veterans. In fact, none of the other military service characteristics assessed (i.e., age of military induction, years of service, and service-connected disability) predicted marital outcomes. We found that age at the beginning of WW II impacted the timing and stability of marriage in both veterans and civilians. Finally, we identified cultural effects on the likelihood of marriage between Nisei and Kibei groups with Nisei men being less likely to marry. CONCLUSION: Similar to other groups in this era, long-term marriage with one partner was the norm for both veterans and civilians. For a small portion of American men of Japanese descent, military service seemed to impact the transition into marriage. However, we found no differences in the timing of marriage or the likelihood of divorce based on military service or level of combat exposure. While our findings are inconsistent with previous research on the impact of military service and combat exposure, much of that research was conducted with mainland veterans, usually of European descent. There appears to be little long-term disruption of life course events. Results highlight the importance of studying diverse groups of veterans to understand how experiences in the military interact with pre-military factors in defining long-term responses to military service