The Relationship Between Trauma Exposure, Somatic Symptoms, and Mental Health in Australian Defence Force Members Deployed to the Middle East Area of Operations

There is an increase in the prevalence of physical symptoms in military veterans who have deployed to combat zones compared to those who have not been deployed. These symptoms can be distressing, disabling, and negatively impact quality of life. Current paradigms regarding the effects of traumatic deployment exposures on military personnel tend to consider non-specific physical symptoms (that are not due to injury) as simply a comorbidity of psychological disorder following trauma, rather than independent sequelae. For example, the diagnostic criteria for a condition specifically caused by traumatic exposures, posttraumatic stress disorder (PTSD), do not include physical symptoms. Uncertainty surrounding the aetiology of physical symptoms has led to some fierce controversies, such as the existence of Gulf War Syndrome. The aim of this thesis was to examine how physical and psychological symptoms occur independently as well as co-occur in veterans post-deployment, and to examine the strength of associations between traumatic deployment exposures (TDEs) and these profiles of physical and psychological symptom presentation. A further aim was to explore how well a checklist of physical symptoms could identify concurrent PTSD. The final aim was to examine whether inflammation mediated associations between TDEs and physical symptoms. Data used in this thesis were from several related studies of Australian Defence Force (ADF) members who deployed to the Middle East Area of Operations (MEAO) from 2001 to 2012. These studies were commissioned by the Australian Government’s Department of Defence to explore the impact of increased operational tempo on the health of military personnel. These large-scale correlational studies surveyed tens of thousands of personnel using self-reported questionnaires which included gold-standard measures of psychological distress and PTSD, as well as checklists of trauma exposure and physical symptoms. This thesis substantiated prior findings of high rates of comorbidity between PTSD and physical symptoms in veterans. While results confirmed that physical and psychological symptoms can co-occur, analyses identified a subgroup of veterans who exhibited physical symptoms without psychological distress; this ‘physical only’ presentation was as common as the ‘psychological only’ and comorbid symptom presentations. Moreover, this presentation was associated with lower quality of life, and as such is worthy of clinical attention. Importantly, TDEs showed similar associations with both ‘physical only’ and ‘psychological only’ symptom presentations. As with First Gulf War research, there did not appear to be a particular post-deployment physical ‘syndrome’; while symptoms often co-occurred, it was symptom number and intensity rather than type that identified affected veterans. A list of 10 physical symptoms demonstrated good diagnostic utility for predicting cases of concurrent PTSD. The findings also suggest that sub-types of PTSD exist, differentiated by the level of somatic symptoms. While a relationship was found between some individual physical symptoms and inflammation, the hypothesis that inflammation mediates the relationship between trauma and physical symptoms was not supported. These findings validate physical symptoms as a discrete symptom outcome following deployment, and this presentation had a similar prevalence to co-occurring physical and psychological symptoms. Therefore, physical symptoms should not be regarded simply as a comorbidity of an underlying psychological disorder for all veterans. As physical symptoms are just as likely to occur as psychological symptoms following TDEs and they impact quality of life, they should be assessed during post-deployment screening and considered in civilian treatment of veterans. Furthermore, the inclusion of physical symptoms in PTSD screening checklists may improve PTSD identification rates and better describe the patient experience.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 201

DEVELOPMENT AND PRELIMINARY FEASIBILITY OF THE MOBILE PARTICIPATION ASSESSMENT TOOL: AN ECOLOGICAL MOMENTARY ASSESSMENT OF PARTICIPATION IN TRAUMATIC BRAIN INJURY

Participation as a primary outcome of interest has gained increasing focus for disability and rehabilitation research and practice. Current means of assessing participation are limited by their static nature and reliance on an individual’s accurate and unbiased recall of past events. In particular, participation is an important outcome in traumatic brain injury (TBI) research and practice, and for these individuals accurate and unbiased recall can be impacted by the functional limitations that are commonly associated with this injury. Ecological momentary assessment (EMA) is an assessment approach that employs the repeated measurement of an outcome of interests in the natural, real-world environment. EMA may reduce the limitations of current measures of participation as well as enhance reporting accuracy and reliability of individuals with a history of TBI. The main objectives of this dissertation were to 1) develop a preliminary measure of participation that can be delivered using EMA techniques and 2) examine the feasibility and usability of EMA in a TBI population that exhibits cognitive impairment. The first aim of this study was the preliminary development of a participation assessment that could be delivered via EMA techniques. The Mobile Participation Assessment Tool (mPAT) was developed and underwent preliminary validation by the research team in conjunction with a group of experts in the field of rehabilitation and disability sciences and individuals with a history of TBI. An accompanying scoring algorithm was also developed by the group. The second aim of examining the feasibility of using EMA techniques to assess participation in community dwelling adults with TBI and presence of cognitive impairment was completed by asking adults with TBI (n=12) to complete a four week EMA protocol to assess participation in the real-world environment in which they live. This study was funded in part through the School of Health & Rehabilitation Sciences’ Dean’s Research Development Fund at the University of Pittsburgh

Conditional disclosure on pathways to care: coping preferences of young people at risk of psychosis

The interrelationship between stigma and help-seeking is under-researched among children and adolescents. This study explored stigma in relation to pathways to care among young people putatively in an early stage of increased risk of developing psychotic disorders. “Pathways to care” was defined as help-seeking and support from informal and formal resources, and increased risk was determined through the presence of persistent psychotic-like experiences and internalizing/externalizing psychopathology. Twenty-nine qualitative interviews were analyzed using thematic analysis. We defined the superordinate theme in these data as “conditional disclosure,” a concept reflecting the rules and prerequisites that influenced how/whether participants sought help. Through parallels between these findings and established stigma theory, we examined how these conditions could be interpreted as influenced by stigma. Our findings demonstrate the influence of stigma on young people’s perceptions of a range of pre-clinical symptoms, and on how they seek support for these symptoms

Development of the Telehealth Usability Questionnaire (TUQ)

Current telehealth usability questionnaires are designed primarily for older technologies, where telehealth interaction is conducted over dedicated videoconferencing applications. However, telehealth services are increasingly conducted over computer-based systems that rely on commercial software and a user supplied computer interface. Therefore, a usability questionnaire that addresses the changes in telehealth service delivery and technology is needed.  The Telehealth Usability Questionnaire (TUQ) was developed to evaluate the usability of telehealth implementation and services.  This paper addresses: 1) the need for a new measure of telehealth usability, 2) the development of the TUQ, 3) intended uses for the TUQ, and 4) the reliability of the TUQ. Analyses indicate that the TUQ is a solid, robust, and versatile measure that can be used to measure the quality of the computer-based user interface and the quality of the telehealth interaction and services.   

Tertiary lymphoid structures are associated with higher tumor grade in primary operable breast cancer patients

Published version, also available at http://dx.doi.org/10.1186/s12885-015-1116-1Background: Tertiary lymphoid structures (TLS) are highly organized immune cell aggregates that develop at sites of inflammation or infection in non-lymphoid organs. Despite the described role of inflammation in tumor progression, it is still unclear whether the process of lymphoid neogenesis and biological function of ectopic lymphoid tissue in tumors are beneficial or detrimental to tumor growth. In this study we analysed if TLS are found in human breast carcinomas and its association with clinicopathological parameters. Methods: In a patient group (n = 290) who underwent primary surgery between 2011 and 2012 we assessed the interrelationship between the presence of TLS in breast tumors and clinicopathological factors. Prognostic factors were entered into a binary logistic regression model for identifying independent predictors for intratumoral TLS formation. Results: There was a positive association between the grade of immune cell infiltration within the tumor and important prognostic parameters such as hormone receptor status, tumor grade and lymph node involvement. The majority of patients with high grade infiltration of immune cells had TLS positive tumors. In addition to the degree of immune cell infiltration, the presence of TLS was associated with organized immune cell aggregates, hormone receptor status and tumor grade. Tumors with histological grade 3 were the strongest predictor for the presence of TLS in a multivariate regression model. The model also predicted that the odds for having intratumoral TLS formation were ten times higher for patients with high grade of inflammation than low grade. Conclusions: Human breast carcinomas frequently contain TLS and the presence of these structures is associated with aggressive forms of tumors. Locally generated immune response with potentially antitumor immunity may control tumorigenesis and metastasis. Thus, defining the role of TLS formation in breast carcinomas may lead to alternative therapeutic approaches targeting the immune system

ICAM1 expression is induced by proinflammatory cytokines and associated with TLS formation in aggressive breast cancer subtypes

Source at https://doi.org/10.1038/s41598-018-29604-2.Intratumoral formation of tertiary lymphoid structures (TLS) within the tumor microenvironment is considered to be a consequence of antigen challenge during anti-tumor responses. Intracellular adhesion molecule 1 (ICAM1) has been implicated in a variety of immune and inflammatory responses, in addition to associate with triple negative breast cancer (TNBC). In this study, we detected TLS in the aggressive tumor phenotypes TNBC, HER2+ and luminal B, whereas the TLS negative group contained solely tumors of the luminal A subtype. We show that ICAM1 is exclusively expressed in TNBC and HER2 enriched subtypes known to be associated with inflammation and the formation of TLS. Furthermore, cell from normal mammary epithelium and breast cancer cell lines expressed ICAM1 upon stimulation with the proinflammatory cytokines TNFα, IL1β and IFNγ. ICAM1 overexpression was induced in MCF7, MDA-MB-468 and SK-BR-3 cells regardless of hormone receptor status. Taken together, our findings show that ICAM1 is expressed in aggressive subtypes of breast cancer and its expression is inducible by well-known proinflammatory cytokines. ICAM1 may be an attractive molecular target for TNBC, but further investigations elucidating the role of ICAM1 in targeted therapies have to take into consideration selective subtypes of breast cancer

The Grizzly, April 21, 2005

A Taste of Asia • Students Raise Over $3,000 for Multiple Sclerosis • U.S.-Israeli Relations: On Cold Terms? • Why Kaleidoscope? • Class Elections: Who Will Get Your Vote? • Talent Show this Friday • Ursinus Students Take a Vow of Silence • New Mugs in Zack\u27s Promote Environmental Awareness • Our Town Makes its Mark as Ritter\u27s Last Play • Spread Your Legs and Turn Your Head and Cough • Opinions: Academic Honor Code: Is it Really Necessary?; Scope the Opening ; Questions that Need to be Considered by the Ursinus Campus • Men\u27s Baseball: Trying to Make a Push for the Playoffs • Conference Woes Continue for Men\u27s Lacrosse • A Struggling Season Shows Some Signs of Improvement for Tennis Teamshttps://digitalcommons.ursinus.edu/grizzlynews/1584/thumbnail.jp