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BACKGROUND: Available empirical evidence on participant-level factors associated with dropout from psychotherapies for post-traumatic stress disorder (PTSD) is both limited and inconclusive. More comprehensive understanding of the various factors that contribute to study dropout from cognitive-behavioural therapy with a trauma focus (CBT-TF) is crucial for enhancing treatment outcomes. OBJECTIVE: Using an individual participant data meta-analysis (IPD-MA) design, we examined participant-level predictors of study dropout from CBT-TF interventions for PTSD. METHODS: A comprehensive systematic literature search was undertaken to identify randomised controlled trials comparing CBT-TF with waitlist control, treatment-as-usual or another therapy. Academic databases were screened from conception until 11 January 2021. Eligible interventions were required to be individual and in-person delivered. Participants were considered dropouts if they did not complete the post-treatment assessment. FINDINGS: The systematic literature search identified 81 eligible studies (n=3330). Data were pooled from 25 available CBT-TF studies comprising 823 participants. Overall, 221 (27%) of the 823 dropped out. Of 581 civilians, 133 (23%) dropped out, as did 75 (42%) of 178 military personnel/veterans. Bivariate and multivariate analyses indicated that military personnel/veterans (RR 2.37) had a significantly greater risk of dropout than civilians. Furthermore, the chance of dropping out significantly decreased with advancing age (continuous; RR 0.98). CONCLUSIONS: These findings underscore the risk of premature termination from CBT-TF among younger adults and military veterans/personnel. CLINICAL IMPLICATION: Understanding predictors can inform the development of retention strategies tailored to at-risk subgroups, enhance engagement, improve adherence and yield better treatment outcomes.

This article will review myogenic cell transplantation for congenital and acquired diseases of skeletal muscle. There are already a number of excellent reviews on this topic, but they are mostly focused on a specific disease, muscular dystrophies and in particular Duchenne Muscular Dystrophy. There are also recent reviews on cell transplantation for inflammatory myopathies, volumetric muscle loss (VML) (this usually with biomaterials), sarcopenia and sphincter incontinence, mainly urinary but also fecal. We believe it would be useful at this stage, to compare the same strategy as adopted in all these different diseases, in order to outline similarities and differences in cell source, pre-clinical models, administration route, and outcome measures. This in turn may help to understand which common or disease-specific problems have so far limited clinical success of cell transplantation in this area, especially when compared to other fields, such as epithelial cell transplantation. We also hope that this may be useful to people outside the field to get a comprehensive view in a single review. As for any cell transplantation procedure, the choice between autologous and heterologous cells is dictated by a number of criteria, such as cell availability, possibility of in vitro expansion to reach the number required, need for genetic correction for many but not necessarily all muscular dystrophies, and immune reaction, mainly to a heterologous, even if HLA-matched cells and, to a minor extent, to the therapeutic gene product, a possible antigen for the patient. Finally, induced pluripotent stem cell derivatives, that have entered clinical experimentation for other diseases, may in the future offer a bank of immune-privileged cells, available for all patients and after a genetic correction for muscular dystrophies and other myopathies.

Post-traumatic stress disorder (PTSD) genetics are characterized by lower discoverability than most other psychiatric disorders. The contribution to biological understanding from previous genetic studies has thus been limited. We performed a multi-ancestry meta-analysis of genome-wide association studies across 1,222,882 individuals of European ancestry (137,136 cases) and 58,051 admixed individuals with African and Native American ancestry (13,624 cases). We identified 95 genome-wide significant loci (80 new). Convergent multi-omic approaches identified 43 potential causal genes, broadly classified as neurotransmitter and ion channel synaptic modulators (for example, GRIA1, GRM8 and CACNA1E), developmental, axon guidance and transcription factors (for example, FOXP2, EFNA5 and DCC), synaptic structure and function genes (for example, PCLO, NCAM1 and PDE4B) and endocrine or immune regulators (for example, ESR1, TRAF3 and TANK). Additional top genes influence stress, immune, fear and threat-related processes, previously hypothesized to underlie PTSD neurobiology. These findings strengthen our understanding of neurobiological systems relevant to PTSD pathophysiology, while also opening new areas for investigation.

Abstract Ibrutinib and acalabrutinib are both associated with an increased risk of atrial fibrillation (AF); however, the comparative risk of AF between these 2 BTK inhibitors remains largely unknown. Our primary aim was to evaluate the risk of incident AF in patients exposed to ibrutinib compared to those exposed to acalabrutinib. Using the TriNetX research network database, we established a retrospective cohort of adult patients (≥ 18 years) previously diagnosed with a B-cell malignancy (using ICD-10-CM codes) in whom a first BTKi introduction occurred between January 1st, 2013 (first patient exposed to ibrutinib in TriNetX) and July 1st, 2024. Patients were divided into 2 groups based on their exposure to ibrutinib or acalabrutinib. After propensity score matching (PSM) across 37 covariates, Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) to compare the 2 matched groups. The appropriateness of the proportional hazard assumption was examined and risk differences (RDs) were used if appropriate. Results were summarized with the use of Kaplan–Meier survival curves. Follow-up started from 1 day after first BTKi introduction and continued over a 6-year follow-up period. A cohort of 12,449 patients exposed to ibrutinib and 4,131 to acalabrutinib were included in the study. After PSM, 4,090 patients remained in each group (1:1). During a mean duration of BTKi exposure of 2.3 ± 1.8 years, we found a significantly higher risk of incident AF in the ibrutinib group compared to the acalabrutinib group (RD 0.09, 95% CI 0.07–0.10). This difference was consistent across subgroups (age ≤ or > 75 and lower or higher baseline cardiovascular risk of developing AF). In conclusion, among patients with B-cell malignancies, the risk of developing incident AF is increased when treated with ibrutinib compared to acalabrutinib. Trial registration ClinicalTrial registration number: NCT06561243.

The article offers a fresh insight into the relations between the European Union and Africa from “migration diplomacy” perspective which is being introduced in migration and international relations research in Russia. The author notes the explanatory and predictive potential of the “migration diplomacy” concept for considering the complex relations between states within different migration systems. The analysis of interactions and cooperation of the EU, as a receiving side, with the states of origin and transit of international migrants in Africa allowed to highlight the specifics of the EU approach. The latter consists in using various diplomatic means and formats to address the problem of illegal immigration and reducing the number of asylum seekers in the EU. The increasing dependence of the European Union on cooperation with third countries results in the use of migration as a tool of political pressure by partner states. Intra-continental migration processes are at the centre of the migration diplomacy of the African continent, including those related to freedom of movement. Despite the differences in the approaches of the parties, the potential for cooperation lies in the development of channels for legal labour migration.

Abstract Coulomb explosion is an established momentum imaging technique, where the molecules are ionized multiple times on a femtosecond time scale before breaking up into ionized fragments. By measuring the momentum of all the ions, information about the initial molecular structure is theoretically available. However, significant geometric changes due to multiple ionizations occur before the explosion, posing a challenge in retrieving the ground-state structure of molecules from the measured momentum values of the fragments. In this work, we investigate theoretically and experimentally such a connection between the ground-state geometry of a polyatomic molecule (OCS) and the detected momenta of ionic fragments from the Coulomb explosion. By relying on time-dependent density functional theory (TDDFT), we can rigorously model the ionization dynamics of the molecule in the tunneling regime. We reproduce the energy release and the Newton plot momentum patterns of an experiment in which OCS is ionized to the 6+ charge state. Our results provide insight into the behavior of molecules during strong field multiple ionization, opening a way toward precision imaging of real-space molecular geometries using tabletop lasers.

The polar decomposition $X=WR$, with $X \in \mathrm{GL}(n, \mathbb{R})$, $W \in \mathcal{S}_+(n)$, and $R \in \mathcal{O}_n$, suggests a right action of the orthogonal group $\mathcal{O}_n$ on the general linear group $\mathrm{GL}(n, \mathbb{R})$. Equipped with the Frobenius metric, the $ \mathcal{O}_n $-principal bundle $\pi : X \in \mathrm{GL}(n, \mathbb{R}) \mapsto X\mathcal{O}_n \in \mathrm{GL} (n, \mathbb{R}) / \mathcal{O}_n$ becomes a Riemannian submersion. In this note, we derive an expression for the derivative of its unique symmetric section $ s \circ \pi $ in any dimension, in terms of a solution to a Sylvester equation. We discuss how to solve this type of equation and verify that our formula coincides with those derived in the literature for low dimensions. We apply our result to the characterization of geodesics of the Frobenius metric in the quotient space $\mathrm{GL} (n, \mathbb{R}) / \mathcal{O}_n$.

Abstract Background People living in precarious socio-economic conditions are at greater risk of developing mental and physical health disorders, and of having complex needs. This places them at risk of health inequity. Addressing social determinants of health (SDH) can contribute to reducing this inequity. Case management in primary care is an integrated care approach which could be an opportunity to better address SDH. The aim of this study is to better understand how case management in primary care may address the SDH of people with complex needs. Methods A case management program (CMP) for people with complex needs was implemented in four urban primary care clinics. A qualitative study was conducted with semi-structured interviews and a focus group with key informants (n = 24). An inductive thematic analysis was carried out to identify emerging themes. Results Primary care case managers were well-positioned to provide a holistic evaluation of the person’s situation, to develop trust with them, and to act as their advocates. These actions helped case managers to better address individuals’ unmet social needs (e.g., poor housing, social isolation, difficulty affording transportation, food, medication, etc.). Creating partnerships with the community (e.g., streetworkers) improved the capacity in assisting people with housing relocation, access to transportation, and access to care. Assuming people provide their consent, involving a significant relative or member of their community in an individualized services plan could support people in addressing their social needs. Conclusions Case management in primary care may better address SDH and improve health equity by developing a trusting relationship with people with complex needs, improving interdisciplinary and intersectoral collaboration and social support. Future research should explore ways to enhance partnerships between primary care and community organizations.

ABSTRACT Archaeal molecular biology has been a topic of intense research in recent decades as their role in global ecosystems, nutrient cycles, and eukaryotic evolution comes to light. The hypersaline-adapted archaeal species Halobacterium salinarum and Haloferax volcanii serve as important model organisms for understanding archaeal genomics, genetics, and biochemistry, in part because efficient tools enable genetic manipulation. As a result, the number of strains in circulation among the haloarchaeal research community has increased in recent decades. However, the degree of genetic divergence and effects on genetic integrity resulting from the creation and inter-lab transfer of novel lab stock strains remain unclear. To address this, we performed whole-genome re-sequencing on a cross-section of wild-type, parental, and knockout strains in both model species. Integrating these data with existing repositories of re-sequencing data, we identify mutations that have arisen in a collection of 60 strains, sampled from two species across eight different labs. Independent of sequencing, we construct strain lineages, identifying branch points and significant genetic events in strain history. Combining this with our sequencing data, we identify small clusters of mutations that definitively separate lab strains. Additionally, an analysis of gene knockout strains suggests that roughly one in three strains currently in use harbors second-site mutations of potential phenotypic impact. Overall, we find that divergence among lab strains is thus far minimal, though as the archaeal research community continues to grow, careful strain provenance and genomic re-sequencing are required to keep inter-lab divergence to a minimum, prevent the compounding of mutations into fully independent lineages, and maintain the current high degree of reproducible research between lab groups.IMPORTANCEArchaea are a domain of microbial life whose member species play a critical role in the global carbon cycle, climate regulation, the human microbiome, and persistence in extreme habitats. In particular, hypersaline-adapted archaea are important, genetically tractable model organisms for studying archaeal genetics, genomics, and biochemistry. As the archaeal research community grows, keeping track of the genetic integrity of strains of interest is necessary. In particular, routine genetic manipulations and the common practice of sharing strains between labs allow mutations to arise in lab stocks. If these mutations affect cellular processes, they may jeopardize the reproducibility of work between research groups and confound the results of future studies. In this work, we examine DNA sequences from 60 strains across two species of archaea. We identify shared and unique mutations occurring between and within strains. Independently, we trace the lineage of each strain, identifying which genetic manipulations lead to observed off-target mutations. While overall divergence across labs is minimal so far, our work highlights the need for labs to continue proper strain husbandry.

The research presented here draws on both work carried out in the 1990s and new data updated by the latest census, in an attempt to analyze the diversity of socio-demographic trajectories on the Ponant islands. The aim is to understand the driving forces behind the upheavals in these territories, studied by Françoise Péron [1993, 2005] and Louis Brigand [1983, 2002], as a result of the socio-demographic transformations and ways of living that have taken place since then. Coastal areas, and islands in particular, have seen their populations change dramatically in recent decades: strong attractiveness, new seasonal patterns, intermittent living, spatial competition between activities, new demographic (dis)balances, as well as challenges linked to access to housing, social and inter-generational diversity, and so on. These are all factors that are upsetting territorial balances and reshaping island societies, as reflected in the emergence of residents' collectives and mobilizations committed to maintaining island populations in these territories under pressure.

IntroductionAlteration of the oral microbiome could potentially play a role in the etiology of certain patients with Autism Spectrum Disorder (ASD), similar to the established link between gut microbiota dysbiosis and ASD. Most studies have assessed oral microbiota in children only and few have explored the oral flora composition in adults with ASD.MethodsIn our study, periodontal and dental status was evaluated in 30 adults with ASD using appropriate indices. Oral microbiota samples were collected in crevicular fluid and supra-gingival plaque at inflamed sites in each patient and analyzed using PCR for bacteria and qPCR for protozoa. Demographic data, co-morbidities, medication and oral hygiene habits were also collected.ResultsA total of 86.7% of the patients recruited suffering from severe ASD had periodontal disease and 67% had a high level of supra-gingival plaque. Two major periodontopathogens belonging to the red complex, Treponema denticola and Tannerella forsythia, were both detected in the supra-gingival plaque of 86.2% of patients and in the gingival crevicular fluid of 80 and 86.7% of patients, respectively. Certain microorganisms were statistically more frequently detected in patients with digestive disorders and taking certain medications.DiscussionThe oral microbiota composition of the adults with ASD showed significant differences compared to neurotypical individuals, particularly in the prevalence of the specific microorganisms P. gingivalis, T. tenax and E. gingivalis ST1. The detection frequency of periodontitis and periodontopathogens may have been underestimated due to the lack of cooperation of the adults with ASD during clinical examination and microbiota sampling. Further studies on larger cohorts are needed to consolidate these results to gain a better understanding of variations in oral microbiota.

Potrauminio streso sutrikimas (PTSS) yra paplitusi psichikos sveikatos problema, tačiau tik dalis šį sutrikimą turinčių žmonių gauna tinkamą psichologinę pagalbą. Internetu teikiamos psichologinės intervencijos galėtų tapti lengviau prieinama ir pigesne alternatyva įprastiems psichologinės pagalbos būdams. „Spring“ – tai Kardifo universiteto (Jungtinė Karalystė) mokslininkų sukurta į traumą orientuotos kognityvinės elgesio terapijos principais grįsta psichologinė internetu teikiama savigalbos intervencija. „Spring“ skirta vidutinio sunkumo potrauminio streso sutrikimo simptomams išgyvenus vienkartines traumines patirtis mažinti ir yra taikoma įsitraukus psichologui. Šio bandomojo tyrimo tikslas – įvertinti PTSS turinčių asmenų psichologinės savijautos pokyčius pasinaudojus „Spring“ intervencinės programos lietuviškąja versija. Šiam tikslui pasiekti buvo analizuoti septynių TLK-11 potrauminio streso sutrikimą turinčių moterų, dalyvavusių „Spring“ intervencijoje, duomenys. Tyrimo dalyvių amžiaus vidurkis buvo 41 m. (SD = 15). Naudota vienos grupės, kai įvertinama prieš intervenciją ir po jos, tyrimo schema. Savijauta vertinta Tarptautiniu traumos klausimynu (ITQ), Tarptautiniu depresijos klausimynu (IDQ), Tarptautiniu nerimo klausimynu (IAQ) ir PSO psichologinės gerovės indeksu (WHO-5). Duomenų analizei naudotas Wilcoxono kriterijus ir patikimo pokyčio indeksas (RCI). Rezultatai atskleidė, jog po „Spring“ intervencijos reikšmingai sumažėjo tyrimo dalyvių potrauminis stresas, depresijos ir nerimo simptomai, o psichologinės gerovės rodiklis padidėjo. Visų dalyvių PTSS simptomų sumažėjimas buvo statistiškai patikimas, o šešios iš septynių dalyvių po intervencijos nebepriklausė PTSS rizikos grupei. Bendras pasitenkinimas gauta pagalba buvo didelis. Pirmieji „Spring“ internetu teikiamos intervencijos lietuviškos versijos žvalgomojo tyrimo rezultatai rodo, kad ši pagalbos programa gali būti daug žadantis būdas gydyti potrauminio streso sutrikimą. Siekiant įvertinti šios intervencijos veiksmingumą, svarbu atlikti atsitiktinių imčių kontroliuojamus tyrimus surinkus didesnių imčių.

Ischia island represents the westernmost portion of the Phlegraean Volcanic District (Campania Region, Italy) and is characterized by the presence of Mt. Epomeo, a giant centrally located resurgent volcanic horst. This horst is controlled by fault systems and magmatic dynamics able to generate recurrent seismicity. Such seismicity, associated with the presence of volcanic terrains with different degrees of erodibility, makes Ischia highly subjected to several ground instability phenomena such as landslides. This multidisciplinary study aimed to map the seismically induced landslide susceptibility of the island, taking into account the Md 4.0 earthquake that occurred on August 21, 2017, as a reference seismic event. Eight parameters were isolated as relevant predisposing factors for landslide occurrence and combined, through GIS elaborations, to compute a numerical index (SNAP index) that quantified the seismically induced landslide susceptibility for each 5 × 5 m area. The resulting map, through five classes of susceptibility, highlights that the highest exposed areas are mainly localized along the N–NW flanks of Mt. Epomeo, involving mainly the municipality of Casamicciola Terme. Moreover, the map is discussed considering the spatial distribution of historical and recent seismically induced ground effects, an ERT field survey carried out on significant test sites, and the displacement map obtained by 2015–2022 InSAR data.

Background: Inadequate and excessive gestational weight gain (GWG) are rising epidemiological health concerns, affecting a substantial proportion of pregnant women in high-income countries and contributing to a multitude of adverse maternal and infant health outcomes. The aim of this scoping review was to identify key structural vulnerability factors (SVFs) related to GWG, and to examine the extent, range, and nature of the existing literature to inform future research. Methods: Electronic searches were performed in October 2018 (updated in August 2019) in MEDLINE(R) ALL, EMBASE, PsycINFO, CINAHL, and Sociological Abstracts databases. Eligible studies had an observational design, had to be conducted before COVID-19, in a high-income country, have pregnant participants, and perform inferential statistics between an SVF and GWG. Results: Of the 157 included articles, the eight SVFs most commonly studied in association with GWG were race/ethnicity (n=91 articles), age (n=87), parity (n=48), education (n=44), income (n=39), marital status (n=28), immigration (n=19), and abuse (n=12). Substantial heterogeneity across study contexts, methodologies, populations, and findings was identified. Studies spanned 22 high-income countries, were predominantly conducted in the USA (77%), and most studies (60%) had a retrospective design. Race/ethnicity was the most extensively studied factor, covering the longest time period (since 1976) and having the largest sample size, and the second-highest proportion of studies reporting a significant relationship with GWG (79%), following immigration status (95%). Conclusions: Given the heterogeneity in findings across studies, adopting an intersectional approach may enhance our understanding of the complex interplay between SVFs and the social context in relation to GWG. This nuanced perspective is critical for informing future research and developing effective strategies to address the pervasive perinatal health challenges associated with inadequate and excessive GWG.

Future fusion reactors like ITER and DEMO will have all-tungsten (W) walls and long pulses. These features will make wall conditioning more difficult than in most of the existing devices. The W Environment Steady-state Tokamak (WEST) is one of the few long pulse (364 s) fusion devices with actively cooled W plasma-facing components in the world. WEST is a unique test bed to study impurity migration and plasma density control via reactor relevant wall conditioning techniques. The phase II of WEST operations began in 2022, after the installation of a new lower divertor, now entirely equipped with actively cooled, ITER grade, W monoblocks. After pump down, we baked WEST between 90 °C and 170 °C for ∼2 weeks. After 82.5 h at 90 °C and 33 h at 170 °C, vacuum conditions were stable with a vessel pressure of 6x10-5 Pa and mass spectra dominated by H2 molecules. While at 170 °C, we performed ∼40 h of D2 glow discharge cleaning (GDC) and ∼5 h of glow discharge boronization (GDB), using a 15 %-85 % B2D6-He mix and a total boron mass of ∼12 g. This was the very first GDB at such high temperature for WEST. The whole wall conditioning sequence led to a ∼10 times reduction of the H2O signal as well as to a ∼3 times reduction of the O2 signal, according to mass spectra. Once back to 70 °C, the vessel pressure was 5.5x10-6 Pa and plasma restart was seamless with ∼30 s cumulated over the very first 5 pulses and an Ohmic radiated power fraction Frad = 0.6, showing successful conditioning of the new ITER grade divertor. The effect of the first, ‘hot’ GDB faded with a characteristic cumulative injected energy of 2.45 GJ and saturation towards Frad ∼0.8. After 1.4 h and 7.5 GJ of cumulative plasma time and injected energy, we carried out a second GDB, this time at 70 °C. This ‘cold’ GDB initially led to a much lower Ohmic Frad = 0.3–0.4 but the effect lasted ∼7 times less, with a characteristic cumulative injected energy of 0.37 GJ. At the end of the campaign, we cumulated ∼3h and ∼30 GJ through repetitive, minute long pulses without any boronization. Throughout this 4-weeks-long experiment, Frad in the 4 MW heating phase evolved only marginally (from 0.5 to 0.55). This increase is mostly due to the build-up of re/co-deposited layers on both lower divertor targets.

Campi Flegrei is an active volcanic area located in the Campanian region (southern Italy). It is characterized by a caldera structure including a subaerial portion densely populated and a submarine area represented by the Gulf of Pozzuoli. Altimetry data acquired by Airborne Laser Scanning and seafloor depth data coming from several bathymetry surveys were used to show a Digital Elevation Model with a spatial resolution of 1 m for the topography of Campi Flegrei. This model, for the first time, reconstructs a topographic continuum from land to seafloor for a total extent of 138.32 km2. Thanks to the high spatial resolution, the model allowed to map and measure seafloor features such as landslides and terraces as well as Roman-epoch artefacts. Our results provide accurate reference topography for a more complete mapping and modelling of natural hazards that affect, directly or indirectly, the entire area of the Campi Flegrei caldera.

In this work, we investigate the optical properties variation of thermally grown W oxides during the exposure to low energy deuterium (D) plasma. In-situ ellipsometry in the 400–1000 nm range was coupled to ex-situ diagnostics, such as X-ray photoelectron spectroscopy (XPS) and focused ion beam coupled to scanning electron microscopy (FIB-SEM), to probe the evolution of chemical and morphological properties of the W oxides. First, a 70 nm thick WO3 layer was exposed to D plasma at a surface temperature of 650 K. An important reduction of the oxide layer was observed by FIB-SEM, and in-situ ellipsometry showed the evolution of the optical constants n and k of the oxide towards the ones of pure W metal. Secondly, a 300 nm thick WO3 layer was exposed to D plasma at a surface temperature below 373 K. In order to follow the oxide evolution step by step, we alternated in-situ ellipsometry and XPS surface characterization. A quite similar evolution of the optical constants was observed, in particular an increase of the extinction coefficient k in the near infrared, which was linked to a progressive reduction of the oxidation level at the surface, as seen by XPS. Interestingly, the reduction of the oxide at 373 K was below the resolution of the FIB-SEM. This observation indicates that ellipsometry in the 400–1000 nm range is able to follow in-situ the reduction of WO3 oxides by D plasma with high surface sensitivity.

Background Available empirical evidence on participant-level factors associated with dropout from psychotherapies for post-traumatic stress disorder (PTSD) is both limited and inconclusive. More comprehensive understanding of the various factors that contribute to study dropout from cognitive-behavioural therapy with a trauma focus (CBT-TF) is crucial for enhancing treatment outcomes.Objective Using an individual participant data meta-analysis (IPD-MA) design, we examined participant-level predictors of study dropout from CBT-TF interventions for PTSD.Methods A comprehensive systematic literature search was undertaken to identify randomised controlled trials comparing CBT-TF with waitlist control, treatment-as-usual or another therapy. Academic databases were screened from conception until 11 January 2021. Eligible interventions were required to be individual and in-person delivered. Participants were considered dropouts if they did not complete the post-treatment assessment.Findings The systematic literature search identified 81 eligible studies (n=3330). Data were pooled from 25 available CBT-TF studies comprising 823 participants. Overall, 221 (27%) of the 823 dropped out. Of 581 civilians, 133 (23%) dropped out, as did 75 (42%) of 178 military personnel/veterans. Bivariate and multivariate analyses indicated that military personnel/veterans (RR 2.37) had a significantly greater risk of dropout than civilians. Furthermore, the chance of dropping out significantly decreased with advancing age (continuous; RR 0.98).Conclusions These findings underscore the risk of premature termination from CBT-TF among younger adults and military veterans/personnel.Clinical implication Understanding predictors can inform the development of retention strategies tailored to at-risk subgroups, enhance engagement, improve adherence and yield better treatment outcomes.

Objective Chronic pain affects approximately 7.6 million Canadians and access to care remains an issue. The Power Over Pain (POP) Portal offers immediate access to evidence-based resources ranging from low- (e.g. education, self-management), to high- (e.g. individual counseling) intensity. We explored the POP Portal's acceptability, usability, and perceived usefulness among patients newly referred to a tertiary care pain clinic. Methods We used a descriptive, qualitative approach with a prospective cohort of 60 adult patients recently referred to The Ottawa Hospital Pain Clinic. Patients were offered an orientation session and asked to participate in a seven-week follow-up interview. Data were thematically analyzed in an iterative process, whereby responses were reviewed and coded by two members of the research team. Results Of the 60 patients referred to the POP Portal by clinic clerks, 45 participated in the orientation session, and 40 completed a four-week follow-up. All 40 patients had used the POP Portal and recommended that we continue to offer the POP Portal to patients awaiting care. We identified overarching themes of acceptability (five subthemes), usability (ten subthemes), accessibility (three subthemes), and patient value of the POP Portal (three subthemes). This includes (1) the POP Portal provides easy access to chronic pain resources; (2) the POP Portal is helpful in developing an understanding of chronic pain; and (3) improvements to the POP Portal are needed to increase usability and foster a user-friendly experience. Conclusions The POP Portal offers accessible and diverse resources for people living with pain awaiting a tertiary care consultation; however, patients would like to see resources specific to diagnosis. Improvements are suggested to allow greater increase the POP Portal usability.