Search

BACKGROUND Rapid infusion of warmed blood products is the cornerstone of trauma resuscitation and treatment of surgical and obstetric massive hemorrhage. Integral to optimizing this delivery is selection of an intravenous (IV) catheter and use of a rapid infusion device (RID). We investigated which IV catheter and RID system enabled the greatest infusion rate of blood products and the governing catheter characteristics. STUDY DESIGN AND METHODS The maximum flow rates of nine IV catheters were measured while infusing a mixture of packed red blood cells and fresh frozen plasma at a 1:1 ratio using a RID with and without a patient line extension. To account for IV catheters that achieved the RID's maximum 1000 ml/min, the conductance of each infusion circuit configuration was calculated. RESULTS IV catheters of 7-Fr caliber or higher reached the maximum pressurized flow rate. The 9-Fr multi-lumen access catheter (MAC) achieved the greatest conductance, over sevenfold greater than the 18 g peripheral catheter (4.6 vs. 0.6 ml/min/mmHg, p

In 1905, Boston immigration officials detained four Chinese students of the King family, inciting protest from Euro-American elites and sparking an international controversy that gave momentum to the American Boycott movement in Shanghai. A prominent family, the Kings successfully rallied business leaders to take their cause to President Theodore Roosevelt and effectively used the press to articulate Chinese grievances. Bringing to a head the tension between race-based and class-based interpretations of exclusion that troubled the legislation from its inception, the case prompted key reforms in the administration of Chinese exclusion and helped promote a pivot away from the movement for a wholesale “Chinese ban.” An examination of this incident and its role in struggles over immigration law illuminates the conflicted position of Chinese elites—disempowered by race yet empowered by class status—under exclusion. It also provides insights into the agency of Chinese elites in mobilizing resources to combat immigration abuses.

Evidence-based treatments for posttraumatic stress disorder (PTSD) are available for veterans, but many do not benefit due to low treatment engagement. This may be partially due to avoidance behaviors characteristic of individuals with PTSD. Acceptance and Commitment Therapy (ACT) is a transdiagnostic treatment approach that aims to reduce avoidance. The authors propose the use of adjunctive ACT techniques to enhance engagement with treatment for PTSD. ACT techniques such as cognitive defusion and values clarification have been shown to promote engagement with other cognitive-behavioral treatments, but no studies to date have examined these techniques as adjuncts to treatment for PTSD. Because of its focus on reducing avoidance, ACT is uniquely suited for promoting treatment engagement with the “gold standard” treatments for PTSD. The authors review the existing research on ACT as an adjunctive intervention, discuss specific concepts and techniques from ACT that are relevant to PTSD, and provide recommendations for future research.

Early detection of bacterial transmission and outbreaks in hospitals is important because nosocomial infections can result in health complications and longer hospitalization. Current practice to detect outbreaks uses genotyping methods amplified fragment length polymorphism (AFLP) and whole genome sequencing (WGS), which are not suitable methods for real-time transmission screening of both susceptible and resistant bacteria. The aim was to assess the typing technique Fourier transform infrared (FTIR) spectroscopy as real-time screening method to discriminate large amounts of susceptible and resistant bacteria at strain level when there is no evident outbreak in comparison with the WGS reference. Isolates of past hospital outbreak strains of Acinetobacter baumannii/calcoaceticus complex (n = 25), Escherichia coli (n = 31), Enterococcus faecium (n = 22), Staphylococcus aureus (n = 37) and Pseudomonas aeruginosa (n = 30) were used for validation of FTIR. Subsequently, Enterococcus faecalis (n = 106) and Enterococcus faecium (n = 104) isolates from weekly routine screening samples when no potential outbreak was present were analysed. FTIR showed reproducibility and congruence of cluster composition with WGS for A. baumannii/calcoaceticus complex and E. faecium outbreak isolates. The FTIR results of E. faecalis and E. faecium isolates from routine samples showed reproducibility, but the congruence of cluster composition with WGS was low. For A. baumannii/calcoaceticus complex and E. faecium outbreak isolates, FTIR appears to be a discriminatory typing tool. However, our study shows the discriminatory power is too low to screen real-time for transmission of E. faecium and E. faecalis at patient wards based on isolates acquired in routine surveillance cultures when there is no clear suspicion of an ongoing outbreak.

Hip and knee replacement surgery is common, yet more than 10% of patients who undergo total hip replacement (THR) and total knee replacement (TKR) report postsurgery dissatisfaction. Recommendations for improving patient experience after total joint replacement surgery include increasing support to patients, including having a patient navigator available to patients before and after surgery. This article reports on THR and TKR patients' experiences of using an orthopaedic patient navigator. We employed qualitative description to understand THR and TKR patients' experiences of interacting with an orthopaedic patient navigator in a community teaching hospital. Telephone interviews were conducted with 15 purposefully selected total joint replacement patients (TKR: n = 11; THR: n = 4) who had at least one contact with the navigator. Interview transcripts were analyzed using thematic analysis. Patients described receiving physical support services, emotional support services, informational support services, and care coordination services from the patient navigator. All interactions with the patient navigator were positive. Knowing the patient navigator was available for any future concerns also provided indirect benefits of reassurance, comfort, and security. Patients described these direct and indirect benefits as potentially having long-lasting and resilient positive effects. An orthopaedic patient navigator can have a positive impact on patients' THR and TKR experience and fill gaps in support identified in earlier studies. Addressing patients' complex and varied care needs is well suited to a clinical nurse specialist in the role. Investing in an orthopaedic patient navigator provides reassurance to patients that their needs are a priority and will be addressed in a timely manner.

We examined multiple dimensions of religiosity and their relationship to the four DSM-5 PTSD symptom clusters among US Veterans and Active Duty Military (ADM), hypothesizing that religiosity would be most strongly inversely related to negative cognitions/emotions (Criterion D symptoms) and less strongly to neurobiologically based symptom clusters (B, C, and E). This cross-sectional multisite study involved 591 Veterans and ADM from across the southern USA. Inclusion criteria were having served in a combat theater and the presence of PTSD symptoms. Measures of religious beliefs/practices, social involvement, and PTSD symptoms were administered, and bivariate and multivariate analyses were conducted in the overall sample, and in exploratory analyses, in the sample stratified by race (White, Black, and Hispanic). In the overall sample, multivariate analyses revealed that the only PTSD symptom cluster inversely related to religiosity was Criterion D, and only to organizational (b = - 0.08, P = 0.028) and cognitive/intrinsic religiosity (b = - 0.06, P = 0.049), relationships that were fully explained by social factors. Religious struggles, in contrast, were positively related to all four symptom clusters. Inverse relationships with Criterion D symptoms were particularly strong in Blacks, in whom inverse relationships were also present with Criterion E symptoms. In contrast, only positive relationships with PTSD symptom clusters were found in Hispanics, and no relationships (except for religious struggles) were present in Whites. As hypothesized, the inverse relationship between religious involvement and PTSD symptoms in Veterans and ADM was strongest (though modest) for Criterion D negative cognitions/emotions, especially in Blacks.

Intolerance of uncertainty (IU) has been conceptualized as a transdiagnostic vulnerability for emotional psychopathology, but few studies have tested whether it prospectively predicts emotional psychopathology, and none have utilized transdiagnostic and clinician-rated outcomes. To fill this gap, the present study tested whether IU prospectively predicted the clinician-rated severity of transdiagnostic emotional psychopathology six months later in a treatment-seeking Veteran sample. Participants completed the Intolerance of Uncertainty 12-item scale (IUS-12) and the Structured Clinical Interview for the DSM-5 (SCID-5) at Time 1 and again six-months later (Time 2); assessed emotional disorders included both anxiety-related disorders (i.e., post-traumatic stress disorder, generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive compulsive disorder, specific phobia) and depressive conditions (i.e., major depressive disorder and persistent depressive disorder). Linear regression analyses revealed a bidirectional prospective relation between IU and emotional psychopathology, wherein higher Time 1 IUS-12 predicted greater Time 2 emotional disorder severity and greater Time 1 emotional disorder severity predicted higher Time 2 IUS-12. Follow-up analyses revealed that IU prospectively predicted the maintenance (but not the development) of anxiety-related issues, whereas prediction of Time 2 depression was nullified when controlling for Time 1 anxiety pathology. These findings implicate IU as a transdiagnostic vulnerability for emotional psychopathology and suggest the construct can be particularly useful as a treatment target and prognostic indicator for anxiety-related conditions.

The present work aimed to investigate the mechanisms of nitric oxide (NO) and reactive oxygen species (ROS) generations and to explore their roles in the regulation of antioxidative responses in the wheat leaves under salinity. Except for an insignificant change of NO content and nitrate reductase (NR) activity due to 50 mM NaCl, NO, hydrogen peroxide, superoxide anion (O2•-), hydroxyl radical (•OH), chlorophyll and malondialdehyde content, as well as activities of nitric oxide synthase, NR, peroxidases (POD), catalase (CAT), and ascorbate peroxidase rose in response to different NaCl concentrations. Meanwhile, leaf superoxide dismutase activity lowered only at 50 mM NaCl. NaCl-stimulatory effects on NO content as well as POD and CAT activities could be partly alleviated by the application of 2-phenyl-4,4,5,5-tetrame-thylimidazoline-3-oxide-1-oxyl (PTIO, NO scavenger), exogenous CAT, or diphenylene iodonium (DPI, NADPH oxidase inhibitor). Native polyacrylamide gel electrophoresis also showed that the amount of POD (especially POD4, POD5, and POD7) and CAT (especially CAT1, CAT2, and CAT3) isozymes increased with increasing salinity but decreased by application of PTIO, CAT, or DPI. Furthermore, histochemical staining showed a similar change of O2•- generation. In addition, the inhibition of diamineoxidase (DAO), polyamine oxidase (PAO), and cell wall-bound POD (cw-POD) activities in NaCl-stressed seedlings seemed to be insensitive to the application of PTIO or DPI. Taken together, salinity-induced NO, H2O2, and O2•- generation influenced each other and played different roles in the regulation of antioxidant enzyme activities in the leaves of wheat seedlings under NaCl treatment.

Although metal accumulation has been investigated in coastal Antarctic soil, the information about to what extent station activities influence soil quality remains limited, especially in East Antarctica. Here, we carried out an investigation on element accumulation (Pb, Zn, Cu, Ni, Mn, Cr, Ti, Zr, Fe, Ca, K, Al, Mg and Na) in topsoils collected from Larsemann Hills, the second largest oasis along East Antarctica. Results show that metal contents in soils generally fall within the ranges of local rocks, suggesting a dominant source of parent minerals. In spatial, a content gradient of Pb was found, with elevated values inside station areas, while no obvious trend was found for other metals. Contents of total organic carbon (TOC) and nitrogen are rather low, and no association exists between metals and TOC or nitrogen, suggesting a minor role of nutrients in soil metal accumulation in this cold-xeric environment. Chemical weathering assessment suggests a low degree of chemical weathering in topsoils in Larsemann Hills. The results of multivariate statistical analysis suggest that lithological inputs are the dominant source of soil metals, and the different metal groups are likely associated with different geochemistry of elements during weathering process. Among the observed 14 metals, only soil Pb levels was affected by local human activities, but this influence is only confined to inside station areas. The influences of marine inputs and long-range pollutant transport on metal levels in topsoils were found to be negligible.

An improved delayed detached eddy simulation (IDDES) is carried out to investigate both the mean and the instantaneous flow characteristics of conical cavities fixed on a cone surface in a Mach 0.9 freestream. Two model categories, a single cavity model with different length (L) to depth (D) ratio and a multi-cavity model that inserted the separation disk into a single cavity are studied. Results indicate that in case of a single cavity model, the cavity L/D ratio is the key parameter that influences mean flow structure and oscillatory characteristics. The bulk reverse flow structure can be broken up into smaller structures as L/D value reduces from 4.0 to 0.51 inside the cavity. Smaller longitudinal pressure gradients on the cavity wall and the thicker downstream boundary layer are observed when larger L/D values are present. The cavities with smaller L/D values can stimulate the pressure oscillation fundamental frequency as well as the acoustic tones to increase the value. Multi-cavity configurations through insertion of a separation disk into the single cavity are helpful in cutting the large reverse flow structure inside a cavity into a smaller, similar, coherent structure, and to reduce the overall cone drag. The insertion of the separation disk can modulate pressure oscillation peaks and sound pressure levels to higher frequency, however, they are not able to reduce the overall sound pressure inside the cavity. Pressure oscillations within each cavity of the multi-cavity configuration have a weak correlation.

The majority of women who use contraception acknowledge the non-contraceptive benefits and many women use contraception solely for these benefits. The purpose of this review is to discuss the established benefits and highlight recent advances in our understanding of non-contraceptive benefits. Combined hormonal contraception (CHC), especially extended-cycle CHC, provides significant improvement for women suffering from heavy menstrual bleeding, pelvic pain, menstrual migraines, and mood disorders. The levonorgestrel intrauterine device (LNG IUD) provides improvement in pain and bleeding beyond that of CHC although its effectiveness may be mediated by pre-existing bleeding patterns. CHC and LNG IUD are protective against gynecologic cancers and data continues to emerge on non-gynecologic cancer risk. Hyperandrogenism is best treated with CHC containing newer progestins. LNG IUD may be used in the treatment of endometrial hyperplasia or carcinoma and is effective for endometrial protection during estrogen replacement. CHCs promote healthy vaginal flora. Counseling on contraception should include a discussion of both the risks and benefits. In most women, the benefits are substantial and outweigh the risks.

The effective treatment for hepatocellular carcinoma (HCC) with American Joint Committee on Cancer stage IIIB remains controversial and challenging because of the high recurrence rate after resection and low survival rate. The median survival of those with macroscopic portal vein tumor thrombus (PVTT) is short. We reported such a case which received liver transplantation (LT) after successful consecutive downstaging therapies. A 40-year-old man with alcohol related liver cirrhosis and repeated esophageal varices bleeding had HCC with tumor thrombi in right main portal vein and the second portal branch of segment VI (stage IIIB). The received percutaneous alcohol injection, radiofrequency ablation, 8 sessions of transcatheter hepatic arterial chemoembolization, radiotherapy, and target therapy with sorafenib. Computed tomography (CT) scan and magnetic resonance imaging after treatments showed no viable fragments in the tumor and revealed both the right main portal vein and V1 branch were patent. One month later, the patient received a deceased LT. The perioperative course was rather smooth. After discharge, the interval follow-up CT studies of the chest and liver and whole body bone scan showed no tumor recurrence or metastasis up to 20 months postoperation.

The aim of this study was to clarify the biological roles of microRNA-488 and transforming growth factor β1 (TGF-β1) pathway in the occurrence and progression of diabetic nephropathy (DN).Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was used to detect the expressions of microRNA-488, fibrinogen factors coII, coIIV, and fibronectin (FN) in Human mesangial cells (HMCs) with high-glucose or low-glucose treatment. After transfection of microRNA-488 mimics or inhibitor, expression levels of coII, coIIV, and FN in HMCs were determined by qRT-PCR and Western blot. Their expressions in HMC cells treated with different doses of TGF-β1 at different time points were also detected. Finally, we evaluated the potential influence of microRNA-488 on TGF-β1-induced fibrosis of HMC cells by qRT-PCR.Compared with low-glucose treatment, the expression of microRNA-488 markedly increased in HMCs treated with high-glucose, as well as coII, coIIV, and FN. Overexpression of microRNA-488 remarkably upregulated mRNA and protein levels of coII, coIIV, and FN, whereas microRNA-488 knockdown downregulated their levels. Expression levels of microRNA-488, coII, coIIV, and FN gradually upregulated with the increase of TGF-β1 dose and treatment duration.MicroRNA-488 regulates the development of diabetic nephropathy-induced fibrosis by TGF-β1 pathway.

Background:Cognitive behavioural therapy (CBT) for panic disorder encourages patients to learn about and make changes to thoughts and behaviour patterns that maintain symptoms of the disorder. Instruments to assess whether or not patients understand therapy content do not currently exist.Aims:The aim of this study was to examine if increases within specific knowledge domains of panic disorder were related to improvement in panic symptoms following an intensive 2-day panic treatment.Method:Thirty-nine Veterans enrolled in an intensive weekend panic disorder treatment completed knowledge measures immediately before the first session of therapy and at the end of the last day of therapy. Four panic disorder experts evaluated items and reached consensus on subscales. Subscales were reduced further to create psychometrically sound subscales of catastrophic misinterpretation (CM), behaviours (BE), and self-efficacy (SE). A simple regression analysis was conducted to determine whether increased knowledge predicted symptom change at a 3-month follow-up assessment.Results:The overall knowledge scale was reduced to three subscales BE (n = 7), CM (n = 13) and SE (n = 8) with good internal consistency. Veterans’ knowledge of panic disorder improved from pre- to post-treatment. Greater increase in scores on the knowledge assessment predicted lower panic severity scores at a 3-month follow-up. A follow-up analysis using the three subscales as predictors showed that only changes in CM significantly contributed to the prediction.Conclusions:In an intensive therapy format, reduction in panic severity was related to improved knowledge overall, but particularly as a result of fewer catastrophic misinterpretations.

To reduce the influence of time delay on the Active Mass Damper (AMD) control systems, influence analysis of time delay on system poles and stability is applied in the paper. A formula of the maximum time delay for ensuring system stability is established, by which the influence analysis of control gains on system stability is further arisen. In addition, the compensation controller is designed based on the given analysis results and pole assignment. A numerical example and an experiment are illustrated to verify that the performance of time-delay system. The result is consistent to that of the long-time delay control system, as well as to proof the better effectiveness of the new method proposed in this article.

Synopsis In 2000, Lu Hsiu-lien was elected Taiwan's first female vice president, adding to the striking successes of Asian women in electoral politics. Lu differs from the majority of Asia's “ruling women” in two key respects: she was elected without reliance on “dynastic descent” and she has a long track record as a feminist activist. Her position as both a pioneering feminist and a female vice president prompts us to ask whether she was able to promote a pro-woman agenda during her tenure as vice president. We conclude that despite constraints on Lu's pursuit of an overt feminist agenda—including the patriarchal political culture and a gap between Lu and Taiwan's contemporary feminist movement—she is significant as a female leader who transcends both the Asian dynastic model and the tokenistic model of women as “flower vases,” while also contributing vitally to the development of an indigenous Taiwanese feminist theory.

Cognitive-behavioral therapy (CBT) is an evidence-based treatment for anxiety; however, a growing body of research suggests that CBT effect sizes are smaller in Veteran samples. The aim of this study was to perform secondary data analyses of a randomized controlled trial of CBT for late-life generalized anxiety disorder compared with treatment as usual (TAU) in a Veteran (n = 101) and community-based (n = 122) sample. Veterans had lower income and less education than community participants, greater severity on baseline measures of anxiety and depression, poorer physical health, and higher rates of psychiatric comorbidity. Treatment effects were statistically significant in the community sample (all ps < .01), but not in Veterans (all ps > .05). Further analyses in Veterans revealed that poorer perceived social support significantly predicted poorer outcomes (all ps

This pilot study examines the feasibility, acceptability, and potential effectiveness of delivering an intensive weekend group treatment for panic disorder (PD) to Veterans returning from deployments to Iraq and Afghanistan with co-occurring posttraumatic stress disorder (PTSD). The treatment program lasted 6 h each day and was delivered by two experienced therapists. Patients received core components of panic treatment, including psychoeducation, cognitive restructuring, and interoceptive exposure. The interoceptive exposure exercises directly targeted anxiety sensitivity, a psychological construct also implicated in the maintenance of PTSD. Eighty-nine percent of patients who expressed interest in the treatment attended a baseline evaluation, and 63% of those who were study eligible initiated treatment. Treatment retention was high, with all 10 patients who initiated treatment completing the program. Veterans reported finding the treatment and delivery format highly acceptable and reported high levels of satisfaction. Panic symptoms improved significantly following the treatment and were maintained at a 7-month follow-up, with 71.4% of the sample reporting being panic free. Co-occurring PTSD symptoms also improved along with symptoms of anxiety and depression. Preliminary findings suggest that brief and intensive group treatments for PD/PTSD are a promising method of delivering cognitive behavioral therapy that may rapidly improve symptoms. This innovative treatment delivery format also may be a cost-effective way of increasing treatment engagement through increased access to quality care.

Metals and metalloids in continental precipitation have been widely observed, but the data over open oceans are still very limited. Investigation of metals and metalloids in marine precipitation is of great significance to understand global transport of these elements in the atmosphere and their input fluxes to the oceans. So shipboard sampling of precipitation was conducted during a Chinese National Antarctic Research Expedition campaign from Shanghai, China, to Zhongshan Station, East Antarctica, and 22 samples (including 17 rainfall and 5 snowfall events) were collected and analyzed for concentrations of Pb, Ni, Cr, Cu, Co, Hg, As, Cd, Sb, Se, Zn, Mn, and Ti. Results show that concentrations of both metals and metalloids vary considerably along the cruise, with higher concentrations at coastal sites and lower values on the south Indian Ocean. Although only soluble fractions were determined for elements, concentrations in this study are generally comparable to the reported values of marine rain. Enrichment factor analysis shows that most of metals and metalloids are enriched versus crustal sources, even in the samples collected from remote south Indian Ocean. In addition, metals and metalloids in precipitation are also very enriched above sea-salt abundance, indicating that impacts of sea-salt aerosols on their concentrations are negligible. Main sources of metals and metalloids were explored with the aid of multivariate statistical analyses. The results show that human emissions have far-reaching distribution, which may exert an important influence on the solubility of elements in precipitation. This investigation provides valuable information on spatial variation and possible sources of trace elements in precipitation over the open oceans corresponding to understudied region.

Introduction Veterans with post-traumatic stress disorder (PTSD) experience high rates of sexual dysfunction. However, the topic of sexual dysfunction is often overlooked clinically and underexamined in the PTSD research literature. Clinician assessment and treatment of sexual dysfunction are particularly important for Veterans, who are at increased risk of exposure to trauma. Aim Review the literature regarding sexual dysfunction among Veterans with PTSD. Method Review of the literature. Results Sexual dysfunction, including erectile difficulties in males and vaginal pain in females, is common among Veterans with PTSD. Several underlying mechanisms may account for the overlap between PTSD and sexual dysfunction. Certain barriers may contribute to the reluctance of providers in addressing problems of sexual dysfunction in Veterans with PTSD. Conclusions With the high likelihood of sexual dysfunction among Veterans with PTSD, it is important to consider the integration of treatment strategies. Efforts to further the research on this important topic are needed.

A systematic review of trauma treatment outcome literature was conducted to determine the impact of treatment on comorbid panic symptoms. Major databases were searched (from 1989 to 2013) and 64 randomized controlled trials using cognitive behavioral approaches to treat acute stress disorder, subthreshold posttraumatic stress disorder (PTSD), and full PTSD met inclusion criteria for this review. Results showed that 41% of the studies reviewed did not assess for Axis I psychiatric comorbidity at any point during the course of treatment. Only 5% of the studies reviewed reported rates of comorbid panic disorder (PD) at more than one time point during the study. Results indicate that approximately 56% of people no longer meet PD criteria following PTSD treatment.

This case report examines the unusual symptom presentation of a middle-aged, Caucasian man referred for treatment of intrusive somatic concerns and behaviors involving mucous sensations. Although the patient's symptoms overlapped phenomenologically and functionally with multiple disorders, including obsessive-compulsive disorder, hypochondriasis, panic disorder and tic disorder, the patient did not meet criteria for any one. This case challenged the DSM-IV nosology and supports the shift to conceptualize obsessive-compulsive disorder and other related disorders as comprising a spectrum or family of disorders. Despite complexities in diagnosis, treatment was tailored to the patient's unique symptom set and employed cognitive behavioral therapy with exposure and response prevention. Across 16 sessions of treatment, the patient's somatic obsessions and intrusive safety and reassurance seeking improved. His total score on the Yale-Brown Obsessive Compulsive Scale – Second edition decreased from 43 at the start of treatment to 17 at the end of treatment, with gains maintained at one-month follow-up. Frequency of emergency-room visits decreased, respectively, from 22 to 0 in the month preceding and following treatment. This case highlights the importance of continued examination of uncommon cases to further advance conceptualization and treatment of obsessive-compulsive related disorders.

Panic disorder is a debilitating and costly mental health condition which commonly presents in primary care settings; however, little is known about the impact of panic disorder on quality of life and health utility valuations among Veterans in primary care. A cross-sectional investigation of quality of life was conducted in a sample of 21 Veterans with panic disorder in a VA primary care clinic. Health utilities were determined using an algorithm based upon the Medical Outcomes Study Short-Form 36 Health Survey (SF-36). Veterans in the current sample reported significantly greater impairment on all eight of the SF-36 subscales in comparison to published norms. Veterans with panic and comorbid mood disorders reported significantly greater impairment on the Vitality, Social Functioning, and Mental Health subscales, while Veterans with panic and comorbid anxiety disorders reported significantly greater impairment on the Physical Functioning and Bodily pain subscales. Health utilities for the current sample were comparable to previous reports of Veterans with PTSD and depression, as well as health utilities of persons with chronic pulmonary disease and irritable bowel syndrome. The findings from this study highlight the devastating nature of panic disorder and reflect the need for increased attention to the identification and treatment of panic disorder in VA primary care settings.

Although the efficacy of exposure is well established in individual cognitive behavioral treatments for posttraumatic stress disorder (PTSD), some clinicians and researchers have expressed concerns regarding the use of in-session disclosure of trauma details through imaginal exposure in group cognitive behavioral therapy (GCBT) for PTSD. Thus, the aim of the present study was to conduct a systematic review of the empirical support for GCBT in the treatment of PTSD and to compare GCBT protocols that encourage the disclosure of trauma details via in-session exposure to GCBT protocols that do not include in-session exposure. Randomized controlled trials that assessed the efficacy of GCBT for PTSD were included in the meta-analysis. A total of 651 participants with PTSD were included in the 12 eligible GCBT treatment conditions (5 conditions included in-group exposure, 7 conditions did not include in-group exposure). The overall pre–post effect size of GCBT for PTSD (ES = 1.13 [SE = 0.22, 95% CI: 0.69 to 1.56, p .001]). suggests that GCBT is an effective intervention for individuals with PTSD. No significant differences in effect sizes were found between GCBT treatments that included in-group exposure and those that did not. Although the attrition rate was higher in treatments that included exposure in-group, this rate is comparable to attrition rates in individual CBT treatments and pharmacotherapy for PTSD. The results from this meta-analysis suggest that concerns about the potentially negative impact of group exposure may be unwarranted, and support the use of exposure-based GCBT as a promising treatment option for PTSD.