Search

Video telehealth experienced rapid growth throughout the COVID-19 pandemic in many healthcare sectors, including mental health. The Veterans Health Administration’s video telehealth platform, VA Video Connect, has been widely used to reach veterans who may have experienced difficulty accessing care, such as those living in rural areas or other barriers (e.g., transportation). Implementing VVC requires a multifaceted approach, including training providers on technical skills, increasing access to equipment for providers and veterans, and integrating VVC within the culture and processes of the clinic unit. Prior successful VVC implementation efforts in rural areas have focused on simultaneous one-on-one provider and leadership engagement using implementation facilitation (IF). However, given the rapid need for VVC expansion in light of limits and dangers associated with in-person care during the pandemic, our team developed group facilitation to increase the reach of VVC implementation through IF. Group facilitation combined training in technical and policy elements of VVC with IF with groups of providers from clinic units. This approach was designed to rapidly disseminate the necessary knowledge to conduct VVC combined with collaborative problem solving as a team to improve the ability of the clinical team to sustain VVC. Attendees were asked for feedback on the session through multiple choice and open-ended questions. Participants (N = 26) reported being highly satisfied with the training and reported a high degree of confidence in their ability to use VVC. Based on evaluation data and interview feedback, providers and clinic leaders were satisfied with group facilitation. Group facilitation may be a helpful tool in rapidly training clinical teams to implement and sustain video telemental health.

Patient microaggressions affect practitioners in all fields of healthcare and especially psychiatry. In multiple studies, healthcare professionals reported high rates of patient microaggressions and discrimination. To date, this is the first scoping review of recommendations and trainings on patient microaggressions. A scoping review of articles indexed in PubMed, PsycINFO, Medline, ERIC, and MedEdPORTAL was conducted from July 2020 to August 2020 to identify recommendations and solutions for healthcare professionals on responding to patient microaggressions. The review identified 27 studies that provide recommendations and trainings for healthcare professionals to address patient microaggressions. Twenty studies outlined recommendations for healthcare professionals and systems on how to respond to patient offenses. These 20 studies were grouped into establishing a supportive culture, addressing the microaggression, supporting the targets of microaggressions, discriminatory requests, and institutional responses. Six articles described trainings that equip providers with tools to address patient microaggressions, including the ERASE framework (“Expect/Recognize/Address/Support/Establish, Encourage”); Stop, Talk, and Roll; interrupting microaggressions; XYZ (“I felt X when Y because Z”); the ACTION model (“Ask/Come/Tell/Impact/Own/Next”); and the OWTFD tool (“Observe/Why/Think/Feel/Desire”). Recommendations and trainings for the response to microaggressions are emerging, and results of trainings are encouraging. However, more work is needed to evaluate the effectiveness of these trainings in clinical settings and longitudinally.

Background The suicide rate among Veterans is 1.5 times greater than that for civilians, partly a result of the high use of firearms as the means for suicide. One effective strategy to reduce Veteran suicide by firearms is to provide counseling on firearm safety as a method of means reduction. However, many clinicians do not discuss firearm safety with Veterans. Aims This study evaluates a one-hour educational seminar for clinicians on lethal means safety. Materials and methods One hundred and ninety clinicians from the Veterans Health Administration, including social workers, psychologists, psychiatrists, and nurses, participated in the training. The seminar was streamed during the South Central Mental Health Illness Research, Education and Clinical Center's Community-Based Outpatient Clinic Mental Health Grand Rounds, for which participants were eligible for continuing education units. Data were collected immediately after the training and four months later. Results After completing the training, participants believed that it was important to speak with Veterans about firearm safety and felt knowledgeable and empowered to do so. Four months after the seminar, participants had counseled, on average, over half of Veterans treated about lethal means safety. Discussion Participants reported the value of normalizing discussions about firearm safety with their Veterans and focusing on the safety aspect while discussing firearms. Conclusions This webinar was effective in providing clinicians the skills to talk with Veterans about firearm safety and continued to impact their practice four months after training. The training is available for free on our website at https://www.mirecc.va.gov/visn16/public-health-approach-to-firearms-and-death-by-suicide.asp.

Objective: Research has demonstrated relative success with brief interventions that utilize social psychological theory to target the root cause of unwanted behaviours. Given the intersections amon...

Objectives Despite the growing number of individuals with dementia, clinicians skilled in caring for people with dementia, especially in rural areas, are lacking. The Program for Advancing Cognitive Disorders Education for Rural Staff (PACERS) was designed to improve clinician competency and comfort when caring for individuals with dementia. Based on an interprofessional needs assessment, six 1-hour training modules were created: (1) Dementia and Delirium, (2) Identifying and Assessing for Dementia, (3) Treating Dementia: Case Studies, (4) Normal Cognitive Aging and Dementia Caregiving, (5) Addressing Decision Making and Safety in Dementia, and (6) Dementia and Driving. Each module is available for free on the Department of Veterans Affairs Talent Management System (TMS) for employees and the free TrainingFinder Real-time Affiliate Integrated Network (TRAIN) platform for clinicians in the community. One continuing education unit is earned upon completion of each module. Design Posttest. Setting Online training at VA TMS and TRAIN. Participants To date, more than 3000 modules have been completed by interprofessional healthcare learners (eg, nurses, physicians, psychologists, and social workers). Measurements Satisfaction, perceived utility of training, knowledge, skills, and attitudes were assessed. Results The learners reported high satisfaction (mean [M] > 4) and ability to apply the knowledge and skills learned from the module to their job (M > 4) on a Likert scale (1 = Strongly disagree to 5 = Strongly agree). Conclusion Learners also reported perceived impact on both direct patient care (eg, ability to provide education and support to individuals with dementia and their caregivers) and system-level care (eg, more appropriate referrals). Given the number of users and their evaluation data, PACERS can serve as a model curriculum for online interprofessional dementia training. J Am Geriatr Soc 68:192-197, 2019.

Twenty years ago, the US Congress articulated a need to decrease the time it takes clinical best practices to move from the literature to daily clinical practice. The Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center was one of several centers of excellence established to address this need. It is also unique in that it focuses on rural and underserved veterans. This article summarizes the education accomplishments of the South Central Mental Illness Research, Education, and Clinical Center thus far in providing educational resources and trainings to frontline Veterans Affairs mental health staff with the goal of bringing best practices to routine clinical care, thus improving mental health services. We describe the use of implementation science to support dissemination of information, such as the monthly mental health grand rounds, especially for rural staff to receive continuing education, and the adoption of evidence-based psychotherapy trainings. The Clinical Educator Grants program allows clinicians to share their clinical expertise through development of practical tools for practice gaps they identify. We describe some future directions to meet the evolving needs of Veterans Affairs and community clinicians to provide the best possible care to Veterans. Take-away messages are that, for trainings to be successful, an implementation plan is critical and that an effective educational program requires funding and leadership commitment.

INTRODUCTION Behavioral health and other preventable factors account for nearly half of all premature deaths in the United States. Motivational interviewing (MI) is effective for engaging ambivalent patients in behavior change. However, many clinicians report barriers to receiving MI training, including time, cost, and travel. This study examined the effect of a 2-day virtual MI training built around didactic and real-play learning activities. METHODS Thirty interprofessional clinicians from eight Veterans Affairs medical centers and their community-based outpatient clinics across 4 US states attended a 2-day virtual MI training. Participants completed a posttraining evaluation and a 3-month posttraining evaluation. RESULTS Participants reported that they learned new knowledge and skills, and they would be able to apply these to their practice (M > 4).They reported high satisfaction with the training and platform and found the technology easy to use (M > 4). In the 3-month posttraining survey, participants reported that they were using MI in their practice (M = 4.19) and that they would like additional support, such as additional reading (n = 8). DISCUSSION This study demonstrates the effect of a 2-day virtual MI training built around didactic and real-play learning activities. Virtual training particularly enhances training opportunities in rural settings. Our training removed travel and payment as barriers to participation.

Postdoctoral fellowships are costly: institutions incur substantial monetary costs, and fellows suffer the opportunity cost of delaying entry into their professional careers. Nevertheless, fellowship training is a beneficial academic investment; the right resources can attract high-quality candidates and maximize return on investment for all parties. This study examined the availability and perceived utility of training resources in a national, multisite interprofessional health services research fellowship program and examined differences in resource perception between alumni and directors as well as M.D. and Ph.D. alumni. One-hundred thirty-one alumni and 15 directors from a multisite interprofessional postdoctoral fellowship completed surveys regarding fellowship resources. Results from the fellowship sample as a whole revealed that mentoring and seminars were the most commonly available resources in fellowships and alumni from the same site often disagreed about resource availability. When we compared alumni and directors’ responses from the same site, we found they often disagreed about resource availability, with directors often being more likely to respond that the resource is available than the alumni. Finally, M.D. alumni reported availability of more resources and found resources to be more useful overall than Ph.D. alumni. Mentoring and seminars are important and commonly provided resources for trainees in fellowship programs; however, M.D.s and Ph.D.s vary in perceived usefulness of other resources, suggesting that one resource does not fit all. Given the gap, postdoctoral fellows may benefit from direct communication of available resources. Moreover, as Ph.D. fellows reported less resource availability and usefulness, attention should be given to meeting their unmet needs. Taken together, this will optimize their fellowship experience, thus better preparing them for their career and, ultimately, their impact on health care.

Over the past 20 years, there has been an increased focus on quality improvement (QI) in health care, which is critical in achieving care that is patient-centered, safer, timelier, and more effective, efficient, and equitable. At the center of this movement is QI education, which is known to lead to learning, behavior change, and improved outcomes. However, there is a need for the development and provision of long-duration, interactive, interprofessional training in QI, to allow for in-depth learning and application of learned skills. To this end, we designed a curriculum for an established interprofessional, interactive, web-based QI fellowship for doctorally prepared clinicians. Curricular content is delivered virtually to geographically dispersed learners over a 2-year time span. The didactic curriculum and experiential learning opportunities provide learners with the foundational knowledge and practical skills to engage in—and eventually, lead—QI initiatives around the country. Evaluation of learner satisfaction and cognitive, affective, and skills-based learning has found that this model is an effective method to train geographically distributed learners. A hybrid training structure is used, where learners interact with the material through 3 distinct delivery modes: (1) virtual instruction in QI topics; (2) face-to-face training, mentorship, and the opportunity for practical application of applied knowledge and skills through the completion of QI projects; and (3) opportunities for other types of training, tailored to each learner’s Individual Development Plan. This training program model holds value for QI learning in various health care settings, which are interprofessional by nature. These foundational concepts of hybrid learning to distributed learners—wherein an instructor delivers curriculum in small, face-to-face batches, interprofessional learning is supplemented in a virtual, longitudinal manner, and learners are allowed the opportunity to put skills into action for real-world problems in interdisciplinary clinical teams—can be applied in a multitude of settings, with comparatively lower time and cost expenditure than traditional training programs.

Aims Veterans have high rates of cannabis use, and rates of cannabis use disorder (CUD) are rising among this population. These rising rates are particularly true for veterans with post-traumatic stress disorder (PTSD), which is common among veterans of recent conflicts, Operations Enduring Freedom, Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND). Although prior work has documented links between PTSD and cannabis use, a better understanding of the intersection among CUD, PTSD, and other disorders in real-world clinical practice can inform prevention and treatment efforts. This study examined the prevalence and comorbidities of CUD and PTSD in OFE/OIF/OND veterans. Method The study analyzed data from the Veterans Affairs Corporate Data Warehouse (2010–2016) for returning war veterans who were diagnosed with CUD (N = 46,268). The study determined prevalence of PTSD, and examined additional differences in comorbidities. Results The prevalence of a comorbid PTSD diagnosis among OEF/OIF/OND veterans with a CUD diagnosis was 72.3%. Further analysis revealed additional co-occurring disorders. Veterans with a diagnosis of CUD and PTSD were more likely to have a comorbid diagnosis of depression (odds ratio, 1.69; 95% CI, 1.62–1.71), panic disorder (odds ratio; 1.58; 95% CI, 1.43–1.75), alcohol use disorder (odds ratio; 1.30; 95% CI, 1.24–1.35), opioid use disorder (odds ratio; 1.52; 95% CI, 1.43–1.62), and insomnia (odds ratio; 1.74; 95% CI, 1.65–1.84) than veterans without a PTSD diagnosis. Conclusions Findings highlight that the majority of returning war veterans with CUD are highly complex. Our findings substantiate the need for urgent, comprehensive care for veterans with co-occurring CUD and PTSD, including integrated and transdiagnostic treatment approaches.

As health care systems move toward value-based care, training future leaders in quality improvement (QI) is essential. Web-based training allows for broad dissemination of QI knowledge to geographically distributed learners. The authors conducted a longitudinal evaluation of a structured, synchronous web-based, advanced QI curriculum that facilitated engagement and real-time feedback. Learners (n = 54) were satisfied (overall satisfaction; M = 3.31/4.00), and there were improvements in cognitive (immediate QI knowledge tests; P = .02), affective (self-efficacy of QI skills; P < .001), and skill-based learning (Quality Improvement Knowledge Application Tool; P < .001). There was significant improvement in affective transfer (interprofessional attitudes on the job; p < .01) but no significant change on cognitive (distal QI knowledge test; P = .91), or skill-based transfer (self-reported interprofessional collaboration job skills; P = .23). The findings suggest that this model can be effective to train geographically distributed future QI leaders.

Health care professionals in the United States are expected to engage in quality improvement (QI) as part of their daily practice. This has created the need for QI training at all levels of health professional education. A reported barrier to increasing QI-trained health care professionals is the lack of QI-trained faculty at health care institutions and the limited availability of practitioners, given their daily clinical demands. E-learning is a potential solution. E-learning allows learning outside the traditional classroom setting, where instructors can flexibly deliver practical QI curricula to an interprofessional audience in multiple practice locations. The 11 principles presented in this article are derived from established evidence and experience and provide QI educators with practical principles for course design, implementation, and learner feedback of an e-learning course in QI.

Background: Coxsackievirus A21 (V937) is an RNA oncolytic virus targeting ICAM-1 receptors. Pharmacodynamic effects of oncolytic viruses in the tumor microenvironment (TME), including increased CD8+ T cells and PD-L1 expression, support their use in combination with checkpoint inhibitors. We present updated clinical and correlative data from the multicenter phase 1b CAPRA study (NCT02565992) of V937 + pembro in pts with advanced melanoma. Methods: Eligible pts had metastatic/unresectable stage IIIB-IV melanoma and ≥1 cutaneous/subcutaneous tumor or lymph node amenable to V937 intratumoral injection. Pts received V937 on days 1, 3, 5, and 8; then Q3W for up to 19 injections (maximum dose, 3 × 108 50% TCID50). Pts received IV pembro 2 mg/kg Q3W on day 8, continuing for up to 2 y. Primary endpoints were incidence of AEs, serious AEs (SAEs), and dose-limiting toxicities (DLTs). Secondary endpoints were ORR, duration of response (DOR), PFS, and OS. Biomarkers were an exploratory endpoint. Results: 36 pts were enrolled (mean age, 68.5 y; 75% male; 22% had prior immunotherapy). As of 4 Nov 2019, median (range) time from first dose to data cutoff was 32.0 (10.7−45.3) mo. No DLTs occurred. Grade 3-5 treatment-related AEs occurred in 5 (14%) pts. 3 (8%) pts had treatment-related SAEs (autoimmune encephalitis and septic shock in 1 pt, keratoacanthoma, autoimmune hepatitis); 1 died from septic shock. Efficacy results included ORR of 47% (CR, 22%; PR, 25%; Table 1). In comparing responders vs nonresponders, baseline tumor samples showed no difference in PD-L1 expression and lower CD3+CD8- infiltrate in responders. Conclusions: V937 + pembro had manageable safety and promising efficacy in pts with advanced melanoma. Response was not associated with an inflamed TME at baseline, indicating that V937 may induce an immune responsive TME. The combination is being studied in the neoadjuvant setting in pts with stage III melanoma (KEYMAKER-U02). Table 1.Efficacy OutcomesV937 + Pembro (N = 36)ORR,a % (95% CI)b47 (30-65)- CR22 (10-39)- PR25 (12-42)DOR,c median (range), moNR (1.4+ to 22.0+)PFS,c,d median (95% CI), mo11.9 (3.4-NR)12-mo PFS,c % (95% CI)45 (28-60)OS,c median (95% CI), mo30.9 (20.3-40.5)12-mo OS,c % (95% CI)85 (68-94)+ indicates no PD by the time of last disease assessment. NR, not reached.aBest overall response with confirmation based on investigator assessment per immune-related response criteria; imaging was performed Q6W.bBased on the exact method for binomial data.cKaplan-Meier estimate.dBased on investigator assessment per immune-related response criteria. Citation Format: Ann W. Silk, Steven J. O'Day, Howard L. Kaufman, Jennifer Bryan, Jacqueline T. Norrell, Casey Imbergamo, Daniella Portal, Edwin Zambrano-Acosta, Marisa Palmeri, Seymour Fein, Cai Wu, Leslie Guerreiro, Daniel Medina, Praveen K. Bommareddy, Andrew Zloza, Bernard A. Fox, Carmen Ballesteros-Merino, Darren Shafren, Mark Grose, Joshua A. Vieth, Janice M. Mehnert. Intratumoral oncolytic virus V937 in combination with pembrolizumab (pembro) in patients (pts) with advanced melanoma: Updated results from the phase 1b CAPRA study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT139.

Personality-level authenticity is a robust predictor of both well- and ill-being. Recent research has explored the ways in which this element of personality is associated with interpersonal relationships and interactions. The present study examines the valence of interpersonal interactions (i.e., positivity and lack of negativity) as a mediator of the associations between authenticity and well-/ill-being. Participants reported authenticity at baseline, recorded their perceptions of valence for each interaction in which they participated for two weeks, and reported several indicators of well- and ill-being at follow-up. We then averaged each interaction valence report within participants to get a participant-level (i.e., chronic) measurement of interaction valence. Results revealed that authenticity positively predicted well-being and that interaction valence mediated these associations. These same mediation analyses were not significant for ill-being, though all results were in the predicted directions. Results were interpreted as evidence suggesting that the personality trait of authenticity has implications for interaction with others and that these interactions, in turn, may have implications for one's state of being.

Background: With more than 1 million older adults being abused each year, it is imperative for nurses to be knowledgeable about signs and symptoms of elder abuse, assessment, and interventions. This article describes a three-part learning strategy consisting of lecture, simulation using standardized patients (SPs), and debriefing to educate prelicensure nursing students about how to identify, assess, and report elder abuse. Furthermore, the effects of the teaching strategies were assessed. Method: Students received a lecture on elder abuse, followed by a simulation with an SP and debriefing. Pre- and posttests were used to assess knowledge, skills, and attitudes about elder abuse. Results: Significant differences were found in pre- and posttest results for knowledge and skills. There were no significant differences in attitude. Teaching strategies affected learning, and students reported increased knowledge and skills in identifying abuse and advocating for vulnerable older adults. Conclusion: Lecture and SP simulation followed by debriefing was an effective approach to educate prelicensure nursing students about elder abuse. [ J Nurs Educ . 2020;59(6):331–335.]

Background Metastatic Merkel cell carcinoma (mMCC) is a rare skin cancer with poor prognosis. Avelumab is the first approved treatment option for patients with mMCC. Immune checkpoint inhibitors, such as avelumab, are associated with unique toxicities that can be effectively addressed with prompt recognition and appropriate management. Objectives This article discusses the use of avelumab for the treatment of mMCC and management of associated toxicities. Methods Literature on mMCC disease state and clinical trial data for avelumab were reviewed. Findings Avelumab has been investigated in patients with mMCC either following disease progression after one or more prior lines of chemotherapy or no prior systemic therapy. These patients experience clinically meaningful benefit. About 70% of patients receiving avelumab experience treatment-related adverse events. Given the limited benefit of chemotherapy, managing symptoms related to avelumab is key to administering this effective treatment to patients with mMCC.

Evidence-based self-help wellness interventions have several benefits, including low cost, brevity, and lack of need for a health care professional. Veterans, in particular, may benefit from a self-guided resource, given a culture of self-reliance, mental health help-seeking stigma, and a high need for mental health care. Despite the high need, few self-help resources are designed for veterans.The goal of this project was to create the Veteran Wellness Guide, a self-guided resource comprising SMART goal setting and evidence-based interventions for veterans (e.g., self-kindness, gratitude, diaphragmatic breathing, mindfulness).First, a Veteran Engagement Group reviewed the guide and provided feedback on veteran-centric content and design. After the authors revised the guide, a subset of the group approved changes. Additional veterans used it for 2 weeks and provided feedback.Veterans reported the guide as being highly useful, were willing to recommend it to other veterans, and identified a need for it in the veteran community. Veterans and Veterans Health Administration clinicians and leadership helped to craft a dissemination plan to reach veterans whether they receive care through the Veterans Health Administration or the community.Partnering with veterans in the creation of the wellness guide led to a veteran-centric product tailored to meet the unique wellness needs of veterans. The guide has been nationally disseminated and downloaded over 3000 times and can be downloaded for free from our website.

Personalized normative feedback (PNF) has been used extensively to reduce alcohol consumption, particularly among heavy drinkers. However, the majority of PNF studies have used only descriptive norms (real or perceived pervasiveness of a given behavior). The purpose of the current study was to explore the efficacy of PNF both with and without an injunctive message indicating approval or disapproval based on the participants' standing relative to other students' drinking levels. This randomized trial evaluated two brief web-based alcohol intervention conditions (descriptive-norms-feedback-only condition versus a descriptive-plus-injunctive-message condition relative to an assessment-only control condition).Participants included 176 students who had reported at least one heavy drinking episode in the past month. Participants completed baseline and follow-up assessments of perceived norms and drinking. Follow-up assessments were completed at 2 weeks post-intervention by 165 (94%) participants.Analyses were conducted using zero-inflated negative binomial regression models. As expected, the descriptive-norms-only condition was effective in reducing drinking among heavier baseline drinkers at follow-up relative to the control condition. However, contrary to expectations, the descriptive-plus-injunctive-message condition did not predict less drinking at follow-up.This study was unique in using an injunctive message as an adjunct to descriptive-norms feedback within the context of drinking. Findings highlight the need for additional research into the role of defensiveness, which may serve as an impediment to using injunctive norms/messages in interventions for problematic substance use and other potentially stigmatizing behaviors.

Introduction It is estimated that 10% of older adults in the United States experience elder abuse. There are several types of elder abuse, including physical abuse, financial abuse, and neglect. One form of neglect, self-neglect, accounts for over 40% of elder abuse cases reported to Adult Protective Services. Studies on elder abuse have highlighted the need to train physicians in the detection and reporting of abuse in the older adult population. Methods We piloted an elder abuse training with PGY-3 and PGY-4 general psychiatry residents at Baylor College of Medicine. The residents were emailed two PowerPoint presentations; the first was an introduction to elder abuse and the second focused on capacity assessment of financial decision-making in older adults. One week after receiving the training materials, the residents participated in a standardized patient (SP) encounter. The case featured a 75-year-old individual presenting with signs of self-neglect, including weight loss and poor medication adherence. The older adult was accompanied by a neighbor who was present during the encounter. The residents were paired, with one playing the role of a psychiatrist and the other playing the role of a social worker. The residents completed a knowledge assessment prior to the encounter and a post-encounter evaluation. Results 18 resident physicians participated in the encounter. On average, participants agreed or strongly agreed that identifying and reporting elder abuse were important aspects of their roles as psychiatrists, but were less confident in their abilities to recognize the signs of elder abuse based on physical examination and psychological presentation. In the post-encounter survey, 72% of participants felt that the SP encounter enhanced their ability to detect and report elder abuse. There was a significant improvement in self-reported comfort with performing these skills after completing the encounter (p = 0.01). Conclusions SP encounters can effectively teach the detection of elder abuse and increase learners’ confidence in their skills. Using feedback from this pilot study, future SP scenarios can be expanded to other groups of medical learners, including medical students. This research was funded by: This work was funded by the Norton Rose Fulbright Educational Grant Fund of the Academy of Distinguished Educators at Baylor College of Medicine.

In recent years, there has been a renewed interest in criminal justice reform. Movements such as the #cut50 campaign, a bipartisan effort to reduce the prison population by 50 % in 10 years, demonstrates how much things have changed from the “tough on crime” rhetoric which dominated much of the 1980’s. Philanthropy has historically and will continue to play a large role in the reform movement. As this paper suggests, however, if the current momentum is to continue, there must be a push towards a “collective impact,” collaborative approach in the field of prisoner reentry.

This study investigated authenticity as a moderator of the association between loneliness and depressive symptoms, anxiety, physical symptoms, and alcohol-related problems. It was expected that loneliness and health outcomes would be negatively related and that relationship would be weaker among those higher in authenticity. Significant interactions emerged between authenticity and loneliness for each outcome such that authenticity mitigated the relationship between higher loneliness and negative health outcomes. Results suggest that authenticity may be an underutilized resource for lonely individuals and warrants future investigation. The potential implications are diverse and could be incorporated in college adjustment and health promotion programs.

The detrimental effect of ambivalence over emotional expression (AEE) on social support has been well documented. However, the underlying mechanism of this effect remains unclear. Research has demonstrated that when general needs are not met, negative psychological outcomes occur. Thus, the current study investigated general needs satisfaction (GNS) as a potential mediator of the association between AEE and social support among 352 undergraduates. Results revealed that AEE was negatively associated with autonomy, relatedness, competence, and social support, whereas social support was positively associated with autonomy, competence, and relatedness. Further, GNS and each of its three subscales were all found to significantly mediate the association between AEE and social support. Thus, findings from the present study contribute to our understanding of AEE by illustrating a potential mechanism through which AEE may lead to a lack of perceived social support, namely GNS.

Although social networking sites such as Facebook have been touted as creating a global village, there may be a downside to such computer-mediated interactions on user's well-being. One such consequence is that stimuli via computer-mediated interactions may be anxiety-provoking for some users. As such, recent studies have tried to ascertain personality factors and individual differences that are associated with higher anxiety in connection with extensive Facebook use. The current study evaluated the relationships among extraversion, time on Facebook, need for approval, and anxiety among college students (N=280). Results revealed that need for approval significantly moderated the association between extraversion and anxiety. Specifically, individuals higher in extraversion tended to be less anxious, although this was less true for those extraverts who were higher in need for approval. Further, this moderating effect was stronger among extraverts who were high in need for approval and spent more time on Facebook relative to those who spent less time on Facebook. The present research contributes to the emerging literature by providing evidence regarding how personality factors interact with Facebook usage.

This study evaluated pet affinity as a buffer between ambivalence over emotional expression (AEE) and social support. AEE occurs when one desires to express emotions but is reluctant to do so and is related to negative psychological outcomes. Individuals high in AEE may have difficulty receiving social support and thus may not gain accompanying benefits. Social support has been associated with positive health outcomes, and pet support is positively associated with human social support. The present study explores the potential protective effect of pet affinity. One hundred ninety-eight undergraduate dog owners completed measures assessing perceived social support, pet affinity, and AEE. AEE was expected to be negatively associated with social support, and pet affinity was expected to buffer the negative effects of AEE on social support. We found that AEE was negatively associated with perceived social support. An interaction between pet affinity and AEE emerged such that the negative association between AEE and social support was weaker among those higher in pet affinity. Thus, at high levels of AEE, those who felt a close connection with their pets reported more perceived social support than those less connected with their pets. Overall, these findings emphasize the potential benefits of pet affinity.

The aim of the present study was to test promising constructs (decisional balance and drinking identity) and their interaction with gender as predictors of risky college drinking. We expected that, consistent with previous work, drinking identity would be positively associated with alcohol consumption and problems. We further expected that drinking identity would be more strongly related to outcomes among individuals scoring low in decisional balance. Additionally, we expect the relationship between drinking identity and alcohol behavior to vary as a function of decisional balance.Participants included 329 undergraduates (M=23.11; SD=5.63; 74.47% female) who met heavy drinking criteria (defined as women who consumed 4 or more drinks per occasion and men who consumed 5 or more drinks per occasion) and completed an online survey comprised of self-report measures.Decisional balance was negatively correlated with both drinking and problems, which partially supported expectations. As expected, drinking identity was positively correlated with drinking and problems. A two-way interaction emerged between drinking identity and decisional balance regarding problems, indicating that drinking identity was associated with more problems, especially among those lower in decisional balance. A three-way interaction between drinking identity, decisional balance, and gender emerged regarding problems such that drinking identity was associated with more problems for those lower in decisional balance and this effect was stronger among men.Findings lend support to the perspective that decisional balance, drinking identity, and gender are all influential factors that are associated with the experience of alcohol problems.

This study implemented and evaluated the effectiveness of an expressive writing intervention among patients with Stargardt’s disease, a rare disease due to macular degeneration. Participants were randomly assigned to either an expressive writing intervention or a neutral writing condition. Participants completed measures at three time points: baseline, 3 weeks, and 6 weeks post-intervention. Psychological health outcomes improved at the 3-week follow-up for the intervention condition compared to control. Self-reported physical health improved at the 6-week follow-up in the intervention condition compared to control. These results suggest that expressive writing may be an effective, practical, and low-cost intervention for those with Stargardt’s disease.

This study evaluated benefit finding as a moderator of the relationship between spiritual and religious attitudes and drinking. Previous research indicates that undergraduates who drink heavily experience negative alcohol-related consequences. Literature also suggests that spirituality and religiosity (S/R) are protective against heavy drinking (e.g., Yonker, Schnabelrauch, & DeHaan, 2012) and that finding meaning, which is conceptually related to benefit finding, is negatively associated with alcohol use (e.g., Wells, 2010). Seven hundred undergraduate students completed the study materials including measures of drinking, benefit finding, and S/R. Based on previous research, we expected that S/R and benefit finding would be negatively associated with drinking. Furthermore, we expected that benefit finding would moderate the association between S/R and drinking, such that S/R would be more negatively associated with drinking among those higher in benefit finding. Consistent with expectations, a negative association between S/R and drinking was present, and was stronger among those high in benefit finding. These findings extend previous research by demonstrating that the protective effect of S/R on drinking appears to be particularly true among those who find benefit following stressful experiences. This study extends previous research showing that S/R is negatively associated with drinking by evaluating benefit finding (measured via the Post-Traumatic Growth Inventory; Tedeschi & Calhoun, 1996) as a potential moderator of the relationship between S/R and drinking. This study contributes to the alcohol literature seeking to understand and identify individual factors in drinking and determine how S/R and benefit finding relate to drinking.

Objectives The present study assessed combinations of spirituality/religiosity (S/R), a known protective factor against heavy drinking, with drinking motives, and alcohol-related ambivalence to better understand how these factors interrelate and are associated with drinking and alcohol-related problems. Methods Participants were 241 heavy drinking undergraduate students (81.74% female; M age = 23.48 years; SD = 5.50) who completed study questionnaires online. Results Coping, enhancement, and conformity drinking motives were associated with greater alcohol use and problems, however there were no main effects of either ambivalence or S/R on alcohol outcomes. S/R interacted with ambivalence with respect to drinking and problems. S/R also interacted with conformity drinking motives with respect to drinking and problems. Further, ambivalence interacted with conformity drinking motives regarding problems. Three-way interactions emerged between ambivalence, S/R, and drinking motives (social, coping, and enhancement motives) regarding drinking and problems. Results show that individuals at highest risk for problematic drinking are those who more strongly endorse drinking motives, are low in S/R, and high in ambivalence. Conclusions Findings supported hypotheses and provide support for clusters of individual difference factors that put heavy drinking college students at higher risk for problematic drinking. These examinations have practical utility and may inform development and implementation of interventions and programs targeting alcohol misuse among heavy drinking undergraduate students.

The current study investigated whether religious coping would moderate the association between ambivalence over emotional expression (AEE) and depressive symptoms and anxiety symptoms such that the positive relationship between AEE and depressive symptoms and anxiety symptoms would be weaker among those higher in religious coping. Three-hundred and fifty-two undergraduates (M age=23.51 years, SD=6.80; 84.4% female) completed study materials. Contrary to expectations, results revealed a significant interaction between religious coping and AEE such that religious coping exacerbated the relationship between higher AEE and distress symptoms. The implications of this study suggest that religious coping may not be an ideal coping mechanism for individuals with high levels of AEE. These results indicate the need to further examine the role of AEE in religious coping, and have potential implications for clinicians, healthcare professionals, and religious mentors who may promote the use of religious coping in treatment.

Introduction Individuals rate opposite sex faces as more attractive after consuming or being primed with alcohol. However, other traits such as intelligence and likeability have not been examined and might vary as a function of information about one's drinking habits. We expected social drinkers to be rated more positively than heavy drinkers, abstainers, or recovering alcoholics. We further hypothesized that faces with similar drinking habits to participants would be rated as more appealing. Methods Five hundred ninety-four undergraduates viewed 25 opposite sex faces randomly paired with drinking information, and rated each face on perceived appeal. Results Hierarchical linear models revealed that social drinkers were rated as most appealing, as expected. Unexpectedly, recovering alcoholics were rated as the next most appealing, followed by abstainers, then heavy drinkers. The interaction between drinker type and participants' own drinking predicting ratings indicated that the heavier the participant drinks, the more favorably they rated heavy drinkers compared to other types of drinkers. Thus, as expected, ratings varied as a function of participants' own drinking; however, ratings did not vary as a function of participants' alcohol-related problems. Conclusions Findings support hypotheses in that social drinkers were generally perceived as appealing compared to other drinker types, and ratings tended to be influenced by participants' own drinking. Individuals' prototypes and norms regarding drinking may influence how they perceive others when others' drinking habits are known. This might be especially important to consider with heavy drinkers who may seek out others who drink similarly, which could reinforce problematic drinking.

Background: Coxsackievirus A21 (CVA21) is a novel bio-selected oncolytic, immunotherapeutic agent. Intratumoral (i.t.) CVA21 injection can induce selective tumor-cell infection, immune-cell infiltration, IFN-γ response gene up-regulation, increased PD-L1 expression, tumor cell lysis and systemic anti-tumor immune responses. Preclinical studies in an immune-competent mouse model of melanoma have revealed that combinations of i.t. CVA21 and anti-PD-1 blockade mediate significantly greater antitumor activity compared to use of either agent alone. A clinical trial evaluating combination CVA21 and pembrolizumab in patients with melanoma was initiated and preliminary data on a pre-established futility endpoint are presented here. Materials and Methods: This is a single-arm, multi-institutional open-label phase Ib clinical trial of i.t. CVA21 and i.v. pembrolizumab for treated or untreated unresectable Stage IIIC-IVM1c melanoma. Subjects with injectable disease receive up to 3 x 108 TCID50 CVA21 i.t. on Days 1, 3, 5, 8, and then every 3 weeks for up to 19 injections. Subjects also receive pembrolizumab (2mg/kg) i.v. every 3 weeks starting on Day 8. The primary endpoint is safety/tolerability by incidence of dose-limiting toxicity. Secondary endpoints include best ORR by immune-related response criteria, progression-free survival, overall survival, quality of life, changes in melanoma-specific T cells, PD-L1 expression and Th1/Th2 gene expression profiles. The protocol included a futility analysis after the first 12 patients. Results: To date, 14 subjects have started on protocol therapy. Overall, the adverse events have been low-grade constitutional symptoms related to CVA21 and expected pembrolizumab-related side effects. No DLT’s have been reported. Currently, 11 patients are evaluable for investigator response assessment, not including 2 subjects who have not yet reached their first assessment and 1 subject who left the study early due to an unrelated adverse event. Among the evaluable subjects, the ORR was 73% (8/11). The DCR (CR+PR+SD) is currently 91% (10/11). In subjects with stage IVM1c disease, the ORR and the DCR is 100% (5/5). The study has met its primary statistical futility endpoint of achieving ≥2 confirmed objective responses (CR or PR) in the first 12 patients enrolled. Currently, the median time to response is 1.6 months. One of the 8 responders displayed early pseudo-progression and later developed a partial response. Conclusions: At a pre-specified futility analysis, combination CVA21 and pembrolizumab appears to be well-tolerated. Early tumor monitoring has identified encouraging reductions in a number of injected and non-injected lesions. Based on these initial results, the sample size has now been expanded to enroll up to 50 patients. Combination therapy of CVA21 and pembrolizumab may represent a new approach for the treatment of patients with injectable advanced melanoma. Citation Format: Ann W. Silk, Howard Kaufman, Nashat Gabrail, Janice Mehnert, Jennifer Bryan, Jacqueline Norrell, Daniel Medina, Praveen Bommareddy, Darren Shafren, Mark Grose, Andrew Zloza. Phase 1b study of intratumoral Coxsackievirus A21 (CVA21) and systemic pembrolizumab in advanced melanoma patients: Interim results of the CAPRA clinical trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr CT026. doi:10.1158/1538-7445.AM2017-CT026

This study evaluates associations between coping drinking motives (CDM; drinking to regulate negative affect), depressive symptoms, and drinking behavior and extends the literature by also taking into account gender differences. Two hundred forty-three college students (Mean age = 22.93, SD = 6.29, 82% female) participated. Based on previous research, we expected that CDM would be positively associated with drinking and problems, particularly among those higher in depressive symptoms, as individuals experiencing higher levels of negative affect (i.e. depressive symptoms) and who drink to cope are likely to drink more and experience more alcohol-related problems. Lastly, based on established gender differences, we expected that CDM would be positively associated with drinking and problems, especially among females higher in depressive symptoms. Unexpectedly, findings suggested that CDMs were positively related to peak drinking, especially among those lower in depressive symptoms. Results further revealed a significant three-way interaction between CDM, depressive symptoms, and gender when predicting alcohol-related problems and drinking frequency. Specifically, we found that CDM were more strongly associated with problems among women who were lower in depressive symptoms; whereas CDM were more strongly associated with problems among men who were higher in depressive symptoms. These findings offer a more comprehensive depiction of the relationship between depressive symptoms, CDM, and drinking behavior by taking into account the importance of gender differences. These results provide additional support for considering gender when designing and implementing alcohol intervention strategies.

In challenging freedoms afforded by the First Amendment of the U.S. Constitution, official campaigns to prohibit flag desecration have continued to surface on America's political landscape. With th...

Although flag burnings today rarely draw the amount of attention they received in the late 1980s, efforts to protect the flag have persisted for nearly a decade. Accordingly, the flag protection campaign has captured the interest of intellectuals from various academic backgrounds, including political scientists, egal scholars, and journalists. Conspicuously absent from the literature on flag desecration, however, are sociologists and criminologists. Combining historical evidence with recent cases, this article unveils key sociological aspects of social control, including formal and informal responses to flag desecration.

Adoration for the United States flag is emblematic of American nationalism and patriotism. Moreover, in extreme forms, its rigid orthodoxy also reflects civil religion — a non-sectarian faith in which secular objects are transformed into sacred icons. Ostensibly, elements of civil religion imbue reverence for the flag, and although the recent flag protection campaign has caught the attention of intellectuals from various academic disciplines, sociologists are conspicuously absent from such discourse. In light of its relevance to civil religion, the dearth of sociological analysis on flag desecration is especially disconcerting. This article offers several theoretical explanations for the social construction of flag desecration and its sociological significance to civil religion.