Interpersonal coping in sport: A systematic review.

PURPOSE: To systematically search for, appraise, and synthesize peer-reviewed literature on interpersonal coping (IC) in sport. DESIGN: A systematic review adhering to PRISMA-P guidelines. METHOD: Systematic searches of CINAHL, PsycArticles, APA PsycInfo, and SPORTDiscus were conducted. To be eligible for inclusion, papers had to be published in full in the English language in a peer-reviewed journal and had to contain empirical data that focused on IC among individuals in sport (i.e., athletes, coaches, sport parents, practitioners). RESULTS: The final sample consisted of 28 studies (22 qualitative, five quantitative, one mixed methods) spanning from September 01, 1981 to July 10, 2023. The results highlight eight antecedents and facilitators of IC (closeness, commitment, communication, complementarity, cultural values, environment and situations, sharing of demands, support), three mediators and moderators of IC (appraisal of own and others' emotions and or coping, gender, individuals within the relationship), and three outcomes of IC (performance, relationships, regulation or management of emotions). The findings were used to develop the first working definition of IC in sport. CONCLUSION: A volte-face of thought is needed to shift attention toward the interpersonal manifestation of coping. IC has wide-reaching implications for individuals, relationships, and other psychological constructs. Methodological innovation is needed to realize stepwise changes in intellectual and practical progress and to develop quantitative measures of IC. Coaches, family members, practitioners, and retired athletes are considerably underrepresented in research on IC. This systematic review offers a vantage point from which composed and coordinated action can be taken to develop research on IC.

Improving Asthma Action Plan Completion Rates across Five Divisions in an Academic Children's Hospital.

Introduction: Asthma is the most common chronic disease among children. Asthma Action Plans (AAPs) enable asthma self-management tailored to each patient and should be updated annually. At our institution, providers face challenges in creating reliable processes to consistently complete AAPs for patients with asthma. This project's aim was to increase the percentage of patients across five hospital divisions who have an up-to-date AAP from 80% in May 2021 to 85% by October 1, 2021. Methods: We launched a quality improvement (QI) project using the Model for Improvement, focusing on improving AAP completion rates across five hospital divisions providing ambulatory care for asthma patients. The divisions (Adolescent/Young Adult Medicine, Allergy, Pulmonary, and two Primary Care sites) participated in the QI process using tools to understand the problem context. They implemented a cross-divisional AAP completion competition from June to October 2021. Each month during Action Periods, divisions trialed their interventions using Plan-Do-Study-Act cycles. We held monthly Learning Sessions for divisions to collaborate on successful intervention strategies. Results: Statistical process control chart analysis demonstrated that the overall AAP completion rate increased from a baseline of 80% to 87% with the initiation of the competition. All divisions showed improvement in AAP completion rates during the active intervention period, but sustainment varied. Conclusions: The cross-divisional competition motivated five divisions to improve processes to increase AAP completion rates. This approach effectively fostered engagement and idea sharing to boost performance, and may be considered for other QI projects.

A daily diary study of primary appraisals, emotional exhaustion, and turnover intentions in sport coaches.

Cognitive-motivational-relational theory asserts that stress is a dynamic process, during which daily fluctuations in mediating processes (primary appraisals) can explain a range of ill-being and performance related outcomes. We tested this idea using a daily diary study to examine the relationships between primary appraisals, emotional exhaustion, and turnover intentions in sport coaches. Forty-four sport coaches (61% male; Mage = 34.98 years) completed an online questionnaire twice per day for five days. The findings of within-person analyses indicated that hourly harm appraisals positively predicted momentary emotional exhaustion over the diary period (ß = .30, p < .05). Additionally, emotional exhaustion positively predicted coaches' job turnover intentions (ß = .18, p < .05). The findings offer unique insight into the cognitive-motivational-relational theory of stress and emotion by illustrating how exhaustion and turnover intentions may be intensified as a function of primary appraisals experienced during the working day.

Interpersonal psychological well-being among coach-athlete-sport psychology practitioner triads.

The importance of psychological well-being (PWB) is widely acknowledged in global policy and has important ramifications for health, performance, and engagement among sport performers. Despite this compelling knowledge, little is known about PWB in close sport relationships. We aimed to explore the interpersonal antecedents, transfer mechanisms, and outcomes of PWB within and among athletes, coaches, and sport psychology practitioners (SPPs). Underpinned by an interpretative paradigm, we conducted individual and triadic interviews with three coach-athlete-SPP triads from individual sports and analyzed data using abductive reasoning applied to reflexive thematic analysis. The themes we constructed relating to antecedents of PWB were situational properties of stressors, factors relating to the organization, shared values and characteristics, and interpersonal resilience. PWB was transferred among the triad via interpersonal coping, emotional contagion, and social appraising. PWB was cyclic in nature and, thus, we constructed themes (i.e., psychological safety, meaningful experiences of growth and development, and relational dynamics), which represented those factors that acted as both antecedents and outcomes. Our findings transcend individual understandings of PWB in sport by representing the first interpersonal examination of PWB among coach-athlete-SPP triads. This shift is crucial for informing how performers can collectively evaluate and manage PWB in the context of their close sport relationships. These findings implicate two primary recommendations: first, we recommend that researchers extend conceptual understanding of PWB among those in close sport relationships. Second, organizations and practitioners are encouraged to consider how mentoring and relationship-building schemes can be tailored within wider education and support programs to bolster PWB among athletes, coaches, and practitioners.

Mesonephric Adenocarcinoma and Mesonephric-like Adenocarcinoma of the Urinary Tract.

Given the association of mesonephric adenocarcinoma (MA) of the uterine cervix with florid mesonephric hyperplasia, one would expect MAs to rarely arise in other anatomical locations that harbor mesonephric remnants. In contrast, mesonephric-like adenocarcinoma (MLA) is thought to arise from Müllerian origin without an association with mesonephric remnants. The current case series characterizes 4 cases of MA arising in the urinary bladder (1 woman and 3 men), 1 case of MA in the perirenal region (woman), and 1 case of MLA in the ureter (woman). All cases displayed morphologic features similar to MA of the uterine cervix and MLA of the ovary and endometrium, characterized by predominant tubular and focal glandular/ductal architecture. Mesonephric remnants in the bladder wall were closely associated with adjacent MA in cases 1 and 4. MLA in case 6 was associated with mesonephric-like proliferations and endometriosis. All cases (6/6) were diffusely positive for Pax8, and all displayed a luminal pattern of CD10 staining, except case 4 for which CD10 immunostain was not available for review. Gata3 was either focally positive (cases 1, 2, and 6), negative (case 3), or diffusely positive (case 5). TTF-1 was diffusely expressed in cases 1 and 3 and negative in cases 2, 5, and 6. Although a KRAS G12C somatic mutation was detected in case 6, hotspot mutations in KRAS, NRAS, and PIK3CA were not present in other tested cases. Our study demonstrates that MAs and MLAs of the urinary tract share similar histopathogenesis, morphology, and immunophenotype to their counterparts in the female genital tract. We propose that, in the urinary tract, MA might be classified as a distinctive tumor that arises from mesonephric remnants or presumed Wolffian origin if they are not related to Müllerian-type precursors. The tumor displaying similar morphology and immunoprofile to MA but associated with Müllerian-type precursors should be classified as MLA.

Twin/Multiple Gestations With a Hydatidiform Mole: Clinicopathologic Analysis of 21 Cases With Emphasis on Molecular Genotyping and Parental Contribution.

Complete hydatidiform moles (CHMs) and partial hydatidiform moles (PHMs) are abnormal gestations characterized by vesicular chorionic villi accompanied by variable trophoblastic hyperplasia, with or without embryonic development. CHMs are purely androgenetic (only paternal [P] chromosome complements), mostly homozygous/monospermic (~85%) but occasionally heterozygous/dispermic, whereas PHMs are overwhelmingly diandric triploid (2 paternal [P] and 1 maternal [M] chromosome complements) and heterozygous/dispermic (>95%). The presence of a fetus in a molar pregnancy usually indicates a PHM rather than a CHM; however, CHMs and PHMs rarely can be associated with a viable fetus or a nonmolar abortus in twin pregnancies and rare multiple gestation molar pregnancies have been reported. A "one-oocyte-model," with diploidization of dispermic triploid zygotes, has been proposed for twin CHM with coexisting fetus, and a "two-oocyte-model" has been proposed for twin PHM with coexisting fetus. Among 2447 products of conception specimens, we identified 21 cases of twin/multiple gestations with a molar component, including 20 CHMs (17 twins, 2 triplets, 1 quintuplet) and 1 PHM (twin). P57 immunohistochemistry was performed on all; DNA genotyping of molar and nonmolar components was performed on 9 twin CHMs, 1 triplet CHM, 1 quintuplet CHM, and 1 twin PHM. All CHM components were p57-negative and those genotyped were purely androgenetic. Twin CHMs had genotypes of P1M1+P2P2 in 5, P1M1+P1P1 in 1, and P1M1+P2P3 in 1, consistent with involvement of 1 oocyte and from 1 to 3 sperm-most commonly a homozygous CHM but involving 2 sperm in the whole conception-and compatible with a "one-oocyte-model." The triplet CHM was P1M1+P1P1+P2M2 and the quintuplet CHM was P1M1+P2M2+P2M2+P3M3+P4P4, consistent with involvement of 2 sperm and at least 2 oocytes for the triplet and 4 sperm and at least 3 oocytes for the quintuplet. The twin PHM had a P1M1+P2P3M2 genotype, consistent with involvement of 2 oocytes and 3 sperm. p57 immunohistochemistry is highly reliable for diagnosis of CHMs in twin/multiple gestations. Refined diagnosis of molar twin/multiple gestations is best accomplished by correlating morphology, p57 immunohistochemistry, and molecular genotyping, with the latter clarifying zygosity/parental chromosome complement contributions to these conceptions.

The Role of Social Determinants of Health in the Use of Telemedicine for Asthma in Children.

Asthma is the most common chronic health condition among children in the United States. The adverse impacts of social determinants of health often manifest in unmet health-related social needs, potentially contributing to worse asthma outcomes. With the onset and rapid spread of coronavirus disease 2019 (COVID-19) and the identification of asthma as a potential risk factor for more severe disease, our asthma program quickly pivoted to a remote-access telemedicine asthma population management platform to best meet the needs of our most at-risk patients. Our practice provides care to a large proportion of Black and Latino/a/e children in urban areas insured by the State Medicaid Program and impacted by unmet social needs. As we pivoted to telemedicine, we consistently reached a greater number of patients and families than prepandemic and observed decreased emergency department visits and hospitalizations. About 1 in 5 families received resource touch points spanning categories of transportation, food and supplies, clothing, utilities, and rent. Overall, families reported positive experiences with telemedicine, including the ability to connect remotely with our social work and resource teams. Telemedicine may be an effective strategy for addressing both the medical and the social needs of children with asthma at risk for worse outcomes.

Demographics and outcomes of laboratory-confirmed COVID-19 cases during the first epidemic wave in Senegal.

BACKGROUND: Few studies have focused on the effects of COVID-19 on African populations. During the first epidemic wave in Senegal (May 1 to July 31, 2020), COVID-19 cases were isolated in treatment centers of epidemics (TCEs). We described the demographics and outcomes of COVID-19 cases in TCEs. PATIENTS AND METHODS: All cases with laboratory-confirmed COVID-19 in Thiès medical region of Senegal were included. RESULTS: COVID-19 was confirmed in 600 cases. Median age of cases (men: 357, 59.5%; women: 243, 40.5%) was 34.0years. The incidence was 12 per 100,000 inhabitants per month. Overall, 46 (7.7%) cases had a severe or critical form of the disease, and nine of them died. Of 455 cases quarantined in non-hospital TCEs, 340 (74.7%) had no symptom and 115 (25.3%) had mild or moderate symptoms. CONCLUSION: In this African retrospective cohort, COVID-19 cases were young and mostly asymptomatic with a low case fatality rate.

Causes infectieuses de décompensation du diabète: « un prédateur infectieux se cache chez tout diabétique en Afrique¼ / Infectious causes of diabetes decompensation: "an infectious predator hides in any diabetic in Africa"

Introduction : Les infections survenant chez les sujets diabétiques ont été longtemps considérées comme une des causes de l'accroissement de la morbidité et de la mortalité. Elles représentent un motif de plus en plus fréquent d'admission dans le service de médecine interne du Centre Hospitalier Régional et Universitaire de Thiès. Les mécanismes sont plus ou moins élucidés par l'influence de l'hyperglycémie sur les fonctions des polynucléaires neutrophiles. Le but de cette étude est de déterminer les particularités épidémiologiques des infections chez les diabétiques. Patients et Méthode : Il s'agissait d'une étude rétrospective avec recueil de données réalisée sur 24 mois (1er janvier 2016 au 31 décembre 2018) au service de Médecine Interne du Centre Hospitalier Régional et Universitaire de Thiès. Cette étude incluait tous les patients diabétiques quel que soit le genre et le type de diabète, âgés de 15 ans et plus, présentant une infection comme facteur principal de décompensation. Résultats : Durant la période d'étude 2350 patients ont été hospitalisés dans le service de médecine interne dont 390 diabétiques. Parmi eux, 138 patients ont répondu à nos critères d'inclusion soit une prévalence de 35,38%. La moyenne d'âge de nos malades était de 53,49 ans ± 15,65 ans avec un sex-ratio H/F était de 0,70 en faveur des femmes (81 femmes contre 57 hommes). Les infections responsables de la décompensation étaient à localisation cutanéo-muqueuse (30,4%), pulmonaire (22,4%), uro-génitale (18,11%), buccodentaire (10,11%), ORL (1,44%), phanérienne (0,72%). Ailleurs, une infection aux pieds était retrouvée chez 43 patients soit 31,15% des cas. Plusieurs infections pouvaient être présentes chez un même malade. Le diabète était déséquilibré dans 86,2 % (n=94) des cas avec une HbA1c moyenne à 10, 5 % à l'admission Nous n'avons pas noté de corrélation entre l'infection et l'ancienneté du diabète (p =0, 60), l'infection et le type de diabète (p = 0,50) et paradoxalement entre l'infection et le déséquilibre du diabète (p=0,70). Conclusion : Le dépistage des infections chez le diabétique en déséquilibre chronique ou diabétique de novo doit être systématique car généralement ces infections peuvent être asymptomatiques.

Introduction: Infections in people with diabetes have long been considered one of the causes of increased morbidity and mortality. They represent an increasingly frequent reason for admission to the Department of Internal Medicine of the Regional and University Hospital of Thies. The mechanisms are more or less elucidated by the influence of hyperglycemia on neutrophil polynuclear functions. The purpose of this study is to determine the epidemiological characteristics of infections in diabetics. Method: This was a retrospective study with data collected over 24 months (1 January 2016 to 31 December 2018) at the Internal Medicine Department of the Regional and University Hospital of Thies. This study included all diabetic patients, regardless of gender and type of diabetes, aged 15 years and older, with an infection as the primary decompensation factor. Result: During the study period 2,350 patients were hospitalized in the Internal Medicine Department, 390 of whom were diabetic. Of these, 138 patients met our inclusion criteria, a prevalence of 35.38%. The average age of our patients was 53.49 years 15.65 years with a sex-ratio H/F was 0.70 in favor of women (81 Women versus 57 Men). The infections responsible for decompensation were dermal localization (30.4%), pulmonary (22.4%), urogenital (18.11%), oral (10.11%), ENT (1.44%), phanerian (0.72%). Elsewhere, a foot infection was found in 43 patients or 31.15% of cases. Several infections could be present in the same patient. Diabetes was unbalanced in 86.2% (n=94) of cases with an average HbA1c of 10.5% at admission We did not find a correlation between the infection and the age of diabetes (p =0, 60), the infection and the type of diabetes (p = 0.50), and paradoxically between the infection and the imbalance of diabetes (p = 0.70). Conclusion: The detection of infections in diabetics in chronic imbalance or de novo diabetics must be systematic because generally these infections can be asymptomatic.

Mise en place d'un centre de traitement des épidémies (CTE) pour COVID-19 dans un service de Médecine Interne; les leçons apprises / Establishment of an Outbreak Center for Covid-19 (OCC), in an Internal Medicine department

Introduction: La fulgurante progression de la pandémie à covid -19 a imposé au Sénégal l'adoption de stratégies de riposte parmi lesquelles la mise en place de centres de traitement des épidémies (CTE) au sein des hôpitaux . Nous nous proposons d'évaluer les activités d'un CTE Covid-19 implanté dans un service de médecine interne et les leçons tirées de ce vécu. Méthodologie : Le CTE Covid -19 a été installé dans le service de médecine interne de l'Hôpital Régional de Thiès (HRT), mais avec conservation de lits dédiés aux patients non atteints de Covid-19. Les étudiants en année de doctorat affectés dans le service de médecine interne étaient responsables de la gestion quotidienne du CTE sous la supervision des spécialistes en médecine interne Ce service était subdivisé en deux parties: le CTE qui prenait en charge les cas de Covid -19 et le reste du service qui devait continuer à accueillir les patients atteints d'autres affections ou qui y étaient régulièrement suivies. Résultats : Du 1er mai au 30 octobre 2020, 237 patients ont été admis dans le CTE. Ils étaient âgés de 7 à 88 ans avec une moyenne d'âge de 53,41 ans et un sexe ratio de 1,60. Les motifs d'admission étaient une désaturation en oxygène inférieure à 90%, la présence d'au moins une comorbidité (autres infections, diabète , hypertension artérielle , obésité, maladies auto-immunes, cancers…). L'âge avancé mais aussi les patients ne pouvant être à domicile faisaient également partie des critères d'admission . Trois (3) cas de co-infection Covid-19 et tuberculose pulmonaire ont été relevés et trois (3) patients avaient un portage chronique du virus de l'hépatite B. Dans le cadre des hospitalisations non Covid -19, les affections suivantes ont été retrouvées : 8 cas de diabète déséquilibrés et autant d'hépatopathie (6,10%); l'accès palustre dans 3, 05% (n=3) ; la tuberculose pulmonaire (3,81%, n=3) ; 3 cas (2,29 %) d'anémie de type biermerien et de lupus érythémateux systémique. De même, 1 cas (0,76%) d 'empyème cérébral ; une polyarthrite rhumatoïde (0,76 %), une (01) maladie rénale chronique , 1 cas de défaillance cardiaque ont également été enregistrées. Cinq (5) cas (3,81 %) non affectés par l'infection à Covid -19 , à leur admission l'ont été au cours de leur hospitalisation et donc transférés au niveau de la zone rouge du CTE. Conclusion: La mise en place du CTE au niveau du service de Médecine interne , a permis une adaptation efficiente dans la prise en charge des patients concernés mais aussi de ceux qui étaient suivis pour des pathologies chroniques comme les urgences médicales reçues durant la période. La continuité des soins a été assurée et les liens avec les autres secteurs de la pyramide sanitaire du Sénégal ont été raffermis.

Introduction : The fast progression of covid -19 throughout the world has forced Senegal to adopt response strategies including the establishment of Outbreak Center for Covid- 19 (OCC ) within hospitals . We propose to evaluate the activi ties of an OCC implemented in an internal medicine department and the lessons learned from this experience. Methodology: The center for care of Covid-19 has been installed in the Internal Medicine department of the Thies Regional Hospital (HRT ), but with dedicated beds for patients non affected by the pandemic . Fifteen doctoral students were assigned, by local medical school , to the Department of Internal Medicine in order to be responsible for the day-to-day management of the OCC. They were supervised by internal medicine specialists . This service was divided into two parts: the OCC that handled Covid -19 cases and the rest of the service , which was to continue to take care of patients with other conditions or who were regularly monitored. Results: From May 1 to October 30, 2020, 237 patients were admitted to the CTE They ranged from 7 to 88 years old with an average age of 53.41 and a sex ratio of 1.60 .The reasons for admission were an oxygen desaturation of less than 90%, the presence of at least one comorbidity (other infections, diabetes, arterial hypertension, obesity, autoimmune diseases, cancers, etc .). Advanced age but also patients who could not be at home were also part of the admission criteria. Three (3) cases of Covid -19 co -infection and pulmonary tuberculosis were identified and three (3) patients had a chronic carriage of the hepatitis B virus. In the context of non -Covid -19 hospitalizations, the following conditions have been found: 8 cases of unbalanced diabetes and as many hepatopathy (6.10%); malaria access in 3.05% (n = 3); pulmonary tuberculosis (3.81%, n = 3); 3 cases (2.29%) of biermeric type anemia and systemic lupus erythematosus. Similarly, 1 case (0.76 %) of cerebral empyema; rheumatoid arthritis (0.76%), one (01) chronic kidney disease, 1 case of heart failure were also recorded Five (5) cases (3.81%) not affected by Covid-19 infection, on admission, were during their hospitalization and therefore transferred to the red zone of the CTE. Conclusion : The establishment of the OCC in the internal medicine service allowed an efficient adaptation in the care of the patients affected by covid disease but also of those who were followed for chronic pathologies or admitted for other medical emergencies This strategy has improved and strengthened the links with other sectors of Senegal 's health pyramid.

Acute abdomen caused by a large solitary jejunal diverticulum that induced a midgut volvulus. Report of a case.

BACKGROUND: Jejunal diverticula are a rare subtype of false diverticula found in the gastrointestinal tract. When present, they are usually multiple, in the proximal jejunum and asymptomatic. Rarely, they can cause acute complications that can develop into an acute abdomen requiring surgical intervention. We present the rare manifestation of a single jejunal diverticulum causing midgut volvulus and bowel ischemia. Early surgical intervention with small bowel derotation allowed complete recovery. METHODS: Data regarding the case, operative intervention, and patient follow-up was prospectively accumulated with permission of the patient at an academic institution. All patient identifiers were removed. All research steps were performed under guidance outlined in the SCARE criteria. RESULTS: We present the case of a 78-year-old man who presented to our institution with an acute abdomen. CT imaging demonstrated a whirlpool sign without an obvious lead point. The patient was without prior surgical intervention. Urgent exploratory laparotomy revealed a midgut volvulus with associated bowel ischemia and impending infarction secondary to adhesive disease from a large single jejunal diverticulum. Derotation resulted in gradual recovery of bowel vascularity. Resection of the portion of the jejunum containing the diverticulum resulted in full clinical recovery of the patient. CONCLUSIONS: Complications of jejunal diverticula, although rare, should be considered as part of the differential diagnosis of an acute abdomen of unknown etiology. Urgent surgical intervention was required to avoid a potential catastrophic outcome.

Design and preliminary validation of the barriers to sports coaching questionnaire for women in South Africa: An application of the ecological model.

The purpose of this study was to develop and preliminarily validate a questionnaire to examine barriers to coaching that are encountered by women sports coaches in South Africa. Two series of studies were conducted to assess content and face validity, factorial structure, and reliability of a new questionnaire. In study one, 40 items were developed based on LaVoi and Dutove's ecological model of barriers and supports for female coaches and a thorough literature review. A panel of experts was employed to explore content validity and suitability of the provisional items. In study two, an initial 35-item questionnaire (the Barriers to Sports Coaching Questionnaire for Women; BSCQW) was administered to 152 women sports coaches who were working in South Africa. Principal component analysis was used to reduce items and determine the factorial structure of the questionnaire. Analyses resulted in a 32-item BSCQW, which consists of intrapersonal, interpersonal, organisational, and socio-cultural barriers to coaching. The most proximal barriers were organisational (M = 2.71, SD = 1.24) and interpersonal (M = 2.22, SD = 1.04). The findings indicate that the overall internal consistency of the BSCQW was .81, demonstrating that the questionnaire was reliable. Thus, BSCQW is a valid tool to assess barriers experienced by women sports coaches in South Africa. Further rigorous psychometric assessments are warranted.

A phenomenographic study: Exploring the variations of registered nurses' perceived roles and experiences as HIV counselors

OBJECTIVES: The study explored the variations of registered nurses' perceived roles and experiences before, during and after HIV counseling. METHODS: The study is anchored on Parse's Human Becoming Theory structured around three abiding themes: meaning, rhythmicity, and transcendence. A qualitative phenomenographical approach was used and the data were collected through semi structured, face-to-face, in-depth interview sessions with ten registered nurses who were eligible under the set criterion: HIV counselors employed in both government and private health facilities with HIV Testing and Counseling facilities and services in Iligan City and Cagayan de Oro City. Verbatim transcriptions were analyzed in iterative process using Jan Larssons and Inger Holmstrom's (2007) seven simple steps of phenomenographic analysis. Triangulation and validation established rigor and trustworthiness of the data. RESULTS: Emergent themes of differences in participants' perceived roles and experiences conveyed in a metaphor: The Employee vs. The Educator; The Professional vs. The Shepherd. CONCLUSION: The variations ascertained the association of perceived roles and experiences of HIV Counselors and posited equally vast challenges as nursing takes the core in collaboration for the care of persons living with HIV toward a dignified death

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Diffusion kurtosis imaging of gray matter in schizophrenia.

Prior postmortem studies have shown gray matter (GM) microstructural abnormalities in schizophrenia. However, few studies to date have examined GM microstructural integrity in schizophrenia in vivo. Here, we employed diffusion kurtosis imaging (DKI) to test for differences in GM microstructure in eighteen schizophrenia (SZ) patients versus nineteen healthy controls (HC). GM microstructure was characterized in each participant using DKI-derived metrics of mean kurtosis (MK) and mean diffusivity (MD). Individual T1-weighted images were used to create subject-specific cortically-labelled regions of interest (ROIs) of the four cortical lobes and sixty-eight cortical GM regions delineated by the Desikan-Killiany atlas, and to derive the associated cortical thickness and area measures. The derived ROIs were also registered to the diffusion space of each subject and used to generate region-specific mean MK and MD values. We additionally administered the Wisconsin Card Sorting Test (WCST), Stroop test, and Trail Making Test part B (Trails-B) to test the relationship between GM metrics and executive function in SZ. We found significantly increased MK and MD in SZ compared to HC participants in the temporal lobe, sub-lobar temporal cortical regions (fusiform, inferior temporal, middle temporal and temporal pole), and posterior cingulate cortex after correcting for multiple comparisons. Correlational analyses revealed significant associations of MK and MD with executive function scores derived from the WCST, Stroop, and Trails-B tests, along with an inverse relationship between MK and MD and cortical thickness and area. A hierarchical multiple linear regression analysis showed that up to 85% of the inter-subject variability in cognitive function in schizophrenia measured by the WCST could be explained by MK in combination with either GM thickness or area. MK and MD appear to be sensitive to GM microstructural pathology in schizophrenia and may provide useful biomarkers of abnormal cortical microstructure in this disorder.

Advancing Our Understanding of Psychological Stress and Coping Among Parents in Organized Youth Sport.

The current study investigated psychological stress among parents of competitive British tennis players. Adopting a multipart concurrent mixed method design, 135 British tennis parents completed a cross sectional online questionnaire to examine their primary appraisals, emotions, and coping strategies associated with self-disclosed stressors. Hierarchical content analysis was conducted on open ended questionnaire responses to identify key stressors and coping strategies, and descriptive and inferential statistics were utilized to explore the differences between various components of the process. The findings revealed a range of organizational, competitive, and developmental stressors. These stressors were predominantly appraised as harm or challenge, and anxiety and anger were the most prominent emotions that the parents experienced. Statistically, parents experienced greater anger in relation to competition (compared to organizational and developmental) stressors, whilst harm appraisal increased negative emotions, and challenge appraisal increased positive emotions. Findings also highlighted how parents used a number of mastery, internal regulation, and goal withdrawal coping strategies, which varied statistically in degrees of reported effectiveness. The contribution of these findings to the stress literature and their applied implications are discussed.

A Group Visit for High-Risk Pediatric Asthma Patients: A Quality Improvement Initiative to Improve Asthma Care.

INTRODUCTION: Asthma disproportionately affects poor and minority children. Limited parental knowledge and confidence in asthma management, as well as stress from chronic illness, may contribute to poor outcomes. Novel approaches for providing care are essential for this vulnerable population. Our objective was to evaluate the feasibility and impact of an asthma group visit for high-risk children. METHODS: Our primary care practice cares for more than 2600 children with asthma. The majority have public insurance. Children classified as high risk (≥1 asthma-related emergency department visit/hospitalization in the preceding 2 years) were eligible. Children received brief physical examinations, medication review, and updated Asthma Action Plans. Educational sessions were held for children and parents. Pre and post surveys were used to assess parents' experience and changes in confidence in asthma management. RESULTS: Twenty children and their parents participated. Mean parent confidence scores (5-point Likert-type scale, 5 indicating greatest confidence) improved in managing their child's asthma symptoms (3.60, 4.40, P ≤ .005), managing their child's asthma medications (3.85, 4.30, P ≤ .005), using their child's Asthma Action Plan (3.79, 4.45, P ≤ .02), communicating with the school about their child's food allergies (4.32, 4.72, P ≤ .03), and helping their child relax to reduce emotional triggers of asthma (3.25, 4.47, P ≤ .01). All families reported that they would return to a group visit. CONCLUSION: Group visits are feasible for providing care, education, and peer support to a vulnerable population. Parents expressed satisfaction and improved confidence in aspects of asthma management. Group visits have the potential to improve asthma outcomes for high-risk families.

Associations Between Patient-Reported Outcome Measures of Asthma Control and Psychosocial Symptoms.

There is growing emphasis on using patient-reported outcome measures to enhance clinical practice. This study was a retrospective review of scores on the Childhood Asthma Control Test (C-ACT) and the Pediatric Symptom Checklist-17 (PSC-17) at a pediatric primary care center in Boston, Massachusetts. A total of 218 patients were selected at random using billing codes for well-child (WC) care and asthma, excluding complex medical conditions. Cutoff scores were used to identify uncontrolled asthma (C-ACT ⩽19) and clinically significant psychosocial symptoms (+PSC-17). Multiple logistic regression was used to measure associations between C-ACT ⩽19 and +PSC-17, adjusting for covariates. In multivariable analysis, C-ACT ⩽19 at WC visits was associated with +PSC-17 at WC visits (adjusted odds ratio = 3.2 [95% confidence interval = 1.3-8.6]). C-ACT ⩽19 at non-WC visits was also associated with +PSC-17 at WC visits (adjusted odds ratio = 3.1 [95% confidence interval = 1.2-8.9]). Patient-reported outcome measures of asthma control and psychosocial symptoms were positively correlated in this sample.

The antecedents and outcomes of dyadic coping in close personal relationships: a systematic review and narrative synthesis.

BACKGROUND AND OBJECTIVES: Theories of dyadic coping and empirical literature have intermittently and inconsistently highlighted antecedents and outcomes of dyadic coping. The purpose of this review was to systematically identify the antecedents and outcomes of dyadic coping in close personal relationships. DESIGN: A PRISMA-guided systematic review and narrative synthesis. METHODS: Literature searches were conducted using CINAHL, PubMed, PsycINFO, and citation pearl growing to identify studies that were relevant to the aim of the review. The search strategy and exclusion criteria led to a final sample of 46 studies that each highlighted antecedents and outcomes of dyadic coping among married couples. Each study was critically appraised and analyzed using narrative synthesis. RESULTS: The narrative synthesis highlighted five antecedents (learning, gender, relationship characteristics, relationship role, and cultural influences) and two outcomes (relationship functioning and personal health) of dyadic coping. CONCLUSION: The review exposes inconsistencies in the conceptualization of dyadic coping, highlights a range of antecedents that influence dyadic coping, and suggests that dyadic coping can have positive benefits for relationship functioning and personal health. The findings have implications for future research and practice (e.g. when working with couples to improve relationship functioning).

Surgical follow-up results for apocrine adenosis and atypical apocrine adenosis diagnosed on breast core biopsy.

Apocrine adenosis (AA) and atypical apocrine adenosis (AAA) are uncommon findings in breast biopsies that may be misinterpreted as carcinoma. The clinical significance and risk implications of AAA diagnosed on core biopsy are not well established. This study aimed to determine the frequency of carcinoma on follow-up excision in patients with a diagnosis of AA or AAA on core biopsy. Forty-one breast core biopsies of AA (n=29) and AAA (n=12) were identified during a study period of 12 years. Of the 41 core biopsies with AA or AAA, 10 biopsies showed coexisting/concurrent atypical hyperplasia or carcinoma. In the absence of coexisting/concurrent atypical hyperplasia or carcinoma in core biopsy, none of the follow-up excision specimens after a diagnosis of AA or AAA showed ductal carcinoma in situ or invasive carcinoma. In conclusion, AA or AAA by itself is an uncommon core biopsy diagnosis that may not require surgical excision.