Proximal Motives of Sexual Arousal, Power, and Relationship for Sexual Aggression: Supporting the Millennial Shift.

We examined three proximal motives for sexual aggression (sexual persistence after a turn down): sexual arousal, power, and relationship. The MTurk sample consisted of 264 adults: 92 Millennial men (35%), 51 Millennial women (19%), 82 Gen X men (31%) and 39 Gen X women (15%). The motive data, measured by the Sexual Aggression Motive Assessment (SAMA), were unanalyzed data extracted from the authors' previous study of the Millennial shift, a phenomenon in which Millennial women, as compared to older generation women, showed higher levels of sexual aggression, while Millennial men, in comparison to older generation men, demonstrated lower levels of sexual aggression. For all respondents combined, the most chosen motive category was sexual arousal (95%), followed by relationship (49%), and then by power (18%) with 50% choosing two or more motive categories. Providing conceptual support for the Millennial shift, significantly more Millennial women than Gen X women chose motives of sexual arousal and power as reasons for perpetrating sexual aggression. An important finding for the relationship motive is that substantial numbers of both men and women engaged in sexual aggression because they felt that having sex would make the person like them.

Methodologies for soil extraction and conservation analysis of ferns and lycophytes with belowground gametophytes.

Premise: Studies of fern and lycophyte gametophyte biology in natural settings can be challenging, but such analyses are critical to understanding the dispersal, ecology, and conservation of these species. It is especially challenging to study species whose gametophytes and early sporophyte stages develop belowground, as is the case for species of the Ophioglossaceae, Psilotaceae, some species of the Schizeaceae (Actinostachys), and some species of the Lycopodiaceae. To study these taxa, gametophytes and young sporophytes must be extracted from the soil. Methods: In 1989, Mason and Farrar described a methodology for accomplishing the collection of belowground gametophytes and sporophytes using soil centrifugation. Here, we refine this procedure based on subsequent years of experience. Results: We found that many more sporophytes exist belowground than are represented by aboveground leaves, and that belowground sporophytes can survive indefinitely without production of aboveground leaves. Belowground gametophytes are common in areas where spore-releasing sporophyte leaves are present. Gametophytes are bisexual with male and female gametangia intermixed. Some species of Botrychium also reproduce asexually belowground through production of gemmae. Discussion: We conclude that in Botrychium, assessments of population health and structure must include analyses of the belowground plants and their habitat. Conservation management strategies must also include potential changes in the belowground habitat.

Understanding sexual activity while driving as a form of distracted driving.

Sexual activity while driving has been reported in emerging research. Sexual activity while driving is a form of distracted driving because it includes an individual (the driver) who deviates resources from the primary task (driving) towards a secondary task (sexual activity). However, most of our current knowledge about the range of sexual activities while driving is based on self-reported data or media reports. Thus, an in-depth understanding of sexual activities while driving and their interactions with non-sexual driving behaviours and vehicle control is missing. Additionally, there is limited information on the context of where sexual activities while driving occurs and the influence of factors such as the environment, the vehicle, interactions with other road users, and other in-vehicle distractions. To cover this gap, a content analysis of sexually explicit media (SEM) was conducted on a sample of 270 videos depicting real driving. We conducted descriptive analyses and used decision tree analysis to explore the association between sexual activities while driving and their interactions with non-sexual driving behaviours and vehicle control. The videos portrayed a naturalistic driving situation of a driver of a moving vehicle engaging in sexual activity. The results show that when engaging in sexual activity, drivers do not present safe vehicle control. Sexual activity imposes additional cognitive, physical, and visual demands on the driver, thereby decreasing safety. Similar to other distractions, drivers engaging in sexual activity while driving appear to mitigate risks. Concerning the potential for legal sanctions, it appears that drivers may attempt to conceal sexual activity by reducing their visible nudity and minimising interactions with other road users. Finally, mobile phones and cameras appear to interact with sexual activities while driving, by imposing potential restrictions on the range of sexual activities. Implications for policymakers and practitioners are discussed.

Direct observation in a large-scale randomized trial of parent training in children with autism spectrum disorder and disruptive behavior.

A direct observation strategy (Standardized Observation Analogue Procedure, SOAP) was used in a large-scale randomized trial of parent training versus parent education in young children with autism spectrum disorder (ASD) and disruptive behavior. The 16-minute SOAP, modified from an earlier version of this same measure, included parentchild interaction to assess child behavior in a clinical laboratory setting. Despite study entry criteria for all child participants requiring moderate levels of disruptive behavior in this project, 126 of 168 children with complete SOAP data at baseline showed no disruptive behavior on this measure. Although the primary purpose of the study was to determine whether the SOAP could detect differences between the two conditions (i.e.,parent training (PT) and parent education (PE)), baseline observation data was not consistent with parent ratings at baseline or subsequent follow up visits, leaving little room to demonstrate improvement with this observation measure. This and the challenging, time-consuming and resource intensive effort involved in using such a measure in a large randomized scale trial, raises fundamental questions about the validity of the SOAP as an outcome measure in such a study. Further consideration related to the feasibility and practicality of using direct observation as a primary measure in larger scale efforts overall are also discussed.

Generation by Gender Differences in Use of Sexual Aggression: A Replication of the Millennial Shift.

Adult perpetration rates of sexual aggression (defined as: acts in which an individual uses verbal pressure, arousal techniques, coercion, alcohol or drugs, or force to have sexual contact with someone against his or her will) were compared among an MTurk sample of 341 Baby Boom-GenX men, 356 Baby Boom-GenX women, 465 Millennial men, and 309 Millennial women (Mdn age = 30). Logistic regression analyses revealed a significant generation by gender interaction effect for use of six behaviors: pressured or forced sexual outcomes (PFSOs) without sexual intercourse; PFSOs with sexual intercourse, any tactic of post-refusal sexual persistence (PRSP), and PRSP tactic sets related to arousal, emotional coercion, and intoxication. No interaction effect was found for the PRSP tactic set of physical force. Follow-up analyses revealed that for four measures (any PRSP, PRSP sets for arousal, emotional coercion, and intoxication), Baby Boom-GenX men had significantly higher rates of sexual aggression than same-generation women, but Millennial men and women had statistically similar rates. This outcome replicated a pattern termed the Millennial Shift which we detected in earlier work. We suggest that the Millennial Shift involves higher sexual aggression rates reported by Millennial women compared to older generation women, in conjunction with lower rates reported by Millennial men compared to older generation men. We speculate that the Millennial Shift reflects changes in the traditional sexual script.

End of the line for fetal lung maturity testing.

OBJECTIVE: During the last decade, guidelines published by the American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal Fetal Medicine (SMFM) have emphasized an increasingly limited role for fetal lung maturity (FLM) testing. As a reference laboratory for FLM testing, we were therefore interested in determining the impact of changing guidelines on our test volumes. METHODS: We retrospectively reviewed FLM test volume data from 2006 to 2016 for the following FLM assays: lecithin/sphingomyelin ratio, phosphatidylglycerol, disaturated lecithin, and lamellar body count. RESULTS: We found that there was a precipitous decline in test volumes from 2006 to 2016; our analysis led us to discontinue providing reference laboratory FLM testing in 2016 given the very low volumes. CONCLUSIONS: The 2019 ACOG guidelines now state that FLM testing no longer has clinical utility. Therefore, clinical laboratory directors should meet with obstetrics providers to discuss discontinuation of FLM testing at their institutions.

Evaluation of LeadCare Ultra® as an initial screen for elevated blood lead levels.

OBJECTIVE: The LeadCare Ultra® (LCU) was compared to inductively coupled plasma mass spectrometry ICP-MS for use as a screening test for elevated blood lead levels (BLLs) in capillary samples from children. METHODS: During the validation, method comparisons between LCU and ICP-MS were analyzed to determine the bias above, near, and below the BLL cut-off of 5 µg/dL. Additionally, capillary samples that screened positive by LCU (above the 5 µg/dL cut-off) were compared to venous samples analyzed by ICP-MS for confirmatory testing. RESULTS: LCU had a positive bias (1.7 µg/dL) below the cut-off of BLL <5 µg/dL, no bias near the cut-off from BLL 5-10 µg/dL, and a negative bias (-0.8 µg/dL) for BLL >10 µg/dL compared to ICP-MS. Of the 59 capillary samples that screened positive by LCU between May of 2017 to April of 2018, 19 were confirmed positive by ICP-MS, 30 were confirmed negative by ICP-MS, and 10 did not have a confirmed result. CONCLUSION: The LCU assay is an acceptable screen for capillary samples with the BLL cut-off of 5 µg/dL.

Medical-Legal Partnerships At Veterans Affairs Medical Centers Improved Housing And Psychosocial Outcomes For Vets.

Medical-legal partnerships-collaborations between legal professionals and health care providers that help patients address civil legal problems that can affect health and well-being-have been implemented at several Veterans Affairs (VA) medical centers to serve homeless and low-income veterans with mental illness. We describe the outcomes of veterans who accessed legal services at four partnership sites in Connecticut and New York in the period 2014-16. The partnerships served 950 veterans, who collectively had 1,384 legal issues; on average, the issues took 5.4 hours' worth of legal services to resolve. The most common problems were related to VA benefits, housing, family issues, and consumer issues. Among a subsample of 148 veterans who were followed for one year, we observed significant improvements in housing, income, and mental health. Veterans who received more partnership services showed greater improvements in housing and mental health than those who received fewer services, and those who achieved their predefined legal goals showed greater improvements in housing status and community integration than those who did not. Medical-legal partnerships represent an opportunity to expand cross-sector, community-based partnerships in the VA health care system to address social determinants of mental health.

Sexual Behavior in Parked Cars Reported by Midwestern College Men and Women.

In an anonymous survey of 195 men and 511 women (Mage = 19.8) at a small Midwestern university, 119 men (61%) and 303 women (59.5%) reported that they had engaged in sex while parked. Of these 422, 14% lost their virginity in a parked car. Having sex in parked cars was more likely to involve relational dating partners than hookups. In most recent incidents, the majority of respondents were with a serious but noncohabiting romantic partner (56.9%) in the back seat (63.4%) of a standard car (56.4%) parked out in the country (56.0%). The most common sexual acts were penile-vaginal sex and genital touching, reported by 84.6% and 57.5% of respondents, respectively. Condoms were used by 58.2% of respondents. Less than 1% of respondents reported sexually transmitted infections (STIs) or pregnancy outcomes. These data, including personal stories of memorable incidents, revealed that despite discomfort, body bumps, and risk of being caught, sex while parked was primarily a positive sexual and romantic experience for both men and women. A dark side of parked-car sex existed in that 2.5% of men and 4.3% of women reported being sexually coerced. The future study of sex in parked cars in urban environments is recommended.

Partnerships Between Health Care and Legal Providers in the Veterans Health Administration.

Medical-legal partnerships (MLPs) represent an innovative service model in which lawyers are integrated into health care teams to address diverse legal problems that affect vulnerable populations. The Veterans Health Administration (VHA) operates the largest safety-net health care system in the country and serves many low-income and disabled veterans who could benefit from MLP services. In this column, the authors describe the development and operations of MLPs at four VHA medical centers that serve veterans who are homeless or who have serious mental illness. The authors also briefly report on the characteristics of 700 veterans served by these MLPs from 2014 to 2016. MLPs can fit within the interdisciplinary, comprehensive system of care provided by VHA, and they offer opportunities to expand VHA-community partnerships to address social determinants of health.

Comparisons of Contraceptive Use between Rural and Urban Teens.

STUDY OBJECTIVE: The purpose of the study was to determine if barriers in rural areas might decrease an adolescent's likelihood of obtaining effective contraception. Previous studies have reported mixed results in comparisons of rural and urban contraception use. DESIGN: Electronic survey. SETTING: Midwestern Public University. PARTICIPANTS: Undergraduate and graduate women. INTERVENTIONS: Questionnaire. MAIN OUTCOME MEASURES: Participants retrospectively recalled their contraceptive use and barriers to contraceptive use between the 9th and 12th grades. RESULTS: A Barriers to Contraception Use Scale was created using exploratory factor analysis and yielded 31 questions with 1 underlying factor: barriers. Participants were identified as rural or urban using the Office of Management and Budget (OMB) definition and the participant's self-identification. Overall, rural participants endorsed more barriers to accessing contraceptives than urban participants using the OMB definition (χ(2) (2; n = 388) = 2.04; P < .05), and self-identification (χ(2) (2; n = 398) = 2.37; P < .05). However, no differences were found in contraception use according to the OMB definition, t (380) = -1.90; P = .06, or self-identification, t (380) = -2.11; P > .05. The Barriers to Contraception Use Scale total score predicted whether an individual would have a prescription for contraceptives 70.5% of the time compared to the base rate of 54.1%. CONCLUSION: Although no rural-urban differences in actual contraception use were found, rural participants reported more barriers to accessing contraception, and those who endorsed more barriers were less likely to obtain contraceptives while in high school. Pregnancy prevention programs should thus take these barriers into account when developing future interventions.

Gender differences in psychosocial predictors of texting while driving.

A sample of 158 male and 357 female college students at a midwestern university participated in an on-line study of psychosocial motives for texting while driving. Men and women did not differ in self-reported ratings of how often they texted while driving. However, more women sent texts of less than a sentence while more men sent texts of 1-5 sentences. More women than men said they would quit texting while driving due to police warnings, receiving information about texting dangers, being shown graphic pictures of texting accidents, and being in a car accident. A hierarchical regression for men's data revealed that lower levels of feeling distracted by texting while driving (20% of the variance), higher levels of cell phone dependence (11.5% of the variance), risky behavioral tendencies (6.5% of the variance) and impulsivity (2.3%) of the variance) were significantly associated with more texting while driving (total model variance=42%). A separate regression for women revealed that higher levels of cell phone dependence (10.4% of the variance), risky behavioral tendencies (9.9% of the variance), texting distractibility (6.2%), crash risk estimates (2.2% of the variance) and driving confidence (1.3% of the variance) were significantly associated with more texting while driving (total model variance=31%.) Friendship potential and need for intimacy were not related to men's or women's texting while driving. Implications of the results for gender-specific prevention strategies are discussed.

A preliminary study of sexual activity as a distraction for young drivers.

In what may be the first in-depth study of sexual activity as a driving distraction in the US, a sample of 195 male and 511 female college students at a Midwestern university (M age=19.7) participated in an on-line study of sex while driving (SWD). Of these, 64 (32.8%) men and 47 (9.3%) women had engaged in sex while driving (SWD). Nine percent of men and 29% of women had engaged in SWD as a passenger. In most recent SWD incidents, respondents reported that the two most common acts were oral sex (70.3%) and genital touching (60.4%). About 11% engaged in vaginal intercourse. Sexual activity lasted from 1 to 10min for 42.7% of the respondents. Nearly half (49.1%) were traveling 61-80mph during sex. Considering respondents' lifetime incidents of SWD, the most common driving errors reported were speeding (37.8%), drifting into another lane (36%), and letting go of the steering wheel (10.8%). Only 1.8% nearly had a crash, and none actually had a crash. Separate regression analyses for male and female respondents revealed that lower intentions to engage in SWD in the future were associated with higher estimates of the probability of a car crash. The authors consider SWD to be an under-reported in-vehicle distraction and encourage more research and prevention efforts.

Practice patterns of heart failure nurses.

OBJECTIVE: Little is known about the practice patterns of nurses who work in the specialty of heart failure (HF). This specialty includes inpatient and outpatient sites for practice that incorporate intensive care to rehabilitation. The purpose of this study was to describe the current practice of nurses who are members of the American Association of Heart Failure Nurses (AAHFN). METHODS: A convenience sample of nurses attending the 2010 Annual Meeting of AAHFN was surveyed to determine current practice patterns. RESULTS: The mean age of the nurses completing the survey was 48 years (standard deviation [SD] +10), and the majority were white (85%) and female (98%). Approximately half (48%) completed a Master's degree. The mean time worked as a nurse was 23 years (SD +10), with a mean of 11 years (SD +8.2) caring for patients with HF. Both HF education and physical assessment were reported to be provided frequently. CONCLUSION: This survey provides insight into the practice patterns of HF nurses. Continued monitoring of this role is warranted and can serve to assist the AAHFN in advancing HF knowledge and skills.

A phase II study of oral enzastaurin in patients with metastatic breast cancer previously treated with an anthracycline and a taxane containing regimen.

PURPOSE: Enzastaurin is a potent, serine-threonine kinase inhibitor which selectively targets PKCß and PI3K/AKT signaling pathways to reduce cell proliferation, induce apoptosis, and inhibit angiogenesis. As PKCbeta and PI3K/AKT signaling are both involved in breast cancer pathogenesis, this phase II study evaluated the efficacy and toxicity of enzastaurin in previously treated patients with metastatic breast cancer (MBC). PATIENTS AND METHODS: Eligible patients had histologically confirmed MBC with measurable disease, and must have received prior anthracycline and taxane chemotherapy, but not more than two prior regimens for MBC. Human epidermal growth factor 2 (HER2)-positive patients must have progressed on prior trastuzumab therapy. Enzastaurin, 1,125-mg loading dose on day 1 followed by 500 mg daily, was administered orally in 28-day cycles. Response was assessed every 2 cycles according to the Response Evaluation Criteria in Solid Tumors (RECIST) criteria. RESULTS: Twenty-one patients enrolled between November 2006 and September 2007. Fourteen (66.7%) patients completed at least two cycles of therapy. No patients developed Grade 3/4 hematologic toxicity. Grade 3 nonhematologic toxicity was rare (<5%) and most commonly attributed to MBC progression. There were no objective responses and no patients with stable disease for >/=6 months. Median progression-free survival was 1.68 months (95%CI: 1.02, 1.74). CONCLUSIONS: Enzastaurin monotherapy was well tolerated, but demonstrated no activity in patients with heavily pretreated MBC.

A comparison of sexual coercion experiences reported by men and women in prison.

Comparisons were made between self-reports from 382 men and 51 women who had experienced sexual coercion while incarcerated. Victim data were obtained from a sample of 1,788 male inmates and 263 female inmates who responded to an anonymous written survey distributed in 10 midwestern prisons. Men reported that their perpetrators in worst-case incidents were inmates (72%), staff (8%), or inmates and staff collaborating (12%). Women reported that their perpetrators were inmates (47%) and staff (41%). Greater percentages of men (70%) than women (29%) reported that their incident resulted in oral, vaginal, or anal sex. More men (54%) than women (28%) reported an incident that was classified as rape. Men and women were similar in feeling depression; however, more men (37%) than women (11%) reported suicidal thoughts and suicide attempts (19% for men, 4% for women). Implications of results for prevention of sexual coercion in prison are discussed.

Hospital doctors' views of their CPD and its relationship to learning in the organization.

Continuing professional development (CPD) has traditionally been an autonomous, professional concern of doctors in the UK. In a changing educational and service climate, can individualized approaches to CPD be reconciled with adult learning principles and learning that is practice-based and multidisciplinary? A survey of the CPD of consultant and non-consultant career grade staff in Wales (UK) has provided some clues on how doctors perceive their learning needs in relation to those of Trust hospitals. It indicated that these doctors pursued traditional forms of continuing education (reading, lectures and meetings), gained clinical knowledge and changed their practice as a result. The majority saw themselves as accountable for CPD to their college and specialty. Trusts had yet to promote CPD as a clinical governance priority but respondents felt that appraisal helped to mediate individual and organizational perspectives of CPD. Most career-grade doctors believed their CPD activities met the needs of their employing organizations and felt satisfied with a 'traditional' approach to CPD. Doctors and service organizations may need to confront preconceptions regarding education and respective roles in the negotiation of CPD if team-based learning in practice is to become established.

An examination of sexual strategies used by urban Southern and rural Midwestern university women.

The purposes of this study were (a) to determine whether women's use of persuasion, non-physical coercion, and physical force strategies to obtain sex from a man varied between U.S. women from an urban Southern and rural Midwestern university and (b) to determine if sexual behavior history and early courtship behavior affected the use of these strategies (or not using any strategy). Women from the Midwest and the South did not differ in their use of sexual strategies. There were, however other variables that accounted for differences in women's use of sexual strategies. Women who used persuasion strategies had fewer lifetime sexual partners than women who used any other strategy. Women who used physical force strategies reported a lower age at first intercourse and more early courtship behaviors than all others. Overall, the results indicated that sexual strategies are related to sexual behavior history and early courtship behaviors rather than cultural setting or demographics.

Tactics of sexual coercion: when men and women won't take no for an answer.

We investigated women's and men's reports of experiencing and using tactics of postrefusal sexual persistence, defined as persistent attempts to have sexual contact with someone who has already refused. Participants were 275 men and 381 women at Midwestern and Southern universities. More women (78%) than men (58%) reported having been subjected to such tactics since age 16; this difference was significant for the categories of sexual arousal, emotional manipulation and lies, and intoxication, and for two tactics within the physical force category (physical restraint and threats of harm). More men (40%) than women (26%) reported having used such tactics; this difference was significant for the sexual arousal, emotional manipulation and lies, and intoxication categories. We present participants' written descriptions of their experiences.

Sexual coercion reported by women in three midwestern prisons.

The study was an anonymous self-report survey of coercive sexual experiences of women incarcerated in three Midwestern prisons. Inmate populations were 295 (Facility 1), 113 (Facility 2) and 60 (Facility 3). Return rates were over 50%. Some prison staff were also surveyed. The 150 inmates in Facility 1 reported relatively high rates of sexual coercion: 27% had been coerced in the state system and 19% in their present facility. The 80 inmates in Facility 1 and 36 inmates in Facility 3 reported lower rates: 8% to 9% for prisons statewide and 6% to 8% for their present facility. One half of the perpetrators were females. Most incidents involved genital touching. About one fifth of the incidents were classifiable as rape. We concluded that the prison environment potentially fosters female sexual aggression among inmates and sexual exploitation by staff.