Traumatic Thoracic Aortic Coarctation after Blunt Thoracic Aortic Injury Mandates Emergent Thoracic Endovascular Aortic Repair.

OBJECTIVE: This study sought to elucidate clinical and imaging findings predictive for malperfusion syndrome after blunt thoracic aortic injury (BTAI). SUMMARY BACKGROUND DATA: There is limited literature on malperfusion syndrome after BTAI and the timing of thoracic endovascular aortic repair (TEVAR) in patients with this condition has not been defined. METHODS: A retrospective analysis of prospectively collected data of patients with BTAI treated between January 2021 and October 2023. Clinical and thoracic aortic (TA) imaging data, time to TEVAR, in-hospital death, and malperfusion/reperfusion sequelae (paraplegia, renal/visceral/limb ischemia, and compartment syndromes) were assessed. Correlations between clinical and imaging findings, time to TEVAR, and outcomes were evaluated. RESULTS: Of the 19,203 trauma patients evaluated, 13,717 (71%) had blunt injuries and 77 (0.6%) had BTAI. The majority (67.5%) were male with a median age of 40 years (IQR:33-55). TEVAR was performed in 42 (54.5%) patients. Seven (9.1%) patients presented with clinical and TA imaging criteria for traumatic thoracic aortic coarctation (TTAC), including diminished/absent femoral pulses and TA luminal narrowing of 50-99%. The median time to TEVAR was 9 (IQR:5-32), 11, and 4 hours for all non-TTAC and TTAC BTAI patients, respectively (P=0.037). Only TTAC patients presented/developed malperfusion/reperfusion sequelae. In-hospital mortality rates were 7.8%, 5.8%, and 29% for all non-TTAC and TTAC BTAI patients, respectively (P=0.09). Aortic-related mortality occurred in only two (2.6%) TTAC patients.. CONCLUSIONS: Patients with clinical and TA imaging manifestations of TTAC are predisposed to malperfusion/reperfusion sequelae if TEVAR is delayed. We recommend the emergent repair of all BTAIs with TTAC.

Comparative efficacy of the relationship checkup for same-gender couples.

Same-gender couples face unique sexual minority stressors that significantly impact individual and relationship health. This impact may be even greater among same-gender couples living in regions where there are pervasive social and legal biases that affect the lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, two-spirit (LGBTQIA2S+) community (e.g., south central Appalachia). Brief relationship interventions, like the relationship checkup, are effective at improving relationship health and can be widely disseminated due to the brief and flexible nature of the program. Yet, this program was developed for different-gender couples and, as a result, may lack specific intervention for the unique stressors of same-gender couples. While many skills delivered in relationship interventions, including the relationship checkup, are applicable to all couples, untailored interventions for same-gender couples may result in less impactful outcomes. The present study examined whether the relationship checkup, in its original, unadapted format, is as effective for same-gender couples as it is for different-gender couples. Using a subsample from the larger relationship checkup study (N = 656 couples), the present sample included 64 committed couples (same-gender = 32; different-gender = 32). We used propensity score matching to match different-gender participants to the same-gender participants based on racial minority status, poverty status, marital status, and parenting status. Results revealed that same-gender couples presented similarly to different-gender couples on baseline relationship functioning and changed similarly on all relationship functioning outcomes through 1-month postintervention. Same-gender couples also reported similar degrees of satisfaction with and perceived helpfulness of the relationship checkup. The relationship checkup appears to be equally effective and acceptable for same-gender and different-gender couples. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Risk Factors for Venous Thromboembolism and Eventual Amputation in Traumatic Femoral and Iliac Vein Injuries: A Trauma Quality Improvement Program Analysis.

BACKGROUND: Iliac and femoral venous injuries represent a challenging dilemma in trauma surgery with mixed results. Venous restoration of outflow (via repair or bypass) has been previously identified as having higher rates of VTE (venous thromboembolism) compared to ligation. We hypothesized that rates of VTE and eventual amputation were similar whether restoration of venous outflow vs ligation was performed at initial operation. METHODS: Patients in the 2019-2021 National Trauma Data Bank with iliac and femoral vein injuries were abstracted and analyzed. The primary outcomes of interest were in-hospital lower extremity amputation and VTE. RESULTS: A total of 2642 patients with operatively managed iliac and femoral vein injuries were identified VTE was found in 10.8% of patients. Multivariable logistic regression was performed and identified bowel injury, higher ISS, older age, open repair, and longer time to VTE prophylaxis initiation as independent predictors of VTE. Amputation was required in 4.2% of patients. Multivariable logistic regression identified arterial or nerve injury, femur or tibia fracture, venous ligation, percutaneous intervention, fasciotomy, bowel injury, and higher ISS as independent factors of amputation. CONCLUSION: Venous restoration was not an independent predictor of VTE. Venous ligation on index operation was the only modifiable independent predictor of amputation identified on regression analysis.

Accreditation Council for Graduate Medical Education Milestone Training Ratings and Surgeons' Early Outcomes.

Importance: National data on the development of competence during training have been reported using the Accreditation Council for Graduate Medical Education (ACGME) Milestones system. It is now possible to consider longitudinal analyses that link Milestone ratings during training to patient outcomes data of recent graduates. Objective: To evaluate the association of in-training ACGME Milestone ratings in a surgical specialty with subsequent complication rates following a commonly performed operation, endovascular aortic aneurysm repair (EVAR). Design, Setting, and Participants: This study of patient outcomes followed EVAR in the Vascular Quality Initiative (VQI) registry (4213 admissions from 208 hospitals treated by 327 surgeons). All surgeons included in this study graduated from ACGME-accredited training programs from 2015 through 2019 and had Milestone ratings 6 months prior to graduation. Data were analyzed from December 1, 2021, through September 15, 2023. Because Milestone ratings can vary with program, they were corrected for program effect using a deviation score from the program mean. Exposure: Milestone ratings assigned to individual trainees 6 months prior to graduation, based on judgments of surgical competence. Main Outcomes and Measures: Surgical complications following EVAR for patients treated by recent graduates during the index hospitalization, obtained using the nationwide Society for Vascular Surgery Patient Safety Organization's VQI registry, which includes 929 participating centers in 49 US states. Results: The study included outcomes for 4213 patients (mean [SD] age, 73.25 [8.74] years; 3379 male participants [80.2%]). Postoperative complications included 9.5% major (400 of 4213 cases) and 30.2% minor (1274 of 4213 cases) complications. After adjusting for patient risk factors and site of training, a significant association was identified between individual Milestone ratings of surgical trainees and major complications in early surgical practice in programs with lower mean Milestone ratings (odds ratio, 0.50; 95% CI; 0.27-0.95). Conclusions and Relevance: In this study, Milestone assessments of surgical trainees were associated with subsequent clinical outcomes in their early career. Although these findings represent one surgical specialty, they suggest Milestone ratings can be used in any specialty to identify trainees at risk for future adverse patient outcomes when applying the same theory and methodology. Milestones data should inform data-driven educational interventions and trainee remediation to optimize future patient outcomes.

Improvements in depressive symptoms following a brief relationship intervention.

In the United States, 21 million adults are diagnosed with depression. Couple therapy effectively treats depression, however, couples encounter access barriers. The Relationship Checkup is an assessment and feedback intervention delivered in participants' homes. The current study examines changes in relationship satisfaction and depressive symptoms, and moderators and mechanisms of change in a community sample (N = 85 couples). Changes in depressive symptoms and satisfaction, and the association between changes in satisfaction and depressive symptoms were examined with multilevel modeling. Depressive symptoms (Cohen's d = 0.36) and satisfaction (d = 1.43) improved from baseline to 1-month follow-up, with greater declines in depression (d = 0.44) for those with more severe symptoms. Increases in satisfaction were associated with decreases in depressive symptoms (d = 0.23), and decreases in depressive symptoms were associated with increases in satisfaction (d = 0.33). Individuals with depression and relationship distress may be well served by this intervention.

Trust but Verify? Utility of Intraoperative Angiography After Revascularization for Vascular Trauma.

BACKGROUND: Trauma surgical dogma teaches that patients should have intraoperative angiography (IA) if the surgeon cannot identify a pulse in the injured extremity following a vascular repair. This study was undertaken to assess the utility of IA in trauma patients who underwent open brachial or femoral artery revascularization. METHODS: Retrospective analysis of the Prospective Observational Vascular Injury Trial (PROOVIT) database from 2013 to 2021 evaluated patients >15 years with penetrating or blunt injuries requiring operative intervention of the brachial, superficial femoral, or common femoral arteries. Prospective Observational Vascular Injury Trial data evaluated included documented pulse in the injured extremity at revascularization completion, adjunctive IA, immediate revision, and vascular reintervention during the hospitalization. RESULTS: Of the 5057 patients with vascular injury, 185 patients met our inclusion criteria. The majority were male (86.5%) with a median age, injury severity score, and systolic blood pressure of 29, 12, and 117, respectively. Of the study patients, 39% underwent IA, 14% had immediate revision, and 8% required vascular reoperation during their admission. Patients who underwent IA and with no documented palpable pulse after repair were significantly more likely to require immediate revision before leaving the operating room (22% vs 9%, P = .013) and were not more likely to require reoperation, than those who did not undergo IA (7% vs 9%, P = .613). CONCLUSIONS: Intraoperative angiography is a valuable tool for surgeons for vascular extremity trauma and is associated with a greater rate of immediate revision. Familiarity with angiographic technique is essential for vascular trauma and should be a focal point of training.

Management of Traumatic Radial and Ulnar Artery Injuries and Risk Factors for Amputation.

INTRODUCTION: Traumatic injuries to the radial and/or ulnar arteries represent a subset of arterial injuries. In the absence of injury to both forearm arteries, treatment was historically ligation if perfusion was maintained to the hand via the uninjured vessels or adequate collateral vessels. We sought to determine management of traumatic forearm arterial injuries in 2019 and to identify risk factors for major upper extremity amputation. METHODS: The American College of Surgeons Trauma Quality Improvement Program database was queried by International Classification of Diseases 10 code for patients with traumatic radial and/or ulnar artery injuries within the year 2019. Patient demographics, Injury Severity Score, time to operating room, type of repair, outcomes, and mortality were collected. Multivariable logistic regression was used to identify risk factors for major upper extremity amputation. RESULTS: A total of 4048 patients with traumatic radial and/or ulnar artery injuries were identified. A total of 1907 radial artery operations were performed including repair (59%), ligation (29%), and interposition bypass (12%). A total of 1637 ulnar artery operations were completed including repair (67%), ligation (21%), and interposition bypass (12%). Major upper extremity amputation occurred in 0.6%. Older age (adjusted odds ratio [AOR]: 1.014, 95% confidence interval [CI]: 1.004-1.024, P = 0.0048), blunt mechanism (AOR: 2.457, 95% CI: 1.730-3.497, P < 0.0.0001), and ipsilateral radial and ulnar artery injury (AOR: 2.148, 95% CI: 1.298-3.553, P = 0.0029) were associated with major amputation. Surgical revascularization, time to operating room, fasciotomy, and compartment syndrome were not associated with major amputation, but this may be secondary to Type II error. CONCLUSIONS: In the operating room, radial and ulnar artery injuries were managed more often with restoration of flow versus ligation. Older age, blunt mechanism, and ipsilateral radial and ulnar artery injury were associated with major amputation. Amputation rate was low at 3% overall and 0.6% for amputation of the hand or a more proximal level. Upper extremity fracture, upper extremity nerve injury, and ipsilateral radial and ulnar artery injury were associated with need for revision operation.

Effects of online relationship programs for low-income couples during the perinatal period.

Low-income couples experience increased stress and declines in relationship quality during the perinatal period. They also encounter many barriers to accessing relationship services. Using a subsample of low-income perinatal couples (n = 180) from two randomized controlled trials, the current study examined the impact of online relationship interventions, OurRelationship (OR) and ePREP, in a Bayesian framework. From pre to post, relative to waitlist control couples, couples in OR and ePREP experienced improvements in relationship quality (Mean d = 0.51) and psychological distress (Mean d = 0.28); OR couples, relative to waitlist control couples, also experienced improvements in perceived stress (Mean d = 0.33). These improvements were maintained through four-month follow-up and did not differ across gender. These findings suggest brief online relationship interventions may be an important resource for low-income perinatal couples.

A special section: Recruiting and retaining couples from underrepresented backgrounds in intervention research.

This special section represents a collection of papers on recruitment and retention of couples from underrepresented backgrounds in couple intervention research. Research shows that couples from underrepresented backgrounds tend to be missing from intervention research. This gap is concerning; conclusions about the effectiveness of these interventions are not being drawn from diverse and representative samples and it may be that scholars are inadvertently creating inappropriate and inaccessible services for these couples. Recruiting and retaining these couples require specialized efforts and attention. In this summary paper, we describe (a) the origins of this special section, (b) the existing research on recruitment and retention in couple intervention research, (c) an overview of the papers in this special section, and (d) future recommendations and directions for this aspect of methodology in couple research. This collection of papers elevates the need to involve community members from the beginning, reduce barriers to access, and create recruitment materials and a service delivery environment that is specific for the target population.

Simulation of the VUV Absorption Spectra of Oxygenates and Hydrocarbons: A Joint Theoretical-Experimental Study.

Vacuum UV absorption spectroscopy is regularly used to provide unambiguous identification of a target species, insight into the electronic structure of molecules, and quantitative species concentrations. As molecules of interest have become more complex, theoretical spectra have been used in tandem with laboratory spectroscopic analysis or as a replacement when experimental data is unavailable. However, it is difficult to determine which theoretical methodologies can best simulate experiment. This study examined the performance of EOM-CCSD and 10 TD-DFT functionals (B3LYP, BH&HLYP, BMK, CAM-B3LYP, HSE, M06-2X, M11, PBE0, ωB97X-D, and X3LYP) to produce reliable vacuum UV absorption spectra for 19 small oxygenates and hydrocarbons using vertical excitation energies. The simulated spectra were analyzed against experiment using both a qualitative analysis and quantitative metrics, including cosine similarity, relative integral change, mean signed error, and mean absolute error. Based on our ranking system, it was determined that M06-2X was consistently the top performing TD-DFT method with BMK, CAM-B3LYP, and ωB97X-D also producing reliable spectra for these small combustion species.

The Use of Learning Analytics to Enable Detection of Underperforming Trainees: An Analysis of National Vascular Surgery Trainee ACGME Milestones Assessment Data.

OBJECTIVE: This study aims to investigate at-risk scores of semiannual Accreditation Council for Graduate Medical Education (ACGME) Milestone ratings for vascular surgical trainees' final achievement of competency targets. SUMMARY BACKGROUND DATA: ACGME Milestones assessments have been collected since 2015 for Vascular Surgery. It is unclear whether milestone ratings throughout training predict achievement of recommended performance targets upon graduation. METHODS: National ACGME Milestones data were utilized for analyses. All trainees completing 2-year vascular surgery fellowships in June 2018 and 5-year integrated vascular surgery residencies in June 2019 were included. A generalized estimating equations model was used to obtain at-risk scores for each of the 31 subcompetencies by semiannual review periods, to estimate the probability of trainees achieving the recommended graduation target based on their previous ratings. RESULTS: A total of 122 vascular surgery fellows (VSFs) (95.3%) and 52 integrated vascular surgery residents (IVSRs) (100%) were included. VSFs and IVSRs did not achieve level 4.0 competency targets at a rate of 1.6% to 25.4% across subcompetencies, which was not significantly different between the 2 groups for any of the subcompetencies ( P = 0.161-0.999). Trainees were found to be at greater risk of not achieving competency targets when lower milestone ratings were assigned, and at later time-points in training. At a milestone rating of 2.5, with 1 year remaining before graduation, the at-risk score for not achieving the target level 4.0 milestone ranged from 2.9% to 77.9% for VSFs and 33.3% to 75.0% for IVSRs. CONCLUSION: The ACGME Milestones provide early diagnostic and predictive information for vascular surgery trainees' achievement of competence at completion of training.

University-church partnerships: A mechanism to enhance relationship health.

Romantic relationship distress leads to decreased satisfaction and dissolution. While therapy is effective for helping distressed couples, it is often inaccessible due to cost, time, and childcare barriers. Churches are often able to offer lower-cost services and provide childcare. In partnership with a network of local churches, university staff trained lay leaders to deliver an evidence-based relationship education program and collected data from 97 couples to evaluate pre- to post-workshop changes in couple functioning. Multilevel modeling was used to examine changes from pre- to post-workshop and thematic analysis was used to analyze open-ended feedback responses. Results showed improvements in communication, relationship satisfaction, commitment, and intimacy safety, with the largest effect found for communication. Participants also reported improved communication skills were one of the most beneficial parts of the program. Through the partnership with a university, churches can offer and rigorously evaluate evidence-based programs to strengthen couple relationships in their communities.

Predicting Performance at Graduation From Early ACGME Milestone Ratings: Longitudinal Learning Analytics in Professionalism and Communication in Vascular Surgery.

OBJECTIVE: Program directors in surgical disciplines need more tools from the ACGME to help them use Milestone ratings to improve trainees' performance. This is especially true in competencies that are notoriously difficult to measure, such as professionalism (PROF) and interpersonal and communication skills (ICS). It is now widely understood that skills in these two areas have direct impact on patient care outcomes. This study investigated the potential for generating early predictors of final Milestone ratings within the PROF and ICS competency categories. DESIGN: This retrospective cohort study utilized Milestone ratings from all ACGME-accredited vascular surgery training programs, covering residents and fellows who completed training in June 2019. The outcome measure studied was the rate of achieving the recommended graduation target of Milestone Level 4 (possible range: 1-5), while the predictors were the Milestone ratings attained at earlier stages of training. Predictive probability values (PPVs) were calculated for each of the 3 PROF and two ICS sub-competencies to estimate the probability of trainees not reaching the recommended graduation target based on their previous Milestone ratings. SETTING: All ACGME-accredited vascular surgery training programs within the United States. PARTICIPANTS: All trainees completing a 2 year vascular surgery fellowship (VSF) in June 2019 (n = 119) or a 5 year integrated vascular surgery residency (IVSR) in June 2019 (n = 52) were included in the analyses. RESULTS: The overall rate of failing to achieve the recommended graduation target across all PROF and ICS sub-competencies ranged from 7.7% to 21.8% of all trainees. For trainees with a Milestone rating at ≤ 2.5 with 1 year remaining in their training program, the predictive probability of not achieving the recommended graduation target ranged from 37.0% to 71.5% across sub-competencies, with the highest risks observed under PROF for "Administrative Tasks" (71.5%) and under ICS for "Communication with the Healthcare Team" (56.7%). CONCLUSIONS: As many as 1 in 4 vascular surgery trainees did not achieve the ACGME vascular surgery Milestones targets for graduation in at least one of the PROF and ICS sub-competencies. Biannual ACGME Milestone assessment ratings of PROF and ICS during early training can be used to predict achievement of competency targets at time of graduation. Early clues to problems in PROF and ICS enable programs to address potential deficits early in training to ensure competency in these essential non-technical skills prior to entering unsupervised practice.

Application of Multiconfiguration Pair-Density Functional Theory to the Diels-Alder Reaction.

Transition states for Diels-Alder reactions are strongly correlated, as evidenced by high-to-very-high M diagnostics, and therefore they require treatment by multireference methods. Multiconfiguration pair-density functional theory (MC-PDFT) combines a multiconfiguration wave function with a functional of the electron density and the on-top pair density to calculate the electronic energy for strongly correlated systems at a much lower cost than wave function methods that do not employ density functionals. Here we apply MC-PDFT to the Diels-Alder cycloaddition reaction of 1,3-butadiene with ethylene, where two kinds of reaction paths have been widely studied: concerted synchronous paths and diradical stepwise paths. The lowest-energy reaction path is now known to be a concerted synchronous one, and a method's ability to predict this is an important test. By comparison to the best available theoretical results in the literature, we test the accuracy of MC-PDFT with several choices of on-top functional for geometries and enthalpies of stable structures along both paths and for the transition state geometries. We also calculate the Arrhenius activation energies for both paths and compare these to experiment. We also compare to Kohn-Sham density functional theory (KS-DFT) with selected exchange-correlation functionals. CAS-PDFT gives consistently good energies and geometries for both the concerted and stepwise mechanisms, but none of the KS-DFT functionals gives accurate activation energies for both. The stepwise transition state is very strongly correlated, and MC-PDFT can treat it, but KS-DFT (which involves a single-configuration treatment) has larger errors. The results confirm that using a multiconfigurational reference function for strongly correlated transition states can significantly improve the reliability and that MC-PDFT can provide good accuracy at a much lower computational cost than competing multireference methods.

Is mindfulness one-size-fits-all?: Consulting community members and stakeholders to adapt mindfulness for communities with low-income and economic marginalization.

BACKGROUND AND PURPOSE: Although stress is pertinent to all people, individuals with low-income and economic marginalization (LIEM) tend to experience greater psychosocial stressors as well as different relationship stressors than individuals with higher income. While mindfulness may be a particularly useful tool for individuals with LIEM, it has yet to be adapted for this community. Using a community-based participatory research (CBPR) approach, the present study conducted focus groups with community members with LIEM to identify effective dissemination strategies. MATERIALS AND METHODS: Thirteen individuals with LIEM were recruited to participate in one of two focus groups. The focus groups collected information on how individuals with LIEM cope with stress, how these individuals perceive mindfulness, and how to reduce barriers to participating in a brief mindfulness intervention for stress. Focus groups were transcribed and coded by four coders using thematic analysis within a grounded theory framework. RESULTS: Twelve themes were identified: movement-based coping, behavioral/tactile coping, interest in mindfulness, familiarity with mindfulness, tangible mindfulness, narrow understanding of practicing mindfulness, relaxing, affiliation, alliance with healthcare facility, storytelling, breaking bread, and mental health treatment stigma. CONCLUSION: Themes derived from the focus groups were discussed with community stakeholders. Findings from this study informed clinical considerations for using mindfulness with individuals with LIEM.

Expert consensus on the conceptual alignment of Accreditation Council for Graduate Medical Education competencies with patient outcomes after common vascular surgical procedures.

BACKGROUND: The quality and effectiveness of vascular surgery education should be evaluated based on patient care outcomes. To investigate predictive associations between trainee performance and subsequent patient outcomes, a critical first step is to determine the conceptual alignment of educational competencies with clinical outcomes in practice. We sought to generate expert consensus on the conceptual alignment of the Accreditation Council for Graduate Medical Education (ACGME) Vascular Surgery subcompetencies with patient care outcomes across different Vascular Quality Initiative (VQI) registries. METHODS: A national panel of vascular surgeons with expertise in both clinical care and education were recruited to participate in a modified Delphi expert consensus building process to map ACGME Vascular Surgery subcompetencies (educational markers of resident performance) to VQI clinical modules (patient outcomes). A master list of items for rating was created, including the 31 ACGME Vascular Surgery subcompetencies and 8 VQI clinical registries (endovascular abdominal aortic aneurysm repair, open abdominal aortic aneurysm, thoracic endovascular aortic repair, carotid endarterectomy, carotid artery stent, infrainguinal, suprainguinal, and peripheral vascular intervention). These items were entered into an iterative Delphi process. Positive consensus was reached when 75% or more of the participants ranked an item as mandatory. Intraclass correlations (ICCs) were used to evaluate consistency between experts for each Delphi round. RESULTS: A total of 13 experts who contributed to the development of the Vascular Surgery Milestones participated; 12 experts (92%) participated in both rounds of the Delphi process. Two rounds of Delphi were conducted, as suggested by excellent expert agreement (round 1, ICC = 0.79 [95% confidence interval, 0.74-0.84]; round 2, ICC = 0.97 [95% confidence interval, 0.960-.98]). Using the predetermined consensus cutoff threshold, the Delphi process reduced the number of subcompetencies mapped to patient care outcomes from 31 to a range of 9 to 15 across the 8 VQI clinical registries. Practice-based learning and improvement, and professionalism subcompetencies were identified as less relevant to patient outcome variables captured by the VQI registries after the final round, and the only the systems-based practice subcompetency that was identified as relevant was radiation safety in two of the endovascular registries. CONCLUSIONS: A national panel of vascular surgeon experts reported a high degree of agreement on the relevance of ACGME subcompetencies to patient care outcomes as captured in the VQI clinical registry. Systems-based practice, practice-based learning and improvement, and professionalism competencies were identified as less relevant to patient outcomes after specific surgical procedures.

Couple variables predicting retention in a brief intervention and research.

Therapy is an effective form of treatment for couple distress; yet, research shows that 20%-60% of couples terminate treatment prematurely. Predictors of couple retention in therapy and research are unclear, particularly for couples from marginalized populations, which has important implications for the quality and generalizability of research results, and the benefits derived from therapy are limited when participants are not retained. The purpose of this study (N = 1310) was to identify couple-level variables that predict (1) retention in a brief, two-session couple intervention (The Relationship Checkup) delivered as a home visitation program and (2) retention in research participation at 1- and 6-month follow-up. Hypotheses were tested using a two-level multi-level model. Couples are significantly less likely to be retained in the brief intervention if (1) at least one partner identifies as Asian, Pacific Islander, or Native American, (2) at least one partner identifies as Hispanic/Latinx, or (3) both partners report mental or emotional health as a concern in their relationship. Couples are significantly less likely to be retained in research if (1) at least one partner identifies as Asian, Pacific Islander, or Native American (1 month only), (2) at least one partner identifies as Hispanic/Latinx (1 and 6 months), (3) if either partner reports clinically significant relationship distress at baseline (1 and 6 months), or (4) if either partner reports relationship aggression at baseline (6 months only). These findings are discussed with relevance to clinicians and researchers to recruit and retain more diverse and marginalized participants in couple interventions and follow-up research.

Affair recovery: Exploring similarities and differences of injured and involved partners.

Infidelity is associated with negative effects on couples' relationships, yet some couples are able to overcome these and rebuild their relationship. Few studies have examined this process for couples who stay together after an affair. With a sample of 18 individuals (nine couples), this study explored similarities and differences between injured (i.e., partner who did not have the affair) and involved (i.e., partner who had the affair) partners' experiences across three categories of affair recovery: (a) commitment to the relationship, (b) dimensions of the attachment bond, and (c) healing process. Thematic analysis revealed similarities amongst both partners across categories: (a) frequent and quality communication, (b) mechanisms for rebuilding safety and trust, and (c) the importance of forgiveness. However, partners' experiences varied regarding (a) responses to needs for comfort, (b) their sexual relationship, and (c) responding to reminders. A discussion of these key findings and clinical implications are included.

A gender-based analysis of predictors and sequelae of burnout among practicing American vascular surgeons.

OBJECTIVE: Surgeons report higher burnout and suicidal ideation (SI) rates than the general population. This study sought to identify the prevalence and gender-specific risk factors for burnout and SI among men and women vascular surgeons to guide future interventions. METHODS: In 2018, active Society for Vascular Surgery members were surveyed confidentially using the Maslach Burnout Index embedded in a questionnaire that captured demographic and practice-related characteristics. Results were stratified by gender. Univariate and multivariate logistic regression models were developed to identify predictors for the end points of burnout and SI. RESULTS: Overall survey response rate was 34.3% (N = 878) of practicing vascular surgeons. A higher percentage of women responded (19%) than compose membership in the Society for Vascular Surgery (13.7%). Women respondents were significantly younger, with fewer years in practice, and were less likely to be in private practice than the men who responded. Women were also less likely to be married/partnered, or to have children. The prevalence of burnout was similar for women and men (42.3% and 40.9%; P = nonsignificant); however, the prevalence of SI was significantly higher in women (12.9% vs 6.6%; P < .007). Whereas there was no difference in mean hours worked or call taken, women were more likely to have had a recent conflict between work and home responsibilities and to have resolved this conflict in favor of work. Although men and women had the same incidence of reported recent medical errors, women were less likely to self-report a recent malpractice suit or to think that a fair resolution was reached. There was no gender difference in reported work-related pain. Multivariable analysis revealed that not enough family time and work-related pain were predictors for burnout in both men and women. Additional factors were associated with burnout in men, such as malpractice and electronic medical record dissatisfaction. Multivariable analysis revealed that work-related pain was an independent predictor for SI for the entire cohort. CONCLUSIONS: The prevalence of burnout among vascular surgeons is high. Women vascular surgeons have double the rates of SI compared with male vascular surgeons. Taken together, this study demonstrated that many of the same factors are associated with burnout in women and men, which include not enough family time, conflict between work and personal life, and work-related pain. Additional factors in men included conflict between work and family, work-related pain, and electronic medical record dissatisfaction.