Machine Learning to Predict Outcomes of Endovascular Intervention for Patients With PAD.

Importance: Endovascular intervention for peripheral artery disease (PAD) carries nonnegligible perioperative risks; however, outcome prediction tools are limited. Objective: To develop machine learning (ML) algorithms that can predict outcomes following endovascular intervention for PAD. Design, Setting, and Participants: This prognostic study included patients who underwent endovascular intervention for PAD between January 1, 2004, and July 5, 2023, with 1 year of follow-up. Data were obtained from the Vascular Quality Initiative (VQI), a multicenter registry containing data from vascular surgeons and interventionalists at more than 1000 academic and community hospitals. From an initial cohort of 262 242 patients, 26 565 were excluded due to treatment for acute limb ischemia (n = 14 642) or aneurysmal disease (n = 3456), unreported symptom status (n = 4401) or procedure type (n = 2319), or concurrent bypass (n = 1747). Data were split into training (70%) and test (30%) sets. Exposures: A total of 112 predictive features (75 preoperative [demographic and clinical], 24 intraoperative [procedural], and 13 postoperative [in-hospital course and complications]) from the index hospitalization were identified. Main Outcomes and Measures: Using 10-fold cross-validation, 6 ML models were trained using preoperative features to predict 1-year major adverse limb event (MALE; composite of thrombectomy or thrombolysis, surgical reintervention, or major amputation) or death. The primary model evaluation metric was area under the receiver operating characteristic curve (AUROC). After selecting the best performing algorithm, additional models were built using intraoperative and postoperative data. Results: Overall, 235 677 patients who underwent endovascular intervention for PAD were included (mean [SD] age, 68.4 [11.1] years; 94 979 [40.3%] female) and 71 683 (30.4%) developed 1-year MALE or death. The best preoperative prediction model was extreme gradient boosting (XGBoost), achieving the following performance metrics: AUROC, 0.94 (95% CI, 0.93-0.95); accuracy, 0.86 (95% CI, 0.85-0.87); sensitivity, 0.87; specificity, 0.85; positive predictive value, 0.85; and negative predictive value, 0.87. In comparison, logistic regression had an AUROC of 0.67 (95% CI, 0.65-0.69). The XGBoost model maintained excellent performance at the intraoperative and postoperative stages, with AUROCs of 0.94 (95% CI, 0.93-0.95) and 0.98 (95% CI, 0.97-0.99), respectively. Conclusions and Relevance: In this prognostic study, ML models were developed that accurately predicted outcomes following endovascular intervention for PAD, which performed better than logistic regression. These algorithms have potential for important utility in guiding perioperative risk-mitigation strategies to prevent adverse outcomes following endovascular intervention for PAD.

Association between CFTR modulators and changes in iron deficiency markers in cystic fibrosis.

BACKGROUND: Iron deficiency (ID) is a common extrapulmonary manifestation in cystic fibrosis (CF). CF transmembrane conductance regulator (CFTR) modulator therapies, particularly highly-effective modulator therapy (HEMT), have drastically improved health status in a majority of people with CF. We hypothesize that CFTR modulator use is associated with improved markers of ID. METHODS: In a multicenter retrospective cohort study across 4 United States CF centers 2012-2022, the association between modulator therapies and ID laboratory outcomes was estimated using multivariable linear mixed effects models overall and by key subgroups. Summary statistics describe the prevalence and trends of ID, defined a priori as transferrin saturation (TSAT) <20 % or serum iron <60 µg/dL (<10.7 µmol/L). RESULTS: A total of 568 patients with 2571 person-years of follow-up were included in analyses. Compared to off modulator therapy, HEMT was associated with +8.4 % TSAT (95 % confidence interval [CI], +6.3-10.6 %; p < 0.0001) and +34.4 µg/dL serum iron (95 % CI, +26.7-42.1 µg/dL; p < 0.0001) overall; +5.4 % TSAT (95 % CI, +2.8-8.0 %; p = 0.0001) and +22.1 µg/dL serum iron (95 % CI, +13.5-30.8 µg/dL; p < 0.0001) in females; and +11.4 % TSAT (95 % CI, +7.9-14.8 %; p < 0.0001) and +46.0 µg/dL serum iron (95 % CI, +33.3-58.8 µg/dL; p < 0.0001) in males. Ferritin was not different in those taking modulator therapy relative to off modulator therapy. Hemoglobin was overall higher with use of modulator therapy. The prevalence of ID was high throughout the study period (32.8 % in those treated with HEMT). CONCLUSIONS: ID remains a prevalent comorbidity in CF, despite availability of HEMT. Modulator use, particularly of HEMT, is associated with improved markers for ID (TSAT, serum iron) and anemia (hemoglobin).

Exploring false negatives in self-reported trauma exposure status.

INTRODUCTION: Trauma exposure is often assessed using checklists such as the Life Events Checklist for DSM-5 (LEC-5; Weathers et al., 2013b). When participants endorse multiple events, respondents are asked to identify a single, worst event (i.e., index event). Recent work indicates that the "worst event" method leads to a concerning number of false negatives. The purpose of the current study was to replicate previous findings of false negatives and extend them by examining characteristics associated with false negatives, such as trauma type, means of exposure, recency of trauma, and posttraumatic stress disorder (PTSD) symptom severity. METHOD: Adults (n = 476) provided data on trauma history assessed using a revised version of the LEC-5 that asked participants to provide follow-up information for each traumatic event endorsed. Participants also provided demographic data and completed the PTSD Checklist for DSM-5. Results: Two hundred thirty-four participants (49.16%) reported a worst event that met the DSM-5 definition of Criterion A trauma ("primary Criterion A" group). However, of the 242 participants who did not, 138 participants (57.02%, or 28.99% of the total sample) reported a secondary event that did meet Criterion A ("secondary Criterion A" group). The secondary Criterion A group most commonly reported serious life-threatening illnesses/injuries and "other" stressful life experiences as their index trauma that did not fulfill Criterion A. Participants in the primary and secondary Criterion A groups reported similar levels of PTSD symptoms. No differences were observed in means of exposure and recency of index trauma between the Criterion A groups. DISCUSSION: Findings raise questions regarding the efficiency and accuracy of the worst event method to determine trauma exposure status via self-report. Researchers should consider alternative methods for assessing trauma exposure rather than relying on the worst event scoring method. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Social Media's Impact on Rape Myth Acceptance and Negative Affect in College Women: Examining the #MeToo and #HimToo Movement.

This study examined how the #MeToo movement, and backlash against it (#HimToo), influence rape myth acceptance (RMA) and negative affect among female sexual trauma survivors and controls. We randomly assigned college women (N = 389) to three social media conditions that either promoted RMA (#HimToo), challenged RMA (#MeToo), or did not address rape myths (general social media (GSM)). The findings demonstrated that women in the #HimToo condition reported more RMA, whereas women in the #MeToo and GSM conditions reported less negative affect. The results highlight that the way we talk about rape on social media influences momentary affect and RMA.

Adjuvant intraluminal therapies for upper tract urothelial carcinoma.

Upper urinary tract urothelial carcinomas (UTUCs) are often identified and first treated endoscopically. After proper risk stratification, adjuvant treatment may be recommended. Consequently, as adjuvant therapy becomes more common place in the oncological armamentarium, we seek to better characterize its existing and future therapeutic landscape. In this article, we present an overview of the most up-to-date information about intracavitary instillations as an adjuvant therapy in the context of UTUC. We reviewed the current literature on the epidemiology, disease characteristics, treatment, and outcomes of UTUC with a particularly focus on intraluminal adjuvant therapy for UTUC. This review provides a comprehensive overview of the most recent available data regarding adjuvant therapies used for UTUC. Intraluminal therapy plays an increasingly important role in the management of UTUC. Mitomycin C is the most common adjuvant treatment for UTUC with bacillus Calmette-Guerin (BCG) being utilized to a lesser extent. UGN-101 is a novel topical gel-based therapy that has shown promising results and thus recently garnered Food and Drug Administration (FDA) approval for UTUC. Other treatments such as BCG-IFN, gemcitabine, docetaxel, and drug-eluting stents (DES) may play a future role in UTUC treatment given further research. It is important to caveat that current studies on topical adjuvant treatments demonstrate varying degrees of effectiveness. This is largely due to limited research on UTUC, consisting of small sample sizes, and mostly retrospective experiences. Accordingly, further clinical trials are needed to evaluate the true benefit of these treatments.

Use of a scent-detection dog for sea turtle nest monitoring of three sea turtle species in Florida.

Sea turtles are threatened with extinction around the world and rely on sandy beaches for laying their eggs. To protect eggs and locate them for calculation of reproductive success, beach surveyors must find the exact placement of each clutch. Eggs may be buried up to one meter deep under a nest mound several square meters in area. To locate sea turtle eggs, beach surveyors might spend hours searching for these eggs hidden in the sand, especially for difficult-to-locate leatherback (Dermochelys coriacea) and green turtle (Chelonia mydas) eggs. Scent-detection dogs (Canis lupus familiaris) are a novel tool that could provide a means to more accurately identify nests and efficiently locate eggs that need assessment, protection, or relocation. We assessed the effectiveness and feasibility of using a detection dog to locate sea turtle eggs buried in beach sand as compared to the traditional method using human beach surveyors. The detection dog was significantly more accurate in detecting loggerhead sea turtle (Caretta caretta) eggs and more efficient (less time spent and fewer holes dug) in assisting with locating the eggs. This case study presents results on the performance of one detection dog only, and additional research is needed with multiple detection dogs and handlers.

Negative emotion differentiation in trauma-exposed community members: Associations with posttraumatic stress disorder symptoms in daily life.

The ability to make fine-grained distinctions between discrete negative emotions-termed negative emotion differentiation (NED)-is important for emotion regulation and psychological well-being. Posttraumatic stress disorder (PTSD) is associated with elevated trauma-related negative emotions (e.g., fear, anger, guilt, shame) and self-reported difficulty identifying feelings, suggesting that low NED may be a feature of PTSD. PTSD is also characterized by overreliance on avoidance as an emotion regulation strategy-a characteristic that could be influenced by low NED. Here, we examined whether NED is reduced in PTSD and the role NED plays in the association between trauma-related avoidance and other PTSD symptoms (traumatic reexperiencing, negative alterations in cognition and mood, alterations in arousal and reactivity). Hypotheses were tested using 3 days of ecological momentary assessment (up to 17 prompts per day) in 80 trauma-exposed participants (39 with PTSD, 41 without PTSD; total completed surveys = 2,158). NED was reduced and self-reported difficulty identifying feelings was elevated in those with PTSD, and both predicted PTSD severity (Clinician-Administered PTSD Scale-5 score) and momentary PTSD symptoms. Furthermore, low NED, but not difficulty identifying feelings, predicted a stronger association between momentary trauma-related avoidance and PTSD symptoms. Results suggest that NED is involved in the emotional processing of trauma by decreasing the negative impact of avoidance behavior on other PTSD symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Data on Sea turtle relative abundance in nearshore waters adjacent to the Mississippi River delta, Gulf of Mexico, United States.

We measured the relative abundance of sea turtles using standardized transect surveys conducted during the summer and fall of 2013 in neritic waters surrounding the Mississippi River delta in Louisiana, USA. Data comprise sea turtle locations, observation circumstances, and environmental covariates recorded at the beginning of each transect and at the time of each turtle observation. Turtles were recorded by species and size class, as well as location in the water column and the distance the turtle was from the transect line. Transects were performed on an 8.2 meter vessel with two observers atop a 4.5 meter elevated platform, with vessel speed standardized at ∼15 km/hr. These data are the first to describe relative abundance of sea turtles observed from small vessels in this region. Detection of turtles <45 cm SSCL and data detail are greater than aerial surveys. The data serve to inform resource managers and researchers regarding these protected marine species.

Positive emotion in posttraumatic stress disorder: A global or context-specific problem?

Problems with positive emotion are an important component of posttraumatic stress disorder (PTSD), with competing perspectives as to why. The global model suggests that people with PTSD experience a relatively permanent shift in their capacity for positive emotion regardless of context, whereas the context-specific model posits access to the full repertoire of positive emotion that only becomes reduced during exposure to trauma reminders. We tested the global versus context-specific models using ecological momentary assessment (EMA). Trauma-exposed adult community members (N = 80) with (n = 39) and without diagnosed PTSD completed 3 days of EMA (n = 2,158 observations). Participants with PTSD reported lower average momentary levels of positive emotion, B = -0.947, 95% CI [-1.35, -0.54], p < .001, and positive situations, B = -0.607, 95% CI [-1.16, -0.05], p = .032, and more thinking about trauma reminders, B = 0.360, 95% CI [0.21, 0.51], p < .001. There was no between-group difference in positive emotion reactivity (degree of positive emotion derived from positive situations), B = 0.03, 95% CI [-0.09, 0.14], p = .635. Increased thinking about trauma reminders predicted lower momentary levels of positive emotion, B = -0.55, 95% CI [-0.83, -0.26], p < .001, but not reactivity, B = 0.02, 95% CI [-0.35, 0.40], p = .906, irrespective of PTSD status. Findings supported the global model and were inconsistent with the context-specific model. This study helps clarify positive emotional functioning in trauma-exposed adults and highlights future directions to better understand problems with positive emotion in PTSD.

Effects of trauma-focused rumination among trauma-exposed individuals with and without posttraumatic stress disorder: An experiment.

Rumination, or thinking repetitively about one's distress, is a risk factor for posttraumatic stress disorder (PTSD). Current theories suggest that rumination contributes to PTSD symptoms directly, by increasing negative reactions to trauma cues (i.e., symptom exacerbation), or represents a form of cognitive avoidance, if verbal ruminations are less distressing than trauma imagery. The goal of this study was to test the symptom exacerbation and cognitive avoidance accounts of trauma-focused rumination. We recruited 135 trauma-exposed participants (n = 60 diagnosed with PTSD) and randomly assigned them to ruminate about their trauma, distract themselves, or engage in trauma imagery. For individuals with and without PTSD, rumination led to larger increases in subjective distress (i.e., negative affect, fear, sadness, subjective arousal, valence) than distraction, ηp 2 s = .04-.13, but there were no differences between rumination and imagery ηp 2 s = .001-.02. We found no evidence that rumination or imagery elicited physiological arousal, ds = 0.01-0.19, but did find that distraction reduced general physiological arousal, as measured by heart rate, relative to baseline, d = 0.84, which may be due to increases in parasympathetic nervous system activity (i.e., respiratory sinus arrhythmia), d = 0.33. These findings offer no support for the avoidant function of rumination in PTSD. Instead, the findings were consistent with symptom exacerbation, indicating that rumination leads directly to emotional reactivity to trauma reminders and may be a fruitful target in PTSD intervention.

Emotion regulation repertoires in trauma-exposed college students: Associations with PTSD symptoms, emotional awareness, and emotional clarity.

OBJECTIVE: Emotion regulation (ER) plays a prominent role in the development and maintenance of posttraumatic stress disorder (PTSD). Although links between ER strategies and PTSD symptoms are well documented, recent advancements in ER research emphasize the need to move beyond examining ER strategies as isolated processes. Instead, there is a growing movement to understand ER repertoires, or the patterns in which individuals report habitually using the multiple ER strategies available to them. Additionally, awareness and clarity of one's emotional experiences might play a key role in the effective use of ER strategies. METHOD: The current study examined person-centered repertoires of the habitual use of eleven ER strategies among 372 undergraduates exposed to Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) Criterion A trauma-and their relations to PTSD symptoms, emotional awareness, and emotional clarity. RESULTS: Latent profile analysis yielded a three-profile solution (Adaptive, Average, and Maladaptive Regulators) and profiles differed on mean levels PTSD symptoms. Emotional clarity, but not emotional awareness, emerged as a significant predictor of profile classification, even after adjusting for negative affect. CONCLUSIONS: Findings suggest that emotional clarity might help foster healthy repertoires of ER strategy use and buffer against the development of PTSD among trauma-exposed individuals. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Margarita glasses and high heels: How attention to shape, age, and vocabulary impacts children's recognition of typical and atypical exemplars.

Children's ability to recognize object shape is foundational for successful early word learning. However, the prototypical shape of objects may not be easily accessible-take margarita glasses, for instance. The current study examined 304 U.S. children 17- to 42-month-old (152 females) from 2017 to 2020, asking how shape, age, and vocabulary abilities predict recognition of everyday objects. Children's ability to recognize objects increases with age and vocabulary, replicating prior work. Moreover, performance was partially moderated by object's typicality and shape features, and children's own attention to shape (shape bias) may mediate the effect, especially with prototypically shaped objects. The current study highlights how both child-specific variables and context features interact to shape language abilities, underscoring the emergent and multi-causal nature of word learning.

Management of scleral melt.

Scleral melting, while rare, can lead to significant ocular morbidity. Several possible risk factors for scleral melt have been identified, such as infection, autoimmune disease, trauma, and post-surgical state, and these may act in combination with each other. Treatment should be tailored according to the etiology and severity of the scleral melt. Medical management may be indicated, especially in cases of autoimmune-related melt; however, surgical procedures are often necessary due to compromised ocular integrity and limited penetration of medications into the avascular sclera. An understanding of the surgical options available and their operative outcomes is particularly important when choosing the appropriate treatment protocol for each patient.

Retrospective study comparing outcomes of multimodal epidural and erector spinae catheter pain protocols after pectus surgery.

INTRODUCTION: There are no optimal postoperative analgesia regimens for Nuss procedures. We compared the effectiveness of thoracic epidurals (EPI) and novel ambulatory erector spinae plane (ESP) catheters as part of multimodal pain protocols after Nuss surgery. METHODS: Data on demographics, comorbidities, perioperative details, length of stay (LOS), in hospital and post discharge pain/opioid use, side effects, and emergency department (ED) visits were collected retrospectively in children who underwent Nuss repair with EPI (N = 114) and ESP protocols (N = 97). Association of the group with length of stay (LOS), in hospital opioid use (intravenous morphine equivalents (MEq)/kg over postoperative day (POD) 0-2), and oral opioid use beyond POD7 was analyzed using inverse probability of treatment weighting (IPTW) with propensity scores, followed by multivariable regression. RESULTS: Groups had similar demographics. Compared to EPI, ESP had longer block time and higher rate of ketamine and dexmedetomidine use. LOS for ESP was 2 days IQR (2, 2) compared to 3 days IQR (3, 4) for EPI (p < 0.01). Compared to EPI, ESP group had higher opioid use (in MEq/kg) intraoperatively (0.32 (IQR 0.27, 0.36) vs. 0.28 (0.24, 0.32); p < 0.01) but lower opioid use on POD 0 (0.09 (IQR 0.04, 0.17) vs. 0.11 (0.08, 0.17); p = 0.03) and POD2 (0.00 (IQR 0.00, 0.00) vs. 0.04 (0.00, 0.06) ; p < 0.01). ESP group also had lower total in hospital opioid use (0.57 (IQR 0.42, 0.73) vs.0.82 (0.71, 0.91); p < 0.01), and shorter duration of post discharge opioid use (6 days (IQR 5,8) vs. 9 days (IQR 7,12) (p < 0.01). After IPTW adjustment, ESP continued to be associated with shorter LOS (difference -1.20, 95% CI: -1.38, -1.01, p < 0.01) and decreased odds for opioid use beyond POD7 (OR 0.11, 95% CI: 0.05, 0.24); p < 0.01). However, total in hospital opioid use in MEq/kg (POD0-2) was now similar between groups (difference -0.02 (95% CI: -0.09, -0.04); p = 0.50). The EPI group had higher incidence of emesis (29% v 4%, p < 0.01), while ESP had higher catheter malfunction rates (23% v 0%; p < 0.01) but both groups had comparable ED visits/readmissions. DISCUSSION/CONCLUSION: Compared to EPI, multimodal ambulatory ESP protocol decreased LOS and postoperative opioid use, with comparable ED visits/readmissions. Disadvantages included higher postoperative pain scores, longer block times and higher catheter leakage/malfunction. LEVELS OF EVIDENCE: Level III.

Understanding internalizing and externalizing symptoms in trauma exposed community members.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is highly comorbid with internalizing and externalizing symptoms, but few studies have examined risk factors that can account for these comorbidities. The primary aim of this study is to investigate the role of blame attribution (i.e., self-blame and other blame) and impulsivity dimensions (i.e., negative and positive urgency) in predicting internalizing (i.e., social anxiety, depression, and worry) and externalizing symptoms (i.e., aggression, risky thrill-seeking, risky substance use, and sexual risk-taking) when statistically controlling for PTSD. METHOD: Participants were 63 trauma-exposed community members (47.6% diagnosed with PTSD; Mage = 27.17, 84.1% female) interviewed using the Clinician-Administered PTSD Scale-5. We hypothesized that self- and other blame would predict internalizing symptoms and that self-blame, negative urgency, and positive urgency would predict externalizing symptoms after controlling for PTSD. RESULTS: Findings showed that self-blame was associated with all three internalizing symptoms and risky sex and that negative urgency predicted risky aggression. CONCLUSION: This study provides evidence that self-blame is an important risk factor for a broad range of internalizing symptoms and for at least one type of externalizing symptom and that the effects of self-blame are not fully explained by PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Acute kidney injury in cystic fibrosis patients treated with intravenous colistimethate sodium or tobramycin.

OBJECTIVES: Colistimethate sodium and tobramycin are important systemic antibiotics for treatment of cystic fibrosis (CF) pulmonary exacerbations but can induce acute kidney injury (AKI). We characterize the rate of AKI in CF patients treated with systemic colistimethate sodium compared with tobramycin. METHODS: This single-centre, retrospective cohort study included hospitalized CF patients treated with IV colistimethate sodium or tobramycin. The primary outcome was AKI defined using the RIFLE criteria. Multivariate logistic regression using a mixed model was performed to identify variables that were independently associated with AKI. RESULTS: Overall, 156 patients representing 507 care encounters were included. The OR of AKI was not increased with IV colistimethate sodium relative to IV tobramycin after adjusting for other potential predictor variables (aOR 1.00; 95% CI 0.16-6.03). The frequency of AKI was 9.5% across all encounters, 6.9% with IV colistimethate sodium and 9.9% with IV tobramycin, with RIFLE category R (risk) being the most common stage, accounting for 4.2% of encounters with IV colistimethate sodium and 9.2% with IV tobramycin. The concomitant use of another nephrotoxin (aOR 2.51; 95% CI 1.27-4.95) or the combination of vancomycin and piperacillin/tazobactam (aOR 5.95; 95% CI 2.05-17.3) were both associated with increased odds of AKI. CONCLUSIONS: Systemic treatment with colistimethate sodium or tobramycin in the CF patient population is associated with a similar rate of nephrotoxicity. However, clinicians should be mindful of the increased risk for AKI in patients treated with either IV colistimethate sodium or IV tobramycin when used concurrently with other nephrotoxic agents, particularly the combination of vancomycin and piperacillin/tazobactam.

Supporting habitat restoration in the northern Gulf of Mexico through synthesis of data on multiple and interacting benefits and stressors.

Outcomes of landscape scale restoration and conservation can be maximized when planning is based upon quantitative and decision-relevant information. Existing tools to support data-driven planning are hindered by regionally inconsistent information and a need for advanced methods to analyze data of varying spatial resolution and coverage. We present a synthesis methodology for region-wide derived metrics to characterize natural resource value, ecosystem stress, and social vulnerability to inform implementation of conservation and restoration projects. Our three-part methodology was developed and tested for the Gulf of Mexico in support of the Southeast Conservation Blueprint that was created to advance the Southeast Conservation and Adaptation Strategy. The first step included integration of prioritized natural resource metrics alongside socio-ecological metrics to create a data layer of synthesized natural resource priority across the northern Gulf of Mexico. The second component was calculation of ecosystem stress indices based on ecologically relevant thresholds and a cumulative ecosystem stress layer, in addition to analyzing correlations between individual stressors and their relative importance. The final component was development of a social vulnerability (SoVI) index. Analysis of these metrics illustrate their ability to effectively capture variability at multiple scales in the Gulf of Mexico, including expected spatial correlation of stressors such as road density and non-point source pollution in populated areas and the dominance of sea-level rise as a future stressor along the coast. Significant composite components of social vulnerability for the northern Gulf of Mexico region were identified and include economic status, professional workforce, elderly population, population stability, migrant workforce, and rural population. To demonstrate the utility of the data synthesis approach, we used the developed data layers to evaluate proposed marsh creation projects in southern Louisiana. The synthesized data layers were capable of distinguishing differences at the scale of individual habitat restoration projects, and high-value projects could be aligned with the goals of key funding streams. This pilot application illustrates how restoration programs could use the methodology developed here to maximize benefits from conservation and restoration actions along the northern Gulf of Mexico or other regions globally.

Posttraumatic stress disorder-related anhedonia as a predictor of psychosocial functional impairment among United States veterans.

Prior research suggests that anhedonia symptoms related to posttraumatic stress disorder (PTSD; i.e., diminished interest, detachment from others, and difficulty experiencing positive emotions) are consistently associated with a higher degree of impairment in psychosocial functioning beyond that associated with other PTSD symptoms. Unfortunately, much of this research has used cross-sectional study designs; relied upon outdated DSM diagnostic criteria; and failed to control for potentially confounding variables, such as the presence of co-occurring depression. This study used data from Waves 2 and 4 (n = 1,649) of the Veterans' After-Discharge Longitudinal Registry (Project VALOR), a longitudinal dataset of U.S. Army and Marine veterans. As measured using the Inventory of Psychosocial Functioning, Wave 4 psychosocial functioning was regressed on seven PTSD symptom factors at Wave 2 (i.e., intrusions, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal) and potential Wave 2 confounds. The Anhedonia factor, ß = .123, most strongly predicted later psychosocial functional impairment beyond the impact of other PTSD symptom factors, ßs = -.076-.046. Clinical implications of these findings are also discussed.