Parenting Expectations, NICU Experiences, and Maternal Psychological Outcomes: An Exploratory Mixed-Methods Study.

BACKGROUND: Infant neonatal intensive care unit (NICU) hospitalization increases maternal risk for psychological distress. However, no universal screening standards exist and predicting maternal risk remains challenging. Reconceptualizing maternal distress in relation to differences between parenting expectations and NICU experiences may illuminate commonalities across a range of experiences. PURPOSE: This study explored parenting expectation-experience differences (EEDs) among NICU mothers and assessed correlations between EED scores and psychological outcomes 1 to 5 years post-NICU hospitalization. METHODS: A 3-phase explanatory sequential mixed-methods design was used. Pearson's correlation coefficients were used to measure relationships between EED scores and maternal psychological outcomes. Reflexive thematic analysis of one-on-one, semi-structured interviews contextualized EED scores. RESULTS: Most participants (92.9%) reported negative EED scores, indicating NICU experiences fell short of parenting expectations. Significant inverse correlations were found between EED scores and maternal outcomes, including depression ( r = -0.25, P < .01), anxiety ( r = -0.25, P < .01) and posttraumatic stress disorder symptoms ( r = -0.41, P < .001), and perceived parenting self-efficacy ( r = -0.28, P < .01). Major qualitative themes included unexpected versus prepared, lost parenting experiences, and surviving and thriving. Data synthesis contextualized EED scores and revealed key differences in meaning ascribed to unmet parenting expectations. IMPLICATIONS FOR PRACTICE AND RESEARCH: Preparing mothers for infant NICU hospitalization and creating a NICU parenting environment, which better supports mothers and their engagement in parenting tasks, may help to reduce differences between parenting expectations and NICU experiences. Further research is needed to elucidate the impacts of parenting EEDs in this population.

Application of Trauma-Informed Care Principles to Care Needs Identified by Mothers of NICU-Hospitalized Children.

Systematic uptake of family-centered care (FCC) interventions remains challenging and frequently suboptimal in many neonatal intensive care units (NICUs). Across NICUs in the United States, integrating family members as partners in infant caregiving and decision-making has not been well supported and routine screening and provision of psychological support for parents remains inadequate. Trauma-informed care (TIC) may offer a more comprehensive approach to NICU care which can encompass FCC principles and promote family recovery and resilience by recognizing and responding to the traumas experienced by NICU infants and families. The current paper aimed to understand needs identified by mothers of NICU-hospitalized children and reports a focused analysis of one-on-one interview data (n = 13 mothers) collected during a larger mixed methods study. Reflexive thematic analysis was used to understand needs identified by mothers and to explore how these needs aligned with TIC principles. Six themes were identified and subsequently examined in the context of the principles of TIC: I Just Had No Control, That Really Caught Us Off Guard, So Much Was Already Taken Away, We're People and There Needs To Be More Support and Practices Which Helped. Mothers' care needs were found to align with TIC principles. Findings suggest that implementation of TIC principles in NICU settings can support parental presence, participation in infant care, and mental health and support the potential of TIC as a more comprehensive approach to meeting the needs of NICU parents.

COVID-19 as a chronic stressor and the importance of individual identity: A data-driven look at academic productivity during the pandemic.

The COVID-19 pandemic impacted personal and professional life. For academics, research, teaching, and service tasks were upended and we all had to navigate the altered landscape. However, some individuals faced a disproportionate burden, particularly academics with minoritized identities or those who were early career, were caregivers, or had intersecting identities. As comparative endocrinologists, we determine how aspects of individual and species-level variation influence response to, recovery from, and resilience in the face of stressors. Here, we flip that framework and apply an integrative biological lens to the impact of the COVID-19 chronic stressor on our endocrine community. We address how the pandemic altered impact factors of academia (e.g., scholarly products) and relatedly, how factors of impact (e.g., sex, gender, race, career stage, caregiver status, etc.) altered the way in which individuals could respond. We predict the pandemic will have long-term impacts on the population dynamics, composition, and landscape of our academic ecosystem. Impact factors of research, namely journal submissions, were altered by COVID-19, and women authors saw a big dip. We discuss this broadly and then report General and Comparative Endocrinology (GCE) manuscript submission and acceptance status by gender and geographic region from 2019 to 2023. We also summarize how the pandemic impacted individuals with different axes of identity, how academic institutions have responded, compile proposed solutions, and conclude with a discussion on what we can all do to (re)build the academy in an equitable way. At GCE, the first author positions had gender parity, but men outnumbered women at the corresponding author position. Region of manuscript origin mattered for submission and acceptance rates, and women authors from Asia and the Middle East were the most heavily impacted by the pandemic. The number of manuscripts submitted dropped after year 1 of the pandemic and has not yet recovered. Thus, COVID-19 was a chronic stressor for the GCE community.

Investigating relationships among stress, reproduction, and immunity in three species of watersnake.

Energy is a finite resource required for all physiological processes and must be allocated efficiently among essential activities to ensure fitness and survival. During the active season, adult organisms are expected to prioritize investment in reproduction over other energetically expensive processes, such as responding to immunological challenges. Furthermore, when encountering a stressor, the balance between reproduction and immunity might be disrupted in order to fuel the stress response. Because of the distinct differences in life histories across species, watersnakes provide a unique group of study in which to examine these tradeoffs. Over a two-year period, we captured three watersnake species throughout Northeast Arkansas. Animals were subjected to restraint stress and blood samples were collected throughout the acute stress response. Blood samples were used to assess innate immunity and steroid hormone concentrations. We found the peak in corticosterone concentration is season-specific, potentially because energetic reserves fluctuate with reproductive activities. We also found body condition was positively related to acute stress and negatively related to immunity. Watersnakes evidently prioritize reproduction over immunity, especially during the energetically intensive process of vitellogenesis. Energetic tradeoffs between reproduction, immunity, and the stress response are complex, and this study contributes to our understanding of energetic shifts in free-living organisms in the context of stress.

Assessment of glucocorticoids, sex steroids, and innate immunity in wild red-eared slider turtles (Trachemys scripta elegans).

When access to resources is limited, organisms must shift energy investment among physiological processes to survive, reproduce, and respond to unpredictable events. The shifting of these limited resources among processes may result in physiological tradeoffs, often mediated by glucocorticoids. We assessed relationships among the physiological processes of immunity, reproduction, and the stress response in wild adult red-eared slider turtles (Trachemys scripta elegans). Red-eared sliders exhibit a multi-clutching reproductive strategy that requires high energetic investment in reproduction at the beginning of the nesting season in females. Males mate in spring and undergo spermatogenesis and mating in late summer/early fall. We expected to observe tradeoffs when investment toward reproductive processes was particularly demanding. To test this, we subjected 123 individuals to a standardized acute stressor and collected blood to measure innate immunocompetence and circulating steroid hormone concentrations. Tradeoffs between female reproduction and immunocompetence occurred early in the nesting season. This high reproductive investment was evident by heightened circulating progesterone and reduced baseline innate immunity. Corticosterone (CORT) was also high during this period, indicating a role in facilitating allocation of energy. Tradeoffs were not as evident in males, though males upregulated innate immune function, baseline CORT, and testosterone prior to fall spermatogenesis and mating. Throughout the entire sampling period, both males and females increased CORT and immunocompetence following the acute standardized stressor. Taken together, we concluded that reproduction requires shifts in energy allocation in during the highest reproductive period for females but all individuals in this population remain able to respond to the standardized stressor even during increased reproductive investment. These findings reinforce the continuing evidence that physiological relationships are context-dependent and resource demands are dynamic across the reproductive season.

Immune and stress physiology of two captively-housed tortoise species.

Ecoimmunology affords us the ability to better understand immunological processes through consideration of external factors, such as the thermal microenvironment. This consideration is imperative when examining the immunological processes of ectothermic organisms like reptiles. Reptiles uniquely rely heavily on their innate immune function but remain poorly understood in immunological studies. In this study, we examined innate immunity in two zoo-housed tortoise species, the Indian star tortoise (Geochelone elegans, Schoepff, 1795) and northern spider tortoise (Pyxis arachnoides brygooi, Vuillemin & Domergue, 1972). Bacterial killing assays (BKAs) were optimized and used to assess the monthly immunocompetence of these tortoises to three different bacteria: Escherichia coli, Salmonella enterica, and Staphylococcus aureus. We evaluated differences in blood biochemistry values (lactate and glucose) among months and species as well as fecal corticosterone (CORT) between species. Lastly, we examined the potential influences of individual thermal microenvironments on bactericidal ability. Both G. elegans and P. a. brygooi demonstrated immunocompetence against all bacterial challenges, but only bactericidal ability against E. coli varied over months. Optimal BKA serum dilutions, blood glucose levels, and fecal CORT concentrations differed between the two species. Finally, there was evidence that the thermal microenvironment influenced the tortoises' bactericidal ability against E. coli. Through use of nonmodel organisms, such as tortoises, we are given insight into the inner workings of innate immunity and a better understanding of the complexities of the vertebrate immune system.

In her own words: a phenomenological analysis of stories told by female service members and veterans after traumatic brain injury.

PURPOSE: Given the majority of Service Members and Veterans (SMV) who have sustained a traumatic brain injury (TBI) are male, the female experience with TBI has not been captured in the general understanding of TBI. To improve understanding of the experience of female SMV after TBI utilizing a qualitative phenomenological approach on stories as told by female SMV. MATERIALS AND METHODS: Ten female SMV participated in storytelling workshops and created video stories documenting their personal experience with TBI. Workshops were hosted by the VA Palo Alto Health Care System Polytrauma System of Care (VAPAHCS PSC). A grounded thematic analysis was conducted on the video stories. RESULTS: Three common content themes emerged from all the stories: (1) negative psychological and emotional impacts of TBI, (2) acceptance and healing process associated with recovery, and (3) military contexts. Negative psychological and emotional impacts included intrapersonal impacts such as negative emotions, suicidal ideation, and dealing with cognitive and physical challenges, and interpersonal impacts in relationships and loss of independence. Notably, all the stories acknowledged an acceptance and healing process, characterized by several subthemes including motivational factors, TBI education, spirituality, and advocacy work. Lastly, each story mentioned military context, highlighting the unique experience within this population. CONCLUSIONS: This phenomenological examination adds evidence-based understanding to the experience after TBI among female SMV. Each story uncovered nuanced and multifaceted issues that women experience in their TBI recovery. Our findings provide context to guide future intervention on the care, support, and TBI recovery for the female SMV population.

This phenomenological examination adds evidence-based understanding to the experience after traumatic brain injury (TBI) among female active duty servicemembers and veterans.Rehabilitation for female active duty servicemembers and veterans can use an approach of equity-oriented health care that acknowledges that trauma affects physical/emotional health, interpersonal relationships, and ability to access care.Sharing stories in a group setting help to establish personal connection, build trust, and process emotions about their experience with other female storytellers, and can combat isolation in female active duty servicemembers and veterans after TBI.

Reptilian Innate Immunology and Ecoimmunology: What Do We Know and Where Are We Going?

Reptiles, the only ectothermic amniotes, employ a wide variety of physiological adaptations to adjust to their environments but remain vastly understudied in the field of immunology and ecoimmunology in comparison to other vertebrate taxa. To address this knowledge gap, we assessed the current state of research on reptilian innate immunology by conducting an extensive literature search of peer-reviewed articles published across the four orders of Reptilia (Crocodilia, Testudines, Squamata, and Rhynchocephalia). Using our compiled dataset, we investigated common techniques, characterization of immune components, differences in findings and type of research among the four orders, and immune responses to ecological and life-history variables. We found that there are differences in the types of questions asked and approaches used for each of these reptilian orders. The different conceptual frameworks applied to each group has led to a lack of unified understanding of reptilian immunological strategies, which, in turn, have resulted in large conceptual gaps in the field of ecoimmunology as a whole. To apply ecoimmunological concepts and techniques most effectively to reptiles, we must combine traditional immunological studies with ecoimmunological studies to continue to identify, characterize, and describe the reptilian immune components and responses. This review highlights the advances and gaps that remain to help identify targeted and cohesive approaches for future research in reptilian ecoimmunological studies.

Foreword: Biology/embodiment/desire.

The sexological roots of "lesbian" and the "queer" turn from biologized categories of sexual difference pose an exciting set of questions and tensions for thinking about queer feminism and biological meanings. This issue seeks to open space to explore how we might reconcile assumptions about "female same-sex sexuality" that often accompany "lesbian" with queer and trans-feminist treatments of science, embodiment, and desiring, while at the same time insisting on the importance of an undertheorized dyke legacy for thinking the at-once material and political nature of sexuality.

The Support, Education, and Research in Chronic Heart Failure Study (SEARCH): a mindfulness-based psychoeducational intervention improves depression and clinical symptoms in patients with chronic heart failure.

BACKGROUND: The Support, Education, and Research in Chronic Heart Failure (SEARCH) study was designed to assess the impact of a mindfulness-based psychoeducational intervention on clinical outcomes, depression, and quality of life in patients with chronic heart failure (CHF). Although research has shown that psychosocial factors including depression are important risk factors for adverse events in patients with CHF, no large clinical trials have investigated the efficacy of psychosocial interventions to reduce these factors in this population. METHODS: This was a prospective cohort study of 208 adults with left ventricular ejection fraction < or =40% and CHF geographically assigned to treatment or control groups with follow-up at 3, 6, and 12 months. Treatment groups met weekly for 8 consecutive weeks for training in mindfulness meditation, coping skills, and support group discussion. RESULTS: Subjects had a mean age of 61 years, left ventricular ejection fraction 26%, and median New York Heart Association class II. The majority were treated with angiotensin-converting enzyme inhibitors (80%) and beta-blockers (86%). At baseline, patients in the treatment group had more severe CHF with higher New York Heart Association class (P = .0209) and more severe psychological distress (Center of Epidemiology - Depression, Profile of Mood States; P < .05). When compared with controls, treatment resulted in lower anxiety (Profile of Mood States, P = .003), depression (Center of Epidemiology - Depression, P = .05), improved symptoms (Kansas City Cardiomyopathy Questionnaire symptom scale, P = .033) and clinical scores (Kansas City Cardiomyopathy Questionnaire clinical score, P = .024) over time. There were no treatment effects on death/rehospitalization at 1 year. CONCLUSIONS: An 8-week mindfulness-based psychoeducational intervention reduced anxiety and depression; this effect was attenuated at 1 year. Importantly, the intervention led to significantly better symptoms of CHF at 12 months compared to control subjects. Our results suggest that interventions of this type might have a role in optimal therapy for CHF.

TRUSS, a tumor necrosis factor receptor-1-interacting protein, activates c-Jun NH(2)-terminal kinase and transcription factor AP-1.

Tumor necrosis factor-alpha (TNF-alpha) induces the transcriptional activation of numerous genes involved in the inflammatory response. The recently identified protein TRUSS was investigated for its role in TNF-alpha-induced activation of c-Jun-NH(2) terminal kinase (JNK) and transcription factor, AP-1. Ectopic expression of TRUSS activated JNK and AP-1 in the absence and presence of TNF-alpha stimulation. The C-terminal region of TRUSS interacted with TNF receptor-associated factor-2 (TRAF2) and co-expression of dominant-inhibitory TRAF2 with TRUSS inhibited AP-1 activation, suggesting that TRUSS signaling occurs upstream of TRAF2. Further, a dominant-inhibitory mutant of TRUSS inhibited TNF-alpha-induced AP-1 activation. These findings suggest that TRUSS activates JNK in a TRAF2-dependent fashion and is involved in TNF-alpha-induced AP-1 activation via JNK kinases.

Long-chain (n-3) fatty acid intake and risk of cancers of the breast and the prostate: recent epidemiological studies, biological mechanisms, and directions for future research.

The association between dietary (n-3) fatty acids and hormone-responsive cancers continues to attract considerable attention in epidemiological, clinical, and experimental studies. We previously reviewed the epidemiological literature on the association between hormone-responsive cancers and the long-chain fatty acids eicosapentaenoic acid and docosahexaenoic acid. We concluded that the compelling evidence from ecological studies, animal models, and mechanistic experiments in vitro was not supported clearly by the available epidemiological data. To various degrees, epidemiological studies published more recently attempted to address some of the methodological limitations plaguing earlier studies by using validated questionnaires, examining specific fatty acids and their interrelationships, and adjusting estimates for a wider range of potentially confounding factors than in previous studies. In this review, our aim was to update the previous review with the results of recent epidemiological studies and to discuss possible biological mechanisms and directions for future research.

TRUSS, a novel tumor necrosis factor receptor 1 scaffolding protein that mediates activation of the transcription factor NF-kappaB.

We describe the cloning and characterization of tumor necrosis factor receptor (TNF-R)-associated ubiquitous scaffolding and signaling protein (TRUSS), a novel TNF-R1-interacting protein of 90.7 kDa. TRUSS mRNA was ubiquitously expressed in mouse tissues but was enriched in heart, liver, and testis. Co-immunoprecipitation experiments showed that TRUSS was constitutively associated with unligated TNF-R1 and that the complex was relatively insensitive to stimulation with TNF-alpha. Deletion mutagenesis of TNF-R1 indicated that TRUSS interacts with both the membrane-proximal region and the death domain of TNF-R1. In addition, the N-terminal region of TRUSS (residues 1 to 440) contains sequences that permit association with the cytoplasmic domain of TNF-R1. Transient overexpression of TRUSS activated NF-kappaB and increased NF-kappaB activation in response to ligation of TNF-R1. In contrast, a COOH-terminal-deletion mutant of TRUSS (TRUSS(1-723)) was found to inhibit NF-kappaB activation by TNF-alpha. Co-precipitation and co-immunoprecipitation assays revealed that TRUSS can interact with TRADD, TRAF2, and components of the IKK complex. These findings suggest that TRUSS may serve as a scaffolding protein that interacts with TNF-R1 signaling proteins and may link TNF-R1 to the activation of IKK.

MHC class I-dependent Vgamma4+ pulmonary T cells regulate alpha beta T cell-independent airway responsiveness.

Mice exposed to aerosolized ovalbumin (OVA) develop increased airway responsiveness when deficient in gammadelta T cells. This finding suggests that gammadelta T cells function as negative regulators. The regulatory influence of gammadelta T cells is evident after OVA-sensitization and -challenge, and after OVA-challenge alone, but not in untreated mice. With aerosolized Abs to target pulmonary T cells, we now demonstrate that negative regulation of airway responsiveness is mediated by a small subpopulation of pulmonary gammadelta T cells. These cells express Vgamma4 and depend in their function on the presence of IFN-gamma and MHC class I. Moreover, their effect can be demonstrated in the absence of alphabeta T cells. This novel type of negative regulation seems to precede the development of the adaptive, antigen-specific allergic response.