Anesthesia awareness is a rare, but severe complication of anesthesia with possible severe long-term effects that is more commonly reported after trauma and emergent surgery. Anesthesia awareness in trauma patients who require emergency surgery has not been researched on since Bogetz and Katz’s study in 1984. This landmark study reported a higher risk of anesthesia awareness due to multiple factors, including intolerance of anesthetic agents in these patients who often present with hemodynamic instability and low blood pressure. Given the reported risk of awareness in this population, clinicians continue to administer standard doses of anesthetic agents despite the associated hemodynamic effects and the concern for other anesthesia-related complications. Therefore, it is important to determine if the risk factors and incidence of awareness remains high despite recent advances in anesthetic techniques and monitoring. We hypothesized that awareness under general anesthesia in trauma patients is less common with the use of modern-day anesthetic agents and monitoring devices. To examine this hypothesis, the incidence of anesthesia awareness was retrospectively studied in all trauma patients requiring emergency surgery at Boston Medical Center (BMC) between January 2020 and February 2022. The patients were asked a 5-minute questionnaire which included questions from the modified Brice questionnaire to determine the incidence of perioperative awareness. It was found that the incidence of awareness during general anesthesia in trauma surgery patients at BMC from January 2020 through February 2022 was significantly lower (with an incidence of 0%) than the previously reported incidence of 11% by Bogetz and Katz, (p = 0.028, CI -0.22-0.00). Further research is warranted to confirm our findings and further explore the incidence and impact of awareness in this vulnerable population. Future prospective studies should examine a greater number of trauma patients, associated risk factors, and the role of processed EEG monitoring in preventing awareness during general anesthesia.

No description available.

This study explored the use of adding trauma resolution therapy to standard cognitive-behavioral relapse prevention therapy for sex offenders. Ten adjudicated sex offenders with sexual abuse histories were treated with eye movement desensitization and reprocessing as an adjunct to standard outpatient sex offender treatment. Data points include self-report, other-report, assessment instruments, session transcripts, research journals, and physiological measures. Systematic treatment research and development methods (Bischoff, McKeel, Moon, & Sprenkle, 1996) resulted in a proposed treatment protocol. Emergent themes from a cross-case, grounded theory data analysis are presented. The data suggests the adjunct treatment provided some benefit both to participants and to the goals of standard sex offender-specific treatment. Implications for treatment providers, marriage and family therapy, and future research are discussed. / Ph. D.

The purpose of the current study was to further explore the relations between parent trauma, parenting behavior, child trauma, and child adjustment. The sample included 358 children (191 boys and 167 girls) and their primary caregiver (48 fathers and 310 mothers). The children's ages ranged from 10 to 17 with an average age of 13. Parent trauma was not found to be related to child trauma through parenting behaviors. Child trauma was found to mediate the relations between parenting and child adjustment. There was some evidence of parenting mediating the relation between parent trauma and child adjustment. This research underscores the importance of understanding the risk and protective factors associated with parent trauma and its influences on child trauma and adjustment as well as the importance of good parenting as a protective factor. Further, this study supports past research which highlights those pathways which lead to resilience. / Master of Science

This study explored the relationship of each partner's immigration stress and exposure to traumatic life experiences, with both his or her own problem drinking and the partner's problem drinking. The study was guided by Bodenmann's systemic-transactional stress model and used secondary data collected in 2009 from 104 Latino immigrant couples living in the Washington DC area. Results from the path model analysis indicated that even though men's overall immigration stress was not significantly related to their own problem drinking, emotional dimensions of immigration stress were in a positive direction. Men's overall immigration stress was negatively related to their partners' problem drinking. The women's overall immigration stress was significantly and positively related to their own problem drinking, particularly for acculturation related aspects and stress from missing family, but it was not significantly related to their partner's problem drinking. Additionally, men's exposure to traumatic life experiences was significantly, positively associated with problem drinking but it was not significantly associated with their own overall immigration stress. For women, results were different as exposure to traumatic life experiences was not associated with their own problem drinking but it was significantly and positively related to their overall immigration stress in the hypothesized direction. Limitations, research, and clinical implications of the findings are discussed. / Master of Science

Perinea! trauma is defined as damage that occurs to the perineum during childbirth that can be unintentional or iptentional. Lacerations can range from first degree, which involves only injury to the skin, to fourth degree which involves injury to underlying structures· and the anus. An episiotomy, a cut made to the perineum, is considered trauma as well. One of the common concerns of women about childbirth is suffering some form of perineal trauma. Perineal trauma can lead to many complications such as pain, infections, increased bleeding, and incontinence. There are many interventions that can decrease a woman's chances of sustaining damage to the perineum whether unintentional or intentional. This integrated literature review explores research that has been performed to examine the different types of interventions and their success at preventing perineal trauma from 1997 to 2008. Perineal Massage, obstetric gel, warm compress, hands off method, oils and lubricants, birthing positions, using hyaluronidase, avoidance of Valsalva pushing, not using augmentation, not using episiotomies, and using a Midwife were examined. All interventions showed a decreased amount of perineal trauma during childbirth, however, some were more effective than others. By using evidence-based interventions, practitioners can decrease the occurrence and severity of perineal trauma, and make the child birthing process have more positive outcomes.

Yes / Perineal trauma is associated with short- and long-term maternal morbidity. Research has found that maternal position at birth can influence perineal trauma. However, there is a dearth of evidence examining specific maternal positions, including waterbirth, and how these can influence incidence and degree of perineal trauma. Such evidence is important to help reduce trauma rates and improve information for women and midwives. To address this gap in reliable evidence, a systematic review was conducted. Seven studies met the inclusion criteria. Compared to land birth, waterbirth was found to cause an increase in perineal trauma. Kneeling and all-fours positions were most protective of an intact perineum. Allowing for different variables, sitting, squatting and using a birth-stool caused the greatest incidence of trauma. The findings of this review demonstrate that further research is required around perineal guarding in alternative birth positions and how parity affects trauma rates with waterbirth, so that women may be advised appropriately. It also suggests findings that midwives can use when discussing alternative birth positions with women.

In der vorliegenden Dissertation wurde die Aktivität des NLRP3-Inflammasoms bei depressiven Patienten untersucht. Im Unterschied zu bisherigen klinischen Studien mit ähnlicher Thematik erfolgten sämtliche laborchemische Analysen im Rahmen einer Glukokortikoidchallenge, sodass initial die Auswirkung von Dexamethason auf die Expression der Gene des Inflammasoms analysiert wurde. Hier zeigte sich eine statistisch signifikante Expressionsabnahme des IL-1β (baseline) sowie eine Expressionszunahme von Caspase-1 zum zweiten Messzeitpunkt in Woche 4. Die Expression der Gene NLRP3 und IL-18 wurde allein durch Dexamethason nicht beeinflusst. Trotz verschiedener Erklärungsansätze, warum eine Expressionsänderung nicht bei allen Komponenten des NLRP3-Inflammasoms durch Dexamethason gleichermaßen verzeichnet werden konnte, wäre eine Replikation dieses Versuchs in einem größeren Patientenkollektiv interessant. Zur Detektion potentieller genetischer Einflüsse wurden regulatorische Unterschiede in Abhängigkeit von Single Nucleotide-Polymorphismen analysiert. Da für NLRP3 und Caspase-1 keine geeigneten Polymorphismen gefunden werden konnten, erhielten lediglich genetische Variationen des IL-18 (rs187238 und rs1946518) und IL-1β (rs16944) Einzug. Innerhalb von Carriermodellen, in denen Träger eines Allels zusammengefasst wurden, konnten keine genotypabhängigen Expressionsunterschiede des IL-18 und IL-1β beobachtet werden. Da genotypische Effekte häufig erst im Haplotypkontext hervortreten, wäre der Einbezug weiterer Variationen und eine damit verbundene genauere Repräsentation eines Gens eine sinnvolle Erweiterung bei der Untersuchung von Single Nucleotide-Polymorphismen. Der Hauptfokus der vorliegenden Arbeit war auf die Untersuchung von Genexpressionsunterschieden in Abhängigkeit von Kindheitstraumata sowie auf klinische, therapeutische und stressspezifische Aspekte vor diesem Hintergrund gerichtet. Das grundsätzliche Vorliegen eines Kindheitstraumas war mit einer Hochregulation von Caspase-1 und NLRP3, das Trauma einer emotionalen Vernachlässigung mit einer erhöhten Expression von NLRP3 assoziiert. Körperlich misshandelte Patienten exprimierten dagegen NLRP3 und IL-1β tendenziell geringer als rein depressive Patienten. Ähnliches zeigten emotional misshandelte Patienten für IL-1β. Die Aktivität des NLRP3-Inflammasoms wurde bisher nie in diesem Zusammenhang untersucht, sodass unsere Ergebnisse erstmals regulatorische Unterschiede einzelner Komponenten in Abhängigkeit verschiedener Traumatypen bei depressiven Patienten zur Diskussion stellen. Dies könnte einen möglichen Ansatz für zukünftige Behandlungsstrategien darstellen. In Anbetracht der reduzierten Patientenzahl sowie dem Fehlen gesunder Kontrollen wäre eine Wiederholung unserer Analysen in ähnlichem Setting zielführend. Klinische Aspekte einer Depression wie Suizidalität oder die Erkrankungsdauer sowie einzelne Stressoren waren bei statistischer Signifikanz ausnahmslos mit Kindheitstraumata assoziiert. Ein schlechteres Therapieansprechen ging mit einer körperlichen Vernachlässigung, einem sexuellem Missbrauch und tendenziell auch einer emotionalen Misshandlung einher. Unterschiede im Hinblick auf eine Therapieresponse und Krankheitsremission in Abhängigkeit der Traumasubtypen waren jedoch nicht signifikant, was allerdings dem kurzen Beobachtungszeitraum von 4 Wochen geschuldet sein könnte. Diesbezüglich wäre eine Bewertung nach einem längeren Zeitintervall von Interesse. / In this study we investigated the activity of the NLRP3-inflammasome in depressed patients. In difference to previous clinical trials all analyzes were carried out using a glucocorticoid challenge test. First, the impact of Dexamethasone on gene expression levels was explored. We found a significant decrease of the expression levels of the IL-1β gene (baseline), as well as an increase in Caspase-1 gene expression to the second measurement point in week 4. Gene expression levels of NLRP3 and IL-18 were not influenced by Dexamethasone. Besides different approaches to explain this observation, a replication in a larger sample would be interesting. To cover genetic influences, differences in regulation within the context of single nucleotide polymorphisms were analyzed. As there were no adequate polymorphisms found for the NLRP3 gene and the Caspase-1 gene, only variants of the IL-18 gene (rs187238 and rs1946518) and the IL-1β gene (rs16944) were included. Using carrier models, no genotype dependent differences on the expression levels of IL-18 and IL-1β could be observed. As genotypic effects often become evident in the haplotype context, the inclusion of additional genetic variants resulting in a more specific representation of the gene could be a useful approach when investigating single nucleotide polymorphisms. The main topic of this project was the exploration of gene expression differences of the NLRP3-inflammasome in relation to childhood trauma, as well as clinical, therapeutic and stress-associated aspects in this context. The presence of childhood trauma, regardless of trauma subtypes, was associated with an upregulation of Caspase-1 and NLRP3. Emotionally neglected patients also showed an elevated expression of the NLRP3 gene. In comparison to depressed patients without childhood trauma, physical abuse was rather accompanied by reduced gene expression levels of NLRP3 and IL-1β. Similar findings were observed for the IL-1β gene regarding emotional abuse. To our knowledge, the activity of the NLRP3-inflammasome has never been analyzed in this context before. With the results indicating differences in gene regulation of several components of the NLRP3-inflammasome depending on different types of childhood trauma in depressed patients, this might be an approach for future treatment strategies. Considering the small sample and the lack of healthy controls, replication in an extended setting might be beneficial. In case of statistical significance, clinical characteristics of depression like suicidality or the duration of illness, as well as several stressors were unexceptional associated with childhood trauma. A more severe course of depression was linked to the trauma of physical neglect, sexual abuse and, at least in part, to emotional abuse. Considering trauma subtypes, there were no differences in treatment response or remission from depression, which might be due to the rather short observation time of 4 weeks. Therefore an evaluation following a longer time period would be interesting.

Many asylum seekers have experienced trauma that causes them to flee their home country. A large portion of asylum seekers are women and are fleeing gender-based violence or experiencing it while fleeing. Due to this trauma, the researcher and the Human Rights Initiative of North Texas, a non-profit legal and social services organization, developed a research project to examine how trauma-informed,the asylum-seeking system is in the United States, specifically for those who are fleeing gender-based violence. A trauma-informed care approach attempts to address trauma and retraumatization systematically for both traumatized persons and those who work with traumatized people. This research takes a qualitative approach because it would allow for more in-depth and detailed analysis through trauma-informed, governmentality, and necropolises lenses. I interviewed 18 experts who, either as a social or legal service, specialize in working with asylum seekers who have experienced gender-based violence. These interviews, ranging from thirty minutes to an hour and a half, were recorded, transcribed, and coded for themes such as gender, trauma, and social determinants of health. None of the participants found the United States asylum-seeking system to be trauma-informed. The asylum-seeking system in the United States is not set up to meet clients where they are, and it works against their needs in a way that retraumatizes them and makes arguing their cases more complicated.

2023 / The constructs of forgiveness and spirituality/religion (S/R) have long been associated with recovery from trauma exposure, but how they relate to potential mechanistic variables of health, socioeconomic status (SES), and social engagement is less understood. To examine this issue, self-report data were collected from 254 monozygotic twin pairs with a mean age of 53 who were discordant for combat-related trauma exposure in Vietnam. Participants with missing data on relevant variables were removed, leaving 360 individuals in the sample comprised of 157 twin pairs and 46 unmatched twins.Regression models were created in 4 stages. Stage 1 examined hypothesized direct effects of combat exposure on multiple components of health, SES, and social engagement. Stage 2 examined the hypothesized impact of combat exposure on forgiveness variables and S/R-related variables. Stage 3 examined the hypothesized relationship between forgiveness variables and S/R variables and multiple components of health, SES, and social engagement. Stage 4 examined the impact of forgiveness separately among combat-exposed and non-combat-exposed participants to test for a differential pattern of association across these groups. Each stage of the study revealed statistically significant associations (p=<.05), with variable support for the hypotheses in stages 1-3. In Stage 1, combat exposure was significantly related only to mental health. In Stage 2, combat exposure was related to forgiveness, but not to S/R. In Stage 3, forgiveness of self was a unique and influential predictor as it was associated with all health-related variables as well as relationship satisfaction. Forgiveness of others and S/R variables were highly correlated, potentially masking unique effects of each variable when they were included together in the regression model. Nevertheless, S/R variables were significantly associated with mental health, physical functioning, and engagement in family relationships. As hypothesized, Stage 4 revealed differing patterns of significant associations among the two groups, such that forgiveness of self was related to social engagement among combat-exposed but not among non-combat-exposed participants. The results of this study provide insight into the complex relationship between the constructs of trauma, forgiveness, and spirituality. This study also highlights the relevance of these constructs to the development of clinical interventions given their impact on key aspects of well-being.