Hofstra University

Lay counselor delivery of trauma-focused cognitive behavioral therapy (TF-CBT) may be a promising strategy to increase access to trauma-focused care and prevent trauma-related health disparities among youth in low-resource settings in the United States. This pre-registered systematic review sought to synthesize how TF-CBT has been tailored for lay counselor delivery globally, which can inform broader dissemination. Specifically, we examined (1) the modification process, (2) treatment modifications, and (3) implementation strategies (e.g., training and supervision) to support lay counselor delivery of TF-CBT. In May 2024, a literature search was conducted across PsycINFO, PubMed, MEDLINE, and PILOTS. Grey literature was identified through Google Scholar and ProQuest. A narrative synthesis summarized findings by research question. Ten trials (21 articles) met inclusion criteria and described modifications or implementation strategies for lay counselor-delivered TF-CBT. All trials implemented culturally tailored versions of TF-CBT, with most (90%) conducted in low- and middle-income countries. The modification process relied on input from local experts through community-researcher collaborations. TF-CBT modifications were contextual (e.g., modality) or surface-level (e.g., language), with no trials reporting modifications to core components. Implementation strategies included enhancing training and supervision, addressing implementation barriers, and preserving counselor wellbeing. Findings suggest that TF-CBT can be successfully delivered by lay counselors with peripheral modifications, enhanced counselor supports, and strong community partnerships. This review provides a foundation for future research aimed at disseminating lay counselor-delivered TF-CBT in low-resource settings – a critical direction to close the mental health treatment gap and promote health equity in the United States and globally.

Postoperative hematoma is a common yet unfavorable complication following head and neck free flap reconstruction (HNFFR). This study aims to clarify how perioperative blood pressures influence postoperative neck hematoma development and its effect on outcomes in patients undergoing HNFFR.A retrospective chart review was conducted for all patients who underwent HNFFR at a single academic institution between January 2020 and December 2023. Data included demographics, radiation history, comorbidities, flap type, complications, and blood pressures at preoperative, intraoperative, early (<24 hours), and late (days 1-7) postoperative periods.A total of 317 patients with 329 flaps were included in our analysis. Twenty-seven patients developed a neck hematoma, and flap failure was significantly higher in these patients (11.1% vs. 2.4%, p = 0.044). After adjusting for potential confounding variables, hematoma formation was significantly associated with higher preoperative systolic and pulse pressures; peak early postoperative systolic pressures; and peak late postoperative systolic, diastolic, and mean arterial pressures (MAP). In a multivariate model including preoperative, early, and late postoperative MAP, only late postoperative MAP remained an independent predictor of hematoma. Each 1 mm Hg rise in late MAP raised hematoma odds by 4% (OR: 1.04, p = 0.004), and receiver operator curve analysis identified late MAP ≥ 117.8 carried a fivefold higher risk of hematoma (OR: 5.24, p < 0.001).Our findings suggest that postoperative blood pressure control is critical in reducing hematoma risk following HNFFR. Strict postoperative blood pressure management, particularly maintaining a MAP goal of < 110 mm Hg, may reduce hematoma risk and associated flap failure.

Vortexing is a reliable, reproducible, and practical method for resolving platelet clumping in EDTA samples without compromising sample integrity. Its implementation can reduce redraws, minimize manual smear reviews, and streamline sample processing in high-volume hematology laboratories.

Abstract Snow squalls remain a dangerous meteorological hazard, particularly to highway drivers. While snow squalls do not cause significant amounts of total snowfall, their rapid onset and intense nature create an environment conducive to roadway fatalities. In particular, the near-zero visibility and slick roadways caused by snow squalls can catch drivers by surprise, leading to multi-vehicle pileups. Though the US National Weather Service began issuing Snow Squall Warnings to mobile phones in 2018, many individuals remain unaware of the risks posed by this hazard. Additionally, extra cultural and language barriers exist when using traditional text-based warnings and guidance to communicate risks to Spanish-speaking groups with Limited English Proficiency. To enhance more traditional methods of risk communication, especially among non-native English-speaking groups, we created a virtual reality (VR) snow squall driving simulation. The simulation provides an open-ended environment in which users drive through a simulated snow squall. We conducted a user study in which 216 individuals tested the simulation and completed a survey. In total, 146 of the participants used the simulation and answered the survey questions in English, while the other 70 participants used the simulation and completed the survey in Spanish. Using the results, we compared the effectiveness of the VR simulation across the two survey cohorts. We found the VR simulation to be an effective communication tool across both groups, with participants finding the experience enjoyable and reporting intent for behavior change if faced with a real snow squall.

Mutations in protein tyrosine phosphatase non-receptor type 11 (PTPN11) have been considered late acquired mutations in acute myeloid leukemia (AML) development. Using single-cell DNA sequencing, we found that PTPN11 mutations can occur as initiating events in some patients with AML when accompanied by strong oncogenic drivers, commonly NPM1 mutations. The resulting AML has a diverse set of variably differentiated myeloid cells with few myeloid cells that lack leukemic mutations. The role of Ptpn11 as a codriver was confirmed in a murine model that exhibits an AML phenotype with a comparable immune diversity that is serially engraftable and reconstituted from early precursor cells. Furthermore, lineage-negative bone marrow cells from these mice reconstitute the full diversity of mature myeloid cells, and these cells exhibit an altered cytokine response after physiologic stimulation. Our work highlights how PTPN11-mutated AML is derived from a multitude of codominant and late acquired aberrations that have a previously unrecognized differentiated myeloid clonal expansion potentially contributing to pathogenesis of the disease.

Superficial leiomyosarcoma is a rare soft tissue sarcoma that typically presents as a firm, painful nodule in adults older than 50 years. We report a unique case of a 35-year-old woman with a slow-growing, mobile, subcutaneous nodule on the upper arm, initially presumed to be a benign lesion, most likely an angiolipoma. After excisional biopsy, histopathologic evaluation revealed an intermediate-grade leiomyosarcoma with focal dedifferentiation, demonstrating an abrupt transition from well-differentiated leiomyosarcoma to a high-grade, immunophenotypically undifferentiated sarcoma. Immunohistochemical staining showed loss of smooth muscle actin and desmin in the central dedifferentiated region, with retention of these stains at the peripheral lower-grade components. Wide local excision achieved clear margins, and imaging revealed no metastasis. Only 2 prior cases of cutaneous dedifferentiated leiomyosarcoma have been reported, both in the head and neck and with a more classic clinical presentation of a firm and immobile nodule. Our case is unusual in its location and deceptively benign clinical presentation. Given its aggressive potential and high reported rates of metastasis and mortality, prompt recognition and excisional biopsy are essential for diagnosis. This case highlights the importance of maintaining clinical suspicion for malignancy in persistent subcutaneous nodules and adds to the limited literature on dedifferentiated cutaneous leiomyosarcoma.