Traumatic Model Research Articles

The Physiological and Psychological Impact of Race-Based Trauma: Implications for Counselor Education

The area of trauma has been well researched within counseling literature; however, discussions around race-based trauma have been proportionately minimal. Given the physiological, psychological, and behavioral impacts of race-based trauma it is imperative that counselors and counselor educators are equipped to broach and address client's experiences. Therefore, this article provides a review of race-based trauma literature and models. In addition, this article calls counseling professionals to action on exploring and addressing their own attitudes, beliefs, and biases, along with informing clinicians on how to advocate for people of color and translate their knowledge into their work.

Nonselective beta blockade enhances gut microbiome diversity in a rodent model of trauma, hemorrhage, and chronic stress

BACKGROUND Traumatic injury leads to gut dysbiosis with changes in microbiome diversity and conversion toward a “pathobiome” signature characterized by a selective overabundance of pathogenic bacteria. The use of non-selective beta antagonism in trauma patients has been established as a useful adjunct to reduce systemic inflammation. We sought to investigate whether beta-adrenergic blockade following trauma would prevent the conversion of microbiome to a “pathobiome” phenotype. METHODS Sprague-Dawley rats (n = 6–8/group) were subjected to routine daily handling (naïve), lung contusion with hemorrhagic shock (LCHS), or LCHS with daily chronic stress (LCHS/CS), each with or without administration of intraperitoneal propranolol (BB) (10 mg/kg/day). Fecal microbiome was measured on Days 0, 7, and 14 using high-throughput 16S rRNA sequencing and QIIME2 bioinformatics analyses. Alpha- and beta-diversity and microbiome composition were assessed with significance defined as *p < 0.05. RESULTS Use of propranolol following LCHS or LCHS/CS demonstrated a significant increase in the number of bacterial species (Chao1 index), as well as overall richness and evenness (Shannon index) compared with their untreated counterparts at Day 7. By Day 14, these differences were no longer apparent between BB and untreated groups subjected to LCHS/CS. There was an abundance of commensal bacteria such as Oscillospiraceae and Clostridia in LCHS and LCHS/CS treated with BB after 7 days which persisted at 14 days. CONCLUSION These findings suggest a role for beta-antagonism in altering the diversity of the gut microbiome and the need for further studies to elucidate the cellular and molecular mechanisms underlying this intriguing connection of microbiome with trauma and beta-blockade.

Autologous platelet-rich fibrin enhances skin wound healing in a feline trauma model

Trauma is a common cause of cutaneous surgical disease with an increased risk of secondary infection in cat clinics. Platelet-rich fibrin (PRF), a platelet and leukocyte concentrate containing multiple cytokines and growth factors, is known to accelerate the healing of wounds. However, how PRF affects wound healing in the cat trauma model has not been fully investigated. The study aimed to examine the impact of PRF on skin wound healing in the cat trauma model. In this study, PRF from cats was successfully produced for our investigation. The models of feline trauma were effectively established. A total of 18 cats were randomly divided into 3 groups (n = 6): (1) Control group (CON); (2) PRF group; (3) Manuka honey group (MAN, as a positive control). Experiments were performed separately on days 7, 14, 21, and 28. Our results showed that PRF was a safe and efficient method of wound healing that did not influence the cat’s body temperature, respiration rate, and heart rate (HR). PRF accelerated skin wound healing in the cat trauma model based on the rate and histological observation of wound healing. In addition, PRF promoted the production of growth factors and suppressed inflammation during wound healing. PRF accelerated wound healing by increasing the formation of collagen fibers, as shown by Masson-trichrome staining. The outcomes of the PRF and MAN groups were comparable. In conclusion, PRF improves the healing of skin wounds in cats by boosting the synthesis of growth factors, reducing inflammation, and enhancing the synthesis of collagen fibers.Graphical

Diagnostic Value of Serum Clara Cell Secretory Protein Level in an Experimental Blunt Chest Trauma Model

Objective: Blunt chest trauma is a significant clinical problem leading to injury of the lungs that may be fatal. Experimental blunt chest trauma is well established in animal models. This study aimed to investigate whether Clara cell secretory protein (CC16) can be a biomarker in an experimentally created blunt chest trauma model. Material and Methods: A total of 30 rabbits were used in our study. A modified bilateral blunt thoracic trauma model was used to produce different levels of lung contusion. We divided the rabbits into four groups according to the energy level at which blunt thoracic trauma was applied. Blood samples were taken from the control and trauma groups to evaluate CC16 levels at 0, 12, and 24 hours. Results: The CC16 levels measured at the start of the experiment were significantly lower in the control and low-energy groups compared to the medium- and high-energy groups (p =.002). While there was a significant difference in CC16 levels measured at the 12th hour (p =.004), no significant difference was found among the groups at the 24th hour. Upon analyzing the change in CC16 levels over time within the groups, we observed that CC16 levels decreased from 0–12 hours and subsequently increased after the 12th hour. Histopathologically, we observed that the level of contusion increased in proportion to the severity of trauma across the different groups. Conclusion: With the designed platform, we created a reproducible experimental model of pulmonary contusion from blunt thoracic trauma in rabbits. Increased levels of CC16 following a lung contusion could serve as a foundation for clinical decision-making. Thus, CC16 has the potential to serve as a rapid and simple biochemical indicator for acute traumatic lung injury.

Correlations between coagulation abnormalities and inflammatory markers in trauma-induced coagulopathy.

In multiple trauma patients, the occurrence of trauma-induced coagulopathy (TIC) is closely associated with tissue damage and coagulation function abnormalities in the pathophysiological process. This study established a multiple trauma and shock model in Sprague-Dawley (SD) rats and comprehensively utilized histological staining and radiographic imaging techniques to observe injuries in the intestine, liver, skeletal muscles, and bones. Monitoring activated partial thromboplastin time (APTT), platelet (PLT) count, respiratory rate, blood pressure, and other physiological indicators revealed time-dependent alterations in coagulation function and physiological indicators. Enzyme-linked immunosorbent assay (ELISA) measurements of inflammatory factors Tumor Necrosis Factor-alpha (TNF-α), Interleukin-6 (IL-6) and vascular endothelial injury marker (Syndecan-1) were also conducted. Experimental results demonstrated significant changes in tissue structure after multiple traumas, although widespread necrosis or hemorrhagic lesions were not observed. There were time-dependent alterations in coagulation function and physiological indicators. ELISA measurements showed a strong positive correlation between the significant decrease in PLT count and the increase in TNF-α and IL-6 concentrations. The study provides crucial information for the early diagnosis and treatment of TIC. The findings suggest that structured monitoring of coagulation and inflammatory indicators can help in understanding the pathophysiological changes and aid in the management of TIC in multiple trauma patients.

Trauma and social pathways to psychosis: Examining the role of attachment, social rank and dissociation in a clinical sample.

The trauma and social pathways model of psychosis proposes interactions between trauma, attachment, social rank and dissociation in pathways to psychosis, though this model has yet to be empirically investigated. The primary aim of this study was to examine the overall predictive value of the trauma and social pathways model using regression analysis. A secondary aim was to delineate hypothesized pathways between trauma and positive symptoms of psychosis using serial mediation analysis. This was a cross-sectional study of people attending mental health services for a psychosis-related diagnosis (N = 71). Measures of trauma, positive symptoms of psychosis, attachment, social comparison and dissociation were completed. A model of recurrent trauma, insecure attachment, social rank and dissociation predicted 23.2% of the variance in positive symptoms of psychosis. Recurrent trauma, attachment and dissociation contributed significantly to the model, while social rank did not. Further, serial mediation analysis indicated that the sequence of disorganized attachment and dissociation fully mediated the relationship between recurrent trauma and positive symptoms. Results provide preliminary support for the trauma and social pathways model of psychosis, specifically as it relates to recurrent trauma, insecure attachment and dissociation. Results did not support the social rank component of this model, however. These findings provide clear targets for the development of next-wave psychological interventions that focus on trauma-related variables in psychosis. Future studies should replicate these findings with a larger clinical sample, and consider a measure of shame to further elucidate social processes in pathways to psychosis.

Family therapy and EMDR after child abuse and neglect: moderating effects of child attachment style and PTSD symptoms on treatment outcome

ABSTRACT Background: Effective and appropriate care and treatment for children in order to decrease the psychosocial problems that arose after experiencing child abuse and neglect (CAN) is of vital importance, given the severity of symptomatology that may develop. Objective: The purpose of the present study was to examine whether attachment style and core cluster Posttraumatic Stress Disorder symptoms acted as moderators for treatment outcomes of a new integrative treatment model for trauma and attachment. In this treatment model, family therapy is combined with EMDR and obstacles for trauma processing are tackled first. Method: we included children, ages 6–12 years, with a history of CAN, who did not respond to evidence-based trauma treatment. Target treatment outcomes were problems in attachment, posttraumatic stress symptoms, behaviour, and emotion regulation. We conducted a multiple-baseline ABC Single-Case Experimental Design (SCED). We categorized 12 participants into four groups of attachment style and core cluster PTSD symptoms: (1) non-disorganized & re-experiencing; (2) non-disorganized & avoidance/hyperarousal; (3) disorganized & re-experiencing; & (4) disorganized & avoidance/hyperarousal. We compared the four groups with each other and across time, and the interaction between groups and effect over time. We conducted non-parametric permutation tests and estimated q-values for false discovery rate control. Results: Children with a disorganized attachment style had more severe symptomatology in general, except for posttraumatic stress symptoms. The treatment appeared more effective in targeting and successfully treating children with a non-disorganized attachment style, and specifically children with a non-disorganized attachment style and re-experiencing as core cluster PTSD symptoms. Conclusion: Our study underlines the complexity of treating children who developed a complicated combination of symptomatology after CAN and calls for the continuous development of innovative interventions.

A comparative study of the established methods and evaluation of rat trauma models.

Scientific animal models are indispensable for studying trauma repair. This work aimed at establishing a more scientific rat trauma model by studying different rat trauma models caused by different trauma numbers, locations, and trauma attachment tension unloaders and rat age. A four-trauma self-upper, lower, left and right control model; a two-trauma self-trauma bare and ring control model; and a young and old rat trauma model were created to evaluate the condition of these traumas. In the four-trauma self-control model, the healing status of the upper proximal cephalic trauma was better than that of the lower proximal caudal trauma, whereas there was no significant difference between the left and right trauma. The healing rate and postwound condition of the trauma with a ring control in the two-trauma model were better than those of the bare side. The healing speed of the old rats was slower, and the amount of extracellular matrix in the subcutaneous tissue after healing was significantly lower than that of the young rats. The double trauma with a ring is a more scientific and reasonable experimental model. There is a significant difference between young and old rats in the wound healing process. Therefore, the appropriate age of the rats should be selected according to the main age range of the patients with similar conditions in the clinical setting being mimicked.

HOUSING TEMPERATURE ALTERS BURN INDUCED HYPERMETABOLISM IN MICE.

Mice used in biomedical research are typically housed at ambient temperatures (22-24 °C) below thermoneutrality (26-31 °C). This chronic cold stress triggers a hypermetabolic response that may limit the utility of mice in modeling hypermetabolism in response to burns. To evaluate the effect of housing temperature on burn-induced hypermetabolism, mice were randomly assigned to receive sham, small, or large scald burns. Mice recovered for 21 days in metabolic phenotyping cages at 24 °C or 30 °C. Regardless of sex or sham/burn treatment, mice housed at 24 °C had greater total energy expenditure (TEE, P < 0.001), which was largely attributable to greater basal energy expenditure (BEE) when compared to mice housed at 30 °C (P < 0.001). Thermoneutral housing (30 °C) altered adipose tissue mass in a sex-dependent manner. Compared to sham and small burn groups, large burns resulted in greater water vapor loss, regardless of housing temperature (P < 0.01). Compared to sham, large burns resulted in greater BEE and TEE in mice housed at 24 °C, however, this hypermetabolic response to large burns was blunted in female mice housed at 30 °C, and absent in male mice housed at 30 °C. Locomotion was significantly reduced in mice with large burns compared to sham and small burn groups, irrespective of sex or housing temperature (P < 0.05). Housing at 30 °C revealed sexual dimorphism in terms of the impact of burns on body mass and composition, where males with large burns displayed marked cachexia, whereas females did not. Collectively, this study demonstrates a sex-dependent role for housing temperature in influencing energetics and body composition in a rodent model of burn trauma.

Childhood trauma and dissociative symptoms among young adults: A longitudinal study of the role of self-stigma

Dissociative symptoms, which are psychiatric phenomena recognized in both ICD-11 and DSM-5-TR, refer to failures in the process of integrating one's biopsychosocial experiences. While research shows that childhood trauma is associated with dissociative symptoms, little is known about whether childhood trauma could predict increases in dissociative symptoms even within a short period of time. Additionally, it remains unclear what moderators may influence this relationship. This study examined the effects of childhood trauma on subsequent dissociative symptoms and explored the potential moderating effects of mental health-related self-stigma. We analyzed longitudinal survey data from an international sample of young adults (N = 146). Participants completed validated standardized measures of childhood trauma, self-stigma, and dissociative symptoms at baseline, and they reported their dissociative symptoms again after approximately three months. Over 75 % of participants with pathological dissociation at baseline continued to exhibit pathological dissociation at follow-up. Baseline childhood trauma was associated with increases in dissociative symptoms even within a short period of time. Self-stigma significantly moderated the relationship between baseline childhood trauma and subsequent dissociative symptoms, after controlling for baseline dissociative symptoms. This study confirmed that childhood trauma is associated with increases in dissociative symptoms even within three months. We also found that self-stigma may exacerbate the effects of childhood trauma on subsequent dissociative symptoms. The results provide insights into the prevention and management of dissociative symptoms in childhood trauma survivors and inform the modification of the trauma model of dissociation.

Racialized Gender Stress and Mental Health Among Black Women: a Test of the Vance-wade Intersectional Suicide Risk Model with Longitudinal Data.

The recent shift in Black women's suicide risk calls for a new paradigm focused on unique factors specific to Black womanhood. The Vance-Wade Intersectional Suicide Risk Model (VWISRM) was introduced to contextualize this unexpected spike. According to the VWISRM, for Black women, psychosocial risk factors, gendered racism, and the Strong Black Woman script (SBW) lead to racialized gender stress (RGS) which results in mental health outcomes which are established predictors of suicide-related behaviors. The National Longitudinal Study of Adolescent Health (Add Health) was used to test for empirical evidence supporting the VWISRM. Our sample consisted of 418 Black female adolescent respondents who fully participated in data collection during Waves 1, 3, and 4. We ran bivariate analyses to examine both (1) what psychosocial factors of Black women are associated with SBW traits, gendered racism, and racialized gendered stress and (2) what mental health outcomes are predicted by SBW traits, gendered racism, and racialized gendered stress. Our analysis showed having both lower scores on the SBW traits and experiencing gendered racism are associated with a PTSD diagnosis. Specifically, the analysis explained 30% of the variation in PTSD diagnoses among Black women. Having both lower scores on the SBW traits predicted anxiety, PTSD, and contemplating suicide, and having experienced RGS linked to depression anxiety and contemplating suicide. Importantly, there were no moderating effects among SBW traits and RGS on PTSD, anxiety, or suicidality. Findings highlight important research and clinical implications for Black women's mental health. The Gendered Racism Intersectional Trauma model (GRIT) is introduced to better understand the breadth of mental health outcomes for Black women. Notably, our findings make a new contribution to the scientific inquiry of PTSD in Black women.

Kathy’s Trauma Response as a Means of Recovery in Kazuo Ishiguro’s Never Let Me Go

Trauma is a psychological condition resulting from distressing events experienced by an individual, leading to ongoing mental and emotional pain throughout their life. Survivors of trauma often develop various trauma responses, which act as implications or triggers stemming from their traumatic experiences. These mechanisms are essential for individuals to undergo in order to achieve healing and recovery from their trauma. This study aims to analyze how Kathy’s trauma responses influence her journey toward recovery in Kazuo Ishiguro’s novel Never Let Me Go. The novel presents Kathy’s narration about her experiences as a career and how she endures traumatic events, particularly the knowledge of her existence as a clone with a fated life, which generates traumatic responses in various aspects of her life. This study employs Judith Herman’s model of trauma and recovery, which is divided into three phases: establishment of safety, remembrance and mourning, and reconnection with ordinary life. Using this method, the researcher scrutinizes Kathy’s life as a career and her past throughout the novel. This study hypothesizes that Kathy undergoes trauma in her life, generating traumatic responses in many aspects of her life. However, those trauma responses are essential to be undergone as she eventually manages to achieve healing and recovery, offering her a sense of relief despite her unfortunate existence as a clone with predetermined fate

A Deployable Viscoelastic Coagulation Monitor Enables Point-of-Care Assessment of Coagulopathy in Swine With Polytrauma.

Absence of pre-hospital coagulation tests challenges prompt management of hemostasis after trauma. The Viscoelastic Coagulation Monitor (VCM, Entegrion, Durham, NC) is a hand-held coagulation test for point-of-care. We evaluated VCM in a translational swine polytrauma model, hypothesizing that VCM correlates with a laboratory reference method, the TEG 5000 (Haemonetics, Boston, MA), and can identify coagulopathic phenotypes relevant to trauma. Our secondary hypothesis was that pre-warming of VCM disposable test cartridges using a heating plate versus pre-warming of cartridges by carrying the cartridge in the user's pocket does not significantly alter results. This study was conducted in tandem with a parent study involving anesthetized, mechanically ventilated swine (n = 20; 54 ± 5 kg) that encountered traumatic brain injury, pulmonary contusion and hemorrhage, or combination/polytrauma injury. Blood was collected at baseline, post-injury, post-shock, post-transfusion, and 6-, 24-, and 48 h post-injury to perform VCM at point-of-care. Within-group effect of time was assessed. Spearman correlation examined linear relations between VCM and standard laboratory-based coagulation tests; as well as lactate, ionized calcium, and body temperature. Logistic regression examined predictiveness of VCM to identify coagulopathic phenotypes, with receiver operator characteristic curves generated to assess diagnostic capability. At a subset of timepoints, necessity of pre-warming the VCM test cartridge using a heating plate versus pre-warming the cartridge by placement in the user's pocket was assessed by conducting simultaneous tests on two separate instruments, with results analyzed by paired t-test with crossover design. VCM revealed time-dependent changes in clotting time, clot formation time (CFT), alpha, maximum clot firmness (MCF), and lysis index (LI30). All VCM metrics correlated with the respective TEG 5000 metrics, with strongest correlation for VCM MCF with TEG MA (rhos = 0.77, P < .0001) and VCM LI30 with TEG LY30 (rhos = -0.76, P < .0001). VCM demonstrated good (area under the curve >0.70) to excellent (area under the curve >0.90) diagnostic accuracy in detection of low platelet count (MCF), low hematocrit (clotting time, clot formation time, alpha, and MCF), low fibrinogen (MCF), and high fibrinogen (alpha, MCF). There was no statistically or clinically relevant effect of cartridge warming method on results. In a trauma model, VCM detected significant changes in coagulation at point-of-care in a simplified portable form factor. VCM could enable informed hemostasis management in pre-hospital settings where coagulations tests are unavailable, pending further validation in clinical trials.

ThP7.3 - Time of admission has no impact on outcome in trauma laparotomy

Abstract Introduction Trauma laparotomy outcomes are influenced by both patient and system factors. Out of hours (OOH) is associated with reduced staffing and on-site seniority which may impact patient outcomes. We aimed to establish if OOH laparotomy is associated with poorer outcomes. Methods A retrospective analysis was performed on all patients that underwent a trauma laparotomy at a major trauma centre between 2019 and 2023. Groups were divided into in-hour admission (IH) (08:00 - 20:00) and OOH (20:00– 08:00). The primary outcome was mortality and secondary outcomes included intensive care and total length of stay. Statistical analysis was performed to determine differences between groups. Results 176 patients were included. The majority (62.5%) were OOH and penetrating the commonest mechanism of injury in both OOH (63.6%) and IH (57.5%). Comparing those admitted OOH and IH there was no difference inactivation of code red protocols (42.7% vs 39.4% p=0.663). ITU admissions (36.3% vs 43.9% p=0.318), length of ITU stay (mean days 9.1 ± 11.1 vs 15.7 ±17.4 p=0.068), total hospital stay (mean days 14.4 ± 25.3 vs 19 ± 25.4 p=0.204) or mortality (7.3% vs 4.5% p=0.469). Conclusion Although a larger proportion of trauma laparotomies occur in the OOH period, no statistical difference was found in any patient outcomes. This is likely due to established processes in our mature trauma model.

Collaborative Preaching for Collective Trauma Healing: A Model from Indonesia

In this article, I propose a collaborative preaching model for healing collective trauma. It begins with the preaching context of a society in the grip of collective trauma after a traumatic event. Taking the May 1998 tragedy in Jakarta, Indonesia, as a case study and employing descriptive, historical, and analytical methods, this study argues that the Church is called to respond to collective trauma in its ministries as part of God’s mission. The research focuses specifically on the ministry of preaching and explores theories of trauma-aware preaching to affirm that preaching can indeed be a medium for healing collective trauma. I then present a collaborative preaching model for collective trauma healing by integrating a conversational preaching approach with the local Indonesian traditions of gotong-royong and musyawarah-mufakat.

Clinical validation of artificial intelligence-based preoperative virtual reduction for Neer 3- or 4-part proximal humerus fractures

BackgroundIf reduction images of fractures can be provided in advance with artificial-intelligence (AI)-based technology, it can assist with preoperative surgical planning. Recently, we developed the AI-based preoperative virtual reduction model for orthopedic trauma, which can provide an automatic segmentation and reduction of fractured fragments. The purpose of this study was to validate a quality of reduction model of Neer 3- or 4-part proximal humerus fractures established by AI-based technology.MethodsTo develop the AI-based preoperative virtual reduction model, deep learning performed the segmentation of fracture fragments, and a Monte Carlo simulation completed the virtual reduction to determine the best model. A total of 20 pre/postoperative three-dimensional computed tomography (CT) scans of proximal humerus fracture were prepared. The preoperative CT scans were employed as the input of AI-based automated reduction (AI-R) to deduce the reduction models of fracture fragments, meanwhile, the manual reduction (MR) was conducted using the same CT images. Dice similarity coefficient (DSC) and intersection over union (IoU) between the reduction model from the AI-R/MR and postoperative CT scans were evaluated. Working times were compared between the two groups. Clinical validity agreement (CVA) and reduction quality score (RQS) were investigated for clinical validation outcomes by 20 orthopedic surgeons.ResultsThe mean DSC and IoU were better when using AI-R that when using MR (0.78 ± 0.13 vs. 0.69 ± 0.16, p < 0.001 and 0.65 ± 0.16 vs. 0.55 ± 0.18, p < 0.001, respectively). The working time of AI-R was, on average, 1.41% of that of MR. The mean CVA of all cases was 81%±14.7% (AI-R, 82.25%±14.27%; MR, 76.75%±14.17%, p = 0.06). The mean RQS was significantly higher when AI-R compared with MR was used (91.47 ± 1.12 vs. 89.30 ± 1.62, p = 0.045).ConclusionThe AI-based preoperative virtual reduction model showed good performance in the reduction model in proximal humerus fractures with faster working times. Beyond diagnosis, classification, and outcome prediction, the AI-based technology can change the paradigm of preoperative surgical planning in orthopedic surgery.Level of evidenceLevel IV.

Mitigating rACEsm in K-12 Classrooms: The Consideration of Culturally-Informed Adverse Childhood Experiences and Utilization of Culturally Relevant Education and Systemically Trauma-Informed Practice

Forty-six percent of children in the United States experience a potentially traumatic event (PTE), also known as an Adverse Childhood Experience (or ACE), including abuse (physical, sexual, emotional), neglect, and/or household dysfunction (incarceration of a family member, parental mental illness, divorce, etc.) before their 18th birthday. In the United States, 61% of African-American youth experience at least one ACE (more than any other racial or ethnic group), compared with 40% of White children. A culturally informed conceptualization of the ACEs framework (C-ACEs) that considers the effects of historical trauma, racist social conditions, and race-based biological stress on African-American youth is essential. This is particularly important in K-12 Educational institutions for two reasons: (1) Schools are a major environment in which African-American youth are exposed to racial trauma via teachers, peers, policies, and practices within the school itself; (2) Popularity of the “trauma-informed” movement in schools that overemphasizes and overuses the existing ACEs framework (i.e., a “neoliberal biomedical trauma model”) and does not consider larger systems that cause and perpetuate trauma (p. 105). Further, it is essential to review how school teachers, administrators, and staff can amalgamate Systemically Trauma-Informed Practice (SysTIP) with Culturally Relevant Education (CRE) to increase education equity, reduce the trauma of racism experienced within educational spaces, and help ensure that African-American students succeed academically and personally.

A preoperative dose of the pyridoindole AC102 improves the recovery of residual hearing in a gerbil animal model of cochlear implantation

Sensorineural hearing loss (SNHL) is the most common sensory deficit worldwide. Due to the heterogeneity of causes for SNHL, effective treatment options remain scarce, creating an unmet need for novel drugs in the field of otology. Cochlear implantation (CI) currently is the only established method to restore hearing function in profound SNHL and deaf patients. The cochlear implant bypasses the non-functioning sensory hair cells (HCs) and electrically stimulates the neurons of the cochlear nerve. CI also benefits patients with residual hearing by combined electrical and auditory stimulation. However, the insertion of an electrode array into the cochlea induces an inflammatory response, characterized by the expression of pro-inflammatory cytokines, upregulation of reactive oxygen species, and apoptosis and necrosis of HCs, putting residual hearing at risk. Here, we characterize the small molecule AC102, a pyridoindole, for its protective effects on residual hearing in CI. In a gerbil animal model of CI, AC102 significantly improves the recovery of hearing thresholds across multiple frequencies and confines the cochlear trauma to the directly mechanically injured area. In addition, AC102 significantly preserves auditory nerve fibers and inner HC synapses throughout the whole cochlea. In vitro experiments in an ethanol challenged HT22 cell-line revealed significant and dose-responsive anti-apoptotic effects following the treatment of with AC102. Further, AC102 treatment resulted in significant downregulation of the expression of pro-inflammatory cytokines in an organotypic ex vivo model of electrode insertion trauma (EIT). These results suggest that AC102’s effects are likely elicited during the inflammatory phase of EIT and mediated by anti-apoptotic and anti-inflammatory properties, highlighting AC102 as a promising compound for hearing preservation during CI. Moreover, since the inflammatory response in CI shares similarities to that in other etiologies of SNHL, AC102 may be inferred as a potential general treatment option for various inner ear conditions.

An Umbrella Review of Systematic Reviews on Trauma Informed Approaches.

Trauma and adversity significantly impact on morbidity and mortality. Hence, trauma-informed care is proliferating practice and research contexts. However, the evidence base for organisational wide trauma-informed care is far from conclusive, with the extant literature providing low quality and conflicting evidence. The purpose of this umbrella review of systematic reviews, is to summarise the existing evidence on trauma-informed care implemented at the organisational level. The preferred reporting items for systematic review and meta-analyses (PRISMA) was used to conduct an umbrella review. Six databases were searched; Academic Search Complete, APA Psych Articles, Cochrane Library, Embase, Scopus, and the Web of Science, supplemented with bibliography searches. Articles were included if they were peer reviewed in the English language from inception to 2024 and reported on trauma-informed care with an implementation context. The Joanne Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses was used to assess the quality of the included reviews. Findings are mapped to the 10 trauma-informed care implementation domains described by the Substance Use and Mental Health Service Administration (SAMHSA) and reported using a narrative synthesis. The search strategy yielded 5,297 articles, of which (N = 14) systematic reviews are included. The reviews had a combined study count of (N = 311), with a total sample size of (N = 157,724). Most reviews used a narrative synthesis to report results, with no meta-analyses. Critical appraisal categorised the reviews as 28% high quality, 22% moderate quality, and 50% as low quality. Most reviews (50%), were conducted on youth populations, with school settings being the most studied context. There was a great deal of heterogeneity across the reviews, with 62 different models of trauma informed approaches discussed. The composition of the individual studies included in each systematic review were generally of low quality with mixed findings of effectiveness and implementation. Findings are discussed for moving forward with trauma-informed care implementation. Trauma-informed care is proposed as a system wide intervention to improve outcomes for service users, however the research base is still under scrutiny. Emerging research identifies the benefit of using the 10 trauma-informed implementation domains to shift cultural practices. Further research needs to be undertaken in various contexts with different populations.

Changes in Emergency Department Pediatric Readiness and Mortality.

High emergency department (ED) pediatric readiness is associated with improved survival, but the impact of changes to ED readiness is unknown. To evaluate the association of changes in ED pediatric readiness at US trauma centers between 2013 and 2021 with pediatric mortality. This retrospective cohort study was performed from January 1, 2012, through December 31, 2021, at EDs of trauma centers in 48 states and the District of Columbia. Participants included injured children younger than 18 years with admission or injury-related death at a participating trauma center, including transfers to other trauma centers. Data analysis was performed from May 2023 to January 2024. Change in ED pediatric readiness, measured using the weighted Pediatric Readiness Score (wPRS, range 0-100, with higher scores denoting greater readiness) from national assessments in 2013 and 2021. Change groups included high-high (wPRS ≥93 on both assessments), low-high (wPRS <93 in 2013 and wPRS ≥93 in 2021), high-low (wPRS ≥93 in 2013 and wPRS <93 in 2021), and low-low (wPRS <93 on both assessments). The primary outcome was lives saved vs lost, according to ED and in-hospital mortality. The risk-adjusted association between changes in ED readiness and mortality was evaluated using a hierarchical, mixed-effects logistic regression model based on a standardized risk-adjustment model for trauma, with a random slope-random intercept to account for clustering by the initial ED. The primary sample included 467 932 children (300 024 boys [64.1%]; median [IQR] age, 10 [4 to 15] years; median [IQR] Injury Severity Score, 4 [4 to 15]) at 417 trauma centers. Observed mortality by ED readiness change group was 3838 deaths of 144 136 children (2.7%) in the low-low ED group, 1804 deaths of 103 767 children (1.7%) in the high-low ED group, 1288 deaths of 64 544 children (2.0%) in the low-high ED group, and 2614 deaths of 155 485 children (1.7%) in the high-high ED group. After risk adjustment, high-readiness EDs (persistent or change to) had 643 additional lives saved (95% CI, -328 to 1599 additional lives saved). Low-readiness EDs (persistent or change to) had 729 additional preventable deaths (95% CI, -373 to 1831 preventable deaths). Secondary analysis suggested that a threshold of wPRS 90 or higher may optimize the number of lives saved. Among 716 trauma centers that took both assessments, the median (IQR) wPRS decreased from 81 (63 to 94) in 2013 to 77 (64 to 93) in 2021 because of reductions in care coordination and quality improvement. Although the findings of this study of injured children in US trauma centers were not statistically significant, they suggest that trauma centers should increase their level of ED pediatric readiness to reduce mortality and increase the number of pediatric lives saved after injury.