Evaluation of an SMS Based Alcohol Intervention for Same Sex Attracted Women: A Randomized Controlled Trial to Examine Feasibility, Acceptability, and Efficacy.

PURPOSE: The purpose of this randomized controlled trial (Trial registration ID: redacted) was to examine the feasibility, acceptability, and efficacy of the Step One program, an SMS-based alcohol intervention for same-sex attracted women (SSAW). METHODS: Ninety-seven SSAW who scored ≥8 on the Alcohol Use Disorders Identification Test (AUDIT) were randomly allocated to receive the Step One program (n = 47; mean age = 36.79) or a weekly message containing a link to a website with health information and support services for LGBT individuals (n = 50; mean age = 34.08). Participants completed questionnaires on alcohol use, wellbeing, and help-seeking at baseline (T1), intervention completion (T2; 4 wk after baseline) and 12 wk post-intervention (T3). In addition, participants in the intervention condition completed feasibility and accessibility measures at T2, and a subsample (n = 10) was interviewed about acceptability at T3. RESULTS: Across conditions, participants significantly reduced their alcohol intake and improved their wellbeing and help-seeking over time. However, there were no significant differences between the intervention and control condition. Furthermore, frequency of help-seeking was low; only four intervention group participants and three control group participants began accessing support between T1 and T3. Overall, our findings indicate the intervention would benefit from revision prior to implementation. CONCLUSIONS: Our approach was consistent with best practice in the development of an ecologically valid intervention; however, this intervention, in its current form, lacks the complexity desired by its users to optimally facilitate alcohol reduction among SSAW. Keywords: Alcohol intervention; Intervention mapping framework; Randomized controlled trial (RCT); Same-sex attracted women; Short-message service (SMS).

Addressing the Mental Health of Nursing Students During the Pandemic: The Evaluation of a Needs Assessment by a College of Nursing Mental Health Task Force.

BACKGROUND: A Mental Health Task Force (MHTF) was developed in a large public college of nursing in the Southeastern United States to address the urgent mental health needs expressed by growing numbers of nursing students related to the coronavirus disease 2019 (COVID-19). AIMS: The purpose of this study was to report on a needs assessment conducted by the MHTF. METHODS: The needs assessment study design was a 16-item cross-sectional online survey and four "Town Hall" focus groups with nursing students, faculty, and staff (n = 1-8 participants per group). Survey data were analyzed using descriptive statistics and free-text questions from the survey and focus groups were analyzed using a qualitative descriptive approach. RESULTS: Undergraduate and graduate students (n = 115) ranging in age from 17 to 50 years completed the survey; 95% female, 94% full-time, 56% employed, 77% White, and 81% in the Bachelor of Science in Nursing program. Eleven students participated in the focus groups. The analysis of the free-text survey questions identified the students' perceived needs. Mental health care was the most frequently requested, followed by faculty check-ins, stress management, and peer support. CONCLUSIONS: The administration of the survey provided an opportunity for students to communicate concerns and make requests. To address the ongoing effects of the COVID-19 pandemic on nursing students, multi-modal needs assessments should be conducted periodically to identify priority mental health needs.

Efficacy and safety of local candida immunotherapy in recalcitrant warts in pediatric kidney transplantation: A case report.

BACKGROUND: Warts are common in recipients of kidney transplantation (KT). Resistant warts which are not amenable to conventional therapies may lead to significant mor bidity. Limited data exists on safety and efficacy of local immunotherapy among immunocompromised KT recipients. CASE SUMMARY: We report a seven-year-old child who presented with recalcitrant plantar per iungual warts in the early KT period. Immunosuppression consisted of tacrolimus, mycophenolate and steroid. Due to failure of conventional anti-wart therapies, he was treated with two sessions of intralesional (IL) candida immunotherapy along with liquid nitrogen cryotherapy leading to complete resolution of the warts. Interestingly, de novo BK viremia was seen about three weeks following the last candida immunotherapy. This required reduction of immu nosuppression and other anti-BK viral therapies. Allograft function remained stable but there were donor specific antibodies detected. There also was elevated level of plasma donor derived cell-free DNA. A pneumocystis jirovecii pneumonia occurred ten months following completion of immunotherapy that was successfully treated with trimethoprim-sulfamethoxazole. During this ten-month follow-up period, there have been no recurrence of warts, and transplant kidney function has remained stable. CONCLUSION: Stimulation of cell-mediated immunity against the human papilloma virus induced by the IL candida immunotherapy is thought to be a cause for wart resolution. With this therapy, whether it is necessary to augment the immunosuppression to prevent rejection is unclear as that may come with a risk of infectious complications. Larger, prospective studies in pediatric KT recipients are needed to explore these important issues.

Building Spiritual Care Competency in Undergraduate Psychiatric Mental Health Nursing Students: A Quality Improvement Project.

Purpose: The spiritual care of patients is often overlooked in health care as many nurses are unprepared to provide competent, holistic care that addresses patients' spiritual needs. Since undergraduate academic instruction prepares nurses for practice, innovative strategies that train pre-licensure nurses to care for the spiritual needs of patients are essential. Design: A course needs assessment identified spiritual care as the most deficient competency for undergraduate psychiatric students. A three-phase quality improvement project designed to increase student awareness and practice of spiritual care included (a) development of a quality improvement plan, (b) implementation, and (c) outcome evaluation. Methods: Spiritual care was introduced into the Spring 2020 semester through didactic content and experiential practice. Additionally, an evidence-based spiritual assessment tool (i.e., HOPE questions) was integrated into the course to train students for use in clinical and simulation. Surveys were used to compare the 2019 and 2020 cohorts. Findings: Results showed a statistically significant increase in students' perception of spiritual care competency after project completion. Conclusions: Future implications include the use of similar methods to improve spiritual care competency for pre-licensure nursing students. Keywords: Spiritual care, undergraduate nurse, spiritual assessment.

Short-Term Outcomes of COVID-19 Pandemic on Non-Small Cell Lung Cancer Screening and Management.

Background To assess the impact of coronavirus disease 2019 (COVID-19) pandemic on non-small cell lung cancer (NSCLC) screening, staging, and management in a single health care system. Materials and Methods From November 2015 to December 2020, a total of 1,547 NSCLC cases was reported at our institution including 1,329 cases pre-COVID-19 and 218 cases during COVID-19. Pre-COVID-19 was defined as November 2015 to February 2020, while during COVID-19 was March 2020 to December 2020. Data were collected from tumor registry and medical record review. Patients with mesothelioma, lymphoma, small cell, or mixed small cell cancer were excluded from the study. Results Both pre-COVID-19 and during COVID-19 cohorts had similar comorbidities including age (70 vs. 71 years), current smokers (35 vs. 32%), and chronic obstructive lung disease (32 vs. 28%). The number of low-dose computed tomography lung cancer screening scans decreased by 25% during COVID-19 compared with pre-COVID-19 era. There were more cases of stage 1A NSCLC pre-COVID-19 (31 vs. 25%) and more stage 4 cancer during COVID-19 (42 vs. 33%); p = 0.01. The proportion of patients treated with radiotherapy was similar between pre-COVID-19 and during COVID-19 (49 vs. 50%), but fewer patients underwent surgery during COVID-19 (17 vs. 27%; p = 0.004). The median time to radiotherapy (67 days) and surgery (29 days) was similar between the groups. The unadjusted overall 6-month mortality after lung cancer diagnoses was higher during COVID-19 compared with pre-COVID-19 (28 vs. 22%; p = 0.04). Conclusion The COVID-19 pandemic resulted in delayed lung cancer screening scans, and more patients had diagnosis of advanced NSCLC; however, short-term mortality was unchanged.

A direct dynamics study of the exotic photochemistry of the simplest Criegee intermediate, CH2OO.

Criegee intermediates are amongst the most fascinating molecules in modern-day chemistry. They are highly reactive intermediates that find vital roles that range from atmospheric chemistry to organic synthesis. Their excited state chemistry is exotic and complicated, and a myriad of electronic states can contribute to their photodissociation dynamics. This article reports a multi-state direct dynamics (full-dimensional) study of the photoinduced fragmentation of the simplest Criegee intermediate, CH2OO, using state-of-the-art MS-CASPT2 trajectory surface hopping. Following vertical excitation to the strongly absorbing S2(1ππ*) state, internal conversion, and thus changes in the electronic state character of the separating O + CH2O fragments, is observed between parent electronic states at separations that, traditionally, might be viewed as the classically asymptotic region of the potential energy surface. We suggest that such long-range internal conversion may account for the unusual and non-intuitive total kinetic energy distribution in the O(1D) + CH2O(S0) products observed following photoexcitation of CH2OO. The present results also reveal the interplay between seven singlet electronic states and dissociation to yield the experimentally observed O(1D) + CH2O(S0) and O(3P) + CH2O(T1) products. The former (singlet) products are favored, with a branching ratio of ca. 80%, quantifying the hitherto unknown product branching ratios observed in velocity map imaging experiments. To the best of our knowledge, such long-range internal conversions that lead to changes in the electronic state character of the fragment pairs originating from a common parent - at classically asymptotic separations - have not been recognized hitherto in the case of a molecular photodissociation.

Identification of Anxiety and Depression Among Adolescent Kidney Transplant Recipients: A Cross-Sectional Observational Study.

INTRODUCTION: Studies demonstrate an association between mental health disorders and organ transplantation, with adolescents five times more likely to experience anxiety and depression than their nontransplant peers. The purpose of this study is to describe the prevalence of anxiety and depression in adolescent kidney transplant recipients using standardized mental health screening tools. METHOD: The standardized screening tools, generalized anxiety disorder-7 for anxiety and Patient Health Questionnaire-9 for depression, were administered over 6 months to kidney transplant recipients aged 12-21 years during the transplant clinic visit. RESULTS: Mental health screening increased by 74.0%. Patients reported mild to moderate anxiety at 46.4% and depression at 35.7%. DISCUSSION: Routine screening for mental health disorders in the transplant clinic allows for early identification of anxiety and depression, prompt referrals to a mental health professional, and improved health outcomes in adolescent kidney transplant recipients.

The states that hide in the shadows: the potential role of conical intersections in the ground state unimolecular decay of a Criegee intermediate.

Criegee intermediates are of great significance to Earth's troposphere - implicated in altering the tropospheric oxidation cycle and in forming low volatility products that typically condense to form secondary organic aerosols (SOAs). As such, their chemistry has attracted vast attention in recent years. In particular, the unimolecular decay of thermal and vibrationally-excited Criegee intermediates has been the focus of several experimental and computational studies, and it is now recognized that Criegee intermediates undergo unimolecular decay to form OH radicals. In this contribution we reveal insight into the chemistry of Criegee intermediates by highlighting the hitherto neglected multi-state contribution to the ground state unimolecular decay dynamics of the Criegee intermediate products. The two key intermediates of present focus are dioxirane and vinylhydroperoxide - known to be active intermediates that mediate the unimolecular decay of CH2OO and CH3CHOO, respectively. In both cases the unimolecular decay path encounters conical intersections, which may play a pivotal role in the ensuing dynamics. This hitherto unrecognized phenomenon may be vital in the way in which the reactivity of Criegee intermediates are modelled and is likely to affect the ensuing dynamics associated with the unimolecular decay of a given Criegee intermediate.

Risk and protective factors for the development of gambling-related harms and problems among Australian sexual minority men.

BACKGROUND: Sexual minority men (SMM) often experience stressful social environments dominated by stigma and discrimination. SMM are typically more likely than heterosexual men to engage in certain risky behaviours such as problem gambling. This study aimed to compare gambling behaviour among SMM and examine potential risk factors (erroneous gambling cognitions, gambling outcome expectancies, hazardous alcohol use, impulsivity, and psychological distress; as well as perceived stigma and discrimination for the SMM participants) and potential protective factors (resilience, social support, and community connectedness) for problem gambling severity and gambling-related harms among SMM living in Australia. METHODS: An online survey, with an over-representation of SMM participants and problem, moderate-risk, and low-risk gamblers, was completed by 101 SMM (mean age = 28.5) and 207 heterosexual men (mean age = 26.4). RESULTS: SMM were found to have significantly lower levels of problem gambling severity compared with heterosexual men, and report significantly lower gambling participation, frequencies and expenditure on any gambling activity, casino table games, horse racing/greyhound betting, sports betting, and keno. However, in the SMM group, 38.3% were classified in the problem gambling category of the Problem Gambling Severity Index and 27.6% were classified in the moderate-risk gambling category. There were no significant differences between groups in gambling-related harms. Multiple regression analyses revealed that problem gambling severity and related harms were independently predicted by higher levels of impulsivity and erroneous gambling cognitions for both groups. CONCLUSIONS: Lower frequency of gambling behaviours among SMM and similar risk factors predicting problem gambling severity/harms for both groups suggests that problem gambling is not pronounced among SMM. This study adds new evidence to the gambling literature which can be used as comparative benchmarks for future research.

Mobile Apps to Reduce Tobacco, Alcohol, and Illicit Drug Use: Systematic Review of the First Decade.

BACKGROUND: Mobile apps for problematic substance use have the potential to bypass common barriers to treatment seeking. Ten years following the release of the first app targeting problematic tobacco, alcohol, and illicit drug use, their effectiveness, use, and acceptability remains unclear. OBJECTIVE: This study aims to conduct a systematic literature review of trials evaluating mobile app interventions for problematic tobacco, alcohol, and illicit drug use. METHODS: The review was conducted according to recommended guidelines. Relevant databases were searched, and articles were included if the mobile app study was a controlled intervention trial and reported alcohol, tobacco, or illicit drug consumption as outcomes. RESULTS: A total of 20 studies met eligibility criteria across a range of substances: alcohol (n=11), tobacco (n=6), alcohol and tobacco (n=1), illicit drugs (n=1), and illicit drugs and alcohol (n=1). Samples included the general community, university students, and clinical patients. The analyzed intervention sample sizes ranged from 22 to 14,228, and content was considerably diverse, from simple stand-alone apps delivering self-monitoring or psychoeducation to multicomponent apps with interactive features and audio content, or used as adjuncts alongside face-to-face treatment. Intervention duration ranged from 1 to 35 weeks, with notifications ranging from none to multiple times per day. A total of 6 of the 20 app interventions reported significant reductions in substance use at post or follow-up compared with a comparison condition, with small to moderate effect sizes. Furthermore, two other app interventions reported significant reductions during the intervention but not at post treatment, and a third reported a significant interaction of two app intervention components. CONCLUSIONS: Although most app interventions were associated with reductions in problematic substance use, less than one-third were significantly better than the comparison conditions at post treatment. A total of 5 out of the 6 apps that reported intervention effects targeted alcohol (of those, one targeted alcohol and illicit drugs and another alcohol and tobacco) and 1 targeted tobacco. Moreover, 3 out of 6 apps included feedback (eg, personalized) and 2 had high risk of bias, 1 some risk, and 3 low risk. All 6 apps included interventions of 6 weeks or longer. Common study limitations were small sample sizes; risk of bias; lack of relevant details; and, in some cases, poorly balanced comparison conditions. Appropriately powered trials are required to understand which app interventions are most effective, length of engagement required, and subgroups most likely to benefit. In sum, evidence to date for the effectiveness of apps targeting problematic substance use is not compelling, although the heterogeneous comparison conditions and trial designs across studies limit the ability to compare efficacy between apps. We discuss potential approaches that can help ascertain whether the promise of mobile app interventions for problematic substance use can be fulfilled.

Persistent viral shedding despite seroconversion in a kidney transplant recipient with severe extrapulmonary COVID-19.

Renal transplant (RT) recipients are at increased risk for infectious complications. The clinical course of COVID-19 has been described in several RT recipients with varying clinical outcomes. Most present with pulmonary manifestations, however extrapulmonary presentations are not uncommon. Also, the timing and efficacy of seroconversion in transplant recipients is not well known. This report describes the duration of viral shedding and timing of seroconversion in a young adult RT recipient with COVID-19 who presented with severe diarrhoea and acute kidney injury requiring dialysis. She developed anti-SARS-CoV-2 IgG antibody after 5 weeks despite persistently shedding the virus in the nasopharynx until 6 weeks after symptom onset. Further studies are needed to determine if immunosuppressed patients have prolonged viral shedding and are still contagious despite seroconversion.

BK virus encephalitis and end-stage renal disease in a child with hematopoietic stem cell transplantation.

BK virus encephalitis after HSCT is uncommon. Several reports of native kidney BKVN in patients with HSCT, hematologic malignancies, human immunodeficiency virus infection, and non-renal solid organ transplantation have been described. However, an uncommon combination of BK encephalitis and ESRD of native kidneys secondary to BK virus in a child with HSCT has not been described. We report a 10-year-old boy who presented with a gradually rising serum creatinine during treatment for severe autoimmune hemolytic anemia, which he developed 9 months after receiving an allogeneic HSCT for aplastic anemia. There was no proteinuria or hematuria present. Serum BK virus load was 5 × 106  copies/mL. A renal biopsy showed evidence of BKVN. He developed fever, seizures, and confusion, and the (CSF) showed significant presence of the BK virus (1 × 106  copies/mL) along with biochemical evidence of viral encephalitis. Cerebrospinal fluid cultures were negative. Despite significant clinical symptoms and presence of BK virus in CSF, the magnetic resonance brain imaging findings were minimal. With reduction of immunosuppression, there was resolution of BK encephalitis but BKVN remained resistant to multiple anti-BK virus agents, including leflunomide and cidofovir. He eventually became dialysis-dependent and, 6 years later, received a renal transplant from his mother. This case illustrates that BK virus in severely immunocompromised HSCT recipient may lead to BK encephalitis and BKVN of native kidneys, even without hemorrhagic cystitis, leading to ESRD. Knowledge of such is important for appropriate timely evaluation and management.

Mild COVID-19 in a pediatric renal transplant recipient.

As of mid-April 2020, the coronavirus disease of 2019 (COVID-19) pandemic has affected more than 2 million people and caused 135 000 deaths worldwide. Not much is known about the effect of this disease in immunosuppressed children with renal transplantation (RT). Here we report a 13-year-old child with multiple comorbidities who acquired COVID-19 5 years post-RT in the United States. Maintenance immunosuppression (IS) consisted of sirolimus and mycophenolate. There was no history of travel or exposure to sick contacts. The presenting features were fever, cough, rhinorrhea, and hypoxemia. Diarrhea was the only extrapulmonary manifestation. Chest X-ray was normal. He did not require intensive care unit care or ventilation. There was a transient rise in his serum creatinine without change in urine output; dialysis was not required. Slight reduction in IS was done. He had an excellent clinical recovery within 4 days and was able to be discharged home. His respiratory symptoms resolved but the diarrhea persisted during a 4-week follow-up period. This report provides a brief perspective on the short-term COVID-19 clinical course in an immunosuppressed child. More reports will add valuable information on the potential variety of spectrum of the illness in this subset of children.

Limited Utility of Serology and Heterophile Test in the Early Diagnosis of Epstein-Barr Virus Mononucleosis in a Child after Renal Transplantation.

Background: Epstein-Barr virus (EBV) infection is associated with significant morbidity and mortality in renal transplant (RT) recipients. The spectrum of illness ranges from infectious mononucleosis (IM) to post-transplant lymphoproliferative disorder (PTLD). In association with clinical signs and symptoms, virus-specific serology and heterophile antibody tests are widely used in confirming the diagnosis of IM in the general population. However, these tests may have a limited role in immunosuppressed RT recipients from seropositive donor, especially in children who were EBV-seronegative prior to the transplant. The aim of this study is to evaluate the utility of these tests in the early diagnosis of IM in this subset of patients. Methods: This is a case study with a review of literature. Results: Here, we present a 14-year-old male with hemophilia B who presented with fever, fatigue, sore throat, palatal petechial rash, exudative tonsillitis and cervical lymphadenopathy 3 months post-RT. He was EBV seronegative prior to RT and received a deceased donor kidney transplant from a seropositive donor. Induction was done with Thymoglobulin and maintenance immunosuppression consisted of tacrolimus and mycophenolate. Initial heterophile antibody test (monospot) was negative, but became positive at 5 months and remained positive at 9 months follow-up post-RT. EBV viral capsid antigens (VCA) IgM and IgG, early antigen (EA) and nuclear antigen (EBNA) were all negative at the time of presentation. VCA IgM and IgG both became positive at 5 months and peaked at 9 months follow-up, however the EA and EBNA remained negative. EBV viral load as measured by polymerase chain reaction (PCR) was negative for the first 3 months post-RT but became positive at presentation, peaked at 6 months and started declining thereafter. Peripheral blood smear examination showed no absolute and atypical lymphocytosis. Cytomegalovirus PCR in the blood and throat culture for streptococcus were negative. There was no splenomegaly. He was managed conservatively with intravenous fluids, bed rest, antipyretics and reduction of immunosuppression. Conclusions: EBV serological markers have a limited role in the early diagnosis of EBV-IM following RT in prior seronegative children. Initial heterophile antibody test may also be negative, and hence a repeat test may be necessary. Once becoming positive, the VCA IgM may remain persistently elevated for prolonged duration. In addition to the suppressed cellular immunity secondary to immunosuppression, humoral response to viral infections is also delayed in transplant recipients, especially in the early transplant period. Hence, routine monitoring with PCR is superior to serology in diagnosing IM early and monitoring the EBV infection post-RT for timely evaluation and management.

Transplant renal artery stenosis in a child with BK nephropathy.

TRAS and BK nephropathy are known complications of RT, but the association between both has not been reported. A 2-year-old girl underwent a deceased donor renal transplant from a 20-year-old donor, along with bilateral native nephrectomies. She had a DGF due to a renal artery thrombus and required thrombectomy with re-anastomosis. Heparin and aspirin were used. Immunosuppressive agents included thymoglobulin, steroid, tacrolimus, and MMF. CMV and EBV DNA PCRs were negative, but she developed BK viremia at 2 months with stable allograft function. Immunosuppression was reduced, and leflunomide was initiated. Blood pressures were well controlled on low-dose amlodipine. Five months after RT, she presented with hypertensive emergency, following a respiratory infection, and required dialysis for oliguric acute kidney injury. Allograft biopsy showed evidence of BK nephropathy. Immunosuppression was further minimized. Doppler renal US and renal artery duplex studies were both suggestive of TRAS. Angiogram showed severe proximal anastomotic TRAS (>95% occlusion). PTA with stenting was done with immediate improvement in the blood flow and reduction in the pressure gradient. BPs and renal function normalized. Ten months post-RT, she remains normotensive with stable renal function and resolution of BK viremia. Although ureteral stenosis and nephropathy are known to occur with BK infection, TRAS is an interesting association and possibly suggest the tropism of BK virus to the vascular endothelial cells. Timely recognition and management of both is important to prevent uncontrolled hypertension and allograft dysfunction.

Effectiveness of a culturally tailored SMS alcohol intervention for same-sex attracted women: protocol for an RCT.

BACKGROUND: There is a large disparity between alcohol treatment access and prevalence of hazardous drinking among same-sex attracted women (SSAW). Yet, this population typically report low satisfaction with care and a reluctance to attend mainstream health services. Currently, there are few culturally tailored services for SSAW available despite evidence indicating that many feel uncomfortable in mainstream services. This paper describes the protocol of a randomised controlled trial aimed at examining the impact of a culturally sensitive four-week short message service (SMS) alcohol intervention on SSAW's alcohol intake, wellbeing, and engagement with alcohol treatment. METHODS: A randomised controlled trial comparing a culturally tailored SMS intervention (The Step One Program) with a generic 'thank you' message, and a nested qualitative study to further explore the intervention's feasibility and acceptability. The Step One Program was co-designed using an Intervention Mapping framework and engaging potential consumers in the developmental process. Participants are block randomised (1:1 ratio) and followed up at the completion of the intervention and at 12 weeks post-intervention. The primary outcomes are alcohol reduction (as measured by the Alcohol Use Disorders Identification Test and self-reported alcohol intake), wellbeing (as measured by the Personal Wellbeing Index - Adult), and help-seeking (as measured by the number of alcohol services accessed and frequency of access). Upon completion of the 12-week post-intervention survey, participants in the intervention group were contacted via email regarding a phone interview on intervention acceptability. DISCUSSION: This study may have important implications for clinical practice, improve healthcare access and equity for SSAW, and provide direction for future research in this field. The outcomes of the current study may stimulate the development of other culturally tailored health programs for SSAW. The results will inform whether individually tailoring the messages according to content and delivery frequency may be warranted to increase its acceptability. TRIAL REGISTRATION: This trial was registered with the Australian New Zealand Clinical Trials Registry (trial ID: ACTRN12617000768392 ).

Mental health help seeking patterns and associations among Australian same sex attracted women, trans and gender diverse people: a survey-based study.

BACKGROUND: Same sex attracted women (SSAW) are disproportionately affected by depression and anxiety, due to experiences of sexuality and gender based discrimination. They access mental health services at higher rates than heterosexual women, however with lower levels of satisfaction. This study examined the range of professional and social help seeking by same-sex attracted women, and patterns according to sexual orientation and gender identity subgroup. METHODS: Eight key stakeholders were interviewed, and a convenience sample of 1628 Australian SSAW completed an online survey in 2015. This included several scales to measure mental health, community connectedness and resilience; and measured past 12 month help seeking behaviour, enablers, barriers and preferences for mental health care. Chi-square analyses and binary logistic regression analyses examined demographic associations with mental health. Correlations between help seeking, mental and physical health, and connectedness were run. RESULTS: A high proportion (80 %) of the total sample had perceived mental health problems over the past 12 months. Over half had depression, and over 96 % had anxiety. Trans and gender diverse participants were twice as likely as female participants to have mental health problems, and lesbians were least likely. High levels of past 12 month help seeking included 74.4 % seeing a GP, 44.3 % seeing a psychologist/counsellor, 74.7 % seeking family/friends support and 55.2 % using internet based support. Professional help was prioritised by those with higher mental health need. Trans participants were most likely to have sought professional help and participated in support groups, but least likely to have sought help from friends or family. The most common barriers to help seeking were discrimination and lack of LGBTI sensitivity of services, particularly for gender diverse, queer and pansexual participants. Enablers included mainstream community connectedness, having a trustworthy GP, and encouragement by friends. CONCLUSIONS: Mental health services need to be LGBTI inclusive and to understand the emerging diverse sexual and gender identities. Peer support is an important adjunct to professional support, however may not be fully meeting the needs of some identity sub-groups. Mental health promotion should be tailored for diverse sub-groups to build mental health literacy and resilience in the face of ongoing discrimination.

Effect of cerebral perfusion pressure on cerebral cortical microvascular shunting at high intracranial pressure in rats.

BACKGROUND AND PURPOSE: Recently, we showed that decreasing cerebral perfusion pressure (CPP) from 70 mm Hg to 50 mm Hg and 30 mm Hg by increasing intracranial pressure (ICP) with a fluid reservoir induces a transition from capillary (CAP) to microvascular shunt (MVS) flow in the uninjured rat brain. This transition was associated with tissue hypoxia, increased blood-brain barrier (BBB) permeability, and brain edema. Our aim was to determine whether an increase in CPP would attenuate the transition to MVS flow at high ICP. METHODS: Rats were subjected to progressive, step-wise increases in ICP of up to 60 mm Hg by an artificial cerebrospinal fluid reservoir connected to the cisterna magna. CPP was maintained at 50, 60, 70, or 80 mm Hg by intravenous dopamine infusion. Microvascular red blood cell flow velocity, BBB integrity (fluorescein dye extravasation), and tissue oxygenation (nicotinamide adenine dinucleotide) were measured by in vivo 2-photon laser scanning microscopy. Doppler cortical flux, rectal and cranial temperatures, ICP, arterial blood pressure, and gases were monitored. RESULTS: The CAP/MVS ratio increased (P<0.05) at higher ICP as CPP was increased from 50 to 80 mm Hg. At an ICP of 30 mm Hg and CPP of 50 mm Hg, the CAP/MVS ratio was 0.6±0.1. At CPP of 60, 70, and 80 mm Hg, the ratio increased to 0.9±0.1, 1.4±0.1, and 1.9±0.1, respectively (mean±SEM; P<0.05). BBB opening and increase of reduced form of nicotinamide adenine dinucleotide occurred at higher ICP as CPP was increased. CONCLUSIONS: Increasing CPP at high ICP attenuates the transition from CAP to MVS flow, development of tissue hypoxia, and increased BBB permeability.