Experiences, Expectations, and Satisfaction with Police-a Population-Based Study of Differences by Race and Ethnicity in Two Counties.

We used the 2021 Policing in America Survey to examine experiences with police and perceptions of policing in Cook County, IL, and Dallas County, TX. Substantial portions of residents believe that local police use force during at least half of arrests (Cook 45.8%, Dallas 52.2%) and report dissatisfaction with local policing efforts (Cook 49.0%, Dallas 48.5%). Black and Hispanic residents in both communities were more likely than white, non-Hispanic residents to have frequent use of force expectations and dissatisfaction with police. Several other indicators of experiences with and perceptions of police also varied by race and ethnicity. We combined individual-level survey data with neighborhood-level data from the American Community Survey in multilevel logistic regression models to examine differences between groups for primary outcomes. Some findings were consistent for both counties. Black residents (Cook aOR = 3.63; Dallas aOR = 5.07) and those who had witnessed police misconduct were more likely to have frequent use of force expectations (Cook aOR = 6.44; Dallas aOR = 14.91). Differences between Black, Hispanic, and white residents were not associated with dissatisfaction in the adjusted models. Negative experiences with police (Cook aOR = 10.73; Dallas aOR = 12.11), witnessing misconduct (Cook aOR = 3.87; Dallas aOR = 3.55), and feeling unsafe in one's neighborhood (Cook aOR = 4.56; Dallas aOR = 3.49) were independently associated with greater odds of dissatisfaction. Inequities in exposure to unsafe neighborhoods, witnessing misconduct, and negative interactions with police are key drivers of variation in expectations and perceptions of police. Optimizing transparency and assurances of procedural justice are needed to reduce fear and increase satisfaction with police in the USA.

Multiyear Evaluation of Maintenance Electroconvulsive Therapy in an Adult With Autism Spectrum Disorder, Catatonia, and Challenging Behavior.

ABSTRACT: We report the case of a 30-year-old man diagnosed with autism spectrum disorder who received electroconvulsive therapy (ECT) over a 4-year period to treat catatonia associated with life-threatening self-injury, aggression, major depression, and associated self-care, daily living, and communication skills deficits. A systematic schedule of maintenance ECT (m-ECT) was associated with elimination of challenging behavior, catatonic and depressive symptom remission, removal of protective equipment, and reduced dosages of psychotropic medications.

2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility.

RATIONALE: A guideline that both evaluates current practice and provides recommendations to address sedation, pain, and delirium management with regard for neuromuscular blockade and withdrawal is not currently available. OBJECTIVE: To develop comprehensive clinical practice guidelines for critically ill infants and children, with specific attention to seven domains of care including pain, sedation/agitation, iatrogenic withdrawal, neuromuscular blockade, delirium, PICU environment, and early mobility. DESIGN: The Society of Critical Care Medicine Pediatric Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill pediatric patients with consideration of the PICU Environment and Early Mobility Guideline Taskforce was comprised of 29 national experts who collaborated from 2009 to 2021 via teleconference and/or e-mail at least monthly for planning, literature review, and guideline development, revision, and approval. The full taskforce gathered annually in-person during the Society of Critical Care Medicine Congress for progress reports and further strategizing with the final face-to-face meeting occurring in February 2020. Throughout this process, the Society of Critical Care Medicine standard operating procedures Manual for Guidelines development was adhered to. METHODS: Taskforce content experts separated into subgroups addressing pain/analgesia, sedation, tolerance/iatrogenic withdrawal, neuromuscular blockade, delirium, PICU environment (family presence and sleep hygiene), and early mobility. Subgroups created descriptive and actionable Population, Intervention, Comparison, and Outcome questions. An experienced medical information specialist developed search strategies to identify relevant literature between January 1990 and January 2020. Subgroups reviewed literature, determined quality of evidence, and formulated recommendations classified as "strong" with "we recommend" or "conditional" with "we suggest." Good practice statements were used when indirect evidence supported benefit with no or minimal risk. Evidence gaps were noted. Initial recommendations were reviewed by each subgroup and revised as deemed necessary prior to being disseminated for voting by the full taskforce. Individuals who had an overt or potential conflict of interest abstained from relevant votes. Expert opinion alone was not used in substitution for a lack of evidence. RESULTS: The Pediatric Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill pediatric patients with consideration of the PICU Environment and Early Mobility taskforce issued 44 recommendations (14 strong and 30 conditional) and five good practice statements. CONCLUSIONS: The current guidelines represent a comprehensive list of practical clinical recommendations for the assessment, prevention, and management of key aspects for the comprehensive critical care of infants and children. Main areas of focus included 1) need for the routine monitoring of pain, agitation, withdrawal, and delirium using validated tools, 2) enhanced use of protocolized sedation and analgesia, and 3) recognition of the importance of nonpharmacologic interventions for enhancing patient comfort and comprehensive care provision.

"We are just magic": A qualitative examination of self-love among Black same-gender loving men.

OBJECTIVES: Black same-gender loving men (BSGLM) represent a population with understudied lived experiences as both racial and sexual minority individuals. Most existing research among BSGLM focuses on sexual health outcomes in the context of minority stress, without consideration of the full experiences of BSGLM or strengths-based approaches. The present study aimed to address this gap in the literature by examining self-love among BSGLM using a phenomenological qualitative approach. METHOD: Adult BSGLM in the U.S. (n = 19; Mage = 31.79 years [SD = 8.88]) were recruited online and completed interviews via phone and video conferencing. Data were coded independently by two trained coders via an iterative approach that included in vivo coding and line-by-line comparative coding. Codes were grouped thematically, guided by sexual minority identity and positive psychology literature. RESULTS: Three major themes related to self-love among BSGLM emerged: (a) Freedom of identity, meaning participants' ability to construct an identity outside of societal expectations; (b) Community connection and pride, or participants' connection to and pride derived from the BSGLM community; and (c) Adversarial growth and resilience, or ways that adversity related to BSGLM identity generated personal growth. CONCLUSIONS: Current findings may have clinical implications. Using narrative therapy approach, facilitating connectedness to the BSGLM community, and implementing gratitude interventions in therapeutic settings may enhance self-love and positive self-regard among BSGLM. Future research should continue to give voice to the full lived experience of BSGLM. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Prospective Validation of the Preschool Confusion Assessment Method for the ICU to Screen for Delirium in Infants Less Than 6 Months Old.

OBJECTIVES: ICU delirium is a predictor of greater morbidity and higher mortality in the pediatric population. The diagnostic obstacles and validity of delirium monitoring among neonates and young infants have yet to be fully delineated. We sought to validate the Preschool Confusion Assessment Method for the ICU in neonates and young infants and determine delirium prevalence in this young population. DESIGN: Prospective cohort study to validate the Preschool Confusion Assessment Method for the ICU for the assessment of ICU delirium in neonates and young infants compared with the reference standard, Child and Adolescent Psychiatry. SETTING: Tertiary medical center PICU, including medical, surgical, and cardiac patients. PARTICIPANTS: Infants less than 6 months old admitted to the PICU regardless of admission diagnosis. MEASUREMENTS AND MAIN RESULTS: We enrolled 49 patients with a median age of 1.8 months (interquartile range, 0.7-4.1 mo), 82% requiring mechanical ventilation. Enrolled patients were assessed for delirium in blinded-fashion by the research team using the Preschool Confusion Assessment Method for the ICU and independently assessed by the psychiatry reference rater using Diagnostic and Statistical Manual of Mental Disorders-5 criteria. A total of 189 paired assessments were completed, and the Preschool Confusion Assessment Method for the ICU performed with a sensitivity of 95% (95% CI, 89-100%), specificity of 81% (68-90%), "negative and positive predictive values" of 97% (94-100%) and 69% (55-79%), respectively, compared with the reference rater. Delirium prevalence was 47%, with higher rates of 61% observed among neonates (< 1 mo old) and 39% among infants 1-6 months old. CONCLUSIONS: The Preschool Confusion Assessment Method for the ICU is a valid screening tool for delirium monitoring in infants less than 6 months old. Delirium screening was feasible in this population despite evolving neurocognition and arousal architecture. ICU delirium was prevalent among infants. The consequence of acute brain dysfunction during crucial neurocognitive development remains unclear. Future studies are necessary to determine the long-term impact of ICU delirium and strategies to reduce associated harm in critically ill infants.

Self-Compassion in PLWH: Less Internalized Shame and Negative Psychosocial Outcomes.

People living with HIV (PLWH) may experience internalized shame, which has been associated with negative psychosocial outcomes. Some of these psychosocial outcomes also are linked with worsening disease. Self-compassion, however, is the antithesis of internalizing shame, with elements of self-compassion (self-kindness, mindfulness, common humanity) at odds with indicators of internalized shame (negative beliefs about the self, desire to withdraw or avoid emotion, feelings of isolation). Therefore, we examined whether self-compassion among PLWH was associated with lower levels of internalized shame and, in turn, better psychosocial outcomes. We examined these relations using cross-sectional data collected from 181 PLWH living in the US via their participation in an online survey. Results revealed initial support for lower levels of internalized shame as potential mechanism that may explain how self-compassion comes to be associated with better outcomes among PLWH. Given self-compassion can be induced through intervention, we discuss how future research and clinical work with PLWH might address shame and improve outcomes.

Effects of a peer-mediated performance improvement intervention on recording of child well-body checks by educational care-providers.

We report the effects of peer-mediated training as a performance improvement intervention on recording of well-body checks by classroom instructors at a specialized school for children and youth. The instructors were trained as peer mediators and then assumed performance monitoring responsibilities in the classroom. Compared to baseline phases in a withdrawal design, peer-mediation increased recording of well-body checks to near-100% among the instructors. Results of the study document positive training effects on a critical health and wellness objective, support and expand the limited research base concerning the effects of peer-mediated training, suggest further application of such training in human services settings.

Preparing Students for Success: Differential Outcomes by Preschool Experience in Baltimore City, Maryland.

An early adopter of public preschool (i.e., pre-kindergarten, "pre-k"), evidence from Baltimore City, Maryland, can provide insight for those working to improve access to early education opportunities. We followed a cohort of children entering kindergarten in Baltimore City Public Schools during the 2007-2008 year through the 2010-2011 academic year. Students were grouped by pre-k experience: public pre-k (n = 2828), Head Start (n = 839), Head Start plus public pre-k (n = 247), private pre-k (n = 993), or informal care (n = 975). After adjusting for individual- and school-level characteristics, students from the Head Start plus public pre-k group were the most likely to enter kindergarten with the foundational skills and behaviors needed to be successful (vs. all groups, P ≤ .001). Students in informal care were the least likely to enter kindergarten with this skillset (vs. all pre-k groups P ≤ .001). Children from informal care were also significantly more likely than all other groups to be chronically absent in kindergarten (P ≤ .001). By third grade, children from informal care were least likely to be reading on grade level and most likely to have been retained a grade (vs. all pre-k groups P ≤ .001). Children from disadvantaged populations who were not enrolled in pre-k faced significant difficulties keeping up with their peers throughout elementary school; interventions to improve their transition to school and increase their likelihood of academic success are warranted. Universal preschool is likely to improve education outcomes for children in urban areas.

Measurement of Social Processes at the Neighborhood Level in Baltimore City.

Small-area ecological research is critical to inform place-based interventions at the neighborhood level; however, objective measurement of the social context has been limited. The current study extends the application of the Neighborhood Inventory for Environmental Typology (NIfETy) through the development and evaluation of measures of social context for a longer period of observation (3 years) and at a larger area of aggregation (census tract clusters) compared to previous studies using measures at the block-face level from a single observation. Observations from the 172-item inventory were collected from a random sample of block faces (n = 793) in Baltimore City annually over a three-year period. Through a multistep process including replication of previous measures, data reduction, and factor analysis, six unique neighborhood-level indices were generated to describe the environmental context: drug and alcohol use, violence, physical disorder, epicenter, youth activity, and improvements. An assessment of measurement consistency and validity provided support for some indices, while others had notable limitations. These indices can assist local policymakers and public health practitioners assessing the needs of individual neighborhoods and evaluating the effectiveness of place-based interventions designed to improve the neighborhood environment and population health outcomes.

Delirium and Benzodiazepines Associated With Prolonged ICU Stay in Critically Ill Infants and Young Children.

OBJECTIVES: Delirium is prevalent among critically ill children, yet associated outcomes and modifiable risk factors are not well defined. The objective of this study was to determine associations between pediatric delirium and modifiable risk factors such as benzodiazepine exposure and short-term outcomes. DESIGN: Secondary analysis of collected data from the prospective validation study of the Preschool Confusion Assessment Method for the ICU. SETTING: Tertiary-level PICU. PATIENTS: Critically ill patients 6 months to 5 years old. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Daily delirium assessments were completed using the Preschool Confusion Assessment Method for the ICU. Associations between baseline and in-hospital risk factors were analyzed for likelihood of ICU discharge using Cox proportional hazards regression and delirium duration using negative binomial regression. Multinomial logistic regression was used to determine associations between daily risk factors and delirium presence the following day. Our 300-patient cohort had a median (interquartile range) age of 20 months (11-37 mo), and 44% had delirium for at least 1 day (1-2 d). Delirium was significantly associated with a decreased likelihood of ICU discharge in preschool-aged children (age-specific hazard ratios at 60, 36, and 12 mo old were 0.17 [95% CI, 0.05-0.61], 0.50 [0.32-0.80], and 0.98 [0.68-1.41], respectively). Greater benzodiazepine exposure (75-25th percentile) was significantly associated with a lower likelihood of ICU discharge (hazard ratio, 0.65 [0.42-1.00]; p = 0.01), longer delirium duration (incidence rate ratio, 2.47 [1.36-4.49]; p = 0.005), and increased risk for delirium the following day (odds ratio, 2.83 [1.27-6.59]; p = 0.02). CONCLUSIONS: Delirium is associated with a lower likelihood of ICU discharge in preschool-aged children. Benzodiazepine exposure is associated with the development and longer duration of delirium, and lower likelihood of ICU discharge. These findings advocate for future studies targeting modifiable risk factors, such as reduction in benzodiazepine exposure, to mitigate iatrogenic harm in pediatric patients.

People Who Inject Drugs and Have Mood Disorders-A Brief Assessment of Health Risk Behaviors.

BACKGROUND: People who inject drugs have a greater risk of infectious disease and mortality than other substance abusers and nondrug users. Variation in risk behavior among people who inject drugs is likely associated with comorbid mental health disorders. OBJECTIVES: Examine the association between a history of mood disorder and recent risk behavior among people who inject drugs. METHODS: With baseline data from a behavioral HIV prevention clinical trial in a population of people who inject drugs, we used logistic regression models to compare the risk behaviors of people who report a past diagnosis of bipolar disorder (n = 113) or depression (n = 237) to a comparison group with no history of diagnosed mental illness (n = 446). We also assessed differences between groups before and after adjusting for demographic characteristics and current depressive symptoms. RESULTS: While there were no differences between groups in frequency of drug use, people who inject drugs who report a history of mood disorders reported more injection risk behaviors, drug overdoses, sex exchanges, and multiple partners than those with no history of mental illness. Adjusting the comparison for demographic characteristics and current depressive symptoms had little impact on these findings. Variation in risk between depression and bipolar disorder groups was minimal. Conclusions/Importance: People who inject drugs and have mood disorders have unique and significant social, clinical, and risk reduction needs. Despite the limited validity of self-reported mental health history, simply asking about a history of mood disorder may be effective for identifying a particularly vulnerable population of people who inject drugs.

The Preschool Confusion Assessment Method for the ICU: Valid and Reliable Delirium Monitoring for Critically Ill Infants and Children.

OBJECTIVES: Delirium assessments in critically ill infants and young children pose unique challenges due to evolution of cognitive and language skills. The objectives of this study were to determine the validity and reliability of a fundamentally objective and developmentally appropriate delirium assessment tool for critically ill infants and preschool-aged children and to determine delirium prevalence. DESIGN AND SETTING: Prospective, observational cohort validation study of the PreSchool Confusion Assessment Method for the ICU in a tertiary medical center PICU. PATIENTS: Participants aged 6 months to 5 years and admitted to the PICU regardless of admission diagnosis were enrolled. MEASUREMENTS AND MAIN RESULTS: An interdisciplinary team created the PreSchool Confusion Assessment Method for the ICU for pediatric delirium monitoring. To assess validity, patients were independently assessed for delirium daily by the research team using the PreSchool Confusion Assessment Method for the ICU and by a child psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders criteria. Reliability was assessed using blinded, concurrent PreSchool Confusion Assessment Method for the ICU evaluations by research staff. A total of 530-paired delirium assessments were completed among 300 patients, with a median age of 20 months (interquartile range, 11-37) and 43% requiring mechanical ventilation. The PreSchool Confusion Assessment Method for the ICU demonstrated a specificity of 91% (95% CI, 90-93), sensitivity of 75% (95% CI, 72-78), negative predictive value of 86% (95% CI, 84-88), positive predictive value of 84% (95% CI, 81-87), and a reliability κ-statistic of 0.79 (0.76-0.83). Delirium prevalence was 44% using the PreSchool Confusion Assessment Method for the ICU and 47% by the reference rater. The rates of delirium were 53% versus 56% in patients younger than 2 years old and 33% versus 35% in patients 2-5 years old using the PreSchool Confusion Assessment Method for the ICU and reference rater, respectively. The short-form PreSchool Confusion Assessment Method for the ICU maintained a high specificity (87%) and sensitivity (78%) in post hoc analysis. CONCLUSIONS: The PreSchool Confusion Assessment Method for the ICU is a highly valid and reliable delirium instrument for critically ill infants and preschool-aged children, in whom delirium is extremely prevalent.

Gender differences in disclosure concerns and HIV-related quality of life.

HIV-related disclosure concerns are associated with higher rates of concealment and poorer well-being, including poorer health related HIV quality of life (HIV-QOL). Little research, however, has examined whether gender differences exist in the links between HIV disclosure concerns and HIV-QOL. We expected that disclosure concerns and gender would be associated with HIV-QOL, such that the relationship between disclosure concerns and poorer HIV-QOL to be stronger in women living with HIV (WLWH) than in men living with HIV (MLWH). One hundred and forty MLWH (n = 102) and WLWH (n = 38) completed an online questionnaire consisting of measures regarding their demographics, disclosure concerns (HIV-stigma scale), and HIV-QOL (HIV-AIDS-Targeted Quality of Life Instrument). Results suggested that more disclosure concerns were associated with poorer HIV-QOL, but in general, men and women did not differ in their levels of HIV-QOL. As expected, interactions emerged between gender and disclosure concerns such that disclosure concerns were associated with increased health worries and poorer sexual functioning for WLWH but not for MLWH. Interventions should acknowledge the differing needs and experiences of WLWH in order to improve HIV-QOL and increase longevity.

Ethnic differences in the links between benefit finding and psychological adjustment in people living with HIV.

Experiencing growth after the diagnosis of a life threatening illness is commonly reported among people living with HIV (PLWH). The links between benefit finding and better adjustment in PLWH have been identified, but it is less clear whether these links vary by ethnicity. Minority stress theory suggests that individuals from minority populations may have unique stress experiences, which can have negative health implications but may also provide opportunity for growth. We hypothesized that the association between benefit finding and psychological adjustment would be stronger for Black (n = 80) than White (n = 87) PLWH. Contrary to predictions, the relationship between benefit finding and better adjustment was significant for White but not Black PLWH. Post-hoc analyses suggested that sexual orientation played role in this relationship. The relationship between benefit finding and psychological adjustment may be complex for Black PLWH, or they may achieve adjustment using other resources.

Reef flattening effects on total richness and species responses in the Caribbean.

There has been ongoing flattening of Caribbean coral reefs with the loss of habitat having severe implications for these systems. Complexity and its structural components are important to fish species richness and community composition, but little is known about its role for other taxa or species-specific responses. This study reveals the importance of reef habitat complexity and structural components to different taxa of macrofauna, total species richness, and individual coral and fish species in the Caribbean. Species presence and richness of different taxa were visually quantified in one hundred 25-m(2) plots in three marine reserves in the Caribbean. Sampling was evenly distributed across five levels of visually estimated reef complexity, with five structural components also recorded: the number of corals, number of large corals, slope angle, maximum sponge and maximum octocoral height. Taking advantage of natural heterogeneity in structural complexity within a particular coral reef habitat (Orbicella reefs) and discrete environmental envelope, thus minimizing other sources of variability, the relative importance of reef complexity and structural components was quantified for different taxa and individual fish and coral species on Caribbean coral reefs using boosted regression trees (BRTs). Boosted regression tree models performed very well when explaining variability in total (82·3%), coral (80·6%) and fish species richness (77·3%), for which the greatest declines in richness occurred below intermediate reef complexity levels. Complexity accounted for very little of the variability in octocorals, sponges, arthropods, annelids or anemones. BRTs revealed species-specific variability and importance for reef complexity and structural components. Coral and fish species occupancy generally declined at low complexity levels, with the exception of two coral species (Pseudodiploria strigosa and Porites divaricata) and four fish species (Halichoeres bivittatus, H. maculipinna, Malacoctenus triangulatus and Stegastes partitus) more common at lower reef complexity levels. A significant interaction between country and reef complexity revealed a non-additive decline in species richness in areas of low complexity and the reserve in Puerto Rico. Flattening of Caribbean coral reefs will result in substantial species losses, with few winners. Individual structural components have considerable value to different species, and their loss may have profound impacts on population responses of coral and fish due to identity effects of key species, which underpin population richness and resilience and may affect essential ecosystem processes and services.

The Perceived Stigma of Mental Health Services Among Rural Parents of Children With Psychosocial Concerns.

OBJECTIVE: To examine parents' perceptions of stigma regarding mental health services for their child, consider stigma in the context of novel service delivery settings (e.g., telehealth, primary care, and schools), and evaluate stigma with other factors known to influence service access. METHODS: 347 caregivers of children with psychosocial concerns completed surveys regarding their perceptions of stigma, service delivery settings, and barriers to care. RESULTS: Parents endorsed low levels of stigma around services. Greater perceived stigma was related to less willingness to seek services in a mental/behavioral health center or schools but not in other settings, even when other barriers were considered. Having a younger child and a history of prior services was associated with greater willingness to seek services. CONCLUSIONS: Stigma does appear to present as a barrier, but only for some parents. Providing mental health services to young children and their parents in some nontraditional settings may increase access.

Development and analyses of stakeholder driven conceptual models to support the implementation of ecosystem-based fisheries management in the U.S. Caribbean.

Fisheries management agencies in the U.S. Caribbean are currently taking steps into transitioning from a single species approach to one that includes Ecosystem Based Fisheries Management (EBFM) considerations. In this study, we developed and analyzed stakeholder-driven conceptual models with seven different stakeholder groups in Puerto Rico and the US Virgin Islands to assess and compare their perceptions of the fishery ecosystem. Conceptual models were developed for each stakeholder group during 29 separate workshops involving a total of 236 participants representing Commercial Fishers, Managers, Academics, Local Businesses, Environmental NGOs, and the Caribbean Fishery Management Council (CFMC) District Advisory Panels (DAPs) and Scientific and Statistical Committee (SSC). Non-Metric Multidimensional Scaling (nMDS) and two-mode social network analysis were used to investigate differences and similarities between stakeholder groups as well as to identify priority ecosystem elements and threats. Results show important variations between stakeholders and islands in terms of their perceived importance of ecosystem components and relationships, which supports the need for collaborative approaches and co-production of knowledge in the United States (U.S.) Caribbean region. Despite this variation, important areas of common concern among stakeholders were identified such as: habitat integrity (e.g., coral reefs), water quality, and influence of recreational fisheries and tourism on marine ecosystems. Findings of this study support the use of stakeholder-driven conceptual models as effective tools to guide decision-making, aid prioritization of data collection, and increase collaboration and cooperation among stakeholders in the context of fisheries management.

Non-Mass-Forming Myeloid Sarcoma of the Colon Presenting With Diarrhea.

A female patient in her mid-70s, with a history of diverticulosis, presented with a 2-month history of severe diarrhea, left lower quadrant abdominal pain, decreased appetite, and fever. She was treated for diverticulitis, but did not improve. Subsequent workup revealed leukocytosis and circulating myeloblasts on a peripheral blood smear. Bone marrow evaluation and flow cytometry confirmed the diagnosis of acute myeloid leukemia. Abdominal computed tomography and sigmoidoscopy were performed for her persistent diarrhea. While both failed to show an obvious mass or anatomical abnormality, pathology from the colorectum showed infiltration by leukemic cells consistent with myeloid sarcoma. The diarrhea improved with acute myeloid leukemia chemotherapy.

The Buckle of the Bible Belt: Sexual Minority Emerging Adults' Minority Stress in South Central Appalachia.

Introduction: Sexual minority emerging adults in Appalachia face multiple sources of stigma and discrimination. Methods: We conducted four focus groups and five one-on-one interviews with sexual minority young adults and community stakeholders. Results: Themes emerged from qualitative analysis: 1) Appalachian culture engenders discrimination and isolation; 2) A need to identify safe spaces; 3) Lack of access to identity-affirming health services; and 4) participants draw strength from limited but persistent resistance, advocacy, and visibility. Conclusion: Sexual minority emegerging adults experience intersectional stigma in a socially conservative Appalachian setting. Attention to their unique experiences points towards specific service and community support needs.

Anticipated Sexual Minority Stress and Mental Health after the 2016 Presidential Election: Examining a Psychological Mediation Framework.

Sexual minorities are at an increased risk for psychopathology, compared to heterosexual counterparts, in part due to stressors unique to their sexual minority identity. The greater socio-political climate may exacerbate sexual minority stress, and the context of the 2016 United States presidential election infringed upon the rights and well-being of LGBQ individuals. In our sample of sexual minorities (n = 253), we examined the association between anticipated stigma in response to the 2016 presidential election and symptoms of anxiety and depression, and the potential mediating role of self-compassion, hopelessness and social support. Greater anticipated stigma was associated with less self-compassion, less perceived social support, and greater hopelessness, and, in turn, greater symptoms of anxiety and depression. Anticipated stigma may erode feelings of environmental support and may be internalized as negative views of the self and future. From a public health perspective, policy-makers should be aware that the discussion and/or enactment of policies which discriminate against LGBQ persons may negatively impact mental health. Clinically, bolstering self-compassion and interpersonal functioning, and targeting hopelessness, through strategies such as Acceptance and Commitment Therapy and Compassion-Focused Therapy, may buffer the impact of minority stress among sexual minorities.