Is all prejudice created equal? The role of modern and aversive racism in mock juror decisions.

The current study examined whether aversive and modern racists would convict Black defendants differently based on theoretical differences: aversive racists are egalitarian and discriminate when not reminded of their values, whereas modern racists do not espouse egalitarian values and discriminate when a non-racial reason exists to justify their behavior. Participants read a criminal trial where defendant race (Black vs. White), race salience (present vs. absent), and justification (weak vs. strong evidence) were manipulated. Results showed that aversive and modern racists convicted the Black defendant at similar rates, but aversive racists were more likely to convict the White than the Black defendant. Aversive racists were also more egalitarian and less socially conservative. The finding that aversive racists convict Black and White defendants differently, but modern racists did not, suggests the importance of distinguishing aversive and modern racists to obtain a more complete picture of racial discrimination in juror decision making.

Primary medication nonadherence to oral oncology specialty medications.

BACKGROUND: Patients prescribed specialty oncology medications face logistical and financial challenges to medication procurement, leading to primary medication nonadherence (PMN). Limited research has evaluated rates and reasons for PMN within a specialty oncology population. Addressing PMN is essential to ensuring patient access and uptake and realizing benefits of these therapies. OBJECTIVES: The objectives of this study were to compute the rates of and reasons for PMN in patients prescribed oral oncology medications at an integrated health-system specialty pharmacy (IHSSP). METHODS: We performed a single-center, retrospective analysis of specialty oncology prescriptions electronically prescribed between January and December 2018. Data were extracted from electronic health record (EHR) and pharmacy claims databases. Prescriptions were PMN eligible if none of the following were met: fill of any cancer medication within the previous 180-day lookback window, duplicate prescription, cancellation within 30 days, rerouting to an external pharmacy within 30 days of prescribing, filled through alternate method, or nononcology or hematology condition. PMN was calculated by dividing eligible prescriptions unfilled during the study period by all eligible prescriptions. Reasons for a lack of prescription fulfillment were assessed via EHR review. Data were analyzed using descriptive statistics. RESULTS: We evaluated 4482 prescriptions from 1422 patients, resulting in 861 PMN-eligible prescriptions. Most PMN-eligible prescriptions (n = 668, 78%) were filled within 30 days, leaving 193 prescriptions as potential instances of PMN. After EHR review, 158 prescriptions met the exclusion criteria, resulting in a PMN rate of 4%. Of PMN prescriptions (n = 35), most were caused by clinical reasons (n = 22, 63%); however, 10 prescriptions were unfilled owing to patient decision, 2 owing to unaffordable treatment, and 1 owing to inability to reach the patient. Patients with PMN had a median age of 72 years and were mostly male (60%), with a median Charlson comorbidity index score of 7. CONCLUSION: Low rates of PMN to prescribed anticancer medications were found among electronic prescriptions intended to be filled at an IHSSP.

Upper Airway Pathology Contributes to Respiratory Symptoms in Children Born Very Preterm.

OBJECTIVE: To evaluate the role of upper airway dysfunction, indicated by altered vocal quality (dysphonia), on the respiratory symptoms of children surviving very preterm birth. STUDY DESIGN: Children born <32 weeks of gestation participated in 2 separate assessments during midchildhood. The first visit assessed voice quality by a subjective evaluation using the Consensus Auditory-Perceptual Evaluation of Voice and a computerized analysis of the properties of the voice via the Acoustic Voice Quality Index. The second assessment recorded parentally reported respiratory symptoms and measures of lung function, including spirometry, lung volumes, oscillatory mechanics, and a cardiopulmonary exercise test. RESULTS: Preterm children (n = 35; median gestation 24.3 weeks) underwent paired voice and lung assessments at approximately 11 years of age. Preterm children with dysphonia (n = 25) reported significantly more respiratory symptoms than those with normal voices (n = 10) including wheeze (92% vs 40%; P = .001) and asthma diagnosed by a physician (60% vs 10%; P = .007). Lung function outcomes were generally not different between the dysphonic group and the group with normal voice (P > .05), except for the oscillatory mechanics measures, which were all at least 0.5 z score lower in the dysphonic group (Xrs8 mean difference = -0.91 z scores, P = .003; fres = 1.06 z scores, P = .019; AX = -0.87 z scores, P = .010; Rrs8 = 0.63 z scores, P = .068). CONCLUSIONS: The upper airway may play a role in the respiratory symptoms experienced by some very preterm children and should be considered by clinicians, especially when symptoms are in the presence of normal lung function and are refractory to treatment.

Development and validation of the Attitudes Towards Police Legitimacy Scale.

Although there is a substantial body of work examining attitudes towards the police, no measure has been developed to consistently capture citizens' beliefs regarding police legitimacy. Given that police conduct has garnered a great deal of attention, particularly in the last few years, the current research sought to develop a scale measuring perceptions of police legitimacy. Across multiple studies, items were created and the scale's factor structure explored (Study 1 and Study 2), the factor structure was confirmed (Study 3a), and the predictive validity of the scale was tested (Studies 3b-3d). Results provided evidence for a reliable and valid 34-item scale with a single-factor solution that predicted multiple outcomes, including justification of a police shooting (Study 3b) and resource allocation to a police charity (Study 3c), as well as correlations with self-reported criminal activity, right-wing authoritarianism, and social dominance orientation (Study 3d). We hope this scale will be useful in the study of police legitimacy, expanding the current literature, and improving police-community relations. (PsycINFO Database Record

The Role of Pharmacists in the Opioid Epidemic: An Examination of Pharmacist-Focused Initiatives Across the United States and North Carolina.

A pharmacy presence on national, state, and local levels is helping to address the opioid epidemic. This article will comment on and examine how pharmacists are working together with the health care team and community to address the opioid crisis.

I Don't Like the Cut of your Jib: Perceived Facial Masculinity as a Cue to Criminality.

Previous research has established that the appearance of criminal suspects and defendants can affect subsequent legal decisions. Specifically, researchers have proposed that (1) masculine suspects are believed to commit more stereotypically male crimes (e.g., burglary), (2) masculine suspects are believed to commit more violent crimes (e.g., assault), and (3) masculinity is a general cue for committing crime. The current study sought to test these competing hypotheses regarding masculine appearance and perceived criminality. Across three studies, participants read a brief crime scenario and were asked to select out of a lineup the suspect they believed had committed the crime. Suspect masculinity and type of crime were manipulated to determine whether the degree of masculinity influenced whether participants believed they had committed the crime. Results showed that participants consistently associated masculinity with committing violent crime and showed some evidence for the general criminality hypothesis on secondary measures. These findings have important implications regarding law enforcement, eyewitness and juror bias, and legal decisions.

Better Breathing, Tougher Speaking? A Scoping Review of the Effects of Inhaled Corticosteroids on the Voice Quality of Asthmatic Children.

BACKGROUND: Inhaled corticosteroids (ICS) are a common treatment for certain lung diseases, including chronic obstructive pulmonary disorder in adults, and asthma across the lifespan. There is a link between the use of ICS and dysphonia in adults. This scoping review aims to investigate the incidence of dysphonia, in children aged under 12, who use ICS to treat asthma. METHODS: A scoping review was conducted, in accordance with the guidelines prescribed by Arksey and O'Malley (2005). ASHAWire, Science Direct, PubMed, and ProQuest databases were searched. Out of the total yield of 1471 articles, four articles met the inclusion criteria, that is, were primary studies reporting on voice quality in children who use ICS, who present with asthma and/or allergy. RESULTS: The majority of papers yielded from the initial search were retrieved because of the use of the term "dysphonia" in the basic definitions of asthma and descriptors of its side effects. Only four studies presented primary data about the presence of dysphonia in asthmatic children (with or without comorbid allergic conditions). None specifically investigated the relationship between ICS and dysphonia. Research questions focused on side effects associated with allergies and asthma, which included some information about medication. Only three of the four studies conducted a comprehensive review of the voice and utilized video laryngoscopy. DISCUSSION: The evidence of a relationship, between ICS and dysphonia in children, is not conclusive, and is complicated by the connection between asthma, and breath support for phonation. There is a need for more thorough and focused investigation of the relationship between ICS, with or without bronchodilator use, and any resultant effects on children's vocal quality.

Persistent Disparities in Pediatric Health Care Engagement During the COVID-19 Pandemic.

OBJECTIVE: The COVID-19 pandemic has disrupted traditional health care, including pediatric health care. We described the impact of the pandemic on disparities in pediatric health care engagement. METHODS: Using a population-based cross-sectional time-series design, we compared monthly ambulatory care visit volume and completion rates (completed vs no-show and cancelled visits) among pediatric patients aged 0-21 years in 4 states in the mid-Atlantic United States during the first year of the COVID-19 pandemic (March 2020-February 2021) with the same period before the pandemic (March 2019-February 2020). We used unadjusted odds ratios, stratified by visit type (telehealth or in-person) and sociodemographic characteristics (child race and ethnicity, caregiver primary language, geocoded Child Opportunity Index, and rurality). RESULTS: We examined 1 556 548 scheduled ambulatory care visits for a diverse pediatric patient population. Visit volume and completion rates (mean, 70.1%) decreased during the first months of the pandemic but returned to prepandemic levels by June 2020. Disparities in in-person visit completion rates among non-Hispanic Black versus non-Hispanic White patients (64.9% vs 74.3%), patients from socioeconomically disadvantaged versus advantaged communities as measured by Child Opportunity Index (65.8% vs 76.4%), and patients in rural versus urban neighborhoods (66.0% vs 70.8%) were the same during the remainder of the first year of the pandemic as compared with the previous year. Concurrent with large increases in telehealth (0.5% prepandemic, 19.0% during the pandemic), telehealth completion rates increased. CONCLUSIONS: Disparities in pediatric visit completion rates that existed before the pandemic persisted during the pandemic. These findings underscore the need for culturally tailored practices to reduce disparities in pediatric health care engagement.

Photosystems in the eye-like organelles of heterotrophic warnowiid dinoflagellates.

Warnowiid dinoflagellates contain a highly complex camera-eye-like structure called the ocelloid that is composed of different organelles resembling parts of metazoan eyes, including a modified plastid that serves as the retinal body.1 The overall structure of the ocelloid has been investigated by microscopy; because warnowiids are not in culture and are rare in nature, we know little about their function.1,2 Here, we generate single-cell transcriptomes from 18 warnowiid cells collected directly from the marine environment representing all 4 known genera and 1 previously undescribed genus, as well as 8 cells from a related lineage, the polykrikoids. Phylogenomic analyses show that photosynthesis was independently lost twice in warnowiids. Interestingly, the non-photosynthetic taxa still express a variety of photosynthesis-related proteins. Nematodinium and Warnowia (known or suspected to be photosynthetic1,3) unsurprisingly express a full complement of photosynthetic pathway components. However, non-photosynthetic genera with ocelloids were also found to express light-harvesting complexes, photosystem I, photosynthetic electron transport (PET), cytochrome b6f, and, in Erythropsidinium, plastid ATPase, representing all major complexes except photosystem II and the Calvin cycle. This suggests that the non-photosynthetic retinal body has retained a reduced but still substantial photosynthetic apparatus that perhaps functions using cyclic electron flow (CEF). This may support ATP synthesis in a reduced capacity, but it is also possible that the photosystem has been co-opted to function as a light-driven proton pump at the heart of the sensory mechanism within the complex architecture of ocelloids.

Multiple parallel origins of parasitic Marine Alveolates.

Microbial eukaryotes are important components of marine ecosystems, and the Marine Alveolates (MALVs) are consistently both abundant and diverse in global environmental sequencing surveys. MALVs are dinoflagellates that are thought to be parasites of other protists and animals, but the lack of data beyond ribosomal RNA gene sequences from all but a few described species means much of their biology and evolution remain unknown. Using single-cell transcriptomes from several MALVs and their free-living relatives, we show that MALVs evolved independently from two distinct, free-living ancestors and that their parasitism evolved in parallel. Phylogenomics shows one subgroup (MALV-II and -IV, or Syndiniales) is related to a novel lineage of free-living, eukaryovorous predators, the eleftherids, while the other (MALV-I, or Ichthyodinida) is related to the free-living predator Oxyrrhis and retains proteins targeted to a non-photosynthetic plastid. Reconstructing the evolution of photosynthesis, plastids, and parasitism in early-diverging dinoflagellates shows a number of parallels with the evolution of their apicomplexan sisters. In both groups, similar forms of parasitism evolved multiple times and photosynthesis was lost many times. By contrast, complete loss of the plastid organelle is infrequent and, when this does happen, leaves no residual genes.

A preliminary exploration of conversation sampling in pediatric voice disorders.

OBJECTIVE: Current methods of eliciting running speech for subjective rating, or perceptual analysis, in the assessment of pediatric voice disorders are not standardized. Whilst different assessment tools have different requirements, a commonality is the requirement to judge the perceptual characteristics of the individual's everyday speaking voice. However, it is unclear whether current practices yield ecologically valid running speech samples. The aim of this study was to analyse the length and characteristics of conversational responses, to stimuli that were designed to elicit running speech samples from pediatric clients. METHOD: Twenty conversations, conducted as part of the evaluation of voice in a pediatric population, were analysed. Length of responses, number of responses and question types were recorded. RESULTS: The median maximum utterance length was 15.9 s; seven participants presented with a maximum of less than 10 s. Response length was significantly associated with question type, F = 10.68, p<.001. The most frequent number of responses produced was 11 (range = 17, IQR = 5, 11). There was a moderate correlation between response length and number of responses, r(18)=.53, p=.02. DISCUSSION: These data demonstrated that informal conversational methods did not consistently yield running speech samples of greater than 10 s in length, the minimum sample length recommended by the CAPE-V protocol. There was considerable variability in the characteristics of the responses produced by participants. Using a task such as a narrative re-tell might allow for better standardization of responses, including elicitation of vocal behaviors of interest, as well as yield a longer sample.

Vocal health of sporting, fitness, and wellness leaders in Northern New York and Vermont.

INTRODUCTION: Fitness trainers and sporting coaches use their voices in acoustically poor conditions, for extended periods of time. Knowledge of the risk of voice problems in this cohort is emerging and has been documented in studies performed in Europe and Australia. This pilot study sought to identify the prevalence of voice problems of fitness trainers and sporting leaders in United States college towns. MATERIALS AND METHODS: An online questionnaire was distributed. The survey was based on the instrument developed by Rumbach (2013), "Vocal health of GFIs" (group fitness instructors (GFIs)) and adapted to account for the wider target population of this study. The survey included questions about participants' demographic information, as well as working conditions, including acoustic environment, leading requirements, equipment provision and maintenance and vocal diagnoses and symptoms. Questions on symptomatology included voice quality and physical symptoms (e.g. throat soreness). Recruitment took place between May and September 2018. RESULTS: Sixty-two participants completed the survey. Three participants (5.08%) reported having received a formal diagnosis of dysphonia, yet many more reported vocal symptoms, including physical symptoms (n = 15, 24.19%) and voice disturbance (n = 8, 12.90%). Few participants had received vocal education (n = 5, 8.06%) and many thought this should be included in their formal training (n = 24, 38.71%). CONCLUSIONS: In contrast to previous investigations, diagnosed voice disorders are less prevalent in this sample, based in US college towns. However, physical and vocal symptoms associated with voice overuse were common, suggesting that participants were unaware of their voice and the significance of the changes they reported.

Exploring rates of PCSK9 inhibitor persistence and reasons for treatment non-persistence in an integrated specialty pharmacy model.

BACKGROUND: Nearly 40% of patients do not continue proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) therapy after 6 months, despite their ability to lower low-density lipoprotein cholesterol (LDL-C) and risk of cardiovascular events. Limited work has assessed persistence to PCSK9i therapy in an integrated specialty pharmacy model. OBJECTIVE: To assess rates of persistence to PCSK9i therapy and report reasons for non-persistence in patients serviced within an integrated specialty pharmacy. METHODS: We conducted a single-center, retrospective review of patients prescribed a PCSK9i at an academic health system between September 2015 and August 2018. Persistence was calculated as a binary measure (yes/no) of whether the patient was still receiving PCSK9i therapy at 3-, 12-, and 24-months; frequency distributions described reasons for non-persistence and descriptive statistics described the change in LDL-C from baseline to 24 months. RESULTS: 477 patients met inclusion criteria, 53% were male with median age of 63 years [IQR 56-70]. Median LDL-C at baseline was 157mg/dL and 86% had an atherosclerotic cardiovascular disease indication. Persistence at 3-, 12-, and 24-months was 94%, 80%, and 68%, respectively. Of the 262 patients persistent on PCSK9i therapy at 24 months with LDL-C values available, median LDL-C was 65 mg/dL. The most common reasons for non-persistence at 24 months included medication adverse effects (54%) and loss to follow-up (17%). CONCLUSIONS: High rates of persistence to PCSK9i were seen in patients receiving care within an integrated specialty pharmacy model compared with rates in previous studies, suggesting specialty pharmacists may play a role in mitigating many common reasons for PCSK9i non-persistence.

Release or Denial: Evaluating the Roles of Emotion and Risk in Parole Decisions.

Parole boards often incorporate numerous factors when making release decisions. These factors are typically related to the inmates' case files. However, in some instances, parole boards' decisions are influenced by factors outside of the case files, sometimes referred to as extra-legal factors. According to the emotion as social information model, emotion can communicate specific messages to others, and in this case, parole board members might unknowingly incorporate their own emotions and inmates' emotional displays into their decisions. The current study examines the role of parole board member and inmate emotional expressions as predictors of parole release decisions. Parole hearings were coded for emotion, parole board and inmate gender, supporter presence, and risk scores. Overall, risk scores and parole board members' emotions predicted release decisions. Higher risk scores were associated with a lower likelihood of release, and inmates' negative emotion was related to a lower likelihood of release. Implications are discussed.

Primary medication nonadherence calculation method specifications impact resulting rates.

BACKGROUND: Previous literature has illustrated a wide range of primary medication nonadherence (PMN) rates due to inconsistent calculation methods and parameters, but the impact of parameter specifications on PMN rates has not been assessed. OBJECTIVES: The objective of this study was to evaluate the impact of lookback window (LBW), duplicate window (DW), and fill window (FW) specifications on PMN rates in patients prescribed specialty self-administered oncology medications. METHODS: This was a single-center, retrospective cohort analysis. Patients receiving a new electronic specialty oncology prescription January-December 2018 were included; excluded if re-routed to an external pharmacy within 2 days, fell within a DW, or cancelled within a FW. Twenty-four methods were used to calculate PMN based on combinations of the following parameters: (i) absence of prior specialty self-administered oncology medication fill within LBW (90, 180 days); (ii) absence of a duplicate prescription within DW (2, 7, 30 days); and (iii) sold status within FW (14, 30, 60, 90 days). For each method, PMN was calculated as the number of unsold prescriptions within the FW divided by all eligible prescriptions. RESULTS: We evaluated 4,482 prescriptions, resulting in PMN ranging from 16% to 23%. Patients were commonly male (53%) and white (83%), with a median age of 64 years (interquartile range, IQR, 54, 72). Increasing the LBW from 90 to 180 days resulted in exclusion of 72 (2%) prescriptions and minimally impacted PMN rates. Most duplicate prescriptions (87%) occurred within two days of original prescription and PMN rates were minimally affected by DW. Most fulfilled prescriptions were filled within FW 30 days, 98% with a method of LBW 180, DW 2, and FW 30. Adjusting the FW consistently impacted PMN rates. CONCLUSIONS: Because various PMN definitions can significantly impact results, a thorough explanation of all parameter specifications should be reported in research using PMN.

Geographic distribution of prejudice toward African Americans: Applying the two-dimensional model.

Using the two-dimensional model of prejudice as a theoretical framework, we examined the geographic distribution of prejudice toward African Americans in the United States (N = 10,522). We found the East South Central, West South Central, and South Atlantic regions were associated with modern racism, principled conservatism characterized the Mountain region, aversive racism was prevalent in the East North Central region, and finally, low in prejudice was found in the Pacific, West North Central, Mid Atlantic, and New England regions. Additional analyses on political conservatism, social conservatism, and egalitarianism generally supported the distinctions between prejudice types made by the two-dimensional model. We believe mapping regional prejudice may have implications for testing theoretical differences between distinct types of prejudice as well as for implementing prejudice reduction strategies.

Conducting a pediatric randomized clinical trial during a pandemic: A shift to virtual procedures.

Background/Objective: Prior to the COVID-19 pandemic, our research group initiated a pediatric practice-based randomized trial for the treatment of childhood obesity in rural communities. Approximately 6 weeks into the originally planned 10-week enrollment period, the trial was forced to pause all study activity due to the COVID-19 pandemic. This pause necessitated a substantial revision in recruitment, enrollment, and other study methods in order to complete the trial using virtual procedures. This descriptive paper outlines methods used to recruit, enroll, and manage clinical trial participants with technology to obtain informed consent, obtain height and weight measurements by video, and maintain participant engagement throughout the duration of the trial. Methods: The study team reviewed the IRB records, protocol team meeting minutes and records, and surveyed the site teams to document the impact of the COVID-19 shift to virtual procedures on the study. The IRB approved study changes allowed for flexibility between clinical sites given variations in site resources, which was key to success of the implementation. Results: All study sites faced a variety of logistical challenges unique to their location yet successfully recruited the required number of patients for the trial. Ultimately, virtual procedures enhanced our ability to establish relationships with participants who were previously beyond our reach, but presented several challenges and required additional resources. Conclusion: Lessons learned from this study can assist other study groups in navigating challenges, especially when recruiting and implementing studies with rural and underserved populations or during challenging events like the pandemic.

Giant pattern VEPs in children.

Our aim is to elaborate the clinical significance of giant amplitude pattern reversal visual evoked potentials (VEPs) in children. 'Giant' amplitude VEPs exceed the upper 97.5th centile, 90% CI for age. We scrutinised 2750 pattern VEPs recorded to international standards between Jan 2015 and 2017 from children aged 16 years and under, attending a specialist children's hospital. Twenty seven children, median age 6yrs, (range 1-16 yrs), were identified with giant VEPs (P100 amplitude range 65-163 µV). Most, 22/27 (81%), had conditions associated with a risk of raised ICP. Sixteen of these twenty two children had craniosynostosis; six multi-sutural and eight single suture disease. Others had Idiopathic Intracranial Hypertension, arachnoid cyst, NF1 with shunted hydrocephalus, chronic infantile neurological cutaneous and articular (CINCA) syndrome, nephrotic cystinosis and obstructive sleep apnoea. Five children presented with a range of conditions, some associated with seizures some symptomatic, but as yet undiagnosed. Frequent structural associations were optical coherence tomography measures of optic disc maximum anterior axial horizontal retinal thickness projection >160 µm and neuro-radiological findings of CSF effacement and copper beaten appearance. Ultrasonography measures of optic nerve sheath diameters varied, but in one child took 2 years to resolve after treatment for raised ICP. Optic disc gradings by fundoscopy were mostly normal, as were visual acuities. Raised ICP was confirmed by gold standard ICP bolt measurements in five of seven children tested. These data suggest that rICP should be considered if a child has sustained giant amplitude VEPs at normal latency.

Evaluation of lifetime trauma exposure and physical health in women with posttraumatic stress disorder or major depressive disorder.

The current study examines lifetime trauma exposure rates in 148 women with posttraumatic stress disorder (PTSD), major depressive disorder (MDD), or neither diagnosis and whether this is related to measures of PTSD, depression, hostility, health symptoms, and health care utilization. Findings indicate that multiple trauma exposures were prevalent in this sample, with 96% of those with PTSD and 79% of those with MDD reporting three or more trauma exposures compared to 46% in the comparison group. Controlling for diagnostic status, regression analysis for PTSD symptom severity reveals that the trauma exposure adult physical assault category was significantly associated with more severe PTSD and depressive symptoms, whereas the childhood violence category was most associated with increased hostility. PTSD and MDD groups reported greater past year health conditions and health care utilization.

The experiences of migrants to Australia who stutter.

PURPOSE: Migration is a contemporary, global matter. With the number of international migrants doubling over the past four decades, speech-language pathologists will likely work with migrants who have childhood-onset stuttering. However, combined migration and stuttering experiences have never been investigated specifically. This study is the first to investigate the experiences of migrants to Australia who stutter. METHODS: Three women and six men, aged 23 to 66 years old, participated. Data from individual interviews were analysed using Interpretative Phenomenological Analysis to examine the 'lived experience' of participants, as well as with NVivo 12 software for the management of coding. Participants also completed The Overall Assessment of the Speaker's Experience of Stuttering (OASES™). RESULTS: The stress experienced from migration interacted and compounded the existing stress of stuttering. Central themes emerged pertaining to the impact of increased stress on self-identity, the interactions of the stresses, as well as the coping strategies/facilitators. Stuttering and other personal factors, such as language(s) spoken and accent, had a negative impact on communication skills. CONCLUSION: Migration cannot be experienced independently of a stutter, as both are intrinsically linked to self-identity. The combined stress of migration with stuttering amplified the perception of feeling abnormal and resulted in difficulties with establishing a stable self-identity and a sense of belonging in the new context. Participants found strength in the company of others and considered Australia to be accepting of stuttering.