Raising voices of 2SLGBTQIA+ patients: The intersection of minority stress and systemic oppression in pharmacy practice.

BACKGROUND: Two-spirit, lesbian, gay, bisexual, trans, queer, intersex, asexual, and other sex, sexual, and gender identities (2SLGBTQIA+) experience minority stress processes in pharmacy settings. Processes may be distal (objective prejudicial events) or proximal (subjective internalized feelings) and lead to delay or avoidance of care. The nature of these experiences in pharmacies and ways to reduce occurrence is largely unknown. OBJECTIVES: This study aimed to characterize 2SLGBTQIA+ individuals' perceived experiences in pharmacies according to the minority stress model (MSM) and to elicit patient-identified individual, interpersonal, and systemic strategies for reducing systemic oppression of 2SLGBTQIA+ individuals in pharmacy practice. METHODS: This was a qualitative phenomenological study using semistructured interviews. Thirty-one 2SLGBTQIA+ individuals from the Canadian Maritime provinces completed the study. Transcripts were coded according to domains of the MSM (distal and proximal processes) and the lens of systemic oppression (LOSO) (individual, interpersonal, and systemic factors). Framework analysis was used to identify themes within each theoretical domain. RESULTS: Distal and proximal minority stress processes were described by 2SLGBTQIA+ individuals in pharmacy settings. Distal processes included direct and indirect perceived discrimination and microaggressions. Proximal processes included expectation of rejection, concealment, and internalized self-stigma. Nine themes were identified according to the LOSO. Two related to the individual (knowledge and abilities, respect), 2 related to interpersonal relations (rapport and trust, holistic care), and 5 related to systemic factors (policies and procedures, representation and symbols, training/specialization, environment/privacy, technology). CONCLUSION: Findings support the notion that individual, interpersonal, and systemic strategies can be implemented to reduce or prevent minority stress processes from occurring in pharmacy practice. Future studies should evaluate these strategies to better understand effective ways to improve inclusivity for 2SLGBTQIA+ people in pharmacy settings.

Community pharmacists' acceptance of prescribing pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV).

Background: Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention is highly effective. Pharmacists can increase PrEP accessibility through pharmacist prescribing. This study aimed to determine pharmacists' acceptance of a pharmacist PrEP prescribing service in Nova Scotia. Methods: A triangulation mixed methods study consisting of an online survey and qualitative interviews was conducted with Nova Scotia community pharmacists. The survey questionnaire and qualitative interview guide were underpinned by the 7 constructs of the Theoretical Framework of Acceptability (affective attitude, burden, ethicality, opportunity costs, intervention coherence, perceived effectiveness and self-efficacy). Survey data were analyzed descriptively and with ordinal logistic regression to determine associations between variables. Interview transcripts were deductively coded according to the same constructs and then inductively coded to identify themes within each construct. Results: A total of 214 community pharmacists completed the survey, and 19 completed the interview. Pharmacists were positive about PrEP prescribing in the constructs of affective attitude (improved access), ethicality (benefits communities), intervention coherence (practice alignment) and self-efficacy (role). Pharmacists expressed concerns about burden (increased workload), opportunity costs (time to provide the service) and perceived effectiveness (education/training, public awareness, laboratory test ordering and reimbursement). Conclusion: A PrEP prescribing service has mixed acceptability to Nova Scotia pharmacists yet represents a model of service delivery to increase PrEP access to underserved populations. Future service development must consider pharmacists' workload, education and training as well as factors relating to laboratory test ordering and reimbursement.

Frequent Assembly of Chimeric Complexes in the Protein Interaction Network of an Interspecies Yeast Hybrid.

Hybrids between species often show extreme phenotypes, including some that take place at the molecular level. In this study, we investigated the phenotypes of an interspecies diploid hybrid in terms of protein-protein interactions inferred from protein correlation profiling. We used two yeast species, Saccharomyces cerevisiae and Saccharomyces uvarum, which are interfertile, but yet have proteins diverged enough to be differentiated using mass spectrometry. Most of the protein-protein interactions are similar between hybrid and parents, and are consistent with the assembly of chimeric complexes, which we validated using an orthogonal approach for the prefoldin complex. We also identified instances of altered protein-protein interactions in the hybrid, for instance, in complexes related to proteostasis and in mitochondrial protein complexes. Overall, this study uncovers the likely frequent occurrence of chimeric protein complexes with few exceptions, which may result from incompatibilities or imbalances between the parental proteomes.

Environmental enrichment normalizes hippocampal timing coding in a malformed hippocampus.

Neurodevelopmental insults leading to malformations of cortical development (MCD) are a common cause of psychiatric disorders, learning impairments and epilepsy. In the methylazoxymethanol (MAM) model of MCDs, animals have impairments in spatial cognition that, remarkably, are improved by post-weaning environmental enrichment (EE). To establish how EE impacts network-level mechanisms of spatial cognition, hippocampal in vivo single unit recordings were performed in freely moving animals in an open arena. We took a generalized linear modeling approach to extract fine spike timing (FST) characteristics and related these to place cell fidelity used as a surrogate of spatial cognition. We find that MAM disrupts FST and place-modulated rate coding in hippocampal CA1 and that EE improves many FST parameters towards normal. Moreover, FST parameters predict spatial coherence of neurons, suggesting that mechanisms determining altered FST are responsible for impaired cognition in MCDs. This suggests that FST parameters could represent a therapeutic target to improve cognition even in the context of a brain that develops with a structural abnormality.

Modulation of neural activity by reward in medial intraparietal cortex is sensitive to temporal sequence of reward.

To restore movements to paralyzed patients, neural prosthetic systems must accurately decode patients' intentions from neural signals. Despite significant advancements, current systems are unable to restore complex movements. Decoding reward-related signals from the medial intraparietal area (MIP) could enhance prosthetic performance. However, the dynamics of reward sensitivity in MIP is not known. Furthermore, reward-related modulation in premotor areas has been attributed to behavioral confounds. Here we investigated the stability of reward encoding in MIP by assessing the effect of reward history on reward sensitivity. We recorded from neurons in MIP while monkeys performed a delayed-reach task under two reward schedules. In the variable schedule, an equal number of small- and large-rewards trials were randomly interleaved. In the constant schedule, one reward size was delivered for a block of trials. The memory period firing rate of most neurons in response to identical rewards varied according to schedule. Using systems identification tools, we attributed the schedule sensitivity to the dependence of neural activity on the history of reward. We did not find schedule-dependent behavioral changes, suggesting that reward modulates neural activity in MIP. Neural discrimination between rewards was less in the variable than in the constant schedule, degrading our ability to decode reach target and reward simultaneously. The effect of schedule was mitigated by adding Haar wavelet coefficients to the decoding model. This raises the possibility of multiple encoding schemes at different timescales and reinforces the potential utility of reward information for prosthetic performance.