Preliminary Validation of Two Brief Measures of Masculine and Feminine Honor Endorsement.

Researchers have developed numerous individual differences measures to assess people's endorsement of honor ideology (i.e., beliefs regarding the importance of honor and reputation) with most ranging from 12-36 items in length. Despite having great utility, the length of these measures magnifies the costs associated with survey research, especially in research contexts that use large, representative samples (e.g., health surveys). The present study aimed to develop and validate single-item measures that assess participants' agreement with gender-specific honor prototypes, as well as short-form versions of the honor ideology for manhood (HIM) and honor ideology for womanhood (HIW) scales. An initial sample of participants (N = 879) completed single-item honor prototype measures, a battery of previously validated honor measures (including the HIM and HIW), and measures of constructs previously shown to be related to the dynamics of honor (e.g., aggression, firearm ownership). A second sample of participants (N = 100) completed the new measures, as well as an abbreviated battery of honor measures, to examine test-retest reliability. Results indicated that the new, brief measures were strongly correlated with both the original HIM and HIW as well as several other established honor measures. Moreover, the associations between these new measures and honor-related outcomes were nearly identical to those found with the original HIM and HIW. Our new measures also demonstrated acceptable test-retest reliability, despite being single-item scales. Overall, the present work provides preliminary support for several brief measures of honor endorsement that researchers can use when longer scales are not feasible.

Veteran suicide rates mirror, but do not account for, elevated suicide rates among the general population in US cultures of honor.

INTRODUCTION: Veteran total and firearm suicide rates are higher compared to the general population. Among the general population, total and firearm suicide rates are higher in US states deemed cultures of honor compared to non-honor states, likely because honor states have higher firearm ownership rates and fewer firearm laws. Considering that veterans tend to live in states with fewer firearm laws and that veteran population rates predict both statewide total and firearm suicide rates, it is possible that the elevated suicide rates seen in honor states in part due to those states having a greater presence of veterans compared to non-honor states. METHOD: Publicly available databases were used to obtain total and firearm suicide rates (per 100 k) for veterans and non-veterans, as well as our covariates (e.g., rurality). RESULTS: Veteran population proportions were higher in honor states than non-honor states. Veteran and non-veteran total and firearm suicide rates were higher in honor states compared to non-honor states. Statewide differences in all four suicide rates were indirectly explained by honor states having higher firearm ownership than non-honor states. CONCLUSIONS: These findings add to a growing body of literature showing that enacting firearm regulations may be a viable public health approach for preventing suicide.

A patient-centered nurse-supported primary care-based collaborative care program to treat opioid use disorder and depression: Design and protocol for the MI-CARE randomized controlled trial.

BACKGROUND: Opioid use disorder (OUD) contributes to rising morbidity and mortality. Life-saving OUD treatments can be provided in primary care but most patients with OUD don't receive treatment. Comorbid depression and other conditions complicate OUD management, especially in primary care. The MI-CARE trial is a pragmatic randomized encouragement (Zelen) trial testing whether offering collaborative care (CC) to patients with OUD and clinically-significant depressive symptoms increases OUD medication treatment with buprenorphine and improves depression outcomes compared to usual care. METHODS: Adult primary care patients with OUD and depressive symptoms (n ≥ 800) from two statewide health systems: Kaiser Permanente Washington and Indiana University Health are identified with computer algorithms from electronic Health record (EHR) data and automatically enrolled. A random sub-sample (50%) of eligible patients is offered the MI-CARE intervention: a 12-month nurse-driven CC intervention that includes motivational interviewing and behavioral activation. The remaining 50% of the study cohort comprise the usual care comparison group and is never contacted. The primary outcome is days of buprenorphine treatment provided during the intervention period. The powered secondary outcome is change in Patient Health Questionnaire (PHQ)-9 depression scores. Both outcomes are obtained from secondary electronic healthcare sources and compared in "intent-to-treat" analyses. CONCLUSION: MI-CARE addresses the need for rigorous encouragement trials to evaluate benefits of offering CC to generalizable samples of patients with OUD and mental health conditions identified from EHRs, as they would be in practice, and comparing outcomes to usual primary care. We describe the design and implementation of the trial, currently underway. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05122676. Clinical trial registration date: November 17, 2021.

Factors contributing to honor-endorsing men's suicide capability: Firearm ownership, practical capability, and exposure to painful and provocative events.

OBJECTIVE: White men in U.S. cultures of honor die by suicide at greater rates than other demographic groups. This finding has been attributed to factors such as the prevalence and use of firearms in men's suicide in honor states, as well as motivational risk factors (e.g., thwarted belongingness). Other features of honor cultures (e.g., physical aggression, risk-taking behaviors) suggest that honor-endorsing men may frequently experience painful and provocative events (PPEs), which, in turn, may facilitate practical capability for suicide. The present work tested this hypothesis and honor ideology's relationship to firearm ownership and storage practices. METHOD: In two samples of mostly White U.S. men-one undergraduate sample (N = 472, Mage  = 19.76) and one middle- to older adult sample (N = 419, Mage  = 65.17)-we assessed honor ideology endorsement, PPEs, practical capability for suicide, and firearm-related outcomes. RESULTS: Honor endorsement was greater among firearm owners (particularly self-protective owners), but it was unrelated to storage practices. Honor endorsement was positively associated with PPEs and practical capability. Additionally, the relationship between honor ideology and practical capability was indirectly explained by PPE exposure. CONCLUSIONS: Results highlight multiple avenues-PPEs, practical capability for suicide, (self-protective) firearm ownership-by which masculine honor norms may place men at risk for suicide.

Survey of public attitudes towards imminent death donation in the United States.

Imminent death donation (IDD) is described as living organ donation prior to a planned withdrawal of life-sustaining care in an imminently dying patient. Although IDD was ethically justified by United Network for Organ Sharing, the concept remains controversial due to presumed lack of public support. The aim of this study was to evaluate the public's attitudes towards IDD. A cross-sectional survey was conducted of US adults age >18 years (n = 2644). The survey included a case scenario of a patient with a devastating brain injury. Responses were assessed on a 5-point Likert scale. Results showed that 68% - 74% of participants agreed or strongly agreed with IDD when posed as a general question and in relation to the case scenario. Participants were concerned about "recovery after a devastating brain injury" (34%), and that "doctors would not try as hard to save a patient's life" (33%). Only 9% of participants would be less likely to trust the organ donation process. In conclusion, our study demonstrates strong public support for IDD in the case of a patient with a devastating brain injury. Notably, participants were not largely concerned with losing trust in the organ donation process. These results justify policy change towards imminent death donation.

Assessment of primary care practitioners' attitudes and interest in pharmacogenomic testing.

Aims: Identify the attitudes and interests of primary care providers (PCPs) in applying clinical pharmacogenomics (PGx) test results. Materials & methods: A questionnaire was designed and then disseminated to PCPs across the MedStar Health System. Results: Ninety of 312 (29%) PCPs responded and were included in analyses. Seventy-six (84%) had heard of PGx and 12 (13%) previously ordered PGx testing. Most, 68 (76%), believed PGx can improve care; however, a minority, 23 (26%), reported confidence in using PGx in prescribing decisions. Sixty-four (70%) wanted a pharmacist consultation. PCPs desired PGx for antidepressants (75%), proton pump inhibitors (72%) and other medications. Conclusion: Most PCPs felt unprepared to interpret PGx results and desired pharmacist consultations. These data can inform future PGx implementations with PCPs.

Analytical evaluation of the clonoSEQ Assay for establishing measurable (minimal) residual disease in acute lymphoblastic leukemia, chronic lymphocytic leukemia, and multiple myeloma.

BACKGROUND: The clonoSEQ® Assay (Adaptive Biotechnologies Corporation, Seattle, USA) identifies and tracks unique disease-associated immunoglobulin (Ig) sequences by next-generation sequencing of IgH, IgK, and IgL rearrangements and IgH-BCL1/2 translocations in malignant B cells. Here, we describe studies to validate the analytical performance of the assay using patient samples and cell lines. METHODS: Sensitivity and specificity were established by defining the limit of detection (LoD), limit of quantitation (LoQ) and limit of blank (LoB) in genomic DNA (gDNA) from 66 patients with multiple myeloma (MM), acute lymphoblastic leukemia (ALL), or chronic lymphocytic leukemia (CLL), and three cell lines. Healthy donor gDNA was used as a diluent to contrive samples with specific DNA masses and malignant-cell frequencies. Precision was validated using a range of samples contrived from patient gDNA, healthy donor gDNA, and 9 cell lines to generate measurable residual disease (MRD) frequencies spanning clinically relevant thresholds. Linearity was determined using samples contrived from cell line gDNA spiked into healthy gDNA to generate 11 MRD frequencies for each DNA input, then confirmed using clinical samples. Quantitation accuracy was assessed by (1) comparing clonoSEQ and multiparametric flow cytometry (mpFC) measurements of ALL and MM cell lines diluted in healthy mononuclear cells, and (2) analyzing precision study data for bias between clonoSEQ MRD results in diluted gDNA and those expected from mpFC based on original, undiluted samples. Repeatability of nucleotide base calls was assessed via the assay's ability to recover malignant clonotype sequences across several replicates, process features, and MRD levels. RESULTS: LoD and LoQ were estimated at 1.903 cells and 2.390 malignant cells, respectively. LoB was zero in healthy donor gDNA. Precision ranged from 18% CV (coefficient of variation) at higher DNA inputs to 68% CV near the LoD. Variance component analysis showed MRD results were robust, with expected laboratory process variations contributing ≤3% CV. Linearity and accuracy were demonstrated for each disease across orders of magnitude of clonal frequencies. Nucleotide sequence error rates were extremely low. CONCLUSIONS: These studies validate the analytical performance of the clonoSEQ Assay and demonstrate its potential as a highly sensitive diagnostic tool for selected lymphoid malignancies.

Pharmacogenetics in Practice: Estimating the Clinical Actionability of Pharmacogenetic Testing in Perioperative and Ambulatory Settings.

Most literature describing pharmacogenetic implementations are within academic medical centers and use single-gene tests. Our objective was to describe the results and lessons learned from a multisite pharmacogenetic pilot that utilized panel-based testing in academic and nonacademic settings. This was a retrospective analysis of 667 patients from a pilot in 4 perioperative and 5 outpatient cardiology clinics. Recommendations related to 12 genes and 65 drugs were classified as actionable or not actionable. They were ascertained from Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines and US Food and Drug Administration (FDA) labeling. Patients displayed a high prevalence of actionable results (88%, 99%) and use of medications (28%, 46%) with FDA or CPIC recommendations, respectively. Sixteen percent of patients had an actionable result for a current medication per CPIC compared with 5% per FDA labeling. A systematic approach by a health system may be beneficial given the quantity and diversity of patients affected.

Culture, Masculine Honor, and Violence Toward Women.

Prior research has connected the cultural ideology of honor to intrasexual violence between men and to attitudes supporting intersexual aggression in response to perceived honor violations by female romantic partners. We extend this research to show that honor ideology is also associated with an increased likelihood of men actually engaging in violent and sexually coercive behaviors toward women. Extending previous research on honor-based schemas and scripts linked to relationship violence, comparisons between honor states and non-honor states in the United States show that official rape and domestic homicide rates by White male perpetrators (Study 1) and experiences of rape and violence in relationships anonymously reported by White female teenagers (Study 2) were higher in honor states, controlling for a variety of potential confounds. These results extend prior laboratory research on honor-based schemas and scripts into the realm of extreme, real-world behaviors.

Gender, status, and psychiatric labels.

We examine a key modified labeling theory proposition-that a psychiatric label increases vulnerability to competence-based criticism and rejection-within task- and collectively oriented dyads comprised of same-sex individuals with equivalent education. Drawing on empirical work that approximates these conditions, we expect the proposition to hold only among men. We also expect education, operationalized with college class standing, to moderate the effects of gender by reducing men's and increasing women's criticism and rejection. But, we also expect the effect of education to weaken when men work with a psychiatric patient. As predicted, men reject suggestions from teammates with a psychiatric history more frequently than they reject suggestions from other teammates, while women's resistance to influence is unaffected by their teammate's psychiatric status. Men also rate psychiatric patient teammates as less powerful but no lower in status than other teammates, while women's teammate assessments are unaffected by their teammate's psychiatric status. Also as predicted, education reduces men's resistance to influence when their teammate has no psychiatric history. Education also increases men's ratings of their teammate's power, as predicted, but has no effect on women's resistance to influence or teammate ratings. We discuss the implications of these findings for the modified labeling theory of mental illness and status characteristics theory.

Honor and the Stigma of Mental Healthcare.

Most prior research on cultures of honor has focused on interpersonal aggression. The present studies examined the novel hypothesis that honor-culture ideology enhances the stigmatization of mental health needs and inhibits the use of mental health services. Study 1 demonstrated that people who strongly endorsed honor-related beliefs and values were especially concerned that seeking help for mental health needs would indicate personal weakness and would harm their reputations. Studies 2 and 3 showed that honor states in the U.S. South and West invested less in mental healthcare resources, compared with non-honor states in the North (Study 2), and that parents living in honor states were less likely than parents in non-honor states to use mental health services on behalf of their children (Study 3). Together, these studies reveal an overlooked consequence of honor ideology for psychological well-being at the individual, social, and institutional levels.

Naming patterns reveal cultural values: patronyms, matronyms, and the U.S. culture of honor.

Four studies examined the hypothesis that honor norms would be associated with a pronounced use of patronyms, but not matronyms, for naming children. Study 1 shows that men who endorse honor values expressed a stronger desire to use patronyms (but not matronyms) for future children, an association that was mediated by patriarchal attitudes. Study 2 presents an indirect method for assessing state patronym and matronym levels. As expected, patronym scores were significantly higher in honor states and were associated with a wide range of variables linked previously to honor-related dynamics. Study 3a shows that following the terrorist attacks of 9/11, patronyms increased in honor states, but not in non-honor states. Likewise, priming men with a fictitious terrorist attack (Study 3b) increased the association between honor ideology and patronym preferences. Together, these studies reveal a subtle social signal that reflects the masculine values of an honor culture.

Threats to Moral Identity: Testing the Effects of Incentives and Consequences of One's Actions on Moral Cleansing.

Individuals engage in moral cleansing, a compensatory process to reaffirm one's moral identity, when one's moral self-concept is threatened. However, too much moral cleansing can license individuals to engage in future unethical acts. This study examined the effects of incentives and consequences of one's actions on cheating behavior and moral cleansing. Results found that incentives and consequences interacted such that unethical thoughts were especially threatening, resulting in more moral cleansing, when large incentives to cheat were present and cheating explicitly harmed others. Implications are discussed in terms of ethics training, using incentives as motivators, and the depersonalized norms of science.

Self-Serving Bias or Simply Serving the Self? Evidence for a Dimensional Approach to Narcissism.

Previous research has suggested that narcissism can be conceptualized as a multidimensional construct consisting of the related, but unique, dimensions of grandiosity and entitlement. The current studies examined the divergent associations of grandiosity and entitlement with respect to different types of self-serving strategies. In Study 1, we found that narcissistic grandiosity, but not entitlement, was positively associated with a self-enhancing strategy of unrealistic optimism. This association was not mediated by self-esteem. In Study 2, narcissistic entitlement, but not grandiosity, was predictive of unethical decision-making, an interpersonal self-promotional strategy that advances the self at the expense of others. Together, both studies support a model of narcissism consisting of a relatively intrapersonal dimension of grandiosity and a relatively interpersonal dimension of entitlement.

Don't tread on me: masculine honor ideology in the U.S. and militant responses to terrorism.

Using both college students and a national sample of adults, the authors report evidence linking the ideology of masculine honor in the U.S. with militant responses to terrorism. In Study 1, individuals' honor ideology endorsement predicted, among other outcomes, open-ended hostile responses to a fictitious attack on the Statue of Liberty and support for the use of extreme counterterrorism measures (e.g., severe interrogations), controlling for right-wing authoritarianism, social dominance orientation, and other covariates. In Study 2, the authors used a regional classification to distinguish honor state respondents from nonhonor state respondents, as has traditionally been done in the literature, and showed that students attending a southwestern university desired the death of the terrorists responsible for 9/11 more than did their northern counterparts. These studies are the first to show that masculine honor ideology in the U.S. has implications for the intergroup phenomenon of people's responses to terrorism.

Culture of honor and violence against the self.

Cultures of honor facilitate certain forms of interpersonal violence. The authors suggest that these cultures might also promote values and expectations that could heighten suicide risk, such as strict gender-role standards and hypersensitivity to reputational threats, which could lead people living in such cultures to consider death as an option when failure occurs or reputation is threatened sufficiently. Study 1 shows that, controlling for a host of statewide covariates, honor states in the United States have significantly higher male and female suicide rates than do nonhonor states, particularly in nonmetropolitan areas among Whites. Study 2 shows that statewide levels of antidepressant prescriptions (an indicator of mental health resource utilization) are lower in honor states, whereas levels of major depression are higher, and statewide levels of depression are associated with suicide rates only among honor states. Finally, Study 3 shows that individual endorsement of honor ideology is positively associated with depression.

Moral Credentialing and the Rationalization of Misconduct.

Recent studies lead to the paradoxical conclusion that the act of affirming one's egalitarian or pro-social values and virtues might subsequently facilitate prejudiced or self-serving behavior, an effect previously referred to as "moral credentialing." The present study extends this paradox to the domain of academic misconduct and investigates the hypothesis that such an effect might be limited by the extent to which misbehavior is rationalizable. Using a paradigm designed to investigate deliberative and rationalized forms of cheating (von Hippel, Lakin, & Shakarchi, 2005), we found that when participants had credentialed themselves (versus a non-close acquaintance) via a set of hypothetical moral dilemmas, they were more likely to cheat on a subsequent math task, but only if cheating was highly rationalizable. When cheating was difficult to rationalize, moral credentialing had almost no impact on cheating.

An A643V amino acid substitution in Upc2p contributes to azole resistance in well-characterized clinical isolates of Candida albicans.

The Candida albicans Upc2p transcription factor regulates ERG11, encoding the target of azole drugs. Gain-of-function mutations that contribute to resistance were recently identified in a series of sequential clinical isolates (N. Dunkel, T. T. Liu, K. S. Barker, R. Homayouni, J. Morschhauser, and P. D. Rogers, Eukaryot. Cell 7:1180-1190, 2008). In the present study, UPC2 was sequenced from a matched set of 17 isolates. An A643V substitution was present in all of the isolates in the series that overexpressed ERG11. Azole susceptibility, ergosterol levels, and expression of ERG genes were elevated in the A643V clinical isolates and in reconstructed strains.

Creativity and Ethics: The Relationship of Creative and Ethical Problem-Solving.

Students of creativity have long been interested in the relationship between creativity and deviant behaviors such as criminality, mental disease, and unethical behavior. In the present study we wished to examine the relationship between creative thinking skills and ethical decision-making among scientists. Accordingly, 258 doctoral students in the health, biological, and social sciences were asked to complete a measure of creative processing skills (e.g., problem definition, conceptual combination, idea generation) and a measure of ethical decision-making examining four domains, data management, study conduct, professional practices, and business practices. It was found that ethical decision-making in all four of these areas was related to creative problem-solving processes with late cycle processes (e.g., idea generation and solution monitoring) proving particularly important. The implications of these findings for understanding the relationship between creative and deviant thought are discussed.

Forgiveness and the need to belong.

People who experience a strong need to belong might be particularly inclined to forgive wrongdoings to preserve social bonds. Three studies that utilized different methods and measures of forgiveness consistently demonstrated this is not the case. The authors found that individuals high in the need to belong report practicing forgiveness with less frequency and value it no more than those low in the need to belong (Study 1). In Study 2, they found that satisfying the need to belong led participants to express greater willingness to forgive hypothetical offenses compared to participants in a control group. Finally, in Study 3, the authors linked the need to belong to forgiveness of specific transgressions and found that this negative relationship was mediated by offense-related anger and perceptions of offense severity. These findings suggest that needing to belong paradoxically interferes with forgiveness, even though forgiving could promote the satisfaction of belongingness needs following transgressions.