'I've never been so stressed in my life': a qualitative analysis of young adults' lived experience amidst pandemic restrictions in Prince Edward Island, Canada.

OBJECTIVES: This qualitative study aimed to explore how young adults experienced the COVID-19 pandemic in relation to extensive lockdowns, social isolation and psychosocial distress. Specifically, this research focused on how the pandemic impacted those who did not contract COVID-19 and lived in a low-risk geographical location. The focus was young adults given they have large social circles (high risk for disease transmission) and have an increased propensity to mental health conditions. These insights can inform planning for future pandemics. DESIGN: This paper draws on 30 in-depth semistructured interviews. Data were analysed inductively following the principles of a constructivist grounded theory approach. SETTING AND PARTICIPANTS: 30 young adults living in Prince Edward Island during the COVID-19 pandemic, a Canadian province with a low number of COVID-19 cases at the time of data collection. RESULTS: We developed four themes that describe the experience of young adults during the COVID-19 pandemic: (1) life course disruption, (2) fear and anxiety about the COVID-19 virus, (3) isolation and loss of hope and (4) strategies for managing adversity. Our findings highlight the areas of young adults' lives that were affected by extensive social changes related to the COVID-19 pandemic. We demonstrate that even individuals who had not contracted the virus were considerably impacted. CONCLUSION: We provide a detailed description of the comprehensive impact of COVID-19 on low-risk young adults not previously infected with the COVID-19 virus. By reflecting on the biographical disruption experienced by young adults, we highlight the need and opportunity to direct healthcare resources towards identifying and addressing the secondary impacts of pandemics. Consequently, these findings can guide decisions relating to future pandemic restrictions to better account for the experiences of individuals living through them.

A solider and a victim: Masculinity, violence, and incels celebration of December 6th.

In 1989, Marc Lépine murdered 14 women at L'École Polytechnique de Montréal. We demonstrate how involuntarily celibate ("incel") men celebrate Lépine and claim him as a member of their community. Our analysis draws on 637 comments made on incels.is, the main English-language incel forum, that explicitly mentions Marc Lépine. We argue that incels use Lépine to situate themselves in relation to masculinity and to justify violence against women. First, incels orient to both hegemonic and subordinate masculinity by arguing that feminists are waging a gender war against men. Second, incels celebrate Lépine as a methodical and efficient murderer, connecting both themselves and Lépine to hegemonic masculinity. Third, incels describe both themselves and Lépine as victims of feminists and use this perceived subordination to justify violence against women. We discuss findings in relation to theories of masculinity and policies regulating online communities.

En 1989, Marc Lépine a assassiné 14 femmes à l'École Polytechnique de Montréal. Nous montrons comment des hommes involontairement célibataires (« incel ¼) cèlébrent Lépine et le revendiquent comme membre de leur communauté. Notre analyse s'appuie sur 637 commentaires formulés sur incels.is, le principal forum incel anglophone, qui mentionnent explicitement Marc Lépine. Nous soutenons que les incels utilisent Lépine pour se situer par rapport à la masculinité et justifier les violences faites aux femmes. Premiérement, les incels s'orientent vers une masculinité à la fois hégémonique et subordonnée en soutenant que les féministes mènent une guerre de genre contre les hommes. Deuxièmement, les incels célèbrent Lépine comme un meurtrier méthodique et efficace, les liant eux-mêmes et Lépine à la masculinité hégémonique. Troisièmement, les incels se décrivent eux-mêmes et Lépine comme des victimes des féministes et utilisent cette subordination perςue pour justifier la violence contre les femmes. Nous discutons des résultats relatifs aux théories de la masculinité et aux politiques régissant les communautés en ligne.

Between two pandemics: Older, gay men's experiences across HIV/AIDS and COVID-19.

Pandemics are a component of human life, and have had great bearing on the trajectory of human evolution. Historically, the biomedical aspects of pandemics have been overrepresented, but there is growing recognition of the degree to which pandemics are socially and culturally embedded, highlighting how virus perception is socially and politically informed. Older (50+), gay men represent a population who have experienced two global pandemics in their lifespans: HIV/AIDS and COVID-19. Although governments and health officials largely failed gay men during the HIV/AIDS pandemic, gay men represent an important source of pandemic information and their experiences have much to offer health professionals and policymakers. As such, a small but growing body of literature has compared gay men's experiences amidst the two pandemics. The current study drew on constructivist grounded theory methods to examine how living through the HIV/AIDS pandemic has influenced older gay men's perspectives of COVID-19. Twenty Canadian-based gay men aged 50+ participated in semi-structured interviews via Zoom. Analysis revealed three key processes: (1) uncertainty and the familiarity of loss, (2) witnessing pandemic inequities, and, (3) navigating constantly evolving (mis)information. We highlight the utility of this knowledge to informing future pandemic planning and policies.

Adherence of those at low risk of disease to public health measures during the COVID-19 pandemic: A qualitative study.

Public health measures (PHMs) proactively and reactively reduce the spread of disease. While these measures target individual behaviour, they require broad adherence to be effective. Consequently, the World Health Organization issued a special appeal to young adults, a known non-adherent population, for increased adherence with COVID-19 guidelines. However, little is known about why these low-risk individuals do or do not adhere to PHMs. This study investigates why young adults in a low-risk setting adhered to PHMs implemented during the COVID-19 pandemic. A qualitative research approach was chosen to gain an in-depth understanding of participants' thoughts and experiences related to PHM adherence. Semi-structured interviews were conducted in April-May 2021 with 30 young adults living in Prince Edward Island (PEI), the province with the lowest COVID-19 case rate in Canada at that time. Thematic analysis was used to create a codebook based on the Theoretical Domains Framework, which was then inductively modified. The analysis identified eight themes that explained the adherence of young adults: (1) clear, purpose-driven adherence rationale, (2) developing trust in the local leadership, (3) adapting to novel measures, (4) manageable disruption, (5) adhering to reduce anxiety, (6) collective duty towards one's community, (7) moral culpability and (8) using caution rather than compliance. Together, these themes demonstrate that young adults adhered to PHMs because of their sense of connection to their community, public health leadership, and concerns over stigma. We further argue that clear guidelines and communication from public health officials during both periods of high and low COVID-19 cases facilitate adherence. These findings are important for mitigating future public health emergencies as they explain why young adults, an important segment of the population whose adherence is critical to the success of PHMs, follow PHMs. Further, these findings can inform public health officials and other stakeholders aiming to develop successful adherence strategies.

Efficacy, Safety, and Calcium Balance of an Accelerated Citrate Anticoagulated Membrane-Based Plasma Exchange Algorithm.

INTRODUCTION: To assess the safety, efficacy, and calcium flux of an accelerated algorithm for regional citrate anticoagulation in membrane-based plasma exchange. METHODS: This was an observational study in patients receiving citrate anticoagulated, membrane-based plasma exchange at the Canberra Hospital between July 2017 and May 2020. Data were collected prospectively using an electronic medical record and compared to data from our previous published algorithm. RESULTS: There were 134 plasma exchange sessions performed during the observational period. Circuit clotting occurred in 4 sessions, and 1 session was affected by symptomatic hypocalcaemia. A systemic ionized calcium <0.96 mmol/L was seen in 19.4% of sessions, which was a similar frequency to that seen in our previous algorithm. A systemic ionized Ca <0.81 mmol/L occurred in 4 sessions (all asymptomatic). This hypocalcaemia occurred towards the end of the sessions, after switching from albumin to fresh frozen plasma replacement fluid. Median treatment time was 135 min, compared to 219 min in our previously published algorithm. Mean net Ca gain/session was 7.7 ± 2.3 mmol. CONCLUSION: An accelerated algorithm for regional citrate anticoagulation achieves substantial time saving while maintaining efficacy and safety. The 4 episodes of systemic ionized calcium <0.81 mmol/L may have been due to recirculation of infused citrate but, probably more likely, are due to the additional citrate load imposed by use of fresh frozen plasma in these sessions. Future algorithms need to better account for the citrate load present in fresh frozen plasma.

The Black Pill: New Technology and the Male Supremacy of Involuntarily Celibate Men.

Involuntary celibates, or "incels," are people who identify themselves by their inability to establish sexual partnerships. In this article, we use analytic abduction to qualitatively analyze 9,062 comments on a popular incel forum for heterosexual men that is characterized by extensive misogyny. Incels argue that emerging technologies reveal and compound the gender practices that produce involuntarily celibate men. First, incels argue that women's use of dating apps accelerates hypergamy. Second, incels suggest that highly desirable men use dating apps to partner with multiple women. Third, incels assert that subordinate men inflate women's egos and their "sexual marketplace value" through social media platforms. We argue that incels' focus on technology reinforces essentialist views on gender, buttresses male domination, dehumanizes women, and minimizes incels' own misogyny. We discuss findings in relation to theories of masculinity and social scientific research on the impacts of emerging technology.

Effects of Sodium Caseinate and Varying Protein Sources on In Vitro Fermentation of Forages by Mixed Equine Cecal Microorganisms.

To assess the impact of protein on fermentation by equine cecal microorganisms, cecal fluid from 4 cecally cannulated horses was used to inoculate fermentation bottles containing buffer, forage, and supplemental protein. In experiment 1, sodium caseinate (SC) provided 0, 0.5%, 1%, 2%, or 4% additional crude protein (CP) to bottles containing alfalfa or native warm-season prairie grass hay. Bottles were equipped with continuous gas pressure monitors and placed into a shaking incubator for 48 hours at 39°C. Cultures with alfalfa had greater (P < .0001) in vitro dry matter disappearance (IVDMD), neutral detergent fiber disappearance (NDFD), acid detergent fiber disappearance (ADFD), cumulative gas production, and total volatile fatty acid (VFA). Sodium caseinate increased gas production (P ≤ .05) and decreased pH (P < .003) in cultures with grass hay. Sodium caseinate at 1%, 2%, or 4% additional CP increased IVDMD, NDFD, and ADFD (P < .01), while 4% additional CP also increased total VFA (P < .01). For experiment 2, SC, fishmeal, soybean meal (SBM), whey, porcine blood plasma, and L-lysine hydrochloride were added to supply 2% additional CP to cultures with grass hay. All protein sources decreased pH and increased IVDMD, NDFD, and ADFD (P ≤ .01), with the largest effects elicited by SC, L-lysine, and whey (P ≤ .05). Total VFA (P ≤ .04) and gas (P ≤ .05) production increased with L-lysine, whey, SC, SBM, and fishmeal. While protein supplementation had minimal effects on cultures containing alfalfa, it altered fermentation of grass hay, more notably with more soluble protein sources.

Uncertainty and certain death: the role of clinical trials in terminal cancer care.

We consider uncertainty in relation to clinical trials for terminal non-small cell lung cancer, which is an aggressive and difficult to treat form of cancer. Using grounded theory to analyse 85 clinical interactions between doctors, patients and family members, we argue that uncertainty is a major source of tension for terminally ill patients, with individuals confronting a choice between transitioning to palliative care or volunteering for an experimental/trial medication that might postpone death. Regardless of their efficacy, patients must also consider how such experimental treatments might impact their quality-of-life. We argue that clinical trials produce uncertainty through (i) discussions about the efficacy of clinical trials; (ii) the physiological consequences of clinical trial medications; and (iii) the impact clinical trials have on patient's prognostic understanding of their terminal cancer. Accordingly, while study participants encounter high prognostic certainty (i.e. they have a fatal cancer), they nonetheless experience considerable uncertainty in relation to their participation in clinical trials.

The DSM and Professional Practice: Research, Clinical, and Institutional Perspectives.

How mental illnesses are defined has significant ramifications, given the substantial social and individual repercussions of these conditions. Using actor-network theory, I analyze how mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) in their work. Drawing on observations of a neuropsychological laboratory and interviews with 27 professionals (i.e., psychiatrists, psychologists), I investigate how the DSM is used in research, clinical, and institutional work. In research, the DSM influences study design and exclusion/inclusion criteria. In the clinic, the DSM influences how disorders are conceptualized and diagnosed. Institutionally, the DSM aligns the patient-professional encounter to insurance and pharmaceutical interests. I conclude that the DSM operates as multiple, context-specific taxonomies that pervasively influence professional practices, such that all possible actions must orient to DSM criteria, with professionals both a source and an object of institutionalized gaze.

Accounts of suicidality in the Huntington disease community.

Health professionals, researchers, and philosophers have debated extensively about suicide. Some believe suicides result from mental pathology, whereas others argue that individuals are capable of rational suicide. This debate is particularly poignant within illness communities, where individuals may be suffering from chronic and incurable conditions. This article engages with these issues by presenting the accounts of 20 individuals with Huntington disease (HD), a fatal degenerative condition, and 10 informal caregivers (e.g., spouses). Suicide is a leading cause of death amongst people with HD, with an incidence rate many times higher than the general population. In contrast to the majority of the academic literature on HD suicidality, study participants did not connect suicide with mental pathology. Instead, they perceived suicide as a response to the realities of living with HD, such as prolonged physiological degeneration and the need for long-term intensive health care. These findings are subsequently discussed in relation to the rational-pathological suicide binary.

Violence in the massage parlor industry: experiences of Canadian-born and immigrant women.

We examined and contrasted 129 Canadian-born and immigrant women's experiences of violence and associated structural and interpersonal factors within indoor commercial sex venues. The majority experienced at least one form of structural, interpersonal, or both types of violence, with the attempted removal of a condom during sexual services being cited most frequently. Canadian-born women reported more frequent violent assaults in the survey data. The women's qualitative narratives illustrated that perceptions of violence differed significantly among Canadian versus non-Canadian born women. Findings concerning racialization and gendered relations of power have important implications for prevention and interventions to support victims of abuse.

Diagnosis, psychiatry and neurology: the case of Huntington Disease.

Although Huntington Disease (HD) is recognized as a neurological condition, it has a number of psychiatric effects, with recent studies suggesting that these effects can appear years prior to the telltale neurological symptoms. This trajectory has, in part, led to the misdiagnosis of HD as a psychiatric illness, as explicated in numerous case studies. This paper utilizes HD as a case study to investigate the social consequences of diagnosis by highlighting the tensions and ambiguities between neurology and psychiatry, while also discussing the difficulties that HD creates for psychiatry's diagnostic schema. Findings are based on 30 in-depth interviews conducted with both individuals with HD and informal caregivers (e.g., spouses) in British Columbia, Canada. The findings address numerous instances of misdiagnosis and the resulting negative impacts for individual health and well-being. The findings are further discussed in relation to the work of Bakhtin and Latour, with suggestions presented to ameliorate such misdiagnoses.

Structure and agency: reflections from an exploratory study of Vancouver indoor sex workers.

Sex work research continues to be characterised by debates around decriminalization. Central to these debates are claims about the agency of those involved in the sex trade. Some researchers argue that individuals involved in the sex trade are victims of structural and interpersonal constraint, whilst others depict them as workers exercising choice. Drawing on structure-agency theory, a review of legal and media accounts of the sex trade and qualitative interviews with 21 indoor sex workers in Vancouver, Canada, we argue that both of these perspectives are insufficient. Rather than reducing the sex trade to part of a binary, we suggest that it is necessary to analyse sex work through the complex interplay of both structure and agency. Specifically, structural analyses undercover the numerous ways that sex workers are controlled, observed and influenced whilst agency perspectives elicit the means that sex workers continue to exercise control in spite of disadvantage. While we do not finalise decriminalisation debates, we do critique current Canadian laws for the lack of responsiveness to the lives of sex workers and their exploitative and contradictory stance on sex work.

Connecting humor, health, and masculinities at prostate cancer support groups.

OBJECTIVE: Many commentaries about men's health practices and masculinities indicate that men do not typically engage with self-health or acknowledge illness, let alone openly discuss their health concerns with other men. Prostate cancer support groups (PCSGs) appear to run contrary to such ideals, yet the factors that influence men's attendance and engagement at group meetings are poorly understood. As part of a larger PCSG study, we noticed that humor was central to many group interactions and this prompted us to examine the connections between humor, health, and masculinities. METHODS: A qualitative ethnographic design was used to direct fieldwork and conduct participant observations at the meetings of 16 PCSGs in British Columbia, Canada. Individual semi-structured interviews were completed with 54 men who attended PCSGs to better understand their perceptions about the use of humor at group meetings. RESULTS: Four themes, disarming stoicism, marking the boundaries, rekindling and reformulating men's sexuality, and when humor goes south were drawn from the analyses. Overall, humor was used to promote inclusiveness, mark the boundaries for providing and receiving mutual help, and develop masculine group norms around men's sexuality. Although there were many benefits to humor there were also some instances when well-intended banter caused discomfort for attendees. CONCLUSIONS: The importance of group leadership was central to preserving the benefits of humor, and the specificities of how humor is used at PCSGs may provide direction for clinical practice and the design of future community-based men's health promotion programs.

Prostate cancer stories in the Canadian print media: representations of illness, disease and masculinities.

Despite the popularity of print media as an information source for men with prostate cancer, the representation of prostate cancer within this medium remains relatively understudied. This article details the findings from an analysis of prostate cancer articles published in two Canadian national newspapers, The Globe and Mail and the National Post, from January 2001 through to December 2006. The 817 prostate cancer articles published during this period were retrieved and reviewed using manifest and latent analyses. Three article categories, illness perspectives, medical perspectives and supplementary were identified in the manifest analysis. The latent analysis was guided by the connections between masculinities and prostate cancer in the newspapers' stories. Findings indicated a low frequency of articles that substantively discussed prostate cancer and that the descriptive content reproduced hegemonic masculine ideals, such as competition and stoicism. The presentation of a truncated illness trajectory and privileging of the curative aspects of biomedicine also depicted medicalised male bodies. Any discussion on the negative effects of treatment or explicit references to marginalized forms of masculinity was conspicuously absent. These findings support how representations of prostate cancer in Canadian newspapers predominately replicate detrimental ideologies and perspectives of men's health.

FDA regulatory pathways for knee cartilage repair products.

Over the past 2 decades there has been significant progress in the treatment of articular cartilage pathology with the introduction of cell biology, tissue engineering, and biomaterials to address long standing challenges in this debilitating condition. However, cell therapies and products combining cells, other biologics, devices, and/or drugs do not easily fit within traditional regulatory frameworks of the US Food and Drug Administration (FDA) or agencies outside the United States. Regulations have evolved to specifically address these types of products in terms of their unique scientific and clinical issues. This paper reviews the characteristics of cell and combination products that distinguish them from more traditional medical devices and drugs, FDA regulatory pathways for marketing approval of these new types of products, and the implications of these regulations for orthopedic product development and practice.

Women and prostate cancer support groups: the gender connect?

There are more than 100 prostate cancer support groups (PCSGs) in Canada, most of which meet on a monthly basis-yet little attention has been paid to the role of women at these groups. As part of an ongoing ethnographic study of PCSGs, we examined women's motivations for attending the groups, their ways of functioning in PCSGs and the benefits they accrued. Participant observations conducted at 13 British Columbian-based PCSGs and individual interview data from 20 women who regularly attended PCSG meetings were analyzed. Although the groups did not overtly limit women's attendance, the women's decisions to attend and their participation at group meetings were subject to much self-reflection, uncertainty and tension. Motivations to access a PCSG included a desire to support their partners, develop understandings about the illness and disease, and to manage their own experience of prostate cancer. Our analyses revealed that women assume three roles in PCSGs: social facilitator, background supporter and cancer co-survivor. The women reported many interrelated benefits as a result of attending, including information, hope and reassurance, and connecting with other women in similar circumstances. The results from this study reveal how traditional feminine ideals, such as nurturing and caring for the men in their lives, facilitating social connections and the desire to share emotional experiences guided the behaviors. Based on the study findings, we suggest that efforts to support women's involvement in PCSGs are critical to enhancing the effectiveness of the groups for both men and women.

How prostate cancer support groups do and do not survive: British Columbian perspectives.

Many prostate cancer support groups (PCSGs) have formed in North America during the past decade, yet their operation or factors influencing sustainability are poorly understood. This article reports micro (intragroup), meso (intergroup), and macro (group/structure) analyses drawn from the fieldwork and participant observations conducted for an ethnographic study of PCSGs based in British Columbia, Canada. The findings indicate that effective group leadership is integral to group sustainability and the recruitment and retention of attendees. At the meso level, intergroup connections and communication were often informal; however, the primary purpose of all the PCSGs was to provide information and support to men and their families. Many PCSGs were uncertain how formal associations with cancer fund-raising societies would influence group effectiveness. Macro issues such as prostate cancer activism resided with individual group "champions" through activities coordinated by provincial and national PCSG organizations. However, activism did not guarantee group sustainability. The study findings reveal why some groups flourish while others appear untenable, and form the basis for discussion about how PCSG sustainability might be best achieved.