Interpersonal Risk Factors, Sexual and Gender Minority Status, and Suicidal Ideation: Is BDSM Disclosure Protective?

Suicidal ideation is elevated among individuals who engage in BDSM practices and those with sexual and gender minority (SGM) identities. There is limited research on the intersectionality of these identities and how they relate to suicidal ideation, especially within a theoretical framework of suicide risk, such as the interpersonal theory of suicide. Thus, we tested the indirect relation between BDSM disclosure and suicidal ideation through thwarted belongingness and perceived burdensomeness, as well as the moderating role of SGM identity on these indirect associations. Participants were 125 (Mage = 28.27 years; 64% cisgender men) individuals recruited via online BDSM-related forums who endorsed BDSM involvement and recent suicidal ideation. Results indicated significant moderated mediation, such that BDSM disclosure was indirectly negatively related to suicidal ideation through lower thwarted belongingness, but not perceived burdensomeness, among SGM individuals. This was due to the significant relation between BDSM disclosure and thwarted belongingness. There were no significant moderated mediation or indirect effects related to perceived burdensomeness. We also provide supplemental analyses with positive ideation (i.e., positive thoughts toward life) as the criterion variable. In conclusion, BDSM disclosure appears to be protective against suicidal ideation through thwarted belongingness but only for SGM individuals. This work furthers our understanding of the impact of intersecting marginalized identities on suicide risk and resilience. Implications, limitations, and future directions are further discussed.

Is lesbian identity obsolete?

In this special issue we asked the question "Is lesbian identity obsolete?" We posed this provocation in order to think through what has changed about lesbian identities and their articulations in the face of recent developments-from the rise of transphobia in the name of feminism to increased income inequality and gentrification and the accompanying loss of community spaces. The special issue turned into a triple issue receiving a large number of submissions from across the world. A synthesis of the articles suggests several threads. First, lesbian identity remains important to many women across the world. Whereas some academic writing and communities in the United States have shifted toward queerness, this move is resisted among many lesbians, especially in communities outside of the U.S. Women who sustain lesbian identity must confront attacks that morph and change across time and space. Some lesbians are marginalized because they are seen as psychologically deviant, whereas others are framed as criminals; a more recent form of marginalization equates lesbianism with transphobia. To face these attacks, lesbian intellectual traditions offer an understanding of lesbian identity as political, nonessentialist, intersectional, and community grounded. The rejection of the "born this way narrative" of lesbian identity allows lesbianism to be inclusive of different configurations of gender identities including trans, nonbinary, and cis women as well as sexual orientations including bisexuality, demisexuality, and asexuality. An understanding of lesbianism as grounded in politics of inclusion and solidarity sustains the power of the lesbian movement to fight the rise of neo-fascism and the devastation of climate change.

Evaluation of an initiation protocol of 4 mg of warfarin for atrial fibrillation in the outpatient setting.

OBJECTIVE: To describe the efficacy and safety of an initiation algorithm for 4 mg of warfarin in ambulatory patients with atrial fibrillation. DESIGN: Prospectively planned retrospective chart review. SETTING: Centre for Family Medicine Family Health Team in Kitchener, Ont. PARTICIPANTS: Ambulatory patients requiring anticoagulation for atrial fibrillation. INTERVENTIONS: Patients were prescribed 4 mg of warfarin to be taken once daily for 3 days. An international normalized ratio (INR) measured on the morning of the fourth day was used to predict the maintenance dose of warfarin. Subsequent INR measurements were obtained biweekly until patients reached their actual maintenance dose. MAIN OUTCOME MEASURES: Number of INR values greater than or equal to 4.0 before the warfarin maintenance dose was achieved. Secondary outcome measures included thromboembolic and bleeding events, number of days required to reach therapeutic INR, and correlation between predicted and actual warfarin maintenance dose. RESULTS: Twenty-five patients were included in the study. The average age was 76.0 years (range 56.0 to 89.0), and 17 patients were women. The average CHADS2 (congestive heart failure, hypertension, age ≥ 75 years,diabetes mellitus, and stroke or transient ischemic attack) score was 2.0.Only 1 patient had an INR greater than 4.0 during the study period. The mean time to achieve a therapeutic INR was 11.0 days. The day 4 INR was moderately predictive of the maintenance dose (r2 = 0.47). There were no adverse events that required medical attention during the study period. CONCLUSION: In this pilot study, an initiation algorithm for 4 mg of warfarin was safe and achieved a therapeutic INR within a reasonable time frame in outpatients with atrial fibrillation.

Helping pharmacists to reduce fall risk in long-term care: A clinical tool to facilitate the medication review process.

BACKGROUND: One-third to one-half of adults older than 65 fall at least once per year. Fall prevention through medication management requires little effort and has consistently been shown to reduce risk of falls. The objective of this study was to further develop and perform preliminary pilot testing of an algorithm designed to assist consultant pharmacists in systematically identifying medications that might be modifiable, in order to reduce the risk of falls in older adults. We hypothesized that algorithm use would increase the number of fall-related medication change recommendations made to physicians. METHODS: Four consultant pharmacists were trained to use the algorithm during their routine medication reviews over a 3-week period. An informal survey was administered at the end of the study period to assess the algorithm. RESULTS: Overall, 51% of residents of long-term facilities had 1 or more recommendations for medication changes related to reducing fall risk (range 0-3 recommendations per resident), with an average 0.675 recommendations made per resident. There were more recommendations for men compared with women and for residents receiving more medications, but the number of recommendations did not correspond with age. All 4 pharmacists agreed that the algorithm was useful and worthwhile. DISCUSSION: The absolute 20% increase in recommendations related to falls supports the study hypothesis. Time was cited as a barrier to using the algorithm, but this should decrease with continued use of this tool. CONCLUSION: This preliminary study furthered the development of and confirmed the possible utility and acceptability of a fall risk-reducing algorithm that may be used in practice.

Mega-dose intravenous octreotide for the treatment of carcinoid crisis: a systematic review.

PURPOSE: Carcinoid crises are rare life-threatening events involving cardiac instability when carcinoid tumours release vasoactive peptides. Such events can occur in the perioperative setting. Octreotide, a somatostatin analogue, is administered as a bolus dose of 100-500 µg iv or by infusion to treat carcinoid crises. Due to the apparent low risk-to-benefit profile, a much higher dose is sometimes used in urgent situations. The purpose of this study was to assess the evidence for administering doses or hourly infusions of octreotide that exceeded 1,500 µg iv to treat carcinoid crises. We also sought to identify which patients may require large doses and to describe the adverse effects of such doses. SOURCE: We systematically searched Medline, EMBASE, and Cochrane databases and hand-searched reference lists of relevant articles in 2006 and again in 2010 and 2011. All study designs were included in our search. Resolution of crisis symptoms was the primary outcome. PRINCIPAL FINDINGS: Eighteen articles were included. No patient died during a carcinoid crisis. A retrospective chart review of 89 patients with carcinoid heart disease reported octreotide doses of 25-54,000 µg to treat carcinoid crises, although neither crisis symptoms nor outcomes were described. CONCLUSION: In the included case reports, carcinoid crises were managed effectively using octreotide 25-500 µg iv. Previous exposure to octreotide and carcinoid heart disease may warrant the need for higher doses. In addition to the low quality of the articles and the small sample size, inconsistent use of the term "carcinoid crisis" and paucity of reported outcomes were also limitations of this systematic review. These findings highlight the need for further investigation into dose-response relationships of octreotide for the treatment of carcinoid crisis.

The Roles of Minority Stress and Thwarted Belongingness in Suicidal Ideation among Cisgender and Transgender/Nonbinary LGBTQ+ Individuals.

Rates of suicidal ideation (SI), attempts, and death by suicide are consistently elevated among persons from sexual and gender minority groups relative to the general population. Experiences of minority stress and thwarted belongingness may contribute to elevated risk, and be most pernicious among persons with multiple marginalized identities. AIM: The present study sought to examine the relation between gender identity (cisgender vs. transgender and nonbinary individuals [TNB]) and recent SI among a convenience sample of lesbian, gay, bisexual, questioning, and queer adults. METHODS: Participants (N = 807) completed an online survey with measures of minority stress, SI, and thwarted belongingness. RESULTS: We tested a mediation model in which TNB identity was indirectly associated with SI via minority stress (ß = 1.94, SE = 0.30, Bootstrap 95% CI = [1.39, 2.58]). We also investigated thwarted belongingness as a moderator between minority stress and SI, and found evidence of a two-way interaction (ß = 0.01, SE = 0.001, p < .001). The conditional indirect effect of gender identity on SI through minority stress was higher for individuals with higher levels of thwarted belongingness (ß = 0.07, SE = 0.02, Bootstrap 95% CI = [0.04, 0.11]). CONCLUSION: Gender identity was indirectly associated with SI through minority stress and elevations in minority stress were associated with more frequent SI. The minority stress and SI association was strongest for participants reporting higher thwarted belongingness. Building and maintaining strong social support networks may be especially important for persons with intersecting gender and sexual minority identities who face minority stress.HIGHLIGHTSTNB gender identity was indirectly associated with SI via minority stressThwarted belongingness moderated the relation between minority stress and SIThe minority stress SI relation was strongest at higher thwarted belongingness.

Introducing BASE: the Biomes of Australian Soil Environments soil microbial diversity database.

BACKGROUND: Microbial inhabitants of soils are important to ecosystem and planetary functions, yet there are large gaps in our knowledge of their diversity and ecology. The 'Biomes of Australian Soil Environments' (BASE) project has generated a database of microbial diversity with associated metadata across extensive environmental gradients at continental scale. As the characterisation of microbes rapidly expands, the BASE database provides an evolving platform for interrogating and integrating microbial diversity and function. FINDINGS: BASE currently provides amplicon sequences and associated contextual data for over 900 sites encompassing all Australian states and territories, a wide variety of bioregions, vegetation and land-use types. Amplicons target bacteria, archaea and general and fungal-specific eukaryotes. The growing database will soon include metagenomics data. Data are provided in both raw sequence (FASTQ) and analysed OTU table formats and are accessed via the project's data portal, which provides a user-friendly search tool to quickly identify samples of interest. Processed data can be visually interrogated and intersected with other Australian diversity and environmental data using tools developed by the 'Atlas of Living Australia'. CONCLUSIONS: Developed within an open data framework, the BASE project is the first Australian soil microbial diversity database. The database will grow and link to other global efforts to explore microbial, plant, animal, and marine biodiversity. Its design and open access nature ensures that BASE will evolve as a valuable tool for documenting an often overlooked component of biodiversity and the many microbe-driven processes that are essential to sustain soil function and ecosystem services.