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Purpose: No information exists on the needs of transgender youth transitioning their gender-affirming health care from pediatric to adult settings. We obtained perspectives of transgender youth, their parents, and providers, and aimed to identify barriers and unmet needs during the transition of care. Methods: Five online focus groups were conducted between February and March 2019 with separate groups for transgender youth 13-17 and 18-21 years old; parents of transgender youth 13-17 and 18-21 years old; and gender-affirming health care providers. Thematic analysis of transcripts was conducted by two researchers. Pooled Cohen's κ was 0.83, indicating excellent inter-rater reliability. Results: Sixty-six participants (29 youth, 27 parents, and 10 providers) identified 10 themes. Themes related to barriers to transition included access and insurance challenges, patient readiness and hesitancy to transfer care, and multidisciplinary-system inefficiencies. Themes related to improving transition focused on prioritizing referrals from trusted sources, establishing gradual patient independence, aligning gender transition goals, and setting impetus for transferring care. Conclusion: Successful health care transition for transgender youth must consider the intricacies of a complex medical system and challenges that they pose to adolescents' perceived abilities to independently manage health care and willingness to prepare transfer of care. Given that patients, parents, and providers assume important roles during the process, each can uniquely contribute toward ensuring a smooth transition. Efforts to improve this process should focus on enhancing collaboration between clinics and families through crowdsourcing resources, continued verification of health goals, supporting greater patient autonomy, and delineating an explicit timeline for transition.

This study examined the validity and predictive utility of the three-step theory (3ST) of suicide in psychiatric patients. Participants were 190 consecutively admitted adult psychiatric inpatients (53% female, 60% White, ages 18–73) assessed at three time points: baseline, 4 weeks later (n = 112), and 3 months postdischarge (n = 102). Results were broadly supportive of the 3ST. First, at baseline, an interactive model of pain and hopelessness accounted for substantial variability in suicidal desire, even when controlling for depression and lifetime ideation. This result replicated in different genders and age ranges (i.e., 18–32 and 33–73). Further, pain and hopelessness were robust predictors of suicidal desire weeks and months into the future. Second, among those with pain and hopelessness, lower connectedness, as well as the extent to which pain exceeds connectedness, were robust predictors of higher suicidal desire. Last, a baseline measure of practical capability for suicide predicted suicide attempts both retrospectively and prospectively, even when controlling for lifetime ideation—however, dispositional and acquired contributors to capability were less predictive. Results support the validity and predictive utility of the 3ST, and suggest that the theory may have utility for guiding risk assessment and intervention.

Aim of the studyWhile there has been some evidence supporting the relevance of patients’ perceptions of treatment credibility to the process and outcome of individual cognitive behavioural therapy (CBT), its importance to group CBT remains unknown. Moreover, no studies to date have explored potential mechanisms through which perceived treatment credibility may contribute to therapeutic change. To address this void, this pilot study investigated associations between patients’ perceptions of treatment credibility and outcome among psychiatric outpatients receiving group CBT for depression. A secondary aim was to determine whether the therapeutic alliance mediated the effect of credibility on treatment outcome.Subject or material and methodsConsecutively admitted outpatients (N=80) completed measures of credibility, alliance, and outcome.ResultsFindings indicated that higher ratings of credibility were associated with greater improvement in interpersonal problems, but were unrelated to changes in depression, anxiety, and quality of life. We did not find evidence for the alliance serving as a mediator. Yet, we found a direct relationship between credibility and alliance.DiscussionDepressed patients who perceive treatment to be more credible may be more likely to engage in meaningful exchanges with fellow group members, thus leading to improvement in interpersonal problems.ConclusionsIn a group context, there are many agents of influence, with the other group members, the therapist, and the group-as-a-whole each having some effect. This study has helped illuminate one aspect of the therapist's influence on the group, as perceived by patients.

Ninety-two adults attending outpatient mental health services completed measures of attachment style and readiness to engage in psychotherapy. Correlation and linear regression analyses found anxious attachment to be positively associated with treatment-seeking distress and found avoidant attachment to be negatively associated with openness to personal disclosure in the therapy relationship. Practitioner points Insecure attachment may influence prospective patients' readiness for psychotherapy. Patients with an avoidant attachment style may need assistance in preparing for the relational aspects of psychotherapy.

Background: Breast cancer is the most common cancer for Chinese women living in the United States (U.S.). Despite overall rates being significantly lower than other races and ethnicities, incidence has steadily increased over the last few decades. This is concerning given that Asian Americans are the fastest growing racial group in the U.S. and Chinese Americans constitute the largest Asian American ethnic population. In addition, mammography screening rates are low among Chinese American women, and this may be attributable to a lack of breast cancer knowledge and awareness. Methods: The Chinese E-Women Project (CEWP) is a breast health education and engagement program developed by the Orange County Herald Center (OCHC), a non-profit organization that serves the Chinese American community in Orange County, California. Two key CEWP components are the Community Gatekeeper Education Session (CGES), which is a formal education session led by trained OCHC staff to engage and educate Chinese American community leaders, and the E-Women Tea Time (EWTT), which is an informal peer group education session led by a past CGES participant. All CGES and EWTT events presented information on breast cancer epidemiology, biology, and screening. Questionnaires testing breast cancer knowledge were administered before and after the education session at each event. We pooled data across the CGES and EWTT events separately and used Wilcoxon signed rank test to evaluate change in participants’ overall knowledge. We also examined change in knowledge by question using McNemar’s test. Results: Our analysis included a total of 94 CGES and 149 EWTT female participants. For both CGES and EWTT, we observed significant improvements in overall breast cancer knowledge after the education session (both p Citation Format: Alice W Lee, Cindy Puga, Michelle Tsai, Sherry Huang. Chinese E-Women Project: A community-based approach to improving breast cancer knowledge among Chinese American women [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D021.

Objective Psychache has been proposed to cause suicide when it becomes unbearable. However, existing measures of psychache do not directly target unbearable psychache. Thus, the purpose of the current study was to provide initial validation for a brief measure of unbearable psychache. Method Three items were selected to create the Unbearable Psychache Scale (UP3). Psychometric properties were assessed in two populations: (1) an online sample composed of 1,006 adults (53% male) from various locations in the United States and (2) a sample of 190 psychiatric inpatient adults (47% male) from a hospital in Western Canada. Results In both samples, the UP3 demonstrated excellent internal reliability, and strong convergent and predictive validity. Additionally, the UP3 predicted significant variance in suicidal ideation over and above documented correlates of suicidal ideation including general psychache, hopelessness, perceived burdensomeness, and low belongingness. Conclusions The UP3 is a brief, psychometrically sound measure of unbearable psychache that may be well-suited for use in research protocols and clinical assessments.

Objective: To explore the relationship between types of pathological narcissism and somatic symptoms among psychiatric outpatients.Methods: Patients (N = 95) completed measures of somatic symptoms, narcissistic grandiosity and vulnerability, and psychiatric symptoms. Relationships among variables were analysed using t-tests and correlations, controlling for psychiatric distress.Results: Somatic symptoms were positively associated with two types of narcissistic dysfunction. Among women there was a positive association between somatic symptoms and narcissistic vulnerability, but not grandiosity. Among men, somatic symptoms were positively associated with narcissistic grandiosity, but not vulnerability.Conclusions: The connection between narcissistic pathology and somatic symptom severity appears to differ based on gender. Further research is needed to confirm and extend this preliminary finding.

There is growing evidence for the important role of patients' outcome expectations to the process and outcome of psychotherapy, yet its relevance to group cognitive–behavioural therapy (CBT) for depression has not been examined. In an effort to fill this void, the present study investigated expectations for improvement among 80 psychiatric outpatients attending a group CBT program for depression. The study addressed the following four questions: (1) Which baseline patient characteristics might be associated with patients' expectations for improvement? (2) Does providing a rationale and outline for treatment affect patients' expectations? (3) Are patients' expectations related to the quality of therapeutic alliance? and (4) Are patients' expectations associated with the outcome of treatment? The main findings of the study are as follows: (a) baseline symptoms of depression, quality of life and current suicidal ideations were consistently associated with outcome expectancies; (b) outcome expectancies were unrelated to treatment completion status; (c) although expectancy ratings did not change significantly for the group as a whole, there was some variability in how individual patient's expectancy ratings changed; (d) baseline expectancies were related to early-treatment alliance quality, but not to mid-treatment alliance, whereas early-treatment expectancies were significantly associated with mid-treatment alliance; and (e) baseline expectations of favourable outcome had a negative association with improvement in anxiety symptoms, yet expectancy ratings from session 3 had a positive association with improvement in quality of life and interpersonal problems. Increases in expectancy ratings were significantly related to improvement in anxiety, quality of life and interpersonal problems. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Patients who present in a particularly hopeless and demoralized state are likely to have low expectations for a positive outcome of treatment. Efforts should be made in the first few sessions of therapy to mobilize patients' hope and expectation of success, for increases in one's expectations may facilitate a favourable treatment outcome. An optimistic outlook on the probability of success in treatment may contribute to the development of a strong working relationship between the patient and the therapist.

This study evaluates the impact of an independent postmidterm question analysis exercise on the ability of students to answer subsequent exam questions on the same topics. It was conducted in three sections (∼400 students/section) of introductory biology. Graded midterms were returned electronically, and each student was assigned a subset of questions answered incorrectly by more than 40% of the class to analyze as homework. The majority of questions were at Bloom's application/analysis level; this exercise therefore emphasized learning at these higher levels of cognition. Students in each section answered final exam questions matched by topic to all homework questions, providing a within-class control group for each question. The percentage of students who correctly answered the matched final exam question was significantly higher (p < 0.05) in the Topic Analysis versus Control Analysis group for seven of 19 questions. We identified two factors that influenced activity effectiveness: 1) similarity in topic emphasis of the midterm–final exam question pair and 2) quality of the completed analysis homework. Our data suggest that this easy-to-implement exercise will be useful in large-enrollment classes to help students develop self-regulated learning skills. Additional strategies to help introductory students gain a broader understanding of topic areas are discussed.

Advances in microfabrication techniques have enabled the production of inexpensive and reproducible microfluidic systems for conducting biological and biochemical experiments at the micro- and nanoscales (1,2). In addition, microfluidics have also been specifically used to quantitatively analyze hematologic and microvascular processes, because of their ability to easily control the dynamic fluidic environment and biological conditions(3-6). As such, researchers have more recently used microfluidic systems to study blood cell deformability, blood cell aggregation, microvascular blood flow, and blood cell-endothelial cell interactions(6-13).However, these microfluidic systems either did not include cultured endothelial cells or were larger than the sizescale relevant to microvascular pathologic processes. A microfluidic platform with cultured endothelial cells that accurately recapitulates the cellular, physical, and hemodynamic environment of the microcirculation is needed to further our understanding of the underlying biophysical pathophysiology of hematologic diseases that involve the microvasculature. Here, we report a method to create an "endothelialized" in vitro model of the microvasculature, using a simple, single mask microfabrication process in conjunction with standard endothelial cell culture techniques, to study pathologic biophysical microvascular interactions that occur in hematologic disease. This "microvasculature-on-a-chip" provides the researcher with a robust assay that tightly controls biological as well as biophysical conditions and is operated using a standard syringe pump and brightfield/fluorescence microscopy. Parameters such as microcirculatory hemodynamic conditions, endothelial cell type, blood cell type(s) and concentration(s), drug/inhibitory concentration etc., can all be easily controlled. As such, our microsystem provides a method to quantitatively investigate disease processes in which microvascular flow is impaired due to alterations in cell adhesion, aggregation, and deformability, a capability unavailable with existing assays.

In hematologic diseases, such as sickle cell disease (SCD) and hemolytic uremic syndrome (HUS), pathological biophysical interactions among blood cells, endothelial cells, and soluble factors lead to microvascular occlusion and thrombosis. Here, we report an in vitro "endothelialized" microfluidic microvasculature model that recapitulates and integrates this ensemble of pathophysiological processes. Under controlled flow conditions, the model enabled quantitative investigation of how biophysical alterations in hematologic disease collectively lead to microvascular occlusion and thrombosis. Using blood samples from patients with SCD, we investigated how the drug hydroxyurea quantitatively affects microvascular obstruction in SCD, an unresolved issue pivotal to understanding its clinical efficacy in such patients. In addition, we demonstrated that our microsystem can function as an in vitro model of HUS and showed that shear stress influences microvascular thrombosis/obstruction and the efficacy of the drug eptifibatide, which decreases platelet aggregation, in the context of HUS. These experiments establish the versatility and clinical relevance of our microvasculature-on-a-chip model as a biophysical assay of hematologic pathophysiology as well as a drug discovery platform.

There is growing evidence for the important role of patients' outcome expectations to the process and outcome of psychotherapy, yet its relevance to group cognitive-behavioural therapy (CBT) for depression has not been examined. In an effort to fill this void, the present study investigated expectations for improvement among 80 psychiatric outpatients attending a group CBT program for depression. The study addressed the following four questions: (1) Which baseline patient characteristics might be associated with patients' expectations for improvement? (2) Does providing a rationale and outline for treatment affect patients' expectations? (3) Are patients' expectations related to the quality of therapeutic alliance? and (4) Are patients' expectations associated with the outcome of treatment? The main findings of the study are as follows: (a) baseline symptoms of depression, quality of life and current suicidal ideations were consistently associated with outcome expectancies; (b) outcome expectancies were unrelated to treatment completion status; (c) although expectancy ratings did not change significantly for the group as a whole, there was some variability in how individual patient's expectancy ratings changed; (d) baseline expectancies were related to early-treatment alliance quality, but not to mid-treatment alliance, whereas early-treatment expectancies were significantly associated with mid-treatment alliance; and (e) baseline expectations of favourable outcome had a negative association with improvement in anxiety symptoms, yet expectancy ratings from session 3 had a positive association with improvement in quality of life and interpersonal problems. Increases in expectancy ratings were significantly related to improvement in anxiety, quality of life and interpersonal problems.Patients who present in a particularly hopeless and demoralized state are likely to have low expectations for a positive outcome of treatment. Efforts should be made in the first few sessions of therapy to mobilize patients' hope and expectation of success, for increases in one's expectations may facilitate a favourable treatment outcome. An optimistic outlook on the probability of success in treatment may contribute to the development of a strong working relationship between the patient and the therapist.

article This study examined the relationship between components of pathological narcissism and types of depressive tendencies among a sample of 117 psychiatric outpatients. Findings revealed that depressive themes concerning dependency were associated with narcissistic grandiosity. Depressive tendencies concerning self-criticism were positively associated with narcissistic vulnerability.