A Double-Edged Sword: Dual-Identity Centrality and the Health of Asian American Sexual Minority Individuals.

Asian American sexual minority individuals (AASMI) face the challenge of navigating two identities as both a sexual minority and a racial minority. However, the research base examining AASMI dual-identities remains underdeveloped. In the current study, we investigated the link between AASMI dual-identity centrality and their health and wellbeing using a subsample of 303 AASMI drawn from the Social Justice Sexuality Project dataset (n = 4,953). We conducted structural equation modeling (SEM) to test our hypothesized model and used bootstrap analysis to test the indirect effects therein. Findings indicated strong support for our model, which theorized that dual-identity centrality among AASMI can act as a "double-edged sword" on their health, whereby the process worsens their health through increased discomfort in their racial/ethnic community while simultaneously improving it through increased outness. Implications for future research and new avenues of intervention efforts at improving AASMI health are discussed.

Refractory Human Cutaneous Protothecosis.

A 67-year-old Scottish woman presented to her general practitioner with a subcentimeter lump between her shoulder blades. The lump was suspected to be an epidermal cyst and was excised. The patient had a history of controlled diabetes. Most summers, she spent a month near a beach resort in Mexico. The lump reappeared after 6 months within the scar area and was re- excised. Both skin excisions were performed in the primary care setting without histologic assessment.

Substance Use Among a National Sample of Sexual and Gender Minority Adolescents: Intersections of Sex Assigned at Birth and Gender Identity.

Purpose: We examined how substance use differed as a function of sex assigned at birth and gender identity (cisgender, transgender, or nonbinary/genderqueer) by type of substance. We sought to test whether current gender identity and sex assigned at birth were key factors in substance use among a large contemporary sample that included transgender and nonbinary/genderqueer adolescents. Methods: We analyzed data from a large national U.S. sample of sexual and gender minority (SGM) adolescents (n = 11,129) collected between April and December 2017. Chi-square tests of independence were used to test whether substance use behaviors varied by sex assigned at birth and gender identity. A series of multivariate logistic regression models tested the odds of substance use by sex assigned at birth and gender identity, as well as the interaction between sex assigned at birth and gender identity. Results: More than half of our sample reported lifetime alcohol use, and one-fourth of the sample reported lifetime marijuana use. Adolescents assigned male at birth had higher prevalence of substance use compared with adolescents assigned female at birth (AFAB). Multivariate models elucidated greater risk for most substance use outcomes for transgender adolescents compared with cisgender adolescents. We found significant interaction effects between gender identity and sex assigned at birth for recent alcohol use and lifetime and recent cigarette use among adolescents AFAB. Conclusions: These findings have implications for stakeholders who develop nationally representative surveys, researchers who examine substance use disparities among SGM adolescents, and mental health professionals who treat underage substance use among vulnerable populations.

"No [Right] Way to be a Black Woman": Exploring Gendered Racial Socialization Among Black Women.

Using the theoretical lenses of intersectionality and racial-ethnic socialization, we conducted a focus group study with 29 Black women. We analyzed transcripts for the sources of messages about skin color and hair and for participants' responses to these messages via a grounded theory approach. Family members were the primary source of messages about skin color and hair. Peers and the media also communicated such messages. Messages ranged from endorsement of Western standards of beauty to an embrace of darker skin colors and natural hair texture. Rather than serving as passive recipients of messages, participants sifted through and reconciled messages with varying degrees of resolution. Their accounts reflected their intersectional experiences as Black women, representing a variety of physical attributes. We discuss the influence of these physical attributes on their individual racial-gender identity development in light of a second burgeoning Black hair movement that embraces Black natural hair in the U.S. Findings may help families and others build understanding of and increase sensitivity towards the intra- and interpersonal implications of colorism for Black women. Findings may also inform institutional policies (e.g., school, work) and practices such that they no longer create barriers or yield consequences for the Black women navigating these settings.

Considering the Role of Nativity in the Health and Psychological Wellbeing of Black LGBT Adults.

Recent scholars have underscored how the experiences of LGBT people of color cannot be fully understood by considering only the independent contributions of race and sexual orientation. Framed by an intersectional lens, the current study seeks to address this gap in understanding by considering the role of nativity on the health and wellbeing of Black sexual minority adults; we also examined the moderating effects of family support and racial community climate on this relationship. Using national data from the Social Justice Sexuality Project (N = 2,166), we discovered that foreign-born Black LGBT adults had similar levels of psychological wellbeing and physical health as their native counterparts; family support and racial community climate did not moderate this relationship. Our findings did, however, substantiate the importance of family and community support for all Black LGBT adults, regardless of immigration status. Implications of this finding, in addition to directions for future intersectional work on racial minority LGBT people, are discussed.

Viraemia and Ebola virus secretion in survivors of Ebola virus disease in Sierra Leone: a cross-sectional cohort study.

BACKGROUND: In survivors of Ebola virus disease, clinical sequelae including uveitis, arthralgia, and fatigue are common and necessitate systematic follow-up. However, the infection risk to health-care providers is poorly defined. Here we report Ebola virus RT-PCR data for body site and fluid samples from a large cohort of Ebola virus survivors at clinic follow-up. METHODS: In this cross-sectional cohort study, consecutive survivors of Ebola virus disease attending Kerry Town survivor clinic (Freetown, Sierra Leone), who had been discharged from the Kerry Town Ebola treatment unit, were invited to participate. We collected and tested axillary, blood, conjunctival, forehead, mouth, rectal, semen, urine, and vaginal specimens for presence of Ebola virus using RT-PCR. We regarded samples to be positive for Ebola virus disease if the cycle threshold was 40 or lower. We collected demographic data from survivors of their age, sex, time since discharge from the treatment unit, and length of acute admission in the Ebola treatment unit using anonymised standard forms. FINDINGS: Between April 2, and June 16, 2015, of 151 survivors of Ebola virus disease invited to participate, 112 (74%) provided consent. The median age of participants was 21·5 years (IQR 14-31·5) with 34 (30%) participants younger than 16 years. 50 (45%) of 112 participants were male. We tested a total of 555 specimens: 103 from the axilla, 93 from blood, 92 from conjunctiva, 54 from forehead, 105 from mouth, 17 from the rectum, one from semen, 69 from urine, and 21 from the vagina. The median time from Ebola treatment unit discharge to specimen collection was 142 days (IQR 127-159). 15 participants had a total of 74 swabs taken less than 100 days from discharge. The semen sample from one participant tested positive for Ebola virus at 114 days after discharge from the treatment unit; specimens taken from the axilla, blood, conjunctiva, forehead, mouth, rectum, and urine of the same participant tested negative. All specimens from the other 111 participants tested negative. INTERPRETATION: Patients recovering from Ebola virus disease who do not meet the case definition for acute disease pose a low infection risk to health-care providers 6 weeks after clearance of viraemia. Personal protective equipment after this time might be limited to standard barrier precautions, unless contact with fluids from sanctuary sites is envisaged. FUNDING: Save the Children International, Public Health England.

Expedition medicine in the tropics: through heat and sleet.

Expeditionary travel-for the purposes of scientific discovery, personal challenge, or survival-represents an essential human instinct. Risks come with the territory although not all the risks can be anticipated. This is part of the appeal of exploration. Risks can be minimised through proper planning and preparation. High risk appetite does not necessarily mean recklessness. For the expedition medic, behavioural modification and communication skills are every bit as important as clinical acumen. Extreme endurance events and unfamiliar surroundings provide both physical and mental challenges. These challenges are not uncommonly exploited by consumer reality television shows when novices are placed in such situations. Studies of human adaptation to extreme environments, such as at or near the summit of Everest, may provide new insights into human physiology that could translate into important medical interventions. Working in extreme environments-such as in tropical jungle heat or within Everest's 'death zone'-presents unique challenges but it also brings unique rewards and discovery. As long as humans have the urge to explore, whatever perils lie ahead boredom will not be one of them.

Viral exanthems in the tropics.

Viral exanthems are a common problem in tropical regions, particularly affecting children. Most exanthems are transient and harmless, but some are potentially very dangerous. Pregnant women and malnourished or immunocompromised infants carry the greatest risk of adverse outcome. In this article, parvovirus B19; dengue and yellow fever; West Nile, Barmah Forest, Marburg, and Ebola viruses, and human herpesviruses; asymmetric periflexural exanthema of childhood; measles; rubella; enteroviruses; Lassa fever; and South American hemorrhagic fevers will be discussed.