Prevalence of Sexual Strangulation/Choking Among Australian 18-35 Year-Olds.

In Australia, strangulation has been explicitly criminalized in all states and territories. However, it continues to be a "normalized" sexual practice despite its potentially fatal consequences and associated short and long-term sequelae. This research aimed to establish the prevalence of strangulation during sex and examine predictors of positive perceptions toward sexual strangulation in Australia. Confidential, cross-sectional online surveys were conducted with 4702 Australians aged 18-35 years. Participants were 47% cis-men, 48% cis-women, and 4% trans or gender diverse. A total of 57% reported ever being sexually strangled (61% women, 43% men, 79% trans or gender diverse) and 51% reported ever strangling a partner (40% women, 59% men, 74% trans or gender diverse). Differences were found across genders on all variables of sexual strangulation, including frequency of engagement, level of pressure on the neck, consequences, wanting and enjoyment, and how consent was given/received. However, when split by gender, sexual orientation of men and women revealed further differences in behaviors, consequences, and wanting, particularly among straight and bisexual women. After accounting for exposure to strangulation in pornography and previous experience of sexual strangulation, positive perceptions of being strangled (R2 = .51) and strangling a partner (R2 = .53) were predicted by ratings that it could be done safely and social normative factors. These findings suggest strangulation is common during sex among young Australians. Non-stigmatizing education strategies are needed to engage with young people so they have a better understanding of the risks involved and how to negotiate consent and safety regarding sexual strangulation.

Patient and Public Perceptions in Canada About Decentralized and Hybrid Clinical Trials: "It's About Time we Bring Trials to People".

BACKGROUND: Little is known about patient and the public perspectives on decentralized and hybrid clinical trials in Canada. METHODS: We conducted an online survey (English and French) promoted on social media to understand perspectives of people in Canada about decentralized and hybrid clinical trials. The survey had two sections. We co-produced this project entirely with patient, caregiver, and family partners. RESULTS: The survey had 284 (14 French) individuals who started or completed Section 1, and 180 (16 French) individuals who started or completed Section 2. People prefer to have options to participate in clinical trials where aspects are decentralized or hybridized. 79% of respondents preferred to have options related to study visits. There were concerns about handling adverse events or potential complications in decentralized trials, however, communication options such as a dedicated contact person for participants was deemed helpful. Most respondents were amenable to informed consent being done at a satellite site closer to home or via technology and were split on privacy concerns about this. Most preferred travel to a site within an hour, depending on what the trial was for or its impact on quality of life. Due to the response rate, we were unable to explore associations with gender, age, health status, geography, ethnicity, and prior clinical trial participation. CONCLUSION: Our findings indicate an openness in Canada to participating in trials that decentralize or hybridize some aspects. These trials are perceived to provide benefits to participants and ways to increase equity and accessibility for participants.

Transcoding of French numbers for first- and second-language learners in third grade.

Transcoding is the process of translating between spoken and written numbers, and it is correlated with other mathematical skills. In the present study, we investigated the link between French number writing of 49 students in the third grade (aged 7-9 years) and their language skills. Transcoding in French is of particular interest because the spoken number language system does not completely correspond to that of the written digits (e.g., quatre-vingt-dix [four-twenty-ten] and 90). We hypothesised that the complex linguistic structure of spoken numbers in French would be challenging for students who are learning to transcode. First and second French-language learners' accuracy and errors were recorded during a writing task of 3- to 7-digit numbers. Children also completed linguistic tests (e.g., receptive vocabulary, receptive syntax). Results showed that first- and second-language learners did not differ in their transcoding accuracy. Number size, decade complexity of stimulus number words in French (i.e., numbers containing a complex decade, operationalized as a number between soixante-dix, 70, and quatre-vingt-dix-neuf, 99), and receptive vocabulary predicted children's French transcoding skills. Students were more likely to produce errors (e.g., 68 or 6018 for 78) when they transcoded complex decade numbers compared with simple decade numbers. When an error was made on the complex decade portion of a number, it was likely a lexical error. In conclusion, third graders, both first- and second-language learners, found complex decade numbers challenging and their performance was related to their general vocabulary skills.

The problem with confidence: too much and too little results in poorer achievement, inner conflict, and social inhibition.

Introduction: Confidence is defined as the feelings and thoughts people have during a task that result in judgments about their performance. Evidence suggests that confidence is trait-like, but thus far research on the relative match between confidence and accuracy has been primarily restricted to over-confidence effects, and subject to the methodological flaws involved with using difference scores. We sought to answer an exploratory question in this research, whether discrepancies in ability and confidence in either direction reliably predicted individual differences on a broad-spectrum and commercially available personality test, the California Psychological Inventory (CPI260). Methods: Participants were 220 employed adults who had previously taken the CPI260 for career development purposes. They were invited to complete a measure of cognitive ability and confidence in return for feedback on the same. Data were modeled using polynomial regression and response surface analysis, to determine whether and how CPI260 personality traits were associated with matches or mismatches between accuracy and confidence in the same test. Results: We identified negative curvilinear effects along the line of disagreement for four CPI260 scales, suggesting that both under- and over-confidence were associated with personality. Discussion: In contrast to our expectations, individuals who were under-confident and those who were over-confident had lower achievement potential, less social confidence, and more inner conflict than other individuals in this sample. Although preliminary, these findings suggest that both over-confident and under-confident individuals are aware of potential weaknesses that impede their functioning.

Medical evidence assisting non-fatal strangulation prosecution: a scoping review.

OBJECTIVES: Non-fatal strangulation (NFS) is a serious form of gendered violence that is fast becoming an offence in many jurisdictions worldwide. However, it often leaves little or no externally visible injuries making prosecution challenging. This review aimed to provide an overview of how health professionals can support the prosecution of criminal charges of NFS as part of regular practice, particularly when externally visible injuries are absent. METHOD: Eleven databases were searched with terms related to NFS and medical evidence in health sciences and legal databases. Eligible articles were English language and peer reviewed, published before 30 June 2021; sample over 18 years that had primarily survived a strangulation attempt and included medical investigations of NFS injuries, clinical documentation of NFS or medical evidence related to NFS prosecution. RESULTS: Searches found 25 articles that were included for review. Alternate light sources appeared to be the most effective tool for finding evidence of intradermal injury among NFS survivors that were not otherwise visible. However, there was only one article that examined the utility of this tool. Other common diagnostic imaging was less effective at detection, but were sought after by prosecutors, particularly MRIs of the head and neck. Recording injuries and other aspects of the assault using standardised tools specific for NFS were suggested for documenting evidence. Other documentation included writing verbatim quotes of the experience of the assault and taking good quality photographs that could assist with corroborating a survivor's story and proving intent, if relevant for the jurisdiction. CONCLUSION: Clinical responses to NFS should include investigation and standardised documentation of internal and external injuries, subjective complaints and the experience of the assault. These records can assist in providing corroborating evidence of the assault, reducing the need for survivor testimony in court proceedings and increasing the likelihood of a guilty plea.

Characterizing the Impact of Clinical Exposure to Patients with Opioid Use Disorder on Medical Students' Perceptions of Stigma and Patient Care.

PHENOMENON: Opioid use disorder (OUD) is a growing public health crisis. Many residents and physicians do not feel comfortable working with patients with OUD. Social stigma promotes negative attitudes toward these patients and is a roadblock to delivering equitable and effective care. This study sought to (1) characterize medical students' experiences with patients with OUD, (2) understand the features that make a patient encounter memorable, (3) explore factors that influence future practice, and (4) describe the influence on stigma toward patients with OUD. Approach: A study was conducted using qualitative descriptive theory and purposive sampling of fourth-year medical students (M4s) enrolled at Wake Forest School of Medicine (WFSOM). Data collection consisted of a free-text question as a part of a larger survey to M4s in the Class of 2019 and 2020, followed by semi-structured interviews. The goal of the survey was to gain a broad understanding of student encounters with patients with OUD. The goal of the interviews was to gain a deeper understanding of the impact of these encounters on future practice and stigma. Thematic analysis was used to analyze all data. Findings: One-hundred-seventy out of 237 students (RR = 71.7%) completed the free text question describing a memorable encounter with a patient with OUD. Twelve students then completed interviews. Patient encounters occurred in three primary settings: Emergency department, inpatient clerkship, or Intensive Outpatient Program (IOP) meetings during psychiatry clerkship. Clinical encounters were memorable when there was: (1) conflict with patients or teams, (2) complicated care, (3) inadequate care, and (4) relevance to the student's future career. Memorable encounters influenced future practice by changing students' approaches to: (1) future treatment, (2) future communication, or (3) allowing students to practice professionalism. Regarding opioid stigma, students reported that these encounters made them: (1) more aware of stereotypes in medicine, (2) stereotypes in their personal lives, and (3) generated actions that students want to take in the future. Insights: A single, influential clinical encounter has the potential to substantially influence medical students' approach to patients with OUD, including both clinical management and attitudes toward care. Affecting encounters increased knowledge of OUD and fostered empathy and perspective-taking. Not all encounters had a defining impact on students' stigma toward OUD. Medical schools need to create opportunities that will have lasting impact by encouraging students to fully engage with patients with OUD.Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2022.2038175 .

Development and validation of an electronic health records-based opioid use disorder algorithm by expert clinical adjudication among patients with prescribed opioids.

BACKGROUND: In the US, over 200 lives are lost from opioid overdoses each day. Accurate and prompt diagnosis of opioid use disorders (OUD) may help prevent overdose deaths. However, international classification of disease (ICD) codes for OUD are known to underestimate prevalence, and their specificity and sensitivity are unknown. We developed and validated algorithms to identify OUD in electronic health records (EHR) and examined the validity of OUD ICD codes. METHODS: Through four iterations, we developed EHR-based OUD identification algorithms among patients who were prescribed opioids from 2014 to 2017. The algorithms and OUD ICD codes were validated against 169 independent "gold standard" EHR chart reviews conducted by an expert adjudication panel across four healthcare systems. After using 2014-2020 EHR for validating iteration 1, the experts were advised to use 2014-2017 EHR thereafter. RESULTS: Of the 169 EHR charts, 81 (48%) were reviewed by more than one expert and exhibited 85% expert agreement. The experts identified 54 OUD cases. The experts endorsed all 11 OUD criteria from the Diagnostic and Statistical Manual of Mental Disorders-5, including craving (72%), tolerance (65%), withdrawal (56%), and recurrent use in physically hazardous conditions (50%). The OUD ICD codes had 10% sensitivity and 99% specificity, underscoring large underestimation. In comparison our algorithm identified OUD with 23% sensitivity and 98% specificity. CONCLUSIONS AND RELEVANCE: This is the first study to estimate the validity of OUD ICD codes and develop validated EHR-based OUD identification algorithms. This work will inform future research on early intervention and prevention of OUD.

Explaining emergency physicians' capacity to recover from interruptions.

OBJECTIVE: To assess whether the capacity to utilize cues amongst emergency physicians is associated with differences in the capacity to recover performance following an interruption. BACKGROUND: Interruptions are implicated in errors in emergency medicine due to the cognitive load that they impose on working memory, resulting in a loss of performance on the primary task. The utilization of cues is associated with a reduction in cognitive load during the performance of a task, thereby enabling the allocation of residual resources that mitigates the loss of performance following interruptions. METHOD: Thirty-nine emergency physicians, recruited at a medical conference, completed an assessment of cue utilization (EXPERTise 2.0) and an online simulation (Septris) that involved the management of patients presenting with sepsis. During the simulation, physicians were interrupted and asked to check a medication order. Task performance was assessed using scores on Septris, with points awarded for the accurate management of patients. RESULTS: Emergency physicians with higher cue utilization recorded significantly higher scores on the simulation task following the interruption, compared to physicians with lower cue utilization (p = .028). CONCLUSION: The results confirm a relationship between cue utilization and the recovery of performance following an interruption. This is likely due to the advantages afforded by associated reductions in cognitive load. APPLICATION: Assessments of cue utilization may assist in the development of interventions to support clinicians in interruptive environments.

Reproductive coercion and abuse among pregnancy counselling clients in Australia: trends and directions.

BACKGROUND: Reproductive coercion and abuse (RCA) interferes with a person's reproductive autonomy and can be classified into behaviours that are pregnancy promoting or pregnancy preventing (including coerced abortion). However, prevalence data are lacking, and little is known about whether particular forms of RCA are more or less common. The aims of our study were to explore how frequently people seeking pregnancy counselling reported RCA, the proportions reporting the different forms of RCA, and whether there were different trends based on a range of demographic factors. METHODS: Data were collected from 5107 clients seeking counselling support for their pregnancy between January 2018 and December 2020 from two leading providers of pregnancy counselling and sexual and reproductive health services in Australia, Marie Stopes Australia and Children by Choice. Counsellors identified and recorded the presence of RCA and whether the behaviour was pregnancy promoting and/or pregnancy preventing. Demographic factors included age, and whether the person identified as being from a migrant or refugee community or as an Aboriginal and/or Torres Strait Islander person. RESULTS: RCA was identified in 15.4% of clients, with similar proportions disclosing RCA towards pregnancy (6%) and towards pregnancy prevention or abortion (7.5%), and 1.9% experiencing RCA towards pregnancy and abortion concurrently. There were no differences based on age or whether the person identified as being from a migrant or refugee background, though people who identified as Aboriginal and/or Torres Strait Islander experienced RCA that was significantly more likely to be pregnancy promoting. CONCLUSIONS: RCA is commonly disclosed by people seeking support in a pregnancy counselling context, and coercion and abuse is equally likely to be towards pregnancy promotion or pregnancy prevention/abortion. Given the prevalence and negative impacts of RCA, regardless of age and background, we recommend sensitive and culturally respectful enquiry around experiences of RCA be embedded in healthcare, health education, and health research.

Reproductive coercion and abuse (RCA) is behaviour that interferes with a person's decision to become pregnant or to continue a pregnancy. We classified RCA into behaviours that attempt to promote pregnancy or to prevent/end a pregnancy. Drawing on data collected from 5107 people seeking counselling support for their pregnancy from two Australian services, this research explored how common the different types of RCA are. The research also looked at whether a person's age or whether the person identified as being from a migrant or refugee community or as an Aboriginal and/or Torres Strait Islander person made any difference to the type of RCA they experienced. We found that 15.4% of people reported RCA, with similar proportions reporting behaviours attempting to promote pregnancy and prevent/end pregnancy. Around 2% reported experiencing both forms of RCA. We found that there were no differences in frequency of RCA based on age or whether the person identified as being from a migrant or refugee background, although we found that people who identified as Aboriginal and/or Torres Strait Islander were proportionally more likely to experience RCA that was pregnancy promoting. Given how common RCA is, regardless of age and background, we recommend sensitive and culturally respectful enquiry around experiences of RCA be included in any conversations around sexual and reproductive health care and education.

Walking another pathway: The inclusion of patterning in the pathways to mathematics model.

According to the Pathways to Mathematics model [LeFevre et al. (2010), Child Development, Vol. 81, pp. 1753-1767], children's cognitive skills in three domains-linguistic, attentional, and quantitative-predict concurrent and future mathematics achievement. We extended this model to include an additional cognitive skill, patterning, as measured by a non-numeric repeating patterning task. Chilean children who attended schools of low or high socioeconomic status (N = 98; 54% girls) completed cognitive measures in kindergarten (Mage = 71 months) and numeracy and mathematics outcomes 1 year later in Grade 1. Patterning and the original three pathways were correlated with the outcomes. Using Bayesian regressions, after including the original pathways and mother's education, we found that patterning skills predicted additional variability in applied problem solving and arithmetic fluency, but not number ordering, in Grade 1. Similarly, patterning skills were included in the best model for applied problem solving and arithmetic fluency, but not for number ordering, in Grade 1. In accord with the hypotheses of the original Pathways to Mathematics model, patterning varied in its unique and relative contributions to later mathematical performance, depending on the demands of the tasks. We conclude that patterning is a useful addition to the Pathways to Mathematics model, providing further insights into the range of cognitive precursors that are related to children's mathematical development.

Reproductive coercion and abuse against women from minority ethnic backgrounds: views of service providers in Australia.

Reproductive coercion and abuse is defined as behaviour that deliberately interferes with a person's reproductive autonomy. It is typically perpetrated by men against women in a context of fear and control and includes forcing a woman to become pregnant or to terminate a pregnancy. There is a dearth of qualitative research investigating experiences of reproductive coercion and abuse, particularly for women from minority ethnic backgrounds. In this study, we address this gap through qualitative analysis of data from six focus groups with service providers in Australia. Three main themes were developed: 1) exploiting structural inequalities; 2) women as reproductive property; and 3) pregnancy as a form of control. Findings confirm the complex interplay between reproductive coercion and abuse, intimate partner and sexual violence, and suggest that community attitudes towards women's role in sex and reproduction and structural risk factors may complicate this nexus even further for minority ethnic women. It is important for service providers supporting minority ethnic women - particularly in antenatal and abortion care - to be aware of reproductive coercion and abuse. Similarly, policies concerning access to financial support for minority ethnic women should acknowledge the critical role this could play in facilitating or preventing abuse.

Experiences of Reproductive Coercion in Queensland Women.

Reproductive coercion is any interference with a person's reproductive autonomy that seeks to control if and when they become pregnant, and whether the pregnancy is maintained or terminated. It includes sabotage of contraceptive methods and intervention in a woman's access to health care. Our study sought to explore the prevalence and associations with reproductive coercion within Queensland, Australia, where legislation addressing domestic violence and abortion are largely state based and undergoing a period of law reform. The study was a retrospective analysis of 3,117 Queensland women who contacted a telephone counseling and information service regarding an unplanned pregnancy. All data were collected by experienced counselors regarding circumstances within a current pregnancy between January 2015 and July 2017. Overall, experience of current domestic violence was significantly more likely to co-occur with reproductive coercion (21.1%) compared with reproductive coercion identified in the absence of other domestic violence (3.1%). Furthermore, significantly more mental health issues were reported by 36.6% of women affected by reproductive coercion, compared with 14.1% of women with no reproductive coercion present. Disclosure for reproductive coercion, violence, and mental health issues was much higher among women who made a repeat contact to the counselors about their pregnancy (17.8%) compared with those who disclosed at first contact (5.9%). These findings demonstrate the importance for health services to ensure that appropriate screening (and re-screening) for reproductive coercion is completed as a distinct part of screening for violence during a health care relationship.

Individual differences in the development of children's arithmetic fluency from grades 2 to 3.

In the present research, we provide empirical evidence for the process of symbolic integration of number associations, focusing on the development of simple addition (e.g., 5 + 3 = 8), subtraction (e.g., 5 - 3 = 2), and multiplication (e.g., 5 × 3 = 15). Canadian children were assessed twice, in Grade 2 and Grade 3 (N = 244; 55% girls). All families were English-speaking, and parent education levels ranged from high school to postgraduate, with a median of community college. In Grade 2, children completed general cognitive tasks (i.e., receptive vocabulary, working memory, nonverbal reasoning, and inhibitory control). In both grades, children completed single-digit addition and complementary subtraction problems. In Grade 3, they completed single-digit multiplication problems and measures of applied mathematics, specifically, word-problem solving, algebra, and measurement. We found that addition and subtraction were reciprocally related (controlling for cognitive skills). Subtraction fluency predicted multiplication in Grade 3, whereas addition fluency did not. In Grade 3, both subtraction and multiplication fluency were predictors of applied mathematics, with multiplication partially mediating the relation between subtraction and applied mathematics performance. These findings support the view that learning arithmetic associations is a hierarchical process. As students practice each new skill, individual differences reflect the integration of the novel component into the developing associative network. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Opioid stewardship training during the transition to residency to prepare medical students to recognize and treat opioid use disorder.

Background: With a drastic shortage of addiction medicine specialists-and an ever-growing number of patients with opioid use disorder (OUD)-there is a dire need for more clinicians to feel confident in prevention and management of OUD and obtain a DEA-X waiver to prescribe medications to treat OUD. Here we determine if it is feasible to certify 4th year medical students with DEA-X waiver training as a component of the PROUD (Prevent and Reduce Opioid Use Disorder) curriculum, and if PROUD enhanced preparedness for medical students to manage OUD as interns. Methods: We implemented a sequential mixed-methods IRB approved study to assess feasibility (completing all required components of DEA-X waiver training) and impact of PROUD (measured by knowledge growth, enhancement for residency, and utilization of training during internship). Students completed 11 hours of required OUD training. Quantitative data included pre-/post- knowledge and curriculum satisfaction assessments as well as long-term impact with follow up survey as interns. Qualitative data was collected by survey and semi-structured focus groups. Results: All 120 graduating medical students completed the required components of the curriculum. Knowledge improved on the Provider Clinical Support Services (12.9-17.3, p < 0.0001) and Brief Opioid Overdose Knowledge assessments (10.15-10.81, p < 0.0001). Course satisfaction was high: 90% recommended online modules; 85% recommended training overall. Six qualitative themes emerged: (1) curriculum content was practical, (2) online modules allowed flexibility, (3) in-person seminars ensured authenticity, (4) timing at the transition to residency was optimal, (5) curriculum enhanced awareness and confidence, and (6) training was applicable to future careers. At 3 months, 60% reported using their training during internship; 64% felt more prepared to treat OUD than peers. Conclusions: PROUD trained 4th year medical students in opioid stewardship. As interns, students felt ready to serve as change agents to prevent, diagnose, and treat OUD.

Investigating the educational experiences of transnational students: Differences in academic integration, social integration, and institutional and goal commitment.

BACKGROUND: Despite the growing popularity of transnational education, there is a dearth of quantitative research regarding how transnational students experience higher education. AIMS: This comparative study sought to explore differences in educational experiences between transnational and onshore domestic students enrolled either at the Australian (domestic) or Singapore (transnational) campus of an Australian university. SAMPLE AND METHODS: An online survey gathered responses from 199 domestic students and 313 transnational students. RESULTS: Results indicated transnational students to be significantly lower than domestic students on social and academic integration, institutional commitment, and satisfaction. No group differences were found in persistence intentions. A series of regression analyses showed integration and commitment significantly predicted student persistence intentions, across both cohorts, beyond demographic and course characteristics. CONCLUSIONS: This study offers several recommendations for how universities can better foster integration and commitment in their transnational students, including better funding the development of student societies and providing realistic course previews and career advice to students upon entry into their courses. Further, universities are encouraged to reconsider their transnational staffing models to provide more opportunities for academic support and student consultation beyond the classroom.

Number line development of Chilean children from preschool to the end of kindergarten.

Children's performance on number line tasks reflects their developing number system knowledge. Before 5 years of age, most children perform poorly on even the simplest number lines (i.e., 0-10). Our goal was to understand how number line skills develop before formal schooling. Chilean preschoolers attempted a 0-10 number line task three times over 2 years: at the beginning of pre-kindergarten (M = 4:7 [years;months]; Time 1), at the end of pre-kindergarten (M = 5:0; Time 2), and at the end of kindergarten (M = 5:10; Time 3). We used latent class analysis to group children according to their patterns of performance across number targets. At Time 1, 86% of children had error patterns indicating that they randomly placed estimates on the line. At Time 2, 56% of children continued to respond randomly. At Time 3, 56% of children showed competent performance across the number line, 23% were accurate only near the endpoints, and 21% were accurate only for low target numbers near the origin. Latent transition analyses showed that the transition from less to more proficient estimation classes was predicted by children's number identification skills. Thus, number line performance changed dramatically from 4 to 6 years of age as children began to develop the cognitive and numerical skills necessary to accurately estimate numbers on a number line.

Sentencing, Domestic Violence, and the Overrepresentation of Indigenous Australians: Does Court Location Matter?

The significant overrepresentation of Indigenous people in Australian prisons has been the subject of numerous studies. In this article, we build on recent research suggesting that sentencing in domestic violence cases might be an important contributor to this overrepresentation of Indigenous people. We broaden the existing research by examining differences for Indigenous and non-Indigenous defendants in domestic violence cases across a range of sentencing outcomes including imprisonment, probation, fines, and good behavior orders. We also consider whether the degree of geographic remoteness of the court influences these sentencing outcomes. To accomplish this, we use administrative court data from Queensland, Australia, and employ a multinomial hierarchical modeling strategy appropriate for nested court-level multilevel data. The findings further support recent Australian research suggesting that there are sentencing disparities for Indigenous and non-Indigenous people in relation to domestic violence, and in particular, that harsher sentences such as imprisonment are disproportionately reserved for Indigenous defendants. Our research demonstrates that these disparities in the likelihood of imprisonment occur irrespective of defendants' domestic violence protection order (DVO) breach histories and the location of the sentencing court. Based on the findings, we conclude with a discussion of possible ways forward. Although there is no question that Indigenous women should be safe and free from violence, supporting a harsher sentencing regime for those who breach DVOs is not effective. Instead, we argue that flexible strategies that work within and for Indigenous communities in Australia are required.

Treatment of Kratom Withdrawal and Dependence With Buprenorphine/Naloxone: A Case Series and Systematic Literature Review.

INTRODUCTION: Some opioid use disorder (OUD) patients attempt to self-treat using herbal remedies such as kratom. However, kratom use itself can paradoxically cause physical dependence and OUD. Currently, there are no guidelines for treating patients with OUD stemming from kratom use. Our empirically-based hypothesis was that there would be a correlation between the amount of kratom used and the amount of buprenorphine-naloxone required for opioid agonist therapy. METHODS: This study includes a systematic review assessing treatment of kratom-dependent patients with buprenorphine-naloxone; a case series of our kratom-dependent patients; calculation of the correlation between the kratom dose and the buprenorphine-naloxone dose required to treat kratom-associated OUD; and our proposed starting doses for using buprenorphine-naloxone to treat kratom OUD. RESULTS: The OVID MEDLINE (1946-2020) database was searched using the terms "kratom," "buprenorphine," and "case report." This search yielded 3 relevant cases of patients having kratom OUD who were treated with buprenorphine-naloxone with the amounts of all substances reported. Review of the bibliographies, citing articles, and Google Scholar turned up three additional cases, yielding 6 literature cases that were analyzed. We also analyzed 2 patients from our clinic, giving a total of 8 patients included in the Pearson correlation coefficient calculation. We found a strong correlation of 0.84 between these variables, consistent with our hypothesis. CONCLUSIONS: Based on our analysis, patients using <20 g of kratom/d could be initiated on opioid agonist therapy with 4/1 mg-8/2 mg buprenorphine-naloxone/d, while patients using kratom doses >40 g/d could be initiated with 12/3 mg-16/4 mg of buprenorphine-naloxone/day.

Isolation, self-blame and perceived invalidation in aid personnel: identifying humanitarian-specific distress using the PostAID/Q.

Objective: Humanitarian-specific psychological distress following deployment can elude detection using contemporary measures of trauma-related stress. This study assesses the unidimensional structure and convergent validity of the Post-deployment Altruistic Identity Disruption Questionnaire (PostAID/Q), an 18-item questionnaire underpinned by the construct Altruistic Identity/Disruption (AI/AID). Method: Humanitarian aid personnel (N=108) completed an online web survey, inclusive of the Moral Injury Questionnaire (MIQ), Posttraumatic Distress Disorder Checklist (PCL-5), Psychological Well-Being Posttraumatic Changes Questionnaire (PWB-PTCQ) and Social Provisions Scale (SPS). Results: A confirmatory factor analysis suggested a single factor structure providing further support for the conception of AI/AID as a unidimensional construct. Convergent validity was demonstrated through (1) utility for predicting a posttraumatic stress disorder (PTSD) diagnosis assessed by the PCL-5, and (2) moral injury assessed by the MIQ. The PostAID/Q was further moderately and negatively associated with the availability of social support (assessed by the SPS) and lower self-reports of psychological well-being post trauma (assessed by the PWB-PCTQ). Finally, the PostAID/Q demonstrated evidence of incremental validity in predicting humanitarian specific psychological distress over and above the PCL-5. Specifically, the PostAID/Q predicted increased moral injury on the MIQ, and decreased psychological well-being post trauma. Conclusions: The PostAID/Q can assist in identifying humanitarian specific psychological responses post deployment guiding support for personnel, over and above more traditional measures of posttraumatic stress.

Children's Home Numeracy Environment Predicts Growth of their Early Mathematical Skills in Kindergarten.

This study investigated the longitudinal associations between children's early mathematics and their home numeracy environment (HNE). Chilean children from families who varied widely in socioeconomic status were assessed at the beginning and end of prekindergarten in 2016 (N = 419, Mage  = 4:7 [years:months]), and at the end of kindergarten in 2017 (N = 368, Mage  = 5:10). Children whose parents provided frequent operational numeracy activities (e.g., learning simple sums) at prekindergarten showed better arithmetic performance and growth in nonsymbolic and symbolic number comparison at the end of kindergarten. Parents' knowledge of number-related games predicted children's arithmetic skills and growth in nonsymbolic number comparison. These findings underscore the persistent relations between the HNE and the development of children's mathematical skills.