Zahra or Zoe, Arjun or Andrew? Bicultural baby names reflect identity and pragmatic concerns.

OBJECTIVES: Ethnic first names are a visible product of diversity in the West, yet little is known about the psychological factors that influence naming preferences and choices among bicultural individuals. METHOD: Participants in Studies 1a (South Asian Canadians; N = 326) and 1b (Iranian Canadians; N = 126) were prospective parents who completed an online survey with measures of naming (consequences of ethnic naming, naming preferences) and psychological factors related to naming: heritage and mainstream acculturation, ethno-cultural continuity. Study 2 participants (N = 211) were parents of an Indian background living in three English speaking countries (Canada, United States, UK). They completed an online survey with measures of naming (consequences of ethnic naming, names as markers of cultural identity, actual naming choices) and psychological factors: heritage and mainstream cultural identifications, ethno-cultural continuity. RESULTS: Across all 3 studies we observed a strong preference for ethnic over mainstream names. In Studies 1a and 1b heritage acculturation and motivation for ethno-cultural continuity predicted stronger preference for ethnic names. In contrast, a preference for mainstream names was predicted by mainstream acculturation and expectations of negative consequences of ethnic names. In Study 2 choice of an ethnic name was positively related to beliefs about names as markers of ethnic identity, and negatively related to expectations of negative consequences of ethnic names. CONCLUSIONS: Baby naming among ethnic minorities is a complex cultural decision, reflecting both identity and pragmatic concerns. Implications for studies of acculturation and identity, and future research directions are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Know Your Heritage: Exploring the Effects of Fit in Cultural Knowledge on Chinese Canadians' Heritage Identification.

In the present research, we introduce the notion of fit in cultural knowledge (FICK) - which we define as a match between the self and others in representing a cultural tradition. For ethnic minorities, FICK can be manifested in different degrees of matching their personal beliefs about their heritage culture with outgroup as well as ingroup beliefs about their heritage culture. We conducted two studies with the objective of exploring the potentially negative effects of FICK on Chinese Canadians' heritage identification. In both studies, Chinese Canadian university students (N = 102; N = 156) indicated their personal beliefs about what values are normative in Chinese culture. Ingroup beliefs were assessed by beliefs about Chinese values that Chinese Canadians ascribed to their parents (Study 2), whereas outgroup beliefs were assessed by beliefs about Chinese values that were held by Euro-Canadians (Study 1) or that Chinese Canadians ascribed to Euro-Canadians (Study 2). The main findings based on a series of path models are as follows: (1) a stronger FICK generally predicted lower Chinese identification (centrality, ingroup ties, and affect), yet those negative effects were largely manifested in the openness to change versus conservation rather than in the self-transcendence versus self-enhancement value dimension. (2) The negative effects could be explained by Chinese Canadians' experience of bicultural conflict (Study 1) and the frustration of continuity, meaning, and belonging identity motives (Study 2), suggesting that it matters which specific views of Chinese culture are matched in FICK. 3) Individuals who agreed with the perceived outgroup beliefs, and parental beliefs to a lesser extent, were more likely to apply the model minority stereotype to other Chinese Canadians (Study 2). Taken together, those findings demonstrate the challenges FICK presents to heritage identity maintenance among Chinese Canadian young adults. Implications for enculturation and cultural fit are discussed.

Therapeutic drug monitoring in treatment-experienced HIV-infected patients receiving darunavir-based salvage regimens: A case series.

Therapeutic drug monitoring (TDM) constitutes a compelling approach for the optimization of antiretroviral therapy in treatment-experienced HIV-1 patients. While various inhibitory indices have been proposed to predict virologic outcome, there is a lack of consensus on the clinical value of TDM. Here, we report the comparative results of TDM in 14 HIV-1-infected patients who had previously received at least two different PI-based regimens and who initiated darunavir (DRV)-based salvage therapy. Pharmacokinetic/pharmacodynamics (PK/PD) parameters were calculated for each subject. Seventy-nine percent of subjects had a viral load <50 copies/mL at 48 weeks. The only subject with two consecutive viral loads >50 copies/mL at the end of the study period was the patient with the lowest instantaneous inhibitory potential (IIP). The sample size was insufficient to show an association between any of the PK/PD parameters and virologic response. Based on our observations, we suggest that the utility of IIP for antiretroviral combinations for the prediction of virologic outcome in HIV-1 drug-experienced patients should be studied further.

Self-consistency in Bicultural Persons: Dialectical Self-beliefs Mediate the Relation between Identity Integration and Self-consistency.

Prior research differentiates dialectical (e.g., East Asian) from non-dialectical cultures (e.g., North American and Latino) and attributes cultural differences in self-concept consistency to naïve dialecticism. In this research, we explored the effects of managing two cultural identities on consistency within the bicultural self-concept via the role of dialectical beliefs. Because the challenge of integrating more than one culture within the self is common to biculturals of various heritage backgrounds, the effects of bicultural identity integration should not depend on whether the heritage culture is dialectical or not. In four studies across diverse groups of bicultural Canadians, we showed that having an integrated bicultural identity was associated with being more consistent across roles (Studies 1-3) and making less ambiguous self-evaluations (Study 4). Furthermore, dialectical self-beliefs mediated the effect of bicultural identity integration on self-consistency (Studies 2-4). Finally, Latino biculturals reported being more consistent across roles than did East Asian biculturals (Study 2), revealing the ethnic heritage difference between the two groups. We conclude that both the content of heritage culture and the process of integrating cultural identities influence the extent of self-consistency among biculturals. Thus, consistency within the bicultural self-concept can be understood, in part, to be a unique psychological product of bicultural experience.

Development and Validation of the Bicultural Youth Acculturation Questionnaire.

OBJECTIVES: Acculturation is a multidimensional process involving changes in behaviour and beliefs. Questionnaires developed to measure acculturation are typically designed for specific ethnic populations and adult experiences. This study developed a questionnaire that measures acculturation among ethnically diverse populations of youth that can be included as a module in population surveys. METHODS: Questionnaires measuring acculturation in youth were identified in the literature. The importance of items from the existing questionnaires was determined using a Delphi process and this informed the development of our questionnaire. The questionnaire was then pilot tested using a sample of 248 Canadians aged 18-25 via an online system. Participants identified as East and South East Asian (27.8%), South Asian (17.7%) and Black (13.7%). The majority were 1st (33.5%) or 2nd generation immigrants (52.0%). After redundant items were eliminated, exploratory factor analysis grouped items into domains, and, for each domain, internal consistency, and convergent validity with immigrant generation then age at immigration estimated. A subset of participants re-completed the questionnaire for reliability estimation. RESULTS: The literature review yielded 117 articles that used 13 questionnaires with a total of 440 questions. The Delphi process reduced these to 32 questions. Pilot testing occurred in 248 Canadians aged 18-25. Following item reduction, 16 questions in three domains remained: dominant culture, heritage language, and heritage culture. All had good internal consistency (Cronbach's alphas > .75). The mean dominant domain score increased with immigrant generation (1st generation: 3.69 (95% CI: 3.49-3.89), 2nd: 4.13 (4.00-4.26), 3rd: 4.40 (4.19-4.61)), and mean heritage language score was higher among those who immigrated after age 12 than before (p = .0001), indicative of convergent validity. CONCLUSIONS: This Bicultural Youth Acculturation Questionnaire has demonstrated validity. It can be incorporated into population health surveys to elucidate the impact of acculturation on health outcomes among bicultural youth.

Modeling and simulation for medical product development and evaluation: highlights from the FDA-C-Path-ISOP 2013 workshop.

Medical-product development has become increasingly challenging and resource-intensive. In 2004, the Food and Drug Administration (FDA) described critical challenges facing medical-product development by establishing the critical path initiative [1]. Priorities identified included the need for improved modeling and simulation tools, further emphasized in FDA's 2011 Strategic Plan for Regulatory Science [Appendix]. In an effort to support and advance model-informed medical-product development (MIMPD), the Critical Path Institute (C-Path) [www.c-path.org], FDA, and International Society of Pharmacometrics [www.go-isop.org] co-sponsored a workshop in Washington, D.C. on September 26, 2013, to examine integrated approaches to developing and applying model- MIMPD. The workshop brought together an international group of scientists from industry, academia, FDA, and the European Medicines Agency to discuss MIMPD strategies and their applications. A commentary on the proceedings of that workshop is presented here.

Drinking too much and feeling bad about it? How group identification moderates experiences of guilt and shame following norm transgression.

The role of reference group norms in self-regulation was examined from the perspective of transgressions. Results from four studies suggest that following the transgression of a reference group's norms, individuals who strongly identify with their group report more intense feelings of guilt, an emotion reflecting an inference that "bad" behaviors are perceived as the cause of the transgression. Conversely, weakly identified individuals reported more intense feelings of shame, an emotion reflecting an inference that "bad" characteristics of the person are perceived as the cause of the transgression. The studies also explored the differential relevance of the reference groups when assessing transgressive behaviors, the counterfactual thoughts individuals have about possible causes for the transgressions, and the motivational outcomes of guilt and shame using behavioral data. Results of the studies offer insights into self-regulation, maintenance of group norms, and offer implications for alcohol consumption interventions, such as social marketing campaigns.

Understanding placebo responses in Alzheimer's disease clinical trials from the literature meta-data and CAMD database.

BACKGROUND: The placebo response and the underlying disease progression is difficult to differentiate in longitudinal Alzheimer's disease (AD) studies, yet it is crucial to understand for designing clinical trials and interpreting results. OBJECTIVES: The placebo response in ADAS-cog11 from various studies was evaluated against model predictions derived from historical placebo data to demonstrate potential interpretation of study results using a prior understanding of expected disease progression. METHODS: The placebo response component from a previously published disease progression model was used to estimate the longitudinal placebo response, and the disease progression in the placebo group in various case studies were evaluated. In addition, placebo data from the Coalition Against Major Diseases (CAMD) database in mild to moderate AD patients is described. RESULTS: The case studies demonstrated potential different results in disease progression in a placebo group, and the impact on understanding the magnitude of drug effect. Baseline cognitive function is an important covariate of disease progression, therefore, it is important to evaluate the baseline severity and predict disease progression accordingly when comparing trial results. Furthermore, study duration, sample size, and study design may affect the placebo response, all of which have the potential to confound understanding of study results. CONCLUSION: The recent failures in Phase III AD studies are not likely due to insufficient cognitive decline in the control groups. A meta-analytic approach using all available data provides a robust understanding of placebo effect, disease progression, and potential interpretation of treatment effects, and offers a useful tool to aid in both trial design and interpretation.

Diversity policy, social dominance, and intergroup relations: predicting prejudice in changing social and political contexts.

In contrast to authors of previous single-nation studies, we propose that supporting multiculturalism (MC) or assimilation (AS) is likely to have different effects in different countries, depending on the diversity policy in place in a particular country and the associated norms. A causal model of intergroup attitudes and behaviors, integrating both country-specific factors (attitudes and perceived norms related to a particular diversity policy) and general social-psychological determinants (social dominance orientation), was tested among participants from countries where the pro-diversity policy was independently classified as low, medium, or high (N = 1,232). Results showed that (a) anti-Muslim prejudice was significantly reduced when the pro-diversity policy was high; (b) countries differed strongly in perceived norms related to MC and AS, in ways consistent with the actual diversity policy in each country and regardless of participants' personal attitudes toward MC and AS; (c) as predicted, when these norms were salient, due to subtle priming, structural equation modeling with country included as a variable provided support for the proposed model, suggesting that the effect of country on prejudice can be successfully accounted by it; and (d) consistent with the claim that personal support for MC and AS played a different role in different countries, within-country mediation analyses provided evidence that personal attitudes toward AS mediated the effect of social dominance orientation on prejudice when pro-diversity policy was low, whereas personal attitudes toward MC was the mediator when pro-diversity policy was high. Thus, the critical variables shaping prejudice can vary across nations.

Negligible effect of tenofovir on atazanavir trough concentrations and genotypic inhibitory quotients in the presence and absence of ritonavir.

BACKGROUND: It is recommended to boost atazanavir with ritonavir (ATV/r) when it is combined with tenofovir disoproxil fumarate (TDF) because of drug interactions. For tolerability, unboosted atazanavir (ATV) is sometimes coadministered with TDF. The objective of this study was to evaluate the impact of this interaction on the proportion of patients achieving target ATV C troughs and genotypic inhibitory quotients (GIQ). MATERIALS AND METHODS: A therapeutic drug monitoring database was screened to evaluate ATV concentrations. Differences in C trough and GIQ values among 4 antiretroviral drug combinations were evaluated. RESULTS: Three hundred eight C troughs, 91 GIQs, and 92 viral loads were evaluated for 238, 68, and 69 patients, respectively. Patients receiving ATV/r and TDF compared with ATV and TDF were more likely to have a therapeutic C trough (odds ratio, 2.27; 95% confidence interval: 1.46-3.52; P < 0.001). Among patients on unboosted ATV, the odds of having a therapeutic ATV C trough did not differ between groups with TDF versus without TDF. Although ritonavir increased the GIQ in patients receiving TDF (odds ratio, 3.38; 95% confidence interval: 1.30-8.81; P = 0.013), a similar proportion of patients on TDF and either ATV/r or ATV achieved a therapeutic GIQ. CONCLUSIONS: In patients receiving TDF, ritonavir increased the ATV C trough and GIQ and patients on ATV/r were more likely to have therapeutic C troughs. However, among subjects without ritonavir boosting, TDF compared with other nucleosides did not influence the odds of achieving a therapeutic ATV C trough. These data suggest that ritonavir boosting of ATV is prudent, particularly in patients with resistance mutations.

HIV-1 tropism testing and clinical management of CCR5 antagonists: Quebec review and recommendations.

HIV-1 tropism assays play a crucial role in determining the response to CCR5 receptor antagonists. Initially, phenotypic tests were used, but limited access to these tests prompted the development of alternative strategies. Recently, genotyping tropism has been validated using a Canadian technology in clinical trials investigating the use of maraviroc in both experienced and treatment-naive patients. The present guidelines review the evidence supporting the use of genotypic assays and provide recommendations regarding tropism testing in daily clinical management.

Les tests de détermination du tropisme du VIH-1 jouent un rôle capital dans la détermination de la réponse aux antagonistes des récepteurs du CCR5. Au début, on utilisait des tests phénotypiques, mais leur accès limité a suscité l'élaboration d'autres stratégies. Récemment, le génotypage du tropisme a été validé à l'aide d'une technologie canadienne, dans le cadre d'essais cliniques faisant appel au maraviroc tant chez des patients déjà en traitement que chez des patients naïfs au traitement. Les présentes lignes directrices passent en revue les données probantes en appui à l'utilisation de tests génotypiques et contiennent des recommandations au sujet des tests de détermination du tropisme dans la prise en charge clinique quotidienne.

The effect of ß-carotene supplementation on the pharmacokinetics of nelfinavir and its active metabolite M8 in HIV-1-infected patients.

ß-Carotene supplements are often taken by individuals living with HIV-1. Contradictory results from in vitro studies suggest that ß-carotene may inhibit or induce cytochrome P450 enzymes and transporters. The study objective was to investigate the effect of ß-carotene on the steady-state pharmacokinetics of nelfinavir and its active metabolite M8 in HIV-1 infected individuals. Twelve hour nelfinavir pharmacokinetic analysis was conducted at baseline and after 28 days of ß-carotene supplementation (25,000 IU twice daily). Nelfinavir and M8 concentrations were measured with validated assays. Non-compartmental methods were used to calculate the pharmacokinetic parameters. Geometric mean ratios comparing day 28 to day 1 area under the plasma concentration-time curve (AUC(0-12 h)), maximum (C(max)) and minimum (C(min)) concentrations of nelfinavir and M8 are presented with 90% confidence intervals. Eleven subjects completed the study and were included in the analysis. There were no significant differences in nelfinavir AUC(0-12 h) and C(min) (-10%, +4%) after ß-carotene supplementation. The M8 C(min) was increased by 31% while the M8 AUC(0-12 h) and C(max) were unchanged. During the 28 day period, mean CD4+ % and CD4+:CD8+ ratio increased significantly (p < 0.01). ß-carotene supplementation increased serum carotene levels but did not cause any clinically significant difference in the nelfinavir and M8 exposure.

Outcomes of chronic hepatitis C therapy in patients treated in community versus academic centres in Canada: final results of APPROACH (a prospective study of peginterferon alfa-2a and ribavirin at academic and community centres in Canada).

BACKGROUND: In patients chronically infected with the hepatitis C virus (HCV), it is not established whether viral outcomes or health-related quality of life (HRQoL) differ between individuals treated at academic or community centres. METHODS: In the present observational study, adults with chronic HCV were treated with peginterferon alfa-2a 180 ìg/week plus ribavirin at 45 Canadian centres (16 academic, 29 community). The primary efficacy end point was sustained virological response (SVR). Other outcome measures included HRQoL (assessed using the 36-item Short-Form Health Survey), heath resource use, and workplace productivity and absences within a 60-day interval. RESULTS: In treatment-naive patients infected with HCV genotype 1, significantly higher SVR rates were achieved in those treated at academic (n=54) compared with community (n=125) centres (52% versus 32% [P=0.01]), although rates of dosage reduction and treatment discontinuation were similar across settings. SVR rates among patients infected with genotype 2/3 were similar between academic (n=59) and community (n=100) centres (64% versus 67% [P=0.73]). Following antiviral therapy, patients with genotype 1 who achieved an SVR (n=67) had significantly higher mean scores on the physical (P=0.005) and mental components of the 36-item Short-Form Health Survey (P=0.043) compared with those without an SVR (n=111). In contrast, HRQoL scores were similar in HCV genotype 2/3 patients with and without an SVR. There were no differences in workplace productivity or absences between patients with and without an SVR. The most frequently used health care resources by all patients were visits and phone calls to hepatitis nurses, and general practice or walk-in clinics. CONCLUSION: Patients infected with HCV genotype 1 achieved higher SVR rates when treated at academic rather than community centres in Canada. The reasons for this difference require additional investigation.

Management and treatment of hepatitis B virus in patients with HIV infection: A practical guide for health care professionals.

The management and treatment of HIV and hepatitis B virus (HBV)-coinfected patients present specific challenges for clinicians. The morbidity and mortality related to these concomitant infections are growing concerns, while the use of antiviral drugs effective against both viruses complicates therapeutic decision making. The present document provides guidelines for physicians regarding care and treatment of patients coinfected with HIV and HBV. Primary prevention of HBV in HIV-positive patients is achieved through appropriate vaccination schedules. Follow-up before treatment of HBV may include liver biopsy, screening for hepatocellular carcinoma and testing for esophageal varicies in cases of cirrhosis. In HBV-infected patients requiring treatment, recommendations regarding initiation, duration and choice of first-line drugs are made. Finally, in the case of resistance, appropriate alternative therapies are necessary.

Antiretroviral therapy for adults infected with HIV: Guidelines for health care professionals from the Quebec HIV care committee.

The appropriate use of antiretrovirals reduces morbidity and mortality caused by HIV infection. The present article provides health care professionals with a practical guide for the use of antiretrovirals. Therapy should be initiated based predominantly on clinical presentation and CD4 count, and should consist of three active drugs or at least two active drugs when this is not possible, as in cases of some treatment-experienced patients. This is the most effective way to achieve long-term suppression of viral replication. Selection of individual drugs in the regimen should consider the weight of the evidence supporting these choices, as well as their tolerability profiles and ease of use, the patients' comorbidities and treatment history. Treatment interruption is not recommended, either in aviremic patients or in those who have experienced virological failure. Instead, the therapeutic regimen should be adjusted to minimize side effects, promote adherence and suppress viral replication.

Bias against foreign-born or foreign-trained doctors: experimental evidence.

OBJECTIVES: Bias against foreign-born or -trained medical students and doctors is not well understood, despite its documented impact on recruitment, integration and retention. This research experimentally examines the interaction of location of medical education and nationality in evaluations of doctors' competence and trustworthiness. METHODS: A convenience sample of prospective patients evaluated fictitious candidates for a position as a doctor in community practice at a new local health clinic. All applicants were described as having the same personality profile, legal qualifications to practise, a multi-degree education and relevant work experience. The location of medical education (the candidate's home country or the UK) and national background (Australia or Pakistan) of the applicants were independently experimentally manipulated. RESULTS: Consistent with previous research on skills discounting and bias, foreign-born candidates were evaluated less favourably than native-born candidates, despite their comparable education level, work experience and personality. However, overseas medical education obtained in the First World both boosted evaluations (of competence and trustworthiness) and attenuated bias based on nationality. CONCLUSIONS: The present findings demonstrate the selective discounting of foreign-born doctors' credentials. The data show an interaction of location of medical education and birth nationality in bias against foreign doctors. On an applied level, the data document that the benefits of medical education obtained in the First World can extend beyond its direct outcomes (high-quality training and institutional recognition) to the indirect benefit of the attenuation of patient bias based on nationality.

Fostering culture and optimizing organizational structure for implementing model-based drug development.

Model-based drug development (MBDD) is a promising approach to improve decision making in drug development. The pharmaceutical industry has made substantial progress from engaging in empirical decision making to increasingly using pharmacometrics (ie, modeling and simulation [M&S]) as a quantitative decision-making tool. Focusing on culture and an organizational structure perspective, this commentary summarizes experiences and vision from industry M&S leaders on implementing MBDD. A culture for MBDD needs to have wide acceptance of MBDD, enhanced decision making with probability-based evidence and transparent rationale, quantitative impact metrics, and a brand that emphasizes cross-disciplinary collaboration and ownership. An organizational structure for MBDD needs to have a dedicated pharmacometrics function, fine balance between quick wins and impact on long-term R&D goals, and collaborative MBDD teams among clinical pharmacologists, statisticians, pharmacometricians, and clinicians. Pharmaceutical companies with these characteristics are prepared to fully embrace and implement MBDD.

Canadian consensus guidelines for the optimal use of maraviroc in the treatment of HIV-infected adults.

BACKGROUND AND OBJECTIVES: A Canadian group, consisting of six physicians and an HIV researcher with significant experience and knowledge in HIV management, reviewed the available data and developed guidelines for Canadian health care providers (who treat HIV infection) on the appropriate use of maraviroc (UK-427,857) in HIV-infected adults. METHODS: Evidence from the published literature and conference presentations, as well as the expert opinions of the group members were considered and evaluated to develop the recommendations. Feedback on the draft recommendations was obtained from this core group, as well as from four other physicians across Canada with expertise in HIV treatment and experience with the use of maraviroc. The final recommendations represent the core group's consensus agreement once all feedback was considered. RESULTS/CONCLUSIONS: Recommendations were developed to guide physicians and other health care providers in the optimal use of maraviroc. The recommendations were considered in light of the fact that the decision to include maraviroc in an antiretroviral regimen depends not only on issues that concern all antiretroviral agents, such as efficacy, safety, resistance and drug interactions, but also on the issue of viral tropism, which is unique to maraviroc and other CCR5 inhibitors.

Exposure-response analysis in patients with schizophrenia to assess the effect of asenapine on QTc prolongation.

An exposure-response (E-R) analysis using linear mixed effects modeling was conducted on data from a thorough QTc trial for asenapine in 148 patients with schizophrenia. In a parallel design, patients received asenapine 5 mg twice daily (BID) for 10 days (10d) followed by 10 mg BID (6d), asenapine 15 mg BID (10d) followed by 20 mg BID (6d), quetiapine 375 mg BID (for assay sensitivity; 16d) or placebo (16d). Triplicate 12-lead electrocardiograms and concentration measurements were obtained on day -1 (baseline), 1, 10, and 16 at 8 scheduled times on each day. At mean C(max) for all asenapine doses, the E-R model predicted that the mean QTcF increase was less than 5 milliseconds, the International Conference on Harmonisation-established threshold for clinical concern. The model predicted a mean increase of 7 to 8 milliseconds for quetiapine. The corresponding upper bounds of the 95% confidence intervals were 7.5 milliseconds and 11.2 milliseconds for asenapine and quetiapine, respectively.