Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program-level implementation intervention using a strength-based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.     

Differences in the importance of romantic structures among transgender and cisgender adults during the COVID-19 pandemic

The stressors of the global COVID-19 pandemic have led to an increased need for support. For adults, romantic relationships often represent an environment of emotional support and stability; as such, attitudes toward—and particularly the importance of—romantic relationships may have shifted as a result of the pandemic. The present cross-sectional study explores how U.S. transgender (n = 99) and cisgender people (n = 1886) report whether they have perceived a change in their feelings about the importance of long-term romantic structures (i.e., committed relationships, monogamy, cohabiting with a romantic partner, and marriage) as a result of the COVID-19 pandemic. Results found that transgender people reported a more positive perceived change in importance placed on all four romantic items relative to cisgender people. Different forms of stress (e.g., social, financial, health) associated with the COVID-19 pandemic may have contributed to an increased need, and subsequent desire, for social connection and support in the form of romantic relationships among transgender individuals to a greater extent than cisgender individuals, perhaps in part due to the additional layers of stress transgender people must navigate. Results are discussed through the lens of the minority stress framework.     

Drug effects in squirrel monkeys trained on a multiple schedule with a punishment contingency

The behavior of four monkeys trained on a multiple schedule was differentially sensitive to selected pharmacological agents. The three components of the multiple schedule were: (1) a variable-interval schedule in which responses were reinforced on the average of once per minute; (2) a concurrent schedule in which every tenth response was reinforced and every fifteenth response, on the average, was shocked; and, (3) a neutral stimulus in the presence of which responses were neither reinforced nor shocked. Pentobarbital, chlordiazepoxide, and meprobamate increased responding during each of the components. Scopolamine and d-amphetamine decreased variable-interval performance, had minimal effects on performance during the concurrent-schedule component, and increased responding in the presence of the neutral stimulus. Chlorpromazine decreased variable-interval responding and had slight effects on the responding during the other two components.     

Development of knowledge bases and the reliability of a decision support system for behavioral treatment consultation for persons with mental retardation: The Mental Retardation-Expert

The development of expert and decision support systems requires the collection, organization, codification, and storage of a body of specialized knowledge. The development, using reconstructive methods, of two such knowledge bases, the first containing the current scientific literature and the second containing an expert’s knowledge, is described for an automated decision support system, the Mental Retardation-Expert. This system provides practitioners with assistance in the treatment of aggressive, self-injurious, and destructive behaviors displayed by individuals with mental retardation or developmental disabilities. The average interobserver reliability of the expert knowledge base ranged from 92.5% to 95.0% when calculated across four clinicians’ assessments of 31 abstracted cases.     

Procuring organs from a non-heart-beating cadaver: commentary on a case report

Procurement of organs from non-heart-beating cadaver donors raises concerns. Standards for optimal patient care during withdrawal of life-sustaining therapy are evolving and continue to be debated and studied. Consensus on specific procedures and methods has not been attained, however, and protocols for the procurement of organs from patients following the withdrawal of life-sustaining therapies may compromise the evolving standards and harm the patient and the attendant family. In addition, there is little evidence to suggest that such protocols will significantly increase the number of organs procured. "Non-heart-beating cadaver" protocols that do not give comprehensive attention to optimal patient/family care at the time of withdrawal of life-sustaining therapy ought not to be endorsed.     

An advocacy intervention program for women with abusive partners: Six-month follow-up

Presented the 6-month follow-up findings of an experimental intervention designed to provide postshelter advocacy services to women with abusive partners. The intervention involved randomly assigning half the research participants to receive the free services of an advocate, 4 to 6 hours per week, for the first 10 weeks postshelter. One hundred forty-one battered women were interviewed about their experiences immediately upon their exit from a domestic violence shelter: 95% of the sample were interviewed 10 weeks thereafter (postintervention), and 93% were successfully tracked and interviewed 6 months later. At the 6-month follow-up, participants in both groups reported increased social support, increased quality of life, less depression, less emotional attachment to their assailants, and an increased sense of personal power. Although women in both groups reported some decrease in physical abuse over time, there were no statistically significant differences between those with and those without advocates, and abuse continued to be a problem for many women. Those who were still involved with their assailants continued to experience higher levels of abuse and had been more economically dependent upon the men prior to entering the shelter. Women who had worked with advocates continued to report being more satisfied with their overall quality of life than did the women in the control group. The authors thank the Editor and anonymous reviewers for their helpful comments. Thanks also to all present and past staff of the Community Advocacy Project, who helped in data collection and analyses. This work was supported by National Institute of Mental Health Grant 1R01 MH 44849.