The US in Uterus: A Collaborative Autoethnography of Psychologists Advocating for Reproductive Justice

In light of the recent Supreme Court decision to overturn Roe v. Wade, millions of people with uteruses have been forced to navigate precarious access to reproductive care. Although health service psychologists have an ethical responsibility to engage in reproductive justice advocacy, training programs often do not adequately address sexual and reproductive health. Therefore, we sought to better understand how health service psychologists’ personal and professional experiences influence each other and explore the ways in which we as reproductive beings and advocates sustain ourselves amidst tremendous sociopolitical uncertainty. In order to do so, we employed a feminist collaborative autoethnography approach grounded in critical theory. Attending to intersectional identities that help shape diverse expectations and experiences, two early career psychologists and four trainees uncovered 12 domains: barriers in academia; reproductive (dis)empowerment; relational connection; power(lessness) associated with social locations; internalization of sex-negative messages; the influence of sociopolitical climate; burdens related to reproductive rights; evaluations of reproductive justice efforts; component of professional identity; expectations from family and community; overwhelming and exhausting advocacy; and fears of inadequacy. We conclude with limitations and implications for the continued promotion of advocacy through practice and training within and beyond the field of psychology

Cryptococcal meningitis: A neglected NTD?

Although HIV/AIDS has been anything but neglected over the last decade, opportunistic infections (OIs) are increasingly overlooked as large scale donors shift their focus from acute care to prevention and earlier antiretroviral treatment (ART) initiation. Of these OIs, cryptococcal meningitis, a deadly invasive fungal infection, continues to affect hundreds of thousands of HIV patients with advanced disease each year and is responsible for an estimated 15%-20% of all AIDS-related deaths [1,2]. Yet cryptococcal meningitis ranks amongst the most poorly funded “neglected” diseases in the world, receiving 0.2% of available relevant research and development (RandD) funding according to Policy Cures’ 2016 G-Finder Report [3,4]

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Hidden in Plain Sight: Working Class and Low-Income Atheists

The current study sought to qualitatively examine the role of social class in the development of atheist identity, the experience of atheism-related minority stress, and relationships between atheists. Using a critical phenomenological design, we captured the experiences of 15 working-class and the low-income U.S. American atheists and identified five themes: Early Doubts and Establishment of Atheist Values; Diverse Experiences of Antiatheist and Class-Based Stigma; Expecting Indifference, Exercising Caution; Strategies of Concealment and Disclosure; and Atheism as an Individual, Rather Than Collective, Experience. Results suggested working-class and low-income atheists engaged in strategic outness to manage risk, and their atheist identities developed similarly to studies including primarily class-privileged atheists. However, working-class and low-income atheists diverged from extant atheism scholarship in their relatively low atheist identity centrality and limited engagement with and perceived connection to other atheists. We conclude with implications for our findings and directions for future research

Ecosystem services and disservices by birds, bats and monkeys change with macadamia landscape heterogeneity

The relative importance of ecosystem services and disservices can change with landscape structure in a poorly understood way. We compare the impact of biocontrol, provided by bats and birds, with that of crop raiding by vervet monkeys on yield in South African macadamia orchards. Insectivorous bats and birds are known to feed on macadamia pest insect species, like the macadamia nut borer or the green vegetable bug. Vervet monkeys move into the orchards during the day to feed on premature macadamia nuts. Bats, birds and monkeys benefit from patches of natural vegetation adjacent to orchards. With exclusion experiments (four treatments: day, night, day and night, control) we quantified the relative importance of biocontrol and crop raiding on yield, comparing two different landscape settings of the orchards, a natural and a human-modified. Crop raiding occurred only close to natural vegetation and caused yield losses of about 26%. Biocontrol by bats and birds was higher near natural vegetation, but still significant in human-modified landscapes, at up to 530 m distance to forest patches. Prevented biocontrol through the exclusion of bats and birds resulted in yield losses of up to 60%. Effects of biocontrol by bats and birds (USD ~5,000 ha/year) were economically more important than the losses of crop raiding (USD ~1,600 ha/year). As both are linked to the vicinity of forest patches, the removal of natural vegetation to limit monkey abundances would also limit biocontrol service provision. Synthesis and applications. This study highlights the high economic benefits of biocontrol by bats and birds, which outweighed negative impacts through yield losses caused by crop raiding monkeys. Management practices to prevent crop damage, such as guarding, excluding vertebrates or removal of adjacent natural vegetation, would also limit access for bats and birds and the great economic benefits provided by their biocontrol. Ecosystem services by bats and birds can be promoted by the exposure of artificial roost and nest sites, but research into species-specific preferences is needed. The education of farmers is crucial, as many are unaware of the benefits from birds and bats and the fact that these benefits can outweigh the disadvantages of the monkeys' crop raiding

Plexus 2024: Navigate

Welcome to the 25th anniversary edition of PLEXUS, UC Irvine School of Medicine’s annual student-organized Journal of Medical Humanities & Arts. To mark this celebratory milestone, it is with great pleasure that I present to you NAVIGATE. In the ever-evolving landscape of medicine, the ability to navigate through challenges and unforeseen obstacles is paramount. NAVIGATE serves as a timely invitation for our colleagues to reflect on the distances traversed and to envision the new horizons that lie ahead. We sought to highlight the constellation of tools utilized when we feel lost and to acknowledge the beacons that steer our actions. The subsequent pages offer its readers profoundinsights into the extraordinary journeys undertaken by the greater UCI Health community. We hope it delivers a sense of direction, solace, and clarity to all readers.As we celebrate our 25th anniversary, wehonor the visionaries, contributors, and readers that have propelled us forward on this remarkable voyage. Their collective support fuels our efforts to serve as a creative outlet for the community, catalyze meaningful discussions, and apply the tenets of medical humanities to foster a cohort of compassionate healers.We extend our deepest gratitude to our faculty advisors Dr. Juliet McMullin and Dr. TanNguyen for their invaluable guidance and for sharing their expertise within the field. We thank the UCISOM Medical Humanities & Arts Program and the UCI Department of Family Medicine for their unwavering support. I invite you to embark on this exploration with us, and witness the intricate tapestry of our contributors’ lived experiences that defines our shared journey in healthcare.Bon voyage,Christopher SahagianEditor-in-ChiefCreative Review — Caroline GeeCreative Review — Huan NguyenCreative Review — Sana ShahDesign — Nicole ParkerDesign — Britney WengFaculty Advisor — Dr. Juliet McMullinFaculty Advisor — Dr. Tan NguyenStaff Advisor — Leonora Naser-Saravia{Front Cover): NEW HEIGHTS Britney Weng, MS1San Pedro de Atacama, Chile(Inner Cover): TRAVERSING  Britney Weng, MS1Chile Route 2

Insights into the accuracy of social scientists' forecasts of societal change

How well can social scientists predict societal change, and what processes underlie their predictions? To answer these questions, we ran two forecasting tournaments testing the accuracy of predictions of societal change in domains commonly studied in the social sciences: ideological preferences, political polarization, life satisfaction, sentiment on social media, and gender-career and racial bias. After we provided them with historical trend data on the relevant domain, social scientists submitted pre-registered monthly forecasts for a year (Tournament 1; N = 86 teams and 359 forecasts), with an opportunity to update forecasts on the basis of new data six months later (Tournament 2; N = 120 teams and 546 forecasts). Benchmarking forecasting accuracy revealed that social scientists' forecasts were on average no more accurate than those of simple statistical models (historical means, random walks or linear regressions) or the aggregate forecasts of a sample from the general public (N = 802). However, scientists were more accurate if they had scientific expertise in a prediction domain, were interdisciplinary, used simpler models and based predictions on prior data. How accurate are social scientists in predicting societal change, and what processes underlie their predictions? Grossmann et al. report the findings of two forecasting tournaments. Social scientists' forecasts were on average no more accurate than those of simple statistical models