Foundation Level Research Articles

Case Article—Humanitarian Supply Chains and Inventory Management: Planning Medical Supply at the International Committee of the Red Cross

This case is based on an actual project with the International Committee of the Red Cross. The rich context allows instructors to cover important topics in inventory management, supply chain management, and humanitarian logistics at a level appropriate for different student backgrounds. At a foundational level, the case presents opportunities to practice concepts like cycle stock, safety stock, and service level. Technical audiences can appreciate applications of machine learning and optimization for inventory management. Practice-oriented audiences learn about the challenges of applying commercial operations metrics and heuristics like ABC analysis to humanitarian logistics. Realistic data and models are provided. Funding: B. Thakur-Weigold acknowledges funding from the Engineering for Humanitarian Action initiative launched by the ICRC, ETH Zurich, and EPFL. International Committee of the Red Cross (ICRC), Eidgenössische Technische Hochschule (ETH) Zürich, and École Polytechnique Fédérale de Lausanne (EPFL). Supplemental Material: Supplemental materials are available at https://www.informs.org/Publications/Subcribe/Access-Restricted-Materials .

Development of a pharmacy research career pathway discussion tool

Abstract Introduction Research is one of the four pillars of the RPS curriculum and forms Domain 5 of the credentialing pathway. However, gaining and using these research skills in the workplace appears challenging with low self-reported research confidence identified1, lowest domain pass rates in RPS Credentialing reports2 and a minority of the workforce identified as research active3. In order to support Welsh practitioners, Pharmacy Research Wales (PRW) has developed a tool to aid research discussions and awareness, identifying National research opportunities and potential career pathways, with relevant practice and portfolio evidence. Aims Develop a pharmacy research career pathway discussion tool to support career planning and evidence for the RPS credentialing portfolio. Method A literature search and review of RPS, National and local guidelines informed the tool drafting. A Microsoft form “tool” questionnaire was developed (PRW working group) and disseminated by email to a pharmacist cohort (n=10) established by Health Education Improvement Wales to support consultant credentialing. Subsequently members were invited to an in-person one-hour stakeholder development group (n=7) to discuss the tool and agree any modifications. A support moderator took anonymised notes which were reviewed for accuracy, with stakeholder clarification where necessary. No ethics approval was required as no patient involvement and data were anonymised. Questions explored usefulness, self-explanation, pathway self-recognition and improvements. A second draft was presented at 2023 RPS Wales conference research workshop for feedback. Results A schema was drafted describing timelines from foundation to consultant together with relevant examples of research opportunities and suggested portfolio evidence. All survey responses (7/10) indicated usefulness of tool: “good visual guide; draws everything together for the research domain” with 6/7 recognising this pathway as part of their own journey. Respondents (4/7) indicated it was not “self-explanatory”, suggesting removal of abbreviations, an introduction or a step-by-step guide but were positive for use as a mentor/mentee discussion tool. At the RPS research workshop tables (n=6) of ~7 delegates discussed and were asked to self-identify their research progression. Delegates annotated the tool (n=12) with 3, 8, and 1 respectively reporting foundation, advanced and consultant levels. Discussion and conclusion A research tool has been developed to support discussions relating to research career pathway planning and execution. Although there are methodological limitations to this work, for example sample size, it has been well received by the workforce with feedback highlighting areas such as increased awareness of research opportunities, a clear overview of research pathway examples and time investments required, supporting the need for advanced planning. Although aimed at Welsh practitioners, the template is generic and could be extrapolated to the UK workforce. The schema exemplars uni-professional and multi-disciplinary team pathways, the latter relying on research active medical staff. A high percentage of currently credentialled consultant pharmacists described using this latter route, confirming the need to build our own clinical academic workforce and support NHSE survey2 recommendations. Further work is required to embed this tool within the workforce and leadership bodies, facilitating research career pathway awareness, discussions and growth both within and across organisations.

Supporting prescriber progression: a group concept mapping study

Abstract Introduction Education reforms allow pharmacists to become prescribers earlier in their career and from 2026, new registrants will be independent prescribers.1 In NHS Scotland, an operational framework supports the development of pharmacist independent prescribing.2 We wanted to supplement the operational framework by identifying our core areas of prescribing to articulate prescribing progression and inform education and training provision. Aim To develop a core prescribing framework to support safe prescribing and a spiral approach to expanding scope of practice. Methods We conducted a participatory mixed-method approach using group concept mapping methodology.3 Phase 1 (brainstorming): all hospital pharmacists working in a patient-facing clinical role were invited to enter statements on a cloud-based platform (Padlet®) using the prompt ‘In my day-to-day practice I prescribe and/or make prescribing recommendations about the following medicines / conditions …’. The statements were triangulated with electronic inpatient pharmacist prescribing data over the previous three months. Phase 2 (sorting and rating): a project group comprised of pharmacists with different levels of practice and areas of clinical expertise, individually sorted the statements into groups based on the statements’ conceptual similarity and rated each statement by level of practice (post-registration foundation, advancing, advanced) and importance for including in a core framework (5-point Likert scale). R software applied multidimensional scaling to sorting data to create a similarity matrix, cluster map and Go-Zones. ChatGPT generated cluster titles. The project group discussed the results and following a few revisions, consensus was achieved on the content of the prescribing framework. This study was not considered research and was approved by the pharmacy quality improvement team in line with local governance process. Results Forty-three pharmacists participated in the brainstorming phase and generated 158 statements. Fourteen pharmacists participated in the sorting and rating phase. Multidimensional scaling analysis identified three clusters of prescribing activities: initiating, adjusting and deprescribing. The data identified activities involving initiating medicines and autonomous decision making rated at advancing/advanced level practice while adjusting/deprescribing medicines (often with the caveat of within guidelines, protocols or team decisions) was rated at post-registration foundation level. The prescribing framework includes the activities considered important and is organised by cluster and level of practice. Discussion / Conclusion This study provides a structured conceptualisation of prescribing across the levels of practice. The prescribing framework reflects the needs of our patients and hospital inpatient service and provides a scaffolded approach to progressing from inexperienced to more advanced prescribing roles. Post-registration foundation prescribing activities focus on processes or types of prescribing, whilst advanced are more autonomous and complex. Limitations we didn’t collect clinical area of practice as part of the demographic information for the brainstorming phase and some specialities may not be represented. Further work includes a training needs analysis and developing entrustable professional activities for core and higher risk areas of prescribing (e.g. post-operative pain).

NGHIÊN CỨU HIỆU QUẢ CỦA PHƯƠNG PHÁP TƯƠNG TÁC TRONG PHÁT TRIỂN KĨ NĂNG NÓI TIẾNG TRUNG QUỐC GIAI ĐOẠN CƠ SỞ TẠI TRƯỜNG ĐẠI HỌC HÙNG VƯƠNG

The ultimate goal of foreign language teaching and learning is communicative competence. Speaking holds a particularly vital position in the communication process. For language-specialized students at the foundation level, developing speaking skills is of utmost importance. Among these, interactive methods employed in communicative tasks have a positive impact on the language acquisition process in general and speaking skills in particular. From the perspective of applied linguistics, this study employs scientific experimentation to demonstrate the constructive influence of interactive methods on enhancing vocabulary usage, grammatical structures, accurate language forms, attention engagement, retelling, and precise responses of students towards teaching Chinese speaking skills at the foundation level. The research also suggests the application of interactive methods in the development of Chinese speaking skills at the foundation level at Hung Vuong University.

Introducing a Framework for Surgical Discharge Summaries to Improve Accuracy and Succinctness in a Busy District General Hospital.

Background Discharge summaries (TTOs) are essential documents in the effective communication between primary and secondary care, particularly in conveying critical post-discharge instructions to patients. Inconsistencies and omissions in TTOs can significantly undermine patient outcomes and disrupt continuity of care. This is particularly relevant to surgical patients, who often require specific follow-up care such as the removal of clips or drains shortly after discharge. Following the recent transition from paper-based to electronic records at a busy district general hospital (Royal Blackburn Hospital, Blackburn), the quality of TTOs was noted to be substandard.This quality improvement project aimed to enhance the accuracy and clarity of surgical TTOs. Methods A targeted framework was developed in collaboration with local consultants and the consideration of national guidelines to guide the content of surgical TTOs, focusing on five essential components: Reason for Admission, Intervention, Surgical Details, Discharge Plan, and Follow-up Instructions. Initial retrospective data analysis includedTTOs (n=60) across five surgical wards, evaluating their quality against the framework. The framework was then introduced via educational initiatives and integrated into the hospital's electronic patient record (EPR) system (CERNER). The impact of these interventions was assessed through data collection after two Plan-Do-Study-Act (PDSA) cycles. Results Baseline data highlighted significant deficiencies; 42 (70%) of TTOs were missing at least one key element, with missing follow-up details most often the reason. Many TTOs also included excessive or inappropriate information, and their format varied greatly depending on individual writing styles. Following the first PDSA cycle and the introduction of the framework, the numberof TTOs containing all essential data points increased by 14 (30% increase), while those missing two or more elements decreased by 16 (48% decrease). After the second cycle, further improvements were observed, with the number of TTOs missing one or more data points decreased by 6 (21%). Despite the overall progress, follow-up information continued to be the most frequently omitted element. Feedback from resident doctors was positive and the unanimous opinion was that the framework improved not only the quality of TTOs, but also how efficiently they were written. Conclusions Implementing a standardised framework significantly improved the quality of surgical TTOs, particularly by increasing the inclusion of critical information. These results are encouraging. However, anecdotal evidence suggests there is a lack of training in writing TTOs at both undergraduate and foundation levels. Ongoing efforts are required to address these areas to ensure a sustained improvement in quality.

Factors Impacting Perceptions of Gender Inequality in the Spanish Society

This study uses Ordinary Least Squares Multiple Regression with data on perceptions regarding gender equality from the Spanish general population. Overall, the results indicate that perceptions of equal treatment under the law and equality in political life are significantly associated with perceptions of gender equality. However, perceptions of discrimination in education do not seem to affect perceptions of gender equality significantly. In addition, the results show a clear association between the belief that gender equality leads to a fairer society and the perception of gender equality itself. Results also suggest that while certain perceptions related to the law, society, and political life are instrumental in shaping views on gender inequality, there remains a foundational level of perceived inequality in Spanish society. As a concluding remark, when examining the impact of female representation in leadership positions, the results provide empirical support that the presence of women in leadership positions improves the perception of gender equity in the contexts in which it occurs; this fact reflects the importance of promoting the participation of women in management positions through public policies.

Development of the Joint Expeditionary Medical Officer.

The Uniformed Services University is known for its dual mission of preparing military medical officers for operational readiness and leadership roles. The Joint Expeditionary Medical Officer (JEMO) project is a novel internal program that was initiated in 2022 and aims to fortify and evaluate the essential Knowledge, Skills, and Abilities (KSAs) within the School of Medicine's Molecules to Military Medicine curriculum that are pivotal for the development of a deployment-ready military medical officer. The JEMO-KSA program identifies and deliberately develops a core set of mission-critical skills during the course of students' undergraduate medical education. This helps ensure that Uniformed Services University graduates attain a strong foundational level of operational readiness across various military medical domains. Currently, 371 distinct KSAs have been integrated into the curriculum, with over 86% being assessed at different time frames. Over time, our goal is to present individual students with a customized JEMO "report card" depicting their readiness level; a document that could be updated and expanded throughout their military medical career. The JEMO project represents a significant stride toward optimizing the readiness of military medical officers by systematically identifying, strengthening, and assessing vital operational skills and abilities. With an ongoing commitment to excellence, the project envisages creating an even more robustly structured curriculum that is continually refined to address current operational readiness, setting a new standard for military medical education. While challenges such as accurately measuring the impact of integrated KSAs and continuously updating them to meet evolving military needs remain, the forward momentum associated with the JEMO project will help facilitate the development of military medical officers who have the KSAs to actively support mission success while simultaneously enhancing the overall effectiveness of military health care.

Ground failures and foundation performances in Adıyaman–Gölbaşı following the 6 February 2023 Kahramanmaraş–Türkiye Earthquake Sequence

The 6 February 2023 Kahramanmaraş–Türkiye earthquake sequence (M7.8 and M7.6) presents an exceptional opportunity to investigate both the effects of local soil conditions on damage patterns under strong shaking conditions and the performance of building foundations in areas that experienced ground failure. The significant ground failure and structural damage in Adıyaman–Gölbaşı triggered an intensive series of detailed reconnaissance and field surveys. This article aims to present the resulting database of observations on ground failures, building, and foundation performances. The field reconnaissance of ground failures and their effects on building performances involved aerial and walk-down surveys, including high-quality photographs taken across the town. In addition, data on building damage statistics compiled by the Ministry of Environment, Urbanization, and Climate Change were accessed and analyzed. The subsurface characteristics of the town were characterized using available data from pre-earthquake site investigation campaigns employed for town planning purposes. It is concluded that the ground failures in the town primarily resulted from soil liquefaction and cyclic softening. Most of the poor building and foundation performances and ground failures were documented in the northern part of Atatürk Boulevard, closer to the lake of Gölbaşı, where soil site characteristics were unfavorable. This revealed once again the significant effects of local soil site conditions, particularly soil liquefaction, on the intensified ground failures, foundation, and structural damage levels.

De la sustancia al yo como fundamento de la persona. Respuesta a John F. Crosby

This text continues the debate started with the article by Juan Manuel Burgos, The self as the ontological root of the person. Reflections on John F. Crosby, “Who” 6 (2017), pp. 33-54, to which John Crosby responded with the text On solitude, subjectivity and substantiality. Response to Juan Manuel Burgos, “Who” 8 (2018), pp. 7-18. In it, he responds to Crosby’s reflections by pointing out: 1) Crosby’s insistence on the relevance of intersubjectivity can be assumed as long as it is accepted that the self is situated at a more decisive foundational level of the person; 2) I accept, following Crosby, that the expression incommunicability can be used to refer to the person, although perhaps the use of this expression weakens his theses on intersubjectivity; 3) I continue to consider the use of the notion of substance to refer to the person to be inadequate and I believe that its functions should be replaced by a self understood in an ontological or foundational way.

Can Industrial Digitalization Boost a Consumption-Driven Economy? An Empirical Study Based on Provincial Data in China

A consumption-driven economy refers to an economic growth model primarily driven by domestic consumption and is a common goal for the economic growth of various countries. To explore the impact of industrial digitalization on a consumption-driven economy, this paper conducts an empirical study based on data from 31 provinces in China from 2013 to 2021. The empirical test results indicate: first, industrial digitalization significantly promotes the development of a consumption-driven economy, mainly reflected in the improvement of economic foundation and consumption levels, but shows no significant effect on improving the consumption structure. Second, mechanism analysis results show that industrial digitalization can promote the development of a consumption-driven economy by fostering innovation and advancing the industrial structure. Third, heterogeneity analysis results reveal that the promotion effect of industrial digitalization on the consumption-driven economy exists only in eastern and central China but not in western China, indicating that industrial digitalization in underdeveloped areas cannot exert a positive effect on the consumption-driven economy.

Christian Interiority in the Wild

Abstract: We live in an era of crisis when the Earth itself calls us to reconsider our most basic assumptions. Encounters with the wild world and with wild beings may impact us deeply, yet we rarely acknowledge them as sources for our own spirituality, let alone for our academic work as scholars of spirituality. By exploring how such encounters engage us at a more foundational level than that of articulated meaning, this essay strives to take another step toward thinking through the full implications of a participative epistemology and relational ontology.

Lateral-torsional buckling investigation of multi-tiers eccentrically braced frames with shear link beam

Multi-tiered braced frames (MTBF) are a type of braced frames with two or more tiers of bracing or bracing panels between horizontal diaphragm levels or locations of out-of-plane support, along with a beam at every tier level. They are commonly used in tall single-story building structures when it is not practical to use single bracing members spanning from roof to foundation levels. Additionally, they find application in multistory buildings with tall story heights. In this paper, lateral-torsional buckling of beams in a new type of MTBF called multi-tiered eccentrically braced frames (MT-EBF) is evaluated. This structural system is not mentioned in any of the current code and seismic criteria have not been provided. The main different of this system with eccentrically brace frame is the lack of laterally supported in the intermediate beam. Also, in industrial buildings that need architectural openings, this system is more useful than concentrically braced frame. For this purpose, the seismic behavior of four different MT-EBF with one and two tiers, along with two different configurations for the connection of braces to the beams, is studied. In the first configuration, the braces are connected to the beam using a gusset plate, and in the second configuration, the braces are directly connected to the beam using full penetration groove weld. The results of the numerical study indicate that in the first configuration, lateral-torsional buckling occurs in the intermediate beams, and the connection of the gusset plate to the beams lacks the necessary stiffness to prevent lateral-torsional buckling. However, in the second configuration, lateral-torsional buckling of the intermediate beams is prevented, and the connection of the braces to the beams has the adequate stiffness to prevent lateral-torsional buckling.

Taxonomy of Educational Objectives: Teaching, Learning, and Assessing in the Information and Artificial Intelligence Era

This study reviews existing taxonomies and proposes a new educational taxonomy that fulfills the educational needs of the current era, the information and Artificial Intelligence (AI) era. The review of previous educational taxonomies revealed that although they provide insights into establishing educational objectives and learning outcomes, they still need to address recent changes and challenges in learning processes. To (1) integrate the new realities into the landscape of learning (i.e., Education for sustainable development (ESD), soft skills development, and AI), (2) maintain the classroom as the formal venue for learning, and (3) strengthen the position and role of instructors as facilitators, a new six-category two-fold hierarchy-based taxonomy is proposed (AlAfnan Taxonomy): (1) Knowledge and Comprehension, (2) Synthesis and Evaluation, (3) Ethical and Moral Reasoning, (4) Application and Strategic Thinking, (5) Creativity and Innovation, and (6) Lifelong Learning and Adaptability. The taxonomy begins with foundational levels of ‘Knowledge and Comprehension’ stressing the importance of understanding fundamental realities and concepts within specific fields. Then, it addresses the importance of ‘Synthesis and Evaluation’ as essential and crucial skills for navigating an information-rich world. ‘Ethical and Moral Reasoning’ highlights the significance of ethical decision-making, moral frameworks, and culture-based diversity. Further, the taxonomy introduces ‘Application and Strategic Thinking’, emphasizing the practical use of knowledge in real-world scenarios and the ability to devise long-term plans. ‘Creativity and Innovation’ are essential drivers of progress in an era characterized by rapid technological advancements encouraging learners to explore novel solutions and approaches. Lastly, ‘Lifelong Learning and Adaptability’ underscores the necessity of continuous learning and flexibility in response to evolving circumstances, ensuring students and graduates remain competitive and relevant throughout their lives. By nurturing a multifaceted skill set encompassing critical thinking, ethical awareness, practical application, creativity, and adaptability, this taxonomy aims to equip learners with the necessary tools to excel in a dynamic and complex world, making it indispensable for modern education.

An arginine-rich nuclear localization signal (ArgiNLS) strategy for streamlined image segmentation of single cells

High-throughput volumetric fluorescent microscopy pipelines can spatially integrate whole-brain structure and function at the foundational level of single cells. However, conventional fluorescent protein (FP) modifications used to discriminate single cells possess limited efficacy or are detrimental to cellular health. Here, we introduce a synthetic and nondeleterious nuclear localization signal (NLS) tag strategy, called "Arginine-rich NLS" (ArgiNLS), that optimizes genetic labeling and downstream image segmentation of single cells by restricting FP localization near-exclusively in the nucleus through a poly-arginine mechanism. A single N-terminal ArgiNLS tag provides modular nuclear restriction consistently across spectrally separate FP variants. ArgiNLS performance in vivo displays functional conservation across major cortical cell classes and in response to both local and systemic brain-wide AAV administration. Crucially, the high signal-to-noise ratio afforded by ArgiNLS enhances machine learning-automated segmentation of single cells due to rapid classifier training and enrichment of labeled cell detection within 2D brain sections or 3D volumetric whole-brain image datasets, derived from both staining-amplified and native signal. This genetic strategy provides a simple and flexible basis for precise image segmentation of genetically labeled single cells at scale and paired with behavioral procedures.

The biblical sources of morality

In the context of a “Residential Course in Bioethics,” this report obviously stands as a contribution at the foundational level. In this respect it relates to other reports, from which, however, it must be clearly and adequately distinguished. In other words, I intend to respect to the utmost the biblical framework that has been indicated to me and that I now point out to you as a fertile and promising field for every man of good will who intends to ethically ground his prass.

In the Eye of the Beholder-Visual Search Behavior in Equestrian Dressage Judges.

This study investigated the visual search behavior of equestrian dressage judges at different expertise levels during the assessment of Grand Prix horse-rider combinations. Twenty judges (11 foundational level, 9 advanced level) participated in the study, with their eye movements recorded using Tobii Fusion Eyetracker as they evaluated video recordings of dressage tests. Fixation metrics, namely Total Duration of Fixation (TDF), Average Duration of Fixation (ADF), and Total Number of Fixations (TNF), were analyzed across four Areas of Interest (AOIs): front, back, rider, and horse's feet. Statistical analysis utilized linear mixed-effects models. Results demonstrated that judges consistently focused more on the front of the horse, with additional differences in fixation duration and frequency based on judge experience and specific movements. Advanced judges focused more on the horses' feet, suggesting they draw meaning from specific areas indicative of performance quality. Conversely, foundational level judges focused more on the rider, reflecting different evaluative priorities at lower levels of the sport. These findings suggest that judges focus on a limited number of highly relevant areas, differing across movements and expertise levels. The study underscores the necessity of understanding both gaze behavior and subsequent interpretations of visual information to increase judging transparency, fairness, and equine welfare.

The Moderating Efforts of Blended Learning on The Flexible Work Arrangements Approach and Students' Performance: Evidence from Student Perceptions

This research explores students' perceptions regarding the impact of flexible working arrangements (FWA) approach on their academic performance, with a focus on the moderating role of blended learning (BL) as an educational setting. A survey was conducted with students across foundation, undergraduate, and postgraduate levels in a Malaysian university to gather insights on how FWA and BL intersect to influence their performance. The findings indicate that FWA positively and significantly influences student performance. Additionally, the integration of BL was found to enhance the relationship between FWA and student performance. This suggests that the flexibility afforded by FWA, when combined with the benefits of BL such as increased engagement and personalised learning, can lead to improved academic outcomes from the students' perspective. The study provides practical implications for educators and institutions seeking to leverage technology and flexible arrangements to create more effective and adaptive learning environments. The theoretical contributions lie in enriching existing frameworks on student engagement, educational technology integration, and the dynamics of BL settings. Overall, this research offers valuable insights into how students perceive the combined effects of FWA and BL on their academic performance. Keywords: Student perceptions, flexible working arrangements, blended learning and teaching, students' performances, university students

THE PHILOSOPHY OF FRATERNITY AND THE FOUNDATIONS OF MORAL SOLIDARITY

Analyzing the historical forms of moral solidarity, one of which is the phenomenon of fraternity and trying to see in this form the foundations of constructive cooperation in modern conditions, we should pay close attention to the underestimated conceptual provisions and mechanisms. We believe that these factors play an important role in overcoming disintegration processes, both at the level of social communication and at the level of the mental foundations of intercultural and intercivilizational communication. The article is devoted to the philosophical foundations of the phenomenon of fraternity, mainly based on the material of European and domestic socio-philosophical reflection. The relevance of this topic is determined by the fact that the current international situation presents new challenges and that Russia is looking for constructive solutions to complex contradictions that have arisen in the international community. On the other hand, the axiological foundations of Russian civilization, which have been its genetic basis for many centuries, require constant philosophical reflection. The article discusses the essential importance of the phenomenon of fraternity for overcoming social disharmony, clarifies the advantages of this form of social interaction over formal cooperation. The methodology of the work is based on a socio-philosophical analysis of the axiological and ethical foundations of various forms of joint human activity. The article attempts to identify the structure-forming foundations of the system of social relations by the example of the phenomenon of fraternity.

Entanglement criterion and strengthened Bell inequalities based on the Pearson correlation

Entanglement is a property associated with quantum correlations and represents a key resource in several applications of quantum technology. Therefore, the ability to characterize entanglement is important at both foundational and practical levels. This work demonstrates how the Pearson correlation coefficient can be used to establish an entanglement criterion for quantum systems of two qubits. This criterion is then used to prove that a proposed conjecture is correct for the case of two qubits, which allows to efficiently identify entanglement without the need of complete prior knowledge of the quantum state. For higher dimensional quantum states the conjecture is demonstrated to be false through counter-examples, therefore a modified version of it is proposed. Finally, two new strengthened Bell inequalities are derived, which are also efficient in entanglement identification.

Narratives of Disconnection: A Life Course Perspective of Methamphetamine Use Among Sexual Minority Men Living with HIV.

Sexual minority men (SMM) are exposed to societal and structural stressors that translate into poor health outcomes. One such outcome is substance use, which research has long documented as a prominent disparity among SMM. Methamphetamine is a particularly deleterious substance for SMM because its use is often framed as a coping response to social and structural stressors. Guided by stress and coping theory and a life course perspective, the purpose of this qualitative study is to assess the development of coping strategies in the context of prominent social and structural determinants among SMM living with HIV who use methamphetamine. Data were collected from 2016 to 2018 via in-depth interviews with 24 SMM living with HIV who use methamphetamine in San Francisco, CA. Mean age of participants was 47 and over half self-identified as ethnoracial minorities. Narrative analysis surfaced a sequential pattern of disconnection at foundational, relational, and recovery levels. This analysis revealed that multi-level stressors were present across the life course that amplified engagement in methamphetamine use. Findings highlight the benefits of holistic, integrated, and trauma-informed approaches to address the function of methamphetamine use as a response to societal, cultural, and institutional processes of stigmatization and discrimination. Peer-based approaches may also be beneficial to reframe the ways in which SMM living with HIV who use methamphetamine form and sustain relationships.