Supportive Statements Research Articles

Development and Implementation of Postdischarge Text Messages to Adolescents With Suicidal Thoughts and Behaviors Through Caring Contacts: Implementation Study.

Youth suicide is a pressing public health concern, and transitions in care after a suicidal crisis represent a period of elevated risk. Disruptions in continuity of care and emotional support occur frequently. "Caring contacts" validating messages post discharge have the potential to enhance connections with patients and have been shown to improve outcomes. More recently, positive outcomes have been noted using caring contact text messages (SMS and MMS), which hold promise for engaging patients in a pediatric setting, but there are few studies describing the large-scale implementation of such an approach. This study aims to describe the process of developing and implementing automated caring contacts within a quality improvement framework, using a standardized series of supportive texts and images, for adolescents discharged from high-acuity programs at a large midwestern pediatric hospital. We describe lessons learned, including challenges and factors contributing to success. We implemented the caring contacts intervention in 3 phases. Phase 1 entailed developing supportive statements and images designed to promote hope, inclusivity, and connection in order to create 2 sets of 8 text messages and corresponding images. Phase 2 included piloting caring contacts manually in the hospital's Psychiatric Crisis Department and Inpatient Psychiatry Unit and assessing the feasibility of implementation in other services, as well as developing workflows and addressing legal considerations. Phase 3 consisted of implementing an automated process to scale within 4 participating hospital services and integrating enrollment into the hospital's electronic medical records. Process outcome measures included staff compliance with approaching and enrolling eligible patients and results from an optional posttext survey completed by participants. Compliance data are presented for 4062 adolescent patients eligible for caring contacts. Overall, 88.65% (3601/4062) of eligible patients were approached, of whom 52.43% (1888/3601) were enrolled. In total, 94.92% (1792/1888) of enrolled participants completed the program. Comparisons of the patients eligible, approached, enrolled, and completed are presented. Primary reasons for eligible patients declining include not having access to a mobile phone (686/1705, 40.23%) and caregivers preferring to discuss the intervention at a later time (754/1705, 44.22%). The majority of patients responding to the optional posttext survey reported that the texts made them feel moderately to very hopeful (219/264, 83%), supported (232/264, 87.9%), that peers would be helped by these texts (243/264, 92%), and that they would like to keep receiving texts given the option (227/264, 86%). This study describes the successful implementation of automated postdischarge caring contacts texts to scale with an innovative use of images and demonstrates how a quality improvement methodology resulted in a more effective and efficient process. This paper also highlights the potential for technology to enhance care for at-risk youth and create more accessible, inclusive, and sustainable prevention strategies.

Disparities uncovered: LGBTQ+ patients report on their cancer care journey.

1516 Background : In the U.S, LGBTQ+ people face higher cancer rates and worse outcomes than the general population. Few studies have described the experiences of LGBTQ+ people and their caregivers during treatment. As part of an implementation science initiative aimed at improving care for LGBTQ+ patients, we conducted a large survey (n=817) to understand treatment experiences of this population. Here we report our findings which provide insight into how stigma and incorrect assumptions may contribute to medical mistrust and worse experiences. Methods: In 2023, 817 diverse LGBTQ+ cancer patients from academic and community-based settings, as well as patient advocacy groups, completed web-based surveys evaluating their care experiences during cancer treatment. Participants included patients with gastric (n=165), breast (n=238), ovarian (n=218), prostate (n=56), and colorectal cancers (n=140), including 83 gender non-conforming patients. Results: Most LGBTQ+ patients (80%) reported not receiving appropriate preventative cancer screening, with top barriers including provider did not mention cancer screening tests (40%) and did not have a healthcare provider (28%). Additionally, only 24% felt at least moderately comfortable disclosing their LGBTQ+ status. Inclusive measures that helped patients feel most comfortable included care teams sharing/displaying their own pronouns (39%), making public statements of support (43%), or wearing personal items indicating acceptance (39%). Of those who did disclose their identity, only 50% of gender-expansive patients reported consistently being referred to by the correct names and pronouns. Importantly, patients reported that only 34% of their partners/caregivers felt welcome at appointments, and only 4% felt respected by the care team. Few patients reported receiving key supportive care services, including counseling/support groups (23%), quality-of-life related care, such as sexual function counseling (23%), and LGBTQ-specific resources/education (19%). Furthermore, less than half of LGBTQ+ patients discussed with HCPs how cancer treatment affects fertility (41%), fertility preferences (26%), or fertility preservation (14%), even though only 22% of patients reported not being eligible for fertility services. Interestingly, many of these gaps in care differed based on cancer type. For example, prostate, colorectal, and gastric patients were more likely to report not feeling safe disclosing their LGBTQ+ status (80%, 69%, and 54% respectively), while breast cancer patients were more likely to report having discussed fertility prior to starting treatment (64%). Conclusions: This study offers insights into experiences of LGBTQ+ patients and confirms disparities in care are real and pervasive. Ongoing education and inclusion efforts can help create a safe and welcoming environment, enabling equitable care and improved outcomes.

Patriarch and patriot: history in Patriarch Kirill’s sermons in the first year of the full-scale war in Ukraine

ABSTRACT The leader of the Russian Orthodox Church, Patriarch Kirill of Moscow and all Rus, has correctly been seen as a staunch supporter of the Russian full-scale invasion of Ukraine in 2022. However, explicit statements of support for the war are rare in his public sermons and speeches, and it is worth exploring the mechanisms of his support in some detail. The article presents an analysis of all the patriarch’s sermons and speeches between February 2022 and February 2023 and shows how the patriarch uses references to history to nurture a worldview that makes the war both legitimate and necessary. Using Duncan Bell’s notion of a mythscape, the author argues that Kirill infuses secular history with divine meaning in order to give indirect divine legitimation for the war in Ukraine. He further relates this to Stoeckl’s contention that the Russian Orthodox Church’s promotion of so-called traditional values functions as civil religion for today’s Russia and suggests that Kirill’s use of history nurtures this civil religion further.

Sovereign climate bonds: Policy innovation for just transitions in developing countries

This paper proposes sovereign climate-aligned bonds (SCBs) as an innovation that could mobilise climate investment towards developing countries. The research focuses on identifying the mechanisms underlying the issuance of SCBs in developing countries to unlock climate investment from capital markets and what they imply for facilitating just transitions. The research bridges scholarship across three fields: policy innovation, climate finance and just transitions, undertaking semi-structured interviews in two samples: SCB direct managers and intermediary and expert organisations. Drawing on Seychelles’s blue bond and Indonesia’s green sukuk as case studies, the research found that gaps in the public budgets of both countries were the main triggers for issuing SCBs and internationally, the influence of international organisations (World Bank and UNDP). Domestically, national wealth, access to international markets, alignment of the instruments' characteristics with political agendas and compatibility with regulations were key factors. SCB benefits, such as capital mobilisation, new investors and transparency, were perceived to outweigh additionality concerns or reputational risks (though higher transaction costs compared with non-green issuances remained a consideration). SCBs may be used as political statements in support of climate agendas, surpassing the perceived benefits of the mobilised capital. A legacy of exclusive dynamics in private markets remains a structural barrier for SCBs to be transformational in addressing climate change. Risk-return rationales and the exclusion of climate from countries’ risk profiling place developing countries in a more challenging position. While these instruments may not be sufficient to close the climate investment gap, they have an important role to play.

French attitude to Ukraine’s EU membership: from indifference through securitisation to alternatives

ABSTRACT After Russia invaded Ukraine in 2022, EU enlargement rebounded from the sidelines to take centre stage in the European debate. The overall support of the EU towards Kyiv was framed by a sudden moral imperative to help Ukraine enter the EU even though it had been stuck in the perpetual waiting room of Eastern Partnership for quite some time. France repeatedly attempted to form a pan-European body and created the European Political Community (EPC), allegedly intended primarily to help Ukraine. However, France has had an ambiguous attitude to EU enlargement which is domestically a politically sensitive topic. We examined to what extent a rationalist or securitisation-driven stance to EU enlargement prevails in France. To do so, an analysis of the geopolitical ambitions of France in Central and Eastern Europe together with its pan-European projects such as EPC was carried out. Our analysis proves that despite all the political statements of support for the EU candidate states, the French ruling elite and society do not favour enlargement. Potential member states are securitised in the political discourse and potential cons of their entry are emphasised. Moreover, French president Emmanuel Macron openly stated he expects the accession process of Ukraine would take decades.

Relations of Azerbaijan with Central Asian Turkic States within the framework of the Organisation of Turkic States

Following the dissolution of the USSR, Turkic States came together for the first time in 1992 at the Summit of Heads of State of Turkic Speaking Countries. The Summit was transformed into the Turkic Council with the Nakhchivan Agreement in 2009 and renamed the Organisation of Turkic States in 2021. This Organisation is one of the most important institutions shaping Azerbaijan's foreign policy. In this context, the support of the Organisation's member Turkic states in the Nagorno-Karabakh conflict with Armenia is critical; in fact, during the Second Karabakh War, the Organisation of Turkic States issued a statement in support of Azerbaijan. Similarly, the Organisation has been an effective tool in supporting Azerbaijan's foreign policy and increasing its regional and global influence. Moreover, within the framework of the Organisation, Turkic States have had the opportunity to share their experiences in areas such as science, technology, education and culture. This study focuses on the importance of Central Asian countries in Azerbaijan's foreign policy and the relations developed within the framework of the Organisation of Turkic States.

Statement of Support and Solidarity with Afghan Women

We, a coalition of independent Iranian women's organizations, express our solidarity with the women of Afghanistan in the fight against the reinstated Taliban, and deeply commiserate with them on the suffering that has been inflicted upon them. Iranian and Afghan women have a common experience in dealing with political Islam, oppression, repression, and lawlessness imposed by misogynistic and reactionary governments. In these critical times we are determined to raise our voices against the reactionary, fundamentalist, and anti-woman forces in this dangerous situation. Together with the women of Afghanistan, we strongly condemn all human rights violations against women in the name of law, religion, faith, and tradition.

Additional Data in Expanded Patient Populations and New Indications Support the Practice of Biosimilar-to-Biosimilar Switching.

As of 31 December, 2023, 31 observational studies have been published, including a total of 6081 patients who underwent a switch from one biosimilar to another biosimilar of the same reference biologic. Most studies evaluated infliximab, while a smaller number evaluated adalimumab, rituximab or etanercept. Indications studied now include sarcoidosis, as well as the indications previously reported of rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis/ankylosing spondylitis and inflammatory bowel disease (Crohn's disease and ulcerative colitis). This updated data set includes eight additional studies and 2386 more patients compared with those included in an earlier systematic review of biosimilar-to-biosimilar switching. In addition, since the earlier systematic review was published in 2022, the European Medicines Agency has stated that reference-to-biosimilar and biosimilar-to-biosimilar switching in the European Union is safe and efficacy remains unchanged after switching. Furthermore, following a review of the available evidence, the US Food and Drug Administration has confirmed that initial safety and immunogenicity concerns related to biosimilar switching are unfounded and that no differences are observed in efficacy, safety or immunogenicity following one or more switches. The availability of this new efficacy and safety data together with the supportive statements from the European Medicines Agency and the Food and Drug Administration re-confirm the conclusion that as a scientific matter, biosimilar-to-biosimilar switching is an effective clinical practice, with no new safety concerns. Any suggestions to the contrary are not supported by the evidence.

The Norwegian Dugnad in Times of COVID-19

ABSTRACT On 12 March 2020, the Norwegian government instigated measures to limit the spread of COVID-19, the most drastic policies of any Norwegian government in peacetime. A particularly Norwegian metaphor used when introducing those measures concerned the “dugnad” tradition, a cultural practice of voluntary work carried out as a community. This article traces the trajectory of dugnad metaphors related to COVID-19 in Norwegian public discourse, to shed light on the aptness of their use. Aptness is measured in terms of “resonance,” the public reception to the metaphor. It follows a threefold categorization: imposition, endorsement, or resistance, all of which are divided into inductively developed subcategories. The data consists of all relevant concordances of the lexeme DUGNAD appearing from March 2020-June 2021 in one of the three largest Norwegian national online newspapers. Findings indicate that the imposition of the dugnad struck a chord with the Norwegian people; supportive statements far outweighed those of opposition and continued throughout the investigated period, even though national government officials mostly stopped using the dugnad metaphor after May 2020. Resistance was nevertheless also present from the outset, reaching a renewed peak around March 2021. Aptness thus varies over time, a finding with implications for future pandemic communication.

An assessment of the informative value of data sharing statements in clinical trial registries

BackgroundThe provision of data sharing statements (DSS) for clinical trials has been made mandatory by different stakeholders. DSS are a device to clarify whether there is intention to share individual participant data (IPD). What is missing is a detailed assessment of whether DSS are providing clear and understandable information about the conditions for data sharing of IPD for secondary use.MethodsA random sample of 200 COVID-19 clinical trials with explicit DSS was drawn from the ECRIN clinical research metadata repository. The DSS were assessed and classified, by two experienced experts and one assessor with less experience in data sharing (DS), into different categories (unclear, no sharing, no plans, yes but vague, yes on request, yes with specified storage location, yes but with complex conditions).ResultsBetween the two experts the agreement was moderate to substantial (kappa=0.62, 95% CI [0.55, 0.70]). Agreement considerably decreased when these experts were compared with a third person who was less experienced and trained in data sharing (“assessor”) (kappa=0.33, 95% CI [0.25, 0.41]; 0.35, 95% CI [0.27, 0.43]). Between the two experts and under supervision of an independent moderator, a consensus was achieved for those cases, where both experts had disagreed, and the result was used as “gold standard” for further analysis. At least some degree of willingness of DS (data sharing) was expressed in 63.5% (127/200) cases. Of these cases, around one quarter (31/127) were vague statements of support for data sharing but without useful detail. In around half of the cases (60/127) it was stated that IPD could be obtained by request. Only in in slightly more than 10% of the cases (15/127) it was stated that the IPD would be transferred to a specific data repository. In the remaining cases (21/127), a more complex regime was described or referenced, which could not be allocated to one of the three previous groups. As a result of the consensus meetings, the classification system was updated.ConclusionThe study showed that the current DSS that imply possible data sharing are often not easy to interpret, even by relatively experienced staff. Machine based interpretation, which would be necessary for any practical application, is currently not possible. Machine learning and / or natural language processing techniques might improve machine actionability, but would represent a very substantial investment of research effort. The cheaper and easier option would be for data providers, data requestors, funders and platforms to adopt a clearer, more structured and more standardised approach to specifying, providing and collecting DSS.Trial registrationThe protocol for the study was pre-registered on ZENODO (https://zenodo.org/record/7064624#.Y4DIAHbMJD8).

Disclosure of Support Statement: Increasing student transparency about support from software like ChatGPT

Disclosure of Support Statement: Increasing student transparency about support from software like ChatGPT

FIGIJ Advocacy Statement in Support of Comprehensive Sexuality Education.

FIGIJ Advocacy Statement in Support of Comprehensive Sexuality Education.

“I Wasn't Expecting That Question”: Responses to Requests for Abortion Referral at College Student Health Centers

BackgroundWomen 18–24 years of age have the highest proportion of unintended pregnancies of any age group, and thus represent a significant population in need of abortion services. Prior research indicated that only half of college student health centers provide appropriate abortion referrals. Our objective was to better understand the referral experience and barriers to abortion referral at college student health centers. ProceduresWe conducted a “secret caller” study at all 4-year colleges in Pennsylvania between June 2017 and April 2018, using a structured script requesting abortion referral. Calls were transcribed, coded using an iteratively developed codebook, and analyzed for themes related to barriers and facilitators of abortion referral. Main FindingsA total of 202 completed transcripts were reviewed. Themes that emerged were knowledge, experience, and comfort with abortion referral; support, empathy, and reassurance; coercion; misleading language; questioning the caller's autonomy; and institutional policy against referral. Most staff lacked knowledge and comfort with abortion referral. Although some staff members made supportive statements toward the caller, others used coercive language to try to dissuade the caller from an abortion. Many staff cited religious institutional policies against abortion referral and expressed a range of feelings about such policies. ConclusionsAbortion referrals at student health centers lack consistency. Staff members frequently did not have the knowledge needed to provide appropriate abortion referrals, used coercive language in responding to requests for referrals, and perpetuated abortion stigma. Some health staff used coercive or evasive language that further stigmatized the caller's request for an abortion referral. College health centers should improve training and resources around abortion referral to ensure they are delivering appropriate, high-quality care.

CARE, INC.: HOW BIG TECH RESPONDED TO THE END OF ROE

After the leak of the Dobbs decision that ultimately overturned Roe v. Wade, technology companies made a series of public statements in support of user privacy: Apple released an advertisement showcasing privacy features; Google promised to delete location data of abortion clinic visitors; Meta announced testing of default end-to-end-encryption. Corporations like Meta once worked to convince users that their platforms were morally neutral. Now, they publicly “crack down” on manipulation and speak out for racial justice, despite privately subjecting activists to state surveillance. To bolster their authority and popularity, platforms engage in “commodity activism,” in which corporations take positions on social issues. Ultimately, this enhances corporate capital rather than enacting social change. Care, in its ideal, is opposed to neoliberalism: resisting individuality in favor of community and refusing to reduce humans to capital. Yet, paternalistic care can be a weapon – used to ensnare and to oppress. Through a critical technocultural discourse analysis of platforms’ public utterances and policy changes after the Dobbs leak, we find that platforms redefine care in three main ways. For users, care is neoliberal - platforms provide good privacy options, for which users are individually responsible. For employees, care is paternalistic - employees are offered money for healthcare, at the expense of free expression. Finally, ultimate care is for the platform - that company culture is protected, alliance with the state unthreatened, and above all, profit is promoted. Platform decisions are revealed to extend care in some ways, while also maintaining control over users and their data.

EOLP-03. BALANCING HOPE AND REALITY: A THEMATIC ANALYSIS OF PATIENT-CLINICIAN COMMUNICATIONS AT INITIAL NEURO-ONCOLOGY OUTPATIENT CLINIC VISITS FOR PATIENTS WITH NEWLY DIAGNOSED HIGH-GRADE GLIOMA

Abstract BACKGROUND: Patients facing a new diagnosis of a high-grade glioma often report an inaccurate understanding of their poor prognosis. However, how oncologists communicate prognostic information at initial visits in the neuro-oncology clinic has not been fully studied. We sought to analyze how physicians share this devastating news with patients and their caregivers. METHODS: We audio-recorded and transcribed the initial neuro-oncology clinic appointments with patients with high-grade gliomas at a single academic medical center; during these visits, neuro-oncology clinicians (physicians and fellowship trainees) shared diagnostic and prognostic information with patients and caregivers. We analyzed visit content using thematic analysis. RESULTS: We enrolled 14 patients with newly diagnosed malignant gliomas (glioblastoma: 11 and anaplastic astrocytoma: 3); 9 neuro-oncology clinicians (6 attending physicians and 3 fellowship trainees) participated in the appointments. Emergent themes included: (1) Neuro-oncologists proactively offered diagnostic and prognostic information using clear and simple language to disclose incurability (e.g., that this is an “incurable,” “aggressive” cancer that “will come back”); (2) Neuro-oncologists shifted their language, content, and tone to balance this bad news with clinical information that offered hope and optimism (e.g., emphasizing a patient’s positive prognostic indicators, sharing examples of long-term survivors, and discussing ongoing research and clinical trials); (3) Neuro-oncologists further balanced diagnostic disclosure with offers of logistical support (e.g., support programs for the patient’s minor children and access to 24/7 telephone care) and emotional support (e.g., stating "I am always here”) to patients and family members. CONCLUSION: During initial clinic visits with patients with high-grade gliomas, neuro-oncologists disclosed frank information about the incurability of the illness while balancing this life-changing news with statements of hope, optimism, and support. Understanding how clinicians provide diagnostic and prognostic information may help inform efforts to improve patient-clinician communication and optimize support for patients and their families.

BIPOC Collective Statement of Support

BIPOC Collective Statement of Support

"We're tolerant and they're prejudiced": Same-sex marriage supporters' and opponents' perceptions of supportive and oppositional claims.

The current research examined the proposition that debates over same-sex marriage are characterized, at least in part, by conflicting understandings about what is and is not prejudiced, normative and true. Toward this end, Australians' (N = 415) prejudice judgements of supportive and oppositional statements toward same-sex marriage were measured and analysed with analyses of variance. Unsurprisingly, same-sex marriage supporters perceived a supportive statement as unprejudiced, tolerant, truthful, in pursuit of individual liberty, and normative; oppositional statements were seen in precisely the opposite manner. Same-sex marriage opponents, however, disagreed, instead judging an oppositional statement as unprejudiced, tolerant, truthful, in pursuit of individual liberty, and normative; it was a supportive statement that was seen as relatively prejudiced. These effects remained even after controlling for independent expressions of in-group favouritism. The current data align with a collective naïve realism perspective, in which group members see their own views as veridical and those of disagreeing others as biased. We argue that prejudice-reduction efforts must be instantiated to facilitate a common in-group identity between supporters and opponents to enable consensus over facts and, ultimately, what is and is not prejudice. Without this consensus, each side of the political debate may simply hurl the pejorative label of "prejudice" against the other, with likely little opportunity for social influence and social change.

Solution-Focused Brief Therapy for Stuttering in the Public Schools: Children Solve Their Own Stuttering Problems in This Case Study.

This clinical focus article follows the case studies of three school-age children who stutter in solution-focused brief therapy (SFBT), highlighting treatment features and demonstrating positive outcomes. Empowerment and self-agency are emphasized as desired characteristics. Children searched within themselves and acted to influence therapy results. Techniques such as self-disclosure and fluency shaping were incorporated into this approach. In a public school district, participants with moderate-to-severe stuttering used the Clinical Use of Self-Reports to measure their perceived stuttering severity across various contexts and audiences. The speech-language pathologist (SLP) provided verbal feedback/contingencies including personalized questions, supportive statements, and positive gestures/comments. The students identified a stuttering problem, implemented the suggested techniques in clinic and in their natural environments, and shared pertinent feedback during the following therapy sessions. Participants solved stuttering problems and took charge of their own treatment. After 5 weeks of SFBT, the 18-year-old demonstrated sufficient problem-solving skills to agree to be discharged from the program. The remaining two students exhibited growth toward their individualized goals. They showed curiosity about their own stuttering situations and applied innovative strategies, in the outside world, that had been practiced and formulated in their therapy sessions. The participants engaged in conversations with the SLP, teachers, peers, and family members. They documented conversations, reflections, performance scales, and personal goals in their journals. During therapy sessions, the children clarified real-life goals and tried out techniques for managing their stuttering difficulties. In addition, they completed the Clinical Use of Self-Reports to assess their communication values, successes, and challenges. https://doi.org/10.23641/asha.23706363.

Ephemeral promises of happiness: Coming out in the Australian accounting profession into the late 2010s

AbstractThis interview‐based study explores how shifting promises of happiness impact on LGBTIQ+ individuals within the workplace. Our study situates within the “Big 4” Australian professional service firms at a time of significant political change, centered around the legislating of marriage equality in 2017. Together with statements of support issued by each of these firms, these moves offered an increasing sense that secure promises of happiness were now offered to “out” LGBTIQ+ staff. A shifting of hetero‐cis normativities was suggested, offering some sense of greater safety, visibility, connection, and acceptance within these workplaces. However, these promises of happiness remained precarious and did little for issues that mattered most (including promotion), particularly individuals of intersectionality, including ethnically diverse and female individuals.

HONOUR KILLING AND GENDER-BASED DOMESTIC VIOLENCE: A CASE STUDY OF QANDEEL BALOCH

Qandeel Baloch was a prominent social media star and feminist activist from Pakistan, who was brutally murdered by her brother Mr. Waseem in the name of honour killing. The incident of Qandeel Baloch is a subject of international scrutiny as it shed light on gender disparities, entrenched cultural norms, and social pressures. Honour killing and gender-based domestic violence reflect a negative impact on the country’s image. It is very important to analyze how such events are being portrayed in the foreign press and how people have reacted and shown their feedback in terms of posts/ comments. This research work is focused to analyze the foreign press (The Guardian) online stories/news and readers' posts about the murder case of Qandeel Baloch via content analysis. The documentary selected is "Qandeel - The Guardian". Even numbered 50 posts selected based on “Top Comments” are chosen. The results showed that the majority of posts are favorable as compared to un-favorable and neutral posts. Moreover, the favorable posts pertain to parental support, women supremacy, fatherly support, complimentary support, condemnation, motherly support, and sympathetic statements. A multi-faceted approach to underpin such violence is the need of the hour to cater to honour killing issues in Pakistan which encompass legal reforms, education, awareness, and collective action campaigns at all levels of society to ensure the rights and safety of women across the nation.