Braithwaite's (1989) theory of reintegrative shaming has been increasingly used to explain how social control efforts may result in both conformity and deviance. Using this theory as an interpretive framework, this study examines the relative effectiveness of a specialized drug court in reducing recidivism risks. Contrary to expectations based on its structural similarity to the principles of reintegrative shaming, the authors find that risks of recidivism for drug court participants are significantly higher than comparable offenders processed outside drug court. Field observations and a more detailed examination of daily practices explain these unexpected findings by revealing that the drug court is actually more stigmatizing than conventional courts and is not reintegrative enough in its orientation toward punishment. The results of this study are then discussed in terms of their implications for further research.

Increased ethnic diversity of physicians is associated with increased access to health care for underserved communities, better anticipation of patient needs, and acceleration of medical research. 1 Similarly, sex concordance between physicians and patients can improve communication and patient satisfaction. 2 Although sex and ethnic diversity of US physicians have both increased over the past several decades, not all clinical specialties have been impacted equally. To better characterize the dermatology field's evolution during this time period, we analyzed sex and ethnicity trends among dermatology residents and compared them with other specialties and medical school graduates over multiple decades. Methods | Thirty-six years of self-reported ethnicity and 19 years of self-reported sex composition data of American College of Graduate Medical Education (ACGME)-registered dermatology, internal medicine, emergency medicine, obstetrics/ gynecology, ophthalmology, general surgery, and orthopedic surgery residents were obtained from the National Graduate Medical Education Census. 3 Similar ethnic and sex composition data of graduating medical school classes were obtained from the Association of American Medical Colleges (AAMC) Data Book. 4 Ethnic groups were defined as white, Asian, African American, Hispanic, or other. Respondents could choose more than 1 category. The categories for sex were male or female. Changes in sex and ethnic compositions were analyzed across the periods for which data were available. Institutional review board approval was waived by the Beth Israel Deaconess Medical Center, because only publicly accessible data was used. Using Stata 14 statistical software (StataCorp), specialtyspecific logistic regression models were constructed to evaluate the proportion of residents across ethnicity and sex groups over time. Demographic differences over time between specialties were evaluated with the likelihood ratio test. To assess recent differences between specialties in sex and ethnic compositions, data from 2011 to 2013 were averaged and binomial proportions were compared using a 2-sample z test. All 2-sided P values <.05 were considered statistically significant.

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1584 Background: This study compared patient-reported stress, anxiety, and depression between newly diagnosed ovarian cancer patients with pathogenic genetic testing results versus patients with non-informative results (i.e., variants of uncertain significance (VUS) or negative). Methods: Patients underwent genetic testing (GT) via a facilitated referral pathway (Frey et al, Gynecol Oncol 2020) through which they were referred for genetic counseling and GT by their gynecologic oncologist within six weeks of diagnosis from 10/2015 to 5/2019. English-speaking patients completed three quality of life (QoL) instruments: Impact of Events Scale (IOES), State-Trait Anxiety Questionnaire (STAI), Hospital Anxiety and Depression Scale (HADS) immediately pre-and post-GT and 6 months post GT. Two-way mixed ANOVA was performed to analyze effect of GT results on QoL over time with significance p < 0.05. Results: One hundred ten patients were enrolled in the pathway and 83 (76%) patients underwent GT. Among these, 15 (18%) had potentially actionable pathogenic mutations ( BRCA1-8, BRCA2-4, MSH2-2, MRE11A-1); 26 (31%) had VUS results; 3 (4%) had both a pathogenic mutation and a VUS result; and 42 (51%) had negative results. Sixty patients (72%) completed QoL assessments pre and post GT, and 37 (44%) patients at 6-9 months post GT. For all patients, GT results did not affect QoL scales across our time points. By mean scores across all-comers, patients demonstrated mild stress at each time point and clinically significant anxiety immediate post-GT. All patients had a statistically significance decrease in HADS depression scores over time from pre-GT to 6 months post-GT (mean score 4.98 vs 2.97, p = 0.020). Patients with VUS had lower HADS mean anxiety scores across time (3.62) compared to patients with pathogenic (7.44) or negative mutations (6.83, p = 0.029). For patients without mutations, there was a significant decrease in clinically significant anxiety by STAI-state score at 6 months (p = 0.002) and a decrease in borderline anxiety by HADS scores at 6 months (p = 0.005). This effect was not present for patients with pathogenic mutations or VUS. Conclusions: A pathogenic result does not impact QoL scales immediately pre or post GT or at 6 months post GT, though patients with negative mutations were more likely to show a decrease in anxiety over time. Patients should be recommended GT at time of diagnosis of ovarian cancer without concern of increased stress, anxiety, or depression based on GT results.

e13024 Background: Genetic assessment (GA) is recommended for all women with ovarian cancer however little is known about the psychological implications of this intervention. We sought to evaluate the psychological response to GA in newly diagnosed ovarian cancer patients as part of our facilitated genetics referral pathway. Methods: English-speaking patients with ovarian cancer undergoing GA at the time of cancer diagnosis completed three validated anxiety, stress and depression survey instruments immediately prior to and following GA and again 6-9 months after GA. Results: Forty-eight English-speaking patients underwent GA; 43 (90%) completed the pre-GA survey, 32 (67%) post-GA survey and 11 (23%) 6-9 months follow-up survey. Eight patients (17%) had documented psychiatric diagnoses (5 anxiety, 2 depression, 1 anxiety+depression) prior to cancer diagnosis. Overall, patients demonstrated mild to moderate stress, clinically significant anxiety and borderline depression (Table 1). There was no change in depression, anxiety or stress scores when comparing pre- to post-GA surveys. Age, stage, method of treatment, performance status at enrollment and history of psychiatric disorders were not associated with anxiety, stress or depression. Conclusions: A genetic testing pathway whereby GA is encouraged and facilitated at the time of diagnosis has not increased patient depression, anxiety or stress in our cohort. Concern about causing additional emotional distress should not deter clinicians from early genetics referral. [Table: see text]