Purpose: There is a paucity of data regarding transgender and gender diverse (TGD) people who ''detransition,'' or go back to living as their sex assigned at birth. This study examined reasons for past detransition among TGD people in the United States. Methods: A secondary analysis was performed on data from the U.S. Transgender Survey, a cross-sectional nonprobability survey of 27,715 TGD adults in the United States. Participants were asked if they had ever detransitioned and to report driving factors, through multiple-choice options and free-text responses. A mixed-methods approach was used to analyze the data, creating qualitative codes for free-text responses and applying summative content analysis. Results: A total of 17,151 (61.9%) participants reported that they had ever pursued gender affirmation, broadly defined. Of these, 2242 (13.1%) reported a history of detransition. Of those who had detransitioned, 82.5% reported at least one external driving factor. Frequently endorsed external factors included pressure from family and societal stigma. History of detransition was associated with male sex assigned at birth, nonbinary gender identity, bisexual sexual orientation, and having a family unsupportive of one's gender identity. A total of 15.9% of respondents reported at least one internal driving factor, including fluctuations in or uncertainty regarding gender identity. Conclusion: Among TGD adults with a reported history of detransition, the vast majority reported that their detransition was driven by external pressures. Clinicians should be aware of these external pressures, how they may be modified, and the possibility that patients may once again seek gender affirmation in the future.

Background: Inclusive STEM (traditionally known to stand for "Science, Technology, Engineering, and Math") high schools are emerging across the country as a mechanism for improving STEM education and getting more and diverse students into STEM majors and careers. However, there is no consensus on what these schools are or should be, making it difficult to both evaluate their effectiveness and scale successful models. We addressed this problem by working with inclusive STEM high school leaders and stakeholders to articulate and understand their intended school models. This "bottom-up" approach is in contrast with other studies that have taken a "top-down," literature-based approach to defining STEM schools. Results: Through this process, we identified 76 critical components of STEM schools and derived a theoretical framework of eight elements that represent the common goals and strategies employed by inclusive STEM high schools across the country: Personalization of Learning; Problem-Based Learning; Rigorous Learning; Career, Technology, and Life Skills; School Community and Belonging; External Community; Staff Foundations; and External Factors. This framework offers a clear picture of what exactly inclusive STEM schools are and common language for both researchers and practitioners. Interestingly, STEM disciplinary content did not emerge as a defining component across school models.

As HIV-infected patients live longer, the increasing burden of noncommunicable diseases may complicate their clinical management, requiring primary care providers to be trained in chronic disease management for this population.

Disasters provide a distinctive context in which to study the robustness and resilience of response systems. Therefore, in the aftermath of a large-scale crisis, every effort should be invested in forming a coalition and collecting critical lessons so they can be shared and incorporated into best practices and preparations. Novel communication strategies, flexible leadership structures, and improved information systems will be necessary to reduce morbidity and mortality during future events.

The tradeoff between knowing when to seek greater rewards (exploration), and knowing when to settle (exploitation), is critical to success. One dispositional factor that may modulate this tradeoff is “grit.” Gritty individuals tend to persist in the face of difficulty and consequently experience greater life success. It is possible that they may also experience a greater tendency to explore in a reward task. However, although most exploration/exploitation tasks manipulate beliefs about the presence/magnitude of rewards in the environment, the belief of one’s ability to actually achieve a reward is also critical. As such, we investigated whether individuals higher in grit were more likely to explore, and how beliefs about the magnitude/presence of rewards, and the perceived ability to achieve a reward, modulated their exploration tendencies. Over two experiments, participants completed 4 different exploration/persistence tasks: two that tapped into participant beliefs about the presence/magnitude of rewards, and two that tapped into participant beliefs about their ability to achieve a reward. Participants also completed measures of dispositional grit (Experiment 1a and 1b), conscientiousness (Experiment 1b), and working memory (Experiment 1a and 1b). In both experiments, we found a relationship between the two “belief of rewards” tasks, as well as between the two “belief of ability” tasks, but performance was unrelated across the two types of task. We also found that dispositional grit was strongly associated with greater exploration, but only on the “belief of ability” tasks. Finally, in Experiment 1b we showed that conscientiousness better predicted exploration on the “belief of ability” tasks than grit, suggesting that it is not grittiness per se that is associated with exploration. Overall, our findings showed that individuals high in grit/conscientiousness are more likely to explore, but only when there is a known reward available that they believe they have the ability to achieve.

Many patients demonstrated difficulty identifying the name and purpose of prescribed medications; this did not differ by demographic group or medication storage type. Patients may benefit from routine review of medications with their provider in order to improve health literacy, outcomes, and patient-reported adherence measurement.

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Background Electronic patient-reported outcome (ePRO) systems can improve health outcomes by detecting health issues or risk behaviors that may be missed when relying on provider elicitation. Objective This study aimed to implement an ePRO system that administers key health questionnaires in an urban community health center in Boston, Massachusetts. Methods An ePRO system that administers key health questionnaires was implemented in an urban community health center in Boston, Massachusetts. The system was integrated with the electronic health record so that medical providers could review and adjudicate patient responses in real-time during the course of the patient visit. This implementation project was accomplished through careful examination of clinical workflows and a graduated rollout process that was mindful of patient and clinical staff time and burden. Patients responded to questionnaires using a tablet at the beginning of their visit. Results Our program demonstrates that implementation of an ePRO system in a primary care setting is feasible, allowing for facilitation of patient-provider communication and care. Other community health centers can learn from our model in terms of applying technological innovation to streamline clinical processes and improve patient care. Conclusions Our program demonstrates that implementation of an ePRO system in a primary care setting is feasible, allowing for facilitation of patient-provider communication and care. Other community health centers can learn from our model for application of technological innovation to streamline clinical processes and improve patient care.