Medicine and Health Sciences Commons^™

Metabolic Capabilities Of Latilactobacillus Curvatus And The Potential Use As An Adjunct Culture For Food Safety And Quality Control In Yogurt, R. Chase Wahlstrom

All Graduate Theses and Dissertations, Fall 2023 to Present

In the quest for healthier and more natural food products, using beneficial lactic acid bacteria to preserve food, known as biopreservation, is becoming increasingly important. This research focused on a strain of beneficial bacteria called Latilactobacillus curvatus and its ability to inhibit fungal growth both in lab settings and in a yogurt system. This has the potential to enhance the safety and quality of dairy products.

We studied a specific strain of this bacteria, named WSU-1, found in dairy. Through detailed analysis, we discovered that this strain could produce substances that may help protect food from harmful microbes. In laboratory …

Development Of A Multidimensional Index Of Fall Risk For Older Adults: The Cache County Study, Alexandra G. Hammond

All Graduate Theses and Dissertations, Fall 2023 to Present

One out of four adults over the age of 65 are estimated to fall each year in the U.S. alone, with that number expected to rise to 52 million falls per year by the year 2030. Improving accuracy for identification of older adults at a higher risk of falling is increasingly important and may be integral in informing the distribution of limited resources and assist in preventing falls in older adults. This project examined the relationship between previously identified risk factors and fall risk to create multidimensional fall risk indexes for older adults, specific for each sex.

Factors best associated …

Supporting Cancer-Related Fatigue Self-Management: A Conversation Analytic Study Of Nurse Counsellor And Cancer Survivor Consultations, Oluwaseyifunmi Andi Agbejule, Stuart Ekberg, Nicolas H. Hart, Raymond J. Chan

Research outputs 2022 to 2026

Purpose: Cancer-related fatigue (CRF) is a prevalent and distressing symptom experienced by people affected by cancer. A breakdown of the clinician-patient partnership and suboptimal clinician communication has been identified as a significant barrier to implementing into clinical practice effective self-management strategies for CRF. This study examined the use and impact of communication practices employed by trained cancer nurse counsellors when providing CRF self-management support to cancer survivors.

Methods: Interactions from 41 telehealth consultations between three nurse counsellors and 23 cancer survivors in a CRF self-management support clinic in Queensland, Australia were recorded and analysed using conversation analysis methods.

Results: Analysis …

Machine Learning-Augmented Interventions In Perioperative Care: A Systematic Review And Meta-Analysis, Divya Mehta, Xiomara T Gonzalez, Grace Huang, Joanna Abraham

2020-Current year OA Pubs

BACKGROUND: We lack evidence on the cumulative effectiveness of machine learning (ML)-driven interventions in perioperative settings. Therefore, we conducted a systematic review to appraise the evidence on the impact of ML-driven interventions on perioperative outcomes.

METHODS: Ovid MEDLINE, CINAHL, Embase, Scopus, PubMed, and ClinicalTrials.gov were searched to identify randomised controlled trials (RCTs) evaluating the effectiveness of ML-driven interventions in surgical inpatient populations. The review was registered with PROSPERO (CRD42023433163) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Meta-analysis was conducted for outcomes with two or more studies using a random-effects model, and vote …

Vitamin D In Patients With Low Tumor-Burden Indolent Non-Hodgkin Lymphoma Treated With Rituximab Therapy (Ilyad): A Randomized, Phase 3 Clinical Trial, Jonathan W Friedberg, Brad S Kahl, Et Al.

2020-Current year OA Pubs

BACKGROUND: There is a significant association between low vitamin D levels at diagnosis of indolent B-cell lymphomas and inferior overall survival (OS). To determine whether supplemental vitamin D improves event-free survival (EFS) in these patients, we conducted a comparative double-blind study of vitamin D

METHODS: In this phase 3, randomized, double-blind, placebo-controlled trial, patients with low tumor burden follicular, marginal zone or small lymphocytic lymphoma, age 18 or older, with stage two or greater disease and no prior systemic treatment were enrolled at 7 academic cancer centers. Patients were stratified by histology and FLIPI (Follicular Lymphoma International Prognostic Index) score …

The Sodium-Proton Exchangers Snhe And Nhe1 Control Plasma Membrane Hyperpolarization In Mouse Sperm, Analia G Novero, Celia M Santi, Et Al.

2020-Current year OA Pubs

Sperm capacitation is a complex process that takes place in the female reproductive tract and empowers mammalian sperm with the competence to fertilize an egg. It consists of an intricate cascade of events that can be mimicked in vitro through incubation in a medium containing essential components, such as bicarbonate, albumin, Ca

Nivolumab Plus Relatlimab And Nivolumab Plus Ipilimumab For Patients With Advanced Renal Cell Carcinoma: Results From The Open-Label, Randomised, Phase Ii Fraction-Rcc Trial, T K Choueiri, R K Pachynski, Et Al.

2020-Current year OA Pubs

BACKGROUND: The Fast Real-time Assessment of Combination Therapies in Immuno-ONcology study in patients with aRCC (FRACTION-RCC) was designed to assess new immuno-oncology (IO) combinations in patients with advanced renal cell carcinoma (aRCC). We present results in IO-naive patients treated with nivolumab (NIVO) + relatlimab (RELA) or NIVO + ipilimumab (IPI) in track 1.

METHODS: The open-label, randomised, phase II FRACTION-RCC trial enrolled patients with aRCC from 32 hospitals and cancer centres across six countries. Patients were enrolled in track 1 (IO-naive) or track 2 (IO-experienced). IO-naive patients were stratified by previous tyrosine kinase inhibitor therapy and randomised to NIVO (240 …

Vasa Previa In Singleton Pregnancies: Diagnosis And Clinical Management Based On An International Expert Consensus, Yinka Oyelese, Anthony Odibo, Et Al.

2020-Current year OA Pubs

BACKGROUND: There are limited data to guide the diagnosis and management of vasa previa. Currently, what is known is largely based on case reports or series and cohort studies.

OBJECTIVE: This study aimed to systematically collect and classify expert opinions and achieve consensus on the diagnosis and clinical management of vasa previa using focus group discussions and a Delphi technique.

STUDY DESIGN: A 4-round focus group discussion and a 3-round Delphi survey of an international panel of experts on vasa previa were conducted. Experts were selected on the basis of their publication record on vasa previa. First, we convened a …

Solid-State Nmr Compositional Analysis Of Sputum From People With Cystic Fibrosis, Kathy Duong, Evan Moss, Courtney Reichhardt

2020-Current year OA Pubs

People with the genetic disease cystic fibrosis (CF) often have chronic airway infections and produce airway secretions called sputum. A better understanding of sputum composition is desired in order to track changes in response to CF therapeutics and to improve laboratory models for the study of CF airway infections. The glycosylated protein mucin is a primary component. Along with extracellular DNA, mucin gives rise to the high viscoelasticity of sputum, which inhibits airway clearance and is thought to promote chronic airway infections in people with CF. Past studies of sputum composition identified additional biomolecular components of sputum including other proteins, …

Meeting Aerobic Physical Activity Guidelines And Associations With Physical Fitness In Men With Metastatic Prostate Cancer: Baseline Results Of The Multicentre Interval-Gap4 Trial, Lisa Umlauff, Stacey A. Kenfield, Robert U. Newton, Nicolas H. Hart, Fred Saad, Kerry S. Courneya, Rosemary Greenwood, Wilhelm Bloch, Moritz Schumann

Research outputs 2022 to 2026

Background: This study compared the physical activity level of men with metastatic prostate cancer at baseline of the multicentre INTERVAL-GAP4 trial to the American Cancer Society guidelines and examined associations with physical fitness. Methods: A total of 140 men on androgen deprivation therapy (ADT) were included in this cross-sectional analysis of baseline data from the INTERVAL-GAP4 trial. Exclusion criteria included a maximum of 1 h of vigorous aerobic exercise or one structured resistance exercise session per week but no restrictions on habitual physical activity. Moderate-to-vigorous physical activity (MVPA) was assessed using a modified Godin–Shephard Leisure-Time Physical Activity Questionnaire. Physical fitness …

Immersive Virtual Reality Aggression And Violence Management Education For Nursing Students: A Pre-Test, Post-Test, Follow-Up Evaluation, Joshua Johnson, Sara Hansen, Luke Hopper, Jessica Watson, Sean Cashman, Wyatt De Souza, Brennen Mills

Research outputs 2022 to 2026

Background: Nursing students attending clinical placement encounter similar exposure to aggression and violence as qualified clinicians. Universities encounter barriers in aggression and violence management education delivery due to resourcing and time requirements. Immersive Virtual Reality (IVR) education may reduce barriers while maintaining comparable learning outcomes to face-to-face simulation-based education. Method: Nursing students (n = 72), recruited from one public university in Perth, Western Australia, completed a 15-20 minute IVR education program. Pre-, post-, and 4-month post-intervention questionnaires investigated self-reported confidence. Cross-sectional data were collected for system usability and motion sickness. Results: Significant differences in self-reported confidence were observed (p < .001, partial η2 = 0.53), with large improvements from pre- to post-intervention (p < .001, d = 1.21) and follow-up (p < .001, d = 1.25). Cross-sectional data indicated the program is easy to use and incurs negligible motion sickness. Conclusion: IVR can deliver effective aggression and violence education for nursing students. The short duration, high usability, and persistence of confidence improvements over time indicate potential for IVR to support current nursing education practices.

Impact Of Healthy Pregnancy And Lifestyle In Mothers On Developmental Delay In Their Offspring: A Strength-Based Analysis Of A Longitudinal Study Among Indigenous Children In Australia, Md Irteja Islam, Thomas Stubbs, Tuguy Esgin, Alexandra Martiniuk

Research outputs 2022 to 2026

Introduction: Extensive literature has investigated the prenatal risk factors of developmental delay in children, with evidence highlighting the impact of prenatal health, mental health, and behavioural factors. While a deficit discourse has underscored Indigenous health research and policies, strengths-based approaches provide an opportunity to reframe this discourse, to illustrate and celebrate the strength and resilience of Australian Indigenous families. As such, this study aimed to identify the protective impact of healthy pregnancy and lifestyle in mothers on developmental delay in Indigenous Australian children; and whether it varies by child birthweight adjusted for gestational age. Further, we also tested whether child …

Oscillometry Changes Reflect Clinically Meaningful Improvement After Bronchial Thermoplasty For Uncontrolled Asthma: A Case Report, Niranjan Setty, Alice Crawford, Brooke Kyle, Dhaval Thakkar, Rajesh Thomas, John Blakey

Research outputs 2022 to 2026

Asthma is a highly prevalent but heterogenous condition. Uncontrolled disease is relatively common and may be due to ongoing inflammation and/or persisting bronchial hyper-reactivity. Bronchial thermoplasty has been in use for many years but optimal case selection and post-procedure assessment remain uncertain. We present a case of a gentleman in his 50s with lifelong asthma who experienced a persistent loss of control following influenza A in 2017. Despite multidisciplinary assessment and guideline-based escalation of therapy, he had persisting symptoms. In the context of his atopy, he was trialled unsuccessfully on dupilumab. Bronchial thermoplasty (BT) was undertaken with good clinical benefit. …

Cohort Profile: The Origins Pregnancy And Birth Cohort, Jacqueline Davis, Zenobia Talati, Sarah Whalan, Wesley Billingham, Nina D'Vaz, Lisa Gibson, Susan L. Prescott, Desiree T. Silva

Research outputs 2022 to 2026

No abstract provided.

Family Members’ Experiences With Depression Through The Lens Of Frank's Illness Narratives, Amanda Cole, Julie Ann Pooley, Lisa Whitehead

Research outputs 2022 to 2026

Background: Depression impacts around 300 million people worldwide and places significant strain on families who care for relatives with chronic mental health conditions. This strain can lead to substantial burdens and affect the mental health and well-being of family members. Aim: This study explores family members’ experiences with depression through the lens of Frank's illness narratives. Methods: Employing a narrative inquiry approach, interviews were conducted with eight family members of adults diagnosed with major depressive disorder. The data were analysed through the lens of Frank's illness narratives. Findings: Family members’ experiences revealed a complex interplay of narratives that reflected the …

Downhill Running Does Not Alter Blood C1q Availability Or Complement-Dependent Cytotoxicity Of Therapeutic Monoclonal Antibodies Against Haematological Cancer Cell Lines In Vitro, Harrison D. Collier-Bain, Frankie F. Brown, Adam J. Causer, Lois Ross, Daniela Rothschild-Rodriguez, Noah Browne, Rachel Eddy, Kirstie L. Cleary, Juliet C. Gray, Mark S. Cragg, Sally Moore, James Murray, James E. Turner, John P. Campbell

Research outputs 2022 to 2026

Complement-dependent cytotoxicity (CDC) is a primary mechanism-of-action of monoclonal antibody (mAb) immunotherapies used to treat haematological cancers, including rituximab and daratumumab. However, mAb efficacy may be limited by reduced bioavailability of complement C1q – which activates the complement classical pathway following interactions with mAb-opsonised target cells. C1q is secreted by phagocytes upon recruitment to sites of muscle damage to facilitate muscular repair, hence we hypothesised that muscle damaging exercise may increase C1q ‘spill-over’ into blood. Additionally, other complement proteins (e.g., C1s) have been reported to increase following ultra-endurance and resistance exercise. Taken together, we hypothesised that muscle damaging exercise could …

Response: Use Of The Wisci-Ii Score In Assessing Outcome Of Intensive Robot-Assisted Gait Training In Spinal Cord Injury, Dylan J. Edwards, A. Jayaraman

Research outputs 2022 to 2026

No abstract provided.

Planning And Evaluating An Integrated Clinical Exercise Oncology Service: An Exploratory Mixed-Methods Study, Ciaran M. Fairman, Shana E. Harrington, Alec R. Schumpp, Alex M. Brooks, Morgan J. Jones, Julian Kim, Mary A. Kennedy

Research outputs 2022 to 2026

Background: This project aimed to design and evaluate the potential to integrate an exercise oncology service into clinical care in a local healthcare system. The goal was to inform the design of an implementation strategy to promote its sustainable use in standard care. Methods: This two-phase, exploratory study used a mixed-methods approach. First, qualitative measures were used to understand the context for exercise integration into oncology care by clinicians and administrators in the healthcare system. Next, the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework guided a comprehensive evaluation of the exercise service. Reach and Adoption were measured via number of …

Stop, Pause And Take A Break: A Mixed Methods Study Of The Longer-Term Outcomes Of Digital Emotional Wellbeing Training For Perinatal Women, Jacqueline A. Davis, Jeneva L. Ohan, Natasha Bear, Lisa Gibson, Desiree Silva, Susan Prescott, Amy Finlay-Jones

Research outputs 2022 to 2026

Background: Maternal psychological distress is related to poorer physical and mental health as well as child developmental problems. Interventions that optimise maternal mental health and wellbeing during the “first 1,000 days” of life should have wide-reaching benefits for the mother and her child. Digital mental health interventions (DMHIs) during this critical period have the potential to equip women with enhanced coping strategies that can be applied and maintained in daily life. This study aimed to understand uptake of DMHIs in pregnancy, and the extent participants apply intervention strategies 10–12 months post-participation in a pilot randomised controlled trial (RCT) comparing different …

Protocol To Implement And Evaluate A Culturally Secure, Strength-Based, Equine-Assisted Learning Program, "Yawardani Jan-Ga" (Horses Helping), To Support The Social And Emotional Wellbeing Of Australian Aboriginal Children And Young People, Juli Coffin, Sharmila Vaz, Cheryl Kickett-Tucker, Helen Milroy, Craig Olsson, Meg Kirby, Lesley Nelson, Rob Mcphee, Donna Cross

Research outputs 2022 to 2026

Australian Aboriginal people experience stressors from inequalities across crucial social determinants, including deep and entrenched disadvantage and exclusion. The impact of unaddressed historical issues is pervasive and intergenerational. The disproportionate rates of Aboriginal youth suicide, juvenile detention and imprisonment highlight the inadequacy of existing social and emotional wellbeing programs and services for Aboriginal children and young people. There is increasing recognition in Australia that aligning social and emotional wellbeing interventions with Western values and conceptions of mental health is one of the main barriers to service uptake among Aboriginal people. This suggests fundamental questions remain unanswered about what type of …

Role Of N-Glycosylation In Gastrointestinal Cancers, Ruirui Xu, Lois Balmer, Gengzhen Chen, Manshu Song

Research outputs 2022 to 2026

Gastrointestinal cancers pose a significant global health challenge. N-glycosylation modulates various cellular processes, including key cancer-related mechanisms. Elucidating its involvement in the onset and advancement of these cancers can offer critical insights for enhancing diagnostic and therapeutic approaches. This review outlines the core process of protein N-glycosylation and highlights its contribution to the progression of gastrointestinal cancers, encompassing cell proliferation, survival, invasion, metastasis, and immune evasion, mainly through its impact on critical signaling pathways. Notably, aberrant N-glycosylation patterns have emerged as crucial biomarkers for the diagnosis and prognosis of various gastrointestinal cancers, providing the foundation for more personalized therapeutic approaches. …

Tyk2 Regulates Tau Levels, Phosphorylation And Aggregation In A Tauopathy Mouse Model, Jiyoen Kim, Bakhos Tadros, Yan Hong Liang, Youngdoo Kim, Cristian Lasagna-Reeves, Jun Young Sonn, Dah-Eun Chloe Chung, Bradley Hyman, David M Holtzman, Huda Yahya Zoghbi

2020-Current year OA Pubs

Alzheimer's disease is one of at least 26 diseases characterized by tau-positive accumulation in neurons, glia or both. However, it is still unclear what modifications cause soluble tau to transform into insoluble aggregates. We previously performed genetic screens that identified tyrosine kinase 2 (TYK2) as a candidate regulator of tau levels. Here we verified this finding and found that TYK2 phosphorylates tau at tyrosine 29 (Tyr29) leading to its stabilization and promoting its aggregation in human cells. We discovered that TYK2-mediated Tyr29 phosphorylation interferes with autophagic clearance of tau. We also show that TYK2-mediated phosphorylation of Tyr29 facilitates pathological tau …

Inferring Allele-Specific Copy Number Aberrations And Tumor Phylogeography From Spatially Resolved Transcriptomics, Cong Ma, Metin Balaban, Jingxian Liu, Siqi Chen, Michael J Wilson, Christopher H Sun, Li Ding, Benjamin J Raphael

2020-Current year OA Pubs

Analyzing somatic evolution within a tumor over time and across space is a key challenge in cancer research. Spatially resolved transcriptomics (SRT) measures gene expression at thousands of spatial locations in a tumor, but does not directly reveal genomic aberrations. We introduce CalicoST, an algorithm to simultaneously infer allele-specific copy number aberrations (CNAs) and reconstruct spatial tumor evolution, or phylogeography, from SRT data. CalicoST identifies important classes of CNAs-including copy-neutral loss of heterozygosity and mirrored subclonal CNAs-that are invisible to total copy number analysis. Using nine patients' data from the Human Tumor Atlas Network, CalicoST achieves an average accuracy of …

Sitravatinib In Patients With Solid Tumors Selected By Molecular Alterations: Results From A Phase Ib Study, Lyudmila Bazhenova, Douglas R Adkins, Et Al.

2020-Current year OA Pubs

No abstract provided.

Volumetric Breast Density Estimation From Three-Dimensional Reconstructed Digital Breast Tomosynthesis Images Using Deep Learning, Vinayak S Ahluwalia, Nehal Doiphode, Walter C Mankowski, Eric A Cohen, Sarthak Pati, Lauren Pantalone, Spyridon Bakas, Ari Brooks, Celine M Vachon, Emily F Conant, Aimilia Gastounioti, Despina Kontos

2020-Current year OA Pubs

PURPOSE: Breast density is a widely established independent breast cancer risk factor. With the increasing utilization of digital breast tomosynthesis (DBT) in breast cancer screening, there is an opportunity to estimate volumetric breast density (VBD) routinely. However, current available methods extrapolate VBD from two-dimensional (2D) images acquired using DBT and/or depend on the existence of raw DBT data, which is rarely archived by clinical centers because of storage constraints.

METHODS: We retrospectively analyzed 1,080 nonactionable three-dimensional (3D) reconstructed DBT screening examinations acquired between 2011 and 2016. Reference tissue segmentations were generated using previously validated software that uses 3D reconstructed slices …

Inflammation, Physical Activity, And Disease-Free Survival In Stage Iii Colon Cancer: Cancer And Leukemia Group B-Southwest Oncology Group 80702 (Alliance), Justin C Brown, Chao Ma, Qian Shi, Felix Couture, Philip Kuebler, Pankaj Kumar, Benjamin Tan, Smitha Krishnamurthi, Victor Chang, Richard M Goldberg, Eileen M O'Reilly, Anthony F Shields, Jeffrey A Meyerhardt

2020-Current year OA Pubs

BACKGROUND: Inflammation and insufficient physical inactivity contribute to individual-level risk of disease recurrence and death in stage III colon cancer. The extent to which increased inflammatory risk can be offset by sufficient physical activity remains unknown.

METHODS: This cohort study was nested within the Cancer and Leukemia Group B (now part of the Alliance for Clinical Trials in Oncology) and Southwest Oncology Group randomized trial. Inflammatory burden was quantified by high-sensitivity C-reactive protein, interleukin-6, and soluble tumor necrosis factor-α receptor 2 after recovery from tumor resection. Physical activity was measured during and after postoperative chemotherapy. The primary endpoint was disease-free …

Characteristics Of High-Risk Bipolar Bone Loss Lesions Using 3-Dimensional Imaging, Petar Golijanin, Justin Arner, Claire Ryan, Qais Zai, Liam Peebles, Annalise Peebles, Phob Ganokroj, Ryan Whalen, Stephanie Eble, Danielle Rider, Srdjan Ninković, Matthew Provencher

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: The concept of on-track versus off-track bone lesions in glenohumeral instability continues to evolve. Although much has been ascertained from an original biomechanical model, bony pathological changes, especially on 3-dimensional (3D) imaging, have not been fully evaluated.

PURPOSE: To compare the differences in on-track versus off-track lesions to characterize glenoid and humeral head bone defects using 3D modeling software.

STUDY DESIGN: Cross-sectional study; Level of evidence, 3.

METHODS:A consecutive cohort of 75 patients with recurrent anterior instability, with evidence of Hill-Sachs lesions (HSLs) and
glenoid bone loss (GBL) and a mean age of 27.1 years (range, 18-48 years), were …

Development And Validation Of A Prechiasmatic Mouse Model Of Subarachnoid Hemorrhage To Measure Long-Term Cognitive Deficits, Deepti Diwan, Jogender Mehla, James W Nelson, James D Quirk, Sheng-Kwei Song, Sarah Cao, Benjamin Meron, Aminah Mostofa, Gregory J Zipfel

2020-Current year OA Pubs

Controllable and reproducible animal models of aneurysmal subarachnoid hemorrhage (SAH) are crucial for the systematic study of the pathophysiology and treatment of this debilitating condition. However, current animal models have not been successful in replicating the pathology and disabilities seen in SAH patients, especially the long-term neurocognitive deficits that affect the survivor's quality of life. Therefore, there is an unmet need to develop experimental models that reliably replicate the long-term clinical ramifications of SAH - especially in mice where genetic manipulations are straightforward and readily available. To address this need, a standardized mouse SAH model is developed that reproducibly produced …

Fibrolytic Vaccination Against Adam12 Reduces Desmoplasia In Preclinical Pancreatic Adenocarcinomas, Jing Chen, David Denardo, Et Al.

2020-Current year OA Pubs

A hallmark feature of pancreatic ductal adenocarcinoma (PDAC) is massive intratumoral fibrosis, designated as desmoplasia. Desmoplasia is characterized by the expansion of cancer-associated fibroblasts (CAFs) and a massive increase in extracellular matrix (ECM). During fibrogenesis, distinct genes become reactivated specifically in fibroblasts, e.g., the disintegrin metalloprotease, ADAM12. Previous studies have shown that immunotherapeutic ablation of ADAM12

Minority Stress Mediates Associations Of Sexual Minority State Policies And Tobacco Use Among Us Sexual Minority Young Adults, Katelyn F Romm, Erin A Vogel, Christina Dyar, Laurie A Drabble, Patricia A Cavazos-Rehg, Carla J Berg

2020-Current year OA Pubs

INTRODUCTION: State policies surrounding sexual minority (SM) rights are associated with tobacco use among SM individuals. Research is scant regarding the role of distinct SM policy categories on SM young adults' (SMYAs) tobacco use and mechanisms explaining these associations.

METHODS: We analyzed 2023 survey data from 1100 SMYAs (ages 18-34; 14.2 % gender minority; 66.1 % bisexual+, 29.1 % monosexual; 53.2 % racial/ethnic minority) with representation across 45 US states and DC. Regression-based models examined: 1) direct associations of residing in states with negative and limited (vs. comprehensive) SM state policies with respect to 7 policy categories (relationship/parent recognition, nondiscrimination, …