Nora Yanyi Sun

A digital clinician training module significantly improved attitudes, beliefs, and self-perceived competence in a cohort of medical students (n=87) toward working with transgender and gender diverse (TGD) people with eating disorders. Future clinician training resources can adopt this cost-effective and accessible learning model and build upon existing introductory attitude- and awareness-based programs by focusing on addressing a specific health disparity among TGD people.

Healthcare settings are contexts where Black and Latine sexual minoritised individuals experience stigma when accessing HIV services. Negative experiences have the potential to shape an individual's beliefs, attitudes, and behaviours regarding future HIV prevention. To understand their experiences accessing HIV preventive care, this study used an abductive approach to explore (1) Black and Latine sexual minoritised individuals' experiences with providers when accessing HIV prevention; and (2) how these interactions shaped subsequent feelings and behaviours towards accessing such services. Thirty semi-structured interviews were conducted with Black and Latine sexual minoritised individuals (M_age = 26.30, SD = 2.97) living in the USA. Participants described both negative (stigmatising and uncomfortable) and positive (openness and trusting) patient-provider interactions in healthcare settings. The combination of these negative and positive patient-provider interactions shaped the emotional experiences attached to access experiences in healthcare settings that, in turn, shaped behavioural responses (e.g. impression management or intentions to seek care from more culturally competent providers). Together, these findings highlight mechanisms that underpin the link between patient-provider interactions and the sustained use of HIV preventive services, as well as the importance of further training for healthcare providers.

Background: Colorectal neuroendocrine carcinomas (NECs), including small cell (SCNEC) and large cell (LCNEC) subtypes, are rare but aggressive malignancies with limited population-level data. Moreover, prior studies have limited stratification by histologic subtype and anatomic location, despite evidence of disease heterogeneity in colorectal malignancies. This study aimed to characterize the clinical characteristics, treatment patterns, and outcomes of colorectal NEC by histologic subtype and tumor location, and to compare them with neuroendocrine tumors (NETs) and adenocarcinomas (ACs). Methods: A retrospective cohort review was conducted utilizing the SEER database from 2000 to 2022 to identify patients with colorectal SCNEC, LCNEC, NET, and AC. Demographic, clinical, therapeutic and survival data were analyzed and compared using Kaplan–Meier methods, log-rank tests, and Cox proportional hazards regression. Results: A total of 790 SCNEC, 498 LCNEC, 31,200 NET, and 638,898 AC cases were identified. SCNEC and LCNEC were associated with advanced stage at diagnosis (66% and 55% stage IV, respectively) and inferior survival outcomes compared to NET and AC (median OS (mOS) of 7 and 8 months for SCNEC and LCNEC, respectively, p = 0.0002). Stratified by location, colonic SCNEC had the poorest survival (mOS 5 months), worse than rectal SCNEC (mOS 9 months); this pattern was not observed in LCNEC. Surgical resection was associated with improved OS in both NEC subtypes (HR range 0.25–0.56, all p < 0.012). Radiation therapy was associated with improved survival in NEC overall (SCNEC HR 0.58; LCNEC HR 0.71, both p < 0.05), with the observed benefit appearing greatest in rectal NEC. Demographic factors were associated with survival in NET and AC but had no significant impact in NEC. Conclusions: Colorectal SCNEC and LCNEC are highly aggressive malignancies with poor outcomes, with SCNEC demonstrating modestly inferior outcomes compared to LCNEC. This study demonstrates that both histologic subtype and anatomic site of disease are important determinants of prognosis and treatment response. This supports the concept that colorectal NEC represents a biologically heterogeneous disease, with colonic SCNEC showing the worst outcomes and rectal NEC associated with a potential enhanced response to radiation. These findings support the need for further prospective and molecular studies to better define treatment approaches and targeted therapies for these rare malignancies.

Background: Large language models (LLMs) are being used by surgeons for education and reference yet concerns about hallucinations and reliability limit safe adoption. Retrieval-augmented generation (RAG) can offer a potential solution by grounding responses in a high-quality external database (e.g., medical textbooks) to enhance accuracy. However, performance tradeoffs across different RAG configurations—many of which exponentially increase computational cost—remain poorly characterized. Methods: In total, 120 lightweight, open-source RAG configurations were evaluated across 40 plastic surgery-focused question-answering tasks (20 single-hop, 20 multi-hop), spanning multiple subspecialties (4800 total evaluations). Configurations varied by base LLM (Phi-3-mini-128k-instruct vs. BioMistral-7B), embedding model, database size, chunk size, and query hop type. Performance was assessed using semantic similarity (Ragas) to physician-validated reference answers. Performance was analyzed using linear mixed-effects regression with query as a random effect and fixed and interaction effects selected via likelihood testing and AIC. Results: High performance was achievable using lightweight, open-source models. While BioMistral-7B had high mean sematic similarity under specific configurations (mean semantic similarity up to 0.786), Phi-3-mini-128k-instruct demonstrated more consistent performance across query complexity. Larger database sizes significantly improved semantic similarity, with the largest gain at intermediate sizes (e.g., size 5: +0.043, p = 0.001). Embedding choice had a strong effect, with bge-large-en-v1.5 improving performance (p = 0.0016) and Bio_ClinicalBERT markedly reducing it (p < 0.001). Multi-hop queries substantially reduced performance (p < 0.001), though this effect was attenuated for Phi-3-mini-128k-instruct via a strong model × hop-type interaction (p < 0.001). Conclusions: RAG systems for plastic surgery do not require large proprietary models, as performance depends on configuration choices and interaction effects rather than isolated components. With advancements, predictive modeling may enable resource-efficient, safe deployment of clinical RAG systems.

In modern society, the advancement of technology has blurred the boundaries between real and imaginary, and human and machine. The collapse of these foundational binaries generates a hyperreal state, which philosopher Jean Baudrillard defines as a reality where truth has been replaced with symbols. This article explores the influence of signs and simulacra on medical care through an analysis of The Membranes by Chi Ta-wei, a Taiwanese speculative fiction novella set in the dystopic underwater T City in the year 2100. In its culminating twist, The Membranes reveals that the life of the main character Momo—a 30-year-old transgender celebrity ‘dermal care technician’—was a simulation written by Mother. Through the lens of Baudrillard’s Simulacra and Simulation , this article dissects how the body has been reduced to a symbol in the hyperreality of T City and explores the impact of this on Momo as a queer-crip patient; then, by analysing the ethics of Mother’s decision, this article examines considerations for caretaking in a world of simulacra. Altogether, these findings reflect the potential of speculative fiction works ‘of the universe of simulation’ as a tool for reimagining queer-crip futurity.

Objectives: This study examined associations of social identity and experience variables with specific patterns of disordered eating behaviors among sexual and gender diverse youth, a population at elevated risk of disordered eating behaviors and eating disorders. Methods: Using data from a nationwide U.S. survey of sexual and gender diverse youth between the ages of 13 and 18 ( n = 10,743), we determined profiles of engagement across three disordered eating behaviors: restriction, binge-eating, and purging through Latent Profile Analysis and examined the associations between profile membership and gender, sexual orientation, race/ethnicity, four types of bullying victimization (gender-based, sexual orientation-based, race-based, weight-based), lesbian, gay, bisexual, transgender, and queer (LGBTQ)-specific parental acceptance, and depressive and anxiety symptoms. Results: Three latent profiles emerged: (1) High Restriction & Binge-eating (28.6%), (2) Low Disordered Eating Behaviors (36.9%), (3) High Restriction (34.4%). All bullying victimization was significantly associated with increased odds of belonging to a disordered profile (Restriction and Binge-eating, and High Restriction); weight-based bullying was specifically associated with greater odds of belonging to the High Restriction & Binge-eating profile. Parental acceptance was most strongly associated with not belonging to either disordered profile. The High Restriction & Binge-eating profile was associated with more elevated depressive and anxiety symptoms than the High Restriction profile. Conclusions: Binge-eating distinguished two patterns of disordered eating behaviors among sexual and gender minority youth; the High Restriction & Binge-eating profile associated with slightly worse social experiences and outcomes. Future prevention and intervention efforts may focus on fostering safer environments for sexual and gender diverse youth through reducing bullying and increasing parental acceptance, as these social experience variables were more strongly associated with disordered eating behaviors profile membership than identity variables.

Asian American sexual and gender minoritized youth (SGMY) experience unique patterns of emotional distress in part linked to bullying based on their multiple marginalized identities, leading to elevated rates of depressive and anxiety symptoms. This article examined the modifying associations of LGBTQ family support, teacher support, and therapy attendance in relation to depressive and anxiety symptoms among Asian American SGMY. Using a national sample of Asian American SGMY ( N = 1,335) between the ages of 13 and 18 ( M _age = 15.80, standard deviation = 1.54), this study investigated the protective factors against negative mental health outcomes of Asian American youth who experienced bullying based on race and sexual orientation, gender identity, and gender expression (SOGIE). The results showed that SOGIE- and race-based bullying and past-year therapy attendance were related to elevated depressive and anxiety symptoms. Whereas higher LGBTQ family support and teacher support were associated with lower depressive symptoms among Asian American SGMY, only teacher support was associated with anxiety symptoms. These results emphasize the need for further research on both culturally informed, school-based interventions against SOGIE- and race-based bullying faced by Asian American SGMY, and culturally informed, family-based interventions to increase LGBTQ family support and teacher support for Asian American SGMY.

To elucidate the complex relationship between spirituality and obsessive-compulsive disorder (OCD), we performed a qualitative analysis of messages (n=225) referencing spiritualities in r/OCD, a public online peer support forum for people with OCD with over 250,000 users; two central themes emerged: (1) influence of spirituality on OCD symptom manifestation and (2) impact of OCD on relationship with spirituality.

Asian American sexual and gender diverse youth experience bias-based stressors rooted in stereotypes and forms of oppression, which can contribute to coping behaviors like alcohol use. Few studies examine lifetime alcohol use with a focus on understanding heterogeneity within Asian American adolescents. The analytic sample included Asian American youth in 9^th through 12^th grade (N = 86,799) who completed the 2017-2019 California Healthy Kids Survey, a statewide, school-based survey. Exhaustive Chi-square automatic interaction detection was conducted using SPSS. Variables included exposure to sexual orientation and gender identity-based (SOGI) and race-based bullying and different social identities (ethnic, sexual, and gender identities and sex assigned at birth). Past-year SOGI-based bullying was reported by 11.2% of students and race-based bullying was reported by 18.8% of students. 19.6% of students indicated lifetime alcohol use, with higher rates among those in older grades (13.1% 9^th grade to 31.8% 12^th grade). Lowest lifetime alcohol use prevalence were among monoracial Asian American youth who were not the targets of bias-based bullying, while highest lifetime alcohol use rates were among youth identifying as multiracial and/or with a minoritized sexual orientation and experiencing bias-based bullying. Findings suggest bias-based victimization may lead youth to cope or attempt to fit in through alcohol use. Bisexual and multiracial youth, who are often marginalized from monoracial and monosexual communities also had high lifetime alcohol use prevalence. Future research should identify intersectionality-informed strategies to address the nuanced bias-based bullying experiences of Asian American sexual and gender diverse youth, particularly in school settings.

Background: Scarring has been shown to have adverse health effects on marginalized patient groups. However, experiences of scarring among transgender and gender diverse (TGD) people have not yet been thoroughly characterized. Objective: This study aimed to investigate the impacts of scarring related to gender-affirming care and other causes among TGD people. Methods: Anonymous data were extracted from Reddit, a popular online platform organized into “subreddit” groups based on identities and interests. A combined total of 604 posts and comments that explicitly reference physical scarring were extracted from r/FtM, a subreddit for transmasculine people (449 posts and comments) and r/MtF, a subreddit for transfeminine people (155 posts and comments). Applying inductive thematic analysis, all posts and comments were coded and codes were sorted into overarching themes.  Results: Among the 604 posts and comments, the scars most discussed were secondary to gender-affirming care procedures, including mastectomy (n=338 posts and comments), hormone administration (n=102 posts and comments), and hair removal (n=38 posts and comments). Nongender-affirming care-related scars, such as those due to self-harm (n=43 posts and comments), were discussed less often. A total of five overarching themes emerged through thematic analysis: (1) concerns about physical outcomes related to scarring; (2) psychological distress related to scarring; (3) societal perceptions of scarring; (4) strategies to prevent, conceal, and minimize scarring; and (5) positive experiences with scarring. Conclusions: For TGD people, scar complications, visibility, and permanence represent major concerns. While many TGD people ultimately accept scarring as an unavoidable consequence, scarring both related and unrelated to gender-affirming care can present a significant psychosocial stressor for TGD people. Scarring can result in physical health complications, gender dysphoria, and negative body image; visible scarring is also a barrier for TGD people who wish to blend into society. Clinicians should improve communication regarding scarring outcomes and scar-care procedures. Future research should focus on the development of scar prevention, care, and reduction techniques for TGD people.