Despite continued growth in the number of kinship care families, little is known about the experiences of the children. This retrospective study, which was informed by the perspective of intergenerational ambivalence, examined how adults who were raised by grandparents or great-grandparents experienced their relationships with their caregivers. It also explored how these intergenerational relationships evolved over time and were influenced by the caregiving context. Participants included 20 adults whose grandparents or great-grandparents had been their primary caregivers for at least 5 years. Participation involved completing a semistructured, qualitative interview. Findings revealed both strengths and challenges in participants' relationships with their kinship caregivers. In terms of strengths, participants experienced intense emotional bonds to their caregivers that they equated to a parent-child relationship. They were grateful for these relationships and respected their kinship caregivers' efforts in raising them. Participants also reported how instrumental and emotional support from their caregivers provided them with a sense of stability and unconditional love. At the same time, participants described sources of relational conflict or distance. One issue was loyalty conflicts between participants, their parents, and their kinships caregivers. Navigating differing rules and expectations related to the generation gap between

INTRODUCTION There is an unprecedented opioid epidemic in the United States with the rate of drug overdose deaths tripling between 2000 and 2014. The literature suggests that preoperative opioid exposure prior to any surgery independently predicts poorer surgical outcomes. There is a paucity of research on preoperative opioid use and craniotomies. This study proposes to characterize the effects of opioid use on craniotomy outcomes, and triangulate epidemiological sources that predispose patients to adverse outcomes. METHODS From January 1, 2013 to October 1, 2018, 861 craniotomy patients were identified by CPT codes. Relevant medical and surgical information was extracted from the electronic medical record. Adverse outcomes and readmissions were recorded within 90 d of discharge. Opioid use was recorded by converting dosage into a milligram morphine equivalent (MME) using the Oregon Health Authority online calculator. Regression analysis determined significant factors impacting postoperative outcomes. RESULTS Patients receiving opioids preoperatively were more likely to be prescribed higher MMEs postoperatively (beta = 0.445, 95% CI 0.320-0.569; P < .001) and at discharge (beta = 0.151, 95% CI 0.069-0.232; P < .001). Preoperative MME significantly impacted postoperative respiratory failure (OR 1.004, 95% CI 1.002-1.006; P < .001) and pneumonia (OR 1.005, 95% CI 1.002-1.007; P < .001). Preoperative MME positively correlated with an increased length of stay (LOS) (beta = 0.024, 95% CI 0.014-0.034, P < .001). Preoperative MME did not correlate with other adverse outcomes. Employment and insurance status lacked correlation with preoperative MME. CONCLUSION Craniotomy patients with higher preoperative MMEs are more likely to suffer from respiratory failure, pneumonia, and have a longer LOS compared to the no-opioids group. Our findings show that these patients should be more closely monitored for these negative events postoperatively. The lack of significance with other outcomes suggests that other factors impact negative outcomes in the opioid-exposed craniotomy population. Future work should further elucidate the mechanisms behind adverse events in this patient population.

Beliefs about health are influenced by culture; psychological phenomena are interpreted and dealt with in diverse ways across cultures. Cultural health beliefs are especially important in the area of mental health in which there is often an aversion toward seeking help, especially outside the family, and client behavior is often regarded as problematic (Williams & Healy, 2001). Guided by the Health Beliefs Model (Rosenstock, 1990), we explored the influence of cultural health beliefs, physical health, ethnicity, and gender on self-reported general mental health and the use of mental health services in a racially diverse sample (African American (N = 56), non-Hispanic White (N = 140)) of adults aged 65 years and older. The sample was obtained from a rural, economically disadvantaged county in southwest Virginia in 2005. Results from the hierarchical and logistic regression analyses are reported, followed by discussion and recommendations.

The authors of this article include the professor and most of the students in a doctoral course on marriage and family therapy ethical and professional issues that met the semester that a disturbed student shot and killed 32 Virginia Tech students and faculty before killing himself. In this article, we reflect through short essays on issues related to the tragedy, ethics, and recovery.

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