Study Protocol for Investigating Physician Communication Behaviours that Link Physician Implicit Racial Bias and Patient Outcomes in Black Patients with Type 2 Diabetes Using an Exploratory Sequential Mixed Methods Design

Introduction Patient-physician racial discordance is associated with Black patient reports of dissatisfaction and mistrust, which in turn are associated with poor adherence to treatment recommendations and underutilisation of healthcare. Research further has shown that patient dissatisfaction and mistrust are magnified particularly when physicians hold high levels of implicit racial bias. This suggests that physician implicit racial bias manifests in their communication behaviours during medical interactions. The overall goal of this research is to identify physician communication behaviours that link physician implicit racial bias and Black patient immediate (patient-reported satisfaction and trust) and long-term outcomes (eg, medication adherence, self-management and healthcare utilisation) as well as clinical indicators of diabetes control (eg, blood pressure, HbA1c and history of diabetes complication). Methods and analysis Using an exploratory sequential mixed methods research design, we will collect data from approximately 30 family medicine physicians and 300 Black patients with type 2 diabetes mellitus. The data sources will include one physician survey, three patient surveys, medical interaction videos, video elicitation interviews and medical chart reviews. Physician implicit racial bias will be assessed with the physician survey, and patient outcomes will be assessed with the patient surveys and medical chart reviews. In video elicitation interviews, a subset of patients (approximately 20–40) will watch their own interactions while being monitored physiologically to identify evocative physician behaviours. Information from the interview will determine which physician communication behaviours will be coded from medical interactions videos. Coding will be done independently by two trained coders. A series of statistical analyses (zero-order correlations, partial correlations, regressions) will be conducted to identify physician behaviours that are associated significantly with both physician implicit racial bias and patient outcomes

Identifying Implicit Component Interactions in Distributed Cyber-Physical Systems

Modern distributed systems and networks, like those found in cyber-physical system domains such as critical infrastructures, contain many complex interactions among their constituent software and/or hardware components. Despite extensive testing of individual components, security vulnerabilities resulting from unintended and unforeseen component interactions (so-called implicit interactions) often remain undetected. This paper presents a method for identifying the existence of implicit interactions in designs of distributed cyber-physical systems using the algebraic modeling framework known as Communicating Concurrent Kleene Algebra (C²KA). Experimental results verifying the applicability of C²KA for identifying dependencies in system designs that would otherwise be very hard to find are also presented. More broadly, this research aims to advance the specification, design, and implementation of distributed cyber-physical systems with improved cybersecurity assurance by providing a new way of thinking about the problem of implicit interactions through the application of formal methods

Consistent treatment of hydrophobicity in protein lattice models accounts for cold denaturation

The hydrophobic effect stabilizes the native structure of proteins by minimizing the unfavourable interactions between hydrophobic residues and water through the formation of a hydrophobic core. Here we include the entropic and enthalpic contributions of the hydrophobic effect explicitly in an implicit solvent model. This allows us to capture two important effects: a length-scale dependence and a temperature dependence for the solvation of a hydrophobic particle. This consistent treatment of the hydrophobic effect explains cold denaturation and heat capacity measurements of solvated proteins.Comment: Added and corrected references for design procedure in main text (p. 2) and in Supplemental Information (p. 8

Hamevol1.0: a C++ code for differential equations based on Runge-Kutta algorithm. An application to matter enhanced neutrino oscillation

We present a C++ implementation of a fifth order semi-implicit Runge-Kutta algorithm for solving Ordinary Differential Equations. This algorithm can be used for studying many different problems and in particular it can be applied for computing the evolution of any system whose Hamiltonian is known. We consider in particular the problem of calculating the neutrino oscillation probabilities in presence of matter interactions. The time performance and the accuracy of this implementation is competitive with respect to the other analytical and numerical techniques used in literature. The algorithm design and the salient features of the code are presented and discussed and some explicit examples of code application are given.Comment: 18 pages, Late

Elaboration in Dependent Type Theory

To be usable in practice, interactive theorem provers need to provide convenient and efficient means of writing expressions, definitions, and proofs. This involves inferring information that is often left implicit in an ordinary mathematical text, and resolving ambiguities in mathematical expressions. We refer to the process of passing from a quasi-formal and partially-specified expression to a completely precise formal one as elaboration. We describe an elaboration algorithm for dependent type theory that has been implemented in the Lean theorem prover. Lean's elaborator supports higher-order unification, type class inference, ad hoc overloading, insertion of coercions, the use of tactics, and the computational reduction of terms. The interactions between these components are subtle and complex, and the elaboration algorithm has been carefully designed to balance efficiency and usability. We describe the central design goals, and the means by which they are achieved

Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review

Background. In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities. Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition. Objectives.We investigated the extent towhich implicit racial/ethnic bias exists among health care professionals and examined the relationships between health care professionals’ implicit attitudes about racial/ethnic groups and health care outcomes. Search Methods. To identify relevant studies, we searched 10 computerized bibliographic databases and used a reference harvesting technique. Selection Criteria. We assessed eligibility using double independent screening based on a priori inclusion criteria. We included studies if they sampled existing health care providers or those in training to become health care providers, measured and reported results on implicit racial/ethnic bias, and were written in English. Data Collection and Analysis. We included a total of 15 studies for review and then subjected them to double independent data extraction. Information extracted included the citation, purpose of the study, use of theory, study design, study site and location, sampling strategy, response rate, sample size and characteristics, measurement of relevant variables, analyses performed, and results and findings.We summarized study design characteristics, and categorized and then synthesized substantive findings. Main Results. Almost all studies used cross-sectional designs, convenience sampling, USparticipants, and the Implicit Association Test to assess implicit bias. Low to moderate levels of implicit racial/ethnic bias were found among health care professionals in all but 1 study. These implicit bias scores are similar to those in the general population. Levels of implicit bias against Black, Hispanic/Latino/Latina, and dark-skinned people were relatively similar across these groups. Although some associations between implicit bias and health care outcomes were nonsignificant, results also showed that implicit bias was significantly related to patient–provider interactions, treatment decisions, treatment adherence, and patient health outcomes. Implicit attitudesweremore often significantly related to patient–provider interactions and health outcomes than treatment processes. Conclusions. Most health care providers appear to have implicit bias in terms of positive attitudes toward Whites and negative attitudes toward people of color. Future studies need to employ more rigorous methods to examine the relationships between implicit bias and health care outcomes. Interventions targeting implicit attitudes among health care professionals are needed because implicit bias may contribute to health disparities for people of color

Design Grammar - a pedagogical approach for observing teacher and student interaction.

Teacher and student interaction in a design-studio setting, also referred to as tutorial-learning or learning-by-doing, has been the blueprint of design education for decades. A crucial difficulty of design education is that the content of these meetings remains remarkably implicit. In this study we propose to explore the concept of Design Grammar as an observation framework for teacher-student interactions. Design grammar can be defined as the visual language used to design, i.e., the elements, and relationships between them, that are synthesized in the Form (understood as a unified structure of parts) of an artifact. In order to make this concept operational we developed a Design Grammar Model (DGM) which explicits the different elements involved in form-giving in design. We used the DGM to analyze the content of the interactions of junior Industrial Design students. We compared the results in terms of the student and teacher’s fluency in Design Grammar (DG), the criteria to evaluate fluency was: the frequency of references to DG, variety of references and articulation of DG elements. The main insight of our study was the observation that interactions with students with lower fluency in DG resulted in poorer performances from the teacher and therefore lower quality interactions