Mindfulness Training in Mitigating Implicit Bias: Improving Cultural Competency for Nurses Caring for LGBT Individuals

Background: Equitable care remains a goal of the United States healthcare system, with cultural competency training used as one intervention to mitigate disparities. Cultural competency education is primarily based on racial and ethnic differences, often omitting other marginalized groups. Implicit bias consequences are not addressed in such training programs despite the association with health outcome disparities. Research related to implicit bias has demonstrated the ability to promote malleability in implicit associations. Objectives: This project assessed a mindfulness meditation exercise intervention on nursing awareness in interacting with lesbian, gay, bisexual, and transgender (LGBT) patients. Additionally, an LGBT health education module that integrates affirmative practice and implicit bias concepts was introduced. This project served to improve awareness of implicit bias against LGBT individuals in order to begin mitigating the associations with poorer health outcomes. Methods: Using a pre-post intervention design, participant acceptance and comfort in working with LGBT individuals was measured using the Sexuality Implicit Association Test (IAT). Participants were instructed on the use of a mindfulness meditation exercise and completed a self-paced LGBT health education module. Content included LGBT terminology, health disparities, effective communication, and an overview of implicit bias awareness. Results: Participants were comprised of registered nurses and licensed practical nurses working at a non-profit healthcare organization. A total of 81 participants completed the pre-intervention IAT, and 51 completed the post-intervention IAT. In comparing pre- and post-intervention IAT scores, there was an overall increase in neutrality of bias between heterosexual and homosexual individuals. Conclusions: Mindfulness provides a promising opportunity to decrease bias in healthcare workers interacting with marginalized groups. This project provides a basis for organizational change using implicit bias awareness education. The research contributes to the paucity of available literature related to LGBT-specific healthcare, implicit bias, and cultural competence

Swine- Origin Influenza A (H1N1) Pandemic Revisited

Since the beginning of January 2008 sporadic cases of infections in humans caused by influenza A (H1N1) virus- resistant to available anti-influenza drugs have been reported worldwide [1,2]. The World Health Organization (WHO) in its report published on 18 March 2009 indicated that during weeks 1- 4 (28 December 08-24 January 09), the level of overall influenza activity in the world increased. During this period, 1291 of 1362 A (H1N1) cases from 30 countries showed resistance to the antiviral drug osaltamivir. [3]. In Canada, United States of America, Japan, Republic of Korea, Hong Kong, France, Germany, Ireland, Sweden and United Kingdom the prevalence of oseltamivir resistance was reported to be more than 95% [3]. On 24 April WHO released the first alert indicating the occurrence of confirmed human cases of swine influenza (H1N1) in Mexico and the United States [4]. Subsequently the Centre for Disease Control and Prevention (CDC), in the United States confirmed that these human influenza cases were caused by a new strain of influenza A virus subtype (H1N1) [5]

Quit Smoking and Run For Your Life!

To The Editor: The World Health Organization promotes the World No Tobacco Day on May 31

A comparison of methods to adjust for continuous covariates in the analysis of randomised trials

BACKGROUND: Although covariate adjustment in the analysis of randomised trials can be beneficial, adjustment for continuous covariates is complicated by the fact that the association between covariate and outcome must be specified. Misspecification of this association can lead to reduced power, and potentially incorrect conclusions regarding treatment efficacy. METHODS: We compared several methods of adjustment to determine which is best when the association between covariate and outcome is unknown. We assessed (a) dichotomisation or categorisation; (b) assuming a linear association with outcome; (c) using fractional polynomials with one (FP1) or two (FP2) polynomial terms; and (d) using restricted cubic splines with 3 or 5 knots. We evaluated each method using simulation and through a re-analysis of trial datasets. RESULTS: Methods which kept covariates as continuous typically had higher power than methods which used categorisation. Dichotomisation, categorisation, and assuming a linear association all led to large reductions in power when the true association was non-linear. FP2 models and restricted cubic splines with 3 or 5 knots performed best overall. CONCLUSIONS: For the analysis of randomised trials we recommend (1) adjusting for continuous covariates even if their association with outcome is unknown; (2) keeping covariates as continuous; and (3) using fractional polynomials with two polynomial terms or restricted cubic splines with 3 to 5 knots when a linear association is in doubt

Spatially-resolved electronic and vibronic properties of single diamondoid molecules

Diamondoids are a unique form of carbon nanostructure best described as hydrogen-terminated diamond molecules. Their diamond-cage structures and tetrahedral sp3 hybrid bonding create new possibilities for tuning electronic band gaps, optical properties, thermal transport, and mechanical strength at the nanoscale. The recently-discovered higher diamondoids (each containing more than three diamond cells) have thus generated much excitement in regards to their potential versatility as nanoscale devices. Despite this excitement, however, very little is known about the properties of isolated diamondoids on metal surfaces, a very relevant system for molecular electronics. Here we report the first molecular scale study of individual tetramantane diamondoids on Au(111) using scanning tunneling microscopy and spectroscopy. We find that both the diamondoid electronic structure and electron-vibrational coupling exhibit unique spatial distributions characterized by pronounced line nodes across the molecular surfaces. Ab-initio pseudopotential density functional calculations reveal that the observed dominant electronic and vibronic properties of diamondoids are determined by surface hydrogen terminations, a feature having important implications for designing diamondoid-based molecular devices.Comment: 16 pages, 4 figures. to appear in Nature Material

Relaxin family peptide receptors Rxfp1 and Rxfp2: mapping of the mRNA and protein distribution in the reproductive tract of the male rat

<p>Abstract</p> <p>Background</p> <p>Relaxin is the endogenous ligand of the G-protein coupled receptor RXFP1, previously known as LGR7. In humans relaxin can also activate, but with lower affinity, the closely related receptor for the insulin-like peptide from Leydig cells, RXFP2, previously known as LGR8. The lack of relaxin impairs male fertility but the precise distribution and the function of relaxin receptors in the male reproductive tract is not known. We investigated the distribution of Rxfp1 and Rxfp2 in the reproductive tract of the male rat and the function of relaxin in the vas deferens, a tissue with high expression of both receptors.</p> <p>Methods</p> <p>The presence of mRNA for Rxfp1 and Rxfp2 was investigated in testes, cultured Sertoli cells, epididymis, vas deferens, seminal vesicle, prostate, and spermatozoa by RT-PCR and Southern blot. Protein expression in the testis, vas deferens, primary culture of Sertoli cells, and spermatozoa was assessed by immunohistochemistry and immunofluorescence. The role of relaxin in the vas deferens was evaluated by contractility studies and radioimmunoassay of cAMP production. The effect of relaxin on mRNA levels for metalloproteinase-7 was measured by Northern blot.</p> <p>Results</p> <p>Transcripts for Rxfp1 and Rxfp2 were present in almost all parts of the male reproductive tract, with high levels in testis and vas deferens. Both receptors were immunolocalized in late stage germ cells but not in mature spermatozoa, although mRNAs for both receptors were also present in mature spermatozoa. Rxfp1 but not Rxfp2 was detected in cultured Sertoli cells. Strong immunostaining for Rxfp1 and Rxfp2 was seen in muscular and epithelial layers of the vas deferens and in arteriolar walls. Relaxin did not affect contractility and cyclic AMP production of the vas deferens, but increased the levels of mRNA for metalloproteinase-7.</p> <p>Conclusion</p> <p>Rxfp1 and Rxfp2 are widely and similarly distributed throughout the male reproductive tract. Our results suggest that Rxfp1 on spermatids and Sertoli cells may be important in spermatogenesis. Relaxin in the vas deferens does not affect contractility, but may affect vascular compliance and collagen and matrix remodeling.</p

Clinical and prognostic features among children with acute encephalitis syndrome in Nepal; a retrospective study

<p>Abstract</p> <p>Background</p> <p>Acute encephalitis syndrome (AES) is commonly seen among hospitalized Nepali children. Japanese Encephalitis (JE) accounts for approximately one-quarter of cases. Although poor prognostic features for JE have been identified, and guide management, relatively little is reported on the remaining three-quarters of AES cases.</p> <p>Methods</p> <p>Children with AES (n = 225) were identified through admission records from two hospitals in Kathmandu between 2006 and 2008. Patients without available lumbar puncture results (n = 40) or with bacterial or plasmodium infection (n = 40) were analysed separately. The remaining AES patients with suspected viral aetiology were classified, based on positive IgM antibody in serum or cerebral spinal fluid, as JE (n = 42) or AES of unknown viral aetiology (n = 103); this latter group was sub-classified into Non-JE (n = 44) or JE status unknown (n = 59). Bad outcome was defined as death or neurological sequelae at discharge.</p> <p>Results</p> <p>AES patients of suspected viral aetiology more frequently had a bad outcome than those with bacterial or plasmodium infection (31% versus 13%; P = 0.039). JE patients more frequently had a bad outcome than those with AES of unknown viral aetiology (48% versus 24%; P = 0.01). Bad outcome was independently associated in both JE and suspected viral aetiology groups with a longer duration of fever pre-admission (P = 0.007; P = 0.002 respectively) and greater impairment of consciousness (P = 0.02; P < 0.001). A higher proportion of JE patients presented with a focal neurological deficit compared to patients of unknown viral aetiology (13/40 versus 11/103; P = 0.005). JE patients weighed less (P = 0.03) and exhibited a higher respiratory rate (P = 0.003) compared to Non-JE patients.</p> <p>Conclusions</p> <p>Nepali children with AES of suspected viral aetiology or with JE frequently suffered a bad outcome. Despite no specific treatment, patients who experienced a shorter duration of fever before hospital admission more frequently recovered completely. Prompt referral may allow AES patients to receive potentially life-saving supportive management. Previous studies have indicated supportive management, such as fluid provision, is associated with better outcome in JE. The lower weight and higher respiratory rate among JE patients may reflect multiple clinical complications, including dehydration. The findings suggest a more systematic investigation of the influence of supportive management on outcome in AES is warranted.</p

Supersymmetric particle mass measurement with the boost-corrected contransverse mass

A modification to the contransverse mass (MCT) technique for measuring the masses of pair-produced semi-invisibly decaying heavy particles is proposed in which MCT is corrected for non-zero boosts of the centre-of-momentum (CoM) frame of the heavy states in the laboratory transverse plane. Lack of knowledge of the mass of the CoM frame prevents exact correction for this boost, however it is shown that a conservative correction can nevertheless be derived which always generates an MCT value which is less than or equal to the true value of MCT in the CoM frame. The new technique is demonstrated with case studies of mass measurement with fully leptonic ttbar events and with SUSY events possessing a similar final state.Comment: 33 pages, 33 .eps figures, JHEP3 styl