Mixed-Method Analyses of Federal Court Decisions During 1980-2007 Involving Race and Sex Discrimination Under Title VII of the Civil Rights Act of 1964 and Faculty Tenure Denial Decisions in Higher Education

Purpose The Civil Rights Act of 1964 has become the foundation of modem federal equal employment opportunity law. The application of this law to adverse tenure decisions, however, may differ from other adverse employment decisions because of judicial deference toward institutions of higher education. This present study analyzed published federal court cases decided during the period 1980-2007 involving Title VII, tenure denial, and higher education. This will contribute to understandings of the relationship between federal courts, faculty, and higher education by analyzing the extent of a statistical association between case and/or plaintiff characteristics and case outcomes; and isolating those institutional factors and practices that plaintiffs focus on in bringing lawsuits and those that the courts consider most relevant in deciding cases. Understanding this information can help institutions maximize fairness and minimize their liability exposure when designing tenure processes and making tenure decisions. Method This study utilized legal, quantitative, and qualitative research methods to analyze 96 federal court cases involving tenure denial and claims of race and/or sex discrimination. The chi-square test of independence and Cramer’s V were utilized to analyze the statistical association between the independent and dependent variables. Legal briefing and the qualitative historical content analysis approach were utilized to analyze the interplay between federal courts, faculty, and higher education. The content analyses process entailed: determining the coding system; perusing cases to identify concepts, trends, and themes; sorting cases in accord with emerging trends and themes; isolating trends and themes; discerning generalizations about data; and formulating constructs. Results The legal research method was used to identify, retrieve, analyze, and interpret the court cases involved in this study. For instance, Westlaw’s computer-assisted database was examined to identify and retrieve the relevant court cases. This examination process resulted in 204 federal court cases. Each case was then analyzed to ensure subject relevancy. Further, a legal research process known as shepardizing was applied to the cases to ensure that no cases were duplicated and that each was terminated during the period studied. These analyses resulted in 96 federal court cases identified for the purposes of this study. Quantitative analyses involved in this study showed that there was no statistically significant relationship between the independent variables (plaintiffs sex, plaintiff s race, Title VII claim, institution class) and dependent variable (case outcome). However, there was a statistically significant relationship between the independent variables (court level, decision period) and dependent variable. Further, qualitative analyses of the cases indicated that when bringing lawsuits of race and/or sex discrimination under Title VII, higher education faculty tend to make more than one allegation of discriminatory conduct/behavior against their employer (institutions). These allegations tend to surround the themes of procedural irregularities, ambiguous policies, disparate treatment, and hostile environments. Even so, discrimination is difficult for faculty to prove as the data suggest that most faculty fail to show that their institutions’ reasons for denying them tenure is a pretext for discrimination. This finding indicates that the burden of proof under the disparate treatment theory is easier for institutions than for faculty,, as courts tend to not question the merits of the institutions’ tenure decision. Further, the data suggests that faculty tend to lose their lawsuits on appeal. However, faculty are more successful when they claim both sex and race discrimination. Further still, male faculty who file reverse sex discrimination lawsuits appear to prevail at a similar percentage as female faculty who file sex discrimination lawsuits. Another finding was that during the 1980s the courts’ temporarily departed from their traditional practice of judicial deference. Faculty whose cases were decided during the 1980s prevailed more than faculty whose cases were decided during the 1990s and 2000s. Conclusions When bringing lawsuits against their institutions for adverse tenure decisions based on claims of race and/or sex discrimination faculty tend to present more than one type of allegation/evidence of discrimination. These allegations/evidence tends to center around the themes of procedural irregularities, ambiguous policies, disparate treatments, and hostile environments. However, most plaintiffs lose their lawsuits because they either fail to show they were qualified for tenure or that the institution’s proffered reason for denying them tenure was a pretext for discrimination. Even so, plaintiffs tend to be more successful when they claim both race and sex discrimination. Court’s general responses to plaintiffs’ allegations/evidence is they will not scrutinize or question the soundness or merit of an institution’s decision absent proof that the tenure decision was based on a prohibited factor or a showing of a nexus or causal connection by plaintiff. This judicial deference demonstrates that the burden of proof under the McDonnell Douglas theory is much easier for institutions than for faculty. While case outcomes do not appear to be influenced by plaintiffs race or sex, outcomes do appear to be influenced by court level. The data indicates that plaintiff s experienced a higher success rate at the U.S. District Court level as opposed to the U.S. Appeals court level. As well, plaintiffs whose cases terminated during the 1980s prevailed at a much higher rate than those whose cases terminated during the 1990s and 2000s

Psychometric Properties of the PSWQ-A in a Community Sample of Older Adults

Among older adults, GAD is as prevalent as major depression (Blazer, George, & Hughes, 1991). As a result of scale development and norming that generally incorporates younger samples, psychometrically sound anxiety and worry instruments for older cohorts are limited. The Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metzger, & Brokovec, 1990) is one instrument that may be useful for assessing worry in older adults, although limitations of this scale recently were highlighted that resulted in the development of a revised version that more effectively might assess worry in older adults, the Penn State Worry Questionnaire-Abbreviated (PSWQ-A; Hopko et. al., 2003). The present study addressed limitations of previous work by administering the scale to an independent sample of 115 community dwelling older adults. Analyses revealed that data fit moderately with the single factor model proposed by Hopko et al. (2003). However, internal consistency of the measure was good (α = .89), test-retest reliability of the scale at the two-week (r = .92) and six-week (r = .95) follow-up administrations was excellent, and there was some support for the convergent and disciminant validity of the PSWQ-A with contemporary measures of anxiety and depression. Implications of using the PSWQA in clinical and research settings are discussed, as are study limitations

Evaluation of the Effects of Commercial Yeast Cell Wall Prebiotics and Bacillus Probiotics on Broiler Performance While Subjected to Gastrointestinal Stress

The purpose of this study was to compare the effects of four prebiotic and probiotic treatments on Cobb 500 broilers under gastrointestinal (GI) stress induced by a double coccidiosis vaccination at Day (D) 1 and again on D 7, with a mild heat stress beginning on D 22 of the trial. This study used a Negative Control (NC) treatment (TRT) to test for a positive response to the GI stress challenge and a Positive Control (PC) basal diet with 5% DDGS, to represent current industry type diets more closely, and serve as the control for the 4 antibiotic alternative treatments. The study was conducted using a 4 phase feeding program over 42 D with approximately 3000 broilers housed within 90 pens (3’x 6’) of a single tunnel ventilated rearing barn located at the TAMU Poultry Science Research Farm. The hypothesis was to determine if prebiotics and/or probiotics can be effective alternatives to the use of antibiotics as growth promoters in broilers. Dependent variables analyzed on D 21 for cumulative weight gain, and cumulative feed to gain showed MicroSaf as the best performing. For cumulative weight gain ratios to NC on D 21 the Safmannan was the best, with similar results from Microsaf, and the PC. For the FCR to NC ratio Microsaf performed better, but similarly to the Calsporin, Safmannan, and the PC on D 21. On D 42 with the feed to gain ratio Safmannan, Calsporin, and Microsaf performed significantly better than Celmanax. With the FCR on D 42 Safmannan performed significantly better than Celmanax, but similarly to the other treatments. Based on this data Safmannan, Calsporin, and Microsaf are all viable alternatives to the use of antibiotics for growth promotion

Point-of-care versus central testing of hemoglobin during large volume blood transfusion.

BACKGROUND: Point-of-care (POC) hemoglobin testing has the potential to revolutionize massive transfusion strategies. No prior studies have compared POC and central laboratory testing of hemoglobin in patients undergoing massive transfusions. METHODS: We retrospectively compared the results of our point-of-care hemoglobin test (EPOC®) to our core laboratory complete blood count (CBC) hemoglobin test (Sysmex XE-5000™) in patients undergoing massive transfusion protocols (MTP) for hemorrhage. One hundred seventy paired samples from 90 patients for whom MTP was activated were collected at a single, tertiary care hospital between 10/2011 and 10/2017. Patients had both an EPOC® and CBC hemoglobin performed within 30 min of each other during the MTP. We assessed the accuracy of EPOC® hemoglobin testing using two variables: interchangeability and clinically significant differences from the CBC. The Clinical Laboratory Improvement Amendments (CLIA) proficiency testing criteria defined interchangeability for measurements. Clinically significant differences between the tests were defined by an expert panel. We examined whether these relationships changed as a function of the hemoglobin measured by the EPOC® and specific patient characteristics. RESULTS: Fifty one percent (86 of 170) of paired samples\u27 hemoglobin results had an absolute difference of ≤7 and 73% (124 of 170) fell within ±1 g/dL of each other. The mean difference between EPOC® and CBC hemoglobin had a bias of - 0.268 g/dL (p = 0.002). When the EPOC® hemoglobin was \u3c 7 g/dL, 30% of the hemoglobin values were within ±7, and 57% were within ±1 g/dL. When the measured EPOC® hemoglobin was ≥7 g/dL, 55% of the EPOC® and CBC hemoglobin values were within ±7, and 76% were within ±1 g/dL. EPOC® and CBC hemoglobin values that were within ±1 g/dL varied by patient population: 77% for cardiac surgery, 58% for general surgery, and 72% for non-surgical patients. CONCLUSIONS: The EPOC® device had minor negative bias, was not interchangeable with the CBC hemoglobin, and was less reliable when the EPOC® value was \u3c 7 g/dL. Clinicians must consider speed versus accuracy, and should check a CBC within 30 min as confirmation when the EPOC® hemoglobin is \u3c 7 g/dL until further prospective trials are performed in this population

The clinical and cost burden of coronary calcification in a Medicare cohort: An economic model to address under-reporting and misclassification

AbstractBackgroundCoronary artery calcification (CAC) is a well-established risk factor for the occurrence of adverse ischemic events. However, the economic impact of the presence of CAC is unknown.ObjectivesThrough an economic model analysis, we sought to estimate the incremental impact of CAC on medical care costs and patient mortality for de novo percutaneous coronary intervention (PCI) patients in the 2012 cohort of the Medicare elderly (≥65) population.MethodsThis aggregate burden-of-illness study is incidence-based, focusing on cost and survival outcomes for an annual Medicare cohort based on the recently introduced ICD9 code for CAC. The cost analysis uses a one-year horizon, and the survival analysis considers lost life years and their economic value.ResultsFor calendar year 2012, an estimated 200,945 index (de novo) PCI procedures were performed in this cohort. An estimated 16,000 Medicare beneficiaries (7.9%) were projected to have had severe CAC, generating an additional cost in the first year following their PCI of $3500, on average, or$56 million in total. In terms of mortality, the model projects that an additional 397 deaths would be attributable to severe CAC in 2012, resulting in 3770 lost life years, representing an estimated loss of about $377 million, when valuing lost life years at$100,000 each.ConclusionsThese model-based CAC estimates, considering both moderate and severe CAC patients, suggest an annual burden of illness approaching $1.3 billion in this PCI cohort. The potential clinical and cost consequences of CAC warrant additional clinical and economic attention not only on PCI strategies for particular patients but also on reporting and coding to achieve better evidence-based decision-making

Race and Implicit Bias in the JeffMD Case-Based Learning Curriculum

Purpose: Race is related to health disparities, not to genetic predispositions, but race is often presented to medical students as a biological variable. At Sidney Kimmel Medical College, the curriculum has never been reviewed to analyze how race is presented to students. This Scholarly Inquiry project aims to analyze how the case-based learning (CBL) narratives presented to medical students perpetuate or challenge implicit biases in medicine, especially in regard to race. This paper will describe the methods of the project, which can serve as a model for other institutions to review their own curricula. Methods: Thirty-nine CBL cases from the 2018-2019 SKMC curriculum are being coded using the iterative process of directed content analysis. One of the two coders is a white medical student who has seen all of the cases in the classroom setting, and the other is a black doctoral student and adjunct faculty member in the College of Population Health who has never seen the cases before. The cases were imported into the qualitative analysis program NVivo, and each coder conducted line-by-line open-coding of seven different cases. From those cases, the coders developed a code book which includes definitions and examples of each code. Updates were made to the code book as more cases were coded and new topics emerged, and discrepancies were resolved by consensus. Using the final code book, all cases are now in the process of being double-coded (i.e. coded by each coder independently). Results and Conclusions: The coders aim to complete double-coding by the end of January 2020. At that point, the kappa value will be calculated to assess inter-coder reliability and codes will be organized into themes to write a results section. Already, we have noted the value of having at least one “case-naïve” coder and coders of different racial backgrounds, as many nuances of the cases were overlooked by the non-minority coder

Impact of daily, oral pre-exposure prophylaxis on the risk of bacterial sexually transmitted infections among cisgender women: a systematic review and narrative synthesis [version 2; peer review: 2 approved]

Background: There are concerns that the use of pre-exposure prophylaxis (PrEP) may result in an increased incidence of sexually transmitted infections (STIs). Evidence for this is mixed and has mostly been based on reviews focussed on gay and bisexual men and transgender women, while none have summarised evidence in cisgender women. Methods: We conducted a systematic review to explore whether daily, oral PrEP use is associated with changes in bacterial STI occurrence (diagnoses or self-reported) and/or risk among HIV seronegative cisgender women (ciswomen). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. Results: We included 11 full text articles in a narrative synthesis, with the studies published between 2012 and 2021. The studies were mostly based in Africa (n=7, 63.6%) and reported on 3168 ciswomen using PrEP aged 16–56 years. Studies had marked differences in variables, including measurements and definitions (e.g., STI type) and limited data available looking specifically at ciswomen, principally in studies with both male and female participants. The limited evidence suggests that PrEP use is not associated with increased STI rates in ciswomen generally; however, adolescent girls and young women in Sub Saharan Africa have a higher prevalence of bacterial STIs prior to PrEP initiation, compared to adult ciswomen and female sex workers. Conclusions: We suggest future PrEP research make efforts to include ciswomen as study participants and report stratified results by gender identity to provide adequate data to inform guidelines for PrEP implementation. PROSPERO registration: CRD4201913043

A Systematic Review and Meta-analysis on the Effects of Culturally Tailored Group Diabetic Self-Management Education Programs Versus Usual Care on Hemoglobin A1c(HbA1c) and Health-related Quality of Life (HrQol) for African-American Adults with Type 2 Diabetes

For African-Americans, the burden of diabetes, diabetes-related conditions, and mortality is significant. Diabetic self-management education is an intervention used to increase knowledge, skill, and self-efficacy with diabetes self-care. Efforts have been made to establish culturally-adapted diabetic self-management education programs to improve health outcomes for African-Americans. However, research is limited with assessing their effectiveness. This systematic review and meta-analysis intends to evaluate the impact of existing culturally-tailored diabetic self-management education interventions on hemoglobin A1c and health-related quality of life for African-American adults with type 2 diabetes. Twelve randomized control trials comparing the effect of culturally tailored group diabetic self-management education programs versus usual care were selected for review. Seven trials contained data suitable for meta-analysis. Social determinants of health, including institutional racism, and critical race theory was used to provide context for the analysis. Results determine that existing culturally tailored programs have no impact on hemoglobin A1c and health-related quality of life when compared to usual care for African-American adults with type 2 diabetes. As there are no standards with determining the necessary components of a culturally appropriate intervention, many programs varied and subjective. Furthermore, most programs do not address social determinants of health, and are not comprehensive enough according to concepts of the critical race theory framework. Hence, additional research is needed concerning this subject which has important implications for both public and population health as it relates to historical and cultural competency as well as advocacy. Presentation: 21:0