Canadian residents’ perceptions of cross-cultural care training in graduate medical school

Background: The Royal College of Physicians and Surgeons of Canada specifies both respect for diversity as a requirement of professionalism and culturally sensitive provision of medical care.  The purpose of the present study was to evaluate the perception of preparedness and attitudes of medical residents to deliver cross-cultural care.Methods: The Cross Cultural Care Survey was sent via e-mail to all Faculty of Medicine residents (approx. 450) in an academic health sciences centre. Comparisons were made between psychiatry residents, family medicine residents, and other residency groups with respect to training, preparedness, and skillfulness in delivering cross-cultural care.Results: Seventy-three (16%) residents responded to the survey. Residents in psychiatry and family medicine reported significantly more training and formal evaluation regarding cross-cultural care than residents in other programs. However, there were no significant differences in self-reported preparedness and skillfulness. Residents in family medicine were more likely to report needing more practical experience working with diverse groups. Psychiatry residents were less likely to report inadequate cross-cultural training.Conclusion: While most residents reported feeling skillful and prepared to work with culturally diverse groups, they report receiving little additional instruction or formal evaluation on this topic, particularly in programs other than psychiatry and family medicine

A Unified Approach to the Isomeric α‑, β‑, γ‑, and δ-Carbolines via their 6,7,8,9-Tetrahydro Counterparts

A cross-coupling/reductive cyclization protocol has been employed in a unified approach to all four carbolines. So, for example, the 2-nitropyridine 8, which is readily prepared through an efficient palladium-catalyzed Ullmann cross-coupling reaction, is reductively cyclized under conventional conditions to give 6,7,8,9-tetrahydro-α-carboline that is itself readily aromatized to give α carboline (1)

The Emerald International Handbook of Feminist Perspectives on Women’s Acts of Violence

Over the past twenty years, interest in women’s violence has grown as an area of academic research and teaching across disciplines such as criminology, sociology, history, international relations, public health and film and literary studies. This handbook makes a timely contribution by acting as a comprehensive introduction to a wide range of international, interdisciplinary scholarship which applies feminist perspectives to the phenomenon of women’s violence. Violence is enabled and enacted by individuals, organisations and states with interconnections between these different levels (Collins, 1998, 2017). We adopt this multilevel understanding of violence in the handbook, bringing together contributions on interpersonal and intimate violence by women, women’s violence as agents of institutions, and women’s political violence as state and non-state actors. The handbook is international in scope with contributions from scholars across countries in the Global South and North. Women’s acts of violence are rarer than men’s and frequently perceived as more shocking. Violence by women is regularly sensationalised and stigmatised, especially in media discourses. This sensationalisation and stigmatisation relies on and reproduces misogynistic tropes about violent women as ‘evil’, ‘unnatural’ and masculinised. The chapters in this handbook are written from a feminist perspective and eschew or deconstruct stereotypical portrayals in favour of more considered and complex analyses of the violence women enact and the relevance of their social and political positioning, as well as cultural understandings of womanhood and how these inform understandings of and responses to this violence. Previous literature has emphasised that women’s violence is frequently understood as deviant and transgressive, violating norms of ideal femininity. Such ideas are explored throughout the handbook in contributions which consider, for instance, the vilification and monsterisation of women who kill. These chapters tease out the ways in which violent women are profiled as unnatural and abject. The handbook therefore retains a focus on scholarship which considers the ‘abnormality’ of violent women while also including contributions which demonstrate that women’s violent acts can be normalised and made invisible, for example when perpetrated during a professional role. Adding further nuance, various chapters address how, due to marginalisation across axes of race and class, certain women are not always presumed to be non-violent or perceived through norms of ideal femininity. The handbook explores how these assumptions can lead to overcriminalisation and harsh treatment within the criminal justice system. The significance of women’s intersectional identities is a consistent theme throughout the handbook. Running through the chapters too is the seemingly intractable problem of agency – including the obstacles to fully assigning agency to violent women as well as the frequently unwanted consequences when they are considered to have acted with agency and are punished more harshly. Throughout the handbook, authors grapple with questions of women’s volitional capacity, considering difficult questions of how far we should consider the contexts in which women commit violence, which include structural oppression, domestic- and gender-based violence, and cultural norms. The contributions reveal the necessity of abandoning a binary view of victim-perpetrator, agency/non-agency and evolving a more complex framework in which to gauge questions of intention and deliberation. The handbook is divided into eight sections: historical perspectives; understanding women’s acts of violence; women as perpetrators of interpersonal and intimate violence; power and women’s violence; women and non-state political violence; cultural interpretations of violent women; fictional representations of violent women; and violent women and girls in the criminal justice system. The rest of this introductory chapter outlines the handbook’s structure and summarises each contribution

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Sex and Crime

A comprehensive account of the myriad ways that sex and crime interact in contemporary social life, sensitively confronting topics such as nationhood, abortion, child sexual exploitation, war, disability, pornography, and digital cultures. To explain how sex and crime is composed by, and composes, our understanding of these issues, this book: - Draws on the authors’ research expertise, insightful case studies, and leading scholarship from across the globe. - Develops students’ capacity to engage thoughtfully with diverse problems and to think critically, this is achieved with the help of creative learning exercises, empathetic questioning, and relevant illustrative examples. - Encourages readers to be reflexive, open-spirited, and curious about how issues of sex and crime touch their lives and those of people around them

The Future

In this chapter, we try to look forward, heeding our knowledge of the past and present to ask questions about what might be important, or necessary, issues to address in the future. Of course, none of us has a crystal ball. We can speculate about what the big questions will be, but we cannot know for certain. And each of us, including you, will have different ideas about what is on the horizon

A Palladium-Catalyzed Ullmann Cross-Coupling/Reductive Cyclization Route to the Carbazole Natural Products 3-Methyl-9H-carbazole, Glycoborine, Glycozoline, Clauszoline K, Mukonine, and Karapinchamine A

The title natural products 2-7 have been prepared by reductive cyclization of the relevant 2-arylcyclohex-2-en-1-one (e.g. 20) to the corresponding tetrahydrocarbazole and dehydrogenation (aromatization) of this to give the target carbazole (e.g. 4). Compounds such as 20 were prepared using a palladium-catalyzed Ullmann cross-coupling reaction between the appropriate 2-iodocyclohex-2-en-1-one and o-halonitrobenzene

Parents, health professionals and footwear stakeholders’ beliefs on the importance of different features of young children’s footwear: a qualitative study

BACKGROUND: A small but building pool of evidence of the impact of footwear on children’s function means understanding the different beliefs of stakeholders about footwear key features and flexibility is critical for translation into recommendations and to support parents and caregivers in purchasing footwear for their children. Therefore, this research aimed to describe how different stakeholders (health professionals, parents, and footwear industry representatives) described the importance of flexibility and other footwear features for young children. METHODS: This qualitative study was nested within an international modified Delphi online survey. Participants responded to open-ended questions about footwear component flexibility and asked if and why flexibility in these areas were important. Participants also described any other important footwear features. Inductive thematic analysis was used to generate themes. RESULTS: There were 121 responses from three stakeholder groups including health professionals (n = 90), parents of young children (n = 26) and footwear industry representatives (n = 5). Overarching themes described by participants included developmental impacts of footwear, therapeutic impact and how footwear may play a role in function. CONCLUSION: There were key differences in how stakeholders viewed footwear and any perceived benefits of footwear components, much of which was not backed with empirical evidence. It was also identified that health professionals are using footwear within treatment recommendations. This work highlights the importance of understanding circumstances in which footwear may have a therapeutic impact or be the first line of treatment for children with complex foot needs. This is the first step in developing contemporary footwear recommendations for parents and caregivers

Young children’s footwear taxonomy:An international Delphi survey of parents, health and footwear industry professionals

OBJECTIVE: There is little consistency between commercial grade footwear brands for determining shoe sizing, and no universally accepted descriptors of common types or features of footwear. The primary aim of this research was to develop a footwear taxonomy about the agreed types of footwear commonly worn by children under the age of six. Secondary aims were to gain consensus of the common footwear features, when different types of footwear would be commonly worn, common terms for key footwear parts, and how movement at some of these footwear parts should be described. MATERIALS AND METHODS: Opinions were collected through a three-round modified Delphi international online survey from parents, health professionals, researchers, and footwear industry professionals. The first survey displayed generic pictures about different footwear types and asked participants to provide a grouping term, when the footwear would be worn (for what type of activity) and any grouping features. The second and third rounds presented consensus and gathered agreement on statements. RESULTS: There were 121 participants who provided detailed feedback to open-ended questions. The final round resulted in consensus and agreement on the names of 14 different footwear types, when they are commonly worn and their common features. Participants also reached consensus and agreement on the terms heel counter to describe the back part of footwear and fixtures as the collective term for features allowing footwear adjustability and fastening. They also agreed on terms to quantify the flexibility at footwear sole (bend or twist) or the heel counter. CONCLUSION: This first taxonomy of children’s footwear represents consensus amongst different stakeholders and is an important step in promoting consistency within footwear research. One shoe does not fit all purposes, and the recommendations from this work help to inform the next steps towards ensuring greater transparency and commonality with footwear recommendations