Reproducing Privilege or Hippocratic Habitus: A Critical Discourse Analysis of Personal Statements and the use of Capital to Facilitate Matriculation into Medical School

A national physician shortage has prompted calls to diversify the demographics of medical school student bodies to address the social determinants of health plaguing underrepresented minority communities. Moreover, the Association of American Medical Colleges predicts a deficit of 104,900 physicians by 2030. Despite this, admission into medical school remains competitive, homogenous, and lacking “underrepresented in medicine” (URM) students. Underrepresented groups historically absent from medical education show that the medical degree and overall pursuit of a medical career are tacitly affiliated with a dominant social group acting as a power agent in the reproduction of an economic class. Considering the admissions process, one could question the ability to extend existing cultural-based inequalities into medical education. This dissertation examines how discourse in an applicant’s personal statement shapes the actions of medical-school admissions committees oblivious to hidden influences of power. Inspired by Pierre Bourdieu’s economic notion of capital, I used his theories to examine how applicants use available cultural and social capital in personal statement to obtain in-person interviews. The research questions are: (1) How are forms of capital expressed in URM and non-URM applicants’ medical school personal statements? (2) Do the expressed forms of capital differ in the personal statements of applicants accepted and rejected for in-person interviews? A critical discourse analysis highlights cultural and social capital among accepted and rejected URM and non-URM applicants with similar academic scores. Key findings revealed URM students lacked expressive values of cultural capital and are were less likely to be invited to for interview due to the lack of URM physician mentors evident through cultural relational values. Additionally, non-URM applicants’ evolving interpretation of the medical field influenced their motivation to demonstrate cultural capital at the macro level, presenting the likelihood of an interview. The macro level also revealed how non-URM students used celebrity-status relationships and disproportionality larger social networks related to the field of medicine. Implications are related to executing a formal inventory of pipeline programs through institutional representation at the national level, reforming admissions priorities to leverage applicants’ personal qualities and potential, and redefining the disadvantaged status in the medical school application process

Beyond the brotherhood: Skoal Bandits' role in the evolution of marketing moist smokeless tobacco pouches.

Background:Since 2006, "snus" smokeless tobacco has been sold in the U.S.. However, U.S. Smokeless Tobacco (USST) and Swedish Match developed and marketed pouched moist snuff tobacco (MST) since 1973. Methods:Analysis of previously secret tobacco documents, advertisements and trade press. Results:USST partnered with Swedish Match, forming United Scandia International to develop pouch products as part of the "Lotus Project." Pouched MST was not commonly used, either in Sweden or the U.S. prior to the Lotus Project's innovation in 1973. The project aimed to transform smokeless tobacco from being perceived as an "unsightly habit of old men" into a relevant, socially acceptable urban activity, targeting 15-35 year-old men. While USST's initial pouched product "Good Luck," never gained mainstream traction, Skoal Bandits captured significant market share after its 1983 introduction. Internal market research found that smokers generally used Skoal Bandits in smokefree environments, yet continued to smoke cigarettes in other contexts. Over time, pouch products increasingly featured increased flavor, size, nicotine strength and user imagery variation. Conclusions:Marlboro and Camel Snus advertising mirrors historical advertising for Skoal Bandits, designed to recruit new users and smokers subjected to smokefree places. Despite serious efforts, pouched MST marketing has been unable to dispel its association with traditional smokeless tobacco stereotypes as macho and rural. Public education efforts to discourage new users and dual use of MST and cigarettes should emphasize that "new" pouch products are simply repackaging "old" smokeless tobacco

Sexual function in 16- to 21-year-olds in Britain

Purpose: Concern about young people's sexuality is focused on the need to prevent harmful outcomes such as sexually transmitted infections and unplanned pregnancy. Although the benefit of a broader perspective is recognized, data on other aspects of sexuality, particularly sexual function, are scant. We sought to address this gap by measuring the population prevalence of sexual function problems, help seeking, and avoidance of sex in young people. Methods: A cross-sectional stratified probability sample survey (Natsal-3) of 15,162 women and men in Britain (response rate: 57.7%), using computer-assisted self-interviews. Data come from 1875 (71.9%) sexually active, and 517 sexually inactive (18.7%), participants aged 16–21 years. Measures were single items from a validated measure of sexual function (the Natsal-SF). Results: Among sexually active 16- to 21-year-old participants, 9.1% of men and 13.4% of women reported a distressing sexual problem lasting 3 months or more in the last year. Most common among men was reaching a climax too quickly (4.5%), and among women was difficulty in reaching climax (6.3%). Just over a third (35.5%) of men and 42.3% of women reporting a problem had sought help, but rarely from professional sources. Among those who had not had sex in the last year, just >10% of young men and women said they had avoided sex because of sexual difficulties. Conclusions: Distressing sexual function problems are reported by a sizeable minority of sexually active young people. Education is required, and counseling should be available, to prevent lack of knowledge, anxiety, and shame progressing into lifelong sexual difficulties

Expression of sialic acids and other nonulosonic acids in Leptospira

AbstractBackgroundSialic acids are negatively charged nine carbon backbone sugars expressed on mammalian cell surfaces. Sialic acids are part of a larger family of nonulosonic acid (NulO) molecules that includes pseudaminic and legionaminic acids. Microbial expression of sialic acids and other nonulosonic acids has been shown to contribute to host-microbe interactions in a variety of contexts, including participation in colonization, immune subversion, and behaviors such as biofilm formation, autoagglutination and motility. Previous research has suggested that some spirochetes may also express these molecules.ResultsHere we use a combination of molecular tools to investigate the presence of NulO biosynthetic gene clusters among clinical and saprophytic isolates of the genus Leptospira. Polymerase chain reaction and Southern blotting suggested that a variety of leptospires encoded NulO biosynthetic pathways. High performance liquid chromatography and mass spectrometry analyses provided biochemical evidence that di-N-acetylated NulO molecules are expressed at relatively high levels by L. interrogans serovar Lai strain 55601, and at lower levels by L. alexanderi serovar Manhao and L. fainei serovar Hurstbridge. Endogenous expression of N-acetylneuraminic acid (Neu5Ac, the most common sialic acid) was documented in L. interrogans serovar Copenhageni strain L1-130. Neu5Ac biosynthesis is also supported by a unique gene fusion event resulting in an enzyme with an N-terminal N-acetylneuraminic acid synthase domain and a C-terminal phosphatase domain. This gene fusion suggests that L. interrogans uses a Neu5Ac biosynthetic pathway more similar to animals than to other bacteria. Analysis of the composition and phylogeny of putative NulO biosynthetic gene clusters in L. interrogans serovar Lai and serovar Copenhageni revealed that both strains have complete biosynthetic pathways for legionamimic acid synthesis, a molecule with the same stereochemistry as sialic acid. Lectin-based affinity purification of NulO-modified molecules, followed by mass spectrometric identification suggests post-translational modification of surface lipoproteins, including Loa22.ConclusionsLeptospira species encode NulO biosynthetic pathways and synthesize multiple NulO molecules including sialic acid. Additional studies are needed to clarify the exact context and functional significance of NulO expression. These findings have implications for immune evasion during systemic leptospirosis