Nurses' implicit and explicit attitudes towards transgender people and the need for trans-affirming care

Background: The primary objective of this study is to investigate the implicit and explicit attitudes of healthcare professionals - in particular nurses - towards transgender people. This is especially important in light of recent calls for improved trans-affirming care provision by healthcare professionals to generate quality healthcare access and outcomes for transgender people. Methods: We use publicly available data from the transgender version of the Implicit Association Test from 2020 to 2022. We focus on differences between three subsets of participant: (1) non-healthcare professionals (N = 177,810), (2) non-nursing healthcare professionals (N = 22,443) and (3) nursing healthcare professionals (N = 11,996). We present the results of parametric statistical tests (t-tests) and an ordinary least squares regression, to analyse the robustness of our results when controlling for a host of sociodemographic characteristics. Results: We find that non-healthcare professionals have significantly lower implicit bias towards transgender people compared to healthcare professionals. Further, within healthcare professionals, we find nurses have significantly higher implicit bias towards transgender people compared to non-nurses. We show how implicit bias and explicit attitudes are highly correlated. Further, we provide evidence that healthcare professionals - but in particular nurses - conflate sex and gender identity. Conclusion: Whilst nurses continue to have higher levels of implicit and explicit bias towards transgender people there remains a need to globally establish additional enhanced trans-affirming care training provision for nursing and medical students

“But what do you really think?” Nurses' contrasting explicit and implicit attitudes towards people with disabilities using the implicit association test

Aims: To investigate how nurses' implicit and explicit attitudes towards people with disabilities (PWD) compare to (1) other healthcare providers and (2) non‐healthcare providers.Method: We present an analysis of secondary data from the publicly available disability Implicit Association Test (IAT). We compare the explicit and implicit attitudes towards PWD for (1) nurses (n = 24,545), (2) other healthcare providers (n = 57,818) and (3) non‐healthcare providers (n = 547,966) for a total of 630,238 respondents, between 2006 and 2021.Data Sources: We use publicly available data for the Disability IAT from Open Science Framework repository of Project Implicit available at https://osf.io/tx5fi/.Reporting: STROBE checklist.Results: There is a distinct contrast between nurses' explicit and implicit attitudes. While nurses have more positive explicit attitudes towards PWD compared to other groups, they also have more negative implicit attitudes towards PWD. As such there is a contrast between nurses' stated (explicit) attitudes and their unconscious (implicit) attitudes towards PWD. Further, we find that implicit bias towards PWD—among all groups—has not improved over the 15 year period of our sample.Conclusions: We present a contrast between nurses' explicit and implicit attitude towards PWD compared to non‐healthcare providers. We posit that implicit bias is driven by a combination of workload and stress which drives nurses to unconscious modes of thinking more frequently.Implications: We discuss three potential tools for improved educational praxis regarding treatment of PWD; (1) more PWD service user involvement, (2) the use of mindfulness techniques to reduce stress and (3) the use of patient contact simulation to promote education and understanding.Patient or Public Contribution: There is no patient or public contribution

Vestigialization of an Allosteric Switch: Genetic and Structural Mechanisms for the Evolution of Constitutive Activity in a Steroid Hormone Receptor

An important goal in molecular evolution is to understand the genetic and physical mechanisms by which protein functions evolve and, in turn, to characterize how a protein's physical architecture influences its evolution. Here we dissect the mechanisms for an evolutionary shift in function in the mollusk ortholog of the steroid hormone receptors (SRs), a family of biologically essential transcription factors. In vertebrates, the activity of SRs allosterically depends on binding a hormonal ligand; in mollusks, however, the SR ortholog (called ER, because of high sequence similarity to vertebrate estrogen receptors) activates transcription in the absence of ligand and does not respond to steroid hormones. To understand how this shift in regulation evolved, we combined evolutionary, structural, and functional analyses. We first determined the X-ray crystal structure of the ER of the Pacific oyster Crassostrea gigas (CgER), and found that its ligand pocket is filled with bulky residues that prevent ligand occupancy. To understand the genetic basis for the evolution of mollusk ERs' unique functions, we resurrected an ancient SR progenitor and characterized the effect of historical amino acid replacements on its functions. We found that reintroducing just two ancient replacements from the lineage leading to mollusk ERs recapitulates the evolution of full constitutive activity and the loss of ligand activation. These substitutions stabilize interactions among key helices, causing the allosteric switch to become “stuck” in the active conformation and making activation independent of ligand binding. Subsequent changes filled the ligand pocket without further affecting activity; by degrading the allosteric switch, these substitutions vestigialized elements of the protein's architecture required for ligand regulation and made reversal to the ancestral function more complex. These findings show how the physical architecture of allostery enabled a few large-effect mutations to trigger a profound evolutionary change in the protein's function and shaped the genetics of evolutionary reversibility.</p

An Anisotropic Wormhole:TUNNELLING in Time and Space

We discuss the structure of a gravitational euclidean instanton obtained through coupling of gravity to electromagnetism. Its topology at fixed $t$ is $S^1\times S^2$. This euclidean solution can be interpreted as a tunnelling to a hyperbolic space (baby universe) at $t=0$ or alternatively as a static wormhole that joins the two asymptotically flat spaces of a Reissner--Nordstr\"om type solution with $M=0$.Comment: PLAIN-TEX, 16 pages (4 figures not included), Report DFTT 2/9

Spontaneous DC Current Generation in a Resistively Shunted Semiconductor Superlattice Driven by a TeraHertz Field

We study a resistively shunted semiconductor superlattice subject to a high-frequency electric field. Using a balance equation approach that incorporates the influence of the electric circuit, we determine numerically a range of amplitude and frequency of the ac field for which a dc bias and current are generated spontaneously and show that this region is likely accessible to current experiments. Our simulations reveal that the Bloch frequency corresponding to the spontaneous dc bias is approximately an integer multiple of the ac field frequency.Comment: 8 pages, Revtex, 3 Postscript figure

Living and Dying at the Portus Romae

This paper presents the first results of research into plant, animal, and human remains from Portus, the maritime port of Imperial Rome, in order to examine the diet and geographical origins of its inhabitants between the second and sixth century AD. Comparisons with evidence from the excavation and ceramic analysis show clear changes throughout the period, with shifts in diet and patterns of foods import that can be related to the commercial and political changes following the breakdown of Roman of the Mediterranean

Potential Eradication and Control Methods for the Management of the Ascidian Didemnum perlucidum in Western Australia

Assessments of the key indicator species for the West Coast Demersal Scalefish Resource (WCDSR; West Australian dhufish Glaucosoma hebraicum, Snapper Pagrus auratus and Baldchin groper Choerodon rubescens) in 2007 and 2009 demonstrated that the stocks were experiencing overfishing. Thus, between late 2007 and early 2010, substantial changes were made to the management of the commercial and recreational fisheries that exploit the WCDSR. These were designed to reduce catches of the entire suite of demersal scalefish species (and of each indicator species) by both the commercial and recreational sectors in the West Coast Bioregion (WCB) by at least 50 % of the 2005/06 levels (the catch benchmark), to allow stocks to recover

Theory of Coherent Time-dependent Transport in One-dimensional Multiband Semiconductor Superlattices

We present an analytical study of one-dimensional semiconductor superlattices in external electric fields, which may be time-dependent. A number of general results for the (quasi)energies and eigenstates are derived. An equation of motion for the density matrix is obtained for a two-band model, and the properties of the solutions are analyzed. An expression for the current is obtained. Finally, Zener-tunneling in a two-band tight-binding model is considered. The present work gives the background and an extension of the theoretical framework underlying our recent Letter [J. Rotvig {\it et al.}, Phys. Rev. Lett. {\bf 74}, 1831 (1995)], where a set of numerical simulations were presented.Comment: 15 pages, Revtex 3.0, uses epsf, 2 ps figures attache

Cosmological and Wormhole Solutions in Low-Energy Effective String Theory

We derive and study a class of cosmological and wormhole solutions of low-energy effective string field theory. We consider a general four-dimensional string effective action where moduli of the compactified manifold and the electromagnetic field are present. The cosmological solutions of the two-dimensional effective theory obtained by dimensional reduction of the former are discussed. In particular we demonstrate that the two-dimensional theory possesses a scale-factor duality invariance. Euclidean four-dimensional instantons describing the nucleation of the baby universes are found and the probability amplitude for the nucleation process is given.Comment: 18 pages, Plain-Tex Report No: INFNCA-TH-94-11, SISSA 75/94/

Intersubband gain in a Bloch oscillator and Quantum cascade laser

The link between the inversion gain of quantum cascade structures and the Bloch gain in periodic superlattices is presented. The proposed theoretical model based on the density matrix formalism is able to treat the gain mechanism of the Bloch oscillator and Quantum cascade laser on the same footing by taking into account in-plane momentum relaxation. The model predicts a dispersive contribution in addition to the (usual) population-inversion-dependent intersubband gain in quantum cascade structures and - in the absence of inversion - provides the quantum mechanical description for the dispersive gain in superlattices. It corroborates the predictions of the semi-classical miniband picture, according to which gain is predicted for photon energies lower than the Bloch oscillation frequency, whereas net absorption is expected at higher photon energies, as a description which is valid in the high-temperature limit. A red-shift of the amplified emission with respect to the resonant transition energy results from the dispersive gain contribution in any intersubband transition, for which the population inversion is small.Comment: 10 pages, 6 figure