Identifying Protective Factors in Response to Discriminatory Experiences among Pregnant African American Woman

Adverse maternal-fetal health outcomes, such as low birth weight and preterm delivery, are disproportionately more likely among African-Americans than Non-Hispanic Whites. Experiences of discrimination have been hypothesized as a contributing factor to the large discrepancies in maternal-fetal health outcomes. It is well understood that with increased levels of self-reported discrimination, there are lower ratings of physical and mental health, and higher reporting rates of depressive symptoms; this relationship is stronger in women. In addition to this, skin tone has long been a marker for social class and opportunity, but research on skin tone as a risk factor for African Americans has been less extensive. How skin tone modulates the experience of discrimination for African American women and subsequent maternal-fetal health outcomes still remains a topic of interest. Variations in skin complexion have been implicated in affecting protective factors such as self-esteem and mastery. We aim to identify themes in an interview survey that explores the relationship between self-perceived complexion and the aforementioned protective factors that African American women possess in response to discriminatory experiences. In this project, we propose to complete an exploratory interview among pregnant African American women concerning protective factors in response to discriminatory experiences. Factors to be addressed include reflections on previously encountered discriminatory experiences, self-perceived complexion, mastery, and self-esteem

The Intangible Lightness of Heritage

Although my own fieldwork site in Japan is far from Tohoku, where the Great East Japan Earthquake occurred in 2011, my research in a small rural community helped me to place the narratives of survivors into a context I could better understand. Against this backdrop, I consider the role of certain forms of "heritage," such as local festivals and rituals, in the aftermath of disaster, suggesting that the infrastructure created for the practice of traditional activities during normal times can, in times of trauma, become a template for more urgent forms of organization-such as setting up shelters. Moreover, the fact that many communities persist in performing festivals and rituals soon after disaster suggests that the very practice of such traditions, even when the context has changed, has symbolic and practical value. Ultimately, however, for heritage to work under these circumstances communities must maintain flexibility and a "light" approach

Evaluation and Management of Common Anorectal Complaints

Objectives: Review the anatomy of the rectum and anus Learn skills to perform an appropriate H&P for anorectal complaints Appreciate key diagnostic features to common anorectal diagnoses Recognize risk factors and red flag signs/symptoms that prompt further evaluation and possible referra

PeaceHealth Advance Directives & Palliative Care

Dr. Scott Foster, MD., MPH., Chief Medical Executive for PeaceHealth Medical Group, presented at the Your Voice-Your Choice: Let\u27s Talk About It event on March 22, 2017 at St. Luke\u27s Health Education Center. Dr. Foster highlighted PeaceHealth\u27s commitment to a comprehensive system for understanding, documenting and honoring patient values and goals for care at the end of life in all healthcare settings, including Advance Directives

A Guide to Point of Care Ultrasound Lung and IVC Examination of a Volume Overloaded Patient

A patient presents with dyspnea, hypoxia, and lower extremity edema. Their history is notable for recent high salt intake and non-compliance with diuretics, and their lungs have rales bilaterally. Clinically, we can diagnose a heart failure exacerbation with pulmonary edema. However, we often rely on X-ray and computed tomography (CT) imaging to support the clinical diagnosis and explore the etiology of the hypoxia and dyspnea to narrow the differential. Ultrasound is an effective modality for identifying pulmonary edema and pleural effusions while at the same time ruling out other etiologies such as pneumonia and pneumothorax. With bedside point of care ultrasound (POCUS), there is no radiation risk and no delay in obtaining imaging. A systematic review and meta-analysis study by Maw et al. published in 2019 found that lung ultrasound diagnosis of pulmonary edema in the setting of clinical suspicion for acute decompensated heart failure had a pooled sensitivity of 0.88 and specificity of 0.9, which is superior to X-ray imaging which demonstrated a pooled sensitivity of 0.73 and a pooled specificity of 0.9.

A Guide to Point of Care Ultrasound Evaluation of Pneumonia

A patient presenting with fever, hypoxia, productive cough, and leukocytosis can be diagnosed with pneumonia without any imaging findings. However, we often rely on X-ray and computed tomography (CT) imaging to support the clinical diagnosis. Ultrasound is an effective imaging modality for identifying pneumonia without delay and radiation risks.1,2 A meta-analysis by Ye et al. in 2015 found that ultrasound diagnosis of pneumonia had a pooled sensitivity of 0.95 and a pooled specificity of 0.9, which is superior to X-ray imaging which had a pooled sensitivity of 0.77 and a similar pooled specificity of 0.9.3 This study used CT imaging as a gold standard for comparison

A Guide to Point of Care Ultrasound Examination of a Pericardial Effusion

A patient presents with pleuritic chest pain, dyspnea, and a recent viral illness. They have no prior cardiac or pulmonary history. Their X-ray on admission demonstrates no pulmonary findings and an enlarged cardiac silhouette, and their EKG is low voltage with electrical alternans. Ultrasound is an effective modality for identifying pericardial effusion and cardiac tamponade while at the same time evaluating for other causes, such as heart failure. Often patients with symptomatic pericardial ef fusion present with non-specific symptoms. While a “formal” transthoracic echocardiogram remains the gold standard for diagnosis, a bedside point of care ultrasound (POCUS) cardiac evaluation can significantly decrease the time to diagnosis and trigger an order for an urgent “formal” echocardiogram.1 A retrospective study by Hanson and Chan in 2021 found that POCUS led to an expedited average time to diagnosis of 5.9 hours compared to \u3e12 hours with other imaging. Those with a symptomatic pericardial effusion identified by POCUS had a significantly decreased time to treatment; time to pericardiocentesis of 28.1 hours compared to \u3e 48 hours with other diagnostic modalities.

A Guide to Point of Care Ultrasound Examination of Acute Decompensated Heart Failure

A patient presents with dyspnea on exertion, orthopnea, and lower extremity edema. They have a prior history of coronary artery disease and reported episodes of chest pain three months ago. They did not seek medical evaluation at the time and have had no chest pain recently. In this setting, there is a high clinical suspicion of heart failure with concern for ischemic heart disease. The gold standard for diagnosis of heart failure is a formal transthoracic echocardiogram. Bedside point of care ultrasound (POCUS) is a tool that can provide essential information without delay in diagnosis

Assessing the Accessibility and Integration of Community Resources for Autism in Sri Lanka

Introduction: Similar to many other developing countries, Sri Lanka also has challenges meeting the needs of autistic individuals. While progress has been made in evaluating autism screening tools and home-based therapy, limited data exists on the utilization of community resources. Objective: The objective of this study is to assess the accessibility and integration of community resources for autistic individuals in Sri Lanka. Questions to explore will center on how different sectors work with families and each other to address an autistic individual’s needs. Methods: Informal interviews were conducted with professionals who have direct experience working with individuals with autism and their families. The total sample size was ten interviewees. Interviews were conducted in English or in Sinhalese with assistance from a native speaker. Conversations were not recorded but notes at their permission were taken. Their responses were then categorized based upon shared themes and subthemes. Results: The most frequently identified challenges to families’ access to care centered around transportation and the sparsity of providers. Many interviewees discussed the extensive breadth of services their respective organizations provided, the personalized plans individuals received, and the training of staff done internally. Conclusion: As this is a pilot study with a low sample size, the investigators hesitate to make broad conclusions. However, due to lack of precedent in regard to autism research in Sri Lanka, the investigators hope the noted themes will hopefully point future studies in directions that yield more concrete findings. Next steps should involve including families in the study and expanding the sample size to gain parents’ perspective