Rhodium/phospholane-phosphite catalysts give unusually high regioselectivity in the enantioselective hydroformylation of vinyl arenes

Using the phospholane-phosphite ligand, BOBPHOS, almost perfect regioselectivities and high enantioselectivities (up to 92% ee) are observed in Rh catalysed enantioselective hydroformylation of vinyl arenes. This can be achieved under solvent-free conditions.PostprintPeer reviewe

Comparing Medical Student Nonverbal Behavior With Cisgender And Transgender Standardized Patients

It is essential for medical students to effectively communicate with patients of all gender identities. Evaluating nonverbal behavior is one way to assess the quality of patient care – examining providers’ behaviors while working with cisgender and transgender patients can identify potential biases linked to patient identity. To evaluate nonverbal behavior, the authors analyzed video-recorded training sessions with medical students interviewing standardized patients who identified as cisgender or transgender women. All students identified as cisgender men or cisgender women. The authors rated ten nonverbal behaviors from 1-7 and noted whether these behaviors were perceived to detract from the encounter. Average scores for nonverbal behaviors were similar between students working with cisgender and transgender patients. Nodding frequency showed the largest difference between cisgender (m = 5.65) and transgender (m = 4.93) patients. When considering student gender identity, cisgender men had lower facial expressivity and smiling frequency scores on average but higher scores for unnecessary silence compared to cisgender women across encounters. Detracting behaviors that negatively impacted the patient encounters were most likely to be self-touching/unpurposive movements (41%) and unnecessary silences (26%). Among the students, cisgender men demonstrated detracting behaviors at a higher rate than cisgender women. The consistency in nonverbal behavior during encounters with cisgender and transgender patients is encouraging. It is possible that LGBTQ health training in medical education contributed to this outcome; however, differences in verbal communication could contribute more to health disparities for transgender patients. Additional practice with unpurposive movements and unnecessary silences could improve nonverbal communication skills

Neighborhood dynamics and price effects of Superfund site clean-up

Numerous hedonic price analyses estimate price effects associated with hazardous waste site remediation or other environmental variation. This paper estimates a neighborhood transition model to capture the direct price effect from Superfund site clean-up and the indirect price effects arising from residential sorting and changes in investment in the housing stock following clean-up. First-difference models of neighborhood change and a national sample are used. This approach fails to find consistent positive direct price effects. Positive indirect effects, however, may arise through residential sorting and neighborhood investment spurred by remediation. The findings can be sensitive to policy endogeneity and model specification

Gender Identity and Pronoun Usage in Standardized Patient Encounters

The standardized documentation clinicians use to record evaluations of a patient are called Subjective, Objective, Assessment, and Plan (SOAP) notes. Consistent pronoun documentation and usage in these notes is especially important for affirming transgender and gender non-conforming patients as this population experiences significant health disparities linked to medical mistrust. A sample of SOAP notes (n=286) was taken from standardized patient encounters at the University of Louisville School of Medicine in 2017 (n=137) and 2018 (n=149). There were five case iterations of the standardized patient based on gender identity. The notes were coded using the software Dedoose for the following themes: pronouns clearly established, consistent pronoun usage, no pronoun usage, and disregard for established pronouns. Pronouns were clearly established in only 27.27% of the notes (n=78/286). Non-cisgender patients were more likely to have pronouns that were clearly established (41% vs 5%). Consistent pronoun usage was most often observed among the notes of cisgender patients. Inconsistent pronoun usage and disregard for established pronouns was observed most often for genderqueer patients (16%, n=14). Complete absence of pronoun use occurred in the notes of trans women (7%, n=3), genderqueer patients (8%, n=7), and cisgender women (3%, n=2) patients. These notes demonstrate a lack of rigor in recording pronouns accurately and consistently for patients, which can be profoundly detrimental to non-cisgender patient care. These discrepancies can be remedied by including training about gender-affirming care and interacting with non-cisgender patients in the clinical skills curriculum

Gender Identity and Pronoun Usage in Standardized Patient Encounters

One of the most common documentation frameworks clinicians use for patient evaluations are Subjective, Objective, Assessment, and Plan, (SOAP) notes. The clinician will usually record medical, family, social, etc. history as “subjective” information. Temperature, blood pressure, lab work, etc. would be considered “objective” information. An evaluation of the patient’s health and possible medical issues would be considered the “assessment,” and their intentions for current and future treatment would be the “plan” within these notes. Trainees often write SOAP notes after completing a standardized patient (SP) encounter—an educational practice used in medical schools to simulate real-world physician-patient interactions in order to develop and assess clinical reasoning skills. A standardized patient is employed to act as a patient, memorizing and reciting previously delineated information provided by medical educators

Distraction osteogenesis of the lower extremity with use of monolateral external fixation

We reviewed the results of distraction osteogenesis of 114 femora and 147 tibiae that had been lengthened to treat a variety of diagnoses. The femora had been lengthened an average of eleven centimeters (range, 3.5 to 17.0 centimeters), or 48 per cent (range, 8 to 86 per cent) of the original femoral length. The average total time for the treatment of the femora (use of the fixator and any subsequent immobilization) was 257 days (range, 105 to 420 days). There were 114 complications related to the femoral lengthenings, which led to eighty-seven additional operations. The tibiae were lengthened an average of nine centimeters (range, 3.0 to 15.6 centimeters), or 41 per cent (range, 9 to 100 per cent) of the original tibial length. The average total time for the treatment of the tibiae was 268 days (range, 110 to 497 days). There were 196 complications related to the tibial lengthenings, which led to 219 additional operations. The Achilles tendon was lengthened during or after seventy-three (50 per cent) of the tibial lengthenings. The femoral lengthenings that were performed to treat a limb-length discrepancy were associated with significantly higher rates of complications overall (p = 0.010) and additional operations (p = 0.023) for each percentage of length gained than those that were performed to treat achondroplasia or another skeletal dysplasia. The femoral lengthenings that were performed to treat short stature (of an endocrine or idiopathic etiology) were also associated with higher rates of complications overall and additional operations than those performed to treat skeletal dysplasias, but the rates were lower than those for lengthenings performed to treat limb-length discrepancy. The rate of complications overall associated with femoral lengthening in patients who were fourteen years old or more was significantly higher than that associated with lengthening in patients who were less than fourteen years old (p = 0.047). Femoral lengthening through the metaphysis was associated with significantly higher rates of complications overall (p = 0.031) and additional operations (p = 0.042) for each percentage of length gained than femoral lengthening through the diaphysis. The tibial lengthenings that were performed to treat Turner syndrome and idiopathic short stature were associated with significantly higher rates of complications overall (p = 0.026) and additional operations (p = 0.003) for each percentage of length gained than those performed to treat skeletal dysplasias. The rate of joint-related problems (p = 0.044) and that of additional operations (p = 0.053) after tibial lengthening in patients who were fourteen years old or more were significantly higher than those rates after tibial lengthening in patients who were less than fourteen years old. The site of the tibial osteotomy did not affect the rate of complications or additional operations. The femoral healing indices (in terms of both days per centimeter [p = 0.002] and days for each percentage of length gained [p = 0.019]) were significantly higher in the patients who were fourteen years old or more than in those who were less the fourteen years old. These values could not be used to predict an increase in the complications because of poor bone formation. The results of the present review suggest that the use of healing indices to gauge the final outcome of distraction osteogenesis is questionable; we were unable to discern significance or clinical importance from appropriately adjusted values

Tone and Language Used by Medical Students to Discuss Sexual Orientation and Gender Identity with Standardized Patients

During standardized patient (SP) encounters, medical students interact with mock patients to practice clinical skills.The tone and language used by students with SPs to gather sexual orientation and gender identity (SOGI) information are important reflections of the adequacy, frequency, and retention of training concerning these topics. Prompting these discussions with ease helps ensure gender minority patients are affirmed and receive comprehensive care

Behaviours preceding suicides at railway and underground locations: a multimethodological qualitative approach

Background: Suicides by train have devastating consequences for families, the rail industry, staff dealing with the aftermath of such incidents, and potential witnesses. To reduce suicides and suicide attempts by rail it is important to learn how safe interventions can be made. However, very little is known about how to identify someone who may be about to make a suicide attempt at a railway location (including underground/subways). The current research employed a novel way of understanding what behaviours might immediately precede a suicide or suicide attempt at these locations. Design and Methods: A qualitative thematic approach was used for three parallel studies. Data were gathered from several sources including: interviews with individuals who survived a suicide attempt at a railway or underground location (N=9); CCTV footage of individuals who died by suicide at a rail or underground location (N=16); and qualitative survey data providing views from rail staff (N=79). Results: Our research suggests there are several behaviours that people may carry out before a suicide or suicide attempt at a rail location including: station hopping and platform switching; limiting contact with others; positioning themselves at the end of the track where the train/tube approaches; allowing trains to pass by; and carrying out repetitive behaviours. Interpretation: There are several behaviours that may be identifiable in the moments leading up to a suicide or suicide attempt on the railways, which may present opportunities for intervention. These findings have implications for several stakeholders including rail providers, transport police and other organisations focused on suicide prevention

Comparing Medical Student Nonverbal Behavior With Cisgender And Transgender Standardized Patients

BACKGROUND It is essential for medical students to effectively communicate with patients of all gender identities. Nonverbal behaviors such as eye contact and nodding are key communication skills. Evaluating nonverbal behavior is one way to assess the quality of patient care, and examining providers’ behaviors while working with cisgender and transgender patients can identify potential biases linked to patient identity. METHODS To evaluate nonverbal behavior, we analyzed video-recorded training sessions with medical students interviewing standardized patients who identified as cisgender or transgender women. All students identified as cisgender men or cisgender women. Ten nonverbal behaviors were rated from 1-7 using adapted nonverbal communication scales. We also observed whether nonverbal cues were perceived to detract from the encounter. RESULTS Average scores for nonverbal behaviors were similar between students working with cisgender and transgender patients. Nodding frequency showed the largest difference between cisgender (m=5.65) and transgender (m=4.93) patients. When considering student gender identity, men had lower facial expressivity and smiling frequency scores on average but higher scores for unnecessary silence compared to women across encounters. Detracting behaviors that negatively impacted the patient encounters were most likely to be self-touching/unpurposive movements (41%) and unnecessary silences (26%). DISCUSSION The consistency in nonverbal behavior during encounters with cisgender and transgender patients is encouraging. It is possible that LGBTQ health training in medical education contributed to this outcome; however, differences in verbal communication could be more important to health disparities for transgender patients. Additional practice with unpurposive movements and unnecessary silences could improve nonverbal communication skills.https://ir.library.louisville.edu/uars/1056/thumbnail.jp