Creative Thesis Project: Handbook for Developing Trust with Gender and Sexual Minority Students in a Campus Health Care Clinic

Trust is an important element in patient-provider relationships in the health care field. Patient trust in the provider is linked to higher satisfaction of care, better adherence to treatment plans, overall higher success in health care visits, and better likelihood of seeking out medical care in the future. Trust can be difficult for health care providers to establish with gender and sexual minority (GSM) patients due to health care’s well known history of harassment and discrimination against the GSM community. The Handbook for Developing Trust with Gender and Sexual Minority Students in a Campus Health Care Clinic addresses health care disparities created by lack of trust for GSM patients and how health care providers on Eastern Illinois University’s campus can alter communication behavior to improve trust and thus improve the quality of health care provided to these students. The handbook uses the social penetration theory and uncertainty reduction theory combined with personal testimonies from GSM college students to guide the reader through five main portions of the handbook, including; Introduction, Use of this Handbook, Vocabulary, Diversity of Patient, and Trust, supplemented with reflection questions, assessment tools, and additional resources. The handbook aims to raise awareness of the unique risks and health care needs GSM student-patients experience and provide the reader with practical tools to address these concerns through the development of trust

Creative Thesis Project: Handbook for Developing Trust with Gender and Sexual Minority Students in a Campus Health Care Clinic

Trust is an important element in patient-provider relationships in the health care field. Patient trust in the provider is linked to higher satisfaction of care, better adherence to treatment plans, overall higher success in health care visits, and better likelihood of seeking out medical care in the future. Trust can be difficult for health care providers to establish with gender and sexual minority (GSM) patients due to health care’s well known history of harassment and discrimination against the GSM community. The Handbook for Developing Trust with Gender and Sexual Minority Students in a Campus Health Care Clinic addresses health care disparities created by lack of trust for GSM patients and how health care providers on Eastern Illinois University’s campus can alter communication behavior to improve trust and thus improve the quality of health care provided to these students. The handbook uses the social penetration theory and uncertainty reduction theory combined with personal testimonies from GSM college students to guide the reader through five main portions of the handbook, including; Introduction, Use of this Handbook, Vocabulary, Diversity of Patient, and Trust, supplemented with reflection questions, assessment tools, and additional resources. The handbook aims to raise awareness of the unique risks and health care needs GSM student-patients experience and provide the reader with practical tools to address these concerns through the development of trust

Coming in Warm: Qualitative Study and Concept Map to Cultivate Patient‐Centered Empathy in Emergency Care

Background Increased empathy may improve patient perceptions and outcomes. No training tool has been derived to teach empathy to emergency care providers. Accordingly, we engaged patients to assist in creating a concept map to teach empathy to emergency care providers. Methods We recruited patients, patient caretakers and patient advocates with emergency department experience to participate in three separate focus groups (n = 18 participants). Facilitators guided discussion about behaviors that physicians should demonstrate in order to rapidly create trust, enhance patient perception that the physician understood the patient's point of view, needs, concerns, fears, and optimize patient/caregiver understanding of their experience. Verbatim transcripts from the three focus groups were read by the authors and by consensus, 5 major themes with 10 minor themes were identified. After creating a codebook with thematic definitions, one author reviewed all transcripts to a library of verbatim excerpts coded by theme. To test for inter‐rater reliability, two other authors similarly coded a random sample of 40% of the transcripts. Authors independently chose excerpts that represented consensus and strong emotional responses from participants. Results Approximately 90% of opinions and preferences fell within 15 themes, with five central themes: Provider transparency, Acknowledgement of patient's emotions, Provider disposition, Trust in physician, and Listening. Participants also highlighted the need for authenticity, context and individuality to enhance empathic communication. For empathy map content, patients offered example behaviors that promote perceptions of physician warmth, respect, physical touch, knowledge of medical history, explanation of tests, transparency, and treating patients as partners. The resulting concept map was named the “Empathy Circle”. Conclusions Focus group participants emphasized themes and tangible behaviors to improve empathy in emergency care. These were incorporated into the “Empathy Circle”, a novel concept map that can serve as the framework to teach empathy to emergency care providers

Targeting DNA Damage Response and Replication Stress in Pancreatic Cancer

Background and aims: Continuing recalcitrance to therapy cements pancreatic cancer (PC) as the most lethal malignancy, which is set to become the second leading cause of cancer death in our society. The study aim was to investigate the association between DNA damage response (DDR), replication stress and novel therapeutic response in PC to develop a biomarker driven therapeutic strategy targeting DDR and replication stress in PC. Methods: We interrogated the transcriptome, genome, proteome and functional characteristics of 61 novel PC patient-derived cell lines to define novel therapeutic strategies targeting DDR and replication stress. Validation was done in patient derived xenografts and human PC organoids. Results: Patient-derived cell lines faithfully recapitulate the epithelial component of pancreatic tumors including previously described molecular subtypes. Biomarkers of DDR deficiency, including a novel signature of homologous recombination deficiency, co-segregates with response to platinum (P < 0.001) and PARP inhibitor therapy (P < 0.001) in vitro and in vivo. We generated a novel signature of replication stress with which predicts response to ATR (P < 0.018) and WEE1 inhibitor (P < 0.029) treatment in both cell lines and human PC organoids. Replication stress was enriched in the squamous subtype of PC (P < 0.001) but not associated with DDR deficiency. Conclusions: Replication stress and DDR deficiency are independent of each other, creating opportunities for therapy in DDR proficient PC, and post-platinum therapy

One Manner of Law : The Supreme Court, Stare Decisis and the Immigration Law Plenary Power Doctrine

This note examines the extreme deference the Court gives to Congress in the realm of immigration legislation. The author argues that, in Planned Parenthood of Southeastern Pennsylvania v. Casey, the Supreme Court\u27s analysis of stare decisis, precedent and the rule of law provides a strikingly effective paradigm through which to view the history of Supreme Court immigration rulings. Viewed through the Court\u27s own analysis of its power to make and revise precedent decisions, the immigration plenary power doctrine\u27s jurisprudential shortcomings become more evident and the arguments to overturn the doctrine become more powerful. This Note concludes that no principled constitutional or prudential consideration upholds the Supreme Court\u27s extraordinarily deferential approach to immigration legislation. It further concludes that the Court should review immigration legislation by the same standards it applies to any other act of Congress

Coming in Warm: Qualitative Study and Concept Map to Cultivate Patient‐Centered Empathy in Emergency Care

Background Increased empathy may improve patient perceptions and outcomes. No training tool has been derived to teach empathy to emergency care providers. Accordingly, we engaged patients to assist in creating a concept map to teach empathy to emergency care providers. Methods We recruited patients, patient caretakers and patient advocates with emergency department experience to participate in three separate focus groups (n = 18 participants). Facilitators guided discussion about behaviors that physicians should demonstrate in order to rapidly create trust, enhance patient perception that the physician understood the patient's point of view, needs, concerns, fears, and optimize patient/caregiver understanding of their experience. Verbatim transcripts from the three focus groups were read by the authors and by consensus, 5 major themes with 10 minor themes were identified. After creating a codebook with thematic definitions, one author reviewed all transcripts to a library of verbatim excerpts coded by theme. To test for inter‐rater reliability, two other authors similarly coded a random sample of 40% of the transcripts. Authors independently chose excerpts that represented consensus and strong emotional responses from participants. Results Approximately 90% of opinions and preferences fell within 15 themes, with five central themes: Provider transparency, Acknowledgement of patient's emotions, Provider disposition, Trust in physician, and Listening. Participants also highlighted the need for authenticity, context and individuality to enhance empathic communication. For empathy map content, patients offered example behaviors that promote perceptions of physician warmth, respect, physical touch, knowledge of medical history, explanation of tests, transparency, and treating patients as partners. The resulting concept map was named the “Empathy Circle”. Conclusions Focus group participants emphasized themes and tangible behaviors to improve empathy in emergency care. These were incorporated into the “Empathy Circle”, a novel concept map that can serve as the framework to teach empathy to emergency care providers

Equality, pluralism, universality: current concerns in normative theory

This article reviews recent debates in normative theory. It argues that work on equality has bifurcated in a disturbing way, with much of the work on economic equality focusing on the principles that should regulate the distribution of goods between individuals, and much of the work on social equality dealing with patterns of oppression that affect the relationship between marginal and dominant groups. The first literature has been relatively indifferent to the group nature of contemporary inequality, while the second mirrors this failing by its lack of interest in the distribution of economic resources. The implications of cultural pluralism have also contributed to debates about the status of normative theory and the basis for making universal normative claims

High-dose rifapentine with or without moxifloxacin for shortening treatment of pulmonary tuberculosis: Study protocol for TBTC study 31/ACTG A5349 phase 3 clinical trial.

IntroductionPhase 2 clinical trials of tuberculosis treatment have shown that once-daily regimens in which rifampin is replaced by high dose rifapentine have potent antimicrobial activity that may be sufficient to shorten overall treatment duration. Herein we describe the design of an ongoing phase 3 clinical trial testing the hypothesis that once-daily regimens containing high dose rifapentine in combination with other anti-tuberculosis drugs administered for four months can achieve cure rates not worse than the conventional six-month treatment regimen.Methods/designS31/A5349 is a multicenter randomized controlled phase 3 non-inferiority trial that compares two four-month regimens with the standard six-month regimen for treating drug-susceptible pulmonary tuberculosis in HIV-negative and HIV-positive patients. Both of the four-month regimens contain high-dose rifapentine instead of rifampin, with ethambutol replaced by moxifloxacin in one regimen. All drugs are administered seven days per week, and under direct observation at least five days per week. The primary outcome is tuberculosis disease-free survival at twelve months after study treatment assignment. A total of 2500 participants will be randomized; this gives 90% power to show non-inferiority with a 6.6% margin of non-inferiority.DiscussionThis phase 3 trial formally tests the hypothesis that augmentation of rifamycin exposures can shorten tuberculosis treatment to four months. Trial design and standardized implementation optimize the likelihood of obtaining valid results. Results of this trial may have important implications for clinical management of tuberculosis at both individual and programmatic levels.Trial registrationNCT02410772. Registered 8 April 2015,https://www.clinicaltrials.gov/ct2/show/NCT02410772?term=02410772&rank=1