Does Cultural Competency Training of Health Professionals Improve Patient Outcomes? A Systematic Review and Proposed Algorithm for Future Research

BACKGROUND: Cultural competency training has been proposed as a way to improve patient outcomes. There is a need for evidence showing that these interventions reduce health disparities. OBJECTIVE: The objective was to conduct a systematic review addressing the effects of cultural competency training on patient-centered outcomes; assess quality of studies and strength of effect; and propose a framework for future research. DESIGN: The authors performed electronic searches in the MEDLINE/PubMed, ERIC, PsycINFO, CINAHL and Web of Science databases for original articles published in English between 1990 and 2010, and a bibliographic hand search. Studies that reported cultural competence educational interventions for health professionals and measured impact on patients and/or health care utilization as primary or secondary outcomes were included. MEASUREMENTS: Four authors independently rated studies for quality using validated criteria and assessed the training effect on patient outcomes. Due to study heterogeneity, data were not pooled; instead, qualitative synthesis and analysis were conducted. RESULTS: Seven studies met inclusion criteria. Three involved physicians, two involved mental health professionals and two involved multiple health professionals and students. Two were quasi-randomized, two were cluster randomized, and three were pre/post field studies. Study quality was low to moderate with none of high quality; most studies did not adequately control for potentially confounding variables. Effect size ranged from no effect to moderately beneficial (unable to assess in two studies). Three studies reported positive (beneficial) effects; none demonstrated a negative (harmful) effect. CONCLUSION: There is limited research showing a positive relationship between cultural competency training and improved patient outcomes, but there remains a paucity of high quality research. Future work should address challenges limiting quality. We propose an algorithm to guide educators in designing and evaluating curricula, to rigorously demonstrate the impact on patient outcomes and health disparities

The impact of non-serial publications on research in accounting and finance

This study examines the role of books and official publications in accounting and finance research. From an analysis of thirteen leading journals for the year 1987-8 we report on the characteristics of such non-serial materials used by authors to support their research. We find that the accounting discipline in particular has become more open to influence from other disciplines. The individual perspectives of these thirteen journals can be partially revealed by their use of non-serial materials. Using cluster analysis we examine inter-journal variations in the disciplinary pattern of book citations and the distribution of citations to official bodies. Several relatively homogeneous groupings are identified

Stellar streams discovered in the Dark Energy Survey

We perform a search for stellar streams around the Milky Way using the first 3 yr of multiband optical imaging data from the Dark Energy Survey (DES). We use DES data covering ∼5000 deg2 to a depth of g>23.5 with a relative photometric calibration uncertainty of <1%. This data set yields unprecedented sensitivity to the stellar density field in the southern celestial hemisphere, enabling the detection of faint stellar streams to a heliocentric distance of ∼50 kpc. We search for stellar streams using a matched filter in color–magnitude space derived from a synthetic isochrone of an old, metal-poor stellar population. Our detection technique recovers four previously known thin stellar streams: Phoenix, ATLAS, Tucana III, and a possible extension of Molonglo. In addition, we report the discovery of 11 new stellar streams. In general, the new streams detected by DES are fainter, more distant, and lower surface brightness than streams detected by similar techniques in previous photometric surveys. As a by-product of our stellar stream search, we find evidence for extratidal stellar structure associated with four globular clusters: NGC 288, NGC 1261, NGC 1851, and NGC 1904. The ever-growing sample of stellar streams will provide insight into the formation of the Galactic stellar halo, the Milky Way gravitational potential, and the large- and small-scale distribution of dark matter around the Milky Way

Proper Motions of Stellar Streams Discovered in the Dark Energy Survey

We cross-match high-precision astrometric data from Gaia DR2 with accurate multi-band photometry from the Dark Energy Survey (DES) DR1 to confidently measure proper motions for nine stellar streams in the DES footprint: Aliqa Uma, ATLAS, Chenab, Elqui, Indus, Jhelum, Phoenix, Tucana III, and Turranburra. We determine low-confidence proper motion measurements for four additional stellar streams: Ravi, Wambelong, Willka Yaku, and Turbio. We find evidence for a misalignment between stream tracks and the systemic proper motion of streams that may suggest a systematic gravitational in uence from the Large Magellanic Cloud. These proper motions, when combined with radial velocity measurements, will allow for detailed orbit modeling which can be used to constrain properties of the LMC and its on nearby streams, as well as global properties of the Milky Way's gravitational potential

AKARI/IRC 18 μm survey of warm debris disks

Context. Little is known about the properties of the warm (Tdust ≳ 150 K) debris disk material located close to the central star, which has a more direct link to the formation of terrestrial planets than does the low-temperature debris dust that has been detected to date. Aims: To discover new warm debris disk candidates that show large 18 μm excess and estimate the fraction of stars with excess based on the AKARI/IRC Mid-Infrared All-Sky Survey data. Methods: We searched for point sources detected in the AKARI/IRC All-Sky Survey, which show a positional match with A-M dwarf stars in the Tycho-2 Spectral Type Catalogue and exhibit excess emission at 18 μm compared to what is expected from the KS magnitude in the 2MASS catalogue. Results: We find 24 warm debris candidates including 8 new candidates among A-K stars. The apparent debris disk frequency is estimated to be 2.8 ± 0.6%. We also find that A stars and solar-type FGK stars have different characteristics of the inner component of the identified debris disk candidates. While debris disks around A stars are cooler and consistent with steady-state evolutionary model of debris disks, those around FGK stars tend to be warmer and cannot be explained by the steady-state model

Proposed Standards for Medical Education Submissions to the Journal of General Internal Medicine

To help authors design rigorous studies and prepare clear and informative manuscripts, improve the transparency of editorial decisions, and raise the bar on educational scholarship, the Deputy Editors of the Journal of General Internal Medicine articulate standards for medical education submissions to the Journal. General standards include: (1) quality questions, (2) quality methods to match the questions, (3) insightful interpretation of findings, (4) transparent, unbiased reporting, and (5) attention to human subjects’ protection and ethical research conduct. Additional standards for specific study types are described. We hope these proposed standards will generate discussion that will foster their continued evolution

The 16th Data Release of the Sloan Digital Sky Surveys: First Release from the APOGEE-2 Southern Survey and Full Release of eBOSS Spectra

This paper documents the 16th data release (DR16) from the Sloan Digital Sky Surveys (SDSS), the fourth and penultimate from the fourth phase (SDSS-IV). This is the first release of data from the Southern Hemisphere survey of the Apache Point Observatory Galactic Evolution Experiment 2 (APOGEE-2); new data from APOGEE-2 North are also included. DR16 is also notable as the final data release for the main cosmological program of the Extended Baryon Oscillation Spectroscopic Survey (eBOSS), and all raw and reduced spectra from that project are released here. DR16 also includes all the data from the Time Domain Spectroscopic Survey and new data from the SPectroscopic IDentification of ERosita Survey programs, both of which were co-observed on eBOSS plates. DR16 has no new data from the Mapping Nearby Galaxies at Apache Point Observatory (MaNGA) survey (or the MaNGA Stellar Library "MaStar"). We also preview future SDSS-V operations (due to start in 2020), and summarize plans for the final SDSS-IV data release (DR17)

Effect of a web-based chronic disease management system on asthma control and health-related quality of life: study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Asthma is a prevalent and costly disease resulting in reduced quality of life for a large proportion of individuals. Effective patient self-management is critical for improving health outcomes. However, key aspects of self-management such as self-monitoring of behaviours and symptoms, coupled with regular feedback from the health care team, are rarely addressed or integrated into ongoing care. Health information technology (HIT) provides unique opportunities to facilitate this by providing a means for two way communication and exchange of information between the patient and care team, and access to their health information, presented in personalized ways that can alert them when there is a need for action. The objective of this study is to evaluate the acceptability and efficacy of using a web-based self-management system, My Asthma Portal (MAP), linked to a case-management system on asthma control, and asthma health-related quality of life.</p> <p>Methods</p> <p>The trial is a parallel multi-centered 2-arm pilot randomized controlled trial. Participants are randomly assigned to one of two conditions: a) MAP and usual care; or b) usual care alone. Individuals will be included if they are between 18 and 70, have a confirmed asthma diagnosis, and their asthma is classified as not well controlled by their physician. Asthma control will be evaluated by calculating the amount of fast acting beta agonists recorded as dispensed in the provincial drug database, and asthma quality of life using the Mini Asthma Related Quality of Life Questionnaire. Power calculations indicated a needed total sample size of 80 subjects. Data are collected at baseline, 3, 6, and 9 months post randomization. Recruitment started in March 2010 and the inclusion of patients in the trial in June 2010.</p> <p>Discussion</p> <p>Self-management support from the care team is critical for improving chronic disease outcomes. Given the high volume of patients and time constraints during clinical visits, primary care physicians have limited time to teach and reinforce use of proven self-management strategies. HIT has the potential to provide clinicians and a large number of patients with tools to support health behaviour change.</p> <p>Trial Registration</p> <p>Current Controlled Trials <a href="http://www.controlled-trials.com/ISRCTN34326236">ISRCTN34326236</a>.</p

Measurement of the inclusive isolated-photon cross section in pp collisions at √s = 13 TeV using 36 fb−1 of ATLAS data

The differential cross section for isolated-photon production in pp collisions is measured at a centre-of-mass energy of 13 TeV with the ATLAS detector at the LHC using an integrated luminosity of 36.1 fb. The differential cross section is presented as a function of the photon transverse energy in different regions of photon pseudorapidity. The differential cross section as a function of the absolute value of the photon pseudorapidity is also presented in different regions of photon transverse energy. Next-to-leading-order QCD calculations from Jetphox and Sherpa as well as next-to-next-to-leading-order QCD calculations from Nnlojet are compared with the measurement, using several parameterisations of the proton parton distribution functions. The predictions provide a good description of the data within the experimental and theoretical uncertainties. [Figure not available: see fulltext.