Actively Addressing Systemic Racism Using a Behavioral Community Approach

Recent police brutality and related violence against Black people, coupled with the COVID-19 pandemic, has further evidenced the disproportionate impact of systemic racism in our institutions and across society. In the United States, the alarming mortality rates for Black people due to police violence and COVID-19 related deaths are clear demonstrations of inequities within a long history of disparate outcomes. In understanding systemic racism, it is essential to consider how it is embedded within society and across socio-ecological levels. The Social-Ecological Model (SEM) is used to examine conditions within the environment that maintain systemic racism, including within our field and discipline. A behavioral-community approach for examining racism aids in determining points of intervention across multiple ecological levels that may contribute to behavior change, including with behaviorists. The science of behavior is well-suited to help examine the contingencies governing behaviors within and across systems, which is pivotal for addressing operant behaviors to influence long-term behavior change. This paper calls on the behavioral community to address systemic racism within our environments and systems of influence to contribute to a more equitable community. Systemic racism, including within the context of anti-Blackness, is examined by considering behavior change strategies that can be supported by behaviorists across socio-ecological levels. Tools for collaborative action are provided to support behaviorists in demonstrating the skills needed across a continuum of behaviors from allyship to anti-racism to actively address systemic racism

Dietary calcium intake and Renin Angiotensin System polymorphisms alter the blood pressure response to aerobic exercise: a randomized control design

BACKGROUND: Dietary calcium intake and the renin angiotensin system (RAS) regulate blood pressure (BP) by modulating calcium homeostasis. Despite similar BP regulatory effects, the influence of dietary calcium intake alone and combined with RAS polymorphisms on the BP response following acute aerobic exercise (i.e., postexercise hypotension) has not been studied. Thus, we examined the effect of dietary calcium intake and selected RAS polymorphisms on postexercise hypotension. METHODS: Subjects were men (n = 50, 43.8 ± 1.3 yr) with high BP (145.3 ± 1.5/85.9 ± 1.1 mm Hg). They completed three experiments: non-exercise control and two cycle bouts at 40% and 60% of maximal oxygen consumption (VO(2)max). Subjects provided 3 d food records on five protocol-specific occasions. Dietary calcium intake was averaged and categorized as low (<880 mg/d = LowCa) or high (≥ 880 mg/d = HighCa). RAS polymorphisms (angiotensin converting enzyme insertion/deletion, ACE I/D; angiotensin II type 1 receptor, AT(1)R A/C) were analyzed with molecular methods. Genotypes were reduced from three to two: ACE II/ID and ACE DD; or AT(1)R AA and AT(1)R CC/AC. Repeated measure ANCOVA tested if BP differed among experiments, dietary calcium intake level and RAS polymorphisms. RESULTS: Systolic BP (SBP) decreased 6 mm Hg after 40% and 60% VO(2)max compared to non-exercise control for 10 h with LowCa (p < 0.01), but not with HighCa (p ≥ 0.05). Under these conditions, diastolic BP (DBP) did not differ between dietary calcium intake levels (p ≥ 0.05). With LowCa, SBP decreased after 60% VO(2)max versus non-exercise control for 10 h among ACE II/ID (6 mm Hg) and AT(1)R AA (8 mm Hg); and by 8 mm Hg after 40% VO(2)max among ACE DD and AT(1)R CC/CA (p < 0.01). With HighCa, SBP (8 mm Hg) and DBP (4 mm Hg) decreased after 60% VO(2)max compared to non-exercise control for 10 h (p < 0.05), but not after 40% VO(2)max (p ≥ 0.05). CONCLUSION: SBP decreased after exercise compared to non-exercise control among men with low but not high dietary calcium intake. Dietary calcium intake interacted with the ACE I/D and AT(1)R A/C polymorphisms to further modulate postexercise hypotension. Interactions among dietary calcium intake, exercise intensity and RAS polymorphisms account for some of the variability in the BP response to exercise

Supraclavicular decompression for neurogenic thoracic outlet syndrome in adolescent and adult populations

ObjectiveThis study was conducted to better define clinical results and understand factors determining responsiveness to surgical treatment for neurogenic thoracic outlet syndrome (NTOS) in adolescent and adult populations.MethodsA retrospective review was conducted for 189 patients with disabling NTOS who underwent primary supraclavicular decompression (scalenectomy, brachial plexus neurolysis and first rib resection, with or without pectoralis minor tenotomy) from April 2008 to December 2010. Clinical characteristics were compared between 35 adolescent patients (aged <21 years) and 154 adults (aged >21 years). Functional outcome measures were assessed before surgery and at 3- and 6-month follow-up using a composite NTOS Index combining the Disabilities of the Arm, Shoulder and Hand (DASH) survey, the Cervical-Brachial Symptom Questionnaire (CBSQ), and a 10-point visual analog scale (VAS) for pain.ResultsAdolescent and adult patients were not significantly different with respect to sex (overall 72.5% female), side affected (58.7% right, 60.3% dominant limb), bony anomalies (23.3%), previous injury (55.6%), coexisting pain disorders (11.1%), and positive responses to scalene muscle anesthetic blocks (95.6%). Compared with adults, adolescent patients had a significantly (P < .05) lower incidence of depression (11.4% vs 41.6%), motor vehicle injury (5.7% vs 20.1%), previous operations (11.4% vs 29.9%), preoperative use of opiate medications (17.1% vs 44.8%), and symptom duration >2 years (24.2% vs 50.0%). Mean preoperative NTOS Index (scale 0-100) was significantly lower in adolescent vs adult patients (46.5 ± 3.6 vs 58.5 ± 1.7; P = .009), and hospital length of stay was 4.4 ± 0.2 vs 4.9 ± 0.1 days (P = .03), but the rate of postoperative complications was no different (overall, 4.2%). Although both groups exhibited significant improvement in functional outcome measures at 3 and 6 months, adolescent patients had significantly lower NTOS Index (10.4 ± 3.1 vs 39.3 ± 3.3; P < .001) and use of opiate medications (11.4% vs 47.4%; P < .001) compared with adults.ConclusionsAdolescents undergoing supraclavicular decompression for NTOS had more favorable preoperative characteristics and enhanced 3-month and 6-month functional outcomes than adults. Further study is needed to delineate the age-dependent and independent factors that promote optimal surgical outcomes for NTOS

Survival Strategies: Doctoral Students’ Perceptions of Challenges and Coping Methods

The purpose of this collective case study was to use a critical dialectical pluralistic (CDP) philosophical lens to investigate select doctoral students’ perceptions about the challenges that they encountered while in a doctorate program and the coping strategies that they found effective in mitigating these challenges. A major goal of CDP is to empower research participants maximally by giving them the role of participant-researchers. Participants were 10 doctoral students enrolled at a Tier-II university in the United States, who were selected via convenience sampling. Each student participated in a face-to-face interview with a member of the research team—consistent with a CDP approach. A qualitative-dominant crossover mixed analysis was used wherein both quantitative and qualitative analyses were used to analyze the qualitative data, with the qualitative analysis phase being dominant. The qualitative analyses (e.g., constant comparison analysis, classical content analysis) revealed the following five themes: compartmentalization of life, outside support systems, justification for participation in program, emotional status, and structure of program. These themes indicated that although challenges are plentiful, particularly in terms of balancing one’s academic life with other obligations, participants found support and encouragement from family, friends, and other doctoral students to be the most beneficial coping strategy. These findings have important implications for the structuring of doctoral programs

Increased HIV Incidence in Men Who Have Sex with Men Despite High Levels of ART-Induced Viral Suppression: Analysis of an Extensively Documented Epidemic

Background: There is interest in expanding ART to prevent HIV transmission, but in the group with the highest levels of ART use, men-who-have-sex-with-men (MSM), numbers of new infections diagnosed each year have not decreased as ART coverage has increased for reasons which remain unclear. Methods: We analysed data on the HIV-epidemic in MSM in the UK from a range of sources using an individual-based simulation model. Model runs using parameter sets found to result in good model fit were used to infer changes in HIV-incidence and risk behaviour. Results: HIV-incidence has increased (estimated mean incidence 0.30/100 person-years 1990–1997, 0.45/100 py 1998–2010), associated with a modest (26%) rise in condomless sex. We also explored counter-factual scenarios: had ART not been introduced, but the rise in condomless sex had still occurred, then incidence 2006–2010 was 68% higher; a policy of ART initiation in all diagnosed with HIV from 2001 resulted in 32% lower incidence; had levels of HIV testing been higher (68% tested/year instead of 25%) incidence was 25% lower; a combination of higher testing and ART at diagnosis resulted in 62% lower incidence; cessation of all condom use in 2000 resulted in a 424% increase in incidence. In 2010, we estimate that undiagnosed men, the majority in primary infection, accounted for 82% of new infections. Conclusion: A rise in HIV-incidence has occurred in MSM in the UK despite an only modest increase in levels of condomless sex and high coverage of ART. ART has almost certainly exerted a limiting effect on incidence. Much higher rates of HIV testing combined with initiation of ART at diagnosis would be likely to lead to substantial reductions in HIV incidence. Increased condom use should be promoted to avoid the erosion of the benefits of ART and to prevent other serious sexually transmitted infections

Viewing Nature Scenes Positively Affects Recovery of Autonomic Function Following Acute-Mental Stress

A randomized crossover study explored whether viewing different scenes prior to a stressor altered autonomic function during the recovery from the stressor. The two scenes were (a) nature (composed of trees, grass, fields) or (b) built (composed of man-made, urban scenes lacking natural characteristics) environments. Autonomic function was assessed using noninvasive techniques of heart rate variability; in particular, time domain analyses evaluated parasympathetic activity, using root-mean-square of successive differences (RMSSD). During stress, secondary cardiovascular markers (heart rate, systolic and diastolic blood pressure) showed significant increases from baseline which did not differ between the two viewing conditions. Parasympathetic activity, however, was significantly higher in recovery following the stressor in the viewing scenes of nature condition compared to viewing scenes depicting built environments (RMSSD; 50.0 ± 31.3 vs 34.8 ± 14.8 ms). Thus, viewing nature scenes prior to a stressor alters autonomic activity in the recovery period. The secondary aim was to examine autonomic function during viewing of the two scenes. Standard deviation of R-R intervals (SDRR), as change from baseline, during the first 5 min of viewing nature scenes was greater than during built scenes. Overall, this suggests that nature can elicit improvements in the recovery process following a stressor. © 2013 American Chemical Society