Urvashi Vaid: Justice or Just-Us: Gay, Lesbian, Bisexual and Transgender Politics and the Challenge of Diversity (2004)

https://digitalcommons.ric.edu/av_root/1013/thumbnail.jp

Philanthropy Always Sounds Like Someone Else: A Portrait of High Net Worth Donors of Color

Black, Indigenous, and People of Color (BIPOC) donors with high net worth (HNW) represent a transformational force in social change philanthropy. Their life experience, vision, and leadership are vital in a historical moment in which the salience of race and racism to every institution and system in U.S. society is glaringly evident, and in which new ideas and solutions are urgently needed. These individuals have the means and the ability to move large-scale resources to address the deep imbalance in racial equity giving. They have the interest and skill to fund and create systemic change. And they are getting organized and exerting leadership as never before.Yet this story about donors of color has never been told. Philanthropy Always Sounds Like Someone Else: A Portrait of High Net Worth Donors of Color (hereafter cited as "Portrait"), presents a qualitative analysis of interviews with 113 high net worth Black, Indigenous, and People of Color (BIPOC) donors, conducted over three years in ten cities across the U.S. This is, to our knowledge, the largest qualitative research project of HNW people of color ever reported in the philanthropic literature.The report takes its name from a reflection articulated by one interviewee and shared by others with whom we spoke, that philanthropy as a concept never seemed to include them as people of color. This makes sense. Philanthropy is about class. And class has long had a race and a gender. The racialization of wealth and philanthropy in the U.S. is why the stories in this report have not yet been told. And it is also the reason why so many of the people interviewed in our research keep traditional philanthropic networks and organizations at arms length

A Roadmap for Change: Federal Policy Recommendations for Addressing the Criminilization of LGBT People and People Living with HIV

Each year in the United States, thousands of lesbian, gay, bisexual, transgender, Two Spirit, queer, questioning and gender non-conforming (LGBT) people and people living with HIV come in contact with the criminal justice system and fall victim to similar miscarriages of justice.According to a recent national study, a startling 73% of all LGBT people and PLWH surveyed have had face-to-face contact with police during the past five years.1 Five percent of these respondents also report having spent time in jail or prison, a rate that is markedly higher than the nearly 3% of the U.S. adult population whoare under some form of correctional supervision (jail, prison, probation, or parole) at any point in time.In fact, LGBT people and PLWH, especially Native and LGBT people and PLWH of color, aresignificantly overrepresented in all aspects of the penal system, from policing, to adjudication,to incarceration. Yet their experiences are often overlooked, and little headway has been madein dismantling the cycles of criminalization that perpetuate poor life outcomes and push already vulnerable populations to the margins of society.The disproportionate rate of LGBT people and PLWH in the criminal system can best be understoodin the larger context of widespread and continuing discrimination in employment, education, socialservices, health care, and responses to violence

Making Decisions In the Dark : Learning Through Uncertainty in Clinical Practice During COVID-19

PURPOSE: The purpose of this study was to explore how decision making and informal and incidental learning (IIL) emerged in the clinical learning environment (CLE) during the height of the Covid-19 pandemic. The authors\u27 specific interest was to better understand the IIL that took place among frontline physicians who had to navigate a CLE replete with uncertainty and complexity with the future goal of creating experiences for medical students that would simulate IIL and use uncertainty as a catalyst for learning. METHOD: Using a modified constructivist, grounded theory approach, we describe physicians\u27 IIL while working during times of heightened uncertainty. Using the critical incident technique, we conducted 45-min virtual interviews with seven emergency department (ED) and five intensive care unit (ICU) physicians, who worked during the height of the pandemic. The authors transcribed and restoried each interview before applying inductive, comparative analysis to identify patterns, assertions, and organizing themes. RESULTS: Findings showed that the burden of decision making for physicians was influenced by the physical, emotional, relational, and situational context of the CLE. The themes that emerged for decision making and IIL were interdependent. Prominent among the patterns for decision making were ways to simplify the problem by applying prior knowledge, using pattern recognition, and cross-checking with team members. Patterns for IIL emerged through trial and error, which included thoughtful experimentation, consulting alternative sources of information, accumulating knowledge, and poking at the periphery of clinical practice. CONCLUSIONS: Complexity and uncertainty are rife in clinical practice and this study made visible decision-making patterns and IIL approaches that can be built into formal curricula. Making implicit uncertainty explicit by recognizing it, naming it, and practicing navigating it may better prepare learners for the uncertainty posed by the clinical practice environment

We came, we saw, we cannulated?

Introduction: Despite advances in management of patients with severe acute respiratory distress syndrome (ARDS), mortality due to ARDS still remains high. In patients with refractory gas-exchange abnormalities, extracorporeal membrane oxygenation (ECMO) is considered as salvage therapy that aims to decrease ventilator induced lung injury and provide lung rest. injury and provide lung rest. Methods: We conducted a retrospective study of patients diagnosed with ARDS from October 2010 to September 2012. The aim of the study was to describe the population of patients placed on ECMO for ARDS in our institution. All patients placed on ARDSnet protocol were identified in the electronic patient record. Demographic, laboratory and ventilator data was extracted. Specifically mode of ventilation, use of rescue modalities (which included inhaled epoprostenol, skeletal muscle paralytics and/or use of airway pressure release ventilation (APRV)), Murray score, Oxygenation Index (OI), Alveolar-arterial gradient (A-a) and PaO2/FiO2 ratio (P/F) were tabulated. Survival to hospital discharge was recorded. Results: We identified a total of 149 patients. Of these 87 were managed per ARDSnet protocol, 48 received rescue modalities, and 14 patients were placed on ECMO in addition to rescue therapy after a mean interval of 72 hours. Six of 14 patients were placed on veno-arterial ECMO and the rest on veno-venous ECMO. Table 1 shows the baseline characteristics of these patients. Table 2 depicts the etiology of ARDS among our patient population. Mortality was higher in the ARDS group treated with rescue modalities (other than ECMO) compared to the group placed on ECMO as additional rescue therapy (77% vs. 50%; p = 0.3243). The ECMO group had a survival advantage despite higher A-a gradient, PaO2/Fio2 ratio, Oxygenation Index and Murray Score in the ECMO group (Table 1). Conclusion: Patients with ARDS placed on ECMO had an absolute reduction in mortality of 27% when compared to other rescue modalities. However this did not reach statistical significance due to the small sample size. We believe that ECMO is an important rescue modality in the right clinical setting. Treating physicians should consider ECMO as a treatment modality for severe ARDS patients

Urvashi Vaid: Justice or Just-Us: Gay, Lesbian, Bisexual and Transgender Politics and the Challenge of Diversity (2004)

https://digitalcommons.ric.edu/av_root/1013/thumbnail.jp

Non-Invasive Ventilation: An Evidence-Based Approach to Acute Respiratory Failure

Dr. Urvashi Vaid is an Instructor of Medicine in the Division of Pulmonary and Critical Care Medicine at Thomas Jefferson University Hospital. She did a three year fellowship at Thomas Jefferson University and completed her fellowship in June of 2011. Dr. Vaid attended the Christian Medical College Hospital in Vellore India. Her interests include: pulmonary medicine and GME financing. Presentation: 1 hour and 14 minutes

End of Life Decision-Making in the ICU (Part 2): Strategies for Effective Communication

Objectives: 1. Exploring the evidence backing effective communication in the ICU. 2. Detailing strategies for effective communication: the tool box. 3. Proposing future strategies in communication