An examination of Cultural Competence Training in US Medical Education Guided by the Tool for Assessing Cultural Competence Training

In the United States, medical students must demonstrate a standard level of “cultural competence,” upon graduation. Cultural competence is most often defined as a set of congruent behaviors, attitudes, and policies that come together in systems, organizations, and among professionals to enable effective work in cross-cultural situations. The Association of American Medical Colleges developed the Tool for Assessing Cultural Competence Training (TACCT) to assist schools in developing and evaluating cultural competence curricula to meet these requirements. This review uses the TACCT as a guideline to describe and assess pedagogical approaches to cultural competence training in US medical education and identify content gaps and opportunities for curriculum improvement. A total of 18 programs are assessed. Findings support previous research that cultural competence training can improve the knowledge, attitudes, and skills of medical trainees. However, wide variation in the conceptualization, implementation, and evaluation of cultural competence training programs exists, leading to differences in training quality and outcomes. More research is needed to establish optimal approaches to implementing and evaluating cultural competence training that incorporate cultural humility, the social determinants of health, and broader structural competency within the medical system

When Alcoholism Affects Memory Functions: MRI of the Brain.

The development of modern imaging techniques makes it possible to examine directly the relationship between brain abnormalities and memory impairment. Alcoholic amnesics may perform normally on certain tests (priming tasks) that require implicit (unconscious) memory, even though they may not be able consciously to recall the memory. Researchers have therefore postulated the existence of multiple memory mechanisms. Magnetic resonance imaging (MRI) observations suggest that independent memory mechanisms are not necessary to explain the dissociation between explicit and implicit memory. Alcoholic amnesics appear to suffer from damage to structures in two areas of the brain, affecting two separate processing components that are both required in most priming tasks: a stimulus processing component and a memory processing component

Identifying Interaction Sites in "Recalcitrant" Proteins: Predicted Protein and Rna Binding Sites in Rev Proteins of Hiv-1 and Eiav Agree with Experimental Data

Protein-protein and protein nucleic acid interactions are vitally important for a wide range of biological processes, including regulation of gene expression, protein synthesis, and replication and assembly of many viruses. We have developed machine learning approaches for predicting which amino acids of a protein participate in its interactions with other proteins and/or nucleic acids, using only the protein sequence as input. In this paper, we describe an application of classifiers trained on datasets of well-characterized protein-protein and protein-RNA complexes for which experimental structures are available. We apply these classifiers to the problem of predicting protein and RNA binding sites in the sequence of a clinically important protein for which the structure is not known: the regulatory protein Rev, essential for the replication of HIV-1 and other lentiviruses. We compare our predictions with published biochemical, genetic and partial structural information for HIV-1 and EIAV Rev and with our own published experimental mapping of RNA binding sites in EIAV Rev. The predicted and experimentally determined binding sites are in very good agreement. The ability to predict reliably the residues of a protein that directly contribute to specific binding events - without the requirement for structural information regarding either the protein or complexes in which it participates - can potentially generate new disease intervention strategies.Comment: Pacific Symposium on Biocomputing, Hawaii, In press, Accepted, 200

Discovery of kHz Fluctuations in Centaurus X-3: Evidence for Photon Bubble Oscillations (PBO) and Turbulence in a High Mass X-ray Binary Pulsar

We report the discovery of kHz fluctuations, including quasi-periodic oscillations (QPO) at ~330 Hz and ~760 Hz and a broadband kHz continuum in the power density spectrum of the high mass X-ray binary pulsar Centaurus X-3. These observations of Cen X-3 were carried out with the Rossi X-ray Timing Explorer (RXTE). The fluctuation spectrum is flat from mHz to a few Hz, then steepens to $f^{-2}$ behavior between a few Hz and ~100 Hz. Above a hundred Hz, the spectrum shows the QPO features, plus a flat continuum extending to ~1200 Hz and then falling out to ~1800 Hz. These results, which required the co-adding three days of observations of Cen X-3, are at least as fast as the fastest known variations in X-ray emission from an accreting compact object (kHz QPO in LMXB sources) and probably faster since extension to ~1800 Hz is indicated by the most likely parameterization of the data. Multi-dimensional radiation hydrodynamics simulations of optically thick plasma flow onto the magnetic poles of an accreting neutron star show that the fluctuations at frequencies above 100 Hz are consistent with photon bubble turbulence and oscillations (PBO) previously predicted to be observable in this source. For a polar cap opening angle of 0.25 radians, we show that the spectral form above 100 Hz is reproduced by the simulations, including the frequencies of the QPO and the relative power in the QPO and the kHz continuum. This has resulted in the first model-dependent measurement of the polar cap size of an X-ray pulsar.Comment: received ApJ: April 1, 1999 accepted ApJ: September 1, 199

2009 Clinic Yearbook

The Clinic is the yearbook of the Sidney Kimmel Medical College (formerly Jefferson Medical College) at Thomas Jefferson University

Correctional Nursing: Why is Retention an Issue?

The specialty of correctional nursing has its own set of considerations and concerns that impact retention and affect healthcare outcomes for the offender population. The purpose of this research study was to identify specific areas causing poor nursing staff retention and recruitment within the correctional environment. The literature review revealed correctional nursing can benefit from: improved education and training for correctional nurses, emphasis and focus on public health in the correctional environment, role confusion in correctional nursing, and further investigation and research needed in recruitment and retention. Prison nursing staff at a large, rural correctional facility, completed the revised Casey-Fink Retention Survey through electronic distribution. The study results revealed that a lack of staff appreciation and orientation are factors that negatively affect retention in the correctional setting. With this new information, changes can be implemented to improve correctional nursing orientation, educate managerial staff in positive communication techniques, therefore positively impacting nurse retention within the prison system