What Do You See in this Picture?: Bias and Reflexivity in Physician Narratives of Disparities

Disparities in healthcare stem from historical, social, institutional, and interpersonal factors--all of which can manifest at the level of the clinical encounter. A growing body of research has addressed implicit bias and, more specifically, the implicit bias involved in aversive racism as a mediator of disparate care. While recent studies have suggested links between disparate treatment and implicit bias, little direct evidence exists for how implicit bias may effect disparate care. Qualitative research on physician understanding of processes by which implicit bias translates into disparate care can help fill this gap and identify areas for further research. This study conducted secondary analysis of physician narratives discussing health disparities using thematic analysis to focus on narratives addressing bias and striving for reflexivity. Thematic analysis yielded three distinct themes for bias: paternalism, involving assumptions about patient lack of capacity and agency to engage in discussions around treatment and treatment itself; preferential connection, involving preferential attitudes toward members of one\u27s identified group that come at a cost to others who are not treated so preferentially when physician time and focused attention are in effect rationed commodities; and social prototypes, involving the creation of medical prototypes contaminated by information from devaluing social stereotypes. Physician narratives of reflexivity revealed struggles to identify bias, and strategies for self-awareness and accountability to minimize distortion of patient care. Themes for reflexivity described processes that physicians identified to: encounter and counter bias by becoming aware, via attentiveness to one\u27s own subjectivity, of the ways in which bias can operate and also the ways in which one can search for evidence within one\u27s own experience to counter bias; and connect to and with difference by seeking better understanding of a patient\u27s unique subjectivity, equalizing knowledge and power in the medical encounter, and seeking opportunities to serve diverse and marginalized patients as a positive source of knowledge and professional identity. This study substantiates both the presence of and the need to address physician bias, and suggests links to emerging research on social cognitive strategies for countering physician bias

Substance Use and Barriers to Treatment Across Native Hawaiians/Pacific Islanders and Asian Americans

Research shows that Asian Americans have lower rates of substance abuse treatment utilization than Caucasians. However, investigators have recently begun to separate Native Hawaiians/Pacific Islanders (NH/PI) from Asian Americans. Thus, it remains unclear whether disparities in barriers to treatment utilization differ across NH/Pis and Asian Americans. Data (N = 43,093) from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large, nationally representative survey was used in this study. A chi-square analysis examined whether disparities in barriers and utilization differed between NH/Pis (n = 300) and Asian Americans (n = 1,334). We found that NH/Pis who thought they should seek treatment for their drinking were statistically and significantly less likely than Asian Americans to do so. We found no statistically significant differences for drug use. We also found that NH/Pis were more likely to meet criteria for a substance use disorder than Asian Americans. Results suggest the possibility that alcohol use has become increasingly embedded and normalized in NH/PI culture as opposed to Asian American culture while drug use has not. Thus, alcohol\u27s normalization may result in NH/Pis more frequently failing to seek needed alcohol treatment. This indicates that public health policy should consider alcohol and drug use separately when designing and implementing culturally-specific preventions and interventions and focus on the de-normalization of alcohol use. Large-scale surveys of NH/Pis are needed to better identify barriers to treatment and utilization patterns. In sum, results highlight the need to increasingly consider cross-cultural variation in research while simultaneously developing culturally sensitive prevention and intervention programs

'We need to talk about your assignment': The requirements of procedural fairness when academic misconduct is first suspected

The credibility of Australian universities and their degrees recently came under national and international scrutiny in the wake of contract cheating scandals where students purchased assignments from internet websites, including the ‘MyMaster’ website. As well as threatening the reputation of universities, findings (and even allegations) of academic misconduct can have serious detrimental implications for students whose future careers and livelihoods may be jeopardised. This paper makes recommendations as to how universities should proceed when a suspicion of academic misconduct exists in order to fairly balance the interests of both universities and students. It highlights the importance of an academic staff member having a preliminary discussion with a student at the stage at which that staff member has a suspicion that a student may be guilty of academic misconduct and is in the process of deciding whether or not to make a formal allegation against the student. In doing so, it examines whether, and to what extent, any procedural fairness requirements apply, or should apply, at this preliminary stage with reference to relevant case law including X v University of Western Sydney (No 3)

The effects of a graduated aerobic exercise programme on cardiovascular disease risk factors in the NHS workplace: a randomised controlled trial

BACKGROUND: Sufficient levels of physical activity provide cardio-protective benefit. However within developed society sedentary work and inflexible working hours promotes physical inactivity. Consequently to ensure a healthy workforce there is a requirement for exercise strategies adaptable to occupational time constraint. This study examined the effect of a 12 week aerobic exercise training intervention programme implemented during working hours on the cardiovascular profile of a sedentary hospital workforce. METHODS: Twenty healthy, sedentary full-time staff members of the North West London Hospital Trust cytology unit were randomly assigned to an exercise (n = 12; mean +/- SD age 41 +/- 8 years, body mass 69 +/- 12 kg) or control (n = 8; mean +/- SD age 42 +/- 8 years, body mass 69 +/- 12 kg) group. The exercise group was prescribed a progressive aerobic exercise-training programme to be performed 4 times a week for 8 weeks (initial intensity 65% peak oxygen consumption (VO2 peak)) and to be conducted without further advice for another 4 weeks. The control was instructed to maintain their current physical activity level. Oxygen economy at 2 minutes (2minVO2), 4 minutes (4minVO2), VO2 peak, systolic blood pressure (SBP), diastolic blood pressure (DBP), BMI, C-reactive protein (CRP), fasting glucose (GLU) and total cholesterol (TC) were determined in both groups pre-intervention and at 4 week intervals. Both groups completed a weekly Leisure Time Questionnaire to quantify additional exercise load. RESULTS: The exercise group demonstrated an increase from baseline for VO2 peak at week 4 (5.8 +/- 6.3 %) and 8 (5.0 +/- 8.7 %) (P < 0.05). 2minVO2 was reduced from baseline at week 4 (-10.2 +/- 10.3 %), 8 (-16.8 +/- 10.6 %) and 12 (-15.1 +/- 8.7 %), and 4minVO2 at week 8 (-10.7 +/- 7.9 %) and 12 (-6.8 +/- 9.2) (P < 0.05). There was also a reduction from baseline in CRP at week 4 (-0.4 +/- 0.6 mg.L-1) and 8 (-0.9 +/- 0.8 mg.L-1) (P < 0.05). The control group showed no such improvements. CONCLUSION: This is the first objectively monitored RCT to show that moderate exercise can be successfully incorporated into working hours, to significantly improve physical capacity and cardiovascular health

Understanding the Role of Centrosome Amplification in Health and Disease

Centrioles are microtubule-based structures that are important for forming the mitotic spindle and nucleating cilia. Cycling cells contain exactly two centrosomes, each consisting of two centrioles at their core, in order to form a bipolar spindle in mitosis for proper chromosome segregation. Abnormalities in centriole number are commonly observed in human cancers, and it has long been debated whether increases in centriole number occur as a passenger event in malignant cellular transformation, or whether extra centrioles contribute to tumorigenesis. In the first part of my thesis work, I sought to tackle this question using a mouse model in which extra centrioles can be created at will across a range of different tissues. Using this model, I demonstrate that centriole amplification can play a causative role in tumorigenesis. In the second part of my thesis work, I examined how centrioles are normally amplified in terminally differentiated multiciliated epithelial cells. Multiciliated cells line the epithelial surfaces of the brain ventricles, respiratory tract, and oviducts and require extra centrioles for their proper function. One centriole nucleates each cilium, and the cell must create hundreds of centrioles to have as many motile cilia to produce fluid flow. The process of multiciliogenesis has long been thought to require the deuterosome, a specialized structure upon which multiple new centrioles can form simultaneously. I used a mouse model to test the requirement of deuterosomes for centriole amplification and showed that, surprisingly, this structure is dispensable for multiciliogenesis. Lastly, my work sought to determine whether centriole amplification plays a contributing role in kidney cystogenesis. Autosomal Dominant Polycystic Kidney Disease (ADPKD) affects about 1 in 500 people and manifests as large kidneys with fluid-filled cysts. Although the two genes involved in ADPKD were identified over three decades ago, the molecular mechanism underlying ADPKD is not well understood. It is known that defects in cilia number, length, or function can cause cystogenesis and centriole amplification has been observed in the cyst of ADPKD patients. Therefore, I tested whether extra centrioles could contribute to kidney cystogenesis, and found that they could not. In summary, by studying centriole biogenesis in different cellular contexts in vivo, we now have better understanding of the role of centriole amplification in health and disease

Cardiomyopathy Following Latrodectus Envenomation

Latrodectus envenomations are common throughout the United States and the world. While many envenomations can result in catecholamine release with resultant hypertension and tachycardia, myocarditis is very rare. We describe a case of a 22-year-old male who sustained a Latrodectus envenomation complicated by cardiomyopathy

Short-term modulation of distal tubule fluid nitric oxide in vivo by loop NaCl reabsorption

Short-term modulation of distal tubule fluid nitric oxide in vivo by loop NaCl reabsorption.BackgroundIntrarenal nitric oxide (NO) production and signaling effects are influenced by NaCl loading. To gain further insight into NO mechanisms we determined whether rat distal tubular fluid (DTF) [NO] and collected NO may acutely change when NaCl loop delivery is altered.MethodsAn NO microelectrode was used to measure real-time DTF [NO] and DT-collected NO. With proximal flow blocked (open system), 150mmol/L NaCl, with and without 10−4 mol/L furosemide was perfused with measurement of loop [Cl] reabsorption. Using a closed system, DTF [NO] was also determined using several different loop perfusates.ResultsIn the open system, perfusion with 40 nL/min of 150mmol/L NaCl to which 10−4 mol/L furosemide was added, DT [NO] and DT-collected NO was approximately twice that measured with perfusion of 150mmol/L NaCl alone, while loop Cl reabsorption decreased by half. In the closed system, perfusion at 10 nL/min of 150mmol/L NaCl + furosemide 10−4 mol/L also induced a significant rise in DTF [NO] and collected NO. Perfusion of 10−3 mol/L S-methyl-L-thiocitrulline (SMTC) with 150mmol/L NaCl, induces a significant drop in DT [NO], but without a significant increase in collected NO. Furthermore, with addition of 10−3 mol/L SMTC to the 150mmol/L NaCl + 10−4 furosemide perfusate, the rise in DT [NO] was prevented. Analysis of covariance showed that flow changes within, or between all groups, had no significant additional effect.ConclusionIn both open and closed loop perfusion systems, 10−4 mol/L furosemide inhibition of NaCl transport stimulates net loop NO emission independent of flow; 10−3 mol/L SMTC + 150mmol/L NaCl reduces DT [NO], but not DT-collected NO. Short-term net NO emission from the entire loop, as collected in distal tubule fluid, increases with inhibition of loop NaCl transport

The Wellington Cemetery Desecrations of 2004: Their Impact on Local Jews

The article discusses different interpretations of the desecration's of the Wellington Cemetery in 2004, by people who were personally involved with the events surrounding them, the Jews. The main aim is to present a synthetic account of an understanding of the attacks and their meaning

Perturbations in neuroinflammatory pathways are associated with paclitaxel-induced peripheral neuropathy in breast cancer survivors.

Paclitaxel is a common chemotherapy drug associated with the development of chronic paclitaxel-induced peripheral neuropathy (PIPN). PIPN is associated with neuroinflammatory mechanisms in pre-clinical studies. Here, we evaluated for differential gene expression (DGE) in peripheral blood between breast cancer survivors with and without PIPN and for neuroinflammatory (NI) related signaling pathways and whole-transcriptome profiles from other experiments. Pathway impact analysis identified 8 perturbed NI related pathways. Expression profile analysis found 15 experiments having similar whole-transcriptome profiles of DGE related to neuroinflammation and PIPN. These findings suggest that perturbations in pathways associated with neuroinflammation are found in cancer survivors with PIPN