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In recent years, there have been concerted efforts to better recruit, support, and retain diverse faculty, staff, and trainees in academic medicine. However, many institutions lack comprehensive and strategic plans to provide support to retain and recruit individuals from historically underrepresented groups. In this article, we itemize specific mechanisms through which institutions can support diverse individuals with the goal of improving inclusion and belonging in the workforce to better reflect the diversity of the intended patient and research participant population.
Infusion of an internal teat sealant into the mammary gland of the dairy cow at drying off has been claimed to reduce the incidence of clinical mastitis over many months in the subsequent lactation, despite the absence of any ingredient of the sealant remaining for that long. However, these claims have been poorly substantiated, often by lack of identification on when the infection occurred in the period from calving to disease, if the infection was present at post calving sampling and if the pathogen causing the disease was that causing an earlier infection. Moreover, no hypothesis on how any effect on clinical mastitis might occur has been advanced in any of the publications claiming the effect. That the effect might occur is only reported in a minority of publications, and the possibility that this is relatively specific to Gram-negative pathogens is reviewed.
OBJECTIVES/GOALS: Uterine fibroids (UF), non-cancerous myometrial neoplasms, affect 11 million women in the US. In qualitative research, experiences of Black women (BW) and Latinas (HL) with UF are understudied. UF etiology is poorly understood, and most symptoms are focused on decreasing UF symptoms. This study will showcase a translational approach in studying UF. METHODS/STUDY POPULATION: A community-engaged research process will be used throughout the study. We have a partnership with the Fibroid Foundation (FF), a UF advocacy organization. For our first aim, we have held community-engagement (CE) studios to provide insight for best practices in creating and implementing culturally appropriate studies with ethnoracially diverse women regarding topics of UF. Our CE studios set the foundation for the second aim, which will be in-depth interviews assessing the sociocultural impacts among pre-menopausal BW and HL with UF. The women will be recruited through the FFs social media platform. To address lack of treatment options in UF, we will be focusing on JAK 2/3 pathway. We will be performing immunofluorescence on tissue microarrays on over 100 patient samples with extensive clinical and survey data. RESULTS/ANTICIPATED RESULTS: We held two CE studios, one with BW with UF and another with HL without UF. These participants were chosen as patient stakeholders. One theme from the CE studio was that both groups mentioned a cultural impact around menstrual health and UF discussions. The participant stakeholders provided insight to other influences in their journey that will be used to develop the interview guide questions for Aim 2. We expect the individual interviews to show similar experiences as our CE studio experiences. We anticipate more in-depth conversations about the sociocultural and ethnoracial factors impacting UF treatment. For Aim 3, we hypothesize that there will be increased JAK 2/3 expression in UF of patients with higher sympton burden and larger fibroid volume. DISCUSSION/SIGNIFICANCE: Implementing a community-engaged research framework provides a foundation for qualitative and translational gynecologic research in BW and HL. This project will contribute insight to their UF experience. There is a lack of innovative treatments, and we have access to valuable patient tissue and data that can be used for potential molecular targets.
Minority and older adult patients remain underrepresented in cancer clinical trials (CCTs). The current study sought to examine sociodemographic inequities in CCT interest, eligibility, enrollment, decline motivation, and attrition across two psychosocial CCTs for gynecologic, gastrointestinal, and thoracic cancers.
Patients were approached for recruitment to one of two interventions: (1) a randomized control trial (RCT) examining effects of a cognitive-behavioral intervention targeting sleep, pain, mood, cytokines, and cortisol following surgery, or (2) a yoga intervention to determine its feasibility, acceptability, and effects on mitigating distress. Prospective RCT participants were queried about interest and screened for eligibility. All eligible patients across trials were offered enrollment. Patients who declined yoga intervention enrollment provided reasons for decline. Sociodemographic predictors of enrollment decisions and attrition were explored.
No sociodemographic differences in RCT interest were observed, and older patients were more likely to be ineligible. Eligible Hispanic patients across trials were significantly more likely to enroll than non-Hispanic patients. Sociodemographic factors predicted differences in decline motivation. In one trial, individuals originating from more urban areas were more likely to prematurely discontinue participation.
These results corroborate evidence of no significant differences in CCT interest across minority groups, with older adults less likely to fulfill eligibility criteria. While absolute Hispanic enrollment was modest, Hispanic patients were more likely to enroll relative to non-Hispanic patients. Additional sociodemographic trends were noted in decline motivation and geographical prediction of attrition. Further investigation is necessary to better understand inequities, barriers, and best recruitment practices for representative CCTs.
The hidden curriculum encompasses the norms, values, and behaviors within a learning environment. Navigating the hidden curricula of academia is crucial for doctoral trainees, particularly those from underrepresented backgrounds. Faculty mentors have an important role in helping trainees uncover and cope with the hidden curriculum. The purpose of this paper is to explore perceptions of the hidden curriculum among diverse doctoral trainees and mentors.
Following a presentation on the hidden curriculum at the Association for Clinical and Translational Science annual meeting in March 2021, attendees were asked to brainstorm ideas for diverse trainees and their mentors. Breakout room discussions were held for specific hidden curriculum topics; participants voted on which topics to discuss from a list of topics defined during the presentation. Ideas from these discussions were presented to the larger group to upvote.
Participants (n = 116) voted to discuss the following hidden curriculum topics: “coping with bias,” “assertive communication,” “knowing how things work,” and “developing a career.” Many suggestions emphasized the role of institutions in empowering mentors to help diverse trainees and, more generally, to meaningfully support policies and programs that facilitate the career success of trainees and faculty from underrepresented backgrounds.
This work generated a list of suggested action items for trainees, mentors, and institutions to ameliorate the hidden curricula of academia, especially for diverse trainees. However, institutions need to support changes that will facilitate these discussions as well as more broadly enable the success of faculty and students from diverse backgrounds.
ABSTRACT IMPACT: This study will showcase the importance if incorporating patient stakeholders in the development of an interview guide for a women of color with uterine fibroids, an understudied population. OBJECTIVES/GOALS: Black women and Hispanic/Latinas report having greater symptom burden from uterine fibroids (UF), non-cancerous neoplasms, compared to White women. These disparities may be linked to cultural factors resulting in treatment delays. The objective of this study is to provide insights to barriers and facilitators to timely treatment. METHODS/STUDY POPULATION: In partnership with the Fibroid Foundation, a UF advocacy organization, we plan to conduct a virtual community engagement (CE) studio to serve as a first step for a pilot study with a national cohort of Black women and Hispanic/Latinas who receive treatment in the United States for UF. The studios will include a presentation about UF treatment options and a facilitated discussion. The CE team will use past research and constructs from Model of Improvement and Health Belief Model to develop materials for the studio. A qualitative researcher will guide the discussion, a note-taker will take notes, and they will thematically code the notes. The results will be used to create and implement a cross-sectional in-depth qualitative study with a national sample. RESULTS/ANTICIPATED RESULTS: We hypothesize that timely treatment will be impacted by cultural factors, such as health literacy in uterine fibroids and menstruation. We expect that detailed feedback from this national cohort will contribute to greater insight to the experiences of women of color with UF and address barriers and facilitators to treatment. We anticipate the anecdotes will provide information about the influence of culture in seeking treatment for UF. We will utilize this experience to understand the impact of a virtual CE studio in elucidating open discussion among women of color on a challenging and personal topic. DISCUSSION/SIGNIFICANCE OF FINDINGS: Using CE process with advocates and research partners attains a deeper understanding in the development of an interview guide to examine the cultural impact on the treatment of UF for women of color. Understanding cultural barriers and facilitators can help overcome treatments delays in UF along with other gynecological diseases.
Childhood maltreatment (CM) is a known risk factor for adolescent pregnancy. Sleep disturbances and psychological distress, both common negative sequelae of CM, often co-occur during pregnancy, although directionality remains unclear. Furthermore, little is known about how CM affects sleep–distress associations during pregnancy. In pregnant adolescents, we examined: (a) whether there are significant predictive associations from CM to sleep quality and distress and (b) bidirectional influences of distress and sleep quality. Healthy pregnant adolescents (n = 204) were recruited before or during the 2nd trimester. CM was assessed at enrollment; sleep quality and distress were assessed in the 2nd and 3rd trimesters. Hypotheses were tested using path analysis. Findings revealed that CM was associated with worse 2nd trimester sleep quality and distress (β = .19, p < .05 for sleep; β = .30, p < .001 for distress). Higher levels of 2nd trimester distress were associated with lower 3rd trimester sleep quality (β = .19, p < .05). Findings provide novel information about (a) associations from CM to prenatal mood and sleep in pregnant adolescents, and (b) sleep–distress directionality over the course of pregnancy. These results have implications for better understanding the ways in which CM potentially exerts influences later in life, and for targeting interventions to address physical and mental health during pregnancy.
To mitigate the impact of racism, sexism, and other systemic biases, it is essential for organizations to develop strategies to address their diversity, equity and inclusion (DEI) climates. The objective of this formative evaluation was to assess Mayo Clinic Department of Health Sciences Research (HSR) faculty and staff perceptions toward a proposed departmental DEI plan and to explore findings by diversity and professional subgroups.
Materials and methods:
Key plan components include recruitment and support for diverse individuals; training for all HSR employees and leaders; and a review system to capture diversity and inclusion feedback for leaders. Additional activities include building inclusion “nudges” into existing performance reviews. To assess pre-implementation beliefs about specific plan components, we polled attendees at a departmental staff meeting in July 2020.
Overall, respondents (n = 162) commonly endorsed a blinded promotion review process and DEI training for all staff and leaders as most important. In contrast, respondents expressed less support for plan activities related to “nudges.” However, attitudes among certain diversity or professional groups toward specific plan activities diverged from their non-diversity group counterparts. Qualitative feedback indicated awareness of the need to address DEI issues.
Overall, HSR faculty and staff respondents conveyed support for the plan. However, some specific plan activities were perceived differently by members of certain diversity or professional subgroups.
These findings present a DEI framework on which other institutions can build and point to future directions for how DEI activities may be differentially perceived by impacted faculty and staff.
We performed a prospective study of 501 patients, regardless of symptoms, admitted to the hospital, to estimate the predictive value of a negative nasopharyngeal swab for severe acute respiratory coronavirus virus 2 (SARS-CoV-2). At a positivity rate of 10.2%, the estimated negative predictive value (NPV) was 97.2% and the NPV rose as prevalence decreased during the study.
The development and use of large and dynamic health data repositories designed to support research pose challenges to traditional informed consent models. We used semi-structured interviewing (n=44) to elicit diverse research stakeholders' views of a model of consent appropriate to participation in initiatives that entail collection, long-term storage, and undetermined future research use of multiple types of health data. We demonstrate that, when considering health data repositories, research stakeholders replace a concept of consent as informed with one in which consent is engaged. In engaged consent, a participant's ongoing relationship with a repository serves as a substitute or adjunct to information exchange at enrollment. We detail research stakeholders' views of the risks of engaged consent and suggest questions for further study about engagement and consent procedures in initiatives that aim to store data for future unspecified research purposes.
The objective of the present study was to evaluate intakes and serum levels of vitamin A, vitamin E, and related compounds in a cohort of maternal–infant pairs in the Midwestern USA in relation to measures of health disparities. Concentrations of carotenoids and tocopherols in maternal serum were measured using HPLC and measures of socio-economic status, including food security and food desert residence, were obtained in 180 mothers upon admission to a Midwestern Academic Medical Center labour and delivery unit. The Kruskal–Wallis and independent-samples t tests were used to compare measures between groups; logistic regression models were used to adjust for relevant confounders. P < 0·05 was considered statistically significant. The odds of vitamin A insufficiency/deficiency were 2·17 times higher for non-whites when compared with whites (95 % CI 1·16, 4·05; P = 0·01) after adjustment for relevant confounders. Similarly, the odds of being vitamin E deficient were 3·52 times higher for non-whites (95 % CI 1·51, 8·10; P = 0·003). Those with public health insurance had lower serum lutein concentrations compared with those with private health insurance (P = 0·05), and living in a food desert was associated with lower serum concentrations of β-carotene (P = 0·02), after adjustment for confounders. Subjects with low/marginal food security had higher serum levels of lutein and β-cryptoxanthin compared with those with high food security (P = 0·004 and 0·02 for lutein and β-cryptoxanthin). Diet quality may be a public health concern in economically disadvantaged populations of industrialised societies leading to nutritional disadvantages as well.
‘Photovoice’, a community-based participatory research methodology, uses images as a tool to deconstruct problems by posing meaningful questions in a community to find actionable solutions. This community-enhancing technique was used to elicit experiences of climate change among women in rural Nepal. The current analysis employs mixed methods to explore the subjective mental health experience of participating in a 4- to 5-day photovoice process focused on climate change. A secondary objective of this work was to explore whether or not photovoice training, as a one-time 4-to 5-day intensive intervention, can mobilise people to be more aware of environmental changes related to climate change and to be more resilient to these changes, while providing positive mental health outcomes.
Serum and erythrocyte (RBC) total folate are indicators of folate status. No nationally representative population data exist for folate forms. We measured the serum folate forms (5-methyltetrahydrofolate (5-methylTHF), unmetabolised folic acid (UMFA), non-methyl folate (sum of tetrahydrofolate (THF), 5-formyltetrahydrofolate (5-formylTHF), 5,10-methenyltetrahydrofolate (5,10-methenylTHF)) and MeFox (5-methylTHF oxidation product)) by HPLC–MS/MS and RBC total folate by microbiologic assay in US population ≥ 1 year (n approximately 7500) participating in the National Health and Nutrition Examination Survey 2011–2. Data analysis for serum total folate was conducted including and excluding MeFox. Concentrations (geometric mean; detection rate) of 5-methylTHF (37·5 nmol/l; 100 %), UMFA (1·21 nmol/l; 99·9 %), MeFox (1·53 nmol/l; 98·8 %), and THF (1·01 nmol/l; 85·2 %) were mostly detectable. 5-FormylTHF (3·6 %) and 5,10-methenylTHF (4·4 %) were rarely detected. The biggest contributor to serum total folate was 5-methylTHF (86·7 %); UMFA (4·0 %), non-methyl folate (4·7 %) and MeFox (4·5 %) contributed smaller amounts. Age was positively related to MeFox, but showed a U-shaped pattern for other folates. We generally noted sex and race/ethnic biomarker differences and weak (Spearman's r< 0·4) but significant (P< 0·05) correlations with physiological and lifestyle variables. Fasting, kidney function, smoking and alcohol intake showed negative associations. BMI and body surface area showed positive associations with MeFox but negative associations with other folates. All biomarkers showed significantly higher concentrations with recent folic acid-containing dietary supplement use. These first-time population data for serum folate forms generally show similar associations with demographic, physiological and lifestyle variables as serum total folate. Patterns observed for MeFox may suggest altered folate metabolism dependent on biological characteristics.
Milk consumption decreases inflammatory stress in overweight and obese subjects. Casein is the major protein in milk and enhances the secretion of insulin that has anti-inflammatory activity. The aim of the present study was to compare the acute effect of meals rich in casein and carbohydrate and a combination of both nutrients on postprandial plasma concentrations of IL-6, a marker of inflammation, in obese women. A total of twenty-five obese women aged 38–68 years consumed isoenergetic meals rich in potato (POT) or casein (CA) or a combination of both these meals (POT + CA), in random order in a cross-over trial. After an overnight fast, blood samples were collected before and at 1 and 4 h after the meals and circulating concentrations of IL-6, glucose, insulin and NEFA were measured. Plasma IL-6 concentrations increased significantly (P < 0·001) during 4 h after the meals. The AUC of postprandial IL-6 concentrations was not significantly (P = 0·77) different among the meals. Postprandial serum insulin concentration AUC was significantly higher during the POT + CA meal compared with the POT meal (P = 0·001) and the CA meal (P < 0·05), which in turn was significantly higher than the POT meal (P < 0·05). These data show that while ingestion of CA alone or combined with POT acutely increases circulating insulin concentrations, it does not appreciably alter the postprandial increase in plasma IL-6 concentrations in obese women.
The role of dietary factors in inhibiting or delaying the development of non-melanoma skin cancer (NMSC) has been investigated for many years. Cardamom, which is a dietary phytoproduct, has been commonly used in cuisines for flavour and has numerous health benefits, such as improving digestion and stimulating metabolism and having antitumorigenic effects. We have investigated the efficacy of dietary cardamom against 7,12-dimethylbenz[a]anthracene (DMBA)-induced skin papillomatogenesis in Swiss albino mice that closely resembles human NMSC. Mice were grouped into normal wild type (untreated), vehicle-treated (acetone), carcinogen-treated (DMBA), and DMBA and cardamom-treated (DMBA+CARD) to delineate the role of cardamom against DMBA-induced papillomatogenesis. Oral administration of cardamom to DMBA-treated mice up-regulated the phase II detoxification enzymes, such as glutathione-S-transferase and glutathione peroxidase, probably via activation of nuclear factor erythroid-2-related factor 2 transcription factor in ‘DMBA+CARD’ mice. Furthermore, reduced glutathione, glutathione reductase, superoxide dismutase and catalase were also up-regulated by cardamom in the same ‘DMBA+CARD’ group of mice compared with DMBA-treated mice. Cardamom ingestion in DMBA-treated mice blocked NF-κB activation and down-regulated cyclo-oxygenase-2 expression. As a consequence, both the size and the number of skin papillomas generated on the skin due to the DMBA treatment were reduced in the ‘DMBA+CARD’ group. Thus, the results from the present study suggest that cardamom has a potential to become a pivotal chemopreventive agent to prevent papillomagenesis on the skin.
Lawrence Stone did not invent family history, but his landmark book The Family, Sex and Marriage 1500–1800 remains the first volume to which many students and non-specialists turn for guidance on the history of family life in England. It not only established a new sub-discipline of history in the public consciousness, it presented a coherent and deliberately provocative hypothesis regarding the character of families in the past that continues to court controversy and stimulate further research today. For all the specialist books and articles that have been published on the early modern family in the past three decades none, it is fair to say, has reached as wide an audience, or aroused the same controversy, as Stone's seminal work. This collection of new essays marks the thirtieth anniversary of its publication, and a survey of the terrain that has been charted since then, through which Stone forged a pioneering trail. The considerable volume of traffic now plying this route has led to knowledge and discussion about early modern family history assuming the characteristics of a superhighway, one that has been the site of several notable collisions. It is our purpose to provide a roadmap through the enduringly popular territory staked out by Stone, and to signpost current and future directions.
The aim of The Family, Sex and Marriage, as Stone explained to his readers, was ‘to chart and document, to analyse and explain, some massive shifts in world views and value systems that occurred in England over a period of some three hundred years, from 1500 to 1800’.
On the veryfirst page of that most famous of diaries, Samuel Pepys recorded an intimate detail of his married life from the winter of 1659: ‘My wife, after the absence of her terms for seven weeks, gave me hopes of her being with child.’ When he wrote this, he and Elizabeth had already been married for five years, but although they were both young, the hoped-for pregnancy had not materialised and the resumption of her cycle at the end of December that year proved yet another disappointment. One year later, having a child was still on their minds: Pepys recorded in his diary that they were referring to their bedroom as ‘the Nursery’. By 1662, however, he had begun to countenance ‘the possibility there is of my having no child’. Nonetheless, even in the context of his failing marriage, he did not give up his desire to be a father easily. In 1667 he wished a friend's child (‘a very pretty little boy’ whom he liked ‘very well’) was his own. He admitted to himself that he was troubled by the idea that he could be left without a brother or a son to continue his family name, a circumstance that did indeed materialise. As with so many other subjects, Pepys's diary provides a rare and detailed account of one man's hopes and fears, in this instance, his attitudes towards fatherhood and his personal sense of loss that he did not have children of his own.