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Stigmatizing and Positive Language in Birth Clinical Notes Associated With Race and Ethnicity
Get PDFLanguage used in clinical documentation can reflect biases, potentially contributing to health disparities. Understanding associations between patient race and ethnicity and documentation of stigmatizing and positive language in clinical notes is crucial for addressing health disparities and improving patient care. To examine associations of race and ethnicity with stigmatizing and positive language documentation in clinical notes from hospital birth admission. This cross-sectional study included birthing patients at 2 metropolitan hospitals in the Northeastern US between 2017 and 2019. Eligible participants were admitted for labor and birth and had at least 1 free-text clinical note. Analysis was conducted using natural language processing. Data were analyzed between March and December 2024. Patient race and ethnicity, categorized into mutually exclusive groups of Asian or Pacific Islander, Black, Hispanic, and White. Presence of 4 stigmatizing language categories (marginalized language or identities, difficult patient, unilateral or authoritarian decisions, and questioning patient credibility) and 2 positive language categories (preferred and/or autonomy, power and/or privilege). Among the 18 646 patients included in the study (mean [SD] age, 30.5 [6.2] years), 2121 were Black (11.4%), 11 078 were Hispanic (59.4%), and 4270 were White (22.9%). The majority (10 559 patients [56.6%]) were insured by Medicaid. Compared with White patients, Black patients had higher odds of having any stigmatizing language (model 2: odds ratio [OR], 1.25; 95% CI, 1.05-1.49; P < .001), after adjustment for demographic characteristics. Black patients also had higher odds of any positive language documented (model 2: OR, 1.18; 95% CI, 1.05-1.32; P = .006). Hispanic patients had lower odds of documented positive language (model 2: OR, 0.90; 95% CI, 0.82-0.99; P = .03). Asian or Pacific Islander patients had lower odds of language documented in the power and/or privilege category (model 2: OR, 0.71; 95% CI, 0.57-0.88; P = .002). In this cross-sectional study examining clinical notes of 18 646 patients admitted for labor and birth, there were notable disparities in how stigmatizing and positive language was documented across racial and ethnic groups. This underscores the necessity for improving documentation and communication practices to reduce the use of stigmatizing language
Mapping Karen Parker's Journal: Student archival interpretation as feminist geographic worldmaking pedagogy
Get PDFThis paper draws on an undergraduate archives project to consider student archival interpretation as a worldmaking feminist geographic pedagogy. In Spring of 2021, we embedded an archives-based digital humanities project into GEOG124: Feminist Geographies. The project had students map, analyze, and contextualize the archival journal of Karen Parker, accomplished journalist and the first Black undergraduate woman at the University of North Carolina at Chapel Hill (UNC-CH). The journal she kept as a student is a prized archival object in UNC's Wilson Library. In it, she describes her experience as both a student and leader in the Civil Rights movement against Jim Crow segregation. Student work to visualize her journal spatially onto the campus and town landscapes provided new ways to understand university and town histories. Through spatial and temporal interpretation of this archival object, which included consulting and learning from Parker in the present day, students brought together their own experiences of campus life and histories of struggle on their everyday landscapes. Students challenged official progress narratives to center the work of student activists and identified with recent histories more intimately. This project highlights not only archives themselves as worldmaking institutions but the practice of interpreting materials as also worldmaking
NBA Without Borders: A comparative case study of NBA’s global expansion
Get PDF(Abstract taken from introduction) The global expansion of sports leagues has become significant in today’s interconnected world. The National Football League (NFL) and Major League Baseball (MLB) have been exploring new foreign markets to grow in. Through international games during the season and easier access to games played in the United States of America, they are garnering a larger international audience. Moreover, through championships such as the World Series and the Olympics, sports are quickly bringing different parts of the world together.Master of Art
New perspectives on picocyanobacteria and understudied cyanobacterial diversity in the Albemarle Pamlico sound system, North Carolina, USA
Get PDFCyanobacteria are important primary producers, sources of secondary metabolites, and sentinels of environmental change in aquatic ecosystems – including large estuaries. Here, we newly investigated cyanobacterial diversity within the Albemarle Pamlico Sound System (APES) using (16S rRNA) gene amplicon sequencing analyses. Substantial cyanobacterial diversity including lineages lacking current isolates were recovered (46 genera, 17 potentially cyanotoxic), with oligohaline waters of the Albemarle Sound and its tributaries being notable regional hotspot for diversity. Salinity and temperature were influential drivers of cyanobacterial community composition. Picocyanobacteria (cells <3 µm in diameter) were abundant in amplicon sequence libraries (72% of cyanobacterial sequences) – especially populations within Synechococcus SubClade 5.2. Picocyanobacteria along with picoeukaryotes were large contributors to total phytoplankton biomass comprising ~47% of chlorophyll a. Further, the picocyanobacterial genera Synechococcus, Cyanobium, and Synechocystis (55.4%, 14.8%, and 12.9% of cyanobacterial sequences, respectively) formed a core community spanning from freshwater regions (eastern AST, D949) to polyhaline environments (NRE100 downstream stations to PS5), suggesting resilience to significant salinity fluctuations and associated environmental changes. Amplicon sequence variant (ASV) and environmental data indicate the presence of several putative ecotypes, as well as distinct abundance patterns among closely related populations, highlighting substantial fitness variability among subspecies. Notably, potentially cyanotoxic genera, Synechocystis, Planktothrix, Plectonema, and Dolichospermum were the four more abundant detected in polyhaline APES regions, far beyond conspicuous freshwater sources. These findings reveal previously unrecognized potential sources of cyanotoxics in estuarine food webs and habitats, underscoring the ecological significance of cyanobacterial community dynamics across salinity gradients
Severe outcomes and risk factors of non-neutropenic fever episodes in hospitalized children with cancer in Kenya
Get PDFCompared to febrile neutropenia (FN), non-neutropenic fever (NNF) episodes in children with cancer have not been associated with severe outcomes. Risk factors for severe outcomes in FN and NNF episodes in children with cancer from low-middle-income countries (LMIC) are incompletely described. A prospective, observational cohort study was conducted at a tertiary public referral hospital in western Kenya. Inclusion criteria were age ≤14 years, cancer diagnosis, hospitalized, fever >38.5°C or persistently >38°C. Neutropenia was an absolute count (ANC) <500 K/µL. Severe outcomes were BSI or death. Statistical analysis detected significance between groups and a univariate analysis was conducted. Of the 99 fevers, 54.5% were NNF episodes. Over 66% of NNF episodes were in patients with solid tumors. More severe outcomes were observed in NNF episodes compared to FN [BSI: 7.4% (4/54) vs. 4.4% (2/45); death: 7.4% (4/54) vs. 4.4% (2/45)], yet no deaths occurred in episodes with BSI. Acute leukemia not in remission (OR= 8.67, 95% CI [CI: 2.3-32.62]; p= 0.002) and concern for disease relapse (OR= 14.17, 95% CI [2.08-96.3]; p= 0.012) were significantly associated severe outcomes. Time to antibiotic administration (9 hours) did not differ by ANC. Under half (45.5%) of fever episodes had a blood culture ordered, with 93.9% obtained after administration of antibiotics. Non-neutropenic fever episodes had more severe outcomes. Prompt fever management is recommended in all children with cancer treated in an LMIC setting. Pediatric oncology treatment centers in LMICs should rigorously evaluate their fever management clinical practice. Clinical risk factors were identified, but a risk-stratified approach in an LMIC setting is not recommended. Urgent attention is needed to identify areas of clinical improvement
Implementation of Interventions to Improve Breast, Cervical, and Prostate Cancer Screening Among Transgender Adults in Primary Care Settings: A Systematic Review Protocol
Get PDFTransgender people face harassment in clinics and report feeling uncomfortable seeking care, leading to avoidance of needed medical care. Breast, cervical, and prostate cancer screening may induce gender dysphoria. Transgender people are less likely to be up to date on breast, cervical, and prostate cancer screening compared to cisgender people. This scoping review aims to answer the question: what screening interventions have been implemented to improve breast, cervical, and prostate cancer screening among transgender adults in primary care settings? PubMed, Embase and PsychINFO will be searched for eligible studies. ClinicalTrials.gov will be searched for eligible unpublished studies. Two reviewers will independently screen all records and complete full text review. Intervention categories and themes will be synthesized and presented in a table
The Healthiness of Packaged Food and Beverage Products in the Kingdom of Saudi Arabia
Get PDFBackground/Objectives: In 2020, the National Nutrition Committee in Saudi Arabia launched a nutrient profile model, aiming to support the classification of foods and beverages in line with successful international approaches. The objective of this study was to compare the existing Saudi Arabian nutrient profile model to other established models to help inform diet-related policies in the country. Methods: Packaged food and beverage data were obtained from Mintel’s Global New Products Database. Products were evaluated under the Saudi Arabian nutrient profile model, Nutri-Score and Chile’s high fat, salt, sugar (HFSS) model. Agreement among the three nutrient profile models was examined using Fleiss’ kappa statistic. Results: There were 6940 products used in analysis. All three models showed a low proportion of eligible/healthy products, with 26% for Chile’s HFSS model, 28% for Nutri-Score and 25% for the Saudi Arabian nutrient profile model. There was substantial agreement (86%; k = 0.74) among all three models examined, with the highest agreement between the Saudi Arabian nutrient profile model and the Nutri-Score model. Conclusions: All three demonstrated a sub-optimal level of overall healthiness in the Saudi Arabian packaged food and beverage supply, with <30% of products under all models considered “healthy”. Given the substantial agreement among all three nutrient profiling approaches examined, it is likely that Saudi Arabia could benefit from the use of a categorical approach to nutrient profiling such as the Nutri-Score model, which allows for a more scaled view on product healthiness compared to a binary approach
Supplementary Private Health Insurance and Household Debt, Health Care Utilization, and Medical Spending Following A Health Shock
Get PDFThis article aims to evaluate the effect of enrolling in supplementary private health insurance on household debt, medical spending, and medical service use among South Koreans experiencing a health shock. Using data from the Korean Welfare Panel Study from 2009 through 2017, we compared household debt and health service use for those with and without private supplemental health insurance after experiencing a health shock. We found no significant differences in household debt or the financial burden of a health shock between those with and without supplemental health insurance coverage following a shock. Households with supplemental coverage used more medical services compared to households without supplementary coverage and incurred additional medical expenses
Dual regulatory role of natural killer T cells during development of hepatocellular carcinoma
Get PDFNatural killer T (NKT) cells play a complex role in hepatocellular carcinoma (HCC) progression. Using a diethylnitrosamine (DEN)-induced HCC mouse model, we observed a significant reduction in NKT cells within malignant liver tissue due to apoptosis, with the remaining cells exhibiting impaired cytokine production and cytotoxic potential. CD1d-deficient mice, which lack NKT cells, showed delayed tumor initiation and fewer tumors, yet the tumors that did form were larger and exhibited enhanced proliferation and immunosuppression. Notably, adoptive transfer of healthy NKT cells after tumor establishment reduced tumor burden, suggesting a protective role in later disease stages. These findings indicate that NKT cells contribute to early tumor development but may help control tumor progression in later stages. Their functional impairment in HCC underscores the need for strategies to restore their anti-tumor activity. Understanding the dual role of NKT cells in liver carcinogenesis may pave the way for novel immunotherapeutic approaches to improve HCC treatment and patient outcomes
The Compounding Mechanisms of Pre-Race Anxiety and Exercise on Gastroesophageal Reflux in Endurance Runners
Get PDFThis review synthesizes the psychophysiological and biomechanical literature to elucidate the synergistic relationship between pre-race anxiety and exercise-induced gastroesophageal reflux (EIGER) in endurance runners. It details the independent mechanisms, including the role of the brain-gut axis in stress-induced acid secretion and esophageal vulnerability 1, and the biomechanical drivers of EIGER, such as increased transient lower esophageal sphincter relaxations (TLESRs).3 The central thesis is that pre-race anxiety creates a pro-reflux physiological state that is mechanically exploited by the act of running, leading to a compounding of symptoms. Quantitative evidence linking pre-race state anxiety to reflux (Odds Ratio 3.75) 4 and demonstrating that psychological factors account for 36% of the variance in gastrointestinal symptoms 5 is presented. Finally, the review analyzes the clinical implications of this model, particularly the poor response to proton pump inhibitors (PPIs) in high-anxiety athletes 6, and advocates for an integrated, evidence-based management strategy that combines pharmacological 7, nutritional 8, and essential psychobehavioral interventions, such as relaxation training 9 and diaphragmatic breathing.1