Representation of dark skin tones in foundational nursing textbooks: An image analysis.

PURPOSE: This study aimed to analyze and quantify the representation of dark skin tones (DST) images/graphics across fifteen foundational and clinical nursing textbooks to understand the degree of portrayed diversity in current nursing texts. BACKGROUND: The United States (U.S.) population is becoming more ethnically and racially diverse. There is a scarcity of nursing literature, studies, and educational materials on the assessment and early recognition of common skin assessment in patients with dark skin tones (DST). The underrepresentation of people with DST images in didactic material suggests that omissions of these images in educational resources may introduce bias in health care provider education and practice. METHODS: Fifteen popular foundational and clinical nursing textbooks were selected and analyzed. All the photo images and drawn graphics in these textbooks were coded according to Fitzpatrick's skin phototype (FSP) scale, which categorizes skin tone as (a) "Light" or Fitzpatrick scale I or II, (b) "Medium" or Fitzpatrick scale III or IV, and (c) "Dark" or Fitzpatrick scale V or VI. The training was provided for data collectors before analysis to ascertain good inter-rater reliability (Cohen's kappa = 0.960 for light skin tone, Cohen's kappa = 0.899 for medium skin tone, and Cohen's kappa = 0.913 for dark skin tone). RESULTS: Analysis of 14,192 photo images and drawn graphics depicting skin tone was completed across 15 foundational and clinical nursing textbooks. 12.3 % of photo images and 2.4 % of drawn graphics depicted dark skin tones, compared to 60.9 % of photo images and 82.8 % of drawn graphics that displayed light skin tones in these textbooks. CONCLUSIONS: Nursing textbooks overrepresent light skin tones and underrepresent dark skin tones. While the approximate racial distribution of the U.S. population is 59.3 % non-Hispanic-White, 13.6 % Black/African American, and 26.6 % Person of Color, the images and graphics of skin tones represented 68 % light, 15 % medium, and 9.4 % dark. RELEVANCE TO CLINICAL PRACTICE: All healthcare providers are expected and required to deliver competent clinical care to an increasingly diverse population. For teaching-learning, more visual representations of DST and comparative images between what to expect in dark, medium, and light skin tones can help improve knowledge deficits and increase health equity.

On Kidney and Bladder Diseases in Nuzhat al-adhhan fi islah al-abdan by Physician Dawud b. 'Umar al-Antaki.

OBJECTIVES: Dawud b. 'Umar al-Antaki, known as the Avicenna of his time, was an Ottoman physician and scholar who wrote medical texts in Arabic in the 16th century. He was taught by an Iranian medical scholar, Muhammad Sharif, in the fields of logic, physical sciences, Greek, and medicine. After leaving Antioch, he traveled to Lebanon and then to Damascus, where he began writing his work, Tadhkiratu uli l-albab wa l-jami' li l-'ajab al-'ujab. Dawud b. 'Umar al-Antaki settled in Egypt, where he taught at the Zahiriyya Madrasa and practiced medicine before dying in Mecca in 1599. Here, we examined al-Antaki's writings on kidney and bladder diseases in his work Nuzhat al-adhhan fi islah al-abdan. MATERIALS AND METHODS: We translated sections on kidney and bladder diseases into English and compared Ilter Uzel's copy of Nuzhat al-adhhan fi islah al-abdan with a printed copy. We compared the relevant sections of Nuzhat al-adhhan fi islah al-abdan with the relevant sections of other important works of al-Antaki, al-Nuzhat al-mubhija fi tashhidh al-adhhan wa ta'dil al-amzija, and Tadhkiratu uli l-albab wa l-jami' li l-'ajab al-'ujab. The similarities and differences between these works were revealed. RESULTS: Kidney and bladder diseases are briefly discussed in Nuzhat al-adhhan fi islah al-abdan under the headings "amrad al-kula wa l-mathana," "al-hisa," and "harqan al-bawl wa taqtiruhu." CONCLUSIONS: Issues concerning kidney and bladder diseases are addressed more briefly in Nuzhat al-adhhan fi islah al-abdan than in al-Nuzhat al-mubhija fi tashhidh al-adhhan wa ta'dil al-amzija. Tadhkiratu uli l-albab wa l-jami' li l-'ajab al-'ujab consists solely of kidney and bladder stones. When these works are combined, the information in them complements each other.

A Legacy of Scientific Racism: William Osler's "An Alabama Student".

William Osler's essay "An Alabama Student" made John Young Bassett (1804-1851) a widely admired avatar of idealism in medicine. However, Bassett fiercely attacked the idea that all humans are members of the same species (known as monogenesis) and asserted that Black inferiority was a justification for slavery. Antebellum physician-anthropologists bequeathed a legacy of scientific racism that in subtler forms still runs deep in American society, including in the field of medicine.

Legacy of Syriac-Aramaic Scholars in Transmitting Neurosurgical Knowledge Between Antiquity and the Middle Ages.

The link between ancient Greek medicine and the Arabic translation period in the 9th century cannot be understood without studying the contributions of Syriac scholars. With their mastery of Greek and the related Semitic languages of Syriac and Arabic, they initiated a scientific translation process with methods that prevail to this day. In this paper, we reviewed Hunayn Ibn Isshaq's Ten Treatises on the Eye to elucidate the original contributions of the Syriac physicians to the field of neurologic surgery. We analyzed the oldest known diagram of orbital anatomy along with Hunayn's genuine ideas on the optic nerve anatomy and pathology, optic chiasm, afferent pupillary reflex, and papilledema and venous congestion. We also reviewed the neurosurgical elements found in the Syriac Book of Medicines including the thought process in localizing neurologic deficits based on clinical experience and anatomic dissections and the earliest recorded description of brachial plexus pathology.

Kenyan school book knowledge for water, sanitation, hygiene and health education interventions: Disconnect, integration or opportunities?

BACKGROUND: Schools, depending on their access to and quality of water, sanitation and hygiene (WASH) and the implementation of healthy behaviours, can be critical for the control and spread of many infectious diseases, including COVID-19. Schools provide opportunities for pupils to learn about the importance of hygiene and WASH-related practice, and build healthy habits and skills, with beneficial medium- and long-term consequences particularly in low- and middle-income countries: reducing pupils' absenteeism due to diseases, promoting physical, mental and social health, and improving learning outcomes. WASH services alone are often not sufficient and need to be combined with educational programmes. As pupils disseminate their acquired health-promoting knowledge to their (extended) families, improved WASH provisions and education in schools have beneficial effects also on the community. International organisations frequently roll out interventions in schools to improve WASH services and, in some cases, train pupils and teachers on safe WASH behaviours. How such interventions relate to local school education on WASH, health promotion and disease prevention knowledge, whether and how such knowledge and school books are integrated into WASH education interventions in schools, are knowledge gaps we fill. METHODS: We analyzed how Kenyan primary school science text book content supports WASH and health education by a book review including books used from class 1 through class 8, covering the age range from 6 to 13 years. We then conducted a rapid literature review of combined WASH interventions that included a behaviour change or educational component, and a rapid review of international policy guidance documents to contextualise the results and understand the relevance of books and school education for WASH interventions implemented by international organisations. We conducted a content analysis based on five identified thematic categories, including drinking water, sanitation, hygiene, environmental hygiene & health promotion and disease risks, and mapped over time the knowledge about WASH and disease prevention. RESULTS: The books comprehensively address drinking water issues, including sources, quality, treatment, safe storage and water conservation; risks and transmission pathways of various waterborne (Cholera, Typhoid fever), water-based (Bilharzia), vector-related (Malaria) and other communicable diseases (Tuberculosis); and the importance of environmental hygiene and health promotion. The content is broadly in line with internationally recommended WASH topics and learning objectives. Gaps remain on personal hygiene and handwashing, including menstrual hygiene, sanitation education, and related health risks and disease exposures. The depth of content varies greatly over time and across the different classes. Such locally available education materials already used in schools were considered by none of the WASH education interventions in the considered intervention studies. CONCLUSIONS: The thematic gaps/under-representations in books that we identified, namely sanitation, hygiene and menstrual hygiene education, are all high on the international WASH agenda, and need to be filled especially now, in the context of the current COVID-19 pandemic. Disconnects exist between school book knowledge and WASH education interventions, between policy and implementation, and between theory and practice, revealing missed opportunities for effective and sustainable behaviour change, and underlining the need for better integration. Considering existing local educational materials and knowledge may facilitate the buy-in and involvement of teachers and school managers in strengthening education and implementing improvements. We suggest opportunities for future research, behaviour change interventions and decision-making to improve WASH in schools.

Video-Based Coaching: An Efficient Learning and Teaching Modality for Pediatric Surgery and Pediatric Urology Training Program.

Objective: The development of integrated multimedia operating rooms has made possible to record surgical procedures mainly in minimally invasive surgery (MIS) and robotic surgery. This modality of video storage allows the trainees to study surgical procedures based on video analysis. The aim of this study is to compare two learning methods of surgical procedures, operative textbooks and video-based coaching, in a group of 10 pediatric surgery trainees. Patients and Methods: We selected five surgical procedures to study: three MIS procedures, Nissen fundoplication, partial nephrectomy, and cholecystectomy; and two robotic procedures, Lich-Gregoir reimplantation for vesicoureteral reflux and Henderson-Hynes pyleoplasty for ureteropelvic junction obstruction. Ten trainees were divided into two groups of 5 each, Group 1 (G1) and Group 2 (G2). G1 studied the procedures analyzing videos, G2 studied the same procedure classically reading textbooks. Tutors prepared a questionnaire of 100 multianswered questions that was submitted to both groups, divided into 20 questions for each surgical technique. The questionnaire focused on the different steps of surgical techniques. Results: Analyzing the 10 questionnaires, G1 (video group) obtained a median result of 82 exact answers (74-97), whereas G2 (textbook group) obtained a median result of 64.2 correct answers (53-79). Analyzing statistically the results of two groups, using unpaired t-Student's test with a level of statistical significance >95%, the results of G1 were statistically significantly better that G2 with a P = .0265 for the average scores. Conclusion: Video-based coaching to learn surgical techniques is a novel, feasible, and excellent modality for supplementing surgical techniques learning for pediatric surgery trainees. Objective evaluation using a multianswered questionnaire demonstrates that video-based coaching in pediatric surgery is statistically better than textbook classic education. We suggest to adopt this teaching modality in every surgical training program above all to teach MIS and robotic surgery.

Representation Matters: An Assessment of Diversity in Current Major Textbooks on Burn Care.

Ethnic and gender disparities in healthcare have been well described. Increasing attention is paid to representative diversity in the images and educational resources used during medical training. Nearly 40% of the population of the United States identifies as a person of color, and patients of color reflect 41% of the total burn population seen in the United States. Additionally, national data on providers suggest about 5% of the Burn Team should be people of color. A better understanding of the diversity represented by burn-related medical literature could affect the management of patients with diverse backgrounds, as well as recruitment of black, indigenous, and people of color (BIPOC) into this field. The goal of this study is to investigate the representation of diverse skin tones in several leading medical textbooks of burn care. All photographs that contained people were evaluated for the number of people present and the depicted role of the person present. Diversity count was assessed in a binary fashion-was the individual represented a BIPOC? About 2579 total individuals were identified. BIPOC was represented in 363 total images (14%). There were 6 providers of color identified out of a total of 161 (3.7%); 30 providers were women (19%), of whom only 1 was a female provider of color. BIPOC patients and providers are underrepresented in the leading textbooks of burn care. Proper representation must be included in modern educational materials to better prepare providers for a diverse population of burn-injured patients and ensure effective and thoughtful care.

Data-rich textbook figures promote core competencies: Comparison of two textbooks.

Many molecular biology and biochemistry instructors have altered their classroom behavior in favor of evidence-based, active learning instructional strategies. Overwhelming evidence confirms that lecture-only classrooms are detrimental to student learning outcomes, but we know less about the impact textbooks have on students outside the classroom. Two influential projects, the AP Biology redesign and Vision and Change, called for extensive restructuring of course content and hoped that textbooks would be restructured accordingly. This study evaluated all figures and tables from two introductory biology textbooks to quantify how well they implement recommendations from Vision and Change and AP Biology redesign. We documented significant differences among figures and tables when looking for experimental data, questions for students to answer, and quantitative interpretation. Using think-aloud interviews, we interrogated whether students engage differently with figures from the two textbooks. When figures provided take-home messages, students relied on written text rather than analyzing the graphical information for their understanding. Students frequently employed words from summaries within the figures to construct "inflated explanations" that mimicked comprehension.

Preserving Abstinence and Preventing Rape: How Sex Education Textbooks Contribute to Rape Culture.

Recent academic and popular conversations regarding #MeToo, sexual violence and harassment, and rape culture have begun to focus on K-12 educational spaces in the U.S., but they rarely examine how educational curricula actually foster or combat these dynamics. In this article, we present a qualitative content analysis of health education textbooks, which explores the following question: What implicit and explicit messages do youth receive about sexual violence, and specifically, sexual violence prevention in health education textbooks? As we explored this question, we analyzed the roles that sex education curricula may play in shaping (e.g., contributing to, intervening upon) rape culture. We found the following messages across textbooks: abstinence is the only way to preserve one's safety; lack of abstinence increases risks, including the risk of being raped; and girls/women must assume personal responsibility and enact strategies that preserve one's abstinence and prevent them from being raped. This article concludes by teasing out how curricula can shape interactions, relationships, and culture, and by offering recommendations for improving sex education curricula.

Are textbook lungs really normal? A cadaveric study on the anatomical and clinical importance of variations in the major lung fissures, and the incomplete right horizontal fissure.

INTRODUCTION: The lungs have three main fissures: the right oblique fissure (ROF), right horizontal fissure (RHF), and left oblique fissure (LOF). These can be complete, incomplete or absent; quantifying the degree of completeness of these fissures is novel. Standard textbooks often refer to the fissures as complete, but awareness of variation is essential in thoracic surgery. MATERIALS AND METHODS: Fissures in 81 pairs of cadaveric lungs were classified. Oblique fissures were measured from lung hila posteriorly to the lung hila anteriorly; and the RHF measured from the ROF to the anteromedial lung edge. The degree of completeness of fissures was expressed as a percentage of the total projected length were they to be complete. The frequency and location of accessory fissures was noted. RESULTS: LOF were complete in 66/81 (81.5%), incomplete in 13/81 (16.0%) and absent in 2/81 (2.47%); ROF were complete in 52/81 (64.2%), incomplete in 29/81 (35.8%) and never absent; RHF were more variable, complete in 18/81 (22.2%), incomplete in 54/81 (66.7%) and absent in 9/81 (11.1%). LOF and ROF were on average 97.1% and 91.6% complete, respectively, being deficient posteriorly at the lung hila. The RHF on average 69.4% complete, being deficient anteromedially. There were accessory fissures in 10 left and 19 right lungs. CONCLUSIONS: This study provides a projection of the anatomy thoracic surgeons may encounter at operation, in particular the variable RHF. This knowledge is essential for optimal outcomes in both benign and oncological procedures influenced by the fissures.