Understanding practitioner professionalism in Aboriginal and Torres Strait Islander health: lessons from student and registrar placements at an urban Aboriginal and Torres Strait Islander primary healthcare service.

Aboriginal and Torres Strait Islander peoples continue to be pathologised in medical curriculum, leaving graduates feeling unequipped to effectively work cross-culturally. These factors create barriers to culturally safe health care for Aboriginal and Torres Strait Islander peoples. In this pilot pre-post study, the learning experiences of seven medical students and four medical registrars undertaking clinical placements at an urban Aboriginal and Torres Strait Islander primary healthcare service in 2014 were followed. Through analysis and comparison of pre- and post-placement responses to a paper-based case study of a fictitious Aboriginal patient, four learning principles for medical professionalism were identified: student exposure to nuanced, complex and positive representations of Aboriginal peoples; positive practitioner role modelling; interpersonal skills that build trust and minimise patient-practitioner relational power imbalances; and knowledge, understanding and skills for providing patient-centred, holistic care. Though not exhaustive, these principles can increase the capacity of practitioners to foster culturally safe and optimal health care for Aboriginal peoples. Furthermore, competence and effectiveness in Aboriginal health care is an essential component of medical professionalism.

A meta-analysis of the facilitation of arm flexion and extension movements as a function of stimulus valence.

This article presents a meta-analysis of research on the affective compatibility effect: the relative facilitation of arm flexion and extension movements, in response to positive and negative stimuli, respectively. Across 68 effect sizes (computed on 3169 participants), a small, significant average compatibility effect emerged (ES = .118; 95% CI [.051, .185]). Importantly, analyses also revealed significant heterogeneity in the set of effect sizes. Moderator analyses were conducted to explain this observed heterogeneity with a view to testing between extant theoretical accounts of the compatibility effect. Affective compatibility effects were significantly larger (1) for face stimuli than for words or pictorial stimuli; (2) when the negative stimuli partly comprising the effect were anger-related; (3) for responses made using vertical button press; (4) when situated aspects of the processing task framed flexion as approach and extension as avoidance; and (5) when explicit response labels framed flexion as positive and extension as negative. Significant reverse compatibility effects emerged (1) when aspects of the processing context framed flexion as avoidance and extension as approach and (2) when explicit response labels framed flexion as negative and extension as positive. The results of the meta-analysis provide little support for the strong embodiment, specific muscle activation account of affective compatibility and are broadly consistent with distance regulation, and, in particular, evaluative coding accounts.

Elaborated contextual framing is necessary for action-based attitude acquisition.

Although arm flexion and extension have been implicated as conditioners of attitudes, recent work casts some doubt on the nature and strength of the coupling of these muscle contractions and stimulus evaluation. We propose that the elaborated contextual framing of flexion and extension actions is necessary for attitude acquisition. Results showed that when flexion and extension were disambiguated via elaborated contextual cues (i.e., framed as collect and discard within a foraging context), neutral stimuli processed under flexion were liked more than neutral stimuli processed under extension. However, when unelaborated framing was used (e.g., mere stimulus zooming effects), stimulus evaluation did not differ as a function of muscle contractions. These results suggest that neither arm contractions per se nor unelaborated framings are sufficient for action-based attitude acquisition, but that elaborated framings are necessary.

A search for commonalities in defining the common good: Using folk theories to unlock shared conceptions.

Throughout the course of scholarly history, some concepts have been notoriously hard to define. The 'common good' is one such concept. While the common good has a long and contested scholarly history, social psychology research on folk theories - lay beliefs that represent an individual's informal and subjective understanding of the world - may provide a key for unlocking this nebulous concept. In the current paper, we analysed lay definitions of the common good using the linguistic inquiry and word count's meaning extraction method. From a nationally representative Australian sample of open-ended text responses (n = 14,303), we uncovered a consistent conceptual structure, with nine themes corresponding to three core aspects: (i) outcomes and objects, (ii) principles and processes and (iii) stakeholders and beneficiaries. From this, we developed a working definition of the folk concept of the common good: 'achieving the best possible outcome for the largest number of people, which is underpinned by decision-making that is ethically and morally sound and varies by the context in which the decisions are made'. A working definition benefits the academic community and society more broadly, particularly when diverse stakeholders come together to act for the common good to address shared challenges.

Dr. Who? Providing stability to recruiting and retaining health care professionals in West Virginia.

Primary care physicians comprise less than 15% of the United States outpatient work force, yet they perform 23% of the visits that Americans make to their physicians each year. In rural areas, an even greater proportion or about 42% of these visits are to family physician's offices. The country's rural areas have been medically underserved for decades. United States census data has determined that about 21% of the United States population lives in rural areas. Sparse population, extreme poverty, high proportions of racial and ethnic minorities and lack of cultural amenities characterize rural communities most likely to suffer from a shortage of physicians. This persistent, intractable shortage of physicians in rural communities means that many communities struggle continuously to recruit and retain physicians. The Division of Rural Health and Recruitment, located within the Office of Community Health Systems and Health Promotion, Bureau for Public Health, works diligently to alleviate some of those shortages and to strengthen the health care safety net in West Virginia. The Division of Rural Health and Recruitment utilizes the most up-to-date and relevant provider recruitment and retention strategies available.

The three sisters garden: A cultural approach to cultivating American Indian/Alaska Native (AI/AN) psychological service providers.

Less than 300 practicing Native American (NA) psychologists are available to support over 5.2 million American Indian and Alaska Natives (AI/AN) who reside in the U.S., according to the 2010 census (2010; Society of Indian Psychologists [SIP], 2016). The Three Sisters Model represents a training approach for NA behavioral health students to help address the need for culturally competent behavioral health services for individuals living in Indian country. The model utilizes a socially relevant approach including culture, spirituality, and education as key components to successful recruitment, retention, and training of NA behavioral health professionals. By incorporating culturally informed approaches and a culturally inclusive environment, this model provides a supportive, nurturing and affirming approach to help AI/AN students overcome challenges and complete their degrees. Upon completion, students are culturally proficient in skills which can be applied to Native communities in utilizing the Indigenous lens which can be used with tribes in the Midwestern U.S., but with local cultural adaptation it could be used in other regions. The 15 programs of the Three Sisters Model provide the steps for students to manage the completion of the steps (e.g., from high school to college) toward licensure while managing and balancing Western and Indigenous approaches to proficiency of care. The model includes supports to address barriers which have inhibited past AI/AN from reaching education and professional goals. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Gender equity in emergency medicine: Five years on, where are we headed?

The challenge of addressing gender inequality was highlighted in the 2016 Trainee Focus of Emergency Medicine Australasia. Despite increasing numbers of female medical graduates, including increasing female trainees in emergency medicine (EM), this has not yet translated to equal representation in formal leadership roles. Five years later, as the Australasian College for Emergency Medicine (ACEM) welcomes the second female college president, this article explores the gendered leadership gap in EM from an organisational and intersectional feminist perspective and recommends high-level strategies for change. Notably, ACEM has demonstrated committed engagement with gender equity, such as the establishment of the Advancing Women in Emergency Section. It has also achieved gender parity in provisional trainees and improved women's representation on the ACEM Board. However, broader organisational processes that ensure work-life integration, transparent leadership development pathways and equitable recruitment, promotion, retention and evaluation remain critical. Creating a local evidence-base to support diversity in leadership development remains a priority.

Responsible Leadership and the Reflective CEO: Resolving Stakeholder Conflict by Imagining What Could be done.

In light of grand societal challenges, most recently the global Covid-19 pandemic, there is a call for research on responsible leadership. While significant advances have been made in recent years towards a better understanding of the concept, a gap exists in the understanding of responsible leadership in emerging countries, specifically how leaders resolve prevalent moral dilemmas. Following Werhane (1999), we use moral imagination as an analytical approach to analyze a dilemmatic stakeholder conflict (between indigenous communities in rural India and an emerging market multinational enterprise headquartered in the same country) through the lense of different responsible leadership mindsets and in light of different ethical principles and moral background theories. Based on this analysis, we arrive at a tentative moral judgement, concluding that the instrumental approach is morally inferior and recommending the integrative approach as the morally superior choice. In the subsequent discussion-focussed on what "could" (instead of "should") be done, we apply the integrative script and use moral imagination as a pathway for generating morally justifiable solutions. Through this analysis, we provide novel insights on how to apply an integrative responsible leadership approach to a stakeholder conflict situation, using the single case study to expand the responsible leadership discussion to emerging markets.

Employment Precarity Strengthens the Relationships Between the Dark Triad and Professional Commitment.

The Dark Triad traits of Machiavellianism, narcissism, and psychopathy have been found to negatively impact work behaviors including information sharing, reporting of unethical conduct, and mistreatment of colleagues and subordinates. However, research has found the Dark Triad can also be related to forms of organizational commitment which underpin positive work behaviors, including engaging in tasks and duties beyond those required (i.e., "going above and beyond"). Professional commitment is a broader form of commitment that has been found to be significantly related to organizational commitment, sharing antecedents, and having similar outcomes. Professional commitment, the affective, normative, and continuance commitment toward one's profession or occupation, has the benefit of applying to individuals employed by organizations as well as those working for themselves or between jobs. In this research, we explore relationships between professional commitment, using previous research on the relationship between the dark triad traits of Machiavellianism, psychopathy, and narcissism and organizational commitment, as a basis for predictions. We also explored two forms of precarious employment (career interruptions and part-time or casual work) as possible moderators of the dark triad-professional commitment relationship. Participants were 184 Australian professionals (52.2% men), a slight majority of whom had experienced a career interruption (69.6%) or a year or more of part-time or casual employment (70.7%). The results showed that psychopathy had a negative association with affective commitment, whereas Machiavellianism was positively related to normative commitment, and narcissism was positively related to normative and continuance commitment. Using regression analysis, we found that among individuals who have worked in part-time/casual employment longer, Machiavellianism and psychopathy had significantly stronger negative associations with affective commitment. In contrast, among individuals who have had a significant career interruption, Machiavellianism had significantly stronger positive association with continuance commitment. These findings help expand our understanding of both the dark triad and its contingent impact on workers' attachment to their profession.

Twentieth century morality: The rise and fall of moral concepts from 1900 to 2007.

Trends in the cultural salience of morality across the 20th century in the Anglophone world, as reflected in changing use of moral language, were explored using the Google Books (English language) database. Relative frequencies of 304 moral terms, organized into six validated sets corresponding to general morality and the five moral domains proposed by moral foundations theory, were charted for the years 1900 to 2007. Each moral language set displayed unique, often nonlinear historical trajectories. Words conveying general morality (e.g., good, bad, moral, evil), and those representing Purity-based morality, implicating sanctity and contagion, declined steeply in frequency from 1900 to around 1980, when they rebounded sharply. Ingroup-based morality, emphasizing group loyalty, rose steadily over the 20th century. Harm-based morality, focused on suffering and care, rose sharply after 1980. Authority-based morality, which emphasizes respect for hierarchy and tradition, rose to a peak around the social convulsions of the late 1960s. There were no consistent tendencies for moral language to become more individualist or less grounded in concern for social order and cohesion. These differing time series suggest that the changing moral landscape of the 20th century can be divided into five distinct periods and illuminate the re-moralization and moral polarization of the last three decades.

Assessment of Risk and Protection in Native American Youth: Steps Toward Conducting Culturally Relevant, Sustainable Prevention in Indian Country.

Background: This study constitutes a building block in the cultural adaptation of Communities That Care (CTC), a community-based prevention system that has been found to be effective in reducing youth problem behaviors. Methods: Using the data from the CTC normative survey dataset that consists of more than quarter million youth nationwide, this study examines the reliability and validity of scores derived from the Communities That Care Youth Survey (CTC-YS), one of the primary assessment tools for gathering community data on risk and protective factors related to problem behaviors including substance use. The reliability and criterion validity analyses are conducted overall for the nationwide sample of youth as well as for the student subsample of Native American youth. Results: The results of this study indicate that the existing CTC-YS assessments of risk and protective factors in the domains of community, family, school, and peer groups as well as within individuals yield scores that are reliable and valid within the Native American sample of youth. Conclusions: This study informs the third step in the CTC prevention planning process, which involves the assessment of risk and protective factors to be targeted in preventive interventions. The question of how the assessment of risk and protective factors among Native American youth might be further improved and a description of efforts related to the cultural adaptation of the CTC program currently underway are also addressed in the discussion.

What We Talk About When We Talk About Morality: Deontological, Consequentialist, and Emotive Language Use in Justifications Across Foundation-Specific Moral Violations.

Morality is inherently social, yet much extant work in moral psychology ignores the central role of social processes in moral phenomena. To partly address this, this article examined the content of persuasive moral communication-the way people justify their moral attitudes in persuasive contexts. Across two studies, we explored variation in justification content (deontological, consequentialist, or emotive) as a function of moral foundations. Using justification selection techniques (Study 1) and open-ended justification production (Study 2), results demonstrate a preference (a) for deontological appeals in justifications for the sanctity foundation, (b) for consequentialist appeals for the individualizing foundations (care and fairness), and (c) for emotive appeals in justifications for the binding foundations (loyalty, authority and sanctity). The present research questions the generality of inferences about the primacy of emotions/intuition in moral psychology research and highlights the important role of reasons in persuasive moral communication.

Regulation of Bcl-2 expression by C/EBP in t(14;18) lymphoma cells.

In follicular lymphomas with the t(14;18) translocation, there is increased expression of the bcl-2 gene, which is dependent upon regulatory elements within the bcl-2 5' flanking region and the immunoglobulin heavy-chain gene enhancers. We found that t(14;18) lymphomas expressed C/EBPalpha, which is not normally expressed in B lymphocytes. Expression of C/EBPalpha increased bcl-2 expression, and two regions of the bcl-2 P2 promoter that mediated this effect were identified. C/EBPbeta was also able to increase bcl-2 promoter activity through these sites. The 5' site was GC-rich and did not contain a C/EBP consensus sequence; however, C/EBP was observed to interact with this site both in vitro by EMSA and in vivo by chromatin immunoprecipitation assay. The 3' region contained the Cdx site, which mediates the effect of A-Myb on the bcl-2 promoter. In vivo binding studies revealed that C/EBP interacted with this region of the bcl-2 promoter as well. Decreased expression of C/EBP factors due to targeting of their transcripts by siRNA molecules resulted in downregulation of Bcl-2 protein. We conclude that C/EBPalpha and C/EBPbeta contribute to the deregulated expression of Bcl-2 in t(14;18) lymphoma cells.

Management of the difficult pediatric airway: efficacy of airway exchange catheters with rigid bronchoscopy.

The airway exchange catheter can be used both to ventilate the lungs and to act as a guide for reintubation in patients of all ages who have a tenuous airway. We report the case of a 2-year-old boy with an anatomically challenging airway in whom both an airway exchange catheter and a rigid bronchoscope were used to visualize and maintain a secure airway. We also review the literature as it pertains to the management of the difficult pediatric airway.

ProSeal laryngeal mask airway in 120 pediatric surgical patients: a prospective evaluation of characteristics and performance.

BACKGROUND: The ProSeal LMA (PLMA) has recently been introduced in pediatric sizes (1.5, 2, 2.5, 3). Limited pediatric data have been published. METHODS: After Institutional Review Board (IRB) approval, the PLMA was placed in 120 children aged 4 months to 13 years (5-50 kg). The following data were collected prospectively: induction agent, number of placement attempts (limited to three), placement success or failure, PLMA size, leak pressure, ventilatory pattern [spontaneous (SV) or controlled positive pressure ventilation (PPV)], success or failure of gastric suction tube placement, hypoxemia, dislodgement, laryngospasm, bronchospasm, aspiration, and traumatic placement. RESULTS: The PLMA was easily placed in children with a higher first attempt success rate (94%) than reported for adults. Overall PLMA and gastric tube placement were both 100% successful. Leak pressures were similar to those reported for the PLMA in adults and higher than reported for the Classic LMA in children. No bronchospasm, laryngospasm, hypoxemia, dislodgement, or aspiration occurred. CONCLUSIONS: Although the PLMA can be used with SV or PPV, the higher leak pressure achieved with the PLMA, and the ability to evacuate fluid and air from the stomach suggest that it may be a useful alternative to tracheal intubation for procedures in which PPV is desired in children aged 4 months to 13 years.

The addition of clonidine 2 microg.kg-1 does not enhance the postoperative analgesia of a caudal block using 0.125% bupivacaine and epinephrine 1:200,000 in children: a prospective, double-blind, randomized study.

BACKGROUND: In this prospective, randomized, double-blind study, we compared the efficacy of 0.125% bupivacaine and epinephrine 1:200,000 with and without clonidine 2 microg.kg-1 for 'single shot' pediatric caudal analgesia. METHODS: Thirty ASA I and II children, ages 2-8 years, undergoing outpatient surgical procedures below the umbilicus received 1 ml.kg-1 0.125% bupivacaine with fresh epinephrine 1:200,000 and clonidine 2 microg.kg-1 (group-C) or 1 ml.kg-1 0.125 % bupivacaine with epinephrine 1:200 000 (group-NC). All patients received a standardized general anesthetic (induction with 67% N2O in O2 and sevoflurane followed by isoflurane maintenance). Primary outcome measures were time to first rescue analgesic and number of patients requiring rescue analgesic at 4, 6, 8, 12, and 24 h after caudal placement. Secondary outcome measures included: extubation times, Objective Pain Scale (OPS) scores, sedation scores, time in postanesthesia care unit (PACU), discharge time, number of analgesic doses given in 24 h following caudal blockade, and adverse effects (vomiting, hypotension, and bradycardia). RESULTS: There were no differences in demographics, investigated parameters, or adverse effects between groups. CONCLUSIONS: We found that the addition of clonidine 2 microg.kg-1 to 0.125% bupivacaine with fresh epinephrine 1:200,000 for caudal analgesia did not significantly delay the time to first rescue analgesic or decrease the overall need for rescue analgesics in children 2-8 years undergoing surgical procedures below the umbilicus.

Practical pediatric regional anesthesia.

In children, regional anesthetic techniques are safe and effective adjuncts to general anesthesia and for postoperative pain relief. Application of the techniques described in this article will contribute to improved care for pediatric patients undergoing surgical procedures. The judicious choice of local anesthetics, along with the blockades of targeted nerves, decrease the need for supplemental analgesics in the recovery phase.