Gaps in Framing and Naming: Commentary to "A Viewpoint on Accent Services".

PURPOSE: In this commentary, we offer a critique of "A Viewpoint on Accent Services: Framing and Terminology Matter" (Grover et al., 2022). We argue that the authors' proposal to rename and reframe accent modification lacks criticality, which actually hinders-rather than advances-the movement toward equitable, culturally sustaining, and emancipatory practices. METHOD: We offer an analysis of the shortfall between the authors' calls for linguistic justice in "A Viewpoint on Accent Services" and the actual changes they proposed. We break down major gaps in criticality, reflexivity, practice, and vision and discuss their potential for undercutting meaningful progress as it relates to linguistic justice. RESULTS: We found that the frameworks for the pursuit of equity, cultural sustenance, and emancipatory practices were misrepresented in the article in such a way that suggests that these goals could be achieved through superficial changes in terminology and attitudes. "A Viewpoint on Accent Services" upholds a power-neutral frame of operation that does not address the deeper systemic forces that make accent modification problematic. The lack of criticality toward accent intervention fosters complacency toward real transformation. CONCLUSION: We advocate for a serious and critical interrogation of accent practices and commitment to an emancipatory practice that addresses linguistic discrimination above all else. We emphasize the need to decenter standardized languages and to co-envision linguistic liberation using critical methods in scholarship, pedagogy, clinical practice, and policy.

CRISPR, animals, and FDA oversight: Building a path to success.

Technological advances, such as genome editing and specifically CRISPR, offer exciting promise for the creation of products that address public health concerns, such as disease transmission and a sustainable food supply and enable production of human therapeutics, such as organs and tissues for xenotransplantation or recombinant human proteins to treat disease. The Food and Drug Administration recognizes the need for such innovative solutions and plays a key role in bringing safe and effective animal biotechnology products to the marketplace. In this article, we (the Food and Drug Administration/Center for Veterinary Medicine) describe the current state of the science, including advances in technology as well as scientific limitations and considerations for how researchers and commercial developers working to create intentional genomic alterations in animals can work within these limitations. We also describe our risk-based approach and how it strikes a balance between our regulatory responsibilities and the need to get innovative products to market efficiently. We continue to seek input from our stakeholders and hope to use this feedback to improve the transparency, predictability, and efficiency of our process. We think that working together, using appropriate science- and risk-based oversight, is the foundation to a successful path forward.

Attitudes toward the vaginal ring and transdermal patch among adolescents and young women.

PURPOSE: The vaginal ring and the transdermal patch offer important contraceptive options for women at high risk for unintended pregnancy. Little is known about what adolescents and young women think about these methods and why use of the ring has been relatively low compared with the patch. We sought to examine young women's attitudes and perceptions about the ring and the patch to better understand the relationship between perceptions of these methods and decisions to use them. METHODS: Sixteen focus groups of young women aged 15-26 years (n=113) from family planning clinics in the San Francisco Bay Area were convened. Data from the focus groups were analyzed using standard content analysis. RESULTS: Although young women expressed apprehension and doubt about both methods, for the most part women expressed more positive attitudes about the patch. Two related themes for the ring and the patch were identified: "lack of trust in effectiveness," and "method use concerns". Two themes unique to the ring ("concerns regarding vaginal insertion" and "sexual partner perceptions") and three themes unique to the patch ("ease of remembering," "visibility issues," and "perceived health risk") were identified. CONCLUSIONS: Increased provider education about apprehensions related to the ring and the patch may lead to increased use of the ring and may counter recent declines in use of the patch. It would be unfortunate if these safe and effective options for young women were to be underused because negative attitudes and perceptions about these methods acted as barriers to adoption.

Adolescent experiences with the vaginal ring.

PURPOSE: To understand racial/ethnic minority adolescent females' experiences with the vaginal ring. METHODS: We conducted in-depth interviews with a clinic-based sample of 32 young women aged 15-24 years who had used the vaginal ring. RESULTS: Qualitative analysis using grounded theory revealed that adolescents undergo a multi-stage process when trying the ring and adopting ring use. These stages include hearing about the ring, initial reactions, first experiences with insertion and removal, and first sexual experiences. Adolescents subsequently enter an assessment and adjustment stage in which they decide whether to adopt or discontinue ring use. Ultimately they share their experiences with friends. CONCLUSIONS: The model developed provides a context within which providers may advise adolescents as they begin use of the ring. Some specific recommendations are offered.

A qualitative study of GPs' views of treating obesity.

BACKGROUND: Due to the increased prevalence of obesity GPs now have a key role in managing obese patients. AIM: To explore GPs' views about treating patients with obesity. SETTING: An inner London primary care trust. DESIGN OF STUDY: A qualitative study using semi-structured interviews. METHOD: Twenty-one GPs working in an inner London primary care trust were interviewed about recent obese patients and obesity in general. An interpretative phenomenological approach was used for data analysis. RESULTS: GPs primarily believed that obesity was the responsibility of the patient, rather than a medical problem requiring a medical solution. They also believed that in contrast to this, obese patients wanted to hand responsibility over to their doctor. This contradiction created conflict for the GPs, which was exacerbated by a sense that existing treatment options were ineffective. Further, this conflict was perceived as potentially detrimental to the doctor-patient relationship. GPs described a range of strategies that they used to maintain a good relationship including offering anti-obesity drugs, in which they had little faith, as a means of meeting patients' expectations; listening to the patients' problems, despite not having a solution to them; and offering an understanding of the problems associated with being overweight. CONCLUSION: GPs believe that although patients want them to take responsibility for their weight problems, obesity is not within the GP's professional domain. Until more effective interventions have been developed GPs may remain unconvinced that obesity is a problem requiring their clinical expertise and may continue to resist any government pressure to accept obesity as part of their workload.

Caring for people with learning disability using care management.

Current Government health policy is moving towards the delivery of services for clients with a learning disability through mainstream primary care services. At present there are difficulties in providing health services that meet the needs of clients. These include lack of resources (financial, physical and human), time and expertise. Yet clients with learning disabilities often have some of the most complex physical and mental health needs and they have a right to expect access to services that are responsive and sensitive to their requirements. In light of the current policy and stated difficulties, all service providers and stakeholders need to work together to review how services are provided and to negotiate shared resources. This article suggests adopting a care management approach, where clients are supported by different providers with a lead practitioner taking responsibility for assessment, planning and review in partnership with the client and his/her carers.