Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training.

BACKGROUND: Health care routinely fails Indigenous peoples and anti-Indigenous racism is common in clinical encounters. Clinical training programs aimed to enhance Indigenous cultural safety (ICS) rely on learner reported impact assessment even though clinician self-assessment is poorly correlated with observational or patient outcome reporting. We aimed to compare the clinical impacts of intensive and brief ICS training to control, and to assess the feasibility of ICS training evaluation tools, including unannounced Indigenous standardized patient (UISP) visits. METHOD: Using a prospective parallel group three-arm randomized controlled trial design and masked standardized patients, we compared the clinical impacts of the intensive interactive, professionally facilitated, 8- to10-h Sanyas ICS training; a brief 1-h anti-bias training adapted to address anti-Indigenous bias; and control continuing medical education time-attention matched to the intensive training. Participants included 58 non-Indigenous staff physicians, resident physicians and nurse practitioners from family practice clinics, and one emergency department across four teaching hospitals in Toronto, Canada. Main outcome measures were the quality of care provided during UISP visits including adjusted odds that clinician would be recommended by the UISP to a friend or family member; mean item scores on patient experience of care measure; and clinical practice guideline adherence for NSAID renewal and pain assessment. RESULTS: Clinicians in the intensive or brief ICS groups had higher adjusted odds of being highly recommended to friends and family by standardized patients (OR 6.88, 95% CI 1.17 to 40.45 and OR 7.78, 95% CI 1.05 to 58.03, respectively). Adjusted mean item patient experience scores were 46% (95% CI 12% to 80%) and 40% (95% CI 2% to 78%) higher for clinicians enrolled in the intensive and brief training programs, respectively, compared to control. Small sample size precluded detection of training impacts on clinical practice guideline adherence; 100% of UISP visits were undetected by participating clinicians. CONCLUSIONS: Patient-oriented evaluation design and tools including UISPs were demonstrated as feasible and effective. Results show potential impact of cultural safety training on patient recommendation of clinician and improved patient experience. A larger trial to further ascertain impact on clinical practice is needed. TRIAL REGISTRATION: Clinicaltrials.org NCT05890144. Retrospectively registered on June 5, 2023.

Evaluation of Agricultural Interventions on Human and Poultry-Related Salmonella Enteritidis in British Columbia.

A collaborative investigation between public health and animal health led to numerous interventions along the food chain in response to an outbreak of human salmonellosis and increased incidence of Salmonella Enteritidis (SE) among poultry. Incidence of both human and chicken SE decreased substantially in 2012 and 2013 following these interventions. We used time series analysis to assess the impact of three interventions: vaccination of broiler breeder flocks, separation in the hatchery of breeder eggs, and an industry order to stop farm-gate sales of ungraded broiler hatching eggs. Results show a Granger causal association between human SE incidence and SE incidence in chickens 8 months earlier. Among the interventions, separation of breeder flocks showed a consistent and statistically significant association with declining SE incidence in chickens. Our results did not show consistent declines in chicken SE following breeder flock vaccination (live or inactivated vaccine). None of the interventions had statistically significant impacts on human SE incidence. Our results are consistent with a positive effect of certain interventions and also reveal where additional data are needed for a more comprehensive evaluation. Multiple interventions throughout the food chain are best practices when dealing with enteric pathogens; collecting data on the timing and intensity of these interventions allow proper evaluation of their independent and combined effects. Finally, we identify considerations for others interested in undertaking similar evaluations. Ongoing collaborative work between public health and animal health is required to refine strategies for SE control in British Columbia.

Stereotyping to infer group membership creates plausible deniability for prejudice-based aggression.

In the present study, participants administered painful electric shocks to an unseen male opponent who was either explicitly labeled as gay or stereotypically implied to be gay. Identifying the opponent with a gay-stereotypic attribute produced a situation in which the target's group status was privately inferred but plausibly deniable to others. To test the plausible deniability hypothesis, we examined aggression levels as a function of internal (personal) and external (social) motivation to respond without prejudice. Whether plausible deniability was present or absent, participants high in internal motivation aggressed at low levels, and participants low in both internal and external motivation aggressed at high levels. The behavior of participants low in internal and high in external motivation, however, depended on experimental condition. They aggressed at low levels when observers could plausibly attribute their behavior to prejudice and aggressed at high levels when the situation granted plausible deniability. This work has implications for both obstacles to and potential avenues for prejudice-reduction efforts.

Simulating channel losses in an underwater optical communication system.

A Monte Carlo numerical simulation for computing the received power for an underwater optical communication system is discussed and validated. Power loss between receiver and transmitter is simulated for a variety of receiver aperture sizes and fields of view. Additionally, pointing-and-tracking losses are simulated.

Medical Image sharing: What do the public see when reviewing radiographs? A pilot study.

INTRODUCTION: Policymakers wish to extend access to medical records, including medical imaging. Appreciating how patients might review radiographs could be key to establishing future training needs for healthcare professionals and how image sharing could be integrated into practice. METHOD: A pilot study in the UK using a survey was distributed to adult participants via the online research platform Prolific. All subjects were without prior professional healthcare experience. Participants reviewed ten radiographs (single projection only) and were asked a two-stage question. Firstly, if the radiograph was 'normal' or 'abnormal' and secondly, if they had answered 'abnormal', to identify the abnormality from a pre-determined list featuring generic terms for pathologies. RESULTS: Fifty participants completed the survey. A mean of 65.8 % of participants were able to correctly identify if radiographs were normal or abnormal. Results in relation to the identification of a pathology were not as positive, but still notable with a mean of 46.4 % correctly identifying abnormalities. Qualitative data demonstrated that members of the public are enthralled with reviewing radiographs and intrigued to understand their performance in identifying abnormalities. CONCLUSION: In the pilot, members of the public could identify if a radiograph is normal or abnormal to a reasonable standard. Further detailed interpretation of images requires supportive intervention. This pilot study suggests that patients can participate in image sharing as part of their care. Image sharing may be beneficial to the therapeutic relationship, aiding patient understanding and enhancing consultations between healthcare professional and patient. Further research is indicated.

Developing scientifically validated bias and diversity trainings that work: empowering agents of change to reduce bias, create inclusion, and promote equity.

Purpose ­: Research consistently shows that non-scientific bias, equity, and diversity trainings do not work, and often make bias and diversity problems worse. Despite these widespread failures, there is considerable reason for hope that effective, meaningful DEI efforts can be developed. One approach in particular, the bias habit-breaking training, has 15 years of experimental evidence demonstrating its widespread effectiveness and efficacy. Design/methodology/approach ­: This article discusses bias, diversity, equity, and inclusion (DEI) efforts from the author's perspective as a scientist-practitioner - the author draws primarily on the scientific literature, but also integrates insights from practical experiences working in DEI. The author provides a roadmap for adapting effective, evidence-based approaches from other disciplines (e.g. cognitive-behavioral therapy) into the DEI context and reviews evidence related to the bias habit-breaking training as one prominent demonstration of a scientifically-validated approach that effects lasting, meaningful improvements on DEI issues within both individuals and institutions. Findings ­: DEI trainings fail due to widespread adoption of the information deficit model, which is well-known as a highly ineffective approach. Empowerment-based approaches, in contrast, are highly promising for making meaningful, lasting changes in the DEI realm. Evidence indicates that the bias habit-breaking training is effective at empowering individuals as agents of change to reduce bias, create inclusion, and promote equity, both within themselves and the social contexts they inhabit. Originality/value ­: In contrast to the considerable despair and pessimism around DEI efforts, the present analysis provides hope and optimism, and an empirically-validated path forward, to develop and test DEI approaches that empower individuals as agents of change.

Robust within-session modulations of IAT scores may reveal novel dynamics of rapid change.

The Implicit Association Test (IAT) is employed in the domain of social psychology as a measure of implicit evaluation. Participants in this task complete blocks of trials where they are asked to respond to categories and attributes (e.g., types of faces and types of words). Reaction times in different blocks sharing certain response combinations are averaged and then subtracted from blocks with other response combinations and then normalized, the result of which is taken as a measure indicating implicit evaluation toward or away from the given categories. One assumption of this approach is stationarity of response time distributions, or at a minimum, that temporal dynamics in response times are not theoretically relevant. Here we test these assumptions, examine the extent to which response times change within the IAT blocks and, if so, how trajectories of change are meaningful in relation to external measures. Using multiple data sets we demonstrate within-session changes in IAT scores. Further, we demonstrate that dissociable components in the trajectories of IAT performance may be linked to theoretically distinct processes of cognitive biases as well as behaviors. The present work presents evidence that IAT performance changes within the task, while future work is needed to fully assess the implications of these temporal dynamics.

Development and characterization of a sorghum multi-parent advanced generation intercross (MAGIC) population for capturing diversity among seed parent gene pool.

Multiparent advanced eneration inter-cross (MAGIC) populations improve the precision of quantitative trait loci (QTL) mapping over biparental populations by incorporating increased diversity and opportunities to reduce linkage disequilibrium among variants. Here, we describe the development of a MAGIC B-Line (MBL) population from an inter-cross among 4 diverse founders of grain sorghum [Sorghum bicolor (L.) Moench] across different races (kafir, guinea, durra, and caudatum). These founders were selected based on genetic uniqueness and several distinct qualitative features including panicle architecture, plant color, seed color, endosperm texture, and awns. A whole set of MBL (708 F6) recombinant inbred lines along with their founders were genotyped using Diversity Arrays Technology (DArTseq) and 5,683 single-nucleotide polymorphisms (SNPs) were generated. A genetic linkage map was constructed using a set of polymorphic, quality-filtered markers (2,728 SNPs) for QTL interval-mapping. For population validation, 3 traits (seed color, plant color, and awns) were used for QTL mapping and genome-wide association study (GWAS). QTL mapping and GWAS identified 4 major genomic regions located across 3 chromosomes (Chr1, Chr3, and Chr6) that correspond to known genetic loci for the targeted traits. Founders of this population consist of the fertility maintainer (A/B line) gene pool and derived MBL lines could serve as female/seed parents in the cytoplasmic male sterility breeding system. The MBL population will serve as a unique genetic and genomic resource to better characterize the genetics of complex traits and potentially identify superior alleles for crop improvement efforts to enrich the seed parent gene pool.

Discovering useful genetic variation in the seed parent gene pool for sorghum improvement.

Multi-parent populations contain valuable genetic material for dissecting complex, quantitative traits and provide a unique opportunity to capture multi-allelic variation compared to the biparental populations. A multi-parent advanced generation inter-cross (MAGIC) B-line (MBL) population composed of 708 F6 recombinant inbred lines (RILs), was recently developed from four diverse founders. These selected founders strategically represented the four most prevalent botanical races (kafir, guinea, durra, and caudatum) to capture a significant source of genetic variation to study the quantitative traits in grain sorghum [Sorghum bicolor (L.) Moench]. MBL was phenotyped at two field locations for seven yield-influencing traits: panicle type (PT), days to anthesis (DTA), plant height (PH), grain yield (GY), 1000-grain weight (TGW), tiller number per meter (TN) and yield per panicle (YPP). High phenotypic variation was observed for all the quantitative traits, with broad-sense heritabilities ranging from 0.34 (TN) to 0.84 (PH). The entire population was genotyped using Diversity Arrays Technology (DArTseq), and 8,800 single nucleotide polymorphisms (SNPs) were generated. A set of polymorphic, quality-filtered markers (3,751 SNPs) and phenotypic data were used for genome-wide association studies (GWAS). We identified 52 marker-trait associations (MTAs) for the seven traits using BLUPs generated from replicated plots in two locations. We also identified desirable allelic combinations based on the plant height loci (Dw1, Dw2, and Dw3), which influences yield related traits. Additionally, two novel MTAs were identified each on Chr1 and Chr7 for yield traits independent of dwarfing genes. We further performed a multi-variate adaptive shrinkage analysis and 15 MTAs with pleiotropic effect were identified. The five best performing MBL progenies were selected carrying desirable allelic combinations. Since the MBL population was designed to capture significant diversity for maintainer line (B-line) accessions, these progenies can serve as valuable resources to develop superior sorghum hybrids after validation of their general combining abilities via crossing with elite pollinators. Further, newly identified desirable allelic combinations can be used to enrich the maintainer germplasm lines through marker-assisted backcross breeding.

First reported detection of influenza A (H1N1)pdm09 in turkeys in the United Kingdom.

We report the first occurrence of pandemic (H1N1) 2009 virus [A(H1N1)pdm09] infection on two epidemiologically linked turkey breeder premises in the United Kingdom during December 2010 and January 2011. Clinically, the birds showed only mild signs of disease, with the major presenting sign being an acute and marked reduction in egg production, leading to the prompt reporting of suspected avian notifiable disease for official investigation. Presence of A(H1N1)pdm09 infection in the United Kingdom turkey breeder flocks was confirmed by detailed laboratory investigations including virus isolation in embryonated specific pathogen-free fowls' eggs, two validated real-time reverse transcription-PCR tests, and nucleotide sequencing of the hemagglutinin and neuraminidase genes. These investigations revealed high nucleotide identity with currently circulating human A(H1N1)pdm09 strains, suggesting that human-to-poultry transmission (reverse zoonosis) was the most likely route of infection. Peak levels of human influenza-like illness community transmission also coincided with the onset of clinical signs in both affected turkey breeder flocks. This case demonstrated the value of the existing passive surveillance framework and associated veterinary and laboratory infrastructure that enables the detection and management of both exotic and new and emerging disease hazards and risks. The case also presents further evidence of the susceptibility of turkeys to infection with influenza A viruses of nonavian origin.

Correlation of Pyuria and Bacteriuria in Acute Care.

BACKGROUND: Pyuria is often used as an import marker in the diagnosis of urinary tract infection. The interpretation of pyuria may be especially important in patients with nonspecific complaints. There is a paucity of data to demonstrate the utility of pyuria alone in the diagnosis of bacteriuria or urinary tract infection. This study aims to further define the relationship of pyuria and positive bacterial growth in urine culture, as well as the diagnostic utility of different urine white blood cell cutoff points. METHOD: A total of 46,127 patients older than the age of 18 were selected from the inpatient population of HCA Healthcare System Capital Division. Urine microscopy results were stratified by white blood cell count and correlated with positivity of urine culture bacterial growth. The optimal urine white blood cell cutoff was derived based on the receiver operating characteristic curve plot. RESULTS: Urine microscopy finding of white blood cell 0-5 cell/hpf, 5-10 cell/hpf, 10-25 cell/hpf, and higher than 25 cell/hpf was associated with 25.4%, 28.2%, 33%, and 53.8% rates of bacteriuria, respectively. The receiver operating characteristic curve plot demonstrated that pyuria alone did not provide adequate diagnostic accuracy to predict bacteriuria. The optimal cutoff point for the best combination of sensitivity and specificity was found to be 25 cell/hpf. CONCLUSION: Pyuria alone provides inadequate diagnostic accuracy for predicting bacteriuria. Urine white blood cell count greater than 25 cell/hpf was found to be the optimal cutoff to detect bacteriuria. The result of this study supports the current guideline recommendation against antibiotic treatment based on urine analysis alone. It also informs future design of randomized controlled trial that investigates interventional strategies for patients with pyuria and nonspecific complaints.

Untested assumptions perpetuate stereotyping: Learning in the absence of evidence.

In the present work, we set out to assess whether and how much people learn in response to their stereotypic assumptions being confirmed, being disconfirmed, or remaining untested. In Study 1, participants made a series of judgments that could be influenced by stereotypes and received feedback that confirmed stereotypes the majority of the time, feedback that disconfirmed stereotypes the majority of the time, or no feedback on their judgments. Replicating past work on confirmation bias, patterns in the conditions with feedback indicated that pieces of stereotype-confirming evidence exerted more influence than stereotype-disconfirming evidence. Participants in the Stereotype-Confirming condition stereotyped more over time, but rates of stereotyping for participants in the Stereotype-Disconfirming condition remained unchanged. Participants who received no feedback, and thus no evidence, stereotyped more over time, indicating that, matching our core hypothesis, they learned from their own untested assumptions. Study 2 provided a direct replication of Study 1. In Study 3, we extended our assessment to memory. Participants made judgments and received a mix of confirmatory, disconfirmatory, and no feedback and were subsequently asked to remember the feedback they received on each trial, if any. Memory tests for the no feedback trials revealed that participants often misremembered that their untested assumptions were confirmed. Supplementing null hypothesis significance testing, Bayes Factor analyses indicated the data in Studies 1, 2, and 3 provided moderate-to-extreme evidence in favor of our hypotheses. Discussion focuses on the challenges these learning patterns create for efforts to reduce stereotyping.

Decreased mortality of weaned pigs with Streptococcus suis with the use of in-water potassium penicillin G.

This study evaluated the efficacy of potassium penicillin G in drinking water of weaned pigs to reduce mortality and spread of infection caused by Streptococcus suis. A total of 896 18-day-old weaned pigs were randomly assigned to either treatment with potassium penicillin G in-water (Treated), or no treatment (Control). The outcomes analyzed were total mortality, mortality due to S. suis, and overall counts of S. suis colonies. The risk of mortality due to S. suis and total mortality were significantly increased in the Control group compared with Treated pigs (P < 0.05). Bacterial culture of posterior pharyngeal swabs indicated that Control pigs were significantly more likely to have ≥ 1000 colonies of S. suis per plate than were Treated pigs (P < 0.05). This study demonstrates that potassium penicillin G administered in drinking water is effective in reducing mortality associated with S. suis infection and reducing tonsillar carriage of S. suis.

Correction to: Evidence for Distinct Facial Signals of Reward, Affiliation, and Dominance from Both Perception and Production Tasks.

[This corrects the article DOI: 10.1007/s42761-020-00024-8.].

Evidence for Distinct Facial Signals of Reward, Affiliation, and Dominance from Both Perception and Production Tasks.

Smiles are nonverbal signals that convey social information and influence the social behavior of recipients, but the precise form and social function of a smile can be variable. In previous work, we have proposed that there are at least three physically distinct types of smiles associated with specific social functions: reward smiles signal positive affect and reinforce desired behavior; affiliation smiles signal non-threat and promote peaceful social interactions; dominance smiles signal feelings of superiority and are used to negotiate status hierarchies. The present work advances the science of the smile by addressing a number of questions that directly arise from this smile typology. What do perceivers think when they see each type of smile (Study 1)? How do perceivers behave in response to each type of smile (Study 2)? Do people produce three physically distinct smiles in response to contexts related to each of the three social functions of smiles (Study 3)? We then use an online machine learning platform to uncover the labels that lay people use to conceptualize the smile of affiliation, which is a smile that serves its social function but lacks a corresponding lay concept. Taken together, the present findings support the conclusion that reward, affiliation, and dominance smiles are distinct signals with specific social functions. These findings challenge the traditional assumption that smiles merely convey whether and to what extent a smiler is happy and demonstrate the utility of a social-functional approach to the study of facial expression.

What are the benefits and risks of sharing patients' diagnostic radiological images with them? A cross-sectional study of the perceptions of patients and clinicians in the UK.

OBJECTIVES: The objective for this work was to assess clinical experts' and patients' opinions on the benefits and risks of sharing patients' diagnostic radiological images with them. SETTING: This study was conducted outside of the primary and secondary care settings. Clinical experts were recruited at a UK national imaging and oncology conference, and patients were recruited via social media. PARTICIPANTS: 121 clinical experts and 282 patients completed the study. A further 73 patient and 10 clinical expert responses were discounted due to item non-response. Individuals were required to be a minimum of 18 years of age at the time of participation. PRIMARY AND SECONDARY OUTCOME MEASURES: This study was exploratory in nature. As such, the outcomes to be measured for demonstration of the successful completion of this study were generated organically through the process of the investigation itself. These were: (1) the delineation of the benefits available from, and the risks posed by, widening access to diagnostic radiological images; (2) establishment of the level and nature of demand for access to diagnostic radiological images; and (3) the identification of stakeholder requirements for accessing available benefit from diagnostic radiological images. RESULTS: 403 usable questionnaires were returned consisting of responses from clinical experts (n=121) and patients (n=282). Both groups acknowledge the potential benefits of this practice. Examples included facilitating communication, promoting patient engagement and supporting patients in accepting health information shared with them. However, both groups also recognised risks associated with image sharing, such as the potential for patients to be upset or confused by their images. CONCLUSIONS: There is a demand from patients for access to their diagnostic radiological images alongside acknowledgement from clinical experts that there may be benefits available from this. However, due to the acknowledged risks, there is also a need to carefully manage this interaction. TRIAL REGISTRATION NUMBER: 187752.

Is the diagnostic radiological image an underutilised resource? Exploring the literature.

The number of diagnostic imaging examinations being undertaken in the UK is rising. Due to the expensive nature of producing these examinations and the risks associated with exposing living tissue to the ionising radiation used by many of the imaging techniques, this growth comes with both a financial and a human cost.In a time of limited resources, it is important that we are able to maximise the benefits which we extract from these resources. Therefore, a broad search of the current literature was undertaken to assess our current understanding of the nature of benefit available from diagnostic radiological images.Two broad categories of benefit were identified: primary benefit (n = 470) and secondary benefit (n = 49). Primary benefits are those which are related to the justification for undertaking the imaging, e.g., abnormality detection, to assist in diagnosis or staging, or acting as an aid to clinical decision making, or intervention. Secondary benefits are those that are not related to the justification for imaging, e.g., to promote patient engagement and understanding or to facilitate communication.Existing work considering primary benefits is comprehensive. Secondary benefit, however, is less well recognised and may not be reliably realised. Use of the image to realise these benefits has far-reaching potential. Particularly, there may be underexplored benefits which access to the images may provide to patients. This represents a gap in existing research which should be addressed.

Little race or gender bias in an experiment of initial review of NIH R01 grant proposals.

Many granting agencies allow reviewers to know the identity of a proposal's principal investigator (PI), which opens the possibility that reviewers discriminate on the basis of PI race and gender. We investigated this experimentally with 48 NIH R01 grant proposals, representing a broad range of NIH-funded science. We modified PI names to create separate white male, white female, black male and black female versions of each proposal, and 412 scientists each submitted initial reviews for 3 proposals. We find little to no race or gender bias in initial R01 evaluations, and additionally find that any bias that might have been present must be negligible in size. This conclusion was robust to a wide array of statistical model specifications. Pragmatically, important bias may be present in other aspects of the granting process, but our evidence suggests that it is not present in the initial round of R01 reviews.

Clinical and in vitro efficacy of amoxicillin against bacteria associated with feline skin wounds and abscesses.

A clinical trial involving 122 cats with infected skin wounds or abscesses presented to 10 veterinary clinics was conducted to evaluate the efficacy of 2 oral amoxicillin drug products (a paste and a suspension). A 2nd objective of the study was to identify bacteria involved in such infections and verify their in vitro sensitivity to amoxicillin. Samples of wound exudate were harvested at the time of presentation and submitted for aerobic and anaerobic culture. The sensitivity to amoxicillin of isolates thought to be infecting agents was tested, using a standard minimum inhibitory concentration method. Pasteuralla multocida and obligate anaerobes of the genera Prevotella, Fusobacterium, and Porphyromonas were the most frequently isolated pathogens. Overall, their in vitro susceptibility to amoxicillin was very good. Both drug products were clinically efficacious with a global success rate of 95.1% for cats administered oral amoxicillin at 11-22 mg/kg bodyweight (mean 13.8 mg/kg bodyweight) twice daily for 7 to 10 days.

Ecological Invalidity of Existing Gaydar Research: In-Lab Accuracy Translates to Real-World Inaccuracy: Response to Rule, Johnson, & Freeman (2016).

In recent years, several empirical studies have claimed to provide evidence in support of the popular folk notion that people possess "gaydar" that enables them to accurately identify who is gay or lesbian (Rule, Johnson, & Freeman, 2016). This conclusion is limited to artificial lab settings, however, and when translated to real-world settings this work itself provides evidence that people's judgments about who is gay/lesbian are not pragmatically accurate. We also briefly review evidence related to the consequences of perpetuating the idea of gaydar (i.e., "the gaydar myth"). Although past claims about accurate orientation perception are misleading, the work that gave rise to those claims can nevertheless inform the literature in meaningful ways. We offer some recommendations for how the evidence in past "gaydar" research can be reappraised to inform our understanding of social perception and group similarities/differences.