On the different regimes of stochastic gradient descent.

Modern deep networks are trained with stochastic gradient descent (SGD) whose key hyperparameters are the number of data considered at each step or batch size [Formula: see text], and the step size or learning rate [Formula: see text]. For small [Formula: see text] and large [Formula: see text], SGD corresponds to a stochastic evolution of the parameters, whose noise amplitude is governed by the "temperature" [Formula: see text]. Yet this description is observed to break down for sufficiently large batches [Formula: see text], or simplifies to gradient descent (GD) when the temperature is sufficiently small. Understanding where these cross-overs take place remains a central challenge. Here, we resolve these questions for a teacher-student perceptron classification model and show empirically that our key predictions still apply to deep networks. Specifically, we obtain a phase diagram in the [Formula: see text]-[Formula: see text] plane that separates three dynamical phases: i) a noise-dominated SGD governed by temperature, ii) a large-first-step-dominated SGD and iii) GD. These different phases also correspond to different regimes of generalization error. Remarkably, our analysis reveals that the batch size [Formula: see text] separating regimes (i) and (ii) scale with the size [Formula: see text] of the training set, with an exponent that characterizes the hardness of the classification problem.

Patient activation reduces effects of implicit bias on doctor-patient interactions.

Disparities between Black and White Americans persist in medical treatment and health outcomes. One reason is that physicians sometimes hold implicit racial biases that favor White (over Black) patients. Thus, disrupting the effects of physicians' implicit bias is one route to promoting equitable health outcomes. In the present research, we tested a potential mechanism to short-circuit the effects of doctors' implicit bias: patient activation, i.e., having patients ask questions and advocate for themselves. Specifically, we trained Black and White standardized patients (SPs) to be "activated" or "typical" during appointments with unsuspecting oncologists and primary care physicians in which SPs claimed to have stage IV lung cancer. Supporting the idea that patient activation can promote equitable doctor-patient interactions, results showed that physicians' implicit racial bias (as measured by an implicit association test) predicted racially biased interpersonal treatment among typical SPs (but not among activated SPs) across SP ratings of interaction quality and ratings from independent coders who read the interaction transcripts. This research supports prior work showing that implicit attitudes can undermine interpersonal treatment in medical settings and provides a strategy for ensuring equitable doctor-patient interactions.

Examiner-examinee gender concordance does not impact ratings on the American Board of Surgery Vascular Surgery Certifying Examination.

OBJECTIVE: Implicit bias is a potential factor in the severity of examinee rating during oral examinations. Ratings may be impacted by examinee characteristics, such as gender, that are independent of examinee knowledge base, clinical judgment, or test-taking ability. The effects of examiner-examinee gender concordance in the Vascular Surgery Certifying Examination (VCE) have not been previously studied. We explored whether examiner ratings and likelihood of passing the examination were influenced by gender concordance among examiners and examinees. METHODS: Data collected from examinees who first attempted the VCE between 2018 and 2023 were analyzed. There were 1005 examinees (69.3% male and 30.1% female) and 121 examiners (71.9% male, and 28.1% female). Linear mixed-effects models and generalized linear mixed-effects models were used to evaluate the effects of examinee and examiner gender on VCE ratings and likelihood of passing the examination. RESULTS: Examiner-examinee gender concordance had no significant impact on examiner ratings or likelihood of passing the examination. In addition, examinee gender alone had no significant impact on VCE rating or pass rates. Only Vascular Qualifying Examination scores explained more than 1% of the variance in total VCE scores for the gender model (F(1, 1003.5) = 71.08, P < .01, R2 = 3%). Vascular Qualifying Examination scores were positively related to total VCE scores. CONCLUSIONS: Although implicit bias has the potential to impact examiner scoring, there is no evidence that this is the case with respect to gender in the VCE of the American Board of Surgery.

Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals.

PURPOSE: Black birthing parents and their newborns disproportionately experience newborn drug testing for prenatal substance exposure by health care professionals (HCPs), which contributes to Child Protective Services (CPS) reporting, family separation, and termination of parental rights. This qualitative study aims to interrogate dominant power structures by exploring knowledge, attitudes, and experiences of HCPs and CPS professionals regarding the influence of structural racism on inequities in newborn drug testing practices. METHODS: We conducted semistructured interviews with 30 physicians, midwives, nurses, social workers, and CPS professionals guided by an explanatory framework, and conducted inductive, reflexive thematic analysis. RESULTS: We identified 3 primary themes: (1) levels of racism beyond the hospital structure contributed to higher rates of drug testing for Black newborns; (2) inconsistent hospital policies led to racialized application of state law and downstream CPS reporting; and (3) health care professionals knowledge of the benefits and disproportionate harms of CPS reporting on Black families influenced their decision making. CONCLUSION: Health care professionals recognized structural racism as a driver of disproportionate newborn drug testing. Lack of knowledge and skill limitations of HCPs were barriers to dismantling power structures, thus impeding systems-level change. Institutional changes should shift focus from biologic testing and reporting to supporting the mutual needs of birthing parent and child through family-centered substance use treatment. State and federal policy changes are needed to ensure health equity for Black families and eliminate reporting to CPS for prenatal substance exposure when no concern for child abuse and neglect exists.

The Color of Medicine.

During my family medicine residency training, I was the junior doctor on the wards team when we encountered a young Black man who was hesitant to begin a new medication. I was also the only Black person on the team. After some initial trepidation about speaking up, I discussed my experiences with the patient and his mother and helped them see that the medication was not something to be feared. Later I faced criticism from a senior team member for bringing up the topic of race. Race is in fact an important consideration when treating patients. Understanding patients' lived experiences, especially when it comes to race, is essential in providing equitable health care.

Reflexivity and positionality applied to medical practice: a study on implicit gender bias with medical students in a Swiss university.

BACKGROUND: An array of evidence shows how the presence of implicit bias in clinical encounters can negatively impact provider-patient communication, quality of care and ultimately contribute to health inequities. Reflexive practice has been explored as an approach to identify and address implicit bias in healthcare providers, including medical students. At the Lausanne School of Medicine, a clinically integrated module was introduced in 2019 to raise students' awareness of gender bias in medical practice using a reflexivity and positionality approach. The purpose of this study is to describe the gender bias that were identified by medical students, analysing their types, places and modes of emergence during a clinical encounter. It further explores how positionality supported students' reflection on the way in which social position modulates their relationship to patients. METHODS: As part of the teaching activity, medical students individually reflected on gender bias in a specific clinical encounter by answering questions in their electronic portfolio. The questionnaire included a section on positionality. We qualitatively analysed the students' assignments (n=76), applying a thematic analysis framework. RESULTS: Medical students identified and described gender biases occurring at different moments of the clinical encounter (anamnesis (i.e. patient history), physical exam, differential diagnosis, final management). They causally associated these biases with wider social phenomena such as the gendered division of labour or stereotypes around sexuality and gender. Analysing students' reflections on how their position influenced their relationship with patients, we found that the suggested exercise revealed a major contradiction in the process of medical enculturation: the injunction to be neutral and objective erases the social and cultural context of patients and impedes an understanding of gender bias. CONCLUSION: Gender biases are present in the different steps of a clinical consultation and are rooted in broader gendered social representations. We further conclude that the tension between a quest for objectivity and the reality of social encounters should be made explicit to students, because it is constitutive of medical practice.

Review on clinician bias and its impact on racial and socioeconomic disparities in pediatric heart transplantation.

This expert review seeks to highlight implicit bias in health care, transplant medicine, and pediatric heart transplantation to focus attention on the role these biases may play in the racial/ethnic and socioeconomic disparities noted in pediatric heart transplantation. This review breaks down the transplant decision making process to highlight points at which implicit bias may affect outcomes and discuss how the science of human decision making may help understand these complex processes.

Examining where to go: pediatric psychology trainees' perception of their graduate training in culture and diversity.

OBJECTIVE: Culture and diversity-related training is critical to the development of competent pediatric psychologists. Evaluation of training efforts have been conducted at the program level, yet evaluation of trainee experiences in culture and diversity-related training remains unassessed. This trainee-led study was the first formal assessment of pediatric psychology trainee experiences of culture and diversity-related training and the impact of training on their own cultural humility. METHODS: Study overview and a survey link was distributed across 2 listservs associated with the American Psychological Association (Division 53, Division 54) and sent directly to directors of graduate, internship, and fellowship training programs with a request to share with trainees. Surveys assessing integration of cultural training and trainee cultural humility were completed. Trainees also provided qualitative feedback regarding their multicultural training and development. RESULTS: Pediatric psychology trainees (N = 90) reported inconsistent integration of culture and diversity topics into their training. Of the 34 training areas assessed, 10 were perceived as thoroughly integrated into formal training by at least half of the respondents. Trainees often sought independent cultural training outside of their programs, and no relationship was detected between perceived integration of cultural training and trainee cultural competence. DISCUSSION: Results indicate room for improvement regarding integration of cultural training and a need to better understand driving forces behind trainees independently seeking training outside of their formal training programs. Moreover, understanding the aspects of training that are most contributory to trainee development is needed given that no relationship between training and development emerged in the current study.

When People Do Allyship: A Typology of Allyship Action.

ACADEMIC ABSTRACT: Despite increased popular and academic interest, there is conceptual ambiguity about what allyship is and the forms it takes. Viewing allyship as a practice, we introduce the typology of allyship action which organizes the diversity of ways that advantaged individuals seek to support those who are disadvantaged. We characterize allyship actions as reactive (addressing bias when it occurs) and proactive (fostering positive outcomes such as feelings of inclusion, respect, and capacity), both of which can vary in level of analysis (i.e., targeting oneself, one or a few other individuals, or institutions). We use this framework to profile six productive yet largely independent bodies of social psychological literature on social action and directly compare relative benefits and constraints of different actions. We suggest several future directions for empirical research, using the typology of allyship to understand when, where, and how different forms of allyship might succeed. PUBLIC ABSTRACT: Despite increased popular and academic interest in the word, people differ in what they believe allyship is and the forms it takes. Viewing allyship as a practice, we introduce a new way (the typology of allyship action) to describe how advantaged individuals seek to support those who are disadvantaged. We characterize allyship actions as reactive (addressing bias when it occurs) and proactive (increasing positive outcomes such as feelings of inclusion, respect, and capacity), both of which can vary in level (i.e., targeting oneself, one or a few other individuals, or institutions). We use this framework to profile six large yet mostly separate areas of social psychological research on social action and directly compare the relative benefits and limitations of different actions. We suggest several future directions for how the typology of allyship action can help us understand when, where, and how different forms of allyship might succeed.

In the Mind's Eye: Exploring the Relationship Between Visual Mental Imagery and Stereotyping.

ACADEMIC ABSTRACT: How do social stereotypes shape and reflect images formed in the mind's eye? Visual mental imagery has long been assumed crucial in creating, maintaining, and perpetuating stereotypes and prejudice. Surprisingly, research in social cognition has only recently begun to explore the causal role of mental images in these phenomena. In contrast, cognitive neuroscience research on visual mental imagery (VMI) has explored the pivotal role of imagery in various consequential cognitive and behavioral phenomena. However, cognitive neuroscience has largely neglected how stereotypes influence mental imagery. This article provides a historical overview of the development of these two fields in terms of mental imagery and discusses recent advances at their intersection. Opportunities for additional integration are highlighted, and suggestions for furthering the dual study of stereotyping and mental imagery are provided. PUBLIC ABSTRACT: How can social stereotypes impact and mirror visual imagination? It has long been assumed that visual mental imagery plays a central role in forming, maintaining, and strengthening stereotypes and prejudice. Yet, until recently, there has been limited exploration within social psychology and cognitive neuroscience on the explicit connection between visual mental images and social stereotypes. We describe the historical progression of these fields concerning visual imagery and explore recent advancements that unite stereotyping and mental imagery research. Furthermore, we propose avenues for future research to deepen our understanding of how individuals utilize mental images in stereotyping and how mental imagery can modify stereotypes.

Current Practices in Operationalizing and Addressing Racial Equity in the Provision of Type 1 Diabetes Care: Insights from the Type 1 Diabetes Exchange Quality Improvement Collaborative Health Equity Advancement Lab.

OBJECTIVE: Medical racism contributes to adverse health outcomes. Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI) is a large population-based cohort engaged in data sharing and quality improvement to drive system changes in T1D care. The annual T1DX-QI survey included questions to evaluate racial equity in diabetes care and practices to promote equity. METHODS: The annual T1DX-QI survey was administered to participating clinics in fall 2022 and had a 93% response rate. There were 50 responses (pediatric: 66% and adult: 34%). Questions, in part, evaluated clinical resources and racial equity. Response data were aggregated, summarized, and stratified by pediatric/adult institutions. RESULTS: Only 21% pediatric and 35% adult institutions felt that all their team members can articulate how medical racism contributes to adverse diabetes outcomes. Pediatric institutions reported more strategies to address medical racism than adult (3.6 vs 3.1). Organizational strategies to decrease racial discrimination included employee trainings, equity offices/committees, patient resources, and hiring practices. Patient resources included interpreter services, transportation, insurance navigation, and housing and food assistance. Hiring practices included changing prior protocols, hiring from the community, and diversifying workforces. Most institutions have offered antiracism training in the last year (pediatric: 85% and adult: 72%) and annually (pediatric: 64% and adult: 56%). Pediatric teams felt that their antiracism training was effective more often (pediatric: 60% and adult: 45%) and more commonly, they were provided resources (pediatric: 67% and adult: 47%) to help address inequities. CONCLUSION: Despite increased antiracism training, insufficient institutional support and perceived subeffective training still represent obstacles, especially in adult institutions. Sharing effective strategies to address medical racism will help institutions take steps to mitigate inequities.

Sexual harassment and implicit gender-career biases negatively impact women's life expectancy in the US: a state-level analysis, 2011-2019.

BACKGROUND: Despite some gains, women continue to have less access to work and poorer experiences in the workplace, relative to men. The purpose of this study was to examine the relationships among women's life expectancy and two work-related factors, sexual harassment and gender-career biases. METHOD: We examined the associations at the state level of analysis (and District of Columbia) in the US from 2011 to 2019 (n = 459) using archival data from various sources. Measures of the ratio of population to primary health providers, year, the percent of adults who are uninsured, the percent of residents aged 65 or older, and percent of residents who are Non-Hispanic White all served as controls. RESULTS: Results of linear regression models showed that, after accounting for the controls, sexual harassment and gender-career biases among people in the state held significant, negative associations with women's life expectancy. CONCLUSION: The study contributes to the small but growing literature showing that negative workplace experiences and bias against women in the workplace negatively impact women's health.

Mapping social exclusion in STEM to men's implicit bias and women's career costs.

Why are women socially excluded in fields dominated by men? Beyond the barriers associated with any minority group's mere numerical underrepresentation, we theorized that gender stereotypes exacerbate the social exclusion of women in science, technology, engineering, and math (STEM) workplaces, with career consequences. Although widely discussed, clear evidence of these relationships remains elusive. In a sample of 1,247 STEM professionals who work in teams, we tested preregistered hypotheses that acts of gendered social exclusion are systematically associated with both men's gender stereotypes (Part 1) and negative workplace outcomes for women (Part 2). Combining social network metrics of inclusion and reaction time measures of implicit stereotypes (the tendency to "think STEM, think men"), this study provides unique empirical evidence of the chilly climate women often report experiencing in STEM. Men with stronger implicit gender stereotypes had fewer social ties to female teammates. In turn, women (but not men) with fewer incoming cross-gender social ties reported worse career fit and engagement. Moderated mediation revealed that for women (but not men), cross-gender social exclusion was linked to more negative workplace outcomes via lower social fit. Effects of social exclusion were distinct from respect. We discuss the possible benefits of fostering positive cross-gender social relationships to promote women's professional success in STEM.

'My words would have more weight': exploring weight stigma in UK dietetic practice and dietitian's lived experiences of weight stigma.

BACKGROUND: Weight stigma is pervasive within healthcare and negatively impacts both access to care and the patient-practitioner relationship. There is limited evidence on weight stigma among registered dietitians, particularly in the United Kingdom, though data show weight-related prejudice towards people living with obesity. The aim of this study was to examine both explicit and implicit weight stigma in practicing dietitians in the United Kingdom, as well as the lived experience of weight stigma among dietitians, both towards themselves and towards others. METHODS: An online cross-sectional survey was disseminated between February and May 2022 using snowball sampling. Inclusion criteria were that participants were UK registered dietitians aged 20-70 years. RESULTS: Four hundred and two dietitians responded to the survey (female [94.1%], mean age 40.2 years [standard deviation (SD) 10.7]; White ethnicity [90%]; median 12 years [interquartile range (IQR) 6, 22] within dietetic practice). Mean self-reported body mass index was 25.1 kg/m² (SD 8.7). Most dietitians reported experiencing weight stigma prior to (51%) and postregistration (59.7%), whereas nearly a quarter (21.1%) felt that weight influenced their ability as a dietitian. Weight stigma was experienced across the weight spectrum. Overall participants reported explicit weight bias attitudes, moderate beliefs that obesity is controllable and implicit antifat bias. Within open-ended responses, dietitians reported three key themes related to their personal experiences of weight stigma: (1) experiences of stigma in dietetic practice, (2) impact of weight stigma and (3) perception of weight, appearance and job. CONCLUSION: This study shows that UK dietitians exhibit both explicit and implicit weight bias towards people living with obesity. Dietitians reported experiencing weight stigma, which impacted their career-related decisions and their perception of their own ability to perform as dietitians. The study highlights the need to address weight stigma and its implications within the dietetic profession.

'You don't see what I see': Co-designing simulation to uncover and address cognitive bias in healthcare.

EDUCATIONAL CHALLENGE: Each year, adverse events are reported in healthcare, of which many relate to healthcare workforce cognitive bias. The active involvement of workforce and consumers in the review and co-design of effective training for the healthcare workforce to recognise, monitor, and manage unconscious bias is required. PROPOSED SOLUTION: We used participatory action research to co-design an innovative, interprofessional simulation based on 'real world' clinical incidents and lived experiences to improve the delivery of safe, high quality, consumer-focused healthcare. Following ethics approval, content analysis of serious adverse patient safety events involving cognitive bias was conducted. These data informed audio-recorded interviews with the healthcare workforce and consumers to explore their experiences of cognitive bias. Following thematic analysis, key themes of communication, stigma, diagnostic overshadowing, and fragmented systems were uncovered. Guided by consumers, these themes were interwoven into a simulation scenario that included real places, stories, and verbatim quotes delivered through mixed media artefacts. This heightened the immersive and experiential learning that aimed to uncover unconscious bias and help learners recognise its impact on clinical decisions and practice. POTENTIAL BENEFITS AND NEXT STEPS: To our knowledge, this is the first interprofessional, co-designed simulation to specifically address cognitive bias in current and future healthcare workforce. Plans to translate this research into a practical framework on how to work with key stakeholders (including consumers) to identify 'real-world' health service risks and co-design targeted simulations to address these gaps are described, including lessons learned.

Adolescents' implicit and explicit attitudes toward their peers with genetic conditions.

INTRODUCTION: Previous research has demonstrated that children lacking knowledge about genetic disorders may have harmful attitudes toward people with disabilities, but disability awareness can successfully modify these attitudes. We explored adolescents' implicit and explicit attitudes toward peers with genetic conditions to determine whether improved genetics/genomics literacy can mitigate the impact of ableism in this population. METHODS: English-speaking adolescents (10-18 years) from British Columbia were invited to complete a Disability Attitudes Implicit Association Test (DA-IAT) and participate in a semi-structured focus group centering on a fictionalized vignette about an adolescent with Down syndrome. We used pragmatism as an analytical paradigm. Descriptive and inferential statistics were used to analyze DA-IAT and sociodemographic data; phronetic iterative analysis with constant comparison as a coding strategy for transcripts; and interpretive description to develop a conceptual model. RESULTS: Twenty-two adolescents completed the DA-IAT and participated in one of four focus groups. Participants had a statistically significant implicit preference for non-disabled people (D-score = 0.72, SD = 0.44; t = 7.18, p < .00001). They demonstrated greater diversity in their explicit attitudes during the focus groups. Although participants articulated a positive attitude toward improved genetics education, results demonstrate their belief that social and personal interactions with disabled peers would be essential to address negative perceptions. CONCLUSIONS: This study lays important groundwork to understand, explain, and influence the negative attitudes of adolescents toward individuals with disabilities. Findings will be used to inform the design of interventions that address biased perceptions of people with genetic disorders, with the goal of reducing prejudices and improving social interactions.

Initial evidence of reliability and validity of an implicit association test assessing attitudes toward individuals who use substances.

Background: Substance use disorders (SUDs) are stigmatized conditions, with individual biases driving poor health outcomes. There are surprisingly few validated measures of bias or stigma toward individuals who use substances. Bias can be classified as explicit (self-report) or implicit (behaviorally based).Objectives: The goal of the present study was to establish preliminary indices of reliability and validity of an implicit association test (IAT) designed to measure implicit bias toward individuals who use substances.Methods: A large United States-based, crowd-sourced sample (n = 394, 51.5% male, 45.4% female, 2.5% nonbinary) completed the IAT and a small battery of survey instruments that assessed social distance to mental illness (including heroin use), attitude toward and perceived controllability of injection drug use, perception of public stigma, and social desirability.Results: Nearly all (92%; n = 363) scores on the IAT indicated greater negative than positive attitudes toward those who use substances. Spearman-Brown corrected split-half reliability on the IAT scores was excellent, r = .953. Controlling for social desirability, IAT scores positively correlated with all included measures pertaining to substance use as well as social distance for heroin and schizophrenia (but not diabetes). A principal component analysis resulted in two interpretable components representing disapproval (perceived controllability and negative attitudes) and perceived stigma (social stigma and social distance). Scores on the IAT positively correlated to scores on both components, again, controlling for social desirability.Conclusion: These results provide compelling preliminary evidence of validity of an IAT designed to measure bias toward individuals who use substances.

Pediatric healthcare professionals' attitudes and beliefs about weight stigma: A descriptive study.

PURPOSE: Children face weight-based stigma from their healthcare providers at a disconcerting rate, and efforts to mitigate this have been scant. This study aimed to quantify pediatric healthcare professionals' attitudes and beliefs about weight stigma and to determine stigma reduction interventions that are most supported by pediatric healthcare providers. DESIGN AND METHODS: Participants completed two validated instruments which measured implicit and explicit weight bias, respectively. They then completed a researcher-designed questionnaire to assess their attitudes and beliefs about weight stigma, and demographic questions. ANOVA models were used to examine associations between bias measures and participant characteristics, chi-square analyses were used to examine associations between questionnaire responses and participant characteristics, and Spearman's rank was used to determine correlations between weight bias and questionnaire responses. RESULTS: Participants exhibited moderate-to-high levels of implicit and explicit weight bias (mean Implicit Association Test score = 0.59, mean Crandall Anti-Fat Attitudes Score = 38.95). Associations were noted between implicit bias and years in practice (p < 0.05), and implicit bias and occupation (p < 0.05). There was a significant correlation between explicit bias and multiple questionnaire items, suggesting that healthcare providers with greater weight bias are aware of those biases and are ready to take action to address them. CONCLUSION: Though pediatric healthcare exhibit weight-based biases, they are invested in taking steps to mitigate these biases and their impact on patients. PRACTICE IMPLICATIONS: The results of this study can inform the design of future interventions that aim to reduce healthcare-based weight bias, thus improving the quality of pediatric healthcare.

Social work involvement on student interprofessional teams: a qualitative investigation.

Social workers on interprofessional teams help highlight the mental health aspects of wellness and alert teams to potential social barriers to care. Social work students have been valued in new interprofessional education (IPE) initiatives across the United States; however, researchers have shown that social work practitioners often feel outside of and not valued by interprofessional teams. Social work student reflections were analyzed as research data to explore experiences on student IPE teams. This was an inductive, qualitative study informed by literary analysis methods, reading for power dynamics and implicit bias. This analysis uncovered social work students holding on to stereotypes of other professions as well as detrimental stereotypes of their own profession. Displays of respect for social work and early opportunities for successful advocacy allowed social work students to feel confident in their role and encouraged participation. This study considers how social work participation can be encouraged on interprofessional student teams.

The work of race, culture, and ethnicity in nursing literature, 1970 to 1985.

BACKGROUND: In our current attempts to address health inequities and injustices, it is crucial to critically examine the evidence base from which we are working. The concepts of "race," "ethnicity," and "culture" have been persistently under-examined in healthcare literature. PURPOSE: Earlier reviews found that terms relating to race and ethnicity frequently go undefined, while euphemisms are used to avoid naming racism. This paper will elucidate the ways in which these concepts were put to work in nursing texts between 1970 and 1985. METHODS: This critical narrative review utilizes critical discourse-historical analysis to illuminate mechanisms through which racism operates in nursing and healthcare more broadly. DISCUSSION: Three operational categories, named for titles of representative works, are identified for concepts of racialized social difference during this time period: Working with others who are not like me, Biologic variation in health and illness, and When your patient is Black West Indian. CONCLUSION: The wide lens provided by temporal distance, with the benefit of historical perspective, can help attune us to the function of these concepts in the present.