A comparison of professional identity experiences among minoritized medical professionals.

OBJECTIVE: Professional identity formation (PIF) is considered a fundamental process in the development of healthcare providers. In medical education, the PIF literature has historically centered on medicine's socialization practices involving white male physicians. However, recently researchers have begun to reveal how larger socio-historical contexts influence PIF in minoritized physicians. To better understand what influences Black/African American physicians' PIF, this study compares their PIF experiences to a group of minoritized physician assistants (PAs). In comparing Black physicians' experiences to another provider, this study explored what PIF experiences may be attributed to participants' minoritized status and what might be attributed to the culture of medicine. METHODS: In this cross-case analysis, 45 minoritized PA students and practicing PAs were recruited from several Southeastern universities. The PA participants included 23 Black/African Americans, 12 Latinx, 4 Indigenous/Native, and 6 of mixed races/ethnicities. Interview data were then compared to previously collected data from 41 Black/African American medical trainees and physicians. Using constant comparative method, similarities and differences in PIF were explored. RESULTS: Similarities between the two groups included the importance of participants' racial/ethnic identity to patient care, experiences on-going microaggressions from patients and peers, and a desire to engage in racial uplift. However, one marked difference was found, namely that PAs felt they could bring their entire selves to the profession, whereas physicians described feeling splintered early in their training. CONCLUSIONS: Several possibilities that might explain why Black physicians and minoritized PAs have this one marked difference in their PIF experience, including identity threat, internalization of different discourses, and length of training for physicians. While this study was not designed to answer this question, it is clear that there is something in the culture of medicine and the training of physicians that signals to Black physicians that they cannot bring their whole selves to the profession.

Premolar Axial Wall Height Effect on CAD/CAM Crown Retention.

OBJECTIVE: To evaluate the significance of reduced axial wall height on retention of adhesively luted, all-ceramic, lithium disilicate premolar computer-aided design/computer-aided manufacturing (CAD/CAM) crowns based on preparations with a near ideal total occlusal convergence of 10°. METHODS: Forty-eight recently extracted premolars were randomly divided into four groups (n=12). Each group received all-ceramic CAD/CAM crown preparations featuring axial wall heights of 0, 1, 2, and 3 mm, respectively, all with a 10° total occlusal convergence. Scanned preparations were fitted with lithium disilicate all-ceramic crowns that were luted with a self-etching resin cement. Specimens were tested to failure at a 45° angle to the tooth long axis with failure load converted to megapascals (MPa) based on the measured bonding surface area. Mean data were analyzed using analysis of variance/Tukey's post hoc test (α=0.05). RESULTS: Lithium disilicate crowns adhesively luted on preparations with 0 axial wall height demonstrated significantly less failure resistance compared with the crowns luted on preparations with axial wall heights of 1 to 3 mm. There was no failure stress difference between preparations with 1 to 3 mm axial wall height. CONCLUSIONS: Under conditions of this study, adhesively luted lithium disilicate bicuspid crowns with a total occlusal convergence of 10° demonstrated similar failure resistance independent of axial wall height of 1 to 3 mm. This study provides some evidence that adhesion combined with an ideal total occlusal convergence may compensate for reduced axial wall height.

Medication persistence in older women with osteoporosis: a pilot study.

UNLABELLED: Most osteoporosis patients stop their medications before they should. Side effects are the most common reason patients in this sample stopped their medication before they told their physician. Physicians should use shared decision-making and discuss side effects of osteoporosis medications with their patients and explain the risks of the medications. INTRODUCTION: The aims of this study were to (a) qualitatively examine reasons for medication non-persistence in osteoporosis, and (b) investigate how medication non-persistence in osteoporosis is associated with outcome expectations, self-efficacy, trust in physicians, and health locus of control. METHODS: Subjects were recruited from online support groups to answer an anonymous online survey. Subjects were eligible if they (a) were female, (b) were at least 40 years of age, (c) self-identify as having osteoporosis, and (d) have taken at least one medication for osteoporosis. During the survey, subjects completed measures of self-efficacy, outcome expectations, trust in physicians generally, health locus of control, and demographic information. RESULTS: Thirty-four subjects completed the online survey and had usable data. Approximately 82 % (n = 28) of subjects reported discontinuing an osteoporosis medication without first consulting a physician. The most common reason patients discontinued an osteoporosis medication was adverse effects. Subjects were more likely to discontinue their medications when they had poorer outcome expectations on average (p = 0.01), had lower trust in physicians on average (p < 0.0001), and had more of a doctors-centered locus of control (p = 0.03). Self-efficacy, age, insurance, status, and other measures of locus of control were not associated with medication non-persistence. CONCLUSIONS: Side effects are a significant concern for women with osteoporosis and may be a cause for medication non-persistence.

Efficacy of female rat models in translational cardiovascular aging research.

Cardiovascular disease is the leading cause of death in women in the United States. Aging is a primary risk factor for the development of cardiovascular disease as well as cardiovascular-related morbidity and mortality. Aging is a universal process that all humans undergo; however, research in aging is limited by cost and time constraints. Therefore, most research in aging has been done in primates and rodents; however it is unknown how well the effects of aging in rat models translate into humans. To compound the complication of aging gender has also been indicated as a risk factor for various cardiovascular diseases. This review addresses the systemic pathophysiology of the cardiovascular system associated with aging and gender for aging research with regard to the applicability of rat derived data for translational application to human aging.

Plasma xanthophyll carotenoids correlate inversely with indices of oxidative DNA damage and lipid peroxidation.

Post hoc analysis of data obtained from a study designed to modulate oxidative damage by dietary intervention revealed consistently strong inverse correlations between plasma xanthophyll carotenoids and oxidative damage indices. Thirty-seven women participated in a 14-day dietary intervention that increased mean vegetable and fruit (VF) consumption to approximately 12 servings/day. An additional 10 subjects participated in an intervention that limited VF consumption to less than four servings per day. 8-Hydroxy-2'-deoxyguanosine (8-OHdG) in DNA isolated from peripheral lymphocytes and 8-OHdG excreted in urine were measured as indices of oxidative DNA damage. Lipid peroxidation was assessed by measuring 8-epiprostaglandin F2alpha (8-EPG) in urine. Plasma levels of selected carotenoids were also determined, with the intention of using a-carotene as a biochemical index of VF consumption. Urinary 8-OHdG and 8-EPG were measured by ELISA, and plasma carotenoids were measured by high performance liquid chromatography. Lymphocyte 8-OHdG was measured by reverse phase high performance liquid chromatography with electrochemical detection. We observed that the structurally related xanthophyll carotenoids, lutein and beta-cryptoxanthin, which occur in dissimilar botanical families, were consistently inversely associated with these oxidative indices. Statistically significant inverse correlations were observed between plasma lutein and/or beta-cryptoxanthin levels and lymphocyte 8-OHdG and urinary 8-EPG. Moreover, an inverse correlation was observed between change in plasma xanthophylls and change in lymphocyte 8-OHdG concentration that occurred during the course of the study. These data lead us to hypothesize that lutein and beta-cryptoxanthin serve as markers for the antioxidant milieu provided by plants from which they are derived. Whether these carotenoids are directly responsible for the observed antioxidant phenomena merits further investigation.

Effect of increased vegetable and fruit consumption on markers of oxidative cellular damage.

The goal of this study was to test the hypothesis that increased consumption of vegetables and fruit would reduce markers of oxidative cellular damage that can be assessed in blood or urine. Twenty-eight women participated in a 14 day dietary intervention. The primary end-points assessed were: 8-hydroxydeoxyguanosine (8-OHdG) in DNA isolated from peripheral lymphocytes, determined by HPLC with electrochemical detection; 8-OHdG excreted in urine, measured by ELISA; malondialdehyde (MDA) in urine, measured by fluorimetric detection following derivatization with thiobarituric acid and separation via HPLC; urinary 8-isoprostane F-2alpha (8-EPG) detected by ELISA. Pre- and post-intervention plasma levels of selected carotenoids were determined by HPLC. Subjects were free living and consumed a completely defined recipe-based diet that increased their average daily consumption of vegetables and fruit from 5.8 servings at baseline to 12.0 servings throughout the intervention. Overall, the level of 8-OHdG in DNA isolated from lymphocytes and in urine and the level of 8-EPG in urine were reduced by the intervention, whereas urine concentrations of MDA were minimally affected. The reduction in lymphocyte 8-OHdG was greater in magnitude (32 versus 5%) in individuals with lower average pre-intervention levels of plasma alpha-carotene (56 ng/ml) than in individuals with higher average pre-intervention plasma levels of alpha-carotene (148 ng/ml). The results of this study indicate that consumption of a diet that significantly increased vegetable and fruit intake from a diverse number of botanical families resulted in significant reductions in markers of oxidative cellular damage to DNA and lipids.

Brief psychological intervention with traumatized young women: the efficacy of eye movement desensitization and reprocessing.

To study the efficacy of eye movement desensitization and reprocessing (EMDR) with traumatized young women, 60 women between the ages of 16 and 25 were randomly assigned to two sessions of either EMDR or an active listening (AL) control. Factorial ANOVA interaction effects and simple main effects for outcome measure (Beck Depression Inventory, State-Trait Anxiety Inventory, Penn Inventory for Posttraumatic Stress Disorder, Impact of Event Scale, Tennessee Self-Concept Scale) indicated significant improvement for both groups and significantly greater pre-post change for EMDR-treated participants. Pre-post effect sizes for the EMDR group averaged 1.56 compared to 0.65 for the AL group. Despite treatment brevity, the posttreatment outcome variable means of EMDR-treated participants compared favorably with nonpatient or successfully treated norm groups on all measures.

Energy availability and mammary carcinogenesis: effects of calorie restriction and exercise.

The purpose of this experiment was to compare the carcinogenic response in the mammary gland among groups of rats whose energy metabolism had been modulated by restricting dietary calories and/or by increasing energy expenditure via exercise. Female F344 rats (n = 132) were injected i.p. with 1-methyl-1-nitrosomethylurea (50 mg/kg at 50 and 57 days of age) and were randomized into one of four treatment groups: (i) unrestricted, sedentary; (ii) calorie-restricted, sedentary; (iii) unrestricted, exercised; (iv) calorie-restricted, exercised. The targeted level of calorie-restricted was 20% and exercise was achieved by treadmill-running (20 m/min at a 15% grade for 30 min, 5 days/week). During the 20.5 week study, rats were palpated twice a week for detection of mammary tumors and urine was collected for determination of 24-h cortical steroid excretion. At the end of the study, all mammary lesions were histologically classified. Carcass composition and carcass energy were determined. Mammary carcinogenesis was inhibited among calorie-restricted, sedentary rats compared with unrestricted, sedentary rats (79% inhibition, P < 0.001). No inhibition of carcinogenesis was observed among exercised rats (unrestricted or calorie-restricted) relative to the unrestricted, sedentary rats. Within the present experimental design, exercise had no effect on carcinogenesis despite significant reductions of carcass fat and carcass energy among both groups of rats that exercised. Cortical steroid level was significantly higher only in calorie-restricted, sedentary rats (P < 0.05). These results do not support the hypothesis that reductions of body weight gain, carcass fat or carcass energy are sufficient conditions to inhibit mammary carcinogenesis. The results do suggest that changes in urinary cortical steroid excretion may predict whether an energy-related intervention is likely to alter mammary carcinogenesis.

Interaction of acute changes in exercise energy expenditure and energy intake on resting metabolic rate.

The effects on resting metabolic rate (RMR) of energy intake and exercise energy expenditure were examined in eight trained men under four conditions: 1) high energy flux (HF), 90 min of exercise at 75% VO2max on 3 d while in energy balance; 2) low energy flux (LF), no exercise for 3 d while in energy balance; 3) negative energy balance (NEB), exercise on 3 d while consuming low-flux meals; and 4) positive energy balance (PEB), no exercise for 2 d while consuming high-flux meals. Eight untrained men were studied in LF. There were effects of exercise energy expenditure and energy intake on RMR, and an exercise x diet interaction (P < 0.05). RMR was greater in trained than in untrained subjects only when trained subjects were in HF. These data indicate that RMR is influenced by exercise, energy intake, and their interaction and suggest that higher RMR in trained vs untrained individuals results from acute effects of HF rather than from a chronic adaptation to exercise training.

Postexercise energy expenditure in response to acute aerobic or resistive exercise.

Postexercise energy metabolism was examined in male subjects age 22-35 years in response to three different treatments: a strenuous bout of resistive exercise (REx), a bout of stationary cycling (AEx) at 50% peak VO2, and a control condition (C) of quiet sitting. Resting metabolic rate (RMR) was measured the morning of and the morning following each condition. Recovery oxygen consumption (RcO2) was measured for 5 hr following each treatment. Total 5-hr RcO2 was higher for the REx treatment relative to both AEx and C, with the largest treatment differences occurring early during recovery. There were no large treatment differences in postexercise respiratory exchange ratio values, except for the first hour of recovery following REx. RMR measured 14.5 hr postexercise for the REx condition was significantly elevated compared to C. These results suggest that strenuous resistive exercise results in a greater excess postexercise oxygen consumption compared to steady-state endurance exercise of similar estimated energy cost.

Patient callback program: a quality improvement, customer service, and marketing tool.

The authors developed, implemented, and evaluated a callback program in which hospital patients are contacted three weeks after discharge to resolve clinical or service concerns. Of the more than 2,000 patients contacted during the initial pilot test, 6% said they had a clinical concern and were promptly directed to a physician's office. A randomized/controlled study comparing a control group of patients (who were not called) to an experimental group (called) shows that several satisfaction measures increased positively within the experimental group. The authors conclude that the Patient Callback Program contributes to more effective clinical care and to perceptions of higher customer service.