'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.

Stigma, shame and family secrets as consequences of mental illness in previous generations: A micro-history approach.

In this article we evaluate micro-history as a method for investigating the meaning of stigma, shame and family secrets through generations. We present micro-histories of two Australian soldiers who developed mental illness years after serving in World War 1 and were committed to a psychiatric hospital where they died. Data were drawn from publicly available records and interviews with family members. The contrasting stories held by the families of each man illustrate the transmission of stigma and secrets through families. We explore possible reasons for the differences between the families related to the wider literature on stigma and mental health and show why the family stories people present should be considered social constructions rather than facts. We also address ethical issues that arose during the research, and which have relevance for researchers investigating sensitive or potentially stigmatising topics.

Coal-tar-based pavement sealcoat and PAHs: implications for the environment, human health, and stormwater management.

Coal-tar-based sealcoat products, widely used in the central and eastern U.S. on parking lots, driveways, and even playgrounds, are typically 20-35% coal-tar pitch, a known human carcinogen that contains about 200 polycyclic aromatic hydrocarbon (PAH) compounds. Research continues to identify environmental compartments-including stormwater runoff, lake sediment, soil, house dust, and most recently, air-contaminated by PAHs from coal-tar-based sealcoat and to demonstrate potential risks to biological communities and human health. In many cases, the levels of contamination associated with sealed pavement are striking relative to levels near unsealed pavement: PAH concentrations in air over pavement with freshly applied coal-tar-based sealcoat, for example, were hundreds to thousands of times higher than those in air over unsealed pavement. Even a small amount of sealcoated pavement can be the dominant source of PAHs to sediment in stormwater-retention ponds; proper disposal of such PAH-contaminated sediment can be extremely costly. Several local governments, the District of Columbia, and the State of Washington have banned use of these products, and several national and regional hardware and home-improvement retailers have voluntarily ceased selling them.

Polycyclic aromatic hydrocarbons in stormwater runoff from sealcoated pavements.

Coal-tar based sealcoat has been identified as a source of polycyclic aromatic hydrocarbons (PAHs) in the environment. This study measured the long-term release of PAHs in parking lot runoff and found that the presence of coal tar sealant increased the mass of PAHs released in runoff by over an order of magnitude. PAH concentrations in stormwater from two coal tar sealed parking lots and one unsealed parking lot (control) were monitored over a two-year period. The measured flow volume and concentrations were used to calculate a mass of 9.8-10.8 kg total Σ16 PAHs per hectare exported in stormwater runoff from the two sealed parking lots and 0.34 kg total Σ16 PAHs per hectare from the unsealed control. The study also measured sediment PAH concentration changes in a receiving drainage and found that even partial coverage of a drainage area by coal tar sealant resulted in measurable increases in PAH sediment concentrations; PAH concentrations in sediment in a stormwater swale receiving runoff from both sealed and unsealed lots increased near the outfall from less than 4 mg/kg prior to sealing to 95.7 mg/kg after sealing. Compound ratio plots and principal components analysis were examined and were able to clearly differentiate between pre- and postsealant samples.

Uptake of polycyclic aromatic hydrocarbons (PAHs) in salt marsh plants Spartina alterniflora grown in contaminated sediments.

Polycyclic aromatic hydrocarbon (PAH) concentrations were measured in Spartina alterniflora plants grown in pots of contaminated sediment, plants grown in native sediment at a marsh contaminated with up to 900 microg/g total PAHs, and from plants grown in uncontaminated control sediment. The roots and leaves of the plants were separated, cleaned, and analyzed for PAHs. PAH compounds were detected at up to 43 microg/g dry weight in the root tissue of plants grown in pots of contaminated soil. PAH compounds were detected at up to 0.2 microg/g in the leaves of plants grown in pots of contaminated soil. Concentrations less than 0.004 microg/g were detected in the leaves of plants grown at a reference site. Root concentration factor (RCF) values ranged from 0.009 to 0.97 in the potted plants, and from 0.004 to 0.31 at the contaminated marsh site. Stem concentration factor (SCF) values ranged from 0.00004 to 0.03 in the potted plants and 0.0002 to 0.04 at the contaminated marsh. No correlation was found between the RCF value and PAH compound or chemical properties such as logKOW. SCF values were higher for the lighter PAHs in the potted plants, but not in the plants collected from the contaminated marsh. PAH concentrations in the roots of the potted plants are strongly correlated with soil concentrations, but there is less correlation for the roots grown in natural sediments. Additional plants were grown directly in PAH-contaminated water and analyzed for alkylated PAH homologs. No difference was found in leaf PAH concentrations between plants grown in contaminated water and control plants.