Eradicating Racism From Maternity Care Begins With Addressing Implicit Bias

Black women have long experienced racism in various areas of their lives. Pregnancy is one of the times in a woman’s life when she is most vulnerable, and she should not have to worry that her health care will be subpar simply because she is Black. Most health care providers do not intend to harm their patients; however, systemic racism and the unconscious biases we hold may cause harm. Training nurses and other health care providers about implicit bias is one step toward eradicating racism from maternity care.     

Sociodemographic Differences in the Comprehension of Nutritional Labels on Food Products

ObjectiveTo examine comprehension of nutrition labels across sociodemographic groups using a measure of health literacy.MethodsCross-sectional survey of a community sample of adults including an adapted version of the Newest Vital Sign for Canadian Nutrition Facts table on prepackaged grocery products, including numerical conversion questions for calorie content and percent daily value.ResultsApproximately two thirds of participants were able to correctly identify calorie content and percent daily value from the nutrition label. Participants with higher education and higher income, those aged ≤ 64 years, and those who look at nutritional facts or calories were significantly more likely to estimate the correct calorie content. Participants were significantly more likely to correctly identify percent daily value if they reported higher education, higher income, and white ethnicity.Conclusions and ImplicationsApproximately one third of participants could not comprehend basic information on Canadian nutrition labels. Lower socioeconomic status was associated with poorer performance.     

The Measurement and Health Impact of Endotoxin Contamination in Organic Dusts from Multiple Sources: Focus on the Cotton Industry

Endotoxin is derived from Gram-negative bacterial membranes, and its inflammatory effects following inhalation are well characterized. The significance of this fact becomes apparent when the wide-ranging environments containing high levels of this microbial product are considered. Endotoxin is present in numerous industrial environments, especially where organic fibers are processed. Microbial contamination of these fibers mainly occurs at the agricultural stage. Materials such as flax and hemp are affected in this way, but the most important product in this context is cotton, from which chronic dust inhalation causes the disease byssinosis. Despite the fact that endotoxin constitutes a significant threat to public health, there are currently no occupational exposure limits for this toxicant. This communication describes the toxicology of endotoxin, and its role in inhalation-induced disease, focusing on measurement of airborne endotoxin in the occupational and domestic environments using the Limulus amebocyte lysate (LAL) enzyme assay. Following the success of the LAL assay for measuring endotoxin in dusts, our laboratory has examined its application to aqueous washes from cotton fibers. Reproducibility of the results was high, and data are presented displaying levels of endotoxin contamination in fibers from different cotton producing countries. Hence, worldwide comparison of industrial endotoxin concentrations can be readily made using this test. It would be highly desirable if the performance of the LAL assay facilitated introduction of industrial endotoxin safety limits, and in spite of minor surmountable shortcomings, the test is accurate, reliable, and well field-tested, so its continued widespread use may achieve this goal.     

Ability of Hypnosis to Facilitate Movement Through Stages of Change for Smoking Cessation

On the basis of the transtheoretical model of change, we hypothesized that hypnosis would facilitate significantly greater movement through the stages of change toward smoking cessation in contrast to psychoeducation. Thirty participants were pretested for hypnotizability using the Elkins Hypnotizability Scale (EHS). Participants’ readiness for change was assessed using the University of Rhode Island Change Assessment scale (URICA). The EHS relaxation induction was used to induce hypnosis. Hypnotic suggestions addressed motivation and ambivalence. The URICA was administered following the intervention and at a 10-day follow-up. Two-factor split-plot ANOVAs showed significant changes within groups on the contemplation subscale (p = .002), action subscale (p = .00007), and the number of cigarettes smoked per day (p = .003).     

Locoregional control and survival after lymph node SBRT in oligometastatic disease

Stereotactic body radiotherapy (SBRT) has emerged as an effective option in oligo-metastatic cancer patients affected by lymph node metastases, but its use might be questioned due to risk of regional and distant dissemination through the lymph node chain. The primary aim of our study was to assess the loco-regional control following SBRT in this setting. Ninety-one patients undergoing SBRT for at least one lymph node metastasis from miscellaneous primary tumors were retrospectively evaluated for patterns of failure and toxicity. locoregional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS) at 4 years were 79 and 44%. Repeated use of local therapy after progression resulted in a median interval of 17 months until allocation to systemic therapy or supportive care. Forty-three percent of patients were alive at 4 years. Local failure, occurring in 15% of patients, was the only predictor of poor survival (HR: 3.06). Tumor diameter?≥?30 mm and urothelial primary tumor predicted for impaired local control (HR: 4.59 and 5.43, respectively). Metastases from pulmonary cancer showed a significant earlier distant dissemination (HR: 3.53). Only acute and late grade 1–2 toxicities were reported except for 1 case of G3 dysphagia. Loco-regional failure risk is low (18%) and justifies the use of local therapies for patients with oligometastatic disease. Durable disease remission can be achieved by iterative use of local approaches. Local control is correlated to improved OS. Diameter and primary tumor type may affect response to SBRT and risk for early metastatic dissemination.     

Impact of Acoustic Radiation Force Excitation Geometry on Shear Wave Dispersion and Attenuation Estimates

Shear wave elasticity imaging (SWEI) characterizes the mechanical properties of human tissues to differentiate healthy from diseased tissue. Commercial scanners tend to reconstruct shear wave speeds for a region of interest using time-of-flight methods reporting a single shear wave speed (or elastic modulus) to the end user under the assumptions that tissue is elastic and shear wave speeds are not dependent on the frequency content of the shear waves. Human tissues, however, are known to be viscoelastic, resulting in dispersion and attenuation. Shear wave spectroscopy and spectral methods have been previously reported in the literature to quantify shear wave dispersion and attenuation, commonly making an assumption that the acoustic radiation force excitation acts as a cylindrical source with a known geometric shear wave amplitude decay. This work quantifies the bias in shear dispersion and attenuation estimates associated with making this cylindrical wave assumption when applied to shear wave sources with finite depth extents, as commonly occurs with realistic focal geometries, in elastic and viscoelastic media. Bias is quantified using analytically derived shear wave data and shear wave data generated using finite-element method models. Shear wave dispersion and attenuation bias (up to 15% for dispersion and 41% for attenuation) is greater for more tightly focused acoustic radiation force sources with smaller depths of field relative to their lateral extent (height-to-width ratios <16). Dispersion and attenuation errors associated with assuming a cylindrical geometric shear wave decay in SWEI can be appreciable and should be considered when analyzing the viscoelastic properties of tissues with acoustic radiation force source distributions with limited depths of field.