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In this paper, we examine the academy as a specific case of the racialization of space, arguing that most colleges and universities in the United States are in fact historically white colleges and universities (HWCUs). To uncover this reality, we first describe the dual relationship between space and race and racism. Using this theoretical framing, we demonstrate how seemingly “race neutral” components of most American universities (i.e., the history, demography, curriculum, climate, and sets of symbols and traditions) embody, signify, and reproduce whiteness and white supremacy. After examining the racial reality of HWCUs, we offer several suggestions for making HWCUs into truly universalistic, multicultural spaces.

This critical narrative inquiry explored the motivations for Queer Women of Color to join culturally based sororities. Using Munoz’s concept of disidentifications, we found that participants made s...

Palliative care has potential to improve quality of life and goal-concordant care for patients with adult congenital heart disease (ACHD). However, it is rarely employed prior to critical illness because the best methods for implementation are not well-defined. We qualitatively evaluated ACHD patients' understanding of and opinions regarding palliative care and advance care planning (ACP) to better define the needs of this population. We conducted a thematic analysis of 25 semistructured interviews with patients with ACHD in which we assessed participants' perspectives on the need for, and barriers and facilitators to, the use of palliative care and ACP. In a group of participants with ACHD (mean age 38, 48% male) classified as simple (24%), moderate (32%), or complex (44%), we identified 4 major themes: (1) using knowledge to combat future uncertainties; (2) unfamiliarity with and limited exposure to palliative care and ACP; (3) facilitators and barriers to engaging in palliative care and ACP; and (4) importance of timing and presentation of ACP discussions. In conclusion, participants expressed a desire for knowledge about ACHD progression and treatment. They supported routine incorporation of palliative care and ACP and identified related facilitators and barriers to doing so. Importantly, timing and format of these discussions must be individualized using shared decision-making between clinicians, patients, and their families.

This constructivist grounded theory study examined how Queer Men of Color in culturally-based fraternities made meaning of their masculinities. Through two intensive interviews and a reflection jou...

Community colleges increasingly turn to various types of student success courses for their potential as high-impact practices to foster college completion. Despite commonly held assumptions of what...

This narrative study examined the involvement of Queer Men of Color in culturally based fraternities beyond their undergraduate years. Eight Queer Men of Color discussed how they saw hypermasculine...

Background: Real-world data on non-vitamin K oral anticoagulants (NOACs) are essential in determining whether evidence from randomised controlled clinical trials translate into meaningful clinical benefits for patients in everyday practice. RIVER (RIVaroxaban Evaluation in Real life setting) is an ongoing international, prospective registry of patients with newly diagnosed non-valvular atrial fibrillation (NVAF) and at least one investigator-determined risk factor for stroke who received rivaroxaban as an initial treatment for the prevention of thromboembolic stroke. The aim of this paper is to describe the design of the RIVER registry and baseline characteristics of patients with newly diagnosed NVAF who received rivaroxaban as an initial treatment. Methods and results: Between January 2014 and June 2017, RIVER investigators recruited 5072 patients at 309 centres in 17 countries. The aim was to enroll consecutive patients at sites where rivaroxaban was already routinely prescribed for stroke prevention. Each patient is being followed up prospectively for a minimum of 2-years. The registry will capture data on the rate and nature of all thromboembolic events (stroke / systemic embolism), bleeding complications, all-cause mortality and other major cardiovascular events as they occur. Data quality is assured through a combination of remote electronic monitoring and onsite monitoring (including source data verification in 10% of cases). Patients were mostly enrolled by cardiologists (n = 3776, 74.6%), by internal medicine specialists 14.2% (n = 718) and by primary care/general practice physicians 8.2% (n = 417). The mean (SD) age of the population was 69.5 (11.0) years, 44.3% were women. Mean (SD) CHADS2 score was 1.9 (1.2) and CHA2DS2-VASc scores was 3.2 (1.6). Almost all patients (98.5%) were prescribed with once daily dose of rivaroxaban, most commonly 20 mg (76.5%) and 15 mg (20.0%) as their initial treatment; 17.9% of patients received concomitant antiplatelet therapy. Most patients enrolled in RIVER met the recommended threshold for AC therapy (86.6% for 2012 ESC Guidelines, and 79.8% of patients according to 2016 ESC Guidelines). Conclusions: The RIVER prospective registry will expand our knowledge of how rivaroxaban is prescribed in everyday practice and whether evidence from clinical trials can be translated to the broader cross-section of patients in the real world. Funding: This work is supported by an unrestricted research grant from Bayer AG (Berlin, Germany) to the Thrombosis Research Institute (London, UK), which sponsors the RIVER registry. The funding source had no involvement in the data collection, data analysis or data interpretation.

This qualitative critical narrative inquiry explored how members of Latina/o sororities and fraternities perceived campus climates for racial and ethnic diversity at predominantly White institution...

In this study, we explored higher education doctoral students' perceptions of their socialization, development, and preparation in an online foundational course for all incoming doctoral students in a higher education program at a public research university in the Midwest. Framed by Weidman, Twale, and Stein's (2001) graduate socialization framework and Anderson's (2008) model of online learning, the findings of this qualitative case study shed light on ways online students developed their scholarly identity while gaining knowledge of the skills and habits necessary for navigating their doctoral program. Implications for practice and future research in online education and the socialization and development of graduate students are discussed.

Background/Context Based on well-established evidence that certain student success skills and college knowledge are closely associated with academic achievement, persistence, and completion, community colleges increasingly implement various types of first-year student success courses and programs. However, by looking only at the distal impact of program participation, the question of whether these programs actually influence those mediating skills of college success has scarcely been investigated in the higher education literature, let alone which program features may be determining factors. Purpose/Objective This study examined the scope and design of community college student success courses to address which program features relate to learning objectives of student success skills, college knowledge, and engagement. Population/Participants/Subjects Participants were students and instructors drawn from 47 student success course sections at 42 public community colleges in 24 states, representing all U.S. geographic regions. Research Design The study adopted a multimodal research design, using both qualitative and quantitative research methods while primarily relying on quantitative analysis. Data Collection and Analysis Students in selected student success course sections completed a pre- and postsurvey. Instructors participated in a structured interview and provided course syllabi. Course design information was quantitized and merged with student-level data to model variation in learning outcomes as a function of course features, according to an activity theory conceptual framework. Data were analyzed using hierarchical linear modeling. Conclusions Findings from this research point to several recommendations for practice by highlighting the reality that one term may be too little to learn some student success skills and that particular features of course designs may result in unintended adverse effects. Results indicate that structural elements are the most impactful features and that the skills-based curricular features that receive the most attention may be in fact the least influential features in realizing desired skills and knowledge outcomes. The study points to methodological ways forward to further explore and unpack the relationship between success course design features and educational outcomes.

Ethics consultants and critical care clinicians reflect on Seattle's early experience as the United States' first epicenter of COVID-19. We discuss ethically salient issues confronted at UW Medicine's hospitals and provide lessons for other health care institutions that may soon face what we have faced.

Objective: Beyond understanding whether first-year student success interventions in community colleges are effective—for which there is mixed evidence in the literature—this study’s purpose was to uncover how they work to realize observed outcomes, including at times unanticipated undesirable outcomes. Method: This qualitative multiple case study used cultural historical activity theory (CHAT) to unpack interactions and tensions among programmatic-level features and individual-level experiences and actions. We conducted classroom observation, document analysis, and interviews with instructors and students in four student success courses across diverse contexts. Results: Regardless of particular designs and course emphases, we found in all cases a blurring of activity elements, wherein learning tools and learning goals were often coterminous, or instructors effectively took on the role of learning tools themselves, in the form of object lessons and mediators, for instance. Courses had a distinctive charact...

The purpose of this study was to explore how students integrate learning from one particular experience, participating in a service learning-based alternative break (AB), with other postsecondary experiences and to identify the conditions that may facilitate integrative learning. Using qualitative case studies combined with narrative analysis, we analyzed data from interviews with 38 AB participants. Consistent with Barber's (2012) theory of integrative learning, we found evidence that students were engaging in the processes of connecting, applying, and synthesizing learning from their ABs. We identified the importance of interacting with diverse others in facilitating integrative learning, but also noted barriers to integration such as difficulty connecting information across disparate contexts. Through exploring integrative learning in one particular context, the findings from this study can inform our understanding of how students are engaging in integration and improve our understanding of how...

This chapter provides an overview of organizations and other entities focused on assisting community college staff, faculty, and administrators in developing and promoting student success outcomes. We provide a listing of relevant web resources related to programming and conclude with a summary of suggested readings.

Shared VH1-46 gene usage has been described in B cells reacting to desmoglein 3 (Dsg3) in the autoimmune disease pemphigus vulgaris (PV), as well as B cells responding to rotavirus capsid protein VP6. In both diseases, VH1-46 B cells bearing few to no somatic mutations can recognize the disease Ag. This intriguing connection between an autoimmune response to self-antigen and an immune response to foreign Ag prompted us to investigate whether VH1-46 B cells may be predisposed to Dsg3-VP6 cross-reactivity. Focused testing of VH1-46 mAbs previously isolated from PV and rotavirus-exposed individuals indicates that cross-reactivity is rare, found in only one of seven VH1-46 IgG clonotypes. High-throughput screening of IgG B cell repertoires from two PV patients identified no additional cross-reactive clonotypes. Screening of IgM B cell repertoires from one non-PV and three PV patients identified specific cross-reactive Abs in one PV patient, but notably all six cross-reactive clonotypes used VH1-46. Site-directed mutagenesis studies indicate that amino acid residues predisposing VH1-46 Abs to Dsg3 reactivity reside in CDR2. However, somatic mutations only rarely promote Dsg3-VP6 cross-reactivity; most mutations abolish VP6 and/or Dsg3 reactivity. Nevertheless, functional testing identified two cross-reactive VH1-46 Abs that both disrupt keratinocyte adhesion and inhibit rotavirus replication, indicating the potential for VH1-46 Abs to have both pathologic autoimmune and protective immune functions. Taken together, these studies suggest that certain VH1-46 B cell populations may be predisposed to Dsg3-VP6 cross-reactivity, but multiple mechanisms prevent the onset of autoimmunity after rotavirus exposure.

This study problematizes the common discourse that rapid and widespread Latina/o demographic growth in the United States is a driving force in realizing higher education equity gains. Using equity indices for students, faculty, and administrative leaders at the state level, we present a portrait of changes in Latina/o participation in higher education over the last decade and propose a classification scheme for understanding variation across states at the intersection of changes in both demographics and equitable participation. University of Nebraska - Lincoln

Although increasingly popular, international/global service-learning programs are not without critique; in fact, the role of crossing national borders in service-learning is highly contested. The purpose of the study discussed in this article was to explore this role of crossing borders within the context of a particular experience: participation in an alternative break (AB) program. The authors sought to understand whether there is an aspect of learning in specific places, namely learning across national borders, that is separate (and separable) from what happens in those places. Participants reported a high level of influence of their AB experience on both their intentions to volunteer and to travel internationally, although there were a number of differences between students who participated in domestic and international ABs. Mediation analysis showed that the relationship between program location and the influence of the AB on students’ plans to volunteer was mediated completely by features of the AB program itself, while the relationship between program location and the influence of the AB on students’ plans to travel internationally was only partially mediated by program features.

Objective To compare maternal birth complications early versus late in the academic year and to evaluate the impact of resident work hour limitation on the “July effect.” Study Design We conducted a retrospective, population-based cohort study of 628,414 singleton births in Washington State from 1987 to 2012 measuring the adjusted risk of maternal peripartum complications early (July/August) versus late (April/May) in the academic year. To control for seasonal outcome variation unrelated to trainees' involvement in care as well as long-term trends in maternal complications unrelated to variation in trainees' effect on outcomes across the academic year, we employed difference-in-differences methods contrasting outcomes at teaching to nonteaching hospitals for deliveries before and after restriction of resident work hours in July 2003. Results Prior to resident work hour limitation in July 2003, women delivering early in the academic year at teaching hospitals suffered more complications (relative risk [RR] 1.05; 95% confidence interval [CI]: 1.00–1.09; p = 0.03). After July 2003, complication risk did not vary significantly across the academic year except at teaching-intensive hospitals, where July/August deliveries experienced fewer complications (RR: 0.95; 95% CI: 0.92–0.98; p = 0.001). Conclusion Women delivering at teaching hospitals early in the academic year suffered a modest but significant increase in complications before but not after resident work hour reform.

Due in large part to the 1997 amendments to the Individuals with Disabilities Education Act (IDEA), individualized education program (IEP) teams increasingly are identifying assistive technology (AT) for students with disabilities to ensure the provision of free appropriate public education (FAPE) in the least restrictive environment (LRE). Though this law requires that AT must be considered when developing the IEP of a student with a disability, the high costs of AT devices and services may lead some IEP teams to conclude that such technology is not accessible. IDEA remains the primary funding source for assistive technology that is identified as an educational necessity. However, because funding of AT devices and services through IDEA remains limited, school administrators, parents, and IEP team members need information on other funding resources. Alternative options and guidelines for accessing these possible additional funding resources often are not well known by school professionals. This article provides an overview of several AT funding resources, notes basic requirements for eligibility, and offers suggestions for making successful claims.

Cognitive skills predict academic performance, so schools that improve academic performance might also improve cognitive skills. To investigate the impact schools have on both academic performance and cognitive skills, we related standardized achievement-test scores to measures of cognitive skills in a large sample (N = 1,367) of eighth-grade students attending traditional, exam, and charter public schools. Test scores and gains in test scores over time correlated with measures of cognitive skills. Despite wide variation in test scores across schools, differences in cognitive skills across schools were negligible after we controlled for fourth-grade test scores. Random offers of enrollment to oversubscribed charter schools resulted in positive impacts of such school attendance on math achievement but had no impact on cognitive skills. These findings suggest that schools that improve standardized achievement-test scores do so primarily through channels other than improving cognitive skills., Bill & Melinda Gates Foundation, National Institutes of Health (U.S.) (National Research Service Award)

Stanton Glantz and colleagues investigate efforts by tobacco companies to influence Clearing the Smoke, a 2001 Institute of Medicine report on harm reduction tobacco products. Please see later in the article for the Editors' Summary, Background Spurred by the creation of potential modified risk tobacco products, the US Food and Drug Administration (FDA) commissioned the Institute of Medicine (IOM) to assess the science base for tobacco “harm reduction,” leading to the 2001 IOM report Clearing the Smoke. The objective of this study was to determine how the tobacco industry organized to try to influence the IOM committee that prepared the report. Methods and Findings We analyzed previously secret tobacco industry documents in the University of California, San Francisco Legacy Tobacco Documents Library, and IOM public access files. (A limitation of this method includes the fact that the tobacco companies have withheld some possibly relevant documents.) Tobacco companies considered the IOM report to have high-stakes regulatory implications. They developed and implemented strategies with consulting and legal firms to access the IOM proceedings. When the IOM study staff invited the companies to provide information on exposure and disease markers, clinical trial design for safety and efficacy, and implications for initiation and cessation, tobacco company lawyers, consultants, and in-house regulatory staff shaped presentations from company scientists. Although the available evidence does not permit drawing cause-and-effect conclusions, and the IOM may have come to the same conclusions without the influence of the tobacco industry, the companies were pleased with the final report, particularly the recommendations for a tiered claims system (with separate tiers for exposure and risk, which they believed would ease the process of qualifying for a claim) and license to sell products comparable to existing conventional cigarettes (“substantial equivalence”) without prior regulatory approval. Some principles from the IOM report, including elements of the substantial equivalence recommendation, appear in the 2009 Family Smoking Prevention and Tobacco Control Act. Conclusions Tobacco companies strategically interacted with the IOM to win several favored scientific and regulatory recommendations. Please see later in the article for the Editors' Summary, Editors' Summary Background Up to half of tobacco users will die of cancer, lung disease, heart disease, stroke, or another tobacco-related disease. Cigarettes and other tobacco products cause disease because they expose their users to nicotine and numerous other toxic chemicals. Tobacco companies have been working to develop a “safe” cigarette for more than half a century. Initially, their attention focused on cigarettes that produced lower tar and nicotine yields in machine-smoking tests. These products were perceived as “safer” products by the public and scientists for many years, but it is now known that the use of low-yield cigarettes can actually expose smokers to higher levels of toxins than standard cigarettes. More recently, the tobacco companies have developed other products (for example, products that heat aerosols of nicotine, rather than burning the tobacco) that claim to reduce harm and the risk of tobacco-related disease, but they can only market these modified risk tobacco products in the US after obtaining Food and Drug Administration (FDA) approval. In 1999, the FDA commissioned the US Institute of Medicine (IOM, an influential source of independent expert advice on medical issues) to assess the science base for tobacco “harm reduction.” In 2001, the IOM published its report Clearing the Smoke: Assessing the Science Base for Tobacco Harm and Reduction, which, although controversial, set the tone for the development and regulation of tobacco products in the US, particularly those claiming to be less dangerous, in subsequent years. Why Was This Study Done? Tobacco companies have a long history of working to shape scientific discussions and agendas. For example, they have produced research results designed to “create controversy” about the dangers of smoking and secondhand smoke. In this study, the researchers investigate how tobacco companies organized to try to influence the IOM committee that prepared the Clearing the Smoke report on modified risk tobacco products by analyzing tobacco industry and IOM documents. What Did the Researchers Do and Find? The researchers searched the Legacy Tobacco Documents Library (a collection of internal tobacco industry documents released as a result of US litigation cases) for documents outlining how tobacco companies tried to influence the IOM Committee to Assess the Science Base for Tobacco Harm Reduction and created a timeline of events from the 1,000 or so documents they retrieved. They confirmed and supplemented this timeline using information in 80 files that detailed written interactions between the tobacco companies and the IOM committee, which they obtained through a public records access request. Analysis of these documents indicates that the tobacco companies considered the IOM report to have important regulatory implications, that they developed and implemented strategies with consulting and legal firms to access the IOM proceedings, and that tobacco company lawyers, consultants, and regulatory staff shaped presentations to the IOM committee by company scientists on various aspects of tobacco harm reduction products. The analysis also shows that tobacco companies were pleased with the final report, particularly its recommendation that tobacco products can be marketed with exposure or risk reduction claims provided the products substantially reduce exposure and provided the behavioral and health consequences of these products are determined in post-marketing surveillance and epidemiological studies (“tiered testing”) and its recommendation that, provided no claim of reduced exposure or risk is made, new products comparable to existing conventional cigarettes (“substantial equivalence”) can be marketed without prior regulatory approval. What Do These Findings Mean? These findings suggest that tobacco companies used their legal and regulatory staff to access the IOM committee that advised the FDA on modified risk tobacco products and that they used this access to deliver specific, carefully formulated messages designed to serve their business interests. Although these findings provide no evidence that the efforts of tobacco companies influenced the IOM committee in any way, they show that the companies were satisfied with the final IOM report and its recommendations, some of which have policy implications that continue to reverberate today. The researchers therefore call for the FDA and other regulatory bodies to remember that they are dealing with companies with a long history of intentionally misleading the public when assessing the information presented by tobacco companies as part of the regulatory process and to actively protect their public-health policies from the commercial interests of the tobacco industry. Additional Information Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001450. This study is further discussed in a PLOS Medicine Perspective by Thomas Novotny The World Health Organization provides information about the dangers of tobacco (in several languages); for information about the tobacco industry's influence on policy, see the 2009 World Health Organization report Tobacco interference with tobacco control A PLOS Medicine Research Article by Heide Weishaar and colleagues describes tobacco company efforts to undermine the Framework Convention on Tobacco Control, an international instrument for tobacco control Wikipedia has a page on tobacco harm reduction (note: Wikipedia is a free online encyclopedia that anyone can edit; available in several languages) The IOM report Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction is available to read online The Legacy Tobacco Documents Library is a public, searchable database of tobacco company internal documents detailing their advertising, manufacturing, marketing, sales, and scientific activities The University of California, San Francisco Center for Tobacco Control Research and Education is the focal point for University of California, San Francisco (UCSF) scientists in disciplines ranging from the molecular biology of nicotine addiction through political science who combine their efforts to eradicate the use of tobacco and tobacco-induced cancer and other diseases worldwide SmokeFree, a website provided by the UK National Health Service, offers advice on quitting smoking and includes personal stories from people who have stopped smoking Smokefree.gov, from the US National Cancer Institute, offers online tools and resources to help people quit smoking

Improved patient-physician communication is the only ethically risk-free kind of defensive medicine. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Background An appropriate balance in placental regulatory T cells (Tregs), an immunosuppressive cell population, and Th17 cells, a pro-inflammatory cell population, is essential in allowing tolerance of the semi-allogeneic fetus. TGF-β and IL-6 are cytokines that promote differentiation of Tregs and Th17 cells from a common progenitor; aberrant expression of the cytokines may perturb the balance in the two cell populations. We previously reported a pro-inflammatory placental environment with decreased levels of FoxP3, a Treg marker, and increased levels of IL-6 in the placentas of FIV-infected cats at early pregnancy. Thus, we hypothesized that FIV infection in the pregnant cat causes altered placental Treg and Th17 cell populations, possibly resulting in placental inflammation. Methods We examined the effect of FIV infection on Treg and Th17 populations in placentas at early pregnancy using quantitative confocal microscopy to measure FoxP3 or RORγ, a Th17 marker, and qPCR to quantify expression of the key cytokines TGF-β and IL-6. Results FoxP3 and RORγ were positively correlated in FIV-infected placentas at early pregnancy, but not placentas from normal cats, indicating virus-induced alteration in the balance of these cell populations. In control cats the expression of IL-6 and RORγ was positively correlated as predicted, but this relationship was disrupted in infected animals. TGF-β was reduced in infected queens, an occurrence that could dysregulate both Treg and Th17 cell populations. Co-expression analyses revealed a highly significant positive correlation between IL-6 and TGF-β expression in control animals that did not occur in infected animals. Conclusion Collectively, these data point toward potential disruption in the balance of Treg and Th17 cell populations that may contribute to FIV-induced inflammation in the feline placenta.

Regulatory T cells (Tregs) support pregnancy maintenance by suppressing placental inflammation, while diminished Treg function may accompany reproductive failure. Experimental FIV infection frequently results in vertical transmission and increased pregnancy failure in the cat. The mechanism of reproductive compromise is unknown. We hypothesized that FIV infection alters endometrial Treg population dynamics and function, potentiating vertical transmission and reproductive failure. RNA collected from early and late gestation reproductive tissue and fetuses from FIV infected and control cats was probed for expression of FIV gag and Treg markers CD25, FOXP3, and CTLA4, using real time reverse-transcriptase (RT)-PCR. Frequent placental and fetal infection and reproductive failure were detected at early and late pregnancy. Expression of FOXP3 and CTLA4 was higher in early gestation tissues from control cats. FIV infection significantly reduced expression of FOXP3 and CTLA4 at early, but not late pregnancy. At late pregnancy, CTLA4 was expressed to higher levels in infected tissues. The number of tissues with decreased co-expression of FOXP3 and CTLA4 was significant in infected cats at early pregnancy. No significant changes in CD25 expression occurred between FIV-infected and control animals at early or late pregnancy. Differences in Treg marker expression were not significant between viable and non-viable pregnancies in infected cats. The detection of Treg markers in these feline tissues provides the first evidence of feline endometrial Tregs and suggests that such cells diminish as pregnancy progresses. These cells may be depleted or rendered less functional by viral infection, but understanding their role in pregnancy requires further study.