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Transgenerational trauma is a potential barrier to achieving a healthy and holistic patient-physician relationship, particularly for Black Americans. Examination of deeply rooted historical injustices that Black patients suffer in health care and how they undermine trust can help clarify connections between historical trauma, distrust, and health outcomes. Furthering clinicians' understanding of how daily practice can respond to Black patients' experiences can help restore trust and mitigate racial and ethnic health inequity. [ABSTRACT FROM AUTHOR]

Abstract Background Community learning and e-mentoring, learning methods used in higher education, are not used to any extent in residency education. Yet both have the potential to enhance resident learning and, in the case of community learning, introduce residents to basic lifelong learning skills. We set out to determine whether residents participating in an Internet based e-mentoring program would, with appropriate facilitation, form a community of learners (CoL) and hold regular community meetings. We also determined resident and faculty perceptions of CoL and Internet sessions as effective learning experiences. Methods A six-month e-mentoring pilot was offered to 10 Radiology residents in the Aga Khan University Postgraduate Medical Education Program in Nairobi, Kenya (AKUHN) with a Professor of Radiology, located at University of Virginia, USA, acting as the e-mentor. Monthly Internet case-based teaching sessions were facilitated by the e-mentor. In addition, residents were coached by a community facilitator to form CoL and collectively work through clinical cases at weekly face-to-face CoL sessions. Event logs described observed resident activity at CoL sessions; exit survey and interviews were used to elicit perceptions of CoL and Internet sessions as effective learning experiences. Results Resident adoption of CoL behaviors was observed, including self-regulation, peer mentoring and collaborative problem solving. Analysis revealed high resident enthusiasm and value for CoL. Surveys and interviews indicated high levels of acceptance of Internet learning experiences, although there was room for improvement in audio-visual transmission technologies. Faculty indicated there was a need for a larger multi-specialty study. Conclusions The pilot demonstrated resident acceptance of community building and collaborative learning as valued learning experiences, addressing one barrier to its formal adoption in residency education curricula. It also highlighted the potential of e-mentoring as a means of expanding faculty and teaching materials in residency programs in developing countries.

Abstract Background Molecular oncology testing (MOT) to detect genomic alterations underlying cancer holds promise for improved cancer care. Yet knowledge limitations regarding the delivery of testing services may constrain the translation of scientific advancements into effective health care. Methods We conducted a cross-sectional, self-administered, postal survey of active cancer physicians in Ontario, Canada (N = 611) likely to order MOT, and cancer laboratories (N = 99) likely to refer (i.e., referring laboratories) or conduct (i.e., testing laboratories) MOT in 2006, to assess respondents' perceptions of the importance and accessibility of MOT and their preparedness to provide it. Results 54% of physicians, 63% of testing laboratories and 60% of referring laboratories responded. Most perceived MOT to be important for treatment, diagnosis or prognosis now, and in 5 years (61% – 100%). Yet only 45% of physicians, 59% of testing labs and 53% of referring labs agreed that patients in their region were receiving MOT that is indicated as a standard of care. Physicians and laboratories perceived various barriers to providing MOT, including, among 70% of physicians, a lack of clear guidelines regarding clinical indications, and among laboratories, a lack of funding (73% – 100%). Testing laboratories were confident of their ability to determine whether and which MOT was indicated (77% and 82% respectively), and perceived that key elements of formal and continuing education were helpful (75% – 100%). By contrast, minorities of physicians were confident of their ability to assess whether and which MOT was indicated (46% and 34% respectively), and while majorities considered various continuing educational resources helpful (68% – 75%), only minorities considered key elements of formal education helpful in preparing for MOT (17% – 43%). Conclusion Physicians and laboratory professionals were enthusiastic about the value of MOT for cancer care but most did not believe patients were gaining adequate access to clinically necessary testing. Further, our results suggest that many were ill equipped as individual stakeholders, or as a coordinated system of referral and interpretation, to provide MOT. These challenges should inspire educational, training and other interventions to ensure that developments in molecular oncology can result in optimal cancer care.

Abstract Background Research ethicists have recently declared a new ethical imperative: that researchers should communicate the results of research to participants. For some analysts, the obligation is restricted to the communication of the general findings or conclusions of the study. However, other analysts extend the obligation to the disclosure of individual research results, especially where these results are perceived to have clinical relevance. Several scholars have advanced cogent critiques of the putative obligation to disclose individual research results. They question whether ethical goals are served by disclosure or violated by non-disclosure, and whether the communication of research results respects ethically salient differences between research practices and clinical care. Empirical data on these questions are limited. Available evidence suggests, on the one hand, growing support for disclosure, and on the other, the potential for significant harm. Methods This paper explores the implications of the disclosure of individual research results for the relationship between research and clinical care through analysis of research-based cancer genetic testing in Ontario, Canada in the late 1990s. We analyze a set of 30 interviews with key informants involved with research-based cancer genetic testing before the publicly funded clinical service became available in 2000. Results We advance three insights: First, the communication of individual research results makes research practices seem like clinical services for our respondents. Second, while valuing the way in which research enables a form of clinical access, our respondents experience these quasi-clinical services as inadequate. Finally, our respondents recognize the ways in which their experience with these quasi-clinical services is influenced by research imperatives, but understand and interpret the significance and appropriateness of these influences in different ways. Conclusion Our findings suggest that the hybrid state created through the disclosure of research results about individuals that are perceived to be clinically relevant may produce neither sufficiently adequate clinical care nor sufficiently ethical research practices. These findings raise questions about the extent to which research can, and should, be made to serve clinical purposes, and suggest the need for further deliberation regarding any ethical obligation to communicate individual research results.

The potential benefits of developing a research agenda that explicitly reconstructs a world regional political ecology are explored through a focus on climate change mitigation and adaptation in the Asia Pacific. Through an examination of scale in political ecology, world regional political ecology is identified as a promising analytical and political approach to understanding and addressing the current challenges associated with climate change. In light of this, political ecology scholarship in the region is reviewed to identify current strengths and lacunae. Whilst there is indeed a rich tradition of political ecology research across the Asia Pacific, much of this research focuses upon local/national/global dynamics with relatively little attention devoted to supra-national processes, missing important social, political, financial and material processes constructed at the world regional scale. It is argued that a world regional political ecology of climate change should build upon strengths in previous political ecology work yet extend these in three generative directions: comparative analysis of place-based, single issue research; generation of diverse counter-narratives at the regional scale; and consideration of flows and networks. We argue a rescaled political ecology that incorporates world regional scales opens a range of possibilities for practicing and pursuing more just and progressive climate politics and initiatives. [ABSTRACT FROM AUTHOR]

Technical transport models are commonly relied upon in planning practice for the development of urban rail infrastructure projects. By considering the assessment and management of social impacts in the planning and decision-making of two rail megaprojects (the North-South Metro line in Amsterdam, the Netherlands, and the Parramatta Rail Link in Sydney, Australia), we found that technical approaches continued to overlook social impacts, and had an overemphasis on economic and engineering considerations. We conclude that good practice Social Impact Assessment (SIA) offers opportunities to better consider social issues as a critical component of transport projects. [ABSTRACT FROM AUTHOR]

The paper conceptualises the process of voluntary relocation undertaken by rural farmers to informal settlements in coastal cities. These are journeys that occur without formal institutional support, utilising migrants' own agency. Learning from these community‐driven relocations has merit in rethinking climate change adaptation at the regional level. In this paper we present stories of 17 families who have progressively relocated to the fringes of Khulna city in southwestern Bangladesh. We observe three key attributes: first, relocations are slow, neither singular nor immediately completed, but rather take months of careful back and forth journeys of family members between their places of origin and destination. Second, relocations rely on small networks of relatives and acquaintances at the destination. Third, relocations are built on shared responsibilities distributed among a range of actors in places of origin and destination. We conclude that these slow, small and shared relocations are likely to be realised as forms of ongoing adaptation by rural farmers if their aspirational mobilities, social relations and supports are maintained at a regional scale. This kind of migration as adaptation may bring about just outcomes for those displaced without necessarily promoting rigid planning interventions that tend to fix resettlement solutions in place and time. [ABSTRACT FROM AUTHOR]