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Despite efforts to improve parity in the biomedical workforce, gender bias persists related to equitable pay, promotion, speaking opportunities, journal editorial positions, research funding, and leadership positions. This bias becomes more prominent for women of color and women with other intersectional identities who come from underrepresented groups. It is critical to understand the barriers that women face and why the pathway is especially challenging for women of color. In this commentary, the authors cite research related to the effects of institutional gender bias in academic medicine, including research on bias against women of color. As academic leaders who come from underrepresented groups, the authors are aware that traditional approaches to reducing this bias have not worked well, and they instead highlight promising strategies aimed at filling the pathway to leadership with women of color who are qualified and ready to take the helm. They address solutions to ensure the academic pathway is supportive. They also provide several recommendations, including: offering more opportunities for mentorship and sponsorship, improving access to formal leadership programming, modeling successful upstander initiatives, recognizing the growing role of minority-based medical societies, implementing early-career education, increasing journal editorial board representation, and expanding promotion criteria. Appropriate training, education, and partnership with internal and external stakeholders are necessary to advance leadership equity for women of color in academic medicine.

OBJECTIVES Patients speaking a primary language other than English face barriers to equitable care, particularly patient–provider communications. There is no gold standard for providing inpatient medical interpretation on family-centered rounds (FCR). We aimed to implement simultaneous, in-person interpretation of FCR for Spanish-speaking families and hypothesized improved satisfaction in care. METHODS In-person, Spanish Equipment-Assisted Simultaneous Medical Interpretation (EASMI) was implemented in March 2018 on FCR. Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) experience scores on communication domains were analyzed for Spanish and English-speaking families pre- (n = 118) and postimplementation (n = 552). Postimplementation, we conducted medical team surveys (n = 104) and semistructured interviews with Spanish-speaking families (n = 25) to determine satisfaction with interpretation modalities (phone, video, and EASMI). RESULTS Spanish-speaking families exhibited statistically significant improvements in Child HCAHPS top box scores compared to English-speaking families in multiple communication and informed care-related domains. For example, "How often did your child’s doctors explain things to you in a way that was easy to understand?" top box scores improved from 58% to 95% for Spanish-speaking families, compared to 85% to 83% for English speakers, with the differential effect of the intervention showing statistical significance (P = .001). Medical team surveys demonstrated high satisfaction with EASMI. Qualitative themes from interviews and open-ended survey responses emphasized multiple care benefits with EASMI, including a perceived reduction of communication errors and increased family participation. CONCLUSIONS EASMI was associated with significant improvements in Child HCAHPS scores in communication domains and increased medical team and family members’ satisfaction with interpretation. EASMI presents a novel method for equitable FCR for Spanish-speaking families.

Adenovirus (Ad) type 5 (Ad5) E4 deletion mutants including H5dl1007 (E4-) induce a DNA damage response (DDR) that activates the kinase ataxia-telangiectasia mutated (ATM), which can interfere with efficient viral DNA replication. We find that localization of active phosphorylated ATM (pATM) to E4- viral replication centers (VRCs) is important for its inhibitory effect. ATM is necessary for localization of RNF8 and 53BP1 to E4 mutant VRCs, while recruitment of DDR factors Mre11, Mdc1 and γH2AX is ATM-independent, raising the possibility that ATM may affect viral chromatin at VRCs. We assessed E4- and Ad5 chromatin organization by micrococcal nuclease (MN) digestion. A significant fraction of Ad5 DNA is somewhat resistant to MN digestion, whereas E4- DNA is more susceptible. ATM inhibition increases the fraction of E4- DNA that is resistant to MN digestion. Our results address possible mechanisms through which ATM inhibits E4- DNA replication.

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Graft-versus-host disease (GVHD) is the major cause of non-relapse morbidity and mortality after allogeneic stem cell transplant (allo-SCT). Chronic cutaneous manifestations of GVHD are common late after allo-SCT with limited treatment options beyond protracted steroid therapy. Cytokines are critical mediators of inflammatory processes during GVHD and both IL-17A and IL-22 have been found to have dual pathogenic and protective roles, which are largely dependent upon their cellular source. We have demonstrated in mice that whilst recipient-derived IL-17A and IL-17R signaling suppresses inflammatory responses and prevents gut dysbiosis, donor T cell-derived IL-17A is pathogenic and drives GVHD in both lung and skin. Similarly, contrasting roles have also been described for IL-22 in mice, such that recipient-derived IL-22 helps maintain gut epithelial integrity after allo-SCT, but donor IL-22 can exacerbate acute GVHD pathology. To date, investigation of the effects of donor-derived IL-22 in allo-SCT has focused on acute GVHD, with no data regarding the role of IL-22 in chronic GVHD. Given the complexities and the potential competing risks of targeting IL-22 early post-transplant, we examined IL-22 deficiency in murine models of chronic GVHD following allo-SCT. In the absence of donor-derived IL-22, we observed a significant decrease in skin GVHD clinical scores and chronic GVHD skin pathology (histopathology scores in WT donors: 10.2±2.1, vs. IL-22-/- donors: 2.6±0.9, p 0.05), despite the fact we have recently defined their IL-17-dependency. These data demonstrate a relationship between IL-22 and IL-17 and the distribution of chronic GVHD. We identified CD4+ T cells as the major source of donor IL-22 by both direct protein detection and cytokine reporter systems, where we observed co-expression of IL-22 with a range of pro-inflammatory cytokines including IL-17A, IFNγ, GM-CSF and TNF. We identified IL-22+IL-17A+ and IL-22+IL-17A- CD4+ T cells as two distinct sources of donor-derived IL-22 post-transplant (2.2±0.1% and 6.5±0.3 % of LN CD4+ T respectively), both of which were highly dependent upon IL-6 for their development (IL-22+IL-17A+: IgG 1.3±0.2% vs. anti-IL-6Rα 0.08±0.01% of splenic CD4+ T, p < 0.001; IL-22+IL-17A-:IgG 3.4±0.2 vs. anti-IL-6Rα: 0.6±0. 1% of splenic CD4+ T, p < 0.001). Since we have previously identified significant cytokine plasticity within IL-17A+ T cells after allo-SCT, we performed lineage assessment to determine if these two populations arose independently. Using IL-17creRosa26YFP fate-mapping mice that permanent label any cell that has expressed IL-17A, we found that IL-22+IL-17A- CD4+ T cells did not have a history of IL-17A production and were therefore identified as a definitive Th22 population after allo-SCT. Since IL-22 and IL-17A have been reported to induce synergistic responses in the skin, we also explored the possibility of interdependence between Th17 and Th22 development. Using both IL-17RC-/- mice and an IL-17creRosa26YFP/iDTR reporter-deleter system we demonstrate that IL-17 signaling to donor Th22 directly promotes their development in allo-SCT (WT donors: 6.5±0.4 %, Th/Tc17 deleter donors: 3.6±0.2, IL-17RC-/- donors: 3.7±0.3 % Th22 in LN CD4+ T, p 100 days following allo-SCT but not in those after autologous SCT. These data demonstrate a key role for donor-derived IL-22 in chronic skin GVHD and confirm parallel but symbiotic developmental pathways of Th22 and Th17 differentiation. Together these findings suggest that IL-22 intervention late post-transplant may reduce cutaneous chronic GVHD, whilst maintaining the protective effects of IL-22 in the gut early after transplant. Disclosures Serody: Merck: Research Funding.

Este artículo presenta una síntesis teórico-conceptual sobre los aspectos relevantes de las dimensiones ecológica y estética que definen los atributos del paisaje urbano. La ciudad como producto y creación, tiene sus características, elementos, cualidades y relaciones, que pueden ser percibidos e interpretados a la luz de quien observa, con lo cual, su definición abarca el análisis objetivo y subjetivo. La ecología aporta la perspectiva sistémica de la dinámica urbana observada en la interacción de sus factores naturales y socioculturales; la estética abarca la percepción desde el contacto visual con los elementos del paisaje a las sensaciones, sentimientos y condiciones que influyen en la interpretación. La naturaleza multidimensional basada en la concepción eco-estética de los atributos del paisaje urbano,es una base fundamental para determinar los indicadores de análisis de la calidad visual, orientada a la práctica del diseño urbano.ABSTRACTThis article presents a theoretical and conceptual synthesis on relevant aspects of the ecological and aesthetic dimensions that define the urban landscape attributes. The city, as product and creation, has its characteristics, elements, qualities and relationships that can be perceived and interpreted under the light of the viewer, so that its definition embraces both an objective and a subjective analysis. Ecology provides a systemic perspective of the urban dynamics observed in the interaction of its natural and social-cultural factors; aestheticsencompasses perception from the visual contact, with the elements of the landscape, to sensations, feelings and conditions that influence the interpretation. The multidimensional nature based on the eco-aesthetics conception of the urban landscape attributes is a fundamental base to determine the analysis indicators of visual quality oriented to the , urban design practice. Este artículo presenta una síntesis teórico-conceptual sobre los aspectos relevantes de las dimensiones ecológica y estética que definen los atributos del paisaje urbano. La ciudad como producto y creación, tiene sus características, elementos, cualidades y relaciones, que pueden ser percibidos e interpretados a la luz de quien observa, con lo cual, su definición abarca el análisis objetivo y subjetivo. La ecología aporta la perspectiva sistémica de la dinámica urbana observada en la interacción de sus factores naturales y socioculturales; la estética abarca la percepción desde el contacto visual con los elementos del paisaje a las sensaciones, sentimientos y condiciones que influyen en la interpretación. La naturaleza multidimensional basada en la concepción eco-estética de los atributos del paisaje urbano,es una base fundamental para determinar los indicadores de análisis de la calidad visual, orientada a la práctica del diseño urbano.ABSTRACTThis article presents a theoretical and conceptual synthesis on relevant aspects of the ecological and aesthetic dimensions that define the urban landscape attributes. The city, as product and creation, has its characteristics, elements, qualities and relationships that can be perceived and interpreted under the light of the viewer, so that its definition embraces both an objective and a subjective analysis. Ecology provides a systemic perspective of the urban dynamics observed in the interaction of its natural and social-cultural factors; aestheticsencompasses perception from the visual contact, with the elements of the landscape, to sensations, feelings and conditions that influence the interpretation. The multidimensional nature based on the eco-aesthetics conception of the urban landscape attributes is a fundamental base to determine the analysis indicators of visual quality oriented to the , urban design practice.

There is evidence that group cognitive behavioural therapy for psychosis (CBTp) is an effective treatment, but much of this research has been conducted with outpatient populations. The aim of this review was to determine the utility of group CBTp for inpatients. We systematically searched Scopus, Web of Science and EBSCO electronic databases to identify relevant research. We reviewed the resulting articles and included those which had been conducted with inpatients, with symptoms of psychosis, using cognitive behaviour therapy, delivered in a group format. Fourteen articles relating to ten studies were identified. Two were randomized controlled trials; two were cohort studies and the rest were pre-/post-intervention studies. There was considerable heterogeneity between the studies and all had methodological limitations. The findings suggest positive trends towards the reduction of distress associated with psychotic symptoms, increased knowledge of symptoms, decreased affective symptoms and reduced readmissions over several years. However, there is currently not enough evidence to draw any strong conclusions regarding the utility of group CBTp for inpatients due to the small number of studies and limitations in quality and generalizability. Therefore, this review indicates the need for further research, particularly large, methodologically rigorous, randomized controlled trials.

This study investigates the relationships among patient's gender, physician's gender, and physician's inquiries about depression symptoms and psychosocial stressors, treatment and subsequent medical record notation of depression in primary care. One hundred forty-six physicians at three sites were visited twice by a standardized patient (SP) who enacted either major depression with a psychosocial presentation or minor depression with a somatic presentation. Each of the two cases was portrayed by both male and female SPs who were assigned randomly to physicians. Results showed high rates of inquiry about depression symptoms and treatment, but rates varied considerably by presentation and across physician-patient gender combinations. Male physicians explored symptoms and discussed a diagnosis with female patients significantly more often than with male patients. Both male and female physicians recommended counseling more often for patients with the somatic presentation when they were female than wh...

Individual cognitive behaviour therapy for psychosis (CBTp) is a recommended treatment in the acute phase and beyond. However, less is known about the effectiveness of group CBTp in acute care. This mixed methods study explored the implementation and effectiveness of brief group CBTp with inpatients. This prospective trial compared inpatients who received either a four week group CBTp program or treatment as usual (TAU). Participants (n = 113 at baseline) completed self-report measures of distress, confidence and symptoms of psychosis at baseline, post-intervention and one month follow up. CBTp group participants also completed a brief open-ended satisfaction questionnaire. Using complete case analysis participants who received CBTp showed significantly reduced distress at follow up compared to TAU and significantly increased confidence across the study and follow up period. However, these effects were not demonstrated using a more conservative intention-to-treat analysis. Qualitative analysis of the satisfaction data revealed positive feedback with a number of specific themes. The study suggests that brief group CBTp with inpatients may improve confidence and reduce distress in the longer term. Participants report that the groups are acceptable and helpful. However, given the methodological limitations involved in this ‘real world’ study more robust evidence is needed.

With the passage of a safe patient handling statute in 2009, Minnesota became one of a growing number of states requiring health care providers to become more aware and accountable about providing appropriate assistance during the movement of patients in clinical care settings. The Minnesota Department of Labor and Industry and the Minnesota Dental Association have been working together to ensure that Minnesota's SPH regulations are as practical as possible for dental providers while still achieving the objectives of the statute. A template Safe Patient Handling Program for Clinics has been developed with substantial input from MDA's ESNA Committee and is now available on the DLI website: www.dli.mn.gov/WSC/SPHlegislation.asp. All Minnesota dental practices should use this template to develop their own safe patient handling program as soon as possible. Additional background information and resources related to Minnesota's SPH regulations are also available on the DLI website. MDA and DLI are currently also developing a hazard assessment tool for dental practices to assess their specific risks associated with patient movement. This hazard assessment will, in turn, guide decisions about what type of safe patient handling equipment and staff training will be necessary for total compliance with the new statute. MDA, in cooperation with DLI, will continue to keep dental professionals informed about when these materials will be available. Additionally, MDA is working to ensure appropriate training options will be available for compliance with SPH regulations. The University of Minnesota's School of Dentistry's Oral Health Services for Older Adults Program and Department of Continuing Dental Education have been regularly providing such training in conjunction with the school's "Miniresidency in Nursing Home and Long-term Care for the Dental Team," and efforts are now underway at the dental school to create stand-alone training options for Minnesota's dental professionals. Further information about SPH training may also be found on the DLI website (www.dli.mn.gov/WSC/SPHlegislation.asp). MDA members can also contact MDA's Elderly and Special Needs Adults Committee via the MDA central office.

SUMMARY Blood loss during guillotine adeno-tonsillectomy was measured in 92 children, divided into three groups, comparing the influence of sodium phenobarbitone, trimeprazine and diazepam premedication. The method of anaesthesia and operation was standard in all three groups. The blood loss was similar with each of the three premedicant drugs.

Sodium nitroprusside has been considered to have few side effects when used to produce hypotension in anaesthesia. We report here a patient who developed a severe metabolic acidosis following its use. This complication has also been reported in baboons. As sodium nitroprusside has been used on over 600 occasions in our hospital, experience suggests this complication to be an infrequent occurrence. Nevertheless, should a metabolic acidosis be suspected during the use of sodium nitroprusside, blood-gas measurements should be made.