Do patient-reported outcome measures measure up? A qualitative study to examine perceptions and experiences with heart failure proms among diverse, low-income patients

Background The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a Patient-Reported Outcome Measure (PROM) used to evaluate the health status of patients with heart failure (HF) but has predominantly been tested in settings serving predominately white, male, and economically well-resourced populations. We sought to examine the acceptability of the shorter version of the KCCQ (KCCQ-12) among racially and ethnically diverse patients receiving care in an urban, safety-net setting. Methods We conducted cognitive interviews with a diverse population of patients with heart failure in a safety net system to assess their perceptions of the KCCQ-12. We conducted a thematic analysis of the qualitative data then mapped themes to the Capability, Opportunity, Motivation Model of Behavior framework. Results We interviewed 18 patients with heart failure and found that patients broadly endorsed the concepts of the KCCQ-12 with minor suggestions to improve the instrument’s content and appearance. Although patients accepted the KCCQ-12, we found that the instrument did not adequately measure aspects of health care and quality of life that patients identified as being important components of managing their heart failure. Patient-important factors of heart failure management coalesced into three main themes: social support, health care environment, and mental health. Conclusions Patients from this diverse, low-income, majority non-white population experience unique challenges and circumstances that impact their ability to manage disease. In this study, patients were receptive to the KCCQ-12 as a tool but perceived that it did not adequately capture key health components such as mental health and social relationships that deeply impact their ability to manage HF. Further study on the incorporation of social determinants of health into PROMs could make them more useful tools in evaluating and managing HF in diverse, underserved populations.

EFEKTIVITAS ANALGETIK KRIM TIPE M/A EKSTRAK ETANOL DAUN RANDU (Ceibapentandra (L) Gaertn) PADA HEWAN UJI MENCIT JANTAN

Randu plant leaves (Ceiba pentandra (L) Gaertn) are commonly used in traditional medicine, one of which is an analgesic with secondary metabolites which are thought to be analgesics, namely flavonoids. The purpose of this study was to determine the analgesic effectiveness of the ethanol extract cream of randu leaves (Ceiba pentandra (L) Gaertn) in white male mice (Mus musculus). The research on the analgesic effectiveness of the ethanol extract cream of randum leaves used the hot plate method and used male white mice as the experimental animal media. The soles of the hind legs of the mice were heated over hot plated with a temperature of 550C then the test animals were given the treatment which was divided into 5 treatment groups, namely positive control (Conterpain cream), negative control (F0), F1 (10%), F2 (15%), F3 (20%) and 1 normal group. The response of mice was calculated every 30 minutes in 120 minutes. The data obtained were analyzed using the one-way ANOVA statistical test followed by the Duncan test with a confidence level of 99%. The results of the one-way ANOVA test showed that there were significant differences between treatment groups (0.00 <0.05). The results of the Duncan test showed that the group that provided the best analgesic effectiveness was F2 (15%) but not better than Positive Control.

A red herring CVA with unexpected outcome: illustrative case

BACKGROUND Disruptions to the integrity of the inner table and trabeculae of the calvaria are rare phenomena. Increasingly rare is the phenomenon of herniation of brain parenchyma through the defects in the skull causing neurological deficit. Surgical intervention is commonly performed but is fraught with risk of brain tissue loss. OBSERVATIONS The authors present a case of a 78-year-old White male presenting with strokelike symptoms who was found to have an intradiploic encephalocele that was successfully treated with surgical intervention and neuroplastic reconstruction of the anatomical deficit. The patient had a marked recovery and had near-complete resolution of symptoms. LESSONS This notably rare phenomenon resolved with neurosurgical intervention, sparing the parenchyma, and provided the patient with perceivably normal contour of the head using a collaborative approach with neuroplastic intervention.

Cross-disciplinary, collaborative and student-led: developing a change process for diversifying reading lists

Increasingly across many UK higher education institutions staff and students are questioning and challenging systemic inequalities that affect racially minoritised groups in their learning and sense of belonging within the curriculum. Students are calling for inclusion of diverse sources of knowledge and perspectives, especially from scholars of colour and from the Global South, to enrich what is currently perceived to be a Eurocentric canon. One way to promote more culturally aligned pedagogy is through diversifying reading lists. This article presents findings from two pilot studies that explored the reading lists in one department in social sciences and one in the humanities at the University of Kent, UK. Applying critical race theory as a guiding framework, the first part of the article examines the ways in which a diverse curriculum must include the voices of the marginalised. It then describes the methods: a desk-based review of the reading lists, interviews with academics to inform the work, disseminate the findings, instigate further action and identify future needs, and student focus groups. Crucially, the project resulted from the collaboration between students and staff, and across departments and disciplines. We found that reading lists in both departments overwhelmingly comprised items by White male authors. Students and staff both reflected on the importance of not only curriculum diversification but also barriers to diversification and decolonisation. The article discusses the impact of this project, which has led to a Diversity Mark process, and the Diversity Mark Toolkit, which can be used in any discipline when putting together reading lists to create a more culturally competent curriculum. It concludes by considering other systemic changes needed, with particular attention to changes needed in library services and collections.

Where the Skin Meets

Over the last half century, the analysis of homoerotic themes present in the author’s novels has been a particularly generative subset of Melville studies. Among this body of research, the relationship between Ishmael and Queequeg in Moby-Dick has proven to be a compelling avenue of research regarding modes of queer representation in an historical period wherein the open discussion of homosexuality was viewed as anywhere from taboo to illegal. This paper builds on the work of other Melville scholars, such as Caleb Crain and Kellen Bolt, in examining the ways in which 19th century ideas of race intersect with the representation of an eroticized male relationship between Ishmael and Queequeg. I suggest that the particular lens of racialized eroticism through which 19th century white observers viewed Polynesian men inherently denies the potential for disavowal of same-gender attraction to the non-White subject. This denial necessarily reifies racial hierarchy by giving a White male participant in a homoerotic relationship the ability to dictate its boundaries. I argue that even if, as Bolt suggests, Ishmael’s relationship with Queequeg represents a rejection of 19th century American nativist sentiment, Ishmael retains the ability to distance himself from accusations of homoeroticism in a way that is not possible for Queequeg and his exoticized body. I conclude with an exploration of how the Victorian freak-show archetype of the tattooed man connects with Ishmael’s decision to tattoo himself and thus voluntary take on racializing signifiers within his contemporary context.

Keragaman Fenotipe Kualitatif dan Kuantitatif Itik Sikumbang Jonti sebagai Plasma Nutfah di Sumatera Barat

This research was aimed to identifiaty qualitative and quantitative phenotypic polymorphism of Sikumbang Jonti Duck in Kecamatan Payakumbuh Timur Kota Payakumbuh Sumatera Barat. This research used 206 Sikumbang Jonti duck that were sexual maturity (22-48 weeks), divided of 50 males and 156 females. The qualitative traits observeted were head color, neck color, breaks color, back color, primary wings color, tail color, thigh color, bill color, and shank color. The quantitative traits observed were body weight (kg), beak width (cm), beak length (cm), neck length (cm), wing length (cm), femur length (cm), tibia length (cm), shank length (cm), back length (cm), number of primary wing feathers (strands), number of secondary wing feathers (strands), pelvic width (cm), and chest circumference (cm). The result showed that color of Sikumbang Jonti duck was dominated by white. Male Sikumbang Jonti duck had color head was white-black, and female had color head was white. In addition, the Sikumbang Jonti duck had green primary wing feathers like a beetle. The coefficient of diversity of the Sikumbang Jonti duck was low for beak width, tibia length (female), number of primary wing feathers, and number of secondary wing feathers, moderate value for body weight, beak length, neck length, wing length, femur length (female), length tibia (male), shank length, back length, perlvis width (females), and chest circumference (males), and high value for femur length (males). Keywords: Duck morphometric; Germplasm; Pattern color; Payakumbuh; Sumatera barat Abstrak Penelitian ini bertujuan untuk mengindentifikasi keragaman fenotipe kualitatif dan kuantitatif itik Sikumbang Jonti di Kecamatan Payakumbuh Timur Kota Payakumbuh Provinsi Sumatera Barat. Penelitian ini menggunakan 206 ekor itik Sikumbang Jonti yang sudah dewasa kelamin (22 – 48 minggu), terdiri dari 50 ekor jantan dan 156 ekor betina. Sifat kualitatif yang diamati adalah warna bulu head, warna bulu neck, warna bulu breaks, warna back, warna primary wings, warna tail, warna thigh, warna bill, dan warna shank. Sifat kuantitatif yang diamati adalah bobot badan (kg), lebar paruh (cm), panjang paruh (cm), panjang leher (cm), panjang sayap (cm), panjang femur (cm), panjang tibia (cm), panjang shank (cm), panjang punggung (cm), jumlah bulu sayap primer (helai), jumlah bulu sayap sekunder(helai), lebar pelvis (cm), dan lingkar dada (cm). Hasil menunjukkan warna bulu itik Sikumbang Jonti didominasi dengan warna bulu putih. Warna bulu kepala itik Sikumbang Jonti jantan berwarna putih-hitam, sedangkan itik Sikumbang Jonti betina berwarna putih. Selain itu, itik Sikumbang Jonti memiliki warna bulu sayap primer berwarna hijau seperti kumbang. Koefisien keragaman itik Sikumbang Jonti bernilai rendah untuk lebar paruh, panjang tibia (betina), jumlah bulu sayap primer, dan jumlah bulu sayap sekunder, bernilai sedang untuk bobot badan, panjang paruh, panjang leher, panjang sayap, panajng femur (betina), panjang tibia (jantan), panjang shank, panjang punggung, lebar perlvis (betina), dan lingkar dada (jantan), dan bernilai tinggi untuk panjang femur (jantan). Keragaman fenotipe kualitatif dan kuantitatif pada itik Sikumbang Jonti relatif seragam, kecuali pada fenotipe kuantitatif panjang femur pada itik Sikumbang Jonti jantan memiliki keragaman tinggi. Kata kunci: Morfometrik itik; Payakumbuh; Plasma nutfah; Sumatera barat; Warna bulu

Leaning On Our Academic Shields of Gendered Support

Intersectionality reminds us that women of color face a particular kind of marginalization due to both gendered and racial oppression and underrepresentation. As such, they are more often “presumed incompetent” and may not feel as innately supported in social and professional structures as their white male and female counterparts. Additionally, the silencing effect of being one of very few women of color in academic departments puts us at risk for further marginalization, requiring that we engage in significant invisible labor that is neither recognized nor compensated. Grounded on our intersectionalities, we discuss our respective trajectories within our own fields and research, beginning with research that emphatically perpetuates the cycle of gender inequity in the academy. The discussion is then supported by analyzing the theoretical research on the salience of race, gender, and other axes of identity for the experiences of women of color. As authors, we present these narratives in an attempt to engage with ways of reflexivity that are, especially for women of color in academia, not usually discussed.

Assessment of changes in the main homeostasis indicators in mammals after hyperthermic exposure

Introduction. The occupation of firefighters is characterized by the impact of both hazardous fire factors and a complex of harmful and dangerous characteristics of various natures, often exceeding the expected values. High air temperature is typical for almost all types of fire and is one of the main adverse physical factors affecting the body of firefighters. Experimental models on animals are of leading importance in studying extreme fire factors, including hyperthermic exposure. Material and methods. The study was carried out on 124 outbred white male rats of 3 months of age weighing 250-300 g, divided randomly into two groups. The first group (62 rats) was subjected to a single hyperthermic load. The second group (62 rats) was subjected to daily hyperthermic load during 14 days. The study of the leading indicators of the acid-base state and water-electrolyte balance, biochemical and clinical blood tests, cellular and humoral immunity was carried out before and after hyperthermic exposure. Results. The obtained data indicate high ambient temperatures cause changes in homeostasis indices in laboratory animals. At the same time, there are alterations in the indicators of water-electrolyte balance, acid-base state, clinical and biochemical blood tests and the immune system. Conclusion. An experimental model of extreme heat exposure on animals showed the emergence and persistence of changes in the leading indicators of homeostasis. In the group of single hyperthermia, these parameters were restored to the background levels in a day. In the group of multiple hyperthermia, they remained altered.