Cohort Of Physicians Research Articles

NAMAH—An Innovative Tele-ECHO Mentoring Program to Foster Well-being Among Physicians

Background: The current study aimed to develop and implement the National Assistance in Mental Health for Health Care Providers (NAMAH) module, which focused on wellness and building resilience for a cohort of physicians. Methods: The NAMAH module is a 12-week tele-mentoring program leveraging videoconference technology that uses the ECHO (Extension of Community Healthcare Outcome) HUB and SPOKE and consists of real-life case discussions and a brief didactic. The module’s content was developed after iterative feedback from experts and incorporated suggestions from healthcare providers (HCPs) following a needs assessment. A pre and post-design was used to assess the impact of the module on psychological distress using the self-reported Kessler Psychological Distress Scale (K10) and burnout using the Maslach Burnout—Inventory-Human Services Survey (MBI-HSS) among the 32 physicians who participated. Results: There was a significant decrease in the mean scores before (19.5 ± 6.27) and after (17.38 ± 6.23) the NAMAH module ( p < .05) in the psychological distress as measured by K 10 with a Cohen’s d of 0.41 (95% CI: 0.05–0.77). There was also a significant decrease in the mean scores after the intervention in the emotional exhaustion and depersonalization domain of the MBI-HSS with a medium effect size (Cohen’s d of 0.65) and large effect size (Cohen’s d of 0.94), respectively. Conclusion: The findings from this pilot study lay a foundational framework, encouraging further exploration, research, and scaling-up of such interventions to enhance mental health among physicians and HCPs.

Validation of the Turkish Version of the Professional Fulfillment Index

Introduction: Clinician burnout represents a significant occupational hazard among physicians, with a notably high prevalence among emergency physicians. The Stanford Professional Fulfillment Index (PFI) was developed to comprehensively assess various aspects of doctors’ work experiences, including professional fulfillment. In this study we aimed to validate the Turkish version of the PFI (T-PFI), a 16-item instrument designed to measure physicians’ professional fulfillment and burnout. Methods: In this cross-sectional study, we validated the T-PFI in two phases. The initial phase involved translating and culturally adapting the original PFI into Turkish. We evaluated the content validity of the translated version using item and scale content validity indices (I-CVI and S-CVI, respectively). The validated T-PFI was then distributed among a broad cohort of emergency physicians via an online survey to further assess its reliability and validity. The assessment tools included Cronbach α, confirmatory factor analysis, and content validity indices. Results: Of 1,434 physicians who were sent the survey, 425 fully completed it (29.6%). There was an almost equal distribution of 215 females and 210 males. Only 9.6% of the participants reported high levels of professional fulfillment, whereas a significant majority (79.1%) were susceptible to burnout. The Cronbach α values for the professional fulfillment and overall burnout scales were 0.87 and 0.90, respectively. The content validity was confirmed by I-CVI values exceeding 0.80 and an S-CVI/average relevance of 0.92. The confirmatory factor analysis demonstrated an acceptable model fit after adjustments. Conclusion: The T-PFI is a reliable and valid tool for assessing professional fulfillment and burnout among emergency physicians in Turkey. Effective interventions to mitigate burnout are essential to improve physician well-being in Turkish healthcare settings.

The impact of updates in headache quality measures on adherence to best practices in a neurology resident clinic: Aquality improvement study.

To apply the 2019 joint American Academy of Neurology (AAN) and American Headache Society (AHS) quality measures for headache management to a cohort of neurology resident physicians and then assess outcomes related to guideline adherence. The optimization of headache management is essential to reduce both the individual and systemic impact of these disorders. In 2014, the AAN developed 10 quality measures for evidence-based management of patients with headache. A workgroup updated and condensed its headache quality measures in 2019, narrowing the set to six measurements, four of which would primarily focus on the management of migraine and two of which would address the management of cluster headache. This quality improvement study was conducted using a pretest-posttest study design. A pre-intervention survey based on retrospective analysis of five clinic notes for adherence to the measures was designed and distributed to all neurology residents (n = 32) at a large, academic tertiary referral center. The intervention included the creation of an electronic medical record template to aid residents in following the measures during clinical encounters, as well as the provision of direct feedback based on pre-intervention results. Finally, a post-intervention survey was distributed for completion based on notes written during the intervention period. Analysis was limited to migraine, given the low percentage of cluster headache seen in clinic. An increase in adherence was seen in three of the four migraine-related quality measures, with the Use of Abortive Medications for Migraine and Documentation of Counseling on Modifiable Lifestyle and Chronification Factors demonstrating statistically significant improvements (75.8% to 88.0% [p = 0.013] and 83.9% to 94.0% [p = 0.029] adherence, respectively). For secondary outcomes, the increase in the utilization of appropriate diagnostic criteria (82.6% to 93.2%, p = 0.018) was significant, and the self-assessed confidence rating for adherence to guidelines was significant (p < 0.001). This study provides evidence that the quality improvement intervention led to increased adherence to the AAN and AHS migraine-related measures. It is anticipated that increased adherence may lead to improved patient outcomes.

Assessing the interrater and intrarater reliability of subglottic stenosis grading systems

BackgroundSubglottic stenosis (SGS) is a condition leading to narrowing of the upper airway which can lead to dyspnea and life-threatening airway obstruction. Although other proposed grading systems exist, the Cotton Myer (CM) and percent stenosis systems are the most widespread in clinical practice. Despite this, the CM system has not yet been validated for visual assessment of SGS. ObjectiveTo determine the interrater and intrarater reliability of the CM grading system among a cohort of physicians who manage patients with SGS. MethodsAn online survey created with videos of tracheoscopies from 20 adult patients with subglotticstenosis (SGS) was sent individually to 9 expert physicians from various medical specialties, all of whom managed patients with SGS. Physicians were asked to view the 20 tracheoscopy videos and assess both the percent stenosis and Cotton Myer (CM) grade of each patient. After a period of 4 weeks, the physicians were sent the same survey of the 20 tracheoscopy videos. The interrater and intrarater reliability was calculated using the intraclass correlation coefficient (ICC), a measurement used to evaluate the reliability (the extent to which a measurement can be replicated) of two or more raters measuring the same subject. ResultsOverall, CM and percent stenosis systems were found to have an ICC of 0.94 and 0.90 within the domain of interrater reliability, respectively, and ICC of 0.71 and 0.81 within the domain of intrarater reliability, respectively. ConclusionOur findings suggest that the CM and percent stenosis grading systems remain a valid clinical tool to measure and communicate the severity of airway obstruction in SGS.

Exploring unmet concerns in home hospice cancer care: Perspectives of patients, informal caregivers, palliative care providers, and family physicians.

The study examines perspectives of patients in home hospice care; their informal caregivers; palliative health-care providers (HCPs); and family physicians, all regarding patients' unmet needs and quality of life (QoL)-related concerns. Participants from all 4 groups were approached within 2 months after the patient's admission to the home hospice care unit. Participants completed Edmonton Symptom Assessment Scale (ESAS) and Measure Yourself Concerns and Wellbeing (MYCAW) questionnaires, for patient's QoL-related concerns. Qualitative analysis of short narratives was conducted using ATLAS.ti software for systematic coding. In total, 78 participants completed the study questionnaires: 24 patients, 22 informal caregivers, 22 palliative HCPs, and 11 family physicians. Informal caregivers gave higher scores (i.e., greater severity) than patients for fatigue on ESAS (p = 0.009); and family physicians lower scores than patients for ESAS drowsiness (p = 0.046). Compared with patients, palliative HCPs gave higher scores for patient emotional-spiritual concerns (77.2% vs. 41.7%, p = 0.02); lower scores for gastrointestinal concerns (p = 0.048); and higher scores for overall function (p = 0.049). Qualitative assessment identified a gap between how patients/informal caregivers vs. palliative HCPs/family physicians regard emotional-spiritual themes, including discussing issues related to death and dying. The findings of the present study suggest that exploring a multifaceted cohort of home hospice patients, informal caregivers, palliative HCPs, and family physicians may provide insight on how to reduce communication gaps and address unmet needs of patients, particularly regarding emotional and spiritual concerns. While the 4 groups were similar in their scoring of patient QoL-related concerns, there were discrepancies for some concerns (e.g., patient fatigue) and expectations regarding the need to discuss emotional and spiritual concerns, including on death and dying. Educational initiatives with programs providing training to all 4 groups may help bridge this gap, creating a more open and collaborative hospice care environment.

Gender differences in scholarly productivity of early-career transfusion medicine physicians.

Promotion in academic medicine requires evidence of the creation and dissemination of scholarly output, primarily through peer-reviewed publications. Studies demonstrate that scholarly activity and impact are lower for women physicians than for men physicians, especially during the early stages of their academic careers. This report reviewed physicians' academic productivity after passing their Blood Banking/Transfusion Medicine (BBTM) subspecialty exam to determine if gender discrepancies exist. A cross-sectional analysis was designed to determine trends in scholarly activity for women physicians versus men physicians in BBTM. Indexed publications were reviewed using iCite, the National Institutes of Health (NIH) Office of Portfolio Analysis tool, from 1 January 2017 to 1 December 2021, for BBTM examinees who passed the sub-speciality fellowship exam in the years 2016 through 2018. Overall, women physicians had statistically significant fewer total career publications (median 6 vs. 9 cumulative papers, p = 0.03). Women published at a lower rate after passing BBTM boards, which was not statistically significant (0.7 vs. 1.3 publications per year). Other statistically significant findings include fewer early-career BBTM women physicians were first authors compared with men physicians (p = 0.03) and impact as assessed by relative citation ratio was higher for men (p = 0.01). This study demonstrates that there are gender differences in scholarly productivity and impact on early-career BBTM physicians. Given that this cohort of BBTM physicians are early-career professionals, the significant difference in first authorship publications between women and men physicians is especially concerning. Publication metrics should be followed to ensure equitable research environments for early-career BBTM physicians.

Evaluation of an automated feedback intervention to improve antibiotic prescribing among primary care physicians (OPEN Stewardship): a multinational controlled interrupted time-series study.

Tools to advance antimicrobial stewardship in the primary health care setting, where most antimicrobials are prescribed, are urgently needed. The aim of this study was to evaluate OPEN Stewarship (Online Platform for Expanding aNtibiotic Stewardship), an automated feedback intervention, among a cohort of primary care physicians. We performed a controlled, interrupted time-series study of 32 intervention and 725 control participants, consisting of primary care physicians from Ontario, Canada and Southern Israel, from October 2020 to December 2021. Intervention participants received three personalized feedback reports targeting several aspects of antibiotic prescribing. Study outcomes (overall prescribing rate, prescribing rate for viral respiratory conditions, prescribing rate for acute sinusitis, and mean duration of therapy) were evaluated using multilevel regression models. We observed a decrease in the mean duration of antibiotic therapy (IRR = 0.94; 95% CI: 0.90, 0.99) in intervention participants during the intervention period. We did not observe a significant decline in overall antibiotic prescribing (OR = 1.01; 95% CI: 0.94, 1.07), prescribing for viral respiratory conditions (OR = 0.87; 95% CI: 0.73, 1.03), or prescribing for acute sinusitis (OR = 0.85; 95% CI: 0.67, 1.07). In this antimicrobial stewardship intervention among primary care physicians, we observed shorter durations of therapy per antibiotic prescription during the intervention period. The COVID-19 pandemic may have hampered recruitment; a dramatic reduction in antibiotic prescribing rates in the months before our intervention may have made physicians less amenable to further reductions in prescribing, limiting the generalizability of the estimates obtained.IMPORTANCEAntibiotic overprescribing contributes to antibiotic resistance, a major threat to our ability to treat infections. We developed the OPEN Stewardship (Online Platform for Expanding aNtibiotic Stewardship) platform to provide automated feedback on antibiotic prescribing in primary care, where most antibiotics for human use are prescribed but where the resources to improve antibiotic prescribing are limited. We evaluated the platform among a cohort of primary care physicians from Ontario, Canada and Southern Israel from October 2020 to December 2021. The results showed that physicians who received personalized feedback reports prescribed shorter courses of antibiotics compared to controls, although they did not write fewer antibiotic prescriptions. While the COVID-19 pandemic presented logistical and analytical challenges, our study suggests that our intervention meaningfully improved an important aspect of antibiotic prescribing. The OPEN Stewardship platform stands as an automated, scalable intervention for improving antibiotic prescribing in primary care, where needs are diverse and technical capacity is limited.

(307) Prevalence of Sexual Dysfunction and Pursuit of Sexual Medicine Evaluation Among Male Physicians

Abstract Introduction While the epidemiology of male sexual dysfunction in the general population is well studied, little is known regarding the prevalence of sexual dysfunction in male physicians and their likelihood of seeking treatment. Objective To characterize the prevalence of sexual dysfunction, evaluation patterns, and barriers to treatment among male physicians. Methods Between June 2022 and October 2022, male physicians were invited to complete a questionnaire regarding sexual function. Surveys were disseminated electronically via social media and professional medical societies using Qualtrics (Provo, UT). Results 235 responses were included in the final analysis. The mean age of respondents was 36.3 ± 7.4 years. 27 (11.5%) reported having seen a doctor for sexual health. Of these 27,11 (40.7%) saw a physician for erectile dysfunction, 8 (29.6%) for low libido, 6 (22.2%) for premature ejaculation, 2 (7.4%) for delayed ejaculation, and 9 (33.3%) for some other concern. An additional 29 (13.9%) respondents considered establishing care for sexual issues but didn’t, mostly due to being too busy (N=18, 62.1%). Of the 56 respondents who had either seen or thought about seeing a physician for sexual health issues, the mean IIEF score was 24.4 ± 8.7 with 18 (32.1%) qualifying as having at least mild ED and 7 (12.5%) having severe ED (Table 2). 46 (19.6%) respondents reported having taken medication to improve erectile function. Only 12 (5.1%) respondents reported having ever been diagnosed with low testosterone. Among the 56 respondents who had either seen or thought about seeing a physician for sexual health issues, those who worked more hours (&amp;gt;60 hours per week) were least likely to see a physician (7.2%) compared to those working the fewest hours (33.3%), p=0.02. Conclusions In a cohort of young male physicians, 25.4% had seen or considered seeing a doctor for sexual health concerns, and nearly 1 in 5 had taken medication for erectile dysfunction. Given the highly demanding work schedules, occupational stress, and a variety of other factors associated the medical profession, male physicians appear to be at higher risk for sexual dysfunction than the general population. Moreover, male physicians face significant and unique barriers in access to care for sexual dysfunction. Disclosure No.

Prevalence of sexual dysfunction and pursuit of sexual medicine evaluation among male physicians-a survey.

We sought to characterize the prevalence of sexual dysfunction and barriers to treatment among male physicians. Between June and December 2022, male physicians were invited to complete a questionnaire regarding sexual function. Surveys were disseminated electronically via social media and professional medical societies using Qualtrics (Provo, UT). In totla, 235 responses were included in the final analysis. The mean age of respondents was 36.3 ± 7.4 years (range 23-72). 27 (11.5%) reported having seen a doctor for sexual health. Of these 27, 40.7% saw a physician for erectile dysfunction, 29.6% for low libido, 22.2% for premature ejaculation, 7.4% for delayed ejaculation, and 33.3% for other concerns. An additional 29 (12.3%) considered establishing care for sexual issues but didn't, mostly due to being too busy. 46 (19.6%) respondents reported having taken medication to improve erectile function. Therefore, in a cohort of young male physicians, 23.8% had seen or considered seeing a doctor for sexual health concerns, and nearly 1 in 5 had taken medication for erectile dysfunction. Male physicians appear to be at higher risk for sexual dysfunction than the general population and face significant and unique barriers in access to care for sexual dysfunction.

Practice Patterns of Physicians who Perform Caudal Epidural Steroid Injections.

Caudal epidural steroid injections (ESIs) are commonly employed in the management of low back pain and radiculopathy. Despite their widespread use, practice patterns among physicians performing caudal ESIs can vary significantly. This study aims to identify variability in injection techniques utilized by physicians during caudal ESIs, focusing on steroid use, needle selection, and catheter use. This study also looks at major permanent neurological injuries related to caudal ESIs. A survey was distributed to a cohort of physicians who regularly perform ESIs. The survey comprised questions regarding the type of needle primarily used, steroid selection, the use of catheters, and major neurological injuries from caudal ESIs. The respondents included a diverse group of pain management physicians from various specialties and practice settings. The results revealed a predominant preference for the use of particulate steroids (72.41%) when performing caudal ESIs. Additionally, physicians primarily prefer to use spinal needles (72.41%) compared to other needle types. A majority of physicians (65.12%) reported that they never use a catheter when performing caudal ESIs to access higher pathology. Finally, all physician responders (100%) reported that they have never caused a permanent neurological injury when performing a caudal ESI. This survey provides initial data among physicians who perform caudal ESIs. Our results demonstrate the majority of physicians favor using particulate steroids and a spinal needle, with fewer opting to use a catheter during these procedures. There were no reported major permanent neurological injuries, demonstrating that caudal ESIs are a safe interventional option for managing lumbosacral pain complaints.

Point-of-care-ultrasound for the assessment of post-renal transplant recipients.

Postoperative imaging for deceased donor renal transplants is often delayed, as these surgeries occur after-hours. These delays can be critical in identifying immediate complications. To our knowledge, there are no formal training programs for point-of-care ultrasound (POCUS) in this setting; therefore, we aimed to develop and evaluate a feasible and practical POCUS curriculum for the assessment of a renal transplant graft. Urology and nephrology transplant physicians completed a three-hour online course, followed by a five-hour hands-on seminar for sonographic scanning. Simulated patients with transplanted kidneys were used. Course material was developed with licensed ultrasound technologists based on Sonography Canada national competency profiles. Pre- and post-course surveys focused on user confidence, while pre- and post-course multiple-choice questionnaires assessed theoretical knowledge. Twelve participants were included, six of whom were urologists. Theoretical knowledge in POCUS improved significantly (p<0.001). Confidence in manipulation of ultrasound controls, Doppler imaging, and POCUS of the transplant kidney also improved (all p<0.001, d>2.0). Participants indicated an increased likelihood of POCUS use in clinical practice and that training should be integrated into a transplant fellowship. We introduced a novel and guideline-based POCUS curriculum that leveraged local ultrasound educators and found improved theoretical knowledge and skill confidence in our cohort of transplant physicians. This course will serve as the first step toward a validated competency-based training system for POCUS use in the immediate post-renal transplant setting, and likely will be incorporated into the training of the modern transplant physician.

Disparities by Sex in Promotion to Associate Professor Among a National Cohort of Academic Physicians: Causal Mediation Analysis.

Disparities by Sex in Promotion to Associate Professor Among a National Cohort of Academic Physicians: Causal Mediation Analysis.

Integrated dual training in palliative care and oncology

Fellowship training in Hospice and Palliative Medicine (HPM) and Hematology/Oncology (Hem/Onc) share common themes and roots in the holistic care of people living with cancer. As of 2021, approximately 630 physicians in the United States were board-certified in both HPM and Hem/Onc. There is increasing demand for an integrated fellowship pathway, and the inaugural integrated fellowship Match took place in 2022. We present the historical context of the overlap in HPM and Hem/Onc fellowship training, limitations of the standard training paradigm, and an overview of the recently developed integrated training pathway accredited by the Accreditation Council for Graduate Medical Education (ACGME). We explore applications of dual training in clinical care, program development, and research at the intersection of HPM and Hem/Onc. Finally, we consider challenges to the success and how best to assess the outcomes of this program. Integrated fellowship training in HPM and Hem/Onc is 1 avenue to develop a cohort of dual-trained physicians poised to effect broad cultural change in this important and evolving space. A subset of physicians with dual training has the potential to fill unmet needs by promoting enhanced patient-centered care, developing infrastructure for heightened collaboration between these distinct but closely related fields, and prioritizing research focused on advanced communication skills and symptom management for patients with cancer.

Educating Radiology Stakeholders on Relevant Health Issues and Terminology Regarding LGBTQIA+ Patients in 2023

Over 20% of the Lesbian, Gay, Bisexual, Queer or Questioning, Intersex, Asexual or Ally, and more (LGBTQIA+) community reports experiencing discrimination upon accessing health care, causing many to defer access to care and resulting in poorer outcomes. While members of this community routinely undergo imaging studies, little formal education exists within the field of radiology to review the unique health care needs of this population and the specific relevance to imaging, in addition to actionable methods to promote inclusion. A 1-hour educational conference was held for a cohort of radiology resident physicians at our institution, in which topics including LGBTQIA+health care disparities, clinical nuances relevant to the field of radiology, and actionable suggestions that both academic and private-practice centers can adopt to foster inclusion were presented. All attendees were required to complete a 12-question, multiple-choice preconference and postconference examination. Median prelecture and postlecture quiz scores for four first-year radiology residents were 29% and 75%, for two second-year radiology residents were 29% and 63%, for two third-year radiology residents were 17% and 71%, and for three fourth-year radiology residents were 42% and 80%. Multiple areas of opportunity to foster LGBTQIA+inclusion at the provider and administration levels currently exist throughout the field of radiology. A radiology-focused education module regarding clinical nuances, health care inequities, and ways to foster an inclusive environment with the LGBTQIA+communityis an effective way to promote learner knowledge.

Impact of Updates in Headache Quality Measures on Adherence to Best Practices in a Neurology Resident Clinic (P8-12.001)

<h3>Objective:</h3> To assess the impact of a quality-improvement initiative on adherence to updated American Academy of Neurology (AAN) headache quality measures. <h3>Background:</h3> As an important resource for headache care, the AAN publishes quality measures, which were most recently updated in 2019. This single-site study at a large, academic tertiary referral center aimed to apply the AAN measures to its cohort of neurology resident physicians and evaluate adherence changes (primary outcome) as well as utilization of appropriate diagnostic criteria, patient education, and confidence in following AAN guidelines (secondary outcomes). <h3>Design/Methods:</h3> A pre-intervention (pre-QI) survey based on retrospective analysis of five clinic notes for adherence to the measures was designed and distributed to all neurology residents at our center. The intervention included creation of an electronic medical record template to aid residents in following the measures during clinical encounters as well as provision of direct feedback based on pre-QI results. Finally, a post-intervention (post-QI) survey was distributed for completion based on notes written during the intervention period. Significance testing of differences between pre- and post-QI values was performed using Chi-squared analysis. Analysis was limited to migraine headaches given a low percentage of cluster headaches seen in clinic. <h3>Results:</h3> An increase in adherence was seen in three of the four migraine-related quality measures, with two – utilization of migraine abortive therapies and counseling of modifiable lifestyle and chronification factors – showing significant improvement (p &lt; 0.01). For secondary outcomes, increases in utilization of appropriate diagnostic criteria and patient education were both significant (p &lt; 0.05), and a positive trend in self-assessed confidence rating for adherence to AAN guidelines was significant (p &lt; 0.0001). <h3>Conclusions:</h3> This study provided evidence that our QI intervention led to increased adherence to the AAN migraine-related measures. It is anticipated that increased adherence may lead to improved patient outcomes. <b>Disclosure:</b> Mr. Cascella has nothing to disclose. Dr. Anderson has nothing to disclose. Dr. Perez Martinez has nothing to disclose.

Documenting Difference: Standardizing Foreign Physicians

This essay traces the transformation and standardization of the first cohort of Asian physicians trained outside the United States into Foreign Medical Graduates (FMGs) within the United States through documentary regimes. Congress solicited foreign physicians under the Hart-Celler Immigration and Nationality Act of 1965 to address doctor shortages in inner-city and rural communities throughout the country—a trend that continues today. Central to their migratory journey was an archive of expertise, a compilation of documents intended to verify identity, skill, and competence. Through the analysis of a physician's case file, new relations to documentation emerge that reveal how claims of underdocumentation, incorrect documentation, and overdocumentation regulate immigrant possibilities. In adopting this approach, this case study moves away from the unskilled / model minority dichotomy to show how documentary proceduralism operates as a racializing, disciplinary strategy across categories of immigrant labor.

Editor's Note

Editor's Note Mari Yoshihara We are delighted to commemorate the seventy-fifth anniversary of American Quarterly. In the three-quarters of a century, the field of American studies has been a site of vibrant exchange of ideas and gone through dynamic changes in terms of the agents of knowledge production and objects of study, the approaches to archives and tools of analysis, and the framing of questions and articulations of arguments. The six essays in this issue perfectly exemplify the kinds of scholarship enabled by both the accumulation of knowledge through the generations and the bold challenges to, and departures from, existing modes of analysis. The six essays all interrogate, in various contexts and through diverse approaches, the politics and expressions of the nation, state, capital, rights, body, and life. The first essay, by Emily Holloway, examines the archive of mid-nineteenth-century New York City public health administration that tracked the transit of corpses through Manhattan. Through an analysis of the intersections of biopolitics and urban space, she illuminates the layered meanings of "speculation" and its relations to surveillance and abstractions of financial value. In the essay that follows, Allan Downey also approaches New York City but through a very different lens: Haudenosaunee men who relocated from Canada and the northeastern United States to Brooklyn to work as ironworkers and their families that established the community of Little Caughnawaga. Downey demonstrates that, at a time when Indigenous peoples were removed from urban spaces and "Indian authenticity" was perceived to be the opposite of modernity, Kanien'kehá:ka citizens were central to building modernity and rearticulated their own nationhood, community, and self-determination. The next two essays look at the global circulation of text, body, voice, and their meanings in the Cold War era. In "If Books Could Kill," Mark David Kaufman mines the declassified archives of the Central Intelligence Agency and the Congress for Cultural Freedom to illuminate how these state institutions sought to manipulate the legacy of Leo Tolstoy as an instrument of the Cultural Cold War. He shows that while the US intelligence community sought to champion Tolstoy as a thinker whose individualist philosophy was assimilable neither to Marxism nor to capitalism, such appropriation conflicted with the writer's antipathy to the weaponization of culture for nationalist agenda. In the following essay, "Sonic Transness," Emmanuel David offers a reading of Christine Jorgensen's vocal performance in the 1962 Philippine film Kaming Mga Talyada (We Who Are Sexy), to analyze her voice and sonic practices in [End Page v] her self-constitution as a global, aspirational, and cosmopolitan white trans subject. By focusing on Jorgensen's performance in the Philippines, the essay also brings out the global production and extraction of value from trans and gender-nonconforming voices. The last two essays shed light on the legal mechanisms of racialization that manage knowledge, discourse, labor, and mobility of people of color. Through an interdisciplinary approach to the legal apparatuses surrounding the circulation of Dr. Martin Luther King Jr.'s image, likeness, speeches, and voice, Joseph Coppola illuminates the role of intellectual property in whitewashing King's legacy. By demonstrating how the structural commitments of the law contribute to racial hierarchy and economic inequality, Coppola addresses the power dynamics that shape the flow of knowledge production in the digital information age. In the final essay, Eram Alam traces the transformation and standardization of the first cohort of Asian physicians trained outside the United States into Foreign Medical Graduates within the United States. Analyzing the documentary regimes for verifying identity, skill, and competence, Alam shows that the documentary proceduralism operates as a racializing, disciplinary strategies across categories of immigrant labor. In Book Reviews, Paige A. McGinley discusses three recent works that advance the scholarship on the civil rights movement, and J. T. Roane examines three books on worldmaking practices, ecology, and environmental justice in the "Negrocene." In her event review, "¡No Vengan! Immigration Art in the Post-Trump Era," Maria Liliana Ramirez discusses Sergio de la Torre's exhibition put on as an artistic response to Vice President Kamala Harris's 2021 speech in Guatemala against the backdrop of the history of the history of undocumented immigrants in Santa...

Types of diagnostic errors reported by paediatric emergency providers in a global paediatric emergency care research network

BackgroundDiagnostic errors, reframed as missed opportunities for improving diagnosis (MOIDs), are poorly understood in the paediatric emergency department (ED) setting. We investigated the clinical experience, harm and contributing factors related...

Female Family Physicians Are More Racially Diverse Than Their Male Counterparts in Federal Sites.

Supporting a diverse family physician workforce is an integral component of achieving health equity. This study compared the racial/ethnic composition of Federal family physicians (Military, Veterans Administration/Department of Defense) to the entire cohort of family physicians and stratified by gender. Female family physicians serving at Federal sites were more diverse than the overall population of female family physicians and, also than their male Federal counterparts. This gendered trend among Federal physicians needs further exploration.

Incidence of unknown COVID-19 infection in a cohort of emergency physicians and advance practice providers

IntroductionIn United States, health care workers have been immersed in the COVID-19 pandemic since February 2020. Since availability of COVID-19 vaccines, there is limited literature investigating the incidence of unknown COVID-19 infections in physicians and Advanced Practitioner Providers (APPs) working in emergency departments (EDs). The primary objective is to determine the incidence unknown COVID-19 infection within a cohort of emergency physicians (EPs) and APPs. MethodsProspective observational study at a tertiary academic center with emergency medicine residency and 64,000 annual ED visits. EPs/APPs providing care to ED patients over the prior 12 months were eligible. Serum samples were collected between May 1 and June 30, 2022. Analysis utilized Luminex xMAP® SARS-CoV-2 Multi-Antigen IgG Assay for antibodies to Nucleocapsid, Receptor-binding domain, and Spike subunit 1. Mean Fluorescent Intensity (MFI) ≥ 700 was considered positive. Subjects completed 12 question survey assessing demographics and previously confirmed COVID-19 infection. Fisher's exact test evaluated associations of demographics and clinical characteristics with confirmed COVID-19 status. Analyses performed using SAS, Version 9.4. P < 0.05 considered statistically significant. ResultsSixty-nine of 81 eligible subjects (85.2%) participated, 58.0% were male, 97.1% white, with mean age of 37. Eighteen subjects had MFI ≥ 700 strongly suggestive of prior infection, with 17.7% unknown. No statistically significant difference between age, gender, race, children in home, or household member with previously COVID-19 infection. ConclusionUnknown previous COVID-19 infection was less then expected in this cohort of EPs/APPs, and no association with individual characteristics, previously infected household member, or children in the home.