US Context Research Articles

Competency-based medical education across the continuum: How well aligned are medical school EPAs to residency milestones?

Introduction Competency-based medical education (CBME) provides a framework for describing learner progression throughout training. However, specific approaches to CBME implementation vary widely across educational settings. Alignment between various methods used across the continuum is critical to support transitions and assess learner performance. The purpose of this study was to investigate alignment between CBME frameworks used in undergraduate medical education (UME) and graduate medical education (GME) settings using the US context as a model. Method The authors analyzed content from the core entrustable professional activities for entering residency (Core EPAs; UME model) and residency milestones (GME model). From that analysis, they performed a series of cross-walk activities to investigate alignment between frameworks. After independent review, authors discussed findings until consensus was reached. Results Some alignment was found for activities associated with history taking, physical examination, differential diagnosis, patient safety, and interprofessional care; however, there were far more examples of misalignment. Conclusions These findings highlight challenges creating alignment of assessment frameworks across the continuum of training. The importance of these findings includes implications for assessment and persistence of the educational gap across UME and GME. The authors provide four next steps to improve upon the continuum of education.

Sickle Cell Disease Mortality in Brazil: Real-World Evidence

Background: Sickle cell disease (SCD) is a group of inherited chronic multisystem disorders, being one of the most common hereditary diseases in Brazil.[1] In a modelled US cohort, life expectancy of individuals with SCD was estimated to be 22 years lower compared to the general population (54 versus 76 years, respectively).[2] The life expectancy at birth in Brazil, for the general population, is 77 years.[3] However, little is known about the impact of SCD in mortality in Brazil. The aim of this study was to better understand the patters of mortality of SCD individuals, compared to the general population, using real-world data from Brazilian public databases.Methods: We retrieved data from all registered deaths in Brazil from 2015 to 2019 from the Brazilian public database of the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM). To identify records from individuals with SCD, we selected records with an ICD-10 code referring to SCD (D57, D57.0, D57.1, D57.2 or D57.8) in any field related to cause of death. Using descriptive statistics, we explored the sex, race, age at death, and cause of death recorded in the registries. We also estimated the crude mortality rate of individuals with SCD (per 100.000 inhabitants) and compared the rates from each year with Pearson's correlation. Sensitivity analyses were conducted considering only registries with SCD as the primary (underlying) cause of death. All analyses were conducted with R, version 4.1.0.Results: A total of 6,553,132 deaths were registered in Brazil, from which 3,320 records were from individuals with SCD. Among them, the median age at death was 32.0 (IQR 19.0 - 46.0, Figure 1a), 37 years younger than the general population (median 69.0; IQR 53.0 - 81.0, Figure 1b). Considering only records with SCD as the primary cause of death, we identified 2,603 records. Among them, the median age at death was 30.0 (IQR 19.0 - 45.0). Similar results are observed in subgroup analyses according to sex and race (Table 1). Among registries from individuals with SCD, most were brown or black (79%) and women (52%). In comparison, in the general population, 45% of registries were from brown or black individuals, and 44% were from women. Over the five years evaluated, the crude annual mortality rate of SCD population was 0.32 per 100.000 inhabitants of the general population; considering only deaths with SCD as a primary cause, the mortality rate was 0.25 per 100.000 inhabitants. We did not observe substantial changes or statistical trends in the yearly mortality rate over the period evaluated (from 0.30 to 0.34; Pearson's r = -0.21; p = 0.735). The most common causes of death among individuals with SCD related mortality were sepsis (24.2%) and respiratory failure (7.9%).Conclusions: In Brazil, SCD is associated with a reduction of approximately 37 years on median age at death, in comparison with the general population; data was consistent when stratified by sex and race. This result is similar compared to two other studies: one considering the US context and one evaluating a Brazilian cohort from a reference local center, observed a loss of more than 20 years in the life expectancy of SCD patients at birth.[3, 4] As expected, the main causes of deaths were septicaemias and respiratory failure.[4, 5] Possible misdiagnoses, inaccurate completion of death certificates and possible confounding due to regional differences not accounted in these analyses are the main limitations of our study.

“VeryFemale, with the Allure of a Foreign Aura”: Vocality, Gender, and European Exoticism in the US Careers of Alice Babs and Caterina Valente

Abstract“How can America import ‘American’ jazz?,” asked the music editor ofGood Housekeeping, George Marek, in 1956. Marek answered, “Singers, particularly if they are very female, give the home-grown music the allure of a foreign aura.” Taking these statements as a starting point, this article gives an account of the US careers of Alice Babs and Caterina Valente. Gender, class, and ethnicity were key elements in the US construction of Babs's and Valente's musical personae, which was especially heard in their vocality, with an emphasis on high-pitched vocal stylings, melismas, and “white” timbres to signify gender and European exoticism. The US careers of Babs and Valente show us that musical Americanness or Europeanness are not created separately on either side of the Atlantic. Their European identities were not created in Europe and then imported to the United States but were created in the process of transmission into the United States. Importantly, the article argues that race and ethnicity were used by musicians, critics, and listeners to position Babs and Valente as Europeans. Their whiteness was transposed in a US context and their stories tell us as much about US ideologies of whiteness as it does about European ethnicities.

Trans-, Translation, Transnational

Trans-, Translation, Transnational

Queer in Translation: Sexual Politics under Neoliberal IslamLGBTI Rights in Turkey: Sexuality and the State in the Middle East

Queer in Translation: Sexual Politics under Neoliberal IslamLGBTI Rights in Turkey: Sexuality and the State in the Middle East

Multimodal Framing of Germany’s National Image: Comparing News on Twitter (USA) and Weibo (China)

ABSTRACT This article examines multimodal frame construction and presents comparative research regarding Germany’s mediated national image. We conducted a quantitative content analysis of 2455 news posts (N USA = 1722, N China = 733) published by leading newspapers on Twitter (USA) and Weibo (China) between 2007 and 2019. The results reveal that news texts attribute varying degrees of salience to the dimensions of national image. Chinese news texts portray Germany more positively among most indicators compared to US news texts. News visuals assume more complementary or dramatizing functions in the US context and more elaborated or illustrative roles in the Chinese context. A hierarchical cluster analysis shows how Germany’s national image is constructed through textual contents, visual denotations, and text-image relations in multimodal news. German cultural attractions, football excellence, social diversity, and economic performance are commonly visible across both nations, whereas political debate, crisis, and international controversy are largely absent from Chinese news frames. Contexts shape multimodal frames, where the uniformity of coverage is the result of globalized news production and shared journalistic standards such as (visual) news values relating to eliteness, impact, and consonance. National differences are interpreted by contextual factors of political homophily, journalism culture, and platform affordance.

Decolonising the global to local movement: Time for a new paradigm

ABSTRACT Mama Amaan Project (MAP) delivered perinatal education and doula services to underserved refugee and immigrant communities in Seattle, Washington. MAP presented at a ‘global to local (glocal)’ workshop for US-based global health agencies redirecting their experience and resources to address domestic health crises. Glocal models reference Global South anti-colonial social transformations through Primary Health Care (PHC) – ‘health for all as a right’ and investment in strong public sectors. As Black women working in our communities, we resisted labelling MAP glocal. Western donors and NGOs appropriate PHC’s community participation narratives, meanwhile implementing World Bank/IMF economic structural adjustment health system cuts – thereby shifting austerity-related resource shortfalls to communities. In US contexts of neoliberal shrinking social safety nets and workers’ rights, similar strategies to address austerity-related health disparities are promoted as ‘global to local’. Projects like MAP cannot substitute quality public services. They expose gaps and build community empowerment to demand quality healthcare. Drawing on MAP and ‘global health’ experience in Mozambique, we call for re-embracing PHC’s activist values – agitating for health as a universal human right for all, rather than putting the burden and blame on underserved communities. We propose decolonising the ‘glocal’ paradigm by embracing ‘transnationality’, ‘relationality’ and ‘mutuality’.

Prevalence of Extensive and Limited Gastric Intestinal Metaplasia and Progression to Dysplasia and Gastric Cancer.

Guidelines cite extensive gastric intestinal metaplasia (GIM) as a bigger risk factor for gastric cancer (GC) than limited GIM and an indication for endoscopic surveillance. Data on progression of extensive GIM to GC in the USA are limited. This study aimed to estimate the prevalence and progression rates of extensive GIM in a US cohort. This retrospective study assessed the prevalence of extensive GIM between 1/1/1990 and 8/1/2019 at a large academic medical center. Multivariable regression was used to identify predictors of extensive GIM. Incidence of GC on follow-up was calculated as number of new diagnoses divided by person-years of follow-up. Presence of GIM on subsequent follow-up endoscopy was assessed. Of 1256 individuals with GIM, 352 (28%) had extensive GIM and 904 (72%) had limited GIM. On multivariable analysis, older age (OR 1.01, 95% CI 1.00-1.02) and Hispanic ethnicity (OR 1.55, 95% CI 1.11-2.16) were predictive of extensive GIM. The annual incidence of GC for GIM overall was 0.09%. There was no difference in progression to GC between extensive or limited GIM (IRR 0, 95% CI 0-2.6), or to advanced lesions overall (IRR 0.37, 95% CI 0.04-1.62). 70% of individuals had persistent GIM on follow-up biopsy, and 22% with limited GIM had extensive GIM on follow-up biopsy. 28% of individuals with GIM have the extensive subtype, and are more likely to be older and of Hispanic ethnicity. There was no difference in progression to GC between extensive and limited GIM. Further research is needed to better assess risk of GIM in the US context.

Displacement of race in language and gender studies

As a collaboration between the two authors, this essay first addresses each author’s individual perspective on language and gender studies, particularly as it has taken shape in the US context, and then offers a jointly developed argument regarding the field’s history and trajectory. We write from the respective standpoints of our lived experiences within and beyond the academy. Mary is a white cis female-identified linguistics professor who was deeply involved in the Berkeley Women and Language Group in the 1990s and has conducted research on language and gender throughout her career, especially with respect to its intersection with race. deandre’s Black and gender-creative subjectivity substantially colours the lens through which they experience and interpret the social life of language.

Barriers and Enablers to Circular Building Design in the US: An Empirical Study

As discussions around the circular economy (CE) start to move beyond Eurocentric approaches, US stakeholders are left with the mission of carving their way into CE. The US building sector has substantial impacts in resource use, waste generation, and carbon emissions, and a long way to go on the path toward CE. Circular building design involves strategies such as design for disassembly (DfD) to allow future repair, remanufacture, and reuse of building components, building adaptive reuse, and using salvaged materials in new construction. Although strategies like DfD have been discussed for the last 2 decades, they have failed to gain traction in building design. However, there is a limited body of literature devoted to understanding the barriers and enablers for key circular building design strategies like DfD. A few recent empirical studies in European countries have identified barriers for circular building design, which in this study were categorized according to their nature (regulatory, economic, technical, educational, cultural, technological, and environmental barriers). However, given the different regulatory, economic, and cultural contexts in which the US is situated when compared with European countries, the barriers identified in prior studies and their respective enablers may not apply to the US. For example, contrary to European countries, the US is yet to create a national CE-specific legislation or action plan. Thus, bottom-up efforts from industry stakeholders are key to achieve progress toward CE in the US. Yet there are no studies that investigated barriers and enablers to circular building design in the US context. This study aims to fill this knowledge gap. The authors interviewed architects across the US to understand the perceived and experienced barriers to circular building design in the US building sector and propose enablers to overcome these barriers. The barriers differed in nature from those found in European countries: although the share of technical and economic barriers were similar, more educational and cultural barriers were found in the US, as opposed to a larger shares of regulatory and technological barriers in European countries. The authors discuss the most mentioned barriers in the US (e.g., cost and schedule constraints, lack of clarity on what CE entails, and existing regulations and codes hinder reuse and repair), and the barriers that were new to the literature (e.g., belief that DfD compromises building durability and resiliency, conflicting goals between pre-engineered structures and future reuse, and the widespread use of nondurable building components). Finally, the authors propose enablers to address each barrier and discuss the role of different stakeholders in implementing enablers. Policymakers, non-governmental organizations (NGOs), industry associations, and researchers were the stakeholders with the highest leverage to enable CE in the US building sector.

Perceived weight gain and eating disorder symptoms among LGBTQ+\u2009adults during the COVID-19 pandemic: a convergent mixed-method study

BackgroundIn this study, we further explore the role of COVID-19 pandemic-related stress, social support, and resilience on self-reported eating disorder symptoms (using the EDE-QS) and perceived weight gain among lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+ adults) in the US context during the COVID-19 pandemic.MethodsEmploying a convergent mixed method design, we surveyed 411 individuals, and conducted qualitative semi-structured follow-up interviews with 43 LGBTQ+ -identifying survey respondents. Using OLS regression and multinomial logistic regression, we modeled eating disorder symptoms and perceived weight gain among LGBTQ+ individuals (n = 120) and cisgender and heterosexual-identifying women (n = 230), to cisgender and heterosexual-identifying men (n = 61). We also explored complementary interview narratives among LGBTQ+ people by employing selective coding strategies.ResultsStudy results suggest that LGBTQ+ individuals are likely experiencing uniquely high levels of pandemic-related stress, and secondly, that pandemic-related stress is associated with elevated eating disorder symptoms and higher risk of perceived weight gain. Nearly 1 in 3 participants reported eating disorder symptoms of potentially clinical significance. Social support, but not resilient coping, was found to be protective against increased eating disorder symptoms. Qualitative analyses revealed that LGBTQ+ individuals situated physical exercise constraints, challenging eating patterns, and weight concerns within their pandemic experiences.ConclusionsClinicians of diverse specialties should screen for eating disorder symptoms and actively engage patients in conversations about their COVID-19-related weight gain and eating behaviors, particularly with LGBTQ+ -identifying adults.

Conflict Theory, Extended: A Framework for Understanding Contemporary Struggles Over Education Policy

Conflicts over education and education policy continue, and now new, diversified actors push for change while technologies expand the terrain where conflicts unfold. Conflict theories would seem best suited to address these conflicts. However, despite conflict theories’ substantive contributions, they are infrequently used in the US context and have met with critique, viewed as too reductive to fully contend with the complexities of conflict in the educational arena. In this paper, we extend traditional conflict theories to address these longstanding critiques and to also incorporate contemporary complexities and developments. Our study is grounded in recent developments in sociological field theory and intersectionality theory. Our proposed extension of conflict theory was developed in conversation with twelve empirical cases of recent conflicts in P-16 education. This iterative project’s novel insights offer practical implications for policy actors, researchers, and policymakers.

The Future of Progressive Politics in a Post-Fordist World

The Future of Progressive Politics in a Post-Fordist World

Why the Gap in Evaluating the Social Constructs and the Value of Medicines?

The compounding effects of occupying two or more social identities, such as being “Black” and “female” have been described in intersectionality theory. Intersectionality, a term coined by legal scholar and activist Kimberlé Crenshaw, is a framework to consider race and other social identities as overlapping, dynamic, and interdependent identities. Since its inception, intersectionality has made significant in-roads to inform the conceptualization and empirical investigations of race, gender, and other social identities in sociology, critical race theory, anthropology, feminist theory, and other disciplines. However, to date, cost effectiveness research has not systematically examined race intersecting with other social identities in the valuation of medicines using social theory, such as intersectionality. Consequently, cost effectiveness analysis, which is a method to study the value of medicines in diverse populations, has not been subject to sufficient examination through an intersectionality framework. In the US context, the racial injustices experienced and documented within diverse communities highlight that health outcomes cannot be examined in a vacuum; overlapping social identities such as race and class in relation to context have real effects on health behaviors, measured preferences, and economic costs. Failure to examine the effects of overlapping social identities on heterogeneity in benefits and costs can result in inadequate information for decision makers to evaluate the value of treatments. Without consideration of the overlapping social identities in diverse populations, there is a risk that cost effectiveness analysis results will not accurately reflect the value of treatments in socially disadvantaged populations. In this Current Opinion, we provide an outline for conducting socially conscious cost effectiveness analyses, using intersectionality as one example.

Exploring the impact of diversity climate on individual work role performance: A novel approach

AbstractWhile the positive diversity climate‐performance relationship has already been widely studied, still little is known about the mechanisms by which this relationship operates. Additionally, very few studies using the diversity climate concept were conducted in Europe, as most diversity climate measures were designed for the US context. We create a new measurement instrument that is not US‐sensitive, based on a new underlying conceptualization. We use this new measure to understand the influence of diversity climate on work role performance in the European context. We test our conceptual model through a cross‐level analysis in a large French organization (N = 509; Nunit = 34). We find that unit‐level diversity climate is positively related to work role performance, and that job satisfaction and affective commitment mediate the diversity climate/work role performance relationship. This study has strong theoretical and managerial implications as it highlights the role of diversity climate on performance behaviors.

A Realist Evaluation of Team Interventions in Acute Hospital Contexts-Use of Two Case Studies to Test Initial Programme Theories.

Background: Designing and implementing team interventions to improve quality and safety of care in acute hospital contexts is challenging. There is little emphasis in the literature on how contextual conditions impact interventions or how specific active ingredients of interventions impact on team members’ reasoning and enact change. This realist evaluation helps to deepen the understanding of the enablers and barriers for effective team interventions in these contexts. Methods: Five previously developed initial programme theories were tested using case studies from two diverse hospital contexts. Data were collected from theory driven interviews (n = 19) in an Irish context and from previously conducted evaluative interviews (n = 16) in a US context. Data were explored to unpack the underlying social and psychological drivers that drove both intended and unintended outcomes. Patterns of regularity were identified and synthesised to develop middle-range theories (MRTs). Results: Eleven MRTs demonstrate how and why intervention resources introduced in specific contextual conditions enact reasoning mechanisms and generate intended and unintended outcomes for patients, team members, the team and organisational leaders. The triggered mechanisms relate to shared mental models; openness, inclusivity and connectedness; leadership and engagement; social identity and intrinsic motivational factors. Conclusions: The findings provide valuable information for architects and facilitators of team interventions in acute hospital contexts, as well as help identify avenues for future research. Dataset: The data presented in this study are available on request from the corresponding author. The data are not publicly available due to their sensitive nature and potential identification of participants.

Intersectionality as a new feeling rule for young feminists: Race and feminist relations in France and Switzerland

Black feminist theory and theorizations by feminists of colour have identified and explored emotions linked to race and racism in feminist movements, especially in the US context. Building on this literature, this article explores the changes in feminist emotional dynamics linked to race which have been brought up by the relatively recent adoption of intersectionality in feminist movements’ discourses in two European countries, France and Switzerland, which are both often described as ‘colour-blind’ contexts. Drawing on Hochschild’s concept of feeling rules, we argue that intersectionality has changed the ways feminists are legitimately expected to feel about race and racism within feminist movements in both contexts. As feeling rules vary according to the members’ positions within the movement, we contend that these changes in emotional dynamics contribute to redefine feminists’ relations and feminist membership along racial lines. Based on interviews with young feminist activists in France and Switzerland during mobilization processes characterized by a prominent use of intersectionality, we observe how intersectionality discourses bring about new feeling rules in relation to race and racism. These feeling rules differ for white and non-white feminists: while intersectionality has led young white feminists to self-education and self-critique, racialized feminists often expressed mixed feelings about intersectionality and its use, in particular by white feminists. Importantly, these changes in feeling rules have allowed racialized feminists to renegotiate their relations with white feminists and their emotional content, as well as their position within the movement.

Indulging in the Centre Stage: CEO Narcissism and Successor Selection in Family Firms

Previous research on family business succession indicates that characteristics of the incumbents can influence successor selection. Yet, what and how the incumbents’ personality affects the process has rarely been discussed. In this study, we build on upper echelon theory and narcissistic supply logic to develop and test a model of family business succession as well as the moderating effects of the proportion of independent directors and pre-succession performance, using a dataset of 83 CEOs from family firms in the United States between 1995-2020. To solidify our finding, we use different ways to measure CEOs’ narcissism to check the robustness from the US sample. Furthermore, we explore our main findings in a cross-culture context with 124 Chinese CEO samples. We largely found support for the model in both the US and China context- a positive relationship between CEO narcissism and family member selection. We extend prior theory on family business succession by exploring the relationship between CEO narcissism and successor selection, the moderating effect of independent directors as well as pre-succession performance, and offering a greater understanding of narcissistic supply theory. In this way, our findings shed light on how the CEO’s personality can strongly influence a family firm’s succession decision, which contributes to upper echelon theory, CEO narcissism, and family succession literature.

Dis/possession Afoot: American (Anthropological) Traditions of Anti‐Blackness and Coloniality

In this essay, we call on linguistic anthropology to combat specific modes of White Supremacy (anti‐Blackness, anti‐Indigeneity, and anti‐Nativeness) by recognizing them as intimately central to the formations and formulations of our (sub)field in the US (and broader) context. We speak to and from particular legacies of dispossession and repossession engendered by two mated and enduring structural processes, settler colonialism (Simpson 2014) and racial slavery (Hartman 2008; Sharpe 2016; Mignolo 2006), which continue to animate the ubiquity of owning via the making of (linguistic) anthropological knowledge (owning through knowing and collecting) and via the knowing, collecting, and wearing of Black and Native people that helps make up everyday life in America (e.g., mascots, blackface, pop cultural caricatures, Halloween costumes, language appropriation, slave souvenirs, dream catchers and on and on (Meek 2006; 2020; Smalls and Davis forthcoming; Smalls forthcoming). Finally, we draw on Black and Native theorists to offer practices of solidarities and abolition (Byrd 2019; Harris 2019; Latty et. al 2016; Leroy 2016; King 2019; Tuck et. al 2014; Morrill et al. 2016).

Can Parametric Microinsurance Improve the Financial Resilience of Low-Income Households in the United States?

Natural disaster risk is escalating around the globe and in the United States. A large body of research has found that lower-income households disproportionally suffer from disasters and are less likely to recover. Poorer households often lack the financial resources for rebuilding, endangering other aspects of wellbeing. Parametric microinsurance has been used in many developing countries to improve the financial resilience of low-income households. This paper presents a review of the evidence for implementing parametric microinsurance in the U.S., with spillover lessons for other highly developed countries. We discuss the benefits and the challenges of microinsurance in a US context and explore 4 possible distribution models that could help overcome difficulties, with policies being provided: (1) by an aggregator, (2) through a mobile-based technology, (3) by linking to other products or retailers, or (4) through a public sector insurer.