“Code-switching”—the mixing of languages, dialects, tones, or lexicons within a single conversation—is a prevalent linguistic phenomenon that has been described thoroughly in the social science ...literature. However, it is relatively unknown to the medical community despite its clear implications for clinicians as they navigate their role in the physician-patient relationship. As multilingualism and other forms of mixed speech become increasingly common in the urban and globally minded populations of America’s modern cities, physicians must be cognizant of how they use their language skills—such as code-switching—to communicate with their patients in an ethical, supportive, and non-offensive manner. Multidisciplinary literature, case studies, and thought experiments on the subject provide an actionable framework by which health professionals can work toward achieving this goal of cultural competence.
Objective
While psychosocial factors have been associated with poorer outcomes after knee and hip arthroplasty, we hypothesized that augmented pain perception, as occurs in conditions such as ...fibromyalgia, may account for decreased responsiveness to primary knee and hip arthroplasty.
Methods
A prospective, observational cohort study was conducted. Preoperative phenotyping was conducted using validated questionnaires to assess pain, function, depression, anxiety, and catastrophizing. Participants also completed the 2011 fibromyalgia survey questionnaire, which addresses the widespread body pain and comorbid symptoms associated with characteristics of fibromyalgia.
Results
Of the 665 participants, 464 were retained 6 months after surgery. Since individuals who met criteria for being classified as having fibromyalgia were expected to respond less favorably, all primary analyses excluded these individuals (6% of the cohort). In the multivariate linear regression model predicting change in knee/hip pain (primary outcome), a higher fibromyalgia survey score was independently predictive of less improvement in pain (estimate −0.25, SE 0.044; P < 0.00001). Lower baseline joint pain scores and knee (versus hip) arthroplasty were also predictive of less improvement (R2 = 0.58). The same covariates were predictive in the multivariate logistic regression model for change in knee/hip pain, with a 17.8% increase in the odds of failure to meet the threshold of 50% improvement for every 1‐point increase in fibromyalgia survey score (P = 0.00032). The fibromyalgia survey score was also independently predictive of change in overall pain and patient global impression of change.
Conclusion
Our findings indicate that the fibromyalgia survey score is a robust predictor of poorer arthroplasty outcomes, even among individuals whose score falls well below the threshold for the categorical diagnosis of fibromyalgia.
Poor-quality diet is associated with one in five deaths globally. In the United States, it is the leading cause of death, representing a bigger risk factor than even smoking. For many, education on a ...healthy diet comes from their physician. However, as few as 25% of medical schools currently offer a dedicated nutrition course. We hypothesized that an active learning, culinary nutrition experience for medical students would improve the quality of their diets and better equip them to counsel future patients on food and nutrition.
This was a prospective, interventional, uncontrolled, non-randomized, pilot study. Ten first-year medical students at the Wayne State University School of Medicine completed a 4-part, 8-h course in culinary-nutritional instruction and hands-on cooking. Online assessment surveys were completed immediately prior to, immediately following, and 2 months after the intervention. There was a 100% retention rate and 98.8% item-completion rate on the questionnaires. The primary outcome was changes in attitudes regarding counselling patients on a healthy diet. Secondary outcomes included changes in dietary habits and acquisition of culinary knowledge. Average within-person change between timepoints was determined using ordinary least squares fixed-effect models. Statistical significance was defined as P ≤ .05.
Participants felt better prepared to counsel patients on a healthy diet immediately post-intervention (coefficient = 2.8; 95% confidence interval: 1.6 to 4.0 points; P < .001) and 2 months later (2.2 1.0, 3.4; P = .002). Scores on the objective test of culinary knowledge increased immediately after (3.6 2.4, 4.9; P < .001) and 2 months after (1.6 0.4, 2.9; P = .01) the intervention. Two months post-intervention, participants reported that a higher percentage of their meals were homemade compared to pre-intervention (13.7 2.1, 25.3; P = .02).
An experiential culinary nutrition course may improve medical students' readiness to provide dietary counselling. Further research will be necessary to determine what effects such interventions may have on the quality of participants' own diets.
Social scientists have become increasingly interested in using intensive longitudinal methods to study social phenomena that change over time. Many of these phenomena are expected to exhibit cycling ...fluctuations (e.g., sleep, mood, sexual desire). However, researchers typically employ analytical methods which are unable to model such patterns. We present spectral and cross-spectral analysis as means to address this limitation. Spectral analysis provides a means to interrogate time series from a different, frequency domain perspective, and to understand how the time series may be decomposed into their constituent periodic components. Cross-spectral extends this to dyadic data and allows for synchrony and time offsets to be identified. The techniques are commonly used in the physical and engineering sciences, and we discuss how to apply these popular analytical techniques to the social sciences while also demonstrating how to undertake estimations of significance and effect size. In this tutorial we begin by introducing spectral and cross-spectral analysis, before demonstrating its application to simulated univariate and bivariate individual- and group-level data. We employ cross-power spectral density techniques to understand synchrony between the individual time series in a dyadic time series, and circular statistics and polar plots to understand phase offsets between constituent periodic components. Finally, we present a means to undertake nonparameteric bootstrapping in order to estimate the significance, and derive a proxy for effect size. A Jupyter Notebook (Python 3.6) is provided as supplementary material to aid researchers who intend to apply these techniques.
Translational AbstractMany social and biological phenomena exhibit regular, cyclic patterns, such as the need for regular sleep, and the structure of a seven day week. Such phenomena cannot be modeled with typical methods used in social science and psychology, and it is therefore important that researchers in these fields are equipped with a means to do so. Spectral and cross-spectral analyses can be used for this purpose, and they provide a breakdown of the rates of cycles present in a signal. For example, the seven day week may be associated with a seven day cycle, and any phenomena influenced by this seven day structure would exhibit a peak in the analysis at this rate of fluctuation. This tutorial provides researchers in psychology with a guide for understanding and applying spectral and cross-spectral analyses, as well as supporting software code.
Many coastal communities throughout the world are threatened by local (or near-field) tsunamis that could inundate low-lying areas in a matter of minutes after generation. Although the hazard and ...sustainability literature often frames vulnerability conceptually as a multidimensional issue involving exposure, sensitivity, and resilience to a hazard, assessments often focus on one element or do not recognize the hazard context. We introduce an analytical framework for describing variations in population vulnerability to tsunami hazards that integrates ( i ) geospatial approaches to identify the number and characteristics of people in hazard zones, ( ii ) anisotropic path distance models to estimate evacuation travel times to safety, and ( iii ) cluster analysis to classify communities with similar vulnerability. We demonstrate this approach by classifying 49 incorporated cities, 7 tribal reservations, and 17 counties from northern California to northern Washington that are directly threatened by tsunami waves associated with a Cascadia subduction zone earthquake. Results suggest three primary community groups: ( i ) relatively low numbers of exposed populations with varied demographic sensitivities, ( ii ) high numbers of exposed populations but sufficient time to evacuate before wave arrival, and ( iii ) moderate numbers of exposed populations but insufficient time to evacuate. Results can be used to enhance general hazard-awareness efforts with targeted interventions, such as education and outreach tailored to local demographics, evacuation training, and/or vertical evacuation refuges.
Significance We present an analytical framework for understanding community-level vulnerability to tsunamis that integrates population exposure, demographic sensitivity, and evacuation potential.We identify three types of communities along the US Pacific Northwest coast that are directly threatened by tsunamis associated with a Cascadia subduction zone earthquake: ( i ) demographically diverse with low numbers of exposed people, ( ii ) high numbers of exposed populations but sufficient time to evacuate, and ( iii ) moderate numbers of exposed populations but insufficient time to evacuate. This approach is a significant advance over current practice because traditional measures of social vulnerability do not relate population structure to specific hazard characteristics. Results help managers to develop risk reduction strategies that are tailored to local conditions and needs.
Sexual desire discrepancy is one of the most frequently reported sexual concerns for individuals and couples and has been shown to be negatively associated with sexual and relationship satisfaction. ...Sexual desire has increasingly been examined as a state-like construct that ebbs and flows, but little is known about whether there are patterns in the fluctuation of sexual desire. Utilizing spectral and cross-spectral analysis, we transformed 30 days of dyadic daily diary data for perceived levels of sexual desire for a non-clinical sample of 133 couples (266 individuals) into the frequency domain to identify shared periodic state fluctuations in sexual desire. Spectral analysis is a technique commonly used in physics and engineering that allows time series data to be analyzed for the presence of regular cycles of fluctuation. Cross-spectral analysis allows for dyadic data to be analyzed for shared rates of fluctuation between partners as well as the degree of (a)synchrony (or phase shift) between these fluctuations. Men and women were found to exhibit fluctuations in sexual desire at various frequencies including rates of once and twice per month, and to have sexual desire that was unlikely to fluctuate over periods of three days or less and therefore exhibited persistence. Similar patterns of fluctuation were exhibited within couples and these patterns were found to be largely synchronous. While instances of desire discrepancy may arise due to differences in rates of sexual desire fluctuation and random fluctuations, such instances may be normal for romantic relationships. The results have important implications for researchers, clinicians, and educators in that they corroborate the supposition that sexual desire ebbs and flows and suggest that it does so with predictable regularity.
Tsunamis generated by Cascadia subduction zone earthquakes pose significant threats to coastal communities in the U.S. Pacific Northwest. Impacts of future tsunamis to individuals and communities ...will likely vary due to pre-event socioeconomic and demographic differences. In order to assess social vulnerability to Cascadia tsunamis, we adjust a social vulnerability index based on principal component analysis first developed by Cutter et al. (2003) to operate at the census-block level of geography and focus on community-level comparisons along the Oregon coast. The number of residents from blocks in tsunami-prone areas considered to have higher social vulnerability varies considerably among 26 Oregon cities and most are concentrated in four cities and two unincorporated areas. Variations in the number of residents from census blocks considered to have higher social vulnerability in each city do not strongly correlate with the number of residents or city assets in tsunami-prone areas. Methods presented here will help emergency managers to identify community sub-groups that are more susceptible to loss and to develop risk-reduction strategies that are tailored to local conditions.
Recent disasters highlight the threat that tsunamis pose to coastal communities. When developing tsunami-education efforts and vertical-evacuation strategies, emergency managers need to understand ...how much time it could take for a coastal population to reach higher ground before tsunami waves arrive. To improve efforts to model pedestrian evacuations from tsunamis, we examine the sensitivity of least-cost-distance models to variations in modeling approaches, data resolutions, and travel-rate assumptions. We base our observations on the assumption that an anisotropic approach that uses path-distance algorithms and accounts for variations in land cover and directionality in slope is the most realistic of an actual evacuation landscape. We focus our efforts on the Long Beach Peninsula in Washington (USA), where a substantial residential and tourist population is threatened by near-field tsunamis related to a potential Cascadia subduction zone earthquake. Results indicate thousands of people are located in areas where evacuations to higher ground will be difficult before arrival of the first tsunami wave. Deviations from anisotropic modeling assumptions substantially influence the amount of time likely needed to reach higher ground. Across the entire study, changes in resolution of elevation data has a greater impact on calculated travel times than changes in land-cover resolution. In particular areas, land-cover resolution had a substantial impact when travel-inhibiting waterways were not reflected in small-scale data. Changes in travel-speed parameters had a substantial impact also, suggesting the importance of public-health campaigns as a tsunami risk-reduction strategy.
The Problem with Killer Robots Gabriel Wood, Nathan
Journal of military ethics,
07/02/2020, Letnik:
19, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Warfare is becoming increasingly automated, from automatic missile defense systems to micro-UAVs (WASPs) that can maneuver through urban environments with ease, and each advance brings with it ...ethical questions in need of resolving. Proponents of lethal autonomous weapons systems (LAWS) provide varied arguments in their favor, ranging from claims that LAWS will be more effective to arguments that they will be more moral warfighters than flesh-and-blood soldiers. However, the arguments only point in favor of autonomous weapons systems, failing to demonstrate why such systems should be lethal. In this paper I argue that if one grants the proponents' points in favor of LAWS, then, contrary to what might be expected, this leads to the conclusion that it would be both immoral and illegal to deploy lethal autonomous weapons, because the features that speak in favor of LAWS also undermine the need for them to be programmed to take lives. In particular, I argue that such systems, if lethal, would violate the moral and legal principle of necessity, which forbids the use of weapons that impose superfluous injury or unnecessary harm. I conclude by highlighting that the argument is not against autonomous weapons per se, but only against lethal autonomous weapons.
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