Background: Racial disparities exist in the accessibility, delivery, and quality of healthcare. Clinical images are central to plastic surgery, but choice of images in the literature is susceptible to implicit biases. The objective of this study was to determine if published images reflect the racial demographic of patients. Methods: A search for color photographs and rendered graphics depicting human skin was completed in 6 plastic surgery journals and the New England Journal of Medicine Images in Clinical Medicine for each decade between 1992 and 2017. For each article, images were categorized as white or nonwhite based on Fitzpatrick Scale (1–3 versus 4–6). Additionally, the authors’ geographic region was documented. Proportional data and average number of nonwhite images per article were compared. Regression analyses were performed to assess the correlation of time and geographic region on nonwhite images. Results: In total, 24,209 color photographs and 1,671 color graphics were analyzed. In plastic surgery journals, 22% of photographs were nonwhite and the average number of photographs per article with white skin was 5.4 compared with 1.6 with nonwhite skin (P < 0.0001). There was a significant increase in nonwhite photographs over time (r = 0.086, P < 0.001) and association of nonwhite photographs with international authors (r = 0.12, P < 0.001). Conclusions: Roughly 60%–70% of the world population and 30% of US cosmetic patients are nonwhite. Images in plastic surgery literature reflect neither racial demographics by global region nor the patient population seeking surgery. To advance equitable care, images should better represent the racial composition of the populations served.

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Objectives This study aimed to investigate the energy expenditure of common office-based tasks. The objectives were to: (a) test the classification of tasks as sedentary or light-intensity physical activity and (b) compare the energy expenditure of tasks under two postural conditions (sitting and standing). Background The sedentary nature of office work has been highlighted as a health risk, and strategies to reduce sedentary behavior at work have been developed. However, there is limited evidence to guide the utilization of sit-stand workstations in the workplace for metabolic health benefits. Method A repeated measures laboratory-based study compared the energy expenditure of common office tasks in sitting and standing using indirect calorimetry ( n = 22). Four standardized tasks (sitting/standing quietly, reading, typing, sorting paper) under two postural conditions (sitting, standing) were performed in a randomized order. Results The mean energy expenditure for all tasks in sitting and standing was <1.5 METs. There were no significant differences in the energy expenditure of doing the same task in sitting compared to standing. In a repeated measures ANOVA, task ( p < .001) had a greater influence on METs expended than posture ( p = .030). Conclusion The study confirmed that the difference in energy expenditure of tasks carried out in sitting compared to standing is negligible. Application The ubiquitous use and utility of sit-stand workstations in the workplace needs to be reviewed. Notwithstanding the potential benefits of movement that may occur naturally, this study confirmed that standing as opposed to sitting does not produce a clinically important increase in energy expenditure.

Objective: In this study, the extent of racial diversity in images of breast-related plastic surgery published literature was investigated to better understand disparities that exist in breast surgery. Background: The lack of racial diversity in images of skin color in surgery literature can perpetuate implicit bias and stereotypes. Implicit bias can affect the way patients are evaluated, diagnosed, and treated. The visual aspects of plastic surgery make a lack of diversity in imagery especially impactful on patient care and outcomes. Methods: Published medical images and graphics depicting human skin were analyzed across 4 major plastic surgery journals. Up to 4 years were chosen a priori to evaluate from each journal and represented the initial year of color image publication, the year of study initiation (2016), and representative years for a given decade (2000 and 2010). Images and graphics were tabulated, rated by Fitzpatrick scale and categorized into “White” or “non-White.” Data were evaluated with pair-wise and linear regression statistics. Results: Of the 2774 images and 353 graphics that met inclusion criteria, only 184 (8.18%) images and 9 graphics (6.34%) depicted non-White skin. Temporal analysis showed that there is an increased diversity of images published since 2010 with 0% of images being non-White before and 7.3% to 10.3% after 2010. International and multi-national authors tended to publish more non-White images. Conclusions: There is insufficient racial diversity visually represented in the breast-related plastic surgery literature with a small degree of progress made towards more equitable imagery over time. Increasing awareness of image content, and the need for equitable visual representation may allow for improved racial diversity in surgical literature.

Self-monitoring of blood glucose (SMBG) is commonly recommended to patients with diabetes, although the rationale for this is unclear. This small research project was designed to explore the reasons why nurses working in the community recommend SMBG. Seven interviews were carried out with community nurses caring primarily for housebound patients. Those interviewed believed that a sound evidence-base supported the recommendation that patients test their blood, but not urine, for glucose levels. Though nurses believed in the importance of patient choice and empowerment, the scope for these was limited among housebound patients. There was no evidence that patients understood how to respond to test results, or that comprehensive care planning was normal practice. Although small, this study suggests that nurses working in community settings may need to update their knowledge. It also suggests that a national debate is necessary to disseminate better the evidence about SMBG, and its implications for nursing practice.