This scoping review of the 2000-2015 literature on strategies for and approaches to expanding URM representation in medicine reveals a repetitive, amplifying message of URM physician service commitment to vulnerable populations in medically underserved communities. Such message repetition reinforces policies and practices that might limit the full scope of URM practice, research and leadership opportunities in medicine. Cross-nationally, service commitment and patient-physician concordance benefits admittedly respond to recognised societal need, yet there is an associated risk for instrumentally singling out members of URMs to fulfil that need. The proceedings of a 2001 US Institute of Medicine symposium warned against creating a deterministic expectation that URM physicians provide care to minority populations. Our findings suggest that the expanding emphasis on URM service commitment and patient-physician concordance benefits warrants ongoing scrutiny and, more broadly, represent a cautionary tale of unintended consequences for medical educators globally.

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Health care providers hold negative explicit and implicit biases against marginalized groups of people such as racial and ethnic minoritized populations. These biases permeate the health care system and affect patients via patient–clinician communication, clinical decision making, and institutionalized practices. Addressing bias remains a fundamental professional responsibility of those accountable for the health and wellness of our populations. Current interventions include instruction on the existence and harmful role of bias in perpetuating health disparities, as well as skills training for the management of bias. These interventions can raise awareness of provider bias and engage health care providers in establishing egalitarian goals for care delivery, but these changes are not sustained, and the interventions have not demonstrated change in behavior in the clinical or learning environment. Unfortunately, the efficacy of these interventions may be hampered by health care providers’ work and learning environments, which are rife with discriminatory practices that sustain the very biases US health care professions are seeking to diminish. We offer a conceptual model demonstrating that provider-level implicit bias interventions should be accompanied by interventions that systemically change structures inside and outside the health care system if the country is to succeed in influencing biases and reducing health inequities. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

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Red cell exchange transfusion is frequently of use in the management of patients with sickle cell disease either electively or therapeutically. Modern cell separators allow this procedure to be performed rapidly, effectively and safely. These machines have a number of advantages over manual exchange procedures. The patient remains isovolaemic, there is little loss of plasma or platelets, the procedure is relatively short and in elective circumstances can be performed on an outpatient basis. In this series 66 exchanges were performed on 21 patients with an overall increase in HbA of 70%. The COBE Spectra gave a mean increase in HbA of 77%, with the majority of patients achieving an HbA of > 90% post exchange. Automated redcell exchange was well tolerated by most patients, and adverse effects were limited to symptoms of hypocalcaemia which were easily treated, and to transfusion reactions. Cell separators can therefore be recommended for exchange transfusion in patients with sickle cell disease, who require an increase in HbA levels either prophylactically or therapeutically. They are safe, effective, easy and quick to use.

Aqueous nucleic acid constituents uracil, uridine, and uridine-5‘-monophosphate are selectively adsorbed by a solid German peat-derived humic acid (GHA) and its tightly bound mercury(II) form (MGHA). Adsorption isotherms with GHA and MGHA adsorbents were obtained at 19 solute concentrations from 0 to 1.20 mM and seven fixed temperatures from 5.0 to 35.0 °C. Langmuir data analysis indicates that adsorption occurs in sequential steps A, B, and C, depending on the solute and experimental conditions. MGHA very strongly adsorbs low concentrations of uracil and site capacity vA for uracil adsorption on MGHA in step A increases with increasing temperature. The last steps of adsorption of relatively high concentrations of uridine, and uridine-5‘-monophosphate on MGHA are S-curves ascribed to increasing site capacity with increasing solute concentration. Comparison of the new data for adsorbents GHA and MGHA with data for adsorption of uracil, uridine, and uridine-5‘-monophosphate on compost-derived humic acid (CHA) from part 1 reveals similarities and differences. Nevertheless, linear plots of adsorption enthalpies vs entropies in all detected steps with CHA, GHA, and MGHA as adsorbents indicate that selective adsorption of nucleic acid constituents on different HAs is free energy buffered by similar mechanisms.

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The Tower of London - Drexel University, Second Edition (TOL(DX)) was investigated in order to determine the efficacy of using this instrument in evaluating the impact of traumatic brain injury on cognitive functioning in adults. Performance on the TOL(DX) was compared among 56 individuals with complicated mild to severe traumatic brain injury ("sTBI"), 68 individuals with uncomplicated, mild traumatic brain injury ("mTBI"), and 124 demographically matched, healthy controls. Both TBI groups performed worse than controls on TOL(DX) measures of executive time (ET) and number of moves used (TMS), but only patients with sTBI were more likely to be impaired on TMS (i.e., performing at least 1.5 SD below the mean). Poorer performance on TMS was associated with increasing length of coma. Although poor sensitivity of this measure limits its use in isolation, the TOL(DX) may provide a complementary measurement of aspects of problem-solving deficit in TBI that may not be captured by other tests.