Older adults are vastly underrepresented in clinical trials in spite of shouldering a disproportionate burden of disease and consumption of prescription drugs and therapies, restricting treatments' generalizability, efficacy, and safety. Eliminating Disparities in Clinical Trials, a national initiative comprising a stakeholder network of researchers, community advocates, policymakers, and federal representatives, undertook a critical analysis of older adults' structural barriers to clinical trial participation. We present practice and policy change recommendations emerging from this process and their rationale, which spanned multiple themes: (1) decision making with cognitively impaired patients; (2) pharmacokinetic differences and physiological age; (3) health literacy, communication, and aging; (4) geriatric training; (5) federal monitoring and accountability; (6) clinical trial costs; and (7) cumulative effects of aging and ethnicity.

This paper establishes the feasibility of a reusable biosensor that can be operated and stored at room temperature, for detection of small molecules in low resource settings. The sensor was fabricated using molecularly imprinted polymers (MIP) and cortisol was chosen as a model analyte. Cortisol imprinted polymer films were prepared by electropolymerizing pyrrole on an electrode surface in the presence of cortisol. Electrochemical over-oxidation of polypyrrole (PPy) was performed for the controlled release of cortisol templates and to create cortisol specific imprinting sites. Stepwise fabrication of imprinted sensors was characterized through cyclic voltammetry (CV) and scanning electron microscopy (SEM). The sensor exhibited a detection limit of 1 pM L−1 for cortisol. A unique feature of the sensor was that cross-reactivity with prednisolone (which has 100% interference in ELISA), was minimized to 18.3% compared to ELISA. The sensitivity of the sensor remained over 90% after 7 cycles of elution/rebinding, while the sensitivity decreased by 10% after 4 weeks of storage at room temperature, suggesting the sensor can be used multiple times and used with low overhead costs in low resource settings such as agricultural fields. The sensor was used for detection of cortisol in saliva samples of farm workers; benchmarking with ELISA showed excellent correlation. These findings indicate that such a sensor can be used for in-field measurements of small molecules (e.g. cortisol).

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This study used an intersectional approach (operationalized as the combination of more than one social identity) to examine the relationship between aspects of social identity (i.e., race, gender, age, and socioeconomic status [SES]), self-reported level of mistreatment, and attributions for discrimination. Self-reported discrimination has been researched extensively and there is substantial evidence of its association with adverse physical and psychological health outcomes. Few studies, however, have examined the relationship of multiple demographic variables (including social identities) to overall levels self-reported mistreatment as well the selection of attributions for discrimination. A diverse community sample (N = 292; 42.12% Black; 47.26% male) reported on experiences of discrimination using the Everyday Discrimination Scale. General linear models were used to test the effect of sociodemographic characteristics (i.e., race, gender, age, and SES) on total discrimination score and on attributions for discrimination. To test for intersectional relationships, we tested the effect of two-way interactions of sociodemographic characteristics on total discrimination score and attributions for discrimination. We found preliminary support for intersectional effects, as indicated by a significant race by age interaction on the selection of the race attribution for discrimination; gender by SES on the age attribution; age by gender on the education attribution; and race by SES on the economic situation attribution. Our study extends prior work by highlighting the importance of testing more than one factor as contributing to discrimination, particularly when examining to what sources individuals attribute discrimination.

Although 54 % of the total black immigrant population is from the Caribbean and 34 % is from Africa, we know relatively little about barriers to healthcare access faced by black immigrants. This paper reviews literature on the barriers that black immigrants face as they traverse the healthcare system and develops a conceptual framework to address barriers to healthcare access experienced by this population. Our contribution is twofold: (1) we synthesize the literature on barriers that may lead to inequitable healthcare access for black immigrants, and (2) we offer a theoretical perspective on how to address these barriers. Overall, the literature indicates that structural barriers can be overcome by providing interpreters, cultural competency training for healthcare professionals, and community-based care. Our model reflects individual and structural factors that may promote these initiatives.

Objectives We used community-based ethnography and public health risk assessment to assess beliefs about pesticide exposure risks among farmworkers in the Lower Yakima Valley of Washington State. Methods We used unstructured and semistructured interviews, work-site observation, and detailed field notes to gather data on pesticide exposure risks from 99 farmworkers. Results Farmworkers’ pesticide-relevant beliefs and attitudes could be grouped into 5 major themes: (1) dry pesticides are often perceived as a virtually harmless powder, (2) farmworkers who identify themselves as allergic to pesticides are more acutely affected by exposure, (3) the effect of pesticide exposure is more severe for those perceived as physically weak, (4) protective equipment is used selectively in response to financial pressure to work rapidly, and (5) some farmworkers delay decontamination until they find water deemed an appropriate temperature for handwashing. Conclusions We elucidated farmworkers’ pesticide-relevant beliefs regarding perceived danger and susceptibility to pesticides, the need to put safety second to financial considerations, and reasons for delaying decontamination. Researchers and policymakers should incorporate these data in study designs and legislation concerned with farmworker exposure to pesticides.

The detection of cortisol in saliva is an important screening tool for psychological stress and health monitoring, including the diagnosis of Cushing's syndrome, Addison's disease, and post-traumatic stress disorder (PTSD). In this work, a simple, low-cost, label-free, electrochemical immunosensing platform is explored for highly sensitive and selective detection of cortisol in saliva. Anti-Cortisol antibodies (Anti-C ab ) covalently immobilized on self-assembled monolayer (SAM) of dithiobis(succinimidylpropionte) (DTSP) modified microfabricated interdigitated microelectrodes (IDEs) were used for electrochemical detection of cortisol. The non-binding sites of immunosensor surface were blocked using ethyleneamine (EA). Electrochemical response studies as a function of cortisol concentrations were conducted using cyclic voltammetry (CV). The sensor exhibited a detection range from 10 pg/mL to 100 ng/mL, a detection limit of 10 pg/mL, and a sensitivity of 6 μA/(pg/mL) with the regression coefficient of 0.99. The obtained sensing parameters were in physiological range. The sensor was successfully tested on multiple specimen samples of saliva collected at different time intervals from two participants. The obtained cortisol concentrations from the developed electrochemical system correlate well with those were obtained using ELISA.) unless CC License in place (see abstract). ecsdl.org/site/terms_use address. Redistribution subject to ECS terms of use (see 199.212.65.7 Downloaded on 2014-11-04 to IP B3078Journal of The Electrochemical Society, 161 (2) B3077-B3082 (2014) ) unless CC License in place (see abstract). ecsdl.org/site/terms_use address. Redistribution subject to ECS terms of use (see 199.212.65.7 Downloaded on 2014-11-04 to IP ) unless CC License in place (see abstract). ecsdl.org/site/terms_use address. Redistribution subject to ECS terms of use (see 199.212.65.7 Downloaded on 2014-11-04 to IP ) unless CC License in place (see abstract). ecsdl.org/site/terms_use address. Redistribution subject to ECS terms of use (see 199.212.65.7 Downloaded on 2014-11-04 to IP

BackgroundThe role of patient race in medical decision-making is heavily debated. While some evidence suggests that patient race can be used by physicians to predict disease risk and determine drug therapy, other studies document bias and stereotyping by physicians based on patient race. It is critical, then, to explore physicians' attitudes regarding the medical relevance of patient race.MethodsWe conducted a qualitative study in the United States using ten focus groups of physicians stratified by self-identified race (black or white) and led by race-concordant moderators. Physicians were presented with a medical vignette about a patient (whose race was unknown) with Type 2 diabetes and untreated hypertension, who was also a current smoker. Participants were first asked to discuss what medical information they would need to treat the patient. Then physicians were asked to explicitly discuss the importance of race to the hypothetical patient's treatment. To identify common themes, codes, key words and physician demographics were compiled into a comprehensive table that allowed for examination of similarities and differences by physician race. Common themes were identified using the software package NVivo (QSR International, v7).ResultsForty self-identified black and 50 self-identified white physicians participated in the study. All physicians - regardless of their own race - believed that medical history, family history, and weight were important for making treatment decisions for the patient. However, black and white physicians reported differences in their views about the relevance of race. Several black physicians indicated that patient race is a central factor for choosing treatment options such as aggressive therapies, patient medication and understanding disease risk. Moreover, many black physicians considered patient race important to understand the patient's views, such as alternative medicine preferences and cultural beliefs about illness. However, few white physicians explicitly indicated that the patient's race was important over-and-above medical history. Instead, white physicians reported that the patient should be treated aggressively regardless of race.ConclusionsThis investigation adds to our understanding about how physicians in the United States consider race when treating patients, and sheds light on issues physicians face when deciding the importance of race in medical decision-making.