All Shades of Anxiety: A Review of Therapeutic and Psychotropic Considerations for Child and Adolescent Youth of Color.

The literature on anxiety in Black, Indigenous, and other persons of color youth is a developing area. This article highlights distinct areas for the clinician to consider in working with these populations. We highlight prevalence and incidence, race-related stress, social media, substance use, spirituality, the impact of social determinants of health (including COVID-19 and the Syndemic), as well as treatment considerations. Our aim is to contribute to the readers' developing cultural humility.

Women in cardiology leadership of randomized clinical trials and participation of women in late-breaking clinical trials: Has the COVID-19 pandemic changed a thing or not exactly

Introduction: Despite considerable developments made in the representation of women in cardiology (WIC) recently, there still remain substantial disparities in the representation of women participants in clinical trials, as well as women physicians and scientists in clinical trial leadership. Under-representation of women in Randomized Clinical Trials (RCTs) remains the bane of the modern medicine, impeding the development of sexspecific guidelines in cardiovascular diseases. Female leadership in clinical trials has been shown to enhance the inclusion of women as trial participants. Furthermore, while the COVID-19 pandemic has impacted women in academia, there is no data thus far reporting the impact of the pandemic in terms of presenters and leadership of late-breaking clinical trials (LBCT) in cardiology during this period. Purpose(s): We aimed to determine inclusion of WIC in LBCTs leadership and their correlation to inclusion of women in reported RCTs. Method(s): In our comprehensive analysis, we included all LBCTs presented at major international cardiovascular meetings reported over the period of January 2020 to February 2022. Data were derived from the original presentation at the meeting and/or simultaneous/ subsequent publication of manuscript. Sex of the presenter (woman or man), was assessed by either original videos of the presentation at the meeting, or based on pronoun use in the biographies derived from institutional profiles. The presence or absence of reporting of sex distribution of study participants were also recorded from original presentation at the meeting and/or published manuscript. Proportion of women included in each trial was sourced from either original publication or calculated from any similar data shown during the presentations. Result(s): A total of 400 of RCTs from 19 meetings were included with a total of 400 presenters/principal investigators recorded - 32 (8%) women and 368 (92%) men. There were no significant differences between 2020 and 2021 [15 (7.2%) women in 2021 vs. 17 (19.3%) in 2020 (P=0.446)]. Proportions of women included in RCTs with WIC (37.3%) vs. non-WIC (38.7%) presenters were comparable (p=0.559), while 45% of RCTs didn't report sex distribution of participants. Except for 2 meetings (CRT 2020 and 2022), all others were virtual. Conclusion(s): WIC representation as RCTs presenters was significantly low, despite the opportunity of virtual attendance afforded during the COVID-19 pandemic. Modest inclusion of women irrespective of sex of RCT leadership emphasizes multi-level problems that require more actionable solutions: I.e. implicit bias training started as early as medical school, continuing education on necessity for diversity, equity and inclusion, patient and public involvement, and comprehensive guidance on trial design, such that future RCT participants reflect the populations intended to treat. (Figure Presented).

Decision making in nurse leaders during OVID-19: Allocation of scarce resources

Increased global activity has resulted in increased complexity in decision making for leaders. Complex decision is explored in nurse leaders in pandemic environments such as Covid-19. The purpose of this constructivist grounded theory study is to explore the lived experiences of nurse leaders during COVID-19, specifically in the areas of allocating scarce resources and managing bias within the workplace. Qualitative data were collected using semi-structured open-ended interviews. The overarching research questions explore, how decision making is experienced during resource allocation in conditions of extreme scarcity during Covid-19, and how bias is managed in self and others during clinical decision making involving extreme scarcity of resources. Nurses are taught to focus on patients and patient care. However, concerns for provider safety may affect patient care. Themes that emerged in the data include prioritization of nurse leaders' own safety in care decisions. Advocacy emerges as being synonymous with patient care. Additionally, bias is described in avoidance behavior associated with provider safety concerns. Nursing decision making associated with resource allocation during Covid-19 is portrayed in the Provider Crisis Decision Making model. This emerging theory describes areas of concern in nurse leadership decision making during Covid-19. The Provider Crisis Decision Making model is an organizational leadership tool intended to improve patient care and provider well-being in crisis environments and during pandemics. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Introduction of Implicit Bias Training to oncology faculty as a means to improve minority participation in cancer clinical trials

Background: Following George Floyd's murder in May 2020, conversations about equity and bias became part of our daily national conversation. Simultaneously the COVID-19 outbreak disproportionately affected people of color which further illuminated existing disparities in outcomes. Bias training was introduced in many sectors as a strategy to address inequity. Inclusivity in healthcare is essential to develop evidence-based therapies and treatment plans. Previous studies have demonstrated the consequences when racial and ethnic minorities are excluded from research. (Hamel et al, 2016). Racial and ethnic minorities disproportionately bear adverse outcomes from cancer. Cancer clinical trials would benefit from solutions to promote inclusivity. (Khan et al. 2021) Research Purpose: The purpose of our study was to assess whether Implicit Bias Training can increase minority participation in cancer clinical trials. Methodology: The Office of Diversity, Equity, and Inclusion offered Implicit Bias Training to all clinical oncologists at the Yale Cancer Center (YCC) between May and July 2021. While 109 physicians were eligible to participate, 57 physicians were required by the department to complete this training, and 84% of these physicians completed this opportunity. We analyzed YCC clinical trial enrollment data between two time periods defined as pre-intervention and post-intervention. We selected these periods to investigate not only the efficacy of bias training but specifically bias training as an adjunct to the national conversation during the time of our study. We selected the preintervention period as January 1, 2021, to June 30, 2021. The intervention was designed to be completed by July 1, 2021 therefore the post-intervention period is defined as July 1, 2021 to December 31, 2021. Results/Summary: Our analysis showed an increase of 2.5% in the participation of Black/African American patients. There was a slight (1.5%) decrease in Hispanic patient enrollment during this time. Conclusion(s): Our analysis suggested that implicit bias training delivered once had only a very modest, if any, improvement in racial minority participation in cancer clinical trials. Our project focused on participation by Black/African American patients. The impediment to Hispanic participation is quite nuanced. Hispanic patients, many of whom are non-English speaking with immigration/insurance issues face additional structural barriers. We think that a different strategy is needed to better serve this patient population. While we had hoped for metrics to demonstrate greater impact from bias training, our next investigation will look at if the intervention is best delivered repeatedly. Future Work: We have not abandoned the strategy of bias training to build trust and increase Black/AA participation. After the intervention, we are interested in whether greater impact is seen over time. We have designed a survey to look at the effects of the intervention after a year. Our next step is to examine whether repeated delivery of this intervention will amplify our results.

Pilot Implementation of a Health Equity Checklist to Improve the Identification of Equity-Related Adverse Events

In assessing the occurrence of an unexpected medical adverse event following pharmaceutical,medical, or surgical treatment, the causal or contributory roles played by bias, systemic racism, and social determinants of health should be investigated. Up to 80% of clinical outcomes are estimated to be driven by social determinants including the environments in which patients live, work, learn, worship, and play. Among women, there are racial health disparities in sterilization procedures, method of hysterectomy, cesarean birth rates, preterm birth rates, and, most recently, the rates of COVID-19 death and hospitalizations. At the same time, there is little specific guidance of how to investigate social determinants of health that affect patient outcomes. Differences in health equity-related factors affect the quality of gynecologic care. There is immeasurable potential for bias in patient characteristics: race;ethnicity;persons with obesity;LGBTQ+ (lesbian, gay, bisexual, transgender, queer+) persons;socioeconomic factors;and young and old age. Within existing models for patient safety, inclusion of equity-related aspects of care may improve the current understanding of the causes of medical adverse events. It is critical to consider social determinants of health, structural racism, and both overt and implicit bias. The aim of this studywas to establish a sustainable and trackable process to determine the role of social determinants of health, bias, and racism in adverse gynecologic events. Each adverse event case is assessed for preventability, harm, and standards of care. Cases are identified for review utilizing existing hospital event-reporting systems (RLDatix) and enhanced by resident and attending physician self-reporting. The following equity-focused process was used: (1) creating a standardized health equity checklist;(2) applying the checklist to each gynecologic adverse event beginning on September 1, 2020;(3) collecting event review data in a secure central digital repository;(4) reviewing each adverse case to understand apparent causes of the event;(5) exploring areas for improvement using standard fields;and (6) identifying specific ideas for improvement. Within 15 months (between September 1, 2020, and November 30, 2021), 46 safety cases were identified using standard criteria. Twenty-four of these were deemed preventable.Of the 24 cases, 12 cases were identified inwhich social determinants of health, bias, or both had a role. Delays in diagnosis and care were attributed to social determinants of health and implicit bias. This process has mapped areas of infrastructure as well as the need for culture improvement and restorative work to address implicit bias and improve approaches to shared decision-making. These findings show that with use of a health equity checklist, it is feasible to create a systematic and trackable process to begin delineating the role of social determinants of health, bias, and racism in adverse gynecologic events. Copyright © 2023 Lippincott Williams and Wilkins. All rights reserved.

A Deliberate Educational Initiative in Diversity Inclusion and Racial Equity

Learning Objectives: Covering the domains of knowledge, skills and attitudes, residents were expected to analyze structural violence and health gaps, demonstrate inclusive and trauma-informed care, recognize implicit bias, use strategies to reduce it, and critically assess the EM health equity literature. Introduction/Background: Since the 2003 Unequal Treatment report showed that health gaps are not due to access or income, racial injustice and COVID-19 have laid bare worse inequities. In 2021, the ACGME EM Milestones addressed recognition of health gaps and personal bias, however there is no guidance on how to do this. ED patients require an unbiased evaluation to ensure rapid and accurate diagnosis and treatment, but implicit bias reigns with high cognitive load. Thus, we describe a deliberate and formal diversity, inclusion and racial equity (DIRE) curriculum. Educational Objectives: Residents were expected to analyze structural violence and health gaps, demonstrate inclusive and trauma-informed care, recognize implicit bias, use strategies to reduce it, and critically assess the EM health equity literature. Curricular Design: An ED survey confirmed the need for this curriculum. Since July 2020, the course has been available to all ED staff but is mandatory for residents. The free online platform, Canvas, was chosen for ease of access and use, and for resource sharing, discussion facilitation, and quiz scoring. Biweekly articles, online videos, a journal club and quarterly book clubs led to health equity discourse. Residents took part in simulated cases involving diverse patients. A workshop reviewed strategies to reduce implicit bias. Residents were assessed with quizzes, reflective writing and direct observation. Based on feedback, sessions are now held monthly with more media resources, live seminars, and diverse content. Impact/Effectiveness: As of July 2021, residents have had positive feedback, 100% completion rates, and high knowledge retention. Structural violence must be included in resident didactics. Simulated cases provide an avenue to assess interpersonal communication skills for residents to develop tools to partner with patients. This model may serve as a blueprint for those seeking to improve DIRE knowledge, skills and attitudes.

Confronting implicit bias toward patients: a scoping review of post-graduate physician curricula.

BACKGROUND: Physicians' behavior may unknowingly be impacted by prejudice and thereby contribute to healthcare inequities. Despite increasingly robust data demonstrating physician implicit bias (The Office of Minority Health. Minority Population Profiles, 2021; COVID-19 Shines Light on Health Disparities, National Conference of State Legislatures 2021), the evidence behind how to change this with training programs remains unclear. This scoping review therefore reports on the implementation, outcomes, and characteristics of post-graduate physician implicit bias curricula. METHODS: The authors conducted a literature review using scoping review methodology. They searched 7 databases in February and November 2020 for English-language academic and gray literature on implicit bias curricula for physicians at all levels of post-graduate training. Ten reviewers screened studies for eligibility independently, then extracted data from these studies and compiled it into a chart and analytical summary. RESULTS: Of the 4,599 articles screened, this review identified 90 articles on implicit bias interventions for post-graduate physicians. Inductive data analysis revealed a spectrum of educational approaches, which were categorized int o 4 educational models called Competence, Skills-Based, Social Contact, and Critical Models. The most commonly reported strength was the interactive nature of the curricula (26%), and the most frequently identified challenges were related to time and resources available (53%). Half of the interventions discussed facilitator preparation, and the majority (62%) evaluated outcomes using pre and post self-assessments. CONCLUSIONS: This review provides a comprehensive synthesis of the literature on physician implicit bias curricula. It is our goal that this supports medical educators in applying and improving aspects of these interventions in their own programs.

The impact of gender on diagnosing borderline personality disorder

This study aimed to understand the factors that could impact a clinician's decision to diagnose an individual with borderline personality disorder (BPD) by exploring three different hypotheses. The researcher explored the interaction between client gender, clinician gender, and diagnosis. The researcher also looked at the interaction between the number of years a clinician has been licensed in psychology, social work, or medical field with the capacity to diagnose psychiatric disorders with client gender and diagnosis. Results indicated that male clients were less frequently diagnosed with BPD than female clients, male clinicians more frequently reported needing more information in order to diagnose male clients than for diagnosing female clients, and clinicians who have been licensed for longer than 7 years less frequently diagnosed male clients with BPD than female clients regardless of clinician gender. Implications for clinical training and practice are discussed. Limitations of the current study included a limited sample and research conducted during the COVID-19 pandemic. Future research should use mixed methodologies to collect and expand the research focus on clinical perspective and considerations regarding client diagnoses. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The impact of diversity, equity, and inclusion training in an independent community oncology practice

Background: Historically, Diversity, Equity, and Inclusion (DEI) efforts have largely been left out of private practice medical facilities - mainly present in large academic hospital centers. Virginia Oncology Associates (VOA), a member of The US Oncology Network, is an independent community oncology and hematology practice specializing in the diagnosis and treatment of cancer and blood disorders. VOA has approximately 600 total employees consisting of physicians and clinical and non-clinical staff. In August of 2020, VOA launched an initiative to foster a culture of inclusion with the creation of its Inclusion Council (IC). Sixteen employees', both clinical (3 physicians) and non-clinical, were chosen to participate. The council reports to VOA's joint policy board. Methods: The council partnered with an outside organization, Virginia's Center for Inclusive Communities, to launch a practice-wide DEI training program focusing on unconscious bias and microaggression. The training was initially planned to be in person, but due to the constraints of the COVID pandemic, the training was performed using a virtual platform. The members of IC attended three two-hour sessions while other staff members and physicians were mandated to participate in at least one training session. After completion of the sessions, a survey was sent to all employees and physicians to measure the impact of DEI training. All employees were also given the opportunity to provide additional, anonymous, written feedback. Results: Table. A total of 169 employees responded. 72% of respondents agreed or strongly agreed that the program increased awareness of unconscious bias and microaggression, 67% felt that the program helps foster a culture of inclusion in the workplace, and 66% of respondents felt that the program met expectations. Conclusions: DEI efforts are vital in all aspects of health care delivery and oncology settings. DEI training met staff expectations and positively fostered a culture of inclusion by bringing attention to unconscious bias and microaggression in a community oncology practice.

Seeking racial equity in hematology and oncology: A fellow-led educational series to promote reflection and action

Background: With the murder of George Floyd and health disparities laid bare by the COVID pandemic, the US is reckoning with racial injustice. Across medicine and oncology, institutions are grappling with how to address systemic racism and improve care for patients of color. At the University of North Carolina (UNC), trainees developed an educational curriculum to raise awareness of implicit bias and introduce methods to address racial inequities. We present our findings on feasibility and acceptability of a fellow-led course on racism in medicine at a major academic medical center. Methods: UNC oncology fellows adapted a curriculum on implicit bias and racism in medicine in spring 2021. Our aims were 1) to improve knowledge and awareness about implicit bias and systemic racism and 2) introduce methods to address racial inequities. We used lived experiences and collated materials from scientific literature and lay media to illustrate key points. Sessions were: 1) Introduction and Implicit Bias, 2) Implicit Bias in Action: A Case Study, 3) Race-Based Metrics: Journal Club, 4) Career Perspective on Equity in Oncology. Videos, journal articles, and group discussion were employed to appeal to many learning styles. Results: Four sessions were held virtually for the Divisions of Oncology and Hematology. Attendance ranged from 28 to 35 per session. A post curriculum survey assessed perception of racial inequality in medicine and the series' effects using a Likert scale. Twenty-nine participants completed the survey, 12 of whom were fellows. Of all participants, 71% reported that the course improved knowledge or awareness of racial inequities “some” or “a great deal” and 61% reported that it improved their comfort level addressing racial inequities “some” or “a great deal.” All participants endorsed at least “some” racial inequity in medicine. Notably, over 75% of participants indicated interest in further sessions. Conclusions: Formulation of an educational curriculum by fellows and delivered in a division wide setting was feasible and well received by participants with robust discussion and interest in further work. Fundamental to this series' effectiveness was creating a space for discussion and reflection among colleagues. The goals of improving knowledge and introducing methods to address racial inequities were met. Importantly, our course was integrated alongside institutional efforts on DEI. We were limited by a lack of pre-course survey results due to a technical error. Given the current groundswell of interest and focus in improving racial equity in our society, we encourage other institutions to take similar steps to highlight issues of systemic racism and continue to move our field in the right direction.

BIAS AND ENDOSCOPY TURNOVER TIME IN A TERTIARY REFERRAL ACADEMIC CENTER ENDOSCOPY UNIT

Introduction: Room turnover time (TOT) is a measurement of endoscopy unit efficiency and delays in procedures lead to wasted health care expenditures. Several factors have been identified to influence turnover time including communication, staffing, case complexity, and specific surgeon. Previous research has indicated stereotypes about perceptions of physicians based on their gender or experience. For instance, women in surgical subspecialties endure gender discrimination from conscious and unconscious bias, that produce obstacles to career development and lead to burnout. It is unclear if these biases affect work flow in an endoscopy unit. Here, we sought to evaluate if endoscopists gender or academic experience affected their endoscopy room turnover time. Methods: We evaluated 2,917 inpatient and outpatient endoscopic procedures performed at our large academic tertiary care center between July 2019 and July 2021. TOT was calculated by taking the difference between a prior patient “out of room time” and the next patient “in room time”. TOT was averaged for each endoscopist and T-tests were used to evaluate for any statistical difference between groups. Academic experience was differentiated by having £5 years or >5 years since completing GI fellowship, or holding a leadership position. Results: The average room TOT was 31:28 minutes amongst 26 different gastroenterology providers. There was no statistically significant difference in TOT by gender (p=0.99), serving in a leadership position (p=0.46), or being >5 years since completing fellowship (p=0.63). TOT was longest for advanced endoscopic procedures (p=0.025). TOT increased and case volume decreased in April and May 2020, following the onset of the COVID-19 pandemic. Conclusion: Neither gender or years of academic experience were associated with differences in endoscopic room TOT. More research is needed in gender or professional bias as related to work flow in medicine. Our other future directions include identification and analysis of other endoscopy efficiency metrics for endoscopy suite quality improvement. References: Day, L.W et al. Quality and Efficiency in Gastrointestinal Endoscopy Units. 2018, Springer International Publishing. p. 587- 601. Stephens EH et al. The Current Status of Women in Surgery: How to Affect the Future. JAMA Surg. 2020 Sep.

DOES UNCONSCIOUS SOCIOECONOMIC BIAS INFLUENCE TELE-EVALUATION OF OBSTRUCTIVE SLEEP APNEA? A TELE-EQUITY EXPLORATORY ANALYSIS

Introduction: Telemedicine, once of limited scope, has become common and widespread due to the present and ongoing SARSCoV- 2 pandemic. Center to home delivery, the most common model, allows for convenient and efficient care. Concurrent with this groundshift, there is increasing attention to disparities in medical services, and how these disparities may impact patient outcomes. Telemedicine could be used to help bridge barriers to timely quality care, however, patient access and longstanding institutional biases may limit the potential. Healthcare providers must actively develop systems to ensure that telemedicine is optimized for people across the income spectrum. This exploratory analysis examined how economic disparities in patients being evaluated for obstructive sleep apnea may be associated with providers clinical impressions. The objective was to study the inter-method reliability of pre-test probability of obstructive sleep apnea assessed via telemedicine and in-person evaluations, and to compare that reliability between income classes. Methods: This is a secondary analysis of a pre-pandemic interrater reliability study, conducted between March 2017 and January 2019. Our researchers completed a randomized, blinded study comparing the pre-test probability of obstructive sleep apnea between an in-person physician and a separate physician seeing the same patient via televideo conferencing. Patients referred to the University of Rochester (UR) Sleep Center were eligible for the study. Women and men 30-70 years old were invited to participate. The patients were not necessarily referred to the center for evaluation of sleep disordered breathing. Patients with dementia, hearing or visual loss, severe psychiatric or developmental illness, or not fluent in English were excluded. Patients had adequate computer literacy, access to high speed internet, and a computing device with appropriate video camera and microphone.The primary objective of the original study was to assess the interrater reliability between the in-person and telemedicine raters for pre-test probability of sleep apnea (high, moderate, or low). Providers used clinical judgement from the history and examination to determine pre-test probabilityFor this present analysis, we assessed the inter-method reliability separately for strata defined by reported annual income level: low income (< $50,000), middle income ($50,000-$100,000), and high income (> $100,000). Reliability was quantified for each stratum using weighted kappa statistics given the ordinal nature of the outcome variable, pre-test probability of obstructive sleep apnea (high, moderate, or low). Weighted kappa statistics were compared between the income strata (high vs. middle, high vs. low, middle vs. low). The operant statistic assumed an approximate standard normal distribution under the null hypothesis of equal kappa values in the two income strata. The Bonferroni method was used to adjust the p-values for the three pairwise comparisons performed among the three income strata. Results: Data from 53 patients were avaiable for this analysis. 11 of these patients were in the low income group, 22 in the middle income, and 16 were in the high income group. 9 patients did not include their income bracket, and were not included in the analysis. Inter-method reliabilities, assessed using weighted kappa, were 0.83 (low income), 0.24 (middle income), and 0.66 (high income). When comparing between the strata, the kappa statistics were significantly different (p=0.005) between the low and moderate income groups. There was a trend between the high and moderate income groups that did not meet statistical significance (p=0.07). Conclusion: The intermethod reliability was substantial in the low income stratum, moderate in the high income stratum, and slight in the middle income group based on the kappa statistic. There was a significant difference in the reliability values of telemedicine versus in-person assessments between the low and middle income brackets, and there was a trend between the high and mo er te groups. Since the raters were unaware of the patients income levels, this association might suggest possible unconscious bias in evaluating for OSA. It may also suggest that beyond access to telemedicine technology, the quality of the care may also be influenced by socioeconomic factors. With telemedicine in its early stages, it is important to develop this technology that will minimize biases that could result from patients economic fortunes.

Educational strategies used to improve the knowledge, skills, and attitudes of health care students and providers regarding implicit bias: An integrative review of the literature

Background: The thoughts, feelings, and attitudes health care professionals unconsciously have about patients can negatively impact patients’ health outcomes. Systematic reviews related to implicit bias in health care providers have uncovered negative implicit bias towards older adults, people of color, people with disabilities, psychiatric patients, patients who are obese, people of low socioeconomic status, and women. Implicit bias impacts the quality, safety, and competence of care delivered;interactions between patients and providers;and patient approval of treatment recommendations. Health care professions students and health care providers need to participate in evidence-based educational strategies to manage and diminish bias. Objective: To review the evidence regarding educational strategies used with health care professions students and providers to improve their knowledge of implicit bias, reduce bias, and improve attitudes about bias. Design: Integrative review. Methods: The literature review was completed in July 2020 with two updates performed in February 2021 and June 2021 using nine databases including Academic Search Complete™, Embase®, ERIC®, Ovid, PubMed®, Scopus®, and Web of Science™. Key terms used related to education, health care professions’ students, health care providers, implicit, bias, incivility, microaggression, and microassult. Publications dates from 2011 to 2021 were included. Covidence software was used for the initial screening and for full-text analysis. Results: Thirty-nine articles were analysed for this review. The most commonly used educational strategies to instruct about principles of implicit bias include discussion groups, simulation and case-based learning, pre-tests for awareness, use of expert facilitators, commitment to action/change, and debriefing. Common components of successful strategies include thoughtful program planning, careful selection of program facilitators (who are content experts), support of participants, and a system-level investment. Conclusions: Diverse educational strategies successfully addressed implicit bias across studies. Recommendations for future studies includes addressing limitations in sampling strategies and data collection to clarify relationships between educational strategies and participant outcomes. Educational opportunities are warranted that challenge health care professionals to explore their implicit bias towards others in an effort to provide care that considers diversity, equity, and inclusion and also limits personal implicit bias. © 2022

Cryptogenic organizing pneumonia during the COVID-19 pandemic: A missed diagnosis

Case Report Purpose of Study Interstitial lung disease (ILD) is a group of pulmonary disorders that cause varying degrees of inflammation and fibrosis of pulmonary architecture. The diagnosis requires good clinical history, examination, appropriate workup, and a high degree of suspicion. This case report draws attention toward a unique case of cryptogenic organizing pneumonia after mold exposure. Methods Used Not applicable. Summary of Results A 36-year-old nonsmoker male with no comorbidities presented with worsening shortness of breath after cleaning a walk-in cooler room contaminated with mold. He was seen at multiple facilities for presumed diagnosis of COVID-19 despite being vaccinated and 4 negative COVID-19 results. He was discharged with 2 liters of supplemental home oxygen and a 7-day course of Levofloxacin, with no resolution of symptoms. The patient presented to our hospital 2 months after initial onset of symptoms. On examination, the patient had bronchial breath sounds with fine crepitations, egophony, and increased vocal resonance. Chest x-ray revealed bilateral airspace consolidation with scattered ground-glass opacities in the apices. Computed Tomography (CT) of the thorax showed peripheral upper lobe ground-glass opacities with interstitial thickening in a 'crazy-paving' pattern. A chest CT angiogram showed patchy ground-glass pulmonary infiltrates with peripheral predominance consistent with severe COVID pneumonia. PCR for SARS-CoV-2 was negative. The patient's oxygen demand increased progressively from 4L on nasal cannula to 40L on high flow nasal cannula to maintain an oxygen saturation of 90%. Labs showed normal leukocyte count, ESR, ALT, and AST with a mildly elevated CRP. Workup for infectious etiology was negative for S. pneumoniae, legionella, coccidioides, HIV, hepatitis panel, Quanti- FERON gold and blood culture. Autoimmune workup was negative for ANA, RF, CCP, ANCA, anti-centromere Antibody, anti-ds DNA. The patient underwent a bronchoalveolar lavage with culture negative for acid fast bacilli, fungi, and P. jirovecii. Bronchoscopic biopsy was subsequently performed and revealed lung parenchyma with foci of mild chronic inflammation with focal fibroblastic proliferation and fibrosis, suggestive of an organizing pneumonia. The patient was started on steroids 1 mg/kg resulting in significant clinical improvement requiring only 3L on nasal cannula on day 5 of treatment. He was then discharged with high dose steroid therapy for 3 months. Conclusions The prognosis and treatment of ILD depends on accurate diagnosis and its subtype. Hence appropriate workup is essential to guide therapy. In the setting of the current pandemic, relatively uncommon causes of ILD like cryptogenic organizing pneumonia may go undiagnosed due to the unconscious bias among health care providers resulting in delayed treatment. This report highlights the importance of considering alternative diagnosis when a disease does not follow an expected course.

Documenting Museum Education during Intersecting Pandemics

We continue to feel the immediate effects of the pandemic on the museum sector from intermittent museum closures, budget reductions, lay-offs, furloughs, and dramatic shifts in the ways museums and museum educators operate. Museums and the work museum educators do holds an essential place in the profession - it remains a part of people's lives, their learning, and their lived experiences. [Extracted from the article] Copyright of Journal of Museum Education is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Judging film, not skin: can radiologists combat bias in medicine?

From the more than 700,000 deaths from COVID-19 in the US and the nearly 5 million worldwide, there emerge even more stories than match the statistics when one considers all of the patients' relations. While the numbers are staggering, when we humanize the stories, we are left with even greater devastation, of course. One of the stories among so many that seemed particularly salient and poignant to us was the death of Dr. Susan Moore. Her plaintive Facebook post, which went viral in December 2020, was made a few weeks before she died at the age of 52 from COVID-19 and claimed that she was a victim of racially biased treatment at a hospital in Indiana. It was Dr. Moore's mentioning of CT scans that led us to reflect on the biases of some health care workers and the role of radiologists. Our initial interface with our patients is actually not with their faces, but with their films. This dynamic does not eliminate any biases we may harbor but shields practitioners and patients from potential glaring racial biases in this first and sometimes only stage of the relationship.

Effects of the COVID-19 Pandemic on the Professional Career of Women in Oral and Maxillofacial Surgery.

The COVID-19 pandemic altered all facets of society on a fundamental level, impacting work, mental health, and family life. Female surgeons experienced gender inequity and bias before COVID; therefore, women in oral and maxillofacial surgery (OMS) were affected disproportionately by the repercussions of the pandemic. Well-established inequalities are intensified during times of crisis. This article enlightens readers regarding the preexisting inequalities in the OMS specialty, how the COVID-19 pandemic exacerbated these ubiquitous issues, and how the specialty should accommodate these inequities moving forward.

Facing Racism and Sexism in Science by Fighting Against Social Implicit Bias: A Latina and Black Woman's Perspective.

The editors of several major journals have recently asserted the importance of combating racism and sexism in science. This is especially relevant now, as the COVID-19 pandemic may have led to a widening of the gender and racial/ethnicity gaps. Implicit bias is a crucial component in this fight. Negative stereotypes that are socially constructed in a given culture are frequently associated with implicit bias (which is unconscious or not perceived). In the present article, we point to scientific evidence that shows the presence of implicit bias in the academic community, contributing to strongly damaging unconscious evaluations and judgments of individuals or groups. Additionally, we suggest several actions aimed at (1) editors and reviewers of scientific journals (2) people in positions of power within funding agencies and research institutions, and (3) members of selection committees to mitigate this effect. These recommendations are based on the experience of a group of Latinx American scientists comprising Black and Latina women, teachers, and undergraduate students who participate in women in science working group at universities in the state of Rio de Janeiro, Brazil. With this article, we hope to contribute to reflections, actions, and the development of institutional policies that enable and consolidate diversity in science and reduce disparities based on gender and race/ethnicity.

Engaging faculty in a workshop intervention on overcoming the influence of implicit bias.

INTRODUCTION: To study the effectiveness of any educational intervention for faculty requires first that they attend the training. Using attendance as a measure of faculty engagement, this study examined factors associated with the percentage of faculty in divisions of departments of medicine who attended a workshop as part of a multisite study. METHODS: Between October 2018 and March 2020, 1675 of 4767 faculty in 120 divisions of 14 departments of medicine attended a 3-hour in-person workshop as part of the Bias Reduction in Internal Medicine (BRIM) initiative. This paper describes the workshop development and study design. The number of faculty per division ranged from 5 to 296. Attendance rates varied from 2.7% to 90.1%. Taking a quality improvement approach, the study team brainstormed factors potentially related to variations in workshop attendance, constructed several division- and institution-level variables, and assessed the significance of factors on workshop attendance with hierarchical linear models. RESULTS: The following were positively associated with workshop attendance rate: the division head attended the workshop, the BRIM principal investigator gave Medical Grand Rounds, and the percentage of local workshop presenters who completed training. Workshop attendance rates fell when departments identified more than five on-site study leaders. CONCLUSIONS: Factors associated with higher workshop attendance may have increased the perceived status and value of attending the workshop, leading faculty to choose the workshop over other competing demands. For future investigators studying educational interventions that require participation of faculty in clinical departments at multiple sites, this work offers several valuable lessons.