The social patterning of vicarious discrimination: Implications for health equity.

BACKGROUND: Most research on discrimination and health operationalizes discrimination as direct individual experiences. Here, we examine the social patterning of vicarious discrimination, an important but largely overlooked dimension of discrimination. METHODS: Drawing on community-based participatory research with a multi-stage probability sample (n = 178) of African Americans in Tallahassee, Florida, we measured vicarious discrimination, or exposure to discrimination through one's family and friends. We used chi-square tests to examine gender differences in the social domains and relational sources of vicarious discrimination. Negative binomial regression models were fit to identify predictors of exposure to vicarious discrimination. RESULTS: Vicarious discrimination is more prevalent than direct experiences of discrimination (73 versus 61%) and more than 20% of participants report vicarious discrimination in the absence of direct discrimination. For women, vicarious discrimination most often involved the workplace; for men, police. However, gender differences are smaller for vicarious versus direct discrimination. Close friends and children were top relational sources of vicarious discrimination for men and women, respectively. Middle-aged participants reported the most vicarious discrimination. CONCLUSIONS: Overall, our data show that vicarious discrimination is more common than widely understood and associated with individual-level sociodemographic characteristics that index one's position in broader social systems. The prevalence of vicarious discrimination in the absence of direct discrimination suggests that standard approaches, which measure individual exposures in isolation, are subject to misclassification bias. Our results imply that existing research on discrimination and health, which already demonstrates substantial harm, underestimates African Americans' true exposures to salient aspects of discrimination.

The Development and Demonstration of the Portable Acousto-Optic Spectrometer for Astrobiology in Cave Environments.

Planetary caves are desirable environments for the search for biosignatures corresponding to extant or extinct extraterrestrial life due to the protection they offer from surface-level solar radiation and ionizing particles. Near-infrared (NIR) reflectance spectroscopy is one of a multitude of techniques that, when taken together, can provide a comprehensive understanding of the geomicrobiology in planetary subsurface regions. To that end, we developed two portable NIR spectrometers that employ acousto-optic tunable filters and demonstrated them in three geochemically distinct cave environments. The instruments were deployed both as stand-alone spectrometers positioned against the targets manually and as a component of an instrument payload mounted on a quadruped robot capable of vertical excursions of several meters. In situ measurements of calcium carbonates, sulfates, metal oxides, and microbial colonies and mats revealed spectral signatures that enable a distinction between the targets of interest and the underlying substrates. The ruggedness and portability of the instruments, and their low size, weight, and power, spectral agility, and active illumination make AOTF-based spectrometers ideally suited for studies of planetary caves.

Mars Extant Life: What's Next? Conference Report.

On November 5-8, 2019, the "Mars Extant Life: What's Next?" conference was convened in Carlsbad, New Mexico. The conference gathered a community of actively publishing experts in disciplines related to habitability and astrobiology. Primary conclusions are as follows: A significant subset of conference attendees concluded that there is a realistic possibility that Mars hosts indigenous microbial life. A powerful theme that permeated the conference is that the key to the search for martian extant life lies in identifying and exploring refugia ("oases"), where conditions are either permanently or episodically significantly more hospitable than average. Based on our existing knowledge of Mars, conference participants highlighted four potential martian refugium (not listed in priority order): Caves, Deep Subsurface, Ices, and Salts. The conference group did not attempt to reach a consensus prioritization of these candidate environments, but instead felt that a defensible prioritization would require a future competitive process. Within the context of these candidate environments, we identified a variety of geological search strategies that could narrow the search space. Additionally, we summarized a number of measurement techniques that could be used to detect evidence of extant life (if present). Again, it was not within the scope of the conference to prioritize these measurement techniques-that is best left for the competitive process. We specifically note that the number and sensitivity of detection methods that could be implemented if samples were returned to Earth greatly exceed the methodologies that could be used at Mars. Finally, important lessons to guide extant life search processes can be derived both from experiments carried out in terrestrial laboratories and analog field sites and from theoretical modeling.

Prebiotic Chemistry of Pluto.

We present the case for the presence of complex organic molecules, such as amino acids and nucleobases, formed by abiotic processes on the surface and in near-subsurface regions of Pluto. Pluto's surface is tinted with a range of non-ice substances with colors ranging from light yellow to red to dark brown; the colors match those of laboratory organic residues called tholins. Tholins are broadly characterized as complex, macromolecular organic solids consisting of a network of aromatic structures connected by aliphatic bridging units (e.g., Imanaka et al., 2004; Materese et al., 2014, 2015). The synthesis of tholins in planetary atmospheres and in surface ices has been explored in numerous laboratory experiments, and both gas- and solid-phase varieties are found on Pluto. A third variety of tholins, exposed at a site of tectonic surface fracturing called Virgil Fossae, appears to have come from a reservoir in the subsurface. Eruptions of tholin-laden liquid H2O from a subsurface aqueous repository appear to have covered portions of Virgil Fossae and its surroundings with a uniquely colored deposit (D.P. Cruikshank, personal communication) that is geographically correlated with an exposure of H2O ice that includes spectroscopically detected NH3 (C.M. Dalle Ore, personal communication). The subsurface organic material could have been derived from presolar or solar nebula processes, or might have formed in situ. Photolysis and radiolysis of a mixture of ices relevant to Pluto's surface composition (N2, CH4, CO) have produced strongly colored, complex organics with a significant aromatic content having a high degree of nitrogen substitution similar to the aromatic heterocycles pyrimidine and purine (Materese et al., 2014, 2015; Cruikshank et al., 2016). Experiments with pyrimidines and purines frozen in H2O-NH3 ice resulted in the formation of numerous nucleobases, including the biologically relevant guanine, cytosine, adenine, uracil, and thymine (Materese et al., 2017). The red material associated with the H2O ice may contain nucleobases resulting from energetic processing on Pluto's surface or in the interior. Some other Kuiper Belt objects also exhibit red colors similar to those found on Pluto and may therefore carry similar inventories of complex organic materials. The widespread and ubiquitous nature of similarly complex organic materials observed in a variety of astronomical settings drives the need for additional laboratory and modeling efforts to explain the origin and evolution of organic molecules. Pluto observations reveal complex organics on a small body that remains close to its place of origin in the outermost regions of the Solar System.

Food store owners' and managers' perspectives on the food environment: an exploratory mixed-methods study.

BACKGROUND: Neighborhood characteristics such as poverty and racial composition are associated with inequalities in access to food stores and in the risk of obesity, but the pathways between food environments and health are not well understood. This article extends research on consumer food environments by examining the perspectives of food-store owners and managers. METHODS: We conducted semistructured, open-ended interviews with managers and owners of 20 food stores in low-income, predominantly African American neighborhoods in Tallahassee, Florida (USA). The interviews were designed to elicit store managers' and owners' views about healthy foods, the local food environment, and the challenges and opportunities they face in creating access to healthy foods. We elicited perceptions of what constitutes "healthy foods" using two free-list questions. The study was designed and implemented in accord with principles of community-based participatory research. RESULTS: Store owners' and managers' conceptions of "healthy foods" overlapped with public health messages, but (a) agreement about which foods are healthy was not widespread and (b) some retailers perceived processed foods such as snack bars and sugar-sweetened juice drinks as healthy. In semistructured interviews, store owners and managers linked the consumer food environment to factors across multiple levels of analysis, including: business practices such as the priority of making sales and the delocalization of decision-making, macroeconomic factors such as poverty and the cost of healthier foods, individual and family-level factors related to parenting and time constraints, and community-level factors such as crime and decline of social cohesion. CONCLUSIONS: Our results link food stores to multilevel, ecological models of the food environment. Efforts to reshape the consumer food environment require attention to factors across multiple levels of analysis, including local conceptions of "healthy foods", the business priority of making sales, and policies and practices that favor the delocalization of decision making and constrain access to healthful foods.

Lava cave microbial communities within mats and secondary mineral deposits: implications for life detection on other planets.

Lava caves contain a wealth of yellow, white, pink, tan, and gold-colored microbial mats; but in addition to these clearly biological mats, there are many secondary mineral deposits that are nonbiological in appearance. Secondary mineral deposits examined include an amorphous copper-silicate deposit (Hawai'i) that is blue-green in color and contains reticulated and fuzzy filament morphologies. In the Azores, lava tubes contain iron-oxide formations, a soft ooze-like coating, and pink hexagons on basaltic glass, while gold-colored deposits are found in lava caves in New Mexico and Hawai'i. A combination of scanning electron microscopy (SEM) and molecular techniques was used to analyze these communities. Molecular analyses of the microbial mats and secondary mineral deposits revealed a community that contains 14 phyla of bacteria across three locations: the Azores, New Mexico, and Hawai'i. Similarities exist between bacterial phyla found in microbial mats and secondary minerals, but marked differences also occur, such as the lack of Actinobacteria in two-thirds of the secondary mineral deposits. The discovery that such deposits contain abundant life can help guide our detection of life on extraterrestrial bodies.

Estimation, modeling, and simulation of patterned growth in extreme environments.

In the search for life on Mars and other extraterrestrial bodies or in our attempts to identify biological traces in the most ancient rock record of Earth, one of the biggest problems facing us is how to recognize life or the remains of ancient life in a context very different from our planet's modern biological examples. Specific chemistries or biological properties may well be inapplicable to extraterrestrial conditions or ancient Earth environments. Thus, we need to develop an arsenal of techniques that are of broader applicability. The notion of patterning created in some fashion by biological processes and properties may provide such a generalized property of biological systems no matter what the incidentals of chemistry or environmental conditions. One approach to recognizing these kinds of patterns is to look at apparently organized arrangements created and left by life in extreme environments here on Earth, especially at various spatial scales, different geologies, and biogeochemical circumstances.

A biosignature suite from cave pool precipitates, Cottonwood Cave, New Mexico.

Calcite cave pool precipitates often display a variety of potential biosignatures from the macroscopic to the submicroscopic. A fossil cave pool in Cottonwood Cave, New Mexico, exhibits older stalactites and stalagmites that are completely coated in brown, laminated calcitic crust that extends down as pool fingers and u-loops. The pool fingers and u-loops are mainly micrite to clotted micrite, some recrystallized to microspar, with some isopachous spar layers. Micrite, particularly clotted micrite, is usually interpreted by carbonate workers as microbial in origin. Scanning electron microscopy examination of etched pool fingers, u-loops, and the brown crust revealed abundant calcified microbial filaments and biofilm. Energy dispersive X-ray analysis showed that these features have excess carbon, above that found in pure calcite. Independent carbon analysis indicated that these same samples contain up to 0.2% organic carbon. Since pool fingers hang down but form underwater, we hypothesize they are biogenic with hanging microbial filaments or biofilm acting as nuclei for calcite precipitation. Because of the abundance of micrite and fossil filaments, we further hypothesize that these pendant features formed during a period of plentiful nutrients and active hydrological activity when the pool was literally dripping with microbial slime. Although each of these lines of evidence could be interpreted in other ways, their combined weight strongly suggests the cave pool precipitates in Cottonwood Cave are biogenic. These investigations can be used to help inform extraterrestrial life-detection studies.

[Role of the forensic doctor in the assessment of brain injury]. / Papel del médico forense en la valoración de los traumatismos craneoencefálicos.

Although the rate of brain injury remains stable, due to medical advances, many patients who have suffered serious brain injury survive the accident, but remain with very important consequences. The role of the forensic doctor is increasingly more relevant in establishing curing periods, injury stabilization, treatments received and accident consequences so that the courts can dictate the corresponding compensations, incapacity levels and penal grades.

Papel del médico forense en la valoración de los traumatismos craneoencefálicos / Role of the forensic doctor in the assessment of brain injury

A pesar de que la tasa de traumatismos craneoencefálicos se mantiene estable, los avances de la medicina han conllevado que muchos pacientes con traumatismos craneoencefálicos graves sobrevivan a los mismos, pero queden con secuelas muy importantes. El papel del médico forense es cada vez más relevante para establecer períodos de curación o estabilización lesional, tratamientos recibidos y secuelas, para que los tribunales puedan dictaminar las indemnizaciones correspondientes, los grados de incapacidad y la calificación penal (AU)

Although the rate of brain injury remains stable, due to medical advances, many patients who have suffered serious brain injury survive the accident, but remain with very important consequences. The role of the forensic doctor is increasingly more relevant in establishing curing periods, injury stabilization, treatments received and accident consequences so that the courts can dictate the corresponding compensations, incapacity levels and penal grades (AU)

Human utilization of subsurface extraterrestrial environments.

Caves have been used in the ancient past as shelter or habitat by many organisms (including humans). Since antiquity, humans have explored caves for the minerals they contain and sometimes for ceremonial purposes. Over the past century, caves have become the target of increasing exploration, scientific research, and recreation. The use of caves on extraterrestrial bodies for human habitation has been suggested by several investigators. Lunar lava tube bases received early attention because lava tubes were clearly visible in lunar images from the Apollo Era. More recently, Mars Observer Camera data has shown us clear evidence of large tubes visible in a number of volcanic regions on Mars. The budding field of cave geomicrobiology has direct application to questions about subsurface life on other planets. Caves contain many unusual organisms making their living from unlikely materials like manganese, iron, and sulfur. This makes caves and other subsurface habitats prime targets for astrobiological missions to Mars and possibly other bodies. We present the results of a completed Phase I and on-going Phase II NASA Institute for Advanced Concepts (NIAC) study that intensively examines the possibilities of using extraterrestrial caves as both a resource for human explorers and as a highly promising scientific target for both robotic and future human missions to Mars and beyond.

Spirituality, religion, and health: a critical appraisal of the Larson reports.

The four-volume corpus The Faith Factor, and Scientific Research on Spirituality and Health: A Consensus Report by Larson et al constitute the largest English-language review of research on spirituality and health. We have done a critique of the 329 systematic analyses of peer-reviewed research papers presented therein. The objectives were to determine if the Larson conclusions can be generalized; to document the understanding of the potential of qualitative research in assessing the spiritual domain; and to examine whether the definitions of religion and spirituality used by Larson et al correspond to those in general use. We conclude that their results cannot be generalized to other religious and cultural settings; that there is a need for more research focusing on age groups, cultures, religions, and clinical settings not adequately represented in studies to date; and that the need for more qualitative research methods justifies a detailed analysis of the use of qualitative methods in the studies reviewed by the Larson group. Finally, there is a need to establish a common vocabulary that bridges cultural and religious traditions, and facilitates clinical care, research, and teaching relating to spirituality, religion, and health.

Changes in quality of life following admission to palliative care units.

The primary goal of palliative care is to improve the quality of life (QOL) of people with a terminal illness. Previous studies of the impact of hospice/palliative care have documented improvement in physical and psychological symptoms, but not in overall QOL, due in part to the difficulties of measuring QOL. The McGill Quality of Life Questionnaire (MQOL) was developed to assess QOL in persons with advanced illness. MQOL scores were determined on admission and 7-8 days later for sequential eligible and willing patients admitted to five palliative care units. These 88 patients represented 8% of those admitted to the units during the study period. Following the final MQOL completion, patients were interviewed and asked to describe the nature of the changes in QOL they had experienced since admission. Significant improvements were found in the MQOL total score and subscale scores reflecting physical, psychological and existential well-being. In the interviews patients indicated that they had experienced changes in physical, emotional and interpersonal status, in spiritual outlook, and in their preparation for death. They also described the impact of the palliative care unit environment. This is the first study to demonstrate that hospice/palliative care can improve existential well-being in addition to psychological and physical symptoms. It provides evidence in the patients' own words that improvements in QOL go beyond symptom control following admission to a palliative care unit. However, the study results are generalizable only to those few patients admitted who are well enough to complete a questionnaire 1 week after admission.

Unequal distribution of cognitive deficits in vascular dementia--is this a valid criterion in the ICD-10?

OBJECTIVE: To investigate the appropriateness of the ICD-10 criterion for vascular dementia which requires unequal distribution of deficits between different domains of cognitive function. DESIGN: Cross-sectional comparative study. SETTING: Referrals to a specialist memory clinic in Sheffield and a community sample of patients from a general practice population in Melton Mowbray. METHOD: The CAMCOG part of the Cambridge mental disorders of the elderly examination (CAMDEX) was assessed for 131 Sheffield subjects and 396 Melton Mowbray subjects to examine both total variability and differences between individual subscale items. Depression was also examined as this was a potential confounding factor. RESULTS: After adjustment for age, sex and depression scores, there were no significant differences between vascular dementia subjects and Alzheimer's disease subjects at either centre for total variability of cognitive deficits and little difference between diagnoses for individual subscale items. In Sheffield, subjects with vascular dementia had significantly higher depression scores compared to those with Alzheimer's disease. CONCLUSIONS: The usefulness of the concept of unequal deficits as a diagnostic criterion for vascular dementia in routine clinical practice is doubtful.

Embracing vulnerability: risk and empathy in palliative care.

This paper discusses a case example from a larger case narrative study conducted by the authors during 1995-1999. The case illustrates the premise that the dying experience is ultimately a complex experience and one that the caregiver may never truly understand. Both patient and caregivers remain learners. We propose that while the process of achieving empathic communication necessarily demands "good listening," the palliative care provider may be invited to go beyond the domain of listening, to emotional realms that are neither easy nor comfortable. This paper examines two aspects of empathy: 1) the process of learning to empathize with persons who are dying; 2) empathy as a therapeutic act that requires vulnerability and personal risk within the patient-caregiver relationship.

Cave biosignature suites: microbes, minerals, and Mars.

Earth's subsurface offers one of the best possible sites to search for microbial life and the characteristic lithologies that life leaves behind. The subterrain may be equally valuable for astrobiology. Where surface conditions are particularly hostile, like on Mars, the subsurface may offer the only habitat for extant lifeforms and access to recognizable biosignatures. We have identified numerous unequivocally biogenic macroscopic, microscopic, and chemical/geochemical cave biosignatures. However, to be especially useful for astrobiology, we are looking for suites of characteristics. Ideally, "biosignature suites" should be both macroscopically and microscopically detectable, independently verifiable by nonmorphological means, and as independent as possible of specific details of life chemistries--demanding (and sometimes conflicting) criteria. Working in fragile, legally protected environments, we developed noninvasive and minimal impact techniques for life and biosignature detection/characterization analogous to Planetary Protection Protocols. Our difficult field conditions have shared limitations common to extraterrestrial robotic and human missions. Thus, the cave/subsurface astrobiology model addresses the most important goals from both scientific and operational points of view. We present details of cave biosignature suites involving manganese and iron oxides, calcite, and sulfur minerals. Suites include morphological fossils, mineral-coated filaments, living microbial mats and preserved biofabrics, 13C and 34S values consistent with microbial metabolism, genetic data, unusual elemental abundances and ratios, and crystallographic mineral forms.

Development of a teaching module for quality-of-life assessment of terminal patients. The AACE Multi-Institutional Palliative Cancer Education Section. American Association for Cancer Education.

To enhance the teaching of students to assess quality of life of patients with serious disease, the AACE Palliative Cancer Education Section has developed a teaching module. The module, which focuses on four desired learning objectives, is to be used in an hour-long small-group session. The authors describe the development of the module, as well as its objectives, teaching method, evaluation, and future challenges.

Culturally responsive cancer care in a cost-constrained work-classification system: a qualitative study of palliative care nurses.

This paper reports the results of a qualitative study to evaluate palliative care nurses' knowledge and experiences of providing culturally responsive palliative care within the cost constraints of a work-classification system. Multiple, in-depth interviews were conducted with 50 patients, their families, and health care providers. The study also employed observation techniques and documentary review of patient records. The study concludes that workload-classification measurement initiatives, while useful as a means of budgetary control, are often separate from and unrelated to the interests of cultural groups in palliative care populations.

Factors associated with vascular dementia in an elderly community population.

OBJECTIVE: Examination of associated factors for vascular dementia in comparison with Alzheimer's disease and a non-demented control population. SETTING: A semi-rural geographically defined population, in Melton Mowbray and the surrounding area, consisting of elderly patients aged 75 and over from a 13-doctor general practice. METHOD: 438 subjects, sampled according to results of initial screening with the Mini-Mental State Examination (MMSE), were examined using the Cambridge Mental Disorders of the Elderly Examination (CAMDEX), which was also used to classify the subtypes of dementia. RESULTS: 34 subjects had vascular dementia, 222 had Alzheimer's disease and 140 were non-demented according to the clinician's diagnosis based on the CAMDEX criteria. Significant factors associated with vascular dementia, when compared to the Alzheimer's disease and non-demented groups, were family history of stroke and diabetes. Stroke was also significant, but this factor is one of those defining the criteria for diagnostic grouping. There were no significant differences between groups for falls, heart attack, hypertension, head injury, substance abuse or lipid levels. CONCLUSION: The results are broadly consistent with the published literature and emphasize the importance of diabetes as a key risk factor for vascular dementia.