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Open Access Publications from the University of California

Scholarly Works (11 results)

  • Article
Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 23, Issue 4.1 (2022)

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.

    Cover page: A Deliberate Educational Initiative in Diversity, Inclusion and Racial EquityCreative Commons 'BY' version 4.0 license
    • Article
    Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 24, Issue 3.1 (2023)
      Cover page: Gender and Racial Distribution of Emergency Medicine Bound Medical Student Membership in Professional Honor SocietiesCreative Commons 'BY' version 4.0 license
      • Article
      • Peer Reviewed
      UC Davis Previously Published Works (2015)
      Dietary protein provides essential amino acids (EAAs) for the synthesis of new proteins plus an array of other metabolic functions; many of these functions are sensitive to postprandial plasma and intracellular amino acid concentrations. Recent research has focused on amino acids as metabolic signals that influence the rate of protein synthesis, inflammation responses, mitochondrial activity, and satiety, exerting their influence through signaling systems including mammalian/mechanistic target of rapamycin complex 1 (mTORC1), general control nonrepressed 2 (GCN2), glucagon-like peptide 1 (GLP-1), peptide YY (PYY), serotonin, and insulin. These signals represent meal-based responses to dietary protein. The best characterized of these signals is the leucine-induced activation of mTORC1, which leads to the stimulation of skeletal muscle protein synthesis after ingestion of a meal that contains protein. The response of this metabolic pathway to dietary protein (i.e., meal threshold) declines with advancing age or reduced physical activity. Current dietary recommendations for protein are focused on total daily intake of 0.8 g/kg body weight, but new research suggests daily needs for older adults of ≥1.0 g/kg and identifies anabolic and metabolic benefits to consuming at least 20-30 g protein at a given meal. Resistance exercise appears to increase the efficiency of EAA use for muscle anabolism and to lower the meal threshold for stimulation of protein synthesis. Applying this information to a typical 3-meal-a-day dietary plan results in protein intakes that are well within the guidelines of the Dietary Reference Intakes for acceptable macronutrient intakes. The meal threshold concept for dietary protein emphasizes a need for redistribution of dietary protein for optimum metabolic health.
        Cover page: Defining meal requirements for protein to optimize metabolic roles of amino acids 2–4
        • Article
        Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 25, Issue 3.1 (2024)
        • 1 supplemental PDF
        Cover page: Describing Preliminary Data on Scoring Using the Standardized Letter of Evaluation (SLOE) 2.0 FormatCreative Commons 'BY' version 4.0 license
        • Article
        Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 25, Issue 3.1 (2024)
        • 1 supplemental PDF
        Cover page: Home vs Away Rotation Differences in the Standardized Letters of Evaluation (SLOE) 2.0Creative Commons 'BY' version 4.0 license
        • Article
        Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 25, Issue 3.1 (2024)
        • 2 supplemental PDFs
        Cover page: Differences in Standardized Letter of Evaluation (SLOE) 2.0 Scoring Between Men and Women as well as Under-represented in Medicine and Non-underrepresented in Medicine ApplicantsCreative Commons 'BY' version 4.0 license
        • Article
        Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 25, Issue 3.1 (2024)
        • 1 supplemental PDF
        Cover page: Comparing the Standardized Letter of Evaluation (SLOE) 2.0 with SLOE for Non-residency-based EM PhysiciansCreative Commons 'BY' version 4.0 license
        • Article
        • Peer Reviewed
        UC Davis Previously Published Works (2021)
        BACKGROUND: Developing food-based dietary guidelines (FBDGs) for infants and toddlers is a complex task that few countries have attempted. OBJECTIVES: Our objectives are to describe the process of food pattern modeling (FPM) conducted to develop FBDGs for the Dietary Guidelines for Americans, 2020-2025 for infants 6 to <12 mo and toddlers 12 to <24 mo of age, as well as the implications of the results and areas needing further work. METHODS: The US 2020 Dietary Guidelines Advisory Committee, with the support of federal staff, conducted FPM analyses using 5 steps: 1) identified energy intake targets; 2) established nutritional goals; 3) identified food groupings and expected amounts, using 3 options for the amount of energy from human milk in each age interval; 4) estimated expected nutrient intakes for each scenario, based on nutrient-dense representative foods; and 5) evaluated expected nutrient intakes against nutritional goals. RESULTS: For human milk-fed infants (and toddlers), example combinations of complementary foods and beverages were developed that come close to meeting almost all nutrient recommendations if iron-fortified infant cereals are included at 6 to <12 mo of age. These combinations would also be suitable for formula-fed infants. For toddlers not fed human milk, 2 patterns were developed: the Healthy US-Style Pattern and the Healthy Vegetarian Pattern (a lacto-ovo vegetarian pattern). Achieving nutrient recommendations left virtually no remaining energy for added sugars. CONCLUSIONS: It is challenging to meet all nutrient needs during these age intervals. Added sugars should be avoided for infants and toddlers <2 y of age. Further work is needed to 1) establish a reference human milk composition profile, 2) update and strengthen the DRI values for these age groups, and 3) use optimization modeling, in combination with FPM, to identify combinations of foods that meet all nutritional goals.
          • Article
          • Peer Reviewed
          UC Davis Previously Published Works (2021)

          Background

          Breastfeeding is associated with a lower risk of subsequent overweight or obesity, but it is uncertain whether this is a causal relation because most studies have not adequately reduced risk of bias due to confounding.

          Objectives

          The aim of this review was to examine whether 1) ever compared with never consuming human milk and 2) different durations of human milk consumption among infants fed human milk are related to later risk of overweight or obesity, with emphasis on sibling-pair and intervention studies.

          Methods

          The 2020 Dietary Guidelines Advisory Committee, together with the Nutrition Evidence Systematic Review team, conducted a systematic review of articles relevant to healthy full-term infants in countries with a high or very high level of human development. We searched PubMed, Embase, Cochrane, and CINAHL; dual-screened the results using predetermined criteria; extracted data from and assessed the risk of bias for each included study; qualitatively synthesized the evidence; developed conclusion statements; and graded the strength of the evidence.

          Results

          The review included 42 articles, including 6 cohorts with sibling-pair analyses and 1 randomized controlled trial of a breastfeeding promotion intervention. Moderate evidence suggested that ever, compared with never, consuming human milk is associated with a lower risk of overweight and obesity at ages 2 y and older, particularly if the duration of human milk consumption is >6 mo. However, residual confounding cannot be ruled out. Evidence was insufficient to determine the relation between the duration of any human milk consumption, among infants fed human milk, and overweight and/or obesity at age 2 y and older.

          Conclusions

          Further research, using strong study designs, is needed to disentangle the complex relation between infant feeding practices and the risk of subsequent overweight or obesity, as well as the biological and behavioral mechanisms if the relation is causal.
            Cover page: Breastfeeding and risk of overweight in childhood and beyond: a systematic review with emphasis on sibling-pair and intervention studies
            • Article
            • Peer Reviewed
            UC Davis Previously Published Works (2021)

            Background

            Identification of nutrients of public health concern has been a hallmark of the Dietary Guidelines for Americans (DGA); however, a formal systematic process for identifying them has not been published.

            Objectives

            We aimed to propose a framework for identifying "nutrients or food components" (NFCs) of public health relevance to inform the DGA.

            Methods

            The proposed framework consists of 1) defining terminology; 2) establishing quantitative thresholds to identify NFCs; and 3) examining national data. The proposed framework utilizes available data from 3 key data sources or "prongs": 1) dietary intakes; 2) biological endpoints; and 3) clinical health consequences such as prevalence of health conditions, directly or indirectly through validated surrogate markers.

            Results

            In identifying potential NFCs of public health concern, the 2020 DGA Committee developed a decision-tree framework with suggestions for combining the 3 prongs. The identified NFCs of public health concern for Americans ≥1 y old included fiber, calcium (≥2 y old), vitamin D, and potassium for low intakes and sodium, added sugars, and saturated fats (≥2 y old) for high intakes that were associated with adverse health consequences. Iron was identified among infants ages 6-12 mo fed human milk. For reproductive-aged and pregnant females, iron (all trimesters) and folate (first trimester) were identified for low intake, based on dietary and biomarker data (iron) or the severity of the consequence (folic acid and neural tube defects). Among pregnant women, low iodine was of potential public health concern based on biomarker data. Other NFCs that were underconsumed, overconsumed, and pose special challenges were identified across the life course.

            Conclusions

            The proposed decision-tree framework was intended to streamline and add transparency to the work of this and future Dietary Guidelines Advisory Committees to identify NFCs that need to be encouraged or discouraged in order to help reduce risk of chronic disease and promote health and energy balance in the population.
              Cover page: A Proposed Framework for Identifying Nutrients and Food Components of Public Health Relevance in the Dietary Guidelines for Americans
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