Winston-Salem State University

Healthcare disparities in pain management represent one of the most persistent and pernicious manifestations of systemic bias within medicine. This comprehensive review examines the complex intersection of implicit bias, racial stigmatization, and clinical decision-making in the context of sickle cell disease, a predominantly African descent genetic disorder characterized by severe recurrent acute pain episodes and chronic pain that worsens with age. Through analysis of empirical research spanning psychosocial functioning, pain perception, healthcare utilization patterns, and provider attitudes, we demonstrate how societal-level prejudices become institutionalized within medical practice, resulting in systematic undertreatment of legitimate pain and inappropriate labeling of patients as drug-seeking. The current opioid crisis has paradoxically exacerbated these disparities, as heightened scrutiny of narcotic prescribing disproportionately affects minority patients who already face substantial barriers to adequate pain management. We argue that understanding the biopsychosocial complexity of sickle cell disease within its historical and social context is essential for dismantling discriminatory practices and achieving equitable healthcare delivery. This paper presents a framework for recognizing and addressing implicit bias in clinical settings while maintaining appropriate safeguards against prescription drug diversion. The implications extend beyond sickle cell disease to encompass broader questions about how societal inequities become embedded in medical practice and perpetuated through ostensibly objective clinical assessments.

Chronic musculoskeletal pain (CMP) is the most common and disabling of all pain conditions. Combination treatment that includes duloxetine and web-based cognitive behavioral therapy (CBT) has not been rigorously evaluated. We investigated the effectiveness of the combination treatment against duloxetine monotherapy and also examined the effects of adding motivational interviewing (MI) to enhance participant's motivation to engage in web-based CBT. Participants with CMP (n = 281) were randomized to 1 of 3 treatment arms: (1) duloxetine monotherapy, (2) combination treatment (duloxetine + web-based CBT) without phone-based MI, and (3) combination treatment with 6 sessions of phone-based MI. The primary outcome was the Brief Pain Inventory total pain score (BPI TPS) at week 24. Overall, mean (SD) baseline BPI TPS in arms 1, 2 and 3 were 5.8 (1.8), 5.7 (2.1), and 6.1 (1.6), respectively. Compared with baseline, participants in all 3 arms had significant improvement in their BPI TPS during the 24-week trial. However, BPI TPS were not significantly different among the 3 arms, neither were the BPI pain interference and severity, and global ratings of change. The proportion of participants who completed ≥ 6 web-based modules were about the same in arms 2 and 3: 46.3% vs 45.8%, respectively. Web-based CBT did not demonstrate additional benefits beyond those observed with duloxetine monotherapy, which may, in part, be due to low participant completion of the web-based modules. Unexpectedly, the addition of phone-based MI did not significantly improve module completion rates. These findings support the utility of duloxetine over the 24-week study period.

The Constrained Application Protocol (CoAP) enables RESTful communication for resource-constrained IoT devices over UDP. However, in Separate Response mode, delayed or lost Empty Acknowledgments (ACKs) can trigger unnecessary retransmissions, causing duplicate responses, energy waste, and higher latency. This paper proposes a cooperative retransmission control scheme that enhances CoAP reliability without modifying its standard. The client employs an adaptive retransmission timeout (RTO) using an exponentially weighted moving average (EWMA) of round-trip times, while the server applies a twothreshold duplicate suppression mechanism that differentiates between transient delays and actual losses. Together, these components dynamically balance reliability and responsiveness. Simulation and analytical results in 6LoWPAN environments show reductions of up to 45 % in redundant messages, 25 % in latency, and 18 % in energy consumption compared with baseline CoAP. The proposed scheme provides a lightweight, fully compliant improvement for scalable, low-power IoT networking.

Healthcare systems worldwide face mounting challenges, including shortages of primary and specialty care providers, escalating direct and indirect medical costs, and limited access to high-quality diagnostic and interventional services—burdens that disproportionately affect patients in rural or medically underserved areas. Because timely, reliable, and affordable diagnostic and interventional services are essential to comprehensive, lifelong care, the expanding role of physiotherapists as autonomous, first-contact providers represents a critical and timely innovation. This article underscores the value of electrodiagnostic (EDX) testing and ultrasound imaging (USI) as instrumented point-of-care diagnostic tools available to physiotherapists through recognized pathways of training and credentialing and argues for their greater integration into contemporary practice. The authors contend that expanding training opportunities in both entry-level physiotherapy curricula and post-graduate programs will increase physiotherapist utilization of these technologies, strengthen the evidence-based rationale for physiotherapy as a primary care profession, and solidify the discipline's role as an indispensable member of the interdisciplinary healthcare team. By broadening access to EDX testing and USI, physiotherapists can deliver timely and cost-effective diagnostic and interventional services, mitigate barriers created by provider shortages, and help modernize healthcare systems to better meet the demands of strained populations worldwide.

BackgroundThe DAWN study will build a large genomics resource for AD research in individuals with African (Af) and Hispanic/Latino (H/L) ancestry. Clinical Research Coordinators (CRCs) are recruiting 5,000 Af, 4,000 African Americans (AA) and 4,000 H/L participants from the US and ten African sites. Study recruitment is done through community engagement in rural and urban settings. Coordinators on the front lines play an invaluable role in the success of reaching DAWN goals and assuring participant satisfaction as well as study trustworthiness. Often too little investment is made in this indispensable group.MethodDAWN utilizes a team science approach for recruiting AA and HI participants across four U.S. sites. Outreach and Recruitment (OR) efforts are led by an OR core team. Clinical trainings are led by a Coordinating Site team and by managers at each site. Weekly virtual meetings hosted by the Coordinating Site, and monthly collaborators meetings offer bi‐directional learning between CRCs and trainers. An annual CRC meeting creates platforms for advancing professional development, clinical skills, culturally relevant and patient‐centered recruitment strategies, and camaraderie among cross‐site peers. At face‐to‐face convenings teams review study goals and expectations, celebrate milestones, and empower CRCs to identify organizational, administrative and personal challenges and successes across sites, including collaborating across‐sites to achieve enrollment goals.ResultNineteen DAWN CRCs are of AA and HI descent, representative of the recruitment populations. Approximately, 85% are female and all have at least a bachelor's degree. In the first two years, DAWN CRCs met enrollment goals with (1,616 AAs and 1,599 HIs). They identified 26 impediments and 14 retention strategies to improve recruitment efficiencies. Top strategies involved building community trust, CRC safety, providing additional in‐person trainings and providing resources for community. CRCs at all DAWN sites have assisted at least one other site in their recruitment.ConclusionMulti‐site efforts to provide important ancestral diversity to the global Alzheimer's genomics research effort will continue needing to identify roles, impediments and strategies for successful recruitment and retention of participants. Listening to the voices of CRCs and investing in their development are important strategies for recruitment success and employee retention.

The topological symmetry group $\mathrm{TSG}(Γ)$ of an embedding $Γ$ of a graph in $S^3$ is the subgroup of the automorphism group of the graph which is induced by homeomorphisms of $(S^3,Γ)$. If we restrict to orientation preserving homeomorphisms then we obtain the orientation preserving topological symmetry group $\mathrm{TSG}_+(Γ)$. In this paper we determine all groups that can be $\mathrm{TSG}(Γ)$ or $\mathrm{TSG}_+(Γ)$ for some embedding $Γ$ of a generalized Petersen graph other than the exceptional graphs $P(12,5)$ and $P(24, 5)$ (which will be addressed in a separate paper.

The Winston Essential Skills Survey (WESS) 3.0, the first social-emotional learning (SEL) assessment designed for students with learning disabilities (SwLD), has evidence for reliability and validity in a specific population of teachers. To build on this evidence, 180 educators responded to the WESS 3.0, along with new items and the Devereux Student Strengths Assessment (DESSA), to assess a sample of 397 SwLD. Minor modifications to the WESS 3.0 resulted in the WESS 4.0, which demonstrated internal consistency, an eight-factor structure, and convergent validity with the DESSA. The WESS 4.0 addresses a critical gap in SEL assessments for SwLD, providing researchers and educators with a valid and reliable method to assess SwLD's social-emotional skills. This survey may inform school interventions, policy decisions on SEL programming, and advance understanding of SEL in SwLD, potentially improving educational outcomes and well-being for this population.

Studies in humans and livestock have demonstrated Bacillus coagulans GBI-30, 6086 to have probiotic potential, suggesting that it may alleviate gastrointestinal (GI) distress commonly associated with diet change in dogs. This study aimed to evaluate the effects of B. coagulans GBI-30, 6086 on fecal scores, pH, dry matter (DM) percentage, and microbiota populations of dogs following an abrupt diet change. English Pointer dogs (n = 12; age = 5.9 ± 2.5 yr; body weight = 26.6 ± 6.1 kg) were used in a replicated 3 × 3 Latin square design and fed commercial diets containing no probiotics or prebiotics. The following treatments were administered orally in gelatin capsules before each daily feeding: (1) placebo control (250 mg maltodextrin/day); (2) B. coagulans [low dose; 5 × 108 colony-forming units (CFU)/day]; and (3) B. coagulans (high dose; 2.5 × 109 CFU/day). An extruded kibble diet was fed for 28 days. Dogs were then abruptly switched to a canned diet and fed for 14 days, with fecal samples collected before and 2, 6, 10, and 14 days after diet change. All data were analyzed using the Mixed Models procedure of SAS 9.4, testing the effects of treatment, time, and treatment*time interactions. Treatment*time interactions were not observed, but the abrupt diet change reduced (p < 0.0001) fecal DM content, increased (p < 0.0001) fecal scores and pH, and reduced (p < 0.0001) fecal bacterial species richness and phylogenetic diversity. Diet change also increased (p < 0.001) fecal Bacteroidota, Fusobacteriota, and Proteobacteria, decreased (p < 0.001) fecal Firmicutes, and altered ~40 fecal bacterial genera relative abundances. Diet-induced changes were minimally impacted by B. coagulans, but fecal scores tended to be lower (i.e., firmer stools; p < 0.10), fecal E. coli and Faecalibacterium abundances were greater (p < 0.05), and fecal bacterial phylogenetic diversity was higher (p < 0.05) in dogs supplemented with the low dose than in controls. Our results demonstrate that abruptly transitioning dogs from a kibble to a canned diet negatively influences fecal characteristics and considerably shifts the composition of the fecal microbiota. Supplementation with B. coagulans did not mitigate the diet-induced shifts to fecal characteristics and most of the microbial taxa, although the low dose impacted some microbial taxa. Further investigation into optimal inclusion levels in pet foods is warranted.