National science foundation grant awardees' perspectives on Article X and sexual harassment in science

Federal scientific agencies seek to make an impact on the continued prevalence of sexual harassment in the scientific academic community beyond institutional self-regulation. The National Science Foundation's Article X, released in 2018, is one of the most significant and ambitious federal policy initiatives to address sexual harassment. The present article presents the results of the first study to examine scientists' knowledge and attitudes about this important recent policy. We found, although overall knowledge about Article X was fairly low, the majority of participants responded positively to it. Crucially, impressions of the policy varied based on past experience and demographic factors. Individuals who had experienced harassment in the past year were less likely to believe the policy would help reduce sexual harassment in the sciences compared to those who had not experienced harassment (OR = 0.47, 95% CI:0.23-0.97, p = .034) and had greater odds of endorsing that the policy failed to go far enough (OR = 2.77, 95% CI:1.15-6.66, p = .023). Associations between demographic factors and views of the policy were less pronounced, but it is notable that, compared to their White counterparts, Black participants were more likely to believe the policy went too far (OR = 5.87, 95% CI:1.04-33.17, p = .045). Additionally, concerns were raised about the institutional enforcement of these policies and the existence of sufficient protections for survivors. Our work has implications for NSF's continued evaluation of the efficacy of this program as well as for other federal agencies implementing or considering similar policies.

Genetic Researchers' Use of and Interest in Research With Diverse Ancestral Groups

Importance

Genetic researchers must have access to databases populated with data from diverse ancestral groups to ensure research is generalizable or targeted for historically excluded communities.

Objective

To determine genetic researchers' interest in doing research with diverse ancestral populations, which database stewards offer adequate samples, and additional facilitators for use of diverse ancestral data.

Design, Setting, and Participants

This survey study was conducted from June to December 2022 and was part of an exploratory sequential mixed-methods project in which previous qualitative results informed survey design. Eligible participants included genetic researchers who held US academic affiliations and conducted research using human genetic databases.

Exposure

Internet-administered survey to genetic research professionals.

Main Outcomes and Measures

The survey assessed respondents' experience and interest in research with diverse ancestral data, perceptions of adequacy of diverse data across database stewards (ie, private, government, or consortia), and identified facilitators for encouraging use of diverse ancestral data. Descriptive statistics, χ2 tests, and z tests were used to describe respondents' perspectives and experiences.

Results

A total of 294 researchers (171 men [58.5%]; 121 women [41.2%]) were included in the study, resulting in a response rate of 20.4%. Across seniority level, 109 respondents (37.1%) were senior researchers, 85 (28.9%) were mid-level researchers, 71 (24.1%) were junior researchers, and 27 (9.2%) were trainees. Significantly more respondents worked with data from European ancestral populations (261 respondents [88.8%]) compared with any other ancestral population. Respondents who had not done research with Indigenous ancestral groups (210 respondents [71.4%]) were significantly more likely to report interest in doing so than not (121 respondents [41.2%] vs 89 respondents [30.3%]; P < .001). Respondents reported discrepancies in the adequacy of ancestral populations with significantly more reporting European samples as adequate across consortium (203 respondents [90.6%]), government (200 respondents [89.7%]), and private (42 respondents [80.8%]) databases, compared with any other ancestral population. There were no significant differences in reported adequacy of ancestral populations across database stewards. A majority of respondents without access to adequate diverse samples reported that increasing the ancestral diversity of existing databases (201 respondents [68.4%]) and increasing access to databases that are already diverse (166 respondents [56.5%]) would increase the likelihood of them using a more diverse sample.

Conclusions and Relevance

In this survey study of US genetic researchers, respondents reported existing databases only provide adequate ancestral samples for European populations, despite their interest in other ancestral populations. These findings suggest there are specific gaps in access to and composition of genetic databases, highlighting the urgent need to boost diversity in research samples to improve inclusivity in genetic research practices.

Professional Experiences and Career Trajectories of Mid- to Senior-Career Women Clinician-Scientists: A Qualitative Study

Importance

Despite increasing evidence and recognition of persistent gender disparities in academic medicine, qualitative data detailing the association of gender-based experiences with career progression remain sparse, particularly at the mid- to senior-career stage.

Objective

To investigate the role gender has played in everyday professional experiences of mid- to senior-career women clinician-scientists and their perceptions of gender-related barriers experienced across their careers.

Design, Setting, and Participants

In this qualitative study, a total of 60 of 159 invited clinician-scientists who received National Institutes of Health K08 or K23 awards between 2006 and 2009 and responded to a survey in 2021 agreed to participate. Invitees were selected using random, purposive sampling to support sample heterogeneity. Semistructured in-depth interviews were conducted January to May 2022. For this study, interviews from 31 women were analyzed using the framework approach to thematic analysis. Data analyses were performed between August and October 2023.

Main Outcomes and Measures

Descriptive themes of participant experiences of gender and gender-based barriers in academic medicine.

Results

A total of 31 women clinician-scientists (8 identifying as Asian [25.8%], 14 identifying as White [45.2%], and 9 identifying as members of a minority group underrepresented in medicine [29.0%]; 14 aged 40-49 years [45.2%] and 14 aged 50-59 years [45.2%]) were included. Among them, 17 participants (54.8%) had children who required adult supervision or care, 7 participants (22.6%) had children who did not require supervision or care, and 6 participants (19.4%) did not have children. There were 4 dominant themes identified within participant experiences in academic medicine: the mental burden of gendered expectations at work and home, inequitable treatment of women in bureaucratic processes, subtle and less subtle professional exclusion of women, and value of communities built on shared identities, experiences, and solidarity.

Conclusions and Relevance

This study found that women perceived the institution of academic medicine as a male-centric system misaligned with the needs of women, with associated feelings of exclusion, disillusionment, and loss of trust in their institutions. Findings suggest that the confluence of domestic obligations and unaccommodating institutional environments may make it difficult for women clinician-scientists to achieve established timelines of career progression and productivity; these findings may have long-term implications for the well-being and retention of women in academic medicine.

"Follow to *actually* heal binge eating": A mixed methods textual content analysis of #BEDrecovery on TikTok

Binge eating disorder (BED) has been relatively overlooked in research on eating disorders and social media. Existing literature suggests that time spent on social media may be associated with increased binge eating. However, more granular details of social media experiences such as the consumption of pro-recovery content have not received sufficient scholarly attention. The present study begins to address this gap through analysis of 1074 captions from public posts on TikTok, a video-based social media platform, tagged with #BEDrecovery between July 2021-2022. We generated six themes by examining word frequencies in the data and engaging in reflexive categorization of commonly used words within the context of different posts. These themes were: (1) diets and eating approaches, (2) help and support, (3) mental health, (4) diet culture critique, (5) body monitoring, and (6) fitness. To understand which videos in the BED recovery community had the broadest reach, we also examined how themes were associated with user engagement - concretely, the number plays (times the post was watched) and shares (times users shared a link to the post with other TikTok users). Notably, we found that the number of shares was significantly lower in posts that included diet culture critique than in those that did not. By contrast plays and shares were higher in posts with body monitoring than in those without. Our findings suggest that highly engaged with #BEDrecovery TikTok content may include the promotion of diet culture and potentially create an unproductive environment for individuals seeking BED recovery support.

Visions of recovery: a cross-diagnostic examination of eating disorder pro-recovery communities on TikTok

Individuals seeking support or inspiration for eating disorder recovery may turn to pro-recovery content on social media sites such as TikTok. While research has thus far treated pro-recovery social media as a fairly homogeneous space, many pro-recovery hashtags single out particular eating disorder diagnoses. This exploratory study used codebook thematic analysis of 241 popular pro-recovery videos on TikTok to compare the presentation of eating disorders and eating disorder recovery across five different diagnosis-specific hashtags: #anarecovery, #arfidrecovery, #bedrecovery, #miarecovery, and #orthorexiarecovery. These hashtags refer to the following eating disorder diagnoses respectively: anorexia nervosa, avoidant restrictive food intake disorder, binge eating disorder, bulimia nervosa, and orthorexia nervosa. Our analysis generated the following qualitative themes across the entire dataset: (1) centrality of food to eating disorders and recovery, (2) what eating disorders look and feel like, (3) recovery as a process, (4) getting and giving help, and (5) negotiating diet culture in recovery. To supplement our qualitative findings and facilitate cross-diagnostic comparisons, we also conducted one-way ANOVAs and chi-square tests to probe for statistically significant differences in audience engagement and code prevalence across the different hashtags. Our results indicate that there are clear differences in how recovery is envisioned on TikTok based on which diagnostic hashtags are employed. Such variations in how different eating disorders are imagined on popular social media demand further investigation and clinical consideration.

Tech, Sex, and E-cigarettes: The Gendering of Vape Promotion on Instagram

The promotion of vape products on social media has been implicated in increasing rates of e-cigarette usage, particularly among youth and young adults. While research has examined overall trends in vape-related content across a number of platforms, the role that social media "influencers" play in promoting vaping and potentially augmenting this public health crisis has been insufficiently explored. The present study examined 44,052 Instagram posts by 60 male presenting and 60 female presenting vape influencers to understand how influencer gender mediates the performance of vape culture online. Our textual and visual analysis of these influencers' posts over one year revealed significant bifurcations based on gender. Independent sample t-tests showed statistically significant gender differences in word frequency. Male-presenting influencers tended to emphasize their expertise with vape devices as technologies, while female-presenting influencers tended to focus on their own appearance. Further, factor analysis indicated six major categories of textual features, and multiple linear regression tests showed varying levels of user engagement with the different categories across both genders. Chi-square tests indicated that female-presenting influencers highlighted their own bodies in the visual content of their posts, whereas male presenting influencers often posted images of vape devices or their component parts alone. These findings suggest that gender presentation plays an important role in shaping vape influencers' promotional tactics and vape-related content on Instagram, and also provides insights into what kinds of content receive the most user engagement. This study can therefore help inform interventions to mitigate the impact of social media vape promotion.

"Are people thinking I'm a vector…because I'm fat?": Cisgender experiences of body, eating, and identity during COVID-19

While a range of studies have shown the negative impact of COVID-19 on disordered eating and body image, few have engaged with how identity and social context interact with these domains. The current study used inductive codebook thematic analysis to understand experiences of body and eating during the pandemic among a diverse (sub)clinical sample of individuals with self-reported disordered eating. We interviewed 31 cisgender participants (18/31 Black Indigenous People of Color (BIPOC), 24/31 women) with a history of disordered eating (diagnosed and undiagnosed). Five themes were identified: Body Surveillance and Dissatisfaction, Movement and Intake Fixation, Food Scarcity and Resource Concerns, Changes in Visibility of Body and Eating, and Bodies Are Vulnerable. We examined the extent to which themes pertained to certain identities over others. Notably, BIPOC, large-bodied, queer participants more commonly spoke to body vulnerability than White, small/medium-bodied, straight participants. BIPOC and large-bodied participants also particularly spoke to feeling relief from discrimination as social distancing and mask wearing reduced their public visibility. Participants related these themes to changed body and eating experiences that spanned distress and resilience. Our analysis offers insight into multifaceted and contextual impacts of COVID-19 on experiences of body, eating, and identity.

Flaws in the highlight real: fitstagram diptychs and the enactment of cyborg embodiment

This article inverts Donna Haraway’s proposition that ‘the ideologically charged question of what counts as daily activity, as experience, can be approached by exploiting the cyborg image’ by instead exploiting everyday experience to approach the contemporary cyborg. It utilises digital tools to compile a corpus of Instagram posts that foreground corporeal hybridity, and examines this social media data through the lenses of feminist STS, affect theory and digital studies. This strategy offers a new vantage on the cyborg by connecting it to concrete and ongoing user practices. To make these interventions, this project focuses specifically on a genre of post popularised by Instagram fitness (or fitstagram) influencers – diptych photographic montages that oppose imperfectly ‘real’ material bodies to unrealistically ‘perfect’ media bodies. Although they formally rely on binary logics (real v. perfect, offline v. online), the posts simultaneously deconstruct them in a number of ways. These repeated boundary transgressions reflect users’ lived experiences of hybrid online/offline corporeality and help forward a theory of cyborg embodiment that relies on quotidian practices as opposed to fixed products or identities. Moreover, close engagement with a final dataset of eighty-nine posts illuminates three particular modes of enacting the cyborg corpus on Instagram: occupation of multiple bodies, awareness of the analogue body and anxious boundary-work. This research extends the cyborg as a critical figure by situating it within a social media context, attending to its imbrication in everyday practices, and affirming female Instagram users as theorists of their cyborg selves.

Biomarkers Can't Bypass the Mouth of a Wound

This article critiques the idealization of a biomarker-based "objective pain scale" in order to argue for increased investment in communication-centric approaches to chronic pain diagnosis and treatment. Although new technological advances and the rise of big data have revived old fantasies of objective pain measures, scholars have long affirmed the dangers of converting human experience into numbers, as well as the fundamental impossibility of reducing pain to physiology. Biomarkers can certainly be useful tools, but investments must also be made in fostering the "strong objectivity" that feminist scholars have advocated for and that the incorporation of narrative-driven initiatives can provide. Because expressing pain is notoriously difficult, doing this creative, communication-driven work well requires substantial effort, time, and training. Engaging with chronic pain from a feminist standpoint-one that affirms individuals' situated experiences as valuable data and that attends to the rich multi-modal vocabularies emerging on social media-can pave the way to a more equitable, ethical, and effective future of pain care.

Safety and clinical efficacy of Onyx for embolization of extracranial head and neck vascular anomalies

BACKGROUND AND PURPOSE

Onyx was developed for embolization of central nervous system AVMs but is increasingly used extracranially because of its unique physical properties. We review our experience and results with the use of Onyx for the treatment of fast-flow extracranial vascular lesions.

MATERIALS AND METHODS

We retrospectively analyzed clinical and imaging records of 22 patients who underwent 71 extracranial embolizations from March 2007 through January 2010. The diagnoses were the following: cervicofacial AVM (n = 18), traumatic fistula (n = 3), and vessel laceration (n = 1). In 62 of 71 procedures (87%), Onyx was the sole embolic agent; it was delivered transarterially in 67/71 and percutaneously in 4/71 procedures. Clinical goals included amelioration of pain and control of bleeding. The clinical efficacy of embolization was judged by symptom control, and adverse events were assessed by clinical examination and history, both postembolization and 4 weeks postprocedure.

RESULTS

Cessation of acute bleeding was achieved in 13/14 cases, with 1 case of immediate recurrent massive epistaxis prompting reintubation and further embolization. Control of subacute bleeding episodes and pain was achieved for all patients. Following staged embolization, 7 patients underwent surgical resection without significant blood loss. Surgeons reported high satisfaction with the intraoperative handling properties of Onyx. Transient swelling, local tenderness, or numbness was encountered after 7 procedures. There were no stuck catheters, vessel dissections, or vessel ruptures and no skin discoloration.

CONCLUSIONS

Staged Onyx embolization was clinically efficacious in managing extracranial fast-flow vascular malformations and lesions, with low associated morbidity.

Laparoscopic splenectomy for massive splenomegaly using a Lahey bag

BACKGROUND

Although the recent development of hand-assisted laparoscopic surgery (HALS) has made the laparoscopic retraction of large spleens feasible, the laparoscopic removal of massively enlarged spleens (>1,000 g) remains a significant problem because these spleens do not fit into endoscopic bags. Consequently, in order to remove massive spleens either a large abdominal incision or morcellation of the spleen outside of an endoscopy bag is required.

METHODS

Two patients, with spleens weighing 2,510 g and 1,720 g, underwent laparoscopic splenectomy using a hand port to ensure safe retraction. The massive spleen was placed into a Lahey bag that was inserted into the abdomen through the hand port site. While in the Lahey bag, the spleen was removed piecemeal through the hand port site.

RESULTS

Both operations were completed laparoscopically without complications. The patients were discharged on postoperative day 2 and experienced minimal morbidity.

CONCLUSIONS

The Lahey bag facilitates laparoscopic splenectomy for massive splenomegaly as even the most massive spleens will fit into a Lahey bag. A massive spleen may be removed piecemeal from the Lahey bag through the small hand port incision without risking a large abdominal incision, splenosis, or the insertion of a morcellator.

Lluis Barraquer-Roviralta (1855-1928): Spanish neurologist described progressive lipodystrophy

Lluis Barraquer-Roviralta, a Spanish neurologist, described the syndrome of progressive lipodystrophy in 1907. This syndrome was subsequently known as Barraquer's syndrome. The main feature of Barraquer's syndrome is the progressive atrophy of the subcutaneous fat of the face. Plastic surgeons are familiar with Barraquer's name because they often correct the facial deformity associated with Barraquer's syndrome. Although plastic surgeons recognize Barraquer for his description of progressive lipodystrophy, his main contributions were to the field of neurology. Barraquer, who is considered the founder of the specialty of neurology in Spain, contributed to the start of neurosurgery in Spain, as well. Barraquer was an expert in diseases of the peripheral nervous system and developed medicines to treat tabes dorsalis. His drawings and photographs of the nervous system were unparalleled. His iconographic collection helped to define the anatomy and pathology of numerous neurological diseases. His pictures were featured in the main neurology textbook of the time and are presently housed in the Museum of Medical History in Spain. During his career at the University of Barcelona Barraquer was well known for his lecturing ability and for training the first neurologists in Spain. In addition to describing progressive lipodystrophy, Barraquer also was the first to describe the grasp reflex of the foot, now known as Barraquer's reflex. Of his remarkable accomplishments, Barraquer is best remembered for his description of two phenomena that now bear his name, Barraquer's reflex and Barraquer's syndrome. Although Lluis Barraquer-Roviralta's main contributions were to the field of neurology, his description of progressive lipodystrophy in 1907 will forever endear him to future generations of plastic surgeons.

Laparoscopically assisted ileocolectomy for Crohn's disease through a pfannenstiel incision

Recently, laparoscopically assisted bowel resections have been shown to be less morbid than the traditional laparotomy, especially for benign conditions such as Crohn's disease. While reports describing laparoscopically assisted bowel resections use a small midline or right transverse incision, we describe a novel laparoscopically assisted approach employing a Pfannenstiel incision for Crohn's patients. We attempted the Pfannenstiel incision since it is well known to be associated with less postoperative pain, decreased ileus and hospital stay, and low rates of wound infection and incisional hernia, compared with midline or right transverse incisions. Furthermore, we found that the Pfannenstiel incision offers additional advantages that may be uniquely suited for Crohn's patients. First, the cosmetic position of the incision is particularly attractive to the young population affected by Crohn's. Second, the Pfannenstiel incision preserves fresh tissue in the midline, right, and left lower quadrants in the event that reoperation or stoma placement are required in the future owing to recurrent disease. We describe our technique in 10 consecutive patients undergoing ileocolectomy for Crohn's disease. Our patients experienced minimal morbidity and were pleased with the cosmetic results of their incisions.

Removal of dairy soil from heated stainless steel surfaces: use of ozonated water as a prerinse

Square (2.54 x 2.54 cm2) 304 stainless steel metal plates were cleaned, passivated, and soiled by autoclaving (121 degrees C at 15 psi for 15 min) with reconstituted nonfat dry milk (20% solids). Fifteen-minute treatments using either warm water (40 degrees C) or ozonated cold water (10 degrees C) were conducted to compare prerinse cleaning potential of soiled metal plates. The chemical oxygen demand determination was performed on extracted organic material from treated metal plates. Results indicated that the ozone treatment removed 84% of soil from metal plates versus 51% soil removal by the warm water treatment, but the effectiveness of the two treatments did not differ (P > 0.05). Cleaning effects were visualized using scanning electron microscopy at 200x and 2000x magnification. The amount of soil film present on stainless steel metal surfaces was visibly lower on ozonated treatments versus on warm water treatments.

Organic acids and volatile flavor components evolved during refrigerated storage of kefir

Kefir samples were prepared and transferred to sterile jars for storage at 4 degrees C. After 0, 7, 14, and 21 d of storage, the pH, organic acid, and volatile flavor component content were determined to monitor possible flavor changes during storage. Stored samples were analyzed for organic acid (orotic, citric, pyruvic, lactic, uric, acetic, propionic, butyric, and hippuric) content by HPLC with UV detection at 275 nm. Acetoin, ethanol, acetaldehyde, and diacetyl were monitored using gas chromatography equipped with a headspace autosampler. There was no significant decrease in average pH of samples between d 0 and 21 of storage (P>0.05). Lactic acid concentration increased during storage, reaching a maximum of 7739 ppm by d 21. Orotic and citric acids increased slightly during storage. Although pyruvic and hippuric acids are produced during fermentation, neither was detected during storage. Acetic, propionic, and butyric acids were not detected during kefir storage. Ethanol concentrations increased during storage and reached 0.08% by d 21. The amounts of acetaldehyde and acetoin, common flavor substances in many cultured dairy products, increased during fermentation. Acetaldehyde content in kefir samples doubled from d 0 to 21, reaching a final concentration of 11 microg/g. During storage, the concentration of acetoin decreased from 25 ppm on d 0 to 16 ppm on d 21. However, diacetyl, another common flavor component in cultured dairy products, was not detected during fermentation or storage.

Is sestamibi-guided parathyroidectomy really cost-effective?

BACKGROUND

Sestamibi-guided limited neck explorations are an alternative to the standard bilateral neck exploration for patients with primary hyperparathyroidism. A recently published meta-analysis by Denham and Norman (JACS vol.186, 1998) suggested that a sestamibi-directed approach offers a cost benefit because it decreases operative and recovery room times, hospital stay, and the number of frozen sections needed.

METHODS

We reviewed 41 bilateral neck explorations for primary hyperparathyroidism and compared our results with those reported by the meta-analysis to determine whether a sestamibi-directed approach is cost effective.

RESULTS

Operative and recovery room times averaged 60.3 +/- 19.3 and 45 minutes, respectively. Forty six percent of the patients were treated as outpatients, and 1.21 +/- 0.57 frozen sections were obtained per case. Our standard bilateral exploration cost 47% less than the bilateral approach and 17% less than the sestamibi-directed operation calculated in the meta-analysis. There were no cases of nerve injury or permanent hypocalcemia, 98% of patients were cured, and 61% of patients did not require narcotics postoperatively.

CONCLUSIONS

Sestamibi-guided parathyroidectomy may not offer any advantage over the standard bilateral exploration. In our experience, a bilateral neck exploration can be performed on an outpatient basis and at low cost, with a high success rate and minimal morbidity. Most patients do not require narcotics, and the cosmetic results are excellent.

A comparison of ozonation and chlorination for the disinfection of stainless steel surfaces

Ozonated water and chlorinated sanitizer were compared for effectiveness against biofilms of milk spoilage bacteria. Stainless steel plates were incubated in UHT-pasteurized milk inoculated with pure cultures of either Pseudomonas fluorescens (ATCC 949) or Alcaligenes faecalis (ATCC 337). After incubation, the plates were removed and rinsed in sterile PBS. A control rinsed stainless steel plate was swabbed and plated on standard plate count agar. A second rinsed stainless steel plate was covered and treated for 2 min with a commercial chlorinated sanitizer (dichloro-s-triazinetrione), prepared according to the manufacturer's recommendations; after treatment, the plate was rinsed twice in sterile PBS, swabbed, and plated on standard plate count agar. A third rinsed stainless steel plate from the culture was placed in ozonated deionized H2O (.5 ppm of ozone) for 10 min, rinsed twice as described, swabbed, and plated. Both ozonation and chlorination reduced bacteria populations by > 99% at initial cell densities in the range of approximately 1.24 x 10(5) to 8.56 x 10(5) cfu/cm2 for P. fluorescens and 1.53 x 10(4) to 8.56 x 10(5) cfu/cm2 for A. faecalis in milk films on stainless steel surfaces.