Epidemiology, clinical features and outcome of stroke in rural versus urban hospitals in Cameroon

OBJECTIVES

Stroke is a major public health problem worldwide with disparities between urban and rural areas. The aim of this study was to compare the epidemiological, clinical features and outcomes of stroke between rural and urban hospitals in Cameroon.

MATERIALS AND METHODS

We conducted a retrospective cohort study at the Douala General Hospital (urban) and Ad Lucem Hospital of Banka (rural) from January 1st, 2014, to December 31st, 2019. The medical records of all patients admitted for stroke, and meeting the inclusion criteria were reviewed. Diagnosis of stroke was based on brain imaging and/or the World Health Organization definition. Data were analyzed using SPSS version 20.0.

RESULTS

Among the 15277 files reviewed, 752 were included with 623 cases (82.80%) in urban areas. The percentage of patients hospitalized for stroke were 9.06% and 2.85% in urban and rural hospitals respectively. The frequency of patients admitted for severe stroke (Glasgow coma scale ≤ 8) was higher in the rural hospital (p = 0.004). In-hospital mortality (p = 0.010), cumulative mortality at one-month (p = 0.018), poor functional recovery (p = 0.002), one-year stroke recurrence (p = 0.020) were significantly higher in rural setting. Undefined stroke was predictor of mortality in the rural hospital, while hemorrhagic stroke was predictor of mortality at one-month in the urban hospital.

CONCLUSIONS

Stroke cases were significantly more severe with poor outcomes in the rural hospital. Efforts are needed to improve prevention, and access to stroke care for communities, especially in rural setting.

Efficient quantum algorithms for set operations

Analyzing the relations between Boolean functions has many applications in many fields, such as database systems, cryptography, and collision problems. This paper proposes four quantum algorithms that use amplitude amplification techniques to perform set operations, including Intersection, Difference, and Union, on two Boolean functions in O ( N ) time complexity. The proposed algorithms employ two quantum amplitude amplification techniques divided into two stages. The first stage uses the Younes et al. algorithm for quantum searching via entanglement and partial diffusion to prepare incomplete superpositions of the truth set of the first Boolean function. In the second stage, a modified version of Arima's algorithm, along with an oracle that represent the second Boolean function, is employed to handle the set operations. The proposed algorithms have a higher probability of success in more general and comprehensive applications when compared with relevant techniques in literature.

Ventilation perfusion functional difference images in lung SPECT: A linear and symmetrical scale as an alternative to the ventilation perfusion ratio

PURPOSE

Ventilation Perfusion SPECT is important in the diagnostics of e.g. pulmonary embolism and chronic obstructive pulmonary disease. Classical and reverse mismatched defects can be identified by utilizing the ventilation-perfusion ratio. Unfortunately, this ratio is only linear in the ventilation, the scale is not symmetrical regarding classical and reversed mismatches and small perfusion values give rise to artifacts. The ventilation-perfusion (VQ) difference is developed as an alternative.

METHODS

For both VQ-ratio and VQ-difference a scaling factor for the perfusion is computed, so that voxels with matched ventilation and perfusion (on average) yield zero signal. The relative VQ-difference is calculated by scaling with the summed VQ-signal in each voxel. The scaled VQ-difference is calculated by scaling with the global maximum of this sum.

RESULTS

The relative and scaled differences have a scale from -1 (perfusion only) to + 1 (ventilation only). Image quality of relative VQ-difference and VQ-ratio images is hampered by artifacts from areas with both low perfusion and low ventilation. Ratio and differences have been investigated in ten patients and are shown for three patients (one without defects). Clinical thresholds for the difference images are derived resulting in color maps of relevant (reversed) mismatches with a (reciprocal) ratio larger than two.

CONCLUSIONS

The relative ventilation-perfusion difference is a methodological improvement on the ventilation-perfusion ratio, because it has a symmetrical scale and is bound on a closed domain. A better diagnostic value is expected by utilizing the scaled difference, which represents functional difference instead of relative difference.

Immigration and access to dementia diagnostics and treatment: A nationwide study in Sweden

•Compared to Swedish-born people, foreign-born people were less likely to receive dementia diagnostic tests.•Being born in Africa or Europe was associated with lower chance of receiving cholinesterase inhibitors.•Asian-born people had higher chance of receiving cholinesterase inhibitors, but were less likely to receive memantine.•Disparities existed in dementia diagnostics and treatment between Swedish-born and foreign-born people, but were not consistent after adjusting for MMSE scores.

The Presence of Women in the Dental Profession: A Global Survey

OBJECTIVES

The aim of this research was to acquire knowledge about the female dental workforce, identifying factors to pursue specialty training and career choices and working in dental institutions/associations.

METHODS

An original online questionnaire was developed, validated (n = 22), and sent to 189 member associations in 133 countries of the Women Dentists Worldwide section of the FDI World Dental Federation.

RESULTS

In all, 3232 female dentists from 81 countries participated. Results were divided into 5 geographic areas by continent. Difference in proportion amongst questionnaire items was evaluated with χ2 test or Fisher exact test. Ordinal multinomial linear regression analysis was performed to evaluate the association of questionnaire items with total work experience in dentistry (in years), motivation to study dentistry, type of specialisation, working hours per week, perception of female dentists about working hours, sex-based inequalities, job security after maternity leaves, as well as involvement in political organisations within their country of residence and their role in dental associations. A majority of participating female dentists are self-employed (57.7%), and 60.0% have 10 to 30 years of experience. The most popular form of practice is the single private practice (29.7%), followed by the group private practice (28.8%). Further, 44.8% work 31 to 40 h/wk, 29.1% part-time up to 30 h/wk, and 26.0% more than 40 h/wk.

CONCLUSIONS

Women are still poorly represented in professional organisations, and few are officers in representative assemblies, members of the board, or president. Family life with children influences perceptions and has an impact on professional life, especially in academia and political/professional associations, so that taking on leadership positions poses additional challenges.

Sex bias in immune response: it is time to include the sex variable in studies of autoimmune rheumatic diseases

Healthy females and males differ in their immune cell composition and function and females generally mount stronger immune response than males and are much more susceptible to autoimmune rheumatic diseases. Females differ from males in sex hormones, and X-chromosome genes. Sex hormones affect immune cells and responses, and may induce epigenetic DNA changes. The importance of X-chromosome genes is exemplified in men with the Klinefelter syndrome (47,XXY) who have an additional X-chromosome and develop systemic lupus erythematosus(SLE) as frequently as women. X-chromosome contains genes critical for the immune response, such as FOXP3, toll-like receptor(TLR)7, TLR8, CD40 Ligand, IL2RG, IL9R, BTK, and others. Whereas one X-chromosome in females is randomly inactivated early in embryonic development, around 25% of X-linked genes escape inactivation and result in more X-linked gene dosage in females. We use two key female-biased autoimmune rheumatic diseases, SLE and systemic sclerosis, to review differences in immune response, and clinical manifestations between females and males. The inclusion of sex variable in research will facilitate precision medicine and optimal patient outcome.

Minimal important change and difference in health outcome: An overview of approaches, concepts, and methods

OBJECTIVE

To provide an overview of approaches, concepts, and methods used to define and assess minimal important change and difference in health outcome.

METHOD

A narrative review of the literature, guided by a conceptual framework.

RESULTS

We distinguish between (i) interpretation of health outcome in individuals versus groups, (ii) change within individuals or groups versus difference between change within individuals or groups; and (iii) the responder approach (based on the proportion of patients that obtain a defined response) versus the group average approach (based on the average amount of change in a group). We review approaches, concepts, and methods.

CONCLUSION

By bringing together and juxtaposing various approaches, concepts, and methods, we set a precursory step in the direction of consensus building in the field concerned with defining and assessing minimal important change and difference in health outcome. We emphasize the need for conceptual clarification and terminological standardization. We argue that assessing minimal importance of change and difference in health outcome is essentially a value judgment involving a range of considerations and perspectives.

Effects of posture on heart rate variability in non-frail and prefrail individuals: a cross-sectional study

BACKGROUND

Frailty is an aging-related syndrome leading to high mortality in older adults. Without effective assessment and prevention of frailty, the incidence of frailty and relevant adverse outcomes will increase by 2050 as worldwide populations age. Although evidence suggested heart rate variability (HRV) is a potential measure of frailty, the role of HRV in frailty assessment remains unclear because of controversial findings. This study examined the effects of posture on HRV parameters in non-frail and prefrail individuals to understand the role of HRV in assessing frailty.

METHODS

Forty-six participants aged ≥ 50 years were recruited between April and August 2022. Frailty was defined using Fried's criteria. HRV was measured in standing, sitting, and lying postures, respectively, using a Polar Watch, and analyzed using Kubios HRV Standard 3.5.0 (Kubios). The five most commonly used parameters were examined, including standard deviations of all normal-to-normal intervals (SDNN), root mean square of the successive differences (RMSSD), low frequency (LF), high frequency (HF), and LF/HF. Independent t-tests and Mann-Whitney tests were used for inter-group comparisons. Friedman tests were used for intra-group comparisons across postures.

RESULTS

The non-frail group showed significant differences in HRV parameters across postures (all p < 0.05), whereas the prefrail group did not demonstrate any difference (all p > 0.05). The differences in the non-frail group included higher RMSSD and HF in the lying posture compared to those in the standing posture (29.54 vs 21.99 p = 0.003, 210.34 vs 96.34 p = 0.001, respectively), and higher LF and LF/HF in the sitting posture compared to those in the lying posture (248.40 vs 136.29 P = 0.024, 1.26 vs 0.77 p = 0.011, respectively).

CONCLUSIONS

The effects of posture on HRV were blunted in the prefrail group, which suggests an impaired cardiac autonomic functioning. Measuring the effects of posture on HRV parameters may contribute to frailty assessment. However, further evidence from larger cohorts and including additional HRV parameters is needed.

Facial Nerve in Parotid Surgery- do Landmarks Differ With Varying Statures?

Aim: To measure the distance of facial nerve from tragal pointer, tympanic plate and digastric muscle, also length of the facial nerve trunk and to establish any variation according to different patient stature. Methodology: Intraoperative measurements were taken using Castroviejo Callipers (20 mm). Height and weight of each was taken and tabulated. Results: The average height was 162 ± 9 cm while the average weight was 58 ± 9 kg. The average length of the extratemporal part of the facial nerve trunk, distance of the facial nerve from the tragal pointer, distance from the outer edge of tympanic plate, distance from the posterior end of the superior border of posterior belly of digastric muscle was 1 ± 0.2 cm, 1 ± 0.1 cm, 0.3 ± 0.2 cm and 0.2 ± 0.1 cm, respectively. Summary: No major difference was found in the landmarks despite varying stature.

Discrepancy in parental fear of childbirth: A scoping review

BACKGROUND

Fear of childbirth is a prevalent clinical psychological issue for both mother and father; however, there is a lack of research comparing and summarizing discrepancies in parental fear of childbirth.

AIM

This study aimed to explore differences in parental fear of childbirth, identify gaps in related research area, and provide directions for future studies.

METHODS

Original references were searched from six databases by using subject terms associated with fear of childbirth. The guideline of the scoping review framework proposed by Arksey and O' Malley were applied.

RESULTS

The review covered 203 publications in all. Of them, 181 were maternal studies and 22 were paternal studies. 105 articles examined prevalence and influencing factors ranging from 0.7 % to 89.3 % in mothers and 5 % to 54.3 % in fathers. The current study included 84 influencing factors, 9 of which were common to parents and 75 of which were different, containing fathers' specific influences on fear of childbirth are perceived pregnancy difficulties, perceived birth difficulties, feelings about the upcoming birth, more frequent thoughts of birth in the middle of pregnancy and not attending parent education classes. 12 articles dealt with the experience of fear of childbirth, and the parents' fear of childbirth had 5 common themes, including fear of the birthing process, fear related to the baby, fear of lack of support, fear of postnatal health and life, and adverse psychological problems. But they have different sub-themes. 61 articles on fear of childbirth interventions, including 8 mother-specific approaches and 4 identical approaches for parents, and all of these methods were effective in reducing the prevalence of parental fear of childbirth.

CONCLUSION

Factors such as marital status, personality, etc., that are specific to mothers can also be applied to paternal fear of childbirth. Cognitive-behavioral therapy and group discussion, which are unique to maternal fear of childbirth, may be attempted for paternal fear of childbirth. In addition, future research should be devoted to developing a specific measurement tool for fathers, studying paternal fear of childbirth in depth from various aspects.

Allergen Differences and Correlation Analysis in Siblings Diagnosed with Respiratory Allergic Diseases

INTRODUCTION

Many parents of children with allergies are worried whether their subsequent children will have allergic reactions to the same allergens. Much of the current research on sibling allergens has been focused on twins; however, in real life, very few children are twins. Our study provides an opportunity to initially explore the sensitivity to allergens in siblings diagnosed with respiratory allergic diseases.

METHODS

Siblings diagnosed with bronchial asthma and/or allergic rhinitis in the Outpatient Department of Allergy Department of Yantai Yuhuangding Hospital from January 2018 to December 2021 were selected. The siblings were divided into elder group and younger group. Data of gender, age, feeding history, serum total IgE (TIgE), absolute eosinophil counts, and allergen-specific IgE (sIgE) were collected and analyzed. The sIgEs of allergens were divided into six categories and analyzed.

RESULTS

A total of 98 sibling pairs of patients were included in this study. There were no differences in the positive rates of the different types of allergens, TIgE values, and the absolute eosinophil values between the elder and younger groups and between different genders. Logistic regression analysis indicated that the elder siblings allergic to dust mites, fungi, weed pollens, or food had a statistically significant increased risk of having their younger sibling sensitive to these types of allergens (all p <0.05), and the risk of allergy to dust mites, weed pollens, and tree pollens of younger group increased with age (all p <0.05). Except for the sIgE values of dust mites, the sIgE values of the other allergens were significantly correlated between the two groups (all p <0.05).

CONCLUSION

The positive rates of different allergens were similar between siblings. Elder siblings with dust mites, fungi, weed pollen, or food allergen positivity will have younger siblings sensitive to the same types of allergens.

Social inclusion revisited: sheltered living institutions for people with intellectual disabilities as communities of difference

The dominant idea in debates on social inclusion of people with intellectual disabilities is that social inclusion requires recognition of their 'sameness'. As a result, most care providers try to enable people with intellectual disabilities to live and participate in 'normal' society, 'in the community'. In this paper, we draw on (Pols, Medicine Health Care and Philosophy 18:81-90, 2015) empirical ethics of care approach to give an in-depth picture of places that have a radically different take on what social inclusion for people with intellectual disabilities looks like: places known as 'sheltered living institutions'. We argue these places can be seen as 'communities of difference' catered to the specific needs and capacities of the residents. We then contend that these communities raise questions about what a good life for people with intellectual disabilities looks like and where and how it ought to be realised; questions not posed very often, as they get muzzled by the dominant rhetoric of normalisation and the emphasis on sameness.

Development and differences in mathematical problem-solving skills: A cross-sectional study of differences in demographic backgrounds

Problem-solving skills are the most applicable cognitive tool in mathematics, and improving the problem-solving skills of students is a primary aim of education. However, teachers need to know the best period of development and the differences among students to determine the best teaching and learning methods. This study aims to investigate the development and differences in mathematical problem-solving skills of students based on their grades, gender, and school locations. A scenario-based mathematical essay test was administered to 1067 students in grades 7-9 from schools in east Java, Indonesia, and their scores were converted into a logit scale for statistical analysis. The results of a one-way analysis of variance and an independent sample t-test showed that the students had an average level of mathematical problem-solving skills. The number of students who failed increased with the problem-solving phase. The students showed development of problem-solving skills from grade 7 to grade 8 but not in grade 9. A similar pattern of development was observed in the subsample of urban students, both male and female. The demographic background had a significant effect, as students from urban schools outperformed students from rural schools, and female students outperformed male students. The development of problem-solving skills in each phase as well as the effects of the demographic background of the participants were thoroughly examined. Further studies are needed with participants of more varied backgrounds.

Gastroparesis in geriatrics population: A United States population study

BACKGROUND

Older patients with upper gastrointestinal diseases may lack disease-specific symptoms that are required to make the correct diagnosis. This study aimed to compare the gastroparesis demographics, clinical presentation, and surgical management between the older adult and young populations.

METHODS

The National Inpatient Sample database was used between the years 2012 and 2014 with the primary diagnosis of gastroparesis. Patients were further divided based on their age into two groups: 70 years or older and younger than 70 years.

RESULTS

The older adults were more likely to have early satiety and bloating compared to younger population with an odds ratio (OR) = 3.79; 95% Confidence Interval (95%CI) 2.80- 5.11, p < 0.0001 and OR = 2.80, 95%CI 2.07-3.78, p<0.0001 respectively. Older adults had low odds of having nausea with vomiting (OR = 0.86, 95%CI 0.76-0.95, p = 0.003), or abdominal pain (OR = 0.56, 95%CI 0.50-0.63, p<0.0001).

CONCLUSIONS

Older adults had more early satiety and bloating, whereas younger patients had more nausea with vomiting and abdominal pain.

Patella resurfacing is not associated with a difference in the Oxford knee score after total knee arthroplasty but stair descent is enhanced

BACKGROUND

The primary aim was to assess the Oxford knee scores (OKS) on patients who underwent a total knee arthroplasty (TKA) with patellar resurfacing compared to those who did not. Secondary aims were to identify: (1) factors associated with resurfacing, (2) the effect of resurfacing on specific components of the OKS related to patellofemoral function, (3) the influence on patient satisfaction, and (4) whether a subgroup of patients had an improved outcome when resurfacing was undertaken.

METHODS

A retrospective cohort study was undertaken using outcome data from the arthroplasty database held at the study centre. Patient demographics and OKS were collected preoperatively and at 1 and 2 years postoperatively. Patient satisfaction was assessed at 1 and 2 years postoperatively.

RESULTS

Three thousand one hundred and twenty-two patients met the inclusion criteria of which 46.5% (n = 1453) underwent resurfacing. There were no differences in the OKS change at 1 or 2 years between those undergoing and not undergoing resurfacing (difference 0.2, p ≥ 0.469). Patients undergoing resurfacing were more likely to be female (odds ratio (OR) 1.53, 95% CI 1.30-1.79, p < 0.001), undergo a posterior stabilised knee (OR 6.87, 95% CI 5.71-8.27, p < 0.001) or had a worse response to question 5-standing from a chair, (p = 0.011) or 12-stair descent, (p = 0.017) of the OKS preoperatively. There was no difference in postoperative patient satisfaction (p ≥ 0.180). There was a significantly greater improvement in question 12 of the OKS at 1 year (p = 0.019) in the resurfaced group. There were no patient-related factors or symptoms that were associated with a clinically significant (≥ 5 points) greater postoperative OKS.

CONCLUSION

Patella resurfacing was not associated with a clinically important improvement in OKS. No specific indications for patella resurfacing were identified that offered an improved outcome, but when it was undertaken there was a greater improvement in the ability to descend stairs. Level of evidence Retrospective diagnostic study, Level III.

Sex Differences in Pain and Its Treatment

Pain is a highly personal experience. Pain is often considered to be a purely neurologic phenomenon, but in actuality, it is a combination of both sensory and emotional experiences. This has sometimes been translated clinically toward a more mechanistic approach to the assessment and treatment of pain instead of one that does not discount pain mechanisms, but also is more inclusive of the need for humanism - considering the individual. In today's medical environment, more than ever before there is a significant amount of attention being paid to educating clinicians to better understand that several physiological, neurophysiological, and psychosocial factors can significantly impact responses to pain. The composition of these factors will be unique to that individual's life narrative, context, sex, and prior life experiences. Thus, the concept that a templated approach to pain assessment and pharmacotherapeutic treatment planning should not be expected to provide optimal patient satisfaction and treatment outcomes in the majority. The hypotheses that there may be sex-based differences in the pain experience in a variety of ways including pain sensitivity, tolerance to pain, threshold at which something becomes painful, and the effectiveness of endogenous pain modulation systems are not new and have been well represented in the literature. This chapter reviews important key findings in the scientific literature with respect to sex-based differences in pain and pain responses to experimentally induced painful stimuli, pain experienced in commonly occurring painful medical conditions, and variations in responses to pain treatments. Possible explanations to account for observed differences or similarities will also be discussed.

A feminist opening of resilience: Elizabeth Grosz, Liberian Peace Huts and IR critiques

While the United Nations (UN) and other international organisations have celebrated the 20th anniversary of the Women, Peace and Security agenda, critical scholars claim that the agenda has rarely been able to foster resilience. They show how programmes have only slowly and partially achieved gender balancing and parity in war-affected countries. The limitation we identify in the debate between policy and critique is that resilience has often been reduced to an egalitarian project-where mechanical policies and schemes are deployed to ameliorate the conditions of women, enhance their participation in decision-making and pursue the equality between women and men-to advance in sustaining peace. In this article we complement the existing critiques by engaging with the feminist writings of Elizabeth Grosz, as well as with indigenous feminist practices in Liberia. We nurture a feminism that affirms the agency and inventiveness of women to begin to reimagine resilience as difference: a resilience that thrives outside governance structures and the confines of neoliberal policymaking.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1057/s41268-022-00264-0.

An effective method for preventing cholestatic liver injury of Aucklandiae Radix and Vladimiriae Radix: Inflammation suppression and regulate the expression of bile acid receptors

ETHNOPHARMACOLOGICAL RELEVANCE

Aucklandiae Radix (AR) and Vladimiriae Radix (VR) were used to treat gastrointestinal, liver and gallbladder diseases at practice. In most conditions, VR was used to be a substitute of AR or a local habit may attribute to the same main active ingredients Costunolide and Dehydrocostus lactone, which presented many similar pharmacological activities. However, other different lactone compounds in AR and VR also play a role in disease treatment, so the difference in therapeutic effects of AR and VR in related diseases needs to be further studied.

AIMS OF THE STUDY

Revealing the differences between the chemical compounds of the total lactone extracts of AR and VR (TLE of AR and VR) and the differences in the protective effects of cholestatic liver injury to ensure rational use of AR and VR.

STUDY DESIGN AND METHODS

The macroporous adsorption resin was used to purify and enrich the lactone compounds to obtain the total lactone extracts of AR and VR. HPLC-PDA was used to obtain the data to establish chemical fingerprint and chemometric analysis to compare similarities and differences between TLE of AR and VR. The pharmacodynamic experiment revealed how TLE of AR and VR to show protect effects on cholestatic liver injury.

RESULTS

Similarity analysis results showed TLE of AR and VR had a high similarity (>0.9). Nevertheless, difference analysis results showed 4 compounds, Costunolide, Dehydrocostus lactone, 3β-acetoxy-11β-guaia-4 (15), 10 (14)-diene-12,6α-olide and vladinol F may contribute to the differences between them. The pharmacodynamics experiments results showed the TLE of AR and VR affected the different liver cholate-associated transporters mRNA expression (TLE of AR up-regulated CYP7A1, TLE of VR down-regulated FXR and BSEP), the TLE of AR and VR had an effect to regulate biochemical indicators (AST, ALT, ALP, TBA) of liver function, and TLE of VR was better than TLE of AR in reducing the expression of inflammatory factors (IL-6 and IL-1β).

CONCLUSION

The liver protection of AR and VR have been confirmed, but the differences of material basis and mechanism of drug efficacy needed further study to guarantee formulation research and provide theoretical references for clinical rational applications of AR and VR.

Gender and Racial Disparities among US Psychiatry Residents: A Review of Trends

Diversity provides better patient outcomes, reduces physician burnout, and therefore lessens the burden of the healthcare system. In this study, we explore the gender and racial trends in the recruitment of medical graduates into US psychiatry residency programs. Retrospective data analysis was performed utilizing the data from the Accreditation Council for Graduate Medical Education (ACGME) Data's annual Resource Books from the year 2007 to 2018. Demographic data, including gender and race, were extracted for psychiatry residents. Gender was categorized as Male, Female, and Not Reported. Race/ethnicity was categorized as White (Non-Hispanic), Asian/Pacific Islander, Hispanic, Black/African-American (Non-Hispanic), Native American/Alaskan, Others (not in the aforementioned categories), and Unknown. Female psychiatry residents relatively decreased by 2.6% whereas male psychiatry residents relatively increased by 15.5% from 2007 to 2018. Between the years 2011 and 2018, there was a relative increase in African American/Black and Native American/Alaskan psychiatry residents by 5.5% and 1%, respectively, whereas the Asian/Pacific Islanders, White (Non-Hispanic), and Hispanic/Latino psychiatry residents relatively decreased by 5.1%, 2.3%, and 1.7%, respectively. Despite the overall increase of women and ethnic minorities in US medical schools, women and racial minorities remain significantly under-represented in psychiatry residency programs in the US.

Microplastic pollution in the Yangtze River Basin: Heterogeneity of abundances and characteristics in different environments

Microplastic pollution in the Yangtze River Basin has become a major concern; however, the variations in different environmental compartments are unknown. Here, we compiled published information including detection methods, occurrence, and characterization of microplastics from 624 sampling sites in river water, river sediment, lake and reservoir water, and lake and reservoir sediment in the Yangtze River Basin. The spatial distribution of sampling sites shows fractal pattern and was uniformly concentrated around the main stream of the Yangtze River and the lake geographical zone. Collection, pretreatment, identification, and quantification processes varied among different studies. Non-parametric tests were performed to compare the different microplastic indices. A Pearson correlation analysis was used to study the relationship between microplastic pollution and local socioeconomic conditions. We found that the microplastic size and abundance distribution in river water and lake and reservoir water showed different patterns for different sampling methods, indicating that different methods influenced the results. Population density and urbanization rate are suggested to be important factors influencing the spatial heterogeneity of microplastic abundances in water, rather than in sediment. The microplastic abundances in lake and reservoir water were higher than that in river water in bulk samples. However, microplastic abundances among different sediment environments shows no significant difference. For bulk water samples and sediment samples overall, the proportion of small microplastics (<1 mm, i.e. SMP), fibers, transparent debris, and polypropylene (PP) were 65.1%, 67.8%, 31.8%, and 29.7%, respectively. The microplastic characteristics of lake and reservoir water and sediment were similar, differing from those of river water and sediment. This study provides the first basin scale insight into microplastic occurrence and characteristics in different environments in the Yangtze River Basin.

The difference between cystatin C- and creatinine-based eGFR is associated with adverse cardiovascular outcome in patients with chronic kidney disease

BACKGROUND AND AIMS

Decreased kidney function is an important risk factor for cardiovascular disease (CVD). However, assessing risk of CVD may be difficult when there is a gap between creatinine- and cystatin C-based estimated glomerular filtration rate (eGFR). We studied the association of the difference in eGFRs with major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD).

METHODS

This prospective cohort study was conducted in 2076 patients with CKD stages based on the KDIGO guideline (eGFR categories of G1: ≥90; G 2: 60-89; G3: 30-59; G4: 15-29; G5: <15 mL/min/1.73 m² without kidney replacement therapy). The difference in eGFR (eGFR_diff) was calculated by subtracting the cystatin C-based eGFR (eGFR_cys) from the creatinine-based eGFR (eGFR_creat). The primary outcome was MACE, defined as non-fatal acute myocardial infarction and unstable angina, stroke, congestive heart failure, symptomatic arrhythmia, and cardiac death.

RESULTS

During a median follow-up of 4.1 years, MACE occurred in 147 patients (incidence rate, 15.0 per 1000 patient-years). When patients were categorized into baseline eGFR_diff tertiles, the highest tertile was associated with a significantly higher risk of MACE (hazard ratio, 2.12; 95% confidence interval [CI], 1.28-3.51) than the lowest tertile when adjusted for eGFR_creat, eGFR_cys, or eGFR based on both creatinine and cystatin C. Patients in the highest tertile had more baseline coronary artery calcification (CAC) than those in the lowest tertile (odds ratio [OR], 1.38; 95% CI, 1.03-1.86). In addition, 978 patients had data for both baseline and follow-up CAC at year 4. In this subgroup, baseline eGFR_diff was significantly associated with accelerated CAC progression (≥50/year) (OR, 1.03; 95% CI, 1.01-1.05).

CONCLUSIONS

A large positive difference between eGFR_creat and eGFR_cys was associated with a higher risk of MACE and faster CAC progression in patients with CKD. Therefore, careful monitoring of CVD is needed for patients with a higher eGFR_diff.

Major Depressive Disorder and Difference between Genders

Background

Depression is a common mental disorder and represents a global mental health concern. Presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy and poor concentration. Epidemiologic research have found clear genders differences in the prevalence of Major depressive disorders (MDD).

Objective

The aim of this study was to find the difference in the symptoms of Major depressive disorder (MDD) between genders.

Methods

It was analyzed 92 subjects from Health Center Zivinice in the period from September 2019 to May 2021, of which 57 (62 %) are women and 35 (38%) are men. The study identified and measured the severity of 25 different symptoms of depressive disorders in the analyzed subjects. The average age of women is 56 years ± 8.88, and the average age of men is 52 years ± 11.03. Statistical data were analyzed in SPSS statistical program.

Results

Comparing the results t tests revealed significant difference between genders in symptoms like depressed mood, lack of energy, psychomotor retardation, pessimistic attitude towards the future. Symptoms such as angry outbursts, irritability from frustration, even over small matters, frequent or recurrent thoughts of death, suicidal thoughts suicide attempts and impulsive reaction, risky behaviour statistical significance in men in relation to women.

Conclusion

In this study it was confirmed that MDD is more often diagnosed in women and showing different ways of experiencing, expressing and dealing with the symptoms of MDD. Women complained more about the typical symptoms of depressive disorder according, while men complained more about anger, irritability, waking up early in the morning and alcohol abuse.

Male Sex Is a Significant Predictor of All-cause Mortality in Patients with Antineutrophil Cytoplasmic Antibody-associated Vasculitis

BACKGROUND

We investigated and compared the initial clinical features at diagnosis and the poor outcomes during follow-up in Korean patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) based on sex.

METHODS

The medical records of 223 immunosuppressive drug-naïve patients with AAV were reviewed. Age, body mass index (BMI), smoking history, AAV subtypes, ANCA positivity, clinical manifestations, Birmingham vasculitis activity score (BVAS), five-factor score (FFS), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) at diagnosis were collected. All-cause mortality, end-stage renal disease (ESRD), cerebrovascular accident (CVA) and cardiovascular disease (CVD) were assessed as the poor outcomes of AAV during follow-up.

RESULTS

The median age was 59.0 years and 74 of 223 AAV patients (33.2%) were men. Among variables at diagnosis, male patients exhibited higher BMI than female. However, there were no differences in other demographic data, AAV subtypes, ANCA positivity, BVAS, FFS, ESR and CRP between the two groups. Male patients received cyclophosphamide more frequently, but there were no significant differences in the frequencies of the poor outcomes of AAV between the two groups. Male patients exhibited a significantly lower cumulative patients' survival rate than female patients during the follow-up period based on all-cause mortality (P = 0.037). In the multivariable analysis, both male sex (hazard ratio [HR], 2.378) and FFS (HR, 1.693) at diagnosis were significantly and independently associated with all-cause mortality during follow-up.

CONCLUSION

Male sex is a significant and independent predictor of all-cause mortality in AAV patients.

Distinction between vaginal and cervical microbiota in high-risk human papilloma virus-infected women in China

BACKGROUND

High-risk human papilloma virus (hrHPV) is the main causal factor of cervical precancer and cancer when persistent infection is left untreated. Previous studies have confirmed the vaginal microbiota is associated with HPV infection and the development of cervical lesions. The microbiota at different parts of the female genital tract is closely related but different from each other. To analyze the distinction between the vaginal and cervical microbiota of hrHPV(+) women in China, one hundred subjects were recruited, including 10 patients with HPV16/18(+) and cervical carcinoma, 38 patients with HPV16/18(+) but no cervical carcinoma, 32 patients with other hrHPV(+) and 20 healthy controls with HPV(-). Vaginal and cervical microbiota were separately tested through next-generation sequencing (NGS) targeting the variable region (V3-V4) of the bacterial ribosome 16S rRNA gene.

RESULTS

HrHPV(+) subjects had higher percentages of vaginal douching history (P = 0.001), showed more frequent usage of sanitary pads (P = 0.007), had more sex partners (P = 0.047), were more sexually active (P = 0.025) and more diversed in ways of contraception (P = 0.001). The alpha diversity of the cervical microbiota was higher than that of the vagina. The cervical microbiota consisted of a lower percentage of Firmicutes and a higher percentage of Proteobacteria than the vagina at the phylum level. Sphingomonas, belonging to α-Proteobacteria, was almost below the detection limit in the vagina but accounted for five to 10 % of the bacteria in the hrHPV(-) cervix (P<0.001) and was inversely associated with hrHPV infection (P<0.05). Pseudomonas, belonging to γ-Proteobacteria, could hardly be seen in the normal vagina and shared a small percentage in the normal cervix but was significantly higher in the HPV16/18(+) (P<0.001) and cancerous cervix (P<0.05). No significant difference was shown in the percentage of BV associated anaerobes, like Gardnerella, Prevotella, Atopobium and Sneathia, between the cevix and vigina.

CONCLUSIONS

The proportion of Proteobacteria was significantly higher in the cervical microbiota than that of vagina. The hrHPV infection and cervical cancer was positively associated with Pseudomonas and negatively associated with Sphingomonas. It is of great improtance to deeply explore the cervical microbiota and its function in cervical cacinogenesis.

Feminist Ethics and Women Leaders: From Difference to Intercorporeality

This paper problematises the ways women's leadership has been understood in relation to male leadership rather than on its own terms. Focusing specifically on ethical leadership, we challenge and politicise the symbolic status of women in leadership by considering the practice of New Zealand Prime Minister Jacinda Ardern. In so doing, we demonstrate how leadership ethics based on feminised ideals such as care and empathy are problematic in their typecasting of women as being simply the other to men. We apply different strategies of mimesis for developing feminist leadership ethics that does not derive from the masculine. This offers a radical vision for leadership that liberates the feminine and women's subjectivities from the masculine order. It also offers a practical project for changing women's working lives through relationality, intercorporeality, collective agency and ethical openness with the desire for fundamental political transformation in the ways in which women can lead.

[Influencing Factors on Lactulose Breath Test Results]

Background/Aims

This study aimed to identify the demographic and clinical factors associated with positive breath-test results and to assess the relationship between hydrogen and methane production in patients with suspected irritable bowel syndrome (IBS).

Methods

The demographic and clinical factors of 268 patients with suspected IBS, who had undergone a lactulose breath test, were analyzed.

Results

Of 268 patients included in this study, 143 (53.4%) were females. The median age and BMI of the patients was 58.0 years (range, 18.0-80.0 years) and 22.5 kg/m² (range, 14.4-34.3 kg/m²), respectively. A weak positive correlation was observed between the BMI and baseline hydrogen level (rho=0.134, p=0.031). Women were significantly more likely to show a ≥20 ppm increase in hydrogen within 90 min (early hydrogen increase, p=0.049), a ≥10 ppm increase in methane within 90 min (early methane increase, p=0.001), and a ≥10 ppm increase in methane between 90 min and 180 min (late methane increase, p=0.002) compared to men. The baseline hydrogen level was related to the baseline methane level (rho=0.592, p<0.001) and the maximal hydrogen level within 90 min was related to maximal methane level within 90 min (rho=0.721, p<0.001). Patients with an early hydrogen increase (43.8%) were more likely to show a positive result for an early methane increase compared to patients without an early increase in hydrogen (0%, p<0.001).

Conclusions

Women were associated with high rates of positive lactulose breath-test results. In addition, methane production was correlated with hydrogen production.

Differences in midgut transcriptomes between resistant and susceptible strains of Chilo suppressalis to Cry1C toxin

Background

Chilo suppressalis is a widespread rice pest that poses a major threat to food security in China. This pest can develop resistance to Cry toxins from Bacillus thuringiensis (Bt), threatening the sustainable use of insect-resistant transgenic Bt rice. However, the molecular basis for the resistance mechanisms of C. suppressalis to Cry1C toxin remains unknown. This study aimed to identify genes associated with the mechanism of Cry1C resistance in C. suppressalis by comparing the midgut transcriptomic responses of resistant and susceptible C. suppressalis strains to Cry1C toxin and to provide information for insect resistance management.

Results

A C. suppressalis midgut transcriptome of 139,206 unigenes was de novo assembled from 373 million Illumina HiSeq and Roche 454 clean reads. Comparative analysis identified 5328 significantly differentially expressed unigenes (DEGs) between C. suppressalis Cry1C-resistant and -susceptible strains. DEGs encoding Bt Cry toxin receptors, aminopeptidase-P like protein, the ABC subfamily and alkaline phosphatase were downregulated, suggesting an association with C. suppressalis Cry1C resistance. Additionally, Cry1C resistance in C. suppressalis may be related to changes in the transcription levels of enzymes involved in hydrolysis, digestive, catalytic and detoxification processes.

Conclusion

Our study identified genes potentially involved in Cry1C resistance in C. suppressalis by comparative transcriptome analysis. The assembled and annotated transcriptome data provide valuable genomic resources for further study of the molecular mechanisms of C. suppressalis resistance to Cry toxins.

One-year Oxford knee scores should be used in preference to 6-month scores when assessing the outcome of total knee arthroplasty

Purpose

The primary aim of this study was to assess whether there was a clinically significant difference in the mean Oxford knee score (OKS) between 6 and 12 months after total knee arthroplasty (TKA). The secondary aim was to identify variables associated with a clinically significant change in the OKS between 6 and 12 months.

Methods

A retrospective cohort study was undertaken using an established arthroplasty database of 1574 primary TKA procedures. Patient demographics, body mass index (BMI), comorbidities, OKS and EuroQoL 5-domain (EQ-5D) score were collected preoperatively and at 6 and 12 months postoperatively. A clinically significant change in the OKS was defined as 5 points or more.

Results

There was a 1.1-point increase in the OKS between 6 and 12 months postoperatively, which was statistically significant (95% confidence (CI) 0.8–1.3, p < 0.0001). There were 381 (24.2%) patients who had a clinically significant improvement in their OKS from 6 to 12 months. After adjusting for confounding, patients with a lower BMI (p = 0.028), without diabetes mellitus (p < 0.001), a better preoperative OKS (p < 0.001) or a worse 6-month OKS (p < 0.001) were more likely to have a clinically significant improvement. A 6-month OKS < 36 points was a reliable predictor of a clinically significant improvement in the 6-month to 12-month OKS (area under the curve 0.73, 95% CI 0.70–0.75, p < 0.001).

Conclusion

Overall, there was no clinically significant change in the OKS from 6 to 12 months; however, a clinically significant improvement was observed in approximately a quarter of patients and was more likely in those scoring less than 36 points at 6 months. Level of evidence: retrospective diagnostic study, level III.

There is no clinically important difference in the Oxford knee scores between one and two years after total knee arthroplasty: The one-year score could be used as the benchmark timepoint to assess outcome

BACKGROUND

The aim was to assess the whether there was a clinically important change in the Oxford knee score (OKS) between one and two years after total knee arthroplasty (TKA), and to identify predictors associated with a clinically important change.

METHODS

A retrospective cohort study was undertaken using an established arthroplasty database of 5857 primary TKA. Patient demographics, body mass index, social deprivation, OKS and EuroQoL five-domain (EQ-5D) score were collected preoperatively and at one and two years postoperatively. A clinically important change in the OKS was defined as ≥5 points.

RESULTS

There was a 0.2 point increase in the OKS between one and two years, which was statistically significant (95% confidence interval (CI) 0.1 to 0.4, p < .0001), but not clinically important. A better preoperative OKS (p < .001) and in contrast a worse one year OKS (p < .001) were independently associated with a greater improvement from one to two years. There were 1006 (17.3%) patients that had a clinically important improvement in the OKS between one and two years. Receiver operating characteristic curve analysis showed that a one year OKS of less than 35 was a reliable predictor of a clinically important improvement between one and two years (area under the curve 0.77, 95% CI 0.76 to 0.78, p < .001).

CONCLUSION

There was not a clinically important change in the OKS from one to two years after TKA when assessed as a group. However, individual patients with a one year OKS of less than 35 may demonstrate a clinically important improvement at two years.

LEVEL OF EVIDENCE

Retrospective diagnostic study, Level III.

Split difference method to determine the polynomial function that models the first few given terms of a sequence

When looking at a sequence of numbers, one that can be defined by a polynomial function of a natural number degree, one most commonly would use a difference table to find the degree followed by a system of equations to find the equation that models the sequence. This method can prove to be very time consuming as solving a system of equations can become tedious at higher degrees. Alternately, some people would use a method where they use the difference table to find the leading coefficient in addition to the degree to give the first term. Then they would subtract this term from the function and repeat this process. However, this can be unnecessarily complicated as this method requires one to create a difference table numerous times only to need the last difference. This method uses a simple pattern triangle and only the first difference table of the sequence. It is already necessary to create the first difference table and this pattern triangle can be used to improve upon the second method. The pattern triangle allows us to walk through the difference table of the lower degree polynomials quite easily, removing the need for multiple difference table. This method differs from existing methods in that:•

It is much faster

•

It uses a unique pattern triangle.

The Fear of Cancer from the Standpoint of Oneself, the Opposite Sex and the Fear of Side Effects of Cancer Treatment

Purpose

It is important to understand the differences between men and women when it comes to attitudes and risk perception toward disease. This study aimed to explore the fear of cancer from the standpoint of themselves and the opposite sex by cancer type.

Materials and Methods

A cross-sectional survey with a representative sample was conducted.

Results

The least and the most feared cancers in men were thyroid cancer and lung cancer, respectively. When men assumed the perspective of women, the least and the most feared cancer were thyroid cancer and stomach cancer, respectively. The least and the most feared cancers in women were thyroid cancer and stomach cancer, respectively. When women assumed the perspective of men, the least and the most feared cancer were prostate cancer and lung cancer, respectively. When both men and women assume the perspective of the opposite sex, the fear of sex-specific cancer was relatively low compared to the actual responses of both men and women. The top six of the most feared side effects of cancer treatment were pain, psychological problems, general weakness, digestive dysfunction, fatigue, and appearance change. These were the same between men and women.

Conclusion

Health care providers and caregivers in the family should provide care with more attention to the differences in thoughts about cancer between men and women. Health care providers should provide care with more attention to the differences in these problems between men and women.

Difference of background in research and clinical practice between USA and China

Malignant tumors continue to threaten people’s lives, and the incidence and mortality of lung cancer are particularly high. Due to different ethnic and cultural backgrounds, China and the United States differ in the clinical treatment of lung cancer and related basic research. The discrepancies are mostly visible in the prevention of cancer, the approval of anticancer drugs, availability of medical insurance, structure of medical education, availability of research funds, and many other aspects By understanding these differences, China and the United States, as well as other nations, can learn from each other and make progress together, which will help to improve the outcomes of cancer therapy.

How Cancer Patients Perceive Clinical Trials (CTs) in the Era of CTs: Current Perception and Its Differences Between Common and Rare Cancers

Perception has recently been highlighted as a critical determinant for participation in clinical trials (CTs) among cancer patients. We evaluated cancer patients' current perceptions of CTs using the PARTAKE questionnaires, focusing on differences between patients with common and rare cancers. From November 2015 to May 2017, we prospectively surveyed patients who had received anti-cancer treatment at Asan Medical Center. Among 333 respondents, 70.9% had common and 29.1% had rare cancers. In the cohort, 87.7% of patients with common cancers and 75.3% of patients with rare cancers answered that they heard of and knew about CTs. However, willingness to participate in CTs was expressed only in approximately 56% of patients, although it was significantly associated with awareness and perception. Surprisingly, patients with rare cancers when compared with patients with common cancers showed significantly lower levels of awareness and perception (64.2% vs 79.9%, p = 0.003 and 77.3% vs 91.9%, p < 0.001), and consequently less willingness to participate in CTs (47.4% vs 58.9%, p = 0.06). In addition, cancer patients still harbored fear and concerns about safety and reward of CTs, and demonstrated substantial lack of knowledge about the voluntary nature of CTs, which was more obvious in patients with rare cancers. We identified relatively modest willingness of cancer patients to participate in CTs regardless of generally favorable perception. These findings are highlighted by the more negative perception of CTs among patients with rare cancers relative to those with common cancers. Further education and encouragement by research and public entities seem essential to improve motivation of CTs in cancer patients beyond good perception, especially for patients with rare cancers.

Comparative comprehension on the anti-rheumatic Chinese herbal medicine Siegesbeckiae Herba: Combined computational predictions and experimental investigations

ETHNOPHARMACOLOGICAL RELEVANCE

Siegesbeckiae Herba (SH) is a traditional anti-rheumatic herbal medicine in China. The SH-derived product is the first licensed traditional herbal medicinal product for the management of rheumatism-induced joint and muscle pain in United Kingdom. The authenticated plant origins listed in the official Chinese Pharmacopeia for SH include Siegesbeckia orientalis L. (SO), S. pubescens Markino (SP) and S. glabrescens Markino (SG). Although the therapeutic effects of these SH species in treating rheumatoid arthritis (RA) are similar, their difference in chemical profiles suggested their anti-rheumatisms mechanisms and effects may be different.

AIM OF THE STUDY

This study was designed to comparatively comprehend the chemical and biological similarity and difference of SO, SP and SG for treating rheumatoid arthritis based on the combination of computational predictions and biological experiment investigations.

MATERIALS AND METHODS

The reported compounds for SO, SP and SG were obtained from four chemical databases (SciFinder, Combined Chemical Dictionary v2009, Dictionary of Natural Products and Chinese academy of sciences Chemistry Database). The RA-relevant proteins involved in nuclear factor-kappa B (NF-κB), oxidative stress and autophagy signaling pathways were collected from the databases of Kyoto Encyclopedia of Genes and Genomes and Biocarta. The comparative comprehension of SH plants was performed using similarity analysis, molecular docking and compounds-protein network analysis. The chemical characterization of different SH extracts were qualitatively and quantitatively analyzed, and their effects on specific RA-relevant protein expressions were investigated using Western blotting analysis.

RESULTS

Chemical analysis revealed that SO contains mainly sequiterpenes and pimarenoids; SP contains mainly pimarenoids, sequiterpenes, and kaurenoids; and SG contains mainly pimarenoids, flavonoids and alkaloids. Moreover, coincided with the predicted results from computational analysis, different SH species were observed to present different chemical constituents, and diverse effects on RA-relevant proteins at the biological level.

CONCLUSIONS

The chemical and biological properties of SO, SP and SG were different and distinctive. The systematic comparison between these three confusing Chinese herbs provides reliable characterization profiles to clarify the pharmacological substances in SH for the precise management of rheumatism/-related diseases in clinics.

Assessment of P values for demographic data in randomized controlled trials

In a large number of randomized controlled trials, researchers provide P values for demographic data, which are commonly reported in table 1 of the article for the purpose of emphasizing the lack of differences between or among groups. As such, the authors intend to demonstrate that statistically insignificant P values in the demographic data confirm that group randomization was adequately performed. However, statistically insignificant P values do not necessarily reflect successful randomization. It is more important to rigorously establish a plan for statistical analysis during the design and planning stage of the study, and to consider whether any of the variables included in the demographic data could potentially affect the research results. If a researcher rigorously designed and planned a study, and performed it accordingly, the conclusions drawn from the results would not be influenced by P values, regardless of whether they were significant. In contrasts, imbalanced variables could affect the results after variance controlling, even though whole study process are well planned and executed. In this situation, the researcher can provide results with both the initial method and a second stage of analysis including such variables. Otherwise, for brief conclusions, it would be pointless to report P values in a table simply listing baseline data of the participants.

Variations on a Chip: Technologies of Difference in Human Genetics Research

In this article we examine the history of the production of microarray technologies and their role in constructing and operationalizing views of human genetic difference in contemporary genomics. Rather than the "turn to difference" emerging as a post-Human Genome Project (HGP) phenomenon, interest in individual and group differences was a central, motivating concept in human genetics throughout the twentieth century. This interest was entwined with efforts to develop polymorphic "genetic markers" for studying human traits and diseases. We trace the technological, methodological and conceptual strategies in the late twentieth century that established single nucleotide polymorphisms (SNPs) as key focal points for locating difference in the genome. By embedding SNPs in microarrays, researchers created a technology that they used to catalog and assess human genetic variation. In the process of making genetic markers and array-based technologies to track variation, scientists also made commitments to ways of describing, cataloging and "knowing" human genetic differences that refracted difference through a continental geographic lens. We show how difference came to matter in both senses of the term: difference was made salient to, and inscribed on, genetic matter(s), as a result of the decisions, assessments and choices of collaborative and hybrid research collectives in medical genomics research.

Orienting to Medicine: Scripting Professionalism, Hierarchy, and Social Difference at the Start of Medical School

Nascent medical students' first view into medical school orients them toward what is considered important in medicine. Based on ethnography conducted over 18 months at a New England medical school, this article explores themes which emerged during a first-year student orientation and examines how these scripts resurface across a four-year curriculum, revealing dynamics of enculturation into an institution and the broader profession. We analyze orientation activities as discursive and embodied fields which serve "practical" purposes of making new social geographies familiar, but which also frame institutional values surrounding "soft" aspects of medicine: professionalism; dynamics of hierarchy and vulnerability; and social difference. By examining orientation and connecting these insights to later, discerning educational moments, we argue that orientation reveals tensions between the overt and hidden curricula within medical education, including what being a good doctor means. Our findings are based on data from semi-structured interviews, focus groups, and participant-observation in didactic and clinical settings. This article answers calls within medical anthropology and medical education literature to recognize implicit values at play in producing physicians, unearthing ethnographically how these values are learned longitudinally via persisting gaps between formal and hidden curricula. Assumptions hidden in plain sight call for ongoing medical education reform.

Sex Differences in Pedobarographic Findings and Relationship between Radiographic and Pedobarographic Measurements in Young Healthy Adults

Background

Although pedobarographic measurement is increasingly used for clinical and research purposes, relatively few published studies have investigated normative data. This study examined pedobarographic findings in young healthy adults with regard to sex-related differences and correlations among measurement indices.

Methods

Twenty young healthy adults (mean age, 22.4 years; standard deviation, 1.2 years; and 10 males and 10 females) were included. Weight bearing anteroposterior (AP) and lateral foot radiographs were taken, and dynamic pedobarographic data during treadmill walking and maximum ankle dorsiflexion were obtained. AP talo-first metatarsal angle, naviculocuboid overlap, lateral talo-first metatarsal angle, and plantar soft tissue thickness were measured on foot radiographs. Pedobarographic data including peak pressure and pressure-time integral were measured on five plantar segments: medial forefoot (MFF), lateral forefoot (LFF), medial midfoot (MMF), lateral midfoot (LMF), and heel.

Results

Male and female subjects significantly differed in body mass index (BMI, p < 0.001), AP talo-first metatarsal angle (p = 0.018), soft tissue thickness under the metatarsal head (p = 0.040) and calcaneal tuberosity (p < 0.001), maximum dorsiflexion during stance phase (p = 0.041), peak pressure on the MFF (p = 0.005) and LFF (p = 0.004), and pressure-time integral on the MFF (p = 0.018) and heel (p = 0.001). BMI was significantly correlated with soft tissue thickness under the metatarsal head (r = 0.521, p = 0.018) and calcaneal tuberosity (r = 0.585, p = 0.007), peak pressure on the MFF (r = 0.601, p = 0.005) and LFF (r = 0.487, p = 0.029), pressure-time integral on the heel (r = 0.552, p = 0.012), and total pressure-time integral (r = 0.755, p < 0.001). Maximum dorsiflexion demonstrated significant negative correlations with pressure-time integral on the MFF (r = −0.595, p = 0.007) and total pressure-time integral (r = −0.492, p = 0.032). Pressure-time integral varus/valgus index was significantly correlated with pressuretime integral forefoot/heel index (r = 0.472, p = 0.036).

Conclusions

Sex-related differences in pedobarographic examination were observed, which could provide useful information in setting appropriate treatment goals and obtaining appropriate control data. The effects of subtalar motion in distributing plantar pressure should be investigated in a future study.

Sex differences in rat decision-making: The confounding role of extraneous feeder sampling between trials

Although male and female rats appear to perform differently in some tasks, a clear picture of sex differences in decision-making has yet to develop. This is in part due to significant variability arising from differences in strains and tasks. The aim of this study was to characterize the effects of sex on specific response elements in a reinforcement learning task so as to help identify potential explanations for this variability. We found that the primary difference between sexes was the propensity to approach feeders out of the task context. This extraneous feeder sampling affects choice on subsequent trials in both sexes by promoting a lose-shift response away from the last feeder sampled. Female rats, however, were more likely to engage in this extraneous feeder sampling, and therefore exhibited a greater rate of this effect. Once trials following extraneous sampling were removed, there were no significant sex differences in any of the tested measures. These data suggest that feeder approach outside of the task context, which is often not recorded, could produce a confound in sex-based differences of reinforcement sensitivity in some tasks.

An analysis of radiographic parameters comparison between lumbar spine latericumbent and full-length lateral standing radiographs

BACKGROUND CONTEXT

The lumbar spine latericumbent and full-length lateral standing radiographs are most commonly used to assess lumbar disorder. However, there are few literatures on the difference and correlation of the sagittal parameters between the two shooting positions.

PURPOSE

The study aimed to investigate the difference of sagittal parameters in spine lateral radiographs between latericumbent and upright positions, identify the correlation, and establish a preliminary linear fitting formula.

STUDY DESIGN

The study is a prospective study on radiographic evaluation of sagittal alignment using latericumbent and upright positions.

PATIENT SAMPLE

One hundred fifty-seven patients were recruited from the orthopedics clinic of a single medical center.

OUTCOME MEASURE

Angle measurement, the intra- and interobserver measurement reliability of measurement, and analysis of the angle measurement were carried out.

METHOD

The sagittal alignment of 157 patients were assessed using Surgimap software from two kinds of lateral radiographs to acquire the following parameters: lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), L4-L5 intervertebral angle (IVA4-5), L4-L5 intervertebral height index (IHI4-5), and PI-LL. The Kolmogorov-Smirnov test, paired t test, Pearson correlation analysis, and multivariate linear regression analysis were used to analyze the data.

RESULTS

The results showed significantly statistical difference in LL, SS, PT, IVA4-5, and PI-LL, except for PI and IHI4-5, between the two positions. There was a significant relativity between standing LL and latericumbent LL (r=0.733, p<.01), PI (r=0.611, p<.01), and SS (r=0.626, p<.01). The predictive formula of standing LL was 12.791+0.777 latericumbent LL+0.395 latericumbent PI-0.506 latericumbent SS (adjusted R²=0.619, p<.05).

CONCLUSION

Not all of sagittal parameters obtained from two positions are identical. Thus, the full-spine lateral standing films are difficult to be replaced. The surgeon should give sufficient consideration to the difference between the two views. We may primarily predict standing LL with the formula when we could not get whole-spine lateral standing radiographs.

Epicardial adipose tissue is related to cardiac function in elderly women, but not in men

BACKGROUND AND AIM

Epicardial adipose tissue (EAT) is easily quantifiable visceral adipose tissue that is closely associated with cardiometabolic disease including heart failure with preserved left ventricular (LV) ejection fraction. As body fat distribution and metabolism are different between men and women, we evaluated the sex difference in EAT thickness and its relationship to cardiac function.

METHODS AND RESULTS

A total of 152 consecutive patients (76 men) with mean age of 62 ± 9 years were enrolled. Conventional echocardiography was performed and EAT thickness was measured perpendicularly on the right ventricular free wall at end systole. Mean EAT thickness in all patients was 6.5 ± 2.0 mm. EAT thickness was associated with patient age, body mass index, and the presence of hypertension. EAT thickness was not different by sex in patients younger than 60 years (men, 6.4 ± 2.0 mm; women, 6.2 ± 1.8 mm, p = 0.716); however, among patients aged 60 years or older, EAT thickness was significantly greater in women than men (men, 6.0 ± 1.7 mm; women 7.7 ± 2.1 mm, p < 0.001). LV function represented by E/e' and s' was significantly related to EAT thickness only in women (E/e', β = 0.330, p = 0.002; lateral s', β = -0.225, p = 0.042).

CONCLUSION

EAT thickness was greater in women than men after 60 years old and its relationship with LV function was significant only in women. Greater increase in EAT thickness in elderly women after menopause might partially account for this difference.

Imbalance in Cardiovascular Surgery Medical Service Use Between Regions

Background

This study uses the relevance index to understand the condition of regional medical service use for cardiovascular surgery and to identify the medical service use imbalance between regions.

Methods

This study calculated the relevance index of 16 metropolitan cities and provinces using resident registration address data from the Ministry of Government Administration and Home Affairs and the 2010–2014 health insurance, medical care assistance, and medical benefits claims data from the Health Insurance Review and Assessment Service. We identified developments over the 5-year time period and analyzed the level of regional imbalance regarding cardiovascular surgery through the relative comparison of relevance indexes between cardiovascular and other types of surgery.

Results

The relevance index was high in large cities such as Seoul, Daegu, and Gwangju, but low in regions that were geographically far from the capital area, such as the Gangwon and Jeju areas. Relevance indexes also fell as the years passed. Cardiovascular surgery has a relatively low relevance index compared to key types of surgery of other fields, such as neurosurgery and colorectal surgery.

Conclusion

This study identified medical service use imbalance between regions for cardiovascular surgery. Results of this study demonstrate the need for political intervention to enhance the accessibility of necessary special treatment, such as cardiovascular surgery.

A Decade of Experience of Management of Thyroglossal Duct Cyst in a Tertiary Care Hospital: Differentiation Between Children and Adults

Variations in thyroglossal duct cysts (TGDCs) between children and adult are mentioned very little in literature. The lesion mostly found in children but adult population also possesses this anomaly. The aim of this study was to determine the differences in clinical presentations and surgical outcomes of TGDC between children and adults. A retrospective chart review of all patients with TGDCs managed in our hospital from July 2004 to June 2014. All records were reviewed for age, sex, location of cyst in neck and with relation to hyoid bone, size, postoperative complication and recurrence rates. Differences between children and adults were assessed. A total of 39 patients (21 children and 18 adults) were treated for TGDC. Of the pediatric group, 71.4% were male and 28.5% were female, whereas 72.2% of the adults were male and 27.7% were female. Adults were more likely to develop other complaints like neck pain, dysphagia and dyspnea. Position was almost similar in both age groups with midline and infrahyoid location while laterality was seen in adult only. Size of Cyst was found to be larger in adults. The recurrence and post operative complication rates between children and adults were not significantly different. TGDC has male predominance. Clinical presentations were almost similar in both age groups. Although lateral deviation, increase size of cyst and recurrences were seen in adults only, Sistrunk procedure is recommended as a safe and standard surgical treatment in both age groups.

Leading the Way on Diversity: Community Psychology's Evolution from Invisible to Individual to Contextual

To take up the AJCP editor's call to think forward in this article, I offer up three challenges that revolve around further contextualizing our understandings of diversity, i.e., reconsidering the notion of "difference" between discrete categories; more fully emphasizing diversity as socially situated; and further delving into local, setting-specific practices that shape the meanings of diversity. Enhanced attention to these three challenges can transform theory, research, and action about diversity as we move into community psychology's next 50 years.

The Space That Difference Makes: On Marginality, Social Justice and the Future of the Health Humanities

Feminist theorist and educator, bell hooks, asserts that to seek true liberation one must choose marginality. One must choose to occupy the space outside the binary between colonizer-colonized, hegemonic center-periphery, and us-them in order to create a location of possibility. This essay will reveal the practice of social justice as the navigation of the space that difference makes and argue that choosing marginality provides a framework for health humanities work towards social justice in health care. The space of the launderette that is depicted in Hanif Kureishi's 1986 film, My Beautiful Laundrette, provides an example of choosing marginality and illustrates how difference structures both real and imagined spaces, which influences how individuals ultimately perceive one another. We will draw from the work of bell hooks; political geographer, Edward Soja; and Marxist philosopher, Henri Lefebvre, to demonstrate the importance of the health humanities' position at the margin to traditional health care education.

Incidence Rates in Low-Grade Primary Brain Tumors: Are There Differences Between Men and Women? A Systematic Review

BACKGROUND

Incidence rates of adult low-grade primary brain tumors have previously been widely analyzed nationwide across the world, and most of these studies include data on incidence rates in men and women separately. However, to our knowledge, no worldwide international comparison has been made on possible differences in incidence rates of low-grade brain tumors between men and women. The primary aim was to review the incidence rates between men and women in adult low-grade primary brain tumors.

METHODS

We searched for published articles in internationally peer reviewed journals that were identified through a systematic search of PubMed. Because of difficulties in interpreting data, we excluded all studies only including patient data before the second edition of World Health Organization (WHO) histological classification system of brain tumors (1993). We also made an overall analysis to calculate incidence rates of low-grade brain tumors in men and women separately.

RESULTS

A total of 14 studies from the United States and Europe were reviewed. Overall mean age-adjusted incidence rate in men was 1.07 per 100,000 compared to 1.70 per 100,000 in women. No significant difference was seen in age-adjusted incidence rate between genders (Mann-Whitney U test; P = 0.8347). No significant trend of age-adjusted incidence rate was seen in male patients (P = 0.757) nor in women (P = 0.354).

CONCLUSION

The results must be interpreted with caution and more large international studies are warranted and should be made in a standardized manner differing low-grade tumors from high-grade tumors according to the WHO 2007 brain tumor classification system. Also future studies should always state the ICD-O histology coding to ease future interpretations.

[Ambivalence--a key concept in gerontology? Elements of heuristics exemplified by identity formation in old age]

Ambivalence is a widely used concept in gerontology, mostly used in the common sense meaning. We propose that an elaborated notion based on the historical and systematic analysis, reveals important theoretical, methodological and practical potentials of the idea of ambivalence for the study of aging. We exemplify this view by proposing a heuristic perspective for the analysis of processes to constitute and reconstitute identities in old age using a model based on a multidimensional understanding of ambivalence. Ambivalence is defined as referring to the experiences of vacillating between polar contradictions of feeling, thinking, wanting and social structures in the search for the sense and meaning of social relationships, facts and texts, which are important for unfolding and altering facets of the self and agency.

Between Indifference and the Regimes of Truth. An Essay on Fundamentalism, Tolerance and Hypocrisy

There are two basic positions where tolerance as political strategy and moral viewpoint is rejected or made redundant. We are hostile to tolerance when we hold that we are defending an objective truth-religious or secular-which should also be defended and maintained by means of political and legal power. And tolerance become superfluous also when the affirmation of plurality becomes total, and tolerance identical to a vive la difference. As recent developments in my own country-the Netherlands-have demonstrated, the political outcome of this last position is remarkably enough not necessarily an all-inclusive relativistic tolerance. It may just as well be one of intolerance towards 'believers' of all kinds, in short: tolerance becomes polemical and belligerent. Turning to religious fundamentalism or ultra-orthodoxy could then become a possible (extreme) reaction to this relativistic and subjectivist position, as demonstrated in Isaac Bashevis Singer's novel The Penitent. Between these two positions of hostility or indifference towards tolerance, we can situate that democratic attitude which may rightly be called 'tolerance'. As ethical position, the tolerant citizen accepts the democratic disjunction between my (private) truth and the symmetrical justice between citizens. As political strategy, a tolerant democratic regime is based upon a political act of exclusion of what I will here call 'political fundamentalism'.

A personalized method for estimating centre of mass location of the whole body based on differentiation of tissues of a multi-divided trunk

There are several methods for obtaining location of the centre of mass of the whole body. They are based on cadaver data, using volume and density of body parts, using radiation and image techniques. Some researchers treated the trunk as a one part only, while others divided the trunk into few parts. In addition some researchers divided the trunk with planes perpendicular to the longitudinal trunk's axis, although the best approach is to obtain trunk parts as anatomical and functional elements. This procedure was used by Dempster and Erdmann. The latter elaborated personalized estimating of inertial quantities of the trunk, while Clauser et al. gave similar approach for extremities. The aim of the investigation was to merge both indirect methods in order to obtain accurate location of the centre of mass of the whole body. As a reference location a direct method based on reaction board procedure, i.e. with a body lying on a board supported on a scale was used. The location of the centre of mass using Clauser's and Erdmann's method appeared almost identical with the location obtained with a direct method. This approach can be used for several situations, especially for people of different morphology, for the bent trunk, and for asymmetrical movements.

Lumbar hernia in South Korea: different from that in foreign literature?

PURPOSE

This study aimed to analyze the clinical features of lumbar hernia reported in South Korea and compare these features with those reported in foreign literature.

METHODS

From January 1968 through December 2013, 13 cases reported in South Korea were included in the study. The variables compared were age, sex, main symptoms at hospital visit, etiology, location, herniated contents, lateralization, defect size, diagnostic methods, surgical methods, surgical opinions, and recurrence.

RESULTS

In the South Korean cases, women outnumbered men (3.3:1) and no significant differences were found in the herniated side (left:right, 1.1:1). In contrast, in the foreign cases, men outnumbered women (3:1) and left-sided hernia was dominant (2:1). Moreover, in most of the foreign cases, patients were aged 50-70 years, whereas in the South Korean cases, none of the patients were in their 50 s. However, no substantial differences were found in etiology, anatomical locations, symptoms, and herniated contents.

CONCLUSION

This research revealed that few clinical features of lumbar hernias in South Korea differ from those reported in foreign literature. Thirteen cases were analyzed in the present study, and results obtained from such a small sample size cannot be generalized with certainty. Therefore, more cases should be collected for a definitive analysis. Despite this limitation, this study is important because it is the first attempt to collect and analyze the clinical features of lumbar hernia in South Korea. This study will serve as a basis for future studies investigating the clinical features of lumbar hernia cases in South Korea.