Why Aren't There More Female Pain Medicine Physicians?

Despite a growing awareness about the importance of gender equity and the rising number of women in medicine, women remain persistently underrepresented in pain medicine and anesthesiology. Pain medicine ranks among the bottom quartile of medical specialties in terms of female applicants, female trainees, and proportion of female practitioners. Female pain medicine physicians are also notably disadvantaged compared with their male colleagues in most objective metrics of gender equity, which include financial compensation, career advancement, public recognition, and leadership positions. Increased gender diversity among pain medicine physicians is vital to fostering excellence in pain research, education, and clinical care, as well as creating a high-quality work environment. Pain medicine stands at a crossroads as a specialty, and must examine reasons for its current gender gap and consider a call to action to address this important issue. Accepted for publication December 24, 2017. Address correspondence to: Tina L. Doshi, MD, Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, 550 N Broadway, Suite 309C, Baltimore, MD 21205 (e-mail: tina.doshi@jhmi.edu). The authors have no sources of funding to declare for this article. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Influence of subject presentation on interpretation of body composition change after 6 months of self-selected training and diet in athletic males

Abstract

Purpose

High precision body composition assessment methods accurately monitor physique traits in athletes. The acute impact of subject presentation (ad libitum food and fluid intake plus physical activity) on body composition estimation using field and laboratory methods has been quantified, but the impact on interpretation of longitudinal change is unknown. This study evaluated the impact of athlete presentation (standardised versus non-standardised) on interpretation of change in physique traits over time. Thirty athletic males (31.2 ± 7.5 years; 182.2 ± 6.5 cm; 91.7 ± 10.3 kg; 27.6 ± 2.6 kg/m²) underwent two testing sessions on 1 day including surface anthropometry, dual-energy X-ray absorptiometry (DXA), bioelectrical impedance spectroscopy (BIS) and air displacement plethysmography (via the BOD POD), with combinations of these used to establish three-compartment (3C) and four-compartment (4C) models.

Methods

Tests were conducted after an overnight fast (BASEam) and ~ 7 h later after ad libitum food/fluid and physical activity (BASEpm). This procedure was repeated 6 months later (POSTam and POSTpm). Magnitude of changes in the mean was assessed by standardisation.

Results

After 6 months of self-selected training and diet, standardised presentation testing (BASEam to POSTam) identified trivial changes from the smallest worthwhile effect (SWE) in fat-free mass (FFM) and fat mass (FM) for all methods except for BIS (FM) where there was a large change (7.2%) from the SWE. Non-standardised follow-up testing (BASEam to POSTpm) showed trivial changes from the SWE except for small changes in FFM (BOD POD) of 1.1%, and in FM (3C and 4C models) of 6.4 and 3.5%. Large changes from the SWE were found in FFM (BIS, 3C and 4C models) of 2.2, 1.8 and 1.8% and in FM (BIS) of 6.4%. Non-standardised presentation testing (BASEpm to POSTpm) identified trivial changes from the SWE in FFM except for BIS which was small (1.1%). A moderate change from the SWE was found for BOD POD (3.3%) and large for BIS (9.4%) in FM estimations.

Conclusions

Changes in body composition utilising non-standardised presentation were more substantial and often in the opposite direction to those identified using standardised presentation, causing misinterpretation of change in physique traits. Standardised presentation prior to body composition assessment for athletic populations should be advocated to enhance interpretation of true change.

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Sex Differences in Recombination in Sticklebacks

Recombination often differs markedly between males and females. Here we present the first analysis of sex-specific recombination in Gasterosteus sticklebacks. Using whole-genome sequencing of 15 crosses between G. aculeatus and G. nipponicus, we localized 698 crossovers with a median resolution of 2.3 kb. We also used a bioinformatic approach to infer historical sex-averaged recombination patterns for both species. Recombination is greater in females than males on all chromosomes, and overall map length is 1.64 times longer in females. The locations of crossovers differ strikingly between sexes. Crossovers cluster towards chromosome ends in males, but are distributed more evenly across chromosomes in females. Suppression of recombination near the centromeres in males causes crossovers to cluster at the ends of long arms in acrocentric chromosomes, and greatly reduces crossing over on short arms. The effect of centromeres on recombination is much weaker in females. Genomic differentiation between G. aculeatus and G. nipponicus is strongly correlated with recombination rate, and patterns of differentiation along chromosomes are strongly influenced by male-specific telomere and centromere effects. We found no evidence for fine-scale correlations between recombination and local gene content in either sex. We discuss hypotheses for the origin of sexual dimorphism in recombination and its consequences for sexually antagonistic selection and sex chromosome evolution.

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Missing data treatments matter: an analysis of multiple imputation for anterior cervical discectomy and fusion procedures

The presence of missing data is a limitation of large datasets, including the National Surgical Quality Improvement Program (NSQIP). In addressing this issue, most studies utilize complete case analysis, which excludes cases with missing data, thus potentially introducing selection bias. Multiple imputation, a statistically rigorous approach that approximates missing data and preserves sample size, may be an improvement over complete case analysis.

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Standalone cranio-cervical decompression is feasible in children with mucopolysaccharidosis type I, IVA and VI

In patients with Mucopolysaccharidosis (MPS), glycosaminoglycans deposits in the dura mater and supporting ligaments cause spinal cord compression and consecutive myelopathy, predominantly of the cranio-cervical junction. Disease characteristics of cranio-cervical stenosis (CCS) in MPS patients differ profoundly from other hereditary and degenerative forms.Due to high peri-procedural morbidity and mortality, MPS patients pose a substantial challenge to the unexperienced medical care provider. As literature remains scarce, we present our experience with a large cohort of MPS patients treated for CCS without atlanto-occiptal instrumentation.

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Independent predictors of spinal epidural abscess recurrence

Recurrence of spinal epidural abscess (SEA) after treatment is an important cause of continued morbidity for patients.

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Surgical treatment improves survival of elderly with axis fracture – a national population-based multi-registry cohort study

Background ContextFractures of the axis (C2) are the most common cervical spinal injuries in the elderly population. Several authors have reported improved survival among elderly patients with C2 fractures when treated surgically.PurposeTo analyze whether surgery improves survival of elderly with C2 fractures.Study Design/ SettingObservational population-based longitudinal multi-registry studyPatient SampleSwedish Patient Registry 1997 to 2014, and Swedish Cause of Death Registry 1997 to 2014Outcome measuresSurvival after C2 fracture according to non-surgical and surgical treatment.

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Predictors of adverse discharge disposition in adult spinal deformity and associated costs

With advances in the understanding of adult spinal deformity (ASD), more complex osteotomy and fusion techniques are being implemented with increasing frequency. Patients undergoing ASD corrections infrequently require extended acute care, longer inpatient stays, and are discharged to supervised care. Given the necessity of value-based health care, identification of clinical indicators for adverse discharge disposition in ASD surgeries is paramount.

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Evaluating the effect of growing patient numbers and changing data elements in the national surgical quality improvement program (NSQIP) database over the years: a study of posterior lumbar fusion outcomes

The use of national databases in spinal surgery outcomes research is increasing. A number of variables collected by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) changed between 2010 and 2011, coinciding with a rapid increase in the number of patients included per year. However, there has been limited study evaluating the effect that these changes may have on the results of outcomes studies.

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Anxiety and depression in spine surgery – a systematic integrative review

Symptoms of preoperative anxiety and depression occur in approximately one-third of patients with chronic back pain undergoing surgery. In the last 2 decades, several studies have established that preoperative anxiety and depression are important outcome predictors of greater pain and physical impairments, and lower health-related quality of life in patients undergoing spine surgery. To accommodate symptoms of anxiety and depression and thereby better surgical outcomes, we need to identify factors associated with these symptoms.

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Polyelectrolyte Soft Actuators: 3D Printed Chitosan and Cast Gelatin

3D Printing and Additive Manufacturing, Ahead of Print.


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Ultrasonic versus monopolar energy-based surgical devices in terms of surgical smoke and lateral thermal damage (ULMOST): a randomized controlled trial

Abstract

Background

The purpose of this study was to compare the degree of surgical smoke or vapor and lateral thermal damage caused by two different energy-based surgical devices (ESDs) used in colpotomy during total laparoscopic hysterectomy.

Methods

Patients undergoing laparoscopic hysterectomy were randomly assigned to an ultrasonic ESD group (n = 20) or monopolar ESD group (n = 20). Colpotomy was performed using the assigned ESD. The degree of surgical smoke or vapor obstructing the laparoscopic view was assessed by two independent reviewers using a 5-point Likert scale, in which a higher score indicates worse visibility. The degree of the lateral thermal damage was measured as the width from the point of instrument application to the margins of the unchanged nearby tissue using a light microscope.

Results

The baseline characteristics did not statistically differ between the two groups. The degree of surgical smoke or vapor obstructing vision was 1.2 ± 0.8 points in the ultrasonic group and 3.9 ± 0.7 points in the monopolar groups (p < 0.001). The lateral thermal damage was significantly increased in the monopolar group compared to in the ultrasound group (1500 µm [1200–2500 µm] vs. 950 µm [650–1725 µm], p = 0.037).

Conclusion

Ultrasonic ESD had better laparoscopic visibility and caused less lateral thermal damage during colpotomy compared to monopolar device.

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Applied Sport Science of Australian Football: A Systematic Review

Abstract

Background

In recent years, there has been a large expansion in literature pertaining to the game of Australian football (AF). Furthermore, there have been a number of rule changes that are likely to have changed the demands of the game. Based on these advances and changes, it seemed important to conduct a review assessing the scientific literature surrounding the sport.

Objective

The review evaluates the match demands of AF, the qualities required for success, and the impact training and competition have on adaptation, injury and fatigue.

Methods

A systematic search of PubMed, CINAHL, SPORTDiscus, Web of Science and Scopus for AF literature was conducted; studies investigating match demands, physical qualities, training practices and injury were included. Weighted means and standard deviations were calculated for match demands and physical and anthropometric profiles across playing standards.

Results

A total of 1830 articles were retrieved in the initial search, with 888 removed as duplicates, 626 removed for being non-relevant and a further 152 removed for being AF papers but not relevant to the review. As such, 164 AF papers were included in the review. Due to the intermittent high-intensity nature of match-play, players need a wide range of physical and technical qualities to excel, with speed, aerobic fitness, reactive agility and well-developed lean mass being central to success. Training for AF at the elite level is associated with high workloads, with players engaging in numerous training modalities; even altitude and heat training camps have been utilised by Australian Football League (AFL) teams to further augment fitness improvements. While high chronic workloads can be tolerated and are needed for improving physical qualities, careful planning and monitoring of internal and external workloads is required to minimise sharp spikes in load that are associated with injury.

Conclusions

There is a complex interaction between numerous contextual factors that influence the match demands that are discussed in this review. Whilst players must have the physical capacities to cope with the intense physical demands of AF matches, the successful execution of technical skills during match-play is central to success. To develop these skills and attributes, specific and carefully planned and monitored training must be performed over a number of years.

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Health Care Access and Utilization Among U.S. Immigrants Before and After the Affordable Care Act

Abstract

We examine changes in health insurance coverage and access to and utilization of health care before and after the national implementation of the Patient Protection and Affordable Care Act (ACA) among the U.S. adult immigrant population. Data from the 2011–2016 National Health Interview Survey are used to compare adult respondents in 2011–2013 (before the ACA implementation) and 2014–2016 (after the ACA implementation). Multivariable logistic regression analyses are used to compare changes over time. This study shows that the ACA has closed the coverage gap that previously existed between U.S. citizens and non-citizen immigrants. We find that naturalized citizens, non-citizens with more than 5 years of U.S. residency, and non-citizens with 5 years or less of U.S. residency reduced their probability of being uninsured by 5.81, 9.13, and 8.23%, respectively, in the first 3 years of the ACA. Improvements in other measures of access and utilization were also observed.

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