Among U.S. medical school deans, there is a wide gender gap, most prominent at the highest levels. We aimed to discover how well women physicians were represented within the pool of women deans ...compared with the pool of men deans.
A cross-sectional study was performed on 149 allopathic medical schools in the United States. For each school, information was collected on deans' names, titles, genders, and degree(s). Chi-square analyses were performed to determine association between gender and dean ranks.
Of the 2559 deans included from 149 medical schools, 1649 (64.4%) were physicians, and of these, women physicians accounted for 634 (38.4%), a significant under-representation (
< 0.00001). In comparison, the 626 nonphysician doctorate-holders of which women accounted for 291 (46.5%,
= 0.061) were equally represented. Of the 284 deans with bachelor's or master's degrees, women accounted for 180 (63.4%), a significant over-representation (
< 0.00001). This difference was most profound at the lower tier (assistant) dean level. A lower tier physician dean was 1.25 times more likely to be a man than a woman, and a higher tier (dean of medical school, senior associate, vice, or associate) physician dean was 1.16 times more likely to be a man.
Women physicians were under-represented among medical school deans compared with men. This disparity held among lower tier and higher tier deans.
Gender-related differences have been found among invited speakers in select professional and medical societies. We examined whether similar disparities existed among keynote speakers, plenary ...speakers, and invited lecturers in a broad range of medical specialty conferences from 2013 to 2017.
A cross-sectional study was performed on 27 U.S. medical specialty conferences for which data were available on plenary speakers, keynote speakers, and/or invited lecturers. For each speaker, gender and degree(s) were determined. Fisher's exact test was performed to compare proportions of women among speakers to Association of American Medical Colleges' (AAMC) physician workforce data on gender distribution.
In aggregate, we identified 246 women among 984 speakers, significantly lower than expected when compared with 2015 AAMC data (25.0% vs. 34.0%;
< 0.00001). Compared with AAMC data reported in 2013, 2015, and 2017, women were significantly underrepresented in 2013 (
= 0.0064) and 2015 (
= 0.00004). In 2017, the proportion of women among invited speakers trended lower than AAMC active women physicians but did not reach significance (
= 0.309). Analysis of individual conference data stratified by year indicated that, while the representation of women among all speakers improved between 2015 and 2017, the representation of women among keynote speakers, plenary speakers, and invited lectureships was variable (including zero levels some years during the study period) and remained lower than expected as compared with workforce data for specific medical specialties.
Evaluating for and improving disparities is recommended to ensure gender equity among invited speakers across all medical specialty conferences.
Alcohol use increases the risk of tuberculosis (TB) disease and is associated with worse outcomes.
To determine whether alcohol use affects TB severity at diagnosis in a high-burden setting.
...Participants were smear-positive people living with TB (PLWTB) in India. Disease severity was assessed as 1) high versus low smear grade, 2) time to positivity (TTP) on liquid culture, 3) chest radiograph cavitation, and 4) percent lung affected. Alcohol use and being at-risk for alcohol use disorders (AUD) were assessed using the AUDIT-C. Univariable and multivariable analyses were conducted.
Of 1166 PLWTB, 691 (59.3%) were drinkers; of those, 518/691 (75.0%) were at-risk for AUD. Drinkers had more lung affected than non-drinkers (adjusted mean difference 10.8%, p<0.0001); this was not significant for those at-risk for AUD (adjusted mean difference 3.7%, p = 0.11). High smear grade (aOR 1.0, 95%CI: 0.7-1.4), cavitation (aOR 0.8, 95%CI 0.4-1.8), and TTP (mean difference 5.2 hours, p = 0.51) did not differ between drinkers and non-drinkers, nor between those at-risk and not at-risk for AUD.
A large proportion of PLWTB were drinkers and were at-risk for AUD. Alcohol drinkers had more lung affected than non-drinkers. Studies are needed to explore mechanisms of this association.
Identifying predictors of loss to follow-up (LTFU; treatment lapse ≥ 2 months) among people with tuberculosis (TB) may assist programmatic efforts in controlling the spread of TB. Newly diagnosed ...smear-positive TB patients were enrolled in the Regional Prospective Observational Research for TB study in Puducherry and Tamil Nadu, India. Treatment records were used to identify LTFU of those who were enrolled from May 2014 through December 2017. This nested case-control study evaluated male TB patients. Predictors were assessed using multivariable logistic regression. Of 425 men with TB, 82 (19%) were LTFU. In the adjusted analyses of males, divorced/separated marital status (adjusted odds ratio aOR 3.80; 95% CI: 1.39-10.38) and at-risk alcohol use (aOR 1.92; 95% CI: 1.12-3.27) were significant predictors for increased risk of LTFU, and diabetes was a significant predictor for decreased risk of LTFU (aOR 0.52; 95% CI: 0.29-0.92). Of 53 men with recorded date of last treatment visit, 23 (43%) and 43 (81%) had LTFU within the first 2 and first 4 months of treatment, respectively. Addressing at-risk alcohol use and providing more intensive follow-up could lead to improved treatment completion.
Abstract Objectives Understanding the drivers of delays from diagnosis to treatment can elucidate how to reduce the time to treatment (TTT) in patients with prostate cancer. In addition, the ...available treatments depending on the stage of cancer can vary widely for many reasons. This study investigated the relationship of TTT and treatment choice with sociodemographic factors in patients with prostate cancer who underwent external beam radiation therapy (RT), radical prostatectomy (RP), androgen deprivation therapy (ADT), or active surveillance (AS) at a safety-net academic medical center. Methods and materials A retrospective review was performed on 1088 patients who were diagnosed with nonmetastatic prostate cancer between January 2005 and December 2013. Demographic data as well as data on TTT, initial treatment choice, American Joint Committee on Cancer stage, and National Comprehensive Cancer Network risk categories were collected. Analyses of variance and multivariable logistic regression models were performed to analyze the relationship of these factors with treatment choice and TTT. Results Age, race, and marital status were significantly related to treatment choice. Patients who were nonwhite and older than 60 years were less likely to undergo RP. Black patients were 3.8 times more likely to undergo RT compared with white patients. The median TTT was 75 days. Longer time delays were significant in patients of older age, nonwhite race/ethnicity, non-English speakers, those with noncommercial insurance, and those with non-married status. The average TTT of high-risk patients was 25 days longer than that of low-risk patients. Patients who underwent RT had an average TTT that was 34 days longer than that of RP patients. Conclusions The treatment choice and TTT of patients with prostate cancer are affected by demographic factors such as age, race, marital status, and insurance, as well as clinical factors including stage and risk category of disease.
Understanding the trend of student authorship is crucial in determining its correlation to scholarly impact for corresponding authors. Our objective is to investigate student authorship rates over ...time in articles published in JAMA Internal Medicine (IM), as well as to examine potential effects student authors have on scholarly impact scores of corresponding authors via H-index measures.
Authorship data including student authors (SA), first student authors, and corresponding authors (CA) from prior JAMA IM publications between 2010 and 2018 were collected, with a total of 701 studies. Analysis of variance (ANOVA) and independent sample
tests were performed to assess for differences in the mean by publishing year and student authorship, respectively.
Of 4591 total authors, 683 (14.9%) were considered student authors. The percentage of student authorship increased from 46.3% to 58.0% between 2010 and 2018, respectively. No difference in average H-indices of CA between SA and non-SA groups (overall NSA H
mean: 30.2, vs SA H
mean: 32.1, p=0.371) was noted.
Student participation in research is not a disadvantage to scholarly impact for corresponding authors. Increased student authorship reflects a promising trend towards greater student participation in research within the field of medicine.
Summary Objectives/Hypothesis The purpose of this study was to investigate the intrasubject reliability of aerodynamic characteristics of the voice within typical/normal speakers across testing ...sessions using the Phonatory Aerodynamic System (PAS 6600; KayPENTAX, Montvale, NJ). Methods Participants were 60 healthy young adults (30 males and 30 females) between the ages 18 and 31 years with perceptually typical voice. Participants were tested using the PAS 6600 (Phonatory Aerodynamic System) on two separate days with approximately 1 week between each session at approximately the same time of day. Four PAS protocols were conducted (vital capacity, maximum sustained phonation, comfortable sustained phonation, and voicing efficiency) and measures of expiratory volume, maximum phonation time, mean expiratory airflow (during vowel production) and target airflow (obtained via syllable repetition), peak air pressure, aerodynamic power, aerodynamic resistance, and aerodynamic efficiency were obtained during each testing session. Associated acoustic measures of vocal intensity and frequency were also collected. All phonations were elicited at comfortable pitch and loudness. Results All aerodynamic and associated variables evaluated in this study showed useable test-retest reliability (ie, intraclass correlation coefficients ICCs ≥ 0.60). A high degree of mean test-retest reliability was found across all subjects for aerodynamic and associated acoustic measurements of vital capacity, maximum sustained phonation, glottal resistance, and vocal intensity (all with ICCs > 0.75). Although strong ICCs were observed for measures of glottal power and mean expiratory airflow in males, weaker overall results for these measures (ICC range: 0.60–0.67) were observed in females subjects and sizable coefficients of variation were observed for measures of power, resistance, and efficiency in both men and women. Differences in degree of reliability from measure to measure were revealed in greater detail using methods such as ICCs and coefficients of variation than with means comparison testing. The results of this study also show that reliable aerodynamic and associated measures may be elicited using comfortable pitch and loudness. Conclusions The 1-week test-retest reliability for the majority of aerodynamic and associated acoustic measures assessed in this study is considered good-to-excellent. Clinicians and researchers using aerodynamic and associated measures should be aware of possible significant gender effects that influence both normative expectations as well as the standard error of measurement (ie, typical error) and estimates of minimum difference that may be used to differentiate typical from disordered voice.
Glioblastoma multiforme (GBMs) are recurrent lethal brain tumours. Recurrent GBMs often exhibit mesenchymal, stem-like phenotypes that could explain their resistance to therapy. Analyses revealed ...that recurrent GBMs have increased tension and express high levels of glycoproteins that increase the bulkiness of the glycocalyx. Studies showed that a bulky glycocalyx potentiates integrin mechanosignalling and tissue tension and promotes a mesenchymal, stem-like phenotype in GBMs. Gain- and loss-of-function studies implicated integrin mechanosignalling as an inducer of GBM growth, survival, invasion and treatment resistance, and a mesenchymal, stem-like phenotype. Mesenchymal-like GBMs were highly contractile and expressed elevated levels of glycoproteins that expanded their glycocalyx, and they were surrounded by a stiff extracellular matrix that potentiated integrin mechanosignalling. Our findings suggest that there is a dynamic and reciprocal link between integrin mechanosignalling and a bulky glycocalyx, implying a causal link towards a mesenchymal, stem-like phenotype in GBMs. Strategies to ameliorate GBM tissue tension offer a therapeutic approach to reduce mortality due to GBM.
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