Work and income instability and retirement financial wellbeing for women and men.

Financial wellbeing in retirement is contingent on realizations of financial expectations developed earlier in life and may differ substantially by gender. People's standard of living in retirement is tied to stability in work and income trajectories during working years along with retirement benefits and savings. Women have a greater overall income disadvantage relative to men, including reduced life course labor force exposure that may restrict retirement savings and benefits. Using the Canadian Longitudinal and International Study of Adults (LISA) and 20 years of linked tax record data (N = 2,353), we explore the association between instability in work and income histories and lower perceived retirement standard of living (PRSOL), net of retirement benefits, for women and men in Canada. Results show that for women, life course effects shaping PRSOL are driven by cumulative disability exposure and bouts of social assistance. For men, PRSOL is influenced more by cumulative unemployment. Although retirement benefits do not offset histories of work and income instability for either gender, income assistance is protective for women in retirement while personal investments are protective for men. Overall, our findings suggest that despite Canada's relatively generous pension program in later life, life course instability in work and income have persisting, gendered effects on financial wellbeing in retirement that underscore financial and health disadvantage for women across the life course.

The Double Capsule Phenomenon in a Case Series and its Relationship with the Macro-Textured Breast Implant.

BACKGROUND: Silicone breast augmentation remains one of the most common aesthetic surgery procedures, and 2022 marks the 60th anniversary of the first case. Recent studies suggest a link between double capsule (DC) formation and macro-textured devices. METHODS: Between 2010 and 2015, 268 aesthetic patients underwent bilateral mammary prosthesis exchange for indications including PIP exchange, adverse capsular contracture and ultrasonographic evidence of rupture. All surgery, in the form of implant exchange and capsulectomy, was undertaken by the senior author using standard techniques. A retrospective review was undertaken, and data analysed with descriptive statistics and Fisher's exact and Mann-Whitney U tests. RESULTS: Of 268 patients identified, 40 (14.9%) showed some degree of capsular duplication and bilateral involvement was marginally more common (52.5%). Two macroscopic patterns of duplication were observed: complete and subtotal. Complete DCs correlated with a clinical triad of extreme firmness, mobility and minimal-to-no pain. Whilst a wide range of manufacturers was represented, macro-textured devices were associated with the highest DC prevalence (58.3% vs. 5.6%) (Fisher's exact test p < 0.00001). Patients with DC had been implanted for less than half the time, median 52 versus. 120 months (p = 0.0003) of those without. DISCUSSION: An elevated prevalence of duplicate capsules in macro-textured prostheses is reconfirmed in addition to a novel symptom constellation that may assist with clinical diagnosis. Our study reinforces the aetiopathogenic influence of the elastomer in DC formation and reports DC for the first time in non-macrotextured implants. Single-surgeon cohort of 268 consecutive patients with 532 implants Statistically significant association of macro-textured devices with DC Statistically significant reduced duration of implantation of macro-textured devices First report of DC in non-macro-textured devices LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

EStradiol and PRogesterone in In vitro ferTilization (ESPRIT): a multicenter study evaluating third- versus second-generation estradiol and progesterone immunoassays.

PURPOSE: To assess estradiol (E2) and progesterone levels during ovarian stimulation determined by third-generation (Gen III) and second-generation (Gen II) Elecsys® immunoassays. METHODS: E2 and progesterone concentrations were measured using Elecsys® Gen III and Gen II immunoassays, and progesterone concentrations on the day of ovulation triggering were determined by LC-MS/MS. This was a retrospective, non-interventional study conducted at European tertiary referral infertility clinics in women aged 18-45 years, with a body mass index 18-35 kg/m2, regular menses, and both ovaries. RESULTS: Serum samples were obtained from 230 women classified by oocyte retrieval as poor (33.0%; 0-3 oocytes), normal (40.9%; 4-15 oocytes), or high (26.1%; > 15 oocytes) responders. E2 and progesterone levels increased during ovarian stimulation, with greatest increases observed in high responders. Elecsys® Gen III and Gen II assay results were highly correlated for E2 (Pearson's r = 0.99) and progesterone (r = 0.89); Gen III results were lower than Gen II for both E2 and progesterone. On the day of triggering, Gen III E2 and progesterone levels showed a difference of - 15.0% and - 27.9%, respectively. Progesterone levels (on day of triggering) measured by LC-MS/MS correlated better with Gen III (0.98) than Gen II (0.90). Mean relative differences for Gen III and Gen II assays versus LC-MS/MS were 14.6% and 62.8%, respectively. CONCLUSION: E2 and progesterone levels determined with Elecsys® Gen II and III assays were highly correlated; results were lower for Gen III versus Gen II. Differences observed for progesterone on the day of triggering may be clinically relevant.

Correction to: EStradiol and PRogesterone in In vitro ferTilization (ESPRIT): a multicenter study evaluating third­ versus second­generation estradiol and progesterone immunoassays.

The article "EStradiol and PRogesterone in In vitro ferTilization (ESPRIT): a multicenter study evaluating third­ versus second­generation estradiol and progesterone immunoassays.

Typologies of older adult companion animal owners and non-owners: moving beyond the dichotomy.

Objectives: Research on the influence of companion animals (CA) on the health of older adults has yielded contradictory results. Selection factors, leading to heterogeneity both between and within groups of CA owners and non-owners, likely bias results. We conduct analyses to identify typologies of owners and non-owners. Methods: Using data on older adults (60+) from the 2012 Health and Retirement Study (HRS), and the HRS companion animal module, (owners = 478) and (non-owners = 624), we conducted latent class analyses (LCA). We used key demographic, health, daily engagement, and pet characteristic variables to complete our analyses. Results: Analyses revealed five clusters of CA owners and four clusters of non-owners. Health and CA related characteristics distinguishing clusters suggest important sources of variability and reflect qualitatively different profiles of owners and non-owners. We also found CA owners were more likely than non-owners to be high on neuroticism and to be less extroverted than non-owners-but again there was considerable within group variability. Implications: Factors that select people into pet ownership not only work individually to characterize ownership, they create distinct typologies of CA owners and non-owners that likely contribute to subsequent health outcomes. In order to determine if having a CA is beneficial to health in later life and for whom, future research should consider selection factors like those identified in the typologies. Statistical analyses, such as LCA, that can adequately account for these selection factors is necessary to avoid biases in the interpretation of results.

Epigenetic Regulation of Glutamic Acid Decarboxylase 67 in a Hippocampal Circuit.

GABAergic dysfunction in hippocampus, a key feature of schizophrenia (SZ), may contribute to cognitive impairment in this disorder. In stratum oriens (SO) of sector CA3/2 of the human hippocampus, a network of genes involved in the regulation of glutamic acid decarboxylase GAD67 has been identified. Several of the genes in this network including epigenetic factors histone deacetylase 1 (HDAC1) and death-associated protein 6 (DAXX), the GABAergic enzyme GAD65 as well as the kainate receptor (KAR) subunits GluR6 and 7 show significant changes in expression in this area in SZ. We have tested whether HDAC1 and DAXX regulate GAD67, GAD65, or GluR in the intact rodent hippocampus. Stereotaxic injections of lentiviral vectors bearing shRNAi sequences for HDAC1 and DAXX were delivered into the SO of CA3/2, followed by laser microdissection of individual transduced GABA neurons. Quantitative PCR (QPCR) analyses demonstrated that inhibition of HDAC1 and DAXX increased expression of GAD67, GAD65, and GluR6 mRNA. Inhibition of DAXX, but not HDAC1 resulted in a significant increase in GluR7 mRNA. Our data support the hypothesis that HDAC1 and DAXX play a central role in coordinating the expression of genes in the GAD67 regulatory pathway in the SO of CA3/2.

Racial and Ethnic Variation in the Relationship Between Student Loan Debt and the Transition to First Birth.

The present study employs discrete-time hazard regression models to investigate the relationship between student loan debt and the probability of transitioning to either marital or nonmarital first childbirth using the 1997 National Longitudinal Survey of Youth (NLSY97). Accounting for nonrandom selection into student loans using propensity scores, our study reveals that the effect of student loan debt on the transition to motherhood differs among white, black, and Hispanic women. Hispanic women holding student loans experience significant declines in the probability of transitioning to both marital and nonmarital motherhood, whereas black women with student loans are significantly more likely to transition to any first childbirth. Indebted white women experience only a decrease in the probability of a marital first birth. The results from this study suggest that student loans will likely play a key role in shaping future demographic patterns and behaviors.

Systematic evaluation of radiological findings in the assessment of resectability of peri-ampullary cancer by CT using different contrast phase protocols.

AIMS: To determine the relative significance of radiological signs in determining the resectability of peri-ampullary cancer (PC) and to assess the value of multi-phase imaging in detecting these findings. MATERIALS AND METHODS: Blinded, double re-reporting of preoperative imaging from five hospitals was undertaken of 411 patients undergoing surgery for PC over an 8-year period, of whom 119 patients were found to be inoperable at the time of surgery. RESULTS: The median tumour size was 26.7 mm and the proportion of patients reported to have regional lymphadenopathy (RL), venous (VI) and arterial involvement (AI) was 24.7%, 11.5%, and 3.9%, respectively and was similar regardless of the number of contrast phases undertaken. Significant associations were, however, noted between individual risk factors: VI was closely associated with tumour size (p=0.002) and AI (p<0.0001). In multivariate analysis AI, VI, and RL were independently associated with resectability (relative risk of resection=0.05, 0.31, and 0.51, respectively). Tumour size, however, was not associated with resectability when VI was included in the multivariate model. CONCLUSIONS: The use of multiple vascular contrast phases has no measureable impact on the rate of determination of tumour resectability of PC. In preoperative staging, AI is the most significant adverse finding for resectability. Large tumour diameter is not an adverse finding in isolation from other risk factors.

Footprint of Deepwater Horizon blowout impact to deep-water coral communities.

On April 20, 2010, the Deepwater Horizon (DWH) blowout occurred, releasing more oil than any accidental spill in history. Oil release continued for 87 d and much of the oil and gas remained in, or returned to, the deep sea. A coral community significantly impacted by the spill was discovered in late 2010 at 1,370 m depth. Here we describe the discovery of five previously unknown coral communities near the Macondo wellhead and show that at least two additional coral communities were impacted by the spill. Although the oil-containing flocullent material that was present on corals when the first impacted community was discovered was largely gone, a characteristic patchy covering of hydrozoans on dead portions of the skeleton allowed recognition of impacted colonies at the more recently discovered sites. One of these communities was 6 km south of the Macondo wellhead and over 90% of the corals present showed the characteristic signs of recent impact. The other community, 22 km southeast of the wellhead between 1,850 and 1,950 m depth, was more lightly impacted. However, the discovery of this site considerably extends the distance from Macondo and depth range of significant impact to benthic macrofaunal communities. We also show that most known deep-water coral communities in the Gulf of Mexico do not appear to have been acutely impacted by the spill, although two of the newly discovered communities near the wellhead apparently not impacted by the spill have been impacted by deep-sea fishing operations.

Administration of electroconvulsive therapy for depression associated with deep brain stimulation in a patient with post-traumatic Parkinson's Disease: a case study.

BACKGROUND: Deep brain stimulation (DBS) has been shown to be effective for parkinsonian symptoms poorly responsive to medications. DBS is typically well-tolerated, as are the maintenance battery changes. Here we describe an adverse event during a battery replacement procedure that caused rapid onset of severe depression. CASE PRESENTATION: The patient is a 58-year-old woman who was in a serious motor vehicle accident and sustained a concussion with loss of consciousness. Within weeks of the accident she began developing parkinsonian symptoms that progressively worsened over the subsequent 10 years. Responding poorly to medications, she received DBS, which controlled her movement symptoms. Five years after initiating DBS, during a routine battery change, an apparent electrical event occurred that triggered the rapid onset of severe depression. Anti-seizure and antidepressant medications were ineffective, and the patient was offered a course of electroconvulsive therapy (ECT), which resulted in complete reversal of her depressive episode. CONCLUSION: Parkinson's syndrome can be seen after a single closed head injury event. Post-traumatic parkinsonism is responsive to DBS; however, DBS has been associated with an infrequent occurrence of dramatic disruption in mood. ECT is a therapeutic option for patients who develop intractable depressive illness associated with DBS.

Social support, stress, and maternal postpartum depression: A comparison of supportive relationships.

A large body of literature documents the link between social support, stress, and women's mental health during pregnancy and the postpartum period; however, uncertainty remains as to whether a direct effect or stress mediating pathway best describes the relationship between these factors. Moreover, specific dimensions of social support that may be influential (family type, sources of support) have largely been neglected. Using data from the Fragile Families and Child Well-being Study (N=4150), we examine the pathway between social support, stress exposure, and postpartum depression in greater detail. Findings reveal that social support is a significant, protective factor for postpartum depression, and the variety of support providers in a woman's social network is important, especially in the context of family type. Findings also reveal the importance of considering social support and stress exposure as part of a larger causal pathway to postpartum mental health.

Measuring Psychological Resilience in Aging: Findings From the Health and Retirement Study and National Longitudinal Study of Adolescent to Adult Health.

Background and Objectives: This study aimed to evaluate the measurement properties of 2 emerging psychological resilience (PR) measures constructed for use in large national data sources and to test their reliability across social axes including race/ethnicity, gender, and socioeconomic status. Research Design and Methods: Using 2006/2008 data, the Simplified Resilience Score and the Add Health Resilience Scale were tested using overall and multigroup measurement models in a structural equation modeling framework. Results: Both PR measures perform well as reliable, 1-factor latent constructs capturing adaptive capacity at various life stages. Both measures showed measurement consistency across social axes, with specific differences in item measurement across some racial/ethnic groups. Discussion and Implications: The results indicate these measures represent high quality, consistent measures of PR in nationally representative aging and health data. The availability of reliable, valid measures of PR enables consistent evaluation of resilience in health and aging processes.

High-Degree Heart Block During Noncardiac Surgery Soon After Transcatheter Aortic Valve Replacement: A Case Report.

Patients undergoing transcatheter aortic valve replacement (TAVR) as a bridge to noncardiac surgery have improved outcomes. Older clinical trials concluded no increased risk of performing noncardiac surgery within 30 days of the TAVR procedure. Emerging evidence suggests patients with preexisting conduction abnormalities may require additional intervention to proceed safely with noncardiac surgery. More data are needed to clarify this clinical situation, especially for the anesthesiologist whose job is to mitigate risk for these patients. We present a patient who received a TAVR and suffered associated complications during subsequent surgery. We further discuss preventative measures and perioperative considerations for this patient population.

Short-stay hospitalisation for benign thyroid surgery: a prospective study.

We report our prospective experience of short-stay hospitalisation for benign thyroid surgery. Post-operative outcome, complication rate and duration of hospitalisation were evaluated for 200 similar patients with bilateral multi-nodular goitres treated surgically by total thyroidectomy. All subjects gave written informed consent. A short-stay regimen, with discharge within 24 h of admission, was possible in 92.5 %. Fourteen (7 %) were discharged on the second post-operative day and one on the fourth post-operative day. Causes of the 15 delayed discharges beyond 24 h were 11 hypocalcaemia (5.5 %), 3 haematoma (1.5 %) and 1 dysphonia (0.5 %). All compressive haematoma were treated by urgent reoperation. No mortality occurred. None required tracheostomies. Transient complications were diagnosed in 36 cases: 25 with hypocalcaemia and 11 with recurrent laryngeal nerve injuries. Permanent complications were observed in three patients: two with hypoparathyroidism and one with nerve damage. All patients were carefully counselled about potential thyroid surgery complications and a 24-h emergency-contact number was provided. Short-stay hospitalisation represents safe and cost-saving surgical management for benign thyroid surgery.

Life Satisfaction and Intergenerational Mobility Among Older Hispanics in the United States.

OBJECTIVES: To investigate the impact of intergenerational mobility-measured as the difference between one's own and one's father's education level-on overall life-satisfaction among Hispanic, White, and Black older Americans. METHODS: Data from the Health and Retirement Study were used to estimate life satisfaction by race/ethnicity using ordinary least squares regression (N = 5,057). RESULTS: Hispanic and Black older Americans report greater educational gains relative to their fathers compared to Whites. Despite having the lowest reported education levels, Hispanics report the highest life satisfaction across race/ethnic groups. However, net of education level and other factors, intergenerational mobility decreased rather than increased life satisfaction for Hispanic older Americans. DISCUSSION: These results indicate that intergenerational mobility may not confer equal benefits for overall life satisfaction across racial/ethnic groups. As Hispanic individuals continue to achieve higher education levels, it is unclear whether upward mobility will translate to positive or negative assimilation consequences.

The role of psychotic disorders in religious history considered.

The authors have analyzed the religious figures Abraham, Moses, Jesus, and St. Paul from a behavioral, neurologic, and neuropsychiatric perspective to determine whether new insights can be achieved about the nature of their revelations. Analysis reveals that these individuals had experiences that resemble those now defined as psychotic symptoms, suggesting that their experiences may have been manifestations of primary or mood disorder-associated psychotic disorders. The rationale for this proposal is discussed in each case with a differential diagnosis. Limitations inherent to a retrospective diagnostic examination are assessed. Social models of psychopathology and group dynamics are proposed as explanations for how followers were attracted and new belief systems emerged and were perpetuated. The authors suggest a new DSM diagnostic subcategory as a way to distinguish this type of psychiatric presentation. These findings support the possibility that persons with primary and mood disorder-associated psychotic symptoms have had a monumental influence on the shaping of Western civilization. It is hoped that these findings will translate into increased compassion and understanding for persons living with mental illness.

Spatial pattern analysis of cruise ship-humpback whale interactions in and near Glacier Bay National Park, Alaska.

Understanding interactions between large ships and large whales is important to estimate risks posed to whales by ships. The coastal waters of Alaska are a summer feeding area for humpback whales (Megaptera novaeangliae) as well as a prominent destination for large cruise ships. Lethal collisions between cruise ships and humpback whales have occurred throughout Alaska, including in Glacier Bay National Park (GBNP). Although the National Park Service (NPS) establishes quotas and operating requirements for cruise ships within GBNP in part to minimize ship-whale collisions, no study has quantified ship-whale interactions in the park or in state waters where ship traffic is unregulated. In 2008 and 2009, an observer was placed on ships during 49 different cruises that included entry into GBNP to record distance and bearing of whales that surfaced within 1 km of the ship's bow. A relative coordinate system was developed in ArcGIS to model the frequency of whale surface events using kernel density. A total of 514 whale surface events were recorded. Although ship-whale interactions were common within GBNP, whales frequently surfaced in front of the bow in waters immediately adjacent to the park (west Icy Strait) where cruise ship traffic is not regulated by the NPS. When ships transited at speeds >13 knots, whales frequently surfaced closer to the ship's midline and ship's bow in contrast to speeds slower than 13 knots. Our findings confirm that ship speed is an effective mitigation measure for protecting whales and should be applied to other areas where ship-whale interactions are common.

Trajectories of Marital Conflict Across the Life Course: Predictors and Interactions With Marital Happiness Trajectories.

Using typologies outlined by Gottman and Fitzpatrick as well as institutional and companionate models of marriage, the authors conducted a latent class analysis of marital conflict trajectories using 20 years of data from the Marital Instability Over the Life Course study. Respondents were in one of three groups: high, medium (around the mean), or low conflict. Several factors predicted conflict trajectory group membership; respondents who believed in lifelong marriage and shared decisions equally with their spouse were more likely to report low and less likely to report high conflict. The conflict trajectories were intersected with marital happiness trajectories to examine predictors of high and low quality marriages. A stronger belief in lifelong marriage, shared decision making, and husbands sharing a greater proportion of housework were associated with an increased likelihood of membership in a high happiness, low conflict marriage, and a decreased likelihood of a low marital happiness group.

Financial Hardship and Psychological Resilience During COVID-19: Differences by Race/Ethnicity.

OBJECTIVES: Research on the impact of coronavirus disease 2019 (COVID-19) among older adults has primarily focused on relatively acute virus outcomes, but it is likely financial hardships during this time have eroded the adaptive capacity of older adults. It is also possible these impacts vary by race and ethnicity. We examine changes in psychological resilience (PR) among older adults before and during the pandemic to determine whether financial hardships and other stressors have altered this resource for White, Black, and Hispanic older adults. METHOD: Using the COVID-19 module released by the Health and Retirement Study (n = 735), we examined changes in PR between 2016 and 2020 related to financial hardships during COVID-19. We tested interactions to determine whether the effects were patterned by race and ethnicity. RESULTS: Consistent with previous literature, resilience was relatively stable during this time on average. Financial hardship during COVID-19 diminished resilience, but this effect was concentrated primarily among White Americans. DISCUSSION: The results suggest that PR is a relatively stable resource in later life, even during the pandemic. However, this resource may be affected in the face of specific challenges in later life. Policies related to financial hardship during the pandemic should be seen as supporting the capacity for older adults to adapt to current as well as future challenges.