Still a 'boys' club': a qualitative analysis of how gender affects a career in anaesthesia in Australia and Aotearoa New Zealand.

Gender inequity remains an issue in anaesthesia despite increasing numbers of women training and achieving fellowship in the speciality. Women are under-represented in all areas of anaesthetic research, academia and leadership. The Gender Equity Subcommittee of the Australian and New Zealand College of Anaesthetists recently conducted a survey asking "Does gender still matter in the pursuit of a career in anaesthesia in 2022?". The survey was distributed to a randomly selected sample of 1225 anaesthetic consultants and completed by 470 respondents (38% response rate) with 793 free-text comments provided. Three overarching themes were identified: gender effects on the career and family interface; women do not fit the mould; and gender equity changes the status quo. Women respondents described a need to make a choice between career and family, which was not described by men, as well as stigmatisation of part-time work, a lack of access to challenging work and negative impacts of parental leave. Women respondents also described a sense of marginalisation within anaesthesia due to a 'boys' club' mentality, a lack of professional respect and insufficient structural supports for women in leadership. This was compounded for women from ethnically and culturally diverse backgrounds. A need for specific strategies to support anaesthetic careers for women was described as well as normalisation of flexibility in workplaces, combined with a broadening of our definition of success to allow people of all genders to experience fulfilment both at home and at work. This study is the first published qualitative data on factors affecting gender equity for anaesthetists in Australia and Aotearoa New Zealand. It highlights the need for further exploration, as well providing a foundation for changes in attitude and structural changes towards advancing gender equity.

Association between MC4R rs17782313 polymorphism and overeating behaviors.

BACKGROUND/OBJECTIVES: Melanocortins have a crucial role in appetite and weight regulation. Although the melanocortin 4 receptor (MC4R) gene has been repeatedly linked to obesity and antipsychotic-induced weight gain, the mechanism behind how it leads to this effect in still undetermined. The goal of this study was to conduct an in-depth and sophisticated analysis of MC4R polymorphisms, body mass index (BMI), eating behavior and depressed mood. SUBJECTS/METHODS: We genotyped 328 individuals of European ancestry on the following MC4R markers based on the relevant literature on obesity and antipsychotic-induced weight gain: rs571312, rs17782313, rs489693, rs11872992, and rs8087522. Height and weight were measured, and information on depressed mood and overeating behaviors was obtained during the in-person assessment. RESULTS: BMI was associated with rs17782313 C allele; however, this finding did not survive correction for multiple testing (P = 0.018). Although rs17782313 was significantly associated with depressed mood and overeating behaviors, tests of indirect effects indicated that emotional eating and food cravings, rather than depressed mood, uniquely accounted for the effect of this marker and BMI (n = 152). CONCLUSIONS: To our knowledge, this is the first study to investigate the link between MC4R rs17782313, mood and overeating behavior, as well as to demonstrate possible mechanisms behind MC4R's influence on body weight. If replicated in a larger sample, these results may have important clinical implications, including potential for the use of MC4R agonists in the treatment of obesity and disordered eating.

Changes in the clinical and epidemiological features of group A streptococcal bacteraemia in Australia's Northern Territory.

OBJECTIVE: Invasive group A streptococcus (iGAS) disease is an important cause of mortality globally. The incidence of iGAS in Australia's tropical Northern Territory (NT) has been previously reported as 32.2/100 000 in Indigenous people for the period 1991-1996. We aimed to measure the incidence and severity of iGAS disease in the NT since this time. METHODS: We collected demographic data for all GAS blood culture isolates over a 12-year period (1998-2009) from the three hospital laboratories serving the tropical NT. We then collected detailed clinical information from hospital records and databases for the subset of these patients who were admitted to Royal Darwin Hospital during 2005-2009. RESULTS: There were 295 confirmed cases of GAS bacteraemia over the study period, with a mean (SD) age of 42.1 (22.0) years, and 163 (55.0%) were male. The annual age-adjusted incidence was 15.2 (95% CI 13.4-16.9)/100 000 overall and 59.4 (95% CI 51.2-67.6) in Indigenous Australians. For 2005-2009, there were 123 cases with the most common focus of infection being skin/soft tissue [44 (35.6%)]; 29 patients (23.6%) required intensive care unit admission and 20 (16.3%) had streptococcal toxic shock syndrome. Antecedent sore throat or use of non-steroidal anti-inflammatory drugs was rare, but current or recent scabies, pyoderma and trauma were common. CONCLUSION: The incidence and severity of iGAS are high and increasing in tropical northern Australia, and urgent attention is needed to improve surveillance and the social determinants of health in this population. This study adds to emerging data suggesting increasing importance of iGAS in low- and middle-income settings globally.

Opiates, overeating and obesity: a psychogenetic analysis.

OBJECTIVE: This study provides an original perspective on the associations among endogenous opiates, overeating and obesity. The aim was to assess whether variability in the OPRM1 gene, as assessed by seven single-nucleotide polymorphisms, relates to individual differences in the preference for sweet and fatty foods. We also anticipated that these food preferences would be positively associated with binge eating, hedonic eating and emotionally driven eating-patterns of overeating that would, in turn, predict higher body mass index (BMI). DESIGN: Analysis of variance procedures examined genotype differences in food preferences; bivariate correlation coefficients examined the relationships among food preferences and the overeating variables; and a regression analysis tested the combined influences of the overeating variables on BMI. DNA was extracted from whole blood for the genotyping, and measures of food preferences and eating behaviours were obtained from well-validated self-report questionnaires. SUBJECTS: Participants were 300 healthy adult men and women recruited from the community. RESULTS: All the predicted associations were supported by statistically significant results. In particular, the G/G genotype group of the functional A118G marker of the OPRM1 gene reported higher preferences for sweet and fatty foods compared with the other two groups. Food preferences were also related to all overeating measures, which in turn accounted for a substantial proportion of the variance in BMI. CONCLUSIONS: Our findings suggest that some of the diversity in the preference for highly palatable foods can be explained by genotypic differences in the regulation of mu opioid receptors. The associations reported in this paper are important from a public-health perspective because of the abuse potential of sweet-fat foods and their strong relationship with obesity.

The slippery slope: prediction of successful weight maintenance in anorexia nervosa.

BACKGROUND: Previous research has found that many patients with anorexia nervosa (AN) are unable to maintain normal weight after weight restoration. The objective of this study was to identify variables that predicted successful weight maintenance among weight-restored AN patients. METHOD: Ninety-three patients with AN treated at two sites (Toronto and New York) through in-patient or partial hospitalization achieved a minimally normal weight and were then randomly assigned to receive fluoxetine or placebo along with cognitive behavioral therapy (CBT) for 1 year. Clinical, demographic and psychometric variables were assessed after weight restoration prior to randomization and putative predictors of successful weight maintenance at 6 and 12 months were examined. RESULTS: The most powerful predictors of weight maintenance at 6 and 12 months following weight restoration were pre-randomization body mass index (BMI) and the rate of weight loss in the first 28 days following randomization. Higher BMI and lower rate of weight loss were associated with greater likelihood of maintaining a normal BMI at 6 and 12 months. An additional predictor of weight maintenance was site; patients in Toronto fared better than those in New York. CONCLUSIONS: This study found that the best predictors of weight maintenance in weight-restored AN patients over 6 and 12 months were the level of weight restoration at the conclusion of acute treatment and the avoidance of weight loss immediately following intensive treatment. These results suggest that outcome might be improved by achieving a higher BMI during structured treatment programs and on preventing weight loss immediately following discharge from such programs.

The nonmuscle myosin regulatory light chain gene mlc-4 is required for cytokinesis, anterior-posterior polarity, and body morphology during Caenorhabditis elegans embryogenesis.

Using RNA-mediated genetic interference in a phenotypic screen, we identified a conserved nonmuscle myosin II regulatory light chain gene in Caenorhabditis elegans, which we name mlc-4. Maternally supplied mlc-4 function is required for cytokinesis during both meiosis and mitosis and for establishment of anterior-posterior (a-p) asymmetries after fertilization. Reducing the function of mlc-4 or nmy-2, a nonmuscle myosin II gene, also leads to a loss of polarized cytoplasmic flow in the C. elegans zygote, supporting models in which cytoplasmic flow may be required to establish a-p differences. Germline P granule localization at the time of cytoplasmic flow is also lost in these embryos, although P granules do become localized to the posterior pole after the first mitosis. This result suggests that a mechanism other than cytoplasmic flow or mlc-4/nmy-2 activity can generate some a-p asymmetries in the C. elegans zygote. By isolating a deletion allele, we show that removing zygotic mlc-4 function results in an elongation phenotype during embryogenesis. An mlc-4/green fluorescent protein transgene is expressed in lateral rows of hypodermal cells and these cells fail to properly change shape in mlc-4 mutant animals during elongation.

Stokes Parameters for 1665-Megacycles-per-second Emission from OH near Source W3.

The Stokes parameters were measured as a function of frequency for the anonmalous 1665-megacycles-per-second OH emission originating near the thermal radio source W3. The emission is highly polarized, and the polarization parameters vary rapidly with frequency. The observed polarization can be described in terms of narrow, roughly Gaussian, emission features, all with uniform polarization but with several features overlapping without coherence near the center of the spectrum. Most of the individual features may be 100-percent polarized. Detailed examination of the brightest features suggest that they are not exactly Gaussian in shape.

Water vapor: observations of galactic sources.

We measured the emission of water vapor at a wavelength of 1.35 centimeters from nine sources with the 120-foot (36.5-meter) Haystack antenna. Eight sources lie within 30 seconds of arc of the hydroxyl sources of 18 centimeters but not all hydroxyl sources produced detectable emission of water vapor. All sources are smaller than 30 seconds of arc in angular diameter, but we resolved at least three separate sources in the Orion Nebula. We do not find that the known hyperfine components are present with the equilibrium intensity distribution.

Spectral line interferometry with independent time standards at stations separated by 845 kilometers.

An upper limit of 0.02 second of arc has been determined for a hydroxyl radical (OH) emission region associated with the radio source W3, with the use of a Michelson interferometer consisting of two radio telescopes 845 kilometers apart. Timing was provided at the stations by independent atomic frequency standards. The 1665-megahertz radiation was translated to video frequency and recorded digitally on magnetic tapes which were later processed by computer, yielding fringe phase and amplitude as a function of frequency over the received bandwidth.

The aurora-related kinase AIR-2 recruits ZEN-4/CeMKLP1 to the mitotic spindle at metaphase and is required for cytokinesis.

BACKGROUND: The Aurora/Ipl1p-related kinase AIR-2 is required for mitotic chromosome segregation and cytokinesis in early Caenorhabditis elegans embryos. Previous studies have relied on non-conditional mutations or RNA-mediated interference (RNAi) to inactivate AIR-2. It has therefore not been possible to determine whether AIR-2 functions directly in cytokinesis or if the cleavage defect results indirectly from the failure to segregate DNA. One intriguing hypothesis is that AIR-2 acts to localize the mitotic kinesin-like protein ZEN-4 (also known as CeMKLP1), which later functions in cytokinesis. RESULTS: Using conditional alleles, we established that AIR-2 is required at metaphase or early anaphase for normal segregation of chromosomes, localization of ZEN-4, and cytokinesis. ZEN-4 is first required late in cytokinesis, and also functions to maintain cell separation through much of the subsequent interphase. DNA segregation defects alone were not sufficient to disrupt cytokinesis in other mutants, suggesting that AIR-2 acts specifically during cytokinesis through ZEN-4. AIR-2 and ZEN-4 shared similar genetic interactions with the formin homology (FH) protein CYK-1, suggesting that AIR-2 and ZEN-4 function in a single pathway, in parallel to a contractile ring pathway that includes CYK-1. Using in vitro co-immunoprecipitation experiments, we found that AIR-2 and ZEN-4 interact directly. CONCLUSIONS: AIR-2 has two functions during mitosis: one in chromosome segregation, and a second, independent function in cytokinesis through ZEN-4. AIR-2 and ZEN-4 may act in parallel to a second pathway that includes CYK-1.

Inter- and intraexaminer reliability in identifying and classifying degenerative marrow (Modic) changes on lumbar spine magnetic resonance scans.

OBJECTIVE: Signal intensity changes noted on magnetic resonance imaging scans in degenerated disks and adjacent bone marrow have been described and labeled "Modic" changes. Three types are identified, with type 1 being linked to low back pain. This study reports on the reliability of identifying and categorizing Modic marrow changes as would be done in the normal course of clinical practice. METHODS: Fifty-one lumbar spine sagittal magnetic resonance imaging scans of adult male patients older than 40 years were used. Two radiologists independently read each case at 2 different periods; scans were reordered for the second reading. The radiologists recorded the presence or absence of Modic changes anywhere in the lumbar spine for each case and classified each one as type 1, type 2, or type 3, and the level or levels where they were noted. The kappa statistic was used to evaluate inter- and intraexaminer agreement overall and by disk level. Percent agreement was also calculated. RESULTS: The overall kappa value for the interexaminer agreement of diagnosing the presence/absence of Modic changes for the entire lumbar spine as well as classifying them when present was kappa = 0.52 (moderate) with 71% agreement. At the L4 through 5 level, the kappa value was 0.81 (substantial) with 92% agreement, and at the L5 through S1 level, the kappa value was 0.58 (upper moderate) with 76% agreement. The L3 through L4 level had a kappa value of 0.66 (strong) but was considered "unstable" because of the lack of variability within the cells of the contingency table. The intraexaminer reliability gave a kappa value of 0.71 (strong) (82% agreement) for examiner 1 and a kappa value of 0.87 (almost perfect) (92%) for examiner 2. CONCLUSIONS: The Modic classification system shows moderate to almost perfect inter- and intraexaminer reliability in this study, simulating the methods of diagnosis used in clinical/radiological practice. The results of studies using the Modic system before investigations of its reliability can be viewed with more confidence, and future studies can continue to evaluate the link with patient symptoms and treatment outcomes.

Observations in collinear femtosecond-nanosecond dual-pulse laser-induced breakdown spectroscopy.

In the work reported herein, we have combined a short-lived femtosecond laser-induced plasma (LIP) and a longer-lived nanosecond LIP in a collinear pulse configuration to examine the source(s) of atomic emission and signal-to-noise enhancement in dual-pulse laser-induced breakdown spectroscopy (LIBS). Initial studies indicate that the primary source of dual-pulse LIBS enhancement in the collinear configuration may in large part be a matter of pulse focus; focusing on the sample surface, for example, yields atomic emission enhancements whose lifetime correlates reasonably well with the femtosecond LIP emissive lifetime, suggesting that plasma-plasma coupling may play an important role at that pulse focus. At a second "optimal" focal position above the sample surface, alternatively, atomic emission and signal-to-noise enhancements correlate quite well with the nitrogen and oxygen atomic emission reductions previously seen following use of a femtosecond air spark and a nanosecond ablative pulse in the orthogonal dual-pulse configuration, suggesting that pressure or number density reductions due to femtosecond LIP formation in air may be significant at that pulse focus.

Cognitive-behavioral self-help for binge eating disorder: a controlled effectiveness study.

The aim of this study was to evaluate the effectiveness of 2 methods of administering a cognitive-behavioral self-help program for binge eating disorder. The study was designed to reproduce many of the conditions that apply in settings in which self-help interventions are most relevant. Seventy-two women with binge eating disorder were randomly assigned to 1 of 3 conditions for 12 weeks: pure self-help (PSH), guided self-help (GSH), or a waiting list (WL) control condition (followed by PSH or GSH). They were then followed up for 6 months. Both PSH and GSH had a substantial and sustained impact with almost half the participants ceasing to binge eat. There was little change in the WL condition. Cognitive-behavioral self-help may be of value both as an initial treatment for binge eating disorder and as a form of secondary prevention.

Matching patient variables to treatment intensity. The continuum of care.

This article has reviewed what is currently known regarding the relationship between specific patient variables and treatment response in AN, BN, and BED. Matching patient variables to treatment intensity remains an important and fruitful area for future research. There is a need for established guidelines for clinicians regarding the choice of the appropriateness of treatment settings and type of interventions delivered in those settings. These guidelines should be evidence based, with clear clinical indicators for each of the recognized eating disorders and their subclinical variants.

Hemispheric asymmetry of EEG alpha activation: effects of gender and familial handedness.

Twenty-four male and twenty-four female undergraduates took part in an experiment to investigate the effects of gender and familial handedness on hemispheric activation during numeric and visuospatial thinking. Each gender group was divided into twelve subjects with close left handed relatives and twelve subjects without. All subjects were overtly right handed. EEG alpha activity was recorded from left and right occipital and parietal regions with respect to mastoid references while the subjects performed numeric tasks with eyes open and with eyes closed, a face-recognition and a tactile-discrimination (figural-unification) task. EEG alpha power was quantified during these conditions and during relaxed wakefulness with eyes open and eyes closed. Relative activation, (suppression of alpha activity from rest) of left and right parietal regions during numeric and spatial tasks was found to depend upon gender and familial handedness. Males, not females, tended to switch from left hemisphere activation during face recognition. Irrespective of gender and to some extent of task, a tendency towards greater activation of the right hemisphere was associated with the possession of left handers among close relatives.

Eating disorder examination questionnaire: norms for young adolescent girls.

This paper reports young adolescent female norms for the Eating Disorder Examination Questionnaire (EDE-Q). The standardization sample was comprised of 808 girls aged between 12 and 14 years from three single-sex schools (one private and two state schools). Means, standard deviations and percentile ranks for raw EDE-Q subscale scores are presented. Prevalence figures for key eating disorder behaviors over the previous two weeks were as follows: 4% self-induced vomiting; 1% laxative misuse; 0.4% diuretic misuse; and 8% regular binge eating.

Treating binge eating problems in primary care.

Binge eating problems are a common source of psychiatric morbidity among young adult women. To date, the research on their treatment has been conducted almost exclusively in specialist settings. As it is unlikely there will ever be sufficient specialist resources to address a problem of this scale, a priority is to develop treatments that can be applied more generally. One option is to develop treatments suitable for use in primary care. Four such treatments are available: antidepressant drugs, brief cognitive behavior therapy, and the use of a cognitive behavioral self-help manual with or without supervision from a nonspecialist therapist. Tests of the effectiveness of these treatments are needed.

Enhanced cell-associated plasminogen activator pathway but not coagulation pathway activity contributes to motility in metastatic breast cancer cells.

BACKGROUND: Activation of tumor cell-associated coagulation and plasminogen activator pathways occurs in malignant disease processes, including breast cancer, and may promote metastatic activity. OBJECTIVES/METHODS: To compare the coagulation and plasminogen activator pathways of normal and metastatic cells, we examined two cell lines from the MCF-10 family of breast cells: near-normal immortalized MCF-10A cells, and metastatic MCF-10CA1 cells. RESULTS: MCF-10CA1 cell motility was significantly increased as compared with that of MCF-10A cells. The two cell types supported similar rates of factor Xa generation, plasma thrombin generation, and fibrin formation. MCF-10A cells produced a stable fibrin network, whereas MCF-10CA1 cells lysed the surrounding fibrin network within 24 h of network formation. Importantly, fibrin located proximal to (within 10 microm) the MCF-10CA1 cell surface lysed substantially faster than fibrin located 100 microm from the surface. MCF-10CA1 cells supported significantly increased plasmin generation rates as compared with MCF-10A cells, providing a mechanism for the increased fibrinolytic activity of these cells towards the fibrin network. Metastatic MCF-10CA1 cells had increased expression (mRNA and protein) levels of urokinase plasminogen activator (u-PA) and decreased levels of plasminogen activator inhibitor-1 as compared with MCF-10A cells. Blocking u-PA activity with the active site-directed protease inhibitor amiloride substantially decreased MCF-10CA1 cell motility. Phosphorylated Akt levels were elevated in MCF-10CA1 cells, which partially explains the increased u-PA expression. CONCLUSIONS: These results suggest that the tumor-associated plasminogen activator pathway, not the coagulation pathway, is a key distinguishing feature between metastatic MCF10-CA1 cells and normal MCF-10A cells.