Gender differences in emergency medicine resident assessment: A scoping review.

Background: Growing literature within postgraduate medical education demonstrates that female resident physicians experience gender bias throughout their training and future careers. This scoping review aims to describe the current body of literature on gender differences in emergency medicine (EM) resident assessment. Methods: We conducted a scoping review which adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. We included research involving resident physicians or fellows in EM (population and context), which focused on the impact of gender on assessments (concept). We searched seven databases from the databases' inception to April 4, 2022. Two reviewers independently screened citations, completed full-text review, and abstracted data. A third reviewer resolved any discrepancies. Results: A total of 667 unique citations were identified; 10 studies were included, and all were conducted within the United States. Four studies reported differences in EM resident assessments attributable to gender within workplace-based assessments (qualitative comments and quantitative scores) by both attending physicians and nonphysicians. Six studies investigating clinical competency committee scores, procedural scores, and simulation-based assessments did not report any significant differences attributable to gender. Conclusions: This scoping review found that gender bias exists within EM resident assessment most notably at the level of narrative comments typically received via workplace-based assessments. As female EM residents receive higher rates of negative or critical comments and discordant feedback documented on assessment, these findings raise concern about added barriers female EM residents may face while progressing through residency and the impact on their clinical and professional development.

What is in a Meter? A Qualitative Exploration into the Implementation of Electricity Metering Across Mumbai Communities Using Normalisation Process Theory.

Metering is fundamental in the efficient operation of electricity networks, as meters facilitate controlled usage and improve health and well-being. However, across the Global South, meters have often been found to be lacking or not fit for purpose. Therefore, this study sought to determine residents' perceptions and access to electricity metering across a community in Mumbai, with the goal of developing recommendations to support the implementation of meters in the future. Fifty semi-structured interviews were conducted by phone, with participants from different areas and socioeconomic classes, within Greater Mumbai. The sample consisted of 20 low-income, 20 middle-income, and 10 high-income participants. The Normalisation Process Theory (NPT) was used to inform the interview schedule and to organise the thematic analysis. Meter accessibility and location was variable across the participant groups, as was the education and awareness of metering technology. Socio-political factors were found to directly affect the use of meters, specifically in the low-income group. The high cost associated with metering was a prominent finding; with a preconception that introducing meters would only increase utility expenditure. Future work should focus around ensuring meters are easy to use, practical and accessible to all residents and supporting education programmes around how to use a meter and how they can reduce utility expenditure. The cost of meters should also be investigated, to establish that the costs, associated with introducing new meters, are not passed disproportionately to consumers. Supplementary Information: The online version contains supplementary material available at 10.1007/s43477-022-00059-y.

Comparison of Extrapyramidal Symptoms Among Outpatients With Schizophrenia on Long-Acting Injectable Antipsychotics.

BACKGROUND: Extrapyramidal symptoms (EPSs) are adverse effects of antipsychotics. Different risks of EPSs have been attributed to the 3 classes of antipsychotics. This study aimed to assess EPS in a clinical sample of schizophrenia patients who are on LAI and compare the severity of EPSs among the following 3 antipsychotic groups: (1) partial agonist, (2) second-generation antipsychotics, and (3) first-generation antipsychotics. METHODS: Ninety-two patients were recruited from the Schizophrenia Program Injection Clinic. Using the Extrapyramidal Symptom Rating Scale (ESRS), severity of EPS was assessed and information regarding factors associated with risk of EPS, including coprescriptions, comorbidities, and demographics, was obtained from medical charts. Group differences in ESRS scores and subscores were analyzed using 1-way analyses of variances. RESULTS: Among the 3 groups, there was no significant difference in total ESRS scores and subscores. Risperidone was associated with higher ESRS scores when compared with paliperidone, aripiprazole, and flupenthixol. Doses above maximum were commonly used in the paliperidone group, and there was no significant difference in total ESRS scores between the low, average, or above-maximum doses of paliperidone. CONCLUSIONS: Our results demonstrated a comparative risk of EPS across all 3 antipsychotic classes. Risperidone was associated with more EPS compared with other medications. A higher threshold for the "maximum dose" of paliperidone could be considered and higher doses used with the same cautions as low-average doses.

Willingness of patients with sarcoma to participate in cancer surveillance research: a cross-sectional patient survey.

OBJECTIVES: To determine the proportion of patients with extremity sarcoma who would be willing to participate in a clinical trial in which they would be randomised to one of four different postoperative sarcoma surveillance regimens. Additionally, we assessed patients' perspectives on the burden of cancer care, factors that influence comfort with randomisation and the importance of cancer research. DESIGN: Prospective, cross-sectional patient survey. SETTING: Outpatient sarcoma clinics in Canada, the USA and Spain between May 2017 and April 2020. Survey data were entered into a study-specific database. PARTICIPANTS: Patients with extremity sarcoma who had completed definitive treatment from seven clinics across Canada, the USA and Spain. MAIN OUTCOME MEASURES: The proportion of patients with extremity sarcoma who would be willing to participate in a randomised controlled trial (RCT) that evaluates varying postoperative cancer surveillance regimens. RESULTS: One hundred thirty complete surveys were obtained. Respondents reported a wide range of burdens related to clinical care and surveillance. The majority of patients (85.5%) responded that they would agree to participate in a cancer surveillance RCT if eligible. The most common reason to participate was that they wanted to help future patients. Those that would decline to participate most commonly reported that participating in research would be too much of a burden for them at a time when they are already feeling overwhelmed. However, most patients agreed that cancer research will help doctors better understand and treat cancer. CONCLUSIONS: These results demonstrate that most participants would be willing to participate in an RCT that evaluates varying postoperative cancer surveillance regimens. Participants' motivation for trial participation included altruistic reasons to help future patients and deterrents to trial participation included the overwhelming burden of a cancer diagnosis. These results will help inform the development of patient-centred RCT protocols in sarcoma surveillance research. LEVEL OF EVIDENCE: V.

The potential of urban distributed solar energy in transition economies: The case of Beirut city.

In this paper, using Lebanon's capital, Beirut, as a case study, a methodology is proposed to assess the potential for solar photovoltaics (PV) in urban areas incorporating both economic and non-economic factors. Utilizing a rich spatial dataset of solar irradiation augmented with electricity bills at the building level, the cost and benefit of installing rooftop PV systems for each building is estimated. Additionally, incentives and barriers for adopting those systems are investigated using a probabilistic choice model. The results show that Beirut city has a potential for distributed rooftop solar PV to be between 195 and 295 MWp. However, adoption rates are low at 0.49% and 1.23% for residential and commercial buildings, respectively, reflecting the limitation of financial incentives alone to promote the deployment of distributed renewable energy systems in transition economies. The impact of different incentive policy instruments and the role of solar PV in today's economic crisis in Lebanon is analyzed. The biggest impact was achieved through removing (or lowering) electricity tariff subsidy, although this option remains highly constrained by political calculus. We argue that the Lebanese government should fast-track and implement the required legal framework to facilitate and incentivize distributed power generation from renewable sources to promote both green energy and its financial resilience. The proposed modeling framework together with the results obtained in this study will have important implications for energy policy makers in Lebanon and other transition economies.

A dynamic alternative splicing program regulates gene expression during terminal erythropoiesis.

Alternative pre-messenger RNA splicing remodels the human transcriptome in a spatiotemporal manner during normal development and differentiation. Here we explored the landscape of transcript diversity in the erythroid lineage by RNA-seq analysis of five highly purified populations of morphologically distinct human erythroblasts, representing the last four cell divisions before enucleation. In this unique differentiation system, we found evidence of an extensive and dynamic alternative splicing program encompassing genes with many diverse functions. Alternative splicing was particularly enriched in genes controlling cell cycle, organelle organization, chromatin function and RNA processing. Many alternative exons exhibited differentiation-associated switches in splicing efficiency, mostly in late-stage polychromatophilic and orthochromatophilic erythroblasts, in concert with extensive cellular remodeling that precedes enucleation. A subset of alternative splicing switches introduces premature translation termination codons into selected transcripts in a differentiation stage-specific manner, supporting the hypothesis that alternative splicing-coupled nonsense-mediated decay contributes to regulation of erythroid-expressed genes as a novel part of the overall differentiation program. We conclude that a highly dynamic alternative splicing program in terminally differentiating erythroblasts plays a major role in regulating gene expression to ensure synthesis of appropriate proteome at each stage as the cells remodel in preparation for production of mature red cells.

Rbfox proteins regulate alternative mRNA splicing through evolutionarily conserved RNA bridges.

Alternative splicing (AS) enables programmed diversity of gene expression across tissues and development. We show here that binding in distal intronic regions (>500 nucleotides (nt) from any exon) by Rbfox splicing factors important in development is extensive and is an active mode of splicing regulation. Similarly to exon-proximal sites, distal sites contain evolutionarily conserved GCATG sequences and are associated with AS activation and repression upon modulation of Rbfox abundance in human and mouse experimental systems. As a proof of principle, we validated the activity of two specific Rbfox enhancers in KIF21A and ENAH distal introns and showed that a conserved long-range RNA-RNA base-pairing interaction (an RNA bridge) is necessary for Rbfox-mediated exon inclusion in the ENAH gene. Thus we demonstrate a previously unknown RNA-mediated mechanism for AS control by distally bound RNA-binding proteins.

Altered splicing of Tau in DM1 is different from the foetal splicing process.

Among the different mechanisms underlying the etiopathogenesis of myotonic dystrophy type 1 (DM1), a backward reprogramming to a foetal splicing machinery is an interesting hypothesis. To address this possibility, Tau splicing, which is regulated during development and modified in DM1, was analyzed. Indeed, a preferential expression of the foetal Tau isoform, instead of the six normally found, is observed in adult DM1 brains. By using two cell lines, we show here that the cis-regulating elements necessary to generate the unique foetal Tau isoform are dispensable to reproduce the trans-dominant effect induced by DM1 mutation on Tau exon 2 inclusion. Our results suggest that the mis-splicing of Tau in DM1 is resulting from a disease-associated mechanism.

Asymmetric bias in perception of facial affect among Roman and Arabic script readers.

The asymmetric chimeric faces test is used frequently as an indicator of right hemisphere involvement in the perception of facial affect, as the test is considered free of linguistic elements. Much of the original research with the asymmetric chimeric faces test was conducted with subjects reading left-to-right Roman script, i.e., English. As readers of right-to-left scripts, such as Arabic, demonstrated a mixed or weak rightward bias in judgements of facial affect, the influence of habitual scanning direction was thought to intersect with laterality. We administered the asymmetric chimeric faces test to 1239 adults who represented a range of script experience, i.e., Roman script readers (English and French), Arabic readers, bidirectional readers of Roman and Arabic scripts, and illiterates. Our findings supported the hypothesis that the bias in facial affect judgement is rooted in laterality, but can be influenced by script direction. Specifically, right-handed readers of Roman script demonstrated the greatest mean leftward score, and mixed-handed Arabic script readers demonstrated the greatest mean rightward score. Biliterates showed a gradual shift in asymmetric perception, as their scores fell between those of Roman and Arabic script readers, basically distributed in the order expected by their handedness and most often used script. Illiterates, whose only directional influence was laterality, showed a slight leftward bias.