Who Will Manage American Patients With Diabetes? Residents’ Career Preferences and Perceptions of Diabetes Care

ObjectiveTo identify the factors that encourage or discourage internal medicine and pediatric residents regarding specializing in endocrinology with a focus on diabetes.MethodsWe conducted an electronic survey of internal medicine and pediatric residents using a $10 participation incentive. A total of 653 residents responded to the survey (estimated response rate of 9.2%)—626 from residency programs that were contacted for our survey and 27 from referrals.ResultsAmong internal medicine and pediatric residents surveyed, 39 respondents (6.0%) planned to specialize in endocrinology, and 27 of these (4.1% of total respondents) planned to focus on diabetes. “Intellectual satisfaction, ” “emotional satisfaction, ” and “work-life balance” were identified by respondents as the most important factors in their choice of a specialty, with ratings of 5.5, 5.4, and 5.3 on a 6-point Likert scale. Among these factors identified as most important to a medical career, endocrinology with a focus on diabetes scored poorly with regard to intellectual and emotional satisfaction but received high ranking with regard to lifestyle. With regard to other factors, endocrinology was rated negatively on “compensation, ” “number of procedures, ” and “patient adherence to prescribed treatment.” Exposure to diabetes during training had no major influence on the decision to enter endocrinology.ConclusionEndocrinology with a focus on diabetes care is not an attractive specialty for most internal medicine and pediatric residents. Therefore, new strategies to attract residents to the field of diabetes care are needed. (Endocr Pract. 2011;17:235-239)     

Portrait of an Outsider: Class,Gender, and the Scientific Career of Ida M. Mellen

In 1916, a 41 year old woman with little formal scientific education became the secretary of the New York Aquarium (NYA). In becoming the Aquarium’s first female officer, Ida M. Mellen realized her lifelong dream of successfully pursuing a career in the biological sciences and broke with the limitations and low expectations surrounding her sex and class backgrounds. By 1930, Mellen left the NYA and pursued a career in popular hobbyist writing, becoming the foremost expert on aquarium fishes and domesticated cats in the United States. Margaret Rossiter and other historians of science have illuminated women’s common career paths in the sciences, but little work has been done on individuals whose gender and class impacted their career. Building on Rossiter’s framework, this case study suggests that class, as much as gender, structured the scientific career of women. Through the narrative of the outsider scientific practitioner, we can more fully illuminate the social structure of scientific work. Examining the struggles of Mellen to enter and maintain a scientific career sheds light, not just on her own career path, but those alternately closed to her. If we wish to understand science in the early twentieth century, especially questions of inclusion and exclusion in the scientific process, we must examine those individuals who operated on the periphery of the “traditional” scientific path.     

The upcoming new elite among children of immigrants: a cross-country and cross-sector comparison

ABSTRACT

The European-born children of immigrants, often referred to as the second generation, play an important role in the academic debate about integration and assimilation. The successful second generation, defined in terms of possessing a higher education diploma and or professional position, receives increasing attention. In this special issue, we will look at the most successful group: the upcoming “elite” among the descendants of migrants from Turkey, based on data gathered in the ELITES, Pathways to Success project. In this research project we deliberately selected on the dependent variable: being professionally successful in managerial jobs in the corporate business sector, the corporate law sector and the education sector.     

Electron cryo-microscopy for elucidating the dynamic nature of live-protein complexes

BackgroundRecent innovations in the field of electron cryo-microscopy (cryo-EM) have achieved structure determination of target macromolecules at “near-atomic resolution”. In addition, cryo-EM has the potential to deal with proteins in multiple conformations in close to physiological conditions.Scope of reviewThis is an overview of the latest technical and methodological developments in cryo-EM, especially key features for elucidating the dynamic nature of specimens.Major conclusionsIt is now possible to elucidate “near-atomic resolution” structures by selecting “well-behaved” particles in Single Particle Analysis (SPA) of cryo-EM images.General significanceCurrently, cryo-EM is utilized actively as an alternative to X-ray crystallography to obtain high-resolution structures of macromolecules, especially those which are hard to crystalize. One possible reason for difficulty in crystallization could be the dynamic nature of the specimen. New developments in the field of cryo-EM will make it possible to deal with specimen heterogeneity and reveal the dynamic nature of specimens.     

Challenges of Work–Life Balance for Women Physicians/Mothers Working in Leadership Positions

BackgroundFemale leadership in medicine is still disproportionately small, which might be due to the barriers of combining work and family.ObjectivesThe aim of this study was, first, to perform a strengths, weakness, opportunities, and threats (SWOT) analysis and, second, to create a strategic concept for career development.MethodsIn this study, all women in leadership positions in the health care system in Vienna, Austria, with at least 1 child (n = 8), were interviewed about the advantages and disadvantages of gender with regard to career development, the strengths and weaknesses of female leadership, and their work–life balance. Different factors that influenced the work–life balance were specified, and career strategies to realize adequate solutions were developed.ResultsThe sporadic focus on career advancement, time-consuming child care, responsibility for family life, and a woman's tendency toward understatement were barriers to career development. Work–family enrichment has a positive spillover effect that spreads positive energy and helps to balance the work–life relationship. For each individual, the allocation and interaction of different resources such as time, money, scope of decision making, and physical, emotional, and social resources, were essential to maintain the individual work–life balance.ConclusionsIn addition to the existing “glass ceiling,” the predominant responsibility for child care is still borne by the woman. However, mentoring programs, coaching, networking, and support of the partner or of other people help to strengthen female “soft” skills and achieve a work–life balance.     

The identification of the seeds and fruits of common Scottish aquatic herbs

Background: There have been few quantitative observations of the attributes of native animal paths and no studies of their variation between vegetation types. These paths may be important in extending the local ranges of plant species.

Aims: To determine the incidence, cover and characteristics of native animal paths in different vegetation types, their relationships with other variables and the influence of paths on plant species distributions.

Methods: Randomly located line transects, and paired quadrats on and adjacent to paths, were used to record path and environmental attributes at 10 sites in each of 10 vegetation types. The relationships between path cover, number, width and depth and potential predictor variables were determined by using Pearsons product moment correlation.

Results: The mean cover of paths in plant communities varied between 6.5% and 12.6%. Path cover, number, width and depth varied between vegetation types. Penetration resistance, bare ground, scat density and plant species richness had higher values in path quadrats than in controls. Within particular vegetation types, several plant species were restricted to paths.

Conclusions: Animal trampling is an important influence on vegetation structure and the distribution of plant species in the study area.     

The Organization and Role Of an Amateur Archeological Society

Abstract

The roles and functions of amateur archeologists and archeological societies are critically assayed in constructive terms.

A lot of ink has been spilled recently about “amateurs”, “pothunters”, “professionals”, “nonprofessionals”, and the like, on the pages of American Antiquity, the Plains Anthropologist and other publications. There is no question whatsoever that many professional archeologists have had unpleasant experiences with nonprofessionals, but my opinion is that the current published comments are doing little to help the situation. I object, not from the standpoint of a nonprofessional archeologist, which I am--one whose feelings have been hurt--but from the standpoint of one who is seriously interested in improving the situation.     

The Rise of Man's Best Friend: The Popularity of Dogs as Companion Animals in Late Eighteenth-Century London as Reflected by the Dog Tax of 1796

ABSTRACT

The history of the relationship between humans and their companion animals is long and more than a little complex. This is in large part due to the special status of these animals. Over the years these animals have evolved socially from that of an impersonal “object” to a “subject,” i.e. a sentient being with a recognized mental and emotional life. Histories of this change in relationship are rare. This is due mainly to a lack of source material; little is available and what there is is rarely reflective of a general population. Recently, records of a 1796 English dog tax have become available and they provide a fairly complete overview of the status of the dog as a companion animal in late eighteenth-century London.

The evidence indicates the dog was very popular as a companion animal in late eighteenth-century English urban society. While some of these creatures were former working-class canines others were what might be described as “professional companion animals” i.e. creatures who had no previous work history. The tax records further indicate that concern as to specific breed was still in the future. Dogs often received a generic title such as “yard dog” or “lapdog” or “housedog.” What is particularly interesting from these records is the number of mixed breed creatures—animals with the title of either “mongrel” or “curr.” (At least three Londoners kept foxes as pets.) There is also an almost total absence of kennels of hunting dogs in eighteenth-century London. Other historical records suggest this to be a recent phenomenon. Lastly, this outline appears to correlate strongly with the literary remarks, material accoutrements, and even religious practices of the late eighteenth-century urban dog population of England.     

Participation of women medical Physicists in European scientific events: The European experience

PurposeThough the number of women scientists is increasing over the years, studies show that they are still under-represented in leadership roles. The purpose of this work is to establish the percentage of women Medical Physicists (wMPs) that have participated in European scientific events and evaluate it as an indication of the current position of women in the field of Medical Physics in Europe and to propose possible ways to encourage their participation.Materials and MethodsData regarding the participants in European scientific events of Medical Physics were collected. The participants were divided into categories according to the program of the events and their gender was identified. The percentage of wMPs in each category was evaluated.ResultsThe participation of wMPs attending courses is greater than 50%. The categories with the greatest participation are “Organizing Committees”, “Chairpersons-Moderators” and “Oral Presentations”. The categories with the lower participation of wMPs are “Scientific Committee”, “Symposiums” and “Invited Speakers”. None of wMPs were represented as “Course Directors”.ConclusionsThe attendance of wMPs in courses is slightly greater than average. However, wMPs do not have an equally important recognition in special invited roles in conferences. They are still under-represented in “Scientific Committees”, “Invited Speakers”, “Symposiums” and “Course directors”. wMPs should be encouraged to participate even more actively in European conferences and the organizing committees should invite more wMPs in special roles. More studies concerning the status of female MPs in each country separately should be encouraged as they will help in understanding the position of wMPS in Europe.     

Systematic review on medicinal plants used for the treatment of Giardia infection

BackgroundHowever, broad adoption of herbal remedies for giardiasis is at present hampered by uncertain findings of investigation not always sufficiently powered. This study was aimed at systematically reviewing the existing literature in herbal medicines to treat giardiasis.MethodsThis review was carried out 06- PRISMA guideline and registered in the CAMARADES-NC3Rs Preclinical Systematic Review and Meta-Analysis Facility (SyRF) database. The search was performed in five databases which are Scopus, PubMed, Web of Science, EMBASE, and Google Scholar without time limitation for all published articles (in vitro, in vivo, and clinical studies). The searched words and terms were: “Giardia”, “giardiasis”, “extract”, “essential oil”, “herbal medicines”, “anti-Giardia”, “In vitro”, “In vivo”, “clinical trial” etc.ResultsOut of 1585 papers, 40 papers including 28 in vitro (70.0%), 7 in vivo (17.5%), 2 in vitro/ in vivo (5.0%), and 3 clinical trials (7.5%) up to 2020, met the inclusion criteria for discussion in this systematic review. The most widely used medicinal plants against Giardia infection belong to the family Lamiaceae (30.0%) followed by Asteraceae (13.5%), Apiaceae (10.5%). The most common parts used in the studies were aerial parts (45.0%) followed by leaves (27.4%) and seeds (7.5%). The aqueous extract (30.0%), essential oil (25.4%) and hydroalcholic and methanolic (10.5%) were considered as the desired approaches of herbal extraction, respectively.ConclusionThe current review showed that the plant-based anti-Giardia agents are very promising as an alternative and complementary resource for treating giardiasis since had low significant toxicity. However, more studies are required to elucidate this conclusion, especially in clinical systems.     

The tax revenue potential of manganese nodules

Abstract

Mounting interest in deep seabed mining has raised high expectations in the tax revenue potential of the future nodule industry. In the absence of any existing commercial nodule mining operation, estimates of the likely “take”; are highly conjectural. This paper develops four alternative estimates for 1985 based on sets of variables on nodule mining, mineral markets and “tax rates”; that range from conservative to overly optimistic. The resulting “take”; from these calculations range from $22 million to $I .2 billion, with the most likely actual figure between 50 and 150 million dollars by 1985.     

Le bilan de compétences: une pratique de conseil en orientation professionnelle pour adultes

The “bilan de compétences” is a career counseling practice which enables people to recognize and utilise their resources to make career-related decisions and manage career-related problems, all along their life-career. This practice lasts 24 hours and is composed of 5 interviews. Within the context of a “modern” conception of the person, the coccupational choice is considered as self enhancement. It is the reason why, during the counseling process — whose main characteristics are presented — the person has to focus on his self concept, values and interests. The results of surveys show that the process of “bilan de compétences” helps the clients to enhance personal self efficacy and to make plans. Throughout the career counseling process, the counsellor uses career guidance tools and techniques which are not only chosen according to theoretical aspects, but also according to professional codes of ethics and philosophical principles.     

Vervet monkeys use paths consistent with context‐specific spatial movement heuristics

Animal foraging routes are analogous to the computationally demanding “traveling salesman problem” (TSP), where individuals must find the shortest path among several locations before returning to the start. Humans approximate solutions to TSPs using simple heuristics or “rules of thumb,” but our knowledge of how other animals solve multidestination routing problems is incomplete. Most nonhuman primate species have shown limited ability to route plan. However, captive vervets were shown to solve a TSP for six sites. These results were consistent with either planning three steps ahead or a risk‐avoidance strategy. I investigated how wild vervet monkeys (Chlorocebus pygerythrus) solved a path problem with six, equally rewarding food sites; where site arrangement allowed assessment of whether vervets found the shortest route and/or used paths consistent with one of three simple heuristics to navigate. Single vervets took the shortest possible path in fewer than half of the trials, usually in ways consistent with the most efficient heuristic (the convex hull). When in competition, vervets' paths were consistent with different, more efficient heuristics dependent on their dominance rank (a cluster strategy for dominants and the nearest neighbor rule for subordinates). These results suggest that, like humans, vervets may solve multidestination routing problems by applying simple, adaptive, context‐specific “rules of thumb.” The heuristics that were consistent with vervet paths in this study are the same as some of those asserted to be used by humans. These spatial movement strategies may have common evolutionary roots and be part of a universal mental navigational toolkit. Alternatively, they may have emerged through convergent evolution as the optimal way to solve multidestination routing problems.     

A National Survey of United States-Based Endocrinologists Who Prescribe Gender-Affirming Hormone Therapy

ObjectiveThe World Professional Association for Transgender Health Standards of Care Version 7 recommended that before initiating gender-affirming hormone therapy (GAHT), patients should seek a psychosocial evaluation from a mental health professional documenting a diagnosis of persistent gender dysphoria. The Endocrine Society published guidelines in 2017 recommending against an obligatory psychosocial evaluation, which was affirmed in the recently published World Professional Association for Transgender Health Standards of Care Version 8 from 2022. Little is known about how endocrinologists ensure appropriate psychosocial assessment for their patients. This study assessed the protocols and characteristics of U.S.-based adult endocrinology clinics that prescribe GAHT.MethodsAn anonymous electronic survey sent to members of a professional organization and the “Endocrinologists” Facebook group was responded by 91 practicing board-certified adult endocrinologists who prescribe GAHT.ResultsThirty-one states were represented by the respondents. Overall, 83.1% of GAHT-prescribing endocrinologists reported accepting Medicaid. They reported working in university practices (28.4%), community practices (22.7%), private practices (27.3%), and other practice settings (21.6%). Overall, 42.9% of the respondents reported that their practice required documentation of a psychosocial evaluation from a mental health professional before initiating GAHT.ConclusionEndocrinologists who prescribe GAHT are divided about requiring a baseline psychosocial evaluation before prescribing GAHT. Further work is needed to understand the impact of psychosocial assessment on patient care and facilitate the uptake of new guidelines into clinical practice.     

Fort Union Porcellanite And Fused Glass: Distinctive Lithic Materials Of Coal Burn Origin On The Northern Plains

Abstract

Among the most common surface indicators of archaeological sites in south central Montana and northern Wyoming are the grey and red porcellanite flakes resulting from tool making activities. Although one of the major lithic materials used by prehistoric inhabitants of the northern plains region, porcellanite’s identity has remained relatively unknown. Amateur and professional archaeologist alike have loosely referred to this material as “metamorphosed siltstone”, “baked shale”, “Powder River chert”, “grey chert”, “fired brick”, “jasper”, etc. Similarly, fused glass is often misrepresented as obsidian. Because of its unique origin, definablearea of occurrence (the western coal region, the European coal fields, and perhaps other coalbearing areas), and its extensive utilization by the prehistoric populations of the region, porcellanite and fused glass deserve additional attention from archaeologists.     

Plan quality and robustness in field junction region for craniospinal irradiation with VMAT

PurposeTo propose a “staggered overlap” technique in volumetric modulated arc therapy (VMAT) for craniospinal irradiation (CSI) and compare the dose distribution and plan robustness with “overlap” technique and “gradient optimization” approach.Methods and Materials6 patients previously treated in our clinic were retrospectively selected. 9 VMAT plans of each patient were optimized with “staggered overlap”, “overlap” and “gradient optimization” in overlapping region of 3 cm, 6 cm, and 9 cm separately. For the “staggered overlap” plan, adjacent field sets were intentionally overlapped by staggering field edges in an appropriate step size to avoid sharp dose gradient. Evaluation metrics including V_95%, D_2%, D_98%, conformity number (CN) and homogeneity index (HI) were employed to evaluate the dose distribution. Moreover, shifts of the upper spinal field isocenter in each direction were performed to simulate junction errors for robustness analysis.ResultsThe CN and HI of VMAT plans with “staggered overlap” were 0.82 (0.811–0.822) and 0.113 (0.112–0.114), while they were 0.778 (0.776–0.782) and 0.131 (0.130–0.131) for plans with “gradient optimization”. In the robustness study, <3% dose deviations were found for 5 mm shifts in lateral and vertical directions with all techniques. In cranial-caudal direction, “overlap” technique created hot spots (D_2% > 170%) and cold spots (D_98% < 44%) in the junction region with 10 mm shifts. The dose deviations were decreased to 22% for plans with “staggered overlap” and 9 cm overlapping region.Conclusion“Staggered overlap” technique provides better plan quality as compared to “gradient optimization” approach and makes the plan more robust against junction errors as compared to “overlap” technique.     

Leaders in Cell Adhesion: An Interview with Richard Hynes,Pioneer of Cell–Matrix Interactions

Abstract

On a recent visit Richard O Hynes, FRS, HHMI, Daniel K. Ludwig Professor for Cancer Research at the Koch Institute for Integrative Cancer Research, MIT, graciously agreed to be interviewed in person for the first in Cell Communication and Adhesion's series on “Leaders in Cell Adhesion”. In this interview we discussed three things: 1) the early role of family, mentors, and luck on his career path; 2) his major discoveries of fibronectin, integrins and the evolution of extracellular matrix proteins; and 3) his role in, and thoughts on, current science policy. This interview reveals his characteristic calmness and infectious optimism, his spontaneous and down to earth sense of humor, and his great ability to place scientific questions in perspective. The interview, carried out on April 30^th 2013 is reported here verbatim with only minor editing for clarity.     

Melatonin: A hormone that modulates pain

AimsMelatonin is a hormone synthesized principally in the pineal gland that has been classically associated with endocrine actions. However, several lines of evidence suggest that melatonin plays a role in pain modulation. This paper reviews the available evidence on melatonin's analgesic effects in animals and human beings.Main methodsA medline search was performed using the terms “melatonin”, “inflammatory pain”, “neuropathic pain”, “functional pain”, “rats”, “mice”, “human”, “receptors”, “opioid” and “free radicals” in combinations.Key findingsThe antinociceptive effect of melatonin has been evaluated in diverse pain models, and several findings show that melatonin receptors modulate pain mechanisms as activation induces an antinociceptive effect at spinal and supraspinal levels under conditions of acute and inflammatory pain. More recently, melatonin induced-antinociception has been extended to neuropathic pain states. This effect agrees with the localization of melatonin receptors in thalamus, hypothalamus, dorsal horn of the spinal cord, spinal trigeminal tract, and trigeminal nucleus. The effects of melatonin result from activation of MT₁ and MT₂ melatonin receptors, which leads to reduced cyclic AMP formation and reduced nociception. In addition, melatonin is able to activate opioid receptors indirectly, to open several K⁺ channels and to inhibit expression of 5-lipoxygenase and cyclooxygenase 2. This hormone also inhibits the production of pro-inflammatory cytokines, modulates GABA_A receptor function and acts as a free radical scavenger.SignificanceMelatonin receptors constitute attractive targets for developing analgesic drugs, and their activation may prove to be a useful strategy to generate analgesics with a novel mechanism of action.     

Mapping the factors that influence the career specialty preferences by the undergraduate medical students

It is often perceived that undergraduate medical students do not select their career specialty until they are graduated. This study aimed to probe the preferences of undergraduate medical students about their career specialty and the factors influencing their choices. A self-administered questionnaire was distributed to 3rd through 5th year undergraduate medical students to record their choices of specialties and to identify the factors that influence their career selection. Out of 220 respondents, 29 (13.2%) students selected General Surgery, 24 (10.9%) Pediatrics, and 18 (8.2%) Internal Medicine as their career specialties; whereas 24 (10.9%) students were not able to select a major specialty. The least popular specialties were Gynecology and Obstetrics, Oncology, Histopathology, Orthopedics, Genetics, Psychology, each selected by one student. One hundred and seventeen (53.1%) thought their selected specialty ‘matched their capabilities’ and 82 (37.2%) perceived their selection as “innovative field in medicine”. Career advice by friends and families and the desire to serve academic institutions could not influence career selection. Career preferences by medical students result from the interplay of a range of factors. General Surgery, Pediatrics and Internal Medicine were the most preferred specialties. The professional grooming programs to target specialties matching the trainees’ capabilities and the specialties with state-of-the-art innovative technologies attract medical undergraduate students. The attained knowledge is vitally important for the policy makers in modifying the existing framework that can cater the popular and favored specialties.     

Actividad de la micafungina contra las biopelículas de Candida

BackgroundMost recalcitrant infections are associated to colonization and microbial biofilm development. These biofilms are difficult to eliminate by the immune response mechanisms and the current antimicrobial therapy.AimTo describe the antifungal of micafungin against fungal biofilms based in the scientific and medical literature of recent years.MethodsWe have done a bibliographic retrieval using the scientific terms “micafungin”, “activity”, “biofilm”, “Candida”, “Aspergillus”, “fungi”, “mycos”*, susceptibility, in PubMed/Medline from the National Library of Medicine from 2006 to 2009.ResultsMost current antifungal agents (amphotericin B and fluconazole) and the new azole antifungals have no activity against fungal biofilms. However, micafungin and the rest of echinocandins are very active against Candida albicans, Candida dubliniensis, Candida glabrata, and Candida krusei biofilms but their activities are variable and less strong against Candida tropicalis and Candida parapsilosis biofilms. Moreover, they have not activities against the biofilms of Cryptococcus y Trichosporon.ConclusionsThe activity of micafungin against Candida biofilms gives more strength to its therapeutic indication for candidaemia and invasive candidiasis associated to catheter, prosthesis and other biomedical devices.