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The purpose of this study was to explore career satisfaction and advancement for women in academic surgery. A 48-item web-based survey was emailed to women surgeons in academic centers across Canada, exploring career advancement, family planning, mentorship, discrimination, and career satisfaction. The survey response rate was 38% (81 of 212); 18% of participants felt they experienced gender discrimination in medical school, 36% in residency, 12% in fellowship, and 41% as staff surgeons. More than half felt that their gender had played a role in the career challenges they faced. Responses to open-ended questions suggested that many surgeons struggled to balance their academic careers with family life. Despite this, participants rated their career satisfaction very highly. There remain ongoing challenges for women in academic surgery including lack of gender equality, appropriate mentorship, and accommodations for surgeons with families. Continued advancement of women in academic surgery is dependent on addressing these concerns.

Superparamagnetic iron oxide nanoparticles (SPIONs) offer promising applications in nanomedicine due to their appealing properties. Their magnetic and magnetic hyperthermia properties are considered as relevant tools for low invasive cancer therapeutic applications. In this work, we report on the synthesis of polyhedral core–shell SPIONs. Their size was tuned to improve their magnetic properties. Furthermore, by hybridizing into a core–shell inorganic/inorganic structure, the nanoparticles can achieve significantly improved magnetic-to-thermal energy conversion efficiency (at least tenfold). The designed core NPs are composed of a Zn 0.4 Fe 2.6 O 4 core and a MnFe 2 O 4 shell. Their size and morphology were determined by transmission electron microscopy, Fourier-transform infrared spectroscopy was used to investigate their chemical composition. The iron oxide phase was confirmed by Mössbauer analysis, and the magnetic properties were studied to select the ideal size for magnetic hyperthermia application.

Mammography is the primary imaging modality for screening of breast cancer and evaluation of breast lesions (T staging). Ultrasonography is an adjunctive tool for mammographically suspicious lesions, in patients with mastopathy and as guidance for reliable histological diagnosis with percutaneous biopsy. Dynamic enhanced magnetic resonance mammography (MRM) has a high sensitivity for the detection of breast cancer, but also a high false positive diagnosis rate. In the literature, MRM is reported to have a sensitivity of 86-96%, a specificity of 64-91%, an accuracy of 79-93%, a positive predictive value (PPV) of 77-92% and a negative predictive value (NPV) of 75-94%. In unclarified cases, metabolic imaging using fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) can be performed. In the literature, FDG PET is reported to have a sensitivity of 64-96%, a specificity of 73-100%, an accuracy of 70-97%, a PPV of 81-100% and an NPV of 52-89%. Furthermore, PET or PET/CT using FDG has an important role in the assessment of N and M staging of breast cancer, the prediction of tumour response in patients with locally advanced breast cancer receiving neoadjuvant chemotherapy, and the differentiation of scar and cancer recurrence. Other functional radionuclide-based diagnostic tools, such as scintimammography with sestamibi, peptide scintigraphy or immunoscintigraphy, have a lower accuracy than FDG PET and, therefore, are appropriate only for exceptional indications.

High rates of hospital revisits after pediatric appendectomy are costly to the health care system, patients, and families. We sought to trial a bundle of interventions targeted at reducing the rate of unnecessary revisits to hospital in this population. In February 2021, a working group of relevant stakeholders was created. In June 2021, the group developed and implemented interventions to reduce revisits in a staggered fashion. Interventions included increased education provided to patients and their families, as well as nursing staff, revised discharge pamphlets, and a post-discharge phone call from our nurse practitioner. We tracked revisit rates prospectively using run charts with comparison to historical controls. We tracked revisit rates from July 2018 to October 2022. A total of 793 appendectomies were performed. There was a downward trend in revisit rates, from 16.7% before interventions to 13.4% after intervention implementation, for a relative reduction of 20%. In the postintervention period, 193 appendectomies were performed, with 78.0% contacted by our nurse practitioner in the early postoperative period. Of those contacted, 74% received the discharge pamphlet and 98.7% of respondents expressed that the phone call was useful. Almost all respondents stated they would want the follow-up phone call if they were to have another child with appendicitis. Simple, low-cost interventions aimed at improving education at time of discharge after pediatric appendectomy were associated with a reduction in unnecessary hospital revisits. Ongoing efforts are required to sustain results and assess efficacy of bundle elements to determine if additional initiatives may be beneficial in further reductions of revisits.

The goal of this study was to investigate what is known about the demographic characteristics of Twitter influencers in academic medicine. We conducted a literature search and scoping review exploring the demographic characteristics of Twitter influencers in academic medicine. Included studies evaluated Twitter influence by any metric and reported associated demographic characteristics. There were no date or language restrictions. Data points included metrics of influence, demographics, and study characteristics. From 1656 records, thirteen met inclusion criteria. Influence was variably defined based on followers, measures of centrality, measures of engagement, or through third-party software. Studies were conducted at single time points and relied heavily on facial recognition for classification of sex or gender, with no studies exploring race as a variable of interest. Twitter influencers in academic medicine were found to be disproportionately male: significantly fewer influencers were female at all levels of professional status. Two studies identified more female influencers among trainee populations. Female users were less likely to develop influence based on followers, retweets, likes, or other measures of engagement at academic meetings, despite equal or greater representation at these meetings. Results on associations between Twitter influence and number of publications or h-index varied considerably. No included studies explored race or ethnicity in relation to Twitter influence, which presents a significant gap in the literature. Our findings highlight the need for larger, user-engaged studies of inequities related to social media influence in academic medicine, especially as social media is increasingly incorporated into academic portfolios.

For vulnerable groups in society, water insecurity and deficient water availability for food production commonly reflect unequal distribution of water volumes, quality, and services within unequal power structures. Water security is necessarily a political dilemma. Policy debates, however, tend to naturalize and de-politicize this concept. Instead of recognizing that water security and distribution belong to the realm of human interests, choices, negotiation, and power plays, they are often represented as following universal economic, legal, and natural-scientific rules. In this context, there is a widespread policy assumption that formally recognizing local, customary water rights is one important element to grant water security for marginalized user groups. This paper challenges this assumption and examines the illustrative case of a Peruvian Andes community, Yanque. We scrutinize formalization policies that claim to enhance water security for marginalized communities regarding (1) material water allocation and (re)distribution and (2) water rulemaking, legitimate authority, and cultural-political organization—both elements that stand central in formalization processes. We discuss the complex relationship between formal and alternative \"water securities\" and the cultural politics of rights recognition and show that uncritical formalization of local water rights often leads to weakening rather than strengthening local water security.

The mevalonate-independent methylerythritol phosphate pathway is widespread in bacteria. It is also present in the chloroplasts of all phototrophic organisms. Whereas the first steps, are rather well known, GcpE and LytB, the enzymes catalyzing the last two steps have been much less investigated. 2-C-Methyl-D-erythritol 2,4-cyclodiphosphate is transformed by GcpE into 4-hydroxy-3-methylbut-2-enyl diphosphate, which is converted by LytB into isopentenyl diphosphate or dimethylallyl diphosphate. Only the bacterial GcpE and LytB enzymes have been investigated to some extent, but nothing is known about the corresponding plant enzymes. In this contribution, the prosthetic group of GcpE from the plant Arabidopsis thaliana and the bacterium Escherichia coli has been fully characterized by Mössbauer spectroscopy after reconstitution with 57FeCl3, Na2S and dithiothreitol. It corresponds to a [4Fe-4S] cluster, suggesting that both plant and bacterial enzymes catalyze the reduction of 2-C-methyl-D-erythritol 2,4-cyclodiphosphate into (E)-4-hydroxy-3-methylbut-2-enyl diphosphate via two consecutive one-electron transfers. In contrast to the bacterial enzyme, which utilizes NADPH/flavodoxin/flavodoxin reductase as a reducing shuttle system, the plant enzyme could not use this reduction system. Enzymatic activity was only detected in the presence of the 5-deazaflavin semiquinone radical.

Coxsackievirus B3-induced myocarditis in different immunocompetent mouse strains was used as a model to investigate interrelationships between virus replication and development of chronic enteroviral heart disease. Using in situ hybridization to detect enteroviral RNA, we show that heart muscle infection is not only detected in acute myocarditis but is also detected during the chronic phase of the disease. Coxsackievirus B3 could evade immunological surveillance in a host-dependent fashion, thus inducing a persistent infection of the myocardium in association with ongoing inflammation. Patterns of acute and persistent myocardial infection were quantitatively assessed in one representative mouse strain (A.CA/SnJ, H-2f) by applying computer-assisted digital image processing; these patterns were then related to the extent of myocardial tissue damage as well as to inflammation. We observed a strong correlation, both spatial and temporal, between viral replication and development of myocardial lesions, indicating that acute and chronic myocardial injuries are a consequence of multifocal organ infection. Analysis of strand-specific in situ hybridization revealed that viral replication in persistent infection is restricted at the level of RNA synthesis. The described procedure for quantitating organ infection provides a powerful tool for evaluating virus-host interactions and will be of particular interest to those studying human enterovirus-induced cardiomyopathies.

The work investigates the initial corrosion attack on a low alloyed steel and a stainless steel in a 2 MW test gasifier. The gasifier environment generates homogenous deposits that consist mainly of carbon containing species, potassium sulphate, potassium chloride and zinc sulphide. The stainless steel exhibits better corrosion resistance compared to the low alloyed steel and the analysis indicates a protective thin scale covering parts of the surface after 4 h exposure. However, in some areas the oxide scale has lost its protective properties and thicker oxide scales are seen. The thick oxide islands consist of an inward growing Fe,Cr,Ni oxide and an outward growing iron oxide. The low alloyed steel shows a more homogenous and faster initial corrosion attack. The thick scales exhibit a sharp straight line in the middle of the scale that separates the bottom spinel oxide from the outer iron rich parts of the scale. It is considered that this flat interface corresponds to the original sample surface.

IntroductionSelf-management (SM) may facilitate patient participation and involvement to become active and knowledgeable partners in the care of complex chronic conditions such as ventricular assist device (VAD) therapy. The ‘SM model for patients on VAD support’ will serve to distinguish between SM components, and will guide the development, implementation and evaluation of an evidence-based curriculum.Methods and analysisThis is a 3-phase, multicentre study. In phase 1, a prevalence study will be performed. Phase 2 aims to develop an evidence-based, interprofessional curriculum for SM support for VAD patients. In phase 3, a non-blinded block-randomised controlled trial (RCT), allocation ratio 1:1, intervention group superiority, with an unblinded multifacetted intervention with assessments before (T1) and after (T2) the intervention, and two follow-up assessments at three (T3), and 12 (T4) months after VAD implantation, will be performed. The curriculum guides the intervention in the RCT. Patient recruitment will consider centre-related volume: power analyses require 384 patients for phase 1, and 142 patients for phase 3.Ethics and disseminationEthical considerations will be continuously taken into account and approved by the institutional review boards. Central ethical review board approval has been obtained by the Albert-Ludwigs University Freiburg. This study will be performed in concordance with the Declaration of Helsinki and the European data protection law. Publications will exclusively report aggregated data and will be distributed in the scientific community, and patient support groups. Report languages will be German and English.Trial registration numbersNCT04234230 and NCT04526964; Pre-results.