Gay female-to-male transgenderists (gay FTMs) are women who become men, and who then form erotic relationships with other men. Analysis of interviews with five gay FTMs depicts how they rely upon and reproduce distinctions between sex, gender, and sexuality in order to make sense of their bodies, their feelings and their interactions. Sex, gender and sexuality are produced as distinct and real through a range of interlocking material, discursive, and interactional practices. These categories of intelligibility function in relation to each other and serve to mutually constitute and reinforce each other. Although the distinctions drawn between sex, gender, and sexuality are real, the veracity of these distinctions is limited given their inextricability in the contiguous terrain of actual human lives.
Nerve sheath tumors and meningiomas account for most intradural extramedullary (IDEM) tumors. These tumors are benign and amenable to complete surgical resection. In recent years, these surgeries are performed with intraoperative neurophysiologic monitoring (IONM) in order to minimize neurological injury, but the evidence for the statistical efficacy of this utility is lacking. This paper evaluates IONM benefits in IDEM tumor resection. Data of patients treated surgically for spinal intradural tumors from 1998 to 2003 was previously collected and analyzed. We retrospectively evaluated patients' charts operated in the years 2011 to 2013. Patients' medical files were reviewed including radiological examinations and electrophysiological reports. The data was collected and evaluated. Forty-one cases of meningioma or nerve sheath tumor resection surgery were performed in the study period. The surgical results were compared to 70 cases of historical controls. Demographic data was similar in these two groups. Sensitivity, specificity, and positive and negative predicted values of IONM were 75, 100, 100, and 97%, respectively. New neurological deficit rate was evident in 10 and 14% for the study and control groups, respectively (not significant). While IONM predicts neurological deficits with high accuracy level, this study does not suggest that there is a significant global benefit of IONM in these cases. As reported by others, in this series, the rate of new neurological deficits in non-monitored cases is similar to the monitored cases series; hence, IONM role in preventing new neurological deficits has yet to be proven.
Previous research has found that American patients strongly believe that more testing and more treatment lead to better outcomes and, to a lesser extent, that newer treatments are more effective. We conducted five focus groups with privately insured, healthy, middle-aged Americans (n = 43) to explore these apparent preferences. Contrary to previous research, an unexpected distinction emerged. Participants placed enormous value on testing and screening, reacting with hostility to guidelines recommending less of either. However, they were suspicious of overmedication. The wariness of pharmaceuticals and enthusiasm for testing and screening both appear to reflect participants’ efforts to take responsibility for their health. But recommendations to test and screen less conflicted with their active, engaged, information-seeking roles. Nonetheless, given patients’ concerns about overuse of pharmaceuticals, we maintain that they can learn to understand the connections between over-testing and over-treatment, and can actively choose to do less. We close with suggestions about how treatment guidelines can better communicate these connections to patients. Our findings cannot necessarily be generalized beyond privately-insured, healthy, middle-aged Americans. But because we found that, among these individuals, attitudes towards pharmaceuticals differ from attitudes towards testing and screening, we maintain that future research should also distinguish among and compare attitudes towards different types of medical interventions.
Participatory budgeting (PB)-a democratic process where ordinary residents decide directly how to spend part of a public budget-has gained impressive momentum in US municipalities, spreading from one pilot project in Chicago's 49th ward in 2009 to 50 active PB processes across 14 cities in 2016-2017. Over 93,600 US residents voted in a PB process in 2015-2016, deciding over a total of about $49.5 million and funding 264 projects intended to improve their communities. The vast majority of US PB processes take place in large urban centers (e.g., New York City, Chicago, Seattle, Boston), but PB has also recently spread to some smaller cities and towns [1]. Figure 1 illustrates the growth of PB processes in the USA, and within New York City and Chicago council districts specifically. Fig. 1 Participatory budgeting in the USA has grown from 1 process in 2009-2010 to 50 processes in 2016-2017 PB constitutes a rare form of public engagement in that it typically comprises several distinct stages that encourage residents to participate from project idea collection to project implementation (see Fig. 2). The decisive public vote in US PB is practically binding as elected officials commit to implementing the public decision at the outset of the process. Moreover, all current PB processes in the USA have expanded voting rights to residents under 18 years old and to non-citizens. Under President Obama, the White House recognized PB as a model for open governance. Participatory Budgeting Project, a nonprofit organization that advocates for PB, won the 2014 Brown Democracy Medal, which recognizes the best work being done to advance democracy in the USA and internationally. Fig. 2 Typical stages of a participatory budgeting process in the USA PB has been lauded for its potential to energize local democracy, contribute to more equitable public spending and help reduce inequality [2, 3]. Social justice goals have been explicit in US PB from the start. Grassroots advocates, technical assistance providers, and many elected officials who have adopted it emphasize that PB must focus on engaging underrepresented and marginalized communities [2, 4, 5]. PB steering committees have specified equity and inclusiveness goals in PB rule books [6, 7]. The most conclusive research so far on PB's potential to reduce social inequalities, however, comes from Brazil, where PB started in 1989. In Brazil, PB has been associated with a reduction in extreme poverty, better access to public services, greater spending on sanitation and health services, and, most notably, a reduction in child and infant mortality [8, 9].In this paper, we outline three mechanisms by which PB could affect health disparities in US municipalities: First, by strengthening residents' psychological empowerment; second, by strengthening civic sector alliances; and third, by (re)distributing resources to areas of greatest need. We summarize the theoretical argument for these impacts, discuss the existent empirical evidence, and highlight promising avenues for further research.
Attempts to screen for social determinants of health in pediatrics should be grounded in an understanding of parents’ receptivity to discussing social needs and should be responsive to their concerns about doing so. Yet little research has asked parents, particularly low‐income parents, for their perspectives about social determinants of health and how screenings can be implemented successfully. This research seeks to explore questions including which social stressors concern low‐income parents; what roles these parents think pediatricians could play in addressing social needs; and how these parents think pediatricians should discuss social determinants of health with them. Eight focus groups in New York City with low‐income parents of children ages five years and younger. Each focus group lasted two hours. Two of the groups were conducted in Spanish and six in English. Focus groups were audio recorded and professionally transcribed and translated. The research team collaboratively developed a coding scheme and coded the transcripts using Dedoose software. Low‐income parents of children ages five years and younger in New York City. First, parents in the focus groups cited a broad range of social stressors that affected their children’s health and well‐being, including some that screening tools for social determinants of health may not currently include. Second, the parents did not immediately identify pediatricians as sources of help with social stressors. They saw some topics, such as nutrition, education, and minor behavioral issues, as appropriate to discuss with pediatricians, but others, such as domestic violence, parents’ mental health, and legal issues, as more sensitive. Third, parents’ concerns about discussing sensitive social needs with pediatricians included worries about being judged and discriminated against, fear of intervention by a child welfare agency, lack of time during appointments, and frustration at the prospect of disclosing sensitive information without getting help. Parents’ recommendations for pediatricians about discussing social determinants of health included building trust, choosing the right moment, and making clear that screening is standard protocol. Parents recommended that screening should not take place in front of children. They emphasized that pediatricians should be transparent about what triggers reporting to child welfare. Parents said that if pediatricians ask about sensitive issues, they should be able to offer or suggest help. As social determinants of health screenings become more common in pediatric primary care, pediatricians and their staffs must work with parents to build parents' comfort with disclosing information about social stressors by creating long‐term trusting relationships with them. Attempts to screen for social determinants of health may be more successful if pediatricians develop partnerships with the community organizations and other social service providers that low‐income families may already trust and turn to for information and services for socia...
Trans fats became part of the American food system due to a complex interplay among activism, industrial technology, and nutritional science. Some manufacturers began using partially hydrogenated oils, which contain trans fats, in the early twentieth century. Medical authorities began framing saturated fats as unhealthy in the 1950s. In the 1980s, activist organizations, including the Center for Science in the Public Interest, condemned food corporations’ use of saturated fats and endorsed trans fats as an acceptable alternative. Nearly all targeted corporations responded by replacing saturated fats with trans fats, which fit easily into their existing products. Trans fats thus became the perfect solution to the political problem of saturated fats and to the technical problem of what to use in their place. Activists helped precipitate technological change, but by 1994, trans fats were no longer regarded as a solution. Instead, they became regarded as a new nutritional problem.
Objective : This study aims to evaluate changes in lumbosacral parameters after minimally invasive lumbar interbody fusion. The secondary aim was to evaluate whether interbody cage shape (crescent shaped or rectangular) would influence the results. Method : Retrospective analysis of 70 patients who underwent one or two level lumbar interbody fusion through a minimally invasive posterolateral approach. This included midline preservation and unilateral facetectomy. Pre- and postoperative (three to six months postoperative) radiographs were used for measuring lumbar lordosis (LL), segmental lordosis (SL) at the level of interbody fusion, and sacral slope (SS). Further analyses divided the patients into Roussouly lumbar subgroups. Results : LL was significantly reduced after surgery (59o:39o, p=0.001) as well as the SS (33.8o:31.2o, p=0.05). SL did not change significantly (11.4:11.06, p=0.85). There were no significant differences when comparing patients who received crescent shaped cage (n=27) and rectangular cage (n=43). Hypolordotic patients (Roussouly types 1 and 2) had radiographic improvement in comparison to normolordotic and hyperlordotic groups (types 3 and 4). Conclusion : Minimally invasive lumbar interbody fusion caused reduction in lumbosacral parameters. Cage shape had no influence on the results.
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