This fully powered randomised controlled trial comparing open and laparoscopic sacrocolpopexy has shown clinical equivalence.

Purpose The culture of the work environment inhibits women’s career success in academic medicine. The lack of clarity and consistency in the definition, measurement, and analysis of culture constrains current research on the topic. The authors addressed this gap by defining the construct of a culture conducive to women’s academic success (CCWAS) and creating a measure (i.e., tool) to evaluate it. Method First, the authors conducted a review of published literature, held focus groups, and consulted with subject matter experts to develop a measure of academic workplace culture for women. Then they developed and pilot-tested the measure with a convenience sample of women assistant professors. After refining the measure, they administered it, along with additional scales for validation, to 133 women assistant professors at the University of Pennsylvania. Finally, they conducted statistical analyses to explore the measure’s nature and validity. Results A CCWAS consists of four distinct, but related dimensions: equal access, work-life balance, freedom from gender biases, and supportive leadership. The authors found evidence that women within departments/divisions agree on the supportiveness of their units but that substantial differences among units exist. The analyses provided strong evidence for the reliability and validity of their measure. Conclusions This report contributes to a growing understanding of women’s academic medicine careers and provides a measure that researchers can utilize to assess the supportiveness of the culture for women assistant professors and that leaders can use to evaluate the effectiveness of interventions designed to increase the supportiveness of the environment for women faculty.

A portable stereocamera linked to a computer has been developed capable of taking photographs in the clinical situation. The accuracy and precision of this system has been measured and compared with direct tracing and simple photography, the two systems currently in use for this type of work. It was found to have a precision of better than 2% and to be accurate to within 1% for edge length and area in models of chronic leg ulcers whose dimensions were known exactly. These results are between five and ten times better than direct tracing and simple photography measured under similar circumstances. When used on patients' ulcers, stereophotogrammetry was found to have a precision of 2% for edge length and 3.4% for area, again between five and ten times more accurate than the other two systems. The accuracy with which an epithelial edge can be identified with the naked eye, a possible limiting factor in any visual measuring system, was measured on fixed preparations of healing wounds on pigs. The mean error was found to be 240 micron with a confidence limit of 440 micron. Finally, the rate of healing of chronic leg ulcers was measured in a clinical trial on patients. Only stereophotogrammetry had errors consistently smaller than the changes being measured in the clinical trial, making it the only system which can validly be used to study rates of healing in this model. It is also able to measure volume to within 5% and is unique in being able to do this noninvasively.

Introduction: Despite advances in addiction research and practice, addiction remains a significant public health problem with strikingly high relapse rates and low treatment retention rates. This study explored whether the concept of addictionas-occupation aligned with the experiences of ten persons with addiction(s), and suggests that further development of a model based on this concept may help to elucidate and address some barriers to addiction recovery services.Methods: Semi-structured interviews were performed to gain descriptions of the occupational lives and first-hand experiences of ten persons with addiction(s). Transcripts were analysed using a qualitative thematic analysis methodology.Results: Seven themes were identified in the data: connection, locus of control, penetration, habituation, identity, motivation, and coping/escape. Participants in this study described their addictions using occupational terms, and addressed both the gains and harms of performing their addictions.Conclusion: Further investigation of experiences of addiction-as-occupation could be useful for informing occupational therapy interventions for substancerelated and addictive disorders. Potential implications and contributions of a conceptual model based on the notion of addiction-as-occupation, as well as areas for future research, are discussed.

Background: Given the persistent disparity in the advancement of women compared with men faculty in academic medicine, it is critical to develop effective interventions to enhance women's careers. We carried out a cluster-randomized, multifaceted intervention to improve the success of women assistant professors at a research-intensive medical school.Materials and Methods: Twenty-seven departments/divisions were randomly assigned to intervention or control groups. The three-tiered intervention included components that were aimed at (1) the professional development of women assistant professors, (2) changes at the department/division level through faculty-led task forces, and (3) engagement of institutional leaders. Generalized linear models were used to test associations between assignment and outcomes, adjusting for correlations induced by the clustered design.Results: Academic productivity and work self-efficacy improved significantly over the 3-year trial in both intervention and control groups, but the improvements did not differ between the groups. Average hours worked per week declined significantly more for faculty in the intervention group as compared with the control group (−3.82 vs. −1.39 hours, respectively, p = 0.006). The PhD faculty in the intervention group published significantly more than PhD controls; however, no differences were observed between MDs in the intervention group and MDs in the control group.Conclusions: Significant improvements in academic productivity and work self-efficacy occurred in both intervention and control groups, potentially due to school-wide intervention effects. A greater decline in work hours in the intervention group despite similar increases in academic productivity may reflect learning to “work smarter” or reveal efficiencies brought about as a result of the multifaceted intervention. The intervention appeared to benefit the academic productivity of faculty with PhDs, but not MDs, suggesting that interventions should be more intense or tailored to specific faculty groups.

The respiratory burst oxidase of neutrophils can be activated in a cell-free system in which plasma membranes, cytosol, Mg2+, and a membrane-perturbing detergent, such as arachidonate or sodium dodecyl sulfate, are all required. Using the technique of preparative isoelectric focusing, the cytosol factor required for oxidase activation was resolved into four components termed C1-C4 with respective pI values of approximately 3.1, 6.0, 7.0, and 9.5. Individually, these components were incapable of activating the oxidase and could only be detected in the presence of suboptimal amounts of normal cytosol that served to supply at least a limited amount of each of the required components. Attempts to activate the oxidase with a combination of the four components failed, suggesting that there might be a yet undetected fifth cytosolic component. Patients with autosomal recessive cytochrome b-positive chronic granulomatous disease (type II CGD) are severely deficient in cytosol factor activity' When added to cytosol samples from two patients with this form of CGD, component C4 restored the ability of each patient's cytosol to activate dormant oxidase. None of the other three cytosol factor components (C1-C3) was effective in this regard, a rinding supported by the direct demonstration that these three components were present in normal amounts in this type of CGD.A different form of type II CGD was identified in a third patient on the basis of complementation studies in which the patient's cytosol was able to activate the oxidase in the cell-free system when mixed with cytosol from one of the first two patients. The defect in this third patient's cytosol could be partially corrected by component C2, but not component C4, obtained from normal cytosol. These findings indicate that the role of cytosol in the activation of the respiratory burst oxidase is more complex than previously appreciated in that at least four cytosolic components appear to be required. Defects in two of these components have now been identified and appear to be responsible for two biochemically distinct forms of CGD.Neutrophils and other professional phagocytic cells are endowed with the capacity to generate extremely reactive derivatives of oxygen for the purpose of destroying virulent microbes (1). The precursor of this family of antimicrobial oxidants is superoxide (°2), an oxygen radical produced by the following reaction: 202 + NADPH-2 0 + NADP+ + H+[1]The enzyme responsible for 0°production is the respiratory burst oxidase, a membrane-bound flavoprotein that is dormant in the unstimulated cell but that becomes catalytically active when the phagocyte is stimulated (2, 3). The toxic nature of 0°and its derivatives necessitates that the phagocyte carefully regulate the production of these compounds in such a way that they are produced only when absolutely necessary.The biochemical mechanism by which the respiratory burst oxidase is regulated remained obscure until the development of cell-free systems in which the oxidase could be activated un...

The superoxide-generating enzyme of human neutrophils, NADPH oxidase, is present in a dormant state in unstimulated neutrophils. It can be converted to an active form in a cell-free system if both the plasma membrane and cytosol fractions are incubated together in the presence of arachidonic acid. This system was used to determine the nature of the biochemical defect in seven patients with the autosomal recessive, cytochrome b-positive form of chronic granulomatous disease (CGD). A severe deficiency in the cytosol factor was identified in each patient. The defective activity was not caused by the presence of an inhibitor, nor could it be restored to normal by combining cytosol fractions from different patients. In contrast, the membrane fractions from all seven patients contained normal levels of NADPH oxidase when activated in the presence of control cytosol. Of family members tested (obligate heterozygotes for this disorder), seven of eight had intermediate levels of cytosol factor activity. The respiratory burst defect in this form of CGD is caused by an abnormality in the cytosolic factor required for NADPH oxidase activation.

BackgroundThere is approximately a 17 % dissatisfaction rate with knee replacements. Calls for tools that can pre-operatively identify patients at risk of being dissatisfied have been widespread. However, it is not known how to present such information to patients, how it would affect their decision making process, and at what part of the pathway such a tool should be used.MethodsUsing focus groups involving 12 participants and in-depth interviews with 10 participants, we examined how individual predictions of outcome could affect patients’ decision making by providing fictitious predictions to patients at different stages of treatment. A thematic analysis was used to analyse the data.ResultsOur results demonstrate several interesting findings. Firstly, patients who have received information from friends and family are unwilling to adjust their expectation of outcome down (i.e. to a worse outcome), but highly willing to adjust it up (to a better outcome). This is an example of the optimism bias, and suggests that the effect on expectation of a poor outcome prediction would be blunted. Secondly, patients generally wanted a “bottom line” outcome, rather than lots of detail. Thirdly, patients who were earlier in their treatment for osteoarthritis were more likely to find the information useful, and it was more likely to affect their decision, than patients later in their treatment pathway.ConclusionThis research suggest that an outcome prediction tool would have most effect targeted towards people at the start of their treatment pathway, with a “bottom line” prediction of outcome. However, any effect on expectation and decision making of a poor outcome prediction is likely to be blunted by the optimism bias. These findings merit replication in a larger sample size.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1165-x) contains supplementary material, which is available to authorized users.