Learning or leaving? An international qualitative study of factors affecting the resilience of female family doctors

Background: Many countries have insufficient numbers of family doctors, and more females than males leave the workforce at a younger age or have difficulty sustaining careers. Understanding the differing attitudes, pressures, and perceptions between genders toward their medical occupation is important to minimise workforce attrition. Aim: To explore factors influencing the resilience of female family doctors during lifecycle transitions. Design & setting: International qualitative study with female family doctors from all world regions. Method: Twenty semi-structured online Skype interviews, followed by three focus groups to develop recommendations. Data were transcribed and analysed using applied framework analysis. Results: Interview participants described a complex interface between competing demands, expectations of their gender, and internalised expectations of themselves. Systemic barriers, such as lack of flexible working, excessive workload, and the cumulative impacts of unrealistic expectations impaired the ability to fully contribute in the workplace. At the individual level, resilience related to: the ability to make choices; previous experiences that had encouraged self-confidence; effective engagement to obtain support; and the ability to handle negative experiences. External support, such as strong personal networks, and an adaptive work setting and organisation or system maximised interviewees’ professional contributions. Conclusion: On an international scale, female family doctors experience similar pressures from competing demands during lifecycle transitions; some of which relate to expectations of the female's ’role’ in society, particularly around the additional personal pressures of caring commitments. Such situations could be predicted, planned for, and mitigated with explicit support mechanisms and availability of workplace choices. Healthcare organisations and systems around the world should recognise this need and implement recommendations to help reduce workforce losses. These findings are likely to be of interest to all health professional staff of any gender

A Character Style Library for Syriac Manuscripts

Paleographers study ancient and historical handwriting in order to learn more about documents of significant interest and their creators. Computational tools and methods can aid this task in numerous ways, particularly for languages and scripts that are not widely known today. One project currently underway seeks to gather a collection of securely dated letter samples from Syriac documents dating between 500 and 1100 CE. The set comprises over 60,000 human selected character samples. This paper gives details on the collection and describes the automatic techniques used to process the initial human input so as to produce high-quality segmented character samples ready for analysis

Sedimentation, elevation and marsh evolution in a southeastern Australian estuary during changing climatic conditions

Mangrove and salt marsh vertical accretion and surface elevation change was measured at Kooragang Island within the Ramsar-listed Lower Hunter estuarine wetlands in New South Wales, Australia, using surface elevation tables and marker horizons over a ten-year period. We surveyed mangrove, salt marsh and a zone of mangrove encroachment into salt marsh. The period of analysis was dominated by El Niño (drought) climatic conditions, though included a series of east coast low pressure systems and associated storms over the central coast of NSW in June 2007. The storms may have initially caused scouring of sediments in the mangrove zone, followed by significant accretion within both the mangrove and salt marsh during the six months following the storms, with most of this accretion corresponding to spring tides several months after the storms. These accretion events were not accompanied by an equivalent elevation change, and robust elevation trends over the study period in mangrove and salt marsh indicate that the storms may have had little impact on the longer-term elevation dynamics within both the mangrove and salt marsh at Kooragang Island. Elevation dynamics in these zones appear to be regulated by vertical accretion over longer time periods and modulated by hydrology at shorter temporal scales. Elevation declined in the mangrove encroachment zone despite continued vertical accretion and we propose that this discrepancy may be associated with expansion of tidal creeks near the zone of mangrove encroachment or loss of salt marsh vegetation. This pattern of encroachment is consistent with observations from sites throughout the region and may be related to climatic perturbations (El Niño Southern Oscillation) rather than directly attributed to the storms

New fields on super Riemann surfaces

A new $(1,1)$-dimensional super vector bundle which exists on any super Riemann surface is described. Cross-sections of this bundle provide a new class of fields on a super Riemann surface which closely resemble holomorphic functions on a super Riemann surface, but which (in contrast to the case with holomorphic functions) form spaces which have a well defined dimension which does not change as odd moduli become non-zero.Comment: 12pp, kcl-th-94-

Gender and ethnicity intersect to reduce participation at a large European hybrid HIV conference.

OBJECTIVE To evaluate how gender and ethnicity of panel members intersect to effect audience participation at a large European hybrid conference. DESIGN An observational cross-sectional study design was used to collect data at the conference and descriptive survey was used to collect data retrospectively from the participants. SETTING European AIDS Clinical Society 18th Conference; a 3223-delegate, hybrid conference held online and in London over 4 days in October 2021. MAIN OUTCOME MEASURES We observed the number and type of questions asked at 12 of 69 sessions and described characteristics of the panel composition by ethnicity, gender and seniority. A postconference survey of conference attendees collated demographic information, number of questions asked during the conference and the reasons for not asking questions. RESULTS Men asked the most questions and were more likely to ask multiple questions in the observed sessions (61.5%). People from white ethnic groups asked >95% of the questions in the observed sessions. The fewest questions were asked in the sessions with the least diverse panels in terms of both ethnicity and gender. Barriers to asking questions differed between genders and ethnicities. CONCLUSIONS Our study aims to provide evidence to help conference organisers improve leadership, equality, diversity and inclusion in the professional medical conference setting. This will support equitable dissemination of knowledge and improve education and engagement of delegates. To our knowledge, this is the first study describing conference participation by both ethnicity and gender in panellists and delegates within a hybrid conference setting

Educational attainment as a modifier for the effect of polygenic scores for cardiovascular risk factors:cross-sectional and prospective analysis of UK Biobank

BACKGROUND: Understanding the interplay between educational attainment and genetic predictors of cardiovascular risk may improve our understanding of the aetiology of educational inequalities in cardiovascular disease. METHODS: In up to 320 120 UK Biobank participants of White British ancestry (mean age = 57 years, female 54%), we created polygenic scores for nine cardiovascular risk factors or diseases: alcohol consumption, body mass index, low-density lipoprotein cholesterol, lifetime smoking behaviour, systolic blood pressure, atrial fibrillation, coronary heart disease, type 2 diabetes and stroke. We estimated whether educational attainment modified genetic susceptibility to these risk factors and diseases. RESULTS: On the additive scale, higher educational attainment reduced genetic susceptibility to higher body mass index, smoking, atrial fibrillation and type 2 diabetes, but increased genetic susceptibility to higher LDL-C and higher systolic blood pressure. On the multiplicative scale, there was evidence that higher educational attainment increased genetic susceptibility to atrial fibrillation and coronary heart disease, but little evidence of effect modification was found for all other traits considered. CONCLUSIONS: Educational attainment modifies the genetic susceptibility to some cardiovascular risk factors and diseases. The direction of this effect was mixed across traits considered and differences in associations between the effect of the polygenic score across strata of educational attainment was uniformly small. Therefore, any effect modification by education of genetic susceptibility to cardiovascular risk factors or diseases is unlikely to substantially explain the development of inequalities in cardiovascular risk

Potential effects of phytoestrogen genistein in modulating acute methotrexate chemotherapy-induced osteoclastogenesis and bone damage in rats

Chemotherapy-induced bone damage is a frequent side effect which causes diminished bone mineral density and fracture in childhood cancer sufferers and survivors. The intensified use of anti-metabolite methotrexate (MTX) and other cytotoxic drugs has led to the need for a mechanistic understanding of chemotherapy-induced bone loss and for the development of protective treatments. Using a young rat MTX-induced bone loss model, we investigated potential bone protective effects of phytoestrogen genistein. Oral gavages of genistein (20 mg/kg) were administered daily, for seven days before, five days during, and three days after five once-daily injections (sc) of MTX (0.75 mg/kg). MTX treatment reduced body weight gain and tibial metaphyseal trabecular bone volume (p < 0.001), increased osteoclast density on the trabecular bone surface (p < 0.05), and increased the bone marrow adipocyte number in lower metaphyseal bone (p < 0.001). Genistein supplementation preserved body weight gain (p < 0.05) and inhibited ex vivo osteoclast formation of bone marrow cells from MTX-treated rats (p < 0.001). However, MTX-induced changes in bone volume, trabecular architecture, metaphyseal mRNA expression of pro-osteoclastogenic cytokines, and marrow adiposity were not significantly affected by the co-administration of genistein. This study suggests that genistein may suppress MTX-induced osteoclastogenesis; however, further studies are required to examine its potential in protecting against MTX chemotherapy-induced bone damage

Effects of resveratrol supplementation on methotrexate chemotherapy‐induced bone loss

Intensive cancer chemotherapy is known to cause bone defects, which currently lack treatments. This study investigated the effects of polyphenol resveratrol (RES) in preventing bone defects in rats caused by methotrexate (MTX), a commonly used antimetabolite in childhood oncology. Young rats received five daily MTX injections at 0.75 mg/kg/day. RES was orally gavaged daily for seven days prior to, and during, five‐day MTX administration. MTX reduced growth plate thickness, primary spongiosa height, trabecular bone volume, increased marrow adipocyte density, and increased mRNA expression of the osteogenic, adipogenic, and osteoclastogenic factors in the tibial bone. RES at 10 mg/kg was found not to affect bone health in normal rats, but to aggravate the bone damage in MTX‐treated rats. However, RES supplementation at 1 mg/kg preserved the growth plate, primary spongiosa, bone volume, and lowered the adipocyte density. It maintained expression of genes involved in osteogenesis and decreased expression of adipogenic and osteoclastogenic factors. RES suppressed osteoclast formation ex vivo of bone marrow cells from the treated rats. These data suggest that MTX can enhance osteoclast and adipocyte formation and cause bone loss, and that RES supplementation at 1 mg/kg may potentially prevent these bone defects

Mendelian randomisation for mediation analysis: current methods and challenges for implementation

Mediation analysis seeks to explain the pathway(s) through which an exposure affects an outcome. Traditional, non-instrumental variable methods for mediation analysis experience a number of methodological difficulties, including bias due to confounding between an exposure, mediator and outcome and measurement error. Mendelian randomisation (MR) can be used to improve causal inference for mediation analysis. We describe two approaches that can be used for estimating mediation analysis with MR: multivariable MR (MVMR) and two-step MR. We outline the approaches and provide code to demonstrate how they can be used in mediation analysis. We review issues that can affect analyses, including confounding, measurement error, weak instrument bias, interactions between exposures and mediators and analysis of multiple mediators. Description of the methods is supplemented by simulated and real data examples. Although MR relies on large sample sizes and strong assumptions, such as having strong instruments and no horizontally pleiotropic pathways, our simulations demonstrate that these methods are unaffected by confounders of the exposure or mediator and the outcome and non-differential measurement error of the exposure or mediator. Both MVMR and two-step MR can be implemented in both individual-level MR and summary data MR. MR mediation methods require different assumptions to be made, compared with non-instrumental variable mediation methods. Where these assumptions are more plausible, MR can be used to improve causal inference in mediation analysis. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10654-021-00757-1