The role of gender in the decision to pursue a surgical career: A qualitative, interview-based study

Background: Previous literature has explored the underrepresentation of women in surgery. However, this research has often been quantitative or limited by considering only the perspectives and experiences of women at more advanced career stages. Here, we use a qualitative methodology and a sample of women and men across the career continuum to identify the role that gender plays in the decision to pursue a surgical career. Methods: We audio-recorded and transcribed semi-structured interviews conducted with 12 women and 12 men ranging in their level of medical training from medical students to residents to staff surgeons. We used Braun and Clarke’s six-step approach to thematic analysis to analyze the data, maintaining trustworthiness and credibility by employing strategies including reflexivity and participant input.  Results: Our findings suggested that the characteristics of surgery and early exposure to the profession served as important factors in participants’ decisions to pursue a surgical career. Although not explicitly mentioned by participants, each of these areas may implicitly be gendered. Gender-based factors explicitly mentioned by participants included the surgical lifestyle and experiences with gender discrimination, including sexual harassment. These factors were perceived as challenges that disproportionately affected women and needed to be overcome when pursuing a surgical career. Conclusions: Our findings suggest that gender is more likely to act as a barrier to a career in surgery than as a motivator, especially among women. This suggests a need for early experiences in the operating room and mentorship. Policy change promoting work-life integration and education to target gender discrimination is also recommended

Cardiovascular disease risk score prediction models for women and its applicability to Asians

Purpose: Although elevated cardiovascular disease (CVD) risk factors are associated with a higher risk of developing heart conditions across all ethnic groups, variations exist between groups in the distribution and association of risk factors, and also risk levels. This study assessed the 10-year predicted risk in a multiethnic cohort of women and compared the differences in risk between Asian and Caucasian women. Methods: Information on demographics, medical conditions and treatment, smoking behavior, dietary behavior, and exercise patterns were collected. Physical measurements were also taken. The 10-year risk was calculated using the Framingham model, SCORE (Systematic COronary Risk Evaluation) risk chart for low risk and high risk regions, the general CVD, and simplified general CVD risk score models in 4,354 females aged 20–69 years with no heart disease, diabetes, or stroke at baseline from the third Australian Risk Factor Prevalence Study. Country of birth was used as a surrogate for ethnicity. Nonparametric statistics were used to compare risk levels between ethnic groups. Results: Asian women generally had lower risk of CVD when compared to Caucasian women. The 10-year predicted risk was, however, similar between Asian and Australian women, for some models. These findings were consistent with Australian CVD prevalence. Conclusion: In summary, ethnicity needs to be incorporated into CVD risk assessment. Australian standards used to quantify risk and treat women could be applied to Asians in the interim. The SCORE risk chart for low-risk regions and Framingham risk score model for incidence are recommended. The inclusion of other relevant risk variables such as obesity, poor diet/nutrition, and low levels of physical activity may improve risk estimation

Pteridopytic diversity in Loolkandura forest

The plant category ferns and fern allies are taxonomically known as Pteridophytes. In Sri Lanka about340 Pteridophytes have been recorded belongs to 29 families. They have ornamental, medicinal andedible values and play an important role in biodiversity of forest understory. Unlike flowering plants,studies on Pteridophytes are Iimited in Sri Lanka. Sri Lanka's first tea plantation has started in Loolkanduraarea but the remaining hilly areas still exists as undisturbed forests with high biodiversity. Howeverlimited studies have been carried out on biodiversity of Loolkandura forest area. Consequently, theobjective of this study was identification ofPteridophytic diversity ofLoolkandura forest area.Three elevation levels (1100, 1300 and 1500 m) were selected along the stream networks and threeplots (each of lOx 10m) from each elevation level were established for sampling. Number of species,their population size and habitats were assessed for each plot. Data were analyzed to identify correlationof species and individuals with elevation levels. A total of 56 Pteridophytes from 19 families wereidentified from studied area. Seventeen percent of Sri Lankan Pteridophytic flora represent in Loolkanduraforest area which consists 3 endemic species (Cyathea walkerae, Meringium macroglossum andDiplazium beddomei). Two main Pteridophytic habitats were identified as lithophytes and terrestrial(terrestrial dense forest, terrestrial open and terrestrial road side). In Loolkandura forest area, bothnumber of families and number of species are in increasing trend with increasing of elevation. Thereare three species namely, {15plenium nomale (R-= 0.69), Metathelypteris flassida (W = 0.54) andPolystichum biaristatum (R -= 0.64) showed significantly positive relationship with number of individualof a specie~ with increasing of elevation from 11,00 to 1500 m. Two species namely Araehniodesaristata (W= 0.69) and Teetaria decurrenee (W= 0.59) showed decreasing trend in number ofindividuals with increasing of elevation. Disturbances to the ecosystem and soil moisture content wereidentified as major parameters to variations of Metathelypteris flassida and Araehniodes aristata.Check Iist for Pteridophytes was prepared for the studied area and impl ications offind ings on conservationand uti Iization of Pteridophytes are discussed.

Pteridophyte flora of Udawattakele forest the past, present and future

Pteridophytes represent an important group in the plant kingdom. Approximately 11,300 Pteridophytespecies have been described worldwide, ofwhich about 360 species have been recorded in Sri Lanka.Most of Sri Lankan Pteridophyte species is concentrated in the understory of the rainforests ofCentral Highlands. Udawattakele forest with 132 ha was one of such highlands (510 m above sealevel) which received special attention by European Pteridologists, even during the colonial era. It hasbeen reported that 13 species are already extinct from Sri Lanka mainly because of various threatsfaced by Pteridophytes. Thus, the objective of this study was to compare the diversity of Pteridophyteflora at present with the previous records and identify possible conservation issues.Species diversity of Pteridophytes at Udawattakele forest in the past was obtained from reviewing ofliterature (Karunarathne, 1986; Sledge, 1950-1981) and observations of preserved specimens at theNational Herbarium. Two line transects (10m x 4000 m) on both side of Lady Horton's Walk wereassessed to identify the present level of Pteridophyte diversity. Almost all Pteridophyte species wereidentified at species level through morphological observations and subsequently with the help of keys.The Lady Horton's Walk was selected for the study, because the majority of Pteridophytes atUdawattakele was concentrated in this area and previous assessments of Pteridophytic diversityhave been conducted in the area. At the selected locations species were counted to identify dominantspecies.According to literature, 25 Ptridophytic species and 4 hybrids (29 taxa) have been collected fromLady Horton '5 Walk in Udawattakele forest. Chronologically 7, 17,2 and 3 taxa have been recordedfrom 1888-1900, 1950-1954, 1973 and 1993, respectively. Out of 29 taxa collected by foreignPteridologists, only preserved specimens of27 taxa have been deposited in the British Museum andthe Kew Herbarium. Karunarathne (1986) recorded 23 Pteridophyte species from the forest. Thepresent study was able to identify 36 Pteridophyte species belong to 9 families and 20 genera from theforest, of which 29 species are common and usually grow on harsh environment in the disturbed areasand roadside banks. Seven species occur in relatively high moist and shaded areas of the forest. Thepresent study was able to record 13 additional species compared to Karaunarathne (1986). However,out of 29 taxa recorded in the literature, 9 species were recorded during the present study. Further, 7species iArthropteris palisotti, Christella hispidula x C. parasitica, Diplazium sylvasticum,Microlepia speluncae, Pronephrium articulatum, Teetaria subtriphylla and T trimenii) had notbeen recorded even in the other parts ofthe country during the last 50 years. The present study wasalso unable to record such species from Udawattakele forest. Out of the above 7 species, two rarespecies namely, Pronephrium artieulatum and Christella hispidula x C. parasitiea had beenrecorded only once over the last century. Such records were also found from Lady Horton's Walk inUdawattakele forest before 50 years.However, at present the Lady Horton's walk has severely been invaded by Myroxylon balsamumsuppressing its native biodiversity. Further, roadside banks of the Lady Horton's walk have very dryconditions. Few wet and shaded areas are also invaded by a naturalized fern species such as Adiantumpulverulent um and it has become dominant species in the area. Such causes may have contributedfor loss of some Pteridophyts species from Udawattakele forest. It is well known that Pteridophytesare very sensitive to changes of environmental conditions and human activities. This raises the issueof necessity of continuous monitoring ofPteridophytic biodiversity for their conservation even withintheir natural habitats.

STATUS OF BIODIVERSITY OF MAHAWELI RIVER AND ITS RIVER BANKS BETWEEN WATAWALA AND GINIGATHHENA

A systematic survey was conducted from January to August 2003 to identify existingmajor habitats, status of biodiversity with respect to flora (flowering plants and fern andfern allies) and fauna (birds and mammals, butterflies, amphibians and freshwater fishspecies), and threats they faced in the Mahaweli river and adjacent river banks betweenWatawala and Nawalapitiya. The flora and fauna were documented using scientificallyvalid techniques.The survey enabled to identify seven major vegetationlhabitats along the Mahaweli riverand its adjacent river banks. They are: river bank habitat with secondary growth; flowingfresh water habitat; ephemeral and perennial small stream water habitat; scrub forestarea; Pinus plantation, homegardens, Albizia dominated abandoned tea plantation, teaplantation, abandoned tea plantation with grassland, and Eucalyptus plantation. Withinthe stretch, a total of 170 species of flowering plants and fern and fern allies belongs to64 families were identified. A total of 18 species of birds (9 families), 16 species ofbutterflies (7 families), 10 species of freshwater fishes (5 families), 16 species of reptiles(7 families), 7 species of amphibians (3 families) and 13 species of mammals (10families) have also been documented.At present, the biodiversity of Mahaweli river and its adjacent river banks hasbeen subjected to several threats, namely pollution due to garbage disposal (mainly atGinigathhena), spread of alien invasive species (mainly at river banks due to Clusiarosea), direct exploitation of species (freshwater fish species), encroachment of bankreservation, unplanned land use practices and small hydropower projects. The criticallyaffected group as a result of these threats is fresh wa•er fish species, which includes 6threatened endemic species. Thus, clear mitigatory measures will be required to avoiddisturbances to such species.

Vulnerable plaques and patients: state-of-the-art

Despite advanced understanding of the biology of atherosclerosis, coronary heart disease remains the leading cause of death worldwide. Progress has been challenging as half of the individuals who suffer sudden cardiac death do not experience premonitory symptoms. Furthermore, it is well-recognized that also a plaque that does not cause a haemodynamically significant stenosis can trigger a sudden cardiac event, yet the majority of ruptured or eroded plaques remain clinically silent. In the past 30 years since the term 'vulnerable plaque' was introduced, there have been major advances in the understanding of plaque pathogenesis and pathophysiology, shifting from pursuing features of 'vulnerability' of a specific lesion to the more comprehensive goal of identifying patient 'cardiovascular vulnerability'. It has been also recognized that aside a thin-capped, lipid-rich plaque associated with plaque rupture, acute coronary syndromes (ACS) are also caused by plaque erosion underlying between 25% and 60% of ACS nowadays, by calcified nodule or by functional coronary alterations. While there have been advances in preventive strategies and in pharmacotherapy, with improved agents to reduce cholesterol, thrombosis, and inflammation, events continue to occur in patients receiving optimal medical treatment. Although at present the positive predictive value of imaging precursors of the culprit plaques remains too low for clinical relevance, improving coronary plaque imaging may be instrumental in guiding pharmacotherapy intensity and could facilitate optimal allocation of novel, more aggressive, and costly treatment strategies. Recent technical and diagnostic advances justify continuation of interdisciplinary research efforts to improve cardiovascular prognosis by both systemic and 'local' diagnostics and therapies. The present state-of-the-art document aims to present and critically appraise the latest evidence, developments, and future perspectives in detection, prevention, and treatment of 'high-risk' plaques occurring in 'vulnerable' patients

High dietary diversity is associated with obesity in Sri Lankan adults: An evaluation of three dietary scores.

Background: Dietary diversity is recognized as a key element of a high quality diet. However, diets that offer a greater variety of energy-dense foods could increase food intake and body weight. The aim of this study was to explore association of diet diversity with obesity in Sri Lankan adults. Methods: Six hundred adults aged > 18 years were randomly selected by using multi-stage stratified sample. Dietary intake assessment was undertaken by a 24 hour dietary recall. Three dietary scores, Dietary Diversity Score (DDS), Dietary Diversity Score with Portions (DDSP) and Food Variety Score (FVS) were calculated. Body mass index (BMI) ≥ 25 kg.m−2 is defined as obese and Asian waist circumference cut-offs were used diagnosed abdominal obesity. Results: Mean of DDS for men and women were 6.23 and 6.50 (p=0.06), while DDSP was 3.26 and 3.17 respectively (p=0.24). FVS values were significantly different between men and women 9.55 and 10.24 (p=0.002). Dietary diversity among Sri Lankan adults was significantly associated with gender, residency, ethnicity, education level but not with diabetes status. As dietary scores increased, the percentage consumption was increased in most of food groups except starches. Obese and abdominal obese adults had the highest DDS compared to non-obese groups (p<0.05). With increased dietary diversity the level of BMI, waist circumference and energy consumption was significantly increased in this population. Conclusion: Our data suggests that dietary diversity is positively associated with several socio-demographic characteristics and obesity among Sri Lankan adults. Although high dietary diversity is widely recommended, public health messages should emphasize to improve dietary diversity in selective food items

Intranasal Delivery of E-Selectin Reduces Atherosclerosis in ApoE−/− Mice

Mucosal tolerance to E-selectin prevents stroke and protects against ischemic brain damage in experimental models of stroke studying healthy animals or spontaneously hypertensive stroke-prone rats. A reduction in inflammation and neural damage was associated with immunomodulatory or “tolerogenic” responses to E-selectin. The purpose of the current study on ApoE deficient mice is to assess the capacity of this stroke prevention innovation to influence atherosclerosis, a major underlying cause for ischemic strokes; human E-selectin is being translated as a potential clinical prevention strategy for secondary stroke. Female ApoE−/− mice received intranasal delivery of E-selectin prior to (pre-tolerization) or simultaneously with initiation of a high-fat diet. After 7 weeks on the high-fat diet, lipid lesions in the aorta, serum triglycerides, and total cholesterol were assessed as markers of atherosclerosis development. We also assessed E-selectin-specific antibodies and cytokine responses, in addition to inflammatory responses that included macrophage infiltration of the aorta and altered gene expression profiles of aortic mRNA. Intranasal delivery of E-selectin prior to initiation of high-fat chow decreased atherosclerosis, serum total cholesterol, and expression of the leucocyte chemoattractant CCL21 that is typically upregulated in atherosclerotic lesions of ApoE−/− mice. This response was associated with the induction of E-selectin specific cells producing the immunomodulatory cytokine IL-10 and immunosuppressive antibody isotypes. Intranasal administration of E-selectin generates E-selectin specific immune responses that are immunosuppressive in nature and can ameliorate atherosclerosis, a major risk factor for ischemic stroke. These results provide additional preclinical support for the potential of induction of mucosal tolerance to E-selectin to prevent stroke

Bio-Repository of DNA in stroke (BRAINS): A study protocol

<p>Abstract</p> <p>Background</p> <p>Stroke is one of the commonest causes of mortality in the world and anticipated to be an increasing burden to the developing world. Stroke has a genetic basis and identifying those genes may not only help us define the mechanisms that cause stroke but also identify novel therapeutic targets. However, large scale highly phenotyped DNA repositories are required in order for this to be achieved.</p> <p>Methods</p> <p>The proposed Bio-Repository of DNA in Stroke (BRAINS) will recruit all subtypes of stroke as well as controls from two different continents, Europe and Asia. Subjects recruited from the UK will include stroke patients of European ancestry as well as British South Asians. Stroke subjects from South Asia will be recruited from India and Sri Lanka. South Asian cases will also have control subjects recruited.</p> <p>Discussion</p> <p>We describe a study protocol to establish a large and highly characterized stroke biobank in those of European and South Asian descent. With different ethnic populations being recruited, BRAINS has the ability to compare and contrast genetic risk factors between those of differing ancestral descent as well as those who migrate into different environments.</p