How women change medicine: a case study in a German hospital

In the last decade, Germany has seen a significant increase in the number of female physicians. Literature on the topic suggests that this so called “feminization of medicine” will engender changes in the profession’s structure and the practice of medicine, resulting in an augmenting demand for part-time work, more women in high level positions and a stronger patient-centered and humane care. In order to analyze how feminization has influenced medicine, I conducted qualitative, semi-structured interviews with 21 male and female physicians holding diverse positions in a department of Surgery, a Breast Center and an Internal and Integrative Medicine department of a hospital in the Ruhr area in Germany. Using qualitative content analysis as an analytical framework, this thesis explains that an increase in the number of women doctors has taken place in the departments, but that this has not yet caused for major transformations to come about. Due to the gendered substructure of the departments, part-time work, with the exception of the complementary and alternative medicine unit in the Breast Center, is difficult to accomplish as is the compatibility of work and family life. Furthermore, clear guidelines on the provision of care leave little room for change in the practice of medicine. Most physicians do not see room to alter matters, with which organizational structures, cultures and practices in the distinct departments are in many facets reproduced instead of transformed. It is, however, not the case that the feminization process has not engendered any change at all. But modifications are only allowed when consonant with the dominant organizational culture, structures and prevalent gender stereotypes. As this thesis shows, the increase in female physicians has thus not automatically caused for qualitative changes to take place. It is rather the interplay between the agency of the physicians and organizational cultures and structures that determines how the increase of female physicians is affecting the organization and practice of care.In den letzten Jahren hat Deutschland einen deutlichen Zuwachs an weiblichen Ärzten erlebt. Gemäß der Literatur zur „Feminisierung der Medizin“ wird der Zuwachs an weiblichen Ärzten die Strukturen im Krankenhaus und die Praxis der Medizin verändern und zu mehr Teilzeitstellen, zu mehr Frauen in Führungspositionen und zu einer humaneren und stärker patientenzentrierten Versorgung führen. Um den Einfluss der Feminisierung auf die Medizin zu analysieren, führte ich qualitative, semi-strukturierte Interviews mit 21 Ärzten und Ärztinnen in verschiedenen Positionen in einer chirurgischen Abteilung, einem Brustzentrum sowie einer Abteilung für Innere und Integrative Medizin in einem Krankenhaus im Ruhrgebiet in Deutschland durch. Unter Verwendung von qualitativer Inhaltsanalyse erläutert diese Thesis, dass es einen deutlichen Anstieg des Ärztinnenanteils in den Abteilungen gegeben hat, aber dass dieser nicht zur großen Transformationen führte. Mit Ausnahme der Sektion der komplementären und alternativen Medizin des Brustzentrums, ist Teilzeitarbeit sowie die Vereinbarung von Arbeit und Familie wegen der gendered Substruktur der Abteilungen schwierig zu verwirklichen. Außerdem lassen klare Leitlinien in der medizinischen Versorgung die praktische Anwendung betreffend wenig Raum für Veränderungen. Dieses führt dazu, dass die Organisationsstrukturen und -kultur und die medizinischen Anwendungsverfahren der Abteilungen in den meisten Fällen reproduziert statt geändert werden. Es ist jedoch nicht so, dass der Feminisierungsprozess gar keine Änderungen nach sich gezogen hat. Die Modifikationen sind allerdings nur erlaubt, wenn sie mit der dominanten Organisationskultur und den generellen Stereotypen harmonieren. Die gestiegene Zahl an Ärztinnen selbst hat also nicht direkt für qualitative Änderungen in die Abteilungen gesorgt, sondern vielmehr bestimmt das Zusammenspiel zwischen ärztlichem Agens und der Organisationsstruktur und –kultur den Effekt der Feminisierung auf die Organisation und die Praxis der Medizin

A dCas9-based system identifies a central role for Ctf19 in kinetochore-derived suppression of meiotic recombination

In meiosis, crossover (CO) formation between homologous chromosomes is essential for faithful segregation. However, misplaced meiotic recombination can have catastrophic consequences on genome stability. Within pericentromeres, COs are associated with meiotic chromosome missegregation. In organisms ranging from yeast to humans, pericentromeric COs are repressed. We previously identified a role for the kinetochore-associated Ctf19 complex (Ctf19c) in pericentromeric CO suppression. Here, we develop a dCas9/CRISPR-based system that allows ectopic targeting of Ctf19c-subunits. Using this approach, we query sufficiency in meiotic CO suppression, and identify Ctf19 as a mediator of kinetochore-associated CO control. The effect of Ctf19 is encoded in its NH2-terminal tail, and depends on residues important for the recruitment of the Scc2-Scc4 cohesin regulator. This work provides insight into kinetochore-derived control of meiotic recombination. We establish an experimental platform to investigate and manipulate meiotic CO control. This platform can easily be adapted in order to investigate other aspects of chromosome biology

Masculine gender affects sex differences in the prevalence of chronic health problems - The Doetinchem Cohort Study

Both (biological) sex and (socio-cultural) gender are relevant for health but in large-scale studies specific gender measures are lacking. Using a masculine gender-score based on 'traditional masculine-connotated aspects of everyday life', we explored how masculinity may affect sex differences in the prevalence of chronic health problems. We used cross-sectional data (2008-2012) from the Doetinchem Cohort Study to calculate a masculine gender-score (range 0-19) using information on work, informal care, lifestyle and emotions. The sample consisted of 1900 men and 2117 women (age: 40-80). Multivariable logistic regressions including age and SES were used to examine the role of masculine gender on sex differences in the prevalence of diabetes, coronary heart disease, CVA, arthritis, chronic pain and migraine. Men had higher masculine gender-scores than women (12.2 vs 9.1). For both sexes, a higher masculine gender-score was associated with lower prevalence of chronic health problems. Diabetes, CHD, and CVA were more prevalent in men, and gender-adjustment resulted in greater sex differences: e.g. for diabetes the OR sex changed from 1.21 (95 %CI 0.93-1.58) to 1.60 (95 %CI 1.18-2.17). Arthritis, chronic pain, and migraine were more prevalent in women, and gender-adjustment resulted in smaller sex differences: e.g. for chronic pain the OR sex changed from 0.53 (95 %CI 0.45-0.60) to 0.73 (95 %CI 0.63-0.86). Gender measured as 'everyday masculinity' is associated with lower prevalence of chronic health problems in both men and women. Our findings also suggest that the commonly found sex differences in the prevalence of chronic health problems have a large gender component

Direct and indirect control of the initiation of meiotic recombination by DNA damage checkpoint mechanisms in budding yeast

Meiotic recombination plays an essential role in the proper segregation of chromosomes at meiosis I in many sexually reproducing organisms. Meiotic recombination is initiated by the scheduled formation of genome-wide DNA double-strand breaks (DSBs). The timing of DSB formation is strictly controlled because unscheduled DSB formation is detrimental to genome integrity. Here, we investigated the role of DNA damage checkpoint mechanisms in the control of meiotic DSB formation using budding yeast. By using recombination defective mutants in which meiotic DSBs are not repaired, the effect of DNA damage checkpoint mutations on DSB formation was evaluated. The Tel1 (ATM) pathway mainly responds to unresected DSB ends, thus the sae2 mutant background in which DSB ends remain intact was employed. On the other hand, the Mec1 (ATR) pathway is primarily used when DSB ends are resected, thus the rad51 dmc1 double mutant background was employed in which highly resected DSBs accumulate. In order to separate the effect caused by unscheduled cell cycle progression, which is often associated with DNA damage checkpoint defects, we also employed the ndt80 mutation which permanently arrests the meiotic cell cycle at prophase I. In the absence of Tel1, DSB formation was reduced in larger chromosomes (IV, VII, II and XI) whereas no significant reduction was found in smaller chromosomes (III and VI). On the other hand, the absence of Rad17 (a critical component of the ATR pathway) lead to an increase in DSB formation (chromosomes VII and II were tested). We propose that, within prophase I, the Tel1 pathway facilitates DSB formation, especially in bigger chromosomes, while the Mec1 pathway negatively regulates DSB formation. We also identified prophase I exit, which is under the control of the DNA damage checkpoint machinery, to be a critical event associated with down-regulating meiotic DSB formation

Budding Yeast Pch2, a Widely Conserved Meiotic Protein, Is Involved in the Initiation of Meiotic Recombination

Budding yeast Pch2 protein is a widely conserved meiosis-specific protein whose role is implicated in the control of formation and displacement of meiotic crossover events. In contrast to previous studies where the function of Pch2 was implicated in the steps after meiotic double-strand breaks (DSBs) are formed, we present evidence that Pch2 is involved in meiotic DSB formation, the initiation step of meiotic recombination. The reduction of DSB formation caused by the pch2 mutation is most prominent in the sae2 mutant background, whereas the impact remains mild in the rad51 dmc1 double mutant background. The DSB reduction is further pronounced when pch2 is combined with a hypomorphic allele of SPO11. Interestingly, the level of DSB reduction is highly variable between chromosomes, with minimal impact on small chromosomes VI and III. We propose a model in which Pch2 ensures efficient formation of meiotic DSBs which is necessary for igniting the subsequent meiotic checkpoint responses that lead to proper differentiation of meiotic recombinants

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

Multiomics in the central Arctic Ocean for benchmarking biodiversity change

Multiomics approaches need to be applied in the central Arctic Ocean to benchmark biodiversity change and to identify novel species and their genes. As part of MOSAiC, EcoOmics will therefore be essential for conservation and sustainable bioprospecting in one of the least explored ecosystems on Earth

Queering and diversifying gender in equality work at European higher education institutions

Against the background of recent changes to EU legislation to meet the demands and needs of LGBTIQ* communities, the authors seek to situate a queered and diversified understanding of gender firmly at the centre of the gender equality discourse in higher education (HE). Based on case examples, the legal and discursive status quo in German and Dutch HE institutions as well as actors' motivations, challenges and opportunities are examined through a queer lens. The results highlight how differently EU legislation is transposed into national law. They also show that change is currently driven by highly motivated individual actors, be they students, gender equality and diversity officers, or individual institutions. We argue that queering and diversifying should be understood and used as modes to reflect on and analyse the processes that lead to heteronormative understandings of gender in HE and to develop strategies that take the complexities of gendered identities and discrimination into account.In den letzten Jahren hat die zunehmende Anerkennung von Forderungen und Bedürfnissen der LGBTIQ* Communities zu Änderungen im EU-Recht beigetragen. Vor diesem Hintergrund plädieren die Autor*innen für ein queeres und damit vielfältiges Verständnis von Gender in den Gleichstellungsdiskursen an Hochschulen. Anhand der Fallbeispiele Deutschland und den Niederlanden werden rechtliche und diskursive Bedingungen sowie die Motivationen, Herausforderungen und Chancen der Akteur*innen im jeweiligen Hochschulsystem aus einer queeren Perspektive betrachtet. Die Beispiele zeigen, wie unterschiedlich die Umsetzung von EU-Richtlinien in nationales Recht erfolgt ist. Sie machen ebenfalls deutlich, dass Veränderungen in den Hochschulen derzeit von hoch motivierten Akteur*innen wie Studierenden, Gleichstellungs- und Diversity-Beauftragten oder einzelnen Einrichtungen angestoßen werden. Als aufeinander aufbauende, analytische Konzepte können "queering" und "diversifying" dazu beitragen, heteronormative Vorannahmen und diskriminierende Prozesse im gleichstellungspolitischen Kontext an Hochschulen zu erkennen. Sie erlauben ferner die Entwicklung von Strategien, die die Komplexität von Geschlechteridentitäten und Diskriminierungen berücksichtigen

Socioeconomic status and mental health during the COVID-19 crisis: are sense of coherence, sense of community coherence and sense of national coherence predictors for mental health?

Background Evidence about the impact of the COVID-19 pandemic on existing health inequalities is emerging. This study explored differences in mental health, sense of coherence (SOC), sense of community coherence (SOCC), sense of national coherence (SONC), and social support between low and high socioeconomic (SES) groups, and the predictive value of these predictors for mental health. participants and procedure A cross-sectional study was conducted using an online survey in the Netherlands in October 2021, comprising a total of 91 respondents (n = 41, low SES; n = 50, high SES). results There were no differences in mental health, SOC, SOCC, SONC, and social support between the groups. SOC was a predictor for mental health in both groups and SOCC for the low SES group. conclusions We found that both SOC and SOCC predict mental health during the pandemic. In the article we reflect on possible pathways for strengthening these resources for mental health