Group Experience Research Articles

Variability in sonographic anterior drawer test measurements of the ankle: Experienced versus beginner examiners

BackgroundThis study aimed to clarify the variability in the measurements of stress sonography of the ankle and determine the effects of examiner experience on the measurements. MethodsTwenty examiners (10 experienced and 10 beginners) were included in the study. Each examiner performed stress ultrasonography on a patient with a chronic anterior talofibular ligament injury and a patient with an intact ligament using the reverse anterior drawer method. Changes in ligament length before versus after stress were determined. The same 20 examiners performed ultrasonography on two other patients with an injured or intact ATFL using the anterior drawer method. The length change values and variance were compared between the groups using t-tests and F-tests. ResultsUsing the reverse anterior drawer method, the change in the anterior talofibular ligament length was 3.3 mm (range, 2.2–4.8 mm) in the experienced group and 2.7 mm (0.0–4.1 mm) in the beginner group for the ligament injured patient. The length changes for the patient with intact anterior talofibular ligament were 0.5 mm (0.1–0.9 mm) and 0.4 mm (−0.1–1.5 mm) in the experienced and beginner groups, respectively. There were no significant intergroup differences in measurement amount (P = 0.37) or variance (P = 0.72). Similarly, using the anterior drawer method, no significant differences between the groups were found in measurement amount or variance. ConclusionThe quantitative evaluation of stress sonography of the ankle was variable regardless of examiner experience or stress method, particularly in patients with an anterior talofibular ligament injury. The amount of variability appeared to be unacceptably large for clinical application. Our study results highlight the need for technical standardization.

Исследование основных свойств пушных шкурок, полученных от самок норки с различной степенью интенсивности инвазии эймериями

The article analyzes the obtained results of the study of indicators of some commodity properties and evaluation of quality of female female mink of cellular breeding, obtained from animals with different intensity of invasion of eumeriosis. Infection of the female mink by eumeriosis is a significant reason for stopping the growth of young mink, as well as increasing its waste and changing the quality of the hair. The material for the study was the skins of female mink cellular breeding of the standard dark brown (STK) color type with various degrees of invasion from the animal husbandry of the Kaliningrad region of the North-Western region of the Russian Federation, divided into four experienced groups: the first group of pelts – from clinically healthy animals, the second group of pelts – from patients of mink with a low degree of invasion intensity, the third group of pelts – from patients with eumeriosis of mink with a medium degree of invasion, the fourth group of pelts are from highly invasive Mink eumeriosis patients. The analysis of the results of the study of indicators of natural and true length and thickness of hair, height and thickness of hair, area of female mink skins with different degrees of invasion is presented.

COMPARISON OF THE EFFICACY OF INSERTING MIDLINE CATHETERS BY EXPERIENCED AND INEXPERIENCED NURSES: A RETROSPECTIVE OBSERVATIONAL STUDY

Aim: The purpose of this retrospective observational study was to compare peripheral venous cannulation performed under ultrasound guidance by expe-rienced and inexperienced nurses. Material and Methods: The observational study was retrospective. Analysis was done of eighty-seven charts of successful ultrasound-guided cannulations performed by experienced and inexperienced operators over a 5-month period. Results: In the experienced group, an average of 1.31 puncture attempts were performed (median=1), and in the inexperienced group that number was 1.42 (median=1). One attempt was enough for 76.6% (n=36) and 72.5% (n=29) of cannulations, respectively. Experienced nurses needed statistically signif i cantly less time to successfully puncture a vessel (p=0.003). Conclusions: Implementing the procedure of inserting midline catheters under ultrasound guidance should be based on properly conducted training and supervised clinical experience. Performing an adequate number of cannulations during training reduced the time required for the procedure and decreased the number of failures. Completing 20 to 50 cannulations during the course makes it possible to achieve a high success rate of vascular access insertion with a minimum number of attempts.

The experience of introducing telepathology in Mongolia

BackgroundAnatomical pathology care services play an essential role in cancer diagnosis through histological analysis, effective treatment of patients, and determination of prognosis. Therefore, quality control is necessary for the diagnosis of pathology. Based on this need, telepathology technology is rapidly developing in the world. This study aimed to share the experience of implementing telepathology case consultation between Mongolian and Japanese expert pathologists. MethodsThe study included 173 cases that required telepathology consultation, which was complicated and doubtful in diagnosis, submitted by Mongolian pathologists between May 2019 and April 2022. The scanned digital slides were transmitted with the help of the LOOKREC cloud-based system, and the expert pathologists of Hiroshima University Hospital, Japan, browsed the images through the data on the internet and their advice and made a mutual diagnosis. ResultsDuring the study period, 173 cases were consulted. Out of 58.4% of all cases, consultation reports were released in 2022. The majority of the cases in 2020 had a mean standard deviation turn-around time of 4.2±6.2 days. The most cases were from the lung and mediastinum were 29.4%, followed by head and neck at 12.6%, the bone at 11.9%, lymph nodes at 8.4%, GIT at 7.7%, soft tissues at 6.3%, etc. Comparing the sample submission of biopsy and cytology was significantly higher in the under 10 years of an experienced group than over 10 years of an experienced group (p<.005). The diagnostic agreement between submitter Mongolian pathologists and expert Japanese pathologists was 82.7%, and disagreement was 17.3% of all cases, with a sensitivity of 67.3% and specificity of 85.5%. ConclusionsTelepathology could save many lost opportunities and play an essential role in developing quality control and surgical pathology in Mongolia. This digital technology and the appropriate strategy and policy of the government could accelerate the overall pathology field development.

Something Beautiful and Powerful: Politics, Art, and Bread and Puppet Theater

Something Beautiful and Powerful: Politics, Art, and Bread and Puppet Theater

Comparison of accuracy between free-hand and surgical guide implant placement among experienced and non-experienced dental implant practitioners: an in vitro study.

This study investigated the accuracy of free-hand implant surgery performed by an experienced operator compared to static guided implant surgery performed by an inexperienced operator on an anterior maxillary dental model arch. A maxillary dental model with missing teeth (No. 11, 22, and 23) was used for this in vitro study. An intraoral scan was performed on the model, with the resulting digital impression exported as a stereolithography file. Next, a cone-beam computed tomography (CBCT) scan was performed, with the resulting image exported as a Digital Imaging and Communications in Medicine file. Both files were imported into the RealGUIDE 5.0 dental implant planning software. Active Bio implants were selected to place into the model. A single stereolithographic 3-dimensional surgical guide was printed for all cases. Ten clinicians, divided into 2 groups, placed a total of 60 implants in 20 acrylic resin maxillary models. Due to the small sample size, the Mann-Whitney test was used to analyze mean values in the 2 groups. Statistical analyses were performed using SAS version 9.4. The accuracy of implant placement using a surgical guide was significantly higher than that of free-hand implantation. The mean difference between the planned and actual implant positions at the apex was 0.68 mm for the experienced group using the free-hand technique and 0.14 mm for the non-experienced group using the surgical guide technique (P=0.019). At the top of the implant, the mean difference was 1.04 mm for the experienced group using the free-hand technique and 0.52 mm for the non-experienced group using the surgical guide technique (P=0.044). The data from this study will provide valuable insights for future studies, since in vitro studies should be conducted extensively in advance of retrospective or prospective studies to avoid burdening patients unnecessarily.

Outcomes of Distal Pancreatectomy With Celiac Axis Resection for Pancreatic Cancer.

This study aimed to show the clinical and oncologic outcomes of distal pancreatectomy with celiac axis resection (DP-CAR) from a high-volume single center and analyze them from diverse perspectives. Forty-eight patients with pancreatic body and tail cancer with celiac axis involvement who underwent DP-CAR were included in the study. The primary outcome was morbidity and 90-day mortality, and the secondary outcome was overall survival and disease-free survival. Morbidity (Clavien-Dindo classification grade ≥3) occurred in 12 patients (25.0%). Thirteen patients (27.1%) had pancreatic fistula grade B and 3 patients (6.3%) had delayed gastric emptying. The 90-day mortality was 2.1% (n = 1). The median overall survival was 25.5 months (interquartile range, 12.3-37.5 months) and median disease-free survival was 7.5 months (interquartile range, 4.0-17.0 months). During the follow-up period, 29.2% of participants survived for up to 3 years and 6.3% survived for up to 5 years. Despite its associated morbidity and mortality, DP-CAR should be considered as the only therapeutic option for pancreatic body and tail cancer with celiac axis involvement when carried out on carefully selected patients performed by a highly experienced group.

The comparative analysis of efficacy and safety parameters of Insulin Degludec versus Insulin Glargine: A Narrative Review

Background and aim: Insulin degludec and insuline glargine are the two long-acting insulins most commonly prescribed for the treatment of Diabetes Type 1 as well as Diabetes Type 2. Both insulins were generated to address a clinical need for the basal insulin which produces a more even and flat activity profile and reduces the number of hypoglycemia- a dangerous side effect of insulin therapy. Although glargine and degludec confirmed their superiority in terms of reduced rate of hypoglycemia, especially in comparison with first generations, several studies revealed that degludec is associated with less glycemic variability. Moreover, degludec is more effective in reaching better fasting plasma glucose levels without increasing a risk of nocturnal hypoglycemia. The aim of this study is to compare the five most essential efficacy and safety parameters of insulin degludec versus insulin glargine. Methods: This study used a narrative synthesis of the research findings. The search for existing narrative and systematic reviews on the research topic was conducted through PubMed, Embase, and Google Scholar electronic databases. Reviews were selected according to a study design and methodological quality of the included studies. The reviews published within 2015-2023 period were included. The data on five safety and efficacy parameters (the reduction of fasting plasma glucose level, HbA1c levels, overall and nocturnal hypoglycemia episodes, body weight gain) were retrieved for the analysis. Findings: The analysis of data retrieved out of 10 systematic reviews confirmed superiority of insulin degludec in comparison with insulin glargine in terms of four safety and efficacy parameters. The treatment with degludec was associated with fewer overall and nocturnal hypoglycemia episodes, a better reduction of fasting plasma glucose levels in both Diabetes Type 1 and Diabetes Type 2 groups (insulin naïve and experienced) patients, less weight gain in Diabetes Type 2 insulin experienced group and Diabetes Type 1 groups. Both insulins provided a similar reduction of HbA1c levels among patients with Diabetes Type 1 and Diabetes Type 2. Conclusion: In conclusion, this narrative review revealed that insulin degludec is superior to insulin glargine in terms of four safety and efficacy parameters such as change in fasting plasma glucose, body weight gain, nocturnal and overall hypoglycemia episodes. Degludec and glargine produced similar changes in HbA1c levels. The most pronounced differences in almost all the examined reviews were detected in the variables indicating nocturnal and overall hypoglycemia. The treatment with degludec also resulted in less hypoglycemia, accompanied with a better reduction of fasting plasma glucose levels. This characteristic confirms that degludec produces less glycemic variability and a close to physiological activity profile.

간호대학생의 학습성과기반 온라인 프로그램러닝을 이용한 온라인 실습과 현장중심 지역사회간호실습의 비교연구

Purpose : This study was to compare the effects of field experienced practice program and online based practice program in community health nursing. Method : This is a descriptive investigative design comparing two groups of nursing students who participated in online based practice and field experienced practice. The subjects consisted of 95 students in each group, who were 3rd year students. The data were analyzed through the SPSS 24.0 version program. Results : 27.3% of the field experienced practice group and 18.9% of the online based practice group changed their career path to becoming a public official in nursing after practice. There was no significant difference between the two groups in terms of the awareness of program outcome-based practice content suitability. There was no significant difference degree of achievement on course between the field experienced practice group and the online based practice group. Among the program outcomes, the online based group had a significantly higher level of understanding of health care policy than the field experienced group.&#x0D; Conclusion : It is suggested that the strength of programmed learning be applied to the community nursing practice. Also, a practical education program should be developed according to the characteristics of the program and course outcomes.

The resentful undergrowth of nostalgia: Ontological insecurity, relative deprivation and powerlessness

This article untangles competing conceptualisations of nostalgia and identifies a specific form of collective-restorative nostalgia as politically significant. We argue that the link between resentment and this type of nostalgia emerges from their joint critique of the socio-political realities of the present. Nostalgia provides spatial and temporal orientations for a group's experiences of resentment through highly selective recollections of the heartland and an idealised golden age. We hypothesize that nostalgia leverages the heartland and the golden age to formulate claims for recognition and restored status on behalf of those who feel left behind by late modernity. Next, the article uses structural equation modelling and the 2019 Belgian National Election Study to reveal how resentment (consisting of ontological insecurity, group relative deprivation, and powerlessness) mediates between structural characteristics and nostalgia. Our findings suggest that each component of resentment individually contributes to explaining the nostalgia of less educated and economically deprived individuals.

Feasibility and impact of a bespoke pre-hospital point of care ultrasound teaching and training programme at London's air ambulance service.

Point-of-care ultrasound has seen an increase in its use in pre-hospital emergency care. There is lack of literature around the training requirement for point-of-care ultrasound of pre-hospital clinicians. This service evaluation assesses the effectiveness of a bespoke hybrid teaching programme. This is a service evaluation of the point-of-care ultrasound teaching programme at London's Air Ambulance from 1 April to 28 May 2021. Subjects' knowledge, image interpretation and confidence were assessed at two different points. Data were gathered using REDCap and exported to Excel for analysis. Mean values and delta were calculated, and t-test was applied for statistical significance. In total, 57 participants were included; out of which 11 were excluded, as they did not complete a post-course survey. Of these, 41.3% participants were point-of-care ultrasound naïve. Mean pre- and post-course scores were 76.5% and 81.7%, respectively, with an average delta improvement of 5.2% (95% confidence interval = 4.70%-5.68%) which was statistically significant (p < 0.002). There was a statistically significant mean improvement of pre- and post-course scores between point-of-care ultrasound naïve and point-of-care ultrasound experienced groups (p = 0.014). Confidence in using point-of-care ultrasound showed mean overall improvement from 2.36/4 to 3.34/4, a mean difference of 0.98 (95% confidence interval = 0.61-1.34), which was statistically significant (p = 0.0039). Our service evaluation highlighted that a hybrid teaching model used by London's Air Ambulance was feasible and had shown significant improvement in the knowledge, image interpretation and confidence of both the point-of-care ultrasound naïve and the PoCUS experienced cohort of clinicians.

Beziehungen mit Autoritäten in der Gruppenanalyse

This paper deals with relationships to authority and with authority-related patterns of relational disorders in group analysis, and thus at the same time with the topic of group leadership and authority and with a promising outline of a group analytic theory of disorders. With this theory of disorders as a focus, two experienced group analysts from different backgrounds look from their respective perspectives at group therapy under authoritarian social conditions and at contemporary group analysis. Social conditions influence the framework of groups and dynamic administration. However, different authority-related relational disturbances in group processes also emerge.

A Foreseeable and Desirable Future for the System of Rice Intensification

After some 40 years since when Fr. Henri de Laulanié synthesized the System of Rice Intensification (SRI) methodology, and after more than two decades of experts and practitioners working intensively to disseminate SRI around the world, the time is ripe for a general reflection on what has been done, and especially on how to move forward with the upscaling of SRI methods. This short paper builds on the work carried out by SRI-2030 which, despite being a very young initiative, thanks to the support of the experienced SRI-Rice group from Cornell University, has connected with SRI experts from multiple countries and with various stakeholders of the rice sector. As the international community recognizes the importance of more sustainable and eco-friendly rice production in terms of food security, less water consumption, and adaptation to and mitigation of climate change, concerted actions should be taken to boost the uptake of SRI, an agroecological practice that tackles all these issues and also improves farmers’ livelihoods. However, the diversity within the rice sector and the various context-related barriers to its optimization require diversified strategies. The challenges facing us are global, and a coordinated, collaborative approach is needed. SRI-2030 was established to be a facilitator for the support of synergies among stakeholders in the rice sector with the aim of boosting the upscaling of SRI methods up to 50 million hectares by 2030, to slow the pace of global warming and improve people’s well-being.

OP41 Facilitating Dialogue Of Real-World Evidence Use In Health Technology Assessment: Taxonomy Of Question/Data Source Pairings To Support A Registry Of Studies

IntroductionThis paper reports the results of the collaboration within the European initiative of new Reimbursement and aCCess Approaches (EUreccA) which is concerned with the use of real-world evidence (RWE) in health technology assessment (HTA) decision-making. The work grew from the observation of a large, very experienced group of HTA practitioners which found that the use of RWE varied depending on the type of question asked and the particulars of the data source(s) used. We set out to examine how RWE is used in HTA decision-making and to make proposals on its facilitation.MethodsLiterature reviews covering earlier reviews of RWE use, academic papers, and HTA agency websites were combined with case studies involving interviews with decision-makers in four countries (England, France, Italy, Sweden) to identify the circumstances of breakdown of RWE use and to build a categorization of the uses of RWE and associated difficulties. This evidence supported the creation of a taxonomy of pairings of data sources and the questions they were used to address. The face validity of the approach was tested at an advisory board of senior HTA practitioners.ResultsIn total, 27 questions were identified and 10 types of data source, giving 270 pairings. These pairings were linked to relevant methods guidance and to examples of their use, itemizing HTA issues and decisions made. Reports are being prepared for publication, covering the detail of the methods of the literature searches; methods of the country case studies; a description of the taxonomy; and guidance on governance.ConclusionsWhen using RWE in HTA decision-making, the detail of the particular data sources and question addressed matter. Recently, both the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the Real-World Transparency Initiative have argued for a registry of the uses of RWE. The work described here offers a starting classification of the material that should be held in such a registry, and which in itself could be developed by the stakeholders, both agencies and companies, that use it, furthering trust and confidence.

A Systematic Study to Compare the Precise Implantation of Hololens 2 Assisted with Acetabular Prosthesis for Total Hip Replacement

This study aims to evaluate the accuracy of the precise implantation of Hololens 2 assisted with acetabular prosthesis for total hip replacement. A total of 80 orthopaedic doctors from our hospital are enrolled in this systematic study and these doctors are divided into following four groups based on the experience of doctors treatment for orthopaedic patients and the Hololens 2 assisted:Rich experienced group with Hololens 2, rich experienced group without Hololens 2, inexperienced group with Hololens 2, inexperienced group without Hololens 2. The abduction angle, the anteversion angle, the offset degree in the abduction angle, the offset degree in the anteversion angle in four groups are presented and these result are used to evaluate the accuracy of precise implantation of Hololens 2 assisted with acetabular prosthesis for total hip replacement. Finally, all date in this study is collected and analyzed. The total of 80 physicians are included in this study. The results show that the outcomes between rich experienced group with Hololens 2 and rich experienced group without Hololens 2 are significant difference, and the outcomes between inexperienced group with Hololens 2 and inexperienced group without Hololens 2 are significant difference. The result between any other two groups is no significant difference. Hololens 2 assisted with acetabular prosthesis for total hip replacement can improve the accuracy.

Mission-critical tasks for assessing risks from vestibular and sensorimotor adaptation during space exploration.

To properly assess the risk induced by vestibular and sensorimotor adaptation during exploration missions, we examined how long-duration stays on the International Space Station affect functional performance after gravity transitions. Mission-critical tasks that challenge the balance and the locomotion control systems were assessed: i.e., sit-to-stand, recovery-from-fall, tandem-walk, and walk-and-turn. We assessed 19 astronauts, including 7 first-time flyers and 12 experienced flyers, before their flight, a few hours after landing, and then 1day and 6-11days later. Results show that adaptation to long-term weightlessness causes deficits in functional performance immediately after landing that can last for up to 1week. No differences were observed between first-time and experienced astronaut groups. These data suggest that additional sensorimotor-based countermeasures may be necessary to maintain functional performance at preflight levels when landing on planetary surfaces after a long period in weightlessness.

Comparing the effectiveness of 3D printing technology in the treatment of clavicular fracture between surgeons with different experiences

PurposeThis study aims to examine the use of 3D printing technology to treat clavicular fractures by skilled and inexperienced surgeons.MethodsA total of 80 patients with clavicle fractures (from February 2017 to May 2021) were enrolled in this study. Patients were divided randomly into four groups: group A: Patients underwent low-dose CT scans, and 3D models were printed before inexperienced surgeons performed surgeries; group B: Standard-dose CT were taken, and 3D models were printed before experienced surgeons performed surgeries; group C and D: Standard-dose CT scans were taken in both groups, and the operations were performed differently by inexperienced (group C) and experienced (group D) surgeons. This study documented the operation time, blood loss, incision length, and the number of intraoperative fluoroscopies.ResultsNo statistically significant differences were found in age, gender, fracture site, and fracture type (P value: 0.23–0.88). Group A showed shorter incision length and fewer intraoperative fluoroscopy times than groups C and D (P < 0.05). There were no significant differences in blood loss volume, incision length, and intraoperative fluoroscopy times between group A and group B (P value range: 0.11–0.28). The operation time of group A was no longer than those of groups C and D (P value range: 0.11 and 0.24).ConclusionThe surgical effectiveness of inexperienced surgeons who applied 3D printing technology before clavicular fracture operation was better than those of inexperienced and experienced surgeons who did not use preoperative 3D printing technology.

Bone-related behaviours of captive chimpanzees (Pan troglodytes) during two excavating experiments

After stone tools, bone tools are the most abundant artefact type in the Early Pleistocene archaeological record. That said, they are still relatively scarce, which limits our understanding of the behaviours that led to their production and use. Observations of extant primates constitute a unique source of behavioural data with which to construct hypotheses about the technological forms and repertoires exhibited by our hominin ancestors. We conducted two different experiments to investigate the behavioural responses of two groups of captive chimpanzees (Pan troglodytes; n = 33 and n = 9) to disarticulated, defleshed, ungulate bones while participating in a foraging task aimed at eliciting excavating behaviour. Each chimpanzee group was provided with bone specimens with different characteristics, and the two groups differed in their respective experience levels with excavating plant tools. We found that several individuals from the inexperienced group used the provided bones as tools during the task. In contrast, none of the individuals from the experienced group used bones as excavating tools, but instead continued using plant tools. These chimpanzees also performed non-excavating bone behaviours such as percussion and tool-assisted extraction of organic material from the medullary cavity. Our findings serve as a proof-of-concept that chimpanzees can be used to investigate spontaneous bone tool behaviours such as bone-assisted excavation. Furthermore, our results raise interesting questions regarding the role that bone characteristics, as well as previous tool-assisted excavating experience with other raw materials, might have in the expression of bone tool-assisted excavation.

Development and Validation of Task-Specific Metrics for the Assessment of Linear Stapler-Based Small Bowel Anastomosis.

Task-specific metrics facilitate the assessment of surgeon performance. This 3-phased study was designed to (1) develop task-specific metrics for stapled small bowel anastomosis, (2) obtain expert consensus on the appropriateness of the developed metrics, and (3) establish its discriminant validity. In Phase I, a hierarchical task analysis was used to develop the metrics. In Phase II, a survey of expert colorectal surgeons established the importance of the developed metrics. In Phase III, to establish discriminant validity, surgical trainees and surgeons, divided into novice and experienced groups, constructed a side-to-side anastomosis on porcine small bowel using a linear cutting stapler. The participants' performances were videotaped and rated by 2 independent observers. Partial least squares regression was used to compute the weights for the task-specific metrics to obtain weighted total score. In Phase II, a total of 45 colorectal surgeons were surveyed: 28 with more than 15 years, 13 with 5 to 15 years, and 4 with less than 5 years of experience. The consensus was obtained on all the task-specific metrics in the more experienced groups. In Phase III, 20 subjects participated equally in both groups. The experienced group performed better than the novice group regardless of the rating scale used: global rating scale (p = 0.009) and the task-specific metrics (p = 0.012). After partial least squares regression, the weighted task-specific metric score continued to show that the experienced group performed better (p < 0.001). Task-specific metric items were developed based on expert consensus and showed good discriminant validity compared with a global rating scale between experienced and novice operators. These items can be used for evaluating technical skills in a stapled small bowel anastomosis model.

Understanding health inequalities through a practice-oriented 'capabilities' perspective. Motherhood and leisure time physical activity.

In this article, we explore how a capabilities perspective can advance practice theoretic conceptualisations of persistent health inequalities. Specifically, we seek to understand the capabilities necessary for recruitment to leisure time physical activity (LTPA) practices by low SES mothers, a group traditionally excluded from LTPA. Our study illuminates that mothers living a life of social disadvantage face difficulties in becoming recruited to LTPA practices despite, in many cases, the availability of elements required for performance. We identify that temporal, support and energy capabilities are necessary for low SES mothers to become recruitable to LTPA. The dispossession of these capabilities signals inequalities in the constellation of practices that configure this group's lived experiences, in turn giving rise to practice absence and further consolidating patterns of inequality. We offer a framework of practice capabilities and health inequalities to guide future practice-oriented scholarship in the sociology of illness and health, which signals how capabilities may enable or constrain recruitment to health-promoting practices, give rise to inequalities and condition the possibility of practice absence.