Sex-based Bias Research Articles

Evaluating a predictive model of avoidable hospital events for race- and sex-based bias.

To evaluate whether race- and sex-based biases are present in a predictive model of avoidable hospital (AH) events. We examined whether Medicare fee-for-service (FFS) beneficiaries in Maryland with similar risk scores differed in true AH event risk on the basis of race or sex (n = 324,834). This was operationalized as a logistic regression of true AH events on race or sex with fixed effects for risk score percentile. Beneficiary-level risk scores were derived from 36 months of Medicare FFS claims (April 2019-March 2022) and generated in May 2022. True AH events were observed in claims from June 2022. Black patients had higher average risk scores than White patients; however, the likelihood of experiencing an AH event did not differ by race when controlling for predicted risk (Marginal Effect [ME] = 0.0003, 95%CI -0.0003 to 0.0009). AH event likelihood was lower in males when controlling for risk level; however, the effect was small (ME = -0.0008, 95% CI -0.0013 to -0.0003) and it did not differ by sex for the target group for intervention (ME = 0.0002, 95% CI -0.0031 to 0.0036). We implemented a simple bias assessment methodology and found no evidence of meaningful race- or sex-based bias in this model. We encourage the incorporation of bias checks into predictive model development and monitoring processes.

New Age Mages: An Interactive Way to Explore and Subvert Gender Biases

From a young age, children are exposed to societal standards of gender and gender roles and, by extension, inherent sex-based biases, which can become inculcated into their worldview. These biases affect their daily lives negatively in ways that can seem almost natural unless specifically pointed out. Table Top Role Playing Games (TTRPGs) are pen-and-paper games that revolve around collaborative storytelling in a shared, collectively imagined and built world, usually involving 2 to 5 players. TTRPGs provide a safe, controlled environment to mimic social interactions in a way that video games and other forms of media cannot. This paper introduces a new TTRPG, New Age Mages, aimed at a younger audience, with the goal of introducing the concept of biases and helping them to see things from a different perspective. In New Age Mages, players interact with a world where magic is commonplace as students that have recently unlocked their magic, while a Game Master (GM) narrates the world as determined by the players’ choices. The game’s magic system allows it to mimic the influence and/or impact of modern-day gender roles and biases without referring to them directly while remaining simple and easy to learn for a new player. The game also aims to subtly incentivise the Players to make decisions that would be different from what they might usually make, and promote trying to understand the others’ points of view. We believe this game will be useful for those seeking to help children gain a better understanding of gender roles and their subversion. We use a questionnaire based on the Gender Role Attitudes Scale (GRAS) to measure the impact gameplay has on players’ ideas of gender roles. We also test the game with some initial gameplay experiments among a smaller audience that is more familiar with TTRPGs and present the results. Our work explores not only the ability of TTRPGs to influence perspectives and opinions, but also doing so specifically in the space of understanding gender roles among a younger audience.

Leveraging multiple digital footprint datasets to predict racial, sex-based, and sexual-orientation bias across US states

Introduction & BackgroundRacial, gender, and sexual-orientation biases are pervasive throughout society. Importantly, modern digitally oriented datasets can elucidate important societal variables and potential solutions. One contemporary theory that attempts to explain these biases is parasite-stress: an evolutionary psychology hypothesis suggesting that increased infectious diseases rates increase out-group biases. We present preliminary findings that suggest that disease rates are a meaningful geospatial predictor of multiple biases. Objectives & ApproachWe explored biases using geospatial analyses throughout multiple datasets based on US participants: Project Implicit, American National Election Studies (ANES), Google Trends, and Twitter/X. We included state-based variables to compare between states and assess the most important environmental-level predictors of biases. We built generalised linear and linear mixed-effect models and general linear models. Within Project implicit (n > 3,000,000) and ANES datasets (n > 30,000), we assessed racial and sexual-orientation biases via explicit and implicit measures. For Google Trends and Twitter/X datasets, we assessed racial and sex-based biases via search and tweet-per-state scores. To analyse the biases, we included environmental-level variables, e.g., infectious disease rates (developed by Thornhill and Fincher in 2014), and individual-level variables, e.g., political orientation. Relevance to Digital FootprintsThese preliminary findings analyse everyday people’s online behaviour including volunteered surveys, searches and posts. We attempt to address the pressing societal issue of bias by leveraging modern datasets. Our primary goal is to aid policy makers by recommending cost-effective solutions that can improve several factors of the population’s quality of life. ResultsWe find that the most consistently significant predictor of racial bias is infectious disease rates. When leveraging Google Trends data including anti-women terminology, infectious disease rates and population density are consistent predictors of bias. Finally, we find preliminary results suggesting that increased levels of infectious diseases increases homophobic bias. Conclusions & ImplicationsOverall, we find that as infectious disease rates increase in a state, the level of racial and sexist bias significantly increases. Consistent with parasite-stress theory, we argue that focusing on reducing infectious disease rates in an area can have a plethora of benefits including improving physical and mental health and reducing biases that damage society.

Treatment outcomes in patients with Ewing sarcoma of the spine in a resource-challenged setting: 17-year experience from a single center in India

Ewing sarcoma (ES) of the spine is a rare childhood cancer with sparse literature on treatment outcomes. We aimed to describe survival outcomes and prognostic factors in patients with spinal ES treated at a single institute in a resource-challenged setting. We conducted a retrospective analysis of patients with spinal ES registered at a tertiary care oncology center between 2003–2019. Clinical patient data was retrieved from hospital records. Cox regression analysis was used to identify the association of baseline clinical parameters with event free survival (EFS) and overall survival (OS). A cohort of 85 patients was analyzed including 38 (45%) patients with metastatic disease. The median age was 15 years with 73% being male. Local therapy was administered in 62 (72.9%) patients with surgery alone in 8 (9.4%), radiotherapy alone in 36 (42.4%) and both in 18 (21.2%) patients. A higher proportion of males received local therapy than females (80.3% versus 59.1%; p = 0.049). The median EFS and OS were 20.1 and 28.6 months, respectively. On univariable analysis, age ≤ 15 years, female sex, serum albumin ≤3.5 g/dL and hemoglobin ≤11 g/dL were associated with inferior EFS while younger age, female sex, hypoalbuminemia and metastatic disease were associated with inferior OS. On multivariable analysis, only hypoalbuminemia was predictive for inferior EFS (HR:2.41; p = 0.005) while hypoalbuminemia (HR:2.06;p = 0.033) and female sex (HR:1.83; p = 0.046) were associated with inferior OS. We concluded that hypoalbuminemia confers poor prognosis in ES spine. Survival outcomes are poorer in females treated in our setting, possibly due to prevailing sex-based biases.

Gender biases in legal decision-making: an exploration of judicial and public perceptions across multiple offences

Purpose The purpose of the paper is to investigate how judges and the general population formulate judgments on legal cases, considering both legal and extralegal factors, with a focus on the significance of the defendant’s sex. Design/methodology/approach The first experiment aimed to determine if non-lawyers’ judgments are affected by the defendant’s sex, using brief excerpts from indictments with the defendant’s sex interchanged. Study 2 aimed to verify if this effect applies to future lawyers, suggesting a peculiar approval granted by men to women displaying illegal sexual behaviour towards young men. Findings The findings showed that the sex of the offender only influenced judgments in sexual offences, with male participants being more lenient towards female offenders. Originality/value The originality/value of the paper lies in its examination of the influence of the defendant’s sex on judgments made by both judges and the general population, specifically focussing on non-lawyers’ judgments. While previous studies have shown that judges tend to be more lenient towards women in certain cases, this paper adds novelty by investigating whether a similar effect is observed among non-lawyers. Moreover, the research sheds light on the relevance of the defendant's sex in cases of sexual offences and identifies a gender-specific leniency towards female offenders, particularly among male participants. The study also explores how this effect might extend to future lawyers, providing insights into societal attitudes regarding illegal sexual behaviour involving women and young men. Overall, the paper contributes valuable information to the understanding of how sex-based biases can influence legal judgments and decision-making processes.

Modulation of recovery from neonatal hyperoxic lung injury by sex as a biological variable

Recovery from lung injury during the neonatal period requires the orchestration of many biological pathways. The modulation of such pathways can drive the developing lung towards proper repair or persistent maldevelopment that can lead to a disease phenotype. Sex as a biological variable can regulate these pathways differently in the male and female lung exposed to neonatal hyperoxia. In this study, we assessed the contribution of cellular diversity in the male and female neonatal lung following injury. Our objective was to investigate sex and cell-type specific transcriptional changes that drive repair or persistent injury in the neonatal lung and delineate the alterations in the immune-endothelial cell communication networks using single cell RNA sequencing (sc-RNAseq) in a murine model of hyperoxic injury. We generated transcriptional profiles of >55,000 cells isolated from the lungs of postnatal day 1 (PND 1; pre-exposure), PND 7, and PND 21neonatal male and female C57BL/6 mice exposed to 95 % FiO2 between PND 1–5 (saccular stage of lung development). We show the presence of sex-based differences in the transcriptional states of lung endothelial and immune cells at PND 1 and PND 21. Furthermore, we demonstrate that biological sex significantly influences the response to injury, with a greater number of differentially expressed genes showing sex-specific patterns than those shared between male and female lungs. Pseudotime trajectory analysis highlighted genes needed for lung development that were altered by hyperoxia. Finally, we show intercellular communication between endothelial and immune cells at saccular and alveolar stages of lung development with sex-based biases in the crosstalk and identify novel ligand-receptor pairs. Our findings provide valuable insights into the cell diversity, transcriptional state, developmental trajectory, and cell-cell communication underlying neonatal lung injury, with implications for understanding lung development and possible therapeutic interventions while highlighting the crucial role of sex as a biological variable.

Disparity in sex in ankle fracture treatment

BackgroundLiterature has shown implicit bias in the treatment between non-operative and surgical treatment in patients with certain types of ankle fractures, which comprise 7.6% of all adult fractures. An understanding of any bias across all ankle fracture management may prove to be critical for the understanding of potential correlations between treatment methods and outcomes of patients with ankle fractures. Therefore, this study aimed to determine whether there is a sex-based bias in the operative and non-operative treatment of all ankle fractures. MethodsA retrospective study of 1175 adult patients with ankle fractures was conducted. Data extracted included sex, race, age, type of treatment (non-operative/operative), fracture type (displaced/non-displaced), fracture class, BMI, and length of hospital stay. Odds ratio (OR), Chi-squared, t-test, and Pearson’s correlation tests were used with p < 0.05 considered significant. ResultsThe study population consisted of 750 females (63.8%) and 425 males (36.2%). The study demonstrated a sex-based disparity in operative and non-operative treatment revealing that women are less likely than men to receive operative treatment for displaced ankle fractures (OR = 0.7, 95% CI: 0.5–0.9, p = 0.01). Of the 750 females, 417 (55.6%) underwent non-operative treatment, while 333 (44.4%) females had an operation. Of the 425 males, 204 (48%) had non-operative treatment, while 221 (52%) underwent operative treatment. The distribution of ankle fracture classes between both sexes was similar, suggesting fracture class did not influence the observed disparity. ConclusionOur results suggest sex correlates with the treatment type for ankle fractures, with women more likely to receive non-operative treatment for displaced fractures. As post-treatment outcomes often reflect the chosen form of treatment, it is imperative to determine if a disparity in sex explicates differences in clinical outcomes.

For the Bruhs: The Need for the Racialized and Gendered Support of Black Male College Students

Abstract: Due to institutionalized discrimination, preexisting lower enrollment, and disproportionate disenrollment during the COVID-19 pandemic, Black male college students’ success has a disparately beleaguered trajectory. Disparities in access to academic programs, resources, and support may be due, in part, to those poorer trajectories but also are affected by university policies (or the lack thereof). These students have lower rates of successful recruitment, retention, and graduation. Because institutions that receive federal funding must operate in ways that are free of race-based and sex-based bias, these institutions are obligated to address Black male college students’ lagging numbers as well as any resulting, potentially hostile atmospheres that these students perceive. Failure to address these issues is a form of discrimination and may be tantamount to violations of Titles VI and IX. Racialized and gendered problems require racialized and gendered solutions. Proactive policy shifts and implications are discussed.

Abstract 5730: Targeting intrinsically disordered protein βII-spectrin prevents metabolic syndrome and hepatocellular carcinoma on a sex-based bias

Abstract Background: Hepatocellular carcinoma (HCC) is a lethal cancer that affects males 2-4 times more than females. HCC incidence is rising in parallel with risk factors such as non-alcoholic steatohepatitis (NASH) and alcohol induced cirrhosis. A major enzyme in alcohol metabolism, aldehyde dehydrogenase 2 (ALDH2) deficiency affects ~560 million people globally. In males, different ALDH2 genotypes exhibit significant metabolic differences from females. Yet the mechanism for the sex differences remains unclear. We have found that targeting an intrinsically disordered protein and TGF-β signaling Smad3/4 adaptor, βII-spectrin (Sptbn1) blocks NASH and HCC in a liver-specific knockout (LSKO) mice and siRNA to human NASH microfluidic cultures (Sci Transl Med. 2021. 13(624): eabk2267). In mouse mutants of Smad3/Sptbn1 with HCC, stem cell proteins are markedly altered. Here, we sought to examine this further by intercrossing Sptbn1 deficient mice with ALDH2 deficient mice. Methods: Global heterozygous knockout of Sptbn1 mice were intercrossed with Aldh2 knockout mice (ASKO) to explore the role of βII-spectrin in aldehyde-related liver injury. LSKO mice were intercrossed with ALDH2 deficient mice (ALSKO) and siRNA treatment to explore the therapeutic effects of targeting Sptbn1 during the progression of metabolic syndrome (MetS) or HCC induced by Western diet (WD)/chemical (DEN) in the context of ALDH2 deficiency in both male and female mice. We performed phenotypic analyses of metabolic state, liver pathology, intestinal pathology, and gut microbiomes. Results: LSKO displayed obvious therapeutic effects against liver steatosis in male mice, whereas female mice did not. ASKO mice developed NASH spontaneously and showed impaired glucose handling, disordered lipids metabolism, with increased intestinal permeability and pro-inflammatory species of Bacteroidetes and Firmicutes. ALDH2 deficiency exacerbated toxic reactive aldehydes accumulation. LSKO mice were protected from WD induced MetS and NASH, including decreased body weight and fat weight, decreased serum triglyceride and AST/ALT, downregulated expression of proinflammatory genes and profibrotic genes and improved NAS Score. LSKO mice were also protected from WD/DEN-induced HCC: mice had less tumor number, smaller tumor size and less proliferation. siRNA targeting Sptbn1 also showed similar therapeutic effects as LSKO. Further, LSKO and siRNA targeting Sptbn1 also improved NASH phenotypes resembling MetS in Aldh2−/− mice: decreased liver fat accumulation, improved glucose handling and reduced inflammatory cell infiltration. Conclusions: Our data suggest that βII-spectrin, an intrinsically disordered protein, is a potential therapeutic target for diet/chemical-induced Mets/NASH and preventing HCC development and could provide new insight into sex-based differences in HCC. Citation Format: Xiaochun Yang, Krishanu Bhowmick, Xiyan Xiang, Kazufumi Ohshiro, Anil Vegesna, Lopa Mishra. Targeting intrinsically disordered protein βII-spectrin prevents metabolic syndrome and hepatocellular carcinoma on a sex-based bias. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5730.

Variation in aorta attenuation in contrast-enhanced CT and its implications for calcification thresholds.

CT contrast media improves vessel visualization but can also confound calcification measurements. We evaluated variance in aorta attenuation from varied contrast-enhancement scans, and quantified expected plaque detection errors when thresholding for calcification. We measured aorta attenuation (AoHU) in central vessel regions from 10K abdominal CT scans and report AoHU relationships to contrast phase (non-contrast, arterial, venous, delayed), demographic variables (age, sex, weight), body location, and scan slice thickness. We also report expected plaque segmentation false-negative errors (plaque pixels misidentified as non-plaque pixels) and false-positive errors (vessel pixels falsely identified as plaque), comparing a uniform thresholding approach and a dynamic approach based on local mean/SD aorta attenuation. Females had higher AoHU than males in contrast-enhanced scans by 65/22/20 HU for arterial/venous/delayed phases (p &lt; 0.001) but not in non-contrast scans (p &gt; 0.05). Weight was negatively correlated with AoHU by 2.3HU/10kg but other predictors explained only small portions of intra-cohort variance (R2 &lt; 0.1 in contrast-enhanced scans). Average AoHU differed by contrast phase, but considerable overlap was seen between distributions. Increasing uniform plaque thresholds from 130HU to 200HU/300HU/400HU produces respective false-negative plaque content losses of 35%/60%/75% from all scans with corresponding false-positive errors in arterial-phase scans of 95%/60%/15%. Dynamic segmentation at 3SD above mean AoHU reduces false-positive errors to 0.13% and false-negative errors to 8%, 25%, and 70% in delayed, venous, and arterial scans, respectively. CT contrast produces heterogeneous aortic enhancements not readily determined by demographic or scan protocol factors. Uniform CT thresholds for calcified plaques incur high rates of pixel classification errors in contrast-enhanced scans which can be minimized using dynamic thresholds based on local aorta attenuation. Care should be taken to address these errors and sex-based biases in baseline attenuation when designing automatic calcification detection algorithms intended for broad use in contrast-enhanced CTs.

The Impact of Systemic Inflammation on Sex-based Bias Following SARS-CoV-2 Infection

Background: The unfavorable clinical outcome (higher rates of severity/morbidity/mortality) of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has a disproportionate bias towards the male sex despite no sex-based difference noted in the risk for the infection. These outcomes have widely been hinged on dysregulated systemic inflammation. Hence, this study was aimed to evaluate the influence of systemic inflammation on sex-based bias in SARS-CoV-2 infection among indigenes of Nigerian Methods: Patients’ data with positive real-time polymerase chain reaction (RT-PCR) test for coronavirus disease 2019 (COVID-19), who were admitted/managed at the Eleme treatment center in Port Harcourt, southern Nigeria, were enrolled for this study. All relevant data was acquired from archived case notes, medical review charts, nurses’ charts, and laboratory records by trained research assistants using validated data collection templates. All the collated/abstracted data were analyzed/compared between the male and female patients using both descriptive and comparative statistical tools. Results A total of eligible 598 patients were included in the analysis among them 373 (62.4%) and 225 (37.6%) males and females, respectively. The males were much older (43.63±5.93 vs. 41.15±6.09; p<0.036) with higher mean body mass index and body temperature at presentation. Significant differences were observed in terms of the age distribution, occupational, educational, marital, residential status, cigarette smoking, alcohol consumption, body mass index, comorbid, severity, and clinical outcomes between the males and females (<0.05). In addition, the males had significantly higher mean levels of creatinine, C-reactive protein (CRP), Glasgow Prognostic Score (GPS), D-dimer, total WBC, neutrophil counts, composite neutrophil/lymphocyte ratio (NLR) but lower levels of albumin, total protein, isolated platelet count, and isolated lymphocyte count (p<0.05). The males maintained a significant linear relationship with the CRP (β: 0.61; SE: 0.13; p<0.001), composite GPS (β: 0.59; SE: 0.01; p<0.001), D-dimer (β: 0.52; SE: 0.09; p<0.001), and the composite NLR (β: 0.38; SE: 0.10; p<0.001) compare to their female counterparts. Additionally, CRP (OR: 8.86; 95%CI: 7.34-9.78; p<0.001), the composite GPS (OR: 7.41; 95%CI: 6.36-8.79; p<0.001), D-dimer (OR: 5.4; 95%CI: 4.32-6.65), and the composite NLR (OR: 4.23; 95%CI: 3.44-5.69; p<0.001) all had significant and robust associations with unfavorable clinical outcomes among the males compared to the females. Conclusion: Exaggerated systemic inflammatory markers/indices were more pronounced among the males in association with unfavorable clinical outcomes. These sex-based characteristics should be factored in during the management of SARS-CoV-2 infection. However, further studies are recommended to evaluate conclusions from the current study.

Sex differences in health resource utilization, costs and mortality during hospitalization for infective endocarditis in the United States

BackgroundFew studies have assessed the association between sex and outcomes among patients with infective endocarditis. The aim of the study was to better understand the association between biologic sex, clinical outcomes and surgical treatment patterns among a contemporary cohort of patients admitted to hospital with infective endocarditis. MethodsWe used the National Inpatient Sample dataset from the Health Care Utilization Project to identify adult patients admitted for infective endocarditis between January and December 2016. We compared outcomes between men and women including inpatient hospital mortality, direct hospital costs, length of stay, and inpatient surgical treatment patterns. Multivariable analyses were performed with adjustment for age, socioeconomic status, and comorbidity burden. ResultsAmong 18,702 patients with infective endocarditis, there were 8730 (46.7%) women and 1753 (8.4%) in-hospital deaths. In multivariable analysis, female sex was associated with a trend toward lower in-hospital mortality (adjusted odds ratio (OR) 0.90; 95% confidence interval (CI) 0.80 to 1.01, p = 0.06). Additionally, female sex was associated with significantly shorter hospital length of stay (−0.5 days; 95% CI −0.88 to −0.12, p = 0.009) and lower hospital costs (−$3035; 95% CI −$4277 to −$1792; p < 0.001). Notably, women were less likely to undergo surgical intervention (adjusted OR 0.59; 95% CI 0.52 to 0.67, p < 0.001). ConclusionsIn a contemporary, nationally representative cohort of patients admitted for IE in the United States, there were sex-specific differences in management and in-hospital outcomes. Possible sex-based bias in treatment patterns and access to inpatient surgical intervention for infective endocarditis warrants further study.

Error in trapper-reported sex of lynx (Lynx canadensis) and wolverine (Gulo gulo): implications for analyses of harvest records

Monitoring trends in the abundance of furbearers may be challenging, particularly at the spatio-temporal scales relevant for management. As such, wildlife managers often rely on harvest records to identify broad-scale harvest patterns and trends. Yet, the reliability of harvest records is often unknown. Analyses of harvest records to determine quotas and assess sustainability need to account for error rates when they are > 0. We evaluated the accuracy of trapper-reported sex of lynx (Lynx canadensis; n = 185) and wolverine (Gulo gulo; n = 467)—two meso-carnivores commonly targeted by fur trappers in northwestern Canada and Alaska—by comparing that to sex determined via necropsies of the same carcasses. Overall error rates differed significantly between wolverine (5%) and lynx (13%). Error rates were sex-biased for wolverine, but not lynx. Body size did not affect error rates for either species. Our data demonstrated species- and sex-specific error rates in the sex reported in harvest records. Error rates for wolverine (5%) were likely trivial for determining harvest sustainability because sex-based bias was small, given that overall accuracy was high. While error rates were greater for lynx (13%), there was no sex-based bias in trapper-reported sex. Because accuracy was lower for lynx, managers should exercise caution when using trapper-reported sex to conduct population analyses or assess harvest sustainability. Managers should be particularly interested in error rates of harvested species that exhibit relatively little sexual size dimorphism and lack obvious genitalia, similar to lynx. We recommend assessing error in trapper-reported sex prior to analysis of harvest records, as well as ongoing education with trappers to increase their ability to reliably determine the sex of animals they harvest.

Is mitral valve disease treated differently in men and women?

This study was performed to determine if there is a sex-based bias in referral practices, complexity of disease, surgical treatment, or outcomes in patients undergoing mitral valve surgery at our institution. Data were collected from the Cardiovascular Research Database of the Clinical Trial Unit of the Bluhm Cardiovascular Institute at Northwestern Memorial Hospital and they were defined according to the Society of Thoracic Surgeons National Database ( www.sts.org ). All patients who had mitral valve replacement, mitral valve repair with annuloplasty ring placement, and mitral valve annuloplasty alone were evaluated, including patients who underwent concomitant tricuspid valve surgery, atrial fibrillation ablation, patent foramen ovale closure, and coronary artery bypass grafting. An unmatched comparison was made between the 836 men and 600 women in the entire cohort (N = 1436) and propensity score-matching was performed in 423 pairs of men and women. Additional propensity score-matching for 219 pairs of men and women with Type II mitral valve functional class and no coronary artery disease and for 68 pairs of men and women with Type 1 or Type IIIb mitral valve functional class. Propensity score matching was used to compare sex differences involving a greedy algorithm with a caliper of size 0.1 logit propensity score standard deviation units. Between 1 April 2004 and 30 June 2017, 1436 patients (41.8% women, mean age 61.1 ± 12.6 years (men), 62.9 ± 13.3 years (women)) underwent mitral valve surgery. The unmatched comparison for the entire cohort showed that, on average, at the time of surgery, women had higher Society of Thoracic Surgery risk scores, were older and had more heart failure, coronary artery disease, and mitral stenosis than men. Women received proportionately fewer mitral repairs and more atrial fibrillation ablation, and tricuspid valve surgery. Women had longer intensive care unit and hospital stays, required more dialysis, and suffered more transient ischemic attacks and cardiac arrests postoperatively, and 30-day mortality rate was higher for women. However, propensity score-matching of 846 of the patients (423 men; 423 women) indicated that both the surgical approaches and surgical outcomes were comparable for men and women who had similar levels of disease and co-morbidities. Additional propensity score-matching of only those patients with degenerative mitral regurgitation (DMR) (219 men; 219 women) and those with Type 1 or Type III mitral valve disease showed no differences in the surgical procedures performed or in 30-day mortality rates. Women appear to be referred for mitral valve surgery later in the course of their disease, which could possibly be on the basis of sex bias, but they may also have a more aggressive form of mitral valve disease than men. Regardless of the reasons for the later referral of women for mitral valve surgery, the clinical outcomes are dependent upon the severity of the mitral disease and associated co-morbidities at the time of surgery, not on the basis of sex bias.

Sex Bias in Hand Surgery Research.

It has been long recognized that sex-based biases related to participant inclusion exist in research. To help address inequities in research participation, the National Institutes of Health Revitalization Act was passed into law in 1993. Although this act was primarily designed to increase inclusion of females and minorities in research funded by National Institutes of Health, it has also helped raise global awareness of the value of routinely including females and minority groups in research. Subsequent work has demonstrated a continued gap in inclusion of females in medical and surgical research and female animals and cell lines in basic science research. Hand surgeons have recognized that certain conditions have greater incidence in one sex over the other, but there has been no widespread discussion on whether, when, and how sex should be used as an outcomes variable. This review investigated the recent hand surgery literature to assess for equity in inclusion of both sexes in research as well as whether outcomes were analyzed based on sex.

Sex and Age Aspects in Patients Suffering From Out-Of-Hospital Cardiac Arrest: A Retrospective Analysis of 760 Consecutive Patients.

Cardiopulmonary resuscitation (CPR) is indicated in patients suffering from out-of-hospital cardiac arrest. Several studies suggest a sex- and age-based bias in the treatment of these patients. This particular bias may have a significant impact on the patient's outcome. However, the reasons for these findings are still unclear and discussed controversially. Therefore, the aim of this study was to retrospectively analyze treatment and out-of-hospital survival rates for potential sex- and age-based differences in patients requiring out-of-hospital CPR provided by an emergency physician in the city of Zurich, Switzerland.A total of 3961 consecutive patients (2003–2009) were included in this retrospective analysis to determine the frequency of out-of-hospital CPR and prehospital survival rate, and to identify potential sex- and age-based differences regarding survival and treatment of the patients.Seven hundred fifty-seven patients required CPR during the study period. Seventeen patients had to be excluded because of incomplete or inconclusive documentation, resulting in 743 patients (511 males, 229 females) undergoing further statistical analysis. Female patients were significantly older, compared with male patients (68 ± 18 [mean ± SD] vs 64 ± 18 years, P = .012). Men were resuscitated slightly more often than women (86.4% vs 82.1%). Overall out-of-hospital mortality rate was found to be 81.2% (492/632 patients) with no differences between sexes (82.1% for males vs 79% for females, odds ratio 1.039, 95% confidence interval 0.961–1.123). No sex differences were detected in out-of-hospital treatment, as assessed by the different medications administered, initial prehospital Glasgow Coma Scale, and prehospital suspected leading diagnosis.The data of our study demonstrate that there was no sex-based bias in treating patients requiring CPR in the prehospital setting in our physician-led emergency ambulance service.

Group leadership depends on energetic state in a nomadic collective foraging caterpillar

Group living is a common strategy among animals and has arisen independently in over 300 species of Lepidoptera. Yet, activity synchrony between individuals is necessary to derive the benefits that ensue from an aggregated lifestyle. Which individuals decide which activities to perform and when to perform them is, therefore, a fundamental question. In some species of social caterpillars and sawflies, the role of a potential behavioral polyethism between individuals has been suggested, whereby certain individuals are consistently more likely to initiate and lead a foraging event. However, in these cases, evidence in support of division of labor is lacking. This study was undertaken to determine if certain individuals of Malacosoma disstria are more likely to be consistent group leaders or if transient leaders could be predicted by the differences in energetic states between individuals. The results of this study indicate that unfed caterpillars initiate foraging bouts and are more likely to lead locomotion. There was no size or sex-based bias in those individuals that acted as temporary leaders. Consistent behavioral differences between individuals, if they exist, are therefore not necessary to explain task allocation and synchronization during foraging in this species.

Are there gender-related influences on corporate sustainability? A study of women on boards of directors

AbstractThis study sought to investigate if there is a link between women on boards of directors and corporate sustainability. Using a sample of publicly listed firms from Australia, the results suggest some level of support that a link does exist. Boards that have a strong complement of gender diversity are expected to offer more effective monitoring of agents, as well as offer more stringent enforcement of ethical conduct, thereby minimizing affects of subversion of shareholder funds that can be detrimental to their returns. Accordingly, findings confirm a positive link between women on boards and economic growth. Because of their relational abilities, women on boards are more likely able to engage with multiple stakeholders and respond to their needs, resulting in an avenue for demonstrating social responsiveness, which is confirmed by the results. However, due to their backgrounds and work experiences, sex-based biases and stereotyping might exist in boardrooms with men directors discounting input from women directors on issues relating to environmental quality. The results of this study find that women directors are not significantly associated with environmental quality. Discussion is given to these findings along with paths for future research.

Are there gender-related influences on corporate sustainability? A study of women on boards of directors

AbstractThis study sought to investigate if there is a link between women on boards of directors and corporate sustainability. Using a sample of publicly listed firms from Australia, the results suggest some level of support that a link does exist. Boards that have a strong complement of gender diversity are expected to offer more effective monitoring of agents, as well as offer more stringent enforcement of ethical conduct, thereby minimizing affects of subversion of shareholder funds that can be detrimental to their returns. Accordingly, findings confirm a positive link between women on boards and economic growth. Because of their relational abilities, women on boards are more likely able to engage with multiple stakeholders and respond to their needs, resulting in an avenue for demonstrating social responsiveness, which is confirmed by the results. However, due to their backgrounds and work experiences, sex-based biases and stereotyping might exist in boardrooms with men directors discounting input from women directors on issues relating to environmental quality. The results of this study find that women directors are not significantly associated with environmental quality. Discussion is given to these findings along with paths for future research.

State of the Heart: Building Science to Improve Women’s Cardiovascular Health

Cardiovascular disease is the No. 1 killer of women in the United States, and marked disparities in cardiovascular health exist between women and men and among groups of women. Coronary heart disease is underdiagnosed, undertreated, and under-researched in women. Women with suspected heart disease are less likely than men to receive indicated diagnostic tests and procedures; sex-based biases in treatment of myocardial infarction persist; and women continue to be underrepresented in cardiovascular research. An accumulating body of literature points to 3 major explanations: sex-based physiology, provider bias, and psychosocial influences. Women's acute and prodromal signs and symptoms of myocardial infarction have been described, yet women have difficulty recognizing and acting on these indications. Primary and secondary prevention of heart disease in women is imperative; although the science is lacking in several areas, existing evidence on diet, hormone therapy, aspirin, physical activity and obesity, and diabetes can serve as the basis for interventions. Potentially, large impacts could be made on women's morbidity and mortality if current scientific knowledge were implemented. The state of the science of women and heart disease is reviewed, with a focus on those areas with the greatest potential to address the needs of women's cardiovascular status. Key gaps in the science and remaining questions are presented as a research agenda for the coming decade.