Specific Choice Research Articles

Effects of mandatory residencies on female physicians’ specialty choices: Evidence from Japan's new medical residency program

Female physicians remain underrepresented in surgical specialties in Japan. The 2004 New Postgraduate Medical Education Program mandated a two-year rotating residency that allowed residents to choose their specialty after training in multiple fields, including surgery. Following this reform, there was a 2.7 percentage points increase in female physicians choosing general surgery and a 1.5 percentage points increase in urology being chosen, compared to male physicians, as well as a 3.4 percentage points decrease in internal medicine being chosen. This shift of female physicians toward male-dominated surgical specialties is primarily seen in breast surgery, catering to female patients, and in urology, known for its shorter workweeks.

Endocrinological aspects of gout

Gout is the most common inflammatory joint disease, and its incidence increases with age and the presence of certain diseases, primarily obesity and chronic kidney disease, as well as while taking certain medications. Treatment of a patient with gout requires the interaction of a rheumatologist, cardiologist and endocrinologist, and even better, a well-trained therapist who is able to independently supervise gout-related diseases without the involvement of specialized specialists. This review was written to highlight current data on the most common endocrinopathies in gout for practitioners. The data presented indicate the existence of a relationship between gout and various endocrine diseases. The most important aspect is the presence of metabolic syndrome in most patients with gout, the treatment of which also requires taking into account the effect of prescribed drugs on purine metabolism. On the other hand, effects on certain endocrinological diseases can lead to improved purine metabolism. It has been shown that weight loss, including through bariatric means, is accompanied by a decrease in uric acid levels and may be accompanied by a decrease in the need for urate-lowering therapy. Most glucose-lowering drugs affect purine metabolism, and the presence of concomitant gout may determine the specific choice of antidiabetic therapy. Menopause is characterized by an increase in uric acid levels and the incidence of gout. At the same time, the use of menopausal hormone therapy may be accompanied by both a decrease in uric acid levels and the risk of developing gout. Despite the fact that an increase in testosterone levels in men is positively correlated with uric acid levels, its deficiency is accompanied not by a decrease, but by an increase in uric acid levels.

Dark pottery from the early Iron Age in southern Veneto, Italy: The provenance issue under the adoption of specific technological procedures

One of the earliest known settlements of Pre-Roman Padua, Veneto Region (north-eastern Italy) was located in the very centre of the present-day city. The archaeological excavations revealed structures related to craft activities (metallurgical and pottery workshops) and residential areas datable from the late 9th to the 1st century BCE. A large pyrotechnic structure formed by an earthen block densely filled and covered by broken ceramic vessels was found, bringing to light the earliest foundry of the Pre-Roman Padua known to date. Many potsherds found in the site correspond to a regional ceramic class that included coarse and fine wares mainly composed of very dark ceramic bodies. A multi-analytical study based on macroscopic and petrographic descriptions as well as mineralogical, geochemical and microstructural analyses, was carried out in order to state the technological choices adopted for producing these dark vessels and the provenance of the raw materials. A poorly manufacturing was adopted to produce the common pottery, resulting coarse wares uneven textured, while the fine wares were produced by adopting the purification of the base clays and/or the tempering of the clay pastes. Common geo-resources were used, consisting in illitic-chloritic clays rich in quartz and feldspars, the firing regime conditions covered a range of maximum temperatures (normally under 850 °C) and the temper was constituted by silicate (chiefly quartzite, rhyolite and trachyte rock fragments) and/or carbonate (calcite and/or dolomite) inclusions, that were added after having been grounded and/or sieved. The specific mineral and lithic markers of provenance identified in the sherds confirmed the correspondence of this pottery with a local production. However, the specific technological choices that were carried out must be taking into consideration, since the purification removed the larger grains originally present in the base clays and the tempering influenced the chemical composition of the sherds. The different degree of purification of the base clays and the differential tempering procedures that were accomplished point out the adoption of very specific recipes to produce the fine wares, suggesting the correspondence of this local ceramic class with diverse sub-productions and the high level of specialization achieved by the potters in southern Veneto during the Early Iron Age.

Qualitative study of the lived experience of methylphenidate prescribed for children with a fetal alcohol spectrum disorder.

Fetal Alcohol Spectrum Disorders (FASD) refer to physical, cognitive, and behavioural symptoms in an individual whose mother consumed alcohol during pregnancy. It is the leading cause of non-genetic avoidable mental disability, with an estimated worldwide prevalence of 1%. Attention Deficit Hyperactivity Disorder (ADHD) diagnostic criteria are met for 50-80% of patients with FASD. Methylphenidate (MPH) is the first-line pharmacological treatment for ADHD. This study aims to explore the lived experience of children with FASD taking MPH and their caregivers to adapt prescribing modalities by considering different ways to administer the drugs. We hope to improve the therapeutic alliance between the children and their caregivers by gaining an insiders' view of the medication perception. Semi-structured interviews with children and their caregivers were conducted in this qualitative study. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data were analysed using interpretative phenomenological analysis. We conducted 16 semi-structured interviews: 8 with the children aged 7-12, 5 boys and 3 girls and 8 with their caregivers. The analysis showed that inadequate palatability and capsule form experiences were the leading causes of children's non-adherence to the treatment. MPH appeared to be a valuable aid for caregivers even if they had concerns about its potential toxicity. However, it is necessary to identify caregivers' expectations concerning MPH to adapt the prescription in terms of choice of specialty and intake modalities. Regular support was required to reduce caregivers' fears of dependence, personality transformation and long-term adverse effects. Information on palatability should be given when prescribing MPH to children with ADHD as well as its possible side effects or toxicity. It highlights the need for further studies of the experience of palatability of drugs prescribed to children. When prescribing a treatment, children should be more involved in medical counselling and it is necessary to understand the child's perspectives to co-construct common representations for better therapeutical adherence.

Anisotropy Induced by Electric Charge: A Computational Analytical Approach

This paper presents a novel class of interior solutions for anisotropic stars under the imposition of a self-similar symmetry. This means proposing exact solutions to the Einstein field equations to describe charged matter distribution with radiation flow. The Einstein–Maxwell system by employing specific choices of mass function is formulated to describe the gravitational collapse of charged, anisotropic, spherically symmetric distributions using the Schwarzschild metric. Two ordinary differential equations governing the dynamics are derived by matching a straightforward solution of the symmetry equations to the charged exterior (Reissner–Nordström–Vaidya). Models with satisfactory physical behavior are constructed by extensively exploring self-similar solutions for a set of parameters and initial conditions. Finally, the paper presents the evolution of physical variables and the collapsing radius, demonstrating the inevitable collapse of the matter distribution.

Negative Impact of Smaller Hometown Size on the Educational Experience of Medical Students: A Nationwide Study in Saudi Arabia.

Background and objective Saudi Arabia's rapid medical education expansion has posed unique challenges for its students, particularly concerning specialty selection. Having broad exposure to medical specialties is crucial for making informed decisions. This study explores how the size of students' hometowns influences their exposure to their preferred specialty, thereby affecting their choice. Methods Our cross-sectional study collected data from medical students in their 4th and 5th years, interns, and graduates across Saudi Arabia. An electronic survey gathered information about medical specialty choice, interest levels, students' self-ranking compared to their peers, and level of exposure to the chosen specialty. Overall exposure to specialties was quantified by tallying participants' experiences in preclinical observerships, didactic lectures, research projects, core and elective rotations, and attended conferences. We divided the students into three city sizes: primary urban centers, intermediate urban cities, and small townships and compared the outcomes between these three groups. Results Responses were obtained from 1,072 participants, with 424 (39.6%) from primary urban centers, 367 (34.2%) from intermediate urban cities, and 281 (26.2%) from small townships. Student hometown size was an independent predictor of specialty exposure, with students from smaller cities reporting lower exposure scores (OR = 0.73, (0.63-0.84), p<0.01). The study also identified gender disparities in exposure, with female students found to be correlated with a lower exposure score (OR = 0.72, (0.58-0.89), p<0.01). Conclusion City size is a significant determinant of specialty exposure for Saudi medical students. These findings highlight the need for initiatives that promote equal educational experiences, ensuring comprehensive specialty exposure to all students.

Solution to a class of multistate Landau-Zener model beyond integrability conditions

We study a class of multistate Landau-Zener model which cannot be solved by integrability conditions or other standard techniques. By analyzing analytical constraints on its scattering matrix and performing fitting to results from numerical simulations of the Schrödinger equation, we find nearly exact analytical expressions of all its transition probabilities for specific parameter choices. We also determine the transition probabilities up to leading orders of series expansions in terms of the inverse sweep rate (namely, in the diabatic limit) for general parameter choices. We further show that this model can describe a Su-Schrieffer-Heeger chain with couplings changing linearly in time. Our work presents a new route, i.e., analytical constraint plus fitting, to analyze those multistate Landau-Zener models which are beyond the applicability of conventional solving methods.

Community-based participatory-research through co-design: supporting collaboration from all sides of disability

BackgroundAs co-design and community-based participatory research gain traction in health and disability, the challenges and benefits of collaboratively conducting research need to be considered. Current literature supports using co-design to improve service quality and create more satisfactory services. However, while the ‘why’ of using co-design is well understood, there is limited literature on ‘how’ to co-design. We aimed to describe the application of co-design from start to finish within a specific case study and to reflect on the challenges and benefits created by specific process design choices.MethodsA telepractice re-design project has been a case study example of co-design. The co-design was co-facilitated by an embedded researcher and a peer researcher with lived experience of disability. Embedded in a Western Australian disability organisation, the co-design process included five workshops and a reflection session with a team of 10 lived experience and staff participants (referred to as co-designers) to produce a prototype telepractice model for testing.ResultsThe findings are divided into two components. The first describes the process design choices made throughout the co-design implementation case study. This is followed by a reflection on the benefits and challenges resulting from specific process design choices. The reflective process describes the co-designers’ perspective and the researcher’s and organisational experiences. Reflections of the co-designers include balancing idealism and realism, the value of small groups, ensuring accessibility and choice, and learning new skills and gaining new insights. The organisational and research-focused reflections included challenges between time for building relationships and the schedules of academic and organisational decision-making, the messiness of co-design juxtaposed with the processes of ethics applications, and the need for inclusive dissemination of findings.ConclusionsThe authors advocate that co-design is a useful and outcome-generating methodology that proactively enables the inclusion of people with disability and service providers through community-based participatory research and action. Through our experiences, we recommend community-based participatory research, specifically co-design, to generate creative thinking and service design.

Metaverse Management as Urban Planning: Lessons from Paradise (Nevada)

Metaverse architects face challenges akin to urban planners developing a new city: multiple stakeholders must coordinate on technical standards for interoperability and establish social consensus around specific choices. The article presents an analogy between the metaverse and the Las Vegas Strip in the unincorporated town of Paradise, NV, which arose in the mid-twentieth century as a focal destination for immersive entertainment delivered by eclectic interconnected resorts. It integrates this case study of the Las Vegas Strip with theories of technology management to derive practical insights for building the metaverse: focusing social momentum around a new destination and governing cooperation among de facto competitors.

Møller-Plesset Adiabatic Connection at Large Coupling Strengths for Open-Shell Systems.

We study the adiabatic connection that has as weak-coupling expansion the Møller-Plesset perturbation series, generalizing to the open-shell case previous closed-shell results for the large-coupling limit. We first focus on the hydrogen atom with fractional spins, providing results along the adiabatic connection from small to large coupling strengths. We reveal an intriguing phase diagram and an equation for the large-coupling leading order that has closed-form solutions for specific choices of its relevant quantum numbers. We then show that the hydrogen atom results provide variational estimates for the large-coupling leading terms for the general many-electron open-shell case in terms of functionals of the Hartree-Fock α-spin and β-spin densities.

Survey of bidirectional transmittance distribution function measurement facilities by multilateral scale comparisons

In recent years, a growing demand for the capability of performing accurate measurements of the bidirectional transmittance distribution function (BTDF) has been observed in industry, research and development, and aerospace applications. However, there exists no calibration and measurement capabilities-entry for BTDF in the database of the Bureau International des Poids et Mesures and to date no BTDF comparison has been conducted between different national metrology institutes (NMIs) or designated institutes (DIs). As a first step to a possible future key comparison and to test the existing capabilities of determining this measurand, two interlaboratory comparisons were performed. In comparison one, five samples of three different types of optical transmissive diffusers were measured by five NMIs and one DI. By specific sample choice, the focus for this study lay more on orientation-dependent scatter properties. In comparison two, where one NMI, one DI, one university, and three industrial partners investigated their measurement capabilities, the dependence on the orientation was not assessed, but two additional samples of the same material and different thickness were measured. Results of the two comparisons are presented, giving a good overview of existing experimental solutions, and showing specific sample-related problems to be solved for improved future BTDF measurements.

Personality types of medical students in terms of their choice of medical specialty: Cross-Sectional Study (Preprint)

Personality types of medical students in terms of their choice of medical specialty: Cross-Sectional Study (Preprint)

Fluorescence lifetime imaging microscopy of flexible and rigid dyes probes the biophysical properties of synthetic and biological membranes

Sensing of the biophysical properties of membranes using molecular reporters has recently regained widespread attention. This was elicited by the development of new probes of exquisite optical properties and increased performance, combined with developments in fluorescence detection. Here, we report on fluorescence lifetime imaging of various rigid and flexible fluorescent dyes to probe the biophysical properties of synthetic and biological membranes at steady state as well as upon the action of external membrane-modifying agents. We tested the solvatochromic dyes Nile red and 1,2-dimyristoyl-sn-glycero-3-phosphoethanolamine-N-(7-nitro-2-1,3-benzoxadiazol-4-yl) (ammonium salt) (NBD), the viscosity sensor Bodipy C12, the flipper dye FliptR, as well as the dyes 3,3′-dioctadecyloxacarbocyanine perchlorate (DiO), Bodipy C16, lissamine-rhodamine, and Atto647, which are dyes with no previous reported environmental sensitivity. The performance of the fluorescent probes, many of which are commercially available, was benchmarked with well-known environmental reporters, with Nile red and Bodipy C12 being specific reporters of medium hydration and viscosity, respectively. We show that some widely used ordinary dyes with no previous report of sensing capabilities can exhibit competing performance compared to highly sensitive commercially available or custom-based solvatochromic dyes, molecular rotors, or flipper in a wide range of biophysics experiments. Compared to other methods, fluorescence lifetime imaging is a minimally invasive and nondestructive method with optical resolution. It enables biophysical mapping at steady state or assessment of the changes induced by membrane-active molecules at subcellular level in both synthetic and biological membranes when intensity measurements fail to do so. The results have important consequences for the specific choice of the sensor and take into consideration factors such as probe sensitivity, response to environmental changes, ease and speed of data analysis, and the probe’s intracellular distribution, as well as potential side effects induced by labeling and imaging.

Wormholes inside stars and black holes

We construct models of two exotic objects: (i) a wormhole whose throat is hidden by a stellar object like a neutron star; and (ii) a wormhole inside a black hole. We work within Einstein’s gravity coupled to two scalar fields with a specific choice of the scalar field Lagrangian. In general, the model contains ghosts, but they are eliminated using the constraints given by the Lagrange multiplier fields. The constraints are a generalization of the mimetic constraint, where nondynamical dark matter effectively appears. As a result, in our model, instead of the nondynamical dark matter, nondynamical exotic matter like a phantom effectively arises. For the mixed wormhole-plus-star system, we find the corresponding mass-radius relation and show that it is possible to get characteristics comparable to those of ordinary neutron stars. For the wormhole inside the black hole, we find an extremal limit where the radius of the throat coincides with the radius of the event horizon and demonstrate that the Hawking temperature vanishes in this limit. Published by the American Physical Society 2024

Specialty preferences of undergraduate medical students: What do they choose and why?

BackgroundThe choice of choosing a specialty after completing MBBS is influenced by multiple factors. Personality traits like extraversion, agreeableness, conscientiousness, neuroticism, and open-mindedness form the intrinsic factors. Factors like early financial stability and cost of education form the external factors. This study evaluates the association between these factors and the specialty choice. MethodsThis was a cross-sectional study including students from first year to intern doctors in India. An online questionnaire was used for data collection which included questions about demographics, choice of specialty, personality traits, and external factors affecting their choice. The Big Five Inventory-2-S 30-item Scale (BFI-2-S) was used to assess the personality traits. ResultsOne thousand nine hundred and twenty-one students participated in this study (57.6% females). Most participants, 1761 (91.7%) opted for clinical branches. Only 13 (0.7%) students wanted to pursue a non-clinical branch. Only 20 (1.0%) participants wanted to pursue a pre-clinical branch. Participants who opted for clinical branches were more extraverted, and more open-minded than those who chose non-clinical branches. Participants who opted for surgical branches were more extraverted, more conscientious, and had fewer negative emotions than their peers who chose medicine-related branches. High income generated per annum (65%), early financial stability (within 2–5 years) (60.7%), cost of postgraduate education (46%), and gender predominance (35.3%) were the most influential external factors. ConclusionThese findings show that there are distinct personality traits and external factors associated with specialty choices. This will aid counselors to guide undergraduate medical students to choose a specialty for post-graduation.

Exploring work-life integration in vascular surgery and surgery

ObjectiveThere is a growing emphasis on achieving work-life balance, defined as the balance between work and personal life. However, this concept is gradually shifting towards work-life integration (WLI), which is relevant in the health care sector, particularly surgery. We performed a literature review to evaluate factors that contribute to WLI in the field of surgery, with a particular focus on vascular surgery. MethodsA literature review of WLI in surgery, specifically vascular surgery, was performed from inception to February 2024. PubMed was searched for papers written in the English and French languages using the MeSH terms “work-life balance” or “work-life integration” in “vascular surgery” or “surgery.” Findings were categorized in a tiered framework focused on faculty or staff, trainees (including medical students, residents, or fellows), and people identifying as underrepresented in medicine (URIM). ResultsTwenty-four articles were identified as relevant for this review. Previous reports have identified a high prevalence of burnout and suicide among the vascular surgery workforce. Collegial support and institutional culture were identified as pivotal in enhancing WLI. Inefficiencies in health care delivery, administrative burdens, and a lack of autonomy were recognized as barriers for WLI. Factors specific to gender and parenthood lead to unequal challenges in achieving WLI. Medical trainees’ WLI perceptions influenced their specialty choices and risk of burnout. Also, URIM trainees encountered additional obstacles like discrimination and attrition, though some reports indicated a resilience advantage among minority physicians. ConclusionsThis review has highlighted differences in challenges related to WLI across faculty and staff, trainees, and individuals identifying as URIM and emphasizes the need for systemic and cultural reforms, flexible work arrangements, and greater support for underrepresented groups to foster a healthier work-life ecosystem in health care.

Large-Scale Data-Driven Optimization in Deep Modeling With an Intelligent Decision-Making Mechanism.

This study focuses on building an intelligent decision-making attention mechanism in which the channel relationship and conduct feature maps among specific deep Dense ConvNet blocks are connected to each other. Thus, develop a novel freezing network with a pyramid spatial channel attention mechanism (FPSC-Net) in deep modeling. This model studies how specific design choices in the large-scale data-driven optimization and creation process affect the balance between the accuracy and effectiveness of the designed deep intelligent model. To this end, this study presents a novel architecture unit, which is termed as the "Activate-and-Freeze" block on popular and highly competitive datasets. In order to extract informative features by fusing spatial and channel-wise information together within local receptive fields and boost the representation power, this study constructs a Dense-attention module (pyramid spatial channel (PSC) attention) to perform feature recalibration, and through the PSC attention to model the interdependence among convolution feature channels. We join the PSC attention module in the activating and back-freezing strategy to search for one of the most important parts of the network for extraction and optimization. Experiments on various large-scale datasets demonstrate that the proposed method can achieve substantially better performance for improving the ConvNets representation power than the other state-of-the-art deep models.

Parametric dependence between random vectors via copula-based divergence measures

This article proposes copula-based dependence quantification between multiple groups of random variables of possibly different sizes via the family of Φ-divergences. An axiomatic framework for this purpose is provided, after which we focus on the absolutely continuous setting assuming copula densities exist. We consider parametric and semi-parametric frameworks, discuss estimation procedures, and report on asymptotic properties of the proposed estimators. In particular, we first concentrate on a Gaussian copula approach yielding explicit and attractive dependence coefficients for specific choices of Φ, which are more amenable for estimation. Next, general parametric copula families are considered, with special attention to nested Archimedean copulas, being a natural choice for dependence modelling of random vectors. The results are illustrated by means of examples. Simulations and a real-world application on financial data are provided as well.

MUTUAL FUNDS AND INVESTORS BEHAVIOUR

Mutual funds have been widely acknowledged as a popular investment tool for individuals who are looking to increase their wealth and accomplish their financial objectives for a considerable amount of time. Over the past few years, the study of mutual funds and investor behavior has garnered a substantial amount of attention due to the fact that it is a complex and ever-changing topic. It is essential for both financial professionals and regular investors to have a solid understanding of the complexities of mutual funds and the factors that influence investor behavior. A intriguing connection between mutual funds and investor behavior is going to be investigated, and this preface will lay the context for that investigation. The purpose of this section is to provide a complete overview of the topic, focusing on the most important ideas and topics that will be discussed in later chapters. By delving into the world of mutual funds, we are able to learn about the many investing techniques that are utilized by fund managers, the risks and rewards that are associated with the various types of funds, and the influence that market conditions have on the performance of funds. An investigation into the actions taken by investors in relation to mutual funds is also of equal importance. The judgments, biases, and emotions of investors are critically important factors that contribute to the formation of the dynamics of the mutual fund sector. Exploring the psychological aspects of investing can offer light on the reasons why specific investment choices are made, the role that information processing plays, and the influence that market movements have on investor emotion. We hope that by the end of this investigation, readers will have a full grasp of mutual funds and investor behavior, which will enable them to make educated decisions on their investments and confidently traverse the complex world of finance. Keywords: Mutual Funds, Investor Behaviour, Investment Psychology, Portfolio Management, Risk Tolerance, Asset Allocation, Market Sentiment, Behavioural Finance, Fund Performance, Market Volatility.

The Effect of Learning Style Preference, Clerkship Training and Role Model on Specialization Selection

Aim: The clerkship period in medical schools is an integrated learning experience that is also helpful in choosing a future career. The aim of this study was to evaluate the effect of both general surgery clerkshipship and awareness of learning styles on specialty preferences of medical students. Methods: In this study, which was planned as an educational intervention, a questionnaire questioning specialty preferences and a learning style scale were administered to fourth-year medical students before their general surgery clerkships. Following the questionnaire, brief training was given about specialty branches and learning styles. After the clerkship, the students were asked to answer the questionnaire again about their specialty preferences. Changes between clerkship training, learning style awareness and specialty preferences were evaluated. Results: One hundred eight students participated in the study (M:81, F:27). The mean age was 23.0. The most important factor in choosing a specialty is professional satisfaction (64%) with the work in that specialty. The approach of the trainers in the clerkship training (67%) was to focus on the most influential mind-changing factors for the choice of specialty. The most common learning styles among female students were kinesthetic and visual, while the most common learning style among male students was auditory. However, the learning style of students who preferred surgical branches was generally in the kinesthetic group. Conclusions: An effective clerkship program in which students encounter effective positive role models, gain knowledge about their field of specialization and learning styles, and increase their awareness will provide the right guidance in their specialization preferences.