Racial Disparities in Sacral Neuromodulation for Idiopathic Fecal Incontinence.

IMPORTANCE: Sacral neuromodulation (SNM) is an effective treatment for fecal incontinence (FI). Previous studies found that Black women undergo SNM for urinary incontinence less than White women, but there is less known about racial disparities for FI. OBJECTIVE: This study assessed differences in Black and White patients' FI treatment; SNM counseling was the primary outcome. STUDY DESIGN: This was a retrospective cohort study of adult non-Hispanic Black and White patients who received FI treatment at an academic institution from 2011 to 2021. Medical records were queried for treatments, testing, and treating specialties for a 2:1 age-matched cohort of White:Black patients. RESULTS: Four hundred forty-seven women were included: 149 Black women and 298 age-matched White women. A total of 24.4% (109) of patients had documented SNM counseling, significantly fewer in Black patients (14.8% vs 29.2%, P < 0.001). A total of 5.1% (23) of patients received SNM, less frequent in Black patients (2.7% vs 6.4%, P = 0.003). Among patients with SNM counseling, there was no difference between cohorts. Black patients were less likely to be referred for physical therapy (59.7% vs 77.2%, P < 0.001), sphincter imaging (0.7% vs 5.7%, P = 0.011), and defecography (8.1% vs 17.1%, P = 0.009). Different specialties managed the 2 cohorts. Black patients were less likely to see urogynecology and colorectal surgery (21.5% vs 34.6%, P = 0.004; 9.4% vs 15.4%, P = 0.077). Patients seen by these surgeons were more likely to discuss SNM (48.6% vs 8.5%, P < 0.001). CONCLUSIONS: There were differences between Black and White patients' FI treatment, including counseling about SNM. Multidisciplinary work is needed to provide equitable education for this life-altering condition.

Retained Tampon Fragment as an Unusual Cause of Vesicovaginal Fistula.

BACKGROUND: Vesicovaginal fistula (VVF) is an uncommon cause of urinary incontinence (UI). Iatrogenic etiologies, especially abdominal hysterectomy, are most common; however, a minority of VVFs are caused by retained foreign bodies. Objects associated with VVF include intrauterine devices, gauze, pessaries, bottle caps, and sexual aids, but retained tampons or other menstrual products have not been commonly reported. CASE: We present the case of a 53-year-old woman, gravida 0, with no prior pelvic surgery, with 2 months of intermittent UI and hematuria. Although initial diagnostic test results were negative, cystoscopy and vaginoscopy eventually confirmed the diagnosis of VVF associated with a retained foreign body. In the operating room, all debris was removed using vaginoscopy, and the VVF was repaired using a modified Latzko technique. At the patient's 9-week follow-up appointment, she was found to have complete healing of the VVF and resolution of associated symptoms. CONCLUSION: This is a case of VVF secondary to a retained tampon fragment. In addition to this uncommon etiology, our patient's presenting symptoms were atypical, leading to a delay in diagnosis and treatment for which vaginoscopy was critical.

Deterministic or probabilistic: U.S. children's beliefs about genetic inheritance.

Do children think of genetic inheritance as deterministic or probabilistic? In two novel tasks, children viewed the eye colors of animal parents and judged and selected possible phenotypes of offspring. Across three studies (N = 353, 162 girls, 172 boys, 2 non-binary; 17 did not report gender) with predominantly White U.S. participants collected in 2019-2021, 4- to 12-year-old children showed a probabilistic understanding of genetic inheritance, and they accepted and expected variability in the genetic inheritance of eye color. Children did not show a mother bias but they did show two novel biases: perceptual similarity and sex-matching. These results held for unfamiliar animals and several physical traits (e.g., eye color, ear size, and fin type), and persisted after a lesson.

Like mother, like daughter: Adults' judgments about genetic inheritance.

Do adults think about genetic inheritance as a deterministic or probabilistic process? Do adults display systematic biases when reasoning about genetic inheritance? Knowing how adults think about genetic inheritance is valuable, both for understanding the developmental end point of these concepts and for identifying biases that persist even after formal education. In two studies, we examined adults' reasoning about genetic inheritance for familiar animals (Study 1) and unfamiliar animals (Study 2). First, participants were presented with animals that varied in eye color and were asked to judge whether each could be the offspring of a particular set of animal parents that had either the same or different eye colors. The potential offspring had eye colors that were either identical to the parents, blended the parents' eye colors, or differed from the parents. Next, participants predicted how six offspring of the animal parents would look. Participants judged a variety of choices as possible-not only the ones resembling the parents-suggesting that they thought genetic inheritance was a probabilistic process. Additionally, many participants thought that female offspring would look more like their mothers and male offspring would look more like their fathers. Thus, systemic biases in reasoning about inheritance persist into adulthood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Representing Variability: The Case of Life Cycle Diagrams.

Two foundational concepts in biology education are 1) offspring are not identical to their parents, and 2) organisms undergo changes throughout their lives. These concepts are included in both international and U.S. curricular standards. Research in psychology has shown that children often have difficulty understanding these concepts, as they are inconsistent with their intuitive theories of the biological world. Additionally, prior research suggests that diagrams are commonly used in instruction and that their features influence student learning. Given this prior work, we explored the characteristics of life cycle diagrams and discuss possible implications for student learning. We examined 75 life cycle diagrams from books, including five biology or general science textbooks and 25 specialized trade books focusing on biology for children. We also examined 633 life cycle diagrams from a publicly available online database of science diagrams. Most diagrams failed to show any within-species variability. Additionally, many diagrams had perceptually rich backgrounds, which prior research suggests might hinder learning. We discuss how the design characteristics of diagrams may reinforce students' intuitive theories of biology, which might make it difficult for students to understand key biological concepts in the future.