Gender-based salary differences in academic medicine: a retrospective review of data from six public medical centers in the Western USA.

OBJECTIVES: We assessed the effect of gender, rank and research productivity on compensation for faculty at academic medical centres. DESIGN: A web-based retrospective review of salary for professors in 2016. SETTING: Faculty from six state-run, publicly funded academic medical centres in the Western USA. PARTICIPANTS: 799 faculty members, 225 assistant (51% women), 200 associate (40% women) and 374 full professors (32% women) from general surgery (26% women), obstetrics and gynaecology (70% women) and radiology (34% women). METHODS: Archived online faculty profiles were reviewed for gender, rank and compensation (total, baseline and supplemental). Total compensation was defined as baseline compensation plus supplemental income. Baseline compensation was defined as base salary minus reductions due to participation in the voluntary Employee Reduction in Time and phased retirement programmes. Supplemental income was defined as additional salary for clinical care and research (eg, grants). Elsevier's Scopus was used to collect data on h-index, a measure of research productivity. Linear regression models were estimated to determine the relationship between these factors and salary. RESULTS: Total compensation was significantly higher for men across all professorial ranks in both general surgery [Formula: see text] and obstetrics and gynaecology [Formula: see text]. Women faculty members within these departments earned almost US$75 000 less than their men colleagues. The disparity in salary originates from gaps in supplemental income, as baseline compensation was not significantly different between men and women. No significant gender difference in total compensation for radiology was found [Formula: see text]. Higher h-index was associated with higher baseline compensation across all departments as well as with supplemental income for general surgery. Higher h-index was related to lower supplemental income for radiology and was not related to supplemental income for obstetrics and gynaecology. CONCLUSIONS: Further investigations should focus on discrepancies in supplemental income, which may preferentially benefit men.

Measurement of Marginal Placental Cord Insertion by Prenatal Ultrasound Was Found Not to Be Predictive of Adverse Perinatal Outcomes.

OBJECTIVES: The clinical importance of marginal cord insertion (MCI) is currently controversial. In this study, we examined the association between MCI and adverse perinatal outcomes. We also evaluated the ultrasound-measured distance from the site of placental cord insertion (PCI) to the placental margin (PCI distance) and perinatal outcomes. METHODS: This was a retrospective cohort study of MCI and control pregnancies presenting to a single institution between September 2014 and August 2016. Marginal cord insertion was diagnosed on routine anatomy ultrasound scans at 20 weeks' gestation. The primary outcome was fetal intolerance to labor. Secondary outcomes of interest included mode of delivery, gestational age at delivery, Apgar scores at 1 and 5 minutes, birth weight, delivery complications, and neonatal intensive care unit admission. The PCI distance was determined by an ultrasound review. Statistical significance was evaluated by a χ2 analysis, descriptive statistics, Wilcoxon tests, and regression models with log-transformed outcomes, the PCI distance, or both as needed. RESULTS: Of 675 abnormal cord insertion cases, we identified 183 that met inclusion criteria. We found no statistically significant association between MCI and fetal intolerance to labor (odds ratio, 1.24 [95% confidence interval, 0.55-2.80]; P = .71) or secondary outcomes. Furthermore, we found no significant correlation between perinatal outcomes and the PCI distance. CONCLUSIONS: Our study suggests that MCI pregnancies, regardless of the specific PCI distance, might not be at increased risk of adverse perinatal outcomes. This finding questions the need for heightened antepartum surveillance of this patient population.

Insights on cross-species transmission of SARS-CoV-2 from structural modeling.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the ongoing global pandemic that has infected more than 31 million people in more than 180 countries worldwide. Like other coronaviruses, SARS-CoV-2 is thought to have been transmitted to humans from wild animals. Given the scale and widespread geographical distribution of the current pandemic and confirmed cases of cross-species transmission, the question of the extent to which this transmission is possible emerges, as well as what molecular features distinguish susceptible from non-susceptible animal species. Here, we investigated the structural properties of several ACE2 orthologs bound to the SARS-CoV-2 spike protein. We found that species known not to be susceptible to SARS-CoV-2 infection have non-conservative mutations in several ACE2 amino acid residues that disrupt key polar and charged contacts with the viral spike protein. Our models also allow us to predict affinity-enhancing mutations that could be used to design ACE2 variants for therapeutic purposes. Finally, our study provides a blueprint for modeling viral-host protein interactions and highlights several important considerations when designing these computational studies and analyzing their results.

Insights on cross-species transmission of SARS-CoV-2 from structural modeling.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the ongoing global pandemic that has infected more than 14 million people in more than 180 countries worldwide. Like other coronaviruses, SARS-CoV-2 is thought to have been transmitted to humans from wild animals. Given the scale and widespread geographical distribution of the current pandemic, the question emerges whether human-to-animal transmission is possible and if so, which animal species are most at risk. Here, we investigated the structural properties of several ACE2 orthologs bound to the SARS-CoV-2 spike protein. We found that species known not to be susceptible to SARS-CoV-2 infection have non-conservative mutations in several ACE2 amino acid residues that disrupt key polar and charged contacts with the viral spike protein. Our models also predict affinity-enhancing mutations that could be used to design ACE2 variants for therapeutic purposes. Finally, our study provides a blueprint for modeling viral-host protein interactions and highlights several important considerations when designing these computational studies and analyzing their results.

Synesthetic colors induced by graphemes that have not been consciously perceived.

Grapheme-color synesthetes experience colors when they see printed letters of the alphabet. Currently, we tested four "projector" synesthetes, whose colors evoked by graphemes have sensory support or quale and appear to be restricted spatially to the letters like real colors. We use three different kinds of puzzle pictures that contained hidden letters, which require 30 s or more for nonsynesthetes to identify. Grapheme-color projector synesthetes recognize them three times faster and report that the colors were evoked before conscious letter recognition, clueing them as to what the letters were. Subjectively, the synesthetic subjects reported that they also saw mirror-reversed letters in the same colors as nonreversed letters which enabled them to read mirror-reversed text at thrice the normal speed. We conclude that in some synesthetes colors are evoked preconsciously early in sensory processing.

Interpolation of illusory pain in the human somatosensory system.

Three coins are lined up with the middle coin at room temperature and flanking coins cooled down to 4 degrees C. If digits 2 and 4 are placed on the outer coins and digit 3 on the middle coin, the latter also feels cold; a striking example of perceptual filling in of temperature. We show that if digits 2 and 4 are placed on a thermal grill with alternating hot and cold bars, while digit 3 is placed on cardboard, the sensation of pain will also spread to the middle finger.

Graphemes evoke synesthetic colors even before they are consciously recognized.

We showed a grapheme-color synesthete three different examples of stimuli in which the graphemes were 'hidden'--as in puzzle pictures--and became visible as letters only after prolonged viewing. Intriguingly the subject saw the appropriate colors accurately long before the graphemes became consciously visible--a novel form of blindsight.

Using mirror visual feedback and virtual reality to treat fibromyalgia.

Fibromyalgia is a condition characterized by long term body-wide pain and tender points in joints, muscles and soft tissues. Other symptoms include chronic fatigue, morning stiffness, and depression. It is well known that these symptoms are exacerbated under periods of high stress. When pain becomes severe enough, the mind can enter what is known as a dissociative state, characterized by depersonalization - the feeling of detachment from one's physical body and the illusion of watching one's physical body from outside. In evolutionary terms, dissociative states are thought to be an adaptive mechanism to mentally distance oneself from pain, often during trauma. Similar dissociative experiences are reported by subjects who have used psychoactive drugs such as ketamine. We have previously used non-invasive mirror visual feedback to treat subjects with chronic pain from phantom limbs and suggested its use for complex regional pain syndrome: once considered intractable pain. We wondered whether such methods would work to alleviate the chronic pain of fibromyalgia. We tested mirror visual feedback on one fibromyalgia patient. On 15 trials, the patient's lower limb pain rating (on a scale from 1 to 10) decreased significantly. These preliminary results suggest that non-invasive dissociative anesthetics such as VR goggles, ketamine, and mirror visual feedback could be used to alleviate chronic pain from fibromyalgia. This would furnish us with a better understanding of the mechanism by which external visual feedback interacts with the internal physical manifestation of pain.