Gendered racial microaggressions and stress in PAs who are Black women.

OBJECTIVE: This mixed-methods study explored whether physician associates/assistants (PAs) who are Black women (for brevity, called Black women PAs throughout this article) experience gendered racial microaggressions and whether these experiences correlated with psychologic distress. The phrase Black women encompasses those who identify with the sociocultural roles, behaviors, and expressions of being a Black woman. METHODS: We conducted an online survey of Black women PAs using the Gendered Racial Microaggressions Scale during a 2-month period in 2019. RESULTS: Black women PAs experienced gendered racial microaggressions in clinical settings. Gendered racial microaggressions were correlated with stress, being silenced and marginalized, and assumptions of beauty and sexual objectification. No correlations were found between stress and the angry Black woman and strong Black woman variables. CONCLUSIONS: This study revealed that Black women have interlocking forms of oppression related to their race and gender, which are associated with psychologic distress. Awareness of these occurrences can reduce the unknowing perpetuation of gendered racial microaggressions and create cultural awareness practices.

Twelve new metagenome-assembled genomes from non-axenic culture of Griffithsia monilis (Rhodophyta).

We report 12 metagenome-assembled genomes from a non-axenic culture of the red alga Griffithsia monilis Harvey, some of which are distantly related to publicly available genomes.

Molecular phylogeny of Urvillea (Paullinieae, Sapindaceae) and its implications in stem vascular diversity.

BACKGROUND AND AIMS: The tribe Paullinieae has the highest diversity of vascular variants among the seed plants. The developmental diversity is better understood in the species-rich genera Paullinia and Serjania; however, the phylogeny and diversity of vascular variants in the smaller genera of Paullinieae remain understudied. Here we investigate the evolution of development of stem vasculatures in the small genus Urvillea. METHODS: We generate the first molecular phylogeny of Urvillea derived from 11 markers using a maximum likelihood and Bayesian approach. In combination with phylogenetic reconstruction, stochastic character mapping is used to assess evolutionary changes in stem ontogenies, determined from developmental anatomy of stems collected in the field or from herbarium and wood collections. KEY RESULTS: Urvillea is supported as a monophyletic group and sister to Serjania. There are five stem ontogenies in Urvillea, including typical growth and four different vascular variants. Most stem ontogenies initiate with lobed stems in primary growth. Lobed stems in secondary growth are ancestral in Urvillea, but this ontogeny was lost multiple times. A reversal to typical growth occurred in non-climbing species. Phloem wedges, fissured stems, and ectopic cambia each evolved once independently. Phloem wedges is an intermediate developmental stage in the formation of fissured stems, which is characterized by a continuous fragmentation of vascular tissues. Lobed stems may generate constriction zones and lobes may split or not. CONCLUSIONS: Urvillea is the third most diverse genus (after Serjania and Paullinia) with respect to the number of vascular variants within Paullinieae. One ontogeny (fissured stems) is exclusive to the genus. Differential cambial activity and ectopic cambia are the main ontogenetic processes generating stem diversity. The evolutionary history of vascular variants demonstrates the large developmental plasticity of the cambium in such a small genus and further demonstrates that complex anatomies have repeatedly evolved within Paullinieae lianas.

How does it all end? Trends and disparities in health at the end of life.

OBJECTIVES: To consider trends and disparities in end-of-life health in the US. METHODS: I use data from the National Health Interview Survey, linked to death records through 2015, for respondents who died at ages 65+ to compare the prevalence of three health outcomes in the last six years of life across time, sex, age, race, and educational attainment. Self-rated health (SRH) is available for respondents interviewed in years 1987-2014, while information on activities of daily living (ADL) and instrumental activities of daily living (IADL) is available for the period 1997-2014. RESULTS: By the end of the study period, individuals reported two fewer months of fair/poor health at the end of life than those dying in earlier years. In contrast, time lived with at least one activity limitation at the end of life generally remained comparable. Compared to men, women on average reported an additional year of living with an IADL limitation before death, and an additional eight months with an ADL limitation. Despite sex differences in disability, both sexes reported similar periods of fair/poor SRH before death. Similarly, while individuals who lived to older ages experienced a longer disabled period before death than individuals who died at younger ages, all age groups were equally likely to report fair/poor SRH. Black adults and adults with less formal schooling also spent more time with an end-of-life disability. For men, these racial and socioeconomic disparities lessened as death approached. For women, inequalities persisted until death. DISCUSSION: These findings suggest that despite increasing life expectancy, the period of poor health and disability prior to death has not recently been extended. Black women and women with less than a high school degree, require extended support at the end of life.

Excess mortality in the United States in the 21st century.

We use three indexes to identify how age-specific mortality rates in the United States compare to those in a composite of five large European countries since 2000. First, we examine the ratio of age-specific death rates in the United States to those in Europe. These show a sharp deterioration in the US position since 2000. Applying European age-specific death rates in 2017 to the US population, we then show that adverse mortality conditions in the United States resulted in 400,700 excess deaths that year. Finally, we show that these excess deaths entailed a loss of 13.0 My of life. In 2017, excess deaths and years of life lost in the United States represent a larger annual loss of life than that associated with the COVID-19 epidemic in 2020.

Trends in alcohol-related mortality by educational attainment in the U.S., 2000-2017.

BACKGROUND: Alcohol-related mortality rates in the U.S. have risen since 2000, though how trends vary across socio-economic status is unclear. METHODS: This analysis combines data from vital statistics and the National Health Interview Survey (NHIS) to estimate alcohol-related mortality rates at four levels of educational attainment (less than high school, high school/GED, some college/associate's degree, four-year degree or more) over the period 2000-2017. The analysis includes a comprehensive set of 48 alcohol-related causes of death, including causes which are indirectly influenced by alcohol use. I consider period and cohort patterns in inequality using the relative index of inequality (RII). RESULTS: Mortality rates increased over the study period, at all levels of educational attainment. Relative increases were larger for females than males at nearly all ages and levels of educational attainment, and were largest among 45-59 year-old women. Male and female members of the 1950-1959 birth cohort exhibited elevated rates of alcohol-related mortality relative to neighboring cohorts. Despite widespread increases in alcohol-related mortality, educational inequalities present at the beginning of the analysis persisted and exceeded those in all-cause mortality. Disparities were typically greatest among younger adults ages 30-44, though inequality in this age group declined over time. Inequality increased among females ages 60-74, as well as among males ages 45-74. IMPLICATIONS: While interventions targeting these groups may reduce educational disparities, care should also be taken to stem the increasing prevalence of alcohol-related deaths at all levels of educational attainment.

Life Beyond 65: Changing Spatial Patterns of Survival at Older Ages in the United States, 2000-2016.

OBJECTIVES: To identify levels and trends in life expectancy at age 65 (e65) by geographic region and metropolitan status in the United States. METHODS: Using county-level data on population and deaths from the Census and National Center for Health Statistics, we consider spatial inequality in e65 across 4 metropolitan types and 10 geographic regions from 2000 to 2016. We examine whether changes in e65 are driven by mortality developments in metro types or geographic regions, and compare spatial patterns in the United States to mortality trends in other Organization of Economic Cooperation and Development (OECD) countries. We use decomposition and regression methods to estimate the contributions of 10 causes of death to changes and inequalities in e65. RESULTS: Life expectancy at age 65 increased in all spatial units from 2000 to 2016. Areas with higher e65 in 2000 also experienced larger gains. Longevity increases were greatest in large metropolitan areas and coastal regions. Nonmetropolitan areas and the interior lagged far behind not only other parts of the United States but all OECD comparison countries. Metropolitan status was a better predictor of mortality changes than geographic region. Circulatory diseases and diseases associated with smoking were the principal sources of life expectancy gains and spatial differentiation in those gains. Larger gains in smoking-related mortality accounted for greater improvements among men than women. DISCUSSION: Even at advanced ages, large geographic disparities in life expectancy remain. And as mortality has declined, these disparities have widened. Public health efforts should pay special attention to identifying and ameliorating the sources of lagging life expectancy in nonmetropolitan regions.

Rising geographic inequality in mortality in the United States.

OBJECTIVES: To examine trends in inequality in life expectancy and age-specific death rates across 40 US spatial units from 1990 to 2016. METHODS: We use multiple cause-of-death data from vital statistics to estimate measures of inequality in mortality across metropolitan status and geographic region. We consider trends for 5-year age intervals and examine inequality in cause-specific mortality. RESULTS: For both sexes, spatial inequality in life expectancy and all-cause mortality above age 25 rose between 2002-04 and 2014-16. During this period, the standard deviation in life expectancy at birth increased by 19% for males and by 44% for females. Areas that had higher life expectancy at the beginning of the period enjoyed larger gains in life expectancy. Especially noteworthy are divergent trends between large central metropolitan areas on the coasts and non-metropolitan areas in Appalachia and the South. Spatial inequality in mortality from lung cancer/respiratory diseases rose substantially, particularly for older women. Spatial inequality in mortality from the combination of drug overdose, alcohol use, and suicide increased at ages 30-34, but declined at ages 50-54 and 70-74. Inequality in mortality from circulatory diseases, the largest cause of death, grew for some groups, particularly 30-34 year-old women. Mortality from screenable cancers, an indicator of the performance of medical systems, showed relatively little spatial disparity during the period. CONCLUSIONS: Spatial inequality in life expectancy at birth and adult mortality has increased in recent decades.

Patterns of weight change associated with disease diagnosis in a national sample.

BACKGROUND: The incidence and/or diagnosis of a major disease may activate weight change. Patterns of weight change associated with diagnoses have not been systematically documented. METHODS: We use data on adults ages 30+ in the National Health and Nutrition Examination Survey (NHANES) from 1999-2014. Self-reported current weight and weight one year prior are used to estimate percent weight change in the last year. We use self-reported data on arthritis, diabetes, cancer, cardiovascular disease, liver conditions, and respiratory disease diagnoses to compare weight change among individuals never diagnosed with these conditions, individuals diagnosed 0-1 years ago, and individuals diagnosed 2+ years ago. Multinomial logistic regressions adjust for the presence of multiple conditions. RESULTS: 17.7% of the adult population experienced weight loss of 5.0% or more in the year prior to survey. Individuals diagnosed with any of the conditions were less likely to maintain their weight than those without a diagnosis. Arthritis, diabetes, cancer, cardiovascular disease, and liver conditions were associated with net weight loss, whereas respiratory diseases were associated with higher probabilities of both losing and gaining weight. Among those losing 10% or more, 56.7% had been diagnosed with one of the conditions. Cancer was associated with the highest probability of unintentional weight loss and diabetes with the highest probability of intentional weight loss. CONCLUSIONS: Disease-associated weight changes leave a distinct imprint on patterns of weight change in the population. Individuals losing at least 10% of their weight in the last year have likely been diagnosed with one of the six conditions.

The role of obesity in exceptionally slow US mortality improvement.

Recent studies have described a reduction in the rate of improvement in American mortality. The pace of improvement is also slow by international standards. This paper attempts to identify the extent to which rising body mass index (BMI) is responsible for reductions in the rate of mortality improvement in the United States. The data for this study were obtained from subsequent cohorts of the National Health and Nutrition Examination Survey (NHANES III, 1988-1994; NHANES continuous, 1999-2010) and from the NHANES linked mortality files, which include follow-up into death records through December 2011. The role of BMI was estimated using Cox models comparing mortality trends in the presence and absence of adjustment for maximum lifetime BMI (Max BMI). Introducing Max BMI into a Cox model controlling for age and sex raised the annual rate of mortality decline by 0.54% (95% confidence interval 0.45-0.64%). Results were robust to the inclusion of other variables in the model, to differences in how Max BMI was measured, and to how trends were evaluated. The effect of rising Max BMI is large relative to international mortality trends and to alternative mortality futures simulated by the Social Security Administration. The increase in Max BMI over the period 1988-2011 is estimated to have reduced life expectancy at age 40 by 0.9 years in 2011 (95% confidence interval 0.7-1.1 years) and accounted for 186,000 excess deaths that year. Rising levels of BMI have prevented the United States from enjoying the full benefits of factors working to improve mortality.

The contribution of differences in adiposity to educational disparities in mortality in the United States.

BACKGROUND: There are large differences in life expectancy by educational attainment in the United States. Previous research has found obesity's contribution to these differences to be small. Those findings may be sensitive to how obesity is estimated. METHODS: This analysis uses discrete-time logistic regressions with data from the National Health and Nutrition Examination Survey (NHANES), pooled from 1988 to 1994 and 1999 to 2010, to estimate the contribution of differences in adiposity, or body fat, to educational differences in mortality. I show that results depend upon the measure of adiposity used: body mass index (BMI) at the time of survey or lifetime maximum BMI. RESULTS: College graduates were less likely than high school graduates to be obese at the time of survey (25% vs. 34.6%, respectively) and were also less likely to have ever been obese (35.7% vs. 49.4%, respectively). Lifetime maximum BMI performed better than BMI at the time of survey in predicting mortality using criteria for model selection. Differences in maximum BMI were associated with between 10.3% and 12% of mortality differences between college graduates and all others, compared to between 3.3% and 4.6% for BMI at the time of survey. Among nonsmokers, between 18.4% and 27.6% of mortality differences between college graduates and all others were associated with differences in maximum BMI. CONTRIBUTION: Adiposity is an overlooked contributor to educational differences in mortality. Previous findings that obesity does not contribute to educational disparities were based on BMI at the time of survey, which is less informative than maximum BMI. The contribution of adiposity to educational mortality differences will likely grow as smoking prevalence declines. Health surveys should collect information on weight history.

[From lymphangioma to lymphangiomatosis. Apropos of 10 cases]. / Du lymphangiome à la lymphangiomatose. A propos de 10 observations.

Seven cases of lymphangioma and 3 cases of diffuse lymphangiomatosis have been studied with computed tomography (CT). In the 7 cases of local involvement, the tumor was located in the mediastinum (3 cases), the mesentery (2 cases), the spleen (1 case), and the pelvis (1 case). The disease was diffuse in 3 cases, involving the mesentery, the pelvis, the posterior mediastinum, the retroperitoneal space and the bones in the first case; in the second case, lymphangiomatosis was located in the posterior mediastinum, the spine (T12 and L3) and the right iliac wing; the third case showed diffuse involvement of the posterior mediastinum and of the spleen. The CT study allows suspecting the disease when it demonstrates an encapsulated tumor with liquid or fatty density and thin walls enhancing with contrast. Other, less typical appearances may be observed, which should not lead to challenging this diagnosis. The CT exploration provides a complete assessment of the lesions, including the detection of tumors not seen on plain radiographs. In addition, CT is useful for the prognosis since it identifies the diffuse forms, which are naturally prone to aggravation, or recurrence when surgery has been indicated. Lymphangioma and lymphangiomatosis seem to be different forms of the same abnormality of the lymphatic system, either local or scattered.

[Radiologic aspects of noncalculous inflammation of the biliary tract in AIDS]. / Aspects radiologiques des inflammations non calculeuses des voies biliaires au cours du SIDA.

Six cases of non-lithiasic cholecystitis and 7 cases of inflammatory cholangitis caused by cryptosporidium and/or cytomegalovirus infections have been studied in HIV-1 + patients. All patients were examined with ultrasound and 5 with computed tomography (CT). The appearance is the same as that described for non-lithiasic cholecystitis (pain when the ultrasound probe is applied, thickened gallbladder wall) and sclerosing cholangitis (dilatation and/or stenosis of the bile duct, thickened gallbladder wall). The ultrasound or CT examination of HIV + patients with gallbladder involvement is sufficient to guide treatment when a thickened gallbladder wall is demonstrated. On the other hand, bile duct opacification is the only method allowing the accurate assessment of the extent of lesions in cholangitis, on which the indication for eventual sphincterotomy is based.

[Imaging technics in extra-cardiac thoracic amyloidosis]. / Apport de l'imagerie dans l'amylose thoracique extra-cardiaque.

This report deals with five observations of tracheobronchial, pleuropulmonary and mediastinal amyloidosis. Exploration was performed with plain radiographs, computed tomography in three cases, and magnetic resonance imaging in one case of tracheobronchial and interstitial amyloidosis. After their review of literature, the authors describe the main features of extracardiac thoracic amyloidosis observed with imaging and establish the contribution of the various techniques to the diagnosis and follow-up of the disease.

[High-resolution x-ray computed tomography in lymphoid interstitial pneumonia]. / Tomodensitométrie en haute résolution de la pneumonie lymphoïde interstitielle.

Three patients with lymphoid interstitial pneumonia (two HIV 1+ patients with chronic lymphadenopathic syndromes and one with a not-characterized autoimmune disease) have been studied with high-resolution computed tomography (HR-CT). This technique reveals septal lines, small reticulonodular opacities, polyhedral micronodular opacities, "ground-glass" opacities and a dense, subpleural, curved broken line in one patient. The lesions dominate in the bases of the lungs. They are not characteristic for lymphoid interstitial pneumonia. If a patient present with a chronic lymphadenopathic syndrome, the diagnosis of an opportunistic infection should not be automatically made, since the syndrome can be caused by lymphoid interstitial pneumonia.

[Echographic and x-ray computed tomographic aspects of intramural hematoma of the duodenum. Apropos of a case]. / Aspects échographiques et tomodensitométriques de l'hématome intramural du duodénum. A propos d'un cas.

Radiologic imaging in a case of intramural hematoma of duodenum demonstrated typical appearances of the lesion. Ultrasound imaging of the duodenal hematoma was sufficiently characteristic to be used as a basis for a semeiologic discussion and to orientate diagnosis. The relevant literature is reviewed, and value and indications of different imaging techniques for diagnosis and follow up of the hematoma discussed.

[Retro-aortic left brachiocephalic venous trunk. A rare anomaly: 2 cases]. / Le tronc veineux brachio-céphalique gauche rétro-aortique. Une anomalie rare: deux cas.

Two cases of a rare anomaly of the trajectory of the left brachiocephalic venous trunk were detected by CT scan imaging. In both patients the trunk passed under the aortic arch before emptying into the superior vena cava. One patient presented, in addition, a complex anomaly of the aortic arch.