More Women are Medicated While More Men are Talked Out: Persistent Gender Disparities in Mental Health Care

Introduction

Physician incentives have been shown in previous studies to help reduce socioeconomic disparities in health care. Its impact on gender disparities, however, has rarely been investigated.

Aim

The impact of physician incentives on gender disparities in mental health care was investigated in this retrospective study.

Method

De-identified health administrative data from physician claims, hospital separations, vital statistics, prescription database, and insurance plan registries were linked and examined. Monthly cohorts of individuals with depression who were residing in British Columbia, Canada were identified and their use of mental health services tracked for 12 months following receipt of initial diagnosis. indicators that assess receipt of the following services were created:

– counseling/psychotherapy (CP);

– minimally adequate counseling/psychotherapy (MACP);

– antidepressant therapy (AT);

– minimally adequate antidepressant therapy (MAAT).

interrupted time series analysis was used to estimate changes in these indicators before (01/2005–12/2007) and after (01/2008–12/2012) physician incentives were introduced.

Results

At the beginning of the study period, the percentage of individuals diagnosed with depression who received counseling/psychotherapy was higher, on average, among men (CP: 58.4%, MACP: 13.6%) than women (CP: 57.1%, MACP: 10.9%). in contrast, the percentage who received antidepressant therapy was higher among women (AT: 57.7%, MAAT: 47.4%) than men (AT: 53.6%, MAAT: 41.9%). Levels for these indicators have changed over time but the statistically significant differences between men and women were virtually the same before and after incentives were introduced.

Conclusions

Gender disparities in mental health care persist despite the introduction of physician incentives designed to enhance access to mental health services in primary care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Filter-less submicron hydrodynamic size sorting

We propose a simple microfluidic device able to separate submicron particles (critical size ∼0.1 μm) from a complex sample with no filter (minimum channel dimension being 5 μm) by hydrodynamic filtration. A model taking into account the actual velocity profile and hydrodynamic resistances enables prediction of the chip sorting properties for any geometry. Two design families are studied to obtain (i) small sizes within minutes (low-aspect ratio, two-level chip) and (ii) micron-sized sorting with a μL flow rate (3D architecture based on lamination). We obtain quantitative agreement of sorting performances both with experiments and with numerical solving, and determine the limits of the approach. We therefore demonstrate a passive, filter-less sub-micron size sorting with a simple, robust, and easy to fabricate design.

Comparison of methods for the fabrication and the characterization of polymer self-assemblies: what are the important parameters?

The ability to self-assemble was evaluated for a large variety of amphiphilic block copolymers, including poly(ethyleneoxide-b-ε-caprolactone), poly(ethyleneoxide-b-d,l-lactide), poly(ethyleneoxide-b-styrene), poly(ethyleneoxide-b-butadiene) and poly(ethyleneoxide-b-methylmethacrylate). Different methods of formation are discussed, such as cosolvent addition, film hydration or electroformation. The influence of experimental parameters and macromolecular structures on the size and morphology of the final self-assembled structures is investigated and critically compared with the literature. The same process is carried out regarding the characterization of these structures. This analysis demonstrates the great care that should be taken when dealing with such polymeric assemblies. If the morphology of such assemblies can be predicted to some extent by macromolecular parameters like the hydrophilic/hydrophobic balance, those parameters cannot be considered as universal. In addition, external experimental parameters (methods of preparation, use of co-solvent, …) appeared as critical key parameters to obtain a good control over the final structure of such objects, which are very often not at thermodynamic equilibrium but kinetically frozen. A principal component analysis is also proposed, in order to examine the important parameters for forming the self-assemblies. Here again, the hydrophilic/hydrophobic fraction is identified as an important parameter.

Deinococcus as new chassis for industrial biotechnology: biology, physiology and tools

Deinococcus spp are among the most radiation-resistant micro-organisms that have been discovered. They show remarkable resistance to a range of damage caused by ionizing radiation, desiccation, UV radiation and oxidizing agents. Traditionally, Escherichia coli and Saccharomyces cerevisiae have been the two platforms of choice for engineering micro-organisms for biotechnological applications, because they are well understood and easy to work with. However, in recent years, researchers have begun using Deinococcus spp in biotechnologies and bioremediation due to their specific ability to grow and express novel engineered functions. More recently, the sequencing of several Deinococcus spp and comparative genomic analysis have provided new insight into the potential of this genus. Features such as the accumulation of genes encoding cell cleaning systems that eliminate organic and inorganic cell toxic components are widespread among Deinococcus spp. Other features such as the ability to degrade and metabolize sugars and polymeric sugars make Deinococcus spp. an attractive alternative for use in industrial biotechnology.

Single velocity-component modeling of leading edge turbulence interaction noise

A computational aeroacoustics approach is used to predict leading edge turbulence interaction noise for real airfoils. One-component (transverse), two-component (transverse and streamwise), and three-component (transverse, streamwise, and spanwise) synthesized turbulence disturbances are modeled instead of harmonic transverse gusts, to which previous computational studies of leading edge noise have often been confined. The effects of the inclusion of streamwise and spanwise disturbances on the noise are assessed. It is shown that accurate noise predictions can be made by modeling only transverse disturbances which reduces the computational expense of simulations. The accuracy of using only transverse disturbances is assessed for symmetric and cambered airfoils, and also for airfoils at non-zero angle of attack.

Sensory quality of broiler breast meat influenced by low atmospheric pressure stunning, deboning time and cooking methods

Stunning method (low atmospheric pressure stunning, LAPS and electrical stunning, ES), deboning time (0.75 h and 4 h), and cooking method (baking, frying, and sous vide) were evaluated for their impact on the descriptive sensory characteristics and consumer acceptability of breast meat (n=576, 144 birds per stunning × deboning time combination). Sensory evaluation was conducted by trained descriptive (n=8) and consumer (n=185) panels. On average, no differences (P>0.05) existed in the sensory acceptability of fried and sous vide cooked broiler breast treatment combinations. However, for oven-baking, the LAPS treatment that was deboned at 4 h was more acceptable (P<0.05) than other treatments and the ES and LAPS 4 h samples had greater (P<0.05) acceptability for texture than their ES and LAPS 0.75 h counterparts. Since consumers were highly variable in their liking of chicken breast treatments, consumers were grouped into clusters for each cooking method based on liking and preference. Cluster analysis data revealed that the largest groups of consumers liked (score≥6.0) all chicken breast treatments, but a larger proportion of consumers liked the 4 h LAPS and ES treatments when compared to the 0.75 h LAPS and ES treatments for all cooking methods. In addition, the consumers who indicated that baked chicken breast was highly acceptable preferred (P<0.05) 4 h LAPS over the 4 h ES samples. Based on sensory results, chicken breast meat from all stunning and deboning method combinations was highly acceptable to the majority of consumers, but the LAPS 4 h treatment had enhanced sensory characteristics when baked.

Osmotic flow through fully permeable nanochannels

Osmosis across membranes is intrinsically associated with the concept of semipermeability. Here, however, we demonstrate that osmotic flow can be generated by solute gradients across nonselective, fully permeable nanochannels. Using a fluorescence imaging technique, we are able to measure the water flow rate inside single nanochannels to an unprecedented sensitivity of femtoliters per minute flow rates. Our results indicate the onset of a convective liquid motion under salinity gradients, from the higher to lower electrolyte concentration, which is attributed to diffusio-osmotic transport. To our knowledge, this is the first experimental evidence and quantitative investigation of this subtle interfacially driven transport, which need to be accounted for in nanoscale dynamics. Finally, diffusio-osmotic transport under a neutral polymer gradient is also demonstrated. The experiments highlight the entropic depletion of polymers that occurs at the nanochannel surface, resulting in convective flow in the opposite direction to that seen for electrolytes.

Synthesis and biological activity of 3-N-substituted estrogen derivatives as breast cancer agents

3-N-substituted-estrogen derivatives were synthesized and characterized. Their antiproliferative activities against human ER (+) MCF-7 (Breast), ER (-) MDA-MB-231 (breast) and Ishikawa (endometrial) cancer cell lines were determined after 72 hours drug exposure employing CellTiter-Glo assay at concentrations ranging from (0.01-100,000 nM). The antiproliferative activities of these compounds were compared to tamoxifen (TAM), 4-hydroxytamoxifen (4-OHT, active metabolite of tamoxifen) and raloxifene (RAL). In vitro results indicated that compound 5 (IC50 = 12 µM) displayed comparable antiproliferative activity against MDA-MB 231 cell line; while compounds 6, 7 and 13 (IC50 = 12 µM) displayed higher activity against MCF-7 and Ishikawa cell lines, in comparison to TAM activity (19-33 µM).

Symmetric airfoil geometry effects on leading edge noise

Computational aeroacoustic methods are applied to the modeling of noise due to interactions between gusts and the leading edge of real symmetric airfoils. Single frequency harmonic gusts are interacted with various airfoil geometries at zero angle of attack. The effects of airfoil thickness and leading edge radius on noise are investigated systematically and independently for the first time, at higher frequencies than previously used in computational methods. Increases in both leading edge radius and thickness are found to reduce the predicted noise. This noise reduction effect becomes greater with increasing frequency and Mach number. The dominant noise reduction mechanism for airfoils with real geometry is found to be related to the leading edge stagnation region. It is shown that accurate leading edge noise predictions can be made when assuming an inviscid meanflow, but that it is not valid to assume a uniform meanflow. Analytic flat plate predictions are found to over-predict the noise due to a NACA 0002 airfoil by up to 3 dB at high frequencies. The accuracy of analytic flat plate solutions can be expected to decrease with increasing airfoil thickness, leading edge radius, gust frequency, and Mach number.

Management of colorectal cancer liver metastasis in a patient with immune thrombocytopaenia

Immune thrombocytopaenia (ITP) was referred to previously as idiopathic thrombocytopaenic purpura and is usually of autoimmune or viral aetiology. Colorectal cancer liver metastasis with concomitant ITP is rare and only three cases have been reported in the English literature. Adverse effects of adjuvant chemotherapy may aggravate ITP. The sequencing of chemotherapy, operation for the primary and liver metastasis, and a decision on splenectomy is important. We present our experience in the management of a 52-year-old man who, having undergone anterior resection one year earlier for carcinoma of the rectum, presented with liver metastasis and ITP. He underwent splenectomy with hepatectomy prior to chemotherapy.

Bovine mitochondrial oxygen consumption effects on oxymyoglobin in the presence of lactate as a substrate for respiration

Research suggests that NADH formed from lactate addition can increase mitochondrial oxygen consumption. However, limited research has assessed the subsequent effects of lactate-mediated mitochondrial oxygen consumption on oxymyoglobin. Therefore, our objective was to assess the effects of bovine mitochondrial oxygen consumption on oxymyoglobin in the presence of lactate, LDH, and NAD. Isolated beef cardiac and skeletal muscle mitochondria (n=5) were reacted with lactate (40 mM), LDH (100 units), and NAD (0.02 mM) to initiate oxygen consumption. Myoglobin redox state was measured to assess the effects of oxygen consumption on oxymyoglobin. The addition of lactate-LDH-NAD to mitochondria increased (p<0.05) both oxygen consumption and conversion of oxymyoglobin to deoxymyoglobin compared with control mitochondria without substrates. The addition of antimycin A to mitochondria decreased oxygen consumption and deoxymyoglobin formation (p<0.05). The results suggest that increased oxygen consumption can influence myoglobin redox state and this effect might be partially responsible for the darkening effect in lactate enhanced beef.