Measuring health inequalities between genders and age groups with realization of potential life years (RePLY)

OBJECTIVE: We propose a new method to measure health inequalities caused by conditions amenable to policy intervention and use this to identify health differences between sexes and age groups. METHODS: The lowest observed mortality rates are used as a proxy of unavoidable mortality risks to develop a new measure of health outcome - realization of potential life years (RePLY). The RePLY distribution is used to measure avoidable health inequalities between sex and age groups respectively. FINDINGS: Using RePLY we find that even those countries with very high life expectancy at birth can have substantial health inequalities across different age groups. Also, gender inequality is more pronounced among those aged < 30. Among countries with a life expectancy < 60 years, there is a much larger prevalence of gender inequality against females; countries with life expectancy > 60 years have comparable numbers of cases of inequality among females and males. Finally, high avoidable health inequality is associated with low average income, high income inequality and high population fractionalization. CONCLUSION: It is important to distinguish between unavoidable and avoidable mortality when measuring health outcomes and their distribution in society. The proposed new measure (RePLY) enables policy-makers to focus on age-sex groups with low realization of potential life years and thus high avoidable mortality risks.     

Contaminants in Lesser and Greater Scaup Staging on the Lower Great Lakes

The decrease and subsequent lack of recovery of the North American scaup population has increased concerns about contaminants acquired during migration. We collected 189 fall- and spring-migrant lesser (Aythya affinis) and greater scaup (A. marila) on the lower Great Lakes (LGL) to determine if organic contaminants and trace elements in scaup livers were increased and to evaluate sources of variation in selenium (Se) burdens. We found that all organic contaminants were below toxic levels. Of 18 trace elements, only Se was detected at increased (>10-ppm dry-mass) levels. Se in lesser scaup increased but remained constant in greater scaup throughout fall; levels were increased in 14% of lesser scaup and 46% of greater scaup. During spring, Se increased in lesser scaup but decreased slightly in greater scaup; levels were increased in 75% of lesser scaup and 93% of greater scaup. We suggest that Se may be problematic for some breeding female scaup after departing the LGL, but more research is needed to determine the extent to which it affects scaup demographics.     

Reliability of peer and self-assessment scores compared with trainers' scores following third molar surgery

Context It is sometimes claimed that self‐assessment is inaccurate and that clinicians over‐rate their performance. There is a need to find out why this should be. Is poor self‐assessment caused by some clinicians' inability to accurately judge performance? Or does over‐scoring result from a desire to convey a more favourable impression? Peer assessment is widely advocated and is said to be of benefit to both assessor and assessee. Methods In this study, we wanted to see if postgraduates were able to peer‐assess and if this form of assessment was more reliable than self‐assessment when compared with assessment by a trainer. We used checklist and global rating scales to evaluate surgical skills in removing a mandibular third molar tooth. Results There was no statistically significant difference between peer‐assessed and trainer‐assessed scores. We found that, on average, peer assessment (especially global rating scales) reflected trainer scores more accurately than self‐assessment of surgical skills. Self‐assessment scores were significantly higher on average than those given in peer assessment. Discussion Although peers and trainee surgeons came from the same group, the surgeons were more likely to over‐score when measuring their own performances. The greatest variability (and over‐scoring) between assessor and trainee surgeon appeared to occur in those with lower mean scores. Formative peer assessment may be a useful and less stressful mechanism for encouraging reflection.     

T Cell Receptor (TCR)-β Gene Recombination: Dissociation from Cell Cycle Regulation and Developmental Progression During T Cell Ontogeny

T cell lymphopoiesis involves extensive cell division and differentiation; these must be balanced by export and programmed cell death to maintain thymic homeostasis. Details regarding the nature of these processes, as well as their relationships to each other and to the definitive process of T cell receptor (TCR) gene recombination, are presently emerging. Two widely held concepts are that cell cycle status is inherently and inversely linked to gene recombination and that the outcomes of gene recombination regulate developmental progression. In this study, we analyze TCR-β recombination and cell cycle status with respect to differentiation during early T cell ontogeny. We find that although differentiation, cell cycle fluctuations, and gene recombination are coincident during normal T cell development, differentiation and cell cycle status are not inherently linked to the recombination process or its products. Rather, recombination appears to occur in parallel with these events as part of a genetically patterned program of development. We propose that the outcome of gene recombination (i.e., TCR expression) may not influence developmental progression per se, but instead serves to perpetuate those developing cells that have been successful in recombination. The potential consequences of this model for the regulation of thymic lymphopoiesis and programmed cell death are discussed.     

Quality assessment of out sourced after-hours computed tomography teleradiology reports in a Central London University Hospital

The study was designed to assess the quality of out sourced after-hours computed tomography teleradiology service reports. We evaluated 1028 patients over a time period of five month in 2009/2010 (437 female, 591 male, mean age: 51 years, range: 0-97 years) who were referred either by the A&E or other in house departments from 7 pm to 8 am for different reasons. Reporting was done by a teleradiology service provider located in the UK and Australia. Reports were assessed during the routinely performed morning meeting by a panel of in house radiologists. Assessment was done by a five point agreement scale (5="No disagreement", 1="…unequivocal potential for serious morbidity or threat to life"). In 811 (79%) patients no disagreement was found, 164 (16%) were rated as category 4, 40 (4%) as category 3 ("…likelihood of harm is low"). In 13 (1.3%) patients a decision of category 2 was made ("…strong likelihood of moderate morbidity but not threat to life"). No category 1 decision was made. As this was just a discrepancy decision, a follow up of the category 2 patients was done over a period of a maximum of 6 months. In 8 (0.8%) patients the in house reports were correct, in 2 (0.2%) patients the teleradiology service provider was right and in 3 (0.3%) patients the final diagnoses remained unclear. In conclusion there was a small rate (0.8%) of proven serious misinterpretations by the teleradiology service provider, but these were less than in comparable studies with preliminary in house staff reports (1.6-24.6%).     

Evaluation of scattered radiation in a calibration range using exposure rate energy spectra

ISO standard 4037 specifies that for calibrating protection level dosimeters, scattered radiation should contribute less than 5% of the exposure. In previous work, the authors reported the results of an MCNP analysis of the shadow shield technique that was performed for a calibration range with a Cs irradiator. This paper examines the energy distribution of the photons contributing to the exposure percent scatter (S%) and the detailed origin of the scatter that originates in the irradiator. In summary, it reports that: 1) the majority of S% is due to photons with energies that are significantly below the source energy, 2) a significant percentage of S% is due to photons that scatter within the source and source capsule walls, and 3) S% due to scatter within the irradiator is even more significant than previously reported.     

Credibility of placebo transcutaneous nerve stimulation and acupuncture

In a study comparing the credibility of acupuncture and sham transcutaneous nerve stimulation (TNS) within a group of chronic pain patients, equal suggestion of the sham TNS was achieved by incorporating a visual display and strong verbal suggestion into the placebo treatment. The analgesic effect of placebo is a confounding factor in controlled trials of physical methods of pain relief, and the use of sham therapy distinguishable from active therapy requires that the placebo be validated as a true control for the non-specific components that constitute the placebo aspect of the active treatment. This study uses a questionnaire designed to assess patient expectancy of effectiveness and concludes that sham TNS with strong visual and verbal suggestion may be a valid placebo for controlled studies of the analgesic effect of acupuncture.