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Background Methods Results Discussion Racialised trainees in Canada and the USA continue to disproportionately experience discrimination and harassment in learning environments despite equity, diversity, and inclusion (EDI) reform efforts. Using critical approaches to understand what problems have been conceptualised and operationalised as EDI issues within postgraduate medical education (PGME) is important to inform ongoing learning environment reform in resident training.We conducted a critical narrative review of EDI literature from 2009–2022 using critical race theory (CRT) and the concept of intersectionality to analyse how issues of discrimination in PGME have been studied. Our search yielded 2244 articles that were narrowed down to 349 articles for relevance to Canadian and American PGME contexts. We attended to reflexivity and our positionality in analysing the database and identifying themes related to EDI reform.Interest convergence was noted in how EDI reform was rationalised primarily by increased productivity. Problems of learner representation, gender inequities and curricular problems were conceptualised as EDI issues. The role that racism played in EDI‐related problems was largely invisible, as were explicit conceptualisations of race and gender as social constructs. Overall, there was a lack of critical or intersectional approaches in the literature reviewed. Misalignment was noted where studies would frame a problem through a critical lens, but then study the problem without attention to power.Interest convergence and epistemic injustice can account for the absence of critical approaches due to the alignment of existing EDI work with institutional interests and priorities. Interest convergence conceptually limits existing EDI reform efforts in PGME. CRT and intersectionality connect racialised learner experiences to systemic phenomena like racism and other forms of discrimination to challenge dominant assumptions. Because they attend to power, critical approaches are key to understanding why inequities have persisted to advance equity in learning environments for racialised and intersectionally marginalised learners. [ABSTRACT FROM AUTHOR]

Background: Medical tests provide important information to guide clinical management. Overtesting, however, may cause harm to patients and the healthcare system, including through misdiagnosis, false positives, false negatives and overdiagnosis. Clinicians are ultimately responsible for test requests, and are therefore ideally positioned to prevent overtesting and its unintended consequences. Through this narrative literature review and workshop discussion with experts at the Preventing Overdiagnosis Conference (Sydney, 2019), we aimed to identify and establish a thematic framework of factors that influence clinicians to request non-recommended and unnecessary tests.Methods: Articles exploring factors affecting clinician test ordering behaviour were identified through a systematic search of MedLine in April 2019, forward and backward citation searches and content experts. Two authors screened abstract titles and abstracts, and two authors screened full text for inclusion. Identified factors were categorised into a preliminary framework which was subsequently presented at the PODC for iterative development.Results: The MedLine search yielded 542 articles; 55 were included. Another 10 articles identified by forward-backward citation and content experts were included, resulting in 65 articles in total. Following small group discussion with workshop participants, a revised thematic framework of factors was developed: "Intrapersonal" - fear of malpractice and litigation; clinician knowledge and understanding; intolerance of uncertainty and risk aversion; cognitive biases and experiences; sense of medical obligation "Interpersonal" - pressure from patients and doctor-patient relationship; pressure from colleagues and medical culture; "Environment/context" - guidelines, protocols and policies; financial incentives and ownership of tests; time constraints, physical vulnerabilities and language barriers; availability and ease of access to tests; pre-emptive testing to facilitate subsequent care; contemporary medical practice and new technology CONCLUSION: This thematic framework may raise awareness of overtesting and prompt clinicians to change their test request behaviour. The development of a scale to assess clinician knowledge, attitudes and practices is planned to allow evaluation of clinician-targeted interventions to reduce overtesting. [ABSTRACT FROM AUTHOR]

China has experienced rapid growth and as China grows, so does its global influence. Chinese culture can be seen in countries all over the world, and its influence is evident in various cuisines, languages, and even architecture. However, despite the global trend towards a more modern style, there are various elements present in Chinese architecture that allow it to stand out from the rest. Various real-life structures embody key beliefs of Feng Shui, which is both a theory and a practice for connecting the mind, body, and spirit to one’s space or environment, anchored on the traditional Chinese worldview on the art of spatial alignment and orientation, and its relationship with humans and their environment. These architectural designs do not merely stem from cultural or ideological bases alone; they have practical, economical, and logical applications as well. These real-life examples highlight the practicality behind the practice of Feng Shui in architecture. [ABSTRACT FROM AUTHOR]

Brachialis periosteal avulsion injury is an uncommon injury occurring in young children. The injury may be misinterpreted or overlooked because of misleading or subtle radiological findings. A case of 7-year-old child with post-traumatic elbow pain and subtle findings on elbow radiography is presented. The injury was initially misinterpreted as an avulsion fracture of the medial epicondyle. Following radiological review, a diagnosis of brachialis periosteal avulsion injury was made. The radiographic and magnetic resonance imaging (MRI) findings of this injury are presented to stress the value of comparing the radiographic findings with previous imaging and to increase awareness of this uncommon injury. [ABSTRACT FROM AUTHOR]

This is the first case report of a symptomatic retroperitoneal lymphocoele formation occurring a decade after laparoscopic presacral neurectomy successfully managed by laparoscopic surgery. [ABSTRACT FROM AUTHOR]

A case study of a 14-year-old female who is diagnosed with Gastroesophageal reflux disease (GERD) is presented. Topics discussed include self-inserted nasogastric tube for weight stabilization; symptoms of inflammatory bowel or rheumatologic disease; and patient was admitted to the General Paediatrics unit for correction of electrolyte abnormalities and dehydration as well as symptom interruption.

Background: On 9 June 2021, the Australian Technical Advisory Group on Immunisation and Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommended that pregnant women receive Comirnaty (Pfizer) messenger RNA vaccine at any stage of pregnancy. Aim: This multi‐centre study aimed to assess vaccine acceptance, reasons for hesitancy and determine if differences exist between health districts, to inform future policy strategies for COVID‐19 vaccination in pregnancy. Materials and methods: An online survey (developed based on the World Health Organization Behavioural and Social Drivers survey and modified for the pregnant population) was administered to a sample population of pregnant women attending antenatal clinics at two metropolitan hospitals (Westmead and Royal North Shore Hospital (RNSH)) in New South Wales between 15 September 2021 and 22 October 2021. Results: There were 287 pregnant women surveyed (Westmead 198 (69%), RNSH 66 (23%), no site 23 (8%)). There was a significantly lower Socio‐Economic Indexes for Areas score (5.66 vs 9.45, P = 0.001), fewer women born in Australia (37% vs 53%, P = 0.02) and higher number of children (0.77 vs 0.41, P = 0.01) among Westmead respondents. There was lower vaccination uptake (68% vs 86%, P = 0.01) and willingness to receive vaccine (68% vs 88% P = 0.01) at Westmead compared to RNSH. There was an increased proportion of respondents who were concerned that the vaccine could cause harm to the unborn baby at Westmead (38% vs 11%, P = 0.01). Conclusions: Along with healthcare provider recommendation for vaccination in pregnancy, materials should be targeted to specific safety concerns of pregnant women. [ABSTRACT FROM AUTHOR]

An abstract of the conference paper "In vivo detection and treatment of ischemia-induced cardiac apoptosis using an MRI-detectable molecular probe and an alpha-adrenergic receptor agonist," by Justin Lam, and colleagues is presented.

Introduction: Endometriosis is a common gynaecological condition, usually presenting with pelvic pain or infertility in women of reproductive age. Diagnosis is made on histopathology of deposits excised during laparoscopy, given diagnosis solely made by macroscopic examination can be challenging for even experienced gynaecological surgeons. Case description: A 45-year-old during laparoscopy for fibroids is found to have peritoneal deposits resembling endometriosis. Histopathology reveals multifocal metastatic grade 1 neuroendocrine tumour of the appendix. Conclusion: This incidental finding highlights the importance of thorough examination of the appendix and abdominal cavity for unexpected pathology during gynaecological laparoscopy. Incidental finding of appendiceal pathology at time of laparoscopy for endometriosis is not uncommon; however, the finding of metastatic malignancy is far rarer. While several case studies have reported severe endometriosis mimicking advanced stage cancer, this is the first documented occurrence of an advanced, metastatic tumour, mimicking endometriosis. [ABSTRACT FROM AUTHOR]

Rationale: The chronic mild stress (CMS) paradigm was first described almost 40 years ago and has become a widely used model in the search for antidepressant drugs for major depression disorder (MDD). It has resulted in the publication of almost 1700 studies in rats alone. Under the original CMS procedure, the expression of an anhedonic response, a key symptom of depression, was seen as an essential feature of both the model and a depressive state. The prolonged exposure of rodents to unpredictable/uncontrollable mild stressors leads to a reduction in the intake of palatable liquids, behavioral despair, locomotor inhibition, anxiety-like changes, and vegetative (somatic) abnormalities. Many of the CMS studies do not report these patterns of behaviors, and they often fail to include consistent molecular, neuroanatomical, and physiological phenotypes of CMS-exposed animals. Objectives: To critically review the CMS studies in rats so that conceptual and methodological flaws can be avoided in future studies. Results: Analysis of the literature supports the validity of the CMS model and its impact on the field. However, further improvements could be achieved by (i) the stratification of animals into 'resilient' and 'susceptible' cohorts within the CMS animals, (ii) the use of more refined protocols in the sucrose test to mitigate physiological and physical artifacts, and (iii) the systematic evaluation of the non-specific effects of CMS and implementation of appropriate adjustments within the behavioral tests. Conclusions: We propose methodological revisions and the use of more advanced behavioral tests to refine the rat CMS paradigm, which offers a valuable tool for developing new antidepressant medications. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: To determine if laparoscopic sacral colpopexy (LSC) offers better apical support with a lower exposure rate than transvaginal mesh surgery with Elevate™. Methods: This was a retrospective cohort study comparing patients with apical prolapse (POP-Q point C ≥ −1) who underwent Elevate™ mesh repair ( n = 146) with patients who underwent laparoscopic sacral colpopexy ( n = 267). Results: The sacral colpopexy group had a mean age of 59 years and a BMI of 25.7. Patients in the Elevate™ group were older, with a mean age of 63 and a BMI of 26.3. Most of the patients of both groups presented with pelvic organ prolapse stage III (LSC 73.8% and Elevate™ 87.0%) and their mean POP-Q point C were not significantly different (LSC 1.4 vs Elevate™ 1.2 cm). Operative time was longer in the LSC group (113 vs 91 min, p < 0.001), but estimated blood loss was lower (75 cm vs 137 cm, p < 0.001). No difference in mesh exposure rate could be found between the two groups at one year (Elevate™ 0.7% vs LSC 2.6%, OR 0.26, 95% CI 0.03 to 2.10, p = 0.21). One-year objective cure rate, defined as no descent beyond the hymen, was 97.0% in the LSC group and 96.6% in the Elevate™ group ( p = .81). The overall recurrence (objective, subjective recurrence or reoperation) was also not different between the groups (LSC 4.5% vs Elevate 4.8%, p = 0.89). Conclusion: Transvaginal Elevate™ mesh delivers comparable apical support with a low exposure rate similar to that of laparoscopic sacral colpopexy. [ABSTRACT FROM AUTHOR]

An abstract of the conference paper "Manganese-enhanced MRI detects live human amnion-derived mesenchymal stem cells in vivo after transplantation and restoration of myocardial function in a pig ischemia-reperfusion injury model," by Rajesh Dash, and colleagues is presented.