Gambling Habits Between People from Vietnam and Ukraine Surviving in the Czech Republic

Is it isolated racist acts or institutional racism that is a reflection of white supremacy? The second concern is the notion that professionalism may be used as a tool of social control to maintain the interests of the social groups that dominate medicine. The third concern is that an overly simplistic application of professionalism, regardless of how the problem of racism is defined, may result in trainees practicing professionalism that is performative rather than internally motivated. The authors conclude that professionalism may complement a more systematic and holistic approach to addressing racism and white supremacy in medical education, but it is an insufficient standalone tool to address this core problem.There has been a recent rise in calls for action around wellness and physician health. In medical education, wellness has been proposed as a physician competency. In this article, the authors review the history of the "wellness as a competency" concept within U.S. GSK 3 inhibitor and Canadian residency programs and medical schools. Drawing from literature on the discourses of wellness and competence in medical education, they argue that operationalizing wellness as a physician competency holds profound implications for curricula, admissions, evaluation, and licensure. While many definitions of "wellness" and "competency" are used within medical training environments, the authors argue that the definitions institutions ultimately use will have significant impacts for trainees who are considered "unwell." In particular, medical learners with disabilities--including those with mental health, chronic health, learning, sensory, and mobility disabilities--may not conform to dominant conceptions of "wellness," and there is a risk they will become further stigmatized or even be considered unsuitable to practice in the profession. The authors conclude that framing wellness as a competency has the potential to legitimize support-seeking and prioritize physician health, yet it may also have the potential unintended effect of excluding certain learners from the profession. They propose a universal design approach to understand wellness at a systems level and to remove barriers to wellness for all medical learners.PURPOSE To determine the association of Fitzpatrick skin type (FST) with conjunctival melanoma. METHODS Retrospective case series of 540 patients with conjunctival melanoma to assess clinical features and outcomes per FST. RESULTS The FST was Type I (n = 126, 23%), II (n = 337, 62%), III (n = 56, 10%), IV (n = 8, 2%), V (n = 12, 2%), and VI (n = 1, less then 1%). A comparison (FST I vs. II vs. III, IV, V, and VI) revealed Types I and II associated with older mean patient age (63.9 vs. 60.7 vs. 51.1 years, p less then 0.001), greater percentage of female patients (68% vs. 44% vs. 42%, p less then 0.001), lower frequency of complexion associated melanosis (1% vs. 2% vs. 13%, p less then 0.001), smaller tumor thickness (2.1 vs. 2.8 vs. 3.6 mm, p = 0.01), and less eyelid involvement (13% vs. 13% vs. 28%, p = 0.02). Kaplan-Meier estimates for 5-year risk showed no difference by Types for visual acuity loss ≥3 lines, local tumor recurrence, exenteration, metastasis, or death. A review of 540 patients with conjunctival melanoma based on Fitzpatrick skin type (FST) revealed Type I (n = 126, 23%), Type II (n = 337, 62%), Type III (n = 56, 10%), Type IV (n = 8, 2%), Type V (n = 12, 2%), and Type VI (n = 1, less then 1%). The FST grading did not impact 5-year outcomes of tumor recurrence, exenteration, metastasis, or death. CONCLUSION AND RELEVANCE Most patients with conjunctival melanoma show FST I or II, and this demonstrated no association with 5-year rate of vision loss, tumor recurrence, exenteration, metastasis, or death.PURPOSE To test whether intraoperative stereotactic navigation during orbital decompression surgery resulted in quantifiable surgical benefit. METHODS This retrospective cohort study examined all consecutive patients who underwent primary orbital decompression surgery for thyroid associated orbitopathy performed by a single surgeon (A.K.) during the periods of 2012-2014 (non-navigated), and 2017-2018 (navigated). The study was HIPAA-compliant, was approved by the Institutional Review Board, and adhered to the tenets of the Helsinki declaration. Recorded parameters included patient age, sex, race, decompression technique (side of operation and walls decompressed), estimated blood loss (EBL), intraoperative complications, times that patient entered and exited the operating room (OR), times of surgical incision and dressing completion, pre- and postoperative best corrected visual acuity (BCVA), proptosis, diplopia, postoperative change in strabismus deviation, and need for subsequent strabismus surgery. Recordedus surgery. This study is limited by its size but illustrates that use of intraoperative navigation guidance has substantive benefits in orbital decompression surgery.Orbital actinomyces is a rare diagnosis with only a few cases reported in the literature. It can be difficult to diagnose due to its slow, indolent course, and nonspecific findings on imaging and clinical examination, and frequently it can masquerade as other pathologies such as neoplasm and inflammatory disease. The authors present a case of actinomyces masquerading as meningioma with findings of hyperostosis and a superior orbital roof interosseous tract on imaging.PURPOSE To describe patients presenting with sudden onset of localized hemorrhage from a presumed acute spontaneous rupture of the superior ophthalmic vein. METHODS A retrospective review of the pattern of presentation, clinical implications and outcomes, and the characteristic imaging and histologic features. RESULTS Six patients (5 men; 84%) presented at a mean age of 45 years (range 15-72), with the commonest symptoms and signs being acute onset of Valsalva-negative proptosis (mean 3.3 mm; range 0-7 mm), orbital pain, and diplopia; none had a known precipitating factor (such as severe Valsalva maneuver or coagulopathy). Two patients developed a mild optic neuropathy. Imaging revealed a well-defined, ovoid, homogenous soft-tissue mass above (2 cases), superomedially to (3 cases), or below the superior ophthalmic vein; the masses were typically echogenic on B-mode ultrasonography, and there was no detectable internal blood-flow. Resolution of signs and symptoms was noted in 5 patients over an average of 4.6 months (range 3-7 months), while 1 patient-the youngest-required excision of a persistent mass with increasing exophthalmos and early optic neuropathy.