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[Correspondence] Robot-assisted versus open cystectomy in the RAZOR trial – Authors' reply

Sa, 16/02/2019 - 00:00
We read with great interest the comments from Larcher and colleagues and Khetrapal and colleagues and appreciate their interest.

[Articles] How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up

Sa, 16/02/2019 - 00:00
Assuming that estimates from national registries are less likely to be biased, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients.

[Articles] How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up

Sa, 16/02/2019 - 00:00
Our pooled registry data, which we believe to be more accurate than the case series data, shows that approximately 82% of TKRs last 25 years and 70% of UKRs last 25 years. These findings will be of use to patients and health-care providers; further information is required to predict exactly how long specific knee replacements will last.

[Articles] Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial

Sa, 16/02/2019 - 00:00
Slightly less than 1 h of general anaesthesia in early infancy does not alter neurodevelopmental outcome at age 5 years compared with awake-regional anaesthesia in a predominantly male study population.

[Articles] Lomustine-temozolomide combination therapy versus standard temozolomide therapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter (CeTeG/NOA–09): a randomised, open-label, phase 3 trial

Sa, 16/02/2019 - 00:00
Our results suggest that lomustine-temozolomide chemotherapy might improve survival compared with temozolomide standard therapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter. The findings should be interpreted with caution, owing to the small size of the trial.

[Clinical Picture] Reversible encephalopathy caused by an inborn error of cobalamin metabolism

Sa, 16/02/2019 - 00:00
A 19-year-old woman was admitted because she had been behaving strangely and uncharacteristically for the past 6 months. She had also been unstable on her feet and had been noted to have a change in posture for the past 6 weeks. A neurological examination found that her cognitive ability had declined. A T2-weighted MRI of her brain showed hyperintensity bilaterally in the cerebellum and in the right basal ganglia: modest atrophy of the cerebrum was also seen (figure). Blood pressure and urine analysis showed no abnormalities.

[Seminar] Acute encephalitis in immunocompetent adults

Sa, 16/02/2019 - 00:00
Encephalitis is a condition of inflammation of the brain parenchyma, occurs as a result of infectious or autoimmune causes, and can lead to encephalopathy, seizures, focal neurological deficits, neurological disability, and death. Viral causes account for the largest proportion, but in the last decade there has been growing recognition of anti-neuronal antibody syndromes. This Seminar focuses on the diagnosis and management of acute encephalitis in adults. Although viral and autoimmune causes are highlighted because of their prominent roles in encephalitis, other infectious pathogens are also considered.

[Correspondence] The global syndemic of obesity, undernutrition, and climate change

Ma, 12/02/2019 - 00:30
The Lancet Commission on the global syndemic of obesity, undernutrition, and climate change by Boyd Swinburn and colleagues (Jan 27, published online)1 brings several global phenomena into focus through application of the term global syndemic. The authors emphasise how we should understand how predatory food industries and industrial waste have contributed greatly to the availability and accessibility of foods for consumption. Addressing the link between food production, a changing climate, and malnutrition is crucial.

[Comment] Sponsorship of paediatric associations by manufacturers of breastmilk substitutes

Sa, 09/02/2019 - 00:30
Is it right that paediatric meetings should be sponsored by manufacturers of formula milk? There has recently been criticism of an international conference run by the UK Royal College of Paediatrics and Child Health (RCPCH) in Cairo, Egypt, in January, 2019, that received sponsorship by manufacturers of breastmilk substitutes (BMS).1 On Jan 31, 2019, “in light of recent concerns raised by members”, the RCPCH stated “we have made the decision to suspend future funding agreements with formula milk companies pending a College review of our relationships with them”.

[Department of Error] Department of Error

Sa, 09/02/2019 - 00:30
Bleakley T, Smith R, Taylor R. Has the NHS Long Term Plan forgotten we are all going to die? Lancet 2019; 393: 387–89—In this Comment, the seventh sentence of the third paragraph should read: “Furthermore, increases in life expectancy have stalled and life expectancy has actually decreased in some groups, such as women in deprived areas.” This correction has been made to the online version as of Feb 8, 2019.

[Editorial] Feminism is for everybody

Sa, 09/02/2019 - 00:00
“To be ‘feminist’ in any authentic sense of the term is to want for all people, female and male, liberation from sexist role patterns, domination, and oppression.” bell hooks made this clear and powerful statement in her 1981 study of sexism, racism, and the feminist and civil rights movements Ain't I a Woman: Black Women and Feminism. Almost 40 years on, the world is still reckoning with pervasive and inexcusable gender inequality underpinned by bias and sexism, and research and health care are no exception.

[Comment] Funders should evaluate projects, not people

Sa, 09/02/2019 - 00:00
Since the Cold War, public and private funding agencies have relied on peer review to guide their investments in science.1 This process allows funders to make informed bets when allocating resources to advance their goals. In The Lancet, Holly Witteman and colleagues2 suggest that a traditional, project-based grant review process outperforms the increasingly popular people-not-project funding schemes. Their analysis leverages a natural experiment created by the decision of the Canadian Institutes of Health Research to divide its funding into Project and Foundation grant programmes in 2014.

[Comment] Preventing the tower from toppling for women in surgery

Sa, 09/02/2019 - 00:00
In a rich qualitative analysis of interviews with women who left surgical training in Australia, Rhea Liang and colleagues report in The Lancet1 their study that applied insights from feminist and social theories to illuminate how various factors interact to disadvantage women. They persuasively argue that various stresses accumulate like a tower of stacked blocks. Eventually, an individual's tower can reach a height that it will topple in the absence of efforts to stabilise it; often the final toppling precipitator appears relatively minor.

[Comment] Measurement and meaning: reporting sex in health research

Sa, 09/02/2019 - 00:00
What is normal? In the study of medicine, from the laboratory to the bedside and to the art and craft of public health, we seek and apply standards and measures of normality that are designed to show that there is a baseline from which variation or deviation might be observed and possibly corrected for.

[Comment] From #MeToo to #TimesUp in health care: can a culture of accountability end inequity and harassment?

Sa, 09/02/2019 - 00:00
A 2018 report by the US National Academies of Science, Engineering, and Medicine identified sexual harassment as an enduring problem in scientific fields, and especially in medicine.1–3 Harassment and inequity are interdependent processes, and it is no coincidence that harassment is rife in environments that foster gender disparities in compensation, opportunity, and advancement.4–6 Flagrant examples of abusive and discriminatory treatment continue to emerge, such as sexual harassment and assault of trainees doing scientific fieldwork,7 manipulation of entrance examination scores to limit the number of women at a Japanese medical school,8 and the unremitting gender pay gap in medicine and science in North America and other countries.

[Comment] The good, the bad, and the ugly of implicit bias

Sa, 09/02/2019 - 00:00
The concept of implicit bias, also termed unconscious bias, and the related Implicit Association Test (IAT) rests on the belief that people act on the basis of internalised schemas of which they are unaware and thus can, and often do, engage in discriminatory behaviours without conscious intent.1 This idea increasingly features in public discourse and scholarly inquiry with regard to discrimination,1 providing a foundation through which to explore the why, how, and what now of gender inequity. Attention to the gender gap in academia, particularly pronounced in the science, technology, engineering, mathematics, and medicine (STEMM) fields,2 has led many institutions to mandate implicit bias training.

[Comment] Driving gender equity in African scientific institutions

Sa, 09/02/2019 - 00:00
Women scientists have a vital part to play in scientific leadership and in contributing to Africa's development and transformation, but they remain substantially under-represented in higher education and in science, technology, engineering, and mathematics (STEM).

[Comment] The missing trans women of science, medicine, and global health

Sa, 09/02/2019 - 00:00
A groundswell of support has emerged to bring visibility to and help combat gender inequities for women in science, medicine, and global health. Academic and other institutional workplaces must promote recognition of race and gender intersectionality, equity, and inclusivity of all women, including transgender (trans) women and girls of colour.

[Comment] What is The Lancet doing about gender and diversity?

Sa, 09/02/2019 - 00:00
The academic publishing system is gendered.1 As such, journals and editors are part of what has been called a vicious circle for women (figure).2 We recognise the centrality and role of journals in the transmission of scientific knowledge and validation of academic achievement. We also recognise the evidence that shows women to be vastly under-represented in author, reviewer, and editorial positions across scientific and medical journals.1 These inequities are at odds with our values and track record of advocacy as a journal.

[Comment] Offline: Gender and global health—an inexcusable global failure

Sa, 09/02/2019 - 00:00
WHO has identified “Ten threats to global health in 2019”. Surprisingly—one should say shockingly—gender inequity is not one of them. It is not only WHO that is failing by excluding women and girls from its priority list of dangers. The entire global health community has abdicated its responsibility for achieving gender justice in health. This situation is strange because a vast quantity of evidence linking gender inequity to poor health exists and the mandate is clear, as set out in Sustainable Development Goal 5.