The impact of patient sex on paramedic pain management in the prehospital setting

Objective: The aim of this study was to establish the impact of patient sex on the provision of analgesia by paramedics for patients reporting pain in the prehospital setting.
Methods: This retrospective cohort study of paramedic patient care records included all adult patients with a Glasgow Coma Score higher than 12 transported to hospital by ambulance in a major metropolitan area over a 7-day period in 2005. Data collected included demographics, patient report of pain and its type and severity, provision of analgesia by paramedics, and type of analgesia provided. The outcomes of interest were sex differences in the provision of analgesia. Data analysis was by descriptive statistics, χ2 test, and logistic regression.
Results: Of the 3357 patients transported in the study period, 1766 (53%) reported pain; this forms the study sample. Fifty-two percent were female, median age was 61 years, and median initial pain score (on a 0-10 verbal numeric rating scale) was 6. Forty-five percent of patients reporting pain did not receive analgesia (791/1766) (95% confidence interval [CI], 43%-47%), with no significant difference between sexes (P = .93). There were, however, significant sex differences in the type of analgesia administered, with males more likely to receive morphine (17%; 95% CI, 15%-20%) than females (13%; 95% CI, 11%-15%) (P = .01). The difference remains significant when controlled for type of pain, age, and pain severity (odds ratio, 0.61, 95% CI, 0.44-0.84).
Conclusion: Sex is not associated with the rate of paramedic-initiated analgesia, but is associated with differences in the type of analgesia administered.

Co-localization and distribution of corticotrophin-releasing hormone, arginine vasopressin and enkephalin in the paraventricular nucleus of sheep : a sex comparison

The paraventricular nucleus (PVN) is integral to regulation of the hypothalamo-pituitary-adrenal (HPA) axis and contains cells producing corticotrophin-releasing hormone (CRH), arginine vasopressin (AVP) and enkephalin. We used immunohistochemistry to map these peptides and to resolve the extent of co-localization within PVN cells in intact and gonadectomized male and female sheep. Immunoreactive (ir) CRH, AVP and enkephalin cells were mapped in two rams and two ewes at 180 μm intervals throughout the rostro-caudal extent of the PVN. Similar distributions of AVP-ir cells occurred in both sexes whereas CRH-ir and enkephalin-ir cells extended more rostrally in rams. In groups (n=4) of intact and gonadectomized sheep of both sexes, co-localization and distribution of neuropeptides was influenced by sex and gonadectomy. Males had more AVP and CRH cells than females. Intact animals had more AVP cells than gonadectomized animals. There were no differences between groups in the number or percentage of cells that stained for both CRH and AVP or in the number of cells that stained for both CRH and enkephalin. Differences were observed in the percentage of enkephalin cells that contained CRH with males having a greater percentage of co-localized cells than did females. Differences were also observed in the number and percentage of cells that stained for both enkephalin and AVP; the number of cells that stained for both neuropeptides was greater in males than in females and greater in intact animals than in gonadectomized animals. Differences were observed in the percentage of AVP cells that contained enkephalin, and in the percentage of enkephalin cells that contained AVP with males having a greater percentage of co-localized cells than did females. We conclude that sex and gonadal status affect peptide distribution in the PVN of the sheep which may provide an anatomical basis for sex differences in HPA axis

Sex difference in the effect of cortisol on the LH response of the pituitary to exogenous GnRH in hypothalamo-pituitary disconnected gonadectomised sheep

We have used the hypothalamo-pituitary disconnected (HPD) sheep model to investigate direct pituitary actions of cortisol to suppress LH secretion in response to exogenous GnRH. We previously observed that, during the non-breeding season, treatment with cortisol did not suppress the LH response to GnRH in HPD gonadectomised rams or ewes.1 In the present experiment, we tested the effect of cortisol on the LH response to exogenous GnRH in gonadectomised HPD sheep during the breeding season. Using a cross-over design, HPD gonadectomised Romney Marsh rams (n = 6) and ewes (n = 5) received a saline or cortisol (250 μg/kg/h) infusion for 30 h on each of two days, one week apart. All animals were treated with 125 ng i.v. injections of GnRH every 2 h during a 6 h control period preceding the infusion and during the infusion. Jugular blood samples were taken during the control period and the first 6 h and last 6 h of the infusion (over 3 LH pulses). Mean plasma concentrations of LH and LH pulse amplitudes, driven by programmed GnRH injections, were similar in gonadectomised rams and ewes and there were no significant effects of saline infusion between the control periods or the saline infusion in either sex. The amplitude of LH pulses was significantly (P < 0.05) reduced in rams during the first 6 h of the cortisol infusion compared to the control period, but there were no effects of the cortisol infusion in ewes. These data show that, in the absence of sex steroids, there is a sex difference in the mechanism by which cortisol acts at the pituitary to reduce LH secretion in response to exogenous GnRH in HPD gonadectomized sheep during the breeding season. We conclude that the effect of cortisol to reduce secretion of LH involves an action on the pituitary, at least in gonadectomised rams.

Investigative interviewing of suspected sex offenders : a review of what constitutes best practice

Research on the topic of investigative interviewing of suspected sex offenders is still in its infancy, with the majority of work to date focusing on developing theories underlying confessions, and reflecting on the value of specific interview techniques that have been observed in the field. This paper provides a synthesis of the literature in order to produce a preliminary guide to best practice for the interviewing of this particular interviewee group. Specifically, this review is structured around five elements that should be considered when planning for and administering the interview. These elements include: (a) establishing rapport, (b) introducing the topic of concern, (c) eliciting narrative detail, (d) clarification/specific questions and (e) closure. The unique contribution of this paper is its practical focus, and its synthesis of findings across a variety of streams, including the general eyewitness memory literature, legislation and case law, therapeutic literature, and research specifically related to the interviewing of offenders (including confessions). At the conclusion of the review, recommendations are offered for further research.

Morphological signals of sex and status in spotted bowerbirds

The Spotted Bowerbird, Chlamydera maculata, appears to be sexually monomorphic. We caught and marked 118 birds in central Queensland, and sexed 88 using molecular methods. We found that our catch was strongly male-biased, both at bower sites and at non-bower feeding sites. We continued to observe the bird's behaviour after their release and so sub-divided males into sexual status groups as either bower-owners or non-owners. We searched for morphological measures, subjectively judged colour differences and quantitatively collected spectral measures of the visual properties of the crest feathers that would allow us to separate birds of differing sex and status. We found that bower owners had larger crests than non-owner males or females and that crest area provided the most accurate predictor of a bird's sex and status in a discriminant function analysis. We studied a cohort of seven males who went from non-owners to bower owners over three years, and found that their change in status was accompanied by a change in crest size – the only significant change in their morphology. Crest size did not relate to the mating success of a bower-owner. Instead, we suggest why the crest may differ between status groups and the implications that this may have for the sexual behaviour of male and female Spotted Bowerbirds.

Building realities less limited than their own : young people practising same sex attraction on the internet

The internet has met with mixed community reactions, especially when the focus is on young people's internet use. There are those who fear that the internet will introduce undesirable people and information into the home, leaving the young vulnerable and exploited. Alternatively, there are others who argue that the exclusion of young people from the internet is one of many examples of the diminishing public space that is made available to young people in this post-modern world. In this article we focus on the internet use of one ‘space deprived’ group of marginalized young people, those who are same-sex attracted. Regardless of some important changes in Australian culture and law, these young people's opportunities to openly live their sexual difference remain restricted. In this article we are interested in exploring the role of the internet as a space in which some important sexuality work can be done. What we found was that the internet was providing young people with the space to practise six different aspects of their sexual lives namely identity, friendship, coming out, intimate relationships, sex and community.

Cashmere production and fleece attributes associated with farm of origin, age and sex of goat in Australia

Differences in cashmere production and fleece attributes associated with farm of origin, age and sex were quantified for commercial Australian cashmere goat enterprises. From 11 farms in four states, 1147 does and 97 wethers were monitored, representing 1- to 13-year-old goats. Individual clean cashmere production ranged from 21 to 389 g, with a mean ± standard deviation value of 134 ± 62 g. The mean cashmere production of 2-year-old does from different farms varied from 69 to 225 g and averaged 141 g. Mean ± s.d. greasy fleece weight was 394 ± 123 g, clean washing yield was 90.8 ± 4.1%, clean cashmere yield 33.4 ± 9.4%, cashmere fibre diameter 16.4 ± 1.6 µm, fibre curvature 48 ± 8.7 degrees/mm and staple length 8.7 ± 2.1 cm. There were large, commercially significant differences between farms for clean cashmere weight, mean fibre diameter and other attributes of cashmere. These were much larger than the effects of age and sex. Farm and age accounted for 42 to 67% of the variation in clean cashmere production, mean fibre diameter, fibre curvature, staple length and clean washing yield. Farm of origin affected clean cashmere yield, accounting for 24% of the variation. Sex of the goats had only a minor effect on the staple length of cashmere. The responses to age of clean cashmere weight, mean fibre diameter and the inverse of fibre curvature are very similar. Generally, cashmere production and mean fibre diameter increased with age. For the majority of farms, cashmere fibre curvature declined in a curvilinear manner with increases in age of goat. There were large differences in cashmere staple length from different farms, with means ranging from 7 to 12 cm. Between 1 and 2 years of age, the staple length of cashmere demonstrated a constant proportional increase. At ages older than 2 years, staple length either declined or increased by less than 1 cm with age, depending on the farm of origin. This study demonstrates that there are large gains in productivity that can be achieved from Australian cashmere goats. A better understanding of on-farm factors that influence cashmere production would enable all producers to optimise their production systems.

Effect of sex differences on human MEF2 regulation during endurance exercise

Women exhibit an enhanced capability for lipid metabolism during endurance exercise compared with men. The underlying regulatory mechanisms behind this sex-related difference are not well understood but may comprise signaling through a myocyte enhancer factor 2 (MEF2) regulatory pathway. The primary purpose of this study, therefore, was to investigate the protein signaling of MEF2 regulatory pathway components at rest and during 90 min of bicycling exercise at 60% VO2peak in healthy, moderately trained men (n = 8) and women (n = 9) to elucidate the potential role of these proteins in substrate utilization during exercise. A secondary purpose was to screen for mRNA expression of MEF2 isoforms and myogenic regulatory factor (MRF) family members of transcription factors at rest and during exercise. Muscle biopsies were obtained before and immediately after exercise. Nuclear AMP-activated protein kinase-{alpha} ({alpha}AMPK) Thr172 (P < 0.001), histone deacetylase 5 (HDAC5) Ser498 (P < 0.001), and MEF2 Thr (P < 0.01) phosphorylation increased with exercise. No significant sex differences were observed at rest or during exercise. At rest, no significant sex differences were observed in mRNA expression of the measured transcription factors. mRNA for transcription factors MyoD, myogenin, MRF4, MEF2A, MEF2C, MEF2D, and peroxisome proliferator-activated receptor-{gamma} coactivator 1{alpha} (PGC1{alpha}) were significantly upregulated by exercise. Of these, MEF2A mRNA increased 25% specifically in women (P < 0.05), whereas MEF2D mRNA tended to increase in men (P = 0.11). Although minor sex differences in mRNA expression were observed, the main finding of the present study was the implication of a joint signaling action of AMPK, HDAC5, and PGC1{alpha} on MEF2 in the immediate regulatory response to endurance exercise. This signaling response was independent of sex.

Breeding ecology and bias in offspring sex ratio in little grassbirds (Megalurus gramineus)

Little grassbirds (Megalurus gramineus) are small, sexually monomorphic passerines that live in reed beds, lignum swamps and salt marshes in southern Australia. The breeding biology and patterns of sex allocation of the little grassbird were investigated over a single breeding season. Our observations of this species in the Edithvale Wetland Reserve revealed a highly male-biased population sex ratio, with some breeding territories containing several additional males. Nevertheless, there was little compelling evidence that little grassbirds breed cooperatively. The growth rates of male and female nestlings were similar and, as predicted by theory, there was no overall primary sex ratio bias. However, the primary sex ratio was female-biased early in the breeding season and became increasingly male-biased later in the breeding season.

Pathways to sex offending

The research of the thesis aimed to contribute to the theoretical understanding of the various pathways that offenders follow in committing sexual offences. Using grounded theory a theoretical model was generated which described four major pathways to sexual offending. Quantitative analyses revealed that offenders who take different pathways differ significantly in respect of their risk of recidivism, demographic variables, rape myth acceptance and aggression. The portfolio considered the limitations of sex offender treatment programs for treating sex offenders with histories of childhood sexual abuse and presented four case studies.