Surgeon Understanding and Perceptions of Social Determinants of Health

INTRODUCTION

Social determinants of health impact surgical outcomes. Characterization of surgeon understanding of social determinants of health is necessary prior to implementation of interventions to address patient needs. The study objective was to explore understanding, perceived importance, and practices regarding social determinants of health among surgeons.

METHODS

Surgical residents and attending surgeons at a single academic medical center completed surveys regarding social determinants of health. We conducted semi-structured interviews to further explore understanding and perceived importance. A conceptual framework from the World Health Organization (WHO) Commission on Social Determinants of Health informed the thematic analysis.

RESULTS

Survey response rate was 47.9% (n = 69, 44 residents [63.8%], 25 attendings [36.2%]). Respondents primarily reported good (n = 29, 42.0%) understanding of social determinants of health and perceived this understanding to be very important (n = 42, 60.9%). Documentation occurred seldom (n = 35, 50.7%), and referrals occurred seldom (n = 26, 37.7%) or never (n = 20, 29.0%). Residents reported a higher rate of prior training than attendings (95.5% versus 56.0%, P < 0.001). Ten interviews were conducted (six residents, four attendings). Residents demonstrated greater understanding of socioeconomic positions and hierarchies shaped by structural mechanisms than attendings. Both residents and attendings demonstrated understanding of intermediary determinants of health status and linked social determinants to impacting patients' health and well-being. Specific knowledge gaps were identified regarding underlying structural mechanisms including the social, economic, and political context that influence an individual's socioeconomic position.

CONCLUSIONS

Self-reported understanding and importance of social determinants of health among surgeons were high. Interviews revealed gaps in understanding that may contribute to limited practices.

Disparities in Utilization of Same-Day Discharge Following Appendectomy in Children

INTRODUCTION

Disparities in the delivery of pediatric surgical care exist for racial and ethnic minority groups. Utilization of same-day discharge (SDD) following appendectomy for acute, uncomplicated appendicitis is increasing; however, rates among diverse populations have not been explored to evaluate equitable care delivery and healthcare utilization. Our objective was to determine whether race and ethnicity are associated with rates of SDD and postdischarge healthcare utilization. We hypothesized that racial and ethnic minority groups would have lower rates of SDD.

METHODS

This retrospective cohort study used data from the 2015-2019 American College of Surgeons National Surgical Quality Improvement Program-Pediatric clinical registry and included children who underwent appendectomy. Patients with complicated appendicitis were excluded. Primary exposure was racial or ethnic group. The primary outcome was SDD, and secondary outcomes included postdischarge emergency department visits and hospital readmissions.

RESULTS

Of 37,579 simple appendicitis patients, SDD after appendectomy occurred in 10,012 (26.6%). On multivariable analysis, Black or African American race was associated with lower likelihood of SDD (adjusted odds ratio [aOR]: 0.85; 95% confidence interval [95% CI]:0.79-0.92; P < 0.0001). Hispanic ethnicity was associated with higher likelihood of SDD (aOR: 1.19; 95% CI: 1.12-1.25; P < 0.0001). Likelihood of postoperative emergency department visits was higher in Black or African American patients (aOR: 1.36; 95% CI: 1.14-1.62; P < 0.001) and Hispanic patients (aOR: 1.37; 95% CI: 1.12-1.58; P < 0.0001). Hospital readmission rates were similar across groups.

CONCLUSIONS

Rates of SDD following appendectomy vary among racial and ethnic groups. Interventions to achieve equitable healthcare delivery including SDD after appendectomy are needed.

Why the Utilization of Ready-to-Administer Syringes During High-Stress Situations Is More Important Than Ever

The COVID-19 pandemic has led to a high-stress environment causing a significant impact on frontline workers, including pharmacists and nurses. In addition to the increased workload, scarcity of resources, and emotional challenges, the frontline health care workers are required to wear additional personal protective equipment that can further limit their range of movement and decrease efficiency. The potential for errors can increase in these types of high-stress situations. One way to reduce the risk of errors is to use manufacturer-prepared, ready-to-administer (RTA) prefilled syringes, when appropriate. The use of RTA prefilled syringes is supported by literature evidence, recommendations, and guidelines from various professional organizations and societies.

Differential Gene Expression and Withanolides Biosynthesis During in vitro and ex vitro Growth of Withania somnifera (L.) Dunal

Ashwagandha (Withania somnifera L. Dunal) is a medicinally important plant with withanolides as its major bioactive compounds, abundant in the roots and leaves. We examined the influence of plant growth regulators (PGRs) on direct organogenesis, adventitious root development, withanolide biosynthetic pathway gene expression, withanolide contents, and metabolites during vegetative and reproductive growth phases under in vitro and ex vitro conditions. The highest shooting responses were observed with 6-benzylaminopurine (BAP) (2.0 mg L^-1) + Kinetin (KIN) (1.5 mg L^-1) supplementation. Furthermore, BAP (2.0 mg L^-1) + KIN (1.5 mg L^-1) + gibberellic acid (GA₃) (0.5 mg L^-1) exhibited better elongation responses with in vitro flowering. Half-strength MS medium with indole-3-butyric acid (IBA) (1.5 mg L^-1) exhibited the highest rooting responses and IBA (1.0 mg L^-1) with highest fruits, and overall biomass. Higher contents of withaferin A (WFA) [∼8.2 mg g^-1 dry weight (DW)] were detected in the reproductive phase, whereas substantially lower WFA contents (∼1.10 mg g^-1 DW) were detected in the vegetative phase. Cycloartenol synthase (CAS) (P = 0.0025), sterol methyltransferase (SMT) (P = 0.0059), and 1-deoxy-D-xylulose-5-phosphate reductase (DXR) (P = 0.0375) genes resulted in a significant fold change in expression during the reproductive phase. The liquid chromatography-mass spectrometry (LC-MS) analysis revealed metabolites that were common (177) and distinct in reproductive (218) and vegetative (167) phases. Adventitious roots cultured using varying concentrations of indole-3-acetic acid (IAA) (0.5 mg L^-1) + IBA (1.0 mg L^-1) + GA₃ (0.2 mg L^-1) exhibited the highest biomass, and IAA (0.5 mg L^-1) + IBA (1.0 mg L^-1) exhibited the highest withanolides content. Overall, our findings demonstrate the peculiarity of withanolide biosynthesis during distinct growth phases, which is relevant for the large-scale production of withanolides.

Odderon Exchange from Elastic Scattering Differences between pp and pp[over ¯] Data at 1.96 TeV and from pp Forward Scattering Measurements

We describe an analysis comparing the pp[over ¯] elastic cross section as measured by the D0 Collaboration at a center-of-mass energy of 1.96 TeV to that in pp collisions as measured by the TOTEM Collaboration at 2.76, 7, 8, and 13 TeV using a model-independent approach. The TOTEM cross sections, extrapolated to a center-of-mass energy of sqrt[s]=1.96  TeV, are compared with the D0 measurement in the region of the diffractive minimum and the second maximum of the pp cross section. The two data sets disagree at the 3.4σ level and thus provide evidence for the t-channel exchange of a colorless, C-odd gluonic compound, also known as the odderon. We combine these results with a TOTEM analysis of the same C-odd exchange based on the total cross section and the ratio of the real to imaginary parts of the forward elastic strong interaction scattering amplitude in pp scattering for which the significance is between 3.4σ and 4.6σ. The combined significance is larger than 5σ and is interpreted as the first observation of the exchange of a colorless, C-odd gluonic compound.

Allen: A High-Level Trigger on GPUs for LHCb

We describe a fully GPU-based implementation of the first level trigger for the upgrade of the LHCb detector, due to start data taking in 2021. We demonstrate that our implementation, named Allen, can process the 40 Tbit/s data rate of the upgraded LHCb detector and perform a wide variety of pattern recognition tasks. These include finding the trajectories of charged particles, finding proton-proton collision points, identifying particles as hadrons or muons, and finding the displaced decay vertices of long-lived particles. We further demonstrate that Allen can be implemented in around 500 scientific or consumer GPU cards, that it is not I/O bound, and can be operated at the full LHC collision rate of 30 MHz. Allen is the first complete high-throughput GPU trigger proposed for a HEP experiment.

A 1000-year-old mystery solved: Unlocking the molecular structure for the medieval blue from Chrozophora tinctoria, also known as folium

The molecular structure of the medieval watercolor known as folium has finally been solved in the 21st century. The interdisciplinary approach taken was the key to producing extracts that had been prepared following medieval instructions, and shows the blue/purple chromophore as the major dye in Chrozophora tinctoria fruits (shell). A multi-analytical characterization of its structure was made using HPLC-DAD-MS, GC-MS, NMR (¹H, ¹³C, COSY, HSQC, HMBC, INADEQUATE), and computational studies. The results demonstrate that the blue compound corresponds to 6'-hydroxy-4,4'-dimethoxy-1,1'-dimethyl-5'-{[3,4,5-trihydroxy-6-(hydroxymethyl)tetrahydro-2H-pyran-2-yl]oxy}-[3,3'-bipyridine]-2,2',5,6(1H,1'H)-tetraone, a hermidin derivative, which we named chrozophoridin. Experimental data and computational modeling studies show that this mono-glycosylated dimer is represented by two stable isomers (atropisomers). This is an indispensable piece of knowledge for the characterization of this medieval dye in works of art such as medieval manuscript illuminations and for testing its stability and contributes to the preservation of our cultural heritage.

EPR and 51V NMR studies of prospective anti-diabetic bis(3-hydroxy-4-pyridinonato)oxidovanadium(iv) complexes in aqueous solution and liposome suspensions

EPR/⁵¹V-NMR parallel studies of [VO(3,4-HPO)₂] complexes in MOPS buffer and POPC liposome suspensions provide information regarding solvents for oral administration.

Synthesis and structural characterization, by spectroscopic and computational methods, of two fluorescent 3-hydroxy-4-pyridinone chelators bearing sulphorhodamine B and naphthalene

A crystal structure of a rhodamine labelled 3-hydroxy-4-pyridinone chelator and prediction of the range of conformations in solution is reported.

Association of ACE gene insertion/deletion polymorphism with birth weight, blood pressure levels, and ACE activity in healthy children

BACKGROUND

The human angiotensin-converting enzyme (ACE) gene contains a polymorphism consisting of either an insertion (I) or a deletion (D) of a 287 bp Alu repetitive sequence in intron 16. The potential role of ACE polymorphism in the risk of developing hypertension or other cardiovascular disorders has not been determined in relation to birth weight (BW).

METHODS

The ACE genotype and plasma ACE activity were determined in 167 children. Among these children, 60 were identified with low BW (LBW), and 107 were of normal BW (NBW).

RESULTS

ACE activity levels were significantly elevated in LBW children compared with the NBW group (P < 0.001). There was a significant association of the ACE activity with systolic blood pressure (SBP) levels in our population (P < 0.001). Among the ACE genotypes, no significant differences were found with respect to BW (P = 0.136). However, our results revealed that LBW children had a higher D allele frequency than NBW children (P = 0.036). When analyzed by quartiles of SBP or ACE activity, we found a greater frequency of both the LBW children and those carrying the DD genotype in the highest quartiles of these parameters, whereas the NBW children tended to be in the lowest quartile (P < 0.001). Similar results were observed with the heterozygote ID children after categorization by quartiles of both SBP (P < 0.001) and ACE activity (P = 0.004).

CONCLUSIONS

The ACE I/D polymorphism, especially the DD genotype, can be interpreted as a major factor in association between LBW and high BP levels.

The kinetoplastid chemotherapy revisited: current drugs, recent advances and future perspectives

Leishmaniasis, African sleeping sickness and Chagas disease, caused by the kinetoplastid parasites Leishmania spp, Trypanosoma brucei and Trypanosoma cruzi, respectively, are among the most important parasitic diseases, affecting millions of people and considered to be within the most relevant group of neglected tropical diseases. The main alternative to control such parasitosis is chemotherapy. Nevertheless, the current chemotherapeutic treatments are far from being satisfactory. This review outlines the current understanding of different drugs against leishmaniasis, African sleeping sickness and Chagas disease, their mechanism of action and resistance. Recent approaches in the area of anti-leishmanial and trypanocidal therapies are also enumerated, new modulators from the mode of action, development of new formulations of old drugs, therapeutic switching and "in silico" drug design.

Peridomestic structure, farming activity and triatomine infestation

The role of peridomestic structure and farming activity on triatomine infestation was studied on two vector species of Chagas disease (Triatoma pseudomaculata and T. brasiliensis) in Bahia State, northeastern Brazil. A randomly selected population issued from 136 farms was divided into four categories according to the householder activity. At regional scale, the dwellings of farmers working on degraded land of irrigated farms are less exposed to T. pseudomaculata infestation. At premises scale, the farmers and casual workers, who have smaller peridomiciles and less cattle, are also less exposed to T. pseudomaculata. The association of T. brosiliensis with the most mobile populations (casual workers and young breeders) suggests a passive transport of this competitive species. Finally, the retired farmers that own large premises and cattle, but have more sedentary behavior, are the most exposed to T. pseudomaculata infestation.

A laparoscopic approach to allograft nephrectomy and bilateral native nephrectomy: a case report

INTRODUCTION

Laparoscopic surgery is rapidly emerging as the standard of care for a variety of urological conditions, even among patients who have undergone prior renal transplantation. We describe the technique of bilateral native nephrectomy and allograft nephrectomy by laparoscopy.

CASE REPORT

A 32-year-old man with end-stage renal disease who had undergone a cadaveric renal transplant presented with chronic graft dysfunction. He had received a living donor kidney transplant with a postoperative course complicated by persistent proteinuria and refractory hypertension. Our nephrology service indicated the need for bilateral native nephrectomy and allograft nephrectomy for better blood pressure control following a second transplant. Bilateral native nephrectomy was performed following the previous reported techniques for pure laparoscopic nephrectomy. Allograft nephrectomy started by dissection of the iliac vessels to identify the vascular anastomosis. The hilum of the transplanted kidney was accessed. The renal vessels were clipped and transected. The ureter was identified and clipped. All three kidneys were removed from the abdominal cavity through a 3-cm skin incision.

RESULTS

The left nephrectomy took 25 minutes and the right nephrectomy, 40 minutes. The estimated blood loss was 300 mL and the total operative time was 210 minutes. The patient had an uneventful postoperative course and was discharged on the third postoperative day.

CONCLUSIONS

We demonstrate the feasibility of laparoscopic allograft nephrectomy and bilateral native nephrectomy in a transplant recipient.

In vitro study of the insulin-like action of vanadyl-pyrone and -pyridinone complexes with a VO(O4) coordination mode

The insulin-like action of a novel class of potential insulin-mimetic complexes was investigated in terms of free fatty acid (FFA) release from isolated rat adipocytes. Vanadyl complexes such as VO(ema)2 [(bis(2-ethyl-3-hydroxy-4-pyrone)VO], VO(mpp)2 [bis (3-hydroxy-2-methyl-4(1H)-pyridinone)VO], VO(dmpp)2 [bis(1,2-dimethyl-3-hydroxy-4(1H)-pyridinone)VO] and VO(empp)2 [bis(2-ethyl-3-hydroxy-1-methyl-4(1H)-pyridinone)VO] were tested together with vanadyl sulfate for comparison. The inhibitory effect of the vanadium complexes on FFA release, from rat adipocytes treated with epinephrine, is dependent on concentration and for that reason the results are reported in terms of the IC50 value, the 50% inhibition concentration. The results show that all the complexes have an inhibitory effect on FFA release and that two pyridinone complexes, VO(mpp)2 and VO(empp)2, have a significantly better insulin-mimetic activity than that of vanadyl sulfate.

Structural study of the interaction of vanadate with the ligand 1,2-dimethyl-3-hydroxy-4-pyridinone (Hdmpp) in aqueous solution

The interaction of vanadate with the ligand 1,2-dimethyl-3-hydroxy-4-pyridinone (Hdmpp) was studied in aqueous solution using a combination of multinuclear NMR and EPR spectroscopies, as well as potentiometry and cyclic voltammetry. The different species in solution were identified and characterized, and their pKa values and stability constants determined. The vanadium complexes formed in solution are strongly dependent on media composition (ionic strength, presence of buffer), pH and metal-to-ligand ratio (M:L). Two major species--V(V)/dmpp and V(V)/(dmpp)2--are formed in a 140 mM NaCl solution within the pH range 4.5 to 9.0, when M:L = 1:2. In the presence of excess ligand (M:L < or = 1:5), only the 1:2 complex is present, and at pH < 4 paramagnetic species are detected by EPR in solution, thus indicating a reducing capacity of the ligand. Cyclic voltammetry shows that redox processes in solution are not just electron transfer, but are accompanied by chemical reactions. The pK, values and stability constants were determined both by 51V NMR spectroscopy and potentiometry. The present results have a particular interest in the understanding of the aqueous solution chemistry in aerobic conditions of bis(1,2-dimethyl-3-hydroxy-4-pyridinonato) oxovanadium(IV) complex, VO(dmpp)2, a vanadium compound with potential insulin-mimetic properties.

1,3-Dimethylisoguanine, a new purine from the marine sponge Amphimedon viridis

A new purine, 1,3-dimethylisoguanine (1), has been isolated from the marine sponge Amphimedon viridis and identified by analysis of spectroscopic data. Compound 1 increased the contractions obtained by transmural electrical stimulation in the guinea pig longitudinal muscle/myenteric plexus in a dose-dependent manner.

Hemolytic activity in extracts of the diatom Nitzschia

The few reports about diatom toxins are related to central nervous system toxicity, induced by domoic acid. In the present work Nitzschia sp. (Bacillariophyceae) was studied. The cells were cultured in f/2 medium, under 4000 lux and 14/10 hr light/dark cycle. After massive growth (5 x 10(6) cells/ml) the diatom cells were filtered, and an extract was prepared and partitioned in two fractions (polar and apolar). After cell harvesting by filtration, the diatom cells were shaken in artificial sea water to extract the water-soluble extracellular matrix (mucilage). An extract was prepared with the washed cells (free of mucilage), and polar and apolar fractions were obtained. Hemolytic assays were performed using 4.0 and 0.5% erythrocyte suspensions. Both the diatom polar and apolar fractions showed hemolytic activity. The membrane phospholipid sphingomyelin was tested as an acceptor for the hemolysins in the polar and apolar fractions. The mucilage did not exhibit hemolytic activity.

[Value of left cholangiojejunostomy in palliative treatment of malignant obstruction of the hepatic hilus]

The aim of this study is to analyse the results of the intrahepatic cholangiojejunostomy in the duct of segment III for malignant hilar obstruction performed in a group of 17 consecutive patients. An index for life quality, named comfort index, allowing the numeric comparison of the results was evaluated. An important reduction of the jaundice in 100% of the cases that were discharged from the hospital was observed. The hospital mortality was 11.8% with a comfort index of 81.9%. These results allow the following conclusions: 1) the employed technique represent an effective method for the solution of the cholestasis caused by unresectable tumors of the hepatic hilus; 2) the comfort index of 81.9% showed that the method is suitable as a palliative treatment of malignant hilar biliary obstruction.

Modulation of the release of adenosine by glucose and chemical hypoxia in cultured renal cells (MDCK line)

The effect of changes in the external concentrations of glucose on the release of adenosine of cultured renal cells (MDCK line) was studied. Adenosine release was markedly increased by the addition of glucose (5.5 mM) to monolayers of MDCK cells deprived of glucose for 24 hours. Addition of glucose to either the apical or basolateral side of the monolayer elicited a marked release of adenosine at the contralateral compartment. Removal of sodium in the external media blunted the response to glucose. Methylglucose that is transported into the cell but not metabolized also markedly increased adenosine release. Deoxyglucose that induces chemical hypoxia stimulated the release of adenosine. These results suggest that variations in extracellular glucose might be a physiological modulator of the cell regulation of adenosine.

Pharmacological properties of melochinine, an alkaloid producing Central American cattle paralysis

A Central American cattle paralysis is produced by ingestion of the plant Melochia pyramidata L. (Sterculiaceae). Its main alkaloid "melochinine" has been shown to produce paralysis, bradypnea, bradycardia and hypotension in laboratory animals after p.o., i.p. and i.v. applications. Bradycardia and negative inotropia have been demonstrated in isolated guinea pig atria and paralysis in the isolated phrenic nerve diaphragma preparation as well as in the phrenic nerve in situ preparation with local application. Gas chromatographic measurements suggest a rapid disappearance of melochinine after intravenous application and showed the similarity of the biologically active melochinine concentrations in vivo and in vitro. No unchanged melochinine was found in the urines of mice by thin-layer chromatography. A slight inhibition of the mitochondrial respiration and of some cholinesterases and none of the ATPase was found. Melochinine does not reveal insecticidal activity as does its structural analogue piericidin A, a well known inhibitor of the mitochondrial respiratory chain. The action of the alkaloid may be explained by an unspecific interaction with membranes, partially responsible for a Ca2+-antagonistic effect found in the isolated guinea pig papillary muscle. The proposed non-specific action could be a possible reason for the fact that trials of a specific therapy failed in our experiments.