Nasoalveolar Molding: Prevalence of Cleft Centers Offering NAM and Who Seeks It

Nasoalveolar molding (NAM) is a treatment option available for early cleft care. Despite the growing debate about NAM’s efficacy, questions remain regarding its prevalence and demographic characteristics of families undergoing this technique prior to traditional cleft surgery

Assessing the Brazilian surgical system with six surgical indicators: a descriptive and modelling study

Background: Brazil boasts a health scheme that aspires to provide universal coverage, but its surgical system has rarely been analyzed. In an effort to strengthen surgical systems worldwide, the Lancet Commission on Global Surgery proposed collection of six standardized indicators: two-hour access to surgery, surgical workforce density, surgical volume, perioperative mortality rate (POMR), and protection against impoverishing and catastrophic expenditure. This study aims to characterize the Brazilian surgical health system with these newly devised indicators while gaining understanding on the complexity of the indicators themselves. Methods: Using Brazil’s national healthcare database, commonly reported healthcare variables were used to calculate or simulate the six surgical indicators. Access to surgery was calculated using hospital locations, surgical workforce density was calculated using locations of surgeons, anesthesiologists and obstetricians (SAO), and surgical volume and POMR were identified with surgical procedure codes. The rates of protection against impoverishing and catastrophic expenditure were modelled using cost of inpatient hospitalization and a gamma distribution of incomes based on GINI and GDP/capita. Findings: In 2014, SAO density is 34·7/100,000 population, surgical volume is 4,433 procedures/100,000 people and POMR is 1·71%. 79·4% of surgical patients are protected against impoverishing expenditure and 84·6% were protected against catastrophic expenditure due to surgery each year. Two-hour access to surgery was not able to be calculated from national health data, but a proxy measure suggested that 97·2% of the population has two-hour access to a hospital that may be able to provide surgery. Geographic disparities were seen in all indicators. Interpretation: Brazil‘s public surgical system meets several key benchmarks. Geographic disparities, however, are substantial and raise concerns of equity. Policies should focus on stimulating appropriate geographic allocation of the surgical workforce. In some cases, where benchmarks for each indicator are met, supplemental analysis can further inform our understanding of health systems. This measured and systematic evaluation of surgical systems should be encouraged for all nations seeking to better understand their surgical systems. Funding: There was no funding for this study

Stratified University Strategies: The Shaping of Institutional Legitimacy in a Global Perspective

Globalizing forces have both transformed the higher education sector and made it increasingly homogenous. Growing similarities among universities have been attributed to isomorphic pressures to ensure and/or enhance legitimacy by imitating higher education institutions that are perceived as successful internationally, particularly universities that are highly ranked globally (Cantwell & Kauppinen, 2014; DiMaggio and Powell, 1983). In this study, we compared the strategic plans of 78 high-ranked, low-ranked, and unranked universities in 33 countries in 9 regions of the world. In analyzing the plans of these 78 universities, the study explored patterns of similarity and difference in universities' strategic positioning according to Suchman's (1995) 3 types of legitimacy: cognitive, pragmatic, and moral. We found evidence of stratified university strategies in a global higher education landscape that varied by institutional status. In offering a corrective to neoinstitutional theory, we suggest that patterns of globalization are mediated by status-based differences in aspirational behavior (Riesman, 1958) and "old institutional" forces (Stinchcombe, 1997) that contribute to differently situated universities pursuing new paths in seeking to build external legitimacy.18 month embargo; published online: 13 Sep 2018This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Global rankings at a local cost? The strategic pursuit of status and the third mission

This study examined how hierarchical positions within the global field of higher education influence the selection of strategic priorities by universities in different parts of the world. The study particularly focused on universities' commitment to third missions as reflected in their strategic plans and compared to their global rankings. The findings demonstrate that top globally ranked institutions are generally less explicit about their commitment to the third mission relating to their geographic setting compared to mid/low and unranked institutions. Meanwhile, unranked institutions most consistently exhibit strategies in contributing to the local economy, recognising their local challenges and environment, and working for the benefit of their local community. This study informs debates on the intention and extent of the public good and missions of universities in light of the increasing dependence on ranking schemes.18 month embargo; published online: 30 March 2020This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Connecting Homeless Women to Primary Care Providers: The Effects of a Student Advocacy Model

Introduction: The negative impact of homelessness on health, and the barriers that homeless individuals must overcome to access healthcare are well-documented. Primary care physicians often express difficulty in maintaining stable relationships with homeless patients, and access to free care clinics alone does not predict successful adherence to medical treatment. Motivation to seek care is also often cited as a barrier to adequate care. Methods: The current study assesses the effects of a student-driven, decentralized primary care, and advocacy model on the chronic health conditions and task motivation of female patients. We do this through a pre/post model survey for women who present to student-driven primary care clinics in emergency housing shelters in Philadelphia. The two-part self-assessment survey is administered at the first clinic visit and again once the participant is placed in permanent housing. The survey questions determine the needs of the homeless women population as well as their motivation to seek care, and identify service gaps in meeting these needs. (The method of administering the survey was adjusted according to the experience for the initial participants.) Hypothesis: We hypothesize that homeless women who are served through this clinic will report a change in at least one measured parameter of their health care challenges and will report a greater motivation to continue to address these challenges. To date, we have successfully administered the survey at one clinic event and have several more planned as part of this longitudinal study. The first follow-up is in four months. Discussion: A model to increase health-oriented task motivation in difficult living environments would bolster current health strategies for underserved populations. This strategy may also have ancillary benefits through improvements in motivation to address chronic conditions that may not have been addressed previously and to enable the clinic to be a more evidenced-based practice

The Role of Plastic Surgeons in Advancing Development Global

In September 2015, the international community came together to agree on the 2030 Agenda for Sustainable Development, a plan of action for people, the planet, and prosperity. Ambitious and far-reaching as they are, they are built on three keystones: the elimination of extreme poverty, fighting climate change, and a commitment to fighting injustice and inequality. Critical to the achievement of the Agenda is the global realization of access to safe, affordable surgical and anesthesia care when needed. The landmark report by the Lancet Commission on Global Surgery estimated that between 28 and 32 percent of the global burden of disease is amenable to surgical treatment. However, as many as five billion people lack access to safe, timely, and affordable surgical care, a burden felt most severely in low- and middle-income countries (LMICs). Surgery, and specifically plastic surgery, should be incorporated into the international development and humanitarian agenda. As a community of care providers dedicated to the restoration of the form and function of the human body, plastics surgeons have a collective opportunity to contribute to global development, making the world more equitable and helping to reduce extreme poverty. As surgical disease comprises a significant burden of disease and surgery can be delivered in a cost-effective manner, surgery must be considered a public health priority