A Nationwide Assessment Of Disparities In Primary Cleft Lip Repair

Purpose: This study examined the impact of patient race or ethnicity on the likelihood of experiencing delays to surgery, post-operative surgical complications, or prolonged hospital stays following primary cleft lip (CL) repair.Methods: Patients who underwent CL repair were identified from two large national databases: the Kids Inpatient Database (KID) and the Pediatric National Surgical Quality Improvement Program (NSQIP) database. Primary outcomes were defined as treatment after 6 months of age, the presence of any surgical complication, and a hospital stay greater than 1 day. Chi-squared analyses were performed to compare outcomes across patients of different race/ethnicity, followed by multivariable logistic regression to adjust for various demographic and social factors. Secondary analyses assessed the impact of race/ethnicity on hospital charges, and compared results across the KID and NSQIP databases. Results: There were 10,844 patients included in the study; 4917 patients from NSQIP, and 5927 from KID. Both databases showed significant differences (p \u3c 0.001) in the likelihood of experiencing delayed surgery, complications, and prolonged hospital stay among patients of different race/ethnicity. Delays in care were highest among Hispanic (OR 1.22 – 3.86) and Asian/Pacific Islander (OR 2.26 – 4.67) patients, complications highest among Black (OR 1.28 – 2.11) and Hispanic (OR 1.59 – 2.11) patients, and prolonged stays highest among Other (OR 2.27-3.67) patients. Multivariable regression showed a strong confounding influence of various patient factors (p\u3c0.001), with a particularly strong relationship between baseline pre-operative health status and each of the primary study outcomes. Conclusion There are significant differences in the likelihood of experiencing of delays, complications, and prolonged hospital stays among patients of different race or ethnicity. Advocacy efforts to ameliorate disparity in early infant health may subsequently improve health outcomes in CL repair

A National Assessment Of Racial And Ethnic Disparities In Cleft Lip Repair

AbstractPurpose: This study examined the impact of patient race/ethnicity on the likelihood of experiencing delays to surgery, post-operative surgical complications, and prolonged hospital length of stay (LOS) following primary cleft lip (CL) repair. Methods: Patients who underwent CL repair were identified in the 2006-2012 Kids’ Inpatient Database. Primary outcomes were defined as treatment after 6-months-old, presence of any surgical complication, LOS \u3e1 day, and total hospital charges. Multivariable analyses were performed to adjust for sociodemographic and clinical characteristics that might account for differences in outcomes. Results: There were 5927 eligible patients with cleft lip: 3724 White, 279 Black, 1316 Hispanic, 277 Asian/Pacific-Islander, and 331 other race/ethnicity. Across all outcomes, there were significant unadjusted differences (p\u3c0.001) by race/ethnicity, with White children having the lowest odds of delayed surgery, complications, and prolonged LOS, and the lowest charges. Multivariable analyses suggested that differences in baseline health status may explain disparities in complication rates across race/ethnicity, as well as delays, prolonged LOS, and charge differences in Black and other patients. Even after adjusting for co-variates, however, significantly increased odds of delayed surgery and higher charges remained for Hispanic and Asian/PI patients. Conclusion There are significant differences in the odds of delays, complications, prolonged hospital stays, and total charges among CL patients of different race/ethnicity. Advocacy efforts to ameliorate disparity in early infant health may subsequently improve care outcomes

Louine Lunt Peck, interviewed by Carol Toner and Mazie Hough, Part 1

Louine Lunt Peck, interviewed by Carol Toner and Mazie Hough, August 16, 2000, at her home in Northeast Harbor, Maine. Peck talks about serving as a Second Lieutenant as a nurse in the Navy Nurses Corps from 1938 to 1941; serving in the Army Nurses Corps from 1943 to 1945; serving on the USAHS Acadia, which sailed to the Bay of Naples and Normandy. Text: 53 pp. transcript. Time: 01:34:39. Listen: Part 1: mfc_na3221_c2325_01Part 2: mfc_na3221_c2325_02https://digitalcommons.library.umaine.edu/mf144/1038/thumbnail.jp

Louine Lunt Peck, interviewed by Carol Toner and Mazie Hough, Part 2

Louine Lunt Peck, interviewed by Carol Toner and Mazie Hough, August 16, 2000, at her home in Northeast Harbor, Maine. Peck talks about serving as a Second Lieutenant as a nurse in the Navy Nurses Corps from 1938 to 1941; serving in the Army Nurses Corps from 1943 to 1945; serving on the USAHS Acadia, which sailed to the Bay of Naples and Normandy. Text: 53 pp. transcript. Time: 01:34:39. Listen: Part 1: mfc_na3221_c2325_01 Part 2: mfc_na3221_c2325_02https://digitalcommons.library.umaine.edu/mf144/1039/thumbnail.jp

The Chemotherapeutic Potential of Resveratrol-Based Treatments

Cancer is one of the most prevalent and deadly diseases in the world. In 2012 alone, there were approximately 14 million new cases of cancer and over 8 million cancer-related deaths worldwide. Despite extensive research in past decades, the burden of cancer continues to increase. One of the most common treatments for cancer is chemotherapy, the use of various chemical substances that exhibit anti-cancer activity. Unfortunately, chemotherapy can be quite toxic and often produces inadequate results. There remains a great need for improved chemotherapeutic treatment strategies in order to improve outcomes for cancer patients. The purpose of my project was to investigate the chemotherapeutic potential of an anti-oxidant known as resveratrol. Resveratrol is a compound naturally found in many fruits such as grapes and blueberries. Resveratrol is safe for normal cells in our bodies, but has actually been shown to be toxic to cancer cells. Nonetheless, its potential for therapeutic use continues to be highly debated. In our study, we wanted to see if the effects of chemotherapy on cancer cells could be enhanced by co-treatment with low levels of resveratrol. We also wanted to test the chemotherapeutic potential of an analog of resveratrol called pterostilbene. Previous results in our lab show that pterostilbene might also possess anti-cancer activity, but relatively little research has been done on the compound up to this point

A 2017 Horizon Scan of Emerging Issues for Global Conservation and Biological Diversity

We present the results of our eighth annual horizon scan of emerging issues likely to affect global biological diversity, the environment, and conservation efforts in the future. The potential effects of these novel issues might not yet be fully recognized or understood by the global conservation community, and the issues can be regarded as both opportunities and risks. A diverse international team with collective expertise in horizon scanning, science communication, and conservation research, practice, and policy reviewed 100 potential issues and identified 15 that qualified as emerging, with potential substantial global effects. These issues include new developments in energy storage and fuel production, sand extraction, potential solutions to combat coral bleaching and invasive marine species, and blockchain technology.Cambridge Conservation Initiative, funded by the Natural Environment Research Council and the Royal Society for the Protection of Birds, Arcadia, Natural Environment Research Council (Grant ID: NE/N014472/1

A 2018 Horizon Scan of Emerging Issues for Global Conservation and Biological Diversity.

This is our ninth annual horizon scan to identify emerging issues that we believe could affect global biological diversity, natural capital and ecosystem services, and conservation efforts. Our diverse and international team, with expertise in horizon scanning, science communication, as well as conservation science, practice, and policy, reviewed 117 potential issues. We identified the 15 that may have the greatest positive or negative effects but are not yet well recognised by the global conservation community. Themes among these topics include new mechanisms driving the emergence and geographic expansion of diseases, innovative biotechnologies, reassessments of global change, and the development of strategic infrastructure to facilitate global economic priorities

Solution structure of the N-terminal extension domain of a Schistosoma japonicum asparaginyl-tRNA synthetase

Several secreted proteins from helminths (parasitic worms) have been shown to have immunomodulatory activities. Asparaginyl-tRNA synthetases are abundantly secreted in the filarial nematode Brugia malayi (BmAsnRS) and the parasitic flatworm Schistosoma japonicum (SjAsnRS), indicating a possible immune function. The suggestion is supported by BmAsnRS alleviating disease symptoms in a T-cell transfer mouse model of colitis. This immunomodulatory function is potentially related to an N-terminal extension domain present in eukaryotic AsnRS proteins but few structure/function studies have been done on this domain. Here we have determined the three-dimensional solution structure of the N-terminal extension domain of SjAsnRS. A protein containing the 114 N-terminal amino acids of SjAsnRS was recombinantly expressed with isotopic labelling to allow structure determination using 3D NMR spectroscopy, and analysis of dynamics using NMR relaxation experiments. Structural comparisons of the N-terminal extension domain of SjAsnRS with filarial and human homologues highlight a high degree of variability in the β-hairpin region of these eukaryotic N-AsnRS proteins, but similarities in the disorder of the C-terminal regions. Limitations in PrDOS-based intrinsically disordered region (IDR) model predictions were also evident in this comparison. Empirical structural data such as that presented in our study for N-SjAsnRS will enhance the prediction of sequence-homology based structure modelling and prediction of IDRs in the future

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability