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Determining the Wound Closure Capabilities of a Biological Engineered Blood Vessel for HD Access
Get PDFEnd stage renal disease (ESRD) is a prominent chronic condition with dialysis as a primary treatment option. Dialysis necessitates implementation of an access point, with the gold standard being an AV fistula which possesses multiple shortcomings. Alternative access points, namely synthetic grafts, do not allow wound healing characteristics. This work aims to explore how a tissue engineered vascular graft (TEVG) may be able to address these issues by allowing a long-term access point for HD that can close puncture wounds.
The effects of growth factors on our cells were tested preliminarily by means of a scratch assay on plates of human patient derived dermal fibroblasts (pt-fibs). The defects were monitored with images and RNA extracted at each timepoint for PCR testing of COL1A1 and TGFβ-1 expression. The TEVG was constructed based upon our laboratory’s protocol and was punctured and imaged at 24-hour intervals for 5 days.
The scratch assay demonstrated an increase in wound closure with growth factor. The expression of COL1A1 and TGFβ-1 increased over time for fibroblasts without growth factor, whereas decreased slightly in expression over time with GF1 applied, supporting increased wound healing capabilities with growth factor. The preliminary TEGV puncture test did not show significant changes in wound closure over 5 days and further exploration delving into the use of GF1 with our TEVGs will be conducted. This work will yield a novel alternative to synthetic grafts with superior biological regenerative properties working towards the improvement of access points for those undergoing dialysis
Factors Influencing Emergency Department Length of Stay in Pediatric Burn Patients
Get PDFIntroduction: Globally, the demand for pediatric emergency department (ED) visits has increased, leading to extended lengths of stay (LOS) in the ED. Prolonged ED length of stay (LOS) can delay definitive care and impact outcomes. This study investigates factors contributing to extended ED LOS in an urban, ABA-verified pediatric burn center.
Methods: We conducted a retrospective chart review of pediatric burn patients who presented between March 1, 2023, and March 1, 2024, with ED stays of ≥4 hours. Data on demographics, clinical presentation, and treatment were analyzed.
Results: Among 300 patients, the average ED LOS was 6 hours and 12 minutes. Patients arriving from outpatient burn clinics experienced longer stays (mean: 471 min) compared to injury sites (mean: 364 min, p=0.024) or ED transfers (mean: 362 min, p=0.019). Outpatient-in-bed (OPIB) dispositions were associated with longer LOS (mean: 438 min) than direct discharges home (mean: 362 min, p=0.013). Delays in triage (53 min, p\u3c0.001), IV initiation (105 min, p\u3c0.001), and burn nurse arrival (63 min, p\u3c0.001) significantly correlated with prolonged LOS.
Conclusions: Extended ED LOS appears to be linked to small burns that require overnight stays to ensure appropriate consulting services and wound care teaching is performed. Other factors that contribute to an increase in ED LOS are delays in triage, IV start time, and burn resource team response. Identifying factors that affect length of stay in the ED for burn patients can help providers anticipate the patient’s expected length of stay, provide more cost-effective care, and improve patient outcomes
Robotic vs. Conventional Surgical Approaches in Hospital Outpatient Department Total Knee Arthroplasty: A Value-Comparative Study
Get PDFIntroduction: U.S. healthcare costs have ranked highest among developed nations, emphasizing the need to increase cost-effectiveness while maintaining quality of care.1 Studies have compared cost-effectiveness of robotic versus conventional total knee arthroplasty (TKA), but none through Time-Driven Activity-Based Costing (TDABC) methodology.2 This study compares the value of conventional and robot-assisted TKA performed in hospital-based outpatient department (HOPD) settings.
Methods: Total costs were calculated using TDABC, activity-based supply costing (ABC), and claims-based facility costs. The time each personnel spent per patient was multiplied by their per-minute salary to determine direct variable labor costs. Differences in pre-operative and 6-month post-operative Knee Injury and Osteoarthritis Outcome Score – Joint Replacement (KOOS-JR) scores were multiplied by average life-years remaining for each patient to determine KOOS-JR-adjusted life-years (KALYs). Costs were divided by KALYs to determine average cost-effectiveness ratios (ACER). Results: 22 patients undergoing conventional TKA and 21 undergoing robotic TKA were recruited. In conventional TKA, the average cost was 34,023.12 (p=0.60). The average KALY for the conventional surgeries was 1.89 while the robotic KALY average was 1.88 (p=0.984). Overall, the average ACER for conventional TKA (18,230.80/KALY). Conclusion: Conventional TKA in HOPD has insignificantly lower costs with comparable outcomes than robotic TKA in HOPD. Comparing ACER values shows that conventional TKA in HOPD is marginally more cost-effective than robotic TKA, mainly driven by the slight cost reduction of the conventional TKA procedure
The role of mitochondrial deficiencies in Candida glabrata on azole susceptibility
Get PDFBackground: Next generation sequencing and other molecular approaches are showing that vaginal microbial populations are complex and variable over time and in health versus disease. Vaginal candidiasis (VVC) is caused by Candida, usually C. albicans, an opportunistic yeast that colonizes about 25% of women. Candida glabrata is species within the Candida genus that is less prevalent in the vaginal microbiome and less virulent but more likely to be resistant to azole drugs, thus making it more difficult to treat. The relationship between drug resistivity and mitochondrial function is unclear. Fungal mitochondrial genomes contain genes which encode RNA and other products involved in translation and encoding for protein components involved in the electron transport chain and oxidative phosphorylation. Other studies have found that fungal mitochondrial dysfunction is associated with overexpression of ABC transporter genes such as CDR1 which allows for increased drug efflux from the cell resulting in multi-drug resistance. This study asks what specific mitochondrial mutations are present in azole resistant C. glabrata, that have acquired respiration incompetency making fluconazole (FLZ), a third-generation azole used to treat vaginal fungal infections ineffective for patients colonized with C. glabrata.
Methods: Presence of mitochondrial mutations were determined with the use of PCR, restriction enzyme digests and gel electrophoresis.
Results: All vaginal isolates of C. glabrata from our repository were found to be resistant to fluconazole via MIC, many of the same isolates were respiratory deficient but also found to have high CDR1 expression and therefore increased drug resistance. Although, respiration deficient C. glabrata isolates may have multiple deletions in their mtDNA they are not completely devoid of mtDNA.
Conclusion: Results indicate that lack of mitochondrial function in C. glabrata is associated with high resistance to FLZ in petites derived from vaginal isolates and that intermediate resistance in vaginal parent strains is not due to mutation to petite status
The Financial Implications of Medical Education: An ROI Analysis of School Type, Specialty, and Training Location
Get PDFThe Financial Implications of Medical Education: An ROI Analysis of School Type, Specialty, and Training Location
Introduction
The financial burden of medical education profoundly influences career trajectories and long-term financial outcomes for physicians. This study examined the impact of medical school costs (comparing an in-state public and private medical school), specialty selection (focusing on Pediatrics, OB/GYN, and Orthopedic Surgery), and geographic factors on physicians\u27 financial returns. Further, this study considered loan repayment strategies and their effects on career return on investment (ROI), offering insights into financial decision-making for future medical graduates.
Methods Data on medical school costs, including tuition and cost of living (COA), were collected from information publicly published on schools’ websites. An annual tuition increase of 3.5% was assumed based on historic trends. Three payment scenarios were analyzed: 100% cash, 50/50 cash-loan split, and 100% loans. In forecasting costs, we assumed an 8% interest rate in line with current interest rates. Multiple repayment strategies were analyzed, starting with a 10% salary repayment and progressing to more aggressive plans aimed at repaying loans over 40, 23, or 15 years of practice. Physician salary data, retrieved from Medscape, informed ROI calculations, with consideration to varied tax rates and loan repayment schedules. ROI was compared across school types, specialties, and repayment strategies. ROI was defined as the total career income divided by the aggregate net loan payments.
Results Public in-state institutions, such as Wayne State University, yielded higher ROI compared to private schools, especially for lower-paying specialties like Pediatrics. Orthopedic surgeons experienced the highest ROI across repayment strategies, with aggressive 15-year repayment plans yielding ROIs of up to 2638%, compared to 524% for 40-year plans. Pediatrics showed limited ROI gains due to lower salaries, though repayment strategies significantly influenced financial outcomes.
Discussion
Loan repayment timelines emerged as a critical determinant of financial outcomes. While aggressive repayment reduced interest costs and improved ROI, it imposed greater financial strain early in physicians\u27 careers. Public medical schools offered better financial returns due to lower initial costs, particularly for specialties with modest to high compensation. Specialty choice was also an important consideration for ROI, although its impact was somewhat reduced due to the longer training required. Certain limitations may slightly temper these findings, including the exclusion of loan forgiveness programs, investment opportunities, and non-financial benefits of prestigious institutions.
Conclusion
The cost of medical education, specialty choice, and loan repayment strategies significantly affect physicians’ financial trajectories. Aggressive repayment strategies and studying at public institutions improve ROI, though personal factors and career goals should guide decision-making. Future research should incorporate broader financial variables and explore non-monetary factors shaping physicians’ career choices
Midnight Misses: Imaging Addenda and Pediatric Outcomes
Get PDFBackground: Radiology misreads can adversely impact healthcare delivery, leading to delays in care, suboptimal interventions, or harm through inappropriate discharge or procedures. This ongoing project investigates the frequency of addenda in radiology reports, the underlying reasons for addenda, and their clinical implications for patient care. This study analyzes 1,692 pediatric trauma patients seen in the emergency department at Children’s Hospital of Michigan (CHM) between January 2022 and December 2023. Key variables include: interpreter PGY level, anatomic location, imaging modality, time of reads, severity and type of misinterpretation (e.g., false negatives/positives), and clinical outcomes.
Hypothesis: Our hypothesis posits that pediatric trauma patients seen in the emergency room at night will have higher rates of addenda to their radiology reports indicating a misread of the original report, which will lead to worse clinically significant events.
Methods: Preliminary data collection includes patient demographics (age, gender, race/ethnicity, and home location) and chart reviews to assess defined variables. Statistical analysis is pending to confirm these patterns and their implications. We currently have defined our variables and begun our chart review. We have yet to obtain all information from patient charts and complete a statistical analysis of this data to draw conclusions from this information.
Significance: The study\u27s significance lies in identifying factors contributing to misreads, such as trauma settings or after-hours interpretations by residents, and their impact on patient outcomes. This research aims to inform strategies to reduce radiology misreads, improve care quality and reduce morbidity and mortality in pediatric trauma patients
Comparative Analysis of the ROSA Robot Accuracy for the Placement of Laser Interstitial Thermal Therapy Probes
Get PDFLaser thermal therapy (LITT) is a minimally invasive treatment for intracranial lesions with success dependent on precise placement of the laser probe. The Robotic Surgical Assistant (ROSA) ONE Brain robotic platform is one stereotactic method that is used to aid this process.
This study examined the accuracy of LITT probe placement utilizing the ROSA robot, comparing entry distance, target distance, and entry angle errors across two major LITT platforms: Neuroblate (Monteris Medical) and Visualase Systems.
A prospective review of patients who underwent LITT from 2013 to 2023 with the ROSA was performed. Statistical analyses were performed with the sign test, Spearman correlation, and Kruskal-allis test. Of 105 patients, 337 probes were placed. For Visualase probes, median entry distance was 1.1 mm (IQR 0.4-2.0), target distance 1.6 mm (IQR 0.9-2.4), and entry angle error 1.5° (IQR 0.9-2.5°), all significantly different from zero (P\u3c0.0001). For Neuroblate probes, the corresponding values were 1.5mm (IQR 1.0-2.1), 1.8mm (IQR 1.1-2.4), and 1.8° (IQR 1.1-2.5°), also significantly different from zero (P\u3c0.0001). A negative correlation was found between entry angle error and trajectory length for both systems (P\u3c0.0001).
In conclusion, while the ROSA robotic system aids in LITT probe placement, it does not achieve perfect alignment. Longer trajectory lengths were associated with reduced entry angle errors
Prenatal Stress and Socioeconomic Status as Predictors of Placental Methylation in Pregnant People
No full textDespite growing interest in placental epigenetics, the combined impact of prenatal stress and socioeconomic status on placental methylation is still largely understudied. We conducted a study to examine the associations of prenatal stress and socioeconomic factors (household income, Hollingshead socioeconomic index) with placental methylation. Pregnant people (n = 143; Mage = 25.66) in their second or third trimester (Mgestational age = 23.11 weeks) completed self-report questionnaires including demographic and socioeconomic information and ratings of perceived stress in the past month. Placenta tissue samples were collected after birth, from which placental genomic DNA was extracted to assess methylation levels at the NR3C1 promoter region. Multiple regression analyses were conducted, with prenatal stress, household income, and Hollingshead index predicting methylation at the different CpG glucocorticoid receptor sites, controlling for maternal age, smoking status, gestational age at delivery, and infant sex. Prenatal stress predicted NR3C1 methylation at the CpG8 and CpG9 glucocorticoid receptor sites. Household income was a significant predictor of methylation at the CpG9 site. Hollingshead index was not associated with methylation at any site. The independent effects of prenatal stress and socioeconomic status demonstrate the need for health care providers to recognize the psychological and socioeconomic influences on maternal-fetal health
APOE Genotype Distribution in a Mexican Population: A Comparative Study and its Implications for Alzheimer’s and Cardiovascular Disease
Get PDFThe apolipoprotein E (APOE) ε4 allele is a major genetic risk factor for Alzheimer’s disease (AD) and cardiovascular risk (CVD). This study analyzes the distribution of APOE alleles in 143 patients from a Mexican population based in Mexico City. The ε3 allele was the most prevalent (82.9%) followed by ε4 (12.5%) and ε2 (4.5%). Notably, the APOE 3/4 genotype, associated with increased risk for AD and CVD, was observed in 21% of the cohort, while the APOE 4/4 genotype, representing the highest genetic risk for both conditions, was rare (2.1%). The APOE 2/2 genotype, linked to type III dysbetalipoproteinemia, was absent in this population. These findings align with global trends but highlight unique aspects of the Mexican population, such as the lower prevalence of APOE4 compared to Northern European and African populations. This study underscores the importance of population-specific genetic screening for personalized medicine, particularly in managing AD and CVD risks. The results provide valuable insights into the genetic landscape of APOE in Mexico City, contributing to the growing body of knowledge on APOE allele distribution and its implications for disease prevention and management in Latin America
The Magic of Patwa in Bluebeard and Brer Anancy: Colonial Oppression and the Transgressive Power of Language
No full textCaribbean Renaissance author the Rt. Hon. Dr. Louise Bennett-Coverley (1919–2006) went by “Miss Lou” for most of her artistic career. Her Jamaican vernacular poetry, stories, songs, and performances were nothing short of revolutionary in colonial Jamaica. In 1949, Bennett-Coverley put that power on stage in the first Caribbean pantomime, Bluebeard and Brer Anancy. Bennett-Coverley brought the power of Patwa and traditional Jamaican folklore to the imported British fairy-tale tradition, initiating a new era of Caribbean pantomimes in the British Caribbean