Prior Decades Research Articles

Fueling the future of neurosurgery: increasing trends in female enrollment expanding the neurosurgical workforce from 2010 to 2019.

Regular reporting on recruitment of women into neurosurgery is a mechanism to track the progress of minority inclusion and diversity. For more than 20 years, half of US medical students have been women, yet a disproportionate minority pursue a career in neurosurgery. The authors previously published data tracking women in neurosurgery for the prior decade from 2000 to 2009, which showed an increasing match rate of women over time, from 18 women matched at the beginning of the decade to 36 matched at the end. They now present updated data on the matriculation of women into neurosurgical residencies across the most recent decade, from 2010 to 2019. Public databases from the Association of American Medical Colleges were analyzed for applicants to neurosurgical residency from 2010 to 2019. Demographic data for those matched was obtained from the American Medical Association Masterfile and analyzed for year of match and gender. Secondary outcomes included program location, age, and gap year(s) between medical school and residency. Women made up 18.8% (394/2094) of residents matched into neurosurgery from 2010 to 2019, compared to 12% during the previous decade. There was an increase in overall match rate of 2.2% per year (male + female) from 2010 to 2019, representing the predicted need for expansion of the neurosurgical workforce to meet national needs. Women made up the majority of this expansion, rising by 5.5% over the time period (p = 0.002), compared to men increasing by 1.4% over the time period (p = 0.096). The percentage of women applicants who matched was 34.4%, compared to men at 38.6% (p = 0.009). There was no significant difference in gender with regard to age, number of gap years, or program location. The number of women matching into neurosurgery has continued to increase across the last 2 decades. Despite this, there remains significant disparity between the number of men and women matching into neurosurgery. Ongoing mitigation of barriers to recruitment of women into neurosurgery is critical. The authors' data highlight the fact that women are important to fueling the expansion of the neurosurgical workforce.

Association of Safety-Net Hospital Status With Outcomes Following Head and Neck Cancer Operations.

To assess perioperative and readmission outcomes of patients undergoing head and neck cancer (HNCA) surgery at safety-net hospitals (SNHs) in a modern cohort. Retrospective cohort study. Nationwide Readmissions Database (NRD), 2010 to 2019. All elective adult (≥18 years) admissions involving HNCA resection were identified from the NRD. To calculate safety-net burden, the proportion of Medicaid or uninsured patients admitted to each hospital for any indication was tabulated annually, with centers in the highest quartile defined as SNHs. To perform risk adjustment in assessing perioperative and readmission outcomes, multivariable regression models were developed. Of an estimated 133,018 head and neck surgical patients, 26.5% (n = 35,268) received treatment at a SNH. Utilization of SNHs increased over the decade-long study period, with 29.8% of individuals treated at these sites in 2019. After multivariable adjustment, several patient factors were noted to be associated with SNHs, including younger age, lower comorbidity burden, and income within the lowest quartile. Although incidence of adverse events decreased at both SNHs and non-SNHs during the study period, treatment at SNHs remained associated with these events after risk adjustment (adjusted odds ratio: 1.17, 95% confidence interval: 1.08-1.28, P < .001). SNHs continue to provide valuable specialty care to underserved populations, often with limited financial resources. Despite promising results from prior decades demonstrating comparable perioperative outcomes, the present study noted increased adverse events following HNCA surgery at these sites. Such findings underscore the need for continued advocacy to secure necessary funding for these centers.

Prices and Trends in FDA-Approved Medications for Sarcomas.

Sarcomas represent a diverse set of both malignant and benign subtypes consisting of often rare and ultra-rare conditions. Over the course of the last decade, there have been numerous FDA approvals for agents treating various sarcoma subtypes. Given this burgeoning landscape of sarcoma treatments, we seek to review current FDA-approved agents with respect to their rates of incidence, approval rates, and financial costs. We gathered clinical trial data by searching FDA approval announcements from 2013 to 2023. We determined the 30 day and one year cost of therapy for patients of FDA-approved sarcoma treatments in the aforementioned timeframe. From 2013 to 2023, 14 medications have been FDA-approved for sarcoma subtypes. The 30-day dosing prices for these medications range from $11,162.86 to $46,926.00. Since 2013, the rates of approval for sarcoma medications have been higher than in prior decades. Nonetheless, there remains the potential for significant financial toxicity for patients living with sarcoma.

Recent Developments in Aerosol Pulmonary Drug Delivery: New Technologies, New Cargos, and New Targets.

There is nothing like a global pandemic to motivate the need for improved respiratory treatments and mucosal vaccines. Stimulated by the COVID-19 pandemic, pulmonary aerosol drug delivery has seen a flourish of activity, building on the prior decades of innovation in particle engineering, inhaler device technologies, and clinical understanding. As such, the field has expanded into new directions and is working toward the efficient delivery of increasingly complex cargos to address a wider range of respiratory diseases. This review seeks to highlight recent innovations in approaches to personalize inhalation drug delivery, deliver complex cargos, and diversify the targets treated and prevented through pulmonary drug delivery. We aim to inform readers of the emerging efforts within the field and predict where future breakthroughs are expected to impact the treatment of respiratory diseases.

Racial and Ethnic Disparities in the Medical Management of Poststroke Complications Among Patients With Acute Stroke.

To inform clinical practice, we sought to identify racial and ethnic differences in the medical management of common poststroke complications. A cohort of acutely hospitalized, first-time non-Hispanic White (NHW), non-Hispanic Black, and Hispanic patients with stroke was identified from electronic medical records of 51 large health care organizations (January 1, 2003 to December 5, 2022). Matched propensity scores were used to account for baseline differences. Primary outcomes included receipt of medication(s) associated with the management of the following poststroke complications: arousal/fatigue, spasticity, mood, sleep, neurogenic bladder, neurogenic bowel, and seizure. Differences were measured at 14, 90, and 365 days. Subgroup analyses included differences restricted to patients with ischemic stroke, younger age (<65 years), and stratified by decade (2003-2012 and 2013-2022). Before matching, the final cohort consisted of 348 286 patients with first-time stroke. Matching resulted in 63 722 non-Hispanic Black-NHW pairs and 24 009 Hispanic-NHW pairs. Non-Hispanic Black (versus NHW) patients were significantly less likely to be treated for all poststroke complications, with differences largest for arousal/fatigue (relative risk (RR), 0.58 [95% CI, 0.54-0.62]), spasticity (RR, 0.64 [95% CI, 0.0.62-0.67]), and mood disorders (RR, 0.72 [95% CI, 0.70-0.74]) at 14 days. Hispanic-NHW differences were similar, albeit with smaller magnitudes, with the largest differences present for spasticity (RR, 0.67 [95% CI, 0.63-0.72]), arousal/fatigue (RR, 0.77 [95% CI, 0.70-0.85]), and mood disorders (RR, 0.79 [95% CI, 0.77-0.82]). Subgroup analyses revealed similar patterns for ischemic stroke and patients aged <65 years. Disparities for the current decade remained significant but with smaller magnitudes compared with the prior decade. There are significant racial and ethnic disparities in the treatment of poststroke complications. The differences were greatest at 14 days, outlining the importance of early identification and management.

Extreme fire weather in Chile driven by climate change and El Niño–Southern Oscillation (ENSO)

A string of fierce fires broke out in Chile in the austral summer 2023, just six years after the record-breaking 2017 fire season. Favored by extreme weather conditions, fire activity has dramatically risen in recent years in this Andean country. A total of 1.7 million ha. burned during the last decade, tripling figures of the prior decade. Six of the seven most destructive fire seasons on record occurred since 2014. Here, we analyze the progression during the last two decades of the weather conditions associated with increased fire risk in Central Chile (30°–39° S). Fire weather conditions (including high temperatures, low humidity, dryness, and strong winds) increase the potential for wildfires, once ignited, to rapidly spread. We show that the concurrence of El Niño and climate-fueled droughts and heatwaves boost the local fire risk and have decisively contributed to the intense fire activity recently seen in Central Chile. Our results also suggest that the tropical eastern Pacific Ocean variability modulates the seasonal fire weather in the country, driving in turn the interannual fire activity. The signature of the warm anomalies in the Niño 1 + 2 region (0°–10° S, 90° W–80° W) is apparent on the burned area records seen in Central Chile in 2017 and 2023.

A Review on High Throughput Phenotyping for Vegetable Crops

Abstract Conventional phenotyping approaches for vegetable crops such as Solanaceae, Bulb, and Root crops have contributed significantly to the development of numerous varieties. Despite this, traditional phenotyping procedures are insufficient because of the longer time required to produce a variety, poor genetic gain, environmental influences, and other externalities that impact phenotype-based selection. A novel recent approach of high throughput phenotyping (HTP) is regarded a potential tool for addressing the problems of traditional phenotyping. The advent of sensor, computer vision, automation, and sophisticated machine learning technologies sparked the creation of high-throughput phenotyping technology in the prior decade. HTP platforms are being used to conduct non-destructive evaluations of the whole plant system in a variety of crops. HTP provides precise measurements and suggests the collection of high-quality and accurate data, which is required for standardizing phenotyping for genetic dissection and genomic assisted breeding techniques such as genome-wide association studies (GWAS), linkage mapping, marker-assisted selection (MAS), and genomic selection (GS). The rest of this chapter examines the application of high-throughput phenotyping tools in genomic-assisted breeding for vegetable crops.

Biomarkers linking habitual short sleep duration with risk of cardiometabolic disease: current progress and future directions.

Approximately one in three adults in the United States sleeps less than the recommended 7 h per night. Decades of epidemiological data and data from experimental sleep restriction studies demonstrate short sleep duration is associated with adverse cardiometabolic risk, including risk of type 2 diabetes and cardiovascular disease. However, the precise mechanisms underlying this risk are not fully elucidated and there is a lack of sleep-based interventions designed to mitigate such risk. One strategy to overcome these limitations is to develop biomarkers that link habitual short sleep duration with adverse cardiometabolic risk. Such biomarkers could inform biochemical mechanisms, identify new targets for interventions, support precision medicine by identifying individuals most likely to benefit from sleep-based interventions, and ultimately lead to improved cardiometabolic health in people with habitual short sleep durations. Early progress demonstrates proof-of-principle that omics-based technologies are a viable approach to create biochemical signatures (biomarkers) of short sleep duration, primarily derived from acute studies of experimental sleep restriction. Yet, much work remains. Notably, studies that translate early findings from experimental sleep restriction to free-living adults with habitual short sleep duration have high potential to advance the field. Such studies also create an exciting opportunity for larger randomized controlled trials that simultaneously identify biomarkers of habitual short sleep duration and evaluate the efficacy of sleep-based interventions. Ultimately, early progress in developing molecular biomarkers of short sleep duration combined with the prior decades of progress in the sleep and metabolism fields provide the foundation for exciting progress in the biomarker development space.

Evaluating The Data Analytics For Finance And Insurance Sectors For Industry 4.0

The insurance industry relies heavily on statistics, despite the absence of a physical good or service being sold. A financial, risk, consumer, producer, and actuarial database would be created by such an industry. In prior decades, these sectors gathered structured data that they augmented with product and policyholder details. However, semi- and unstructured data represent a massive untapped resource. This will also prevent the insurance from making the most of the information it collects. Despite the striking similarities between healthcare delivery and insurance funding, life insurer problems have hampered the field for the better part of a century. Organizations that need both unstructured and structured data to flourish can find the optimal places to store both types of data according to research. The insurance industry may make better use of data with the help of applied analytics. The insurance industry is also discussed in relation to big data adoption techniques such as training, research, collaboration, and implementation. Several models of the data adoption and transformation methods that contribute to the insurance sector's extraordinary data analysis and forecasting abilities are shown in this article, which delves into the data transformation practises of the insurance business. Healthcare delivery systems need to be overhauled for "Big Data Analytics" to be of any real use. The purpose of this study is to investigate the ways in which modern data management has changed the insurance sector, as well as the traits and applications that have paved the way for the emergence of cutting-edge tools and the expansion of the economy.

Changing inequalities in life-expectancy by income in Finland 1997-2020

Abstract Background Previous studies show that in recent decades the changes in mortality disparities between income groups in Finland have been driven by alcohol- and smoking-related causes of death. The gap between the extreme income quintiles narrowed in 2008-14 particularly due to the declining alcohol-related mortality. We analysed the most recent changes in mortality disparities and the causes of deaths behind them. Methods We used register based individual level total population data for ages 30-95+ and yearly follow-up for mortality in 1996-2020 including information on disposable household income quintile in the previous year. Preston method was used for assessing the impact of smoking on mortality. We calculated trends in life expectancy (LE) at age 30 for three-year periods in 1997-2020 and then conducted an Arriaga cause of death decomposition of the gap between highest and lowest quintiles and changes in LE for each quintile from 2015-17 to 2018-20. Results We observed an increasing gap in LE by income due to stagnating LE in the lowest income quintile from 2015 onward among both men and women. Among men the stagnation was observed even after eliminating smoking- and alcohol-related mortality and among women the LE slightly increased after accounting for smoking and alcohol but the gap to the highest quintile increased clearly. Decomposing the change in LE from 2015-17 to 2018-2020 by causes of death showed no specific causes of death behind the stagnation and the widening gap. Among both men and women mortality due to circulatory diseases showed a substantial decline in the lowest quintile whereas in all other causes mortality increased or declined only slightly. Conclusions Inequalities in LE by income are widening again in Finland due to stagnation in the lowest income quintile. Contrary to the prior decades the increasing disparities are not attributable to smoking and alcohol-related deaths but occur in the majority of causes of death. Key messages • After nearly a decade of narrowing mortality inequalities we observed an increasing gap in life expectancy by income mainly due to stagnation in the lowest income quintile. • Contrary to the prior decades the increasing disparities and stagnation of the lowest income quintile are not explained by smoking and alcohol-related deaths but occur in majority of causes of death.

Understanding diarrhoeal diseases in response to climate variability and drought in Cape Town, South Africa: a mixed methods approach

BackgroundThe climate of southern Africa is expected to become hotter and drier with more frequent severe droughts and the incidence of diarrhoea to increase. From 2015 to 2018, Cape Town, South Africa, experienced a severe drought which resulted in extreme water conservation efforts. We aimed to gain a more holistic understanding of the relationship between diarrhoea in young children and climate variability in a system stressed by water scarcity.MethodsUsing a mixed-methods approach, we explored diarrhoeal disease incidence in children under 5 years between 2010 to 2019 in Cape Town, primarily in the public health system through routinely collected diarrhoeal incidence and weather station data. We developed a negative binomial regression model to understand the relationship between temperature, precipitation, and relative humidity on incidence of diarrhoea with dehydration. We conducted in-depth interviews with stakeholders in the fields of health, environment, and human development on perceptions around diarrhoea and health-related interventions both prior to and over the drought, and analysed them through the framework method.ResultsFrom diarrhoeal incidence data, the diarrhoea with dehydration incidence decreased over the decade studied, e.g. reduction of 64.7% in 2019 [95% confidence interval (CI): 5.5–7.2%] compared to 2010, with no increase during the severe drought period. Over the hot dry diarrhoeal season (November to May), the monthly diarrhoea with dehydration incidence increased by 7.4% (95% CI: 4.5–10.3%) per 1 °C increase in temperature and 2.6% (95% CI: 1.7–3.5%) per 1% increase in relative humidity in the unlagged model. Stakeholder interviews found that extensive and sustained diarrhoeal interventions were perceived to be responsible for the overall reduction in diarrhoeal incidence and mortality over the prior decade. During the drought, as diarrhoeal interventions were maintained, the expected increase in incidence in the public health sector did not occur.ConclusionsWe found that that diarrhoeal incidence has decreased over the last decade and that incidence is strongly influenced by local temperature and humidity, particularly over the hot dry season. While climate change and extreme weather events especially stress systems supporting vulnerable populations such as young children, maintaining strong and consistent public health interventions helps to reduce negative health impacts.

Relationships between stock returns and real earnings yields over the last 150 years

This research finds ex-ante real earnings yields on the S&P Composite Index of equities to be significantly related to their subsequent annual returns over the last 150 years. The real earnings yield forecast is computed by adding a market-based prediction of long-term future inflation to the ratio between the highest past earnings on the S&P Composite and the current level of that stock market index. Equity return deviations from this real earnings yield over the last 150 years have been positively associated with the prior decade's inflation rate but negatively related to the current inflation rate.

Infant and preschool attachment, continuity and relationship to caregiving sensitivity: findings from a new population-based Australian cohort.

Here, we report new prevalence and temporal stability data for child attachment and parental caregiving behaviour, from infancy (1 year) to preschool (4 years). Attachment (SSP) and caregiving data (MBQS) were from observations of parents and their infants and preschoolers, who represent the third generation of participants within an Australian longitudinal cohort. At 1 year (n = 314 dyads) and at 4 years (n = 368 dyads), proportions assessed secure were 59% and 71%, respectively. Proportions assessed avoidant were 15% and 11%; ambivalent 9% and 6%, and disorganised 17% and 12%, at 1 and 4 years. Continuity of attachment pattern was highest for the infant secure group. Of dyads initially classified disorganised in infancy, 36% remained so at the preschool assessment. Attachment and caregiving continuities across the infancy-preschool period were highest for the stable secure attachment group and lowest for the stable insecure attachment group. Loss of secure attachment to mother by age 4 years correlated with decreased maternal caregiving sensitivity, and acquisition of secure status by age 4 was associated with increased maternal sensitivity. We found no difference in caregiving sensitivity scores for mothers and fathers for female and male preschool children. The contemporary infant and preschool attachment proportions we report here closely mirror the patterns of those reported in prior decades, with an inclination towards secure base relationships. Our findings alert practitioners anew to the responsiveness of early attachment status to change in caregiving responsiveness and support ongoing investment in early identification of disorganised attachment.

Examining ideology and agency within intensive motherhood literature

In exploring why American mothers spend more time on care work compared to prior decades while increasingly engaging in paid work, Hays (1997) attributed women's actions to intensive motherhood (IM) ideology. Hays also asserted that women purposedly adhere to IM to resist an increasingly neoliberal market-based society by dedicating time and effort to nurturing children and family life. Here, we undertake a content analysis to take stock of IM literature's evolution in recent decades. Specifically, we examine scholars’ treatment of how women adhere to IM, and why and whether women do so in resistance to neoliberalism. We found that while scholars consistently cite and echo Hays (1997) on how women adhere to IM, most depart from Hays (1997) by positing women adhere to live up to an ideal of being a perfect mother due to the pervasive nature of IM. We also found many scholars focus on the possibility of resisting IM ideology itself rather than Hays’s (1997) perspective that women employ the ideology to resist neoliberalism. These findings raise questions about how women's agency manifests in the IM context, and concerns about embedded assumptions that limit our understanding of women's realities. Implications are discussed.

Jail Conditions And Mortality: Death Rates Associated With Turnover, Jail Size, And Population Characteristics.

In 2019, there were approximately ten million admissions to more than 3,000 US jails-facilities that had become increasingly deadly in the prior decades. Between 2000 and 2019, jail mortality rose by approximately 11percent. Although incarceration is widely viewed as a health hazard, relationships between jail conditions and jail deaths are understudied. Using data from the Bureau of Justice Statistics and Reuters journalists, we assessed mortality rates and conditions in approximately 450 US jails in the period 2008-19. During those years, certain facility characteristics were related to mortality. For example, high turnover rates and high populations were associated with higher death rates. Greater proportions of non-Hispanic Black people in jail populations were associated with more deaths due to illness, and the presence of larger shares of non-US citizens was associated with lower overall mortality rates. Our findings suggest that heavy reliance on incarceration and the prevalence of broad health disparities escalate jail mortality.

Cone-Beam CT With Enhanced Needle Guidance and Augmented Fluoroscopy Overlay: Applications in Interventional Radiology.

Digital flat-panel detector cone-beam CT (CBCT), introduced in the early 2000s, was historically used in interventional radiology primarily for liver-directed therapies. However, contemporary advanced imaging applications, including enhanced needle guidance and augmented fluoroscopy overlay, have evolved substantially over the prior decade and now work synergistically with CBCT guidance to overcome limitations encountered with other imaging modalities. CBCT with advanced imaging applications has become increasingly used to facilitate a broad range of minimally invasive procedures, particularly relating to pain and musculoskeletal interventions. Potential advantages of CBCT with advanced imaging applications include greater accuracy for complex needle paths, improved targeting in the presence of metal artifact, enhanced visualization during injection of contrast medium or cement, increased ease when space in the gantry is limited, and reduced radiation doses versus conventional CT guidance. Nonetheless, CBCT guidance remains underutilized, partly relating to lack of familiarity with the technique. This article describes the practical implementation of CBCT with enhanced needle guidance and augmented fluoroscopy overlay and depicts the technique's application for an array of interventional radiology procedures, including epidural steroid injections, celiac plexus block and neurolysis, pudendal block, spine ablation, percutaneous osseous ablation fixation and osteoplasty, biliary recanalization, and transcaval type II endoleak repair.

Ferrimagnetic Oscillator Magnetometer

Quantum sensors based on solid-state spins have advanced rapidly over the prior decade, but deploying these sensors in real-world applications remains technically challenging. By introducing an innovative oscillator-based sensor architecture, and employing a ferrimagnetic material rather than the paramagnetic spin defects more commonly studied, this work details the construction of a compact magnetometer with a minimum sensitivity of 100 fT/\ensuremath{\surd}Hz. The sensor's architecture offers advantages in dynamic range, simplicity, and compactness---qualities that may enable widespread use of solid-state quantum sensors outside a laboratory environment.

Pulmonary Protection from Left Ventricular Distension During Venoarterial Extracorporeal Membrane Oxygenation: Review and Management Algorithm.

The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adults for refractory cardiogenic shock has risen exponentially during the prior decade. Although VA-ECMO provides cardiopulmonary support, it can alter left ventricular (LV) loading conditions leading to LV distension, which makes the lungs susceptible to congestion and promotes intracardiac thrombosis. These conditions can be alleviated by pharmacologic and mechanical unloading, but gaps in knowledge remain on optimal timing and methods of this approach. This review provides an overview of the epidemiology of VA-ECMO, describes pathophysiology and methods for monitoring and reducing LV loading and summarizes contemporary studies examining the association between LV unloading and adverse events. We offer a simple protocol for implementing LV unloading during VA-ECMO to provide pulmonary protection and improve outcomes.

Congenital diaphragmatic hernia survival in an English regional ECMO center

IntroductionCongenital diaphragmatic hernia (CDH) remains a cause of neonatal death. Our aims are to describe contemporary rates of survival and the variables associated with this outcome, contrasting these with our...

Self-Reported Reasons for Divorce, Social Support, and Depression: An Exploratory Study With Hmong Women

Contrary to other Asian Americans, Hmong, a subgroup of Southeast Asians, have seen a steady increase of divorce rates in prior decades. Due to their clan-based patrilineal system and collectivistic values, divorce is stigmatized and discouraged, especially for Hmong women. A mixed-methods approach was used to explore Hmong women’s reasons for divorce, divorce initiation, and the relationship of social support and depression levels. To analyze findings, a thematic content analysis of written responses in addition to regression models were conducted. Our qualitative findings show the most prominent reasons for divorce reported by Hmong women were personality or life differences, abusive behaviors, and infidelity. No statistical significance was found between initiation of divorce and perceived social support or depression and perceived social support. Implications of findings are shared.