University Of Texas Medical Branch Research Articles

Personally identifiable information does not always include a name

Case name: Letter to: University of Texas Medical Branch (SPPO 11/22/19).

Qualitative exploration of the medical learner\u2019s journey into correctional health care at an academic medical center and its implications for medical education

Correctional systems in several U.S. states have entered into partnerships with academic medical centers (AMCs) to provide healthcare for persons who are incarcerated. One AMC specializing in the care of incarcerated patients is the University of Texas Medical Branch at Galveston (UTMB), which hosts the only dedicated prison hospital in the U.S. and supplies 80% of the medical care for the entire Texas Department of Criminal Justice (TDCJ). Nearly all medical students and residents at UTMB take part in the care of the incarcerated. This research, through qualitative exploration using focus group discussions, sets out to characterize the correctional care learning environment medical trainees enter. Participants outlined an institutional culture of low prioritization and neglect that dominated the learning environment in the prison hospital, resulting in treatment of the incarcerated as second-class patients. Medical learners pointed to delays in care, both within the prison hospital and within the TDCJ system, where diagnostic, laboratory, and medical procedures were delivered to incarcerated patients at a lower priority compared to free-world patients. Medical learners elaborated further on ethical issues that included the moral judgment of those who are incarcerated, bias in clinical decision making, and concerns for patient autonomy. Medical learners were left to grapple with complex challenges like the problem of dual loyalties without opportunities to critically reflect upon what they experienced. This study finds that, without specific vulnerable populations training for both trainees and correctional care faculty to address these institutional dynamics, AMCs risk replicating a system of exploitation and neglect of incarcerated patients and thereby exacerbating health inequities.

Predictors of the cost of hysterectomy for benign indications

IntroductionHysterectomy is a commonly performed procedure with widely variable costs. As gynecologists divert from invasive to minimally invasive approaches, many factors come into play in determining hysterectomy cost and efforts should be sought to minimize it. Our objective was to identify the predictors of hysterectomy cost. Materials and MethodsThis was a retrospective cohort study where women who underwent hysterectomy for benign conditions at the University of Texas Medical Branch from 2009 to 2016 were identified. We obtained and analyzed demographic, operative, and financial data from electronic medical records and the hospital finance department. ResultsWe identified 1,847 women. Open hysterectomy was the most frequently practiced (35.8 %), followed by vaginal (23.7 %), laparoscopic (23.6 %), and robotic (16.9 %) approaches. Multivariate regression demonstrated that hysterectomy charges can be significantly predicted from surgical approach, patient’s age, operating room (OR) time, length of stay (LOS), estimated blood loss, insurance type, fiscal year, and concomitant procedures. Charges increased by $3,723.57 for each day increase in LOS (P <0.001), by $76.02 for each minute increase in OR time (P <0.001), and by $48.21 for each one-year increase in age (P 0.037). Adjusting for LOS and OR time remarkably decreased the cost of open and robotic hysterectomy, respectively when compared with the vaginal approach. ConclusionMultiple demographic and operative factors can predict the cost of hysterectomy. Healthcare providers, including gynecologists, are required to pursue additional roles in proper resource management and be acquainted with the cost drivers of therapeutic interventions. Future efforts and policies should target modifiable factors to minimize cost and promote value-based practices.

Functional Outcome of Anterior Talofibular Ligament Repair Using Bioabsorbable Suture Anchors

Category:Ankle; SportsIntroduction/Purpose:Suture anchors provide an optimal way of fixating injured soft tissue to bone while promoting healing and structural integrity. With recent innovations, the development of biodegradable ultrasonic liquifying suture anchors has been of particular interest. These devices utilize ultrasound energy to liquify a polylactide anchor tip, which is inserted into cancellous bone, at which point it solidifies and fixates within seconds. Mechanical performance testing in comparison to current mainstream devices suggests this method as more suitable for rapid tissue repair and healing. Initial studies have, however, been limited to artificial bone. The current study aims to evaluate surgical and patient-reported outcomes in the use of bio-absorbable suture anchors used for Broström-Gould lateral ankle ligament reconstruction.Methods:This study consisted of a single-surgeon, retrospective analysis with Institutional Review Board approval (University of Texas Medical Branch (UTMB), August 2 2019). A database search was conducted for patients who underwent primary or secondary Broström-Gould repair indicated for chronic laxity of the anterior talofibular ligament (ATFL) with bioabsorbable suture anchors between May 2017 and May 2019 at UTMB. Exclusion criteria were patient age under 18, incarcerated patient, and patient being a pharmaceutical company employee. Using patient charts, operative and progress notes were reviewed to assess surgical outcomes, concurrent repairs, and complications. Thereafter, patients were contacted via telephone to obtain Patient- Reported Outcomes Measurement Information System (PROMIS) scores through a series of survey questions concerning their physical health and physical function.Results:Twenty-six patients (20 females, 6 males) met inclusion and exclusion criteria. One patient had both ankles repaired separately, therefore 27 ankles were analyzed. Mean age at the time of surgery was 43 years (range 22-63). Preliminary analysis examined the period between surgery and last clinic visit, with a mean of 3.9 months. Mean concurrent repairs was 2.0. There were no intraoperative complications. All patients were compliant with weightbearing protocol. Complications unrelated to device function totaled 29.6% and included cellulitis (18.5%), suture granuloma (7.4%), and tarsal tunnel syndrome (3.7%), which all resolved after proper intervention. Functional complications included recurrent instability in 1 patient (3.7%) at 8.4 months. PROMIS scores are currently being collected and will be compiled by the end of February 2020.Conclusion:Preliminary analysis showed a relatively high overall complication rate at 33.3% (n=7), although recurrent instability was reported by 1 patient only (3.7%). The addition of PROMIS scores will be critical in examining longer term functional outcomes in ATFL repair with bioabsorbable suture anchors.

Personally identifiable information does not always include a name

Case name: Letter to: University of Texas Medical Branch (SPPO 11/22/19).

Space Medicine in Canada

Space medicine is a unique field of medicine applying a broad understanding of medicine to the extreme environment of space. Physicians involved in space medicine play a pivotal role in understanding the effects of space flight on humans as well as mitigating problems associated with space flight, and managing any health effects that might develop on a mission (1). In addition to the many physiological effects, space medicine includes practicing medicine in this extreme environment. Prevention, diagnosis and treatment must be taken into consideration. It is therefore important to understand the mechanisms of altered human physiological functions in space to establish a new “normal” in reduced microgravity, and to then discover new ways of treating astronauts in space. The space environment has a vast array of effects on almost every component of normal human physiology: cardiopulmonary function (2, 3) neurophysiology (2) bone and mineral metabolism (3-5) muscle structure and function (4, 5) hematological and immunologic function (4, 6) biological effects of radiation (7) circadian rhythm (7) psychological effects (8) It is critical to launch a new era of medicine in Canada. There are many applications of space medicine to medical concerns on Earth. The physiological changes observed in space can shed light on common diseases supporting developments of treatments. First, osteoporosis is a public health concern affecting menopausal women, and the complete absence of microgravity is a model of accelerated osteoporosis. Osteoporosis is a slow, progressive disease except in situations such as short and long-duration space missions and immobilization (9). New treatments addressing these issues and further prevention can be a significant benefit to all women suffering from this disease. Motion sickness is also an obstacle for astronauts and cosmonauts living in microgravity. Pharmaceuticals aimed to prevent space motion sickness can prove useful to terrestrial motion sickness, which affects individuals on long journeys by air, sea, and motor vehicles (10). Additionally, reduced gravity influences the cardiovascular system leading to an understanding of cardiovascular functions in different circumstances. Prolonged hospitalizations can lead to adaptation problems requiring rehabilitation for the cardiovascular system and for muscles. Exercise equipment specifically designed for astronauts in space may be a useful addition to rehabilitation medical equipment (10). Currently, there is no Canadian residency for aerospace medicine. However, the Canadian Space Agency (CSA) does offer an aerospace medicine medical elective for fourth year medical students or residents. The CSA sends selected students to the Johnson Space Center or the Kennedy Space Center to promote awareness of this branch of medicine and to encourage career pursuits in aerospace medicine (11). In spite of this, if a student hopes to pursue a career as an aerospace physician, the only residencies offered are in the USA. The Centre for Altitude, Space and Extreme Environment Medicine (CASE Medicine) offers a medical elective in space medicine and extreme environment physiology for medical students at University College London. Finally, some students and residents interested in this field complete a diploma of space studies at the International Space University. The only two American civilian universities that offer aerospace medicine programs are the University of Texas Medical Branch (UTMB) and Wright State University. UTMB focuses more on space medicine whereas the Wright State program centers on aviation medicine. These are competitive programs accepting few candidates from around the world on a per-year basis (12, 13). The space shuttle is retiring in 2010 and it will be making way for the new Ares Launch Vehicles, which will return humans to the Moon and to other destinations (14). Canada has made significant contributions to the development and enhancement of space exploration through pioneering technology; however, new aerospace medicine initiatives should be supported, such as a Canadian fellowship or residency in aerospace medicine. Even though Canada has a small number of astronauts, Canada should establish a training program to train specialists in both an occupational and research setting. There are still many medical challenges associated with space flight, and increased Canadian participation in aerospace medicine research would help in understanding and mitigating the effects of space environment on human physiology. Furthermore, applications of this research could also be beneficial to Earth-related issues. Although Canada should support new training initiatives, political pressure is geared towards addressing the shortage of physicians. For that reason, students interested in this field must be prepared to pursue a unique training path that might not initially include space medicine, but it would be great if students were supported in these pursuits. It is also essential to optimize the health and safety of astronauts before, during, and after space travel. The future of space medicine is for those who would like to embark on a journey to become a pioneer, a student, a teacher, and an explorer in pursuit of understanding the effects of space travel on human physiology, practicing medicine in extreme environments, and applying new knowledge acquired to health care on Earth. Sincerely,

In Reply.

Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio University of Texas Medical Branch at Galveston, Galveston, Texas Brown University, Providence, Rhode Island Financial Disclosure Mona Prasad disclosed that money was paid to her to from The Ohio State University for reimbursement for travel to and from meetings for work related to the study. Ohio State University was an NICHD-funded MFMU center. She has also received funds from Gilead as a consultant for Medical Advisory Panels in 2019. Brenna L. Hughes disclosed that she received funds as a scientific advisor for the Merck CMV program (not relevant to the submitted work). The other author did not report any potential conflicts of interest.

Chester R. Burns (1937-2006) and the origins of the American Osler Society.

The American Osler Society (AOS) traces its origin to a 1970 symposium on Humanism in Medicine in Galveston, Texas. Although John P. McGovern (1921-2007) receives credit for conceiving the symposium and spearheading formation of the AOS, Chester Ray Burns (1937-2006) played a key role that has not been sufficiently recognized. Burns, the first American-born physician to receive a doctorate in the history of medicine from the Johns Hopkins University, did much and perhaps most of the organizational work and brought to the symposium a perspective on the crossroads between medicine and the humanities that proved essential to the nascent organization's success. Burns went on to a productive career at the University of Texas Medical Branch (UTMB) in Galveston, became the 35th president of the AOS, and is among the relatively few physician-historians to have published scholarly articles in the history of medicine, medical biography, medical ethics, and philosophy as related to medicine.

Editorial introductions

Current Opinion in Clinical Nutrition and Metabolic Care was launched in 1998. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of clinical nutrition and metabolic care are divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Anastasia Z. KaleaAnastasia Z. KaleaDr Anastasia Z. Kalea is Senior Teaching Fellow in Nutrition Education at the UCL Division of Medicine, UK, and an honorary Senior Associate Professor at the UCL Institute of Cardiovascular Science, UK. She has over 15 years of research and teaching experience in academic institutions in the US and the UK. She is an external examiner and reviewer for undergraduate nutrition and dietetics programmes in the US, UK, and Greece. Dr Kalea is a registered dietitian with the Health and Care Professions Council (HCPC) and has received a fellowship from the Higher Education Academy in the UK. She joined UCL in 2011 and researched the epigenetic effects of miRNAs in inflammatory diseases, cardiovascular disease and obesity. Prior to her joining UCL, Dr Kalea had been awarded a JDRF Fellowship to study vascular complications in diabetes while at Columbia University, USA, and continued her research at Northwestern University, USA. She held also a post-doctoral position at University of Maine, USA. Her research interests focus on metabolic inflammation and their associated comorbidities, on trace mineral metabolism, and on nutrigenetics and presented her work in numerous national and international conferences. Recent research publications explored the effects of diet on autoimmune diseases (lupus, rheumatoid arthritis), and on management of obesity. Her teaching interests lie on molecular nutrition pathways, personalised nutrition and public health. Dr Kalea leads teaching for the MSc in Clinical and Public Health Nutrition, MSc in Eating Disorders and Clinical Nutrition, and the BSc in Nutrition and Medical Sciences. She is the Programme Director for a new MSc course in Obesity and Clinical Nutrition at UCL. Dorothy Klimis-ZacasDorothy Klimis-ZacasDr Klimis-Zacas is professor of clinical nutrition and cooperating professor of the Graduate School of Biomedical Sciences and Engineering at the University of Maine, USA. As a Fulbright Senior Fellow, she aided in the establishment and curricular development of the Human Nutrition and Dietetics Program at Harokopio University, Greece, where she is a cooperating professor. She is also cooperating professor at DeFENs-Department of Food, Environmental and Nutritional Sciences at the University of Milan, Italy. Dr Klimis-Zacas is external reviewer and examiner for undergraduate and graduate programs, on promotion and tenure committees in the US, Italy and Greece, and grant reviewer for the Ministry of Health and Religion in Greece. Her research and teaching have focused on lipid and trace mineral nutrition and metabolism associated with cardiovascular disease. Additionally, she has explored the role of signalling pathways and gene expression of berry bioactive compounds and berry-enriched diets on endothelial function, inflammation, and lipid metabolism as it relates to cardiovascular disease and the metabolic syndrome in pre-clinical and clinical studies. Her applied research investigations utilized nutritional interventions to reduce cardiovascular disease risk in adolescents both in the United States and in the Mediterranean region. Recently, she is researching the molecular mechanisms and genomic effects of polyphenols on endothelial cell migration and angiogenesis as it relates to diabetes mellitus, ischemic disorders and wound healing. A Fulbright Senior Specialist and Cariplo Fellow, Dr Klimis-Zacas is the author of over 130 peer-reviewed publications, editor of books, series volumes and one patent. She is an editorial board member for The Journal of Nutritional Biochemistry, editor and guest editor for Antioxidants, Nutrients (MDPI) and others. Bettina MittendorferBettina MittendorferBettina Mittendorfer graduated from the University of Vienna in Austria with a MSc in Human Nutrition, and from the University of Texas Medical Branch in Galveston, USA, with a PhD in Nutritional Biochemistry. In 1999 she came to Washington University School of Medicine in St. Louis, USA, for a postdoctoral research fellowship. Currently she is Associate Professor of Medicine and Nutritional Sciences and the Director of the Nutrition and Obesity Research Center Clinical Science Research Core Laboratory at Washington University in St. Louis. Her research interests focus on the regulation of muscle protein and lipid metabolism with special emphasis on obesity, aging and sexual dimorphism, which she studies in vivo in human subjects by using stable isotope labelled tracer techniques. Olle LjungqvistOlle LjungqvistOlle Ljungqvist received his MD, PhD and surgical training from the Karolinska Institutet and Hospital in Sweden where he held several clinical positions in gastrointestinal surgery before being appointed Professor of Surgery Nutrition and Metabolism in 2005 at the Karolinska Insitutet. He chaired the Center for Gastrointestinal Disease at Ersta hospital 1999–2008, Stockholm before taking up his current position as Professor of Surgery at Örebro University, Sweden in 2009. Dr Ljungqvist has served as Chair of ESPEN, IASMEN as part of the International Surgical Society. He co-founded the ERAS® Society 2010 and serves as the Executive Chairman. He proposed the use of preoperative carbohydrates instead of overnight fasting, guideline recommend world-wide. His research interests are surgical stress, metabolism and nutrition and outcomes focusing on ERAS. He has published more than 200 original contributions, textbook chapter, edited textbooks, and has a current H index above 60.

Diabetes Risk Variants Associate With Impaired Insulin Sensitivity In Healthy Adults Following Bed Rest

More than 80 genetic variants increase risk for type 2 diabetes. We hypothesized that increased genetic risk for diabetes may increase susceptibility to impaired insulin sensitivity following bed rest. PURPOSE: To determine whether type 2 diabetes genetic risk variants in healthy older adults are associated with impaired insulin sensitivity following bed rest. METHODS: 37 nondiabetic adults (65.9 ± 7.9 years, BMI 27.1 ± 3.0, 82.2 ± 6.4 mg/dL fasting blood glucose) completed bed rest studies at the University of Texas Medical Branch. The protocol consisted of a 3 day run-in period, 7 days of bed rest and 7 days of rehabilitation. OGTT (75g) were administered before and after bed rest protocol and following rehabilitation. Venous blood was collected at baseline, 0, 30, 60, 90, and 120 minutes, and the Matsuda Insulin Sensitivity Index (Mat-ISI), HOMA-IR, Insulinogenic Index (II), and the Disposition Index (DI) were calculated. DNA from whole blood was used to genotype for MTNR1B (rs10830963), NOTCH2 (rs10923931), RASGRP1 (rs7403531), PROX1 (rs2075423), HHEX (rs1111875), IGF2BP2 (rs4402960), CDKAL1 (rs7754840), SLC30A8 (rs13266634), ZFAND6 (rs11634397), and TCF7L2 (rs7903146) risk variants using TaqMan Assays. Results were collated into an unweighted risk score based on the total number of risk alleles (possible range from 0-20).SPSS version 26 (IBM, Chicago, IL) was used to build a multivariate model including all outcome indices and risk variants. RESULTS: Genetic risk scores ranged from 5 to 11. HOMA-IR and II were not associated with risk scores at any point in the study. Higher overall risk scores were inversely associated with the Mat-ISI and the DI only immediately after the completion of the bed rest period (p= 0.035 and p= 0.017, respectively), but not at baseline or after rehabilitation. Post-bed rest Mat-ISI ranged from 18.1 ± 11.6 for those in the lowest risk group vs. 6.8 ± 0.26 in the highest risk group. Post-bed rest DI was 16.8 ± 12.9 for those in the lowest risk group and 5.8 ± 3 in the highest risk group. CONCLUSION: These results indicate that people with a higher genetic risk for type 2 diabetes may be at increased risk of disuse-related loss of insulin sensitivity.The work was supported by the Claude D. Pepper Older Americans Independence Center (P30 AG024832).

Association between Dry Age-Related Macular Degeneration, Chronic Kidney Disease and Hypertension: a Retrospective Chart Review Study

Background: Chronic kidney disease (CKD) and age-related macular degeneration (AMD) are two global health concerns that cause significant disability in the elderly. These two diseases share common risk factors and pathological mechanisms. This study investigates the association between hypertension (HTN), CKD and dry AMD in a diverse racial population. Methods: Data from 8,837 participants aged 40-100 years was retrieved for this retrospective chart review study. Subjects were identified for HTN, CKD and dry AMD, using ICD-10 codes, from the database of University of Texas Medical Branch, Galveston. Patient demographics and their metabolic panels pertaining to kidney and HTN were collected. Logistic regression models were performed to study the association between HTN, CKD and dry AMD after adjusting for age, gender, race and smoking habits. Results: The logistic regression model for the prevalence of dry AMD with HTN and CKD, excluding an interaction, but without adjustment for demographics (age, gender, race and smoking) suggest positive significant association between HTN and CKD. The coefficients of the model suggest that the odds of dry AMD is 1.4 folds higher for patients with CKD (p=007), and 1.6 folds higher in patients with HTN (p&lt;0001). However, this relationship loses its significance after adjusting for demographic variables suggesting that the effect of CKD and HTN on dry AMD is mediated by age, gender and race. Logistic regression model stratified by race, relating prevalence of dry AMD to the presence of CKD after controlling for effects due to age, gender and HTN show no association of race with HTN. A significant association between dry AMD and CKD in the Hispanic population was noted; with odds of dry AMD being 2.4 folds higher than those without (OR 2.35, 95% 1.21-4.57; p=0.01). Conclusion: Hypertension is a common risk factor for both dry AMD and CKD and therefore should be controlled at the primary care level so as to reduce the burden of concomitant diseases. Dry AMD is associated with CKD in Hispanic population, needs further studies. Nonetheless, yearly fundoscopic examination should be recommended for patients with HTN and CKD for early detection of dry AMD.

Phenotypes Associated with 16p11.2 Copy Number Gains and Losses at a Single Institution.

Chromosome 16p11.2 is one of the susceptible sites for recurrent copy number variations (CNVs) due to flanking near-identical segmental duplications. Five segmental duplications, named breakpoints 1 to 5 (BP1-BP5), have been defined as recombination hotspots within 16p11.2. Common CNVs on 16p11.2 include a proximal ~593 kb between BP4 and BP5, and a distal ~220 kb between BP2 and BP3. We performed a search for patients carrying 16p11.2 CNVs, as detected using chromosome microarray (CMA), in the Molecular Diagnostic Laboratory at the University of Texas Medical Branch (UTMB), in Galveston. From March 2013 through April 2018, a total of 1200 CMA results were generated for germline testing, and 14 patients tested positive for 16p11.2 CNVs, of whom 7 had proximal deletion, 2 had distal deletion, 4 had proximal duplication, and 1 had distal duplication. Herein, we provide detailed phenotype data for these patients. Our study results show that developmental delay, abnormal body weight, behavioral problems, and hypotonia are common phenotypes associated with 16p11.2 CNVs.

In Reply.

Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas Sera Prognostics, Inc. Salt Lake City, Utah Financial Disclosure J. Jay Boniface and Julja Burchard are employees of Sera Prognostics, a company that has developed a screening test for preterm birth prediction and continues to develop such tests. The other author did not report any potential conflicts of interest.

Expanding Knowledge and Exposure to Aerospace Medicine by Creating a Medical Student Curriculum.

BACKGROUND: Aerospace Medicine is a small medical specialty. With the increasing need for aircraft pilots, continued low Earth orbit NASA operations, and the emergence of commercial spaceflight, there is a necessity for recruiting and educating the next generation of Aerospace Medicine specialists. This study was designed to create and validate a short Aerospace Medicine curriculum.METHODS: Medical students at the University of Texas Medical Branch were recruited to attend a series of six 1-h meetings covering Aerospace Medicine career options and key Aerospace Medicine topics. A survey addressing student demographics, interest in a career in Aerospace Medicine, and knowledge of key Aerospace Medicine topics was administered at the beginning and end of the curriculum. Interest in pursuing a career in Aerospace Medicine pre- and postcurriculum was compared with an independent t-test. The knowledge-based portion of the survey was also evaluated using an independent t-test.RESULTS: There were 23 participants who were recruited and filled out the initial survey and 15 participants who attended the final meeting and filled out the postcurriculum survey. Mean interest in pursuing a career in Aerospace Medicine did not change significantly (75.45% before involvement in the curriculum and 83.08% after participation). Knowledge of foundational Aerospace Medicine topics increased from 64.25% before involvement in the curriculum to 73.33% at the end of the study. There was an average of 12 participants at each meeting.DISCUSSION: This demonstrates the utility of this curriculum as an educational tool for medical students. Future efforts will focus on dissemination of the curriculum nationally and internationally.Kreykes AJ, Petersen EH, Lowry CL. Expanding knowledge and exposure to aerospace medicine by creating a medical student curriculum. Aerosp Med Hum Perform. 2020; 91(5):448-452.

\u201cIt\u2019s like heaven over there\u201d: medicine as discipline and the production of the carceral body

BackgroundCorrectional systems in several U.S. states have entered into partnerships with Academic Medical Centers (AMCs) to provide healthcare for people who are incarcerated. This project was initiated to better understand medical trainee perspectives on training and providing healthcare services to prison populations at one AMC specializing in the care of incarcerated patients: The University of Texas Medical Branch at Galveston (UTMB). We set out to characterize the attitudes and perceptions of medical trainees from the start of their training until the final year of Internal Medicine residency. Our goal was to analyze medical trainee perspectives on caring for incarcerated patients and to determine what specialized education and training is needed, if any, for the provision of ethical and appropriate healthcare to incarcerated patients.ResultsWe found that medical trainees grapple with being beneficiaries of a state and institutional power structure that exploits the neglected health of incarcerated patients for the benefit of medical education and research. The benefits include the training opportunities afforded by the advanced pathologies suffered by persons who are incarcerated, an institutional culture that generally allowed students more freedom to practice their skills on incarcerated patients as compared to free-world patients, and an easy compliance of incarcerated patients likely conditioned by their neglect. Most trainees failed to recognize the extreme power differential between provider and patient that facilitates such freedom.ConclusionsUsing a critical prison studies/Foucauldian theoretical framework, we identified how the provision/withholding of healthcare to and from persons who are incarcerated plays a major role in disciplining incarcerated bodies into becoming compliant medical patients and research subjects, complacent with and even grateful for delayed care, delivered sometimes below the standard best practices. Specialized vulnerable-population training is sorely needed for both medical trainees and attending physicians in order to not further contribute to this exploitation of incarcerated patients.

Judge rules in favor of university

Case name: Walker v. University of Texas Medical Branch — Galveston, No. 3:17‐CV‐00313 (S.D. Tex. 08/13/18).

Lessons Learned from Implementation of a Web-Based Environmental Health and Safety Management Database in an Academic Medical Center

An environmental health and safety program for an academic medical center involves managing complex and diverse safety issues. The ability to ensure that required activities are performed and documented as well as ready access to environmental health and safety data to internal stakeholders are a few of the benefits that implementing a centralized environmental health and safety database can provide. The Environmental Health & Safety Department at the University of Texas Medical Branch is organized into operational groups based upon specialty (biological safety, radiation safety, occupational safety, fire safety, and environmental protection management). Historically, the organization has followed a decentralized approach to data management, with each specialty keeping data in their own format and inaccessible to employees in other specialties. Beginning in 2014, the department began the implementation of a unified environmental health and safety database. This database allows for a standardized approach ...

Robert McClelland: surgeon who tried to help save both President John F Kennedy and Lee Harvey Oswald

Picture credit: University of Texas South-western Medical Centre, Dallas, USA Robert McClelland was born in the small town of Gilmer in east Texas, to Robert, a butcher, and Verna (nee...

One More Hurricane, One More Lesson Not Learned.

Considering the trauma that our health system suffered related to Hurricane Ike in September 2008, administrators, employees, and students were hoping to avoid future emergency occurrences. The University of Texas Medical Branch (UTMB) caught a break until August 2017 when Hurricane Harvey washed in. Handling Hurricane Harvey demonstrated yet again the University's strength and resilience in meeting the challenges that hammer facilities and humans during naturally occurring emergencies. Leaders and staff managed the many facets of providing “best care,” the health system's commitment to offer right care, at the right time, in the right way, for the right person. Continuous patient care delivery …

Two Students' Summary of Basil A. Pruitt's Impact on Surgical Care, Teaching and Education

From the The University of Texas Medical Branch at Galveston, Texas. Address for reprints: Ronald Stewart, MD email: [email protected].