The rural mortality penalty in U.S. hospital patients with COVID-19.

Background: The COVID-19 pandemic brought greater focus to the rural mortality penalty in the U.S., which describes the greater mortality rate in rural compared to urban areas.

Desirability of Outcome Ranking and Response Adjusted for Antibiotic Risk (DOOR/RADAR) Post Hoc Analysis Supports Equipoise for Antibiotic Initiation Strategies in Intensive Care Unit-Acquired Pneumonia.

Pneumonia is the most common intensive care unit (ICU)-acquired infection and source of potential sepsis in ICU populations but can be difficult to diagnose in real-time. Despite limited data, rapid initiation of antibiotic agents is endorsed by society guidelines. We hypothesized that a post hoc analysis of a recent randomized pilot study would show no difference between two antibiotic initiation strategies.

Interactive multidisciplinary pilot workshop to improve medical student perception of and interest in breast surgical oncology.

Background: Exposure to breast surgical oncology (BSO) and the multidisciplinary management of patients with breast cancer is limited in medical school. The purpose of this study was to assess changes in student perceptions of BSO as a career following an interactive multidisciplinary workshop.

Methods: Pre-clinical medical students participated in a multidisciplinary, hands-on workshop, composed of breast radiology (BR), breast surgical oncology (BSO) and breast plastic reconstructive surgery (B-PRS).

Provider Perceptions of Antibiotic Initiation Strategies for Hospital-Acquired Pneumonia.

The practice of rapidly initiating antibiotic therapy for patients with suspected infection has recently been criticized yet remains commonplace. Provider comfort level has been an understudied aspect of this practice. We hypothesized that there would be no significant differences in provider comfort level between the two treatment groups.

The rural mortality penalty in U.S. hospital patients with COVID-19.

Background: The COVID-19 pandemic brought greater focus to the rural mortality penalty in the U.S., which describes the greater mortality rate in rural compared to urban areas.

Assessing Second Debridement Timing and Mortality in Necrotizing Soft Tissue Infections.

Background: Patients with necrotizing soft tissue infection undergo an average of 4-5 debridements per hospital admission. Optimal timing for initial debridement is emergent. Second debridement is universally recommended to occur within 24 hours of the first, but no studies have successfully evaluated this time frame.

Evaluation of learning curve with Indocyanine Green (IcG) versus blue dye for sentinel lymph node biopsy in breast cancer.

Background: Indocyanine green (IcG) is an alternative to isosulfan blue (IB) for sentinel lymph node (SLN) mapping in breast cancer (BC). IcG carries improved cost and safety, but oncologic data upon implementation in practice is limited. We evaluated the learning curve defined as oncologic yield and operative (OR) time for IcG in SLN mapping in BC.

US tobacco companies selectively disseminated hyper-palatable foods into the US food system: Empirical evidence and current implications.

Background And Aims: US tobacco companies owned leading US food companies from 1980 to 2001. We measured whether hyper-palatable foods (HPF) were disproportionately developed in tobacco-owned food companies, resulting in substantial tobacco-related influence on the US food system.

Design: The study involved a review of primary industry documents to identify food brands that were tobacco company-owned.

Breast Cancer-Related Lymphedema (BCRL) and Bioimpedance Spectroscopy: Long-Term Follow-Up, Surveillance Recommendations, and Multidisciplinary Risk Factors.

Background: Early detection and intervention for breast cancer-related lymphedema (BCRL) significantly decreases progression to persistent BCRL (pBCRL). We aimed to provide long-term follow-up on our early detection with bioimpedance spectroscopy (BIS) and early home intervention demonstrating reduced pBCRL to guide surveillance recommendations.

Patients And Methods: In total, 148 female patients with breast cancer who had axillary lymph node dissection (ALND) from November 2014 to December 2017 were analyzed.

Advanced degrees, gender, and professional rank in surgery, disparities in academic medicine.

Introduction: Women comprise nearly half of all residents in training, yet there is a significant disparity of women in academic leadership. Surgical subspecialties are dominated by men in both percentages of physicians and leadership positions. We sought to examine the association of advanced non-medical degrees with academic rank and gender in academic surgery departments.

Iodine Intake From Diet and Supplements and Urinary Iodine Concentration in a Cohort of Pregnant Women in the United States.

Background: The DRI Estimated Average Requirement (EAR) in pregnancy for Iodine (I), an essential nutrient for fetal neurodevelopment, is 160 μg/d. Supplementation with 150 μg/d I/day is recommended during pregnancy, however, neither dietary intake or the combination of diet and supplement intake has been reported in US pregnant women.

Objective: Determine iodine intake from diet and supplements and iodine status in pregnancy by urinary iodine concentration in a large cohort of pregnant women.

A Hands-On Surgical Event to Improve Medical Student Operating Room Confidence.

Introduction: The negative perceptions and lack of exposure to surgery and the operating room (OR) have been known to divert students away from surgical specialties. This study describes the impact of a surgical subspecialty exposure event (OR Essentials), combined with surgical faculty and M4 mentorship on preclinical medical students' confidence at an academic medical center.

Methods: OR essentials event teaches surgical skills to preclinical medical students through hands-on skill-based workshops in a simulated OR setting.

A Scoping Review of Iodine and Fluoride in Pregnancy in Relation to Maternal Thyroid Function and Offspring Neurodevelopment.

Iodine (I), an essential nutrient, is important for thyroid function and therefore growth and development. Fluoride (F), also an essential nutrient, strengthens bones and teeth, and prevents childhood dental caries. Both severe and mild-to-moderate I deficiency and high F exposure during development are associated to decreased intelligence quotient with recent reports associating high levels of F exposure during pregnancy and infancy to low intelligence quotient.

Hyper-palatable foods in elementary school lunches: Availability and contributing factors in a national sample of US public schools.

Background: School cafeterias are a major point of influence for child nutrition. United States federal legislation requires the presence of important nutrients in school meals. However, legislation overlooks the potential presence of hyper-palatable foods in school lunches, a hypothesized factor that may influence children's eating behavior and obesity risk.

Dietary Habits of Children 0 - 23 Months in Rural Kansas: Early Life Diets of Rural Children.

Introduction: Children in rural areas face increased rates of obesity compared to their urban counterparts, and diet in early childhood may influence the development of diseases related to food intake. This study sought to determine current diet of children 0-23 months of age in rural Kansas.

Methods: Medical students participating in 6-week, summer, rural clinical experiences offered the survey to caregivers of children 0-23 months, born at term as singletons without a specialized diet.

Trial of antibiotic restraint in presumed pneumonia: A Surgical Infection Society multicenter pilot.

Background: Pneumonia is the most common intensive care unit-acquired infection in the trauma and emergency general surgery population. Despite guidelines urging rapid antibiotic use, data supporting immediate antibiotic initiation in cases of suspected infection are limited. Our hypothesis was that a protocol of specimen-initiated antibiotic initiation would have similar compliance and outcomes to an immediate initiation protocol.

Comparison of two validated instruments to measure financial hardship in cancer survivors: comprehensive score for financial toxicity (COST) versus personal financial wellness (PFW) scale.

Purpose: Financial distress and financial toxicity are recognized challenges in cancer survivorship. Financial toxicity includes both objective measures of hardship and subjective distress. We hypothesized that subjective financial distress is correlated to overall holistic financial toxicity.

DHA Supplementation During Pregnancy Enhances Maternal Vagally Mediated Cardiac Autonomic Control in Humans.

Background: DHA is an essential omega-3 (ω-3; n-3) fatty acid that has well-established benefits for the fetus. DHA also has the potential to influence the health of the mother, but this area is understudied.

Objectives: The objective of this secondary analysis was to determine if DHA was related to maternal heart rate (HR) and heart rate variability (HRV) metrics in a large cohort of pregnant women.

Analysis of Research Productivity and Assessment of Geographical Region in the General Surgery Match: How Much is Enough?

Objectives: The number of publications of prospective surgical residents has steadily increased over the past decade as the emphasis on research output has become paramount. However, the reported data from the National Resident Matching Program (NRMP) does not discriminate amongst impact, author position, and region of matched residents. This study aimed to evaluate categorical general surgery postgraduate year 1 (PGY-1) residents' research productivity by programs' research impact and region of the United States and support the need for additional public data on research metrics of accepted applicants.

Rethinking Routine Surgical Excision for all Radial Sclerosing Lesions of the Breast.

Introduction: The need for routine surgical excision of a radial sclerosing lesions (RSL) of the breast identified on percutaneous biopsy remains controversial, as contemporary upgrade rates are lower than historically cited.

Materials And Methods: A prospectively-maintained database of high-risk breast biopsies undergoing multidisciplinary review at a single institution was queried to identify cases of RSL from 2/2015 to 11/2020. Demographic, radiologic, and pathologic variables were summarized using frequencies and analyzed in association with RSL excision status using mixed-effects logistic regression or Fisher's exact tests.

Intake of eggs, choline, lutein, zeaxanthin, and DHA during pregnancy and their relationship to fetal neurodevelopment.

Background: Maternal intake of eggs and nutrients contained within eggs during pregnancy have the potential to impact fetal neurodevelopment; however, this area is understudied. The purpose of this study was to determine whether maternal egg and choline intake and nutrient interactions between choline, lutein and zeaxanthin (L/Z), and DHA predict fetal neurodevelopment in a large cohort of pregnant women ( = 202). NCT02709239.

Rural-Urban Disparities in Health Access Factors Over Time: Implications for Cancer Prevention and Health Equity in the Midwest.

Purpose: Population-level environmental and socioeconomic factors may influence cancer burden within communities, particularly in rural and urban areas that may be differentially impacted by factors related to health care access.

Methods: The University of Kansas (KU) Cancer Center serves a geographically large diverse region with 75% of its 123 counties classified as rural. Using County Health Rankings data and joinpoint regression, we examined trends in four factors related to the socioeconomic environment and health care access from 2009 to 2017 in rural and urban counties across the KU Cancer Center catchment area.

Change in hyper-palatable food availability in the US food system over 30 years: 1988-2018.

Objective: To quantify the change in availability of hyper-palatable foods (HPF) in the US foods system over 30 years (1988-2018).

Design: Three datasets considered representative of the US food system were used in analyses to represent years 1988, 2001 and 2018. A standardised definition from Fazzino (2019) that specifies combinations of nutrients was used to identify HPF.