Amplifying the Student Voice: Medical Student Perceptions of AΩA.

BACKGROUND: Recent literature has suggested racial disparities in Alpha Omega Alpha Honor Medical Society (AΩA) selection and raised concerns about its effects on the learning environment. Internal reviews at multiple institutions have led to changes in selection practices or suspension of student chapters; in October 2020, the national AΩA organization provided guidance to address these concerns. OBJECTIVE: This study aimed to better understand student opinions of AΩA. DESIGN: An anonymous survey using both multiple response option and free response questions. PARTICIPANTS: Medical students at the Perelman School of Medicine at the University of Pennsylvania. MAIN MEASURES: Descriptive statistics and logistic regressions were used to examine predictors of student opinion towards AΩA. Free responses were analyzed by two independent coders to identify key themes. KEY RESULTS: In total, 70% of the student body (n = 547) completed the survey. Sixty-three percent had a negative opinion of AΩA, and 57% felt AΩA should not exist at the student level. Thirteen percent believed AΩA membership appropriately reflects the student body; 8% thought selection processes were fair. On multivariate analysis, negative predictors of a student's preference to continue AΩA at the student level included belief that AΩA membership does not currently mirror class composition (OR: 0.45, [95% CI: 0.23-0.89]) and that AΩA selection processes were unfair (OR: 0.20 [0.08-0.47]). Self-perception as not competitive for AΩA selection was also a negative predictor (OR: 0.44 [0.22-0.88]). Major qualitative themes included equity, impact on the learning environment, transparency, and positive aspects of AΩA. CONCLUSIONS: This single-institution survey demonstrated significant student concerns regarding AΩA selection fairness and effects on the learning environment. Many critiques extended beyond AΩA itself, instead focusing on the perceived magnification of existing disparities in the learning environment. As the national conversation about AΩA continues, engaging student voices in the discussion is critical.

Renal function after low central venous pressure-assisted liver resection: assessment of 2116 cases.

OBJECTIVES: Low central venous pressure (LCVP)-assisted hepatectomy is associated with decreased blood loss and lower transfusion rates. Concerns about its impact on renal function have prevented widespread application. This study was conducted to review the dynamics of renal function after LCVP-assisted hepatectomy. METHODS: A retrospective analysis of a prospective surgical database was carried out. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. The RIFLE (risk-injury-failure-loss-end-stage) criteria were used to define postoperative biochemical acute kidney injury (bAKI). Occurrences of clinically relevant AKI (cAKI) were identified in the study center postoperative database. RESULTS: During the period 2003-2012, 2116 LCVP-assisted hepatectomies were performed. The median patient age was 61 years [interquartile range (IQR): 51-70 years] and 51% of patients were male. The median number of resected segments was two; resections involved from one to four segments. Median estimated blood loss was 300 ml (IQR: 200-600 ml). Rates of morbidity and 90-day mortality were 21% and 2%, respectively. Low baseline eGFR (<90 ml/min) was seen in 84% of patients; 29% of patients had eGFR of <30 ml/min. Postoperative bAKI was seen in 17% (n = 350) of patients. Biochemical AKI with low eGFR was seen in 336 patients, representing 16% of the whole cohort; 13% of patients had been at risk, 2% experienced injury and 1% experienced failure. Kidney function had normalized at discharge in 159 of these patients. Nine patients (<1%) developed postoperative cAKI. CONCLUSIONS: The majority of patients in the study cohort had low baseline eGFR. Biochemical alterations in eGFR are transient in the vast majority of patients after LCVP-assisted hepatectomy and their clinical impact is limited. The present data suggest that clinically relevant renal dysfunction is a very uncommon event in patients undergoing LCVP-assisted liver resection.

Morphine-Associated Contextual Cues Induce Structural Plasticity in Hippocampal CA1 Pyramidal Neurons.

In people with a prior history of opioid misuse, cues associated with previous drug intake can trigger relapse even after years of abstinence. Examining the processes that lead to the formation and maintenance of the memories between cues/context and the opioid may help to discover new therapeutic candidates to treat drug-seeking behavior. The hippocampus is a brain region essential for learning and memory, which has been involved in the mechanisms underlying opioid cravings. The formation of memories and associations are thought to be dependent on synaptic strengthening associated with structural plasticity of dendritic spines. Here, we assess how dendritic spines in the CA1 region of the hippocampus are affected by morphine-conditioning training. Our results show that morphine pairing with environmental cues (ie, the conditioned place preference (CPP) apparatus) triggers a significant decrease in the number of thin dendritic spines in the hippocampus. Interestingly, this effect was observed regardless of the expression of a conditioned response when mice were trained using an unpaired morphine CPP design and was absent when morphine was administered in the home cage. To investigate the mechanism underlying this structural plasticity, we examined the role of Rho GTPase in dendritic spine remodeling. We found that synaptic expression of RhoA increased with morphine conditioning and blocking RhoA signaling prevented the expression of morphine-induced CPP. Our findings uncover novel mechanisms in response to morphine-associated environmental cues and the underlying alterations in spine plasticity.