Racial Health Disparities Research in Cardiothoracic Surgery Under-represented in Major Meetings.

INTRODUCTION: Black/African Americans and Latinos face significant health disparities and systemic inequities. Heart and lung disease are leading factors affecting morbidity and mortality in these groups. Given this disparity, we sought to determine how often this topic is presented at the most relevant United States annual cardiothoracic surgery meetings. METHODS: Specialty-specific annual meeting abstract books were queried between 2015 and 2021. We included the Society of Thoracic Surgeons, American Association for Thoracic Surgery, Western Thoracic Surgical Association, and the Southern Thoracic Surgical Association. Scientific abstract titles and content were searched for the following keywords and phrases: "racial health disparities," "race," "racism," "racial bias," "institutional racism," and "health disparities". If an abstract included a keyword or phrase, it was counted as a racial health disparity abstract. We calculated the proportion of racial health disparity abstracts and abstracts published as manuscripts in the meeting-associated journals. RESULTS: A total of 3664 abstracts were presented between 2015 and 2021. Of those, 0.90% (33/3664) abstracts presented contained at least one of the keywords or phrases. Of these abstracts, the percentage that went on to publication represented 0.38% (14/3664) of the total number of abstracts presented. CONCLUSIONS: Abstracts on racial health disparities in cardiothoracic surgery represent a very small fraction of total meeting peer-reviewed content. There is a significant gap in research to identify and develop best practice strategies to address these disparities and mitigate structural racism within the care of underserved patients with cardiothoracic diseases.

Dissecting Diversity: A Comprehensive Look at the Present Landscape and Future Challenges in Surgical Specialties.

BACKGROUND: As the US demographic evolves, surgical fields must adapt to ensure equitable healthcare. Healthcare disparities notably affect minority populations, with communities of color often facing physician shortages and higher rates of diseases such as coronary disease, stroke, and cancer. Research shows that minority physicians significantly improve patient satisfaction and outcomes in underserved communities, highlighting the need for increased physician diversity to enhance cultural competency and patient centered care. Data from the Association of American Medical Colleges (AAMC) reveals minimal increases in underrepresented minorities (URM) in surgical residency and academic careers over the past thirty-six years, with little change URM applicants and matriculants in the nine surgical specialties recognized by the American College of Surgeons from 2010 to 2018. OBJECTIVE: This review aims to critically evaluate the current landscape of racial and gender diversity in six out of the nine defined surgical specialties (general surgery, plastic surgery, neurosurgery, orthopedic surgery, cardiothoracic surgery, and vascular surgery) in the US. DESIGN: We conducted a comprehensive literature review to assess of the state of diversity within surgical specialties in the United States. By analyzing the benefits of diversity in surgical fields, evaluating the effectiveness of various diversity programs and initiatives, examining the comparative diversity between surgical subspecialties, and assessing the impact of diversity on patient outcomes, our aim is to highlight the critical importance of enhancing diversity in surgical fields. RESULTS: While nuances in representation and diversity vary across surgical specialties, all fields persistently exhibit underrepresentation of certain racial/ethnic groups and persistent gender disparities. These disparities manifest throughout various phases, including in residency, and in the recruitment and retention of URM individuals in surgery and surgical subspecialties. While interventions over the past decade have contributed to improving diversity in surgical fields, significant disparities persist. Limitations include the time required for recent interventions to show significant impacts and the inability of established interventions to eliminate disparities. CONCLUSIONS: Despite the clear benefits, diversity within surgical specialties remains an uphill battle. Addressing the diversity gap in surgical fields is crucial for improving patient outcomes, healthcare access, and workplace environments, requiring strategies such as targeted recruitment, mentorship programs, and addressing systemic biases. This review highlights the undeniable imperative for change and serve a call to action.

Predictors of Discharge with Supplemental Oxygen after Lobectomy for Lung Cancer.

BACKGROUND: Before lung cancer resection, patients inquire about dyspnea and the potential need for supplemental oxygen. Our objective was to identify predictors of discharge with supplemental oxygen for patients undergoing lobectomy for lung cancer. METHODS: Using the Society of Thoracic Surgeons General Thoracic Surgery Database, we conducted a retrospective cohort study of patients undergoing lobectomy for lung cancer from July 2018 - December 2021. Multivariable logistic regression was used to determine the adjusted association of pulmonary function with discharge on supplemental oxygen and identify independent predictors of discharge with supplemental oxygen. Pulmonary function was modeled as the minimum of either ppoFEV1 or ppoDLCO. RESULTS: Overall, 2,100 (8.4%) patients undergoing lobectomy were discharged with supplemental oxygen. Those with a minimum of either ppoFEV1 or ppoDLCO ≤60% had a progressively increased risk of discharge with supplemental oxygen than those with minimum function >60%. The two strongest predictors of discharge with supplemental oxygen were increasing BMI (25-29 aOR 1.38, 95%CI 1.21-1.57, 30-39 aOR 2.14, 95%CI 1.88-2.45, ≥40 aOR 3.51, 95%CI 2.79-4.39, reference 18.5-24) and former (aOR 2.04, 95%CI 1.67-2.52) and current (aOR 2.61, 95%CI 2.10-3.26) smoking status (reference never smoker). CONCLUSIONS: Of those undergoing lobectomy for lung cancer, 8.4% were discharged with supplemental oxygen. We identified preoperative independent predictors of discharge with supplemental oxygen that may be useful during shared decision-making discussions of treatment options for lung cancer and setting expectations with patients.

Emerging precision neoadjuvant systemic therapy for patients with resectable non-small cell lung cancer: current status and perspectives.

Over the past decade, targeted therapy for oncogene-driven NSCLC and immune checkpoint inhibitors for non-oncogene-driven NSCLC, respectively, have greatly improved the survival and quality of life for patients with unresectable NSCLC. Increasingly, these biomarker-guided systemic therapies given before or after surgery have been used in patients with early-stage NSCLC. In March 2022, the US FDA granted the approval of neoadjuvant nivolumab and chemotherapy for patients with stage IB-IIIA NSCLC. Several phase II/III trials are evaluating the clinical efficacy of various neoadjuvant immune checkpoint inhibitor combinations for non-oncogene-driven NSCLC and neoadjuvant molecular targeted therapies for oncogene-driven NSCLC, respectively. However, clinical application of precision neoadjuvant treatment requires a paradigm shift in the biomarker testing and multidisciplinary collaboration at the diagnosis of early-stage NSCLC. In this comprehensive review, we summarize the current diagnosis and treatment landscape, recent advances, new challenges in biomarker testing and endpoint selections, practical considerations for a timely multidisciplinary collaboration at diagnosis, and perspectives in emerging neoadjuvant precision systemic therapy for patients with resectable, early-stage NSCLC. These biomarker-guided neoadjuvant therapies hold the promise to improve surgical and pathological outcomes, reduce systemic recurrences, guide postoperative therapy, and improve cure rates in patients with resectable NSCLC.

Social Disparities in Thoracic Surgery Education.

Despite an ever-diversifying US population, women, and underrepresented minorities lack proportionate membership in the CT surgery workforce. CT surgery is the surgical specialty practiced by the oldest surgeons as a group. This highlights a deficit within our specialty and foreshadows a shrinking of the CT surgery workforce that will be compounded by a lack of diversity as the workforce ages. If CT surgery is to continue to advance forward and attract the brightest, most skilled, and innovative people, we must invite, encourage, and guide qualified individuals from all races, cultures, genders, sexual orientations, and experiences to join us.

Comprehensive Review of Chest Tube Management: A Review.

IMPORTANCE: Thoracostomy, or chest tube placement, is used in a variety of clinical indications and can be lifesaving in certain circumstances. There have been developments and modifications to thoracostomy tubes, or chest tubes, over time, but they continue to be a staple in the thoracic surgeon's toolbox as well as adjacent specialties in medicine. This review will provide the nonexpert clinician a comprehensive understanding of the types of chest tubes, indications for their effective use, and key management details for ideal patient outcomes. OBSERVATIONS: This review describes the types of chest tubes, indications for use, techniques for placement, common anatomical landmarks that are encountered with placement and management, and an overview of complications that may arise with tube thoracostomy. In addition, the future direction of chest tubes is explored, as well as the management of chest tubes during the COVID-19 pandemic. CONCLUSIONS AND RELEVANCE: Chest tube management is subjective, but the compilation of data can inform best practices and safe application to successfully manage the pleural space and ameliorate acquired pleural space disease.

Cardiothoracic Surgery Training Program Director Awareness of Available Visiting Medical Student Clerkships for the Underrepresented in Medicine.

A diversity gap exists within cardiothoracic (CT) surgery that might be addressed with currently available medical student pipeline programs. We sought to assess CT surgery residency/fellowship program directors' (PD) awareness of and participation in underrepresented in medicine visiting medical student clerkship programs (UIM-VMSCPs). We reviewed the ACGME program finder database and medical school websites to identify thoracic surgery training programs that: (1) offer visiting student clerkships (VSCs), (2) are affiliated with an institution offering a UIM-VMSCP, (3) are at an institution where the existing UIM-VMSCP specifically offers rotations in CT surgery. The PDs in the second group were surveyed via e-mail, assessing their level of awareness of UIM-VMSCPs at their institution, participation in UIM-VMSCPs over the past 3 years, and desire to participate in a UIM-VMSCP in the future. All (n = 76) ACGME CT surgery training programs were affiliated with institutions that offered VSCs in multiple disciplines. Over half, 55.3%, of the programs offered access to visiting students and 61.8% were at institutions with existing UIM-VMSCPs. Our response rate for the 47 PDs from institutions with UIM-VMSCPs was 38.2%. Of the respondents, 61.1% were aware of the UIM-VMSCP at their institution and 44.4% participated in the past 3 years. Most, 88.9% were interested in participating in their institution's UIM-VMSCP in the future. Only half of CT surgery training programs offer VSCs and even fewer are at institutions with an existing UIM-VMSCP that offers a CT surgery clerkship. This is a lost opportunity to broaden exposure to the specialty and increase diversity within the CT surgery workforce.

Metodología para la estimación de daños estructurales ocasionados por vientos huracanados en edificaciones industriales / Methodology to estimate structural damage in industrial buildings due to hurricanes

El incremento en las pérdidas económicas por daños en edificaciones debido al paso de tormentas y huracanes sobre la región del Caribe e los últimos años, motivó a la industria aseguradora de Puerto Rico a auspiciar una investigación tendiente a generar herramientas para realizar evaluaciones másdetalladas de sus portafolios de estructuras aseguradas, acordes con las prácticas constructivas y los escenarios de exposición existentes en la isla. Esta investigación abarca la amenaza que constituyen los huracanes para Puerto Rico, y seconcentra en la estimación de sus efectos sobre los componentes más vulnerables en edificaciones industriales. La metodología de estimación de daño utilizada eneste trabajo se fundamenta en la obtención de una secuencia de falla para los componentes de la edificación, a partir de la comparación directa de sus capacidades resistentes expresadas en términos de velocidades de viento. La recopilación de información, la identificación de sistemas constructivos y la selección de criterios de resistencia, junto con la elaboración de una herramienta computacional que integra los resultados de las tareas anteriores, constituyen el principal aporte de este trabajo a la metodología de estimación de daño desarrollada (AU)

Sobre la estructura de las analogías en ciencias / On the structure of analogies in science

En este trabajo se presenta un análisis acerca de la identidad que tienen las analogías en la práctica científica. Para ello se consideran las perspectivas de estudio, las funciones y estructuras que tienen las analogías en ciencias. Se propone un esquema de estructura que incluye las limitaciones de la relación analógica y de las consecuencias que se derivan de la analogía. Adicionalmente, se propone un esquema de clasificación que permite distinguir analogías de acuerdo a las limitaciones de la relación establecida

Distribución de presiones de vientos huracanados sobre tanques cortos mediante estudios de túnel de viento

La información sobre el patrón de distribución de presiones de viento en estructuras especiales es un problema vital para su análisis estructural. Este es el caso de tanques metálicos de pared cilíndrica localizados en islas del Caribe, los cuales han presentado tanto daños leves como severos durante azotes de diversos huracanes. En respuesta a estas necesidades se realizó una inspección de distintos tanques localizados en fábricas y refinerías de la zona sur y noreste de Puerto Rico con el fin de determinarse geometrías de techo y razones de esbeltez típicas usadas en la práctica constructiva. Una vez establecidas, se construyeron modelos a escala que se sometieron a pruebas experimentales en el laboratorio del túnel de viento. Finalmente, se muestran las distribuciones resultantes de las pruebas de tanques aislados y tanques escudados, discutiéndose comparaciones con estudios previos relacionados al tema.(AU)

Revisión crítica de alguna teorías de accidentes asociadas a la infraestructura

En este trabajo se analizan varias teorías cuyo objeto de estudio son los accidentes de sistemas de ingeniería. Se analizaron tres teorías, independientemente propuestas por Perrow, Petroski y Doner. Petroski presenta un argumento para la valorización de casos históricos, sean antiguos o modernos, iluminando los factores del error humano en el proceso de diseño. Perrow atribuye la generación de accidentes a la complejidad misma del sistema, que produce interacción no esperada entre fallas. Doener pone énfasis en el esquema de razonamiento utilizado por las personas a cargo de la toma de decisiones sobre la operación de sistemas dinámicos, pero no contempla errores humanos en la etapa de diseño del sistema. Se estudian los componentes principales de las teorías desde el punto de vista epistemológico de Lakatos, en el marco de los programas de investigación científica. A los fines de comparar las interpretaciones de dichas teorías entre sí, se estudia el accidente de la central nuclear de Chernobyl (Ucrania) desde el punto de vista de cada una de ellas. Se observa que cada teoría propone una interpretación particular del evento y las interpretaciones de cada teoría no son conflictivas, sino más bien complementarias. Se enfatiza la necesidad de considerar el sistema físico y los postulados que podrían incluirse para lograr una teoría más abarcadora. (AU)