To leave or not to leave: American Association for the Surgery of Trauma (AAST) panel discussion on personal, parental, and family leave.

Navigating planned and emergent leave during medical practice is very confusing to most physicians. This is especially challenging to the trauma and acute care surgeon, whose practice is unique due to overnight in-hospital call, alternating coverage of different services, and trauma center's staffing challenges. This is further compounded by a surgical culture that promotes the image of a 'tough' surgeon and forgoing one's personal needs on behalf of patients and colleagues. Frequently, surgeons find themselves having to make a choice at the crossroads of personal and family needs with work obligations: to leave or not to leave. Often, surgeons prioritize their professional commitment over personal wellness and family support. Extensive research has been conducted on the topic of maternity leave and inequality towards female surgeons, primarily focused on trainees. The value of paternity leave has been increasingly recognized recently. Consequently, significant policy changes have been implemented to support trainees. Practicing surgeon, however, often lack such policy support, and thus may default to local culture or contractual agreement. A panel session at the American Association for the Surgery of Trauma 2022 annual meeting was held to discuss the current status of planned or unanticipated leave for practicing surgeons. Experiences, perspectives, and propositions for change were discussed, and are presented here.

Group Prenatal Care vs. Traditional Prenatal Care: A Parity-Matched Comparison of Perinatal Outcomes in a Rural Community.

PURPOSE: Prenatal care is important for positive outcomes for both mother and infant. The traditional one-on-one method remains the most common. This study aimed to compare perinatal outcomes of patients attending group prenatal care with traditional prenatal care. Most previously published comparisons did not match for parity, a key predictor of perinatal outcome. DESCRIPTION: We collected perinatal outcome data for 137 group prenatal care patients and 137 traditional prenatal care patients, matched for contemporaneous delivery and parity, who delivered at our small rural hospital during 2015-2016. We included key public health variables, including the initiation of breastfeeding, and smoking at the time of delivery. ASSESSMENT: There was no difference between the two groups for maternal age or infant ethnicity, induced or augmented labor, preterm deliveries, APGAR scores less than 7, low birth weight, NICU admissions, or cesarean deliveries. Group care patients had more prenatal visits and were more likely to initiate breastfeeding and were less likely to report smoking at the time of delivery. CONCLUSION: In our rural population matched for contemporaneous delivery and parity, we found no difference in traditional perinatal outcome measures and that group care was positively associated with the key public health variables of not smoking and initiating breastfeeding. If future studies in other populations have similar findings, it may be wise to provide group care more widely to rural populations.

Brain responses to emotional images related to cognitive ability in older adults.

Older adults have been shown to exhibit a positivity effect in processing of emotional stimuli, seemingly focusing more on positive than negative information. Whether this reflects purposeful changes or an unintended side effect of declining cognitive abilities is unclear. For the present study, older adults displaying a wide range of cognitive abilities completed measures of attention, visual, and verbal memory; executive functioning and processing speed; as well as a socioemotional measure of time perspective. Regression analyses examined the ability of these variables to predict neural responsivity to select emotional stimuli as measured with the late positive potential (LPP), an event-related brain potential (ERP). Stronger cognitive functioning was associated with higher LPP amplitude in response to negative images (i.e., greater processing). This does not support a voluntary avoidance of negative information processing in older adults for this particular measure of attentional allocation. A model is proposed to reconcile this finding with the extant literature that has demonstrated positivity effects in measures of later, controlled attentional allocation.

Cognitive function predicts neural activity associated with pre-attentive temporal processing.

Temporal processing, or processing time-related information, appears to play a significant role in a variety of vital psychological functions. One of the main confounds to assessing the neural underpinnings and cognitive correlates of temporal processing is that behavioral measures of timing are generally confounded by other supporting cognitive processes, such as attention. Further, much theorizing in this field has relied on findings from clinical populations (e.g., individuals with schizophrenia) known to have temporal processing deficits. In this study, we attempted to avoid these difficulties by comparing temporal processing assessed by a pre-attentive event-related brain potential (ERP) waveform, the mismatch negativity (MMN) elicited by time-based stimulus features, to a number of cognitive functions within a non-clinical sample. We studied healthy older adults (without dementia), as this population inherently ensures more prominent variability in cognitive function than a younger adult sample, allowing for the detection of significant relationships between variables. Using hierarchical regression analyses, we found that verbal memory and executive functions (i.e., planning and conditional inhibition, but not set-shifting) uniquely predicted variance in temporal processing beyond that predicted by the demographic variables of age, gender, and hearing loss. These findings are consistent with a frontotemporal model of MMN waveform generation in response to changes in the temporal features of auditory stimuli.

Age effects on emotion recognition in facial displays: from 20 to 89 years of age.

UNLABELLED: BACKGROUND/STUDY CONTEXT: An emotion recognition task that morphs emotional facial expressions from an initial neutral expression to distinct increments of the full emotional expression was administered to 482 individuals, 20 to 89 years of age. METHODS: Participants assessed six basic emotions at 25%, 50%, 75%, and 100% of the full facial expression. RESULTS: Participants in the three oldest age groups (60s, 70s, and 80s) demonstrated decreased performance for the recognition of the fear, anger, and sad emotions. Increased age was associated with increased recognition rates for the disgust expression, whereas no age effect was detected for the happy and surprise expressions. Covariate analyses revealed age effects were reduced by processing speed, but were unaffected by decision-making ability. The effects of age on individual emotions and levels of presentation are discussed. CONCLUSION: These findings suggest that age has the greatest impact on the recognition of the sad emotion and the greatest age effect at the 50% level of presentation across the adult life span.

Incidental gallstones.

Gallstones develop in approximately 10% to 15% of the US population and represent one of the most common and most costly of all digestive diseases. Studies investigating gallstones' natural history have shown that gallstone-related complications arise at a rate of approximately 1% per year in asymptomatic patients and 2% per year in patients who already have symptoms. Patients can have any of multiple presentations with gallstone-related problems along a continuum of health threats from intermittent biliary colic to septic shock from ascending infections. In most clinical situations in which the patient's gallstone symptoms are either recurrent or have caused complications, cholecystectomy remains the procedure of choice. Laparoscopic cholecystectomy, first performed in the mid-1980s, has quickly become the gold standard in the US. For clinicians who perform abdominal procedures, the literature is consistent in advocating cholecystectomy for gallstones found incidentally during other abdominal procedures.