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Department of Anesthesiology

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https://hdl.handle.net/1813/117690

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    Post-migration Social Determinants of Health in Asylum Seekers: A Retrospective Qualitative Study
    Oren, T.; Tham, S.; Cheung, C.; Milewski, A.; Kaur, G. (Springer, 2025-11-07)
    In the United States (U.S.), the number of asylum seekers has increased sixfold in the past decade. Limited research has explored the impact of social determinants of health on asylum seekers. To document evidence of torture and trauma, clinicians in medical-legal asylum clinics conduct Forensic Medical Evaluations (FMEs) according to the standardized United Nations Istanbul Protocol. These evaluations represent an uncommon encounter with the U.S. health system during the multi-year asylum process, during which applicants may not otherwise engage with health systems. This study aimed to determine post-migration factors that influence risk for negative health outcomes in U.S. asylum applicants and to categorize risk factors within the U.S. Department of Health and Human Services' social determinants of health framework. We performed a qualitative, retrospective study of a representative, purposive sample of forensic medical evaluations from 2010 to 2020 from the Weill Cornell Center for Human Rights' database. We identified major themes pertaining to post-migration risk and protective factors organized across social determinant domains. The 58 FMEs represented 29 asylum seekers in the U.S. The mean age was 30 years. Of the participants, 55% were female and 45% were male. The sample represented a global population, with origins from the Americas (41%), Africa (45%), and Asia (14%). Our analysis additionally identified the prolonged asylum process as a novel, unique structural barrier and identified protective factors, including community support. Given numerous barriers to accessing care experienced during the asylum process, this study identified a unique opportunity to utilize forensic medical evaluations to screen for social determinants of health.
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    Interpretable framework for predicting preoperative cardiorespiratory fitness using wearable data
    Hussain, I.; Zeepvat, J.; Reid, M.C.; Czaja, S.; Pryor, K.O.; Boyer, R. (Elsevier, 2025-07-21)
    OBJECTIVES: Predicting preoperative cardiorespiratory fitness (CRF) is crucial for assessing the risk of complications and adverse outcomes in patients undergoing surgery. CRF is formally evaluated through submaximal exercise testing with cardiopulmonary exercise testing (CPET) or the 6-minute walk test (6MWT). However, formal CRF testing is impractical as a preoperative screening tool. Wrist-worn devices with actigraphy and heart rate monitoring have become increasingly capable of predicting physiological measurements. Our aim was to develop a clinically interpretable machine learning (ML) model using wearable-derived physiological data to predict CRF for older adults, and to access whether this model can accurately estimate the 6MWT distances for preoperative risk evaluation. METHODS: We examined heart rate and activity data collected from Fitbit devices worn by older adults (N = 65) who were scheduled to undergo major noncardiac surgery. Data collection took place over a 1-week period prior to surgery while participants engaged in their typical daily activities. Our primary aim was to leverage this wearable technology to forecast CRF among this group. We employed a machine-learning ensemble regression model to predict CRF, using 6MWT outcomes as an index. Further, we applied the shapley feature attribution approach to gain insights into how specific features derived from wearable data contribute to CRF prediction within the model, aiding in personalized fitness prediction. RESULTS: Adults with higher CRF exhibited elevated levels of moderate-to-vigorous physical activity (MVPA), maximal activity energy expenditure (aEEmax), heart rate recovery (HRR), and non-linear heart rate variability (HRV). These measures increased concurrently with improvements in 6MWT outcomes. Our regression models, employing random forest and linear regression techniques, demonstrated strong predictive capabilities, with coefficient of determination values of 0.91 and 0.81, respectively, for estimating CRF. The shapley feature attribution approach elucidated those greater levels of MVPA, aEEmax, HRR, and nonlinear dynamics of HRV serve as reliable indicators of enhanced CRF test performance. CONCLUSION: The integration of wearable data-driven activity and heart rate metrics forms the basis for utilizing wearables to provide preoperative cardiorespiratory fitness assessments, supporting surgical risk stratification, personalized prehabilitation, and improved patient outcomes.
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    Deletion of the transcription factor ATF4 in a model of clear cell renal cell carcinoma.
    Chi, Y.; Chikara, S.; Aguila, E.M.D.; Zhang, T.; Geri, J.B.; Nanus, D.M.; Gudas, L.J. (Elsevier, 2025-06-04)
    Clear cell renal cell carcinoma (ccRCC) is the most common form of kidney cancer in adults. We generated TRAnsgenic of Cancer of the Kidney (TRACK) mice that express a triple-mutant (P402A, P564A, and N803A) human HIF1α construct specifically in their proximal tubule (PT) cells. We demonstrated that the elevated lipid content found in human ccRCCs is mimicked in these TRACK PT cells. Additionally, we reported that ATF4 (activating transcription factor 4), a transcription factor, and its target genes were highly expressed both in human ccRCCs and in TRACK PT cells. To delineate the functions of ATF4 in ccRCC we have now generated TRACK mice in which the ATF4 gene is specifically deleted in PT cells (GCREA∆T). Our genome-wide transcriptomics and proteomics studies show that expression of ∼20 % of mRNAs and proteins is significantly altered in GCREA∆T compared to TRACK kidney cortices. Gene set enrichment analyses (GSEAs) of mRNAs demonstrate that the fatty acid metabolism pathway is upregulated in TRACK vs WT and that, conversely, ATF4 deletion reduces mRNAs in the fatty acid metabolism pathway (e.g., ATP citrate lyase). Moreover, some transcripts elevated in human ccRCC are reduced in GCREA∆T vs. TRACK kidney cortices and cystic, pre-cancerous lesions are also reduced. Thus, ATF4 actions increase both lipid droplet accumulation in this ccRCC model and oncogenesis-related gene expression. These data suggest that ATF4 contributes to the formation of ccRCC tumors and may be a potential therapeutic target.
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    Tirzepatide as Compared with Semaglutide for the Treatment of Obesity.
    Aronne, L.J.; Horn, D.B.; le Roux, C.W.; Ho, W.; Falcon, B.L.; Gomez Valderas, E.; Das, S.; Lee, C.J.; Glass, L.C.; Senyucel, C.; Dunn, J.P. (Massachusetts Medical Society, 2025-05-11)
    BACKGROUND: Tirzepatide and semaglutide are highly effective medications for obesity management. The efficacy and safety of tirzepatide as compared with semaglutide in adults with obesity but without type 2 diabetes is unknown. METHODS: In this phase 3b, open-label, controlled trial, adult participants with obesity but without type 2 diabetes were randomly assigned in a 1:1 ratio to receive the maximum tolerated dose of tirzepatide (10 mg or 15 mg) or the maximum tolerated dose of semaglutide (1.7 mg or 2.4 mg) subcutaneously once weekly for 72 weeks. The primary end point was the percent change in weight from baseline to week 72. Key secondary end points included weight reductions of at least 10%, 15%, 20%, and 25% and a change in waist circumference from baseline to week 72. RESULTS: A total of 751 participants underwent randomization. The least-squares mean percent change in weight at week 72 was -20.2% (95% confidence interval [CI], -21.4 to -19.1) with tirzepatide and -13.7% (95% CI, -14.9 to -12.6) with semaglutide (P<0.001). The least-squares mean change in waist circumference was -18.4 cm (95% CI, -19.6 to -17.2) with tirzepatide and -13.0 cm (95% CI, -14.3 to -11.7) with semaglutide (P<0.001). Participants in the tirzepatide group were more likely than those in the semaglutide group to have weight reductions of at least 10%, 15%, 20%, and 25%. The most common adverse events in both treatment groups were gastrointestinal, and most were mild to moderate in severity and occurred primarily during dose escalation. CONCLUSIONS: Among participants with obesity but without diabetes, treatment with tirzepatide was superior to treatment with semaglutide with respect to reduction in body weight and waist circumference at week 72. (Funded by Eli Lilly; SURMOUNT-5 ClinicalTrials.gov number, NCT05822830.).