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Research Roundup
October 16, 2007, Volume 54, No. 8

Where Should I Have My Outpatient Surgery?

Researchers at Penn’s School of Medicine have identified risk factors that may be associated with increased rates of hospital admission immediately following outpatient surgery. These risk factors should be considered by patients and physicians when deciding an appropriate surgical setting, whether outpatient or in a hospital. Corresponding author Dr. Lee A. Fleisher, chair of anesthesiology and critical care for the University of Pennsylvania Health System, and colleagues reported their findings in the March 19 issue of The Archives of Surgery.

The study consisted of 783,558 ambulatory surgery patients, of which 4,351 were sent directly to the hospital following surgery, and of which 19 died. This equates to 1 death per approximately 50,000 patients. Medical risk factors include being 65 years or older, operating time longer than 120 minutes, cardiac diagnoses, peripheral vascular disease, cerebrovascular disease, malignancy, human immunodeficiency virus, and regional or general anesthesia. Medical procedure restrictions are being lifted and more and more procedures are being done on an outpatient basis. Some outpatient facilities are far from hospitals, which adds to the patient’s risk should complications arise.

Surgery in freestanding surgery centers has many advantages, especially from a patient comfort standpoint. Close proximity to the surrounding community, more patient friendly services, such as parking, and in some cases, a more procedure specific focus are all advantages of the outpatient setting. However, ambulatory settings do not have nearly the variety and expertise offered at a hospital.  “We know about 1 in 200 patients get admitted to hospital following outpatient surgery, but that rate can easily vary,” Dr. Fleisher concluded.

Increase in Type 1 Diabetes Among Black Children

A study by Dr. Terri Lipman, associate professor of nursing of children-clinicial educator, and her colleagues published in Diabetes Care, found that for the first time in Philadelphia, black children showed a higher incidence of type 1 diabetes than white children. The incidence rates for Hispanic and white children were unchanged, and have been relatively stable for the past 15 years.

Since the beginning of the registry there has been a 64% increase in black children ages 5–9 and a 37% increase in black children ages 10–14. Researchers report that the incidence in black children rises dramatically with age.
In Philadelphia, the highest percentage of cases (45%) was in children ages 10–14 of all races. The overall increasing rate of incidence of type 1 diabetes in Philadelphia is similar to other US registries.

The study used a retrospective-based population registry of Philadelphia that was started in 1985 and maintained by Dr. Lipman. The Philadelphia registry is one of only four ongoing pediatric type 1 diabetes registries in the country. In light of these findings, the researchers concluded that more studies need to be conducted to identify causes.

“In addition, it has been shown that black children with type 1 diabetes have poorer metabolic control and higher rates of morbidity and mortality,” said Dr. Lipman. “With the rising incidence of type 1 diabetes in the black population, it is crucial that we develop culturally relevant interventions to minimize racial disparities in treatment and outcomes.”

Proposed Reforms to Fix Voting Problems Reported in ’04, ’06 National Elections

Unresolved problems from the 2004 and 2006 elections could affect the outcome of next year’s presidential balloting and other contests, according to the Fels Institute of Government at the University of Pennsylvania.

A new Fels report presents a series of reforms to fix problems American voters complained about in the two most recent election years. “MyVote1 National Election Report: Voice of the Electorate 2006” is a summary of information gathered from thousands of calls into a national election hotline on and around Election Day 2006.

The largest number of voter complaints regarded registration. Many citizens did not know whether they were registered, and if so, where they were registered. Others believed they were registered but were told by poll workers that they were not. The largest number of callers to the hotline did not express complaints, but rather sought their poll location.   

The report identifies, quantifies and localizes other problems affecting voters, including complaints related to voting machines, inadequate local election board help lines and late absentee ballots.

The report presents evidence-based solutions and reforms, requiring states and/or local governments to:

• Provide hotlines and websites that allow voters to find their polling places based on their residential addresses. 

• Implement hotline and Web-based systems that give citizens access to their registration status.

• Improve tests of voting machines and training of poll workers on the use of new equipment and on educating the public about voting equipment, new and old.

• Ensure that county-board help lines will meet demand during each election cycle.

• Implement an absentee-ballot tracker system that gives voters access to the status of their absentee-ballot requests via a hotline and website in the same way that delivery companies and online businesses track packages and orders.

The full report, “MyVote1 National Election Report: Voice of the Electorate 2006,” is available at www.fels.upenn.edu/publications.htm.

Little Support for Mandatory HPV Vaccinations

A study by the Annenberg School for Communication shows that the majority of respondents either oppose or are neutral to proposed legislation making it mandatory for school-age girls to obtain the Human Papillomavirus (HPV) vaccine before they can enter school.

The same study found that Americans are, however, in favor of government-run education programs to help the population understand the value of the vaccine, and allowing parents to make their own decisions about vaccinating their daughters. Americans are also generally in favor of government subsidies to pay for the vaccine for the uninsured.

The responses were obtained from representative samples of adults over 18 years of age, beginning in June 2006, by the Center for Excellence in Cancer Communication Research (CECCR) at the Annenberg School. 
In June 2006–the same month that the vaccine received FDA approval– 634 adults were surveyed about vaccination intentions and policy opinions. Next, from January through June of this year, a new sample was recruited monthly to answer one question about mandatory vaccination.

Nearly half the survey participants oppose mandatory vaccinations in schools; only 15.8% support such legislation, while 34.7% are neutral on the subject. Additionally, nearly half (45.4%) of the participants are against vaccinating girls under the age of 18 without parental consent.

At the same time, respondents generally supported the idea of physicians recommending the vaccine to eligible patients (60.2%), they supported the government covering the vaccine for the uninsured (57.1%), and felt insurers should pay for the vaccine (64.7%). A total of 58.2% said the government should sponsor an educational campaign about the vaccine.

Computer Memory Designed for Faster Retrieval in Nanoscale Form

Scientists from Penn’s School of Engineering and Applied Science designed nanowires capable of storing computer data for 100,000 years and retrieving that data a thousand times faster than existing portable memory devices such as Flash memory and micro-drives, all using less power and space than current memory technologies.

Dr. Ritesh Agarwal, assistant professor in the department of materials science and engineering, and his colleagues developed a self-assembling nanowire of germanium antimony telluride, a phase-changing material that switches between amorphous and crystalline structures, the key to read/write computer memory.

Phase-change memory in general features faster read/write, better durability and simpler construction compared with other memory technologies such as Flash. The challenge has been to reduce the size of phase change materials by conventional lithographic techniques without damaging their useful properties. Self-assembled phase-change nanowires, as created by Penn researchers, operate with less power and are easier to scale. 

Current solid-state technology for products like memory cards, digital cameras and PDAs traditionally utilize Flash memory, a non-volatile and durable computer memory that can be erased and reprogrammed electronically. Data on Flash drives provides most battery-powered devices with acceptable levels of durability and moderately fast data access.  Yet the technology’s limits are apparent. Digital cameras can’t snap rapid-fire photos because it takes precious seconds to store the last photo to memory. If the memory device is fast, such as DRAM and SRAM used in computers, then it is volatile; if the plug on a desktop computer is pulled, all recent data entry is lost. Therefore, a universal memory device is desired that can be scalable, fast, durable and nonvolatile, a difficult set of requirements which have now been demonstrated at Penn. 

“Imagine being able to store hundreds of high-resolution movies in a small drive, downloading them and playing them without wasting time on data buffering, or imagine booting your laptop computer in a few seconds as you wouldn’t need to transfer the operating system to active memory,” Dr. Agarwal said.

Almanac - October 16, 2007, Volume 54, No. 8