BACKGROUND: A report by the American Association of Medical Colleges (AAMC) showed that academic anesthesiology has the highest prevalence of sexual harassment among specialties for both men and women. We aimed to explore the prevalence, sources, and impact of sexual harassment on anesthesiologists in academic centers in the United States and Canada. We also sought recommendations for its mitigation. METHODS: An anonymous online survey instrument was designed based on a previously published report, yielding 39 questions, including demographics and 4 open-ended questions. The survey was sent via email to Association of University Anesthesiologists (AUA) members, who were encouraged to share across academic anesthesiology departments in the United States and Canada. RESULTS: A total of 626 responses were received; after exclusion of incomplete and nonfaculty responses, 484 complete survey responses were analyzed. 52.9% of respondents identified as men and 45.9% as women; 3 respondents (0.6%) identified as nonbinary, and 3 respondents (0.6%) preferred not to answer. 43.6% of respondents perceived there is sexual harassment in academic anesthesiology. Significantly more women than men reported presence of sexual harassment in academic medicine (65.3% vs 38.3%, P < .001), in academic anesthesiology (59.5% vs 30.1%, P < .001), and in their place of work (37.8% vs 18.3%, P < .001). 14.5% of men and 43.2% of women had experienced sexual harassment at least once in the past 12 months (P < .001). 43.7% of women reported ever experiencing unwanted physical contact in the workplace compared to 16.8% of men; 74.3% of women reported ever experiencing verbal or nonverbal conduct in the workplace related to gender that caused embarrassment, distress, or offense compared to 24.6% of men (P < .001). 8.2% of men reported feeling their clinical ability doubted, compared to 87.8% of women (P < .001). Experiences of sexual harassment were most consistent with verbal and nonverbal behaviors that convey hostility, objectification, or exclusion of members of one gender. Colleagues from anesthesiology were most likely to be reported as the source of sexual harassment (44.6% of unwanted physical contact, 59% of verbal or nonverbal conduct). The impact was described along 4 themes: emotional, cognitive, behavioral, and professional. Participants made recommendations for eliminating sexual harassment by raising awareness, providing education, establishing reporting, offering support, and ensuring accountability. CONCLUSIONS: This survey confirms the high prevalence of sexual harassment in academic anesthesiology. The most common sources are anesthesiology colleagues. The recommendations for leaders and institutions include creating a professional environment free from harassment with support for targets and accountability for instigators.

Background: Intraoperative hypotension has been associated with postoperative complications, but its relationship with postoperative delirium remains debated. Methods: This single-centre retrospective cohort study included adults (≥60 yr) with ASA physical status score of 3 or 4 undergoing major noncardiac surgery, with documented Confusion Assessment Method assessments. Patients with a history of neurosurgery, stroke, dementia, or neurocognitive disorders were excluded. The primary exposure was the cumulative duration of a mean arterial pressure <65 mm Hg (minutes). The primary outcome was postoperative delirium within 7 days, diagnosed via Confusion Assessment Method. Multivariable logistic regression was used to assess the association between intraoperative hypotension and delirium, adjusting for confounders. Results: Among 5171 patients included from 2013–2024, 632 (11.8%) developed delirium. The median (Q1–Q3) duration of surgery and time with mean arterial pressure <65 mm Hg were 281 (199–430) min and 28 (9–61) min, respectively. In models adjusted for patient characteristics and perioperative factors, intraoperative hypotension was associated with increased odds of delirium (odds ratio per 60 min, 1.12; 95% confidence interval, 1.01–1.24; P=0.038). However, after adjusting for year of surgery, the association was attenuated and no longer statistically significant (odds ratio, 1.06; 95% confidence interval, 0.95–1.18; P=0.320). Both intraoperative hypotension exposure and delirium incidence declined significantly over the study period. Conclusions: Although intraoperative hypotension initially appeared to be associated with postoperative delirium, this association was no longer significant when accounting for temporal improvements in perioperative care. Intraoperative hypotension may represent a marker of historical practice patterns rather than an independent causal driver of delirium.

Tau is a microtubule-associated protein enriched in the axonal compartment. Its most well-known function is to bind and stabilize microtubules. In Alzheimer's disease and other neurodegenerative diseases known as tauopathies, tau undergoes several abnormal post-translational modifications including hyperphosphorylation, conformational changes, oligomerization, and aggregation. Numerous mouse models of tauopathies have been developed, and Western blotting remains an invaluable tool in studying tau protein physiological and pathological changes in these models. However, many of the antibodies that have been developed to analyze tau post-translational modifications are mouse monoclonal, which are at risk of producing artifactual signals in Western blotting procedures. This risk does not arise due to their lack of specificity, but rather because the secondary antibodies used to detect them will also react with the heavy chain of endogenous mouse immunoglobulins (Igs), leading to a non-specific signal at the same molecular weight as tau protein (around 50 kDa). Here, we present the use of anti-light-chain secondary antibodies as a simple and efficient technique to prevent non-specific Ig signals around 50 kDa. We demonstrate the efficacy of this method by either eliminating or identifying artifactual signals when using monoclonal antibodies directed at non-phosphorylated epitopes (T49, Tau3R, Tau4R), phosphorylated epitopes (MC6, AT180, CP13), or an abnormal tau conformation (MC1), in wild-type (WT) mice with tau hyperphosphorylation (hypothermic), transgenic mice overexpressing human tau (hTau mice), and tau knockout (TKO) mice.

The intracellular accumulation of microtubule-associated protein tau is a characteristic feature of tauopathies, a group of neurodegenerative diseases including Alzheimer's disease. Formation of insoluble tau aggregates is initiated by the abnormal hyperphosphorylation and oligomerization of tau. Over the past decades, multiple transgenic rodent models mimicking tauopathies have been develop, showcasing this neuropathological hallmark. The biochemical analysis of insoluble tau in these models has served as a valuable tool to understand the progression of tau-related pathology. In this chapter, we provide a comprehensive review of the two primary methods for isolating insoluble tau, namely, sarkosyl and formic acid extraction (and their variants), which are employed for biochemical analysis in transgenic mouse models of tauopathy. We also analyze the strengths and limitations of these methods.

BACKGROUND: A greater percentage of surgical procedures are being performed each year on patients 65 years of age or older. Concurrently, a growing proportion of patients in English-speaking countries such as the United States, United Kingdom, Australia, and Canada have a language other than English (LOE) preference. We aimed to measure whether patients with LOE underwent cognitive screening at the same rates as their English-speaking counterparts when routine screening was instituted. We also aimed to measure the association between preoperative Mini-Cog and postoperative delirium (POD) in both English-speaking and LOE patients. METHODS: We conducted a single-center, observational cohort study in patients 65 years old or older, scheduled for surgery and evaluated in the preoperative clinic. Cognitive screening of older adults was recommended as an institutional program for all patients 65 and older presenting to the preoperative clinic. We measured program adherence for cognitive screening. We also assessed the association of preoperative impairment on Mini-Cog and POD in both English-speaking and LOE patients, and whether the association differed for the 2 groups. A Mini-Cog score ≤2 was considered impaired. Postoperatively, patients were assessed for POD using the Confusion Assessment Method (CAM) and by systematic chart review. RESULTS: Over a 3-year period (February 2019–January 2022), 2446 patients 65 years old or older were assessed in the preoperative clinic prior. Of those 1956 patients underwent cognitive screening. Eighty-nine percent of English-speaking patients underwent preoperative cognitive screening, compared to 58% of LOE patients. The odds of having a Mini-Cog assessment were 5.6 times higher (95% confidence interval [CI], 4.6–7.0) P < .001 for English-speaking patients compared to LOE patients. In English-speaking patients with a positive Mini-Cog screen, the odds of having postop delirium were 3.5 times higher (95% CI, 2.6–4.8) P < .001 when compared to negative Mini-Cog. In LOE patients, the odds of having postop delirium were 3.9 times higher (95% CI, 2.1–7.3) P < .001 for those with a positive Mini-Cog compared to a negative Mini-Cog. The difference between these 2 odds ratios was not significant ( P = .753). CONCLUSIONS: We observed a disparity in the rates LOE patients were cognitively screened before surgery, despite the Mini-Cog being associated with POD in both English-speaking and LOE patients. Efforts should be made to identify barriers to cognitive screening in limited English-proficient older adults.

Canales, Cecilia MD, MPH; Ibarra, Andrea J. MD, MS; Burton, Brittany N. MD, MHS, MAS; Cole, Daniel J. MD; Whittington, Robert MD; Cannesson, Maxime MD, PhD Author Information

Objective:Postoperative neurocognitive disorder is common after all forms of surgery in older adults. The mechanisms are multifactorial, and probably require pre-existing neuropathology, whether the patient is symptomatic or not. In Alzheimer's disease (AD) and other tauopathies, the microtubule-associated protein tau can undergo aberrant hyperphosphorylation potentially leading to the development of neurofibrillary pathology, one of the neuropathological hallmarks of the disease. Preclinical and human CSF studies suggest that anesthesia and surgery elicits an increment in CNS tauopathy, which may accelerate any preexisting neuropathology and produce a risk of delirium and the commonly reported changes in cognition.Participants and Methods:In this session, the author will present a bench to beside review of how tau protein is altered by perioperative factors and its potential relationship to the impairment of cognition after surgery and anesthesia. Published and ongoing studies will be reviewed to result in a discussion as to why changes in tau protein are concerning in perioperative disorders of cognition.Results:The presenter will initially review pre-clinical studies focusing on the impact of anesthetics and surgery-induced inflammation on tau pathology and how the impairment of resolution of surgery-induced inflammation, notably decreased lipoxin A4 signaling, is altered by aging, gender, or an increase in the tau pathology burden. These preclinical studies have partially informed a multi-center federally funded observational clinical study, currently in progress, involving neuroimaging to determine whether pre-operative CNS tauopathy, as reflected by PET imaging, predicts delirium and other cognitive and functional outcomes. This translational study will also examine whether anesthesia and spine surgery produces a longitudinal change in the brain tau burden in older adults, as compared to control, nonoperative patients.Conclusions:Bench to bedside research is needed in order to promote evidence-based care for patients at risk for ADRD.

In this Pro-Con commentary article, we discuss the risks and benefits of administering preoperative benzodiazepines to older patients to decrease preoperative anxiety. The Pro side first focuses on the critical importance of treating preoperative anxiety and that benzodiazepines are the best tool to achieve that goal. The competing argument presented by the Con side is that myriad options exist to treat preoperative anxiety without simultaneously increasing the risk for devastating complications such as postoperative delirium. Both sides call for more high-quality investigations to determine the most effective strategies for decreasing preoperative anxiety in older adults while improving outcomes and reducing morbidity.

In preclinical research on Alzheimer's disease and related tauopathies, tau phosphorylation analysis is routinely employed in both cellular and animal models. However, recognizing the sensitivity of tau phosphorylation to various extrinsic factors, notably temperature, is vital for experimental accuracy. Hypothermia can trigger tau hyperphosphorylation, while hyperthermia leads to its dephosphorylation. Nevertheless, the rapidity of tau phosphorylation in response to unintentional temperature variations remains unknown. In cell cultures, the most significant temperature change occurs when the cells are removed from the incubator before harvesting, and in animal models, during anesthesia prior to euthanasia. In this study, we investigate the kinetics of tau phosphorylation in N2a and SH-SY5Y neuronal cell lines, as well as in mice exposed to anesthesia. We observed changes in tau phosphorylation within the few seconds upon transferring cell cultures from their 37°C incubator to room temperature conditions. However, cells placed directly on ice post-incubation exhibited negligible phosphorylation changes. In vivo, isoflurane anesthesia rapidly resulted in tau hyperphosphorylation within the few seconds needed to lose the pedal withdrawal reflex in mice. These findings emphasize the critical importance of preventing temperature variation in researches focused on tau. To ensure accurate results, we recommend avoiding anesthesia before euthanasia and promptly placing cells on ice after removal from the incubator. By controlling temperature fluctuations, the reliability and validity of tau phosphorylation studies can be significantly enhanced.

Introduction: New York State implemented an 11-week elective surgery ban in response to the coronavirus disease-2019 (COVID-19) pandemic, during which pediatric patients from the 10 New York Presbyterian network hospitals requiring urgent or emergent surgical procedures were cared for at Morgan Stanley Children's Hospital (MSCH). Materials and Methods: Data was abstracted from the electronic medical record of all patients aged 0 to 20 years who had surgery at MSCH from March 23, 2020 to June 7, 2020. Comparative analysis of demographic and clinical data elements between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive and negative cohorts was conducted using the Fisher exact tests. Results: A total of 505 surgical procedures were performed in 451 patients, with 32 procedures (6.3%) performed in 21 SARS-CoV-2-positive children. The prevalence of SARS-CoV-2 positivity in Medicaid beneficiaries was more than twice the prevalence in commercially insured (6.8% vs. 2.6%, P = 0.04) children. SARS-CoV-2-positive patients were more likely to undergo multiple surgical procedures (23.8% vs. 7.2%, P = 0.02), and to have higher American Society of Anesthesiologists (ASA) class designations (69.8% III to V vs. 47.4% I to II, P = 0.03). There was no significant difference in the prevalence of SARS-CoV-2 positivity across sex, age, race, or ethnicity groups, or in emergent case status or surgical procedure type. Thirty-day mortality rate was <0.1% overall, with no deaths in the SARS-CoV-2-positive group. Conclusions: During the first wave of the COVID-19 pandemic in New York City, we found a higher prevalence of SARS-CoV-2 positivity in urgent/emergent pediatric surgical patients compared with other institutions in the United States. SARS-CoV-2-positive patients were more likely to be Medicaid beneficiaries, were clinically more complex, and had more surgical procedures.

Delirium has been associated with a variety of unfavorable outcomes, including increasing length of stay in the hospital, poor functioning, and death. We compiled the literature and conducted a meta-analysis (Goldberg et al, JAMA Neurol, 2021) in order to determine if delirium was also associated with long term cognitive decline. Twenty-three studies that included over 3500 delirium and 6900 control patients were included in the meta-analysis. Cognitive assessments were conducted on average at 2.3 years after the episode of delirium. We found that the overall effect size G was .45 (P<.001) indicating that patients who experienced delirium performed significantly worse than controls who did not experience delirium. We will search the literature on cognitive changes after delirium from Jan 1, 2019 onward. We will include all relevant studies with the same inclusion criteria as our prior study (namely an episode of delirium, cognitive assessment 3 or more months after the episode, and a control group). We will then compute the effect size G for each individual study in order to determine if the values are consistent with our previous findings. We will also examine if delirium meets Bradford Hill criteria for playing a causal role in cognitive decline in association studies. Second, we will review the literature on cognitive changes after delirium in individuals experiencing SARS-CoV-2 infection, given the many reports of patients experiencing delirium in the ICU while ventilated. We will derive G for these studies, so long as they incorporate a control group that adjusts for disease severity and virus positivity. We will present results of this new review in terms of G for individual studies, overall G when these are added to the original meta-analysis, and a Bradford Hill criteria checklist. For delirium after SARS-Cov-2 infection we will rely on a narrative description. First, we will examine trends in reports of the magnitude cognitive changes after delirium over the past three years, as well as examine if newer or more comprehensive methodologies are being deployed. Second, we will examine the extent of cognitive changes after delirium in the context of severe COVID-19.

ABSTRACTBackgroundDespite the well-known impact of delirium on long-term clinical outcomes, identification of delirium in electronic health records (EHR) remains difficult due to inadequate assessment or documentation of delirium. The purpose of this research is to present a classification model that identifies delirium using retrospective EHR data. The classification model would support the additional identification of delirium cases otherwise undocumented during routine practice.MethodsDelirium was confirmed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Age, sex, Elixhauser comorbidity index, drug exposures, and diagnoses were used as features to train the logistic regression and multi-layer perceptron models. The clinical notes from the EHR were parsed to supplement the features that were not recorded in the structured data. The model performance was evaluated with a 5-fold cross-validation area under the receiver operating characteristic curve (AUC).ResultsSeventy-six patients (17 cases and 59 controls) with at least one CAM-ICU evaluation result during ICU stay from January 30, 2018 to February 20, 2018 were included in the model. The multi-layer perceptron model achieved the best performance in identifying delirium; mean AUC of 0.967 ± 0.019. The mean positive predictive value (PPV), mean negative predicted value (NPV), mean sensitivity, and mean specificity of the MLP model were 0.9, 0.88, 0.56, and 0.95, respectively.ConclusionA simple classification model showed a mean AUC over 0.95. This model promises to identify delirium cases with EHR data, thereby enable a sustainable infrastructure to build a retrospective cohort of delirium in the ICU. The cohort would be useful for the evaluation of long-term sequelae of delirium in ICU.