No abstract

Disparities in access to care for surgical intervention in craniosynostosis have been suggested as a cause in discrepancies between the surgical approach and consequently perioperative outcomes following surgery. This work aimed to investigate the influence of race, insurance status, and the presence of craniosynostosis-related conditions on the short-term outcomes after the surgical management of craniosynostosis. Using the National Inpatient Sample database for the years 2010 to 2012, sociodemographic predictors for 30-day postoperative complication rates and requirements for blood transfusion in craniosynostosis surgeries were identified. Medicaid patients were significantly more likely to experience complications (P ¼ 0.013) and higher rates of blood transfusions (P ¼ 0.011). Compared to those without any complications, patients who experienced postoperative complications and blood transfusions were older (191.5 versus 181.7 days old, P < 0.001), had a greater number of chronic diseases (P < 0.001), and had a longer average length of stay (P < 0.001). On multivariable regression, Medicaid patients were 1.7 times more likely to experience any postoperative complication compared to privately insured patients. White patients also experienced a 0.741 times lower likelihood of requiring a blood transfusion. At the hospital level, receiving surgery at government-operated hospitals was found to be a protective factor for postoperative complications compared to for-profit private (P ¼ 0.016) and nonprofit private (P ¼ 0.028). Healthcare providers and policy makers should be cognizant of these sociodemographic disparities and their potential causes to ensure equitable treatment for all patients regardless of insurance status and racial/ethnic background.

Though it has been shown that the photothermal heating by pulsed lasers can provide localized heat to cure polymers at an enhanced rate without bulk temperature changes, such an approach has been unsuccessful at driving chemical transformations that require large increases in bulk temperature�such as the curing of blocked isocyanates. We show that photothermal heating using 1 W of continuous wave laser power directed toward a mixture of 6 wt % carbon black in a blocked isocyanate is sufficient to reach temperatures near 142 °C. Additionally, using both infrared and nuclear magnetic resonance spectroscopies, we demonstrate that this heat is sufficient to drive the deblocking of a trimer of hexamethylene diisocyanate blocked by methyl ethyl ketoxime. We also show that 1 s of such heating produces the same degree of deblocking as 8 h in an oven held at 160 °C. Finally, we demonstrate that photothermal heating can also drive the formation of a urethane bond that is spectroscopically identical to that produced after oven heating at 160 °C for 1 h. This work shows that photothermal heating with carbon black and a CW laser can provide bulk heat necessary for high temperature reactions while maintaining the photothermally induced kinetic advantage of localized heat.