Previous studies have demonstrated that the hypothalamus regulates neuroendocrine and autonomic function and behavior. Within the hypothalamus, the paraventricular nucleus (PVN) is an integratory node that contains neurons associated with the control of neuroendocrine and autonomic responses. The PVN also has one of the highest density of blood vessels within the brain. Alterations of normal PVN angiogenesis by dexamethasone could potentially result in long-term modifications of brain and endocrine functions.
Timed-pregnant Sprague Dawley female rats received DEX on gestational days 18-21 and the resulting progeny were sacrificed at Postnatal Day (PND) 0, 4, 14, and 21. A tomato lectin, Lycopersicon Esculentum labeled with DyLight594 was used to stain blood vessels in the PVN and scanning confocal microscopy was used to analyze the experimental brains for PVN blood vessel density
Analysis of data using a 3-way analysis of variance (ANOVA) with age, sex and treatment as main factors, showed a significant age effect in vascular density. Analysis of female data by 2-way ANOVA demonstrated a significant effect of age, but no treatment or interaction effects. Post-hoc analysis shows significant differences at PND 2, 4, 14, and 21 compared to PND0. A Student‘s t-test of a planned comparison on PND2 showed a significant reduction by DEX treatment (p < 0.05). Analysis of data from females, using 2-way ANOVA demonstrated a significant effect of age, but no treatment or interaction effects. Post-hoc analysis shows significant differences at PND 2, 4, 14, and 21 compared to PND0. A planned comparison at PND 2 using Student’s t-test indicated a significant reduction by dex treatment.
The results of these studies demonstrate that there is significant postnatal angiogenic programming and that the vascular density of the PVN is altered by prenatal dexamethasone administration at PND2. The time-course shows developmental fluctuations in vessel density that may prove to be physiologically significant for normal brain function and developmental programming of brain and behavior.

With the recent rise in opioid overdose and death1<br/><br/>, chronic opioid therapy (COT) programs using<br/>Center of Disease Control (CDC) guidelines have been implemented across the United States8<br/>.<br/>Primary care clinicians at Mayo Clinic initiated a COT program in September of 2017, during the<br/>use of Cerner Electronic Health Record (EHR) system. Study metrics included provider<br/>satisfaction and perceptions regarding opioid prescription. Mayo Clinic transitioned its EHR<br/>system from Cerner to Epic in October 2018. This study aims to understand if provider perceptions<br/>about COT changed after the EHR transition and the reasons underlying those perceptions.
Research Objective Social determinants of health (SDOH) are the conditions in one’s living environment that affect health, functioning, and quality of life. Total joint arthroplasty (TJA) is a surgical procedure to replace a damaged joint with an artificial joint. TJA complications include acute myocardial infarction, pneumonia, sepsis, surgical site bleeding, pulmonary embolism, or periprosthetic joint infection. Previous research demonstrates that Black race, Hispanic ethnicity and poverty were negatively associated with TJA outcomes in veterans. The goal of this mixed methods quality improvement study is to determine if SDOHs affect TJA complications at a health system in the Phoenix metropolitan area. Methodology For this study, records from patients who underwent hip or knee TJAs at any of the four system facilities between 2/2019-2/2020 were included. Demographics and clinical data were extracted from the electronic health record (EHR) via Midas+ Care Management with SDOH variables from case manager notes corresponding to food, utilities, housing and transportation insecurities, and interpersonal safety. Complications were identified using ICD-10 codes. SDOH for individuals with and without complications were compared. A multinomial logistic regression was performed in SPSS to identify significant variables. Semi-structured interviews with case managers (n=2), orthopedic surgeons(n=5), and primary care physicians (n=4) were performed to explore care team interactions with SDOH. Interview notes were coded and analyzed based on response frequency and themes. Results Of 2,520 patients who underwent TJA, 50 (1.98%) experienced a TJA complication. Of those, 38% screened positive for an SDOH. For those without a TJA complication, 27% screened positive for an SDOH (p=0.093). Most interview participants identified a correlation between socioeconomic status and surgical outcomes. They also recognized that language barriers for Spanish-speaking individuals and family involvement post-discharge are significant factors in TJA outcomes. Conclusions This single system mixed methods retrospective quality improvement study demonstrates that patients who screen positive for an SDOH are more likely to experience a TJA complication. We recommend that SDOH assessments be obtained for all patients undergoing TJA, be available to care teams, and be incorporated into care plans to improve outcomes.