As the incoming Biden administration prepares its health reform agenda, simplifying access to Medicaid should emerge as a high priority. Medicaid has proven critical during the coronavirus disease 2019 (COVID-19) pandemic, in that enrollment has grown by 5.3 million individuals (to 76.5 million) from February to August 2020 as a result of reduced incomes and job loss. Even with this growth, further enrollment simplification is critical, given Medicaid's role as a pathway for many individuals to affordable COVID-19 testing, treatment, and vaccination.Simplifying enrollment means expanding the use of presumptive eligibility, long a staple of Medicaid policy. Even if near-term legislation expanding presumptive eligibility is not feasible, the Biden administration and states could expand presumptive eligibility as part of a broader effort to test approaches to improving Medicaid performance during public health emergencies.

Introduction Biological race, the fallacy that racial health disparities reflect differences in human biology, exerts undue influence on medicine. Interventions that teach against this myth are largely absent from required medical curricula. Here, we describe and present student and facilitator evaluations of an educational intervention, organised around Dorothy Roberts' book Fatal Invention: How Science, Politics, and Big Business Re‐Create Race in the Twenty‐First Century that included a discussion of preselected chapters from Fatal Invention, case studies illustrating strategies to prevent the misuse of race in medicine and a question‐and‐answer session with Dorothy Roberts. Methods Online feedback surveys were distributed to students and facilitators to capture their general perceptions of the session, how well it satisfied its objectives and the pre‐session training materials provided to facilitators. Quantitative measures were analysed using descriptive statistics, and qualitative responses were evaluated using thematic analysis. Results Student and facilitator surveys garnered response rates of 59.8% (61/102) and 75% (30/40), respectively, and most expressed satisfaction with the session. Students felt more prepared to address the misuse of race in clinical contexts than in pre‐clinical contexts (90.16% vs. 77.05%) and among peers than among superiors (95.08% vs. 72.13%) (p < 0.05). Some students (31.15%) felt that their small group facilitators were unprepared to address microaggressions. Discussion Our survey responses suggest that this intervention was effective in teaching against biological racism and equipped students with tools to address the misuse of race, particularly in clinical contexts. Future iterations should highlight strategies to confront biological racism in pre‐clinical contexts and among superiors.

We describe our technique for totally endoscopic, robotic-assisted thoracic and pericardial adhesiolysis and redo complex mitral valve repair.

Purpose Loeys‐Dietz syndrome (LDS) is a rare connective tissue disorder. In LDS patients with normal arch morphology, whether the arch should be prophylactically replaced at the time of proximal aortic replacement remains unknown. We evaluated the risk of long‐term arch complications in genetically confirmed LDS patients who underwent proximal ascending aortic replacement. Methods We retrospectively reviewed the records of patients with LDS who have been followed at our institution between 1994 and 2020. Patients were only included if whole exome genetic testing confirmed a mutation in an LDS‐causing gene (TGFBR1, TGFBR2, SMAD3, TGFB2, or TGFB3). Mutations were categorized as pathogenic, benign, or of unknown significance. We collected demographic information, aortic dimensions, comorbidities, mortality, and operative course from patients' charts. Descriptive statistics and freedom from reoperation plots were generated. Results Of the 18 patients with a mutation in an LDS‐causing gene, 15 had known pathogenic variants, two had mutations of unknown significance, and one had a benign genetic variant. For the 15 patients with confirmed pathogenic variants of LDS the median follow‐up duration was 5 years (interquartile range [IQR]: 4–8). Eleven patients underwent ascending aortic replacements (AAR) ± aortic valve replacement. Two patients required an additional operation; one required arch and staged elephant trunk for a dissection 18 years post‐AAR and the other patient required an isolated descending aortic replacement for dissection 5 years post‐AAR. Among patients who underwent surgery, the median ascending aortic diameter at intervention was 5.0 cm (IQR: 4.3–5.3). There was no surgical or late follow‐up mortality observed for any of the 18 patients in the study. Conclusion LDS patients who underwent proximal aortic replacement appeared to have low long‐term risk of arch complications. While our study is somewhat limited by its sample size and follow‐up duration, it suggests that routine prophylactic total arch replacement may not be warranted in LDS patients with nonaneurysmal aortic arches.

Background Thoracic aortic aneurysm (TAA) is a significant risk factor for aortic dissection and rupture. Guidelines recommend referral of patients to a cardiovascular specialist for periodic surveillance imaging with surgical intervention determined primarily by aneurysm size. We investigated the association between socioeconomic status (SES) and surveillance practices in patients with ascending aortic aneurysms. Methods We retrospectively reviewed records of 465 consecutive patients diagnosed between 2013 and 2016 with ascending aortic aneurysm ≥4 cm on computed tomography scans. Primary outcomes were clinical follow‐up with a cardiovascular specialist and aortic surveillance imaging within 2 years following index scan. We stratified patients into quartiles using the area deprivation index (ADI), a validated percentile measure of 17 variables characterizing SES at the census block group level. Competing risks analysis was used to determine interquartile differences in risk of death before follow up with a cardiovascular specialist. Results Lower SES was associated with significantly lower rates of surveillance imaging and referral to a cardiovascular specialist. On competing risks regression, the ADI quartile with lowest SES had lower hazard of follow‐up with a cardiologist or cardiac surgeon before death (hazard ratio: 0.46 [0.34, 0.62], p < .001). Though there were no differences in aneurysm size at time of surgical repair, patients in the lowest socioeconomic quartile were more frequently symptomatic at surgery than other quartiles (92% vs. 23%–38%, p < .001). Conclusion Patients with lower SES receive less timely follow‐up imaging and specialist referral for TAAs, resulting in surgical intervention only when alarming symptoms are already present.