bluuebunny/crossref_metadata_2025 huggingface dataset:
Top Wealth in America: New Estimates Under Heterogeneous Returns
Authors: Smith Matthew , Zidar Owen , Zwick Eric
Published: August 2022

This article uses administrative tax data to estimate top wealth in the United States. We assemble new data that link people to their sources of capital income and develop new methods to estimate the degree of return heterogeneity within asset classes. Disaggregated fixed-income data reveal that rich individuals earn much more of their interest income in higher-yielding forms and have much greater exposure to credit risk. Consequently, in recent years, the interest rate on fixed income at the top is approximately 3.5 times higher than the average. We value the population of U.S. firms using firm-level characteristics and apportion this wealth using firm-owner links. We combine this new data on fixed income and pass-through business returns with refined estimates of C-corporation equity, housing, and pension wealth to deliver new capitalized wealth estimates that build upon the methods of Saez and Zucman (2016a). From 1989 to 2016, the top 1%, 0.1%, and 0.01% wealth shares increased by 6.6, 4.6, and 2.9 percentage points, respectively, to 33.7%, 15.7%, and 7.1%. Overall, although we estimate a large degree of return heterogeneity, accounting for this heterogeneity does not change the fundamental story for top wealth shares and their growth—wealth inequality is high and has risen substantially over recent decades.
Subconvexity in Inhomogeneous Vinogradov Systems
Authors: Wooley Trevor D
Published: August 2022

When k and s are natural numbers and ${\mathbf h}\in {\mathbb Z}^k$, denote by $J_{s,k}(X;\,{\mathbf h})$ the number of integral solutions of the system $$ \sum_{i=1}^s(x_i^j-y_i^j)=h_j\quad (1\leqslant j\leqslant k), $$ with $1\leqslant x_i,y_i\leqslant X$. When $s\lt k(k+1)/2$ and $(h_1,\ldots ,h_{k-1})\ne {\mathbf 0}$, Brandes and Hughes have shown that $J_{s,k}(X;\,{\mathbf h})=o(X^s)$. In this paper we improve on quantitative aspects of this result, and, subject to an extension of the main conjecture in Vinogradov’s mean value theorem, we obtain an asymptotic formula for $J_{s,k}(X;\,{\mathbf h})$ in the critical case $s=k(k+1)/2$. The latter requires minor arc estimates going beyond square-root cancellation.
Culture and the Historical Fertility Transition
Authors: Beach Brian , Hanlon W Walker
Published: August 2022

The historical transition to a low fertility regime was central for long-run growth, but what caused it? Existing economic explanations largely focus on the economic incentives to limit fertility. This article presents new evidence highlighting the importance of cultural forces as a complementary driver of the fertility transition. We leverage a sharp change in fertility in Britain in 1877 and document large synchronized declines in fertility among culturally British households residing outside of Britain, in Canada, the US, and South Africa, relative to their non-British neighbours. We propose a plausible catalyst for the change: the famous Bradlaugh–Besant trial of 1877.
Isolation of an “Early” Transit Amplifying Keratinocyte Population in Human Epidermis: A Role for the Low Affinity Neurotrophin Receptor CD271
Authors: Lotti Roberta , Palazzo Elisabetta , Quadri Marika , Dumas Marc , Schnebert Sylvianne , Biondini Diego , Bianchini Maria Anastasia , Nizard Carine , Pincelli Carlo , Marconi Alessandra
Published: August 2022

In the interfollicular epidermis (IFE), stem cells (KSC) generate transit amplifying (TA) cells that, after symmetric divisions, produce differentiating daughters. Here, we isolated and characterized the highly proliferative interfollicular epidermal basal cell population “early” TA (ETA) cells, based on their capacity to adhere to type IV collagen. Proliferation and colony-forming efficiency in ETA cells are lower than in KSC but higher than in “late” TA (LTA). Stemness, proliferation, and differentiation markers confirmed that ETA cells display a unique phenotype. Skin reconstructs derived from ETA cells present different features (epidermal thickness, Ki67, and Survivin expression), as compared to skin equivalents generated from either KSC or LTA cells. The low-affinity neurotrophin receptor CD271, which regulates the KSC to TA cell transition in the human epidermis through an on/off switch control mechanism, is predominantly expressed in ETA cells. Skin equivalents generated from siRNA CD271 ETA cells display a more proliferative and less differentiated phenotype, as compared to mock-derived reconstructs. Consistently, CD271 overexpression in LTA cells generates a more proliferative skin equivalent than mock LTA cells. Finally, the CD271 level declines with cellular senescence, while it induces a delay in p16INK4 expression. We conclude that ETA cells represent the first KSC progenitor with exclusive features. CD271 identifies and modulates ETA cells, thus participating in the early differentiation and regenerative capacity of the human epidermis.
5Economic Criticism
Authors: Valvo Nick
Published: August 2022

This review essay considers recent humanistic scholarship, chiefly historical, that raises important questions about the place of the economic in a broader vision of social life. The essay is divided into three sections: 1. Liberal Protectionism covers an important book from Nicholas Mulder on the history of economic sanctions; 2. The Long History of Social Life discusses the recent contribution to social theory by David Graeber and David Wengrow; and 3. Inflation Retheorized calls for an economic critical response to recent developments in macroeconomic theories of inflation.
First Detection of Wilsonomyces carpophilus Causing Leaf Spot and Shot Hole Disease on Vitis vinifera
Authors: Khalilabad Abbas Atashi , Fotouhifar Khalil-Berdi
Published: August 2022

Grapevines ( Vitis spp.) are cultivated all over the world and viticulture is a horticultural industry. During the spring of 2020, leaf samples with leaf spot and shot-hole symptoms were collected from the vineyards of Urmia county, West Azerbaijan province, Iran. One fungal isolate was recovered from infected tissues. Based on cultural and morphological features, ITS rDNA sequence data, and a generated phylogenetic tree, the obtained fungal isolate was identified as Wilsonomyces carpophilus. Under in vitro conditions, the colony was white to cream colored, sporulation occurred only in a minor proportion of the colony, and the diameter of the colony on potato dextrose agar reached 44 mm after 14 days. To evaluate Koch's postulates, isolate NSS18 was inoculated on leaves of the Chafteh cultivar of grapevine and the same fungus was reisolated from developed symptoms. This is the first report of leaf spot and shot-hole disease on grapevine caused by W. carpophilus, and also Vitis vinifera is a new host for this species in the world.
The Association Between Sleep Disturbance and Health Outcomes in Chronic Whiplash-associated Disorders
Authors: Smith Ashley , Andruski Ben , Deng George , Burnham Robert
Published: August 2022

Objectives:

To investigate the association between sleep disturbance and clinical features of chronic whiplash-associated disorders (WAD). We also aimed to use a bootstrapped mediation analysis approach to systematically examine both direct and indirect pathways by which sleep disturbance may affect chronic pain and functional status.

Materials and Methods:

One hundred sixty-five people (63% female) with chronic WAD and not taking medications for sleep disturbance completed questionnaires evaluating sleep disturbance, pain intensity, pain interference, disability, physical and mental health quality of life, stress, anxiety, depression, pain catastrophizing, and posttraumatic stress severity.

Results:

Greater sleep disturbance was associated with increased duration of symptoms, higher levels of pain and disability, higher levels of emotional distress and pain catastrophizing, and functional impairment (reduced health-related quality of life). Mediation analyses demonstrated that sleep disturbance influenced chronic pain intensity and interference through both direct and indirect associations inclusive of stress, anxiety, and pain catastrophizing. Similarly, sleep disturbance was associated with higher levels of disability and poor health-related quality of life, both directly and also through its negative association with pain intensity and interference.

Discussion:

Sleep disturbance in chronic WAD was associated with worse health outcomes and demonstrated both direct and indirect effects on both chronic pain and function.
Biological Reconstruction of the Coracoclavicular Ligament with Semitendinosus Autograft and Repair of Distal Clavicle Fractures
Authors: Yadav Amit Kumar , Panchal Sameer , Gawhale Sangeet , KS Akshay , Tiwari Anjali , Modi Nihar
Published: August 2022

Most of the options available to treat distal clavicle fractures involve hardware-related complications and high failure rates. This study aims to determine the outcome of distal clavicle fractures treated by a technique that combines biological reconstruction of the coracoclavicular ligament with semitendinosus autograft with reinforced fibrous tissue tapes. In this retrospective study, 8 patients with displaced distal third clavicle fracture cho’s IIB or II C were operated on with the described surgical technique between 2018 and 2021. The results were assessed by comparing the preoperative Constant Murley score and the postoperative DASH score. In addition to these variables, several other variables were also assessed, such as the coracoclavicular distance, the time until union, and all intraoperative and postoperative complications. The study included eight patients with an average age of 36.5 years, and the average time from surgery to recovery was five days. According to Cho’s classification, all eight patients achieved radiographic union within 89 days. Of the eight cases, six were classified as II C and two as II B. The follow-up period was an average of 13 months. During the postoperative period, the Constant Murley score score increased from 22.2 preoperatively to 92.2 postoperatively. The mean DASH score was 89.6, and the mean postoperative DASH score was 7.75. In terms of the coracoclavicular distance, the mean preoperative was 20.2 mm, and the mean postoperative was 10.3 mm. One patient experienced a minor wound complication after surgery, treated with secondary suturing after the operation. No intraoperative complications occurred. There was no donor site morbidity observed in the patients. It has been demonstrated that the use of this technique in displaced unstable distal clavicle fractures using a fiber tape and a semitendinosus autograft results in a satisfactory union and excellent clinical outcomes with very few complications.
Impact on the Quality of Life Following Minimally Invasive Cosmetic Procedures: Assessment Through the Skin Rejuvenation Outcome Evaluation Questionnaire
Authors: Barbeito de Vasconcellos Jaqueline , Alves Pereira Antelo Daniela , Orofino-Costa Rosane
Published: August 2022

BACKGROUND

Aesthetic procedures are widely performed by dermatologists and plastic surgeons, often with subjective results. In cosmetic dermatology, there is a lack of studies that use accurate instruments to assess result outcomes. Quality of life (QoL) questionnaires can objectively assess results.

OBJECTIVE

To assess the impact of nonsurgical facial cosmetic procedures on QoL.

MATERIALS AND METHODS

This was a longitudinal observational study performed with 81 patients who underwent facial cosmetic procedures at a University Hospital in Rio de Janeiro, Brazil. The Skin Rejuvenation Outcome Evaluation questionnaire, previously adapted and translated to the Portuguese language spoken in Brazil, was selected, and the results were compared with the Dermatology Life Quality Index. The impact on QoL was statistically evaluated after the interventions.

RESULTS

The Skin Rejuvenation Outcome Evaluation scores after the procedures were significantly higher than before (p < .001), independent of sociodemographic characteristics. Patients treated with botulinum toxin and dermal fillers showed greater satisfaction than those treated with laser, chemical peels or microneedling.

CONCLUSION

Minimally invasive cosmetic procedures result in improvements in QoL. The use of translated, adapted, and validated questionnaires favors the comparison of results among different populations and reinforces the confidence on the results of established cosmetic treatments.
The science behind banning desflurane
Authors: Hendrickx Jan F.A. , Nielsen Ole John , De Hert Stefan , De Wolf Andre M.
Published: August 2022

Potent inhaled anaesthetics are halogenated hydrocarbons with a large global warming effect. The use of fluorinated hydrocarbons (most are not anaesthetics) are being restricted but volatile anaesthetics have been exempted from legislation, until now: the EU has formulated a proposal to ban or at least severely restrict the use of desflurane starting January 2026. This narrative review addresses the implications of a politics-driven decision – without prior consultation with major stakeholders, such as the European Society of Anaesthesiology and Intensive Care (ESAIC) – on daily anaesthesia practice and reviews the potential scientific arguments that would support stopping the routine use of desflurane in anaesthetic practice.

Of note, banning or severely restricting the use of one anaesthetic agent should not distract the user from sensible interventions like reducing fresh gas flows and developing technology to capture and recycle or destroy the wasted potent inhaled anaesthetics that we will continue to use. We call to join efforts to minimise our professional environmental footprint.
Caesarean scar pregnancy: diagnosis, natural history and treatment
Authors: Noël Laure , Thilaganathan Basky
Published: August 2022

Purpose of review

This review aims at summarizing the latest evidence on diagnosis, natural history and management of caesarean scar pregnancy (CSP).

Recent findings

CSP can result in maternal morbidity from major haemorrhage, uterine rupture, placenta accreta spectrum disorders and hysterectomy. Classification of the CSP types, presence of fetal heart activity, gestational age and residual myometrial thickness seem to influence rates of ongoing pregnancy, subsequent development of placenta accreta with expectant management, as well as success and complication rates associated with various methods of pregnancy termination. Expectant management may be appropriate in certain good prognosis cases, such as absent fetal heart activity or when the myometrial layer at the implantation site is relatively thick. Surgical treatments are typically associated with higher success rates, but seem to result in severe haemorrhage more frequently than medical treatments, which have higher failure rates. Although other treatment modalities are available, in general, the size and quality of evidence to guide care provision in CSP is very poor.

CSP can be associated with severe maternal morbidity but can also lead to a livebirth. There is currently a lack of good-quality evidence to predict the outcome of CSP and provide informed and evidence-based care.
Second-trimester abortion care for those with complex medical conditions
Authors: Henkel Andrea , Blumenthal Paul D.
Published: August 2022

Purpose of the review

This review focuses on patients who are most likely to experience morbidity associated with second trimester abortion care and risk mitigation strategies.

Recent findings

Prior cesarean birth, particularly multiple prior cesarean births, is the most significant risk factor associated with complications during second trimester abortion because of increased risks of hemorrhage, with or without placenta accreta spectrum (PAS), and distorted anatomy, which increases the risk of uterine perforation. Recent data suggests that first trimester ultrasound findings may be predictive of PAS, including multiple lacunae, abnormal uteroplacental interface, and hypervascularity. Multiple common medications interact with mifepristone and are therefore contraindicated; ulipristal shares mifepristone's selective progesterone receptor modulator activity but does not share the same metabolic pathway. Recent data suggests ulipristal may be an effective adjunct for cervical preparation, avoiding potentially mifepristone's drug–drug interactions. Those ending a pregnancy due to severe early-onset hypertensive disorders have a high rate of clinically significant thrombocytopenia: platelet transfusion is recommended for those with platelets <50 000 per cubic millimeter.

Pregnant people presenting for care in the second trimester may have conditions that make an abortion more technically or medically complex. Clinicians can mitigate much of this increased risk with preprocedural planning, and appropriate intra-operative preparedness.
Health inequities within the field of urogynecology
Authors: Boyd Brittni , Guaderrama Noelani , Mishra Kavita , Whitcomb Emily
Published: August 2022

Purpose of review

To summarize some of the most recent evidence on disparities in the prevalence, treatment and outcomes of pelvic floor disorders (PFDs), and to address potential interventions to dismantle these inequities.

Recent findings

There is a paucity of data on the prevalence and treatment of PFDs in racial minority women. The existing studies are limited and poor quality. These studies suggest that racial and ethnic minorities may be at a higher risk of PFDs, however the epidemiologic data regarding prevalence varies by disorder and at times are conflicting. Nevertheless, the data on treatment and complications is clear. Racial and ethnic minorities are less likely to receive gold-standard treatment and are more likely to experience treatment related complications.

We discuss the lack of racially inclusive research that perpetuates ongoing health inequities.
Ocular Mucus Membrane Pemphigoid: A Primary Versus Secondary Entity
Authors: Philip Andrew M. , Fernandez-Santos Carla C. , Ramezani Koosha , Dolinko Andrew H. , Manhapra Ambika , Look-Why Sydney , Chang Peter Y. , Foster C. Stephen , Anesi Stephen D.
Published: August 2022

Purpose:

The purpose of this review was to investigate the idea that inflammatory events of the conjunctiva and ocular surface may act as triggering events for the onset of ocular mucus membrane pemphigoid (oMMP).

Methods:

A retrospective chart review of patients with biopsy-proven oMMP and no systemic pemphigoid disease. The presence, or absence, of the following inflammatory conditions at the time of OMMP diagnosis was noted: significant eyelid disease, significant atopic eye disease, Stevens–Johnson syndrome, graft-versus-host disease, viral keratitis, sarcoidosis with ocular involvement, chemical burns, medicamentosa, Sjogren syndrome, systemic lupus erythematosus with ocular involvement, and epidemic keratoconjunctivitis. Response to immunomodulatory therapy (IMT) was also recorded.

Results:

A total of 779 patient records were identified. Conjunctival biopsy was present in 724 patients, with 646 (89.2%) being positive. One hundred thirty-nine patients (21.5%) with positive biopsies had extraocular pemphigoid disease and were excluded from further analysis. Of the 507 included patients, 154 (30.4%) had at least one of the specified inflammatory conditions present at the time of OMMP diagnosis. One hundred eighteen patients (23.3%) had only 1 such condition, 35 (6.9%) had 2, and 1 patient had 3. In patients with at least one of these conditions present, response to IMT was seen in 84.9% of patients with sufficient follow-up.

Conclusions:

Our study suggests that oMMP may arise as a secondary pathology to acute inflammatory events or chronic inflammatory states of the conjunctiva and ocular surface.
Clinical Characteristics and Therapeutic Outcomes of Pediatric Blepharokeratoconjunctivitis
Authors: Moon Jayoon , Lee Junseok , Kim Mee Kum , Hyon Joon Young , Jeon Hyun Sun , Oh Joo Youn
Published: August 2022

Purpose:

The purpose of this study was to determine the clinical characteristics, disease course, therapeutic outcomes, and prognostic factors for pediatric patients with blepharokeratoconjunctivitis (BKC).

Methods:

A retrospective medical chart review was performed for patients aged 15 years or younger who had been diagnosed with BKC between 2004 and 2020 at 2 tertiary hospitals in Korea. The following data were collected: demographics, medical history, ocular findings, geometric profiling of corneal lesion, medical management, and outcomes.

Results:

A total of 137 patients (90 female and 47 male) were included. The patients’ mean age was 8.3 ± 3.8 years at disease onset. Both eyes were involved in 57.7% of cases. The most common corneal lesion was corneal neovascularization (77.4%), followed by clinically visible corneal infiltration (51.8%) and stromal scarring (43.1%). Most of the corneal lesions involved a single quadrant, most commonly the inferior quadrant. After treatment, disease remission was achieved in 95% of patients, and visual acuities improved from 0.2 ± 0.3 logarithm of minimal angle of resolution at disease presentation to 0.1 ± 0.3 logarithm of minimal angle of resolution at final follow-up (P = 0.001). Recurrence occurred in 52.6% of patients. Cylinder power was significantly higher in patients with recurrence than in those without. The number of cases of recurrence was positively associated with final cylinder power.

Conclusions:

Although the treatment induced disease remission in 95% of children with BKC, recurrence occurred in 52.6% of those cases. Because recurrence resulted in significant astigmatism, careful observation for recurrence and prompt management are warranted for preservation of vision in pediatric patients with BKC.
Auditory disturbances in patients with complex regional pain syndrome
Authors: Drummond Peter D. , Finch Philip M.
Published: August 2022

Complex regional pain syndrome (CRPS) is often associated with reduced sound tolerance (hyperacusis) on the affected side, but the mechanism of this symptom is unclear. As compensatory increases in central auditory activity after cochlear injury may trigger hyperacusis, hearing and discomfort thresholds to pure tones (250, 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz) were assessed in 34 patients with CRPS and 26 pain-free controls. In addition, in 31 patients and 17 controls, auditory-evoked potentials to click stimuli (0.08 ms duration, 6 Hz, 60 dB above the hearing threshold) were averaged across 2000 trials for each ear. Auditory discomfort thresholds were lower at several pitches on the CRPS-affected than contralateral side and lower at all pitches on the affected side than in controls. However, ipsilateral hyperacusis was not associated with psychophysical or physiological signs of cochlear damage. Instead, neural activity in the ipsilateral brainstem and midbrain was greater when repetitive click stimuli were presented on the affected than contralateral side and greater bilaterally than in controls. In addition, click-evoked potentials, reflecting thalamo-cortical signal transfer and early cortical processing, were greater contralaterally in patients than controls. Together, these findings suggest that hyperacusis originates in the ipsilateral brainstem and midbrain rather than the peripheral auditory apparatus of patients with CRPS. Failure of processes that jointly modulate afferent auditory signalling and pain (eg, inhibitory influences stemming from the locus coeruleus) could contribute to ipsilateral hyperacusis in CRPS.
Thrombosis after SARS-CoV2 infection or COVID-19 vaccination: will a nonpathologic anti-PF4 antibody be a solution?—A narrative review
Authors: Rao Elizabeth , Grover Payal , Zhang Hongtao
Published: August 2022

The coronavirus disease 2019 (COVID-19) pandemic was triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a previously unknown strain of coronavirus. To fully understand the consequences and complications of SARS-CoV-2 infections, we have reviewed current literature on coagulation dysfunctions that are related to the disease and vaccination. While COVID-19 is more commonly considered as a respiratory illness, studies indicate that, in addition to respiratory illness, a coagulation dysfunction may develop in individuals after the initial infection, placing them at the risk of developing thrombotic events. Patients who died of COVID-19 had higher levels of D-dimer, a biomarker for blood clot formation and breakdown. Effective treatments for coagulation dysfunctions are critically needed to improve patient survival. On the other hand, antibodies against platelet factor 4 (PF4)/heparin may be found in patients with rare instances of vaccine-induced immunological thrombotic thrombocytopenia (VITT) following vaccination with adenovirus-based vaccines. VITT is characterized by atypical thrombosis and thrombocytopenia, similar to immune-mediated heparin-induced thrombocytopenia (HIT), but with no need for heparin to trigger the immune response. Although both adenovirus-based and mRNA-based vaccines express the Spike protein of SARS-CoV-2, VITT is exclusively related to adenovirus-based vaccines. Due to the resemblance with HIT, the use of heparin is highly discouraged against treating patients with thrombotic thrombocytopenia after SARS-CoV-2 infection or with VITT after vaccination. Intravenous immunoglobulin therapy coupled with anticoagulation is recommended instead. The well-studied anti-PF4 monoclonal antibody RTO, which does not induce pathologic immune complexes in the presence of heparin and has been humanized for a potential treatment modality for HIT, may provide a nonanticoagulant HIT-specific solution to the problem of increased blood coagulation after SARS-CoV-2 infection or the VITT after immunization.
Implementing a Process for Screening Hospitalized Adults for Food Insecurity at a Tertiary Care Center
Authors: Gore Emily , DiTursi Joseph , Rambuss Richard , Pope-Collins Elizabeth , Train Meghan K.
Published: August 2022

Food insecurity has been linked to numerous chronic conditions and higher healthcare costs; however, screening for food insecurity lags behind screening for other social determinants of health, particularly in the hospital setting. Although our hospital serves a population with a high prevalence of food insecurity, no process previously existed to universally screen patients. Our multidisciplinary team developed and implemented a process to screen hospitalized adults for food insecurity and connect them with food resources, which we piloted on a 26-bed hospital medicine unit. We integrated a validated 2-item screen into the electronic health record (EHR) nursing admission workflow, and provided 2 weeks of nursing education before process implementation. Adherence to screening was monitored weekly and adjustments were made using plan-do-study-act cycles. After 28 weeks, 361/587 (61.5%; weekly average 61.1%) encounters were screened (compared with a baseline of 2.2%), with 21/361 (5.8%) identified as food insecure. The implementation of an EHR-based food insecurity screening process in the hospital setting increased screening and identification of food insecure patients. Through improved integration of screening questions into the existing nursing workflow and continued education, success was sustained despite challenges with nursing staff turnover and staff shortages during the COVID-19 pandemic.
No Quick Fixes: Integrating Population Health Education and Quality Improvement in a Large Residency Program
Authors: Shoup John Paul , Kim Azalea , Wilson Jonathan , Pendergast Jane , Ranard Benjamin L. , Boggan Joel C.
Published: August 2022

The intersection of population health (PH), quality improvement (QI), and health disparities is increasingly a focus in graduate medical education. However, it remains unclear how trainees may best improve disparities within clinical training environments. We integrated PH education for residents participating in a practical QI experience in a continuity clinic serving an underserved population. We analyzed whether PH education increased confidence in creating care plans and implementing team-based care strategies after selection of one of three QI metrics with known health disparities led to improvement. Posteducational session, attendees had odds of confidence in creating care plans 10.0 (95% confidence interval [CI] 4.6–21.7) times the presession period, whereas nonattendees' confidence was unchanged (OR 1.63, 95% CI 0.78–3.4). Residents participating in the QI project did not have higher confidence in creating a care plan at baseline (20% vs. 9.6%, p = .09) nor any additional shift in confidence versus other residents (p = .57). There were no differences in QI metric performance rate trends for residents choosing a specific QI metric versus those that did not (p > .33 for all comparisons). PH didactics can increase resident confidence around PH topics. However, translating such learning into outcomes and improved health equity may require dedicated efforts across residency training.
Lessons on Increasing Racial and Health Equity From Accountable Health Communities
Authors: Wilson Brandon G. , Jones Emily
Published: August 2022

Background:

The Accountable Health Communities model (AHC) was developed to test whether systematically screening for health-related social needs and referrals to community-based organizations to resolve unmet needs would affect healthcare use and costs for CMS beneficiaries. Purpose: The AHC model required applicants to develop Disparities Impact Statements (DIS), to increase the model's potential impact on health equity.

Methods:

Authors conducted a thematic analysis of awardees' DISs to identify minority and underserved populations of focus, and the strategies awardees used to increase equitable participation in the model by minority and underserved populations.

Results:

Most awardees focused on multiple minority and underserved populations and used multipronged innovative strategies to pursue equity goals.

Conclusions:

Considering recent health equity advancements as Executive Order 13985 and the release of CMS Innovation Center's Strategy Refresh, with highlights of health equity best practices from the AHC model, assessing use of DISs in the AHC model provides valuable lessons. Implications: Given HHS’ broadscale promotion of DISs adoption as a viable quality improvement approach to achieving health equity, disseminating how the tool was used by a myriad of organizational types in the AHC model is critically important to improving future efforts to increase equity.
Coronavirus disease 2019 and the young heart: prevention, treatment, and return to play
Authors: Beach Cheyenne M. , Faherty Erin , Pesce Meredith
Published: August 2022

Purpose of review

COVID-19-related guidance has changed dramatically since the onset of the pandemic. Awareness of data regarding prevention of disease, the cardiac manifestations and treatment of acute COVID-19 and multisystem inflammatory syndrome in children, and return to physical activity following an infection allows for appropriate adjustment of current care models and guides future study.

Recent findings

Severe acute respiratory syndrome coronavirus 2 transmission can be reduced using various mitigation strategies, though their effectiveness differs based on viral prevalence. The risk of severe disease during acute COVID-19 infection is low in children and adolescents, though specific risk factors have been identified. COVID-19 vaccination significantly decreases the risk of severe disease and poor outcomes. Regular physical activity positively affects well being and has been a focus of recent guidance regarding well tolerated return to activities following an infection.

The use of strategies to reduce viral transmission will depend on individuals’ and communities’ risk tolerance and on current viral prevalence. COVID-19 vaccination should be encouraged, particularly in patients with identified risk factors. Allowing children and adolescents to safely participate in physical and other activities should continue to be a focus of our clinical and research efforts given their myriad benefits in this population.
Genetic testing for psychiatric illness in children: ethical issues
Authors: Lynch Fiona , Vears Danya
Published: August 2022

Purpose of review

Genetic and genomic technologies are showing great potential in the field of psychiatry. Genetic testing for psychiatric conditions poses a range of ethical challenges, many of which are likely to be exacerbated for paediatric populations. As a large proportion of psychiatric conditions present in late adolescence and early adulthood, testing in childhood may be considered in some circumstances. Synthesis of issues specific to psychiatric genetic testing in paediatric populations has been limited.

Recent findings

Balancing the autonomy of the child and parents requires consideration and judging capacity may be complicated by the presence of psychiatric illness in the child and their family. Health professionals’ limited understanding of psychiatric genetics may inhibit delivery of effective psychiatric care. Risk of stigma and discrimination associated with genetic diagnosis and psychiatric illness is compounded for children, who inherently cannot make their own decisions and for whom the impact of a genetic diagnosis is likely to be longest lasting.

Although the current evidence base suggests genetic testing may not be appropriate for clinical use in psychiatric populations right now, when it is, appropriate pre-test counselling and informed decision making will be essential to support and protect children's developing and future autonomy.
Advances in immunoglobulin E mediated antibiotic allergy
Authors: Rukasin Christine R.F. , Phillips Elizabeth J. , Stone Cosby A.
Published: August 2022

Purpose of review

The purpose of this review is to identify recent advances in our understanding and management of immunoglobulin E (IgE)-mediated antibiotic allergy.

Recent findings

Antibiotics remain a leading cause of fatal anaphylaxis reported to the FDA. However, recent advances have defined the features of adult and pediatric patients without true IgE-mediated allergy or any mechanism of anaphylaxis when tested. This has created opportunities to use direct challenges to disprove these allergies at the point-of-care and improves antibiotic stewardship. Additional advances have highlighted cross-reactive structural considerations within classes of drugs, in particular the R1 side-chain of cephalosporins, that appear to drive true immune-mediated cross-reactivity. Further advances in risk-based approaches to skin testing, phenotyping, and re-exposure challenges are needed to standardize antibiotic allergy evaluation.

Recent advances in defining true IgE-mediated drug allergy have helped to identify patients unlikely to be skin-test positive. In turn, this has identified patients who can skip skin testing and proceed to direct ingestion challenge using history risk-based approaches. The ability to identify the small number of patients with true IgE-mediated allergy and study their natural history over time, as well as the vast majority without true allergy will facilitate important and novel mechanistic discoveries.
Blood Transfusion is Associated With Adverse Outcomes in Pediatric Solid Tumor Oncology Patients Following Tumor Resection
Authors: Acker Shannon N. , Nolan Margo M. , Prendergast Connor , Lyttle Bailey , Fares Souha , Bensard Denis D. , Partrick David A.
Published: August 2022

Background:

Packed red blood cell (PRBC) transfusion is a lifesaving intervention that also has proinflammatory and immunosuppressive effects. Adults with a malignancy who receive PRBC transfusion have increased rates of infection, tumor recurrence, and decreased survival. The effect of PRBC transfusion among children with solid tumors is unknown.

Methods:

We performed a retrospective review of all children who underwent operative resection of a solid tumor malignancy. Data collected included demographic information, location of operation, nadir hemoglobin, and any PRBC transfusion within 30 days of tumor resection.

Results:

Three hundred sixty children underwent tumor resection at our institution between 2002 and 2013; 194 (54%) received a perioperative blood transfusion. After adjusting for stage at diagnosis, tumor location, preoperative chemotherapy and nadir hemoglobin, blood transfusion was associated with a higher rate of postoperative infectious complications, shorter disease-free interval, and a higher rate of tumor recurrence. Each additional transfused unit increased the risk of postoperative infection (odds ratio 3.83; 95% confidence interval 1.21, 14.22, P=0.031).

Conclusions:

Among children with solid tumor malignancies, PRBC transfusion within 30 days of operation is associated with higher rates of postoperative infection. If transfusion becomes necessary, single unit increments should be transfused.

Level of Evidence:

Level III.
Sinusoidal Obstruction Syndrome of the Liver Associated With 6-Mercaptopurine During Maintenance in a Child With T-cell Acute Lymphoblastic Leukemia
Authors: Prudowsky Zachary D. , Schafer Eric S. , Brackett Julienne , Herbison Alicia B. , Shapiro Mary C.
Published: August 2022

Sinusoidal obstruction syndrome (SOS) of the liver is a complication of chemotherapy most often encountered with hematopoietic stem cell transplant due to high-dose conditioning regimens, but it can also occur with regimens outside of the transplant setting. Mild-to-moderate SOS is a well-described 6-thioguanine toxicity; however, it has rarely been reported as secondary to 6-mercaptopurine, a related thiopurine. This report details a case of a 10-year-old male with T-cell acute lymphoblastic leukemia who developed severe SOS during maintenance therapy with 6-mercaptopurine, and a review of the related literature.
Carcinoma of Unknown Primary Origin: Application of Immunohistochemistry With Emphasis to Different Cytokeratin 7 and 20 Staining Patterns
Authors: Mokhtari Maral , Safavi Dornaz , Soleimani Neda , Monabati Ahmad , Safaei Akbar
Published: August 2022

Background:

Although the primary origin of some carcinomas may be obscure to clinicians, its identification is crucial as it affects prognosis and treatment (especially novel targeted therapies). Immunohistochemistry (IHC) may be helpful in identifying the primary origin of carcinomas. This retrospective survey aimed to evaluate the frequency and accuracy of each IHC marker used to determine the origin of carcinomas.

Methods:

The review of pathology department archives revealed 307 cases of cancer of unknown primary origin (CUP) between 2015 and 2020, which were accessible in the department archives. Demographic information, site of biopsy, clinical and pathologic diagnoses, and IHC results of the patients were collected.

Results:

The patients included 157 (51.15%) men and 150 (48.85%) women. The age of the patients ranged from 14 to 92 years, including 106 (34.5%) expired cases. In 27% of cases, the primary origin of carcinoma remained unknown. The agreement between pathologic and clinical diagnoses was 59%. The most common pattern of cytokeratin (CK) expression in CUP was CK7+/CK20- (55.3%), followed by CK7-/CK20- (19%), CK7+/CK20+ (15%), and CK7-/CK20+ (10.7%), respectively.

Conclusion:

The IHC analysis may improve the diagnosis of CUPs. However, the origin of some cases remains unknown despite an IHC analysis, thereby necessitating the use of more diagnostic procedures or gene expression studies for reaching a definitive diagnosis.
Impact of PPAM aid use on the time to prosthetic limb delivery in patients with unilateral transtibial amputation: A retrospective analysis
Authors: Lee Julia , Davie-Smith Fiona , Hebenton Joanne , Sharp Kath , Seenan Chris
Published: August 2022

Background:

The pneumatic postamputation mobility (PPAM) aid is the most commonly used early walking aid in the United Kingdom in transtibial amputation (TTA) and promotes wound healing and prepares the stump for prosthetic limb fitting. Optimal guidelines for PPAM aid use and how these factors affect achievement of rehabilitation milestones have not yet been conclusively established.

Objective:

To investigate the relationship between PPAM aid use and the time taken to achieve rehabilitation milestones in patients undergoing unilateral TTA.

Study design:

Retrospective case note analysis.

Methods:

Case notes of patients from one National Health Service amputation rehabilitation center who were identified as having a unilateral TTA in 2017–2018 and fitted with a prosthesis were reviewed.

Results:

One hundred seven patients (67.5% male; mean age of 59.9 years) were identified. Use of PPAM aid during inpatient physiotherapy was associated with the days to reach referral, casting, delivery of prosthetic limb, and inpatient discharge dates (r (105) =−0.345; −0.400; −0.423; 0.546, respectively, all P < 0.05). Frequency of PPAM aid use was associated with the time to reach casting (r (105) =−0.533, P < 0.05) and delivery (r (105) =−0.513, P < 0.05). The days to being PPAM aid use and the frequency of PPAM aid use were predictive of the days to reach referral, casting, delivery, and inpatient discharge.

Conclusions:

The use of the PPAM aid is associated with a reduction in the time taken to reach rehabilitation milestones. Early and more frequent use of PPAM aid during rehabilitation will decrease the time fit and delivery of the prosthetic limb.
Validity and reliability of Turkish transcultural adaptation of the Prosthetic Limb Users Survey of Mobility
Authors: Yosmaoglu Sevgin , Yazicioglu Gul , Demir Yasin , Aydemir Koray , Yosmaoğlu Hayri Baran
Published: August 2022

Background:

Amputee-specific, self-assessment mobility scales are essential to evaluate mobility in lower-limb amputees.

Objectives:

To evaluate the validity and reliability of a Turkish translation and adaptation of the Prosthetic Limb Users Survey of Mobility.

Study design:

This is a validation study.

Methods:

Turkish translation of the Prosthetic Limb Users Survey of Mobility (PLUS-M-T) from its original was performed following the rules of intercultural adaptation and translation methods. The PLUS-M-T and its 12-item short form were applied to '100 induviduals with limb loss twice in 3-day intervals. The structural validity analysis was determined by calculating the correlation with the Amputee Mobility Scale, which is a valid, reliable scale for assessing the functional level in amputees. The Cronbach alpha coefficient was calculated to analyze the internal consistency. The interclass correlation coefficient (ICC) and Spearman correlation coefficient (r) were calculated, and the test–retest reliability was determined.

Results:

A positive, high correlation was found between the first application and its repetition of both PLUS-M-T (ICC = 0.85, r = 0.94, P < 0.001) and 12-item short form (ICC = 0.92, r = 0.93, P < 0.001). The internal consistency was high for both PLUS-M-T (Cronbach alpha = 0.94) and 12-item short form (Cronbach alpha = 0.91). A positive, high correlation was found between the scores obtained from the Amputee Mobility Scale and PLUS-M-T (r = 0.84, P < 0.001) and 12 question short form (r = 0.77, P < 0.001).

Conclusion:

Turkish translation of the PLUS-M questionnaire is a valid and reliable scale for assessing the mobility of individuals who have undergone lower-extremity amputation using a prosthesis.
Feasibility of repeated session error-augmentation gait training for people with nontraumatic transtibial amputation
Authors: Kline Paul W. , Davis-Wilson Hope C. , So Noel F. , Fields Thomas T. , Christiansen Cory L.
Published: August 2022

Background:

Spatiotemporal gait asymmetries are a persistent problem for people with non-traumatic lower-limb amputation. To date, there is limited knowledge of multi-session gait training interventions targeting step length symmetry after non-traumatic amputation.

Objective:

The objective was to evaluate the feasibility and efficacy of an eight-session, treadmill-based error-augmentation gait training (EAT) protocol to improve spatiotemporal gait asymmetry in people with non-traumatic transtibial amputation (TTA).

Study Design:

Pre-post, single group. Methods: The EAT protocol involved eight training sessions (twice per week, four weeks) of supervised split-belt treadmill walking with asymmetrical belt speeds for five, three-minute sets each session. Step length symmetry during overground walking at a self-selected gait speed was assessed prior to, weekly, and one-week after the EAT protocol. Feasibility outcomes included protocol fidelity, safety, participant acceptability, and efficacy.

Results:

Seven of the eight participants (87.5%) completed the intervention at the prescribed dose. One participant developed a skin blister on their residual limb, which was possibly related to the intervention. No falls, musculoskeletal injuries, or increases in pain occurred. Participants rated EAT as acceptable based on scores on the Intrinsic Motivation Inventory – Interest/Enjoyment subscale (6.6 ± 0.5; mean ± SD). Average between-limb step length Normalized Symmetry Index improved (was reduced) one-week following EAT (2.41 ± 6.6) compared to baseline (5.47 ± 4.91) indicating a moderate effect size (d=0.53).

Conclusions:

An eight session EAT program delivered over four weeks using a split-belt treadmill is feasible for people with unilateral non-traumatic TTA and may reduce step length asymmetry up to a week after intervention.
Evaluation and Prediction of Healing Morphology After Closed Reduction for Unilateral Mandibular Condyle Fractures
Authors: Abe Shigehiro , Kobayashi Tatsuro , Yokomizo Naoko , Hyodo Katsuya , Kitano Hisataka , Kobayashi Yutaka
Published: August 2022

Although closed reduction is common for condylar fractures, bone fragments may heal improperly. This study aimed to investigate the healing morphology of unilateral condylar fractures. We retrospectively investigated 70 patients with unilateral condylar fractures. Clinico-statistical analyses were performed on the whole-condylar fracture, closed reduction, and observation/functional therapy groups. Among these patients, 52 patients aged older than 16 years underwent closed reduction. The extent of maximum mouth opening, the incidence of malocclusion, and the relationship between healing morphology and Arbeitsgemeinschaft für Osteosynthesefragen classification or trismus were analyzed in the closed reduction group. There were significant differences in age (P=0.008) and sex (P=0.025) between the closed reduction and observation/functional therapy groups. However, there were no significant differences in trauma etiologies and concomitant fractures between the 2 groups. The average maximum mouth opening extent for unilateral fractures after closed reduction was 42.6±6.1 mm. Only 1 case (2.1%) of post-treatment malocclusion was observed. In all the MacLennan classification of deviation or more, regardless of the classification, upper fractures (head and upper neck) tended to heal through a spherical (P<0.001) morphology, whereas lower fractures (lower neck and subcondylar) tended to heal through an L-shaped and lateral fusion (P<0.001). There was no significant difference in the incidence of trismus between the healing morphology of unchanged type and others (P=0.690). Our results elucidated the etiology, dysfunction, and healing morphology classification of unilateral mandibular condyle fractures treated with closed reduction.
Surgical Treatment of Ossified Cephalhematoma in Young Child
Authors: Kashiyama Kazuya , Yoshida Koichi , Iida Rina
Published: August 2022

Cephalhematoma is a subperiosteal collection of blood. The lesion generally spontaneously resolves, but if cephalhematoma persists beyond this period, it typically begins to ossify and may require surgical treatment for correction. The incidence of ossified cephalhematoma is rare, and its pathogenesis is unclear. There have been reports of surgical treatment of ossified cephalhematoma in newborns and infants, but few reports in 5-year-old children. We experienced the surgical treatment of an ossified cephalhematoma in a 5-year-old boy. We performed periosteal reattachment with onlay bone autograft. Follow-up examination at 2 years revealed a good cosmetic result and a computed tomography scan showed excellent reconstitution of the contour of the skull.