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Introduction: Pediatric head and neck (HN) trauma is an important contributor to pediatric morbidity, resulting in significant downstream consequences. Few studies provide epidemiological predictors of pediatric HN trauma on a national scale. The present study aims to identify risk factors of HN injury and mortality in the pediatric population. Methods: A retrospective cohort study was conducted for patients (age <18 years) using the US National Trauma Data Bank (NTDB 2007–2019). Demographic, injury, and physiologic outcome data were analyzed. HN injury was defined as a head or neck Abbreviated Injury Scale (AIS) >0. Logistic regression identified independent predictors of mortality following HN trauma. Results: Of the 1.42 million pediatric patients analyzed, 44.05% had HN injury. In patients aged 0–4, the most common mechanism was falls (47.67% in this age group) while in ages 14–17, motor vehicle/transport accidents (MVTs) were the most common mechanism (56.06%). Controlling for demographics, comorbidities, and injury severity, HN injury was associated with increased odds of mortality (OR 2.404, 95% CI 1.530–3.778). HN injury mortality was strongly predicted by firearm exposure (OR 11.28, 95% CI 6.074–20.95), age <4 (OR 1.179, 95% CI 1.071–1.299), and self‐insured status (OR 1.977, 95% CI 1.811–2.157). Conclusion: NTDB data demonstrate that the percentage of pediatric patients with HN trauma has decreased over the past 12 years although is associated with increased odds of mortality. Age and insurance status predicted mortality from HN trauma, with falls and MVTs being the most common mechanisms of injury. These data have implications for future public health efforts in this patient population. Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Objective: The current study aims to measure patient‐reported satisfaction with pain control using opioid and non‐opioid medications after undergoing the following otolaryngology procedures: parathyroidectomy, thyroid lobectomy, total thyroidectomy, and bilateral tonsillectomy. Materials and Methods: A prospective cohort study was performed at an academic medical center that included a telephone questionnaire and chart review. Opioid prescriptions, usage, and patient‐reported pain outcomes were recorded. Bivariate analyses were used to compare opioid and non‐opioid users. Results: Of the 107 total patients undergoing otolaryngology procedures included in the study, 49 (45.8%) used an opioid for pain management postoperatively and 58 (54.2%) did not. Among the 81 patients who underwent endocrine procedures (parathyroidectomy, total thyroidectomy/lobectomy), most patients reported being "very satisfied" or "satisfied" with pain control whether they used opioids (n = 27/30, 90%) or not (n = 50/51, 98%). Of the 26 patients who underwent bilateral tonsillectomy, 19 (73%) were prescribed opioids and among these, most (n = 17/19, 89%) reported they were "very satisfied" or "satisfied" with pain control. In the non‐opioid usage group, all patients (n = 7/7, 100%) reported they were "satisfied" with pain control. There was no statistically significant difference in patient‐reported satisfaction with pain control between opioid and non‐opioid users for any of the procedures listed. Conclusion: The results of our study suggest that patients who did not use opioids have a similar level of satisfaction with pain control compared to those using opioids after thyroid, parathyroid and tonsillectomy surgeries. Considering the magnitude of the opioid crisis, providers should reassess the need for opioid prescriptions following certain ENT procedures. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

On-chip interconnection networks (OCINs) have emerged as a modular and scalable solution for wire delay constraints in deep submicron VLSI design. OCIN research has shown that the design of buffers in the router influences the energy consumption, area overhead, and overall performance of the network. In this paper, we propose a low-power low-area OCIN architecture by reducing the number of buffers within the router. To minimize the performance degradation due to the reduced buffer size, we use the already existing repeaters along the inter-router channels to double as buffers along the channel when required. At low network loads, the proposed adaptive channel buffers function as conventional repeaters, propagating the signals. At high network loads, the adaptive channel buffers function as storage elements in addition to the router buffers. The router buffers can be assigned either statically or dynamically to the incoming packets. Static allocation reserves equal buffer space partitioned among all of the incoming packets, whereas dynamic allocation reserves buffer space on a per-flit basis, enabling higher buffer occupancy. We evaluate the proposed adaptive channel buffers with both static and dynamic buffer allocation policies in the 90-nm technology node, using 8 x 8 mesh and folded torus network topologies. Simulation results using the SPLASH-2 suite benchmarks and synthetic traffic patterns show that, by reducing the router buffer size, our proposed architecture achieves nearly 40 percent savings in router buffer power, 30 percent savings in overall network power, and 41 percent savings in area, with only a marginal 1-5 percent drop in throughput under dynamic buffer allocation and about 10-20 percent drop in throughput for statically assigned buffers. [ABSTRACT FROM AUTHOR]

Transfer of trauma patients whose injuries are deemed unsurvivable, often results in early death or transition to comfort care and could be considered misuse of health care resources. This is particularly true where tertiary care resources are limited. Identifying riskfactors for and predicting futile transfers could reduce this impact and help to optimize triage and management. A retrospective study of interfacility trauma transfers to a single rural Level I rauma center from 2014 to 2019. Futility was defined as death, hospice, or declaration of comfort measures within 48 h of transfer without procedural or radiographic intervention at the accepting center. Multiple logistic regressions identified independent predictors of futile transfers. The predictive power of Mechanism,Glasgow coma scale, Age, and Arterial pressure (MGAP), an injury severity score based on Mechanism, Glasgow coma scale, Age, and systolic blood Pressure, were evaluated. Of the 3368 trauma transfers, 37 (1.1%) met criteria as futile. Futile transfers occurred among patients who were significantly older with falls as the most common mechanism. Age, Glasgow coma scale, systolic blood Pressure and Injury Severity Score were significant (P < 0.05) independent predictors of futile transfer. MGAP had a high predictive power area under the receiver operating characteristic (AUROC 0.864, 95% confidence interval 0.803-0.925) for futility. A small proportion (1.1%) of transfers to a rural Level I trauma center met criteria for futility. Predictive tools, such as MGAP scoring, can provide objective criteria for evaluation of transfer necessity and prompt care pathways that involve pre-transfer communications, telemedicine, and/or patient centered goals of care discussions. Such tools could be used in conjunction with a more granular assessment regarding potential operational barriers to reduce futile transfers and to enhance optimization of resource utilization in low-resource service areas. • The rate of futile interfacility transfers to a rural Level I trauma center is 1.1%. • Age, GCS, SBP, and ISS were found to be significant predictors of futile transfer. • Predictive tools could be used to evaluate for futility and inform triage. [ABSTRACT FROM AUTHOR]

We conducted four focus group interviews with 24 high school youth to examine facilitators and barriers to African American high school students' expression of various self‐determination skills (e.g., choice/decision making, self‐advocacy, goal setting, and attainment etc.). The majority of our research participants were African American, with one student identifying as multiracial (African American and White). Key findings revealed that personal (e.g., desire to graduate from school) and contextual factors (e.g., school counselor and teacher support) influenced the participants' expression of multiple self‐determination skills. We also found that some of the participants' motives for utilizing or not utilizing specific skills were influenced by what they perceived as racist, punitive, and restrictive school practices (e.g., teachers holding negative perceptions about African American students and school counselors restricting their access to advanced courses). Findings from this study support ongoing calls for educators to consider students' cultural backgrounds and lived experiences when promoting their expression of self‐determination skills. [ABSTRACT FROM AUTHOR]

The present study examined African American high school students' perceptions of their development and use of self-determination skills (e.g., goal setting, choice/decision making, self-advocacy, etc.) in school. The term development refers to the cultivation of self-determination skills through various means (e.g., structured learning opportunities), and the term use refers to students actually employing the skills in school and other settings across time. We conducted four focus group interviews with a predominately African American female sample to examine (a) how various self-determination skills contributed to their success in school and (b) how they developed these skills through community-based support. Key findings indicate that the participants perceived their use of multiple self-determination skills as facilitating their success in school by helping them (a) be independent, (b) remain motivated in school, (c) prioritize their time, and (d) receive support from classroom teachers. Through their involvement in community-based programs, the participants developed the skills through hands-on activities, group discussions, field trips (e.g., college visits), and interacting with peers in their community organization. Findings from this research support calls for educators to promote African American students' self-determination while taking a culturally responsive approach by collaborating with local community-based organizations that were developed to support these students. [ABSTRACT FROM AUTHOR]