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BACKGROUND: Studies analyzing sex-related differences in anatomy, biomechanics, and injury patterns have burgeoned in recent years. While the majority of these manuscripts have highlighted differences about the knee, there remains a paucity of descriptions of the sex-related differences about the shoulder. Herein we summarize the sex-related differences of shoulder 1) osteology, 2) soft tissue anatomy, and 3) neuromuscular function. METHODS: A systematic review of literature was performed querying manuscripts from Medline, Web of Science, Embase, and Google Scholar databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All articles investigating shoulder differences by sex were included. Metrics of the sex-related differences in osteology, soft-tissue anatomy, and neuromuscular function were recorded. Meta-analysis was performed when metrics were available from 3 or more studies. RESULTS: Sixteen articles were included for analysis. There were 7 cadaveric studies, 1 review article, and 8 studies with Level-III or IV evidence. Glenoid height and width were significantly smaller in females (4.57 mm, p

Eosinophilia with granulomatosis and polyangiitis (EGPA, previously called Churg-Strauss syndrome or allergic granulomatosis and angiitis) is an anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis affecting small-sized vessels, which typically occurs in patients with a history of allergic rhinitis or asthma. The most serious cases arise from the involvement of other organ systems, notably the cardiovascular system. Importantly, patients may first exhibit non-specific manifestations such as malaise, fever, anorexia, and weight loss. This variable presentation and the potential for multi-organ involvement can lengthen time to diagnosis and delay treatment.We describe a patient who presented with progressive myalgias on the background of recently diagnosed rhinosinusitis who was ultimately diagnosed with EGPA. This case is meant to alert general internists to the diagnostic challenges of EGPA.

During JADPRO Live Virtual 2020, Lorena A. Wright, MD, FACE, reviewed the principles of antihyperglycemic management and discussed the importance of working as a team to collaborate in the management of patients with cancer.

Wright, MD and Atkinson, G. Changes in sprint-related outcomes during a period of systematic training in a girls' soccer academy. J Strength Cond Res 33(3): 793-800, 2019-The longitudinal tracking of performance indicators is lacking during the training of young female soccer players. Therefore, changes in 5-m acceleration, 20-m speed, change-of-direction (COD) speed, and repeated-sprint ability (RSA) were quantified during a 3-year period in an English Football Association Center of Excellence. Fourteen players (mean age = 12.1 years, SD = ±0.9) were recruited, and their best performance scores from preseason and in-season testing were averaged. Players were typically exposed to soccer (2 × 90 minutes per week) and strength and conditioning training (1 × 70 minutes per week) and played 20 soccer matches (50-80 minutes) during 35-week seasons. Mean (±90% confidence limits (CL)) overall improvements over the 3 years were 5.9% (1.3) (most likely large) for speed, 4.0% (1.0) (most likely large) for RSA, 8.8% (1.1) for acceleration, and 8.3% (1.4) for COD speed (both most likely very large). Improvements between years one and 2 ranged from most likely moderate to very large. Further small improvements in COD speed and 20-m speed (both likely) were observed between years 2 and 3. Individual differences in response were apparent only for COD speed, which were moderate and small between years 2 and 3. Most likely very large to near-perfect within-player correlations were observed between maturation and sprint measures. These data from a single-arm longitudinal study indicate that systematic exposure to training, which includes one dedicated strength and conditioning session each week, is associated with improvements in sprint-related physical qualities in girls.

The burden of preterm birth remains substantial, with immature infants surviving at rates higher than ever before but with significant morbidities.1 Bronchopulmonary dysplasia is a leading cause of mortality and long-term impairments.2 Given the direct relationship between invasive mechanical ventilation and lung injury, the search continues for strategies that help to successfully establish noninvasive support for management of respiratory distress syndrome. Alternative modes of surfactant administration in preterm infants spontaneously breathing on continuous positive airway pressure have been tested, with the goal of limiting exposure to mechanical ventilation.3 However, there has not been clear-cut evidence that these approaches improve outcomes in high-risk infants so far.4 Offered as a truly noninvasive approach, nebulization of surfactants avoids the harms of laryngoscopy.3 Despite ongoing research, clinical data are scarce, and efficacy has yet to be assessed.4–8 In this issue of Pediatrics , Cummings et al9 report rates of intubation and intratracheal surfactant therapy in 457 infants receiving noninvasive respiratory support for respiratory distress syndrome randomly assigned to either aerosolized calfactant … Address correspondence to Clyde J. Wright, MD, Perinatal Research Facility, Department of Pediatrics, School of Medicine, University of Colorado, 13243 E 23rd Ave, Room 106, Aurora, CO 80045. E-mail: clyde.wright{at}cuanschutz.edu

Tuesday, May 17, 2016 8:00 AM–8:10 AM Detection of Fetal Fraction During Noninvasive Prenatal Screening (NIPS) in HIV-Infected Pregnant Women [22] Aleha Aziz, MD, MPH Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY Anne Van Arsdale, MD, MSc, Susan Klugman, MD, and Rodney L. Wright, MD, MS INTRODUCTION: To describe the reliability of Non Invasive Prenatal Screening (NIPS) in HIV infected pregnant women. NIPS analyzes cell free fetal DNA which circulates in maternal plasma but originates from the placenta and is quantitated as “fetal fraction” (FF). Sensitivity of NIPS increases with FF. In certain populations NIPS reliability decreases, with obesity as the strongest factor negatively associated with FF. Additional variables including PAPP-A and smok- ing have been shown to affect FF. Our study aims to determine if immune system alterations such as HIV or antiretroviral medications impact FF. METHODS: A 2:1 matched case-control study was carried out comparing 15 HIV infected pregnant women to 30 without HIV undergoing NIPS. Variables such as BMI, ethnicity, medical comorbidities, toxic habits, fetal CRL, serum analytes, FF, and pregnancy outcomes were compared. Immune status and antiretro- viral medications were evaluated in correlation with FF in HIV infected patients. RESULTS: HIV infected patients receiving integrase inhibitors (INI) had lower mean FF than those without INI—4.93 (SD 2.20) versus 15.7 (SD 5.43) (P5,.01). NIPS was invalid for three HIV infected patients – all of whom were receiving INI - due to low FF. HIV infected patients with an undetectable viral load (VL) at NIPS had a significantly lower median FF compared to those with detect- able VL (P5.01). CONCLUSION/IMPLICATIONS: Integrase inhibitors may play a role in reliability of NIPS in HIV infected women, as reflected by lower FF for patients taking INI. Further study is needed to fully elucidate the mechanism for INI and decreased FF. Financial Disclosure: The authors did not report any potential conflicts of interest. 8:00 AM–8:10 AM Quality Improvement: Changing Patterns of Antibiotic Prophylaxis for Surgical Abortions [23] Olivia T. Nguyen, MS University of California Davis School of Medicine, Sacramento, CA Jade M. Shorter, MD, Alexa L. Calfee, MPH, Mitchell D. Creinin, MD, and Melody Y. Hou, MD, MPH INTRODUCTION: Patients at our institution having an abortion in the operating room are routinely prescribed prophylactic antibiotics to use the night before the procedure. After a quality assurance assessment from 4/2012–6/2013 showed poor documentation and adherence to prescribed antibiotics, we altered our procedures by pref- erentially using the clinic pharmacy for prescriptions and implement- ing a standardized preoperative template that included assessment of antibiotic adherence. METHODS: Using clinic schedules, we identified women who had abortions in the operating room from 4/2012–6/2013 and 4/2014–6/ 2015. We examined electronic medical records to confirm the abortion occurred and obtained data including demographics, prophylactic anti- biotic documentation, and patient adherence. We compared data from the two time periods to assess the impact of the interventions on anti- biotic provision and documentation. RESULTS: We identified 252 and 445 patients who had abortions during the two time periods, respectively. One patient in the latter group was excluded because she refused antibiotics. Patient character- VOL. 127, NO. 5 (SUPPLEMENT), MAY 2016 istics included mean age of 28 years, 34% white, 24% black, and 72% Medicaid-insured. Antibiotic adherence documentation improved from 69.4% (175/252) to 99.1% (440/444 P,.001). Among patients with documentation, antibiotic use the night before the procedure increased from 78.3% (137/175) to 90.0% (396/440, P,.001). Antibi- otic administration in the pre-operative area for nonadherent patients increased from 84.4% (27/32) to 97.7% (42/43, P5.036). The propor- tion of patients who received no antibiotics decreased from 2.4% (6/ 252) to 0.5% (2/444, P5.009). CONCLUSION/IMPLICATIONS: Using a standardized preopera- tive template and clinic pharmacy improves provision of prophylac- tic antibiotics for patients undergoing abortion in the operating room. Financial Disclosure: The authors did not report any potential conflicts of interest. 8:15 AM–8:25 AM A Short Course of Tamoxifen Reduces Unscheduled Bleeding in Etonogestrel Contraceptive Implant Users [24] Katharine Simmons, MD, MPH University of North Carolina, Chapel Hill, NC Alison Edelman, MD, MPH, Rochelle Fu, PhD, and Jeffrey Jensen, MD, MPH INTRODUCTION: The etonogestrel (ENG) contraceptive implant is highly effective and long-acting, but users may experience bothersome unscheduled bleeding (USB). An evidence-based strategy to reduce USB could increase continuation of the implant. The objective of this randomized trial was to determine whether a short course of tamoxifen would reduce bleeding/spotting days and increase satisfaction com- pared to placebo. METHODS: Women experiencing frequent or prolonged bleeding with the ENG implant were randomized to receive tamoxifen 10 mg or placebo twice daily for seven days, taken at the onset of an episode of bleeding. Treatment was repeated as needed every 30 days. A text message bleeding diary was completed for 180 days. A sample size of 56 was estimated to detect a difference of 6 days of bleeding per 30 days (estimated 40% reduction) with 80% power. Wilcoxian rank sum test compared bleeding/spotting days between groups. Satisfaction was assessed with visual analog scales. RESULTS: Tamoxifen subjects reported more baseline USB than placebo (median 23 vs 20 bleeding/spotting days out of 30, respectively). In the 30 days after study drug, tamoxifen users experienced significantly fewer days of bleeding/spotting than placebo (median 6 vs 12 days, P5.05). Duration of amenorrhea after therapy was longer for tamoxifen subjects than placebo (median 30 vs 8 days, P5.03). Satisfaction was higher in the tamoxifen group and side effects were similar. CONCLUSION/IMPLICATIONS: A 7-day course of tamoxifen was well tolerated and significantly reduced USB compared to placebo. Additional research is needed to determine if tamoxifen treatment can reduce discontinuation for USB. Financial Disclosure: Dr. Edelman (Professor, Obstetrics and Gynecology, Oregon Health & Science University) disclosed the following—Merck: Speaker/Honoraria includes speakers bureau, symposia, and expert witness. Dr. Jensen (Professor, Obstetrics & Gynecology, Oregon Health & Science University) disclosed the following—Abbvie: Consultant/Advisory Board, Other Research Support includes receipt of drugs, supplies, equipment or other in-kind support; Agile: Other Research Support includes receipt of drugs, supplies, equipment or other in-kind support; Bayer: Consultant/ Advisory Board, Other Research Support includes receipt of drugs, supplies, equipment or other in-kind support; Contramed: Consultant/Advisory Board, Other Research Support includes receipt of drugs, supplies, equipment or other in-kind support; Evofem: Consultant/Advisory Board; HRA phar- ma: Consultant/Advisory Board, Other Research Support includes receipt of drugs, supplies, equipment or other in-kind support; Merck: Consultant/ Advisory Board, Other Research Support includes receipt of drugs, supplies, equipment or other in-kind support; MicroChips: Consultant/Advisory Board; Teva: Consultant/Advisory Board. The other authors did not report any potential conflicts of interest. Copyright a by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. TUESDAY PAPERS 9S

Janet S. Wright, MD, FACC, Chair Kathleen Blake, MD, FACC Robert O. Bonow, MD, FACC Ralph G. Brindis, MD, FACC John E. Brush, Jr, MD, FACC Joseph G. Cacchione, MD, FACC Gregory J. Dehmer, MD, FACC Joseph P. Drozda, Jr, MD, FACC Kim A. Eagle, MD, FACC James W. Fasules, MD, FACC Kathleen B

A panel was convened to discuss the topic of the management of hypertension in the African American patient. Jackson T. Wright, MD, PhD, Professor of Medicine, Case Western Reserve University, Cleveland, OH, moderated the panel. Kenneth A. Jamerson, MD, Professor of Medicine, University of Michigan, Ann Arbor, MI, and Keith C. Ferdinand, MD, Association of Black Cardiologists, Inc, and Emory University, Atlanta, GA, participated in the discussion. This expert panel discussion was supported by Novartis and each author received an honorarium from Novartis for time and effort spent participating in the discussion and reviewing the transcript for important intellectual content prior to publication. The authors maintained full control of the discussion and the resulting content of this article; Novartis had no input in the choice of topic, speakers, or content.

Peter J. Stern, MD, is Norman S. & Elizabeth C.A. Hill Professor and Chairman of Orthopaedic Surgery at the University of Cincinnati College of Medicine; Stephen Albanese, MD, is Professor and Chair of Orthopedic Surgery and Medical Director of Orthopedic Surgery Clinic at SUNY Upstate Medical University; Mathias Bostrom, MD, is Residency Program Director and Academic Director of Orthopaedics at Hospital for Special Surgery and Professor of Orthopaedic Surgery, Weill Cornell Medical College, Helen Hayes Hospital; Charles S. Day, MD, MBA, is Rabkin Fellow in Medical Education, Associate Professor of Orthopedic Surgery at Harvard Medical School, and Chief/Program Director of Hand and Upper Extremity Surgery at Beth Israel Deaconess Medical Center; Steven L. Frick, MD, is Chairman of Orthopedic Surgery at Nemours Children’s Hospital and Professor of Orthopedic Surgery at the University of Central Florida College of Medicine; William Hopkinson, MD, is Professor, Vice-Chair, and Program Director of Orthopaedic Surgery & Rehabilitation at Loyola University Stritch School of Medicine; Shepard Hurwitz, MD, is Executive Director of the American Board of Orthopaedic Surgery and Professor of Orthopaedics at the University of North Carolina; Keith Kenter, MD, is Director of the Orthopaedic Surgery Residency Program, Associate Professor of Orthopaedic Surgery, and Associate Professor of Physical Medicine and Rehabilitation at the University of Cincinnati College of Medicine; John S. Kirkpatrick, MD, is Professor and Chair of Orthopaedic Surgery and Rehabilitation and Program Director of Orthopaedic Surgery Residency at the University of Florida College of Medicine; J. L. Marsh, MD, is Program Director of Residency Training Program and Professor and Carroll B. Larson Chair of Orthopaedics and Rehabilitation at the University of Iowa; Anand M. Murthi, MD, is Chief of Shoulder and Elbow Surgery and Fellowship Director at MedStar Union Memorial Hospital; Lisa A. Taitsman, MD, MPH, is Associate Professor of Orthopaedics and Sports Medicine at the University of Washington; Brian C. Toolan, MD, is Associate Professor of Surgery and Director of the Residency Program of Orthopaedic Surgery at the University of Chicago Medicine; Kristy Weber, MD, is Virginia & William Percy Professor of Orthopaedic Surgery, Division Chief of Orthopaedic Oncology, and Director of the Sarcoma Center at Johns Hopkins School of Medicine; Rick W. Wright, MD, is Dr Asa C. Dorothy W. Jones Professor of Orthopaedic Surgery, Residency Program Director, and Co-Chief of Sports Medicine at Washington University School of Medicine; Pamela L. Derstine, PhD, MHPE, is Executive Director of the Review Committees for Colon and Rectal Surgery, Neurological Surgery, Orthopaedic Surgery, and Otolaryngology at the Accreditation Council for Graduate Medical Education; and Laura Edgar, EdD, CAE, is Senior Associate Director of Outcome Assessment at the Accreditation Council for Graduate Medical Education.

David M. Shahian, MD, Fred Edwards, MD, Fred L. Grover, MD, Jeffrey P. Jacobs, MD, Cameron D. Wright, MD, Richard L. Prager, MD, Jeffrey B. Rich, MD, Michael J. Mack, MD, and Douglas J. Mathisen, MD In the August issue of the Journal, 2 articles raised questions regarding the Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database (ACD). Over the past 2 decades, the STS has devoted enormous time and energy to develop and progressively refine the largest clinical cardiac surgery data registry in the world. The issues discussed in these 2 articles have always been of paramount importance to database leadership. The ACD has been the foundation for a set of sophisticated risk adjustment models for isolated coronary artery bypass grafting (CABG) surgery, isolated valve procedures, and combined CABG plus valve procedures. It has also been the basis for a comprehensive quality measurement system for CABG. The ACD has provided data for more than a hundred clinical research studies that have advanced patient care, and its educational content has enhanced the knowledge of both cardiothoracic trainees and experienced surgeons. The Centers for Medicare and Medicaid Services (CMS) RUC process for the valuation of cardiothoracic procedures has been greatly facilitated by having ‘‘hard’ data from the ACD. Overall, patient care has been improved in a myriad of ways by virtue of this rich repository of information. All these efforts depend on the underlying accuracy of our data. The Society is now about to embark on a new and very significant database initiative, the voluntary public release of STS Composite CABG Scores for participants. New York State initiated mandatory public reporting of CABG results 2 decades ago, and a few other states have subsequently implemented similar programs. However, the STS voluntary public reporting initiative, initially conducted in collaboration with Consumers Union and subsequently planned for the STS Web site, is the first of its kind by

Steven Aks, DO, FACMT, FACEP Michelle Blanda, MD, FACEP David Bordo, MD, FACEP Shu B. Chan, MD, MS, FACEP Carlos A. Camargo, Jr., MD, DrPH Andrew K. Chang, MD, FACEP William C. Dalsey, MD, MBA, FACEP Wyatt W. Decker, MD, FACEP Marc Dorfman, MD, FACEP, MACP John E. Duldner, Jr., MD, FACEP Christopher J. Finley, MD, FACEP Steven A. Godwin, MD, FACEP Jonathan A. Handler, MD, FACEP Edward C. Jauch, MD, MS, FACEP A. Antoine Kazzi, MD, FAAEM Mark I. Langdorf, MD, MHPE, FACEP Joseph R. Lex, Jr., MD, FAAEM Thomas W. Lukens, MD, PhD, FACEP Susan Nedza, MD, MBA, FACEP Robert W. Neumar, MD, PhD, FACEP Richard Nunez, MD,FACEP, FAEAM Robert E. O’Connor, MD, MPH, FACEP Brian J. O’Neil, MD, FACEP James R. Roberts, MD, FACEP Philip H. Shayne, MD, FACEP Gary R. Strange, MD, FACEP Stephen J. Wolf, MD, FACEP David W. Wright, MD, FACEP Robert Zalenski, MD, MA, FACEP Leslie S. Zun, MD, MBA, FACEP