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High-intensity resistance training (HIRT) is commonly performed by structural firefighters on duty to enhance occupational readiness. However, exercise-induced fatigue may negatively impact subsequent occupational performance. Therefore, the purpose of this study was to assess the acute effect of HIRT on subsequent occupational physical ability in structural firefighters and to determine the time course of recovery. Seven resistance-trained male firefighters performed a timed maximal effort simulated fireground test (SFGT) in 3 randomized conditions: baseline (SFGTbaseline), 10 minutes post HIRT (SFGT10min), and 60 minutes post HIRT (SFGT60min). Work efficiency and air depletion were assessed during the SFGT. The timed HIRT session consisted of a standardized set of exercises using absolute training loads. Repeated measures analysis of variance and minimal difference (MD) analysis assessed group and individual effects between the conditions, respectively. The level of significance was set at p < 0.05. SFGT10min completion time was greater than SFGTbaseline (430 ± 137 vs. 297 ± 69 seconds, p < 0.01), with no difference between SFGTbaseline and SFGT60min (297 ± 69 vs. 326 ± 89 seconds, p = 0.08). The MD analysis indicated that all firefighters' SFGT10min times exceeded the MD (±26.4 seconds) compared with SFGTbaseline. However, 43% of firefighters still exceeded the MD at SFGT60min. Air depletion during SFGT10min was greater than that during SFGTbaseline (2,786 ± 488 vs. 2,186 ± 276 lb·in-2, p = 0.02), with no difference between SFGTbaseline and SFGT60min (p = 0.25). Work efficiency during SFGT10min was 40% lower than that during SFGTbaseline (p < 0.01), with no difference between SFGTbaseline and SFGT60min (p = 0.25). These findings indicate that an acute bout of HIRT decreases multiple descriptors of firefighters' occupational performance 10 minutes post exercise with varied responses at 60 minutes post exercise. [ABSTRACT FROM AUTHOR]

In 1988, the Committee for the Study of the Future of Public Health identified the core functions of assessment, policy development, and assurance as key roles of the public health governmental sector. Some states have developed accreditation or performance assessment programs to measure how state and/or local government carry out these functions. Several of these programs share a common 'on-site review' component defined as a site-specific visit to assess, observe, interview, review, evaluate, and/or survey a local/state agency or program regarding its ability to meet a set of public health standards. This article describes the experience of four states-Michigan, Missouri, North Carolina, and Washington-in developing and conducting on-site reviews for accreditation or performance assessment. [ABSTRACT FROM AUTHOR]

Given the recent interest in public health accreditation programs and related efforts, there is a need to learn from the shared experiences of states that have developed, implemented, and evaluated their own efforts. The Multistate Learning Collaborative provided such an opportunity. Five states were selected to participate in this national peer group. The states represented in the Collaborative reflect different accreditation and assessment models, varying levels of maturity, and various designs based on the context and needs of a given state. However, despite these differences, common themes, critical elements, and shared challenges have emerged. [ABSTRACT FROM AUTHOR]

To date, there have been few points of intersection between the quality work done in the general health system and performance review in the public health system. This article describes Washington State's set of performance standards for public health, the accreditation-type evaluation process, and some of the results of the recent performance evaluation against the Washington State Standards. Taking action on the evaluation results could enhance the capacity of public health to join general health systems in Washington State to address several of the priority areas described in Transforming Health Care Quality, the 2003 Institute of Medicine Report. [ABSTRACT FROM AUTHOR]

COVID-19 disrupted virtually all aspects of American life during calendar year 2020. PURPOSE: The purpose of this study was to assess the impact of the COVID-19 pandemic response on objectively measured physical activity (PA) of university employees. METHODS: Objectively measured PA data (walking distance, steps·d-1, and Moderate-Vigorous PA (MVPA) time) were collected from commercial grade triaxial accelerometers from Jan- May in calendar years 2019 and 2020. Data were high pass filtered at 1000 steps·d-1 and 20% of their monthly average to eliminate outlier data due to improper function or insufficient wearing of PA monitoring devices. Subjects with less than three data points per week were excluded from data analysis. Data were compared by a two-way repeated ANOVA (N=625) with α = 0.05. RESULTS: Walking distance was significantly lesser in April 2020 compared to Feb 2020 (6.32 ± 0.16 vs. 6.56 ± 0.12 km·d-1, p < 0.001). Walking distance was lesser during the months of April (8.9%, p < 0.001) and May 2020 (5.9%, p < 0.001) compared to similar time periods from calendar year 2019. Daily steps were significantly (4-5%, p < 0.001) lower in April 2020 compared to the months of Jan-March 2020. Daily steps during the month of May 2020 were significantly greater than April 2020 (5%, p < 0.001), but not significantly different from Jan-March 2020. Daily steps were significantly lesser in the months of April 2020 (8759 ± 158 vs. 9815 ± 133 steps·d-1, p < 0.001) and May 2020 (9205 ± 159 vs. 9867 ± 132 steps·d-1, p < 0.001) compared to the same time period of 2019. MVPA time was greater in the months of March-May 2020 compared to Jan and Feb of 2020 (5.0-17.0%, p < 0.001). Time spent in MVPA was similar between calendar years 2019 and 2020 for the months of March, April, and May. CONCLUSION: These data indicate a decrease in walking distance and daily steps, but not time spent in MVPA during the initial stage of the COVID-19 pandemic response. These findings suggest an increased time spent in sedentary behavior, but not reduced time spent in exercise, during the early stages of the COVID-19 pandemic compared to the previous calendar year. FUNDING: National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health UL1TR001998 (LMB). [ABSTRACT FROM AUTHOR]

Many policies and suggestions enacted by governments and employers in response to the COVID-19 pandemic decreased access to common places of physical activity. PURPOSE: The purpose of the study was to assess the impact of individual COVID-19 response policies on objectively measured daily steps (steps·d-1) of university employees. METHODS: To determine the impact of the specific policies chosen, objectively measured steps·d-1 were examined from commercial triaxial accelerometers (N=559). The average steps·d-1 for the three-day period immediately preceding and following new pandemic response policy announcements were compared using paired t-tests. RESULTS: Steps·d-1 were not significantly different before and after Kentucky's "State of Emergency" declaration (10,675±167 vs. 10,472±178 steps·d-1, p=0.110). Steps·d-1 significantly decreased after the announcement of the World Health Organization's worldwide pandemic and social distancing recommendation announcement (10,348±171 v. 9551±156 steps·d-1, p<0.001) as well as after the cessation of in-person classes at the university being examined (10,100±160 v. 9,186±167 steps·d-1, p<0.001). Conversely, there was a significant increase after both the halt of non-essential research at the university (9,186±167 vs. 9,590±175 steps·d-1, p<0.001) and after Kentucky's "Healthy at Home" order went into effect (9,693±177 vs. 10,156±185 steps·d-1, p<0.001). Lastly, a non-significant 1.8% increase in steps·d-1 was seen after the statewide ban on mass gatherings (9,523±171 vs. 9,693±177 steps·d-1, p=0.154). CONCLUSIONS: These results indicate there may be positive or negative unintended consequences on daily steps depending on the nature of the pandemic policy implemented. Moreover, the effect from later withdrawing or relaxing these policies is still unclear. Governments and employers may need to consider not only pandemic policy effectiveness in reducing community disease transmission but also the potentially detrimental effects on health behaviors such as physical activity. The National Institutes of Health supported this research through Grant UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors declare no conflict of interest. [ABSTRACT FROM AUTHOR]

INSTRUMENTATION OF AN INERTIAL KINETIC EXERCISE DEVICE WITH A DUAL AXIS ACCELEROMETER. PURPOSE/INTRODUCTION: An inertial kinetic exercise (IKE) device has potential utility for injury rehabilitation, speed development in athletes, and to counteract space flight-induced muscle atrophy. Yet such high-speed devices often elicit greater levels of data variability. Prior research assessed IKE data reproducibility when instrumentation entailed a single-axis accelerometer. RESULTS showed a high degree of reproducibility, though values may improve if instrumentation entailed a dual-axis accelerometer, which permits gravity compensation without compromising the capacity to measure acceleration. Thus the current project assessed data reproducibility from two IKE workouts instrumented with a dual-axis (Model DE-ACCM5G) accelerometer. We hypothesized a high level of performance variable reproducibility would occur from IKE instrumentation with a dual-axis accelerometer. METHODS: Each workout entailed two one-minute sets of high-speed elbow flexion actions interspersed by a 90-second rest. Variables, compared for both intra- and inter-workout analyses, were examined with intraclass correlation coefficients (ICC). RESULTS: Intra-workout ICC values collected from subjects (n = 16) were as follows: average acceleration = 0.85, mean torque = 0.75, maximum torque = 0.75, total torque = 0.73, mean force = 0.89, maximum force = 0.89 and total force = 0.76. Inter-workout ICC values collected from those same subjects were as follows: average acceleration = 0.71, mean torque = 0.73, maximum torque = 0.70, total torque = 0.72, mean force = 0.82, maximum force = 0.90 and total force = 0.74. The overall average intra- and inter-workout ICC values for the aforementioned variables were 0.80 and 0.76, respectively. CONCLUSIONS: Research suggests ICC values > 0.75-0.80 shows a high level of reproducibility. Though inter-workout average acceleration ICC results were less than suggested values, they demonstrate less dispersion for this same variable than when instrumentation entailed a single-axis accelerometer. PRACTICAL APPLICATIONS: Preliminary results suggest instrumentation with a dual-axis accelerometer yields a high level of reproducibility, though continued research is warranted. Instrumentation of the IKE may be optimized with the use of a dual-axis accelerometer. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study., Objective: The objective of this study was to investigate associations between spine surgeon characteristics and different types of industry payments., Summary of Background Data: Industry funding has played an important role in research and technological innovation within spine surgery, and industry payments supporting research have risen significantly in comparison to funding from other sources. To our knowledge, no studies have investigated academic spine surgeon characteristics associated with different categories of industry payments., Materials and Methods: A query was conducted of the North American Spine Society Spine Fellowship Directory from 2021 to 2022 to identify all orthopaedic or neurosurgical spine fellowship selection committee members. A PubMed search was utilized to collect information on surgeon academic productivity up through December 31, 2021. The authors then conducted a query on the Centers for Medicare and Medicaid Services open payments website from 2015 to 2021 to collect payment records of spine fellowship selection committee members., Results: On linear regression analysis, total publications (8203, P <0.001), attending years (48,823, P <0.001), and publication rate (57,528, P =0.017) were associated with higher general payments. Southeast spine surgeons (80,043, P =0.038) and fellowship directors (79,874, P =0.007) were associated with more research payments. Total publications (7409, P <0.001), attending years (47,100, P <0.001), and publication rate (47,511, P =0.040) were significantly associated with higher royalties. Having a Twitter/X account (60,800, P =0.018), being a director (51,605, P =0.034), total publications (492, P <0.001), and publication rate (6444, P <0.001) were all predictive of greater consulting payments., Conclusions: Spine surgeons who are experienced, academically productive, fellowship directors, and engage with social media receive greater payments on average than their peers across various payment types. As industry influence continues to make its way into health care, experienced leaders in their respective fields will shoulder the responsibility to integrate private innovation in an effective and scientifically rigorous manner., Level of Evidence: 3., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Non-syndromic single-suture sagittal craniosynostosis presentation spans scaphocephalic and normocephalic head shapes. Herein, we studied craniometric differences between scaphocephalic and normocephalic patients with sagittal synostosis., Methods: Head CT scans of 20 scaphocephalic and 20 normocephalic sagittal synostosis patients and their age- and sex-matched controls were analyzed, including cranial base angles, distances-from-midline, and intracranial volumes., Results: Cranial index was significantly decreased in index groups compared to controls (p<0.001, respectively). Right external acoustic meatus angle (EAMA) was significantly larger in scaphocephalic (p<0.001) and left EAMA was significantly smaller in normocephalic patients (p=0.002) when compared with controls. Midline angular analysis showed that bifrontal angle was significantly smaller amongst scaphocephalic patients versus controls (p=0.026). Cranial base distances-from-midline were longer to the right and left internal acoustic meatus and shorter to the euryon-to-zygomaticofrontal suture for both groups of cases than their controls (p<0.05). Scaphocephalic patients had a larger anterior cranial volume ratio (18% vs 13%, p<0.001) and normocephalic patients had a larger posterior volume ratio (42% vs 33%, p<0.001) than controls. Scaphocephalic patients had larger anterior volume ratios than normocephalic patients (1.66 vs 1.16, p=0.025, but smaller posterior compartment volume ratios (0.90 vs 1.53, p<0.001)., Conclusion: There are rightward asymmetries of the linear and angle cranial base measurements in both index groups. Intracranial volume distribution lies anteriorly in scaphocephalic patients but posteriorly in normocephalic patients. These data show craniometric evidence that although normocephalic and scaphocephalic patients share the diagnosis of "sagittal synostosis," they are morphometrically different than each other and controls., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by the American Society of Plastic Surgeons.)

The rapid technological advancements in cardiac implantable electronic devices such as pacemakers, implantable cardioverter defibrillators, and loop recorders, coupled with a rise in the number of patients with these devices, necessitate an updated clinical framework for periprocedural management. The introduction of leadless pacemakers, subcutaneous and extravascular defibrillators, and novel device communication protocols underscores the imperative for clinical updates. This scientific statement provides an inclusive framework for the periprocedural management of patients with these devices, encompassing the planning phase, procedure, and subsequent care coordinated with the primary device managing clinic. Expert contributions from anesthesiologists, cardiac electrophysiologists, and cardiac nurses are consolidated to appraise current evidence, offer patient and health system management strategies, and highlight key areas for future research. The statement, pertinent to a wide range of health care professionals, underscores the importance of quality care pathways for patient safety, optimal device function, and minimization of hemodynamic disturbances or arrhythmias during procedures. Our primary objective is to deliver quality care to the expanding patient cohort with cardiac implanted electronic devices, offering direction in the era of evolving technologies and laying a foundation for sustained education and practice enhancement.

Background: Visual symptoms are common after concussion. Rapid automatized naming (RAN) tasks are simple performance measures that demonstrate worse time scores in the setting of acute or more remote injury., Methods: We evaluated the capacity for the Mobile Universal Lexicon Evaluation System (MULES) and Staggered Uneven Number (SUN) testing to be feasibly administered during preseason testing in a cohort of youth ice hockey athletes using a novel computerized app, the Mobile Integrated Cognitive Kit (MICK). Participants from a youth hockey league underwent preseason testing., Results: Among 60 participants, the median age was 13 years (range 6-17). The median best time for the MULES was 49.8 seconds (range = 34.2-141.0) and the median best time for the SUN was 70.1 (range = 36.6-200.0). As is characteristic of timed performance measures, there were learning effects between the first and second trials for both the MULES (median improvement = 10.6 seconds, range = -32.3 to 92.0, P < 0.001, Wilcoxon signed-rank test) and SUN (median improvement = 2.4 seconds, range= -8.0 to 15.1, P = 0.001, Wilcoxon signed-rank test). Age was a predictor of best baseline times, with longer (worse) times for younger participants for MULES (P < 0.001, rs = -0.67) and SUN (P < 0.001, rs = -0.54 Spearman rank correlation). Degrees of learning effect did not vary with age (P > 0.05, rs = -0.2)., Conclusions: Vision-based RAN tasks, such as the MULES and SUN, can be feasibly administered using the MICK app during preseason baseline testing in youth sports teams. The results suggest that more frequent baseline tests are necessary for preadolescent athletes because of the relation of RAN task performance to age., Competing Interests: M. J. Balcer is the chief architect for Model Compilers. L. J. Balcer is editor-in-chief of the Journal of Neuro-Ophthalmology. The remaining authors report no conflicts of interest., (Copyright © 2024 by North American Neuro-Ophthalmology Society.)

Competing Interests: The authors declare no conflicts of interest.

Study Design: Observational study., Objective: To evaluate the readability of commonly utilized patient-reported outcome measures (PROMs) in spine surgery., Summary of Background Data: Although studies have evaluated patient education materials, discharge instructions, and informed consent forms in spine surgery, there is a dearth of literature on the readability of PROMs despite widespread health illiteracy. Without knowledge of PROM readability, it is unclear whether these measures are able to be understood by the average spine patient., Materials and Methods: We analyzed all commonly utilized nonvisual PROMs within the spinal literature and uploaded PROMs into an online readability calculator. The Flesch Reading Ease Score (FRES) and Simple Measure of Gobbledygook (SMOG) Index were collected. A FRES>79 or SMOG<7 was considered readable by the general population per American Medical Association and Centers for Disease Control guidelines. A stricter threshold recommended in health care (SMOG <6 or FRES>89) was then used to further review readability., Results: Seventy-seven PROMs were included. Based on FRES, the mean readability of all PROMs was 69.2 ± 17.2 (range, 10-96.4), indicating an average eighth to ninth-grade reading level. The mean readability score categorized by the SMOG Index was 8.12 ± 2.65 (range, 3.1-25.6), representing an eighth-grade reading level. Compared with the reading level of the general population, 49 (63.6%) PROMs are written above the United States literacy level, according to FRES. Using stricter definitions of readability, 8 PROMs were considered readable, including PROM Information System pain behavior (FRES: 96.4 and SMOG: 5.2), PROM Information System sleep disturbance (SMOG: 5.6), Neck Pain and Disability Scale (SMOG: 4.3), and Zung Depression Scale (SMOG: 3.1)., Conclusions: Most PROMs utilized in spine surgery require an average reading competency far above the average patient's comprehension. This may have a meaningful impact on understanding PROM instruments and may affect the accuracy of complete surveys and the rates of incompletion., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The primary objective of this study is to further explore associations between social influencers of health and markers of disease severity at the time of presentation of patients with pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) using neighborhood-level Area Deprivation Index (ADI) scores., Methods: A retrospective cross-sectional study was conducted among 344 pediatric MASLD patients. Each patient received an ADI score based on their 9-digit zip code. Groups were defined as low (≤5) and high (6≥) ADI. Associations between ADI and symptomatology and laboratory values at presentation, as well as initial liver biopsy pathology were tested via analyses of covariance, χ 2 testing, and logistic regressions., Results: The mean ADI was 6.54 (standard deviation = 2.09). ADI groups did not significantly differ in age of presentation, type of presentation, or associated conditions, except for the higher ADI group having on average lower vitamin D levels (26.70 vs. 29.91, p = 0.02) and being two times more likely to also be diagnosed with low high-density lipoprotein (HDL) levels (p = 0.04, 95% CI 1.04-3.89). Mean transaminases and histopathologic nonalcoholic fatty liver disease (NAFLD) Activity Scores did not significantly differ between ADI groups., Conclusions: Pediatric patients with MASLD in this study span the entire spectrum of neighborhood deprivation. There were no differences in presentation characteristics or severity of MASLD, aside from lower HDL-cholesterol and vitamin D values in the high ADI group. Area deprivation was not predictive of more severe disease as assessed by serum transaminases and liver biopsy NAFLD activity scores., (© 2024 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Background: In pediatric Crohn's disease (CD), commercial formulas used as exclusive enteral nutrition (EEN) are effective at inducing remission. This study aims to assess the impact of a whole-food blended smoothie as EEN on CD activity and the intestinal microbiome., Methods: A 4-week prospective trial assessed the impact of EEN with a whole-food smoothie on newly diagnosed mild-to-moderate active pediatric CD. The smoothie with a multivitamin were developed to meet age-appropriate nutritional requirements. Assessment over 4 weeks included Pediatric Crohn's Disease Activity Index (PCDAI), serum laboratories, fecal calprotectin (FCP), and stool collection for metagenomic shotgun sequencing and microbiota composition analysis. Clinical remission was defined as PCDAI ≤ 10 at week 4., Results: Ten participants were enrolled with median age 14.5 years, and 8 completed the trial. Baseline mean PCDAI was 26.3 ± 9.1 and mean FCP 1149 ± 718 µg/g. At week 4, 80% of participants achieved clinical remission. FCP decreased by over half in 60% of participants, with FCP below 250 µg/g in 60% and below 100 µg/g in 40%. Microbiome analysis showed a significant increase in species richness over 4 weeks (p = 0.01). Compared to baseline, the relative abundance at week 2 and at week 4 was significantly increased for Bifidobacterium and Streptococcus and decreased for Blautia (p < 0.05 for all)., Conclusion: A whole-food blended smoothie was effective for inducing clinical remission and decreasing FCP in pediatric CD similar to commercial EEN formulas. Further research may give insight into data-driven whole-food dietary approaches for CD management., Clinicaltrials: gov NCT03508193., (© 2024 The Authors. Journal of Pediatric Gastroenterology and Nutrition published by Wiley Periodicals LLC on behalf of European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Objective: The aim of this study was to determine whether urine biomarkers of kidney health are associated with subclinical cardiovascular disease among men with and without HIV., Design: A cross-sectional study within the Multicenter AIDS Cohort Study (MACS) among 504 men with and without HIV infection who underwent cardiac computed tomography scans and had urine biomarkers measured within the preceding 2 years., Methods: Our primary predictors were four urine biomarkers of endothelial (albuminuria), proximal tubule dysfunction (alpha-1-microglobulin [A1 M] and injury (kidney injury molecule-1 [KIM-1]) and tubulointerstitial fibrosis (pro-collagen-III N-terminal peptide [PIIINP]). These were evaluated for association with coronary artery calcium (CAC) prevalence, CAC extent, total plaque score, and total segment stenosis using multivariable regression., Results: Of the 504 participants, 384 were men with HIV (MWH) and 120 were men without HIV. In models adjusted for sociodemographic factors, cardiovascular disease risk factors, eGFR, and HIV-related factors, each two-fold higher concentration of albuminuria was associated with a greater extent of CAC (1.35-fold higher, 95% confidence interval 1.11-1.65), and segment stenosis (1.08-fold greater, 95% confidence interval 1.01-1.16). Associations were similar between MWH and men without HIV in stratified analyses. The third quartile of A1 M showed an association with greater CAC extent, total plaque score, and total segment stenosis, compared with the lowest quartile., Conclusion: Worse endothelial and proximal tubule dysfunction, as reflected by higher urine albumin and A1 M, were associated with greater CAC extent and coronary artery stenosis., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: People with HIV (PWH) generally have worse ambulatory levels of kidney injury biomarkers and excess risk of acute kidney injury (AKI) compared to persons without HIV. We evaluated whether ambulatory measures of subclinical kidney injury among PWH are associated with subsequent AKI., Methods: In the Predictors of Acute Renal Injury Study (PARIS), which enrolled 468 PWH from April 2016 to August 2019, we measured 10 urine biomarkers of kidney health (albumin, a1m, b2M, NGAL, IL18, KIM-1, EGF, UMOD, MCP-1, YKL40) at baseline and annually during follow-up. Using multivariable Cox regression models, we evaluated baseline and time-updated biomarker associations with the primary outcome of AKI (≥0.3 mg/dl or ≥1.5-times increase in serum creatinine from baseline) and secondary outcome of all-cause hospitalization., Results: At baseline, the mean age was 53 years old, and 45% self-identified as female. In time-updated models adjusting for sociodemographic factors, comorbidities, albuminuria, estimated glomerular filtration rate, and HIV-associated factors, higher KIM-1 [hazard ratio (HR) = 1.30 per twofold higher; 95% confidence interval (CI) 1.03-1.63] and NGAL concentrations (HR = 1.24, 95% CI 1.06-1.44) were associated with higher risk of hospitalized AKI. Additionally, in multivariable, time-updated models, higher levels of KIM-1 (HR = 1.19, 95% CI 1.00, 1.41), NGAL (HR = 1.13, 95% CI 1.01-1.26), and MCP-1 (HR = 1.20, 95% CI 1.00, 1.45) were associated with higher risk of hospitalization., Conclusions: Urine biomarkers of kidney tubular injury, such as KIM-1 and NGAL, are strongly associated with AKI among PWH, and may hold potential for risk stratification of future AKI., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The authors report no conflicts of interest.

Introduction: Optic perineuritis (OPN) is a previously undescribed sequela of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here we present a case of OPN that developed several weeks after initial confirmation of the presence of novel coronavirus RNA in the nasopharynx by polymerase chain reaction assay and subsequent confirmation of SARS-CoV-2 IgG seropositivity in the absence of other systemic inflammatory or infectious markers., Case Report: An asymptomatic 71-year-old man with noninsulin-dependent diabetes mellitus (NIDDM) tested RNA positive for SARS-CoV-2 during a routine screening of patients at a skilled nursing facility. ~3 weeks after the positive SARS-CoV-2 polymerase chain reaction test, the patient developed subacute ophthalmoparesis of the left eye, horizontal diplopia, retro-orbital pain, and frontal headache. An urgent magnetic resonance imaging of the head and orbits suggested OPN. Cerebrospinal fluid studies were without evidence of other infectious, inflammatory, neoplastic, or paraneoplastic processes. He was started on a 5-day course of high-dose intravenous steroids and later transitioned to oral steroid therapy. Sixteen days after the initiation of steroid therapy, the patient had no headache or retro-orbital pain and demonstrated a marked improvement in horizontal gaze., Conclusion: SARS-CoV-2-associated neurological sequelae have been increasingly recognized during the current coronavirus disease 2019 pandemic. The present case suggests that patients with confirmed SARS-CoV-2 positivity, even without pulmonary or other classic manifestations of active infection, may manifest diverse clinical presentations including postinfectious OPN that could be related to an underlying autoimmune reactive inflammatory response., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To evaluate the impact of type and dose of swallowed topical steroids (STS) and concurrent steroid therapy on the development and resolution of adrenal insufficiency (AI) in pediatric eosinophilic esophagitis (EoE)., Methods: We performed a retrospective case-control study of pediatric EoE subjects in a single tertiary care center, who were treated with STS for at least 3 months and diagnosed with AI based on a peak stimulated cortisol level of <18 µg/dL (500 nmol/L). Steroid forms and doses, and endoscopy data were collected at the time of AI diagnosis and AI resolution or the last known evaluation. Steroid formulations were converted to a fluticasone-equivalent dose for analysis., Results: Thirty-two EoE subjects with AI were identified, and 20 had AI resolution, including 12 who remained on lower dose STS. Eight of the 32 patients were also treated with extended-release budesonide (ER budesonide), which resulted in a 7-fold higher total daily steroid dose, and thus were analyzed separately. When the 24 cases that were not on ER budesonide were compared to the 81 controls, no difference was found in the STS dose nor total daily steroid dose, although the inhaled steroid dose had marginal significance. Peak eosinophil counts tended to increase when STS doses were decreased, except in subjects on ER budesonide at AI diagnosis., Conclusion: Altering the total daily steroid regimen can lead to resolution of AI in patients with EoE, though this may come at the expense of disease control., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Abstract: Factitious disorder, a disorder characterized by the falsification of symptoms to obtain primary gain, continues to be one of the more challenging cases that psychiatrists encounter. We describe a case of a woman we treated on the medical unit who falsified several of her symptoms but also was diagnosed with Yao syndrome, a disease that can also cause unexplained symptoms such as abdominal pain and fever. We navigate the difficulties in managing this type of patient and comanaging her with medicine and rheumatology. Although the prevalence of factitious disorder is anywhere from 1% to 2% of patients on the medical floor, they typically utilize a disproportionate number of resources. Despite this, the literature is still inconclusive when it comes to the management and treatment approaches. More study is warranted on this complex and burdensome illness., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Significance: This case report demonstrates the use of novel imaging techniques and functional tests to longitudinally evaluate retinal structure and function after laser retinal injury. The structural and functional prognosis could be predicted with clinical findings, high-resolution retinal imaging, and functional testing., Purpose: We present a laser retinal injury case in which an adaptive optics scanning laser ophthalmoscope and adaptive optics-based psychophysics were used to examine and monitor retinal structure and function after accidental exposure to a 1-W infrared laser beam., Case Report: A 23-year-old patient was unwittingly exposed to a 1-W, 852-nm continuous-wave laser at work as they noticed a small central blurry spot in the right eye. An initial eye examination was done 1 day after exposure, and the right eye's acuity was 20/25 -2 . Posterior segment evaluation revealed disrupted outer retina near the right eye's fovea. Adaptive optics imaging 2 weeks after the exposure revealed a 0.50 × 0.75° elliptical area with irregular borders and abnormal cone reflectivity just below the fovea. Starting at 1-month follow-up, structural recovery was observed on optical coherence tomography (OCT). Subsequent adaptive optics imaging showed significant recovery of cone reflectivity. Importantly, adaptive optics microperimetry showed measurable detection thresholds at all affected retinal locations at 6 months. By 10 months, all sites exhibited normal sensitivities., Conclusions: Retinal structure and function from laser injury can be visualized and measured with OCT, adaptive optics imaging, and psychophysics. An intact Bruch's membrane on OCT and measurable retinal sensitivity by adaptive optics microperimetry may serve as good biomarkers for retinal recovery., Competing Interests: Conflict of Interest Disclosure: AR has a patent on the adaptive optics scanning laser ophthalmoscope retinal imaging technology used in this study. The patent is assigned to the University of Rochester and the University of Houston. AR has a patent on the microperimetry technique used in this study. The patent is assigned to the University of California. WST has a patent on the microperimetry technique used in this study. The patent is assigned to the University of California., (Copyright © 2023 American Academy of Optometry.)

Background: Trauma centers (TCs) improve patient outcomes. Few investigations detail the US geographical distribution of Level 1 and 2 TCs (L1TCs, L2TCs) regarding motor vehicle collision (MVC) injuries/fatalities., Objective: We utilized Geographic Information Systems mapping to investigate the distribution of L1TCs and L2TCs in relation to population growth, MVC injuries, and MVC fatalities at the county and regional level to identify any disparities in access to trauma care., Methods: A cross-sectional analysis of L1TC and L2TC distribution, MVC injuries/fatalities, and population growth from 2010 to 2018. Information was gathered at the county and region level for young adults (aged 15-44), middle-aged adults (45-64), and elderly (≥65)., Results: A total of 263 L1TCs across 46 states and 156 counties and 357 L2TCs across 44 states and 255 counties were identified. The mean distance between L1TCs and L2TCs is 28.3 miles and 31.1 miles, respectively. Seven counties were identified as being at-risk, all in the Western and Southern US regions that experienced ≥10% increase in population size, upward trends in MVC injuries, and upward trends MVC fatalities across all age groups., Conclusions: Seven US counties containing ≤2 ACSCOT-verified and/or state-designated L1TCs or L2TCs experienced a 10% increase in population, MVC injuries, and MVC fatalities across young, middle-aged and elderly adults from 2010 to 2018. This study highlights chronic disparities in access to trauma care for MVC patients. Evaluation of state limitations regarding the distribution of L1TCs and L2TCs, frequent evaluation of local and regional trauma care needs, and strategic interventions to improve access to trauma care may improve patient outcomes for heavily burdened counties., Competing Interests: The authors report no conflicts of interests., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: We sought to characterize differences in pancreatectomy recommendation rates to surgically eligible patients with pancreatic ductal adenocarcinoma of the pancreatic head across age and racial groups., Background: Pancreatectomy is not recommended in almost half of otherwise healthy patients with stage I/II pancreatic ductal adenocarcinoma lacking a surgical contraindication. We characterized differences in pancreatectomy recommendation among surgically eligible patients across age and racial groups., Methods: Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) patients were identified in the National Cancer Database with clinical stage I/II pancreatic head adenocarcinoma, Charlson Comorbidity Index of 0 to 1, and age 40 to 89 years. Rates of surgery recommendation and overall survival (OS) by age and race were compared. A Pancreatectomy Recommendation Equivalence Point (PREP) was defined as the age at which the rate of not recommending surgery matched the rate of recommending and completing surgery. Marginal standardization was used to identify association of age and race with recommendation. OS was compared using Kaplan-Meier and Cox regression models., Results: Among 40,866 patients, 36,133 (88%) were NHW and 4733 (12%) were NHB. For the entire cohort, PREP was 79 years. PREP was 5 years younger in NHB patients than in NHW patients (75 vs 80 years). Adjusted rates of not recommending surgery were significantly higher for NHB than for NHW patients in each age group. After adjusting for surgery recommendation, we found no difference in OS between NHW and NHB patients (hazard ratio 0.98 [95% CI 0.94-1.02])., Conclusions: PREP of NHB patients was 5 years younger than NHW patients, and in every age group, the rate of not recommending pancreatectomy was higher in NHB patients. Age and race disparities in treatment recommendations may contribute to shorter longevity of NHB patients., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: This was a retrospective multicenter study., Objective: To develop a novel progression risk stratification scoring system for early-onset scoliosis., Summary of Background Data: There is a lack of investigations into variables affecting the risk of curve progression in early-onset scoliosis, which prevents stratification. A novel risk score system is needed to help in progression risk estimation., Methods: A retrospective analysis was done at three centers, from 1995 to 2020. Scoliosis cases before the age of 10 years, were included. Medical identifier, date of birth, sex, primary diagnosis, curve type, date/modality of treatment, date of follow-up appointments, and Cobb angles, were collected. Five ranks were selected for stratification. Categories with the same ranks were discarded. Point scores started at 0, for the lowest risk, and ended at 4, for highest risk. Iterations of variable combinations were conducted and clinical relevance was determined by evaluating sensitivity, specificity, positive predictive value, and negative predictive value based on score ranges for low and high risk of progression., Results: A total of 476 (230 males, 246 females) early-onset scoliosis patients were collected. The average age at diagnosis was 4.8 years (SD±2.8 yr). The average follow-up duration was 9.3 years (SD±6.9 yr, range: 5 mo-38 yr). Appointments totaled 2911, giving 2182 observations for the analysis. Patient observations numbered: 800 (36.7%) ending in progression, 1265 (58.0%) for nonprogression, 117 (5.4%) for inadequate follow-up, and 368 (16.9%) for rapid progression. The risk scoring system contained four categories: etiology, age, curve magnitude, and curve type. Categorized point combinations totaled 755, giving 1975 iterations. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to be 85.8%, 96.5%, 89.7%, and 95.1%, respectively., Conclusion: A novel progression risk score for early-onset scoliosis was derived. The system can reliably differentiate between low and high-risk cases in clinical settings. Further validation in other regions may be important for verifying clinical relevance., Level of Evidence: Level 3., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Objectives: With the rate of physician suicide increasing, more research is needed to implement adequate prevention interventions. This study aims to identify trends and patterns in physician/surgeon suicide and the key factors influencing physician suicide. We hope such information can highlight areas for targeted interventions to decrease physician suicide., Methods: Review of Centers for Disease Control and Preventions National Violent Death Reporting System (NVDRS) for 2003 to 2017 of physician and dentists dying by suicide. Twenty-eight medical, surgical, and dental specialties were included., Results: Nine hundred five reported suicides were reviewed. Physician suicides increased from 2003 to 2017. Majority surgeons' suicides were middle-aged, White males. Orthopedic surgeons had the highest prevalence of suicide among surgical fields (28.2%). Black/African American surgeons were 56% less likely [odds ratio (OR) = 0.44, 95% confidence interval (CI): 0.06-3.16] and Asian/Pacific Islander were 438% more likely (OR = 5.38, 95% CI: 2.13-13.56) to die by suicide. Surgeons were 362% more likely to have a history of a mental disorder (OR = 4.62, 95% CI: 2.71-7.85), were 139% more likely to use alcohol (OR = 2.39, 95% CI: 1.36-4.21), and were 289% more likely to have experienced civil/legal issues (OR = 3.89, 95% CI: 1.36-11.11)., Conclusions: The prevalence of physician suicide increased over the 2003 to 2017 time-frame with over a third of deaths occurring from 2015 to 2017. Among surgeons, orthopedics has the highest prevalence of reported suicide.Risk factors for surgeon suicide include Asian/Pacific Islander race/ethnicity, older age, history of mental disorder, alcohol use, and civil/legal issues., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The purpose of this retrospective case series was to compare the outcomes of different treatment options for patients diagnosed with hereditary benign intraepithelial dyskeratosis (HBID)., Methods: The study is designed as a single-institution retrospective chart review of patients who were clinically diagnosed with HBID during their care at the Duke Eye Center. Patient demographics were obtained, and disease course after different therapies was analyzed., Results: Seventeen patients were diagnosed with HBID. 52.9% (9/17) of patients identified with HBID reported Native American ancestry. Medical therapy alone failed to reduce the size or number of corneal lesions in any patient identified in this study. Ten of the 17 patients required surgical intervention. Two eyes received corneal biopsies, 3 eyes received a full conjunctival lesion excision with amniotic membrane grafting, 12 eyes received superficial keratectomy with amniotic membrane grafting, and 1 eye received keratoprosthesis. Lesion recurrence was seen in 9 of the 10 patients treated with surgical excision with an average time to recurrence of 1.5 and 2 months for conjunctival excisions and superficial keratectomy, respectively, when excluding patients who missed scheduled postoperative follow-up appointments., Conclusions: Hereditary benign intraepithelial dyskeratosis is a rare and poorly understood disorder that predominantly affects people with Native American ancestry. Medical therapy only provides symptomatic relief, and patients who receive surgical excision almost always develop recurrence. As a result, we recommend future investigations focus on identifying the optimal surgical technique and timing to limit the morbidity of HBID and improve outcomes., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The rapid development and adoption of oral anticancer agents (OAAs) for cancer management have shifted patients' roles from recipient to owner of their care delivery, assuming their responsibilities for self-managing their OAA treatments at home, while the concept of oral anticancer agent self-management (OAA-SM) has not been well clarified and defined., Objective: This study was to clarify the concept of OAA-SM and identify major components, influential factors, and consequences of OAA-SM, as well as propose a representative conceptual model of OAA-SM., Methods: A literature review was conducted concerning the concept and application of OAA-SM. The Walker and Avant method for concept analysis was utilized to guide the examination of OAA-SM., Results: OAA-SM is a multifaceted and dynamic process that requires continuous adaptation by patients as multiple self-management challenges can emerge throughout OAA treatments. The defining attributes of OAA-SM include OAA adherence, adverse-effect self-management, patient-provider communication, and OAA safe storage, handling, and administration practices. Oral anticancer agent-SM is potentially influenced by a variety of patient-related, OAA-related, and healthcare system factors. Effective OAA-SM is associated with better patient and healthcare outcomes., Conclusions: The clarification of the concept of OAA-SM and the identification of attributes of OAA-SM and their interrelationships contribute to the body of knowledge in OAA-SM., Implications for Practice: This concept analysis provides the foundation to increase healthcare providers' understanding of patients' needs for OAA-SM support and guides the development of patient-centered interventions to empower and engage patients and their families in effective OAA-SM, and improve patients' quality of life and care., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Early-onset scoliosis (EOS) is common in children with cerebral palsy (CP). The effectiveness of magnetically controlled growing rods (MCGR) and the risk for unplanned return to the operating room (UPROR) remain to be studied in this patient population. The primary outcome of this study was to examine the frequency of UPROR between MCGRs as compared with traditional growth friendly (TGF) surgeries for children with EOS secondary to CP., Methods: Patients with EOS secondary to CP were prospectively identified from an international database, with data retrospectively analyzed. Scoliosis, kyphosis, T1-S1, and T1-T12 height were measured preoperation, immediate postoperation, and at minimum 2-year follow-up. The risk and etiology of UPRORs were compared between MCGR and TGF., Results: Of the 120 patients that met inclusion criteria, 86 received TGF (age 7.5±0. 1.8 y; mean follow-up 7.0±2.9 y) and 34 received MCGR (age 7.1±2.2 y, mean follow-up 2.8±0.0.5 y). Compared with TGF, MCGR resulted in significant improvements in maintenance of scoliosis (P=0.007). At final follow-up, UPRORs were 8 of 34 patients (24%) for MCGR and 37 of 86 patients (43%) for TGF (P=0.05). To minimize the influence of follow-up period, UPRORs within the first 2 years postoperation were evaluated: MCGR (7 of 34 patients, 21%) versus TGF (20 of 86 patients, 23%; P=0.75). Within the first 2 years, etiology of UPROR as a percentage of all patients per group were deep infection (13% TGF, 6% MCGR), implant failure/migration (12% TGF, 9% MCGR), dehiscence (4% TGF, 3% MCGR), and superficial infection (4% TGF, 3% MCGR). The most common etiology of UPROR for TGF was deep infection and for MCGR was implant failure/migration., Conclusion: For patients with EOS secondary to CP, there was no difference in the risk of UPROR within the first 2 years postoperatively whether treated with TGF surgery or with MCGRs (23% TGF, 21% MCGR)., Level of Evidence: Level III-retrospective cohort, therapeutic study., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)