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Objective To determine the prevalence of poor mental and physical health among mothers of children with special health care needs (CSHCN) and to determine the association between maternal health and the child's number of special health care needs (SHCN) and severity of ability limitation. Methods We used the combined 2016-2018 National Survey of Children's Health Dataset of 102,341 children ages 0-17 including 23,280 CSHCN. We used regression models to examine the associations of a child's number of SHCN and ability limitations with maternal health. Results Twice as many mothers of CSHCN had poor mental and physical health compared to non-CSHCN (mental 10.3% vs. 4.0%, p < .001; physical 11.9% vs 5.0%, p < .001). In regression models, increased number of SHCN and severity of activity limitations were associated with significantly increased odds of poor maternal health. Conclusions for Practice Mothers of CSHCN have worse health compared to mothers of non-CSHCN, especially those who experience social disadvantage and those with children with complex SHCN or severe ability limitations. Interventions to improve the health of these particularly vulnerable caregivers of CSHCN are warranted., Author(s): Thomas K. Hagerman [sup.1] , Gina P. McKernan [sup.2] , Adam C. Carle [sup.3] , Justin A. Yu [sup.4] , Alyson D. Stover [sup.5] , Amy J. Houtrow [sup.6] [...]

Background: Testing etiologic heterogeneity, whether a disorder subtype is more or less impacted by a risk factor, is important for understanding causal pathways and optimizing statistical power. The study of mental health disorders especially benefits from strategic subcategorization because these disorders are heterogeneous and frequently co-occur. Existing methods to quantify etiologic heterogeneity are not appropriate for noncompeting events in an open cohort of variable-length follow-up. Thus, we developed a new method. Methods: We estimated risks from urban residence, maternal smoking during pregnancy, and parental psychiatric history, with subtypes defined by the presence or absence of a codiagnosis: autism alone, attention defi- cit hyperactivity disorder (ADHD) alone, and joint diagnoses of autism + ADHD. To calculate the risk of a single diagnosis (e.g., autism alone), we subtracted the risk for autism + ADHD from the risk for autism overall. We tested the equivalency of average risk ratios over time, using a Wald-type test and bootstrapped standard errors. Results: Urban residence was most strongly linked with autism + ADHD and least with ADHD only; maternal smoking was associated with ADHD only but not autism only; and parental psychiatric history exhibited similar associations with all subgroups. Conclusion: Our method allowed the calculation of appropriate P values to test the strength of association, informing etiologic heterogeneity wherein two of these three risk factors exhibited different impacts across diagnostic subtypes. The method used all available data, avoided neurodevelopmental outcome misclassification, exhibited robust statistical precision, and is applicable to similar heterogeneous complex conditions using common diagnostic data with variable follow-up. [ABSTRACT FROM AUTHOR]

Objective: To better understand the strategies family caregivers of children with medical complexity (CMC) utilize to deal with the stress and challenges associated with caregiving. Methods: We conducted a cross-sectional qualitative study among family caregivers of CMC receiving medical care at a children's hospital in Western Pennsylvania. Participants completed in-depth, semi-structured interviews focused on how CMC family caregivers approach and manage caregiving-related challenges and stress. Using constant comparative methodology, we inductively analyzed deidentified transcripts for emergent themes. Results: We interviewed 19 participants (89.4% female) with a mean age of 43 years (range 32–54 years). The mean age of the participants' children was 10.8 years (range 1–20 years). Twelve participants' children identified as white and four identified as Black. Three central themes regarding CMC caregivers' stress-coping strategies emerged: (1) maintaining a positive mindset, (2) developing and relying on interpersonal support networks, and (3) making time for self-preservation. All three themes were universally reported (n = 19/19) by our participants. The most common subthemes for each theme, respectively, focused on staying hopeful and celebrating moments of joy; cultivating supportive relationships with family, friends, and fellow CMC family caregivers; and finding pleasure in "little things" (e.g., everyday activities and hobbies). Conclusion: Family caregivers of CMC utilize a multi-faceted approach to cope with the stress and challenges routinely encountered in caring for CMC. This study's findings could be used to inform future clinical efforts and research directions aiming to improve clinicians' ability to support CMC caregivers' well-being. [ABSTRACT FROM AUTHOR]

High-cost DNA extraction procedures pose significant challenges for budget-constrained laboratories. To address this, we introduce OpenCell, an economical, open-source, 3-in-1 laboratory device that combines the functionalities of a bead homogenizer, a microcentrifuge, and a vortex mixer. OpenCell utilizes modular attachments that magnetically connect to a central rotating brushless motor. This motor couples to an epicyclic gearing mechanism, enabling efficient bead homogenization, vortex mixing, and centrifugation within one compact unit. OpenCell's design incorporates multiple redundant safety features, ensuring both the device's and operator's safety. Additional features such as RPM measurement, programmable timers, battery operation, and optional speed control make OpenCell a reliable and reproducible laboratory instrument. In our study, OpenCell successfully isolated DNA from Spinacia oleracea (spinach), with an average yield of 2.3 μg and an A260/A280 ratio of 1.77, demonstrating its effectiveness for downstream applications such as Polymerase Chain Reaction (PCR) amplification. With its compact size (20 cm x 28 cm x 6.7 cm) and lightweight design (0.8 kg), comparable to the size and weight of a laptop, OpenCell is portable, making it an attractive component of a 'lab-in-a-backpack' for resource-constrained environments in low-and-middle-income countries and synthetic biology in remote field stations. Leveraging the accessibility of 3D printing and off-the-shelf components, OpenCell can be manufactured and assembled at a low unit cost of less than $50, providing an affordable alternative to expensive laboratory equipment costing over $4000. OpenCell aims to overcome the barriers to entry in synthetic biology research and contribute to the growing collection of frugal and open hardware. [ABSTRACT FROM AUTHOR]

Children with medical complexity (CMC) are a medically fragile pediatric population that experience severe chronic illnesses resulting in significant health care needs, functional limitations, and health care utilization, and are at the highest risk for morbidity and mortality among all children. Furthermore, families and parents of CMC experience significant caregiver hardships and diminished quality of life. The field of pediatric palliative care has grown in recent years, in part to address the physical and psychosocial issues inherent to the care of these chronically ill children. However, as the prevalence and long-term survival of CMC increases with medical advancements, the demand for pediatric palliative care will likely exceed the capacity of current and future pediatric palliative care specialists. Therefore, alternative strategies to ensure access to essential aspects of palliative care must be considered. This article focuses on why and how high-quality palliative care should be integrated into the patient- and family-centered medical home, the ideal care delivery model for CMC and their families. We first discuss how palliative care principles naturally align with and complement the goals of the CMC medical home. Next, we detail what actions pediatric palliative care specialists can take to best support the CMC medical home as 'medical neighbors.' Lastly, we describe the fundamental aspects of pediatric palliative care that all clinicians caring for CMC should be able to provide, referred to as 'primary pediatric palliative care.' Keywords: children with medical complexity, pediatric palliative care, medical home, medical neighborhood, Children with medical complexity (CMC) have multiple, severe chronic health conditions that result in significant health care needs, health care utilization, and functional limitations (Cohen, Jovcevska, Kuo, & Mahant, 2011). [...]

BACKGROUND: The mechanisms by which salt increases blood pressure in people with salt sensitivity remain unclear. Our previous studies found that high sodium enters antigen-presenting cells (APCs) via the epithelial sodium channel and leads to the production of isolevuglandins and hypertension. In the current mechanistic clinical study, we hypothesized that epithelial sodium channel–dependent isolevuglandin-adduct formation in APCs is regulated by epoxyeicosatrienoic acids (EETs) and leads to salt-sensitive hypertension in humans. METHODS: Salt sensitivity was assessed in 19 hypertensive subjects using an inpatient salt loading and depletion protocol. Isolevuglandin-adduct accumulation in APCs was analyzed using flow cytometry. Gene expression in APCs was analyzed using cellular indexing of transcriptomes and epitopes by sequencing analysis of blood mononuclear cells. Plasma and urine EETs were measured using liquid chromatography–mass spectrometry. RESULTS: Baseline isolevuglandin+ APCs correlated with higher salt-sensitivity index. Isolevuglandin+ APCs significantly decreased from salt loading to depletion with an increasing salt-sensitivity index. We observed that human APCs express the epithelial sodium channel δ subunit, SGK1 (salt-sensing kinase serum/glucocorticoid kinase 1), and cytochrome P450 2S1. We found a direct correlation between baseline urinary 14,15 EET and salt-sensitivity index, whereas changes in urinary 14,15 EET negatively correlated with isolevuglandin+ monocytes from salt loading to depletion. Coincubation with 14,15 EET inhibited high-salt–induced increase in isolevuglandin+ APC. CONCLUSIONS: Isolevuglandin formation in APCs responds to acute changes in salt intake in salt-sensitive but not salt-resistant people with hypertension, and this may be regulated by renal 14,15 EET. Baseline levels of isolevuglandin+ APCs or urinary 14,15 EET may provide diagnostic tools for salt sensitivity without a protocol of salt loading. [ABSTRACT FROM AUTHOR]

Objective: For patients with advanced cancer, pain is a common and debilitating symptom that can negatively impact physical, emotional, and spiritual well‐being. This trial examined the feasibility and initial effects of Meaning‐Centered Pain Coping Skills Training (MCPC), a cognitive‐behavioral pain management intervention with an emphasis on enhancing meaning (i.e., a personal sense of purpose, worth, and significance) and peace. Methods: We enrolled 60 adults with stage IV solid tumor cancers and moderate‐severe pain between February 2021 and February 2022. Participants were randomized 1:1 to MCPC + usual care or usual care alone. Meaning‐Centered Pain Coping Skills Training consisted of four weekly 60‐min individual sessions via videoconference or telephone, delivered by a trained therapist using a manualized protocol. Participants completed validated measures of pain severity, pain interference, pain self‐efficacy, spiritual well‐being (i.e., meaning, peace, and faith), and psychological distress at baseline and 5‐week and 10‐week follow‐ups. Results: All feasibility metrics exceeded prespecified benchmarks. Fifty‐eight percent of screened patients were eligible, and 69% of eligible patients consented. Of those assigned to MCPC, 93% completed all sessions and 100% of those who completed follow‐ups reported using coping skills weekly. Retention was strong at 5‐week (85%) and 10‐week (78%) follow‐ups. Meaning‐Centered Pain Coping Skills Training participants reported better scores than control participants across outcome measures, including moderate‐to‐large sized differences at 10‐week follow‐up in pain severity (Cohen's d = −0.75 [95% confidence interval: −1.36, −0.14]), pain interference (d = −0.82 [‐1.45, −0.20]), and pain self‐efficacy (d = 0.74 [0.13, 1.35]). Conclusions: MCPC is a highly feasible, engaging, and promising approach for improving pain management in advanced cancer. Future efficacy testing is warranted. Trial registration: ClinicalTrials.gov Identifier: NCT04431830, registered 16 June 2020. [ABSTRACT FROM AUTHOR]

This article describes a new hands-on, or "kinesthetic," activity for use in a physiology lecture hall to help students comprehend an important concept in cardiopulmonary physiology known as oxygen carrying capacity. One impetus for designing this activity was to address the needs of students who have a preference for kinesthetic learning and to help increase their understanding and engagement during lecture. This activity uses simple inexpensive materials, provides an effective model for demonstrating related pathophysiology, and helps promote active learning. The activity protocol and its implementation are described here in detail. We also report data obtained from student surveys and assessment tools to determine the effectiveness of the activity on student conceptual learning and perceptions. A brief multiple-choice pretest showed that although students had already been introduced to the relevant concepts in lecture, they had not yet mastered these concepts before performing the activity. Two postactivity assessments showed that student performance was significantly improved on the posttest compared with the pretest and that information was largely retained at the end of the course. Survey data showed that one-half of the students stated kinesthetic learning as among their learning preferences, yet nearly all students enjoyed and were engaged in this hands-on kinesthetic activity regardless of their preferences. Most students would recommend it to their peers and expressed a desire for more kinesthetic learning opportunities in the lecture curriculum. (Contains 2 footnotes, 3 tables, and 4 figures.)

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Aim: To quantify financial toxicity and out-of-pocket costs for patients with HNC in Australia and explore their relationship with health-related quality of life (HRQoL). Methods: A cross-sectional survey was administered to patients with HNC 1–3 years after radiotherapy at a regional hospital in Australia. The survey included questions on sociodemographics, out-of-pocket expenses, HRQoL, and the Financial Index of Toxicity (FIT) tool. The relationship between high financial toxicity scores (top quartile) and HRQoL was explored. Results: Of the 57 participants included in the study, 41 (72%) reported out-of-pocket expenses at a median of AUD 1796 (IQR AUD 2700) and a maximum of AUD 25,050. The median FIT score was 13.9 (IQR 19.5) and patients with high financial toxicity (n = 14) reported poorer HRQoL (76.5 vs. 114.5, p < 0.001). Patients who were not married had higher FIT scores (23.1 vs. 11.1, p = 0.01), as did those with lower education (19.3 vs. 11.1, p = 0.06). Participants with private health insurance had lower financial toxicity scores (8.3 vs. 17.6, p = 0.01). Medications (41%, median AUD 400), dietary supplements (41%, median AUD 600), travel (36%, median AUD 525), and dental (29%, AUD 388) were the most common out-of-pocket expenses. Participants living in rural locations (≥100 km from the hospital) had higher out-of-pocket expenses (AUD 2655 vs. AUD 730, p = 0.01). Conclusion: Financial toxicity is associated with poorer HRQoL for many patients with HNC following treatment. Further research is needed to investigate interventions aimed at reducing financial toxicity and how these can best be incorporated into routine clinical care. [ABSTRACT FROM AUTHOR]

Salt-sensitivity of blood pressure is an independent risk factor for cardiovascular disease and affects approximately half of the hypertensive population. While the precise mechanisms of salt-sensitivity remain unclear, recent findings on body sodium homeostasis and salt-induced immune cell activation provide new insights into the relationship between high salt intake, inflammation, and hypertension. The immune system, specifically antigen-presenting cells (APCs) and T cells, are directly implicated in salt-induced renal and vascular injury and hypertension. Emerging evidence suggests that oxidative stress and activation of the NLRP3 inflammasome drive high sodium-mediated activation of APCs and T cells and contribute to the development of renal and vascular inflammation and hypertension. In this review, we summarize the recent insights into our understanding of the mechanisms of salt-sensitive hypertension and discuss the role of inflammasome activation as a potential therapeutic target. [ABSTRACT FROM AUTHOR]

Background: The aim of this review was to determine the prevalence of return to work (RTW) amongst head and neck cancer (HNC) survivors and to determine its impact on quality of life (QoL). Methods: A literature search was conducted in PubMed, Scopus, Embase and CINAHL in March 2021. Articles were included if they reported the number of patients with HNC receiving definitive treatment who were working at the time of diagnosis and returned to work. Results: There were 21 articles deemed eligible for inclusion. Meta‐analysis suggested that 67% of patients with HNC who were employed at diagnosis RTW (95% CI 62%–73%, I2 = 97.53%). Patients who RTW were demonstrated to have lower levels of anxiety and depressive symptoms on the Hospital Anxiety and Depression Scale. Conclusions: Return to work is an important clinical outcome which must be considered in the survivorship care of patients with HNC. [ABSTRACT FROM AUTHOR]

1. Participants will be able to incorporate HCD principles engaging diverse stakeholders to identify patient-centered outcomes in palliative care research. 2. Participants will be able to describe diverse perspectives of patient-centered outcomes for a concurrent hospice and dialysis program. The Concurrent Hospice-Dialysis Program was created to improve care near the end of life for patients with end stage kidney disease (ESKD). We convened a community advisory panel (CAP) comprised of patients, bereaved family caregivers and clinicians to elicit feedback on patient-centered outcomes for concurrent care using a human-centered design methodology. To improve end-of-life experience for patients on dialysis, we developed a concurrent hospice-dialysis program that allows continuation of dialysis alongside hospice. This program increased hospice length of stay (1) and was acceptable to bereaved caregivers and clinicians (2). Using Human Centered Design (HCD), we convened a CAP to identify and prioritize patient-centered outcomes for future testing of concurrent care. HCD is a participatory mechanism to generate ideas that is inclusive and flexible. We utilized HCD to collaborate with CAP members to identify and prioritize potential patient- and family-centered outcomes of the concurrent hospice-dialysis program. To guide HCD activities, we used our previously developed Concurrent Hospice-Dialysis Conceptual Model as a framework. In the first activity ("Creative Matrix"), participants identified outcomes pertinent to the intersection of each phase of our conceptual model and stakeholders (i.e., patients, caregivers, clinicians). Participants organized these outcomes into "affinity clusters", and then prioritized these constructs using an importance-difficulty matrix activity. The CAP was comprised of 1 patient, 3 bereaved caregivers, 1 nephrologist, 1 hospice physician, 1 hospice nurse, and 1 palliative care nurse practitioner. CAP participants identified 6 constructs, ranked in order of importance: (1) ongoing communication, (2) anticipatory guidance, (3) care coordination (4) caregiver support; (5) symptom management and psychosocial support; and (6) utilization metrics. HCD elicited diverse feedback on meaningful patient-centered outcomes for concurrent hospice-dialysis program. Participants identified constructs that will be incorporated into broader implementation and testing of concurrent hospice and dialysis care. Models of Palliative Care DeliveryPatient Outcomes [ABSTRACT FROM AUTHOR]

Objectives  The aim of the study is to evaluate the effect of preoperative vascular embolization (PVE) on juvenile nasopharyngeal angiofibroma (JNA) surgical outcomes using a national pediatric hospitalization database. Methods  The health care cost and utilization project Kids' Inpatient Database was queried for all cases of operative management of JNA between the years of 1997 and 2016. Cases were stratified based on whether the patient received PVE. A multiple linear regression was used to predict the effect of PVE on hospital length of stay (LOS) and total cost while controlling for patient demographic factors and comorbidities. The odds ratio (OR) of receiving a perioperative blood transfusion was computed using a binary logistic regression for PVE patients. Results  A total of 473 patients who underwent JNA surgical resection in this time period were identified. The use of PVE has increased from 0% in 1997 to 66% of all cases by 2016. PVE was found to decrease LOS by 1 day (p  = 0.036) and decrease the odds of needing a perioperative blood transfusion (OR = 0.511, p  = 0.041). Patients receiving PVE were charged an additional $35,600 (p  < 0.001), but recent data in 2016 indicate that hospital costs for PVE are decreasing. Conclusion  PVE of JNA is becoming increasingly prevalent. Embolization results in decreased hospital LOS and lower odds of needing blood transfusions. While embolization increases the cost of management, this trend should be re-evaluated as this procedure is becoming more widespread. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We describe the change in the percentage of children lacking continuous and adequate health insurance (underinsurance) from 2016 to 2019. We also examine the relationships between child health complexity and insurance type with underinsurance. METHODS: Secondary analysis of US children in the National Survey of Children's Health combined 2016--2019 dataset who had continuous and adequate health insurance. We calculated differences in point estimates, with 95% confidence intervals (CIs), to describe changes in our outcomes over the study period. We used multivariable logistic regression adjusted for sociodemographic characteristics and examined relationships between child health complexity and insurance type with underinsurance. RESULTS: From 2016 to 2019, the proportion of US children experiencing underinsurance rose from 30.6% to 34.0% (13.4%; 95% CI, 11.9% to 14.9%), an additional 2.4 million children. This trend was driven by rising insurance inadequacy (24.8% to 27.9% [13.1%; 95% CI, 11.7% to 14.5%]), which was mainly experienced as unreasonable out-of-pocket medical expenses. Although the estimate of children lacking continuous insurance coverage rose from 8.1% to 8.7% (10.6%), it was not significant at the 95% CI (0.5% to 11.7%). We observed significant growth in underinsurance among White and multiracial children, children living in households with income $200% of the federal poverty limit, and those with private health insurance. Increased child health complexity and private insurance were significantly associated with experiencing underinsurance (adjusted odds ratio, 1.9 and 3.5, respectively). CONCLUSIONS: Underinsurance is increasing among US children because of rising inadequacy. Reforms to the child health insurance system are necessary to curb this problem. [ABSTRACT FROM AUTHOR]

Aim: Bedwetting is a common paediatric condition. #Bedwetting has been established as the official hashtag to structure Twitter discussions about the condition. We analysed online Twitter discussions for #Bedwetting. Methods: Symplur, a Twitter analytics service was employed to aggregate Twitter activity, users and content including #Bedwetting, between October 2013 and November 2018. Activity was analysed via tweet volume and user adoption. Users were assorted using geographic location, occupation and affiliation data. Content in #Bedwetting Tweets was undertaken by retrieving information about retweets, links, frequently used words and hashtags. Results: A total of 101 412 tweets and 9957 users utilising #Bedwetting were identified. Most tweets were sent with links (93%). The average ± SD number of tweets using #Bedwetting per month increased from 96 ± 87 in 2013 to 2935 ± 1644 in 2015. Tweet volume decreased to 1960 ± 257 in 2016 and subsequently increased to 2901 ± 1110 in 2017. New users increased from 4 in 2013 to 9957 users in 2018. Users tweeted from 69 countries. Advocacy organisations comprised 35% of the top 100 influencers. Common words in #Bedwetting tweets were 'potty', 'best' and 'training'. Popular associated hashtags were #Pottytraining, #Solutions and #Moms. Hyperlinks in #Bedwetting tweets included advocacy, academic and commercial websites. Conclusions: Our analysis of #Bedwetting highlights that Twitter is frequently used to discuss the condition's diagnosis and management. Various stakeholders in health care are utilising the platform to build awareness about bedwetting. We identified that Twitter is being employed to drive web traffic to other internet websites. [ABSTRACT FROM AUTHOR]