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Data is lacking as to the clinical presentation of erosive esophagitis (EE) in neurologically impaired children compared to non-neurologically impaired children (non-NIC). To determinate the clinical presentation, associations, management, and outcomes of EE in neurologically impaired children compared to children without neurologic impairment.Retrospective chart review of all esophagogastroduodenoscopies performed in pediatric patients at the University of Mississippi Medical Center from 1998 to 2020 with the diagnosis of EE. Fisher's exact test was used to compare results from neurologically impaired children group and non-NIC. A probability0.05 was considered statistically significant.Forty-seven patients were diagnosed with EE and met study criteria. Twenty-six patients were neurologically impaired children, and 21 were non- neurologically impaired children. No significant difference was seen between age at diagnosis, sex, or hematologic markers of anemia. The most common indication for esophagogastroduodenoscopies in neurologically impaired children was hematemesis (65.4%), whereas abdominal pain (33.3%) was the most common in non-NIC. Neurologically impaired children were more likely to be treated with acid-blockade. Nine neurologically impaired children had gastrostomy tubes prior to diagnosis as opposed to 0 non-neurologically impaired children. After diagnosis, 8 neurologically impaired children underwent gastrostomy tube placement compared to 0 non-neurologically impaired children, and fundoplication was performed in 11 neurologically impaired children as compared to 1 non-NIC. The sensitivity of fecal occult blood test for detecting EE was higher for neurologically impaired children (91.7%) than for non-NIC (33.3%).EE in neurologically impaired children presents differently than in non-neurologically impaired children with blood loss being the most common presentation in neurologically impaired children. Neurologically impaired children are more likely to be treated with acid-blockade prior to diagnosis, likely due to heightened risk for gastroesophageal reflux disease (GERD). Additionally, they are more likely to undergo surgical management of EE than non- neurologically impaired children.

IntroductionTrauma activation requires mobilization of significant resources to be available at short notice. In 2014, the American College of Surgeons Committee on Trauma issued its latest recommendations for care of the injured patient. Amongst trauma activation criteria, elderly patients that fell from any height on anticoagulation were included. We hypothesized that a reduced trauma team could preserve patient safety while reducing time and cost spent.MethodA ‘Head Injury Alert’ was created to denote anti-coagulated patients with a GCS > 14 who fell from a height of ResultsTwo hundred and seventy-seven head injury activations occurred; 55% of patients were female, while 45% were male. Average age was 78 years old. The most common anticoagulant was Warfarin (31%). 50% of patients were discharged, 47% were admitted, 2% died before disposition and 1% were transferred to a tertiary care center; 7% required admission to the ICU. The average time-to-CT was 25 min and ISS ranged from 0 to 26. Twenty-two patients (7%) presented with positive head CT. Of the five deaths, three patients had intracranial hemorrhage, one pneumonia present on admission and one cardiac arrest.ConclusionThis level III evidence, prospective study suggests head injury alert can be safely applied as a new level of trauma activation at community hospitals. It helps identify a specific patient population and injury mechanism that can be safely triaged using limited resources. With this, community hospitals can maximize their resources and minimize cost, while maintaining patient safety.

Measurements show large decadal variability in the rate of C O 2 accumulation in the atmosphere that is not driven by C O 2 emissions. The decade of the 1990s experienced enhanced carbon accumulation in the atmosphere relative to emissions, while in the 2000s, the atmospheric growth rate slowed, even though emissions grew rapidly. These variations are driven by natural sources and sinks of C O 2 due to the ocean and the terrestrial biosphere. In this study, we compare three independent methods for estimating oceanic C O 2 uptake and find that the ocean carbon sink could be responsible for up to 40% of the observed decadal variability in atmospheric C O 2 accumulation. Data-based estimates of the ocean carbon sink from p C O 2 mapping methods and decadal ocean inverse models generally agree on the magnitude and sign of decadal variability in the ocean C O 2 sink at both global and regional scales. Simulations with ocean biogeochemical models confirm that climate variability drove the observed decadal trends in ocean C O 2 uptake, but also demonstrate that the sensitivity of ocean C O 2 uptake to climate variability may be too weak in models. Furthermore, all estimates point toward coherent decadal variability in the oceanic and terrestrial C O 2 sinks, and this variability is not well-matched by current global vegetation models. Reconciling these differences will help to constrain the sensitivity of oceanic and terrestrial C O 2 uptake to climate variability and lead to improved climate projections and decadal climate predictions.

e21637 Background: In the Ph 3 IMpower150 study (NCT02366143), 1L treatment (tx) with atezolizumab (A) + bevacizumab (B) + carboplatin + paclitaxel (CP; ABCP) significantly improved PFS and OS vs B + CP (BCP) in pts with chemotherapy-naive metastatic (met) nsq NSCLC. As pts with high tumor burden or large size (bulky disease) have poor survival outcomes, an exploratory analysis was conducted to determine whether pts with bulky disease in IMpower150 could derive benefit from ABCP. Methods: 1202 pts (ITT population) were randomized 1:1:1 to ABCP, atezo + CP (ACP) or BCP arms. Doses were given q3w: A, 1200 mg; B, 15 mg/kg; C, AUC 6 mg/mL/min; P, 200 mg/m2. Disease burden subgroups (high or low) were defined using the 3rd quartile of the sum of the longest diameter (SLD) of the target lesions or median number (no.) of met sites at baseline (BL). Exploratory efficacy analyses included PFS, OS, ORR, time to response (TTR) in these subgroups; safety was also assessed. Outcomes are reported for pts enrolled in the ABCP vs BCP arms. Results: Per 3rd quartile SLD (108 mm), 91 ABCP and 85 BCP pts had high disease burden. Per median no. of met sites (median = 2), 210 ABCP and 190 BCP pts had high disease burden. BL characteristics were generally balanced between ABCP and BCP in high disease burden subgroups. With a minimum follow-up of 32.4 mo (data cutoff: Sep 13, 2019), ABCP showed improved OS, PFS and ORR vs BCP in pts with high and low disease burden (Table). High disease burden did not impact TTR. The safety profile of ABCP was comparable between ITT-WT (no EGFR or ALK alterations) pts and high disease burden subgroups. Conclusions: A tx effect for OS, PFS and ORR was seen in pts with and without bulky disease when ABCP vs BCP was compared, regardless of the method used to define “bulky”; TTR was not affected in high disease burden pts. ABCP had a comparable safety profile in bulky disease and ITT-WT pts. ABCP may be a 1L tx option for pts with nsq NSCLC who have high disease burden. Clinical trial information: NCT02366143. [Table: see text]

A dynamic health care industry continues to call upon health care leaders to possess not one but multiple competencies. Inherent personality characteristics of leaders often play a major role in personal as well as organizational success to include those in health care finance positions of responsibility. A replication study was conducted to determine the Myers-Briggs personality-type differences between practicing health care finance professionals in 2014, as compared with a previous 2003 study. Results indicate a significant shift between both independent samples of health care finance professionals over the 10-year period from original high levels of introversion to that of extraversion, as well as higher sensing personality preferences, as compared with the original sample's high level of intuition preferences. Further investigation into the evolving role of the health care finance manager is suggested, while continued alignment of inherent, personal characteristics is suggested to meet ongoing changes in the industry.

Pyomyositis is a musculoskeletal infection with formation of an intramuscular abscess. Endemic in tropical climates, it is being reported with increasing frequency in temperate climates such as the United States. The most common causative organism is Staphylococcus aureus, present in greater than 90% of reported cases. Risk factors include underlying chronic illness, malnutrition, immunocompromised state, and muscle trauma. We present a case in which Streptococcus agalactae was the causative agent of myositis in a child with a history of perinatally derived human immunodeficiency virus infection.

The initiation of the hospital administration degree at the master's level and not the baccalaureate level was an intentional decision. Unfortunately, during this formative half-decade, the baccalaureate programs developed in a vacuum, isolated from one another and from the long-established graduate programs. While there is not a clear professional consensus that the lack of undergraduate degree articulation with graduate education is a problem, the authors believe this to be the case and believe that many faculty agree. This paper will address the history of health administration education, current academic pathways to careers in health administration, and detailed barriers and strategies to academic degree articulation. The paper concludes that discussion of health administration degree articulation has received modest attention and discussion for more than twenty years, and neither formal relationships nor certification/accreditation has addressed the issue. The authors believe that creation of articulated degrees is desirable and call for AUPHA and CAHME to develop a task force to address barriers and strategies for articulation. Concurrently, while national policy would facilitate more rapid change, we recommend that individual undergraduate and graduate degree programs explore individual relationships as a means to achieve models for the profession as an alternative to the status quo.

This article is offered primarily for the benefit of newcomers to the ranks of academic advising. It can also serve as a quick review for experienced advisors who might have forgotten some of the points made in past JOURNAL articles on this subject.