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Traditional gravimetric instruments used for personal air pollution exposure measurements are often cumbersome and noisy and do not offer real‐time assessment capability. The Enhanced Children's MicroPEM (ECM) is a comparatively lightweight and quiet instrument designed to capture both integrated filter‐based gravimetric samples and real‐time continuous (nephelometric) particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) concentrations. We assessed the performance and reliability of collocated ECMs in a subset of pregnant women participating in a randomized controlled trial in Guatemala to test a liquefied petroleum gas (LPG) cookstove (intervention) versus biomass (control) for cooking. We compared average daily (24 h) PM2.5 concentrations for the paired gravimetric (n = 219) and paired adjusted nephelometric (n = 221) samples using Spearman correlation and Bland–Altman agreement; we also assessed reliability based on the intraclass correlation coefficient (ICC) and root mean square error (RMSE). Median PM2.5 gravimetric concentrations were 93.5 μg/m3 (interquartile range (IQR) = 52.6–160.5) and 21.4 μg/m3 (IQR = 12.0–32.0) in the control and LPG intervention groups, respectively; the median adjusted nephelometric concentrations were 83.7 μg/m3 (IQR = 47.6–148.9) and 22.6 μg/m3 (IQR = 17.5–29.7) in the control and LPG groups, respectively. Spearman correlations were higher in the control arm (0.91) than in the LPG intervention arm (0.67) in the gravimetric comparisons. The same trend was observed for adjusted nephelometric measurements in the control (0.92) and intervention arms (0.75). ICC values were high in both gravimetric (0.93) and nephelometric (0.95) collocations. Small differences in RMSE were observed for the gravimetric (26.69 μg/m3) and nephelometric collocations (31.76 μg/m3). Our findings demonstrate strong reliability between collocated ECMs for both gravimetric and adjusted nephelometric PM2.5 personal exposure samples in rural Guatemala. Trial Registration: ClinicalTrials.gov identifier: NCT02944682 [ABSTRACT FROM AUTHOR]

The ribosomal protein S14 (RPS14) gene located at 5q33 codes for a protein involved in ribosomal biogenesis. The RPS14 gene has a length of 5.9 kb of DNA comprising 5 exons and 4 introns. It is possible that RPS14 is involved in the formation of pre-RNA 18s, an intermediate RNA that serves for the formation of the 40S small subunit of the ribosome. RPS14 haploinsufficiency (HI) produces alterations in intermediate RNA levels (pre-RNA 30S/18SE/18S), which are found in del(5q) MDS. In addition, RPS14 haploinsufficiency results in the formation of the MDM2 (double minute mouse E3 ubiquitin ligase)-RP (ribosomal protein) complex that prevents the MDM2-p53 interaction, generating an accumulation of p53 levels. This accumulation produces cell cycle arrest, impaired DNA repair, senescence, and apoptosis. RPS14 haploinsufficiency has been seen in MDS. Altered expression levels of RPS14 have also been reported in glioma, colorectal cancer, hepatocellular carcinoma, breast cancer, renal cell carcinoma, and primary myelofibrosis. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to evaluate the impact of high-deductible health plans on elective surgery (tonsillectomy) in the pediatric population. Study Design: Cross-sectional study. Setting: Health claims database from a third-party payer. Methods: Data were reviewed for children up to 18 years of age who underwent tonsillectomy or arm fracture repair (nonelective control) from 2016 to 2019. Incidence of surgery by health plan deductible (high, low, or government insured) and met or unmet status of deductibles were compared. Results: A total of 10,047 tonsillectomy claims and 9903 arm fracture repair claims met inclusion and exclusion criteria. The incidence of tonsillectomy was significantly different across deductible plan types. Patients with met deductibles were more likely to undergo tonsillectomy. In patients with deductibles ≥$4000, a 1.75-fold increase in tonsillectomy was observed in those who had met their deductible as compared with those who had not. These findings were not observed in controls (nonelective arm fracture). For those with met deductibles, those with high deductibles were much more likely to undergo tonsillectomy than those with low, moderate, and government deductibles. Unmet high deductibles were least likely to undergo tonsillectomy. Conclusions: Health insurance plan type influences the incidence of pediatric elective surgery such as tonsillectomy but not procedures such as nonelective repair of arm fracture. High deductibles may discourage elective surgery for those deductibles that are unmet, risking inappropriate care of vulnerable pediatric patients. However, meeting the deductible may increase incidence, raising the question of overutilization. [ABSTRACT FROM AUTHOR]

Objective: Third-party payers advocate for prior authorization (PA) to reduce overutilization of health care resources. The impact of PA in elective surgery is understudied, especially in cases where evidence-based clinical practice guidelines define operative candidacy. The objective of this study is to investigate the impact of PA on the incidence of pediatric tonsillectomy.Study Design: Cross-sectional study.Setting: Health claims database from a third-party payer.Methods: Any pediatric patient who had evaluation for tonsillectomy from 2016 to 2019 was eligible for inclusion. A time series analysis was used to evaluate the change in incidence of tonsillectomy before and after PA. Lag time from consultation to surgery before and after PA was compared with segmented regression.Results: A total of 10,047 tonsillectomy claims met inclusion and exclusion criteria. Female patients made up 51% of claims, and the mean age was 7.9 years. Just 1.5% of claims were denied after PA implementation. There was no change in the incidence of tonsillectomy for all plan types (P = .1). Increased lag time from consultation to surgery was noted immediately after PA implementation by 2.38 days (95% CI, 0.23-4.54; P = .030); otherwise, there was no significant change over time (P = .98).Conclusion: A modest number of tonsillectomy claims were denied approval after implementation of PA. The value of PA for pediatric tonsillectomy is questionable, as it did not result in decreased incidence of tonsillectomy in this cohort. [ABSTRACT FROM AUTHOR]

Background: There is variability in opioid prescription patterns among surgeons performing thyroidectomy. Thus, the aim of this study is to evaluate opioid prescription rates and opioid use among hemithyroidectomy (HT) and total thyroidectomy (TT) patients. Design/Method: An electronic postoperative survey was distributed to assess opiate use among patients undergoing HT/TT. Groups were compared using t‐tests, chi‐square tests, and analysis of variance. Results: A total of 142 opiate naïve patients were included, of which 75 (52.8%) underwent HT and 67 (47.1%) underwent TT. The mean number of tablets prescribed was 21.3 (HT = 22.1, TT = 20.4; P = 0.3), with a mean of 14.1 tablets unused after surgery (HT = 13.2 tablets, TT = 15.0 tablets; P = 0.44). The mean morphine milligram equivalent (MME) prescribed was 150.1 mg (HT = 159.0 mg, TT = 140.2 mg; P = 0.3), with a mean of 98.2 MME unused after surgery (HT = 93.7 mg, TT = 103.2 mg; P = 0.6). Conclusions: Opioids are overprescribed after thyroid surgery. Avoidance of overprescribing is vital in mitigating the current opioid crisis. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to evaluate surgeon-prescribing patterns and opioid use for patients undergoing common otolaryngology surgeries. We hypothesized that there was little consistency across surgeons in prescribing patterns and that surgeons prescribed significantly more opioids than consumed by patients.Methods: E-mail-based surveys were sent to all postoperative patients across a 23-hospital system. The survey assessed quantity of opioids consumed postoperatively, patient-reported pain control, and methods of opioid disposal. We compared patient-reported opioid consumption to opioids prescribed based on data in the electronic data warehouse.Results: There was wide variation in prescribing between providers both in the quantity and type of opioids prescribed. Patients used significantly less opioids than they were prescribed (10 vs. 30 tablets, P < 0.001) for both opioid-exposed and opioid-naïve patients. More than 75% of patients had excess opioids remaining.Conclusion: Opioids are consistently overprescribed following ambulatory head and neck surgery. Otolaryngologists have an important role in the setting of the national opioid epidemic and should be involved in efforts to reduce excess opioids in their community.Level Of Evidence: 4 Laryngoscope, 130: 1913-1921, 2020. [ABSTRACT FROM AUTHOR]

The relative saliency of social comparison and anxiety reduction as motives for interpersonal affiliation was examined in nearly 100 Chicano and Anglo adolescents. The experiment's failure to replicate the findings of Darley and Aronson was probably due to lack of functional equivalence across cultural groups. (Author/GC)