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Purpose: To evaluate whether the postponement of dental elective procedures at the start of the COVID-19 pandemic was associated with an increased number of simple dental extractions, and/or decreased restorative procedures by analyzing data obtained from state-funded insurance dental claims., Methods: Paid dental claims collected from March 2019 to December 2019 and from March 2020 to December 2020 for children ages two to 13 years old were analyzed. Dental procedures were selected based on Current Dental Terminology (CDT) codes for simple dental extractions and restorative procedures. Statistical analyses were performed to compare the rates of procedure types between 2019 and 2020., Results: No differences in dental extractions but full-coverage restoration procedure rates per month and child were significantly lower than pre-pandemic (P=0.016)., Conclusion: Further study required to determine the impact of COVID-19 on pediatric restorative procedures and access to pediatric dental care in the surgical setting.

Background: Several studies have reported decreased trauma admissions and increased physical abuse in children resulting from stay-at-home measures. However, these studies have focused on a limited period after the implementation of lockdown policies. The purpose of this study was to examine the effect of quarantine and reopening initiatives on admissions for varying types of injuries in pediatric patients., Study Design: Registry data for an urban Level I pediatric trauma center were evaluated from April 1, 2018, to March 30, 2021. A timeline of local shutdown and reopening measures was established and used to partition the data into 6-month intervals. Data about demographics and injury characteristics were compared with similar intervals in 2018 and 2019 using appropriate statistical methodology for categorical, parametric, and nonparametric data., Results: A total of 3,110 patients met criteria for inclusion. A total of 1,106 patients were admitted the year after the closure of schools and nonessential businesses. Decreases in overall admissions and evaluations for suspected child abuse noted early in the pandemic were not sustained during shutdown or reopening periods. However, we observed a 77% increase in all-terrain vehicle injuries, along with a 59% reduction in sports injuries (chi-square [8, N = 3,110] = 49.7; p < 0.001). Significant shifts in demographic and payor status were also noted., Conclusions: This is the first study to comprehensively examine the effects of quarantine and reopening policies on admission patterns for a pediatric trauma center in a metropolitan area. Total admissions and child abuse evaluations were not impacted. If shutdown measures are re-instituted, preventative efforts should be directed towards ATV use and recreational activities., (Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Adults age 65 and older have high rates of suicide, despite recent efforts to reduce the suicide rate in this population. One suicide prevention strategy with burgeoning empirical support is safety planning; however, there is a lack of information and resources on safety planning for older adults to support uptake of this evidence-based practice in clinical settings where older adults are commonly seen. Safety plans can address risk factors for suicide in older adults, including social isolation, physical illness, functional limitations, and use of highly lethal means. Safety plans also promote relevant protective factors, including increasing use of coping strategies, social support, and help-seeking. Clinicians may encounter challenges and barriers to safety planning with older adults. This paper describes a collaborative, creative approach to safety planning that is relevant and useful for this vulnerable population. Using two case examples, we illustrate how to engage older adults in safety planning, including ways to minimize barriers associated with the aging process.

IntroductionRoutine advanced airway usage by Emergency Medical Services (EMS) has had conflicting reports of being the secure airway of choice in pediatric patients.Hypothesis/ProblemThe primary objective was to describe a pediatric cohort requiring airway management upon their arrival directly from the scene to two pediatric emergency departments (PEDs). A secondary objective included assessing for associations in EMS airway management and patient outcomes., Methods: Retrospective data from the health record were reviewed, including EMS reports, for all arrivals less than 18 years old to two PEDs who required airway support between May 2015 and July 2016. The EMS management was classified as basic (oxygen, continuous positive airway pressure [CPAP], or bag-valve-mask [BVM]) or advanced (supraglottic or endotracheal intubation [ETI]) based on EMS documentation. Outcomes included oxygenation as documented by receiving PED and hospital mortality., Results: In total, 104 patients with an average age 5.9 (SD=5.1) years and median EMS Glasgow Coma Scale (GCS) of nine (IQR 3-14) were enrolled. Basic management was utilized in 70% of patients (passive: n=49; CPAP: n=2; BVM: n=22). Advanced management was utilized in 30% of patients (supraglottic: n=4; ETI: n=27). Proper ETI placement was achieved in 48% of attempted patients, with 41% of patients undergoing multiple attempts. Inadequate oxygenation occurred in 18% of patients, including four percent of ETI attempts, nine percent of BVM patients, and 32% of passively managed patients. Adjusted for EMS GCS, medical patients undergoing advanced airway management experienced higher risk of mortality (risk-ratio [RR] 2.98; 95% CI, 1.18-7.56; P=.021)., Conclusion: With exception to instances where ETI is clearly indicated, BVM management is effective in pediatric patients who required airway support, with ETI providing no definitive protective factors. Most of the patients who exhibited inadequate oxygenation upon arrival to the PED received only passive oxygenation by EMS. TweedJ, GeorgeT, GreenwellC, VinsonL. Prehospital airway management examined at two pediatric emergency centers. Prehosp Disaster Med. 2018;33(5):532-538.

Background: The effectiveness of stainless steel crowns (SSCs) versus direct restorations when placed in primary mandibular molars (teeth nos. L and S) is uncertain. The authors evaluated effectiveness by gauging longevity of treatment., Methods: The authors obtained private dental insurance claims (2004-2016) from a national dental data warehouse. Paid insurance claims records (n = 1,323,489) included type of treating dentist, treatment placed, and patient age., Results: Dentist specialty, type of treatment, and patient age were significant in predicting failure after the first restoration. The authors found high survival rates for all treatments (> 90%) after 5 years; however, as soon as within 3 years after treatment, SCCs had approximately 6% better survival., Conclusions: Teeth nos. L and S first treated with SSCs lasted longer without new treatment compared with teeth first treated with direct restorations; the difference was small. Teeth treated by pediatric dentists had better survival rates., Practical Implications: Primary mandibular first molars initially treated with SSCs lasted longer without new treatment compared with direct restorations. Overall dental care costs of the former were considerably higher., (Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.)

The rapidly growing appreciation of enzymes' catalytic and substrate promiscuity may lead to their expanded use in the fields of chemical synthesis and industrial biotechnology. Here, we explore the substrate promiscuity of enoyl-acyl carrier protein reductases (commonly known as FabI) and how that promiscuity is a function of inherent reactivity and the geometric demands of the enzyme's active site. We demonstrate that these enzymes catalyze the reduction of a wide range of substrates, particularly α,β-unsaturated aldehydes. In addition, we demonstrate that a combination of quantum mechanical hydride affinity calculations and molecular docking can be used to rapidly categorize compounds that FabI can use as substrates. The results here provide new insight into the determinants of catalysis for FabI and set the stage for the development of a new assay for drug discovery, organic synthesis, and novel biocatalysts.

Background: Motor vehicle crashes (MVCs) are a principal cause of death in children; fatal MVCs and pediatric trauma resources vary by state. We sought to examine state-level variability in and predictors of prompt access to care for children in MVCs., Materials and Methods: Using the 2010-2014 Fatality Analysis Reporting System, we identified passengers aged <15 y involved in fatal MVCs (crashes on US public roads with ≥1 death, adult or pediatric, within 30 d). We included children requiring transport for medical care from the crash scene with documented time of hospital arrival. Our primary outcome was transport time to first hospital, defined as >1 or ≤1 h. We used multivariable logistic regression to establish state-level variability in the percentage of children with transport time >1 h, adjusting for injury severity (no injury, possible injury, suspected minor injury, suspected severe injury, fatal injury, and unknown severity), mode of transport (emergency medical services [EMS] air, EMS ground, and non-EMS), and rural roads., Results: We identified 18,116 children involved in fatal MVCs from 2010 to 2014; 10,407 (57%) required transport for medical care. Median transport time was 1 h (interquartile range: [1, 1]; range: [0, 23]). The percent of children with transport time >1 h varied significantly by state, from 0% in several states to 69% in New Mexico. Children with no injuries identified at the scene and crashes on rural roads were more likely to have transport times >1 h., Conclusions: Transport times for children after fatal MVCs varied substantially across states. These results may inform state-level pediatric trauma response planning., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To examine geographic variation in motor vehicle crash (MVC)-related pediatric mortality and identify state-level predictors of mortality., Study Design: Using the 2010-2014 Fatality Analysis Reporting System, we identified passengers <15 years of age involved in fatal MVCs, defined as crashes on US public roads with ≥1 death (adult or pediatric) within 30 days. We assessed passenger, driver, vehicle, crash, and state policy characteristics as factors potentially associated with MVC-related pediatric mortality. Our outcomes were age-adjusted, MVC-related mortality rate per 100 000 children and percentage of children who died of those in fatal MVCs. Unit of analysis was US state. We used multivariable linear regression to define state characteristics associated with higher levels of each outcome., Results: Of 18 116 children in fatal MVCs, 15.9% died. The age-adjusted, MVC-related mortality rate per 100 000 children varied from 0.25 in Massachusetts to 3.23 in Mississippi (mean national rate of 0.94). Predictors of greater age-adjusted, MVC-related mortality rate per 100 000 children included greater percentage of children who were unrestrained or inappropriately restrained (P < .001) and greater percentage of crashes on rural roads (P = .016). Additionally, greater percentages of children died in states without red light camera legislation (P < .001). For 10% absolute improvement in appropriate child restraint use nationally, our risk-adjusted model predicted >1100 pediatric deaths averted over 5 years., Conclusions: MVC-related pediatric mortality varied by state and was associated with restraint nonuse or misuse, rural roads, vehicle type, and red light camera policy. Revising state regulations and improving enforcement around these factors may prevent substantial pediatric mortality., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: To (1) determine adherence to guidelines when prescribing panoramic radiographs (PR) for patients 18 y.o. and younger; and 2) compare PR prescriptions between general dentists (GPs) and pediatric dentists (PDs)., Methods: A retrospective analysis of insurance claims included codes for PRs and associated codes for two cities between 2008 and 2015. Chi-square tests ascertained the likelihood of a PR being associated within three days of routine exams., Results: A total of 81,699 pediatric patients were seen by 2,077 GPs and 103 PDs. There were 11,993 PRs, 119,068 routine exams (7,343 associated with a PR), 13,819 orthodontic procedures (378 associated with a PR), 798 third molar procedures (172 associated with a PR), and 16,636 procedures for acute problems (1,670 associated with a PR). Patients aged eight years old and younger had the largest discrepancy between GPs and PDs. GPs prescribed proportionally more films in patients five years old and younger, but PDs prescribed more in seven and eight year olds. Nine- to 18 year olds. had more similar patterns between GPs and PDs, except for 14- to 15 year olds, when GPs prescribed more., Conclusions: GPs prescribed PR in patients younger than five years old more often and were somewhat less likely to follow guidelines.

The Pediatric Emergency Services Network (PESN) was developed to provide ongoing continuing education on pediatric guidelines and pediatric emergency care to rural and nonpediatric hospitals, physicians, nurses, and emergency personnel. A survey was developed and given to participants attending PESN educational events to determine the perceived benefit and application to practice of the PESN outreach program. Overall, 91% of participants surveyed reported agreement that PESN educational events were beneficial to their clinical practice, provided them with new knowledge, and made them more knowledgeable about pediatric emergency care. Education and outreach programs can be beneficial to health care workers' educational needs., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: The specific aim of this retrospective cross-sectional study was to assess the efficacy of DynaCleft® as a method of presurgical orthopedics with infants with a unilateral cleft lip and cleft palate who used an oral obturator., Study Design: Data was collected from 25 infants all of comparable age diagnosed with a unilateral complete cleft lip and palate. Eight patients used DynaCleft ® and an obturator (Group Alpha) and seventeen patients only had an obturator (Group Beta). Maxillary impression casts were obtained from each patient at the initial clinic visit and at the time of cleft lip repair. Differences in alveolar cleft width were compared between the two groups. Casts were measured twice by one observer using a digital caliper., Results: Group Alpha began treatment on an average age of 24.25 days and Group Beta an average of 15.35 days of age. The average cleft width of Group Alpha was 8.13 mm and after treatment it was 4.59 mm. The average cleft width of Group Beta was 8.09 mm and 6.92 mm after treatment. Results of paired t-tests and two-sample t-test showed that cleft width changes between the two groups were significant (P = .03)., Conclusions: DynaCleft ® significantly decreased the size of the alveolar cleft width compared to infants who did not use it. Providers should consider using DynaCleft® for patients who may not have access to infant maxillary orthopedics.