The Performance of Critical Congenital Heart Disease Screening in Rural Versus Urban Locations in the Northwest United States.

Objectives: Pulse oximetry screening of newborns detects critical congenital heart disease (CCHD). Rural birth location is known to affect timing and management of when infants with CHD undergo surgery, but its association with CCHD screening is unknown. We assess the relationship between rural location and postnatal CCHD diagnosis and describe lesion-specific modes of diagnosis.

Burden with No Benefit: Prior Authorization in Congenital Cardiology.

Prior authorization is a process that health insurance companies use to determine if a patient's health insurance will cover certain medical treatments, procedures, or medications. Prior authorization requests are common in adult congenital and pediatric cardiology (ACPC) due to need for advanced diagnostics, complex procedures, disease-specific medications, and the heterogeneity of the ACPC population. Prior authorizations in ACPC are rarely denied, but nonetheless, they are often accompanied by significant administrative burden on clinical care teams and delays in patient care.

Regional pediatric disaster network guides statewide telehealth initiation during COVID-19 pandemic.

Background: Telehealth emerged early as an important tool to provide clinical care during the COVID-19 pandemic, but statewide implementation strategies were lacking. Needs assessment: We performed a needs assessment at 15 pediatrics clinics in Washington regarding their ability to institute telehealth. Fourteen clinics (93 percent response rate) responded; none had ability to perform telehealth visits.

An unusual cause of repolarization abnormality after congenital heart surgery: A case report.

We present a case of a young boy who developed persistent tachycardia despite fluid resuscitation, antipyretics, and analgesia after a Fontan procedure. Review of telemetry and ECGs revealed repolarization abnormalities, including the appearance of T-wave alternans, for which an uncommon cause was ultimately identified.

Ethical pain management in the emergency department: the canary in the coal mine.

The emergency department serves as the gateway to the acute healthcare system. In the USA and increasingly worldwide, patients view the emergency department as the venue where both diagnostic and therapeutic modalities will be brought to bear regardless of condition or socioeconomic status. At the same time, the emergency department is the canary in the coal mine--the warning location for difficulties in how healthcare is delivered to patients in both the outpatient and inpatient settings.

Respiratory symptoms, spirometric respiratory impairment, and respiratory disease in middle-aged and older persons.

Objectives: To evaluate whether a novel definition of spirometric respiratory impairment from the Global Lung Initiative (GLI) is strongly associated with respiratory symptoms and, in turn, frequently establishes symptomatic respiratory disease.

Design: Cross-sectional.

Setting: Third National Health and Nutrition Examination Survey.

Evaluation of Viewpoints of Health Care Professionals on the Role of Ethics Committees and Hospitals in the Resolution of Clinical Ethical Dilemmas Based on Practice Environment.

We sought to evaluate whether health care professionals' viewpoints differed on the role of ethics committees and hospitals in the resolution of clinical ethical dilemmas based on practice location. We conducted a survey study from December 21, 2013 to March 15, 2014 of health care professionals at six hospitals (one tertiary care academic medical center, three large community hospitals and two small community hospitals). The survey consisted of eight clinical ethics cases followed by statements on whether there was a role for the ethics committee or hospital in their resolution, what that role might be and case specific queries.

Qualitative analysis of healthcare professionals' viewpoints on the role of ethics committees and hospitals in the resolution of clinical ethical dilemmas.

Ethics consultation is a commonly applied mechanism to address clinical ethical dilemmas. However, there is little information on the viewpoints of health care providers towards the relevance of ethics committees and appropriate application of ethics consultation in clinical practice. We sought to use qualitative methodology to evaluate free-text responses to a case-based survey to identify thematically the views of health care professionals towards the role of ethics committees in resolving clinical ethical dilemmas.

Complex fragment coupling by crotylation: A powerful tool for polyketide natural product synthesis.

The first examples of the use of crotylation as a stereocontrolled complex fragment coupling strategy are described. Asymmetric aldehyde isoprenylation provides access to 2-substituted-1,3-butadienes that may be subjected to highly regio- and stereoselective 1,4 hydrosilylation with trichlorosilane. After complexation with a chiral diamine, the 2-sub-stituted--crotylsilanes may be employed in highly diastereoselective Sc(OTf)-catalyzed aldehdye crotylation reactions.

Serine 129 phosphorylation reduces the ability of alpha-synuclein to regulate tyrosine hydroxylase and protein phosphatase 2A in vitro and in vivo.

Alpha-synuclein (a-Syn), a protein implicated in Parkinson disease, contributes significantly to dopamine metabolism. a-Syn binding inhibits the activity of tyrosine hydroxylase (TH), the rate-limiting enzyme in catecholamine synthesis. Phosphorylation of TH stimulates its activity, an effect that is reversed by protein phosphatase 2A (PP2A).