The Art of Clinical Negotiation.

The art of clinical negotiation is an important, yet underappreciated aspect of medicine. Key components of negotiation include the need to consider principles over personalities, to explore all options before deciding on the best course, to realize if consensus cannot be achieved then compromise may still be possible, to work from evidence to incorporate contextual factors, and to stay evidence based. These principles can be helpful in many settings, including contract negotiation, drug pricing, and research.

Adolescents and Young Adults with Germline CDH1 Variants and the Risk of Overtreatment.

Background: Adolescents and young adults (AYA) with germline CDH1 variants are at risk of overtreatment when precancer lesions are detected with endoscopic screening. We characterize diffuse-type gastric cancer prevalence and survival in AYA managed with prophylactic total gastrectomy (PTG) or endoscopic surveillance.

Methods: Prospective cohort study of 188 individuals aged 39 and younger enrolled from January 27, 2017, to May 1, 2023.

Non-detection of emerging and re-emerging pathogens in wastewater surveillance to confirm absence of transmission risk: A case study of polio in New York.

Infectious disease surveillance systems, including wastewater surveillance, can alert communities to the threat of emerging pathogens. We need methods to infer understanding of transmission dynamics from non-detection. We estimate a sensitivity of detection of poliovirus in wastewater to inform the sensitivity of wastewater surveillance for poliovirus using both a clinical epidemiology and fecal shedding approach.

Unraveling the gut: the pivotal role of intestinal mechanisms in Kawasaki disease pathogenesis.

Kawasaki disease (KD), an acute systemic vasculitis that primarily affects children under 5 years of age, is the leading cause of acquired heart disease in this age group. Recent studies propose a novel perspective on KD's etiology, emphasizing the gastrointestinal (GI) tract, particularly the role of gut permeability. This review delves into how disruptions in gut barrier function trigger systemic inflammatory responses, exacerbate vascular inflammation, and contribute to coronary artery aneurysms.