Child Health Needs and the Pediatric Gastroenterology Workforce: 2020-2040.

This article is part of an American Board of Pediatrics Foundation-sponsored effort to analyze and forecast the pediatric subspecialty workforce between 2020 and 2040. Herein, an overview of the current pediatric gastroenterology workforce is provided, including demographics, work characteristics, and geographic distribution of practitioners. Brief context is provided on the changing nature of current practice models and the increasing prevalence of some commonly seen disorders.

Academic Careers in Advocacy: Aligning Institutional Values Through Use of an Advocacy Portfolio.

Academic children's hospitals must embrace advocacy as a central component of their missions to discover new knowledge and improve the health of the communities and patients they serve. To do so, they must ensure faculty have both the tools and the opportunities to develop and articulate the work of advocacy as an academic endeavor. This can be accomplished by integrating the work of advocacy at the community and policy-change levels into the traditional value systems of academic medicine, especially the promotions process, to establish its legitimacy.

Characterization of Electronic Health Record Use Outside Scheduled Clinic Hours Among Primary Care Pediatricians: Retrospective Descriptive Task Analysis of Electronic Health Record Access Log Data.

Background: Many of the benefits of electronic health records (EHRs) have not been achieved at expected levels because of a variety of unintended negative consequences such as documentation burden. Previous studies have characterized EHR use during and outside work hours, with many reporting that physicians spend considerable time on documentation-related tasks. These studies characterized EHR use during and outside work hours using clock time versus actual physician clinic schedules to define the outside work time.

An Initiative to Increase Residency Program Diversity.

A physician workforce that reflects the patient population is associated with improved patient outcomes and promotes health equity. Notwithstanding, racial and ethnic disparities persist within US medical schools, making some individuals underrepresented in medicine (URM). We sought to increase the percentage of URM residents who matched into our pediatric residency programs from a baseline of 5% to 35% to achieve demographic parity with our patients.

Comorbidities in Childhood Celiac Disease: A Phenome Wide Association Study Using the Electronic Health Record.

Objectives: Celiac disease (CD) is associated with a variety of extraintestinal autoimmune and inflammatory findings that manifest clinically as symptoms and comorbidities. Understanding these comorbidities may improve identification of the disease and prevent sequelae. In this study, we use an unbiased electronic health record (EHR)-based Phenome Wide Association Study (PheWAS) method to confirm known comorbidities, discover novel associations and enhance characterization of the clinical presentation of CD in children.

Recent advances in pediatric gastroenterology, hepatology and nutrition.

Pediatric gastroenterology, hepatology and nutrition are rapidly evolving, exciting and diverse disciplines. Because the field is so expansive, this commentary highlights important trends, rather than narrowly focusing on specific advances. Examples of advances in the highest impact and rapidly moving areas of pediatric gastroenterology are reviewed, including the intestinal microbiome, biomedical genomics, the biology of unique gastrointestinal cell types, and microRNAs (miRNAs).

Characteristic size for onset of coffee-ring effect in evaporating lysozyme-water solution droplets.

Liquid droplets containing suspended particles deposited on a solid surface often form a ring-like structure due to the redistribution of solute during evaporation, a phenomenon known as the "coffee ring effect". The complex patterns left on the substrate after evaporation are characteristic of the nature of the solute and the particle transport mechanisms. In this study, the morphological evolution and conditions for coffee ring formation for simplified model biological solutions of DI water and lysozyme are examined by AFM and optical microscopy.

Knockout of Mkp-1 exacerbates colitis in Il-10-deficient mice.

Il-10-deficient mice develop colitis associated with exaggerated Th1/Th17 responses and are a valuable model of inflammatory bowel disease. Mkp-1 is a major negative regulator of MAPKs, and its expression is enhanced by IL-10. To understand the role of Mkp-1 in the regulation of intestinal mucosal immune responses, we studied the effect of Mkp-1 deletion on the pathogenesis of colitis in Il-10(-/-) mice.

Lysozyme pattern formation in evaporating drops.

Liquid droplets containing suspended particles deposited on a solid, flat surface generally form ringlike structures due to the redistribution of solute during evaporation (the "coffee ring effect"). The forms of the deposited patterns depend on interactions between solute(s), solvent, and substrate. In this study, deposition patterns from droplets of a simplified model biological fluid (DI water + lysozyme) are examined by scanning probe and optical microscopy.

Safety of pediatric percutaneous liver biopsy performed by interventional radiologists.

Objective: National data suggest that pediatric percutaneous liver biopsy is increasingly being performed by interventional radiologists rather than pediatric gastroenterologists. The objective of the present report is to describe the safety and effectiveness of percutaneous liver biopsy performed by interventional radiologists in a large cohort of children and to compare the results with the existing literature on biopsies performed by pediatric gastroenterologists.

Patients And Methods: The medical records of 249 children undergoing ultrasound-guided percutaneous liver biopsy by interventional radiologists were reviewed for adverse events and success of obtaining tissue.

ZAS3 accentuates transforming growth factor β signaling in epithelial cells.

In mammals, the ZAS family of transcription factors activates or represses transcription depending on the cellular context. In the current study, we explored the interaction between ZAS3 and TGFβ1 signaling in epithelial cells using HEK293 cells and the intestinal epithelial cell line, RIE-1. Endogenous ZAS3 expression was detected in each cell line and the small intestine of mice.

Temperature-dependent formation of dendrimer islands from ring structures.

Previously unobserved high surface mobility and phase transformation phenomena in condensed, micron-scale dendrimer structures are documented using atomic force microscopy. Stratified dendrimer rings (a unique morphology resulting from microdroplet evaporation of dendrimer-alcohol solutions on mica) undergo dramatic temperature, time, and dendrimer-generation-dependent morphological changes associated with large-scale molecular rearrangements and partial melting. These transformations produce ring structures consisting of a highly stable first monolayer of the scalloped structure in equilibrium with spherical cap shaped dendrimer islands that form at the center of each pre-existing scallop (creating a "pearl necklace" structure).

Transformation by oncogenic Ras expands the early genomic response to transforming growth factor beta in intestinal epithelial cells.

A substantial body of evidence implicates TGFbeta as a tumor promoter in epithelial cells that have become resistant to its tumor suppressor activity. To better understand early, genome-wide TGFbeta responses in cells resistant to growth inhibition by TGFbeta, we used microarray analysis in a well-defined cell culture system of sensitive and resistant intestinal epithelial cells. TGFbeta-regulated gene expression in TGFbeta-growth-sensitive, nontransformed rat intestinal epithelial cells (RIE-1) was compared to expression in TGFbeta-growth-resistant RIE cells stably transformed by oncogenic Ras(12V).

Disruption of ZAS3 in mice alters NF-kappaB and AP-1 DNA binding and T-cell development.

The large zinc finger proteins, ZAS, regulate the transcription of a variety of genes involved in cell growth, development, and metastasis. They also function in the signal transduction of the TGF-beta and TNF-alpha pathways. However, the endogenous protein of a representative member, ZAS3, is rapidly degraded in primary lymphocytes, which limits the determination of its physiological function in vitro.

Dendrimer pattern formation in evaporating drops.

The redistribution of organic solutes during drop evaporation is a nanoscale self-assembly process with relevance to technologies ranging from inkjet printing of organic displays to synthesis of biosmart interfaces for sensing and screening. We have used solutions of dendrimer molecules with incrementally varying terminal site chemistry to explore whether the condensed dendrimer patterns resulting from microdroplet evaporation sensitively depend on, and are characteristic of, the surface chemistry of the solute molecules. This hypothesis has been experimentally confirmed by comparing the behavior of microdroplets of G4, G4-25%C12, and G4-50%C12 dendrimers dissolved in pentanol and deposited on mica substrates.

Gastrointestinal polyps and polyp syndromes in adolescents.

Although gastrointestinal polyps are more common in the first decade of life than during adolescence, underlying genetic polyposis syndromes are more likely in adolescents. In the past decade, the discovery of gene defects associated with polyposis syndromes has improved classification of these disorders, assisted in the stratification of cancer risk, and permitted more precise diagnosis. Genetic testing is now clinically available for the gene defects that occur in familial adenomatous polyposis coli, Peutz-Jeghers syndrome, Cowden syndrome, and juvenile polyposis syndrome.