Interfacility Transfer of Pediatric Supracondylar Elbow Fractures: Transfer by Ambulance Shows No Advantage in Speed of Transfer or Prevention of Complications.

Background: The treatment of supracondylar humerus (SCH) fractures is increasingly centralized in tertiary centers. Interfacility transfer from other facilities may occur by ground ambulance or privately owned vehicle (POV). The objective of this study was to determine if interfacility transfer by POV is equivalent in transfer time and perioperative complications compared with ground ambulance.

Intraoperative Radiation Exposure in Adolescent Idiopathic and Neuromuscular Scoliosis.

Background: Intraoperative imaging is often used to aid pedicle screw placement during scoliosis operations. Higher rates of cancer and death have been observed in orthopaedic surgeons and radiation technologists, including a fourfold higher rate of breast cancer in female orthopaedic surgeons. The purpose of this study was to evaluate variability in intraoperative radiation during spinal fusions for both adolescent idiopathic scoliosis (AIS) and neuromuscular scoliosis (NMS).

Mechanical Failure of 2 Cannulated Screw Fixation for Unstable SCFE: A Case Report.

Case: A 13-year-old obese boy presented with an acute-on-chronic unstable left slipped capital femoral epiphysis (SCFE). He underwent in situ surgical fixation with two 6.5-mm fully threaded cannulated screws.

Twice exceptionality: A hidden diagnosis in primary care.

Here's how to navigate the interplay between cognitive giftedness and emotional/social challenges.

Returning genomic results in a Federally Qualified Health Center: the intersection of precision medicine and social determinants of health.

Purpose: This report describes the return of sequencing results to low-income Latino participants recruited through a Federally Qualified Health Center (FQHC). We describe challenges in returning research results secondary to social determinants of health and present lessons learned to guide future genomic medicine implementation studies in low-resource settings.

Methods: Five hundred Latino adults (76% women) consented to research sequencing for a predetermined panel of actionable genes.

Collaborative Approaches to the Support of People with Disabilities: The Underserved and Unserved.

Background: Underserved and unserved people are individuals who lack necessary health services. They can be found in both high- and low-income countries with disabilities in areas such as speech, language, hearing, swallowing, physical, and neurological, as well as other health problems. In addition, academic programs that prepare students to serve underserved or unserved communities do not exist in some countries.

Developing a Process for Returning Medically Actionable Genomic Variants to Latino Patients in a Federally Qualified Health Center.

Aim: To develop a process for returning medically actionable genomic variants to Latino patients receiving care in a Federally Qualified Health Center.

Methods: Prior to recruitment, researchers met with primary care providers to (1) orient clinicians to the project, (2) establish a process for returning actionable and nonactionable results to participants and providers through the electronic health record, and (3) develop a process for offering clinical decision support for follow-up education and care. A Community Advisory Board was engaged to provide input on recruitment strategies and materials for conveying results to participants.

The Sangre Por Salud Biobank: Facilitating Genetic Research in an Underrepresented Latino Community.

Background/aims: The Sangre Por Salud (Blood for Health; SPS) Biobank was created for the purpose of expanding precision medicine research to include underrepresented Latino patients. It is the result of a unique collaboration between Mayo Clinic and Mountain Park Health Center, a federally qualified community health center in Phoenix, Arizona. This report describes the rationale, development, implementation, and characteristics of the SPS Biobank.

The endoplasmic reticulum, not the pH gradient, drives calcium refilling of lysosomes.

Impaired homeostasis of lysosomal Ca(2+) causes lysosome dysfunction and lysosomal storage diseases (LSDs), but the mechanisms by which lysosomes acquire and refill Ca(2+) are not known. We developed a physiological assay to monitor lysosomal Ca(2+) store refilling using specific activators of lysosomal Ca(2+) channels to repeatedly induce lysosomal Ca(2+) release. In contrast to the prevailing view that lysosomal acidification drives Ca(2+) into the lysosome, inhibiting the V-ATPase H(+) pump did not prevent Ca(2+) refilling.

An Evidence Roadmap for Implementation of Integrated Behavioral Health under the Affordable Care Act.

The Affordable Care Act (ACA) created incentives and opportunities to redesign health care to better address mental and behavioral health needs. The integration of behavioral health and primary care is increasingly viewed as an answer to address such needs, and it is advisable that evidence-based models and interventions be implemented whenever possible with fidelity. At the same time, there are few evidence-based models, especially beyond depression and anxiety, and thus further research and evaluation is needed.

Location of care for patients with borderline personality disorder: Challenges and opportunities in finding a home.

Patients with borderline personality disorder (BPD) represent a population with increased care needs and high provider demand, even in the best cases of quality integrated primary care. The current article outlines the complexities of working with patients with BPD in primary care, including when the transition to the specialty mental health sector may be warranted. Core factors around transitions of care (between integrated primary care and the specialty mental health sector) have been identified.

Governing board, C-suite, and clinical management perceptions of quality and safety structures, processes, and priorities in U.S. hospitals.

To achieve quality improvement in hospitals requires greater attention to systems thinking than is typical at this time, including a shared understanding across different levels of the hospital of the current state of quality improvement efforts. A self-administered survey assessed the perceptions of board members, C-suite executives, and clinical managers regarding quality activities and structures. This instrument, the Hospital Leadership and Quality Assessment Tool (HLQAT), includes 13 domains in six conceptual areas that we believe are major organizational drivers of quality and safety: (1) commitment of senior leaders, (2) a vision of exemplary quality, (3) a supportive culture, (4) accountable leadership, (5) appropriate organizational structures, and (6) adaptive capability.

Cultural and demographic factors influencing noise exposure estimates from use of portable listening devices in an urban environment.

Purpose: This study examined listening levels and duration of portable listening devices (PLDs) used by people with diversity of ethnicity, education, music genre, and PLD manufacturer. The goal was to estimate participants' PLD noise exposure and identify factors influencing user behavior.

Method: This study measured listening levels of 160 adults in 2 New York City locations: (a) a quiet college campus and (b) Union Square, a busy interchange.

Behavioral health integration: an essential element of population-based healthcare redesign.

The fundamental aim of healthcare reform is twofold: to provide health insurance coverage for most of the citizens currently uninsured, thereby granting them access to healthcare; and to redesign the overall healthcare system to provide better care and achieve the triple aim (better health for the population, better healthcare for individuals, and at less cost). The foundation for this improved system will rest on a redesigned (i.e.

Portable music player users: cultural differences and potential dangers.

Many studies have examined the use of portable music players portable listening devices (PLDs) from various ethnic groups. Some findings suggest that there may be differences among ethnic groups that lead to louder or longer listening when using PLD devices. For example, some studies found that Hispanic PLD users listen at higher volume levels while other studies found that African American PLD users listen at higher volume levels.

Ligand- and base-free Pd(II)-catalyzed controlled switching between oxidative Heck and conjugate addition reactions.

A simple change of solvent allows controlled and efficient switching between oxidative Heck and conjugate addition reactions on cyclic Michael acceptor substrates, catalyzed by a cationic Pd(II) catalyst system. Both reactions are ligand- and base-free and tolerant of air and moisture, and the controlled switching sheds light on some of the factors which favor one reaction over the other.

The right stuff.

The interviews with board members at 10 high-performing community health systems revealed many other factors that, in the opinions of some, have contributed to their system's strong operating performance; for example, prudent investments in facilities and services, new technology and strategic mistakes by competitors. On the whole, however, the trustees perceived the six factors outlined above as being most influential in their organizations' successful performance in recent years. The table on Page 21 provides a summary of the trustees' views.

Noise exposure estimates of urban MP3 player users.

Purpose: To examine the sound level and duration of use of personal listening devices (PLDs) by 189 college students, ages 18-53 years, as they entered a New York City college campus, to determine whether noise exposure from PLDs was in excess of recommended exposure limits and what factors might influence exposure.

Method: Free-field equivalent sound levels from PLD headphones were measured on a mannequin with a calibrated sound level meter. Participants reported demographic information, whether they had just come off the subway, the type of PLD and earphones used, and duration per day and days per week they used their PLDs.

Human Barrett's adenocarcinoma of the esophagus, associated myofibroblasts, and endothelium can arise from bone marrow-derived cells after allogeneic stem cell transplant.

This study characterizes the contribution of bone marrow-derived cells (BMDCs) to Barrett's adenocarcinoma of the esophagus using a mouse surgical model of disease and human specimens. Transplantation of bone marrow expressing beta galactosidase into a wild-type mouse, followed by surgical esophagojejunostomy, allowed tracking of BMDCs into the surgical anastomosis and resulting Barrett's metaplasia. Human tissue from a male patient who had been transplanted with female bone marrow and later developed esophageal adenocarcinoma allowed us to tract donor-derived cells into the tumor.

Prostate HDR radiation therapy: a comparative study evaluating the effectiveness of pain management with peripheral PCA vs. PCEA.

Introduction: High dose rate (HDR) brachytherapy is considered one of the most advanced treatment technologies currently available for treatment of localized prostate cancer. It gives the advantage of applying higher dose radiation, with greater precision, directly to the tumor while sparing healthy tissue and surrounding organs, thereby resulting in fewer side effects. In this facility, the treatment requires an overnight stay in the hospital, in a supine position, with a perineal template sutured to the perineum to prevent catheter movement or dislodgement.