An assessment of the influence of trade-off optimization in commercial knowledge based planning library creation for tongue cancer patients.

This article aims to compare the dosimetric performance between knowledge-based plan (KBP) libraries with and without trade-off (TO) exploration using multicriterial optimization (MCO) for tongue cancer patients. The trade-off optimized library (KBP_MCO) contains a minimal number of constituent plans, whereas two nontrade-off optimized libraries contain a minimal and a large number of treatment plans, respectively. Three KBP libraries were created: KBP_100 and KBP_20, each comprising of 100 and 20 manually optimized plans, respectively.

Multisite implementation of a sexual health survey and clinical decision support to promote adolescent sexually transmitted infection screening.

Background: Adolescents are at high risk for sexually transmitted infections (STIs) and frequently present to emergency departments (EDs) for care. Screening for STIs using confidential patient-reported outcomes represents an ideal use of electronic screening methodology.

Objectives: The objectives of this study were to implement a patient-facing, confidential electronic survey to assess adolescent risk for STIs and consent for testing with integrated provider facing electronic clinical decision support (CDS) across six geographically dispersed pediatric EDs and evaluate implementation based on survey and CDS usage metrics.

Facilitators to implementing preventive health interventions for adolescents in the emergency department: A multicenter qualitative analysis.

Objectives: Adolescents frequently use the emergency department (ED) to meet their health care needs, and many use the ED as their primary source of care. The ED is therefore well situated to provide preventive health care to large numbers of adolescents. The objective of this multicenter qualitative analysis was to identify factors that influence the implementation of preventive health care interventions for adolescent patients in the ED.

Childhood Opportunity Index and Low-Value Care in Children's Hospitals.

Background And Objective: Few studies have explored the relationship between social drivers of health and pediatric low-value care (LVC). We assessed the relationship between Childhood Opportunity Index (COI) 2.0 and LVC in children's hospitals.

The dosimetric impact of trade-off optimization in high-quality Craniospinal Irradiation plans based on volumetric modulated arc therapy technique.

This study assesses the dosimetric effectiveness of the commercial trade-off optimization (TO) module in comparison to iterative optimization for volumetric modulated arc therapy (VMAT) in craniospinal irradiation technique.Fifteen patients who had previously undergone VMAT-based craniospinal irradiation (CSI) using manual optimization (TP) underwent re-optimization with trade-off optimization (MCO). All patients were treated using the Halcyon-E O-ring linear accelerator, with maximum field size of 28×28 cm², a 6MV unflattened beam, and adjacent isocenter field overlap of 10 cm.

Spontaneous Hypoglycaemia due to Insulin Autoimmune Syndrome in Six Cases, Response to Steroid Therapy and Rituximab.

Introduction: Dr. Hirata of Japan first described insulin autoimmune syndrome (IAS) in 1970. Seven hundred ninety-five cases of this rare syndrome have been reported from Japan and China and 29 from India.

Contraception Use and Pregnancy Risk Among Adolescents in Pediatric Emergency Departments.

Importance: Unintended pregnancy is a major health risk for adolescents in the US, and adolescents face many barriers to obtaining effective and reliable contraception.

Objective: To measure and describe the use of contraception, pregnancy risk index (PRI), and emergency contraception (EC) prescriptions among female adolescents accessing the emergency department (ED) for care.

Design, Setting, And Participants: This cross-sectional study is a planned secondary analysis of a multicenter trial from April 2021 through April 2022 that used a tablet-based, content-validated, confidential sexual health survey at 6 urban, pediatric tertiary care EDs affiliated with the Pediatric Emergency Care Applied Research Network.

Protocol for a nationwide case-control study of firearm violence prevention tactics and policies in K-12 schools.

Background: Most U.S. K-12 schools have adopted safety tactics and policies like arming teachers and installing metal detectors, to address intentional school gun violence.

Determining the library size for the optimal output plan in the RapidPlan knowledge-based planning system using multicriteria optimization.

Objectives: The aim of this study was to determine the number of trade-off explored (TO) library plans required for building a RapidPlan (RP) library that would generate the optimal clinical treatment plan.

Methods: We developed 2 RP models, 1 each for the 2 clinical sites, head and neck (HN) and cervix. The models were created using 100 plans and were validated using 70 plans (VP) for each site respectively.

Comparative dosimetric, setup margin, and treatment time analysis between ring gantry and C-Arm linear accelerators for VMAT-based craniospinal irradiation plans.

Purpose: The purpose of this study is to evaluate the dosimetric and treatment delivery characteristics of volumetric modulated arc therapy technique (VMAT)-based craniospinal axis irradiation (CSI) between ring gantry Halcyon (HAL) and C-arm based Novalis Tx (NTx) linear accelerator. Set-up margin and treatment delivery time for both machines were also taken into account.

Materials And Methods: Fifteen patients, 4 females and 11 males treated between March 2019 and February 2022 within the age group 4-56 years simulated in the supine position and were planned for multiple isocentre VMAT technique in ring gantry Halcyon and C-Arm Novalis linear accelerator for 6FFF and 6 MV flatten beam energy.

Disparities in Racial, Ethnic, and Payer Groups for Pediatric Safety Events in US Hospitals.

Background And Objectives: Health care disparities are pervasive, but little is known about disparities in pediatric safety. We analyzed a national sample of hospitalizations to identify disparities in safety events.

Methods: In this population-based, retrospective cohort study of the 2019 Kids' Inpatient Database, independent variables were race, ethnicity, and payer.

Sexually Transmitted Infection Diagnoses at Children's Hospitals During COVID-19.

Objectives: COVID-19 mitigation strategies resulted in changes in health care access and utilization, which could negatively impact adolescents at risk for sexually transmitted infections (STIs). We evaluated changes in STI diagnoses during adolescent visits at children's hospitals during COVID-19.

Methods: We conducted a retrospective cohort study using the Pediatric Health Information System database comparing adolescent (11-18 years) hospital visits with an STI diagnosis by International Classification of Diseases, 10th revision, code during COVID-19 (2020) to pre-COVID-19 (2017-2019).

Pediatric Firearm Injury Emergency Department Visits From 2017 to 2022: A Multicenter Study.

Background And Objective: Pediatric firearm injuries increased during the coronavirus disease 2019 pandemic, but recent trends in firearm injury emergency department (ED) visits are not well described. We aimed to assess how pediatric firearm injury ED visits during the pandemic differed from expected prepandemic trends.

Methods: We retrospectively studied firearm injury ED visits by children <18 years old at 9 US hospitals participating in the Pediatric Emergency Care Applied Research Network Registry before (January 2017 to February 2020) and during (March 2020 to November 2022) the pandemic.

The Epidemiology of Violence Exposure in Children.

Exposure to violence remains a significant issue for children in the United States. The COVID-19 pandemic exacerbated many of these exposures. Violence unequally impacts children of color and lesbian, gay, bisexual, transgender, and questioning youth.

Social Navigation for Adolescent Emergency Department Patients: A Randomized Clinical Trial.

Purpose: Adolescent emergency department (ED) patients have unmet social needs that contribute to ED use. This study aimed to evaluate the effect of social needs navigation for adolescents on subsequent ED visits and community resource use and to identify characteristics associated with elevated social risk.

Methods: Between July 2017 and August 2019, we used a random date generator to establish intervention and control group enrollment dates.

Role of Optimal Features Selection with Machine Learning Algorithms for Chest X-ray Image Analysis.

Introduction: The objective of the present study is to classify chest X-ray (CXR) images into COVID-positive and normal categories with the optimal number of features extracted from the images. The successful optimal feature selection algorithm that can represent images and the classification algorithm with good classification ability has been determined as the result of experiments.

Materials And Methods: This study presented a framework for the automatic detection of COVID-19 from the CXR images.

Timing of Mental Health Service Use After a Pediatric Firearm Injury.

Objectives: To examine how timing of the first outpatient mental health (MH) visit after a pediatric firearm injury varies by sociodemographic and clinical characteristics.

Methods: We retrospectively studied children aged 5 to 17 years with a nonfatal firearm injury from 2010 to 2018 using the IBM Watson MarketScan Medicaid database. Logistic regression estimated the odds of MH service use in the 6 months after injury, adjusted for sociodemographic and clinical characteristics.

Undertriage for Children With Caregivers Preferring Languages Other Than English.

Objectives: Undertriage, the underestimation of acuity, can result in delayed care and potential morbidity in the emergency department (ED). Although inequities in ED care based on language preference have been noted, little is known about its association with undertriage. We evaluated for differences in undertriage based on caregiver language preference.

Racial and Ethnic Differences in Insurer Classification of Nonemergent Pediatric Emergency Department Visits.

Importance: Government and commercial health insurers have recently enacted policies to discourage nonemergent emergency department (ED) visits by reducing or denying claims for such visits using retrospective claims algorithms. Low-income Black and Hispanic pediatric patients often experience worse access to primary care services necessary for preventing some ED visits, raising concerns about the uneven impact of these policies.

Objective: To estimate potential racial and ethnic disparities in outcomes of Medicaid policies for reducing ED professional reimbursement based on a retrospective diagnosis-based claims algorithm.