A Data-Driven Approach to Inguinal Hernia Repairs in Infants and Children.

Laparoscopic inguinal hernia repair has become increasingly popular in children. The laparoscopic technique inherently assesses the contralateral processus vaginalis, reducing the risk of metachronous contralateral hernias. We hypothesized that primary laparoscopic repair would be associated with lower rates of subsequent hernia repair in the youngest patients, in whom metachronous contralateral hernias are most common.

Lentigo Maligna Part II: Management.

Lentigo Maligna (LM) arises on chronically-sun damaged skin and can have extensive subclinical spread, often in functionally and cosmetically challenging areas. This two-part continuing medical education (CME) series reviews LM. Part I reviews epidemiology, risk factors, clinical presentation, diagnostic tools, biopsy technique, and histopathology of LM.

Lentigo Maligna Part I: Epidemiology, Risk Factors, and Diagnosis.

Lentigo maligna (LM) is an increasingly common subtype of melanoma, presenting as a slow-growing tan-brown macule or patch with irregular borders arising on chronically solar-damaged skin. This two-part continuing medical education (CME) series provides an overview of LM. Part I reviews LM's epidemiology, risk factors, and clinical presentation.

Impact of Veterans Affairs Geriatric Research, Education, and Clinical Centers: Incubators of innovation in geriatrics.

Since their inception in 1975, the Department of Veterans Affairs Geriatric Research, Education, and Clinical Centers (GRECCs) have served as incubators of innovation in geriatrics. Their contributions to the VA mission were last reviewed in 2012. Herein, we describe the continuing impact of GRECCs in research, clinical, and educational areas, focusing on the period between 2018 and 2022.

Age-Friendly Health Systems and Meeting the Principles of High Reliability Organizations in the VHA.

Background: The Veterans Health Administration (VHA) is the largest integrated health care system in the US, providing care to more than 9 million enrolled veterans. In February 2019, the VHA identified key actionable steps to become a high reliability organization (HRO), transforming how employees think about patient safety and care quality. The VHA is also working toward becoming the largest age-friendly health system in the US to be recognized by the Institute for Healthcare Improvement for its commitment to providing care guided by the 4Ms (what matters, medication, mentation, and mobility), causing no harm, and aligning care with what matters to older veterans.

Advancing nursing practice in Ireland: A pathway of care for nurse-led integrated venous leg ulcer management.

Approximately 80% of patients presenting with leg ulcers are venous in origin. However, lack of standardisation of care has a human and financial impact for patients and service providers. Increases in the aging population and number of patients entering older age with co-morbidities results in increases in the demand for venous leg ulcer treatments.

Mendelian Randomization Analysis reveals Inverse Genetic Risks between Skin Cancers and Vitiligo.

Several observational studies have demonstrated a consistent pattern of decreased melanoma risk among patients with vitiligo. More recently, this finding has been supported by a suggested genetic relationship between the two entities, with certain variants significantly associated with an increased risk of melanoma, basal cell carcinoma, and squamous cell carcinoma but a decreased risk of vitiligo. We compared 48 associated variants from a recently published GWAS and identified three variants-located in the , , and loci- that correlated with an increased risk for melanoma, basal cell carcinoma, and squamous cell carcinoma and a decreased risk for vitiligo.

Implementation and Outcomes of an Empiric Ivermectin Strongyloides Treatment Protocol for Patients Receiving High-Dose Corticosteroids for Severe COVID-19.

Strongyloides stercoralis is a parasitic roundworm that is present worldwide and can cause lifelong, often asymptomatic, infection. Immunosuppression, particularly by corticosteroids, is a risk factor for hyperinfection syndrome and disseminated strongyloidiasis-severe disease states that can lead to septic shock and death. Our institution implemented a strongyloidiasis screening and empiric ivermectin treatment protocol for inpatients receiving high-dose corticosteroids for severe COVID-19.

Antibiotic-induced microbial depletion enhances murine small intestinal epithelial growth in a serotonin-dependent manner.

Regulation of small intestinal epithelial growth by endogenous and environmental factors is critical for intestinal homeostasis and recovery from insults. Depletion of the intestinal microbiome increases epithelial proliferation in small intestinal crypts, similar to the effects observed in animal models of serotonin potentiation. Based on prior evidence that the microbiome modulates serotonin activity, we hypothesized that microbial depletion-induced epithelial proliferation is dependent on host serotonin activity.

Transplantation and immigration: Comparing infectious complications and outcomes between foreign-born and US-born kidney transplant recipients in Minnesota.

Background: Foreign-born kidney transplant recipients (FBKTRs) are at increased risk for reactivation of latent infections that may impact outcomes. We aimed to compare the etiology of infections and outcomes between FBKTR and United States KTRs (USKTR).

Methods: We performed a retrospective study of patients who underwent kidney transplantation between January 1, 2014 and December 31, 2018 at two transplant centers in Minnesota.

Melanoma classification and management in the era of molecular medicine.

Melanoma is the most lethal form of skin cancer although surgery is often curative when combined with early screening and prevention. In recurrent or advanced cancer, the emergence of chemotherapy, targeted therapy, and immune checkpoint inhibitors has demonstrated promising clinical outcomes. Such approaches can remarkably halt the progression of disease for many years, although are limited by the acquisition of resistance.

Evaluation of a Geographic Screening Protocol for Chronic Parasitic Infections Before Kidney Transplant: An Institutional Experience in Minnesota.

Pretransplant recommendations advise risk-based screening for strongyloidiasis, schistosomiasis, and Chagas disease. We evaluated the implementation of a chronic parasite screening protocol at a health system in a nonendemic region serving a large foreign-born population. Candidates listed for kidney transplant at Hennepin Healthcare (Minneapolis, MN) between 2010 and 2020 were included.

Age-friendly care in the Veterans Health Administration: Past, present, and future.

The Veterans Health Administration (VHA) has long recognized the need for age-friendly care. VHA leadership anticipated the impact of aging World War II veterans on VA healthcare systems and in 1975 developed Geriatric Research, Education, and Clinical Centers (GRECCs) to meet this need. GRECCs catalyzed a series of innovations in geriatric models of care that span the continuum of care, most of which endure.

The role of parental health and distress in assessing children's health status.

Purpose: The purpose of the study was to examine the contributions of parents' health and distress to parent's and children's assessments of children's health.

Methods: We used baseline data from a longitudinal study of 364 children (ages 4-12) about to undergo surgery and their parents in a Southern California pediatric hospital. We used the 20-item child self-reported CHRIS 2.

Review of 2007-2020 Humanbecoming Guided Studies and Investigations.

The authors in this article provide a review and synthesis of 46 studies and investigations that were published between 2007 to 2020 that were guided by the everchanging humanbecoming paradigm. Moreover, the authors present details and a synthesis of published studies using the Parse research method and humanbecoming hermeneutic method as well as the extant Parsesciencing and humanbecoming hermeneutic sciencing investigations published up to the date of December 31, 2020. The article builds on the previous review conducted by Doucet and Bournes in 2007, which addressed studies conducted from 1985-2006.

Jejunoileal mucosal growth in mice with a limited microbiome.

Previous work demonstrated enhanced enterocyte proliferation and mucosal growth in gnotobiotic mice, suggesting that intestinal flora participate in mucosal homeostasis. Furthermore, broad-spectrum enteral antibiotics are known to induce near germ-free (GF) conditions in mice with conventional flora (CONV). We hypothesized that inducing near GF conditions with broad-spectrum enteral antibiotics would cause ordered small intestinal mucosal growth in CONV mice but would have no effect in GF mice with no inherent microbiome.

Index Admission Cholecystectomy and Recurrence of Pediatric Gallstone Pancreatitis: Multicenter Cohort Analysis.

Background: We aim to evaluate recurrence rates of gallstone pancreatitis in children undergoing early vs interval cholecystectomy.

Study Design: A multicenter, retrospective review of pediatric patients admitted with gallstone pancreatitis from 2010 through 2017 was performed. Children were evaluated based on timing of cholecystectomy.

Formatively assessing prospective teachers' skills in leading mathematics discussions.

Mathematics discussions are important for helping students to develop conceptual understanding and to learn disciplinary norms and practices. In recent years, there has been increased attention to teaching prospective teachers to lead discussions with students. This paper examines the possibilities of designing a formative assessment that gathers information about prospective elementary teachers' skills with leading problem-based mathematics discussions and makes sense of such information.

Feeling Ashamed: A Parsesciencing Inquiry.

The universal humanuniverse living experience of feeling ashamed was explored using the Parsesciencing mode of inquiry. The inquiry stance was: Historians were 10 adults living in a community in upstate New York. The major discovery of this Parsesciencing inquiry was the discerning extant moment: