Managing acute pain in children presenting to the emergency department without opioids.

Pediatric pain is challenging to assess and manage. Frequently underestimated in children, untreated pain may have consequences including increased fear, anxiety, and psychological issues. With the current opioid crisis, emergency physicians must be knowledgeable in both pharmacologic and non-pharmacologic approaches to address pain and anxiety in children that lead to enhanced patient cooperation and family satisfaction.

Discovery of an NAD analogue with enhanced specificity for PARP1.

Among various protein posttranslational modifiers, poly-ADP-ribose polymerase 1 (PARP1) is a key player for regulating numerous cellular processes and events through enzymatic attachments of target proteins with ADP-ribose units donated by nicotinamide adenine dinucleotide (NAD). Human PARP1 is involved in the pathogenesis and progression of many diseases. PARP1 inhibitors have received approvals for cancer treatment.

Vascular risk profile and white matter hyperintensity volume among Mexican Americans and non-Hispanic Whites: The HABLE study.

Introduction: Among vascular risk factors we hypothesized that an increased prevalence of diabetes in Hispanics would be associated with greater white matter hyperintensity (WMH) volume, which may contribute to cognitive decline.

Methods: A total of 1318 participants (60% female; 49% Hispanic, 51% non-Hispanic White; age 66.2 ± 8.

Leveraging microgrants to support capacity-building workshops in low- and middle-income countries for meeting the Sustainable Development Goals.

Twenty fifteen marked the year of assessment for the Millennium Development Goals (MDGs). The MDGs that achieved the greatest success were those where evidence-based practice (EBP) interventions were implemented. The ability to practice evidence-based medicine is grounded in the creation of and access to medical literature that synthesizes research findings.

Charting the Information and Misinformation Landscape to Characterize Misinfodemics on Social Media: COVID-19 Infodemiology Study at a Planetary Scale.

Background: The novel coronavirus, also known as SARS-CoV-2, has come to define much of our lives since the beginning of 2020. During this time, countries around the world imposed lockdowns and social distancing measures. The physical movements of people ground to a halt, while their online interactions increased as they turned to engaging with each other virtually.

Grayscale Ultrasound Texture Features of Carotid and Brachial Arteries in People With HIV Infection Before and After Antiretroviral Therapy.

Background We aimed to investigate novel grayscale ultrasound characteristics of the carotid and brachial arteries in people with HIV infection before and after starting initial antiretroviral therapy (ART). Methods and Results We performed grayscale ultrasound image analyses of the common carotid artery (CCA) and brachial artery before and after receipt of 1 of 3 randomly allocated ART regimens. We measured arterial wall echogenicity (grayscale median), contrast (gray-level difference statistic method), and entropy.

Neurodegeneration from the AT(N) framework is different among Mexican Americans compared to non-Hispanic Whites: A Health & Aging Brain among Latino Elders (HABLE) Study.

Introduction: We sought to examine a magnetic resonance imaging (MRI)-based marker of neurodegeneration from the AT(N) (amyloid/tau/neurodegeneration) framework among a multi-ethnic, community-dwelling cohort.

Methods: Community-dwelling Mexican Americans and non-Hispanic White adults and elders were recruited. All participants underwent comprehensive assessments including an interview, functional exam, clinical labs, informant interview, neuropsychological testing and 3T MRI of the brain.

Spatial Variation in Humidity and the Onset of Seasonal Influenza Across the Contiguous United States.

In recent years, environmental factors, particularly humidity, have been used to inform influenza prediction models. This study aims to quantify the relationship between humidity and influenza incidence at the state-level in the contiguous United States. Piecewise segmented regressions were performed on specific humidity data from NASA's Atmospheric Infrared Sounder (AIRS) and incident influenza estimates from Google Flu Trends to identify threshold values of humidity that signal the onset of an influenza outbreak.

Congenital duplicated incus in the mastoid cavity.

Many congenital ossicular chain malformations exist, usually involving ossicular deformities, fixation, absence, or discontinuity. Duplication of ossicles has not been reported, much less a duplicated ossicle located in the mastoid. We present a case of a patient who had a duplicated incus in the mastoid antrum.

Association of Alcohol Use Diagnostic Codes in Pregnancy and Offspring Conotruncal and Endocardial Cushion Heart Defects.

Background The pathogenesis of congenital heart disease (CHD) remains largely unknown, with only a small percentage explained solely by genetic causes. Modifiable environmental risk factors, such as alcohol, are suggested to play an important role in CHD pathogenesis. We sought to evaluate the association between prenatal alcohol exposure and CHD to gain insight into which components of cardiac development may be most vulnerable to the teratogenic effects of alcohol.

PACK-CXL vs. antimicrobial therapy for bacterial, fungal, and mixed infectious keratitis: a prospective randomized phase 3 trial.

Background: Infectious keratitis is a major cause of global blindness. We tested whether standalone photoactivated chromophore corneal cross-linking (PACK-CXL) may be an effective first-line treatment in early to moderate infectious keratitis, compared with standard antimicrobial treatment.

Methods: This is a randomized, controlled, multinational phase 3 clinical trial.

Are emergency physicians satisfied? An analysis of operational/organization factors.

Objective: Professional satisfaction is associated with career longevity, individual well-being, and patient care and safety. Lack of physician engagement promotes the opposite. This study sought to identify important facets contributing to decreased career satisfaction using a large national data set of practicing emergency physicians.

Clinical Value of Surveillance Biopsies in Pediatric Liver Transplantation.

Although pediatric liver transplantation (LT) results in excellent long-term outcomes, a high incidence of early acute cellular rejection and late graft fibrosis persists. Routine measurement of allograft enzymes may not reliably detect rejection episodes, identify candidates for immunosuppression minimization, or indicate allograft fibrosis. Surveillance biopsies (SBs) can provide valuable information in this regard, but their role in pediatric LT is not fully established.

Subtle mistakes in self-report surveys predict future transition to dementia.

Introduction: We investigate whether indices of subtle reporting mistakes derived from responses in self-report surveys are associated with dementia risk.

Methods: We examined 13,831 participants without dementia from the prospective, population-based Health and Retirement Study (mean age 69 ± 10 years, 59% women). Participants' response patterns in 21 questionnaires were analyzed to identify implausible responses (multivariate outliers), incompatible responses (Guttman errors), acquiescent responses, random errors, and the proportion of skipped questions.

Lower Alpha-Fetoprotein Threshold of 500 ng/mL for Liver Transplantation May Improve Posttransplant Outcomes in Patients With Hepatocellular Carcinoma.

Under current United Network for Organ Sharing (UNOS) policy, patients with hepatocellular carcinoma (HCC) and alpha-fetoprotein (AFP) levels ≥1000 ng/mL are required to show a reduction in AFP level to <500 ng/mL before liver transplantation (LT). However, effects of AFP reduction on post-LT HCC outcomes among patients with HCC with moderately elevated AFP levels between 100 and <1000 ng/mL are unclear. Adults in the UNOS registry who underwent LTs from January 2005 to September 2015 with initial AFP levels of 100 to 999 ng/mL at listing for Model for End-Stage Liver Disease exceptions were included.

COVID-19 Information Sources and Health Behaviors During Pregnancy: Results From a Prenatal App-Embedded Survey.

Background: Pregnancy is a time of heightened COVID-19 risk. Pregnant individuals' choice of specific protective health behaviors during pregnancy may be affected by information sources.

Objective: This study examined the association between COVID-19 information sources and engagement in protective health behaviors among a pregnant population in a large academic medical system.

Using Point-in-Time Homeless Counts to Monitor Mortality Trends Among People Experiencing Homelessness in Los Angeles County, California, 2015‒2019.

To report trends in mortality rates, mortality rate ratios (MRRs), and causes of death among people experiencing homelessness (PEH) in Los Angeles County, California, by using annual point-in-time homeless counts and to compare findings to published longitudinal cohort studies of homeless mortality. We enumerated homeless deaths and determined causes by using 2015-2019 medical examiner‒coroner data matched to death certificate data. We estimated midyear homeless population denominators by averaging consecutive January point-in-time homeless counts.

Difficulty Regulating Social Media Content of Age-Restricted Products: Comparing JUUL's Official Twitter Timeline and Social Media Content About JUUL.

Background: In 2018, JUUL Labs Inc, a popular e-cigarette manufacturer, announced it would substantially limit its social media presence in compliance with the Food and Drug Administration's (FDA) call to curb underage e-cigarette use. However, shortly after the announcement, a series of JUUL-related hashtags emerged on various social media platforms, calling the effectiveness of the FDA's regulations into question.

Objective: The purpose of this study is to determine whether hashtags remain a common venue to market age-restricted products on social media.

Area-Based Geocoding: An Approach to Exposure Assessment Incorporating Positional Uncertainty.

While the spatial resolution of exposure surfaces has greatly improved, our ability to locate people in space remains a limiting factor in accurate exposure assessment. In this case-control study, two approaches to geocoding participant locations were used to study the impact of geocoding uncertainty on the estimation of ambient pesticide exposure and breast cancer risk among women living in California's Central Valley. Residential and occupational histories were collected and geocoded using a traditional point-based method along with a novel area-based method.

Timing of venous thromboembolic pharmacological prophylaxis in traumatic combined subdural and subarachnoid hemorrhage.

Background: The combination of subdural and subarachnoid hemorrhage is the most common intracranial bleeding. The present study evaluated the timing and type of venous thromboembolic chemoprophylaxis (VTEp) for efficacy and safety in patients with blunt head trauma with combined acute subdural and subarachnoid hemorrhage.

Methods: Patients with isolated combined acute subdural and subarachnoid hemorrhage were extracted from the ACS-TQIP database (2013-2017).

From prostate to the pons: The first reported case of multi-organ septic emboli and brain empyema from an untreated prostate abscess.

Prostate abscesses in developed countries are becoming increasingly less common. Left untreated these abscesses can lead to numerous complications, including some which are very rare.

The Impact of Median Model for End-Stage Liver Disease at Transplant Minus 3 National Policy on Waitlist Outcomes in Patients With and Without Hepatocellular Carcinoma.

As a result of ongoing regional disparities, the United Network for Organ Sharing (UNOS) implemented policy in May 2019 limiting exception points for waitlisted patients with hepatocellular carcinoma (HCC) to median Model for End-Stage Liver Disease at transplant in the area surrounding a transplant center minus 3 points (MMAT-3). The impact of this policy change remains unknown. We included adult patients with HCC (n = 4567) and without HCC (n = 19,773) in the UNOS database added to the waiting list before this policy change (May 7, 2017-May 18, 2019) and after (May 19, 2019-March 7, 2020).

A Peer-Led, Artificial Intelligence-Augmented Social Network Intervention to Prevent HIV Among Youth Experiencing Homelessness.

Background: Youth experiencing homelessness (YEH) are at elevated risk of HIV/AIDS and disproportionately identify as racial, ethnic, sexual, and gender minorities. We developed a new peer change agent (PCA) HIV prevention intervention with 3 arms: (1) an arm using an artificial intelligence (AI) planning algorithm to select PCAs; (2) a popularity arm, the standard PCA approach, operationalized as highest degree centrality (DC); and (3) an observation-only comparison group.

Setting: A total of 713 YEH were recruited from 3 drop-in centers in Los Angeles, CA.