Developing and Implementing Electronic Consent Procedures in Response to Covid-19 Restrictions.

The Covid-19 pandemic resulted in unprecedented restrictions on many public, private, and workplace activities throughout the United States and elsewhere. When restrictions were imposed, we were conducting a type III hybrid effectiveness-implementation trial in 10 pediatric trauma centers. In response to several pandemic-based restrictions, we had to develop procedures for engaging with potential research participants while limiting nonclinical, in-person interactions.

Is Oral Health Essential?

Since 1840, when the first dental school in the United States was founded, educational and policy outcomes have reinforced the separation of dentistry from medicine. Originating in serial historical divides, this separation has produced grave health inequity. The COVID-19 pandemic illuminates differences in medical and dental care delivery streams and also suggests how to design a unified health care system that transcends historical precedent.

Dental Services Utilization by Rurality Among Privately Insured Children in the United States.

The purpose of this study was to determine differences in dental services received between rural and urban residents in a national sample of children with private insurance. This was a retrospective study of deidentified claims data from a major national private insurer. Children younger than 18 years of age enrolled throughout 2018 and who had at least one visit to the dentist that year were included.

Lifetime Prevalence of Cervical Cancer Screening in 55 Low- and Middle-Income Countries.

Importance: The World Health Organization is developing a global strategy to eliminate cervical cancer, with goals for screening prevalence among women aged 30 through 49 years. However, evidence on prevalence levels of cervical cancer screening in low- and middle-income countries (LMICs) is sparse.

Objective: To determine lifetime cervical cancer screening prevalence in LMICs and its variation across and within world regions and countries.

Health Characteristics Associated With Hot Flashes in Women With HIV During Menopause: An Integrative Review.

Hot flashes (HFs) are a prominent symptom of menopause known to unfavorably influence mood, sleep, and quality of life. More women living with HIV are entering menopause and may experience a greater prevalence of HFs and more severe HFs compared with uninfected women. This integrative review evaluated existing evidence on potential health characteristics associated with HFs in women living with HIV during menopause.

Justice in CRISPR/Cas9 Research and Clinical Applications.

CRISPR/Cas9 is a rapidly developing gene editing technology that will soon have many clinical applications. As with many other new technologies, somatic gene editing with CRISPR/Cas9 raises concerns about equitable access to therapies by historically disenfranchised racial and ethnic minorities. We describe justice concerns related to CRISPR/Cas9, including its potential impact on historically mistreated populations through underrepresentation of minorities in genomic databases and the potential for disparate access to somatic gene therapies when they become clinically available.

The Breast Cancer Screening "Arcade" and the "Whack-A-Mole" Efforts to Reduce Access to Screening.

The effort to reduce access to breast cancer screening has been going on for decades. As each piece of misinformation has been published, scientific responses have exposed the fallacies, but then new "alternative facts" are generated. The effort has been compared to the arcade game "Whack-a-Mole" in which one false argument is addressed only to have a new one "pop up" to replace it.

How Should Clinicians Weigh the Benefits and Harms of Discussing Politicized Topics that Influence Their Individual Patients' Health?

Health implications of politically charged phenomena are particularly difficult for physicians to discuss with their patients and communities. Addressing climate change and its associated health effects involves trade-offs between health and economic prosperity, necessitating that physicians weigh the potential benefits and risks of discussing climate change health effects. We argue that the potential benefits of physician communication and advocacy ultimately outweigh the potential risks.

Medical robotics-Regulatory, ethical, and legal considerations for increasing levels of autonomy.

The regulatory, ethical, and legal barriers imposed on medical robots necessitate careful consideration of different levels of autonomy, as well as the context for use.

Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review.

Oxygen therapy can be delivered using low-flow, intermediate-flow (air entrainment mask), or high-flow devices. Low/intermediate-flow oxygen devices have several drawbacks that cause critically ill patients discomfort and translate into suboptimal clinical results. These include limitation of the FiO2 (due to the high inspiratory flow often observed in patients with respiratory failure), and insufficient humidification and warming of the inspired gas.

Vestibular prosthesis tested in rhesus monkeys.

We are studying the effectiveness of a semicircular canal prosthesis to improve postural control, perception of spatial orientation, and the VOR in rhesus monkeys with bilateral vestibular hypofunction. Balance is examined by measuring spontaneous sway of the body during quiet stance and postural responses evoked by head turns and rotation of the support surface; perception is measured with a task derived from the subjective visual vertical (SVV) test during static and dynamic rotation in the roll plane; and the angular VOR is measured during rotation about the roll, pitch, and yaw axes. After the normal responses are characterized, bilateral vestibular loss is induced with intratympanic gentamicin, and then multisite stimulating electrodes are chronically implanted into the ampullae of all three canals in one ear.

Social determinants of mental health treatment among Haitian, African American, and White youth in community health centers.

We examine adequate mental health treatment, emergency room (ER) use, and early treatment dropout for Haitian, African American and White youth with a psychiatric diagnosis treated in community health centers in the United States. We present associations with possible socioeconomic determinants of care. Adequate treatment was less likely among Haitian youth from areas with greater poverty and among all youth from areas with more female-headed households.

Is it time to reconsider subcutaneous administration of epoetin?

Anemia treatment in nondialysis chronic kidney disease (ND-CKD) and dialysis CKD patients (D-CKD) has been recently scrutinized in the literature and by the lay press. New evidence suggests that patients receiving epoetin and achieving higher hemoglobin have a higher risk of death and cardiovascular complications. Data from the Centers for Medicare & Medicaid Services demonstrate upward spiraling costs of injectables, especially epoetin, in the care of CKD patients.

A laboratory driving simulation for assessment of driving behavior in adults with ADHD: a controlled study.

Background: It is now estimated that attention deficit-hyperactivity disorder (ADHD) afflicts at least 4% of adults in the United States and is associated with high levels of morbidity and functional impairment. One key area of dysfunction associated with ADHD is impaired motor vehicle operation. Our goal was to examine the association between ADHD and specific driving outcomes in a sample of adults using a driving simulator.