The period of transition from childhood to adulthood and the period immediately after transfer of care is a challenging time for young people with kidney failure.

Young patients with kidney failure cared for exclusively in adult-oriented facilities experience increased rates of avoidable hospitalizations during late adolescence and young adulthood. Avoidable hospitalizations increased among pediatric kidney failure patients during the years immediately after transfer to adult care. (Read the full article)

Early preventive dental care is cost-effective and can reduce subsequent restorative or emergency visits. Little is known about the factors distinguishing families who receive dental care in early childhood and those who do not.

Our results suggest that among healthy children seen by primary care providers, those most in need of dental care are least likely to receive it. This highlights the importance of promoting early preventive dental care in the primary care setting. (Read the full article)

There is wide variation in pediatric subspecialty supply in the United States. The impact of this variation in supply on utilization and child and family disease burden is not known.

Among children with special health care needs, living in a county with lower subspecialty supply was associated with lower perceived need for subspecialty care, lower subspecialty utilization, and no meaningful differences in examined measures of child and family disease burden. (Read the full article)

Since the introduction of rotavirus vaccines, diarrhea-associated health care utilization among US children has decreased substantially. Moreover, indirect benefits from rotavirus vaccination have been observed in unvaccinated children and in adults.

With increasing rotavirus vaccine coverage during 2009–2011, we observed continued reductions in diarrhea-associated health care utilization and cost. Both rotavirus vaccines conferred high protection against rotavirus hospitalizations; pentavalent rotavirus vaccine provided durable protection through the fourth year of life. (Read the full article)

Pneumonia is a leading cause of hospitalization among children, and readmissions after discharge are common.

Eight percent of children experience a readmission within 30 days after hospital discharge for pneumonia. Readmissions are most common among young children and those with chronic medical conditions, and are associated with substantial costs. (Read the full article)

Previous research has demonstrated that family presence alongside hospitalized patients is associated with improvements in physiologic responses, reductions in anxiety, and expedited recovery. Recently, videoconferencing has been increasingly used for virtual visits to pediatric patients and their parents during hospitalization.

Our study demonstrates that in some cases, the use of videoconferencing by children and their parents for virtual visits is associated with greater reductions in stress during hospitalization compared with children and parents who do not use videoconferencing. (Read the full article)

Lower respiratory tract infections (LRTIs), including pneumonia, are in the top 10 causes of death among children in the United States. In high-income countries, 3% to 14% of LRTI hospitalizations have been reported to require admission to an ICU.

During 2007–2011, approximately 31 289 hospitalizations for severe LRTI occurred in children each year in the United States. Children <1 year of age had the highest rates of severe LRTI and accounted for 30% of severe LRTI hospitalizations. (Read the full article)

With the publication of evidence-based guidelines for asthma, bronchiolitis, and pneumonia, numerous efforts have been made to standardize and improve the quality of care. However, despite these guidelines, variation in care exists.

This study establishes clinically achievable benchmarks of care for asthma, bronchiolitis, and pneumonia. Using a published method for achievable benchmarks of care, we calculated average utilization among the high-performers, which can serve as achievable goals for local quality improvement. (Read the full article)

Although frequent utilizers of emergency departments (EDs) are targeted for quality improvement initiatives across the United States, little is known about the health services these patients receive in the ED.

Eight percent of children account for 24% of ED visits and 31% of all costs. Frequent utilizers of pediatric EDs, especially infants without a chronic condition, are least likely to need medications, testing, and hospital admission during their ED visits. (Read the full article)

Despite child-resistant packaging requirements for most medications and safe storage education for all medicines, tens of thousands of young children are brought to emergency departments and thousands are hospitalized annually after ingesting prescription medications. Targeted prevention efforts may be needed.

Twelve medications were implicated in nearly half of hospitalizations for prescription medication ingestions. Buprenorphine and clonidine were most commonly implicated and had the highest hospitalization rates when accounting for outpatient use. Prevention efforts should focus on most commonly implicated medications. (Read the full article)

Evidence from cohort studies has consistently found that universal bilirubin screening is associated with reductions in rates of severe hyperbilirubinemia but has shown variation in other outcomes such as phototherapy use, length of stay, emergency department visits, and readmission rates.

Universal bilirubin screening may not increase neonatal length of stay or postdischarge hospital use. Preexisting trends in health care utilization have an impact on observed effects of universal bilirubin screening. (Read the full article)

Continuously aerosolized albuterol been shown to be safe and effective for the treatment of severe status asthmaticus in the emergency department and ICU. Little evidence supports its use in the non–intensive care setting.

With the appropriate resources and support, continuous albuterol may be administered in the non–ICU setting with a low incidence of clinical deterioration and adverse effects. Certain clinical factors may help identify which patients may benefit from higher acuity care. (Read the full article)

Pneumococcal conjugated vaccines (PCVs) are known to decrease invasive pneumococcal disease in children, but their effect on pneumonia necessitating hospitalization is more variable across study sites, and effects on hospitalization for sinusitis have not been shown previously.

There was a significant decrease in hospitalizations for sinusitis in children <2 years of age, and hospitalization for pneumonia decreased in children aged <5 years after sequential introduction of PCV7 and PCV13. (Read the full article)

Respiratory syncytial virus (RSV) infection is a common cause of pediatric hospitalizations. Mortality rates associated with RSV hospitalizations are based on estimates from studies conducted decades ago. Accurate understanding of mortality is required for identifying high-risk infants and children.

Mortality associated with RSV is uncommon in the 21st century, with annual deaths far lower than previous estimates. The majority of deaths occurred in infants with complex chronic conditions or in those with life-threatening conditions in addition to RSV infection. (Read the full article)

Influenza represents a leading cause of morbidity and a rare cause of death in children. Annual influenza vaccination was gradually expanded to include all children ≥6 months in 2008. The impact of these recommendations on disease burden is unclear.

We assessed the burden of influenza-related health care encounters in children aged 6 to 59 months from 2000 to 2011. In this ecologic exploration, influenza vaccination and influenza-related emergency department visits increased over time, whereas hospitalizations decreased. Influenza-related health care encounters were greater when A(H3N2) circulated. (Read the full article)

Heart rate (HR) increases with increasing body temperature. Previous studies have characterized the relationship among HR, age, and temperature for patients in primary care and emergency department settings but not in hospitalized children.

Our data demonstrate an overall increase in HR by ~10 beats/minute for each 1°C increase in body temperature. Expected heart rates for hospitalized children differ from those for primary care and emergency department patients at the same age and temperature. (Read the full article)

The 2011 national guidelines for the management of pediatric community-acquired pneumonia recommended narrow-spectrum antibiotic therapy (eg, ampicillin) for most children hospitalized with pneumonia. Before the release of the guidelines, the use of broader-spectrum antibiotics (eg, third-generation cephalosporins) was much more common.

After release of the guidelines, third-generation cephalosporin use declined and penicillin/ampicillin use increased among children hospitalized with pneumonia. Changes were most apparent among institutions that proactively disseminated the guidelines, underscoring the importance of local efforts for timely guideline implementation. (Read the full article)

Although existing analyses of inpatient pediatric pulmonary hypertension (PH) care have established an association with substantial morbidity and mortality, these investigations have been limited to small single-institution series or focused registries representative of selected patient subgroups.

This study provides the first contemporary, national trend analysis of inpatient care for children with PH. Pediatric PH is associated with a rapidly increasing number of hospital discharges and magnitude of resource utilization, and the makeup of this population is changing. (Read the full article)

Childhood inflammatory mediators are associated with adult obesity, but the stimuli that initiate and perpetuate chronic inflammation start in early life are largely unknown.

Childhood infection-related hospitalization was independently associated with adverse adult metabolic variables, which suggests that infections and/or their treatment in childhood may contribute to causal pathways leading to adult cardiometabolic diseases. (Read the full article)

Concern of the risk of malignancy from ionizing radiation has prompted many to advocate for judicious use of computed tomography (CT) and as low as necessary radiation doses administered per scan. Recent analysis has shown a decline in CT utilization.

We identified decreases in CT utilization between 2004 and 2012 for the 10 most common diagnostic groups receiving CT. Decreases were typically associated with increases in alternate imaging modalities. We provide a possible reason for the decrease in CT utilization. (Read the full article)

Infants with neonatal abstinence syndrome are hospitalized for longer after birth and are more likely to be from highly vulnerable families. Determining long-term outcomes is difficult because this is a large and chaotic population.

(Read the full article)

Children with medical complexity require a disproportionate amount of health services due to a multitude of chronic severe illness, and their impact on the health care system appears to be increasing.

This study provides one of the first comparisons of health care utilization patterns for children with medical complexity between medical centers in a population-based cohort. (Read the full article)

Given the efforts to decrease the use of ionizing radiation in pediatric patients, there is significant variability in head computed tomography (CT) scan use in pediatric emergency departments for minor head trauma.

This study characterized variability in CT scan rates for all body regions in emergency department, observation, and inpatient encounters across 30 tertiary pediatric hospitals. Two-fold variation remained after case-mix adjustment, with higher volume hospitals having lower rates of CT scanning. (Read the full article)

In this episode of the podcast, Tom chats with Tim Stuart about his new book, Personalized Learning in a PLC at Work: Student Agency Through the Four Critical Questions.

Los conflictos en los países pequeños suelen agravarse debido a la indiferencia internacional. Sin embargo, en el caso de la República Centroafricana (RCA), el problema es ligeramente distinto. Hay una importante presencia internacional en este Estado, pero los actores principales han decidido mantenerse al margen y esperar en vez de intervenir activamente en la crisis.

BACKGROUND:

For children who cannot be discharged from the emergency department, definitive care has become less frequent at most hospitals. It is uncertain whether this is true for common conditions that do not require specialty care. We sought to determine how the likelihood of definitive care has changed for 3 common pediatric conditions: asthma, croup, and gastroenteritis.

BACKGROUND AND OBJECTIVES:

The albuterol dropper bottle used to prepare solutions for continuous nebulization contains the preservative benzalkonium chloride (BAC). BAC, by itself, has been shown to cause bronchospasm. We hypothesized that BAC would decrease the therapeutic efficacy of albuterol in patients with acute asthma exacerbations.

Massachusetts Sen. Elizabeth Warren's education plan landed on Monday, and among other consequences, it led to a conversation about her past statements addressing "vouchers."

Richard A. Ehrenkranz
Aug 1, 1999; 104:280-289
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Kohei Hasegawa
Jul 1, 2013; 132:28-36
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The IMpact-RSV Study Group
Sep 1, 1998; 102:531-537
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Rio de Janeiro, Brazil, Apr 20, 2020 / 09:25 am (CNA).- On Friday, Brazil’s Federal Supreme Court will hold a virtual hearing to consider whether to decriminalize abortion for pregnant women infected with the Zika virus.

The legal intervention, called “Direct Action on Unconstitutionality-ADI 5581,” was filed with Brazil’s highest court by the National Association of Public Defenders. Supreme Court Justice Cármen Lúcia Antunes Rocha will present the legal action to the court, whose 11 members will have until April 30 to vote on the issue.

Several pro-life organizations have come out strongly against efforts to expand abortion, which is illegal in Brazil but is considered a “non-punishable crime” in cases of rape, a proven risk to life of the mother and, as of 2012, babies diagnosed with anencephaly.

“It’s a usurpation of powers because the Supreme Court does not have competency to rule on this matter,” said jurist José Miranda de Siqueira, president of the National Association of Citizens for Life. “This is a crime against the Federal Constitution of Brazil which in Article V guarantees the inviolability of the right to life.”

“We’re working with the Union of Catholic Jurists of Rio de Janeiro and will soon issue a strong statement on the issue,” continued Miranda, who is also a bioethics professor and authored a book on euthanasia, “O Poder sobre a Vida” (The Power over Life), which specifically addresses ADI 5581.

“Life is a preeminent right in the legal world. I’m asking people to pray and publicize this serious situation which is going on,” the lawyer added.

In an open letter to all Brazilians, the National Network for the Defense of Life and Family argued that the court challenge is “part of a strategy to introduce abortion in case of disabilities in general, or even abortion on demand, with the weak justification that the pregnant woman would be in a state of distress.”

“Eugenic abortion carries an enormous burden of prejudice and discrimination towards people with disabilities, sending an unseemly message that it would be better if they did not exist,” the pro-life organization added.

The Zika virus garnered international attention in 2015 after areas of Brazil noted a spike in cases of the birth defect microcephaly – a condition marked by abnormally small heads, brains, and developmental delays – following a recent outbreak of the virus in areas of northeastern Brazil.

Research on the virus suggested a link between Zika virus infection during pregnancy and severe neurological birth defects, including microcephaly and incomplete brain development.

A CitizenGo petition addressed to the Supreme Court justices called for the case to be removed from the docket and for the lives of the unborn to be respected. The petition was launched April 16. Within 24 hours, it had garnered 35,000 signatures and as of April 20 has 85,000.
 

Rio de Janeiro, Brazil, Apr 27, 2020 / 04:35 pm (CNA).- A majority of Brazil’s Supreme Federal Tribunal has voted against an intervention seeking to decriminalize abortion for expectant mothers diagnosed with the Zika virus.

The judges convened a virtual plenary session April 24 to hear arguments for and against the “Direct Action on Unconstitutionality-ADI 5581,” a legal intervention filed with the court by the National Association of Public Defenders.

While the court has until April 30 to vote on the matter, 7 of its 11 members have already voted in opposition, effectively rejecting the measure.

Abortion is illegal in Brazil but previous Supreme Court rulings have declared it a “non-punishable crime” in cases of rape, a proven risk to life of the mother and, as of 2012, babies diagnosed with anencephaly.

The Zika virus garnered international attention in 2015 after areas of Brazil noted a spike in cases of the birth defect microcephaly – a condition marked by abnormally small heads, brains, and developmental delays – following a recent outbreak of the virus in areas of northeastern Brazil.

Research on the virus suggested a link between Zika virus infection during pregnancy and severe neurological birth defects, including microcephaly and incomplete brain development.

However, some experts criticized what they described as technical and scientific flaws of the premise behind ADI 5581.
The Union of Catholic Jurists of Rio de Janeiro issued an official statement arguing that a causal relationship was never established between Zika virus and the microcephaly outbreak that occurred in Brazil.

Raphael Câmara, an obstetrician at the Federal University of Rio de Janeiro, said that when an attempt was made in 2016 to allow abortion in Zika cases, little was known about the virus.

“Since then, we have answers to many of the issues raised in ADI-5581 in support of allowing abortion,” Câmara said. “The first fact is that recent studies show that fetuses of infected mothers are affected only 5 to 14% of the time, with the majority having mild problems, as shown by research from the Centers for Disease Control and Prevention.”

“In addition, a study recently released by the CDC showed that 73% of Brazilian labs have a low accuracy rate for diagnosing the Zika virus, so the request is meaningless because we cannot talk about someone 'infected with Zika', but rather 'maybe infected by Zika.’ Is it based on this inaccuracy that we will kill fetuses?” the obstetrician continued.

Ahead of the Supreme Court ruling, pro-life groups in Brazil had spoken out against efforts to expand abortion in the country. A CitizenGo petition against the legal action drew more than 184,000 online signatures.

The Brazilian Bishops’ Conference had also opposed the attempt, calling on Catholics to defend life and oppose abortion. The conference wrote an open letter and also wrote privately to the Supreme Court, reiterating the duty to value the inviolable gift of life.

In 2017, the conference stated, “It does not belong to any public authority to selectively recognize the right to life or who will live or die. This discrimination is evil and exclusionary.”

 

This article was originally published by our sister agency, ACI Digital. It has been translated and adapted by CNA.

 

A good grip can mean the difference between life and death for lizards in a hurricane, causing populations hit more frequently by hurricanes to have larger toepads, according to researchers from Washington University and Penn State.

In this blended, mix-and-match, do-it-yourself world of education, what is curriculum, and who develops it? How do we know if it works?

Next-generation sequencing has revolutionized the diagnostic process, making broadscale testing affordable and applicable to almost all specialties; however, there remain several challenges in its widespread implementation. Barriers such as lack of infrastructure or expertise within local health systems and complex result interpretation or counseling make it harder for frontline clinicians to incorporate genomic testing in their existing workflow. The general population is more informed and interested in pursuing genetic testing, and this has been coupled with the increasing accessibility of direct-to-consumer testing. As a result of these changes, primary care physicians and nongenetics specialty providers find themselves seeing patients for whom genetic testing would be beneficial but managing genetic test results that are out of their scope of practice. In this report, we present a practical and centralized approach to providing genomic services through an independent, enterprise-wide clinical service model. We present 4 years of clinical experience, with >3400 referrals, toward designing and implementing the clinical service, maximizing resources, identifying barriers, and improving patient care. We provide a framework that can be implemented at other institutions to support and integrate genomic services across the enterprise.

As we continue to process and understand the ongoing effects of the novel coronavirus, many of us have grown used to viewing COVID-19 dashboards and visualizations, including this popular coronavirus dashboard from SAS. If you are more accustomed to building graphs and visualizations using the SGPLOT and SGPANEL procedures, this [...]

The post Visualizing COVID-19 data using SGPLOT and SGPANEL appeared first on Graphically Speaking.

Governor Jack Markell and Delaware State Housing Authority (DSHA) Director Anas Ben Addi announced today the launch of the Downtown Development Districts (DDD) Grant Program.

The majority of pediatric hospitalization costs are associated with the room; improvement projects that address room costs could have the most financial impact.

Queen Elizabeth II on Friday invoked the wartime spirit to "never despair" as Britain marked 75 years since the end of World War II in Europe under the shadow of coronavirus.

Delaware farmers, lawn care companies, golf courses and other nutrient handlers should not apply nutrients to the ground during the winter months, the Delaware Department of Agriculture says in a reminder.

Delaware farmers, lawn care companies, golf courses and other nutrient handlers should not apply nutrients to the ground during the winter months, the Delaware Department of Agriculture reminds applicators.

SMYRNA (April 5, 2020) – The Delaware Division of Public Health (DPH) is announcing 80 additional positive cases bringing the total cases related to coronavirus disease 2019 (COVID-19) to 673, including 6 new hospitalizations across the state. No new fatalities were reported today in the state. The latest Delaware COVID-19 case statistics, cumulatively since March 11, include: 673 total laboratory-confirmed […]

Trade, import and export for MSMEs: For India to benefit from the relocation of factories and companies from China, the MSME sector is likely to play a key role. This is particularly for food product manufacturing sector where India lacks competitiveness in exports.

How the global hotel chain's loyalty program offers the data it needs to create tailored experiences for its guests.

How the retail pharmacy chain uses customer data to make its marketing messages relevant

The 75th anniversary of victory over Nazi Germany should serve as a reminder to all that the Holocaust was carried out using a tightly controlled, unchallenged narrative, filmmaker Werner Herzog told RT.
Read Full Article at RT.com

Death is always a difficult topic to discuss, and death has been in the news a lot during this tragic coronavirus pandemic. Many news stories focus on states, counties, or cities that have the most cases or the most deaths. A related statistic is the case fatality rate, which is [...]

The post Use a funnel plot to visualize rates: The case fatality rate for COVID-19 in North Carolina counties appeared first on The DO Loop.

A previous article describes the funnel plot (Spiegelhalter, 2005), which can identify samples that have rates or proportions that are much different than expected. The funnel plot is a scatter plot that plots the sample proportion of some quantity against the size of the sample. The variance of the sample [...]

The post Visualize the case fatality rate for COVID-19 in US counties appeared first on The DO Loop.

[Thomson Reuters Foundation] Mexico City -The campaign includes 50 female celebrities from actress Reese Witherspoon to soccer player Megan Rapinoe