Utilizing stricture indices to predict dilation of strictures after esophageal atresia repair.

BACKGROUND: Anastomotic stricture is the most common postoperative complication in infants undergoing repair of esophageal atresia with or without tracheoesophageal fistula (EA/TEF). Stricture indices (SIs) are used to predict infants at risk for stricture requiring dilation. We sought to determine the most accurate SI and optimal timing for predicting anastomotic dilation. MATERIALS AND METHODS: A retrospective study of infants undergoing repair of EA/TEF between 2008 and 2013 was performed. Esophagrams were used to calculate four SIs (upper pouch esophageal anastomotic stricture index [U-EASI], lower pouch esophageal anastomotic stricture index [L-EASI], lateral SI, and anterior/posterior SI). The best performing SI was identified. Logistic regression analysis was performed to determine if a first or second esophagram SI threshold was associated with dilation. A receiver operating characteristic curve measured the accuracy of the model using SIs to predict dilation. RESULTS: Of 45 EA/TEF infants included, 20 (44%) had postoperative strictures requiring dilation. As the best performing SI, logistic regression analysis showed that U-EASI as a continuous variable was predictive of dilation (P = 0.03) but was not significant at U-EASI ≤ 0.37. However, U-EASI ≤ 0.37 was associated with needing earlier dilation. On second esophagram (median, 38 days), U-EASI of ≤0.39 was significantly associated with dilation (OR: 7.8, 95% CI: 1.05-57.58, P = 0.04). The area under the receiver operating characteristic curve of the U-EASI model controlling for days to esophagram demonstrated improved predictive ability from first (AUC 0.73) to second esophagram (AUC 0.81). CONCLUSIONS: Calculation of the SI utilizing a U-EASI ≤ 0.39 on the delayed esophagram is associated with future anastomotic dilation. A multi-institutional study is necessary to confirm the predictive ability of the U-EASI.

NPCC4: Advancing climate justice in climate adaptation strategies for New York City.

The Advancing Climate Justice in Climate Adaptation Strategies for New York City (Equity) chapter of NPCC4 builds on the findings and recommendations from NPCC3 to identify additional metrics and adaptation efforts that can advance climate justice. First, the chapter assesses the efforts of the City to incorporate equity into climate adaptation efforts since NPCC3 and describes how the communities profiled in NPCC3 have implemented and evolved their approaches to addressing the intersecting climate, environmental, and social stressors that they continue to face. Second, it adds to the historical context of climate inequity by linking the bioregion's history of colonization, land dispossession, and slavery building on emerging evidence demonstrating how historical and contemporary land use patterns and decisions shape present and future climate risks and social vulnerability, including climate displacement. Third, it recommends a NYC-focused metric to identify areas of the city that are most vulnerable to the intersection of climate hazards, social vulnerability, and displacement. Finally, it highlights approaches to more equitable and just climate adaptation drawn from local, national, and international examples. As such, the chapter offers best practices that prioritize community-driven climate resilience approaches that are integrated, more equitable, and racially just.

NPCC4: Climate risk and equity-advancing knowledge toward a sustainable future | Conclusions.

This chapter provides an overview of the major themes, findings, and recommendations from NPCC4. It presents summary statements from each chapter of the assessment which identify salient and pressing issues raised and provides recommendations for future research and for enhancement of climate resiliency. The chapter also outlines a set of broader recommendations for future NPCC work and identifies some key topics for the next assessment.