Percutaneous Drainage of Pediatric Pulmonary Abscesses: An Effective Therapy.

INTRODUCTION: Pulmonary abscess is a complication of lung infection with localized necrosis and purulent cavity formation. Pulmonary abscesses are typically managed using antibiotic therapy with anatomic surgical resection reserved as a rescue. Percutaneous drainage is considered relatively contraindicated in some centers due to perceived risk of bronchopleural fistula. However, drain placement has been frequently employed at our institution. The purpose of this study was to review and describe our longitudinal experience. METHODS: Medical records of children diagnosed with lung abscess and treated with percutaneous drainage from 2005 through 2023 were reviewed. Patient clinical parameters, follow-up imaging, and clinical outcomes were evaluated. RESULTS: Percutaneous drainage (n = 24) or aspiration alone (n = 4) under imaging guidance was performed by interventional radiologists for 28 children with lung abscesses. A single catheter (8-12 Fr) was deployed in the pulmonary abscess cavity and remained for a median of 6 days (IQR: 6-8 days). The median hospital stay was 10 days (IQR: 8.8-14.8 days). The technical success rate for percutaneous drainage or aspiration of primary pulmonary abscesses was 100% (26/26). Two children were later diagnosed with secondarily infected congenital pulmonary airway malformations that were both successfully drained and ultimately surgically resected. The abscess cavities resolved in all patients and catheters were removed upon clinical, radiographic, and laboratory improvement. Complications included the presence of two bronchopleural fistula, both of which were treated with immediate pleural drain placement. CONCLUSION: Percutaneous drainage of pulmonary abscesses is an effective therapeutic option in children and can be considered alongside antibiotics as part of the initial treatment for pulmonary abscesses. Bronchopleural fistula can occur, but at a lower frequency than previously reported. LEVEL OF EVIDENCE: Level V.

Combined Percutaneous Transhepatic Lymphatic Embolization and Peroral Duodenal Mucosal Radiofrequency Ablation to Manage Protein-Losing Enteropathy.

Percutaneous transhepatic lymphatic embolization (PTLE) and peroral esophagogastroduodenoscopy (EGD) duodenal mucosal radiofrequency (RF) ablation were performed to manage protein-losing enteropathy (PLE) in patients with congenital heart disease. Five procedures were performed in 4 patients (3 men and 1 woman; median age, 49 years; range, 31-71 years). Transhepatic lymphangiography demonstrated abnormal periduodenal lymphatic channels. After methylene blue injection through transhepatic access, subsequent EGD evaluation showed methylene blue extravasation at various sites in the duodenal mucosa. Endoscopic RF ablation of the leakage sites followed by PTLE using 3:1 ethiodized oil-to-n-butyl cyanoacrylate glue ratio resulted in improved symptoms and serum albumin levels (before procedure, 2.6 g/dL [SD ± 0.2]; after procedure, 3.5 g/dL [SD ± 0.4]; P = .004) over a median follow-up of 16 months (range, 5-20 months). Transhepatic lymphangiography and methylene blue injection with EGD evaluation of the duodenal mucosa can help diagnose PLE. Combined PTLE and EGD-RF ablation is an option to treat patients with PLE.

Treatment of Unicameral Bone Cysts Utilizing the Sclerograft™ Technique.

PURPOSE: To evaluate the Sclerograft™ procedure, which is an image-guided, minimally invasive approach of chemical sclerotherapy followed by bone grafting of unicameral bone cysts (UBC). MATERIALS AND METHODS: A retrospective evaluation from August 2018 through August 2023 was performed at a single institution on patients that underwent the Sclerograft™ procedure for UBCs. Radiographic healing was evaluated utilizing the Modified Neer Classification. Two different regenerative grafts, CaSO4-CaPO4 and HA-CaSO4 were utilized. A total of 50 patients were evaluated with 41 patients grafted with CaSO4-CaPO4 and 9 patients grafted with HA-CaSO4. RESULTS: The average age of the patient was 12.1 years with an average radiographic follow-up of 14.5 months. Average cyst size was 5.5 cm in the largest dimension and average cyst volume was 20.2 cc. 42 out of 50 (84%) showed healed cysts (Modified Neer Class 1) on the most recent radiograph or MRI. Recurrences occurred on average at 7.2 months. Activity restrictions were lifted at 3-4.5 months post-procedure. Cyst stratification by size did not show a difference in recurrence rates (p = 0.707). There was no significant difference in recurrence rate between lesions abutting the physis compared to those that were not abutting the physis (p = 0.643). There were no major complications. CONCLUSIONS: The Sclerograft™ procedure is an image-guided approach to treating unicameral bone cysts, utilizing chemical sclerosis and regenerative bone grafting. The radiographic healing of cysts compares favorably to open curettage and grafting as determined utilizing previously published trials.

Talent Identification and Development in Paralympic Contexts: Current Challenges.

This short review explores the state of talent identification and development of athletes in Paralympic contexts. While talent identification typically occurs during adolescence, this practice is more complex and variable in Paralympic contexts compared to non-Paralympic contexts. For example, Paralympic athletes can have impairments that are congenital or acquired at any time across their lives. Therefore, they can enter performance pathways at unpredictable times. Furthermore, differences and nuances associated with athlete impairments (type and severity), compounded by other systematic complexities (e.g., systems of classification) highlight the need to consider alternative and creative approaches to talent identification and development. We provide an overview of some of these complexities, highlight areas for future research, and provide recommendations for practitioners.

Examining the Influence of Impairment Type on the Development of Paralympic Sport Athletes.

Research has recently examined the role of impairment onset on athlete development in Paralympic sport; however, less is known on how impairment type can impact athlete sporting pathways. In this study, 187 Australian and Canadian Paralympic sport athletes completed a survey. Participants were divided into the following four groups: impaired muscle power (n = 79); ataxia, athetosis, and hypertonia (n = 44); limb deficiencies (n = 42); and other physical impairments (n = 22). Mechanisms of initiation into Paralympic sport varied between groups with some drawn to sport through friends and/or family (i.e., limb deficiencies and other physical impairments groups) while others through talent search programs (i.e., ataxia, athetosis, and hypertonia group) or health care professionals/rehabilitation centers (i.e., impaired muscle power group). Results revealed no significant differences between groups in the chronological age or absolute years for achieving milestones. However, considering the high variability within the sample, more research is necessary to better understand how athletes with different physical impairments navigate through their sporting careers.

Storm Clouds on the Horizon: On the Emerging Need to Tighten Selection Policies.

Athlete selection is fundamental in elite sport, occurring regularly throughout an athlete's development. Research in this area reveals the accuracy of these decisions is questionable in even the most elite sport environments and athletes are increasingly disputing these decisions as unfair and punitive. As a countermeasure to these dispute and arbitration practices, many elite sport systems have created policies where coaches must outline and stand behind the criteria used for their selection decisions. Selection criteria policies have the potential to help encourage fair selection practices by holding selectors accountable to their selection criteria, but their implementation also has the potential to wrongfully nudge selectors toward developing more defendable, but less-accurate selection practices. The paper concludes with 10 suggestions to help support practitioners when implementing selection criteria.

"Looking for a Golden Needle in the Haystack": Perspectives on Talent Identification and Development in Paralympic Sport.

Despite rapid increases in research on talent identification and development in able-bodied sports, there remains limited knowledge regarding how talent is identified and developed in Paralympic contexts. The purpose of this study was to capture the perspectives of experts (coaches, high-performance managers, and pathway specialists) working in elite Paralympic sport to better understand how they conceptualize, measure, and develop talent. Eight coaches and three performance directors from six Paralympic sports, along with two pathway specialists from Paralympics Australia participated in semi-structured interviews. The results suggest impairment type and, therefore, classification are key indicators of identification and anticipated success, highlighting the importance of educating talent selectors in these areas. In addition, familial (e.g., overprotectiveness, sporting background) and biopsychosocial factors (e.g., resilience, work-ethic, sport-specific skills, other life commitments) were noted as being influential when selecting athletes. There were concerns regarding the disproportionately low number of female athletes in the system, suggesting a need for new initiatives to support early-entry points for female athletes (e.g., education on the benefits of sport participation, supportive environments). High-performance staff also lacked resources to better understand the nuances associated with different impairments and their implications (physiological response to training, associated psychological stresses from injury, identity change). Recruitment strategies included "talent search" days, collaborations with school programs and rehabilitation centers, and helping local clubs support "drop-in" athletes. However, limited funding impacted the sustainability of programs, resulting in a regular turnover of staff, loss of intellectual property, and a weakened pathway system. Results from this study generated several practical implications and future directions for research.

Understanding the Development of Elite Parasport Athletes Using a Constraint-Led Approach: Considerations for Coaches and Practitioners.

For the past half-century, the Paralympic Games has continued to grow, evident through increased participation, media recognition, and rising research focus in Para sport. While the competitive pool of athletes has increased, athlete development models have stayed relatively the same. Currently, coaches rely mainly on experiential knowledge, informal communication with colleagues, and theory transferred from able-bodied contexts as main resources to support development for themselves and their athletes. The purpose of this paper was to introduce Newell's constraint-led model and its multidimensional spectrum and practical scope to address the complexities of athlete development. The model consists of three overarching constraint categories (i.e., individual, task, and environment) along with proposed additional sub-categories to capture nuances associated in Para sport in order to provide additional context to coaches regarding athlete development. Utilizing this theoretical framework, we present a holistic approach for coaches and practitioners to consider while addressing athletes' short- and long-term developmental plans. This approach highlights the interactions among factors from a wide range of categories that indirectly and directly impact one another and ultimately influence athletes' developmental processes. It is important to consider the dynamic interaction of constraints over various timescales during development and identify underlying issues to improve athlete experience and maximize developmental opportunities. Coaches and practitioners can use the proposed framework as a guide to key factors to consider for their cohort of athletes. This approach provides a context-specific approach that considers unique factors associated with athletes and their environment.

Congenital Etiology Is an Independent Risk Factor for Complications in Adolescents Undergoing Corrective Scoliosis Surgery: Comparison of In-hospital Comorbidities Using Nationwide KID's Inpatient Database.

BACKGROUND: Congenital scoliosis (CS) is associated with more rigid, complex deformities relative to adolescent idiopathic scoliosis (AIS) which theoretically increases surgical complications. Despite extensive literature studying AIS patients, few studies have been performed on CS patients. The purpose of this study was to evaluate complications associated with spinal fusions for CS and AIS. METHODS: A retrospective review of the Kid's Inpatient Database (KID) years 2000 to 2009 was performed. Inclusion: patients under 20 years with ICD-9 diagnosis codes for idiopathic scoliosis (IS-without concomitant congenital anomalies) and CS, undergoing spinal fusion from the KID years 2000 to 2009. Two analyses were performed according to age below 10 years and 10 years and above. Univariate analysis described differences in demographics, comorbidities, intraoperative complications, and clinical values between groups. Binary logistic regression controlling for age, sex, race, and invasiveness predicted complications risk in CS (odds ratios; 95% confidence interval). RESULTS: In total, 25,131 patients included (IS, n=22443; CS, n=2688). For patients under age 10, CS patients underwent 1 level shorter fusions (P<0.001), had fewer comorbidities (P<0.001), and sustained similar complication incidence. In the 10 and over age analysis, CS patients similarly had shorter fusions, but greater comorbidities, and significantly more complications (odds ratio, 1.6; confidence interval, 1.4-1.8). CONCLUSIONS: CS patients have higher in-hospital complication rates. With more comorbidities, these patients have increased risk of sustaining procedure-related complications such as shock, infection, and Adult Respiratory Distress Syndrome. These data help to counsel patients and their families before spinal fusion. LEVEL OF EVIDENCE: Level III-retrospective review of a prospectively collected database.

Pediatric jugular vein aneurysm (phlebectasia): report of two cases and review of the literature.

Jugular vein aneurysms are rare vascular abnormalities that are most commonly encountered in the pediatric population. We report two separate cases in infants, both of whom presented with enlarging neck masses and were found to have jugular vein aneurysms. Diagnosis was established with duplex ultrasonography, computed tomography angiography, digitally subtracted catheter venography, and magnetic resonance imaging in one case and magnetic resonance imaging with magnetic resonance angiography/magnetic resonance venography, gray scale ultrasonography, and digital subtraction catheter venography in the other case. Both aneurysms were treated by surgical resection.

Barriers and Promoters for Enrollment to a Community-Based Tai Chi Program for Older, Low-Income, and Ethnically Diverse Adults.

BACKGROUND: Low-income, ethnically diverse, older adults may be at greater health risk owing to their lower activity levels and potential cultural barriers to physical activity (PA) programs. To explore the specific barriers and promoters to enrollment to a 16-week Tai Chi (TC) program, we interviewed 87 lower socioeconomic older adults from multiple ethnic backgrounds before the initiation of a TC program. METHOD: Semistructured qualitative focus group interviews were conducted with questions focused on themes of barriers and promoters to enrollment in a TC program that might or might not be culturally or gender related. RESULTS: Important issues emerged that covered six categories. Categories included physical and mental health, time of day, socialization, program pairing, accessibility, and appropriate leadership/teacher. CONCLUSION: This information may have value for tailoring future PA programming in the community that could lead to improved health outcomes through better enrollment and increased participation in PA and exercise.

Levels of Evidence in the Treatment of Slipped Capital Femoral Epiphysis: A Systematic Review.

The primary aim of this study was to analyze the current level of evidence available on the surgical management of Slipped Capital Femoral Epiphysis (SCFE). Secondary aims were to correlate the level of evidence with the impact factor of the journal to evaluate the level of evidence over time, and to evaluate the geographic distribution of the studies. Therapeutic studies published in English between January 1991 and August 2014 that reported on SCFE were identified via electronic search was performed using the databases PubMed, EMBASE, and the Cochrane Library. The search terms used included: Slipped capital femoral epiphyses OR SCFE OR Slipped upper femoral epiphyses OR SUFE AND Management OR Treatment. Correlation between the level of evidence and the impact factor of the journal were analyzed together with linear regression models to reveal any significant trends over time. A total of 1516 studies were found, of which 321 were included in the final analysis. The most frequent study type was the case series (51.1%) followed by case reports (22.4%) and expert opinion (14.0%). Randomized control trial accounted for only 0.6%. The Journal of Pediatric Orthopedics (American) had the most studies (22.6%) and the highest number of level 2 (n=1) and level 3 (n=15) type evidence. There was no progression of level of evidence over time. There was no correlation between level of evidence and impact factor of journal. The majority of therapeutic studies on SCFE are of low level of evidence. High-level RCTs are difficult to perform in pediatric orthopedic surgery, however the management of SCFE would benefit from well-designed, multicenter, clinical RCTs to advance evidence-based practice.

Multistate outbreak of human Salmonella Typhimurium infections linked to live poultry from agricultural feed stores and mail-order hatcheries, United States 2013.

Live poultry-associated salmonellosis is an emerging public health issue in the United States. Public and animal health officials collaborated to investigate one of the largest (356 cases, 39 states) of these outbreaks reported to date. A case was defined as illness in a person infected with the outbreak strain of Salmonella Typhimurium with illness onset between 1 March and 22 October 2013. The median patient age was seven years (range: < 1-87 years); 58% of ill persons were children ≤ 10 years, 51% were female, 25% were hospitalized; 189 (76%) of 250 patients reported live poultry exposure in the week before illness; and 149 (95%) of 157 reported purchasing live poultry from agricultural feed stores. Traceback investigations identified 18 live poultry sources, including 16 mail-order hatcheries. Environmental sampling was conducted at two mail-order hatcheries. One (2.5%) of 40 duplicate samples collected at one hatchery yielded the outbreak strain. Live poultry are an important source of human salmonellosis, particularly among children, highlighting the need for educational campaigns and comprehensive interventions at the mail-order hatchery and agricultural feed store levels. Prevention and control efforts depend on a One Health approach, involving cooperation between public and animal health officials, industry, health professionals, and consumers.

New York's Medicare Marketplace: examining new York's Medicare advantage plan landscape in light of payment reform.

The Patient Protection and Affordable Care Act (ACA) provided for cost savings in the Medicare program, in part to underwrite coverage expansion to Medicare beneficiaries, to finance new coverage for those not eligible for Medicare, and to strengthen Medicare's financial outlook. One cost-saving measure, a reformulation and reduction in payments to private health insurance plans that provide Medicare benefits through the Medicare Advantage (MA) program, had a sound policy basis but was criticized, particularly by opponents o fthe ACA, as a measure that would lead to increased costs, reductions in benefits, and diminished plan choices to Medicare beneficiaries enrolled in MA plans. Despite dire predictions to this effect, a review of a sample of MA plan offerings in New York State in 2012 shows that Medicare beneficiaries enrolled in such plans did not experience significant benefit reductions or increased costs. While the number of plan offerings decreased, the reduction was mostly caused by the elimination of duplicative plan choices in 2011. Although the MA plan executives we interviewed indicated that further reductions in plan reimbursement in future years-tempered by potential bonus payments for meeting quality and performance metrics-could impact plan costs and benefits, they believed plans will employ a number of strategies to remain in the market and maintain benefciary benefits and cost structures. However, government regulators and consumer advocates will need to examine MA plan offerings in the coming years to determine the efect ofplan reaction to the ACA payments on beneficiaries'costs for coverage and access

Brief intervention for perpetration of intimate partner violence (IPV): simulation versus instruction alone.

OBJECTIVE: To compare two brief randomized computer-based interventions about perpetration of intimate partner violence (IPV). METHODS: The study was a prospective cross-sectional cohort study of patients during randomized 4-hour shifts in an urban hospital-based emergency department setting with an emergency medicine residency. The site is a level 1 trauma center emergency department with an annual census of 60,000 adults. A touch-screen computer program was developed in Visual Basic 2005 Studio with consecutive data entry screens. A series of questions to evaluative IPV knowledge, attitude, and practices (KAP) was given before and after the brief intervention. The subjects were randomized to one of two intervention groups. Both groups were shown a set of PowerPoint slides addressing IPV prevention, which was followed by either a control group with nothing further (control) or a five-minute simulation video depicting IPV perpetration in adults (SIM). The main outcome was the net improvement in KAP scores defined as number who improved minus number who did worse. Perpetrators and victims were assessed separately. Demographics were also obtained. For demographics, descriptive statistics and percentages were used. Wilcoxon signed rank test was used for pre-post test paired data. RESULTS: A total of 239 patients, presenting during 52 randomized four-hour shifts, completed the study; 118 were in the control group, 121 in SIM; 115 (48%) were male and 124 (51 %) female (9 unknown). Most participants were from 21 to 30 years old (38%); 77 (32%) were Hispanic and 100 (42%) were white. There was an overall improvement in responses to KAP questions with correct answers to all questions in 46% before vs 59% after the computer intervention (Diff 13% 95% confidence interval [CI] 4-22). The net improvement in KAP score in the control group was 8% and in the SIM group it was 22% (Diff = 15%, 95% CI = 6-24). Forty subjects (17%, 95% CI = 12-21) were perpetrators and 52 subjects (22%, 95% CI = 17-27) were victims. KAP scores were not significantly improved in the SIM group over the control for either perpetrators or victims. CONCLUSION: An IPV simulation video resulted in a greater percent of subjects showing improvement in knowledge, attitudes, and practices about IPV perpetration. A brief IPV simulation video intervention can be performed in a busy emergency department setting.