Racism in Pediatric Serious Illness and Palliative Care: A Scoping Review of Qualitative Research.

CONTEXT: Racial disparities in health outcomes have historically impacted Black and Native American children with serious illness, yet little is known about how racism shapes the healthcare experiences of these families. To improve care experiences for this population, we must understand the myriad of ways that racism may impact their experiences with serious illness. OBJECTIVES: (1) To assess the extent to which the experiences of Black and Native American families have been captured in existing serious illness and palliative care literature and (2) explore how experiences of racism uniquely impact this population. METHODS: We conducted a scoping review and qualitative meta-synthesis of peer-reviewed articles from 1980-2022 that included Black and/or Native American parents' or caregivers' experiences of serious illness care. We abstracted study characteristics, and forms of racism mentioned. RESULTS: Searches yielded 2762 articles, of which 6 were reviewed based on inclusion criteria. Three key themes emerged from the literature on the experiences of Black families navigating pediatric serious illness that highlight how parents navigate their future after a serious illness diagnosis; how relationships and support networks change after diagnosis; and the challenges associated with navigating grief and suffering after a diagnosis. Institutionalized racism and interpersonal racism were the most identified forms of racism experienced by Black families. None of the articles identified included Native American families. CONCLUSION: Our findings highlight the pressing need for further qualitative research to explore the lived experiences of racially minoritized families-especially studies focusing on the experiences of Native American families.

Biomechanical and Mechanobiological Drivers of the Transition From PostCapillary Pulmonary Hypertension to Combined Pre-/PostCapillary Pulmonary Hypertension.

Combined pre-/postcapillary pulmonary hypertension (Cpc-PH), a complication of left heart failure, is associated with higher mortality rates than isolated postcapillary pulmonary hypertension alone. Currently, knowledge gaps persist on the mechanisms responsible for the progression of isolated postcapillary pulmonary hypertension (Ipc-PH) to Cpc-PH. Here, we review the biomechanical and mechanobiological impact of left heart failure on pulmonary circulation, including mechanotransduction of these pathological forces, which lead to altered biological signaling and detrimental remodeling, driving the progression to Cpc-PH. We focus on pathologically increased cyclic stretch and decreased wall shear stress; mechanotransduction by endothelial cells, smooth muscle cells, and pulmonary arterial fibroblasts; and signaling-stimulated remodeling of the pulmonary veins, capillaries, and arteries that propel the transition from Ipc-PH to Cpc-PH. Identifying biomechanical and mechanobiological mechanisms of Cpc-PH progression may highlight potential pharmacologic avenues to prevent right heart failure and subsequent mortality.

Illicit Wildlife Trade, Wet Markets, and COVID-19: Preventing Future Pandemics.

Although the exact origin of SARS-CoV-2, the etiologic agent of COVID-19, is currently unknown, there is substantial evidence to suggest the source of transmission of the virus occurred within the Wuhan wet market. In these markets, bats and wild animals are frequently sold and stored in close contact. During several of the world's past pandemics, bats were essential to the spread of zoonotic diseases from bat to another animal or to humans directly. Live animal markets create the perfect conditions for novel viruses such as COVID-19 to emerge. This paper suggests that to prevent future pandemics, the sale of exotic animals be banned at wet markets. It also advocates for the integration of the analysis of illicit trade with the study of zoonotic disease transmission and pandemics.