Management of tinea capitis in infants and children in the United States: A national survey of pediatric dermatologists.

This study aimed to evaluate the current management of tinea capitis in the United States, specifically focusing on patients aged 0-2 months, 2 months to 2 years, and 2 years to 18 years. An online survey, distributed through the Pediatric Dermatology Research Alliance and the Society of Pediatric Dermatology, revealed the following preferences: fluconazole for those under 2 months, griseofulvin for those aged 2 months to 2 years, and terbinafine for those aged 2 years and older. There exists inter-provider variation in tinea capitis treatment regimens within the pediatric dermatology community.

Stercoral colitis in the emergency department: a review of the literature.

BACKGROUND: Stercoral colitis (SC) is a rare but potentially life-threatening inflammatory colitis caused by the accumulation of impacted fecal material. Despite reported associations with bowel perforation and high mortality rates, stercoral colitis remains a poorly defined and underrecognized diagnosis in the emergency department (ED). OBJECTIVE OF THE REVIEW: This review aims to summarize and synthesize existing literature on SC to guide its recognition and management in the ED. DISCUSSION: SC primarily occurs in elderly or bedbound patients with chronic constipation; however, it does occur in younger patients with comorbidities at increased risk for fecal impaction. Patients may present acutely with abdominal pain and distension, but clinical presentation is often nonspecific and varied, and there are no established diagnostic criteria for SC to date. CT is therefore crucial for diagnosis, revealing key findings such as fecaloma, colonic dilatation, and fat stranding. Treatment depends on severity of illness, ranging from manual disimpaction and other conservative measures for most cases, to surgical intervention for complicated cases, such as stercoral perforation. CONCLUSIONS: SC can be a challenging diagnosis in the ED, often requiring multidisciplinary collaboration. Timely recognition and appropriate treatment are essential to reduce morbidity and mortality associated with this condition. Further research is needed to establish diagnostic criteria and clear management algorithms.

Democratizing Native Hawaiian and Pacific Islander Data: Examining Community Accessibility of Data for Health and the Social Drivers of Health.

Making data accessible to communities is essential for developing community-driven solutions to address health inequities. In this analytic essay, we highlight the importance of democratizing data for Native Hawaiians and Pacific Islanders (NHPIs)-diverse populations that historically have had little access to their data-in the context of achieving equity in health and the social drivers of health. We provide a framework for evaluating community accessibility of data, which includes concepts of data availability, salience, cost, and report back. We apply the framework to evaluate community accessibility of NHPI data from 29 federal data sources. In addition, we provide results from a survey of NHPI-serving community organizations in California conducted from December 2021 to February 2022 to assess community data needs. Findings reveal federal gaps in data accessibility, as well as NHPI community organizational needs for increased data accessibility, data saliency, and technical capacity. Furthermore, organization leads expressed concerns about data privacy, security, and misuse. We provide recommendations for data custodians to improve accessibility of timely, accurate, and robust data to support NHPI communities. (Am J Public Health. 2024;114(S1):S103-S111. https://doi.org/10.2105/AJPH.2023.307503).

Electric Field-Induced Nano-Assembly Formation: First Evidence of Silicon Superclusters with a Giant Permanent Dipole Moment.

The outstanding properties of silicon nanoparticles have been extensively investigated during the last few decades. Experimental evidence and applications of their theoretically predicted permanent electric dipole moment, however, have only been reported for silicon nanoclusters (SiNCs) for a size of about one to two nanometers. Here, we have explored the question of whether suitable plasma conditions could lead to much larger silicon clusters with significantly stronger permanent electric dipole moments. A pulsed plasma approach was used for SiNC production and surface deposition. The absorption spectra of the deposited SiNCs were recorded using enhanced darkfield hyperspectral microscopy and compared to time-dependent DFT calculations. Atomic force microscopy and transmission electron microscopy observations completed our study, showing that one-to-two-nanometer SiNCs can, indeed, be used to assemble much larger "superclusters" with a size of tens of nanometers. These superclusters possess extremely high permanent electric dipole moments that can be exploited to orient and guide these clusters with external electric fields, opening the path to the controlled architecture of silicon nanostructures.

How Effective Was the 2014 AUA Cryptorchidism Guideline? A Multi-institutional Evaluation.

INTRODUCTION: In 2014, the AUA published guidelines regarding the evaluation of cryptorchidism. This multi-institutional study aims to determine if these guidelines reduced the age of referral and the utilization of ultrasound in boys with cryptorchidism. We hypothesize that delayed referral continues, and utilization of ultrasound remains unchanged. METHODS: A retrospective review of boys referred for the evaluation of cryptorchidism was performed at 4 academic institutions, collecting data for 1 year prior (2013) and 2 nonconsecutive years following guideline creation (2015 and 2019). Across these time frames, we compared median ages at evaluation and surgery, and rates of patient comorbidities, orchiopexy, and preevaluation ultrasound. RESULTS: A total of 3,293 patients were included. The median age at initial pediatric urology evaluation in all cohorts was 39 months (IQR: 14-92 months). Following publication of the AUA Guidelines, there was no difference (P = .08) in the median age at first evaluation by a pediatric urologist between 2013 and 2015, and an increase (P = .03) between 2013 and 2019. Overall, 21.2% of patients received an ultrasound evaluation prior to referral, with no significant difference between 2013 and 2015 (P = .9) or 2019 (P = .5) cohorts. CONCLUSIONS: Our data suggest that, despite publication of the AUA Guidelines on evaluation and treatment of cryptorchidism, there has been no reduction in the age of urological evaluation or the utilization of imaging in boys with undescended testis. Finding alternative avenues to disseminate these evidence-based recommendations to referring providers and exploring barriers to guideline adherence is necessary to improve care for patients with cryptorchidism.

Vaccines and use of immunosuppressive and immunomodulatory therapy in a pediatric dermatology clinic-A single institution experience.

Vaccine type and timing are critical issues to prevent unintended infections in those on immunosuppressive therapies. We retrospectively chart reviewed patients at Children's Wisconsin Pediatric Dermatology Clinic on immunosuppressives and immunomodulators between 11/1/2012 and 6/1/2020 and found that approximately 76% of patient encounters do not have documented vaccine counseling in the medical chart before initiation of immunosuppressives and immunomodulators. As age increased, vaccine counseling was less likely to be documented (odds ratio: 0.89; 95% confidence interval: 0.84-0.95, p = .001). In addition, 13 patient encounters (4%) were not up to date with live vaccines before immunosuppressive or immunomodulating therapy. There is an opportunity to improve clinical processes to ensure documentation of vaccination status and vaccine counseling before starting immunosuppressive and immunomodulator medications in a pediatric dermatology clinic.

Assessment of Prior Well Child Checks in Children With Concerns for Testicular Position: Opportunities for Early Referral From an Integrated Health System.

OBJECTIVE: To assess, through an integrated primary and specialty care pediatric health system, the association of well-child checks prior to referral with final urological diagnosis with the aim to identify opportunities for earlier referral of care. METHODS: We performed a retrospective review of children referred from primary care to urology for undescended testis (UDT) within our integrated primary-specialty care health system in 2019, comparing children who had undescended testicles to those with either normal or retractile testicles based on the final urology examination. Demographics, including age, comorbidities, and the status of prior well-child check (WCC) within primary care, were reviewed. Outcomes of age at referral and surgical intervention for UDT were compared across referral categories. RESULTS: Stratifying by final diagnosis of 88 children included in the analysis, children with UDT were referred much later (85months, interquartile ranges 31-113) than children without UDT on final diagnosis (33months, interquartile ranges 15-74, P = .002). Furthermore, children with UDTs had a greater proportion with prior abnormal WCCs (N = 21/41, 51%) than those without UDT (N = 8/47, 17%) (P < .001). CONCLUSION: Children with prior abnormal WCCs were more likely to have a final diagnosis of UDT, with prior abnormalities being documented approximately 12months prior to referral, indicating opportunities for improved referral patterns to urology.

Economic evaluation of a community health worker model for tuberculosis care in Ho Chi Minh City, Viet Nam: a mixed-methods Social Return on Investment Analysis.

BACKGROUND: There is extensive evidence for the cost-effectiveness of programmatic and additional tuberculosis (TB) interventions, but no studies have employed the social return on investment (SROI) methodology. We conducted a SROI analysis to measure the benefits of a community health worker (CHW) model for active TB case finding and patient-centered care. METHODS: This mixed-method study took place alongside a TB intervention implemented in Ho Chi Minh City, Viet Nam, between October-2017 - September-2019. The valuation encompassed beneficiary, health system and societal perspectives over a 5-year time-horizon. We conducted a rapid literature review, two focus group discussions and 14 in-depth interviews to identify and validate pertinent stakeholders and material value drivers. We compiled quantitative data from the TB program's and the intervention's surveillance systems, ecological databases, scientific publications, project accounts and 11 beneficiary surveys. We mapped, quantified and monetized value drivers to derive a crude financial benefit, which was adjusted for four counterfactuals. We calculated a SROI based on the net present value (NPV) of benefits and investments using a discounted cash flow model with a discount rate of 3.5%. A scenario analysis assessed SROI at varying discount rates of 0-10%. RESULTS: The mathematical model yielded NPVs of US$235,511 in investments and US$8,497,183 in benefits. This suggested a return of US$36.08 for each dollar invested, ranging from US$31.66-US39.00 for varying discount rate scenarios. CONCLUSIONS: The evaluated CHW-based TB intervention generated substantial individual and societal benefits. The SROI methodology may be an alternative for the economic evaluation of healthcare interventions.

Traumatic pneumothorax: updates in diagnosis and management in the emergency department.

Pneumothorax, or air in the pleural space, is common in trauma, and has been found in up to 50% of severe polytrauma patients with chest injury. Findings associated with pneumothorax include dyspnea, chest pain, tachypnea, and absent breath sounds on lung auscultation. Although pneumothorax is traditionally diagnosed on plain film and confirmed with CT, the advent of portable ultrasonography has provided a way to rapidly diagnose pneumothorax, with a higher sensitivity than plain film. Patients with traumatic pneumothorax are typically treated with needle decompression or tube thoracostomy. However, recent literature has found that many patients can be managed conservatively via observation, or with a smaller thoracostomy such as a percutaneous pigtail catheter rather than a larger chest tube.

Does game-day circadian misalignment or environmental temperature influence team performance in the Australian Football League? An examination of historical data.

OBJECTIVES: Examine Australian Football League results for evidence that game-day circadian misalignment or environmental temperature influence games with competing teams from each of Western Australia and Victoria. DESIGN: Retrospective observational study. METHODS: Data were obtained for games (n = 791) contested by Western Australian and Victorian teams; including game location, start time, and outcome. Start times were categorised as afternoon, twilight, or night. Game-day maximum temperature (°C) for afternoon games was obtained from the Australian Bureau of Meteorology. Mixed effects generalised linear models examined evidence for a circadian advantage to Victorian teams in afternoon games, and to Western Australian teams in night games. Models examined evidence for an advantage to Western Australian teams as game-day temperature increases. RESULTS: Odds of winning and point margin for home games played in the afternoon, twilight, and night, were not different between Victorian and Western Australian teams (p > 0.05). For afternoon games, each 1 °C increase in temperature improved odds of Western Australian teams winning by 11% (p < 0.001) and their point margin by 2.1 points (p < 0.001). For games played in Victoria, each 1 °C increase in temperature improved odds of Western Australian teams winning by 6% (p = 0.028) and their point margin by 1.7 points (p = 0.005). CONCLUSIONS: There is no evidence here that circadian misalignment between teams influences game outcomes in the AFL. Western Australian teams are more likely to win afternoon games played in warm conditions. This may reflect superior heat acclimatisation among AFL players based in Western Australia.

A Network of Anomalies Prompting VACTERL Workup in a Trisomy 21 Newborn.

VACTERL (vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities) association is a condition defined by having at least three of the following congenital malformations: vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities. While diagnosing the VACTERL association is rare, the conditions that make up the VACTERL core-component features among other congenital abnormalities are even more unique. We present a case of a 34-week-old premature infant with trisomy 21 in addition to esophageal atresia, tracheoesophageal fistula, laryngeal cleft, vascular ring, Hirschsprung's disease, atrioventricular canal defect, ventricular septal defect, and other related conditions diagnosed at birth. To our knowledge, this case represents the first of its kind in relation to the constellation of anomalies diagnosed in one individual at birth of which may or may not be related to Down syndrome, and the associated interventions necessary to continue postnatal living.

COVID-19 associated myocarditis: A systematic review.

BACKGROUND: Most COVID-19 infections result in a viral syndrome characterized by fever, cough, shortness of breath, and myalgias. A small but significant proportion of patients develop severe COVID-19 resulting in respiratory failure. Many of these patients also develop multi-organ dysfunction as a byproduct of their critical illness. Although heart failure can be a part of this, there also appears to be a subset of patients who have primary cardiac collapse from COVID-19. OBJECTIVE: Conduct a systematic review of COVID-19-associated myocarditis, including clinical presentation, risk factors, and prognosis. DISCUSSION: Our review demonstrates two distinct etiologies of primary acute heart failure in surprisingly equal incidence in patients with COVID-19: viral myocarditis and Takotsubo cardiomyopathy. COVID myocarditis, Takotsubo cardiomyopathy, and severe COVID-19 can be clinically indistinguishable. All can present with dyspnea and evidence of cardiac injury, although in myocarditis and Takotsubo this is due to primary cardiac dysfunction as compared to respiratory failure in severe COVID-19. CONCLUSION: COVID-19-associated myocarditis differs from COVID-19 respiratory failure by an early shock state. However, not all heart failure from COVID-19 is from direct viral infection; some patient's develop takotsubo cardiomyopathy. Regardless of etiology, steroids may be a beneficial treatment, similar to other critically ill COVID-19 patients. Evidence of cardiac injury in the form of ECG changes or elevated troponin in patients with COVID-19 should prompt providers to consider concurrent myocarditis.

Traumatic Pneumothorax: A Review of Current Diagnostic Practices And Evolving Management.

BACKGROUND: Pneumothorax (PTX) is defined as air in the pleural space and is classified as spontaneous or nonspontaneous (traumatic). Traumatic PTX is a common pathology identified in the emergency department. Traditional management calls for chest x-ray (CXR) diagnosis and large-bore tube thoracostomy, although recent literature supports the efficacy of lung ultrasound (US) and more conservative approaches. There is a paucity of cohesive literature on how to best manage the traumatic PTX. OBJECTIVE OF THE REVIEW: This review aimed to describe current practices and future directions of traumatic PTX management. DISCUSSION: Lung US has proven to be a potentially more useful tool in the detection of PTX in the trauma bay compared with CXR, and has the potential to become the new gold standard for diagnosing traumatic PTX. Computed tomography remains the ultimate gold standard, although in the setting of trauma, its utility lies more in confirming the presence and measuring the size of a PTX. The traditional mantra calling for large-bore chest tubes as first-line approaches to traumatic PTX is challenged by recent literature demonstrating pigtail catheters as equally efficacious alternatives. In patients with small or occult PTXs, even observation may be reasonable. CONCLUSIONS: Modern management of the traumatic PTX is shifting toward use of US for diagnosis and more conservative management practices (smaller catheters or observation). Ultimately, this shift is favorable in reducing length of stay, development of complications, and pain in the trauma patient.

Business Class Travel Preserves Sleep Quality and Quantity and Minimizes Jet Lag During the ICC Women's T20 World Cup.

PURPOSE: To determine the impact of the quality and quantity of sleep during an international flight on subsequent objective sleep characteristics, training and match-day load, self-reported well-being, and perceptions of jet lag of elite female cricketers during an International Cricket Council Women's T20 World Cup. METHODS: In-flight and tournament objective sleep characteristics of 11 elite female cricketers were assessed using activity monitors. Seated in business class, players traveled west from Melbourne, Australia, to Chennai, India. The outbound flight departed Melbourne at 3:30 AM with a stopover in Dubai for 2 hours. The arrival time in Chennai was 8:10 PM local time (1:40 AM in Melbourne). The total travel time was 19 hours 35 minutes. Perceptual ratings of jet lag, well-being, and training and competition load were collected. To determine the impact of in-flight sleep on tournament measures, a median split was used to create subsamples based on (1) in-flight sleep quantity and (2) in-flight sleep quality (2 groups: higher vs lower). Spearman correlation coefficients were calculated to assess the bivariate associations between sleep measures, self-reported well-being, perceptual measures of jet lag, and internal training and match-day load. RESULTS: Mean duration and efficiency of in-flight sleep bouts were 4.72 hours and 87.45%, respectively. Aggregated in-flight sleep duration was 14.64 + 3.56 hours. Players with higher in-flight sleep efficiency reported higher ratings for fatigue (ie, lower perceived fatigue) during the tournament period. Tournament sleep duration was longer, and bed and wake times were earlier compared with habitual. Compared with other nights during the tournament, sleep duration was shorter following matches. CONCLUSIONS: Maximizing in-flight sleep quality and quantity appears to have implications for recovery and sleep exhibited during competition. Sleep duration was longer than habitual except for the night of a match, which suggests that T20 matches may disrupt sleep duration.

Network analysis of kick-in possession chains in elite Australian football.

The study aim was to investigate ball movement patterns using network analysis techniques, to compare between successful and unsuccessful outcomes and teams in the Australian Football League (AFL). This analysis focused on possession chains starting from a kick-in (n = 1,720), drawn from all games played in the 2015 AFL Premiership season (18 teams, 206 games). Player interactions were quantified using four network metrics: cluster coefficient, degree centrality, network density, and entropy. Three-way ANOVA with Tukey post hoc and ω2 effect sizes were calculated to assess whether differences existed between kick-in outcomes, ladder brackets, and match outcomes for each network metric. No significant differences were observed between ladder brackets or match outcomes for any network metric. More successful kick-in chains were characterised by lower density (ω2 = 0.26, large effect; F(9, 1678) = 66.6, p < 0.00) and higher entropy (ω2 = 0.17, large effect; F(9, 1678) = 39.6, p < 0.00). This suggests that chains resulting in successful kick-in outcomes exhibited lower interconnectedness, with a high number of players involved, and lower predictability in ball movement patterns. These findings have practical value for coaches and performance analysts and support further applications of network analysis in Australian football.

A Complex Relationship: Sleep, External Training Load, and Well-Being in Elite Australian Footballers.

PURPOSE: To assess relationships between objective sleep characteristics, external training loads, and subjective ratings of well-being in elite Australian football (AF) players. METHODS: A total of 38 elite male AF players recorded objective sleep characteristics over a 15-day period using an activity monitor. External load was assessed during main field sessions, and ratings of well-being were provided each morning. Canonical correlation analysis was used to create canonical dimensions for each variable set (sleep, well-being, and external load). Relationships between dimensions representing sleep, external load, and well-being were quantified using Pearson r. RESULTS: Canonical correlations were moderate between pretraining sleep and external training load (r = .32-.49), pretraining sleep and well-being (r = .32), and well-being and posttraining sleep (r = .36). Moderate to strong correlations were observed between dimensions representing external training load and posttraining sleep (r = .31-.67), and well-being and external training load (r = .32-.67). Player load and Player load 2D (PL2D) showed the greatest association to pretraining and posttraining objective sleep characteristics and well-being. Fragmented sleep was associated with players completing the following training with a higher PL2D. CONCLUSIONS: Maximum speed, player load, and PL2D were the common associations between objective sleep characteristics and well-being in AF players. Improving pretraining sleep quality and quantity may have a positive impact on AF players' well-being and movement strategy during field sessions. Following training sessions that have high maximum speed and PL2D, the increased requirement for sleep should be considered by ensuring that subsequent sessions do not start earlier than required.

Large-scale patterning of π-conjugated materials by meniscus guided coating methods.

Printed organic electronics has attracted considerable interest in recent years as it enables the fabrication of large-scale, low-cost electronic devices, and thus offers significant possibilities in terms of developing new applications in various fields. Easy processing is a prerequisite for the development of low-cost, flexible and printed plastics electronics. Among processing techniques, meniscus guided coating methods are considered simple, efficient, and low-cost methods to fabricate electronic devices in industry. One of the major challenges is the control of thin film morphology, molecular orientations and directional alignment of polymer films during coating processes. Herein, the recent progress of emerging field of meniscus guided printing organic semiconductor materials is discussed. The first part of this report briefly summarizes recent advances in meniscus guided coating techniques. The second part discusses periodic deposits and patterned deposition at moving contact lines, where the mass-transport influences film morphology due to convection at the triple contact line. The last section summarizes our strategy to fabricate large-scale patterning of π-conjugated polymers using meniscus guided method.

Australian Football League Injury Characteristics Differ Between Matches and Training: A Longitudinal Analysis of Changes in the Setting, Site, and Time Span From 1997 to 2016.

BACKGROUND: Injury surveillance has been used to quantify the scope of the injury burden in Australian football. However, deeper statistical analyses are required to identify major factors that contribute to the injury risk and to understand how these injury patterns change over time. PURPOSE: To compare Australian Football League (AFL) injury incidence, severity, prevalence, and recurrence by setting, site, and time span from 1997 to 2016. STUDY DESIGN: Descriptive epidemiology study. METHODS: A total of 15,911 injuries and medical illnesses recorded by team medical staff at each club were obtained from the AFL's injury surveillance system and analyzed using linear mixed models with 3 fixed effects (setting, time span, site) and 1 random effect (club). All types of injuries and medical illnesses were included for analysis, provided that they caused the player to miss at least 1 match during the regular season or finals. Five-season time spans (1997-2001, 2002-2006, 2007-2011, and 2012-2016) were used for comparisons. Incidence rates were expressed at the player level. Recurrences were recoded to quantify recurrent injuries across multiple seasons. RESULTS: Compared with training injuries, match injuries had a 2.8 times higher incidence per season per club per player (matches: 0.070 ± 0.093; training: 0.025 ± 0.043; P < .001). Match injuries resulted in 1.9 times more missed matches per club per season (matches: 17.2 ± 17.0; training: 9.1 ± 10.5; P < .001). and were more likely to be recurrences (matches: 11.6% ± 20.0%; training: 8.6% ± 21.8%; P < .001). From the 1997-2001 to 2007-2011 time spans, overall injury severity increased from a mean of 3.2 to 3.7 missed matches (P ≤ .01). For the most recent 2012-2016 time span, injuries resulted in 3.6 missed matches, on average. Hip/groin/thigh injuries had the highest incidence (0.125 ± 0.120) and prevalence (19.2 ± 16.4) rates, and recurrences (29.3% ± 27.9%) were 15% more likely at this site than any other injury site. CONCLUSION: The risks of match injuries are significantly higher than those of training injuries in the AFL. Compared with the 1997-2001 time span, injuries became more severe during the 2007-2011 time span.

The relationship between match performance indicators and outcome in Australian Football.

OBJECTIVES: To identify novel insights about performance in Australian Football (AF), by modelling the relationships between player actions and match outcomes. This study extends and improves on previous studies by utilising a wider range of performance indicators (PIs) and a longer time frame for the development of predictive models. DESIGN: Observational. METHODS: Ninety-one team PIs from the 2001 to 2016 Australian Football League seasons were used as independent variables. The categorical Win-Loss and continuous Score Margin match outcome measures were used as dependent variables. Decision tree and Generalised Linear Models were created to describe the relationships between the values of the PIs and match outcome. RESULTS: Decision tree models predicted Win-Loss and Score Margin with up to 88.9% and 70.3% accuracy, respectively. The Generalised Linear Models predicted Score Margin to within 6.8 points (RMSE) and Win-Loss with up to 95.1% accuracy. The PIs that are most predictive of match outcome include; Turnovers Forced score, Inside 50s per shot, Metres Gained and Time in Possession, all in their relative (to opposition) form. The decision trees illustrate how combinations of the values of these PIs are associated with match outcome, and they indicate target values for these PIs. CONCLUSIONS: This work used a wider range of PIs and more historical data than previous reports and consequently demonstrated higher prediction accuracies and additional insights about important indicators of performance. The methods used in this work can be implemented by other sport analysts to generate further insights that support the strategic decision-making processes of coaches.

What Does It Take to Be an Effective National Steward of Digital Health Integration for Health Systems Strengthening in Low- and Middle-Income Countries?

BACKGROUND: Digital innovations have evolved over the last 15 years to support health activities, and their introduction in low- and middle-income countries has shown the potential to catalyze gains in health systems and service delivery. Despite widespread efforts to roll out these technologies, standardized approaches for formalizing national stewardship responsibilities and ensuring that digital health is a routine, mature, sustainable, and country-owned component of the health system are lacking. In this paper, we define digital health stewardship, with a focus on the ministry of health's role; describe practices undertaken to date; and identify gaps where increased attention could improve sustainability, impact, and local ownership. METHODS: We conducted a purposeful review of peer-reviewed and gray literature. Of the 404 identified resources from the peer-reviewed literature, 12 met all of the inclusion criteria. After searching various online gray literature repositories, we identified 6 sources based on their quality, source, and relevance. Selected resources were abstracted for relevance to our stewardship themes and synthesized. RESULTS: Findings are presented in 4 broad thematic areas: strategic direction, policies and procedures, roles and responsibilities, and health service delivery implications. Evidence related to strategic direction offers guidance on the main responsibilities under digital health stewardship, including regulations and incentives to promote compliance with standards, mechanisms for oversight, and structures to support evidence-based decisions, and the potential institutional structures and goals that could be used to achieve them. A number of examples of high-level policies and implementation-oriented procedures, such as from the European Commission and the World Health Organization, demonstrate how to operationalize the strategic direction. Available evidence for the remaining themes was sparse, drawing attention to key areas for future work. CONCLUSIONS: Despite the importance of country-owned stewardship of digital health, the guidance available is limited and aspirational. Concrete recommendations, including how to adapt existing innovations to the local context, are needed. In particular, the role of external partners needs to be oriented toward building and supporting country capacity to achieve digital health stewardship's potential to support health systems into the future.