Summary Of Opinion Research Articles

Trochleoplasty Utilization in the Management of Patellofemoral Instability: Results From an International Survey of Surgeons.

Considerable variability exists in the described clinical and radiographic indications for use, surgical techniques, postoperative management, and risk profile after trochleoplasty for the management of patellofemoral instability (PFI). In areas of clinical uncertainty, a cohesive summary of expert opinion and identification of areas of variation in current practice can be useful in guiding current practice and future research efforts. To assess the current indications for use, surgical techniques, postoperative rehabilitation practices, and observed complication profile for trochleoplasty in the management of PFI among surgeons who perform this procedure. Cross-sectional study. A 21-item cross-sectional survey was developed to evaluate trochleoplasty in its current practice among surgeons around the world. The survey was distributed between December 2021 and April 2022 to the orthopaedic surgeon membership of multiple national and international knee, arthroscopy, and sports medicine societies to identify any surgeon with experience performing the trochleoplasty procedure in practice for the management of PFI. Descriptive statistics of survey responses were performed to address study aims, and univariate analyses were performed to compare differences between high- and low-volume trochleoplasty surgeons. Survey distribution identified 32 orthopaedic surgeons with experience performing the trochleoplasty procedure. Procedural indications were most commonly felt to be met with Dejour classification of B or D on magnetic resonance imaging. Trochleoplasty was felt by most to be appropriate as a primary surgical intervention for PFI. A majority of surgeons utilized a Bereiter (thin-flap) trochleoplasty technique with suture-based fixation and performed concurrent medial patellofemoral ligament reconstruction, but other concomitant procedures varied. Range-of-motion precautions and bracing practices varied among respondents, and arthrofibrosis was the most frequently cited observed complication. High- and low-volume trochleoplasty surgeons differed in their radiographic and age-based indications for the procedure. Study findings indicated that variation exists in the surgical indicators, technique, and postoperative rehabilitation practices of trochleoplasty surgeons, with specific differences noted between high- and low-volume trochleoplasty surgeons. The results of this survey identified areas of equipoise and treatment variation that should direct future research efforts in the study of the trochleoplasty procedure.

Discontinuation of Cardiac Devices at or Near an Adult Patient's End of Life.

Advances in medical technology have begun to blur the lines between life and death as well as the lines between appropriate and inappropriate therapy. This review addresses the charged issue of the management of cardiac devices at or near the end of a patient's life, provides a summary of prior and current opinion with some historical context, and attempts to provide some modest guidance as to how to approach the various options to the patient's best advantage. Modalities to be addressed include indwelling electronic devices, the left ventricular assistance device, and extracorporeal mechanical oxygenation, and includes available outcome data as well as ethical analysis from a number of commentators. The expected further increase in technical sophistication of these devices is expected to render the various aspects of device deactivation more and more complex over the course of the next few years such that careful attention to and knowledge about this issue will continue to be more and more necessary.

Interpretation of Chinese guideline for the clinical management of patients with ruptured intracranial aneurysms (2024)

Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening neurological emergency with high mortality, and even patients receiving optimal medical care may develop long-term disability, which seriously affects their quality of life and increases the heavy medical burden on society and families. To provide comprehensive clinical management advice, the Society of Neurosurgery of the Chinese Medical Association, the Society of the Chinese Stroke Association of the National Medical Center for Neurological Diseases, and the National Clinical Research Center for Neurological Diseases jointly formulate "Chinese Guidelines for the Clinical Management of Patients With Ruptured Intracranial Aneurysms in 2024". The evidence sources are divided into the Chinese population and other populations, using a modular format to provide recommendations, summaries of relevant opinions, and future research directions on epidemiology, clinical imaging diagnosis, prognosis evaluation, treatment strategies and choices, anesthesia management, perioperative care, and recommendations for the management of aSAH in special populations. It provides practical clinical guidance and recommendations for doctors and related professionals.

Sports Injury of Sanda Wushu Class of Students in Xi'an City

Background and Aim: Wushu is a traditional sport in China and is considered an ancient Chinese martial art. Wushu is a sport that is packaged as a teaching course about martial arts and dances and is also aimed at improving the health of people who train and learn at all ages. Therefore, in wushu martial arts when starting to practice or start playing Students or players must prepare their bodies to be able to fight, but if they learn by starting, injuries that may occur with training or playing this type of sport will always happen. Materials and Methods: Population and sample: The population used in this research were Sanda Wushu students’ a total number of 150 people. The research instrument was a questionnaire on Injury occurred during the Wushu course. created by the researcher with 3 parts, developed from a questionnaire on injuries of track and field athletes participating in the 39th National Games (Pengtee, 2011). The questionnaire has the following details: Part 1: Basic information of the buyer. Part 2: Sanda Wushu Injury Questionnaire Part 3: summarizes comments or suggestions regarding injury prevention. Result: From the survey of the causes of injuries, there were two causes: injuries that occurred from the outside environment from studying Sanda Wushu (66%) and injuries that occurred from the athletes themselves (34%) and of body positions that were injured in most athletes' competitions. It occurred in 38.7% of the body positions, 24% of the upper limbs, 20% of the lower limbs, and 17.3% of the head positions. Conclusion: From the summary of the above opinions, the injuries sustained in the class are injuries that are not serious and can be treated with basic first aid. Because studying at the school level is non-violent training, it is not surprising that it can be rehabilitated. In injury prevention, there were additional comments, namely the recommendation to increase protective equipment to be sufficient for the number of students and to improve the equipment appropriately. In addition, there is currently a training program for physical rehabilitation.

Unpacking the Dobbs Decision

The majority opinion in the Dobbs v. Jackson Women’s Health gave the nation a lesson in the history of the relevant caselaw, legal precedent, and common law traditions regarding abortion in the United States. It also presents a master class on the proper examination of cases in the Supreme Court and the meaning, strengths, and weaknesses of the principle of stare decisis. In this article, Blackwell gives readers a summary of this monumental opinion and its depth of information and analysis.

Dynamic path planning in autonomous driving

With the development of emerging technologies such as the Internet of Things (IoT), Artificial Intelligence (AI) and fifth-generation cellular network technology (5G), good conditions are provided for the level of automation, providing the necessary assistance to coordinate the environment, planning decisions and path optimisation for self-driving vehicles. This paper briefly outlines and analyses the key technologies required to realize autonomous driving and summarizes the corresponding research results for each part; by considering the operation process of self-driving vehicles, this paper chooses path planning as the focus of research and presents it in the form of a methodology; finally, it concludes with a summary of personal opinions and a discussion of possible future research directions.

Expert consensus on the clinical application of single-use (disposable) flexible bronchoscopes

Single-use (disposable) flexible bronchoscope is widely used clinically both in China and abroad and has become an important tool for diagnostic and therapeutic procedures in respiratory diseases. The lightweight, portability, and non-reusability of the single-use flexible bronchoscope makes its use not only similar to that of conventional flexible bronchoscope, but with additional applications and indications. Currently, single-use flexible bronchoscopes are used in pulmonology, critical care medicine, infectious diseases, anesthesia, emergency departments and other clinical settings. Chinese Respiratory Endoscopy Experts have developed a consensus on the clinical application of disposable bronchoscopy in China after extensive online and offline consultation, questionnaire surveys and extensive solicitation of opinions. This consensus was developed using clinical experiences gained and lessons learned during clinical practices over the past ten years to standardize and rationalize use of single-use flexible bronchoscope. The consensus addressed nine key issues concerning single-use flexible bronchoscope: definition, construction, benefits, application scenarios, preoperative preparation, sedation, anesthesia requirements, disinfection processes and training requirement ans management. Finally, twelve recommendations were developed. The consensus used the modified GRADE methodology to grade the evidence evaluation and recommendations. This is the current state of consensus on single-use flexible bronchoscope in China, and we hope to improve the standardized application of single-use flexible bronchoscope in China in the future. Summary of consensus opinions: 1. Definition and structure of single-use flexible bronchoscope.A single-use flexible bronchoscope, also known as a disposable flexible bronchoscope, includes two parts: a portable touch screen display and different types of bronchoscopes.2. The advantages of single-use flexible bronchoscope.[Consensus Opinion 1]: Single-use flexible bronchoscope is sterile (strongly recommended 86.7%).[Consensus Opinion 2]: The cost of single-use flexible bronchoscope is relatively low (strongly recommended at 53.3%).[Consensus Opinion 3]: Single-use flexible bronchoscope is portable and easy to use (strongly recommended at 80%).[Consensus Opinion 4]: Single-use flexible bronchoscope can be used as a complementary tool for teaching and scientific research (strongly recommended at 80%).3. The value of single-use flexible bronchoscope in the diagnosis and treatment of pulmonary infection.[Consensus Opinion 5]: For infectious diseases, unexplained pneumonia, and multi-drug resistant organisms (MDRO), the use of disposable bronchoscopy is recommended(strongly recommended at 90%).4. Application of single-use flexible bronchoscope in the diagnosis and treatment of critically ill patients.[Consensus Opinion 6]: Single-use flexible bronchoscope can be used immediately to manage patients with difficult airways in emergency situations (strongly recommended 53.3%).[Consensus Opinion 7]: Single-use flexible bronchoscope can be used immediately for the management of airway foreign bodies and hemoptysis in emergency situations (strongly recommended 80%).5. Application of single-use flexible bronchoscope in the diagnosis and treatment with complex bronchoscopic procedures.[Consensus Opinion 8]: For complex bronchoscopic procedures, when multiple endoscopic surgeries are required in addition to current endoscopic procedures, given the vulnerability of reusable bronchoscope to damage during the procedures, the use of a single-use flexible bronchoscope combined with a reusable bronchoscope for "dual endoscopic surgery" is recommended (strongly recommended 26.7%).6. Application of single-use flexible bronchoscope in preoperative preparation.[Consensus Opinion 9]: When managing critically ill patients or patients requiring emergency airway management, preoperative preparation can be temporarily delayed (strongly recommended 93.7%).7. Application of single-use flexible bronchoscope in sedation and anesthesia.[Consensus Opinion 10]: Use of single-use flexible bronchoscope for topical anesthesia. For complex procedures, choose topical anesthesia with tracheal intubation or supraglottic airways in general anesthesia (66.7% is strongly recommended).8. Does single-use flexible bronchoscope require standardized training?[Consensus Opinion 11]: The use of disposable bronchoscope requires standardized and systematic training (strongly recommended 93.3%).9. Cleaning and disinfection requirements for single-use flexible bronchoscope.[Consensus Opinion 12]: Single-use flexible bronchoscope is disposable and does not require disinfection (strongly recommended 93.3%).

Challenges and Strategies for Improving Access to Cancer Drugs in Malaysia: Summary of Opinions Expressed at the 2nd MACR International Scientific Conference 2022.

Considerable progress has been made in cancer drug development in recent decades. However, for people in low- and middle-income countries, including Malaysia, many of these drugs are not readily available. During the 2nd Malaysian Association for Cancer Research (MACR) International Scientific Conference, a forum discussion was held to address these challenges and explore strategies to improve access to cancer medicines in the country. This paper presents the results of the said forum discussion. A few challenges to cancer drug access were highlighted, including lengthy approval and regulatory practices, cost of medicines, and manufacturing barriers. Besides, a few strategies for mitigating some of these challenges were proposed, such as mechanisms for cost reduction, uptake of biosimilars and generics, local manufacturing, public-private partnerships, strengthening the role of insurance companies, funding and regulation, and advocacy for fair pricing, by drawing examples from cancer medicines access initiatives in Malaysia and initiatives for different disease groups. Overall, this paper provides a comprehensive overview of the challenges and strategies for improving access to cancer medicines in Malaysia and provides valuable insights for policymakers, healthcare providers, the pharmaceutical industry, cancer patients, cancer support groups, and other stakeholders working on this important issue.

A Deep Learning Framework for News Readers' Emotion Prediction Based on Features From News Article and Pseudo Comments.

With the rapid development of the Internet, readers tend to share their views and emotions about news events. Predicting these emotions provides a vital role in social media applications (e.g., sentiment retrieval, opinion summary, and election prediction). However, news articles usually consist of objective texts that lack emotion words, making emotion prediction challenging. From prior studies, we know that comments that come directly from readers are full of emotions. Therefore, in this article, we propose a deep learning framework that first merges article and comment information to predict readers' emotions. At the same time, in the prediction process, we design a pseudo comment representation for unpublished news articles by the comments of published news. In addition, a better model is required to encode articles that contain implicit emotions. To solve this problem, we propose a block emotion attention network (BEAN) to encode news articles better. It includes an emotion attention mechanism and a hierarchical structure to capture emotion words and generate structural information during encoding. Experiments performed on three public datasets show that BEAN achieves the state-of-the-art average Pearson (AP) and accuracy (Acc@1). Moreover, results on four self-collected datasets show that both the introduction of emotional comments and BEAN in our framework improve the ability to predict readers' emotions.

Existence of the Scholar Ibn al-Mutahhar al-Hilli (died: 726 AH) through his book the hidden Secrets in the Intellectual Sciences: A Contrastive Study


 
 
 
 Existence has a great importance in philosophical and theological thought. It occupied the minds of both the advanced and the late as well. In the current through research the researcher has shown the opinions of Al-Hilli’s existence in comparison between the scholars of his time, and through which the great effort made by this sign is shown. Then, a summary of the comparative opinions presented in saying Philosophers such as Ibn Sina and Al-Razi, and this became clear in what the researcher mentioned to the scholar Al-Hilli and his discussion of the issue of existence in the folds of the research, as well as what is mentioned about the biography of this scientist and the extent of his height in science through his scientific biography and his writings, which exceeded thirty books, a chapter on what was mentioned that he has a large library on the internet entitled Al-Alama Al-Hili.
 
 
 
 
 The current paper has examined the purpose of the frequent encouragement to practice good deeds, which is a legitimate principle, including that its good effect goes beyond the limits of the mind and giving birth, as its practice has an effect on preserving them both in existence and in non-existence.

Hyperrealistic Rendering of Type II Endoleak.

HomeRadiologyRecently Published PreviousNext Reviews and CommentaryFree AccessImages in RadiologyHyperrealistic Rendering of Type II EndoleakBaolei Guo , Liying PengBaolei Guo , Liying PengAuthor AffiliationsFrom the Department of Vascular Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Xuhui District, Shanghai 200032, China (B.G.); and Central Research Institute, United Imaging Healthcare, Shanghai, China (L.P.).Address correspondence to B.G. (email: [email protected]).Baolei Guo Liying PengPublished Online:Feb 14 2023https://doi.org/10.1148/radiol.222150MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Supplemental material is available for this article.A 71-year-old man with a history of abdominal aortic aneurysm status after endovascular aortic repair (EVAR) presented for follow-up CT angiography (CTA) at 19 months. Hyperrealistic rendering (HRR) (United Imaging Healthcare) visually demonstrated an enlarged aneurysm sac measuring 7.2 cm in maximum diameter (previously 6.1 cm, before EVAR), with type II endoleaks involving the bilateral L4 lumbar arteries and the inferior mesenteric artery (Figure, Figure S1, Movie). The patient was admitted to the hospital and underwent embolization of the aforementioned feeding vessels. Follow-up CTA at 6 months after the embolization procedure showed complete thrombosis of the aneurysm sac with no residual endoleak.Images in a 71-year-old man diagnosed with type II endoleak 19 months after the endovascular aortic repair for an abdominal aortic aneurysm. The hyperrealistic rendering from CT angiography provides a clear representation of the endoleak (black arrows) and the three major feeding vessels (white arrows) (ie, bilateral lumbar arteries [LA] and the inferior mesenteric artery [IMA]). (A) The hyperrealistic rendering in posterior view demonstrates the feeding lumbar arteries and the associated iliolumbar-lumbar pathway arising from the internal iliac arteries. (B) The hyperrealistic rendering in anterior view reveals a pathway from the superior mesenteric artery to the inferior mesenteric artery by means of the arc of Riolan feeding into the aneurysm sac (shown as a semitransparent cavity).Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie: Hyper-realistic rendering from CT angiography in a 71-year-old man diagnosed with type II endoleak.Download Original Video (97.3 MB)Endoleaks, in particular type II endoleaks defined as aneurysm sac backfilling from aortic branches (1), are the most common complications of EVAR and pose persistent risk of aortic rupture. Visualization of the inflow vessels is crucial for preoperative planning. As an advanced three-dimensional visualization technique with use of physically based volume rendering, HRR can generate photorealistic images with enhanced display of complex spatial relationships and lifelike surface details. By assisting proceduralists in identifying the endoleak feeding vessels, HRR provides value in developing treatment strategies.Disclosures of conflicts of interest: B.G. No relevant relationships. L.P. No relevant relationships.Supported by the National Natural Science Foundation of China (grant 82000436) and the Science and Technology Commission of Shanghai Municipality (grants 201409004800 and 21410710500).Reference1. Veith FJ, Baum RA, Ohki T, et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg 2002;35(5):1029–1035. Crossref, Medline, Google ScholarArticle HistoryReceived: Aug 29 2022Revision requested: Oct 10 2022Revision received: Oct 21 2022Accepted: Oct 31 2022Published online: Feb 14 2023 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Recently Published Supplemental MaterialMetrics Altmetric Score PDF download

SentiNeg

Sentiment analysis is the process of identifying and categorizing opinions computationally to determine the attitude expressed in the spoken or written text as positive, negative, or neutral. Negation analysis is the task of analyzing the negative opinions by identifying the scope of negation within a sentence and applying linguistic or grammatical rules of the language. In this paper, the rules for identifying the scope of negation within a sentence and the rules applicable to different negation categories are defined. An algorithm by the name SentiNeg has been proposed for processing negations at the sentence level. SentiNeg algorithm filters non-opinionated sentences from the data to avoid unnecessary processing. For opiniated sentences, the algorithm applies different linguistic or grammatical rules of the language to identify negative opinions. SentiNeg algorithm takes opinionated sentences as input and provides a detailed aspect-based summary of negative opinions that are expressed on the entity under analysis.

Attribute-Sentiment-Guided Summarization of User Opinions From Online Reviews

Abstract Eliciting informative user opinions from online reviews is a key success factor for innovative product design and development. The unstructured, noisy, and verbose nature of user reviews, however, often complicate large-scale need finding in a format useful for designers without losing important information. Recent advances in abstractive text summarization have created the opportunity to systematically generate opinion summaries from online reviews to inform the early stages of product design and development. However, two knowledge gaps hinder the applicability of opinion summarization methods in practice. First, there is a lack of formal mechanisms to guide the generative process with respect to different categories of product attributes and user sentiments. Second, the annotated training datasets needed for supervised training of abstractive summarization models are often difficult and costly to create. This article addresses these gaps by (1) devising an efficient computational framework for abstractive opinion summarization guided by specific product attributes and sentiment polarities, and (2) automatically generating a synthetic training dataset that captures various degrees of granularity and polarity. A hierarchical multi-instance attribute-sentiment inference model is developed for assembling a high-quality synthetic dataset, which is utilized to fine-tune a pretrained language model for abstractive summary generation. Numerical experiments conducted on a large dataset scraped from three major e-Commerce retail stores for apparel and footwear products indicate the performance, feasibility, and potentials of the developed framework. Several directions are provided for future exploration in the area of automated opinion summarization for user-centered design.

Some Aspects of Respect and Dignity of Individual On the Europeanism as Values-system: Moral and Individual

The most philosophical writer of the 20th century, Robert Musil wrote: the individual is nothing else but one’s own primary performance. God has become Deus absconditus—claims Milan Kundera—humans have become all’s stone. In this matter, Europeanism signifies that the individual becomes what one makes oneself become. I think the great challenge of pedagogy (from theoretical and practical aspect aspect): how can the ability and competence of independent thinking be realised during educational work? How does the schooling system facilitate the development of the autonomy of pupils, students and teachers? In my opinion (summary of this study) the respect and dignity are the most beautiful and charming quests of Europeanism and education.

State of the practice and engineering framework for using emergent vegetation in coastal infrastructure

Natural and Nature-Based Features (NNBF) are promoted as alternatives to structural flood protection measures. Progress has been made in understanding the physics and engineering of these systems; however, engineering, ecological, and social barriers to implementation remain. This paper identifies these barriers using the results of a literature review and summary of expert opinion; contrasts the state of the practice of NNBF with traditional structures; and details the main engineering challenges to NNBF implementation, including the uncertainty in current calculation techniques and lack of engineering design guidelines. We suggest that emergent vegetation systems can be designed with the current body of information, and an example framework is proposed for assessing these systems for their wave attenuation performance. The framework is discussed in the context of risk, and future research priorities are presented.

Management of haemophilia A with inhibitors: A regional cross-talk.

The development of inhibitors with factor VIII (FVIII) replacement therapy is one of the most common and challenging complications of haemophilia A (HA) treatment, jeopardising treatment efficacy and predisposing patients to high risks of morbidity and mortality. The management of patients with inhibitors is particularly challenging in countries where resources are limited. To provide a comprehensive summary of the management of HA with inhibitors while focusing on differences in practice between Western and non-Western countries and how resource scarcity can impact HA management, leading to suboptimal outcomes in patients with inhibitors. Summary of key evidence and regional expert opinion. We address, particularly, the diagnosis of and testing for inhibitors, as well as the epidemiology of inhibitors, including incidence, prevalence and disease burden. Secondly, we provide an overview of the current treatment landscape in HA with inhibitors regarding the eradication of inhibitors with immune tolerance induction and the treatment and prevention of bleeding with bypassing agents, non-factor replacement agents and other experimental therapies. This is complemented with insights from the authors around the applicability of, and challenges associated with, such therapies in their settings of practice. We conclude by proposing some key steps towards bridging the gaps in the management of HA with inhibitors in resource-limited countries, including: (1) the collection of quality data that can inform healthcare reforms and policies; (2) improving disease knowledge among healthcare practitioners and patients with the aim of standardising disease management across centres and (3) working towards promoting equal access to HA care and therapies for everyone.

Current Issues in Social Medicine and Public Health from the Viewpoint of Early-career Researchers: Summary of Opinions at the Social Medicine Young Retreat.

The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of research, practice, social contribution, and education in social medicine and public health, which relate to the core mission of universities. Early-career researchers and professionals play an important role in these domains, but little is known about the challenges and issues they encountered or recognized during this pandemic. Therefore, we summarized the opinions of 37 participants (30 early-career researchers and seven senior researchers) on this issue from discussions at the Social Medicine Young Retreat, 2019, of the Japanese Medical Science Federation. The retreat was initially planned to be held during March 5-6, 2020 in Yamanashi but was changed to be held virtually on March 5, 2021. Early-career researchers participated in group discussions on how social medicine should transform itself to serve the public during the COVID-19 pandemic. Afterward, each group provided opinions on challenges and issues in social medicine. For example, participants perceived difficulties in implementing research in a timely way and the lack of multidisciplinary collaboration. They recognized challenges in continuing practice because of the limited evidence on COVID-19. On social contribution, they described difficulties in communicating risk as professionals. They also noted issues arising from online teaching and learning. One group suggested that the essence of social medicine did not need to be changed, but methodologies should be updated to tackle multiple existing challenges. These opinions may not cover all issues but could help establish a better relationship between medicine and society in a bottom-up manner. The continuous promotion of interdisciplinary collaboration in social medicine (and basic and clinical medicine) would provide ideas to solve these issues at scale. Organizational support is warranted to ensure sustainability and scalability of these actions.

IoT enabled machine learning framework for social media content-based recommendation system

Analysing huge volume of data from the social media tweets on product reviews provides a better understanding of any product. Exploring customer opinions from tweets is helpful to find the strengths and weaknesses of different products and features. There are several studies on product recommendations from Twitter product reviews. In this paper, Internet of Things-based two level product recommendation framework (TLPRF) is proposed to efficiently handle large amount of Twitter users' product reviews data. TLPRF consists of a Raspberry Pi microcomputer as an IoT mining machine and it is programmed to generate a feature level opinion summary. Feature level opinion is found to be useful in accomplishing the product ranking. Based on the customer interest in the product purchase request, a normalised ranking of each matching product is calculated from the feature-wise opinion summary and the product with maximum ranked score is recommended to Twitter user. The proposed TLPRF is found to be superior to similar other approaches in terms of accuracy, precision, recall and f-measure.

Confidence and Hesitancy During the Early Roll-out of COVID-19 Vaccines Among Black, Hispanic, and Undocumented Immigrant Communities: a Review

Black and Hispanic Americans have been hardest hit with COVID-19 infections, hospitalizations, and deaths, yet during the first several months of vaccine roll-out they had the lowest level of vaccine uptake. Primarily, our research on vaccine hesitancy focused on skepticism around the vaccine itself and its roll-out. Our search strategy used PUBMED and Google with a prescribed set of definitions and search terms for two reasons: there were limited peer-reviewed studies during early period of roll-out and real-time perspectives were crucially needed. Literature searches occurred in April 2021and covered September 2020-April 2021. Analyses included expert opinion, survey results and qualitative summaries. Overall, for the general U.S. population, there was considerable hesitancy initially that remained high during the early roll-out. The general population expressed concerns over the speed of vaccine development (“warp speed”), confidence in the competence of government being involved in the development of vaccines and general mistrust of government. Among Black and Hispanic Americans, hesitancy was further expressed as mistrust in the medical establishment that was related to past and current medical mistreatment. Undocumented immigrants worried about access to insurance and possible deportation. These results on confidence in the vaccine early during vaccine roll-out suggest diverse reasons that influence a person’s decision to vaccinate or not. Additional barriers to vaccine uptake include complacency and access. To ensure health equity, particularly to address disparities in morbidity and mortality, vaccine hesitancy needs to be acknowledged and addressed as COVID-19 vaccine roll-out continues, and these observations calls for conscious planning to address these issues early with future health crises.

Falling Through the Cracks: The Current Gap in the Health Care Transition of Patients With Kawasaki Disease: A Scientific Statement From the American Heart Association.

BackgroundHealth care transition (HCT) is a period of high vulnerability for patients with chronic childhood diseases, particularly when patients shift from a pediatric to an adult care setting. An increasing number of patients with Kawasaki disease (KD) who develop medium and large coronary artery aneurysms (classified by the American Heart Association according to maximal internal coronary artery diameter Z‐scores ≥5 and ≥10, respectively) are becoming adults and thus undergoing an HCT. However, a poor transition to an adult provider represents a risk of loss to follow‐up, which can result in increasing morbidity and mortality.Methods and ResultsThis scientific statement provides a summary of available literature and expert opinion pertaining to KD and HCT of children as they reach adulthood. The statement reviews the existing life‐long risks for patients with KD, explains current guidelines for long‐term care of patients with KD, and offers guidance on assessment and preparation of patients with KD for HCT. The key element to a successful HCT, enabling successful transition outcomes, is having a structured intervention that incorporates the components of planning, transfer, and integration into adult care. This structured intervention can be accomplished by using the Six Core Elements approach that is recommended by the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians.ConclusionsFormal HCT programs for patients with KD who develop aneurysms should be established to ensure a smooth transition with uninterrupted medical care as these youths become adults.