Multidisciplinary Care for Refractory Pediatric Functional Abdominal Pain Decreases Emergency and Inpatient Utilization.

ABSTRACT: Children with refractory functional abdominal pain (FAP) experience functional disability and may utilize emergency department (ED) and/or inpatient services. Whether multidisciplinary programs which help care for children with refractory FAP affect acute healthcare utilization is unknown. A retrospective chart review of children initially evaluated by the outpatient Multidisciplinary Abdominal Pain Program (MAPP) from October 2016 to May 2019 was completed. Patient characteristics and number of ED visits and hospitalizations for abdominal pain in the year prior to versus year after MAPP evaluation were captured. Thirty-eight children (ages 9-17 years [median 13 years]) were included. The median number of ED visits/patient/year decreased from 1 (range: 0-7) to 0 (range: 0-3) (P < 0.0001). Seven (18%) children had been hospitalized and, in these children, the median number of hospitalizations/patient/year decreased from 1 (range: 1-5) to 0 (range: 0-1) (P < 0.05). These data suggest multidisciplinary outpatient intervention for refractory FAP is associated with significant decreases in acute healthcare utilization.

Arts and crafts as an educational strategy and coping mechanism for Republic of Korea and United States parents during the COVID-19 pandemic.

The COVID-19 pandemic and ensuing stay-at-home orders have shifted family lives worldwide. Government regulations about social distancing and isolation have resulted in parents/carers and children spending most of their time together in private spaces. During the northern hemisphere spring 2020 semester, most childcare and school systems closed and parents had to dramatically modify their balance between work and home life. Using data from consumer reports, online parenting forums and blog posts, and Google Trends, the authors of this article explored how some parents have shifted towards cultural and creative enrichment as a resource to occupy their children during governmental stay-at-home directives in both the United States and the Republic of Korea. The authors found that arts and crafts and educational toy sales have increased, parents are sharing advice and resources for at-home creative activities, and arts and cultural institutions have expanded their free online content. Finally, this article discusses whether the short-term stressors from COVID-19 might lead to long-term changes in parenting and sustained interest in these resources. The authors' findings provide additional support for the importance of arts and humanities in the educational experience of children.

Les activités artistiques et artisanales, une stratégie éducative et d'adaptation pour les parents en République de Corée et aux États-Unis pendant la pandémie de COVID-19 ­ La pandémie de COVID-19 et les ordres de confinement qu'elle a entraînés ont bouleversé la vie des familles dans le monde entier. Du fait des mesures de distanciation physique et d'isolement prises par les gouvernements, les enfants et les parents/les personnes chargées de s'occuper d'eux ont passé la majeure partie du temps ensemble, dans des espaces privés. Pendant le printemps 2020 de l'hémisphère nord, la plupart des services de garde d'enfants et des établissements scolaires ont fermé, et les parents ont dû modifier considérablement l'équilibre travail-famille. En s'appuyant sur des informations recueillies dans des rapports sur les consommateurs, dans des forums en ligne et des billets publiés dans des blogs sur la parentalité, et sur une analyse des tendances de Google Trends, les auteures de cet article ont examiné comment certains parents ont fait de l'enrichissement culturel et créatif une ressource pour occuper leurs enfants durant le confinement ordonné par les gouvernements aux États-Unis et en Corée. Elles ont constaté que les ventes de jouets créatifs et éducatifs avaient augmenté, que les parents partageaient des conseils et des ressources pour faire des activités d'art et d'artisanat à la maison, et que les établissements artistiques et culturels proposaient davantage de contenus gratuits. Enfin, l'article se demande si les facteurs de stress à court terme dus à la COVID-19 pourraient provoquer des changements à long terme en ce qui concerne la parentalité et créer un intérêt durable pour ces ressources. Les résultats des recherches menées par les auteures sont des éléments de plus qui étayent l'importance des arts et des sciences humaines dans l'éducation des enfants.

Modeling Airline Crisis Management Capability: Brand attitude, brand credibility and intention.

Crisis management consists of a number of capabilities which evaluate crisis signals and implements actions to minimize damage. Both identifying these capabilities and understanding their influence on perceptions of brand attitude, credibility and intention to purchase offers significant theoretical and managerial insights. This paper, therefore, proposes a cause-effects model of perceived airline crisis management capabilities and their influence on brand credibility, brand attitude and purchase intention in the aftermath of large-scale Taiwanese airline strikes. Using data collected via an online survey, the study makes three contributions to airline crisis management. It, firstly, identifies a set of crisis management capabilities for strike-hit airlines, secondly, it offers a causal chain of perceived airline crisis management capabilities, brand attitude, brand credibility and purchase intention. Furthermore, it the full mediating effects of brand credibility and brand attitude in the causal chain. This study, thus, makes conceptual and methodological contributions to crisis management and purchase intention research and provides practical insights into effective airline crisis management and brand management for the airline industry.

The Anxiety of Being Asian American: Hate Crimes and Negative Biases During the COVID-19 Pandemic.

In this essay, we review how the COVID-19 (coronavirus) pandemic that began in the United States in early 2020 has elevated the risks of Asian Americans to hate crimes and Asian American businesses to vandalism. During the COVID-19 pandemic, the incidents of negative bias and microaggressions against Asian Americans have also increased. COVID-19 is directly linked to China, not just in terms of the origins of the disease, but also in the coverage of it. Because Asian Americans have historically been viewed as perpetually foreign no matter how long they have lived in the United States, we posit that it has been relatively easy for people to treat Chinese or Asian Americans as the physical embodiment of foreignness and disease. We examine the historical antecedents that link Asian Americans to infectious diseases. Finally, we contemplate the possibility that these experiences will lead to a reinvigoration of a panethnic Asian American identity and social movement.

Can greater reliance on test scores ameliorate the association between family background and access to post-collegiate education? Survey evidence from the Beijing College Students Panel survey.

We evaluate whether greater reliance on test scores may reduce the extent of educational inequality by family origin as college graduates seek entrance to graduate school. In this article, we present a case study using survey data of colleges in Beijing, China, where students' performance in standardized graduate school entrance examination (the GSEE) is the primary determinant for the entrance to graduate school. Using multiple waves of the Beijing College Students Panel Survey (BCSPS), we fit a series of models to capture the correlations of family socio-economic status (SES) with the probabilities of seeking entrance to post-collegiate education, registering for and taking the GSEE, and finally obtaining admission to graduate school. After balancing the differential probabilities of seeking graduate level education, we find that family SES is not significantly associated with the likelihood of taking the GSEE, but significantly predicts the probability of applying a foreign graduate program. Although family SES can be marginally correlated with the odds of being admitted by a domestic graduate program, the strength of such an association is significantly weaker than for overseas programs. It is also shown that, for the elite graduate programs, family origin is independent from both GSEE registration and subsequent admission. These findings suggest that the test-oriented evaluations could ameliorate the extent of inequality at the post-collegiate level.

Men and Women's Different Dreams on the Future of the Gendered Division of Paid Work and Household Work after COVID-19 in South Korea.

Men's long hours of paid work and minimal commitment to household work, combined with the comparably low-level of women's labor force participation, characterize the gendered division of work and family in South Korea. Can the changes in work and family arrangements brought on by the COVID-19 pandemic alter the persevering gendered division of paid work and household work in Korea? Along with school closures and the increased number of employees working from home during COVID-19, do Korean men and women anticipate more equal sharing of paid work and household work? We collected data from 1000 Korean adults during the period of July 3-6, 2020, and asked their predictions about various dimensions of social changes, including the gendered division, after COVID-19. Although a substantial share of both men and women anticipate a reduction in the gendered division of paid work and household work after COVID-19, Korean women are not as optimistic as their male counterparts about this potential reduction. In particular, younger women are most skeptical about the prospect that paid work and household work will be less divided by gender beyond the pandemic.

The Pain of Invisibility: A Perspective on the Treatment of Pediatric Chronic Pain.

Although chronic pain can be debilitating and severely impacting, it can also be an affliction many take on privately. For many chronic pain patients and their families, the toll of symptom invisibility is often a prominent concern. The article expounds upon the theme of "symptom invisibility" and the need for and practice of developing a validating provider-family relationship in the treatment of children and adolescents with chronic pain. Suggestions for therapeutic pathways to building adaptive validation are provided.

Addressing Pain With Inpatient Integrative Medicine at a Large Children's Hospital.

BACKGROUND: Pediatric integrative medicine (IM) includes the use of therapies not considered mainstream to help alleviate symptoms such as pain and anxiety. These therapies can be provided in the inpatient setting. METHODS: This 10-week study involved the integration of acupuncture, biofeedback, clinical hypnotherapy, guided imagery, meditation, and music therapy to address pain in children admitted to a large US children's hospital. RESULTS: Of 51 patients enrolled, 60% of the patients, 66% of their mothers, and 56% of their fathers used CAM (complementary and alternative medicine) in the preceding 1 year. Although 51 families requested integrative therapies, only 18 patients received them because of inadequate provider availability. All recorded pain scores improved with integrative therapies. One parent reported a possible side effect of irritability in the child after clinical hypnotherapy while 5 children reported opiate side effects. All participating families interviewed responded that IM services helped their child's pain and helped their child's mood, and that our hospital should have a permanent IM consult service. CONCLUSION: Integrative therapies can be helpful to address pain without significant side effects. Further studies are needed to investigate the integration, cost, and cost-effectiveness of integrative therapies in pediatric hospitals.

Acrodermatitis enteropathica from zinc-deficient total parenteral nutrition.

Acrodermatitis enteropathica (AE) is a rare autosomal-recessive disorder of zinc malabsorption, characterized by acral and periorificial dermatitis, alopecia, and diarrhea. Acquired AE is the result of decreased zinc intake, excessive zinc loss, or other malabsorptive processes. We present a case of a 54-year-old woman who developed characteristic skin lesions of acquired AE after zinc supplementation was removed from her total parenteral nutrition (TPN) solution. She was found to have hypozincemia and eventually exhibited prompt resolution of skin lesions after zinc was added to TPN. This case provides a unique opportunity to illustrate the direct correlation between decreased zinc intake and development of acquired AE.

It hurts to move (on): A family's experience with chronic pain, grief, and healing.

This article describes a family that had to deal with grief from losing a family member. They sought help for 13-yr-old Katie's prolonged pain following a sprain. The family's unresolved grief over their second child's passing continued to emerge, peeping through the small talk, the wry smiles, the daily efforts to move and do, despite physical pain. As the demands of Katie's rehabilitation stripped away reserves of politeness and energy, the family's emotional pain became more fully uncovered.The author describes the 6-week course of physical and occupational therapies, pain medicine management, and individual and family behavioral health support. In this period of family crisis, the author was their partner, coach, advocate, and confidante. (PsycINFO Database Record

Hit, Robbed, and Put Down (but not Bullied): Underreporting of Bullying by Minority and Male Students.

To tackle adolescent bullying and identify students most vulnerable to being bullied, it is essential to examine both occurrences of bullying behaviors and students' own likelihoods of reporting bullying. This study examines ethnic and gender differences in students' odds of reporting bullying using the Education Longitudinal Study of 2002, a nationally representative study of United States high school sophomores (N = 15,362; ages 15-19; 50.2% female). Compared to White and female students, minority (particularly Black and Hispanic) and male students report comparable or greater experiences of bullying behaviors (such as being threatened, hit, put down by peers, or having belongings forced from them, stolen or damaged), but are less likely to report that they have been "bullied." These findings point to racialized and gendered differences in reporting bullying experiences such that indicators of "weakness" in peer relations may carry a greater stigma for minority and male students.

Traumatic Stress and Pediatric Pain: Towards a Neurobiological Stress-Health Perspective.

This theoretical review aims to present the limited findings on traumatic stress and pain in children and adolescents, highlight recent discoveries regarding neurobiological processes, and suggest an alternative stress-health perspective in the future study and conceptualization of pediatric pain and traumatic stress based on results. Current literature highlights a positive correlation between pain and trauma symptoms in youth and suggests a complex relationship that may have mutually maintaining dynamics and intertwined physiological processes. Developmentally sensitive, longitudinal, process-oriented designs assessing neurobiological alterations and stress responses should be utilized in the examination of the trauma-pain relationship. Such investigations may provide a more unified explanation of the relationship between chronic pain and traumatic stress.

Intraoperative Administration of 4-Factor Prothrombin Complex Concentrate Reduces Blood Requirements in Cardiac Transplantation.

OBJECTIVE: Assessing the efficacy of intraoperative 4-factor prothrombin complex concentrate (4F-PCC) use in blood product utilization, time to chest closure, intensive care unit (ICU) and hospital length of stay (LOS), thromboembolic complications, renal injury and mortality in left ventricular assist device (LVAD) patients on home anticoagulation therapy with warfarin, undergoing orthotopic heart transplantation (OHT). DESIGN: Retrospective analysis of OHT patients at Tufts Medical Center from May 2013 to October 2016. SETTING: Single-institution, university hospital setting. PARTICIPANTS: Patients with preexisting LVADs who received orthotopic heart transplants (n = 74; 32 patients 4F-PCC, 42 patients no 4F-PCC). INTERVENTIONS: Warfarin reversal using 4F-PCC in patients with LVADs undergoing orthotopic heart transplantation with the 4F-PCC dosing partitioned such that one-third was given pre-CPB and two-thirds were given post-CPB. MEASUREMENTS AND MAIN RESULTS: The 4F-PCC group required less plasma (6 [IQR 4] v 1.31 [IQR 2] U, p < 0.001), cryoprecipitate (10 [IQR 10] v 7.50 [IQR 5] U, p < 0.001), and packed red blood cells (5 [IQR 4] v 2 [IQR 1.5] U, p < 0.001) and had a shorter time to chest closure (618.8 ± 111.4 v 547.9 ± 110.1 minutes, p = 0.008). There was no difference in platelet transfusion (2 [IQR 1] v 2 [IQR 1] U, p = 0.16), ICU or hospital LOS, acute kidney injury, or mortality. No thrombotic complications occurred. CONCLUSIONS: Replacing plasma with 4F-PCC to reverse preoperative warfarin anticoagulation during OHT was associated with a shorter time to chest closure and less blood product utilization, without an increase in acute kidney injury, thromboembolic complications, or death.

Pain Acceptance as a Predictor of Medical Utilization and School Absenteeism in Adolescents With Chronic Pain.

Objective: Identifying factors contributing to high medical utilization and productivity loss is important, given the high cost of pediatric chronic pain. The current study examined chronic pain acceptance as a predictor of medical utilization and school absenteeism in adolescents with chronic pain. Methods: In all, 122 adolescents (aged 12-21 years) with chronic pain and their parents/guardians completed questionnaires assessing medical visits (past 6 months), medication usage, and number of school absences (past month). Homebound school status was also reported. Adolescents completed the Chronic Pain Acceptance Questionnaire and pain intensity ratings, and underwent a diagnostic psychological evaluation. Results: Multivariate generalized linear model analyses indicated lower pain acceptance predicted increased inpatient hospitalizations and higher number of opioid and nonopioid prescription medications, controlling for pain intensity, age, and sex. Pain acceptance was not associated with outpatient consultations or number of nonprescription medications. Exploratory moderation analyses indicated lower pain acceptance significantly predicted increased emergency department visits and inpatient hospitalizations for patients diagnosed with an internalizing psychological disorder. Patients in homebound schooling reported low pain acceptance and for those in school full-time, linear regression indicated lower pain acceptance significantly predicted higher number of school absences. Conclusions: Findings suggest that lower pain acceptance contributes to the use of higher-level medical care (especially for adolescents with internalizing disorders) and increased productivity loss owing to school absences or homebound school status. Clinical implications exist for recommending acceptance-based interventions for pain acceptance promotion and continued development of cost-effective, easily disseminated acceptance-based therapy modules to curb the economic burden of chronic pain.

Multi-Family Pediatric Pain Group Therapy: Capturing Acceptance and Cultivating Change.

Behavioral health interventions for pediatric chronic pain include cognitive-behavioral (CBT), acceptance and commitment (ACT), and family-based therapies, though literature regarding multi-family therapy (MFT) is sparse. This investigation examined the utility and outcomes of the Courage to Act with Pain: Teens Identifying Values, Acceptance, and Treatment Effects (CAPTIVATE) program, which included all three modalities (CBT, ACT, MFT) for youth with chronic pain and their parents. Program utility, engagement, and satisfaction were evaluated via quantitative and qualitative feedback. Pain-specific psychological, behavioral, and interpersonal processes were examined along with outcomes related to disability, quality of life, pain interference, fatigue, anxiety, and depressive symptoms. Participants indicated that CAPTIVATE was constructive, engaging, and helpful for social and family systems. Clinical and statistical improvements with large effect sizes were captured for pain catastrophizing, acceptance, and protective parenting but not family functioning. Similar effects were found for functional disability, pain interference, fatigue, anxiety, and depression. Given the importance of targeting multiple systems in the management of pediatric chronic pain, preliminary findings suggest a potential new group-based treatment option for youth and families. Next steps involve evaluating the differential effect of the program over treatment as usual, as well as specific CBT, ACT, and MFT components and processes that may affect outcomes.

Trading Youth for Citizenship? The Spousal Age Gap in Cross-Border Marriages.

Prior studies concerning patterns of intermarriage among immigrants have primarily focused on how factors such as race/ethnicity, educational attainment, and country of origin shape the choice of a spouse. Moreover, they have focused on intermarriage patterns among immigrants who are already in the US. Using the 2010-2014 American Community Survey (ACS), we focus on immigrants who were not US citizens at the time of their marriage and highlight patterns of status exchange, specifically, the exchange of youth for citizenship. Towards this end, we compare the age gap between spouses across four different groups of respondents: 1) non-citizens married to a citizen before or upon arrival to the US; 2) non-citizens married to a citizen after arrival to the US; 3) non-citizens married to a non-citizen before or upon arrival to the US; and 4) non-citizens married to a non-citizen after arrival in the US. We document the fact that a large fraction of marriages between citizens and non-citizens occurred before or upon arrival to the US. We also provide evidence that immigrants who migrate to the US after marrying a US citizen, particularly women, tend to be partnered with much older spouses, signaling an exchange of youth for citizenship.

Eruptive melanocytic nevi during azathioprine therapy for antisynthetase syndrome.

Eruptive melanocytic nevi (EMN) are rare multiple benign melanocytic nevi that develop within a few months. The phenomenon has been associated with a variety of dermatologic and systemic conditions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, epidermolysis bullosa, Addison disease, human immunodeficiency virus infection, and internal malignancy, among others. It also is commonly attributed to medications, particularly immunosuppressive and chemotherapeutic agents. We report a case of EMN in a 50-year-old man undergoing azathioprine therapy for antisynthetase syndrome.

Lack of impact of umbilical cord blood unit processing techniques on clinical outcomes in adult double cord blood transplant recipients.

BACKGROUND AIMS: Despite widespread use of umbilical cord blood (UCB) transplantation and distinct practice preferences displayed by individual UCB banks and transplant centers, little information exists on how processing variations affect patient outcomes. METHODS: We reviewed 133 adult double UCB transplants performed at a single center: 98 after reduced-intensity and 35 after myeloablative conditioning. Processing associated with contributing UCB banks and units was surveyed to identify differences in practice. We analyzed effect of selected variables on clinical outcomes of engraftment, dominance, transplant-related mortality, and survival. RESULTS: Eighty-eight percent of banks queried currently practice red blood cell (RBC) depletion before cryopreservation. This reflects a shift in practice because previously 65% of banks employed RBC-replete processing methods (i.e., cryopreservation or plasma/volume reduction). Neither neutrophil nor platelet engraftment was affected by processing conditions analyzed. RBC depletion was not associated with clinical outcomes, except in 17 recipients of 2 RBC-replete units, where survival was better than that observed in 116 recipients of ≥1 RBC-depleted units (hazard ratio 3.26, P = 0.004). When analyzed by attributes of the dominant unit, RBC depletion, time in storage, bank years in existence, and inventory size did not affect clinical outcomes. Postthaw viability and CD34 dose were factors impacting engraftment. Notably, all RBC-replete units in this cohort were washed in dextran-human serum albumin before infusion. DISCUSSION: These findings support continued utilization of the entire existing pool of cord blood units, despite recent trends in processing, and have important implications for banking resources and UCB selection practices.

Cutaneous adnexal carcinoma with apocrine differentiation.

Primary cutaneous apocrine carcinomas are uncommon malignant neoplasms that can be difficult, if not impossible, to distinguish histologically from metastatic breast carcinomas. We present the case of a 71-year-old man with a 5-year history of extensive ulcerated plaques on the posterior neck and posterior scalp. Biopsy revealed a poorly differentiated infiltrating adenocarcinoma consistent with either primary cutaneous apocrine carcinoma or occult metastatic breast carcinoma. Immunohistochemical analysis demonstrated positive staining for cytokeratin (CK) 7, estrogen receptor, and progesterone receptor, and negative staining for p63, podoplanin, CK20, and thyroid transcription factor 1. Extensive radiologic imaging studies showed no evidence of occult breast or other internal malignancies. Based on the indolent clinical course, lack of evidence for an internal primary site, and immunohistochemical staining, the lesion was determined to be consistent with a cutaneous neoplasm with features of apocrine differentiation. This case highlights the distinction between apocrine carcinoma and other primary adnexal carcinomas for which p63 and D2-40 have been reported to be sensitive and specific markers but are negative in apocrine carcinomas.