Disparities and Biases in Food Insecurity Screening Among Admitted Children.

BACKGROUND AND OBJECTIVES: Food insecurity (FI) has increasingly become a focus for hospitalized patients. The best methods for screening practices, particularly in hospitalized children, are unknown. The purpose of the study was to evaluate results of an electronic medical record (EMR) embedded, brief screening tool for FI among inpatients. METHODS: This was a cross-sectional study from August 2020 to September 2022 for all children admitted to a quaternary children's hospital. Primary outcomes were proportion of those screened for FI and those identified to have a positive screen. FI was evaluated by The Hunger Vital Sign, a validated 2-question screen verbally obtained in the nursing intake form in the EMR. Covariates include demographic variables of age, sex, race, ethnicity, primary language, and insurance. Statistical analyses including all univariate outcome and bivariate comparisons were performed with SAS 9.4. RESULTS: There were 31 553 patient encounters with 81.7% screened for FI. Patients had a median age of 6.3 years, were mostly male (54.2%), White (60.6%), non-Hispanic (92.7%), English-speaking (94.3%), and had government insurance (79.8%). Younger (0-2 years), non-White, and noninsured patients were all screened significantly less often for FI (all P < .001). A total of 3.4% were identified as having FI. Patients who were older, non-White, Hispanic, non-English speaking, and had nonprivate insurance had higher FI (all P < .001). CONCLUSIONS: Despite the use of an EMR screening tool intended to be universal, we found variation in how we screen for FI. At times, we missed those who would benefit the most from intervention, and thus it may be subject to implementation bias.

Characteristics of logs with signs of oviposition by the polyphagous xylophage Asian longhorned beetle (Coleoptera: Cerambycidae).

During the eradication program undertaken against Anoplophora glabripennis (Motschulsky) in the Greater Toronto Area, information was collected on the numerous signs of injury found on wounded trees. Herein, we used a portion of this information to assess the characteristics of logs with signs of oviposition (i.e., pits). Specifically, we related the basal diameter, type (log bole vs. log branch), height above ground, and branch hierarchy level of logs with pits to tree size (i.e., height and diameter at breast height) and level of infestation intensity. In general, pits were concentrated on logs from the bole and branches that were 8-14 cm in diameter in the lower 8 m of the bole and in the first 2 levels of the branching hierarchy. Oviposition pit location was strongly influenced by tree size-both height and diameter at breast height, with more pits on the lower bole in small trees and then higher on the bole and into the branches as tree size increased. As tree-level infestation intensity increased, pits were found on both larger and smaller diameter portions of the trees, presumably as preferred oviposition sites became saturated. These findings can improve the efficacy of surveillance activities for A. glabripennis.

Clinical guideline highlights for the hospitalist: Evaluation, management, and prevention of cow's milk allergy.

GUIDELINE TITLE: An ESPGHAN position paper on the diagnosis, management and prevention of cow's milk allergy RELEASE DATE: Journal of Pediatric Gastroenterology and Nutrition, July 26, 2023 PRIOR VERSION: 2012 DEVELOPER: ESPGHAN (European Society of Paediatric Gastroenterology, Hepatology and Nutrition), NASPGHAN (North American Society of Pediatric Gastroenterology, Hepatology and Nutrition) FUNDING SOURCE: ESPGHAN TARGET POPULATION: Infants and young children with suspected cow's milk allergy.

Trends in Anthropometric Measurements of Internationally Adopted Children.

OBJECTIVE: The objective of this study was to describe anthropometric measures from internationally adopted children. Internationally adopted children are at risk for poor growth and development and there is no standardized growth chart evaluation for internationally adopted children due to variations in growth, genetics, and environmental exposures. METHODS: This is a retrospective chart review of 882 patients seen in an international adoption clinic between 2010 and 2017. Anthropometric measurements were converted to Z scores for weight, height, head circumference, and body mass index. RESULTS: A total of 41 countries and 16 subregions were represented. Central America, northern Africa, southern Africa, and southern Europe were the only subregions that had positive mean Z scores for weight, and southeast Asia had the lowest mean Z score for weight (n = 40, -1.76). No subregion had a positive mean Z score for height, and western Asia had the lowest overall mean Z score for height (n = 2, -2.44). Mean Z score for body mass index was positive in several subregions. CONCLUSIONS: Growth is an important predictor of health and development, and this study adds to the literature on growth patterns of internationally adopted children.

The changing virology and trends in resource utilization for bronchiolitis since COVID-19.

BACKGROUND: Bronchiolitis is a viral respiratory illness most commonly caused by respiratory syncytial virus (RSV). COVID-19 disrupted typical patterns of viral transmission. Our study aimed to compare low value care for bronchiolitis in a tertiary emergency department (ED) in the United States from March 2017 to March 2022. METHODS: This was a descriptive cohort study through a retrospective chart review from 2017 to 2022 analyzing ED visits for bronchiolitis including disposition, disease severity, chest radiographs, albuterol, and high flow nasal cannula usage. A year was a 12-month period from March to February. RESULTS: From 2017 to 2020, there were over 2000 ED visits for bronchiolitis per year (3.1% of all ED visits), which decreased to 450 visits for bronchiolitis (1%) in 2020-2021. Human rhino/enterovirus was the most common virus detected (92%) at that time, and admission rates, albuterol, high flow nasal cannula, and chest radiographs were all higher. The summer of 2021 had the highest visits across the 5-study years with a return to previous rates of resource utilization. CONCLUSIONS: Bronchiolitis ED visits due to RSV dramatically reduced during the first year of the COVID-19 pandemic in 2020, with over 80% reduction in bronchiolitis visits from 2018 to 2019. While all ED visits fell in 2020, the proportion of visits due to bronchiolitis also decreased. There was an increase in lower value care during the rhinovirus dominant, low census period. As restrictions lifted in 2021, there was a large resurgence of RSV in the atypical summer months with a return of previous rates of resource utilization.

Food Insecurity Screening of Hospitalized Patients: A Descriptive Analysis.

OBJECTIVES: The purpose of this study is to describe an advocacy effort to implement a food insecurity (FI) screening during hospital admission and describe characteristics of hospitalized patients with household FI. METHODS: This is a descriptive study after the implementation of FI screening at a quaternary-care children's hospital in the Southeastern United States between August 2020 and April 2021. The Hunger Vital Sign, a 2-question screening tool for FI, was added to the intake questionnaire performed on inpatient admissions. A positive screen triggered a social work consult to connect patients with resources. Chart review and statistical analyses were performed on patients with household FI. RESULTS: There were 7751 hospital admissions during the study period, of which 4777 (61.6%) had an FI screen completed. Among those with a completed screen, 233 patients (4.9%) were positive for household FI. Patients with household FI were more likely to be Black (P <.001) and have Medicaid (P <.001). Social work documented care specific to FI in 125 of the 233 (56%) FI patients, of which 39 (31%) were not enrolled in the Women, Infants, and Children Program/Supplemental Nutrition Assistance Program. CONCLUSIONS: This initiative highlights hospitalization as an opportunity to screen for FI using a multidisciplinary approach. Our findings underscore the importance of identifying FI with the goal of reducing FI and mitigating the adverse effects of FI on child health outcomes.

Do We Know Where They Go? Obtaining Travel History in Pediatric Patients.

OBJECTIVE: To determine how often travel histories are obtained in pediatric patients. METHODS: A retrospective medical record review was performed at a single tertiary care children's hospital for patients aged 2 months to 18 years who were admitted October 2015-December 2017 with International Classification of Diseases, 10th Revision codes for potential travel-related illnesses. Demographic information and travel history documentation were obtained, along with travel-related testing. From May to June 2018, prospective, single-blinded, direct observation of a convenience sample of pediatric residents was performed during the initial patient encounter to determine the frequency and quality of travel histories obtained regardless of documentation. RESULTS: Of 249 charts reviewed, 27 (10.8%) patients had a travel history query documented. Patients with complex chronic conditions were significantly less likely to have a travel history documented (37% vs 67%; P = 0.005). Age, sex, length of stay, race, payer status, and critical care admission did not significantly differ between groups. Those with a travel history documented were more likely to have a documented exposure history (100% vs 52%; P < 0.001) and additional testing performed (56% vs 13%, P < 0.001). During this time, a simulation course with residents featuring travel-related diagnoses led to a significant increase in documented travel histories (5% prior versus 21% after, P = 0.03). A total of 37 patient encounters were observed; travel history was asked for 4 times (4/37, 10.8%). CONCLUSIONS: Travel histories are rarely asked for in pediatric patients. Missed diagnoses may not only affect the patient but also have broader public health implications. Simulation is an effective tool to improve history-taking skills, yet more work is still needed.

Quality Improvement Project to Improve Screening for Tobacco Use in Adolescent Inpatients at a Children's Hospital.

Tobacco use begins in adolescence for the majority of smokers. The purpose of this study was to increase screening and reporting of tobacco use in hospitalized adolescents at a tertiary care children's hospital. We completed a nursing focus group to understand challenges and completed four iterative Plan-Do-Study-Act cycles, which included: (1) in-person nursing education regarding tobacco use screening, (2) addition of an e-cigarette-specific screening question, (3) the creation and dissemination of an educational video for nursing, and (4) adding the video as a mandatory component of nursing orientation. Run charts of the percentage of patients screened who reported tobacco use were created. Absolute counts of tobacco products used were also captured. From January 2016 to September 2018, 12,999 patients ≥13 years of age were admitted to the hospital. At baseline, 90.1% of patients were screened and 4.8% reported tobacco use. While the absolute number of adolescents reporting e-cigarette use increased from zero patients per month at baseline to five, the percentage of patients screened and reporting tobacco use was unchanged; the majority of e-cigarette users reported use of other tobacco products. This study demonstrates that adding e-cigarettes to screening increases reporting and suggests systems level changes are needed to improve tobacco use reporting.

WOMEN PEERS IN THE SCIENTIFIC REALM: SARAH BOWDICH (LEE)'S EXPERT COLLABORATIONS WITH GEORGES CUVIER, 1825-33.

The accepted rule for women contributing to nineteenth-century science before 1851 was that they could play only secondary roles in its production and authorship--as translators, illustrators, popularizers--and these by virtue of kinship or marriage to eminent scientists in the field or the laboratory. Sarah Bowdich (Lee) (1791-1856) presents an important amendment to this rule. As an explorer of West Africa on an equal scientific footing with her husband, and then a writer of science independently after his early death, she had other key roles as Georges Cuvier's cross-Channel scientific collaborator and as his first biographer. This article investigates and reframes Sarah's many individual achievements in science and its writing, to examine the larger questions of her case. How were her publications and 'uneasy career' in science possible? Can research on women in science today find inspiration in her example?

Systematics of Catenulifera (anamorphic Hyaloscyphaceae) with an assessment of the phylogenetic position of Phialophora hyalina.

Catenulifera, typified by C. rhodogena (=Scopulariopsis rhodogena), was established to accommodate the anamorphs of Hyphodiscus (Ascomycota, Helotiales) and to delimit these taxa from members of Phialophora section Catenulatae. Catenulifera rhodogena has been inferred as monophyletic, but its relationship to ascomycetes with poorly differentiated phialidic anamorphs remains enigmatic. To test the hypothesis that C. rhodogena is closely related to morphologically similar species of Phialophora and to further explore the systematics of Catenulifera, we analyzed nuclear rDNA and ß-tubulin gene sequences of isolates identified as C. rhodogena, Hyphodiscus hymeniophilus, P. brachyconia, P. brevicollaris and P. hyalina. ITS-LSU and ITS-LSU-ß-tubulin phylogenies positioned all isolates except P. hyalina in a single, well-supported clade that consisted of three subclades. Subclade 1 included fungicolous isolates of C. rhodogena and H. hymeniophilus that did not fluoresce when exposed to long-wave UV light. Subclade 2 contained fungicolous and lignicolous strains of C. rhodogena that produced fluorescent colonies and possessed a 366bp indel in the LSU rRNA gene. Neither lineage encompassed the ex-type strains of Cistella rubescens (=H. hymeniophilus) or S. rhodogena, but the former isolate was inferred as sister to Subclade 2. Subclade 3 included all isolates of P. brachyconia, a species recognized here as C. brachyconia comb. nov. A fourth isolate of P. brachyconia that was extralimital to Subclade 3 is described as C. luxurians sp. nov. The positions of C. brevicollaris comb. nov., a species based on P. brevicollaris, and C. luxurians were not resolved in the ITS-LSU phylogeny. P. hyalina is not closely related to Catenulifera.