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A suboptimal response to the 2-dose COVID-19 vaccine series in the immunocompromised population prompted recommendations for a 3rd primary dose. We aimed to determine the humoral and cellular immune response to the 3rd COVID-19 vaccine in immunocompromised children.Prospective cohort study of immunocompromised participants, 5-21 years old, who received 2 prior doses of an mRNA COVID-19 vaccine. Humoral and CD4/CD8 T-cell responses were measured to SARS-CoV-2 spike antigens prior to receiving the 3rd vaccine dose and 3-4 weeks after the 3rd dose was given.Of the 37 participants, approximately half were solid organ transplant recipients. The majority (86.5%) had a detectable humoral response after the 2nd and 3rd vaccine doses, with a significant increase in antibody levels after the 3rd dose. Positive T-cell responses increased from being present in 86.5% to 100% of the cohort after the 3rd dose.Most immunocompromised children mount a humoral and cellular immune response to the 2-dose COVID-19 vaccine series, which is significantly augmented after receiving the 3rd vaccine dose. This supports the utility of the 3rd vaccine dose and the rationale for ongoing emphasis for vaccination against COVID-19 in this population.Most immunocompromised children mount a humoral and cellular immune response to the 2-dose COVID-19 vaccine series, which is significantly augmented after receiving the 3rd vaccine dose. This is the first prospective cohort study to analyze both the humoral and T-cell immune response to the 3rd COVID-19 primary vaccine dose in children who are immunocompromised. The results of this study support the utility of the 3rd vaccine dose and the rationale for ongoing emphasis for vaccination against COVID-19 in the immunosuppressed pediatric population.

Date Presented 04/02/2022 Focal task-specific dystonia is a fine motor disorder that affects professional musicians, for whom this diagnosis is often career ending. This study explored musicians’ perceptions of the lived experience of focal task-specific dystonia. The findings of this study suggest client-centered and collaborative approaches to care, highlighting the importance of addressing emotional factors related to chronic conditions and occupational transition and the need for improved approaches to evaluation. Primary Author and Speaker: Jill Olson Moser Contributing Authors: Julie Bass

To evaluate whether Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric patient-reported outcome (PRO) measures can serve as valid endpoints in a clinical trial of a chronic pediatric illness.We evaluated the responsiveness of PROMIS pediatric measures collected through the Clinical Outcomes of Methotrexate Binary Therapy in Practice (COMBINE) trial, a multicenter, randomized, double-blind, placebo-controlled, pragmatic clinical trial in pediatric patients with Crohn's disease (CD). We examined the relationships between changes in PROMIS pediatric measures and changes in disease activity by evaluating PRO score changes among patients who did and patients who did not experience improvement in disease activity.Participants included 266 children and adolescents with CD from a total of 35 institutions. Over the course of follow-up, participants showed improvement in most PRO domains, with the largest effect sizes observed for the clinically improved group. Patients who maintained steroid-free remission showed significantly lower PRO scores for the Pain Interference, Fatigue, and inflammatory bowel disease (IBD) Symptoms domains and higher scores for the Positive Affect domain.This study demonstrates the responsiveness of the PROMIS pediatric measures of Fatigue and Pain Interference as study endpoints in a large, multicenter pragmatic trial in pediatric CD, extending a growing body of research supporting the use of PROMIS pediatric measures as reliable PRO endpoints for clinical trials.

Dermal fillers have become increasingly popular as a cosmetic treatment for facial rejuvenation. Although these injections are generally considered to be safe, as the number of injections has increased, so has the rate of complications. Ischemic complications of fillers is critical and include vision loss, ophthalmoplegia, skin necrosis, and cerebral infarction. Knowing the anatomy well to optimally prevent and manage these serious complications. Prevention includes knowledge of the vascular anatomy of the facial area, as well as certain injection techniques such as aspiration, use of a smaller needle, and adoption of a larger cannula. The use of ultrasound has been a recent innovation in preventing and treating filler complications as well. The reversibility of fillers should also be considered when choosing a filler. Some hyaluronic acid (HA) fillers, including the newer ones on the market, are difficult to reverse and non-HA fillers and fat are irreversible. This review aims to discuss facial anatomy, the various ischemic filler complications, the prevention and management of these complications, and the relatively recent use of imaging as an adjunct.

Knowledge of variable anatomy is key for excellent outcomes from the administration of botulinum toxin for aesthetic purposes. One must understand the location and function of each facial muscle to predict the patient's desired outcome. One concept often overlooked by injectors is the understanding of the target muscle's depth. In addition, a firm understanding of where each facial muscle originates and attaches can be essential to correctly identifying and injecting the correct muscle with botulinum toxin. Facial muscles often overlap each other and cross various planes. For example, an injector may be unaware that the corrugator supercilii muscle lies in different depths medially and laterally. Novice injectors may miss the variability of this muscle and inject the lower frontalis muscle by mistake. This may lead to a heavy brow look, or it could drop the area between the brows, creating an appearance of anger. This article explores a three-dimensional anatomical approach to achieve excellent outcomes, rather than the two-dimensional approach traditionally discussed. Many of the injection techniques defined in this article are considered off-label by the Food and Drug Administration at the time of this publication but are commonly discussed in peer-reviewed literature and consensus opinion reports. Twelve facial muscles often injected for positive aesthetic outcomes will be outlined as well as seven facial muscles to generally avoid.

Background and Aims Inflammatory bowel disease (IBD) is a chronic inflammatory condition requiring treatment with lifelong immunosuppressive treatment. Up to 30% of the patients do not respond to standard medical therapy. There is limited data on the use of combining two biological agents in medically refractory patients. Our aims were to review patients who received two biological agents concurrently for at least 4 weeks or longer to assess for safety and efficacy of this approach. Methods We performed a retrospective study on patients (1–22 years old) being treated at Children’s Mercy Kansas City for IBD who were placed on a combination of two biological agents concurrently for medically refractory disease. Charts of eligible patients were reviewed to abstract demographics, Paris classification, extraintestinal manifestations, concomitant morbidities, drug therapy, surgeries, disease activity scores, outcomes and adverse events related to therapy. Results Nine patients with a median age of 16 (8–19 years) were found to be eligible. Eight were Caucasians and one was of African American origin. Eight patients were diagnosed with Crohn’s disease (CD), and one was thought to have ulcerative colitis (UC) but later found to have CD. Two had celiac disease, 2/9 had growth failure, one each had arthritis and sacroiliitis. Two had ileo-anal pouch and one patient had recurrent macrophage activating syndrome. Indications included partially responsive luminal disease(7), pouchitis (2), perianal fistulizing disease (2), sacroiliitis (1). Five patients were also on an immunomodulator at the time of combination therapy. Only one patient received Anakinra with infliximab whereas rest were on combination of either infliximab or adalimumab with vedolizumab. Four patients achieved remission, two were unresponsive, one had improvement in growth only and two had partial response. One patient developed staphylococcal skin infection but there was no other therapy related adverse events. Conclusions Combination of two biological agents is safe. Further studies are needed to determine the utility of this approach.

Aesthetic practitioners prefer various reconstitution volumes for botulinum toxins (BoNTAs). Some injectors prefer larger volumes of bacteriostatic normal saline (NaCl) to achieve a larger diffusion in certain areas and a smaller volume for more precise administration of the BoNTA. Some practitioners believe dilution volumes do not matter at all in relation to spread or diffusion, asserting the diffusion area is simply dose-related. It can get confusing when there is more than one injector in an office, different volumes of saline, and more than one type of syringe to administer the neurotoxin. This leaves possibilities for confusion and dosage errors. This article explores four steps to take the confusion out of reconstituting BoNTAs and delivering accurate and consistent doses within a medical office.

The concept of aesthetic self-esteem was explored for utilization in the medical spa environment. The aims and purposes of the analysis were outlined. The literature review identified various uses of the self-esteem concept as well as published definitions of the word. Defining attributes were also explored and examined, including positive and negative connotations of self-esteem. Two tools were utilized to help aesthetic nurse specialists assess patients for self-esteem and assess for a possible mental illness that may present as low self-esteem. A culturally sensitive theoretical definition of self-esteem was constructed to fit the needs and environment of medical spas. A model case of this definition, as well as a borderline and contrary case, was presented. Antecedents and consequences, as well as empirical referents of the concept, were explored.

This article reviews the models and theories of motor behavior that are the foundation for the traditional approaches to central nervous system (CNS) dysfunction and presents a new theoretical model and approach that are beginning to influence practice. Reflex, hierarchical, and systems models of motor control and developmental and motor learning theories are discussed. The relationships of these models and theories to past, present, and future treatment approaches to CNS dysfunction are explored. The assumptions and limitations of the muscle reeducation, neurodevelopmental, and motor relearning approaches are discussed. A contemporary task-oriented approach based on the systems model is proposed and contrasted with traditional neurodevelopmental approaches.

Julie Bass is director of strategy and HR at Groupama Insurances. She joined the organization in 1982 and her roles have included personnel and training manager, HR manager for Asia‐Pacific and associate director responsible for strategic planning and change management