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Recently, there has been discussion to reclassify pediatric Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) as drug-induced epidermal necrolysis (DEN), separating it from infectious etiologies and redefining pediatric mucocutaneous eruptions as either reactive infectious mucocutaneous eruption (RIME) or DEN. In this report, we describe a previously healthy 4-year-old girl with rapidly progressive mucocutaneous blistering involving four mucosal membranes and 37.5% of total body surface area (BSA) following a prodromal rhinovirus and enterovirus infection. The symptoms occurred in the absence of an inciting medication and improved with only supportive care. This case illustrates a rare occurrence of RIME with TEN-like BSA involvement, prompting a review of the literature exploring the relationship between BSA involvement in RIME and its influence on patient outcomes. Findings support the proposed reclassification of SJS/TEN as DEN and postinfectious mucocutaneous eruptions as RIME.

The length of a college president’s tenure is under six years, meaning that boards and institutions are increasingly grappling with the turnover associated with senior leaders. This turnover is seen in all sectors of higher education, especially in community colleges where the changing roles of these institutions are particularly pronounced. The purpose for conducting the study was to describe the professional development practices of community college presidents in hope of identifying efforts that might help to lengthen presidential tenures. Drawing on a national survey of 500 community college presidents, 159 usable responses were received and point toward the reliance on national conferences and self-direction as the primary methods that presidents use to remain current in their roles.

Summary: Although cancer cachexia is classically characterized as a systemic inflammatory disorder, emerging evidence indicates that weight loss also associates with local tissue inflammation. We queried the regulation of this inflammation and its causality to cachexia by exploring skeletal muscle, whose atrophy strongly associates with poor outcomes. Using multiple mouse models and patient samples, we show that cachectic muscle is marked by enhanced innate immunity. Nuclear factor κB (NF-κB) activity in multiple cells, including satellite cells, myofibers, and fibro-adipogenic progenitors, promotes macrophage expansion equally derived from infiltrating monocytes and resident cells. Moreover, NF-κB-activated cells and macrophages undergo crosstalk; NF-κB+ cells recruit macrophages to inhibit regeneration and promote atrophy but, interestingly, also protect myofibers, while macrophages stimulate NF-κB+ cells to sustain an inflammatory feedforward loop. Together, we propose that NF-κB functions in multiple cells in the muscle microenvironment to stimulate macrophages that both promote and protect against muscle wasting in cancer.

BackgroundYouth are arrested at high rates in the United States; however, long-term health effects of arrest remain unmeasured. We sought to describe the sociodemographic characteristics and health of adults who were arrested at various ages among a nationally representative sample.MethodsUsing the National Longitudinal Study of Adolescent to Adult Health, we describe sociodemographics and health status in adolescence (Wave I, ages 12-21) and adulthood (Wave V, ages 32-42) for people first arrested at age younger than 14 years, 14 to 17 years, and 18 to 24 years, compared to never arrested adults. Health measures included physical health (general health, mobility/functional limitations, death), mental health (depressive symptoms, suicidal thoughts), and clinical biomarkers (hypertension, diabetes). We estimate associations between age of first arrest and health using covariate adjusted regressions.ResultsAmong the sample of 10,641 adults, 28.5% had experienced arrest before age 25. Individuals first arrested as children (ie, age

During 2021-2023, UC Davis Human Rights Studies faculty, staff, and students collaborated with Kepler employees and student fellows to empower higher education access for over 2200 university-age refugee young people in Rwanda through the implementation of Article 26 Backpack (“Backpack”). This is a report of that project and includes key observations, findings and recommendations.

Background: Lipoprotein(a) [Lp(a)] is a low-density lipoprotein variant with atherogenic, thrombogenic, and pro-inflammatory properties that may have numerous pathologic effects, including dyslipidemia. Screening for Lp(a) is clinically significant, due to its causal role in atherosclerotic cardiovascular disease (ASCVD). Among clinicians, however, there remains a general lack of both clinical awareness of Lp(a) and adequate tools to track Lp(a) testing in patients. Objective: To study factors affecting Lp(a) screening by: i) determining the effectiveness of messaging providers at a large community health system about Lp(a) screening and measuring the subsequent percentage of Lp(a) tests requested; and ii) by determining the percentage of patients who obtained Lp(a) testing after being advised by the provider. Methods: From December 2022 through March 2023, messages detailing the need for Lp(a) screening were sent via the Epic EHR™ to providers of patients meeting criteria for Lp(a) testing in advance of scheduled patient appointments. In this prospective study, providers were randomized into 2 groups: those receiving the pre-appointment message (Group 1) and those not receiving the pre-appointment message (Group 2). Results: Sending pre-appointment messages correlated with more Lp(a) orders (16.6 % v. 4.7 %, P < 0.001) and consequently with more tests performed (10.2 % v. 3.7 %, p < 0.001). Among provider types, nurse practitioners and physician assistants had the highest number of Lp(a) results per order (Z = 16.40, P < 0.001), achieving 30.8–39.1 % more test results, even if they did not receive the pre-appointment message. Distribution of Lp(a) values in patients was 59.7 % ≤ 29 mg/dL; 9.7 % > 29 and < 50mg/dL; and 30.6 % ≥ 50 mg/dL. Conclusion: Providers who received pre-appointment messages via an EHR were associated with requesting more tests and consequently receiving more Lp(a) results, compared with providers who did not receive messages.

Background:. Although recent studies demonstrated resident satisfaction in the treatment of skin of color (SOC) related disease, comfort levels treating hair specific to populations within the SOC spectrum is unclear. Objective:. The purpose of this study is to assess dermatology residents comfort level in recognizing and treating various common hair conditions with a focus on those specific to SOC. Methods:. An Institutional Review Board-approved survey was distributed to United States residents of Accreditation Council for Graduate Medical Education-accredited dermatology programs. Data pertaining to hair care knowledge and treatment comfort levels were collected. Analysis was completed using equal variance 2-sample t tests and analysis of variance F tests, P < .05. Results:. Dermatology residents were relatively comfortable with common conditions such as androgenetic alopecia and alopecia areata, but uncomfortable with creating healthy hair regimens, discussing natural hair care products, and treating trichorrhexis nodosa. Resident self-identification as underrepresented in medicine significantly impacted resident knowledge of hair care and treatment in patients with SOC. Limitations:. This study was limited due to small sample size and potential recall bias. Conclusion:. This study highlights knowledge gaps in understanding hair-related care for patients with SOC, affirming the continued importance of diversifying dermatology programs as well as hair-specific training for residents.

The inefficiency of transporting goods contributes to reduced economic growth and environmental sustainability in a country. Autonomous trucks (ATs) are emerging as a solution, but the imbalance in the weight moved and ton-miles produced by long-haul and short-haul trucking creates a challenge in targeting initial deployments. This study offers a unique solution by presenting a robust method that combines data mining and geographic information systems (GISs) to identify the optimal routes for ATs based on a top-down approach to maximize business benefits. Demonstrated in a U.S. case study, this method revealed that despite accounting for only 16% of the weight moved, long-haul trucking produced 56% of the ton-miles, implying a high potential for ATs in this segment. The method identified eight key freight zones in five U.S. states that accounted for 27% of the long-haul weight and suggested optimal routes for initial AT deployment. Interstate 45 emerged as a pivotal route in the shortest paths among these freight zones. This suggests that stakeholders should seek to prioritize funding for infrastructure upgrades and maintenance along that route and the other routes identified. The findings will potentially benefit a broad range of stakeholders. Companies can strategically focus resources to achieve maximum market share, regulators can streamline policymaking to facilitate AT adoption while ensuring public safety, and transportation agencies can better plan infrastructure upgrades and maintenance. Users globally can apply the methodological framework as a reliable tool for decision-making about where to initially deploy ATs.

The successful deployment of Advanced Air Mobility (AAM) requires the safe integration of electric vertical takeoff and landing (eVTOL) aircraft in non-segregated airspace. However, a lack of practical deployment demonstrations can slow the regulatory progress. This study presents a practical deployment framework for the integration of eVTOL aircraft into public airspace, in accordance with the Federal Aviation Administration (FAA) special airworthiness criteria. This study focused on a corporate use case to provide a comprehensive scenario for enhancing intra-company mobility. The scenario supports early implementation and demonstration goals by removing reliance on air traffic management systems or air traffic controller separation services. The practical deployment framework included facility selection, route planning, terrain mapping, collision avoidance, aircraft selection, infrastructure requirements, vertiport placement, electric chargers, ground handling, operational staff, and cost estimates. Planners can use the framework as a template to inform the implementation of real-world AAM services using eVTOL aircraft.

Using Uncrewed Aerial Vehicles (UAVs) to monitor the condition of nodal transportation assets—airports, seaports, heliports, vertiports, and cargo terminals—presents a transformative approach to traditional inspection methods. The focus on nodal assets rather than linear assets like roads, railways, bridges, and waterways fills a gap in addressing the dynamic challenges specific to transportation hubs. This study reviews scholarly literature on applying UAV-based remote sensing (URS) techniques to assess the condition of various transportation hubs, which are critical junctures in global logistics networks. Utilizing a systematic literature review framework, this study reviewed 486 publications from 2015 to 2023 to extract insights from the evolving discourse on URS applications. The findings suggest that these emerging methods resulted in substantial enhancements in time saving, cost efficiency, safety, and reliability. Specifically, this study presents evidence on how URS approaches can overcome the constraints of conventional inspection methods by enabling rapid, high-precision mapping and surveillance in complex and constrained environments. The findings highlight the role of UAVs in enhancing operational workflows and decision making in transportation planning and maintenance. By bridging the gap between traditional practices and innovative technology, this research offers significant implications for stakeholders in the field, advocating for a shift towards more dynamic, cost-effective, and precise asset management strategies.

Background: There is significant variability in how residency programs prepare the primary care workforce in behavioral health competencies. One approach that warrants further exploration is to have integrated behavioral health consultants (BHCs) capitalize on in vivo clinical teaching opportunities in the context of teambased care. This article presents preliminary results from the implementation of a pilot program wherein BHCs use warm handoffs and other clinical interactions to provide brief, targeted education to medical residents. Method: Twelve BHCs from five resident training clinics participated in a 1-hr training on 'microteaching' skills that could be used in clinical teaching interactions. BHCs were asked to track instances of microteaching using an Excel spreadsheet. After 3 months, BHCs and residents responded to electronic surveys that assessed the acceptability and feasibility of this process. Results: In 3 months, BHCs provided 269 instances of microteaching with 66 residents (66.7%) across five clinics. These microteachings occurred within the context of various interactions, including warm handoffs (n = 138, 51.3%), curbside consultations (n = 78, 29.0%), debriefs (n = 46, 17.1%), and team huddles (n = 7, 2.6%). Roughly half (n = 149, 55.4%) of these encounters involved Level 1 microteaching (i.e., lasting 2 min or less), while half (n = 120, 44.6%) involved Level 2 (i.e., lasting 3-10 min). BHCs and residents rated the microteaching interactions as acceptable and feasible. Discussion: Leveraging embedded BHCs as clinical educators in integrated care environments may hold value for increasing behavioral health competencies among medical residents. Keywords: primary care behavioral health, clinical teaching, resident education, integrated care, The Accreditation Council for Graduate Medical Education (ACGME) requires medical residents to learn key behavioral health competencies, including demonstrating 'knowledge of established and evolving social-behavioral sciences' and the ability to [...]

The nation is facing a pediatric mental health crisis that is years in the making. The pandemic potentiated the crisis by isolating youth and compounding family stressors. In response, the US Surgeon General issued an advisory in late 2021 recommending actions that health care and other sectors should take to improve youth well-being. Integrated care has a critical role to play in both implementing and moving beyond the Surgeon General's recommendations. The Collaborative Family Healthcare Association's Pediatric Special Interest Group (SIG) meets monthly to provide support and learning experiences and to promote dissemination of innovations to address the pediatric mental health crisis. In this article, we share recommendations, informed by the conversations in the CHFA Pediatric SIG, to propel the Surgeon General's advice into actions. We prioritize and emphasize structural changes that are needed in the health care system and highlight practical and actionable steps individual providers can take to increase cross sector collaboration. Keywords: pediatrics, behavioral health, integrated care, Our youth are in crisis, and it started long before the COVID-19 pandemic. As leaders within the Pediatrics Special Interest group in the nation's leading integrated care organization (Collaborative Family [...]

Diversifying the STEM workforce is a national concern. To address this concern, researchers, policymakers, and educators are working to increase STEM career interest and achievement in a more diverse population of learners. Black girls and young women represent a unique population of STEM learners that remain relatively untapped and largely under researched in current STEM education scholarship. Therefore, this study focuses on the relationship between the science dispositions of Black girls and advanced science course enrollment. The present study utilized a sample of Black female students (N = 1,810) that participated in the High School Longitudinal Study of 2009/2012 (HSLS:09/12). To examine whether science dispositions are predictive of general enrollment in advanced science courses a canonical correlation analysis (CCA) was performed. The observed relationship between science dispositions and participation in advanced science of r = 0.389 and explains 15.13% of the variance. The majority of the predictive information for the science disposition construct was observed in science identity. Therefore, the development of science identity in Black girls should be the focus of educators and parents seeking to increase Black girls' participation in advanced science courses. Implications are provided for parents and educational stakeholders of Black girls.

The proliferation of autonomous trucking demands a sophisticated understanding of the risks associated with the diverse U.S. interstate system. Traditional risk assessment models, while beneficial, do not adequately address the state and regional variations in factors that significantly impact the safety and efficiency of autonomous freight transport. This study addresses the problem by developing a composite risk index that evaluates the safety of U.S. interstate routes for autonomous trucking, considering both state and regional differences in traffic volumes, road conditions, safety records, and weather patterns. The potential for autonomous trucking to transform the freight industry necessitates a risk assessment model that is as dynamic and multifaceted as the system it aims to navigate. This work contributes a regionally sensitive risk index using GIS methodologies, integrating data from national databases, and applying statistical analysis to normalize risk factors. The findings reveal significant state and regional disparities in risk factors, such as the predominance of precipitation-related risks in the Southeast and traffic in the Far West. This work provides a targeted approach to risk assessment for policymakers and infrastructure planners and offers a strategic tool for logistics companies in optimizing autonomous trucking routes. The long-term benefit is a scalable model that can adapt to evolving data inputs and contribute to the broader application of risk assessment strategies in various domains.

The emergence of autonomous vehicles (AVs) presents a transformative shift in transportation, promising enhanced safety and economic efficiency. However, a fragmented legislative landscape across the United States hampers AV deployment. This fragmentation creates significant challenges for AV manufacturers and stakeholders. This research contributes by employing advanced machine learning (ML) techniques to analyze state data, aiming to identify factors associated with the likelihood of passing AV-friendly legislation, particularly regarding the requirement for human backup drivers. The findings reveal a nuanced interplay of socio-economic, political, demographic, and safety-related factors influencing the nature of AV legislation. Key variables such as democratic electoral college votes per capita, port tons per capita, population density, road fatalities per capita, and transit agency needs significantly impact legislative outcomes. These insights suggest that a combination of political, economic, and safety considerations shape AV legislation, transcending traditional partisan divides. These findings offer a strategic perspective for developing a harmonized regulatory approach, potentially at the federal level, to foster a conducive environment for AV development and deployment.