Digital Commons Network^™

Racial And Ethnic Disparities In Antifibrotic Therapy In Idiopathic Pulmonary Fibrosis, Joy Zhao, Joseph Fares, Gautam George, Arlene Maheu, Giorgos Loizidis, Jesse Roman, Daniel Kramer, Michael Li, Ross Summer

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

BACKGROUND AND OBJECTIVE: Racial disparities have been documented in care of many respiratory diseases but little is known about the impact of race on the treatment of interstitial lung diseases. The purpose of this study was to determine how race and ethnicity influence treatment of idiopathic pulmonary fibrosis.

METHODS: Adults with idiopathic pulmonary fibrosis (>18 years) were identified using TriNetX database and paired-wised comparisons were performed for antifibrotic treatment among White, Black, Hispanic and Asian patients. Mortality of treated and untreated IPF patients was compared after propensity score matching for age, sex, nicotine dependence, oxygen dependence and predicted FVC. …

Transmission Of Yellow Fever Vaccine Virus Through Blood Transfusion And Organ Transplantation In The Usa In 2021: Report Of An Investigation, Carolyn V. Gould, Rebecca J. Free, Julu Bhatnagar, Raymond A. Soto, Tricia L. Royer, Warren R. Maley, Sean Moss, Matthew A. Berk, Rebecca Craig-Shapiro, Rosy Priya L. Kodiyanplakkal, Lars F. Westblade, Thangamani Muthukumar, Yoram A. Puius, Amresh Raina, Azam Hadi, Kymberly A. Gyure, Danielle Trief, Marcus Pereira, Matthew J. Kuehnert, Vennus Ballen, Debra A. Kessler, Kimberly Dailey, Charles Omura, Thuy Doan, Steve Miller, Michael R. Wilson, Jennifer A. Lehman, Jana M. Ritter, Elizabeth Lee, Luciana Silva-Flannery, Sarah Reagan-Steiner, Jason O. Velez, Janeen J. Laven, Kelly A. Fitzpatrick, Amanda Panella, Emily H. Davis, Holly R. Hughes, Aaron C. Brault, Kirsten St George, Amy B. Dean, Joel Ackelsberg, Sridhar V. Basavaraju, Charles Y. Chiu, J. Erin Staples

Department of Medicine Faculty Papers

BACKGROUND: In 2021, four patients who had received solid organ transplants in the USA developed encephalitis beginning 2-6 weeks after transplantation from a common organ donor. We describe an investigation into the cause of encephalitis in these patients.

METHODS: From Nov 7, 2021, to Feb 24, 2022, we conducted a public health investigation involving 15 agencies and medical centres in the USA. We tested various specimens (blood, cerebrospinal fluid, intraocular fluid, serum, and tissues) from the organ donor and recipients by serology, RT-PCR, immunohistochemistry, metagenomic next-generation sequencing, and host gene expression, and conducted a traceback of blood transfusions received by …

A Phenomenological Inquiry Into Healthcare Professionals Who Are Experts In Cannabinoid Therapy And The Endocannabinoid System (Ecs), Courtney Collins

Electronic Theses and Dissertations

Cannabis is a prevalent alternative treatment for many symptoms and conditions given its medicinal qualities and few side effects. As legalization for both medical and recreational purposes continue to develop quickly across the United States of America, there is serious discrepancy between legalization and clinical research. Clinical data is difficult since the U.S. federal government still classifies cannabis as a Drug Enforcement Agency (DEA) Schedule I drug with no clearly established medical value. This lag in evidence-base data has affected cannabinoid therapy and endocannabinoid system education (ECS) for healthcare professionals. There are gaps in medical school and continuing medical education …

Rural-Urban Differences In The Age-Adjusted Pediatric Cancer Mortality In The United States (2000-2020), Reitumetse A. Setai

Capstone Experience: Master of Public Health

In the United States (U.S.), 5-year survival for pediatric cancers improved from 58% in 1975 to 85% in 2017. However, pediatric cancer remains the second leading cause of death in children between 0 – 14 years. Despite the growing body of pediatric cancer research, there is limited knowledge of the urban and rural disparities of pediatric cancer mortality. This study examined: 1) the differences in the U.S. pediatric cancer mortality rates between rural and urban residents during 2016-2020 by demographic characteristics (age group, sex, race/ethnicity, and income) and cancer types and 2) the trend of pediatric cancer mortality in the …

Gender Bias In Cultural Tightness Across The 50 U.S. States And Its Links To Gender Inequality In Leadership And Innovation, Xin Qin, Roy Y. J. Chua, Ling Tan, Wanlu Li, Chen Chen

Research Collection Lee Kong Chian School Of Business

Cultural tightness theory, which holds that “tight” cultures have rigid norms and sanctions, provides unique insights into cultural variations. However, current theorizing has not analyzed gender differences in cultural tightness. Addressing this gap, this research shows that women are more constrained than men by norms within the same society. By recruiting 15,425 respondents, we mapped state-level gender bias in cultural tightness across the United States. Variability in gender bias in cultural tightness was associated with state-level socio-political factors (religion and political ideology) and gender-related threats. Gender bias in cultural tightness was positively associated with state-level gender inequality in (business and …

Graft-Versus-Host Disease: Teaching Old Drugs New Tricks At Less Cost, Shatha Farhan, Shernan G. Holtan

Hematology/Oncology Articles

Graft-versus-host disease (GVHD) remains a major cause of morbidity and mortality after allogeneic stem cell transplantation (SCT). Currently, more patients can receive SCT. This is attributed to the use of reduced intensity regimens and the use of different GVHD prophylaxis that breaks the barrier of human leukocyte antigen, allowing an increase in the donor pool. Once an area with relatively few clinical trial options, there has been an increase in interest in GVHD prophylaxis and treatment, which has led to many US Food and Drug Administration (FDA) approvals. Although there is considerable excitement over novel therapies, many patients may not …

Spanish-Speaking Limited English-Proficient Patient Satisfaction And Comfort When Comparing Spanish-Speaking Provider To An Interpreter, Cindy Hernandez

Dissertations and Theses (Open Access)

A large population of Americans have limited or no English proficiency (LEP) with about 64% of those being Spanish-speaking. This creates challenges in navigating the American healthcare system, where the majority of providers are solely English-speaking. Studies have demonstrated that when patients have language discordant appointments without interpreters, they are more likely to feel less understood, have questions and comments ignored, and are less likely to receive patient-centered care in communication. It is expected that interpreters improve access to healthcare, especially for Spanish-speaking patients. However, the patient comfort and satisfaction in language discordant genetic counseling appointments has not yet been …

Demise Of The Usmle Step-2 Cs Exam: Rationalizing A Way Forward, Robert M Milman, Sharon Obadia, Amy L Waer, Patricia K Watson

Faculty, Staff and Students Publications

The COVID-19 pandemic has compelled rethinking and changes in medical education, the most controversial perhaps being the cancelation of USMLE Step-2 Clinical Skills exam (Step-2 CS). What started in March of 2020 as suspension of this professional licensure exam, because of concerns about infection risk for examinees, standardized patients (SPs), and administrators, soon became permanent cancelation in January 2021. Expectedly, it triggered debate in medical education circles. Positively, however, the USMLE regulatory agencies (NBME and FSMB) saw an opportunity to innovate an exam tainted with perceptions of validity deficits, cost, examinee inconvenience, and worries about future pandemics; they therefore called …

Prevention Of Hepatocellular Carcinoma (Hcc) White Paper Of The Texas Collaborative Center For Hepatocellular Cancer (Tech) Multi-Stakeholder Conference, Amit G Singal, Nicole Rich, Aaron P Thrift, Salil Deshpande, Barbara J Turner, Ahmed O Kaseb, Ariel C Harrison, Brett E Fortune, Fasiha Kanwal

Faculty, Staff and Students Publications

BACKGROUND & AIMS: Texas has the highest age-adjusted incidence rate of hepatocellular carcinoma (HCC) in the United States. The Cancer Prevention and Research Institute of Texas has funded the Texas Collaborative Center for Hepatocellular Cancer (TeCH) to facilitate HCC research, education, and advocacy activities with the overall goal of reducing HCC mortality in Texas through coordination, collaboration, and advocacy.

METHODS: On September 17, 2022, TeCH co-sponsored a multi-stakeholder conference on HCC with the Baker Institute Center for Health and Biosciences. This conference was attended by HCC researchers, policy makers, payers, members from pharmaceutical industry and patient advocacy groups in and …

Association For Academic Surgery/Society Of University Surgeons Research Awards Are Highly Successful In Fostering Future Surgeon-Scientists, Jessica L Mueller, Allan M Goldstein, Sundeep G Keswani, Lily S Cheng

Faculty, Staff and Students Publications

BACKGROUND: The surgeon-scientist brings a unique perspective to surgical research. The Association of Academic Surgeons and Society of University Surgeons foster the development of surgeon-scientists through foundation awards to residents and junior faculty. We sought to evaluate the academic success of surgeons who received an Association for Academic Surgery/Society of University Surgeons award.

METHODS: Information was collected for individuals who received a resident or junior faculty research award from the Association for Academic Surgery or Society of University Surgeons. Google Scholar, Scopus, and the National Institutes of Health Research Portfolio Online Reporting Tools: Expenditures and Results were used to assess …

Transplanting Hepatitis B Surface Antigen-Positive Livers In The United States: Outcomes And Opportunities, Cameron Goff, Anjiya Shaikh, Donghee Kim, Aijaz Ahmed, Carl Berg, Susanna Naggie, Fasiha Kanwal, George Cholankeril, Tzu-Hao Lee

Faculty, Staff and Students Publications

Livers from donors with positive hepatitis B surface antigens (HBsAg+) have been used to expand the donor pool; however, outcome data are limited. We aim to evaluate survival following liver transplant (LT) from HBsAg+ donors. Using the United Network for Organ Sharing registry, we identified HBsAg+ donors used for LT from 2009 to 2020. We used Kaplan-Meier survival and Cox proportional hazards regression to compare post-LT survival in hepatitis B virus-negative recipients who utilized HBsAg+ donors to propensity-matched cohorts who utilized other types of donors. From 2009-2020, 70 patients received HBsAg+ livers, and 58 of them did not carry a …

An Updated Report On The Prevalence Of Prior Cancer Among Persons Newly Diagnosed With Cancer In The Surveillance, Epidemiology, And End Results Program

Faculty, Staff and Student Publications

This cohort study uses population-based data from the National Cancer Institute Surveillance, Epidemiology, and End Results program of cancer registries to estimate prevalence of prior cancer among adults diagnosed with an incident cancer in 2019.

2022 American College Of Rheumatology Guideline For Exercise, Rehabilitation, Diet, And Additional Integrative Interventions For Rheumatoid Arthritis, Bryant R England, Benjamin J Smith, Nancy A Baker, Jennifer L Barton, Carol A Oatis, Gordon Guyatt, Allen Anandarajah, Kristine Carandang, Karmela Kim Chan, Deb Constien, Eileen Davidson, Carole V Dodge, Anita Bemis-Dougherty, Sotiria Everett, Nadine Fisher, Liana Fraenkel, Susan M Goodman, Janet Lewis, Victoria Menzies, Larry W Moreland, Iris Navarro-Millan, Sarah Patterson, Lawrence Rick Phillips, Neha Shah, Namrata Singh, Daniel White, Rawan Alheresh, Kamil E Barbour, Thomas Bye, Dana Guglielmo, Rebecca Haberman, Tate Johnson, Anatole Kleiner, Chris Y Lane, Linda C Li, Hiral Master, Daniel Pinto, Janet L Poole, Kimberly Steinbarger, Daniel Sztubinski, Louise Thoma, Vlad Tsaltskan, Marat Turgunbaev, Courtney Wells, Amy S Turner, Jonathan R Treadwell

Pediatrics Research and Scholarship

OBJECTIVE: To develop initial American College of Rheumatology (ACR) guidelines on the use of exercise, rehabilitation, diet, and additional interventions in conjunction with disease-modifying antirheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis (RA).

METHODS: An interprofessional guideline development group constructed clinically relevant Population, Intervention, Comparator, and Outcome (PICO) questions. A literature review team then completed a systematic literature review and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n = 20 participants) that included 3 individuals with RA achieved consensus …

Mpla Case: I Didn't Realize Those Were The Expectations!, Samantha J Simiele, Serdar Charyyev, Liyong Lin, Leonard Kim, Dongxu Wang

Faculty, Staff and Student Publications

This work of fiction is part of a case study series developed by the Medical Physics Leadership Academy (MPLA). It is intended to facilitate the discussion of how students and advisors can better communicate expectations and navigate difficult conversations. In this case, a fourth-year Ph.D. student Emma learns that her advisor Dr. So is leaving the institution and has not arranged to bring any students with him. As Emma and Dr. So meet to discuss Emma's next steps, the conversation reveals misunderstandings and miscommunications of expectations, including a specific publication requirement for graduation from Dr. So. Having just learned of …

Postoperative Respiratory Complications In Sars-Cov-2 Positive Pediatric Patients Across 20 United States Hospitals: A Cohort Study, Madelyn Hill, Kristen Born, Shale Mack, Abdulraouf Lamoshi, Aaron M Lipskar, Xiao-Yue Han, Elizabeth Fialkowski, Brianna Spencer, Afif N Kulaylat, Amrene Barde, Ami N Shah, Maeva Adoumie, Erica Gross, Steven C Mehl, Monica E Lopez, Valerie Polcz, Moiz M Mustafa, Jeffrey W Gander, Travis M Sullivan, Jason P Sulkowski, Owais Ghani, Eunice Y Huang, David Rothstein, E Peter Muenks, Shawn D St Peter, Jason C Fisher, Dina Levy-Lambert, Allison Reichl, Romeo C Ignacio, Bethany J Slater, Kuojen Tsao, Loren Berman

Faculty, Staff and Student Publications

INTRODUCTION: Data examining rates of postoperative complications among SARS-CoV-2 positive children are limited. The purpose of this study was to evaluate the impact of symptomatic and asymptomatic SARS-CoV-2 positive status on postoperative respiratory outcomes for children.

METHODS: This retrospective cohort study included SARS-CoV-2 positive pediatric patients across 20 hospitals who underwent general anesthesia from March to October 2020. The primary outcome was frequency of postoperative respiratory complications, including: high-flow nasal cannula/non invasive ventilation, reintubation, pneumonia, Extracorporeal Membrane Oxygenation (ECMO), and 30-day respiratory-related readmissions or emergency department (ED) visits. Univariate analyses were used to evaluate associations between patient and procedure characteristics …

Outcomes Of Induction Vs Prelabor Cesarean Delivery At <33 Weeks For Hypertensive Disorders Of Pregnancy, Ronald J Wapner, Mona Prasad, George R Saade, Yoram Sorokin, Dwight J Rouse, Sean C Blackwell, Jorge E Tolosa

Faculty, Staff and Student Publications

BACKGROUND: Hypertensive disorders of pregnancy are the leading cause of indicated preterm birth; however, the optimal delivery approach for pregnancies complicated by preterm hypertensive disorders of pregnancy remains uncertain.

OBJECTIVE: This study aimed to compare maternal and neonatal morbidity in patients with hypertensive disorders of pregnancy who either went induction of labor or prelabor cesarean delivery at <33 >weeks' gestation. In addition, we aimed to quantify the length of induction of labor and rate of vaginal delivery in those who underwent induction of labor.

STUDY DESIGN: This is a secondary analysis of an observational study which included 115,502 patients in 25 …

Altering United States Drug Policy And Shifting The Focus Of Drug Use From Conviction Toward Drug Addiction Treatment, Natalie Marra

Honors Projects

While these substances were not always controlled by law, drug use has been as issue throughout time going back thousands of years and continues to be a concern in the twenty-first century. Possession, distribution, and manufacturing of controlled substances outside of what is considered legal can lead to fines and or jail time and can also increases the severity of other crimes committed either due to or under the influence of drugs. As of Saturday June 10th, 2023, 44.5% of Federal inmates are incarcerated for drug offenses, including possession, distribution, and manufacturing1. Drug offenses make up the largest percentage of …

Ucg Pilot Tests In The United States And Their Contributions To Modern Ucg Technologies, Huang Wan, Wang Jun, Wang Lingxia, Yi Tongsheng, Chen Kexin, Qin Yong

Coal Geology & Exploration

The industrialization of underground coal gasification (UCG), which is conducive to the transformation and development of the coal energy structure and the improvement in the low-carbon utilization level of coal resources, is an environmentally friendly energy development technology in line with the sustainable development strategy. The international energy crisis from the 1980s to the 1990s prompted the United States to vigorously develop UCG technologies. Accordingly, this country has successively carried out six series of UCG pilot tests, which contribute greatly to the progress in UCG technologies and provided the critical foundation for the formation of modern UCG technologies worldwide. This …

Charles Schwab Survived The Recent Banking Crisis. What Comes Next?, Justin Baer

Documents

No abstract provided.

Psychosocial Impacts Of The Covid-19 Pandemic On Women With Spinal Cord Injury, Susan Robinson-Whelen

Faculty, Staff and Student Publications

This study represents the first known research addressing the impact of the COVID-19 pandemic on women with spinal cord injury (SCI) in the United States. Women in this population face unique barriers that put them at elevated risk for compromised quality of life, risk that was magnified by physical and social restrictions imposed during the pandemic. This qualitative study examined the perceptions of women with SCI and the effect of the pandemic on their lives. The predominantly White and relatively well-educated sample of 105 women with traumatic SCI was diverse in age, injury characteristics, and geographic representation. Recruited across the …

Temporal Trends And Geographic Variations In Mortality Rates From Tobacco And Firearms In The United States, Charles H Hennekens

Faculty, Staff and Students Publications

We explored temporal trends and geographic variations in United States of America (US) mortality rates from smoking and firearms from 1999 to 2019. To do so, we used the publicly available Centers for Disease Control and Prevention (CDC) Wide Ranging Online Data for Epidemiologic Research (WONDER) with Multiple Cause of Death files from 1999 to 2019. Using age-specific rates and ArcGIS Pro Advanced software for Optimized Hot Spot Analyses from Esri, we generated maps of statistically significant spatial clusters with 90-99% confidence intervals with the Getis-Ord Gi* statistic for mortality from smoking-related causes and firearms. These data show temporal trends …

Development Of A Covid-19 Vulnerability Index (Cvi) For The Counties And Residents Of New Jersey, Usa., Remo Disalvatore, Sarah K Bauer, Jeong Eun Ahn, Kauser Jahan

Henry M. Rowan College of Engineering Departmental Research

The coronavirus disease 2019, or COVID-19, has impacted countless aspects of everyday life since it was declared a global pandemic by the World Health Organization in March of 2020. From societal to economic impacts, COVID-19 and its variants will leave a lasting impact on our society and the world. During the height of the pandemic, it became increasingly evident that indices, such as the Center for Disease Control's (CDC) Social Vulnerability Index (SVI), were instrumental in predicting vulnerabilities within a community. The CDC's SVI provides important estimates on which communities will be more susceptible to 'hazard events' by compiling a …

Droughtscape, Summer 2023, National Drought Mitigation Center

DroughtScape: Quarterly Newsletter of the National Drought Mitigation Center (2007–2023)

DroughtScape, Summer 2023

Extreme Persuasion: Analyzing Meaning Creation And Persuasive Strategies Within Extreme Discourse On Alternative Social Media, Naomi Kathryn Lawrence

Theses and Dissertations

Despite a long history of counterterrorism strategy, the U.S. has seen a drastic increase in domestic attacks over the past decade. Previous studies have found that, due to increasing content-related restrictions, many individuals who participate in extremist-related discourse have migrated away from mainstream social media and toward alternative social media platforms. This study consists of a comprehensive content analysis based on Multimedia Critical Discourse Analysis theories to study how meaning is created via the combination of text, image, and symbols, as well as how various persuasive narratives and rhetorical appeals are used within extreme discourse on social media. This research …

Are Orthopedic Hand Surgeons Undercompensated For Time Spent In The Operating Room? A Study Of Relative Value Units, Trevor Simcox, Sakib Safi, Jacob Becker, Jason Kreinces, Adam Wilson

Faculty, Staff and Student Publications

Background: This study aims to investigate whether compensation is equitable among the most commonly performed orthopedic hand surgeries and when compared with general orthopedic procedures.

Methods: The National Surgical Quality Improvement Program database was queried for all orthopedic procedures, from 2016 to 2018, performed more than 150 times using Current Procedural Terminology (CPT) codes. Physician work relative value unit (wRVU) data were obtained from the 2020 US Centers for Medicare and Medicaid Services fee schedule. Linear regressions were used to determine whether there was an association among wRVU, operative time, and wRVU per hour (wRVU/h). Reimbursement for hand surgery CPT …

Current Programs And Incentives To Overcome Rural Physician Shortages In The United States: A Narrative Review, Matthew Vincenti, Bradley V Watts

Faculty, Staff and Students Publications

Access to healthcare continues to be a top priority and prominent challenge in rural communities, with 20% of the total U.S. population living in rural areas while only 10% of physicians practice in rural areas. In response to physician shortages, a variety of programs and incentives have been implemented to recruit and retain physicians in rural areas; however, less is known about the types and structures of incentives that are offered in rural areas and how that compares to physician shortages. The purpose of our study is to conduct a narrative review of the literature to identify and compare current …

Defining The Full Spectrum Of Pediatric Firearm Injury And Death In The United States: It Is Even Worse Than We Think, Liang Chen, Lisa A Pompeii

Faculty, Staff and Students Publications

OBJECTIVE: To characterize the full spectrum of pediatric firearm injury in the United States by describing fatal and nonfatal injury data epidemiology, vulnerable populations, and temporal trends.

BACKGROUND: Firearm injury is the leading cause of death in children and adolescents in the United States. Nonfatal injury is critical to fully define the problem, yet accurate data at the national level are lacking.

METHODS: A cross-sectional study combining national firearm injury data from the Centers for Disease Control (fatal) and the National Trauma Data Bank (nonfatal) between 2008 and 2019 for ages 0 to 17 years. Data were analyzed using descriptive …

Immune Effector Cell-Associated Hemophagocytic Lymphohistiocytosis-Like Syndrome, Melissa R Hines, Tristan E Knight, Kevin O Mcnerney, Mark B Leick, Tania Jain, Matthew J Frigault, Michael D Jain, William T Johnson, Yi Lin, Kris M Mahadeo, Gabriela M Maron, Rebecca A Marsh, Sattva S Neelapu, Sarah Nikiforow, Amanda K Ombrello, Nirav N Shah, Aimee C Talleur, David Turicek, Anant Vatsayan, Sandy W Wong, Marcela V Maus, Krishna V Komanduri, Nancy Berliner, Jan-Inge Henter, Miguel-Angel Perales, Noelle V Frey, David T Teachey, Matthew J Frank, Nirali N Shah

Faculty, Staff and Student Publications

T cell-mediated hyperinflammatory responses, such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), are now well-established toxicities of chimeric antigen receptor (CAR) T cell therapy. As the field of CAR T cells advances, however, there is increasing recognition that hemophagocytic lymphohistiocytosis (HLH)-like toxicities following CAR T cell infusion are occurring broadly across patient populations and CAR T cell constructs. Importantly, these HLH-like toxicities are often not as directly associated with CRS and/or its severity as initially described. This emergent toxicity, however ill-defined, is associated with life-threatening complications, creating an urgent need for improved identification and optimal …

Eat, Sleep, Console Approach Or Usual Care For Neonatal Opioid Withdrawal, Leslie W. Young, Songthip T. Ounpraseuth, Stephanie L. Merhar, Zhuopei Hu, Alan E. Simon, Andrew A. Bremer, Jeannette Y. Lee, Abhik Das, Margaret M. Crawford, Rachel G. Greenberg, P Brian Smith, Brenda B. Poindexter, Rosemary D. Higgins, Michele C. Walsh, Ward Rice, David A. Paul, Jessie R. Maxwell, Sucheta Telang, Camille M. Fung, Tanner Wright, Anne Marie Reynolds, Devon W. Hahn, Julie Ross, Jennifer M. Mcallister, Moira Crowley, Sophie K. Shaikh, Karen M. Puopolo, Lori Christ, Jaime Brown, Julie Riccio, Kara Wong Ramsey, Akshatha Akshatha, Erica F. Braswell, Lauren Tucker, Karen R. Mcalmon, Krishna Dummula, Julie Weiner, Jessica R. White, Meghan P. Howell, Sarah Newman, Jessica N. Snowden, Lori A. Devlin, Act Now Collaborative

Pediatrics Research and Scholarship

BACKGROUND: Although clinicians have traditionally used the Finnegan Neonatal Abstinence Scoring Tool to assess the severity of neonatal opioid withdrawal, a newer function-based approach - the Eat, Sleep, Console care approach - is increasing in use. Whether the new approach can safely reduce the time until infants are medically ready for discharge when it is applied broadly across diverse sites is unknown.

METHODS: In this cluster-randomized, controlled trial at 26 U.S. hospitals, we enrolled infants with neonatal opioid withdrawal syndrome who had been born at 36 weeks' gestation or more. At a randomly assigned time, hospitals transitioned from usual care …

The Law Of The Territories Of The United States In Puerto Rico, The Oldest Colony In The World, Carlos Iván Gorrín Peralta

University of Miami Inter-American Law Review

The territorial law and policy of the United States changed towards the turn of the 20th century, as territorial expansion was no longer motivated by the extension of national borders, but by geopolitical, strategic and economic objectives. The new territories acquired in the Spanish American war were different from those previously annexed. The resulting constitutional doctrine of the Insular Cases differentiated the previous incorporated territories from the new unincorporated territories, which were not destined to be part of the U.S. nor to be admitted as new states. Despite purported changes in the relation with the United States in 1950-1952, Puerto …