Background The novel coronavirus pandemic has drastically affected healthcare organizations across the globe. Methods We sought to summarize the current telemedicine environment in order to highlight the important changes triggered by the novel coronavirus pandemic, as well as highlight how the current crisis may inform the future of telemedicine.Results At many institutions, the number of telemedicine visits dramatically increased within days following the institution of novel coronavirus pandemic restrictions on in-person clinical encounters. Prior to the pandemic, telemedicine utilization was weak throughout surgical specialties due to regulatory and reimbursement barriers. As part of the pandemic response, the USA government temporarily relaxed various telemedicine restrictions and provided additional telemedicine funding. Discussion The post-pandemic role of telemedicine is dependent on permanent regulatory solutions. In the coming decade, telemedicine and telesurgery are anticipated to mature due to the proliferation of interconnected consumer health devices and high-speed 5G data connectivity.

BackgroundMuscle wasting is a profound side effect of advanced cancer. Cancer-induced cachexia decreases patient quality of life and is associated with poor patient survival. Currently, no clinical therapies exist to treat cancer-induced muscle wasting. Although cancers commonly associated with cachexia occur in older individuals, the standard animal models used to elucidate the causes of cachexia rely on juvenile mice.MethodsIn an effort to better model human cancer cachexia, we determined whether cachectic features seen in young mice could be achieved in adult, pre-sarcopenic mice following colon 26 (C-26) tumor cell inoculation.ResultsBoth young and adult mice developed similar-sized tumors and progressed to cachexia with similar kinetics, as evidenced by losses in body mass, and adipose and skeletal muscle tissues. Proteolytic signaling, including proteasome and autophagy genes, was also increased in muscles from both young and adult tumor-bearing animals. Furthermore, tumor-associated muscle damage and activation of Pax7 progenitor cells was induced in both young and adult mice.ConclusionsAlthough cancer cachexia generally occurs in older individuals, these data suggest that the phenotype and underlying mechanisms can be effectively modeled using the currently accepted protocol in juvenile mice.Electronic supplementary materialThe online version of this article (doi:10.1007/s13539-014-0141-2) contains supplementary material.

In recent years, white sharks (Carcharodon carcharias) have become more accessible to researchers off the northeastern U.S. as feeding aggregation sites have emerged and the population has increased. However, there has been limited research on young-of-the-year (YOY) sharks relative to older age classes in this region. Previous research indicated that YOY white sharks were most frequently observed in the New York Bight, suggesting the region serves a nursery role. To further examine the species’ use of this area, we deployed satellite and acoustic tags on ten YOY white sharks (138–166 cm total length) off Long Island, New York. The sharks remained resident in New York Bight waters through summer (August through October), further supporting the notion that the region is a nursery area. Southward movements were observed during fall, with overwintering habitat identified off North and South Carolina shelf waters. Return migrations toward the New York Bight were observed in some individuals the following spring. YOY white sharks in this heavily-populated region are exposed to anthropogenic impacts such as fisheries bycatch and coastal habitat degradation. As juvenile survival rates are important for long-term population sustainability, further research is necessary to assess the potential impacts of these activities on the western North Atlantic white shark population.

Objectives: Adults with decreased muscle mass experience worse outcomes and more frequent complications. The effects of sarcopenia on pediatric outcomes are unknown. Our objective was to define reference values for lean muscle mass in a healthy pediatric population to facilitate future studies on the impact of lean muscle mass on pediatric outcomes. Patients and Methods: Bilateral psoas muscle surface area was measured by computed tomography in a healthy pediatric population undergoing evaluation after trauma. Pearson correlation coefficients (PCCs) were calculated for age, weight, height, body mass index (BMI), total psoas muscle area, and psoas muscle index (PMI; defined as psoas muscle area divided by height squared). Quantile regression was used to determine age- and sex-specific percentiles of psoas muscle area and PMI. Results: Analysis of 494 male and 288 female patients with available imaging (median age: 9.3 years, interquartile range: 5.4–13.4; 63.1% male) was performed. For males, age correlated strongly with total psoas volume (PCC = 0.87), height (0.95), and weight (0.88) and poorly with BMI (0.45). In females, age correlated strongly with total psoas volume (0.88), height (0.92), weight (0.88) and poorly with BMI (0.19). Gender-specific curves and charts were created using output from the quantile regression from reference values of the total psoas muscle area corresponding to the 25th, 50th, and 75th percentiles across all ages. Conclusions: We created gender-specific reference charts for total and height-normalized psoas muscle area in healthy children based on age. These results can be used in future studies to establish the effects of sarcopenia in pediatric patients.

As highly mobile predators with extensive home ranges, some shark species often utilize a continuum of habitats across the continental shelf ranging from the surf zone to the open ocean. For many species, these cross-shelf distributions can change depending on ontogeny or seasonal conditions. Recent research has confirmed a white shark (Carcharodon carcharias) summer nursery off Long Island, New York; however, habitat characterization of this nursery has not yet been conducted nor has fine-scale analysis of vertical behavior. Between 2016 and 2019, 21 young-of-the-year and juvenile white sharks were fitted with satellite and acoustic tags to examine distribution and selection for a suite of oceanographic variables during their late summertime (i.e., August to October) residence in the New York Bight. Horizontal position estimates were used to extract a suite of environmental measurements via remote sensing platforms and were linked with vertical profiles to produce three-dimensional movements for a subset of individuals also fitted with pop-up satellite archival tags (n = 7). Sharks exhibited horizontal movements parallel to Long Island’s southern shoreline and coastal New Jersey, with distances from 0.1 to 131.5 km from shore. Log-likelihood chi-square analyses determined selection for waters with underlying bathymetry of 20–30 m, sea surface temperatures between 20.0 and 22.0°C, sea surface salinities between 31.0 and 32.0 ppt, and chlorophyll-a concentrations between 2.0 and 8.0 mg⋅m–3. Multiple individuals also traversed the mid- to outer shelf region after leaving the Montauk tagging area. Vertical depth profiles illustrated oscillations between the surface and 199 m of water, with an average swimming depth of 9.2 ± 8.9 m. Water column temperatures during these oscillations ranged between 7.9 and 26.2°C (mean = 19.5 ± 2.0°C) with several individuals traversing highly stratified regions presumably associated with a mid-shelf cold pool adjacent to the Hudson Shelf Valley. These results suggest young white sharks exhibit connectivity between the immediate shoreline and mid-continental shelf region, where they play important ecological roles as predators on a variety of species. Our study improves characterization of essential fish habitat for young white sharks and provides new insights into their reliance on this productive continental shelf ecosystem.

Background We aimed to estimate the impact of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding transition on traumatic injury-related hospitalization trends among young adults across a geographically and demographically diverse group of U.S. states. Methods Interrupted time series analyses were conducted using statewide inpatient databases from 12 states and including traumatic injury-related hospitalizations in adults aged 19–44 years in 2011–2017. Segmented regression models were used to estimate the impact of the October 2015 coding transition on external cause of injury (ECOI) completeness (percentage of hospitalizations with a documented ECOI code) and on population-level rates of injury-related hospitalizations by nature, intent, mechanism, and severity of injury. Results The transition to ICD-10-CM was associated with a drop in ECOI completion in the transition month (− 3.7%; P < .0001), but there was no significant change in the positive trend in ECOI completion from the pre- to post-transition periods. There were significant increases post-transition in the measured rates of hospitalization for traumatic brain injury (TBI), unintentional injury, mild injury (injury severity score (ISS) < 9), and injuries caused by drowning, firearms, machinery, other pedestrian, suffocation, and unspecified mechanism. Conversely, there were significant decreases in October 2015 in the rates of hospitalization for assault, injuries of undetermined intent, injuries of moderate severity (ISS 9–15), and injuries caused by fire/burn, other pedal cyclist, other transportation, natural/environmental, and other specified mechanism. A significant increase in the percentage of hospitalizations classified as resulting from severe injury (ISS > 15) was observed when the general equivalence mapping maximum severity method for converting ICD-10-CM codes to ICD-9-CM codes was used. State-specific results for the outcomes of ECOI completion and TBI-related hospitalization rates are provided in an online supplement. Conclusions The U.S. transition from ICD-9-CM to ICD-10-CM coding led to a significant decrease in ECOI completion and several significant changes in measured rates of injury-related hospitalizations by injury intent, mechanism, nature, and severity. The results of this study can inform the design and analysis of future traumatic injury-related health services research studies that use both ICD-9-CM and ICD-10-CM coded data. Level of evidence II (Interrupted Time Series)

BACKGROUND: Low-income young adults disproportionately experience traumatic injury and poor trauma outcomes. This study aimed to evaluate the effects of the Affordable Care Act's Medicaid expansion, in its first 4 years, on trauma care and outcomes in young adults, overall and by race, ethnicity, and ZIP code-level median income. STUDY DESIGN: Statewide hospital discharge data from 5 states that did and 5 states that did not implement Medicaid expansion were used to perform difference-in-difference (DD) analyses. Changes in insurance coverage and outcomes from before (2011-2013) to after (2014-2017) Medicaid expansion and open enrollment were examined in trauma patients aged 19 to 44 years. RESULTS:Medicaid expansion was associated with a decrease in the percentage of uninsured patients (DD e16.5 percentage points; 95% CI, e17.1 to e15.9 percentage points). This decrease was larger among Black patients but smaller among Hispanic patients than White patients. It was also larger among patients from lower-income ZIP codes (p < 0.05 for all). Medicaid expansion was associated with an increase in discharge to inpatient rehabilitation (DD 0.6 percentage points; 95% CI, 0.2 to 0.9 percentage points). This increase was larger among patients from the lowest-compared with highest-income ZIP codes (p < 0.05). Medicaid expansion was not associated with changes in in-hospital mortality or readmission or return ED visit rates overall, but was associated with decreased in-hospital mortality among Black patients (DD e0.4 percentage points; 95% CI, e0.8 to e0.1 percentage points). CONCLUSIONS: The Affordable Care Act Medicaid expansion, in its first 4 years, increased insurance coverage and access to rehabilitation among young adult trauma patients. It also reduced the socioeconomic disparity in inpatient rehabilitation access and the disparity in in-hospital mortality between Black and White patients.

Background : Prior to COVID-19, the use of telemedicine within pediatric surgery was uncommon. To curb the spread of the virus many institutions restricted non-emergent clinic appointments, resulting in an increase in telemedicine use. We examined the value of telemedicine for patients presenting to a pediatric surgery clinic before and after COVID-19 Methods Perspectives and the potential value of telemedicine were assessed by surveying patients or caregivers of patients being evaluated by a general pediatric surgeon in-person prior to COVID-19 and by patients or caregivers of patients who completed a telemedicine appointment with a pediatric surgical provider during the COVID-19 period. Results The pre-COVID survey was completed by 57 respondents and the post-COVID survey by 123. Most respondents were white and were caregivers 31-40 years of age. Prior to COVID-19, only 26% were familiar with telemedicine, 25% reported traveling more than 100 miles and >50% traveled more than 40 miles for their appointment. More than 25% estimated additional travel costs of at least $30 and in 43% of households, at least one adult had to miss time from work. Following a telemedicine appointment during the COVID-19 period, 76% reported the care received as excellent, 86% were very satisfied with their care, 87% reported the appointment was less stressful for their child than an in-person appointment, and 57% would choose a telemedicine appointment in the future. Conclusion For families seeking an alternative to the in-person encounter, telemedicine can provide added value over the traditional in-person encounter by reducing the burden of travel without compromising the quality of care. Telemedicine should be viewed as a viable option for pediatric surgery patients and future research directed toward optimizing the experience for patients and providers.