Objective: The purpose of this study was to assess the palatal suture opening and the pterygopalatine suture disarticulation pattern in the tomographic axial plane after treatment with midfacial skeletal expander (MSE). Materials and methods: Pre-and post-expansion CBCT records of 50 subjects (20 males, 30 females, mean age 18 ± 3 years) who were treated with MSE (Biomaterials Korea, Seoul, Korea) appliance were superimposed and compared using OnDemand software. Reference planes were identified and the angulation of the midpalatal suture opening after expansion was calculated as well as the frequency of the pterygopalatine suture split. Results: After MSE treatment, the mean palatal suture opening angle (SOA) was 0.57°. (− 0.8°to 1.3°). There was no significant difference between males and females in terms of the palatal suture opening pattern (P > 0.05). Only 3 out of 50 (6%) subjects presented SOA above 1 degree. Also, 3 out of 50 (6%) patients presented a negative SOA value. With regard to the pterygopalatine suture split, 84 sutures out of 100 (84%) presented openings between the medial and lateral pterygoid plates on both right and left sides. Partial split was detected with 8 patients (5 females, 3 males). Five patients had split only in the medial pterygoid plates of both pterygomaxillary sutures, and 3 patients exhibited disarticulation on the right side only. No significant differences were found in the frequency of suture opening between males and females (P = 1.000). Conclusions: MSE appliance performed almost parallel expansion in the axial view. Remarkably, this study shows that pterygopalatine suture can be split by MSE appliance without the surgical intervention; the disarticulation of pterygopalatine suture was visible in most of the patients.

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Objective Patient satisfaction is now an important metric in emergency medicine, but the means by which satisfaction is assessed is evolving. We sought to examine hospital ratings on Google and Yelp as compared to those on Medicare's Care Compare (CC) and to determine if certain hospital characteristics are associated with crowdsourced ratings. Methods We performed a cross‐sectional analysis of hospital ratings on Google and Yelp as compared to those on CC using data collected between July 8 and August 2, 2021. For each hospital, we recorded the CC ratings, Yelp ratings, Google ratings, and each hospital's characteristics. Using multivariable linear regression, we assessed for associations between hospital characteristics and crowdsourced ratings. We calculated Spearman's correlation coefficients for CC ratings versus crowdsourced ratings. Results Among 3000 analyzed hospitals, the median hospital ratings on Yelp and Google were 2.5 stars (interquartile ratio [IQR], 2–3) and 3 stars (IQR, 2.7–3.5), respectively. The median number of Yelp and Google reviews per hospital was 13 and 150, respectively. The correlation coefficients for Yelp and Google ratings with CC's overall star ratings were 0.19 and 0.20, respectively. For Yelp and Google ratings with CC's patient survey ratings, correlation coefficients were 0.26 and 0.22, respectively. On multivariable analysis, critical access hospitals had 0.22 (95% confidence interval [CI], 0.14–0.30) more Google stars and hospitals in the West had 0.12 (95% CI, 0.05–0.18) more Google stars than references standard hospitals. Conclusion Patients use Google more frequently than Yelp to review hospitals. Median UnS hospital ratings on Yelp and Google are 2.5 and 3 stars, respectively. Crowdsourced reviews weakly correlate with CC ratings. Critical access hospitals and hospitals in the West have higher crowdsourced ratings.

Objectives: The Centers for Disease Control and Prevention has reported increased rates of coronavirus disease 2019 (COVID-19)-related hospitalizations and deaths in Black and Hispanic individuals. One contributing factor to this may be a difference in access to treatment. We thus sought to compare the outcomes of Black, non-Hispanic patients and Hispanic patients with White, non-Hispanic individuals using a group of patients with COVID-19 who received casirivimab/imdevimab.Methods: This was a secondary analysis of data from a previously published retrospective chart review of patients who received casirivimab/ imdevimab for COVID-19 between December 9, 2020 and August 20, 2021, when they were treated at one of three facilities within a single hospital system. We compared the baseline characteristics (including age, sex, body mass index, duration of symptoms, and vaccination status) and outcomes of Black, non-Hispanic patients and Hispanic patients with those of White, non-Hispanic patients. Our primary outcome was the odds of a return visit to the emergency department (ED) within 28 days of treatment as assessed by multivariate logistic regression. We also assessed the rates of return visits to the ED for symptoms caused by COVID-19, hospitalizations, and hospitalizations from hypoxia.Results: In total, 1318 patients received casirivimab/imdevimab for COVID-19 at the three study facilities. Of these, 410 (31.1%) identified themselves as White and non-Hispanic, 88 (6.7%) as Black and non-Hispanic, and 736 (55.8%) as Hispanic. Vaccination rates at the time of treatment were as follows: Black, non-Hispanic 10.2%, Hispanic 13.6%, and White, non-Hispanic 21.5%. On multivariate analysis, the odds of return visits to the ED within 28 days were higher for Black, non-Hispanic patients and Hispanic patients as compared with White, non-Hispanic patients, with odds ratios of 2.8 (95% confidence interval [CI] 1.4-5.5, P = 0.003) and of 2.3 (95% CI 1.5-3.6, P = 0.0002), respectively. For hospitalizations caused by hypoxia within 28 days of treatment, the adjusted odds ratio for Black, non-Hispanic patients was 3.4 (95% CI 1.1-10.5, P = 0.03) as compared with White, non-Hispanic patients. There were no other statistically significant differences among groups in regard to subsequent hospitalizations within 28 days.Conclusions: Black, non-Hispanic patients and Hispanic patients are more likely to make a return visit to the ED within 28 days after casirivimab/imdevimab treatment for COVID-19 as compared with White, non-Hispanic patients. This holds true even when adjusting for higher vaccination rates among White, non-Hispanic individuals.

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