Congenital mesoblastic nephroma is a rare pediatric tumor with a favorable clinical outcome. Cytological features of this uncommon tumor and diagnostic difficulties with other commoner pediatric renal neoplasms have been inadequately discussed in the available literature. We describe the case of a 1-year-old girl who presented with a right renal mass. Fine-needle aspiration smears consisted of a few cellular clusters of spindle cells with mitotic activity and mild nuclear pleomorphism. No blastema was identified. A cytologic impression of mesoblastic nephroma was rendered, which was confirmed on histopathological examination of the right nephrectomy specimen as a cellular mesoblastic nephroma. Cytologic diagnosis of mesoblastic nephroma has important prognostic and therapeutic implications. The cytopathologist should carefully evaluate smears from such patients and attempt to differentiate mesoblastic nephroma from Wilms' tumor and clear cell sarcoma.

To report the relationship of outpatient portal (OPP) use with clinical risk, area social determinants of health (SDoH), and race/ethnicity among pregnant women. Regression models predicting overall and individual portal feature use (main effects and interactions) based on key variables were specified using log files and clinical data. Overall OPP use among non-Hispanic Black women or patients who lived in lower SDoH neighborhoods were significantly less. High-risk pregnancy patients were likely to use the OPP more than those with normal-risk pregnancy. We found similar associations with individual OPP features, like Visit (scheduling) and My Record (test results). We also found significant interactive associations between race/ethnicity, clinical risk, and SDoH. Non-Hispanic Black women and those living in lower SDoH areas used OPP less than non-Hispanic White women from similar or affluent areas. More research must be conducted to learn of OPP use implications for pregnant women with specific clinical diagnoses.

Background A tailored and integrated technology solution (patient mHealth application and provider dashboard) can provide a 360° view of Medicaid-enrolled patients with type 2 diabetes (T2D) during pregnancy that could improve health outcomes and address health inequities. Objectives To develop a set of user specifications for the mHealth and dashboard applications, develop prototypes based on user needs, and collect initial impressions of the prototypes to subsequently develop refined tools that are ready for deployment. Methods Study activities followed a double-diamond framework with a participatory design mindset. Activities were divided into two phases focused on a qualitative inquiry about participant needs and values (phase 1) and design, development, and usability testing of low and high-fidelity prototypes (phase 2). Results We identified themes that exemplified pregnancy experience among Medicaid-enrolled individuals with T2D. Patients ( n  =  7) and providers ( n  =  7) expressed a core set of expectations for the mHealth and dashboard applications. Participants provided feedback to improve the mHealth and dashboard. For both applications, participants reported scores for the NASA Task load Survey (TLX) that were in the 20th percentile of national TLX scores. Conclusions Digital health tools have the ability to transform health care among Medicaid-enrolled patients with T2D during pregnancy, with the goal of managing their blood glucose levels, which is a precursor to experiencing a successful pregnancy and birth. Distilling patient and provider needs and preferences—then using them, along with prior studies and theory, to develop applications—holds great potential in tackling complicated health care issues.

Democratic transition in the 1980s and 1990s ushered in Latin Americas basic constitutional reforms aimed at addressing the issues of indigenous peoples identity and their rights. Although the changes reflect the democratic aspirations and the consolidation of new rights to the hitherto excluded segments of society, they also seem to be a response to a variety of other pressures (both political and economic) currently felt throughout the region. Political and economic changes witnessed in the democratization process suggest the reconfiguration of the state in Latin America. It provides the context for the belated recognition of cultural pluralism and the ensuing balance between indigenous participation within the institutions of state on the one hand, and respect for the autonomy of indigenous institutions on the other. However, given that the constitutionally guaranteed collective rights are only instruments they cannot be substitutes for an inter-cultural dialogue. Therefore, the process of democratization needs to go beyond giving recognition to cultural and legal pluralism.By all accounts, the 1980s can be regarded as the decade of democratic transition throughout Latin America. Several factors, both regional and international, contributed towards the beginning of a process of democratization. When the estado nacional desarrollista (national developmentalist state) model piloted internally by the corporatist military authoritarian regimes of the preceding three decades failed to deliver the desired results, it undermined the legitimacy of the ruling military elite. Latin American military, rulers and economic elite held the view that all unproductive areas should be developed and integrated into the national economy. 1 The development activities proved to be extremely destructive

ObjectiveTo describe the development of an area-level measure of children's opportunity, the Ohio Children's Opportunity Index (OCOI).Data Sources/Study SettingSecondary data were collected from US census based-American Community Survey (ACS), US Environmental Protection Agency, US Housing and Urban Development, Ohio Vital Statistics, US Department of Agriculture-Economic Research Service, Ohio State University Center for Urban and Regional Analysis, Ohio Incident Based Reporting System, IPUMS National Historical Geographic Information System, and Ohio Department of Medicaid. Data were aggregated to census tracts across two time periods.Study DesignOCOI domains were selected based on existing literature, which included family stability, infant health, children's health, access, education, housing, environment, and criminal justice domains. The composite index was developed using an equal weighting approach. Validation analyses were conducted between OCOI and health and race-related outcomes, and a national index.Principal FindingsComposite OCOI scores ranged from 0–100 with an average value of 74.82 (SD, 17.00). Census tracts in the major metropolitan cities across Ohio represented 76% of the total census tracts in the least advantaged OCOI septile. OCOI served as a significant predictor of health and race-related outcomes. Specifically, the average life expectancy at birth of children born in the most advantaged septile was approximately 9 years more than those born in least advantaged septile. Increases in OCOI were associated with decreases in proportion of Black (48 points lower in the most advantaged vs. least advantaged septile), p < 0.001) and Minority populations (54 points lower in most advantaged vs. least advantaged septile, p < 0.001). We found R-squared values > 0.50 between the OCOI and the national Child Opportunity Index scores. Temporally, OCOI decreased by 1% between the two study periods, explained mainly by decreases in the children health, accessibility and environmental domains.ConclusionAs the first opportunity index developed for children in Ohio, the OCOI is a valuable resource for policy reform, especially related to health disparities and health equity. Health care providers will be able to use it to obtain holistic views on their patients and implement interventions that can tackle barriers to childhood development using a more tailored approach.

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Objective: To report the relationship of Outpatient Patient Portal (OPP) use with clinical risk, area social determinants of health (SDoH), and race/ethnicity among pregnant women. Methods: Regression models predicting overall and individual portal feature use (main effects and interactions) based on key variables were specified using logfiles and clinical data. Results: Overall OPP use among non-Hispanic Black women or patients who lived in lower SDoH neighborhoods were significantly less. High-risk pregnancy patients were likely to use the OPP more than those with normal-risk pregnancy. We found similar associations with individual OPP features, like the Visit (scheduling) and My Record (test results). We also found significant interactive associations between race, clinical risk, and SDoH. Non-Hispanic Black women living in lower SDoH areas used OPP less than non-Hispanic White women from similar or affluent areas. Conclusion: More research must be conducted to learn of OPP implications for pregnant women with specific clinical diagnoses.

This article examines the idioms of ‘modernity’ with specific focus on indigenous peoples and their engagement with larger society in respect of culture, development and jurisprudence. This engagement in the past 50 years has largely been within the terms of the nation-state system, and related international fora. It is argued that these indigeneous communities, in all their great diversity across the world, have nevertheless been largely successful in carving out adequate political spaces to stake their claims as distinct ‘peoples’ rather than simply being recognized as one among the several ethnic groups or minorities of a nation-state polity. This distinction is crucial and this paper shows why and how. This is not to say that the indigenous communities the world over have similar terms of engagement as their own heterogeneity defies any neat typological schema. At the same time, the multiple idioms of the current indigenous discourse, however, should not be treated as cacophonic but as embodying consciously crafted tools for boundary negotiations and voicing indigenous identities. This article reflects on this achievement by providing a survey of these developments even as it critically explores the terms of the discourses themselves.