A177: Program Evaluation of the ACR/CARRA Inter‐Institutional Mentoring Program (AMIGO) in Pediatric Rheumatology

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106776/1/art38603.pd

Burden of childhood-onset arthritis

Juvenile arthritis comprises a variety of chronic inflammatory diseases causing erosive arthritis in children, often progressing to disability. These children experience functional impairment due to joint and back pain, heel pain, swelling of joints and morning stiffness, contractures, pain, and anterior uveitis leading to blindness. As children who have juvenile arthritis reach adulthood, they face possible continuing disease activity, medication-associated morbidity, and life-long disability and risk for emotional and social dysfunction. In this article we will review the burden of juvenile arthritis for the patient and society and focus on the following areas: patient disability; visual outcome; other medical complications; physical activity; impact on HRQOL; emotional impact; pain and coping; ambulatory visits, hospitalizations and mortality; economic impact; burden on caregivers; transition issues; educational occupational outcomes, and sexuality

Corrigendum: Increase in pediatric recurrent fever evaluations during the first year of the COVID-19 pandemic in North America

[This corrects the article DOI: 10.3389/fped.2023.1240242.]

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Increase in pediatric recurrent fever evaluations during the first year of the COVID-19 pandemic in North America

The impact of the COVID-19 pandemic on new diagnoses of recurrent fevers and autoinflammatory diseases is largely unknown. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) PFAPA/AID Working Group aimed to investigate the impact of the COVID-19 pandemic on the number of pediatric patients evaluated for recurrent fevers and autoinflammatory diseases in North America. The absolute number of new outpatient visits and the proportion of these visits attributed to recurrent fever diagnoses during the pre-pandemic period (1 March 2019–29 February 2020) and the first year of the COVID-19 pandemic (1 March 2020–28 February 2021) were examined. Data were collected from 27 sites in the United States and Canada. Our results showed an increase in the absolute number of new visits for recurrent fever evaluations in 21 of 27 sites during the COVID-19 pandemic compared to the pre-pandemic period. The increase was observed across different geographic regions in North America. Additionally, the proportion of new visits to these centers for recurrent fever in relation to all new patient evaluations was significantly higher during the first year of the pandemic, increasing from 7.8% before the pandemic to 10.9% during the pandemic year (p < 0.001). Our findings showed that the first year of the COVID-19 pandemic was associated with a higher number of evaluations by pediatric subspecialists for recurrent fevers. Further research is needed to understand the reasons behind these findings and to explore non-infectious triggers for recurrent fevers in children

Spring-time enhancement in aerosol burden over a high-altitude location in western trans-Himalaya: results from long-term observations

Long-term measurements (from August 2009 to December 2014) of aerosol black carbon mass concentration (MBC) and spectral aerosol optical depth (AOD) were carried out from a high-altitude location, Hanle in western trans-Himalaya as part of the Regional Aerosol Warming Experiment. Both MBC and AOD showed distinct annual pattern with a clear spring-time enhancement (April-June) with significant inter-annual variability associated with the changes in source processes. The potential source regions contributing to the spring-time enhancement in aerosol loading are the dust-dominated west Asian region as well as biomass burning from NW India. The overall annual mean value of MBC over Hanle is extremely low compared to many other Himalayan locations, including the Ganges Valley Aerosol Experiment campaign site at Nainital, which also showed spring-time (pre-monsoon) enhancement. The vertical extents of elevated aerosol layers, which contribute to the spring-time enhancement, are found to be in the range 5-7 km amsl from the analysis of vertical profiles of extinction coefficients from CALIPSO data

Meridional gradients in aerosol vertical distribution over Indian mainland: observations and model simulations

Multi-year observations from the network of ground-based observatories (ARFINET), established under the project ‘Aerosol Radiative Forcing over India’ (ARFI) of Indian Space Research Organization and space-borne lidar ‘Cloud Aerosol Lidar with Orthogonal Polarization’ (CALIOP) along with simulations from the chemical transport model ‘Goddard Chemistry Aerosol Radiation and Transport’ (GOCART), are used to characterize the vertical distribution of atmospheric aerosols over the Indian landmass and its spatial structure. While the vertical distribution of aerosol extinction showed higher values close to the surface followed by a gradual decrease at increasing altitudes, a strong meridional increase is observed in the vertical spread of aerosols across the Indian region in all seasons. It emerges that the strong thermal convections cause deepening of the atmospheric boundary layer, which although reduces the aerosol concentration at lower altitudes, enhances the concentration at higher elevations by pumping up more aerosols from below and also helping the lofted particles to reach higher levels in the atmosphere. Aerosol depolarization ratios derived from CALIPSO as well as the GOCART simulations indicate the dominance of mineral dust aerosols during spring and summer and anthropogenic aerosols in winter. During summer monsoon, though heavy rainfall associated with the Indian monsoon removes large amounts of aerosols, the prevailing southwesterly winds advect more marine aerosols over to landmass (from the adjoining oceans) leading to increase in aerosol loading at lower altitudes than in spring. During spring and summer months, aerosol loading is found to be significant, even at altitudes as high as 4 km, and this is proposed to have significant impacts on the regional climate systems such as Indian monsoon