University of Tennessee Health Science Center

Background Surveillance cultures to identify patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) is recommended at pediatric intensive care unit (PICU) admission but doesn’t capture other methicillin-resistant Staphylococcus and is resource intensive. We determined the prevalence and identified nasal microbiome predictors for methicillin-resistant Staphylococcus colonization at the time of PICU admission. Study design A prospective cohort study was performed in a 20-bed pediatric intensive care unit (PICU) between 2020–2021. Anterior nares nasal swabs processed for MRSA culture, nasal microbiome and mecA+ qPCR were obtained within first five days after PICU admission. Predictive values of methicillin-resistant Staphylococcus carriage on symptoms of infection and for nasal microbiome attributes were calculated. Results A total of 5 (8.0%) of 62 patients had a nares culture positive for MRSA and 22 (35.5%) of 63 patients had methicillin-resistant Staphylococcus (MRSA or methicillin-resistant coagulase-negative Staphylococci). In univariate analysis, carriage with MRSA or MRCoNS was associated with having a fever during PICU stay. Colonization with a distinct set of microbes (including Haemophilus, Streptococcus, Prevotella and Corynebacterium sp.) was predictive of having methicillin-resistant Staphylococcus colonization. Conclusions Carriage with methicillin-resistant Staphylococcus may lead to transmission in critically ill pediatric patients. Carriage of particular nasal microbes appears to facilitate colonization with methicillin-resistant Staphylococcus.

Background Vitamin C is a well‐known product used in cosmeceuticals for its various topical application benefits ranging from antioxidative, antiaging, anti‐inflammatory, and anti‐pigmentary among others. The main problems encountered with vitamin C products include the stability, penetrance into the skin, and tolerance of vitamin C's various forms. Aims This paper aims to explore current literature on the role of Vitamin C in cosmetic dermatology and present a review on how products have developed for certain purposes and their outcomes. Methods A literature search was conducted on PubMed reviewing vitamin C in cosmetic and non‐cosmetic formulations and its utility for cosmetic dermatologic conditions. Research produced by various journals was then investigated to highlight its uses and potential in the field. Results Numerous studies support the varied claims regarding topical vitamin C, particularly in its role as an antioxidant, antiaging, anti‐pigmentary, and anti‐inflammatory agent. The integration of Vitamin C with other cosmetic ingredients is rapidly developing, ranging from vitamin E and natural plant extracts to several exfoliative acids and growth factors. The cosmetic industry's next steps involve better stabilization to improve the synergistic mechanisms with other ingredients and without lowering its bioavailability, efficacy, or absorption. Conclusions Vitamin C has proven to be a powerful player in cosmetic dermatology, both as a stand‐alone element and in combination with cosmetic ingredients. This review showcases some of the most pertinent clinical studies that support its efficacy in mitigating photoaging, oxidative stress, abnormal pigmentation, and inflammation among other cosmetic concerns, underscoring the promise behind vitamin C.

Opioid use disorder is heritable, yet its genetic etiology is largely unknown. C57BL/6J and C57BL/6NJ mouse substrains exhibit phenotypic diversity in the context of limited genetic diversity which together can facilitate genetic discovery. Here, we found C57BL/6NJ mice were less sensitive to oxycodone (OXY)‐induced locomotor activation versus C57BL/6J mice in a conditioned place preference paradigm. Narrow‐sense heritability of OXY‐induced locomotor activity traits ranged from 0.22 to 0.31, implicating suitability for genetic analysis. Quantitative trait locus (QTL) mapping in an F2 cross identified a chromosome 1 QTL explaining 7%–12% of the variance in OXY locomotion and anxiety‐like withdrawal in the elevated plus maze. A second QTL for EPM withdrawal behavior on chromosome 5 near Gabra2 (alpha‐2 subunit of GABA‐A receptor) explained 9% of the variance. To narrow the chromosome 1 locus, we generated recombinant lines spanning 163–181 Mb, captured the QTL for OXY locomotor traits and withdrawal, and fine‐mapped a 2.45‐Mb region (170.16–172.61 Mb). Transcriptome analysis identified five, localized striatal cis‐eQTL transcripts and two were confirmed at the protein level (KCNJ9, ATP1A2). Kcnj9 codes for a potassium channel (GIRK3) that is a major effector of mu opioid receptor signaling. Atp1a2 codes for a subunit of a Na+/K+ ATPase enzyme that regulates neuronal excitability and shows functional adaptations following chronic opioid administration. To summarize, we identified two candidate genes underlying the physiological and behavioral properties of opioids, with direct preclinical relevance to investigators employing these widely used substrains and clinical relevance to human genetic studies of opioid use disorder.

Introduction Evidence-based practices (EBPs) use evidence (external and internal), clinician expertise, and client/caregiver perspectives to deliver effective, individualized care. Each component of EBP is highly relevant and most effective when implemented together. Families with cultural or linguistic backgrounds different from the mainstream experience inequitable treatment across all disciplines. As the United States' population becomes increasingly diverse, it is paramount for speech-language pathologists (SLPs) to obtain education and support to provide evidence-based, culturally responsive care. Method This study conducted a scoping review to determine what is known regarding SLPs' perspectives and experiences working with families or children with different cultural or linguistic backgrounds. Articles were included if they (a) contained empirical novel data, were available in English, were peer-reviewed, and were published; (b) included experiences of SLPs who self-reported that they work with children and/or families with cultural and/or linguistic backgrounds different from themselves or the regional mainstream; and (c) reported effects of cultural or linguistic difference on SLP service provision. Results Results indicated that SLPs encounter many barriers but often exhibit culturally responsive clinical decision making through the consideration of evidence (external and internal) and their clinical expertise and opinion. Multiple strategies for increasing culturally responsive care and areas that would benefit from further research and systemic change were identified. Discussion Barriers and solutions to culturally responsive care represented two areas of needed change: personal and within system. Though not all change may occur immediately, the present study offers suggested solutions for SLPs to implement in their clinical practice for increased culturally responsive care. Supplemental Material https://doi.org/10.23641/asha.28119836

Aims In VERTIS CV, ertugliflozin was associated with a 30% risk reduction for adjudication‐confirmed, first and total hospitalizations for heart failure (HHF) in participants with type 2 diabetes and atherosclerotic cardiovascular disease. We evaluated the impact of ertugliflozin on the broader spectrum of all reported heart failure (HF) events independent of adjudication confirmation. Methods and results Data from participants who received ertugliflozin (5 or 15 mg) were pooled and compared versus placebo. HF events included all investigator‐reported HF adverse events (AEs) and serious AEs (SAEs) based on the narrow standardized Medical Dictionary for Regulatory Activities (MedDRA) query ‘cardiac failure’. Terms for orthopnoea, dyspnoea, and peripheral oedema were evaluated separately. The effect of ertugliflozin on the first HF event was assessed by Cox proportional hazard models. Total HF events were assessed by Andersen–Gill models to account for first and recurrent events. A total of 8238 participants received ≥1 dose of ertugliflozin or placebo (mean follow‐up 3.5 years). Investigator‐reported HF events and AE capture yielded 420 first and 627 total HF events (vs. 238 and 345 adjudication‐confirmed HHF events, respectively, in the primary analyses). Ertugliflozin reduced the risk for first (hazard ratio [HR] 0.69; 95% confidence interval [CI] 0.57–0.84; p < 0.001) and total HF AEs (HR 0.66; 95% CI 0.57–0.78; p < 0.001), with similar results for first and total HF SAEs. Additionally, ertugliflozin reduced oedema risk, but not orthopnoea/dyspnoea. Conclusion The effect of ertugliflozin was consistent across the spectrum of total investigator‐reported HF AEs and was similar in magnitude to adjudicated HHF events.

Data on outcomes of extracorporeal membrane oxygenation (ECMO) are limited in patients with pulmonary atresia intact ventricular septum (PAIVS). The objective of this study was to describe the use of ECMO and the associated outcomes in patients with PAIVS. We retrospectively reviewed neonates with PAIVS who received ECMO between 2009 and 2019 in 19 US hospitals affiliated with the Collaborative Research for the Pediatric Cardiac Intensive Care Society (CoRe-PCICS). Patients who received ECMO were compared to those who did not and patients on ECMO who died were compared to those who survived by bivariate analysis and multivariable logistic regression. The predictive ability of a risk score for inpatient mortality (using beta coefficients) was assessed by receiver operator curve analysis. Of 295 identified patients, 32 (11%) were supported with extracorporeal membrane oxygenation. Of these, 15 (46%) experienced mortality. A higher left pulmonary artery z-score (beta coefficient 0.72) and the presence of ventriculocoronary connections by cardiac catheterization (beta coefficient 1.25) were associated with an increased risk of ECMO (p-value < 0.01). The resulting risk score had an area under the curve of 0.71 (p-value 0.03) for the prediction of need for ECMO. In a multicenter cohort of patients with PAIVS, 11% received ECMO. Of those supported with ECMO, 46% experienced inpatient mortality. A higher left pulmonary artery z-score and the presence of ventriculocoronary connections appear to be risk factors for the use of ECMO.

Purpose: To evaluate the color match and stability of single-shade resin-based composites (RBCs) in Class V restorations before and after ultra-violet light artificial aging. Methods: Acrylic resin teeth of A1 and A3 were randomly assigned into seven groups to be restored with single-shade RBCs and universal-shade RBCs, shades A1 and A3. Standardized Class V cavities were restored using RBC and underwent accelerated aging for 480 hours. The color differences between RBC and Class V restorations for A1 and A3 were evaluated before and after artificial aging using a spectrophotometer. Results: All single-shade RBCs better color-matched the A1 tooth (P= 0.10 to P= 0.32), while universal-shade RBCs color better matched the A3 tooth (P= 0.03 to P= 0.87). Omnichroma was the only single-shade RBC that also color-matched the A3 tooth (P= 0.03). There was a statistically significant difference when comparing measurements before and after the aging only for Vittra APS Unique (P= 0.047) and Omnichroma (P= 0.038) and the A3 tooth. Clinical significance: When restoring Class V in teeth color A1, single-shade RBCs demonstrated comparable color matching to multi-shade resin composites even after 4 simulated years of service, however universal-shade RBCs were better options to restore Class V in teeth color A3.

Background In the Systolic Blood Pressure Intervention Trial (SPRINT), intensive systolic blood pressure (SBP) lowering slowed progression of white matter injury (WMI) on MRI. We hypothesized that intensive lowering would be equally as effective and may confer greater benefits for brain health at younger ages compared to older ages. We tested whether the relative effects of intensive lowering on WMI differed by age using 2 MRI measures: white matter hyperintensity volume (WMHv) and peak‐width skeletonized mean diffusivity (PSMD) in SPRINT. Method Participants were age =50 with cardiovascular risk and randomized to intensive (SBP goal <120 mm Hg) or standard treatment (SBP goal <140 mm Hg). We calculated WMHv and PSMD in a subgroup of participants who had a baseline and follow‐up MRI. WMHv were inverse‐hyperbolic sine‐transformed, and the ratio of follow‐up to baseline used to quantify progression. PSMD progression was quantified as a difference. Using mixed‐effects linear models, we estimated the effects of age on relative progression in MRI markers between groups. Age effects were investigated as categorical (<65, 65‐75, or =75 years) or continuous. Result For participants in the intensive group (n=251 with follow‐up), mean SBP was 122 mmHg versus 135 mmHg in the standard group (n=201) over a median 3.9‐year MRI interval. The largest treatment effect on WMHv progression was found in the <65 age group (i.e. greatest relative reduction with intensive treatment): ‐0.19, 95%CI [‐0.27, ‐0.11]), followed by the 65‐75 age group (‐0.11, [‐0.21, ‐0.01]), and least in the >75 age group (‐0.06, [‐0.20, ‐0.08]) (Figure 1). Intensive treatment resulted in a 73%, 52%, and 20% reduction in WMHv progression respectively, although this was not statistically significant (p=0.21). Analyses of PSMD progression produced similar results (Figure 2). When using age as a continuous measure, the beneficial effect of intensive treatment waned with increasing age (Figure 3) without reaching statistical significance (p=0.19). Conclusion Intensive SBP lowering was equally as effective and may have a greater relative effect on reducing WMI when implemented at younger ages compared to older ages. Large prospective interventional studies that include younger individuals are needed to determine the effects of SBP on white matter integrity across the lifespan.

Background In the Systolic Blood Pressure Intervention Trial (SPRINT), intensive systolic blood pressure (SBP) lowering slowed progression of white matter injury (WMI) on MRI. We hypothesized that intensive lowering would be equally as effective and may confer greater benefits for brain health at younger ages compared to older ages. We tested whether the relative effects of intensive lowering on WMI differed by age using 2 MRI measures: white matter hyperintensity volume (WMHv) and peak‐width skeletonized mean diffusivity (PSMD) in SPRINT. Method Participants were age ≥50 with cardiovascular risk and randomized to intensive (SBP goal <120 mm Hg) or standard treatment (SBP goal <140 mm Hg). We calculated WMHv and PSMD in a subgroup of participants who had a baseline and follow‐up MRI. WMHv were inverse‐hyperbolic sine‐transformed, and the ratio of follow‐up to baseline used to quantify progression. PSMD progression was quantified as a difference. Using mixed‐effects linear models, we estimated the effects of age on relative progression in MRI markers between groups. Age effects were investigated as categorical (<65, 65‐75, or ≥75 years) or continuous. Result For participants in the intensive group (n=251 with follow‐up), mean SBP was 122 mmHg versus 135 mmHg in the standard group (n=201) over a median 3.9‐year MRI interval. The largest treatment effect on WMHv progression was found in the <65 age group (i.e. greatest relative reduction with intensive treatment): ‐0.19, 95%CI [‐0.27, ‐0.11]), followed by the 65‐75 age group (‐0.11, [‐0.21, ‐0.01]), and least in the >75 age group (‐0.06, [‐0.20, ‐0.08]) (Figure 1). Intensive treatment resulted in a 73%, 52%, and 20% reduction in WMHv progression respectively, although this was not statistically significant (p=0.21). Analyses of PSMD progression produced similar results (Figure 2). When using age as a continuous measure, the beneficial effect of intensive treatment waned with increasing age (Figure 3) without reaching statistical significance (p=0.19). Conclusion Intensive SBP lowering was equally as effective and may have a greater relative effect on reducing WMI when implemented at younger ages compared to older ages. Large prospective interventional studies that include younger individuals are needed to determine the effects of SBP on white matter integrity across the lifespan.

Regeneration of the multiple tissues and interfaces in the periodontal complex necessitates multidisciplinary evaluation to establish structure/function relationships. This article, an initiative of the Academy of Dental Materials, provides guidance for performing chemical, structural, and mechanical characterization of materials for periodontal tissue regeneration, and outlines important recommendations on methods of testing bioactivity, biocompatibility, and antimicrobial properties of biomaterials/scaffolds for periodontal tissue engineering. First, we briefly summarize periodontal tissue engineering fabrication methods. We then highlight critical variables to consider when evaluating a material for periodontal tissue regeneration, and the fundamental tests used to investigate them. The recommended tests and designs incorporate relevant international standards and provide a framework for characterizing newly developed materials focusing on the applicability of those tests for peri- odontal tissue regeneration. The most common methods of biofabrication (electrospinning, injectable hydrogels, fused deposition modelling, melt electrowriting, and bioprinting) and their specific applications in periodontal tissue engineering are reviewed. The critical techniques for morphological, chemical, and mechanical charac- terization of different classes of materials used in periodontal regeneration are then described. The major ad- vantages and drawbacks of each assay, sample sizes, and guidelines on specimen preparation are also highlighted. From a biological standpoint, fundamental methods for testing bioactivity, the biocompatibility of materials, and the experimental models for testing the antimicrobial potential are included in this guidance. In conclusion, researchers performing studies on periodontal tissue regeneration will have this guidance as a tool to assess essential properties and characteristics of their materials/scaffold-based strategies.

For patients hospitalized with COVID-19, delirium is a serious and under-recognized complication, and people experiencing homelessness (PEH) may be at greater risk. This retrospective cohort study compared delirium-associated risk factors and clinical outcomes between PEH and non-PEH. This study used patient records from 154 hospitals discharged from 2020–2021 from the Texas Inpatient Public Use Data file. Study subjects (n = 878) were patients, aged 18–69 years, who were hospitalized with COVID-19 and were identified as homeless. The baseline group included (n = 176,518) patients with COVID-19 aged 18–69 years who were not homeless. Logistic regression models were used to identify risk factors for delirium. Relevant risk factors included chronic comorbidities, substance use disorders, and traumatic brain injury (TBI). Seven of the delirium-associated risk factors were more prevalent among PEH compared to baseline. PEH had higher rates of TBI, alcohol, cannabis, and opioid use disorders. PEH had significantly higher rates of delirium (10.6% vs. 8.1%; P<0.01). However, PEH had fewer respiratory complications, including pneumonia (48.5% vs. 81.9%; P<0.001) and respiratory failure (28.7% vs. 61.9%; P<0.001), and lower in-hospital mortality (3.3% vs. 9.5%; P<0.001). The anti-viral Remdesivir had a protective effect against delirium (AOR = 0.63; CI: 0.60, 0.66). Mean hospital length of stay (LOS) was more than twice as long for delirious patients compared with non-delirious patients (18.4 days vs. 7.7 days; P<0.001). Delirium greatly increased the risk of in-hospital mortality (AOR = 3.8; CI: 3.6, 4.0). For PEH (n = 29) who died from COVID-19, delirium was present in more than half (52%) of cases. Hospitals should screen PEH for delirium and adopt nursing protocols to prevent delirium and reduce its severity.

Purpose The purpose of this scoping review was to understand what is known about the friendships of individuals who use augmentative and alternative communication (AAC) devices. Because communication is important to friendship, severe communication impairment may impact the establishment or maintenance of friendships in unique and important ways. Method Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews and Covidence software using an established set of operationally defined inclusion criteria supported the identification of the 46 papers included in this review. Included papers presented original data on the friendships of individuals with disabilities (acquired and developmental) who could benefit from AAC across the lifespan. Data were extracted to identify features of the body of literature and to identify themes that could inform future research and clinical practice. Results Themes identified from the included studies related to how friendship is defined, supports for friendship formation and maintenance, help and care in friendships, positive outcomes, barriers, the impact of AAC, and recommendations for moving clinical practice and research forward. Conclusions Friendships are chosen relationships that stem from congruences in perspectives between two individuals. People who use AAC, like the broader population, are likely to seek out and maintain friendships with people who are similar to them: people who share personality traits, past experiences (including experiencing disability), interests, and activities. Creative solutions are needed to increase the independence of disabled children and adults to meet and engage with new people with a variety of lived experiences. Supplemental Material https://doi.org/10.23641/asha.28119857

Executive functioning (EF) has been linked to chronic disease risk in children. Health behaviors are thought to partially explain this association. The current cross-sectional study evaluated specific domains of EF and varied health behaviors in three pediatric life stages. Pediatric participants (early childhood n = 2074, Mage = 6.4 ± 0.9 y; middle childhood n = 3230, Mage = 9.6 ± 1.2 y; adolescence n = 1416, Mage = 15.2 ± 1.7 y) were part of the Environmental influences on Child Health Outcomes (ECHO) Program. They completed neurocognitive tasks measuring cognitive flexibility, behavioral inhibition, and working memory. Parent- and/or child-report measures of dietary intake, physical activity, sleep duration and quality, income, and positive parenting were also collected. Neighborhood crime and greenspace were calculated from publicly available census-tract level indices. After adjusting for study site, child body mass index, and demographics, working memory was related in the hypothesized direction to several dietary behaviors within all pediatric life stages. Working memory and cognitive flexibility were positively related to physical activity in middle childhood and adolescence. In adolescence, behavioral inhibition was positively related to physical activity and inversely related to sugar-sweetened beverage and total caloric intake. Associations with sleep were all non-significant. All significant associations reflected small effect sizes. Income, positive parenting, greenspace, and crime did not significantly influence any of the EF-health behavior associations. Findings highlight the need to consider EF domains, specific health behaviors, and developmental stage in creating intervention strategies that target EF to improve health behaviors. The small effect sizes reinforce the need for multi-tiered interventions to maximize health.

This JAMA Patient Page describes community-acquired pneumonia (CAP) and its risk factors, symptoms, diagnosis, treatment, and prevention measures.

Specialized metabolites are molecules involved in plants' interaction with their environment. Elucidating their biosynthetic pathways is a challenging but rewarding task, leading to societal applications and ecological insights. Furanocoumarins emerged multiple times in Angiosperms, raising the question of how different enzymes evolved into catalyzing identical reactions. To identify enzymes producing lineage‐specific metabolites, an evolutionary‐based approach was developed and applied to furanocoumarin biosynthesis in Ficus carica (Moraceae). This led to the characterization of CYP71B129–131a, three P450 enzymes whose evolution of the function was investigated using phylogenetics, structural comparisons and site‐directed mutagenesis. CYP71B129 and CYP71B130,131a were found to hydroxylate umbelliferone (coumarin) and xanthotoxin (furanocoumarin), respectively. Results suggest that CYP71Bs xanthotoxin hydroxylase activity results from duplications and functional divergence of umbelliferone hydroxylase genes. Structural comparisons highlighted an amino acid affecting CYP71Bs substrate specificity, which may play a key role in allowing xanthotoxin hydroxylation in several P450 subfamilies. CYP71B130‐131a characterization validates the proposed enzyme‐discovery approach, which can be applied to different pathways and help to avoid the classic bottlenecks of specialized metabolism elucidation. The CYP71Bs also exemplify how furanocoumarin‐biosynthetic enzymes can stem from coumarin‐biosynthetic ones and provides insights into the molecular mechanisms underlying the multiple emergences of xanthotoxin hydroxylation in distant P450 subfamilies.

PURPOSE Stigma contributes to fear and shame, resulting in delays in care-seeking behavior among individuals with cancer. As a social construct, stigma is affected by language, religion, culture, and local norms. This study explored pediatric cancer stigma at the time of diagnosis across diverse settings through the adaptation of two stigma measures. METHODS This study was conducted with adolescents and caregivers of children with osteosarcoma and retinoblastoma at three centers in Jordan, Guatemala, and Zimbabwe. The Stigma-related Social Problems (SSP) and the eight-item Stigma Scale for Chronic Illness (SSCI-8) measures were translated into Arabic, Spanish, and Shona and contextually adapted for use with adolescents and caregiver proxies. Adapted measures were pilot-tested and iteratively revised. RESULTS Extensive adaptations were made to both measures to make them relevant to the local pediatric contexts. The final measures were used in nine patients and 28 caregivers. The exploratory analysis found that domain-specific and overall scale scores for both measures indicate a higher level of stigma than those found in previous studies (SSP: patient [51.23], caregiver [40.74]; SSCI-8: patient [50.41], caregiver [49.78]). Paired, patient-caregiver proxy responses were analyzed, with disagreement between the pairs for both scales. CONCLUSION Adapted measures detected high levels of stigma among patients with pediatric cancer and their caregiver proxies and demonstrated a lack of concordance in the reports. This suggests the importance of studying stigma in this population and the need to ask patients about their stigma without using proxy measures. The required adaptations suggest a need for stigma measures developed specifically for pediatric cancer.

Prevalence of autism diagnosis has historically differed by demographic factors. Using data from 8224 participants drawn from the Environmental influences on Child Health Outcomes (ECHO) Program, we examined relationships between demographic factors and parent‐reported autism‐related traits as captured by the Social Responsiveness Scale (SRS; T score > 65) and compared these to relations with parent‐reported clinician diagnosis of ASD, in generalized linear mixed effects regression analyses. Results suggested lower odds of autism diagnosis, but not of SRS T > 65, for non‐Hispanic Black children (adjusted odds ratio [OR] = 0.76, 95% CI 0.55, 1.06) relative to non‐Hispanic White children. Higher maternal education was associated with reduced odds of both outcomes (OR = 0.73, 95% CI 0.51, 1.05 for ASD autism diagnosis and 0.4, 95% CI 0.29, 0.55 for SRS score). In addition, results suggested a lower likelihood of autism diagnosis but a higher likelihood of an SRS score > 65 in Black girls. Findings suggest lower diagnostic recognition of autism in non‐Hispanic Black children, despite a similar degree of SRS‐assessed autism‐related traits falling in the clinically elevated range. Further work is needed to address this disparity.

Pediatric solid organ transplant (SOT) recipients with splenic dysfunction are at increased risk for infections, and tailored guidance on the management of asplenia/hyposplenism among SOT recipients is often lacking. The purpose of this article is to provide practice recommendations via a frequently asked questions (FAQs) format that focuses on three main domains: the identification of asplenia/hyposplenism among SOT recipients/candidates, prophylactic strategies for mitigating the risk of invasive disease associated with splenic dysfunction in the context of transplantation, and the provision of appropriate patient counseling on the risks associated with asplenia/hyposplenism. Answers to the FAQs are based on international expert opinion informed by practices for managing splenic dysfunction and associated data in other populations with asplenia. Gaps in the existing literature and relevant research aims are emphasized.