Pediatric Rheumatologic Effects of COVID-19
A multisystem inflammatory syndrome (MISC) can result from COVID-19 infection in previously healthy children and adolescents. It is potentially life threatening and is treated initially with intravenous immunoglobulin and aspirin but may require anti-inflammatory monoclonal antibody treatment in severe cases. SARS-CoV-2 infection can cause macrophage activation syndrome, chilblains, and flares of existing rheumatologic diseases. The pandemic has led to later presentation of some rheumatologic conditions as parents and patients have avoided health care settings. PubMed and Google scholar have been utilized to review the lit...
Source: Pediatric Clinics of North America - September 17, 2021 Category: Pediatrics Authors: Nivine El-Hor, Matthew Adams Source Type: research

Child Maltreatment During the COVID-19 Pandemic
The present study is systematic rapid review on the nature of the relationship between the COVID-19 pandemic and child maltreatment. Database searches on December 28, 2020, identified 234 unique citations; 12 were ultimately included in our analysis. Included articles measured child maltreatment inclusive of physical, psychological, and sexual abuse, and child neglect during the COVID-19 pandemic. Compared with the prepandemic period, 5 articles found an increase in child maltreatment, 6 articles found a decrease, and 1 study found no difference. There existed variation in geography of study location, age of child maltreat...
Source: Pediatric Clinics of North America - September 17, 2021 Category: Pediatrics Authors: Ashley Rapp, Gloria Fall, Abigail C. Radomsky, Sara Santarossa Source Type: research

Neurological Effects of COVID-19 in Children
The COVID-19 pandemic has spread rapidly across the world in 2020, affecting both adults and, to a lesser extent, children. In this article, the authors describe the neurologic manifestations of COVID-19 in children, including the epidemiology, pathogenesis, clinical features, laboratory and imaging findings, and treatment options. The management of patients with concomitant neuroimmunologic disorders and drug interactions between medications used to treat COVID-19 and other neurologic disorders (especially immune-modifying drugs) is also discussed. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - September 17, 2021 Category: Pediatrics Authors: Tuhina Govil-Dalela, Lalitha Sivaswamy Source Type: research

Health Disparities and Their Effects on Children and Their Caregivers During the Coronavirus Disease 2019 Pandemic
This article explores how the COVID-19 pandemic superimposed on health disparities directly and indirectly affects children, adolescents, and their caregivers. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - September 17, 2021 Category: Pediatrics Authors: Lynn C. Smitherman, William Christopher Golden, Jennifer R. Walton Source Type: research

COVID-19 Pandemic, Children, Pediatricians, and the Future
Severe acute respiratory syndrome coronavirus 2 (more widely known as COVID-19) appears to have made its global debut in December 2019 in China.1 To date (July 4, 2021), 172,612 publications regarding COVID-19 have been recognized by the United States National Library of Medicine (accessible through PubMed). To put into perspective the massive amount of work that this represents over such a short time, let us turn to the publications regarding the human immunodeficiency virus (HIV), also a pandemic of enormous and continuing global recognition, importance, and cost. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - September 17, 2021 Category: Pediatrics Authors: Bonita F. Stanton Tags: Foreword Source Type: research

Covid-19 in Children
PEDIATRIC CLINICS OF NORTH AMERICA (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - September 17, 2021 Category: Pediatrics Authors: Elizabeth Secord, Eric J. McGrath Source Type: research

Copyright
ELSEVIER (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - September 17, 2021 Category: Pediatrics Source Type: research

Contributors
BONITA F. STANTON, MD (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - September 17, 2021 Category: Pediatrics Source Type: research

Contents
Bonita F. Stanton (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - September 17, 2021 Category: Pediatrics Source Type: research

Forthcoming Issues
Pediatric Gastroenterology (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - September 17, 2021 Category: Pediatrics Source Type: research

CME Accreditation Page
(Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - September 17, 2021 Category: Pediatrics Source Type: research

COVID-19 and Pediatric Gastroenterology
Pediatric gastroenterologists took on a variety of challenges during the COVID-19 pandemic, including learning about a new disease and how to recognize and manage it, prevent its spread among their patients and health professions colleagues, and make decisions about managing patients with chronic gastrointestinal and liver problems in light of the threat. They adapted their practice to accommodate drastically reduced in-person visits, adopting telehealth, and instituting new protocols to perform endoscopies safely. The workforce pipeline was also affected by the pandemic because of its impact on trainee education, clinical...
Source: Pediatric Clinics of North America - July 26, 2021 Category: Pediatrics Authors: Richard Taylor, Daniel Mallon Source Type: research

How Do We Take Care of Children During this COVID-19 Pandemic?
On March 10, 2021, a colleague of mine posted the following on Facebook, “A year ago today we were living the last normal week of our lives, and we had no idea.” He was, of course, correct that we have shared a very life-altering and very difficult year due to COVID-19. In the United States alone, over half a million have died of COVID-19; many jobs have been lost, a nd our way of life has been grossly altered due to loss, social distancing, and pandemic precautions. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 14, 2021 Category: Pediatrics Authors: Elizabeth Secord, Eric J. McGrath Tags: Preface Source Type: research

Preface: How Do We Take Care of Children During this COVID-19 Pandemic?
On March 10, 2021, a colleague of mine posted the following on Facebook, “A year ago today we were living the last normal week of our lives, and we had no idea.” He was, of course, correct that we have shared a very life-altering and very difficult year due to COVID-19. In the United States alone, over half a million have died of COVID-19; many jobs have been lost, a nd our way of life has been grossly altered due to loss, social distancing, and pandemic precautions. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 14, 2021 Category: Pediatrics Authors: Elizabeth Secord, Eric J. McGrath Source Type: research

Review of Pediatric Neurologic History and Age-Appropriate Neurologic Examination in the Office
This article offers pearls on what information to ask the caregivers and patients, and salient aspects of a brief neurologic examination. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Ashley T. Ashby, Alexandra D. Beier Source Type: research

Diagnosis and Management of Suture-Related Concerns of the Infant Skull
The cranial fontanelles and sutures have several benign variations, including most cases of “early” or “late” closure of the anterior fontanelle, bathrocephaly, overriding sutures, and benign metopic ridging. However, recognizing true craniosynostosis and referring the patient to a craniofacial specialist in a timely fashion are imperative, as minimally invasive options can be offe red to most patients younger than 6 months of age. Gaining comfort with the physical examination of an infant with an abnormal head shape is best achieved through experience and pattern recognition and will frequentl...
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: David S. Hersh, Markus J. Bookland, Christopher D. Hughes Source Type: research

Pediatric Neurosurgery in Primary Care
There are a wide variety of scalp and skull lesions that can affect the pediatric population, many of which are first encountered by primary care physicians. The differential consists of a broad range of more common congenital lesions, sequelae of trauma, and vascular anomalies, to very rare neoplastic processes. It is important to understand signs and symptoms that may indicate whether a lesion may be benign versus life threatening, what imaging studies are appropriate and how to interpret them, and when to seek referrals to specialists. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Randaline R. Barnett, Martin G. Piazza, Scott W. Elton Source Type: research

Macrocephaly in the Primary Care Provider ’s Office
Macrocephaly is commonly encountered in the primary care provider ’s office. It is defined as an occipitofrontal circumference that is greater than 2 standard deviations above the mean for the child’s given age. Macrocephaly is a nonspecific clinical finding that may be benign or require further evaluation. An algorithmic approach is useful for aiding in the c linical decision-making process to determine if further evaluation with neuroimaging is warranted. Abnormal findings may signify a harmful underlying cause, requiring referral to a genetic specialist or neurosurgeon. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Jean-Paul Bryant, Nicole E. Hernandez, Toba N. Niazi Source Type: research

Incidental Intracranial Cysts in Children
This article describes three common benign intracranial cysts found in the pediatric population: arachnoid cysts, choroid cysts, and pineal cysts. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Whitney E. Muhlestein, Cormac O. Maher Source Type: research

Pediatric Hydrocephalus and the Primary Care Provider
Hydrocephalus is a pathologic condition that results in the disruption of normal cerebrospinal fluid flow dynamics often characterized by an increase in intracranial pressure resulting in an abnormal dilation of the ventricles. The goal of this article was to provide the necessary background information to understand the pathophysiology related to hydrocephalus, recognize the presenting signs and symptoms of hydrocephalus, identify when to initiate a workup with further studies, and understand the management of pediatric patients with a new and preexisting diagnosis of hydrocephalus. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Smruti K. Patel, Rabia Tari, Francesco T. Mangano Source Type: research

Brain and Spinal Cord Tumors in Children
This article provides general principles of managing children with central nervous system tumors. The distribution, diagnostic work-up, and key principles of treatment are reviewed, and special circumstances that may be encountered by pediatricians in the community are discussed. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Jignesh Tailor, Eric M. Jackson Source Type: research

Intracranial Vascular Abnormalities in Children
This article reviews anatomic intracranial vascular lesions, including vascular malformations (arteriovenous malformations/arteriovenous fistulae and cavernous malformations), structural arteriopathies (aneurysms and moyamoya), and common developmental anomalies of the vasculature. The focus includes a general overview of anatomy, pathology, epidemiology, and key aspects of evaluation for the primary care provider and a review of common questions encountered in practice. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Alaa Montaser, Edward R. Smith Source Type: research

Mild Traumatic Brain Injury in Children
Mild traumatic brain injury accounts for an estimated 4.8 million cases of pediatric traumatic brain injuries worldwide every year. In the United States, 70% of mild traumatic brain injury cases are due to sports and recreational injuries. Early diagnosis, especially in active children, is critical to preventing recurrent injuries. Management is guided by graded protocols for returning to school and activity. Ninety percent of children recover within 1  month of injury. Promising research has shown that early referral to specialty concussion care and multidisciplinary treatment with physical and occupational therapy m...
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Aaron M. Yengo-Kahn, Rebecca A. Reynolds, Christopher M. Bonfield Source Type: research

Cervical Spine Injury in Children and Adolescents
Complaints related to the neck are common following mild pediatric trauma. Although significant cervical spine injuries are most often seen and evaluated in the emergency room or inpatient setting, the primary care provider is faced with the evaluation of lower acuity complaints. We provide a review to assist with the efficient evaluation of these patients to facilitate decisions regarding return to play, the need for imaging, and need for referral to subspecialty providers. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Andrew Jea, Ahmed Belal, Mohamed A. Zaazoue, Jonathan Martin Source Type: research

Caring for the Child with Spina Bifida
This article reviews definitions and types of spina bifida, considerations surrounding the initial treatment, including fetal surgery, and the ongoing neurosurgical management of common comorbid conditions. The role of interdisciplinary care is stressed, as well as the importance of coordinated transition to adult care at an appropriate age and developmental stage. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Brandon G. Rocque, Betsy D. Hopson, Jeffrey P. Blount Source Type: research

Neuroimaging for the Primary Care Provider
This article provides an overview of computed tomography, MRI, ultrasonography, and radiography with an emphasis on indications for use, pitfalls to be avoided, and recent advances. A discussion of the appropriate use of ionizing radiation, intravenous contrast, and sedation is also provided. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Jonathan R. Wood, Robert C. Pedersen, Veronica J. Rooks Source Type: research

Chiari Malformation in Children
Chiari malformation type 1 (CM1) is often found incidentally. However, patients with symptoms or signs referable to CM1 or an associated syrinx will likely benefit from surgical intervention. Patients who are not symptomatic from CM1 at presentation are unlikely to become symptomatic at follow-up. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Gregory W. Albert Source Type: research

Epilepsy Surgery in Children
Epilepsy in children continues to present a major medical and economic burden on society. Left untreated, seizures can present the risk of sudden death and severe cognitive impairment. It is understood that primary care providers having concerns about abnormal movements or behaviors in children will make a prompt referral to a trusted pediatric neurologist. The authors present a brief introduction to seizure types, classification, and management with particular focus on what surgery for epilepsy can offer. Improved seizure control and its attendant improvements in quality of life can be achieved with timely referral and in...
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Luis E. Bello-Espinosa, Greg Olavarria Source Type: research

Cutaneous Stigmata of the Spine
Cutaneous stigmata of the midline spine are a common question in pediatrics. They are known to be related to a higher likelihood of underlying dysraphic spinal abnormalities. Clear understanding of different types of cutaneous stigmata and correlating dysraphic findings can aid in appropriate imaging workup and timely management of patient pathology. In this article, the authors review midline spinal cutaneous findings in the pediatric population with occult spinal dysraphism. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Mandana Behbahani, Sandi K. Lam, Robin Bowman Source Type: research

Review of Tone Management for the Primary Care Provider
Movement disorders in a pediatric population represent a spectrum of secondary functional deficits affecting ease of care, ambulation, and activities of daily living. Cerebral palsy represents the most common form of movement disorder seen in the pediatric population. Several medical and surgical options exist in the treatment of pediatric spasticity and dystonia, which can have profound effects on the functionality of these patients. Given the complex medical and surgical problems in these patients, children are well served by a multidisciplinary team of practitioners, including physical therapists, physical medicine and ...
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Samuel G. McClugage, David F. Bauer Source Type: research

Pediatric Neurosurgery in Primary Care
Alone we do so little; together, we can do so much. —Helen KellerNothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.—Marie CurieColleagues, (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Jonathan Martin, Greg Olavarria Tags: Preface Source Type: research

Pediatric Neurosurgery in Primary Care
Among the estimated 2297 pediatric neurosurgeons in practice globally, the vast majority (86%) work in high-income and upper-middle-income countries. By contrast, an estimated 330 pediatric neurosurgeons serve the 1.2 billion children living in low-income and lower-middle-income countries.1 While especially true for pediatric care providers in countries with limited resources, it is very important for all physicians serving children to understand how much they might be able to accomplish in their offices and/or with readily available diagnostic tests. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Bonita F. Stanton Tags: Foreword Source Type: research

CME Accreditation Page
(Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Source Type: research

Pediatric Neurosurgery in Primary Care
PEDIATRIC CLINICS OF NORTH AMERICA (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Authors: Jonathan Martin, Greg Olavarria Source Type: research

Copyright
ELSEVIER (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Source Type: research

Contributors
BONITA F. STANTON, MD (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Source Type: research

Contents
Bonita F. Stanton (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Source Type: research

Forthcoming Issues
Covid-19 in Children (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - July 9, 2021 Category: Pediatrics Source Type: research

The Behavioral Health Consultant
With the scarcity of mental health services, integration of behavioral health into pediatric primary care increases the accessibility and availability to mental health services to a broad range of patients and their families while bridging the gap of physical and mental health. Encouraging whole-person care, the role of the behavioral health consultant serves as a proactive and preventative means fostering early intervention and detection, as 50% of all lifetime mental health disorders begin by the age of 14 years. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - May 25, 2021 Category: Pediatrics Authors: Heidi Joshi, Pilar Corcoran-Lozano Source Type: research

Funding and Billing for Integrated Behavioral Health Care
Integrated behavioral health care (IBHC) improves patient outcomes, decreases cost, and increases patient satisfaction. It has become increasingly evident that IBHC must be incorporated into the US health care system. Although most health care providers agree that IBHC is beneficial, there is great debate regarding financial sustainability. Some studies have shown that incorporating BHCs into primary care clinics allows providers to see more patients, thus generating more revenue indirectly. In this article, the authors discuss funding and billing for IBHC. The authors truly believe that once properly implemented, IBHC wil...
Source: Pediatric Clinics of North America - May 25, 2021 Category: Pediatrics Authors: Keshav Patel, Roger W. Apple, Jessica Campbell Source Type: research

Ethical and Professional Considerations in Integrated Behavioral Health
This article offers a framework for negotiating potential conflicts between professional norms and expectations across disciplines involved in integrated behavioral health teams. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - May 25, 2021 Category: Pediatrics Authors: Tyler S. Gibb, Parker Crutchfield, Michael J. Redinger, John Minser Source Type: research

Integrated Behavioral Health Collaborative Practice Embedded Within the Pediatric Residency Continuity Clinic
Pediatric patients often work with multiple health care providers for complex presenting concerns. This complexity has called for pediatric health care providers to strengthen interdisciplinary relationships with mental health providers to meet patient needs. Integrated behavioral health collaborative practice models, using the Interprofessional Education Collaborative competencies, provide the necessary scaffolding to train medical and mental health professionals. A multicultural framework can be integrated into the interprofessional education curricula to better equip health care professionals to provide culturally compe...
Source: Pediatric Clinics of North America - May 25, 2021 Category: Pediatrics Authors: Sonia Amin, Kristine M. Gibson, Derrick Bines Source Type: research

Integrated Behavioral Health Role in Helping Pediatricians Find Long Term Mental Health Interventions with the Use of Assessments
This article explores the role of assessments in integrated behavioral health within a pediatric primary care setting, specifically exploring what valid and reliable standardized assessments may be used and for what concerns the assessment be of most use. The article also considers how assessments used by integrated behavioral health may inform the type of evidenced-based intervention that would be most appropriate and efficacious for the patient, as well as assist in determining if longer term or more formal mental health treatment may be required. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - May 25, 2021 Category: Pediatrics Authors: Katie White, Lydia Stetson, Khadijah Hussain Source Type: research

Integrated Behavioral Health
This article describes basic definitions and contexts of integrated pediatric behavioral health. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - May 25, 2021 Category: Pediatrics Authors: Nicole Fledderman, Jocelyn DeLeon, Dilip R. Patel Source Type: research

Integrated Behavioral Health Care
Humans have long sought to be provided with optimal health care, and the research continues in the twenty-first century. In the spirit of Galen from 19 centuries ago, empowering the patient ’s physician remains an important approach in health care. There is an emphasis on primary care and integration of behavioral consultation services in primary care. It remains a work in progress with help from the past and realistic hope for the future. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - May 25, 2021 Category: Pediatrics Authors: Donald E. Greydanus, Roger W. Apple, Summer S. Chahin Source Type: research

Need for Integrated Behavior Health Model in Primary Care
Children and adolescents with clinically concerning behavioral health conditions face several barriers to accessing specialized mental health care. One proposed solution is to improve and expand integrated care provided in the primary health care provider ’s office. Several strategies can increase pediatrician comfort and willingness to collaborate in diagnosing and treating behavioral health conditions, and increased utilization of new technologies (such as telehealth) are likely to play an increasingly important role in the process. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - May 25, 2021 Category: Pediatrics Authors: Kevin Cates, Neelkamal Soares Source Type: research

Behavioral Health in Primary Care
This article outlines screening, brief intervention, and referral guidelines for prominent behavioral health problems seen in primary care. The evidence-based approaches have the potential to supplement typical management of behavioral health problems in primary care and provide a foundation for future integrated behavioral health practice. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - May 25, 2021 Category: Pediatrics Authors: Rachel A. Petts, Scott T. Gaynor Source Type: research

Pediatric Residency Training for Integration of Behavior Health: Indian Perspective
This article examines the current medical training programs for IBH of children and adolescents in curriculum of these programs in India. Pediatrics residency programs are described. The impact of Indian culture on IBH issues is also discussed. Ideas for integrating behavioral health in Medical education in India are given. (Source: Pediatric Clinics of North America)
Source: Pediatric Clinics of North America - May 25, 2021 Category: Pediatrics Authors: Swati Y. Bhave, Harish K. Pemde, Rajesh Mehta Source Type: research

Integrated Behavioral Health in Pediatric Subspecialty Clinics
Millions of children and adolescents are living with a chronic condition. It is common for mental and behavioral health challenges to arise during their courses of illness. With the complexity of care needed, pediatric subspecialty providers have recognized the need to integrate behavioral health interventions into practice. Continued research in this area has allowed for focused behavioral interventions, particularly in diabetes and asthma. Adult congenital heart programs have adapted a similar model of care and have shown promising success in promotion of health. More established programs have been in existence for child...
Source: Pediatric Clinics of North America - May 25, 2021 Category: Pediatrics Authors: Ethel Clemente, Gordon Liu, Maria Demma Cabral Source Type: research

Barriers for Ethnic Minorities and Low Socioeconomic Status Pediatric Patients for Behavioral Health Services and Benefits of an Integrated Behavioral Health Model
The integrated behavioral health care model in primary care has the potential to reduce barriers to care experienced by children and families from ethnic minorities and low socioeconomic status. Limited access to pediatric behavioral health care is a significant problem, with up to 40% of children and adolescents with identified mental disorders and only 30% of them receiving care. Barriers include transportation, insurance, and shortage of specialists. Primary care provider bias, decreased knowledge and feelings of competence, and cultural beliefs and stigma also affect earlier diagnosis and treatment, particularly for Hi...
Source: Pediatric Clinics of North America - May 25, 2021 Category: Pediatrics Authors: Cheryl Dickson, Jessica Ramsay, Joshua VandeBurgh Source Type: research