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Electronic cigarettes (e-cigarettes) are handheld, battery-powered vaporizing devices. It is estimated that more than 25% of youth have used these devices recreationally. While vaping-associated lung injury is an increasingly recognized risk, little is known about the risk of traumatic injuries associated with e-cigarette malfunction.A multi-institutional retrospective study was performed by querying the electronic health records at nine children's hospitals. Patients who sustained traumatic injuries while vaping from January 2016 through December 2019 were identified. Patient demographics, injury characteristics, and the details of trauma management were reviewed.15 children sustained traumatic injuries due to e-cigarette explosion. The median age was 17 y (range 13-18). The median injury severity score was 2 (range 1-5). Three patients reported that their injury coincided with their first vaping experience. Ten patients required hospital admission, three of whom required intensive care unit admission. Admitted patients had a median length of stay of 3 d (range 1-6). The injuries sustained were: facial burns (6), loss of multiple teeth (5), thigh and groin burns (5), hand burns (4), ocular burns (4), a radial nerve injury, a facial laceration, and a mandible fracture. Six children required operative intervention, one of whom required multiple operations for a severe hand injury.In addition to vaping-associated lung injury, vaping-associated traumatic injuries are an emerging and worrisome injury pattern sustained by adolescents in the United States. This report highlights another means by which e-cigarettes pose an increasing risk to a vulnerable youth population.

Current studies show cryoablation decreases opioid requirements and lengths of stay (LOS) in patients undergoing the Nuss procedure for pectus excavatum. This study evaluated the relationship between cryoablation and clinical outcomes for the Nuss procedure.A retrospective single-center chart review was performed on patients undergoing the Nuss procedure with intercostal cryoablation from December 2017-August 2021. Demographics, hospital course, and postoperative complications were abstracted. To evaluate the evolution of outcomes over time, the earliest quarter (Q1) of cryoablation patients was compared to the last quarter (Q4).Over 45 months, 350 Nuss procedures with cryoablation were performed. The mean age at operation was 15.7 ± 2.3 years with an average Haller Index of 5.4 ± 4.2. The mean operative time was 136 ± 40.5 minutes. On average, patients used 2.8 ± 2.5 OME/kg of opioid in hospital with a LOS of 2.7 ± 1.1 days. The Q4 patients were discharged 1.3 days earlier (p0.05) than Q1 patients, with 80% of Q4 discharged by postoperative day #2 vs. 23% in Q1 (p0.05). Q4 patients received 74% (p0.05) less opioid in hospital and 21% (p0.05) less on discharge. Within 90 days postoperatively, complication rates (chest tube placement, wound infection, readmission, neuropathic pain) were similar. Only two patients (0.6%) required reoperation for bar migration/slippage.With increased experience, cryoablation for the Nuss procedure decreased opioid use by 74% and was associated with 80% of patients achieving early discharge. Major complication rates were not increased. Cryoablation can be successfully implemented as an effective method of postoperative analgesia.Level III.

International audience; Orbiting Earth's dayside outer magnetosphere on 29 September 2015, the Magnetospheric Multiscale (MMS) satellites measured plasma composition, simultaneous electromagnetic ion cyclotron waves, and intermittent fast plasma flows consistent with ultralow frequency waves or convection. Such flows can accelerate typically unobservable low-energy plasma into a measurable energy range of spacecraft plasma instrumentation. We exploit the flow occurrence to ensure measurement of cold ion species alongside the hot particles—consisting of ionospheric heavy ions and solar wind He++—during a subinterval of wave emissions with spectral properties previously described as peculiar. Through application of the composition and multisatellite wave vector data to linear theory, we demonstrate the emissions are in fact consistent with theory, growing naturally in the He++ band with sufficient free energy.

Peptide and dendritic cell vaccines activate the immune system against tumor antigens to combat brain tumors. Vaccines stimulate a systemic immune response by inducing both antitumor T cells as well as humoral immunity through antibody production to cross the blood-brain barrier and combat brain tumors. Recent trials investigating vaccines against peptides (ie, epithelial growth factor receptor variant III, survivin, heat shock proteins, or personalized tumor antigens) and dendritic cells pulsed with known peptides, messenger RNA or unknown tumor lysate targets demonstrate the potential for therapeutic cancer vaccines to become an important therapy for brain tumor treatment.

We report observations of the ion dynamics inside an Alfven branch wave that propagates near the reconnecting dayside magnetopause. The measured frequency, wave normal angle and polarization are within 1% with the predictions of a dispersion solver, and indicate that the wave is an electromagnetic ion cyclotron wave with very oblique wave vector. The magnetospheric plasma contains hot protons (keV), cold protons (eV), plus some heavy ions. The cold protons follow the magnetic field fluctuations and remain frozen-in, while the hot protons are at the limit of magnetization.The cold proton velocity fluctuations contribute to balance the Hall term in Ohm's law, allowing the wave polarization to be highly-elliptical and right-handed, a necessary condition for propagation at oblique wave normal angles. The dispersion solver indicates that increasing the cold proton density facilitates generation and propagation of these waves at oblique angles, as it occurs for the observed wave.

Although thorough characterization of magnetospheric ion composition is rare for EMIC wave studies, convective processes that occur more frequently in Earth’s outer magnetosphere have allowed the Magnetospheric Multiscale (MMS) satellites to make direct measurements of the cold and hot plasma composition during EMIC wave activity. We will present an observation and linear wave modeling case study conducted on EMIC waves observed during a perturbed activity period in the outer dusk-side magnetosphere. During the two intervals investigated for the case study, the MMS satellites made direct measurements of cold plasmaspheric plasma in addition to multiple hot ion components at the same time as EMIC wave emissions were observed. Applying the in-situ plasma composition data to wave modeling, we find that wave growth rate is impacted by the complex interactions between the cold as well as the hot ion components and ambient plasma conditions. In addition, we observe that linear wave properties (unstable wave numbers and band structure) can significantly evolve with changes in cold and hot ion composition. Although the modeling showed the presence of dense cold ions can broaden the range of unstable wave numbers, consistent with previous work, the hot heavy ions that were more abundant nearer storm main phase could limit the growth of EMIC waves to smaller wave numbers. In the inner magnetosphere, where higher cold ion density is expected, the ring current heavy ions could also be more intense near storm-time, possibly resulting in conditions that limit the interactions of EMIC waves with trapped radiation belt electrons to multi-MeV energies. Additional investigation when direct measurements of cold and hot plasma composition are available could improve understanding of EMIC waves and their interactions with trapped energetic particles in the inner magnetosphere.

Electromagnetic ion cyclotron (EMIC) waves play important roles in particle loss processes in the magnetosphere. Determining the evolution of EMIC waves as they propagate and how this evolution affects wave‐particle interactions requires accurate knowledge of the wave vector, k. We present a technique using the curl of the wave magnetic field to determine k observationally, enabled by the unique configuration and instrumentation of the Magnetospheric MultiScale (MMS) spacecraft. The wave curl analysis is demonstrated for synthetic arbitrary electromagnetic waves with varying properties typical of observed EMIC waves. The method is also applied to an EMIC wave interval observed by MMS on October 28, 2015. The derived wave properties and k from the wave curl analysis for the observed EMIC wave are compared with the Waves in Homogenous, Anisotropic, Multi‐component Plasma (WHAMP) wave dispersion solution and with results from other single‐ and multi‐spacecraft techniques. We find good agreement between k from the wave curl analysis, k determined from other observational techniques, and k determined from WHAMP. Additionally, the variation of k due to the time and frequency intervals used in the wave curl analysis is explored. This exploration demonstrates that the method is robust when applied to a wave containing at least 3–4 wave periods and over a rather wide frequency range encompassing the peak wave emission. These results provide confidence that we are able to directly determine the wave vector properties using this multi‐spacecraft method implementation, enabling systematic studies of EMIC wave k properties with MMS., Key Points The wave curl analysis is a new implementation of determining k using observed wave magnetic field and associated current densityThe wave curl analysis reliably determines k for both synthetic waves and Magnetospheric MultiScale observations of electromagnetic ion cyclotron wavesThe calculated k is robust relative to time and frequency ranges used in the analysis, and agrees well with linear dispersion theory

AeroCube-10 is a two-CubeSat mission built and operated by The Aerospace Corporation. Among several payloads is a space solar cell experiment designed to measure solar cell radiation damage as well as the space radiation environment believed to cause it. This paper describes first on-orbit results of the space solar cell experiment on AeroCube-10.

The near-Earth radiation environment is a force to contend with when designing satellites and their instruments. Solar storms can accelerate and transport energetic particles closer to Earth, populating Earth’s radiation belts and increasing a satellite’s radiation dosage. A major application to the field of space weather is therefore knowing and understanding the near-Earth radiation environment. We use Van Allen Probe data throughout mission lifetime to look at electron fluxes at different energies, pitch angles, and L shells, creating a daily average flux model that can be used to deduce what fluences were observed by any satellite that flew within Van Allen Probe’s seven-year mission. We supplement Van Allen Probe fluxes with THEMIS statistical fluxes at higher L shells. This model can be applied to better understand satellite degradation issues related to the radiation environment. It is an improvement from previous empirical models in this regard by virtue of the fact that actual fluxes from a specific storm (or storms) can be deduced and compared to real satellite degradation data.

It is believed that electrosprayed proteins and protein complexes can retain solution-like conformations in the gas phase. However, the lack of high-resolution structure determination methods for gaseous protein ions implies that their properties remain poorly understood. Many practitioners tackle this difficulty by complementing mass spectrometry-based experiments with molecular dynamics (MD) simulations. It is a potential problem that the standard MD force fields used for this purpose (such as OPLS-AA/L and CHARMM) were optimized for solution conditions. The question whether these force fields produce meaningful gas-phase data has received surprisingly little attention. Standard force fields are overpolarized to account for an aqueous environment, i.e., atomic charges and intramolecular dipole moments are ∼20% larger than predicted by gas-phase ab initio methods. Here, we examined the implications of this overpolarization by conducting a series of MD simulations on electrosprayed proteins. Force fields were modified via a charge scaling factor (CSF), while ensuring that the net protein charge remained unchanged. CSF = 0.8 should roughly eliminate water-associated overpolarization. Gas-phase CHARMM simulations on myoglobin with CSF = 0.8 and with unmodified parameters (CSF = 1) yielded similar results, preserving a compact structure that was consistent with ion mobility experiments. Major structural changes caused by weakened charge-dipole and dipole-dipole contacts occurred only when lowering CSF to physically unreasonable values (0.5 and 0.1). Similar results were obtained in mobile-proton OPLS-AA/L simulations on the collision-induced dissociation of transthyretin. Our data support the view that gas-phase MD simulations with standard (solution) force fields are suitable for modeling gaseous protein ions in a semiquantitative manner. Although this is welcome news for the mass spectrometry community, it is hoped that dedicated gas-phase MD force fields will become available in the near future.

AM0 solar cell measurements currently require calibrated balloon standards for tuning solar simulators. The uncertainty in the solar cell measurement is largely dependent on the quality of the calibrated balloon standard used to tune the simulator. Current practices reduce this uncertainty to ∼1% while requiring expensive and infrequent methods for obtaining new calibration standards. This paper outlines an effort to reduce the uncertainty of the calibration standard, while providing a solution for low cost and frequent standard creation.

The Aerospace Corporation’s AeroCube-6 nanosatellites collected simultaneous on-orbit micro-dosimeter and experimental solar cell data. Building on the results of this previous mission, we have developed new instrumentation and a new experiment to better characterize on-orbit degradation of space solar cells while measuring the charged particle radiation causing it. This paper discusses initial ground test results and instrument development efforts for a payload to be flown on a new mission, called AeroCube-10.

Electromagnetic ion cyclotron (EMIC) wave generation and propagation in Earth's magnetosphere depend on readily measurable hot (a few to tens of keV) plasma sheet ions, elusive plasmaspheric or ionospheric cold (sub-eV to a few eV) ions, and partially heated warm ions (tens to hundreds of eV). Previous work has assumed all low-energy ions are cold and not considered possible effects of warm ions. Using measurements by multiple Time History of Events and Macroscale Interactions during Substorms spacecraft, we analyze four typical EMIC wave events in the four magnetic local time sectors and consider the properties of both cold and warm ions supplied from previous statistical studies to interpret the wave observations using linear theory. As expected, we find that dusk EMIC waves grow due to the presence of drifting hot anisotropic protons and cold plasmaspheric ions with a dominant cold proton component. Near midnight, EMIC waves are less common because warm heavy ions that suppress wave growth are more abundant there. The waves can grow when cold, plume-like density enhancements are present, however. Dawn EMIC waves, known for their peculiar properties, are generated away from the equator and change polarization during propagation through the warm plasma cloak. Noon EMIC waves can also be generated nonlocally and their properties modified during propagation by a plasmaspheric plume combined with low-energy ions from solar and terrestrial sources. Accounting for multiple ion species, measured wave dispersion, and propagation characteristics can explain previously elusive EMIC wave properties and are therefore important for future studies of EMIC wave effects on energetic particle depletion.

Plasma flows related to magnetospheric convection or ULF waves often increase cold ions' kinetic energy sufficiently above the spacecraft potential energy so that these ions can be detected by charged particle instrumentation. Other detection methods also reveal the presence of cold ions even in the absence of flows. By applying such methods to complementary data sets obtained from particle, electric field, and magnetic field measurements by the multiple Time History of Events and Macroscale Interactions during Substorms spacecraft, we study the occurrence rates of cold ions and properties—composition, densities, and temperatures—of the dominant species (H+, He+, and O+) near the equatorial magnetosphere. As plasma flows occur at all magnetic local time (MLT) sectors, predominantly outside the plasmasphere, they enable studies of cold ion occurrence and properties as functions of geocentric distance (up to 13 RE) and MLT. Of the dominant cold ions, protons are most abundant on the dayside and coldest almost everywhere. By comparison, the heavier ions show evidence of larger abundance on the nightside and higher temperatures at most locations: median nHe+/nH+ is ≤0.1 in the afternoon, ≥1.0 on the nightside, and near 0.5 at dawn; median nO+/nH+ exceeds 1 throughout the nightside and around dawn at smaller geocentric distances but varies from 0.0 to 0.1 in the afternoon; and TO+ > THe+ everywhere. By isolating the convective particle drift component of measured ion flows, we deduce that nightside/dawn/prenoon cold ions are components of the warm plasma cloak while cold ions near noon/afternoon are likely of mixed origin, including nightside/cusp outflow, plasmaspheric plumes, and the solar wind.

Stridor is a common presenting symptom in young children and is produced by turbulent flow through the upper airway or trachea. In children under 12 months of age, stridor is commonly caused by laryngomalacia, tracheomalacia, croup, airway foreign body, and/or retropharyngeal abscess. In atypical presentations of stridor, soft tissue neck radiographs can be helpful to determine the underlying etiology. Occasionally, children will require bronchoscopy to determine the etiology and treatment.

The Aerospace Corporation has been building, testing, and flying miniature satellites in the pico-and nano-satellite class for over a decade. Significant advances have been made to the bus avionics unit and other satellite subsystems during this time. The advances have enabled various on-orbit tests and experiments, one of which has been to host space solar cell experiment payloads. Recent solar cell flight experiments on Aerospace's CubeSats (AeroCubes) demonstrated several subsystems can simultaneously operate to obtain precise measurements of space solar cell performance. Low cost, rapid return CubeSat missions can be valuable development tools for advancing the readiness level of space technologies.

This paper reviews the state of knowledge concerning the source of magnetospheric plasma at Earth. Source of plasma, its acceleration and transport throughout the system, its consequences on system dynamics, and its loss are all discussed. Both observational and modeling advances since the last time this subject was covered in detail (Hultqvist et al., Magnetospheric Plasma Sources and Losses, 1999) are addressed.

No formal criteria exist to determine the need for admission of injured children to the pediatric intensive care unit. Our objective was to analyze trauma patient admissions to the PICU at a level 1 pediatric trauma center.The trauma registry was analyzed between 2002 and 2015. A preventable PICU admission was defined as a child discharged home or transferred out of the PICU within 30h without surgical intervention, blood transfusion, or ventilator support.Of 16,209 children, 19% were admitted to the PICU: mean age 7.3years, median ISS 17, and overall mortality 7%. Per our definition, 36% were preventable PICU admissions of which 83% suffered a head injury. The preventable admissions were younger (6.9 vs. 7.6years, p0.001) with a lower median ISS (16 vs. 21, p0.001), shorter median PICU LOS (17 vs. 41h, p0.001) and shorter median hospital LOS (51 vs. 121h, p0.001). These admissions resulted in total facility charges of $9,981,454.76 with 54% produced by children with an isolated head injury.A significant number of children admitted to our PICU were classified as preventable. They carry a substantial economic burden to the health care system with an overutilization of resources. Methods to limit such admissions should be actively pursued.

Torsion of exophytic liver focal nodular hyperplasia (FNH) is a previously undescribed cause of acute abdominal pain in children. We report two cases of torsion of exophytic focal nodular hyperplasia causing acute abdominal pain successfully treated with surgical resection.

Injured children are often treated at one facility then transferred to another that specializes in pediatric trauma care. The purpose of this study was to identify and characterize potentially preventable transfers (PT) to a freestanding level-I pediatric trauma center.Children with traumatic injuries transferred between 2003 and 2013 were retrospectively analyzed. A PT was defined as a child who was discharged within 36hours of arrival without surgical intervention or advanced imaging studies.During this period, 6380 children were transferred, with head injury being the most common injury. 61% had CT imaging performed before transfer. The mean age was 6.9years, mean injury severity score (ISS) 10.4, and median transfer distance 37miles. 27% of these transfers were classified as PT. Air transport was used in 15% at mean charge of $18,574. 29% were discharged from the emergency department. When compared, PTs were younger (6.0 vs. 7.2years, p0.001), with lower median ISS (5 vs. 9, p0.001), shorter median LOS (15 vs. 43.6hours, p0.001), and less PICU admissions (6% vs. 34%, p0.001).A significant number of pediatric trauma transfers can be classified as preventable. Reducing preventable transfers could offer opportunities for improving value in a trauma care system.

A term male baby, after delivery, was found to have a 3-centimeter beefy-red mass protruding from the left chest wall, adjacent to the left nipple. Radiological imaging suggested it’s origin from the left lateral liver segment. A diagnostic laparoscopy confirmed the isolated connection to the liver, elevated left hemidiaphragm, and protrusion between the ribs. The mass was excised using electrocautery, and pathologic examination showed normal liver tissue.

Objectives Successful removal of an airway foreign body can be very challenging. We present three patients with airway foreign body aspiration successfully treated using extracorporeal membrane oxygenation (ECMO). Their clinical presentation and findings will be reviewed to determine when ECMO should be considered for treatment. Study design Retrospective multi-institutional review of a case series of patients with airway foreign body who underwent successful treatment using ECMO. Method After institutional review board approval, the use of ECMO during airway foreign body procedures in children was reviewed from the pediatric research in otolaryngology (PRO) network. This network comprises of over 20 Children's hospitals to improve the health of and healthcare delivery to children and their families with otolaryngology conditions. Specific parameters were recorded for each patient. Results Three children presented with airway foreign body and required ECMO for successful removal. Mean age was 18 months. Presenting symptoms included severe and worsening respiratory distress. Indications for ECMO included an inability to perform rigid bronchoscopy due to the child's unstable respiratory status and an airway foreign body lodged in the trachea that could not be removed without potential loss of airway support. All three children underwent successful removal of their airway foreign bodies. There were no complications from ECMO or bronchoscopy. Conclusion ECMO may be a useful adjunct in cases of life threatening airway foreign body aspiration.

In vitro generation of human urothelium from stem cells would be a major advancement in the regenerative medicine field, providing alternate nonurologic and/or nonautologous tissue sources for bladder grafts. Such a model would also help decipher the mechanisms of urothelial differentiation and would facilitate investigation of deviated differentiation of normal progenitors into urothelial cancer stem cells, perhaps elucidating areas of intervention for improved treatments. Thus far, in vitro derivation of urothelium from human embryonic stem cells (hESCs) or human induced pluripotent stem (hiPS) cells has not been reported. The goal of this work was to develop an efficient in vitro protocol for the induction of hESCs into urothelium through an intermediary definitive endoderm step and free of matrices and cell contact. During directed differentiation in a urothelial-specific medium (“Uromedium”), hESCs produced up to 60% urothelium, as determined by uroplakin expression; subsequent propagation selected for 90% urothelium. Alteration of the epithelial and mesenchymal cell signaling contribution through noncell contact coculture or conditioned media did not enhance the production of urothelium. Temporospatial evaluation of transcription factors known to be involved in urothelial specification showed association of IRF1, GET1, and GATA4 with uroplakin expression. Additional hESC and hiPS cell lines could also be induced into urothelium using this in vitro system. These results demonstrate that derivation and propagation of urothelium from hESCs and hiPS cells can be efficiently accomplished in vitro in the absence of matrices, cell contact, or adult cell signaling and that the induction process appears to mimic normal differentiation.

[1] Observations of left-hand polarized electro-magnetic ion cyclotron (EMIC) waves with significant wave power across fHe+ are presented. Concurrent field and particle measurements reveal pitch angle scattering of thermal ions during the interval of maximum wave power. The observations suggest the presence of multiple cold ion species (H+, He+) at this time, below the sum of spacecraft potential and minimum energy of the ion instrument (i.e.

Clinicians use general practice guidelines as a source of support for their intervention, but how much confidence should they place on these recommendations? How much confidence should patients place on these recommendations? Various instruments are available to assess the quality of evidence of research, such as the revised Wong scale (R-Wong) which examines the quality of research design, methodology and data analysis, and the revision of the assessment of multiple systematic reviews (R-AMSTAR), which examines the quality of systematic reviews.The Grading of Recommendation Assessment, Development, and Evaluation (GRADE) Working Group developed an instrument called the GRADE system in order to grade the quality of the evidence in studies and to evaluate the strength of recommendation of the intervention that is proposed in the published article. The GRADE looks at four factors to determine the quality of the evidence: study design, study quality, consistency, and directness. After combining the four components and assessing the grade of the evidence, the strength of recommendation of the intervention is established. The GRADE, however, only makes a qualitative assessment of the evidence and does not generate quantifiable data.In this study, we have quantified both the grading of the quality of evidence and also the strength of recommendation of the original GRADE, hence expanding the GRADE. This expansion of the GRADE (Ex-GRADE) permits the creation of a new instrument that can produce tangible data and possibly bridge the gap between evidence-based research and evidence-based clinical practice.

This document reports the lot characterization and sample testing required for certification of a new lot of Moli-Energy Li-lon ICR-18650H 2200-mAh, 3.75-V cells to be used for a future picosatellite (PicoSat) or CubeSat flight experiment. Results from the required screening of 100% of the flight cells that constitute this new lot are also presented. All testing began upon receipt of the new cell lot in March 2(K)9 and was performed with the primary objective of flight certifying the cells according to NASA standards. The present document supersedes a previous document published in 2(M)9 on a similar subject.