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Background: Though widely used, resting heart rate (RHR), as measured by a wearable device, has not been previously evaluated in a large cohort against a variety of important baseline characteristics., Objective: This study aimed to assess the validity of the RHR measured by a wearable device compared against the gold standard of ECG (electrocardiography), and assess the relationships between device-measured RHR and a broad range of clinical characteristics., Methods: The Project Baseline Health Study (PHBS) captured detailed demographic, occupational, social, lifestyle, and clinical data to generate a deeply phenotyped cohort. We selected an analysis cohort within it, which included participants who had RHR determined by both ECG and the Verily Study Watch (VSW). We examined the correlation between these simultaneous RHR measures and assessed the relationship between VSW RHR and a range of baseline characteristics, including demographic, clinical, laboratory, and functional assessments., Results: From the overall PBHS cohort (N=2502), 875 (35%) participants entered the analysis cohort (mean age 50.9, SD 16.5 years; n=519, 59% female and n=356, 41% male). The mean and SD of VSW RHR was 66.6 (SD 11.2) beats per minute (bpm) for female participants and 64.4 (SD 12.3) bpm for male participants. There was excellent reliability between the two measures of RHR (ECG and VSW) with an intraclass correlation coefficient of 0.946. On univariate analyses, female and male participants had similar baseline characteristics that trended with higher VSW RHR: lack of health care insurance (both P<.05), higher BMI (both P<.001), higher C-reactive protein (both P<.001), presence of type 2 diabetes mellitus (both P<.001) and higher World Health Organization Disability Assessment Schedule (WHODAS) 2.0 score (both P<.001) were associated with higher RHR. On regression analyses, within each domain of baseline characteristics (demographics and socioeconomic status, medical conditions, vitals, physical function, laboratory assessments, and patient-reported outcomes), different characteristics were associated with VSW RHR in female and male participants., Conclusions: RHR determined by the VSW had an excellent correlation with that determined by ECG. Participants with higher VSW RHR had similar trends in socioeconomic status, medical conditions, vitals, laboratory assessments, physical function, and patient-reported outcomes irrespective of sex. However, within each domain of baseline characteristics, different characteristics were most associated with VSW RHR in female and male participants., Trial Registration: ClinicalTrials.gov NCT03154346; https://clinicaltrials.gov/study/NCT03154346., (©Kent Y Feng, Sarah A Short, Sohrab Saeb, Megan K Carroll, Christoph B Olivier, Edgar P Simard, Susan Swope, Donna Williams, Julie Eckstrand, Neha Pagidipati, Svati H Shah, Adrian F Hernandez, Kenneth W Mahaffey. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 20.12.2024.)

Background: Pectus excavatum (PE) is a common congenital chest wall deformity with various associated health concerns, including psychosocial impacts, academic challenges, and potential cardiopulmonary effects., Objective: This study aimed to investigate the cardiac consequences of right atrioventricular groove compression in PE using cardiac magnetic resonance imaging., Materials and Methods: A retrospective analysis was conducted on 661 patients with PE referred for evaluation. Patients were categorized into three groups based on the degree of right atrioventricular groove compression (no compression (NC), partial compression (PC), and complete compression(CC)). Chest wall indices were measured: pectus index (PI), depression index (DI), correction index (CI), and sternal torsion., Results: The study revealed significant differences in chest wall indices between the groups: PE, NC=4.15 ± 0.94, PC=4.93 ± 1.24, and CC=7.2 ± 4.01 (P<0.0001). Left ventricle ejection fraction (LVEF) showed no significant differences: LVEF, NC=58.72% ± 3.94, PC=58.49% ± 4.02, and CC=57.95% ± 3.92 (P=0.0984). Right ventricular ejection fraction (RVEF) demonstrated significant differences: RVEF, NC=55.2% ± 5.3, PC=53.8% ± 4.4, and CC=53.1% ± 4.8 (P≥0.0001). Notably, the tricuspid valve (TV) measurement on the four-chamber view decreased in patients with greater compression: NC=29.52 ± 4.6; PC=28.26 ± 4.8; and CC=24.74 ± 5.73 (P<0.0001)., Conclusion: This study provides valuable insights into the cardiac consequences of right atrioventricular groove compression in PE and lends further evidence of mild cardiac changes due to PE., (© 2024. The Author(s).)

Objectives: Physical performance tests are predictive of mortality and may screen for certain health conditions (e.g., sarcopenia); however, their diagnostic and/or prognostic value has primarily been studied in age-limited or disease-specific cohorts. Our objective was to identify the most salient characteristics associated with three lower quarter balance and strength tests in a cohort of community-dwelling adults., Methods: We applied a stacked elastic net approach on detailed data on sociodemographic, health and health-related behaviors, and biomarker data from the first visit of the Project Baseline Health Study ( N  = 2,502) to determine which variables were most associated with three physical performance measures: single-legged balance test (SLBT), sitting-rising test (SRT), and 30-second chair-stand test (30CST). Analyses were stratified by age (<65 and ≥65)., Results: Female sex, Black or African American race, lower educational attainment, and health conditions such as non-alcoholic fatty liver disease and cardiovascular conditions (e.g., hypertension) were consistently associated with worse performance across all three tests. Several other health conditions were associated with either better or worse test performance, depending on age group and test. C-reactive protein was the only laboratory value associated with performance across age and test groups with some consistency., Conclusions: Our results highlighted previously identified and several novel salient factors associated with performance on the SLBT, SRT, and 30CST. These tests could represent affordable, noninvasive biomarkers of prevalent and/or future disease in adult individuals; future research should validate these findings., Clinical Trial Registration: ClinicalTrials.gov, identifier NCT03154346, registered on May 15, 2017., Competing Interests: MC and SS are employees of Verily Life Sciences. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Taylor, Carroll, Short, Celestin, Gilbertson, Olivier, Haddad and Cauwenberghs.)

Low hand grip strength (HGS) is associated with several conditions, but its value outside of the older adult population is unclear. We sought to identify the most salient factors associated with HGS from an extensive list of candidate variables while stratifying by age and sex. We used data from the initial visit from the Project Baseline Health Study (N = 2502) which captured detailed demographic, occupational, social, lifestyle, and clinical data. We applied MI-LASSO using group methods to determine variables most associated with HGS out of 175 candidate variables. We performed analyses separately for sex and age (< 65 vs. ≥ 65 years). Race was associated with HGS to varying degrees across groups. Osteoporosis and osteopenia were negatively associated with HGS in female study participants. Immune cell counts were negatively associated with HGS for male participants ≥ 65 (neutrophils) and female participants (≥ 65, monocytes; < 65, lymphocytes). Most findings were age and/or sex group-specific; few were common across all groups. Several of the variables associated with HGS in each group were novel, while others corroborate previous research. Our results support HGS as a useful indicator of a variety of clinical characteristics; however, its utility varies by age and sex., (© 2024. The Author(s).)

Rationale & Objective: Accurate detection of hypertension is crucial for clinical management of pediatric chronic kidney disease (CKD). The 2017 American Academy of Pediatrics (AAP) clinical practice guideline for childhood hypertension included new normative blood pressure (BP) values and revised definitions of BP categories. In this study, we examined the effect of applying the AAP guideline's normative data and definitions to the Chronic Kidney Disease in Children (CKiD) cohort compared with use of normative data and definitions from the 2004 Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents., Study Design: Observational cohort study., Setting & Participants: Children and adolescents in the CKiD cohort., Exposure: Clinic BP measurements., Outcome: BP percentiles and hypertension stages calculated using the 2017 AAP guideline and the Fourth Report from 2004., Analytical Approach: Agreement analysis compared the estimated percentile and prevalence of high BP based on the 2017 guideline and 2004 report to clinic and combined ambulatory BP readings., Results: The proportion of children classified as having normal clinic BP was similar using the 2017 and 2004 systems, but the use of the 2017 normative data classified more participants as having stages 1-2 hypertension (22% vs 11%), with marginal reproducibility (κ=0.569 [95% CI, 0.538-0.599]). Those identified as having stage 2 hypertension by the 2017 guideline had higher levels of proteinuria compared with those identified using the 2004 report. Comparing use of the 2017 guideline and the 2004 report in terms of ambulatory BP monitoring categories, there were substantially more participants with white coat (3.5% vs 1.5%) and ambulatory (15.5% vs 7.9%) hypertension, but the proportion with masked hypertension was lower (40.2% vs 47.8%, respectively), and the percentage of participants who were normotensive was similar (40.9% vs 42.9%, respectively). Overall, there was good reproducibility (κ=0.799 [95% CI, 0.778-0.819]) of classification by ambulatory BP monitoring., Limitations: Relationship with long-term progression and target organ damage was not assessed., Conclusions: A greater percentage of children with CKD were identified as having hypertension based on both clinic and ambulatory BP when using the 2017 AAP guideline versus the Fourth Report from 2004, and the 2017 guideline better discriminated those with higher levels of proteinuria. The substantial differences in the classification of hypertension when using the 2017 guideline should inform clinical care., (Copyright © 2022 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Due to its excellent properties, monolithic silica aerogel is a promising material for innovative glazing systems. Since glazing systems are exposed to deteriorating agents during building service life, it is essential to investigate the long-term performance of aerogel. In the present paper, several 12.7 mm-thick silica aerogel monoliths produced by a rapid supercritical extraction method were tested, including both hydrophilic and hydrophobic samples. After fabrication and characterization of hydrophobicity, porosity, optical and acoustic properties, and color rendering, the samples were artificially aged by combining temperature and solar radiation effects in an experimental device specifically developed at the University of Perugia. The length of the experimental campaign was determined using acceleration factors (AFs). Temperature AF was evaluated according to the Arrhenius law using thermogravimetric analysis to estimate the aerogel activation energy. A natural service life of 12 years was achieved in about 4 months, and the samples' properties were retested. Contact angle tests supported by FT-IR analysis showed loss of hydrophobicity after aging. Visible transmittance values in the 0.67-0.37 range were obtained for hydrophilic and hydrophobic samples, respectively. The aging process involved optical parameter reduction of only 0.02-0.05. There was also a slight loss in acoustic performance (noise reduction coefficient (NRC) = 0.21-0.25 before aging and NRC = 0.18-0.22 after aging). For hydrophobic panes, color shift values in the 10.2-59.1 and 8.4-60.7 ranges were obtained before and after aging, respectively. The presence of aerogel, regardless of hydrophobicity, results in a deterioration in light-green and azure tones. Hydrophobic samples had lower color rendering performance than hydrophilic aerogel, but this did not worsen after the aging process. This paper makes a significant contribution to the progressive deterioration assessment of aerogel monoliths for applications in sustainable buildings.

Background: The General Anxiety Disorder-7 (GAD-7) questionnaire is a standard tool used for screening and follow-up of patients with Generalized Anxiety Disorder (GAD). Although it is generally accepted that anxiety correlates with clinical and psychosocial stressors, precise quantitative data is limited on the relations among GAD-7, traditional biomarkers, and other measures of health. Further research is needed about how GAD-7 relates to race, ethnicity, and socioeconomic status (SES) as an assembly. We determined how multiple demographic and socioeconomic data correlate with the participants' GAD-7 results when compared with laboratory, physical function, clinical, and other biological markers., Methods: The Project Baseline Health Study (BHS) is a prospective cohort of adults representing several populations in the USA. We analyzed a deeply phenotyped group of 2502 participants from that study. Measures of interest included: clinical markers or history of medical diagnoses; physical function markers including gait, grip strength, balance time, daily steps, and echocardiographic parameters; psychometric measurements; activities of daily living; socioeconomic characteristics; and laboratory results., Results: Higher GAD-7 scores were associated with female sex, younger age, and Hispanic ethnicity. Measures of low SES were also associated with higher scores, including unemployment, income ≤$25,000, and ≤12 years of education. After adjustment for 158 demographic, clinical, laboratory, and symptom characteristics, unemployment and overall higher SES risk scores were highly correlated with anxiety scores. Protective factors included Black race and older age., Limitations: Correlations identified in this cross-sectional study cannot be used to infer causal relationships; further, we were not able to account for possible use of anxiety treatments by study participants., Conclusions: These findings highlight the importance of understanding anxiety as a biopsychosocial entity. Clinicians and provider organizations need to consider both the physical manifestations of the disorder and their patients' social determinants of health when considering treatment pathways and designing interventions., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: Patient selection for pediatric extracorporeal membrane oxygenation (ECMO) support has broadened over the years to include children with pre-existing neurologic morbidities. We aimed to determine the prevalence and nature of pre-ECMO neurologic disorders or disability and investigate the association between pre-ECMO neurologic disorders or disability and mortality and unfavorable neurologic outcome., Design: Multicenter retrospective observational cohort study., Setting: Eight hospitals reporting to the Pediatric ECMO Outcomes Registry between October 2011 and June 2019., Patients: Children younger than 18 years supported with venoarterial or venovenous ECMO., Interventions: The primary exposure was presence of pre-ECMO neurologic disorders or moderate-to-severe disability, defined as Pediatric Cerebral Performance Category (PCPC) or Pediatric Overall Performance Category (POPC) 3-5. The primary outcome was unfavorable outcome at hospital discharge, defined as in-hospital mortality or survival with moderate-to-severe disability (discharge PCPC 3-5 with deterioration from baseline)., Measurements and Main Results: Of 598 children included in the final cohort, 68 of 598 (11%) had a pre-ECMO neurologic disorder, 70 of 595 (12%) had a baseline PCPC 3-5, and 189 of 592 (32%) had a baseline POPC 3-5. The primary outcome of in-hospital mortality ( n = 267) or survival with PCPC 3-5 with deterioration from baseline ( n = 39) was observed in 306 of 598 (51%). Overall, one or more pre-ECMO neurologic disorders or disability were present in 226 of 598 children (38%) but, after adjustment for age, sex, diagnostic category, pre-ECMO cardiac arrest, and ECMO mode, were not independently associated with increased odds of unfavorable outcome (unadjusted odds ratio [OR], 1.34; 95% CI, 1.07-1.69; multivariable adjusted OR, 1.30; 95% CI, 0.92-1.82)., Conclusions: In this exploratory study using a multicenter pediatric ECMO registry, more than one third of children requiring ECMO support had pre-ECMO neurologic disorders or disability. However, pre-existing morbidities were not independently associated with mortality or unfavorable neurologic outcomes at hospital discharge after adjustment for diagnostic category and other covariates., Competing Interests: Dr. Dante’s institution received funding from the National Heart, Lung, and Blood Institute (T32 HL 125239). Drs. Dante, Ng, Patel, Steiner, and Bembea received support for article research from the National Institutes of Health (NIH). Drs. Ng’s and Patel’s institutions received funding from the NIH. Dr. Ng received funding from Ashvattha Therapeutics. Dr. Steiner received funding from Infant Jarvik Heart Data Safety Monitoring Board honorarium from HealthCore and Octapharma. Dr. Bembea’s institution received funding from the National Institute of Neurological Disorders and Stroke (R01NS106292) and a Grifols Investigator Sponsored Research Grant. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)

Background: Inflammatory and endothelial activation responses during extracorporeal membrane oxygenation (ECMO) support in children are poorly understood. In this study, we aimed to determine if circulating inflammatory, endothelial activation, and fibrinolytic markers are associated with mortality and with neurologic outcomes in children on ECMO., Methods: We conducted a secondary analysis of a two-center prospective observational study of 99 neonatal and pediatric ECMO patients. Inflammatory (interferon gamma [IFNγ], interleukin-6 [IL-6], IL-1β, tumor necrosis factor alpha [TNFα]), endothelial activation (E-selectin, P-selectin, intercellular adhesion molecule-3 [ICAM-3], thrombomodulin [TM]), and fibrinolytic markers (tissue plasminogen activator [tPA], plasminogen activator inhibitor-1 [PAI-1]) were measured in plasma on days 1, 2, 3, 5, 7, and every third day thereafter during the ECMO course., Results: All ECMO day 1 inflammatory biomarkers were significantly elevated in children with abnormal vs. normal neuroimaging. ECMO day 1 and peak levels of IL-6 and PAI-1 were significantly elevated in children who died compared to those who survived to hospital discharge. Tested biomarkers showed no significant association with long-term neurobehavioral outcomes measured using the Vineland Adaptive Behavioral Scales, Second Edition., Conclusions: High levels of circulating inflammatory, endothelial activation, and fibrinolytic markers are associated with mortality and abnormal neuroimaging in children on ECMO., Impact: The inflammatory, endothelial activation, and fibrinolytic profile of children on ECMO differs by primary indication for extracorporeal support. Proinflammatory biomarkers on ECMO day 1 are associated with abnormal neurologic imaging in children on ECMO in univariable but not multivariable models. In multivariable models, a pronounced proinflammatory and prothrombotic biomarker profile on ECMO day 1 and longitudinally was significantly associated with mortality. Further studies are needed to identify inflammatory, endothelial, and fibrinolytic profiles associated with increased risk for neurologic injury and mortality through potential mediation of bleeding and thrombosis., (© 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Background: Recombinant growth hormone (rGH) is an efficacious therapy for growth failure in children with chronic kidney disease (CKD). We described rGH use and estimated its relationship with growth and kidney function in the Chronic Kidney Disease in Children (CKiD) cohort., Methods: Participants included those with growth failure, prevalent rGH users, and rGH initiators who did not meet growth failure criteria. Among those with growth failure, height z scores and GFR were compared between rGH initiators and non-initiators across 42 months. Inverse probability weights accounted for differences in baseline variables in weighted linear regressions., Results: Among 148 children with growth failure and no previous rGH therapy, 42 (28%) initiated rGH therapy. Of the initiators, average age was 8.9 years, height z score was 2.50 standard deviations (SDs) (0.6 th percentile), and GFR was 44 ml/min/1.73m 2 . They were compared to 106 children with growth failure who never initiated therapy (8.8 years, -2.33 SDs, and 51 ml/min/1.73m 2 ). At 30 and 42 months after rGH, height increased +0.26 (95%CI: -0.11, +0.62) and +0.35 (95%CI: -0.17, +0.87) SDs, respectively, relative to those who did not initiate rGH. rGH was not associated with GFR., Conclusions: Participants with growth failure receiving rGH experienced significant growth, although this was attenuated relative to RCTs, and were more likely to have higher household income and lower GFR. A substantial number of participants, predominantly boys, without diagnosed growth failure received rGH and had the highest achieved height relative to mid-parental height. Since rGH was not associated with accelerated GFR decline, increasing rGH use in this population is warranted., (© 2021. IPNA.)

Background: Hypertension is common among children with chronic kidney disease (CKD), and dihydropyridine calcium channel blockers (dhCCBs) are frequently used as treatment. The impact of dhCCBs on proteinuria in children with CKD is unclear., Methods: Data from 722 participants in the Chronic Kidney Disease in Children (CKiD) longitudinal cohort with a median age of 12 years were used to assess the association between dhCCBs and log transformed urine protein/creatinine levels as well as blood pressure control measured at annual visits. Angiotensin-converting enzyme inhibitor (ACEi) and angiotensin receptor blocker (ARB) use was evaluated as an effect measure modifier., Results: Individuals using dhCCBs had 18.8% higher urine protein/creatinine levels compared to those with no history of dhCCB or ACEi and ARB use. Among individuals using ACEi and ARB therapy concomitantly, dhCCB use was not associated with an increase in proteinuria. Those using dhCCBs had higher systolic and diastolic blood pressures., Conclusions: Use of dhCCBs in children with CKD and hypertension is associated with higher levels of proteinuria and was not found to be associated with improved blood pressure control.

Background: Control of hypertension delays progression of pediatric chronic kidney disease (CKD), yet few data are available regarding what clinic blood pressure (BP) levels may slow progression., Methods: Longitudinal BP data from children in the Chronic Kidney Disease in Children cohort study who had hypertension or an auscultatory BP ≥ 90th percentile were studied. BP categories were defined as the maximum systolic or diastolic BP percentile (< 50th, 50th to 75th, 75th to 90th, and ≥ 90th percentile) with time-updated classifications corresponding to annual study visits. The primary outcome was time to kidney replacement therapy or a 30% decline in estimated glomerular filtration rate. Cox proportional hazard models described the effect of each BP category compared to BP ≥ 90th percentile., Results: Seven hundred fifty-four participants (median age 9.9 years at study entry) met inclusion criteria; 65% were male and 26% had glomerular CKD. Any BP < 90th percentile was associated with a decreased risk of progression for those with glomerular CKD (hazard ratio (HR), 0.63; 95% CI, 0.28-1.39 (< 50th); HR, 0.59; 95% CI, 0.28-1.26 (50th-75th); HR, 0.40; 95% CI, 0.18-0.93 (75th-90th)). Similar results were found for those with non-glomerular CKD: any BP < 90th percentile was associated with decreased risk of progression (HR, 0.78; 90% CI, 0.49-1.25 (< 50th); HR, 0.53; 95% CI, 0.33-0.84 (50th-75th); HR, 0.71; 95% CI, 0.46-1.08 (75th-90th))., Conclusions: Achieved clinic BP < 90th percentile was associated with slower CKD progression in children with glomerular or non-glomerular CKD. These data provide guidance for management of children with CKD in the office setting. Graphical abstract.

A procedure for aesthetically enhancing silica aerogel monoliths by laser etching and incorporation of dyes is described in this manuscript. Using a rapid supercritical extraction method, large silica aerogel monolith (10 cm x 11 cm x 1.5 cm) can be fabricated in about 10 h. Dyes incorporated into the precursor mixture result in yellow-, pink- and orange-tinged aerogels. Text, patterns, and images can be etched onto the surface (or surfaces) of the aerogel monolith without damaging the bulk structure. The laser engraver can be used to cut shapes from the aerogel and form colorful mosaics.

Objective: In cross-sectional studies, pelvic organ prolapse is strongly associated with genital hiatus (GH) size. The objective of this study was to estimate prolapse incidence by the size of the GH among parous women followed prospectively., Methods: Data were derived from a longitudinal study of pelvic floor disorders. Participants were followed annually for 2-9 years. Genital hiatus size and prolapse beyond the hymen were assessed with annual pelvic organ prolapse quantification examinations. Kaplan-Meier methods described prolapse-free survival as a function of GH size. Accounting for changes over time in GH size, lognormal models were used to estimate prolapse-free survival by GH size. This analysis was repeated separately for women who gave birth exclusively by cesarean versus those with at least one vaginal birth., Results: Among 1,492 participants, median age at enrollment was 38 years; 153 (10.3%) developed prolapse over 2-9 years. The cumulative probability of prolapse increased substantially as the size of the GH increased. Lognormal models predicted that the estimated median time to develop prolapse would be 33.4 years for women with a persistent GH of 3 cm; in contrast, the estimated median time to develop prolapse would be 5.8 years for a GH of 4.5 cm or greater. Considering separately women who gave birth by cesarean versus those with at least 1 vaginal birth, GH size drastically modified prolapse risk in both birth groups., Conclusions: Prolapse incidence is strongly associated with GH size, regardless of delivery mode. These findings suggest that a wider GH is an important predictor of future prolapse risk., Competing Interests: The author has declared that there are no conflicts of interest., (Copyright © 2020 American Urogynecologic Society. All rights reserved.)

Background: Outcomes for patients with oncologic disease and/or after hematopoietic stem cell transplant (HSCT) requiring intensive care unit admission have improved, but indications for and outcomes after extracorporeal membrane oxygenation (ECMO) support in this population are poorly characterized., Procedure: We analyzed data from consecutive patients < 18 years with oncologic disease and/or after HSCT reported to a pediatric ECMO registry by nine pediatric centers in the United States between 2011 and 2018., Results: We identified 18 ECMO patients with oncologic disease and/or HSCT, and 415 ECMO controls matched with a propensity score algorithm based on age, gender, race, severity of illness at admission, and reason for ECMO. The primary indication for ECMO was respiratory failure in 66.7% in the oncologic disease and/or HSCT group, and in 70.7% in the matched ECMO control group. Eleven of 18 patients survived to hospital discharge (61.1%), similar to the matched control group (60.8%), P = 0.979. Children with oncologic disease and/or HSCT had lower mean platelet counts during ECMO and received higher volumes of platelets compared with the control group, mean 14.6 mL/kg/day (standard deviations [SD], 9.8) versus mean 9.3 mL/kg/day (SD, 10.4), P = 0.001. Of the 11 surviving children with oncologic disease and/or HSCT, five sustained new neurologic disorders (45.5%) versus 45 of 222 (20.3%) in the control group, P = 0.061. Bleeding complications were similar in the two groups., Conclusions: Outcomes of patients with oncologic disease and/or HSCT supported on ECMO in the current era are not significantly different compared with matched ECMO controls and are improved from previously published reports., (© 2020 Wiley Periodicals, Inc.)

Many unilateral amputations are followed by a contralateral amputation within three years, sometimes presenting as bilateral transfemoral amputations. Bilateral transfemoral amputees that successfully use prostheses are an understudied patient population. This study establishes reference values for this population in users of short non-articulating (stubby) or full-length articulating prostheses. Anthropometric and demographic information was collected from participants. Additionally, participants completed a self-reported Prosthesis Evaluation Questionnaire-Mobility Subscale 12/5 (PEQ-MS) and performed multiple physical mobility tests, including walking tests and the multi-directional Four Square Step Test (FSST). Full-length users rated their abilities to complete the PEQ-MS tasks as less difficult than stubby users in eight of the 12 items. Gait analysis revealed a greater amount of time is spent in stance phase with a greater portion in double limb support for both user groups, and a greater percentage in stance phase for the subject-reported dominant limb. Stubby users' gait velocity had a significant reduction from that of their full-length peers; however, cadence was similar between groups. Both user groups completed the FSST at comparable times. These outcomes may be of benefit for identifying tasks bilateral transfemoral prosthetic users may find to be most difficult as well as for identifying normal ambulation patterns within this population. Future studies with a greater number of subjects would enable these results to be further generalized.

Protocols for preparing and testing catalytic aerogels by incorporating metal species into silica and alumina aerogel platforms are presented. Three preparation methods are described: (a) the incorporation of metal salts into silica or alumina wet gels using an impregnation method; (b) the incorporation of metal salts into alumina wet gels using a co-precursor method; and (c) the addition of metal nanoparticles directly into a silica aerogel precursor mixture. The methods utilize a hydraulic hot press, which allows for rapid (<6 h) supercritical extraction and results in aerogels of low density (0.10 g/mL) and high surface area (200-800 m 2 /g). While the work presented here focuses on the use of copper salts and copper nanoparticles, the approach can be implemented using other metal salts and nanoparticles. A protocol for testing the three-way catalytic ability of these aerogels for automotive pollution mitigation is also presented. This technique uses custom-built equipment, the Union Catalytic Testbed (UCAT), in which a simulated exhaust mixture is passed over an aerogel sample at a controlled temperature and flow rate. The system is capable of measuring the ability of the catalytic aerogels, under both oxidizing and reducing conditions, to convert CO, NO and unburned hydrocarbons (HCs) to less harmful species (CO2, H2O and N2). Example catalytic results are presented for the aerogels described.

A procedure for the fabrication of monolithic silica aerogels in eight hours or less via a rapid supercritical extraction process is described. The procedure requires 15-20 min of preparation time, during which a liquid precursor mixture is prepared and poured into wells of a metal mold that is placed between the platens of a hydraulic hot press, followed by several hours of processing within the hot press. The precursor solution consists of a 1.0:12.0:3.6:3.5 x 10(-3) molar ratio of tetramethylorthosilicate (TMOS):methanol:water:ammonia. In each well of the mold, a porous silica sol-gel matrix forms. As the temperature of the mold and its contents is increased, the pressure within the mold rises. After the temperature/pressure conditions surpass the supercritical point for the solvent within the pores of the matrix (in this case, a methanol/water mixture), the supercritical fluid is released, and monolithic aerogel remains within the wells of the mold. With the mold used in this procedure, cylindrical monoliths of 2.2 cm diameter and 1.9 cm height are produced. Aerogels formed by this rapid method have comparable properties (low bulk and skeletal density, high surface area, mesoporous morphology) to those prepared by other methods that involve either additional reaction steps or solvent extractions (lengthier processes that generate more chemical waste).The rapid supercritical extraction method can also be applied to the fabrication of aerogels based on other precursor recipes.

We explore to what extent the combination of predictive and interpretable modeling can provide new insights for functional brain imaging. For this, we apply a recently introduced regularized regression technique, the Elastic Net, to the analysis of the PBAIC 2007 competition data. Elastic Net regression controls via one parameter the number of voxels in the resulting model, and via another the degree to which correlated voxels are included. We find that this method produces highly predictive models of fMRI data that provide evidence for the distributed nature of neural function. We also use the flexibility of Elastic Net to demonstrate that model robustness can be improved without compromising predictability, in turn revealing the importance of localized clusters of activity. Our findings highlight the functional significance of patterns of distributed clusters of localized activity, and underscore the importance of models that are both predictive and interpretable.

Initial oral signs of multiple myeloma may involve pain, paraesthesia, swelling, tooth mobility and radiolucency. A 62-year-old female patient presented with the chief complaint of numbness in the right lower jaw. Intraoral examination revealed no abnormalities and her history was non-contributory. A panoramic radiograph revealed an irregular, small radiopacity in the premolar region and small, multiple and diffuse osteolytic alterations in the mandible. Computed tomography revealed maxillary and mandibular cortical destruction. An incisional biopsy was performed. The histopathological diagnosis was plasma cell myeloma and further investigations lead to the diagnosis of multiple myeloma. Dysfunction of a nerve coursing through diseased bone is an ominous sign and may be an indication that a malignant process is present.

Background: Twenty years have elapsed since the National Institute of Mental Health Collaborative Depression Study reported on the early course and treatment of major depression within the mental health sector. Using similar methods, an observational study was conducted to assess relationships between initial depression severity, personality dysfunction and other baseline characteristics, subsequent treatment, and 3-month outcomes among persons admitted to public and voluntary sector outpatient clinics, including 1 academic program., Methods: A 2-stage sampling technique was used to recruit subjects (N = 165) diagnosed by the Structured Clinical Interview for DSM-IV, Patient Version, as having a major depression episode. Sociodemographic and clinical characteristics were assessed at admission. Data on treatment and outcome were obtained at 3 months using structured instruments from the Longitudinal Interview Follow-up Evaluation. Logistic regression was used to assess hypothesized predictors of early recovery. Analyses were carried out in the total sample and after dichotomizing subjects by baseline depression severity., Results: Fifty (30.3%) of the 165 subjects met recovery criteria. Less than half of the subjects (45%) met criteria for adequate pharmacotherapy. Less severe depression, having received adequate antidepressant treatment, female sex, and being married independently predicted early recovery. In the more depressed subgroup, early recovery was associated with female sex. Among less severely depressed subjects, high personality dysfunction scores and being married were significant predictors., Conclusions: Initial depression severity and receiving adequate pharmacotherapy predict early recovery in individuals with major depression seeking outpatient treatment. A minority of persons receive intensive antidepressant treatment. Less severe personality dysfunction and being married predicts early recovery among persons with less severe depression.

Objective: To assess the actual state of oral and maxillofacial radiology departments in US and Canadian dental schools against the ideal characteristics defined by the American Academy of Oral and Maxillofacial Radiology (AAOMR) 1997 position paper., Study Design: Cross-sectional survey of all 65 US and Canadian dental schools., Results: Sixty-four surveys were returned (98%). At most schools, oral and maxillofacial radiology (OMR) was an identifiable division of a department, established policies, and had operational authority for radiographic practices in the primary radiology clinic. The majority of full-time faculty (72%) had formal training in OMR; the majority of part-time faculty (86%) did not. Full-time faculty spent approximately 60% of their time teaching, with the remainder of their time divided among research and scholarship, faculty practice, and service. Routine x-ray equipment was universally available; advanced imaging technologies were not. OMR faculty involvement in the interpretation of radiographs varied across diseases and conditions. Most published scholarship (85%+) was produced by full-time faculty. Average output was 1 paper per person per year, but a relatively small cadre of OMR faculty generated most papers., Conclusions: In some attributes, the status of OMR closely approximated the ideal characteristics established in the AAOMR report. Among the remaining attributes, bridging the difference between the actual and the ideal will be the challenge for the next 5 years.

Introduction: The purpose of this study was to identify the fears of school-age children and determine the relationship between fear and anxiety., Method: A descriptive, correlational, secondary analysis study was conducted using a convenience sample of 90 children between the ages of 8 and 12 years. Each child was instructed to complete the Revised Children's Anxiety Scale and then answer questions from a structured interview. On completion, each child was instructed to draw a human figure drawing. Frequency charts and correlational statistics were used to analyze the data., Results: Findings indicated that the most significant fears of the boys were in the categories of animals, safety, school, and supernatural phenomena, whereas girls were more fearful of natural phenomena. High correlations existed between anxiety scores and the number of fears and emotional indicators on human figure drawings., Discussion: Because human figure drawings are reliable tools for assessing anxiety and fears in children, practitioners should incorporate these drawings as part of their routine assessments of fearful children.

In this report, two giant sialoliths are described that had recurred 25 years after removal of small stones from the same ducts. This is a longer interval between occurrences than has been reported elsewhere. The sialoliths did not cause distress, so the patients declined further investigations or treatment.

This is a report of a kindred of at least 181 members, of whom 35 exhibit or are reported to have dentin dysplasia type I. Six others are suspected of having the condition. Radiographic evidence that included obliterated or semilunar pulp chambers and short or undeveloped roots confirmed the diagnosis in 18 persons. The autosomal dominant mode of inheritance has been confirmed. One hundred percent penetrance has been demonstrated. There were insufficient data to determine the degree of expressivity.

An unusual presentation of a focal osteoporotic bone marrow defect is documented. A definitive diagnosis could not be established on the basis of the location, history, clinical, and radiographic appearance. A biopsy provided the identity of the lesion.

Two cases of rare metastases from malignant neoplasms to the posterior mandible in young adults are reported. Multiple imaging modalities were necessary to identify the many metastases and, in one case, the suspected primary site. Many of the radiographic images are presented for that case.

A 13-year-old black girl was referred for evaluation of a nonhealing extraction site of 2 years' duration. Radiographs revealed a large, irregularly shaped, mixed radiolucent/radiopaque lesion that occupied almost the entire left area of the maxilla and crossed the midline. Microscopic examination revealed irregular dentinoid material with odontogenic epithelium that exhibited ghost cell keratinization and anaplastic changes. The patient underwent a hemimaxillectomy, and 7 years after surgery she appears to be free of disease.

This article presents an unusual case of idiopathic bone cavity that originally was either not observed or diagnosed as a fibro-osseous condition. When a differential diagnosis was established, it included fibro-osseous conditions, odontogenic cysts and neoplasms, and central giant cell granuloma but not the definitive diagnosis. The patient's demographic data, history, symptoms, and clinical and radiographic appearance all conspired to obscure the true nature of the condition, which was not revealed until a biopsy was attempted. A more thorough initial radiographic examination might have led to an earlier diagnosis.

Dentin dysplasia is a rare developmental disturbance of dentin affecting approximately 1:100,000 people. It has been classified as an autosomal dominant disease. Two distinct forms of dentin dysplasia have been described. As more cases of dentin dysplasia were reported these categories seemed inadequate; subclassification of type I dentin dysplasia were proposed based on root length and the presence or not of a pulpal remnant. This paper presents two cases demonstrating the classic features of type I dentin dysplasia in the mixed and permanent dentitions and discusses the suggested subclassifications. The authors suggest that while differences in root length may be useful in determining treatment options, thinking of these variables as separate types of dentin dysplasia is not warranted at this time. Justification of a subcategory of type I dentin dysplasia should be based on a different disease process, different histology, significantly different symptoms, or different etiologies, and until researchers can clearly prove from a genetic or chromosomal standpoint that the subcategories are separate entities, we should accept, as we do for many other genetic disorders, that some patients are more severely affected than others.

The literature is reviewed to determine the radiographic appearance of the reported cases of dentin dysplasia. The sometimes confusing nomenclature is rationalized. Four distinct forms of dentin dysplasia type I and one form of dentin dysplasia type II are identified. There seems to be no need to identify more than two distinct types of this relatively rare inherited defect of human dentin, but a proposed subclassification of type I dentin dysplasia could make identification of the two types easier.

A study was initiated to evaluate the effectiveness of aerial ULV spraying for the control of Aedes aegypti and Culex quinquefasciatus as an emergency antiepidemic measure against dengue fever and St. Louis encephalitis, respectively. Malathion was aerially applied at 219 ml/ha over 344 ha area of the Ninth Ward in New Orleans. Laboratory susceptibility tests and field-cage exposures indicated that the target populations were susceptible to malathion and that acceptable coverage of the study area occurred. Two consecutive aerial applications decreased the relative abundance and ovipositional activity of adult mosquitoes. However, suppression was transient and, in the event of an epidemic, multiple treatments may be required to decrease vector abundance below the threshold levels required for the spread of virus to the human populations.

This article describes the incidence of calcification in the stylohyoid ligament in a sample of the patient population of the University of Mississippi School of Dentistry. The records of 479 patients were reviewed, with particular attention given to the panoramic radiograph. The patients ranged in age from 4 to 78 years, with a mean age of 29. There was a sharp increase in incidence of calcification during the first three decades of age from 45.3% in the first decade to 86.2% in the third, with a gradual increase from the fourth to the seventh decade (87.3% to 92%). The eighth decade, represented by nine patients, showed an incidence of 100%. There appears to be no race predilection for calcification, a slight sex predilection for females, and an age incidence that seems to support both the developmental and degenerative theories of etiology of calcification in the stylohyoid ligament.