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Both diabetes and obesity can affect the brain, yet their impact is not well characterized in children with type 2 (T2) diabetes and obesity. This pilot study aims to explore differences in brain function and cognition in adolescents with T2 diabetes and obesity and nondiabetic controls with obesity and lean controls.Participants were 12-17 years old (5 T2 diabetes with obesity [mean HgbA1C 10.9%], 6 nondiabetic controls with obesity and 10 lean controls). Functional MRI (FMRI) during hyperglycemic/euglycemic clamps was performed in the T2 diabetes group.When children with obesity, with and without diabetes, were grouped (mean BMI 98.8%), cognitive scores were lower than lean controls (BMI 58.4%) on verbal, full scale, and performance IQ, visual-spatial and executive function tests. Lower scores correlated with adiposity and insulin resistance but not HgbA1C. No significant brain activation differences during task based and resting state FMRI were noted between children with obesity (with or without diabetes) and lean controls, but a notable effect size for the visual-spatial working memory task and resting state was observed.In conclusion, our pilot study suggests that obesity, insulin resistance, and dysglycemia may contribute to relatively poorer cognitive function in adolescents with T2 diabetes and obesity. Further studies with larger sample size are needed to assess if cognitive decline in children with obesity, with and without T2 diabetes, can be prevented or reversed.

Recognition of paediatric respiratory distress and timely intervention is critical, especially during the weaning phase of support in paediatric acute respiratory failure, as weaning too aggressively can lead to further setbacks in a patient's recovery. We aimed to determine if pulmonary function measurements obtained with the pneuRIP device, a noninvasive pulmonary function testing device that provides measurements of labored breathing index (LBI), phase angle and %rib cage (%RC) contribution to breathing, will provide predictive values to assess the adequacy of respiratory support while weaning from HFNC.We reviewed patients ages 0-18 years admitted to the PICU for respiratory distress due to respiratory infections receiving HFNC. Patients with history of chronic lung disease and chronic neuromuscular disease with baseline habnormal breathing patterns were excluded. Phase angle, LBI and %RC were obtained every hour and with every wean of HFNC. Nine patients were enroled.Mean LBI range remained 1.27-1.68 when LBI was plotted as a function of the HFNC flow rate. Mean values of %RC contribution to breathing ranged 43.65-57.12 as a function of the HFNC flow rate. No significant deviations existed in either %RC (P = 0.16) or LBI (P = 0.16) during the weaning of HFNC. Mean phase angle for all subjects was 41.48°-74.12° for the duration of wean and showed significant deviation from baseline during the weaning process (p = 0.001).Measurements of LBI and %RC on the pneuRIP device effectively demonstrated tolerance of weaning HFNC during the recovery phase of acute respiratory failure from a respiratory infection.

Background The effect of intravenous fluid (IVF) administration during cardiopulmonary resuscitation (CPR) is an unexplored factor that may improve cardiac output (CO) during CPR. The aim of this study was to determine the effect of IVF administration on CO and oxygenation during CPR. Methods This experimental animal study was performed in a critical care animal laboratory. Twenty-two Landrace-Yorkshire female piglets weighing 27–37 kg were anesthetized, intubated, and placed on positive pressure ventilation. Irreversible cardiac arrest was induced with bupivacaine. CPR was performed with a LUCAS 3 mechanical compression device. Pigs were randomized into IVF or no-IVF groups. Pigs in the IVF group were given 20 mL/kg of Plasma-Lyte (Baxter International, Deerfield, IL USA), infused from 15 to 35 min of CPR. CPR was maintained for 50 min with serial measurements of CO obtained using ultrasound dilution technology and partial pressure of oxygen (PaO2). Results A mixed-effects repeated measures analysis of variance was used to compare within-group, and between-group mean changes in CO and PaO2 over time. CO and PaO2 for the piglets were measured at 10-min intervals during the 50 min of CPR. CO was greater in the IVF compared with the control group at all time points during and after the infusion of the IVF. Mean PaO2 decreased with time; however, at no time was there a significant difference in PaO2 between the IVF and control groups. Conclusions Administration of IVF during CPR resulted in a significant increase in CO during CPR both during and after the IVF infusion. There was no statistically significant decrease in PaO2 between the IVF and control groups.

Peak exercise parameters are considered the gold standard to quantify cardiac reserve in cardiopulmonary exercise testing (CPET). We studied whether submaximal parameters would add additional values in analyzing sex differences in CPET. We reviewed CPET of age-matched healthy male and female adolescents by cycle ergometer. Besides peak parameters, submaximal CPET parameters, including ventilatory anaerobic threshold (VAT), oxygen uptake efficiency slope (OUES), and submaximal slopes of Δoxygen consumption (ΔVO2)/Δwork rate (ΔWR), Δheart rate (ΔHR)/ΔWR, ΔVO2/ΔHR, and Δminute ventilation (ΔVE)/ΔCO2 production (ΔVCO2), were obtained. We studied 35 male and 40 female healthy adolescents. Peak VO2 (pVO2), peak oxygen pulse (pOP), and VAT were significantly lower in females than males (1.9 ± 0.4 vs. 2.5 ± 0.6 L/min; 10 ± 2.0 vs. 13.2 ± 3.5 ml/beat; 1.23 ± 0.3 vs. 1.52 ± 0.5 L/min, respectively, all p 0.005). Females showed significantly lower pVO2, VAT, and OUES with the same body weight than males, implying higher skeletal muscle mass in males. When simultaneously examining ΔHR/ΔWR and pOP, females showed higher dependency on increases in HR than in stroke volume. Females demonstrated significantly lower pOP with the same levels of ΔVO2/ΔHR, suggesting more limited exercise persistence than males under an anaerobic condition at peak exercise. Oxygen uptake efficiency in relation to peak VE was significantly higher in males. There was no sex difference in either ΔVO2/ΔWR or ΔVE/ΔVCO2. Combinational assessment of peak and submaximal CPET parameters delineates the multiple mechanisms that contribute to the sex differences in exercise performance.

This work reports the fabrication and characterization of multifunctional, nanostructured passivation layers formed using a self-assembly process that provide both surface passivation and improved light trapping in crystalline silicon photovoltaic (PV) cells. Scalable block copolymer self-assembly and vapor phase infiltration processes are used to form arrays of aluminum oxide nanostructures (Al2O3) on crystalline silicon without substrate etching. The Al2O3 nanostructures are characterized using scanning electron microscopy (SEM), transmission electron microscopy (TEM), and spectroscopic ellipsometry. Injection-level dependent photoconductance measurements are used to determine the effective carrier lifetime of the samples to confirm the nanostructures successfully passivate the Si surface. Finite element method simulations and reflectance measurement show that the nanostructures increase the internal rear reflectance of the PV cell by suppressing the parasitic optical losses in the metal contact. An optimized morphology of the structures is identified for their potential use in PV cells as multifunctional materials providing surface passivation, photon management, and carrier transport pathways.

Objectives Childhood adenotonsillar hypertrophy (ATH) with sleep-disordered breathing (SDB) frequently occurs concomitant with asthma. Adenotonsillectomy and reduction in asthma severity association has been reported. We describe changes in asthma control in nonobese or normal weight and obese/overweight children undergoing adenotonsillectomy for SDB. Methods This prospective, nonrandomized cohort trial with 6-month follow-up at a tertiary children’s hospital enrolled 41 children with persistent asthma undergoing adenotonsillectomy for SDB. Children with significant chronic medical conditions, premature birth (< 28 weeks), or recent respiratory infection were excluded. Patients were stratified by baseline BMI into nonobese or normal weight (BMI < 85 percentile) and obese/overweight (BMI > 85%). The primary outcome was change in Childhood Asthma Control Test (cACT) scores 3 and 6 months following adenotonsillectomy. Secondary outcome examined improvement in Pediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLQ) 3 and 6 months following adenotonsillectomy. Results Baseline characteristics were similar except for anthropometric measures and mean PACQLQ ( P = .03). Children with nonobese or normal weight (n = 26) had statistically significant improvement in change in cACT at 3 (22.80 ± 2.33 vs. 17.86 ± 3.53, P < .001) and 6 (20.71±3.29 vs. 18.24 ± 4.16, P = .044) months compared with baseline. PACQLQ scores also improved at 3 (6.20 ± 0.87 vs. 4.56 ± 1.12, P < .001) and 6 (6.36 ± 0.72 vs. 4.93 ± 0.96, P < .001) months. Obese/overweight children (n = 10) had significant improvement in cACT scores at 6 months (20.00 ± 3.90 vs. 15.00 ± 6.90, P = .048). Change of cACT scores at 3 months (17.86 ± 3.53 vs. 14.86 ± 6.31, P = .272) was not significantly different. PACQLQ scores improved at 3 (5.47 ± 1.09 vs. 3.70 ± 0.85, P < .001) and 6 (5.75 ± 2.19 vs. 3.67 ± 1.04, P = .016) months. Conclusion Nonobese or normal-weight children undergoing adenotonsillectomy demonstrated significant improvement in asthma control scores at 3 and 6 and obese/overweight children at 6 months. Using the PACQLQ, caregiver quality of life improved for all children at 3 and 6 months. Surgical management of ATH in children with comorbid SBD and asthma is a good treatment option.

Climate change is evident with the extreme climatic indices changing all over the world. Bangladesh is one of the most vulnerable countries to climate change. The patterns of climatic hazards here are changing with time. Such changes inevitably affect the life and livelihood of people. Focusing on this background, this study was conducted to assess the spatial variability of climatic multi-hazards in Bangladesh in relation to the extreme climate indices. To achieve the objective of this study, hydro-climatic data for the past 31 years (1990–2020) were collected from 27 stations of the Bangladesh Meteorological Department. Fifteen climate indices were calculated using the “RClimDex” software. The principle component analysis was used for assigning weightage to the selected indices as well as for the multi-hazard assessment. Using the indices, multi-hazard maps were prepared for the extreme rainfall, extreme temperature, and combined hazard (both rainfall and temperature). The multi-hazard maps identified the northeastern and southeastern parts of Bangladesh as high rainfall affected area, while the southwestern parts were revealed to be exposed to high temperature related hazards. The combined hazard map revealed most of the northern and southern region of the country to be in the “High” or “Moderate” extreme climate hazard zone categories. The findings are particularly alarming as the northern region has a high percentage of net cropped area falling in the high climate hazard zone. The findings of this study can guide the policy makers and academics from national to local level to develop and prioritize climate resilient programs based on the location-specific climatic hazards.

Roughly 9% of African-Americans carry 1 copy of the sickle β-globin allele [sickle-cell trait (SCT)]. The sickle allele may affect the host responses in a way that protects against sequelae of malaria. Besides the association with sporadic episodes of erythrocyte sickling, acute chest syndrome, and sudden death, the SCT is generally regarded as asymptomatic. Separately, and for unclear reasons, the African-Americans have an elevated risk compared to whites for several immune-mediated diseases, including asthma, eczema, and other respiratory conditions. We propose to determine whether the SCT contributes to the elevated risk of these inflammatory conditions. We performed a retrospective cohort study of children with and without the sickle trait to assess the risk for common immune-mediated conditions. The cohorts were individually matched, and multiple logistic regression was used with variables selected using a backward stepwise approach. A second approach (case-control design) assessed the odds of the SCT among African-Americans with and without asthma. We found 2,481 children with and 4,962 matched patients without the SCT in the cohort design. The sickle trait was associated with greater odds for several immune-mediated conditions in a multivariable analysis, but not associated with asthma (odds ratio, OR=1.10

Context Elevated concentrations of branched-chain amino acids (BCAA) are strong predictors of type 2 diabetes mellitus (T2DM). Their association with cardiovascular disease (CVD) remains uncertain, particularly in youth. Objective We investigated the role of BCAA and aromatic amino acids (AAA) in obesity, their relationships with novel biomarkers of CVD, and response to a physical activity-based lifestyle intervention (PAL-I) in a randomized controlled study in youth with normal weight (NW) and obesity (OB). Methods Age (14-18 years) and Tanner stage (≥IV) matched youth (OB, n = 15 and NW, n = 6) were studied; the 15 participants with OB underwent a 3-month randomized controlled PAL-I. Circulating amino acid profile, glucose, insulin, lipids, adiponectin, retinol binding protein-4, fibrinogen, high-sensitivity C-reactive protein, interleukin-6, and 25-hydroxy vitamin-D, along with body composition, were measured at baseline and after PAL-I. Independent t tests, analysis of covariance, and mixed-effect models were used for analysis of the data. Results Compared with NW, the concentration of various amino acids, including BCAA and AAA, were altered in OB (P 0.05) on BCAA and AAA. Glutamine, glycine, and aspartic acid decreased with PAL-I (all P Conclusion The novel finding of the BCAA–inflammation relationship, along with strong correlations with nontraditional biomarkers of CVD, may raise the prospect of BCAA as a biomarker of CVD and evoke a potential link between obesity, T2DM, and CVD.

Background: The sustainability of health benefits in response to lifestyle-based interventions remains unclear in children with overweight and obesity, and cardiometabolic disease (CMD). We determi...

Power quality (PQ) issues are significant in inverter-fed distributed generation system with non-linear loads which degrades the performance of the consumer equipments and the power system itself. Therefore, this work presents an improved photovoltaic (PV) coupled hybrid filter for the improvement in PQ in an active distribution system. A shunt hybrid active filter (SHAF) integrated with PV is designed with the help of an advanced signal processing approach called dual tree-complex wavelet transform (DT-CWT) for extracting the frequency information in the voltage and current due to the PQ disturbances. For calculating the reference current and switching signals, zero attracting least mean square (ZA-LMS) is considered in the hybrid filter and adaptive perturb and observe-fuzzy algorithm is proposed for maximum power point tracking in PV system to improve the performance under different operating conditions. The system model using the proposed technique is developed in MATLAB/Simulink and real-time experimental set up using two different controllers, i.e. the conventional proportional-integral (PI) and fuzzy-PI controllers. The results on comparison illustrates better performance of the proposed ZA-LMS and DT-CWT with fuzzy-PI based SHAF technique for PQ improvements with respect to that of LMS/normalised LMS with PI/fuzzy-PI based SHAF under different operating scenarios.

Children with cancer have a greater risk for vitamin D concerns because of compromised health before diagnosis, the disease itself, and treatments for the cancer. This IRB-approved retrospective, matched case–control study of children with and without cancer included three race categories: black, other, and Caucasian. This is the first study to directly compare serum 25-hydroxy vitamin D (25(OH)D) levels and status in newly diagnosed pediatric cancer patients with age-, sex-, and race-matched cancer-free children from the same geographic region of the US, all of whom are free from other conditions that negatively impact 25(OH)D levels. Univariable and multivariable ordinal logistic regressions were performed. In the 544 children (mean age of 8.5 years, 53% female), there were 136 newly diagnosed children with cancer and 408 matched non-cancer controls. Serum 25(OH)D levels at cancer diagnosis were lower (22.4 ng/mL) than in controls (30.1 ng/mL; p < 0.0001). Differences persisted across race (p < 0.001) and age (p < 0.001), but not sex. Older children exhibited lower 25(OH)D levels. Only 18.4% of the children with cancer had sufficient levels. Black children with cancer had the greatest rate of deficiency (39%). Race differences were evident: children of color (other and black) displayed higher levels of insufficiency; black children were most deficient.

Background Late-onset cardiovascular complications are of serious concerns for even asymptomatic pediatric cancer survivors (PCS). We investigated whether cardiopulmonary exercise testing (CPET) can delineate the underlying pathophysiology of preclinical cardiovascular abnormalities in PCS. Methods We examined CPET data via cycle ergometer in asymptomatic PCS with normal echocardiogram and age-matched controls. Peak and submaximal parameters were analyzed. Results Fifty-three PCS and 60 controls were studied. Peak oxygen consumption (VO2), peak work rate (WR), and ventilatory anaerobic threshold (VAT) were significantly lower in PCS than controls (1.86 ± 0.53 vs. 2.23 ± 0.61 L/min, 125 ± 45 vs. 154 ± 46 watt, and 1.20 ± 0.35 vs. 1.42 ± 0.43 L/min, respectively; all p p = 0.0006). Stroke volume (SV) reserve was decreased in PCS, indicated by simultaneous higher dependency on HR (higher ΔHR/ΔWR) and lower peak oxygen pulse (OP) at the peak exercise. Twelve PCS with high peak RQ (≥ 1.3) revealed lower pVO2 and VAT than the rest of PCS despite higher ventilatory efficiency (lower DVE/DVCO2), suggesting fundamental deficiency in oxygen utilization in some PCS. Conclusions Poor exercise performance in PCS is mainly attributed to limited stroke volume reserve, but the underlying pathophysiology is multi-factorial. Combined assessment of peak and submaximal CPET parameters provided critical information in delineating underlying exercise physiology of PCS. (244 words)

Objective Previous research has suggested an association between plagiocephaly and developmental delay. However, study samples drawn from children seen in subspecialty clinics increase the potential for selection and referral bias. Our study evaluates the association between plagiocephaly and developmental delay and the timing of these diagnoses in a primary care setting, where plagiocephaly is commonly diagnosed and managed. Methods Our retrospective analysis used electronic medical record data from 45 primary care sites within a children's health system from 1999 to 2017, including children aged 0 to 5 years with diagnoses determined by physician diagnosis codes at primary care visits. Children were classified in the plagiocephaly group if diagnosis occurred by 12 months of age. Primary outcome was any developmental delay. Pearson χ2 test, Fisher exact test, and logistic regression analyses were conducted, with multivariable models adjusted for sex, race, ethnicity, insurance, prematurity status (22-36 weeks' gestation), primary care sites, birth year, and diagnoses of abnormal tone and torticollis. Results Of 77,108 patients seen by 12 months, 2315 (3.0%) were diagnosed with plagiocephaly, with an increase in diagnosis prevalence over the study time frame. Plagiocephaly was independently associated with an increased odds of any developmental delay diagnosis (adjusted odds ratio 1.50, 95% confidence interval 1.32-1.70). The diagnosis of plagiocephaly was recorded before the diagnosis of developmental delay in most cases when both diagnoses were present (374 of 404, 92.6%). Conclusion Data from a large primary care cohort demonstrate an association between plagiocephaly and developmental delay, affirming findings in previous subspecialty literature.

A unique structured carrier depletion ring modulator is fabricated. We achieved high modulation efficiency of 0.9nm with a large extinction ratio of about 20dB. The device has a free spectral range of about 13nm.

A very compact ring resonator based multiplexer is demonstrated. The fabricated four channel multiplexer shows the extinction ratio of about 25dB in each of the four consecutive resonances with a channel spacing of 2nm.

Objectives To investigate the impact of rhGH on measures of skeletal muscle strength, power, endurance, agility, and lean body mass accrual in prepubertal boys with significant short stature compared to age-matched healthy controls growing normally. Methods 40 prepubertal boys were recruited, 25 with significant short stature -either isolated GH deficiency or idiopathic (mean (SE) age: 8.9±0.3yrs; HT SDS: -2.3±0.1) and 15 normally growing healthy controls (age: 8.8±0.4yrs; HT SDS: -0.3±0.2). All had testing at baseline including anthropometry, blood, DEXA scan (body composition), and indirect calorimetry (resting energy expenditure (REE)). Protocolized muscle function tests were performed by expert personnel including measures of skeletal muscle strength (isokinetic dynamometry (flexion/extension) upper and lower extremities), power (vertical jump), endurance (modified push-ups), and agility (timed shuttle-runs). Boys with short stature were started on daily rhGH (Norditropin®, 0.3mg/kg/w) and baseline studies repeated identically in all at 6 and 12 months. Mixed effects model ANOVA (and 2 sample t-test) was used to compare main outcomes over time between groups (significance p ≤0.05). Results Baseline N=40, 6 months N=34, 12 months N=27 participants thus far. All grew well and remained prepubertal throughout the study. At baseline, there were measurable differences in fat free mass (FFM) between groups: short stature: 15.9±0.5kg, controls: 20.4±1.1 (p=0.001); both groups gained FFM at 12 months, short stature group gained 27.3% (p There were significant differences between groups in muscle strength at baseline, lower particularly in elbow flexion (biceps) in the short stature group: 79.7±3.7 Newtons vs. controls: 97.6±5.5 (p=0.008), and knee flexion (hamstrings): 82.6±3.4 Newtons vs. 95.7±3.2 (p=0.013). At 12 months the rhGH-treated group improved biceps strength (25.7%, p There were no significant differences in REE (kcal/kg/d) between groups during 12 months. Conclusion There are significant differences in FFM and skeletal muscle strength and endurance in prepubertal boys with severe short stature compared to healthy age-matched controls. FFM accrual and isokinetic measures of muscle strength, endurance, agility and power improve after 12 months of rhGH, changes approaching measures of those of healthy controls. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Glycosaminoglycans (GAGs) are present in proteoglycans, which play critical physiological roles in various tissues. They are known to be elevated in mucopolysaccharidoses (MPS), a group of rare inherited metabolic diseases in which the lysosomal enzyme required to break down one or more GAG is deficient. In a previous study, we found elevation of GAGs in a subset of patients without MPS. In the current study, we aim to investigate serum GAG levels in patients with conditions beyond MPS. In our investigated samples, the largest group of patients had a clinical diagnosis of viral or non-viral encephalopathy. Clinical diagnoses and conditions also included epilepsy, fatty acid metabolism disorders, respiratory and renal disorders, liver disorders, hypoglycemia, developmental disorders, hyperCKemia, myopathy, acidosis, and vomiting disorders. While there was no conclusive evidence across all ages for any disease, serum GAG levels were elevated in patients with encephalopathy and some patients with other conditions. These preliminary findings suggest that serum GAGs are potential biomarkers in MPS and other disorders. In conclusion, we propose that GAGs elevated in blood can be used as biomarkers in the diagnosis and prognosis of various diseases in childhood, however, further designed experiments with larger sample sizes are required.

Salinity intrusion both in surface and groundwater caused a crisis for safe drinking water in coastal Bangladesh. The situation is even worse for children especially at school. However, information on water services in coastal schools is limited. Here we assess the quality of drinking water and supply infrastructures in the primary schools of a severely saline affected coastal area of Bangladesh. To fulfill the objective, thirty-eight schools were purposively selected and investigated in Dacope Upazila of Khulna district in Bangladesh. Findings revealed that harvested rainwater (63%) and pond (21%) are the major drinking water sources where countries' leading water supply technology, tube well (16%) were the least used option. Moreover, salinity in all the tube wells exceeded the national standard. DO, pH, NO

Background Compressions given during cardiopulmonary resuscitation generate small, ineffective passive ventilations through oscillating waves. Positive end-expiratory pressure increases the volume of these passive ventilations; however, its effect on passive ventilation is unknown. Our objective was to determine if increasing positive end-expiratory pressure during cardiopulmonary resuscitation increases passive ventilation generated by compressions to a clinically significant point. This study was conducted on 13 Landrace-Yorkshire pigs. After inducing cardiac arrest with bupivacaine, cardiopulmonary resuscitation was performed with a LUCAS 3.1. During cardiopulmonary resuscitation, pigs were ventilated at a positive end-expiratory pressure of 0, 5, 10, 15, 20 cmH2O (randomly determined) for 9 min. Using the NM3 respiratory monitoring device, expired minute ventilation and volumetric capnography were measured. Arterial blood gas was obtained for each positive end-expiratory pressure level to compare the effects of positive end-expiratory pressure on carbon dioxide. Results Increasing positive end-expiratory pressure from 0 to 20 cmH2O increased the mean (SEM) expired minute ventilation from 6.33 (0.04) to 7.33 (0.04) mL/min. With the 5-cmH2O incremental increases in positive end-expiratory pressure from 0 to 20 cmH2O, volumetric capnography increased from a mean (SEM) of 94.19 (0.78) to 115.18 (0.8) mL/min, except for 15 cmH2O, which showed greater carbon dioxide exhalation with volumetric capnography compared with 20 cmH2O. PCO2 declined significantly as positive end-expiratory pressure was increased from 0 to 20 cmH2O. Conclusions When increasing positive end-expiratory pressure from 0 to 20, the contribution to overall ventilation from gas oscillations generated by the compressions became more significant, and may even lead to hypocapnia, especially when using positive end-expiratory pressures between 15 and 20.

In this work, we present a novel approach to extract spatially resolved series resistance using electroluminesence and photoluminescence images taken at different conditions.

Background: Low carbohydrate (CHO) diets are used to improve diabetes control, but the safety of these diets has not been studied in children. We assessed counterregulatory response to hypoglycemia after short-term low (LC) or very low (VLC) CHO diets in children with T1D. Methods: Epinephrine (epi), norepinephrine (NE), glucagon (gluc), and beta-hydroxybutyrate (BOHB) were measured before and immediately after becoming hypoglycemic at baseline and after 3 months on a LC or VLC diet (CHO made up 30-39% or 20-29% of total daily calories, respectively). 13 children were enrolled, mean (±SE) A1c 7.8±0.2%, diabetes duration 6.3±1.0 yrs. Participants were given sufficient insulin to decrease glucose to Results: Mean age (±SE) for LC and VLC, 10.5±1.7 (n=7) and 15.0±0.6 yrs (n=6), respectively. Epi increased in response to hypoglycemia at baseline in both groups (mean±SE increase, pg/mL) (LC 130.9±60.1, p=0.072; VLC 412.6±84.0, p= 0.008). At 3 mos Epi increased in LC (181.6±66.7, p=0.053) but not significantly in VLC (100.2±67.9, p=0.214). The change in Epi in response to hypoglycemia was significantly less at 3 mos vs. baseline in VLC (100.2±67.9 vs. 412.6±84.0, p=0.019) but not in LC (181.6±66.7 vs. 191.4±61.7, p=0.935). Change in NE, gluc and BOHB during hypoglycemia was similar in both groups when comparing 3 months of diet with baseline. There was no effect of diet when comparing baseline and 3-month changes in Epi, NE, gluc and BOHB in response to hypoglycemia. Conclusion: Short-term use of a diet very low in CHO in children with T1D may adversely affect counterregulatory response to hypoglycemia, whereas LC diet did not affect response. Further studies are needed to confirm these findings and to assess whether these diets affect growth and development in young children. Disclosure L. Fox: None. J. W. Permuy: None. D. Perez santiago: None. M. Fox: None. M. Hossain: None. Funding Nemours Research Programs; Dexcom, Inc.

Background: Platelet Rich Plasma (PRP) is increasingly applied in clinical practice to treat knee degenerative pathology. Both PRP and hyaluronic acid (HA) have been extensively used to improve lubrication, modulate inflammation and modify the catabolic micro-environment of the joint. Objective: This study was aimed to evaluate the potential synergistic effects of PRP in combination with hyaluronic acid in primary knee osteoarthritis. Methodology: This randomized control trial was carried out on adult patients with primary knee osteoarthritis who attended the Pain Clinic of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, during the period of September 2015 to August 2017. The patients were randomly assigned to one of the two groups designated as group P (control group) who were only treated with PRP and group PH (experimental group) who were treated with the combination of PRP and hyaluronic acid. After providing the allocated treatment, all patients were undergone follow-up examination at 1st week, 1st month and 3rd month for pain improvement by VAS scale and for functional improvement by International Knee Documentation Committee (IKDC) score. Results: A total number of 34 patients were recruited for this study. Visual analogue score 1st month (5.85±0.83) and 3rd month (3.01±0.12) follow up showed statistically significant difference among two group (p=0.001). Inter group comparison showed that, mean VAS score of group PH (3.01±0.12) decreased more than Group P (4.01±1.01). In case of functional improvement, group PH also showed statistically better improvement during 1st month (45.76±3.25) and 3rd month (62.06±5.37) follow up than Group P. Conclusion: In conclusion articular platelet rich plasma in combination with hyaluronic acid provide better pain relief and improvement of functional status than PRP therapy alone in primary knee osteoarthritis. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 137-142

Novel, high-throughput metrology methods are used in this paper for detailed performance loss analysis of approximately 400 industrial crystalline silicon solar cells, all coming from the same production line. The characterization sequence combines traditional global cell measurements (e.g., current–voltage, Suns- ${V}_{\text{OC}}$ ) with camera-based cell imaging of voltage distribution and power dissipation from photoluminescence and lock-in thermography, respectively. Spatial variations in current collection are visualized using a high-speed external quantum efficiency and reflectance measurement technique. A nondestructive transfer length method (TLM) measurement technique is also implemented, featuring circular TLM structures hidden within the busbars of the cells. The variance of individual loss parameters and their impact on cell performance are quantified for this large group of cells. Based on correlations performed across parameters, recombination losses in the bulk and rear surface of the cell are shown to be the primary limiting factor for the cell efficiency. The nature of these distributions and correlations provide important insights about loss mechanisms in industrial solar cells, helping to prioritize efforts for optimizing the performance of the production line. Additionally, many of the parameters extracted from these techniques can be tied back to incoming material quality issues (e.g., poor bulk carrier lifetime, nonuniform wafer doping) and to individual unit processes (e.g., texturing, phosphorus diffusion, silicon nitride deposition, metallization), allowing the data to be used directly for process control in manufacturing. All of the datasets are made available for download.

The spatial distribution of device performance parameters of solar cells provides important insight into their operation, including the type and magnitude of conversion losses and potential areas of improvement. In most of the procedures used to create these parameter images, a uniform (i.e., global) short-circuit current density (JSC) is usually assumed. However, JSC is known to vary over the surface of a solar cell, especially in polycrystalline absorber materials like multicrystalline silicon. In this work, a high speed quantum efficiency measurement rastered over the surface of a solar cell is used to obtain images of JSC. These JSC images are then used to calculate images of series resistance, dark saturation current density, fill factor, and conversion efficiency. Comparisons are made between the images created with a global JSC and with the spatially-resolved JSC. Negligible variation is observed in the series resistance and dark saturation current density images, but a drastic change is observed in the efficiency images between these two methods.

Rationale Obesity in children increases the risk for new asthma. How age, sex, race/ethnicity, and allergy status affect the relationship between obesity and asthma is unclear. This study describes the relationship between high body mass index (BMI) and incident asthma. Methods We conducted a retrospective cohort study to compare asthma incidence among normal weight, overweight, and obese 2 to 6, 7 to 11, and 12 to 17 year olds to define the effects of sex, race/ethnicity, and allergy status. Weight status was determined at baseline and asthma incidence was defined as ≥2 asthma encounters and ≥1 asthma prescriptions. We used multivariable Poisson regression to estimate adjusted incident asthma rates and risk ratios. Results Data from 192 843 2 to 6 year olds, 157 284 7 to 11 year olds, and 157 369 12 to 17 year olds were included. The relative risks (95% confidence interval [CI]) of new asthma among obese children in 2 to 6 year olds, 7 to 11 year olds, and 12 to 17 year olds were 1.25 (1.15, 1.37), 1.49 (1.32, 1.69) and 1.40 (1.21, 1.63), respectively. Among children with underlying allergic rhinitis, obesity did not increase the risk of new asthma. In children without allergic rhinitis, the risk for obesity-related asthma was highest in 7 to 11 year olds (risk ratio = 1.50 95% CI, 1.33, 1.60). Before age 12, females had a higher risk for obesity-related asthma; but after age 12, obese males had a higher asthma risk (interaction P-value Conclusion Obesity is a major preventable risk factor for pediatric asthma that appears to vary along the pediatric age continuum and depends on sex, race/ethnicity and atopy status.

We present a leaf-inspired biomimetic omnidirectional photon management scheme for ultrathin flexible graphene silicon Schottky junction solar cell. An all-dielectric approach comprising lossless spheroidal silica and titania nanoparticle bilayers is used for mimicking the two essential light trapping mechanisms of a leaf - focusing and waveguiding, and scattering. The ratio of the nanoparticle diameters of the two optically tuned layers plays a crucial role in confining the incident light through whispering gallery modes and subsequent forward scattering into the substrate via strong leaky channels. The scheme does not employ any nanostructuring of the silicon substrate, thereby preventing the optical gain from being offset by recombination losses, completely decoupling the optical and electrical performances of the device. The light-trapping scheme shows ultralow broadband reflection of only 10.3% and causes a 30% increase in efficiency compared to a bare graphene/silicon solar cell. An efficiency of ~9% is obtained for solar cell with 20 µm thick n-silicon absorber and doped bilayer graphene, resulting in highest (1.89) watt/gram utilization of silicon among all graphene/silicon solar cells. The light-trapping nanoparticle-embellished solar cell retains its characteristics for >103 bending cycles for a bend radius as low as 3 mm, demonstrating its flexibility, durability and reliability.