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We sought to assess the feasibility of virtually assisted personalized tracheostomy tube (vapTT) implementation for patients with congenital airway anomalies (CAAs) and persistent tracheostomy tube (TT)–related respiratory failure at a tertiary pediatric hospital. Three patients (0‐18 years) with CAAs and recurrent TT‐related respiratory complications were managed with vapTT over 5 years. Patients underwent airway computed tomography acquisition with 3‐dimensional reconstruction and TT virtual modeling for shape customization. Models were transferred to Bivona for fabrication based on industry‐standard materials and processes. Clinical information and tracheoscopies assessing position, obstruction, and granulation were reviewed. Patients demonstrated resolution of visualized TT‐related obstruction, granulation, or ulceration and de‐escalation of respiratory support. Clinical events requiring urgent tracheoscopy decreased in all 3 patients. Sufficient relief of critical airway obstruction allowed progression of medical care and/or discharge. VapTTs are feasible for patients with CAA. This new frontier in personalized devices may serve uniquely challenging patient populations for whom standard treatments have failed. [ABSTRACT FROM AUTHOR]

The critically endangered hawksbill sea turtle (Eretmochelys imbricata) is of conservation concern worldwide. Conservation actions which act to reduce high levels of embryonic mortality aid to boost hatchling production. At Cousine Island, Seychelles, a mixed management method has been adopted to maximize the number of hatchlings entering the ocean. We examined the effectiveness of a hatchery at increasing hatching and emergence success from four seasons of data (2017–2021). Hatchery nests had significantly higher hatching and emergence success across all years relative to nests left in situ (i.e., natural), with inter‐annual variation observed. A greater percentage of in situ clutches was found to be influenced by both crab activity and predation as compared to relocated clutches. Overall, the mixed management approach increased hatching success (mean = 75.1%) relative to the various nest management techniques previously used (2004/2005–2016/2017; mean = 63.5%). By mitigating external influences such as tidal flooding, beach erosion, and crab activity/predation, this study provides evidence for the success of a hatchery in directly increasing hatchling recruitment. Strict and careful hatchery management as well as timely and efficient relocation procedures are needed to minimize potential negative effects of nest relocation. [ABSTRACT FROM AUTHOR]

Objective: To determine predictors of success following Veau 1 and 2 cleft palate repair in patients with and without syndromes. Study Design: Retrospective review of prospectively collected data. Setting: Tertiary care children's hospital. Methods: All children <18 months of age undergoing Furlow palatoplasty for Veau 1 and 2 cleft repair between 2000 and 2014 with postoperative perceptual speech assessment (PSA). Results: In total, 368 consecutive patients were identified; 95 were excluded, resulting in 273 patients. Median age at surgery was 13.0 months (interquartile range [IQR], 11-15 months) with postoperative PSA at a median of 32.3 months (IQR, 26.3-44.5 months). Fifty patients (18.3%) had syndrome diagnosis; 59 patients (21.6%) had nonsyndromic Robin sequence. Velopharyngeal insufficiency (VPI) occurred in 27 patients (10.5%); 13 underwent secondary speech surgery. Cleft-related speech errors occurred in 46 patients (17.6%). Non-cleft-related speech errors occurred in 155 patients (59.6%) and reduced intelligibility in 127 patients (47.9%). Oronasal fistula occurred in 23 patients (8.8%) and was exclusive to Veau 2 clefts. In multivariate analysis, age >13 months at palatoplasty demonstrated a 6-fold higher rate of VPI (hazard ratio [HR], 6.64; P <.01), worse speech outcomes (HR, 6.04; P <.01; HR, 1.60; P <.01; HR, 1.57; P =.02), and greater speech therapy utilization (HR, 2.18; P <.01). Conclusion: VPI occurred in 10% of patients undergoing Furlow palatoplasty repair of Veau 1 or 2 clefts. Age <13 months at palatoplasty was associated with improved speech outcomes and lower VPI incidence (2.8% vs 16.2%). Syndromic diagnosis was associated with noncleft speech errors and reduced intelligibility on univariate analysis but not velopharyngeal function after palatoplasty. [ABSTRACT FROM AUTHOR]

Background: As targeted treatments for amyloid transthyretin cardiomyopathy (ATTR‐CM) are becoming available, we aim to characterize the rates of ventricular arrhythmias (VAs), implantable cardioverter‐defibrillator (ICD) utilization, and their impact on survival. Methods: This is a retrospective cohort study of 130 patients with ATTR‐CM diagnosed at Emory University's Cardiac Amyloidosis Center between April 2012 and September 2020. VAs were defined as nonsustained or sustained ventricular tachycardia and ventricular fibrillation. Results: Of 130 patients, 42 had wild‐type disease (wtATTR) and 88 had hereditary variants (hATTR), most commonly Val122Ile (89%). At ATTR‐CM diagnosis, 80 (62%) patients had EF ≤ 40% consistent with systolic heart failure. Of the 69 (53%) patients with documented VAs significantly higher rates occurred among those with EF ≤ 40% compared with EF > 40% (67% vs. 28%, p =.001). Thirty‐two patients (25 hATTR, 7 wtATTR) had primary prevention ICDs implanted. Eight (25%) of these patients received appropriate ICD therapy while two (6%) experienced inappropriate therapy. Comparing patients with EF ≤ 35% with and without ICDs did not reveal any survival difference (3.3 ± 0.5 vs. 2.8 ± 0.4 years, p =.699). Conclusions: High rates of VAs and appropriate ICD therapy were found among a unique cohort of largely hereditary ATTR‐CM patients with a high rate of systolic heart failure. [ABSTRACT FROM AUTHOR]

Introduction/Aim: Eptacog beta is a recombinant activated human factor VII approved to treat and control bleeding in haemophilia A and B patients with inhibitors. Emicizumab is a factor VIIIa mimetic antibody approved for prophylactic treatment of haemophilia A with and without inhibitors (HAI and HA, respectively). Inhibitor patients treated with emicizumab should expect breakthrough bleeding that requires bypassing agent treatment to restore haemostasis. The aim of this study is to quantify the in vitro thrombin generation induced by the addition of eptacog beta to HAI and HA plasma containing emicizumab. Methods: Thrombin generation assays were performed using HAI and HA plasma. Thrombin generation parameters were examined using a fixed effects model with inhibitor titre, eptacog beta concentration and emicizumab concentration as main effects, and eptacog beta concentration with inhibitor and emicizumab concentration with inhibitor as interaction effects. Results: A significant increase in peak thrombin, ETP and velocity was observed when combinations of eptacog beta (0, 1, 2 or 5 µg/ml) and emicizumab (0, 50 or 100 µg/ml) were evaluated in HA and HAI plasma; the effect remained below that observed in Normal Plasma (NP). A small shortening of lag time below that of NP was observed. Conclusions: Eptacog beta and emicizumab induced thrombin generation in haemophilia A plasma (with and without inhibitors) with the thrombin generation parameters remaining below those of normal plasma. These data provide in vitro proof of concept supporting the concept of use of eptacog beta for the treatment and control of breakthrough bleeding in patients on emicizumab prophylaxis. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is a novel coronavirus resulting in high mortality in the adult population but low mortality in the pediatric population. The role children and adolescents play in COVID-19 transmission is unclear, and it is possible that healthy pediatric patients serve as a reservoir for the virus. This article serves as a summary of a single pediatric institution's response to COVID-19 with the goal of protecting both patients and health care providers while providing ongoing care to critically ill patients who require urgent interventions. A significant limitation of this commentary is that it reflects a single institution's joint effort at a moment in time but does not take into consideration future circumstances that could change practice patterns. We still hope dissemination of our overall response at this moment, approximately 8 weeks after our region's first adult case, may benefit other pediatric institutions preparing for COVID-19. [ABSTRACT FROM AUTHOR]

Objective: Examine the patient characteristics of those undergoing upper airway stimulation (UAS) for the treatment of continuous positive airway pressure (CPAP)-refractive obstructive sleep apnea (OSA) at a tertiary care medical center to determine objective clinical predictors of success.Methods: Retrospective chart review of the first 25 consecutive patients between August 2015 and December 2016 treated with UAS at a tertiary care academic center. Demographic data, medical and sleep history, pre- and postoperative polysomnography data, and sleep endoscopy findings were collected. Statistical analysis was performed using two-sided t test with bivariate and linear regression analysis.Results: In our cohort of 25 patients, mean age was 67.5 ± 7.6 years, and mean body mass index (BMI) was 28.2 ± 3.8 kg/m2 with 42% female. One patient was excluded from analysis for unmasking of complete central apnea with therapy. AHI decreased by a mean of 33.8 events/hour following treatment (95% confidence interval: 25.8 to 41.7, P < 0.001). Preintervention AHI was associated with therapy response, with each point of preintervention AHI leading to an average decrease of 1.03 points (P < 0.001). Eighty-three percent of patients achieved a treatment AHI < 5, whereas 92% achieved an AHI < 10. Mean device use was 49.5 ± 10.4 hours per week. Ninety-two percent of patients were discharged the day of surgery. No major adverse events occurred.Conclusion: UAS continues to gain popularity for the treatment of CPAP-refractive OSA; therefore, identification of predictors of success is crucial. Our study, although small, suggests that more severe preintervention AHI does not preclude significant therapy response and may expand the inclusion criteria for UAS, meriting further investigation.Level Of Evidence: 4 Laryngoscope, 130:556-560, 2020. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: The objectives of this study were to examine patient outcomes using a 36-month age cutoff as a strict admission criterion following tonsillectomy, and review the safety and determine the plausibility of same-day discharge of children under 3 years old following tonsillectomy.Study Design: Retrospective chart review.Methods: A chart review of patients aged 24 to 42 months undergoing tonsillectomy over a 3-year period was conducted. Patients were stratified into <36 months and ≥ 36 months cohorts. Data collected included demographics, medical/sleep history, inpatient records, 30-day emergency department visits, and readmission data. Bivariate comparisons were made using χ2 and Wilcoxon tests for categorical and continuous variables.Results: Between July 2014 and July 2017, 427 patients aged 24 to 42 months underwent tonsillectomy at our institution. Thirty-day emergency department visit, readmission, and greater-than-expected length of stay rates were 3.0% versus 3.7% (P = .75), 1.0 versus 1.8% (P = .61), and 4.7% versus 4.5% (P = 1.00) between the younger and older cohorts, respectively, with no difference in complication rates identified based on age.Conclusions: No significant difference in adverse outcomes was appreciated based on a cutoff of 36 months of age at a tertiary center over 3 years. There should continue to be ongoing studies addressing strict age-related admission criteria.Level Of Evidence: 4 Laryngoscope, 129:E389-E394, 2019. [ABSTRACT FROM AUTHOR]

The article provides information on team-based learning (TBL) introduced into online seven-week prematriculation courses (PMCs) as the pedagogical approach to learning biomedical sciences, replacing an entirely lecture-based format. Topics discussed include communications platform used, modifications to traditional TBL readiness assurance tests (RATs) that were made to promote problem-solving and collaboration, and lessons learned from the TBL model.

Objective: To evaluate the impact of age on safety, efficacy, and usage of upper airway stimulation (UAS).Study Design: Multicenter observational study.Setting: Thirteen US hospitals and 3 German hospitals.Subjects and Methods: The ADHERE registry is a multicenter database enrolling patients undergoing UAS implantation from October 2016 to April 2018. Outcome measures included the Epworth Sleepiness Scale, apnea-hypopnea index (AHI), therapy usage, and complications. Data were segmented by age (<65 vs ≥65 years).Results: Younger adults (n = 365) were a mean ± SD 52.7 ± 7.9 years old and 82% male, with a body mass index of 29.6 ± 3.8. Older adults (n = 235) were 71.1 ± 4.8 years old and 71% male, with a body mass index of 28.8 ± 3.8. Baseline AHI was similar (younger, 36.2 ± 15.9; older, 36.1 ± 14.8). Both groups had lower AHI at 12 months versus baseline (P < .001), but the older group showed a greater reduction (7.6 ± 6.9 vs 11.9 ± 13.4, P = .01). The Epworth Sleepiness Scale score decreased from 12.3 ± 5.4 to 7.1 ± 4.8 (P < .001) among younger adults and from 10.7 ± 5.7 to 6.3 ± 4.4 (P < .001) among older adults. Usage was slightly higher among older adults (6.0 ± 2.0 vs 5.4 ± 2.1 hours/night, P = .02). Surgical time was similar between younger patients (2.4 ± 0.7 hours) and older patients (2.3 ± 0.7 hours, P = .40), with comparably low complications.Conclusion: AHI reduction and therapy usage were found to be somewhat higher among patients aged ≥65 years who were treated with UAS. Surgical complications were low, in contrast to traditional sleep surgery. [ABSTRACT FROM AUTHOR]

COVID-19 is a rapidly growing global pandemic caused by a novel coronavirus. With no vaccine or definitive treatment, public health authorities have recommended a strategy of "social distancing," reducing individual interaction, canceling elective procedures, and limiting nonessential services. Health care providers must determine what procedures are considered "elective," balancing risk of treatment delays with that of coronavirus exposure to patient, family, and providers. Given critical periods for language development and the long-term impact of auditory deprivation, some audiologic and otologic services should be considered essential. In this article, we describe the experience of a quaternary referral pediatric hospital in Seattle, the epicenter of COVID-19 in the United States, and share strategies for risk minimization employed by Seattle Children's Hospital. We hope that this work can be a reference for other centers continuing care for children who are deaf and hard of hearing during the COVID-19 and future resource-limiting crises. [ABSTRACT FROM AUTHOR]

BACKGROUND Cases of western corn rootworm ( WCR) field-evolved resistance to Cry3Bb1 and other corn rootworm ( CRW) control traits have been reported. Pyramid products expressing multiple CRW traits can delay resistance compared to single trait products. We used field studies to assess the pyramid CRW corn products, SmartStax (expressing Cry3Bb1 and Cry34Ab1/ Cry35Ab1) and SmartStax PRO (expressing Cry3Bb1, Cry34Ab1/ Cry35Ab1 and DvSnf7), at locations with high WCR densities and possible Cry3Bb1 resistance, and to assess the reduction in adult emergence attributable to DvSnf7 and other traits. Insect resistance models were used to assess durability of SmartStax and SmartStax PRO to WCR resistance. RESULTS SmartStax significantly reduced root injury compared to non- CRW-trait controls at all but one location with measurable WCR pressure, while SmartStax PRO significantly reduced root injury at all locations, despite evidence of Cry3Bb1 resistance at some locations. The advantage of SmartStax PRO over SmartStax in reducing root damage was positively correlated with root damage on non- CRW-trait controls. DvSnf7 was estimated to reduce WCR emergence by approximately 80-95%, which modeling indicated will improve durability of Cry3Bb1 and Cry34Ab1/ Cry35Ab1 compared to SmartStax. CONCLUSION The addition of DvSnf7 in SmartStax PRO can reduce root damage under high WCR densities and prolong Cry3Bb1 and Cry34Ab1/ Cry35Ab1 durability. © 2017 Society of Chemical Industry [ABSTRACT FROM AUTHOR]

This article discusses the use of ChatGPT, an artificial intelligence system, in generating multiple-choice questions (MCQs) for exams in medical education. The study found that ChatGPT was able to generate high-quality MCQs and save time compared to traditional methods. However, careful review by content experts is necessary to ensure the quality of the questions, as ChatGPT-generated questions may have flaws. The study also suggests that students can use ChatGPT to assist with their studies, and faculty can integrate this tool into their question writing processes. [Extracted from the article]

Pediatric obstructive sleep apnea (OSA) is a common condition, affecting up to 1% to 4% of children under 8 years old. Five studies representing 120 patients undergoing DISE-directed surgery and four studies representing 68 patients undergoing cine MRI-directed surgery found the most common surgeries to be lingual tonsillectomy and/or supraglottoplasty regardless of diagnostic modality. Systematic review evaluating the workup of residual OSA after AT highlight the two most common diagnostic modalities: sedated cine magnetic resonance imaging (MRI) and drug-induced sleep endoscopy (DISE). [Extracted from the article]

The article focuses on the effective direct student observation strategies in neurology. It informs that direct observation of histories and physicals rarely occurs in the training of neurology. It is suggested that doctors should be confident about its usefulness in busy clinical settings. This strategy was also applied on a student and the author in which the student interviewed the patient whereas the author observed and generated documentation.