Prevention of concussion and long-term effects of repetitive traumatic brain injury: Unanimous consensus from the Cantu Concussion Summit.

Objective: The Cantu Concussion Summit aimed to gather clinicians and researchers to share findings and identify research gaps in brain injury and long-term cognitive disorders in athletes.

Design: The conference concluded with a discussion of ways to best mitigate the risk of concussion and repetitive traumatic brain injury (RTBI).

Setting And Participants: The summit was supported by an unrestricted educational grant from the National Football League and featured a diverse group of experts from multiple disciplines.

Functional connectivity changes in mouse models of maple syrup urine disease.

Maple syrup urine disease is a rare metabolic disorder that results in neurodevelopmental injury despite dietary therapy. While structural neuroimaging has shown a characteristic pattern of edema and white matter injury, no functional neuroimaging studies of maple syrup urine disease have been performed. Using widefield optical imaging, we investigated resting-state functional connectivity in two brain-specific mouse models of maple syrup urine disease (an astrocyte-specific knockout and a whole-brain knockout).

Frequency and Clinical Significance of Clonal and Subclonal Driver Mutations in High-Risk Neuroblastoma at Diagnosis: A Children's Oncology Group Study.

Purpose: Relapsed high-risk neuroblastomas (NBLs) are enriched for targetable mutations in and RAS-MAPK pathways, yet the prognostic effect of these aberrations and relevance of subclonal mutations at diagnosis remain undefined. We describe the spectrum and clinical significance of clonal and subclonal pathogenic alterations in high-risk NBL.

Methods: We developed a focused high-risk NBL sequencing panel including , , , , , , , and genes for ultra-deep sequencing and applied this assay to 242 pretherapy tumors from patients enrolled on the phase III trial Children's Oncology Group ANBL0532.

Moyamoya Across the Lifespan: Current Neurologic Care and Future Directions.

Moyamoya arteriopathy is an important cause of stroke across the lifespan, with high rates of incident and recurrent stroke in affected individuals. Although it affects adults and children globally, moyamoya is more prevalent in East Asian countries, particularly Japan and Korea. The R4810K variant of the gene, most common in Asian populations, is associated with severe, early onset, multisystem vasculopathy.

Supplementing Consent for a Prospective Longitudinal Cohort Study of Infants With Antenatal Opioid Exposure: Development and Assessment of a Digital Tool.

Background: The Outcomes of Babies With Opioid Exposure (OBOE) study is an observational cohort study examining the impact of antenatal opioid exposure on outcomes from birth to 2 years of age. COVID-19 social distancing measures presented challenges to research coordinators discussing the study at length with potential participants during the birth hospitalization, which impacted recruitment, particularly among caregivers of unexposed (control) infants. In response, the OBOE study developed a digital tool (consenter video) to supplement the informed consent process, make it more engaging, and foster greater identification with the research procedures among potential participants.

Healthcare-Associated Gastroenteritis: Outbreak Report and Systematic Review of the Literature.

Healthcare-associated gastroenteritis continues to be associated with significant pediatric morbidity and mortality despite the introduction of rotavirus vaccines. Infection prevention (IP) measures are critical in mitigating outbreaks. We describe an outbreak of norovirus and effective IP strategies utilized and calculated the costs associated with the outbreak.

Admissions to MD-PhD programs: How well do application metrics predict short or long-term physician-scientist outcomes?

MD-PhD programs prepare physicians for research-focused careers. The challenge for admissions committees is to select from among their applicants those who will achieve this goal, becoming leaders in academic medicine and biomedical research. Although holistic practices are encouraged, the temptation remains to use metrics such as grade point average, MCAT scores, and postbaccalaureate gap length, combined with race/ethnicity, age at college graduation, and sex to select whom to interview and admit.

Vitamin A treatment restores vision failures arising from Leber's hereditary optic neuropathy-linked mtDNA mutation.

Leber hereditary optic neuropathy (LHON) is a paradigm for mitochondrial retinopathy due to mitochondrial DNA (mtDNA) mutations. However, the mechanism underlying retinal cell-specific effects of LHON-linked mtDNA mutations remains poorly understood and there has been no effective treatment or cure for this disorder. Using a mice model bearing a LHON-linked ND6P25L mutation, we demonstrated that the mutation caused retinal cell-specific deficiencies, especially in retinal ganglion cells (RGC), rods and Müller cells.

Prodrug activation in malaria parasites mediated by an imported erythrocyte esterase, acylpeptide hydrolase (APEH).

The continued emergence of antimalarial drug resistance highlights the need to develop new antimalarial therapies. Unfortunately, new drug development is often hampered by undesirable drug-like properties of lead compounds. Prodrug approaches temporarily mask undesirable compound features, improving bioavailability and target penetration.

Considerations and recommendations from the ISMRM diffusion study group for preclinical diffusion MRI: Part 2-Ex vivo imaging: Added value and acquisition.

The value of preclinical diffusion MRI (dMRI) is substantial. While dMRI enables in vivo non-invasive characterization of tissue, ex vivo dMRI is increasingly being used to probe tissue microstructure and brain connectivity. Ex vivo dMRI has several experimental advantages including higher SNR and spatial resolution compared to in vivo studies, and enabling more advanced diffusion contrasts for improved microstructure and connectivity characterization.

Use of food restrictions to prevent infections in paediatric patients with cancer and haematopoietic cell transplantation recipients: a systematic review and clinical practice guideline.

Background: Food restrictions during periods of neutropenia have been widely used in oncology settings to prevent infections. As there is a lack of clearly demonstrated effectiveness, this strategy is being increasingly questioned.

Methods: A multi-national panel of 23 individuals was convened to develop a clinical practice guideline (CPG) on the use of food restrictions to prevent infections in paediatric patients with cancer and haematopoietic cell transplantation (HCT) recipients.

Evaluation of a notes-based rapid qualitative analysis method to facilitate implementation.

Background: Qualitative methodologies offer a nuanced approach to understanding stakeholder perspectives, preferences, and context in implementation research. However, traditional qualitative data analysis can be time consuming and create barriers to responsive implementation of interventions. Rapid qualitative methods that yield timely, actionable results have emerged to expedite the evidence-to-practice gap, but often require all analysts to have implementation science expertise and resources for interview transcription.

Exploring social impairment in those with opioid use disorder: linking impulsivity, childhood trauma, and the prefrontal cortex.

Background: Challenges with social functioning, which is a hallmark of opioid use disorder (OUD), are a drawback in treatment adherence and maintenance. Yet, little research has explored the underlying mechanisms of this impairment. Impulsivity and corresponding neural alterations may be at the center of this issue.

Improving the Infrastructure for Pediatric Medical Device Trials at Children's Hospitals.

The shortage of novel pediatric devices that accommodate the unique needs of children exists due to several scientific, clinical, regulatory, and financial barriers. This global unmet need is being addressed in the United States by multiple stakeholders including the Food and Drug Administration (FDA) and its Pediatric Device Consortia (PDC) grant program. One critical area of interest is the suboptimal medical device clinical trial infrastructure that currently exists in academic medical centers and compounded at children's hospitals.

Is Excretory Phase Computerized Tomography Important for Evaluation of Pediatric High-Grade Renal Trauma?

Purpose: There are no standardized guidelines for evaluation of pediatric renal trauma. We hypothesize that screening radiographic studies performed to rule out traumatic renal injuries in children can initially be evaluated by contrast-enhanced CT scans that lack an excretory phase.

Materials And Methods: We retrospectively collected data from five pediatric trauma centers between 2007-2020.

Recessive genetic contribution to congenital heart disease in 5,424 probands.

Variants with large effect contribute to congenital heart disease (CHD). To date, recessive genotypes (RGs) have commonly been implicated through anecdotal ascertainment of consanguineous families and candidate gene-based analysis; the recessive contribution to the broad range of CHD phenotypes has been limited. We analyzed whole exome sequences of 5,424 CHD probands.

Ventilator Liberation Practices in Pediatric Cardiac Critical Care.

Mechanical ventilation is common in critically ill children with cardiac disease, but literature focused on ventilator liberation practices for this unique pediatric subpopulation is limited. We aimed to describe current ventilator liberation practices in critically ill children with cardiac disease. Through the Pediatric Cardiac Critical Care Consortium, an electronic survey was distributed to pediatric ICU attending physicians caring for patients with cardiac disease evaluating institutional protocols and individual practices around ventilator liberation including criteria for extubation readiness testing (ERT), ERT components, spontaneous breathing trial (SBT) method and duration, timing of extubation, and postextubation respiratory support.

Associations Between U.S. Women's Toileting Behaviors and Lower Urinary Tract Symptoms: A Cross-Sectional Analysis of RISE for HEALTH Study Data.

Toileting behaviors are recognized as potential contributors to lower urinary tract symptoms (LUTS) in women. This study examines the association between toileting behaviors and LUTS among community-dwelling women and whether age modifies these associations. Cross-sectional analyses were conducted using baseline data from a population-based cohort study, RISE FOR HEALTH (RISE).

Reduced Severity of Arterial Catheter-Associated Proximal Ischemic Injuries Through a Quality Improvement Initiative.

Objectives: To define and reduce the incidence of severe arterial catheter-associated proximal ischemic injuries (ACAPII).

Design: Quality improvement (QI) initiative.

Setting: University affiliated PICU in a quaternary children's hospital.

Kittredge Lecture: Determining Noninvasive Ventilation Failure in Pediatric Patients.

Noninvasive ventilation is a standard therapy to treat respiratory distress in children and its successful use has been shown to shorten stay. However, with its application there are risks for adverse events, and therapy failure has been linked to prolonged time on invasive mechanical ventilation, increased stay, and mortality. It is essential for respiratory therapists to understand the factors contributing to noninvasive ventilation failure and what is known on how to predict which children will fail noninvasive ventilation from the existing literature.