Pediatric sleep: current knowledge, gaps, and opportunities for the future.

This White Paper addresses the current gaps in knowledge, as well as opportunities for future studies in pediatric sleep. The Sleep Research Society's Pipeline Development Committee assembled a panel of experts tasked to provide information to those interested in learning more about the field of pediatric sleep, including trainees. We cover the scope of pediatric sleep, including epidemiological studies and the development of sleep and circadian rhythms in early childhood and adolescence. Additionally, we discuss current knowledge of insufficient sleep and circadian disruption, addressing the neuropsychological impact (affective functioning) and cardiometabolic consequences. A significant portion of this White Paper explores pediatric sleep disorders (including circadian rhythm disorders, insomnia, restless leg and periodic limb movement disorder, narcolepsy, and sleep apnea), as well as sleep and neurodevelopment disorders (e.g. autism and attention deficit hyperactivity disorder). Finally, we end with a discussion on sleep and public health policy. Although we have made strides in our knowledge of pediatric sleep, it is imperative that we address the gaps to the best of our knowledge and the pitfalls of our methodologies. For example, more work needs to be done to assess pediatric sleep using objective methodologies (i.e. actigraphy and polysomnography), to explore sleep disparities, to improve accessibility to evidence-based treatments, and to identify potential risks and protective markers of disorders in children. Expanding trainee exposure to pediatric sleep and elucidating future directions for study will significantly improve the future of the field.

Adenovirus causing hepatic abscess formation and unexplained fever in adult liver transplant recipients.

Adenovirus infection is commonly associated with self-limited respiratory and gastrointestinal illnesses. However, infection in immunocompromised individuals, such as transplant recipients, can cause severe life-threatening illness including pneumonitis, hemorrhagic cystitis, nephritis, hepatitis, and enterocolitis. In orthotopic liver transplant recipients, adenovirus viremia can cause hepatitis leading to marked transaminitis, allograft loss, and death. Although hepatic abscesses mediated by adenovirus have been described in other immunosuppressed patient populations, it has very rarely been described in liver transplant recipients. Here, we report two adult cases of hepatic abscesses following liver transplantation secondary to adenovirus infection and describe the successful treatment of these patients. Adenovirus should be considered as an uncommon etiology of hepatic abscess and unexplained fevers in adults following liver transplantation.

Sleep, energy balance, and meal timing in school-aged children.

OBJECTIVE: To determine associations among objectively-measured nocturnal sleep time, bedtime and obesogenic behaviors, including dietary intake, timing of intake, and physical activity, in a diverse sample of school-aged children who presented for behavioral treatment to enhance sleep duration. METHODS: Eighty-seven children (8-11 y, 66.7% female, zBMI: 0.86 ± 1.0) who self-reported sleeping <9.5 h/night were studied for one week using wrist actigraphy to estimate sleep; hip-worn accelerometers to measure physical activity; and 24 h dietary recalls to capture dietary intake and meal timing. Pearson and Spearman's rho correlations and linear regressions controlling for age, gender and race were used for statistical analyses. RESULTS AND CONCLUSION: Mean bedtime was 10:31 PM (±58.2 min) and mean nocturnal sleep time was 7.7 h (±37.5 min). Although later bedtime was associated with shorter sleep time (r = -0.61, p < 0.001), the two variables were differentially related to obesity risk factors. Later bedtime, but not sleep time, correlated with greater daily fat intake, later first meal of the day, and greater after-dinner intake (all p < 0.05). Nocturnal sleep time, but not bedtime, correlated with zBMI (p = 0.04). Both sleep time and later bedtime were associated with a later last meal of the day (all p < 0.05). Findings remained consistent after controlling for demographic factors. In short-sleeping school-aged children, bedtime may be more predictive of dietary obesity risk factors whereas sleep duration may be more predictive of zBMI. Results suggest that health providers should consider both bedtime and sleep duration for reducing obesity risk in children. CLINICAL TRIAL: Enhancing Sleep Duration: Effects on Children's Eating and Activity Behaviors, NCT03186508, https://clinicaltrials.gov/ct2/show/NCT03186508.

A Novel Classification System for Injuries After Electronic Cigarette Explosions.

Electronic cigarettes (e-cigarettes) contain lithium batteries that have been known to explode and/or cause fires that have resulted in burn injury. The purpose of this article is to present a case study, review injuries caused by e-cigarettes, and present a novel classification system from the newly emerging patterns of burns. A case study was presented and online media reports for e-cigarette burns were queried with search terms "e-cigarette burns" and "electronic cigarette burns." The reports and injury patterns were tabulated. Analysis was then performed to create a novel classification system based on the distinct injury patterns seen in the study. Two patients were seen at our regional burn center after e-cigarette burns. One had an injury to his thigh and penis that required operative intervention after ignition of this device in his pocket. The second had a facial burn and corneal abrasions when the device exploded while he was inhaling vapor. The Internet search and case studies resulted in 26 cases for evaluation. The burn patterns were divided in direct injury from the device igniting and indirect injury when the device caused a house or car fire. A numerical classification was created: direct injury: type 1 (hand injury) 7 cases, type 2 (face injury) 8 cases, type 3 (waist/groin injury) 11 cases, and type 5a (inhalation injury from using device) 2 cases; indirect injury: type 4 (house fire injury) 7 cases and type 5b (inhalation injury from fire started by the device) 4 cases. Multiple e-cigarette injuries are occurring in the United States and distinct patterns of burns are emerging. The classification system developed in this article will aid in further study and future regulation of these dangerous devices.

Desmoplastic infantile astrocytoma/ganglioglioma with rare BRAF V600D mutation.

BACKGROUND: Desmoplastic infantile astrocytoma (DIA) and desmoplastic infantile gangliogliomas (DIGs) are rare, massive, cystic and solid tumors of infants usually found in superficial cerebral hemispheres. They manifest prominent desmoplastic stroma, admixed neoplastic astrocytes, primitive-appearing small cells, and additional neoplastic ganglion cells in the case of DIGs. While v-Raf murine sarcoma viral oncogene homolog B (BRAF) mutation is found in up to 50% of pediatric gangliogliomas, two recent studies found that it was rare in DIA/DIGs; we sought to assess BRAF status in DIA/DIGs from our institution. PROCEDURE: Departmental files from 2000 to 2016 were reviewed to identify cases. Clinical, neuroimaging, histological, and immunohistochemistry (IHC) features were assessed; the latter included IHC for astrocytic and neuronal markers and BRAF VE1. BRAF mutational assessment by Sanger and next-generation sequencing was attempted in all cases. RESULTS: All six identified cases (four males-two females; three DIA-three DIG) occurred in children <1-year old, were large, cerebral-hemispheric, cystic and solid, and enhancing tumors. Only one case, a DIG with prominent aggregates of neoplastic ganglion cells, showed either BRAF VE1 IHC positivity or mutation by Sanger and next-generation sequencing (rare c. 1799_1800delinsAT; p. V600D). Four of six archival cases were BRAF VE1 IHC negative, but failed mutational sequencing. CONCLUSION: Five of six classic DIA/DIGs were negative for BRAF mutation; previous series have identified BRAF mutation in two of 18 and one of 14 cases, although all were the more common BRAF V600E. We were unable to find other examples of glial tumors in public databases with this rare BRAF V600D mutation. Identification of BRAF mutational opens the possibility of BRAF-targeted therapies for the subset of DIA/DIG that clinically progress postresection.

Fundamental Limits in Combine Harvester Header Height Control.

This paper investigates fundamental performance limitations in the control of a combine harvester's header height control system. There are two primary subsystem characteristics that influence the achievable bandwidth by affecting the open loop transfer function. The first subsystem is the mechanical configuration of the combine and header while the second subsystem is the electrohydraulic actuation for the header. The mechanical combine + header subsystem results in an input-output representation that is underactuated and has a noncollocated sensor/actuator pair. The electrohydraulic subsystem introduces a significant time delay. In combination, they each reinforce the effect of the other thereby exacerbating the overall system limitation of the closed loop bandwidth. Experimental results are provided to validate the model and existence of the closed loop bandwidth limitations that stem from specific system design configurations.

Learning characteristics of the CERAD word list in an elderly VA sample.

The Consortium to Establish a Registry for Alzheimer's Disease (Morris et al., 1989) neuropsychological battery, including its 10-word list-learning task, remains in clinical and research use. The present study examined learning characteristics of this word list in a clinical series of elderly military veterans referred for neuropsychological evaluation of suspected dementia. Findings are presented establishing specific normative data by age, education, race, and diagnosis on learning outcomes including total new learning, delayed recall, and recognition memory. In addition, variables such as primacy and recency, intrusion and repetition errors, learning slope, and across-trial consistency are reported. There were no unexpected between-group findings, and the current data may be valuable as a reference when patients with similar demographic and health backgrounds are evaluated.

Caregiver stress and outcomes of children with pediatric feeding disorders treated in an intensive interdisciplinary program.

OBJECTIVE: This study investigated the impact of an intensive interdisciplinary feeding program on caregiver stress and child outcomes of children with feeding disorders across three categories. METHODS: Children were categorized into either tube dependent, liquid dependent, or food selective groups. Outcomes for caregiver stress levels, child mealtime behaviors, weight, and calories were examined at admission and discharge for 121 children. Repeated measures ANOVAs were used to examine differences pre- and post-treatment and across feeding categories. RESULTS: Caregiver stress, child mealtime behaviors, weight, and caloric intake improved significantly following treatment in the intensive feeding program, regardless of category placement. CONCLUSIONS: Few studies have examined the impact of an intensive interdisciplinary approach on caregiver stress, as well as on child outcome variables with such a diverse population. This study provides support that regardless of a child's medical and feeding history, an intensive interdisciplinary approach significantly improves caregiver stress and child outcomes.

On-line reoptimization of filter designs for multivariate optical elements.

An automated method for producing multivariate optical element (MOE) interference filters that are robust to errors in the reactive magnetron sputtering process is described. Reactive magnetron sputtering produces films of excellent thickness and uniformity. However, small changes in the thickness of individual layers can have severe adverse effects on the predictive ability of the MOE. Adaptive reoptimization of the filter design during the deposition process can maintain the predictive ability of the final filter by changing the thickness of the undeposited layers to compensate for the errors in deposition. The merit function used, the standard error of calibration, is fundamentally different from the standard spectrum matching. This new merit function allows large changes in the transmission spectrum of the filter to maintain performance.