ABSTRACT
The effectiveness of newborn screening (NBS) for congenital hypothyroidism (CH) relies on timely screening, confirmation of diagnosis, and initiation and ongoing monitoring of treatment. The objective of this study was to ascertain the extent to which infants with CH have received timely and appropriate management within the first 3 years of life, following diagnosis through NBS in Alberta, Canada. Deidentified laboratory data were extracted between 1 April 2014 and 31 March 2019 from Alberta Health administrative databases for infants born in this time frame. Time to lab collection was anchored from date of birth. Timeliness was assessed as the frequency of monitoring of Thyroid Stimulating Hormone (TSH) and appropriateness as the frequency of children maintaining biochemical euthyroidism. Among 160 term infants, 95% had confirmation of diagnosis by 16 days of age. The cohort had a median of 2 (range 0-5) TSH measurements performed in the time interval from 0 to 1 month, 4 (0-12) from 1 to 6 months, 2 (0-10) from 6 to 12 months, and 7 (0-21) from 12 to 36 months. Approximately half were still biochemically hypothyroid (TSH > 7 mU/L) at 1 month of age. After becoming euthyroid, at least some period of hypo- (60%) or hyperthyroidism (TSH < 0.2 mU/L) (39%) was experienced. More work needs to be performed to discern factors contributing to prolonged periods of hypothyroidism or infrequent lab monitoring.
ABSTRACT
Self-gravity plays a decisive role in the final stages of star formation, where dense cores (size approximately 0.1 parsecs) inside molecular clouds collapse to form star-plus-disk systems. But self-gravity's role at earlier times (and on larger length scales, such as approximately 1 parsec) is unclear; some molecular cloud simulations that do not include self-gravity suggest that 'turbulent fragmentation' alone is sufficient to create a mass distribution of dense cores that resembles, and sets, the stellar initial mass function. Here we report a 'dendrogram' (hierarchical tree-diagram) analysis that reveals that self-gravity plays a significant role over the full range of possible scales traced by (13)CO observations in the L1448 molecular cloud, but not everywhere in the observed region. In particular, more than 90 per cent of the compact 'pre-stellar cores' traced by peaks of dust emission are projected on the sky within one of the dendrogram's self-gravitating 'leaves'. As these peaks mark the locations of already-forming stars, or of those probably about to form, a self-gravitating cocoon seems a critical condition for their existence. Turbulent fragmentation simulations without self-gravity-even of unmagnetized isothermal material-can yield mass and velocity power spectra very similar to what is observed in clouds like L1448. But a dendrogram of such a simulation shows that nearly all the gas in it (much more than in the observations) appears to be self-gravitating. A potentially significant role for gravity in 'non-self-gravitating' simulations suggests inconsistency in simulation assumptions and output, and that it is necessary to include self-gravity in any realistic simulation of the star-formation process on subparsec scales.
