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Growth faltering is widespread in many low- and middle-income countries, but its effects on childhood bone mass accrual are unknown. The objective of this study was to estimate associations between length (conditional length-for-age z-scores, cLAZ) and weight (conditional weight-for-age z-scores, cWAZ) gain in three age intervals (ages 0–6, 6–12 and 12–24 months) with dual-energy X-ray absorptiometry-derived measures of bone mass (total body less head (TBLH) bone mineral content (BMC), areal bone mineral density (aBMD) and bone area) at 4 years of age.
Design:
Associations between interval-specific growth parameters (cLAZ and cWAZ) and bone outcomes were estimated using linear regression models, adjusted for maternal, child and household characteristics.
Setting:
Data collection occurred in Dhaka, Bangladesh.
Participants:
599 healthy children enrolled in the BONe and mUScle Health in Kids Study.
Results:
cLAZ in each age interval was positively associated with TBLH BMC, aBMD and bone area at 4 years; however, associations attenuated towards null upon adjustment for concurrent height-for-age z-scores (HAZ) at age 4 years and confounders. cWAZ from 0 to 6 and 6 to 12 months was not associated with bone mass, but every sd increase in cWAZ between 12 and 24 months was associated with greater BMC (7·6 g; 95 % CI: 3·2, 12·0) and aBMD (0·008 g/cm2; 95 % CI: 0·003, 0·014) after adjusting for concurrent WAZ, HAZ and confounders.
Conclusions:
Associations of linear growth (birth to 2 years) with bone mass at age 4 years were explained by concurrent HAZ. Weight gain in the second year of life may increase bone mass independently of linear growth in settings where growth faltering is common.
Rapid antigen detection tests (Ag-RDT) for SARS-CoV-2 with emergency use authorization generally include a condition of authorization to evaluate the test’s performance in asymptomatic individuals when used serially. We aim to describe a novel study design that was used to generate regulatory-quality data to evaluate the serial use of Ag-RDT in detecting SARS-CoV-2 virus among asymptomatic individuals.
Methods:
This prospective cohort study used a siteless, digital approach to assess longitudinal performance of Ag-RDT. Individuals over 2 years old from across the USA with no reported COVID-19 symptoms in the 14 days prior to study enrollment were eligible to enroll in this study. Participants throughout the mainland USA were enrolled through a digital platform between October 18, 2021 and February 15, 2022. Participants were asked to test using Ag-RDT and molecular comparators every 48 hours for 15 days. Enrollment demographics, geographic distribution, and SARS-CoV-2 infection rates are reported.
Key Results:
A total of 7361 participants enrolled in the study, and 492 participants tested positive for SARS-CoV-2, including 154 who were asymptomatic and tested negative to start the study. This exceeded the initial enrollment goals of 60 positive participants. We enrolled participants from 44 US states, and geographic distribution of participants shifted in accordance with the changing COVID-19 prevalence nationwide.
Conclusions:
The digital site-less approach employed in the “Test Us At Home” study enabled rapid, efficient, and rigorous evaluation of rapid diagnostics for COVID-19 and can be adapted across research disciplines to optimize study enrollment and accessibility.
By
Martin Dauber, Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois,
Steven Roth, Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
Edited by
Charles E. Smith, Case Western Reserve University, Ohio
Define the basic anatomic and physiologic concepts of ocular trauma.
Review the anesthetic implications of eye injuries, including blindness following major surgery.
Evaluate the use of succinylcholine in patients with open-globe injuries.
INTRODUCTION
Trauma to the eyes and resulting blindness can have life-altering impact. This chapter will present the implications for the anesthesiologist of trauma to the eye. Ocular trauma and basic anatomic and physiologic concepts will be defined and the incidence of these potentially devastating injuries will be reviewed. Anesthetic implications, including the timing of surgery, anesthetic drug selection, and other perianesthetic concerns will be addressed. The use of succinylcholine in patients with open-globe injuries is a long-standing controversy that we will discuss. Blindness following major trauma and resuscitation has significant implications for physicians caring for trauma patients.
DEFINITION
A standard terminology for eye injury that has been adopted in the United States and internationally is known as the Birmingham Eye Trauma Terminology (BETT; Figure 23.1). The entire globe is considered, and the BETT is unambiguous, consistent, and simple to use. The definitions it provides will be utilized in this chapter. The BETT system clearly defines all injuries and places each type of injury within a comprehensive system of the whole eyeball [1].
The eye wall is defined as the cornea and the sclera. A full-thickness wound of these layers is an “open-globe” injury, whereas a “closed-globe” injury does not involve a full-thickness wound (Figure 23.2, see also color plate after p. 294).
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