Feasibility and Utility of a Fitbit Tracker Among Ambulatory Children and Youth With Disabilities.

PURPOSE: To examine the feasibility and utility of the Fitbit Charge HR to estimate physical activity among ambulatory children and youth with disabilities. METHOD: Participants (4-17 y old) with disabilities were recruited and asked to wear a Fitbit for 28 days. Feasibility was assessed as the number of participants who adhered to the 28-day protocol. Heat maps were generated to visually examine variability in step count by age, gender, and disability group. Between-group differences for wear time and step counts by age, gender, and disability type were assessed by independent sample t tests for gender and disability group, and a 1-way analysis of variance for age group. RESULTS: Participants (N = 157; median age = 10 y; 71% boys; 71% nonphysical disabilities) averaged 21 valid days of wear time. Wear time was higher in girls than boys (mean difference = 18.0; 95% confidence interval [CI], 6.8 to 29.1), and in preadolescents (mean difference = 27.6; 95% CI, 15.5 to 39.7) and adolescents (mean difference = -21.2; 95% CI, -33.6 to -8.7) than children. More daily steps were taken by boys than girls (mean difference = -1040; 95% CI, -1465 to -615) and individuals with a nonphysical disability than a physical disability (mean difference = -1120; 95% CI, -1474 to -765). The heat maps showed peaks in physical activity on weekdays before school, at recess, lunchtime, and after school. CONCLUSION: The Fitbit is a feasible tool for monitoring physical activity among ambulatory children and youth with disabilities and may be useful for population-level surveillance and intervention.

Evaluation of conventional troponin I testing for the detection of myocardial dysfunction in children.

Objectives: Troponin is a marker of myocardial injury but is not well studied in children. Our primary objective was to ascertain the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of conventional troponin I for the detection of acute myocardial dysfunction in previously healthy children. Our secondary objective was to identify clinical predictors of myocardial dysfunction in the setting of elevated troponin. Study Design: This was a retrospective chart review in a single, paediatric, tertiary care centre of troponin tests performed in all admitted children over a 4-year period. Demographics, symptoms, signs, chest x-ray, ECG, and echocardiogram abnormalities were documented. Myocardial dysfunction was presumed to be absent when the patient had a normal cardiac assessment, with or without echocardiography, and did not re-present. Results: From January 2014 through December 2017, 566 patients had troponin tested as a screen for myocardial injury. Troponin was positive in 38 of 566 cases (6.7%). Myocardial dysfunction was detected in 9 of 566 cases (1.6%). Troponin was elevated in six of nine cases of myocardial dysfunction. The sensitivity of conventional troponin I for detecting acute myocardial dysfunction was 66% (95% confidence interval [CI] 30 to 93%). The specificity was 94% (95% CI 92 to 96%). PPV was 16% (95% CI 6 to 31%) and NPV 99% (95% CI 98 to 100%). An abnormal ECG was more prevalent in patients with a true positive versus a false-positive troponin result (P=0.03). Conclusion: Troponin testing identified few cases of myocardial dysfunction. We found the test to have only 66% sensitivity. Troponin testing as a screen for myocardial injury in children has limited utility.

Pulmonary artery wall thickness in children with Fontan physiology: an optical coherence tomography case control study.

INTRODUCTION: Failure of the Fontan circulation is not a well-understood clinical phenomena.For some patients, a gradual increase in pulmonary vascular resistance (PVR) and structural changes in the pulmonary artery may be an important causative factor. To further investigate this issue, we employed optical coherence tomography (OCT) to evaluate structural changes within the pulmonary arteries of Fontan patients and compared to those with a normal pulmonary circulation. MATERIALS AND METHODS: Pulmonary artery OCT was performed, without complications, in 12 Fontan and 11 control patients. Wall thickness and wall:vessel cross-sectional area (CSA) ratio were calculated after image acquisition, using digital planimetry. RESULTS: There was no difference in wall thickness between both groups. Median wall thickness for Fontan patients was 0.12 mm (IQR, 0.10-0.14) and for controls was 0.11 mm (IQR, 0.10-0.12; p = 0.62). Wall:vessel CSA ratio for Fontan patients was 0.13 (IQR, 0.12-0.16) and for controls was 0.13 (IQR, 0.11-0.15) (p = 0.73). There was no association between wall thickness and ventricle morphology, age at catheterisation, age at Fontan, years since Fontan completion, pulmonary artery pressure, and PVR. The vessel media was more readily visualised in control patients. DISCUSSION: OCT of the pulmonary arteries in Fontan patients is safe and feasible. Our OCT findings suggest that during childhood, pulmonary artery wall dimensions are normal in Fontan children with reassuring hemodynamics. Further evaluation of Fontan patients with abnormal hemodynamics and serial evaluation into adulthood are required to conclude on the utility of OCT for identifying early pulmonary artery structural changes.

Functional plasticity in vertebrate scavenger assemblages in the presence of introduced competitors.

Introduced species may suppress or enhance ecological functions, or they may have neutral effects in ecosystems where they replace or complement native species. Few studies, however, have explicitly tested for these trajectories, and for the effect these might have for native species. In this study, we experimentally test the trajectory and scale of change in the function of 'carrion removal' at different carrion loads along ocean beaches in Eastern Australia that have different numbers of introduced red foxes (Vulpes vulpes) and several species of native raptors. We hypothesized that the 'positive' effect of foxes on carrion removal would be greatest at high carrion loads, because competition for resources between native and introduced species is lower. Scavenger abundance, fox occurrences, and carrion consumption by these species differed widely between locations and times. Despite distinct spatial differences in the structure of vertebrate scavenger assemblages, total carrion consumption was not significantly different between locations at any carrion load. This lack of variation in functional rates indicates potential functional plasticity in the scavenger assemblage and possible functional accommodation of red foxes. Neutral fox effects on ecological functions or the ecosystem more broadly are, however, very unlikely to extend beyond carrion consumption.

Intimal thickening at coronary bifurcations in pediatric heart transplant recipients.

Heart transplant recipients are at increased risk for atherosclerosis and cardiac allograft vasculopathy, both initially presenting as intimal thickening. We aimed to determine the presence, extent, and anatomical characteristics of intimal thickness at coronary bifurcations in children using OCT. We measured the intimal thickness of coronary arteries in pediatric transplant recipients using OCT during routine cardiac catheterization. Intimal thickening was defined as (i) a percent change in contralateral intimal thickness greater than 50% when comparing the thickness at the bifurcation to the baseline thickness, and (ii) greater than 0.1 mm. We evaluated 153 unique coronary bifurcations in 31 children (58% boys, median 12.7 years). Intimal thickening was almost exclusively observed in the left coronary system (22 of 67 bifurcations) and rare in the right coronary system (2 of 86 bifurcations; P < .001). There was a positive association between the relative size of the side branch and contralateral intimal thickening at coronary bifurcations (P = .009). Intimal thickening at coronary bifurcations is already present in the left coronary system in many pediatric transplant recipients. The correlation between intimal thickening and side branch size suggests that low shear stress and oscillating shear stress may have an important role in the development of intimal thickening at coronary bifurcations.

Wrist Accelerometry for Physical Activity Measurement in Individuals With Spinal Cord Injury-A Need for Individually Calibrated Cut-Points.

OBJECTIVE: To create and compare individual and group-based cut-points for wrist accelerometry that correspond to moderate-to-vigorous physical activity (MVPA) in people with spinal cord injury (SCI). DESIGN: Participants completed a graded treadmill-wheeling test while being assessed for oxygen consumption, wrist-acceleration vector magnitude, and spoke acceleration. Oxygen consumption was converted to SCI metabolic equivalents (METs), and linear regression was applied to determine an individualized vector magnitude cut-point (counts per minute, VM-CPM) corresponding with MVPA (≥3 SCI METs). Multilevel linear regression was applied to determine a group MVPA cut-point. Participants then completed a 6-day monitoring period while wearing the accelerometers. SETTING: A local SCI research center. PARTICIPANTS: Manual wheelchair users (N=20; aged 31-64y; injury levels, C5 to L2) with chronic (>1y) SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mean total daily MVPA, wheeled MVPA, and nonwheeled MVPA were calculated using both the individual and group cut-points. Agreement on measures of minutes per day of MVPA between the individual and group mean cut-point method was assessed using Bland-Altman plots. RESULTS: Individual cut-points for MVPA ranged from 6040 to 21,540 VM-CPM, with a group cut-point of 11,652 (95% confidence interval, 7395-15,909). For total daily MVPA, Bland-Altman analysis revealed a bias of .22±33.0 minutes, with 95% limits of agreement from -64.5 to 64.9 minutes, suggesting a large discrepancy between total MVPA calculated from individual and group mean cut-points. CONCLUSIONS: Individual calibration of wrist-worn accelerometry is recommended for effective habitual PA monitoring in this population.

Anomalously High Recruitment of the 2010 Gulf Menhaden (Brevoortia patronus) Year Class: Evidence of Indirect Effects from the Deepwater Horizon Blowout in the Gulf of Mexico.

Gulf menhaden (Brevoortia patronus) exhibited unprecedented juvenile recruitment in 2010 during the year of the Deepwater Horizon well blowout, exceeding the prior 39-year mean by more than four standard deviations near the Mississippi River. Abundance of that cohort remained exceptionally high for two subsequent years as recruits moved into older age classes. Such changes in this dominant forage fish population can be most parsimoniously explained as consequences of release from predation. Contact with crude oil induced high mortality of piscivorous seabirds, bottlenose dolphin (Tursiops truncatus), waders, and other fish-eating marsh birds, all of which are substantial consumers of Gulf menhaden. Diversions of fresh water from the Mississippi River to protect coastal marshes from oiling depressed salinities, impairing access to juvenile Gulf menhaden by aquatic predators that avoid low-salinity estuarine waters. These releases from predation led to an increase of Gulf menhaden biomass in 2011 to 2.4 million t, or more than twice the average biomass of 1.1 million t for the decade prior to 2010. Biomass increases of this magnitude in a major forage fish species suggest additional trophically linked effects at the population-, trophic-level and ecosystem scales, reflecting an heretofore little appreciated indirect effect that may be associated with major oil spills in highly productive marine waters.

Delayed bedtime due to screen time in schoolchildren: importance of area deprivation.

BACKGROUND: Sleep duration is an important predictor of obesity and health. This study evaluated the association between late bedtime and screen time, and the role of geographical deprivation in English schoolchildren. METHODS: We collected bedtime and waking time, screen time, sociodemographic data and measured body mass index in a cross-section of 1332 11-15-year-old schoolchildren (45.7% female) participating in the East of England healthy heart study. Logistic regression was used to determine the likelihood of late bedtime in schoolchildren with different screen time and from a different geographic location. Mean differences were assessed either on ANOVA or t-test. RESULTS: Approximately 42% of boys went to bed late at night compared with 37% of girls. When compared to those with <2 h of daily screen time, schoolchildren with 2-4 h of screen time were more likely [odds ratio (OR) = 1.50, 95% confidence interval (CI): 1.07-2.09] to go to bed late at night while those with >4 h of daily screen time were most likely to go to sleep late at night (OR, 1.97; 95%CI: 1.34-2.89). Late bedtime was associated with deprivation in schoolchildren. CONCLUSIONS: High screen time and deprivation may explain lateness in bedtime in English schoolchildren. This explanation may vary according to area deprivation and geographic location. Family-centered interventions and parental support are important to reduce screen time, late bedtime and increase sleep duration.

Association between habitual school travel and muscular fitness in youth.

OBJECTIVE: To determine whether active school travel is associated with muscular fitness, which is an emerging marker of youth health. METHODS: Handgrip strength, vertical jump and vertical jump peak power were measured in n=6829 English schoolchildren (53% males, age 12.9 ± 1.2 years) between 2007 and 2011. Participants were grouped according to self-reported habitual school travel modality. RESULTS: Cyclists had greater handgrip strength than passive travelers. Vertical jump height was greater in walkers and cyclists compared with passive travelers. Jump peak power was also higher in walkers than in the passive travel group. Compared with passive travelers, cyclists had a higher (age, sex and BMI-adjusted) likelihood of good handgrip strength (OR 1.42, 95%CI;1.14-1.76) and walkers were more likely to have good measures for vertical jump peak power (OR 1.14, 95%CI;1.00-1.29). Cyclists' likelihood of having good handgrip strength remained significantly higher when adjusted for physical activity (OR 1.29, 95%CI;1.08-1.46). CONCLUSION: Muscular fitness differs according to school travel habits. Cycling is independently associated with better handgrip strength perhaps due to the physical demands of the activity. Better muscular fitness may provide another health-related reason to encourage active school travel.

Prevalence of elevated mean arterial pressure and how fitness moderates its association with BMI in youth.

OBJECTIVE: Cardiorespiratory fitness is known to be cardioprotective and its association with the components of the metabolic syndrome in children is becoming clearer. The aim of the present study was to examine the extent to which cardiorespiratory fitness may offset the weight-related association with mean arterial pressure (MAP) in schoolchildren. DESIGN: Cross-sectional study. SETTINGS: Schoolchildren from the East of England, U.K. SUBJECTS: A total of 5983 (48% females) schoolchildren, 10 to 16 years of age, had height, weight and blood pressure measured by standard procedures and cardiorespiratory fitness assessed by the 20 m shuttle-run test. Participants were classified as fit or unfit using internationally accepted fitness cut-off points; and as normal weight, overweight or obese based on BMI, again using international cut-off points. Age-adjusted ANCOVA was used to determine the main effects and interaction of fitness and BMI on MAP Z-score. Logistic regression models were used to estimate odds ratios of elevated MAP. RESULTS: Prevalence of elevated MAP in schoolchildren was 14.8% overall and 35.7% in those who were obese-unfit. Approximately 21% of participants were overweight and 5% obese, while 23% were classified as unfit. MAP generally increased across BMI categories and was higher in the aerobically unfit participants. Obese-fit males had lower MAP compared with obese-unfit males (P < 0.001); this trend was similar in females (P = 0.05). CONCLUSIONS: Increasing fitness level may have a positive impact on the weight-related elevations of MAP seen in obese and overweight schoolchildren.

Physical Activity Questionnaire for children and adolescents: English norms and cut-off points.

BACKGROUND: The Physical Activity Questionnaire for Children and Adolescents (PAQ-C/-A) provides general estimates of physical activity levels. Following recent expert recommendations for using the PAQ for population surveillance, the aim of this paper was twofold: first, to describe normative PAQ data for English youth; and second, to determine a criterion-referenced PAQ-score cut-off point. METHODS: Participants (n = 7226, 53% boys, 10-15 years) completed an anglicized version of the PAQ. Peak oxygen uptake (VO2peak ) was predicted from PACER lap count according to latest FITNESSGRAM standards and categorized into "at-risk" and "no-risk" for metabolic syndrome. ROC curves were drawn for each age-sex group to identify PAQ scores, which categorized youth into "sufficiently active" versus "low-active" groups, using cardiorespiratory fitness as the criterion-referenced standard. RESULTS: PAQ scores were higher in boys than in girls and declined with age. Mean PAQ score was a significant, albeit relatively weak (area under the curve < 0.7) discriminator between "at-risk" and "no-risk." PAQ scores of ≥2.9 for boys and ≥2.7 for girls were identified as cut-off points, although it may be more appropriate to use lower, age-specific PAQ scores for girls of 13, 14 and 15 years (2.6, 2.4, 2.3, respectively). CONCLUSION: The normative and criterion-referenced PAQ values may be used to standardize and categorize PAQ scores in future youth population studies.

Quantification of the relative age effect in three indices of physical performance.

The relative age effect (RAE) describes the relationship between an individual's birth month and their level of attainment in sports. There is a clustering of birth dates just after the cutoff used for selection in age-grouped sports, and it is hypothesized that such relatively older sportspeople may enjoy maturational and physical advantages over their younger peers. There is, however, little empirical evidence of any such advantage. This study investigated whether schoolchildren's physical performance differed according to which quarter of the school year they were born in. Mass, stature, body mass index, cardiorespiratory fitness, strength, and power were measured in 10 to 16 year olds (n = 8,550, 53% male). We expressed test performance as age- and sex-specific z-scores based on reference data with age rounded down to the nearest whole year and also as units normalized for body mass. We then compared these values between yearly birth quarters. There were no significant main effects for differences in anthropometric measures in either sex. Girls born in the first quarter of the school year were significantly stronger than those born at other times when handgrip was expressed as a z-score. As z-scores, all measures were significantly higher in boys born in either the first or second yearly quarters. Relative to body mass, cardiorespiratory fitness was higher in boys born in the first quarter and power was higher in those born in the second quarter. The RAE does not appear to significantly affect girls' performance test scores when they are expressed as z-score or relative to body mass. Boys born in the first and second quarters of the year had a significant physical advantage over their relatively younger peers. These findings have practical bearing if coaches use fitness tests for talent identification and team selection. Categorizing test performance based on rounded down values of whole-year age may disadvantage children born later in the selection year. These relatively younger children may be less to gain selection for teams or training programmes.

A multi-center prospective study of plant-based nutritional support in adult community-based patients at risk of disease-related malnutrition.

Introduction: There is an emerging need for plant-based, vegan options for patients requiring nutritional support. Methods: Twenty-four adults at risk of malnutrition (age: 59 years (SD 18); Sex: 18 female, 6 male; BMI: 19.0 kg/m2 (SD 3.3); multiple diagnoses) requiring plant-based nutritional support participated in a multi-center, prospective study of a (vegan suitable) multi-nutrient, ready-to-drink, oral nutritional supplement (ONS) [1.5 kcal/mL; 300 kcal, 12 g protein/200 mL bottle, mean prescription 275 mL/day (SD 115)] alongside dietary advice for 28 days. Compliance, anthropometry, malnutrition risk, dietary intake, appetite, acceptability, gastrointestinal (GI) tolerance, nutritional goal(s), and safety were assessed. Results: Patients required a plant-based ONS due to personal preference/variety (33%), religious/cultural reasons (28%), veganism/reduce animal-derived consumption (17%), environmental/sustainability reasons (17%), and health reasons (5%). Compliance was 94% (SD 16). High risk of malnutrition ('MUST' score ≥ 2) reduced from 20 to 16 patients (p = 0.046). Body weight (+0.6 kg (SD 1.2), p = 0.02), BMI (+0.2 kg/m2 (SD 0.5), p = 0.03), total mean energy (+387 kcal/day (SD 416), p < 0.0001) and protein intake (+14 g/day (SD 39), p = 0.03), and the number of micronutrients meeting the UK reference nutrient intake (RNI) (7 vs. 14, p = 0.008) significantly increased. Appetite (Simplified Nutritional Appetite Questionnaire (SNAQ) score; p = 0.13) was maintained. Most GI symptoms were stable throughout the study (p > 0.06) with no serious adverse events related. Discussion: This study highlights that plant-based nutrition support using a vegan-suitable plant-based ONS is highly complied with, improving the nutritional outcomes of patients at risk of malnutrition.

Centile curves and normative values for the twenty metre shuttle-run test in English schoolchildren.

The aim of this study was to provide normative data for performance on the 20 m shuttle-run test of cardiorespiratory fitness in English schoolchildren. A total of 7366 10-16 year olds completed the 20 m shuttle-run test. We expressed performance as the number of shuttles completed, test score (shuttles and levels) and estimated peak oxygen consumption (VO2peak). We calculated descriptive statistics for each age-sex group to construct percentile curves and tables. To assess the cardiorespiratory fitness of our sample, we calculated the number of participants who fell below proposed cut-offs for low cardiorespiratory fitness based on either completed shuttles or VdotO2peak. These cut-offs did not agree in terms of frequency of classification. The classification based on estimated VO2peak suggested low fitness was more prevalent in males and that the incidence of low fitness increased with age in both sexes. These are the first normative data for shuttle-run performance in English youth and can now be used to interpret data from this cardiorespiratory fitness test. The two cut-offs used for low fitness did not agree and future research should establish a cut-off for test performance which can predict present or future ill-health.

Patterns of Early Coronary Artery Changes in Pediatric Heart Transplant Recipients Detected Using Optical Coherence Tomography.

BACKGROUND: Cardiac allograft vasculopathy, the leading cause of graft failure in pediatric heart transplant recipients, is characterized by diffuse and concentric coronary intimal thickening. Early treatment yields better outcomes. While coronary angiography is the standard for cardiac allograft vasculopathy screening and diagnosis, it only identifies luminal narrowing, which occurs in more severe disease. Coronary optical coherence tomography (OCT) is a high-definition intravascular imaging modality that may offer earlier diagnosis. We used OCT to investigate coronary intimal thickening in pediatric transplant recipients and examined its (1) location (ie, vessel type and location) and (2) nature (ie, characteristics of cross-sectional and longitudinal thickening). METHODS: Sites collected coronary angiography and OCT data from participants (N=258 vessel segments from 73 individuals; median age: 11.5 years [8.4-15.3]; 55% male). Images were collected from the left anterior descending, left circumflex, and right coronary arteries, and location (ie, proximal, middle, and distal) were classified using coronary angiography. RESULTS: OCT identified 32 vessel segments meeting criteria for significant thickening, 88% of which were angiographically silent. Longitudinal thickening was segmental rather than global in 88%, and cross-sectional thickening was 48% eccentric and 52% concentric. Intimal thickening prevalence and severity measures did not consistently differ between coronary artery type (P=1.000) or location (P=0.248) but increased with time since transplant and age at transplant and OCT procedure. CONCLUSIONS: In pediatric transplant recipients, we observed a surprisingly high prevalence of segmental and eccentric intimal thickening. Insights from intravascular imaging suggest these patterns of coronary vascular changes may precede overt cardiac allograft vasculopathy. Identifying early changes may offer opportunity for enhanced surveillance and earlier intervention.

Primary care provider-led cancer survivorship care in the first 5 years following initial cancer treatment: a scoping review of the barriers and solutions to implementation.

PURPOSE: To synthesize the barriers to primary care provider (PCP)-led cancer survivorship care (≤ 5 years after initial cancer treatment) experienced by healthcare systems around the world, and to explore potential solutions that would succeed within a developed country. METHODS: A scoping review of peer-reviewed articles and grey literature was conducted. Four electronic databases (Medline, Embase, Web of Science Core Collection, and Google Scholar) were searched for articles prior to April 2021. RESULTS: Ninety-seven articles published across the globe (USA, Canada, Australia, European Union, and UK) met the review inclusion/exclusion criteria. The four most frequently discussed barriers to PCP-led survivorship care in healthcare systems were as follows: (1) insufficient communication between PCPs and cancer specialists, (2) limited PCP knowledge, (3) time restrictions for PCPs to provide comprehensive survivorship care, and (4) a lack of resources (e.g., survivorship care guidelines). Potential solutions to combat these barriers were as follows: (1) improving interdisciplinary communication, (2) bolstering PCP education, and (3) providing survivorship resources. CONCLUSIONS: This scoping review identified and summarized key barriers and solutions to the provision of PCP-led cancer survivorship care. Importantly, the findings from this review provide insight and direction to guide optimization of cancer care practice within BC's healthcare system. IMPLICATIONS FOR CANCER SURVIVORS: Optimizing the PCP-led survivorship care model will be a valuable contribution to the field of cancer survivorship care and will hopefully lead to more widespread use of this model, ultimately lessening the growing demand for cancer-specific care by cancer specialists.

Comparison of cardiorespiratory fitness and body mass index between rural and urban youth: findings from the East of England Healthy Hearts Study.

BACKGROUND: The aim of the present study was to determine if there were differences in cardiorespiratory fitness (CRF) and body mass index (BMI) in rural versus urban youth. METHODS: We measured BMI in 6628 10.0-15.9-year-olds and classified them as normal weight, overweight or obese. CRF was assessed with a 20-m shuttle-run test and subjects were classified as unfit, fit or highly fit. Rural or urban dwelling was calculated from postcodes. RESULTS: There were no differences in frequency of BMI categories or CRF between rural and urban children (<13 years) or adolescents (>13 years). Rural adolescents were less likely to be fit (OR = 0.80; 95%CI 0.67-0.96) or highly fit (OR = 0.69; 95%CI 0.55-0.86) independent of their age, sex, race or level of deprivation. CONCLUSIONS: Whilst there were no differences evident in children <13 years, rural adolescents were significantly less likely to meet criterion-based cut-off points for CRF. Research to elucidate why such differences exist is warranted.

Association of Preoperative Diuretic Use With Early Acute Kidney Injury in Infants With Biventricular Hearts Following Cardiac Surgery.

Background Diuretics are used to manage congestive heart failure in infants with congenital heart disease. Adult data indicate that preoperative diuretic use increases the risk of cardiac surgery associated acute kidney injury (CS-AKI). We have sought to understand if preoperative diuretics in infants increases the risk of CS-AKI. Methods and Results This is a single-center retrospective study of infants (1-12 months) who had CS requiring cardiopulmonary bypass between 2013 and 2018. The diagnosis and severity of CS-AKI was defined according to the Kidney Disease Improving Global Outcomes guidelines. Three hundred patients were included (mean 6 months, SD 2.4, range 1.2-12.9 months). A total of 149 (49.7%) patients were diagnosed with CS-AKI (stage 1: 80 [54%], stage 2: 57 [38%], stage 3: 12 [8%]). Logistic regression analysis showed preoperative diuretics were not associated with CS-AKI (odds ratio [OR], 0.79; 95% CI, 0.43-1.44; P=0.45). A diagnosis of tetralogy of Fallot was an independent risk factor for CS-AKI (OR, 3.49; 95% CI, 1.33-9.1, P=0.01). A diagnosis of tetralogy of Fallot (OR, 3.6; 95% CI, 1.28-10.22; P=0.02) and longer cardiopulmonary bypass (OR, 1.01; 95% CI, 1.0-1.02; P=0.04) time are risk factors for moderate to severe CS-AKI. Conclusions Preoperative diuretic use does not contribute to the risk of CS-AKI in infants early after surgery. A diagnosis of tetralogy of Fallot was the only risk factor for CS-AKI identified using multivariate analysis in our cohort. Furthermore, a diagnosis of tetralogy of Fallot and longer cardiopulmonary bypass time are risk factors for moderate to severe CS-AKI.

Vertical jumping and leg power normative data for English school children aged 10-15 years.

Although vertical jumping is often incorporated into physical activity tests for both adults and children, normative data for children and adolescents are lacking in the literature. The objectives of this study were to provide normative data of jump height and predicted peak leg power for males and females aged 10.0-15.9 years. Altogether, 1845 children from 12 state primary and secondary schools in the East of England participated in the study. Each child performed two countermovement jumps, and jump height was calculated using a NewTest jump mat. The highest jump was used for analysis and in the calculation of predicted peak power. Jump height and predicted peak leg power were significantly higher for males than females from the age of 11 years. Jump height and peak power increased significantly year on year for males. For females, jump height and predicted peak leg power reached a plateau after age 12 and 13 years respectively. This study provides normative data that can be used as a tool to classify jumping performance in children aged 10-15 years.