Pediatric Pulmonary Milestones 2.0: Development, Lessons Learned, and Future Directions.

Pediatric pulmonology fellowship training programs are required by the Accreditation Council for Graduate Medical Education to report Pediatric Subspecialty Milestones biannually to track fellow progress. However, several issues, such as lack of subspecialty-specific context and ambiguous language, have raised concerns about their validity and applicability to use for fellow assessment and curriculum development. In this Perspective, we briefly share the process of the Pediatric Pulmonology Milestones 2.0 Work Group in creating new specialty-specific Milestones and tailoring information on the Harmonized Milestones to pediatric pulmonologists, with the goal of improving the Milestones' utility for stakeholders, including pulmonology fellows, faculty, program directors, and accrediting bodies. In addition, we created a supplemental guide to better link the Milestones to pulmonary-specific scenarios to create a shared mental model between stakeholders and remove a potential detriment to validity. Through the process, a number of guiding principles were clarified, including: 1) every Milestone should be able to be assessed independently, without overlap with other Milestones; 2) there should be clear developmental progression from one Milestone to the next; 3) Milestones should be based on the unique skills expected of pediatric pulmonologists; and 4) health equity should be a core component to highlight as a top priority to all stakeholders. In this Perspective, we describe these principles that guided formulation of the Pediatric Pulmonary Milestones to help familiarize the pediatric pulmonary community with the new Milestones. In addition, we share lessons learned and challenges in our process to inform other specialties that may soon participate in this process.

A 13-Year-Old Male Patient With Severe Multifocal Pneumonia and Bronchiectasis That Required Extracorporeal Membrane Oxygenation.

CASE PRESENTATION: A 13-year-old male patient with intermittent asthma and joint hypermobility presented to the ED in acute hypoxemic respiratory distress. He reported experiencing cough, increased work of breathing, and worsening chest pain for 3 days before presentation. He also reported fatigue and decreased appetite for 2 weeks. He had no known fever, myalgias, or recent weight loss. His medical history included two hospitalizations during early childhood for viral respiratory illnesses, one of which required intubation at 8 months of age. He had a gastrostomy tube placed shortly after his hospitalization because of failure to thrive secondary to aspiration based on a swallow study. His weight gain and growth improved with adequate nutrition, and his gastrostomy tube was removed at 2 years of age. His newborn screen, which included immunoreactive trypsinogen, was normal. He was noted to have hypermobile joints on physical examination at a clinic visit in childhood, but his examination results were not concerning for a hypermobility syndrome, and further diagnosis was not pursued. His parents endorsed that he has been a "healthy child" overall other than the occasional cough, which was attributed to asthma. His lifestyle was described as sedentary; he did not play any sports or have any unusual hobbies. He did not take any daily medications and no environmental exposures were reported. There was no family history of pulmonary, autoimmune, or connective tissue disease.

Maternal Depressive Symptoms, Lung Function, and Severe Asthma Exacerbations in Puerto Rican Children.

BACKGROUND: Maternal depression has been linked to health care use for asthma in cross-sectional or short-term follow-up studies of school-aged children. OBJECTIVE: To examine whether increased or persistent maternal depressive symptoms over approximately 5 years are associated with severe asthma exacerbations or worse lung function in youth. METHODS: A prospective study of 386 youth living in Puerto Rico, aged 6 to 14 years at a baseline visit and 9 to 20 years at a second visit, was performed. Our exposure of interest was change in persistence of maternal depressive symptoms, assessed at both visits using the Center for Epidemiologic Studies Depression Scale (CESD). Our outcomes of interest were change in percent predicted forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) between the first and second visits in all subjects, and ≥1 severe asthma exacerbation in the year before the second visit in subjects with asthma. RESULTS: In a multivariable analysis, each 1-point increment in the CESD score was associated with decrements of 0.15% in percent predicted FEV1 (95% confidence interval [CI] = -0.28% to -0.01%; P = .03) and 0.10% in percent predicted FEV1/FVC (95% CI = -0.20% to 0.001%; P = .05) between visits, as well as with 1.03 times increased odds of ≥1 severe asthma exacerbation at the second visit (95% CI for odds ratio = 0.99 to 1.06, P = .09). In a multivariable analysis, the presence of maternal depressive symptoms (a CESD score ≥21 points) at the second visit or at both visits was significantly associated with 3.17 to 3.52 times increased odds of ≥1 severe asthma exacerbation in the year before the second visit. CONCLUSIONS: Increasing or persistent maternal depressive symptoms over approximately 5 years are associated with worse lung function measures and severe asthma exacerbations among Puerto Rican youth, a high-risk population.

Data on the densification during sintering of binder jet printed samples made from water- and gas-atomized alloy 625 powders.

Binder jet printing (BJP) is a metal additive manufacturing method that manufactures parts with complex geometry by depositing powder layer-by-layer, selectively joining particles in each layer with a polymeric binder and finally curing the binder. After the printing process, the parts still in the powder bed must be sintered to achieve full densification (A. Mostafaei, Y. Behnamian, Y.L. Krimer, E.L. Stevens, J.L. Luo, M. Chmielus, 2016; A. Mostafaei, E. Stevens, E. Hughes, S. Biery, C. Hilla, M. Chmielus, 2016; A. Mostafaei, Y. Behnamian, Y.L. Krimer, E.L. Stevens, J.L. Luo, M. Chmielus, 2016) [1-3]. The collected data presents the characterization of the as-received gas- and water-atomized alloy 625 powders, BJP processing parameters and density of the sintered samples. The effect of sintering temperatures on the microstructure and the relative density of binder jet printed parts made from differently atomized nickel-based superalloy 625 powders are briefly compared in this paper. Detailed data can be found in the original published papers by authors in (A. Mostafaei, J. Toman, E.L. Stevens, E.T. Hughes, Y.L. Krimer, M. Chmielus, 2017) [4].

Brief data overview of differently heat treated binder jet printed samples made from argon atomized alloy 625 powder.

Powder bed binder jet printing (BJP) is an additive manufacturing method in which powder is deposited layer-by-layer and selectively joined in each layer with binder. The data presented here relates to the characterization of the as-received feedstock powder, BJP processing parameters, sample preparation and sintering profile ("Effect of solutionizing and aging on the microstructure and mechanical properties of powder bed binder jet printed nickel-based superalloy 625" (A. Mostafaei, Y. Behnamian, Y.L. Krimer, E.L. Stevens, J.L. Luo, M. Chmielus, 2016) [1], "Powder bed binder jet printed alloy 625: densification, microstructure and mechanical properties" (A. Mostafaei, E. Stevens, E. Hughes, S. Biery, C. Hilla, M. Chmielus, 2016) [2]). The data presented here relates to the characterization of the as-received feedstock powder, BJP processing parameters, sample preparation and sintering profile. Effect of post heat treatments including solutionizing and aging on the microstructure and mechanical properties of powder bed binder jet printed nickel-based superalloy 625 were compared to that of sintered samples.