Three-dimensional (3D) printing offers the potential for rapid customization of medical devices. The advent of 3D-printable biomaterials has created the potential for device control in the fourth dimension: 3D-printed objects that exhibit a designed shape change under tissue growth and resorption conditions over time. Tracheobronchomalacia (TBM) is a condition of excessive collapse of the airways during respiration that can lead to life-threatening cardiopulmonary arrests. Here we demonstrate the successful application of 3D printing technology to produce a personalized medical device for treatment of TBM, designed to accommodate airway growth while preventing external compression over a pre-determined time period before bioresorption. We implanted patient-specific 3D-printed external airway splints in three infants with severe TBM. At the time of publication, these infants no longer exhibited life-threatening airway disease and had demonstrated resolution of both pulmonary and extra-pulmonary complications of their TBM. Long-term data show continued growth of the primary airways. This process has broad application for medical manufacturing of patient-specific 3D-printed devices that adjust to tissue growth through designed mechanical and degradation behaviors over time.

IMPORTANCE Congenital cytomegalovirus (cCMV) infection is a major cause of childhood deafness. Most cCMV infections are not diagnosed without newborn screening, resulting in missed opportunities for directed care.OBJECTIVE To estimate the cost-effectiveness of universal and targeted newborn cCMV screening programs compared with no cCMV screening. DESIGN, SETTING, AND PARTICIPANTS Models were constructed using rates and outcomes from prospective cohort studies of newborn cCMV screening in US postpartum care and early hearing programs. Costs of laboratory testing, treatment, and hearing loss were drawn from Medicaid data and published estimates. The benefits of cCMV screening were assumed to come from antiviral therapy for affected newborns to reduce hearing loss and from earlier identification of hearing loss with postnatal onset. Analyses were performed from July 2014 to March 2016.INTERVENTIONS Models compared universal or targeted cCMV screening of newborns with a failed hearing screen, with standard care for cCMV infection. MAIN OUTCOMES AND MEASURESThe incremental costs of identifying 1 cCMV infection, identifying 1 case of cCMV-related hearing loss, and preventing 1 cochlear implant; the incremental reduction in cases of severe to profound hearing loss; and the differences in costs per infant screened by universal or targeted strategies under different assumptions about the effectiveness of antiviral treatment.

We estimate whether a land reform program led to higher incomes for ethnic minority households. In 2002, in the Central Highlands of Vietnam, Program 132 directed the transfer of farm land to ethnic minority households that had less than one hectare of land. Using the 2002 Vietnam Household Living Standards Survey as a baseline, in 2008 we resurveyed over one-thousand households to provide a retrospective evaluation of the impact of their participation in Program 132. Contrary to official reports, our findings show that there was considerable deviation from the planned program parameters: many eligible households did not receive land, while ineligible households often did. We estimate that beneficiaries of the program in the province of Kon Tum experienced increases of household income largely in line with what one would expect from a small plot of poor farm land. Outside Kon Tum, where participation rates were substantially lower, the story is more mixed, and household incomes did not improve with program participation. Overall, our results underscore the limitations of simple transfers of land as a mechanism for improving the living standards of ethnic minorities. Our results also show the significant gap that can exist between program design and decentralized implementation. We discuss the potential implications for program evaluation.

We recently developed a novel approach to the creation of a fully synthetic, covalently crosslinked extracellular matrix (sECM). This material may be crosslinked in situ in the presence of cells to provide an injectable cell‐seeded hydrogel for tissue repair, or with drugs in a controlled‐release format. Chemical modification of hyaluronan (HA), other glycosaminoglycans (GAGs), proteins, or other carboxylate‐containing polymers with thiol residues creates macromonomers that can be crosslinked with biocompatible electrophiles. First, we show in vitro and in vivo growth of healthy cellularized tissues using films, sponges, and hydrogels based on the sECM technology. Second, we extend the use of the in situ crosslinkable sECM to the growth for the in vivo repair of cartilage and bone defects and for the healing of tympanic membrane perforations. Third, we describe the use of biointeractive, crosslinked heparin‐containing GAG dressings for controlled release of bFGF and re‐epithelializaion of full‐thickness wounds in a diabetic mouse model of chronic wound healing. Finally, we illustrate the use of in situ crosslinkable HA‐derived hydrogels, with and without covalently linked antiproliferatives, for prevention of abdominal surgical adhesions for scar‐free healing following sinus surgery.

All patients with FS had either persistent fevers or symptoms localized to the sinuses (facial pain, nasal congestion, or rhinorrhea). Endoscopic examination was helpful when necrosis was detected. We recommend directed biopsies of suspicious lesions, the middle and inferior turbinate, in immunocompromised, neutropenic pediatric patients with cancer who present with either persistent fevers or localizing symptoms to the sinuses. We favor the use of "rush" biopsies over frozen sections because of the better-quality sections and ability to perform appropriate stains.