Background Occupational exposures at the WTC site after 11 September 2001 have been associated with presumably inflammatory chronic lower airway diseases. Aims In this study, we describe the trajectories of expiratory air flow decline, identify subgroups with adverse progression, and investigate the association of those trajectories with quantitative computed tomography (QCT) imaging measurement of increased and decreased lung density. Methods We examined the trajectories of expiratory air flow decline in a group of 1,321 former WTC workers and volunteers with at least three periodic spirometries, and using QCT‐measured low (LAV%, −950 HU) and high (HAV%, from −600 to −250 HU) attenuation volume percent. We calculated the individual regression line slopes for first‐second forced expiratory volume (FEV1slope), identified subjects with rapidly declining (“accelerated decliners”) and increasing (“improved”), and compared them to subjects with “intermediate” (0 to −66.5 mL/year) FEV1slope. We then used multinomial logistic regression to model those three trajectories, and the two lung attenuation metrics. Results The mean longitudinal FEV1 slopes for the entire study population, and its intermediate, decliner, and improved subgroups were, respectively, −40.4, −34.3, −106.5, and 37.6 mL/year. In unadjusted and adjusted analyses, LAV% and HAV% were both associated with “accelerated decliner” status (ORadj, 95% CI 2.37, 1.41–3.97, and 1.77, 1.08–2.89, respectively), compared to the intermediate decline. Conclusions Longitudinal FEV1 decline in this cohort, known to be associated with QCT proximal airway inflammation metric, is also associated with QCT indicators of increased and decreased lung density. The improved FEV1 trajectory did not seem to be associated with lung density metrics.

Purpose. The goal of our study was to investigate the prevalence of late DDH cases in breech infants who had a normal screening hip ultrasound and subsequent follow-up hip x-ray imaging. Methods. Infants with a history of intrauterine breech position, normal hip ultrasound within 3-months of birth, and follow-up hip x-rays within 2-years were included. Acetabular indices were measured on a supine AP pelvis radiograph. Results. Fifty-six patients had breech presentation at birth, a normal hip ultrasound, and returned for radiographic evaluation within 2 years. Of those, 11/112 (10%) of hips had late DDH based on their radiographic images at 1 standard deviation greater than normative values from age-adjusted controls. No infants showed hip dysplasia at 2 standard deviations greater than normative values from age-adjusted controls. Conclusions. Our results support previous studies that follow up should be considered for infants with breech presentation and normal hip ultrasounds near birth. Level of evidence. II.

The purpose of our study is to evaluate athletic identity (AI) and mental health measures of youth and young adult athletes during the COVID-19 pandemic. This cross-sectional study recruited athletes aged 11–25 years from universities, high schools, and middle schools in California and New York. Participants were emailed a link to an anonymous, cross-sectional electronic survey. The measure included the athletic identity measurement scale (AIMS), the Patient Health Questionnaire-4 (PHQ-4), and demographic variables. Chi-square, Fisher’s Exact Test, and linear regression were used to examine the relationships between AI, symptoms of anxiety, and symptoms of depression by age, gender, and race. The survey was completed by 653 participants. AI was stratified by tertiary percentiles. The odds of positively scoring for symptoms of anxiety were 60% higher for participants in college compared with high school (OR: 1.60, 95% CI: [1.09, 2.35]). Conversely, the odds of scoring positively for symptoms of depression were 68% higher for participants in high school compared to college (OR: 1.68, 95% CI: [1.09, 2.59]). The odds of scoring positively for symptoms of depression were higher for athletes who scored as high AI, compared to those who scored as moderate (OR: 1.72, 95% CI: [1.11, 2.68]) or low (OR: 1.93, 95% CI: [1.20, 3.12]). The odds of scoring positively for symptoms of anxiety on the PHQ-4 were 3.2 times higher for participants who identified as female (OR: 3.19, 95% CI: [2.31, 4.41]), and the odds of scoring positively for symptoms of depression were 2.4 times higher for participants who identified as female (OR: 2.35, 95% CI: [1.56, 3.54]). Female athletes experienced symptoms of depression and anxiety at significantly higher rates than male athletes during the COVID-19 pandemic. High school students experienced fewer symptoms of anxiety, but greater symptoms of depression as compared to the collegiate group, while college students experienced greater odds of symptoms of anxiety. Athletes in the high AI group were more likely to report symptoms of depression than moderate or low identity groups. Female athletes reported lower AI than male athletes, but still had greater symptoms of anxiety and depression.

Background Disability among women of reproductive age is common; many of these women desire children and do not have impaired fertility. Objectives To examine the epidemiological literature on perinatal health outcomes among women with physical disabilities. Data sources We searched Medline and CINAHL for articles published January 2009–April 2020 following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Study selection and data extraction Eligible studies were observational, quantitative, and reported on physical disabilities in association with prenatal, perinatal, postpartum, and/or infant health outcomes. We included studies that grouped physical and non‐physical disabilities, such as surveys that queried only about general daily life limitations. We excluded case reports, descriptive studies without comparison groups, and studies conducted in low‐ or middle‐income countries. Data extraction was done using predefined data fields. Synthesis All authors were involved in screening activities, data extraction, and/or quality assessment (rating and areas for bias). Results A total of 2650 articles were evaluated, of which sixteen met inclusion criteria (8 cross‐sectional studies and 8 retrospective cohort studies). Assessments of disability status and perinatal outcomes widely varied across studies. Studies were rated as poor (n = 8) or fair quality (n = 8). Findings suggested that women with physical disabilities were at risk of several adverse outcomes, including caesarean delivery, infections, preterm complications, and maternal post‐delivery hospitalisations, while their infants may be at risk of low birthweight and small‐for‐gestational age. Women classified as having complex/severe disabilities were often observed to be at higher risk of adverse outcomes compared to women with less severe disabilities. Conclusions Research assessing how physical, functional, and medical restrictions influence health outcomes among women with physical disabilities, from preconception through postpartum, is limited. Longitudinal studies with comprehensive data collection that accurately identify women with physical disabilities are critical to understanding their reproductive health risks and outcomes.

Purpose Non-ossifying fibromas (NOF) are benign, fibrous lesions of the skeleton estimated to occur in about 30% of children and adolescents. In the general pediatric population, they are twice as common in males, usually asymptomatic and self-limiting. Etiology is largely unknown, though multiple NOF are described with genetic syndromes such as neurofibromatosis 1. We have observed NOF in children with various forms of rickets. However, there is limited information on the frequency and characteristics of NOF in rickets. The purpose of this study was to evaluate the frequency of NOF in various congenital forms of rickets under care in tertiary care centers and describe their characteristics. Methods This was a retrospective chart review of patients with congenital forms of rickets and at least one bilateral lower extremity radiograph taken between 4 and 18 years of age at two academic children's hospitals in the United States and Canada between 2004 to 2020. Rickets diagnosis was confirmed by clinical, biochemical, radiographic, and genetic testing where available. Data are described as proportions and percentages for categorical variables and means with standard deviations for continuous variables. Results Sixty-four patients, mean age 13.3 ± 5.1 years old (66%F, 46% Hispanic) were included with the following diagnoses: X-linked Hypophosphatemia (XLH, n=55, 86%), renal hypophosphatemia [n=4, 6% (3 Fanconi syndrome, 1 Dent disease)], hereditary vitamin D resistant rickets (HVDRR, n=3, 5%), and hereditary vitamin D dependent rickets type 1 (VDDR1, n=2, 3%). Fifteen patients (23%, 67%F) had at least one NOF, of whom 13 (87%) had XLH, one (7%) had HVDRR, and one (7%) had VDDR1. All NOF were localized to the lower extremities (60% femur, 27% tibia, and 13% fibula); there were no NOF in the upper extremities or at other sites among those with relevant skeletal imaging (n=32 with upper extremity and/or full skeletal survey data). The mean NOF height was 24.1 ± 13.8 mm and width 10.1 ± 5.3 mm. Nine of 15 patients with NOF (60%) compared with 21/49 without NOF (43%) required angular deformity surgery. Three patients (20%) experienced fractures within the lesions, two (13%) had two lesions each, and one (7%) had a progressive lesion requiring surgery with grafting. Conclusion We describe the frequency of NOF in children with congenital forms of rickets followed in academic centers. NOF were identified in almost a quarter of patients, and patients with NOF required angular surgery more often. Fractures were present within the lesions in one fifth of those with NOF, suggesting clinically important osteomalacia at that site. Interestingly, in contrast to the general pediatric population, we found no male preponderance. Long-term follow up and future studies are important to further characterize NOF in various forms of rickets, their pathogenesis, progression, and association with the disease severity. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.