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Marcus CL, Smith RJH, Mankarious LA, Arens R, Mitchell GS, Elluru RG, Forte V, Goudy S, Jabs EW, Kane AA, Katz E, Paydarfar D, Pereira K, Reeves RH, Richtsmeier JT, Ruiz RL, Thach BT, Tunkel DE, Whitsett JA, Wootton D, Blaisdell CJ. Developmental aspects of the upper airway: report from an NHLBI Workshop, March 5-6, 2009. PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY 2009; 6:513-20. [PMID: 19741259 PMCID: PMC3136952 DOI: 10.1513/pats.200905-024cb] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 07/17/2009] [Indexed: 11/20/2022]
Abstract
The upper airway serves three important functions: respiration, swallowing, and speech. During development it undergoes significant structural and functional changes that affect its size, shape, and mechanical properties. Abnormalities of the upper airway require prompt attention, because these often alter ventilatory patterns and gas exchange, particularly during sleep when upper airway motor tone and ventilatory drive are diminished. Recognizing the relationship of early life events to lung health and disease, the National Heart, Lung, and Blood Institute (NHLBI), with cofunding from the Office of Rare Diseases (ORD), convened a workshop of extramural experts, from many disciplines. The objective of the workshop was: (1) to review the state of science in pediatric upper airway disorders; (2) to make recommendations to the Institute to fill knowledge gaps; (3) to prioritize new research directions; and (4) to capitalize on scientific opportunities. This report provides recommendations that could facilitate translation of basic research findings into practice to better diagnose, treat, and prevent airway compromise in children.
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Affiliation(s)
- Carole L. Marcus
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Richard J. H. Smith
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Leila A. Mankarious
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Raanan Arens
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Gordon S. Mitchell
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Ravindhra G. Elluru
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Vito Forte
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Steven Goudy
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Ethylin W. Jabs
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Alex A. Kane
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Eliot Katz
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - David Paydarfar
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Kevin Pereira
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Roger H. Reeves
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Joan T. Richtsmeier
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Ramon L. Ruiz
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Bradley T. Thach
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - David E. Tunkel
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Jeffrey A. Whitsett
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - David Wootton
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Carol J. Blaisdell
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The University of Iowa, Iowa City, Iowa; Harvard Medical School, Boston, Massachusetts; Albert Einstein College of Medicine, Bronx, New York; University of Wisconsin, Madison, Wisconsin; University of Cincinnati College of Medicine, Cincinnati, Ohio; Hospital for Sick Children, Toronto, Canada; Vanderbilt Medical Center, Nashville, Tennessee; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; Children's Hospital Boston, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; University of Maryland School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Pennsylvania State University, State College, Pennsylvania; Arnold Palmer Hospital for Children, Orlando, Florida; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cooper Union for the Advancement of Science and Art, New York, New York; National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
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