bluuebunny/crossref_metadata_2025 huggingface dataset:
30 Access to Autism Spectrum Disorder services for marginalized families in Canada: A scoping review
Authors: Chow Selina , Chang Oswin , Rajeswaran Thenugaa , Gojsevic Milena , Lewis Iveta , Smile Sharon , Kawamura Anne , D'Costa Rhea
Published: October 2024

Background

In Canada, despite universal healthcare, immigrant and racially marginalized families face unique barriers when accessing Autism Spectrum Disorder (ASD) services for their children. Exploring these experiences is critical to inform the federal government’s efforts to create a national autism strategy that serves children and families with ASD in Canada.

Objectives

We conducted a scoping review of immigrant, refugee, and racially marginalized families’ access to, utilization, and experiences with ASD services in Canada.

Design/Methods

The Joanna Briggs Institute scoping review methodology was used. A literature search in MEDLINE, EMBASE, CINAHL, APA PsycINFO, Scopus, and Web of Science was conducted in August 2023. English and French-language qualitative studies describing the experiences of marginalized families in Canada with accessing and/or using ASD services for their child <18 years were included. To assess eligibility of search results, title, abstract, and full-text screening were conducted independently by two reviewers. For included studies, two reviewers extracted data and appraised articles using the Critical Appraisal Skills Programme qualitative checklist.

Results

There were 4,489 search results. After de-duplication, 3,804 studies remained. Of these studies, 12 met inclusion criteria – representing 320 immigrant caregivers living in Ontario (n=167), Quebec (n=151), and British Columbia (n=2). Caregivers immigrated from Africa (n=55), Latin America (n=43), Europe (n=25), Asia (n=13), North America (n=11), the Middle East (n=4), and unreported (n=169). Of note, no studies focused on refugees. Common barriers when accessing ASD services were related to: difficulties navigating the health system (wait times, limited resources in the public system, high costs for private services, lack of collaboration between school and healthcare providers), challenges interacting with service providers (feeling unheard, discrimination, lack of continuity of care), and cultural differences (regarding ASD, language barriers, social isolation). In contrast, families identified supportive healthcare and school personnel, provision of culturally-specific multilingual resources, and parent-led peer support networks as key facilitators to ASD service access and use.

Conclusion

These results highlight gaps in existing research, especially around the experiences of refugee families. Our findings reiterate the importance of greater caregiver involvement in informing evidence-based recommendations to improve Canadian service provision, policy, and research. This national focus is especially relevant, given that 23% of Canadians in the most recent 2021 census are landed immigrants – representing the highest proportion of immigrants in Canada to date and emphasizing the growing need for culturally competent care.
38 Disparities in health outcomes by the age of five among preterm children in rural versus urban communities in British Columbia
Authors: Richter Lindsay , Shen Ye , Lisonkova Sarka , Ting Joseph
Published: October 2024

Background

Health disparities exist between than urban and rural communities, as rates of preterm birth, severe maternal morbidity and severe neonatal morbidity are higher in rural areas. There are limited population-based studies on early childhood health outcomes among those born preterm by geographical area.

Objectives

To compare health service use, morbidity, and medication use for up to five years of age between preterm children in rural versus urban residences.

Design/Methods

The study included liveborn infants at 22-44 weeks’ gestational age (GA) in British Columbia (BC), Canada, 2004-2014. Follow-up data to December 2019 included linked health information from four provincial databases (perinatal database, outpatient visits, hospitalizations, and outpatient prescriptions). Urban-rural status was based on maternal residence at birth. Rate ratios (RR) of health service use, childhood morbidity and medication use were compared within GA categories (22-27, 28-33, 34-36, 37-44) by rural vs. urban region using Poisson regression.

Results

There were 49,555 (10.9%) rural and 406,149 (89.1%) urban children included in this study. 42,789 children were born at <37 weeks GA, and the preterm birth rate was 9.4%. Compared to urban areas, children in rural regions had more hospitalizations (28-33 weeks: RR 1.35, 95% CI: 1.19-1.51; 34-36 weeks: RR 1.35, 95% CI 1.27-1.44; 37-44 weeks: RR 1.32, 95% CI 1.29-1.34) by five years of age; and significantly fewer outpatient visits (22-27 weeks: RR 0.90, 95% CI: 0.87-0.93; 28-33 weeks: RR 0.81, 95% CI: 0.80-0.82; 34-36 weeks: RR 0.75, 95% CI 0.74-0.75; 37-44 weeks: RR 0.71, 95% CI 0.71-0.71). Rural children born at 34-36 weeks had significantly higher rates of bronchiolitis (RR: 1.35, 95% CI: 1.16-1.56) compared to urban children. They were prescribed more antibiotics and bronchodilators (RR: 1.15, 95% CI: 1.13-1.17, and RR: 1.12, 95% CI: 1.05-1.19, respectively).

Conclusion

Compared with urban areas, preterm children living in rural regions of BC had higher rates of hospitalization, higher rates of bronchiolitis and more frequent prescriptions of antibiotics and bronchodilators by five years of age. These disparities in health status and service use warrant further research and public health interventions.
41 Neonatal outcomes with exclusive breast milk in infants with gastroschisis: A systematic review and meta-analysis
Authors: Suntharalingam Hareshan , Armstrong Jennifer , Briatico Daniel , Huisman Esther , Shah Prakesh S , Livingston Michael H
Published: October 2024

Background

Infants with gastroschisis may experience prolonged stays in hospital as they transition from parenteral nutrition to enteral feeds. Some studies suggest that patients who receive exclusive breast milk experience better outcomes than those who receive supplemental or exclusive formula. These findings are inconsistent and the evidence for exclusive breast milk remains uncertain.

Objectives

To systematically review and meta-analyze the effectiveness of exclusive breast milk in infants with gastroschisis.

Design/Methods

We searched Medline, Embase, and Cochrane without language restriction from inception until June 2023. Manual searches of trial registries and reference lists of relevant articles were also performed. We included studies that assessed the effectiveness of exclusive breast milk compared to formula among infants with gastroschisis. Title, abstract, full-text screening, and data extraction were completed by two independent reviewers. The Newcastle-Ottawa Scale was used to assess the risk of bias. Our outcomes of interest were time to full enteral feeds, days of parenteral nutrition, length of stay, necrotizing enterocolitis (NEC), cholestasis, and mortality. RevMan was used to meta-analyze treatment effects using a random effects model whenever possible. Summary statistics were reported as relative risk (RR) with 95% confidence intervals (95% CI).

Results

We identified 130 studies of which six were selected for review. All included studies were observational and retrospective. Only 3 studies (n=3211 participants) reported outcome data that were amenable to meta-analysis. All participants received exclusive breast milk (n=1009) or supplemental or exclusive formula (n=2202). Exposure to exclusive breast milk was associated with a lower risk of mortality compared to those who received formula (unadjusted RR=0.36; 95% CI: 0.13-0.96, 2 studies, n=3157, I2=0%). Exposure to exclusive breast milk was not associated with a decrease in NEC (unadjusted RR=0.20; 95% CI: 0.03-1.14; 3 studies, n=3211, I2=0%). The primary source of bias among included studies was lack of adjustment for confounders. We identified one randomized controlled trial comparing exclusive breast milk to formula. This study was stopped due to low recruitment.

Conclusion

The use of exclusive breast milk among infants with gastroschisis may be associated with a reduction in mortality; however, this estimate is based on small numbers from observational studies. Estimates may change as more data become available. Further research is needed to establish best feeding practices, including the role of human donor milk.
50 Co-designing an intervention with asylum seeking youth to improve access to healthcare in Canada using human-centered design
Authors: Nwebube Chioma , Parmar Puneet , McIntyre Jenn , Johnson Shay , Begun Stephanie , Vandermorris Ashley , Giroux Ryan , Ye Amber , Suleman Shazeen
Published: October 2024

Background

Asylum seeking youth in Canada and the United States face multiple barriers to accessing healthcare, leaving them at greater risk of worse health outcomes. In a previous study, we found that limited knowledge of the Canadian health care system and few navigation supports were a key barrier to care for asylum seeking youth, yet no youth-developed intervention existed to support this population. Human-centered design (HCD) develops meaningful interventions with communities who have been historically marginalized.

Objectives

This study sought to co-design an intervention to increase youth empowerment and access to health care for asylum seeking youth in Canada.

Design/Methods

This was a community-based participatory-action research (CBPAR) study, and combined human-centered design (HCD) methodologies. We obtained research ethics board approval for this study (#SMH REB 22-117). In partnership with two community organizations that supported asylum seeking youth in a large Canadian city, a youth advisory board was created. In multiple co-creation sessions over a calendar year, an intervention was developed in rapid prototyping sessions and refined with feedback, to develop a final pilot intervention.

Results

A total of 7 asylum-seeking youth participated in the youth advisory board, ranging in age from 12-19, representing 3 different languages and included youth who self-identified with chronic medical conditions. Over a 15-month period, they participated in 6 co-creation sessions to develop a multi-lingual, web-based tool; youth specifically stated they did not believe an app would be helpful, but rather a resource that could be easily accessed. The youth advisory board shared they had limited understanding of the Canadian healthcare system, as well as interim and provincial health insurance. Youth felt the tool should answer questions about how health insurance worked, be brightly colored, use dyslexia-friendly font and be easily saved on a smartphone as an image. A multi-lingual wallet card was developed for youth to easily present at healthcare encounters, particularly if they did not have provincial health insurance, to help youth communicate their coverage, language and needs.

Conclusion

To our knowledge, we developed the first co-designed tool in Canada for youth asylum seekers, by youth, to improve and empower youth to receive health care services they are entitled to through navigation support. Given the high degree of marginalization faced by asylum seeking youth, this intervention has the promise to improve health outcomes. Feasibility and acceptability of this study will be evaluated in subsequent studies.
64 Respiratory outcomes by five years of age among children born preterm: A population-based study using health services data
Authors: van Warmerdam Jacqui , Shen Ye , Richter Lindsay , Yang Connie , Lisonkova Sarska , Wong Jonathan , Roberts Ashley , Chan Edmond , Bone Jeffrey , Kieran Emily , Ting Joseph
Published: October 2024

Background

While neonatal care advancements have led to increased survival of preterm infants, many experience ongoing respiratory complications.

Objectives

Healthcare administrative data offers a comprehensive measure of neonatal outcomes. Our study used population-based data to describe rates of healthcare contacts for respiratory disease among children born preterm.

Design/Methods

A retrospective cohort of infants born in British Columbia between 2004-2014 was identified using a provincial birth registry. By linking to population-based healthcare data, we captured population demographics, birth data, and healthcare visits for respiratory causes [outpatient visits, hospitalizations, and intensive care (ICU) admissions] up to 5 years of age. The rate of healthcare visits due to asthma, bronchiolitis, and pneumonia were compared between preterm (22-36 weeks) and term/post-date infants (37-44 weeks GA) using Poisson regression.

Results

Children born at term (n=413,140) were compared to children born at 34-36 week GA (n=33,227), 28-33 week GA (n=8362), and 22-27 week GA (n=1231). Compared to term infants, rates of hospitalizations and ICU admission for all respiratory causes were higher among children born preterm. Children born 22-27 weeks GA had the highest rates of hospitalization for asthma [rate ratio (RR) 9.4, 95% CI 7.9-11.1], bronchiolitis (RR 10.5, 95% CI 9.3-11.8) and pneumonia (RR 15.9, 95% CI 14.3-17.7). Rates of ICU admission for asthma (RR 27.1, 95% CI 17.2-40.4) and pneumonia (RR 58.1, 95% CI 46.6-71.7) were highest among 22-27 week GA infants. Increased rates persist among children born 34-36 weeks GA, with higher rates of hospitalization for asthma (RR 1.8, 95% CI 1.6-1.9), bronchiolitis (RR 2.1, 95% CI 2.0-2.2), and pneumonia (RR 1.8, 95% CI 1.7-2.0) compared to term infants.

Conclusion

Preterm infants experience significantly higher rates of outpatient visits, hospitalizations, and ICU admissions for respiratory disease compared to term infants. Healthcare utilization, including ICU admissions, increased with decreasing gestational age. Of note, increased rates of respiratory disease were also found among infants born 34-36 weeks GA. Our study is the first to use population based data to describe rates of healthcare contacts for respiratory disease among preterm infants, providing insight to long-term respiratory disease burden.
68 Feasibility of applying synchronized and proportional negative pressure ventilation in preterm infants with respiratory distress (NeoVest)
Authors: Beck Jennifer , Sinderby Christer , Campbell Douglas
Published: October 2024

Background

In preterm infants, application of negative pressure ventilation (NPV) may offer advantages to traditional methods of nasal continuous positive airway pressure (nCPAP). In a pre-clinical model, we recently described the “NeoVest”, a system consisting of a sealed abdominal interface and a ventilator that applies NPV in synchrony and in proportion to the diaphragm electrical activity (Edi) (Beck 2022). In animals with loaded breathing, the Neovest allowed a 50% reduction in Edi, and demonstrated specific diaphragm unloading, without hemodynamic effects. The NeoVest system, and its interface, have yet to be evaluated in human infants.

Objectives

The aim of the study was to evaluate the feasibility of applying synchronized and proportional NPV with an abdominal interface in infants with respiratory distress.

Design/Methods

This is a prospective feasibility trial. The inclusion criteria were admission to the Neonatal Intensive Care Unit with respiratory distress, birthweight>1.5kg, <6 weeks of age, FiO2 <0.35, clinically stable with no recent apneas and bradycardias, nCPAP <8 cm H2O and at least 48 hrs old, or post-extubation. After parental consent, the feeding tube was exchanged for a 6F “Edi catheter” (for feeding and measuring Edi), and sensors were placed (heart rate, oxygen saturation, transcutaneous CO2, and non-invasive blood pressure (BP)). Figure 1 shows the Neovest interface on a manikin. The five protocol steps were: nCPAP ON/NeoVest OFF (10 min), nCPAP ON/NeoVest ON (10 min), NO ASSIST (1 min), NeoVest only medium (10 min), NeoVest high (5 min), NeoVest low (5 min).

Results

Eight babies have been included to this point. The principal diagnoses were Respiratory Distress Syndrome and/or Transient Tachypnea of the Newborn. Mean weight was 2186±480g and age 10±8 days old. All babies tolerated the physical application of the vest. As shown in Figure 2, there was no significant difference in Edipk when the vest was placed (12.4±5.5 vs. 11.1±3.5 uV). During the period of no assist, Edipk was higher (18.8 ±7.3 uV) than nCPAP or NeoVest periods (p= 0.012), which were not significantly different from each other. Neural respiratory rate was the same for all periods tested. As per its design, the Neovest system delivered negative pressure in synchrony and in proportion to the Edi. Negative pressures applied (□PVEST) were -9±4, -11±4, and -7±5 cmH2O (Figure 2) for the three NeoVest periods. All infants were clinically stable with no disruptions to vital signs.

Conclusion

Applying synchronized and proportional negative pressure with the NeoVest system was feasible and showed promise with regards to diaphragm unloading. Future studies are required to evaluate the NeoVest utility for longer periods and compared to other methods of respiratory support.
70 Implementation of nurse facilitated, structured, post-event clinical debriefs in four neonatal intensive care units using the INFO model
Authors: Ediger Krystyna , Law Brenda , Godbout Vanessa , Trinh Faith , Rose Stuart
Published: October 2024

Background

Neonatal intensive care units (NICUs) often experience acute clinical events. Post-event team debriefs can reinforce success, identify areas for improvement, and improve healthcare providers’ (HCP) psychological coping. However, barriers exist to successful debriefs, and poor debriefs can increase HCP stress.

Objectives

To implement and evaluate structured post-event clinical debriefs for NICUs within a regional neonatal program.

Design/Methods

We assembled a multi-disciplinary implementation team, adapted an existing tool (INFO Clinical Debriefing Tool), and identified champions for each site (2 level 2 NICUs, 1 level 3 perinatal NICU, and 1 level 4 surgical NICU). A REDCap database, debrief triggers, feedback process for recommendations to quality improvement leads and frontline HCPs were developed. We chose charge nurses as facilitators as they were consistently present but were not team leads. Facilitators were trained in 2-hour Zoom sessions with a didactic presentation followed by simulated debriefing practice. Debriefs were then started and tracked. A post-implementation survey was conducted at 6 months.

Results

Eighty-one HCPs responded to the pre survey, identifying time stress and skill / availability of facilitators as main barriers. Most nurses (75%) were comfortable participating in debriefs; this approached 100% in other disciplines. However, there were negative experiences reported. (Table 1) Ninety-five debriefs were conducted in 6 months; 50% were delivery room resuscitations, 14% were in-unit events. Median 7 (IQR 5-8) HCPs attended; 85% had 3 or more disciplines attending. Most (81%) were led by trained facilitators, with 80% led by nurses or respiratory therapists. Debriefs took a median 12 minutes (IQR 8-17), and generated recommendations for improvements to equipment, team communication, and processes. Two sites had more success with uptake, facilitated by consistent presence of champions. Barriers to implementation included: availability of trained facilitators, time constraints, competing unit priorities. The post survey (85 responses) showed a positive view of INFO debriefs. Most respondents (88%) had participated in at least 1 debrief; of these 76% report positive / very positive experience, 76% thought team members always had the chance to speak up, and 78% felt the INFO process provided an effective mechanism for communicating concerns. Participants still listed time pressure as the main barrier.(Table 2)

Conclusion

Nurse-led, structured post-event clinical debriefs can be implemented in NICUs and are positively viewed by participants. NICUs experience implementation barriers that need to be considered.
75 Lung ultrasound severity scores and its utility in predicting success of weaning off respiratory support in neonates born preterm
Authors: Elkordy Ahmed , Abuelnour Ahmed , De La Hoz Andrea , Miller Michael R , Brar Jagraj , Lalitha Renjini , Roychaudhuri Sriya
Published: October 2024

Background

Preterm infants often require respiratory support in the newborn intensive care unit. Complete trial off around 30-34 weeks post-menstrual age (PMA) is by trial and error based on clinical and physiological variables. Lung ultrasound (LUS) is a reliable adjunct in the diagnosis and management of most neonatal lung conditions. However, its utility in accessing readiness for successful weaning off respiratory pressure support in preterm neonates has not been explored.

Objectives

To determine the utility of LUS severity score (LUS-sc) in predicting successful weaning off of respiratory pressure support after 32weeks CGA in neonates born ≤32 weeks gestational age (GA).

Design/Methods

Prospective cohort study involving preterm neonates born ≤32 weeks needing any respiratory pressure support modes, admitted to a single tertiary care center in Canada between Sept 2022-Sept 2023. Eligible neonates were assessed by LUS at two time points- LUS1 at 30-30 + 6 weeks for those born <30weeks GA and between 48-72hours of life for those born at 30-32 + 6 weeks GA; LUS2 within 12hours prior to trial off respiratory pressure support to room air or low flow after 32weeks PMA. LUS were scored for disease severity by two independent reviewers using the LUS-sc by Brat et al. Receiver operator characteristics (ROC) curves analyzed the reliability of LUS-sc to predict the successful cessation of respiratory pressure support to room air or low flow post LUS2.

Results

Of 50 preterm neonates included in the study, 32 (64%) were successfully weaned from pressure support after LUS2 at a mean (SD) GA of 33.03 (0.29). The mean (SD) GA at birth was 28.78 (0.46) in the successful group and 27.78 (0.62) in the unsuccessful group (p=0.197). The mean (SD) LUS-sc for LUS2 at which cessation of support was possible was significantly lower from those who failed [6.95(0.33) vs 8.69(0.55), p=0.006] (Table 1). The ROC curve (Figure 1) showed AUC of 0.717 (95%CI=0.56-0.86), for a cut-off of LUS-sc of 7.75, with sensitivity of 0.75 (95%CI=0.60-0.90) and specificity of 0.61 (95%CI=0.38-0.84). Independent of GA at birth and at respiratory pressure support trial off, LUS-sc ≤8 was associated with an increased odd of cessation of support by 9.0 (95%CI=1.9-42.6), p=0.005, and each additional week of GA at first trial off increased the odds of cessation by 2.2 (95%CI=1.1-4.4), p=0.031.

Conclusion

LUS is a reliable tool to assess readiness for successful non-invasive respiratory pressure support trial off. A LUS-sc ≤8 was associated with higher successful weaning off of non-invasive pressure support after 32weeks GA.
86 Sociodemographic and family characteristics of children with and without neurodevelopmental impairment in a Canadian cohort of extreme preterm children
Authors: Afifi Jehier , Lee Seungwoo , Colby Lindsay , Butt Arsalan , Hicks Matt , Beltempo Marc , Bourque Claude Julie , Olukotun Mary , Salami Bukola , Synnes Anne
Published: October 2024

Background

Despite improved survival of extreme preterm infants (<29 weeks’ gestation), neurodevelopmental impairment (NDI) remains high. Certain sociodemographic characteristics (SDC) and limited family resources are known to adversely affect children health and development, particularly those born preterm. There is a dearth of recent data from large cohorts examining the impact of social determinants of health on the neurodevelopment of preterm children.

Objectives

(1) to describe SDC and family composition in a population-based cohort of extreme preterm children using the Canadian Neonatal Follow Up Network (CNFUN) database; (2) to develop a logistic regression model examining the association of significant NDI (sNDI any of: CP ≥ GMFCS stage 3, Bayley III < 70 in any domain, deafness requiring aids, or bilateral blindness) with SDC using a unique family descriptor.

Design/Methods

A retrospective review of a national cohort of extreme preterm infants (230 -286 weeks) born between April 2009 and December 2018. We included children who had neurodevelopmental assessment at 18-24 month corrected age at a CNFUN participating Centre. We compared SDC of infants and caregivers and family descriptors (moderating variables) between children with no NDI and those with any NDI and sNDI. Multivariate logistic regression models were developed in two steps to evaluate the effect of SDC (Model 1) and family composition (Model 2) on the primary outcome of sNDI. GEE was used to account for clustering by multiples and within site.

Results

Out of 10833 eligible infants, 6219 (57%) were included. Of those, 3412 (55%) had no NDI and 2807 (45%) had any NDI. sNDI accounted for 17% of the cohort and 37% of those with NDI. Comparison of the SDC and family descriptors between the three groups are shown in Table 1. On multivariate analysis using SDC, infant’s gestational age and male sex, and primary caregiver’s ethnicity and level of education were independently associated with sNDI. Immigration and employment status were associated with sNDI when family descriptors were added to the first model (Table 2).

Conclusion

In this national cohort, half of extreme preterm children developed NDI and 1 in 7 had sNDI. There were differences in sociodemographic and family characteristics between those with and without sNDI. The degree of prematurity and caregiver’s education, employment and immigration status were independently associated with sNDI in those children. Future research is needed to determine what interventions and support to benefit those children at risk.
88 Evaluating the impact of ChatGPT-4 on medical abstracts
Authors: Gravel Jocelyn , Dion Chloé , Kermani Mandana Fadaei , Mousseau Sarah , Osmanlliu Esli
Published: October 2024

Background

Since its launch in November 2022, ChatGPT has received recognition for its use in medical writing. Some even suggested it could write scientific abstracts. However, its real-life effectiveness to help researchers improve conference abstracts remains unexplored.

Objectives

To evaluate whether ChatGPT 4.0 could improve the quality of abstracts submitted to a medical conference by clinical researchers with various experiences.

Design/Methods

In October 2023, we conducted an experimental study involving 24 international researchers who provided one “original” abstract intended for submission at the 2024 Pediatric Academic Society (PAS) conference. Our research team created a prompt asking ChatGPT-4 to improve the quality of the abstract while adhering PAS submission guidelines. Researchers received the revised version and were tasked with creating a “final” abstract. The quality of each version (original, ChatGPT and final) was evaluated by the researchers themselves using a numeric scale (0-100). Additionally, three co-investigators assessed abstracts blinded to the version. The primary analysis focused on the mean difference in scores between the final and original abstracts. We also compared scores of the three versions and determined the proportion of researchers reporting ChatGPT's impact on their abstract and its acceptance probability. For an effect size of 0.7, it was estimated that we needed at least 20 pairs of abstracts.

Results

Abstract quality varied between the three versions with mean scores of 82, 65 and 90 for the original, ChatGPT and final versions, respectively. Overall, the final version displayed significantly improved quality compared to the original (mean difference 8.0 points; 95% CI: 5.6-10.3). Of note, 3 (14%) abstracts remained unchanged between final and original versions. Independent ratings by the co-investigator confirmed statistical improvements (mean difference 0.94 points; 95% CI: 0.44-1.44). Researchers identified minor (n=10) and major (n=3) factual errors in ChatGPT’s abstracts. However, 18 (75%) participants reported that ChatGPT contributed to the enhancement of their final abstract. Ten (42%) participants believed it improved their abstract's chances of acceptance. Eighteen (75%) researchers reported being uncomfortable using ChatGPT version for submission.

Conclusion

While ChatGPT 4.0 does not produce abstracts of better quality then the one crafted by researchers, it serves as a valuable tool for researchers to enhance the quality of their own abstracts. The utilization of such tools is a potential strategy for researchers seeking to improve their abstracts.
Evaluation of Huanglongbing-Tolerant Citrus Hybrid Rootstocks for Resistance to Tylenchulus semipenetrans
Authors: Hamid M. Imran , Bowman Kim D. , Seymour Danelle K. , Rolshausen Philippe E.
Published: October 2024

The response of seven Poncirus trifoliata hybrid rootstocks tolerant to Huanglongbing (HLB) was evaluated for resistance against the citrus nematode (CN) Tylenchulus semipenetrans. HLB, caused by the bacterium ‘ Candidatus Liberibacter asiaticus’, is one of the most destructive diseases of citrus and has become established in citrus production areas across the United States. Trees affected by HLB decline faster when coinfected with soilborne pathogens. Thus, planting citrus rootstocks that can withstand multiple pathogens is the foundation of an integrated pest management (IPM) program in areas infested by HLB. The rootstocks that were screened for CN resistance were the best performing in Florida field trials under HLB pressure. The level of resistance of citrus hybrid rootstocks to T. semipenetrans was assessed in controlled conditions by comparison to standard rootstocks with documented resistance (Swingle citrumelo) and susceptibility (sour orange and Cleopatra mandarin) to CN. Typical symptoms caused by CN were reproduced on susceptible rootstocks (sour orange, Cleopatra mandarin, Ridge, US-802, US-812, US-1283, and US-1284) and included the characteristic development of the dark root phenotype, a decreased root and shoot growth, and the appearance of leaf chlorosis. Three hybrid rootstocks (US-897, US-942, and US-1516) displayed CN resistance levels comparable to Swingle citrumelo and did not express any visible root and shoot symptoms. Our results showed that the resistance mechanism was not caused by chemotaxis but rather by restricting female penetration into the roots and impeding its ability to reproduce and form juveniles. These results provide valuable information to help citrus growers make educated decisions about rootstock selection.
Hospital Cyberattacks Are on the Rise
Authors: Seegert Liz
Published: October 2024

Nurses play a crucial role in ensuring optimal patient care.
FDA Denies Approval of MDMA-Assisted Therapy for PTSD
Authors: Roush Karen
Published: October 2024

The agency cited potential dangers and flaws in research methodology.
Genomic Nursing
Authors: Hannon Heather , Hassen Elizabeth
Published: October 2024

Translating genetic and genomic information to improve health outcomes
Wide Range of First-Line Treatments for New Episode of Depression
Authors: Rosenberg Karen
Published: October 2024

According to this study:
Outcomes for Female Physicians Compared With Nonphysicians After Assisted Reproductive Technology
Authors: Vanderhoff Anna C. , Lanes Andrea , Herz-Roiphe Rachel , Mecklai Keizra , Camacho Oscar Leyva , Srouji Serene S. , Easter Sarah Rae , Fox Janis , Rangel Erika L.
Published: October 2024

OBJECTIVE:

To evaluate outcomes of female physicians after assisted reproductive technology (ART).

METHODS:

We conducted a retrospective cohort study using data from 248 physician patients and 3,470 nonphysician patients who underwent a total of 10,095 fresh or frozen ART cycles at a single academic center in an insurance-mandated state between January 2015 and March 2022. The primary outcome was live-birth rate. The secondary outcomes were implantation rate, early pregnancy loss rate, and time to pregnancy. Models were adjusted for confounders where appropriate.

RESULTS:

Both groups were similar in age (mean physician age 36.29 years; mean nonphysician age 35.96 years, P=.35). Physicians had lower body mass index (BMI) (mean physician BMI 23.51, mean nonphysician BMI 26.37, P<.01), and a higher proportion were diagnosed with unexplained infertility (physician 33.9%, nonphysician 25.9%, P<.01) and used preimplantation genetic testing for aneuploidy (physician 21.5%, nonphysician 12.7%). Physicians and nonphysicians had similar live-birth rates (physician 39.3%, nonphysician 38.2%; adjusted relative risk [aRR] 1.01 95% CI, 0.91–1.13), implantation rates (physician 34.7%, nonphysician 33.7%; relative risk 1.03 95% CI, 0.94–1.14), and early pregnancy loss rates (physician 21.9%, nonphysician 19.8%; aRR 1.18 95% CI, 0.99–1.41) per transfer. Physicians had a shorter time from initial ART cycle to pregnancy (physician 21.82 weeks, nonphysician 25.16 weeks; aRR 0.86, 95% CI, 0.83–0.89).

CONCLUSION:

There was no difference between female physicians and nonphysicians in assisted reproduction cycle outcomes. Physicians become pregnant slightly faster than nonphysicians.
Nasal Light Reflex: A Useful Intraoperative Tool in Correction of Cleft Lip Nasal Deformity
Authors: Madaree Anil
Published: October 2024

Background:

The correction of a unilateral cleft lip nasal deformity remains a challenge to cleft surgeons. It is difficult to obtain a routinely predictable outcome. This is in part due to there being no objective intraoperative method to assess the correction.

Methods:

We have come up with a simple objective intraoperative method to plan and assess the correction of the nasal deformity. This is done by assessing the nasal light reflex using a mobile phone camera to define the deformity. The points of the desired correction of the lower lateral cartilage are transposed onto the patient. Once the lip and nose repair is completed, another photograph is taken to assess the nasal light reflex and assess the extent of correction. If this is inadequate, further nasal correction is performed. We have used this procedure in 122 cleft lip patients with 93 complete and 29 incomplete.

Results:

We have found this to be a useful objective intraoperative method to assist in obtaining improved nasal correction in cleft lip patients. As is well known, relapse of the nose is common in cleft lip repairs, but this method allows one to better gauge the correction at the primary surgery.

Conclusion:

Nasal light reflex should be added to the armamentarium of cleft surgeons to assist in superior correction of the nose, which is an item that continues to vex these surgeons.
Periodontitis accelerates the onset of hypertension in spontaneously hypertensive rats, while the electrical activation of the carotid sinus nerve delays the beginning of the increase in blood pressure
Authors: Buzinari Tereza C. , Castania Jaci A. , Salvador Sergio L.S. , Ribeiro Aline B. , Junior Rubens Fazan , Salgado Helio C.
Published: October 2024

Background:

We have previously demonstrated that electrical stimulation of the carotid sinus nerve (CSN) protects the development of periodontitis. In the current study, we evaluated whether periodontitis accelerates the onset of hypertension in spontaneously hypertensive rats (SHR); and whether electrical stimulation of the CSN would delay the onset of hypertension.

Methods:

Three-week old SHR were implanted with electrodes around the CSN for electrical stimulation for 13 days. Bilateral ligation of the first molar and oral administration of Porphyromonas gingivalis induced periodontitis. The femoral artery of the SHR was cannulated, and 24 h later, in a conscious state, the blood pressure was recorded.

Results:

Five-week old sham SHR (subjects without electrical stimulation of the CSN) did not demonstrate hypertension. However, when the SHR were submitted to periodontitis they exhibited hypertension at 5 weeks of age. Nevertheless, the stimulation of the CSN prevented the onset of hypertension. Periodontitis promoted alveolar bone loss in SHR; but, electrical stimulation of the CSN prevented this undesirable outcome following the exposure to periodontitis.

Conclusion:

Periodontitis accelerated the onset of hypertension in SHR; while the electrical stimulation of the CSN delayed the onset of hypertension.
Topical Losartan Dosage Response and Corneal Toxicity at Higher Concentrations
Authors: Dutra Barbara Araujo Lima , Martinez Valeria Villabona , Santhiago Marcony R. , Wilson Steven E.
Published: October 2024

Purpose:

The purpose of this study was to evaluate the efficacy and safety of higher dosages of topical losartan in an alkali-burn fibrosis model in rabbits.

Methods:

In total, 18 rabbits had standardized alkali burns that trigger stromal fibrosis. Six eyes per group were treated with topical losartan (0.8 mg/mL, 8 mg/mL, or 40 mg/mL) 6 times per day. Slit-lamp photographs were obtained, and multiplex immunohistochemistry was performed for myofibroblast marker alpha-smooth muscle actin (α-SMA), mesenchymal cell marker vimentin, and basement membrane marker laminin alpha-5.

Results:

Topical losartan at 40 mg/mL 6 times per day produced severe discomfort and ocular surface toxicity in all rabbits, and treatment was discontinued at nine days in this group. Topical losartan at 8 mg/mL 6 times per day caused less rabbit discomfort on application, but there were persistent epithelial defects and marked stromal opacity in 5 of 6 eyes after 1 month of treatment. Topical losartan 0.8 mg/mL was well tolerated by rabbits, and corneal opacity was markedly reduced at 1 month in 5 of 6 corneas compared with corneas in the 8 mg/mL and 40 mg/mL losartan groups. A persistent epithelial defect with opacity was noted in 1 cornea in the 0.8 mg/mL losartan group. Both total SMA-positive stromal cells per section (14.5 ± 2.8 vs. 3.5 ± 0.7, P = 0.04) and total stromal vimentin intensity units (310 ± 64 vs. 132 ± 35, P = 0.02) were significantly greater after 1 month of treatment in corneas treated with 8 mg/mL than corneas treated with 0.8 mg/mL of topical losartan.

Conclusions:

Topical losartan dosages over 0.8 mg/mL should be used cautiously in patient eyes. In eyes with a current epithelial defect, it is recommended that 0.2 mg/mL losartan 6 times per day be used until the epithelium closes.
A look at the emerging trends of large language models in ophthalmology
Authors: Tan Ting Fang , Quek Chrystie , Wong Joy , Ting Daniel S.W.
Published: October 2024

Purpose of review

As the surge in large language models (LLMs) and generative artificial intelligence (AI) applications in ophthalmology continue to expand, this review seeks to update physicians of the current progress, to catalyze further work to harness its capabilities to enhance healthcare delivery in ophthalmology.

Recent findings

Generative AI applications have shown promising performance in Ophthalmology. Beyond native LLMs and question-answering based tasks, there has been increasing work in employing novel LLM techniques and exploring wider use case applications.

In this review, we first look at existing LLM use case applications specific to Ophthalmology, followed by an overview of commonly used LLM techniques. We finally focus on the emerging trends of the generative AI space with an angle from ophthalmology.
Association Between Tidal Volume in Invasive Mechanical Ventilation and Mortality in Children With Extracorporeal Membrane Oxygenation
Authors: Guijarro Jennifer , Fernández-Sarmiento Jaime , Acevedo Lorena , Sarta-Mantilla Mauricio , Mulett Hernando , Castro Daniel , Reyes Casas Martha Cecilia , Pardo Daniel Felipe , Santacruz Carlos Miguel , Bernal Ligia Tatiana , Ramírez Laura Henao , Gómez María Camila , Di Giovanna Giovanni A. , Duque-Arango Catalina
Published: October 2024

Mechanical ventilation (MV) strategies in children on extracorporeal membrane oxygenation (ECMO) have not been studied much and the ventilatory parameters to avoid greater lung damage are still unclear. Our objective was to determine the relationship between conventional tidal volume (4–8 ml/kg, CTV) versus low tidal volume (<4 ml/kg, LTV) and mortality in children with MV at the beginning of ECMO. This was a retrospective cohort study that included 101 (10.9 months interquartile range [IQR]: 6.0–24.0) children. Children with LTV had greater odds of hospital mortality (adjusted odds ratio [aOR]: 2.45; 95% confidence interval [CI]: 1.05–5.71; p = 0.03) regardless of age, reason for ECMO, and disease severity, as well as a longer duration of MV after ECMO. We found no differences between the groups in other MV settings. The CTV group required fewer fibrobronchoscopies than patients with LTV (aOR: 0.38; 95% CI: 0.15–0.99; p = 0.04). We found that a tidal volume (VT) lower than 4 ml/kg at the onset of ECMO support in children with MV was associated with higher odds of mortality, longer post-decannulation ventilation, and a greater need for fibrobronchoscopies. Lung-protective bundles in patients with ECMO and MV should consider the VT to maintain plateau and driving pressure that avoid major lung injury caused by MV.
Monitoring and modulating respiratory drive in mechanically ventilated patients
Authors: Consalvo Sebastián , Accoce Matías , Telias Irene
Published: October 2024

Purpose of review

Respiratory drive is frequently deranged in the ICU, being associated with adverse clinical outcomes. Monitoring and modulating respiratory drive to prevent potentially injurious consequences merits attention. This review gives a general overview of the available monitoring tools and interventions to modulate drive.

Recent findings

Airway occlusion pressure (P0.1) is an excellent measure of drive and is displayed on ventilators. Respiratory drive can also be estimated based on the electrical activity of respiratory muscles and measures of respiratory effort; however, high respiratory drive might be present in the context of low effort with neuromuscular weakness. Modulating a deranged drive requires a multifaceted intervention, prioritizing treatment of the underlying cause and adjusting ventilator settings for comfort. Additional tools include changes in PEEP, peak inspiratory flow, fraction of inspired oxygen, and sweep gas flow (in patients receiving extracorporeal life-support). Sedatives and opioids have differential effects on drive according to drug category. Monitoring response to any intervention is warranted and modulating drive should not preclude readiness to wean assessment or delay ventilation liberation.

Monitoring and modulating respiratory drive are feasible based on physiological principles presented in this review. However, evidence arising from clinical trials will help determine precise thresholds and optimal interventions.
Spontaneous breathing trials: how and for how long?
Authors: Thille Arnaud W. , Arrivé François , Le Pape Sylvain
Published: October 2024

Purpose of review

Guidelines recommend systematic performance of a spontaneous breathing trial (SBT) before extubation in ICUs, the objective being to reduce the risk of reintubation. In theory, a more challenging SBT performed with a T-piece may further reduce the risk of reintubation, whereas a less challenging SBT performed with pressure-support ventilation (PSV) may hasten extubation.

Recent findings

Recent findings show that a more challenging SBT with a T-piece or for a prolonged duration do not help to reduce the risk of reintubation. In contrast, a less challenging SBT with PSV is easier to pass than a T-piece, and may hasten extubation without increased risk of reintubation. Although SBT with PSV and additional positive end-expiratory pressure is indeed a less challenging SBT, further studies are needed to generalize such an easy trial in daily practice. Earlier screening for a first SBT may also decrease time to extubation without increased risk of reintubation. Lastly, reconnection to the ventilator for a short period after successful SBT facilitates recovery from the SBT-induced alveolar derecruitment.

Several recent clinical trials have improved assessment of the most adequate way to perform SBT before extubation.
Neutrophil count predicts the complete response after transarterial chemoembolization related to favorable outcome in hepatocellular carcinoma
Authors: Hong Young Mi
Published: October 2024

Background

Systemic inflammatory markers have emerged as novel prognostic biomarkers associated with prognosis for tumors. This study aims to investigate the predictive value of systemic inflammatory markers for complete response (CR) in patients with hepatocellular carcinoma (HCC) who underwent transarterial chemoembolization (TACE).

Methods

This retrospective study enrolled 575 HCC patients undergoing TACE. Survival outcomes were evaluated based on tumor response, and the analysis was conducted using a Kaplan–Meier curve. Predictive factors for achieving a CR after the initial TACE were analyzed by univariate and multivariate analyses in a Cox regression model.

Results

After the initial TACE, 246 of 575 (42.8%) patients achieved a CR. During a median of 60 months follow-up, the CR group had better overall survival than non-CR group (median: 82.3 vs. 51.6 months, P < 0.001). Pre-TACE neutrophil count was associated with tumor response (P = 0.06). Multivariate analysis showed that hepatitis B virus infection [hazard ratio (HR) = 0.585, 95% confidence interval (CI) = 0.360–0.952, P = 0.031] and pre-TACE neutrophil count (HR = 2.854, 95% CI = 1.115–7.307, P = 0.029) were independent predictive factors for CR after the initial TACE. Additionally, a high pre-TACE neutrophil count was associated with male gender (P < 0.001), large tumor size (P < 0.001), advanced Barcelona Clinic Liver Cancer stage (P = 0.003), and high protein induced by vitamin K absence or antagonist-II level (P < 0.001).

Conclusion

Patients who achieved CR after the initial TACE showed a favorable prognosis. Pre-TACE neutrophil count was found to be an independent predictor of CR. These findings offer valuable insights for identifying patients who would derive the greatest benefit from TACE and for distinguishing those who may require alternative treatment approaches for HCC.
Perioperative systemic therapy, current paradigm and ongoing clinical trials in upper tract urothelial cancer
Authors: Bhanvadia Raj R. , Khene Zine-Eddine , Margulis Vitaly
Published: October 2024

Purpose of review

To provide a comprehensive overview of existing and future paradigms for perioperative systemic therapy in the treatment of upper tract urothelial carcinoma.

Recent findings

Contemporary treatment paradigms for the management of upper tract urothelial carcinoma focus on use of neoadjuvant cisplatin based chemotherapy for high grade disease primarily based on two small single arm phase II clinical trials. More robust evidence from a phase III randomized clinical trial exists for the use of adjuvant platinum based chemotherapy for invasive disease after radical nephroureterectomy, but there are significant concerns about renal function and platinum eligibility after nephroureterectomy. There are currently ongoing clinical trials for nonplatinum based perioperative systemic therapies including checkpoint inhibitors/immunotherapy as well as antibody–drug conjugates, but currently no recommendation can be made for these approaches.

Current evidence supports neoadjuvant cisplatin chemotherapy in the setting of high grade disease or concern for significant renal dysfunction after radical nephroureterectomy or platinum based adjuvant chemotherapy in eligible patients with advanced disease after surgery. While there is no established role for nonplatinum based therapies yet, multiple ongoing trials exploring use of immunotherapies and antibody–drug conjugates as monotherapy or combination may provide new therapeutic options in this population.