bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Two Training Programs on Transcriptional Levels of Neurotrophins and Glial Cells Population in Hippocampus of Experimental Multiple Sclerosis
Authors: Naghibzadeh Maryam , Ranjbar Rouhollah , Tabandeh Mohammad , Habibi Abdolhamid
Published: May 2018

The aim of the present study was to investigate the effects of high-intensity interval training (HIIT) versus low-intensity continuous training (LICT) on transcriptional levels of neurotrophic factors and oligodendrocyte/microglia cell loss in a cuprizone (CP) induced animal model of demyelination. Male C57BL/6 mice were assigned to six groups: control (C), cuprizone-induced demyelination (CP), interval training (IT), continuous training (CT), IT plus CP (ITCP), and CT plus CP (CTCP). Training programs on the treadmill were performed for four weeks, and then demyelination was induced by feeding mice a diet containing 0.2% cuprizone for five weeks. Animals that received cuprizone showed poorer motor function, lower expression of BDNF, GDNF, NGF, and fewer oligodendrocytes in the hippocampus compared to the control animals. The numbers of oligodendrocyte and microglia cells increased in the ITCP group compared to the CTCP group (P<0.05). Both training programs increased the mRNA levels of BDNF, GDNF and NGF, and the HIIT program was more effective than the LICT program (P<0.05). Both exercise programs prevented the abnormal neurological movements induced by cuprizone. Our results indicated that HIIT versus LICT had a greater neuroprotective effect against multiple sclerosis by improving gene expression for abnormal neurotrophins and cellular loss in the hippocampus.
Some Aspects of the Chemistry of Alkynylsilanes
Authors: Larson Gerald
Published: May 2018

In amongst the considerable chemistry of acetylenes there lies some unique chemistry of alkynylsilanes (silylacetylenes) some of which is reviewed herein. This unique character is exemplified not only in the silyl protection of the terminal C–H of acetylenes, but also in the ability of the silyl group to be converted into other functionalities after reaction of the alkynylsilane and to its ability to dictate and improve the regioselectivity of reactions at the triple bond. This, when combined with the possible subsequent transformations of the silyl group, makes their chemistry highly versatile and useful.

1 Introduction

2 Safety

3 Synthesis

4 Protiodesilylation

5 Sonogashira Reactions

6 Cross-Coupling with the C–Si Bond

7 Stille Cross-Coupling

8 Reactions at the Terminal Carbon

9 Cross-Coupling with Silylethynylmagnesium Bromides

10 Reactions of Haloethynylsilanes

11 Cycloaddition Reactions

11.1 Formation of Aromatic Rings

11.2 Diels–Alder Cyclizations

11.3 Formation of Heterocycles

11.4 Formation of 1,2,3-Triazines

11.5 [2+3] Cycloadditions

11.6 Other Cycloadditions

12 Additions to the C≡C Bond

13 Reactions at the C–Si Bond

14 Miscellaneous Reactions
The Effect on Performance Time and Quality of the Knots after Mono or Bimanual Training of Laparoscopic Intracorporeal Knot Tying according to the Gladiator Rule Technique
Authors: Asencio Fernanda de Almeida , Ribeiro Helizabet Abdala Salomão Ayroza , Romeo Armando , Wattiez Arnauld , Ribeiro Paulo Augusto Galvão Ayroza
Published: May 2018

Objective To assess whether the monomanual or bimanual training of laparoscopic suture following the same technique may interfere with the knots' performance time and/or quality.

Methods A prospective observational study involving 41 resident students of gynecology/obstetrics and general surgery who attended a laparoscopic suture training for 2 days. The participants were divided into two groups. Group A performed the training using exclusively their dominant hand, and group B performed the training using both hands to tie the intracorporeal knot. All participants followed the same technique, called Romeo Gladiator Rule. At the end of the course, the participants were asked to perform three exercises to assess the time it took them to tie the knots, as well as the quality of the knots.

Results A comparative analysis of the groups showed that there was no statistically significant difference (p = 0.334) between them regarding the length of time to tie one knot. However, when the time to tie 10 consecutive knots was compared, group A was faster than group B (p = 0.020). A comparison of the knot loosening average, in millimeters, revealed that the knots made by group B loosened less than those made by group A, but there was no statistically significant difference regarding the number of knots that became untied.

Conclusion This study demonstrated that the knots from group B showed better quality than those from group A, with lower loosening measures and more strength necessary to untie the knots. The study also demonstrated that group A was faster than B when the time to tie ten consecutive knots was compared.
From Auto- to Allotransplantation: Immunomodulatory Protocol for Hand and Arm Transplantation
Authors: Shores Jaimie , Brandacher Gerald , Lee W.
Published: May 2018

Aim To achieve a favorable risk–benefit balance for hand transplantation, an immunomodulatory protocol was developed in the laboratory and translated to clinical application.

Methods Following donor bone marrow infusion into transplant recipients, hand and arm allografts have been maintained on low-dose tacrolimus monotherapy.

Results Good-to-excellent functional recovery has been achieved in patients compliant with medication and therapy, thus restoring autonomous and productive lives.

Conclusion The risk-benefit balance can be tilted in favor of the hand transplant recipients by using an immunomodulatory protocol with minimum immunosuppression.
IFK-Modellvorhaben für mehr Autonomie – Die Zeit für Modellvorhaben zum Direktzugang ist reif!
Authors: Oldenburg Elke
Published: May 2018

Es gibt Krankenkassen, die ein großes Interesse daran haben, dass ihre Versicherten bei bestimmten Erkrankungen direkt zum Physiotherapeuten gehen können und nicht den Umweg über den Arzt nehmen müssen. Eine davon ist die BIG direkt gesund. Sie und der Berufsverband IFK haben jüngst in einem Modellvorhaben belegt: Physiotherapeuten gehen verantwortlich mit Entscheidungsfreiheit um.
A thermo-economic approach for determination of optimum thickness of thermal insulation applied to piping systems
Authors: Ucar Aynur
Published: May 2018

In the present work, the exergetic cost, exergy losses, and optimum insulation thicknesses of pipes by the usage of thermoeconomic analysis are found for the selected four cities, each with different climate regions in Turkey. Glasswool, EPS, and XPS are selected as the insulation materials in this work. It is seen that the optimum value of the insulation thickness such as exergetic cost and exergy losses is dependent on degree-days and it increases with the increasing degree-days. With natural gas as a fuel type and XPS as an insulation material, the optimum values of insulation thicknesses are found to be 0.019, 0.030, 0.036, and 0.057 m for Aydın, Tekirdağ, Elazığ, and Kars, respectively. The exergy savings and payback periods increase with the increasing pipe diameters. Additionally, the optimum insulation thickness is dependent on the convective heat transfer coefficient on the outer surface of the pipe, and it increases with the increasing convective heat transfer coefficient. It is seen from the results of sensitivity analysis that the sensitivity degree of increase in the discount and inflation rate is greater than other variations with respect to the optimum insulation thickness.
Effects of etchants in the transfer of chemical vapor deposited graphene
Authors: Wang M. , Yang E. H. , Vajtai R. , Kono J. , Ajayan P. M.
Published: May 2018

The quality of graphene can be strongly modified during the transfer process following chemical vapor deposition (CVD) growth. Here, we transferred CVD-grown graphene from a copper foil to a SiO2/Si substrate using wet etching with four different etchants: HNO3, FeCl3, (NH4)2S2O8, and a commercial copper etchant. We then compared the quality of graphene after the transfer process in terms of surface modifications, pollutions (residues and contaminations), and electrical properties (mobility and density). Our tests and analyses showed that the commercial copper etchant provides the best structural integrity, the least amount of residues, and the smallest doping carrier concentration.
Magnetization reversal process and evaluation of thermal stability factor in Cu doped granular L1 FePt films
Authors: Jain S. , Papusoi C. , Admana R. , Yuan H. , Acharya R.
Published: May 2018

Curie temperature TC distributions and magnetization reversal mechanism in Cu doped L10 FePt granular films is investigated as a function of film thickness in the range of ∼5–12 nm with Cu mol. % varying in the range of 0%–6%. It is shown that Cu doping increases the FePt tetragonality and chemical ordering. For Cu doped FePt-X films, coercivity (HC) exhibits a non-monotonic behavior with increasing film thickness, i.e., HC increases initially up to tcr ∼ 7 nm, and decreases thereafter. We attribute this behavior to the change in magnetization reversal mechanism from coherent to an incoherent (domain-wall driven) mode. While in un-doped films, the domain-walls nucleate at the grain boundaries, in doped films the Cu atoms may act as domain-wall nucleation and pinning sites, isolating magnetic spin clusters of reduced dimensionality with respect to the physical grain size. This is experimentally supported by a much poorer dependence of the AC susceptibility (both, real and imaginary components) on the film thickness above 7 nm than in the case of un-doped films. The formation of magnetic spin clusters inside the grains as a consequence of the reduced coupling between Fe-Fe and Fe-Pt-Fe atoms with increasing Cu doping can explain the experimentally evidenced reduction of both, the film Curie temperature, TC, and intrinsic anisotropy energy density, KC, with increasing Cu doping.
On the issue of closed versus open forms of gamma-aminobutyric acid (GABA) in water: Ab initio molecular dynamics and metadynamics studies
Authors: Sharma Bikramjit , Chandra Amalendu
Published: May 2018

Gamma-aminobutyric acid (GABA), a primary neurotransmitter, accomplishes its activities by binding to different receptor sites in different conformations. It is known to have two major conformers: the closed and open forms. Earlier studies on preferred conformation of GABA in water revealed differing results with some reporting the open form while others inferring the closed form to be more stable. We found the existence of many open forms and only one closed form of GABA in water through ab initio metadynamics simulation. Some of the open conformers are equally or more stable while others are less stable than the closed form. Free energy barriers reveal that different conformers are interconvertible at room temperature in typical experimental time scales. Ab initio molecular dynamics simulations are performed to further investigate the inter-conversion of various conformers of GABA in water and their dipole moments and also to make connections to experiments on the conformation of GABA in water.
A temperature-controlled photoelectrochemical cell for quantitative product analysis
Authors: Corson Elizabeth R. , Creel Erin B. , Kim Youngsang , Urban Jeffrey J. , Kostecki Robert , McCloskey Bryan D.
Published: May 2018

In this study, we describe the design and operation of a temperature-controlled photoelectrochemical cell for analysis of gaseous and liquid products formed at an illuminated working electrode. This cell is specifically designed to quantitatively analyze photoelectrochemical processes that yield multiple gas and liquid products at low current densities and exhibit limiting reactant concentrations that prevent these processes from being studied in traditional single chamber electrolytic cells. The geometry of the cell presented in this paper enables front-illumination of the photoelectrode and maximizes the electrode surface area to electrolyte volume ratio to increase liquid product concentration and hence enhances ex situ spectroscopic sensitivity toward them. Gas is bubbled through the electrolyte in the working electrode chamber during operation to maintain a saturated reactant concentration and to continuously mix the electrolyte. Gaseous products are detected by an in-line gas chromatograph, and liquid products are analyzed ex situ by nuclear magnetic resonance. Cell performance was validated by examining carbon dioxide reduction on a silver foil electrode, showing comparable results both to those reported in the literature and identical experiments performed in a standard parallel-electrode electrochemical cell. To demonstrate a photoelectrochemical application of the cell, CO2 reduction experiments were carried out on a plasmonic nanostructured silver photocathode and showed different product distributions under dark and illuminated conditions.
Efficient correction of wavefront inhomogeneities in X-ray holographic nanotomography by random sample displacement
Authors: Hubert Maxime , Pacureanu Alexandra , Guilloud Cyril , Yang Yang , da Silva Julio C. , Laurencin Jerome , Lefebvre-Joud Florence , Cloetens Peter
Published: May 2018

In X-ray tomography, ring-shaped artifacts present in the reconstructed slices are an inherent problem degrading the global image quality and hindering the extraction of quantitative information. To overcome this issue, we propose a strategy for suppression of ring artifacts originating from the coherent mixing of the incident wave and the object. We discuss the limits of validity of the empty beam correction in the framework of a simple formalism. We then deduce a correction method based on two-dimensional random sample displacement, with minimal cost in terms of spatial resolution, acquisition, and processing time. The method is demonstrated on bone tissue and on a hydrogen electrode of a ceramic-metallic solid oxide cell. Compared to the standard empty beam correction, we obtain high quality nanotomography images revealing detailed object features. The resulting absence of artifacts allows straightforward segmentation and posterior quantification of the data.
Impact of magnetic fields on the morphology of hybrid perovskite films for solar cells
Authors: Corpus-Mendoza Asiel N. , Moreno-Romero Paola M. , Hu Hailin
Published: May 2018

The impact of magnetic fields on the morphology of hybrid perovskite films is assessed via scanning electron microscopy and X-ray diffraction. Small-grain non-uniform perovskite films are obtained when a large magnetic flux density is applied to the sample during reaction of PbI2 and methylammonium iodide (chloride). Similarly, X-ray diffraction reveals a change of preferential crystalline planes when large magnetic fields are applied. Furthermore, we experimentally demonstrate that the quality of the perovskite film is affected by the magnetic field induced by the magnetic stirring system of the hot plate where the samples are annealed. As a consequence, optimization of the perovskite layer varies with magnetic field and annealing temperature. Finally, we prove that uncontrolled magnetic fields on the environment of preparation can severely influence the reproducibility of results.
Understanding and improving the low optical emission of InGaAs quantum wells grown on oxidized patterned (001) silicon substrate
Authors: Roque J. , Haas B. , David S. , Rochat N. , Bernier N. , Rouvière J. L. , Salem B. , Gergaud P. , Moeyaert J. , Martin M. , Bertin F. , Baron T.
Published: May 2018

In 0.3 Ga 0.7 As quantum wells (QW) embedded in AlGaAs barriers and grown on oxidized patterned (001) silicon substrates by metalorganic chemical vapor deposition using the aspect ratio trapping method are studied. An appropriate method combining cathodoluminescence and high resolution scanning transmission electron microscopy characterization is performed to spatially correlate the optical and structural properties of the QW. A triple period (TP) ordering along the ⟨111⟩ direction induced by the temperature decrease during the growth to favor indium incorporation and aligned along the oxidized patterns is observed in the QW. Local ordering affects the band gap and contributes to the decrease of the optical emission efficiency. Using thermal annealing, we were able to remove the TP ordering and improve the QW optical emission by two orders of magnitude.
Torsional wave band gap properties in a circular plate of a two-dimensional generalized phononic crystal
Authors: Zhao Lei , Shu Haisheng , Liang Shanjun , Shi Xiaona , An Shuowei , Ren Wanyue , Zhu Jie
Published: May 2018

The torsional wave band gap properties of a two-dimensional generalized phononic crystal (GPC) are investigated in this paper. The GPC structure considered is consisted of two different materials being arranged with radial and circumferential periodicities simultaneously. Based on the viewpoint of energy distribution and the finite element method, the power flow, energy density, sound intensity vector together with the stress field of the structure excited by torsional load are numerically calculated and discussed. Our results show that, the band gap of Bragg type exists in these two-dimensional composite structures, and the band gap range is mainly determined by radial periodicity while the circumferential periodicity would result in some transmission peaks within the band gap. These peaks are mainly produced by two different mechanisms, the energy leakage occurred in circumferential channels and the excitation of the local eigenmodes of certain scatterers. These results may be useful in torsional vibration control for various rotational parts and components, and in the application of energy harvesting, etc.
Highly stable silica-coated manganese ferrite nanoparticles as high-efficacy T2 contrast agents for magnetic resonance imaging
Authors: Ahmad Ashfaq , Bae Hongsub , Rhee Ilsu
Published: May 2018

Highly stable silica-coated manganese ferrite nanoparticles were fabricated for application as magnetic resonance imagining (MRI) contrast agents. The manganese ferrite nanoparticles were synthesized using a hydrothermal technique and coated with silica. The particle size was investigated using transmission electron microscopy and was found to be 40–60 nm. The presence of the silica coating on the particle surface was confirmed by Fourier transform infrared spectroscopy. The crystalline structure was investigated by X-ray diffraction, and the particles were revealed to have an inverse spinel structure. Superparamagnetism was confirmed by the magnetic hysteresis curves obtained using a vibrating sample magnetometer. The efficiency of the MRI contrast agents was investigated by using aqueous solutions of the particles in a 4.7 T MRI scanner. The T1 and T2 relaxivities of the particles were 1.42 and 60.65 s-1 mM-1, respectively, in water. The ratio r2/r1 was 48.91, confirming that the silica-coated manganese ferrite nanoparticles were suitable high-efficacy T2 contrast agents.
On-chip beam positioning sensor via frequency locked cascaded ring resonators
Authors: Naiman Alex , Stern Liron , Levy Uriel
Published: May 2018

We demonstrate an approach for on-chip beam positioning with a position accuracy of up to 100 nm. This approach is based on tracking the resonance of two adjacent microring resonators that are implemented on a silicon on insulator chip. We demonstrate the functionality of our approach by illuminating the chip through a Near Field Scanning Optical Microscope tip and monitoring the shift of the microring resonances due to the thermo-optic effect. We also discuss the contribution of different effects such as free carrier absorption and dispersion to the resonance shift.
Crystal structure and elasticity of Al-bearing phase H under high pressure
Authors: Liu Guiping , Liu Lei , Yang Longxing , Yi Li , Li Ying , Liu Hong , Gao Yang , Zhuang Chunqiang , Li Shuchen
Published: May 2018

Al has significant effect on properties of minerals. We reported crystal structure and elasticity of phase H, an important potential water reservoir in the mantle, which contains different Al using first principles simulations for understanding the effect of Al on the phase H. The crystal and elastic properties of Al end-member phase H (Al2O4H2) are very different from Mg end-member (MgSiO4H2) phase H and two aluminous phase H (Mg0.875Si0.875Al0.25O4H2 (12.5at%Al) and Mg0.75Si0.75Al0.5O4H2 (25at% Al)). However differences between Mg end-member phase H and aluminous phase H are slight except for the O-H bond length and octahedron volume. Al located at different crystal positions (original Mg or Si position) of aluminous phase H has different AlO6 octahedral volumes. For three Al-bearing phase H, bulk modulus (K), shear modulus (G), compressional wave velocity (Vp) and shear wave velocity (Vs) increase with increasing Al content. Under high pressure, density of phase H increases with increasing Al content. The Al content affects the symmetry of the phase H and then affects the density and elastic constants of phase H. The total ground energy of phase H also increases with increasing Al content. So an energy barrier for the formation of solid solution of phase H with δ-phase AlOOH is expected. However, if the phase H with δ-phase AlOOH solid solution does exit in the mantle, it may become an important component of the mantle or leads to a low velocity layer at the mantle.
Preparation of copper-graphene layered composites by spark plasma sintering
Authors: Chen Xiaohong , Liu Pengzhong , Liu Ping , Chen Haohan
Published: May 2018

In situ chemical vapour deposition-based graphene growth was designed with copper foil as a substrate and used to prepare copper matrix-graphene layered composites by spark plasma sintering. Mechanical properties and corrosion resistance of layered composites were greatly improved when sintered at 700°C and 25 kN for 10 min. Composite had 12% higher Vickers hardness and 30% higher tensile strength comparing with pure copper, respectively. The corrosion potential ( Vcorr) of the layered composites shifted towards more positive values and the corrosion current ( Icorr) was significantly lower than that of copper. Corrosion inhibition efficiency ([Formula: see text]) was as high as 68.38% and 36.90%, and the corrosion rate (CR) was 0.047 and 0.093 mm year−1 for the parallel sample and vertical sample, respectively.
Electrodeposition and properties of Ni–B/SiC nanocomposite coatings
Authors: Li B. S. , Huan Y. X. , Luo H. , Zhang W. W.
Published: May 2018

Ni–B/SiC composite coatings were electrodeposited using trimethylamine borane as a boron source. The effects of bath composition and operating parameters on the microstructure and properties of the composite coatings were investigated. The results show that Ni–B/SiC composite coating exhibits uniform structure with a desirable interface. Incorporation of SiC particles led to a signiﬁcant increase in hardness. Both boron and SiC content in the coating increases initially and then decreases as the current density increased. Incorporation of inert SiC particles also enhanced their corrosion resistance, which attributed to the dense structure, barrier effect and the reduction in the active surface area of Ni–B matrix. XPS analysis indicated that the as-deposited coating contains metallic nickel, oxide or hydroxide nickel, and the SiC particles. Owing to dispersion hardening of the added SiC particles and the reduction in the active surface area of Ni–B matrix, Ni–B/SiC composite coating shows superior anti-corrosion and wear resistance.
Exploring drug space with ChemMaps.com
Authors: Borrel Alexandre , Kleinstreuer Nicole C , Fourches Denis
Published: May 2018

Motivation

Easily navigating chemical space has become more important due to the increasing size and diversity of publicly-accessible databases such as DrugBank, ChEMBL or Tox21. To do so, modelers typically rely on complex projection techniques using molecular descriptors computed for all the chemicals to be visualized. However, the multiple cheminformatics steps required to prepare, characterize, compute and explore those molecules, are technical, typically necessitate scripting skills, and thus represent a real obstacle for non-specialists.

Results

We developed the ChemMaps.com webserver to easily browse, navigate and mine chemical space. The first version of ChemMaps.com features more than 8000 approved, in development, and rejected drugs, as well as over 47 000 environmental chemicals.

Availability and implementation

The webserver is freely available at http://www.chemmaps.com.
Microsurgical Resection of Posterior Third Ventricular/Pineal Region Papillary Tumor Via Supracerebellar Infratentorial Approach: 3-Dimensional Operative Video
Authors: Sayyahmelli Sima , Dogan Ihsan , Başkaya Mustafa K
Published: May 2018

The posterior third ventricle and pineal region can harbor different pathologies. The supracerebellar infratentorial approach allows a direct access to the pineal region and posterior third ventricle and provides wide exposure of the arachnoid planes and deep venous system.

 In this 3-dimensional video, we present a patient with posterior third ventricular/pineal region tumor who underwent microsurgical resection via supracerebellar infratentorial approach. The patient is a 28-year-old woman with history of hydrocephalus who underwent endoscopic third ventriculostomy and biopsy at an outside hospital. The histopatology of the tumor was papillary tumor of the pineal region. The patient was referred for further surgical resection due to enlargement of her tumor on follow-up radiological imaging. The surgery and the patient's postoperative course were uneventful and the patient remained unchanged in the postoperative period.

 The important steps of the surgical approach and microsurgical resection are demonstrated in this 3-dimensional surgical video. The patient consented to publication of her images.
Microsurgical Treatment of Distal Anterior Cerebral Artery Aneurysms: 3-Dimensional Operative Video
Authors: Agarwal Vijay , Barrow Daniel L
Published: May 2018

Selecting appropriate patient position for surgery must take into consideration a variety of factors. For an interhemispheric approach to distal anterior cerebral artery (DACA) aneurysms, the patient may be positioned with the head either horizontal or vertical with respect to the floor. We preferentially place the patient in the supine position with the shoulder elevated and the head turned parallel to the floor with the side of the approach down and the vertex tilted 45° up. In this way, gravity is utilized to allow the right frontal lobe to fall away from the falx, eliminating the need for retraction. To demonstrate the importance of individualizing the choice of position to each patient, we present here 2 illustrative cases of DACA aneurysms in which different positioning was selected. One patient presented with a 7-mm bilobed pericallosal artery aneurysm; the aneurysm was approached with the head horizontal with respect to the floor. The second patient had a 3-mm DACA aneurysm and a right frontal proliferative angiopathy and developmental venous anomaly with evidence of prior hemorrhage. Due to the vascular anomaly, we positioned the head in a vertical position for surgery to clip the aneurysm, which was thought to be the source of hemorrhage. The videos illustrate the approach to DACA aneurysms, which typically exposes the aneurysm before complete exposure of the proximal parent artery is obtained. In one case, the use of both frameless guidance and intraoperative angiography was useful in identifying a small previously ruptured aneurysm.

 All appropriate patient consents were obtained for this submission.

 Video and Figures (0:57-1:16 and 6:30-6:37), © 2017 Department of Neurosurgery, Emory University. Used with permission.
PARTNERING OF A FRONTLINE HEALTHCARE TEAM WITH A FAMILY ADVISOR TO IMPROVE ACUTE ASTHMA CARE IN A PEDIATRIC EMERGENCY DEPARTMENT: COST SAVINGS ANALYSIS
Authors: Rich Catherine , Dubrovsky Alexander Sasha
Published: May 2018

BACKGROUND

In 2016, a Canadian paediatric emergency department (ED) partnered with families in the co-design of a LEAN-based quality improvement (QI) project with the goal of increasing the proportion of asthmatic children receiving oral corticosteroids within one hour of arrival. LEAN projects aim to eliminate non-value-added process steps and to creatively solve problems as a team. Implemented changes included a process redesign with steroids given at the door and a revised asthma pathway increasing nurse autonomy prior to physician assessment. A sustained improvement (>12 months) was achieved, with asthmatic children consistently (>90%) receiving timely steroids within a mean time of 20 minutes.

OBJECTIVES

The objective of this study was to determine the cost savings of the improvements achieved by eliminating non-value-added process steps executed by physicians and nurses. The primary outcome measure was the number of documented care acts by physicians and nurses.

DESIGN/METHODS

Cases were identified by using the diagnostic code for asthma in the electronic medical record. This study included children 1 to 18 with Pediatric Respiratory Assessment Measure (PRAM) score ≥ 4 at triage. Patients who required admission were excluded. We reviewed a random sample of 20 to 30 charts monthly for 12 months, 6 months pre- and post-implementation of the revised asthma pathway. Physicians are remunerated on a fee-for-service basis and we modeled cost-savings of physician remunerations based on publically available physician fees. We assessed the number of documented nursing acts as a proxy for resource allocation in the ED given that the pathway increased nursing autonomy prior to physician assessment.

RESULTS

A total of 270 patients were included. With a simple process redesign aimed at getting children timely steroids at triage, the number of physician assessments decreased by 18%. In terms of physician billing, the cost savings were $24 per asthmatic patient in the ED. With >3000 asthma ED visits annually, the resulting estimated cost savings were >$72,000 per year. Even though increased nursing autonomy was part of the new process, documented nursing acts decreased by 10%. Moreover, although not included in the cost savings analysis, ED length of stay and admission rates both decreased.

CONCLUSION

Engaging frontline healthcare teams to co-design improvement initiatives with family partners in the ED is an excellent mechanism for leaders to sponsor. Frontline teams can implement creative and simple solutions that result in improved quality of care while also reducing unnecessary healthcare expenditures.
SEVERE MICROCEPHALY IN CANADA
Authors: Nelson Chantal
Published: May 2018

BACKGROUND

Microcephaly is a congenital anomaly of the central nervous system. It is a condition in which an infant’s head is significantly smaller than the heads of other children of the same age and sex. Sometimes detected at birth, microcephaly usually results from the brain developing abnormally in the womb or not growing normally after birth. At the present time there is an increase of microcephaly cases which have are linked to an ongoing Zika virus outbreak. While the increase was mostly seen in Brazil, due to the possible modes of transmission of the Zika virus and the increased travel of Canadians to warmer climates, conducting this study was highly responsive, timely and relevant to an emerging public health issue that has received significant international concern.

OBJECTIVES

This study aims to address two specific objectives: 1) define the minimum incidence of severe microcephaly in Canada, and 2) describe Canadian -specific epidemiology (including etiology, when known) of severe microcephaly.

DESIGN/METHODS

Data is collected by questionnaire through the Canadian Paediatric Surveillance Program. Each paediatrician who is registered with the network is asked to report every month any new cases of infants, < 1 year of age, with a head circumference < 3 standard deviations below the mean for gestational age and sex, based on the sex-specific WHO growth parameters. Any infant with confirmed microcephaly will have additional information completed by questionnaire by his/her paediatrician.

RESULTS

As of October 2017, a total of 44 questionnaires have been completed and submitted (n=1 duplicate case, n=2 did not meet case definition) yielding a total of 41 questionnaires for analysis. To date, one case of severe microcephaly has been confirmed due to Zika virus. The other leading suspected causes (when reported) include: 3.4% infection, 34.5% genetic, 13.8% ischemic, 34.5% unknown, and 13.8% other. The average head circumference at birth is 28.3 cm for all cases. Most of the cases are males (64%) and the majority are singleton births (94%). Data is less complete for diagnostic testing information, including test results, and parental travel history.

CONCLUSION

An increase in prevalence of the Zika virus and the emergence of its association with microcephaly warrants heightened awareness and targeted surveillance to better understand this issue in the Canadian context. Data collection is still ongoing, but once analysis is complete it will provide valuable baseline incidence and etiologic information on severe microcephaly in Canada.
DEVELOPING SKILLS FOR DEVELOPMENTAL DISABILITIES PRE-CLINICAL ELECTIVE: DIFFERENT SETTING AND POPULATION PRODUCES CONSISTENT IMPROVEMENT IN STUDENT CONFIDENCE
Authors: Le Andy , Fong-Leboeuf Alexis , Penner Stephanie , Andrews Debra
Published: May 2018

BACKGROUND

Medical students feel they are inadequately trained in caring for patients with developmental disabilities (PWDD) (Troller et al. 2016; Salvador-Carulla et al., 2015). Consequently, PWDD may not receive timely, empathetic care from their future clinicians (Sahin and Akyol, 2010).

We developed a preclinical elective, “Developing Skills with Developmental Disabilities” (DSDD), to improve student knowledge, skills, and attitudes toward paediatric PWDD. The first cohorts worked with pre-schoolers; DSDD was effective in improving student confidence working with PWDD (Penner et al. 2017). The current project compared the efficacy of DSDD using a hospital-based day-school for elementary-aged children, to previous cohorts.

OBJECTIVES

Our goal was to determine if changing the population being observed and the setting in which they are being observed could reproduce improvement in student confidence as seen in past cohorts.

DESIGN/METHODS

The DSDD module was an elective offered to preclinical medical students for credit. Students were given 6 hours of didactics on child development, assistive technologies, and breaking bad news. Students also participated in 6 clinical hours at the Glenrose Rehabilitation Hospital, where they observed school-aged PWDD in a classroom and interacted with an interdisciplinary team. Students also interviewed children’s families during medical intakes.

Students completed pre- and post-elective surveys administered on a 5-point Likert scale. Questions pertained to students’ self-perceived comfort and knowledge regarding PWDD. Scores pre- and post-elective were compared using t-test analysis. This data was compared to data collected from previous cohorts, which used the same survey.

RESULTS

24 students registered for DSDD, and 21 surveys were able to be analysed. Statistically significant (p<0.01) increases were present in 9/10 self-reported scores, with the statistically insignificant score pertaining to confidence using positive reinforcement. There was no significant difference in pre- and post-elective score improvement when comparing this cohort with past cohorts, across all scores. The critical components of DSDD were maintained across setting changes with significant (p<0.01) increases in students’ self-reported confidence and knowledge in working with PWDD.

CONCLUSION

This elective demonstrates effectiveness in different settings and ages. The general structure and principles of this elective may be applied by Paediatricians to improve medical education. Examples include having students attend developmental programmes they might provide support for, using a short set of parent interview questions and/or a child observation to improve developmental teaching, and allocating time for interaction with other allied health professionals to better understand their roles in the management of paediatric PWDD.
COLLABORATIVE RESEARCH, CAPACITY BUILDING AND KNOWLEDGE TRANSLATION DEVELOPMENT FOR RESEARCH ON ADVERSE BIRTH OUTCOMES AND THE ENVIRONMENT
Authors: Wine Osnat , Spiers Jude , van Manen Michael , Burns Katharina Kovacs , Vargas Alvaro Osornio ,   DoMiNO Project
Published: May 2018

BACKGROUND

The DoMiNO (Data mining & Neonatal outcomes) project explores the relationship between the environment and adverse birth outcomes. The project applies Integrated Knowledge Translation; a collaborative approach that builds on the participation, expertise and perspectives of interdisciplinary researchers, clinicians and knowledge-users, to ground and enhance the depth and breadth of research and to facilitate knowledge translation. Understanding the components that impact team building processes can contribute to supporting collaborative efforts.

OBJECTIVES

Based on the DoMiNO project we present major components that contributed to building team capacity for knowledge creation and the development of a knowledge translation plan.

DESIGN/METHODS

We use this project’s Integrated Knowledge Translation process as a case study in a qualitative evaluation of the ongoing research collaboration (experience and learnings) following team engagement in the research process (e.g., meetings, informal interactions). Participants included all 24 DoMiNO team members. Data were collected through interviews, focus groups, surveys and participant observations, all adding to the cumulative understanding of the collaborative research process and the knowledge translation plan evolution. All data were coded and analyzed using thematic analysis procedures.

RESULTS

Findings highlight the interrelated components of building capacity to support the research progress, co-production and knowledge translation plan development. These components include commitment, work etiquette, balancing perspectives, power and ownership, as well as communication, transparency, learning/ sharing knowledge and alignment. These contribute to building relationships, trust and capacity. Once those were established and research deliverables were clearer, the main messages and attainable knowledge translation goals were identified. The knowledge translation Several components contribute to capacity building and the development of the KT plan. In this complex context, it is an ongoing iterative process that evolves through time, as the team works and builds capacity. Identifying and supporting the essential components of team development could optimize capacity building.

plan was then articulated to identify potential users, audiences, and strategies.

CONCLUSION

Several components contribute to capacity building and the development of the KT plan. In this complex context, it is an ongoing iterative process that evolves through time, as the team works and builds capacity. Identifying and supporting the essential components of team development could optimize capacity building.
EXPERIENCE WITH USING RAPID MOLECULAR TESTING IN DIAGNOSING PULMONARY AND EXTRA-PULMONARY PEDIATRIC TUBERCULOSIS IN A NON-ENDEMIC SETTING - A RETROSPECTIVE CASE SERIES
Authors: Mijovic Hana , Al-Nasser Yossef , Al-Rawahi Ghada , Roberts Ashley
Published: May 2018

BACKGROUND

Tuberculosis (TB) is a rare but potentially devastating infection among Canadian children. Accurate diagnosis and initiation of treatment are limited in part by the fact that it takes 2–6 weeks for culture results to be confirmed. Xpert MTB/RIF (Xpert) is a rapid, automated molecular assay that has been validated for diagnosing pulmonary but not extra-pulmonary TB in children.

OBJECTIVES

This was a retrospective study of children investigated for active TB at our facility in order to:

1.Outline demographic characteristics and describe clinical presentations of children diagnosed with active TB.

2.Compare performance of molecular testing (Xpert) to stain and Mycobacterium tuberculosis culture on pulmonary and extra-pulmonary specimens.

DESIGN/METHODS

We conducted a retrospective chart review of all paediatric patients investigated for active TB at our facility with stain, culture and molecular (Xpert) testing between January 2015 and August 2017. Due to a small number of patients, our data analysis was limited to narrative summary and descriptive statistics.

RESULTS

A total of 10 children were diagnosed with active TB, including 3 cases of pulmonary, 4 extra-pulmonary and 3 disseminated disease. Age range at diagnosis was 2 months to 16 years, with 3 children younger than 1 year. Most children contracted TB while travelling to and/or being exposed to an index case from endemic areas, including East Asia/Western Pacific (5), South Asia (2) and Africa (1). All children were HIV negative.

Time from symptom onset to TB diagnosis and treatment ranged from approximately 4 days to 5 months. Multi-drug resistant TB was confirmed in 1 child. Sadly, 1 child passed away from TB related complications.

AFB stain was positive on at least one specimen in 4/10 cases, cultures were positive in 8/10 and molecular testing (Xpert) in 7/10 cases. Time to positive cultures ranged from 10 to 35 days, with an average of 19 days. All cases positive on Xpert were also culture positive. Xpert test diagnosed TB in 5/6 of extra-pulmonary specimens submitted, including pericardial fluid, lymph node tissues and cerebrospinal fluid.

CONCLUSION

Many paediatric TB patients at our facility are children who have traveled to/have contacts from TB endemic regions, emphasizing the need for obtaining thorough exposure and travel history. Culture and molecular testing demonstrated similar TB detection rates, albeit based on a small patient population. While cultures remain the most reliable diagnostic method, molecular testing may facilitate rapid diagnosis and treatment of pulmonary and extra-pulmonary paediatric TB in a non-endemic setting.
DO MODIFIABLE HOUSEHOLD BEHAVIORS AND EARLY INFANT FEEDING PRACTICES CONTRIBUTE TO VARIATIONS IN INFANT LINEAR GROWTH? EVIDENCE FROM A BIRTH COHORT IN DHAKA, BANGLADESH
Authors: Silverberg Sarah , Shi Joy , Al Mahmud Abdullah , Roth Daniel
Published: May 2018

BACKGROUND

Numerous postnatal risk factors have been associated with child length/height in cross-sectional studies in low- and middle-income countries. However, there have been few longitudinal studies of the effects of modifiable risk factors on postnatal linear growth during discrete developmental windows of infancy.

OBJECTIVES

We aimed to assess associations between modifiable household behaviours and conditional growth from birth to 1 year of life.

DESIGN/METHODS

We conducted a longitudinal cohort study using data from women and their infants (n=1162 pairs) in the Maternal Vitamin D and Infant Growth trial in Dhaka, Bangladesh. Infant length was measured tri-monthly from birth to 12 months, and infant feeding patterns were ascertained at weekly visits from 0 to 6 months of age. Confounder-adjusted associations of selected modifiable household factors (i.e., household air quality, sanitation/hygiene) or early infant feeding with change in length-for-age z-score (LAZ) were estimated in five intervals: birth to 3 months, 3 to 6 months, birth to 6 months, 6 to 12 months and birth to 12 months. In primary analyses, the outcome was conditional growth in LAZ (cLAZ) in each interval, derived as model residuals from regression of end-interval LAZ on initial LAZ. Effect estimates were expressed as mean difference in cLAZ (95% confidence interval) between the exposed versus referent group.

RESULTS

LAZ was symmetrically distributed, with mean (± standard deviation) LAZ of -0.95 (± 1.02) at birth and -1.00 (± 1.04) at 12 months. In multivariable-adjusted linear regression models, indicators of household air quality and sanitation/hygiene were not significantly associated with cLAZ in any interval. No breastfeeding and partial breastfeeding (versus exclusive breastfeeding), and any infant formula use (versus no formula use) were associated with slower growth in the 0–3 month interval: -0.11 (95% CI: -0.20, -0.02), -0.30 (95% CI: -0.52, -0.08), and -0.13 (95% CI: -0.22, -0.05), respectively, but not in later intervals. Several non-modifiable factors (maternal height, paternal education, and household wealth) were associated with cLAZ and LAZ in multivariable models.

CONCLUSION

Compared to international standards, the length distribution of infants in Dhaka, Bangladesh was harmonically shifted down at birth and throughout the first year of life, suggesting that observed infant length deficits relative to international norms were primarily caused by ubiquitous factors. Infant feeding practices explained some between-child variation in linear growth in the early postnatal period (0–3 months). Behaviors related to cooking or sanitation/hygiene were not related to infant linear growth trajectories.
CHARACTERIZATION AND RISK FACTOR IDENTIFICATION IN CHILDREN WITH SEVERE CROUP
Authors: Bensoussan Natan , Nguyen Lily , Oosenbrug Marcus , He Haitian , Duval Melanie
Published: May 2018

BACKGROUND

Croup is a self-limiting illness predominantly affecting young children, the most common etiology being Parainfluenza virus types 1 and 2. While the majority of croup remains self-limiting, 1.6–3% of cases are severe requiring acute airway management such as intubation and ventilatory support. While much is known about the diagnosis, management, and clinical course of self-limiting croup, factors contributing to severe cases remain unexplored.

OBJECTIVES

To characterize the clinical features and risk factors associated with severe croup in children admitted to a tertiary care centre.

DESIGN/METHODS

A retrospective chart review study of paediatric patients with severe croup presenting at a single tertiary care paediatric institution between 2011 and 2015 was performed. Severe croup was defined as those requiring major airway intervention (i.e. intubation), emergent management in the operating room (i.e. rigid bronchoscopy) or admission to the paediatric intensive care unit. Our findings were compared to previous reported characteristics of children with viral croup and recurrent croup. Multiple univariate regression models were constructed to isolate predictor variables of longer hospital stay and isolate confounders such as known comorbidities and risk factors.

RESULTS

Sixty-seven croup patients were analyzed, aged 4–170 months (median, 15) of which 76.8% were male. Several presented with risk factors, namely previous croup history (23.2%), intubation history (13%), airway abnormalities (8.7%) and nonspecific reactive airway disease (8.7%), while others exhibited comorbid conditions such as asthma (7.3%), GERD (14.5%) and known drug allergy (5.8%). In our cohort, Parainfluenza virus type 3 (PIV3) was shown to be a predictor for increased length of stay with a univariate regression coefficient of 3.2 (95% CI 0.72–5.7). Known croup risk factors did not contribute to the effect observed with PIV3 (coefficient 3.0, 95% CI 0.4–5.7). Further analysis accounting for comorbidity confounders predicted a coefficient of 2.6 for PIV3 (95% CI 0.01–5.12). Mean length of stay for PIV3 infected children was 7.4 nights.

CONCLUSION

To our knowledge, this is the first study linking PIV3 with severe croup and predicting longer hospitalizations in this cohort. Further investigation is required to determine optimal management of PIV3-infected croup patients to shorten clinical course and improve patient outcomes.