bluuebunny/crossref_metadata_2025 huggingface dataset:
Two close binaries across the hydrogen-burning limit in the Praesepe open cluster
Authors: Lodieu N , del Burgo C , Manjavacas E , Zapatero Osorio M R , Alvarez C , Béjar V J S , Boudreault S , Lyke J , Rebolo R , Chinchilla P
Published: August 2020

We present Keck I/OSIRIS and Keck II/NIRC2 adaptive optics imaging of two member candidates of the Praesepe stellar cluster (d  =  186.18 ± 0.11 pc; 590–790 Myr), UGCS J08451066+2148171 (L1.5 ± 0.5) and UGCS J08301935+2003293 (no spectroscopic classification). We resolved UGCS J08451066+2148171 into a binary system in the near-infrared, with a K-band wavelength flux ratio of 0.89 ± 0.04 and a projected separation of 60.3 ± 1.3 mas (11.2 ± 0.7 au; 1σ). We also resolved UGCS J08301935+2003293 into a binary system with a flux ratio of 0.46 ± 0.03 and a separation of 62.5 ± 0.9 mas. Assuming zero eccentricity, we estimate minimum orbital periods of ∼100 yr for both systems. According to theoretical evolutionary models, we derive masses in the range of 0.074–0.078 and 0.072–0.076 M⊙ for the primary and secondary of UGCS J08451066+2148171 for an age of 700 ± 100 Myr. In the case of UGCS J08301935+2003293, the primary is a low-mass star at the stellar/substellar boundary (0.070–0.078 M⊙), while the companion candidate might be a brown dwarf (0.051–0.065 M⊙). These are the first two binaries composed of L dwarfs in Praesepe. They are benchmark systems to derive the location of the substellar limit at the age and metallicity of Praesepe, determine the age of the cluster based on the lithium depletion boundary test, derive dynamical masses, and improve low-mass stellar and substellar evolutionary models at a well-known age and metallicity.
7 Understanding Regional Site Transfer: Perceptions of Health Care Professionals
Authors: Bele Sumedh , Bailey J A Michelle , Randhawa Alam
Published: August 2020

Background

Alberta Health Services identified that tertiary sites are often in overcapacity (admitted patients exceeding inpatient beds) while regional sites have low occupancy in their pediatric inpatient units. Hospital overcapacity may have negative effects on the care received by patients, such as increased risk of infection, less time spent with each patient and increased stress on the hospital staff (Keegan, 2010). In addition, rural families face several barriers to access to health care including traveling long distances to access the sub-specialty care present in urban tertiary centers. Previous studies conducted by our team found that transfers back to regional sites are not common. Increasing transfers of pediatric patients from tertiary to regional sites with care supported by the tertiary site could aid in addressing tertiary overcapacity and enable patients and families to receive care closer to home.

Objectives

This qualitative study sought to understand tertiary site health care professionals’ perceptions of tertiary to regional inpatient transfer.

Design/Methods

Four semi-structured focus groups were held with health care professionals. Focus groups included a mixed group of staff physicians, residents, nurses and managers. Common themes of discussion included the current transfer process, understanding of regional site resources and ways to increase patient transfer. A qualitative data analysis software, NVivo 11, was used to code, organize, and manage the data to facilitate data interpretations and generate themes regarding the current patient transfer process.

Results

The main barriers of pediatric transfer to rural sites include a lack of standardized transfer guidelines, limited understanding of rural regional site resources and mistrust between medical teams that prohibit patient transfer. The most likely pediatric patients that could be transferred back to rural sites include clearly diagnosed, single body system patients. Participants who had previous experience working in regional sites were more comfortable with transfer to regional sites. Transfer to regional sites could be increased by improving communication between medical teams and correcting misinformation about regional inpatient pediatric sites.

Conclusion

There is a historical practice of concentrating resources at tertiary care sites. However, there are a lack of shared guidelines for transfer as well as well as limited knowledge of regional site capabilities. Health care professionals across the entire continuum of patient care recognize the need to find solutions that would aid in transfer.
21 Communicating Sensitive Information - An Exploration of Parental Perspectives on Prognostication of High Risk Infants
Authors: Fong Emily
Published: August 2020

Background

Preterm infants are at high risk of experiencing a range of impairments that may contribute to long-term challenges such as neurocognitive deficits. Physicians are often expected to give an outlook on future developmental outcomes of high risk infants, often before sufficient time has elapsed to observe whether that particular child will demonstrate neurologic recovery from the initial injury. Clinicians often struggle with communicating this information, especially a poor prognosis because of the worry about how these conversations affect families and their future expectations of the child.

Objectives

Our aim was to capture parents’ retrospective perception of how their infant’s prognosis was communicated to them during their NICU stay.

Design/Methods

Semi-structured interviews were conducted over the phone with parents of former preterm infants with a birthweight below 1500 grams or parents of term infants who have sustained HIE requiring cooling. Parents were invited to participate when their child was between 12-36 months old at the time of the interview, so that parents would be able to have a sense of their child’s development and possible impairments. The data was analyzed thematically, with particular focus around the discourse of communication and prognostication.

Results

Twenty-three interviews were conducted, 20 with the biological mother, 2 with both biological parents, and 1 with the biological father. The average length of the interviews was 30 minutes. The main themes that recurred in the interviews include parental loss of control, needing to prepare for the unexpected, the value of shared decision making between the health care practitioners and parents, recognition and conveyance of uncertainty by the physician, and the importance of celebrating the present. Above all, a recurring theme mentioned by the majority of interviewees was the power of hope. While wanting to receive transparent and honest updates, parents felt strongly that giving them realistic hope was of utmost importance.

Conclusion

Although clinicians often feel pressured to deliver answers, parents found it helpful when clinicians acknowledged and explained the uncertainty that surrounds prognostication. While healthcare providers may feel the need to prepare parents for the worst, the importance of balancing this information with hope and positivity is what families remember and value years after the prognosis was given.
26 Not What Clinicians Thought: Decisional Regret in Parents of Extremely Preterm Children
Authors: Thivierge Emilie , Duquette Laurie-Anne , Mai-Vo Thuy-An , Fortin Aurélie , Jaworski Magdalena , Bourque Claude Julie , Pearce Rebecca , Luu Thuy Mai , Janvier Annie
Published: August 2020

Background

Preterm birth is associated with higher risk of death and severe neurodevelopmental impairment. There is an increased risk in extremely preterm infants, raising questions among ethicists and clinicians as to whether providing active care to infants born at the lower extreme is worth the outcomes, and if these outcomes are a source of decisional regrets for parents.

Objectives

Explore decisional regrets in parents of extremely preterm children.

Design/Methods

We consecutively recruited all parents of infants born <29 weeks’ gestational age, aged between 18 months corrected age and 7 years, and seen for neonatal follow-up at a single tertiary center over a one-year period. We asked the following question: “Knowing what you know now, is there anything you would have done differently?” Answers were analyzed independently by two reviewers using qualitative methodology, and discrepancies were resolved by a third reviewer. Mixed methods were used to examine the frequency of each theme and associate parental answers to demographic and clinical factors.

Results

Responses were obtained from 249 parents (98% participation rate). The following main themes emerged: (1) Nothing – I did what I could or was told to do: 53%; (2) Regrets about self-care: 31%; “I would listen to the nurses’ advice to sleep more” (3) Guilt related to the impression preterm labor could have been prevented by them or the medical team: 19%; “I would have pushed for better care and monitoring during pregnancy. I felt as though I wasn’t listened to when I thought I was in labour when sure enough I was” (4) Regrets about parental role in decision-making: 15%; “I would speak up more at the beginning of the hospitalisation”. None of the parents reported on regretting any life-and-death decisions they made at birth and in the neonatal unit.

Conclusion

In our cohort, more than half of parents of surviving preterm infants did not have any regrets associated to their NICU experience. However, lessons can be learned to improve parental support, self-care and solutions to improve their role as parents. Unlike what can be stated using “opinion-based medicine”, limiting or forgoing intensive care is not a solution to eliminate decisional regrets in parents.
34 Newborn Jaundice Screening Nomogram for Universal Screening in Saskatchewan
Authors: Baerg Krista , Smith-Fehr Julie , Lee Chel
Published: August 2020

Background

Transcutaneous (TcB) meters support clinical decision making at point-of-care, reduces nurses’ time to screen, decreases the frequency of painful blood draws and minimizes health care costs. Best practice for TcB screening is unknown and international guidelines vary. Meter bias may result in over- or underestimation of TSB in a Canadian population. The Canadian Paediatric Society suggests screening between 24 and by 72 hours of age and reducing total serum bilirubin (TSB) action thresholds by the 95th confidence interval of the meter. To support point-of-care decision making, a tertiary center and community follow-up program uses universal screening and follow-up protocols. ​

Objectives

The aim of this analysis is to develop a locally validated TcB nomogram with action thresholds based on age and risk for clinical use at point-of-care. ​

Design/Methods

This prospective cross-sectional study includes newborns ≥35 weeks gestation <14 days old requiring TSB sampling in hospital or community and 13 JM-105 meters. Participants are included if TcB reading ranges from 1-340µmol/L (0.1-20.0 mg/dL) and TSB is collected within 1 hour of TcB measurement. TSB samples are analyzed using Roche™ Bilirubin Total Gen.3. To measure how close the TcB reading is to TSB, the difference is found by subtracting TSB from mean TcB. Lin’s Concordance statistics are calculated for each meter. Using a 2-dimentional 95th Confidence Interval ellipse, we select 13 JM-105 meters with similar accuracy and precision for use by the universal screening program. Using a quadratic model we fit a line based on the lower 95th predictive interval of the grouped meter data collected from 13 meters to Canadian Paediatric Society low, medium and high risk TSB thresholds for intensive phototherapy. ​

Results

The study population includes 498 newborns that received 620 visits and 705 meter readings with thirteen JM-105 with mean birth weight 3.38 kilograms (SD=0.51) with thirteen JM-105. Along with the clinical screening protocol, nomograms for newborns 35-37 weeks gestation (high and medium risk thresholds) and 38+ weeks gestation medium and low risk thresholds) are presented. Newborns with TcB that plots in a potential treatment range will receive a TSB to determine if intensive phototherapy is required.

Conclusion

To support point-of-care decision making, a tertiary center and community follow-up program uses universal screening and follow-up protocols. TcB nomograms with action thresholds based on age and risk support point-of-care decision making.
41 Fostering Hope: The Comprehensive Accessible care for Infants with Neonatal abstinence (CAIN) Study
Authors: Clarke Denise , Hicks Matt , Foss Karen , Lifeso Natasha
Published: August 2020

Introduction/Background

Neonatal Abstinence Syndrome (NAS) occurs in newborns exposed to drugs in-utero. In Canada, maternal opiate use in pregnancy has been steadily rising resulting in as many as 1850 babies born with NAS per year. Management of babies born with NAS requires supportive, interdisciplinary care. Depending on the severity of NAS, babies may be cared for with non-pharmacological interventions or some may need to be admitted to the Neonatal Intensive Care Unit for extended hospital stays to receive medication and management of ongoing complex health care needs. Hospital and community health care providers have expressed concerns around the continuity of care for these babies in their stay in hospital and their transition to home.

Objectives

This study examined the experiences of hospital and community-based health care providers and families regarding the management of babies with NAS. The driving force behind our inquiry related to our interest in streamlining care for these babies in highly complex health and social systems.

Design/Methods

In total, 47 interdisciplinary participants were interviewed over a four-month period with individuals from Women’s and Child Health, Community, and family members. Interviewed transcripts were reviewed over several months and were completed in December 2019 using an inductive thematic analysis which culminated in the identification of an overarching theme linked with primary themes. ​

Results

The study identified existing gaps in the management of these patients, determined how to improve communication between hospital and community networks, and provided a better understanding of the attitudes, perceptions and experiences of hospital and community personnel. The overarching theme identified was hope, with the primary themes being: system, mental health, mother/baby, judgement, and knowledge (see Figure 1). Several gaps identified in the system included fear, stigma, and language. Certain solutions proposed for improvement included focused care in a rooming in model for the mother and baby dyad, supporting mothers’ well-being, involving mothers and families, and supporting care providers in a family centered care model. In Figure 1, green lines indicate themes that are linked with and support hope, and red lines indicate themes that are barriers to hope.

Conclusion

This research demonstrates that programs and interventions implemented when working with mothers and babies with NAS must foster hope in mothers, families, and in the extended care provider team.
60 Precision Medicine in Developmental Pediatrics: Image-based Classification of Children with Autism Spectrum Disorder using Deep Learning
Authors: MacEachern Sarah , Rajashekar Deepthi , Mouches Pauline , Rowe Nathan , Mckenna Emily , Yeom Kristen , Forkert Nils Daniel
Published: August 2020

Introduction/Background

Autism spectrum disorder (ASD) is a neurodevelopmental disorder resulting in challenges with social communication, sensory differences, and repetitive and restricted patterns of behavior. ASD affects approximately 1 in 66 children in North America, with boys being affected four times more frequently than girls. Currently, diagnosis is made primarily based on clinical features and no robust biomarker for ASD diagnosis has been identified. Potential image-based biomarkers to aid ASD diagnosis may include structural properties of deep gray matter regions in the brain.

Objectives

The primary objective of this work was to investigate if children with ASD show micro- and macrostructural alterations in deep gray matter structures compared to neurotypical children, and if these biomarkers can be used for an automatic ASD classification using deep learning.

Design/Methods

Quantitative apparent diffusion coefficient (ADC) magnetic resonance imaging data was obtained from 23 boys with ASD ages 0.8 – 19.6 years (mean 7.6 years) and 39 neurotypical boys ages 0.3 – 17.75 years (mean 7.6 years). An atlas-based method was used for volumetric analysis and extraction of median ADC values for each subject within the cerebral cortex, hippocampus, thalamus, caudate, putamen, globus pallidus, amygdala, and nucleus accumbens. The extracted quantitative regional volumetric and median ADC values were then used for the development and evaluation of an automatic classification method using an artificial neural network.

Results

The classification model was evaluated using 10-fold cross validation resulting in an overall accuracy of 76%, which is considerably better than chance level (62%). Specifically, 33 neurotypical boys were correctly classified, whereas 6 neurotypical boys were incorrectly classified. For the ASD group, 14 boys were correctly classified, while 9 boys were incorrectly classified. This translates to a precision of 70% for the children with ASD and 79% for neurotypical boys.

Conclusion

To the best of our knowledge, this is the first method to classify children with ASD using micro- and macrostructural properties of deep gray matter structures in the brain. The first results of the proposed deep learning method to identify children with ASD using image-based biomarkers are promising and could serve as the platform to create a more accurate and robust deep learning model for clinical application.
69 Exploring learners’ perspectives of a pediatric palliative care tele-mentoring and education program (project ECHO) in a resource-limited setting
Authors: Evans Emily , Doherty Megan , Modanloo Shokoufeh , Rowe Jennifer , Newhook Dennis , Archibald Doug
Published: August 2020

Introduction/Background

More than 98% of children who need palliative care live in low- or middle-income countries where access to palliative care is extremely limited. A lack of palliative care education for health care providers has been identified as a significant barrier to improving access to palliative care. Project ECHO (Extension of Community Healthcare Outcomes) is an online tele-mentoring educational platform developed to improve access to specialist care in these underserved areas. From 2018 to 2019, we piloted a one-year Project ECHO program which provided pediatric palliative care training for healthcare professionals mainly within India and surrounding South Asian countries.

Objectives

The objective of this study was to explore the learning experiences of participants in a Project ECHO on pediatric palliative care in South Asia and explore considerations to improve ECHO to cater to the unique learning needs and challenges for healthcare professionals in resource-limited settings.

Design/Methods

We implemented a one-year Project ECHO targeting healthcare providers in South Asia, which consisted of 24 bi-weekly 90-minute sessions. Learners who attended at least 20% (5 sessions) were invited to participate in focus groups. Focus groups were designed to explore participants’ experiences and the perceived strengths and weaknesses of the program. Recordings of the focus group sessions were transcribed, coded and independently verified. The codes were then arranged into overarching themes.

Results

Seventeen individuals from India and Bangladesh participated in four focus groups at the end of ECHO PPC. Following coding and analysis, two major themes and seven sub-themes were identified. The themes included: (1) Benefits of participation in ECHO PPC (creation of a community of practice; opportunity to exchange cultures, ideas and experiences; supportive role of the facilitator and peers; increased relevant knowledge and skills; and access to additional learning resources) and (2) Barriers to participation (difficulties with time and practice schedule management; and language and sociocultural factors).

Conclusion

Healthcare professionals in resource-limited settings benefit from project ECHO through the creation of a supportive, online learning community of peers where ideas, experiences and learning resources can be shared. Addressing barriers to participation may enhance the learning experience of project ECHO in the future.
83 Electrocardiogram in Syncope: An old habit or clinically helpful?
Authors: Manouzi Anas , Doan Quynh , Sanatani Shubhayan
Published: August 2020

Background

Syncope affects up to 50% of individuals by age 21 years and accounts for 1% of presentations to the emergency department (ED). Cardiac causes of syncope, including structural heart defects and rhythm disorders, cannot always be ruled out by an electrocardiogram (ECG) as this test lacks sensitivity and specificity. Conflicting recommendations for the role of ECG in evaluation of pediatric syncope underscore the clinical equipoise of how ECG findings influence physicians’ clinical decisions.

Objectives

The primary objective of this study is to determine how ECG findings affect ED physicians’ management of children presenting with vasovagal syncope. Our secondary objective is to document the practice pattern variation among ED physicians regarding their decision to obtain an ECG for the evaluation of vasovagal syncope in children.

Design/Methods

We conducted a prospective cross-sectional survey study using the REDCap platform. Our sample frame consisted of practicing emergency physicians enrolled in the Pediatric Emergency Research Canada (PERC) network. Outcome measures included frequency investigations, specialist consultation, and disposition stratified by type of syncope presentation (low/high risk). We also evaluated which specific ECG findings were likely to change physicians’ management and explored factors influencing the decision to perform or not perform the ECG.

Results

We obtained data from 105/225 (47%) potential respondents. In a clinical scenario presenting a vasovagal syncope, 52% of respondents would order an ECG. Forty-five percent changed their management if the ECG interpretation was anything other than “Normal ECG”. In a high-risk syncope scenario, an ECG was performed by 96% of respondents. Cardiology referral was requested by 93% of respondents, despite normal ECG findings. Borderline ECG findings led to significant practice variation in management, for both low and high-risk presentations scenarios. Overall, 66% of respondents stated that performing an ECG is not important to rule out a cardiac etiology in a typical vasovagal syncope presentation, but 64% stated that performing an ECG is important to reassure the patient.

Conclusion

There is substantial practice pattern variation among emergency physicians with regards to the frequency and motivations to order ECGs, and how ECG findings impact the management of pediatric syncope in the ED. Information provided by an ECG can lead to unnecessary change to clinical management, additional testing, and referrals to specialists for typical vasovagal syncope. This reinforces the importance of better knowledge translation surrounding evidence-based management of vasovagal syncope among ED physicians.
87 Is Canadian Federal Legislation Effective in Preventing Youth Access to Vaping Initiation Products? A secret shopper and online study
Authors: Kilcommons Sebastian James , Horwitz Simonne , Ha Seong Eon , Ebbert Kirsten , Restivo Lea , Verbeke Mary-Claire , Hays-Alberstat Ally , Cooke Lorcan , Mackay Cameron , Anselmo Mark A , Mitchell Ian , Guichon Juliet
Published: August 2020

Background

Electronic cigarette use (“vaping”) is associated with negative health outcomes. Vaping among youth has recently risen to the highest levels recorded. Between 2017 and 2018, Canadians 16 to 19 years old who reported vaping over the past 30 days increased by 74%. This directly coincides with the Tobacco and Vaping Products Act (the “Act”) enactment, which lifted the ban on e-cigarette importation and sales without pre-approval while attempting to restrict youth access to e-cigarettes, and the entry of JUUL e-cigarette products into the Canadian market.

Objectives

The purpose of the study was to evaluate the Act’s effectiveness in protecting the health of youth by preventing their access to vaping products, using a secret shopper interventional design.

Design/Methods

Study subjects were vaping and convenience store employees and deliverers of vaping products ordered online. Confederate researchers (minors aged 15-16 and young adults aged 19-21) entered retail stores to buy JUUL Starter Kits. Three improper scenarios were used: (1) a minor(s); (2) a young adult with no or invalid identification; and (3) a young adult with valid identification clearly purchasing on behalf of an accompanying minor. The main outcome measured was vendor willingness to sell, recorded upon exit from stores. Five minors also ordered JUUL Starter Kits online from their homes. Frequencies were calculated for each variable and tests of association were completed using chi square analysis.

Results

In total, 42.5% of vendors (51/120) were willing to sell JUUL Starter Kits to the young adults and minors. Most vendors requested identification in all scenarios (97/120, 80.8%) but, of these, 28 vendors were willing to sell even though no or false identification was provided (28.9% of those who requested identification). Of those vendors who did not request identification (23/130, 19.2%), all were willing to sell. Where a young adult was clearly buying vaping products for a minor, vendors were willing to sell 63.2% of the time (24/38, p=0.016). In five online purchase attempts, 60% of deliverers did not meet the Act’s verification requirements.

Conclusion

Given that almost half of the vendors were willing to sell JUUL Starter Kits in improper circumstances, the Act does not adequately achieve its goal of protecting the health of youth. To prevent youth access to vaping products, the Act needs stricter enforcement and amendment to impose positive obligations on vendors to request identification, to prohibit sales to adults buying for minors, and to require manufacturers to disclose the product contained in delivered parcels.
88 Vegetarian diet, growth and micronutrient stores in childhood: A prospective cohort study
Authors: Elliott Laura , Maguire Jonathon , Birken Catherine , Keown-Stoneman Charles , Jenkins David
Published: August 2020

Background

Vegetarian diets are becoming increasingly popular among Canadians, yet few studies have evaluated the relationship between a vegetarian diet and childhood growth and nutritional status. Since vegetarian diets can be less energy dense and may have lower micronutrient content, we hypothesized that a vegetarian diet may affect childhood growth including lower adiposity and height, as well as lower micronutrient stores.

Objectives

The primary objective of this study was to evaluate the relationship between vegetarian diet and growth, including adiposity and height among healthy children 6 months to 10 years of age. Secondary objectives included the examination of the relationship between vegetarian diet and iron and vitamin D stores. We also explored whether cow’s milk intake or age modified the associations between vegetarian diet and growth, and micronutrient stores.

Design/Methods

This was a prospective cohort study of healthy children age 6 months to 10 years. The primary exposure was vegetarian diet measured by parent report. The primary outcome was BMI z-score. Secondary outcomes included height-for-age z-score, serum ferritin, and serum 25-hydroxyvitamin D. Anthropometric measures and venous blood samples were collected at health supervision visits by trained research assistants. Linear mixed effect modelling was used to determine the association between vegetarian diet, growth, and micronutrient stores.

Results

A total of 8912 children (n = 248 vegetarian) participated. In the adjusted models there was no evidence of an association between vegetarian diet and BMI z-score (p = 0.605, 95% CI: -0.06, 0.10), height-for-age z-score (p 0.057, 95% CI: -0.16, 0.002), serum ferritin (p = 0.768, 95% CI: -3.84, 2.84), or 25-hydroxyvitamin D (p = 0.204, 95% CI: -2.14, 0.46). The relationship between vegetarian diet and serum 25-hydroxyvitamin D was modified by child age. Volume of cow’s milk intake did not modify the relationships between vegetarian diet and BMI z-score, height-for-age z-score, serum ferritin, or 25-hydroxyvitamin D. In a secondary analysis, we examined adiposity through weight status categories and found children with a vegetarian diet had higher odds of being underweight (BMI z-score <-2) (OR 1.9, p = 0.006, 95% CI 1.21-3.00).

Conclusion

In this prospective cohort study, evidence of an association between vegetarian diet and lower BMI z-score, height-for-age z-score, and micronutrient stores was not found. Our results suggest children with vegetarian diets had higher odds of being underweight. Future research is needed to evaluate dietary factors and patterns of children following vegetarian diets, especially those with an underweight weight status.
96 Sublingual allergen-specific immunotherapy in pediatric patients: biomarkers and molecular allergy diagnostics as predictors of therapeutic success
Authors: Allahverdiyeva Lala , Agaragimova G E , Mugarab Samedi Veronica
Published: August 2020

Background

Efficacy of allergen-specific immunotherapy (ASIT) in patients with asthma could be significantly enhanced when physicians have an opportunity to identify those who are most likely to respond, determine when to stop treatment, and predict relapse. Thus, molecular allergy diagnostic is an effective tool that could help to individualize the diagnosis and treatment of asthma by accurate detection of the causative and cross-reactive allergens in pediatric patients. Cytokines are known as reliable diagnostic and prognostic biomarkers for asthma and can be used to evaluate the therapeutic effect.

Objectives

To evaluate the roles of molecular allergy diagnostic and biomarkers (L-10, IFNγ и TGFβ) as predictors of ASIT efficacy in pediatric patients with asthma.

Design/Methods

Eighty children aged 5 to 18 years with mild and moderate atopic bronchial asthma were included in the study. Sixty-eight out of 80 (85%) were found to have sensitization to house dust mites Dermatophagoides Pteronyssinus and/or Dermatophagoides Farinae. All these patients underwent molecular diagnostics using ImmunoCAP (Phadia 100) to determine the major (r Der p1, r Der p 2) and minor allergens (r Der p10) of the house dust mites. Twenty-eight patients with mild and moderate asthma were found to have a high sensitivity to these allergens and received SLIT with a mixture of house dust mites (Dermatophagoides Pteronyssinus and/or Dermatophagoides Farinae). To compare the efficacy of SLIT, we evaluated the severity of asthma clinical symptoms on a point scale from 0 to 3, and biomarker levels (IL-10, IFNγ и TGFβ) before and 6 months after SLIT. Twelve healthy children were included in the study as a reference group.

Results

At the beginning of the study, the average daily score in the SLIT group of 2.5 ± 0.7, and after 6 months of treatment, it decreased to 0.5 ± 0.2. The levels of biomarkers were markedly decreased prior to the treatment, especially TGFβ levels, and normalized at the end of treatment (Tab.1).

Conclusion

These findings support the efficacy of molecular diagnosis to determine the efficacy of allergen-specific immunotherapy in patients with asthma.
106 Neighbourhood socioeconomic deprivation and assault injuries in urban youth
Authors: Singh Tanjot , Khan Mayesha , Tansley Gavin , Chan Herbert , Brubacher Jeffrey , Staples John
Published: August 2020

Introduction/Background

Youth violence is a major global public health concern. Assault injuries are a major cause of trauma among youth, yet the causes for and medical consequences of assault victimization in this group remain uncertain.

Objectives

Using data from the third-largest urban area in Canada, we sought to describe the demographic, temporal and geographic influences on the incidence of youth assault injuries.

Design/Methods

We performed a population-based cross sectional study of Canadian youth aged 10 to 24 years seeking emergency medical care between April 2012 and March 2018 at any of the 16 hospitals in a major Canadian metropolitan area. Injury characteristics were described using graphical and statistical techniques. Neighbourhood material and social deprivation indices were examined as independent predictors of the population incidence of youth assault injury using negative binomial regression and geospatial methods.

Results

A total of 2,784 assaulted youth sought emergency medical care during the 6-year study interval, corresponding to an incidence rate of 101 youth assault injuries per 100,000 person-years. Assaulted youth were most commonly males between 20 and 24 years of age. Prior diagnoses of substance use and mental health disorders were common. Examination of temporal variation in the incidence of assault injury revealed a 103-fold difference between the riskiest and safest hours of the week (incident rate ratio, 103). The risk of youth assault injury in the most materially deprived quintile of neighbourhoods was more than four-fold greater than that in the wealthiest quintile (incident rate ratio per quintile increase, 1.42; 95%CI [1.27, 1.59]; p <0.001), and the risk of youth assault injury in the most socially deprived quintile of neighbourhoods was more than twelve-fold greater than that in the least deprived quintile (incident rate ratio per quintile increase, 1.88; 95%CI [1.69, 2.11]; p <0.001).

Conclusion

Assault injuries among youth vary substantially across time and space. Targeted violence prevention interventions might focus on weekend evenings and on socioeconomically deprived neighbourhoods.
Petrology of the April 2015 Eruption of Calbuco Volcano, Southern Chile
Authors: Namur Olivier , Montalbano Salvatrice , Bolle Olivier , Vander Auwera Jacqueline
Published: August 2020

Understanding the origin of intermediate magmas that commonly erupt from subduction zone volcanoes is important to better constraining the mechanisms of continental crust formation. We performed a detailed mineralogical and petrological study of the eruptive products from the April 2015 eruption of Calbuco volcano, Chile, a three-phase sub-Plinian eruption that produced pyroclastic deposits of andesitic composition. The eruptive products comprise a glass phase and a high but variable proportion of minerals dominated by plagioclase, clinopyroxene, and orthopyroxene, with minor olivine, amphibole, and magnetite. Plagioclase is very strongly zoned with highly anorthitic cores surrounded by more albitic rims, and no intermediate compositions between them. Based on thermodynamic calculations and published experimental data, we estimate that the anorthitic cores crystallized from a basaltic andesite melt containing 3·5–4·5 wt% H2O. The bulk-rock major and trace element variability at Calbuco is best explained by the accumulation of a variable amount of minerals (in relative proportion 72 % plagioclase, 28 % pyroxene) in a dacitic melt. These minerals most probably formed in the crystal mush zone of the magma chamber, at 200–300 MPa (8–11 km depth) according to pyroxene and amphibole compositions. A few weeks to months before the eruption, the crystal mush was disaggregated, perhaps owing to magmatic underplating, and a crystal-bearing dacitic melt migrated into a subsurface storage region where the albitic plagioclase rims crystallized. The eruption was probably internally triggered by over-pressurization in the shallow magma chamber.
Petrological Implications of Seafloor Hydrothermal Alteration of Subducted Mid-Ocean Ridge Basalt
Authors: Hernández-Uribe David , Palin Richard M , Cone Kim A , Cao Wentao
Published: August 2020

Determining the mineralogical changes occurring in subducted oceanic crust is key to understanding short- and long-term geochemical cycles. Although numerous studies have explored the mineral assemblages that form in mid-ocean ridge basalt (MORB) at different depths below the Earth’s surface, it is widely recognized that seafloor hydrothermal alteration of the uppermost portion of the oceanic crust can change its composition between a ridge and a trench prior to subduction. In this study, we use petrological modelling to explore the effects of different types of pre-subduction hydrothermal alteration on the phase changes that occur during seafloor alteration of MORB-like compositions during subduction along an average Phanerozoic geotherm. We consider a representative composition of altered oceanic crust, as well as extreme end-member scenarios (pervasive spilitization, chloritization, and epidotization). Our models show that epidotization and chloritization of MORB strongly affects phase equilibria at different depths, whereas spilitization and an average style of alteration produce relatively fewer changes on the mineral assemblage to those expected in a pristine MORB. Devolatilization of MORB during subduction occurs mostly in the forearc region, although the type and extent of alteration strongly control the depth and magnitude of fluid released. Altered compositions carry significantly more H2O to sub- and postarc depths than unaltered compositions; the H2O carrying capacity of unaltered and altered compositions is further enhanced during subduction along colder geotherms. Extremely localized areas affected by epidotization can transport up to 22 times more H2O than unaltered MORB and up to two times more than average altered oceanic crust compositions to depths beyond the arc. Regardless of the extent and style of alteration, the stability of hydrous phases, such as epidote and phengite (important trace element carriers), is expanded to greater pressure and temperature conditions. Thus, hydrothermal alteration of the subducted oceanic slab-top represents a viable, and probably common, mechanism that enhances geochemical recycling between the Earth’s hydrosphere and shallow interior.
The Prevalence of Opioid Analgesic Use in People with Chronic Noncancer Pain: Systematic Review and Meta-Analysis of Observational Studies
Authors: Wertheimer Graeme , Mathieson Stephanie , Maher Christopher G , Lin Chung-Wei Christine , McLachlan Andrew J , Buchbinder Rachelle , Pearson Sallie-Anne , Underwood Martin
Published: August 2020

Objective

To review studies examining the proportion of people with chronic noncancer pain who report consuming opioids and characteristics associated with their use.

Design

Systematic review.

Methods

We searched databases from inception to February 8, 2020, and conducted citation tracking. We included observational studies reporting the proportion of adults with chronic noncancer pain who used opioid analgesics. Opioids were categorized as weak (e.g., codeine) or strong (e.g., oxycodone). Study risk of bias was assessed, and Grading of Recommendations Assessment, Development and Evaluations provided a summary of the overall quality. Results were pooled using a random-effects model. Meta-regression determined factors associated with opioid use.

Results

Sixty studies (N=3,961,739) reported data on opioid use in people with chronic noncancer pain from 1990 to 2017. Of these 46, 77% had moderate risk of bias. Opioid use was reported by 26.8% (95% confidence interval [CI], 23.1–30.8; moderate-quality evidence) of people with chronic noncancer pain. The use of weak opioids (17.3%; 95% CI 11.9–24.4; moderate-quality evidence) was more common than the use of strong opioids (9.8%; 95% CI, 6.8–14.0; low-quality evidence). Meta-regression determined that opioid use was associated with geographic region (P=0.02; lower in Europe than North America), but not sampling year (P=0.77), setting (P=0.06), diagnosis (P=0.34), or disclosure of funding (P=0.77).

Conclusions

Our review summarized data from over 3.9 million people with chronic noncancer pain reporting their opioid use. Between 1990 and 2017, one-quarter of people with chronic noncancer pain reported taking opioids, and this proportion did not change over time.
Self-enforcing Agreements and Forward Induction Reasoning
Authors: Catonini Emiliano
Published: August 2020

In dynamic games, players may observe a deviation from a pre-play, possibly incomplete, non-binding agreement before the game is over. The attempt to rationalize the deviation may lead players to revise their beliefs about the deviator’s behaviour in the continuation of the game. This instance of forward induction reasoning is based on interactive beliefs about not just rationality, but also the compliance with the agreement itself. I study the effects of such rationalization on the self-enforceability of the agreement. Accordingly, outcomes of the game are deemed implementable by some agreement or not. Conclusions depart substantially from what the traditional equilibrium refinements suggest. A non-subgame perfect equilibrium outcome may be induced by a self-enforcing agreement, while a subgame perfect equilibrium outcome may not. The incompleteness of the agreement can be crucial to implement an outcome.
Recognizing and responding to sex-trafficked minors in the healthcare setting
Authors: Quincy Brenda L. , Falteisek Kylie , Johnston Jennifer
Published: August 2020

Nearly 6,100 reports of sex trafficking were made to the United States Human Trafficking Hotline in 2017; 29% of those reports involved minors. Physician assistants (PAs), especially those working in emergency medicine and primary care, are among the few frequently accessed healthcare providers who have the opportunity for a private conversation with a sex trafficking victim or survivor. PAs must be able to recognize the risk factors and signs of trafficking and respond in a trauma-informed, survivor-centered manner. Connecting trafficking victims, survivors, and at-risk youth with wraparound services is critical to their well-being.
An NP's guide to current physical activity recommendations
Authors: Hudson Geoffrey M. , Hauff Caitlyn , Hayes Katey , Fruh Sharon
Published: August 2020

Physical inactivity is a public health crisis that contributes to many of the chronic diseases that affect Americans. This review emphasizes the beneficial health implications of physical activity along with the dangers of sedentary lifestyles. It also provides advice tailored to NPs to help their patients become more physically active.
Organizational Characteristics Associated With ICU Liberation (ABCDEF) Bundle Implementation by Adult ICUs in Michigan
Authors: Barr Juliana , Ghaferi Amir A. , Costa Deena Kelly , Hedlin Haley K. , Ding Victoria Y. , Ross Corine , Pun Brenda T. , Watson Sam R. , Asch Steven M.
Published: August 2020

Objectives:

The ICU Liberation (ABCDEF) Bundle can help to improve care and outcomes for ICU patients, but bundle implementation is far from universal. Understanding how ICU organizational characteristics influence bundle implementation could inform quality improvement efforts. We surveyed all hospitals in Michigan with adult ICUs to determine whether organizational characteristics were associated with bundle implementation and to determine the level of agreement between ICU physician and nurse leaders around ICU organizational characteristics and bundle implementation.

Design:

We surveyed ICU physician and nurse leaders, assessing their safety culture, ICU team collaboration, and work environment. Using logistic and linear regression models, we compared these organizational characteristics to bundle element implementation, and also compared physician and nurse leaders’ perceptions about organizational characteristics and bundle implementation.

Setting:

All (n = 72) acute care hospitals with adult ICUs in Michigan.

Subjects:

ICU physician and nurse leader pairs from each hospital’s main ICU.

Interventions:

We developed, pilot-tested, and deployed an electronic survey to all subjects over a 3 month period in 2016.

Results:

Results from 73 surveys (28 physicians, 45 nurses, 60% hospital response rate) demonstrated significant variation in hospital and ICU size and type, organizational characteristics, and physician/nurse perceptions of ICU organization and bundle implementation. We found that a robust safety culture and collaborative work environment that uses checklists to facilitate team communication are strongly associated with bundle implementation. There is also a significant dose-response effect between safety culture, a collaborative work environment, and overall bundle implementation.

Conclusions:

We identified several specific ICU practices that can facilitate ABCDEF Bundle implementation. Our results can be used to develop effective bundle implementation strategies that leverage safety culture, interprofessional collaboration, and routine checklist use in ICUs to improve bundle implementation and performance.
Gender Differences in Outcomes of Patients With Mesothelioma
Authors: Alpert Naomi , van Gerwen Maaike , Flores Raja , Taioli Emanuela
Published: August 2020

Background:

Mesothelioma is a rare and deadly form of cancer, linked to asbestos exposure. Although the United Kingdom has banned asbestos, the incidence rate remains high. Previous research has indicated that female individuals have better survival than male individuals, but this has never been examined in the United Kingdom.

Materials and Methods:

Pleural mesothelioma cases from 2005 to 2014 were extracted from the United Kingdom Lung Cancer Dataset. Multivariable logistic regression was used to assess the clinical and demographic factors associated with gender. A multivariable Cox proportional hazards model and propensity matching methods were used to assess gender differences in overall survival while accounting for potential confounders.

Results:

There were 8479 (87.8%) male and 1765 (17.2%) female individuals included in the analysis. Female individuals were significantly younger, with more epithelial histology than male individuals. Female individuals had significantly better overall survival (adjusted hazard ratio, 0.85, 95% confidence interval, 0.81-0.90). Results remained similar when stratifying by age and performance status, and when limiting to patients with epithelial histology.

Conclusions:

The study increases knowledge about gender differences in mesothelioma survival and is the first to directly examine this in the United Kingdom. It further disentangles the effects of age, histology, and health status. Increased estrogen may improve survival and could provide a potential target for future therapies.
Tropisetron enhances recognition memory in ovariectomized female rats
Authors: Hassell Joel , Maswood Sharmin
Published: August 2020

The present study evaluated the acute effects of the 5-HT3 receptor antagonist, tropisetron, on recognition memory in ovariectomized adult female rats. The non-spatial novel object recognition task was used to assess recognition memory. In this task, ovariectomized rats explored two identical objects during Trial 1. Immediately after Trial 1, rats were primed either with oil, 250 µg progesterone, 20 µg of estrogen, or 20 µg of estrogen + 250 µg progesterone. Four hours later, the test trial (Trial 2) was initiated. Thirty minutes before Trial 2, rats were injected intraperitoneally with either saline, 1.5 or 2.5 mg/Kg tropisetron. During Trial 2, one arm of the T maze contained an object from Trial 1 (familiar or previously encountered), and a new object (novel) was introduced into the other arm. Exploration times with the novel and familiar objects were recorded and data were converted to percent time spent with the novel object. In oil-primed ovariectomized female rats, treatment with 2.5 mg/Kg tropisetron significantly increased percent time with the novel object. Hormonal-priming with estrogen, progesterone, or estrogen + progesterone did not further accentuate the effects of tropisetron. These results suggest that although tropisetron, estrogen, and progesterone all act as antagonists at the 5-HT3 receptors and blocking 5-HT3 receptors enhances cognition, there appears to be no interaction between tropisetron and these hormones on object recognition.