bluuebunny/crossref_metadata_2025 huggingface dataset:
9 Congenital Heart Disease and Autism Spectrum Disorders: Is There a Link?
Authors: Gu Sophia , Zhang Qian , Katyal Abhay , Chung Winnie , Franciosi Sonia , Sanatani Shubhayan
Published: October 2022

Background

Congenital heart disease (CHD) has been linked to an increased incidence of intellectual disability and neurodevelopmental impairments in young patients. The relationship between CHD and autism spectrum disorders (ASD) is not well investigated.

Objectives

We performed a systematic review and meta-analysis of the medical literature to assess the evidence linking CHD to incidence of ASD.

Design/Methods

A systematic review of studies on CHD and ASD in PubMed, Cochrane and ISI from 1965 to May 2021 was conducted. Only retrospective or prospective cohort, case-control and cross-sectional human studies in the English language were included. Quantitative estimates of association between CHD and ASD were extracted from eligible studies for the meta-analysis. Pooled estimates were obtained using a random effect models fit by a generalised linear mixed model. Quantitative results not included in the meta-analysis were summarized using descriptive statistics.

Results

We screened 2,709 articles and 24 articles were included in this review. Among the 24 studies, there was a total of 348,771 subjects (12,114 CHD, 9,829 ASD and 326,828 controls). Patient age (range of 0 to 26 years) was reported in all studies. The proportion of males in CHD, ASD and controls were 50%, 80%, and 55%. CHD diagnosis ranged from non-specific (9/16), single ventricle lesion (2/16), dextro-transposition of the great arteries (2/16), and tetralogy of Fallot (1/16). Overall, seven articles reported a 4.66 times increase in the percentage of ASD cases in patients with CHD compared to the percentage of ASD cases in the general population: (5.87% vs 1.14% of ASD cases in CHD vs the general population). Seven of 24 studies were eligible for the meta-analysis, which included information on a total of 250,611 subjects (3,984 CHD, 9,829 ASD, and 236,798 controls). The summary estimate indicated that CHD patients are associated with almost double the odds of being diagnosed with autism compared with non-CHD patients: (OR 1.99, 95% CI 1.77-2.24, p<0.01). Early developmental delay, perinatal factors, genetics and neurological development were potential risk factors and etiologies for the onset of ASD in CHD patients. Suggestions for improvement of future clinical care include early identification and treatment of ASD among the CHD population. Limitations of this study include few articles explicitly exploring the link between CHD and ASD and lack of standardized ASD endpoints.

Conclusion

This review outlines that CHD patients are at an increased risk of presenting with a diagnosis or symptoms suggestive of ASD.
11 Clinician Management of Childhood Dyslipidemia in the Community Setting
Authors: Tom Katherine , De Silva Natasha , Polack Alicia , Singh Karishma , Keown-Stoneman Charles , Maguire Jonathon , Birken Catherine , Wong Peter
Published: October 2022

Background

Childhood dyslipidemia is a known risk factor for the development of cardiovascular disease (CVD) in adulthood. Although adverse health outcomes of dyslipidemias are rare in childhood, the atherosclerotic process begins in early life. An overlooked lifelong progression of disease may result in myocardial infarction and stroke in later life. There are currently no Canadian paediatric guidelines for lipid screening. Despite dyslipidemia identification, early treatment or management may not be initiated. Primary care providers (PCP) are well positioned to advise and reinforce cardiovascular health behaviours to minimize the risk of CVD and promote lifelong cardiovascular health.

Objectives

To describe clinician practice patterns associated with childhood dyslipidemia management in the community setting.

Design/Methods

A retrospective chart review was conducted for children 2 to 10 years of age with abnormal lipid profiles. Participants were recruited from a practice-based research network. Non-fasting blood samples were obtained. The primary study outcome was the proportion of physicians engaging in each step of management practice. R version 3.6.2 (R Foundation for Statistical Computing, Vienna, Austria) was used for statistical analysis.

Results

Among 462 children identified with dyslipidemia, all were seen by PCP at their next follow-up visit. PCP rarely informed families about abnormal lipid profiles. PCP frequently counselled on diet and eating habits (n=424, 95.1%), but less often on physical activity (n=154, 34.5%), screen time (n=24, 5.4%), and sleep (n=1, 0.2%). Family history of CVD, diabetes, high cholesterol, or hypertension was infrequently discussed (n=5, 1.1%). PCP repeated fasting lipid profiles uncommonly (n=20, 4.5%). Management plans for abnormal lipid profiles were not documented. Only one participant had a follow-up visit (n=1, 0.2%). Referrals were rarely made to dieticians (n=2, 0.4%) and were not in response to abnormal lipid levels.

Conclusion

Dyslipidemia in childhood is a risk factor for the development of adult cardiovascular disease. Among children with abnormal lipid profiles, our study showed PCP rarely identified and initiated early management for abnormal lipid levels. Our results may inform the need for paediatric lipid screening and management guidelines to develop best clinical practice.
15 Ranking and rating severity: stakeholder perspectives of neurodevelopmental impairment after preterm birth
Authors: Richter Lindsay , Chera Amarpreet , Luu Thuy-Mai , Bone Jeffrey N , Bourque Claude-Julie , Janvier Annie , Zhang-Jiang Sofía , Synnes Anne
Published: October 2022

Background

Children born very preterm are at increased risk of neurodevelopmental impairment (NDI). NDI rates are used to make critical healthcare decisions. The Canadian Neonatal Follow-Up Network (CNFUN) defines severe NDI at age 18–24 months as Bayley-III Cognitive, Motor or Language composite scores <70, need for hearing aids or cochlear implants, bilateral visual impairment or non-ambulatory cerebral palsy (Gross Motor Classification System level 3 or higher). This definition was developed using the perspectives of clinicians and scientists. Stakeholders including parents/caregivers, persons born preterm and community partners have never been asked how they categorize disabilities and rank different impairments.

Objectives

To evaluate stakeholder perspective of severity of disability and ranking of different health conditions all defined as severe by CNFUN using clinical vignettes.

Design/Methods

Ten clinical vignettes describing 18 month old children with combinations of single and multiple impairments based on the CNFUN definition of severe NDI and one clinical vignette describing a child without NDI (control) were co-developed by clinicians and parents. The survey of 11 vignettes was distributed to: (1) British Columbian parents of very preterm children during follow-up clinic visits; and (2) Canadian and international parents, families, individuals with lived experience with prematurity and/or NDI and their social networks using a snowball sampling technique. Participants rated the severity of each vignette on a scale from 0 (worst possible health) to 10 (best possible health) and answered if they perceived the vignette to represent a severe disability. Results were analyzed descriptively and mean differences from the control were compared using a linear mixed effects model.

Results

827 participants and 4553 vignettes were completed with no significant difference by population sampled. Participants classified the clinical vignettes as describing a severe condition ranging from 5% for the cognitive delay vignette to 55% for the cerebral palsy and language delay vignette. Mean difference in rank compared to control is shown in Figure 1. Only the ranking of the latter vignette was significantly different from the control.

Conclusion

Most key stakeholders do not perceive clinical vignettes describing CNFUN definitions of severe NDI as truly severe. Components of severe NDI rank differently but only the cerebral palsy and language delay vignette varies significantly. Current CNFUN definitions of severe NDI need to be revised.
17 Early nasal intermittent positive pressure ventilation versus early nasal continuous positive airway pressure for preterm infants
Authors: Lemyre Brigitte , Deguise Marc-Olivier , Benson Paige , Haresh Kirpalani , Ekhaguere Osayame A , Davis Peter G
Published: October 2022

Background

Respiratory distress syndrome (RDS) is very common in preterm infants and multiple options are available to support their breathing in the early neonatal course. Non-invasive ventilation has become widely used given the opportunity to avoid intubation, mechanical ventilation and reduce the risk of ventilator-associated lung injury. Non-invasive ventilation includes nasal continuous positive airway pressure (NCPAP) and non-invasive positive pressure ventilation (NIPPV). NCPAP provides one constant pressure throughout the respiratory cycle. NIPPV additionally provides higher-pressure breaths (peak inspiratory pressure – PIP) over the constant baseline pressure. The use of these two modalities has previously been compared in a Cochrane systematic review to better comprehend the favoured option in preterm with RDS.

Objectives

We re-examine the risks and benefits of NIPPV versus NCPAP when implemented within the first 6 hours after birth, for preterm infants with respiratory distress in this updated Cochrane review.

Design/Methods

We used the criteria and standard methods of Cochrane and Cochrane Neonatal to conduct a comprehensive literature search for inclusion of all randomized, quasi-randomized trials and cross-over trials fitting our inclusion criteria. Primary endpoints are respiratory failure and the need for intubated ventilatory support during the first week of life. Secondary endpoints included chronic lung disease, length of stay (LOS), pneumothorax, and mortality. We analyzed the included trials using risk ratio (RR), risk difference and the number needed to treat for an additional beneficial outcome or an additional harmful outcome for dichotomous outcomes, and mean difference (MD) for continuous outcomes. We used the GRADE approach to assess the quality of evidence.

Results

In this updated systematic review, we screened 1143 studies for the title and abstract screening. 36 studies were retained for full-text review and 8 new trials were added to this update. We re-affirmed the superiority of NIPPV VS CPAP to prevent respiratory failure (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.52 to 0.75), in reducing the need for intubation (risk ratio RR 0.70, CI 0.60 to 0.82), chronic lung disease (risk ratio RR 0.68, CI 0.50 to 0.92) and LOS (Mean difference -3.05 days, CI -4.92, -1.17). We did not find any difference in the mortality rate or rate of pneumothorax. For most outcomes, the certainty of evidence was graded as moderate or low.

Conclusion

NIPPV is superior to NCPAP as a primary respiratory support modality for preterm infants with RDS, in preventing respiratory failure and the need for intubation in the first week of life.
26 Investigating Noise Exposure to Newborn Infants with Respiratory Support: Methodological Considerations
Authors: Singh Devika , Fusch Gerhard
Published: October 2022

Background

Excessive noise in the NICU may lead to serious long-term effects on hearing impairment and sensory development in newborns. As such, the maximum recommended noise level is 45 dBA. Reported studies regarding noise exposure of ventilated preterm infants show inconsistent results; however, these studies also vary considerably in their methodology in terms of noise ascertainment (Table 1). We hypothesize that the study methodology significantly influenced data quality.

Objectives

Our aim is to investigate if measured ventilator noise levels from previous literature could potentially be the result of methodological shortfalls of the study design rather than perceivable noise levels.

Design/Methods

A ventilator circuit was set up using nCPAP and high frequency mode with nasal prongs. Noise levels were measured using a commercially calibrated noise meter. Three different scenarios were tested. (1) Measurements were taken at different angles of (0°to 180°), with 180° facing the end of the nasal prongs, without a mannequin, with the membrane/orifice of the noise meter placed 2 mm laterally from the prongs. (2) Noise levels were measured at 180° at distances of 0 to 20 mm from the nasal prongs. (3) Measurements were taken in the oral cavity of a life-size intubation mannequin of a newborn baby.

Results

Overall, the noise levels produced at different settings varied significantly, ranging from 45.7 dB to 82.2 dB. The average environmental background noise was 44.4 dB. Noise levels typically increased as the angle increased, with the highest noise level at 180° for both high frequency and nCPAP mode, at 58.4 dB and 58.2 dB, respectively (Figure 1). Noise levels recorded at high frequency were slightly higher than nCPAP values. Furthermore, in regards to distance, the highest mean value, 82.2 dB was recorded with the noise meter approximately 3 mm from the nasal prongs, with the lowest mean value, 47.6 dB, being recorded at ~20 mm. During trials with the mannequin, the lowest value, 50.1 dB, was recorded at the entrance of the mouth with slightly higher values being recorded within the oral cavity.

Conclusion

The results indicate that small changes in experimental settings, such as positioning and distance from the nasal prongs, can greatly influence noise levels, particularly above the recommended levels for neonates. In summary, some study results are potentially influenced more by the study design than the device type or ventilator setting. Further research and detailed reporting in the NICU is recommended.
27 Neurodevelopmental Outcomes of Preterm Infants Born <29 weeks with Bronchopulmonary Dysplasia Associated Pulmonary Hypertension: A Multicenter Study
Authors: Thomas Soumya , Jain Sunil , Murthy Prashanth , Joseph Chacko , Soraisham Amuchou , Tang Selphee , Dosani Aliyah , Lodha Abhay
Published: October 2022

Background

More than 1 in 4 preterm infants with bronchopulmonary dysplasia (BPD) develop BPD-associated pulmonary hypertension (BPD-PH) that is associated with significant morbidity. Data regarding neurodevelopmental outcomes with BPD-PH in preterm infants are lacking.

Objectives

To determine neurodevelopmental outcomes of preterm infants born < 29 weeks gestational age (GA) with BPD associated pulmonary hypertension at 18 to 24 months corrected gestational age (CGA).

Design/Methods

In this retrospective cohort study, preterm infants born < 29 weeks GA between January 2016 and December 2019 at level 3 Neonatal Intensive Care Units at Foothills Hospital in Calgary and the University of Texas Medical Branch (UTMB) in Galveston, who were evaluated at 18-24 months CGA in the neonatal follow-up clinics were included. We compared demographic factors, neurodevelopmental status including Bayley-III scores and sensory impairments between the two groups based on the presence of PH at 36 weeks CGA: Group I: BPD with PH and Group II: BPD without PH, using univariate and multivariable regression models. The primary outcome was a composite of death or neurodevelopmental impairments (NDI). NDI was defined as any cerebral palsy (GMFCS≥1), Bayley-III score < 85 on one or more of the cognitive, motor, or language composite scores, sensorineural or mixed hearing impairment or unilateral or bilateral visual impairment.

Results

Of 372 eligible infants, 118 (Group I [BPD-PH] =7, Group II [BPD with no PH] =111) were lost to follow up. Of the remaining 254 infants, 52 in Group I and 202 in Group II were followed at 18-24 months CGA. Group I and Group II had median (IQR) birth weight of 710g (323) and 815g (314) [p=0.004] and median gestational ages (IQR) were 25 weeks (2) and 26 weeks (2) [p=0.020], respectively . Rates of associated impairments are shown in Figure 1. Infants in BPD-PH group (Group I) were more likely to have mortality or NDI (adjusted Odds Ratio [aOR] 3.82; 95% CI: 1.17-12.41) (Table 1).

Conclusion

BPD-PH in preterm infants born < 29 weeks GA is associated with increased odds of the composite outcome of death or neurodevelopmental impairment and language delay at 18-24 months CGA.
35 Co-Creation, Development and Evaluation of Online Care Maps for Children with Medical Complexity
Authors: Adams Sherri , Dharmaraj Blossom , Beatty Madison , Moore Clara , Desai Arti , Bartlett Leah , Culbert Erin , Cohen Eyal , Stinson Jennifer , Orkin Julia
Published: October 2022

Background

Given the nature of their child’s underlying condition, parents of children with medical complexity (CMC) are relied upon to act as the primary care coordinator for their child. Tools like a care map have been shown to be effective in supporting patients and families, however, the use of an online care map that can be edited in real time has not been used and evaluated.

Objectives

The aims of this study were to: 1) determine the requirements and design features of a co-created online platform supporting care map creation, 2) use the platform for the development of a shareable standardized parent created care map, and 3) explore the utility and feasibility of an online care map from multiple perspectives including (i) parents, (ii) health care providers (HCPs), and (iii) non-HCPs.

Design/Methods

This qualitative study utilized interpretive description. Purposive sampling guided participant selection. In phase 1, the requirements and design features for a care map creation tool situated in an online patient and family facing platform were identified through semi-structured interviews with parents and HCPs/non-HCPs of CMC. This data was used to co-create the care map feature. In phase 2, parents used this online platform to create, update, and share care maps. Semi-structured interviews with parents and HCPs/non-HCPs of CMC were conducted to explore care map creation and utility.

Results

In phase 1, thirty-two interviews with parents (n=16) and HCPs/non-HCPs (n=16) were conducted. Four primary themes related to the requirements and design features for an online care map were identified and included: 1) useful features, 2) suggestions, 3) sharing, and 4) future use, which informed development of the online tool. In phase 2, thirty-six parents were on boarded to the online platform with n=25 (69%) choosing to create a care map. Semi-structured interview data with parents (n=15) and HCPs/non-HCPs (n=13) demonstrated four primary themes to inform the future use of online care maps: 1) clinical usage of care maps, 2) benefits of use, 3) challenges for usage, and 4) suggestions to improve usability.

Conclusion

Parents have valuable feedback informing the co-creation of an online platform to create and share care maps. Parents reported uncertainty in the clinical usage of care maps, however, HCPs found them very informative. Further research is needed to understand the importance of education and clarity of roles in the use of a care map for clinical care of CMC.
40 Disparities in Diagnosis of Neurodevelopmental Disabilities in Canadian Indigenous and Racialized Children
Authors: Lee Iris Hyunkyoung , Salh Gurpreet (Preety)
Published: October 2022

Background

A core racial injustice faced by Indigenous and racialized people in North America lies in access to healthcare services. It is especially important for those with neurodevelopmental disabilities (NDDs) to access appropriate diagnostic services so that they can receive appropriate and timely healthcare resources. While there is a significant amount of literature from the U.S. documenting later diagnoses of NDDs in certain racialized groups, it is unclear whether such trends have been documented in Canada.

Objectives

Our objective was to review the research on the diagnosis of NDDs in Indigenous and racialized children in Canada.

Design/Methods

We reviewed OVID, CINAHL, and Web of Sciences with a thorough two-step screening process for English papers from 1991 to 2021. We used the following search term categories: 1) diagnosis, 2) NDDs including autism spectrum disorder (ASD), fetal alcohol spectrum disorder (FASD), cerebral palsy (CP), and intellectual disabilities (ID), 3) Indigenous and racialized populations. Racialized populations included those such as immigrants, Black, Hispanic, Asian, and refugees living in Canada.

Results

In total, we found twelve papers. Nine were on ASD, one on CP, and two on NDDs in general. As well, out of the twelve papers, six were on immigrants, five on Indigenous children, and one on both Indigenous and immigrant children. Some of the studies on immigrant children distinguished the world regions they were from, one distinguished refugees from immigrants, while others did not specify. Studies discussed disparities in rates of diagnosis, explored possible explanations for these disparities, as well as potential solutions for Indigenous and racialized children to receive their NDD diagnosis in a timely manner.

Conclusion

There was a disproportionately large number of studies on FASD in Indigenous children, which may reflect a lack of appropriate representation of neurodiverse racialized and Indigenous children in Canadian NDD literature. Ultimately, these were excluded during screening, as they were not focused on FASD diagnosis but rather on other aspects such as prevention. The remaining studies do not fully reflect the wide variety of NDDs of Indigenous and racialized children. It is our hope that more research be done to represent all children in an equitable fashion and in doing so, shape policies and interventions to improve access to healthcare.
56 Gastroesophageal reflux disease in children with neurological impairment: a population-based retrospective cohort study
Authors: Dewan Tammie , Johnson David , Turner Justine
Published: October 2022

Background

Children with neurological impairment (NI) are at increased risk of gastroesophageal reflux disease (GERD) and may be more susceptible to complications such as esophagitis and aspiration. Diagnosis is challenging due to communication impairments and frequent comorbidities, such as dysphagia, that present similarly to GERD. There is a risk of both under and over diagnosis with detrimental effects. Prior research has suggested the prevalence of GERD is as high as 75%. However, these studies examined subpopulations such as children presenting with symptoms or living in institutions, often many decades ago.

Objectives

Our aim was to determine the incidence and prevalence of GERD diagnosis and treatment in children with NI at a population level.

Design/Methods

This is a retrospective cohort study using provincial administrative data. Children with NI were identified by International Classification of Diseases (ICD-10) codes in the Discharge Abstract Database (DAD) between 2006 and 2018. GERD was defined as: (1) 1+ codes in DAD or National Ambulatory Care Reporting System; (2) 2+ specialist claims; (3) 1+ ASM prescription. Age, gender, complex chronic conditions (CCC) and technology assistance (TA) were covariates. ASM prescriptions and anti-reflux procedures were collected. Descriptive statistics included means with standard deviations and counts with proportions. Univariable and multivariable Poisson regressions calculated incidence rates and rate ratios for the presence of GERD and prescription of ASM.

Results

Among 10,309 children with NI, 2,772 (26.9%) met the GERD definition. The unadjusted incidence rate was 52.1 per 1000 person-years. Increasing numbers of CCCs were associated with a higher risk of GERD. Children with four or more CCCs had an incidence almost three times that of children with no CCCs. A gastrostomy tube incurred a five times higher rate of GERD. Overall, 2486 (23.7%) of the children were treated with ASMs of which 1535 (61.7%) met no other GERD criteria. The incidence rate was 16.9 prescriptions per year. Neonatal, respiratory and congenital CCCs were associated with higher rates of ASM prescribing. The prevalence of gastrojejunostomy tubes was 1.1% (n=121), surgical jejunostomy tubes was 0.7% (n=79) and fundoplication was 3.3% (n=351).

Conclusion

The incidence of GERD in children with NI is dramatically higher than in the general pediatric population, as is the use of ASM. Both disparities are heightened in children with gastrostomy tubes, perhaps due to increased severity of NI or relevant comorbidities. Regardless, GERD is clearly a significant clinical issue in this population that warrants additional study to determine optimal diagnosis and treatment practices.
63 Translational Research Capacity in Canadian Pediatric Emergency Departments Participating in the Precision Medicine for Improving the Diagnosis of Pediatric Appendicitis in the Emergency Department (PRIMED) Study
Authors: Mitevska Elena , Mickiewicz Beata , Thompson Graham
Published: October 2022

Background

Pediatric clinical and translational research are essential to acquire effective diagnostic and treatment options for children, but they are underfunded and under prioritized in comparison to research focused on treatments for adults. The Precision Medicine for Improving the Diagnosis of Pediatric Appendicitis in the Emergency Department (PRIMED) study aimed to characterize the proteomic and metabolic bio-profiles of children with appendicitis and to investigate these bio-profiles as a clinical prediction tool.

Objectives

In this current work, we aimed to evaluate translational research capacity at Canadian pediatric Emergency Departments (EDs) and to describe some of the challenges experienced in the implementation of the PRIMED study and various strategies used to improve local research capacity.

Design/Methods

Participating sites provided basic demographic and administrative data along with laboratory- and human-resource availability during enrolment for the PRIMED study. Data was summarized using descriptive statistics. Eleven pediatric EDs participated in the PRIMED study.

Results

Six study hospitals (54.5%) used on-site clinical laboratories to process research samples; the remaining hospitals (5/11, 45.5%) required access to research facilities, of which two (18.2%) were off-site. Fewer than two thirds of the study sites (7/11, 63.6%) had any laboratory that would process samples 24 hours per day. Four study sites (36.4%) only enrolled patients during business hours and over half of the sites (6/11, 54.5%) were unable to collect samples for the entire 17:00 to 21:00 peak when the greatest number of pediatric patients present to the ED (Figure 1). There was no nighttime coverage for patient enrollment and sample collection and only three study sites (3/11, 27.3%) had enrollment hours that captured over 75% of the potential study participants. Over half (6/11, 54.5%) of the PRIMED study sites developed novel processes to enable study success, for example creating graduate student on-call schedules and hiring bioscience trained site coordinators to perform sample processing requirements.

Conclusion

Despite site-specific efforts to overcome resource barriers, the gap in translational research capacity at academic pediatric emergency departments remains a significant concern. University research institutes and pediatric hospitals should invest in infrastructure and human resources to increase after-hours clinical and translational research capacity to optimize child health and wellness outcomes.
65 XyloFUNS: Xylocaine to Freeze during Unpleasant Nasopharyngeal Swabs in Children – A Randomized Controlled Trial
Authors: Gagnon Francois , Gravel Jocelyn , Duranceau Camille , Harman Stuart , Bhatt Maala , Vallières Émilie , Trottier Evelyne D
Published: October 2022

Background

Nasopharyngeal (NP) swabs have been recommended to detect SARS-CoV-2 since the beginning of the COVID-19 pandemic, but are reported to be at least moderately painful.

Objectives

To evaluate the efficacy of intranasal vaporized lidocaine compared to a sham treatment in reducing pain in children undergoing a NP swab in the Emergency Department (ED).

Design/Methods

A randomized double-blinded clinical trial was conducted in a pediatric ED. Both participants and the researcher evaluating the primary outcome were blinded. Children 6 to 17 years old requiring a NP swab were eligible. Participants were randomly allocated to receive intranasal lidocaine or a sham treatment prior to their NP swab. The primary outcome measure was pain during the swab as assessed by the visual analog scale. Secondary outcome measures were pain using the verbal numeric rating scale, fear using the children fear scale, and side effects of the intervention.

Results

Eighty-eight participants were enrolled: 45 to the lidocaine group and 43 to the control group. The mean visual analog scale scores for pain were 46 mm in the lidocaine group and 53 mm in the control group (mean difference 7 mm; 95%CI -5 to 19 mm). The numeric rating scale and children fear scale were not statistically different between groups. No serious adverse events were observed. Fear prior to the test and younger age were associated with higher pain scores.

Conclusion

Intranasal lidocaine administered prior to NP swabs in the ED did not lower pain scores for school-aged children and youth.
67 Is Ophthalmia Neonatorum associated with Invasive Bacterial Infection? A single centre retrospective study
Authors: St-Onge-St-Hilaire Alexandra , Boutin Ariane , Gravel Jocelyn
Published: October 2022

Background

The immature immune system of neonates puts them at an increased risk of invasive bacterial infections (IBI). Ocular complications due to ophthalmia neonatorum (ON) are well described, unlike the association with IBI for which only case reports of ON with bacteremia and meningitis are documented. The risk of IBI in neonates with ophthalmia neonatorum (ON) is poorly known and part of the issue is the lack of clinical data.

Objectives

Our objective was to document the association of ON with IBI.

Design/Methods

This is a retrospective observational chart review of all afebrile neonates who presented to a single emergency department (ED) between January 2018 and December 2019 and were diagnosed with ON. Newborns with craniofacial malformations and premature infants were excluded. The primary outcome was IBI as defined by growth of any bacterial pathogen in the blood or cerebrospinal fluid. Perinatal risk factors, ED visit details (symptoms on presentation, management and treatment plan) as well as complications (ocular morbidity, death and unscheduled return visits to the ED) were collected. Data were analyzed using descriptive statistics.

Results

Fifty-two neonates were included in this retrospective review. There were no case of IBI associated with ON (0%, 95%CI 0-6.9%). Six ocular bacterial infections were identified, one of which was C trachomatis. Although there was no IBI, ocular complications, death or unscheduled return visits to the ED, there was a wide variation in physician management of ON. Physicians performed at least para-clinical investigation in 49% (95%CI: 34-62%) of neonates, prescribed antibiotics to 87% (95% CI: 74-94%) and involved specialists in 39% (95%CI: 27-52%) of cases. Most neonates were discharged home (92%; 95%CI: 81-98%) and three neonates (6%; 95%CI: 1-16%) were admitted to the hospital following their ED visit.

Conclusion

ED presentations of afebrile neonates with ON are associated with a low risk of IBI. A better understanding of the current practice variation is needed to inform clinical guidelines for the management of term neonates with ON presenting to the ED.
69 Triage Administration of Ondansetron for Gastroenteritis in children; a randomized controlled trial
Authors: Weill Olivia , Labrosse Mélanie , Levy Arielle , Desjardins Marie-Pier , Trottier Evelyne D , Gravel Jocelyn
Published: October 2022

Background

Acute gastroenteritis is an important reason for emergency department (ED) consultation in children. Ondansetron is reported to be effective in reducing vomiting in children with gastroenteritis, leading to less intravenous rehydration and hospital admission.

Objectives

The aim of this study was to assess the effectiveness of triage nurse-initiated administration of ondansetron for children with suspected gastroenteritis in the paediatric ED to reduce the number of patients requiring observation following the first physician assessment.

Design/Methods

This was a randomized controlled trial performed in a tertiary care paediatric ED. All children 6 months to 17 years old who presented to the ED with at least four episodes of non-billous, non-bloody vomiting in the previous 24 hours and the last vomiting occurring within the previous 2h were eligible. The intervention consisted of administration of a liquid formulation of an adapted to weight dose of ondansetron at triage compared to a color- and taste-matched placebo. The primary outcome was the number of patients requiring observation after the first physician’s evaluation. Secondary outcomes were the number of episodes of vomiting after receiving the intervention, length of stay in the ED, comfort, and the proportion of children who returned for a medical visit within 48 hours. A sample size of 248 participants was initially identified to have a power of 90% to find a 20% difference in the proportion of children needing observation following physician evaluation.

Results

Because of multiple external factors, including the COVID-19 pandemic, recruitment was stopped before the expected sample size was reached. A total of 91 patients were included and randomized to receive ondansetron (n= 44) or a placebo (n=47) just after triage. The baseline characteristics of the participants was similar between the two groups. A total of 40 (45%) participants were discharged immediately after the first evaluation by the treating physician. This was similar for both groups 44% vs. 45%; (95% CI for the difference -20 to 19%). There was no difference between the two groups for the total length of stay (median 232 vs. 227 minutes; p= 0.677) and for the length of stay after being seen by the physician (72 vs. 68 minutes; p=0.821). There was no statistical difference between the two groups in the number of vomiting episodes (difference of 15%; 95% CI -2, 31), and proportion of participants needing a rescue medication (difference: 19%; 95%CI:-0.6 to 36%) or an intravenous rehydration (difference: 8; 95%CI:-6, 22).

Conclusion

This study failed to demonstrate any benefit in using ondansetron at triage for children with presumed gastroenteritis.
89 Centre-based child care attendance in early childhood and adiposity in later childhood: a prospective cohort study
Authors: Kucab Michaela , Keown-Stoneman Charles , Birken Catherine , Perlman Michal , Maguire Jonathon
Published: October 2022

Background

One in three children are living with overweight or obesity in North America. The burden of childhood obesity is disproportionately experienced by children from low-income families, who are more likely to have obesity. Centre-based child care attendance may influence important adiposity risk factors such as dietary intake, eating behaviour, and physical activity, but its impact on childhood obesity is unclear.

Objectives

The primary objective was to evaluate the relationship between the intensity of centre-based child care attendance between 1 and 4 years of age and Body Mass Index z-score (zBMI) from 4 to 10 years of age relative to non-centre-based child care (i.e., home-based, grandparents, relatives, and nanny’s). The secondary objective was to explore if family income modified the relationship.

Design/Methods

A prospective cohort study of children 1 to 10 years of age was conducted through the TARGet Kids! primary care research network. The primary exposure was intensity of centre-based child care attendance (hours/week). The primary outcome was zBMI, an age and sex adjusted measure of child adiposity. Interaction terms for child age and family income were explored. A linear mixed effects model and logistic generalized estimating equations were used to determine the association between centre-based child care attendance and child zBMI.

Results

3,503 children were included (mean age: 2.7 years). Children who attended centre-based child care full time (40 hours/week) had a 0.11 lower zBMI at 4 years (95% CI -0.19, -0.03; p=0.005) and lower odds of obesity (zBMI > 2) at 4 (OR 0.58; 95% CI 0.34, 0.99; p=0.04) and 10 years of age (OR 0.52; 95% CI 0.29, 0.90; p=0.02) relative to children who attended non-centre-based child care. The relationship was modified by family income such that, children from families with an income of <$50,000CDN who attended centre-based child care full time had a 0.35 (95% CI -0.56, -0.15; p=0.001), 0.34 (95% CI -0.54, -0.13, p=0.001) and 0.29 (95% CI -0.50, -0.07, p=0.009) lower zBMI at 4, 7 and 10 years of age, respectively, relative to children who attended non-centre-based child care.

Conclusion

Centre-based child care attendance in early childhood was associated with lower adiposity and odds of obesity in later childhood. This relationship was stronger for children who were from lower income families. Centre-based child care may be an effective early intervention to prevent childhood obesity.
Current Practices and Nurse Readiness to Implement Standardized Screening for Commercially and Sexually Exploited Individuals in Emergency Departments in Western Washington Hospitals
Authors: Hulick Johanna , Jensen Lauren , Mihaiuc Abigail , Shin Ruth Hyewoo , Pope Stephen , Gimbel Sarah
Published: October 2022

Approximately 80% of trafficked individuals access health care during their victimization. The emergency department is a frontline of care. This study examines current screening practices of Western Washington emergency department nurses to determine nurse and facility readiness for improved identification. Interviews were conducted with nurses to understand their current screening practices for identifying potential victims of sexual exploitation; the acceptability of existing screening questions for use in their settings; and their opinions about the utility of a standardized screening tool for identifying victims and improving care. There is an absence of formal protocols and screening tools, limited clarity regarding roles and responsibilities in the identification and care of trafficked persons among the health care team, and a desire to provide improved care quality to patients. Standardized processes and screening may lead to more efficient and effective identification of, care for, and linkage to vital support services and resources.
PheWAS and cross-disorder analyses reveal genetic architecture, pleiotropic loci and phenotypic correlations across 11 autoimmune disorders
Authors: Topaloudi Apostolia , Jain Pritesh , Martinez Melanie B. , Bryant Josephine K. , Reynolds Grace , Drineas Petros , Paschou Peristera
Published: October 2022

Autoimmune diseases (ADs) are a group of more than 80 heterogeneous disorders that occur when there is a failure in the self-tolerance mechanisms triggering self-attacking autoantibodies. Most autoimmune disorders are polygenic and associated with genes in the human leukocyte antigen (HLA) region. However, additional non-HLA genes are also found to be associated with different ADs, and often these are also implicated in more than one disorder. Previous studies have observed associations between various health-related and lifestyle phenotypes and ADs. Polygenic risk scores (PRS) allow the calculation of an individual’s genetic liability to a phenotype and are estimated as the sum of the risk alleles weighted by their effect sizes in a genome-wide association study (GWAS). Here, for the first time, we conducted a comparative PRS-PheWAS analysis for 11 different ADs (Celiac Disease, Juvenile Idiopathic Arthritis, Multiple Sclerosis, Myasthenia Gravis, Primary Sclerosing Cholangitis, Psoriasis, Rheumatoid Arthritis, Systemic Lupus Erythematosus, Type 1 Diabetes, Vitiligo Early Onset, Vitiligo Late Onset) and 3,281 outcomes available in the UK Biobank that cover a wide range of lifestyle, socio-demographic and health-related phenotypes. We also explored the genetic relationships of the studied ADs, estimating their genetic correlation and performing cross-disorder GWAS meta-analyses for the identified AD clusters. In total, we observed 554 outcomes significantly associated with at least one disorder PRS, and 300 outcomes were significant after variants in the HLA region were excluded from the PRS calculations. Based on the genetic correlation and genetic factor analysis, we observed five genetic factors among studied ADs. Cross-disorder meta-analyses in each factor revealed genome-wide significant loci that are pleiotropic across multiple ADs. Overall, our analyses confirm the association of different factors with genetic risk for ADs and reveal novel observations that warrant further exploration.
Research on protein structure prediction and folding based on novel remote homologs recognition
Authors: Zhao Kailong , Xia Yuhao , Zhang Fujin , Zhou Xiaogen , Li Stan Z. , Zhang Guijun
Published: October 2022

Recognition of remote homologous structures is a necessary module in AlphaFold2 and is also essential for the exploration of protein folding pathways. Here, we developed a new method, PAthreader, which identifies remote homologous structures based on the three-track alignment of distance profiles and structure profiles originated from PDB and AlphaFold DB by deep learning. Based on the identified templates, we further enhanced state-of-the-art modelling method and explored protein folding pathways based on the residue frequency distribution of homologs and the secondary structure. The results show that the average accuracy of templates identified by PAthreader is 11.6% higher than those of HHsearch on 551 nonredundant proteins. In terms of structure modelling, PAthreader improves the performance of AlphaFold2 and ranks first in CAMEO blind test for the last three months. Furthermore, we explored protein folding pathways for 37 proteins. The results are almost consistent with biological experiments for 7 proteins, and the remaining 30 human proteins have yet to be verified by biological experiments, revealing that folding information can be exploited from remote homologous structures.
Digitalization strategies and evaluation of maritime container supply chains
Authors: Seo Jungyong , Lee Byung Kwon , Jeon Yongsik
Published: October 2022

Purpose

This study proposes practical digitalization strategies and well-grounded evaluation criteria for maritime container supply chains.

Design/methodology/approach

The authors identified the status of supply chain digitalization of the Port of Busan in South Korea and developed three digitalization strategies based on industry requirements and consultations with port experts. The authors proposed 11 evaluation criteria for examining the main digitalization strategies in the supply chain operations reference model, based on a survey among 46 experts and used multi-criteria decision-making approaches to prioritize the strategies and evaluation criteria.

Findings

The results delineate the status of the digitalization of a real-world port-focal supply chain. The model can be successfully customized to include well-grounded evaluation criteria for digitalization strategies, and presents a practical way to advance the supply chain digitalization strategies. Based on the survey and evaluation, the authors find that increasing data accessibility and improving quality are preferred to adopting a data and information sharing platform.

Research limitations/implications

As the study is limited to the Port of Busan, future case studies could be undertaken to container supply chains driven by different regional ports.

Practical implications

Stakeholders, such as truckers, terminal operators, and shipping liners, might consider the proposed strategies and evaluation criteria when digitalizing their supply chains.

Originality/value

By identifying the needs and specifications of maritime container supply chain digitalization strategies, developing evaluation criteria, and conducting a case study for proof of concept, the study proposes an operational management process with practical, real-world benefits for port-focal supply chains.
Getting back to human touch: habit and change decisions during mobile device intermediations at events
Authors: Sisson Annamarie , Whalen Elizabeth
Published: October 2022

Purpose

As mobile device use in the events industry increases worldwide, an essential component for successful events is creating a unique experience. One way to enhance entertainer and attendee experience is by offering a phone-free space to enjoy an event. This study aims to examine mobile device habits and attendee willingness to adopt a mobile locking mechanism product at events and festivals.

Design/methodology/approach

Analysis of variance and regression analyses were used to test the research questions using data collected from 299 attendees recruited through an online research company.

Findings

Results reveal that mobile device habits are significantly related to the adoption of the phone locking product at events.

Practical implications

This study provides contributions to event planners to offer distraction-free settings that provide an overall escapist experience for attendees.

Originality/value

To the best of the authors’ knowledge, this study is among the first to empirically examine the role of mobile device habits and willingness to adopt a phone-locking device with event attendees.
Determinants of cloud computing deployment in South African construction organisations using structural equation modelling and machine learning technique
Authors: Aghimien Douglas , Aigbavboa Clinton Ohis , Chan Daniel W.M. , Aghimien Emmanuel Imuetinyan
Published: October 2022

Purpose

This paper presents the findings from the assessment of the determinants of cloud computing (CC) deployment by construction organisations. Using the technology-organisation-environment (TOE) framework, the study strives to improve construction organisations' project delivery and digital transformation by adopting beneficial technologies like CC.

Design/methodology/approach

This study adopted a post-positivism philosophical stance using a deductive approach with a questionnaire administered to construction organisations in South Africa. The data gathered were analysed using descriptive and inferential statistics. Also, the fusion of structural equation modelling (SEM) and machine learning (ML) regression models helped to gain a robust understanding of the key determinants of using CC.

Findings

The study found that the use of CC by construction organisations in South Africa is still slow. SEM indicated that this slow usage is influenced by six technology and environmental factors, namely (1) cost-effectiveness, (2) availability, (3) compatibility, (4) client demand, (5) competitors' pressure and (6) trust in cloud service providers. ML models developed affirmed that these variables have high predictive power. However, sensitivity analysis revealed that the availability of CC and CC's ancillary technologies and the pressure from competitors are the most important predictors of CC usage in construction organisations.

Originality/value

The paper offers a theoretical backdrop for future works on CC in construction, particularly in developing countries where such a study has not been explored.