bluuebunny/crossref_metadata_2025 huggingface dataset:
Federated learning of medical concepts embedding using BEHRT
Authors: Ben Shoham Ofir , Rappoport Nadav
Published: October 2024

Objectives

Electronic health record data is often considered sensitive medical information. Therefore, the EHR data from different medical centers often cannot be shared, making it difficult to create prediction models using multicenter EHR data, which is essential for such models’ robustness and generalizability. Federated learning (FL) is an algorithmic approach that allows learning a shared model using data in multiple locations without the need to store all data in a single central place. Our study aims to evaluate an FL approach using the BEHRT model for predictive tasks on EHR data, focusing on next visit prediction.

Materials and Methods

We propose an FL approach for learning medical concepts embedding. This pretrained model can be used for fine-tuning for specific downstream tasks. Our approach is based on an embedding model like BEHRT, a deep neural sequence transduction model for EHR. We train using FL, both the masked language modeling (MLM) and the next visit downstream model.

Results

We demonstrate our approach on the MIMIC-IV dataset. We compare the performance of a model trained with FL to one trained on centralized data, observing a difference in average precision ranging from 0% to 3% (absolute), depending on the length of the patients’ visit history. Moreover, our approach improves average precision by 4%-10% (absolute) compared to local models. In addition, we show the importance of the usage of pretrained MLM for the next visit diagnoses prediction task.

Discussion and Conclusion

We find that our FL approach reaches very close to the performance of a centralized model, and it outperforms local models in terms of average precision. We also show that pretrained MLM improves the model’s average precision performance in the next visit diagnoses prediction task, compared to an MLM without pretraining.
Activation of platelet-derived growth factor receptors regulate connective tissue growth factor protein levels via the AKT pathway in malignant mesothelioma cells
Authors: Suehiro Tomoya , Ahmad Khoja Mouhand , Hoang Nguyen Truong Duc , Xu Bingwen , Komatsu Honoka , Kurachi Komei , Nikawa Hiroki , Mine Yuichi , Matsuki Tohru , Asano Katsura , Fujii Makiko
Published: October 2024

The incidence of malignant mesothelioma (MM), a disease linked to refractory asbestos exposure, continues to increase globally and remains largely resistant to various treatments. Our previous studies have identified a strong correlation between connective tissue growth factor (CTGF) protein expression and MM malignancy, underscoring the importance of understanding CTGF regulation in MM cells. In this study, we demonstrate for the first time that stimulation with platelet-derived growth factor receptor (PDGFR) ligand, PDGF-BB, increases CTGF protein expression levels without affecting CTGF mRNA levels. Inhibition of PDGFR resulted in a reduction of CTGF protein expression, indicating that PDGFR activation is essential in regulating CTGF protein expression in MM cells. PDGF-BB also activated the protein kinase B (AKT) pathway, and inhibition of AKT phosphorylation abolished the PDGFR-induced CTGF protein expression, suggesting that PDGFR acts upstream of CTGF via the AKT pathway. This reinforces the role of CTGF protein as a key regulator of MM malignancy. Additionally, PDGFR activation led to the phosphorylation of mTOR and 4E-BP1, critical regulators of protein synthesis downstream of AKT, suggesting that PDGFR controls CTGF protein expression through the regulation of CTGF mRNA translation.
Are they there, how many, and how big? Investigating potential trap biases in the surveillance of La Crosse virus vectors
Authors: Day Corey A , Trout Fryxell Rebecca T
Published: October 2024

Several methods of mosquito collection are used for the surveillance of the primary La Crosse virus (LACV) vectors, Aedes triseriatus (Say, 1823), Ae. albopictus (Skuse, 1895), and Ae. japonicus (Theobald, 1901). However, little is known about how the choice of collection method may confound inferences made from LACV vector surveillance data. Therefore, the objective of this study was to investigate potential biases in the surveillance of LACV vectors using the Biogents BG-Sentinel 2 (BGS), CDC-Light Trap (CDC-LT), Biogents Gravid Aedes Trap (BG-GAT), and standard oviposition cup (ovicup). The traps were deployed simultaneously at 10 sites in Knovxille, Tennessee, USA for 20 consecutive weeks. Surveillance results differed widely among the traps, demonstrating a strong potential for trap biases in LACV vector surveillance. The BGS and CDC-LT were effective for collecting Ae. albopictus but were not sensitive to the presence of Ae. triseriatus or Ae. japonicus. The ovicup was the best trap for detecting Ae. triseriatus, while the BG-GAT was the only trap that regularly collected Ae. japonicus. Surveillance conducted with the CDC-LT or BGS indicated that Ae. albopictus was dominant at all sites, but the ovicup and BG-GAT suggested a much larger relative abundance of Ae. triseriatus and Ae. japonicus, respectively. Aedes albopictus and Ae. triseriatus collected in the BG-GAT were significantly larger than those collected from the BGS and CDC-LT, indicating that the traps sampled different sub-populations. A multi-method surveillance approach is recommended to reduce potential biases when conducting surveillance of LACV vectors.
Gendered administrative burden: regulating gendered bodies, labor, and identity
Authors: Herd Pamela , Moynihan Donald
Published: October 2024

Gendered burdens are experiences of coercive and controlling state actions that directly regulate gendered bodies, labor, and identity. Burdens are not simply about preventing access to rights and benefits, they're about control and coercian. Gendered burdens generate gender inequality through four mechanisms. First, administrative burdens regulate reproductive bodies, legitimating the state’s direct control over reproductive health care, including abortions, with consequent implications for peoples’ health. Second, burdens require reproductive labor, shifting unpaid and underpaid reproductive labor onto women as the policies that support such labor tend to have high administrative burdens that impede access. Third, gendered burdens restrict reproductive labor, impeding the right to provide such care labor with dignity, by exerting control over how, and sometimes whether, care is performed, including in rights-granting venues, like redistributive benefits, and rights-depriving venues, like the supervision of families by child protective services. Fourth, burdens regulate gendered identities, reinforcing heteronormative and cis-normative constructions of gender, including by directly controlling gender identification. While gendered burdens are not only experienced by women, they are most strongly applied to poor and racially marginalized groups of women. These claims provide a basis for public administration scholarship to connect with feminist theory by illustrating the centrality of administrative processes and related experiences to structural patterns of inequality.
What interval of daily pain assessment is required to reliably diagnose chronic pain in SCD? The Pain in Sickle Cell Epidemiology Study
Authors: Smith Wally Renee , McClish Donna K , Valrie Cecelia , Sisler India
Published: October 2024

Objectives

Chronic pain in SCD has been defined as pain on most days over 6 months. In the landmark Pain in Sickle Cell Epidemiology Study, 60% of patients submitted <5 of the expected 6 months of pain diaries. Identifying chronic SCD pain using this long daily assessment interval is impractical. We therefore examined whether shorter, less burdensome intervals could accurately identify chronic SCD pain.

Methods

As the gold-standard sample, we chose the 116 Pain in Sickle Cell Epidemiology Study patients who submitted >5 months of diaries (153) and >49% of diaries during all months from 1 to 4. Using the same dataset, we tested daily diary assessment over shorter intervals: 2 weeks, 1 month, 2 months, 3 months, and 4 months. We defined chronic pain as intensity rated as >0 on >50% of diary days, regardless of interval. We then calculated the sensitivity and specificity of each diary interval.

Results

Among the gold-standard sample, 51.3% of patients had diary-defined chronic pain. Collection intervals of 2 months or more yielded similar chronic pain prevalences with identically high sensitivity (98.3%) and specificity (93%). Intervals of 1 month and 2 weeks yielded increasingly lower specificity (80.7%, 73.7%, respectively), but preserved sensitivity (≥96.6%).

Conclusion

In the Pain in Sickle Cell Epidemiology Study, intervals of 2 months or more of daily diary collection yielded high sensitivity and specificity, compared to an interval of 5-6 months. One may reasonably diagnose chronic SCD pain using 2 months of daily diaries.
Marine Pseudomonas: diving into the waves of blue biotechnology
Authors: Canellas Anna Luiza Bauer , Laport Marinella Silva
Published: October 2024

From marine to terrestrial environments, Pseudomonas spp. exhibit a remarkable ability not only to adapt but also thrive even amidst adverse conditions. This fact turns Pseudomonas spp. into one of the most prominent candidates for novel biotechnological solutions. Even though terrestrial isolates have been extensively studied, there is still an almost untapped source to be explored in marine Pseudomonas. Harnessing such strains offers an opportunity to discover novel bioactive compounds that could address current global challenges in healthcare and sustainable development. Therefore, this minireview aimed to provide an overview of the main recent discoveries regarding antimicrobials, antifouling, enzymes, pigments, and bioremediation strategies derived from marine isolates of Pseudomonas spp. Future research perspectives will also be discussed to foster forthcoming endeavors to explore the marine counterparts of such a prolific bacterial genus.
Rotational excitation of methyl mercaptan (CH3SH) in collisions with molecular hydrogen
Authors: Dagdigian Paul J
Published: October 2024

This paper presents the calculation of rate coefficients for transitions between rotational levels of the A-type and E-type levels of methyl mercaptan (CH$_3$SH), resulting from collisions with molecular hydrogen. Radiative transfer modelling requires both radiative and collisional rates to describe the rotational populations under the usual conditions in interstellar clouds where local thermodynamic equilibrium conditions do not apply. To compute the intermolecular interaction between CH$_3$SH and H$_2$, the explicitly correlated CCSD(T)-F12a coupled-cluster method that utilized a correlation-consistent aug-cc-pVTZ basis was employed. The computed energies were fit to a functional form suitable for use in scattering calculations. Rate coefficients were calculated over the temperature range from 5 to 100 K for transitions between the 110 lowest CH$_3$SH rotational levels (having energies less than 107 cm$^{-1}$ (ca. 150 K) within both the A-type and E-type manifolds caused by collisions with para- and ortho-H$_2$. The rate coefficients were obtained through time-independent quantum close coupling quantum scattering calculations utilizing the calculated potential energy surface.
High precision accelerator for our hybrid model of the redshift space power spectrum
Authors: Icaza-Lizaola M , Song Yong-Seon , Oh Minji , Zheng Yi
Published: October 2024

Upcoming Large Scale Structure surveys aim to achieve an unprecedented level of precision in measuring galaxy clustering. However, accurately modelling these statistics may require theoretical templates that go beyond two-loop order perturbation theory, especially for achieving precision at smaller scales. In our previous work, we introduced a hybrid model for the redshift space power spectrum of galaxies. This model combines two-loop order templates with N-body simulations to capture the influence of scale-independent parameters on the galaxy power spectrum. However, the impact of scale-dependent parameters was addressed by pre-computing a set of input statistics derived from computationally expensive N-body simulations. As a result, exploring the scale-dependent parameter space was not feasible in this approach. To address this challenge, we present an accelerated methodology that utilizes Gaussian Processes, a machine-learning technique, to emulate these input statistics. Our emulators exhibit remarkable accuracy, achieving reliable results with just 13 N-body simulations for training. Our emulators can reproduce the set of statistics we are interested in with less than 0.1 per cent error in the parameter space within $5\sigma$ of the Planck Lambda cold dark matter predictions, specifically for scales around $k \gt 0.1$ h Mpc$^{-1}$. Following the training of our emulators, we can predict all inputs for our hybrid model in approximately 0.2 s at a specified redshift. Given that performing 13 N-body simulations is a manageable task, our present methodology enables us to construct efficient and highly accurate models of the galaxy power spectra within a manageable time frame.
Multiwavelength high-resolution polarimetric imaging of second-generation disc around post-AGB binary IRAS 08544–4431 with SPHERE
Authors: Andrych Kateryna , Kamath Devika , Van Winckel Hans , Kluska Jacques , Schmid Hans Martin , Corporaal Akke , Milli Julien
Published: October 2024

Exploring the formation and evolution of second-generation circumbinary discs around evolved binary stars, such as post-asymptotic giant branch (post-AGB) and post-red giant branch binaries, provides valuable insights into the complex binary interaction process that concludes the red-giant phase of evolution in these systems. Additionally, it offers a novel opportunity to investigate the formation of second-generation planets within dusty discs surrounding evolved stars. We present a pilot multiwavelength polarimetric imaging study of the post-AGB binary system IRAS 08544–4431 using the European Southern Observatory–Very Large Telescope/Spectro-Polarimetric High-contrast Exoplanet Research (VLT/SPHERE) instrument. This study is focused on optical V- and $I^{\prime }$-band Zurich Imaging Polarimeter (ZIMPOL) data to complement near-infrared (near-IR) H-band IRDIS data presented previously. The study aims to investigate the dust scattering properties and surface morphology of the post-AGB circumbinary disc as a function of wavelength. We successfully resolved the extended disc structure of IRAS 08544–4431, revealing a complex disc morphology, high polarimetric disc brightness (up to $\sim$1.5 %), and significant forward scattering at optical wavelengths. Additionally, we found that the disc shows a grey polarimetric colour in both optical and near-IR. The findings highlight similarities between post-AGB circumbinary discs and protoplanetary discs, suggesting submicron-sized porous aggregates as the dominant surface dust composition, and indicating potential warping within the disc. However, further expansion of the multiwavelength analysis to a larger sample of post-AGB binary systems, as well as high-resolution observations of dust continuum and gas emission, is necessary to fully explore the underlying structure of post-AGB circumbinary discs and associated physical mechanisms.
Graphite: painting genomes using a colored de Bruijn graph
Authors: Beeloo Rick , Zomer Aldert L , Deorowicz Sebastian , Dutilh Bas E
Published: October 2024

The recent growth of microbial sequence data allows comparisons at unprecedented scales, enabling the tracking of strains, mobile genetic elements, or genes. Querying a genome against a large reference database can easily yield thousands of matches that are tedious to interpret and pose computational challenges. We developed Graphite that uses a colored de Bruijn graph (cDBG) to paint query genomes, selecting the local best matches along the full query length. By focusing on the best genomic match of each query region, Graphite reduces the number of matches while providing the most promising leads for sequence tracking or genomic forensics. When applied to hundreds of Campylobacter genomes we found extensive gene sharing, including a previously undetected C. coli plasmid that matched a C. jejuni chromosome. Together, genome painting using cDBGs as enabled by Graphite, can reveal new biological phenomena by mitigating computational hurdles.
More than words: can free reports adequately measure the richness of perception?
Authors: Hirschhorn Rony , Mudrik Liad
Published: October 2024

The question of the richness (or sparseness) of conscious experience has evoked ongoing debate and discussion. Claims for both richness and sparseness are supported by empirical data, yet they are often indirect, and alternative explanations have been put forward. Recently, it has been suggested that current experimental methods limit participants’ responses, thereby preventing researchers from assessing the actual richness of perception. Instead, free verbal reports were presented as a possible way to overcome this limitation. As part of this approach, a novel paradigm of freely reported words was developed using a new metric, intersubjective agreement (IA), with experimental results interpreted as capturing aspects of conscious perception. Here, we challenge the validity of freely reported words as a tool for studying the richness of conscious experience. We base our claims on two studies (each composed of three experiments), where we manipulated the richness of percepts and tested whether IA changed accordingly. Five additional control experiments were conducted to validate the experimental logic and examine alternative explanations. Our results suggest otherwise, presenting four challenges to the free verbal report paradigm: first, impoverished stimuli did not evoke lower IA scores. Second, the IA score was correlated with word frequency in English. Third, the original positive relationship between IA scores and rated confidence was not found in any of the six experiments. Fourth, a high rate of nonexisting words was found, some of which described items that matched the gist of the scene but did not appear in the image. We conclude that a metric based on freely reported words might be better explained by vocabulary conventions and gist-based reports than by capturing the richness of perception.
Radiological, clinical, and molecular analyses reveal distinct subtypes of butterfly glioblastomas affecting the prognosis
Authors: Shibahara Ichiyo , Shigeeda Ryota , Watanabe Takashi , Orihashi Yasushi , Tanihata Yoko , Fujitani Kazuko , Handa Hajime , Hyakutake Yuri , Toyoda Mariko , Inukai Madoka , Uemasu Kohei , Shinoda Mitsuhiro , Komai Hideto , Sato Sumito , Hide Takuichiro , Kumabe Toshihiro
Published: October 2024

Background

Glioblastoma (GB) is known for its highly invasive nature. Images of butterfly GB (bGB) often illustrate this characteristic, but the molecular background and origins of bGB remain unknown.

Methods

We analyzed a cohort of 34 bGB patients from our dataset (K-cohort) and 46 bGB patients from publicly available datasets, including TCGA-GBM, CPTAC-GBM, IvyGAP, and UPENN-GBM.

Results

In the K-cohort, the median age was 66 years, and molecular analyses revealed TERT promoter mutations in 55.9% of cases, with no cases exhibiting H3F3A, HIST1H3B, or BRAF mutations. Sequential radiological imaging from the K-cohort provided unique insights, showing one case originating in the corpus callosum (CC) and 3 cases originating in the cerebral hemisphere before developing into bGB. Multi-regional sampling supported a mutational trajectory from the hemisphere to the CC. These observations indicate the presence of 2 distinct radiological origins for bGB. Consequently, we classified cases into CC-type and Hemispheric-type based on the tumor volume ratio within the CC. This subgrouping was clinically meaningful; the CC-type is an independent poor prognostic factor for overall survival, with a hazard ratio of 1.8 (95% confidence interval 1.1–3.0, P = .033), and is molecularly distinct by a higher frequency of methylated MGMTp (P = .0039) compared to the Hemispheric-type.

Conclusions

Our results highlight that the radiological features of bGB are not homogenous and can indicate 2 potential subtypes based on their origins. Further studies are mandatory, but CC-type and Hemispheric-type exhibit distinct clinical backgrounds, outcomes, and molecular features.
Factors contributing to variability in neurocognitive performance before glioma neurosurgery
Authors: Lövgren Izabelle , Voets Natalie Laura , Isaac Claire , Honeyman Susan Isabel , Mier Juan Felipe , Stacey Richard , Apostolopoulos Vasileios , Plaha Puneet
Published: October 2024

Background

Cognitive impairment following anti-tumor treatment is a common concern for brain tumor patients. However, growing evidence indicates that significant impairments can be present even before treatment. The purpose of this study was to identify factors that explain variability in pretreatment test performance, beyond that of tumor burden.

Methods

Using multi-step linear regression, we retrospectively probed the contribution of clinical-, tumor-, patient-, and self-reported factors to variance in performance among 96 treatment-naïve brain tumor patients across 13 objective neurocognitive tests. Agreement between subjective and objective reports of cognitive impairment was also examined.

Results

Clinically significant preoperative impairments were observed in both objective and subjective domains. Estimated premorbid intelligence quotient (IQ), tumor volume, diagnosis of an astrocytoma, self-reported depression, and perceived cognitive functioning scores were the most common predictors of objective neurocognitive performance prior to treatment, explaining 12.3%–58.3% of the variance. No association was identified between objective and subjective reports of cognitive impairment.

Conclusions

Glioma patients frequently exhibit objective and subjective impairments prior to treatment. Both tumor- and self-reported factors were identified as predictors of performance, after correcting for estimated premorbid IQ. Nevertheless, more than 41.7% of the variance in cognitive performance remained unexplained, indicating a substantial role for additional, as yet unaccounted for, clinical factors. Notable disparity between objective and subjective cognitive impairment status re-emphasizes the importance of assessing both domains to ascertain a patient’s overall functioning in the context of treatment outcomes.
Contribution of irrigation to the production of maize, wheat, and rice in the major global producing countries
Authors: Ai Zhipin , Boulange Julien , Zhao Xin , Li Fadong , Mahmood Rashid , Manevski Kiril , Yang Yonghui , Yu Guirui
Published: October 2024

This study offers new insights into the heterogeneity behind the widely accepted notion that irrigated crops contribute 40% to global food production. It also highlights the potential of irrigation to mitigate the negative effects of climate change on crop yields.
Tropical Indian Ocean drives Hadley circulation change in a warming climate
Authors: Sun Yong , Ramstein Gilles , Fedorov Alexey V , Ding Lin , Liu Bo
Published: October 2024

The weakening and poleward expansion of the Hadley circulation (HC) are considered robust responses of atmospheric meridional circulation to anthropogenic warming. Climate impacts arising from these changes enhance drought conditions and reduce food production in the affected regions. Therefore, understanding the mechanisms of HC changes is critical to anticipating the resultant climate risks. First, we demonstrate that robust future HC changes in boreal winter, and the uncertainty in their future projections, are both largely related to sea surface temperature (SST) warming. Next, we investigate the impact of anthropogenic regional ocean warming on the future HC. Accordingly, we conduct a large ensemble of individual ocean basin perturbation experiments at 1.5°C, 2°C, and 3°C warming thresholds (as in the Paris Agreement). These experiments highlight (i) the leading role of tropical Indian Ocean warming in HC changes and (ii) inter-model differences in tropical Pacific warming as a source of uncertainty in HC projections.
Implementation of Injectable Cabotegravir/Rilpivirine for Treatment of Human Immunodeficiency Virus in Patients With Substance Use Disorders at a Syringe Exchange Clinic
Authors: Perez Amanda , Nieves Shane , Meisner Jessica
Published: October 2024

Cabotegravir + rilpivirine (CAB + RPV-LA) is a long-acting antiretroviral therapy (ART) that can be utilized for people with human immunodeficiency virus (HIV) who face barriers to daily ART. Here, we describe the implementation of a program that provides low-barrier access to CAB + RPV-LA for people with HIV and opioid use disorder at a syringe exchange.
02 Youth perspectives on virtual healthcare appointments in Nova Scotia – a qualitative study
Authors: Bartlett Emma , Wong Tania , Mokashi Arati , Poole Emily
Published: October 2024

Background

With the onset of the COVID-19 pandemic, public safety measures required healthcare providers to look for alternative ways of delivering care in a safe and timely fashion. This led to an escalated use of virtual appointments to continue to provide patient care. For future decision-making regarding virtual care in our community, we must consider the youth perspective to ensure our healthcare delivery meets the needs of this patient population.

Objectives

Our study aims to determine the perspectives of local youth patients on their experience with virtual and in-person paediatric clinic appointments.

Design/Methods

Participants were recruited from general and subspecialty paediatrics clinics at the IWK Health Centre, in Nova Scotia, Canada. Eligibility criteria included attending both a virtual and in-person appointment from 2019-2022. Participants completed a semi-structured interview and provided their perspective on comfort level, accessibility, participation, and general preferences between virtual and in-person clinics. Transcribed data was analyzed using thematic analysis with both inductive and deductive approaches to identify themes.

Results

12 participants aged 14-18 provided interviews. Participants represented clinical areas of general paediatrics, rheumatology, diabetes clinic and gender clinic. Virtual appointments were preferred for convenience, flexibility, and efficiency during shorter conversations. In-person appointments were preferred for physical concerns, communication and relationship building. Some youth appreciated talking face-to-face for the ease of communication, feeling able to “get the point across” in this setting. The value of the in-person connection with their healthcare team was expressed by some youth, and building this relationship held importance. When appointments provided education, youth preferred for that information to be delivered in-person. Participants overall felt more comfortable during virtual appointments, and participation levels varied based on the individual and not based on an appointment being virtual versus in-person. Accessibility issues were predominantly associated with in-person appointments, with barriers including access to transportation, time spent attending appointment, and the cost of travelling to a tertiary care centre.

Conclusion

Youth patients have unique and individual preferences for virtual versus in-person appointments. This study provided insight into situations when each appointment type should be considered and emphasizes the importance of including the youth in the decision-making process around appointment scheduling when possible.
09 Penicillin allergy de-labeling: Adaptation of risk stratification tool for patients and families
Authors: Horwitz Simonne L , Shen Ye , Erdle Stephanie C , Mak Raymond , Jacob John , Wong Tiffany
Published: October 2024

Background

Penicillin allergy is reported in 10% of the population, however, over 90% of patients are deemed non-allergic upon allergist assessment. A validated mobile penicillin allergy risk assessment tool was previously developed to help healthcare providers identify patients at low risk of penicillin allergy and de-label them.

Objectives

The goal of this quality improvement project is to validate a patient-driven version of the assessment tool.

Design/Methods

Patients 6 months to 18 years old and pregnant women referred to the institution’s allergy clinics for penicillin allergy assessment were invited to use the patient tool to complete a self-assessment prior to their appointment, resulting in the assignment of a risk category: allergic, high risk, low risk, or not allergic. At their appointment, the allergist conducted an assessment with the standardized validated tool. The risk categories determined using the patient tool were compared against the allergist assessment. Patients were provided satisfaction surveys.

Results

The allergist assessment and patient tool demonstrated agreement in 57/84 (67.9%, 95% CI [56.7%,77.4%]) assessments, intra-class correlation (ICC) = 0.618, p<0.001. Of these, 45/57 (78.9%) patients were stratified as low risk or not allergic. In 22/84 (26.2%) assessments, the patient tool determined a higher risk category than the allergist, primarily due to differences in patients’ perceived timing and description of symptoms. Only 5/84 (6.0%) patients were placed in a lower risk category using the patient tool compared to the validated tool. Of these, one patient responded to the self-assessment accounting for a mild reaction, whereas the allergist assessment accounted for a second, more severe reaction. The other 4/5 patients mistakenly answered that they had never taken penicillin so were stratified as not allergic on the patient tool; however, they had previously taken penicillin and were found at risk of possible allergy by the allergist. Of those who responded to the satisfaction survey, 53/62 (85.5%) agreed that the patient tool was easy to use.

Conclusion

The patient tool demonstrates good agreement in determining penicillin allergy risk, generally aligning with the validated tool and offering potential as a method of empowering patients to assess their risk and advocate for their care. For a small minority of patients, the patient tool determined a lower risk category than the allergist assessment. To improve safety, agreement, and accessibility, iterative cycles of assessment and changes to the patient tool structure will be applied.

Potential competing interests

Funding was obtained from Valeo, Polaris Health, CeraVe, ALK, Astra Zeneca, Medexus, Novartis, Sanofi, Pfizer
18 Past and current care practices for neonates with complex medical needs: A scoping review to support clinical program evaluation
Authors: Loewen Nicole , Kieran Emily
Published: October 2024

Background

Neonates with complex medical needs (NCMN) are a rapidly growing patient population internationally. Although NCMN are a relatively small proportion of all Neonatal Intensive Care Unit (NICU) admissions, they are high healthcare utilizers. Since 2018, a dedicated Neonatal Complex Care Team (NCCT) has cared for NCMN at a large quaternary care center. The NCCT cares for NCMN in a dedicated, single-family room, patient area within the NICU. This model of care has yet to be evaluated for its potential impact on healthcare outcomes.

Objectives

The objective of the scoping review is to determine the breadth of available literature on the care practices for the management of NCMN and to collate the available evidence to define outcome measures to be used in a formal program evaluation.

Design/Methods

The review followed the PRISMA extension for scoping reviews and utilized resources from the Joanna Briggs Institute. The two databases that were utilized include Medline via OVID and CINAHL. The dates for included publications are January 1st 1993, until July 15th 2023. Only studies published in English and primary research were included. Two independent reviewers performed the initial title and abstract screening, and the full text review. The data extraction was completed by one independent reviewer.

Results

102 articles were included in the title and abstract screen, and 12 were considered for full text review. Four articles were included. Interventions discussed in the included articles ranged from discharge conferences with patient’s caregivers, to the implementation of an entirely new model of care. Multidisciplinary health care teams appear to be integral to the in-hospital care and smooth discharge of NCMN. We identified that caregiver involvement and satisfaction are important to the discharge process as they are primarily responsible for their infant’s care after discharge, and so it is important that the specifics of care are communicated and taught effectively. The outcomes of interest identified as most useful for clinical program evaluation were length of stay and readmission rate. Additionally there was limited data reported on long-term health outcomes of this patient population.

Conclusion

This scoping review identified few articles that reported new models of care, a lack of consistent outcomes used in evaluating existing care models and overall a gap in research in this rapidly growing patient population. There is more work to be done to improve care of NCMN and our findings will be used in designing future studies that evaluate care models.
20 Co-occurring behaviours of concern and sleep problems in children with neurodevelopmental disorders
Authors: Ryan Margaret , Estes Myka , MacEachern Sarah
Published: October 2024

Background

Many children with neurodevelopmental disorders (NDDs) have behaviours of concern (BoC). These behaviours, such as aggression and self-injury, can impair functioning, cause distress to the child and caregivers, and threaten physical safety. This population also commonly experiences chronic and frequent sleep problems including issues falling asleep and staying asleep. Studies in sub-populations of NDDs suggest insufficient sleep is related to worsening BoC. Therefore, sleep may be a modifiable risk factor in children with NDDs and BoC. However, no studies have systematically characterized co-occurring behaviour and sleep problems in the general NDD population. To our knowledge this is the first study to take a transdiagnostic approach in assessing the co-occurrence of sleep problems and BoC in children with NDDs, and systematically characterizing BoC and sleep problems by their type and severity.

Objectives

To assess the co-occurrence of BoC and sleep problems in a population of children with diverse NDDs and systematically characterize both BoC and sleep problems.

Design/Methods

A literature review and clinical experience informed the creation of a REDCap database. Medical information, the nature, frequency, and severity of BoC and sleep problems, and other relevant information (e.g., demographics, medications) were included. Charts from children ages 2-18 years who visited the Child Development Centre for consultation from May – October 2022 and had confirmation of an NDD diagnosis were manually reviewed.

Results

241 children met eligibility criteria. Of children with data available for both sleep and behaviour, 55% had co-occurring behaviour and sleep problems. These children displayed aggression (75%) and self-injury (49%) more frequently than children who had behaviours but no sleep problems (66% and 34%, respectively). Children with co-occurring behaviours and sleep problems were more likely to have severe BoC, including severe aggression (48%) and self-injury (45%), compared to children who had behavioural concerns but no sleep problems (21% and 20%, respectively).

Conclusion

The majority of children with NDDs have co-occurring BoC and sleep problems. This co-occurrence was related to increased frequency and severity of BoC in children with NDDs. Addressing sleep problems may represent a previously underrecognized therapeutic target to address BoC in this population.
24 Community provider perspectives on an autism learning health network: A qualitative study
Authors: Kearney Josie , Bosyj Catherine , Rombos Victoria , Curran Alicia Brewer , Clark Brenda , Cornell Wendy , Mah Shannon , Mahurin Melissa , Piroddi Nicholas , Sohl Kristin , Zwaigenbaum Lonnie , Penner Melanie
Published: October 2024

Background

Although autism is highly prevalent, no single care centre has a sufficient number of patients to produce generalizable knowledge; this slows the pace of quality improvement research. Learning health networks (LHNs) offer a promising solution to improve the quality and efficiency of healthcare by integrating clinical and research data. The Autism Care Network (ACNet) is an LHN composed of 20 clinics across the United States and Canada dedicated to developing the most effective approach to care for children with autism. In Canada, the majority of autistic patients receive a majority of their ongoing care in the community. Therefore, to make meaningful improvements in the continuum of care for patients and their families, it is essential that the ACNet be extended to include community physicians.

Objectives

The primary objectives were to (1) understand the current data collection practices, learning needs, clinic capacity, areas of improvement, and overall interest of community physicians in participating in a LHN and (2) identify community physicians’ perspectives on the benefits and disadvantages of participating in a LHN and ways in which their engagement in a LHN can be supported.

Design/Methods

In-depth semi-structured interviews were conducted participants who were purposively sampled from community providers who had previously participated in autism-focused educational programming. The interview guide was developed by the three ACNet sites based on experience with LHNs and working with community physicians. Data were analyzed using an interpretative phenomenological analysis approach with a social constructivist paradigm.

Results

Analysis of 29 interviews identified 5 primary themes: (1) “Navigating Administrative Challenges,” which highlighted the lack of time, resources, and administrative capacity in the community; (2) “Improving Data Collection Practices”, which emphasized the barriers to consistently collecting information from patients and families; (3) “Increasing Provider Confidence and Competence,” which explored the challenges of navigating the everchanging landscape of community autism care; (4) “Breaking Down Silos”, which focused on fragmented care and the lack of communication between allied health resources, diagnostic hubs, and community physicians; and (5) “Systemic and Societal Barriers to Achieving Best Practices,” which explored the systemic barriers that impact autism care for physicians and families.

Conclusion

This study provides an understanding of the experiences of community physicians regarding the challenges of community-based autism care. LHNs have the potential to address several of the issues highlighted by community physicians in autism care. Additionally, LHNs can play an important role in improving community care in fields beyond autism.
34 Improving language concordant care in the paediatric emergency department
Authors: Bravo Michael , Paluck Felicia , Taibah Omar , Amini Ameneh , Annan Henry , Tachejian Sevag , Harvey Gregory , Schonfeld Deborah
Published: October 2024

Background

Paediatric patients and families with limited English proficiency (LEP) experience worse health outcomes. Use of professional medical interpreter services (IS) helps ensure that all patients receive high quality care, regardless of their preferred language of communication.

Objectives

The aim of this quality improvement (QI) study was to improve language concordant care within a paediatric emergency department (ED) in downtown Toronto by increasing the rate of over-the-phone interpreter use by 50% by July 2024 and to understand common reasons for interpreter non-use.

Design/Methods

Using the model for improvement, we assembled an interdisciplinary team that included physicians, ED registration clerks, triage nurses, and language services staff to understand current workflow and develop targeted interventions aimed at addressing key drivers through multiple plan-do-study-act (PDSA) cycles. Interventions included introduction of a standardized script to capture language preference at ED registration, EMR-integrated preferred language notification and smart text template in provider notes for standardized IS use or non-use documentation, and departmental education. Our primary outcome measure was rate of over-the-phone IS use for all ED visits. Process measures were rate of EMR documentation of patients and caregivers with non-English language preference (NELP) and rate of provider documentation of IS use or non-use. Balancing measures included time to provider initial assessment (PIA) and ED length of stay.

Results

The baseline period (November 2022-April 2023) revealed an over-the-phone IS rate of 5.2% for all ED visits. The initial results from the first 6 months of the intervention period demonstrated an increase in physician documentation of IS use or non-use in patients with NELP, from 10% to 76%. Additionally, 18.6% of patients or caregivers with NELP had IS use per provider notes. Over the next 9 months of the intervention period, special cause variation is anticipated in the rate of IS use and rate of EMR documentation of NELP. The most common reasons for IS non-use were: ‘deemed unnecessary by provider’, ‘declined by family’ and ‘use of family member/friend as interpreter’. There was no change in PIA or ED length of stay for patients with NELP.

Conclusion

This QI initiative increased consistent provider documentation of IS use in ED patient records in one of the most linguistically diverse cities in the world. Future efforts will focus on exploring additional ways to capture language preference beyond registration, facilitating IS use in the ED, and addressing top reasons for non-use of IS in patients and caregivers with NELP.
36 The long-term consequences of short-course systemic corticosteroid therapy for childhood acute asthma exacerbations
Authors: Earl Brian Richard , Sucha Ewa , Webster Richard , Radhakrishnan Dhenuka
Published: October 2024

Background

Paediatric emergency department (ED) asthma guidelines recommend the administration of short-course systemic corticosteroids (SCS) for moderate to severe asthma exacerbations. The potential adverse implications of frequent, short-course SCS in children are poorly characterized.

Objectives

To determine the risk of adverse outcomes in children with asthma who receive multiple short-courses of SCS for asthma exacerbation management.

Design/Methods

In this population-based, retrospective cohort study, we identified children aged 1-16 years with an ED asthma presentation/hospitalization between October 1, 2017, and February 28, 2020. We divided participants into an SCS-exposed and unexposed cohort. A minimum washout period of 3 years was applied to exclude any SCS use before the index date. During a 24-month follow-up period, we captured cumulative short-courses of SCS for acute asthma management and the primary outcome, development of steroid-associated complications. We excluded participants with steroid-treated comorbidities, non-asthma-related SCS exposure and development of adverse outcome(s) before the index visit. We compared baseline characteristics between cohorts using descriptive statistics. A Prentice-Williams-Peterson model was used to determine the risk of adverse outcomes amongst children receiving SCS for asthma management with results expressed as adjusted hazard ratios (HR) and 95% Wald confidence intervals (CI).

Results

We identified 1468 participants with an asthma ED visit who received ≥1 SCS course for acute management and 541 participants who did not receive SCS during our study window, after applying inclusion/exclusion criteria. Baseline demographics were balanced between cohorts aside from age at index, which was significantly younger (4.31 ± 3.71 vs 7.64 ± 4.21 p<0.001) in the SCS-exposed cohort. Overall, the risk of developing a recurrent SCS-associated adverse outcome was not increased in the SCS-exposed cohort (HR = 0.95, 95% CI: 0.74-1.23, p=0.7). However, when the number of SCS courses was considered, a significant risk of recurrent SCS-associated outcomes emerged, especially for those receiving 4+ SCS courses (HR = 2.30, 95% CI: 0.92-5.80). This potential dose-response effect was negated when patients who were likely on medium to high dose maintenance inhaled corticosteroids, were removed in a sensitivity analysis (HR = 1.38, 95% CI: 0.35-5.39).

Conclusion

At a tertiary care Canadian paediatric hospital, children and adolescents receiving short-course SCS for asthma exacerbation management overall do not demonstrate an increased risk of developing complications after two years follow-up. However, complication risk may be increased among those receiving 4+ cumulative SCS courses.
53 Clinical characteristics and outcomes of children hospitalized with RSV-associated acute respiratory infections
Authors: Kirolos Nardin , Fortini Jonathan , Mtaweh Haifa , Seaton Claire , Farrar Daniel , Mahant Sanjay , Freire Gabrielle , Campigotto Aaron , Yeung Rae , Buchanan Francine , Barrowman Nicholas , Zitikyte Gabriele , Morris Shaun K , Gill Peter J
Published: October 2024

Background

Respiratory syncytial virus (RSV) is one of the most common acute respiratory infections (ARI) in infants and young children. After the relaxation of COVID-19 pandemic restrictions, children’s hospitals worldwide experienced unprecedented volumes and severity in presentation of children admitted with ARIs, such as RSV. It is unknown whether the increase in volumes was also associated with changes in the typical demographic, severity and outcomes of patients with RSV infections.

Objectives

To describe sociodemographic characteristics, clinical presentation, management including diagnosis and disposition and clinical outcomes of children under the age of 18 years admitted to tertiary care paediatric hospital with RSV-associated ARI.

Design/Methods

Observational cohort of children and adolescents aged 0-18 years admitted to two large Canadian children’s hospitals between July 1, 2022 - December 31, 2022, who had microbiological evidence of RSV infection. Detailed clinical and demographic information were extracted, including admission and discharge diagnoses, diagnostic tests, viral and bacterial testing, interventions, and respiratory settings. Clinical outcomes and complications were collected, including length of hospital admission, paediatric intensive care unit (PICU) admission, need for invasive mechanical ventilation, disposition, and death.

Results

There were 455 patients admitted with an RSV infection, of which a third (35.0%, n=146) were transfers from other hospitals. Cases were 41.0% male and the median age was 1.22 years (interquartile range [IQR] 0.19-3.06). Nearly two-thirds of patients (62.0%, n=284) were younger than 2 years of age, 8.6% had a history of prematurity. One third (31.0%, n=142) of patients had at least one documented comorbid condition, the most common diagnosis was asthma (6.6%). In addition to RSV, 3.5% (n=16) of patients had a simultaneous bacterial pathogen identified. Most patients (73%, n=330) were only RSV positive, while 24% (n=109) had two pathogens identified. One quarter (25.9%) were admitted to the PICU. The median length of hospital stay was 3 days (IQR 2.00-5.00) and for those admitted to the PICU, nearly two thirds of patients (63.0%, n=75) were admitted for less than 4 days. 0 patients died. The most common discharge diagnosis in 61.0% of patients (n=279) was bronchiolitis. There were 56 patients (12.3%) who had an unscheduled return visit to the ED within 30 days of discharge with 23.0% (n=13) requiring readmission to the hospital.

Conclusion

There continues to be a substantial volume of hospitalizations secondary to RSV infection, predominantly in those <2 years of age, with a prominent diagnosis of bronchiolitis. A quarter of patients had notable severity requiring PICU admission.