bluuebunny/crossref_metadata_2025 huggingface dataset:
PARENTAL PERCEPTIONS OF MEDICATION IMPACT ON BEHAVIOUR AND LEARNING IN CHILDREN WITH ATTENTION/DEFICIT-HYPERACTIVITY DISORDER
Authors: Lemay Jean-Francois , Lemay Julie-Anne , Kubas Hanna
Published: May 2018

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often negatively impacts behaviour, cognition, and learning. Stimulant medications are the most commonly used treatment for ADHD, with informant reports (e.g., parent questionnaires, surveys) frequently used to evaluate medication impact on behavioural and academic functioning in affected children.

OBJECTIVES

To determine parental perceptions of medication impact on behaviour and learning in a long-acting methylphenidate (LA-MPH) trial of their children with ADHD.

DESIGN/METHODS

A randomized controlled LA-MPH medication trial was conducted with children ages 8–12 with a diagnosis of ADHD. Trial began with one-week of baseline assessment, followed by a randomized three-week standard of care medication trial, and a one-week best dose assessment. Following the conclusion of the study (6 months to 2 years’ range post-treatment), families were asked to participate in a voluntary follow-up phone survey to evaluate parental perceptions on child’s behaviour and learning.

RESULTS

A total of 34/42 (81%) families participated (male to female ratio: 2.1/1). At the time of the follow-up survey, 53% (18/34) and 68% (23/34) of patients were having “difficulty” or “significant difficulty” with their behaviour and learning, respectively. Twenty-three patients (68%) were still on psycho-stimulant medications. Although parents of those 23 children said LA-MPH had in general “significant” or “very significant” impact on their child’s behaviour (87%) and learning (79%), these parents were still reporting challenges with behaviour (52%) and learning (61%) at follow-up. In addition, parents of children not on medication said that their current child’s behaviour and learning was still having the same or more challenging issues (82% and 73% respectively).

CONCLUSION

Overall, parents reported that medication significantly impacted their child’s behaviour and learning; however, long-term medication impact appears less effective. Thus, an ongoing relationship with families and paediatricians is recommended to better understand the impact of medication on behaviour and learning. Evaluating the effects of medication on behaviour and learning may ultimately lead to targeted intervention that help foster long-term treatment efficacy for children with ADHD.
What are the Informational Preferences about Genetic Testing of Parents with Children with Autism Spectrum Disorder?
Authors: Lacelle-Webster Fanny , Mazumder Rinita , Hodgetts Sandy , Zwaigenbaum Lonnie
Published: May 2018

BACKGROUND

Autism Spectrum Disorder (ASD) affects more than 1% of the population. In 2009, the Canadian College of Medical geneticists recommended genome-wide microarray analysis as a first-line investigation for children with a diagnosis of ASD.

OBJECTIVES

The purpose of this study is to explore experiences and preferences of parents with children with ASD regarding information about genetic testing.

DESIGN/METHODS

In this mixed method study, parents of children with a diagnosis of ASD (age 2 to 17 years) were recruited through advertisements on websites and Facebook pages of community partners. The first step was an on-line survey housed on a secure web-based platform. In addition to demographic data, the survey collected information about the experiences and informational preferences of the parents about genetic testing. A subset of participants, based on expressed interest, participated in an in-person semi-structured interview. All interviews were recorded, transcribed and coded for major themes and sub-themes.

RESULTS

A total of 31 participants responded to the survey and 5 interviews were completed. Their children had received their diagnosis between 2004 and 2017. The online survey revealed that 69% of participants were aware of genetic testing and 38% had genetic testing completed. Overall, 94% wanted to have more information about genetic testing; notably, only 25% had heard about microarray. Receiving information about genetic testing was preferred in a follow up appointment by 56% of participants, but 28% preferred to receive information on the date of ASD diagnosis. Most participants (81%) identified their community paediatrician as the preferred physician to discuss genetic testing with them. Almost all interview participants were concerned that the information from genetic testing could be detrimental to their child, noting, for example, potential difficulties obtaining insurance coverage. Some shared their concerns regarding their paediatrician’s knowledge about genetic testing and ASD; in fact, two families decided to change to a new paediatrician to fulfill their needs of information about ASD and genetic testing.

CONCLUSION

This study showed that parents of children with ASD are globally interested to learn more about genetic testing, with their paediatrician being their preferred resource. For that reason, it appears important that paediatricians be aware of the recommended investigations for children with ASD and have a good understanding of the implications of genetic testing.
AN INTEGRATIVE AND COLLABORATIVE APPROACH TO ASSOCIATING ADVERSE BIRTH OUTCOMES AND INDUSTRIAL AIR POLLUTION
Authors: Serrano Lomelin Jesus , Nielsen Charlene , Jabbar M Shazan M , Wine Osnat , Zaiane Osmar , Vargas Alvaro Osornio
Published: May 2018

BACKGROUND

The relationship of many hazardous pollutants present in ambient air with adverse birth outcomes (ABO) is still unknown, particularly from those released by industry. The knowledge gap is even greater when considering the impact of mixtures of hazardous pollutants on pregnancy outcomes.

OBJECTIVES

We aimed to collaboratively overcome methodological limitations to identify potential hazardous mixtures of industrial air pollutants spatially related to the occurrence of ABO in Alberta.

DESIGN/METHODS

We applied integrative data analyses on large existing databases (2006–2012) from (i) the National Pollutant Release Inventory on chemicals released into air by industry; (ii) the Alberta Perinatal Health Program on births, known maternal risk factors for ABO, and the maternal postal code at birth; (iii) an area-level socioeconomic status index (SES). We developed a novel spatial data mining (DM) algorithm to identify significant spatial colocation rules of combinations of emitted chemicals and ABO (i.e., preterm birth [PTB], small for gestational age [SGA], and low birth weight at term [LBWT]). We used a Geographic Information System (GIS) to assign exposures to residences within 10 km of emission sites. We used epidemiological analysis to calculate the corresponding odds ratios of exposures to chemical mixtures and the occurrence of ABO, adjusted by maternal covariates and SES.

RESULTS

DM distinguished eleven rules combining three chemicals - gases, particulate matter and organics - as associated with ABO. GIS assigned exposure and epidemiological analysis identified seven rules with increased odds for induced PTB, SGA, and LBWT. One exclusively increased the odds for PTB (15%).

CONCLUSION

The combined interdisciplinary use of data mining, GIS, and epidemiology strategies enabled us to identify the risks associated with mixtures of hazardous chemicals and ABO – findings that proved elusive when applying methodologies individually. These discoveries enhance our understanding of the role of chemical mixtures in ABO.
SAFE TRANSITION TO ORAL ANTIBIOTIC THERAPY FOR PYELONEPHRITIS IN CHILDREN UNDER 2 MONTHS OF AGE: A RETROSPECTIVE STUDY
Authors: Lessard David-Alexandre , Tremblay Arnaud , Huard-Girard Thelma , Turcotte Jean-Francois
Published: May 2018

BACKGROUND

Febrile urinary tract infection (UTI) is a common cause of acute illness in paediatric medicine. Whereas oral antibiotic therapy (OAT) has become common practice in older children, the evidence supporting OAT in infants less than 2 months of age is still limited. The need for future research in the management strategies of UTIs in infants < 2 months of age has been acknowledged by the Canadian Paediatric Society.

OBJECTIVES

Describe the use of antibiotics in children < 2 months of age with a diagnosis of pyelonephritis at a Canadian tertiary care paediatric hospital and assess the safety of an early OAT switch in this population.

DESIGN/METHODS

A retrospective observational cohort study of infants < 2 months of age with a diagnosis of pyelonephritis based on 1) fever or systemic symptoms (lethargy, vomiting) and 2) a positive urine culture obtained from urinary catheterization. All children were seen between January 1st 2015 and July 30th 2017 at a single tertiary care centre. Infants were either hospitalized or followed in an outpatient day clinic. Chart review was performed and multiple variables were included in the analysis.

RESULTS

105 patients were included. Among those, 81 (77%) were boys. Most patients (87%) had Escherichia coli infection. Patients presented at a mean age of 33 ± 15 days and were admitted for 3.7 ± 2.7 days. Intravenous antibiotic therapy (IAT) – ampicillin and tobramycin or ampicillin and cefotaxime – were initially used in most patients (96%) with transition to OAT after a mean IAT duration of 3.9 days ± 2.4 days. A renal ultrasound was performed in all patients. In a subgroup of patients aged less than 30 days without bacteremia (44 patients), mean age at presentation was 19 ± 6 days. They were treated with IAT for 3.7 days ± 1.9 days before transition to OAT based on urine culture and resolution of fever. No patient was readmitted for a renal complication following discharge.

CONCLUSION

Early use of OAT following an initial IAT in infants < 2 months of age with a diagnosis of pyelonephritis appears to be a safe option. In infants < 30 days of age without bacteremia, our data suggests that early transition to OAT is not associated with worse outcomes.
IMPROVING COMMUNICATION IN THE NICU: PARENTAL PERCEPTIONS AND KNOWLEDGE ABOUT RESIDENT PHYSICIANS
Authors: Pellerin-Leblanc Amelie-Ann , Derynck Michael , Dow Kim
Published: May 2018

BACKGROUND

Residents play a pivotal role in patient care. Past research has demonstrated a lack of understanding of the roles of medical learners. It is therefore pertinent to assess patients and families’ views of the roles of residents, and how patient-resident interactions can alter their understanding. Furthermore, since patients are the ultimate stakeholders in the health care system, our goal should be to encourage their much deserved voice in the way we practice medicine, particularly in the neonatal intensive care unit (NICU) which is a challenging environment for families and learners.

OBJECTIVES

Our primary objective was to to better characterize parental knowledge and perception of resident’s roles. We also determined how medical learners can best identify themselves to family. Moreover, we explored the role of residents as effective communicators with parents. We also assessed parental satisfaction regarding their interactions with residents.

DESIGN/METHODS

Parents whose children were admitted to the NICU at our hospital for at least 24 hours were asked to complete a self-administered survey. Our cross-sectional survey, administered from January to December 2016, contained three types of questions: (1) neonatal and parental demographics; (2) parental knowledge and perceptions; and (3) parental preferences. Exclusion criteria included infant death, apprehension by child protection services and parents not fluent in French or English.

RESULTS

A total of 73 surveys were collected, for a final response rate of 38%. The majority (i.e., 81% of parents) reported having a resident involved in the care of their child. Significant findings included that level of education was shown to be directly correlated with knowledge of residents (r = 0.336, p = 0.006). Questions on parental knowledge revealed that 21% of respondents were not aware that residents are physicians. Most parents would like members of the medical team to identify their role. While 70 % of parents reported that residents effectively introduced themselves to them, 29% of desirous parents did not.

CONCLUSION

Most parents were familiar with the role of residents in this single-centre, prospective qualitative study. This survey highlights the importance of a clear introduction of the resident’s role to parents. Improved awareness of this factor may help residents improve their communication skills, and improve the family’s experience in the NICU.
USE OF SIMULATION-BASED SKILL ACQUISITION INSTRUCTION (SSAI) FOR MANUAL MASK VENTILATION (MMV) IMPROVES THE ABILITY OF NEONATAL RESUSCITATION PROGRAM (NRP) PROVIDERS TO DELIVER AND RETAIN EFFECTIVE MMV SKILLS
Authors: Amin Harish , Singhal Nalini , Beran Tanya , Kamaluddeen Majeeda , Amin Parthiv , Soraisham Amuchou , Brown Paul , Aziz Khalid
Published: May 2018

BACKGROUND

Ten percent of infants require resuscitation at birth. Effective manual mask ventilation (MMV) establishes functional residual capacity and delivers tidal volumes that promote gas exchange. A standard 4 to 6-hour NRP workshop does not ensure MMV competence. In fact, studies show that MMV is ineffective in 30 to 70% of simulated resuscitations. Effective MMV requires continual evaluation, and appropriate use of corrective steps when necessary. We hypothesize that simulation-based learning with video feedback improves MMV performance compared to traditional teaching.

OBJECTIVES

1. To assess MMV skills in NRP providers before and after simulation-based skill acquisition instruction (SSAI) using video-feedback.

2. To compare MMV performance between SSAI intervention and control groups.

3. To determine retention of MMV skills at 3 to 4 months post-intervention.

DESIGN/METHODS

In this randomized controlled study, perinatal care providers who had completed a standard NRP workshop were randomly assigned to an intervention (SSAI) or control group. All participants were assessed and videorecorded performing a standard MMV skill station using a NeoNatalie™ manikin. The intervention group reviewed their videorecordings and received instructor feedback on MMV performance. The control group reviewed the MMV chapter in the NRP textbook and received instructor feedback using a standard performance checklist without reviewing their videorecording. Feedback included observation of chest rise. Participants were assessed at 3 periods: (a) after first MMV station, (b) after immediate feedback, and (c) 3 to 4 months later.

Video recordings were scored by two investigators blinded to the randomization groups using a 13-item MMV skill scale. (0=not done; 1= done partly; 2 = done correctly) giving a maximum score of 26. We compared scores between the two groups.

RESULTS

Of the 91 participants, 46 were assigned to intervention and 45 to control group. The mean scores for the control group were: 20.1 (pre); 22.6 (post); and 21.6 (at 3–4 months post) compared to 22.1 (pre); 25.1 (post) and 24.7 (at 3–4 months post) for the intervention group.

Repeated measures analysis showed that there is an effect of group and time, with the intervention group performing and retaining skills better at follow up, Wilks’ lambda = 0.66, F(3,67) = 11.31, p < .001.

CONCLUSION

Use of SSAI with video-feedback in the teaching of MMV skills improves the ability of NRP providers to deliver and retain effective MMV in a manikin. NRP providers should be trained using SSAI. Video-feedback should be considered during NRP training. Video-feedback following real-life resuscitations should be studied for its potential benefit.
A PAN-CANADIAN STUDY ON THE COMPOUNDED MEDICINES MOST IN NEED OF COMMERCIALIZED ORAL PEDIATRIC FORMULATIONS
Authors: Gilpin Andrea , Autmizguine Julie , Allakhverdi Zoulifa , Tessier J-E , Giroux Denis , Lebel Denis , Litalien Catherine
Published: May 2018

BACKGROUND

A large number of drugs administered to children have no commercially available formulations. As a result, health care providers and parents manipulate dosage forms designed for adults. Although compounding is essential to increase access to medicines for children, it can result in adverse events or therapeutic failure. There is an urgent need to undertake a mapping of the needs for child-friendly medicines in Canada.

OBJECTIVES

To determine: 1) the most frequently compounded medicines in Canadian paediatric hospitals; 2) the challenges associated with drug compounding; and 3) medicines most in need of commercialized oral paediatric formulations.

DESIGN/METHODS

Sixteen Canadian paediatric academic hospitals were contacted to participate in a telephone survey including 12 open-, close-ended or Likert-scale questions.

RESULTS

Thirteen centers participated in the survey (81.3%). Fifty-three drugs were identified as most in need of a commercialized oral paediatric formulation. Of those, 12 were reported by ≥4 hospitals as a priority (Table). The most frequently reported compounding challenges were: lack of standardization, bad taste, lack of awareness of prescribers, stability of the formulation, and availability of compounding pharmacies.

CONCLUSION

This study highlights which drugs are most needed for paediatric oral formulations in Canada. For compounded medicines with paediatric formulations available in other countries we are currently assessing their adequacy and partnering with pharmaceutical industry to bring them to the Canadian market. As for those medicines without paediatric formulations in Canada or abroad we are looking for partners interested in developing such formulations. Furthermore, harmonized regulations and data-sharing should be pursued to facilitate access to child-friendly medicines.
HOUSING AND HEALTH: AN EXPLORATION OF HOUSING NEED IN CHILDREN WITH MEDICAL COMPLEXITY
Authors: Hounsell Kara Grace , Orkin Julia , Cohen Eyal , Soscia Joanna , Netten Kathy , Zahavi Arielle
Published: May 2018

BACKGROUND

Children with medical complexity (CMC), are defined by at least one chronic condition, functional limitation requiring technology support, multiple subspecialist involvement, and high healthcare utilization. A potentially significant social determinant that has yet to be examined in this population is that of “housing need.” According to the Canada Mortgage and Housing Corporation, “housing need” refers to housing that is crowded, unaffordable, or in need of major repairs. Given the known associations between housing and health, we hypothesize that housing need could be particularly relevant in CMC. Population-specific housing considerations may include in-home medical services, housing space, and disability accommodations.

OBJECTIVES

1) Determine the prevalence of housing need in families with CMC and 2) Explore the experience and meaning of housing need of caregivers of CMC.

DESIGN/METHODS

We conducted a mixed methods study using questionnaires and semi-structured interviews. Recruitment occurred through a tertiary paediatric hospital. Research ethics board approval was obtained. All participants were English-speaking primary caregivers of CMC living in the same household. Questionnaires were completed in person, by phone, or online via REDCap, a secure data collection application. Questionnaires explored safety, affordability, and accommodations and were analyzed using descriptive statistics. Following the questionnaire, participants were invited to be interviewed in person or by phone. Interview questions were developed iteratively and were analyzed using grounded theory.

RESULTS

Of the 354 eligible caregivers, 93 participated in the questionnaire. A total of 36 caregivers (40%) reported some difficulties paying for housing each month. In addition, 56 participants (62%) described unmet need for accommodations (i.e. a lift, toilet accommodations, etc.). A total of 65 participants (83%) reported that their child’s condition(s) affected their preferred housing location, while 55 participants (70.5%) felt it affected their preferred housing type. Of the fifteen interviews completed, several themes emerged including limited housing options for families with CMC and financial, physical, and mental health consequences of housing challenges. In addition, caregivers felt counseling was lacking on 1) safe evacuation and 2) housing requirements, such as space and equipment, as children age.

CONCLUSION

This is the first in-depth exploration of housing need amongst families of CMC. Challenges identified include affordability, disability accommodations, and restrictions on housing type and location due to children’s illnesses. Clinicians can support families of CMC by offering counseling on evacuation planning and common housing requirements for CMC.
Reevaluating Immunization Delays Post Red Blood Cell Transfusion
Authors: Zabeida Alexandra , Robitaille Nancy , Lebel Marc , Renaud Christian
Published: May 2018

BACKGROUND

Current Canadian guidelines recommend to delay the measles, mumps, rubella (MMR) and varicella live attenuated vaccines by 6 months following transfusion of unwashed red blood cells (RBC) due to potential interference by serum antibodies. Thus, patients chronically transfused with RBC commonly suffer from a delay or absence of MMR and varicella vaccination. Over the last decades, not only has RBC handling changed, but also fewer blood donors have had natural mumps, measles and rubella infections, resulting in lower blood antibody levels. The recommendations may thus be unfounded and outdated, and prevent valuable vaccination opportunities for children with frequent blood transfusions.

OBJECTIVES

The primary aim of this project was to determine MMR vaccination immunogenicity in patients chronically transfused with RBC.

DESIGN/METHODS

Medical charts were reviewed for vaccination and transfusion histories. MMR-specific antibodies were quantified in 25 paediatric patients who received both doses of the MMR vaccine at 12 and 18 months of age while they were on a chronic RBC transfusion program for sickle cell disease, B-thalassemia major, Diamond-Blackfan anemia or pyruvate kinase deficiency. There was no formal control group; long-term immunity rates in the literature are ≥90% for all MMR components.

RESULTS

Table 1 shows immunogenicity to MMR vaccine components. Delays between vaccination and serology testing averaged 5.9 years (0.3 to 15.8 years).

CONCLUSION

To the best of our knowledge, this is the first study designed to measure the effect of RBC transfusions on MMR vaccine immunogenicity. Although lower than the rates reported in the literature, the results suggest a high rate of immunogenicity to each component of the MMR vaccine in chronically transfused patients. Weighing the risks and benefits of disease prevention in a highly vulnerable population, a reevaluation of immunization delays post RBC transfusions is called for.
Evaluation of Vaso-Occlusive Crisis Management with Patient Controlled Analgesia in Children with Sickle Cell Disease Requiring Admission
Authors: Arbitre Claire , Trottier Evelyne D , Pastore Yves , Bailey Benoit , Robitaille Nancy , Kleiber Niina , Bergeron Marie Joelle Dore , Villeneuve Edith
Published: May 2018

BACKGROUND

Vaso-occlusive crisis (VOC) is one of the most distressing occurrences in patients with sickle cell disease (SCD). Patient controlled analgesia (PCA) is recommended by NIH and expert opinions favor its early use.

OBJECTIVES

We aim to review the use of PCA in patients with VOC and to evaluate if its early use is associated with faster pain control and reduced length of stay (LOS).

DESIGN/METHODS

This retrospective single center study included all paediatric patients admitted and treated with PCA for a severe VOC from 2010 to 2016. “Early” use was defined as start of PCA within 48 hours of arrival in the emergency department (ED) and “late” use after 48 hours. Time to reach adequate analgesia was defined as OUCHER, verbal scale or Faces Pain Scale < 5/10 obtained twice consecutively in a 4-hours interval. Time to reach adequate analgesia and LOS were compared between early-PCA and late-PCA groups.

RESULTS

A total of 46 patients presented 87 episodes of VOC treated with PCA during the study. Sixty-one episodes (70%) were treated with early-PCA and 26 (30%) with late-PCA. Both groups were comparable in terms of age (13.2 vs 12.8 years old), gender (55.8% female vs 57.7%), hemoglobin phenotype (80.3% HbSS vs 76.9%), but median pain score at admission was higher in early-PCA than in late-PCA (9/10 vs 7/10, median difference 1 (95% CI 0, 2). Early-PCA was associated with a median reduction in LOS of 3.15 days (95% CI 1.65, 4.82) (median early-PCA LOS 6.4 vs late-PCA 10.0 days). Time to reach analgesia could be evaluated only in a subset of patients (20 in early-PCA and 12 in late-PCA group). Although time to reach adequate analgesia tended to be shorter in the early-PCA group, it was not statistically different: median102.9 hours vs 123.5 hours, difference of 30.4 (95% CI -4.0,72.5). Side effects were observed during 29 (33.3%) PCA treatments (19/61 (31.2%) episodes in early-PCA, 10/26 (38.5%) in late-PCA group) among which 16 (18.6%) were significant adverse events. These were observed in 15 patients who required interventions: 2 desaturations requiring oxygen without intubation, 8 neurologic abnormalities (hallucinations, visual abnormalities, no stroke), 6 urinary retentions.

CONCLUSION

Early use of PCA for severe VOC was associated with a reduced length of hospital stay despite that these patients had higher pain score on admission. Prospective studies are needed to support these positive outcomes.
Utilizing Facebook and Automated Telephone Calls to Increase Adoption of a Local Smoke Alarm Installation Program
Authors: Frattaroli Shannon , Schulman Eric , McDonald Eileen M. , Omaki Elise C. , Shields Wendy C. , Jones Vanya , Brewer William
Published: May 2018

Context:

Innovative strategies are needed to improve the prevalence of working smoke alarms in homes. To our knowledge, this is the first study to report on the effectiveness of Facebook advertising and automated telephone calls as population-level strategies to encourage an injury prevention behavior.

Objective:

We examine the effectiveness of Facebook advertising and automated telephone calls as strategies to enroll individuals in Baltimore City's Fire Department's free smoke alarm installation program.

Participants:

We directed our advertising efforts toward Facebook users eligible for the Baltimore City Fire Department's free smoke alarm installation program and all homes with a residential phone line included in Baltimore City's automated call system.

Design:

The Facebook campaign targeted Baltimore City residents 18 years of age and older. In total, an estimated 300 000 Facebook users met the eligibility criteria. Facebook advertisements were delivered to users' desktop and mobile device newsfeeds. A prerecorded message was sent to all residential landlines listed in the city's automated call system.

Results:

By the end of the campaign, the 3 advertisements generated 456 666 impressions reaching 130 264 Facebook users. Of the users reached, 4367 individuals (1.3%) clicked the advertisement. The automated call system included approximately 90 000 residential phone numbers. Participants attributed 25 smoke alarm installation requests to Facebook and 458 to the automated call.

Conclusion:

Facebook advertisements are a novel approach to promoting smoke alarms and appear to be effective in exposing individuals to injury prevention messages. However, converting Facebook message recipients to users of a smoke alarm installation program occurred infrequently in this study. Residents who participated in the smoke alarm installation program were more likely to cite the automated call as the impetus for their participation. Additional research is needed to understand the circumstances and strategies to effectively use the social networking site as a tool to convert passive users into active participants.
Identification of the Critical Nontechnical Skills for Surgeons Needed for High Performance in a Variable-resource Context (NOTSS-VRC)
Authors: Scott John W. , Lin Yihan , Ntakiyiruta Georges , Mutabazi Zeta , Davis William A. , Morris Megan A. , Smink Douglas S. , Riviello Robert , Yule Steven
Published: May 2018

Objective:

To identify the critical nontechnical skills (NTS) required for high performance in variable-resource contexts (VRC).

Background:

As surgical training and capacity increase in low- and middle-income countries (LMICs), new strategies for improving surgical education and care in these settings are required. NTS are critical for high performance in surgery around the world. However, the essential NTS used by surgeons operating in LMICs to overcome the challenges specific to their contexts have never been described.

Method:

Using a constructivist grounded theory approach, 52 intraoperative team observations as well as 34 critical incident interviews with surgical providers (surgeons, anesthetists, and nurses) were performed at the 4 tertiary referral hospitals in Rwanda. Interview transcripts and field notes from observations were analyzed using line-by-line coding to identify emerging themes until thematic saturation was achieved.

Results:

Four skill categories of situation awareness, decision-making, communication/teamwork, and leadership emerged. This provided the framework for a contextually informed skills taxonomy consisting of 12 skill elements with examples of specific behaviors indicative of high performance. While the main skill categories were consistent with those encountered in high-income countries, the specific behaviors associated with these skills often focused on overcoming the frequently encountered variability in resources, staff, systems support, and language in this context.

Conclusion:

This is the first description of the critical nontechnical skills, and associated example behaviors, used by surgeons in a VRC to overcome common challenges to safe and effective surgical patient care. Improvements in the NTS used by surgeons operating in VRCs have the potential to improve surgical care delivery worldwide.
Finding the signal in the Noise of Citizen Science Observations
Authors: Kelling Steve , Johnston Alison , Fink Daniel , Ruiz-Gutierrez Viviana , Bonney Rick , Bonn Aletta , Fernandez Miguel , Hochachka Wesley M. , Julliard Romain , Kraemer Roland , Guralnick Robert
Published: May 2018

While many observations of species are being collected by citizen science projects worldwide, it can be challenging to identify projects collecting data that effectively monitor biodiversity. Over the past several years the allure of taking a “Big Data” approach has provided the opportunity to gather massive quantities of observations via the Internet, too often with insufficient information to describe how the observations were made. Information about species populations — where and when they occur and how many of them are there — (i.e., the signal) can be lost because insufficient information is gathered to account for the inherent biases in data collection (i.e., the noise). Here we suggest that citizen science projects that have succeeded in motivating large numbers of participants, must consider factors that influence the ecological process that affect species populations as well as the observation process that determines how observations are made. Those citizen science projects that collect sufficient contextual information describing the observation process can be used to generate increasingly accurate information about the distribution and abundance of organisms. We illustrate this using eBird as a case study, describing how this citizen science platform is able to collect vital contextual information on the observation process while maintaining a broad global constituency of participants. We highlight how eBird provides information with which to generate biodiversity indicators — specifically distribution, abundance, and habitat associations — across the entire annual cycle, even for populations of long distance migratory birds, a highly challenging taxon.
A study of parent–adolescent interaction
Authors: Kim Chankon , Lee Hanjoon , Han Sang-Lin
Published: May 2018

Purpose

The purpose of this study is to examine the impact of family communication patterns (FCP) on adolescents’ choice of influence strategies and parents’ choice of response strategies in situations of parent–child purchase decision disagreement.

Design/methodology/approach

This study uses family triadic (mother–father–child) survey data collected from 294 Korean families. The study develops classifications of adolescent influence strategies and parental response strategies in the initial stage and subsequently investigates the impact of FCP on the adolescent child’s use of influence strategies and each parent’s use of response strategies. The final stage of the study involved an exploratory investigation aimed at discovering the adolescent influence strategies and parental response strategies that are likely used in conjunction.

Findings

Results show an overall significant impact of FCP on both adolescents’ use of influence strategies and parents’ use of response strategies. They further reveal that Korean mothers tended to encounter their children’s persistent influence attempts with unyielding, strict response strategies. The types of response strategies used by Korean fathers were not linked to particular types of influence strategies used by their children but linked to their level of education attained and household income.

Practical implications

Findings of this study may help marketers formulate an appropriate marketing communication strategy that can be effective in resolving parent–child purchase disagreement.

Originality/value

With its focus on the adolescent influence strategies, parental response strategies, and FCP as a factor influencing the strategy choice by adolescents and parents, this study provides new insights into the parent–child interaction taking place in situations of parent–child disagreement about a purchase decision.
Digital dividends in the phase of falling productivity growth and implications for policy making
Authors: Shahiduzzaman Md. , Kowalkiewicz Marek , Barrett Rowena
Published: May 2018

Purpose

Despite the rapid pace of digitalization, aggregate productivity growth rates in most advanced countries have slowed down consistently in recent years. It creates a “puzzle”, as investment in information technology (IT) has often been thought of as a remedy to solve productivity problems. The purpose of this paper is to examine the “puzzle” by using industry-level data.

Design/methodology/approach

This research uses industry-level longitudinal data and examines changes in both labour and multifactor productivity (MFP) in Australian industries. This study uses an instrumental variable (IV) approach to estimate the models.

Findings

Findings suggest an improvement in IT-led productivity performance in recent years. Industries with an above-average share of IT (IT investment as a share of total investment) have experienced MFP boosts since 2005.

Research limitations/implications

Because of the aggregate nature of the data it was not possible to incorporate firm-specific factors, such as managerial and organisational factors, in the analysis.

Practical implications

The performance of IT has improved despite the falling growth in technology investment in recent years, suggesting that intangible factors, such as better regulatory and policy frameworks, have potentially played a positive role.

Originality/value

There are only a few studies using sectoral and longitudinal-type data, with many having become dated, meaning that there is a lack of understanding surrounding recent developments.
Longitudinal research into the effects of the high performance organisation framework
Authors: de Waal André , de Haas Jeroen
Published: May 2018

Purpose

Many models for designing a high-performance organization (HPO) have been proposed in the past decades. However, not much information can be found in the extant literature on whether these models actually improve the results of an organization over time in a sustainable manner. The purpose of this paper is to evaluate whether de Waal’s (2012) HPO framework does help organizations increase their performance in a sustainable manner.

Design/methodology/approach

De Waal’s HPO framework was applied at Nader & Ebrahim S/O Hassan (NEH), a Philippine banana producer and exporter. In 2013, a first HPO diagnosis was conducted, in which the HPO status and possible improvements were identified. This application entailed conducting a questionnaire, holding interviews, and organizing a feedback workshop with management and employees. The aim was to identify possible improvements which the organization could implement in order to achieve high performance. Subsequently, NEH started to work on these improvements, and in 2015, a second diagnosis followed.

Findings

The second HPO diagnosis showed that both NEH’s HPO scores and organizational results had gone up considerably. The research results also showed which of the interventions, which NEH applied during working on the improvements, were most effective.

Originality/value

Virtually all of the HPO frameworks and models described in the literature have not been tested scientifically on their effectiveness. Thus, the research into the workings and effectiveness of de Waal’s framework belongs to an exclusive and limited set of longitudinal research studies which actually brings the study of effective performance models further.
The dilemma of institutional duality and multinational firms 1967-2017
Authors: Ahworegba Akiebe Humphrey
Published: May 2018

Purpose

The purpose of this paper is to improve the understanding of the dilemma of institutional duality (ID) confronting multinational corporations and to propose a workable solution for this problem.

Design/methodology/approach

The author has searched the literature using several terms directly related to the dilemma of ID and multinational firms.

Findings

The findings reveal that to attain “legitimacy”, subsidiaries strive to balance institutional pressures stemming from external environments in the host country and their parent organizations. Understanding institutional theories of multinational corporations enables the subsidiaries to manage external pressures. ID impact varies among subsidiaries, depending on institutional contexts and internal strategies of subsidiaries.

Originality/value

An “institutional duality incidence model” portraying how dual institutions make “legitimacy” problematic for subsidiaries is proposed. A framework for identifying factors generating ID dilemma and their management approach is also proposed. It is concluded that a multinational corporation that recognizes ID as a central concern is more likely to achieve and maintain a higher level of harmony with its subsidiaries and host countries.
High spatial and temporal resolution film thickness planar sensor: comparison of geometries
Authors: Bonilla Riaño Adriana , Velasco Peña Hugo Fernando , Hernandez Rodriguez Oscar Mauricio , Bannwart Antonio Carlos
Published: May 2018

Purpose

The purpose of this paper is to study planar sensor geometries for the measurement of film thickness in a viscous oil–water flow. The study is relevant due to there are only a few measurement techniques for oil-water flow and these techniques involve oil with low viscosity (close to the water viscosity). Specifically, some techniques have been used in the studies of annular flow (gas–liquid and liquid–liquid flows), but applications in other flow patterns were not encountered.

Design/methodology/approach

Different sensor geometries were numerically simulated to compare their characteristics and choose the best to measure the water film thickness in the oil–water flow through an impedance-based technique. Finite element method was used for resolving the tridimensional electric field over each sensor. The compared characteristics were the penetration depth, the sensitivity, the minimum spatial resolution (high spatial resolution) and the quasi-linear curve.

Findings

The best geometry tested has a spatial resolution of 2 × 2 mm, a penetration depth of 700 µm and a quasi-linear response in the measuring range. This geometry was tested by means of conductance and capacitance static experiments. From these experiments, it could be determined that conductance and the capacitance systems are promising for measuring water film thickness in an oil–water flow.

Originality/value

Several measurement techniques such as micro-PIV, planar laser-induced fluorescence and planar conductive or capacitive sensors that are supposed to be adaptable to the liquid–liquid flow have been proposed recently. Micro-PIV and planar-induced fluorescence need transparent pipes and fluids. On the other hand, conductive or capacitive methods have been only applied to low viscosity fluids. In that context, this paper proposes to study a new technique for non-intrusive measurement of the liquid-liquid flow. The main goal is the validation of the new planar sensor as a reference tool for the development of instrumentation for oilfield application.
Explaining the diversity of antipassives: Formal grammar vs. (diachronic) typology
Authors: Sansò Andrea
Published: May 2018

Antipassives have different structural and semantic properties and are used under different conditions across languages. They also show a few universal tendencies: For instance, they generally correlate with imperfectivity. Both the diversity and the universal tendencies of antipassives have fostered a variety of analyses of this construction type in the formalist and the functional typological frameworks. In this article, these analyses will be surveyed with a view to establishing their explanatory potential and will be compared with a diachronic typological account of how antipassives diverge and what they have in common. It will be shown that at least part of this diversity finds a straightforward explanation once the sources of the antipassive are taken into account and that most of the semantic and distributional universals of antipassives are persistent features of their sources.
Pepsin: biomarker, mediator, and therapeutic target for reflux and aspiration
Authors: Johnston Nikki , Dettmar Peter W. , Ondrey Frank G. , Nanchal Rahul , Lee Sang‐Hyuk , Bock Jonathan M.
Published: May 2018

Extra‐esophageal reflux is suspected to cause a wide range of clinical symptoms in the upper airways. Diagnosis and treatment has focused on acid, but realization of the role of nonacid reflux has resulted in research investigating the use of pepsin as a biomarker for gastric reflux and aspiration. Pepsin analysis can complement the use of questionnaires and office‐based diagnosis and lessen the dependency on invasive and expensive diagnostic tests. Furthermore, pepsin as a first‐line diagnostic biomarker has been shown to improve the accuracy of reflux diagnosis. In addition to its use as a diagnostic biomarker, pepsin has been shown to cause inflammation independent of the pH of the refluxate and thus despite acid suppression therapy. Research is ongoing to develop new therapies for airway reflux that specifically target pepsin.
The Limits of Partisanship: Federalism, the Role of Bureaucrats, and the Path to Universal Health Care Coverage in Brazil
Authors: Segatto Catarina Ianni , Béland Daniel
Published: May 2018

Scholars have argued that partisanship is the main driving force behind universal social policy, including universal health coverage. This article contributes to this debate by analyzing the Brazilian path to universal health coverage in light of this international social policy literature. The empirical research it features is grounded in the systematization of the literature and the analysis of documents and in‐depth interviews. The analysis shows that the historical and institutional path of federalism, as it intersects with the role of bureaucrats, largely account for the universalization of health care coverage in Brazil. This analysis contributes to the study of social policy universalization by stressing both the limits of partisanship as an explanatory factor and the need to take into account the institutional dynamics of federalism as it interacts with the involvement of bureaucrats in the politics of universality.

Related Articles

Bernick,Ethan M., andNathanMyers.2012. “.”Politics & Policy40():131‐159.http://onlinelibrary.wiley.com/doi/10.1111/j.1747-1346.2011.00340.x/full

Lamb,Charles M., andEric M.Wilk.2009. “.”Politics & Policy37():127‐149.http://onlinelibrary.wiley.com/doi/10.1111/j.1747-1346.2008.00164.x/abstract

Palley,Howard A.2009. “.”Politics & Policy37():1074‐1077.http://onlinelibrary.wiley.com/doi/10.1111/j.1747-1346.2009.00211.x/abstract

Related Media

.2013. “Maps and Video Discussion” (in Portuguese).https://saudeamanha.fiocruz.br.2017. “Tracking Universal Health Coverage: 2017 Global Monitoring Report.”http://www.who.int/healthinfo/universal_health_coverage/report/2017/en/
The Features of Crime of Threat in the Iran and US Criminal Law
Authors: Mehdi Rahimi Mohammad
Published: May 2018

Threat is one of behaviors which punishment is considered for it in the criminal law of Iran and US. The importance of investigating on crime of threat is where, persons and civilians in accordance with domestic laws and international instruments have the very important right as “freedom of speech” and the mentioned right violation is accompanied by criminal sanctions, on the other hand, some words or committing a specific behavior by them and according the same rules is banned and considered as is criminal threats. Nevertheless, laws of both countries have adopted different approaches in regards to terms of realization of the crime and its various manifestations. Knowing the characteristics of the crime play a significant role in explaining and analyzing criminal behavior and compliance with legal cases. Some of these features in the laws of both countries explicitly and others have been stated implicitly. The lack of clear rules regarding certain characteristics of the threat, made it difficult that jurists, judges and lawyers to understand these features. Therefore, in this paper determine the characteristics of the threat in the Iran an US law.