bluuebunny/crossref_metadata_2025 huggingface dataset:
TP10.2.7Reintroduction of elective colorectal cancer surgery following the first wave of Covid-19 in the UK – an audit of risk mitigation strategies and review of patient outcome
Authors: Malcolm Francesca , Ng James Chean Khun , Speake William
Published: October 2021

Aim

Perioperative acquisition of Covid-19 is associated with high mortality and morbidity. We have analysed the effectiveness of newly designed ‘green’ pathway for elective colorectal cancer (CRC) patients, which aimed to minimise risk of Covid-19.

Method

Data collected with concurrent implementation of ‘green’ pathway for all patients undergoing CRC surgery over a 6 week period following the ‘first wave’ of the Covid-19 pandemic. The standard audited were appropriately timed pre-operative CT chest, Covid-19 swabs and shielding adherence. The impact of positive pre-operative swabs and post-operative complications were analysed. Additional risk mitigation strategies included dual consultant operating, open operating, and defunctioning ileostomy for high risk anastomoses.

Results

49 operations performed of 56 planned. 1 cancelled due to patient being positive for Covid-19, 5 due to progression of cancer on restaging CT, 1 required further medical optimisation. All had a 2 week pre-operative swab and then shielded until the day of the operation. 48/49 had swab 2 days pre-op. CT chest performed in all, 37 (66.7%) were to restage. 4 (8%) had post-operative complication graded as ≥ 2 on Clavien-Dindo score; none of which were Covid related. 1 patient tested positive for Covid-19 post-operatively but remained asymptomatic. All procedures were open and performed by 2 consultants.

Conclusion

We demonstrate an effective pathway and various operative strategies which can be employed to reduce risk for patients undergoing CRC surgery in the midst of the ongoing global pandemic.
What patients with eosinophilic esophagitis may not share with their providers: a qualitative assessment of online health communities
Authors: Chang Joy W , Chen Vincent L , Rubenstein Joel H , Dellon Evan S , Wallner Lauren P , De Vries Raymond
Published: October 2021

Background

Little is known about how patients with eosinophilic esophagitis (EoE) experience their symptoms, receive care, and cope with their disease. Patients commonly seek peer support from online communities, which provide insights on unmet needs and barriers to care. We performed a qualitative analysis of electronic health forums to characterize patient-to-patient conversations about EoE symptoms and the experience of disease.

Methods

We identified three publicly accessible electronic health forums hosting EoE communities. Conversation threads posted between July 2018 and June 2020 were coded using emergent and a priori codes based on the THRIVE conceptual framework of coping with chronic illness.

Results

Of 659 threads (4,933 posts) collected over two years, a random sample of 240 threads (30 per 3-month quarter) were selected for analysis. Thematic saturation was reached after 172 threads. Patient experience of EoE was driven by their perspectives in four key domains: (i) perception of EoE as episodic rather than chronic, (ii) treatment choices, (iii) personal definitions of success in the disease, and (iv) views of providers.

Conclusion

Online health communities are a valuable and unfiltered source of patient perspectives that can be used to understand patient needs and goals. EoE patients interpret their disease as sporadic events and lack reliable sources of knowledge, which may influence how patients prioritize treatment. If providers are to succeed in providing high-quality EoE care, they need to equip themselves with evidence-based knowledge, engage in shared decision making, and look outside of clinical settings to recognize barriers to disease management.
A new genus and species of tanager (Passeriformes, Thraupidae) from the lower Yungas of western Bolivia and southern Peru
Authors: Lane Daniel F , Aponte Justiniano Miguel Angel , Terrill Ryan S , Rheindt Frank E , Klicka Luke B , Rosenberg Gary H , Schmitt C Jonathan , Burns Kevin J
Published: October 2021

We describe a colorful and distinctive new species of tanager from the lower slopes of the Andes of southeastern Peru and western Bolivia. The species was first noted from southeastern Peru in 2000, but little of its natural history was uncovered until the 2011 discovery of a breeding population in deciduous forest in an intermontane valley, the Machariapo valley, in Bolivia. This species appears to be an intratropical migrant, breeding in deciduous forest during the rainy season (November–March) and spending the dry season dispersed along the lower slopes of the Andes, apparently favoring Guadua bamboo-dominated habitats in both seasons. Phylogenetic evidence suggests this tanager is embedded within a clade of thraupids that includes Ramphocelus, Coryphospingus, Loriotus, Tachyphonus, and related genera in the subfamily Tachyphoninae. Within this subfamily, the new species falls in a clade with two monotypic genera, Eucometis penicillata (Gray-headed Tanager) and Trichothraupis melanops (Black-goggled Tanager). There is strong support for a sister relationship between the new tanager and T. melanops, but because all three species in this clade are highly distinctive phenotypically, we propose erecting a new genus and species name for the new tanager.
26 Supporting the Transition to Postsecondary for Students with Mental Health Conditions: A Scoping Review
Authors: Devoe Dan , Lange Thomas , MacPherson Pauline , Traber Dillon , Perry Rosemary , Schraeder Kyleigh , Patten Scott , Arnold Paul , Dimitropoulos Gina
Published: October 2021

Primary Subject area

Mental Health

Background

The transition from high school to postsecondary is a critical milestone for independence and empowerment. This life stage frequently coincides with the emergence of most mental health conditions (MHCs). Without adequate support to assist with the transition to postsecondary education, the mental health of arriving students with existing MHCs is likely to decline or remain unmet. Declining mental health is strongly associated with students withdrawing from both secondary and postsecondary education. However, a scoping review of interventions aiming to support youth with MHCs transition to postsecondary has not been conducted.

Objectives

The objectives of this scoping review were to identify: (1) researched interventions that support youth with MHCs during the transition to postsecondary; (2) best practices used to support this transition; (3) methods of evaluating these interventions and any limitations; and (4) gaps where future research is warranted.

Design/Methods

A database search of MEDLINE, PsycINFO, Embase, SocINDEX, ERIC, CINHAL, and Education Research Complete was undertaken. Two reviewers independently screened studies and extracted the data. Thematic analysis and risk-of-bias assessment were conducted on included studies.

Results

Nine studies were included in this review, describing eight unique interventions (Figure 1). Sixty-two percent of interventions were nonspecific in the MHCs that they were targeting in postsecondary students. These interventions were designed to support students upon arrival to postsecondary. Peer mentorship, student engagement, and interagency collaboration were found to be beneficial approaches to supporting youth transitioning into postsecondary (Table 1). The overall quality and level of evidence in these studies was low. Three knowledge gaps were found: evidence was not generalizable to the diversity of MHCs, intervention studies were mostly cross-sectional in nature and lacked follow-up data, and sustaining intervention funding remained a challenge for postsecondary institutions.

Conclusion

The volume of research identified was limited but indicated overall that offering support during the transition to postsecondary was beneficial for students with MHCs. Further evidence is needed that is generalizable across the mental health spectrum, and that assesses intervention outcomes in relation to intervention costs.
43 The Prevalence of Serious Bacterial Infections in Infants less than 90 Days with and without Features of a Viral Infection: A Retrospective Cohort Study
Authors: Algrigri Osama , Mirza Asma , Rezk Eman , Pernica Jeffrey , Eltorki Mohamed
Published: October 2021

Primary Subject area

Emergency Medicine - Paediatric

Background

Prior studies suggest the prevalence of serious bacterial infections (SBI) (i.e., urinary tract infection [UTI], bacteremia, or meningitis) is lower in infants with a viral infection compared to those with fever without a source (FWS) (2-3% vs. 10-15%).

Objectives

To determine the difference in proportion of SBI in infants with and without clinical features of a viral infection.

Design/Methods

A retrospective cohort study was done on a consecutive sample of infants ≤ 90 days seen at a pediatric ED over a 5-year period ending August 30, 2019. Eligible subjects had rectal temperatures ≥ 38°C, and had ≥ 1 screening test for SBI (urine, blood and/or cerebrospinal fluid cultures). Excluded were infants who received antibiotics in the past 7 days, had congenital anomalies, required intensive care, or were preterm. We defined a clinical viral infection as > 1 clinical features of a respiratory viral infection (new-onset sneezing, cough, rhinorrhea, or shortness of breath). UTI was defined as per American Academy of Pediatrics guidelines.

Results

We screened 7021 charts and 885 (12%) were eligible. Of these, 498 (56%) had a clinical viral infection and 387 (44%) did not. Blood and urine cultures were collected from 860 (97%) infants and 308 (35%) had a lumbar puncture. Overall, 84 (10%) infants had an SBI: 76 (9%) UTI, 6 (0.7%) isolated bacteremia, and 2 (0.2%) meningitis. Among those with clinical viral infection, 23 (5%) had SBI, compared to 61 (16%) without viral infection (risk difference [RD] 11%, 95% CI [7%, 15%]). Both cases of meningitis occurred in infants ≤28 days and without any viral symptoms. A logistic regression was done to ascertain the effects of clinical viral infection, known risk factors for sepsis, age ≤ 28 days, or a temperature ≥ 39°C on the likelihood of SBI. Of the 4 predictors, only clinical viral infection and the presence of known risk factors for sepsis were significantly associated with SBI (odds ratio [OR] 0.3, 95% CI [0.17, 0.48] and 2.5, 95% CI [1.4, 4.5], respectively). Proportions of contaminated blood culture and urine culture were 5% (95% CI [4%, 7%]) and 14% (95% CI [12%, 17%]), respectively.

Conclusion

SBI prevalence in infants without features of a viral infection on assessment is triple that of infants with viral symptoms. Contaminant blood and urine cultures are folds higher than true pathological cultures. Future research is needed to identify infants at low risk of SBI without invasive testing.
55 Evidence behind drug use in vascular anomalies: From infantile hemangioma to rare vascular anomalies … What do we know about what we do with local, systemic, or sclerotherapy treatment?
Authors: Marcoux Simon , Théorêt Yves , Dubois Josée , Essouri Sandrine , Pincicy Alix , Coulombe Jerome , McCuaig Catherine , Powell Julie , Soulez Gilles , Kleiber Niina
Published: October 2021

Primary Subject area

Clinical Pharmacology and Toxicology

Background

The most common vascular anomaly (VA) requiring medical treatment are infantile hemangiomas, but many other vascular anomalies affecting children are treated with local, systemic drugs or sclerosing agents.

Rational drug prescribing implies assessment of whether a drug’s benefits outweigh the risk of adverse effects for treatment of a specific vascular anomaly. This process relies on the quality of the literature on efficacy and safety for drug treatment of vascular anomalies.

Objectives

To evaluate the level of evidence surrounding drug use in vascular anomalies.

Design/Methods

A list of drugs used in vascular anomalies was created with existing guidelines. For each drug, the article displaying the highest level of evidence was determined, using Oxford criteria. Levels of evidence were compared between efficacy and safety data, routes of administration, pharmacological categories, and a subset of specific vascular anomalies. The influence of research quality on study results was explored by comparing the percentage of clinical efficacy between high- and low-quality studies.

Results

We identified 71 different drugs for treating vascular anomalies. The median level of evidence was low, with a predominance of retrospective cohort studies and case reports. The level of evidence was higher for efficacy than safety data and for common diseases like infantile hemangiomas. The level of evidence was lower for systemic vs. local drugs. Clinical efficacy was more frequently reported in low quality studies (retrospective cohort studies and case reports) than in high quality studies (randomized clinical trial and meta-analysis).

Conclusion

Quality of research on drugs used for treating vascular anomalies in infants is poor and challenges rational drug use. Indeed, knowledge of drug treatment in VA relies mainly on research of poor methodological quality. Despite the use of drugs carrying a significant risk of adverse effects, drug safety is also poorly reported. This is alarming because some treatments, like antineoplastic agents and immunosuppressants, display an unsafe adverse effect profile. A publication bias towards positive results probably leads to overestimation of drug efficacy in vascular anomalies. An independent international pharmacovigilance system for drug use in vascular anomalies is proposed to improve efficacy and safety reporting and promote quality drug prescribing.
61 Adherence to Daily Medication Regimens in Pediatric Asthma: Do Socioeconomic Status and Daily Dose Frequency have an Impact?
Authors: Armellin-Ducharme Frédérique , Drouin Olivier
Published: October 2021

Primary Subject area

Respirology

Background

Children with asthma from lower socioeconomic status (SES), and those with poor adherence to controller medications have worse health outcomes, including higher rates of exacerbations and hospitalizations. Simpler medication regimens could potentially improve medication adherence and asthma control.

Objectives

We aimed to determine if: (1) medication adherence (proportion of prescribed days covered [PPDC]) and primary non-adherence (PPDC = 0%) varied by SES; and if (2) there was an interaction between SES and daily dose frequency on adherence.

Design/Methods

This retrospective cohort study included children 2-17 years old followed at the asthma clinic of a large Canadian pediatric hospital between 2011 and 2020. Patients were prescribed one of five medication regimens that included one or more of the following medication classes: inhaled corticosteroids (ICS), long-acting beta-agonists (LABA) and leukotriene receptor antagonists (LTRA). Primary outcome was medication adherence, using the PPDC: the number of days for which a medication was dispensed divided by the number of days for which it was prescribed. For regimens with two different medications, total PPDC was the average of the PPDCs for each medication. The main predictor was SES, measured by the Pampalon’s material deprivation index, a compounded index of income, employment, and education, based on postal codes. It is divided in quintiles, with quintile 1 being the least materially deprived. Comparison of PPDC between quintiles of SES was achieved by a Kruskal-Wallis test. Chi-square testing was used to assess the relationship between the proportion of patients with primary non-adherence (PPDC=0) and quintiles of SES. In the subset of patients who did not have primary non-adherence (n = 462), interaction between SES and daily dose frequency on log transformed PPDC was examined using linear regression models.

Results

Among 551 patients, mean age was 7.1 years (SD 3.8) (Table1), and there was a similar number of patients in each quintile of SES based on a chi-square goodness of fit test (p=0.61). For the overall sample, mean PPDC was 38.1% (SD 27.6). PPDC was not statistically different between quintiles of SES (p=0.57) (Figure 1). Distribution of primary non-adherence (PPDC = 0) in the cohort was independent of the quintiles of SES (p=0.57). Keeping SES constant, twice-daily dose frequency was associated with a 1.1% decrease in PPDC (p=0.85). The interaction between daily dose frequency and SES was not statistically significant (p=0.66).

Conclusion

Medication adherence (PPDC) and primary non-adherence (PPDC = 0) did not vary significantly by SES, but twice-daily dose frequency was associated with a small decrease in mean PPDC. Quebec’s mandatory medication insurance could potentially explain the absence of difference in medication adherence across SES quintiles.
67 Are NICUs too busy?
Authors: Beltempo Marc , Platt Robert , Julien Anne-Sophie , Blais Regis , Valerie Bertelle , Lapointe Anie , Lacroix Guy , Gravel Sophie , Cabot Michèle , Piedboeuf Bruno
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

In a health care system with limited resources, hospital organizational factors such as unit occupancy and nurse-to-patient ratios may contribute to patient outcomes.

Objectives

We aimed to assess the association of NICU occupancy and nurse staffing with outcomes of very preterm infants born < 33 weeks gestational age (GA).

Design/Methods

This was a multicenter retrospective cohort study of infants born 23-32 weeks GA without major congenital anomaly, admitted within 2 days after birth to one of four Level 3 NICUs in Quebec, Canada (2015-2018). For each 8 h shift, data on unit occupancy were obtained from a central provincial database (SiteNeo) and linked to the hospital nursing hours database (Logibec). Unit occupancy rates and nursing provision ratios (nursing hours/recommended nursing hours based on patient dependency categories) were pooled for the first shift, 24 h, and 7 days of admission for each infant. Patient data were obtained from the Canadian Neonatal Network database. Primary outcome was mortality and/or morbidity (severe neurological injury, bronchopulmonary dysplasia, necrotizing enterocolitis, and late-onset sepsis, severe retinopathy of prematurity). Adjusted odds ratios (AOR) for association of exposure with outcomes were estimated using generalized linear mixed models with a random effect for center, while adjusting for confounders (gestational age, small for gestational age, sex, outborn, Score for Neonatal Acute Physiology version 2, mode of delivery, and the other organizational variables).

Results

Among 1870 infants included in analyses, 796 (43%) had mortality/morbidity. Median occupancy was 89% (IQR 82-94) and median nursing provision was 1.13 (IQR 0.97-1.37). Overall higher NICU occupancy on shift of admission, first 24 h, and 7 days were associated with higher odds of mortality/morbidity (Figure 1) but nursing provision was not (Figure 2). Subgroup analysis by GA (< 29 and 29-32 weeks) yielded similar results (not shown). Generalized linear mixed model analyses showed that a 5% reduction in occupancy in the first 24 h of admission was associated with a 6% reduction in mortality/morbidity.

Conclusion

NICU occupancy is associated with mortality/morbidity among very preterm infants and may reflect lack of adequate resources in periods of high activity. Interventions aimed at reducing occupancy and maintaining adequate resources need to be considered as strategies to improve patient outcomes.
84 Looking back to move forward; can fetal placental inflammatory response play a role in risk of sepsis and clinical decision making in preterm infant
Authors: Hudson Jo-Anna , Viel-Thériault Isabelle , El Demellawy Dina , Ruschkowski Brittany , Tan Yvonne , Bijelic Vid , Rouvinez Bouali Nicole
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

Sepsis adversely impacts the survival of very low birth weight infants (VLBW), with a mortality risk up to 50%. Its diagnosis in premature infants is challenging. Conversely, prolonged antibiotic use is associated with perilous potential consequences, propelling the need to better identify those at risk of sepsis. The presence of a histological intra-amniotic inflammation (IAI) response may be associated with an increased risk of early onset sepsis (EOS). Currently, it is unknown how the diagnosis of histological IAI impacts the risk of sepsis.

Objectives

Our research goal is to explore histological fetal and maternal inflammation in the placenta in VLBW infants and to evaluate if specific recommendations about antibiotic management of VLBW infants with histological fetal response can be proposed.

Design/Methods

Retrospective cohort study of all infants < 1500 g born to a mother with histologically confirmed IAI. Demographic information about the pregnancy, delivery and postnatal course up to 28 days of life was extracted. Descriptive statistical analysis was conducted to compare the characteristics of infants with histological fetal response using χ2 test or Fisher’s exact test and Wilcoxon rank sum test or ANOVA.

Results

Seventy-three mother-baby pairs were reviewed. EOS prevalence (19%) in our IAI group of VLBW infants is much higher than EOS observed in all VLBW infants from the Canadian Neonatal Network database (below 3%). In our cohort, the majority had fetal inflammatory stage 1 (31.6%) and fetal inflammatory grade 0 (50%). There was no statistically significant distribution amongst the fetal stages or grades. Time to sepsis event analysis showed that the earlier fetal inflammatory grade was associated with positive cultures occurring earlier, while in the later grades there demonstrated longer latency to positive cultures. This trend was also true when looking at the maternal inflammatory stages. Nine infants who had antibiotics discontinued from day of life (DOL) 2-5 developed a positive blood culture ≤ DOL8.

Conclusion

Our results suggest that the presence of mild fetal inflammatory changes is associated with earlier positive cultures. We hypothesize that later grades may be associated with longer infection exposure leading to prolonged maternal antibiotics, resulting in less EOS. Majority of positive cultures were within the 3-8 day window, suggesting a role of knowing the fetal inflammatory response when deciding duration of antibiotic treatment.
119 Communicating Sensitive Information - An Exploration of Parental Perspectives on Prognostication of High Risk Infants
Authors: Fong Emily , Mesterman Ronit
Published: October 2021

Primary Subject area

Neonatal-Perinatal Medicine

Background

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

Objectives

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

Design/Methods

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

Results

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

Conclusion

Although clinicians often feel pressured to deliver answers, parents found it helpful when clinicians acknowledged and explained the uncertainty that surrounds prognostication. While healthcare providers may feel the need to prepare parents for the worst, the importance of balancing this information with hope and positivity is what families remember and value years after the prognosis was given.
122 Comparing the External Validity of Clinical Prediction Tools Incorporating Serum Procalcitonin to Identify Febrile Infants (0-90 days) at Low Risk for Serious Bacterial Infection: A Retrospective Analysis
Authors: Harper Chris , Trottier-Boucher Marie-Noelle , Chen Michael
Published: October 2021

Primary Subject area

Hospital Paediatrics

Background

Procalcitonin (PCT), a serum inflammatory biomarker, has recently been incorporated into several clinical decision tools to identify febrile infants at low risk for serious bacterial infection (SBI). These include the Pediatric Emergency Care Applied Research Network (PECARN) tool, the “Step-by-Step” approach, and the “Laboratory-Score.” Our institution is one of a few in Canada to incorporate serum PCT routinely, allowing us to complete these clinical decision tools. Thus, the objectives of this study were to externally validate and compare these tools in a Canadian pediatric population, indirectly assessing the utility of serum PCT in clinical practice.

Objectives

The primary outcomes were to derive the sensitivity, specificity, and negative predictive value (NPV) of each stratification tool in predicting SBI.

Design/Methods

We retrospectively reviewed the medical records of all infants less than 90 days of age presenting to our emergency departments between April 2016 and October 2019 with fever without a source, who had sufficient investigations to apply one (or more) of the above clinical decision tools.

Results

We applied the PECARN tool to 51 cases, and had sufficient data to apply the Step-by-Step and Lab Score criteria to 43 of these patients. Seventeen of the 51 patients (33%) were identified to have a SBI. The PECARN and Step-by-Step tools both had NPV of 100%; both were sensitive enough to detect all patients with SBI. They had poor specificity (0.47 and 0.55 respectively). These two tools were in agreement in 38 of 43 (88%) cases. Though the Laboratory-Score had the highest positive predictive value (0.88) and specificity (0.85), it failed to identify 3 of 16 true cases of SBI and had a suboptimal sensitivity of 0.81.

Conclusion

The ability to identify febrile infants at low risk for SBI in a reliable way would have significant clinical potential to change practice. Given the strong NPV of both the PECARN and Step-by-Step tools, we conclude that their use, incorporating the measurement of serum PCT, may be of use in reducing pediatric hospitalization, use of empiric broad-spectrum antibiotics, and investigations such as lumbar punctures, in these low-risk patients. This study had a small sample size. We look forward to analyzing a larger population of febrile infants, particularly in infants of a chronologic age (28-90 days) more amenable to clinical practice change.
127 Impact of CYP2D6, CYP3A4, and CYP2C9 pharmacogenomic profile on pain relief and adverse events in Canadian children treated with oxycodone and ibuprofen
Authors: Yukseloglu Aran , Ali Samina , Drendel Amy , Carleton Bruce , Ross Colin , Le May Sylvie , Manaloor Robin , Rosychuk Rhonda , Johnson David
Published: October 2021

Primary Subject area

Clinical Pharmacology and Toxicology

Background

Genomic variation impacts drug pharmacokinetics for commonly used children’s pain medications such as oxycodone and ibuprofen. In order to personalize and best treat children’s pain, how cytochrome enzyme polymorphisms for CYP2D6, CYP3A4, and CYP2C9 impact clinical effectiveness and safety for oxycodone and ibuprofen were studied.

Objectives

Primary objectives were to evaluate if allelic variations of CYP2D6, CYP2C9, and CYP3A4 would a) alter clinical effectiveness of ibuprofen and oxycodone for pain relief, and b) impact the occurrence of adverse events. Secondary objectives were to determine the degree to which these genetic and other clinical factors influence analgesic effectiveness and safety.

Design/Methods

This prospective, observational cohort included children aged 4-16 years who were seen in a pediatric emergency department (between June 2010 - July 2014) with an acute fracture and used ibuprofen OR oxycodone for at-home pain management. Saliva samples were obtained prior to discharge, and daily telephone follow-up collected self-reported pain scores, medication use, adverse events, and functional limitations for 3 days. Genotyping identified allelic variants of CYP2D6, CYP3A4, and CYP2C9. Pain was measured using the Faces Pain Scale-Revised. CYP2D6 metabolic phenotypes were determined based on identified variants. Regression analyses were employed to determine relationships between clinical and genomic patient characteristics, pain relief, and adverse events.

Results

We included 210 children (n=140 ibuprofen, n=70 oxycodone); mean age was 11.1 (±3.5) years, 66.2% were male, and 79.5% self-identified as Caucasian. The median pain reduction in the ibuprofen group was 4 (±2.0) and 4 (±3.5) in the oxycodone group on Day 1 (p = 0.69). Adverse events were experienced by 53.2% of the ibuprofen group and 78.3% of the oxycodone group (p < 0.001). CYP2D6 Intermediate Metabolizers had significantly less pain relief using oxycodone than Extensive Metabolizers (p = 0.04). CYP3A4 variants did not significantly impact pain relief or adverse events. Those with the decreased functioning CYP2C9*2 allele experienced less adverse events compared to the normal functioning allele CYP2C9*1 (p = 0.003) when using ibuprofen. Males (p = 0.035) and all children using non-pharmacological pain strategies (p = 0.02) experienced less pain relief with oxycodone.

Conclusion

A better understanding of pharmacogenomic variation could help personalize medication choice. Sex and non-pharmacologic pain management impact pain relief with oxycodone, warranting further study to better understand their relationship with opioid pain relief in children.
151 For The Parent, By The Parent: Defining the Characteristics of a Novel Program to Empower Parents of Refugee Background Using the Participatory Approaches
Authors: Kaur Pardeep , Minhas Ripudaman , Ho Bernice
Published: October 2021

Primary Subject area

Developmental Paediatrics

Background

With more than 28 million individuals of refugee or asylum-seeking background globally, the current situation has been described as one of the largest humanitarian crises of all time. Families of refugee background have complex, multigenerational mental health and developmental needs that are not accounted for in current programming frameworks. Difficulties in resettlement have been further compounded by COVID-19-related lockdowns, straining parental mental health and placing children at an increased risk for developmental or behavioural problems. Providing appropriate support services and educational resources that address the multigenerational concerns of families of refugee background will address these challenges, allowing for improved parental mental health, family cohesion, and developmental outcomes for children.

Objectives

To gather data about the experiences, resources, referral pathways and barriers that impact the experience of parents of refugee background in the Greater Toronto Area (GTA) and to develop a novel, multi-dimensional parenting program model using Community-Based Participatory Research (CBPR) principles.

Design/Methods

This was a qualitative community-based participatory study using a formative research framework, in accordance with COREQ guidelines. In-depth interviews (IDIs) were conducted with parents of refugee background and care providers that work closely with this population. Data were recorded, transcribed, and coded using deductive and inductive coding methods by two independent coders. A peer debriefing strategy was used to verify the coding approach and interpretation of findings in accordance with the RATS (relevancy, appropriateness, transparency and soundness) guidelines for qualitative research.

Results

A total of 20 IDIs were conducted (7 parents and 13 care providers). The main topics that were identified to be incorporated into the program include features of child development, how to address resettlement issues, child advocacy, and parenting in the Canadian context. Participants felt that tackling the language barriers, addressing the overlapping responsibilities of the mothers attending the sessions, providing incentives, increasing awareness of the program, and using an anti-racist and anti-oppressive approach is key to the program’s success. Participants emphasized the need for trauma-informed mental health support within the program model.

Conclusion

This study describes the key considerations for a novel parenting program for families of refugee background, by engaging them as key stakeholders in the program design process. Future iteration of this project would involve a pilot and evaluation of the program.
Increased endogenous reactive oxygen species normalizes proliferation defects of Bmi1 heterozygous knockout neural stem cells
Authors: Cao Qiuchen , Wang Tianqi , Xiao Ming , Bai Lei
Published: October 2021

Objectives

The Bmi1gene, one of transcriptional suppressor genes in multi-comb family, maintains proliferation of neural stem cells (NSCs) and redox homeostasis. However, heterozygous deletion of the Bmi1 gene (Bmi1+/−) does not reduce the proliferative ability of NSCs. The aim of the present study was to reveal the underlying mechanism of this phenotype.

Methods

NSCs derived from the cortex of newborn Bmi1+/− and wild-type (WT) mice were treated with different concentrations of hydrogen peroxide (H2O2) and antioxidant N-acetyl-L-cysteine (NAC) for 24 h followed by analyses of NSC proliferation and oxidative stress-related indexes.

Results

The levels of reactive oxygen species (ROS) of Bmi1+/−-NSCs were slightly higher than that of WT-NSCs at baseline. H2O2 increased ROS and NAC reduced ROS in a concentration-dependent pattern, but the change was significantly greater in Bmi1+/−-NSCs than WT-NSCs. The proliferation and self-renewal ability of Bmi1+/−-NSCs and WT-NSCs were comparable in a basic state. After 1 μM H2O2 treatment, Brdu incorporation ratio, cell viability, total antioxidant capacity (T-AOC) and total superoxide dismutase activity were increased slightly in WT-NSCs, but decreased in Bmi1+/−-NSCs. H2O2 at 10 μM decreased proliferation and self-renewal ability of both genotype NSCs, with greater effect in Bmi1+/−. After treatment with 1 mM NAC, the number and diameter of neurospheres, Brdu incorporation rate, cell viability, T-AOC and total superoxide dismutase activity of Bmi1+/−-NSCs were lower than those of WT-NSCs.

Conclusion

These results suggest that Bmi1+/−-NSCs exhibit normal proliferation and self-renewal due to a slight increase in ROS, but are more vulnerable to changes in redox status.
Neuronally Produced Betaine Acts via a Novel Ligand Gated Ion Channel to Control Behavioural States
Authors: Hardege I , Morud J , Yu J , Wilson TS , Schroeder FC , Schafer WR
Published: October 2021

Trimethyl glycine, or betaine, is an amino acid derivative found in diverse organisms, from bacteria to plants and animals. It can function as an osmolyte to protect cells against osmotic stress, and building evidence suggests betaine may also play important functional roles in the nervous system. However, despite growing interest in betaine’s roles in the nervous system, few molecular mechanisms have been elucidated. Here we identify the expression of betaine synthesis pathway genes in the nervous system of the nematode worm, C. elegans. We show that betaine, produced in a single pair of interneurons, the RIMs, can control complex behavioural states. Moreover, we also identify and characterise a new betaine-gated inhibitory ligand gated ion channel, LGC-41, which is required for betaine related behavioural changes. Intriguingly we observed expression of LGC-41 in punctate structures across several sensory and interneurons, including those synaptically connected to the RIMs. Our data presents a neuronal molecular mechanism for the action of betaine, via a specific receptor, in the control of complex behaviour within the nervous system of C. elegans. This may suggest a much broader role for betaine in the regulation of animal nervous systems than previously recognised.
Silencing of an efflux pump coding gene decreases the efflux rate of pyrazinoic acid in Mycobacterium smegmatis
Authors: Quiñones-Garcia Stefany , Gilman Robert H. , Sheen Patricia , Zimic Mirko
Published: October 2021

Background

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (MTB). The recommended treatment for TB is based on the use of first-line drugs, including pyrazinamide (PZA). PZA is also a drug used in the treatment of multidrug-resistant TB (MDR-TB) because of its main effect against the latent stage. The main cause of resistance to PZA is mutations in the pncA gene, which compromise the activity of the encoded enzyme pyrazinamidase (PZAse), which hydrolyzes PZA into POA, the active antituberculosis molecule. The mechanism of action of PZA requires that POA is expelled from the bacterium by an efflux mechanism. After that, if the extracellular medium is sufficiently acidic, POA is protonated and returns to the cytosol, releasing the proton and repeating the cycle, resulting lethal to the bacteria. The efflux pump responsible for extruding the POA to the extracellular environment is not yet known. Mycobacterium smegmatis is naturally resistant to PZA and has a 900-fold faster POA efflux rate than MTB, and has the advantage to be a faster growing mycobacterium.

Methods

In the present study we have silenced the transcription of several genes encoding efflux pumps in M. smegmatis by CRISPRi (CRISPR interference). These genes (MSMEG_0250, MSMEG_3815, MSMEG_0241, MSMEG_5046 and MSMEG_0410) were homologous to efflux pump genes in MTB. POA efflux rate was measured, and a quantitative Wayne’s test was performed after silencing each gene.

Results

Silencing of MSMEG_0250, resulted in approximately 5-fold decrease in the POA efflux rate in M. smegmatis (P<0.0001). None of the other silenced genes showed a notable decrease in POA efflux rate.
Vaccine-induced humoral and cellular immunity against SARS-CoV-2 at 6 months post BNT162b2 vaccination
Authors: Kato Hideaki , Miyakawa Kei , Ohtake Norihisa , Yamaoka Yutaro , Yajima Satoshi , Yamazaki Etsuko , Shimada Tomoko , Goto Atsushi , Nakajima Hideaki , Ryo Akihide
Published: October 2021

To evaluate vaccine-induced humoral and cell-mediated immunity at 6 months post BNT162b2 vaccination, immunoglobulin G against SARS-CoV-2 spike protein (SP IgG), 50% neutralizing antibody (NT50), and spot-forming cell (SFC) counts were evaluated by interferon-γ releasing ELISpot assay of 98 healthy subjects (median age, 43 years). The geometric mean titers of SP IgG and NT50 decreased from 95.2 (95% confidence interval (CI) 79.8–113.4) to 5.7 (95% CI 4.9–6.7) and from 680.4 (588.0–787.2) to 130.4 (95% CI 104.2–163.1), respectively, at 3 weeks and 6 months after the vaccination. SP IgG titer was negatively correlated with age and alcohol consumption. Spot-forming cell counts at 6 months did not correlate with age, gender, and other parameters of the patients. SP IgG, NT50, and SFC titers were elevated in the breakthrough infected subjects. Although the levels of vaccine-induced antibodies dramatically declined at 6 months after vaccination, a certain degree of cellular immunity was observed irrespective of the age.
Questing a walkable city: a case of urban neighbourhood walkability environment in Bangladesh
Authors: Shuaib A.S.M. , Rana Md Masud Parves
Published: October 2021

Purpose

What makes neighbourhood environment more walkable is an important question for urban planning and design research. The purpose of this paper is to explore this question through a case study of urban sidewalks in different contexts of urban neighbourhoods in Rajshahi city of Bangladesh.

Design/methodology/approach

Using participatory observation, Google street view and photography techniques, it examines the quality of the street facilities by demonstrating physical attributes of sidewalks and by analysing how various obstructions on them characterize neighbourhood walkability environment.

Findings

The findings suggest that the unusable sidewalks in Rajshahi city, Bangladesh, are a production of inadequate and inappropriate planning and design that unable to capitalize the functionality of sidewalks as a means of walking. It further argues that the urban planners and designers of streets have paid little attention to the diverse requirements of sidewalks in accordance with spatial and socio-economic categories of urban neighbourhoods.

Originality/value

This study adds insights about the urban sidewalks planning and design in the context of a developing country. It provides an empirical evidence about the constraints and potentials of making a walkable city.
Sensitivity of Remotely Sensed Vegetation to Hydrologic Predictors across the Colorado River Basin, 2001–2019
Authors: Saby Linnea , McKee Kevin L. , Kansara Prakrut , Goodall Jonathan L. , Band Lawrence E. , Lakshmi Venkataraman
Published: October 2021

In water‐limited regions, it is important to understand the response of vegetation to hydrologic predictors for fire management and water resource planning. We present a novel spatially distributed analysis of ecohydrological interactions in the semi‐arid Colorado River Basin (CRB) over 18 years, 2001–2019. The hydrologic predictors used include precipitation from the Integrated Multi‐satellitE Retrievals for GPM, 0‐ to 10‐cm‐depth surface soil moisture (SSM) estimations from the National Land Data Assimilation System, and newly available 0‐ to 40‐cm depth Soil MERGE root zone soil moisture (RZSM) estimations. These are evaluated using time‐lagged correlations with the Enhanced Vegetation Index (EVI) from MODerate Resolution Imaging Spectroradiometer (MODIS). We demonstrate that EVI response is strongest and most immediate to the hydrologic predictors in the hot and dry southwestern CRB, with lag times of 0–32 days. RZSM was expected to provide the best predictor of EVI, but we found SSM to be a superior predictor of EVI with interquartile range correlations of 0.20–0.37 across the CRB. RZSM had slightly lower interquartile range correlations of 0.15–0.35, and precipitation was the least effective predictor of EVI with interquartile range correlations of 0.11–0.26. Plotting these cross‐correlations provides a spatially explicit overview of temporal dependence between SSM, RZSM, precipitation, and EVI with publicly available datasets.
Can digital transformation improve the information environment of the capital market? Evidence from the analysts' prediction behaviour
Authors: Chen Wanyi , Zhang Liguang , Jiang Pinyan , Meng Fanli , Sun Qianyi
Published: October 2021

This study tests the impact of enterprise digital transformation on the information environment. The results show that while analyst coverage increase significantly and the accuracy of public information improves after enterprises implement digital transformation, there is no significant change in the accuracy of private information. The main influence channels are information disclosure quality and stock price information content. Further analysis shows that this relationship is affected by cyber‐attacks, market competition, and social media. This study enriches the analytical paradigm of the influencing factors of analysts' prediction behaviour and provides evidence for exploring digital transformation in the emerging capital market.
Repeated echocardiographic imaging of aortic stenosis: Real‐life lessons
Authors: Bray Jonathan J. H. , Ionescu Adrian
Published: October 2021

Background

Timing of aortic valve intervention is dependent on the accuracy and reproducibility of echocardiographic (ECHO) parameters. We aimed to assess haemodynamic subsets of aortic stenosis (AS), their change over time, and variability of ECHO parameters.

Method

This retrospective, longitudinal study compared sequential ECHO over 15 months to identify concordant or discordant aortic valve area (AVA) and mean pressure gradient (MPG) in order to determine the real world variability of echocardiographic indices.

Results

We included 143 patients with a mean age of 76.0 years. The median length of time between studies was 112 days (IQR 38–208). Initially, participants were classified as 9 (6.4%) mild, 47 (33.6%) moderate, and 84 (60.0%%) severe AS. In 80 (55.9%) AVA and MPG were concordant; stroke volume index (SVi) was < 35 mL/m2 in 53 (74.6%). AS severity was downgraded in 29 (20.7%) patients. MPG was most consistent and AVA was the least consistent between successive investigations (intraclass correlation coefficients R = .86 and R = .76, respectively). Even small variations in left ventricular outflow tract (LVOT) measurement of 1 standard deviation reclassified up to 67% of participants from severe to non‐severe.

Conclusion

Almost half of patients with AS have valve area/gradient discordance. Variations in LVOT diameter measurement commensurate with clinical practice reclassified AS severity in up to two‐third of cases. Change in AS severity should only be accepted following careful scrutiny of all available ECHO data.
Application of kinesiology taping to equine abdominal musculature in a tension frame for muscle facilitation increases longitudinal activity at the trot
Authors: Biau Sophie , Burgaud Isabelle
Published: October 2021

Background

Kinesiology taping (KT) has been used on human subjects for many years. More recently, KT has been used in sport horses. The physiological mechanisms involved remain unclear and its benefits are controversial.

Objectives

To investigate the effects of application of kinesiology taping to abdominal muscles on locomotor parameters before and after lungeing exercise in horses.

Study design

Cross‐over study.

Methods

Eleven horses were tested twice, once with an application of KT without tension on abdominal muscles (condition 1) and once with a facilitation application of KT on abdominal muscles (condition 2). A triaxial accelerometric device, located in the trunk (Equimetrix system®), was used at walk and trot in hand on a straight line before (30 min after the KT application) and after a lungeing session. Locomotor parameters were calculated, including stride frequency, regularity and symmetry, dorsoventral displacement and dorsoventral, mediolateral and longitudinal activities.

Results

At trot, the longitudinal activity was significantly higher for condition 2 than for condition 1, before (7.6 ± 1.8 W/kg vs. 5.4 ± 2.2 W/kg, P = .02) and after (7.3 ± 1.3 W/kg vs. 6.1 ± 1.7 W/kg, P = .005) the lungeing session.

Main limitations

The speed was not measured. The recording conditions and the experimenter, unaware of conditions, were the same for all horses to limit variations.

Conclusions

Kinesiology taping on abdominal muscles immediately increased longitudinal activity at trot in hand and this benefit was still present after a lungeing session. Longitudinal activity is a sought‐after quality; thus, this method could be used as a way to enhance a training program. Future investigations are needed to confirm this result in horses being ridden.