bluuebunny/crossref_metadata_2025 huggingface dataset:
Mass fraction assignment of folic acid in a high purity material
Authors: Westwood Steven , Josephs Ralf , Choteau Tiphaine , Daireaux Adeline , Stoppacher Norbert , Wielgosz Robert , Davies Stephen , Rego Eliane de , Wollinger Wagner , Garrido Bruno , Fernandes Jane , Lima Jonathan , Oliveira Rodrigo , Sena Rodrigo de , Windust Anthony , Huang Ting , Dai Xinhua , Quan Can , He Haihong , Zhang Wei , Wei Chao , Li Na , Gao Dexin , Liu Zhao , Lo Man-fung , Wong Wai-fun , Pfeifer Dietmar , Koch Matthias , Dorgerloh Ute , Rothe Robert , Philip Rosemary , Hirari Nobuyasu , Rezali Mohd Fazlin , Arzate Claudia Marcela Salazar , Berenice Mercado Pedraza Evelina , Caballero Victor Serrano , Osuna Mariana Arce , Krylov A , Kharitonov S , Lopushanskaya E , Liu Qinde , Lin Teo Tang , Fernandes-Whaley Maria , Quinn Laura , Nhlapo Nontete , Prevoo-Franzsen Desiree , Archer Marcelle , Kim Byungjoo , Baek Song-Yee , Lee Sunyoung , Lee Joonhee , Marbumrung Sornkrit , Kankaew Ponhatai , Chaorenpornpukdee Kanokrat , Chaipet Thitiphan , Shearman Kittiya , Goren Ahmet Ceyhan , Gunduz Simay , Yilmaz Hasibe , Un Ilker , Bilsel Gokhan , Clarkson Cailean , Bedner Mary , Camara Johanna E , Lang Brian E , Lippa Katrice A , Nelson Michael A , Toman Blaza , Yu Lee L
Published: May 2018

The comparison required the assignment of the mass fraction of folic acid present as the main component in the comparison sample. Performance in the comparison is representative of a laboratory's measurement capability for the purity assignment of organic compounds of medium structural complexity [molecular weight range 300–500] and high polarity (pKOW < −2).

Methods used by the eighteen participating NMIs or DIs were based on a mass balance (summation of impurities) or qNMR approach, or the combination of data obtained using both methods. The qNMR results tended to give slightly lower values for the content of folic acid, albeit with larger associated uncertainties, compared with the results obtained by mass balance procedures. Possible reasons for this divergence are discussed in the report, without reaching a definitive conclusion as to their origin.

The comparison demonstrates that for a structurally complex polar organic compound containing a high water content and presenting a number of additional analytical challenges, the assignment of the mass fraction content property value of the main component can reasonably be achieved with an associated relative standard uncertainty in the assigned value of 0.5%

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCQM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
Disease classification: from phenotypic similarity to integrative genomics and beyond
Authors: Dozmorov Mikhail G
Published: May 2018

A fundamental challenge of modern biomedical research is understanding how diseases that are similar on the phenotypic level are similar on the molecular level. Integration of various genomic data sets with the traditionally used phenotypic disease similarity revealed novel genetic and molecular mechanisms and blurred the distinction between monogenic (Mendelian) and complex diseases. Network-based medicine has emerged as a complementary approach for identifying disease-causing genes, genetic mediators, disruptions in the underlying cellular functions and for drug repositioning. The recent development of machine and deep learning methods allow for leveraging real-life information about diseases to refine genetic and phenotypic disease relationships. This review describes the historical development and recent methodological advancements for studying disease classification (nosology).
Large Traumatic Skull Base Internal Carotid Artery Pseudoaneurysm managed With Endovascular Flow Diversion: 2-Dimensional Operative Video
Authors: Rajah Gary , Garling Richard Justin , Rangel-Castilla Leonardo
Published: May 2018

We present a case of a traumatic skull base internal carotid artery (ICA) pseudoaneurysm treated with endovascular flow diversion stenting. The patient was a 27-year-old male who was involved in a motorcycle accident suffering multiple traumatic injuries including a large skull base fracture that extended through the carotid canal. Computed tomography angiography revealed a 2-cm right ICA pseudoaneurysm. Once the patient was stable, a digital subtraction angiography demonstrated enlargement of the pseudoaneurysm. After his other injuries were addressed by trauma and orthopedic surgery, at day 9 after his initial injury, the patient was loaded with aspirin and clopidrogel in preparation for stent reconstruction of his ICA injury. Under conscious sedation and systemic heparinization, the patient underwent endovascular reconstruction of the large pseudoaneurysm using telescoping flow diversion stents. Immediate intra-aneurysm flow stasis was observed. No procedure-related complications occurred. The patient did well and at last follow-up remained neurologically intact.
TWO YEARS IN THE DEVELOPMENT OF A NEW INTERDISCIPLINARY PEDIATRIC CHRONIC PAIN PROGRAM: OPPORTUNITIES, INITIATIVES, AND CHALLENGES
Authors: Edwards Kim , Elik Nez , McMurtry C Meghan , Findlay Sheri , Rodrigues Allison , Kattailr Deepa
Published: May 2018

BACKGROUND

“…The field of paediatric pain medicine has demonstrated the benefits of interdisciplinary collaboration more than any other endeavour” (Law, Palermo, & Walco, 2013). Recently, the Ontario Ministry of Health and Long-term Care announced the funding of specialty paediatric chronic pain programs in several children’s hospitals across the province of Ontario, including McMaster Children’s Hospital. The Pediatric Chronic Pain Program includes Physicians (Pediatricians, Psychiatrist, Anesthesiologist), Psychologists, Child Life Specialist, Registered Nurse, Nurse Practitioner, Occupational Therapist, Physiotherapist, Social Workers, Pharmacist, and a Clinical Manager.

OBJECTIVES

The purpose of this poster is to highlight new initiatives within our clinic, including the development of a pain education session for families, group treatments (e.g., a 5 week Rise Above Pain Group; a 5-week Parenting Group), and a research database (to allow for program evaluation integrated within our clinical work).

DESIGN/METHODS

Challenges in developing a new clinic/new programs and providing care to complex families (e.g., professional roles and competencies, diagnostic discrepancies) will be discussed.

CONCLUSION

Implications for program development in new and established clinics will be highlighted.
INTERVENTIONS TO ASSIST PARENTS IN ACCURATELY DOSING LIQUID MEDICATIONS FOR THEIR CHILDREN: A SCOPING REVIEW
Authors: Pan Jun Feng (Alex) , Hurley Katrina , Curran Janet , Fitzpatrick Eleanor
Published: May 2018

BACKGROUND

Parents’ inaccurate dosing of liquid medications for their children is common, resulting in treatment failure and potential adverse effects. Educational interventions delivered by health care professionals are a means to help parents properly administer liquid medications.

OBJECTIVES

This scoping review was conducted to identify and describe empirically researched educational interventions that prevent inaccurate dosing of liquid medications by parents of children less than 12 years old.

DESIGN/METHODS

We conducted a scoping review using the Joanna Briggs Institute Methodology for Scoping Reviews. With assistance from a library scientist, we searched PubMed, CINAHL, and Web of Science for English-language articles published before June 2017. We also looked at the reference lists of the included articles and subsequent articles that have cited them to identify additional studies (forward and backward searching). Two reviewers independently screened the retrieved titles and abstracts using predetermined criteria. Only quantitative, empirically designed studies that examined interventions delivered by health care professionals to help parents of children under 12 years old to accurately dose liquid medications were included. We appraised the quality of the included articles using the mixed methods appraisal tool (MMAT) and conducted a thematic analysis to identify trends and patterns.

RESULTS

Of the 180 abstracts identified in the search strategy, 9 studies met our inclusion criteria. We identified four main types of interventions: 1. use of visual aids (n=6); 2. use of advanced counselling strategies (n=2); 3. use of standardized measuring tools (n=3); and, 4. use of standardized units of measurement (n=2). Some studies evaluated more than one type of intervention. The overall quality of the included studies was moderate, with 11.1% (n=1) scoring 0.25, 33.3% (n=3) scoring 0.50, 55.6% (n=5) scoring 0.75, and none scoring 1.0.

CONCLUSION

Dosing accuracy of liquid medication for children by their parents is an important topic. More high quality studies conducted by a variety of research groups are needed to ensure the development and implementation of effective evidence-based educational interventions. There is a lack of standardization in the definition of a dosing error. Consensus regarding a standard definition would help studies be more comparable.
Final Results of National Surveillance of Childhood Tuberculosis in Canada: 2013–2016
Authors: Giroux Ryan , Montgomery-Song Aaryn , Consunji-Araneta Raquel , Kitai Ian , Morris Shaun
Published: May 2018

BACKGROUND

There is little detailed epidemiologic and clinical data about tuberculosis (TB) disease in children in Canada.

OBJECTIVES

This study characterizes the epidemiologic, clinical, and treatment data for all cases of TB in children under age 15 in Canada surveyed through the Canadian Paediatric Surveillance Program’s (CPSP) Childhood Tuberculosis Study from October 2013 to September 2016.

DESIGN/METHODS

New active TB cases were identified through a monthly form sent by the CPSP to approximately 2500 active paediatricians, paediatric subspecialists, and select non-paediatricians who manage childhood TB. For cases meeting inclusion criteria, a detailed questionnaire was sent to the treating physician to collect clinical, epidemiological, and treatment data, followed by 6-month follow-up surveys until 6 months after treatment completion. Cases were reviewed by at least one TB specialist for inclusion and classification of disease.

RESULTS

Of 285 unique incident cases reported, 188 cases met inclusion criteria, returned a detailed questionnaire, and were classified. Selected demographic data are shown in Table 1.

92% of cases had intrathoracic involvement (N=172, 91%), but a minority were confirmed by culture or nucleic acid amplification (62/172, 36%). The most common sites of intrathoracic involvement were lymph nodes (N=118, 69%) and lungs (N=54, 31%). There were 143 attempted respiratory microbiological studies, with 32 (22%) yielding a positive culture or NAAT in sputum and 33 (23%) in gastric aspirate. Highest yield was in the 10+ age group with 54% (20/37) positivity.

31 cases of extrathoracic TB were recorded, with 19/35 (54%) having simultaneous intrathoracic TB. The most common forms of extrathoracic TB included CNS or meningeal disease (N=13) and extrathoracic lymphadenopathy (N=11). Miliary or disemminated disease (2 or more non-continguous sites involved) was found in 15 cases (8%).

16 cases reported at least one adverse drug reactions, with pyrazinamide (N=10) and isoniazid (N=5) being most common. 4 children were hospitalized and the most common ADR was hepatotoxicity. There was one case of multi-drug resistant TB.

CONCLUSION

This study suggests a high incidence of TB in Inuit and First Nations children, as well as a higher proportion of extrathoracic TB and greater success in culture positivity in children aged 10+. It also shows a significant number of adverse drug reactions to anti-TB treatment. Further analysis of this data will serve to refine practice in monitoring, detecting, and treating this infection.
OUTCOMES IN EXTREMELY PREMATURE INFANTS WITH TWIN-TWIN TRANSFUSION SYNDROME TREATED BY LASER THERAPY
Authors: Sommer Julie , Altit Gabriel , Nuyt Anne-Monique , Audibert François , Dorval Véronique , Lapointe Anie
Published: May 2018

BACKGROUND

Twin pregnancies and fetal therapies are associated with increased risk of preterm delivery. Limited literature exists on outcomes for extremely preterm infants born in the context of a pregnancy complicated with twin-twin transfusion syndrome (TTTS).

OBJECTIVES

To compare mortality of preterm newborns who received laser therapy for TTTS to preterm controls born in the context of a dichorionic-diamniotic (di-di) pregnancy. Secondary outcomes are: short-term neonatal morbidities and neurodevelopmental measures at 18 months of corrected gestational age (cGA).

DESIGN/METHODS

Case-control retrospective study of all twins infant born <29 weeks of gestation between 2006 and 2015 at Sainte-Justine Hospital. Preterm with TTTS and fetal laser therapy were compared to preterm di-di twins. Survival analysis was done using Cox proportional regression model.

RESULTS

Thirty-three preterms with TTTS (TTTS-laser group) were compared to 101 preterms without TTTS (non-TTTS group). Demographic data and comparisons for short-term morbidities are presented in Table 1. TTTS status was not associated with increased mortality when adjusting for birth weight and antenatal steroids (Table 2). No differences were found for Bayley-3rd edition score, cerebral palsy, vision impairment, hearing impairment and growth parameters at 18-month cGA.

CONCLUSION

Extremely premature newborns exposed to fetal laser therapy due to TTTS had similar survival and neurodevelopmental outcomes compared to contemporaneous extremely preterm di-di twins.
USING DIFFERENT CHEST COMPRESSIONS AND VENTILATION RATIOS (2:1, 3:1, 4:1) DURING NEONATAL ASPHYXIA IN A PORCINE MODEL OF NEONATAL RESUSCITATION – A RANDOMIZED CONTROLLED ANIMAL TRIAL
Authors: Pasquin Matteo , Cheung Po-Yin , Wagner Michael , Lee Tze-Fun , O’Reilly Megan , Schmolzer Georg
Published: May 2018

BACKGROUND

The rationale for a compression to ventilation ratio of 3:1 in neonates with primary hypoxic, hypercapnic cardiac arrest is to emphasize the importance of ventilation; however, there are no published studies testing this approach against alternative methods.

OBJECTIVES

To evaluate if using a 2:1 C:V ratio or a 4:1 C:V ratio will improve ROSC compared to using a 3:1 C:V ratio.

DESIGN/METHODS

Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 40-min normocapnic hypoxia followed by asphyxia. Asphyxia was achieved by clamping the endotracheal tube until the piglet had asystole; at that time CPR was initiated. Piglets were then randomized into 3 groups: 2:1 C:V ratio (n=8), 3:1 ratio (n=8), 4:1 C:V ratio (n=8), or a sham operated group. A two-step randomization was used to reduce selection bias. After surgical instrumentation and stabilization, a sequentially numbered, sealed brown envelope containing the allocation “sham” or “intervention” was opened (step one). The sham-operated group had the same surgical protocol, stabilization, and equivalent experimental periods without hypoxia and asphyxia. Only piglets randomized to “intervention” underwent hypoxia and asphyxia. Once the criteria for CPR were met, a second envelope containing the allocations “2:1”,“3:1”,or “4:1”, was opened (step two). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment.

RESULTS

The median (IQR) duration of asphyxia was similar between the groups with 318 (194–576)sec, 255 (226–334)sec, 233 (169–395)sec for 2:1, 3:1, 4:1 C:V, respectively (p=0.68; oneway ANOVA with Bonferroni). The median (IQR) time to ROSC was also similar between groups 127 (82–210)sec, 96 (88–126)sec, 119 (83–256)sec for 2:1, 3:1, 4:1 C:V, respectively (p=0.67; oneway ANOVA with Bonferroni). Overall, 8/8 in the 2:1 C:V ratio group, 7/8 in the 3:1 C:V ratio group, and 7/8 in the 4:1 C:V ratio group survived.

CONCLUSION

There was no significant difference in time to ROSC for either chest compression technique during cardiopulmonary resuscitation in a porcine model of neonatal asphyxia.
Impact of high flow nasal cannula implementation on the rate of intubation for bronchiolitis in Canada
Authors: Garland Hilarie
Published: May 2018

BACKGROUND

Bronchiolitis affects more than one-third of children less than two years of age and is the most common reason for admission to hospital in the first year of life. Hospitalization rates have been on the rise, leading to an increase in healthcare expense, morbidity and impact on families. Bronchiolitis can have a heavy burden on health care resources including intubation and Intensive Care Unit (ICU) admissions. Non-invasive respiratory support with high-flow nasal cannula (HFNC) is being used more routinely in paediatric centers, though evidence of efficacy in bronchiolitis is insufficient to date. We examined the impact that implementation of HFNC has had on intubation rate and ICU admissions for patients with bronchiolitis in Paediatric centres in Canada.

OBJECTIVES

Our primary objective was to determine the impact of HFNC on intubation rate in Canada for paediatric patients with bronchiolitis. Our secondary objectives were to determine the impact of HFNC on ICU admission rate, ICU length of stay (LOS) and total hospital LOS.

DESIGN/METHODS

We conducted a multicentre, interrupted time series analysis to examine intubation rates pre- to post-implementation of HFNC for children less than 2 years with bronchiolitis. Data were obtained from the CIHI database using the Canadian Coding Standards. Paediatric tertiary centres that introduced HFNC between 2009–2014 were included, and data were collected from January 2005 to December 2016.

RESULTS

A total of 17,643 patients met inclusion criteria; 5,862 were before and 11,791 after implementation of HFNC. Comparing the two groups, there was no significant change in the rate of intubation after HFNC was introduced. There was also no significant change in the trend of average LOS in hospital between the two groups. There was a significant increase in ICU admission rates after the introduction of HFNC. Prior to HFNC implementation, there was an increase in average ICU LOS, with a decrease in the overall trend following the introduction of HFNC.

CONCLUSION

Initiating HFNC in Canadian paediatric centres resulted in no significant change in intubation rates or total LOS in hospital, but was associated with an increase in ICU admissions and a decrease in ICU LOS. Though HFNC does not prevent intubations, it may improve clinical severity with shorter time in ICU needed. Adopting use of HFNC on the ward in the tertiary care setting may help to address increasing ICU admission rates with associated healthcare expenses.
UNRAVELING INCONTINENTIA PIGMENTI: A COMPARISON OF PHENOTYPE AND GENOTYPE VARIANTS
Authors: Wang Rebecca , Lara-Corrales Irene , Kannu Peter , Pope Elena
Published: May 2018

BACKGROUND

Incontinentia pigmenti (IP) is a rare X-linked dominant genodermatosis that predominantly affects the skin, beginning with a characteristic linear vesicular rash shortly after birth. Multisystem abnormalities can further be seen in hair, nail, ocular, dental, and central nervous system. Although most affected individuals carry a common pathological deletion of the IKBKG gene, approximately 20% have no molecular confirmation. There remains a lack of understanding of phenotypic variations between mutation positive and negative patients with IP.

OBJECTIVES

We aim to 1) Describe clinical characteristics, phenotype, and genotype of patients with IP, and 2) Compare clinical differences between mutation positive and negative cohorts.

DESIGN/METHODS

A retrospective chart review was conducted at a large tertiary paediatric centre from January 1990 to June 2017, for children under 19 with a clinical diagnosis of IP by a paediatric dermatologist or geneticist. Baseline characteristics, diagnostic history, family history, cutaneous and extracutaneous symptoms were extracted. Further subspecialty reports such as dental and ophthalmology, and available laboratory results including bloodwork, histopathology, and genetic reports were reviewed. Patients who had undergone molecular genetic testing were further divided into either positive (IKBKG mutation) or negative (no identifiable mutation) genetics cohorts for analyses.

RESULTS

A total of 44 children with IP were identified, including 79% female, 64% white (non-hispanic), 24% with IP family history, and 85% were confirmed on biopsy. Median age at first dermatology or genetics consult was 6 weeks and 26% had undergone a full septic workup (cultures negative) prior for the IP rash. Extracutaneous involvements were common: dental (49%), ocular (32%), hair (31%), nail (15%), and neurodevelopmental (24%). Compared to the mutation positive (59%) cohort, those with negative mutations (41%) were significantly more likely to be male, have a negative family history of IP, and lower incidences of dental and hair anomalies (P <0.05).

CONCLUSION

Clinical approach to IP should involve not only dermatology and genetics evaluation, but may benefit from multidisciplinary monitoring for extracutaneous manifestations. Findings of unique clinical variations between positive and negative mutation cohorts suggests the need for further in-depth evaluation into key differences as they may affect disease counselling and future prognosis.
DIAGNOSTIC AND COLLABORATION NEEDS REGARDING ASD BY COMMUNITY PAEDIATRICIANS IN SOUTHERN ALBERTA
Authors: Coret Marian , Yohemas Meridith , Goldade Roxanne , Gibbard Ben
Published: May 2018

BACKGROUND

Paediatricians play a central role in the screening and diagnosis for autism spectrum disorder (ASD). Current diagnostic procedures rely on a history, screening and diagnostic tools, and collaboration with developmental specialists. The assessment process may vary among paediatricians due to the variety of available screening and diagnostic tools and opportunities to collaborate. As part of a quality improvement initiative through Child Development Services at the Alberta Children’s Hospital, paediatricians were surveyed about their present ASD screening and diagnostic practice.

OBJECTIVES

To examine ASD screening and diagnostic practices among paediatricians for 4 to 6 year-old children in southern Alberta.

DESIGN/METHODS

Paediatricians were recruited from southern Alberta to complete an anonymous online survey. Data were analyzed using descriptive statistics.

RESULTS

The response rate was 40% (36/90). The majority of participants (86%) reported using an ASD screening tool, and (56%) reported experiencing one or more barriers related to screening tool use. All participants reported experiencing one or more barriers to ASD diagnosis. Despite these barriers, 69% of participants reported making an ASD diagnosis within the last 12 months, and 61% of paediatricians indicated feeling confident in their ability to diagnose ASD. Most participants (57%) indicated that they would prefer to make an ASD diagnosis themselves, rather than have this be undertaken by another clinician.

CONCLUSION

Paediatricians in southern Alberta report important barriers in screening and diagnostic practices related to ASD. Further discussion with community paediatricians is required related to addressing these barriers to develop care pathways for this population.
OBESITY TRENDS AND RISK FACTORS AMONG REFUGEE CHILDREN/YOUTH: A SCOPING REVIEW
Authors: Amirazodi Elmira , Turcotte Michelle , Hunter Andrea
Published: May 2018

BACKGROUND

Overweight and obese children are at a heightened risk of adult-onset health complications including hypertension, cardiovascular disease, type 2 diabetes, certain cancers, and psychosocial complications. These disorders can begin in childhood, which increases the likelihood of early morbidity and mortality. In parallel, over the past two decades, the global population of refugees has grown substantially.

OBJECTIVES

Given the rapid increase of refugee populations in Canada, it is important to understand how obesity and overweight patterns for refugee children and youth differ from those of native-born populations. To date, no review has comprehensively documented weight gain trends and risk factors in paediatric refugee populations.

DESIGN/METHODS

A scoping review of the literature was conducted using Medline, CINAHL, and EMBASE for publications in English from August 1991 to April 2017. A total of 11 articles were identified relating to prevalence and risk factors for becoming overweight/obese in refugee children and youth aged 0 to 18 years old after arrival in a high-income setting.

RESULTS

Paediatric refugees were at increased risk of rapid weight gain after migration. After living in a HIC for 1.5 to 9 years, refugee children demonstrated a prevalence of obesity that ranged from 1.4 to 21%. The prevalence of overweight children and youth ranged from 5.7 to 22.8%. Refugee children and youth had a steeper increase in their BMI compared with non-refugees (P < 0.001). Younger children (< 2 years) experienced an increase in BMI at a slower rate (P = 0.002) than older children and youth. A longer length of stay in HICs was associated with an increase in BMI percentile among refugee children. Populations of Eastern European, African, and Middle Eastern ethnic backgrounds demonstrated a higher risk of becoming overweight/obese in comparison to other paediatric refugees or non-refugee children.

CONCLUSION

This review demonstrates that despite methodological differences between the 11 included studies, 6 of them consistently demonstrate a direct relationship between increased BMI and length of residence in HICs among refugee children. Multiple studies (n=7) emphasize the need for culturally tailored prevention strategies including timely orientation to nutrition in HICs. Preventing the development of obesity among refugee children is crucial for reducing the short and long-term health consequences associated with childhood obesity.
DEVELOPMENT OF COMPETENCY ASSESSMENT TOOLS FOR NEONATAL BAG MASK VENTILATION AND INTUBATION: A DELPHI STUDY
Authors: DiLabio Julia , Bismilla Zia , Finan Emer , Ayoub Mohammed , Almandhari Hilal , Moussa Ahmed , Schmölzer Georg M , Prashad Anupa , Walsh Catharine M
Published: May 2018

BACKGROUND

As paediatric training programs shift to a competency-based education model, there is a growing need for tools with strong evidence of validity to teach and assess procedural skills. To date, there are no competency-based assessment tools for bag mask ventilation or neonatal intubation that are widely accepted in the field of paediatrics.

OBJECTIVES

We aimed to develop a neonatal bag mask ventilation competency assessment tool (BMVCAT) and neonatal intubation competency assessment tool (NICAT) to assess proficiency in these skills for application in both the clinical and simulation-based training environments. Delphi methodology was used to determine expert consensus regarding critical items to be included.

DESIGN/METHODS

Systematic literature reviews were performed to generate potential items to include in the assessment tools, consisting of two parts: a checklist of specific actions required to complete the procedures competently and global ratings reflecting overall competence on general aspects of the skill. Checklist items were grouped into 3 domains: pre-procedure, intra-procedure, and post-procedure. A Delphi panel of North American neonatal experts was established to determine expert consensus regarding critical items required to objectively assess the competence of individuals performing neonatal bag mask ventilation and intubation. Panelists completed iterative surveys to rate the importance of checklist and global rating items using a 7-point Likert scale. Responses were evaluated and items were removed after each round if the mean rating was <5.5 until consensus was achieved.

RESULTS

Thirty-four experts from 26 centres in Canada (N=23) and the United States (N=11) participated in the Delphi process: 18 neonatologists, 9 neonatal nurses or nurse practitioners, 4 respiratory therapists, 2 paediatricians, and 1 paediatric anesthesiologist. Systematic literature reviews generated 48 checklist items and 23 global rating items for the BMVCAT and 67 checklist items and 24 global rating items for the NICAT. The first Delphi round reduced the BMVCAT to 43 checklist items and 20 global rating items and the NICAT to 63 checklist items and 23 global rating items. The second Delphi round reduced the BMVCAT to 27 checklist items and 16 global rating items and the NICAT to 50 checklist items and 22 global rating items. The Delphi process was continued until expert consensus was achieved to generate the BMVCAT and NICAT.

CONCLUSION

Delphi methodology allowed for the determination of consensus regarding essential items to be included in tools designed to measure competence in performing neonatal bag mask ventilation and intubation. Further studies are planned to prospectively validate the BMVCAT and NICAT in clinical and simulated settings.
RESIDENTS’ AND RECENT GRADUATES’ PERSPECTIVES ON SIMULATION TRAINING IN NEONATAL RESUSCITATION COMPETENCY ACQUISITION
Authors: Woodward Mary
Published: May 2018

BACKGROUND

Simulation training has been incorporated into Canadian residency programs in order to teach both the technical and behavioral skills of resuscitation. Current literature speaks to ‘improvement’ in skills following a simulation encounter. Residents’ perspectives on competency acquisition through simulation training have not been previously reported.

OBJECTIVES

To explore the perspectives of residents and recent graduates on simulation as an educational modality for competency acquisition in neonatal resuscitation

DESIGN/METHODS

This project employed an interpretive design qualitative methodology, using an a priori educational theory incorporating the principles of social cognitive theory, deliberate practice, distributive practice, and ‘choke phenomenon’. Semi structured focus groups of residents and paediatricians were used for data collection. Interpretive analysis in the style of Crabtree and Miller was employed. Data validity was optimized through member checking and triangulation of themes across investigators. Validity criteria as described by Lincoln and Guba were applied. Institutional ethics board approval was obtained.

RESULTS

Participants recognized the important role of simulation which allowed for a safe space to practice in order to become familiar with the algorithm and the equipment of resuscitation. Strengths associated with simulation training included: teaching geared toward the junior learner on the team, the opportunity to build and consolidate learning, and ideal preparation for examinations. In particular, given the current limited neonatal clinical exposure (constraints of reduced workload and hours), simulation was often seen as the trainee’s only opportunity for leading resuscitation. However, both groups of participants highlighted that for neonatal resuscitation the technology was less important than the scenario itself, i.e. ‘high fidelity is not the doll, it’s the stress of the situation’. They identified a lack of the ‘fear’ element in simulated scenarios, with a controlled comfortable environment, artificial ‘time component’, and ‘hypothetical resolution’ of every scenario. Finally, participants identified another potential pitfall of simulation which led to overconfidence and a false sense of expertise that cannot be translated to the ‘real baby’.

CONCLUSION

Participants perceived simulation to be a useful training modality for aspects of competency acquisition in neonatal resuscitation but highlighted a number of challenges and gaps toward preparedness for practice. In the development of future curricula in competency based training models, educators should consider in the design, graduated levels of simulation aimed toward transition to practice.
IS BEING A PREMATURE OR HAVING ABNORMAL BIRTH WEIGHT ASSOCIATED WITH DEPRESSION AMONG 6 - 17 YEARS OLD U.S. CHILDREN?
Authors: Bahassan Abdulaziz , Depp Colin
Published: May 2018

BACKGROUND

Reports in 2015 showed that premature birth rate in the United States increased when compared to 2014 data, and this was the first increment since 2007. Major complications of prematurity and birth weight abnormalities are well known, but other complications including mental health abnormalities require more investigation to understand their association well.

OBJECTIVES

We aimed in this study to determine if prematurity and birth weight abnormalities including very low birth weight (VLBW) and low birth weight (LBW) are associated with depression among United States children aged between six and seventeen years old.

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DESIGN/METHODS

This is a cross sectional study using data from the National Survey of Children’s Health (NSCH) 2011–2012. When we applied our selection criteria, 84,182 children out of the total 95,677 NSCH population were selected. Our exclusion criteria were: age less than six years, child’s history of cerebral palsy, and mental retardation. Multivariable logistic regression was done to control for confounding effects when studying the association of prematurity, birth weight abnormalities and depression.

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RESULTS

Our results reveal that 3.6% of our population had history of depression, 11% were born prematurely, 7.4% had low birth weight, and 1.5% had very low birth weight. Depression was more frequent in children who were born prematurely (prevalence 4.3%) when compared to children born at term. Different models were built to analyze the association between prematurity, birth weight abnormalities and depression. There was no detectable statistically significant association when controlling for demographic data (age, gender, race, family structure) and mental health risk factors (parental poor mental health, chronic health conditions) as well as other factors. Results reveal that children who had chronic health conditions or had adverse family experiences have greater odds of having depression. On the other hand, African-American, male, and younger (6–11 years old) children have lower odds of depression.

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CONCLUSION

Further longitudinal studies are required to establish a causal relationship of behavioral and psychological complications, and to determine the biological mechanisms of brain development that could be associated with depression among premature infants or those who have birth weight abnormalities.
Poor concordance between reason for consultation and parental expectations in behavioral referrals
Authors: Gander Sarah , Campbell Sarah , Borodovski Andrew
Published: May 2018

BACKGROUND

Behavioural conditions such as Attention-deficit/hyperactivity disorder (ADHD) are present in up to 5% of children across the world. This is a common reason for referral from primary care to paediatricians. When a primary care provider refers a patient to a specialist, they often create a set of expectations in the patient. These expectations may have a strong effect on the patient relationship with the specialist. It has been shown that parental expectations can influence prescribing practices in paediatrics. Low socioeconomic status, a risk factor for behavioural conditions is also a risk factor for poor physician-patient communication. If patient expectations set up in primary care are not reflected in the referral question sent to the paediatrician, this may hinder paediatrician-patient communication and impact care.

OBJECTIVES

The primary objective of this project was to determine the level of concordance between physician referrals and parent expectations in the consultant paediatrician’s office. A secondary objective was to examine demographic and socio-economic trends within this population.

DESIGN/METHODS

A clinic nurse conducted almost 500 pre-appointment intake interviews of guardians in children with a referral related to a behavioural concern and asked them their expectations for the consultation. The referral question and parental expectations were categorized by question of behavioural diagnosis, learning difficulties, medical complaint or unknown. Chi sqaured analysis was performed to measure concordance.

RESULTS

Among this population, 70.4% were male, with 54% coming from single parent families. Chi-square analysis indicated a small-moderate level of concordance on issues relating to attention, behaviour and academics, (59.9%, p<0.001; 57.3%, p<0.001; 62.6%, p=0.001), and high concordance but low correlation for social and medical issues (80.1%, p=0.002, 91.6%, p=0.06).

CONCLUSION

This study demonstrates how we could improve our patient-centered approach by being clear in what is being offered by paediatric consultation. When primary care providers consult paediatrics for behavior referrals there should be clear commnication of the concern at hand and management of the expectations for the visit with the family. This will improve efficiency and lessen dealys or barriers to access to care allowing approriate triage of referrals and patient satisfaction.
Assessment of heart rate changes during positive pressure ventilation in asphyxia induced bradycardia porcine model of neonatal resuscitation
Authors: Espinoza Liza , Cheung Po-Yin , Lee Tze-Fun , O’Reilly Megan , Schmolzer Georg
Published: May 2018

BACKGROUND

The Neonatal Resuscitation Program (NRP) states that if positive pressure ventilation (PPV) was started because a baby had a low heart rate (HR), the baby’s HR should begin to increase within the first 15sec of PPV. However, this recommendation has not been examined in either an animal models nor in the delivery room.

OBJECTIVES

To assess changes in HR in piglets with asphyxia induced bradycardia.

DESIGN/METHODS

Term newborn piglets (n=30) were anesthetized, intubated, instrumented, and exposed to 40min normocapnic hypoxia followed by asphyxia. Asphyxia was achieved by clamping the endotracheal tube until the piglet had bradycardia (defined as HR 25% of baseline); at that time CPR was initiated. As per NRP protocol PPV was immediately started for 30sec followed by chest compression. HR was continuously recorded using an ECG during the whole duration of the experiment. Changes in HR during PPV were assessed and divided into four epochs (0-10sec, 5-15sec, 10-20sec and 20-30sec, respectively) after start of PPV.

RESULTS

The median (IQR) duration of asphyxia was similar between the groups with 189 (128–291)sec, 126 (70–197)sec, 118 (66–250)sec for 3:1C:V, SI+90 and SI+120 respectively (p=0.37; oneway ANOVA with Bonferroni). At time of start of PPV the mean (SD) HR was 35 (13)/min. An increase in HR >100/min was observed in 6/30 (5%) at 30 seconds of PPV. None achieved changes in HR at the epochs 0-10sec, 5-15sec, or 10-20sec. After 15sec of PPV 13/30 (43%) had a decrease in HR and 11/ 30 (36%) had no change in HR.

CONCLUSION

Adequate PPV does not increase HR in piglets with asphyxia induced bradycardia. This is contrary to the current NRP, which recommends that after 15 sec of PPV HR should be assessed.
Neither Here nor There? How the New Geography of Ethnic Minority Entrepreneurship Disadvantages African Americans
Authors: Somashekhar Mahesh
Published: May 2018

Recent research shows that the foreign born utilize both local and long-distance social relationships to become entrepreneurs, affecting immigrants’ chances at upward mobility and their contributions to economic development. Scholars have yet to assess how African American entrepreneurs take part in similar types of geographically dispersed business communities. Using multi-level social network analyses and OLS regressions to compare the geography of buyer-supplier ties originating from one immigrant neighborhood and one African American neighborhood in Chicago, this article highlights a unique mechanism that places African Americans at a disadvantage compared to immigrants: a lack of geographic diversity in African American social capital. Immigrant entrepreneurs’ social networks, unlike African Americans’ networks, connect the foreign born to more people in different places, enabling them to circumvent the limitations of their local communities and accrue more business assets. Contrary to existing research, many foreign-born business owners in this study relied on intra-national rather than local or transnational social ties. These findings challenge researchers to reevaluate the geographic foundations of immigrant and African American entrepreneurship and reexamine how ethnic minority entrepreneurship affects patterns of social stratification and economic development.
Appropriateness of Pediatric Orthopaedic Transfers to a Level 1 Hospital
Authors: McKenna Jaclyn , Novikov David , Pawlak Amanda , Park Jihye , Yang Jie , Iyer Hariharan , Barsi James
Published: May 2018

Objective:

To compare a cohort of transferred pediatric orthopaedic patients with orthopaedic patients who primarily presented to a Level 1 pediatric emergency department to identify risk factors for transfer.

Design:

Retrospective cohort study.

Setting:

Level 1 trauma center in New York.

Patients:

The cohort consisted of patients younger than 18 years who presented to 1 Level 1 pediatric trauma center between January 1, 2013, and December 31, 2013, with an orthopaedic fracture diagnosis code (ICD-9 805.0-839.9). The control group included the patients who presented to that hospital primarily, and the study group included patients who were transferred to that same hospital from another institution.

Intervention:

Demographic and injury-related data [age, sex, mechanism of injury, location of injury, injury severity score, and insurance status] were collected.

Main Outcome Measurements:

Regression analysis was performed to assess for predictors of transfer to a Level 1 hospital. Subgroup analysis examined whether transfers were appropriate, based on the type of injury.

Results:

There were 1064 patients in the nontransfer group and 67 patients in the transfer group. Transferred patients were more likely to have surgery within 24 hours (39.42% vs. 2.63%) and were more likely to have no insurance or Medicaid (50.75% vs. 33.24%). Injury severity score and insurance status were independent predictors for transfer.

Conclusions:

This study indicates that injury severity is the primary predictor in deciding to transfer a pediatric patient; however, insurance status may play a role in that decision.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Effect of Repeated Sterilization by Different Methods on Strength of Carbon Fiber Rods Used in External Fixator Systems
Authors: Unal Omer Kays , Poyanli Oguz Sukru , Sur Unal Ulku , Mutlu Hasan Huseyin , Ozkut Afsar Timucin , Esenkaya Irfan
Published: May 2018

Objectives:

We aimed to study the effects of repeated sterilization, using different methods, on the carbon fiber rods of external fixator systems.

Methods:

We used a randomized set of 44 unused, unsterilized, and identical carbon fiber rods (11 × 200 mm), randomly assigned to 2 groups: unsterilized (4 rods) and sterilized (40 rods). The sterilized rods were divided into 2 groups, those sterilized in an autoclave and those sterilized using hydrogen peroxide. These were further divided into 5 subgroups based on the number of sterilization repetition to which the fibers were subjected (25, 50, 75, 100, and 200). A bending test was conducted to measure the maximum bending force, maximum deflection, flexural strength, maximum bending moment and bending rigidity. We also measured the surface roughness of the rods.

Results:

An increase in the number of sterilization repetition led to a decrease in maximum bending force, maximum bending moment, flexural strength, and bending rigidity, but increased maximum deflection and surface roughness (P < 0.01). The effect of the number of sterilization repetition was more prominent in the hydrogen peroxide group.

Conclusions:

This study revealed that the sterilization method and number of sterilization repetition influence the strength of the carbon fiber rods. Increasing the number of sterilization repetition degrades the strength and roughness of the rods.
Poly(ADP-ribose) polymerase 1 Searches DNA via a ‘Monkey Bar’ Mechanism
Authors: Rudolph Johannes , Mahadevan Jyothi , Dyer Pam , Luger KarolinKarolin
Published: May 2018

Poly(ADP-ribose) polymerase 1 (PARP1) is both a first responder to DNA damage and a chromatin architectural protein. How PARP1 rapidly finds DNA damage sites in the context of a nucleus filled with undamaged DNA, to which it also binds, is an unresolved question. Here we show that PARP1 association with DNA is diffusion-limited, and release of PARP1 from DNA is promoted by binding of an additional DNA molecule that facilitates a “monkey bar” mechanism, also known as intersegment transfer. The WGR-domain of PARP1 is essential to this mechanism, and a point mutation (W589A) recapitulates the altered kinetics of the domain deletion. Demonstrating the physiological importance of the monkey bar mechanism for PARP1 function, the W589A mutant accumulates at sites of DNA damage more slowly following laser micro-irradiation than wild-type PARP1. Clinically relevant inhibitors of PARP1 did not alter the rate or mechanism of the release of PARP1 from DNA.
The Roles of Neighborhood Composition and Autism Prevalence on Vaccination Exemption Pockets: A Population-wide Study
Authors: Gromis Ashley , Liu Kayuet
Published: May 2018

The number of children entering schools without mandated vaccinations has increased in high-income countries due to the rise of nonmedical exemptions from school vaccination requirements. Herd immunity is threatened when unvaccinated children are concentrated in spatial pockets. It is often assumed that these exemption clusters are merely the result of population composition. On the other hand, despite the role of vaccine-autism controversy to the current wave of anti-vaccine movement, we do not know if exemption clusters are associated with local autism rates. Our spatial analysis of California shows that while racial/ethnic composition is associated with the locations of large exemption pockets, other sociodemographic factors and access to health care resources have limited geographical span. We decouple the race/ethnicity effect from that of unobserved socioeconomic status by examining families in poverty. Using unique address-level data on the locations of the majority of children with an autism diagnosis, we show that the prevalence of autism is not associated with the locations of large pockets of vaccination exemptions. In addition, we find charter schools in most exemption clusters; potential spillovers from charter schools to neighboring public schools are evaluated. Exemption pockets are not merely the result of population composition and community-level interventions are needed to maintain herd immunity.

Highlights

Autism prevalence rates are not associated with the locations of large exemption pockets.

The average exemption rate in charter schools (7.5%) was higher than private schools.

Proportion non-Hispanic white has the strongest association with large exemption clusters.

Population composition cannot fully explain the exemption clusters.