bluuebunny/crossref_metadata_2025 huggingface dataset:
Monitoring the delicate operations of surgical robots via ultra-sensitive ionic electronic skin
Authors: Wei Danyang , Guo Jiajie , Qiu Yuqi , Liu Shaoyu , Mao Jiangyan , Liu Yutian , Chen Zhenbing , Wu Hao , Yin Zhouping
Published: October 2022

The arrival of surgical robots in high-end medical equipment is a landmark, and the realization of tactile sensation a major challenge in this important cutting-edge research field. Aiming to address this issue, we present ultra-sensitive ionic electronic skin in the form of flexible capacitive pressure sensors, which incorporate multistage bionic microstructures in ion gels for the purpose of monitoring the delicate operations of surgical robots. Significantly, the ionic skin exhibits an ultra-high sensitivity of 9484.3 kPa−1 (<15 kPa), and the sensitivity remains higher than 235 kPa−1 in the wide range of 15–155 kPa. The device has also achieved a detection limit as low as 0.12 Pa or, equivalently, 0.31 mg, fast response within 24 ms, and high robustness (loading/unloading for 5000 cycles without fatigue). The sensor facilitates the challenging task of tele-operated robotic threading, which exceeds the human tactile perception limit when threading a needle. We have also confirmed that ionic skin can be used in robot-assisted invasive surgery, such as incision/resection of tissues and suturing of wounds, providing tactile information to surgeons to improve operation success rates. The flexible ionic skin is capable of conforming to the various shapes of robotic manipulators, thus has great promise for applications in robotic dexterous manipulation, prosthetics and human–machine interfaces.
A Janus heteroatom-doped carbon electrocatalyst for hydrazine oxidation
Authors: Ding Jieting , Wang Hao-Fan , Yang Xianfeng , Ju Wenbo , Shen Kui , Chen Liyu , Li Yingwei
Published: October 2022

The trade-off between the intrinsic activity and electronic conductivity of carbon materials is a major barrier for electrocatalysis. We report a Janus-type carbon material combining electrically conductive nitrogen-doped carbon (NC) and catalytically active boron, nitrogen co-doped carbon (BNC). The integration of NC with BNC can not only ensure high electronic conductivity of the hybrid, but also achieve an enhancement in the intrinsic activity of the BNC side due to the electron redistribution on their coupling interfaces. In the electrocatalytic hydrazine oxidation reaction (HzOR), the Janus carbon electrocatalyst exhibits superior activity than their single counterparts and simple physical mixtures. Density functional theory calculations reveal that the NC/BNC interfaces simultaneously promote efficient electron transport and decrease the free energy of the rate-determining step in the HzOR process.
Prevalence and Predictors of High-Grade Anal Dysplasia in People With HIV in One Southeastern Ryan White HIV/AIDS Program Clinic
Authors: Geba Maria , Cardenas Benjamin , Williams Brooke , Hoang Sook , Newberry Yvonne , Dillingham Rebecca , Thomas Tania A
Published: October 2022

Background

Prevalence of anal cancer is increasing among people with HIV (PWH). Screening for anal cancer involves evaluating cytology and biopsy with high-resolution anoscopy (HRA) if indicated. In this study, we sought to identify the prevalence of abnormal anal cytology and biopsy-proven high-grade dysplasia, defined as anal intraepithelial neoplasia 2 and 3 (AIN2+).

Methods

Demographic and clinical data were collected from participants age ≥30 years with ≥1 anal Pap smear performed during the study period (12/18/2017–05/29/2021). A subgroup analysis was performed on those with ≥1 HRA. Logistic regression estimated adjusted odds ratios (aORs) for variables of interest such as age, race, gender, presence of HPV strains, and sexual practices.

Results

Of 317 participants, 48% (n = 152) had abnormal cytology (93% low-grade squamous intraepithelial lesion [SIL] or atypical cells of undetermined significance [ASCUS] and 7% high-grade SIL). Most with abnormal cytology proceeded to HRA (n = 136/152). Of those with HRA, 62% (n = 84/136) had AIN2+. History of anoreceptive intercourse (aOR 4.62; 95% CI 1.08–23.09; P = .047), HPV 16 (aOR 4.13; 95% CI 1.63–11.30; P = .004), and “other” high-risk HPV strains (aOR 5.66; 95% CI 2.31–14.78; P < .001) were significantly associated with AIN2+.

Conclusions

Nearly half of those screened had abnormal cytology, highlighting the high prevalence of anal dysplasia in PWH. Though only 7% had high-grade SIL on cytology, 62% of those biopsied had AIN2+, suggesting that cytology underestimates the severity of dysplasia on biopsy. HPV 16 and “other” high-risk strains were associated with AIN2 + and could be considered for risk-stratifying patients in the screening algorithm.
Central concentration of warm and dense molecular gas in a strongly lensed submillimeter galaxy at z = 6
Authors: Tsujita Akiyoshi , Tadaki Ken-ichi , Kohno Kotaro , Hatsukade Bunyo , Egusa Fumi , Tamura Yoichi , Nishimura Yuri , Zavala Jorge , Saito Toshiki , Umehata Hideki , Lee Minju M
Published: October 2022

We report the detection of the CO(12–11) line emission toward G09-83808 (or H-ATLAS J090045.4+004125), a strongly-lensed submillimeter galaxy at z = 6.02, with Atacama Large Millimeter/submillimeter Array observations. Combining previously detected [O iii] 88 μm, [N ii] 205 μm, and dust continuum at 0.6 mm and 1.5 mm, we investigate the physical properties of the multi-phase interstellar medium in G09-83808. A source-plane reconstruction reveals that the region of the CO(12–11) emission is compact ($R_\mathrm{{e, CO}}=0.49^{+0.29}_{-0.19}\:\mbox{kpc}$) and roughly coincides with that of the dust continuum. Non-local thermodynamic equilibrium radiative transfer modeling of CO spectral-line energy distribution reveals that most of the CO(12–11) emission comes from a warm (kinetic temperature of Tkin = 320 ± 170 K) and dense [log (nH2/cm−3) = 5.4 ± 0.6] gas, indicating that the warm and dense molecular gas is concentrated in the central 0.5 kpc region. The luminosity ratio in G09-83808 is estimated to be LCO(12-11)/LCO(6-5) = 1.1 ± 0.2. The high ratio is consistent with those in local active galactic nuclei (AGNs) and 6 < z < 7 quasars, the fact of which implies that G09-83808 would be a good target to explore dust-obscured AGNs in the epoch of reionization. In the reconstructed [O iii] 88 μm and [N ii] 205 μm cubes, we also find that a monotonic velocity gradient is extending over the central starburst region by a factor of 2 and that star-forming sub-components exist. High-resolution observations of bright [C ii] 158 μm line emissions will enable us to characterize the kinematics of a possible rotating disk and the nature of the sub-components.
2 Estimating the Impact of Menstrual Poverty on Adolescents in Nova Scotia
Authors: Lukindo Mary , Price Victoria E , Pike Meghan
Published: October 2022

Background

Menstrual poverty is defined as the inability of people who menstruate to obtain menstrual products due to financial burden. The impact of menstrual poverty on adolescents is unknown.

Objectives

This study aimed to estimate the impact of menstrual poverty on adolescents who reside in Nova Scotia (NS), Canada.

Design/Methods

The authors developed a web-based, 25-item questionnaire, the adolescent Menstrual Poverty Questionnaire (aMPQ), and distributed it via social media. Adolescents who were less than 18 years of age, English-speaking, and living in NS were eligible to complete the survey. Data were analyzed using descriptive analysis. 420 adolescents completed the survey, with a mean age of 16.1 years (14.4 – 17.9 years).

Results

Results revealed that 65% of respondents do not always have enough money to buy menstrual products. This led to unsafe menstrual hygiene practices including using alternatives for menstrual products (e.g., rags), washing disposable menstrual products, and/or wearing products for longer than intended. 40% of respondents reported a lack of affordability of menstrual products as a cause for school absenteeism and lack of participation in sport/social activities. 70% of respondents feel embarrassed to ask for products even when they are provided for free, and almost all supported the idea of having freely available menstrual products in public washrooms.

Conclusion

This study determined that menstrual poverty impacts adolescents in Nova Scotia. To address menstrual poverty, menstrual products should be freely available in all public washrooms, as this will provide unrestricted access to menstruators and promote their full participation in society.
7 Does Physical Activity Vary By Virtual or In-Person School Models in School-Aged Children?
Authors: Metivier Emma , McCann Maggie , Kumar Kriti , Lepore Natasha , Lahey Kelcie , Barootes Hailey , Holyer Karissa , Miller Michael , Lim Rod
Published: October 2022

Background

Current recommendations for school-aged children’s physical activity include at least one hour of moderate to vigorous intensity physical activity per day. Schools play an essential role in providing access to physical activity, through both structured and unstructured activity such as physical education and recess. North American data has shown that due to restrictions placed on in-person schooling, children were not meeting recommended levels of physical activity during the first wave of the COVID-19 pandemic.

Objectives

The objective of this study was to understand the effect schooling models have on access to physical activity and subsequent reported changes in mental and physical health.

Design/Methods

An online survey was distributed to parents of school-aged children aged 4-13 in Ontario. The survey included questions regarding demographics, children’s physical activity prior to and during the first wave of the COVID-19 pandemic, and parental perceptions regarding the pandemic’s impact on mental and physical health. This study received ethics approval, was hosted on the REDCapTM platform, and distributed from February-June 2021 through a local school board, the Pediatrics section of the Ontario Medical Association, and through social media.

Results

A total of 361 survey participants responded. Although there was a statistically significant decrease in the overall mean number of hours of physical activity per week from prior to the COVID-19 pandemic and the first wave of the COVID-19 pandemic (mean difference = 9.34 hours, SD = 10.06, p<0.001), there was no significant difference in hours of physical activity when comparing in-person and virtual school models (p=0.892 pre-COVID-19 pandemic and p=0.146 during the first wave of the COVID-19 pandemic). There was no significant difference in parent-reported impact of either physical (p=0.724) or mental (p=0.822) health between those that were enrolled in virtual or in-person school models, and no significant difference between school model and restarting activities (p=0.078).

Conclusion

This survey highlights not only that parents identified a significant decrease in children’s physical activity during the pandemic but also that there was no correlation between school model and physical activity. This may be due to several organized physical activities not being re-started despite schools reopening, thus contributing to similar outcomes for children in both school models. Future research may include exploring why virtual and in-person models demonstrated no significant difference in physical activity and to conduct a qualitative analysis on methods used by parents to engage children in activity.
13 Quantifying the Intensity of Adverse Events in Children Receiving Ibuprofen and Oxycodone Following Acute Fracture
Authors: Gourlay Katie , Ali Samina
Published: October 2022

Background

Treatment of pain is an essential component of optimizing an injured child’s quality of life and experience. Ibuprofen and oxycodone are widely used for treating childhood fracture pain. While oxycodone is generally associated with increased frequency of adverse events (AEs), little is known on the comparative intensity of AEs associated with these medications.

Objectives

Our primary objective was to quantify the frequency and intensity of AE's associated with ibuprofen and oxycodone in children following acute fracture. Our secondary objective was to assess functional outcome impairment in children taking ibuprofen and oxycodone, specifically their ability to eat, sleep, play, and attend school.

Design/Methods

Patients aged 4-16 years diagnosed with a fracture in the Stollery emergency department who were prescribed either ibuprofen or oxycodone were recruited from 2010-2014. Patient characteristics were collected using a structured chart review. Families were called for the first three days after discharge and asked to report the frequency and intensity of AEs, as well as whether their child’s ability to eat, sleep, play or attend school was impaired.

Results

A total of 240 children were recruited (ibuprofen n=176, oxycodone n=59). Children using oxycodone were more likely to report any AE (p<0.001), nausea (p<0.001), vomiting (p<0.001), drowsiness (p<0.001), constipation (p=0.003), and dizziness (p<0.001), compared to ibuprofen. Using an 11-point rating scale, children receiving oxycodone reported more severe abdominal pain (oxycodone: mean 5.4 SD 3.1; ibuprofen mean 2.5 SD 1.4) on Day 1 (p=0.02) and worse constipation (oxycodone: mean 4.9 SD 2.1; ibuprofen mean 3.2 SD 2.2) over all three days (p=0.04). Children with upper limb fractures experienced more impairment in playing (oxycodone 93.8%, ibuprofen 65.7%, p<0.001) and attending school (oxycodone 80.9%, ibuprofen 57.6%, p=0.004) when prescribed oxycodone, while children with lower limb fractures experienced similar impairments regardless of medication used.

Conclusion

Oxycodone is associated with more frequent overall, gastrointestinal, and neurologic AEs and higher intensity gastrointestinal AEs compared to ibuprofen. Function with upper limb fractures is worse in children prescribed oxycodone, over ibuprofen. Clinicians should be aware of differences in AE profiles when caring for children in pain.
16 RAM cannula versus Infant Flow Driver systems for post-extubation non-invasive ventilation support in extremely preterm infants - A retrospective cohort study
Authors: Kumar Manoj , Keil Eric
Published: October 2022

Background

Non-invasive ventilation (NIV) delivered by RAM cannula is being used for post-extubation support of preterm infants in some centers for its potential benefits of ease of setup and less nasal trauma.

Objectives

To assess characteristics and clinical outcomes for infants extubated to NIV support delivered via RAM cannula, as compared to those extubated to Vyaire Infant Flow Driver (IFD) systems.

Design/Methods

Retrospective cohort study. All infants born at 25 to 27 + 6 weeks of gestation during a 3-year period (2016-2018) and admitted to a regional Level-3 NICU, were eligible if: 1) they were ventilated for RDS within 48 hours of birth, and 2) extubated to NIV support using RAM cannula or IFD systems (using Viasys or FabianTM devices). Primary outcome was the failure of the primary mode of NIV support within the first 72 hours post-extubation (defined as need for reintubation or change of initial NIV mode to prevent reintubation). We adjusted for antenatal steroid use and delivery route. Data was stratified for gestational age (GA) <26 wks/>=26 wks. Sensitivity analysis were performed on additional parameters, e.g., inborn status, duration of initial ventilation restricted to <4 days. Logistic and linear regression models were built for the categorical and continuous outcomes.

Results

150 infants were enrolled, RAM cannula (n = 62) and IFD devices (n = 88). The majority of patients in both groups were on conventional ventilation, received one dose of surfactant, and were on FiO2 <0.3 prior to extubation. RAM cannula group had significantly longer duration of intubation prior to first extubation (median duration 99 hrs vs 19 hrs). There was no difference in the primary outcome between the groups [(RAM 51.6% and IFD 45.5%; adjOR 1.25(95% CIs: 0.65 – 2.4)]. However, RAM cannula group had higher rates of reintubation within <=7 days after extubation (89.5% vs 68.5%; adjOR 3.87(95% CIs: 1.18, 12.73), p-value=0.026] and higher incidence of IVH [62.9% vs 38.6%; 2.77(95% CIs: 1.39, 5.53), p-value 0.004], with lesser infants weaned to room air prior to discharge [58.1% vs 76.1.6%; adjOR 0.42(95% CIs: 0.21, 0.85), p-value 0.016]. In the stratified analyses by GA, these differences were noted to be restricted to those born at >=26 weeks, with an additional risk for increased BPD36 (adjORs 2.76 (95% CIs: 1.16, 6.57), p-value 0.022] associated with the RAM cannula use in this stratum.

Conclusion

Post-extubation NIV support via RAM cannula, as compared to IFD systems, was associated with higher rates of reintubation in <=7 days, IVH, with a greater number of infants discharged home on supplemental oxygen.
25 Paracetamol versus Indomethacin for management of Patent Ductus Arteriosus in Premature Infants- A Systematic Review and Meta-Analysis
Authors: Kumar Manoj , Bitar Eyad , Campbell Sandra , Hyderi Abbas
Published: October 2022

Background

Premature infants with hemodynamically significant patent ductus arteriosus (HsPDA) have high rates of morbidity and mortality in neonatal units. Indomethacin has been the most common agent used for pharmacological closure of the PDA. Recently, paracetamol has gained interest in the neonatal community for its use for management of HsPDA.

Objectives

To conduct a systematic review of randomized controlled trials (RCTs) comparing the efficacy and safety of paracetamol with indomethacin for HsPDA management in preterm infants.

Design/Methods

We searched PROSPERO, OVID Medline, OVID EMBASE, Wiley Cochrane Library (CDSR and Central), EBSCO CINAHL, and SCOPUS using controlled vocabulary and key words representing the concepts "preterm neonates" and "acetaminophen" and "indomethacin". Databases were searched from inception to June 15, 2021. Bibliographies of identified studies were searched for additional references. Studies were included if they enrolled preterm infants with HsPDA (diagnosed on echocardiogram), and randomised them for treatment with paracetamol or indomethacin for the primary outcome of HsPDA closure. Discrepancies among reviewers for study selection, RoB assessments, and data extraction were resolved by consensus. Data were analyzed with the help of Review Manager (RevMan) Version 5.3.

Results

Four RCTs were identified, enrolling a total of 380 subjects. There was no difference between the two interventions for the rates of PDA closure either after one course (4 studies; RR 1.04 [95% CIs: 0.84, 1.29], p-value 0.70) or after two courses of treatment (2 studies; RR 1.01 [95% CIs: 0.92, 1.12], p-value 0.77), and for PDA ligation (3 studies; RR 1.56 [95% CIs: 0.48, 5.12], p-value 0.46). However, the patients who received paracetamol had lower rates of necrotizing enterocolitis (NEC) (3 studies; RR 0.37 [95% CIs: 0.14, 0.95], p-value 0.04). There were no significant differences noted in the other important secondary outcomes, i.e., Intraventricular hemorrhage, bronchopulmonary dysplasia, retinopathy of prematurity requiring treatment, and death. Two studies reported baseline and post-treatment serum markers for renal and hepatic injury; there was significant post-treatment elevation of serum creatinine and blood urea noted with the indomethacin use in each of these studies, as compared to no change noted with paracetamol use.

Conclusion

The efficacy of paracetamol is comparable to indomethacin for the outcome of PDA closure, with lesser rate of NEC and post-treatment azotemia noted with the paracetamol use. Paracetamol should be preferred over indomethacin for HsPDA management in premature infants.
29 Maternal overweight and obesity’s impact on long-term neurodevelopmental outcomes in premature infants (<29 weeks) at 18-24 months corrected age
Authors: Journault Marina , Murthy Prashanth , Bansal Neha , Tang Selphee , Al-Awad Essa , Creighton Dianne , Crawford Susan , Lodha Abhay
Published: October 2022

Background

Increasing rates of obesity are of growing concern to maternal and child health as mothers with obesity are at risk of pregnancy complications. Infants of mothers with overweight/obese pre-pregnancy body mass index (BMI) may also be at risk of significant neurodevelopmental disorders. The relationship between maternal pre-pregnancy BMI and neurodevelopmental outcomes in preterm infants is not yet clearly defined.

Objectives

To determine the association of pre-pregnancy BMI of mothers of infants born <29 weeks gestational age (GA) and neurodevelopmental impairment (NDI) at 18-24 months corrected age (CA).

Design/Methods

Preterm infants born <29 weeks GA between January 2005 and December 2015 evaluated in the neonatal follow-up clinic at 18-24 months CA were included. Demographic characteristics as well as neurodevelopmental status including Bayley-III cognitive, language, and motor scores and sensory impairments were compared between three groups based on maternal pre-pregnancy BMI (BMI1 [18.5-24.9 kg/m2] vs. BMI2 [25-29.9 kg/m2] vs. BMI3 [≥30 kg/m2]) using univariate and multivariable regression models. The primary outcome was a composite of death or NDI.

NDI was defined as the presence of Bayley-III <85 on one or more of the cognitive, motor, or language composite scores, any cerebral palsy (GMFCS ≥1), sensorineural or mixed hearing impairment, or unilateral or bilateral visual impairment.

Results

Of 771 eligible infants, 53 not seen in the follow-up clinic and 21 born to mothers with BMI <18.5 kg/m2 were excluded. Of the remaining 697 participants, 315 (45%) infants were in BMI1, 235 (34%) in BMI2, and 147 (21%) in BMI3 groups. Infants in BMI1, BMI2, and BMI3 groups had mean (SD) birth weight of 897 (231), 854 (208), and 867 (234) grams and median GA (IQR) of 27 (3), 26 (2), and 27 (3) weeks respectively. Rates of associated impairments are shown in Figure 1. The odds of a composite of death or NDI in BMI2 vs. BMI1 and BMI3 vs BMI1 groups were 1.33 (95%CI 0.86-2.06) and 0.76 (95%CI 0.47-1.22) respectively (Table 1). Infants born to mothers in the BMI2 group had twice the odds of scoring <85 on the Bayley-III language composite than those in BMI1 (adjusted odds ratio 2.06 [95% CI; 1.28-3.32]).

Conclusion

Pre-pregnancy body mass index was not associated with death or neurodevelopmental impairment in very preterm infants at 18-24 months corrected age. However, infants born to mothers who were overweight were more likely to have lower language scores.
30 Exploring the lived experience of non-offending caregivers in paediatric abusive head trauma
Authors: Shannon Meggie , Sahiti Qendresa , Ornstein Amy
Published: October 2022

Background

Abusive head trauma (AHT) is the most common cause of death due to physical abuse and despite prevention efforts, the incidence remains largely unchanged. For survivors, there can be multiple adverse health consequences with lifetime costs in the range of millions per child. While studies have focused on both short- and long-term outcomes for children with AHT, little is known about the experience of their non-offending caregivers (NOCs).

Objectives

To explore the lived experience of NOCs in paediatric AHT, including their perspectives on paediatric practice and prevention strategies.

Design/Methods

Institutional Research Ethics Board approval was obtained. Recruitment materials were shared through the National Centre on Shaken Baby Syndrome’s email, social media, and presentation at their Family Symposium. Inclusion criteria were North American NOCs in paediatric AHT, who lived with the offender. Using a phenomenological approach, six semi-structured interviews were conducted over Zoom for Healthcare, audio-recorded, transcribed, and rendered anonymous. Transcripts were coded using ATLAS.ti and classified by consensus into major themes and subthemes by the research team. Data collection and analysis continued until saturation was reached.

Results

All participants reported ongoing, multidimensional impacts of the trauma on their physical and mental health, years after occurrence. Primary themes identified included: (1) NOCs need compassion and support. Among other aspects of their experience, feeling judged and accused by healthcare providers (HCPs), compounded their trauma, (2) NOCs reported varied experiences within healthcare including a perceived lack of AHT knowledge among HCPs, and could be better served by an extension of multidisciplinary supports, (3) NOCs are resilient, devoted, and powerful advocates for their children all while managing negative emotions such as feeling betrayed, guilt and fear for their child’s life, (4) NOCs experienced challenges navigating systems and accessing supports, including financial, geographical and psychosocial barriers, and (5) There was varied exposure to AHT prevention materials, and many felt the stigma associated with AHT limits engagement with the subject, which may be a barrier to prevention efforts.

Conclusion

NOCs hold a unique and relevant perspective, not previously documented. While further research is required, our findings suggest that by extending compassion to caregivers and accessible multidisciplinary supports, the experience and overall wellbeing of NOCs could be improved. By better addressing the complex needs of NOCs, and increasing knowledge of AHT, HCPs have an opportunity to mitigate the negative impacts of the event and create better outcomes for children.
42 For the Parent, by the Parent: Creating a Program to Empower Parents of Refugee Background Using Novel Participatory Approaches
Authors: Kaur Pardeep , Ho Bernice , Kaukab Tanvir , Rashid Meb , Bowry Ashna , Yousafzai Aisha , Minhas Ripudaman
Published: October 2022

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.

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.
49 Implementation of a Sensory Toolkit in the Emergency Department for Children with Autism Spectrum Disorder
Authors: Roy Meagan , Kinlin Ceilidh , MacEachern Sarah
Published: October 2022

Background

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by deficits in social communication and restricted, repetitive patterns of behaviour, interests, or activities. Children with ASD frequently visit the emergency department (ED), and present more for primary care-related issues and other non-emergent reasons than children without ASD. Visiting the ED can be challenging and stressful for children with ASD, their caregivers, and the healthcare professionals caring for them. Sensory Toolkits are a collection of sensory items that can help to distract and calm children, including during times of stress. We hypothesized that a Sensory Toolkit will improve the experience of children with ASD and their families in our ED.

Objectives

The primary objective of this study was to evaluate the effect of a Sensory Toolkit on the experience of children with ASD and their families visiting a tertiary-care hospital ED.

Design/Methods

After ethical approval was obtained, a pre-implementation survey was conducted on parents of children with ASD about prior experiences in the ED and their interest in a Sensory Toolkit. A Sensory Toolkit specific to children with ASD was developed through literature review and in consultation with families of children with ASD. The Sensory Toolkit, which included a light wand, squeeze ball, push-pop bubble toy, and other items, was launched in a tertiary-care hospital ED in June 2021 with 50 Toolkits. A post-implementation survey was conducted to explore parents’ experiences of their child using the Sensory Toolkit in the ED and to obtain feedback to help improve the Toolkit.

Results

In the pre-implementation survey, 80% (32/40) of parents felt that a Sensory Toolkit would improve the experience of children with ASD in the ED. Post-implementation, 100% (12/12; response rate ~25% from 50 Toolkits) of parents felt that the Sensory Toolkit was helpful for their child. Parents reported that the Sensory Toolkit was “AMAZING” and “A really great idea, thank you!”. Feedback provided regarding improvements that could be made to the Sensory Toolkit was highly patient-specific and often contradictory. One parent suggested more items to chew on while another parent suggested elimination of the chewable items and one parent loved the light up toy while another suggested to remove it.

Conclusion

The Sensory Toolkit contributes positively to the experience of children with ASD and their families in a tertiary-care hospital ED. This study will help inform improvement of the Sensory Toolkit in the ED, including consideration of more specialized Sensory Toolkits to meet individual patient needs. Given the success in the ED, the Sensory Toolkit could be expanded into other areas of the tertiary-care hospital and beyond.
51 Influenza Vaccine Programs with the Cell-Based Quadrivalent Influenza Vaccine and Adjuvanted Trivalent Influenza Vaccine are Highly Cost Effective in Canada
Authors: Nguyen Van Hung , Roy Bertrand
Published: October 2022

Background

Influenza vaccination with quadrivalent egg-based vaccines (QIVe) in adults ≥ 65 years may be less effective due to immunosenescence. An MF59®-adjuvanted trivalent influenza vaccine (aTIV) has been developed to provide stronger, broader and longer protection in older adults. For the younger age groups, lower effectiveness may be associated to the mutagenesis of influenza viruses that are propagated in eggs. A cell- based quadrivalent influenza vaccine (QIVc) was developed to improve the vaccine effectiveness by eliminating egg-adaptation.

Objectives

The objective of this analysis was to evaluate the potential public health impact on the utilization of both vaccines in Canada.

Design/Methods

An SEIR dynamic-transmission model was created and adapted to four influenza strains for the 2013-2019 seasons. Strain-specific circulation was obtained from Canada’s national surveillance system. Influenza incidence estimates were calibrated using CDC published data. The model used rVE from peer reviewed publications for QIVc and aTIV showing superiority to QIVe vaccines. Frequency of egg-based genetic changes were estimated from a published review of Crick Institute reports. Estimates of specific vaccines efficacy and economic assumptions were derived from the published literature. Different vaccination scenarios, based on the provincial vaccination programs, were modelled.

Results

Replacing QIVe with QIVc in subjects 6 months-64 years led to an annual reduction of 462 156 symptomatic cases; 58 122 GP visits; 40,871 emerging consultations; 3 788 hospitalizations and 662 deaths versus a QIVe-for-all scenario. The adoption of QIVc and aTIV will be highly cost effective over the use of QIVe. aTIV would also be more cost effective than QIVHD. Table 1 provides the detailed results for the others scenario. Sensitivity analyses confirmed the robustness of the assumptions used in the analysis.

Conclusion

The greatest public health impact is obtained by using QIVc and aTIV in influenza vaccine programs in Canada versus other combinations of available vaccine.
62 Multicenter validation of the C-3PO rule to identify young children at risk of skull fracture following head trauma
Authors: Hoeffe Julia , Manzano Sergio , Gouin Serge , Gravel Jocelyn
Published: October 2022

Background

There is no widely accepted clinical tool to safely predict skull fracture in young children who sustained a head trauma. The C-3PO rule is a clinical decision rule which reported that age up to 3 months, or parietal/occipital scalp hematoma are predictors of skull fracture in young children.

Objectives

The present study prospectively evaluated the C-3PO rule in multiple new settings.

Design/Methods

This was a prospective multi-centre observational study conducted in three tertiary Emergency Departments (ED) in Canada and Switzerland. Patients were included if they were up to the age of 24 months of age and had a head trauma without high risk factors for clinically important intracranial injury according to the PECARN head trauma rule. The primary outcome was a radiologically identified skull fracture identified by any radiographic imaging modalities. The independent variables were the three components of the C-3PO rule as assessed by the treating physician. The patients were treated as per the physician’s discretion and followed up by phone if there was no initial skull radiological imaging. Criterion validity of the rule was calculated.

Results

A total of 844 patients were included with a median age of 8 months. Thirty percent of these patients (n=263) received radiological imaging, and 52 (6.2%) patients had a skull fracture. The C-3PO rule identified 51/52 children with a fracture for a sensitivity of 98% (95% CI: 90-100%), and a specificity of 70% (95% CI: 67-74%). Applying the rule would have reduced radiological imaging from 263 to 211 patients (-20%; 95%CI: 15-25%).

Conclusion

The C-3PO rule can safely be applied by pediatric emergency physicians evaluating children younger than 24 months with a head trauma. It helps ED clinicians to identify young children at low risk for skull fracture, improving decision making regarding the use of CT scan for children at intermediate risk of clinically important traumatic brain injury.
64 A Canadian multicentre survey of family needs when attending the pediatric emergency department
Authors: Rahimi Asa , Ali Samina , Rajagopal Manasi , Ma Keon , Yaskina Maryna , Goldman Ran , Stang Antonia , Beer Darcy , Poonai Naveen , Alqurashi Waleed , Weingarten Laura , Kam April , Principi Tania , Curran Janet , Gardner Katie , Hartling Lisa , Wright Bruce , Plint Amy , Gouin Serge , Schreiner Kurt , Leung Julie , Scott Shannon
Published: October 2022

Background

Parents/caregivers strongly influence their child’s experience in the pediatric emergency department (PED). Understanding their needs can improve families’ PED experience and care.

Objectives

To describe caregivers’ perceived emotional, practical, and informational needs in the PED and how well these needs were met

Design/Methods

This descriptive, cross-sectional survey with medical record review was conducted at 10 Canadian PEDs from October 2018 to March 2020, over a 1-week period every season, for a total of 4 weeks per site. Digital surveys available in English or French were completed by caregivers in the PED and 7 days after their visit. Health literacy was evaluated by the Newest Vital Sign tool.

Results

A total of 2005 caregivers participated; mean age was 37.8 (SD 7.7) years, and 74.3% (1462/1969) were mothers. The mean child age was 5.9 (5.1) years and 51.9 % (1040/2003) were male. Caregivers’ main spoken language was mostly English [72.6% (1425/1964)] or French [10.5% (206/1964)]. Over half of caregivers had a university/professional degree [51.0% (997/1956)]; 37.4% (746/1998) had possible/probable limited health literacy. 77.9% (1132/1454) of caregivers reported that their overall care needs were met. 71.7% (1081/1507) of caregivers reported that their emotional needs were met; they reported most emotional support by doctors [(35.6%, 535/1510)] and bedside nurses [(24.2%, 364/1507)]. The median (IQR) length of stay was 3.9 (2.6, 6.1) hours; 36.7% (546/1487) of caregivers felt they waited ‘too long’, and 77.8% (1158/1489) did not know how long they would have to wait. 11.7% of families were dissatisfied with the care updates provided. A safe PED was the top overall identified practical need [(45.1%, 602/1336)]. Internet access was the most important practical need throughout the visit [(28.1%, 378/1345)], while more space was the most reported [(49.8%, 696/1398)] need in the waiting room. The most desired improvements in the PED were better communication of wait times and delays [(41.1%, 745/1812)], shorter wait times [(38.8%, 699/1801)] and faster diagnosis [(24.9%, 449/1803)].

Conclusion

Almost one quarter of Canadian caregivers report that their overall needs were not fully met when attending the PED. Safety during the PED visit was of utmost importance. Nationally, caregivers value shorter wait times, rapid diagnosis, and better communication about perceived delays. Top practical needs included internet access and more waiting room space. Creating innovative waiting systems, better methods to share wait time information, free internet access, and improved physical spaces could better address identified caregiver needs in the PED.
68 Are Health Equity Rounds (HER) an acceptable format to address education on implicit bias and structural racism in pediatric emergency settings?
Authors: Levreault Eleni , Sheridan Nicole , Masud Fahad , Robinson Amy , Tse Sandy
Published: October 2022

Background

Implicit bias and structural racism in healthcare create significant social and health inequities that can lead to poorer care and health outcomes. Canadian medical training programs have created curricula addressing these issues, but there remains a lack of education targeting faculty members and multidisciplinary teams. Perdomo et al. created a longitudinal case-based curriculum called Health Equity Rounds (HER) to engage faculty and teams in discussions about the effects of implicit bias and racism on patient care. Curriculum pilot results suggested some opportunities to mitigate the potential impact on patient care.

Objectives

This study assessed the feasibility, acceptability, and effectiveness of incorporating HER for multidisciplinary educational rounds in a Pediatric Emergency Medicine (PEM) division. By following previously published curricula, our HER aimed to provide a forum to discuss evidence-based strategies to address implicit bias and structural racism in healthcare.

Design/Methods

Two HER were embedded within PEM Update Rounds over six months and targeted an interdisciplinary audience from all stages of training. Selected cases were provided by the institution’s Equity, Diversity, and Inclusivity steering committee, where 1) patient care and/or outcomes were affected by implicit bias and/or racism, and 2) experiences were appropriate for analysis and education. Participants in this mixed-methods study completed an online survey following HER and were invited to individual interviews that further explored their experience and any resulting professional and personal impacts.

Results

The two topics selected for HER rounds were Implicit Bias in Medicine and Linguistic Barriers to Healthcare, with high post-rounds survey uptake of 80% (20/25) and 65% (14/22), respectively. Among respondents, 73.7% and 78.6% indicated that learned objectives would impact their clinical practice; 80% found both presentations engaging; 80% and 61.6% found educational value of HER to be good/excellent; and 94.7% and 78.6% indicated interest in future HER presentations. Three respondents completed interviews. After thematic analysis, overarching themes included receptiveness to creating more equitable infrastructures in PEM; equity being a shared and multi-disciplinary responsibility; and strategies for implementing HER topics into practice.

Conclusion

There is a need in academic and clinical medicine to address implicit bias and structural racism as contributors to health inequities. Positive feedback from this study suggests HER may be an acceptable and feasible forum to promote safe discussion and reflective practice on potentially provoking topics within interdisciplinary PEM educational sessions.
73 Parenting Experiences of Families of Refugee Background in the Greater Toronto Area: A Formative Study
Authors: Ho Bernice , Kaur Pardeep , Kaukab Tanvir , Rashid Meb , Bowry Ashna , Yousafzai Aisha , Minhas Ripudaman
Published: October 2022

Background

As of date, the world is experiencing its highest levels of human displacement, with many families resettling in Canada. While there is an understanding that families of refugee background have complex, multigenerational mental health, and developmental needs, little is known about whether their parenting needs are met adequately in Canada after resettlement nor how COVID-19 related restrictions have further complicated their resettlement experience.

Objectives

To gather data about the facilitators and barriers that impact the parenting experience of families of refugee background in the Greater Toronto Area (GTA) in the context of their children’s unique developmental and resettlement needs.

Design/Methods

This was a qualitative, community-based participatory research study. All data was collected from August 2019 to July 2020. In-depth interviews (IDIs) were conducted with caregivers of refugee background and healthcare providers that work closely with this population. Data were recorded, transcribed, and coded by two independent coders and a peer-debriefing strategy was used to verify the coding approach.

Results

In total, 20 IDIs were conducted (7 caregivers, 13 care providers). Six key themes were identified: (1) Mental Health and Healthcare Access, (2) Language, (3) Navigating Canadian Systems, (4) Finances, (5) Cultural Dimensions of Caregiving, and (6) Advocacy and Agency. The caregivers and healthcare providers agreed that language is a migration barrier, housing and financial stability are challenging to obtain, and that families struggle to self-advocate. There was disagreement as to how families and healthcare providers viewed healthcare access: caregivers reported that they have good access, but the providers cited that there are still barriers, including health literacy and cultural differences. While caregivers believe they are well supported by the government, healthcare providers believe more funding and education on the families’ rights are necessary. Finally, although most caregivers describe Canada as welcoming, healthcare providers highlighted more incidences of misunderstandings and gaps within the system that may allow families to fall through the cracks.

Conclusion

Our study describes the unique facilitators and barriers to the resettlement, healthcare access, and lived experiences of families of refugee background raising children within the GTA.
79 Impact of COVID-19 wave 3 paediatric inpatient unit closures on transfers to tertiary care paediatric hospital
Authors: Esser Kayla , Badour Bryn , Davis Paul , Langrish Kate , Chan Pamela , Shouldice Michelle , Beck Carolyn , Van Clieaf Judy , Baker Andrew , Orkin Julia
Published: October 2022

Background

During Wave 3 of the COVID-19 pandemic, 15 community hospital paediatric inpatient units (comprising 167 beds) in Toronto were directed to close by the Greater Toronto Area (GTA) Hospital Incident Management System (IMS) Command Centre to increase adult inpatient bed capacity. All paediatric patients from closed inpatient units were redirected to a single tertiary care paediatric hospital, which increased capacity to accommodate these additional patients through activation of surge plans, while community hospitals redeployed resources to fill much needed gaps in adult care.

Objectives

The objective was to describe patient characteristics of all transfers during the closure to explore the impact of community paediatric inpatient unit closures on transfers to the tertiary hospital.

Design/Methods

A chart review of all transferred patients was conducted during the mandated closure and subsequent reopening. Transfers excluded ICU-level transfers as these were not impacted by IMS mandated closures. All transfers were categorized as requiring tertiary care (i.e. would typically be transferred) or not requiring tertiary care (i.e. only transferred due to the closure). Variables collected included sending hospital, admitting diagnosis, patient age, hospital disposition, and length of stay. Data was collected until the last paediatric unit reopened. Quality improvement project approval was granted by the institution.

Results

A total of 858 patients were transferred to the tertiary hospital during the 67 day closure; of those, 530 were transferred solely to increase adult bed capacity (i.e. were categorized as patients requiring non-tertiary care). The majority of patients were admitted to general paediatrics (52%), and 39% went to a surgical inpatient unit. Most patients (68%) admitted had a length of stay between 24 and 72 hours. A third of patients admitted were under 2 years old, and a third were over 12 years old. The top three diagnoses for admission were infections, gastrointestinal issues, and general surgery. Two-thirds (60%) of transfers from closed sites came from three sites.

Conclusion

More than half of the transfers occurred solely due to the mandated closures, and transfers returned to a stable volume once all sites re-opened. The GTA hospital system was able to respond to the mandated closure effectively through clear high-level communication, escalation processes and structures as well as responsive, real-time problem solving. Closures increased potential adult inpatient capacity by 6740 bed days and demonstrated an unprecedented system-wide approach to the provision of integrated paediatric care across the region.