bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ontogenesis of the digestive gland through the planktotrophic stages of Strombus gigas
Authors: Aldana Aranda Dalila , Enríquez Díaz Martha , Gros Olivier 
Published: August 2020

ABSTRACT
The queen conch, Strombus gigas (Linnaeus, 1758), is a marine mollusc of ecological and economic importance in the Caribbean. Its populations are declining due to overexploitation. We describe ontogenesis of the digestive gland in S. gigas during the larval stages. Larvae were studied over a period of 42 d in laboratory culture, from eggs to crawling stage. Experiments were conducted at 28 ± 1°C. Veligers were reared at a density of 100 larvae l−1 in 10-l containers. Larvae were fed with the microalgae Nannochloropsis oculata at a concentration of 1,000 cells l−1. In this study, we analysed ultrastructural ontogenesis of the digestive gland in strombid larvae using light and electron microscopy. Examination for Coccidia (Apicomplexa) symbionts in the digestive gland was done by viewing sections with light and scanning electron microscopes at different larval development stages during a 42-d period. In early veligers (9 d after hatching), only digestive cells were observed in the digestive gland. By the late veliger stages (17 d old), both digestive and crypt cells were apparent in the digestive gland. Within crypt cells, spherocrystals were detected and the presence of Ca, Cl, Cu, P and Zn was identified by energy-dispersive X-ray spectroscopy. In late pediveligers (35 d old), the digestive gland still exhibited only digestive and crypt cells. Vacuolated cells (i.e. harbour the coccidian symbionts in adults) were only observed in newly settled juveniles (42 d old) and were devoid of apicomplexan structures. While coccidian symbionts were found in the digestive gland of adult S. gigas, they were not observed in the digestive gland of S. gigas larvae from hatching to settlement under laboratory conditions. This suggests that this symbiont is not vertically transmitted to new host generations in this marine gastropod species.
Feeding and digestion periodicity of Manila clam Ruditapes philippinarum in natural intertidal and subtidal zones estimated from the morphological condition of the crystalline style
Authors: Houki Shouji , Kawamura Tomohiko 
Published: August 2020

ABSTRACT
Feeding periodicities and rhythms of suspension-feeding bivalves in coastal waters are closely related to diel and tidal cyclic environmental changes, such as food availability and predation risk. Although such feeding periodicities of bivalves are important for understanding how their feeding strategies adapt to localized habitats, the feeding periodicity in bivalves in the field remains to be clarified, especially in infaunal species. The present study focused on the morphological condition of the crystalline style as an indicator of the feeding activity of the infaunal bivalve Manila clam, Ruditapes philippinarum, and estimated their feeding periodicity in the field. First, the effects of feeding (siphon-extending) behaviour, food and the light/dark cycle on the condition of the crystalline style (defined based on its morphology and hardness) were investigated in the laboratory. Results of the ordered logistic models and model selection showed that clams extending their siphons kept their crystalline styles hard. Furthermore, the effects of the light/dark cycle and tidal phase on the condition of the crystalline style were investigated in natural intertidal and subtidal zones and assessed using the results of the ordered logistic models. In the intertidal zone, the effect of the tidal phase was significant, whereas the effect of the light/dark cycle was not, and feeding was estimated to be active at ebb and flood tides, when the density of food particles was likely to be high. On the other hand, in the subtidal zone, the results of the model selection were not clear because of significant effects of interactions between the light/dark cycle and tidal phase. However, when the interactions were removed from the models, the effect of the light/dark cycle was significant, and feeding was estimated to be active at night when the predation risk from visual predators would be relatively low. These results confirm that R. philippinarum possesses behavioural plasticity in feeding periodicity, which is adaptable to both intertidal and subtidal zones.
5 Close to Home: Implementation of a transfer process for paediatric inpatients from tertiary to community care
Authors: Gamulka Beth , Abreo Kathleen , Lee Frances 
Published: August 2020

Abstract

Background
Patients presenting to the emergency department who require inpatient care are either admitted to our tertiary care inpatient units or transferred directly to a community hospital. When patients appropriate for community care cannot be transferred due to a lack of community beds and instead remain in a tertiary care bed, there are palpable downstream effects on patient flow. A pre-study audit confirmed that, once admitted, transfers from the inpatient unit to a community bed are rare. This project aimed to improve access to tertiary care beds by increasing inpatient transfers to community hospitals.

Objectives
The project aimed to transfer 25% of all eligible patients from the Paediatric Medicine inpatient units to community hospitals over a 4-month period by identifying eligible patients and streamlining the transfer process.

Design/Methods
An Ishikawa diagram with input from inpatient physicians and nurses and community hospital colleagues identified 4 modifiable barriers. A process map was created along with a simplified transfer process. Medical teams and nurse leaders were provided with the charts of contact numbers, geographic locations and levels of care for community hospitals. Intake nurses tracked eligible patients. Encrypted text messages were sent to inpatient physicians on their mobile devices every morning reminding them to assess specific patients for transfer. The outcomes of all identified patients including process and balancing measures were tracked.

Results
Multiple PDSA cycles focused on improving the success of identifying eligible patients at multiple points in the process. The study’s outcome measure was the rate of successful inpatient transfers for all eligible patients. From November 2018 to March 2019, 120 patients were identified as eligible for transfer at the time of admission: 45 (37.5%) were discharged within 24 hours, 42 (35%) were not considered clinically appropriate for transfer by the attending physician and 33 were considered appropriate for transfer. Twenty-four were approached for transfer (72.7%); 9 were not approached for non-clinical reasons. Six (18.2%) refused transfer and 10 (30%) were successfully transferred. These rates were sustained over the study period.

Conclusion
A streamlined transfer process can improve patient flow, optimize utilization of tertiary care beds and provide care closer to home. A more robust method of tracking patients that could flag patients and send physicians electronic reminders is needed. Most importantly, optimal use of tertiary care beds requires a culture shift to ensure every patient is considered for transfer to the community when medically appropriate.
20 Evaluation of Compliance with the 2017 Canadian Pediatric Society (CPS) Position Statement for the Management of Newborns at Risk for Early-Onset Sepsis (EOS): A Retrospective Cohort Study
Authors: Simeonova Marina , Piszczek Jolanta , Hoi Sannifer , Harder Curtis , Pelligra Gustavo 
Published: August 2020

Abstract

Background
Due to the high mortality and non-specific clinical presentation, clinicians often empirically treat newborns at risk of early-onset sepsis (EOS). Recently, the Canadian Pediatric Society (CPS) published updated recommendations that promote a more judicious approach to EOS management.

Objectives
To examine the compliance with the CPS position statement at a tertiary perinatal site.

Design/Methods
A retrospective chart review was conducted between Jan 1 – Jun 30, 2018. Newborns were categorized into 5 groups, depending on the number of EOS risk factors. Management strategies were assessed against the CPS recommendations to establish the rate of non-compliance. The reason for non-compliance, readmission rate and rate of culture-positive EOS were also examined. Results were expressed using descriptive statistics. A Chi-squared test was conducted to assess the association between the readmission rate and initial management.

Results
The total non-compliance rate was 47%. This was mostly due to inappropriate investigations in lower EOS risk groups [3 (71%) and 4 (94%)] and withholding antibiotics in groups with more risk factors [1 (43%) and 2 (67%)]. The rate of readmission for a septic work-up was low (&lt;2%), and no newborns had culture-positive EOS. There was no significant association between the readmission rate and initial management (p=0.13).

Conclusion
Although the rate of non-compliance to the 2017 CPS recommendations was high, no neonates had culture-positive EOS, suggesting that our management strategies may be too aggressive. An initial observational period for newborns at lower EOS risk (groups 3 and 4) may warrant consideration for future quality improvement initiatives.
31 Strengthening care for infants with medical complexity during the transition from the neonatal intensive care unit to the community
Authors: Kieran Emily , Dyck Chan Laura , Shivananda Sandesh 
Published: August 2020

Abstract

Background
With advances in technology and innovative medical treatments, infants who previously would have died in early infancy are living longer. These infants have significant needs in the medical system and pose challenges in coordinating care from multiple providers, especially after discharge from NICU.

Objectives
To engage neonatal-to-early-childhood care-transition stakeholders in implementing system-level change to champion the successful transition of infants with medical complexity into early childhood. We believe this engagement activity will spark action amongst stakeholders to adopt best practices leading to improvements in care for this vulnerable patient population.

Design/Methods
We explored four key care transition related questions:
We organized journey mapping and focus groups with NICU alumni families whose children have medical complexity. We conducted a literature review to identify evidence-based interventions. We compiled this information to create evidence briefs that were presented to an interprofessional group of senior stakeholders using the deliberative dialogue approach. Following presentation of the evidence briefs surveys were administered to measure stakeholder intention to act on solutions presented.

Results
Twenty-five opportunities for improving transitions between hospital and community care teams were identified through engagement with families and project team members (graphic A). These opportunities focused on facilitating clinical navigation, navigating community services, and improving parental mental health. Forty-two stakeholders representing a children’s and women’s hospital, families, community care providers, and provincial bodies were engaged in this project.
A rapid review of the literature was carried out using multiple databases searches to ensure comprehensiveness and flexible search strategies to ensure literature was found for all issues. This included a broader search of NICU discharges and nine targeted searches with medical complexity populations. Proposed solutions from stakeholders were further validated through comparisons with the literature and ultimately thirty-five papers were included in the evidence briefs.
Specific care interventions were recommended to key healthcare decision makers, such as providing post-discharge care coordination in a specialized complex care clinic, implementing patient-oriented discharge summaries, and facilitating access to mental health resources.
Using a seven point Likert scale the majority of stakeholders agreed that both the evidence briefs and deliberative dialogues were very successful in achieving their aim. Stakeholder intention to act on solutions presented in evidence briefs and deliberative dialogues were rated as very likely.

Conclusion
35 DUNN method versus weight based formulae to estimate umbilical arterial and venous catheters position
Authors: Correa Salustiano Maria Helena , Asselin Sarah , Olivier François , Patel Sharina , Beltempo Marc 
Published: August 2020

Abstract

Background
Umbilical arterial catheters (UAC) and umbilical venous catheters (UVC) are frequently used in infants admitted to neonatal intensive care units (NICU). Dunn method (DM) was used in our NICU to calculate length of insertion of UAC/UVC until July 2018, before the adoption of the weight-based formulae (WBF).

Objectives
Our primary objective was to compare both methods in regards to correct position of UAC/UVC on first attempt. As a secondary objective we assessed the correlation between the tip position of catheters in anteroposterior radiographies (APR) and lateral radiographies (LatR).

Design/Methods
This is a retrospective cohort study of infants with UAC/UVC inserted in the NICU from 2017-2019. Charts were reviewed for demographic data and catheters position in APR and LatR. The position was considered appropriate if the tip was between thoracic vertebral level (Th)6 and Th9 on APR for UAC and at Th8-Th9 on APR for UVC. Length of insertion of catheters was calculated via DM in one group and WBF in the other. Secondarily, we compared position of catheters on APR and LatR. For statistical analysis we used t student test for continuous data, Chi square test for categorical data and Pearson r for coefficient of correlation(r).

Results
Among 462 infants with UAC/UVC placed, demographic characteristics in both groups were similar (Table 1).
There was a good correlation between APR and LatR for the assessment of UVC and UAC position.
Appropriate position on first attempt for UAC was 60% (49/82) with Dunn method and 66% (74/112) with WBF (p=0.67).
Appropriate position on first attempt in UVC insertion beyond liver was 36% (46/127) using Dunn method and 43% (67/157) with WBF (p=0.47).
Rate of low positioned UVC was significantly lower using WBF compared to Dunn method: 3%(5/157) vs 9% (11/127), (p=0.04).
Position of catheters on APR and LatR were well correlated for UVC (n=146, r=0.87, p&lt;0.001) and UAC (n=62, r=0.82, p&lt;0.001).

Conclusion
No difference was observed for appropriate position of UAC and UVC on first attempt using DM versus WBF.
There was significantly less low positioned UVCs with WBF.
36 Contrast Enhanced Radiography for Peripherally Inserted Central Venous Catheter Tip localization- Is it really needed for all infants?
Authors: Jim Jose Mary , Soraisham Amuchou 
Published: August 2020

Abstract

Background
Contrast enhanced radiography (CER) is considered one of the best available methods for localizing the tip of a peripherally inserted central venous catheters (PICC) in neonates, which was the standard practice at our NICU. It was observed that multiple catheter readjustments and radio-graphs were required due to contrast jet appearing radio-graphically as a distal extension of the catheter creating a false impression of deep location of the PICC tip. This raised the question of whether we need to use contrast routinely for all infants or can we selectively use contrast when needed.

Objectives
The intention of this quality improvement project was to adopt the use of plain radiography (PR) as the first modality for PICC tip localization and use CER only if localization was unsuccessful in the first instance. The objective was to examine the effect of this change of clinical practice on the:

a)
number of radio-graphs taken for PICC insertions b) the frequency of intravenous contrast use in PICC insertion.

Design/Methods
This was a QI initiative conducted over a 7 month period. After educating all care providers who insert PICC, we changed our practice to use plain radiography as first modality for PICC tip visualization starting June 1, 2019. CER was only used if catheter tip was not visualized on plain radiography. We collected the information on infants who had PICC inserted in the NICU before and after the implementation of the initiative for a given period.
Outcome measures were a) proportion of infants with PICC tip visualized on first plain radiography (b) proportion of infants who received CER (c) Number of X-rays per line insertion. We compared the data regarding the above outcomes between the two time periods.

Results
Of the 113 PICC inserted, 39 PICCs were inserted during routine CER period, and 74 PICCs were inserted during PR period. The mean gestational age (26 ± 2.8 vs 27± 3.5), birth weight (878 ± 406g vs 1024g ± 559g, site of insertion - upper limb PICC (74% vs 69%) were comparable between the two groups.
Catheter was visualized on first plain radiography in 56/74 (75%) in the PR period. Overall, the CER was performed in 30/74 (40%), of which 18 were for non-visualization of tip on first plain radio-graph and 11 for non-visualization after subsequent manipulation. There was no difference in the median (IQR) number of radio-graphs between CER period and PR period [2 (2-3) vs 2 (1-3), p =NS] with similar proportion of infants requiring 2 or less X-rays (71% vs 67%).

Conclusion
The use of plain radiography as the initial imaging modality is a safe alternative, without increasing radiation exposure and it minimizes the use of intravenous contrast in neonates undergoing PICC insertions. In spite of being superior for tip visualization, CER does not reduce the number of X-rays taken for the same purpose.
46 Preparation for MRI through imaginary visualization of an astronaut’s rocket journey to space for children 3 to 7 years old
Authors: Truchon Laurence , Lacombe Catherine , Doyon Myriam , Tremblay-Roy Jean-Sébastien , Cyr Claude , Choker Ghassan , Roulier Sébastien , Patenaude Yves , Santschi Miriam 
Published: August 2020

Abstract

Background
Medical imaging by magnetic resonance imaging (MRI) is now frequently used in the pediatric population. Up to now, sedation is used almost systematically to provide adequate immobilization during the exam. However, sedation is not without risks.

Objectives
The objective of this study is to evaluate whether a prior familiarization to MRI procedures with a video staging the imaginary world of an astronaut’s rocket journey into space will decrease the number of required sedations for an MRI for children aged 3 to 7 years old.

Design/Methods
A total of 136 children between 3 and 8 years of age, referred for an MRI between April 2016 and October 2019, were recruited for this prospective non-randomized quasi-experimental study. The control group (April 2016 to August 2017, n=73) received the usual sedation protocol for MRI used in our center. A pictorial step-by-step brochure and a three-minute video explaining the parallel between the MRI reality and the imaginary world of an astronaut was developed and shown to the intervention group (July 2018 to October 2019, n=63) before the MRI. Compared to the control group, any MRI in the intervention group was first attempted without sedation.

Results
A significant decrease in the number of sedations was observed in the intervention group (n=18; 28.6%) compared to the control group (n=47; 64.4%) (odds ratio: 0.22; p &lt;0.001). The effect of the intervention was even stronger for younger children (3 and 4 years old) (odds ratio: 0.03) compared to older children (5 years old and above) (odds ratio: 0.3). After logistic regression, age remained the sole other significant factor to influence the need for sedation, even in the intervention group.

Conclusion
A video and a brochure staging the imaginary world of an astronaut’s rocket journey into space showed just before a MRI significantly reduces the rate of sedation in children aged 3 to 7 years, especially for young children. We believe the implementation of interventions using imaginary visualization in this age group should be widely used to limit the necessity of sedation.
53 Implementation of a Developmental Outreach Clinic housed within a Family Health Team - preliminary findings in building a shared care model for children and youth with mental health and developmental disorders
Authors: Young Elizabeth , Goldfarb Rachel , Green Laurie , Hollamby Kathleen , Weyman Karen , Jackson Linda , Milligan Karen 
Published: August 2020

Abstract

Background
At our inner city hospital, we developed a shared care model between family health teams (FHTs), pediatricians and developmental pediatricians to care for children with mental health and developmental disorders. In phase one of our study, 84 FHT members participated in focus groups to inform the development of our clinic. Family physicians described their role as “referral agent”, “long term supporter” and “healthcare coordinator”. They expressed the desire to “learn” and “do more”, but noted barriers to providing care, including limited training, lack of service knowledge, limited communication, and cumbersome access to mental health and dual diagnosis services. Phase One was completed and accepted for publication. Phase Two describes the implementation of our clinic using a mixed methods approach and report preliminary findings.

Objectives
To evaluate the first two years of implementation of the developmental clinic housed within a family health team (FHT) an obtain feedback from members of the shared care model.

Design/Methods
Mixed methods were used including chart review of all patients referred to the clinic and semi structured interviews with primary care physicians, pediatricians and developmental pediatricians regarding their roles in managing children with developmental and mental health disorders, as well as use and impact of the developmental clinic.

Results
A total of 115 charts were reviewed between Feb 2016 and Jan 2018. Of all patients seen, 34% were female 64% male and 2% transgender. Ages ranged from 1-17 years. Eighty-one percent had an existing diagnosis and were referred for re-assessment while 43% received a new diagnosis: ASD (72%), ADHD (11%), GDD (11%), learning disorder (3%), Anxiety (1%), Other (1%). There was an 8% no show rate. Providers endorsed improved communication through use of a shared EMR for documentation and messaging, and improved service knowledge through availability of a pediatric service navigator who also used EMR to document service and funding applications. Longer term follow up, namely the roles and responsibilities of pediatrics vs. developmental pediatrics vs. primary care remained unclear.

Conclusion
Implementation of the shared care model for this population with primary care is feasible, and does address some stated barriers to care, including improved communication, increased service knowledge, and provision of reassessments. Further areas to develop include clarifying the roles and responsibilities of the different healthcare providers of children with mental health and developmental disorders, and determining what is needed for long-term follow up and transitional care.