bluuebunny/crossref_metadata_2025_split huggingface dataset:
69 Exploring learners’ perspectives of a pediatric palliative care tele-mentoring and education program (project ECHO) in a resource-limited setting
Authors: Evans Emily , Doherty Megan , Modanloo Shokoufeh , Rowe Jennifer , Newhook Dennis , Archibald Doug 
Published: August 2020

Abstract

Introduction/Background
More than 98% of children who need palliative care live in low- or middle-income countries where access to palliative care is extremely limited. A lack of palliative care education for health care providers has been identified as a significant barrier to improving access to palliative care. Project ECHO (Extension of Community Healthcare Outcomes) is an online tele-mentoring educational platform developed to improve access to specialist care in these underserved areas. From 2018 to 2019, we piloted a one-year Project ECHO program which provided pediatric palliative care training for healthcare professionals mainly within India and surrounding South Asian countries.

Objectives
The objective of this study was to explore the learning experiences of participants in a Project ECHO on pediatric palliative care in South Asia and explore considerations to improve ECHO to cater to the unique learning needs and challenges for healthcare professionals in resource-limited settings.

Design/Methods
We implemented a one-year Project ECHO targeting healthcare providers in South Asia, which consisted of 24 bi-weekly 90-minute sessions. Learners who attended at least 20% (5 sessions) were invited to participate in focus groups. Focus groups were designed to explore participants’ experiences and the perceived strengths and weaknesses of the program. Recordings of the focus group sessions were transcribed, coded and independently verified. The codes were then arranged into overarching themes.

Results
Seventeen individuals from India and Bangladesh participated in four focus groups at the end of ECHO PPC. Following coding and analysis, two major themes and seven sub-themes were identified. The themes included: (1) Benefits of participation in ECHO PPC (creation of a community of practice; opportunity to exchange cultures, ideas and experiences; supportive role of the facilitator and peers; increased relevant knowledge and skills; and access to additional learning resources) and (2) Barriers to participation (difficulties with time and practice schedule management; and language and sociocultural factors).

Conclusion
Healthcare professionals in resource-limited settings benefit from project ECHO through the creation of a supportive, online learning community of peers where ideas, experiences and learning resources can be shared. Addressing barriers to participation may enhance the learning experience of project ECHO in the future.
83 Electrocardiogram in Syncope: An old habit or clinically helpful?
Authors: Manouzi Anas , Doan Quynh , Sanatani Shubhayan 
Published: August 2020

Abstract

Background
Syncope affects up to 50% of individuals by age 21 years and accounts for 1% of presentations to the emergency department (ED). Cardiac causes of syncope, including structural heart defects and rhythm disorders, cannot always be ruled out by an electrocardiogram (ECG) as this test lacks sensitivity and specificity. Conflicting recommendations for the role of ECG in evaluation of pediatric syncope underscore the clinical equipoise of how ECG findings influence physicians’ clinical decisions.

Objectives
The primary objective of this study is to determine how ECG findings affect ED physicians’ management of children presenting with vasovagal syncope. Our secondary objective is to document the practice pattern variation among ED physicians regarding their decision to obtain an ECG for the evaluation of vasovagal syncope in children.

Design/Methods
We conducted a prospective cross-sectional survey study using the REDCap platform. Our sample frame consisted of practicing emergency physicians enrolled in the Pediatric Emergency Research Canada (PERC) network. Outcome measures included frequency investigations, specialist consultation, and disposition stratified by type of syncope presentation (low/high risk). We also evaluated which specific ECG findings were likely to change physicians’ management and explored factors influencing the decision to perform or not perform the ECG.

Results
We obtained data from 105/225 (47%) potential respondents. In a clinical scenario presenting a vasovagal syncope, 52% of respondents would order an ECG. Forty-five percent changed their management if the ECG interpretation was anything other than “Normal ECG”. In a high-risk syncope scenario, an ECG was performed by 96% of respondents. Cardiology referral was requested by 93% of respondents, despite normal ECG findings. Borderline ECG findings led to significant practice variation in management, for both low and high-risk presentations scenarios. Overall, 66% of respondents stated that performing an ECG is not important to rule out a cardiac etiology in a typical vasovagal syncope presentation, but 64% stated that performing an ECG is important to reassure the patient.

Conclusion
There is substantial practice pattern variation among emergency physicians with regards to the frequency and motivations to order ECGs, and how ECG findings impact the management of pediatric syncope in the ED. Information provided by an ECG can lead to unnecessary change to clinical management, additional testing, and referrals to specialists for typical vasovagal syncope. This reinforces the importance of better knowledge translation surrounding evidence-based management of vasovagal syncope among ED physicians.
87 Is Canadian Federal Legislation Effective in Preventing Youth Access to Vaping Initiation Products? A secret shopper and online study
Authors: Kilcommons Sebastian James , Horwitz Simonne , Ha Seong Eon , Ebbert Kirsten , Restivo Lea , Verbeke Mary-Claire , Hays-Alberstat Ally , Cooke Lorcan , Mackay Cameron , Anselmo Mark A , Mitchell Ian , Guichon Juliet 
Published: August 2020

Abstract

Background
Electronic cigarette use (“vaping”) is associated with negative health outcomes. Vaping among youth has recently risen to the highest levels recorded. Between 2017 and 2018, Canadians 16 to 19 years old who reported vaping over the past 30 days increased by 74%. This directly coincides with the Tobacco and Vaping Products Act (the “Act”) enactment, which lifted the ban on e-cigarette importation and sales without pre-approval while attempting to restrict youth access to e-cigarettes, and the entry of JUUL e-cigarette products into the Canadian market.

Objectives
The purpose of the study was to evaluate the Act’s effectiveness in protecting the health of youth by preventing their access to vaping products, using a secret shopper interventional design.

Design/Methods
Study subjects were vaping and convenience store employees and deliverers of vaping products ordered online. Confederate researchers (minors aged 15-16 and young adults aged 19-21) entered retail stores to buy JUUL Starter Kits. Three improper scenarios were used: (1) a minor(s); (2) a young adult with no or invalid identification; and (3) a young adult with valid identification clearly purchasing on behalf of an accompanying minor. The main outcome measured was vendor willingness to sell, recorded upon exit from stores. Five minors also ordered JUUL Starter Kits online from their homes. Frequencies were calculated for each variable and tests of association were completed using chi square analysis.

Results
In total, 42.5% of vendors (51/120) were willing to sell JUUL Starter Kits to the young adults and minors. Most vendors requested identification in all scenarios (97/120, 80.8%) but, of these, 28 vendors were willing to sell even though no or false identification was provided (28.9% of those who requested identification). Of those vendors who did not request identification (23/130, 19.2%), all were willing to sell. Where a young adult was clearly buying vaping products for a minor, vendors were willing to sell 63.2% of the time (24/38, p=0.016). In five online purchase attempts, 60% of deliverers did not meet the Act’s verification requirements.

Conclusion
Given that almost half of the vendors were willing to sell JUUL Starter Kits in improper circumstances, the Act does not adequately achieve its goal of protecting the health of youth. To prevent youth access to vaping products, the Act needs stricter enforcement and amendment to impose positive obligations on vendors to request identification, to prohibit sales to adults buying for minors, and to require manufacturers to disclose the product contained in delivered parcels.
88 Vegetarian diet, growth and micronutrient stores in childhood: A prospective cohort study
Authors: Elliott Laura , Maguire Jonathon , Birken Catherine , Keown-Stoneman Charles , Jenkins David 
Published: August 2020

Abstract

Background
Vegetarian diets are becoming increasingly popular among Canadians, yet few studies have evaluated the relationship between a vegetarian diet and childhood growth and nutritional status. Since vegetarian diets can be less energy dense and may have lower micronutrient content, we hypothesized that a vegetarian diet may affect childhood growth including lower adiposity and height, as well as lower micronutrient stores.

Objectives
The primary objective of this study was to evaluate the relationship between vegetarian diet and growth, including adiposity and height among healthy children 6 months to 10 years of age. Secondary objectives included the examination of the relationship between vegetarian diet and iron and vitamin D stores. We also explored whether cow’s milk intake or age modified the associations between vegetarian diet and growth, and micronutrient stores.

Design/Methods
This was a prospective cohort study of healthy children age 6 months to 10 years. The primary exposure was vegetarian diet measured by parent report. The primary outcome was BMI z-score. Secondary outcomes included height-for-age z-score, serum ferritin, and serum 25-hydroxyvitamin D. Anthropometric measures and venous blood samples were collected at health supervision visits by trained research assistants. Linear mixed effect modelling was used to determine the association between vegetarian diet, growth, and micronutrient stores.

Results
A total of 8912 children (n = 248 vegetarian) participated. In the adjusted models there was no evidence of an association between vegetarian diet and BMI z-score (p = 0.605, 95% CI: -0.06, 0.10), height-for-age z-score (p 0.057, 95% CI: -0.16, 0.002), serum ferritin (p = 0.768, 95% CI: -3.84, 2.84), or 25-hydroxyvitamin D (p = 0.204, 95% CI: -2.14, 0.46). The relationship between vegetarian diet and serum 25-hydroxyvitamin D was modified by child age. Volume of cow’s milk intake did not modify the relationships between vegetarian diet and BMI z-score, height-for-age z-score, serum ferritin, or 25-hydroxyvitamin D. In a secondary analysis, we examined adiposity through weight status categories and found children with a vegetarian diet had higher odds of being underweight (BMI z-score &lt;-2) (OR 1.9, p = 0.006, 95% CI 1.21-3.00).

Conclusion
In this prospective cohort study, evidence of an association between vegetarian diet and lower BMI z-score, height-for-age z-score, and micronutrient stores was not found. Our results suggest children with vegetarian diets had higher odds of being underweight. Future research is needed to evaluate dietary factors and patterns of children following vegetarian diets, especially those with an underweight weight status.
96 Sublingual allergen-specific immunotherapy in pediatric patients: biomarkers and molecular allergy diagnostics as predictors of therapeutic success
Authors: Allahverdiyeva Lala , Agaragimova G E , Mugarab Samedi Veronica 
Published: August 2020

Abstract

Background
Efficacy of allergen-specific immunotherapy (ASIT) in patients with asthma could be significantly enhanced when physicians have an opportunity to identify those who are most likely to respond, determine when to stop treatment, and predict relapse. Thus, molecular allergy diagnostic is an effective tool that could help to individualize the diagnosis and treatment of asthma by accurate detection of the causative and cross-reactive allergens in pediatric patients. Cytokines are known as reliable diagnostic and prognostic biomarkers for asthma and can be used to evaluate the therapeutic effect.

Objectives
To evaluate the roles of molecular allergy diagnostic and biomarkers (L-10, IFNγ и TGFβ) as predictors of ASIT efficacy in pediatric patients with asthma.

Design/Methods
Eighty children aged 5 to 18 years with mild and moderate atopic bronchial asthma were included in the study. Sixty-eight out of 80 (85%) were found to have sensitization to house dust mites Dermatophagoides Pteronyssinus and/or Dermatophagoides Farinae. All these patients underwent molecular diagnostics using ImmunoCAP (Phadia 100) to determine the major (r Der p1, r Der p 2) and minor allergens (r Der p10) of the house dust mites. Twenty-eight patients with mild and moderate asthma were found to have a high sensitivity to these allergens and received SLIT with a mixture of house dust mites (Dermatophagoides Pteronyssinus and/or Dermatophagoides Farinae). To compare the efficacy of SLIT, we evaluated the severity of asthma clinical symptoms on a point scale from 0 to 3, and biomarker levels (IL-10, IFNγ и TGFβ) before and 6 months after SLIT. Twelve healthy children were included in the study as a reference group.

Results
At the beginning of the study, the average daily score in the SLIT group of 2.5 ± 0.7, and after 6 months of treatment, it decreased to 0.5 ± 0.2. The levels of biomarkers were markedly decreased prior to the treatment, especially TGFβ levels, and normalized at the end of treatment (Tab.1).

Conclusion
These findings support the efficacy of molecular diagnosis to determine the efficacy of allergen-specific immunotherapy in patients with asthma.
106 Neighbourhood socioeconomic deprivation and assault injuries in urban youth
Authors: Singh Tanjot , Khan Mayesha , Tansley Gavin , Chan Herbert , Brubacher Jeffrey , Staples John 
Published: August 2020

Abstract

Introduction/Background
Youth violence is a major global public health concern. Assault injuries are a major cause of trauma among youth, yet the causes for and medical consequences of assault victimization in this group remain uncertain.

Objectives
Using data from the third-largest urban area in Canada, we sought to describe the demographic, temporal and geographic influences on the incidence of youth assault injuries.

Design/Methods
We performed a population-based cross sectional study of Canadian youth aged 10 to 24 years seeking emergency medical care between April 2012 and March 2018 at any of the 16 hospitals in a major Canadian metropolitan area. Injury characteristics were described using graphical and statistical techniques. Neighbourhood material and social deprivation indices were examined as independent predictors of the population incidence of youth assault injury using negative binomial regression and geospatial methods.

Results
A total of 2,784 assaulted youth sought emergency medical care during the 6-year study interval, corresponding to an incidence rate of 101 youth assault injuries per 100,000 person-years. Assaulted youth were most commonly males between 20 and 24 years of age. Prior diagnoses of substance use and mental health disorders were common. Examination of temporal variation in the incidence of assault injury revealed a 103-fold difference between the riskiest and safest hours of the week (incident rate ratio, 103). The risk of youth assault injury in the most materially deprived quintile of neighbourhoods was more than four-fold greater than that in the wealthiest quintile (incident rate ratio per quintile increase, 1.42; 95%CI [1.27, 1.59]; p &lt;0.001), and the risk of youth assault injury in the most socially deprived quintile of neighbourhoods was more than twelve-fold greater than that in the least deprived quintile (incident rate ratio per quintile increase, 1.88; 95%CI [1.69, 2.11]; p &lt;0.001).

Conclusion
Assault injuries among youth vary substantially across time and space. Targeted violence prevention interventions might focus on weekend evenings and on socioeconomically deprived neighbourhoods.
Petrology of the April 2015 Eruption of Calbuco Volcano, Southern Chile
Authors: Namur Olivier , Montalbano Salvatrice , Bolle Olivier , Vander Auwera Jacqueline 
Published: August 2020

Abstract
Understanding the origin of intermediate magmas that commonly erupt from subduction zone volcanoes is important to better constraining the mechanisms of continental crust formation. We performed a detailed mineralogical and petrological study of the eruptive products from the April 2015 eruption of Calbuco volcano, Chile, a three-phase sub-Plinian eruption that produced pyroclastic deposits of andesitic composition. The eruptive products comprise a glass phase and a high but variable proportion of minerals dominated by plagioclase, clinopyroxene, and orthopyroxene, with minor olivine, amphibole, and magnetite. Plagioclase is very strongly zoned with highly anorthitic cores surrounded by more albitic rims, and no intermediate compositions between them. Based on thermodynamic calculations and published experimental data, we estimate that the anorthitic cores crystallized from a basaltic andesite melt containing 3·5–4·5 wt% H2O. The bulk-rock major and trace element variability at Calbuco is best explained by the accumulation of a variable amount of minerals (in relative proportion 72 % plagioclase, 28 % pyroxene) in a dacitic melt. These minerals most probably formed in the crystal mush zone of the magma chamber, at 200–300 MPa (8–11 km depth) according to pyroxene and amphibole compositions. A few weeks to months before the eruption, the crystal mush was disaggregated, perhaps owing to magmatic underplating, and a crystal-bearing dacitic melt migrated into a subsurface storage region where the albitic plagioclase rims crystallized. The eruption was probably internally triggered by over-pressurization in the shallow magma chamber.
Petrological Implications of Seafloor Hydrothermal Alteration of Subducted Mid-Ocean Ridge Basalt
Authors: Hernández-Uribe David , Palin Richard M , Cone Kim A , Cao Wentao 
Published: August 2020

Abstract
Determining the mineralogical changes occurring in subducted oceanic crust is key to understanding short- and long-term geochemical cycles. Although numerous studies have explored the mineral assemblages that form in mid-ocean ridge basalt (MORB) at different depths below the Earth’s surface, it is widely recognized that seafloor hydrothermal alteration of the uppermost portion of the oceanic crust can change its composition between a ridge and a trench prior to subduction. In this study, we use petrological modelling to explore the effects of different types of pre-subduction hydrothermal alteration on the phase changes that occur during seafloor alteration of MORB-like compositions during subduction along an average Phanerozoic geotherm. We consider a representative composition of altered oceanic crust, as well as extreme end-member scenarios (pervasive spilitization, chloritization, and epidotization). Our models show that epidotization and chloritization of MORB strongly affects phase equilibria at different depths, whereas spilitization and an average style of alteration produce relatively fewer changes on the mineral assemblage to those expected in a pristine MORB. Devolatilization of MORB during subduction occurs mostly in the forearc region, although the type and extent of alteration strongly control the depth and magnitude of fluid released. Altered compositions carry significantly more H2O to sub- and postarc depths than unaltered compositions; the H2O carrying capacity of unaltered and altered compositions is further enhanced during subduction along colder geotherms. Extremely localized areas affected by epidotization can transport up to 22 times more H2O than unaltered MORB and up to two times more than average altered oceanic crust compositions to depths beyond the arc. Regardless of the extent and style of alteration, the stability of hydrous phases, such as epidote and phengite (important trace element carriers), is expanded to greater pressure and temperature conditions. Thus, hydrothermal alteration of the subducted oceanic slab-top represents a viable, and probably common, mechanism that enhances geochemical recycling between the Earth’s hydrosphere and shallow interior.
The Prevalence of Opioid Analgesic Use in People with Chronic Noncancer Pain: Systematic Review and Meta-Analysis of Observational Studies
Authors: Wertheimer Graeme , Mathieson Stephanie , Maher Christopher G , Lin Chung-Wei Christine , McLachlan Andrew J , Buchbinder Rachelle , Pearson Sallie-Anne , Underwood Martin 
Published: August 2020

AbstractObjectiveTo review studies examining the proportion of people with chronic noncancer pain who report consuming opioids and characteristics associated with their use.DesignSystematic review.MethodsWe searched databases from inception to February 8, 2020, and conducted citation tracking. We included observational studies reporting the proportion of adults with chronic noncancer pain who used opioid analgesics. Opioids were categorized as weak (e.g., codeine) or strong (e.g., oxycodone). Study risk of bias was assessed, and Grading of Recommendations Assessment, Development and Evaluations provided a summary of the overall quality. Results were pooled using a random-effects model. Meta-regression determined factors associated with opioid use.ResultsSixty studies (N=3,961,739) reported data on opioid use in people with chronic noncancer pain from 1990 to 2017. Of these 46, 77% had moderate risk of bias. Opioid use was reported by 26.8% (95% confidence interval [CI], 23.1–30.8; moderate-quality evidence) of people with chronic noncancer pain. The use of weak opioids (17.3%; 95% CI 11.9–24.4; moderate-quality evidence) was more common than the use of strong opioids (9.8%; 95% CI, 6.8–14.0; low-quality evidence). Meta-regression determined that opioid use was associated with geographic region (P=0.02; lower in Europe than North America), but not sampling year (P=0.77), setting (P=0.06), diagnosis (P=0.34), or disclosure of funding (P=0.77).ConclusionsOur review summarized data from over 3.9 million people with chronic noncancer pain reporting their opioid use. Between 1990 and 2017, one-quarter of people with chronic noncancer pain reported taking opioids, and this proportion did not change over time.
Self-enforcing Agreements and Forward Induction Reasoning
Authors: Catonini Emiliano 
Published: August 2020

Abstract
In dynamic games, players may observe a deviation from a pre-play, possibly incomplete, non-binding agreement before the game is over. The attempt to rationalize the deviation may lead players to revise their beliefs about the deviator’s behaviour in the continuation of the game. This instance of forward induction reasoning is based on interactive beliefs about not just rationality, but also the compliance with the agreement itself. I study the effects of such rationalization on the self-enforceability of the agreement. Accordingly, outcomes of the game are deemed implementable by some agreement or not. Conclusions depart substantially from what the traditional equilibrium refinements suggest. A non-subgame perfect equilibrium outcome may be induced by a self-enforcing agreement, while a subgame perfect equilibrium outcome may not. The incompleteness of the agreement can be crucial to implement an outcome.