bluuebunny/crossref_metadata_2025_split huggingface dataset:
96 The pediatric health app landscape: Results of an environmental scan
Authors: Benoit James , Hartling Lisa , Scott Shannon 
Published: October 2021

Abstract

Primary Subject area
Technology

Background
Providing resources that aid in detection and identification of serious childhood illness helps parents feel better equipped to assess their child’s health and significantly changes parental health-seeking behaviours. Some of these resources are limited by accessibility and scalability. Remote locations and staffing limitations create challenges for parents aiming to access health information about their child. Mobile health (mHealth) apps offer a scalable, accessible solution for improving health literacy by enabling access to health information through mobile devices.

Objectives
To systematically identify all Canadian and US child health apps for parents.

Design/Methods
We used an environmental scan approach – a review designed to summarize information for decision makers. The Android and Apple app marketplaces were used as search platforms. We built a list of search terms and used these platforms to search for apps targeted at parents, related to pediatric illnesses in US and Canada. Then once we determined that the app met the inclusion criteria, each included app was assessed using the Mobile App Rating Scale (MARS), a validated tool for assessing health apps. The MARS examines apps on five domains: engagement, functionality, aesthetics, information quality, and subjective quality.

Results
650 unique apps were screened and 53 apps were included. On a scale of 1-5, the 53 apps assessed had an average Engagement score of 2.82/5 (θ = 0.86), Functionality of 3.98/5 (θ = 0.72), Aesthetics of 3.09/5 (θ = 0.87), Information quality of 2.73/5 (θ = 1.32), and Subjective quality of 2.2 (θ = 0.79). App scores ranged from 2.2/5 to 4.5/5 (µ= 3.2, θ =0.6).The top three apps were Baby and Child First Aid (4.5/5), Ada (4.5/5), and HANDi Paediatric (4.2/5). Taken together, the top three apps covered topics of emergency pediatric first aid, identification of (and appropriate response to) common childhood illnesses, a means of checking symptoms, and a means of responding to emergency situations. There was a lack of Canadian-based app content available to parents in both marketplaces. In addition, published evidence of the included apps’ impact was poor: only 5/53 apps had an evidence base showing the app had been trialed.

Conclusion
There is a need for evidence-based apps of Canadian origin related to childhood illnesses. The results of this scan created a picture of the health app landscape by examining trends in apps related to pediatric health that are readily available to parents, and by identifying gaps in app design that can be addressed.
107 Addition of CRP and Respiratory Viral Testing for Risk-Stratification of Febrile Young Infants
Authors: Poirier Cassandra , Filion-Ouellet Emilie , Anderson Gregory , Burstein Brett 
Published: October 2021

Abstract

Primary Subject area
Emergency Medicine - Paediatric

Background
Febrile young infants are frequently brought for medical attention. Although most have viral illnesses, approximately 10% have serious bacterial infections (SBIs) including urinary tract infections, bacteremia or bacterial meningitis. Risk-stratification must have high sensitivity given the consequences of a missed SBI diagnosis. The most widely used risk-stratification criteria rely upon the serum white blood cell count (WBC) and urinalysis (UA), but predate the widespread use of CRP and respiratory virus testing (RVT), both of which offer enhanced ability to detect high-risk infants. CRP and RVT have never been evaluated together or in combination with traditional biomarkers, particularly for the detection invasive bacterial infections (IBI), bacteremia and meningitis.

Objectives
Compare the diagnostic utility of CRP and RVT in combination with WBC and UA for risk-stratification of febrile young infants.

Design/Methods
This was a retrospective study of healthy term febrile infants ≤ 90 days old evaluated in an urban tertiary Pediatric Emergency Department from 2010-2018. Only infants with both blood and urine cultures were included. Test characteristics for detecting SBI and IBI were calculated for tests individually and in composite.

Results
Of 3461 included infants, 442 (12.7%) had SBIs and 56 (1.6%) had IBIs. Overall use of CRP (25%) and RVT (78%) increased over time, and 698 (22%) infants had complete testing with UA, WBC, CRP and RVT. When considering individual diagnostic tests (Table 1), risk of SBI with a normal CRP (1.4%), negative UA (0.18%) or positive RVT (2.6%) was lower than with a normal WBC (6.7%) alone. Risk of IBI was lowest among infants with a positive RVT (0.19%; vs 0.57%, 0.59%, 0.70% for CRP, UA, WBC respectively), and RVT performed best for detection of IBI (Sn 0.857; NPV 0.996). When risk-stratifying infants using tests in combination (Table 2), 43/3339 (1.3%) infants had a SBI despite meeting low-risk criteria with a normal WBC and UA (Sn 0.900; NPV 0.980), compared to 4/698 (0.57%) with a normal WBC, UA, CRP and positive RVT (Sn 0.951; NPV 0.981). IBI was present in 10/3339 (0.3%) infants stratified as low-risk by a normal WBC and UA (Sn 0.818; NPV 0.995), compared to 0/698 (0%) with a normal WBC, UA, CRP and positive RVT (Sn 1.00; NPV 1.00). Subanalysis restricted only to infants with complete testing yielded similar results.

Conclusion
This is the first study to compare use of CRP and RVT in addition to traditional biomarkers for febrile young infants. Use of these widely available tests in combination may improve risk-stratification to reduce unnecessary invasive testing and hospitalizations. Prospective efficacy and cost-effectiveness studies are warranted.
109 Effectiveness of Neuromuscular Electrical Stimulation for Children with Dysphagia: A Systematic Review
Authors: Propp Roni , Gill Peter , Marcus Sherna , Ren Lily Yuxi , Cohen Eyal , Friedman Jeremy , Mahant Sanjay 
Published: October 2021

Abstract

Primary Subject area
Complex Care

Background
Dysphagia is common in children with medical complexity and can result in undernutrition, respiratory complications and negatively impact child and caregiver quality of life; however, evidence on the effectiveness of treatments for dysphagia in children is limited. Neuromuscular electrical stimulation (NMES) is a novel proposed treatment for dysphagia where electrical current is applied to neck muscles using cutaneous electrodes during swallowing therapy. It is hypothesized that NMES improves dysphagia by strengthening swallowing muscles and/or enhancing sensory signals of the swallowing response.

Objectives
To systematically review the evidence on the effectiveness of NMES for treatment of oropharyngeal dysphagia in children.

Design/Methods
MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL and Scopus databases were searched from inception to November 2020. Studies of children (18 years and younger) diagnosed with oropharyngeal dysphagia using NMES in the throat/neck region were included. Screening, data extraction, and risk of bias assessment followed PRISMA guidelines. Risk of bias was assessed using the Cochrane Collaboration’s tool for RCTs and the Newcastle-Ottawa tool for observational studies. [Registration: PROSPERO CRD42019147353]

Results
Of the 844 records screened, 26 were identified for full text review, and 8 studies were included (4 RCTs and 4 cohort studies). These studies represented 338 children, with a mean (or median) age below 7 years, including children with and without neurological impairments. In all studies, swallowing function as measured by imaging studies improved after NMES treatment; in the trials, the standardized mean difference ranged from 0.32 (95% CI -0.56, 1.20) to 1.18 (95% CI 0.40, 1.97) compared to control groups who received usual care without NMES. Seven of eight studies reported on the child’s feeding ability, and, with one exception, there was improvement in feeding ability (Figure 1). Few studies reported on health status (N=1), child’s quality of life (N=1), and adverse events and harms (N=1). No studies reported on the social impact on the child, impact on the caregiver, and the caregiver’s quality of life. In most studies, outcome follow-up was limited to less than 6 months. Overall, the studies demonstrated moderate to high risk of bias. A pooled intervention effect and meta-analysis was not conducted due to clinical heterogeneity.

Conclusion
NMES treatment may be beneficial in improving swallowing function for children with dysphagia, however, given the quality of the studies, inadequate outcome reporting, and short follow-up duration, additional well-designed RCTs are needed to establish its effectiveness.
110 Interim Federal Health Program (IFHP): Survey of Access & Utilization by Pediatric Health Care Providers
Authors: Leps Caroline , Monteiro Jessica , Barozzino Tony , Bowry Ashna , Rashid Meb , Sgro Michael , Suleman Shazeen 
Published: October 2021

Abstract

Primary Subject area
Public Health and Preventive Medicine

Background
Canada is currently facing an increasing number of refugees and refugee claimants, yet Canadian health professionals are underutilizing the system intended to provide these individuals with healthcare. The Interim Federal Health Program (IFHP) provides temporary healthcare coverage for those who are ineligible for provincial or territorial insurance, including resettled refugees and asylum seekers. Research suggests there are ongoing challenges around the program such as who is covered and what services are covered.

Objectives
The objective of this study was to assess Canadian pediatricians’ current understanding and utilization of the IFHP, and perceived barriers to its utilization.

Design/Methods
A one-time survey was administered via the Canadian Paediatric Surveillance Program. The ten question adaptive survey was available in English or French, in either paper or electronic format. Survey responses were collected for 6 weeks in early 2020 with two reminders sent prior to survey closing. In addition to descriptive statistics, multinomial logistic regressions were built to examine pediatrician use of the IFHP, work with IFHP-covered patients, and provider characteristics associated with registration and use.

Results
Of the 2,753 pediatricians and pediatric subspecialists surveyed, there were 1006 respondents (36.5% response rate). 52.2% of respondents had provided care to the IFHP-eligible patients in the previous 6 months. Of those participants, only 26.4% were registered IFHP providers, and just 10% could identify all services covered by the IFHP (Figure 1). Knowledge of 80% or more of supplemental benefits was associated with registration status (adjusted odds ratio [aOR] 1.92; 95% CI 1.09 - 3.37). Amongst those who knew they were not registered, 70.2% indicated they did not know they had to register. aOR demonstrated that those with fewer years of practice had higher odds of not knowing that they had to register (aOR 1.22; 95% CI 1.01 - 1.49)

Conclusion
We demonstrate that the IFHP is poorly utilized by pediatric providers, with low registration rates and poor understanding of the IFHP-covered supplemental services, even among those who have recently provided care to the IFHP-eligible patients. Efforts to improve registration and knowledge of the IFHP are essential to improving access to health care for refugee children and youth.
Funding: Study funded by the CPSP Resident Research Grant
126 BRUE and evaluation of higher-risk infants with overnight oximetry
Authors: Morin-Gagnon Raphaël , Gagnon Josée-Anne 
Published: October 2021

Abstract

Primary Subject area
Hospital Paediatrics

Background
BRUE (Brief resolved unexplained event) is a worrisome event for parents. Investigation guidelines for infants 2 months and older have been published, but an evaluation framework for higher-risk infants is still evolving.

Objectives
The goal of this study is to determine if an overnight oximetry for patients presenting with BRUE under the age of the 2 months would help to target patients at higher risk of recurrent BRUE. The secondary goals are to evaluate the characteristics of those infants, the rate of recurrence of BRUE and to evaluate the effectiveness of other investigations.

Design/Methods
This was an observational retrospective study of infants presenting with BRUE between the age of 7 days and 60 days between January 1 2010 and October 1 of 2018. Patients were selected if they matched the definition of BRUE defined by the American Academy of Pediatrics in 2016. Patient demographics and antecedents, characteristics of the events, investigations results, recurrence of BRUE, and hospitalizations until the age of 1 year were recorded.

Results
103 patients presented with BRUE under the age of 2 months. Of those, 63 (61.2%) were boys. Only four (3.9%) had a recurrence of BRUE. The mean corrected age at the presentation was 20.7 days. Thirty-three (32%) infants had an overnight oximetry; of those 19 (18.4%) had an abnormal result. An abnormal overnight oximetry result was associated with a lower risk of recurrent BRUE (0%) compared to infants without an oximetry (4.3%) or with a negative result (7.1%) (p=0.6195). 68.4% of patients with an abnormal overnight oximetry had received medical treatment (caffeine, oxygen or anti-acid), which was significantly higher than those with normal overnight oximetry (14.3%) or no oximetry (9.4%) (p &lt; 0.0001). There was an association between male sex and abnormal overnight oximetry (p=0.0137). No other investigation was able to predict a higher risk of recurrent BRUE among those evaluated.

Conclusion
In our cohort, boys were more frequently affected and had a higher rate of abnormal overnight oximetry. One hypothesis is that BRUE under 2 months of age might be a presentation mode for immature respiratory control and boys might be at higher risk for such events. Even though an abnormal result was present in 18.4% of the overnight oximetry, this investigation was not able to identify infants at higher risk of recurrent BRUE. This could be partly explained by the fact that a recurrent BRUE is a rare event and that a majority of patients with abnormal overnight oximetry were treated medically, which might have prevented recurrence.
142 Costs Associated with Fetal Alcohol Spectrum Disorder: A comparison of Indigenous and Non-Indigenous Children
Authors: Stade Brenda , Gideon James , Bonifacio Joey (Herbert) , Campbell Douglas , Sgro Michael 
Published: October 2021

Abstract

Primary Subject area
Developmental Paediatrics

Background
The incidence of Fetal Alcohol Spectrum Disorder (FASD) is estimated to be 1 in 100 live births. Caused by prenatal exposure to alcohol, FASD is the leading cause of developmental and cognitive disabilities among Ontario’s children. No study has conducted a comparison of the costs associated with FASD among Indigenous children, and Non-Indigenous children.

Objectives
To calculate and compare an estimate of direct and indirect costs associated with FASD at the patient level among Indigenous children and Non-Indigenous children living in Ontario.

Design/Methods
A cross-sectional study design was used. Eight-hundred and thirty (830) participants completed the study tool. Participants included caregivers of children aged 3 months to 17.5 years, living in urban and rural communities throughout Ontario. Four-hundred and twelve (412) participants were Indigenous Ontarians, and 418 participants were Non-Indigenous Ontarians. Participants completed the Health Services Utilization Inventory (HSUI). Key cost components were elicited: direct costs (medical, education, social services, out-of-pocket costs); and indirect costs (productivity losses). Total average costs per child with FASD were calculated by summing the costs for each, in each cost component, and dividing by the sample size. Costs were extrapolated to one year. A t-test was used to compare costs associated with FASD in the two groups. A stepwise multiple regression analysis was used to identify significant determinants of costs.

Results
Total adjusted annual costs associated with FASD at the individual level was $51,543 (95% CI $46,825; $56,642) among Indigenous children compared to $36,435 (95% CI $31,935; $42,245), among Non-Indigenous children (p&lt;0.01). Severity of the child’s condition and relationship of the child to the caregiver (biological, adoptive, foster) were significant determinants of costs in both groups (p &lt; 0 .01). Age of diagnosis was a significant determinant of costs among the Indigenous group (p &lt; 0.001) but was not a significant determinant in the Non-Indigenous group. On average, Indigenous children were diagnosed with FASD 3.9 years later than Non-Indigenous children.

Conclusion
Study results demonstrated the cost associated with FASD in Ontario was significantly greater among Indigenous children compared to Non-Indigenous children. Implications for practice, policy, and research are discussed.
A bifunctional MXene-modified scaffold for photothermal therapy and maxillofacial tissue regeneration
Authors: Li Fengji , Yan Yanling , Wang Yanan , Fan Yaru , Zou Huiru , Liu Han , Luo Rui , Li Ruixin , Liu Hao 
Published: October 2021

Abstract
Oral squamous cell carcinoma (OSCC) is one of the most common malignant tumours in the oral and maxillofacial regions and is highly malignant and prone to recur despite the development of various effective treatments, including surgery and chemoradiotherapy. Actually, it is difficult to ensure the complete elimination of tumour cells, and maxillofacial bone defects caused by surgery are hard to heal by themselves. In addition, chemoradiotherapy can bring serious side effects. Therefore, it is imperative to develop a postoperative therapy to kill residual squamous cancer cells and repair bone defects without any side effects. Here, we prepared a three-dimensional (3D) scaffold by a 3D printing technique and freeze-drying method, which contained collagen, silk and hydroxyapatite (CSH) and was functionalized with MXene nanosheets (M-CSH). The considerable photothermal effect with long-term stability can significantly kill squamous CAL-27 cancer cells in vitro and inhibit tumour growth in vivo, increasing the probability of the M-CSH scaffold being applied in the photothermal therapy of OSCC. Moreover, the cell proliferation- and osteogenic-related protein expression of mouse embryonic osteogenic precursors (MC3T3-E1) indicated excellent biocompatibility and osteogenic activity of M-CSH scaffolds. The good compression modulus (52.83 ± 2.25 kPa) and in vivo bone formation performance made it possible to be used as reconstructive materials for bone defects. This scaffold is likely promising in future tissue engineering, especially for the multifunctional treatment of maxillofacial tumours.
Tick virome diversity in Hubei Province, China, and the influence of host ecology
Authors: Xu Lin , Guo Moujian , Hu Bing , Zhou Hong , Yang Wei , Hui Lixia , Huang Rui , Zhan Jianbo , Shi Weifeng , Wu Ying 
Published: November 2021

Abstract
Ticks are important vector hosts of pathogens which cause human and animal diseases worldwide. Diverse viruses have been discovered in ticks; however, little is known about the ecological factors that affect the tick virome composition and evolution. Herein, we employed RNA sequencing to study the virome diversity of the Haemaphysalis longicornis and Rhipicephalus microplus ticks sampled in Hubei Province in China. Twelve RNA viruses with complete genomes were identified, which belonged to six viral families: Flaviviridae, Matonaviridae, Peribunyaviridae, Nairoviridae, Phenuiviridae, and Rhabdoviridae. These viruses showed great diversity in their genome organization and evolution, four of which were proposed to be novel species. The virome diversity and abundance of R. microplus ticks fed on cattle were evidently high. Further ecological analyses suggested that host species and feeding status may be key factors affecting the tick virome structure. This study described a number of novel viral species and variants from ticks and, more importantly, provided insights into the ecological factors shaping the virome structures of ticks, although it clearly warrants further investigation.
Cluster detection with random neighbourhood covering: application to invasive Group A Streptococcal disease
Authors: Cavallaro Massimo , Coelho Juliana , Ready Derren , Decraene Valerie , Lamagni Theresa , McCarthy Noel D. , Todkill Dan , Keeling Matt J. 
Published: October 2021

AbstractThe rapid detection of outbreaks is a key step in the effective control and containment of infectious diseases. In particular, the identification of cases which might be epidemiologically linked is crucial in directing outbreak-containment efforts shaping the intervention of public health authorities. Often this requires the detection of clusters of cases whose numbers exceed those expected by a background of sporadic cases. Quantifying exceedances rapidly is particularly challenging when only few cases are typically reported in a precise location and time. To address such important public health concerns, we present a general method which can detect spatio-temporal deviations from a Poisson point process and estimate the odd of an isolate being part of a cluster. This method can be applied to diseases where detailed geographical information is available. In addition, we propose an approach to explicitly take account of delays in microbial typing. As a case study, we considered invasive group A Streptococcus infection events as recorded and typed by Public Health England from 2015 to 2020.
Deep neural networks learn general and clinically relevant representations of the ageing brain
Authors: Leonardsen Esten H. , Peng Han , Kaufmann Tobias , Agartz Ingrid , Andreassen Ole A. , Celius Elisabeth Gulowsen , Espeseth Thomas , Harbo Hanne F. , Høgestøl Einar A. , de Lange Ann-Marie , Marquand Andre F. , Vidal-Piñeiro Didac , Roe James M. , Selbæk Geir , Sørensen Øystein , Smith Stephen M. , Westlye Lars T. , Wolfers Thomas , Wang Yunpeng 
Published: October 2021

AbstractThe discrepancy between chronological age and the apparent age of the brain based on neuroimaging data — the brain age delta — has emerged as a reliable marker of brain health. With an increasing wealth of data, approaches to tackle heterogeneity in data acquisition are vital. To this end, we compiled raw structural magnetic resonance images into one of the largest and most diverse datasets assembled (n=53542), and trained convolutional neural networks (CNNs) to predict age. We achieved state-of-the-art performance on unseen data from unknown scanners (n=2553), and showed that higher brain age delta is associated with diabetes, alcohol intake and smoking. Using transfer learning, the intermediate representations learned by our model complemented and partly outperformed brain age delta in predicting common brain disorders. Our work shows we can achieve generalizable and biologically plausible brain age predictions using CNNs trained on heterogeneous datasets, and transfer them to clinical use cases.