bluuebunny/crossref_metadata_2025_split huggingface dataset:
UNRAVELING INCONTINENTIA PIGMENTI: A COMPARISON OF PHENOTYPE AND GENOTYPE VARIANTS
Authors: Wang Rebecca , Lara-Corrales Irene , Kannu Peter , Pope Elena 
Published: May 2018

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

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

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

Design:
Retrospective cohort study.

Setting:
Level 1 trauma center in New York.

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

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

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

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

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

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.