bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detection of extended gamma-ray emission in the vicinity of Cl Danks 1 and 2
Authors: Liu Jia-hao , Liu Bing , Yang Rui-zhi 
Published: October 2024

ABSTRACT
We report the detection of high-energy gamma-ray emission towards the G305 star-forming region. Using almost 15 yr of observation data from Fermi Large Area Telescope, we detected an extended gamma-ray source in this region with a significance of $\sim 13 \sigma$. The gamma-ray radiation reveals a clear pion-bump feature and can be fitted with the power-law parent proton spectrum with an index of $-2.5$. The total cosmic ray (CR) proton energy in the gamma-ray production region is estimated to be of the order of $10^{49}\ \rm erg$. We further derived the CR radial distribution from both the gamma-ray emission and gas distribution and found it roughly obeys the $1/r$ type profile, though a constant profile is not ruled out. This is consistent with other similar systems and expected from the continuous injection of CRs by the central powerful young massive star cluster Danks 1 or Danks 2 in this region. Together with former detections of similar gamma-ray structures, such as Cygnus cocoon, Westerlund 1, Westerlund 2, NGC 3603, and W40, the detection supports the hypothesis that young massive star clusters are CR accelerators.
The decline in tropical land carbon sink drove high atmospheric CO2 growth rate in 2023
Authors: Gui Yanchen , Wang Kai , Jin Zhe , Wang Heyuan , Deng Hanzhi , Li Xiangyi , Tian Xiangjun , Wang Tao , Chen Wei , Wang Tengjiao , Piao Shilong 
Published: October 2024

ABSTRACT
Atmospheric CO2 growth rate (CGR), reflecting the carbon balance between anthropogenic emissions and net uptake from land and ocean, largely determines the magnitude and speed of global warming. The CGR at Mauna Loa Baseline Observatory reached a record high in 2023. We quantified major components of the global carbon balance for 2023, by developing a framework that integrated fossil fuel CO2 emissions data and an atmospheric inversion from the Global ObservatioN-based system for monitoring Greenhouse GAses (GONGGA) with two artificial intelligence (AI) models derived from dynamic global vegetation models. We attributed the record high CGR increase in 2023 compared to 2022 primarily to the large decline in land carbon sink (1803 ± 197 TgC year−1), with minor contributions from a small reduction in ocean carbon sink (184 TgC year−1) and a slight increase in fossil fuel emissions (24 TgC year−1). At least 78% of the global decline in land carbon sink was contributed by the decline in tropical sink, with GONGGA inversion (1354 TgC year−1) and AI simulations (1578 ± 666 TgC year−1) showing similar declines in the tropics. We further linked this tropical decline to the detrimental impact of El Niño-induced anomalous warming and drying on vegetation productivity in water-limited Sahel and southern Africa. Our successful attribution of CGR increase within a framework combining atmospheric inversion and AI simulations enabled near-real-time tracking of the global carbon budget, which had a one-year reporting lag.
Beyond Words: Enhancing Clinical Guideline Comprehension With Icons
Authors: Comba Isin Y , O’Horo John C , Gordon Joel E , Falck-Ytter Yngve , Moore Matthew M , Morgan Rebecca L , Mustafa Reem A , Bhimraj Adarsh 
Published: October 2024

Abstract

Background
The Grading Recommendations, Assessment, Development, and Evaluations (GRADE) framework is widely applied in clinical guidelines to facilitate transparent evidence evaluation. While developing Infectious Diseases Society of America (IDSA) guidelines on the management of patients with coronavirus disease 2019 (COVID-19), panel members suggested developing and implementing a visual aid to enable quicker identification of key information by providers at bedside seeking guidance.

Methods
We conducted a mixed-methods study evaluating the usability of a newly designed infographic/icon using a survey and focus groups. The survey incorporated a simulated COVID-19 IDSA guideline with and without the icon, followed by comprehension questions. Focus group discussions provided qualitative feedback on the GRADE methodology and icon usability.

Results
The survey was returned by 289 health care providers. There was no statistical difference in the correct response rates between icon-aided and non-icon-aided guideline questions (McNemar's chi-square test, P &gt; .1 for both questions). Interactions with the icon notably increased the time taken and number of clicks required to respond to the first question (Wilcoxon signed-rank test, P &lt; .01). In contrast, response time did not differ between versions for the second question (P = .38). Most subjects (85%) indicated that the icon improved the readability of the guidelines. A focus group follow-up suggested alternative designs for the icon.

Conclusions
This study highlights the promise of iconography in clinical guidelines, although the specific icons tested did not measurably improve usability metrics. Future research should focus on icon design and testing within a formal usability framework, considering the impact of GRADE language on user experience.
12 Access to paediatric maltreatment services through a northern community hospital
Authors: Ng Pamela , Corbeil Chantal 
Published: October 2024

Abstract

Background
Few studies have evaluated how paediatric maltreatment services based in community hospitals can provide access to care for populations who live far away from tertiary centres. The Violence Intervention Prevention Program (VIPP) and the Paediatric Abuse and Referral Evaluation (PARE) clinic based in a northern community hospital in Canada offer assessment for sexual and physical maltreatment.

Objectives
The aim of the study was to describe demographic and clinical characteristics of patients accessing VIPP and PARE services and to characterize the length of time required to access care.

Design/Methods
We conducted a retrospective chart review of patients, under 16 years of age, who attended PARE clinic for initial consultation between 2017-2019. Analyses were descriptive. This work was approved by the research ethics board at our hospital. There are no funding disclosures.

Results
Of 164 patients, 62.2% were female; 37.8% male. The mean age was 6.6 years, ranging from 1 month to 15.9 years. 54.3% of referrals were for suspected physical maltreatment, 44.4% for suspected sexual maltreatment and 1.2% for both. 87.5% of patients listed home addresses within the hospital’s city limits. The maximum distance travelled from home to access care was 171 km. 87.2% of patients presented through the emergency department; a minority presented through direct referral to outpatient services (11.5%) or through inpatient (1.2%). When called from the emergency department, on-call VIPP nurses responded within a mean of 32 minutes for initial assessment. These patients received a maltreatment assessment by a paediatrician through the PARE clinic a mean of 14.3 days later. If patients did not present through the emergency department, the mean wait time for a maltreatment assessment by a paediatrician was 16 days. 13.4% (22/164) required referral to other medical or multidisciplinary services. General paediatrics (11/22) was the most frequent referral, followed by community speech programs (5/22). A minority (3.0%) of cases required consultation with external maltreatment teams, where two cases were peer-reviewed with a tertiary care team, one with a paediatric maltreatment physician at another community hospital and two cases were reviewed with a paediatric tertiary care radiologist.

Conclusion
Our results suggest that community-based paediatric maltreatment services provide care for our regional northern population. There is timely on-call access to allied-health providers through the emergency department. All patients were able to be assessed locally and none were required to travel to a tertiary care hospital. Further study is needed to assess how our data compares to other community maltreatment programs.
44 Spotting the clotting: a 3-year national surveillance study of paediatric pulmonary thromboembolism
Authors: Ramsay Lily , Pike Meghan , Moorehead Paul , Chan Anthony K C , McMullen Sarah , Plint Amy C , Krmpotic Kristina 
Published: October 2024

Abstract

Background
Pulmonary thromboembolism (PE) is a rare event in the paediatric population but can be acutely life-threatening and result in chronic complications. Awareness of contemporary patterns of clinical presentation, diagnostic modalities, and management may aid clinicians in ensuring that patients are promptly identified and treated.

Objectives
To describe the risk factors, symptoms, diagnostic modalities, therapeutic interventions, and short-term outcomes in paediatric patients (neonate up to 18 years) with PE through national surveillance.

Design/Methods
Between January 2020 and December 2022, monthly surveillance was conducted with over 2,800 paediatricians and sub-specialists through the Canadian Paediatric Surveillance Program. Voluntary reporting of cases meeting a standardized definition of PE was followed up with a detailed questionnaire.

Results
58 confirmed cases were reported; 33 (57%) were females age 15 to 18 years. Detailed information was available for 31 (53%) of 58 cases. At least 1 risk factor was identified in 28 (90%) cases and 12 (39%) patients had 2 or more risk factors. The most common risk factors were oral contraceptive use (n=10 of 31; 32%) and obesity (n=9 of 31; 29%). Presentation was symptomatic in 28 (90%) cases; 24 (77%) patients presented with 2 or more symptoms. The most common symptoms were chest pain (n=18; 58%), dyspnea (n=13; 42%) and tachycardia (n=13; 42%). The most common diagnostic modality utilized was computed tomography pulmonary angiography (n=25; 81%). Initiation of systemic anticoagulation was reported for 24 (77%) of 31 cases; thrombolysis and surgical interventions were uncommon (&lt; 5 cases). Treatment complications were common (n=8; 29%). Mortality was reported, but in fewer than 5 cases.

Conclusion
PE in children often presents with non-specific symptoms, but usually occurs in patients with known risk factors. Clinicians should maintain a high index of suspicion in symptomatic patients, particularly those with risk factors and in cases when other diagnoses that may explain symptoms have been excluded. Anticoagulation is the mainstay of treatment; complications can occur. Prompt recognition and management presumably reduce morbidity and mortality, but this cannot be inferred from our data.
45 Home-based phototherapy for neonatal hyperbilirubinemia: A one-time Canadian Paediatric Surveillance Program Survey
Authors: Holyer Karissa , Abdulsatar Farah , Miller Michael 
Published: October 2024

Abstract

Background
Home-based phototherapy (HP) has gained popularity as a viable alternative to hospital-based treatment for neonatal hyperbilirubinemia, with longstanding use internationally and availability in specific regions of Canada. HP has been shown to be cost-effective and beneficial for parent-infant bonding, but its safety remains unclear, especially with current use in Canada.

Objectives
The primary objective of this study was to identify adverse events related to HP within Canada over the past 12 months. Secondary objectives included identifying risk factors associated with these adverse outcomes and gathering information on the current status of HP in Canada.

Design/Methods
A one-time survey, distributed through the Canadian Paediatric Surveillance Program, collected retrospective data from paediatricians. The survey included questions about adverse events associated with HP and associated risk factors and outcomes, as well as the provision of HP. A descriptive statistical analysis was conducted.

Results
The survey response rate was 31% (844/2741). Among the 497 respondents providing care for neonatal hyperbilirubinemia, 15 (3%) physicians reported a total of 28 cases of adverse events associated with HP in the preceding 12 months. Most adverse events resulted in admissions or readmissions to the hospital for in-hospital phototherapy with no serious adverse events or long-term consequences. Risk factors were identified in 67% of cases, with infant-related factors being the most prevalent. HP was offered at the centre of 12% of the responding physicians, with formal protocols for patient assessment and follow-up at most centres.

Conclusion
This survey revealed no serious adverse related to HP in the preceding 12 months. The survey also revealed that while HP is available in Canada, there is a lack of standardization in its administration across the country. This study provides valuable insights into the safety and practice of HP for neonatal hyperbilirubinemia in Canada, contributing to evidence-based decision-making and optimization of care protocols.
52 The bag is not always bad: Implementing a two-step method for urine testing on the inpatient paediatric units
Authors: Rossos Andrea , Bal Chandandeep , Kirolos Nardin , Paluck Felicia , Gamulka Beth 
Published: October 2024

Abstract

Background
Urinary tract infections (UTIs) are a common source of infection in children. Best practice for diagnosis includes interpreting a urinalysis (UA) and urine culture. Urine cultures obtained through bladder catheterization are invasive and time consuming. A two-step approach with noninvasive UA screen, followed by urine culture if positive has previously demonstrated a reduction in unnecessary catheterizations and urine cultures in children 6-24 months with suspected UTIs. Pre-intervention, there was inconsistent use of screening point-of-care urinalysis prior to bladder catheterization for culture.

Objectives
To decrease the number of bladder catheterizations in children 6-24 months with a negative screen on Point of Care Test (POCT) urinalysis by 25% over 1 year on paediatrics wards at a paediatric tertiary care centre. Outcome measures: 1. Proportion of bladder catheterizations with negative or no UA screen prior 2. Proportion of UA completed as POCT rather than lab sample Process measures: 1. Number of urinary catheterizations performed for UTI screen 2. Number of times pathway is followed Balancing measure: 1. Missed UTIs

Design/Methods
Baseline data was collected from the paediatric inpatient units at a tertiary paediatric hospital from April 2020 – April 2021. A two-step pathway for collecting urine samples was adopted, including POCT UA screen on a bag sample, followed by bladder catheterization for culture if positive. The pathway was implemented using the Model for Improvement and multiple PDSA cycles. Intervention focused on education, interdisciplinary collaboration, and process standardization.

Results
Baseline data demonstrated a high rate of urinary catheter cultures despite a negative UA or no UA prior (69%). After pathway implementation, this rate decreased to 23%, with a reduction in initial UA collected by catheter from 14% to 5% (figure 1). The number of POCT UA performed has increased from a median of 64% pre-intervention to 80% post-intervention, resulting in fewer samples processed in the lab (figure 2).

Conclusion
Variability in practice for specimen choice for collection and investigation contributed to unnecessary catheterizations. Process standardization successfully improved patient-centered care and efficiency. Next steps include broadening pathway inclusion criteria to the 3–6-month age group.

Potential competing interests
This work was partially supported by the UMC (Utilization Management Committee) Resource Stewardship Grant. The authors declare no additional sources of funding or conflicts of interest.
58 A hospital paediatrics education curriculum: Quality improvement for inpatient paediatric learner education on CTU
Authors: Laguë Sabine , Remington Mia 
Published: October 2024

Abstract

Background
Paediatric learners experience the bulk of their inpatient medicine on the wards. While bedside teaching is invaluable, ward learning can be impacted by seasonal exposure, clinical homogeneity, and volume. Locally our learners requested more formal ward teaching to encourage dialogue around common topics perhaps not encountered on rotation. We queried whether having a database of interactive guideline-based educational experiences would minimize barriers (eg. time, resources) to providing formal inpatient learner education.

Objectives
We sought to enhance general paediatrics ward teaching by developing a curriculum of guideline-based interactive educational content on common inpatient paediatric topics.

Design/Methods
This study was conducted at a Canadian tertiary care paediatric hospital with a range of learners (MSI3, MSI4, paediatric residents (R1-R4)) over 12 months. 1) Needs Assessment: We surveyed residents, hospitalist fellows, and CTU physicians regarding a) perceived need for a curriculum, b) content (top 5 CPS guidelines and top 5 non-CPS topics), c) teaching modality, d) need for handouts, and e) curriculum structure. 2) Curriculum generation: Curriculum was developed according to needs assessment results. 3) Quality improvement: Learners were surveyed after each session with four Likert scale questions (5=strongly agree) regarding teaching quality, clinical translatability, enhanced knowledge/understanding, and improved clinical confidence.

Results
1) Needs assessment: Needs assessment (N=25) unanimously supported a structured curriculum. Eleven CPS statements and twelve non-CPS guideline-based topics were identified for content. Three preferred teaching formats were highlighted, and handouts were important to 88% of respondents. The curriculum was favoured to be 50-75% standardized. 2) Curriculum generation: We developed a curriculum of 13 topics with different delivery modalities (e.g. case-based powerpoints, whiteboard talks, Jeopardy, simulation). All were guideline-based, interactive, and had fill-in-the-blank learner handouts. The curriculum was standardized with 4/6 CTU teaching sessions per block being derived from the curriculum bank, and the remainder being at educator discretion (e.g. curriculum bank, interesting case). 3) Quality improvement: Likert scales (5=strongly agree) were positive from all learners (MSI3-R4; N=52), with scores of 4.9+/-0.2 for teaching quality, translatability to practice, and improved understanding, and 4.8+/-0.3 for improved clinical confidence.

Conclusion
Here we present an interactive and guideline-based paediatric inpatient learner education curriculum whose development, from content to delivery modality, was directed by community needs. We are now seeking funding to prepare for national distribution (e.g. peer-review, licensure), and intend to publish on platform where the curriculum would be downloadable for use by all educators (i.e. senior residents, staff).
Loosely Trapped Surface for Slowly Rotating Black Hole
Authors: Izumi Keisuke , Shiromizu Tetsuya , Yoshida Daisuke , Tomikawa Yoshimune , Yoshino Hirotaka 
Published: October 2024

Abstract
We construct the marginal loosely trapped surface (marginal LTS) for the Kerr spacetime with a small Kerr parameter perturbatively, where the LTS condition is saturated. An LTS is a surface that specifies the strong gravity region, which is a generalization of the photon sphere in the Schwarzschild spacetime. It turns out that there are an infinite number of marginal LTSs. At the leading order of the small Kerr parameter, all of the marginal LTSs have the same area. However, one can see that the maximal marginal LTS among them is uniquely determined at the higher order.
Nanomaterials based on hollow gold nanospheres for cancer therapy
Authors: Li You , Wang Jing , Li Ying , Luo Ziqiang , Peng Tao , Zou Tao 
Published: October 2024

Abstract
Gold nanoparticles have recently been exploited as versatile nanocarriers in diagnostic and therapeutic drug delivery for cancer nanomedicine, owing to their biocompatibility, low biotoxicity, surface modifiability and plasma optical properties. A variety of gold nanoparticles have emerged for drug delivery, mainly including gold nanorods, gold nanocages, gold nanostars, gold solid nanospheres and hollow gold nanospheres (HGNs). Among these, HGNs have widely been studied for their higher photothermal conversion efficiency, wider spectral absorption range and stronger surface-enhanced Raman scattering compared with solid gold nanospheres. Therefore, nowadays, researchers prefer to use HGNs to other metal nanocarriers, which can not only play the role of controlled-release drugs but also act as photothermal agents for tumor therapy and diagnosis, due to their properties of surface modification. Combined with the Au–S bond on the surface of HGNs, the targeted preparation is loaded to achieve precise drug delivery. With the assistance of the photothermal characteristics of HGNs themselves, the efficacy of loaded drugs in HGNs is enhanced. In addition, HGNs also have vital values in the field of bioimaging, which serve as photothermal imaging agents and Raman scattering-guided preparations due to their surface-enhanced Raman scattering properties to assist researchers in achieving the purpose of tumor diagnosis. In this review, we summarize the synthesis methods of HGNs and the recent application of HGNs-based nanomaterials in the field of cancer diagnosis and therapy. In addition, the issues to be addressed were pointed out for a bright prospect of HGNs-based nanomaterials.
Effect of supplementation to offspring during early gestation and the growing phase with different sources of fatty acids on learning and memory ability of postweaning lambs
Authors: Whalin Megan , Roque-Jiménez José A , Oviedo-Ojeda Mario F , Lee-Rangel Héctor A , Relling Alejandro E 
Published: October 2024

Abstract
The objective of the current experiment was to evaluate the effects of supplementation with different dietary fatty acid profiles on the dam during the first third of gestation and on the offspring during growth on the offspring’s cognitive behavior. Seventy-nine postweaning lambs were blocked by body weight and sex using a 2 × 2 factorial arrangement of treatments. The first factor (maternal supplementation; MS) was supplementation to the ewes in the first third of gestation with 1.61% Ca salts of palm fatty acid distillate (PFAD) or Ca salts enriched with eicosapentaenoic (EPA) and docosahexaenoic acids (DHA) to early pregnant ewes. The second factor (offspring supplementation; OS) was to supplement the offspring during their growing phase with diets that contained 1.48% of PFAD or Ca salts of PFAD or EPA and DHA. Ewes were housed in groups, 3 ewes per pen and 12 pens per treatment, with different treatments until day 50 of gestation. From day 51 of gestation until weaning, all the animals (ewes and lambs) were housed in a common pen. After weaning, lambs were housed in group pens (5 pens per treatment, 3 to 5 per pen). The lambs ran maze tests on weeks 5 and 7 after weaning to evaluate cognitive ability. The maze contained 2 trap zones and had the pen conspecific lambs at the end of the maze. The measurements were the times to solve the traps and the total time to complete the maze. Data were analyzed using a mixed procedure considering the 2×2 factorial arrangement of treatments. There was an MS × OS × time interaction for the time to complete the maze (P = 0.02). Lambs receiving a different type of fatty acid supplementation during gestation than postweaning took less time to complete the maze on the second relative to the first day compared with the lambs fed the same type of fatty acids during gestation and growing. In conclusion, combining different fatty acids during different life stages may improve lambs’ cognitive abilities.