bluuebunny/crossref_metadata_2025_split huggingface dataset:
94 Understanding Parental Behaviours Related to Infant Sleep Environment
Authors: Smith Jennifer , Johnstone Julie , Mahant Sanjay , Shouldice Michelle 
Published: September 2023

Abstract

Introduction/Background
Sudden unexplained death in infants continues to make up a significant proportion of infant deaths. Despite wide dissemination of Canadian Paediatric Society and American Academy of Paediatrics safe sleep recommendations, studies demonstrate significant caregiver nonadherence to the recommendations. Few studies have examined caregiver reasons for low uptake of recommendations. There is an urgent need to understand these issues not only for individual providers counseling about sleep, but also for implementation of public health initiatives which attempt to target parental behaviour change.

Objectives
Our study aimed to explore parental perceptions, beliefs and influences regarding safe infant sleep environment and factors contributing to parental behaviour related to sleep environment.

Design/Methods
A qualitative study utilizing ground theory methodology was conducted with in-depth individual interviews of 14 parents of infants less than six months admitted to a large paediatric hospital in Toronto, Canada. Data collection occurred from November 2017 to January 2018, until a saturation of themes was reached. Interview transcripts were analyzed for recurrent and emergent themes and a coding structure was developed.

Results
Interviews with caregivers were completed, and a range of sleep locations and environments were described. Most caregivers reported that a bassinet or crib was the main sleeping location, but most infants were also placed in other locations at various times, including infant swings, couches, and bed-sharing with caregivers. Three dominant themes affecting decision-making about sleep location were identified: 1. safety, 2. feasibility and convenience and, 3. perception of infant preference and developmental needs. These factors were often present simultaneously in parental decision-making, frequently acting in opposition to one another. Caregivers’ methods of mitigating harm were often counter to recommendations, such as using pillows to prevent rolling. Information sources regarding sleep choices typically included family, friends, healthcare providers and media. Most caregivers placed greater significance on healthcare recommendations than the advice of family members.

Conclusion
This study identified key factors that impact caregivers’ decision-making regarding infant sleep. These results can inform healthcare providers counselling about safe sleep recommendations and public health interventions aimed at increasing adherence to safe sleep recommendations and reducing preventable infant deaths.
97 Handwriting Speed in Juvenile Idiopathic Arthritis Using the Detailed Assessment of Speed of Handwriting
Authors: Marchak Caitlin , James Sarah , Davidson Iris , Brown Jennifer , Houghton Kristin 
Published: September 2023

Abstract

Background
Juvenile idiopathic arthritis (JIA) is the most common cause of arthritis in children. Common symptoms include pain, joint stiffness, joint swelling, fatigue, and decreased physical function. Over 50% of children have hand or wrist involvement and handwriting is the most commonly reported functional limitation in daily activities. To date there has been limited study of the specific limitations of handwriting in children with JIA.

Objectives
To better understand handwriting limitations in children with JIA, this pilot study aimed to: (a) describe handwriting speed measured by the Detailed Assessment of Speed of Handwriting (DASH), a standardized assessment of handwriting speed; (b) compare the DASH scores with age- and sex-matched normative data; (c) examine the association between DASH scores and active wrist and hand arthritis; and (d) explore associations between DASH scores and grip strength, quality of life, function, and pain.

Design/Methods
Participants diagnosed with JIA and actively followed by the paediatric rheumatology clinic at a large tertiary care centre underwent physician assessment with active joint count, occupational therapist (OT) assessment including administration of the DASH, and grip strength measurement by a physiotherapist. Participant-reported outcomes included questionnaires on function (Childhood Health Assessment Questionnaire [CHAQ]), pain, and quality of life (QOL).

Results
A total of 12 participants aged 9-15 years (M = 12.7y) completed the study. The mean DASH score was 35th percentile (SD = 23) for all participants, 58th percentile (SD = 14) with active hand/wrist arthritis, 25th percentile (SD = 19) with history of hand/wrist arthritis, and 24th percentile (SD = 25) with no history of hand/wrist arthritis. Grip strength was low overall (M = 18th percentile, SD = 28), and lower in participants with active hand/wrist arthritis (M = 4th percentile, SD = 5) and history of hand/wrist arthritis (M = 5th percentile, SD = 7). DASH scores were negatively associated with grip strength (r = -.31), and positively associated with QOL (r = .41) and pain (r = .43). There was no relationship between the DASH and the CHAQ.

Conclusion
Handwriting speed difficulties are common in children with JIA and may not relate to arthritis disease activity, pain, or function. Handwriting speed may be used in the clinic as a screen to identify children who may benefit from a full OT handwriting assessment. In the absence of access to OT, general guidance can be provided to schools to support a child with JIA in the classroom.
C2 (Clinical Case) Complicated Sinusitis in an Adolescent Swimmer in the COVID-19 Pandemic: An Unexpected Microbial Player
Authors: Abeytunge Kawmadi , Algain Sulwan , Ranger Adrianna , Tay KengYeow , Cabrera Ana , Sowerby Leigh , Barton-Forbes Michelle 
Published: September 2023

Abstract

Introduction/Background
There are increasing reports of complicated sinusitis following post-pandemic viral surges. Streptococcus anginosus and Staphylococcus aureus (SA) are common causes. However, unusual pathogens may need to be considered in the face of inadequate therapeutic response.

Case Description
A previously healthy 13-year-old boy presented with fever, facial pain, and headache two weeks following presumed COVID-19 infection based on exposure history and symptoms. While recovering, he had been swimming daily and recalled inhaling pool water. On examination he was febrile with a tender mid-forehead swelling and left periorbital swelling without features of orbital cellulitis. There was no meningism or focal neurological deficits. Investigations revealed leukocytosis (19.1 x109/L), elevated CRP (156.8 mg/L) and sterile blood cultures. Head imaging confirmed sinusitis complicated by Pott’s puffy tumor, a small subdural empyema and sinus venous thrombosis. Ceftriaxone, metronidazole, and vancomycin were initiated with de-escalation of the latter to cloxacillin after sinus cultures grew methicillin-sensitive SA. Despite broadening to meropenem and vancomycin, he progressed to develop cerebritis. Legionella species identified from intracranial sampling using 16s RNA, allowed targeted therapy with levofloxacin and successful resolution after six weeks of therapy.

Discussion
The development of this patient’s Pott’s puffy tumor and intracranial complications seemed consistent with post-viral sinusitis in terms of onset and growth of SA. However, his inadequate response to broad-spectrum therapy and sterile cultures from intracranial sampling prompted request for 16sRNA testing. Subsequent disclosure of freshwater swimming exposure with aspiration event raised concerns for water-borne pathogens such as Legionella. The aspiration event occurring in presence of persisting congestion, resulted in Legionella species seeding already inflamed sinuses and further tracking intracranially. Without special cultures required to recover Legionella, this pathogen was initially missed, resulting in disease progression and delayed targeted therapy. Fluroquinolones or macrolides are required for treatment of this pathogen.

Conclusion
Given that post-viral sinusitis may be anticipated during viral surges, practitioners should consider the role of waterborne pathogens in hosts with significant swimming exposure who worsen on usual therapy. Microbiology and infectious diseases involvement is encouraged to optimize detection and management of waterborne infection. Practitioners are reminded that in the face of therapeutic failure, it is critical to revisit the history for unusual exposures, determine immunocompetence, and explore potential bug-drug mismatch.
C10 (Clinical Case) Precocious Puberty in Internationally Adopted Children: A Tale of Two Thelarches
Authors: Shapka Larissa , MacDonnell Heather 
Published: September 2023

Abstract

Introduction/Background
Internationally adopted (IA) children may commonly experience post-adoption medical issues in the infectious, nutritional, developmental and psychological domains. We present a rare endocrinologic case of 2 biologically unrelated children adopted into the same Canadian family with diagnoses of idiopathic central precocious puberty (CPP), years after adoption.

Case Description
A 13-month-old female was adopted from Kazakhstan with a past history of prematurity (29 weeks gestational age), grade II intraventricular hemorrhage, query hypoxic ischemic encephalopathy, perinatal CMV infection, and malnourishment. She demonstrated catch-up growth after adoption and was monitored for developmental concerns. She presented at 7 years 9 months with report of thelarche at 6 years 6 months, pubarche at 7 years 6 months and accelerated height velocity. Bone age was advanced by 3 years (+4 SD). By Endocrinology consultation at 8 years 1 month, gonadotropin-releasing hormone (GnRH) stimulation test confirmed CPP. There was no central nervous system (CNS) symptomatology. Leuprolide was initiated to minimize psychosocial impacts of CPP and not necessarily to improve final adult height.
Seven years after their first adoption, the family welcomed a female child from Vietnam, aged 2 years 11 months. Medical profile included malnutrition and atopic dermatitis. Thelarche was noted at 5 years 4 months. By Endocrinology consultation at 5 years 5 months, she had isolated breast development with accelerated height velocity. Bone age was advanced by 2.5 years (+3 SD). GnRH stimulation test revealed CPP. Leuprolide was started. MRI brain showed no CNS lesion, which confirmed the diagnosis of idiopathic CPP.

Discussion
Whereas there is a rare, but documented, increased prevalence of CPP among IA children, etiology is unclear. Theories postulate that it may be related to rapid catch-up growth post-adoption or past exposure to endocrine disruptors. Awareness of this risk may vary. Initial post-adoption consults often focus on other medical and developmental screening. Depending on the age at adoption, counselling about puberty may seem remote. This may impact the timing at which pubertal concerns are identified. As early identification of CPP provides an opportunity to intervene to preserve adult height, as well as minimize psychosocial impact on the child, pubertal surveillance should not be overlooked. Based on caregiver feedback from our cases, we now include counselling on, and examination for, early pubertal changes in our IA clinic visits.

Conclusion
IA children are at increased risk of central precocious puberty. Paediatric clinicians and caregivers should be aware of this risk to allow for timely identification and treatment of this condition.
The relationship between low handgrip strength with or without asymmetry and fall risk among middle-aged and older males in China: evidence from the China Health and Retirement Longitudinal Study
Authors: Wang Yilin , Huang Yalian , Chen Xiaoyan 
Published: September 2023

Abstract

Purpose
This study sought to explore the potential correlation between low handgrip strength (HGS) with or without asymmetry and fall risk in middle-aged and older Chinese adults.

Methods
Baseline characteristic data from participants 45+ years of age and data regarding fall events collected from two rounds (2011–2013) of the China Health and Retirement Longitudinal Study were utilized for the present analyses. HGS and HGS asymmetry was defined according to the updated American Society of Hand Therapist. Fall events were identified through self- or proxy-reported details. Logistic regression analyses were employed to gauge the potential relationship between abnormal HGS and fall risk.

Results
In total, 10 563 participants were enrolled in this analysis, of whom 47.49% (5016/10 563) were male. The proportions of low HGS alone, HGS asymmetry alone, and low HGS with asymmetry were 22.23%, 18.34%, and 22.75%, respectively, in males, but just 3.64%, 35.12%, and 6.62% in females. A total of 693 and 1019 fall events were recorded for male (13.82%) and female (18.37%) participants over the 2-year follow-up period, respectively. Significant differences in fall event incidence among different HGS groups were only observed among males. An adjusted logistic regression analysis model confirmed that low HGS with dominant asymmetry was closely related to fall risk among middle-aged and older males [P = 0.014, odds ratio = 1.332, 95% confidence interval: 1.059–1.676).

Conclusion
These results demonstrated that low HGS with dominant asymmetry is a risk factor linked to increased fall risk among middle-aged and older Chinese males.
What is already known on this topic Low HGS or HGS asymmetry is been reported to be linked to an increased risk of falls in middle-aged and older adults; however, little is known about the association between fall risk and low HGS and/or HGS asymmetry. Main messages The prevalence of low HGS alone and low HGS asymmetry in men was significantly higher than in women, while HGS alone asymmetry was more common in women than men. The risk factor for the increased risk of falls in Chinese middle-aged and older men is low and asymmetric HGS, rather than low or asymmetric HGS alone. Low HGS with dominant asymmetry rather than nondominant asymmetry is associated with future fall risk among middle-aged and older Chinese males. Current research questions What is the mechanism for the significant difference in the proportion of abnormal HGS components between the sexes? If female subjects with low HGS and asymmetric HGS were added, would an association be observed between low HGS and asymmetric HGS falls? Is there an association between the severity of asymmetric HGS with weakness and falls?
Predictors of height in Romanian infants 6–23 months old: findings from a national representative sample
Authors: Stativa Ecaterina , Rus Adrian V , Lee Wesley C , Salinas Kailei A D , Cossey Hannah M , Lobo Austin , Nanu Michaela 
Published: September 2023

Abstract

Background
The research explored the association between infants’ height and various demographic factors in Romania, a country where such critical information has been lacking.

Methods
This study was conducted on a nationally representative sample and used a family physicians database to determine a sample of 1532 children (713 girls and 819 boys) 6–23 months of age (M = 14.26; SD = 5.15). Infants’ height-for-age z-scores (HAZ) were calculated using the World Health Organization’s computing algorithm. A multiple regression analysis was conducted to investigate whether certain risk factors, such as infant mother’s age, location, marital status, socioeconomic status (SES), as well as infant’s term status at birth, age, anemia, minimum dietary diversity (MDD) and birth order, could significantly predict the HAZ.

Results
The study identified several significant predictors of height. Specifically, lower HAZ was associated with rural living, preterm birth, age 18–23 months, unmarried mothers, anemia, lack of MDD and being third or later born in the family. In contrast, higher HAZ was associated with medium or high maternal SES and older maternal age.

Conclusions
The study underscores the importance of addressing these significant risk factors through distinct interventions to improve height outcomes in at-risk Romanian populations.
Mesoporous polydopamine delivery system for intelligent drug release and photothermal-enhanced chemodynamic therapy using MnO2 as gatekeeper
Authors: Wang Zhaoyang , Li Zekai , Shi Yuehua , Zeng Leyong 
Published: September 2023

Abstract
The non-specific leakage of drugs from nanocarriers seriously weakened the safety and efficacy of chemotherapy, and it was very critical of constructing tumor microenvironment (TME)-responsive delivery nanocarriers, achieving the modulation release of drugs. Herein, using manganese dioxide (MnO2) as gatekeeper, an intelligent nanoplatform based on mesoporous polydopamine (MPDA) was developed to deliver doxorubicin (DOX), by which the DOX release was precisely controlled, and simultaneously the photothermal therapy (PTT) and chemodynamic therapy (CDT) were realized. In normal physiological environment, the stable MnO2 shell effectively avoided the leakage of DOX. However, in TME, the overexpressed glutathione (GSH) degraded MnO2 shell, which caused the DOX release. Moreover, the photothermal effect of MPDA and the Fenton-like reaction of the generated Mn2+ further accelerated the cell death. Thus, the developed MPDA-DOX@MnO2 nanoplatform can intelligently modulate the release of DOX, and the combined CDT/PTT/chemotherapy possessed high-safety and high-efficacy against tumors.
Enhancing student understanding of rheumatic disease pathologies through augmented reality: findings from a multicentre trial
Authors: Pfeil Alexander , Klemm Philipp , Hueber Axel J , Hoffmann Tobias , Weise Tobias , Oelzner Peter , Knop Stefan , Müller-Ladner Ulf , Lange Uwe , Wolf Gunter , Schett Georg , Simon David , Kleyer Arnd 
Published: September 2023

Abstract

Objective
The possibility of combining real and virtual environments is driving the increased use of augmented reality (AR) in education, including medical training. The aim of this multicentre study was to evaluate the students’ perspective on the AR-based Rheumality GO!® app as a new teaching concept, presenting six real anonymized patient cases with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA).

Methods
The study encompassed 347 undergraduate medical students (232 women and 115 men) from four medical universities in Germany (Jena, Bad Nauheim/Gießen, Nuremberg, Erlangen). The course was divided into a theoretical refresher lecture followed by six AR-based cases in each of the three indications presented in the Rheumality GO! app. All participants evaluated the course after completion, assessing the benefit of the app from a student’s perspective using a questionnaire with 16 questions covering six subject areas.

Results
The use of the AR-based app Rheumality GO! improved the understanding of pathologies in RA, PsA and axSpA for 99% of the participants. For 98% of respondents, the concept of AR with real patient data has made a positive impact on the teaching environment. On the other hand, 82% were in favour of the use of virtual tools (e.g. AR) in addition to this conventional approach.

Conclusion
The results of our survey showed that from the medical students' perspective, an AR-based concept like the Rheumality GO! app can complement rheumatology teaching in medical school as an effective and attractive tool though not replace bedside teaching.
3WJ RNA Nanoparticles-Aptamer Functionalized Exosomes From M2 Macrophages Target BMSCs to Promote the Healing of Bone Fractures
Authors: Shou Jiali , Li Shuyi , Shi Wenzhe , Zhang Sijuan , Zeng Zheng , Guo Zecong , Ye Ziming , Wen Zhuohao , Qiu Huiguo , Wang Jinheng , Zhou Miao 
Published: September 2023

Abstract
Up to now, impaired bone regeneration severely affects the healing of bone fractures, thus bringing tremendous suffering to patients. As a vital mediator between inflammatory response and bone regeneration, M2 macrophage-derived exosomes (M2-Exos) attenuate inflammation and promote tissue repair. However, due to a lack of specific targeting property, M2-Exos will be rapidly eliminated after systematic administration, thus compromising their effectiveness in promoting bone regeneration. To solve this hurdle, we initially harvested and characterized the pro-osteogenic properties of M2-Exos. A bone marrow mesenchymal stem cell (BMSC)-specific aptamer was synthesized and 3-way junction (3WJ) RNA nanoparticles were applied to conjugate the BMSC-specific aptamer and M2-Exos. In vitro assays revealed that M2-Exos bore the representative features of exosomes and significantly promoted the proliferation, migration, and osteogenic differentiation of BMSCs. 3WJ RNA nanoparticles-aptamer functionalized M2-Exos (3WJ-BMSCapt/M2-Exos) maintained the original physical characteristics of M2-Exos, but bore a high specific binding ability to BMSCs. Furthermore, when being systemically administered in the mice model with femoral bone fractures, these functionalized M2-Exos mainly accumulated at the bone fracture site with a slow release of exosomal cargo, thereby significantly accelerating the healing processes compared with the M2-Exos group. Our study indicated that the 3WJ-BMSCapt/M2-Exos with BMSCs targeting ability and controlled release would be a promising strategy to treat bone fractures.
Against domicile as a connecting factor to tax overseas trusts and global wealth
Authors: Lidbetter John 
Published: September 2023

Abstract
An enduring dilemma is how to tax overseas trusts consistently with the Revenue’s competing goals of raising revenue, whilst also attracting wealthy individuals to invest in the UK. This article suggests that the current approach to taxing overseas trusts achieves neither goal. The main issue, it is contended, lies in the connecting factors utilised to charge overseas trusts. This article argues that (i) domicile should be abandoned as a connecting factor to tax trusts and (ii) greater emphasis should be placed on the settlor and beneficiary’s long-term residence.
In vitro modeling of the post-ingestion bioaccessibility of per- and polyfluoroalkyl substances sorbed to soil and house dust
Authors: Parker Bethany A , Valentini Evelyn , Graham Stephen E , Starr James M 
Published: September 2023

Abstract
Per- and polyfluoroalkyl substances (PFAS) are regularly found in soils and dusts, both of which can be consumed by children at relatively high amounts. However, there is little data available to model the bioaccessibility of PFAS in soils and dusts when consumed or to describe how the physiochemical properties of PFAS and soils/dusts might affect bioaccessibility of these chemicals. Because bioaccessibility is an important consideration in estimating absorbed dose for exposure and risk assessments, in the current study, in vitro assays were used to determine bioaccessibility of 14 PFAS in 33 sets of soils and dusts. Bioaccessibility assays were conducted with and without a sink, which was used to account for the removal of PFAS due to their movement across the human intestine. Multiple linear regression with backward elimination showed that a segmented model using PFAS chain length, number of branches, and percent total organic carbon explained 78.0%–88.9% of the variability in PFAS bioaccessibility. In general, PFAS had significantly greater bioaccessibility in soils relative to dusts and the addition of a sink increased bioaccessibility in the test system by as much as 10.8% for soils and 20.3% for dusts. The results from this study indicate that PFAS bioaccessibility in soils and dusts can be predicted using a limited set of physical chemical characteristics and could be used to inform risk assessment models.