bluuebunny/crossref_metadata_2025_split huggingface dataset:
40 Disparities in Diagnosis of Neurodevelopmental Disabilities in Canadian Indigenous and Racialized Children
Authors: Lee Iris Hyunkyoung , Salh Gurpreet (Preety) 
Published: October 2022

Abstract

Background
A core racial injustice faced by Indigenous and racialized people in North America lies in access to healthcare services. It is especially important for those with neurodevelopmental disabilities (NDDs) to access appropriate diagnostic services so that they can receive appropriate and timely healthcare resources. While there is a significant amount of literature from the U.S. documenting later diagnoses of NDDs in certain racialized groups, it is unclear whether such trends have been documented in Canada.

Objectives
Our objective was to review the research on the diagnosis of NDDs in Indigenous and racialized children in Canada.

Design/Methods
We reviewed OVID, CINAHL, and Web of Sciences with a thorough two-step screening process for English papers from 1991 to 2021. We used the following search term categories: 1) diagnosis, 2) NDDs including autism spectrum disorder (ASD), fetal alcohol spectrum disorder (FASD), cerebral palsy (CP), and intellectual disabilities (ID), 3) Indigenous and racialized populations. Racialized populations included those such as immigrants, Black, Hispanic, Asian, and refugees living in Canada.

Results
In total, we found twelve papers. Nine were on ASD, one on CP, and two on NDDs in general. As well, out of the twelve papers, six were on immigrants, five on Indigenous children, and one on both Indigenous and immigrant children. Some of the studies on immigrant children distinguished the world regions they were from, one distinguished refugees from immigrants, while others did not specify. Studies discussed disparities in rates of diagnosis, explored possible explanations for these disparities, as well as potential solutions for Indigenous and racialized children to receive their NDD diagnosis in a timely manner.

Conclusion
There was a disproportionately large number of studies on FASD in Indigenous children, which may reflect a lack of appropriate representation of neurodiverse racialized and Indigenous children in Canadian NDD literature. Ultimately, these were excluded during screening, as they were not focused on FASD diagnosis but rather on other aspects such as prevention. The remaining studies do not fully reflect the wide variety of NDDs of Indigenous and racialized children. It is our hope that more research be done to represent all children in an equitable fashion and in doing so, shape policies and interventions to improve access to healthcare.
56 Gastroesophageal reflux disease in children with neurological impairment: a population-based retrospective cohort study
Authors: Dewan Tammie , Johnson David , Turner Justine 
Published: October 2022

Abstract

Background
Children with neurological impairment (NI) are at increased risk of gastroesophageal reflux disease (GERD) and may be more susceptible to complications such as esophagitis and aspiration. Diagnosis is challenging due to communication impairments and frequent comorbidities, such as dysphagia, that present similarly to GERD. There is a risk of both under and over diagnosis with detrimental effects. Prior research has suggested the prevalence of GERD is as high as 75%. However, these studies examined subpopulations such as children presenting with symptoms or living in institutions, often many decades ago.

Objectives
Our aim was to determine the incidence and prevalence of GERD diagnosis and treatment in children with NI at a population level.

Design/Methods
This is a retrospective cohort study using provincial administrative data. Children with NI were identified by International Classification of Diseases (ICD-10) codes in the Discharge Abstract Database (DAD) between 2006 and 2018. GERD was defined as: (1) 1+ codes in DAD or National Ambulatory Care Reporting System; (2) 2+ specialist claims; (3) 1+ ASM prescription. Age, gender, complex chronic conditions (CCC) and technology assistance (TA) were covariates. ASM prescriptions and anti-reflux procedures were collected. Descriptive statistics included means with standard deviations and counts with proportions. Univariable and multivariable Poisson regressions calculated incidence rates and rate ratios for the presence of GERD and prescription of ASM.

Results
Among 10,309 children with NI, 2,772 (26.9%) met the GERD definition. The unadjusted incidence rate was 52.1 per 1000 person-years. Increasing numbers of CCCs were associated with a higher risk of GERD. Children with four or more CCCs had an incidence almost three times that of children with no CCCs. A gastrostomy tube incurred a five times higher rate of GERD. Overall, 2486 (23.7%) of the children were treated with ASMs of which 1535 (61.7%) met no other GERD criteria. The incidence rate was 16.9 prescriptions per year. Neonatal, respiratory and congenital CCCs were associated with higher rates of ASM prescribing. The prevalence of gastrojejunostomy tubes was 1.1% (n=121), surgical jejunostomy tubes was 0.7% (n=79) and fundoplication was 3.3% (n=351).

Conclusion
The incidence of GERD in children with NI is dramatically higher than in the general pediatric population, as is the use of ASM. Both disparities are heightened in children with gastrostomy tubes, perhaps due to increased severity of NI or relevant comorbidities. Regardless, GERD is clearly a significant clinical issue in this population that warrants additional study to determine optimal diagnosis and treatment practices.
63 Translational Research Capacity in Canadian Pediatric Emergency Departments Participating in the Precision Medicine for Improving the Diagnosis of Pediatric Appendicitis in the Emergency Department (PRIMED) Study
Authors: Mitevska Elena , Mickiewicz Beata , Thompson Graham 
Published: October 2022

Abstract

Background
Pediatric clinical and translational research are essential to acquire effective diagnostic and treatment options for children, but they are underfunded and under prioritized in comparison to research focused on treatments for adults. The Precision Medicine for Improving the Diagnosis of Pediatric Appendicitis in the Emergency Department (PRIMED) study aimed to characterize the proteomic and metabolic bio-profiles of children with appendicitis and to investigate these bio-profiles as a clinical prediction tool.

Objectives
In this current work, we aimed to evaluate translational research capacity at Canadian pediatric Emergency Departments (EDs) and to describe some of the challenges experienced in the implementation of the PRIMED study and various strategies used to improve local research capacity.

Design/Methods
Participating sites provided basic demographic and administrative data along with laboratory- and human-resource availability during enrolment for the PRIMED study. Data was summarized using descriptive statistics. Eleven pediatric EDs participated in the PRIMED study.

Results
Six study hospitals (54.5%) used on-site clinical laboratories to process research samples; the remaining hospitals (5/11, 45.5%) required access to research facilities, of which two (18.2%) were off-site. Fewer than two thirds of the study sites (7/11, 63.6%) had any laboratory that would process samples 24 hours per day. Four study sites (36.4%) only enrolled patients during business hours and over half of the sites (6/11, 54.5%) were unable to collect samples for the entire 17:00 to 21:00 peak when the greatest number of pediatric patients present to the ED (Figure 1). There was no nighttime coverage for patient enrollment and sample collection and only three study sites (3/11, 27.3%) had enrollment hours that captured over 75% of the potential study participants. Over half (6/11, 54.5%) of the PRIMED study sites developed novel processes to enable study success, for example creating graduate student on-call schedules and hiring bioscience trained site coordinators to perform sample processing requirements.

Conclusion
Despite site-specific efforts to overcome resource barriers, the gap in translational research capacity at academic pediatric emergency departments remains a significant concern. University research institutes and pediatric hospitals should invest in infrastructure and human resources to increase after-hours clinical and translational research capacity to optimize child health and wellness outcomes.
65 XyloFUNS: Xylocaine to Freeze during Unpleasant Nasopharyngeal Swabs in Children – A Randomized Controlled Trial
Authors: Gagnon Francois , Gravel Jocelyn , Duranceau Camille , Harman Stuart , Bhatt Maala , Vallières Émilie , Trottier Evelyne D 
Published: October 2022

Abstract

Background
Nasopharyngeal (NP) swabs have been recommended to detect SARS-CoV-2 since the beginning of the COVID-19 pandemic, but are reported to be at least moderately painful.

Objectives
To evaluate the efficacy of intranasal vaporized lidocaine compared to a sham treatment in reducing pain in children undergoing a NP swab in the Emergency Department (ED).

Design/Methods
A randomized double-blinded clinical trial was conducted in a pediatric ED. Both participants and the researcher evaluating the primary outcome were blinded. Children 6 to 17 years old requiring a NP swab were eligible. Participants were randomly allocated to receive intranasal lidocaine or a sham treatment prior to their NP swab. The primary outcome measure was pain during the swab as assessed by the visual analog scale. Secondary outcome measures were pain using the verbal numeric rating scale, fear using the children fear scale, and side effects of the intervention.

Results
Eighty-eight participants were enrolled: 45 to the lidocaine group and 43 to the control group. The mean visual analog scale scores for pain were 46 mm in the lidocaine group and 53 mm in the control group (mean difference 7 mm; 95%CI -5 to 19 mm). The numeric rating scale and children fear scale were not statistically different between groups. No serious adverse events were observed. Fear prior to the test and younger age were associated with higher pain scores.

Conclusion
Intranasal lidocaine administered prior to NP swabs in the ED did not lower pain scores for school-aged children and youth.
67 Is Ophthalmia Neonatorum associated with Invasive Bacterial Infection? A single centre retrospective study
Authors: St-Onge-St-Hilaire Alexandra , Boutin Ariane , Gravel Jocelyn 
Published: October 2022

Abstract

Background
The immature immune system of neonates puts them at an increased risk of invasive bacterial infections (IBI). Ocular complications due to ophthalmia neonatorum (ON) are well described, unlike the association with IBI for which only case reports of ON with bacteremia and meningitis are documented. The risk of IBI in neonates with ophthalmia neonatorum (ON) is poorly known and part of the issue is the lack of clinical data.

Objectives
Our objective was to document the association of ON with IBI.

Design/Methods
This is a retrospective observational chart review of all afebrile neonates who presented to a single emergency department (ED) between January 2018 and December 2019 and were diagnosed with ON. Newborns with craniofacial malformations and premature infants were excluded. The primary outcome was IBI as defined by growth of any bacterial pathogen in the blood or cerebrospinal fluid. Perinatal risk factors, ED visit details (symptoms on presentation, management and treatment plan) as well as complications (ocular morbidity, death and unscheduled return visits to the ED) were collected. Data were analyzed using descriptive statistics.

Results
Fifty-two neonates were included in this retrospective review. There were no case of IBI associated with ON (0%, 95%CI 0-6.9%). Six ocular bacterial infections were identified, one of which was C trachomatis. Although there was no IBI, ocular complications, death or unscheduled return visits to the ED, there was a wide variation in physician management of ON. Physicians performed at least para-clinical investigation in 49% (95%CI: 34-62%) of neonates, prescribed antibiotics to 87% (95% CI: 74-94%) and involved specialists in 39% (95%CI: 27-52%) of cases. Most neonates were discharged home (92%; 95%CI: 81-98%) and three neonates (6%; 95%CI: 1-16%) were admitted to the hospital following their ED visit.

Conclusion
ED presentations of afebrile neonates with ON are associated with a low risk of IBI. A better understanding of the current practice variation is needed to inform clinical guidelines for the management of term neonates with ON presenting to the ED.
69 Triage Administration of Ondansetron for Gastroenteritis in children; a randomized controlled trial
Authors: Weill Olivia , Labrosse Mélanie , Levy Arielle , Desjardins Marie-Pier , Trottier Evelyne D , Gravel Jocelyn 
Published: October 2022

Abstract

Background
Acute gastroenteritis is an important reason for emergency department (ED) consultation in children. Ondansetron is reported to be effective in reducing vomiting in children with gastroenteritis, leading to less intravenous rehydration and hospital admission.

Objectives
The aim of this study was to assess the effectiveness of triage nurse-initiated administration of ondansetron for children with suspected gastroenteritis in the paediatric ED to reduce the number of patients requiring observation following the first physician assessment.

Design/Methods
This was a randomized controlled trial performed in a tertiary care paediatric ED. All children 6 months to 17 years old who presented to the ED with at least four episodes of non-billous, non-bloody vomiting in the previous 24 hours and the last vomiting occurring within the previous 2h were eligible. The intervention consisted of administration of a liquid formulation of an adapted to weight dose of ondansetron at triage compared to a color- and taste-matched placebo. The primary outcome was the number of patients requiring observation after the first physician’s evaluation. Secondary outcomes were the number of episodes of vomiting after receiving the intervention, length of stay in the ED, comfort, and the proportion of children who returned for a medical visit within 48 hours. A sample size of 248 participants was initially identified to have a power of 90% to find a 20% difference in the proportion of children needing observation following physician evaluation.

Results
Because of multiple external factors, including the COVID-19 pandemic, recruitment was stopped before the expected sample size was reached. A total of 91 patients were included and randomized to receive ondansetron (n= 44) or a placebo (n=47) just after triage. The baseline characteristics of the participants was similar between the two groups. A total of 40 (45%) participants were discharged immediately after the first evaluation by the treating physician. This was similar for both groups 44% vs. 45%; (95% CI for the difference -20 to 19%). There was no difference between the two groups for the total length of stay (median 232 vs. 227 minutes; p= 0.677) and for the length of stay after being seen by the physician (72 vs. 68 minutes; p=0.821). There was no statistical difference between the two groups in the number of vomiting episodes (difference of 15%; 95% CI -2, 31), and proportion of participants needing a rescue medication (difference: 19%; 95%CI:-0.6 to 36%) or an intravenous rehydration (difference: 8; 95%CI:-6, 22).

Conclusion
This study failed to demonstrate any benefit in using ondansetron at triage for children with presumed gastroenteritis.
89 Centre-based child care attendance in early childhood and adiposity in later childhood: a prospective cohort study
Authors: Kucab Michaela , Keown-Stoneman Charles , Birken Catherine , Perlman Michal , Maguire Jonathon 
Published: October 2022

Abstract

Background
One in three children are living with overweight or obesity in North America. The burden of childhood obesity is disproportionately experienced by children from low-income families, who are more likely to have obesity. Centre-based child care attendance may influence important adiposity risk factors such as dietary intake, eating behaviour, and physical activity, but its impact on childhood obesity is unclear.

Objectives
The primary objective was to evaluate the relationship between the intensity of centre-based child care attendance between 1 and 4 years of age and Body Mass Index z-score (zBMI) from 4 to 10 years of age relative to non-centre-based child care (i.e., home-based, grandparents, relatives, and nanny’s). The secondary objective was to explore if family income modified the relationship.

Design/Methods
A prospective cohort study of children 1 to 10 years of age was conducted through the TARGet Kids! primary care research network. The primary exposure was intensity of centre-based child care attendance (hours/week). The primary outcome was zBMI, an age and sex adjusted measure of child adiposity. Interaction terms for child age and family income were explored. A linear mixed effects model and logistic generalized estimating equations were used to determine the association between centre-based child care attendance and child zBMI.

Results
3,503 children were included (mean age: 2.7 years). Children who attended centre-based child care full time (40 hours/week) had a 0.11 lower zBMI at 4 years (95% CI -0.19, -0.03; p=0.005) and lower odds of obesity (zBMI &gt; 2) at 4 (OR 0.58; 95% CI 0.34, 0.99; p=0.04) and 10 years of age (OR 0.52; 95% CI 0.29, 0.90; p=0.02) relative to children who attended non-centre-based child care. The relationship was modified by family income such that, children from families with an income of &lt;$50,000CDN who attended centre-based child care full time had a 0.35 (95% CI -0.56, -0.15; p=0.001), 0.34 (95% CI -0.54, -0.13, p=0.001) and 0.29 (95% CI -0.50, -0.07, p=0.009) lower zBMI at 4, 7 and 10 years of age, respectively, relative to children who attended non-centre-based child care.

Conclusion
Centre-based child care attendance in early childhood was associated with lower adiposity and odds of obesity in later childhood. This relationship was stronger for children who were from lower income families. Centre-based child care may be an effective early intervention to prevent childhood obesity.
PheWAS and cross-disorder analyses reveal genetic architecture, pleiotropic loci and phenotypic correlations across 11 autoimmune disorders
Authors: Topaloudi Apostolia , Jain Pritesh , Martinez Melanie B. , Bryant Josephine K. , Reynolds Grace , Drineas Petros , Paschou Peristera 
Published: October 2022

AbstractAutoimmune diseases (ADs) are a group of more than 80 heterogeneous disorders that occur when there is a failure in the self-tolerance mechanisms triggering self-attacking autoantibodies. Most autoimmune disorders are polygenic and associated with genes in the human leukocyte antigen (HLA) region. However, additional non-HLA genes are also found to be associated with different ADs, and often these are also implicated in more than one disorder. Previous studies have observed associations between various health-related and lifestyle phenotypes and ADs. Polygenic risk scores (PRS) allow the calculation of an individual’s genetic liability to a phenotype and are estimated as the sum of the risk alleles weighted by their effect sizes in a genome-wide association study (GWAS). Here, for the first time, we conducted a comparative PRS-PheWAS analysis for 11 different ADs (Celiac Disease, Juvenile Idiopathic Arthritis, Multiple Sclerosis, Myasthenia Gravis, Primary Sclerosing Cholangitis, Psoriasis, Rheumatoid Arthritis, Systemic Lupus Erythematosus, Type 1 Diabetes, Vitiligo Early Onset, Vitiligo Late Onset) and 3,281 outcomes available in the UK Biobank that cover a wide range of lifestyle, socio-demographic and health-related phenotypes. We also explored the genetic relationships of the studied ADs, estimating their genetic correlation and performing cross-disorder GWAS meta-analyses for the identified AD clusters. In total, we observed 554 outcomes significantly associated with at least one disorder PRS, and 300 outcomes were significant after variants in the HLA region were excluded from the PRS calculations. Based on the genetic correlation and genetic factor analysis, we observed five genetic factors among studied ADs. Cross-disorder meta-analyses in each factor revealed genome-wide significant loci that are pleiotropic across multiple ADs. Overall, our analyses confirm the association of different factors with genetic risk for ADs and reveal novel observations that warrant further exploration.
Research on protein structure prediction and folding based on novel remote homologs recognition
Authors: Zhao Kailong , Xia Yuhao , Zhang Fujin , Zhou Xiaogen , Li Stan Z. , Zhang Guijun 
Published: October 2022

ABSTRACTRecognition of remote homologous structures is a necessary module in AlphaFold2 and is also essential for the exploration of protein folding pathways. Here, we developed a new method, PAthreader, which identifies remote homologous structures based on the three-track alignment of distance profiles and structure profiles originated from PDB and AlphaFold DB by deep learning. Based on the identified templates, we further enhanced state-of-the-art modelling method and explored protein folding pathways based on the residue frequency distribution of homologs and the secondary structure. The results show that the average accuracy of templates identified by PAthreader is 11.6% higher than those of HHsearch on 551 nonredundant proteins. In terms of structure modelling, PAthreader improves the performance of AlphaFold2 and ranks first in CAMEO blind test for the last three months. Furthermore, we explored protein folding pathways for 37 proteins. The results are almost consistent with biological experiments for 7 proteins, and the remaining 30 human proteins have yet to be verified by biological experiments, revealing that folding information can be exploited from remote homologous structures.
Digitalization strategies and evaluation of maritime container supply chains
Authors: Seo Jungyong , Lee Byung Kwon , Jeon Yongsik 
Published: October 2022

PurposeThis study proposes practical digitalization strategies and well-grounded evaluation criteria for maritime container supply chains.Design/methodology/approachThe authors identified the status of supply chain digitalization of the Port of Busan in South Korea and developed three digitalization strategies based on industry requirements and consultations with port experts. The authors proposed 11 evaluation criteria for examining the main digitalization strategies in the supply chain operations reference model, based on a survey among 46 experts and used multi-criteria decision-making approaches to prioritize the strategies and evaluation criteria.FindingsThe results delineate the status of the digitalization of a real-world port-focal supply chain. The model can be successfully customized to include well-grounded evaluation criteria for digitalization strategies, and presents a practical way to advance the supply chain digitalization strategies. Based on the survey and evaluation, the authors find that increasing data accessibility and improving quality are preferred to adopting a data and information sharing platform.Research limitations/implicationsAs the study is limited to the Port of Busan, future case studies could be undertaken to container supply chains driven by different regional ports.Practical implicationsStakeholders, such as truckers, terminal operators, and shipping liners, might consider the proposed strategies and evaluation criteria when digitalizing their supply chains.Originality/valueBy identifying the needs and specifications of maritime container supply chain digitalization strategies, developing evaluation criteria, and conducting a case study for proof of concept, the study proposes an operational management process with practical, real-world benefits for port-focal supply chains.