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Purpose: Musculoskeletal (MSK) screening tools can allow athletic trainers (AT) to focus prevention efforts by providing patient risk information. The purpose of this study is to examine lower extremity MSK screening tool practices and perceptions of ATs in traditional settings. Methods: A cross-sectional online survey was distributed to 4,937 full- and part-time collegiate and secondary school ATs randomly selected by the NATA. MSK screening tools were grouped into 7 categories: Range of Motion (ROM), Strength, Balance, Drop and Jump Landing (D/J Land), Double- and Single-Leg Hopping (D/S Hop), Movement Quality (MQual), and Injury History (History). For each screening tool category, questions assessed MSK screening tool usage, the perceived effectiveness of MSK screening tools to provide relevant injury risk and return to play (RTP) information, and MSK screening tools effect on decisions to implement prevention programs. Results: A total of 372 participants (female=215(48.4%), male=152(34.2%), age=35±10 years, experience=12±10 years, secondary school=194(52.2%), collegiate=178(47.8%)) completed the survey. Participants within our study indicated the used of the following screening tools categories in clinical practice: ROM=339(91.1%), Strength=342(91.9%), Balance=238(64.0%), D/J-Landing=134(36.0%), D/S-Hopping=233(62.6%), MQual=212(57.0%), History=316(85.0%), and None=18(4.8%). Conclusions: ATs in traditional settings indicate that they primarily use ROM, Strength, and History screening tools to gather information concerning LE injury risk and RTP. Implementation of screening tools most frequently occurred post-injury. Lastly, it seemed that intervention prescriptions were consistent regardless of screening tool used, suggesting blanket interventions prescription. This may have been do feelings of moderate effectiveness of these tools to determine injury risk.

Computer science students often evaluate the behavior of the code they write by running it on specific inputs and studying the outputs, and then apply their comprehension to a more general understanding of the code. While this is a good starting point in the student's career, successful graduates must be able to reason analytically about the code they create or encounter. They must be able to reason about the behavior of the code on arbitrary inputs, without running the code. Abstraction is central for such reasoning. In our quest to help students learn to reason abstractly and develop logically correct code, we have developed tools that rely on a verification engine. Code involves assignment, conditional, and loop statements, along with objects and operations. Reasoning activities involve symbolic reasoning with simple assertions and design-by-contract assertions such as pre-and post-conditions as well as loop invariants with data abstractions. Students progress from tracing and reading code to the design and implementation of code, all relying on abstraction for verification. This paper reports some key results and findings from associated studies spanning several years.

Land‐atmosphere interactions are central to the evolution of the atmospheric boundary layer and the subsequent formation of clouds and precipitation. Existing global climate models represent these connections with bulk approximations on coarse spatial scales, but observations suggest that small‐scale variations in surface characteristics and co‐located turbulent and momentum fluxes can significantly impact the atmosphere. Recent model development efforts have attempted to capture this phenomenon by coupling existing representations of subgrid‐scale (SGS) heterogeneity between land and atmosphere models. Such approaches are in their infancy and it is not yet clear if they can produce a realistic atmospheric response to surface heterogeneity. Here, we implement a parameterization to capture the effects of SGS heterogeneity in the Community Earth System Model (CESM2), and compare single‐column simulations against high‐resolution Weather Research and Forecasting (WRF) large‐eddy simulations (LESs), which we use as a proxy for observations. The CESM2 experiments increase the temperature and humidity variances in the lowest atmospheric levels, but the response is weaker than in WRF‐LES. In part, this is attributed to an underestimate of surface heterogeneity in the land model due to a lack of SGS meteorology, a separation between deep and shallow convection schemes in the atmosphere, and a lack of explicitly represented mesoscale secondary circulations. These results highlight the complex processes involved in capturing the effects of SGS heterogeneity and suggest the need for parameterizations that communicate their influence not only at the surface but also vertically. Plain Language Summary: Land surface temperature and soil moisture are known to influence the daily evolution of the overlying atmosphere and the formation of clouds and rainfall. While global climate models represent these interactions on relatively coarse spatial scales (i.e., 100 km or greater), smaller scale differences in surface characteristics are increasingly recognized for their ability to impact the atmosphere. Here, we implement a new feature in a climate model that communicates information on small‐scale surface differences from the land to the atmospheric model. We compare the results of this addition against a high‐resolution model that has previously been used to isolate the impacts of surface flux gradients, with the latter serving as a proxy for observations. Though there are some encouraging signs of the implemented approach to drive an atmospheric response to surface variability, we find that a missing representation of large‐scale circulations between warm/cool surfaces likely limits model agreement. Key Points: A new method of conveying information on subgrid‐scale surface heterogeneity to the atmosphere is introduced to Community Earth System Model, version 2A comparison with large‐eddy simulations suggests that the atmospheric response to heterogeneity in CESM2 is too vertically constrainedFuture model development efforts should focus on heterogeneity representations that account for secondary circulations more realistically [ABSTRACT FROM AUTHOR]

Land–atmosphere (L–A) interactions are important for understanding convective processes, climate feedbacks, the development and perpetuation of droughts, heatwaves, pluvials, and other land-centered climate anomalies. Local L–A coupling (LoCo) metrics capture relevant L–A processes, highlighting the impact of soil and vegetation states on surface flux partitioning and the impact of surface fluxes on boundary layer (BL) growth and development and the entrainment of air above the BL. A primary goal of the Climate Process Team in the Coupling Land and Atmospheric Subgrid Parameterizations (CLASP) project is parameterizing and characterizing the impact of subgrid heterogeneity in global and regional Earth system models (ESMs) to improve the connection between land and atmospheric states and processes. A critical step in achieving that aim is the incorporation of L–A metrics, especially LoCo metrics, into climate model diagnostic process streams. However, because land–atmosphere interactions span timescales of minutes (e.g., turbulent fluxes), hours (e.g., BL growth and decay), days (e.g., soil moisture memory), and seasons (e.g., variability in behavioral regimes between soil moisture and latent heat flux), with multiple processes of interest happening in different geographic regions at different times of year, there is not a single metric that captures all the modes, means, and methods of interaction between the land and the atmosphere. And while monthly means of most of the LoCo-relevant variables are routinely saved from ESM simulations, data storage constraints typically preclude routine archival of the hourly data that would enable the calculation of all LoCo metrics. Here, we outline a reasonable data request that would allow for adequate characterization of sub-daily coupling processes between the land and the atmosphere, preserving enough sub-daily output to describe, analyze, and better understand L–A coupling in modern climate models. A secondary request involves embedding calculations within the models to determine mean properties in and above the BL to further improve characterization of model behavior. Higher-frequency model output will (i) allow for more direct comparison with observational field campaigns on process-relevant timescales, (ii) enable demonstration of inter-model spread in L–A coupling processes, and (iii) aid in targeted identification of sources of deficiencies and opportunities for improvement of the models. [ABSTRACT FROM AUTHOR]

This critical policy analysis is concerned with the discursive linguistic practices and social justice implications surrounding the passage of Florida's controversial "Parental Rights in Education Act" (PREA), which enacts limitations on classroom instruction involving topics related to gender and sexuality. Foregrounding this essay lays a call for social work scholarship to recognize the significance of the critical semiotic and post-structural turn in social science research, which evinces the importance of attending to the nuanced relationship between discourse, power, ideology, and identity formation. As a field espousing the tenets of social justice and commitments to the broader aims of social equality, social work holds an inherent investment in understanding the politics of language and, by extension, the language of emancipatory change. Informed by critical discourse analysis (CDA) and feminist post-structural thought, this analysis brings to the forefront the relevance of discourse, language, and semiotics as crucial objects of inquiry and seeks to examine what norms are in operation in the context of this legislation. What can discourse reveal about the nature of the social problem as postulated by PREA, and what discursive implications might it contain? Ultimately, this analysis contends that PREA represents a new threshold of educational and queer surveillance, best understood when bracketed by the ideologies of neoliberalism, cis-/heteropatriarchy, and the concomitant articulation of transphobia. [ABSTRACT FROM AUTHOR]

Land-atmosphere (L-A) interactions are important for understanding convective processes, climate feedbacks, the development and perpetuation of droughts, heatwaves, pluvials, and other land-centred climate anomalies. Local L-A coupling (LoCo) metrics capture relevant L-A processes, highlighting the impact of soil and vegetation states on surface flux partitioning, and the impact of surface fluxes on boundary layer (BL) growth, development, and entrainment of air above the BL. A primary goal of the Climate Process Team on Coupling Land and Atmospheric Subgrid Parameterizations (CLASP) is parameterizing and characterizing the impact of subgrid heterogeneity in global and regional earth system models (ESMs) to improve the connection between land and atmospheric states and processes. A critical step in achieving that aim is the incorporation of L-A metrics, especially LoCo metrics, into climate model diagnostic process streams. However, because land-atmosphere interactions span time scales of minutes (e.g., turbulent fluxes), hours (e.g., BL growth and decay), days (e.g., soil moisture memory), and seasons (e.g., variability of behavioural regimes between soil moisture and latent heat flux), with multiple processes of interest happening in different geographic regions at different times of year, there is not a single metric that captures all the modes, means, and methods of interaction between the land and the atmosphere. And while monthly means of most of the LoCo-relevant variables are routinely saved from ESM simulations, data storage constraints typically preclude routine archival of the hourly data that would enable the calculation of all LoCo metrics. Here we outline a reasonable data request that would allow for adequate characterization of sub-daily coupling processes between the land and the atmosphere, preserving enough sub-daily output to describe, analyse, and better understand L-A coupling in modern climate models. A secondary request involves embedding calculations within the models to determine mean properties in and above the BL to further improve characterization of model behaviour. Higher-frequency model output will (i) allow for more direct comparison with observational field campaigns on process-relevant time scales, (ii) enable demonstration of inter-model spread in L-A coupling processes, and (iii) aid in targeted identification of sources of deficiencies and opportunities for improvement of the models. [ABSTRACT FROM AUTHOR]

Background: Pain is one of the most common symptoms encountered in the healthcare system, and opioids are among the top three medications used to treat it. Understanding the reasoning behind physicians' opioid prescribing practices is vital to safe practice. The primary objective of our study was to describe pediatric emergency physicians' decision-making process when prescribing opioids for children's acute pain management. Methods: This study employed qualitative methodology, using one-on-one semi-structured interviews within a grounded theory analytic framework. We employed purposeful sampling to recruit pediatric emergency physicians from across Canada. Interviews were conducted by telephone (December 2019–January 2021). Transcript analysis occurred concurrently with data collection, supporting data saturation and theory development considerations. Results: Eleven interviews were completed with participants representing each of Canada's geographic regions. Nine major themes emerged: (1) practice setting and outpatient opioid use, (2) condition-specific considerations, (3) physician confidence in medical evidence, (4) pain assessment challenges, (5) patient and family perspectives, (6) opioid safety concerns, (7) personal biases and experiences, (8) personal practice context, and (9) the Opioid Crisis/media influence. Most clinicians felt that they limited opioid use to those who needed it most; all participants described challenges managing acute pain, emphasizing the need for accurate pain measurement and better guidelines, evidence-based data, and knowledge translation. Clinicians were more comfortable treating pain in the emergency department, compared to discharge prescribing. They recognized the importance of co-therapy with non-opioids and the need for opioid risk assessment when prescribing. A family centered approach was recognized as the goal of practice. Conclusion: Clinicians are less comfortable prescribing opioids to children for at-home use and find pain assessment and lack of clear guidelines to be barriers to pain care. Knowledge translation strategies for safer practice and optimal acute pain management could support responsible and judicious opioid use. [ABSTRACT FROM AUTHOR]

The Earth's land surface features spatial and temporal heterogeneity over a wide range of scales below those resolved by current Earth system models (ESMs). State-of-the-art land and atmosphere models employ parameterizations to represent their subgrid heterogeneity, but the land–atmosphere coupling in ESMs typically operates on the grid scale. Communicating the information on the land surface heterogeneity with the overlying atmospheric boundary layer (ABL) remains a challenge in modeling land–atmosphere interactions. In order to account for the subgrid-scale heterogeneity in land–atmosphere coupling, we implement a new coupling scheme in the Energy Exascale Earth system model version 1 (E3SMv1) that uses adjusted surface variances and covariance of potential temperature and specific water content as the lower boundary condition for the atmosphere model. The new lower boundary condition accounts for both the variability of individual subgrid land surface patches and the inter-patch variability. The E3SMv1 single-column model (SCM) simulations over the Atmospheric Radiation Measurement (ARM) Southern Great Plain (SGP) site were performed to assess the impacts. We find that the new coupling parameterization increases the magnitude and diurnal cycle of the temperature variance and humidity variance in the lower ABL on non-precipitating days. The impacts are primarily attributed to subgrid inter-patch variability rather than the variability of individual patches. These effects extend vertically from the surface to several levels in the lower ABL on clear days. We also find that accounting for surface heterogeneity increases low cloud cover and liquid water path (LWP). These cloud changes are associated with the change in cloud regime indicated by the skewness of the probability density function (PDF) of the subgrid vertical velocity. In precipitating days, the inter-patch variability reduces significantly so that the impact of accounting for surface heterogeneity vanishes. These results highlight the importance of accounting for subgrid heterogeneity in land–atmosphere coupling in next-generation ESMs. [ABSTRACT FROM AUTHOR]

The Earth's land surface features spatial and temporal heterogeneity over a wide range of scales below those resolved by current Earth system models. State-of-the-art land and atmosphere models employ parameterizations to represent their subgrid heterogeneity, but the land-atmosphere coupling in ESMs typically operates on the grid scale. Communicating the information of the land surface heterogeneity with the overlying atmospheric boundary layer (ABL) remains a challenge in modeling land-atmosphere interactions. In order to account for the subgrid scale heterogeneity in land-atmosphere coupling, we implement a new coupling scheme in the Energy Exascale Earth System Model version 1 (E3SMv1) that uses adjusted surface variances and covariance of potential temperature and specific water content as the lower boundary condition for the atmosphere model. The new lower boundary condition accounts for both the variability of individual subgrid land surface patches and the inter-patch variability. E3SMv1 single-column model simulations over the Atmospheric Radiation Measurement (ARM) Southern Great Plain (SGP) site were performed to assess the impacts. We find that the new coupling parameterization increases the magnitude and diurnal cycle of the temperature variance and humidity variance in the lower ABL in non-precipitating days. The impacts are primarily attributed to subgrid inter-patch variability rather than variability of individual patches. These effects extend vertically from the surface to several levels in the lower ABL on clear days. We also find that accounting for surface heterogeneity increases low cloud cover and liquid water path. These cloud changes are associated with the change in cloud regime indicated by the skewness of the probability density function (PDF) of the subgrid vertical velocity. In precipitating days, the inter-patch variability reduces significantly, so that the impact of accounting for surface heterogeneity vanishes. These results highlight the importance of accounting for subgrid heterogeneity in land-atmosphere coupling in next generation Earth system models. [ABSTRACT FROM AUTHOR]

Computer science students often evaluate the behavior of the code they write by running it on specific inputs and studying the outputs, and then apply their comprehension to a more general understanding of the code. While this is a good starting point in the student's career, successful graduates must be able to reason analytically about the code they create or encounter. They must be able to reason about the behavior of the code on arbitrary inputs, without running the code. Abstraction is central for such reasoning. In our quest to help students learn to reason abstractly and develop logically correct code, we have developed tools that rely on a verification engine. Code involves assignment, conditional, and loop statements, along with objects and operations. Reasoning activities involve symbolic reasoning with simple assertions and design-by-contract assertions such as pre-and post-conditions as well as loop invariants with data abstractions. Students progress from tracing and reading code to the design and implementation of code, all relying on abstraction for verification. This paper reports some key results and findings from associated studies spanning several years. [ABSTRACT FROM AUTHOR]

Soil moisture anomalies underpin a number of critical hydrological phenomena with socioeconomic consequences, yet systematic studies of soil moisture predictability are limited. Here, we use a data-adaptive technique, Linear Inverse Modeling, which has proved useful as an indication of predictability in other fields, to investigate the predictability of soil moisture in northern California. This approach yields a model of soil moisture at 10 stations in the region, with results that indicate the possibility of skillful forecasts at each for lead times of 1–2 weeks. An important advantage of this model is the a priori identification of forecasts of opportunity—conditions under which the model’s forecasts may be expected to have particularly high skill. Given that forecast errors (and inversely, their skill) can be estimated in advance, these findings have the potential to greatly increase the utility of soil moisture forecasts for practical applications including drought and flood forecasting. [ABSTRACT FROM AUTHOR]

Background Given the current opioid crisis, caregivers have mounting fears regarding the use of opioid medication in their children. We aimed to determine caregivers' a) willingness to accept, b) reasons for refusing, and c) past experiences with opioids. Methods A novel electronic survey of caregivers of children aged 4 to 16 years who had an acute musculoskeletal injury and presented to two Canadian paediatric emergency departments (ED) (March to November 2017). Primary outcome was caregiver willingness to accept opioids for moderate pain for their children. Results Five hundred and seventeen caregivers participated; mean age was 40.9 (SD 7.1) years with 70.0% (362/517) mothers. Children included 62.2% (321/516) males with a mean age of 10.0 (SD 3.6) years. 49.6% of caregivers (254/512) reported willingness to accept opioids for ongoing moderate pain in the ED, while 37.1% (190/512) were 'unsure'; 33.2% (170/512) of caregivers would accept opioids for at-home use, but 45.5% (233/512) were 'unsure'. Caregivers' primary concerns were side effects, overdose, addiction, and masking of diagnosis. Caregiver fear of addiction (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.01 to 1.25) and side effects (OR 1.25, 95% CI 1.11 to 1.42) affected willingness to accept opioids in the emergency department ; fears of addiction (OR 1.19, 95% CI 1.07 to 1.32), and overdose (OR 1.15, 95% CI 1.04 to 1.27) affected willingness to accept opioids for at-home use. Conclusions Only half of the caregivers would accept opioids for moderate pain, despite ongoing pain following nonopioid analgesics. Caregivers' fears of addiction, side effects, overdose, and masking diagnosis may have influenced their responses. These findings are a first step in understanding caregiver analgesic decision making. [ABSTRACT FROM AUTHOR]

Background: In the midst of the current opioid crisis, physicians are caught between balancing children's optimal pain management and the risks of opioid therapy. This study describes pediatric emergency physicians' practice patterns for prescribing, knowledge and attitudes regarding, and perceived barriers to and facilitators of short-term use of opioids. Methods: We created a survey tool using published methodology guidelines and distributed it from October to December 2017 to all physicians in the Pediatric Emergency Research Canada database using Dillman's tailored design method for mixed-mode surveys. We performed bivariable binomial logistic regressions to ascertain the effects of clinically significant variables (e.g., training, age, sex, degree of worry regarding severe adverse events) on use of opioids as a first-line treatment for moderate pain in the emergency department, and prescription of opioids for moderate or severe pain for at-home use in children. Results: Of the 224 physicians in the database, 136 (60.7%) completed the survey (60/111 [54.1%] women; median age 44 yr). Of the 136, 74 (54.4%) had subspecialty training. Intranasally administered fentanyl was the most commonly selected opioid for first-line treatment of moderate (47 respondents [34.6%]) and severe (82 [60.3%]) pain due to musculoskeletal injury. On a scale of 0 (not worried) to 100 (extremely worried), physicians' median score for worry regarding physical dependence was 6.0 (25th percentile 0.0, 75th percentile 16.0), for worry regarding addiction 10.0 (25th percentile 2.0, 75th percentile 20.0) and for worry regarding diversion of opioids 24.5 (25th percentile 14.0, 75th percentile 52.0). On a scale of 0 (not at all) to 100 (extremely), the median score for influence of the opioid crisis on willingness to prescribe opioids was 22.0 (25th percentile 8.0, 75th percentile 49.0). The top 3 reported barriers to prescribing opioids were parental reluctance (57 [41.9%]), lack of clear guidelines for pediatric opioid use (35 [25.7%]) and concern about adverse effects (33 [24.3%]). Binomial logistic regression did not identify any statistically significant variables affecting use of opioids in the emergency department or prescribed for use at home. Interpretation: Emergency department physicians appeared minimally concerned about physical dependence, addiction risk and the current opioid crisis when prescribing opioids to children. Evidence-based development of guidelines and protocols for use of opioids in children may improve physicians' ability to manage pain in children responsibly and adequately. [ABSTRACT FROM AUTHOR]

Holding in mind Barbara Creed’s assertion that the werewolf is a ‘feminized male monster, a queer creature aligned to the primal uncanny’, this article explores gender trouble and queerbaiting in MTV’s Teen Wolf – a series infamous in online fan circles for baiting fan favourite pairing Derek Hale/Stiles Stilinski (dubbed ‘Sterek’ by fans) while largely failing to fulfil its promises of dynamic, three-dimensional LGBTQ representation. This article enumerates the queer cues embedded in Stiles and Derek’s narratives, paying special attention to Stiles’ implied bisexuality and Derek’s constant objectification by the camera, repeated sexual victimization, and the often queered repositioning of his body into the role of ‘damsel in distress’. By doing so, this article attempts to contextualize Teen Wolf fans’ reasons for shipping Sterek and will argue that this queer reading is indeed not a ‘willful misreading’, but one drawing upon a complex web of queer affect and queerbaiting in the show. This article will also examine the ways in which fans use both fan works and social media not only to explore readings of Derek and Stiles as queer and fight back against queerbaiting, but also to articulate the reparative potential of a consensual relationship with Stiles for Derek’s healing from his repeated trauma. [ABSTRACT FROM AUTHOR]

[0.1]Racebending fan work has the potential to be a productive site of postcolonial critique. A close analysis of fans' racebending of the primary characters of two young adult literature texts--the titular hero of J. K. Rowling's Harry Potter series (1997-2007) and major character Ronan Lynch from Maggie Stiefvater's Raven Cycle (2012-16)--finds that fans' racebending permits postcolonial revision by challenging the predominantly white worlds the books depict as well as recuperating the erasure of diaspora by other fans who insist Britishness and Irish-Americanness equate to whiteness. In addition, many racebending Harry and Ronan fan works center on queer romances: Harry with school rival Draco Malfoy and Ronan with his in-series boyfriend, Adam Parrish. Racebent Harry fan work, particularly work incorporating a queer romance with Draco, creates a space for fans to imagine alternative possibilities for the series beyond the heteronormative, hegemonic conclusion represented in Rowling's epilogue. Similarly, racebent queer Ronan fan works offer depictions of a soft black masculinity that subverts the common association of blackness with anger and aggression. By depicting two characters of color at the center of queer schoolboy romances, fans disrupt the white homoeroticism and imperialism of the school story genre upon which both series draw. [ABSTRACT FROM AUTHOR]

Climate change is expected to increase the frequency of flooding events and, thus, the risks of flood‐related mortality and infrastructure damage. Global‐scale assessments of future flooding from Earth system models based only on precipitation changes neglect important processes that occur within the land surface, particularly plant physiological responses to rising CO2. Higher CO2 can reduce stomatal conductance and transpiration, which may lead to increased soil moisture and runoff in some regions, promoting flooding even without changes in precipitation. Here we assess the relative impacts of plant physiological and radiative greenhouse effects on changes in daily runoff intensity over tropical continents using the Community Earth System Model. We find that extreme percentile rates increase significantly more than mean runoff in response to higher CO2. Plant physiological effects have a small impact on precipitation intensity but are a dominant driver of runoff intensification, contributing to one half of the 99th and one third of the 99.9th percentile runoff intensity changes. Plain Language Summary: Floods are one of the most devastating natural disasters in the world, contributing to thousands of deaths and billions of dollars in damages annually. Climate change is expected to increase flood exposure considerably through the 21st century. However, recent studies assessing future flood risk on global scales by downscaling precipitation from Earth system models often neglect important plant physiological responses to rising CO2. In particular, higher CO2 concentrations may lower stomatal conductance and, in the absence of significant plant growth, reduce water loss through transpiration, increasing soil moisture in many regions. For a given precipitation rate, higher soil moisture can decrease the amount of rain that infiltrates the soil and increase runoff. Here we apply a simulation design that isolates the independent effects of higher CO2 on radiatively driven precipitation intensification from plant‐driven soil moisture changes. We show that plant‐physiological responses to increasing CO2 are major drivers of the runoff intensity change in the tropics. Land surface changes contribute to one half of the 99th percentile runoff change and one third of the 99.9th percentile change. Our results suggest that comprehensive flood assessments should account for plant physiology as well as radiative impacts of higher CO2 in order to better inform flood prediction and mitigation practice. Key Points: Plant physiological responses drive a larger increase in the daily intensity of runoff than the annual mean in simulations with rising CO2Plant physiological responses to rising CO2 contribute as much as radiative greenhouse effects to changes in the 99th percentile daily runoffAssessments of future flood risk on global scales should include both atmosphere and land‐driven impacts on rainfall and runoff intensity [ABSTRACT FROM AUTHOR]

Background: Given the current opioid crisis, caregivers have mounting fears regarding the use of opioid medication in their children. We aimed to determine caregivers' a) willingness to accept, b) reasons for refusing, and c) past experiences with opioids., Methods: A novel electronic survey of caregivers of children aged 4 to 16 years who had an acute musculoskeletal injury and presented to two Canadian paediatric emergency departments (ED) (March to November 2017). Primary outcome was caregiver willingness to accept opioids for moderate pain for their children., Results: Five hundred and seventeen caregivers participated; mean age was 40.9 (SD 7.1) years with 70.0% (362/517) mothers. Children included 62.2% (321/516) males with a mean age of 10.0 (SD 3.6) years. 49.6% of caregivers (254/512) reported willingness to accept opioids for ongoing moderate pain in the ED, while 37.1% (190/512) were 'unsure'; 33.2% (170/512) of caregivers would accept opioids for at-home use, but 45.5% (233/512) were 'unsure'. Caregivers' primary concerns were side effects, overdose, addiction, and masking of diagnosis. Caregiver fear of addiction (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.01 to 1.25) and side effects (OR 1.25, 95% CI 1.11 to 1.42) affected willingness to accept opioids in the emergency department ; fears of addiction (OR 1.19, 95% CI 1.07 to 1.32), and overdose (OR 1.15, 95% CI 1.04 to 1.27) affected willingness to accept opioids for at-home use ., Conclusions: Only half of the caregivers would accept opioids for moderate pain, despite ongoing pain following nonopioid analgesics. Caregivers' fears of addiction, side effects, overdose, and masking diagnosis may have influenced their responses. These findings are a first step in understanding caregiver analgesic decision making., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Canadian Paediatric Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)