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IntroductionEvidence suggests the presence of deficiencies in the quality of care provided to up to half of all paediatric trauma patients in Canada, the USA and Australia. Lack of adherence to evidence-based recommendations may be driven by lack of knowledge of clinical practice guidelines (CPGs), heterogeneity in recommendations or concerns about their quality. We aim to systematically review CPG recommendations for paediatric injury care and appraise their quality.Methods and analysisWe will identify CPG recommendations through a comprehensive search strategy including Medical Literature Analysis and Retrieval System Online, Excerpta Medica dataBASE, Cochrane library, Web of Science, ClinicalTrials and websites of organisations publishing recommendations on paediatric injury care. We will consider CPGs including at least one recommendation targeting paediatric injury populations on any diagnostic or therapeutic intervention from the acute phase of care with any comparator developed in high-income countries in the last 15 years (January 2007 to a maximum of 6 months prior to submission). Pairs of reviewers will independently screen titles, abstracts and full text of eligible articles, extract data and evaluate the quality of CPGs and their recommendations using Appraisal of Guidelines Research and Evaluation (AGREE) II and AGREE Recommendations Excellence instruments, respectively. We will synthesise evidence on recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework and present results within a recommendations matrix.Ethics and disseminationEthics approval is not a requirement as this study is based on available published data. The results of this systematic review will be published in a peer-reviewed journal, presented at international scientific meetings and distributed to healthcare providers.PROSPERO registration numberInternational Prospective Register of Systematic Reviews (CRD42021226934).

BackgroundIn 2010 in British Columbia (BC), Canada, total injury costs per capita were higher among youth aged 15–24 years than in any other age group. Injury prevention efforts have targeted injuries with high mortality (transportation injuries) or morbidity (concussions). However, the profile and health costs of common youth injuries (types, locations, treatment choices and prevention strategies) and how these change from adolescence to young adulthood is not known.MethodsParticipants (n=662) were a randomly recruited cohort of BC youth, aged 12–18, in 2003. They were followed biennially across a decade (six assessments).ResultsSerious injuries (defined as serious enough to limit normal daily activities) in the last year were reported by 27%–41% of participants at each assessment. Most common injuries were sprains or strains, broken bones, cuts, punctures or animal bites, and severe bruises. Most occurred when playing a sport or from falling. Estimated total direct cost of treatment per injury was approximately $2500. In addition, 25% experienced serious injuries at three or more assessments, indicating possible differences that warrents further investigation.ConclusionsThe occurence and health cost of common injuries to youth and young adults are underestimated in this study but are nevertheless substantial. Ongoing surveillence, awareness raising, and prevention efforts may be needed to reduce these costs.

Background & Aims Tethered capsule endomicroscopy (TCE) involves swallowing a small tethered pill that implements optical coherence tomography (OCT) imaging, procuring high resolution images of the whole esophagus. Here, we demonstrate and evaluate the feasibility and safety of TCE and a portable OCT imaging system in patients with Barrett’s esophagus (BE) in a multi-center (5-site) clinical study. Methods Untreated patients with BE as per endoscopic biopsy diagnosis were eligible to participate in the study. TCE procedures were performed in unsedated patients by either doctors or nurses. After the capsule was swallowed, the device continuously obtained 10-μm-resolution cross-sectional images as it traversed the esophagus. Following imaging, the device was withdrawn through mouth, and disinfected for subsequent reuse. BE lengths were compared to endoscopy findings when available. OCT-TCE images were compared to volumetric laser endomicroscopy (VLE) images from a patient who had undergone VLE on the same day as TCE. Results 147 patients with BE were enrolled across all sites. 116 swallowed the capsule (79%), 95/114 (83.3%) men and 21/33 (63.6%) women (P = .01). High-quality OCT images were obtained in 104/111 swallowers (93.7%) who completed the procedure. The average imaging duration was 5.55 ± 1.92 minutes. The mean length of esophagus imaged per patient was 21.69 ± 5.90 cm. A blinded comparison of maximum extent of BE measured by OCT-TCE and EGD showed a strong correlation (r = 0.77-0.79). OCT-TCE images were of similar quality to those obtained by OCT-VLE. Conclusions The capabilities of TCE to be used across multiple sites, be administered to unsedated patients by either physicians or nurses who are not expert in OCT-TCE, and to rapidly and safely evaluate the microscopic structure of the esophagus make it an emerging tool for screening and surveillance of BE patients. Clinical trial registry website and trial number: NCT02994693 and NCT03459339.

Children under the age of 5 years have the highest rate of hospitalization and mortality from burns. Studies of costs associated with pediatric burns have included a limited number of patients and focused on inpatient and complication costs, limiting our understanding of the full economic burden of pediatric burns. This study aimed to develop a costing model for burn injuries among children to estimate the economic burden of child burns in British Columbia, Canada. Costs of services and resources used by children aged 0 to 4 years old who were treated at BC Children’s Hospital (BCCH) between January 1, 2014 and March 15, 2018 for a burn injury were estimated and summed, using a micro-costing approach. The average cost of burn injuries per percentage of total body surface area (%TBSA) was then applied to the number of 0 to 4 years old children treated for a burn injury across British Columbia between January 1 and December 31, 2016. Based on 342 included children, a 1–5%, 6–10%, 11–20%, and >20% burn, respectively cost an average of $3338.80, $13,460.00, $20,228.80, and $109,881.00 to society. The societal cost of child burns in BC in 2016 totaled $2,711,255.01. In conclusion, pediatric burn injuries place an important, yet preventable economic burden on society. Preventing even a small number of severe pediatric burns or multiple small burns may have considerable economic impacts on society and allow for the reallocation of healthcare funds toward other clinical priorities.

Background Coronary artery aneurysms (CAAs) may occur after Kawasaki disease (KD) and lead to important morbidity and mortality. As CAA in patients with KD are rare and heterogeneous lesions, prognostication and risk stratification are difficult. We sought to derive the cumulative risk and associated factors for cardiovascular complications in patients with CAAs after KD. Methods and Results A 34‐institution international registry of 1651 patients with KD who had CAAs (maximum CAA Z score ≥2.5) was used. Time‐to‐event analyses were performed using the Kaplan–Meier method and Cox proportional hazard models for risk factor analysis. In patients with CAA Z scores ≥10, the cumulative incidence of luminal narrowing (>50% of lumen diameter), coronary artery thrombosis, and composite major adverse cardiovascular complications at 10 years was 20±3%, 18±2%, and 14±2%, respectively. No complications were observed in patients with a CAA Z score Z score and a greater number of coronary artery branches affected were associated with increased risk of all types of complications. At 10 years, normalization of luminal diameter was noted in 99±4% of patients with small (2.5≤ Z Z Z ≥10). CAAs in the left anterior descending and circumflex coronary artery branches were more likely to normalize. Risk factor analysis of coronary artery branch level outcomes was performed with a total of 893 affected branches with Z score ≥10 in 440 patients. In multivariable regression models, hazards of luminal narrowing and thrombosis were higher for patients with CAAs of the right coronary artery and left anterior descending branches, those with CAAs that had complex architecture (other than isolated aneurysms), and those with CAAs with Z scores ≥20. Conclusions For patients with CAA after KD, medium‐term risk of complications is confined to those with maximum CAA Z scores ≥10. Further risk stratification and close follow‐up, including advanced imaging, in patients with large CAAs is warranted.

AimTo undertake a comprehensive review of the best available evidence related to risk factors for child pedestrian motor vehicle collision (PMVC), as well as identification of established and emerging prevention strategies.MethodsArticles on risk factors were identified through a search of English language publications listed in Medline, Embase, Transport, SafetyLit, Web of Science, CINHAL, Scopus and PsycINFO within the last 30 years (~1989 onwards).ResultsThis state-of-the-art review uses the road safety Safe System approach as a new lens to examine three risk factor domains affecting child pedestrian safety (built environment, drivers and vehicles) and four cross-cutting critical issues (reliable collision and exposure data, evaluation of interventions, evidence-based policy and intersectoral collaboration).ConclusionsResearch conducted over the past 30 years has reported extensively on child PMVC risk factors. The challenge facing us now is how to move these findings into action and intervene to reduce the child PMVC injury and fatality rates worldwide.

The significance of cord blood neutropenia as a screening tool for early-onset sepsis (EOS) is unclear. The objectives were to define reference values for cord blood neutrophil count and to determine the sensitivity and positive likelihood ratio of cord neutropenia for the detection of EOS. This retrospective observational cohort study included all mother–infant pairs with deliveries between 2009 and 2014 for whom cord neutrophil counts were routinely done. EOS cases were identified by interrogation of electronic charts. Maternal and perinatal factors were assessed to determine reference values of cord neutrophil. The diagnostic value of neutropenia for detecting EOS was assessed. A nested case–control design was used to measure the value of neutropenia in the detection of EOS in comparison with other risk factors. A total of 8,590 mother–infant pairs were included. We identified 84 sepsis cases. The neutrophil count was strongly associated with gestational age. Neutropenia adjusted for gestational age was strongly associated with EOS and had good specificity but poor sensitivity. The addition of neutropenia to other EOS risk factors increased sensitivity without decreasing specificity. Cord blood neutropenia was significantly associated with EOS and the addition of cord neutropenia to current EOS risk factors increased the detection rate of EOS.

Objectives: To explore the relationship between neighborhood social and material deprivation and the rates of abusive head trauma (AHT), and whether it differs according to sex, and following the implementation of the Period of PURPLE Crying ( PURPLE) program. Method: A cross-sectional study design was applied to data from children 0 to 24 months old with a confirmed AHT diagnosis between 2005 and 2017 in British Columbia. Dissemination area–based social and material deprivation scores were assigned to residential areas, where AHT cases were recorded. Poisson regression models tested the relationship between deprivation scores and AHT rates, adding sex and pre–post program implementation as interaction terms. Results: With each increase in material and social deprivation quintiles, AHT rates increased by 42% (95% CI [1.18, 1.72]) and 25% (95% CI [1.06, 1.51]), respectively, following a social gradient. AHT rate disparities between neighborhoods did not change following the PURPLE program implementation. Conclusions: This study stresses the need to provide additional AHT prevention services proportionately to the levels of neighborhood disadvantage, in addition to universal AHT programs, to successfully protect all children.

BACKGROUND: This study assessed whether socioeconomic factors affect the rates of residential fire incidence and fire-related injuries and deaths, and whether children are affected differently than the general population. METHODS: We employed a cross-sectional study design using data for British Columbia, Alberta, Manitoba and Ontario from the National Fire Information Database, which includes fire incidents and losses reported by provincial fire marshals across Canada between 2005 and 2015. It also contains 2011 census subdivision social domain data from Statistics Canada based on fire location. Multivariable negative binomial regressions tested the significance of relations between census subdivision socioeconomic factors (average household size, educational attainment, median income and unemployment rate) and the rates of residential fires and casualties per person-year, and casualties per fire incident. RESULTS: Census subdivisions with higher educational attainment and unemployment rates had higher rates of residential fires (incidence rate ratio [IRR] 1.07, 95% confidence interval [CI] 1.05–1.10, and IRR 1.24, 95% CI 1.18–1.31, respectively) and of residential fire casualties per person-year (IRR 1.09, 95% CI 1.05–1.13, and IRR 1.29, 95% CI 1.20–1.40, respectively). Census subdivisions with smaller average households had higher rates of residential fire casualties per person-year (IRR 0.43, 95% CI 0.22–0.83) and per fire incident (IRR 0.75, 95% CI 0.58–0.97), and the association was even stronger for children (IRR 0.17, 95% CI 0.08–0.36, and IRR 0.41, 95% CI 0.20–0.86, respectively). INTERPRETATION: The results suggest that efforts to prevent residential fires should be prioritized in neighbourhoods with higher educational attainment and unemployment, whereas house fire safety programs should be intensified in neighbourhoods with smaller households to prevent fire casualties, especially among children, once a fire does occur.

Diabetes is characterized by dysregulated glucose homeostasis that leads to hyperglycemia, due in part to increased hepatic glucose production (GP) and insulin resistance. Excessive levels and/or action of glucocorticoids (GCs) are associated with obesity, insulin resistance, and hyperglycemia. We aim to delineate a mechanism of GC action in the mediobasal hypothalamus (MBH) that modulates GP in normal and pre-obese rodents. Male SD rats underwent stereotaxic MBH bilateral cannulation and intravenous (iv) and intraarterial catheterization to enable simultaneous direct infusions into the MBH, iv infusions, and blood sampling, respectively. Mildly hyperinsulinemic-euglycemic clamps with tracer dilution methodology combined with MBH GC infusion ± GC receptor (GR) inhibition enables measurement of GP and utilization while assessing MBH GC interaction with its MBH receptors independent of changes in plasma insulin, glucagon, and glucose levels. MBH GC infusion potently stimulates GP and lowers the requirement for exogenous glucose infusion without altering glucose utilization. This effect is mediated via GRs since co-infusion of GR antagonist mifepristone, or a HSP90 inhibitor, negates the ability of MBH GCs to increase GP. MBH GCs similarly increased glucose excursions during iv glucose tolerance tests, which was reversed with concomitant MBH mifepristone infusion. Rats fed with high fat diet (HFD) for 3 days had altered glucose kinetics and increased basal plasma corticosterone, insulin, and blood glucose levels without changes in body weight. Chronic MBH GR inhibition with MBH GR shRNA lowered GP compared to MBH mismatch control HFD rats with MBH vehicle infusions, suggesting that blocking excessive MBH GC action resulting from HFD-feeding attenuates GP to improve glucose homeostasis. We provide novel evidence that MBH GC action modulates GP in healthy and pre-obese rats. Importantly, targeted inhibition of MBH GC action may help improve glucose regulation in obesity-related metabolic disease. Disclosure E. Beaulieu-Bayne: None. M. Cardoso: None. H. Kim: None. S. Yang: None. J.T. Yue: None. Funding Diabetes Canada; Natural Sciences and Engineering Research Council of Canada; Alberta Diabetes Institute; Canadian Institutes of Health Research

While the most common method used to evaluate and survey patients with Barrett’s Esophagus (BE) is endoscopic biopsy, this procedure is invasive, time-consuming, and suffers from sampling errors. Moreover, it requires patient sedation that increases cost and mandates its operation in specialized settings. Our lab has developed a new imaging tool termed tethered capsule endomicroscopy (TCE) that involves swallowing a tethered capsule which utilizes optical coherence tomography (OCT) to obtain three-dimensional microscopic (10µm) images of the entire esophageal wall as it traverses the luminal organ via peristalsis or is retrieved by pulling up tether. As opposed to endoscopy, TCE procedure is non-invasive, doesn’t require patient sedation and mitigates sampling error by evaluating the microscopic structure of the entire esophagus. The merits of TCE make it a suitable device to investigate the microscopic natural history of BE in a longitudinal manner. Here, we present our initial experience of a multicenter (5-site) clinical trial to study the microscopic natural history of BE. The TCE device used for the study is the new generation capsule with the ball lens optical configuration and a distal scan stepper motor, which provides 30µm (lateral) resolution and 40Hz imaging rate. The portable OCT imaging system is a custom in-house built swept source system and provides 7µm (axial) at a 100 kHz A-line rate with a center wavelength of ~1310 nm. To date, we have successfully enrolled 69 subjects at all sites (MGH: 33, Columbia University: 11, Kansas City VA: 10, Mayo Jacksonville: 8, Mayo Rochester: 7) and 59 have swallowed the capsule (85.5%). There have been no reported adverse events associated with TCE procedure. High-quality OCT images were reliably obtained from patients who swallowed the device, and BE tissues were identified by expert readers. Our initial experience with TCE in a multicenter study demonstrates that this technology is easy to use and efficient in multiple clinical settings. Completion of this longitudinal study is likely to provide new insights on the temporal progression of BE that may impact management strategies.

International audience; The weathering of silicate minerals in the Critical Zone (CZ) is fundamental for numerous environmental and societal issues. Despite decades of efforts to accurately record biogeochemical variables controlling mineral reactivity in the field and to reproduce them in the laboratory, weathering rate estimates still differ from those observed in natural settings. Here we examine the biogeochemical environment of mineral surfaces exposed to contrasted weathering conditions in various compartments of a temperate CZ (Strengbach observatory, France). A novel approach was developed to probe both in-situ mineral dissolution rates and bacterial diversity associated with mineral surfaces. Labradorite and olivine minerals were either buried in the A and C horizons of a soil profile, directly exposed to meteoric fluids or immersed in stream water. Dissolution rates recorded in the soil profile were up to 2 orders of magnitude slower than those predicted using a numerical weathering model. Samples directly exposed to meteoric fluids exhibited contrasted dissolution rates that could not be explained by simple abiotic weathering, while dissolution rates of samples incubated in stream water were particularly low. In soil profiles, the field-laboratory discrepancy by up to 2 orders of magnitude was attributed to heterogeneity of fluid circulation and local variation of reaction conditions. Mineral substrates changed bacterial communities of the mineralosphere after 9 and 20 months of incubation in the CZ. However, we observed that this effect could be delayed or driven by extrinsic factors. Although mineral probes in soil horizons were enriched in bacterial phylotypes potentially involved in mineral weathering (e.g., Pseu-domonas sp., Collimonas sp., Burkholderia sp., Janthinobacterium sp., Leifsonia sp., and Arthrobacter sp.), the relative contribution of biotic weathering could not be quantified in-situ. Altogether, the heterogeneity of in-situ mineral dissolution rates in compartments of the CZ underscores the need to improve spatial characterization of hydrogeochemical properties at the soil profile scale, and to evaluate quantitatively the role of microbial communities in mineral weathering.

We developed a near-infrared small animal imaging system, IR VIVO, that provides real-time images, videos and spectral imaging in the NIR-I and shortwave infrared (SWIR or NIR-II) regions. We found that SWIR wavelengths can give optimal resolution for in vivo optical imaging of deep organs in mice up to 3 cm due to the low tissue autofluorescence, scattering and absorption of light at these wavelengths. We also showed how this higher penetration depth can enable the detection of small wavelength changes in the emission of carbon nanotube-based sensors implanted in vivo using a continuously tunable filter. First, we demonstrated superior image clarity and penetration depth at NIR-II wavelengths (1000-1700 nm) in vivo using an FDA approved dye, indocyanine green (ICG) in a mouse. We used 780 nm excitation, detection using a Zephir 1.7 InGaAs camera and 1250 nm long-pass emission filter. We found low tissue autofluorescence at 1250 nm. The ICG dye imaging resulted in superior visualization of microvasculature, perfusion, measurement of hearst rate, respiratory rate, hepatobiliary and intestinal contractions. Further anatomical and functional imaging was carried out by looking at the kinetics of ICG, resulting in the identification of different organs. Second, In vivo near-infrared hyperspectral imaging of carbon nanotubes was conducted using a continuously-tunable filter in the imager. A diffraction volume Bragg grating (VBG), was used to provide narrow-band wavelength selection. Coupled with a homogeneous global illumination, spectrally-defined images were acquired in the entire field of view. The result was a dataset containing both 2D spatial information and the full spectrum for each point in the image. We conducted near-infrared hyperspectral imaging of single-walled carbon nanotubes to measure small wavelength changes of the nanotubes implanted into live mice. Hyperspectral measurements of carbon nanotube sensors for lipids in the liver as well as implantable sensors for doxorubicin were conducted, facilitating liver disease monitoring and drug pharmacokinetics measurements. Finally, we believe wide-area NIR-II imaging and spectral/hyperspectral measurements have broad potential applications for the use of carbon nanotubes and other NIR-I/II materials in basic materials/biology, translational, and clinical work, including sensor arrays, point-of-care measurements, implants, whole small animal imaging and intraoperative/surgical imaging.

Vegetal cover and the water cycle are closely linked. The climate controls the distribution and productivity of terrestrial vegetation, and the vegetal cover type is a key determinant for evapotranspiration and global runoff. In this study, a dynamic vegetation model (LPJ) has been coupled with a 3D hydrogeological model (MODFLOW) to estimate, for the first time, the impact of climate change on a small forested temperate watershed (Strengbach, Vosges, France). The model, calibrated with monthly hydrological and climate data, is able to globally reproduce the observed vegetal cover distribution and the water cycle over the 1987–2009 period. The discrepancies between calculated and observed intra-annual discharge variations highlight the importance of processes such as snow formation, snowmelt, and catchment recharge after drought periods, as well as the impact of evapotranspiration. Long-term simulations extending up to the year 2100 have been performed with climatic output from the Meteo-France climate model ARPEGE/Climate (IPCC, 2007 scenario A1B). With a predicted increase in temperature of 2.6 °C and a rise in atmospheric CO2 concentration of 80%, the mean annual precipitation decreases by 4.5% in the Strengbach watershed over the course of the century. The models cascade predicts a limited decrease of evapotranspiration (by 2.5%), an impact on discharge (11% decrease) at the watershed outlet over the 21st century, and a significant change in vegetation distribution starting in approximately 2085. The response of land plants to climate change in the future seems to only slightly affect the water resources in the Strengbach catchment. This study also highlights existing shortcomings and limitations of simulations for measuring the impacts of climate change.

A numerical coupling of a dynamic biogeochemical model (B-WITCH) and a model of forest balance water (BILJOU) was used to simulate the concentration of major species within soil profiles from two contrasted ecosystems: beech and spruce stands located in the Vosges Mountains and their evolution during decades. This coupled modelling allows an important vertical discretization of water and cation cycle and a direct comparison with the hydrological and geochemical data available over twenty-five years and on a seasonal basis. The processes controlling the past evolution of soil solution chemistry have been identified and tested. The biogeochemical cycles of cations estimated on the two sites shows that the biological fluxes control up to 70% (for Ca and Mg) and up to 95% (K) of the chemical composition of the soil solutions. The Ca and Mg concentrations decrease over the last decades, which can be explained by the evolution of atmospheric inputs and by the behavior of the exchange complex. This paper highlights the weak contribution of mineral dissolution and the key role of biological recycling and cation exchange processes in the soil solution signatures. The future sustainability of forest, in mountainous environment on base poor bedrock, depends strongly on the forest management and evolution of exchangeable pool nature.

We developed a near-infrared small animal imaging system, IR VIVO, that provides real-time images, videos, and spectral imaging in the NIR-I and shortwave infrared (SWIR or NIR-II) regions. We found that SWIR wavelengths can give optimal resolution for in vivo optical imaging of deep organs in mice due to the low tissue autofluorescence, scattering and absorption of light at these wavelengths. We also show how this higher penetration depth can enable the detection of small wavelength changes in the emission of carbon nanotube-based sensors implanted in vivo using a continuously tunable filter. First, we demonstrated superior image clarity and penetration depth at NIR-II wavelengths (1000-1700 nm) in vivo using an FDA approved dye, indocyanine green (ICG). We used 780 nm excitation and detection using a Zephir 1.7 InGaAs camera and 1250 nm long-pass emission filter. We found low tissue autofluorescence at 1250 nm. The ICG dye imaging resulted in superior visualization of microvasculature, perfusion, measurement of heart rate, respiratory rate, hepatobiliary, and intestinal contractions. Further anatomical and functional imaging was carried out by looking at the kinetics of ICG, resulting in identification of different organs. In vivo near-infrared hyperspectral imaging of carbon nanotubes was conducted using a continuously-tunable filter in the imager. A diffraction volume Bragg grating (VBG), was used to provide narrow-band wavelength selection. Coupled with a homogeneous global illumination, spectrally-defined images were acquired in the entire field of view. The result was a dataset containing both 2D spatial information and the full spectrum for each point in the image. We conducted near-infrared hyperspectral imaging of single-walled carbon nanotubes to measure small wavelength changes of the nanotubes implanted into live mice. Hyperspectral measurements of carbon nanotube sensors for lipids in the liver as well as implantable sensors for doxorubicin were conducted, facilitating liver disease monitoring and drug pharmacokinetics measurements. We believe wide-area NIR-II imaging and spectral/hyperspectral measurements have broad potential applications for the use of carbon nanotubes and other NIR-I/II materials in basic materials/biology, translational, and clinical work, including sensor arrays, point-of-care measurements, implants, whole-animal imaging, and intraoperative/surgical imaging.

Introduction Children under the age of five years are particularly vulnerable to scalds and contact burns and have the highest rate of hospitalization and mortality from burns. Studies of costs associated with pediatric burns have included a limited number of patients and focused on inpatient and complication costs, limiting our understanding of the full economic burden of pediatric burns, including costs incurred through outpatient care and caregivers’ productivity loss. This study aimed to develop a societal costing model for burn injuries among children aged 0 to 4 years. Methods Children aged 0 to 4 years identified through the local Burn Registry with a burn injury between January 1, 2014 and March 15, 2018 were included in this study. Patients with inhalation injury, electrical, chemical and friction burns were excluded. An incidence-based cost-of-illness analysis with a human capital approach was used to quantify the cost of partial and full-thickness burns according to the percentage of total body surface area (%TBSA) involved. The cost of a burn injury was assessed from a societal perspective through the following cost categories: emergency department visits, inpatient, outpatient dressing changes, outpatient burnbaths, day surgeries, clinic visits and caregiver productivity losses. A list of resource items for each category were extracted from patient chart review, the local Burn Registry, and the local Hospital Finance Database, and assigned unit prices. Costs were discounted to a present value in 2017 dollars at 1.5% per annum. Results Burn injuries were observed for 342 children, of which 249 (73%) had their burn severity classified (%TBSA and partial/full thickness) and were included in this study. Burn severity categories (1–5%, 6–10%, 11–20%, and >20%) were developed based on the differential distribution of the costs allocated to each burn incident. The majority of children (60.8%) suffered from a 1–5% burn. A 1–5%, 6–10%, 11–20%, and >20% burn respectively cost an average of $2,229, $8,653, $13,663, and $98,634 to society. Costs incurred by the 1–5% burns were related mostly to emergency department visits and dressing changes, while costs incurred by the >20% were related mostly to inpatient and clinic visits (garments) costs. Conclusions This costing approach raises awareness about the important, yet preventable economic burden that pediatric burn injuries place on society. Applicability of Research to Practice This evidence may persuade policymakers and clinicians to invest in pediatric burns prevention programs in order to decrease pediatric burns costs allowing for the allocation of funds towards other clinical initiatives. This costing model may also facilitate cost-effectiveness analyses of burn prevention programs in the coming years.

Fire is a leading cause of unintentional injuries in children and youth in Canada. Although evidence supports low socio-economic status (SES) as a significant predictor of unintentional injuries in general, far less attention has been paid specifically to the SES of residential fire related injuries among Canadian children and youth. This study aimed to determine the role of SES (low education, median income and average number of persons per dwelling (ANPD) in residential fire related injuries and deaths among children and youth in Canada. We used a cross-sectional study design on data from the National Fire Information Database, which includes 10 years (2005–2015) of microdata information on fire incidents and losses reported by provincial/territorial Fire Marshals and Fire Commissioners Offices across Canada. Census 2011 data at the CMA level, from Statistics Canada, provided the SES variables. We used a Poisson regression model to examine the relationship between SES and the rate of residential fire casualties, defined as deaths and injuries per fire incident, in children and youth (ages 0–16). We adjusted for province in the model. Per region, the risk of children and youth being injured or killed in a fire decreased by 95% for every additional person in the house (p This is one of the first studies addressing the role of SES in residential fire related injuries and deaths among children and youth across Canada. ANPD and median income were strongly associated with rate of fire casualties. This outcome has high clinical relevance and provides evidence to support informed interventions targeting children from small and poor families regarding residential fire prevention.

Substantial efforts devoted to decreasing the burden of transport-related injuries (TRIs) in Canada, including public awareness campaigns aiming to influence attitudes and behaviors, may lead the public to perceive other types of injuries differently. This study examined the relationship between public perception of the preventability of injuries and the type of injury (TRIs vs. non-transport unintentional injuries (NTUIs)); and assessed whether exposure to a social marketing campaign (Preventable) influenced this association. A cross-sectional study design employed survey data collected by Preventable between 2015 and 2016 from 1501 British Columbians aged 25–54 years. A multiple linear regression model was applied to examine the relationship between the type of injury (TRIs vs. NTUIs) and attitudes towards preventability, controlling for socio-demographic variables. Exposure to the campaign was tested as an effect modifier. On a scale from 1 to 10, respondents perceived TRIs to be 1.08 points more preventable than NTUIs (95% CI: 1.00 to 1.16, p-value

Tethered capsule endomicroscopy (TCE) is a new method for performing comprehensive microstructural OCT imaging of gastrointestinal (GI) tract in unsedated patients in a well-tolerated and cost-effective manner. These features of TCE bestow it with significant potential to improve the screening, surveillance and management of various upper gastrointestinal diseases. To achieve clinical adoption of this imaging technique, it is important to validate it with co-registered histology, the current diagnostic gold standard. One such method for co-registering OCT images with histology is laser cautery marking, previously demonstrated using a balloon-centering OCT catheter that operates in conjunction with sedated endoscopy. With laser marking, an OCT area of interest is identified on the screen and this target is marked in the patient by exposing adjacent tissue to laser light that is absorbed by water, creating superficial, visible marks on the mucosal surface. Endoscopy can then be performed after the device is removed and biopsies taken from the marks. In this talk, we will present the design of a tethered capsule laser marking device that uses a distal stepper motor to perform high precision (< 0.5 mm accuracy) laser targeting and high quality OCT imaging. Ex vivo animal tissue tests and pilot human clinical studies using this technology will be presented.

This study focuses on 20 years of hydrochemical monitoring of the small springs that emerge in the experimental granitic catchment of Strengbach (OHGE, France) and the simulation of these data using the KIRMAT code. The data indicate that the Strengbach springs display chemostatic behavior; that is, limited temporal variations were noted in the concentrations of dissolved silica (H4SiO4) and most of the basic cations during the studied period (1987–2010), resulting in relative stability of the global weathering fluxes exported by the springs. Only the Ca2+ concentrations reflect a significant decrease in all the Strengbach springs since 1987, and the variations differ from one spring to another. The modeling results show that the decrease in Ca2+ in the Strengbach springs is due to the response of the water-rock interactions within the bedrock to the variations in the chemical composition of the soil solutions, which were characterized by a significant increase in pH and a decrease in Ca2+ concentrations between 1987 and 2010. The decrease in Ca2+ concentrations seen in the Strengbach springs is controlled by changes in the apatite dissolution rate and the compositions of clay minerals induced by the soil solution changes. The differences observed between the Ca2+ trends of the springs are related to changes in the residence time of the water supplying the different springs. The weak impact of the soil solution modifications on the dissolution rates of other primary minerals and on the bulk precipitation rates of the clay minerals explains the relative stability over time of the concentrations of the other cations and dissolved silica in the water derived from the Strengbach springs. Further, the hydrochemical simulations suggest that the chemostatic behavior of the Strengbach springs cannot be explained by the mobilization of waters that are close to chemical equilibrium, but rather by a hydrological control of the spring water residence times. Finally, a comparison of current and long-term weathering rates determined from the spring water monitoring and a regolith profile shows that the modern chemical fluxes of Ca2+ are higher than the long-term ones, whereas the weathering fluxes of H4SiO4 and Na+ have likely been much more stable over time. All of these results indicate that the silicate weathering processes are characterized by weak spatial and temporal variability in the Strengbach catchment, while the chemical elements such as Ca2+, for which the budget in the spring waters is controlled by the dynamic behavior of clay minerals and minor minerals such as apatite, are significantly affected by Quaternary climatic variations and decennial environmental changes.

Research activity associated with various observations at the Strengbach catchment in the Vosges Massif (880-1150 m) addresses many questions in the domains of hydrology and geochemistry. The catchment is the observation and experimental site of the Observatoire Hydro-Geochimique de l'Environnement appointed by the Centre National de la Recherche Scientifique. It also belongs to the research facilities that form the French Network of Critical Zone Observatories (OZCAR), which supports a network of critical zone observatories. The catchment is small (0.8 km(2)) with steep slopes (20-30%) on granitic bedrock that mainly allow for forestry (spruce and beech stands) as the main land cover. Meteorological, hydrological, and geochemical data have been monitored since 1986. The first studies conducted were dedicated to the elucidation of acid rain effects on forest ecosystems and particularly on forest decline. Multidisciplinary research studies conducted on the Strengbach catchment enable exploration of the following issues: (i) hydrological functioning at the scale of a small catchment and questions regarding the evolution and preservation of the water resources in mountainous environments (stock, recharge, infiltration, and water pathways), (ii) exchange processes observed at the soil-plant-atmosphere continuum and in particular weathering processes and the evolution of soil mineral fertility (Ca, Mg, K, P), (iii) processes responsible for the export of water and for associated fluxes (dissolved chemicals, suspended materials, bed loads) and their dynamic at the outlet, and (iv) responses of the ecosystems to environmental disturbances (acid rain, forest management, and climate change) and their current and future modeling.

Celiac disease (CD) affects around 1% of the global population and can cause serious long-term symptoms including malnutrition, fatigue, and diarrhea, amongst others. Despite this, it is often left undiagnosed. Currently, a tissue diagnosis of CD is made by random endoscopic biopsy of the duodenum to confirm the existence of microscopic morphologic alterations in the intestinal mucosa. However, duodenal endoscopic biopsy is problematic because the morphological changes can be focal and endoscopic biopsy is plagued by sampling error. Additionally, tissue artifacts can also an issue because cuts in the transverse plane can make duodenal villi appear artifactually shortened and can bias the assessment of intraepithelial inflammation. Moreover, endoscopic biopsy is costly and poorly tolerated as the patient needs to be sedated to perform the procedure. Our lab has previously developed technology termed tethered capsule OCT endomicroscopy (TCE) to overcome these diagnostic limitations of endoscopy. TCE involves swallowing an optomechanically-engineered pill that generates 3D images of the GI tract as it traverses the lumen of the organ via peristalsis, assisted by gravity. In several patients we have demonstrated TCE imaging of duodenal villi, however the current TCE device design is not optimal for CD diagnosis as the villi compress when in contact with the smooth capsule’s wall. In this work, we present methods for structuring the outer surface of the capsule to improve the visualization of the villi height and crypt depth. Preliminary results in humans suggest that new TCE capsule enables better visualization of villous architecture, making it possibly to comprehensively scan the entire duodenum to obtain a more accurate tissue diagnosis of CD.

Endoscopy, the current standard of care for the diagnosis of upper gastrointestinal (GI) diseases, is not ideal as a screening tool because it is costly, necessitates a team of medically trained personnel, and typically requires that the patient be sedated. Endoscopy is also a superficial macroscopic imaging modality and therefore is unable to provide detailed information on subsurface microscopic structure that is required to render a precise tissue diagnosis. We have overcome these limitations through the development of an optical coherence tomography tethered capsule endomicroscopy (OCT-TCE) imaging device. The OCT-TCE device has a pill-like form factor with an optically clear wall to allow the contained opto-mechanical components to scan the OCT beam along the circumference of the esophagus. Once swallowed, the OCT-TCE device traverses the esophagus naturally via peristalsis and multiple cross-sectional OCT images are obtained at 30-40 μm lateral resolution by 7 μm axial resolution. While this spatial resolution enables differentiation of squamous vs columnar mucosa, crucial microstructural features such as goblet cells (~10 μm), which signify intestinal metaplasia in BE, and enlarged nuclei that are indicative of dysplasia cannot be resolved with the current OCT-TCE technology. In this work we demonstrate a novel design of a high lateral resolution OCT-TCE device with an extended depth of focus (EDOF). The EDOF is created by use of self-imaging wavefront division multiplexing that produces multiple focused modes at different depths into the sample. The overall size of the EDOF TCE is similar to that of the previous OCT-TCE device (~ 11 mm by 26 mm) but with a lateral resolution of ~ 8 μm over a depth range of ~ 2 mm. Preliminary esophageal and intestinal imaging using these EDOF optics demonstrates an improvement in the ability to resolve tissue morphology including individual glands and cells. These results suggest that the use of EDOF optics may be a promising avenue for increasing the accuracy of OCT-TCE for the diagnosis of upper GI diseases.

Background Abusive head trauma (AHT) is a severe form of child abuse causing devastating outcomes for children and families, but its economic costs in Canada has yet to be determined. The Period of PURPLE crying program (PURPLE) is an AHT prevention program implemented in British Columbia for which success in reducing AHT events was recently reported. Objective This study estimated the lifetime costs to society of incidental AHT events and compared the benefits and associated costs of AHT before and after the implementation of the PURPLE program. Participants and Setting: Children aged 0–24 months old with a definite diagnosis of AHT between 2002 and 2014 in British Columbia were included in this study. Methods An incidence-based cost-of-illness analysis, using the human capital approach was used to quantify the lifetime costs of AHT events according to their severity (least severe, severe and fatal). A cost-effectiveness analysis of the PURPLE program was conducted from both a societal and a health services’ perspectives using decision tree models. Results There were sixty-four AHT events between 2002–2014, resulting in a total cost of $354,359,080 to society. The costs associated with fatal, severe and least severe AHT averaged $7,147,548, $6,057,761 and $1,675,099, respectively. The investment of $5 per newborn through the PURPLE program resulted in a $273.52 and $14.49 per child cost avoidance by society and by the healthcare system. Conclusions This study provides evidence to policymakers and health practitioners that investing upstream in well-developed AHT prevention programs, such as PURPLE, not only promote child safety and health, but also translates into avoided costs to society.

To evaluate the attitudes of adolescents toward communicating with their doctor about different aspects of their sexuality.The present descriptive survey was conducted with the participation of teenagers from four high schools in Sherbrooke, Quebec. In each school, the students of two grade 8 classes (≤14 years of age) and two grade 10 classes (≥15 years of age) anonymously completed a self-administered questionnaire. Permission from the school board and parental consent for every participant was obtained.A total of 387 adolescents completed the self-administered questionnaire. The response rate for the study was 98%. Only 27% of the respondents remembered being questioned by their doctor about sexuality, and 17% of the respondents had already brought up the topic of sexuality themselves with their doctor. More than one-half (57%) of the adolescents reported they would be moderately comfortable to totally comfortable discussing sexuality with their doctor if they felt the need to. Overall, when asked to evaluate their degree of comfort if questioned on specific questions about their sexuality, 73.8% to 99.5% believed they would be moderately to totally comfortable responding. Nevertheless, there was a statistically significant difference between age groups, with the older age group being more comfortable than the younger age group (P0.001). There was no difference between the level of comfort among boys and girls answering the same questions. Respondents believed that their treating physician should discuss sexuality with them (73.8%) and, in the majority of cases (78%), that he/she should initiate the conversation.Regardless of age or sex, teenagers considered themselves to be at ease discussing sexuality with their doctor and found it an important topic best brought up by their practitioner.Évaluer les attitudes des adolescents envers la communication de divers aspects de leur sexualité à leur médecin.Les chercheurs ont effectué le présent sondage descriptif avec la participation des adolescents de quatre écoles secondaires de Sherbrooke, au Québec. Dans chaque école, les étudiants de deux classes de 8Au total, 387 adolescents ont rempli le questionnaire autoadministré. Le taux de réponse à l’étude s’élevait à 98 %. Seulement 27 % des répondants se souvenaient s’être fait poser des questions par leur médecin au sujet de la sexualité, et 17 % avaient déjà soulevé eux-mêmes la question avec leur médecin. Plus de la moitié (57 %) des adolescents ont déclaré qu’ils se seraient sentis modérément ou totalement à l’aise de discuter de sexualité avec leur médecin s’ils en ressentaient le besoin. Dans l’ensemble, lorsqu’on leur demandait d’évaluer leur degré d’aisance à se faire poser des questions précises sur leur sexualité, de 73,8 % à 99,5 % pensaient qu’ils seraient modérément ou totalement à l’aise d’y répondre. Néanmoins, on constatait une différence statistiquement significative entre les groupes d’âge, le groupe plus âgé se disant plus à l’aise que le groupe plus jeune (P0,001). On ne constatait pas de différence entre le degré d’aisance des garçons et des filles à répondre aux mêmes questions. Les répondants trouvaient que leur médecin traitant devrait parler de sexualité avec eux (73,8 %) et, dans la majorité des cas (78 %), qu’il devrait amorcer la conversation.Quel que soit leur âge ou leur sexe, les adolescents se disaient à l’aise de discuter de sexualité avec leur médecin et trouvaient qu’il s’agissait d’un sujet important qu’ils préféraient voir soulevé par leur praticien.

Early-onset sepsis is a major cause of morbidity and mortality in newborns. Peripheral white blood cells count is a known powerful marker of infection but changing neutrophil kinetics in the first hours of life impair its diagnostic value. The objective of this study was to assess the predictive value of cord blood neutropenia for the detection …

A zebrafish model has recently been introduced to study various genetic mutations that could lead to spinal deformities such as scoliosis. However, current imaging techniques make it difficult to perform longitudinal studies of this condition in zebrafish, especially in the early stages of development. The goal of this project is to determine whether optical coherence tomography (OCT) is a viable non-invasive method to image zebrafish exhibiting spinal deformities. Images of both live and fixed malformed zebrafish (5 to 21 days postfertilization) as well as wild-type fish (5 to 29 days postfertilization) were acquired non-invasively using a commercial SD-OCT system, with a laser source centered at 930nm (λ=100nm), permitting axial and lateral resolutions of 7 and 8μm respectively. Using two-dimensional images and three-dimensional reconstructions, it was possible to identify the malformed notochord as well as deformities in other major organs at different stages of formation. Visualization of the notochord was facilitated with the development of a segmentation algorithm. OCT images were compared to HE histological sections and images obtained by calcein staining. Because of the possibility of performing longitudinal studies on a same fish and reducing image processing time as compared with staining techniques and histology, the use of OCT could facilitate phenotypic characterization in studying genetic factors leading to spinal deformities in zebrafish and could eventually contribute to the identification of the genetic causes of spinal deformities such as scoliosis.