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Children with critical CHD are at risk for neurodevelopmental impairments, including delays in expressive and receptive language development. However, no study has synthesised the literature regarding language abilities in children with this condition.
We summarised the literature regarding expressive and receptive language in preschool children with critical CHD.
MEDLINE, Embase, Scopus, Child Development and Adolescent Studies, ERIC, PsycINFO, and CINAHL.
We included studies published between January, 1990 and 1 July, 2021, focused on children aged ≤5 years with critical CHD requiring a complex cardiac procedure at age <1 year. Language ability was documented using standardised, validated tools assessing both expressive and receptive language outcomes.
Data (study, patient and language characteristics, and results) were extracted by two reviewers.
Seventeen studies were included. Among children 2–5 years old with critical CHD, there were statistically significant deficits in overall (standardised mean difference: –0.46; 95 % confidence interval: –0.56, –0.35), expressive (standardised mean difference: –0.45;95 % confidence interval: –0.54, –0.37), and receptive (standardised mean difference: –0.32; 95 % confidence interval: –0.40, –0.23) language compared to normative data. Results reported as medians were similar to meta-analysis findings. Subgroup analysis showed that children with univentricular physiology had lower language scores than children with biventricular physiology.
Preschool children with critical CHD had statistically significantly lower language outcomes compared to expected population norms. Healthcare professionals should test early and often for language deficits, referring to individually tailored supports.
To examine the use of telemedicine among Canadian concussion providers and clinics before and after the COVID-19 pandemic onset and identify barriers and facilitators for future use.
Ninety-nine concussion clinics and healthcare providers across Canada that offered one or more clinical concussion-related service were identified using standardized online searches and approached to complete a cross-sectional online survey.
Thirty clinics or providers completed the survey and two completed subsections of the survey (response rate of 32.3%). Only 28.1% of respondents indicated that they used telemedicine to provide care prior to the COVID-19 pandemic. Providers most commonly using telemedicine prior to the pandemic were occupational therapists and physicians, while the most commonly used services were in-person videoconferencing and eConsultation. Most respondents (87%) indicated their clinic’s use of telemedicine changed following the onset of the COVID-19 pandemic including new use of in-person video-conferencing, telephone calls, and eConsultation. Ninety-three percent indicated that they would consider using telemedicine to provide care to their concussion patients once the pandemic was over. Barriers needed to be overcome to facilitate use or greater use of telemedicine-based services were the inability to conduct a complete physical examination, lack of appropriate reimbursement, lack of start-up, and maintenance funding and medico-legal risk.
Telemedicine was used by a minority of Canadian concussion clinics and providers prior to the COVID-19 pandemic but was rapidly adopted by many facilities. This study provides important insight into the factors that must be considered to optimize use of telemedicine in concussion care in the future.
The objectives were to examine clinical characteristics, length of recovery, and the prevalence of delayed physician-documented recovery, compare clinical outcomes among those with sport-related concussion (SRC) and non-sport-related concussion (nSRC), and identify risk factors for delayed recovery.
Included patients (8–18 years) were assessed ≤14 days post-injury at a multidisciplinary concussion program and diagnosed with an acute SRC or nSRC. Physician-documented clinical recovery was defined as returning to pre-injury symptom status, attending full-time school without symptoms, completing Return-to-Sport strategy as needed, and normal physical examination. Delayed physician-documented recovery was defined as >28 days post-injury.
Four hundred and fifteen patients were included (77.8% SRC). There was no difference in loss of consciousness (SRC: 9.9% vs nSRC: 13.0%, p = 0.39) or post-traumatic amnesia (SRC: 24.1% vs SRC: 31.5%, p = 0.15) at the time of injury or any differences in median Post-Concussion Symptom Scale scores (SRC: 20 vs nSRC: 23, p = 0.15) at initial assessment. Among those with complete clinical follow-up, the median physician-documented clinical recovery was 20 days (SRC: 19 vs nSRC: 23; p = 0.37). There was no difference in the proportion of patients who developed delayed physician-documented recovery (SRC: 27.7% vs nSRC: 36.1%; p = 0.19). Higher initial symptom score increased the risk of delayed physician-documented recovery (IRR: 1.39; 95% CI: 1.29, 1.49). Greater material deprivation and social deprivation were associated with an increased risk of delayed physician-documented recovery.
Most pediatric concussion patients who undergo early medical assessment and complete follow-up appear to make a complete clinical recovery within 4 weeks, regardless of mechanism.
This study reports on the changes in stress, anxiety, and depressive symptoms of subscribers after 3 months using Text4Hope, a supportive text messaging program designed to provide support during the pandemic.
Standardized self-report measures were used to evaluate perceived stress (measured with the Perceived Stress Scale-10 [PSS-10]), anxiety (measured with the General Anxiety Disorder Scale 7 [GAD-7]), and depressive symptoms (measured with the Patient Health Questionnaire [PHQ-9]), at baseline and 3rd month (n = 373).
After 3 months of using Text4Hope, subscribers’ self-reports revealed significant (p< 0.001) mean score reductions compared with baseline on: the GAD-7 by 22.7%, PHQ-9 by 10.3%, and PSS-10 scores by 5.7%. Reductions in inferred prevalence rates for moderate to high symptoms were also observed, with anxiety demonstrating the largest reduction (15.7%).
Observed Text4Hope-related reductions in psychological distress during COVID-19 indicate that Text4Hope is an effective, convenient, and accessible means of implementing a population-level psychological intervention.
Objectives: The objective of this study was to evaluate the feasibility and implementation of a standardized medically supervised concussion protocol established between a city-wide AAA hockey league and a multi-disciplinary concussion program. Methods: We conducted a retrospective review of injury surveillance, clinical and healthcare utilization data from all athletes evaluated and managed through the Winnipeg AAA Hockey concussion protocol during the 2016-2017 season. We also conducted post-season email surveys of head coaches and parents responsible for athletes who competed in the same season. Results: During the 2016-2017 season, 28 athletes were evaluated through the medically supervised concussion protocol, with two athletes undergoing evaluation for repeat injuries (a total of 30 suspected injuries and consultations). In all, 96.7% of the athletes managed through the concussion protocol were captured by the league-designated Concussion Protocol Coordinator and 100% of eligible athletes underwent complete medical follow-up and clearance to return to full hockey activities. Although 90% of responding head coaches and 91% of parents were aware of the concussion protocol, survey results suggest that some athletes who sustained suspected concussions were not managed through the protocol. Head coaches and parents also indicated that athlete education and communication between medical and sport stakeholders were other elements of the concussion protocol that could be improved. Conclusion: Successful implementation of a medically supervised concussion protocol for youth hockey requires clear communication between sport stakeholders and timely access to multi-disciplinary experts in traumatic brain and spine injuries. Standardized concussion protocols for youth sports may benefit from periodic evaluations by sport stakeholders and incorporation of national guideline best practices and resources.
The increased proportion of UK children diagnosed with autism spectrum disorder (ASD) has been attributed to improved identification, rather than true increase in incidence.
To explore whether the proportion of children with diagnosis of ASD and/or the proportion with associated behavioural traits had increased over a 10-year period.
A cross-cohort comparison using regression to compare prevalence of diagnosis and behavioural traits over time. Participants were children aged 7 years assessed in 1998/1999 (n=8139) and 2007/2008 (n=13831).
During 1998/1999, 1.09% (95% CI 0.86–1.37) of children were reported as having ASD diagnosis compared with 1.68% (95% CI 1.42–2.00) in 2007/2008: risk ratio (RR)=1.55 (95% CI 1.17–2.06), P=0.003. The proportion of children in the population with behavioural traits associated with ASD was also larger in the later cohort: RR=1.61 (95% CI 1.35–1.92), P<0.001. Increased odds of diagnosis at the later time point was partially accounted for by adjusting for the increased proportion of children with ASD-type traits.
Increased ASD diagnosis may partially reflect increase in rates of behaviour associated with ASD and/or greater parent/teacher recognition of associated behaviours.
In the context of an austere financial climate, local health care budget holders are increasingly expected to make and enact decisions to decommission (reduce or stop providing) services. However, little is currently known about the experiences of those seeking to decommission. This paper presents the first national study of decommissioning in the English National Health Service drawing on multiple methods, including: an interview-based review of the contemporary policy landscape of health care decommissioning; a national online survey of commissioners of health care services responsible for managing and enacting budget allocation decisions locally; and illustrative vignettes provided by those who have led decommissioning activities. Findings are presented and discussed in relation to four themes: national-local relationships; organisational capacity and resources for decommissioning; the extent and nature of decommissioning; and intended outcomes of decommissioning. Whilst it is unlikely that local commissioners will be able to ‘successfully’ implement decommissioning decisions unless aspects of engagement, local context and outcomes are addressed, it remains unclear what ‘success’ looks like in terms of a decommissioning process.
Purpose: To examine the safety and tolerability of clinical graded aerobic treadmill testing in recovering adolescent moderate and severe traumatic brain injury (TBI) patients referred to a multidisciplinary pediatric concussion program. Methods: We completed a retrospective case series of two moderate and five severe TBI patients (mean age, 17.3 years) who underwent initial Buffalo Concussion Treadmill Testing at a mean time of 71.6 days (range, 55-87) postinjury. Results: Six patients completed one graded aerobic treadmill test each and one patient underwent initial and repeat testing. There were no complications. Five initial treadmill tests were completely tolerated and allowed an accurate assessment of exercise tolerance. Two initial tests were terminated early by the treatment team because of neurological and cardiorespiratory limitations. As a result of testing, two patients were cleared for aerobic exercise as tolerated and four patients were treated with individually tailored submaximal aerobic exercise programs resulting in subjective improvement in residual symptoms and/or exercise tolerance. Repeat treadmill testing in one patient performed after 1 month of treatment with submaximal aerobic exercise prescription was suggestive of improved exercise tolerance. One patient was able to tolerate aerobic exercise following surgery for posterior glottic stenosis. Conclusions: Preliminary results suggest that graded aerobic treadmill testing is a safe, well tolerated, and clinically useful tool to assess exercise tolerance in appropriately selected adolescent patients with TBI. Future prospective studies are needed to evaluate the effect of tailored submaximal aerobic exercise prescription on exercise tolerance and patient outcomes in recovering adolescent moderate and severe TBI patients.
In this article, we conduct a review of introduced and enacted youth concussion legislation in Canada and present a conceptual framework and recommendations for future youth sport concussion laws. We conducted online searches of federal, provincial, and territorial legislatures to identify youth concussion bills that were introduced or successfully enacted into law. Internet searches were carried out from July 26 and 27, 2016. Online searches identified six youth concussion bills that were introduced in provincial legislatures, including two in Ontario and Nova Scotia and one each in British Columbia and Quebec. One of these bills (Ontario Bill 149, Rowan’s Law Advisory Committee Act, 2016) was enacted into provincial law; it is not actual concussion legislation, but rather a framework for possible enactment of legislation. Two bills have been introduced in federal parliament but neither bill has been enacted into law. At present, there is no provincial or federal concussion legislation that directly legislates concussion education, prevention, management, or policy in youth sports in Canada. The conceptual framework and recommendations presented here should be used to guide the design and implementation of future youth sport concussion laws in Canada.
Objectives: To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. Methods: We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team. Results: 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team. Conclusion: Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.
In 1969, Robert E. Gregg collected five species of ants (Hymenoptera: Formicidae) in three Subarctic localities near the town of Churchill, Manitoba, Canada, which he documented in a 1972 publication in The Canadian Entomologist. To determine whether there have been any additions to the local fauna – as might be predicted to occur in response to a warming climate and increased traffic to the Port of Churchill in the intervening 40 years – we re-collected ants from the same localities in 2012. We identified the ants we collected from Gregg’s sampling sites using both traditional morphological preparations and DNA barcoding. In addition, we examined specimens from Gregg’s initial collection that are accessioned at the Field Museum of Natural History (Chicago, Illinois, United States of America). Using this integrative approach we report seven species present at the same sites Gregg sampled 40 years earlier. We conclude that the apparent increase is likely not due to any arrivals from more southerly distributed ants, but to the increased resolution provided by DNA barcodes to resident species complexes with a complicated history. We provide a brief synopsis of these results and their taxonomic context.
Helmets have been shown to decrease the risk of brain injury; however, helmets must be worn correctly and fit well in order to be effective. The objective of this study is to determine whether kindergarten-aged children could learn and retain appropriate helmet wearing technique through an educational bicycle safety program.
Retrospective analysis of scores in questionnaires administered before and after an educational intervention to kindergarten students four to six years of age. The study took place in Prince Edward Island, Canada. A Wilcoxon Sign-Rank Test was used to determine if there was a significant overall increase in knowledge; McNemar chi-square tests were used to determine if there was an increase in knowledge for individual questions.
There was significant improvement in pre-test to immediate post-tests scores and pre-test to delay post-test scores when the results were stratified by age, sex, bike riding status, and helmet wearing status (p<0.001 for all comparisons). In particular, correct responses for the questions regarding appropriate helmet distances from the eyes increased from 38.9% in the pre-test to above 90% in the post-tests (p<0.001). Correct responses for the question pertaining to appropriate fitting of helmet straps increased from 71.7% pre-test to above 90% in the post-tests (p<0.001).
There was improved knowledge of appropriate helmet-wearing technique among kindergarten-aged children as a result of the educational intervention, and knowledge gains were retained for at least one month.
An examination of the evidence provided by medieval Irish chronicles for political organisation in the Gaelic world before about 1200 has shown that there was an absolute minimum of 600 population groups led by kings in the 750 years of record from the mid-fifth to the late twelfth century. The distribution of these across time and space is interestingly complicated, and detailed discussion of it will have to await publication of the evidence. Suffice it to say, for the moment, that, contrary to what has been stated by some historians over the last generation, the local kingship of local population groups is as visible in Ireland in the twelfth century as it is in the seventh. For what is now Scotland, of course, one could not make any such statement: from the later ninth century at the very latest (and arguably from the mid-eighth) Gaelic North Britain underwent a series of transformations, not the least aspect of which is the dramatic reduction in coverage of its affairs in the extant Irish chronicles – which date, as they stand, from the late eleventh to the mid-seventeenth century.
Early medieval Ireland is famed for its monasticism, and the century running from 540 to 640 is that of the major monastic founders, while also being marked by individual ascetic enthusiasm. For the most part, however, contemporary documentation comprises laconic notices in the annals, with just a scattering of more informative texts such as the Penitential of Finnian and The Alphabet of Piety. Against this background Columbanus stands out as the one figure for whom we have sufficient sources to enable us to discern his monastic vision and to see something of how he put it into practice. From his pen we have six letters, a series of thirteen sermons preached to his monks, a Regula Monachorum and Regula Coenobialis, a penitential and two poems, while within a generation of his death Jonas produced his Life of Columbanus and his Disciples, which, for all its spin-doctoring, was the work of a well-informed author.
There is, however, a problem about taking Columbanus as representative of the formative period of Irish monasticism. Although born in Leinster and trained in Comgall's monastery of Bangor, Columbanus had left Ireland around 591 to go as a peregrinus to the Continent. Thereafter he was based in Frankia, where his most important foundation was Luxeuil, until 610, when he was expelled. However, he escaped being sent back to Ireland and instead found his way to the Bregenz area and then over the Alps to northern Italy, where he founded a final monastery at Bobbio, and died in 615.
She's young. She's beautiful. She's Irish. So she's dead meat: at least in opera, where box office and body count go hand in hand.
This review of Healy Willan's opera Deirdre, a distant descendant of the early Irish tale Longes Mac nUislenn, is in a long interpretative tradition, even if indirectly. Of course, the twentieth-century opera is at many removes from the medieval narrative, separated by time and language, by substance and genre. Nevertheless, it reflects an assumption that this saga of broken bonds between men, of fraternal exile, of sex and death, pivots around its central female character, Deirdre. She is simultaneously catalyst and victim, helpless to save her lover Noísiu, and Noísiu's brothers, from deathly betrayal. This is no surprise: the Gaelic Irish themselves recalibrated the story. It was reinvented in the fourteenth or fifteenth century as Oidheadh Chloinne Uisnigh – still a tale of shattered male loyalties but now acted against a more emotive narrative of doomed love. This appealingly affective aesthetic underlies nearly all subsequent versions of what was increasingly seen as Deirdre's story, including those in English. Significantly, even Keating's retelling of the tale in Foras Feasa ar Éirinn, one largely based on Longes Mac nUislenn rather than Oidheadh Chloinne Uisnigh, did not displace the latter. Instead, subsequent redactions of the narrative attempted to harmonise the accounts, ultimately leaving the main substance of Oidheadh Chloinne Uisnigh intact. In the process Deirdre's identification as a suitably tragic Irish woman became predominant.
A cartulary of the Benedictine cathedral priory of Bath, which on the evidence of its script has been dated to around the mid-twelfth century, contains an indulgence granted by Marcus Cluanensis episcopus to the ‘truly penitent’ who with alms and prayers would visit the church at Bath on the feast of the Exaltation of the Cross (14 September). The text, which is printed in Appendix 1,2 is preceded in the cartulary by similar indulgences from Theobald, archbishop of Canterbury (1138–61), and Robert, bishop of Bath (1136–66), and followed by one from Nicholas, bishop of Llandaff (1148–83). As is usual in texts of indulgences, none contains a witness-list and this makes dating difficult, with the added consequence in the case of Marcus that his very identity remains obscure. The four indulgences evidently form a series, as in each the period of remission is twenty days and is linked to the celebration of the same feast. However, there are also differences in the wording of the four texts which may indicate that they were not necessarily issued on the same occasion. The indulgence of Robert, bishop of Bath, recorded that he had consecrated a cross in the cathedral church on the feast of the Exaltation of the Cross, and it was the acquisition of this new cross which appears to have occasioned the indulgences. It is conceivable that Robert may have been assisted at the consecration ceremony by one or more of the other bishops who also granted indulgences.
In 1988 Máire Herbert's magisterial Iona, Kells and Derry laid out a clear map of the progression of the authority within the Columban familia along the lines indicated in the title, with the comarbus or ‘successorship’ of the founder saint Columba passing to each of the named major monasteries within the federation from the sixth to the twelfth century. Importantly, she gave careful consideration to the nature of the ‘hand-over’ periods between the institutions, making it clear, for instance, that despite the construction of the monastery of Kells during the period 807–14, the idea of Iona's abandonment for Kells in the early ninth century owing to Viking raids was simply a modern myth. The comarbus of Colum Cille, by her reckoning, arrived in Kells de facto only with the accession of the comarba Pátraic, Mael Brigte mac Tornáin (891–927). There is no clear evidence that Mael Brigte was based at Kells itself, but his long rule (nearly forty years in Armagh, thirty-six as successor of Colum Cille), apparently spent in Ireland, and the certain fact that by the early eleventh century successors of Columba were based there, made it probable to Herbert that subsequent tenthcentury successors were in Kells de jure. Its loss of authority came only in the twelfth century, with the rise of Derry under the patronage of the Mac Lochlainn dynasty, 1150 being, in John Bannerman's words, Derry's ‘annus mirabilis’.