Ethical Considerations in Ever-Expanding Utilization of ECLS: A Research Agenda.

Technological advancements and rapid expansion in the clinical use of extracorporeal life support (ECLS) across all age ranges in the last decade, including during the COVID-19 pandemic, has led to important ethical considerations. As a costly and resource intensive therapy, ECLS is used emergently under high stakes circumstances where there is often prognostic uncertainty and risk for serious complications. To develop a research agenda to further characterize and address these ethical dilemmas, a working group of specialists in ECLS, critical care, cardiothoracic surgery, palliative care, and bioethics convened at a single pediatric academic institution over the course of 18 months.

When and Why Do Neonatal and Pediatric Critical Care Physicians Consult Palliative Care?

Background: Parents of children admitted to neonatal and pediatric intensive care units (ICUs) are at increased risk of experiencing acute and post-traumatic stress disorder. The integration of palliative care may improve child and family outcomes, yet there remains a lack of information about indicators for specialty-level palliative care involvement in this setting.

Objective: To describe neonatal and pediatric critical care physician perspectives on indicators for when and why to involve palliative care consultants.

Physicians Perceptions of Shared Decision-Making in Neonatal and Pediatric Critical Care.

Background: Most children die in neonatal and pediatric intensive care units after decisions are made to withhold or withdraw life-sustaining treatments. These decisions can be challenging when there are different views about the child's best interest and when there is a lack of clarity about how best to also consider the interests of the family.

Objective: To understand how neonatal and pediatric critical care physicians balance and integrate the interests of the child and family in decisions about life-sustaining treatments.

The Family Communication Study: A randomized trial of prospective pediatric palliative care consultation, study methodology and perceptions of participation burden.

Background: To describe the study methods, baseline characteristics and burden of study procedures of an intervention designed to reduce family stress symptoms through early support from the palliative care team. Length of stay of ≥8days was the trigger for early palliative care involvement.

Methods: Cluster-randomized trial with children as the unit of randomization.

Examining palliative care team involvement in automatic consultations for children on extracorporeal life support in the pediatric intensive care unit.

Background: Extracorporeal life support (ECLS) is an advanced form of life-sustaining therapy that creates stressful dilemmas for families. In May 2009, Seattle Children's Hospital (SCH) implemented a policy to involve the Pediatric Advanced Care Team (PACT) in all ECLS cases through automatic referral.

Objective: Our aim was to describe PACT involvement in the context of automatic consultations for ECLS patients and their family members.

Genetic evidence for kin aggregation in the intertidal acorn barnacle (Semibalanus balanoides).

It is generally assumed that larvae of benthic species are thoroughly mixed in the plankton and distributed randomly at settlement. Yet, it has also been hypothesized that a combination of larval gregarious behaviour coupled with particular oceanographic conditions may prevent larvae from mixing completely, and result in nonrandom spatial distributions following settlement. Using microsatellite markers, the main objective of this study was to investigate the occurrence of statistical connections between relatedness and settlement in the intertidal acorn barnacle from the Gulf of St Lawrence, Canada.

Stable genetic polymorphism in heterogeneous environments: balance between asymmetrical dispersal and selection in the acorn barnacle.

Elucidating the processes responsible for maintaining polymorphism at ecologically relevant genes is intimately related to understanding the interplay between selection imposed by habitat heterogeneity and a species' capacity for dispersal in the face of environmental constraints. In this paper, we used a model-based approach to solve equilibria of balanced polymorphism, given values of fitness and larval dispersal among different habitats in the acorn barnacle Semibalanus balanoides from the Gulf of St Lawrence. Our results showed that allele frequencies observed at both MPI* and GPI* loci represented stable equilibria, given empirical estimates of fitness values, and that considerably more larvae dispersed from one region (north) to the other (south) than vice versa.

Regional variation in the spatial scale of selection at MPI* and GPI* in the acorn barnacle Semibalanus balanoides (Crustacea).

Elucidating the ecological processes by which adaptive genetic polymorphism is maintained in heterogeneous environments requires knowledge on the spatial scale at which alternate habitats affect genotype-specific fitness. The general objective of this study was to document patterns of temporal and spatial variation of genetic polymorphism in the acorn barnacle (Semibalanus balanoides) at MPI* and GPI* allozyme loci. A total of 7261 barnacles were sampled in the intertidal at various locations north and south of the Miramichi estuary, New Brunswick, Canada.

Differential patterns of spatial divergence in microsatellite and allozyme alleles: further evidence for locus-specific selection in the acorn barnacle, Semibalanus balanoides?

We compared patterns of genetic structure at potentially selected (two allozyme loci) and neutral molecular markers (six microsatellite loci) in the acorn barnacle, Semibalanus balanoides from the Gulf of St. Lawrence. Our results confirmed the presence of a geographical shift in alleles MPI and GPI near the Miramichi River.

Community development following removal of urchins, Strongylocentrotus droebachiensis, from the rocky subtidal zone of the St. Lawrence Estuary, Eastern Canada.

The role of sea urchins, Strongylocentrotus droebachiensis, in structuring the rocky subtidal community was examined at Anse aux Basques on the north shore of the St. Lawrence Estuary, Québec. In an experimental area, measuring 20x20 m and extending from 0 to 10 m in depth, we greatly reduced the intensity of urchin grazing by eliminating all urchins larger than 10 mm in test diameter.