The diagnosis of concussion in a pediatric emergency department.

Objectives: To compare the proportion of children diagnosed with a concussion by pediatric emergency physicians vs the proportion who met criteria for this injury as recommended by Zurich Fourth International Conference on Concussion consensus statement and to determine clinical variables associated with a physician diagnosis of a concussion.

Study Design: This was a prospective, cross-sectional study conducted at a tertiary care pediatric emergency department. We enrolled children ages 5 through 17 who presented with a head injury and collected data on demographics, mechanism of injury, head injury-related symptoms/signs, physician diagnosis, and discharge advice.

Therapeutic hypothermia after out-of-hospital cardiac arrest in children.

Background: Therapeutic hypothermia is recommended for comatose adults after witnessed out-of-hospital cardiac arrest, but data about this intervention in children are limited.

Methods: We conducted this trial of two targeted temperature interventions at 38 children's hospitals involving children who remained unconscious after out-of-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose patients who were older than 2 days and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.

Mild Angelman syndrome phenotype due to a mosaic methylation imprinting defect.

Angelman syndrome (AS) is a neurogenetic disorder causing severe to profound intellectual disability, absent or very limited speech and a high risk for seizures. AS is caused by a loss of function of the maternally-derived UBE3A allele due to one of several mechanisms including imprinting defects (ImpDs). We present a girl with AS due to a mosaic ImpD who has relatively high developmental function (VABS-II composite score of 76) and communication skills (as demonstrated in supplemental video links).

13C, 2h NMR studies of structural and dynamical modifications of glucose-exposed porcine aortic elastin.

Elastin, the principal component of the elastic fiber of the extracellular matrix, imparts to vertebrate tissues remarkable resilience and longevity. This work focuses on elucidating dynamical and structural modifications of porcine aortic elastin exposed to glucose by solid-state NMR spectroscopic and relaxation methodologies. Results from macroscopic stress-strain tests are also presented and indicate that glucose-treated elastin is mechanically stiffer than the same tissue without glucose treatment.

Learning curves in health professions education.

Learning curves, which graphically show the relationship between learning effort and achievement, are common in published education research but are not often used in day-to-day educational activities. The purpose of this article is to describe the generation and analysis of learning curves and their applicability to health professions education. The authors argue that the time is right for a closer look at using learning curves-given their desirable properties-to inform both self-directed instruction by individuals and education management by instructors.

NMR Studies of Thermo-responsive Behavior of an Amphiphilic Poly(asparagine) Derivative in Water.

The thermo-responsive behavior of a unique biocompatible polymer, poly(-substituted α/β-asparagine) derivative (PAD), has been studied with several NMR methods. The H and C solution NMR measurements of the PAD in DMSO- were used to investigate the isolated polymer and perform spectral assignments. By systematic addition of DO we have tracked structural changes due to aggregation and observed contraction of hydrophilic side chains.

Quantitative comparison of structure and dynamics of elastin following three isolation schemes by 13C solid state NMR and MALDI mass spectrometry.

Methods for isolating elastin from fat, collagen, and muscle, commonly used in the design of artificial elastin based biomaterials, rely on exposing tissue to harsh pH levels and temperatures that usually denature many proteins. At present, a quantitative measurement of the modifications to elastin following isolation from other extracellular matrix constituents has not been reported. Using magic angle spinning (13)C NMR spectroscopy and relaxation methodologies, we have measured the modification in structure and dynamics following three known purification protocols.

Revisiting NMR composite pulses for broadband (2)H excitation.

Quadrupolar echo NMR spectroscopy of static solids often requires RF excitation that covers spectral widths exceeding 100 kHz, which is difficult to obtain due to instrumental limitations. In this work we revisit four well-known composite pulses (COM-I, II, III and IV) for broadband excitation in deuterium quadrupolar echo spectroscopy. These composite pulses are combined with several phase cycling schemes that were previously shown to decrease finite pulse width distortions in deuterium solid-echo experiments performed with two single pulses.

Paediatrician office follow-up of common minor fractures.

Background: Evidence suggests that minor paediatric fractures can be followed by primary care paediatricians (PCPs).

Objectives: To determine PCP opinions, knowledge and perceived barriers to managing minor paediatric fractures in the office.

Methods: An online survey was sent between June and September 2013 to all paediatricians who subscribed to the American Academy of Pediatrics PROS-Net Listerv and to those who were registered with the Scott's Canadian Medical Directory as paediatricians who treated children in a primary care capacity.

The professional benefits for volunteer research assistants in a pediatric emergency department.

Background: Emergency departments (EDs) have utilized university student volunteers to facilitate enrollment of patients into prospective studies; however, the impact of this experience on participant careers is relatively unknown.

Objectives: We determined the proportion of successful postgraduate school/research job applications supported by our program reference letter. We also examined participant satisfaction.

The effectiveness of a student volunteer program for research in a pediatric Emergency Department.

Background: Emergency Department (ED) student-based research assistant programs have been shown to be effective in enrolling patients when the students receive university course credit or pay. However, the impact on research outcomes when university students act as volunteers in this role is relatively unknown.

Objectives: The main objective of this study was to determine how often potentially eligible children were accurately identified by volunteer research assistants for enrollment into prospective research in the ED.

Evidence into practice: emergency physician management of common pediatric fractures.

Objectives: Randomized trials have shown that removable immobilization devices are at least as good as circumferential casts for the management of common specific types of pediatric wrist and ankle fractures. Our main objective was to determine the proportion of emergency physicians who prescribe removable devices for distal radius buckle fractures and/or nondisplaced distal fibular Salter-Harris I fractures. We also examined follow-up referral patterns for these injuries.

Evidence into practice: pediatric orthopaedic surgeon use of removable splints for common pediatric fractures.

Objectives: Removable splints when compared with circumferential casts in randomized trials have been shown to be a safe and cost-effective method of managing many common minor distal radius and fibular fractures. This study estimated the extent to which this evidence is being implemented in clinical practice, and determined the perceived barriers to the adoption of this evidence.

Methods: A cross-sectional survey of practicing orthopaedic surgeon members of the Pediatric Orthopedic Surgeons of North America (POSNA) was conducted, using a 22-item online questionnaire, and distributed using a modified Dillman technique.

Do obese children experience more severe fractures than nonobese children? A cross-sectional study from a paediatric emergency department.

Objectives: To determine whether there is an association between childhood obesity and severe extremity fractures. Associations between obesity and complications related to the fracture and/or fracture management were also examined.

Methods: The present study was a retrospective, cross-sectional study conducted at a tertiary care children's emergency department.

Bone fractures in children: is there an association with obesity?

Objective: To determine the relationship between body mass index (BMI) and odds of extremity bone fractures in children.

Study Design: This was a prospective cross-sectional study conducted at 2 tertiary care pediatric emergency departments. A convenience sample of children 2-17 years of age with a nonpenetrating extremity injury was enrolled.

Radiation exposure from imaging tests in pediatric emergency medicine: a survey of physician knowledge and risk disclosure practices.

Background: Disclosing potential future malignancy risks from diagnostic tests that expose children to ionizing radiation in the emergency department may be challenging.

Objectives: We determined the proportion of pediatric emergency medicine (PEM) physicians who are aware of current malignancy risk estimates associated with head computed tomography (CT). We also examined reported risk and strategy disclosure practice patterns.

Inverse temperature transition of elastin like motifs in major ampullate dragline silk: MD simulations of short peptides and NMR studies of water dynamics.

Using deuterium 2D T1 − T2 Inverse Laplace Transform (ILT) NMR, we have investigated the distribution, population, and dynamics of waters of hydration in major ampullate N. clavipes and A. aurantia silk as a function of temperature.

Bleomycin cardiotoxicity during chemotherapy for an ovarian germ cell tumor.

Introduction: Platinum-based chemotherapeutic regimens, including BEP (bleomycin, etoposide, cisplatin) represent the standard of care, first line therapy in non-epithelial ovarian tumours. Cardiovascular toxicity is a rare adverse effect of bleomycin.

Case Report: A 41-year-old woman with ovarian granulosa tumor, treated with first line BEP chemotherapy experienced chest discomfort rapidly progressing to severe precordial pain during bleomycin infusion.

The role of mode of delivery on elastic fiber architecture and vaginal vault elasticity: a rodent model study.

We report on an experimental study of the role of mode of delivery and pregnancy on the architecture of vaginal elastic fibers and vaginal vault elasticity in female Sprague-Dawley rats. In primiparous rats submitted to spontaneous or Cesarean delivery and virgin rats submitted to simulated delivery, the tortuosity of elastic fibers (defined as the ratio of length to end-to-end distance) was observed to decrease when measured from two days to two weeks postpartum. In addition, the measured tortuosity of elastic fibers in multiparous rats was greater than that of virgin rats.

Effect of the Low Risk Ankle Rule on the frequency of radiography in children with ankle injuries.

Background: The Low Risk Ankle Rule is a validated clinical decision rule that has the potential to safely reduce radiography in children with acute ankle injuries. We performed a phased implementation of the Low Risk Ankle Rule and evaluated its effectiveness in reducing the frequency of radiography in children with ankle injuries.

Methods: Six Canadian emergency departments participated in the study from Jan.

A hinting strategy for online learning of radiograph interpretation by medical students.

Context: We examined whether a 'hint' manoeuvre increases the time novice medical learners spend on reviewing a radiograph, thereby potentially increasing their interpretation accuracy.

Methods: Senior year medical students were recruited into a randomised control, three-arm, multicentre trial. Students reviewed an online 50-case learning set that varied in degree of 'hint' intervention.

Predicting and preventing postconcussive problems in paediatrics (5P) study: protocol for a prospective multicentre clinical prediction rule derivation study in children with concussion.

Introduction: Persistent postconcussive symptoms (PCSs) is the persistence of somatic, cognitive, physical, psychological and/or behavioural changes lasting more than 1 month following concussion. Persistent concussion impacts the quality of life through impaired cognition, memory and attention affecting school performance, mood and social engagement. No large epidemiological studies have determined the true prevalence of persistent concussion symptoms.

Parental knowledge of potential cancer risks from exposure to computed tomography.

Objective: Computed tomography (CT) imaging of children is increasing in emergent settings without an understanding of parental knowledge of potential cancer risks. In children with head injuries, our primary objective was to determine the proportion of parents who were aware of the potential of CT to increase a child's lifetime risk of malignancy. We also examined willingness to proceed with recommended CT after risk disclosure and preference to be informed of potential risks.

Multispin correlations and pseudo-thermalization of the transient density matrix in solid-state NMR: free induction decay and magic echo.

Quantum unitary evolution typically leads to thermalization of generic interacting many-body systems. There are very few known general methods for reversing this process, and we focus on the magic echo, a radio-frequency pulse sequence known to approximately "rewind" the time evolution of dipolar coupled homonuclear spin systems in a large magnetic field. By combining analytic, numerical, and experimental results we systematically investigate factors leading to the degradation of magic echoes, as observed in reduced revival of mean transverse magnetization.

Effects of experimental imperfections on a spin counting experiment.

Spin counting NMR is an experimental technique that allows a determination of the size and time evolution of networks of dipolar coupled nuclear spins. This work reports on an average Hamiltonian treatment of two spin counting sequences and compares the efficiency of the two cycles in the presence of flip errors, RF inhomogeneity, phase transients, phase errors, and offset interactions commonly present in NMR experiments. Simulations on small quantum systems performed using the two cycles reveal the effects of pulse imperfections on the resulting multiple quantum spectra, in qualitative agreement with the average Hamiltonian calculations.