Aerosol Box Use in Reducing Health Care Worker Contamination During Airway Procedures (AIRWAY) Study: Secondary Workload and Provider Outcomes in a Simulation-Based Trial.

OBJECTIVES: An aerosol box aims to reduce the risk of healthcare provider (HCP) exposure to infections during aerosol generating medical procedures (AGMPs), but little is known about its impact on workload of team members. We conducted a secondary analysis of data from a prospective, multicenter, randomized controlled trial evaluating the impact of aerosol box use on patterns of HCP contamination during AGMPs. The objectives of this study are to: 1) evaluate the effect of aerosol box use on HCP workload, 2) identify factors associated with HCP workload when using an aerosol box, and 3) describe the challenges perceived by HCPs of aerosol box use. DESIGN: Simulation-based randomized trial, conducted from May to December 2021. SETTING: Four pediatric simulation centers. SUBJECTS: Teams of two HCPs were randomly assigned to control (no aerosol box) or intervention groups (aerosol box). INTERVENTIONS: Each team performed three scenarios requiring different pediatric airway management (bag-valve-mask [BVM] ventilation, laryngeal mask airway [LMA] insertion, and endotracheal intubation [ETI] with video laryngoscopy) on a simulated COVID-19 patient. National Aeronautics and Space Administration-Task Load Index (NASA-TLX) is a standard tool that measures subjective workload with six subscales. MEASUREMENTS AND MAIN RESULTS: A total of 64 teams (128 participants) were recruited. The use of aerosol box was associated with significantly higher frustration during LMA insertion (28.71 vs. 17.42; mean difference, 11.29; 95% CI, 0.92-21.66; p = 0.033). For ETI, there was a significant increase in most subscales in the intervention group, but there was no significant difference for BMV. Average NASA-TLX scores were all in the "low" range for both groups (range: control BVM 23.06, sd 13.91 to intervention ETI 38.15; sd 20.45). The effect of provider role on workloads was statistically significant only for physical demand (p = 0.001). As the complexity of procedure increased (BVM → LMA → ETI), the workload increased in all six subscales (p < 0.05). CONCLUSIONS: The use of aerosol box increased workload during ETI but not with BVM and LMA insertion. Overall workload scores remained in the "low" range, and there was no significant difference between airway provider and assistant.

Factors Influencing Parental Decision-Making Regarding Analgesia for Children with Musculoskeletal Injury-Related Pain: A Qualitative Study.

OBJECTIVES: To explore and understand parental decision-making relating to acute pain management for their children presenting to the emergency department. STUDY DESIGN: This study employed one-on-one semistructured interviews. Parents of children with acute musculoskeletal injuries were recruited from 3 Canadian pediatric emergency departments. Interviews were conducted via telephone from June 2019 to March 2021. Verbatim transcription and thematic analyses occurred concurrently with data collection, supporting data saturation and theory development considerations. RESULTS: Twenty-seven interviews were completed. Five major themes regarding pain care emerged: (1) my child's comfort is a priority, (2) every situation is unique, (3) opioids only if necessary, (4) considerations when choosing opioids, and (5) pain research is important. Overall, parents were highly comfortable with their assessment of their child's pain. Participants' willingness to use opioid analgesia for their children was primarily dependent on perceptions of injury and pain severity. Opioid-averse and opioid-accepting families had similar considerations when making analgesic decisions but weighed risks and benefits differently. CONCLUSIONS: Parents assess and manage their children's pain globally and multimodally, with comfort being prioritized. For most parents, the desire to relieve their children's pain outweighed concerns of substance use disorder, misuse, and adverse events when making decisions about opioid analgesia for short-term use. These results can inform evidence-based family-centered approaches to co-decision-making of analgesic plans for children with acute pain.

Setting Targets for Wetland Restoration to Mitigate Climate Change Effects on Watershed Hydrology.

How much wetland we should protect or restore is not a simple question, such that conservation targets are often set according to political agendas, then standardized globally. However, given their key regulating hydrological functions, wetlands represent nature-based solutions to the anticipated, exacerbating effect of climate change on drought and flood events, which will vary at the regional scale. Here, we propose a science-based approach to establishing regional wetland restoration targets centered on their hydrological functions, using a case study on several sub-watersheds of a northern temperate basin in south-eastern Canada. We posit that restoration targets should minimally mitigate the negative effects of climate change on watershed hydrology, namely peak and low flows. We used a semi-distributed hydrological model, HYDROTEL, to perform a hydroclimatic assessment, including 47 climate projections over the 1979-2099 period, to test the effect of wetland restoration scenarios on peak and low flows. The results showed that hydrological responses to climate change varied among sub-watersheds (even at the scale of a relatively small region), and that, to mitigate these changes, increases in wetland coverage should be between 20% and up to 150%. At low restoration levels, increasing wetland coverage was more effective in attenuating floods than alleviating droughts. This study indicates that a no-net-loss policy is insufficient to maintain current hydrological cycles in the face of climate change; rather, a 'net gain' in wetland cover is needed.

Ex situ germination as a method for seed viability assessment in a peatland orchid, Platanthera blephariglottis.

UNLABELLED: • PREMISE OF THE STUDY: Assessing seed quality in orchids has been hindered by stringent germination requirements. Seed quality has traditionally been assessed in orchids using in vitro or in situ germination protocols or viability staining. However, these methods are not always well suited for rapid assessment of viability in the context of ecological studies.• METHODS: The potential of an ex situ protocol for seed viability assessment of orchids in ecological studies was investigated by sowing seeds of Platanthera blephariglottis on Sphagnum moss collected in the orchid's natural habitat. Ex situ germination results were compared with those obtained by viability staining using triphenyltetrazolium chloride (TTC), and the effect of seed testa color on staining and germination results was investigated.• KEY RESULTS: The ex situ protocol yielded high germination rates, with 66% of the seeds germinating after 9 wk. Depending on the seed testa color class, ex situ germination rates were about 1.4 to 2.5 times higher than viability rates determined using TTC, indicating that the TTC technique underestimated viability compared with the method using ex situ germination. The TTC estimates of viability rates were higher for seeds with dark-colored testae than for pale ones, whereas seed testa color had no effect on germination.• CONCLUSIONS: Our study showed promising results for the use of ex situ germination as an alternative to previously developed protocols for seed viability assessment of orchids in ecological studies. Staining using TTC might not be well suited for this purpose, since it introduced a bias with respect to seed testa color.

Above and belowground carbon stocks among organic soil wetland types, accounting for peat bathymetry.

Wetlands are widely recognized for their carbon (C) sequestration capacity and importance at mitigating climate change. Yet, to best inform regional conservation planning, the variability of C stocks among wetland types and between above and belowground compartments requires further investigation. Additionally, the bathymetry of peat basins has often been ignored, with soil C stock calculations mostly relying on the thickest peat section, potentially leading to overestimates. Here, we sampled vegetation and soil of 57 wetlands of southeastern Canada to characterize the variability of above and belowground organic C stocks among four wetland types: open bogs, open fens, swamps, and forested peatlands. We also compared carbon stock estimation approaches considering peat bathymetry or not. Results showed that peat thickness, and thus soil organic C (SOC), varied substantially within sites due to peat basin shapes. Omitting bathymetry led to site-scale SOC overestimates of about 20-38 % on average, depending on the approach used, with wide variability among sites (overestimates up to 200 %). Belowground C stocks varied among wetland types with mean values of 132, 101, 19, and 44 kg C m-2 for bogs, fens, swamps, and forested peatlands, respectively. Aboveground C was nearly zero in open bogs and fens but reached ∼30 % of total C stock in swamps and âˆ¼ 15 % in forested peatlands. C stocks in tree roots and shrubs were negligible. Despite the lower C density (per m2) of swamps and forested peatlands, these ecosystems represented the dominant C stocks at the regional scale due to their abundance in the landscape. Overall, the four wetland types stored an estimated 2-7 times more C than forest per unit area. Evaluating differences in C stocks according to wetland type, while integrating peat bathymetry in calculations, can significantly improve regional wetland conservation planning.

Aerosol Box Use in Reducing Health Care Worker Contamination During Airway Procedures (AIRWAY Study): A Simulation-Based Randomized Clinical Trial.

Importance: The aerosol box has been used during the management of patients with COVID-19 to reduce health care practitioner (HCP) exposure during aerosol-generating medical procedures (AGMPs). Little is known about the effect of aerosol box use on HCP contamination and AGMP procedure time. Objective: To investigate whether use of an aerosol box during AGMPs reduces HCP contamination or influences the time to successful completion and first-pass success rate for endotracheal intubation (ETI) and laryngeal mask airway (LMA) insertion. Design, Setting, and Participants: This multicenter, simulation-based, randomized clinical trial was conducted from May to December 2021 at tertiary care pediatric hospitals. Participant teams performed 3 simulated patient scenarios: bag-valve-mask ventilation, ETI, and LMA insertion. During the scenarios, aerosols were generated using Glo Germ. Teams of 2 HCPs were randomly assigned to control (no aerosol box) or intervention groups (aerosol box). Statistical analysis was performed from July 2022 to February 2023. Interventions: The aerosol box (or SplashGuard CG) is a transparent, plastic barrier covering the patient's head and shoulders with access ports allowing HCPs to manage the airway. Main Outcomes and Measures: The primary outcome was surface area of contamination (AOC) on participants. Secondary outcomes were time to successful completion and first-pass success rates for ETI and LMA insertion. Results: A total of 64 teams (128 participants) were enrolled, with data from 61 teams (122 participants) analyzed. Among the 122 participants analyzed, 79 (64.8%) were female and 85 (69.7%) were physicians. Use of an aerosol box was associated with a 77.5% overall decreased AOC to the torso (95% CI, -86.3% to -62.9%; P < .001) and a 60.7% overall decreased AOC to the facial area (95% CI, -75.2% to -37.8%; P < .001) in airway HCPs. There was no statistically significant difference in surface contamination after doffing personal protective equipment between groups. Time to completing ETI was longer in the aerosol box group compared with the control group (mean difference: 10.2 seconds; 95% CI, 0.2 to 20.2 seconds; P = .04), but there was no difference between groups for LMA insertion (mean difference: 2.4 seconds; 95% CI, -8.7 to 13.5 seconds; P = .67). Conclusions and Relevance: In this randomized clinical trial of aerosol box use in AGMPs, use of an aerosol box reduced contamination deposition on HCPs' torso and face predoffing; the use of an aerosol box delayed time to successful intubation. These results suggest that the incremental benefits of reduced surface contamination from aerosol box use should be weighed against delayed time to complete intubation, which may negatively affect patient outcome. Trial Registration: ClinicalTrials.gov Identifier: NCT04880668.

Mutations in SYNGAP1 in autosomal nonsyndromic mental retardation.

Although autosomal forms of nonsyndromic mental retardation account for the majority of cases of mental retardation, the genes that are involved remain largely unknown. We sequenced the autosomal gene SYNGAP1, which encodes a ras GTPase-activating protein that is critical for cognition and synapse function, in 94 patients with nonsyndromic mental retardation. We identified de novo truncating mutations (K138X, R579X, and L813RfsX22) in three of these patients. In contrast, we observed no de novo or truncating mutations in SYNGAP1 in samples from 142 subjects with autism spectrum disorders, 143 subjects with schizophrenia, and 190 control subjects. These results indicate that SYNGAP1 disruption is a cause of autosomal dominant nonsyndromic mental retardation.

De novo STXBP1 mutations in mental retardation and nonsyndromic epilepsy.

We sequenced genes coding for components of the SNARE complex (STX1A, VAMP2, SNAP25) and their regulatory proteins (STXBP1/Munc18-1, SYT1), which are essential for neurotransmission, in 95 patients with idiopathic mental retardation. We identified de novo mutations in STXBP1 (nonsense, p.R388X; splicing, c.169+1G>A) in two patients with severe mental retardation and nonsyndromic epilepsy. Reverse transcriptase polymerase chain reaction and sequencing showed that the splicing mutation creates a stop codon downstream of exon-3. No de novo or deleterious mutations in STXBP1 were found in 190 control subjects, or in 142 autistic patients. These results suggest that STXBP1 disruption is associated with autosomal dominant mental retardation and nonsyndromic epilepsy.

Vegetation changes in temperate ombrotrophic peatlands over a 35 year period.

Global changes in climate and land use are occurring at an unprecedented rate, often triggering drastic shifts in plant communities. This study aims to reconstruct the changes that occurred over 35 years in the plant communities of temperate bogs subjected to indirect human-induced disturbances. In 2015-17, we resurveyed the vascular flora of 76 plots located in 16 bogs of southern Québec (Canada) first sampled in 1982. We evaluated changes in species richness, frequency of occurrence and abundance, while considering species shade-tolerance and preferential habitat. We calculated beta diversity as between-site similarities in composition, and evaluated differences between the two surveys using tests for homogeneity in multivariate dispersion. We found a significant increase in species richness and beta diversity over the last 35 years associated with major species turnovers, indicating a biotic differentiation of the Sphagnum-bog plant communities. These changes were mostly associated with an increase in the abundance and frequency of shade-tolerant and facultative species, suggesting a global phenomenon of woody encroachment. Because the observed changes occurred in a few decades on sites free of in situ human disturbances, we suggest that they were likely induced by the synergic effect of the agricultural drainage occurring in the surrounding mineral soils, climate warming, and nitrogen atmospheric depositions. We also believe that further changes are to be expected, as the triggering factors persist. Finally, our results highlight the need for increased bog conservation or restauration efforts. Indeed, a rise in beta diversity due to the introduction of nearby terrestrial species could induce biotic homogenization of the bog flora with that of surrounding habitats and ultimately impoverish the regional species pool.

A pilot study comparing corifollitropin alfa associated with hp-HMG versus high dose rFSH antagonist protocols for ovarian stimulation in poor responders.

Does corifollitropin alfa associated with hp-HMG protocol from the beginning of ovarian stimulation perform better than high dose rFSH alone for ovarian stimulation with GnRH antagonist in poor responders? This retrospective, monocentric, case-control pilot study was conducted in 65 poor responders (Bologna criteria) undergoing 2 consecutive IVF cycles. All patients underwent a first ovarian stimulation cycle with high dose rFSH (≥300 IU/day) alone in antagonist protocol, unfortunately leading to poor ovarian response and no pregnancy. The following cycle was performed with 150 µg of corifollitropin alfa associated with daily injections of hp-HMG from the beginning of the cycle. The primary outcome was the number of mature oocytes retrieved. The secondary outcomes were ovarian stimulation cancellation and embryo transfer rate per initiated cycle. The number of mature oocytes was not significantly different between the 2 groups. However, cycle cancellation rate was significantly lower and the proportion of cycles with embryo transfer was significantly higher with corifollitropin + hp-HMG protocol, leading to an encouraging clinical pregnancy rate of 24.1% per oocyte retrieval. This pilot study based on corifollitropin alfa associated with hp-HMG from the onset of stimulation appears to be promising for ovarian stimulation in poor responders.

Functional responses and resilience of boreal forest ecosystem after reduction of deer density.

The functional trait-based approach is increasingly used to predict responses of ecological communities to disturbances, but most studies target a single taxonomic group. Here, we assessed the resilience of a forest ecosystem to an overabundant herbivore population by assessing changes in 19 functional traits for plant, 13 traits for ground beetle and 16 traits for songbird communities after six years of controlled browsing on Anticosti Island (Quebec, Canada). Our results indicated that plants were more responsive to 6 years of reduced browsing pressure than ground beetles and songbirds. However, co-inertia analysis revealed that ground beetle communities responded in a similar way than plant communities with stronger relationships between plant and ground beetle traits at reduced deer density, a pattern not detected between plant and songbird. High deer density favored plants species that reproduce vegetatively and with abiotic pollination and seed dispersal, traits implying little interaction with animal. On the other hand, traits found at reduced deer density mostly involved trophic interaction. For example, plants in this treatment had fleshy fruits and large seeds dispersed by birds or other animals whereas ground beetle species were carnivorous. Overall, our results suggest that plant communities recovered some functional components to overabundant herbivore populations, since most traits associated with undisturbed forests were reestablished after six years of deer reduction. The re-establishment of functional plant communities with traits involving trophic interaction induces changes in the ground-beetle trait community, but forest structure remains likely insufficiently heterogeneous to shift the songbird trait community within six years.

Environmental factors explaining the vegetation patterns in a temperate peatland.

Although ombrotrophic temperate peatlands are important ecosystems for maintaining biodiversity in eastern North America, the environmental factors influencing their flora are only partly understood. The relationships between plant species distribution and environmental factors were thus studied within the oldest temperate peatland of Québec. Plant assemblages were identified by cluster analysis while CCA was used to related vegetation gradients to environmental factors. Five assemblages were identified; three typical of open bog and two characterized by more minerotrophic vegetation. Thicker peat deposit was encounter underlying the bog assemblages while higher water table level and percentage of free surface water distinguished the minerotrophic assemblages. Overall, the floristic patterns observed were spatially structured along the margins and the expanse. The most important environmental factors explaining this spatial gradient were the percentage of free surface water and the highest water-table level.