"You're not gay; You're a child of god": Microaggressions experienced by LGBTQ+ teens and their parents in the Church of Jesus Christ of Latter-day Saints.

Like other teens in conservative religious environments, LGBTQ+ teens raised in the Church of Jesus Christ of Latter-day Saints (CJCLDS) likely experience unique microaggressions. Furthermore, like other conservatively religious parents of LGBTQ+ teens, active Latter-day Saint (LDS) parents who openly support their LGBTQ+ teens likely both witness microaggressions toward their teens and may personally experience microaggressions. The present study sought to understand parents' and teens' experiences of microaggressions in conservative religious contexts by focusing specifically on the microaggressions experienced by (a) LGBTQ+ teens raised in the CJCLDS and (b) their active LDS parents. Thematic analysis of separate interviews with 19 dyads of LGBTQ+ teens and their active LDS parents (38 total interviews) revealed various ways in which they experienced verbal, nonverbal, and environmental microaggressions. We highlight parents' and teens' shared experiences of microaggressions that may be uniquely related to their religious contexts, such as assumptions that LGBTQ+ teens or their parents are not faithful and exclusionary Church policies. Additionally, we identified microaggressions that specifically targeted parents of LGBTQ+ teens, such as comments suggesting parents should limit their support for their teens. Finally, we found that parents had vicarious experiences with microaggressions through witnessing or learning about microaggressions that targeted their teens. Findings highlight the ways that the religious contexts in which microaggressions occur can influence the way that microaggressions are communicated to and experienced by LGBTQ+ teens - and their parents.

Impact of Hospitalizations due to Chronic Health Conditions on Early Child Development.

OBJECTIVE: To assess the impact of hospitalization for chronic health conditions on early child development and wellbeing at school start. METHODS: We conducted a longitudinal cohort study of children starting school using population-based record linkage of routinely collected admitted hospital data and standardized assessment of early childhood development (Australian Early Developmental Census: AEDC). Developmental vulnerability (DV) was defined as children scoring <10th centile in any one of five developmental domains. Children scoring <10th centile on two or more domains were considered developmentally high-risk (DHR). Children hospitalized with chronic health conditions were compared to children without hospitalizations prior to school start. RESULTS: Among 152,851 children with an AEDC record, 22,271 (14·6%) were hospitalized with a chronic condition. Children hospitalized with chronic health conditions were more likely to be DHR (adjusted odds ratio 1.25, 95% CI: 1.18-1.31) compared to children without hospitalizations. Children hospitalized more frequently (>7 times) or with longer duration (>2 weeks) had a 40% increased risk of being DHR (1.40, 95% CI: 1.05-1.88 and 1.40, 95% CI: 1.13-1.74, respectively). Children hospitalized with mental health/behavioral/developmental conditions had the highest risk of DHR (2.23, 95% CI: 1.72-2.90). Developmental vulnerability was increased for physical health (1.37, 95% CI: 1.30-1.45), language (1.28, 95% CI: 1.19-1.38), social competence (1.22, 95% CI: 1.16-1.29), communication (1.17, 95% CI: 1.10-1.23), and emotional maturity (1.16, 95% CI: 1.09-1.23). CONCLUSIONS: Frequent and longer duration hospitalizations for chronic health conditions can impact early childhood development. Research and interventions are required to support future development and well-being of children with chronic health conditions who are hospitalized.

School academic performance of children hospitalised with a chronic condition.

OBJECTIVE: To examine academic outcomes among children hospitalised with a chronic health condition. DESIGN: Population-level birth cohort. SETTING: New South Wales, Australia. PARTICIPANTS: 397 169 children born 2000-2006 followed up to 2014. INTERVENTION/EXPOSURE: Hospitalisations with a chronic condition. MAIN OUTCOME MEASURES: Academic underperformance was identified as 'below the national minimum standard' (BNMS) in five literacy/numeracy domains using the national assessment (National Assessment Program-Literacy and Numeracy) data. Multivariable logistic regression assessed the adjusted ORs (aORs) of children performing BNMS in each domain at each grade (grades 3, 5 and 7, respectively). RESULTS: Of children hospitalised with a chronic condition prior to National Assessment Program-Literacy and Numeracy (NAPLAN) (16%-18%), 9%-12% missed ≥1 test, with a maximum of 37% of those hospitalised ≥7 times, compared with 4%-5% of children not hospitalised. Excluding children who missed a NAPLAN test, more children hospitalised with a chronic condition performed BNMS across all domains and grades, compared with children not hospitalised (eg, for BNMS in reading at grade 3: n=2588, aOR 1.35 (95% CI 1.28 to 1.42); for BNMS in numeracy at grade 3: n=2619, aOR 1.51 (95% CI 1.43 to 1.59)). Increasing frequency and bed-days of hospitalisation were associated with 2-3 fold increased odds of performing BNMS across all domains and grades. Children hospitalised with mental health/behavioural conditions had the highest odds of performing BNMS across all domains at each grade. CONCLUSIONS: Children hospitalised with a chronic condition underperform academically across literacy/numeracy domains at each school grade. Health and educational supports are needed to improve these children's academic outcomes.

Socio-demographic and familial factors associated with hospital admissions and repeat admission for dental caries in early childhood: A population-based study.

OBJECTIVES: Dental caries remains a complex childhood condition often requiring preventable hospital admissions. There are limited population-based epidemiological studies that use large and linked data sets to quantify the clinical, socio-demographic and familial risk factors related to hospital admissions for dental caries. The aim of this study was to describe and quantify the rates, socio-demographic, clinical characteristics and familial factors including repeat admissions associated with young children admitted to hospital for dental caries. METHODS: This cohort study (n = 33,438) used longitudinally linked hospital admission data among all children aged

Making community voices heard in a research-health service alliance, the evolving role of the Community Advisory Group: a case study from the members' perspective.

BACKGROUND: The Melbourne Genomics Health Alliance (the Alliance) is a collaboration of leading hospitals, research and academic organisations, supported by its member organisations and the Victorian Government. The Alliance was set up by its members in 2013 to steer the translation of genomics, making it an integral part of health care in Victoria, Australia. The Community Advisory Group (CAG) was formed soon after, to give input and advice across the program. This was to ensure consideration of community values, perspectives and priorities, and knowledge translation for patient care. The CAG was charged with providing a strong community voice for the duration of the program. Appointed members were experienced consumer advocates with developed connections to the community. MAIN BODY: The Alliance progressed from an initial Demonstration Project (2013-2015) to a multifaceted program (2016-2020). The CAG worked strategically to help address complex issues, for example, communication, privacy, informed consent, ethics, patient experience, measurement and evaluation standards and policies, data storage and re-use of genomic data. Many aspects of translating genomics into routine care have been tackled, such as communicating with patients invited to have genomic testing, or their caregivers, and obtaining informed consent, clinical questions across 16 areas of health care, training and education of health and laboratory professionals, genomic data management and data-sharing. Evidence generated around clinical utility and cost-effectiveness led to government funding of testing for complex genetic conditions in children. CONCLUSION: The CAG activities, recorded in a CAG-inspired Activity register, span the full spectrum of information sharing and consultation to co-design and partnership. The CAG were involved at multiple levels of participation and in all tiers of activity including governance, development of policies and procedures, program planning and evaluation. Working relationships were built up and a level of trust instilled to advance the Alliance work program in ensuring an effective patient-care model of delivery of genomics. CAG input into project deliverables has been tangible. Less tangible contributions included presentations at external meetings and conferences, direct interactions at meetings with Alliance members, interactions with visitors and external experts, taking part in consultations with experts, state and federal government.

Melbourne Genomics Health Alliance was established in 2013 to steer genomics into health care in Victoria, Australia. The Community Advisory Group (CAG) was formed soon after to provide advice and insights from the patient perspective. The CAG has added value to the Alliance's complex research-to-clinical service program of work over eight years to date. Following an explanation of the program, the CAG members identified priority areas and mechanisms for their involvement. Areas that members were involved in included: communication, visual identity and website, patient portal and its evaluation, information management, consent processes, laboratory requirements, tools for patient experience and quality of life measures, predictive health issues study, storage and sharing of data, databases, CAG Communication Plan, the Patient Guide, role with Victorian Government Department of Health and Human Services, implementation plan, workshop to upskill patient advocates, financial and strategic planning. Members also presented on the role of the CAG at conferences and symposia. The balanced, trusting relationship that developed between the CAG, the Program Team and its governance structure was of great value to and an achievement for the Alliance. CAG input into project deliverables and impact was recorded in a CAG inspired Activity Register and has been very tangible. Their less tangible contribution to the project is also important. Contributions included presentations at external meetings, direct interactions at annual meetings with Alliance members, interactions with visitors and external experts, taking part in consultations with experts, state and federal government. These provided opportunities to influence mindsets.

Gun violence in Australia, 2002-2016: a cohort study.

OBJECTIVES: To describe the burden, geographic distribution, and outcomes of firearm-related violence in New South Wales during 2002-2016. DESIGN, SETTING, PARTICIPANTS: Population-based record linkag study of people injured by firearms in NSW, 1 January 2002 - 31 December 2016. MAIN OUTCOME MEASURES: Frequency, proportion, and rate of firearm-related injuries and deaths by intent category (assault, intentional self-harm, accidental, undetermined/other) and socio-demographic characteristics; medical service use (hospitalisations, ambulatory mental health care) before and after firearm-related injuries; associations between rates of firearm-related injury and those of licensed gun owners, by statistical area level 4. RESULTS: Firearm-related injuries were recorded for 2390 people; for 849 people, the injuries were caused by assault (36%), for 797 by intentional self-harm (33%), and for 506 by accidents (21%). Overall rates of firearm injuries were 4.1 per 100 000 males and 0.3 per 100 000 females; the overall rate was higher in outer regional/rural/remote areas (3.8 per 100 000) than in major cities (1.6 per 100 000) or inner regional areas (1.8 per 100 000). During 2002-2016, the overall firearm-related injury rate declined from 3.4 to 1.8 per 100 000 population, primarily because of declines in injuries caused by assault or accidental events. The rate of self-harm injuries with firearms were highest for people aged 60 years or more (41.5 per 100 000 population). Local rates of intentional self-harm injuries caused by firearms were strongly correlated with those of licensed gun owners (r = 0.94). CONCLUSIONS: Rates of self-harm with firearms are higher for older people, men, and residents in outer regional and rural/remote areas, while those for assault-related injuries are higher for younger people, men, and residents of major cities. Strategies for reducing injuries caused by self-harm and assault with firearms should focus on people at particular risk.

The accuracy of hospital discharge data in recording major congenital anomalies in Australia.

BACKGROUND: There has been increasing use of hospital discharge data to identify congenital anomalies, with limited information about the accuracy of these data. OBJECTIVES: To evaluate the accuracy of hospital discharge data in ascertaining major congenital anomalies in infants. METHODS: All liveborn infants with major congenital anomalies born between 2004 and 2009 in New South Wales, Australia were included. They were separated into two study groups: (a) infants identified from the Register of Congenital Conditions with a corresponding record in linked hospital discharge data; and (b) infants with a recorded congenital anomaly in hospital data, but without a register record. For the first group, we assessed agreement (concordant diagnoses) and the proportion of anomalies with discrepant diagnoses in each dataset. For the second group, we determined the number of anomalies recorded only in hospital data and applied specific conditions restricting to those recorded in the birth admission, excluding nonspecific diagnoses, or those with relevant surgical procedures to minimize potential false positives or over-reporting. RESULTS: The first study group included 9,346 infants with an average 84% agreement in the ascertainment of major anomalies between hospital and registry data, and >93% agreement for cardiac, abdominal wall, and gastrointestinal anomalies. Discrepant diagnoses occurred on average in 20% of cases from hospital data and 17% from registry data, and were slightly reduced with the use of diagnoses recorded only in tertiary pediatric hospitals. The second group included 25,893 infants where anomalies were only recorded in hospital data, most commonly skin and unspecified anomalies. Excluding unspecified cases, those only diagnosed at the birth admission and restricting to surgical procedures reduced over-reporting by up to 96%. CONCLUSIONS: Hospital discharge data provide an acceptable means to ascertain congenital anomalies, but with variable accuracy for different anomalies. Application of specific conditions and limited to surgical procedures improves the utility of using hospital discharge data to ascertain congenital anomalies.

Survival of infants born with esophageal atresia among 24 international birth defects surveillance programs.

BACKGROUND: Esophageal atresia (EA) affects around 2.3-2.6 per 10,000 births world-wide. Infants born with this condition require surgical correction soon after birth. Most survival studies of infants with EA are locally or regionally based. We aimed to describe survival across multiple world regions. METHODS: We included infants diagnosed with EA between 1980 and 2015 from 24 birth defects surveillance programs that are members of the International Clearinghouse for Birth Defects Surveillance and Research. We calculated survival as the proportion of liveborn infants alive at 1 month, 1- and 5-years, among all infants with EA, those with isolated EA, those with EA and additional anomalies or EA and a chromosomal anomaly or genetic syndrome. We also investigated trends in survival over the decades, 1980s-2010s. RESULTS: We included 6,466 liveborn infants with EA. Survival was 89.4% (95% CI 88.1-90.5) at 1-month, 84.5% (95% CI 83.0-85.9) at 1-year and 82.7% (95% CI 81.2-84.2) at 5-years. One-month survival for infants with isolated EA (97.1%) was higher than for infants with additional anomalies (89.7%) or infants with chromosomal or genetic syndrome diagnoses (57.3%) with little change at 1- and 5-years. Survival at 1 month improved from the 1980s to the 2010s, by 6.5% for infants with isolated EA and by 21.5% for infants with EA and additional anomalies. CONCLUSIONS: Almost all infants with isolated EA survived to 5 years. Mortality was higher for infants with EA and an additional anomaly, including chromosomal or genetic syndromes. Survival improved from the 1980s, particularly for those with additional anomalies.

Baby bottle and other disinfection devices used during travel to low electrical voltage (110V) regions: A practical experiment with implications for baby, lactating mothers and patient safety.

BACKGROUND: Baby bottle steam disinfectors are important for the disinfection of devices used with baby nutrition, lactating mothers and respiratory patients (e.g. nebulisers). There have been no reports to date describing the effect of incorrect voltage on thermal performance. It was the aim of this study to evaluate thermal output, at low (110 V) voltage compared to 220 V. Such data will determine if variation in voltage, results in temperature differences, constituting a microbiological safety risk. METHODS: Thermal performance was evaluated by positioning calibrated thermocouple probes in multiple locations operating the device at 110 V and 220-240 V. RESULTS: Within the upper tray at 220-240 V, a maximum temperature (TempMAX) of 100 °C was achieved, with the unit remaining at 90 °C for 420 s (A0 = 3000), whereas at 110 V, TempMAX = 71.1 °C, remaining at >70 °C for 630 s. Most importantly, when the lower tray of the device was examined at 110 V, TempMAX = 48.6 °C at one location, remaining >40 °C for 1140 s, whereas at 220-240 V, the lowest temperature achieved was 86.1 °C, with an A0 equivalence of A0 = 60. CONCLUSIONS: This study showed that input voltage of 110 V to the baby bottle steam disinfector had an adverse effect on thermal performance, by not achieving intended time/temperature combinations, compared to 220-240 V. Parents of babies and infants need to be made aware of the microbiological safety risks of operating such devices outside the manufacturers' specification. For the safety of babies, infants, mothers and patients, users must ensure that such devices are always operated safely within manufacturer's specifications and instructions for use.

The virtual CF clinic: Implications for sputum microbiology.

The COVID19 pandemic has shifted the paradigm of how outpatient clinics are delivered within CF care, resulting in a significant reduction of patient visits to CF centres. One consequence of this has been a reduction in the number of sputa/cough swabs that patients submit for routine analysis. This report examines why it is important to maintain optimal sputum microbiology and explores (i). the microbiological efficiency of postal submission of sputum specimens from the community and (ii) the regulatory conditions that must be met through postal submission of respiratory specimens. Virtual clinics have now been established within CF care and it is incumbent on each speciality within the CF MDT to explore ways to nurture and support their individual contribution to the success of the virtual clinic. Within microbiology, adopting innovative approaches to sputum collection in the community and transportation via postal services will allow for continued microbiological vigilance thereby supporting patient safety.

Nebuliser hygiene in cystic fibrosis: evidence-based recommendations.

Nebulised therapies are extensively used in the daily therapeutic management of cystic fibrosis both for mucociliary clearance and for the management of chronic infections. Extensive developments have been made in relation to nebulised drug delivery mechanisms and drug formulations, and guidelines have been prepared that have addressed the appropriate use of such therapies. However, due to these developments, a plethora of nebuliser devices and drug chambers exist, and frequently, the limited guidance provided in relation to nebuliser hygiene is to follow manufacturers' instructions. Such instructions are inconsistent and at times confusing, translating to an increase in the burden associated with nebuliser maintenance. An evidence-based universal guideline relating to nebuliser care and hygiene is urgently required that is applicable to both at-home use and inpatient use. This article reviews the scientific literature in order to propose an evidence-based approach to nebuliser hygiene to ensure optimum drug delivery, and infection prevention and control. EDUCATIONAL AIMS: To understand the reasons why nebuliser hygiene is important.To give an overview of the current nebuliser care instructions that have been described by manufacturers, societies and the scientific literature.To outline the current nebuliser hygiene practices used by persons with cystic fibrosis in the home and hospital settings.To highlight areas that need further evaluation to promote optimum nebuliser care.To establish an evidence-based guideline for nebuliser hygiene in relation to cystic fibrosis.

Prevalence, hospital admissions and costs of child chronic conditions: A population-based study.

AIM: To determine population-based prevalence, hospital use and costs for children admitted to hospital with chronic conditions. METHODS: We used hospital admissions data for children aged <16 years, 2002-2013 in New South Wales, Australia. RESULTS: Of all admissions, 35% (n = 692 514) included a diagnosis of a chronic condition. In 2013, prevalence was 25.1 per 1000 children. Children with greater socio-economic disadvantage or living in regional and remote areas had lower prevalence, but a higher proportion of emergency admissions. Prevalence rates were highest for respiratory and neurological conditions (9.4, 7.4 per 1000, respectively). Mental health conditions were most common in older children. Admissions involving chronic conditions had longer length of stay (3.0 vs. 1.6 days), consumed more bed-days (50% of total) and involved 43% of total hospital costs. CONCLUSION: Differences in prevalence and use of hospital services suggest inequities in access and need for more appropriate and equitable models of care.

Importance of Nebulizer Drying for Patients With Cystic Fibrosis.

BACKGROUND: Nebulizer therapy is an important treatment component for patients with cystic fibrosis (CF). Nebulizer manufacturers' guidelines advocate thorough nebulizer drying after washing. The aim of this study, therefore, was to examine the microbiology associated with nebulizer drying, particularly related to Pseudomonas control, and to examine microbiologically non-adherence to the recommended drying procedures. METHODS: Four aspects of nebulizer drying were examined in 3 common nebulizers, including examination of the drying profile, improvement to the drying profile of assembled nebulizers, survival of Pseudomonas aeruginosa in tap water and in tap water plus 0.5% (v/v) dishwashing detergent, and the effect of drying of P. aeruginosa in tap water and tap water plus residual sputum (1%v/v, 10%v/v). Microbiologic examination was performed by using P. aeruginosa (5 clinical CF strains plus 1 National Collection of Type Cultures Reference strain). RESULTS: There were differences in the time to complete dryness between disassembled and fully assembled nebulizers. Vigorous repeated shaking was unable to drive off all residual water on assembled nebulizers. P. aeruginosa counts did not decrease significantly in either tap water or in tap water plus detergent after 24 h storage at ambient temperature. In contrast, all Pseudomonas organisms were killed when nebulizers were dried for 24 h, even when contaminated with 1% and 10% sputum. Dishwashing detergent did not demonstrate any antibacterial activity. CONCLUSIONS: This study demonstrated that nebulizer drying, if applied properly, had the ability to reduce counts of P. aeruginosa to non-detectable levels. Equally, this study showed that, if the device was not dried thoroughly and moisture remained, then the device was able to support the survival of P. aeruginosa at high numbers, which constituted an infection risk to the patient with CF. This information may help educate and inform the patient with CF about the importance of proper nebulizer drying for Pseudomonas control to improve patient awareness and safety.

Nebuliser cleaning and disinfection practice in the home among patients with cystic fibrosis.

BACKGROUND: Nebulised delivery of different classes of drugs is of fundamental importance in therapeutic regimens relating to both the management of disease progression in cystic fibrosis disease and its associated complications. The aim of this study was to determine if current nebuliser hygiene practices in the home environment by paediatric and adult cystic fibrosis populations are appropriate to ensure appropriate infection control and prevention measures have been addressed. METHODS: An Audit Questionnaire Study was completed with adult cystic fibrosis patients (n=20) or with parents of cystic fibrosis children (n=24), through a healthcare professional interview on a one-to-one basis, during either a home visit or during patient/parent attendance at cystic fibrosis clinic. RESULTS: Hygienic practices relating to nebuliser care varied, with paediatric carers more likely to clean and disinfect their devices. This study suggests there is much variation and confusion with regard to how to clean and disinfect nebulisers, as well as who is responsible for delivering this advice. CONCLUSION: The adult cystic fibrosis community in particular needs to be educated on practicalities associated with nebuliser hygiene and the reasons why this is important. Furthermore, to date there is a lack of a universally recommended guideline suitable for all types of cystic fibrosis nebulisers that all relevant pharmaceutical manufacturers advocate.

Prescription opioid dispensing in Australian children and adolescents: a national population-based study.

BACKGROUND: There are few population-based studies of paediatric opioid use. We aimed to investigate the prevalence of opioid dispensing in Australian children and adolescents. METHODS: In this population-based study, we used data from a random sample of 15% of the children and adolescents who had received any medicines between Feb 1, 2013, and Dec 31, 2017, through the Australian Pharmaceutical Benefits Scheme (PBS). We identified children younger than 18 years who had been dispensed at least one PBS-listed opioid in the study period. We calculated the annual prevalence of children being dispensed one or more opioid presciptions, by age group and by opioid characteristics (such as strength and mode of action), and we assessed trends over time with negative binomial regression. We also identified new treatment episodes and quantified the number of opioid prescriptions dispensed in the ensuing year. FINDINGS: During the study period, 78 320 opioid prescriptions were dispensed to 50 730 Australian children, aged 0-17 years, in our sample. In 2017, 135·4 children per 10 000 were dispensed opioids, representing a slight decrease equal to a change of -2·2% (95% CI -3·5 to -0·8) per annum since 2013. The prevalence of opioid dispensing was greater at older ages: in 2017, 5·7 infants per 10 000 younger than 1 year were dispensed opioids, versus 404·8 adolescents per 10 000 aged 13-17 years, meaning that roughly one in 25 adolescents were dispensed opioids. Weak opioids (ie, codeine and tramadol) accounted for 60·7% of the opioids dispensed, and codeine was the most commonly dispensed opioid, accounting for 39 531 (50·5%) prescriptions dispensed. The prevalence of weak opioid dispensing significantly decreased in all age groups (other than infants younger than 1 year), particularly in those younger than 12 years, for whom weak opioids are not recommended. Dispensing of strong opioids, particularly oxycodone, increased in every age group. Of the 29 073 children who received a new course of treatment, 23 318 (80·2%) children were dispensed only one prescription of opioids in that year. Those dispensed two or more opioids were more likely to be adolescents (vs children younger than 13 years), female, and to have been dispensed several unique medicine types in the 3 previous months (vs those receiving one or fewer types). INTERPRETATION: In 2017, one in 74 Australian children, including one in 25 adolescents, were dispensed an opioid. Dispensing of weak opioids decreased between 2013 and 2017, but codeine is still commonly dispensed in younger children and education to reduce this practice is required. Dispensing of strong opioids increased in all age groups. Children and adolescents must receive appropriate pain management, but further evidence on the risks and benefits of opioid use in this young population is needed. FUNDING: Financial Markets Foundation for Children, National Health and Medical Research Council Centre of Research Excellence in Medicines and Ageing, Australian Government Department of Industry, Innovation and Science, Research Foundation of the Cerebral Palsy Alliance (Australia).

Five-year survival of infants with major congenital anomalies: a registry based study.

AIM: To determine survival of infants with major congenital anomalies (CA) and assess the effect of co-existing anomalies and gestational age. METHODS: All liveborn infants with major CA born in New South Wales (NSW), Australia, 2004-2009 were identified from the NSW Register of Congenital Conditions. Deaths were identified via record linkage to death registrations and five-year survival was estimated using Kaplan-Meier methods. RESULTS: There were 8521 liveborn infants with CA of whom 617 (7.2%) died within the first five years of life. Half of deaths occurred in the first week of life. The overall five-year survival rate was 92.8% (95%CI: 92.2-93.3) and 83.2% (95%CI: 79.0-87.4) for syndromes, 83.4% (95%CI: 80.9-85.9) for multiple, 85.1% (95%CI: 82.6-87.5) for chromosomal, 95.3% (95%CI: 94.8-95.8) for isolated and 96.2% (95%CI: 94.3-98.1) for non-Q chapter anomalies. Five-year survival for chromosomal, syndromes and sub-groups was higher for isolated compared with multiple anomalies ranging from 77.5% to 98.9% and 68.6% to 89.5%, respectively. Survival was lower for preterm (79.4%; 95%CI: 77.5-81.4) than for term infants (95.8%; 95%CI: 95.3-96.3). CONCLUSION: Nine in ten infants with major CA survive up to five years, although there is variability in survival across CA groups. Survival of infants with major congenital anomalies has improved in recent years.

Snow angels - the microbiology of freshly fallen snow: implications for immunocompromised patients.

The frequency of seasonal snowfall results in the transient covering of gardens/amenity sites/open public spaces, which encourages recreational interaction mainly with children. No data is available demonstrating the microbiological composition of such fallen snow and therefore a study was undertaken to examine the microbiology of snow from 37 sites, estimating (i) total viable count (TVC), (ii) identification of bacteria, and (iii) the presence of Pseudomonas aeruginosa. Mean TVC count of 8.3 colony-forming units (cfu)/ml snow melt water, 51.7 cfu/ml, 865 cfu/ml and 2,197 cfu/ml, was obtained for public amenity sites, domestic gardens, public open spaces and melting snow from public footpaths, respectively. No bacterial organisms (<10 cfu/ml) were detected in 5/14 (35.7%) open public spaces, 2/5 (40%) amenity sites and in 1/10 (10%) domestic gardens. Pseudomonas aeruginosa was not detected from any snow sample examined. Bacterial diversity consisted of 15 bacterial species (11 Gram-positive/four Gram-negative). The six Gram-positive genera identified from snow were Actinomyces, Bacillus, Brevibacillus, Micrococcus, Staphylococcus and Streptococcus. The four Gram-negative genera identified were Enterobacter, Pantoea, Pseudomonas and Xanthomonas. Bacillus licheniformis was the most commonly isolated organism from snow; it was isolated from every snow type. Snow may contain a diverse range of bacteria, many of which are capable of causing human infections.