Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death-Summary Report

OBJECTIVES: Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada. METHODS: We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners. RESULTS: We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation after circulatory determination of death, 7) cardiac and innovative pediatric donation after circulatory determination of death, and 8) implementation. For brevity, 48 Good Practice Statement and truncated justification are included in this summary report. The remaining recommendations, detailed methodology, full Grading of Recommendations Assessment, Development, and Evaluation tables, and expanded justifications are available in the full text report. CONCLUSIONS: This process showed that rigorous, transparent clinical practice guideline development is possible in the domain of pediatric deceased donation. Application of these recommendations will increase access to pediatric donation after circulatory determination of death across Canada and may serve as a model for future clinical practice guideline development in deceased donation

Preference for violent electronic games, self-concept, and gender differences in young children.

Electronic game-playing has been linked to adjustment problems in player subgroups. This study examined relationships among time commitment, gender, preference for violent games, and self-concept in 364 fourth and fifth graders. Main effects were identified for game preference and gender, with stronger preference for violent games being associated with lower self-perceived behavioral conduct. Implications for future research are discussed.

Female reproductive strategies as social organizers.

When male philopatry is linked to patriarchy, it is often assumed that female reproductive strategies are secondary to male reproductive strategies. By comparing the social structures of chimpanzees (Pan troglodytes) and bonobos (Pan paniscus) with those of other non-human primates, I argue that female reproductive strategies can be viewed as primary principles of social organization, including the establishment of patriarchies through differential investment in offspring. Emphasis on the contributions of female reproductive strategies may lead to a different picture of the evolution of primate social organization.

Monoclonal antibodies to digoxin: comparison of in vitro and in vivo immunization.

We compared the primary response in vitro with the secondary response in vivo of A/J inbred and CD-1 outbred mice to digoxin-HSA. The frequencies of hybrid formation and growth, and of the hybridomas that secreted antibody to digoxin were similar in both strains regardless of the immunization procedure. The patterns of cross-reactivity of the monoclonal antibodies to two compounds structurally related to digoxin (ouabain and digitoxin) were likewise similar for both strains and immunization procedures.

Effects of recycling on metallic direct-bond orthodontic brackets.

Recycling of metallic direct-bond orthodontic brackets is of current interest to the profession. The methods of three recycling companies (Esmadent, Ortho-Cycle, and Ortho-Bonding) as well as the author's flame method were examined for their effects on bracket base torque, slot width, and mechanical properties. There was no statistically significant difference among the four methods of recycling in terms of change in base torque angle and slot width. A slightly statistically significant number of brackets in the control group had a change in slot width of not more than 0.0015 inch (0.038 mm.), and the number of brackets with any change in slot width was less than 20 percent. The recycling methods of the author and Ortho-Bonding caused a loss of ferromagnetism in the recycled brackets, suggesting annealing of the metal. The effect of thermal treatment on brackets was evaluated by measuring hardness and theoretical tensile strength and by evaluating microstructure. The Ortho-Cycle method did not alter the mechanical properties of the bracket metal while the Esmadent method caused subtle changes. The author's process and the Ortho-Bonding method caused carbode separation. While it appears that the amount of dimensional changes in the brackets is of little clinical significance, the changes in the metallurgic microstructure suggest susceptibility to metallic intergranular corrosion.