Quantum gas mixtures and dual-species atom interferometry in space.

The capability to reach ultracold atomic temperatures in compact instruments has recently been extended into space1,2. Ultracold temperatures amplify quantum effects, whereas free fall allows further cooling and longer interactions time with gravity-the final force without a quantum description. On Earth, these devices have produced macroscopic quantum phenomena such as Bose-Einstein condensates (BECs), superfluidity, and strongly interacting quantum gases3. Terrestrial quantum sensors interfering the superposition of two ultracold atomic isotopes have tested the universality of free fall (UFF), a core tenet of Einstein's classical gravitational theory, at the 10-12 level4. In space, cooling the elements needed to explore the rich physics of strong interactions or perform quantum tests of the UFF has remained elusive. Here, using upgraded hardware of the multiuser Cold Atom Lab (CAL) instrument aboard the International Space Station (ISS), we report, to our knowledge, the first simultaneous production of a dual-species BEC in space (formed from 87Rb and 41K), observation of interspecies interactions, as well as the production of 39K ultracold gases. Operating a single laser at a 'magic wavelength' at which Rabi rates of simultaneously applied Bragg pulses are equal, we have further achieved the first spaceborne demonstration of simultaneous atom interferometry with two atomic species (87Rb and 41K). These results are an important step towards quantum tests of UFF in space and will allow scientists to investigate aspects of few-body physics, quantum chemistry and fundamental physics in new regimes without the perturbing asymmetry of gravity.

Using Aromatherapy to Improve Nighttime Comfort in Hospitalized Patients With Cancer: A Pilot Study.

BACKGROUND: Sleep disturbances have been shown to have negative health effects leading to inferior well-being, increased fatigue, and impaired performance. For hospitalized patients receiving oncology care, improving nighttime comfort may positively affect well-being and health outcomes, leading to decreased length of stay. Aromatherapy can improve sleep quantity and quality. OBJECTIVES: This pilot study aimed to determine whether aromatherapy improves nighttime comfort, in particular well-being and sleep quality, for hospitalized patients with cancer. METHODS: This quasi-experimental pilot study with a single-arm pre-/post-test design evaluated the effects of nighttime aromatherapy for hospitalized patients with cancer. Measures were the World Health Organization-Five Well-Being Index and Pittsburgh Sleep Quality Index. FINDINGS: A total of 34 hospitalized patients with cancer participated. After aromatherapy, mean well-being scores improved significantly. Mean sleep quality scores also improved but did not reach significance. Of participants who submitted open-ended responses, 20 of 22 described a positive experience with aromatherapy, including better sleep, relaxation, soothing effects, and nausea relief.

Effect of Post-traumatic Amnesia Duration on Traumatic Brain Injury (TBI) First Year Hospital Costs: A Veterans Affairs Traumatic Brain Injury Model Systems Study.

OBJECTIVE: To examine the association between severity of traumatic brain injury (TBI) as measured by duration of post-traumatic amnesia (PTA) and first year hospitalization costs for service members and veterans (SMVs) treated for TBI at Polytrauma Rehabilitation Centers (PRCs) within the Veterans Health Administration (VHA). DESIGN: Multivariable models of merged datasets from the VA TBI Model Systems (VA TBIMS) national database containing TBI clinical characterization including PTA with VHA hospital cost data. SETTING: Five VA PRCs. PARTICIPANTS: VA TBIMS participants with known PTA who received inpatient rehabilitation within 1 year of their TBI at any of 5 PRCs between 2010 and 2020 (N=717). INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Total, acute care, rehabilitation, intensive care unit (ICU), and surgery costs across all VA hospitals. RESULTS: A total of 717 SMVs (mean age 36.9 years, 94.1% men, 76.8% non-Hispanic White, 7.8% active duty) met inclusion criteria for the unadjusted analyses. Unadjusted mean total hospital costs in the first-year post TBI were approximately $201,214 higher for those with PTA duration ≥24 hours ($351,157) than PTA <24 hours ($149,943). In adjusted models (n=583), each additional day of PTA duration incrementally increased total ($1453), rehabilitation ($1324), ICU ($78), and surgery ($39) costs. Other significant covariates included age, acute care length of stay, Disability Rating Scale on rehabilitation admission, penetrating violent cause of injury, and drug abuse. CONCLUSIONS: This study demonstrates that PTA as a quantitative measure of TBI severity significantly affects first-year hospitalization costs of SMVs treated at PRCs. Each additional day of PTA was associated with higher total, rehabilitation, ICU, and surgery costs. Mean first year hospital costs were also found to exceed the highest budget allocation to VHA facilities for a veteran treated at a PRC. These findings have possible implications for hospital care provision for those receiving inpatient rehabilitation in VHA settings.

Moral distress: Does this impact on intent to stay among adult critical care nurses?

BACKGROUND: Moral distress is recognized as an international problem that contributes to decreased work productivity, job dissatisfaction and intent to leave for adult Critical Care nurses. AIM: To explore Critical Care nurses moral distress levels using the Moral Distress Scale Revised (MDS-R) and its relationship with intention to stay. The study reported in this paper was part of a larger study that also investigated Critical Care nurses' work environment in Canada and the Midlands region of the UK. STUDY DESIGN: During January to August 2017 a cross-sectional survey was distributed to adult Critical Care nurses in the Midlands region of the UK. METHODS: Surveys were distributed to adult Critical Care Registered Nurses in the Midlands region of the UK examining moral distress levels and intention to stay in Critical Care, the organization (NHS Trust) and in the nursing profession. RESULTS: Two hundred sixty-six number of a potential sample of 1066 Critical Care nurses completed the survey (25% response rate). Age and moral distress were significantly positively correlated with intention to stay on their current unit (r = 0.16, P = .05), indicating older nurses were more likely to stay in the critical care unit. Moral distress was negatively correlated with intent to stay scores, showing critical care nurses with higher levels of moral distress were less likely to stay on their unit (r = -0.20, P = .02). Moral distress was also significantly negatively correlated with intention to stay with their current employer (r = -0.28, P < .001). Nurses that stated they had high rates of moral distress were more likely to consider leaving their current employer. CONCLUSION: Moral distress appears to be an issue among adult Critical Care nurses requiring further exploration and development of effective strategies to reduce this phenomenon and stabilize the workforce by reducing turnover. RELEVANCE TO CLINICAL PRACTICE: By identifying the top causes of moral distress, tools and strategies can be developed to allow the Critical Care nurse to work within an ethically safe clinical environment and reduce the turnover of experienced adult Critical Care nurses.

The impact of the work environment on the health-related quality of life of Licensed Practical Nurses: a cross-sectional survey in four work environments.

BACKGROUND: Nurses are known to have negative health outcomes related to their work. While it is acknowledged that nursing work is associated with things like back injuries and burnout, there is limited evidence as to what factors in the work environment contribute to these issues. PURPOSE: The aims of this study were to assess how Licensed Practical Nurses (LPNs) report their Health-related quality of life (HRQoL), and how nurses' health is impacted by their work environment. METHODS: These data used for analysis comes from a cross-sectional survey administered online to all LPNs in Alberta (2018). The survey collected data on the following variables: participant's demographics, the SF-36 HRQoL, Practice Environment Scale of the Nursing Work Index (PES-NW) and the CD-RISC measure of resilience. The beta distribution was used to model HRQoL outcomes. In instances where optimal health (score of '1') was observed then an extended version of beta distribution (called one-inflated beta) was applied. RESULTS: 4,425 LPNs responded to the survey. LPNs (mean age: 40) report lower scores on each SF-36 subscale than the general Canadian population aged 35-44. LPNs who work 'causal' had better physical health, (OR 1.21, CI 1.11-1.32, p = 0.000), and mental health (OR 1.22, CI 1.12-1.30, p = 0.000) than LPNs who work full time, even after controlling for resilience. LPNs' views on the adequacy of staffing and resources in their workplaces have an influence across all dimensions of health. CONCLUSION: This study suggests that improvements in the work environment could positively impact health outcomes and that adequate resourcing could support the nursing workforce.

Licenced practical nurses' perceptions of their work environments and their intention to stay: A cross-sectional study of four practice settings.

AIMS AND OBJECTIVES: This study aimed to understand how licenced practical nurses perceive their work environments across different work settings and to analyse the association between these nurses' perceptions of their work environments and their intentions to stay employed at their current nursing unit. DESIGN: A cross-sectional descriptive survey was conducted with Licensed Practical Nurses in Alberta, Canada. METHODS: The study population consisted of 598 licenced practical nurses. Survey measures included demographic information, the Perceived Work Environment-Nursing Work Index, and an intention to stay scale. Descriptive statistics were calculated and mean scores for perceptions about the work environment were compared by work setting. The associations between perceived work environment and intention to stay were analysed using linear regression. RESULTS: Overall, licenced practical nurses rated their work environment as mixed, with statistically significantly lower scores in acute care settings. Nurse manager ability and adequate staffing and resources were the highest contributing variables.

Comparison of Diagnostic Sleep Studies in Hospitalized Neurorehabilitation Patients With Moderate to Severe Traumatic Brain Injury.

BACKGROUND: OSA is prevalent during a time of critical neural repair after traumatic brain injury (TBI). The diagnostic utility of existing sleep studies is needed to inform clinical management during acute recovery from TBI. RESEARCH QUESTION: This study aimed to evaluate the non-inferiority and diagnostic accuracy of a portable level 3 sleep study relative to level 1 polysomnography in hospitalized neurorehabilitation patients with TBI. STUDY DESIGN AND METHODS: This is a prospective clinical trial conducted at six TBI Model System study sites between May 2017 and February 2019. Of 896 admissions, 449 were screened and eligible for the trial, with 345 consented. Additional screening left 263 eligible for and completing simultaneous administration of both level 1 and level 3 sleep studies, with final analyses completed on 214 (median age = 42 years; ED Glasgow Coma Scale = 6; time to polysomnography [PSG] = 52 days). RESULTS: Agreement was moderate to strong (weighted kappa = 0.78, 95% CI, 0.72-0.83) with the misclassification commonly occurring with mild sleep apnea due to underestimation of apnea hypopnea index (AHI). Most of those with moderate to severe sleep apnea were correctly classified (n = 54/72). Non-inferiority was not demonstrated: the minimum tolerable specificity of 0.5 was achieved across all AHI cutoff scores (lower confidence limits [LCL] range, 0.807-0.943), but the minimum tolerable sensitivity of 0.8 was not (LCL range, 0.665-0.764). INTERPRETATION: Although the non-inferiority of level 3 portable diagnostic testing relative to level 1 was not established, strong agreement was seen across sleep apnea indexes. Most of those with moderate to severe sleep apnea were correctly identified; however, there was risk of misclassification with level 3 sleep studies underestimating disease severity for those with moderate to severe AHI and disease presence for those with mild AHI during early TBI neurorehabilitation.

Cost-Benefit Analysis From the Payor's Perspective for Screening and Diagnosing Obstructive Sleep Apnea During Inpatient Rehabilitation for Moderate to Severe TBI.

OBJECTIVE: To describe the cost benefit of 4 different approaches to screening for sleep apnea in a cohort of participants with moderate to severe traumatic brain injury (TBI) receiving inpatient rehabilitation from the payor's perspective. DESIGN: A cost-benefit analysis of phased approaches to sleep apnea diagnosis. SETTING: Six TBI Model System Inpatient Rehabilitation Centers. PARTICIPANTS: Trial data from participants (N=214) were used in analyses (mean age 44±18y, 82% male, 75% white, with primarily motor vehicle-related injury [44%] and falls [33%] with a sample mean emergency department Glasgow Coma Scale of 8±5). INTERVENTION: Not applicable. MAIN OUTCOME: Cost benefit. RESULTS: At apnea-hypopnea index (AHI) ≥15 (34%), phased modeling approaches using screening measures (Snoring, Tired, Observed, Blood Pressure, Body Mass Index, Age, Neck Circumference, and Gender [STOPBANG] [-$5291], Multivariable Apnea Prediction Index MAPI [-$5262]) resulted in greater cost savings and benefit relative to the portable diagnostic approach (-$5210) and initial use of laboratory-quality polysomnography (-$5,011). Analyses at AHI≥5 (70%) revealed the initial use of portable testing (-$6323) relative to the screening models (MAPI [-$6250], STOPBANG [-$6237) and initial assessment with polysomnography (-$5977) resulted in greater savings and cost-effectiveness. CONCLUSIONS: The high rates of sleep apnea after TBI highlight the importance of accurate diagnosis and treatment of this comorbid disorder. However, financial and practical barriers exist to obtaining an earlier diagnosis during inpatient rehabilitation hospitalization. Diagnostic cost savings are demonstrated across all phased approaches and OSA severity levels with the most cost-beneficial approach varying by incidence of OSA.

Incidence and predictors of adherence to sleep apnea treatment in rehabilitation inpatients with acquired brain injury.

OBJECTIVE: The purpose of this study was to describe incidence and assess predictors of adherence to Positive Airway Pressure (PAP) therapy for Obstructive Sleep Apnea (OSA) in persons with acquired brain injury (ABI). METHODS: A 2012-2015 retrospective analysis of consecutive ABI patients admitted for neurorehabilitation, referred for polysomnography (PSG), and prescribed PAP for OSA. Univariable linear regressions were conducted to examine predictors of average hours of nightly PAP use. Univariable logistic regressions were conducted to examine predictors of PAP adherence using the conventional clinical definition of ≥4 h per night ≥70% of the time. Persons with traumatic etiology were separately analyzed. RESULTS: ABI etiology was 51% traumatic, 36% stroke, and 13% other nontraumatic causes. Nearly two-thirds were nonadherent to PAP. For the overall sample, higher average nightly PAP usage was significantly predicted by positive hypertension diagnosis (ß = 0.271, p = 0.019). Likewise, greater adherence based on the conventional cutoff was predicted by poorer motor functioning at hospital admission (OR = 0.98, p = 0.001) and lower oxygen saturation nadir (OR = 0.99, p = 0.003). For those with traumatic injuries, greater adherence was predicted by poorer functional status at hospital admission (OR = 0.98, p = 0.010) and positive hypertension diagnosis (OR = 0.16, p = 0.023). CONCLUSIONS: In this study of hospitalized neurorehabilitation patients with ABI and comorbid OSA, predictors of adherence included lower oxygen saturation, poorer functional status and hypertension diagnosis, perhaps signifying the role of greater severity of illness on treatment adherence. High rates of refusal and nonadherence to frontline PAP therapy for sleep apnea is a concern for persons in recovery form ABI who are at a time of critical neural repair.

Comparative Effectiveness of Sleep Apnea Screening Instruments During Inpatient Rehabilitation Following Moderate to Severe TBI.

OBJECTIVE: To determine the diagnostic sensitivity and specificity and comparative effectiveness of traditional sleep apnea screening tools in traumatic brain injury (TBI) neurorehabilitation admissions. DESIGN: Prospective diagnostic comparative effectiveness trial of sleep apnea screening tools relative to the criterion standard, attended level 1 polysomnography including encephalography. SETTING: Six TBI Model System Inpatient Rehabilitation Centers. PARTICIPANTS: Between May 2017 and February 2019, 449 of 896 screened were eligible for the trial with 345 consented (77% consented). Additional screening left 263 eligible for and completing polysomnography with final analyses completed on 248. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Area under the curve (AUC) of screening tools relative to total apnea hypopnea index≥15 (AHI, moderate to severe apnea) measured at a median of 47 days post-TBI (interquartile range, 29-47). RESULTS: The Berlin high-risk score (receiving operating curve [ROC] AUC=0.634) was inferior to the Multivariable Apnea Prediction Index (MAPI) (ROC AUC=0.780) (P=.0211; CI, 0.018-0.223) and Snoring, Tired, Observed, Blood Pressure, Body Mass Index, Age, Neck Circumference, and Gender (STOPBANG) score (ROC AUC=0.785) (P=.001; CI, 0.063-0.230), both of which had comparable AUC (P=.7245; CI, -0.047 to 0.068). Findings were similar for AHI≥30 (severe apnea); however, no differences across scales was observed at AHI≥5. The pattern was similar across TBI severity subgroups except for posttraumatic amnesia (PTA) status wherein the MAPI outperformed the Berlin. Youden's index to determine risk yielded lower sensitivities but higher specificities relative to non-TBI samples. CONCLUSION: This study is the first to provide clinicians with data to support a choice for which sleep apnea screening tools are more effective during inpatient rehabilitation for TBI (STOPBANG, MAPI vs Berlin) to help reduce comorbidity and possibly improve neurologic outcome.

Information literacy skills and training of licensed practical nurses in Alberta, Canada: results of a survey.

BACKGROUND: Although information literacy skills are recognized as important to the curriculum and professional outcomes of two-year nursing programs, there is a lack of research on the information literacy skills and support needed by graduates. OBJECTIVE: To identify the information literacy skills and consequent training and support required of Licensed Practical Nurses (LPNs) in Alberta, Canada. METHOD: An online survey using a random sample of new graduates (graduated within 5 years) from the registration database of the College of Practical Nurses of Alberta (CLPNA). RESULTS: There was a 43% response rate. Approximately 25-38% of LPNs felt they were only moderately or to a small extent prepared to use evidence effectively in their professional practice. LPNs use the internet and websites most frequently, in contrast to library resources that are used least frequently. Developing lifelong learning skills, using information collaboratively, and locating and retrieving information are areas where LPNs desire more effective or increased training. CONCLUSION: The results suggest there are significant gaps in the preparedness and ability of LPNs to access and apply research evidence effectively in the workplace. There are several areas in which the training provided by Librarians appears either misaligned or ineffective.

Building Capacity for Evidence-Based Practice: Understanding How Licensed Practical Nurses (LPNs) Source Knowledge.

BACKGROUND: In Canada, all nurses are required to engage in evidence-based practice (EBP) as an entry-to-practice competency; however, there is little research that examines Licensed Practical Nurses' (LPNs') information seeking behaviors or preferred sources of knowledge to conduct EBP. AIMS: Due to the differences in education and roles of LPNs and Registered Nurses (RNs), it is both necessary and important to gain an understanding of how LPNs utilize evidence in their unique nursing practice. The purpose of this study was to investigate how LPNs source knowledge for their nursing practice. METHODS: A descriptive, cross-sectional survey of LPNs from Alberta, Canada asked participants to rank sources of knowledge that inform their practice. Responses were correlated with age and years of practice. Analysis of variance was used to determine if there were significant mean differences between average scores and place of employment. RESULTS: LPN participants used similar sources of knowledge as RNs. The top source of knowledge for both RNs and LPNs was the information they learn about each individual client and the least utilized sources of knowledge were articles published in nursing, medical, and research journals, tradition, and popular media. This finding is consistent with previous studies on RNs that found nurses do not often access current research evidence to inform their practice. LINKING EVIDENCE TO ACTION: Since relatively few LPNs access nursing and research journals, it is important to tailor EBP education information to the workplace context. Future avenues of research might explore the potential of using in-services and webinars to disseminate information and skills training on EBP to the LPNs, as this was a popular source of practice knowledge.

Return on investment in healthcare leadership development programs.

Purpose Strong leadership has been shown to foster change, including loyalty, improved performance and decreased error rates, but there is a dearth of evidence on effectiveness of leadership development programs. To ensure a return on the huge investments made, evidence-based approaches are needed to assess the impact of leadership on health-care establishments. As a part of a pan-Canadian initiative to design an effective evaluative instrument, the purpose of this paper was to identify and summarize evidence on health-care outcomes/return on investment (ROI) indicators and metrics associated with leadership quality, leadership development programs and existing evaluative instruments. Design/methodology/approach The authors performed a scoping review using the Arksey and O'Malley framework, searching eight databases from 2006 through June 2016. Findings Of 11,868 citations screened, the authors included 223 studies reporting on health-care outcomes/ROI indicators and metrics associated with leadership quality (73 studies), leadership development programs (138 studies) and existing evaluative instruments (12 studies). The extracted ROI indicators and metrics have been summarized in detail. Originality/value This review provides a snapshot in time of the current evidence on ROI indicators and metrics associated with leadership. Summarized ROI indicators and metrics can be used to design an effective evaluative instrument to assess the impact of leadership on health-care organizations.

Scope of practice review: providers for triage and assessment of spine-related disorders.

PURPOSE: This study explored which health care providers could be involved in centralized intake for patients with nonspecific low back pain to enhance access, continuity, and appropriateness of care. METHODS: We reviewed the scope of practice regulations for a range of health care providers. We also conducted telephone interviews with 17 individuals representing ten provincial colleges and regulatory bodies to further understand providers' legislated scopes of practice. Activities relevant to triaging and assessing patients with low back pain were mapped against professionals' scope of practice. RESULTS: Family physicians and nurse practitioners have the most comprehensive scopes and can complete all restricted activities for spine assessment and triage, while the scope of registered nurses and licensed practical nurses are progressively narrower. Chiropractors, occupational therapists, physiotherapists, and athletic therapists are considered experts in musculoskeletal assessments and appear best suited for musculoskeletal specific assessment and triage. Other providers may play a complementary role depending on the individual patient needs. CONCLUSION: These findings indicate that an interprofessional assessment and triage team that includes allied health professionals would be a feasible option to create a centralized intake model. Implementation of such teams would require removing barriers that currently prevent providers from delivering on their full scope of practice.

Combative Sports Injuries: An Edmonton Retrospective.

OBJECTIVE: Mixed martial arts (MMA) is an increasingly popular combative sport involving aggressive techniques that present substantial injury risk. We examined the incidence and types of injuries sustained in MMA fights and compared this with injuries sustained in boxing matches. DESIGN: Consecutive Case Series. SETTING: We used data from post-fight medical examinations on all bouts in Edmonton, Canada, between 2000 and 2013. PARTICIPANTS: The participants were 1181 MMA competitors and 550 boxers. MAIN OUTCOME MEASURES: The attending physician conducted a mandatory post-fight examination of all fighters and documented the nature of injuries sustained. RESULTS: Boxers were significantly more likely not to experience injury (49.8% vs 59.4%, P < 0.001), whereas MMA fighters were significantly more likely to experience 1 injury (typically contusion/bruising, P < 0.001). Boxers were more likely to experience loss of consciousness (7.1% vs 4.2%, P = 0.01) and serious eye injury (1.1% vs 0.3%, P = 0.02). CONCLUSIONS: The overall injury incidence in MMA competitors appears slightly higher than for boxers, but MMA fighters experience more minor contusion/bruising injuries. Boxers are more likely to experience serious injury such as concussion/head trauma involving loss of consciousness or eye injury such as retinal detachment.

Development of key performance indicators to evaluate centralized intake for patients with osteoarthritis and rheumatoid arthritis.

INTRODUCTION: Centralized intake is integral to healthcare systems to support timely access to appropriate health services. The aim of this study was to develop key performance indicators (KPIs) to evaluate centralized intake systems for patients with osteoarthritis (OA) and rheumatoid arthritis (RA). METHODS: Phase 1 involved stakeholder meetings including healthcare providers, managers, researchers and patients to obtain input on candidate KPIs, aligned along six quality dimensions: appropriateness, accessibility, acceptability, efficiency, effectiveness, and safety. Phase 2 involved literature reviews to ensure KPIs were based on best practices and harmonized with existing measures. Phase 3 involved a three-round, online modified Delphi panel to finalize the KPIs. The panel consisted of two rounds of rating and a round of online and in-person discussions. KPIs rated as valid and important (≥7 on a 9-point Likert scale) were included in the final set. RESULTS: Twenty-five KPIs identified and substantiated during Phases 1 and 2 were submitted to 27 panellists including healthcare providers, managers, researchers, and patients in Phase 3. After the in-person meeting, three KPIs were removed and six were suggested. The final set includes 9 OA KPIs, 10 RA KPIs and 9 relating to centralized intake processes for both conditions. All 28 KPIs were rated as valid and important. CONCLUSIONS: Arthritis stakeholders have proposed 28 KPIs that should be used in quality improvement efforts when evaluating centralized intake for OA and RA. The KPIs measure five of the six dimensions of quality and are relevant to patients, practitioners and health systems.

The impact of fatal pediatric trauma on aboriginal children.

BACKGROUND/PURPOSE: Injuries are the leading cause of death in young people. Our aim is to examine the differences between aboriginal and non-aboriginal pediatric trauma mortality as a means to focus on prevention strategies. METHODS: The records for all traumatic pediatric (0-18 years) deaths between 1996 and 2010 were reviewed from the regional Medical Examiner's office. RESULTS: The majority of the total 932 pediatric deaths were the result of non-intentional injuries (640) followed by suicide (195), homicide (65), child abuse (15), and undetermined (17). Despite being only 3.3% of the provincial population, Aboriginals represented 30.9% of pediatric trauma fatalities. Aboriginal fatalities occurred most commonly in the home, with males and females equally affected. Road related events were the main causes of injury overall. Up to three-quarters of Aboriginal children who died in a non-pedestrian road related event did not wear an indicated protective device. Pedestrian deaths were over-represented in Aboriginal children. The second most common cause of death was suicide for both non-Aboriginal and Aboriginal children. Almost half of all of the suicides were Aboriginal. Homicide and child abuse had similar proportions for both non-Aboriginal and Aboriginal children. CONCLUSION: Pediatric Aboriginal injury prevention should be a priority and tailored for Aboriginal communities.

Non-pharmacological sleep interventions for youth with chronic health conditions: a critical review of the methodological quality of the evidence.

PURPOSE: Restorative sleep is clearly linked with well-being in youth with chronic health conditions. This review addresses the methodological quality of non-pharmacological sleep intervention (NPSI) research for youth with chronic health conditions. METHOD: The Guidelines for Critical Review (GCR) and the Effective Public Health Practice Project Quality Assessment Tool (EPHPP) were used in the review. RESULTS: The search yielded 31 behavioural and 10 non-behavioural NPSI for review. Most studies had less than 10 participants. Autism spectrum disorders, attention deficit/hyperactivity disorders, down syndrome, intellectual disabilities, and visual impairments were the conditions that most studies focused upon. The global EPHPP scores indicated most reviewed studies were of weak quality. Only 7 studies were rated as moderate, none were strong. Studies rated as weak quality frequently had recruitment issues; non-blinded participants/parents and/or researchers; and used outcome measures without sound psychometric properties. CONCLUSIONS: Little conclusive evidence exists for NPSIs in this population. However, NPSIs are widely used and these preliminary studies demonstrate promising outcomes. There have not been any published reports of negative outcomes that would preclude application of the different NPSIs on a case-by-case basis guided by clinical judgement. These findings support the need for more rigorous, applied research. IMPLICATIONS FOR REHABILITATION: • Methodological Quality of Sleep Research • Disordered sleep (DS) in youth with chronic health conditions is pervasive and is important to rehabilitation therapists because DS contributes to significant functional problems across psychological, physical and emotional domains. • Rehabilitation therapists and other healthcare providers receive little education about disordered sleep and are largely unaware of the range of assessment and non-pharmacological intervention strategies that exist. An evidence-based website of pediatric sleep resources can be found at http://www.SleepRight.ualberta.ca • The current research on non-pharmacological sleep interventions (NPSI) for youth with health conditions is methodologically weak. However, consistently positive outcomes reported in the literature demonstrate that pragmatic interventions such as bright light therapy, activity, massage and behavioral interventions are promising areas. No studies found reasons that a trail of a NPSI matched to the youth's context and condition should not attempted. More rigorous clinically relevant study of pragmatic non-pharmacological interventions appropriate for therapists' and parents' needs is required.

Focus on pediatric intentional trauma.

BACKGROUND: Based on our previous study, pediatric intentional trauma injuries with Injury Severity Scores (ISS) ≥ 12 were more commonly observed in the urban than the rural setting (15.2% vs. 5.5%) in Alberta from 1996 to 2006. We wish to understand differences between urban and rural pediatric intentional trauma to plan for prevention and supportive strategies. METHODS: Data were extracted from the Alberta Trauma Registry on pediatric patients (0-17 years) with ISS ≥ 12, treated from 1996 to 2010 at the Stollery Children's Hospital. Statistical analysis was made comparing urban versus rural groups using t test and χ2 with p < 0.05 considered significant. RESULTS: There were 170 pediatric patients who suffered intentional injury (urban = 58.3%; rural = 41.8%; not significant), with a majority of males (72.4%). Two groups were predominant: the very young (<1 year) at 17.1% of all injuries and the teens (≥ 15 years) at 54.1%. The cause of intent injury was child abuse (31.2%), assault with blunt object (24.6%), assault with a sharp object (22.9%), and suicide (18.2%). The mean ISS was 22.9 ± 7.8 standard deviation. Tragically, 29 patients (17.1%) died. There were no differences between urban and rural pediatric trauma in terms of age, gender, cause of injury, ISS, survival, length of stay, pediatric intensive care unit length of stay, number of operations needed, or alcohol. CONCLUSION: An important pattern of intentional injuries can be seen where preventative efforts can be strengthened regardless of urban or rural area: the very young as shaken baby cases and the teens, who unfortunately, accounted for the majority of suicidal attempts.