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Abstract A novel laboratory platform has been designed and built for the irradiation of a plasma crystal (PC) with an electron beam (e-beam) having an energy around 10 keV and a current of tens of milliamperes. The pulsed e-beam collimated to a few millimeter-size spot is aimed at a crystal made of dust particles levitated in a radio-frequency (RF) plasma. The platform consists of three vacuum chambers connected in-line, each with different utility: one for generating free electrons in a pulsed hollow-anode Penning discharge, another for the extraction and acceleration of electrons at $$\sim 10$$ ∼ 10 kV and for focusing the e-beam in the magnetic field of a pair of circular coils, and the last one for producing PCs above a RF-driven electrode. The main challenge is to obtain both a stable e-beam and PC by insuring appropriate gas pressures, given that the e-beam is formed in high vacuum ( $$\lesssim 10^{-4}$$ ≲ 10 - 4 Torr), while the PC is produced at much higher pressures ( $$\gtrsim 10^{-1}$$ ≳ 10 - 1 Torr). The main diagnostics include a high speed camera, a Faraday cup and a Langmuir probe. Two applications concerned with the creation of a pair of dust flow vortices and the rotation of a PC by the drag force of the e-beam acting on the strongly coupled dust particles are presented. The dust flow can become turbulent as demonstrated by the energy spectrum, featuring vortices at different space scales.

Introduction. Glaucoma is a bilateral progressive hereditary optic neuropathy which determines the slow and irreversible destruction of the optic nerve fibres. Cases presentation. We present two cases of primitive open-angle glaucoma developed following sustained stress. In both cases, the cause of glaucoma was the depressive disorder. Once glaucoma is installed, therapy will be continued long-life, to prevent irreversible vision damage and thus to increase the quality of life of these patients. Conclusions. Glaucoma, as a disease with blinding potential, determines an additional stress, besides the preexisting stress, which itself is the triggering cause of the disease. The relationship between stress and increased intraocular pressure is known into practice, but it is still insufficiently researched. The relationship between elevated intraocular pressure and worsening glaucoma during the life of these patients is known, and the existence of stress leads to increased intraocular pressure. This cascade of side effects of stress leads to the aggravation of glaucomatous disease.

The Airborne ROmanian Measurements of Aerosols and Trace gases (AROMAT) campaigns took place in Romania in September 2014 and August 2015. They focused on two sites: the Bucharest urban area and large power plants in the Jiu Valley. The main objectives of the campaigns were to test recently developed airborne observation systems dedicated to air quality studies and to verify their applicability for the validation of space-borne atmospheric missions such as the TROPOspheric Monitoring Instrument (TROPOMI)/Sentinel-5 Precursor (S5P). We present the AROMAT campaigns from the perspective of findings related to the validation of tropospheric NO2, SO2, and H2CO. We also quantify the emissions of NOx and SO2 at both measurement sites. We show that tropospheric NO2 vertical column density (VCD) measurements using airborne mapping instruments are well suited for satellite validation in principle. The signal-to-noise ratio of the airborne NO2 measurements is an order of magnitude higher than its space-borne counterpart when the airborne measurements are averaged at the TROPOMI pixel scale. However, we show that the temporal variation of the NO2 VCDs during a flight might be a significant source of comparison error. Considering the random error of the TROPOMI tropospheric NO2 VCD (σ), the dynamic range of the NO2 VCDs field extends from detection limit up to 37 σ (2.6×1016 molec. cm−2) and 29 σ (2×1016 molec. cm−2) for Bucharest and the Jiu Valley, respectively. For both areas, we simulate validation exercises applied to the TROPOMI tropospheric NO2 product. These simulations indicate that a comparison error budget closely matching the TROPOMI optimal target accuracy of 25 % can be obtained by adding NO2 and aerosol profile information to the airborne mapping observations, which constrains the investigated accuracy to within 28 %. In addition to NO2, our study also addresses the measurements of SO2 emissions from power plants in the Jiu Valley and an urban hotspot of H2CO in the centre of Bucharest. For these two species, we conclude that the best validation strategy would consist of deploying ground-based measurement systems at well-identified locations.

The fungus Fusarium oxysporum (Fo) is widely known for causing wilt disease in over 100 different plant species. Endophytic interactions of Fo with plants are much more common, and strains pathogenic on one plant species can even be beneficial endophytes on another species. However, endophytic and beneficial interactions have been much less investigated at the molecular level, and the genetic basis that underlies endophytic versus pathogenic behavior is unknown. To investigate this, 44 Fo strains from non-cultivated Australian soils, grass roots from Spain, and tomato stems from United States were characterized genotypically by whole genome sequencing, and phenotypically by examining their ability to symptomlessly colonize tomato plants and to confer resistance against Fusarium Wilt. Comparison of the genomes of the validated endophytic Fo strains with those of 102 pathogenic strains revealed that both groups have similar genomes sizes, with similar amount of accessory DNA. However, although endophytic strains can harbor homologs of known effector genes, they have typically fewer effector gene candidates and associated non-autonomous transposons (mimps) than pathogenic strains. A pathogenic ‘lifestyle’ is associated with extended effector gene catalogs and a set of “host specific” effectors. No candidate effector genes unique to endophytic strains isolated from the same plant species were found, implying little or no host-specific adaptation. As plant-beneficial interactions were observed to be common for the tested Fo isolates, the propensity for endophytism and the ability to confer biocontrol appears to be a predominant feature of this organism. These findings allow prediction of the lifestyle of a Fo strain based on its genome sequence as a potential pathogen or as a harmless or even beneficial endophyte by determining its effectorome and mimp number.

In this study we report on airborne imaging DOAS measurements of NO2 from two flights performed in Bucharest during the AROMAT campaign (Airborne ROmanian Measurements of Aerosols and Trace gases) in September 2014. These measurements were performed with the Airborne imaging Differential Optical Absorption Spectroscopy (DOAS) instrument for Measurements of Atmospheric Pollution (AirMAP) and provide nearly gapless maps of column densities of NO2 below the aircraft with a high spatial resolution of better than 100 m. The air mass factors, which are needed to convert the measured differential slant column densities (dSCDs) to vertical column densities (VCDs), have a strong dependence on the surface reflectance, which has to be accounted for in the retrieval. This is especially important for measurements above urban areas, where the surface properties vary strongly. As the instrument is not radiometrically calibrated, we have developed a method to derive the surface reflectance from intensities measured by AirMAP. This method is based on radiative transfer calculation with SCIATRAN and a reference area for which the surface reflectance is known. While surface properties are clearly apparent in the NO2 dSCD results, this effect is successfully corrected for in the VCD results. Furthermore, we investigate the influence of aerosols on the retrieval for a variety of aerosol profiles that were measured in the context of the AROMAT campaigns. The results of two research flights are presented, which reveal distinct horizontal distribution patterns and strong spatial gradients of NO2 across the city. Pollution levels range from background values in the outskirts located upwind of the city to about 4 × 1016 molec cm−2 in the polluted city center. Validation against two co-located mobile car-DOAS measurements yields good agreement between the datasets, with correlation coefficients of R = 0.94 and R = 0.85, respectively. Estimations on the NOx emission rate of Bucharest for the two flights yield emission rates of 15.1 ± 9.4 and 13.6 ± 8.4 mol s−1, respectively.

Root endophytes can confer resistance against plant pathogens by direct antagonism or via the host by triggering induced resistance. The latter response typically relies on jasmonic acid (JA)/ethylene (ET)-depended signaling pathways, but can also be triggered via salicylic acid (SA)-dependent signaling pathways. Here, we set out to determine if endophyte-mediated resistance (EMR), conferred by the Fusarium endophyte Fo47, against Fusarium wilt disease in tomato is mediated via SA, ET or JA. To test the contribution of SA, ET, and JA in EMR we performed bioassays with Fo47 and Fusarium oxysporum f. sp. lycopersici in tomato plants impaired in SA accumulation (NahG), JA biosynthesis (def1) or ET-production (ACD) and -sensing (Nr). We observed that the colonization pattern of Fo47 in stems of wildtype plants was indistinguishable from that of the hormone mutants. Surprisingly, EMR was not compromised in the lines affected in JA, ET, or SA signaling. The independence of EMR on SA, JA, and ET implies that this induced resistance-response against Fusarium wilt disease is distinct from the classical Induced Systemic Resistance (ISR) response, providing exciting possibilities for control of wilt diseases independent of conventional defense pathways.

Resistance (R) genes and endophytic organisms can both protect plants against pathogens. Although the outcome of both processes is the same, little is known about the commonalities and differences between both immune responses. Here we set out to phenotypically characterize both responses in the tomato-Fusarium pathosystem, and to identify markers to distinguish these responses at the molecular level. As endophyte Fusarium oxysporum (Fo) strain Fo47 was employed, which confers protection against various pathogens, including the vascular wilt fungus F. oxysporum f.sp. lycopersici (Fol). As R-gene conferring Fol resistance, the I-2 gene of tomato (Solanum lycopersicum) was used. Fol colonizes the xylem vessels of susceptible and I-2 resistant tomato plants, but only causes disease in the former. Fol was found to colonize the vasculature of endophyte-colonized plants, and could be isolated from stems of non-diseased plants co-inoculated with Fo47 and Fol. Because the xylem vessels form the main interface between plant and pathogen, the xylem sap proteomes during R gene- and Endophyte-Mediated Resistance (RMR and EMR) were compared using label-free quantitative nLC-MS/MS. Surprisingly, both proteomes were remarkably similar to the mock, revealing only one or two differentially accumulated proteins in the respective resistant interactions. Whereas in I-2 plants the accumulation of the pathogenesis-related protein PR-5x was strongly induced by Fol, the endophyte triggered induction of both NP24, another PR-5 isoform, and of a β-glucanase in the presence of Fol. Notably, over 54% of the identified xylem sap proteins have a predicted intracellular localization, which implies that these might be present in exosomes. In conclusion, whereas both resistance mechanisms permit the pathogen to colonize the vasculature, this does not result in disease and this resistance coincides with specific induction of two distinct PR-5 isoforms and a β-glucanase.

Considering the well-known mechanism of adaptable resistance of microorganisms to chemical compounds through biofilms formation and the widespread use of N-heterocyclic quaternary ammonium salts (QAC) as disinfectants, in this study we have evaluate the effect of 8 newly synthesized symmetrical and unsymmetrical diquaternary ammonium salts of 1,2-bis-(4-pyridil)-ethane on bacterial biofilms produced by three different bacterial strains. The effect of the exposure to quaternary ammonium salts on biofilm communities was investigated within biofilms obtained in a conventional testing system, on stainless steel and glass surfaces. Differential plate counts were used to characterize the developed communities and the effects of QAC exposure and the results were correlated with epifluorescence microphotographs. The data obtained revealed a significant reduction of bacterial cells in the biofilms tested with 4-7 log CFU for all the QAC.

Root colonization by Fusarium oxysporum (Fo) endophytes reduces wilt disease symptoms caused by pathogenic Fo strains. The endophytic strain Fo47, isolated from wilt suppressive soils, reduces Fusarium wilt in various crop species such as tomato, flax, and asparagus. How endophyte-mediated resistance (EMR) against Fusarium wilt is achieved is unclear. Here, nonpathogenic colonization by Fo47 and pathogenic colonization by Fo f.sp. lycopersici (Fol) strains were assessed in tomato roots and stems when inoculated separately or coinoculated. It is shown that Fo47 reduces Fol colonization in stems of both noncultivated and cultivated tomato species. Conversely, Fo47 colonization of coinoculated tomato stems was increased compared to single inoculated plants. Quantitative PCR of fungal colonization of roots (co)inoculated with Fo47 and/or Fol showed that pathogen colonization was drastically reduced when coinoculated with Fo47, compared with single inoculated roots. Endophytic colonization of tomato roots remained unchanged upon coinoculation with Fol. In conclusion, EMR against Fusarium wilt is correlated with a reduction of root and stem colonization by the pathogen. In addition, the endophyte may take advantage of the pathogen-induced suppression of plant defences as it colonizes tomato stems more extensively.

This review focuses on the mobility of small RNA (sRNA) molecules from the perspective of trans-kingdom gene silencing. Mobility of sRNA molecules within organisms is a well-known phenomenon, facilitating gene silencing between cells and tissues. sRNA signals are also transmitted between organisms of the same species and of different species. Remarkably, in recent years many examples of RNA-signal exchange have been described to occur between organisms of different kingdoms. These examples are predominantly found in interactions between hosts and their pathogens, parasites, and symbionts. However, they may only represent the tip of the iceberg, since the emerging picture suggests that organisms in biological niches commonly exchange RNA-silencing signals. In this case, we need to take this into account fully to understand how a given biological equilibrium is obtained. Despite many observations of trans-kingdom RNA signal transfer, several mechanistic aspects of these signals remain unknown. Such RNA signal transfer is already being exploited for practical purposes, though. Pathogen genes can be silenced by plant-produced sRNAs designed to affect these genes. This is also known as Host-Induced Genes Silencing (HIGS), and it has the potential to become an important disease-control method in the future.

Sphingosine-1-phosphate (S1P) is a key regulator of immune response. Immune cells, epithelia and blood cells generate high levels of S1P in inflamed tissue. However, it is not known if S1P acts on the endings of nociceptive neurons, thereby contributing to the generation of inflammatory pain. We found that the S1P₁ receptor for S1P is expressed in subpopulations of sensory neurons including nociceptors. Both S1P and agonists at the S1P₁ receptor induced hypersensitivity to noxious thermal stimulation in vitro and in vivo. S1P-induced hypersensitivity was strongly attenuated in mice lacking TRPV1 channels. S1P and inflammation-induced hypersensitivity was significantly reduced in mice with a conditional nociceptor-specific deletion of the S1P₁ receptor. Our data show that neuronally expressed S1P₁ receptors play a significant role in regulating nociceptor function and that S1P/S1P₁ signaling may be a key player in the onset of thermal hypersensitivity and hyperalgesia associated with inflammation.

In recent years, a plethora of new type III and IV portable sleep monitors (PSM) have been developed, although evidence regarding their diagnostic accuracy for use in children remains heterogeneous. This study systematically reviews the literature addressing the diagnostic accuracies of type III and IV PSM for pediatric sleep apnea. Publications indexed in Medline, Embase, or Web of Science were reviewed using the PRISMA framework. Of 1054 studies, 62 fulfilled the inclusion criteria. Of the studies evaluating oximetry-based type IV PSM, one (6.25 %) demonstrated a balanced set of high (≥80 %) sensitivities and specificities for the diagnosis of any pediatric sleep apnea, while five studies (27.8 %) showed similar accuracies for moderate-to-severe sleep apnea. For non-oximetry-based type IV PSM, two studies (40 %) reported a balanced set of high diagnostic accuracies for moderate-to-severe sleep apnea. Type III PSM repeatedly demonstrated higher diagnostic accuracies, with six studies (66.7 %) reporting a balanced set of high diagnostic accuracies for moderate-to-severe sleep apnea. This review highlights the potential of type III PSM to detect moderate-to-severe pediatric sleep apnea, although current evidence is limited to support the stand-alone use of type IV PSM for the diagnosis of sleep apnea in most children., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Pediatric otolaryngologists rely on HSAT literature to guide their diagnostic methods related to obstructive sleep apnea (OSA). Our objectives were to review the rates of presence of funding and/or potential conflict of interest (COI), as well as its relationship to the overall quality of HSAT publications in the literature over the last two decades., Data Sources: Medline, Web of Science and Embase databases., Review Methods: A review was performed reviewing publications from January 2000 to December 2021. Oxford Level of Evidence (OLE) was used as a quality metric. COI and funding were recorded verbatim as self-declared in the text of the manuscript., Results: Literature search yielded 4257 articles with 400 articles included in final analysis. The odds of higher quality studies (LOE 1 or 2) were higher in the last five years from 2016 to 2021 (OR, 3.6; 95% CI 1.4 to 6.9). Nearly half of all articles (43.0%) lacked a statement regarding funding or COI. There was a positive correlation between level of evidence and industry funding. The largest source of funding was from industry, comprising 39.6% of all studies that had a funding statement. Of these industry-funded studies, 37.5% reported no COI or lacked a COI statement., Conclusion: Despite a growing interest in HSATs for OSA evaluation, there is heterogeneity in reporting of COI and high prevalence of industry funding and COI. Re-evaluation and consensus amongst journals on guidelines for reporting disclosures are needed., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Children with neurodevelopmental disorders have a high risk of sleep disturbances, with insomnia being the most common sleep disorder (ie, chronic and frequent difficulties with going and staying asleep). Insomnia adversely affects the well-being of these children and their caregivers. Pediatric sleep experts recommend behavioral interventions as the first-line treatment option for children. Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) is a 5-session eHealth behavioral intervention delivered to parents to improve outcomes (eg, Pediatric Quality of Life Inventory [PedsQL]) for their children (ages 4-12 years) with insomnia and who have a diagnosis of mild to moderate attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, or fetal alcohol spectrum disorder. If cost-effective, BNBD-NDD can be a scalable intervention that provides value to an underserved population., Objective: This protocol outlines an economic evaluation conducted alongside the BNBD-NDD randomized controlled trial (RCT) that aims to assess its costs, efficacy, and cost-effectiveness compared to usual care., Methods: The BNBD-NDD RCT evaluates the impacts of the intervention on children's sleep and quality of life, as well as parents' daytime functioning and psychosocial health. Parent participants were randomized to the BNBD-NDD treatment or to usual care. The economic evaluation assesses outcomes at baseline and 8 months later, which include the PedsQL as the primary measure. Quality of life outcomes facilitate the comparison of competing interventions across different populations and medical conditions. Cost items include the BNBD-NDD intervention and parent-reported usage of private and publicly funded resources for their children's insomnia. The economic evaluation involves a reference case cost-effectiveness analysis to examine the incremental cost of BNBD-NDD per units gained in the PedsQL from the family payer perspective and a cost-consequence analysis from a societal perspective. These analyses will be conducted over an 8-month time horizon., Results: Research funding was obtained from the Kids Brain Health Network in 2015. Ethics were approved by the IWK Health Research Ethics Board and the University of Calgary Conjoint Health Research Ethics Board in January 2019 and June 2022, respectively. The BNBD-NDD RCT data collection commenced in June 2019 and ended in April 2022. The RCT data are currently being analyzed, and data relevant to the economic analysis will be analyzed concurrently., Conclusions: To our knowledge, this will be the first economic evaluation of an eHealth intervention for insomnia in children with neurodevelopmental disorders. This evaluation's findings can inform users and stakeholders regarding the costs and benefits of BNBD-NDD., Trial Registration: ClinicalTrial.gov NCT02694003; https://clinicaltrials.gov/study/NCT02694003., International Registered Report Identifier (irrid): DERR1-10.2196/46735., (©Xiao Yang Jia, Pantelis Andreou, Cary Brown, Evelyn Constantin, Roger Godbout, Ana Hanlon-Dearman, Osman Ipsiroglu, Graham Reid, Sarah Shea, Isabel M Smith, Jennifer D Zwicker, Shelly K Weiss, Penny Corkum. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 12.09.2023.)

Competing Interests: Dr. Heather Waters has received payments for teaching, research, and administrative work from the Department of Family Medicine and Faculty of Health Sciences at McMaster University, honoraria from the Foundation for Medical Practice Education, and a Medical Education Research Grant from the RCPSC.Dr. Anna Oswald has received payments for teaching and administrative work from the Royal College of Physicians and Surgeons of Canada. Dr Evelyn Constantin received a stipend from the Collège des médecins du Québec as an expert advisor; she also receives a salary from McGill University for her role as Special Advisor, International Faculty Development/Continuing Professional Development for International Affairs at the McGill Faculty of Medicine and Health Sciences. Dr Constantin also holds external research grant funding from the Canadian Institutes of Health Research. Dr. Brent Thoma has received payments for teaching, research, and administrative work from the University of Saskatchewan College of Medicine, payments for teaching and administrative work from the Royal College of Physicians and Surgeons of Canada, honoraria for teaching or writing from Harvard Medical School, the New England Journal of Medicine, the University of Cincinnati Children's Hospital, and NYC Health + Hospitals, and research grant funding from the Government of Ontario and the Canadian Association of Emergency Physicians. Dr. Damon Dagnone has none to declare.

Background: The CanMEDS physician competency framework will be updated in 2025. The revision occurs during a time of disruption and transformation to society, healthcare, and medical education caused by the COVID-19 pandemic and growing acknowledgement of the impacts of colonialism, systemic discrimination, climate change, and emerging technologies on healthcare and training. To inform this revision, we sought to identify emerging concepts in the literature related to physician competencies., Methods: Emerging concepts were defined as ideas discussed in the literature related to the roles and competencies of physicians that are absent or underrepresented in the 2015 CanMEDS framework. We conducted a literature scan, title and abstract review, and thematic analysis to identify emerging concepts. Metadata for all articles published in five medical education journals between October 1, 2018 and October 1, 2021 were extracted. Fifteen authors performed a title and abstract review to identify and label underrepresented concepts. Two authors thematically analyzed the results to identify emerging concepts. A member check was conducted., Results: 1017 of 4973 (20.5%) of the included articles discussed an emerging concept. The thematic analysis identified ten themes: Equity, Diversity, Inclusion, and Social Justice; Anti-racism; Physician Humanism; Data-Informed Medicine; Complex Adaptive Systems; Clinical Learning Environment; Virtual Care; Clinical Reasoning; Adaptive Expertise; and Planetary Health. All themes were endorsed by the authorship team as emerging concepts., Conclusion: This literature scan identified ten emerging concepts to inform the 2025 revision of the CanMEDS physician competency framework. Open publication of this work will promote greater transparency in the revision process and support an ongoing dialogue on physician competence. Writing groups have been recruited to elaborate on each of the emerging concepts and how they could be further incorporated into CanMEDS 2025., Competing Interests: Thoma, Atkinson, Hall, Frank, Snell, Anderson, and Van Melle have received stipends from the Royal College of Physicians and Surgeons of Canada. Thoma also reports payments for teaching, research, and administrative work from the University of Saskatchewan College of Medicine and teaching honoraria from various institutions within the past 3 years (Harvard Medical School, the New England Journal of Medicine, the University of Cincinnati Children's Hospital, and NYC Health + Hospitals). Samson receives stipends from the Collège des médecins du Québec and the Université de Montréal. Giuliani has an unrelated conflict-of-interest with AstraZeneca and Bristol Myers Squibb. Chan reports honoraria from McMaster University for her education research work with the McMaster Education Research, Innovation, and Theory (MERIT) group and administrative stipend for her role of Associate Dean via the McMaster Faculty of Health Sciences Office of Continuing Professional Development. Chan also reports teaching honoraria from various institutions within the past three years (UBC, UNBC, Baylor College of Medicine, Harvard University, NOSM, Catholic University of Korea, Taiwan Veteran’s General Hospital, Prince of Songkla University). Waters reports honoraria and salary support for academic contributions from McMaster University. Chan and Waters have received educational research grant funding from the Royal College of Physicians and Surgeons of Canada. Fowler is a paid employee of the College of Family Physicians of Canada. Tourian receives a salary from McGill University for his administrative work as the Assistant Dean of Postgraduate Medical Education. Constantin received a stipend from the Collège des médecins du Québec as an expert advisor; she also receives a salary from McGill University for her administrative and education work within Postgraduate Medical Education as well as within the Office of International Affairs. Karwowska receives a stipend from the Association of Faculties of medicine of Canada., (© 2023 Thoma, Karwowska, Samson, Labine, Waters, Giuliani, Chan, Atkinson, Constantin, Hall, Gomez-Garibello, Fowler, Tourian, Frank Anderson, Snell, Van Melle; licensee Synergies Partners.)

Study Objectives: Behavioral characteristics and outcomes of positive airway pressure (PAP) therapy in children with obesity and moderate-severe sleep-disordered breathing (SDB) have not been reported. Our aims were to 1) determine baseline behavioral/emotional symptoms of this population and characterize changes over time with PAP, and 2) examine associations between baseline behavioral/emotional symptoms and PAP adherence., Methods: This multicenter prospective cohort study of children with obesity prescribed PAP for moderate-severe SDB assessed PAP adherence (≥ 4 h/night, >50% of nights, usage diaries, downloads) and compared behavioral/emotional characteristics with parent- and child-reported Conners Rating Scale (Conners) and the Child Behavior Checklist (CBCL) at baseline and 1 year after PAP prescription between adherent and nonadherent participants; scores at baseline were compared retrospectively between adherence groups., Results: Twenty-four children were included (median 14.1 years [IQR:12.4,16.0]; 87.5% males). Baseline Conners and CBCL scores were elevated (parent- and child-reported Conners inattention and hyperactivity subscales and CBCL subscales [total, internalizing, externalizing]). Baseline parent-reported Conners scores were significantly more elevated in the nonadherent than adherent group (inattention: 73.3 ± 8.5 vs 60.5 ± 14.6, P = .01; hyperactivity: 70.9 ± 11.1 vs 59.1 ± 16.0, P = .05). This difference was present 1 year later for inattention ( P = .01) but not for hyperactivity ( P = .09). Parent-reported CBCL scores improved over 1 year in adherent but not nonadherent participants., Conclusions: We found that children with obesity and moderate-severe SDB have elevated symptoms of behavioral/emotional concerns on standardized testing. Parent-reported emotional characteristics improved in the adherent but not in the nonadherent group. Children with greater inattention/hyperactivity at baseline were less adherent to PAP, suggesting this may contribute to PAP nonadherence., Citation: Constantin E, MacLean JE, Barrowman N, et al. Behavioral and emotional characteristics of Canadian children with obesity and moderate-severe sleep-disordered breathing treated with positive airway pressure: longitudinal changes and associations with adherence. J Clin Sleep Med . 2023;19(3):555-562., (© 2023 American Academy of Sleep Medicine.)

A novel laboratory platform has been designed and built for the irradiation of a plasma crystal (PC) with an electron beam (e-beam) having an energy around 10 keV and a current of tens of milliamperes. The pulsed e-beam collimated to a few millimeter-size spot is aimed at a crystal made of dust particles levitated in a radio-frequency (RF) plasma. The platform consists of three vacuum chambers connected in-line, each with different utility: one for generating free electrons in a pulsed hollow-anode Penning discharge, another for the extraction and acceleration of electrons at [Formula: see text] kV and for focusing the e-beam in the magnetic field of a pair of circular coils, and the last one for producing PCs above a RF-driven electrode. The main challenge is to obtain both a stable e-beam and PC by insuring appropriate gas pressures, given that the e-beam is formed in high vacuum ([Formula: see text] Torr), while the PC is produced at much higher pressures ([Formula: see text] Torr). The main diagnostics include a high speed camera, a Faraday cup and a Langmuir probe. Two applications concerned with the creation of a pair of dust flow vortices and the rotation of a PC by the drag force of the e-beam acting on the strongly coupled dust particles are presented. The dust flow can become turbulent as demonstrated by the energy spectrum, featuring vortices at different space scales., (© 2023. The Author(s).)

Obese youth with sleep-disordered breathing are treated with positive airway pressure to improve sleep and cardiovascular status. While improvements in sleep parameters have been confirmed, a study by Katz et al. showed no major improvement in ambulatory blood pressure. The aim of this ancillary study was to analyze short-term blood pressure variability, following positive airway pressure treatment, as a more sensitive marker of cardiovascular health. We analyzed 24-h blood pressure variability data in 17 children, taken at baseline and after 12 months of treatment. These data were derived from an already published prospective, multicenter cohort study conducted in 27 youth (8-16 years) with obesity who were prescribed 1-year of positive airway pressure for moderate-severe sleep-disordered breathing. Significant decreases were found in 24 h systolic blood pressure (p = 0.040) and nighttime diastolic blood pressure (p = 0.041) average real variability, and diastolic blood pressure (p = 0.035) weighted standard deviation. Significant decreases were noted in nighttime diastolic blood pressure time rate variability (p = 0.007). Positive airway pressure treatment resulted in a significant decrease in blood pressure variability, suggesting a clinically significant improvement of sympathetic nerve activity in youth with obesity and sleep-disordered breathing. IMPACT: Cardiovascular variability, as measured by blood pressure variability, is improved in children following positive airway pressure treatment. Our novel findings of improved blood pressure time rate variability are the first described in the pediatric literature. Future studies aimed at analyzing target organ damage in this patient population will allow for a better understanding as to whether alterations in blood pressure variability translate to decreasing target organ damage in children, as seen in adults., (© 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Study Objectives: Social jetlag (SJL) measures the discrepancy between circadian and social clocks. Using accelerometry-derived data, our objective was to assess the prevalence of SJL in young healthy children and determine the association of SJL and sleep with temperament., Methods: Of 117 children participating in TARGet Kids!, a Canadian cohort of healthy preschool-aged children, 78 children (39 girls; 50%; mean age [SD]: 35.1 [20.5] months) were included. Sleep was measured objectively using accelerometry. Temperament dimensions (surgency, negative affectivity, and effortful control) were assessed with the very short forms of Rothbart's child and infant behavior questionnaires. We examined associations of SJL and sleep with temperament using multivariable linear regression models adjusted for sex, age, ethnicity, and preschool/daycare attendance., Results: 20 out of 78 (25.6%) experienced SJL of greater than 30 minutes. SJL was greater in children who attended preschool/daycare compared with children who did not (26.3[18.8] minutes vs 17.6 [14.8] minutes; P < .05). There was no evidence of an association between SJL and any temperament dimension. We found evidence of an association between increased sleep duration and increased negative affectivity scores (longer 24-hour sleep; β: 0.347; 95% confidence interval: 0.182, 0.512; P < .0001; and longer nighttime sleep duration: β: 0.413; 95% confidence interval: 0.163, 0.663; P = .002)., Conclusions: In our cohort, 1 in 4 preschool-aged children experienced SJL. Increased sleep duration was associated with increased negative affect, which could have implications for children developing internalizing behavior such as depression or low self-esteem. We found that sleep duration, but not SJL, was associated with temperament and may impact daytime behavior of young children., Citation: Giannoumis M, Mok E, Borkhoff CM, et al. Association of accelerometry-derived social jetlag and sleep with temperament in children less than 6 years of age. J Clin Sleep Med . 2022;18(8):1993-1999., (© 2022 American Academy of Sleep Medicine.)

Objective: Emotional problems such as anxiety and low mood have been associated with sleep problems in children. The study's objectives were to 1) assess the association between sleep duration and internalizing symptoms (anxiety and low mood) in children aged 5-12 years (y), and 2) evaluate whether insufficient sleep according to the National Sleep Foundation (NSF) guidelines is associated with internalizing symptoms., Methods: A cross-sectional study of N =796 children aged 5-12y, recruited from primary care physicians' offices in Toronto, Canada was conducted through the TARGet Kids! research network. Using linear regression, we investigated 1) the cross-sectional association between parent reported 24-hour sleep duration (hours) and parent reported symptoms using the Strengths and Difficulties Questionnaire (SDQ), controlling for child age, sex, family income, maternal education, family composition, and standardized body-mass index (zBMI). The analysis was repeated using insufficient sleep per NSF guideline as the independent variable., Results: Sleep duration was inversely associated with internalizing symptoms, B estimate = -0.33 (95%CI -0.57, -0.07), p=0.012. Twenty-eight (14%) children aged 5 y, and 36 (6%) of those aged 6-12y, experienced insufficient sleep. There was a trend toward association between insufficient sleep and internalizing symptoms, B estimate = 0.64 (-0.09, 1.38), p=0.086., Conclusion: The relationship between insufficient sleep and internalizing symptoms among children requires further elucidation. Children who show internalizing symptoms may benefit from interventions supporting sleep., Competing Interests: Conflicts of Interest The authors have no financial relationships or other ties to disclose., (Copyright © 2022 Canadian Academy of Child and Adolescent Psychiatry.)

Surface plasmon resonance (SPR) is a label-free, real-time bio-sensing technique with high potential in the diagnostic area, especially when a signal amplification strategy is used to improve the detection limit. We report here a simple method for enhancing the detection limit of bovine serum albumin (BSA), by attaching gold nanorods (AuNRs). AuNRs were obtained by a seedless synthesis technique and characterized using scanning electron microscopy (SEM), UV-VIS spectroscopy, FT-IR spectroscopy and dynamic light scattering (DLS). Finite element method (FEM) simulations were employed to explore the enhancement of the SPR signal by adding AuNRs on the SPR sensor's metallic layer. SPR spectroscopy was used to analyze the changes in the refractive index brought by the immobilization of unconjugated BSA and BSA modified with AuNRs. The results confirmed that the AuNRs conjugated with the protein increase the SPR signal ~ 10 times, leading to a limit of detection of 1.081 × 10 -8  M (0.713 μg/mL)., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents' and children's needs to support sleep during the pandemic., Methods: Eighty-five Canadian parents with children aged 4-14 years participated in this explanatory sequential, mixed-methods study using an online survey of children's and parents' sleep, with a subset of 16 parents, selected based on changes in their children's sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial., Results: While some parents perceived their child's sleep quality improved during the COVID-19 pandemic (14.1%, n = 12), many parents perceived their child's sleep had worsened (40.0%, n = 34). Parents attributed children's worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children's and parents' sleep., Conclusions: The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children's sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Study Objectives: Sleep-disordered breathing (SDB) is common in patients with neuromuscular disorders (NMD), developing before chronic hypercapnia appears. Polysomnography (PSG) is the diagnostic gold standard but is often impractical and poorly accessible for individuals with NMD. We sought to determine the diagnostic accuracy, feasibility, and patient preference of home sleep apnea testing (HSAT) compared with PSG for the detection of SDB in NMD., Methods: Participants with NMD at risk for SDB aged ≥ 13 years underwent HSAT followed by overnight PSG with concomitant laboratory sleep apnea testing (same device as HSAT). Sensitivity and specificity were calculated for standard apnea-hypopnea index cutoffs for mild (≥ 5 events/h), moderate (≥ 15 events/h), and severe SDB (≥ 30 events/h) and for an oxygen desaturation index ≥ 5 events/h. Receiver operating characteristic curves were built. A questionnaire assessed patient preference., Results: Of 38 participants, 73% had moderate to severe SDB and 79% had technically acceptable HSAT. For an apnea-hypopnea index ≥ 15 events/h, HSAT sensitivity and specificity were 50% and 88%, respectively. For an oxygen desaturation index ≥ 5 events/h, HSAT sensitivity and specificity were 95% and 78%, respectively. The area under the receiver operating characteristic curve for an apnea-hypopnea index ≥ 15 events/h was 0.88 (95% confidence interval, 0.69-1.00) for HSAT. The HSAT underestimated the apnea-hypopnea index from PSG (bias, -10.7 ± 15.9 events/h). HSAT was preferred to PSG by 61% of participants., Conclusions: HSAT is feasible, preferred by patients, and reliable for detecting SDB in most patients, although it cannot definitively rule out SDB. Therefore, HSAT is a viable diagnostic approach for SDB in NMD when PSG is not feasible, recognizing that it does not accurately distinguish between upper-airway obstruction and hypoventilation. Additional work is needed to further optimize home sleep testing in NMD., Citation: Westenberg JN, Petrof BJ, Noel F, et al. Validation of home portable monitoring for the diagnosis of sleep-disordered breathing in adolescents and adults with neuromuscular disorders. J Clin Sleep Med. 2021;17(8):1579-1590., (© 2021 American Academy of Sleep Medicine.)

Two protoporphyrin IX (PpIX) adamantane derivatives were synthesized and then metallated with zinc. The Zn-PpIX derivatives, exhibiting a high singlet oxygen quantum yield, were tested for their photodynamic activity against the HT-29 cell line. In order to enhance their water-solubility and their cellular bioavailability, these photosensitizers were encapsulated into the hydrophobic cavity of cyclodextrins (CD) previously attached to cellulose nanocrystals (CNCs) via electrostatic interactions. Under illumination, the encapsulated adamantanyl-porphyrins exerted an enhanced in vitro cytotoxicity, as compared with the corresponding free photosensitizers., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: The 'Developmental Origins of Health and Disease' hypothesis suggests that a healthy trajectory of growth and development in pregnancy and early childhood is necessary for optimal health, development and lifetime well-being. The purpose of this paper is to present the protocol for a randomised controlled trial evaluating a preconception-early childhood telephone-based intervention with tailored e-health resources for women and their partners to optimise growth and development among children in Canada: a Healthy Life Trajectory Initiative (HeLTI Canada). The primary objective of HeLTI Canada is to determine whether a 4-phase 'preconception to early childhood' lifecourse intervention can reduce the rate of child overweight and obesity. Secondary objectives include improved child: (1) growth trajectories; (2) cardiometabolic risk factors; (3) health behaviours, including nutrition, physical activity, sedentary behaviour and sleep; and (4) development and school readiness at age 5 years., Method and Analysis: A randomised controlled multicentre trial will be conducted in two of Canada's highly populous provinces-Alberta and Ontario-with 786 nulliparous (15%) and 4444 primiparous (85%) women, their partners and, when possible, the first 'sibling child.' The intervention is telephone-based collaborative care delivered by experienced public health nurses trained in healthy conversation skills that includes detailed risk assessments, individualised structured management plans, scheduled follow-up calls, and access to a web-based app with individualised, evidence-based resources. An 'index child' conceived after randomisation will be followed until age 5 years and assessed for the primary and secondary outcomes. Pregnancy, infancy (age 2 years) and parental outcomes across time will also be assessed., Ethics and Dissemination: The study has received approval from Clinical Trials Ontario (CTO 1776). The findings will be published in peer-reviewed journals and disseminated to policymakers at local, national and international agencies. Findings will also be shared with study participants and their communities., Trial Registration Number: ISRCTN13308752; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Study Objectives: Adults with obesity and obstructive sleep apnea (OSA) are at risk for cardiometabolic disease, and this risk likely extends to children with both conditions. Noninvasive ventilation (NIV; including continuous and bilevel positive airway pressure) is often used to treat OSA in children with obesity. The aim of this study was to examine the impact of NIV treatment on heart rate variability (HRV), as a marker of cardiovascular risk, in children with obesity and newly diagnosed OSA., Methods: A prospective multicenter cohort study was conducted in children with obesity prescribed NIV therapy for newly diagnosed moderate-severe OSA. Measurements of HRV were derived from polysomnography recordings at baseline and after 12 months of treatment. HRV parameters were examined by sleep stage, before and after arousal and oxygen desaturation events. HRV parameters were compared between time points using pair t tests as well as mixed model analysis., Results: Twelve children had appropriate data for analysis at baseline and 12 months. Heart rate decreased by 4.5 beats/min after NIV treatment, with no change in HRV parameters. HRV parameters differed by sleep stage and showed an increase in arousal-related sympathetic-parasympathetic balance after 12 months of NIV treatment. HRV parameters did not differ before and after oxygen desaturation events., Conclusions: NIV for the treatment in children with obesity and OSA resulted in a small decrease in heart rate and an increase in arousal-related sympathetic-parasympathetic balance. These findings suggest small, potentially positive impacts of NIV on cardiovascular risk in children with concurrent obesity and OSA., (© 2020 American Academy of Sleep Medicine.)

Background/aims: Insomnia is highly prevalent in children with neurodevelopmental disorders (NDDs), yet little research exists on sleep treatment access, utilization, and provision in this population. This study explores barriers and facilitators to access, use, and provision of treatment for sleep problems as experienced by parents of children with NDDs, including Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), Cerebral Palsy (CP) and Fetal Alcohol Spectrum Disorder (FASD), and health care professionals who work with children with these conditions., Method: Transcripts from online focus groups and interviews, conducted separately with parents of children with NDDs (n = 43) and health care professionals (n = 44), were qualitatively analyzed using content analysis for key themes., Results: Barriers included limited access to/availability of treatment, lack of knowledge/training, NDD-specific factors (e.g., symptoms, medications, and comorbidities), parent factors (e.g., capacity to implement treatment, exhaustion), and the challenging, intensive nature of sleep treatment. Facilitators included positive beliefs and attitudes, education, support, and ability to modify treatments for NDD symptoms. Barriers and facilitators were similar across all four NDDs., Conclusions: Results highlight a need for more education about sleep in NDDs and to develop accessible interventions, as well as the potential of a transdiagnostic approach to sleep treatment in this population., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Study Objectives: Positive airway pressure (PAP) is used to treat children with concurrent obesity and sleep-disordered breathing (SDB), but achieving adherence remains challenging. We aimed to identify factors associated with PAP adherence in a prospective cohort of children with obesity prescribed PAP for newly diagnosed SDB., Methods: A questionnaire to assess factors related to PAP adherence was administered to participants and their parent ≥12 months after enrollment. Adherence (PAP use ≥4 hours/night on >50% of nights) was measured with PAP machine downloads, diaries, and physician assessments. Questionnaire responses were compared between adherent/nonadherent participants and between children/parents. Age, total and obstructive apnea-hypopnea index (OAHI), lowest oxygen saturation, and highest carbon dioxide were compared between adherent/nonadherent children with univariate differences of medians, with 95% confidence intervals., Results: Fourteen children (median age: 14.3 years; 93% male; all with obstructive sleep apnea) were included. Eleven (79%) were adherent to PAP. SDB symptom improvement was reported in 9 of 14 children (64%); 8 of 14 children (57%) had positive experiences with PAP. Most children assumed an active role in PAP initiation and felt supported by the clinical team. Responses between adherent/nonadherent groups and between children/parents were similar. Oxygen saturation nadir (median difference between nonadherent and adherent groups: 8.9%; 95% confidence interval: 1.7, 16.1), but not age, apnea-hypopnea index, OAHI, or maximum carbon dioxide, was associated with PAP adherence., Conclusions: Children with obesity-related SDB with lower nocturnal oxygen saturation nadir were more likely to adhere to PAP therapy. Ensuring adequate understanding of PAP therapy and medical team support are key factors in PAP success., (© 2020 American Academy of Sleep Medicine.)

Introduction: Cow's milk is a dietary staple for children in North America. Though clinical guidelines suggest children transition from whole (3.25% fat) milk to reduced (1% or 2%) fat milk at age 2 years, recent epidemiological evidence supports a link between whole milk consumption and lower adiposity in children. The purpose of this trial is to determine which milk fat recommendation minimises excess adiposity and optimises child nutrition and growth., Methods and Analysis: Cow's Milk Fat Obesity pRevention Trial will be a pragmatic, superiority, parallel group randomised controlled trial involving children receiving routine healthcare aged 2 to 4-5 years who are participating in the TARGet Kids! practice-based research network in Toronto, Canada. Children (n=534) will be randomised to receive one of two interventions: (1) a recommendation to consume whole milk or (2) a recommendation to consume reduced (1%) fat milk. The primary outcome is adiposity measured by body mass index z-score and waist circumference z-score; secondary outcomes will be cognitive development (using the Ages and Stages Questionnaire), vitamin D stores, cardiometabolic health (glucose, high-sensitivity C-reactive protein, non-high density lipoprotein (non-HDL), low density lipoprotein (LDL), triglyceride, HDL and total cholesterol, insulin and diastolic and systolic blood pressure), sugary beverage and total energy intake (measured by 24 hours dietary recall) and cost effectiveness. Outcomes will be measured 24 months postrandomisation and compared using analysis of covariance (ANCOVA), adjusting for baseline measures., Ethics and Dissemination: Ethics approval has been obtained from Unity Health Toronto and The Hospital for Sick Children. Results will be presented locally, nationally and internationally and published in a peer-reviewed journal. The findings may be helpful to nutrition guidelines for children in effort to reduce childhood obesity using a simple, inexpensive and scalable cow's milk fat intervention., Trial Registration Number: NCT03914807; pre-results., Competing Interests: Competing interests: JLM received an unrestricted research grant for a completed investigator-initiated study from the Dairy Farmers of Canada (2011–2012) and Ddrops provided non-financial support (vitamin D supplements) for an investigator initiated study on vitamin D and respiratory tract infections (2011–2015)., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Sleep problems, particularly insomnia, are highly prevalent in children with neurodevelopmental disorders (NDD) and can negatively affect health and development. eHealth interventions may increase access to evidence-based care for insomnia for children with NDD, as programs are rare in most communities. Better Nights, Better Days (BNBD) is an online, parent-implemented intervention for pediatric insomnia in typically developing 1- to 10-year-olds., Aims: The present study examined whether parents of children with NDD perceived the original BNBD to be usable, acceptable, and feasible, and what modifications might be necessary to adapt it for children with NDD., Methods and Procedures: Twenty Canadian parents/caregivers of children aged 4-10 years with NDD and insomnia implemented the BNBD intervention with their children, and completed usability questionnaires. Questionnaire data were analyzed quantitatively (descriptive statistics) and qualitatively (thematic analysis)., Outcomes and Results: Participants reported the intervention to be usable, useful, acceptable, and feasible. Several modifications were suggested to make the intervention more appropriate and acceptable for use with children with NDD., Conclusions and Implications: Results support a largely transdiagnostic approach to treating sleep in children with NDD, and will inform the development of BNBD for Children with Neurodevelopmental Disorders (BNBD-NDD)., Competing Interests: Declaration of Competing Interest Should the Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) intervention prove to be effective after a randomized controlled trial, we will pursue commercialization of the intervention in order to ensure its sustainability and access., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The main goal of this paper is to give some primal and dual Karush-Kuhn-Tucker second-order necessary conditions for the existence of a strict local Pareto minimum of order two for an inequality-constrained multiobjective optimization problem. Dual Karush-Kuhn-Tucker second-order sufficient conditions are provided too. We suppose that the objective function and the active inequality constraints are only locally Lipschitz in the primal necessary conditions and only strictly differentiable in sense of Clarke at the extremum point in the dual conditions. Examples illustrate the applicability of the obtained results., (© Springer Science+Business Media, LLC, part of Springer Nature 2020.)

Background: Children with cerebral palsy (CP) may be at risk of behavioral difficulties., Aims: 1) Determine the prevalence of behavioral difficulties in preschool- and school-aged children with CP and 2) Assess the association between behavioral difficulties and a) sleep problems, b) nighttime pain and c) child characteristics (age, CP phenotype, comorbidities)., Methods and Procedures: Caregivers of 113 children with CP aged 4-12 years [mean (SD) age = 7.4 (2.5) years; 61.9% male] completed the Strengths and Difficulties Questionnaire, Sleep Disturbance Scale for Children and a sleep quality questionnaire to assess child behavior, sleep and nighttime pain, respectively., Outcomes and Results: 25.6% of children (17.6% preschool-aged; 29.1% school-aged) had behavioral difficulties. Sleep problems (odds ratio [OR] 9.1, 95% confidence interval [CI] 3.4-24.4) and nighttime pain (OR 4.1, 95% CI 1.5-11.5) were associated with behavioral difficulties. Sleep problems remained significantly associated with behavioral difficulties (adjusted OR 7.5, 95% CI 2.6-21.4) when adjusted for nighttime pain, age and non-ambulatory status., Conclusions and Implications: Behavioral difficulties were reported in one in four children with CP and were associated with sleep problems and nighttime pain. Identifying and treating behavioral difficulties, sleep problems or nighttime pain is important in the care of children with CP., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Up to 85% of children with neurodevelopmental disorders have sleep problems, compared with 25% of typically developing children. Children with cerebral palsy (CP)may have risk factors (brain injury, physical disability, and comorbidities) that make them more likely to have sleep problems compared with typically developing children., Objective: To determine prevalence of sleep problems in children with CP., Methods: We conducted a systematic review and meta-analysis to report on the prevalence of sleep problems in children with CP, within subgroups (age, CP phenotype, presence of impairments [auditory, visual, and cognitive], and presence of epilepsy) and compared with control groups of healthy children. We searched eight relevant electronic databases from their respective start dates until September 2018., Results: 23 full-text articles (n=2,908 children with CP) were included in the review. All studies were cross-sectional and examined caregiver-reported sleep measures. The Sleep Disturbance Scale for Children (SDSC) was the most commonly used questionnaire. No study met all Joanna Briggs Institute quality assessment criteria for prevalence studies; selection, coverage, classification, and/or confounding biases were present in all studies. Using a random effects model with a Freeman-Tukey double arcsine transformation, the pooled prevalence was 23.4% (95% confidence interval [CI] 18.8-28.4%; n=9 studies) for an abnormal total score on the SDSC and 26.9% (95% CI 21.5-32.7%; n=9 studies) for disorders of initiation and maintenance of sleep, the most prevalent sleep problem reported. For the studies that reported prevalence for control groups of healthy children (n=4 studies), sleep problems were generally more prevalent in the CP group., Conclusion: The prevalence of sleep problems in children with CP is high. There is notable variability in the prevalence of sleep problems between subgroups of children with CP. Future studies using questionnaires validated in children with CP and objective measures (such as polysomnography or actigraphy) in well-described, large, broadly recruited samples are recommended., (Copyright © 2019 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: The learning benefits associated with residents teaching peers and junior trainees are well documented. However, the concept of Reverse Educational Distance (RED), when residents teach an academically senior audience, is poorly described. Methods: We explored Pediatric residents' and community health care providers' (cHCPs) perceptions of a RED teaching intervention, whereby residents would engage in teaching cHCPs. We explored the anticipated learning benefits, challenges, and ways to optimize its implementation in a residency program. We conducted a descriptive qualitative study with focus groups. We also compared RED with the traditional Resident-As-Teacher (RAT) approach from a theoretical framework perspective. Results: Benefits anticipated by residents included: (1) optimizing their incentive to learn; (2) focusing on the practical 'real-world application' of knowledge; and (3) a better understanding of community practice. Benefits anticipated by cHCPs included: (1) being updated on evidence-based practices; and (2) improving collaboration between cHCPs and future pediatricians. The major anticipated challenge was the residents' lack of clinical experience, for which key solutions were proposed. Conclusions: Engaging residents in teaching cHCPs could lead to enhanced and unique learning benefits compared to the traditional RAT approach. RED is a promising strategy for RAT curricula aiming at best preparing trainees for their future role as educators.

Objectives/background: This paper outlines the current state of Canadian training, clinical services, research, and advocacy initiatives related to non-respiratory sleep disorders, with a specific focus on insomnia, the most common sleep problem in children., Methods: Information for this narrative review was collected from peer-reviewed publications, web-resources, and personal communications and experiences., Results: It is estimated that approximately one-third of Canadian children and youth present with insomnia, and that this is impacting their physical and mental health, as well as learning in school. Training in pediatric sleep is limited and highly inconsistent within and across disciplines. While there are some publicly and privately funded pediatric sleep services available, these are mostly focused on respiratory sleep problems and are not equally accessible across the country., Conclusions: Pediatric assessment and treatment services for non-respiratory sleep disorders needs to be more integrated into the Canadian health care system., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: To evaluate, in Canadian children with cerebral palsy (CP): (1) health-related quality of life (HRQoL) as well as (2) associations between HRQoL and (a) sleep problems, (b) nighttime pain, and (c) child characteristics (eg, age, CP phenotype, comorbidities)., Methods: Children aged 3-12 years were recruited from neurology clinics and a provincial CP registry. Caregivers completed the Pediatric Quality of Life Inventory (PedsQL) Generic Core and CP Modules as well as the Sleep Disturbance Scale for Children (SDSC) to assess HRQoL and sleep, respectively. Child characteristics were extracted from hospital records and registry data., Results: A total of 146 children with CP (mean age ± standard deviation: 6.9 ± 2.9 years) completed the study. Impaired HRQoL (scores more than 2 SDs below the normative population mean) on the PedsQL Total, Physical and Psychosocial Health scales was found in 33.6%, 38.4% and 17.6% of children, respectively. Non-ambulatory status, sleep problems and significant comorbidity were the strongest predictors of impaired Total HRQoL, with odds ratios (95% confidence intervals) of 30.1 (8.2-110.4), 3.8 (1.1-12.5) and 3.3 (1.2-9.2), respectively, adjusted for young age (5-7 years) and nighttime pain. Non-ambulatory status and sleep problems exclusively increased the risk of impaired physical and psychological health, respectively, with adjusted ORs (95% CIs) of 58.3 (11.9-284.5) and 7.5 (2.5-22.5). More severe sleep problems were associated with worse pain-related HRQoL., Conclusions: Sleep, non-ambulatory status and presence of comorbidities are important determinants of HRQoL in children with CP. Monitoring sleep, psychosocial functioning and pain is important in this population, as their management should improve HRQoL., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Children with neurodevelopmental disorders (NDD) are at high risk for sleep problems, especially insomnia. It is currently not known whether behavioural sleep interventions developed for typically developing (TD) children are effective for children with NDD, and if interventions need to be modified for each diagnostic group. The aim of this systematic review was to identify and evaluate commonalities, trends in outcomes, and the methodological quality of parent-delivered behavioural sleep interventions for children with NDD, specifically Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), Cerebral Palsy, and Fetal Alcohol Spectrum Disorder. Nine databases were searched. A total of 40 studies met eligibility criteria. The majority of studies were conducted with ASD and ADHD populations. Common sleep problems were evident across the NDD populations. The most frequently reported included bedtime resistance, night-waking, early morning awakening, and co-sleeping. The most common interventions used were implementation of healthy sleep practices, reinforcement, graduated extinction, and faded bedtime. All studies reported at least one behavioural treatment component as effective. Commonalities across NDD populations, as well as the TD population, for both sleep problems reported and behavioural interventions implemented, suggest the feasibility of developing a transdiagnostic behavioural sleep intervention suitable for children with a range of NDD., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: To determine, in preschool- and school-aged children with cerebral palsy (CP): (i) the prevalence of sleep disorders, including disorders of initiation and maintenance of sleep, and (ii) the association between child characteristics and sleep disorders., Methods: Children with CP aged 3-12 years were recruited from neurology clinics and a provincial CP registry. Caregivers completed the Sleep Disturbance Scale for Children (SDSC) and a questionnaire on sleep-related characteristics. Children's medical information was collected from the registry and hospital records., Results: 150 children with CP (mean age ± standard deviation: 6.9 ± 2.9 years) completed the study (66 preschool-and 84 school-aged children). An abnormal total score on the SDSC was found in 20.7% of children (10.6% and 28.6% of preschool-and school-aged children, respectively). Overall, 44.0% of children had one or more sleep disorder (24.2% and 59.5% in preschool-and school-aged children, respectively), as determined by subscales of the SDSC. The most common sleep problem, disorders of initiation and maintenance of sleep, was found in 26.0% of children (18.2% of preschool- and 32.1% of school-aged children, respectively). Pain was the strongest predictor of having an abnormal total score and disorders of initiation and maintenance of sleep, with odds ratios (95% confidence intervals) of 6.5 (2.2-18.9) and 3.4 (1.3-9.3), respectively, adjusted for age group and degree of motor impairment., Conclusions: Sleep disorders are prevalent in children with CP, with higher frequencies in school-aged as compared to preschool-aged children. Health care professionals caring for this population should routinely inquire about sleep problems and pain., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: To determine the scope of sleep concerns, clinical features, and polysomnography (PSG) results and to identify factors that predict obstructive sleep apnea (OSA) in a cohort of children with obesity., Methods: The study was a multicenter retrospective chart review. Data were collected from three pediatric sleep laboratories over a two year period for all children of age 8-16 years with a body mass index [BMI] ≥95th centile who were undergoing PSG. Data sources included clinical charts and PSG results. Clinical and PSG factors were examined as predictors of OSA., Results: A total of 210 children met inclusion criteria, and 205 had sufficient data for analysis. The mean age was 12.5 ± 2.7 years; and 65% were male. Multiple sleep concerns and comorbidities were reported in most children (90% and 91%, respectively). OSA was identified by PSG in 44% of children; and 28% of children demonstrated moderate/severe OSA. Mouth breathing/nasal congestion (odds ratio [OR] = 0.33, 95% confidence interval [CI] = 0.18-0.61), syndrome/multiple anomalies (OR = 2.4, 95% CI = 1.22-4.93), and family history of OSA (OR = 2.7, 95% CI = 1.2-5.8) or sleep problems (OR = 12.4, 95% CI = 1.5, 99.6) were the only factors predictive of OSA. Oxygen desaturation index <6 events/h measured by PSG showed an OR of 4.96 (95% CI = 2.27-10.86) for the absence of OSA., Conclusions: Children with obesity who undergo PSG are medically complex with multiple sleep concerns including a high burden of daytime symptoms; slightly less than half of children demonstrate polysomnographic features of OSA. Earlier identification of OSA, recognition of non-OSA sleep concerns, and treatment strategies to improve sleep may contribute to overall health outcomes for children with obesity., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: To examine the feasibility and acceptability of a PICU Soothing intervention using touch, reading, and music., Design: Nonblinded, pilot randomized controlled trial., Setting: The PICU and medical-surgical wards of one Canadian pediatric hospital., Patients: Twenty PICU patients age 2-14 years old and their parents, randomized to an intervention group (n = 10) or control group (n = 10)., Intervention: PICU Soothing consisted of: 1) parental comforting (touch and reading), followed by 2) a quiet period with music via soft headbands, administered once daily throughout hospitalization., Measurements and Main Results: Acceptability and feasibility of the intervention and methods were assessed via participation rates, observation, measurement completion rates, semistructured interviews, and telephone calls. Psychological well-being was assessed using measures of distress, sleep, and child and parent anxiety in the PICU, on the wards and 3 months post discharge. Forty-four percent of parents agreed to participate. Seventy percent and 100% of intervention group parents responded positively to comforting and music, respectively. Most intervention group parents (70%) and all nurses felt children responded positively. All nurses found the intervention acceptable and feasible. Measurement completion rates ranged from 70% to 100%. Pilot data suggested lower intervention group child and parent anxiety after transfer to hospital wards., Conclusions: PICU Soothing is acceptable and feasible to conduct. Results support the implementation of a full-scale randomized controlled trial to evaluate intervention effectiveness.

Insomnia, which is related to daytime deficits and is a common problem for children with neurodevelopmental disorders (NDDs), is often successfully treated with behavioral strategies. However, there are barriers to accessing these treatments, and there has been little research examining what these interventions need to be usable and effective. The goal of this study was to gain consensus from experts in the field on the key components of an eHealth, parent-implemented, intervention program aimed at improving sleep in children with attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, and fetal alcohol spectrum disorder. This was achieved using the Delphi method, which involves asking participants to respond to open-ended questions about a topic of interest and then, in iterative rounds, to rate the recommendations that were made by the group. In the current study, participants (27 responders in the first round, 21 in the second, and 18 in the third) rated a total of 131 recommendations. Of those 131 recommendations, 52 items had high importance and high consensus and were deemed to be priority items to consider for creating an eHealth, parent-delivered, behaviorally-based intervention for insomnia in children with NDD. Furthermore, 75% (n = 84) of the 112 recommendations from the first round were believed to be applicable across all 4 NDD groups, thus providing evidence of the potential for a transdiagnostic intervention., (Copyright © 2018. Published by Elsevier Inc.)

Study Objectives: (1) To determine baseline quality of life (QOL) among children with obesity and newly diagnosed moderate-severe sleep-disordered breathing (SDB) and to compare it to the reported QOL of children with obesity or SDB alone and healthy children. (2) To evaluate QOL change after 1 year., Methods: A prospective multicenter cohort study was conducted in children (8-16 years) with obesity, prescribed positive airway pressure (PAP) therapy for moderate-severe SDB. Outcomes included parent-proxy and self-report total and subscale scores on the PedsQL questionnaire (baseline and 1-year)., Results: Total PedsQL scores were indicative of impaired QOL in 69% of cases based on parent-report and in 62% on self-report. Parents reported significantly lower QOL in our cohort than that reported in other studies for children with obesity or SDB alone or healthy children, on total PedsQL score and on social and psychosocial subscales. PedsQL total scores for participants were significantly higher (mean difference 7.3 ± 15.3, P = .03) than those reported by parents. Parents reported significant improvements in total PedsQL (mean change 7.29 ± 13.73, P = .04) and social functioning (mean change 17.65 ± 24.69, P = .04) scores after 1 year. No significant differences were found by children's self-report or by PAP adherence., Conclusions: QOL of children with obesity and SDB is lower than in children with obesity or SDB alone or healthy children. One year later, children reported no significant changes in QOL; parents reported significant improvements in total PedsQL and social functioning scores. PAP adherence did not significantly affect QOL change in this population., Commentary: A commentary on this article appears in this issue on page 307., (© 2018 American Academy of Sleep Medicine.)

Background: Glycemic control in hepatic glycogen storage diseases (GSDs) relies on specific nutritional recommendations, including strict avoidance of a fasting period. Uncooked cornstarch (UCCS) is an important therapeutic component. A new modified UCCS, Glycosade™, was created with the objective of prolonging euglycemia. We aimed to determine the length of euglycemia on Glycosade™ using a continuous glucose monitor (CGM) and to evaluate whether longer euglycemia and thus less nighttime interruptions would improve sleep and quality of life (QoL) after the introduction of the modified cornstarch., Methods: We conducted a prospective cohort study to assess quality and quantity of sleep and quality of life (QoL) in patients with GSDs on standard UCCS and after the introduction of Glycosade™. Sleep and QoL evaluation was done for patients using validated questionnaires, a standardized sleep diary and actigraphy. Length of fast and glucose variability were determined with CGM., Results: Nine adults with GSD Ia took part in the study. Glycosade™ introduction was done under close supervision during a hospital admission. Comparison of sleep in 9 patients showed sleep disturbances on standard UCCS that were improved with Glycosade™. QoL was normal both pre and post Glycosade™. The CGM confirmed maintenance of a longer fasting period with Glycosade™ at home., Conclusion: Glycosade™ represents an alternative option for GSD patients. We showed possible benefits in terms of sleep quality. We also confirmed the longer length of fast on Glycosade™., Synopsis: A new modified form of uncooked starch for patients with glycogen storage disease represents an alternative option as it showed a longer length of fast and improvements in sleep quality., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Simulation allows for learner-centered health professions training by providing a safe environment to practice and make mistakes without jeopardizing patient care. It was with this goal in mind that the McGill Medical Simulation Center was officially opened on September 14, 2006, as a partnership between McGill University, the Faculty of Medicine and its affiliated hospitals. Its mandate is to provide state-of-the-art facilities to support simulation-based medical and allied health education initiatives. Since its inception, the center, recently renamed the Steinberg Center for Simulation and Interactive Learning (SCSIL), has undergone a major expansion and logged more than 130,000 learner visits. Educational activities are offered at all levels of medical and allied health care training, and include standardized patient encounters, partial task trainers, multidisciplinary courses, and high-fidelity trainers, among many others. In addition to its educational mandate, the center also supports an active research program, programs to enhance collaboration with disciplines outside of health care to spur innovation, and community outreach initiatives., (Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Study Objectives: There is evidence that cardiometabolic disease associated with obesity and sleep-disordered breathing (SDB) in adults is present in youth. SDB is often treated with positive airway pressure (PAP) in youth with obesity. Our aims were to determine: (1) the prevalence of cardiometabolic disease and (2) whether PAP improves markers of cardiometabolic disease, in youth with obesity and newly diagnosed moderate-severe SDB., Methods: A prospective multicenter cohort study was conducted in youth (8 to 16 years old) with obesity, prescribed PAP therapy for newly diagnosed moderate-severe SDB. Assessments occurred at baseline and at 6 and 12 months. Outcomes included markers of insulin resistance (change in homeostasis model assessment of insulin resistance (HOMA-IR) at 6 months = primary outcome), hypertension (24-hour ambulatory/blood pressure) and inflammation (high-sensitivity C-reactive protein: hs-CRP)., Results: Twenty-seven participants were enrolled. Of those with baseline testing available, 10/25 (40%) had HOMA-IR above the 97th percentile, 10/23 (44%) were hypertensive, 16/23 (70%) had loss of nocturnal blood pressure dip and hs-CRP was elevated in 16/27 (64%). There were no significant changes over time in markers of metabolic dysfunction or blood pressure, nor between PAP-adherent and non-adherent subgroups., Conclusions: In youth with obesity and SDB, metabolic dysfunction and hypertension were highly prevalent. There were no statistically significant improvements in cardiometabolic markers 1 year after the prescription of PAP therapy, although clinically relevant improvements were seen in insulin resistance and systolic blood pressure load, important predictors of future risk of cardiovascular disease. Larger, longer-term studies are needed to determine whether PAP improves cardiometabolic outcomes in obese youth., Commentary: A commentary on this article appears in this issue on page 1025., (© 2017 American Academy of Sleep Medicine)

Background: Sleep disorders are prevalent in children and are associated with significant comorbidity., Objective: To assess the training, knowledge, attitudes and practices of Canadian health care providers (HCPs) regarding sleep disorders in children., Method: A 42-item survey, designed to collect information on frequency of paediatric sleep disorders-related screening and diagnosis, implementation of evidence-based interventions and related knowledge base, was completed by HCPs., Results: Ninety-seven HCPs completed the survey. One per cent obtained training in paediatric sleep during undergraduate training and 3% obtained such training during their residencies, yet 34.9% estimated that 25 to 50% of their patients suffered from sleep disorders. Most HCPs thought that sleep disorders significantly impacted children's health and daytime function. Most HCPs screened for developmental sleep issues, but not consistently for sleep disorders. Most recommended evidence-based behavioural interventions for behavioural sleep disorders, but some also reported behavioural interventions that were not first-line or recommended. Inadequate knowledge regarding melatonin use was evident. Most participants reported rarely/never ordering a sleep study for a child with suspected obstructive sleep apnea (OSA). Most were familiar with surgical and weight loss management options for OSA; many were unfamiliar with benefits of continuous positive airway pressure. Participants' knowledge scores were highest on developmental and behavioural aspects of sleep, and lowest on sleep disorders., Conclusions: HCPs exhibit significant gaps in their knowledge, screening, evaluation and treatment practices for paediatric sleep disorders. Training at the undergraduate, graduate and postgraduate levels, as well as Continuing Medical Education are needed to optimize recognition, treatment and follow-up of paediatric sleep disorders.