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Background: While the emergency department (ED) is often a first point of entry for children and youth with mental health (MH) concerns, there is a limited capacity to respond to MH needs in this setting. Child MH systems are typically fragmented among multiple ministries, organizations, and providers. Communication among these groups is often poor, resulting in gaps, particularly in transitions of care, for this vulnerable population. The evidence-based Emergency Department Mental Health Clinical Pathway (EDMHCP) was created with two main goals: (1) to guide risk assessment and disposition decision-making for children and youth presenting to the ED with MH concerns and (2) to provide a streamlined transition to follow-up services with community MH agencies (CMHAs) and other providers. The purpose of this paper is to describe our study protocol to implement and evaluate the EDMHCP.Methods/design: This mixed methods health services research project will involve implementation and evaluation of the EDMHCP in four exemplar ED-CMHA dyads. The Theoretical Domains Framework will be used to develop a tailored intervention strategy to implement the EDMHCP. A multiple baseline study design and interrupted time-series analysis will be used to determine if the EDMHCP has improved health care utilization, medical management of the MH problems, and health sector coordination. The primary process outcome will be the proportion of patients with MH-specific recommendations documented in the health record. The primary service outcome will be the proportion of patients receiving the EDMHCP-recommended follow-up at 24-h or at 7 days. Data sources will include qualitative interviews, health record audits, administrative databases, and patient surveys. A concurrent process evaluation will be conducted to assess the degree of variability and fidelity in implementation across the sites.Discussion: This paper presents a novel model for measuring the effects of the EDMHCP. Our development process will identify how the EDMHCP is best implemented among partner organizations to deliver evidence-based risk management of children and youth presenting with MH concerns. More broadly, it will contribute to the body of evidence supporting clinical pathway implementation within novel partnerships.Trial Registration: ClinicalTrials.gov ( NCT02590302 ). [ABSTRACT FROM AUTHOR]

An increasing amount of attention has been devoted to studying the impact of non-native plant and animal species on native species. In this paper, we examined the antipredator response of naïve European brown frog (Rana temporariaLinnaeus, 1758) tadpoles to water-borne chemical cues from invasive red-eared slider turtles (Trachemys scripta elegansWied, 1838) in the presence and the absence of conspecific tadpoles. The level of swimming activity was expressed as the length of the tadpoles’ trajectory. The tadpoles showed a decrease in swimming activity when predator stimuli were present, which was highly significant when the tadpoles were measured individually and did not have contact (visual and chemical) with other tadpoles. In the absence of chemical cues of slider turtles, the presence of other tadpoles had no effect on the level of swimming activity. Moreover, for the first time in tadpoles, we found that the decrease in swimming activity was also accompanied by changes in swimming trajectory, with tadpoles exposed to predator cues swimming in more zigzagged trajectories. Our experiment shows that invasive slider turtles, as a novel predator, have a measurable influence on the swimming behaviour of European brown frog tadpoles. Consequences of the reduced swimming activity of tadpoles, like its impact on growth, are discussed. [ABSTRACT FROM AUTHOR]

Background: Physical activity optimizes children's health but current tools cannot identify children, under 15 years, with medically necessary activity restrictions. Expert consensus was that medically necessary activity restrictions should be identified by asking parents, "Has a healthcare provider told you that there are some types of physical activity that your child should not do?" This study evaluated the sensitivity, specificity, and reliability of this proposed question. Methods: Parents of children 3 to 14 years old who visited the Children's Hospital of Eastern Ontario from June to August, 2015, were approached and asked to answer the proposed question along with 9 distractor questions. A second survey sent 7 days later evaluated response reliability. Sensitivity and specificity were assessed comparing parent-reported activity restrictions to information obtained from each child's treating physician. Results: A total of 200 initial parent surveys were collected (Rheumatology=34, Rehabilitation=11, Cardiology=52, Emergency Department=31, Respirology=22, Neurology=50), 74 of which completed the second survey. The sensitivity, specificity, and reliability of the question of interest were 27%, 94%, and 93%, respectively. Low sensitivity occurred among patients seen in the epilepsy (n=19) and rehabilitation (neuromuscular=8; spina bifida=2; chronic pain=1)) clinics. Excluding these patients, sensitivity was 86%. Agreement beyond what would be expected by chance was found for parents' and corresponding treating physician's answers to the question (Kappa = 0.25, p<.0005) and parents' answers on the first and second survey (Kappa = 0.7, p<.0005). Discussion: Misunderstanding of the question occurred routinely among epilepsy and rehabilitation medicine patients, resulting in overall low sensitivity. Many parents recruited from these clinics focused on the word "types" in the question of interest. Alternative wording of the question, such as focusing more broadly on how physical activities are performed and supervised, is required for identifying activity restrictions in children with physical disabilities or epilepsy. The current question effectively identified children requiring physical activity restrictions in cardiology, respirology, rheumatology, and emergency medicine clinics, with overall sensitivity, specificity, and Kappa calculations being 86%, 95%, and 0.55 (p<.0005), respectively. Future research should examine modified question wording in a larger and more diverse sample of children with medical conditions. [ABSTRACT FROM AUTHOR]

Introduction: Oral corticosteroids are the cornerstone of acute asthma management in the emergency department. Recent evidence has raised doubts about the efficacy of this treatment in preschool-aged children with viral-induced wheezing and in smoking adults. The aims of the study were to: (1) document the magnitude of response to oral corticosteroids in children presenting to the emergency department with moderate or severe asthma; (2) quantify potential determinants of response to corticosteroids and (3) explore the role of gene polymorphisms associated with the responsiveness to corticosteroids. Methods and analysis: The design is a prospective cohort study of 1008 children aged 1-17 years meeting a strict definition of asthma and presenting with a clinical score of ≥4 on the validated Pediatric Respiratory Assessment Measure. All children will receive standardised severity-specific treatment with prednisone/prednisolone and cointerventions (salbutamol with/without ipratropium bromide). Determinants, namely viral aetiology, environmental tobacco smoke and single nucleotide polymorphism, will be objectively documented. The primary efficacy endpoint is the failure of emergency department (ED) management within 72 h of the ED visit. Secondary endpoints include other measures of asthma severity and time to recovery within 7 days of the index visit. The study has 80% power for detecting a risk difference of 7.5% associated with each determinant from a baseline risk of 21%, at an a of 0.05. Ethics and dissemination: Ethical approval has been obtained from all participating institutions. An impaired response to systemic steroids in certain subgroups will challenge the current standard of practice and call for the immediate search for better approaches. A potential host-environment interaction will broaden our understanding of corticosteroid responsiveness in children. Documentation of similar effectiveness of corticosteroids across determinants will provide the needed reassurance regarding current treatment recommendations. Results: Results will be disseminated at international conferences and manuscripts targeted at emergency physicians, paediatricians, geneticists and respirologists. Trial registration number: This study is registered at Clinicaltrials.gov (NCT02013076). [ABSTRACT FROM AUTHOR]

Laboratory experiments were conducted to assess the efficiency of the new strain CCM 8367 ofIsaria fumosoroseaon different stages of the Egyptian cotton leafworm,Spodoptera littoralis(Boisd.), including soil treatments with pre-pupal and pupal stages. Treatments of larval instars showed a high susceptibility with 3rd, 5th and last instars to suspension of this fungus with concentration 5 × 107spores/ml. Larval mortality was over 90%. There were no significant differences (P = 0.7929,F = 0.2346) between instar treatments. The commercial fungus, PreFeRal® strain Apopka 97 ofI. fumosorosea, which was used in comparison with this new strain caused mortality rates of between 63.33 and 90%. Statistically, differences between the effects of CCM 8367 strain and Apopka 97 were highly significant on the last instar (P = 0.0064,F = 6.479) and extremely significant on the 3rd instar (P < 0.0001,F = 13.29). No significant differences were recorded between the two strains on the 5th instar (P = 0.0597,F = 3.233). Fungal treatments with the late stage insects (end of the last instar or pupal stage) in soil yielded interesting results: the mortality rate on end of final instar larvae was 16.66% when treated with Apopka 97 and 83.33% when treated with CCM 8367. Soil containing pupae ofS. littoralisthat were inoculated with CCM8367 resulted in a high number of malformed adults, and the mortality rate was 64.52% (32.27% of malformed adults died and 32.25% of pupae fully infected by fungus). Only 3.23% of samples produced morphologically normal adults in this test. The results conclude that the strain ofI. fumosoroseaCCM 8367 has strong insecticidal effects onS. littoralisand has the potential to be implemented as a novel biocontrol agent. [ABSTRACT FROM AUTHOR]

Prey consumption byTyphlodromus pyriScheuten was studied in the presence and absence of apple powdery mildew,Podosphaera leucotricha(Ell. and Everh.) under constant laboratory conditions. Eggs ofTetranychus urticaeKoch were offered to predatory mites as a prey. Seven densities ranging from five to 100T. urticaeeggs per arena were used. Mildew conidia (approximately 0.5 mg) were added to half of the arenas by brushing them from infected apple leaves. A single adult female ofT. pyriwas introduced onto each arena and number of prey eggs consumed was counted 12 h later when the predator was offered newT. urticaeeggs again and the procedure was repeated once. Data showed that predators consumed in both experimental periods nearly all prey in experiments with densities up to 40 eggs per arena and no mildew. However, the number of eggs consumed decreased more than twofold when mildew conidia were supplied, even at high prey densities. Differences in predation rate between treatments with and without mildew were highly significant. The results thus indicate that availability of mildew as an alternative food can reduce prey suppression byT. pyri. Possible implications of these findings in biological control of spider mites by generalist predatory mites are discussed. [ABSTRACT FROM AUTHOR]

The sexual activity of long-winged (macropterous) and short-winged (brachypterous) adult males and females of Pyrrhocoris apterus (L.) from a temperate opulation (Czech Republic) were compared. The long-term arena tests revealed postponed sexual maturation and lower sexual activity (longer precopulatory period, longer inter-copulatory period, lower copulation frequency and shorter total duration of copulations) of macropterous pairs when compared with brachypterous pairs of the same age. The total sexual activity of both macropterous and brachypterous pairs increased with the age of the adults, but was significantly lower in the macropterous pairs. The short-term tests showed that the lowered mating propensity of macropterous pairs was mainly due to a decrease in the sexual receptivity of the females. It is the first demonstration of wing morph-related differences in the mating activity of P. apterus females and a first report of a mating disadvantage in the macropterous morph of a wingpolymorphic insect whose macropterous specimens have evolved flightlessness. Evolutionary transformation of the “oogenesis-flight” syndrome, that occurs in flying insects, into an “oogenesis-walking” syndrome in the flightless macropters of P. apterus is discussed. [ABSTRACT FROM PUBLISHER]

Background: Academic hospitals combine clinical care, research and teaching. It is expected that patients will be seen by trainees (implied consent) but how patients are approached for research varies. Research may be integrated within the clinic setting or a distinct entity. Little is known about parent perceptions of research and teaching activities at academic hospitals, and whether perceptions differ by medical condition. Methods: Surveys of parents of children attending a tertiary care hospital. Four questions asked willingness to be approached for a) research or b) teaching, either i) during the hospital visit or ii) at home. Responses were always willing, probably willing, depends on specific request, not prior to discussion with the child's physician, not willing to be approached.Results: 158 parent surveys collected from parents of children, 3 to 14 years, with chronic illnesses (rheumatology (n=34), cardiology (n=52), respirology (n=22), neurology (n=50)), physical disabilities (rehabilitation (n=8), spina bifida (n=2) chronic pain (n=1)) or seen in the emergency department (n=31). 87%/91% of illness/disability parents, respectively, would always/probably be willing to have their child seen by a trainee, compared to 74% of emergency parents. Always/probably willing to participate in trainee education outside clinic visit was 50%, 63% and 42% among illness, disability and emergency parents. 72%/92% of illness/disability parents were always/probably willing to be approached for research during the clinic visit, compared to 55% of emergency parents. Contact at home regarding research differed significantly between groups (p=0.02). 76%/92% of illness/disability parents were always/probably willing, versus 52% of emergency parents. 7% of emergency parents would never want their child seen by a trainee or to be approached for research compared to <2% of illness/disability parents.Discussion: Parents have positive attitudes towards both education and research activities during the clinic visit. Support for research is similarly strong among parents of children with a chronic illness or disability approached at home. These results indicate that parents view both research and education in a similar fashion. Clinicians who follow children with a chronic illness or disability should contact families regarding research opportunities, either in clinic or at home. [ABSTRACT FROM AUTHOR]

Examines the locomotor activity of adult males and females of short-winged and long-winged flightless bug. Measurement of the walking activity; Analysis on the physiological status of bugs; Study on the locomotor activity of female bugs.

Abstract. Macropterous females of Pyrrhocoris apterus (L.) reared under short-day conditions (LD 12:12 h) were analysed for temporal patterns of feeding and drinking behaviour, activities of digestive enzymes in the gut, and lipid and glycogen content in the haemolymph and fat body. Peaks of drinking activity were recorded at days 3, 7 and 10 during the first 14 days after imaginal ecdysis. Feeding activity peaked on the third day, ceasing completely after the fourth day of adult life. Esterase, protease, amylase and aminopeptidase activities exhibited the highest overall activity in the first days after imaginal emergence; then enzyme activities decreased. In the fat body, the content of lipids was highest on day 5, then a decrease of about 40% was observed at day 14; the amount of glycogen was highest on day 1 at 11 μg of glucose equivalents/mg of fat body, then decreased to 2 μg at day 14 after the imaginal moult. In the haemolymph, the lipid content rose until day 8 when it reached almost 0.3 μmol/μl; at day 14 the value was slightly lower. The association of fasting with reproductive arrest in macropterous females of P. apterus , accompanied by a decrease in digestive enzyme activities and a mobilization of lipid reserves from the fat body, was demonstrated. [ABSTRACT FROM AUTHOR]

Understanding the lethal and sublethal impacts of pesticides on biocontrol agents is crucial for the successful implementation of integrated pest management (IPM) programs. This study investigated the sublethal effects of fenpyroximate, a broad-spectrum acaricide/insecticide, on the fitness of Scolothrips longicornis Priesner (Thysanoptera: Thripidae), a key predator of the two-spotted spider mite, in controlled laboratory environments. Adult predators were exposed to pesticide residues on leaf discs to estimate parameters of concentration-mortality response models for females and males and calculate median lethal concentration (LC 50 ) as well as sublethal concentrations (LC 10 , LC 20 and LC 30 ) used in subsequent bioassays. The estimated LC 50 values for female and male predators were 18.32 and 15.49 µg a.i./mL, respectively. Results of sublethal concentrations experiments did not reveal any significant impact on the development of each stage or the survival rate of S. longicornis juveniles compared to those in the control group. However, the longevity of adult males and females was significantly lower at all sublethal concentrations than in the control. Moreover, the fecundity decreased significantly at all sublethal concentration treatments. With one exception (LC 10 ), both the adult preoviposition period and total preoviposition period increased with increasing sublethal concentrations compared to those of the control. The shortest oviposition period (9.30 days) was observed at the LC 30 . For the life table parameters of S. longicornis females treated with sublethal concentrations, a significant decrease was found in the intrinsic rate of increase, net reproductive rate and finite rate of increase, whereas the mean generation time in the LC 10 treatment was lower than that in the other treatments. This underscores the imperative need to consider sublethal concentration effects of fenpyroximate in the strategic design and implementation of IPM systems., Competing Interests: Compliance with ethical standards. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Importance: There is limited research on clinical features and symptom recovery from sport-related concussion (SRC) and non-SRC in younger children., Objective: To investigate the trajectory of symptom recovery in children aged 5 to 7 years and 8 to 12 years with SRC and non-SRC at 1, 2, 4, 8, and 12 weeks postinjury., Design, Setting, and Participants: This secondary analysis of a prospective multicenter cohort study (Predicting and Preventing Postconcussive Problems in Pediatrics) included participants aged 5 to 12 years with acute concussion who presented to 9 pediatric emergency departments within the Pediatric Emergency Research Canada network between August 2013 and June 2015. Analyses were conducted from September 2023 to May 2024., Exposure: Participants had a concussion consistent with the Zurich consensus diagnostic criteria and 85% completeness of the Post-Concussion Symptom Inventory (PCSI) at each time point., Main Outcomes and Measures: The primary outcome was symptom change, defined as current minus preinjury ratings 1, 2, 4, 8, and 12 weeks postinjury, measured using the PCSI. Symptoms were self-rated for children aged 8 to 12 years and child- and parent-rated for children aged 5 to 7 years. Mixed-effect models were conducted using total PCSI score adjusting for random effects; fixed-effect indicators included injury setting (SRC and non-SRC), time, injury setting × time, and other variables associated with recovery., Results: A total of 1747 children, including 513 aged 5 to 7 years (mean [SD] age, 6.57 [0.85] years; 320 male [62.4%]) and 1234 aged 8 to 12 years (mean [SD] age, 10.68 [1.40] years; 806 male [65.3%]) were recruited, of whom 477 aged 5 to 7 years and 1157 aged 8 to 12 years were included in the analysis. Of those included in the analysis, 207 aged 5 to 7 years (43.4%; mean [SD] age, 6.68 [0.84] years; 142 male [68.6%]) and 790 aged 8 to 12 years (67.2%; mean [SD] age, 10.77 [1.40] years; 547 male [69.2%]) sustained an SRC. No significant differences in recovery curves across time postinjury were found between those with SRC and non-SRC (5-7 years: β = -0.09; 95% CI, -1.10 to 0.92; 8-12 years: β = 0.11; 95%CI, -1.50 to 1.70)., Conclusions and Relevance: In this cohort study of children aged 5 to 12 years with an acute SRC or non-SRC, symptom recovery trajectories over time were similar in both groups. This finding suggests similar management protocols can be used for sport and nonsport mechanisms of injury (excluding assault and motor vehicle crash) in the younger population.

Context: Clinical concussion assessments do not typically simulate the speed or complexity of sport. Performance changes arising from combined physical, cognitive, and sensory demands of sport may thus remain undetected during rehabilitation. We developed R2Play, a multidomain return-to-play assessment tool for youth with concussions. R2Play involves levels and conditions that vary in physical, cognitive, and sensory load to simulate the multidomain demands of sport., Objectives: To explore cross-site feasibility, face validity, and content validity of R2Play by integrating quantitative and qualitative data., Methods: Convergent mixed-methods feasibility study. Five sites will each recruit 5 clinicians (total nc = 25) and 10 youth sport participants (ages 10-25 y) with a history of concussion in the previous year (total ny = 50). Feasibility will be evaluated using quantitative criteria for acceptability, demand, implementation, practicality, and integration, and qualitative investigated data from content analysis of postassessment interviews with youth and clinician participants. Face validity will be investigated in postassessment interviews. Content validity will be established through (1) changes in performance metrics (time to completion, errors, and heart rate) across R2Play levels, (2) youth-perceived physical and cognitive exertion for each level, and (3) overall clinician perceptions determined through postassessment interviews. Qualitative and quantitative data will be merged through joint display to identify areas of convergence, divergence, and complementarity, and to establish meta-inferences about feasibility, face validity, and content validity., Discussion: This study aims to demonstrate the face and content validity of R2Play, and its feasibility for cross-site implementation. Findings will guide further iteration of R2Play and establish the foundation for a larger multicenter validation study to establish the psychometric properties of R2Play. This work represents an important first step toward the implementation of an ecologically valid multidomain assessment tool designed to support a safe and efficient return-to-play after concussion, ultimately reducing the risk of recurrent concussion and subsequent injury.

To optimize the identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children, specimen collection and testing method are crucial considerations. Ideally, specimen collection is easy and causes minimal discomfort, and the laboratory approach is simple, accurate, and rapid. In this prospective cohort study we evaluated the accuracy of a point-of care nucleic acid device using caregiver/patient self-collected buccal swabs. Participants were recruited in 14 Canadian tertiary care pediatric emergency departments. Children <18 years of age deemed to require SARS-CoV-2 testing were eligible. Caregivers or the patient-collected buccal swabs which were tested on the ABBOTT ID NOW. The reference standard was nasopharyngeal swab specimens collected by a healthcare provider tested via laboratory reverse transcription PCR (RT-PCR). We enrolled 2,640 study participants and 14.4% (381/2,640) were SARS-CoV-2 RT-PCR-positive. Eight percent (223/2,640) and 85.0% (2,244/2,640) were concordant test-positive and concordant test-negative, respectively. Sensitivity and specificity of the investigational approach were 58.5% [95% confidence interval (CI): 53.4, 63.5] and 99.3% (95% CI: 98.9, 99.6), respectively. Cycle threshold values were lower among concordant [median 17 (15, 21)] relative to discordant [median 30 (22, 35)] swabs ( P < 0.001). Sensitivity was greatest among children <4 years of age, when caregivers performed the swabs, among unvaccinated children, and those with shorter symptom duration. Across multiple pain measures, less pain was associated with buccal swab testing. Although accuracy of the buccal swab point-of-care SARS-CoV-2 test was good and negative agreement was excellent, sensitivity was only 58.5%. Concordance was greater among those with higher viral loads, and the approach involving buccal swabs was less painful.IMPORTANCETo optimize the identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children, specimen collection and testing method are crucial considerations. Ideally, specimen collection is easy and causes minimal discomfort, and laboratory approach is simple, accurate, and rapid. We evaluated the accuracy and pain associated with buccal swab specimen collection by caregivers or children themselves who were tested using a point-of-care isothermal nucleic acid amplification SARS-CoV-2 test. This novel approach was compared to nasopharyngeal swab specimens tested using laboratory-based PCR tests. While negative agreement was excellent, positive percent agreement was less than 60%. Concordance was greater among those with higher viral loads, and thus, sensitivity is excellent when transmissibility is more likely to occur. Importantly, the approach involving buccal swabs was significantly less painful, and thus, children and their caregivers are more likely to agree to testing using such an approach.CLINICAL TRIALSRegistered at ClinicalTrials.gov (NCT05040763).

Importance: Reducing low-value care has the potential to improve patient experiences and outcomes and decrease the unnecessary use of health care resources. Research suggests that low-value practices (ie, the potential for harm exceeds the potential for benefit) in adult trauma care are frequent and subject to interhospital variation; evidence on low-value practices in pediatric trauma care is lacking., Objective: To estimate the incidence of low-value practices in pediatric trauma care and evaluate interhospital practice variation., Design, Setting, and Participants: A retrospective multicenter cohort study in a Canadian provincial trauma system was conducted. Children younger than 16 years admitted to any of the 59 provincial trauma centers from April 1, 2016, to March 31, 2022, were included., Main Outcomes and Measures: Low-value practices were identified from systematic reviews of clinical practice guidelines on pediatric trauma. The frequencies of low-value practices were evaluated by estimating incidence proportions and cases per 1000 admissions (low if ≤10% and ≤10 cases, moderate if >10% or >10 cases, and high if >10% and >10 cases) were identified. Interhospital variation with intraclass correlation coefficients (ICCs) were assessed (low if <5%, moderate if 5%-20%, and high if >20%)., Results: A total of 10 711 children were included (mean [SD] age, 7.4 [4.9] years; 6645 [62%] boys). Nineteen low-value practices on imaging, fluid resuscitation, hospital/intensive care unit admission, specialist consultation, deep vein thrombosis prophylaxis, and surgical management of solid organ injuries were identified. Of these, 14 (74%) could be evaluated using trauma registry data. Five practices had moderate to high frequencies and interhospital variation: head computed tomography in low-risk children (7.1%; 33 per 1000 admissions; ICC, 8.6%), pretransfer computed tomography in children with a clear indication for transfer (67.6%; 4 per 1000 admissions; ICC, 5.7%), neurosurgical consultation in children without clinically important intracranial lesions (11.6%; 13 per 1000 admissions; ICC, 15.8%), hospital admission in isolated mild traumatic brain injury (38.8%; 98 per 1000 admissions; ICC, 12.4%), and hospital admission in isolated minor blunt abdominal trauma (10%; 5 per 1000 admissions; ICC, 31%)., Conclusions and Relevance: In this cohort study, low-value practices appeared to be frequent and subject to interhospital variation. These practices may represent priority targets for deimplementation interventions, particularly as they can be measured using routinely collected data.

Aims: The Colorado potato beetle, Leptinotarsa decemlineata (Say) (Coleoptera: Chrysomelidae) is the most widespread insect pest that causes major economic losses, especially on potatoes. Due to heavy insecticide use, this species now resists most pesticides, posing a significant control challenge. Frequent pesticide application also harms non-target organisms, the environment, and human health. Hence, utilizing biocontrol agents like entomopathogenic fungi (EPF) offers a viable alternative for pest management. The aim of this study was to identify and characterize new EPF strains isolated from soil samples and evaluate their efficacy against adult L. decemlineata under laboratory conditions., Methods and Results: Soil samples were collected in potato fields or uncultivated areas adjacent to the field in the Czech Republic and the EPF strains were isolated using a modified Tenebrio bait method. A total of 20 fungal strains were isolated and identified using morphological and molecular markers based on the 28S rRNA, ITS, and elongation factor 1-alpha gene sequences as Beauveria bassiana (Bals.-Criv.) Vuill., Beauveria brongniartii (Sacc.) Petch, and Cordyceps fumosorosea (Wize) Kepler, B. Shrestha & Spatafora (Hypocreales: Cordycipitaceae), Purpureocillium lilacinum (Thom.) Luangsa-ard, Houbraken, Hywel-Jones & Samson (Hypocreales: Ophiocordycipitaceae), Metarhizium brunneum (Petch), and Metarhizium robertsii Bisch., Rehner & Humber (Hypocreales: Clavicipitaceae). The bioassays revealed high variability among virulence of these strains against L. decemlineata with the shortest median time to death (LT50 = 5 days) in M. robertsii strain MAN3b., Conclusions: Results shown that some EPF strains, particularly those of genera Metarhizium, can be promising biocontrol agents against the Colorado potato beetle., (© The Author(s) 2024. Published by Oxford University Press on behalf of Applied Microbiology International.)

Purpose: This study investigated the association between psychological resilience and resting-state network functional connectivity of three major brain networks in pediatric concussion. Methods: This was a substudy of a randomized controlled trial, recruiting children with concussion and orthopedic injury. Participants completed the Connor-Davidson Resilience 10 Scale and underwent magnetic resonance imaging at 72 h and 4-weeks postinjury. We explored associations between resilience and connectivity with the default mode network (DMN), central executive network (CEN), and salience network (SN) at both timepoints and also any change that occurred over time. We also explored associations between resilience and connectivity within each network. Results: A total of 67 children with a concussion (median age = 12.87 [IQR: 11.79-14.36]; 46% female) and 30 with orthopedic injury (median age = 12.27 [IQR: 11.19-13.94]; 40% female) were included. Seed-to-voxel analyses detected a positive correlation between 72-h resilience and CEN connectivity in the concussion group. Group moderated associations between resilience and SN connectivity at 72 h, as well as resilience and DMN connectivity over time. Regions-of-interest analyses identified group as a moderator of longitudinal resilience and within-DMN connectivity. Conclusions: These results suggest that neural recovery from concussion could be reliant on resilience. Resilience was related to functional connectivity with three of the main networks in the brain that are often impacted by concussion. Improving resilience might be investigated as a modifiable variable in children as both a protective and restorative in the context of concussion. Clinical Trial Registration Identifier: NCT05105802. PedCARE +MRI team (see Supplementary Appendix S1).

Objective: To evaluate how social behaviors relate to SARS-CoV-2 test positivity across pediatric age groups., Methods: Multicenter, cross-sectional study recruiting children <18 years old tested for SARS-CoV-2 infection in emergency departments between 2020 and 2022. We used multivariate logistic regression to assess how self-reported social behaviors affect SARS-CoV-2 test positivity across four age groups. Causal mediation analysis quantified how mask-wearing and presence of an infected close contact mediated the SARS-CoV-2 risk of given behaviors., Results: Seven thousand two hundred and seventy two children were enrolled and 1457 (20.0%) tested positive for SARS-CoV-2. Attending a social gathering was associated with increased odds (aOR 1.64, 95% CI: 1.05, 2.57) of SARS-CoV-2 positivity among children aged 5-<12 years. Those attending in-person school/daycare were less likely to test positive for SARS-CoV-2 across all age categories. Attending childcare was associated with 16.3% (95% CI: -21.0%, -11.2%) and 9.0% (95% CI: -11.6%, -6.5%) reductions in the probability of testing positive for SARS-CoV-2 infection, with 53.5% (95% CI: 39.2%, 73.9%) and 22.8% (95% CI: 9.7%, 36.2%) of the effects being mediated by the presence of a close contact among <1 year and 1-<5 year age groups, respectively. Masking in public mediated the association between childcare attendance and SARS-CoV-2 positivity in children aged <1 year., Conclusions: Attending social gatherings increased the risk of SARS-CoV-2 test positivity in 5-<12-year-old children, but in-person daycare/school was associated with a reduced odds of testing positive across all ages. Settings with high public health adherence (ie, schools) reduced the risk of testing positive for SARS-CoV-2, possibly from reduced close contact with SARS-CoV-2 positive individuals., Competing Interests: Declaration of Competing Interest No conflicts of interest to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The immune response to coronavirus disease 2019 (COVID-19) vaccination is stronger among adults with prior infection (hybrid immunity). It is important to understand if children demonstrate a similar response to better inform vaccination strategies. Our study investigated the humoral response after BNT162b2 COVID-19 vaccine doses in SARS-CoV-2 naïve and recovered children (5-11 years)., Methods: A multi-institutional, longitudinal, prospective cohort study was conducted. Children were enrolled in a case-ascertained antibody surveillance study in Ottawa, Ontario from September/2020-March/2021; at least one household member was severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) positive on RT-PCR. In November 2021, BNT162b2 COVID-19 vaccine was authorized for children aged 5-11 in Canada. Children enrolled in the surveillance study intending to receive two vaccine doses were invited to participate in this study from November 2021-April 2022. Main exposure was prior SARS-CoV-2 infection, defined by positive RT-PCR or SARS-CoV-2 anti-N IgG antibody presence. Primary outcome was spike IgG antibody levels measured following the first vaccine dose (2-3 weeks) and second vaccine dose (3-4 weeks)., Results: Of the 153 eligible children, 75 participants (median age 8.9 IQR (7.4, 10.2) years; 38 (50.7 %) female; 59 (78.7 %) Caucasian) had complete follow-up. Fifty-four (72 %) children had prior SARS-COV-2 infection. Spike IgG antibody levels are significantly higher in SARS-CoV-2 recovered participants after receiving the first dose (p < 0.001) and the second (p = 0.01) compared to infection naïve children., Conclusions and Relevance: SARS-CoV-2 recovered children (5-11 years) demonstrated higher antibody levels following first BNT162b2 vaccine dose compared with naïve children. Most reached antibody saturation two to three weeks after the first dose; a second dose didn't change the saturation level. A single vaccine dose in SARS-CoV-2 recovered children may be equivalent or superior to a 2-dose primary series in naïve children. Further research is needed on the durability and quality of a single vaccine dose in this population., Competing Interests: Declaration of competing interest AP reports a relationship with Member of the Task Force for COVID-19 in Children, Government of Canada (no financial compensation) that includes: non-financial support. RZ is supported by a Tier 1 Clinical Research Chair from University of Ottawa., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The adoption of the European Green Deal will limit acaricide use in high value crops like raspberry, to be replaced by biological control and other alternative strategies. More basic knowledge on mites in such crops is then necessary, like species, density, and their role as vectors of plant diseases. This study had four aims, focusing on raspberry leaves at northern altitude: (1) identify mite species; (2) study mite population densities; (3) investigate mite intra-plant distribution; (4) investigate co-occurrence of phytophagous mites, raspberry leaf blotch disorder and raspberry leaf blotch virus (RLBV). Four sites in south-eastern Norway were sampled five times. Floricanes from different parts of the sites were collected, taking one leaf from each of the upper, middle, and bottom zones of the cane. Mites were extracted with a washing technique and processed for species identification and RLBV detection. Mites and leaves were tested for RLBV by reverse transcription polymerase chain reaction (RT-PCR) with virus-specific primers. Phytophagous mites, Phyllocoptes gracilis, Tetranychus urticae, and Neotetranychus rubi, and predatory mites, Anystis baccarum and Typhlodromus (Typhlodromus) pyri were identified. All phytophagous mites in cultivated raspberry preferred the upper zone of floricanes, while in non-cultivated raspberry, they preferred the middle zone. The presence of phytophagous mites did not lead to raspberry leaf blotch disorder during this study. RLBV was detected in 1.3% of the sampled plants, none of them with leaf blotch symptoms, and in 4.3% of P. gracilis samples, and in some spider mite samples, implying that Tetranychids could also be vectors of RLBV., (© 2024. The Author(s).)

Objective: To assess the association between Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and long-term quality of life (QoL)., Methods: Prospective cohort study with 6- and 12-months follow-up conducted in 14 Canadian institutions. Children tested for SARS-CoV-2 between August 2020 and February 2022 were eligible. QoL was measured using PedsQL-4.0, overall health status scores 6- and 12-months after testing., Results: Among SARS-CoV-2 positive and negative participants eligible for long-term follow-up, 74.8% (505/675) and 71.8% (1106/1541) at 6- and 59.0% (727/1233) and 68.1% (2520/3699) at 12-months, completed follow-up, respectively. Mean ± SD PedsQL scores did not differ between positive and negative groups; difference: -0.86 (95% CI: -2.33, 0.61) at 6- and -0.48 (95% CI: -1.6, 0.64) at 12-months, respectively. SARS-CoV-2 test-positivity was associated with higher social subscale scores. Although in bivariate analysis, overall health status at 6-months was higher among SARS-CoV-2 cases [difference: 2.16 (95% CI: 0.80, 3.53)], after adjustment for co-variates, SARS-CoV-2 infection was not independently associated with total PedsQL or overall health status at either time point. Parental perception of recovery did not differ based on SARS-CoV-2 test-status at either time point., Conclusions: SARS-CoV-2 infection was not associated with QoL, overall health status, or parental perception of recovery 6- and 12-months following infection., Competing Interests: Declaration of Competing Interest This work was supported by the Public Health Agency of Canada’s Immunization Partnership Fund (Emerging Issues Fund) and their Emerging Issues Fund (Enhanced Surveillance), and the Canadian Institute of Health Research (Operating Grant: Emerging COVID 19 Research Gaps and Priorities Funding Opportunity). SF is supported by the Alberta Children’s Hospital Foundation Professorship in Child Health and Wellness. FD is supported by the University of Calgary, Eyes High Post-Doctoral Fellowship., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Protective factors, including psychological resilience, cognitive reserve, and brain reserve, may be positively associated with recovery after pediatric mild traumatic brain injury (mTBI) but are yet to be studied concurrently. We sought to examine these factors as moderators of post-concussive symptoms (PCS) in pediatric mTBI compared with mild orthopedic injury (OI). Participants included 967 children (633 mTBI, 334 OI) aged 8-16.99 years, recruited from 5 Canadian pediatric emergency departments as part of a prospective longitudinal cohort study. At 10 days post-injury, psychological resilience was measured using the Connor-Davidson Resilience Scale and brain reserve was measured using total brain volume derived from structural magnetic resonance imaging. Cognitive reserve was measured at 3 months post-injury using IQ scores from the Wechsler Abbreviated Scale of Intelligence-Second Edition. Cognitive and somatic PCS were measured using child and parent ratings on the Health and Behavior Inventory, completed weekly for 3 months and biweekly to 6 months. Analyses involved generalized least-squares regression models using restricted cubic splines. Covariates included age at injury, sex, racialized identity, material and social deprivation, pre-injury migraine and concussion history, and retrospective pre-injury PCS. Psychological resilience moderated group differences in parent-reported PCS. At 30 days post-injury, estimated group differences in parent-reported cognitive and somatic PCS (mTBI > OI) were larger at higher (75th percentile) resilience scores ( Est = 2.25 [0.87, 3.64] and Est = 2.38 [1.76, 3.00], respectively) than at lower (25th percentile) resilience scores ( Est = 1.44 [0.01, 2.86] and Est = 2.08 [1.45, 2.71], respectively). Resilience did not moderate group differences in child-reported PCS but was negatively associated with child-reported PCS in both groups ( p s ≤ 0.001). Brain reserve (i.e., total brain volume [TBV]) also moderated group differences, but only for parent-reported somatic PCS ( p = 0.018). Group difference (mTBI > OI) at 30 days was larger at smaller (25th percentile) TBV ( Est = 2.78 [2.17, 3.38]) than at larger (75th percentile) TBV ( Est = 1.95 [1.31, 2.59]). TBV was not associated with parent-reported cognitive PCS or child-reported PCS. IQ did not moderate PCS in either group but had a significant non-linear association in both groups with child-reported somatic PCS ( p = 0.018) and parent-reported PCS ( p < 0.001), with higher PCS scores at both lower and higher IQs. These findings suggest that higher resilience predicts fewer PCS, but less strongly after mTBI than OI; greater brain reserve may reduce the effect of mTBI on somatic PCS; and cognitive reserve has an unexpected curvilinear association with PCS across injury types. The results highlight the importance of protective factors as predictors of recovery and potential targets for intervention following pediatric mTBI.

A novel negative-sense single-stranded RNA virus showing genetic similarity to viruses of the genus Rubodvirus has been found in raspberry plants in the Czech Republic and has tentatively been named raspberry rubodvirus 1 (RaRV1). Phylogenetic analysis confirmed its clustering within the group, albeit distantly related to other members. A screening of 679 plant and 168 arthropod samples from the Czech Republic and Norway revealed RaRV1 in 10 raspberry shrubs, one batch of Aphis idaei , and one individual of Orius minutus . Furthermore, a distinct isolate of this virus was found, sharing 95% amino acid identity in both the full nucleoprotein and partial sequence of the RNA-dependent RNA polymerase gene sequences, meeting the species demarcation criteria. This discovery marks the first reported instance of a rubodvirus infecting raspberry plants. Although transmission experiments under experimental conditions were unsuccessful, positive detection of the virus in some insects suggests their potential role as vectors for the virus.

Objectives: Symptoms and cognition are both utilized as indicators of recovery following pediatric concussion, yet their interrelationship is not well understood. This study aimed to investigate: 1) the association of post-concussion symptom burden and cognitive outcomes (processing speed and executive functioning [EF]) at 4 and 12 weeks after pediatric concussion, and 2) the moderating effect of sex on this association., Methods: This prospective, multicenter cohort study included participants aged 5.00-17.99 years with acute concussion presenting to four Emergency Departments of the Pediatric Emergency Research Canada network. Five processing speed and EF tasks and the Post-Concussion Symptom Inventory (PCSI; symptom burden, defined as the difference between post-injury and retrospective [pre-injury] scores) were administered at 4 and 12 weeks post-concussion. Generalized least squares models were conducted with task performances as dependent variables and PCSI and PCSI*sex interaction as the main predictors, with important pre-injury demographic and injury characteristics as covariates., Results: 311 children (65.0% males; median age = 11.92 [IQR = 9.14-14.21 years]) were included in the analysis. After adjusting for covariates, higher symptom burden was associated with lower Backward Digit Span (χ 2 = 9.85, p = .043) and Verbal Fluency scores (χ 2 = 10.48, p = .033) across time points; these associations were not moderated by sex, ps ≥ .20. Symptom burden was not associated with performance on the Coding, Continuous Performance Test, and Color-Word Interference scores, ps ≥ .17., Conclusions: Higher symptom burden is associated with lower working memory and cognitive flexibility following pediatric concussion, yet these associations were not moderated by sex. Findings may inform concussion management by emphasizing the importance of multifaceted assessments of EF.

Purpose: The study aimed to examine the reporting completeness of randomized controlled trials (RCTs) of non-pharmacological interventions following concussion., Methods: We searched MEDLINE, Embase, PsycInfo, CINAHL, and Web of Science up to May 2022. Two reviewers independently screened studies and assessed reporting completeness using the Template for Intervention Description and Replication (TIDieR), Consensus on Exercise Reporting Template (CERT), and international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) checklists. Additional information was sought my study authors where reporting was incomplete. Risk of bias (ROB) was assessed with the Cochrane ROB-2 Tool. RCTs examining non-pharmacological interventions following concussion., Results: We included 89 RCTs (n = 53 high ROB) examining 11 different interventions for concussion: sub-symptom threshold aerobic exercise, cervicovestibular therapy, physical/cognitive rest, vision therapy, education, psychotherapy, hyperbaric oxygen therapy, transcranial magnetic stimulation, blue light therapy, osteopathic manipulation, and head/neck cooling. Median scores were: TIDieR 9/12 (75%; interquartile range (IQR) = 5; range: 5-12), CERT 17/19 (89%; IQR = 2; range: 10-19), and i-CONTENT 6/7 (86%; IQR = 1; range: 5-7). Percentage of studies completely reporting all items was TIDieR 35% (31/89), CERT 24% (5/21), and i-CONTENT 10% (2/21). Studies were more completely reported after publication of TIDieR (t 87  = 2.08; p = 0.04) and CERT (t 19  = 2.72; p = 0.01). Reporting completeness was not strongly associated with journal impact factor (TIDieR: r s  = 0.27; p = 0.01; CERT: r s  = -0.44; p = 0.06; i-CONTENT: r s  = -0.17; p = 0.48) or ROB (TIDieR: r s  = 0.11; p = 0.31; CERT: r s  = 0.04; p = 0.86; i-CONTENT: r s  = 0.12; p = 0.60)., Conclusion: RCTs of non-pharmacological interventions following concussion demonstrate moderate to good reporting completeness, but are often missing key components, particularly modifications, motivational strategies, and qualified supervisor. Reporting completeness improved after TIDieR and CERT publication, but publication in highly cited journals and low ROB do not guarantee reporting completeness., Competing Interests: Competing interests JJvI reported being the founder of R2P Concussion Management. RM reported receiving research funds from grants from the National Institutes of Health, the Department of Defense, the National Football League and Abbott Laboratories. KOY reported receiving grant funding from the Canadian Institutes of Health Research (CIHR), book royalties (Guilford Press and Cambridge University Press), and editorial stipend from American Psychological Association, as well as funding through the Ronald and Irene Ward Chair in Pediatric Brain Injury funded by the Alberta Children's Hospital Foundation. RZ reported receiving competitively-funded research grants from CIHR, Ontario Neurotrauma Foundation, Physician Services Incorporated Foundation, Children's Hospital of Eastern Ontario Foundation, Ontario Brain Institute, Ontario SPOR Support Unit, and the National Football League Scientific Advisory Board. He holds a Clinical Research Chair in Pediatric Concussion from University of Ottawa, and is on the concussion advisory board for Parachute Canada (a non-profit injury prevention charity), and is the co-founder, Scientific Director and a minority shareholder in 360 Concussion Care. All the support had no involvement in the study design and writing of the manuscript or the decision to submit it for publication., (Copyright © 2023. Production and hosting by Elsevier B.V.)

Background: Predicting recovery following pediatric mild traumatic brain injury (mTBI) remains challenging. The identification of objective biomarkers for prognostic purposes could improve clinical outcomes. Telomere length (TL) has previously been used as a prognostic marker of cellular health in the context of mTBI and other neurobiological conditions. While psychosocial and environmental factors are associated with recovery outcomes following pediatric mTBI, the relationship between these factors and TL has not been investigated. This study sought to examine the relationships between TL and psychosocial and environmental factors, in a cohort of Canadian children with mTBI or orthopedic injury (OI)., Methods: Saliva was collected at a postacute (median 7 days) timepoint following injury to assess TL from a prospective longitudinal cohort of children aged 8 to 17 years with either mTBI (n = 202) or OI (n = 90), recruited from 3 Canadian sites. Questionnaires regarding psychosocial and environmental factors were obtained at a postacute follow-up visit and injury outcomes were assessed at a 3-month visit. Univariable associations between TL and psychosocial, environmental, and outcome variables were assessed using Spearman's correlation. Further adjusted analyses of these associations were performed by including injury group, age, sex, and site as covariates in multivariable generalized linear models with a Poisson family, log link function, and robust variance estimates., Results: After adjusting for age, sex, and site, TL in participants with OI was 7% shorter than those with mTBI (adjusted mean ratio = 0.93; 95% confidence interval, 0.89-0.98; P = .003). As expected, increasing age was negatively associated with TL (Spearman's r = -0.14, P = .016). Sleep hygiene at 3 months was positively associated with TL (adjusted mean ratio = 1.010; 95% confidence interval, 1.001-1.020; P = .039)., Conclusion: The relationships between TL and psychosocial and environmental factors in pediatric mTBI and OI are complex. TL may provide information regarding sleep quality in children recovering from mTBI or OI; however, further investigation into TL biomarker validity should employ a noninjured comparison group., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Background: The ability to cope with concussion symptoms and manage stress is an important determinant of risk for prolonged symptoms., Objective: This open-label mixed-methods pilot study assessed the acceptability and credibility of a mindfulness-based intervention delivered through a digital therapeutic (DTx; therapeutic smartphone app) for pediatric concussion., Methods: Participants aged 12 to 18 years were recruited from an emergency department within 48 hours of a concussion (acute cohort) or from a tertiary care clinic at least 1-month post-concussion (persisting symptoms cohort). Participants completed a novel 4-week mindfulness-based intervention, for 10 to 15 minutes/day, at a minimum of 4 days/week. At 2 weeks, participants completed a credibility and expectancy questionnaire. At 4 weeks, participants completed questionnaires assessing satisfaction, usability and working alliance, as well as a semi-structured phone interview., Results: Ten participants completed the study outcomes (7 acute; 3 persisting symptoms). The intervention was perceived as credible (median/max possible = 6.50/9.00 [6.83,8.75]) and DTx was usable (median/max possible = 70.00/100.00 [55.00,82.50]). Participants rated their satisfaction with the DTx (median/max possible = 27.00/32.00 [24.50,29.50]) and the working alliance with the digital mindfulness guides (median/max possible = 3.92/5.00 [3.38-4.33]) as high. Four themes were identified from the qualitative data: (a) positive attributes; (b) negative attributes; (c) ideas for modifications; and (d) technical issues., Conclusion: Results show modifications to the DTx, instructions and mindfulness intervention, and potential ways to increase adherence by leveraging positive attributes. A randomized control trial will assess the effectiveness of the DTx MBI to decrease the risk of persisting symptoms and reduce the symptom burden following pediatric concussion., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AAL reported being one of the authors of the Mindfulness-Based Intervention for Concussion protocol used in this study, she did not receive any financial benefit. AAL received funding from the Ontario Brain Institute NERD program for a separate component of the study. AAL has no other conflict of interest to disclose. BJS is the Chief Scientist and CEO of Mobio Interactive PTE LTD (Singapore), the parent company of Mobio Interactive Inc. (Toronto, Canada), and he owned approximately 22% of the company at the time of manuscript submission. BJS exclusively served as a technical liaison for the study and did not contribute to the specific study design, or select the outcome measures, nor did he directly contribute to, or have influence over, data collection or analysis. RZ is the cofounder, Scientific Director, and a minority shareholder in 360 Concussion Care, an interdisciplinary concussion clinic. RZ holds a Clinical Research Chair in Pediatric Concussion from University of Ottawa, and is on the concussion advisory board for Parachute Canada (a non-profit injury prevention charity). VS receives royalties for the publication of a book on concussion by Flammarion. The remaining authors have no conflicts of interest to report., (© The Author(s) 2024.)

Background: Concussion in children and adolescents is a significant public health concern, with 30% to 35% of patients at risk for prolonged emotional, cognitive, sleep, or physical symptoms. These symptoms negatively impact a child's quality of life while interfering with their participation in important neurodevelopmental activities such as schoolwork, socializing, and sports. Early psychological intervention following a concussion may improve the ability to regulate emotions and adapt to postinjury symptoms, resulting in the greater acceptance of change; reduced stress; and recovery of somatic, emotional, and cognitive symptoms., Objective: The primary objective of this study is to assess the feasibility of conducting a parallel-group (1:1) randomized controlled trial (RCT) to evaluate a digital therapeutics (DTx) mindfulness-based intervention (MBI) in adolescents aged 12 to <18 years. The attention-matched comparator intervention (a math game also used in previous RCTs) will be delivered on the same DTx platform. Both groups will be provided with the standard of care guidelines. The secondary objective is to examine intervention trends for quality of life; resilience; self-efficacy; cognition such as attention, working memory, and executive functioning; symptom burden; and anxiety and depression scores at 4 weeks after concussion, which will inform a more definitive RCT. A subsample will be used to examine whether those randomized to the experimental intervention group have different brain-based imaging patterns compared with those randomized to the control group., Methods: This study is a double-blind Health Canada-regulated trial. A total of 70 participants will be enrolled within 7 days of concussion and randomly assigned to receive the 4-week DTx MBI (experimental group) or comparator intervention. Feasibility will be assessed based on the recruitment rate, treatment adherence to both interventions, and retention. All outcome measures will be evaluated before the intervention (within 7 days after injury) and at 1, 2, and 4 weeks after the injury. A subset of 60 participants will undergo magnetic resonance imaging within 72 hours and at 4 weeks after recruitment to identify the neurophysiological mechanisms underlying the potential benefits from MBI training in adolescents following a concussion., Results: The recruitment began in October 2022, and the data collection is expected to be completed by September 2024. Data collection and management is still in progress; therefore, data analysis is yet to be conducted., Conclusions: This trial will confirm the feasibility and resolve uncertainties to inform a future definitive multicenter efficacy RCT. If proven effective, a smartphone-based MBI has the potential to be an accessible and low-risk preventive treatment for youth at risk of experiencing prolonged postconcussion symptoms and complications., Trial Registration: ClinicalTrials.gov NCT05105802; https://classic.clinicaltrials.gov/ct2/show/NCT05105802., International Registered Report Identifier (irrid): DERR1-10.2196/57226., (©Andrée-Anne Ledoux, Roger Zemek, Molly Cairncross, Noah Silverberg, Veronik Sicard, Nicholas Barrowman, Gary Goldfield, Clare Gray, Ashley D Harris, Natalia Jaworska, Nick Reed, Bechara J Saab, Andra Smith, Lisa Walker. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 11.04.2024.)

Study Objective: Our primary objectives were to identify clinical practice guideline recommendations for children with acute mild traumatic brain injury (mTBI) presenting to an emergency department (ED), appraise their overall quality, and synthesize the quality of evidence and the strength of included recommendations., Methods: We searched MEDLINE, EMBASE, Cochrane Central, Web of Science, and medical association websites from January 2012 to May 2023 for clinical practice guidelines with at least 1 recommendation targeting pediatric mTBI populations presenting to the ED within 48 hours of injury for any diagnostic or therapeutic intervention in the acute phase of care (ED and inhospital). Pairs of reviewers independently assessed overall clinical practice guideline quality using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool. The quality of evidence on recommendations was synthesized using a matrix based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework., Results: We included 11 clinical practice guidelines, of which 6 (55%) were rated high quality. These included 101 recommendations, of which 34 (34%) were based on moderate- to high-quality evidence, covering initial assessment, initial diagnostic imaging, monitoring/observation, therapeutic interventions, discharge advice, follow-up, and patient and family support. We did not identify any evidence-based recommendations in high-quality clinical practice guidelines for repeat imaging, neurosurgical consultation, or hospital admission. Lack of strategies and tools to aid implementation and editorial independence were the most common methodological weaknesses., Conclusions: We identified 34 recommendations based on moderate- to high-quality evidence that may be considered for implementation in clinical settings. Our review highlights important areas for future research. This review also underlines the importance of providing strategies to facilitate the implementation of clinical practice guideline recommendations for pediatric mTBI., (Copyright © 2023 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Background: Despite the promising benefits of self-guided digital interventions for adolescents recovering from concussion, attrition rates for such interventions are high. Evidence suggests that adults can develop therapeutic alliance with self-guided digital interventions, which is in turn associated with intervention engagement. However, no research has examined whether adolescents develop therapeutic alliance with self-guided digital interventions and what factors are important to its development. Additionally, social presence-the extent to which digital encounters feel like they are occurring in person-may be another relevant factor to understanding the nature of the connection between adolescents and a self-guided digital intervention, though this has yet to be explored., Objective: This qualitative study explored the extent to which adolescents recovering from concussion developed therapeutic alliance and social presence during their use of a self-guided digital mindfulness-based intervention. Additionally, this study aimed to determine factors important to adolescents' development of therapeutic alliance and social presence with the intervention., Methods: Adolescents aged between 12 and 17.99 years who sustained a concussion were recruited from 2 sites: a pediatric emergency department up to 48 hours after a concussion and a tertiary care clinic over 1 month following a concussion to capture adolescents who had both acute and persisting symptoms after concussion. Participants (N=10) completed a 4-week mindfulness-based intervention delivered through a smartphone app. Within the app, participants listened to audio recordings of mindfulness guides (voice actors) narrating psychoeducation and mindfulness practices. At 4 weeks, participants completed questionnaires and a semistructured interview exploring their experience of therapeutic alliance and social presence with the mindfulness guides in the intervention., Results: Themes identified within the qualitative results revealed that participants developed therapeutic alliance and social presence by "developing a genuine connection" with their mindfulness guides and "sensing real people." Particularly important to the development of therapeutic alliance and social presence were the mindfulness guides' "personal backgrounds and voices," such that participants felt more connected to the guides by knowing information about them and through the guides' calm tone of voice in audio recordings. Quantitative findings supported qualitative results; participants' average score for therapeutic alliance was far above the scale midpoint, while the mixed results for social presence measures aligned with qualitative findings that participants felt that the mindfulness guides seemed real but not quite as real as an in-person connection would., Conclusions: Our data suggest that adolescents can develop therapeutic alliance and social presence when using digital interventions with no direct human contact. Adolescents' development of therapeutic alliance and social presence with self-guided digital interventions can be bolstered by increasing human-like qualities (eg, real voices) within interventions. Maximizing therapeutic alliance and social presence may be a promising way to reduce attrition in self-guided digital interventions while providing accessible treatment., (©Kiarah M K O'Kane, Thalia Otamendi, Noah D Silverberg, Esther Choi, Veronik Sicard, Roger Zemek, Katherine Healey, Olivier Brown, Lauren Butterfield, Andra Smith, Gary Goldfield, Rachel Kardish, Bechara Saab, Andrée-Anne Ledoux, Molly Cairncross. Originally published in JMIR Formative Research (https://formative.jmir.org), 22.03.2024.)

Background: Social determinants of health (SDH), including "the conditions in which individuals are born, grow, work, live and age" affect child health and well-being. Several studies have synthesized evidence about the influence of SDH on childhood injury risks and outcomes. However, there is no systematic evidence about the impact of SDH on accessing care and quality of care once a child has suffered an injury. We aim to evaluate the extent to which access to care and quality of care after injury are affected by children and adolescents' SDH., Methods: Using Cochrane methodology, we will conduct a systematic review including observational and experimental studies evaluating the association between social/material elements contributing to health disparities, using the PROGRESS-Plus framework: place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital and care received by children and adolescents (≤ 19 years of age) after injury. We will consult published literature using PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, and Academic Search Premier and grey literature using Google Scholar from their inception to a maximum of 6 months prior to submission for publication. Two reviewers will independently perform study selection, data extraction, and risk of bias assessment for included studies. The risk of bias will be assessed using the ROBINS-E and ROB-2 tools respectively for observational and experimental study designs. We will analyze data to perform narrative syntheses, and if enough studies are identified, we will conduct a meta-analysis using random effects models., Discussion: This systematic review will provide a synthesis of evidence on the association between SDH and pediatric trauma care (access to care and quality of care) that clinicians and policymakers can use to better tailor care systems and promote equitable access and quality of care for all children. We will share our findings through clinical rounds, conferences, and publication in a peer-reviewed journal., Systematic Review Registration: PROSPERO CRD42023408467., (© 2024. The Author(s).)