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Objective: Acute agitation in pediatrics is commonly encountered in hospital settings, can contribute to significant physical and psychological distress, and management is highly varied in practice. As such, the development of a standardized pharmacologic guideline is paramount. We aimed to develop a novel clinical pathway (CP) for management of acute agitation for all hospitalized pediatric patients in Canada. Methods: Healthcare professionals in Canada with expertise in treating and managing pediatric agitation formed a working group and developed a CP through conducting a literature review, engaging key partners, and obtaining interdisciplinary consensus (iterative real-time discussions with content experts). Once developed, the preliminary CP was presented to additional internal and external partners via multiple grand rounds and a webinar; feedback from participants guided final CP revisions. Results: The working group created a pediatric inpatient CP to guide pharmacologic management of agitation and serve as an easy-to-use clinical and educational resource with three complementary sections including: 1) a treatment algorithm, 2) a quick reference medication chart, and 3) two supporting documents, which provide a general overview of non-pharmacologic strategies prior to CP implementation and an illustrative scenario to accompany the medication chart to ensure effective utilization. Conclusions: This is the first CP to standardize pharmacological treatment and management of acute agitation in children in inpatient settings in Canada. Although further research is warranted to assess implementation and support process improvement, the CP can be adapted by individual institutions to assist in prompt pharmacological management of pediatric agitation to potentially improve outcomes for patients, families, and healthcare professionals. [ABSTRACT FROM AUTHOR]

Background: Pediatric intensive care unit (PICU)-associated delirium contributes to a decline in postdischarge quality of life, with worse outcomes for individuals with delayed identification. As delirium screening rates remain low within PICUs, caregivers may be able to assist with early detection, for which they need more education, as awareness of pediatric delirium among caregivers remains limited. Objective: This study aimed to develop an educational tool for caregivers to identify potential delirium symptoms during their child's PICU stay, educate them on how to best support their child if they experience delirium, and guide them to relevant family resources. Methods: Web-based focus groups were conducted at a tertiary pediatric hospital with expected end users of the tool (ie, PICU health care professionals and caregivers of children with an expected PICU length of stay of over 48 h) to identify potential educational information for inclusion in a family resource guide and to identify strategies for effective implementation. Data were analyzed thematically to generate requirements to inform prototype development. Participants then provided critical feedback on the initial prototype, which guided the final design. Results: In all, 24 participants (18 health care professionals and 6 caregivers) attended 7 focus groups. Participants identified five informational sections for inclusion: (1) delirium definition, (2) key features of delirium (signs and symptoms), (3) postdischarge outcomes associated with delirium, (4) tips to inform family-centered care, and (5) education or supportive resources. Participants identified seven design requirements: information should (1) be presented in an order that resembles the structure of the clinical discussion around delirium; (2) increase accessibility, recall, and preparedness by providing multiple formats; (3) aim to reduce stress by implementing positive framing; (4) minimize cognitive load to ensure adequate information processing; (5) provide supplemental electronic resources via QR codes; (6) emphasize collaboration between caregivers and the health care team; and (7) use prompting questions to act as a call to action for caregivers. Conclusions: Key design requirements derived from end-user feedback were established and guided the development of a novel pediatric delirium education tool. Implementing this tool into regular practice has the potential to reduce distress and assist in the early recognition and treatment of delirium in the PICU domain. Future evaluation of its clinical utility is necessary. [ABSTRACT FROM AUTHOR]

Many current computational models of object categorization either include no explicit provisions for dealing with incomplete stimulus information (e.g. Kruschke, Psychological Review 99:22-44, ) or take approaches that are at odds with evidence from other fields (e.g. Verguts, Ameel, & Storms, Memory & Cognition 32:379-389, ). In two experiments centered around the inverse base-rate effect, we demonstrate that people not only make highly informed inferences about the values of unknown features, but also subsequently use the inferred values to come to a categorization decision. The inferences appear to be based on immediately available information about the particular stimulus under consideration, as well as on higher-level inferences about the stimulus class as a whole. Implications for future modeling efforts are discussed. [ABSTRACT FROM AUTHOR]

The article discusses bilingual legislation drafting in Canada. It states that bilingual legislation in the country is written in both English and French, and the requirement to pass bilingual legislation in Ontario is self-imposed under subsection 3(2) of the French Language Services Act. Process of drafting bilingual legislation has been offered.

The growth in online retail purchases has increased significantly, especially through the COVID-19 pandemic, yet causes more packaging waste than brick-and-mortar retail. Free and easy returns further exacerbate the problem. Current research addressing post-consumer packaging waste has focused on packaging design and material choices. Yet, effective guidelines, policies, strategies, and practices for e-commerce packaging waste management must be determined (Escursell et al., 2021). Therefore, this research identifies global best practices to address transport packaging waste in e-commerce, focusing on Canada. A systematic review of the extant literature (2011–2020) revealed five key objectives of packaging sustainability guidelines: Optimizing Resources, Responsible Sourcing, Resource Recovery, Material Health, and Consumer Engagement. The analysis showed that Responsible Sourcing and Resources Recovery were highlighted in 41% of publications, Optimizing Resources in 31%, and Consumer Engagement in 23% of the studies. The most popular waste reduction strategy was Design for Environment under the Optimizing Resources guideline. This work is the first to identify and articulate clear guidelines, policies, and practices to support industry and policy decision-makers in addressing the transport packaging waste problem in e-commerce. [ABSTRACT FROM AUTHOR]

Background: British Columbia's 8-1-1 telephone service connects callers with nurses for health care advice. As of Nov. 16, 2020, callers advised by a registered nurse to obtain in-person medical care can be subsequently referred to virtual physicians. We sought to determine health system use and outcomes of 8-1-1 callers urgently triaged by a nurse and subsequently assessed by a virtual physician., Methods: We identified callers referred to a virtual physician between Nov. 16, 2020, and Apr. 30, 2021. After assessment, virtual physicians assigned callers to 1 of 5 triage dispositions (i.e., go to emergency department [ED] now, see primary care provider within 24 hours, schedule an appointment with a health care provider, try home treatment, other). We linked relevant administrative databases to ascertain subsequent health care use and outcomes., Results: We identified 5937 encounters with virtual physicians involving 5886 8-1-1 callers. Virtual physicians advised 1546 callers (26.0%) to go to the ED immediately, of whom 971 (62.8%) had 1 or more ED visits within 24 hours. Virtual physicians advised 556 (9.4%) callers to seek primary care within 24 hours, of whom 132 (23.7%) had primary care billings within 24 hours. Virtual physicians advised 1773 (29.9%) callers to schedule an appointment with a health care provider, of whom 812 (45.8%) had primary care billings within 7 days. Virtual physicians advised 1834 (30.9%) callers to try a home treatment, of whom 892 (48.6%) had no health system encounters over the next 7 days. Eight (0.1%) callers died within 7 days of assessment with a virtual physician, 5 of whom were advised to go to the ED immediately. Fifty-four (2.9%) callers with a "try home treatment" disposition were admitted to hospital within 7 days of a virtual physician assessment, and no callers who were advised home treatment died., Interpretation: This Canadian study evaluated health service use and outcomes arising from the addition of virtual physicians to a provincial health information telephone service. Our findings suggest that supplementation of this service with an assessment from a virtual physician safely reduces the overall proportion of callers advised to seek urgent in-person visits., Competing Interests: Competing interests: Kendall Ho, Riyad Abu-Laban, Frank Scheuermeyer, Rina Chadha, Jim Christenson and John Tallon received professional fees from HealthLink BC for part-time work as virtual physicians with the HealthLink BC Emergency iDoctor in Assistance Program (HEiDi) during the course of this study. Kendall Ho and Rina Chadha receive additional funding from HealthLink BC for administration of the HEiDi program. No other competing interests were declared., (© 2023 CMA Impact Inc. or its licensors.)

Introduction: Survivors of critical illness frequently exhibit acute and chronic neurological complications. The underlying aetiology of this dysfunction remains unknown but may be associated with cerebral ischaemia. This study will use near-infrared spectroscopy to non-invasively quantify regional cerebral oxygenation (rSO 2 ) to assess the association between poor rSO 2 during the first 72 hours of critical illness with delirium severity, as well as long-term sensorimotor and cognitive impairment among intensive care unit (ICU) survivors. Further, the physiological determinants of rSO 2 will be examined., Methods and Analysis: This multicentre prospective observational study will consider adult patients (≥18 years old) eligible for enrolment if within 24 hours of ICU admission, they require mechanical ventilation and/or vasopressor support. For 72 hours, rSO 2 will be continuously recorded, while vital signs (eg, heart rate) and peripheral oxygenation saturation will be concurrently captured with data monitoring software. Arterial and central venous gases will be sampled every 12 hours for the 72 hours recording period and will include: pH, PaO2, PaCO2, and haemoglobin concentration. Participants will be screened daily for delirium with the confusion assessment method (CAM)-ICU, whereas the brief-CAM will be used on the ward. At 3 and 12 months post-ICU discharge, neurological function will be assessed with the Repeatable Battery for the Assessment of Neuropsychological Status and KINARM sensorimotor and cognitive robot-based behavioural tasks., Ethics and Dissemination: The study protocol has been approved in Ontario by a central research ethics board (Clinical Trials Ontario); non-Ontario sites will obtain local ethics approval. The study will be conducted under the guidance of the Canadian Critical Care Trials Group (CCCTG) and the results of this study will be presented at national meetings of the CCCTG for internal peer review. Results will also be presented at national/international scientific conferences. On completion, the study findings will be submitted for publication in peer-reviewed journals., Trial Registration Number: NCT03141619., Competing Interests: Competing interests: JM is the scientific director of the Canadian Frailty Network. SHS is the cofounder of BKIN Technologies, the manufacturer of the KINARM device. IB receives a stipend from the Trillium Gift of Life Network to support his role as a Regional Medical Lead. NO received funding from the Academic Medical Organization of Southwestern Ontario. MS receives a stipend from the Trillium Gift of Life Network to support his role as a Hospital Donation Physician. DG is funded through a Health-Professional Investigator Award from the Michael Smith Foundation for Health Research. JGB receives a stipend from the Trillium Gift of Life Network to support his role as a Regional Medical Lead., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)