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The article features food allergy as a risk factor for scurvy. Oral allergy syndrome is a clinical syndrome often seen in allergy practice. Its symptoms affect oral cavity and can often lead to more severe symptoms such as anaphylactic shock. Allergic people are cautious and avoid all fruits and vegetables which are rich in vitamin C. Daily intake of these foods are needed to avoid the clinical manifestation of vitamin C deficiency.

Background The prevalence of peanut allergy in younger siblings of children with peanut allergy has been reported between 7% and 8.5%, but the anaphylactic risk at the time of introduction is currently unknown, which limits our ability to best counsel parents on this issue. Objective To determine the risk of anaphylaxis and working parameters of allergy testing in this context. Methods One hundred and fifty-four peanut-naïve younger siblings of peanut-allergic children underwent double-blinded skin testing, followed by parent-led peanut introduction. Questionnaires were dispensed to parents to investigate preferences with regard to peanut introduction in this subgroup. Results Eight participants (5.2%) presented unequivocal IgE-mediated reactions to peanut upon introduction, including five anaphylaxes. These participants were significantly older compared to the rest of the cohort (median 4.0 vs 1.9 years, P = 0.04). The negative predictive value of skin prick test with peanut extract and peanut butter and of specific IgE was 99%, 100%, and 100%, respectively. Six peanut-tolerant participants had positive peanut allergy tests. The option of introducing at home without prior skin testing was associated with high levels of anxiety (median 8.4 on 10-point Likert scale) when compared to supervised introduction (median 3.8, P < 0.0001) or home introduction after negative skin test (median 4.3, P < 0.0001). Conclusions There is an increased risk of anaphylaxis upon peanut introduction in siblings of children with peanut allergy, and parents are reluctant to introduce at home without testing. Allergy testing prior to introduction is negative in over 90% of cases and carries a high negative predictive value. [ABSTRACT FROM AUTHOR]

This study examines the effects of tonal and rhythmic components of a melody-based intervention on the repetition abilities of two individuals with non-fluent aphasia. The subjects presented lesions restricted to the left hemisphere and showed moderate to severe limitations on repetition tasks. An alternate-treatment design was used where pre-recorded stimuli served to guide a therapist's production of models in treatment conditions emphasising the tonal or rhythmic attributes of target utterances. The results show that, relative to baseline performance, treatment emphasising the tonal attributes of target phrases had little or no impact on the subjects' immediate or deferred repetitions of the phrases. By comparison, exercises emphasising rhythm corresponded to substantial gains in the subjects' ability to repeat target utterances. Implications are drawn with respect to the rationale of melody-based therapies, specifically on the assumption that a right-hemisphere processing of tone may facilitate fluent speech. [ABSTRACT FROM AUTHOR]

The article discusses adverse reactions resulting from skin testing in the diagnosis of red grubs or Chiromides allergy. It is stated that chironornus larvae have proven to be a potent allergen. According to the author, skin testing with red grubs can result in severe reactions including anaphylaxis and should therefore be performed only in controlled hospitalized settings. Details of the trial testing done on a patient are also discussed.

Objectives: To identify characteristics of infants with tracheostomy that require gastrostomy tube insertion versus those likely to orally feed to predict which patients may benefit from insertion of gastrostomy at the time of tracheostomy placement., Methods: Retrospective review of infants undergoing tracheostomy from birth to 18 months of age. The primary outcome was to identify pre-operative factors predictive of future gastrostomy tube use. Univariate and multivariate analyses evaluated association between pre-operative patient characteristics and feeding outcomes., Results: Of 103 patients identified, 73 met inclusion criteria. Upper airway anomaly was the indication for tracheostomy in 70.4 %. Gastrostomy tube was required in 52 patients (75.4 %), with 7 (13.5 %) placed concurrently with tracheostomy. Infants with birth complications, a neurologic diagnosis, multiple co-morbidities, or identified with aspiration risk were more likely to require a gastrostomy tube (p < 0.05)., Conclusions: Most infants who require tracheostomy placement from birth until 18 months of age will require nutritional support. Tracheostomy and gastrostomy are uncommonly placed concurrently. Coordination of placement would theoretically minimize the risk of general anesthetic exposure while potentially reducing hospital length of stay and healthcare related costs., Competing Interests: Declaration of competing interest None of the authors have any relevant conflicts of interest or financial relationships to disclose., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Importance: Intensive interventions are provided to young children with unilateral cerebral palsy (UCP), classically focused on the upper extremity despite the frequent impairment of gross motor function. Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) effectively improves manual dexterity and gross motor function in school-aged children., Objective: To verify if HABIT-ILE would improve manual abilities in young children with UCP more than usual motor activity., Design, Setting, and Participants: This prospective randomized clinical trial (November 2018 to December 2021), including 2 parallel groups and a 1:1 allocation, recruitment took place at European university hospitals, cerebral palsy specialized centers, and spontaneous applications at 3 sites: Brussels, Belgium; Brest, France; and Pisa, Italy. Matched (age at inclusion, lesion type, cause of cerebral palsy, and affected side) pairs randomization was performed. Young children were assessed at baseline (T0), 2 weeks after baseline (T1), and 3 months after baseline (T2). Health care professionals and assessors of main outcomes were blinded to group allocation. At least 23 young children (in each group) aged 12 to 59 months with spastic/dyskinetic UCP and able to follow instructions were needed. Exclusion criteria included uncontrolled seizures, scheduled botulinum toxin injections, orthopedic surgery scheduled during the 6 months before or during the study period, severe visual/cognitive impairments, or contraindications to magnetic resonance imaging., Interventions: Two weeks of usual motor activity including usual rehabilitation (control group) vs 2 weeks (50 hours) of HABIT-ILE (HABIT-ILE group)., Main Outcomes and Measures: Primary outcome: Assisting Hand Assessment (AHA); secondary outcomes: Gross Motor Function Measure-66 (GMFM-66), Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), and Canadian Occupational Performance Measure (COPM)., Results: Of 50 recruited young children (26 girls [52%], median age; 35.3 months for HABIT-ILE group; median age, 32.8 months for control group), 49 were included in the final analyses. Change in AHA score from T0 to T2 was significantly greater in the HABIT-ILE group (adjusted mean score difference [MD], 5.19; 95% CI, 2.84-7.55; P < .001). Changes in GMFM-66 (MD, 4.72; 95% CI, 2.66-6.78), PEDI-CAT daily activities (MD, 1.40; 95% CI, 0.29-2.51), COPM performance (MD, 3.62; 95% CI, 2.91-4.32), and satisfaction (MD, 3.53; 95% CI, 2.70-4.36) scores were greater in the HABIT ILE group., Conclusions and Relevance: In this clinical trial, early HABIT-ILE was shown to be an effective treatment to improve motor performance in young children with UCP. Moreover, the improvements had an impact on daily life activities of these children., Trial Registration: ClinicalTrials.gov Identifier: NCT04020354.

Introduction: Active surveillance (AS) has emerged as a primary management strategy for low-risk prostate cancer (PC) patients. We aimed to assess AS uptake over a 1-year snapshot throughout Quebec and to compare it to 2010 multicentric Canadian data., Methods: A retrospective chart review and data collection was performed in 1 academic and 2 non-academic community centres from Quebec, among men identified in 2016 with localized T1c-T2c PC on biopsy, fulfilling NCCN criteria of low-risk (LR)-PC, including very-low-risk (VLR) and non-VLR-PC, and favourable-intermediate risk (FIR)-PC. AS adherence was defined when chosen as initial strategy, without any radical treatment within 6 months., Results: Overall, 259 patients fulfilled the inclusion criteria with 50.2% of VLR-PC patients. At 6 months, 81% patients in the LR group and 65% in the FIR group were considered as adherent to AS, in both centres, but with an increased use of AS in the community centres compared to 2010 data. The rates of AS maintenance decreased at 12 months to respectively 69% and 58%. Among the VLR group, the rate of initiation was 98% and decreased to 85% at 12 months., Conclusion: Our data suggest that the majority of low-risk PC patients indeed initiated an AS in 2016, with even a greater proportion of VLR-PC patients compared to 2010. This ideal strategy should be encouraged and improved at 12 months, and assessed with recent data and longer follow-up., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: The implementation of virtual devices can facilitate the role of therapists (e.g., patient motivation, intensity of practice) to improve the effectiveness of treatment for children with cerebral palsy. Among existing therapeutic devices, none has been specifically designed to promote the application of principles underlying evidence-based motor skill learning interventions. Consequently, evidence is lacking regarding the effectiveness of virtual-based sessions in motor function rehabilitation with respect to promoting the transfer of motor improvements into daily life activities. We tested the effectiveness of implementing a recently developed virtual device (REAtouch ® ), specifically designed to enable the application of therapeutic motor skill learning principles, during a Hand Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) intervention., Methods: Forty children with unilateral cerebral palsy (5-18 years; MACS I-III; GMFCS I-II) were randomly assigned to a control group or a "REAtouch ® " experimental group for a 90-h HABIT-ILE day-camp intervention (two weeks). Children in the REAtouch ® group spent nearly half of their one-on-one therapeutic time using the REAtouch ® . Participants underwent three testing sessions: the week before (T1), after intervention (T2), and at three months follow-up (T3). The primary outcome was the Assisting Hand Assessment (T3-T1; blinded). Secondary outcomes measured uni-bimanual hand function, stereognosis, gait endurance, daily life abilities, and functional goals. Accelerometers and a manual report of daily activities served to document therapeutic dosage and treatment characteristics. We used one-way RMANOVA to compare the efficacies of the two interventions, and non-inferiority analyses to contrast changes in the "REAtouch ® " group versus the "HABIT-ILE" control group., Results: We found significant improvements in both groups for most of the outcome measures (p < 0.05). There was significant non-inferiority of changes in the REAtouch ® group for upper extremities motor function, functional goals attainment, and abilities in daily life activities (p < 0.05)., Conclusions: Use of the REAtouch ® device during HABIT-ILE showed non-inferior efficacy compared to the conventional evidence-based HABIT-ILE intervention in children with unilateral cerebral palsy. This study demonstrates the feasibility of using this virtual device in a high dosage camp model, and establishes the possibility of applying the therapeutic principles of motor skill learning during specifically designed virtual-based sessions., Trial Registration: Trial registration number: NCT03930836-Registration date on the International Clinical Trials Registry Platform (ICTRP): June 21th, 2018; Registration date on NIH Clinical Trials Registry: April 29th, 2019. First patient enrollment: July 3rd, 2018., (© 2023. The Author(s).)

Bilingual children are a more heterogenous group than their monolingual counterparts with respect to the sources of variation in their language learning environments, as well as the wide individual variation in their language abilities. Such heterogeneity in both individual difference factors and language abilities argues for the importance of an individual differences approach in research on bilingual development. The main objective of this article is to provide a review and synthesis of research on the sources of individual differences in the second language (L2) and heritage language (HL) development of child bilinguals. Several child-internal and child-external individual difference factors are discussed with respect to their influence on children's dual language abilities. In addition, the emergent research on individual differences in bilingual children with developmental language disorder is reviewed. Both the theoretical and applied relevance of individual difference approaches to bilingual development are discussed.

The current study sought to investigate whether word properties can facilitate the identification of developmental language disorder (DLD) in sequential bilinguals by analyzing properties in nouns and verbs in L2 spontaneous speech as potential DLD markers. Measures of semantic (imageability, concreteness), lexical (frequency, age of acquisition) and phonological (phonological neighbourhood, word length) properties were computed for nouns and verbs produced by 15 sequential bilinguals (5;7) with DLD and 15 age-matched controls with diverse L1 backgrounds. Linear mixed modelling revealed a significant interaction of group and word category on phonological neighbourhood values but no differences across imageability, concreteness, frequency, age of acquisition, and word length measures in spontaneous speech. Outcomes suggest that group-level differences may not be apparent at the word-level, due to the heterogeneous nature of DLD and potential similarities in production during early L2 acquisition.

Background: Previous literature demonstrates that female surgeons face difficulties in family planning, meeting breastfeeding goals, leadership and advancement opportunities. These issues have received limited attention in Canadian surgeons despite different maternity leave patterns compared to the general Canadian population. We sought to describe the experience of otolaryngologist-head and neck surgeons in family planning, fertility, and lactation and to identify the role of gender and career stage in these experiences., Methods: A RedCAP ® survey was disseminated to Canadian otolaryngology-head and neck surgeons and residents from March to May of 2021 through social media and the national listserv. This survey examined fertility, pregnancy losses, and infant feeding. Major independent variables include gender and career stage (faculty and resident). Dependent variables include respondent experiences with fertility, number of children, and length of parental leave. Responses were tabulated and presented descriptively to communicate the experience of Canadian otolaryngologists. Further, statistical comparisons such as chi-square and t-tests were employed to identify relationships between these variables. Thematic analysis was conducted for narrative comments., Results: We received 183 completed surveys (22% response rate). 54% of females versus 13% of males agreed that career influenced their ability to have children (p = 0.002). 74% of female respondents without children have concerns about future fertility compared to 4% of men (p < 0.001). Furthermore, 80% of women versus 20% of men have concerns about future family planning (p < 0.001). The average maternity leave was 11.5 weeks for residents, and 22.2 weeks for staff. Additionally, significantly more women than men stated that maternity leave impacted advancement opportunities (32% vs. 7%) and salary/remuneration (71% vs. 24%) (p < 0.001). Over 60% of those choosing to pump breastmilk at work reported having inadequate time, space, and breastmilk storage. In total, 62% of breastfed infants were receiving breastmilk at 1 year., Conclusion: Canadian female otolaryngologists-head and neck surgeons face challenges in family planning, ability to conceive, and breastfeeding. Focused effort is required to provide an inclusive environment that helps all otolaryngologists-head and neck surgeons achieve both their career and family goals, regardless of gender or career stage., (© 2023. The Author(s).)

Introduction: Women in surgical specialties face different challenges than their male peers. However, there is a paucity of literature exploring these challenges and their effects on a Canadian surgeon's career., Methods: A REDCap® survey was distributed to Canadian Otolaryngology-Head and Neck Surgery (OHNS) staff and residents in March 2021 using the national society listserv and social media. Questions examined practice patterns, leadership positions, advancement, and experiences of harassment. Gender differences in survey responses were explored., Results: 183 completed surveys were obtained, representing 21.8% of the Canadian society membership [838 members with 205 (24.4%) women]. 83 respondents self-identified as female (40% response rate) and 100 as male (16% response rate). Female respondents reported significantly fewer residency peers and colleagues identifying as their gender (p < .001). Female respondents were significantly less likely to agree with the statement "My department had the same expectations of residents regardless of gender" (p < .001). Similar results were observed in questions about fair evaluation, equal treatment, and leadership opportunities (all p < .001). Male respondents held the majority of department chair (p = .028), site chief (p = .011), and division chief positions (p = .005). Women reported experiencing significantly more verbal sexual harassment during residency (p < .001), and more verbal non-sexual harassment as staff (p = .03) than their male colleagues. In both female residents and staff, this was more likely to originate from patients or family members (p < .03)., Discussion: There is a gender difference in the experience and treatment of OHNS residents and staff. By shedding light on this topic, as a specialty we can and must move towards greater diversity and equality., (© 2023. The Author(s).)

Background: High-fidelity simulations based on real-life clinical scenarios have frequently been used to improve patient care, knowledge and teamwork in the acute care setting. Still, they are seldom included in the allergy-immunology curriculum or continuous medical education. Our main goal was to assess if critical care simulations in allergy improved performance in the clinical setting., Methods: Advanced anaphylaxis scenarios were designed by a panel of emergency, intensive care unit, anesthesiology and allergy-immunology specialists and then adapted for the adult allergy clinic setting. This simulation activity included a first part in the high-fidelity simulation-training laboratory and a second at the adult allergy clinic involving actors and a high-fidelity mannequin. Participants filled out a questionnaire, and qualitative interviews were performed with staff after they had managed cases of refractory anaphylaxis., Results: Four nurses, seven allergy-immunology fellows and six allergy/immunologists underwent the simulation. Questionnaires showed a perceived improvement in aspects of crisis and anaphylaxis management. The in-situ simulation revealed gaps in the process, which were subsequently resolved. Qualitative interviews with participants revealed a more rapid and orderly response and improved confidence in their abilities and that of their colleagues to manage anaphylaxis., Conclusion: High-fidelity simulations can improve the management of anaphylaxis in the allergy clinic and team confidence. This activity was instrumental in reducing staff reluctance to perform high-risk challenges in the ambulatory setting, thus lifting a critical barrier for implementing oral immunotherapy at our adult center., (© 2023. The Author(s).)

Background: Deliberate practice research has consistently shown that intense, concentrated, goal-oriented practice in a focused domain, such as medicine, can improve skill development and performance. To date, little is known about how surgical residents approach their surgical training, how they evaluate their current weaknesses, and how they plan to transition from one milestone to another. Without knowledge of residents' role in their development, educators miss the opportunity to optimize progression of these lifelong learning skills. Therefore, the purpose of this study was to gain a better understanding of how surgical residents approach their surgical training from the perspective of the surgical residents themselves and to explore if elements of deliberate practice are observed. Methods: Eight surgical trainees participated in one of two focus groups depending on their training level (five junior residents; three senior residents). With the exploratory nature of this research, a focus group methodology was utilized. Results: By employing both deductive and inductive thematic analysis techniques, three themes were extracted from the data: learning resources and strategies, role of a junior/senior, and approaching weaknesses. Conclusions: Although elements of deliberate practice were discussed, higher functioning is necessary to achieve performance excellence, leading to improved patient outcomes., Competing Interests: No competing interests were disclosed., (Copyright: © 2022 Nelson Ferguson K and Paradis J.)

Aim: To investigate potential changes in mirror movements after Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) training in children with unilateral cerebral palsy (CP)., Method: Thirty-one children with unilateral CP (mean age 9 years 4 months, SD 4 years 3 months; range 5 years 4 months-17 years 3 months; 14 females, 17 males) were randomized to either a control or treatment group. After allocation, children were assessed three times: before (T1, baseline) and after (T2) a 2-week interval and again at 3 months after T1 (T3) as follow-up. Between T1 and T2, the treatment group received 90 hours of HABIT-ILE training, while the control group continued their customary treatment. Mirror movements were assessed in all children using the Woods and Teuber Scale, as well as the Assisting Hand Assessment, Pediatric Evaluation of Disability Inventory, and Canadian Occupational Performance Measure., Results: Repeated measures analysis of variance indicated a significant decrease in mirror movements in the more-affected (mean difference = 0.97; 95% confidence interval [CI] = 0.51-1.42; p < 0.001) and less-affected (mean difference = 0.71; 95% CI = 0.37-1.0; p < 0.001) hands of children after HABIT-ILE; these improvements were maintained at the 3-month follow-up. Moreover, the mirror movement changes observed at the second assessment (T2) were inversely correlated with changes in the assessment of activities of daily living, especially in the less-affected hand., Interpretation: HABIT-ILE decreased the intensity of mirror movements in a group of children with CP. Furthermore, mirror movement changes were associated with bimanual performance and activities of daily living in these children., What This Paper Adds: The intensity of mirror movements decreased in both hands after 2 weeks of Hand and Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) training. Mirror movement changes were maintained at the 3-month follow-up after HABIT-ILE. Mirror movement changes were associated with improvements in bimanual performance and activities of daily living., (© 2022 Mac Keith Press.)

Abstract: ICNIRP 2020 guidelines have defined a practical temperature elevation threshold for human health effects, namely the operational adverse health effect threshold that forms the basis of the absorbed power and energy density basic restrictions. These basic restrictions for localized exposures at frequencies above 6 GHz were evaluated by comparing numerically computed temperature rise against the target temperature rise of 2.5 o C, which is the operational adverse health effect threshold divided by the occupational safety factor of 2. The numerical model employs the maximum absorbed power and energy density levels allowed by the occupational basic restriction for both pulsed and continuous wave exposures. These analyses were performed considering 3- and 4-tissue layer models and a variety of beam diameters, frequencies, and exposure durations. The smallest beam diameters were based on a study of theoretically achievable beam widths from half-wave resonant dipoles and show the impact of the averaging area on the computed temperature elevation. The results demonstrated that ICNIRP's assumed occupational safety factors in the frequency range above 6 GHz were not sufficiently maintained for all exposure scenarios and particularly for short pulse exposures at frequencies of 30 GHz or higher with small beam diameters. Worst-case tissue temperature elevations were estimated to be as much as 3.6 times higher than ICNIRP's target temperature increases. Consequently, the authors suggest a small modification in the application of the ICNIRP 2020 localized basic restrictions, thereby limiting the worst-case tissue temperature increases to 1.4 times the target value., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Health Physics Society.)

Despite growing research on individual differences in child bilinguals, few studies have focused on the development of syntax, included both languages, and studied newly arrived school-age migrant children. Accordingly, this study investigated the syntactic development of heritage language (HL) Syrian Arabic and L2 English by Syrian refugee children ( N = 119) recently arrived in Canada using a sentence repetition task. Regression analyses showed that a partially overlapping set of child-level (input and cognitive skills) and language-level (syntactic structure) factors accounted for performance in each language. HL performance was particularly sensitive to language, cognitive, and input variables indexing cumulative HL exposure. L2 performance, however, was sensitive to cognitive and environmental variables indexing current and cumulative L2 use. Finally, despite stronger performance in Arabic than in English, results revealed interdependence between the two languages, indicating that participants with stronger syntactic abilities in their HL tended to have stronger syntactic abilities in their emerging L2.