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The article presents a study which compared the ability of a second-generation light-emitting diode (LED) light with that of a conventional quartz-tungsten-halogen (QTH) light in photopolymerizing a variety of resin composites. Results revealed that the two lights have similar power densities but have different spectral distributions. The study concluded that the two lights could not polymerize all of the resin composites.

The inflammatory response to cardiopulmonary bypass (CPB) in pediatric patients remains an unresolved challenge. Sanguineous CPB prime, composed of allogenic blood products, is one potentially important stimulus. This study aims to identify specific inflammatory mediators active in sanguineous CPB prime and their impact on the inflammatory response at CPB initiation.In a post-hoc analysis of a prospective observational cohort study (NCT05154864), where pediatric patients undergoing cardiac surgery with CPB were enrolled after informed consent, patients were grouped by CPB prime type (sanguineous vs crystalloid). Arterial samples were collected post-sternotomy as a baseline and again at CPB initiation from all patients. In the sanguineous group, CPB prime samples were also collected after buffered ultrafiltration but before CPB initiation. Luminex® measured concentrations of 24 inflammatory mediators for comparison between groups. Statistical analyses were by Mann-Whitney test and Wilcoxon signed-rank test. Data are presented as median [IQR].Forty consecutive pediatric patients participated. The sanguineous group (n = 26) was younger (4.0 [0.2 – 6.0] vs 48.5 [39.0 – 69.5] months; p = 2.6 × 10−7) and smaller (4.9 [34 – 6.6] vs 17.2 [14.9 – 19.6] kg; p = 2.6 × 10−7) than the crystalloid group (n = 14). Despite this, baseline concentrations of 20 complement and cytokine concentrations were comparable between groups (p > 0.05) while four showed differences between groups (p < 0.05). The sanguineous prime contained supraphysiologic concentrations of complement mediators: C2, C3, C3a, C3b, and C5a. Correspondingly, upon CPB initiation, patients receiving sanguineous prime exhibited a significantly larger burden of C2, C3, C3b, C5, and C5a (p < 0.001) relative to the crystalloid group. Cytokine and chemokine mediators were present at trace levels in the sanguineous prime.Sanguineous prime contains activated complement that accelerates the inflammatory response at CPB initiation in neonates and infants. Immunomodulatory interventions targeting complement during CPB prime preparation could offer substantial benefits for these vulnerable patients. [ABSTRACT FROM AUTHOR]

Introduction: Surgical repair is the standard of care for most infants and children with congenital heart disease. Cardiopulmonary bypass (CPB) is required to facilitate these operations but elicits a systemic inflammatory response, leading to postoperative organ dysfunction, morbidity and prolonged recovery after the surgery. Subzero-balance ultrafiltration (SBUF) has been shown to extract proinflammatory cytokines continuously throughout the CPB exposure. We hypothesize that a high-exchange SBUF (H-SBUF) will have a clinically relevant anti-inflammatory effect compared with a low-exchange SBUF (L-SBUF)., Methods and Analysis: The ULTrafiltration to enhance Recovery After paediatric cardiac surgery (ULTRA) trial is a randomised, double-blind, parallel-group randomised trial conducted in a single paediatric cardiac surgery centre. Ninety-six patients less than 15 kg undergoing cardiac surgery with CPB will be randomly assigned to H-SBUF during CPB or L-SBUF during CPB in a 1:1 ratio with stratification by The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) score 1 and STAT score 2-5. The primary outcome is peak postoperative vasoactive-ventilation-renal score. Time series and peak values of vasoactive-ventilation renal score, vasoactive-inotrope score, ventilation index and oxygenation index will be collected. Secondary clinical outcomes include acute kidney injury, ventilator-free days, inotrope-free days, low cardiac output syndrome, mechanical circulatory support, intensive care unit length of stay and operative mortality. Secondary biomarker data include cytokine, chemokine and complement factor concentrations at baseline before CPB, at the end of CPB exposure and 24 hours following CPB. Analyses will be conducted on an intention-to-treat principle., Ethics and Dissemination: The study has ethics approval (#1024932 dated August 31, 2021) and enrolment commenced in September 2021. The primary manuscript and any subsequent analyses will be submitted for peer-reviewed publication., Trial Registration Number: NCT04920643., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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

Background: This study sought to determine the impact of the COVID-19 pandemic response to healthcare delivery on outcomes in patients with cardiovascular disease., Methods: This is a population-based cohort study performed in the province of Nova Scotia, Canada (population 979,499), between the pre-COVID (March 1, 2017-March 16, 2020) and in-COVID (March 17, 2020-December 31, 2020) periods. Adult patients (age ≥ 18 years) with new-onset or existing cardiovascular disease were included for comparison between periods. The main outcome measures included the following: cardiovascular emergency department visits or hospitalizations, mortality, and out-of-hospital cardiac arrest., Results: In the first month of the in-COVID period, emergency department visits (n = 51,750) for cardiac symptoms decreased by 20.8% (95% confidence interval [CI] 14.0%-27.0%, P < 0.001). Cardiovascular hospitalizations (n = 20,609) declined by 48.1% (95% CI 40.4% to 54.9%, P < 0.001). The in-hospital mortality rate increased in patients with cardiovascular admissions in secondary care institutions by 55.1% (95% CI 10.1%-118%, P  = 0.013). A decline of 20.4%-44.0% occurred in cardiovascular surgical/interventional procedures. The number of out-of-hospital cardiac arrests (n = 5528) increased from a monthly mean of 115 ± 15 to 136 ± 14, beginning in May 2020. Mortality for ambulatory patients awaiting cardiac intervention (n = 14,083) increased from 0.16% (n = 12,501) to 2.49% (n = 361) in the in-COVID period ( P < 0.0001)., Conclusions: This study demonstrates increased cardiovascular morbidity and mortality during restrictions maintained during the COVID-19 period, in an area with a low burden of COVID-19. As the healthcare system recovers or enters subsequent waves of COVID-19, these findings should inform communication to the public regarding cardiovascular symptoms, and policy for delivery of cardiovascular care., (© 2021 The Authors.)

Treatment barriers have prompted the development of new models of care. Distance delivery systems bridge the access gap, increasing service availability. Understanding differences between systems can inform system improvements. Sixty participants from the Strongest Families telephone intervention for child behavior difficulties participated. Participants completed a questionnaire to explore differences in perceived treatment barriers (Treatment Barriers Index-TBI) and therapeutic processes (eg, therapeutic alliance, self-disclosure, health outcome) between face-to-face versus distance treatment. The TBI scale has strong internal reliability (Cronbach α: 0.95 [face-to-face]; 0.90 [distance]). Statistically significant differences were found between delivery system TBI mean scores, indicating fewer barriers with distance treatment. Therapeutic process differences between delivery modes suggest enhanced therapeutic alliance and self-disclosure scores with distance treatment. Increased access, convenience, and sense of privacy (visual anonymity) offered by a distance delivery system may provide an enhanced experience for some individuals.

Third-generation light-emitting diode (LED) curing lights use several different types of LEDs within the light to deliver a broader spectral output compared with the narrower spectral output of second-generation curing lights. This study determined the benefits of this broader spectral output. A third-generation LED curing light was modified so that the 4 peripheral LEDs, which provide the lower wavelengths, could be turned on or off, allowing the light to be used as a third- or a second-generation LED curing light. Twelve composites of A2 and lighter shades were packed into molds 2 mm deep with an internal diameter of 12 mm, and then irradiated for 20 seconds. A laboratory-grade spectroradiometer was used to ensure that all the specimens received the same irradiance and total energy (16.82 J/cm2) from the curing light in both the second- and third-generation modes. The results showed the benefits of using a broader spectrum third-generation LED curing light. This light produced composites that were as hard as when the narrower spectrum second-generation LED curing light was used (P < or = .01). In 7 of the 12 resin composites, the top surface was harder when the third-generation LED curing light was used (P < or = .01).

Purpose: To compare the effect of reduced exposure times on the microhardness of resin composites cured with a "second-generation" light-emitting diode (LED) curing light and a quartz-tungsten-halogen (QTH) curing light., Methods: Ten composites were cured with a LED curing light for 50% of the manufacturers" recommended exposure time or a QTH light at the high power setting for 50% of the recommended time or on the medium power setting for 100% of the recommended time. The composites were packed into Class I preparations in extracted human molar teeth and cured at distances of 2 or 9 mm from the light guide. The moulds were separated, and the Knoop microhardness of the composites was measured down to 3.5 mm from the surface., Results: The LED light delivered the greatest irradiance at 0 and 2 mm, whereas the QTH light on the standard (high power) setting delivered the highest irradiance at 9 mm. According to distribution-free multiple comparisons of the hardness values, at 2 mm from the light guide the LED light (50% exposure time) was ranked better than or equivalent to the QTH light on the high power setting (50% exposure time) or on the medium power setting (100% exposure time). At 9 mm, the LED light was ranked better than or equivalent to the QTH light (both settings) to a depth of 1.5 mm, beyond which composites irradiated by the LED light were softer (p < 0.01). At both distances, the QTH light operated on the high power setting for 50% of the recommended exposure time produced composites that were as hard as when they were exposed on the medium power setting for 100% of the recommended exposure time., Conclusions: The ability to reduce exposure times with high-power LED or QTH lights may improve clinical time management.

This study compared 3 light-emitting diode curing lights (UltraLume 5, FreeLight 2, LEDemetron I) with a quartz-tungsten-halogen light (Optilux 401) to determine which was the better at photopolymerizing 5 resin composites. The composites were 2 mm thick and were irradiated for the manufacturers' recommended curing times at distances of 2 mm and 8 mm from the light guide. The Knoop hardness at each of 22 points over a 10-mm diameter footprint at the top and bottom of the composites was used to compare the lights. The 4 curing lights and irradiation distances did not have the same effect on all the composites (P < .001). It was concluded that overall the UltraLume 5 dual peak third generation LED curing light was able to polymerize these 5 resin composites as well as or better than the other curing lights.

Background: Light-emitting diode (LED) curing lights offer advantages over quartz-tungsten-halogen (QTH) lights, but the first-generation LED lights had some disadvantages., Purpose: This study compared a second-generation LED light with a QTH light to determine which was better at photopolymerizing a variety of resin composites., Methods: The ability of a LED light used for 20 and 40 seconds to cure 10 resin composites was compared with that of a QTH light used for 40 seconds. The composites were 1.6 mm thick and were irradiated at distances of 2 and 9 mm from the light guide. The Knoop hardness at the top and the bottom of each composite was measured at 15 minutes and 24 hours after irradiation., Results: The different curing lights and irradiation times did not have the same effect on all of the composites (p < 0.01). For specimens analyzed 24 hours after irradiation, the LED light used for 20 seconds cured 5 of the composites as well as when the QTH light was used for 40 seconds (p > 0.01). When used for 40 seconds, the LED light cured 6 of the composites as well as when the QTH light was used (p > 0.01), and all 10 composites achieved more than 80% of the hardness produced with the QTH light., Conclusions: This LED light could not polymerize all of the composites as well as the QTH light. However, when used for 40 seconds, it cured more than half of the composites as well as when the QTH light was used, and all of the composites achieved a hardness comparable to that produced with the QTH light.