Long-term Need Research Articles

"It Takes a Village": Reflections from participants after a Hispanic community-based health promotion program.

Physical activity (PA) among Hispanic and other minority adolescents in the U.S. lag behind White, non-Hispanic adolescents. Previous studies have examined the beneficial impact of culturally informed, community-based health programs within the Hispanic community on PA levels. There is a need for longer term follow up to determine the impact on family and individual habits over time. Our study aims to explore the aspects of a two-year PA and nutrition program, Families Inspired Together 4 Youth Empowered to Succeed (FIT4YES), that continue to influence family health habits and child development. Community-based focus groups were held in Milwaukee, WI with Hispanic parent participants of the FIT4YES program three years after program conclusion. A semi-structured guide of open-ended questions was used to facilitate the discussion of the lasting impact of FIT4YES. Each group was audio recorded, transcribed, and translated from Spanish when necessary. Four student researchers utilized a grounded theory qualitative approach to identify overarching themes. Three focus groups with 16 total parents (N = 16) spoke about the program. Three overarching themes emerged from the transcripts indicating that cultural exposure, relationships, and self-growth were necessary for families to sustain the healthy behaviors promoted in FIT4YES. Specifically, parents discussed increased comfort levels with their children participating in school sports, the impact of shared experiences with community members, and continued skills initially taught and practiced during active programming. Our group adapted our previously published model to a "post-program" state that incorporated the major themes and sub-themes with levels of the social-ecological model. Although the FIT4YES program ended, multiple ideals instilled by the program continued, we believe, due to the common themes illustrated by our model. This study utilized a community check-in approach to gain insight into the long-term impacts of the FIT4YES program. We propose three recommendations for consideration in the creation of community-based health programs: utilize dynamic, culturally appropriate components based on the intended community; understand the strength of the program as a whole is dependent on the strength of each individual component; and incorporate an anchor institution for consistency and trust within the community.

Long term follow up and outcomes of Covid-19 vaccine associated myocarditis in Victoria, Australia: A clinical surveillance study

BackgroundMyocarditis and myopericarditis are well described adverse events of special interest (AESI) following COVID-19 vaccinations. Although reports are reassuring regarding initial clinical outcomes, information about longer term outcomes remains limited. We aimed to further this knowledge and report outcomes to 6 months post diagnosis from a single population cohort. MethodsReports of myocarditis following COVID-19 vaccination were followed up by SAEFVIC (Surveillance of Adverse Events Following Vaccination in the Community), the state-wide vaccine safety service for Victoria, Australia. Confirmed myocarditis cases (Brighton Collaboration Criteria levels 1–3) were followed up via surveys at 1, 3 and 6 months post symptom onset. Responses received between 22 February 2021 and 30 September 2022 were analysed. Results87.5 % (N = 182) of eligible participants completed at least 1 survey report. 377 reports were analysed. 76.9 % of completed reports were from male patients. The median age of patients was 21 years [IQR: 16 to 32].54.8 % (n = 74) of survey reports at 6 months, reported ongoing symptoms. At all follow-up time points, females were significantly more likely to have ongoing symptoms. At 6 months, 51.9 % of male respondents reported symptom resolution compared to 22.6 % of female patients (p = 0.002). Females were also more likely to continue medication and have ongoing exercise restrictions. However, males were significantly more likely to have higher initial peak troponin results and abnormal initial cardiac imaging investigations. ConclusionsThere appears to be a significant proportion of patients who experience ongoing symptoms to 6 months post onset amongst patients that experience these AESI. Male patients were more likely to report earlier and more complete symptom recovery, despite significantly higher average initial peak troponin. This difference in phenotypic presentation in females compared to males warrants further investigation and there is a need for longer term follow up data.

Public uncertainties in relation to COVID-19 vaccines in the United Kingdom

Uncertainties about COVID-19 vaccines and variants have been linked to vaccination refusal on a significant scale. To optimise public health communication on vaccination and inform vaccination policy, it is necessary to understand the substantive nature of these uncertainties. Our study, using a corpus of texts from 324 UK citizens, examines these uncertainties. The results suggest that major public uncertainties regarding COVID-19 vaccines are expressed in terms of: (1) concerns about the safety of the vaccines; (2) concerns about the effectiveness of the vaccines; (3) perceived lack of trustworthiness and/or competence of actors in the vaccination process; (4) concerns about the logistics of the vaccination roll-out; and (5) uncertainty about the longer-term need for vaccines and social consequences. Public uncertainties regarding COVID-19 are complex and will continue to evolve. Policy responses must be informed by an understanding of the factors that instigate and maintain uncertainties in individuals and the wider society.

Psychological influences on COVID-19 preventive behaviours and vaccination engagement in the United Kingdom and the United States: the significance of ethnicity

Two studies are reported here: a mapping review of literature on the effect of ethnicity on psychological influences upon COVID-19 responses, and a survey simultaneously undertaken in the United Kingdom and United States designed to examine ethnic differences in levels of, and in relationships between, identity resilience, social support, science trust, COVID-19 fear, COVID-19 risk and vaccination likelihood. The review found that very few studies during 2020–2021 examined the effect of ethnicity on the psychological influences on COVID-19 preventive behaviours. The survey study found that science trust, vaccine positivity, perceived risk, COVID-19 fear, identity resilience and social support account for roughly 50 per cent of the variability in COVID-19 vaccination likelihood. Ethnic categories report different levels of these influences but similarity in the way they interact. Taken together, the results indicate that a single model of psychological influences on vaccination decisions is applicable across ethnic categories.

Procurement and commissioning during COVID-19: reflections and (early) lessons

This commentary reflects on some common themes that are starting to emerge in the early analysis of the healthcare procurement and commissioning response to the COVID-19 pandemic. Although it largely results from the observation of the situation in the English NHS, the most salient issues are common to procurement in other EU healthcare systems, as well as more broadly across areas of the public sector that have strongly relied on the extremely urgent procurement exception in the aftermath of the first wave of the pandemic. Given the disfunction and abuse of ‘unregulated procurement’ in the context of COVID-19, the commentary reflects on the longer term need for suitable procurement rules to face impending challenges, such as Brexit and, more importantly, climate change.

Procurement and Commissioning during COVID-19: reflections and (early) lessons

This commentary reflects on some common themes that are starting to emerge in the early analysis of the healthcare procurement and commissioning response to the COVID-19 pandemic. Although it largely results from the observation of the situation in the English NHS, the most salient issues are common to procurement in other EU healthcare systems, as well as more broadly across areas of the public sector that have strongly relied on the extremely urgent procurement exception in the aftermath of the first wave of the pandemic. Given the disfunction and abuse of ‘unregulated procurement’ in the context of COVID-19, the commentary reflects on the longer term need for suitable procurement rules to face impending challenges, such as Brexit and, more importantly, climate change.

Procurement and Commissioning during COVID-19: Reflections and (Early) Lessons

This piece reflects on some common themes that are starting to emerge in the early analysis of the healthcare procurement and commissioning response to the COVID-19 pandemic. Although it largely results from the observation of the situation in the English NHS, the most salient issues are common to procurement in other EU healthcare systems, as well as more broadly across areas of the public sector that have strongly relied on the extremely urgent procurement exception in the aftermath of the first wave of the pandemic. Given the disfunction and abuse of ‘unregulated procurement’ in the context of COVID-19, the piece reflects on the longer term need for suitable procurement rules to face impending challenges, such as Brexit and, more importantly, climate change.

Rapid Gel Card Agglutination Assays for Serological Analysis Following SARS-CoV-2 Infection in Humans.

High-throughput and rapid serology assays to detect the antibody response specific to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) in human blood samples are urgently required to improve our understanding of the effects of COVID-19 across the world. Short-term applications include rapid case identification and contact tracing to limit viral spread, while population screening to determine the extent of viral infection across communities is a longer-term need. Assays developed to address these needs should match the ASSURED criteria. We have identified agglutination tests based on the commonly employed blood typing methods as a viable option. These blood typing tests are employed in hospitals worldwide, are high-throughput, fast (10–30 min), and automated in most cases. Herein, we describe the application of agglutination assays to SARS-CoV-2 serology testing by combining column agglutination testing with peptide–antibody bioconjugates, which facilitate red cell cross-linking only in the presence of plasma containing antibodies against SARS-CoV-2. This simple, rapid, and easily scalable approach has immediate application in SARS-CoV-2 serological testing and is a useful platform for assay development beyond the COVID-19 pandemic.

Multi-Hour Blood Glucose Prediction in Type 1 Diabetes: A Patient-Specific Approach Using Shallow Neural Network Models.

Background: Considering current insulin action profiles and the nature of glycemic responses to insulin, there is an acute need for longer term, accurate, blood glucose predictions to inform insulin dosing schedules and enable effective decision support for the treatment of type 1 diabetes (T1D). However, current methods achieve acceptable accuracy only for prediction horizons of up to 1 h, whereas typical postprandial excursions and insulin action profiles last 4-6 h. In this study, we present models for prediction horizons of 60-240 min developed by leveraging "shallow" neural networks, allowing for significantly lower complexity compared with related approaches. Methods: Patient-specific neural network-based predictive models are developed and tested on previously collected data from a cohort of 24 subjects with T1D. Models are designed to avoid serious pitfalls through incorporating essential physiological knowledge into model structure. Patient-specific models were generated to predict glucose 60, 90, 120, 180, and 240 min ahead, and a "transfer learning" approach to improve accuracy for patients where data are limited. Finally, we determined subgroup characteristics that result in higher model accuracy overall. Results: Root mean squared error was 28 ± 4, 33 ± 4, 38 ± 6, 40 ± 8, and 43 ± 12 mg/dL for 60, 90, 120, 180, and 240 min, respectively. For all prediction horizons, at least 93% of predictions were clinically acceptable by the Clarke error grid. Variance of historic continuous glucose monitor (CGM) values was a strong predictor for the need of transfer learning approaches. Conclusions: A shallow neural network, using features extracted from past CGM data and insulin logs, can achieve multi-hour glucose predictions with satisfactory accuracy. Models are patient specific, learnt on readily available data without the need for additional tests, and improve accuracy while lowering complexity compared with related approaches, paving the way for new advisory and closed loop algorithms able to encompass most of the insulin action timeframe.

Addressing critical knowledge and capacity gaps to sustain CRVS system development

BackgroundImproving civil registration and vital statistics (CRVS) systems requires strengthening the capacity of the CRVS workforce. The improvement of data collection and diagnostic practices must be accompanied by efforts to ensure that the workforce has the skills and knowledge to assess the quality of, and analyse, CRVS data using demographic and epidemiological techniques. While longer-term measures to improve data collection practices must continue to be implemented, it is important to build capacity in the cautious use of imperfect data. However, a lack of training programmes, guidelines and tools make capacity shortages a common issue in CRVS systems. As such, any strategy to build capacity should be underpinned by (1) a repository of knowledge and body of evidence on CRVS, and (2) targeted strategies to train the CRVS workforce.Main textDuring the 4 years of the Bloomberg Philanthropies Data for Health (D4H) Initiative at the University of Melbourne, an extensive repository of knowledge and practical tools to support CRVS system improvements was developed for use by various audiences and stakeholders (the ‘CRVS Knowledge Gateway’). Complementing this has been a targeted strategy to build CRVS capacity in countries that comprised two approaches – in-country or regional training and a visiting Fellowship Program. These approaches address the need to build competence in countries to collect, analyse and effectively use good quality birth and death data, and a longer-term need to ensure that local staff in countries possess the comprehensive knowledge of CRVS strategies and practices necessary to ensure sustainable CRVS development.ConclusionThe Knowledge Gateway is a dynamic, useful and long-lasting repository of CRVS knowledge for countries and development partners to use to formulate and evaluate CRVS development strategies. Capacity-building through in-country or regional training and the University of Melbourne D4H Fellowship Program will ensure that CRVS capacity and knowledge is developed and maintained, facilitating improvements in CRVS data systems that can be used by policymakers to support better decision-making in health.

The Intersection of Food Insecurity and Tobacco Use: A Scoping Review.

Cigarette smoking is increasingly concentrated in socioeconomically disadvantaged groups, and food insecurity also disproportionately affects lower-income groups. Recent studies have suggested that smoking and food insecurity operate as risk factors for one another, but there is limited understanding of their intersection. This scoping review aimed to synthesize the published literature on the association between food insecurity and tobacco use across population groups in the United States and Canada. We searched PubMed, Web of Science, and PsycINFO using key words. Studies included were published in English between 2008 and 2018, reported empirical findings, measured both tobacco use and food insecurity, and considered either variable as a study outcome. Nineteen articles were identified; 6 examined tobacco use as an outcome variable and 13 examined food insecurity as an outcome variable. Most articles were of studies using cross-sectional designs. Study samples ranged from general populations, clinical samples, and underserved populations. For each article, we extracted information including specific findings related to the association between food insecurity and tobacco use. We synthesized the current research by formulating a model by which food insecurity and tobacco use are bidirectionally associated. This scoping review concludes that the co-occurrence of food insecurity and tobacco use exists across populations in the United States and Canada. As the evidence is largely from cross-sectional investigations, there is a need for longer term, comprehensive assessments of relationships between tobacco use and food insecurity. Such investigations can inform policies and interventions aimed toward addressing the inequitable burden of tobacco use and of food insecurity among disadvantaged populations.

The effect of thin stillage on the chemical and biological properties of a Chernozem in Western Canada

The aim of the current study was to assess the effects of direct application of thin stillage on soil residual available nitrogen (N) and phosphorus (P) content along with some selected soil chemical (organic carbon, pH, electrical conductivity, metals content) and biological (dehydrogenase activity and microbial biomass) properties after crop harvest in a two-year field study. The experimental treatments included injected TS, broadcasted and incorporated TS and urea fertilizer with 3 application rates equivalent to 50, 100, and 200 kg available N ha−1 in addition to a control. Overall, NO3−-N content in TS treated soil was higher in the second year, but was not significantly different from that of urea treatments. Soil available P content increased in both years, but was greater in the second year, indicating the high release of N and P nutrients through TS organic matter decomposition after application to soil. In selected treatments, microbial biomass was higher in TS than urea treatments, but not significantly different from the control. The other measured soil parameters remained unchanged for both years. This study indicates that application of TS for two years did not contribute to NO3−-N accumulation in soil beyond the year of application when compared to urea fertilizer. Further studies with longer-term need to be conducted to monitor possible build-up of NO3−-N and P in soil via carryover of unused inorganic forms and also possibly through increased microbial mineralization.

Longer-term needs of stroke survivors with communication difficulties living in the community: a systematic review and thematic synthesis of qualitative studies

ObjectiveTo review and synthesise qualitative literature relating to the longer-term needs of community dwelling stroke survivors with communication difficulties including aphasia, dysarthria and apraxia of speech.DesignSystematic review and thematic synthesis.MethodWe...

Seasonal and Annual Variation in Trematode Infection of Stream SnailElimia proximain the Southern Appalachian Mountains of Virginia

Understanding temporal variation of host-pathogen dynamics can be important for predicting disease risks and anticipating how disease systems may change in response to natural or human disturbances. Seasonal changes in weather, especially those associated with changes in temperature or precipitation, are often a key component of temporal changes in infection risk and can have important impacts on disease systems. However, these patterns can be difficult to track due to interannual variation and the need for longer term, multi-year surveillance efforts. We assessed seasonal and annual changes in the trematode component community of first-intermediate host stream snail Elimia (= Oxytrema = Goniobasis) proxima across 5 streams in the southern Appalachian Mountains. Over 3 yr, we found no evidence of consistent seasonal peaks of trematode infection in E. proxima. There was some across-site consistency in infection prevalence over 4 yr, because high prevalence sites tended to maintain higher prevalence from year to year, relative to lower prevalence sites. In addition, we examined the relationship between prevalence of first-intermediate host infection, weather variables, and site-level factors, including snail density and water quality metrics. Trematode prevalence was negatively related to total precipitation, which may have been due to the movement of infectious parasite stages and hosts downstream during high flows. We found no strong relationships between trematode prevalence and snail density or any of the water quality metrics examined in this study, indicating that snail infection may be driven primarily by definitive host activity.

Dietary fibre for the primary prevention of cardiovascular disease

The prevention of cardiovascular disease (CVD) is a key public health priority. A number of dietary factors have been associated with modifying CVD risk factors. One such factor is dietary fibre which may have a beneficial association with CVD risk factors. There is a need to review the current evidence from randomised controlled trials (RCTs) in this area. The primary objective of this systematic review was to determine the effectiveness of dietary fibre for the primary prevention of CVD. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, Ovid MEDLINE (1946 to January 2015), Ovid EMBASE (1947 to January 2015) and Science Citation Index Expanded (1970 to January 2015) as well as two clinical trial registers in January 2015. We also checked reference lists of relevant articles. No language restrictions were applied. We selected RCTs that assessed the effects of dietary fibre compared with no intervention or a minimal intervention on CVD and related risk factors. Participants included adults who are at risk of CVD or those from the general population. Two authors independently selected studies, extracted data and assessed risk of bias; a third author checked any differences. A different author checked analyses. We included 23 RCTs (1513 participants randomised) examining the effect of dietary fibre. The risk of bias was unclear for most studies and studies had small sample sizes. Few studies had an intervention duration of longer than 12 weeks. There was a wide variety of fibre sources used, with little similarity between groups in the choice of intervention.None of the studies reported on mortality (total or cardiovascular) or cardiovascular events. Results on lipids suggest there is a significant beneficial effect of increased fibre on total cholesterol levels (17 trials (20 comparisons), 1067 participants randomised, mean difference -0.23 mmol/L, 95% CI -0.40 to -0.06), and LDL cholesterol levels (mean difference -0.14 mmol/L, 95% CI -0.22 to -0.06) but not on triglyceride levels (mean difference 0.00 mmol/L, 95% CI -0.04 to 0.05), and there was a very small but statistically significant decrease rather than increase in HDL levels with increased fibre intake (mean difference -0.03 mmol/L, 95% CI -0.06 to -0.01). Fewer studies (10 trials, 661 participants randomised) reported blood pressure outcomes where there is a significant effect of increased fibre consumption on diastolic blood pressure (mean difference -1.77 mmHg, 95% CI -2.61 to -0.92) whilst there is a reduction in systolic blood pressure with fibre but this does not reach statistical significance (mean difference -1.92 mmHg, 95% CI -4.02 to 0.19). There did not appear to be any subgroup effects by the nature of the type of intervention (fibre supplements or provision of foods/advice to increase fibre consumption) or the type of fibre (soluble/insoluble) although the number of studies contributing to each subgroup were small. All analyses need to be viewed with caution given the risks of bias observed for total cholesterol and the statistical heterogeneity observed for systolic blood pressure. Adverse events, where reported, appeared to mostly reflect mild to moderate gastrointestinal side-effects and these were generally reported more in the fibre intervention groups than the control groups. Studies were short term and therefore did not report on our primary outcomes, CVD clinical events. The pooled analyses for CVD risk factors suggest reductions in total cholesterol and LDL cholesterol with increased fibre intake, and reductions in diastolic blood pressure. There were no obvious effects of subgroup analyses by type of intervention or fibre type but the number of studies included in each of these analyses were small. Risk of bias was unclear in the majority of studies and high for some quality domains so results need to be interpreted cautiously. There is a need for longer term, well-conducted RCTs to determine the effects of fibre type (soluble versus insoluble) and administration (supplements versus foods) on CVD events and risk factors for the primary prevention of CVD.

Leaving Nepal After the Earthquake: Sometimes Stepping Away May be the Best Disaster Response.

Leaving Nepal After the Earthquake: Sometimes Stepping Away May be the Best Disaster Response.

Impacts of altered precipitation regimes on soil communities and biogeochemistry in arid and semi-arid ecosystems.

Altered precipitation patterns resulting from climate change will have particularly significant consequences in water-limited ecosystems, such as arid to semi-arid ecosystems, where discontinuous inputs of water control biological processes. Given that these ecosystems cover more than a third of Earth's terrestrial surface, it is important to understand how they respond to such alterations. Altered water availability may impact both aboveground and belowground communities and the interactions between these, with potential impacts on ecosystem functioning; however, most studies to date have focused exclusively on vegetation responses to altered precipitation regimes. To synthesize our understanding of potential climate change impacts on dryland ecosystems, we present here a review of current literature that reports the effects of precipitation events and altered precipitation regimes on belowground biota and biogeochemical cycling. Increased precipitation generally increases microbial biomass and fungal:bacterial ratio. Few studies report responses to reduced precipitation but the effects likely counter those of increased precipitation. Altered precipitation regimes have also been found to alter microbial community composition but broader generalizations are difficult to make. Changes in event size and frequency influences invertebrate activity and density with cascading impacts on the soil food web, which will likely impact carbon and nutrient pools. The long-term implications for biogeochemical cycling are inconclusive but several studies suggest that increased aridity may cause decoupling of carbon and nutrient cycling. We propose a new conceptual framework that incorporates hierarchical biotic responses to individual precipitation events more explicitly, including moderation of microbial activity and biomass by invertebrate grazing, and use this framework to make some predictions on impacts of altered precipitation regimes in terms of event size and frequency as well as mean annual precipitation. While our understanding of dryland ecosystems is improving, there is still a great need for longer term in situ manipulations of precipitation regime to test our model.

Reoperations after paediatric Ross operation

Alsoufi et al. [1] describe their experience with reoperation after the Ross procedure. In their study, they report 92 different procedures in 58 reoperations in 50 of 227 children who received a Ross operation in the period 1991–2004. The population in their study is different from most reports on paediatric Ross operations from western countries, as it contains a much higher percentage of children who were operated on for rheumatic heart disease. This explains the relatively early reoperations: in the majority, replacement of the pulmonary autograft valve was done by a stented prosthesis and (re-) repair or replacement of the mitral valve. The mortality of these reoperations was very low despite the fact that almost half of the reoperations were complex, with two to four simultaneous cardiac procedures. It has to be noted that reoperation for autograft dilatation was not necessary in any of their patients. All failing autograft valves could be replaced by stented prostheses that were placed inside the pulmonary autograft root, without the need to perform a root replacement. This also differs from other series and is probably explained by earlier reoperation of the autograft valve when root dilation has not yet become significant. On the other hand, no repairs of the autograft valve are reported by the authors. This seems logical when considering the nature of rheumatic valve disease and the high chance of another reoperation when repairing the valve. What can we learn from the experience of Alsoufi et al.? First of all, patient selection for the Ross operation is of paramount importance. Children with rheumatic heart disease are poor candidates for the Ross procedure. Especially when the aortic valve presents with annular dilatation and regurgitation and when the mitral valve is also damaged by rheumatic fever, one should refrain from doing a Ross operation. It was reported and histologically documented by Kumar et al. in 1999 and later in 2006 that the pulmonary autograft will frequently suffer from rheumatic degeneration once it is transposed to the aortic position. The reason for this is not entirely clear. Why does a pulmonary valve, that is often the only valve untouched by rheumatic fever, suffer from the rheumatic process once it is placed in the aortic position? [2, 3]. Concomitant rheumatic mitral valve disease should also be considered as a reason to avoid a Ross operation. Multiple valve involvement carries a higher risk of early reoperation and replacement of a mitral valve with subsequent anticoagulation abolishes one of the main purposes of the Ross technique. A second lesson from this study is that it is again confirmed that aortic valve insufficiency increases the risk of pulmonary autograft failure and reoperation [1]. Recently, this was stressed by David et al. who found that aortic annular dilatation and valvular insufficiency do increase the risk of autograft failure even when annular reduction techniques were used during the Ross operation [4]. Finally, as was also reported by Stulak et al. [5] in 2010, reoperations after the Ross operation are often complex, with multiple concomitant procedures. The pulmonary autograft valve is usually lost at reoperation. Valve sparing root replacement and autograft valve repair have been reported, but the outcomes of these techniques in the longer term need to be awaited [6]. In experienced hands, reoperation after a Ross procedure can have a low mortality but there may be considerable morbidity. For all these reasons, careful patient selection is what a Ross operation should begin with.

Hypothermia and Other Treatment Options for Neonatal Encephalopathy: An Executive Summary of the Eunice Kennedy Shriver NICHD Workshop

HIE is not a single disease from a single cause, and is characterized by great diversity in the timing and magnitude of brain injury. It is therefore unreasonable to expect any single intervention to provide uniformly favorable outcome. The known heterogeneity in neuropathological changes after perinatal HIE combined with potential regional heterogeneity of treatment effects will lead to marked differential effects on outcomes among survivors of HIE (e.g. physical disability versus cognitive deficits). This underscores the need for longer term follow up of all infants with HIE undergoing any treatment. In spite of rapidly accumulating clinical and laboratory data related to hypothermia as a neuroprotective strategy for HIE, the speakers and discussants at the workshop underscored numerous gaps in knowledge in this field summarized in the Table, which compares the gaps identified at the 2005 NICHD workshop8 with current gaps. The participants noted that with only six completed studies1-6 providing information on follow-up for up to 18 months of age, the longer-term neurodevelopmental impact of hypothermia for HIE are pending.23,24 This, they concluded, should lead to an overall measure of caution in applying the new therapy of hypothermia indiscriminately for all cases of HIE. Table 1 Comparison of Categories of Gaps in Knowledge and Change from 2005 to 2010 Based on the available data and large knowledge gaps, the expert panel suggested that although hypothermia is unequivocally a promising therapy for HIE, a substantial proportion of infants still suffer from death or disability despite treatment. Further analysis of existing trial data, development of adjuvant therapies to hypothermia, development of biomarkers and further refinements of hypothermia therapy for use in infants suffering from HIE and clinical trials of therapeutic hypothermia in mid resource settings with different risk factors but adequate facilities and infrastructure are all urgently needed and were identified as areas of high priority for study.

Design of an Innovative Double Degree Graduate Program in Health Informatics and Nursing: Bridging Nursing and Health Informatics Competencies

This article describes a novel double-degree Master’s program in Nursing and Health Informatics. The program was designed to prepare nurses with graduate level competencies in both nursing and health informatics. Such competencies are essential for professionals working in the rapidly expanding fields of nursing and health informatics. There is an immediate and longer-term need for clinical professionals with such expertise in Canada. Furthermore, a program was needed to provide graduate level credentialing in nursing and health informatics so graduate students could develop needed workplace competencies at the intersection of nursing and health informatics in the international move towards electronic health records. The double-degree program described in this paper is the first of its kind. The design, underlying rationale, and initial experiences with the program are described in detail in this paper.