Opportunities for play in paediatric healthcare environments: a scoping review.

Play spaces are important components of paediatric healthcare environments. They provide children with critical opportunities to experience the social, emotional, and developmental benefits of play while in healthcare settings for appointments or hospitalizations. These spaces can help to mitigate stress, provide a sense of normalcy in unfamiliar environments, and facilitate social engagement for children and their families. Given the benefits of play spaces in paediatric healthcare settings, it is important to understand how these spaces can be designed to enhance children's inclusion and quality of care. The aim of this scoping review was to explore the current understanding of paediatric play space design. Using search terms related to children, health care, and play space, six interdisciplinary databases were searched over a 30-year period. The search found 2,533 records from which eighteen were included for review. Findings suggest that although it is well-documented that play spaces offer valuable social and emotional benefits, little is known about the specific design features that can and should be incorporated to enhance play opportunities and ensure that they benefit all children and families. Further, the literature mostly considers play spaces in the context of designated play or recreational rooms. Scholars are encouraged to consider how play opportunities can be incorporated into the designs of paediatric healthcare environments beyond the boundaries of these rooms. Future studies should also consider the diversity of play space users, including children of varying ages and abilities, to create more accessible and inclusive paediatric play spaces for children and their families. Advancing knowledge on play space design can help to optimize the quality of these important spaces and to ensure their designs meaningfully enhance children's play experiences and quality of care.

Accessible independent housing for people with disabilities: A scoping review of promising practices, policies and interventions.

BACKGROUND: Accessible housing is imperative to enabling independent living for many people with disabilities; yet, research consistently shows how people with disabilities often lack appropriate accessible housing and are more likely to experience unaffordable, insecure, and/or poor quality housing. Therefore, the aim of this study was to understand promising practices, policies and interventions regarding accessible independent housing for people with disabilities. METHODS: We conducted a scoping review that involved searching seven international literature databases that identified 4831 studies, 60 of which met our inclusion criteria. RESULTS: The reviewed studies involved 18 countries over a 20-year period. Our review highlighted the following key trends: (1) removing barriers to obtaining accessible housing (e.g., advocacy, builders enhancing housing supply, subsidies and financial incentives); (2) policies influencing accessible housing; (3) interventions to enhance accessible housing (i.e., home modifications, smart homes, mobile applications and other experimental devices); and (4) the impact of accessible independent housing on health and wellbeing. CONCLUSIONS: Our findings emphasize the importance of accessible housing for people with disabilities and the urgent need to advance accessible housing options.

A Scoping Review of Pediatric Healthcare Built Environment Experiences and Preferences Among Children With Disabilities and Their Families.

BACKGROUND: Some children with disabilities (CWD) frequently visit pediatric healthcare settings for appointments. Their age, disability, and regular visits mean that they have unique experiences in healthcare settings. While previous research has explored the clinical experiences of CWD, little is known about their experiences of pediatric healthcare built environments, even though these environments may play an important role in shaping their perceptions of care. Given the significant time that some CWD and chronic illnesses (e.g., cancer) spend in healthcare environments and the impact that these settings can have on their experiences, the knowledge gap concerning how they view, and experience healthcare built environments demands attention. OBJECTIVE: To explore how CWD and their families experience pediatric healthcare built environments. METHODS: A scoping review was conducted by searching five health science and interdisciplinary literature databases using terms related to children, disability, healthcare, and built environment. The search identified 5,397 records that were screened independently by three reviewers. RESULTS: Nineteen studies met inclusion criteria and were considered in the final review. Findings indicate that CWD and their families value healthcare built environment features that support social engagement, patient privacy, and parental presence. Further, the age of a child was highlighted as an important factor that influences the built environment preferences of CWD. CONCLUSIONS: CWD and their families prefer certain healthcare built environment features to optimize their experiences in these settings. Healthcare designers can leverage these findings to advance more inclusive pediatric healthcare spaces to improve care and the quality of life for CWD and their families.

Hospital, hospice, or home: A scoping review of the importance of place in pediatric palliative care.

BACKGROUND: Palliative care necessitates questions about the preferred place for delivering care and location of death. Place is integral to palliative care, as it can impact proximity to family, available resources/support, and patient comfort. Despite the importance of place, there is remarkably little literature exploring its role in pediatric palliative care (PPC). OBJECTIVES: To understand the importance and meaning of place in PPC. METHODS: We conducted a scoping review to understand the importance of place in PPC. Five databases were searched using keywords related to "pediatric," "palliative," and "place." Two reviewers screened results, extracted data, and analyzed emergent themes pertaining to place. RESULTS: From 3076 search results, we identified and reviewed 25 articles. The literature highlights hospital, home, and hospice as 3 distinct PPC places. Children and their families have place preferences for PPC and place of death, and a growing number prefer death to occur at home. Results also indicate numerous factors influence place preferences (e.g., comfort, grief, cultural/spiritual practices, and socioeconomic status). SIGNIFICANCE OF RESULTS: Place influences families' PPC decisions and experiences and thus warrants further study. Greater understanding of the importance and roles of place in PPC could enhance PPC policy and practice, as well as PPC environments.

Children's Usage of Inclusive Playgrounds: A Naturalistic Observation Study of Play.

Inclusive playgrounds that are designed to be physically accessible and welcoming to children with disabilities may provide equal and equitable access to play for all children. Using a naturalistic observational design, this study examines children's use of a playground designed to be accessible and inclusive for all ages and abilities. A modified version of the System for Observing Play and Recreation in Communities was used to collect child data on observed gender, age, play behaviour types, social interactions, and activity levels. A relatively equal number of female (52%) and male (48%) observations was made, and the majority (96%) of children observed appeared to be under 12 years of age. Most children (71%) were observed to be engaging in active play. Functional play (e.g., climbing, swinging, running) was the predominant play behaviour observed on the playground (88%), and the majority of social interactions were with peers (48%) or an adult (26%). These findings provide information on how children use a playground designed to be inclusive for children of all ages and abilities. This information can be used to help inform the design of inclusive play spaces as well as types of programming that may occur within such settings.

A Scoping Review of Evidence-Informed Recommendations for Designing Inclusive Playgrounds.

Background: Playgrounds provide children with many sensory, motor, and socioemotional experiences that are critical to child development. Unfortunately, playgrounds also represent an environment where children with disabilities experience barriers to accessing play. Structures and materials that are prominently found in almost all playground designs (e.g., swings, slides, sand) can present as obstacles for many children with disabilities to engage in independent play. Aims: This scoping review engaged in the empirical literature to address the research question, "What are the evidence-informed recommendations for designing inclusive playgrounds to enable participation for children with disabilities?" Consideration was given not only to the physical design of playgrounds, but also the playgrounds' surrounding built and social environments. Methods: A systematic search of Medline, PsycINFO, CINAHL, EMBase, ERIC and Scopus was conducted. Only peer-reviewed literature published in English between January 1990 and January 2021, with a primary focus on inclusive playground structure design related to any type of disability were included. Data extraction included the study author(s), year of publication, country of origin, purpose, disability types considered, methods, sample characteristics and key findings. Key findings were synthesized into evidence-informed recommendations, which were later collated, using inductive content analysis, into five broader thematically congruent groups. Results: Thirty-five studies were included using case study (n = 17); observational (n = 6); survey (n = 5); experimental (n = 4); and multiple study (n = 3) designs. Thirteen evidence-based recommendations and one promising practice were categorized into five broad playground elements: entry points; surfacing and paths; features to foster inclusive play; staffing/supervision; and design process. Conclusion: These recommendations build upon previous design-based best-practices that focused exclusively on the physical design of the playground. Our recommendations have implications for how future playgrounds should be designed to maximize usability and inclusiveness and the overall playground experiences for children with disabilities.

The decline in active school transportation (AST): A systematic review of the factors related to AST and changes in school transport over time in North America.

Active travel to school has declined during the last 50years in North America. During the last decade, the children's active school transportation (AST) literature has grown. This systematic review provides an updated examination of AST correlates, and discusses why school travel mode (STM) share may have changed over time. AST trends are described and a systematic literature review of AST correlates in North America for the period 1990-2016 was conducted. Strength of association between correlates and AST, and relationship direction are assessed and reported. Graphical presentation of correlates included in ≥5 studies were included. Sixty-three studies were identified and reviewed. Distance to school was most strongly associated with AST. Individual, parental and societal correlates had moderate positive associations with AST including: child age, lower parental education, income and other income related factors, race and positive perceptions of AST. Longitudinal studies were few in number, as were studies about exceptional populations, policy, and interventions. AST intervention should focus on key AST correlates. Social and environmental diversity calls for local solutions to school travel challenges. Changes in AST correlates over time should be considered for evaluating existing policy approaches, and to support development of new policy, regulation, design, and program interventions.

Metabolism of 14C-octamethylcyclotetrasiloxane ([14C]D4) or 14C-decamethylcyclopentasiloxane ([14C]D5) orally gavaged in rainbow trout (Oncorhynchus mykiss).

Critical factors (uptake, distribution, metabolism and elimination) for understanding the bioaccumulation/biomagnification potential of Octamethylcyclotetrasiloxane (D4) and Decamethylcyclopentasiloxane (D5) siloxanes in fish were investigated to address whether these chemicals meet the "B" criteria of the Persistent, Bioaccumulative, and Toxic (PBT) classification. A metabolism study was conducted in rainbow trout whereby a 15mg [14C]D4/kg bw or [14C]D5/kg bw as a single bolus oral dose was administered via gavage. Of the administered dose, 79% (D4) and 78% (D5) was recovered by the end of the study (96-h). Eighty-two percent and 25% of the recovered dose was absorbed based on the percentage of recovered dose in carcass (69% and 17%), tissues, bile and blood (12% and 8%) and urine (1%) for D4 and D5, respectively. A significant portion of the recovered dose (i.e. 18% for D4 and 75% for D5) was eliminated in feces. Maximum blood concentrations were 1.6 and 1.4µg D4 or D5/g blood at 24h post-dosing, with elimination half-lives of 39h (D4) and 70h (D5). Modeling of parent and metabolite blood concentrations resulted in estimated metabolism rate constants (km(blood)) of 0.15 (D4) and 0.17day-1(D5). Metabolites in tissues, bile, blood, and urine totaled a minimum of 2% (D4) and 14% (D5) of the absorbed dose. The highest concentration of 14C-activity in the fish following D4 administration was in mesenteric fat followed by bile, but the opposite was true for D5. Metabolites were not detected in fat, only parent chemical. In bile, 94% (D4) and 99% (D5) of the 14C-activity was due to metabolites. Metabolites were also detected in the digestive tract, liver and gonads. Approximately 40% of the 14C-activity detected in the liver was due to the presence of metabolites. Urinary elimination represented a minor pathway, but all the 14C-activity in the urine was associated with metabolites. Clearance may occur via enterohepatic circulation of metabolic products in bile with excretion via the digestive tract and urinary clearance of polar metabolites.

Human chorionic gonadotropin increases serum progesterone, number of corpora lutea and angiogenic factors in pregnant sheep.

Early gestation is a critical period when implantation and placental vascularization are established, processes influenced by progesterone (P4). Although human chorionic gonadotropin (hCG) is not endogenously synthesized by livestock, it binds the LH receptor, stimulating P4 synthesis. We hypothesized treating pregnant ewes with hCG would increase serum P4, number of corpora lutea (CLs) and concepti, augment steroidogenic enzymes, and increase membrane P4 receptors (PAQRs) and angiogenic factors in reproductive tissues. The objective was to determine molecular alterations induced by hCG in pregnant sheep that may promote pregnancy. Ewes received either 600 IU of hCG or saline i.m. on day 4 post mating. Blood samples were collected daily from day 0 until tissue collection for serum P4 analysis. Reproductive tissues were collected on either day 13 or 25 of gestation and analyzed for PAQRs, CXCR4, proangiogenic factors and steroidogenic enzymes. Ewes receiving hCG had more CL and greater serum P4, which remained elevated. On day 25, StAR protein production decreased in CL from hCG-treated ewes while HSD3B1 was unchanged; further, expression of CXCR4 significantly increased and KDR tended to increase. PAQR7 and CXCR4 protein was increased in caruncle tissue from hCG-treated ewes. Maternal hCG exposure influenced fetal extraembryonic tissues, as VEGFA, VEGFB, FLT1, and ANGPT1 expression increased. Our results indicate hCG increases serum P4 due to augmented CL number per ewe. hCG treatment resulted in greater PAQR7 and CXCR4 in maternal endometrium and promoted expression of proangiogenic factors in fetal extraembryonic membranes. Supplementing livestock with hCG may boost P4 levels and improve reproductive efficiency.

Getting the shots: methods to gain adherence to a multi-dose vaccination program for inner city, drug-involved prostitution communities.

Street-based sex-work and poly-substance drug use, coupled with low vaccination rates and limited utilization of the mainstream health care system, put the sex worker communities of Bogotá's city center at extreme risk of infection with the hepatitis B virus (HBV). Vaccination is critical to maintaining low prevalence of the disease and low incidence of new cases, yet the floating and inconsistent nature of Bogotá's drug-involved female and transsexual prostitution communities make it difficult to complete a 3-dose vaccination program. Between December 2011 and March of 2012, the Fénix Foundation collaborated with the Bogotá Health Department to deliver free HBV vaccines to this vulnerable population. This paper outlines methods used in the vaccination program to generate a 37.7% adherence rate, significantly higher than that previously reported for HBV vaccination programs also targeting marginalized populations. This program's practices are based on the Fénix peer leader method, and are offered as a model that can be applied to other health interventions operating in analogous contexts, with similarly high-risk populations.

[Sexually-transmitted disease prevalence and the factors associated with it in sexually-exploited children in Bogota, Colombia]. / Prevalencia y Factores Asociados a Enfermedades de Transmisión Sexual en Menores Explotados Sexualmente en Bogotá, Colombia.

OBJECTIVE: Presenting the characteristics of a group of children who have been sexually exploited in Bogota, determining the prevalence of sexually-transmitted disease (STD) in this group of children and establishing the factors associated with STD in this population. METHODOLOGY: This was a descriptive, cross-sectional study. The medical charts of children aged 10 to 17 years who sought medical attention at Fundación Renacer between January 2002 and June 2004 were reviewed. The analysis included descriptive statistics, correlations and binomial logistic regression. RESULTS: 255 children's charts were included, producing the following characteristics: being female (58.8%), average age was 15.4, 5.9% were affiliated to social security, 89.8% engaged in substance abuse, 41.2% used family planning, 3.9% used a condom during every intercourse and there were 0.86 average pregnancies per female adolescent. Sexually-transmitted disease prevalence was 30.9%. The most common diseases were condilomatosis and Neisseria gonorrhoeae infection. Substance abuse and infrequent condom use were associated with a diagnosis of STD. CONCLUSION: Child sexual exploitation is a reality in Colombia. In spite of the limitations of this study, it can be concluded that STDs are an important problem in the sexually-abused child population in Bogota. Preventing child sexual exploitation and integral attention for these children (including health service provision) must become a priority.

Prevalencia y Factores Asociados a Enfermedades de Transmisión Sexual en Menores Explotados Sexualmente en Bogotá, Colombia / Sexually-transmitted disease prevalence and the factors associated with it in sexually-exploited children in Bogota, Colombia

Objetivos Presentar características de un grupo de niños que han sido explotados sexualmente en Bogotá, determinar la prevalencia de Enfermedades de Transmisión Sexual (ETS) en estos menores y establecer factores asociados a estas enfermedades en este grupo. Metodología Estudio descriptivo de corte transversal. Se revisaron historias clínicas de pacientes entre 10 y 17 años que asistieron a la consulta médica ambulatoria de la Fundación Renacer entre Enero del 2002 y Junio del 2004. El análisis incluyó estadísticas descriptivas, correlaciones y regresión logística binomial. Resultados Se incluyeron 255 historias de menores. Características: 58,8 por ciento mujeres, 15,4 años edad promedio, 5,9 por ciento tenían alguna afiliación a seguridad social, 89,8 por ciento consumían alguna sustancia psicoactiva, 41,2 por ciento utilizaba algún método anticonceptivo, el 3,9 por ciento refirió utilizar condón en todas sus relaciones y 0,86 embarazos en promedio por adolescente femenina. La prevalencia de diagnósticos de enfermedades de transmisión sexual fue de 31,0 por ciento. Las enfermedades mas comunes fueron condilomatosis e infección por Neisseria gonorrhoeae. Las ETS se asociaron con número de sustancias psicoactivas consumidas y con uso poco frecuente de condón. Conclusión La explotación sexual infantil es una realidad en Colombia. Este estudio confirma que las enfermedades de transmisión sexual son un problema importante en los menores explotados sexualmente en Bogotá. La prevención de explotación sexual infantil y la atención integral a estos menores, incluyendo la atención en salud, deben ser una prioridad.

Objective Presenting the characteristics of a group of children who have been sexually exploited in Bogota, determining the prevalence of sexually-transmitted disease (STD) in this group of children and establishing the factors associated with STD in this population. Methodology This was a descriptive, cross-sectional study. The medical charts of children aged 10 to 17 years who sought medical attention at Fundación Renacer between January 2002 and June 2004 were reviewed. The analysis included descriptive statistics, correlations and binomial logistic regression. Results 255 children's charts were included, producing the following characteristics: being female (58.8 percent), average age was 15.4, 5.9 percent were affiliated to social security, 89.8 percent engaged in substance abuse, 41.2 percent used family planning, 3.9 percent used a condom during every intercourse and there were 0.86 average pregnancies per female adolescent. Sexually-transmitted disease prevalence was 30.9 percent. The most common diseases were condilomatosis and Neisseria gonorrhoeae infection. Substance abuse and infrequent condom use were associated with a diagnosis of STD. Conclusion Child sexual exploitation is a reality in Colombia. In spite of the limitations of this study, it can be concluded that STDs are an important problem in the sexually-abused child population in Bogota. Preventing child sexual exploitation and integral attention for these children (including health service provision) must become a priority.

Control loop noise rejection using fuzzy logic.

This paper describes an application of fuzzy logic to noise rejection in a control loop. This new use of fuzzy logic solves the problem of sluggish control loop response when using a set-point range to stop constant valve chattering due to noise in the output signal being sent to a control valve. Multiple related variables and a general understanding of their inter-relationship must be available for this method to be successfully applied. An overview of the specific fuzzy logic method used for this application is presented along with guidelines for the practical application. In addition, this paper includes results from the successful implementation of fuzzy logic to a control loop on a pilot plant distillation column.

Eczema--practical management issues.

BACKGROUND: Eczema is a common, and at times challenging, condition to manage. It often involves an irritable child, concerned parents and numerous return visits. A variety of mainstream and alternative treatments can confuse both the clinician and patient. OBJECTIVE: This article aims to refresh readers by reviewing evidenced based treatment protocols, and exploring some of the new and evolving treatments in eczema. DISCUSSION: Managing eczema is a multifocal task involving a variety of medicinal and practical approaches. Education of parents and carers is critical. Having a clear plan that can be adapted to each patient's needs is helpful for all involved, with management focussing on control rather than cure. Simple emollients and preventive measures are used to reduce heat, dryness and prickling of the skin. Topical corticosteroids remain the gold standard in the treatment of the inflammation of eczema. However, combining topical steroids with the new calcineurin inhibitors, wet dressings and behavioural modification should increase the time interval between exacerbations.

Accurate confidence intervals for binomial proportion and Poisson rate estimation.

Estimates of proportion and rate-based performance measures may involve discrete distributions, small sample sizes, and extreme outcomes. Common methods for uncertainty characterization have limited accuracy in these circumstances. Accurate confidence interval estimators for proportions, rates, and their differences are described and MATLAB programs are made available. The resulting confidence intervals are validated and compared to common methods. The programs search for confidence intervals using an integration of the Bayesian posterior with diffuse priors to measure the confidence level. The confidence interval estimators can find one or two-sided intervals. For two-sided intervals, either minimal-length, balanced-tail probabilities, or balanced-width can be selected.

Bridging child welfare and juvenile justice: preventing unnecessary detention of foster children.

Gaps in service coordination between child welfare and other child-serving agencies are well documented. This article examines the gap between the child welfare and juvenile justice systems and discusses a program, Project Confirm, designed to reduce the problems associated with this gap. Project Confirm aims to improve cooperation between juvenile justice and child welfare agencies to prevent the unnecessary detention of arrested foster children in secure facilities. The program's design is outlined, and implementation statistics and government partner perceptions of the program in its first year of operations are provided. The article also identifies future challenges to implementation and discusses the broader implications of the program. In making this appeal for coordination and collaboration among public agencies, I'm not talking about pro forma integration efforts-I'm not talking about memoranda of understanding or top-level reorganizations that have autonomous agencies vaguely reporting to a single box labeled "human services." Rather, I'm talking about the much more challenging objective of achieving real working partnerships at the front line. (Nelson, 1998, p. 6)