Pharmacological Emergency management of Agitation in Children and Young people: protocol for a randomised controlled trial of intraMuscular medication (PEAChY-M)

Introduction: Acute severe behavioural disturbance (ASBD) is a condition seen with increasing frequency in emergency departments (EDs) in adults and young people. Despite the increasing number of presentations and significant associated risks to patients, families and caregivers, there is limited evidence to guide the most effective pharmacological management in children and adolescents. The aim of this study is to determine whether a single dose of intramuscular olanzapine is more effective than intramuscular droperidol at successfully sedating young people with ASBD requiring intramuscular sedation. Methods and analysis: This study is a multicentre, open-label, superiority randomised controlled trial. Young people aged between 9 and 17 years and 364 days presenting to an ED with ASBD who are deemed to require medication for behavioural containment will be recruited to the study. Participants will be randomised in a 1:1 allocation between a single weight-based dose of intramuscular olanzapine and intramuscular droperidol. The primary outcome is the proportion of participants who achieve successful sedation at 1-hour post randomisation without the need for additional sedation. Secondary outcomes will include assessing for adverse events, additional medications provided in the ED, further episodes of ASBD, length of stay in the ED and hospital and satisfaction with management. Effectiveness will be determined using an intention-to-treat analysis, with medication efficacy determined as part of the secondary outcomes using a per-protocol analysis. The primary outcome of successful sedation at 1 hour will be presented as a percentage within each treatment group, with comparisons presented as a risk difference with its 95% CIs. Ethics and dissemination: Ethics approval was received from the Royal Children’s Hospital Human Research Ethics Committee (HREC/69948/RCHM-2021). This incorporated a waiver of informed consent for the study. The findings will be disseminated in a peer-reviewed journal and at academic conferences. Trial registration number: ACTRN12621001238864.Elyssia M Bourke, Meredith L Borland, Amit Kochar, Shane George, Deborah Shellshear, Shefali Jani, Kent Perkins, Doris Tham, Michael Solomon Gordon, Kate Klein, Chidambaram Prakash, Katherine Lee, Andrew Davidson, Jonathan C Knott, Simon Craig, Franz E Babl, On behalf of the Paediatric research in Emergency Departments International Collaborative (PREDICT

Lessons from the removal of lead from gasoline for controlling other environmental pollutants: A case study from New Zealand

<p>Abstract</p> <p>Background</p> <p>It took over two decades to achieve the removal of leaded gasoline in this country. This was despite international evidence and original research conducted in New Zealand on the harm to child cognitive function and behaviour from lead exposure.</p> <p>Objective</p> <p>To identify lessons from the New Zealand experience of removing leaded gasoline that are potentially relevant to the control of other environmental pollutants.</p> <p>Discussion</p> <p>From the available documentation, we suggest a number of reasons for the slow policy response to the leaded gasoline hazard. These include: (1) industry power in the form of successful lobbying by the lead additive supplier, Associated Octel; (2) the absence of the precautionary principle as part of risk management policy; and (3) weak policymaking machinery that included: (a) the poor use of health research evidence (from both NZ and internationally), as well as limited use of expertise in academic and non-governmental organisations; (b) lack of personnel competent in addressing technically complex issues; and (c) diffusion of responsibility among government agencies.</p> <p>Conclusion</p> <p>There is a need for a stronger precautionary approach by policymakers when considering environmental pollutants. Politicians, officials and health workers need to strengthen policymaking processes and effectively counter the industry tactics used to delay regulatory responses.</p

Approximate distance queries for path-planning in massive point clouds

In this paper, algorithms have been developed that are capable of efficiently pre-processing massive point clouds for the rapid computation of the shortest distance between a point cloud and other objects (e.g. triangulated, point-based, etc.). This is achieved by exploiting fast distance computations between specially structured subsets of a simplified point cloud and the other object. This approach works for massive point clouds even with a small amount of RAM and was able to speed up the computations, on average, by almost two orders of magnitude. Given only 8 GB of RAM, this resulted in shortest distance computations of 30 frames per second for a point cloud originally having 1 billion points. The findings and implementations will have a direct impact for the many companies that want to perform path-planning applications through massive point clouds since the algorithms are able to produce real-time distance computations on a standard PC

Levodopa enhances explicit new-word learning in healthy adults: a preliminary study

ObjectiveWhile the role of dopamine in modulating executive function, working memory and associative learning has been established; its role in word learning and language processing more generally is not clear. This preliminary study investigated the impact of increased synaptic dopamine levels on new-word learning ability in healthy young adults using an explicit learning paradigm

Spoken Language Change in Children on the Autism Spectrum Receiving Community-Based Interventions

OnlinePublWe assessed the spoken language of 73 preschool aged children on the autism spectrum receiving community-based early intervention at two time points, approximately 7 months apart. Using the Spoken Language Benchmarks, there was a small non-signifcant change in the proportion of children transitioning from below, to at or above, Phase 3 (word combinations). Using binomial regression, a model comprising seven of nine clinician-proposed child-related predictors explained 64% of the variance. None of the predictors were individually signifcant, although a large efect size (OR=16.71) was observed for children’s baseline rate of communicative acts. The fndings point to substantial unmet clinical need in children with minimal verbal language, but also the relevance of clinician-proposed predictors of their spoken language outcomes.David Trembath, Matt Stainer, Teena Caithness, Cheryl Dissanayake, Valsamma Eapen, Kathryn Fordyce, Veronica Frewer, Grace Frost, Kristelle Hudry, Teresa Iacono, Nicole Mahler, Anne Masi, Jessica Paynter, Katherine Pye, Shannon Quan, Leanne Shellshear, Rebecca Sutherland, Stephanie Sievers, Abirami Thirumanickam, Marleen F. Westerveld, Madonna Tucke