IntroductionPaediatric mild traumatic brain injury (mTBI) is a public health burden. Clinicians urgently need evidence-based guidance to manage mTBI, but gold standards for diagnosing and predicting the outcomes of mTBI are lacking. The objective of the Advancing Concussion Assessment in Pediatrics (A-CAP) study is to assess a broad pool of neurobiological and psychosocial markers to examine associations with postinjury outcomes in a large sample of children with either mTBI or orthopaedic injury (OI), with the goal of improving the diagnosis and prognostication of outcomes of paediatric mTBI.Methods and analysisA-CAP is a prospective, longitudinal cohort study of children aged 8.00–16.99 years with either mTBI or OI, recruited during acute emergency department (ED) visits at five sites from the Pediatric Emergency Research Canada network. Injury information is collected in the ED; follow-up assessments at 10 days and 3 and 6 months postinjury measure a variety of neurobiological and psychosocial markers, covariates/confounders and outcomes. Weekly postconcussive symptom ratings are obtained electronically. Recruitment began in September 2016 and will occur for approximately 24 months. Analyses will test the major hypotheses that neurobiological and psychosocial markers can: (1) differentiate mTBI from OI and (2) predict outcomes of mTBI. Models initially will focus within domains (eg, genes, imaging biomarkers, psychosocial markers), followed by multivariable modelling across domains. The planned sample size (700 mTBI, 300 OI) provides adequate statistical power and allows for internal cross-validation of some analyses.Ethics and disseminationThe ethics boards at all participating institutions have approved the study and all participants and their parents will provide informed consent or assent. Dissemination will follow an integrated knowledge translation plan, with study findings presented at scientific conferences and in multiple manuscripts in peer-reviewed journals.

We used the dual capability of hyperpolarized 129 Xe for spectroscopy and imaging to develop new measures of xenon diffusing capacity in the rat lung that (analogously to the diffusing capacity of carbon monoxide or D LCO ) are calculated as a product of total lung volume and gas transfer rate constants divided by the pressure gradient. Under conditions of known constant pressure breath-hold, the volume is measured by hyperpolarized 129 Xe MRI, and the transfer rate is measured by dynamic spectroscopy. The new quantities (xenon diffusing capacity in lung parenchyma (D LXeLP )), xenon diffusing capacity in RBCs (D LXeRBC ), and total lung xenon diffusing capacity (D LXe )) were measured in six normal rats and six rats with lung inflammation induced by instillation of fungal spores of Stachybotrys chartarum. D LXeLP , D LXeRBC , and D LXe were 56 ؎ 10 ml/min/mmHg, 64 ؎ 35 ml/min/mmHg, and 29 ؎ 9 ml/min/mmHg, respectively, for normal rats, and 27 ؎ 9 ml/min/mmHg, 42 ؎ 27 ml/min/ mmHg, and 16 ؎ 7 ml/min/mmHg, respectively, for diseased rats. Lung volumes and gas transfer times for LP (T trLP ) were 16 ؎ 2 ml and 22 ؎ 3 ms, respectively, for normal rats and 12 ؎ 2 ml and 35 ؎ 8 ms, respectively, for diseased rats. Xenon diffusing capacities may be useful for measuring changes in gas exchange associated with inflammation and other lung diseases. Anatomical and functional imaging of small animals has become important in the study of lung biology (1). The use of genetically altered mice has also increased the demand for methods to establish physiological phenotypes, including those corresponding to lung disease (2). Xe) for lung applications has been illustrated by the use of 3 He in rats and guinea pigs, including in vivo determination of regional ventilation (3-5), ventilation/perfusion ratio (6), and diffusion (7). The production of high-quality images in human subjects has also been demonstrated (8). Although hyperpolarized 129 Xe (hereafter referred to simply as "xenon") suffers from lower polarizations and gyromagnetic ratios relative to 3 He, it has several advantages due to its high lipid solubility and sensitivity of chemical shift to the molecular environment. In particular, dynamic xenon spectroscopy is capable of identifying the gas exchange properties of the lung. Wagshul et al. (9) were the first to report xenon spectra and images of the mouse lung consisting of three dissolved phase peaks at 190 ppm, 196 ppm, and 198 ppm with respect to the gas resonance, which were tentatively assigned to thoracic tissue, lung parenchyma (LP), and blood, respectively. Subsequent work identified three dissolved-phase resonances in tracheostomized Sprague Dawley rats at 191 ppm, 199 ppm, and 213 ppm, which were attributed to plasma/adipose tissue, LP, and red blood cells (RBCs), respectively (10). To confirm the compartmental assignment of these three peaks, Swanson et al. (11) correlated xenon spectroscopy with 1D chemical shift imaging in Sprague Dawley rats. They observed the in vivo dynamics of xenon in rats that breat...

BackgroundChamplain BASE™ (Building Access to Specialists through eConsultation) is a web-based asynchronous electronic communication service that allows primary-care- practitioners (PCPs) to submit “elective” clinical questions to a specialist. For adults, PCPs have reported improved access and timeliness to specialist advice, averted face-to-face specialist referrals in up to 40% of cases and high provider satisfaction.ObjectiveTo determine whether the expansion of eConsult to a pediatric setting would result in similar measures of improved healthcare system process and high provider acceptance reported in adults.DesignProspective observational cohort study.SettingSingle Canadian tertiary-care academic pediatric hospital (June 2014–16) servicing 1.2 million people.Participants1. PCPs already using eConsult. 2.Volunteer pediatric specialists provided services in addition to their regular workload. 3.Pediatric patients (< 18 years-old) referred for none-acute care conditions.Main outcomes and measuresSpecialty service utilization and access, impact on PCP course-of-action and referral-patterns and survey-based provider satisfaction data were collected.Results1064 eConsult requests from 367 PCPs were answered by 23 pediatric specialists representing 14 specialty-services. The top three specialties represented were: General Pediatrics 393 cases (36.9%), Orthopedics 162 (15.2%) and Psychiatry 123 (11.6%). Median specialist response time was 0.9 days (range <1 hour-27 days), most consults (63.2%) required <10minutes to complete and 21/21(100%) specialist survey-respondents reported minimal workload burden. For 515/1064(48.4%) referrals, PCPs received advice for a new or additional course of action; 391/1064(36.7%) referrals resulted in an averted face-to-face specialist visit. In 9 specialties with complete data, the median wait-time was significantly less (p<0.001) for an eConsult (1 day, 95%CI:0.9–1.2) compared with a face-to-face referral (132 days; 95%CI:127–136). The majority (>93.3%) of PCPs rated eConsult as very good/excellent value for both patients and themselves. All specialist survey-respondents indicated eConsult should be a continued service.Conclusions and relevanceSimilar to adults, eConsult improves PCP access and timeliness to elective pediatric specialist advice and influences their care decisions, while reporting high end-user satisfaction. Further study is warranted to assess impact on resource utilization and clinical outcomes.

b-propeller protein-associated neurodegeneration (BPAN) is a recently identified X-linked dominant form of neurodegeneration with brain iron accumulation caused by mutations in the WDR45 gene. BPAN commonly presents as global developmental delay in childhood with rapid onset of parkinsonism and dementia in early adulthood and associated pathognomonic changes seen on brain MRI. In this case report, we present a pediatric patient with mild cognitive delay and pathognomonic MRI changes indicative of BPAN preceding neurologic deterioration who is found to have a novel de novo mutation in the WDR45 gene.