Robert S. Ware

To the Editor: The results of the PICNIC trial reported by Ullman et al. (Jan. 9 issue)1 provide valuable insights into materials used in peripherally inserted central catheters (PICCs). However, two issues warrant further clarification. First, the authors report a higher incidence of catheter occlusion with the chlorhexidine PICC (33.6%) than with either the hydrophobic PICC (17.0%) or the standard polyurethane PICC (14.2%). This finding contrasts with those in previous trials that focused on chlorhexidine gluconate, such as the work by Mimoz et al.,2 which showed lower rates of infection without an increased incidence of catheter occlusion.

Limited information exists for when potentially pathogenic bacteria first colonize the airways. Weekly nasal swabs from an Australian birth cohort (N = 158) revealed the median (interquartile range) ages when Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae were first detected as 3.0 (0.8-7.1), 5.5 (2.8-8.7) and 11.2 (6.4-18.0) months, respectively. RNA viruses were associated with first H. influenzae detections.

Background: Mass-gathering events (MGEs) such as sporting competitions and music festivals that take place in stadiums and arenas pose challenges to health care delivery that can differ from other types of MGEs. This scoping review aimed to describe factors that influence patient presentations to in-event health services, ambulance services, and emergency departments (EDs) from stadium and arena MGEs. Methods: This scoping review followed the Preferred Reporting Items of Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) checklist and blended both Arksey and O'Malley methodology and the Joanna Briggs Institute's (JBI's) approach. Four databases (CINAHL, Embase, PubMed, and Scopus) were searched using keywords and terms about "mass gatherings," "stadium" or "arena," and "in-event health services." In this review, the population pertains to the spectators who seek in-event health services, the concept was MGEs, and the context was stadiums and/or arenas. Results: Twenty-two articles were included in the review, most of which focused on sporting events (n = 18; 81.8%) and music concerts (n = 3; 13.6%). The reported patient presentation rate (PPR) ranged between one and 24 per 10,000 spectators; the median PPR was 3.8 per 10,000. The transfer to hospital rate (TTHR) varied from zero to four per 10,000 spectators, and the median TTHR was 0.35 per 10,000. Key factors reported for PPR and TTHR include event, venue, and health support characteristics. Conclusions: There is a complexity of health care delivery amid MGEs, stressing the need for uniform measurement and continued research to enhance predictive accuracy and advance health care services in these contexts. This review extends the current MGE domains (biomedical, psychosocial, and environmental) to encompass specific stadium/arena event characteristics that may have an impact on PPR and TTHR.

Sleep problems in young children are highly prevalent and place children at risk for numerous detrimental child and family outcomes. This pilot study aimed to assess the feasibility of an unguided, parent-focused, online sleep intervention, the Lights Out Online program, in terms of adherence rates, acceptability to parents, and effects on (a) child sleep, anxiety, and behaviour problems, and (b) parental self-efficacy, and parent sleep, depression, anxiety. The study was a pilot, open (uncontrolled) trial with a within-group repeated measures (baseline (T1), 12-weeks post-baseline (T2)) design. Participants were 24 parents (Mage = 36.2, SD = 4.1) of children aged 3-6 years (Mage = 4.1 years, SD = 1.1) with sleep problems. Participants completed an average of 3.58 out of 4 sessions by T2, and parents reported satisfaction with program content and presentation. A series of mixed-effects linear regression models demonstrated significant improvements in child sleep, child anxiety, child behaviour problems, parent sleep, parent anxiety and parental self-efficacy, from T1 to T2. However, significant improvements were not demonstrated for parent depression and parent stress. The results of this study should be taken with caution given the small sample size and lack of control group. However, the study provides preliminary support for the feasibility of Lights Out Online.

Background: Infants born very preterm (VPT) are at increased risk of neurodevelopmental impairments. The Test of Infant Motor Performance (TIMP) is an assessment used to evaluate an infant's gross motor skills, however, understanding of its predictive accuracy in VPT infants is limited. Objective: To determine the accuracy of the TIMP assessed at term equivalent age (TEA), and 3 months corrected age (CA), to identify motor or cognitive impairment at 12 months CA in VPT infants. Methods: This prospective observational cohort study recruited 202 infants born at <31wks gestational age (GA). At TEA and 3 months CA the TIMP was performed. At 12 months CA the following neurodevelopmental assessments were conducted; Alberta Infant Motor Scale (AIMS), Neurological Sensory Motor Development Assessment (NSMDA) and Bayley Scale of Infant and Toddler Development 3rd edition (Bayley III). Results: The TIMP had higher specificity than sensitivity across all four outcome measures. Using a cut off-of ≤ -0.5 at TEA, TIMP z-scores demonstrated low sensitivity and specificity for motor outcomes on the NSMDA (sensitivity 61 %, specificity 50 %), AIMS (sensitivity 59 %, specificity 50 %) and Bayley III (sensitivity 56 %, specificity 51 %). Area under the curve analyses showed that the TIMP assessed at 3 months had greater accuracy than at TEA in identifying neurodevelopmental impairments at 12 months CA. Conclusions: The TIMP assessed at TEA and 3 months CA correctly identified the majority of VPT infants without motor and cognitive impairments. However, it missed VPT infants who developed adverse neurodevelopmental outcomes by 12 months CA.