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Background Neonatal Abstinence Syndrome (NAS), a problem common in newborns exposed to substances in-utero, is an emerging health concern. In traditional models of care, infants with NAS are routinely separated from their mothers and admitted to the Neonatal Intensive Care Unit (NICU) with long, expensive length of stay (LOS). Research shows a rooming-in approach (keeping mothers and infants together in hospital) with referral support is a safe and effective model of care in managing NAS. The model’s key components are facilitating 24-h care by mothers on post-partum or pediatric units with support for breastfeeding, transition home, and access to Opioid Dependency Programs (ODP). This study will implement the rooming-in approach at eight hospitals across one Canadian Province; support practice and culture shift; identify and test the essential elements for effective implementation; and assess the implementation’s impact/outcomes. Methods A stepped wedge cluster randomized trial will be used to evaluate the implementation of an evidence-based rooming-in approach in the postpartum period for infants born to mothers who report opioid use during pregnancy. Baseline data will be collected and compared to post-implementation data. Six-month assessment of maternal and child health and an economic evaluation of cost savings will be conducted. Additionally, barriers and facilitators of the rooming-in model of care within the unique context of each site and across sites will be explored pre-, during, and post-implementation using theory-informed surveys, interviews, and focus groups with care teams and parents. A formative evaluation will examine the complex contextual factors and conditions that influence readiness and sustainability and inform the design of tailored interventions to facilitate capacity building for effective implementation. Discussion The primary expected outcome is reduced NICU LOS. Secondary expected outcomes include decreased rates of pharmacological management of NAS and child apprehension, increased maternal ODP participation, and improved 6-month outcomes for mothers and infants. Moreover, the NASCENT program will generate the detailed, multi-site evidence needed to accelerate the uptake, scale, and spread of this evidence-based intervention throughout Alberta, leading to more appropriate and effective care and use of healthcare resources. Trial registration ClinicalTrials.gov, NCT0522662. Registered February 4 th , 2022.

Hospital and community healthcare providers have expressed concerns around the continuity and quality of care for infants with neonatal abstinence syndrome (NAS) during hospitalization and transition home. This qualitative study explored the experiences of hospital and community-based healthcare providers and identified themes related to the management of NAS for mothers and infants. Healthcare providers that cared for women with substance use disorders and/or cared for newborns with NAS in a large urban setting in Canada met inclusion criteria for this study and were interviewed in groups or as individuals. Interview transcripts were reviewed iteratively using inductive thematic analysis to identify an overarching theme linked with primary themes. In total, 45 healthcare providers were interviewed. Qualitative analysis of their experiences derived the overarching theme of hope with five primary themes being: mother/infant, mental health, system, judgement, and knowledge. The study identified gaps in NAS care including fear, stigma, and language. This research demonstrates that programs and interventions that work with mothers and newborns with NAS must foster hope in mothers, families, and in the extended care provider team and improve communication between hospital and community networks.

Study Objective:To determine the impact of continuous positive airway pressure (CPAP) on weight change in persons with obstructive sleep apnea (OSA).Design, Setting, and Participants:The Apnea Positive Pressure Long-term Efficacy Study (APPLES) was a 6-month, randomized, double-blinded sham-controlled multicenter clinical trial conducted at 5 sites in the United States. Of 1,105 participants with an apnea hypopnea index ≥ 10 events/ hour initially randomized, 812 had body weight measured at baseline and after 6 months of study.Intervention:CPAP or Sham CPAP.Measurements:Body weight, height, hours of CPAP or Sham CPAP use, Epworth Sleepiness Scale score.Results:Participants randomized to CPAP gained 0.35 ± 5.01 kg, whereas those on Sham CPAP lost 0.70 ± 4.03 kg (mean ± SD, p = 0.001). Amount of weight gain with CPAP was related to hours of device adherence, with each hour per night of use predicting a 0.42 kg increase in weight. This association was not noted in the Sham CPAP group. CPAP participants who used their device ≥ 4 h per night on ≥ 70% of nights gained the most weight over 6 months in comparison to non-adherent CPAP participants (1.0 ± 5.3 vs. −0.3 ± 5.0 kg, p = 0.014).Conclusions:OSA patients using CPAP may gain a modest amount of weight with the greatest weight gain found in those most compliant with CPAP.Commentary:A commentary on this article appears in this issue on page 995.Citation:Quan SF; Budhiraja R; Clarke DP; Goodwin JL; Gottlieb DJ; Nichols DA; Simon RD; Smith TW; Walsh JK; Kushida CA. Impact of treatment with continuous positive airway pressure (CPAP) on weight in obstructive sleep apnea. J Clin Sleep Med 2013;9(10):989-993.

The Fetus and Newborn Committee of the Canadian Paediatric Society (CPS) addressed clinical concerns about the increase in neonatal abstinence syndrome as a result of drug withdrawal in newborns from maternal opioid use in Canada today.2 The suggestions from the CPS are an important step forward in supporting a more holistic approach to the management of neonatal abstinence syndrome by advocating a model of \"rooming-in\" care for parents and families, advising less emphasis on pharmacotherapy, and highlighting the need for comprehensive discharge planning in this situation.Harm reduction-based care, relating to an understanding of previous life experiences involving neglect and abuse, may be a foreign concept in tertiary care hospital settings, where opioid-exposed neonates are likely to be born.[...]the success of the rooming-in model requires strong financial and infrastructure support in the birthing hospital to allow mothers, babies and other family members to remain central to care in hospital for 7 to 10 days.

Despite comprehensive antenatal screening recommendations and inexpensive treatment, congenital syphilis has long been and continues to be a public health concern, causing substantial morbidity and adverse outcomes. The following article reviews syphilis etiology and presentation, clinical disease, laboratory diagnosis, and treatment of congenital syphilis. A case will be presented describing a 31-week male infant exposed to infectious syphilis in utero. The neonate presented with classic signs of infection at birth. After initial serology testing of the infant, appropriate treatment was commenced. The infant received crystalline penicillin G for a period of ten days in consultation with pediatric infectious disease specialists. As expected, the infant's rapid plasma reagin (RPR) titers declined by three and six months of age. An interdisciplinary approach provided safe and optimal care for this infant. He was discharged, stable, and thriving at 38 weeks corrected age. Long-term multidisciplinary management and follow-up were arranged.

Abstract Introduction/Background Neonatal Abstinence Syndrome (NAS) occurs in newborns exposed to drugs in-utero. In Canada, maternal opiate use in pregnancy has been steadily rising resulting in as many as 1850 babies born with NAS per year. Management of babies born with NAS requires supportive, interdisciplinary care. Depending on the severity of NAS, babies may be cared for with non-pharmacological interventions or some may need to be admitted to the Neonatal Intensive Care Unit for extended hospital stays to receive medication and management of ongoing complex health care needs. Hospital and community health care providers have expressed concerns around the continuity of care for these babies in their stay in hospital and their transition to home. Objectives This study examined the experiences of hospital and community-based health care providers and families regarding the management of babies with NAS. The driving force behind our inquiry related to our interest in streamlining care for these babies in highly complex health and social systems. Design/Methods In total, 47 interdisciplinary participants were interviewed over a four-month period with individuals from Women’s and Child Health, Community, and family members. Interviewed transcripts were reviewed over several months and were completed in December 2019 using an inductive thematic analysis which culminated in the identification of an overarching theme linked with primary themes. ​ Results The study identified existing gaps in the management of these patients, determined how to improve communication between hospital and community networks, and provided a better understanding of the attitudes, perceptions and experiences of hospital and community personnel. The overarching theme identified was hope, with the primary themes being: system, mental health, mother/baby, judgement, and knowledge (see Figure 1). Several gaps identified in the system included fear, stigma, and language. Certain solutions proposed for improvement included focused care in a rooming in model for the mother and baby dyad, supporting mothers’ well-being, involving mothers and families, and supporting care providers in a family centered care model. In Figure 1, green lines indicate themes that are linked with and support hope, and red lines indicate themes that are barriers to hope. Conclusion This research demonstrates that programs and interventions implemented when working with mothers and babies with NAS must foster hope in mothers, families, and in the extended care provider team.

In cocaine dependent individuals, changes in subjective and objective sleep quality accompany their characteristic binge-abstinence cycle. Preliminary studies suggest that sleep quality may decline with prolonged abstinence. Reported here are results of the most extensive study to date on sleep abnormalities during cocaine binge and confirmed abstinence under controlled conditions. The purpose of the current study was to use an experimental, inpatient model of the cocaine binge and abstinence cycle to examine the course and magnitude of sleep disturbances during cocaine use and abstinence. Five inpatient non-treatment seeking cocaine users completed 3 baseline days of drug abstinence followed by 3 days of medically monitored \"binge\" cocaine use, and then 15 days of drug abstinence. Physiological sleep was recorded with polysomnography and the Nightcap ambulatory monitor, while subjective sleep was assessed by questionnaire. Across 3 days of binge cocaine use and 15 subsequent days of confirmed drug abstinence, mean sleep duration, efficiency and latency changed in the direction of poorer sleep quality. In contrast, subjective reports of sleep quality remained unchanged across the same period. Physiological sleep quality deteriorated from days when cocaine was used across the first 2 weeks of confirmed drug abstinence. In contrast, subjective reports of sleep quality remained unchanged across the same period. We postulate that this dissociation between objective and subjective sleep quality results from a cocaine-use related disruption of the sleep homeostat. Worsening sleep quality during cocaine abstinence may contribute to the risk of relapse and its treatment may offer novel therapeutic strategies for cocaine dependence.

Entering the academy as an adult, working-class student in a program that prepared me for university, and subsequently as an undergraduate student, challenged me in many ways, especially in learning how to write in the language of the academy. Employing an arts-based and auto-ethnographic approach, I discuss some of my experiences in the academy, drawing attention to language usage in expository writing while focusing on written wounding comments from teaching assistants on my marked papers. This thesis reveals how teaching assistants' written comments can wound and traumatize students, injuring their spirit. This work raises awareness about how story-telling can also help build self-confidence, can empower and can foster peaceful environments that enable students to heal and recover academically from invisible wounds. It also shows how students may gain spiritual strength for academic success to solve and respond to trauma in the academy. The learning objectives are to share my story, extend the discussion to a critique of the academy, and to point to broader questions of students' resistance and survival in the academy.

My Ph.D. journey traversed a period of ten and a half years from the day I handed in my enrolment papers to graduation day. The timeline included periods of leave of absence totalling nearly a year, data collection periods which were unsuitable for collecting data in schools and a number of hiatus times between enrolling and starting, submission and examiners reporting, submission of changes and approval, and completion and graduation. My period of candidature was marked and supported by three Heads of the School of Education, a couple of name changes to the faculty, changes in senior faculty personnel as well as in the senior leadership of the university.