Cognitive enrichment through art: a randomized controlled trial on the effect of music or visual arts group practice on cognitive and brain development of young children

BACKGROUND

The optimal stimulation for brain development in the early academic years remains unclear. Current research suggests that musical training has a more profound impact on children's executive functions (EF) compared to other art forms. What is crucially lacking is a large-scale, long-term genuine randomized controlled trial (RCT) in cognitive neuroscience, comparing musical instrumental training (MIP) to another art form, and a control group (CG). This study aims to fill this gap by using machine learning to develop a multivariate model that tracks the interconnected brain and EF development during the academic years, with or without music or other art training.

METHODS

The study plans to enroll 150 children aged 6-8 years and randomly assign them to three groups: Orchestra in Class (OC), Visual Arts (VA), and a control group (CG). Anticipating a 30% attrition rate, each group aims to retain at least 35 participants. The research consists of three analytical stages: 1) baseline analysis correlating EF, brain data, age, gender, and socioeconomic status, 2) comparison between groups and over time of EF brain and behavioral development and their interactions, including hypothesis testing, and 3) exploratory analysis combining behavioral and brain data. The intervention includes intensive art classes once a week, and incremental home training over two years, with the CG receiving six annual cultural outings.

DISCUSSION

This study examines the potential benefits of intensive group arts education, especially contrasting music with visual arts, on EF development in children. It will investigate how artistic enrichment potentially influences the presumed typical transition from a more unified to a more multifaceted EF structure around age eight, comparing these findings against a minimally enriched active control group. This research could significantly influence the incorporation of intensive art interventions in standard curricula.

TRIAL REGISTRATION

The project was accepted after peer-review by the Swiss National Science Foundation (SNSF no. 100014_214977) on March 29, 2023. The study protocol received approval from the Cantonal Commission for Ethics in Human Research of Geneva (CCER, BASEC-ID 2023-01016), which is part of Swiss ethics, on October 25, 2023. The study is registered at clinicaltrials.gov (NCT05912270).

The 2023 Impact of Inflammatory Bowel Disease in Canada: The Influence of Sex and Gender on Canadians Living With Inflammatory Bowel Disease

Sex (the physical and physiologic effects resulting from having specific combinations of sex chromosomes) and gender (sex-associated behaviours, expectations, identities, and roles) significantly affect the course of inflammatory bowel disease (IBD) and the experience of living with IBD. Sex-influenced physiologic states, like puberty, the menstrual cycle, pregnancy, and andropause/menopause may also impact and be impacted by IBD. While neither Crohn's disease nor ulcerative colitis is commonly considered sex-determined illnesses, the relative incidence of Crohn's disease and ulcerative colitis between males and females varies over the life cycle. In terms of gender, women tend to use healthcare resources at slightly higher rates than men and are more likely to have fragmented care. Women are more commonly prescribed opioid medications and are less likely than men to undergo colectomy. Women tend to report lower quality of life and have higher indirect costs due to higher rates of disability. Women are also more likely to take on caregiver roles for children with IBD. Women with IBD are more commonly burdened with adverse mental health concerns and having poor mental health has a more profound impact on women than men. Pregnant people with active IBD have higher rates of adverse outcomes in pregnancy, made worse in regions with poor access to IBD specialist care. The majority of individuals with IBD in Canada do not have access to a pregnancy-in-IBD specialist; access to this type of care has been shown to allay fears and increase knowledge among pregnant people with IBD.

The 2023 Impact of Inflammatory Bowel Disease in Canada: COVID-19 and IBD

The COVID-19 pandemic had a monumental impact on the inflammatory bowel disease (IBD) community. At the beginning of the pandemic, knowledge on the effect of SARS-CoV-2 on IBD was lacking, especially in those with medication-suppressed immune systems. Throughout the pandemic, scientific literature exponentially expanded, resulting in clinical guidance and vaccine recommendations for individuals with IBD. Crohn's and Colitis Canada established the COVID-19 and IBD Taskforce to process and communicate rapidly transforming knowledge into guidance for individuals with IBD and their caregivers, healthcare providers, and policy makers. Recommendations at the onset of the pandemic were based on conjecture from experience of prior viruses, with a precautionary principle in mind. We now know that the risk of acquiring COVID-19 in those with IBD is the same as the general population. As with healthy populations, advanced age and comorbidities increase the risk for severe COVID-19. Individuals with IBD who are actively flaring and/or who require high doses of prednisone are susceptible to severe COVID-19 outcomes. Consequently, sustaining maintenance therapies (e.g., biologics) is recommended. A three-dose mRNA COVID-19 vaccine regimen in those with IBD produces a robust antibody response with a similar adverse event profile as the general population. Breakthrough infections following vaccine have been observed, particularly as the virus continues to evolve, which supports receiving a bivalent vaccine booster. Limited data exist on the impact of IBD and its therapies on long-term outcomes following COVID-19. Ongoing research is necessary to address new concerns manifesting in those with IBD throughout the evolving pandemic.

A215 EVALUATING THE COMPARABILITY OF CARE FOR PERSONS ADMITTED TO TORONTO AREA HOSPITALS WITH ACUTE SEVERE ULCERATIVE COLITIS

Background

Approximately 20% of patients with ulcerative colitis will experience an acute severe exacerbation requiring hospitalization. Acute severe ulcerative colitis (ASUC) is a medical emergency associated with significant morbidity and a mortality rate of 1%. Timely initiation of treatment and assessment of clinical response is critical in the management of ASUC. With an aim to reduce treatment variability and improve outcomes, multiple gastrointestinal societies have published guidelines highlighting recommendations for optimal care in ASUC. It remains unclear how closely these guidelines are implemented in clinical practice. Measuring adherence to these recommended processes of care may act as a surrogate measure for quality of care and a way to indirectly evaluate outcomes in the management of patients with ASUC. Studies have shown that even amongst experienced providers practice pattern variability exists. Identifying significant variations in the management of patients with ASUC will highlight where improvement in guideline dissemination and greater adherence is required.

Purpose

We sought to evaluate how quality of care indicators varied across 7 hospital sites for patients admitted ASUC in the Greater Toronto Area.

Method

Using GEMINI, a research collaborative that collects and analyses data from inpatient admissions at 7 Toronto area hospitals, we identified patients admitted to hospital with ASUC from June 2016-December 2019. Hospital sites were further categorized into 3 hospital types; 1 IBD specialty centre (ISC), 3 other academic centres (AC) and 3 community centres (CC). Process measures assessed included proportion tested for C-reactive protein at baseline and following treatment initiation, duration of corticosteroid use, timing and initiation of biologic agents, rates of venous thromboembolism prophylaxis and opioid use. Outcome measures included hospital length of stay, rates of colectomy and mortality.

Result(s)

765 hospitalizations were included in the study; 320 occurring at ISC, 308 at AC and 137 at CC. Corticosteroid use on admission were highest at the ISC at 78% compared to 64% at AC and 63% at CC (p <0.001). Among those who received steroids on admission, 47% of patients remained on intravenous corticosteroids for at least 5 days in the ISC compared to 39% in AC and 75% in CC (p< 0.001). Initiation of biologic rescue therapy was highest at the ISC occurring in 37% of hospitalizations compared to 22% in AC and 23% in CC (p<0.001). In addition, VTE prophylaxis rates were highest at the ISC at 83% followed by 60% in AC and 45% in CC (p<0.001). Rates of colectomy were highest at ISC (12% of hospitalizations vs. 7% in AC).

Conclusion(s)

Greater adherence to indicators of quality of care were seen at the ISC compared to ACs and CCs, although patient outcomes assessed were not clearly different between sites. Further strategies are required to improve adherence to markers of quality care for patients admitted with ASUC.

Please acknowledge all funding agencies by checking the applicable boxes below

None

Disclosure of Interest

None Declared

A117 MANAGEMENT OF VARICEAL BLEEDING WITH ENDOSCOPIC INJECTION OF N-BUTYL-2-CYANOACRYLATE IN PREGNANCY

Background

Although variceal bleeding is rare in pregnancy, pregnant woman with non-cirrhotic portal hypertension are at greater risk of variceal hemorrhage due to increased splanchnic blood flow. Variceal hemorrhage is associated with increased risk of maternal and fetal mortality. Most documented cases of variceal bleeding in pregnancy report the use of elastic ligation for hemostatic management. Histoacryl glue has become increasingly utilized in the acute management and secondary prophylaxis of gastric and ectopic varices in the general population.

Aims

Evidence surrounding the use of Histoacryl glue in pregnancy is limited. We report two cases of variceal bleeding during pregnancy managed successfully with glue.

Methods

Varices were confirmed endoscopically. Images were obtained and reviewed. Aliquots of injected glue were recorded. Maternal and fetal outcomes were monitored during pregnancy and post-partum.

Results

Case 1: A 39-year-old G4P3L0, presented at 20 weeks gestation following several episodes of hematemesis. Urgent esophagogastroduodenoscopy (EGD) revealed hyperemia and portal hypertensive gastropathy in the fundus. A gastric varix with high-risk stigmata was injected with a total of 9mL of 50/50 Histoacryl/Lipodol and bleeding stopped. The patient returned to the hospital two weeks following discharge with melena. Repeat EGD showed mild portal hypertensive gastropathy with a clot at the site of the previous bleeding. No further intervention was required, and the patient delivered at 37 weeks via elective caesarian-section.

Case 2: A 41-year-old G2P0L1 presented at 26 weeks gestation with severe anemia refractory to five units of blood transfusion. Urgent EGD showed a large gastric varix with recent stigmata of hemorrhage, but no active bleed. A total of 13 mL of 75/50 Histoacryl/Lipidol was injected into the varix with no further bleeding. She delivered by elective caesarian-section at 37 weeks gestation. Repeat EGD performed following delivery showed a larger varix with fresh clot at the inferior portion of the fundus. Due to concern for re-bleeding, a total of 4 mL of 50/50 Histoacryl/Lipidol was injected at the site. CT scan post-partum showed prominent gastric varices with glue visualized within the peripheral branches of the portal vein (Figure 1).

Conclusions

Our cases highlight the successful management of gastric varices using Histoacryl glue in pregnancy. Risks associated with Histoacryl glue include glue embolization, local venous thrombosis, as well as extrusion of glue and ulceration. The general complication rate is quoted between 0.5%-5%. One of the two cases was associated with a maternal complication, with evidence of new portal vein thrombosis following injection. The safety of sclerotherapy in pregnancy with cyanoacrylate remains unclear, and further evaluation of the management of gastric varices in this unique population are required.

Funding Agencies

None

Putting our best foot forward: Clinical, treatment-based and ethical considerations of nusinersen therapy in Canada for spinal muscular atrophy

Spinal muscular atrophy (SMA) is the most common genetic cause of infant mortality. SMA is a spectral disorder and is categorised based on symptom onset and severity. The median life expectancy for infants with SMA presenting before 6 months of age is less than 2 years without respiratory support. To date, there is no cure for SMA. In June 2017, nusinersen was approved in Canada as the first disease-modifying drug for SMA because of its demonstrated benefits on motor function and survival in clinical trials. However, with a price tag of almost 1 million dollars for the first year of therapy, careful clinical, treatment-based and ethical consideration of the principles of (i) best interests; (ii) universality; (iii) portability; (iv) public administration; (v) accessibility; and (vi) comprehensiveness are important guideposts to ensure transparent and equitable allocation of health-care resources for nusinersen and all other future orphan drugs.

Andrée Gruslin award lecture: Metabolomics as an important modality to better understand preeclampsia

Preeclampsia (PE) is a complex disorder that affects 3-5% of all pregnancies and is a leading cause of maternal and fetal morbidity and mortality. To date, the heterogeneity of clinical presentation, disease severity and outcomes have limited significant advances in early prediction, diagnosis, and therapeutic intervention of PE. The rapidly expanding field of metabolomics, which has the capacity to quantitatively detect low molecular weight compounds (metabolites) in tissue and biological fluids, shows tremendous promise in gaining a better understanding of PE. This review will discuss this emerging field and its contribution to recent advances in the understanding of PE pathophysiology, and identification of early predictive metabolic biomarkers for this complex disorder.

Power-flux-dependent polarization of nonlinear surface waves

The complete set of Maxwell's equations coupled by means of intrinsic nonlinearities in Kerr-type media has been analyzed and the integrated power flux has been found as a function of refractive index for hybrid TE-TM nonlinear surface waves. We demonstrate that for a fixed refractive index the electric-field vector of the nonlinear surface waves rotates with an adiabatic increase of the power flux from pure TE polarization at the threshold to pure TM polarization at the cutoff, passing through all possible hybrid polarization states for intermediate power fluxes.

Hybrid TE-TM nonlinear guided waves

The first integral of the complete set of Maxwell's equations coupled through intrinsic nonlinearities in Kerr-type media has been found. The application of this result to wave propagation along a nonlinear optical waveguide leads to a general dispersion relation for nonlinear surface and guided waves of arbitrary polarization, i.e., hybrid TE-TM waves.

Enhanced Raman scattering in a flowing plasma

The growth rate for the Raman scattering instability has been found for the case when the plasma flow has a component perpendicular to the wave vector of the pump. Such a configuration allows the pump and the scattered waves to be linearly converted into corresponding longitudinal waves. The linear conversion has a resonant character that results in an enhancement of the growth rate of the parametric process.

Surface wave induced high transparency of an overdense warm plasma layer

We have found conditions in which a structure consisting of an overdense warm plasma layer spaced between two underdense warm plasma layers becomes transparent to a p-polarized obliquely incident electromagnetic wave. The energy of the incident wave is transferred across the overdense region by a pair of coupled surface waves.