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Gustafson S, Poynter SE, Turner TL, Condus M, Waggoner-Fountain LA. Starting with the end in mind: Transformative curriculum development in Competency-based medical education (CBME). Curr Probl Pediatr Adolesc Health Care 2024; 54:101678. [PMID: 39227234 DOI: 10.1016/j.cppeds.2024.101678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Affiliation(s)
- Sarah Gustafson
- David Geffen School of Medicine at UCLA, Charles R. Drew University of Medicine and Science, Los Angeles County Harbor UCLA Medical Center, Torrance, CA, United States
| | - Sue E Poynter
- Cincinnati Children's/University of Cincinnati Medical Center, United States
| | - Teri Lee Turner
- Baylor College of Medicine/Texas Children's Hospital, Houston, TX, United States
| | - Maria Condus
- Pediatric Residency Review Committee for ACGME, Chicago, IL, United States
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Burke AE, Sklansky DJ, Haftel HM, Mitchell A, Mann KJ. Competency-based medical education and the education continuum: Establishing a framework for lifelong learning. Curr Probl Pediatr Adolesc Health Care 2024; 54:101642. [PMID: 38851971 DOI: 10.1016/j.cppeds.2024.101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Affiliation(s)
- Ann E Burke
- Wright State University Boonshoft School of Medicine and Dayton Children's Hospital.
| | - Daniel J Sklansky
- University of Wisconsin School of Medicine and Public Health and American Family Children's Hospital
| | - Hilary M Haftel
- American Academy of Pediatrics, Senior Vice President, Education
| | - Andrew Mitchell
- Wright State University Boonshoft School of Medicine and Dayton Children's Hospital
| | - Keith J Mann
- American Board of Pediatrics, Vice President for Continuing Certification
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Kerth JL, Bosse HM. The Future of Postgraduate Training? An Update on the Use of Entrustable Professional Activities in Pediatric Professional Training. Acad Pediatr 2024; 24:1035-1037. [PMID: 38971522 DOI: 10.1016/j.acap.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/05/2024] [Accepted: 06/28/2024] [Indexed: 07/08/2024]
Affiliation(s)
- Janna-Lina Kerth
- Department of General Pediatrics, Pediatric Cardiology and Neonatology, Medical Faculty, University Children's Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
| | - Hans Martin Bosse
- Department of General Pediatrics, Pediatric Cardiology and Neonatology, Medical Faculty, University Children's Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
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Gilliam CA, Lurie B, Winn AS, Barber A, Jackson D, Weisgerber M, Unaka N. The role of competency based medical education in addressing health inequities and cultivating inclusive learning environments. Curr Probl Pediatr Adolesc Health Care 2024; 54:101641. [PMID: 38851972 DOI: 10.1016/j.cppeds.2024.101641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
Pediatric health inequities are pervasive and reflect the confluence of social and structural determinants of health including racism in all its forms. Current approaches in graduate medical education that prepare trainees to address health inequities and improve population health are inadequate. Competency based medical education (CBME) can advance equity-oriented efforts to improve patient outcomes, optimize the learning environment and encourage lifelong learning. We briefly describe the impact of racism and discrimination on the clinical learning environment. We then highlight how to apply the 5 core principles of CBME to equip learners across the continuum to address health inequities. We provide specific examples including 1) how CBME can inform teaching, assessment and professional development activities to promote equitable pediatric health outcomes via enturstable professional activities, 2) competency-focused instruction that address racism and inequities, 3) multimodal learning approaches to facilitate the acquisition of the desired competencies to address health inequities, 4) sequenced learning approaches across the continuum of practicing pediatricians, and 5) tools and resources for programmatic assessment of trainee and program performance in addressing pediatric health inequities.
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Affiliation(s)
- Courtney A Gilliam
- Division of Hospital Medicine, Cincinnati Children's, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Brian Lurie
- The Warren Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, RI
| | - Ariel S Winn
- Boston Children's Hospital, Boston MA, United States; Department of Pediatrics, Harvard Medical School, Boston MA, United States
| | - Aisha Barber
- Children's National Hospital, Washington D.C, United States; George Washington University School of Medicine and Health Sciences, United States
| | - Darcel Jackson
- Children's National Hospital, Washington D.C, United States
| | - Michael Weisgerber
- Section of Pediatric Hospital Medicine, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI, United States
| | - Ndidi Unaka
- Division of Hospital Medicine, Cincinnati Children's, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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Cianciolo AT, O'Brien BC, Klamen DL, Mellinger J. Building on Strengths: An Affirmational and Systems-Level Approach to Revisiting Character in Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:708-715. [PMID: 38466581 DOI: 10.1097/acm.0000000000005670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
ABSTRACT Although U.S. medical education has continued to place increased emphasis on defining competency standards and ensuring accountability to the public, health care inequities have persisted, several basic health outcomes have worsened, public trust in the health care system has eroded, and moral distress, burnout, and attrition among practicing physicians have escalated. These opposing trends beg the question of how the "good doctor" concept may be strengthened. In this perspective, the authors argue that revisiting the construct of physician character from an affirmational perspective could meaningfully improve medical education's impact on overall health by more holistically conceptualizing what-and who-a good doctor is. The authors introduce positive psychology's framework of character strengths, probe the distinction between character strengths and medical professionalism, and summarize the role of character strengths in promoting physician engagement and well-being in health care work. They contend that a systems-level approach to cultivating character strengths will foster physician moral agency and well-being and, by extension, transformational change in health care. Consistent with best practice in modern character education, the authors propose that institutions mindfully cultivate moral community among all stakeholders (students, faculty, staff, postgraduate trainees, and patients) and that moral community interaction centers on each member's personal aspirations with respect to living a good life, guided by the character strengths framework and informed by patient perspectives.
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Fannin DK, Williams EDG, Fuller M, Pearson JN, Boyd BA, Drame E, Taylor J, Dickerson AS, Spinks-Franklin A, Coles-White D. Unpacking the prevalence: A warning against overstating the recently narrowed gap for Black autistic youth. Autism Res 2024; 17:1072-1082. [PMID: 38804591 PMCID: PMC11186720 DOI: 10.1002/aur.3168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
Recent findings from the Centers for Disease Control and Prevention's (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network's 2020 prevalence report indicate that disparities in autism diagnoses between Black and White youth have narrowed, reflecting improved screening, awareness, and access to services (Maenner et al., 2023. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 72, 1-14.). Claims of reducing disparities beyond prevalence rates, however, are not fully supported, as indicated by the reality that Black youth whose screenings indicate autistic traits are still not being referred for full evaluation or early intervention services at the same rate as their White peers (Major et al., 2020. Autism, 24, 1629-1638; Smith et al., 2020. Pediatrics, 145, S35-S46.). Black 8-year-olds identified as autistic still experience disparate educational placements (Waitoller et al., 2010. The Journal of Special Education. 44, 29-49.) where services may not be autism-specific or have Individual Education Plan goals only focused on "behavior problems" (Severini et al., 2018. Journal of Autism and Developmental Disorders, 48, 3261-3272.), are served in the most restrictive environments (Skiba et al., 2006. Exceptional Children, 72, 411-424.) and lack consistent augmentative and alternative communication support (Pope et al., 2022. American Journal of Speech-Language Pathology, 31, 2159-2174.). Additionally, ADMM researchers report consistent disparities in the identification of co-occurring intellectual disability where Black autistic children have significantly more co-occurrences than White autistic children. The purpose of this commentary is to first examine the assertion that the narrowed gap indicates, "…improved…access to services among historically underserved groups," (p. 9) (Maenner et al., 2023. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 72, 1-14.). We will then recommend strategies to address the ongoing disparities.
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Affiliation(s)
- Danai Kasambira Fannin
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham, NC
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC
| | | | - Marcus Fuller
- Department of Education, University of Maryland Eastern Shore, Princess Anne, MD
| | - Jamie N. Pearson
- Department of Teacher Education and Learning Sciences, North Carolina State University, Raleigh, NC
| | - Brian A. Boyd
- School of Education, University of North Carolina, Chapel Hill, NC
- Frank Porter Graham Child Development Institute, Chapel Hill, NC
| | - Elizabeth Drame
- Department of Teaching and Learning, University of Wisconsin, Milwaukee, WI
- Division of Diversity, Equity, and Inclusion, University of Wisconsin, Milwaukee, WI
| | - Jonte’ Taylor
- Department of Educational Psychology, Counseling, and Special Education, Penn State University, University Park, PA
| | - Aisha S. Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - D’Jaris Coles-White
- Department of Speech, Language, Hearing Science, Western Michigan University, Kalamazoo, MI
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Simpson JN, Wright JL. Pandemic Planning, Response, and Recovery for Pediatricians: A Focus on Health Equity and Social Determinants of Health. Pediatr Clin North Am 2024; 71:515-528. [PMID: 38754939 DOI: 10.1016/j.pcl.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
This article summarizes how pediatricians may be uniquely positioned to mitigate the long-term trajectory of COVID-19 on the health and wellness of pediatric patients especially with regard to screening for social determinants of health that are recognized drivers of disparate health outcomes. Health inequities, that is, disproportionately deleterious health outcomes that affect marginalized populations, have been a major source of vulnerability in past public health emergencies and natural disasters. Recommendations are provided for pediatricians to collaborate with disaster planning networks and lead strategies for public health communication and community engagement in pediatric pandemic and disaster planning, response, and recovery efforts.
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Affiliation(s)
- Joelle N Simpson
- Department of Pediatrics and Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA; Emergency Medicine & Trauma Center, Children's National Hospital, 111 Michigan Avenue, Northwest, Washington, DC 20010, USA.
| | - Joseph L Wright
- Department of Pediatrics and Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA; Department of Health Policy and Management, George Washington University School of Public Health, Washington DC 20052
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Gborkorquellie TT, Ward MC, Falusi OO, Barber AN, Smith TK. Diversity, Equity, Inclusion, and Justice in Medical Education: A Faculty Development Perspective. Pediatr Ann 2023; 52:e266-e272. [PMID: 37427969 DOI: 10.3928/19382359-20230516-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
As many residency programs expand teaching to address the knowledge, skills, and attitudes that residents need to dismantle structural racism and other systemic inequities, many faculty are not prepared to teach these topics. However, there is limited literature on which to base faculty development in this area. The aim of this article is to review how diversity, equity, inclusion, and justice education is integrated in pediatric faculty development efforts. This review will include published and gray literature on curricula and programs in medical education for faculty learners and will address common barriers and challenges faced by faculty members. [Pediatr Ann. 2023;52(7):e266-e272.].
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Russ CM, Gao Y, Karpowicz K, Lee S, Stephens TN, Trimm F, Yu H, Jiang F, Palfrey J. The Pediatrician Workforce in the United States and China. Pediatrics 2023:191246. [PMID: 37158018 DOI: 10.1542/peds.2022-059143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 05/10/2023] Open
Abstract
From 2019 to 2022, the For Our Children project gathered a team of Chinese and American pediatricians to explore the readiness of the pediatric workforce in each country to address pressing child health concerns. The teams compared existing data on child health outcomes, the pediatric workforce, and education and combined qualitative and quantitative comparisons centered on themes of effective health care delivery outlined in the World Health Organization Workforce 2030 Report. This article describes key findings about pediatric workload, career satisfaction, and systems to assure competency. We discuss pediatrician accessibility, including geographic distribution, practice locations, trends in pediatric hospitalizations, and payment mechanisms. Pediatric roles differed in the context of each country's child health systems and varied teams. We identified strengths we could learn from one another, such as the US Medical Home Model with continuity of care and robust numbers of skilled clinicians working alongside pediatricians, as well as China's Maternal Child Health system with broad community accessibility and health workers who provide preventive care.In both countries, notable inequities in child health outcomes, evolving epidemiology, and increasing complexity of care require new approaches to the pediatric workforce and education. Although child health systems in the United States and China have significant differences, in both countries, a way forward is to develop a more inclusive and broad view of the child health team to provide truly integrated care that reaches every child. Training competencies must evolve with changing epidemiology as well as changing health system structures and pediatrician roles.
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Affiliation(s)
- Christiana M Russ
- Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Yijin Gao
- Shanghai Children's Medical Center, Shanghai, China
- Shanghai JiaoTong University School of Medicine, Shanghai, China
| | | | - Shoo Lee
- Mount Sinai Hospital, New York City, New York
- University of Toronto, Toronto, Canada
| | - Timothy Noel Stephens
- Haikou Affiliated Hospital of Central South University Xiangya School of Medicine, Haikou, China
| | - Franklin Trimm
- University of South Alabama College of Medicine, Mobile, Alabama; and
| | - Hao Yu
- Harvard Medical School, Boston, Massachusetts
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Fan Jiang
- Shanghai Children's Medical Center, Shanghai, China
- Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Judith Palfrey
- Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Falusi O, Chun-Seeley L, de la Torre D, Dooley DG, Baiyewu M, Gborkorquellie TT, Merrill CT, Davis E, Ward MC. Teaching the Teachers: Development and Evaluation of a Racial Health Equity Curriculum for Faculty. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11305. [PMID: 36999061 PMCID: PMC10043344 DOI: 10.15766/mep_2374-8265.11305] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/05/2022] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Faculty are increasingly expected to teach about the impact of racism on health and to model the principles of health equity. However, they often feel ill-equipped to do so, and there is limited literature on faculty development on these topics. We developed a curriculum for faculty education on racism and actions to advance racial health equity. METHODS The curriculum design was based on a literature review and needs assessments. Implementation consisted of four live virtual 1-hour sessions incorporating interactive didactics, cases, reflection, goal setting, and discussion offered to a multidisciplinary group of pediatric faculty at a children's hospital. Topics included the history of racism, racism in health care, interacting with trainees and colleagues, and racial equity in policy. Evaluation consisted of pre- and postsurveys at the beginning and end of the curriculum and a survey after each session. RESULTS A mean of 78 faculty members attended each session (range: 66-94). Participants reported high satisfaction and increased knowledge at the end of each session. Qualitative themes included self-reflection on personal biases, application of health equity frameworks and tools, becoming disruptors of racism, and the importance of systemic change and policy. DISCUSSION This curriculum is an effective method for increasing faculty knowledge and comfort. The materials can be adapted for various audiences.
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Affiliation(s)
- Olanrewaju Falusi
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Associate Program Director, Pediatric Residency Program, Children's National Hospital; Medical Director of Advocacy Education, Child Health Advocacy Institute, Children's National Hospital
| | - Lin Chun-Seeley
- Program Lead, Advocacy Education and Community Affairs, Pediatric Resident Health Equity Education, Child Health Advocacy Institute, Children's National Hospital
| | - Desiree de la Torre
- Director, Community Affairs and Population Health Improvement, Child Health Advocacy Institute, Children's National Hospital
| | - Danielle G. Dooley
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Medical Director of Community Affairs, Child Health Advocacy Institute, Children's National Hospital
| | - Melissa Baiyewu
- Program Manager, Health Promotion and Disease Prevention Programs, Child Health Advocacy Institute, Children's National Hospital
| | - Theiline T. Gborkorquellie
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Assistant Director of Health Equity Education, Pediatric Residency Program, Children's National Hospital; Affiliate Faculty, Child Health Advocacy Institute, Children's National Hospital
| | - Chaya T. Merrill
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Director, Child Health Data Lab, Child Health Advocacy Institute, Children's National Hospital
| | - Elizabeth Davis
- Manager, Government Affairs, Child Health Advocacy Institute, Children's National Hospital
| | - Maranda C. Ward
- Assistant Professor and Director of Equity, Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences
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Buonsenso D, Liu JF, Shanmugavadivel D, Davis T, Roland D. Impact of Diversity in Training Resources on Self-Confidence in Diagnosing Skin Conditions Across a Range of Skin Tones: An International Survey. Front Pediatr 2022; 10:837552. [PMID: 35281251 PMCID: PMC8916608 DOI: 10.3389/fped.2022.837552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Medical images are invaluable in facilitating recognition of clinical signs. Recent studies highlight a lack of diversity of skin tone images used within medical education. However, there is a paucity of data on the impact of this on patient care. AIMS To investigate diversity in training resources used by users of an International online teaching platform and self-confidence in diagnosing skin conditions in all skin tones. METHODS Users of an online teaching platform (www.dftbskindeep.com) were invited to participate in a survey evaluating key points including geographical location, ethnicity, profession, specialty, years of experience, training resources and confidence in diagnosing skin conditions. Data analyses were performed using SPSS. Categorical variables were presented as proportions. Chi-squared or Fisher's exact tests were used to compare the distribution between groups as appropriate. RESULTS Of 600 participants, 74% reported training resources featuring predominantly white skin. Participants were "generally uncertain" in 43% cases, "sometimes uncertain but clinically safe" (52%), and "confident across a range of skin tones" in a minority (5%). Self-confidence was associated with location [higher in Africa (29%) and Latin America (11%), (p < 0.001)]; diversity of training resources [higher with a mix (10%) or darker tones (20%) (p < 0.001)]; clinical experience [6-10 (5%) or >10 years of practice (11%) (p < 0.001)] and specialty [highest in dermatologists (53%, p < 0.001)]. Self-confidence was lowest among pediatricians, emergency medicine and pediatric emergency medicine specialists (<5%). CONCLUSIONS These data provide preliminary evidence that training resources used by healthcare professionals on a global scale may lack enough diversity on representation of skin images, and a lack of self-confidence in diagnosing pediatric skin conditions. Further work is needed to understand the impact on knowledge and patient care to ensure equitable healthcare for all.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jo-Fen Liu
- Academic Unit of Population and Lifespan Science, University of Nottingham, Nottingham, United Kingdom
| | | | - Tessa Davis
- Paediatric Emergency Department, Royal London Hospital, London, United Kingdom.,Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, United Kingdom.,SAPPHIRE Group, Health Sciences, Leicester University, Leicester, United Kingdom
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