chi Development of the Children With Disabilities Algorithm By pediatrics.aappublications.org Published On :: 2015-09-28T00:07:28-07:00 There are no validated claims-based algorithms for identifying children with disabilities (CWD) to facilitate larger-scale studies of care quality for CWD.This study develops the CWD algorithm, a claims-based algorithm for identifying diagnostic codes with a ≥75% chance of indicating CWD, and triangulates the algorithm against parent report and physician chart abstraction. (Read the full article) Full Article
chi Hospital Use in the Last Year of Life for Children With Life-Threatening Complex Chronic Conditions By pediatrics.aappublications.org Published On :: 2015-10-05T00:07:47-07:00 Children with life-threatening complex chronic conditions (LT-CCCs) experience high hospital use.Hospital use in the last year of life for these children varies by type and number of LT-CCCs. Most children with ≥3 LT-CCCs are admitted to the hospital for more than 2 months in the last year of life. (Read the full article) Full Article
chi Testing for Abuse in Children With Sentinel Injuries By pediatrics.aappublications.org Published On :: 2015-10-05T00:07:44-07:00 Several injuries have been suggested to be disproportionately associated with abuse in young children, but rates of abuse among children with these injuries are not currently known.Abuse is diagnosed commonly in children with sentinel injuries, including the majority of children <24 months with rib fractures. (Read the full article) Full Article
chi Hospital Variation in Health Care Utilization by Children With Medical Complexity By pediatrics.aappublications.org Published On :: 2015-10-05T00:07:46-07:00 Children with medical complexity require a disproportionate amount of health services due to a multitude of chronic severe illness, and their impact on the health care system appears to be increasing.This study provides one of the first comparisons of health care utilization patterns for children with medical complexity between medical centers in a population-based cohort. (Read the full article) Full Article
chi Stigma and Parenting Children Conceived From Sexual Violence By pediatrics.aappublications.org Published On :: 2015-10-05T00:07:44-07:00 Maternal–child relationships among women raising children from sexual violence-related pregnancies (SVRPs) are not well understood. Limited case reports suggest widely varied and complex relationships. The determinants of these relationships are unknown.With its large sample size, this article quantifies and analyzes maternal–child relationships among women raising children from SVRPs, and assesses the impact of stigma, acceptance, and maternal mental health on these relationships. (Read the full article) Full Article
chi Childhood Health and Developmental Outcomes After Cesarean Birth in an Australian Cohort By pediatrics.aappublications.org Published On :: 2015-10-12T00:07:20-07:00 A number of studies have reported an association between birth by cesarean delivery and adverse childhood health outcomes such as obesity, asthma, atopy, and a number of neurodevelopmental abnormalities. However, these studies have had limited capacity to control for confounders.Using a prospective cohort while controlling for birth factors, social vulnerability, maternal BMI, and breastfeeding, we found few differences between children delivered by cesarean delivery and those born vaginally. Higher child BMI was explained by maternal BMI. (Read the full article) Full Article
chi Outpatient Visits and Medication Prescribing for US Children With Mental Health Conditions By pediatrics.aappublications.org Published On :: 2015-10-12T00:07:19-07:00 Seven percent of children in the United States receive mental health services each year. There are more pediatric outpatient mental health care visits to primary care physicians (PCPs) than to psychiatrists. Mental health utilization patterns regarding different conditions and medication prescribing are unknown.One-third of children with mental health conditions see PCPs only. A greater proportion of children with attention-deficit/hyperactivity disorder see PCPs for this than do those with anxiety/mood disorders. Children seeing PCPs are prescribed psychotropic medications more often than those seeing psychiatrists. (Read the full article) Full Article
chi Safety of Botulinum Toxin Type A for Children With Nonambulatory Cerebral Palsy By pediatrics.aappublications.org Published On :: 2015-10-19T00:07:49-07:00 Children with marked cerebral palsy (CP) are considered at greater risk of adverse events (AEs) after intramuscular injections of BoNT-A. To date there has been no randomized controlled trial examining safety of intramuscular BoNT-A injections in children with marked CP.Children with nonambulatory CP had no greater risk of moderate or serious AEs after intramuscular injections of BoNT-A compared with a sham/control group. There was no greater risk of AEs for children receiving 2 compared with 1 episode of BoNT-A. (Read the full article) Full Article
chi Polysomnographic Markers in Children With Cystic Fibrosis Lung Disease By pediatrics.aappublications.org Published On :: 2015-10-19T00:07:48-07:00 Children with cystic fibrosis demonstrate gas exchange abnormalities and increased respiratory loads during sleep independent of lung function, age, and BMI. Assessment of breathing patterns during sleep provides an opportunity for detection of early lung disease progression.Children with cystic fibrosis demonstrated increased respiratory loads and gas exchange abnormalities during sleep compared with controls. Based on these findings, sleep assessment in this patient population can identify markers for the early detection of lung disease progression. (Read the full article) Full Article
chi Maternal Gestational and Postdelivery Weight Gain and Child Weight By pediatrics.aappublications.org Published On :: 2015-10-19T00:07:47-07:00 Maternal gestational weight gain is associated with childhood overweight. It is unknown whether gestational weight gain programs the child’s health or whether gestational weight gain is an indicator of postnatal behavioral factors.We disentangled these influences by studying the effect of gestational weight gain simultaneously with postdelivery maternal weight change as an indicator for shared family lifestyle on child’s weight development and found that both had an independent effect. (Read the full article) Full Article
chi Growth Charts for Children With Down Syndrome in the United States By pediatrics.aappublications.org Published On :: 2015-10-26T00:07:21-07:00 Children with Down syndrome (DS) grow differently from other children. Advances in medical care, access to care, and improved life expectancy suggest that contemporary growth patterns may have improved over recent decades for children with DS in the United States.New growth charts are presented for length/height, weight, head circumference, and BMI for children with DS (birth to 20 y). Weight gain in children <36 months, and stature for males are improved compared with older growth charts. (Read the full article) Full Article
chi Exposure and Use of Mobile Media Devices by Young Children By pediatrics.aappublications.org Published On :: 2015-11-02T00:06:44-08:00 Interactive mobile media devices have revolutionized children’s access to and experience of media, but research is lagging behind its adoption. A critical first step is to understand when and how young children adopt mobile media devices.Our study found almost universal exposure, early adoption, and use of mobile media devices among young children in an urban, low-income, minority community. Studies are needed to update guidelines on the use of mobile media by young children. (Read the full article) Full Article
chi John Solomon on Adam Schiff: he’s “a modern day Joe McCarthy” By www.letfreedomringblog.com Published On :: Sat, 09 May 2020 11:54:00 GMT Source: www.letfreedomringblog.com - Saturday, May 09, 2020 John Solomon has worked overtime and then some to rip Adam Schiff’s mask off. So have Catherine Herridge, Sara Carter, Lee Smith, Gregg Jarrett, Kim Strassel, Mollie Hemmingway and Byron York. Solomon’s article highlights how utterly dishonest Adam Schiff is. Ditto with the upper echelon of the FBI. Strap yourself in. This isn’t a short ride. The pursuit of the truth ended Thursday when the Justice Department formally asked a court to vacate Flynn’s conviction and end the criminal case, acknowledging the former general had indeed been cleared by FBI agents and that the bureau did not have a lawful purpose when it interviewed him in January 2017. Attorney General William Barr put it more bluntly in an interview Thursday : “They kept it open for the express purpose of trying to catch, to lay a perjury trap for General Flynn.” According to Solomon’s reporting, the FBI didn’t have a reason to investigate Gen. Flynn: 3. Case closed memo. FBI agents wrote a memo to close the investigation of Flynn on Jan. 4, 2017, writing they found “no derogatory” evidence that Flynn committed a crime or posed a national security threat. FBI management then ordered the closure to be rescinded and pivoted toward trying lure Flynn into an interview. https://justthenews.com/accountability/russia-and-ukraine-scandals/fbi-found-no-derogatory-russia-evidence-flynn-planned Corrupt FBI agent Peter Strzok allegedly ordered Crossfire Razor, the codename for thAll Related Full Article
chi ‘Lynched by a Racial Mob’: Ahmaud Arbery’s Father Wrenchingly Describes His Son’s Murder to Chris Cuomo By www.mediaite.com Published On :: Sat, 09 May 2020 13:32:00 GMT Source: www.mediaite.com - Saturday, May 09, 2020 (() => { window.amJwVideos = window.amJwVideos || []; const iframe = document.createElement('iframe'); const jwBaseUrl = 'https://content.jwplatform.com/players/'; iframe.setAttribute('allowfullscreen', true); iframe.jwUrlWithAds = jwBaseUrl + 'tmqgnsNB-KfS9hzfO.html'; iframe.jwUrlWithNoAds = jwBaseUrl + 'tmqgnsNB-I23UVzQH.html'; amJwVideos.push(iframe); })(); Want to avoid video ads? Subscribe to Mediaite+ Marcus Arbery , father of slain unarmed jogger Ahmaud Arbery , gave a wrenching description of his son’s killing even as he said he did not believe the suspects who have been arrested in the crime should be put to death. On Friday night’s edition of CNN’s Cuomo PrimeTime , Mr. Arbery and family attorney Benjamin Crump joined host Chris Cuomo to discuss the Feb. 23 killing that was captured on a video that was leaked this week, but which police have had since the crime was committed. “What do you want people to know about your son, and what this means to you?” Cuomo asked. “I just want people to know that he was a very good young man, and he loved the people, and I just want people to remember him as a good-hearted young man,” Mr. Arbery said, adding that his late son “was the type of young man, if he had one dollar, and you needed that one dollar, he would give it to you. That’s just how good his heart was.” Mr. Arbery went on to say that “to see him just get lynched like that by a racial mob, it’s just devastating to our famAll Related Full Article
chi National Study Bolsters Case for Teaching 'Growth Mindset' By www.edweek.org Published On :: Wed, 07 Aug 2019 00:00:00 +0000 A national study of nearly 12,500 9th graders finds that two sessions of a 25-minute exercise on “growth mindset” can boost students’ grades and their willingness to take on challenging classes. Full Article Growth+Mindset
chi The Teaching Force Is Mostly Female. Is That Bad for Boys? By feedproxy.google.com Published On :: Wed, 25 Jul 2018 00:00:00 +0000 A new brief from the Brookings Institution poses the question: Is overrepresentation of women in the teaching force negatively affecting boys' achievement? Full Article Gender
chi Do You Have a Good Idea for Teaching Civics? By feedproxy.google.com Published On :: Tue, 12 Nov 2019 00:00:00 +0000 Do you have a good idea for teaching civics? Share it with us and we’ll post the best ideas online. Full Article Idea
chi Canada backs U.S.-led effort for Taiwan at WHO over China’s objections By www.thestar.com Published On :: Sat, 09 May 2020 14:30:00 GMT Source: www.thestar.com - Saturday, May 09, 2020 Canada approved a verbal demarche to two senior WHO executives that urged them to allow Taiwan to be admitted as an observer to an upcoming meeting because its input would be “meaningful and important.”All Related Full Article
chi Study: Digital Summer Learning Boosts Achievement By feedproxy.google.com Published On :: Mon, 18 Jun 2012 00:00:00 +0000 The report suggests programs delivering instruction through multiple media platforms can lead to significant improvement in students' mathematics, numeracy, and phonics skills. Full Article Multimedia
chi Multimedia Tool: Teaching the Presidential Campaign By feedproxy.google.com Published On :: Fri, 07 Sep 2012 00:00:00 +0000 The Newseum in Washington has just launched Decision 2012: Exploring Elections and the Media, an online resource for teaching about the presidential campaign and election. Full Article Multimedia
chi Should I keep my child's vaccine appointments? By news.psu.edu Published On :: Fri, 01 May 2020 14:19 -0400 Full Article
chi Get Ready for 14nm and 16nm Chips By forwardthinking.pcmag.com Published On :: It won't surprise me if we see very few 20nm chips, and instead see a lot of designs skip it and go right to 14 or 16nm. Full Article
chi The Šuker chip By www.uefa.com Published On :: Mon, 30 Jan 2012 09:07:00 GMT Croatian legend Davor Šuker recalls his classic goal against Denmark in EURO '96. Full Article
chi Teaching in the U.S. Should Be More 'Intellectually Attractive,' Global Expert Says By feedproxy.google.com Published On :: Thu, 20 Jun 2019 00:00:00 +0000 A panel of experts—including a national teacher's union president and an official from the Department of Education—discussed how to make teaching a more attractive profession. Full Article Professionaldevelopment
chi When Teaching Media Literacy, Which News Sources Are Credible? Even Teachers Don't Agree By feedproxy.google.com Published On :: Thu, 05 Mar 2020 00:00:00 +0000 Like other Americans, liberal and conservative teachers perceive news sources' credibility differently. How does that affect their teaching of media literacy? Full Article Professionaldevelopment
chi Teachers Share Resources for Teaching Online During Coronavirus School Closures By feedproxy.google.com Published On :: Mon, 16 Mar 2020 00:00:00 +0000 To help ease the transition to remote instruction, educators have launched virtual professional learning communities to share resources, ask questions, and give advice. Full Article Professionaldevelopment
chi Calling all children By feedproxy.google.com Published On :: Fri, 17 Nov 2017 10:30:35 +0000 One OMer’s obedience to God’s plan results in a multiplying and tireless ministry. Full Article
chi Implementing Peace and Security Architecture (I): Central Africa By feedproxy.google.com Published On :: Mon, 07 Nov 2011 12:14:00 GMT More than a decade after the Economic Community of Central African States (ECCAS) was requested by the African Union (AU) to give life to a new peace and security architecture, political and security cooperation on the continent is still in need of reinforcement. Full Article
chi Data: Student Achievement in the Era of Accountability - Education Week By feedproxy.google.com Published On :: Sat, 09 May 2020 03:12:15 +0000 The Education Week Research Center looks at student scores on the National Assessment of Educational Progress from 2003 to 2015, a period overlapping with the No Child Left Behind Act. Full Article Assessment+Accountability+Achievement
chi Throwback Thursday: Achievement, Assessment, and Accountability By feedproxy.google.com Published On :: Thu, 14 Aug 2014 00:00:00 +0000 If we continue to focus on student growth and improvement as learners, keep track of that progress, and watch its impact on standard test results, will we be able to know if what we are doing is helping students develop as learners and thinkers. Full Article Assessment+Accountability+Achievement
chi Education Week: Assessment, Accountability, Achievement By feedproxy.google.com Published On :: Sun, 16 Feb 2020 20:01:04 +0000 Full Article Assessment+Accountability+Achievement
chi Assessment, Accountability, Achievement By feedproxy.google.com Published On :: Fri, 02 Nov 2012 00:00:00 +0000 Full Article Assessment+Accountability+Achievement
chi Reconciling the potentially irreconcilable? Genotypic and phenotypic amoxicillin-clavulanate resistance in Escherichia coli [Mechanisms of Resistance] By aac.asm.org Published On :: 2020-03-23T08:47:35-07:00 Resistance to amoxicillin-clavulanate, a widely used beta-lactam/beta-lactamase inhibitor combination antibiotic, is rising globally, yet susceptibility testing remains challenging. To test whether whole-genome sequencing (WGS) could provide a more reliable assessment of susceptibility than traditional methods, we predicted resistance from WGS for 976 E. coli bloodstream infection isolates from Oxfordshire, UK, comparing against phenotypes from the BD Phoenix (calibrated against EUCAST guidelines). 339/976 (35%) isolates were amoxicillin-clavulanate resistant. Predictions based solely on beta-lactamase presence/absence performed poorly (sensitivity 23% (78/339)) but improved when genetic features associated with penicillinase hyper-production (e.g. promoter mutations, copy number estimates) were considered (sensitivity 82% (277/339); p<0.0001). Most discrepancies occurred in isolates with peri-breakpoint MICs. We investigated two potential causes; the phenotypic reference and the binary resistant/susceptible classification. We performed reference standard, replicated phenotyping in a random stratified subsample of 261/976 (27%) isolates using agar dilution, following both EUCAST and CLSI guidelines, which use different clavulanate concentrations. As well as disagreeing with each other, neither agar dilution phenotype aligned perfectly with genetic features. A random-effects model investigating associations between genetic features and MICs showed that some genetic features had small, variable and additive effects, resulting in variable resistance classification. Using model fixed-effects to predict MICs for the non-agar dilution isolates, predicted MICs were in essential agreement (±1 doubling dilution) with observed (BD Phoenix) MICs for 691/715 (97%) isolates. This suggests amoxicillin-clavulanate resistance in E. coli is quantitative, rather than qualitative, explaining the poorly reproducible binary (resistant/susceptible) phenotypes and suboptimal concordance between different phenotypic methods and with WGS-based predictions. Full Article
chi Evaluation of the effect of contezolid (MRX-I) on the corrected QTc interval: a randomized, double-blind, placebo- and positive-controlled crossover study in healthy Chinese volunteers [Clinical Therapeutics] By aac.asm.org Published On :: 2020-03-30T10:04:32-07:00 Contezolid (MRX-I), a new oxazolidinone, is an antibiotic in development for treating complicated skin and soft tissue infections (cSSTI) caused by resistant Gram-positive bacteria. This was a thorough QT study conducted in 52 healthy subjects who were administered oral contezolid at a therapeutic (800 mg) dose, a supratherapeutic (1600 mg) dose, placebo, and oral moxifloxacin 400 mg in 4 separate treatment periods. The pharmacokinetic profile of contezolid was also evaluated. Time-point analysis indicated that the upper bounds of the two-sided 90% confidence interval (CI) for placebo-corrected change-from-baseline QTc (QTc) were <10 ms for the contezolid therapeutic dose at each time point. The upper bound of the 90% CI for QTc were slightly more than 10 ms with the contezolid supratherapeutic dose at 3 and 4 hours postdose, and the prolongation effect on the QT/QTc interval was less than that of the positive control, moxifloxacin 400 mg. At 3 and 4 h after the moxifloxacin dose, the moxifloxacin group met the assay sensitivity criteria outlined in ICH Guidance E14 with having a lower confidence bound ≥5 ms. The results of a linear exposure-response model which were similar to that of a time point analysis demonstrated a slightly positive relationship between contezolid plasma levels and QTcF interval with a slope of 0.227 ms per mg/L (90% CI: 0.188 to 0.266). In summary, contezolid did not prolong the QT interval at a therapeutic dose and may have a slight effect on QT interval prolongation at a supratherapeutic dose. Full Article
chi Epidemiological study on prevalence, serovar diversity, multi-drug resistance and CTX-M-type extended-spectrum {beta}-lactamases of Salmonella spp. from patients with diarrhea, food of animal origin, and pets in several provinces of China [Epidemiology an By aac.asm.org Published On :: 2020-04-20T08:36:46-07:00 A total of 2,283 Salmonella spp. isolates were recovered from 18,334 samples including patients with diarrhea, food of animal origin and pets across 5 provinces of China. The highest prevalence of Salmonella spp. was detected in chicken meats (39.3%, 486/1,237). Fifteen serogroups and 66 serovars were identified, with Typhimurium and Enteritidis being the most dominant. Most (85.5%, 1,952/2,283) isolates exhibited resistant to ≥ 1 antimicrobial and 56.4% were multi-drug resistant (MDR). A total of 222 isolates harbored extended-spectrum β-lactamases (ESBLs), 200 of which were CTX-M-type that were mostly detected from chicken meat and turtle fecal. Overall, eight blaCTX-M genes were identified, with blaCTX-M-65, blaCTX-M-123, blaCTX-M-14, blaCTX-M-79, and blaCTX-M-130 being the most prevalent. Totally, 166 of the 222 ESBL-producing isolates had amino acid substitutions in GyrA (S83Y, S83F, D87G, D87N, and D87Y) and ParC (and S80I), whilst the PMQR-encoding genes oqxA/B, qepA, and qnrB/S were detected in almost all isolates. Of the fifteen sequence types (STs) identified in the 222 ESBLs, ST17, ST11, ST34, and ST26 ranked among the top 5 in the number of isolates. Our study revealed considerable serovars diversity, high prevalence of co-occurrence of MDR determinants, including CTX-M-type ESBLs, QRDRs mutations and PMQR genes. This is the first report of CTX-M-130 Salmonella spp. from patients with diarrhea and QRDRs mutations from turtle fecal samples. Our study emphasizes the importance of actions, both in the health care settings and in the veterinary medicine sector, to control the dissemination of MDR, especially the CTX-M Salmonella spp. isolates. Full Article
chi A novel class of chikungunya virus small molecule inhibitors that targets the viral capping machinery [Antiviral Agents] By aac.asm.org Published On :: 2020-04-27T08:14:57-07:00 Despite the worldwide re-emergence of the chikungunya virus (CHIKV) and the high morbidity associated with CHIKV infections, there is no approved vaccine or antiviral treatment available. We here aim to identify the target of a novel class of CHIKV inhibitors i.e. CHVB series. CHVB compounds inhibit the in vitro replication of CHIKV isolates with 50% effective concentrations in the low micromolar range. A CHVB-resistant variant (CHVBres) was selected that carried two mutations in the gene encoding nsP1 (responsible for viral RNA capping), one mutation in nsP2 and one mutation in nsP3. Reverse genetics studies demonstrated that both nsP1 mutations were necessary and sufficient to achieve ~18-fold resistance, suggesting that CHVB targets viral mRNA capping. Interestingly, CHVBres was cross-resistant to the previously described CHIKV capping inhibitors from the MADTP series, suggesting they share a similar mechanism of action. In enzymatic assays, CHVB inhibited the methyltransferase and guanylyltransferase activities of alphavirus nsP1 proteins. To conclude, we identified a class of CHIKV inhibitors that targets the viral capping machinery. The potent anti-CHIKV activity makes this chemical scaffold a potential candidate for CHIKV drug development. Full Article
chi Comparative Genomic Analysis of Third Generation Cephalosporin-Resistant Escherichia coli Harboring blaCMY-2-Positive IncI1 group, IncB/O/K/Z, and IncC Plasmids Isolated from Healthy Broilers in Japan. [Epidemiology and Surveillance] By aac.asm.org Published On :: 2020-05-04T08:49:24-07:00 The off-label use of third generation cephalosporin (3GC) during in ovo vaccination or vaccination of newly hatched chicks, was a common practice worldwide. CMY-2-producing Escherichia coli have been disseminated among broiler production. The objectives of this study were to determine the epidemiological linkage of blaCMY-2-positive plasmids among broilers both within and outside Japan because grandparent stock and parent stock were imported in Japan. We examined the whole genome sequences of 132 3GC-resistant E. coli isolates collected from healthy broilers during 2002-2014. The predominant 3GC-resistance gene was blaCMY-2, which was detected in the plasmids of 87 (65.9%) isolates. The main plasmid replicon types were IncI1-I (n=21; 24.1%), IncI (n=12; 13.8%), IncB/O/K/Z (n=28; 32.2%), and IncC (n=22; 25.3%). Those plasmids were subjected to gene clustering and network analyses and plasmid multi-locus sequence typing (pMLST). The chromosomal DNA of isolates was subjected to MLST and single nucleotide variant (SNV)-based phylogenetic analysis.MLST and SNV-based phylogenetic analysis revealed high diversity of E. coli isolates. ST429 harboring blaCMY-2-positive IncB/O/K/Z was closely related to isolates from broiler in Germany harboring blaCMY-2-positive IncB/O/K/Z. pST55-IncI and pST12-IncI1-I and pST3-IncC were prevalent in western Japan. pST12-IncI1-I and pST3-IncC were closely related to those detected in E. coli isolates from chicken in American continent, whereas 26 IncB/O/K/Z were related to those in Europe. These data will be useful to reveal the whole picture of transmission of CMY-2-producing bacteria in and out of Japan. Full Article
chi Grantmakers for Education Chief on Philanthropy's Response to Coronavirus By feedproxy.google.com Published On :: Wed, 29 Apr 2020 00:00:00 +0000 Funders have been both fast and thoughtful about how to work with national and local partners to listen to needs from the field, identify best practices, and deploy resources quickly, says Celine Coggins. Full Article Philanthropy
chi Philanthropy Roundtable K-12 Chief on Funders' Response to Coronavirus By feedproxy.google.com Published On :: Fri, 01 May 2020 00:00:00 +0000 "This pandemic has given us an opportunity to think boldly about students' educational needs and how to creatively respond to them," says Katherine Haley. Full Article Philanthropy
chi Antibiotic Use and Outcomes in Children in the Emergency Department With Suspected Pneumonia By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:57-07:00 BACKGROUND AND OBJECTIVES: Antibiotic therapy is often prescribed for suspected community-acquired pneumonia (CAP) in children despite a lack of knowledge of causative pathogen. Our objective in this study was to investigate the association between antibiotic prescription and treatment failure in children with suspected CAP who are discharged from the hospital emergency department (ED). METHODS: We performed a prospective cohort study of children (ages 3 months–18 years) who were discharged from the ED with suspected CAP. The primary exposure was antibiotic receipt or prescription. The primary outcome was treatment failure (ie, hospitalization after being discharged from the ED, return visit with antibiotic initiation or change, or antibiotic change within 7–15 days from the ED visit). The secondary outcomes included parent-reported quality-of-life measures. Propensity score matching was used to limit potential bias attributable to treatment selection between children who did and did not receive an antibiotic prescription. RESULTS: Of 337 eligible children, 294 were matched on the basis of propensity score. There was no statistical difference in treatment failure between children who received antibiotics and those who did not (odds ratio 1.0; 95% confidence interval 0.45–2.2). There was no difference in the proportion of children with return visits with hospitalization (3.4% with antibiotics versus 3.4% without), initiation and/or change of antibiotics (4.8% vs 6.1%), or parent-reported quality-of-life measures. CONCLUSIONS: Among children with suspected CAP, the outcomes were not statistically different between those who did and did not receive an antibiotic prescription. Full Article
chi Efficacy of Melatonin in Children With Postconcussive Symptoms: A Randomized Clinical Trial By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:57-07:00 BACKGROUND: Approximately 25% of children with concussion have persistent postconcussive symptoms (PPCS) with resultant significant impacts on quality of life. Melatonin has significant neuroprotective properties, and promising preclinical data suggest its potential to improve outcomes after traumatic brain injury. We hypothesized that treatment with melatonin would result in a greater decrease in PPCS symptoms when compared with a placebo. METHODS: We conducted a randomized, double-blind trial of 3 or 10 mg of melatonin compared with a placebo (NCT01874847). We included youth (ages 8–18 years) with PPCS at 4 to 6 weeks after mild traumatic brain injury. Those with significant medical or psychiatric histories or a previous concussion within the last 3 months were excluded. The primary outcome was change in the total youth self-reported Post-Concussion Symptom Inventory score measured after 28 days of treatment. Secondary outcomes included change in health-related quality of life, cognition, and sleep. RESULTS: Ninety-nine children (mean age: 13.8 years; SD = 2.6 years; 58% girls) were randomly assigned. Symptoms improved over time with a median Post-Concussion Symptom Inventory change score of –21 (95% confidence interval [CI]: –16 to –27). There was no significant effect of melatonin when compared with a placebo in the intention-to-treat analysis (3 mg melatonin, –2 [95% CI: –13 to 6]; 10 mg melatonin, 4 [95% CI: –7 to 14]). No significant group differences in secondary outcomes were observed. Side effects were mild and similar to the placebo. CONCLUSIONS: Children with PPCS had significant impairment in their quality of life. Seventy-eight percent demonstrated significant recovery between 1 and 3 months postinjury. This clinical trial does not support the use of melatonin for the treatment of pediatric PPCS. Full Article
chi Dietary Fats and Atherosclerosis From Childhood to Adulthood By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:57-07:00 BACKGROUND: The association of dietary fat distribution with markers of subclinical atherosclerosis during early life is unknown. We examined whether success in achieving the main target of an infancy-onset dietary intervention based on the distribution of dietary fat was associated with aortic and carotid intima-media thickness (IMT) and distensibility from childhood to young adulthood. METHODS: In the prospective randomized controlled Special Turku Coronary Risk Factor Intervention Project trial, personalized dietary counseling was given biannually to healthy children from infancy to young adulthood. The counseling was based on Nordic Nutrition Recommendations, with the main aim of improving the distribution of dietary fat in children’s diets. IMT and distensibility of the abdominal aorta and common carotid artery were measured repeatedly at ages 11 (n = 439), 13 (n = 499), 15 (n = 506), 17 (n = 477), and 19 years (n = 429). The targeted distribution of dietary fat was defined as a ratio of saturated fatty acids to monounsaturated and polyunsaturated fatty acids of <1:2 and as an intake of saturated fatty acids of <10% of energy intake. Participants who met ≥1 of these 2 criteria were defined to achieve the main intervention target. RESULTS: Individuals who achieved the main intervention target had lower aortic IMT (age- and sex-adjusted mean difference 10.4 µm; 95% confidence interval: 0.3 to 20.5 µm) and better aortic distensibility (0.13% per 10 mm Hg; 95% confidence interval: 0.00% to 0.26% per10 mm Hg) compared with their peers who did not meet the target. CONCLUSIONS: Achieving the main target of an infancy-onset dietary intervention, reflecting dietary guidelines, was favorably associated with aortic IMT and distensibility during the early life course. These data support the recommendation of favoring unsaturated fat to enhance arterial health. Full Article
chi Costs and Use for Children With Medical Complexity in a Care Management Program By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:57-07:00 BACKGROUND AND OBJECTIVES: Children with medical complexity (CMC) comprise only 6% of the pediatric population, account for ~40% of pediatric health care spending, and provide an important opportunity for cost saving. Savings in this group can have an important impact on pediatric health care costs. The objective of this study was to assess the impact of a multicenter care management program on spending and use in CMC. DESIGN AND METHODS: We conducted a prospective cohort analysis of a population of 4530 CMC enrolled in a learning collaborative designed to improve care for CMC ages 0 to 21 years identified using 3M Clinical Risk Group categories 5b through 9. The primary outcome was total per-member per-year standardized spending; secondary outcomes included inpatient and emergency department (ED) spending and use. We used a 1:1 propensity score match to compare enrolled patients to eligible nonenrolled patients and statistical process control methods to analyze spending and usage rates. RESULTS: Comparison with the matched group showed a 4.6% (95% confidence interval [CI]: 1.9%–7.3%) decrease in total per-member per-year spending (P < .001), a 7.7% (95% CI: 1.2%–13.5%) decrease in inpatient spending (P = .04), and an 11.6% (95% CI: 3.9%–18.4%) decrease in ED spending (P = .04). Statistical process control analysis showed a decrease in hospitalization rate and ED visits. CONCLUSIONS: CMC enrolled in a learning collaborative showed significant decreases in total spending and a significant decrease in the number of hospitalizations and ED visits. Additional research is needed to determine more specific causal factors for the results and if these results are sustainable over time and replicable in other settings. Full Article
chi Non-HDL Cholesterol Levels in Childhood and Carotid Intima-Media Thickness in Adulthood By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:57-07:00 BACKGROUND: Elevated non–high-density lipoprotein cholesterol (HDL-C) levels are used to identify children at increased cardiovascular risk, but the use of non–HDL-C in childhood to predict atherosclerosis is unclear. We examined whether the National Heart, Lung, and Blood Institute classification of youth non–HDL-C status predicts high common carotid artery intima-media thickness in adulthood. METHODS: We analyzed data from 4 prospective cohorts among 4582 children aged 3 to 19 years who were remeasured as adults (mean follow-up of 26 years). Non–HDL-C status in youth and adulthood was classified according to cut points of the National Heart, Lung, and Blood Institute and the National Cholesterol Education Program Adult Treatment Panel III. High carotid intima-media thickness (cIMT) in adulthood was defined as at or above the study visit-, age-, sex-, race-, and cohort-specific 90th percentile of intima-media thickness. RESULTS: In a log-binomial regression analysis adjusted with age at baseline, sex, cohort, length of follow-up, baseline BMI, and systolic blood pressure, children with dyslipidemic non–HDL-C were at increased risk of high cIMT in adulthood (relative risk [RR], 1.29; 95% confidence interval [CI], 1.07–1.55). Compared with the persistent normal group, the persistent dyslipidemia group (RR, 1.80; 95% CI, 1.37–2.37) and incident dyslipidemia (normal to dyslipidemia) groups (RR, 1.45; 95% CI, 1.07–1.96) had increased risk of high cIMT in adulthood, but the risk was attenuated for the resolution (dyslipidemia to normal) group (RR, 1.17; 95% CI, 0.97–1.41). CONCLUSIONS: Dyslipidemic non–HDL-C levels predict youth at risk for developing high cIMT in adulthood. Those who resolve their non–HDL-C dyslipidemia by adulthood have normalized risk of developing high cIMT in adulthood. Full Article
chi Predicting School-Aged Cognitive Impairment in Children Born Very Preterm By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:57-07:00 BACKGROUND AND OBJECTIVES: Children born very preterm (VPT) are at high risk of cognitive impairment that impacts their educational and social opportunities. This study examined the predictive accuracy of assessments at 2, 4, 6, and 9 years in identifying preterm children with cognitive impairment by 12 years. METHODS: We prospectively studied a regional cohort of 103 children born VPT (≤32 weeks’ gestation) and 109 children born term from birth to corrected age 12 years. Cognitive functioning was assessed by using age-appropriate, standardized measures: Bayley Scales of Infant Development, Second Edition (age 2); Wechsler Preschool and Primary Scale of Intelligence (ages 4 and 6); and Wechsler Intelligence Scale for Children, Fourth Edition (ages 9 and 12). RESULTS: By 12 years, children born VPT were more likely to have severe (odds ratio 3.9; 95% confidence interval 1.1–13.5) or any (odds ratio 3.2; 95% confidence interval 1.8–5.6) cognitive impairment compared with children born term. Adopting a severe cognitive impairment criterion at age 2 under-identified 44% of children born VPT with later severe impairment, whereas a more inclusive earlier criterion identified all severely affected children at 12 years. Prediction improved with age, with any delay at age 6 having the highest sensitivity (85%) and positive predictive value (66%) relative to earlier age assessments. Inclusion of family-social circumstances further improved diagnostic accuracy. CONCLUSIONS: Cognitive risk prediction improves with age, with assessments at 6 years offering optimal diagnostic accuracy. Intervention for children with early mild delay may be beneficial, especially for those raised in socially disadvantaged family contexts. Full Article
chi Continuous Albuterol With Benzalkonium in Children Hospitalized With Severe Asthma By pediatrics.aappublications.org Published On :: 2020-04-01T01:00:57-07:00 BACKGROUND AND OBJECTIVES: The albuterol dropper bottle used to prepare solutions for continuous nebulization contains the preservative benzalkonium chloride (BAC). BAC, by itself, has been shown to cause bronchospasm. We hypothesized that BAC would decrease the therapeutic efficacy of albuterol in patients with acute asthma exacerbations. METHODS: We performed a retrospective cohort study comparing the clinical outcomes of patients <18 years of age receiving continuous nebulized albuterol with and without BAC. For the primary end point (duration of continuous albuterol nebulization), we compared the 2 groups with Kaplan-Meier estimate of survival curves, conducted a log-rank test of difference, and adjusted for baseline characteristics using multivariable Cox regression. A P value <.05 was considered significant. RESULTS: A total of 477 patients were included in the analysis (236 exposed to BAC and 241 controls). The duration of continuous nebulization was significantly longer in the BAC group than in the control group (median of 9 vs 6 hours; 15.7% required continuous nebulization compared to 5.8% of controls at 24 hours). The control group was 79% more likely to stop continuous nebulization at any particular point in time (hazard ratio 1.79; 95% confidence interval: 1.45 to 2.22; P < .001) and 43% more likely to stop additional respiratory support (hazard ratio 1.43; 95% confidence interval: 1.16 to 1.75; P < .001). CONCLUSIONS: BAC is a functional albuterol antagonist associated with a longer duration of continuous albuterol nebulization treatment and additional respiratory support, suggesting that preservative-free albuterol formulations are safer for use in continuous nebulization. Full Article
chi Mailchimp By www.pcmag.com Published On :: Mailchimp is still leading the email marketing category, but it now adds CRM features and a website builder to help small to midsize businesses carry out marketing campaigns. Full Article
chi An architect explores using his passion in missions By feedproxy.google.com Published On :: Thu, 04 Jul 2019 11:48:48 +0000 For years, Gustavo, an architect from Central America, felt drawn to working in the Arabian Peninsula. Then, on a short-term trip, he saw what it could be like to use his profession overseas. Full Article
chi Digital Technology Is Gambling With Children's Minds By feedproxy.google.com Published On :: Tue, 13 Nov 2018 00:00:00 +0000 Writing, reading, focusing, and remembering have all been transformed in ways we don't yet fully understand, writes psychologist Elias Aboujaoude. Full Article Technology
chi Technology Has No Impact on Teaching and Learning By feedproxy.google.com Published On :: Wed, 24 Apr 2019 00:00:00 +0000 If we truly want educational technology to take root in schools and finally live up to the promise we've been expecting for more than a decade, schools need to develop a cadre of well-trained tech instructional coaches. Full Article Technology