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To meet the diverse needs of school-aged children, school psychologists often must collaborate with other professionals within and outside the school setting. Despite potential benefits, challenges exist related to interprofessional collaboration, including ethical challenges. This article explores some of the most salient ethical dilemmas that school psychologists are likely to face when collaborating with other professionals. Specifically, ethical issues related to competence, multiple relationships, informed consent/assent, privacy/confidentiality, assessment, and therapy are examined. Using vignettes, recommendations for navigating common ethical issues that may arise when engaging in interprofessional collaboration are offered. Suggestions are contextualized within the ethical principles and standards outlined in the American Psychological Association's Ethical Principles of Psychologists and Code of Conduct (2017) and the National Association of School Psychologists Professional Standards (2020), which includes the Principles for Professional Ethics. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Competing Interests: Conflicts of interest C Felmingham was supported by a Monash University Research Training Program Scholarship. Y Pan has previously reported for MoleMap Ltd. A Chamberlain was a reporting teledermatologist for MoleMap Ltd from 2009 to 2010. A Chamberlain has honoraria from Proctor & Gamble, Schering-Plough, CSL, Leo-Pharma; a consulting/advisory role for L'Oreal (La Roche Posay); and is on the Speakers Bureau for Novartis, Janssen, HealthCert International, Cancer Council of Victoria, Merck Sharp & Dohme. A Oakley is a diagnosing consultant for MoleMap Ltd; and was involved in another study of the MoleMap AI system (abstract published https://www.iproc.org/themes/1158-9th-world-congress-of-teledermatology-imaging-and-ai-for-skin-diseases-abstracts-2021). S Tucker is a diagnosing consultant for MoleMap Ltd and Dermatology Solutions. A Robinson is a sub-Investigator for Dermira, Galderma, Pfizer, Arcutis, Bristol Myers Squib, Leo Pharma, Argenx, Genesis Care; has had sponsored conference attendance from Lilly, and Janssen was on the steering committee for conference for Novartis; and on the Advisory Board for Lilly. P Foley has received grant support from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galderma, Janssen, Leo Pharma, Merck, Novartis, Pfizer, Sanofi, and Sun Pharma; has served as an investigator for AbbVie, Amgen, Arcutis, Argenx, Aslan, AstraZeneca, Boehringer Ingelheim, Botanix, Bristol-Myers Squibb, Celgene, Celtaxsys, CSL, Cutanea, Dermira, Eli Lilly, Evelo, Galderma, Genentech, Geneseq, GlaxoSmithKline, Hexima, Janssen, Kymab, Leo, Merck, MedImmune, Novartis, Pfizer, Regeneron Pharmaceuticals Inc, Reistone, Roche, Sanofi, Sun Pharma, Teva, UCB Pharma, and Valeant; has served on advisory boards for AbbVie, Amgen, Aslan, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Galderma, GlaxoSmithKline, Janssen, Leo, Mayne Pharma, Merck, Novartis, Pfizer, Sanofi, Sun Pharma, UCB Pharma, and Valeant; has served as a consultant for Aslan, Bristol-Myers Squibb, Eli Lilly, Galderma, GenesisCare, Hexima, Janssen, Leo Pharma, MedImmune, Mayne Pharma, Novartis, Pfizer, Roche, and UCB Pharma; has received travel grants from AbbVie, Eli Lilly, Galderma, Janssen, Leo Pharma, Merck, Novartis, Pfizer, Roche, Sun Pharma, and Sanofi; and has served as a speaker for or received honoraria from AbbVie, Amgen, Celgene, Eli Lilly, Galderma, GlaxoSmithKline, Janssen, Leo Pharma, Merck, Novartis, Pfizer, Roche, Sanofi, Sun Pharma, and Valeant. A Bowling is a shareholder, founder and consultant to MoleMap Ltd. Z Ge has received personal fees from MoleMap Ltd. M Haskett has received personal fees from MoleMap Ltd and is a shareholder in MoleMap Ltd. V Mar is supported by a National Health and Medical Research Council Early Career Fellowship; and has honoraria from Novartis, Merck, Bristol-Myers-Squibb, Janssen, and Eli Lily; and has had sponsored conference attendance from L'Oreal.

Background/objectives: Sequential digital dermoscopic imaging (SDDI) and total body photography (TBP) are recommended as a two-step surveillance method for individuals at high-risk of developing cutaneous melanoma. Dermoscopic features specific to melanoma have been well described, however, dynamic changes on serial imaging are less understood. This study aims to identify and compare dermoscopic features in developing melanomas and benign naevi that underwent SDDI and TBP to understand which dermoscopic features may be associated with a malignant change., Method: Histopathology reports from a private specialist dermatology clinic from January 2007 to December 2019 were reviewed. Histopathologically confirmed melanoma and benign naevi that underwent SDDI and TBP with a minimum follow-up interval of 3 months were included., Results: Eighty-nine melanomas (38.2% invasive, median Breslow thickness 0.35 mm, range: 0.2-1.45 mm) and 48 benign naevi were evaluated by three experienced dermatologists for dermoscopic changes. Features most strongly associated with melanoma included the development of neovascularisation, asymmetry and growth in pigment network, additional colours, shiny white structures, regression, structureless areas and change to a multi-component pattern. The presence of atypical vessels (p = 0.02) and shiny white structures (p = 0.02) were significantly associated with invasive melanoma., Conclusion: Evaluation for certain evolving dermoscopic features in melanocytic lesions monitored by SDDI and TBP is efficient in assisting clinical decision making. SDDI with TBP is an effective tool for early detection of melanoma., (© 2023 The Australasian College of Dermatologists.)

Introduction: Convolutional neural networks (CNNs) can diagnose skin cancers with impressive accuracy in experimental settings, however, their performance in the real-world clinical setting, including comparison to teledermatology services, has not been validated in prospective clinical studies., Methods and Analysis: Participants will be recruited from dermatology clinics at the Alfred Hospital and Skin Health Institute, Melbourne. Skin lesions will be imaged using a proprietary dermoscopic camera. The artificial intelligence (AI) algorithm, a CNN developed by MoleMap Ltd and Monash eResearch, classifies lesions as benign, malignant or uncertain. This is a preintervention/postintervention study. In the preintervention period, treating doctors are blinded to AI lesion assessment. In the postintervention period, treating doctors review the AI lesion assessment in real time, and have the opportunity to then change their diagnosis and management. Any skin lesions of concern and at least two benign lesions will be selected for imaging. Each participant's lesions will be examined by a registrar, the treating consultant dermatologist and later by a teledermatologist. At the conclusion of the preintervention period, the safety of the AI algorithm will be evaluated in a primary analysis by measuring its sensitivity, specificity and agreement with histopathology where available, or the treating consultant dermatologists' classification. At trial completion, AI classifications will be compared with those of the teledermatologist, registrar, treating dermatologist and histopathology. The impact of the AI algorithm on diagnostic and management decisions will be evaluated by: (1) comparing the initial management decision of the registrar with their AI-assisted decision and (2) comparing the benign to malignant ratio (for lesions biopsied) between the preintervention and postintervention periods., Ethics and Dissemination: Human Research Ethics Committee (HREC) approval received from the Alfred Hospital Ethics Committee on 14 February 2019 (HREC/48865/Alfred-2018). Findings from this study will be disseminated through peer-reviewed publications, non-peer reviewed media and conferences., Trial Registration Number: NCT04040114., Competing Interests: Competing interests: VM is supported by an NHMRC Early Career Fellowship. VM reports personal fees from Novartis, personal fees from Bristol-Myers-Squibb, personal fees from Merck, outside the submitted work. MH reports personal fees from MoleMap Ltd, during the conduct of the study; and is a shareholder in MoleMap Ltd. AB reports personal fees from MoleMap Ltd, during the conduct of the study; personal fees from Molemap Ltd, outside the submitted work; and is a shareholder in Molemap Ltd. AS reports personal fees from MoleMap Ltd, during the conduct of the study; personal fees from Molemap Ltd, outside the submitted work. ZG reports personal fees from MoleMap Ltd. NW and SM are former employees of the Cancer Collaborative Trials Group contracted to implement the SMARTI Study—Melanoma and Skin Cancer Trials (MASC Trials) Ltd. CF is supported by a Monash University Research Training Program Scholarship. RW, NA, WC and MW have nothing to disclose. The study is sponsored by Monash University and endorsed by MASC Trials Ltd., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Lentigo maligna (LM) is a common subtype of in situ melanoma on chronically sun-exposed skin, particularly the head and neck of older patients. Although surgery is the standard treatment, there is associated morbidity, and options such as imiquimod cream or radiotherapy may be used if surgery is refused or inappropriate. Complete response rates following imiquimod treatment are variable in the literature. The aim of this study was to evaluate the host immune response both before and following treatment with imiquimod to better identify likely responders. Paired pre- and post-imiquimod treatment specimens were available for 27 patients. Patients were treated with imiquimod 5 days per week for 12 weeks; at 16 weeks, lesions were excised for histological assessment. Of the 27 patients, 16 were responders and 11 failed to clear the disease. PDL1 protein expression was increased, accompanied by a unique gene signature in lesions from patients that subsequently histologically cleared LM by 16 weeks. This comprised 57 upregulated immune genes in signaling networks for antigen presentation, type I interferon signaling, and T-cell activation. This may represent an early responder group to imiquimod, and this unique gene signature potentially can be used as a biomarker of LM response to imiquimod., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Child abuse is prevalent worldwide, with most of the burden in developing countries. To reduce and prevent child abuse occurrence, many efforts are directed toward reducing maladaptive parental behaviors (MPBs), a predictor of parents' risk of engaging in child abusive behaviors. MPBs have been associated with child (e.g., behavioral difficulties) and parent characteristics (e.g., parenting stress and parental cognitions), although little research tested for mediational pathways. This study aimed to test the pathways through which child and parent characteristics are linked to MPB. Consistent with the social information processing model of parenting, we hypothesized that child behavioral difficulties would exert an indirect influence on MPB through parenting stress and that parenting stress will exert a direct and indirect effect on MPB through parental cognitions (i.e., expectations, attitudes, and attributions). This study used data from 243 mothers of children aged between 2 and 9 years in Romania. Two-stage structural equation modeling was employed to test the hypothesized model. Results support the role of child behavior, parenting stress, and parental cognitions in predicting MPB (R 2  = 0.69). Significant indirect effects were found from child behavior to MPB via parenting stress and parental cognitions. Direct effects from parenting stress and parental cognitions to MPB were significant. Findings show that parenting stress and parental cognitions are important mechanisms through which child behavioral difficulties influence maladaptive parental behavior, underscoring the need to focus on these mechanisms when assessing or intervening with families at risk for child abuse., (© 2024 Family Process Institute.)

Aim: The American Society of Clinical Oncology and US Institute of Medicine emphasize the need to trial novel models of posttreatment care, and disseminate findings. In 2011, the Victorian State Government (Australia) established the Victorian Cancer Survivorship Program (VCSP), funding six 2-year demonstration projects, targeting end of initial cancer treatment. Projects considered various models, enrolling people of differing cancer types, age and residential areas. We sought to determine common enablers of success, as well as challenges/barriers., Methods: Throughout the duration of the projects, a formal "community of practice" met regularly to share experiences. Projects provided regular formal progress reports. An analysis framework was developed to synthesize key themes and identify critical enablers and challenges. Two external reviewers examined final project reports. Discussion with project teams clarified content., Results: Survivors reported interventions to be acceptable, appropriate and effective. Strong clinical leadership was identified as a critical success factor. Workforce education was recognized as important. Partnerships with consumers, primary care and community organizations; risk stratified pathways with rapid re-access to specialist care; and early preparation for survivorship, self-management and shared care models supported positive project outcomes. Tailoring care to individual needs and predicted risks was supported. Challenges included: lack of valid assessment and prediction tools; limited evidence to support novel care models; workforce redesign; and effective engagement with community-based care and issues around survivorship terminology., Conclusion: The VCSP project outcomes have added to growing evidence around posttreatment care. Future projects should consider the identified enablers and challenges when designing and implementing survivorship care., (© 2015 Wiley Publishing Asia Pty Ltd.)

Importance: Mitotic rate is now recognized as having independent prognostic significance in melanoma survival. However, its clinicopathologic associations have not been the focus of any previous study., Objective: To identify a set of patient and tumor characteristics associated with high-mitotic-rate melanoma with the aim of facilitating the earlier detection of aggressive primary invasive melanoma., Design, Setting, and Participants: Cross-sectional study of patients from a multidisciplinary melanoma clinic based in a public hospital. A total of 2397 cases from January 2006 to December 2011 were reviewed by the Victorian Melanoma Service, and 1441 patients with 1500 primary invasive melanomas were included in the study., Main Outcomes and Measures: Mitotic rate was measured as number of mitoses per mm2 and analyzed as ordered categories (0, <1, 1 and <2, 2, 3-4, 5-9, and ≥10) according to patient demographics, phenotypic markers, historical data, tumor presentation, and histopathologic features., Results: Melanomas with higher mitotic rates were more likely to occur in men (odds ratio [OR], 1.5; 95% CI, 1.3-1.8), patients 70 years or older (OR, 2.1; 95% CI, 1.7-2.8), and those with a history of solar keratosis (OR, 1.3; 95% CI, 1.1-1.6). These melanomas occurred more frequently on the head and neck (OR, 1.4; 95% CI, 1.0-1.9) and presented more often as amelanotic (OR, 1.9; 95% CI, 1.4-2.5) and rapidly growing (≥2 mm/mo) lesions (OR, 12.5; 95% CI, 8.4-18.5). An association was seen with the nodular melanoma subtype (vs superficial spreading [reference]) (OR, 2.5; 95% CI, 1.8-3.4), greater tumor thickness (vs ≤1 mm [reference]) (>1-4 mm: OR, 4.5; 95% CI, 3.2-6.1; >4 mm: OR, 12.6; 95% CI, 7.5-21.1), and ulceration (OR, 2.0; 95% CI, 1.5-2.7). These histopathologic features, along with amelanosis and rate of growth, remained as significant associations with high mitotic rate in the overall multivariate analysis., Conclusions and Relevance: High-mitotic-rate primary cutaneous melanoma is associated with aggressive histologic features and atypical clinical presentation. It has a predilection for the head and neck region and is more likely to be seen in elderly men with a history of cumulative solar damage who present clinically with rapidly developing disease.

Background: Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy with a high mortality rate. Diagnosis is often delayed., Objectives: To characterize the dermoscopic features of MCC., Methods: Clinical and dermoscopic images of 12 biopsy-proven MCCs were analysed in a retrospective manner, with existing dermoscopic criteria being scored independently by three dermatologists., Results: The four most frequent clinical features were cherry red colour, shiny surface, sharp circumscription and nodular morphology. Significant dermoscopic features included linear irregular and polymorphous vessels, poorly focused vessels, milky pink areas, white areas, structureless areas and architectural disorder. Pigmented structures were absent from all lesions., Conclusions: The dermoscopic features described herein help the clinician to distinguish MCC from other benign and malignant red nodules. Increasing recognition of the presenting features will facilitate earlier diagnosis of MCC and reduced mortality., (© 2013 The Authors BJD © 2013 British Association of Dermatologists.)

Recent national reports suggest that nearly 1,000,000 families with children experience homelessness and that this number is rising (National Center on Family Homelessness, 2009; U.S. Conference of Mayors, 2010; U.S. Department of Housing and Urban Development, 2011). Families experiencing homelessness are disproportionately more likely to have experienced economic, health, and social risk factors. These experiences can adversely influence the parent-child relationship. The purpose of this article is to (a) review the literature on the determinants and contextual issues of parenting in shelters; (b) describe specific programs that are focused on positive parenting in the context of homelessness; and (c) provide practice, research, and policy recommendations for supporting positive parenting among families living without homes., (© 2012 American Orthopsychiatric Association.)

Objective: To determine the efficacy of imiquimod cream, 5%, in the treatment of lentigo maligna (LM)., Design: Open-label before-and-after interventional study., Setting: A multidisciplinary melanoma clinic at a major tertiary hospital., Patients: Forty-three patients with biopsy-proven LM of greater than 5 mm in diameter completed this study., Interventions: Imiquimod cream, 5%, was applied to the lesion 5 days a week for 12 weeks. The original lesion was excised with a 5-mm margin., Main Outcome Measures: The primary outcome was histopathologic evidence of LM in the excision specimen assessed independently by 2 of 3 dermatopathologists. Visible inflammation during treatment and macroscopic clearance were recorded., Results: When 5 of the 43 patients with discordant histopathologic assessment of the excision specimen were excluded, 20 of 38 patients (53% [95% confidence interval, 36%-69%]) demonstrated histopathologic clearance of LM after imiquimod treatment. Visible inflammation was significantly associated with histopathologic clearance (P = .04), but the positive predictive value was low (62%). Macroscopic clearance showed some association with histopathologic clearance (P = .11). Dermatopathologist concordance for all 43 specimens was substantial (κ = 0.77; 95% confidence interval, 0.57-0.96)., Conclusions: Imiquimod cream, 5%, has limited efficacy in the treatment of LM when determined by histopathologic assessment of the entire treated area. The clinical signs of visible inflammation during treatment and apparent lesion clearance cannot be relied on to assess efficacy.

Background: Teledermoscopy is a rapidly developing field of dermatology with studies demonstrating excellent agreement with face-to-face diagnosis. However, we are unaware of studies evaluating interobserver variability in diagnosis between dermatologists from different continents. This evaluation is important to determine the robustness of teledermoscopy and allow comparisons to be made between different studies., Objectives: To assess the interobserver diagnostic variability between five independent experienced dermatologists (A-E) in New Zealand, Australia and the U.S.A., Methods: Images from 979 lesions from 206 patients were distributed to five dermatologists. The lesions were viewed and diagnoses recorded using MoleMap Diagnose (MoleMap, Auckland, New Zealand) software. The diagnoses were analysed for interobserver variability., Results: There was excellent agreement between four of five dermatologists (A-D) for lesions that were agreed upon as melanoma (κ = 0·81-0·97) and benign naevus (κ = 0·77-0·82).The fifth dermatologist (E) made a more frequent diagnosis of atypical naevus and melanoma than the others. For nonmelanocytic lesions, there was moderate to very good agreement for seborrhoeic keratosis (κ = 0·64-0·80) and basal cell carcinoma (κ = 0·55-0·67), but poor agreement for invasive squamous cell carcinoma (SCC) (κ = 0·05-0·15). Agreement for actinic keratosis (κ = 0·32-0·67) and SCC in situ (κ = 0·15-0·32) was only moderate. When atypical and benign naevi were grouped together and actinic keratosis and SCC in situ grouped together, there was better agreement among all dermatologists. There was good ability to distinguish malignant from benign lesions (κ = 0·57-0·93)., Conclusions: There was good agreement among dermatologists A-D but dermatologist E varied from the group with more frequent diagnosis of melanoma and atypical naevus. This difference could be due to different definition of terms with lack of consensus guidelines in definition of atypical naevus, lack of familiarity with the specific patient population and/or diagnostic drift., (© 2010 The Authors. BJD © 2010 British Association of Dermatologists.)

Background: Intraepidermal carcinoma (IEC), superficial basal cell carcinoma (sBCC), and psoriasis are common entities that may all present as well-defined, brightly erythematous plaques. Currently, there are limited data on the dermatoscopic features that differentiate these diagnoses., Objective: We sought to describe the most significant morphologic findings seen on dermatoscopy of IEC, sBCC, and psoriasis, and formulate a diagnostic model based on these features., Method: We conducted a retrospective observational study using macrophotography and dermatoscopy to evaluate the presence or absence of dermatoscopic features and formulated diagnostic models for each diagnosis. A convenient sample of 300 lesions was collected from 255 patients from two hospital dermatology clinics and 4 private dermatology practices. These comprised 150 cases of sBCC, 100 cases of psoriasis, and 50 cases of IEC., Results: The most significant dermatoscopic features of IEC were a clustered vascular pattern, glomerular vessels, and hyperkeratosis. When all 3 features were observed together, the diagnostic probability for IEC was 98%. sBCCs were characterized by a scattered vascular pattern, arborizing microvessels, telangiectatic or atypical vessels, milky-pink background, and brown dots/globules; the diagnostic probability was 99% if 4 of these 6 features were identified. For psoriasis, the significant features identified were a homogenous vascular pattern, red dots, and light-red background, yielding a diagnostic probability of 99% if all 3 features were present., Limitations: Lack of evaluation of interobserver/intraobserver reproducibility is a limitation., Conclusion: Dermatoscopy is valuable in the diagnosis and differentiation of IEC, sBCC, and psoriasis because of consistent dermatoscopic morphology.

Background: Young children who stay with their families in homeless shelters face chronic challenges related to extreme poverty and acute risks from stressful events surrounding the loss of housing and move to shelter. These adversities increase the likelihood of a range of poor developmental outcomes. Consistent with the risk and resilience perspective, however, many children who experience family homelessness succeed, functioning as well or better than their non-homeless peers. As such, efforts to support resilience should consider how best to enhance protective factors, such as supportive environments within shelter settings., Methods: With data from 60 caregivers of children ages birth to 5 years recruited from family shelters, we assessed caregivers' perceptions of community support as well as child and family well-being in terms of recent adverse experiences, parenting stress, access to social support, and child social-emotional functioning., Results: Many caregivers experiencing family homelessness perceived negative aspects of the shelters where they were staying with their children. Furthermore, children whose caregivers had more negative perceptions of the shelter environment displayed worse social-emotional functioning, even when accounting for differences in parenting stress, recent family adversity, and other sources of social support., Conclusions: Because young children rely on their caregivers as primary resources for nurturance and support, we encourage family homelessness service providers to work in partnership with caregivers to create more inclusive and empowering practices within the shelter context. Doing so is likely to improve children's developmental outcomes and the overall well-being of the families., (© 2022 John Wiley & Sons, Ltd.)

Emotion-focused parenting practices, known as parent emotion socialization, play a crucial role in shaping youth's emotion regulation (ER) abilities. The impact of parent emotion socialization behaviors (ESB) on youth ER has been studied extensively in community samples. However, research on these relations in clinical samples is more limited, albeit growing. The current systematic review sought to evaluate the existing literature examining parent ESB of negative affect in various clinical child and adolescent samples. A literature search was conducted in April 2023, resulting in 1153 abstracts being reviewed. Two reviewers independently screened the titles and abstracts to identify relevant papers, with 152 articles being independently reviewed in full, of which 26 articles met inclusion criteria and are included in the current review. Studies (16 cross-sectional, 6 longitudinal, 4 intervention) utilized multi-methods of assessing youth ER, including questionnaires, physiological, and observational measures in a range of clinical samples, including youth diagnosed with internalizing, externalizing, and neurodevelopmental disorders, as well as youth at-risk for clinical diagnoses such as physically abused children. Overall, results support significant, negative associations between parent ESB practices and youth emotion dysregulation (rs = .22-.35) and negativity/lability (rs = .19-.60), and positive associations with youth ER abilities (rs = .18-.76). Some studies highlighted varying impacts of parental ESB on children with versus without clinical disorders/symptomology, with effects being more pronounced within clinical populations. Implications for these findings and future research directions are discussed, including the significance of focusing on parent ESB in intervention work with clinical child populations., Competing Interests: Declarations Conflict of interest All authors declare no conflict of interest., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Family environment, emotion regulation and biological sensitivity have been shown to be associated with adolescents' externalizing problem behaviours. However, findings regarding respiratory sinus arrhythmia (RSA) reactivity are mixed and sometimes contradictory. This study aims to clarify the roles of RSA reactivity and anger regulation in the relationship between negative family expressiveness (NFE) and adolescents' externalizing behaviour by measuring RSA reactivity during the Parent-Adolescent Interaction Task (PAIT), designed to simulate a naturalistic negative family environment. In this study, 125 Chinese adolescents (M = 13.95 years, SD = 0.95; 48% male) completed questionnaires assessing negative family expressiveness, anger regulation and externalizing problems. Additionally, we collected electrocardiogram and respiration data during both the resting period and a 10-min PAIT. Results showed that anger regulation mediated the relationship between NFE and externalizing problem behaviours. Moreover, adolescents' RSA reactivity moderated this mediation effect, even after controlling for baseline RSA. Greater RSA suppression potentially indicated greater susceptibility, with the relationship between NFE and anger regulation being more pronounced in adolescents with greater RSA suppression compared to those with lesser RSA suppression. These findings highlight the importance of considering physiological systems, especially within the context of adverse family environments, when studying the relationships with externalizing problems., (© 2024 British Psychological Society.)

Background: Merkel cell carcinoma (MCC) is a rare neuroendocrine skin cancer with poor 5-year survival rates. Surgery and radiation are the current first-line treatments for local and nodal disease., Objectives: The Brazilian Society of Surgical Oncology developed this document aiming to guide the surgical oncology role in multimodal MCC management., Methods: The consensus was established in three rounds of online discussion, achieving consensus on specific topics including diagnosis, staging, treatment, and follow-up., Results: Patients suspected of having MCC should undergo immunohistochemical examination and preferably undergo pathology review by a dermatopathologist. Initial staging should be performed with dermatologic and nodal physical examination, combined with complementary imaging. Whole-body imaging, preferably with positron emission tomography (PET) or computed tomography (CT) scans, are recommended. Due to the need for multidisciplinary approaches, we recommend that all cases should be discussed in tumor boards and referred to other specialties as soon as possible, reducing potential treatment delays. We recommend that all patients with clinical stage I or II may undergo local excision associated with sentinel lymph node biopsy. The decision on margin size should consider time to recovery, patient's comorbidities, and risk factors. Patients with positive sentinel lymph nodes or the presence of risk factors should undergo postoperative radiation therapy at the primary site. Exclusive radiation is a viable option for patients with low performance. Patients with positive sentinel lymph node biopsy should undergo nodal radiation therapy or lymphadenectomy. In patients with nodal clinical disease, in addition to primary tumor treatment, nodal radiation therapy and/or lymphadenectomy are recommended. Patients with advanced disease should preferably be enrolled in clinical trials and discussed in multidisciplinary meetings. The role of surgery and radiation therapy in the metastatic/advanced setting should be discussed individually and always in tumor boards., Conclusion: This document aims to standardize a protocol for initial assessment and treatment for Merkel cell carcinoma, optimizing oncologic outcomes in middle-income countries such as Brazil., (© 2024 Wiley Periodicals LLC.)

Background: We aimed to develop tools that could predict the occurrence of distant metastases in melanoma and its prognosis based on clinical and pathological characteristics., Materials and Methods: We obtained data from the Surveillance, Epidemiology, and End Results (SEER) database of melanoma patients diagnosed between 2010 and 2019. Logistic analyses were performed to identify independent risk factors associated with distant metastasis. Additionally, multivariate Cox analyses were conducted to determine independent prognostic factors for patients with distant metastasis. Two nomograms were established and evaluated with the receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Furthermore, we performed a retrospective analysis of melanoma with distant metastasis from our institute between March 2018 and June 2022., Results: Of the total 19 396 melanoma patients, 352 (1.8%) had distant metastases at the time of diagnosis. The following clinical and pathological characteristics were identified as independent risk factors for distant metastasis in melanoma: N stage, tumor size, ulceration, mitosis, primary tumor site, and pathological subtype. Furthermore, tumor size, pathological subtype, and radiotherapy were identified as independent prognostic factors. The results of the training and validation cohorts' ROC curves, calibration, DCA, and Kaplan-Meier survival curves demonstrate the effectiveness of the two nomograms. The retrospective study results from our center supported the results from the SEER database., Conclusion: The clinical and pathological characteristics of melanoma can predict a patient's risk of metastasis and prognosis, and the two nomograms are expected to be effective tools to guide therapy decisions., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

While parenting children with difficult behaviors can intensify stress within the entire family system, families may lean on other familial relationships to mitigate that stress. The coparenting relationship is known to play a key role within the family system for child outcomes and familial interactions, but it is not clear whether it eases the stress and challenge of raising a difficult child, nor how that plays out differently for mothers versus fathers. Ninety-six couples (89.7% married) parenting young children (Mean age = 3.22 years) were included in this study. Using cross-sectional and aggregated daily response data, actor-partner interdependence models were used to examine how mothers' and fathers' perceived coparenting support lessened or intensified parenting stress and/or daily problems with their child/children-for themselves or their parenting partner. We found that greater coparenting support reported by mothers coincided with stronger links between the mother's report of child difficulty and daily problems encountered by both mothers and fathers. In contrast, when fathers reported greater coparenting support, the intensity between reported child difficulty and daily problems decreased for mothers, and fathers reported lower parenting stress. Coparenting support also moderated associations between parents' perception of child difficulty and daily problems with their children. These results suggest that mothers incur heightened coparenting support from fathers when experiencing more difficult child behavior and that coparenting support experienced by fathers may alleviate parenting challenges for mothers. These findings further contribute to the literature by emphasizing distinct differences between mothers and fathers in coparenting associations within the family system., (© 2023 The Authors. Family Process published by Wiley Periodicals LLC on behalf of Family Process Institute.)

Parents of children with autism spectrum disorder (ASD) report increased distress relative to parents of children with neurotypical development. Parent well-being is generally considered a key determinant of parenting behavior, thus increased distress may spill over into less optimal parenting in families of children with ASD. However, evidence is mixed regarding the degree to which parenting is actually compromised in this population, suggesting the possibility of buffering, wherein the parenting of children with ASD may be robust against spillover from increased parental distress. The current study tested competing spillover and buffering models with regard to relations among child ASD status, parental distress, and parenting behavior. Parents of preschoolers with (n = 73) and without (n = 55) ASD completed self-report measures of parenting stress, depressive symptoms, and emotion dysregulation, as well as of positive and negative parenting behaviors. Families of preschoolers with ASD reported higher distress and negative parenting, and lower positive parenting than did their counterparts. Findings supported the spillover model for negative parenting such that increased parental distress accounted for status-group differences in negative parenting. In contrast, potential buffering was observed for positive parenting in that an inverse association between distress and parenting was observed for parents of children with neurotypical development only. Findings highlight the potential benefit of intervention to reduce parental distress in families of children with ASD, but also suggest some existing ability of these families to buffer certain parenting behaviors from deleterious effects of parent distress., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Lower extremity nodular melanoma (NM) is a common malignant tumor with a poor prognosis. We aims to identify the prognostic factors and develop a nomogram model to predict overall survival (OS) in patients with lower extremity NM. A total of 746 patients with lower extremity NM were selected and randomly divided into a training set (522 cases) and a validation set (224 cases) from the Surveillance, Epidemiology, and End Results(SEER) database. The training set underwent univariate and multivariate Cox regression analyses to identify independent prognostic factors associated with patient outcomes, and to develop a nomogram model. The effectiveness of the nomogram was subsequently validated using the validation set. Multivariable Cox regression analysis of the training set indicated that age, ulceration, radiotherapy, chemotherapy, primary site of first malignant tumor, and Breslow thickness were independent variables associated with OS. In the training set, the area under the curve (AUC) of the nomogram for predicting 3-year and 5-year OS was 0.796 and 0.811, respectively. In the validation set, the AUC for predicting 3-year and 5-year OS was 0.694 and 0.702, respectively. The Harrell's C-index for the training set and validation set were 0.754 (95% CI: 0.721-0.787) and 0.670 (95% CI: 0.607-0.733), respectively. Calibration curves for both training and validation sets showed good agreement. In this study, we develop and validate a nomogram to predict OS in patients with lower extremity NM. The nomogram demonstrated reasonable reliability and clinical applicability. Nomograms are important tools assessing prognosis and aiding clinical decision-making., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Merkel Cell Carcinoma is a rare and aggressive cutaneous carcinoma with a propensity for metastasis and death. Our study describes the prevalence, sociodemographics and inpatient mortality of Merkel Cell Carcinoma related hospitalizations in the United States from 2011 to 2020. We conducted an observational study using the Nationwide Inpatient Sample database, which captures a 20% sample of all hospitalizations in the United States. We utilized the International Classification of Disease Clinical Modification codes from the ninth and tenth revision to identify Merkel Cell Carcinoma and demographic factors. There was a total of 28,809 cases of Merkel Cell Carcinoma in the United States from 2011 to 2020. Merkel Cell Carcinoma was associated with white race (11.4 per 100,000) and disposition of death (26.8 per 100,000). It was most prevalent in the highest quartile income (12.5 per 100,000) and Medicare as primary payer (13.0 per 100,000). Hospitalization was lowest in nonwhite races, particularly NH-Blacks and NH-Others. Inpatient mortality was significantly associated with NH-Others (odds ratio 2.18, 95% confidence interval = 1.38-3.45) and self-pay patients (odds ratio = 2.93, 95% confidence interval 1.84-4.67).This study contributes to reported socio-demographic factors related to Merkel Cell Carcinomas and brings awareness to factors associated with increased hospitalization and inpatient mortality., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Children who experience homelessness are vulnerable to mental health problems, developmental delays and lower academic achievement. Research suggests that parental health literacy, sensitive parenting behaviour and child self-regulation are modifiable mechanisms that might enhance children's resilience to adversities associated with homelessness, yet empirical evidence on implementing such interventions in shelter settings is limited. Through a coordinated academic-community partnership, this study aimed to examine the (1) feasibility of conducting an integrated health approach in shelter settings and (2) the effectiveness of separate interventions on child and parent outcomes. Results are discussed in terms of best practices in shelter settings and building resilience in families experiencing homelessness with young children., (© 2024 John Wiley & Sons Ltd.)

The causal attributions of learning-disabled (LD) and normally achieving (NA) children in grades 3 through 8 were compared. Attributions were measured by two scales that asked children to attribute hypothetical academic failure situations to factors that were either within (e.g., insufficient effort) or beyond (e.g., insufficient ability, blaming others) their control. Consistent with a learned helplessness hypothesis. LD girls, regardless of age, were more likely than NA children to attribute their failures to factors beyond their control. In contrast, LD boys' explanations for their failures paralleled those of NA children. That is, with increasing age the LD boys were more likely to attribute their failures to insufficient effort. Explanations and implications of sex differences in developmental patterns of LD children's causal attributions are discussed.

Assessment and remedial approaches derived from the field of learning disabilities were applied in two studies of hyperlexic children. Information-processing strengths and weaknesses of hyperlexic children were assessed in the first study, and the hypothesis that hyperlexic children have superior abilities to retain sound/symbol associations was investigated. Results supported this hypothesis, and indicated that the exceptional reading skills of hyperlexic children are not simply a result of repeated exposure to words. In the second study, a hyperlexic child's ability to decode words was used to increase her functional speech. Written prompts resulted in rapid increases in appropriate verbal responses in naturalistic settings. Furthermore, our results demonstrated maintenance and generalization of the positive effects of written prompts.

My Baby's First Teacher is an intervention designed specifically for parents with infants staying in emergency homeless shelters. Infants are overrepresented in shelter populations and face considerable risk to their development, including mental health. We utilized a randomized controlled design across three family shelters to evaluate the program's effectiveness with 24 dyads assigned to the intervention compared to 21 dyads in care-as-usual. Dyads were randomized by round at each site to account for shelter effects. We used path analysis to illustrate change over time and in relation to intervention assignment., (© 2020 Michigan Association for Infant Mental Health.)

Objective: Research overwhelmingly demonstrates that sleep is key to human health and wellbeing. Several factors likely contribute to sleep quality, including factors, such as food security and low income. In addition, exposure to structural inequalities early in life likely have downstream effects upon multiple dimensions of health. The objective of this study is to fill gaps in literature by specifically examining the associations between childhood food insecurity, current food insecurity, psychological distress, and sleep among college students., Methods: QR codes were randomly distributed to students, linking them to an online quantitative survey. The survey measured sociodemographic variables, food security (current and childhood), diet, mental distress, and sleep quality. A total of n = 134 completed the entire survey. Data were analyzed using binary and multiple linear regressions, as well as cross-tabulations., Results: The findings revealed that psychological distress was the primary factor influencing sleep health (𝛽 = 1.51, p < .01). Students reporting higher childhood food insecurity were more likely to experience extreme psychological distress (OR = 4.61), food insecurity in college (OR = 8.41), and lack of stable housing (OR = 5.86)., Conclusion: This study demonstrates that potential linkages exist between childhood food insecurity, poor sleep, and greater psychological distress. While acknowledging the contribution of other factors, the study highlights the importance of addressing food insecurity in relation to sleep health, considering the significant impact of sleep to overall health and wellbeing., (© 2023 Wiley Periodicals LLC.)

Background: Differential diagnosis of amelanotic/hypomelanotic melanoma among solitary flat pink lesions is challenging, due to limited clinical and dermoscopic clues. Dermoscopy and reflectance confocal microscopy assessments improve diagnostic accuracy, but their combined capacity among solitary flat pink lesions is yet to be defined., Objectives: To determine (i) whether diagnostic accuracy is improved with combined dermoscopy and reflectance confocal microscopy, (ii) a model to estimate probability of flat amelanotic/hypomelanotic melanoma among solitary flat pink lesions., Methods: A retrospective single-centre study of solitary flat pink lesions, excised for suspected malignancy between 2011 and 2022 was performed. Images were independently evaluated by two dermatologists, blinded to histopathological diagnosis. Diagnostic performance was evaluated on the receiver operating characteristic curve and the area under the curve. Predictive features were identified by univariate and multivariate logistic regression analyses. A final predictive nomogram of independent risk factors was calculated by backward likelihood ratio. Hypothesis being tested was formulated before data collection., Results: A total of 184 patients (87 females, 47.3%) were included; mean age was 57.6 years (19-95). Combined dermoscopy and reflectance confocal microscopy was more sensitive (83%, CI 69.2-92.4 and 91.5%, CI 79.6-97.6) than dermoscopy alone (76.6%, CI 62.0-87.7 and 85.1%, CI 71.7-93.8). Predictive features defined the new model, including linear irregular vessels (4.26-folds, CI 1.5-12.1), peripheral pigment network (6.07-folds, CI 1.83-20.15), remnants of pigmentation (4.3-folds, CI 1.27-14.55) at dermoscopy and atypical honeycomb (9.98-folds, CI 1.91-51.96), disarranged epidermal pattern (15.22-folds, CI 2.18-106.23), dendritic pagetoid cells in the epidermis (3.77-folds, CI 1.25-11.26), hypopigmented pagetoid cells (27.05-folds, CI 1.57-465.5), and dense and sparse nests (3.68-folds, CI 1.24-10.96) in reflectance confocal microscopy. Diagnostic accuracy of the model was high (AUC 0.91)., Conclusions: Adjunctive reflectance confocal microscopy increases diagnostic sensitivity of flat amelanotic/hypomelanotic melanoma differential diagnosis. The proposed model requires validation., (© 2024 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)

Youth with autism spectrum disorder (ASD) often experience difficulties related to aggression, disruptive behavior, and regulation of emotions that precipitate these behaviors (i.e., anger). The extent to which aggression, disruptive behaviors, and anger dysregulation are correlated with distinct or overlapping factors has not yet been explored. The present study examined whether aspects of participant demographics, individual youth functioning, caregiver stress, and family warmth contributed to youth aggression, disruptive behavior, and anger dysregulation. Participants were caregivers of 511 youths with ASD. Analyses revealed that significant proportions of variance in aggression, disruptive behaviors, and anger dysregulation were accounted for by shared variables pertaining to demographics, the individual youth, and caregiver stress. Implications of treatment and future research are discussed., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Parents of atypically developing children such as parents of children with ASD, attention deficit hyperactivity disorder, and intellectual disability experience higher levels of parenting stress than parents of typically developing children. However, whether they possess enhanced emotional negativity bias was unclear. In the present study, 28 parents of typically developing children and 29 parents of atypically developing children were recruited. The emotional Stroop task and event-related potentials were adopted to measure their emotional negativity bias, in which participants were required to respond to the borders' color of face pictures. Behaviorally, the impact of parenting stress on emotional negativity bias was not found. At the electrophysiological level, the P2 differential amplitude (negative minus positive) was greater in parents of atypically developing children than in parents of typically developing children, reflecting an enhanced early attentional bias toward negative faces. N2 amplitude for the emotionally negative face was smaller than the positive face in parents of atypically developing children, indicating a too weak attentional control to inhibit distractors. Furthermore, sustained attention to negative faces was observed in parents of atypically developing children, that is, the emotionally negative face elicited greater frontal P3 (300 ~ 500 ms) than the positive faces. These findings revealed that compared to parents of typically developing children, parents of atypically developing children owned an enhanced emotional negativity bias at the early and late stages of information processing., (© 2024 Society for Psychophysiological Research.)

The many adverse effects of child maltreatment make the scientific investigation of this phenomenon a matter of vital importance. Although the relationship between maltreatment and problematic emotion reactivity and regulation has been studied, the strength and specificity of these associations are not yet clear. We examine the magnitude of the maltreatment-child-emotion reactivity/regulation link. Studies with substantiated maltreatment involving children aged up to 18 were included, along with a smaller number of longitudinal studies (58 papers reviewed, encompassing more than 11,900 children). In comparison to nonmaltreated children, maltreated children experience more negative emotions, behave in a manner indicative of more negative emotion, and display emotion dysregulation. We outline several theoretical implications of our results., (© 2019 Society for Research in Child Development.)

Background: Dermoscopy is a noninvasive technique that has attracted increasing attention in the field of inflammatory skin diseases (such as psoriasis) in recent years., Objective: This study aimed to provide an up-to-date overview of the role of dermoscopy in the diagnosis and extra-diagnosis of psoriasis., Methods: This study sought to review the published literature regarding use of dermoscopy in the evaluation of psoriasis., Results: The diagnostic value of dermoscopy in psoriasis vulgaris, nail psoriasis, and other types of psoriasis was summarized from the aspects of vascular pattern, scale pattern, and other features. Meanwhile, the application value of dermoscopy in the differential diagnosis, efficacy and severity assessment, prediction and monitoring of psoriasis was discussed., Conclusion: Dermoscopy has good clinical value in the diagnosis and differential diagnosis of psoriasis and shows great prospects for severity assessment and efficacy prediction monitoring., (© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Maltreatment survivors may be at risk for parenting challenges, although the previous literature is inconsistent, has focused on individual maltreatment forms, and has overlooked posttraumatic stress symptoms (PTSS) and other trauma exposure. The current study, thus, aimed to expand this research in four key ways by (a) examining all five maltreatment forms; (b) controlling for other nonmaltreatment trauma exposure to better isolate the role of maltreatment; (c) investigating maltreatment types and PTSS simultaneously; and (d) exploring novel parenting factors, specifically four types of parenting beliefs and developmental knowledge. Trauma-exposed parents (N = 301; M age = 26.49 years, SD = 8.34, range: 18-69 years; 66.8% female; 59.8% White) participated in the study. A path analytic model indicated that, surprisingly, none of the maltreatment types nor cumulative trauma exposure corresponded with parental beliefs related to one's child, self, partner, or social relationships. PTSS, however, were tied to all four parenting belief types as well as developmental knowledge, βs = -.05-.40. Physical and emotional abuse were linked to less accurate developmental knowledge, β = .02, and maladaptive parenting practices, β = .03. Sexual abuse, neglect, and witnessing domestic violence were not associated with any of the parenting factors. Thus, current trauma symptoms are likely a more critical intervention focus than maltreatment experiences, although physical and emotional abuse may also play a role in parenting knowledge and behaviors. These findings also signal the importance of including all five maltreatment forms and PTSS when conducting research on the interaction between trauma and parenting., (© 2023 International Society for Traumatic Stress Studies.)

The COVID-19 pandemic resulted in increased parenting stress and substance use. At the same time that mental health and social service needs increased, access to services, including among those receiving treatment, decreased due to stay-at-home orders. Few programs were equipped or prepared to translate their interventions to a virtual format at the start of the pandemic. There is a critical need to identify effective adaptations to substance use and family-focused treatment during the COVID-19 pandemic. Effective program adaptations have continued relevance for the expansion of access to family-focused addiction services beyond the pandemic itself, particularly for rural or other hard to reach populations. Seventy-three semi-structured interviews were conducted with the five agencies participating in the implementation of the In-Home Recovery Program (IHRP), an in-home, substance use disorder (SUD) treatment program. Using a rapid analysis approach two coders analyzed interviews for recurring concepts and themes. Facilitators for adapting services included: (1) the introduction of virtual toxicology screens, (2) helping parents access technology, (3) assisting parents with non-identified children to decrease their stress, and (4) anticipating reoccurrences of substances during the pandemic. Barriers to adapting services included: (1) engaging young children in virtual treatment, (2) privacy, and (3) engaging in telehealth with parents experiencing domestic violence or reoccurrence of substances. Findings reveal virtual substance use treatment is possible. Facilitators to adaptation such as providing access to technology and virtual toxicology screens demonstrate the feasibility and acceptability of utilizing telehealth interventions for substance use. Barriers to adaptations were primarily related to the infant mental health component. Telehealth is likely not appropriate for children below the age of five. Individual sessions focusing on caregiving, rather than dyadic treatment may be more suitable to virtual formats., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Parents of children with developmental disorders (DD) or disabilities report greater parenting stress than parents of typically developing children. To minimise this stress, stressful factors need to be known and stress needs to be recognised early. The present cross-sectional study aims to systematically assess and compare parenting stress in families of children with various types of disabilities. In addition, the assessment of parenting stress by attending paediatricians will be evaluated., Methods: We surveyed 611 parents about their parenting stress at the Children's Development Center (CDC). Three questionnaires, including the German versions of the Parenting Stress Index (PSI) and Impact on Family Scale (IOFS), were used to evaluate parenting stress. Furthermore, attending paediatricians assessed of the child's type of disability and their perception of parenting stress in a separate questionnaire., Results: Fifty-five percent of all parents reported stress at a clinically relevant level, 65% in the child domain and 39% in the parent domain of the PSI. Parenting stress differed significantly across diagnostic categories (p < 0.01) and was associated with childhood disability related issues of behaviour, sleep or feeding issues. Parenting stress was often underestimated by the paediatricians, especially when the children had disabilities perceived as less severe. In one-third of parents with clinically relevant total stress, paediatricians reported low stress levels. Parent-reported financial problems, social isolation, and partnership conflicts were not suspected by paediatricians in ≥85% of cases., Conclusions: Clinically relevant parenting stress was found more often than in comparable studies. An assessment of parenting stress by paediatricians may be complicated by time constraints in medical appointments, the mainly child-centred consultation, or restricted expression of parents' stress. Paediatricians should move from a purely child-centred to a holistic, family-centred approach to treatment. Routine screening of parenting stress using standardised questionnaires could be helpful to identify affected families., (© 2023 The Authors. Child: Care, Health and Development published by John Wiley & Sons Ltd.)

Psychological distress is the most common complication of pregnancy. High-risk concerns can include severe emotion dysregulation, suicidality and self-injury, and health risk behaviours, which bear substantial consequences for caregivers and families. Yet, effective, comprehensive interventions for high-risk caregivers have received limited attention. Dialectical behaviour therapy (DBT) is a frontline treatment for such concerns. Accordingly, we conducted a scoping review on the implementation of DBT in the perinatal period. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Seven studies were identified; study designs included case studies and single-arm pilot trials. Most studies used DBT-informed protocols with significant adaptations, few included multiple components of DBT (i.e. skills group, individual therapy, phone coaching and consultation team), and none met criteria for adherent delivery of all four modes of DBT treatment. Findings suggest DBT-informed interventions may be successfully implemented to treat a range of perinatal mental health symptoms, including borderline personality disorder, depression, anxiety, and post-traumatic stress, and to promote emotion regulation and positive parenting behaviours. While results provide preliminary support for perinatal DBT, this literature is scant and empirical rigour considerably lacking. Clinical implications and future directions are outlined to aid researchers and providers in addressing the ongoing perinatal mental health crisis and developing sorely needed interventions to address the needs of high-risk caregivers., (© 2023 John Wiley & Sons, Ltd.)

Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with epithelial and neuroendocrine differentiation, the incidence of which has increased substantially during the last decades. Risk factors include advanced age, fair skin type, UV exposure, and immunosuppression. Pathogenetically, a type caused by the Merkel cell polyomavirus is distinguished from a UV-induced type with a high tumor mutational burden. Clinically, MCC presents as a mostly painless, rapidly growing, reddish-violet tumor with a shiny surface, which is preferentially localized in the head-neck region and at the distal extremities. A reliable diagnosis can only be made based on histological and immunohistochemical features. At initial diagnosis, 20-26% of patients show locoregional metastases and 8-14% distant metastases, making staging examinations indispensable. If there is no clinical evidence of metastases, a sentinel lymph node biopsy is recommended. Essential columns of therapy are surgery, adjuvant or palliative radiotherapy and, in advanced inoperable stages, medicamentous tumor therapy. The introduction of immune checkpoint inhibitors has led to a paradigm shift, as they provide a considerably longer duration of response and better survival rates than chemotherapy. The PD-L1 inhibitor avelumab is approved for treatment of metastatic MCC in Germany, but the PD-1 antibodies pembrolizumab and nivolumab are also used with success. Adjuvant and neoadjuvant treatment concepts, immune combination therapies and targeted therapies as monotherapy or in combination with immune checkpoint inhibitors are in the clinical trial phase., (© 2023 Deutsche Dermatologische Gesellschaft (DDG).)

Structural racism contributes to homelessness in the United States, as evidenced by the stark racial disparities in who experiences it. This paper reviews research at the intersections of race and homelessness to advance efforts to understand and address racial inequities. Part 1 offers a synthesis of homelessness research from the 1980s to 2015, where several scholars examined the role of race and racism despite mainstream efforts to present the issue as race-neutral. Part 2 presents the results of a systematic scoping review of research at the intersections of race and homelessness from 2016 to 2021. The 90 articles included demonstrate a growing, multidisciplinary body of literature that documents how needs and trajectories of people experiencing homelessness differ by race, examines how the racialized structuring of society contributes to homelessness risk, and explores how programs, policies, and grassroots action can address inequities. In addition to charting findings and implications, included studies are appraised against research principles developed by Critical Race Theory scholars, mapping the potential of existing research on race and homelessness to challenge racism., (© 2023 Society for Community Research and Action.)

For new fathers, parenting stress is a risk factor for impaired early parenting and child maltreatment perpetration. Predictors of parenting stress, including fathers' own experiences of trauma, could be useful intervention targets to support new fathers. We aim to examine associations between new fathers' own histories of child maltreatment, and their perinatal mental health, relationships, and parenting stress. We recruited 298 first-time fathers for a survey that measured child maltreatment history, trauma sequelae including posttraumatic stress disorder (PTSD), major depressive disorder (MDD), interpersonal reactivity, substance use, anger expression, coparenting quality, and parenting stress. On the Parenting Stress Index (PSI) (from 36 to 180), bivariate analysis demonstrated that new fathers who experienced child maltreatment (n = 94) had significantly higher parenting stress (x̅ = 85.3, σ = 18.7) than those who did not (n = 204; x̅ = 76.0, σ = 16.6; P < .000). Hierarchical linear regression modeling indicated that a child maltreatment history, PTSD, and MDD were significantly associated with parenting stress. The strongest predictors of parenting stress were coparenting quality and complex trauma sequelae-interpersonal reactivity and anger expression. Interventions to reduce fathers' parenting stress by targeting known mental health and relationship sequelae of maltreatment are promising avenues to breaking intergenerational transmission of child maltreatment and psychiatric vulnerability., (© 2023 The Authors. Infant Mental Health Journal published by Wiley Periodicals LLC on behalf of Michigan Association for Infant Mental Health.)

The benefits of active music participation and training for cognitive development have been evidenced in multiple studies, with this link leveraged in music therapy approaches with clinical populations. Although music, rhythm, and movement activities are widely integrated into children's play and early education, few studies have systematically translated music therapy-based approaches to a nonclinical population to support early cognitive development. This study reports the follow-up effects of the Rhythm and Movement for Self Regulation (RAMSR) program delivered by generalist preschool teachers in low socioeconomic communities. This randomized control trial (RCT) involved 213 children across eight preschools in disadvantaged communities in Queensland, Australia. The intervention group received 16-20 sessions of RAMSR over 8 weeks, while the control group undertook usual preschool programs. Primary outcome measures included executive function (child assessment of shifting, working memory, and inhibition) and self-regulation (teacher report), with secondary outcomes of school readiness and visual-motor integration. Data were collected pre- and post-intervention, and again 6 months later once children had transitioned into school. Results demonstrated significant intervention effects across the three time points for school readiness (p = 0.038, η p 2  = 0.09), self-regulation (p < 0.001, η p 2  = 0.08), and inhibition (p = 0.002 η p 2  = 0.23). Additionally, the feasibility of building capacity in teachers without any music background to successfully deliver the program was evidenced. These findings are important given that children from low socioeconomic backgrounds are more likely to need support for cognitive development yet have inequitable access to quality music and movement programs. RESEARCH HIGHLIGHTS: Initial effects of self-regulation from a rhythm and movement program were sustained following transition into school for children from disadvantaged backgrounds. Delayed effects of inhibition and school readiness from a rhythm and movement program appeared 6 months post-intervention as children entered school. Generalist teachers can successfully implement a rhythm and movement program, which boosts critical developmental cognitive skills., (© 2022 The Authors. Developmental Science published by John Wiley & Sons Ltd.)

Reinforcement corrosion in concrete structures with excessive crack width poses a high risk of reducing the structure's service life. The crack width behavior is one of the most complex aspects of the mechanics of reinforced concrete (RC). With most of the models used in practice being semi-empirical or empirical, very few analytical approaches have been proposed. However, the analytical models lack either accuracy or simplicity, or both. This paper presents a new analytical model, termed the Pure Shear Model, that predicts mean crack width by a simple formula. It is based on the partial interaction tension stiffening model considering a short RC tie subjected to short-term loading. The model assumes elastic material properties and neglects shrinkage, internal cracking, and slip at the interface. It presumes that the only deformations that occur in concrete are the shear strains due to shear lag that are taken constant across the cover thickness. Deplanation of concrete section due to shear lag results in crack width linearly increasing from zero at the bar to its maximum value on the surface of the RC member. Despite the simplicity of the proposed model, its accuracy in predicting mean crack width was shown to be comparable to that of the design code methods., (© 2023. Springer Nature Limited.)

The ability to empathize with others enables us to effectively interact with each other and may have specifically evolved to support parental roles and caregiving. The relationship between parenting and trait empathy is little understood as previous research focused on empathy exclusively in the context of parenting, for example parental sensitivity. Here we aimed to understand how trait empathy may moderate the association between child's negative emotionality and parental burnout. Two cohorts were examined (1) parents of infants (10-18 months old; N = 203) and (2) parents of children (3-10 years old, N = 201). Parents filled out a battery of online questionnaires assessing maternal empathy, parental burnout and child temperament. We found that the relationship between higher levels of negative emotionality and parental burnout is moderated by specific aspects of maternal emotional empathy. Our findings suggest that maternal emotional empathy acts as a buffer against parental burnout when faced with a child's characteristics that incur higher parental demands., (© 2023 The Authors. British Journal of Psychology published by John Wiley & Sons Ltd on behalf of The British Psychological Society.)

Background: Specificities regarding the quality and quantity of sleep of preterm infants and their parents following discharge of the preterm infant from the hospital are not well known. Given this lack of knowledge, the links between the sleep characteristics of these parents, family functioning, and their psychological well-being are also unclear., Objectives: The purpose of this article is to summarize the research protocol of a cross-sectional, mixed-methods, convergent design study, which aims to evaluate the sleep patterns of preterm infants and both their parents and document the associations between sleep quality, parents' psychological well-being, and family functioning during the posthospitalization period., Methods: A convenience sample is used to recruit 30 families. For quantitative data collection, a questionnaire booklet consisting of validated questionnaires is used to measure sleep quality of each family member, parental psychological well-being, and family functioning completed by each parent. An actigraph and a sleep diary measure sleep quantity of each parent and the preterm infant. Afterward, semistructured interviews are carried out with each parent to explore their perceptions and needs concerning their infant's and their own sleep quality. For data analysis, qualitative and quantitative data are analyzed separately and then merged to allow for an integrative interpretation of the results., Results: The research project is ongoing; 25 of 30 families have completed the data collection. Data analysis is underway., Discussion: This research will provide a global portrait of the families' sleep 1 month after the preterm infant is discharged from the hospital, which is not well known to date. The results will help healthcare providers involved with preterm infants and their families after discharge from the hospital to increase their comprehension of the families' reality and adapt their interventions to meet these needs., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Daily childcare can be challenging for parents with a physical disability who have young children. Occupational therapists are valuable facilitators to family participation. However, occupational therapists have reported significant gaps in knowledge when documenting the parenting role of parents with a physical disability in occupational therapy practice. This study explored and described the parenting assessment methods used with parents with a physical disability in the scientific literature., Methods: A scoping review was conducted, and search results were reviewed by two separate reviewers. The search strategy was applied to five databases (Embase, CINAHL, MEDLINE, HaPI, PsycInfo). Numerical and thematic analyses were conducted., Results: Four thousand one hundred fifty articles were screened, and 73 relevant scientific articles were included. Seventy-six assessment methods were identified, including 20 assessment instruments with few reported population-specific psychometric studies. Most assessments were conducted via interviews (n = 45), followed by questionnaires (n = 27), and only six were performance based. Parenting practices and experience were the two dimensions most assessed, with little attention given to parenting responsibility. Mothers with multiple sclerosis, spinal cord injury, rheumatoid arthritis, and cerebral palsy were the most assessed., Conclusion: Further research is needed to develop specific, multidimensional, and validated parenting assessments for all parents with a physical disability, including performance-based assessments. Formal assessments should be conducted by professionals, including occupational therapists, who have the necessary training., (© 2022 Occupational Therapy Australia.)

Background: This study sought to analyse the impact of elderly age on long-term prognosis of superficial spreading melanoma (SSM) after surgery., Methods: A population-based cohort of patients undergoing resection for SSM from 2004 to 2015 was collected, using data from National Cancer Institute' Surveillance, Epidemiology, and End Results (SEER)* Stat software. Patients were divided into the non-elderly group (≤70 years) and elderly group (>70 years). Baseline characteristics and long-term survivals were compared between the two groups. A 1:1 propensity score matching (PSM) was used to reduce the risk of bias. The impact of the elderly age on overall survival (OS) and cause-specific mortality (CSM) was estimated by Cox-regression and competing-risk regression models., Results: Among 12 536 patients with SSM after resection included into the cohort, 8664 patients were ≤70 years, and 3872 were >70 years. Patients in the elderly group had higher incidences of multiple tumours, worse tumour stage and infiltration degree, lymphatic metastasis, and larger size of primary lesions. Using PSM, 3581 pairs of patients were created. On matched analysis, the elderly group was associated with worse OS and CSM. On multivariable Cox-regression and competing-risk regression analyses, elderly age was identified as an independent risk factor of OS and CSM after adjusting for other prognostic variables., Conclusions: The elderly age of patients was independently associated with worse OS and CSM after resection of SSM when baseline and tumour characteristics were balanced. Adjuvant therapy and individualized strategy on follow-up should be made for elderly patients after resection of SSM., (© 2022 Royal Australasian College of Surgeons.)