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In this review we bring a psychological perspective to the issue of intergenerational economic mobility. More specifically, we present a new dual developmental science framework to consider the educational outcomes of parents and children together in order to foster economic mobility. We focus on two key populations: children in early childhood (from birth to age 6) and parents in early adulthood (in their 20s and early 30s). We posit that mastery of three sets of developmental tasks for each generation—academic/language skills, self-regulation/mental health, and parent-child relationship—will lead to improved educational outcomes for both. Taken as a whole, the dual developmental science framework integrates theory and research on single-generation development (i.e., children or parents) with dynamic and bidirectional theories about the interdependence of children and parents over time.We conclude the review by evaluating existing education interventions and research using the dual developmental science framework, and we discuss opportunities for innovation.

Two-generation human capital programs seek to promote the education of parents and children simultaneously. This study examines relations between family participation in CareerAdvance, which recruits parents of Head Start children into a workforce training program, and children's Head Start attendance. The sample included 293 children (on average 4 years old) and their parents. After one semester, CareerAdvance children demonstrated higher rates of attendance and lower rates of absence and chronic absence (missing 10% or more of school days) than matched comparison children. These associations were similar across a range of high- and low-risk subgroups at baseline. These findings are discussed in terms of the implications of a family systems approach for improving children's Head Start attendance.

Innovation in English as a Second Language (ESL) services to support Latino immigrant parents and their children is needed, and this study examines a novel program that suggests future directions for the field. The Community Action Project of Tulsa County, Oklahoma’s two-generation ESL program recruits parents of children enrolled in Head Start and delivers an ESL curriculum that is contextualized to child development and children’s early school experiences. This mixed methods study explores the progress and the perspectives of parents and staff in this ESL program over two semesters (n = 35). Among enrollees in each semester, parents had high levels of completion (83% in semester 1; 70% in semester 2) and class attendance (94% in semester 1; 88% in semester 2). Yet, only about half (46%) of the parents completed both semesters 1 and 2. Parents who completed either semester 1 or semesters 1 and 2 did exhibit advancement in their English language skills, moving on average from beginner ESL levels to high intermediate levels based on National Reporting System benchmarks. Data from focus groups with parents and staff suggest that involvement in a two-generation ESL program can support parents’ focus on their children, including: (a) alignment of parent curriculum with child development, (b) bidirectional parent and child learning, and (c) an improved sense of parent agency with their children’s schooling and other child-related domains. Implications for future two-generation ESL programming are discussed.

Two-generation human capital programs for families provide education and workforce training for parents simultaneously with education for children. This study uses a quasi-experimental design to examine the effects of a model two-generation program, CareerAdvance, which recruits parents of children enrolled in Head Start into a health care workforce training program. After 1 year, CareerAdvance parents demonstrated higher rates of certification and employment in the health care sector than did matched-comparison parents whose children were also in Head Start. More important, there was no effect on parents' short-term levels of income or employment across all sectors. CareerAdvance parents also experienced psychological benefits, reporting higher levels of self-efficacy and optimism, in addition to stronger career identity compared with the matched-comparison group. Notably, even as CareerAdvance parents juggled the demands of school, family, and employment, they did not report higher levels of material hardship or stress compared with the matched-comparison group. These findings are discussed in terms of the implications of a family perspective for human capital programs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The phenomenon of maternal employment during infancy and its consequences for child development is currently very much in the limelight-in the popular press, public policy debates, and the research arena. Maternal employment during infancy has become a majority phenomenon, topping the SO percent mark only within the last five years. In contrast, the maternal employment literature has only very recently begun to explore the short and long term effects on cognitive outcomes of the timing of mothers' employment in infancy. In terms of long term effects on cognitive development of maternal employment during infancy, there are three studies along these lines, all with different methodologies and contexts. Although the grouping of employed mothers did not distinguish between employment before or after the first year, the majority of employed mothers had been employed in their children's infancy. The maternal employment variables of interest in their study are patterns reflecting the timing and intensity of mothers’ employment.

In 2010, Dr Howard Brody introduced the idea of “the top 5 list” in the New England Journal of Medicine , calling on medical specialties to identify items of overuse to provide high-value care.1 This led to the “choosing wisely” campaign to identify commonly overused measures in medicine in >70 different medical specialties.1 One aspect of this campaign is the “Things We Do For No Reason” articles in the Journal of Hospital Medicine , which focus on the evidence behind common overuse, overdiagnosis, or high-value care issues. These discussions are an important part of pediatric hospital medicine, and efforts to promote this subject must continue. As hospitalists, we also have an obligation to reassess things we should be doing. We will discuss 3 examples briefly in this article but encourage this discussion to continue, at conferences, meetings, and break rooms everywhere. Bronchiolitis is the most common reason infants are hospitalized, and over half require nonoral hydration.2,3 Multiple studies have shown that enteral and nasogastric hydration is comparable to intravenous (IV) hydration in terms of safety and tolerance.2,4,5 A large, randomized controlled trial of infants hospitalized with bronchiolitis did not reveal any significant difference in rates of ICU admission, oxygen therapy duration, ventilator support requirement, or length of stay when comparing IV with nasogastric hydration.2 In a 2018 survey, only 12% of physicians and nurses would choose nasogastric hydration for a healthy infant with bronchiolitis.6 Many practitioners reported concerns about nasal obstruction, parental resistance, and aspiration risk, and 66% did not know that nasogastric hydration was a documented …

OBJECTIVES:To describe interfacility transfers among children with complex chronic conditions (CCCs) and determine if interfacility transfer was associated with health outcomes. We hypothesized that interfacility transfer would be associated with length of stay (LOS), receipt of critical care services, and in-hospital mortality.METHODS:In this retrospective cohort study, we used data from the 2012 Kids’ Inpatient Database. CCC hospitalizations were identified by International Classification of Diseases, Ninth Revision codes. Receipt of critical care services was inferred by using International Classification of Diseases, Ninth Revision diagnosis and procedure codes. We performed a descriptive analysis of CCC hospitalizations then determined if transfer was associated with LOS, mortality, or receipt of critical care services using survey-adapted quasi-Poisson or logistic regression models, controlling for hospital and patient demographics.RESULTS:There were 551 974 non–birth hospitalizations with at least 1 CCC diagnosis code. Of these, 13% involved an interfacility transfer. Compared with patients with CCCs who were not transferred, patients with CCCs who were transferred in and ultimately discharged from the receiving hospital had an adjusted LOS rate ratio of 1.6 (95% confidence interval [CI]: 1.5–1.7; P < .001), were more likely to have received critical care services (adjusted odds ratio 3.0; 95% CI: 2.7–3.2; P < .001), and had higher in-hospital mortality (adjusted odds ratio 3.6; 95% CI: 3.2–3.9; P < .001) (controlling for patient and hospital characteristics).CONCLUSIONS:Many hospitalizations for children with CCCs involve interfacility transfer. Compared with in-house admissions, hospitalizations of patients who are transferred in and ultimately discharged from the receiving hospital involve longer LOS, greater odds of receipt of critical care services, and in-hospital mortality. Further evaluation of the role of clinical and transfer logistic factors is needed to improve outcomes.

Improving children's attendance is a high priority for Head Start and other early childhood education programs serving low-income children. We conducted a randomized control trial in a major northern city to evaluate the impact of a low-cost intervention designed to promote parents' social capital as a potential influence on children's attendance in Head Start centers. The intervention assigned children to treatment group classrooms based on (a) neighborhood of residence (geography condition) or (b) the geography condition plus the opportunity for parents to form partnerships in support of their children's attendance, or to control group classrooms according to Head Start guidelines only. We did not find impacts on average attendance throughout the year. However, the intervention did lead to increased attendance during the winter when average center attendance was lowest. There were no impacts on fall or spring attendance. Follow-up exploratory analyses of focus groups with parents and staff sugge...

Two-generation programs provide education and training services for parents while their children attend early childhood education programs. This study examines the rates of persistence and certification of parents in one of the only two-generation interventions in the country under study, Career Advance ®, which offers training in the healthcare sector to parents while their children attend Head Start ( n = 92). Results indicate that 16 months after enrolling in Career Advance ®, 76% of participants attained at least one workforce-applicable certificate of the program and 59% were still in the program. The majority of parents who left the program during the 16 months had attained a certificate (68%). Parents with high levels of material hardship were more likely to attain a certificate and stay enrolled in the program, and parents with higher levels of psychological distress were less likely to attain a certificate in the same time period. Implications for future two-generation programming are discussed.

This paper examines the extent to which a new nationally representative household panel survey could bring children and adolescents to the forefront of its design. We begin by discussing how major demographic shifts, such as reduced social mobility and transformations in family structure, may affect children and adolescent development through individual, family, and sociocultural processes. We then review the existing household surveys in the United States and highlight the strengths and weaknesses for studying how major societal trends and changes affect child and adolescent development. We then debate several different design approaches for a new study and recommend either a longitudinal panel design, which includes all children in the panel survey, or a sequential cohort design, that includes a subsample of children and embedded birth cohort study. We highlight that a large, nationally representative dataset cannot replace standalone, more in-depth developmental studies of children and adolescents with high-fidelity measurement of processes. Instead, we argue that a new panel survey could take a more targeted approach and measure the major constructs of children's development as well as select family and sociocultural processes by drawing on recent advances in survey measurement techniques. We conclude by affirming that new household survey has the potential to contribute greatly to our understanding of the developmental origins of life long wellbeing as well as the effects of major demographic shifts in the 21st century on child and adolescent development.

A 2-year-old female presents for evaluation of 4 weeks of daily fevers. When the fevers began, she had mild upper respiratory tract symptoms, which quickly resolved. The fevers persisted, however, with a maximum of 40°C. The child’s review of symptoms was significant for a 1-kg weight loss over the past month. Ten months before presentation, she had moved from Saudi Arabia with her family. One week before the onset of symptoms, she had visited a petting zoo. During episodes of fever, the patient was ill-appearing and had an elevated heart rate and respiratory rate. On examination, she was found to be thin, febrile, tachycardic, and with scattered lymphadenopathy. Results of laboratory tests were remarkable for an elevated white blood cell count of 16 100 cells per uL with a neutrophilic predominance. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated at 99 mm/h and 27 mg/dL, respectively. A chest radiograph indicated a small amount of fluid in the interlobar fissures. Our expert panel examines her case, offers a definition of fever of unknown origin, and makes diagnostic considerations.

Background Although often short-lived and self-limiting, postoperative atrial fibrillation (POAF) is a well-recognized postoperative complication of cardiac surgery and is associated with a 2-fold increase in cardiovascular mortality and morbidity. Objective Our aim was to determine whether intraoperative bilateral pulmonary vein radiofrequency ablation decreases the incidence of POAF in patients undergoing coronary artery bypass grafting (CABG). Methods A total of 175 patients undergoing CABG was prospectively randomized to undergo adjuvant bilateral radiofrequency pulmonary vein ablation in addition to CABG (group A; n=89) or CABG alone (group B; n=86). Intraoperative pulmonary vein isolation was confirmed by the inability to pace the heart via the pulmonary veins after ablation. All patients received postoperative β-blocker. Results There was no difference in the incidence of POAF in the treatment group who underwent adjuvant pulmonary vein ablation (group A; 37.1%) compared with the control group who did not (group B; 36.1%) ( P = .887). There were no differences in postoperative inotropic support, antiarrhythmic drug use, need for oral anticoagulation, and complication rates. The mean length of postoperative hospital stay was 8.2 ± 6.5 days in the ablation group and 6.7 ± 4.6 days in the control group ( P Conclusion Adjuvant pulmonary vein isolation does not decrease the incidence of POAF or its clinical impact but increases the mean length of stay in the hospital. The mechanism of POAF does not appear to depend on the pulmonary veins.

OBJECTIVE: To improve the frequency of electronic prescribing (e-prescribing) of discharge prescriptions at a children’s hospital via a bundle of quality improvement interventions. METHODS: Surveys and focus groups were conducted with patient families and pediatric residents to identify barriers and propose solutions to e-prescribing. These data were used to generate a series of interventions, including the following: (1) provider education; (2) changes in patient registration workflow; and (3) electronic health record changes to improve the frequency of e-prescribing on the pediatric hospital medicine (PHM) service. The primary outcome measure was the e-prescribing frequency, with a balance measure of e-prescribing errors. RESULTS: From July 2014 through June 2015, e-prescribing frequency on the PHM service improved from a median of 7.4% to 48.9% (P < .001) and was sustained for an additional 6 months (July 2015–December 2015), surpassing meaningful use targets with associated US News and World Report hospital ranking points. The frequency of PHM prescription errors remained unchanged, and in comparison, the resident outpatient clinic revealed no statistically significant change in e-prescribing frequency during this time period. CONCLUSIONS: Engaging front-line providers in hospital-wide initiatives and quality improvement interventions can directly affect hospital metrics in programs such as meaningful use and US News and World Report, as shown through successful improvement in PHM e-prescribing frequency. Future studies are necessary to determine whether increased e-prescribing frequency affects patient outcomes and compliance.

OBJECTIVES: Breastfeeding rates differ among racial/ethnic groups in the United States. Our aim was to test whether racial/ethnic disparities in demographic characteristics, hospital use of infant formula, and family history of breastfeeding mediated racial/ethnic gaps in breastfeeding outcomes. METHODS: We analyzed data from the Community and Child Health Network study (N = 1636). Breastfeeding initiation, postnatal intent to breastfeed, and breastfeeding duration were assessed postpartum. Hierarchical linear modeling was used to estimate relative odds of breastfeeding initiation, postnatal intent, and duration among racial/ethnic groups and to test the candidate mediators of maternal age, income, household composition, employment, marital status, postpartum depression, preterm birth, smoking, belief that “breast is best,” family history of breastfeeding, in-hospital formula introduction, and WIC participation. RESULTS: Spanish-speaking Hispanic mothers were most likely to initiate (91%), intend (92%), and maintain (mean duration, 17.1 weeks) breastfeeding, followed by English-speaking Hispanic mothers (initiation 90%, intent 88%; mean duration, 10.4 weeks) and white mothers (initiation 78%, intent 77%; mean duration, 16.5 weeks); black mothers were least likely to initiate (61%), intend (57%), and maintain breastfeeding (mean duration, 6.4 weeks). Demographic variables fully mediated disparities between black and white mothers in intent and initiation, whereas demographic characteristics and in-hospital formula feeding fully mediated breastfeeding duration. Family breastfeeding history and demographic characteristics helped explain the higher breastfeeding rates of Hispanic mothers relative to white and black mothers. CONCLUSIONS: Hospitals and policy makers should limit in-hospital formula feeding and consider family history of breastfeeding and demographic characteristics to reduce racial/ethnic breastfeeding disparities.

We introduce this special issue on the critical matter of whether the existing household panel surveys in the U.S. are adequate to address the important emerging social science and policy questions of the next few decades. We summarize the conference papers which address this issue in different domains. The papers detail many new and important emerging research questions but also identify key limitations in existing panels in addressing those questions. To address these limitations, we consider the advantages and disadvantages of initiating a new, general-purpose omnibus household panel in the U.S. We also discuss the particular benefits of starting new panels that have specific targeted domains such as child development, population health and health care. We also develop a list of valuable enhancements to existing panels which could address many of their limitations.

Despite a growing understanding that the social determinants of health have an impact on body mass index (BMI), the role of fatherhood on young men’s BMI is understudied. This longitudinal study examines BMI in young men over time as they transition from adolescence into fatherhood in a nationally representative sample. Data from all four waves of the National Longitudinal Study of Adolescent Health supported a 20-year longitudinal analysis of 10,253 men beginning in 1994. A “fatherhood-year” data set was created and changes in BMI were examined based on fatherhood status (nonfather, nonresident father, resident father), fatherhood years, and covariates. Though age is positively associated with BMI over all years for all men, comparing nonresident and resident fathers with nonfathers reveals different trajectories based on fatherhood status. Entrance into fatherhood is associated with an increase in BMI trajectory for both nonresident and resident fathers, while nonfathers exhibit a decrease over the same period. In this longitudinal, population-based study, fatherhood and residence status play a role in men’s BMI. Designing obesity prevention interventions for young men that begin in adolescence and carry through young adulthood should target the distinctive needs of these populations, potentially improving their health outcomes.

Individuals with a bicuspid aortic valve (BAV) are at increased risk for ascending aortic dilation and dissection. Loss of aortic medial smooth muscle cells (SMCs) and disruption of the extracellular matrix are well-recognized pathologies, but the underlying cellular mechanisms remain elusive. We tested the hypothesis that the dilated aorta in patients with BAV was marked by accelerated cellular aging. Samples of human ascending aorta were obtained from individuals with BAV undergoing thoracic aorta replacement (n=37, age 54.7±2.2, aortic diameter 4.8±0.9 cm) or patients with a tricuspid aortic valve and non-dilated aorta undergoing heart transplantation or coronary bypass procedures (n=6, age 55.3±8.1, aortic diameter 3.1±0.3 cm). Assessment of fresh aortic samples for senescence-associated β-galactosidase revealed evidence for rare medial cell senescence that was 4.2-fold more prevalent in dilated aortas (0.83±0.10%) than in non-dilated aortas (0.20±0.10%, p=0.048). Expression of p16 was abundantly detected in medial SMCs within dilated aortas (27.0±2.1%) and 3-fold more abundant than in non-dilated aortas (8.9±1.8%, p