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Objective: To assess the level of child and adolescent psychiatric staff's knowledge regarding pain management, to determine group differences between the medically more educated (physicians, nurses) and the less educated (psychologists, educators, special therapists) and to investigate the influence of gender, age, or professional experience as well as staff's own pain experiences., Methods: A total of 193 staff members from different professional backgrounds from three independent child and adolescent psychiatry clinics in Northern Germany were tested using the German version of the Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain Shriner's revision (PNKAS-Sr)., Results: In total, the staff scored correctly 66% of the inventory questions. There was no difference between medically more educated and less educated staff members regarding the knowledge of pain management. The main factors influencing PNKAS score were age, profession, and pain education training., Conclusions: Although chronic pain is not one of the main aspects of continuing education in child and adolescent psychiatry, the resulting level of knowledge was comparable to results of similar surveys with paediatric staffs. Nevertheless, further education is needed to enhance knowledge and understanding of children's pain in child psychiatry staff in order to professionally treat patients with chronic somatic and mental illnesses.

Work with the looking-while-listening (LWL-) paradigm suggested that 6-month-old English-learning infants associated several labels for common nouns with pictures of their referents: While one distractor picture was present, infants systematically fixated the named target picture. However, recent work revealed constraints of infants' noun comprehension. The age at which these abilities can be obtained appears to relate to the infants' familiarity with the talker, the target language, and word frequency differences in target-distractor pairs. Here, we present further data to this newly established field of research. We tested 42 monolingual German-learning infants aged 6-14 months by means of the LWL-paradigm. Infants saw two pictures side-by-side on a screen, whilst an unfamiliar male talker named one of both. Overall, infants did not fixate the target picture more than the distractor picture. In line with previous results, infants' performance on the task was higher when target and distractor differed within their word frequency-as operationalized by the parental rating of word exposure. Together, our results add further evidence for constraints on early word learning. They point to cross-linguistic differences in early word learning and strengthen the view that infants might use extra-linguistic cues within the stimulus pairing, such as frequency imbalance, to disambiguate between two potential referents., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Steil, Friedrich and Schild.)

Phonemic awareness and rudimentary grapheme knowledge concurrently develop in pre-school age. In a training study, we tried to disentangle the role of both precursor functions of reading for spoken word recognition. Two groups of children exercised with phonemic materials, but only one of both groups learnt corresponding letters to trained phonemes. A control group exercised finger-number associations (non-linguistic training). After the training, we tested how sensitive children were to prime-target variation in word onset priming. A group of young adults took part in the same experiment to provide data from experienced readers. While decision latencies to the targets suggested fine-grained spoken word processing in all groups, event-related potentials (ERPs) indicated that both phonemic training groups processed phonemic variation in more detail than the non-linguistic training group and young adults at early stages of speech processing. Our results indicate temporal plasticity of implicit speech processing in pre-school age as a function of explicit phonemic training., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Bauch, Friedrich and Schild.)

It is widely accepted that finger and number representations are associated: many correlations (including longitudinal ones) between finger gnosis/counting and numerical/arithmetical abilities have been reported. However, such correlations do not necessarily imply causal influence of early finger-number training; even in longitudinal designs, mediating variables may be underlying such correlations. Therefore, we investigated whether there may be a causal relation by means of an extensive experimental intervention in which the impact of finger-number training on initial arithmetic skills was tested in kindergarteners to see whether they benefit from the intervention even before they start formal schooling. The experimental group received 50 training sessions altogether for 10 weeks on a daily basis. A control group received phonology training of a similar duration and intensity. All children improved in the arithmetic tasks. To our surprise and contrary to most accounts in the literature, the improvement shown by the experimental training group was not superior to that of the active control group. We discuss conceptual and methodological reasons why the finger-number training employed in this study did not increase the initial arithmetic skills beyond the unspecific effects of the control intervention., (Copyright © 2020 Schild, Bauch and Nuerk.)

Background: A comprehensive in-hospital patient management with reasonable and economic resource allocation is arguably the major challenge of health-care systems worldwide, especially in elderly, frail, and polymorbid patients. The need for patient management tools to improve the transition process and allocation of health care resources in routine clinical care particularly for the inpatient setting is obvious. To address these issues, a large prospective trial is warranted., Methods: The "Integrative Hospital Treatment in Older patients to benchmark and improve Outcome and Length of stay" (In-HospiTOOL) study is an investigator-initiated, multicenter effectiveness trial to compare the effects of a novel in-hospital management tool on length of hospital stay, readmission rate, quality of care, and other clinical outcomes using a time-series model. The study aims to include approximately 35`000 polymorbid medical patients over an 18-month period, divided in an observation, implementation, and intervention phase. Detailed data on treatment and outcome of polymorbid medical patients during the in-hospital stay and after 30 days will be gathered to investigate differences in resource use, inter-professional collaborations and to establish representative benchmarking data to promote measurement and display of quality of care data across seven Swiss hospitals. The trial will inform whether the "In-HospiTOOL" optimizes inter-professional collaboration and thereby reduces length of hospital stay without harming subjective and objective patient-oriented outcome markers., Discussion: Many of the current quality-mirroring tools do not reflect the real need and use of resources, especially in polymorbid and elderly patients. In addition, a validated tool for optimization of patient transition and discharge processes is still missing. The proposed multicenter effectiveness trial has potential to improve interprofessional collaboration and optimizes resource allocation from hospital admission to discharge. The results will enable inter-hospital comparison of transition processes and accomplish a benchmarking for inpatient care quality.

Navigation crucially depends on the capability to estimate time elapsed and distance covered during movement. From adults it is known that magnitude estimation is subject to characteristic biases. Most intriguing is the regression effect (central tendency), whose strength depends on the stimulus distribution (i.e. stimulus range), a second characteristic of magnitude estimation known as range effect. We examined regression and range effects for time and distance estimation in eleven-year-olds and young adults, using an egocentric virtual navigation task. Regression effects were stronger for distance compared to time and depended on stimulus range. These effects were more pronounced in children compared to adults due to a more heterogeneous performance among the children. Few children showed veridical estimations similar to adults; most children, however, performed less accurate displaying stronger regression effects. Our findings suggest that children use magnitude processing strategies similar to adults, but it seems that these are not yet fully developed in all eleven-year-olds and are further refined throughout adolescence.

Languages with contrastive stress, such as English or German, distinguish some words only via the stress status of their syllables, such as "CONtent" and "conTENT" (capitals indicate a stressed syllable). Listeners with a fixed-stress native language, such as Hungarian, have difficulties in explicitly discriminating variation of the stress position in a second language (L2). However, Event-Related Potentials (ERPs) indicate that Hungarian listeners implicitly notice variation from their native fixed-stress pattern. Here we used ERPs to investigate Hungarian listeners' implicit L2 processing. In a cross-modal word fragment priming experiment, we presented spoken stressed and unstressed German word onsets (primes) followed by printed versions of initially stressed and initially unstressed German words (targets). ERPs reflected stress priming exerted by both prime types. This indicates that Hungarian listeners implicitly linked German words with the stress status of the primes. Thus, the formerly described explicit stress discrimination difficulty associated with a fixed-stress native language does not generalize to implicit aspects of L2 word stress processing., (Copyright © 2018 Elsevier B.V. All rights reserved.)

It is a matter of debate, whether and how improved auditory discrimination abilities enable speeded speech comprehension in congenitally blind adults. Previous research has concentrated on semantic and syntactic aspects of processing. Here we investigated phonologically mediated spoken word access processes by means of word onset priming. Blind adults and age- and gender-matched sighted adults listened to spoken word onsets (primes) followed by complete words (targets). Phonological overlap between primes and targets varied. Blind participants made faster lexical decision responses than sighted participants, yet their speeded responses were not restricted to phonologically overlapping trials. Furthermore, timing of Event Related Potential (ERP) results did not differ between blind and sighted participants. Together these results suggest that blind and sighted listeners are equally fast in implicit phonological encoding and lexical matching mechanisms. It appears that blind adults' speeded speech processing emerges when phonological analysis makes promising word candidates available for further processing. As one possible interpretation, we speculate that lexical selection processes in blind adults do not need to wait for information from the visual domain, while auditory-visual integration mechanisms are mandatorily implemented in speech recognition routines of sighted adults., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Recent evidence suggests division of labor in phonological analysis underlying speech recognition. Adults and children appear to decompose the speech stream into phoneme-relevant information and into syllable stress. Here we investigate whether both speech processing streams develop from a common path in infancy, or whether there are two separate streams from early on. We presented stressed and unstressed syllables (spoken primes) followed by initially stressed early learned disyllabic German words (spoken targets). Stress overlap and phoneme overlap between the primes and the initial syllable of the targets varied orthogonally. We tested infants 3, 6 and 9 months after birth. Event-related potentials (ERPs) revealed stress priming without phoneme priming in the 3-month-olds; phoneme priming without stress priming in the 6-month-olds; and phoneme priming, stress priming as well as an interaction of both in 9-month-olds. In general the present findings reveal that infants start with separate processing streams related to syllable stress and to phoneme-relevant information; and that they need to learn to merge both aspects of speech processing. In particular the present results suggest (i) that phoneme-free prosodic processing dominates in early infancy; (ii) that prosody-free phoneme processing dominates in middle infancy; and (iii) that both types of processing are operating in parallel and can be merged in late infancy., (© 2017 John Wiley & Sons Ltd.)

Background: Early identification of patients requiring transfer to post-acute care (PAC) facilities shortens hospital stays. With a focus on interprofessional assessment of biopsychosocial risk, this study's aim was to assess medical and neurological patients' post-acute care discharge (PACD) scores on days 1 and 3 after hospital admission regarding diagnostic accuracy and effectiveness as an early screening tool. The transfer to PAC facilities served as the outcome ("gold standard")., Methods: In this prospective cohort study, registered at ClinicalTrial.gov (NCT01768494) on January 2013, 1432 medical and 464 neurological patients (total n = 1896) were included consecutively between February and October 2013. PACD scores and other relevant data were extracted from electronic records of patient admissions, hospital stays, and interviews at day 30 post-hospital admission. To gauge the scores' accuracy, we plotted receiver operating characteristic (ROC) curves, calculated area under the curve (AUC), and determined sensitivity and specificity at various cut-off levels., Results: Medical patients' day 1 and day 3 PACD scores accurately predicted discharge to PAC facilities, with respective discriminating powers (AUC) of 0.77 and 0.82. With a PACD cut-off of ≥8 points, day 1 and 3 sensitivities were respectively 72.6% and 83.6%, with respective specificities of 66.5% and 70.0%. Neurological patients' scores showed lower accuracy both days: using the same cut-off, respective day 1 and day 3 AUCs were 0.68 and 0.78, sensitivities 41.4% and 68.7% and specificities 81.4% and 83.4%., Conclusion: PACD scores at days 1 and 3 accurately predicted transfer to PAC facilities, especially in medical patients on day 3. To confirm and refine these results, PACD scores' value to guide discharge planning interventions and subsequent impact on hospital stay warrants further investigation., Trial Registration: ClinialTrials.gov Identifier, NCT01768494 .

Background: Urinary tract infections (UTIs) are common drivers of antibiotic use. The minimal effective duration of antibiotic therapy for UTIs is unknown, but any reduction is important to diminish selection pressure for antibiotic resistance, costs, and drug-related side-effects. The aim of this study was to investigate whether an algorithm based on procalcitonin (PCT) and quantitative pyuria reduces antibiotic exposure., Methods: From April 2012 to March 2014, we conducted a factorial design randomized controlled open-label trial. Immunocompetent adults with community-acquired non-catheter-related UTI were enrolled in the emergency department of a tertiary-care 600-bed hospital in northwestern Switzerland. Clinical presentation was used to guide initiation and duration of antibiotic therapy according to current guidelines (control group) or with a PCT-pyuria-based algorithm (PCT-pyuria group). The primary endpoint was overall antibiotic exposure within 90 days. Secondary endpoints included duration of the initial antibiotic therapy, persistent infection 7 days after end of therapy and 30 days after enrollment, recurrence and rehospitalizations within 90 days., Results: Overall, 394 patients were screened, 228 met predefined exclusion criteria, 30 declined to participate, and 11 were not eligible. Of these, 125 (76% women) were enrolled in the intention-to-treat (ITT) analysis and 96 patients with microbiologically confirmed UTI constituted the per protocol group; 84 of 125 (67%) patients had a febrile UTI, 28 (22%) had bacteremia, 5 (4%) died, and 3 (2%) were lost to follow-up. Overall antibiotic exposure within 90 days was shorter in the PCT-pyuria group than in the control group (median 7.0 [IQR, 5.0-14.0] vs. 10.0 [IQR, 7.0-16.0] days, P = 0.011) in the ITT analysis. Mortality, rates of persistent infections, recurrences, and rehospitalizations were not different., Conclusions: A PCT-pyuria-based algorithm reduced antibiotic exposure by 30% when compared to current guidelines without apparent negative effects on clinical outcomes.

The directionality of space-number association (SNA) is shaped by cultural experiences. It usually follows the culturally dominant reading direction. Smaller numbers are generally associated with the starting side for reading (left side in Western cultures), while larger numbers are associated with the right endpoint side. However, SNAs consistent with cultural reading directions are present before children can actually read and write. Therefore, these SNAs cannot only be shaped by the direction of children's own reading/writing behavior. We propose six distinct processes - one biological and five cultural/educational - underlying directional SNAs before formal reading acquisition: (i) Brain lateralization, (ii) Monitoring adult reading behavior, (iii) Pretend reading and writing, and rudimentary reading and writing skills, (iv) Dominant attentional directional preferences in a society, not directly related to reading direction, (v) Direct spatial-numerical learning, (vi) Other spatial-directional processes independent of reading direction. In this mini-review, we will differentiate between these processes, elaborate when in development they might emerge, discuss how they may create the SNAs observed in preliterate children and propose how they can be studied in the future.