Search

ObjectiveOur study addressed aims: (1) test the hypothesis that moderate-severe TBI in pediatric patients is associated with widespread white matter (WM) disruption; (2) test the hypothesis that age and sex impact WM organization after injury; and (3) examine associations between WM organization and neurobehavioral outcomes.MethodsData from ten previously enrolled, existing cohorts recruited from local hospitals and clinics were shared with the ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Pediatric msTBI working group. We conducted a coordinated analysis of diffusion MRI (dMRI) data using the ENIGMA dMRI processing pipeline.ResultsFive hundred and seven children and adolescents (244 with complicated mild to severe TBI [msTBI] and 263 controls) were included. Patients were clustered into three post-injury intervals: acute/subacute -

Traumatic brain injury (TBI) is a major cause of death and disability in children in both developed and developing nations. Children and adolescents suffer from TBI at a higher rate than the general population, and specific developmental issues require a unique context since findings from adult research do not necessarily directly translate to children. Findings in pediatric cohorts tend to lag behind those in adult samples. This may be due, in part, both to the smaller number of investigators engaged in research with this population and may also be related to changes in safety laws and clinical practice that have altered length of hospital stays, treatment, and access to this population. The ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Pediatric Moderate/Severe TBI (msTBI) group aims to advance research in this area through global collaborative meta-analysis of neuroimaging data. In this paper, we discuss important challenges in pediatric TBI research and opportunities that we believe the ENIGMA Pediatric msTBI group can provide to address them. With the paucity of research studies examining neuroimaging biomarkers in pediatric patients with TBI and the challenges of recruiting large numbers of participants, collaborating to improve statistical power and to address technical challenges like lesions will significantly advance the field. We conclude with recommendations for future research in this field of study.

Premise of research. The maintenance of mixed selfing and outcrossing is an enduring mystery in evolutionary biology. Cleistogamy, in which individuals produce both potentially outcrossing chasmogamous (CH) and obligately selfing cleistogamous (CL) flowers, provides an ideal framework in which to study the evolutionary forces maintaining mixed mating. Despite their promise for providing insight into mating system evolution, few studies of cleistogamous species have comprehensively investigated the relative costs and benefits of CL selfing. Methodology. We quantified the necessary components to calculate the relative energetic cost of reproduction of each flower type—CH and CL—in a greenhouse study using three populations of the perennial Ruellia humilis Nutt (Acanthaceae). These components included flower dry mass, fertility (i.e., fruit set), seed mass per fruit, and number of seeds per fruit. We also measured pollen-ovule ratios for both flower types as another measure of relative energetic investment. Last, we tracked phenology of the two flower types and used the proportion of CH flowers to estimate maximum potential outcrossing rates. Pivotal results. We found that the energetic cost of reproduction via CL flowers was four to 10 times lower than that of reproduction via CH flowers. This energetic economy derived both from the reduced mass and from the increased fertility of CL flowers. Pollen-ovule ratios in CL flowers were one-third to one-half those of CH flowers, providing additional support for their energetic economy. Maximum potential outcrossing rates in these populations based on CH flower production were between 43% and 61%, but CH flowers can autogamously self at rates between 33% and 75%. Conclusions. These results suggest that selection should favor only CL flowers due to their greater energetic economy. Additional work in this species demonstrates that neither inbreeding depression nor heterosis can provide an advantage strong enough to overcome the energetic benefits of CL reproduction. Further research on the developmental genetics of the two flower types and potential genetic constraints on the loss of CH flowers is needed. [ABSTRACT FROM AUTHOR]

Objective To assess parent psychological distress in families of children with common chronic health conditions (CHC) and to explore relationships between parent psychological distress, unmet supportive care needs and children's quality of life (QoL). Method Cross-sectional study involving parents of children diagnosed with a common CHC between 0 and 12 years of age and who had received treatment within the last 5 years. Eligible parents completed an online survey, that included the Depression Anxiety Stress Scale (DASS-21) assessing distress in parents and a 34-item assessment of unmet supportive care needs across 6 domains. Parents completed ratings of their child's current functioning (QoL) using the 23-item PedsQL. Multivariable regression models examined the relative association between unmet needs, children's QoL and parents' depression, anxiety, and stress. Results The sample consisted of 194 parents of children with congenital heart disease (n =97; 50%), diabetes (n =50; 26%), cancer (n =39; 20%), and asthma (n =8; 4%). A significant proportion of parents had moderate–severe symptoms of depression (26%), anxiety (38%), and stress (40%). Of the PedsQL scales, the poorest outcomes were found for emotional and school functioning. Multivariable analyses showed that both higher unmet needs and poorer child emotional functioning were associated with parent depression, anxiety, and stress symptoms. Conclusion Evidence linking parent distress symptoms to higher unmet needs and poorer child emotional functioning suggests these factors may be targets for interventions to alleviate parent distress. Longitudinal research using larger samples is required to replicate findings, and clarify the magnitude and direction of associations. [ABSTRACT FROM AUTHOR]

The minimum performance principle is a rule for determining the measure of damages for breach of contract when the defendant had at its election two or more alternative ways of performing the contract. In such cases, that mode of performance which is least onerous to the defendant is adopted as the measure of damages. Disagreement persists as to this doctrine's continued utility and how it is to be appropriately applied. The Court of Appeal for Ontario upheld the minimum performance principle in two recent cases which raised questions regarding the effect of bad faith on applying the doctrine. In light of this jurisprudence, this paper reviews leading authorities on the minimum performance principle and engages with scholarly critiques of the doctrine. With the rising prevalence of flexible relational contracts and 'termination for convenience' clauses, the minimum performance principle is likely to become a subject of more frequent litigation in the near future. This paper offers a new interpretation of the doctrine that provides a workable solution to some actual and anticipated critiques. KEYWORDS Minimum performance principle, Minimum obligation rule, Contract, Damages, Good faith, I THE ASSUMPTION OF MINIMUM PERFORMANCE: RECOGNIZING RIGHTS AND RISKS 165 A. Ability to perform as a condition for determining the least onerous option 169 B. The defendant's conduct but [...]

Background and Aims: Unmet supportive care needs (SCN) refer to perceived gaps in the support parents want to manage caregiving activities for children with chronic health conditions (CHC) and the support received. This review aims to systematically identify the unmet SCN of families with children living with five common paediatric CHC and characterise the assessment tools used to measure SCN. Design: Systematic review methodology with narrative synthesis of data. Reporting followed the PRISMA statement guidelines. Method: Literature searches were conducted in electronic databases Medline complete, PsycINFO, CINHAL and EMBASE to retrieve relevant articles published between 1990 and July 2022. Eligible studies involved (i) children aged 0–18 years diagnosed with either of cancer, congenital heart disease (CHD), diabetes, asthma, renal disease and (ii) assessment of unmet SCN. Studies involving children with genetic or developmental conditions were excluded. The methodological quality of studies was assessed using JBI assessment tool. Results: Of 6223 articles screened, 34 papers were included (25 quantitative, 5 qualitative and 4 mixed design). Most papers explored unmet needs of families with cancer (n = 26). The remaining articles concerned CHD (n = 5), asthma (n = 2) and mixed CHC (n = 1, renal failure, and diabetes). Information (e.g. treatment, lifestyle, etc.) and health care (e.g. emotional support, practical services, etc.) were the most common unmet need domains across health conditions. A variety of methods and need assessments hampered comparisons between studies both across and within CHC. Conclusion: Irrespective of illness, addressing unmet informational or health care needs may help to optimise outcomes and care for children and families living with common CHC. There was considerable variation in reporting styles, study design and need assessments both within and across conditions. Relevance to Clinical Practice: Health care professionals must routinely evaluate the type, quality and quantity of psychoeducation and support that families of children with CHC want and receive. Providing nurses with more effective strategies to assess child and family needs across a broad range of domains may help to increase understanding of where further support for families is required. Patient or Public Contribution: There was no patient or public contribution to this study as it involved a systematic review of existing literature. [ABSTRACT FROM AUTHOR]

This prospective study sought to characterise the educational experiences, mental health, and behavioural functioning of Australian children with a pre-existing learning difficulty or specific learning disorder (SLD) during the COVID-19 pandemic. The study also evaluated the potential role of parent psychological distress as a risk factor for poorer child functioning in this high-risk population. Using a prospective longitudinal design, the study involved 58 parents of children and adolescents with a pre-existing learning difficulty or specific learning disorder (M age = 11.9 years; range 7–17 years) who were initially referred to a state-wide diagnostic centre for specific learning disorders in Melbourne, Victoria, Australia. Child outcomes were assessed using the COVID-19 Wellbeing and Mental Health Survey (a modified version of the CoRonavIruS Health Impact Survey [CRISIS] tool), the Strengths and Difficulties Questionnaire (SDQ), and the Emotional Distress Scale from the Patient-Reported Outcomes Measurement Information System (PROMIS). Parents' mental health was assessed using the CRISIS tool and the Kessler Psychological Distress Scale (K10). In keeping with initial predictions, a large proportion of parents expressed significant disruption to child educational experience and routines, including challenges related to child engagement in remote learning platforms during COVID-19. Compared to pre-pandemic mental health symptom ratings, children experienced significantly higher symptoms of worry, negative thoughts, loneliness, agitation, and aggression during the pandemic period (all p < 0.05). As expected, higher levels of parent distress predicted greater child worry symptoms (p = 0.003) and more frequent child behavioural difficulties (p = 0.004). These results help elucidate the specific psychological and educational challenges faced by children with pre-existing learning difficulty or SLD during the COVID-19 pandemic. Family-centred intervention and/or supports may help to address the unique educational and psychological needs of young people with pre-existing learning differences and their families during future global pandemics. [ABSTRACT FROM AUTHOR]