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• Harsh caregiving behavior amongst non-parental daycare-givers is highly prevalent. • No screening tools exist to accurately predict such behavior for prevention purpose. • Using machine learning, we identified an extremely accurate predictive model. • Based on this model, we built an extremely accurate predictive screening tool. • Specifically, the tool has 95.2 % accuracy in predicting harsh caregiving behavior. Harsh Caregiving behavior amongst daycare providers (i.e., non-parental Harsh Caregiving) negatively impacts children's development across a variety of domains. As prevalences of non-parental Harsh Caregiving appear to increase worldwide, identifying its predictors is crucial for screening and intervention. The goal of this study was to identify a set of indicators and predictive rules that may accurately predict women's risk for Harsh Caregiving behavior in daycare environments. The study recruited 75 female non-parental caregivers, from the general population, who work with infants aged 0-1. Caregivers filled out self-report questionnaires including a Harsh Caregiving measure as well as a broad variety of potential predictors. To elucidate combinations of input variables that are predictive of non-parental Harsh Caregiving, we used machine learning Decision Three Inference and CHAID algorithms. Study results revealed a predictive model including 27 questions and four different prediction paths. For example, the first path indicated that women who reported low levels of attention deficit and hyperactivity problems and low levels of rigid-negative caregiving philosophies, had 100 % chance to report low levels of Harsh Caregiving behavior. Overall classification accuracy for "High Harsh Caregiving behavior" was 95.2 %. After replication in larger samples, the model can be used as a screening tool for women expressing their wish to work with infants. Women at risk can either be declined employment or alternatively receive targeted supervision throughout their work with small infants. [ABSTRACT FROM AUTHOR]

In daycare centers, infants come in close contact with each other, and contact, droplet, and mouth-to-mouth infections may occur owing to sharing of toys. Additional effective disinfection methods should be considered aside from wiping with disinfectants—including alcohol or sodium hypochlorite solution—for environmental disinfection of daycare centers. We aimed to examine the usefulness of hypochlorous acid water atomization in the effective disinfection of the classroom environment and toys at a nursery school. Environmental cultures of the nursery and toys were prepared to evaluate the species and bacterial load and to assess the contaminated areas. Staphylococcus aureus petri dishes were placed at high-frequency contact sites, and hypochlorous acid water was atomized to achieve a 0.03-ppm atmospheric chlorine concentration. After the atomization, the amount of S. aureus bacteria on the Petri dish and the changes in bacterial count isolated from the environment and toys were evaluated. Hypochlorous acid water atomization was performed for 5 h to avoid condensation. After a 3-h atomization, ≥99.99% of S. aureus was eliminated on petri dishes; furthermore, a significant disinfection effect was observed on environmental bacteria at least 1 h after atomization. For rubber and textile toys, the significant disinfection effect was observed 1 h after atomization, and for plastic toys, the effect was observed 3 h after atomization. Hypochlorous acid water atomization is a useful strategy to disinfect nursery school classrooms. [ABSTRACT FROM AUTHOR]

• The Child Observation in Preschool (COP) and Teacher Observation in Preschool (TOP) are a companion set of observational tools used to assess the quality of preschool classrooms. • Half of the examined associations between COP-TOP classroom processes and Classroom Assessment Scoring System (CLASS) Pre-K domains were significant and ranged in size from small to moderate. • Four of nine COP-TOP classroom processes were associated with gains in math, preliteracy, vocabulary, or social skills, though effect sizes were small. • All three CLASS Pre-K domains were associated with gains in social skills, though effect sizes were small. Previous research indicates that the Child Observation in Preschool (COP) and Teacher Observation in Preschool (TOP), a companion set of observational tools used to assess the quality of preschool classrooms, capture important aspects of the preschool environment that are associated with children's growth (Farran et al., 2017; Nesbitt et al., 2015; Spivak & Farran, 2016). This study is the first to assess the convergent and predictive validity of these tools in community-based child care centers and compare the tools to the Classroom Assessment Scoring System Pre-K (CLASS Pre-K), a widely used classroom observation tool. We collected COP-TOP and CLASS Pre-K data in 138 classrooms in Georgia as part of a validation study of Georgia's Quality Rated and Improvement System. We also collected child assessment data from 583 preschool-aged children in those same classrooms. Over half of the COP-TOP classroom processes were moderately correlated with at least one of the three CLASS Pre-K domains. COP-TOP classroom processes related to time spent in transition, time spent engaging in sequential activities, involvement in learning activities, and opportunities for math learning were associated with children's math skills, preliteracy skills, and socioemotional development at the end of the year, after controlling for their scores at the start of the year and demographic characteristics. All three CLASS Pre-K domains were significantly associated with children's socioemotional development. We discuss the implications of these results for assessing quality in early care and education programs. [ABSTRACT FROM AUTHOR]

The federal Child and Adult Care Food Program (CACFP) improves nutrition and reduces food insecurity among young children by helping cover the food costs for child care providers and families. This nationwide study evaluated the extent and predictors of the CACFP's utilization among licensed child care centers to identify opportunities for expanding CACFP nutrition support. Administrative data from the CACFP and child care licensing agencies in 47 states and District of Columbia were compiled and geocoded for 93,227 licensed child care centers. CACFP participation was predicted using a multivariable Bayesian spatial logistic regression model in the sample of low-income areas to target CACFP eligible child care centers. Data were collected in 2020–2021 and analyzed in 2022. Of all licensed child care centers, 36.5% participated in the CACFP, ranging from 15.2% to 65.3% across states; when restricted to low-income areas, 57.5% participated (range, 15.7%–85.7%). Income differences did not explain the large variation in CACFP participation rates across states. Having at least three CACFP sponsoring agencies per state predicted a 38% higher probability of CACFP participation (OR=1.38; 95% Credible Interval=1.08–1.78). Currently CACFP participation rates among licensed child care centers point to program underutilization and unequal access, particularly in some states and regions. Work at the federal and state levels is warranted to expand participation in the program, above all in low-income areas, so that more young children could eat healthfully with the CACFP. [ABSTRACT FROM AUTHOR]

• Provider subsidy participation is examined in a mixed methods statewide study. • Centers' operations and funding structures are related to subsidy participation. • Centers in high poverty areas are more likely to accept subsidies. • State policies play an important role in subsidy participation decisions. • Center, community, and state level factors can influence subsidy participation. The number of early care and education centers that accept child care subsidies has declined, limiting access for children and families from low-income backgrounds. This statewide mixed methods study explores how centers make decisions about accepting subsidies in Arkansas. Quantitative results suggest that provider and community characteristics are important, while qualitative results help to enhance our overall understanding of the decision-making process by emphasizing the importance of a center's overall operational and financial structure and state subsidy policies. Integrated findings suggest the importance of the combination of a variety of factors at the center, community, and state levels. Findings from this study point to ways that policymakers may encourage early learning programs to accept child care subsidies. [ABSTRACT FROM AUTHOR]

• Explored link between leader support and teacher retention in child care centers. • Used survey and administrative data from 1,114 child care teachers at 152 centers. • Leader support positively associated with teacher retention. • Methodological and policy implications discussed. There is high turnover among child care teachers in the United States. Center directors could play an important role in reducing this turnover, but to date, research on how leaders in child care support workforce stability typically has not been conducted beyond small, selected samples. This study links survey responses from 1,114 teachers working in 152 publicly funded child care centers to examine how leader support (as reported by teachers) is associated with teachers' intentions to stay and observed retention at their center eight months later. Results suggest leader support is positively associated with observed teacher retention, above and beyond a set of teacher, leader, and center characteristics. Our findings suggest child care leaders may be important in promoting workforce stability and quality improvement. [ABSTRACT FROM AUTHOR]

• Family risks and resources at age 1 were examined using latent profile analysis. • Four profiles were identified among families enrolled in Early Head Start. • The profiles were not predictive of child outcomes at age 3. • Families in the depressed profile had higher family conflict and parenting stress. • Associations between the profiles and outcomes varied by Early Head Start dosage. This study utilized latent class analysis to identify classes of family ecological resources and risks among low-income families with infants, examine differences in child and parent outcomes two years later, and explore Early Head Start (EHS) program quality and dosage from ages to 1 to 3 years as moderators of these associations. Data from a longitudinal study of families enrolled in EHS, the EHS Child and Family Experiences Study 2009–2012 (n = 527), were utilized to identify four classes: (a) Healthy, (b) Financial and Health Risks, (c) Educated and Supported, and (d) Depressed. There were no differences between the classes in children's outcomes, supportive parenting, or home environments two years later. Families in the Depressed class had higher family conflict and parenting stress. EHS quality did not moderate associations, however, some links between the classes and outcomes varied by dosage (numbers of home visits or days in center care). [ABSTRACT FROM AUTHOR]

Given the growing number of dependent elderly and of young children who attend day care centers, and in order to foster intergenerational links, intergenerational programs (IG) or facilities have been developed. However, research in this area is still emerging in Europe. Most of the available studies have been carried out in the United States and focus on the content and modalities of IG programs and their impact on elderly and children. We conducted a systematic review of the literature aimed at presenting a synthesis of the benefits and challenges related to this type of program or facility, both for children and the elderly. This systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method and the methodological quality of the selected articles was assessed using the Mixed Methods Appraisal Tool (MMAT). Studies were identified in February 2021 from the PubMed, PsycINFO and Google Scholar databases. Only scientific articles in French and English published between 1986 and 2020 were selected. Other inclusion criteria were: studies with samples of children up to 6 years old and adults at least 65 years old; IG programs with at least one weekly IG meeting. We used the following search combination: intergenerational AND nursing home OR care homes OR long term care OR residential care OR aged care facility OR child care centers OR daycare OR preschool education OR pre-k OR elders OR elderly OR older people OR seniors OR children OR kids OR youth OR child. The benefits seem quite obvious for the elderly in terms of positive emotions, involvement in activities, and self-esteem. Children also benefit from these intergenerational programs, particularly through a better understanding of the abilities and limitations of the elderly, thereby fostering greater empathy towards them. Several IG programs have implemented Montessori activities to bring children and elderly together. Despite the positive impacts described, to achieve their goals IG programs need to meet several criteria, particularly appropriate planning that takes into account individual needs and skills, and adequate staff training. If IG programs are not sufficiently well-prepared, their impact may be null or even opposite to the expected goals, generating frustration in the elderly or reinforcing stereotypes in the children. Another risk is the infantilization of the elderly, such as involving them in activities that are inappropriate to their age and dignity, or doing things for them rather that promoting their active participation. The selected studies have limitations that should be considered for future research. Most studies were conducted on small samples, which prevents from generalizing their results. In addition, results are often based on qualitative or subjective information, sometimes concerning only part of the participants. Finally, most of the studies are purely descriptive, and therefore did not allow for pre- and/or post-testing. This literature review can guide practitioners and researchers in defining their IG programs and projects protocols. [ABSTRACT FROM AUTHOR]

The neuroscience of music originated as part of a laboratory-based scientific tradition with rigid experimental control. During the past two decades, the field has moved toward more naturalistic settings through various means. Sound stimulation and empirical paradigms are now closer to real music, regardless of the research method being used. Study participants cover the whole lifespan and include participants with typical and atypical behavioral and neuropsychiatric profiles. Methods and contexts of data acquisition are more versatile and also include everyday settings, such as daycare centers and schools. Further needs for improved practices have been identified, such as self-reports based on digital data collection tools and inclusion of music cultures not based on Western music practices. Studies in the neuroscience of music gained momentum in the 1990s as an integrated part of the well-controlled experimental research tradition. However, during the past two decades, these studies have moved toward more naturalistic, ecologically valid paradigms. Here, I introduce this move in three frameworks: (i) sound stimulation and empirical paradigms, (ii) study participants, and (iii) methods and contexts of data acquisition. I wish to provide a narrative historical overview of the development of the field and, in parallel, to stimulate innovative thinking to further advance the ecological validity of the studies without overlooking experimental rigor. [ABSTRACT FROM AUTHOR]

• Essentialness of child care revealed through COVID-19 pandemic. • Child care is mutually beneficial for children, parents, families, staff, and the community. • Child care enhances capabilities, child development, and economic opportunity. • Investments in child care reap short and long-term benefits. Child care centers in the United States allow many parents and caregivers to work in and outside of the home and support the growth and development of children. Child care closures and COVID-19 mitigation measures at the onset of the pandemic heightened the need for and awareness of the role of child care as core infrastructure. The purpose of our study was to examine the perceived role and benefits of child care based on the lived experiences of parents/caregivers and staff navigating child care during the pandemic. We conducted in-depth qualitative interviews with parents/caregivers (n = 20) of children who attended child care and staff (n = 12) who were working at child care programs in Ohio from September to November 2020. Qualitative data were coded and analyzed through the lens of four frameworks (i.e., capabilities, developmental, economics, and mutualism) related to child well-being. Our results highlight the perceived value of child care (a) for fostering capabilities and developmental growth in children; (b) for providing economic benefits for children, parents, and staff of child care programs; and (c) as an essential infrastructure that mutually benefits children, parents, families, staff, and the community. Findings support existing evidence regarding the broader impacts of child care and further investigation into the role of child care. We highlight the potential need for further investments in policies, resources, and supports for child care that reflects its essentialness and generative role. [ABSTRACT FROM AUTHOR]

• Explored teacher-leader racial/ethnic match in child care centers • Used survey and administrative data from 1,011 teachers at 188 child care centers • White teachers had leader racial match more often than Black and Hispanic teachers • With controls, match had no significant link to views of leader, satisfaction, or turnover The leaders of child care centers shape the everyday experiences of child care teachers, who play a critical role in supporting young children. While research has linked leadership to policy-relevant outcomes such as teacher job satisfaction and turnover, little is known about specific leader characteristics linked to teacher job outcomes. In K-12, one key factor associated with increased job satisfaction and lower turnover is teacher-principal racial/ethnic match, however there is no evidence to date on how teacher-leader racial/ethnic match relates to teacher job outcomes in child care settings. Using data from a sample of 1,011 teachers at child care centers in Virginia, this study documents the prevalence of teacher-leader racial/ethnic match. We estimate associations between racial/ethnic match and teachers' views of leadership, job satisfaction, turnover intentions, and turnover after six months. Although two-thirds of child care teachers experienced racial/ethnic match with their child care center leader, Black and Hispanic teachers were far less likely to experience racial/ethnic match than White teachers. We did not find significant associations between racial/ethnic match and teacher job outcomes after adjusting for covariates. We discuss potential explanations, directions for future research, and implications for policy. [ABSTRACT FROM AUTHOR]

Background Mothers in low-income settings who work in agricultural employment are challenged to meet breastfeeding (BF) recommendations. Recent legislation in Kenya mandates maternity leave and workplace supports, yet the relation of these benefits with BF practices is poorly understood. Objectives We evaluated the associations with workplace-provided BF supports and BF practices among formally employed mothers in Kenya. The availability of supports was hypothesized to be associated with a higher prevalence and greater odds of exclusive breastfeeding (EBF). Methods We conducted repeated cross-sectional surveys among formally employed mothers at 1–4 d and 6, 14, and 36 wk (to estimate 24 wk) postpartum in Naivasha, Kenya. We used logistic regression adjusted for maternal age, education, physical burden of work, HIV status, and income to evaluate associations between workplace supports and EBF practices. Results Among formally employed mothers (n  = 564), those who used onsite workplace childcare were more likely to practice EBF than those who used community- or home-based childcare at both 6 wk (95.7% compared with 82.4%, P  = 0.030) and 14 wk (60.6% compared with 22.2%, P  < 0.001; adjusted OR: 5.11; 95% CI: 2.3, 11.7). Likewise, at 14 wk among mothers who currently used daycare centers, a higher proportion of mothers who visited daycare centers at or near workplaces practiced EBF (70.0%) than of those not visiting daycare centers (34.7%, P  = 0.005). EBF prevalence was higher among mothers with access to workplace private lactation spaces than among mothers without such spaces (84.6% compared with 55.6%, P  = 0.037), and among mothers who lived in workplace housing than those without onsite housing (adjusted OR: 2.06, 95% CI: 1.25, 3.41). Conclusions Formally employed mothers in Kenya who have access to and use workplace-provided BF supports were more likely to practice EBF than mothers who lacked these supports. As the Kenya Health Act is implemented, lactation rooms, onsite housing and daycare, and transportation to visit children can all support BF and EBF among employed mothers. [ABSTRACT FROM AUTHOR]

• Explored center-level variation in child care teacher turnover over time. • Mean annual, center-level turnover rate was 40% of lead teachers. • Nine percent of centers lost more than half of teachers each year in study period. • Policy implications for identifying center-level drivers of turnover discussed. High rates of teacher turnover in child care settings have negative implications for young children's learning experiences and for efforts to improve child care quality. Prior research has explored the prevalence and predictors of turnover at the individual teacher level, but less is known about turnover at the center level––specifically, how turnover varies across child care centers or whether staffing challenges persist year after year for some centers. This study tracks annual turnover rates for all publicly funded child care centers that were continuously operating in Louisiana from the 2015-16 to 2018-19 school years (n = 575 centers). We document high and variable turnover rates across centers throughout the state: The annual mean turnover rate was 40%, and each year nearly one-third of centers experienced high turnover, that is, lost more than half of their teachers. About 27% of centers experienced high turnover for multiple years in our panel, while 44% of centers did not experience high turnover in any year. Our findings underscore concerns that sustained staffing challenges may hinder efforts to provide high-quality child care. [ABSTRACT FROM AUTHOR]

• We sought to understand how infant-toddler teachers' wellbeing related to their teaching. • Teachers reported high levels of adverse childhood experiences (ACEs) and depression. • Individual ACEs and depression were associated with teachers' work-related wellbeing. • Work-related wellbeing was associated with plans to continue teaching in child care centers. • Community ACEs and depression were associated with teachers' support for toddlers' learning. The purpose of this study was to examine the psychological wellbeing of infant-toddler child care teachers in a mid-Atlantic city (n = 160; 69% African American, 98% women) and to explore associations with teaching intentions and quality. Using survey measures and classroom observations, we tested associations between teachers' adverse childhood experiences (ACEs), depressive symptoms, work-related wellbeing (i.e., perceived organizational functioning and workload), intentions to continue teaching, and teaching quality. We found that infant-toddler teachers experienced similar levels of ACEs to Early Childhood Education (ECE) teachers in other studies. However, rates of depressive symptoms were relatively high in this sample (27% scored in the clinical range). Both ACEs and depressive symptoms were associated with teachers' work-related wellbeing. Notably, individual-level ACEs (e.g., household dysfunction and abuse) were associated with depressive symptoms and organizational wellbeing, whereas community ACEs (e.g., neighborhood safety) were not. Organizational wellbeing was significantly and positively associated with the number of years that infant-toddler teachers intended to continue working at their child care centers. Multilevel regression models indicated that community-level ACEs and current depressive symptoms were significantly associated with teachers' engaged support for toddlers' learning. When knowledge of child development was added to the model, depressive symptoms were no longer uniquely associated with engaged support for learning. However, community-level ACEs remained a significant correlate. These findings show that infant and toddler teachers may need more resources to support their psychological wellbeing so that they can support children in the classroom. [ABSTRACT FROM AUTHOR]

• We explore child care and school-based teacher wellbeing before and during COVID-19. • Pre-COVID wellbeing was low, particularly for teachers in child care centers. • We find clear reductions in emotional wellbeing and job commitment after COVID. • COVID changes do not differ between child care and school-based teachers. • Target COVID recovery funding at child care teachers with emphasis on wellbeing. [ABSTRACT FROM AUTHOR]

• Impact of COVID-19 on ECE programs differed greatly by program type, funding source. • Family child care homes fared worse in most measures of economic well-being with direct implications for individual providers during COVID-19. • Lower attendance, staffing concerns were pandemic challenges for center-based care. • Voucher-receiving centers more likely to face negative impacts during COVID-19. • Head Start/state-contract centers more able to support staff well-being in pandemic. The COVID-19 crisis has overwhelmed and weakened the United States early care and education (ECE) sector, jeopardizing a system that was already precariously situated atop a weak foundation. While multiple national- and state-level studies have highlighted the overwhelming impacts of the pandemic on the ECE sector, little has been reported about how much variation in impacts exists, and in what forms, within the ECE sector. Based on a statewide survey of 953 licensed care providers in California conducted in June 2020, this paper examines the impact of COVID-19 experienced by ECE providers, focusing on the variations between centers and family child care homes (FCCs) and among center-based programs. Results indicate that the challenges programs face differ greatly depending on program type and funding source. Compared to center-based programs, FCCs fared worse in most measures of economic hardship that directly impact individual providers with medium to large effect sizes. Centers were more likely than FCCs to struggle with reduced attendance and changes in program operations by medium to large effect sizes and report staffing challenges by small to medium effect sizes. Among the center-based programs, subsidized programs holding contracts with Head Start or the California Department of Education (such as state preschool programs) were more stable and better able to financially support their staff during the pandemic, with effect sizes ranging from medium to large. Centers receiving government subsidies in the form of vouchers were more likely to be negatively impacted by the pandemic compared to unsubsidized centers and Head Start and state-contracted centers. Implications for future research and policy are discussed in the context of addressing the complex delivery system of ECE services and supporting outcomes that are effective and equitable for children, families, and the ECE workforce. [ABSTRACT FROM AUTHOR]

Idiopathic steroid-resistant nephrotic syndrome (iSRNS) is a common problem in pediatric nephrology. About 10%–20% of children with nephrotic syndrome have iSRNS and almost 50 percent progress to end-stage renal disease. Very few studies have tried to study the histopathological spectrum, correlate clinical features, renal biopsy patterns and treatment outcome in children presenting with iSRNS in India. In this study, we compared the histopathologic distribution of different subtypes of glomerular morphologic patterns in iSRNS and the clinical and biochemical parameters at the time of diagnosis and outcome of patients after immunosuppressive therapy. It is a retrospective cross-sectional study involving review of records of all children with iSRNS presenting to our pediatric nephrology OPD who underwent renal needle biopsy and followed-up for a period of atleast six months post biopsy. Histopathological subtypes were correlated with clinical features (viz. age of onset, gender, oliguria, microscopic hematuria, hypertension, serum creatinine at presentation, serum total protein, serum albumin, 24 h urine protein, persistent proteinuria after 12 weeks of calcineurin inhibitor therapy, and progress to end stage renal disease (ERSD), if any, outcome. It was found that minimal change disease (MCD) was overall the most common cause of iSRNS. These patients have a significantly greater incidence of remission with immunosuppression as compared with focal segmental glomerulosclerosis (FSGS) and IgA nephropathy subgroup. Kidney biopsy is of prognostic value in children with iSRNS. The prognosis of children with SRNS owing to MCD is much better than with other nephropathy. [ABSTRACT FROM AUTHOR]

This study investigates the presence of biocides and other semi-volatile organic compounds (SVOCs) in cleaning products used in daycare centers and health impact through ingestion of settled dust by young children. In Paris metropolitan area, 106 daycares area were investigated between 2019–2022. Fifteen substances were analyzed in settled indoor dust by gas chromatography-tandem mass spectrometry. Detection rates and concentrations ranged from 5 to 100%, and 95% of samples. • Median concentrations of biocides ranged from

• Socio-emotional abilities develop as a result of early childhood influences. • Teaching attitudes at child care centers impact children's problem behaviors. • Long hours in Japanese child care do not adversely affect socio-emotional abilities. This study investigated the relationship between the development of the socio-emotional abilities of Japanese children between the ages of one and 2 years, and the quality of care they receive at their childcare centers. The participants were 872 pairs of parents (M = 34.13 years old) and their children (M = 25.65 months old) who attended one of 57 public childcare centers in urban Japan, as well as 373 childcare teachers (M = 37.26 years old) who conducted classes. Parents rated their children's social competence and problem behaviors, and the child-centered teaching attitudes in classrooms were rated by the teachers. The results revealed that the child-centered teaching attitudes in classrooms contributed significantly to low problem behavior among 1- to 2-year-old children, even when child variables (age, sex) and family variables (family income, parent's education, and parent's responsibility) were controlled. Child-centered teaching attitude had a particularly pronounced effect when the family variable of parent responsibility was low. This is the first empirical evidence of this relationship in a non-Western country. Our results suggest the importance of child-centered teaching attitudes for children who experience long hours of childcare outside the home, along with teachers' beliefs and attitudes regarding the quality of early childhood education and care, and related professional training. [ABSTRACT FROM AUTHOR]

Oral exercise is a training method for swallowing dysfunction in older adults. The study investigated the effect of oral exercise on tongue pressure in older adults in Taiwanese community day care centers over a 3-month period. Participants over age 50 who were able to communicate and participating for the duration of the 12-week period were recruited from five community day care centers. A 15-min weekly group oral exercise activity was conducted. The tongue pressures were measured and multivariable linear regression models were used to assess the effect of oral exercise intervention on the participants' tongue pressures. A total of 66 older adult participants, among whom the mean age was 78.06 ± 10.74 years. Tongue pressure continued improving during the intervention period, and the mean tongue pressure at the end of the study was 20.63 ± 10.45 kPa, which was significantly higher than the baseline measurement (16.92 ± 10.62 kPa, p < 0.001). Participants exhibited significant improvement in tongue pressure regardless of their age groups. Moreover, participants with one to seven pairs of functional tooth units (FTUs) exhibited significantly more improvement in tongue pressure (16.00 kPa, 95% CI = 2.58–29.43) than those without FTUs (p = 0.021). Oral exercise over a 3-month period significantly improved tongue pressure among the study participants regardless of their gender or age group. Oral exercise should be integrated into comprehensive health promotion programs to assist in the improvement and maintenance of oral function among older adults. [ABSTRACT FROM AUTHOR]

Objectives: Sleep difficulties are associated with various behavioral problems and cognitive development, but the association has not been thoroughly evaluated in preschoolers with and without developmental disability (DD). The aim of this study was to compare the behavioral and cognitive characteristics of poor and good sleepers with and without DD in a community-based sample of preschool children.Methods: We recruited 196 children aged 34-77 months from community-based daycare centers, kindergartens, and special education centers. Children were classified as poor sleepers with DD (n = 23), poor sleepers without DD (n = 23), good sleepers with DD (n = 64), and good sleepers without DD (n = 94). Poor sleepers were defined based on Children's Sleep Habits Questionnaire Total Sleep Disturbance Score (CSHQ TSDS) cutoff of >52.Results: When compared to good sleepers with DD, poor sleepers with DD scored significantly higher on the Attention Problems (p = 0.005) and Aggressive Behaviors (p = 0.001) subscales of the CBCL, indicating greater difficulty. Caregivers of the poor sleepers with DD reported more depressive symptoms (p = 0.028) and more stress related to the child (p = 0.002) and the parent (p = 0.045) than caregivers of the good sleepers with DD. On the other hand, when compared to good sleepers without DD, poor sleepers without DD scored significantly higher only on the Anxious/Depressed subscale (p = 0.045) of the CBCL. Cognitive development and adaptive functioning were not significantly different between poor and good sleepers with and without DD. Among the subscales of the CSHQ, the Sleep Onset Delay showed strongest correlation with behavioral measures of the children and distress of the caregivers.Conclusion: Externalizing problems such as aggressive behaviors, rather than cognitive development, are associated with sleep difficulties in preschool children with DD. [ABSTRACT FROM AUTHOR]

• There can be a significant difference between bone age and chronological age in evaluating IGF-1 levels in children. • This can significantly reduce the proportion of IGF-1 values above the upper limit of the kit reference range in children. • This suggests that it is more appropriate to use BA to determine the results of IGF-1 in puberty. By measuring serum insulin-like growth factor-1 (IGF-1) levels in children aged 2–16, we aimed to analyze the changes in IGF-1 levels in different sex and age groups, and compare the consistency of IGF-1 results evaluated by chronological age (CA) and bone age (BA) in children. A cross-sectional study was conducted between January 2017 and December 2020 among 2979 relatively healthy children who attended the Department of Growth and Development outpatient clinic and health care center of the Affiliated Children's Hospital of the Capital Institute of Pediatrics and underwent health examination and development assessment. Height, weight, and Tanner pubertal stage were measured by pediatricians. The CHN method was used to estimate BA. Venous blood samples were collected from the children, and IGF-1 levels were determined via chemiluminescence. IGF-1 levels in childhood increased slowly with age, dramatically during puberty, and continuously with growth until to 15 years for boys and reached a peak value at 13 years for girls based on CA. IGF-1 levels reached peak values at 14 and 13 years for boys and girls, respectively, based on BA. There were differences in IGF-1 values between the CA and BA groups at the age of 10–11 years for boys and 7–11 years for girls. A total of 103 boys (7.7%) and 17 girls (1.0%) had IGF-1 levels below the lower limit of the reference range based on CA; evaluating based on BA, there were 82 boys (6.1%) and 15 girls (0.9%) still had IGF-1 values less than the lower limit of the reference range. Eighteen boys (1.3%) and 173 girls (10.5%) had IGF-1 levels above the upper limit of the reference range based on CA; evaluating based on BA, these numbers reduced to 5 (0.4%) among boys and 41 (2.5%) among girls. There is a significant difference between BA and CA in evaluating IGF-1 levels in children, which can significantly reduce the proportion of IGF-1 values above the upper limit of the kit reference range in children. This suggests that children with BA advanced in pubertal period, the evaluating results of IGF-1 should be corrected by using BA. [ABSTRACT FROM AUTHOR]

Background: Subpial hemorrhages are underrecognized, underreported, and poorly understood. The spectrum of their clinical manifestations and consequences in neonates has not been fully described. Here, we describe the demographic, clinical, and radiographic characteristics of neonates with subpial hemorrhages.Methods: We reviewed the medical records and neuroimaging studies of neonates with subpial hemorrhage who were admitted to our neonatal intensive care unit between September 2009 and December 2020.Results: Of 114 neonates with intracranial hemorrhage, 31 (27%) had subpial hemorrhage. The majority of neonates in our cohort were male (68%) and born at term (55%). The most common imaging indication was apneas and/or seizures in 58%. Common comorbid conditions included cardiorespiratory failure (42%), hypoxic-ischemic encephalopathy (26%), and coagulopathy (23%). Subpial hemorrhages were multifocal in 45% of neonates, located in the temporal lobe in 45% of neonates, and tended to be larger in neonates with coagulopathy, birth trauma, or hydrocephalus requiring neurosurgical intervention. Subpial hemorrhage was associated with another type of intracranial bleed in 77% of cases and with arterial ischemic stroke in 16% of cases. Of 17 patients with more than one year of follow-up data, 14 (82%) have developmental delay and four (24%) have epilepsy. Of 14 patients with follow-up imaging, 10 (71%) had encephalomalacia subjacent to the subpial hemorrhage.Conclusions: This is the largest cohort of neonates with subpial hemorrhages to date. Outcome data are limited by duration of follow-up and may be confounded by comorbid conditions and other concurrent hemorrhages. Further study is needed to define the spectrum of risk factors and expected neurological outcomes. [ABSTRACT FROM AUTHOR]

Recent decades have seen a major rise in demand for daycare services for children aged 0 to 3 years, and this has increased research interest in the child-professional caregiver relationship at daycare centers: How does the relationship between children and their new caregivers develop over time? How long does it take for children to settle in at daycare? What variables can influence the settling-in process? These questions are all of the utmost salience and bear crucial implications for children, parents, and daycare practitioners. In this study, we set out to explore the relationship between infants and their new caregivers over the first two months in daycare, using the Professional Caregiver Attachment Diary. The study involved seven Italian daycare centres and 55 professional caregivers, who observed 148 children (M =17.8 months). The children's attachment behaviors were assessed at three time-points: when the children started attending daycare (T1), one month later (T2), and two months later (T3). We found that positive attachment behaviors (Secure and Non-Distressed) increased over time, whereas insecure behaviors (Avoidant and Resistant) decreased. Most of the change took place during the first month. Furthermore, children who had attended more daycare more regularly (with fewer days of absence) displayed fewer avoidant behaviors and a more rapid decrease in resistant behaviors than did children who were absent more frequently. The findings suggest that the PCAD may be usefully deployed to observe and analyze children while they are settling into a new daycare setting, especially in relation to their exploratory behaviors. • Children had developed positive relationships with caregivers after two months of daycare. • Children displayed a significant increase in exploratory behaviors. • Exploratory behaviors were strongly associated with secure attachment to the caregiver. • Children with a higher level of attendance at daycare displayed less insecure behaviors over time. • The PCAD is a valuable tool for monitoring the process of settling into daycare. [ABSTRACT FROM AUTHOR]

Nature-based daycare centers offer young children valuable opportunities to establish a meaningful connection with the natural world. These opportunities frequently remain underrealized as caregivers often lack adequate skills in effectively integrating the natural environment into their daily pedagogical practices. This study evaluated the impact of a one-year Community of Practice training program to enhance the pedagogical use of the outdoor area of nature-based daycare centers. It examined the impact of the program on children's stress levels, wellbeing, involvement, and behavior in the outdoor area, among a total sample of 133 children aged 0–4 years. The program aimed at strengthening caregivers' pedagogical interaction skills in the outdoor area with a focus on vulnerable groups including the youngest and oldest children and boys. Measures of children's hair cortisol, and observations of wellbeing, involvement, physical activity, social behavior and play behavior during free play in the natural outdoor playground were collected post-program at 6 intervention and 7 control locations. Results indicate positive impacts of the program for boys in terms of their stress levels, wellbeing, involvement, physical activity, and creative play behavior. Youngest children at interventions showed more functional play behavior, while the oldest children showed more creative play. Children at locations with a high-quality outdoor area seemed to benefit more from the intervention than children at locations with a low-quality outdoor area. These findings underscore the importance of the pedagogical use of the outdoor natural area as a contributor to the effectiveness of nature-based daycare, alongside considerations of environmental qualities. [ABSTRACT FROM AUTHOR]

• Centers serving larger share of subsidy children more likely to be higher quality. • Quantitative results indicate monetary incentives worked as incentive theory predicts. • In interviews, few center directors reported incentive payments motivated behaviour. • Capacity constraints appeared to limit centers' ability to improve quality. This study used a sequential explanatory equal-status mixed-method design to investigate whether Maryland's child care tiered reimbursement system incentivized child care centers to be rated at least 3 (and receive an incentive payment) on Maryland's 5-level Quality Rating and Improvement System (QRIS). The first stage of research consisted of multilevel logistic regressions to determine the association between centers' reliance on child care subsidy payments and whether the center had a rating of 3 or higher. Reliance on subsidy payments was defined as the percentage of licensed slots filled by children receiving a child care subsidy. State administrative data on 1003 centers that received a subsidy payment in January 2018 were combined with demographic data from the U.S. Census. The second stage of research consisted of 14 interviews with center directors to understand how they made decisions about which QRIS rating to attain and how tiered reimbursements factored into their decisions. Results from the quantitative research showed that a greater subsidy density was associated with a greater likelihood of a center being rated 3 and receiving an incentive payment. However, results from the qualitative research showed that few center directors reported that tiered payments factored into their decision on what QRIS rating to reach and no directors were singularly motivated by the incentives. Rather, directors reported being intrinsically motivated to improve QRIS ratings or motivated by technical assistance providers. Additionally, directors who did not attain a rating of 3 experienced capacity challenges. Policy implications are discussed. [ABSTRACT FROM AUTHOR]

Les pratiques de soins intégratives (PSI) dans la prise en charge des troubles du spectre autistique (TSA) ne bénéficient pas suffisamment d'évaluations rigoureuses. En outre, elles manquent de formalisation malgré leur place importante dans la pratique clinique, en particulier en France, où elles sont mises en œuvre dans des structures d'hôpital de jour. Nous présentons ici la méthodologie de l'étude EPIGRAM financée par la Direction générale de l'organisations des soins (PREPS 2013), le profil de la population à l'inclusion (M0) et le retour de l'expérience des familles à 12 mois de prise en charge. Dans un souci d'homogénéisation des pratiques, un manuel a été formalisé suivant la méthodologie du chemin clinique et les recommandations de la Haute Autorité de santé. Puis, nous avons conduit une étude observationnelle ouverte, multicentrique et en milieu naturel en soins courants évaluant les PSI dans les TSA pour les enfants de 3 à 6 ans. Les principaux critères d'inclusion ont été le diagnostic (autisme typique ou atypique, selon la CIM10) et la durée des soins (2 à 4 demi-journées par semaine) au cours de la première année de prise en charge. Les enfants ont été évalués cliniquement à l'aide de plusieurs instruments dont le PEP-3 (Psychoeducational Profile-3), et le CARS (Children Autism Rating Scale). Afin de maintenir une évaluation en aveugle pour la variable principale, des vidéos du PEP-3, réparties selon un mode aléatoire, ont été cotées par deux psychologues indépendantes. Un questionnaire, rempli séparément par les familles et les professionnels à l'inclusion et à un an, complète l'étude. Nous avons inclus 89 enfants qui présentent en moyenne un autisme de niveau sévère à la CARS (moyenne = 44 ; écart-type = 6,51) et modéré à la catégorie comportements inadaptés (CATCI) du PEP-3 (moyenne = 30 ; écart-type = 29,89). Les enfants ont tous été diagnostiqués avant l'âge de 3 ans, 6 mois. Ils souffrent, pour la plupart, de troubles sévères du langage. Au PEP-3, l'atteinte est plus marquée en motricité globale et pour les comportements verbaux caractéristiques. Les familles ont un statut socioéconomique faible pour 30 % d'entre elles et 56 % sont immigrées de première génération. Parmi les enfants, 77 % sont scolarisés en école maternelle avec une auxiliaire de vie scolaire. Les enfants de parents immigrés ont un autisme plus sévère (CARS : moyenne = 45,8 (± 6,51) vs 41,2 (± 5,58), t-test, p = 0,001) et avec un déficit de la cognition plus marqué (CVP : médiane = 24,5 [min–max : 9,75–45,5] vs 52 [min–max : 26–76], Wilcoxon, p = 0,001). À l'entrée, le recueil des signes à l'observation clinique structurée rejoint ceux relevés par les familles comme étant objet de leur préoccupation. Avec les outils standardisés, ces observations produisent une analyse de l'efficience fonctionnelle et pluridimensionnelle pour le projet de soins intégratifs. À 12 mois, le niveau de satisfaction des familles est élevé et concordant à celui des praticiens. Nos résultats montrent que les unités de jour soignent une population d'enfants présentant des TSA à dominante sévère et complexe, issue majoritairement de familles à faible statut socioéconomique et d'immigration de la première génération. La pertinence de l'observation pluridimensionnelle et le projet de soins des PSI sont confortés par les familles à l'entrée et après 12 mois de prise en charge. Integrative care practices (ICPs) in the management of autism spectrum disorders (ASDs) do not currently receive sufficient rigorous evaluation. Moreover, they lack formalisation despite their important place in clinical practice, particularly in France, where they are implemented in day care hospital structures. We present here the methodology of the EPIGRAM study financed by the French General Directorate of Healthcare Organisations (PREPS 2013), the profile of the inclusive population (M0), and the experience of families after 12 months of care. In order to homogenise practices, a manual has been formalised following the methodology of the clinical pathway and the recommendations of the High Authority of health. We then conducted an open, multi-centre, observational study in a natural environment in routine care evaluating ICPs in ASDs for children aged 3 to 6 years. The main inclusion criteria were the diagnosis (typical or atypical autism, according to the ICD10) and the duration of care (2 to 4 half-days per week) during the first year of care. The children were clinically assessed using several instruments including the PEP-3 (Psychoeducational Profile-3) and the CARS (Children Autism Rating Scale). In order to maintain a blind assessment for the main variable, randomly assigned videos of the PEP-3 were rated by two independent psychologists. A questionnaire, completed separately by the families and the professionals at inclusion and at one year, complemented the study. We included 89 children demonstrated to have severe autism through the CARS (mean = 44; SD = 6.51) and moderate autism through he PEP-3 maladaptive behaviour category (CAT MB) (mean = 30; SD = 29.89). The children were all diagnosed before the age of 3 years 6 months. Most of the children had severe language impairments. With PEP-3, the impairment is more pronounced in gross motor skills and characteristic verbal behaviours. Thirty percent of the families had a low socioeconomic status and 56 % were first generation immigrants. Seventy-seven percent of the children were enrolled in kindergarten with school life support. Children of immigrant parents have more severe autism (CARS : mean = 45.8 (± 6.51) vs. 41.2 (± 5.58), t -test, P = 0.001) in addition to a more marked cognitive deficit (CVP : median = 24.5 [min–max: 9.75–45.5] vs. 52 [min–max: 26–76], Wilcoxon, P = 0.001). At entry, the collection of the signs at the structured clinical observation met the signs noted by the families as being the object of their concern. With standardised tools, these observations constituted an efficient functional and multidimensional analysis for the integrative care project. At 12 months, the families' level of satisfaction was high and consistent with that of the practitioners. Our results show that the day units take care of a population of children with predominantly severe and complex ASDs, for the most part, from families with low socioeconomic status and first-generation immigration. The relevance of the multidimensional observation and the care project of the ISPs were confirmed by the families at entry and after 12 months of care. [ABSTRACT FROM AUTHOR]

Diarrhoea is a leading killer of children <5 years old, accounting for 480,000 deaths in 2017. Zimbabwe introduced Rotarix into its vaccination program in 2014. In this evaluation, we estimate direct medical, direct non-medical, and indirect costs attributable to a diarrhea hospitalization in Zimbabwe after rotavirus vaccine introduction. Children <5 years old admitted to Harare Central Hospital from June 2018 to April 2019 with acute watery diarrhea were eligible for this evaluation. A 3-part structured questionnaire was used to collect data by interview from the child's family and by review of the medical record. A stool specimen was also collected and tested for rotavirus. Direct medical costs were the sum of medications, consumables, diagnostic tests, and service delivery costs. Direct non-medical costs were the sum of transportation, meals and lodging for caregivers. Indirect costs are the lost income for household members. A total of 202 children were enrolled with a median age of 12 months (IQR: 7–21) and 48 (24%) had malnutrition. Children were sick for a median of 2 days and most had received outpatient medical care prior to admission. The median monthly household income was higher for well-nourished children compared to malnourished children (p < 0.001). The median total cost of a diarrhea illness resulting in hospitalization was $293.74 (IQR: 188.42, 427.89). Direct medical costs, with a median of $251.74 (IQR: 155.42, 390.96), comprised the majority of the total cost. Among children who tested positive for rotavirus, the median total illness cost was $243.78 (IQR: 160.92, 323.84). The median direct medical costs were higher for malnourished than well-nourished children (p < 0.001). Direct medical costs are the primary determinant of diarrhea illness costs in Zimbabwe. The descriptive findings from this evaluation are an important first step in calculating the cost effectiveness of rotavirus vaccine. [ABSTRACT FROM AUTHOR]

The educational and social benefits provided by school far outweigh the risks of a possible COVID-19 contamination of children in school environments or in daycare centers. Following summer break, the back-to-school period in France is taking place in the context of an increasing viral spread and requires strict adherence to health measures to limit the risk of outbreaks in communities. Based on a critical update of the role of children in the transmission of the infection, and of children's susceptibility to infection, the French Pediatric Society published practical guidelines for school re-entry and the management of COVID-19 infections in schools. [ABSTRACT FROM AUTHOR]

• We designed a dialogic reading intervention with a narrative comprehension focus. • The intervention improved preschoolers' narrative comprehension and vocabulary skills. • The effect on inferential narrative comprehension was maintained until first grade. • Dialogic reading provides unique learning opportunities for inferential comprehension. Shared reading has the potential to promote a wide range of language skills that are important for reading acquisition. Dialogic reading interventions in preschool facilitate the acquisition of vocabulary and narrative production skills, but it is unclear (a) whether dialogic reading can also foster inferential and literal narrative comprehension and (b) whether intervention effects are maintained until the beginning of formal reading instruction. To close these two gaps, we designed and conducted a low-dose narrative dialogic reading intervention with wordless picture books. On the child care center level, 201 German preschoolers (M age = 5;5 years) were randomly assigned to the dialogic reading group, an alternative treatment group, or a no treatment group. Hierarchical linear models showed positive effects of dialogic reading on inferential and literal narrative comprehension and on vocabulary depth and breadth. The effect on inferential narrative comprehension was maintained five months after posttest. Overall, our findings indicate that even a small amount of narrative dialogic reading has small, albeit mostly short-term effects on narrative comprehension and vocabulary skills. We conclude that narrative dialogic reading is a promising approach for supporting the development of preschoolers' inferential skills. Long-term intervention studies are needed for the evaluation of long-term effects. [ABSTRACT FROM AUTHOR]

Introduction: This study examines the associations between objectively measured sedentary time and physical activity among child care educators and children in their direct care and aims to determine if the associations differed between toddlers (aged 19-35 months) and preschoolers (aged 36-60 months).Methods: The participants were educators and children from 19 child care centers in Edmonton and Ottawa, Canada, as part of the Supporting Healthy Active Child Care Settings study. Sedentary time, light-intensity physical activity, and moderate to vigorous-intensity physical activity during child care were measured with accelerometers in 2017-2018. Nap time data were removed for children and educators based on room schedules. Children were matched with the main educator in their room that had the highest total physical activity, resulting in 187 children and 38 educators. Multilevel linear regression models with interaction terms were conducted in 2019.Results: Children engaged in 30.0, 23.1, and 6.9 minutes per hour of sedentary time, light-intensity physical activity, and moderate to vigorous-intensity physical activity, respectively. Educators engaged in 33.5, 23.6, and 2.9 minutes per hour of sedentary time, light-intensity physical activity, and moderate to vigorous-intensity physical activity, respectively. No significant interactions were observed, so age-stratified analyses were not conducted. Each additional 5 minutes per hour of educator sedentary time was significantly associated with 0.5 minutes per hour lower child moderate to vigorous-intensity physical activity. Each additional 5 minutes per hour of educator moderate to vigorous-intensity physical activity was significantly associated with 1.3 minutes per hour higher child moderate to vigorous-intensity physical activity. No other significant observations were observed.Conclusions: The educators' sedentary time and moderate to vigorous-intensity physical activity may have a small but potentially meaningful influence on children's moderate to vigorous-intensity physical activity because educators directly care for multiple children. Targeting these educator behaviors may be one strategy to increase children's moderate to vigorous-intensity physical activity during child care. [ABSTRACT FROM AUTHOR]

Rotavirus is one of the causes of severe diarrhea and death in young children. To control the disease, safe and effective vaccines are being used in several countries. We assessed the impact of vaccination on the risk factors for acute rotavirus diarrhea (ARD) in Bangladesh. We used the data of a cluster-randomized trial. The clusters were 142 villages, 71 in each of the two arms of study. The infants were offered human rotavirus vaccine (HRV), Rotarix, over three-year period. We divided the time period into two equal periods (T1 and T2). A generalized estimating equation with logit-link function was used to evaluate the risk factors by arm and by period. Among 10,917 children, 5,759 (53%) were in the HRV villages. We had 359 cases; 44% in the HRV villages. Mean age of attack was similar between the arms of study in T1, but significantly higher in HRV villages than that in the non-HRV villages in T2. In HRV villages, males were at a higher risk of having ARD than females in T1, but not in T2. In contrast, males were at a higher risk of having ARD in both the time periods in non-HRV villages. In HRV-villages, children having literate mother were at significantly higher risk of having ARD in T1 but not in T2; whereas children in the non-HRV villages had a higher risk of having ARD in T2. Children living in an area with higher phone users had more cases than their counterpart in non-HRV villages, but not in HRV villages. Our study illustrates that several risk factors for ARD varied between the two arms of study as well as between the two periods of study. Assessing post-vaccination risk factors is, therefore, important for understanding the impact of vaccination and undertaking post-vaccination control measures. [ABSTRACT FROM AUTHOR]

Introduction: This study was undertaken to assess the effect of climate variability on diarrhoeal disease burden among children under 5 years of age living in Kathmandu, Nepal. The researchers sought to predict future risk of childhood diarrhoea under different climate change scenarios to advance the evidence base available to public health decision-makers, and the Nepalese infection control division, in planning for climate impacts.Methods: A time series study was conducted using the monthly case count of diarrhoeal disease (2003-2013) among children under 5 years of age living in Kathmandu, Nepal. A quasi Poisson generalised linear equation with distributed lag linear model was fitted to estimate the lagged effect of monthly maximum temperature and rainfall on childhood diarrhoea. The environmental framework of comparative risk assessment was used to assess the environmental burden of diarrhoea within this population.Results: A total of 219,774 cases of diarrhoeal disease were recorded during the study period with a median value of 1286 cases per month. The results of a regression model revealed that the monthly count of diarrhoea cases increased by 8.1% (RR: 1.081; 95% CI: 1.02-1.14) per 1 °C increase in maximum temperature above the monthly average recorded within that month. Similarly, rainfall was found to have significant effect on the monthly diarrhoea count, with a 0.9% (RR; 1.009; 95% CI: 1.004-1.015) increase in cases for every 10 mm increase in rainfall above the monthly cumulative value recorded within that month. It was estimated that 7.5% (95% CI: 2.2%-12.5%) of the current burden of diarrhoea among children under 5 years of age could be attributed to climatic factors (maximum temperature), and projected that 1357 (UI: 410-2274) additional cases of childhood diarrhoea could be climate attributable by the year 2050 under low-risk scenario (0.9 °C increase in maximum temperature).Conclusion: It is estimated that there exists a significant association (p < 0.05) between childhood diarrhoea and an increase in maximum temperature and rainfall in Kathmandu, Nepal. The findings of this study may inform the conceptualization and design of early warning systems for the prediction and control of childhood diarrhoea, based upon the observed pattern of climate change in Kathmandu. [ABSTRACT FROM AUTHOR]

We report the sudden death of a 33-month-old child owing to acute respiratory distress syndrome due to human metapneumovirus (hMPV) infection. Of 30 children attending the same day care centre, 26% and 59% had hMPV and multiple infections, respectively; three of six children with pneumonia had a diagnosis of hMPV. hMPV infection is common in childhood viral co-infections but it can cause sudden death. [ABSTRACT FROM AUTHOR]

Child care is essential infrastructure. Without child care—or without adequate access to child care—parents and household caregivers are unable to work or conduct other critical activities, which can adversely affect their outcomes. In the U.S., child care supply has long fallen short of demand, with variations across neighborhoods that differ by income, race, and ethnicity. Yet there is relatively little research on child care access, use, and travel. In this study, we test the relationship between formal child care supply and households' use of formal care and home-to-child-care travel distances in California. Using a two-step floating catchment area method, we develop a time-weighted spatial measure of child care access and apply this measure in statistical models to predict two outcome measures: the likelihood of making a home-to-child-care trip and travel distance to the child care center, controlling for other factors. We find that child care access is associated with an increased likelihood of using formal child care—and among households that use such care, access is associated with shorter travel distances. Our analysis underscores the importance of policies to address spatial barriers to child care, particularly in neighborhoods—low-income, Latinx, non-urban—where child care supply is limited. [ABSTRACT FROM AUTHOR]

• There are considerable discrepancies between awareness and use of available EYS dietary guidelines in England. • While reported awareness of guidelines was high, reported use was much lower across nursery types. • The main reason for not using guidelines by EYS was 'I know what is healthy without them.' • Working towards a food-based award and being in a large setting were both drivers of guideline use. • More research is needed about variations in EYS dietary guideline knowledge and use and whether they should be mandatory. Good nutrition in early life is vital for healthy development, and sets the stage for good health throughout the life-course. Most children aged 0–4 years old in the UK spend at least some time each week in an early years' setting (EYS), such as a nursery or childminder. Unlike schools which serve older children, there are no statutory standards for the food and drinks served to the youngest children in EYS, despite the potential for greater public health gains due to early intervention. Two comprehensive, age-appropriate voluntary guidelines were developed, one called the Example Menus for Early Years Settings in England by the government and another, called Eat Better, Start Better by a charity. Both are seen as standard across the sector. To assess nurseries' awareness and use of voluntary guidelines, including how they are used and how they can be improved upon, and examine how these vary by socioeconomic deprivation and setting types (private nurseries and voluntary, community and charity nurseries), we conducted the first nationally representative cross-sectional survey of nurseries in England via an online survey. Using frequency distributions and binomial multivariate logistic regression models, considerable discrepancies between awareness (82.6 %) and use (48.8 %) of available EYS dietary guidelines were found. A key reason for not using guidelines was 'I know what is healthy without them.' The question about whether following food and drink guidelines should be voluntary or statutory generated mixed findings. More research is required to understand the factors influencing nurseries' views on whether guidelines should be voluntary or statutory. [ABSTRACT FROM AUTHOR]

• Determination of the bioavailability of plasticizers in house dust. • Identifying house dust as an exposure source for children. • This data can help to improve risk assessments. For decades, phthalates have been widely used as plasticizers in a large number of consumer products, leading to a complex exposure to humans via ingestion, inhalation or dermal uptake. Children may have a higher unintended dust intake per day compared to adults. Therefore, dust intake of children could pose a relevant exposure and subsequently a potential health risk. The aim of this study was to determine the relative bioavailability of certain phthalates, such as di(2-ethylhexyl) phthalate (DEHP), di-isononyl phthalate (DINP) and the non-phthalate plasticizer diisononyl 1,2-cyclohexanedicarboxylic acid (DINCH®, Hexamoll®), after ingestion of dust. Seven 5-week-old male piglets were fed five different dust samples collected from daycare centers. Overall, 0.43 g to 0.83 g of dust sieved to 63 μm were administered orally. The piglets' urine was collected over a period of 38 h. The excreted metabolites were quantified using an LC–MS/MS method. The mean uptake rates of the applied doses for DEHP, DINP, and DINCH® were 43% ± 11%, 47% ± 26%, and 9% ± 3.5%, respectively. The metabolites of DEHP and DINP showed maximum concentrations in urine after three to five hours, whereas the metabolites of DINCH®, reached maximum concentrations 24 h post-dose. The oral bioavailability of the investigated plasticizers was higher compared to the bioaccessibility reported from in vitro digestion tests. Furthermore, the bioavailability of DEHP did not vary substantially between the dust samples, whereas a dose-dependent saturation process for DINP was observed. In addition to other intake pathways, dust could be a source of plasticizers in children using the recent intake rates for dust ingestion. [ABSTRACT FROM AUTHOR]

• A census of Chicago-area center directors combined with interviews of a subsample. • Child-initiated instructional styles were common, with varying direct instruction. • As institutional theory predicted, style correlated with ECE field embeddedness. • And, use of Creative Curriculum went together with exposure to regulatory standards. • Directors explained how they perceived outside guidance and chose their approaches. Using institutional theory as a framework, we examined how professional norms and regulatory standards were associated with the instructional styles and curricular approaches that directors reported were used building-wide in centers serving 3- and 4-year-old children. We conducted a census surveying 229 child care center directors located in 31 ZIP Codes on the west and north sides of Chicago. We also completed in-depth interviews with a subsample of 29 directors. Most directors reported a highly child-initiated instructional style, although these directors were evenly balanced among those that reported little, some, or very much direct instruction. Directors who were highly embedded in the field of early care and education (ECE)—signaled for instance by their ECE certificates—most often reported highly child-initiated styles combined with little direct instruction. The majority of directors reported using Creative Curriculum, and those highly exposed to regulatory standards—such as the requirements of their local public funding grantees—were most likely to use it exclusively. In-depth interviews revealed some directors were able to explain the rationale and mechanisms through which a child-initiated instructional style supported child learning, whereas others pointed to outside requirements when justifying their center-wide style and curriculum. We encourage future studies regarding how and why ECE programs adopt various pedagogical approaches in the context of their institutional environments. [ABSTRACT FROM AUTHOR]

Vaccines may reduce antibiotic use and the development of resistance. To provide a comprehensive, up-to-date assessment of the evidence base relating to the effect of vaccines on antibiotic use. Ovid MEDLINE, Embase, the Cochrane Library, ClinicalTrials.gov and WHO Trials Registry. Randomized controlled trials (RCTs) and observational studies published from January 1998 to March 2018. Any population. Vaccines versus placebo, no vaccine or another vaccine. Titles, abstracts and full-texts were screened independently by two reviewers. Certainty of RCT evidence was assessed using GRADE. In all, 4980 records identified; 895 full-text reports assessed; 96 studies included (24 RCTs, 72 observational). There was high-certainty evidence that influenza vaccine reduces days of antibiotic use among healthy adults (one RCT; n = 4253; rate reduction 28·1%; 95% CI 16·0–38·4); moderate-certainty evidence that influenza vaccines probably reduce antibiotic use in children aged 6 months to 14 years (three RCTs; n = 610; ratio of means 0·62; 95% CI 0·54–0·70) and probably reduce community antibiotic use in children aged 3–15 years (one RCT; n = 10 985 person-seasons; risk ratio 0·69, 95% CI 0·58–0·83); and moderate-certainty evidence that pneumococcal vaccination probably reduces antibiotic use in children aged 6 weeks to 6 years (two RCTs; n = 47 945; rate ratio 0·93, 95% CI 0·87–0·99) and reduces illness episodes requiring antibiotics in children aged 12–35 months (one RCT; n = 264; rate ratio 0·85, 95% CI 0·75–0·97). Other RCT evidence was of low or very low certainty, and observational evidence was affected by confounding. The evidence base is poor. Although some vaccines may reduce antibiotic use, collection of high-quality data in future vaccine trials is needed to improve the evidence base. CRD42018103881. [ABSTRACT FROM AUTHOR]

Despite the importance of training residential youth care professionals to increase their professional competences, little attention has been paid so far to the influence of training on the behaviour and skills of residential professionals. This study aims to gain greater insight into the effects of training on the skills of these professionals. We conducted a systematic literature review using the PsycINFO, Eric, SocIndex and Academic Search Premier databases. Within the 12 studies retrieved, the outcomes of nine different training programme were examined. These nine training programmes include The Solution Strategy (TSS), (Professional) Skills for Residential Child Care Workers (PSRCCW/SRCCW), Therapeutic Crisis Intervention (for Youth Care Worker) (TCIYCW/TCI), Child Teacher Relationship Training (CTRT), a Brief Training Program (BTP), Social Skills Training (SST), Behavior Analysis Services Program (BASP), Mental Health Training (MHT) and a Brief Training Manual (BTM). Our results demonstrate that some training programmes may produce positive outcomes for professionals after a training course. TSS (in both studies), PSFCCW, SRCCW, TCI, CTRT, BTP, SST, BASP and BTM programmes are associated with positive outcomes regarding improvements in professional's individual characteristics or improvements in the work environment. However, two studies also found negative outcomes with regard to decreases in the perceived recognition of youth care workers' value to the agency and a decrease in the knowledge and skills that they learned through training after 6 months (TSS [ Hickey, 1994 ] and PSRCCW). In addition, the most common 'other' outcome was a variable effect of training on the professionals' skills. Although we did find positive and negative training outcomes on the professionals' skills, none of the studies specified the training elements which caused these changes. More thorough empirical studies using an experimental or repeated case study design are needed to identify effective training elements which could further improve the effectiveness of interventions targeting youths in residential youth care. • Little knowledge available about training effects on the skills of professionals • Training may produce positive outcomes on the skills of professionals • Negative outcomes on the skills of professionals through training are limited found • Training can lead to unexpected outcomes on the skills of professionals. [ABSTRACT FROM AUTHOR]

We present the results of a study of the connectivity between Pacific cod spawning and nursery areas, and settlement of Pacific cod in the Gulf of Alaska. This work was conducted to address the hypothesis that spatial and temporal patterns of recruitment are related to variability in connectivity between spawning and nursery areas. To examine this hypothesis, we developed a Lagrangian, biophysical, individual-based model of Pacific cod early life history and dispersal using the Dispersal Model for Early Life Stages (DisMELS) framework. This model is driven by currents and scalars such as temperature from a version of the Regional Oceanographic Model System (ROMS) developed for the Gulf of Alaska. Results of our study show connectivity patterns predicted by the model that agree with our understanding (based on genetic analyses) that there is a high degree of localized retention in Pacific cod. The results indicate that the Shumagin Islands and Prince William Sound regions may serve as important collectors of Pacific cod recruits from upstream spawning areas. We also find correlations between individual-based model outputs and several large-scale climate indicators that appear to show settlement in several important nursery areas, and recruitment overall, are positively affected by slower gyre circulation in the Gulf of Alaska. We hypothesize that this is due to enhancement of retention, settlement in the Shumagin Island region, and reduction of transport of young cod out of the Gulf of Alaska to the southwest. [ABSTRACT FROM AUTHOR]

Little is known about the mechanism of transport that enables age-0 sablefish (Anoplopoma fimbria) to reach suitable nursery sites from spawning locations far offshore, or the strength of the connection between individual spawning sites and nursery areas, or how variability in the strength of these connections may impact recruitment success. Using a model for the early life stages of sablefish, we explored the variability in connectivity between spawning and recruitment sites that can arise solely from interannual variability in environmental forcing and its impact on transport. Our major findings are that 1) the model indicates young sablefish settling in nursery areas in the Gulf of Alaska were most likely spawned in the eastern Gulf; 2) sablefish spawned in the western Gulf of Alaska are unlikely to settle anywhere in the Gulf, and are more likely to be advected farther west, perhaps to settle in the Aleutian islands or Bering Sea (to contribute to the Alaska population, they would have to undergo an active return migration as they mature); 3) total connectivity between all spawning sites and nursery areas showed stronger correlation with recruitment estimates than the strength of connections to or from specific regions; and 4) transport to St. John Baptist Bay, a known sablefish nursery area, was not the most probable end point for sablefish spawned throughout our Gulf of Alaska model domain. This suggests that young individuals arrive at this persistent nursery area due to directional swimming behavior, highly localized spawning, or small-scale currents not captured in the hydrographic model. The fact that no single correlate in our analysis had a very strong relationship to sablefish recruitment indicates that recruitment variability arises from complex interactions between the environment and the individual, and a possible disconnect in spatial scales between the Gulf of Alaska sablefish IBM and the broader sablefish stock assessment, which includes both the GOA and the Eastern Bering Sea, as well as possible contributions from Canadian stocks to the south. Our analyses determined that although the timing and extent of this transport shows significant interannual variability, both the location of likely sablefish spawning (source) areas and the comparative strength of connectivity between spawning and nursery sites appear to be relatively consistent year-to-year. [ABSTRACT FROM AUTHOR]

To fight against the biodiversity loss and to take advantage of ecosystem services that nature can offer, urban planners integrate green spaces in urban projects. However to assess green spaces, attention is generally paid to local biodiversity (i.e. " in situ ") which concerns the plot on which buildings are constructed. The biodiversity impacted outside the construction site (i.e. " ex situ ") which concerns the extraction of materials, transportation and waste, is rarely associated to the project assessment. In this study, two endpoint Life Cycle Assessment (LCA) methods are applied: ReCiPe 2016 and Impact World + to assess a conventional roof and three different types of green roofs. As Life Cycle Inventory (LCI) data about urban plants are missing, we created new data to model the vegetation layer of green roofs by collecting information nearby plants nursery. This work shows that 1) extensive green roof generates the least biodiversity loss, 2) " ex situ " biodiversity is 10 times more impacted than " in situ " biodiversity, 3) the impact of the vegetation layer on the biodiversity loss is significant. LCA methods do not enable to cover all pressures threatening biodiversity and they also lack precision to assess " in situ " biodiversity. Nevertheless, their main strength is to consider " ex situ " biodiversity along the value chain of the studied systems. Coupling LCA with ecological expertise should improve the assessment by taking into account local specificities and both negative and positive impacts of a system (e.g. " in situ " biodiversity gains with green roofs). • Biodiversity impacts are calculated and compared for four roof systems. • Two Life Cycle Assessment (LCA) methods are used for calculation. • Both impacts, on (in situ) and outside (ex situ) construction site, are considered. • Data about plants used on green roofs are collected to consider their impacts. • Limits of LCA methods for biodiversity assessment are highlighted. [ABSTRACT FROM AUTHOR]

• 89% of children did not achieve a potassium adequate intake. • Calcium and selenium were the micronutrients with highest inadequate intake rates. • 48% of children had a sodium intake higher than the tolerable upper level. • Overweight and obesity prevalence in the studied preschool group was 17%. Inadequate micronutrient intake in childhood harms growth and development, and it is related to increased rates of morbidity and mortality. The aim of this study is to evaluate the dietary intake and prevalence of inadequate micronutrient intake in preschool children (1–4 years old) attending two-day care centers. To assess children's dietary micronutrient intake, 24-h duplicate diets (n = 64) were collected for one week-day, including everything the children ate and drank both at home and in kindergarten. Anthropometric measurements were carried out to evaluate the children's nutritional status. The micronutrients copper, iron, calcium, magnesium, selenium, zinc, potassium, sodium, and manganese were determined by inductively coupled plasma mass spectrometry or graphite furnace atomic absorption spectrometry. Calcium and selenium were found with high inadequate intake rates: 50% and 42%, respectively, for children aged 1–3 years old, and 93% and 90% for children aged 4 years. Potassium was consumed in very low amounts, 13% and 5% of children aged 1–3 and 4 years old, respectively, achieved the adequate intake for the nutrient. Sodium intakes were excessive: 23% of the 1–3-year old and 42% of the 4-year-old children, respectively, had an intake higher than the tolerable upper levels. Regarding the nutritional status, overweight and obesity prevalence was 17%. Therefore, considering the damaging health effects for children of micronutrient deficiency and overweight and obesity status, it is necessary that government authorities be aware and update public policies and educational programs in order to promote healthy eating habits in early childhood. [ABSTRACT FROM AUTHOR]

Climate change may bring more frequent and severe floods which will heighten public health problems, including an increased risk of infectious diarrhea in susceptible populations. Affected by heavy rainfall and an El Niño event, a destructive flood occurred in Anhui province, China on 18th June 2016. This study investigates the impact of this severe flood on infectious diarrhea at both city-level and provincial level, and further to identify modifying factor. We obtained information on infectious diarrheal cases during 2013–2017 from the National Disease Surveillance System. An interrupted time-series design was used to estimate effects of the flood event on diarrhea in 16 cities. Then we applied a meta-analysis to estimate the area-level pooled effects of the flood in both flooded areas and non-flooded areas. Finally, a meta-regression was applied to determine whether proximity to flood was a predictor of city-level risks. Stratified analyses by gender and age group were also conducted for flooded areas. A significant increase in infectious diarrhea risk (RR = 1.11, 95% CI: 1.01, 1.23) after the flood event was found in flooded area with variation in risks across cities, while there was no increase in non-flooded areas. Diarrheal risks post-flood was progressively higher in cities with greater proximity to the Yangtze River. Children aged 5–14 were at highest risk of diarrhea post-flood in the flooded areas. Our study provides strong evidence that the 2016 severe flood significantly increased infectious diarrheal risk in exposed populations. Local public health agencies are advised to develop intervention programs to prevent and control infectious diarrhea risk when a major flood occurs, especially in areas close to water bodies and among vulnerable populations. • The 2016 flood event increases the risk of infectious diarrhea in Anhui Province. • Diarrhea risk became progressively higher with closer proximity to the Yangtze River. • Children aged 5–14 were at the highest risk of diarrhea post-flood. [ABSTRACT FROM AUTHOR]

• Studies reported that children in child care are more likely to have disrupted patterns of diurnal cortisol secretion. • Children in child care can benefit from a social skills training as it is inexpensive and easy to implement by educators. • Our social skills training led to decreasing diurnal cortisol secretion patterns in preschoolers in child care. • Children from lower-income families benefit the most from such a program. Most preschool children in Western industrialized countries attend child care during the day while parents work. Studies suggest that child care may be stressful to young children, perhaps because they still lack the social skills to interact daily in a group setting away from parents. This gap in social abilities may be greater for children in lower-income families, who may face more adversity at home, with fewer resources and more social isolation. We conducted a cluster-randomized controlled trial in 2013–2014 to test whether a social skills intervention led by early childhood educators within the child care center could reduce diurnal cortisol levels to more typical patterns expected of children this age. We randomized 19 public child care centers (n = 361 children) in low-income neighborhoods of Montreal, Canada, to either: 1) the Minipally program – intervention group (n = 10 centers; 186 children), or 2) waiting list – control group (n = 9 centers; 175 children). Saliva samples for cortisol levels were collected 3 times/day, pre- and post-implementation. The Minipally puppet program consists of 2 workshops/month for 8 months for the development of social skills and self-regulation in 2–5-year-olds, with reinforcement activities between workshops. Educators received 2-days' training and 12 h' supervision in Minipally. Linear mixed models for repeated measures revealed a significant interaction between intervention status and time of day of cortisol sampling (β = −0.18, p = 0.04). The intervention group showed patterns of decreasing diurnal cortisol secretion (β = −0.32, p < 0.01), whereas the control group showed increasing slopes (β = 0.20, p < 0.01). Moreover, family income was a moderator; children in lower-income families benefited most from the intervention. Results suggest that a social skills training program, when integrated into a preschool education curriculum, can foster an environment more conducive to typical childhood patterns of cortisol secretion. [ABSTRACT FROM AUTHOR]

Abstract Infants and children under 6 years old spend most of daily time in Child Care Centers (CCCs), especially in the tropical regions like Singapore. Environmental exposure and associated risk during this early critical developmental stage is of great public concern. In this study, seven representative volatile organic compounds (VOCs) and five typical phthalates were analyzed in the indoor and outdoor air samples collected from 32 Singapore CCCs. The median of total VOC and phthalate concentration in indoor air was 19.03 and 5.41 μg m−3; respectively. For both indoors and outdoors environment, benzene, toluene and xylene were the dominant VOC contributors (more than 68%). For indoor air phthalates, di(2-ethylhexyl) phthalate and di-butyl phthalate (DBP) accounts for 60–76%. The level of both VOCs and phthalates in indoor environment was significantly higher than that in outdoor, with an average indoor/outdoor ratio of 1.24 and 1.45; respectively. A strong correlation (r > 0.50, p < 0.05) was observed between indoor and outdoor air compounds. VOC and phthalate levels have no significant difference between CCCs with split-unit and centrally ventilated air conditioners. Monte Carlo simulation was used to estimate exposure uncertainty and variability for the risk assessment. Overall, the concentrations of VOC were below the healthy reference values from either EPA Integrated Risk Information System (IRIS) or Singapore guideline. However, similar to other countries' report, benzene, DBP, ethylbenzene and naphthalene were at levels that could exceed the stringent standards such as Office of Environmental Health Hazard Assessment (OEHHA) cancer and reproductive health-based benchmarks. Graphical abstract Image 1 Highlights • VOCs and Phthalates were widely detected in the Child Care Centers air samples. • VOCs and Phthalates in the indoor air was significantly higher than that in outdoor. • Monte Carlo simulation applied to estimate uncertainty of exposure risk assessment. [ABSTRACT FROM AUTHOR]

• During 2000–2013, cyclic epidemics of Shigella sonnei shigellosis occurred every 2 years. • The incidence was 2.6-fold higher in Elad (ultraorthodox community) compared to the sub-district. • Having family members with diarrhea increased the risk of S. sonnei shigellosis. • Characteristics of daycare centers affected the disease risk. • Children's hand-washing before meals was protective against S. sonnei shigellosis. Ultraorthodox Jewish populations living in towns with good sanitary infrastructure but with conditions of crowding have been the epicenter of Shigella sonnei shigellosis outbreaks. In this study, the incidence and risk factors of S. sonnei shigellosis in children living in an ultraorthodox community were determined. Data for the years 2000–2013 for all reported culture-proven S. sonnei shigellosis cases in children aged 0–59 months in the city of Elad were compared with data for the rest of the sub-district. Environmental factors obtained through parental interviews were evaluated for 78 incident cases of S. sonnei shigellosis and 141 community controls, matched by age, sex, and neighborhood. Conditional logistic regression models were performed. Cyclic epidemics of S. sonnei shigellosis occurred every 2 years. The mean annual incidence was 10.0 per 1000 children in Elad (95% confidence interval 7.9–12.6) vs. 3.8 per 1000 children (95% confidence interval 3.3–4.4) in the sub-district (p < 0.001). Concurrent diarrheal disease in family members, having the same person in the daycare center responsible for food handling and changing diapers, and more rooms and sinks in the center, were positively associated with S. sonnei shigellosis, while children's hand-washing before meals was inversely associated. The burden of S. sonnei shigellosis in ultraorthodox communities is high. Enhanced hygiene interventions are required for epidemic control. [ABSTRACT FROM AUTHOR]

Highlights • A one-secondary factor and six-primary factor CFA model for the 36-item TCDFS-2. • And, a one-secondary factor and six-primary factor CFA model for the 36-item TCFSS-2. • Schizophrenic subjects might have different measurement structures of TCDFS-2 and TCFSS-2 as compared to ordinary subjects. • The mental deficiencies might affect the flow experiences and the measurement structures of TCDFS-2 and TCFSS-2. Abstract Introduction The 36-item Dispositional Flow Scale-2 (DFS-2) and Flow State Scale-2 (FSS-2) were developed to assess flow experience in daily and specific activities. Although their validity and reliability had been examined in general populations and different cultures, little is known for schizophrenic subjects. Thus, this study aimed to validate Traditional-Chinese DFS-2 (TCDFS-2) and FSS-2 (TCFSS-2) in Taiwanese subjects with schizophrenia or schizoaffective disorder. Methods We recruited 229 adult participants from outpatient clinics, day care centers, and psychiatric rehabilitation centers in Taipei. They filled out 36-item TCDFS-2 and TCFSS-2 under guidance. The LISREL 9.30 software was used to conduct exploratory factor analysis for exploring measurement structures, and then confirmatory factor analysis for identifying factor models. Results The six first-order factor and one second-order factor measurement models were obtained for both 36-item TCDFS-2 (Chi-square statistic = 999.1, df = 545, p < 0.0001, Root Mean Square Error of Approximation [RMSEA] = 0.0603, and Comparative Fit Index [CFI] = 0.9213) and TCFSS-2 (Chi-square statistic = 987.9, df = 539, p < 0.0001, RMSEA = 0.0603, and CFI = 0.9213). Conclusion Our factor models differed remarkably from those of 36-item DFS-2 and FSS-2. Yet, they were barely acceptable to be used to measure flow experiences in schizophrenic subjects in clinical applications. Since the factor scores, measurement structures, or even definitions of flow experiences could differ substantially between healthy people and patients with mental illness, disease-specific instruments of flow experiences should be considered in the future. [ABSTRACT FROM AUTHOR]

Objective: To describe the annual volume of pediatric urology cases in an academic, tertiary care setting.Methods: A retrospective review was performed of all patients operated on by 4 pediatric urologists (total of 2.5 full-time equivalents) at an academic, tertiary care center with a free-standing children's hospital from 2016 to 2017 (24 months). Basic case information was collected from operative reports. Descriptive statistics are reported using nonparametric methods. "Uncommon" was defined a priori as occurring <10% of the time.Results: During the entire study period, 2718 patients underwent 4580 procedures. This equated to 1088 patients and 1832 procedures per full-time equivalent. Median age at surgery was 3.2 years (IQR 0.8-10) and 757 (16.5%) of patients were female. Most procedures were elective (4406, 96.2%) and did not require postoperative admission (3842, 83.9%). Urgent and emergent cases were uncommon (174, 3.8%). Most cases were classified as general pediatric urology (3894, 85%) with 319 (7%) classified as major reconstruction, 275 (6%) as laparoscopy/endourology and 92 (2%) as oncology. The most common cases involved the groin/scrotum (1415, 30.9%), prepuce (809, 17.7%), phallus (802, 17.5%), and endoscopy (652, 14.2%). All other case types were uncommon.Conclusion: This description of an academic pediatric urology practice at a tertiary care center with a free-standing children's hospital noted a high volume of elective, outpatient procedures that are largely general pediatric urology. Uncommon cases include urgent/emergent interventions, major reconstruction, laparoscopy/endourology, and oncology procedures. [ABSTRACT FROM AUTHOR]