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Background: Despite increasing evidence of a link between early life brain injury and anti‐social behavior, very few studies have assessed factors that explain this association in children with traumatic brain injury (TBI). One hypothesis suggests that childhood TBI elevates risk for anti‐social behavior via disruption to anatomically distributed neural networks implicated in executive functioning (EF). In this longitudinal prospective study, we employed high‐resolution structural neuroimaging to (a) evaluate the impact of childhood TBI on regional morphometry of the central executive network (CEN) and (b) evaluate the prediction that lower EF mediates the prospective relationship between structural differences within the CEN and postinjury anti‐social behaviors. Methods: This study involved 155 children, including 112 consecutively recruited, hospital‐confirmed cases of mild‐severe TBI and 43 typically developing control (TDC) children. T1‐weighted brain magnetic resonance imaging (MRI) sequences were acquired sub‐acutely in a subset of 137 children [TBI: n = 103; TDC: n = 34]. All participants were evaluated using direct assessment of EF 6 months postinjury, and parents provided ratings of anti‐social behavior 12 months postinjury. Results: Severe TBI was associated with postinjury volumetric differences within the CEN and its putative hub regions. When compared with TD controls, the TBI group had significantly worse EF, which was associated with more frequent anti‐social behaviors and abnormal CEN morphometry. Mediation analysis indicated that reduced EF mediated the prospective association between postinjury volumetric differences within the CEN and more frequent anti‐social behavior. Conclusions: Our longitudinal prospective findings suggest that detection of neurostructural abnormalities within the CEN may aid in the early identification of children at elevated risk for postinjury executive dysfunction, which may in turn contribute to chronic anti‐social behaviors after early life brain injury. Findings underscore the potential value of early surveillance and preventive measures for children presenting with neurostructural and/or neurocognitive risk factors. [ABSTRACT FROM AUTHOR]

The severe acute respiratory syndrome coronavirus 2 (COVID‐19) pandemic has placed an unprecedented challenge on healthcare systems across the globe. Rapid assessment of the cardiorespiratory function to monitor disease progression and guide treatment is essential. Therefore, we have designed the COVID‐US: a simplified cardiopulmonary ultrasound approach to use in suspected and confirmed COVID‐19 patients, to aid front‐line health workers in their decision‐making in a surge crisis. [ABSTRACT FROM AUTHOR]

Weak contract enforcement may reduce the efficiency of production in developing countries. I study how contract enforcement affects efficiency in procurement auctions for the largest power projects in India. I gather data on bidding and ex post contract renegotiation and find that the renegotiation of contracts in response to cost shocks is widespread, despite that bidders are allowed to index their bids to future costs like the price of coal. To study heterogeneity in bidding strategies, I construct a new measure of firm connectedness, based on whether a firm has been awarded coal concessions by the Government. Connected firms choose to index less of the value of their bids to coal prices and, through this strategy, expose themselves to cost shocks to induce renegotiation. I use a structural model of bidding in a scoring auction to characterize equilibrium bidding when bidders are heterogeneous both in cost and in the payments they expect after renegotiation. The model estimates show that bidders offer power below cost due to the expected value of later renegotiation. The model is used to simulate bidding and efficiency with strict contract enforcement. Contract enforcement is found to be pro‐competitive. With no renegotiation, equilibrium bids would rise to cover cost, but markups relative to total contract value fall sharply. Production costs decline, due to projects being allocated to lower‐cost bidders over those who expect larger payments in renegotiation. [ABSTRACT FROM AUTHOR]

High pollution persists in many developing countries despite strict environmental rules. We use a field experiment and a structural model to study how plant emission standards are enforced. In collaboration with an Indian environmental regulator, we experimentally doubled the rate of inspection for treatment plants and required that the extra inspections be assigned randomly. We find that treatment plants only slightly increased compliance. We hypothesize that this weak effect is due to poor targeting, since the random inspections in the treatment found fewer extreme violators than the regulator's own discretionary inspections. To unbundle the roles of extra inspections and the removal of discretion over what plants to target, we set out a model of environmental regulation where the regulator targets inspections, based on a signal of pollution, to maximize plant abatement. Using the experiment to identify key parameters of the model, we find that the regulator aggressively targets its discretionary inspections, to the degree that half of the plants receive fewer than one inspection per year, while plants expected to be the dirtiest may receive ten. Counterfactual simulations show that discretion in targeting helps enforcement: inspections that the regulator assigns cause three times more abatement than would the same number of randomly assigned inspections. Nonetheless, we find that the regulator's information on plant pollution is poor, and improvements in monitoring would reduce emissions. [ABSTRACT FROM AUTHOR]

Pediatric traumatic brain injury (TBI) can result in a range of social impairments, however longitudinal recovery is not well characterized, and clinicians are poorly equipped to identify children at risk for persisting difficulties. Using a longitudinal prospective design, this study aimed to evaluate the contribution of injury and non-injury related risk and resilience factors to longitudinal outcome and recovery of social problems from 12- to 24-months post-TBI. 78 children with TBI (injury age: 5.0–15.0 years) and 40 age and gender-matched typically developing (TD) children underwent magnetic resonance imaging including a susceptibility-weighted imaging (SWI) sequence 2–8 weeks post-injury ( M = 39.25, SD = 27.64 days). At 12 and 24-months post- injury, parents completed questionnaires rating their child’s social functioning, and environmental factors including socioeconomic status, caregiver mental health and family functioning. Results revealed that longitudinal recovery profiles differed as a function of injury severity, such that among children with severe TBI, social problems significantly increased from 12- to 24-months post-injury, and were found to be significantly worse than TD controls and children with mild and moderate TBI. In contrast, children with mild and moderate injuries showed few problems at 12-months post-injury and little change over time. Pre-injury environment and SWI did not significantly contribute to outcome at 24-months, however concurrent caregiver mental health and family functioning explained a large and significant proportion of variance in these outcomes. Overall, this study shows that longitudinal recovery profiles differ as a function of injury severity, with evidence for late-emerging social problems among children with severe TBI. Poorer long-term social outcomes were associated with family dysfunction and poorer caregiver mental health at 24-months post injury, suggesting that efforts to optimize the child’s environment and bolster family coping resources may enhance recovery of social problems following pediatric TBI. [ABSTRACT FROM AUTHOR]

Childhood and adolescence are critical periods for maturation of neurobiological processes that underlie complex social and emotional behavior including Theory of Mind (ToM). While structural correlates of ToM are well described in adults, less is known about the anatomical regions subsuming these skills in the developing brain or the impact of cerebral insult on the acquisition and establishment of high-level social cognitive skills. This study aimed to examine the differential influence of age-at-insult and brain pathology on ToM in a sample of children and adolescents with traumatic brain injury (TBI). Children and adolescents with TBI ( n = 112) were categorized according to timing of brain insult: (i) middle childhood (5-9 years; n = 41); (ii) late childhood (10-11 years; n = 39); and (iii) adolescence (12-15 years; n = 32) and group-matched for age, gender, and socioeconomic status to a typically developing (TD) control group ( n = 43). Participants underwent magnetic resonance imaging including a susceptibility-weighted imaging (SWI) sequence 2-8 weeks postinjury and were assessed on a battery of ToM tasks at 6- and 24-months after injury. Results showed that for adolescents with TBI, social cognitive dysfunction at 6- and 24-months postinjury was associated with diffuse neuropathology and a greater number of lesions detected using SWI. In the late childhood TBI group, we found a time-dependent emergence of social cognitive impairment, linked to diffuse neuropathology. The middle childhood TBI group demonstrated performance unrelated to SWI pathology and comparable to TD controls. Findings indicate that the full extent of social cognitive deficits may not be realized until the associated skills reach maturity. Evidence for brain structure-function relationships suggests that the integrity of an anatomically distributed network of brain regions and their connections is necessary for the acquisition and establishment of high-level social cognitive skills. Hum Brain Mapp 36:1677-1691, 2015. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Highlights: [•] We investigate very-long social outcomes in 34 young adult survivors of pediatric TBI, and 16 healthy controls. [•] Results provide evidence for persisting socio-cognitive and communicative dysfunction 16-years post-TBI. [•] Greater social communication difficulty is linked to more frequent externalizing behaviors. [•] Social communication mediates the relationship between emotion perception and externalizing behaviors in the TBI sample. [ABSTRACT FROM AUTHOR]

This longitudinal study was designed to investigate whether or not social connectedness predicts psychological well-being over time. Structural equation modeling was used to examine the temporal relations between these constructs assessed yearly for 3 years for a sample of 1,774 10- to 15-year-olds (at Time 1). Results indicated that global connectedness (i.e., connectedness combined across the domains of family, school, peers, and neighborhood) predicted well-being, but no reciprocal relation was found. However, reciprocal relations were revealed by analyses that examined connectedness at the domain level, that is, for family and school contexts. The results suggest that youth who reported higher levels of social connectedness at one point in time would subsequently report higher well-being (i.e., life satisfaction, confidence, positive affect, and aspirations). [ABSTRACT FROM AUTHOR]

Aim: To determine if an evidence-based implementation (EBI) could lead to improved compliance with guidelines for acute asthma in children aged 1–15 years presenting to a large rural emergency department. Methods: Pre-intervention, post-intervention and 12-month follow-up audits were performed to determine the impact of an EBI strategy used to increase compliance with current asthma guidelines. The pre-intervention audit was conducted from 1 April to 30 June 2004, and follow-up data were collected from 1 September to 30 November 2004. The 12-month follow-up audit was conducted from 1 August to 31 October 2005. All audits were chart reviews. The intervention was an EBI strategy that was devised and then used to implement established guidelines for the emergency department management of paediatric asthma. Results: There were 51 presentations pre-intervention, 66 post-intervention and 68 at 12-month follow-up with no differences noted in the severity of asthma between the groups. At 12-month follow-up, there were significant increases in the documentation of asthma severity (45% to 90%, P < 0.001), use of spirometry (32% to 66%, P = 0.012), use of spacers (5% to 53%, P < 0.001) and use of written short-term asthma management plans (16% to 69%, P < 0.001). There was a reduction in the use of ipratropium bromide in mild asthma (31% to 3%, P < 0.001). There was no significant change in the use of systemic steroids (74% to 62%, P = 0.29) or antibiotic use in afebrile patients (15% to 6%, P = 0.175). For the seven clinical indicators (CIs) combined, compliance with the guideline increased from 47% to 79% ( P < 0.001). Positive changes in clinical behaviour occurred immediately and compliance with all seven CIs was 83% immediately post intervention before falling, non-significantly, to 79% at 12-month follow-up ( P = 0.142). Conclusions: The pre-intervention audit identified a low rate of compliance with current asthma guidelines across seven CIs of asthma care. The intervention significantly increased compliance with five of the CIs and for the seven CIs aggregated. Positive changes in clinical behaviour were immediate and the gains were sustained at 12 months. [ABSTRACT FROM AUTHOR]

Objective: To determine if an evidence-based implementation (EBI) strategy could lead to the successful implementation of guidelines for the management of adult asthma in a large rural ED. Methods: This was a pre- and post-intervention trial, comparing data for seven clinical indicators from a study hospital and a control hospital. Retrospective pre-intervention audits were conducted at the study hospital for 3 months (1 April−30 June 2004) and the control hospital for 4 months (1 March−30 June 2004). The effect of an EBI to implement established guidelines for the management of asthma at the study hospital was compared with the effect of a mail-out of guideline booklets and wall charts to the control hospital. Post-intervention audits were then performed at both hospitals. Sustainability of the EBI was gauged by 12 month follow-up data at the study hospital. Results: There were 55 presentations of adult asthma at the study hospital in the pre-intervention phase and 67 post-intervention. The corresponding numbers for the control hospital were 51 and 42, respectively. Following the EBI there were significant improvements at the study hospital for the documentation of severity (27–99%, P < 0.01), use of spirometry (38–84%, P < 0.01), medication delivery via spacer device (0–26%, P < 0.01), use of systemic steroids (66–84% P < 0.05), use of written short-term asthma plans (14–82%, P < 0.01), reduction of ipratropium use in mild asthma (43–16%, P < 0.05) and reduction in antibiotic use in afebrile asthmatics (37–6%, P < 0.01). For the control hospital there was a significant increase in spirometry use from 2% to 40% ( P < 0.01). For seven clinical indicators combined, compliance with the guideline increased from 38% to 79.1% ( P < 0.01) at the study hospital, whereas there was no change at the control hospital, 44.3% to 43% ( P = 0.75) There were 68 presentations at 12 month follow up at the study hospital and compliance with the seven clinical indicators was 78.2%. Conclusion: An EBI significantly improved compliance at the study hospital with no improvement noted in the control hospital. These improvements were maintained at 12 month follow up. An EBI can lead to significant improvements in the management of asthma at a large rural referral hospital ED and might have implications for hospitals with similar roles and profiles. [ABSTRACT FROM AUTHOR]

Patients with nasal foreign bodies frequently present to emergency departments. Nasal foreign bodies are often difficult to remove and may require referral to an ENT surgeon or admission to hospital for removal under general anaesthetic. This study reviews patients with nasal foreign bodies who presented to the Gosford District Hospital Emergency Department over a three and a half year period. The results indicate that a technique for the removal of nasal foreign bodies in the emergency department using a Fogarty catheter may be successful. [ABSTRACT FROM AUTHOR]