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Background: Traumatic birth experiences may give rise to PTSD following childbirth (PTSD-FC). The perinatal period is associated with neurobiological alterations in HPA axis- and oxytocinergic systems also implicated in the response to trauma. However, little is known about neurobiological alterations in PTSD-FC and how these may play a role in the prevention and treatment of PTSD-FC. Recent research indicates a potential role for oxytocin. Aim and Objectives: To provide a synthesis of evidence on epidemiology, prevention, and treatment of PTSD-FC including neurobiological alterations and treatment-potential of hormones such as oxytocin. Method: Literature searches were performed in PubMed, Psychinfo, and Web of Science. Results: The prevalence for PTSD-FC ranges from 3-4% in community samples to up to 19% in high risk samples. Clinical trials in the treatment or prevention of PTSD-FC are scarce and do not include neurobiological alterations but the related domains of PTSD and the perinatal period provide findings relevant for PTSD-FC. A systematic search for exogenous oxytocin trials in women with PTSD-FC generated no findings. However, direct neurobiological and psychological effects of oxytocin were positive in trials with PTSD patients albeit negative in trauma-exposed individuals. In postpartum women an oxytocin-related increase of neural processing in reward-related areas was found as well as improved therapist- and infant relationships in women with postpartum depression although their mood worsened. Interpretation: Knowledge of epidemiological factors of PTSD-FC is adequate but research of treatment and prevention of PTSD-FC is scarce and lacks neurobiological data. Exogenous oxytocin has not been studied in PTSD-FC but treatment-relevant neurobiological and psychological changes have been found in PTSD and postpartum depression although negative oxytocin findings should also be acknowledged. Conclusions: This review provides recommendations and cautionary notes for future research into the neurobiological aspects of preventing and treating PTSD-FC.

I never intended to become a scientist. My career developed on the basis of chance happenings, repeated failure, the willingness to take risks and the acceptance and provision of mentoring. My career has included periods of difficulty and shifted back and forth between academic health centers and universities in Canada. Although I have been amply recognized for my successes, my greatest learning has come from my failures. My greatest satisfaction has been in the development, evaluation and dissemination of interventions. The combination of intellectual stimulation and emotional gratification has meant a rewarding career.

Perplexing medical presentations encompass many situations encountered by paediatricians, where a child is reported to have symptoms or disabilities that impact significantly on their everyday functioning, and yet thorough medical evaluation has not revealed an adequate and realistic medical explanation. Unlike in other medically unexplained symptoms (MUS), the parent(s) are reluctant to support a rehabilitative approach to the child and insist on continued investigations. The clinicians dealing with the child are, in addition, alert to the possibility that there may be an unusual and potentially harmful parent-child interaction that is causing or perpetuating the presentation.1 If any of the professionals involved with the child becomes concerned that the child may be suffering (or at risk of) significant harm, and if that concern cannot be quickly and easily resolved, then under current safeguarding procedures a referral should be made to Children’s Social Care. These will be managed under existing fabricated or induced illness (FII) guidelines and procedures. However, paediatricians recognise that there are many cases just below that threshold, where safeguarding does not provide a suitable framework for managing the child, and where there is room for a rehabilitative approach to be attempted before considering a safeguarding approach. These are cases where harm to the child is predominantly iatrogenic and avoidable. There may be a potential for some of these cases to progress to ‘True’ FII over time but they are not at that stage. We propose that the essence of the management of perplexing presentations (PP)/FII is to recognise these PP at an early stage. We suggest that early intervention may reduce the potential for iatrogenic harm, help to restore normal functioning and may reduce the need for safeguarding interventions. We also propose that current procedures may need to be revised to take account of the wider spectrum of …

To study the factors associated with the subsequent (over next 9 years) full-text publication of papers presented at the 44th National Conference of Indian Academy of Pediatrics (PEDICON), 2007.All papers presented at PEDICON 2007 were searched for subsequent full-text publication over the next 9 years in English-language journals by an internet-based search. The published papers were compared with the conference-abstracts.74 (16%) of the 450 abstracts presented were subsequently published; 61 (82.4%) in Medline-indexed journals. Majority (50, 67.6%) of the papers was published within the first 36 mo in journals with mean (SD) impact factor of 2.62 (1.63). The factors significantly associated with subsequent publication were papers presented as award papers (P0.001), those reporting on Interventional trials (P0.001), and those from medical colleges (P0.05). On comparison of the conference abstracts with the subsequently published full-papers, 55% had a change in title; authors were changed in 65%, and participants' numbers were dissimilar in 8.6%.There is a need to identify the factors responsible for this low rate of subsequent publication, and interventions to improve it both at institutional and researchers' level.

INoEA is the International Network of Esophageal Atresia and consists of a broad spectrum of pediatric specialties and patient societies. The working group on long gap esophageal atresia set out to develop guidelines regarding the definition of long gap esophageal atresia, the best diagnostic and treatment strategies, and highlight the necessity of experience and communication in the management of these challenging patients. Review of the literature and expert discussion concluded that long gap esophageal atresia should be defined as any esophageal atresia that has no intra-abdominal air, realizing that this defines esophageal atresia with no distal trachea-esophageal fistula. Long gap esophageal atresia is considerably more complex than esophageal atresia with distal tracheo-esophageal fistulas, and should be referred to a center of expertise. The first choice is to preserve the native esophagus and pursue primary repair, delayed primary anastomosis or traction/growth techniques to achieve anastomosis. A cervical esophagostomy should be avoided if possible. Only if primary anastomosis is not possible, replacement techniques should be used. Jejunal interposition is proposed as the best option among the major esophageal atresia centers. In light of the infrequent occurrence of long gap esophageal atresia and the technically demanding techniques involved to achieve esophageal continuity, it is strongly advised to develop regional or national centers of expertise for the management and follow-up of these very complex patients.

Objectives Surgical intervention such as myringoplasty or tympanoplasty is an option in the current clinical management of chronic tympanic membrane perforation (TMP). Animal models of chronic TMP are needed for pre-clinical testing of new materials and to improve existing techniques. We evaluated several reported animal model techniques from the literature for the creation of chronic TMPs. The aim of this study was to evaluate production of chronic TMPs in a rat model using topical mitomycin C/dexamethasone, paper insertion into middle ear cavity (MEC) or re-myringotomy. Methods Forty male Sprague–Dawley rats underwent myringotomy of the right tympanic membrane (TM) and were randomly divided into 3 experimental groups: application of topical mitomycin C/dexamethasone, paper insertion into middle ear cavity, or re-myringotomy. Control perforations were allowed to close spontaneously. TMs were assessed regularly with otoscopy for 8 weeks. At the end of 8 weeks, animals were sacrificed for histology. Results The closure of TMPs was significantly delayed by mitomycin C/dexamethasone (mean patency, 18.9 days; P ≤ 0.01) compared with the control (mean patency, 7 days), but was not significantly delayed in the paper insertion group (mean patency, 9.4 days; P = 0.74). Repeated myringotomy of closed perforations (mean number of myringotomies, 8.9 per ear) stimulated acceleration of closure rather than delay. Histologically, the mitomycin C/dexamethasone group had almost normal TM morphology, while the paper insertion group revealed inflammatory and granulomatous responses. The re-myringotomy group had a thickened TM fibrous layer with collagen deposition. Conclusions Mitomycin C/dexamethasone delayed TMP closure in rats but the effect was not sufficiently long-lasting to be defined as a chronic TMP. Neither paper insertion into middle ear cavity nor re-myringotomy created chronic TMP in rats.

This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.

The use of the laparoscopic approach to perform antireflux procedures has increased dramatically since its introduction in 1991. To date, no prospective randomized studies comparing open surgery to the minimal invasive approach in children have been reported. Many retrospective reviews and case series have demonstrated that laparoscopic antireflux procedures are safe and effective once the learning curve is achieved. This position paper is coauthored by the New Technology Committee of the American Pediatric Surgery Association. The goal is to discuss the ongoing controversies and summarize the available evidence to identify the risks and benefits of laparoscopic antireflux procedures.

Pediatric empyema can be managed with a variety of modalities, and the evidence for an ideal management strategy is limited. Early or simple effusions can be treated with antibiotics alone or with drainage when respiratory distress occurs. Once fibrinopurulent empyema has developed, therapy may involve either chest tube placement with instillation of fibrinolytics or video-assisted thoracoscopic surgery with pleural decortication. In late or fibrotic empyema, an assumption persists that the fibrotic peel must be managed by decortication that can be done either thoracoscopically or through a minithoracotomy incision. This position paper is coauthored by the New Technology Committee of the American Pediatric Surgery Association. The goal is to discuss the ongoing controversies and summarize, in an evidence-based manner, the various treatment options and to suggest a reasonable therapeutic algorithm for the care of children with empyema.

OBJECTIVE Motor vehicle crashes are a leading source of pediatric morbidity and mortality in children younger than 13 years. Proper car seat safety device (CSD) markedly reduces mortality, but the majority of families misuse them. Emergency department (ED)-based educational interventions can improve knowledge patient regarding proper CSD use but historically have been resource intensive. Our study evaluated the utility of a novel educational intervention in improving patient knowledge of proper CSD use and in evaluating for proper CSD installation. METHODS Parents of children younger than 14 years presenting to the ED were given a paper-based quiz followed by a CSD-educational handout. Improvement in patient knowledge and evaluation for proper CSD installation were evaluated by repeat quiz and a phone-based survey 2 to 4 weeks later. RESULTS Parents exhibited an 18% improvement in quiz answers evaluating knowledge of proper CSD use (P value < 0.0001). Eighty-two percent and 72% of families felt that the intervention improved their understanding of proper CSD use and increased their awareness of their importance, respectively, but only 18% had their CSD checked by a professional. CONCLUSIONS A paper-based educational intervention in the pediatric ED is well received by parents, may improve patient knowledge surrounding proper CSD use, and encourages some families to get their CSDs checked for proper installation.

This paper describes the use of Interpretative Phenomenological Analysis (IPA) in qualitative research and its adaptability to medical research. Whilst presenting the main tenets of the approach, it also highlights its' strengths in helping medical professionals gain rich information about their service users' needs, symptoms and experiences, via research. It discusses the application of IPA on various levels such as by contextualising quantitative data or gaining insight into patients' understanding of clinical guidelines. The paper also describes methodological choices of the approach and the reasoning behind them. It outlines the sample, data collection tools and method of analysis utilised in IPA. To help researchers locate the particular use of this approach on the qualitative research landscape, this paper also compares its' use to that of other qualitative approaches. Finally, it discusses ways of evaluating IPA studies and hence, to ensure that such studies respect the philosophical roots of qualitative research in general, and those of IPA in particular.

This WASP (Write a Scientific Paper) Best Practice Guidelines (BPG) will wrap up all of the aspects pertaining to qualitative analyses as well as some more theoretical aspects of paper writing. These include types of studies and their importance in the hierarchy of evidence base as practiced in medicine. In addition, two papers review very practical aspects of paper writing including which journals to target (and why), and realistic methods for dealing with editors. Another paper also deals with fraud and hoax in science. Since the next BPG collection pertaining to WASP will deal with qualitative methods of analysis, by way of introduction to different ways of doing things, this collection will also review the practical differences between writing and presentation in the humanities and in the sciences. A paper will also very briefly review interdisciplinarity, including the depiction of interdisciplinarians as envisaged in future, in the (albeit speculative) science fiction genre. A final paper will demonstrate several precepts that have been highlighted over these BPGs, utilising as a practical example, a novel study that uses past requirements in order to estimate anticipated trends in cardiology service requirements at Mater Dei Hospital, Malta.

[No Abstract Available]

Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥8 days/month) asthma-like symptoms or recurrent (≥2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.L’asthme fait souvent son apparition avant l’âge de six ans. Cependant, il subsiste des incertitudes relativement à quand et comment un enfant d’âge préscolaire ayant des symptômes de type asthmatique peut être diagnostiqué avec cette condition. Ceci retarde le traitement et contribue à la morbidité à court et à long terme. L’Assemblée clinique sur l’asthme de la Société canadienne de thoracologie s’est associée à la Société canadienne de pédiatrie pour créer un groupe de travail conjoint afin de préparer un document de principes sur le diagnostic et la prise en charge de l’asthme chez les enfants d’âge préscolaire. En l’absence de mesures de la fonction pulmonaire, le diagnostic d’asthme devrait être envisagé chez les enfants de un à cinq ans ayant des symptômes de type asthmatique fréquents (≥8 jours/mois) ou des exacerbations récurrentes (≥2) (épisodes accompagnés de signes compatibles). Le diagnostic nécessite une documentation objective des signes cliniques ou un compte rendu parental convaincant de symptômes d’obstruction des voies respiratoires et de réversibilité de l’ obstruction (amélioration suite à un traitement pour l’asthme), ainsi que l’absence de suspicion clinique de tout autre diagnostic. La respiration sifflante, souvent accompagnée de difficultés respiratoires et de toux, est le signe cardinal de l’obstruction des voies respiratoires. La réversibilité à la suite de la prise de médicaments pour l’asthme se définie par l’observation directe par un professionnel de la santé compétent, d’une amélioration après l’administration de ß

Introduction: Allergic contact dermatitis (ACD) in children appears to be on the increase, and contact sensitization may already begin in infancy. The diagnosis of contact dermatitis requires a careful evaluation of a patient's clinical history, physical examination, and skin testing. Patch testing is the gold standard diagnostic test. Methods: Based on consensus, the EAACI Task Force on Allergic Contact Dermatitis in Children produced this document to provide details on clinical aspects, the standardization of patch test methodology, and suggestions for future research in the field. Results: We provide a baseline list of test allergens to be tested in children with suspected ACD. Additional tests should be performed only on specific indications.

OBJECTIVES: This European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position statement provides a comprehensive guide for health care providers to manage percutaneous endoscopic gastrostomy tubes in a safe, effective, and appropriate way.METHODS: Relevant literature from searches of PubMed, CINAHL, and recent guidelines was reviewed. In the absence of evidence, recommendations reflect the expert opinion of the authors. Final consensus was obtained by multiple e-mail exchange and during 3 face-to-face meetings of the gastroenterology committee of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.RESULTS: Endoscopically placed gastrostomy devices are essential in the management of children with feeding and nutritional problems. The article focuses on practical issues such as indications and contraindications.CONCLUSIONS: The decision to place an endoscopic gastrostomy has to be made by an appropriate multidisciplinary team, which then provides active follow-up and care for the child and the device.

Writing and publishing scientific papers have become requisites for all scientists (researchers and academics alike) to maintain their professional career. The prospects of writing a scientific paper are often regarded as somewhat daunting to the uninitiated. However a universal, well established structure format known as "IMRAD": i.e. Introduction, Methods, Results And Discussion has been established. This paper details this methodology.

Immunization is highly effective in preventing infectious diseases and therefore an indispensable public health measure. Allergic patients deserve access to the same publicly recommended immunizations as nonallergic patients unless risks associated with vaccination outweigh the gains. Whereas the number of reported possible allergic reactions to vaccines is high, confirmed vaccine-triggered allergic reactions are rare. Anaphylaxis following vaccination is rare, affecting less than 1/100,000, but can occur in any patient. Some patient groups, notably those with a previous allergic reaction to a vaccine or its components, are at heightened risk of allergic reaction and require special precautions. Allergic reactions, however, may occur in patients without known risk factors and cannot be predicted by currently available tools. Unwarranted fear and uncertainty can result in incomplete vaccination coverage for children and adults with or without allergy. In addition to concerns about an allergic reaction to the vaccine itself, there is fear that routine childhood immunization may promote the development of allergic sensitization and disease. Thus, although there is no evidence that routine childhood immunization increases the risk of allergy development, such risks need to be discussed. This article is protected by copyright. All rights reserved.

International child protection standards aim to ensure that non-governmental organisations ‘do no harm’ but the current approach to reporting abuse may actually leave children unprotected and, in some cases, expose them to greater risk. This discussion paper gives voice to concerns raised by local practitioners in Africa and places them within the context of available research in order to stimulate a debate aimed at enhancing the impact of current safeguards. Drawing on systems theory and the work of Pierre Bourdieu, the article illustrates how the current model of reporting often fails to take into account the significant disconnect between formal and informal protection mechanisms, as well as the unpredictability of individual decision-making. Examples from research and practitioner experience illustrate how reporting procedures may provide a route to protection which is impractical and undesirable to local people, and may ultimately be unhelpful to local practitioners. The article calls for further research to inform changes to the current approach and for a review of funding requirements in order that local organisations have greater scope to engage communities in the co-creation of procedures, thereby indigenising responses to ensure that they are realistic and genuinely respond to the specificities of children's lives. ‘The current approach to reporting abuse may actually leave children unprotected’ Key Practitioner Messages Formal reporting procedures may actually offer routes to protection that are inaccessible or unacceptable to local people. Reporting procedures should be developed with a much greater participation of local people. There is a need for investment in piloting and implementing locally led approaches to capacity building. The engagement of donors is critical in order to develop a new approach to evaluating ‘child safe’ organisations. ‘Procedures should be developed with a much greater participation of local people’

Objective Attention-deficit/hyperactivity disorder (AD/HD) is a common developmental disorder. Many reports have suggested that symptoms of AD/HD are related to frontal lobe dysfunctions, particularly disinhibition. However, measuring neurological findings with biomarkers during frontal functional tasks has sometimes been difficult in children with AD/HD. This study aimed to investigate frontal inhibitory function objectively in children with AD/HD during “rock, paper, scissors” (RPS) tasks, as a familiar game for Japanese children, using near-infrared spectroscopy (NIRS). Subjects and methods Eighteen children with AD/HD were compared with 27 typically developing children (TDC). Children from each group were divided into two age groups: younger, 6–10 years; and older, 11–16 years. Changes in oxygenated hemoglobin [oxy-Hb] were measured in the prefrontal region using NIRS during a ‘to lose’ RPS task, in which subjects were asked to present the RPS signal that would lose in response to one of the three signals displayed randomly on a computer screen every 2.0 s. Results The rate of correct performance with both TDC and AD/HD increased with age. Only in the older group, the rate of correct performance was significantly higher with TDC than with AD/HD. However, children with AD/HD in both age groups showed significantly lower [oxy-Hb] activity in the prefrontal region during the ‘to lose’ RPS task, particularly in the dorsolateral area. Conclusions Our results suggest that prefrontal region activation during the ‘to lose’ RPS task could offer a biomarker for diagnosing AD/HD, and may help in the early treatment of AD/HD.

This publication coincided with Juliet Hopkins’ 80th birthday in 2015 and is a collection of 12 papers gathered together into four sections: work with trauma; attachment theory; infant–parent psych...

The measurement of insulin-like growth factor I (IGF-I) from extracted whole dried blood spots on filter paper is a simple method allowing sample collection to be carried out by the patient at home. One drop of blood is applied to a filter card, air dried and posted to the laboratory. The IGF-I is dissociated from its binding protein by an acidification and neutralization procedure, and IGF-I is then measured by an enzyme-linked immunosorbent assay. Results from the analysis of IGF-I using blood spots on filter paper compared favourably with those from conventional methods, thus showing it to be an ideal and cost-effective technique for the measurement of IGF-I in both adults and children.

Evidence-based Practice in Child and Adolescent Mental Health (EPCAMH) is now accepting papers for a special issue focused on acute, intensive, and residential mental health services for youth, gue...

The academic world revolves around research which is both a requisite to achieve a degree, as well as part of the job description of academics. Obtaining a research grant is often essential in order to cover the running costs of a research project. Once a research proposal has been formulated, with the help of supervisors/collaborators, both tangible costs and non-tangible costs can be calculated. These predicted values are essential when applying for a research grant. Different funding opportunities are available from different sources, often both local and international. The latter funding bodies are usually either dedicated to a specific disease or process. It is essential to identify the appropriate funding opportunity according to the funding body's priorities and guidelines so that the grant can then be accordingly formulated. The great majority of funding sources issue competitive calls, so the aim of your application is not to show that the researcher deserves funds, but why the study in question is the one most deserving of the limited funds available. In any funding application, the strengths of the individual researcher/research group and the relevance of the project itself are the main two selling points. However, without a well prepared management plan, applications flounder. This paper will outline how best to target and formulate this approach.

Summary This is arguably the most exciting era in the treatment of Cystic Fibrosis (CF) with the emergence of potentially disease modifying therapies. The last year has seen fewer landmark papers, with the consolidation of existing knowledge and advances in the understanding of the patho-physiology and management of CF.

The calculation of descriptive statistics includes the calculation of standard error and confidence interval, an inevitable component of data analysis in inferential statistics. This paper provides pointers as to how to do this in Microsoft Excel™.

The plotting of data into graphs should be a mandatory step in all data analysis as part of a descriptive statistics exercise, since it gives the researcher an overview of the shape and nature of the data. Moreover, outlier values may be identified, which may be incorrect data, or true outliers, from which important findings (and publications) may arise. This exercise should always precede inferential statistics, when possible, and this paper in the Early Human Development WASP series provides some pointers for doing so in Microsoft Excel™.

Readers are drawn towards tables and figures (such as graphs) because these are perceived as easy reading, when compared to attempting to interpret a verbose account of the same content. Previous publications in these Best Practice Guidelines series have already given some basic instruction in Excel chart creation and in Excel automatic histogram creation. This paper will outline some more advanced instructions with regard to graphs and tables, along with suggestions pertaining to the general formatting of these items. Specific recommendations pertaining to Microsoft Excel will also be highlighted since this is the most commonly used charting software. At all times, graphs "should avoid prolixity, complexity and gaucheness and strive instead for simplicity, brevity, cogency and clarity."

Commentary on the original paper entitled “Can a home-based cardiac physical activity program improve and sustain quality of life and exercise capacity in children with Fontan circulation?”

Fecal microbiota transplantation (FMT) is becoming part of the treatment algorithms against recurrent Clostridium difficile infection (rCDI) both in adult and pediatric gastroenterology practice. With our increasing recognition of the critical role the microbiome plays in human health and disease, FMT is also being considered as a potential therapy for other disorders, including inflammatory bowel disease (Crohn disease, ulcerative colitis), graft versus host disease, neuropsychiatric diseases, and metabolic syndrome. Controlled trials with FMT for rCDI have not been performed in children, and numerous clinical and regulatory considerations have to be considered when using this untraditional therapy. This report is intended to provide guidance for FMT in the treatment of rCDI in pediatric patients.

Liver biopsy (LB) is still the criterion standard procedure for obtaining liver tissue for histopathological examination and a valuable tool in the diagnosis, prognosis, and management of many parenchymal liver diseases. The aim of this position paper is to summarise the present practice of paediatric LB and make recommendations about its performance. Although histological evaluation of the liver is important in assessing prognosis and exploring treatment, noninvasive techniques (ie, imaging, laboratory markers) may replace use of liver histology. The indications for LB are changing as present knowledge of aetiologies, pathomechanism, and therapeutic options in paediatric liver disease is evolving. Adult and paediatric literature was reviewed to assess the existing clinical practice of LB with focus on the technique, indications, risk of complications, and contraindications in paediatrics. This position paper presents types of LB, indications, complications, contraindications, and an essential checklist for paediatric LB.

New vaccines are being targeted to help protect the adolescent population from disease. The Society for Adolescent Medicine strongly urges compliance with adolescent vaccination recommendations provided by the Advisory Committee on Immunization Practices. These vaccines will significantly impact the health and well-being of the adolescent population. To enhance vaccination compliance and access to prevention health care and promotion, the Society supports linking vaccination to the three distinct comprehensive preventive health care visits already recommended by multiple organizations during early, middle, and late adolescence. In addition, multiple provider strategies should be used to increase vaccination rates among adolescents.

A simplified method for organic acidemia screening using GC/MS, the urease/direct method, is now available. To establish a practical screening system for organic acidemias, we studied the usefulness of dried urine filter paper (filter paper urine) and the application of a personal computer-based system of automated metabolic profiling and interpretation (automated system) that we earlier developed. In a comparison of filter paper urine with liquid urine, creatinine levels ranging from 4.6 to 122.5 mg/dl, showed an excellent correlation (r=0.9554), when the volumes of blotted urine and distilled water soaked were the same. Recovery of all 17 compounds except for citrate was similar between liquid and filter paper urine. CV values of 22 compounds tested ranged from 5.5 to 22.4% in the liquid urine, and from 7.7 to 29.8% in the filter paper urine. The CV values in stable isotope dilution analysis were much smaller in all nine compounds tested. As to the stability of compounds, the percentage changes to values at day 0 were within about ±25% on day 28. We compiled GC/MS data, including methylene unit values, quantifying and confirming ions of 163 different organic acids and others, to use the automated system. We analyzed specimens from 55 patients with 17 different metabolic disorders. In 54 of the 55 specimens, the correct diagnosis was successfully indicated. Neonatal mass screening for organic acidemias warrants ongoing attention using this simplified method and filter paper urine.

When writing up a grant application, the proposal has to be targeted to the funding source identified and being approached. However, some general rules apply in all cases. Provision of preliminary data may be useful and collaboration with well-known/published colleagues and top centres may also help and may be a prerequisite for some kinds of application. The quality and originality of the science is the main selling point as well as convincing the review board that you/your consortium are the best placed group to do the job. A strong organisational structure showing how the fund will be managed, as well as realistic targeted deliverables and a research timeline will help convince funding bodies/assessment boards of the likelihood that the team can handle the project. Before submission of the grant proposal, a more experienced grant writer should review the proposal. Using a checklist to assess adherence to the funding body's guidelines and grant submission guidelines is essential prior to submission.

Fetuses at low gestational age limit of viability, neonates with life threatening or life limiting congenital anomalies and deteriorating acutely ill newborn babies in intensive care, pose taxing ethical questions on whether to forego or stop treatment and allow them to die naturally. Although there is essentially no ethical difference between end of life decision between neonates and other children and adults, in the former, the fact that we are dealing with a new life, may pose greater problems to staff and parents. Good communication skills and involvement of all the team and the parents should start from the beginning to see which treatment can be foregone or stopped in the best interests of the child. This article deals with the importance of clinical ethics to avoid legal and moral showdowns and discusses accepted moral practice in this difficult area.

Research Ethics Committees are composed of a minimum of five members which include a lay person, a member from a different institution and at least another three members which should be versed in ethics. Legal and expert advisors can be sought by the committee. The REC will require a detailed protocol from the researcher including the curriculum of the principal investigator and all other researchers under him/her. The protocol should include all details of the research to be undertaken including a detailed description, the reasons for the research, literature pertaining to the research, a clear description of the target population, the actual consent form including what information is to be given to the participants, a declaration where necessary that things prohibited by the law (such as use of embryonic stem cells if this is the case in the country [2] will not be researchers, and a declaration that the relevant directives and rules and procedures which the REC falls under will be followed. The REC will also require a description of any risks and what actions are to be undertaken to eliminate hazards. The researchers must adhere only to the protocol given and any changes, minor or major, must be reported to the REC and approved.

Past experience in science has thought us the importance of ethics in research. Research is important to the advancement of medicine and therefore good clinical practice in research maintains public trust which otherwise is not only lost but may cause science to seem negative. The rights of participants in the research trial are discussed. This includes knowledge and information about the research itself, the obligations of the researchers and the rights of participants during the research. The EU Directive on Good Clinical Practice in research trials is reviewed, including the twelve principles of the directive. The function and composition of Research Ethics Committees is discussed in the context of protecting patients and participants, asserting quality and monitoring of the research, qualifications of the scientists and liability.

The increasing demand on academics and researchers to publish has led to the development of fake journals (also known as predatory journals). Such journals lack peer review and precipitate unfair criticism toward legitimate open access journals. Predatory journals tend to bombard a researcher's mailbox on a daily basis, inviting authors to submit a review/manuscript/opinion/short case to their journal while promising expedited publication – against a fee. This study assessed the unsolicited emails received over the period of November 2017 by a young and by a senior researcher. The young researcher received a substantially higher amount of emails (n = 101) compared to the senior researcher (n = 23). The article processing costs for solicited journals received, ranged between $49 and $3019. These journals are almost all only indexed in Google Scholar and do not display any meaningful journal metrics. Furthermore, the majority of the unsolicited emails were not relevant to the researcher's field of study. Therefore authors and readers alike should evaluate emails received with regard to journal legitimacy prior to submission of work to possibly predatory journals.