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Objective. To study developmental changes in the thickness of the cortex and its layers in the paramedian lobule of the cerebellum in children. Materials and methods. Studies were performed using post mortem specimens (62 cerebella) from children aged from birth to 12 years who had died as a result of trauma without brain injury. Computerized morphometry was used to measure the thickness of the cortex and its molecular and granular layers on Nissl-stained frontal histological sections of the cortex taken bilaterally from the area of the paramedian (thin) lobule (HVIIB) at the vertex of the cerebellar folia. Quantitative data were analyzed year by year. Results. Increases in cortical thickness in the paramedian lobule of the cerebellum occurred in four stages: in the right hemisphere from birth to 1, 3, 5, and 9 years, and in the left hemisphere to 1, 5, 7, and 9 years. Left-sided asymmetry of cerebellar cortical thickness was noted in children aged one and two years, and of molecular layer thickness in three-year-old children. Right-sided asymmetry was characteristic of granular layer thickness in three-year-old children and of cortical thickness in six-year-old children. The group mean thickness of the cortex and its layers in the paramedian lobule of the cerebellum reached the adult level by age nine years. Conclusions. The thickness of the cerebellar cortex and its layers in lobule HVIIB increased heterochronously and heterodynamically in the right and left cerebellar hemispheres in children in the first year of life and in the periods of the early, fi rst, and second periods of childhood (1–3 years, 4–7 years, and 8–12 years, respectively). No decreases were seen in the thickness of the cortex and its layers in the paramedian lobule of the cerebellum in children from birth to age 12 years.

Learning is one of the activities that can be managed in education, with this discussion entitled Creative Learning Methods Through Educational Game Tools in Forming Early Childhood Character, we can make learning in education more creative so that students do not experience boredom in following the learning process given. Creative learning methods through educational play tools in shaping early childhood character, can help character formation of students in education levels ranging from kindergarten, elementary, junior high, high school and up to higher education, as for the educational game tool in question is a game tool that can be played without any burden for students and can be enjoyed by those entering the adult level. With this creative learning method through educational play tools in shaping early childhood character, it can be enjoyed when they enter adolescence and adulthood, because interesting learning will always be remembered and can be applied various kinds of learning models that can foster children's creative power, so that patterns think children are getting more advanced and modern.

The research hypothesis starts from the premise that the level of adult body fat positively influences the possibility of practising physical exercise by the adult population, by maintaining an optimal level of physical condition. The object of the research is the model of growth and development of the adult, FEFSM students from the final year. The purpose of the research is the model of growth and development by analysing the body fat of adults, FEFSM students in accordance with the ability to have an optimal level of the specific physical condition. The practical value of the research is given by the possibility of developing growth and development models for adults.

Both training volume and overall physical activity (PA) play a role in young athletes’ sports performance and athletic development. The purpose of this study was to describe the training volume and PA of young athletes in endurance, aesthetics, ball games, and power sports. Questionnaire data (n = 671) were obtained from 15-year-old Finnish athletes on sports participation, along with accelerometer data (n = 350) assessing the amount and intensity of their PA. The athletes’ mean weekly training volume was 11 h 41 min. Objectively assessed PA amounted to 4 h 31 min daily, out of which 1 h 31 min was at a level of moderate-to-vigorous intensity (MVPA). Among 24% of the athletes, the weekly training volume (in hours) exceeded the recommended level of age-in-years, which might increase their risk of sports injuries. At the same time, one in six athletes (16%) did not—on average—reach the internationally recommended threshold level of at least 60 minutes of MVPA per day. Compared to girls, boys averaged 2.5 more hours of training per week, and had 21 more minutes of MVPA per day. Moreover, boys had a higher goal orientation than girls, with 52% of the boys and only 29% of the girls focused on success at adult level. Although total training volume and PA did not differ among sports types, there were differences in training forms, and in the proportions of MVPA. The young athletes were found to vary greatly in training forms, training volumes, MVPA, and goal orientation; hence, training should be planned individually, both for team sports and individual sports. peerReviewed

The period of emancipation in seabirds, when juveniles change from a terrestrial existence to a life at sea, is associated with many challenges. Apart from finding favourable foraging sites, they have to develop effective prey search patterns and physiological capacities that enable them to capture sufficient prey to meet their energetic needs. Animals that dive to forage, such as king penguins (Aptenodytes patagonicus), need to acquire an adequate breath-hold capacity, allowing them to locate and capture prey at depth. To investigate the ontogeny of their dive capacity and foraging performance, we implanted juvenile king penguins before their first departure to sea and also adult breeders with a data-logger recording pressure and temperature. We found that juvenile king penguins possess a remarkable dive capacity when leaving their natal colony, enabling them to conduct dives in excess of 100 m within their first week at sea. Despite this, juvenile dive/foraging performance, investigated in relation to dive depth, remained below the adult level throughout their first year at sea, probably reflecting physiological limitations as a result of incomplete maturation. A significantly shallower foraging depth of juveniles, particularly during their first 5 months at sea, could also indicate differences in foraging strategy and targeted prey. The initially greater wiggle rate suggests that juveniles fed opportunistically and also targeted different prey from adults and/or that many of the wiggles of juveniles reflect unsuccessful prey-capture attempts, indicating a lower foraging proficiency. After 5 months, this difference disappeared, suggesting sufficient physical maturation and improvement of juvenile foraging skills.

Effective time-motion analysis can provide information directly applicable to the design of physical conditioning and testing programmes. The aim of the present study was to determine the external output of female beach volleyball players during tournament match-play and to assess the effect of competition level, margin of score differential and alterations of external output within matches. The external output profile of ten adult level (age 27 ± 3 y) and ten under 23 (‘U23’; age 19 ± 2 y) female beach volleyball players were determined using GPS technology (10 Hz) during 60 matches (n = 50 first and second sets and 20 third sets files) played during their respective Australian Beach Volleyball Championship tournaments. Comparisons between groups and the influence of contextual factors on the external output within matches were analysed using linear mixed models. Adult beach volleyball players covered a greater relative distance (i.e., m·min-1) in speed zone 2 (1.0-1.99 m·s-1; 42.0% of total relative distance) and zone 3 (≥2.0 m·s-1; 10.9% of total relative distance) compared to U23 players. Relative distance, mean acceleration/deceleration and the relative distance covered in acceleration zone 2 and deceleration zone 2 and 3 was greater in set 1 compared to set 2. Sets that were decided by smaller score margins (5-point score differential). The findings from this study suggest that there are contextual factors that influence the speed and acceleration/deceleration profile of female beach volleyball players such as tournament level, score margin and set-to-set variations that may have implications for the physiological and mechanical requirements of female players preparing for competition.

INTRODUCTION Computed tomography (CT) is the criterion standard for identifying blunt trauma injuries in pediatric patients, but there are long-term risks of CT exposure. In pediatric blunt trauma, multiple studies have shown that increased CT usage does not necessarily equate to improvements in mortality. The aim of this study was to compare CT usage between level 1 pediatric trauma centers versus level 2 pediatric centers and adult level 1 and 2 centers. METHODS We performed a retrospective, multicenter analysis of National Trauma Data Bank patient records from the single admission year of 2015. Eligible subjects were defined as younger than 18 years with abdominal or thoracic blunt trauma, had an Injury Severity Scale score of greater than 15, and were treated at a level 1 or 2 trauma center. Data were then compared between children treated at level 1 pediatric trauma centers (PTC group) versus level 2 PTCs or adult level 1/2 trauma centers (ATC group). The primary outcomes measured were rates of head, thoracic, abdominal CT, and mortality. Data from ATC and PTC groups were propensity matched for age, sex, race, and Glasgow Coma Scale. RESULTS There were 6242 patients after exclusion criteria. Because of differences in patient demographics, we propensity matched 2 groups of 1395 patients. Of these patients, 39.6% of PTC patients received abdominal CT versus 45.5% of ATC patients (P = 0.0017). Similarly, 21.9% of PTC patients received thoracic CT versus 34.7% of ATC patients (P < 0.0001). There was no difference in head CT usage between PTC and ATC groups (P = 1.0000). There was no significant difference in mortality between patients treated in the PTC versus ATC groups (P = 0.1198). CONCLUSIONS Among children with severe blunt trauma, patients treated at level 1 PTCs were less likely to receive thoracic and abdominal CTs than those treated at level 2 pediatric or adult trauma level 1/2 centers, with no significant differences in mortality. These findings support the use of selective imaging in severe blunt pediatric trauma.

Objective Report eccentric knee flexor strength values of elite Gaelic football players from underage to adult level whilst examining the influence of body mass and previous hamstring injury. Design Cross-sectional study. Setting Team's training facility. Participants Elite Gaelic football players (n = 341) from under 14 years to senior age-grades were recruited from twelve teams. Main outcome measures Absolute (N) and relative (N·kg −1 ) eccentric hamstring strength as well as corresponding between-limb imbalances (%) were calculated for all players. Results Mean maximum force was 329.4N (95% CI 319.5–340.2) per limb. No statistically significant differences were observed in relative force values (4.4 N ·kg −1 , 95% CI 4.2–4.5) between age-groups. Body mass had moderate-to-large and weak associations with maximum force in youth (r = 0.597) and adult (r =0 .159) players, respectively. Overall 40% (95 CI 31.4–48.7) presented with a maximum strength between-limb imbalance >10%. Players with a hamstring injury had greater relative maximum force (9.3%, 95% CI 7.0–11.8; p > 0.05) and a 28% (95% CI 10.0–38.0) higher prevalence of between-limb imbalances ≥15% compared to their uninjured counterparts. Conclusions Overlapping strength profiles across age-groups, combined with greater strength in previously injured players, suggests difficulties for establishing cut-off thresholds associated with hamstring injury risk.

Rural trauma education emphasizes that radiologic imaging should be discouraged if it delays transfer to definitive care. With increased capacity for image sharing, however, radiography obtained at referring hospitals (RH) could help providers at trauma centers (TC) prepare for patients with traumatic brain injury. We evaluated whether a head CT prior to transfer accelerated time to neurosurgical intervention at the TC. The study was conducted at a combined adult Level I and pediatric Level II TC with a catchment area that includes rural hospitals within a 150 mile radius. The trauma registry was used to identify patients with traumatic brain injury who went to surgery for a neurosurgical procedure immediately after arrival at the TC. All patients were transferred in from a RH. Differences between groups were assessed using analysis of variance and chi-square. Fifty-six patients met study criteria during the study period (2010-2015). The majority (86%) of patients received head CT imaging at the RH, including a significant percentage of patients (18%) who presented with GCS ≤8. There was no statistically significant decrease in time to surgery when patients received imaging at the RH. CTimaging was associated with a delay in transfer that exceeded 90 minutes. Findings demonstrate that imaging at the RH delayed transfer to definitive care and did not improve time to neurosurgical intervention at the TC. Transfer to the TC should not be obstructed by imaging, especially for patients with severe TBI.

BackgroundEmergency department (ED) crowding is a critical problem in the delivery of acute unscheduled care. Many causes are external to the ED, but antiquated operational traditions like triage also contribute. A physician intake model has been shown to be beneficial in a single-centre study, but whether this solution is generalisable is not clear. We aimed to characterise the current state of front-end intake models in a national sample of EDs and quantify their effects on throughput measures.MethodsWe performed a descriptive mixed-method analysis of ED process changes implemented by a cross section of self-selecting institutions who reported 2 years of demographic/operational data and structured process descriptions of any ‘new front-end processes to replace traditional nurse-based triage’.ResultsAmong 25 participating institutions, 19 (76%) provided data. While geographically diverse, most were urban, academic adult level 1 trauma centres. Thirteen (68%) reported implementing a new intake process. All were run by attending emergency physicians, and six (46%) also included advanced practice providers. Daily operating hours ranged from 8 to 16 (median 12, IQR 10.25–15.85), and the majority performed labs, imaging and medication administration and directly discharged patients. Considering each site’s before-and-after data as matched pairs, physician-driven intake was associated with mean decreases in arrival-to-provider time of 25 min (95% CI 13 to 37), ED length of stay 36 min (95% CI 12 to 59), and left before being seen rate 1.2% (95% CI 0.6% to 1.8%).ConclusionsIn this cross section of primarily academic EDs, implementing a physician-driven front-end intake process was feasible and associated with improvement in operational metrics.

We present a case of a 10-year-old girl shot in the thigh by a stray bullet who had a favorable outcome when treated with a multidisciplinary approach at the nearest nonpediatric level II trauma center. Point-of-care thromboelastography facilitated effective resuscitation based on her coagulation profile, minimized blood product use, and allowed for damage-control surgery to stabilize and revascularize her complex femur fracture.

Background. Latvian sports authorities under the Ministry of Education and Science are the main organisers of the sports life in Latvia. However, they have not been successful in providing equally good support to all athletes who need it. It is especially difficult to receive support for improving skills of individual athletes engaged in team sports. Often it is the individual mastery of an athlete that prohibits them from moving on to the adult level of sports of high achievement, even if the athlete was very talented and one of the best in the country when he/she was young. Methods. The descriptive statistics method and content analysis were used to assess shortcomings in the allocation of finances in the Latvian sports industry. Conclusions were drawn on the data collected, on the basis of which a new method was developed in sports management, the efficiency of which was verified by performing an experiment. Results. After analysing the most popular sports among young people in the country, as well as the available infrastructure, it may be suggested which sports are the most attractive for investors. It may be concluded that the state is able to successfully solve this problem by attracting private investors who would be personally interested in the development of athletes and also carry out successful investment management. The study demonstrated that a successful process of private investments ensures a positive return on the investments, as well as the development of athletes. One way to build successful cooperation is by creating high-quality sports development centres or sports investment management companies which will efficiently contribute to athletes’ transition from youth to professional sports. The efficiency of the methodology developed can be demonstrated by creating a company which would act as an example for attracting private investments in the development of athletes. Conclusion. The development of athletes would become more efficient and purposeful if sports could attract potential investments with promising returns. This would create a tripartite cooperation among the state, athletes and private investors, which would benefit each of the three cooperating parties. Additional funding in the development of Latvian athletes would have a positive impact on the entire sports industry as a whole. Keywords: Latvian sports, private investments, sports funding, massive sports system, investment criteria, high-class sports, sports development, efficient investment management

In human, no studies are available regarding changes in kisspeptin1 receptor (KISS1R) sensitivity during pubertal transition. In this study, healthy boys were classified into 5 Tanner stages of puberty (n=5/stage). Human kisspeptin-10 was administered to boys at each Tanner stage and to adult men (n=5) as an IV bolus for comparison. Serial blood samples were collected for 30 min pre- and 120 min post-kisspeptin injection periods at 30 min interval for measuring plasma LH and testosterone levels. There was insignificant effect of kisspeptin on LH and testosterone levels in boys of Tanner stages I–III. At Tanner stage IV, the effect of kisspeptin on plasma LH was insignificant. However, a paired t-test on a log-transformed data showed a significant (P<0.05) increase in mean peak post-kisspeptin testosterone level. In Tanner stage V, a significant (P<0.05) increase was observed in mean post-kisspeptin peak LH level as compared to the mean basal LH value. Post-kisspeptin plasma testosterone levels were also significantly (P<0.05) increased as compared to the pre-kisspeptin level in Tanner stage V. Our data suggest that sensitivity of KISS1R on GnRH neurons with reference to LH stimulation in boys develops during the later part of puberty reaching to adult level at Tanner stage V. This trial is registered with WHO International Clinical Trial Registration ID NCT03286517.

Context:Abnormal scapular kinematics during throwing motion in baseball players with shoulder disorders has not yet been clarified, although altered scapular position has been suggested to be associated with shoulder disorder.Objective:To determine if the shoulders of baseball players with throwing disorders demonstrate abnormal scapular kinematics during the simulated arm-cocking phase of throwing activity.Design:Cross sectional study.Setting:Laboratory.Participants:Eleven baseball players (age 21.1 ± 1.2 y) with a unilateral shoulder disorder volunteered to participate, including 9 players at the college level and 2 at the adult level. The mean playing experience was 12.1 ± 2.7 y.Main Outcome Measures:Scapular upward/downward rotation, anteroposterior tilting, and external/internal rotation during simulated arm-cocking motion were analyzed using a 3-to-2-dimensional registration technique.Results:Scapular external rotation in the throwing shoulder was significantly smaller by 2.0–6.0° than that of the contralateral shoulder. There were no detectable differences in scapular upward/downward rotation or anteroposterior tilting between the throwing and contralateral shoulders.Conclusions:Compared with that in the contralateral shoulder, scapular external rotation was smaller in the throwing shoulder, which would increase glenohumeral horizontal abduction during the arm-cocking phase and be related to the throwing-shoulder disorder.

With changing weaponry associated with injuries in civilian trauma, there is no clinical census on the utility of presacral drainage (PSD) in penetrating rectal injuries (PRIs), particularly in pediatric patients.Patients with PRI from July 2004-June 2014 treated at two free-standing children's hospitals and two adult level 1 trauma centers were compared by age (pediatric patients ≤16 years) and PSD. A stratified analysis was performed based on age. The primary outcome was pelvic/presacral abscess.We identified 81 patients with PRI; 19 pediatric, 62 adult. Forty patients had PSD; only three pediatric patients had a drain. Adult patients were more likely to have sustained gunshot wounds (84%), whereas pediatric patients were more likely to sustain impalement injuries (59%). Pediatric patients were more likely to have distal extraperitoneal injuries (56% versus 27% in adults, P = 0.03). PSD was more common in adult patients (59% versus 14%, P = 0.0004), African-Americans (71% versus 11% Caucasian, P 0.01), and those sustaining gun shot wounds (63% versus 18% impalement, P 0.01); only race remained significant in stratified analysis for both adult and pediatric patients. There were three cases of pelvic/presacral abscess, all in the adult patients (P = 0.31); one patient with PSD and two without PSD (P = 0.58). In stratified analysis, there were no differences in any infectious complication between those with and without PSD.Pelvic/presacral abscess is a rare complication of PRI, especially in pediatric patients. PSD is not associated with decreased rates of infectious complications and may not be necessary in the treatment of PRI.

The physical activity (PA) plays an important role in the fight against the chronic noncommunicable diseases.The objective of this study was to assess the level of physical activity in an adult population in rural and urban area in Côte d'Ivoire. To achieve this goal, a group of 1046 participants was submitted to the Global Physical Activity Questionnaire (GPAQ). The data analysis was done according to the GPAQ guidelines. The prevalence of the recommended level of the physical activity during the work, the leisure and the displacement was calculated.This assessment has showed that the intense Physical Activity (PA) decreased with age, from 34% (19-29 years) to 14% (50-60 years).Then the results have showed that the workers had the highest intensity Physical Activity Level (NAP) at 70%, versus 13% for the office workers.Moreover, more the Level of Study (LS) was higher, more the physical activity practiced decreased, whatever the area of living. Finally, it has been shown that men were more active than women. Also, the level of physical activity was higher in rural than in urban areas, and the limited physical activity level was present in the adult population. This work has shown that the level of physical activity and the contexts of practice vary according to the socio-demographic characteristics. At that fact, targeted interventions to promote the physical activity are necessary.

The aim of this study was to develop a children's version of the Cantonese Hearing in Noise Test (CHINT-C). This was accomplished in two stages. First, a total of 120 sentences understood by children aged 6-7 years were selected from the original pool of CHINT sentences and were grouped into 12 lists, each containing 10 sentences composed of 10 characters. Following this, 260 primary and secondary school children, with ages ranging from 6 to 17 years, and 21 adults of age 18 or older were administered the CHINT-C to determine its reliability/validity, normative data, and age-specific correction factors. The result showed good interlist reliability, and test–retest reliability for the CHINT-C. The speech perception skills assessed using the CHINT-C do not reach adult level until after 11-13 years of age. Correction factors were established that could be used to determine age-specific norms for the evaluation of speech intelligibility of children in various sound fields.

Localization of tactile stimuli to the hand and digits is fundamental to somatosensory perception. However, little is known about the development or genetic bases of this ability in humans. We examined tactile localization in normally developing children, adolescents, and adults and in people with Williams syndrome (WS), a genetic disorder resulting in a wide range of severe visual-spatial deficits. Normally developing 4-year-olds made large stimulus-localization errors, sometimes across digits, but nevertheless their errors revealed a structured internal representation of the hand. In normally developing individuals, errors became exponentially smaller over age, reaching the adult level by adolescence. In contrast, people with WS showed large localization errors regardless of age and a significant proportion of cross-digit errors, a profile similar to that of normally developing 4-year-olds. Thus, tactile localization reflects internal organization of the hand even early in normal development, undergoes substantial development in normal children, and is susceptible to developmental, but not organizational, impairment under genetic deficit.

Many auditory skills continue to develop beyond infancy and even into adolescence, but the factors underlying this prolonged development remain poorly understood. Of interest here is the contribution of on-line statistical learning of stimulus repetitions (anchoring) to the development of auditory spectral and temporal discrimination, as well as the potential contributions of auditory attention and working memory. Children, aged 6–13 years, as well as adults (age range: 21–33 years) were tested on auditory frequency and duration discrimination. Each type of discrimination was measured in two conditions (XAB and XXXAB) designed to afford different levels of anchoring by varying the number of repetitions of a standard stimulus (X) prior to the presentation of the test tone (A or B) in each trial. Auditory attention and working memory were also assessed. Whereas duration and frequency discrimination in either condition did not reach adult level prior to 11 years of age, the magnitude of the anchoring effect was similar across ages. These data suggest that perceptual anchoring matures prior to the attainment of adult-like discrimination thresholds. Likewise, neither attention nor working memory could account for the observed developmental trajectories. That auditory discrimination and anchoring follow dissociable developmental trajectories suggests that different factors might contribute to the development of each. We therefore conclude that although anchoring might be necessary for attaining good auditory discrimination, it does not account for the prolonged development of auditory frequency and duration discrimination in school-aged children.

The purpose of this study was to investigate the frequency and characteristics of injury and musculo-skeletal complaints in Swiss football referees of all levels. A representative sample of 489 Swiss referees was interviewed regarding their socio-demographic characteristics, refereeing qualifications, time spent in training and in matches, history of injuries and musculo-skeletal complaints caused by training or refereeing, and other medical problems. A total of 110 referees (22.5%) reported having suffered at least one injury related to officiating, and 126 referees (25.8%) at least one refereeing-related musculo-skeletal complaint. Thigh strains and ankle sprains were the most frequent injuries, with the most frequent locations of complaints being the knee and lower back. The incidence of match injuries in the last 12 months was on average 2.06 per 1000 match hours; the incidence of training injuries was substantially lower (0.09 per 1000 training hours). The injury rates were similar for referees officiating at an adult level, but lower at a junior level. In comparison with elite football referees, the incidence of training injuries and the prevalence of musculo-skeletal complaints were lower in amateur referees. Nevertheless, preventive programs are indicated for referees at all levels, especially when considering the length of a referee's career.

Background: Neonatal sepsis is frequently associated with multiple hematologic abnormalities, including depletion of protein C. The status of protein C is not known in infants who clinically present with a sepsis-like picture without a culture-proven sepsis. The objectives of this study were to determine whether sepsis-like illness is associated with a reduction in protein C. Methods:In this case-control, cross-sectional study, 49 full-term neonates admitted to the neonatal intensive care unit (NICU) with the clinical manifestation of sepsis that was not proven by cultures. Fifty healthy full-term newborns were also randomly selected as a control group. Protein C concentrations were compared between both groups. Results: There was no difference between the case and control groups regarding sex and gestational age. Protein C concentration did not differ between groups (p > 0.05); mean protein C concentration was 29.4% of the normal adult level in cases with clinical sepsis and 32% in the control group. Conclusion: Protein C deficiency was not related to clinical manifestations in sepsis-like illness. Further studies examining other predictors of sepsis-like illness are recommended.

Summary Introduction It has been established that patients with congenital diseases, including spina bifida (SB) are often lost to routine medical care in young adulthood. While the reasons for this observation are not entirely defined, many believe it is multifactorial. Objective This study sought to characterize self-reported barriers to transition among adults with SB who failed to transition to adult urological care. Study design This study, conducted at two tertiary centers with established adult myelomeningocele multidisciplinary clinics, enrolled patients with SB who had not been seen in >18 months. A visit was scheduled and upon arrival patients were provided a questionnaire with 22 yes/no questions about barriers to arranging a visit and eight questions regarding their health issues. Questions were categorized as relating to patient factors, provider factors, and system factors. To facilitate targeted areas of improvement, patient factors were further subdivided into self-management/support (SMS), preferences, and education, and provider factors into knowledge, communication, and location. System factors included only questions related to insurance issues. The questionnaire was uncomplicated, which eliminated the need for assistance when answering the questions. Results There were 27 questionnaires collected. Overall, a total of seven patients (26%) identified no barriers to follow-up, eight identified one barrier (30%), and 12 (44%) identified more than one barrier. Patient factors made up approximately 52% (28 of 54 total “Yes” responses) of all barriers, with Preference being the largest contributor (30%, 16/54) (Fig.). Provider factors accounted for about 37% (20/54) of all barriers, with the Communication (26%, 14/54) subcategory making up the vast majority. System factors contributed only 11% (6/54) of all barriers. The majority of patients (18/27, 67%) reported having a new health issue since their last visit to their pediatric urologist, with only five of 18 (28%) seeking urological care. Discussion This study demonstrated that the decision to pursue adult urologic care is multifactorial. The questionnaire may not have captured all of the reasons SB patients are lost to follow-up, as a quarter of patients did not identify a barrier. Limitations of this study include the small number of participants, use of only two study locations, and the closed-ended nature of the questionnaire. Conclusion Multiple factors contribute to the SB patient's decision to pursue adult urologic care. Targeted areas of improvement include provider communication at both the pediatric and adult level, as well as education regarding patient preferences and SMS. Download : Download high-res image (118KB) Download : Download full-size image Figure . Overall proportion of barriers to establishing follow-up among adults with spina bifida. SMS = self-management/support.

Groups of 8-16 rats at various ages (20, 26, 32, 42 days old and adult animals) were injected subcutaneously with morphine and the degree of analgesia measured, using the hot plate technique, at 30, 60, 90, 120 and 150 min. after the injection. The rise and decline of analgesia war steeper in animals in the younger age groups than in the 42 days old or in the adult animals. The degree of analgesia was thus at a maximum at 30 or 60 min. in the 20, 26 and 32 days old rats, whereas a peak analgesic effect was measured at 60 or 90 min. in the 42 days old and the adult animals. Sensitivity to morphine analgesia was greatest in the youngest age group and then gradually declined towards the adult level. When comparisons were made at the height of analgesia, 7,5-10 times greater doses were required in the adult animals in order to produce a degree of analgesia of the same order of magnitude as that obtained in the 20 days old animals. At the age of 26 days the difference in sensitivity was about threefold and approximately twofold at the age of 32 days. The analgesic effect was very similar in the 42 days old rats and in the adult animals. The high degree of sensitivity to morphine analgesia in the 20 days old animals was matched by very high amounts of morphine in the brain 40 min. after the subcutaneous injection of 5 mg/kg morphine labelled with 14C in the aminomethyl group. The amounts of morphine in the brain of the 26 days old rats were thus less than one half of that found in the brain of the youngest animals. Brain levels of morphine in the 26 days old animals were significantly different from those in the brain of 42 days old and adult rats but not from those found in the brain of the 32 days old animals. The amounts of morphine in the brain of the 32 days old animals did not differ significantly from that found in the 42 days old or in the adult animals. The ratio between the amounts of morphine in plasma versus brain increased gradually with age (20 days old animals: 1.77; adult animals: 3.44). Accessability of morphine to the brain thus decreased with age by a factor of two. It was accordingly concluded that the relatively lower amounts of morphine in the brain could to a certain extent, at any rate, explain the lower sensitivity in the older than in the younger rats. The results also indicate that the sensitivity to morphine analgesia may decrease per se with age. Analgesic experiments with young of mothers treated with morphine late in pregnancy showed that the highest degree of analgesia obtained was the same as that in the respective control young. It was, however, found that analgesia declined faster in the morphine treated young than in the control young in the 20 and 26 days groups (the degree of analgesia was significantly lower at 90 min. in the morphine treated young), whereas this was not the case in the 32 or 42 days old rats. This was taken as a sign of residual tolerance to morphine. Residual tolerance (significantly lower analgesic effect of morphine at 90 and 120 min.) was also observed in the mothers 42 days after delivery, following treatment with morphine during pregnancy. The young of the morphine treated mothers weighed significantly less at the age of 20 and 26 days than the control young. This difference however, was not seen after 4 weeks of age.

Normative data on the simple acoustic reaction time were obtained from 56 children without neurological or psychiatric symptoms aged between four and 14 years, and the results were compared with those for an adult reference group. Mean reaction times declined precipitously from 465 msec at age five to 190 msec at 15 years. The relationship between reaction time and age during childhood can be described by a linear equation in a log-log system. The adult level is achieved at 16 years.

Contrast sensitivity is one of several factors necessary to obtain good visual quality. The aim of this study was to develop normal data on the Cambridge Low Contrast Gratings test in children and to compare these data with data from a group of children with developmental delay. Ninety-nine normal children (aged 2-14 years) and 146 children with developmental delay were tested with the contrast sensitivity test. All children had normal visual acuity and stereopsis. The normal children had an age-dependent development in contrast sensitivity, and adult level was reached after the age of 10 years. A significantly lower score was found in children with developmental delay compared to normal children. The Cambridge Low Contrast Gratings test is suitable for preschool children and children with developmental delay because of its simplicity, and it might be a valuable tool in diagnosing ophthalmologic diseases in children with developmental delay.

Physical and psychological differences related to birthdate amongst athletes of the same selection year have been characterised as the “relative age effects” (RAEs). RAEs have been identified in a variety of sports, both at youth and adult level, and are linked with dropout of athletes and a reduction of the talent pool. This study examined the existence, mechanisms and possible solutions to RAEs using qualitative methodology. Seven experts in the field of talent identification and development were interviewed. Inductive analysis of the data showed that, while there was mixed evidence for the existence of RAEs across sports, the eradication of RAEs was attributed to controllable features of the development environment. The factors reported included the structure of “categories” used to group athletes within the sport (e.g. age, weight, size, skills), recognition and prioritisation of long-term development over “short term win focus.” Education of relevant parties (e.g. coaches, scouts, clubs) about RAEs and the nature of “talent” within a long-term context was suggested, along with careful consideration of the structure of the development environment (e.g. delayed selection, provision for late developers, focus on skills not results, use of challenge). Implications for research and practice are discussed.

We investigated the impact of early childhood and adulthood bilingualism on the attention system in a group of linguistically and culturally homogeneous children (5- and 6-year olds) and young adults. We administered the child Attention Network Test (ANT) to 63 English monolingual and Korean-English bilingual children and administered the adult ANT to 39 language- and culture-matched college students. Advantageous bilingual effects on attention were observed for both children and adults in global processing levels of inverse efficiency, response time, and accuracy at a magnitude more pronounced for children than for adults. Differential bilingualism effects were evident at the local network level of executive control and orienting in favor of the adult bilinguals only. Notably, however, bilingual children achieved an adult level of accuracy in the incongruent flanker condition, implying enhanced attentional skills to cope with interferences. Our findings suggest that although both child and adult bilinguals share cognitive advantages in attentional functioning, age-related cognitive and linguistic maturation differentially shapes the outcomes of attentional processing at a local network level.

Tissue samples of inferior colliculus and cerebellar cortex were obtained from rat brains at various postnatal developmental stages. Samples were analysed by two-dimensional SDS gel electrophoresis. Spots of proteins and their variants were visualized with automated silver staining, the number of spots was determined with a computer-based image analysis system, and age groups were statistically compared. Judging from the waxing and waning of protein spot numbers, colliculus and cerebellum take distinctly different routes through postnatal development. Whereas molecular complexity in the colliculus was initially high, it decreased soon after the onset of hearing and settled on a significantly lower adult level. By contrast, the cerebellum initially showed low molecular complexity, rose sharply in complexity to reach highest values at late juvenile stages corresponding to peak scores of explorative behaviour, and fell off again to an adult level that remained, however, significantly higher than that of the colliculus. We conclude that the changing diversity of proteins may be used to identify landmarks in brain development.