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All 6 WHO regions have committed themselves to eliminate measles. (1) The aim of the Immunization Agenda 2021-2030 (IA2030) (2) is to achieve regional targets as a core indicator of [...]

Human languages typically employ a variety of spatial metaphors for time (e.g., "I'm looking forward to the weekend"). The metaphorical grounding of time in space is also evident in gesture. The gestures that are performed when talking about time bolster the view that people sometimes think about regions of time as if they were locations in space. However, almost nothing is known about the development of metaphorical gestures for time, despite keen interest in the origins of space-time metaphors. In this study, we examined the gestures that English-speaking 6-to-7-year-olds, 9-to-11-year-olds, 13-to-15-year-olds, and adults produced when talking about time. Participants were asked to explain the difference between pairs of temporal adverbs (e.g., "tomorrow" versus "yesterday") and to use their hands while doing so. There was a gradual increase across age groups in the propensity to produce spatial metaphorical gestures when talking about time. However, even a substantial majority of 6-to-7-year-old children produced a spatial gesture on at least one occasion. Overall, participants produced fewer gestures in the sagittal (front-back) axis than in the lateral (left-right) axis, and this was particularly true for the youngest children and adolescents. Gestures that were incongruent with the prevailing norms of space-time mappings among English speakers (leftward and backward for past; rightward and forward for future) gradually decreased with increasing age. This was true for both the lateral and sagittal axis. This study highlights the importance of metaphoricity in children's understanding of time. It also suggests that, by 6 to 7 years of age, culturally determined representations of time have a strong influence on children's spatial metaphorical gestures.

We investigated whether the developmental emergence of episodic future thinking (EFT) is associated with performance on a type of delay of gratification task: a delay choice task that involved choosing between a small reward now or a larger reward the next day. In Study 1, 4- to 5-year-olds' (N = 99) EFT as measured by a tool saving task was significantly associated with performance on the delay choice task, but this was not the case for other EFT measures. Study 2 compared the performance of 4- to 5-year-olds (N = 130) on the delay choice task when cued to think about either a future, past, or habitual event versus a no-cue baseline. Overall, cuing impaired performance on the delay choice task. Although EFT does show a relation to performance in a delay choice task in preschoolers, deliberately engaging in thought about future events may be too taxing in young children to reliably enhance the ability to make future-oriented decisions.

The proper design of near-infrared light-absorbing agents enables efficient optoacoustic imaging-guided phototherapy. In particular, several croconaine-based organic agents with excellent optical properties have been recently reported for this purpose. However, most of them absorb light below 800 nm, limiting deep-tissue imaging applications. To this end, we utilized a recently described novel croconaine derivative (CR880) to develop CR880-based nanoparticles (CR880-NPs) for effective in vivo delivery, deep tissue optoacoustic imaging and photothermal therapy applications. Radicals and strong π–π stacking in CR880 result in an 880 nm absorption peak with no blue-shift upon condensing to the solid phase. DSPE-PEG2000-formulated CR880-NPs exhibited high optoacoustic generation efficiency and photostability, and could be visualized in the tumors of three different mouse tumor models (breast, brain, and colon tumor) with high image contrast. The high photothermal conversion efficiency of CR880-NPs (∼58%) subsequently enabled efficient in vivo tumor elimination using a low energy laser, while remaining biocompatible and well-tolerated. This work introduces a promising novel agent for cancer theranostics of challenging deep-seated tumors.

Whereas some evidence exists that math anxiety may interfere with math performance from the very beginning of primary school, no study to date has attempted to investigate whether math anxiety may also interfere with early math learning (i.e., the encoding of new math knowledge) and not only with recalling already mastered contents in test situations. Across 2 experiments carried out in 2 different countries (Study 1: N = 115, conducted in Italy; Study 2: N = 120, conducted in the United Kingdom), we addressed this question by presenting 6-year-old children with 2 math contents that had not been covered by their school curriculum before the study. Children were tested immediately before and immediately after the learning phase, and after a 1-week delay. Longitudinal models revealed that math anxiety was negatively related to initial level of knowledge in the case of 3 out of 4 math contents. More importantly, math anxiety was also negatively related to rate of learning in 2 out of 4 tasks (1 task in Study 1 and 1 in Study 2). These studies provide the first evidence that math anxiety may reduce the encoding of novel math contents in memory in very young children, potentially leading to cumulative gaps in math proficiency for children with math anxiety from the very beginning of their formal education.

BackgroundAppendicitis is a common surgical emergency in children, yet diagnosis can be challenging. An electronic health record (EHR) based, clinical decision support (CDS) system called Appy CDS was designed to help guide management of pediatric patients with acute abdominal pain within the Health Care Systems Research Network (HCSRN).ObjectivesTo describe the development and implementation of a clinical decision support tool (Appy CDS) built independently but synergistically at two large HCSRN affiliated health systems using well-established platforms, and to assess the tool's Triage component, aiming to identify pediatric patients at increased risk for appendicitis.ResultsDespite differences by site in design and implementation, such as the use of alerts, incorporating gestalt, and other workflow variations across sites, using simple screening questions and automated exclusions, both systems were able to identify a population with similar appendicitis rates (11.8 percent and 10.6 percent), where use of the full Appy CDS would be indicated.DiscussionThese 2 HCSRN sites designed Appy CDS to capture a population at risk for appendicitis and deliver CDS to that population while remaining locally relevant and adhering to organizational preferences. Despite different approaches to point-of-care CDS, the sites have identified similar cohorts with nearly identical background rates of appendicitis.Next stepsThe full Appy CDS tool, providing personalized risk assessment and tailored recommendations, is undergoing evaluation as part of a pragmatic cluster randomized trial aiming to reduce reliance on advanced diagnostic imaging. The novel approaches to CDS we present could serve as the basis for future ED interventions.

With the advent of interoperability standards such as FHIR, SMART, CDS Hooks, and CQL, interoperable clinical decision support (CDS) holds great promise for improving healthcare. In 2018, the Agency for Healthcare Research and Quality (AHRQ)-sponsored Patient-Centered CDS Learning Network (PCCDS LN) chartered a Technical Framework Working Group (TechFWG) to identify barriers, facilitators, and potential solutions for interoperable CDS, with a specific focus on addressing the opioid epidemic. Through an open, multi-stakeholder process that engaged 54 representatives from healthcare, industry, and academia, the TechFWG identified barriers in 6 categories: regulatory environment, data integration, scalability, business case, effective and useful CDS, and care planning and coordination. Facilitators and key recommendations were also identified for overcoming these barriers. The key insights were also extrapolated to CDS-facilitated care improvement outside of the specific opioid use case. If applied broadly, the recommendations should help advance the availability and impact of interoperable CDS delivered at scale.

On 13 January 2021, a vaccine-derived poliovirus type 2 (VDPV2) was identified by the Regional Reference Laboratory (RRL) for polio in Moscow (1) in a specimen from a patient with [...]

Since the World Health Assembly (WHA) in 2012 endorsed the Global Vaccine Action Plan (GVAP), which included regional measles and rubella elimination goals by 2020, global progress towards verification of measles and rubella elimination has been incremental. Even though the 2020 elimination goals were not achieved, commitment towards achieving measles and rubella elimination has been firmly established in the Immunization Agenda 2030 (IA2030) and the Measles and Rubella Strategic Framework (MRSF) 2021–2030. In 2023, the six Regional Verification Commissions for measles and rubella elimination (RVCs) reviewed data as of 31 December 2022 and confirmed that 82 (42%) Member States have been verified for measles elimination, and 98 (51%) Member States have been verified for rubella elimination. The six RVCs are composed of independent public health and immunization experts who are well-placed to support accelerating measles and rubella elimination. RVCs should be leveraged not only to review elimination documents but also to advocate for and champion public health programming that supports measles and rubella activities. The verification of elimination process is one of many tools that should be deployed to reinforce and accelerate efforts towards achieving a world free of measles and rubella. [ABSTRACT FROM AUTHOR]

Measles or rubella elimination is verified when endemic transmission of the corresponding virus has been absent for over 36 months in a defined area, in the presence of a well-performing surveillance system. This report updates the progress by 47 countries in the WHO African Region towards the goal of attaining verification of measles and rubella elimination in at least 80% of the countries of the region by 2030. We reviewed the WHO-UNICEF vaccination coverage estimates for the first and second doses of measles- and measles-rubella-containing vaccines, as well as the available coverage data for measles supplementary immunization activities, during 2022–2023. We also reviewed the measles-surveillance performance and analyzed the epidemiological trends of measles and rubella as reported in the case-based surveillance database. The WHO-UNICEF estimates of first measles vaccine dose (MCV1) and second measles vaccine dose (MCV2) coverage for the African Region for 2022 were 69% and 45%, respectively. Rubella-containing vaccines have been introduced in the routine immunization program in 32 of 47 (68%) countries as of the end of 2022, with no introductions during 2023. In 2022 and 2023, a total of 144,767,764 children were vaccinated in the region with measles or MR vaccines in 24 countries through 32 mass vaccination campaigns. The administrative coverage target of 95% was reached in only 15 (49%) of the 32 vaccination campaigns. In 2023, a total of 125,957 suspected cases of measles were reported through the case-based surveillance system, and 73,625 cases (58%) were confirmed to be measles, either by laboratory testing, by epidemiological linkage, or based on clinical compatibility. A total of 4805 confirmed rubella cases were reported, though this total represents substantial under-ascertainment. The regional incidence of measles was 60.3 cases per million population. Twenty-six countries (55%) met the targets for the two principal surveillance system performance-monitoring indicators. No country in the region has attained the verification of measles or rubella elimination as of the end of 2023. Addressing systemic problems with routine immunization and using tailored approaches to reach unvaccinated children can contribute to progress towards measles and rubella elimination. In addition, periodic and timely high-quality preventive SIAs remain a critical programmatic strategy to reach unvaccinated children. [ABSTRACT FROM AUTHOR]

Human languages typically employ a variety of spatial metaphors for time (e.g., "I'm looking forward to the weekend"). The metaphorical grounding of time in space is also evident in gesture. The gestures that are performed when talking about time bolster the view that people sometimes think about regions of time as if they were locations in space. However, almost nothing is known about the development of metaphorical gestures for time, despite keen interest in the origins of space-time metaphors. In this study, we examined the gestures that English-speaking 6-to-7-year-olds, 9-to-11-year-olds, 13-to-15-year-olds, and adults produced when talking about time. Participants were asked to explain the difference between pairs of temporal adverbs (e.g., "tomorrow" versus "yesterday") and to use their hands while doing so. There was a gradual increase across age groups in the propensity to produce spatial metaphorical gestures when talking about time. However, even a substantial majority of 6-to-7-year-old children produced a spatial gesture on at least one occasion. Overall, participants produced fewer gestures in the sagittal (front-back) axis than in the lateral (left-right) axis, and this was particularly true for the youngest children and adolescents. Gestures that were incongruent with the prevailing norms of space-time mappings among English speakers (leftward and backward for past; rightward and forward for future) gradually decreased with increasing age. This was true for both the lateral and sagittal axis. This study highlights the importance of metaphoricity in children's understanding of time. It also suggests that, by 6 to 7 years of age, culturally determined representations of time have a strong influence on children's spatial metaphorical gestures.

We sought to develop and validate a clinical calculator that can be used to quantify risk for appendicitis on a continuous scale for patients with acute abdominal pain. The pediatric appendicitis risk calculator (pARC) was developed and validated through secondary analyses of 3 distinct cohorts. The derivation sample included visits to 9 pediatric emergency departments between March 2009 and April 2010. The validation sample included visits to a single pediatric emergency department from 2003 to 2004 and 2013 to 2015. Variables evaluated were as follows: age, sex, temperature, nausea and/or vomiting, pain duration, pain location, pain with walking, pain migration, guarding, white blood cell count, and absolute neutrophil count. We used stepwise regression to develop and select the best model. Test performance of the pARC was compared with the Pediatric Appendicitis Score (PAS). The derivation sample included 2423 children, 40% of whom had appendicitis. The validation sample included 1426 children, 35% of whom had appendicitis. The final pARC model included the following variables: sex, age, duration of pain, guarding, pain migration, maximal tenderness in the right-lower quadrant, and absolute neutrophil count. In the validation sample, the pARC exhibited near perfect calibration and a high degree of discrimination (area under the curve: 0.85; 95% confidence interval: 0.83 to 0.87) and outperformed the PAS (area under the curve: 0.77; 95% confidence interval: 0.75 to 0.80). By using the pARC, almost half of patients in the validation cohort could be accurately classified as at 8. In our validation cohort of patients with acute abdominal pain, the pARC accurately quantified risk for appendicitis.